Treatment of locally advanced pancreatic cancer using localized trans-arterial micro perfusion of gemcitabine: combined analysis of RR1 and RR2.

BACKGROUND: Locally advanced pancreatic cancer (LAPC) comprises 40% of pancreatic cancer diagnoses and has a relatively poor prognosis. Trans-arterial micro perfusion (TAMP)-mediated chemotherapy delivery to the primary tumor is a novel approach worthy of investigation. The RR1 (dose escalation) and RR2 (observational) studies examined the safety and preliminary efficacy of TAMP-delivered gemcitabine for LAPC. PATIENTS AND METHODS: RR1 and RR2 data were pooled. Both studies enrolled patients with LAPC with histologically confirmed adenocarcinoma. Participant data, including age, sex, race, stage, previous treatments, toxicity, disease progression, and death, were collected. Median number of cycles and average treatment dosage were calculated. Overall survival (OS) was determined for the whole group and separately for patients who received and did not receive previous treatments. Aims of the analysis were to assess procedure safety, OS, and evaluate factors associated with OS. RESULTS: The median age of the 43 patients enrolled in RR1 and RR2 was 72 years (range, 51-88 years). Median OS for the 35 eligible patients with stage III disease was 12.6 months (95% CI, 2.1-54.2 months). Previous chemoradiation was associated with significantly longer OS [27.1 months (95% CI, 8.4-40.6 months)] compared to previous systemic chemotherapy [14.6 months (95% CI, 6.4-54.2 months)] or no prior treatment [7.0 months (95% CI, 2.1-35.4 months)] (P < .001). The most common adverse events were GI related (abdominal pain, emesis, and vomiting); the most common grade 3 toxicity was sepsis. CONCLUSION: Study results indicate that TAMP-mediated gemcitabine delivery in patients with LAPC is potentially safe, feasible, and provides potential clinical benefits. CLINICAL TRIAL REGISTRATION: NCT02237157 (RR1) and NCT02591082 (RR2).

Linear accelerator stereotactic radiosurgery for metastatic brain tumors: 17 years of experience at the University of Florida.

OBJECTIVE: To review one of the largest single-institution experiences treating metastatic brain disease with stereotactic radiosurgery. METHODS: We performed a retrospective analysis of 619 patients who underwent linear accelerator-based stereotactic radiosurgery for 1569 brain metastases between May 1989 and February 2006. Patient characteristics and treatment parameters were obtained prospectively. Patients were followed up at regular intervals clinically and with imaging studies to document local control, regional control, and survival. Cox proportional hazards analysis was performed using SAS version 9.1 software (SAS Institute, Cary, NC). RESULTS: Median actuarial survival was 7.9 months. 1- and 2-year actuarial survival probabilities were 0.36 and 0.14, respectively. Radiation Therapy Oncology Group Recursive Partitioning Analysis Class I or II was associated with improved survival, but the difference between the two was insignificant. Female sex, younger age, higher Karnofsky performance status, controlled primary tumor, absence of systemic metastases, asynchronous presentation of brain metastasis, fewer brain metastases, smaller total volume of brain metastases, surgery prior to radiosurgery, and multiple radiosurgical treatments were also associated with improved survival. Melanoma metastasis was associated with impaired survival. Local control was achieved in 84.3% of all lesions treated. 1- and 2-year actuarial local control probabilities were 0.82 and 0.72, respectively. Whole brain radiation therapy prior to radiosurgery was associated with improved regional control. CONCLUSIONS: Linear accelerator-based stereotactic radiosurgery is a safe and effective treatment for patients with metastatic brain tumors. Selection of patients who are likely to benefit most from radiosurgery is complex and treatment decisions should be based on the entire clinical picture.

Pontine atypical neurocytoma: case report.

OBJECTIVE AND IMPORTANCE: Neurocytomas are typically located within the supratentorial ventricular system. Extraventricular neurocytomas are very rare, and this is only the second reported case of a pontine neurocytoma. We discuss the clinical presentation, histology, and treatment of these rare tumors. CLINICAL PRESENTATION: A 58-year-old man presented with a 4-month history of headache and unilateral facial and distal extremity paresthesia. Magnetic resonance imaging (MRI) scans demonstrated a 2.6 x 2.2-cm ring-enhancing cystic mass in the right pons. INTERVENTION: MRI-guided stereotactic biopsy yielded a diagnosis of atypical neurocytoma. Because of the location and malignant histological features of the tumor, the patient was initially treated with external beam radiation therapy. Several months later, MRI scans demonstrated tumor progression. The patient then underwent three rounds of temozolomide chemotherapy, during and after which his symptoms worsened. Aggressive subtotal resection of the tumor was achieved via a right suboccipital craniectomy. CONCLUSION: Twenty-eight months postoperatively, the patient is symptom free, and MRI scans demonstrate no evidence of residual or recurrent tumor.