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2 results

  • Stereotactic radiosurgery in brain metastasis: treatment outcomes and patterns of failure

  • Menekse Turna, Rashad Rzazade, Esra Küçükmorkoç, Mehmet Doğu Canoğlu, Nadir Küçük, Hale Başak Çağlar
  • Journal:
    Journal of Radiotherapy in Practice / Volume 22 / 2023
    Published online by Cambridge University Press:
    02 March 2023, e84
    • Article
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  • Introduction:

    Stereotactic radiosurgery (SRS) has become a preferred treatment in the initial management of brain metastases (BM). This study reported treatment outcomes and identified the patient, tumour, and treatment-related factors that predict failure, survival, and brain necrosis (BN).

    Methods:

    We retrospectively reviewed the electronic medical records of all BM patients treated with SRS. Patient, tumour characteristics and treatment details data were collected. All recurrences and BN were defined in the neurooncological tumour board.

    Results:

    From December 2016 to April 2020, 148 patients were analysed. The median follow-up was 14·8 months (range 6–51). At the time of analyses, 72·3% of the patients were alive. Presence of initial neurological deficit (HR; 2·71 (1·07–6·9); p = 0·036) and prior RT (HR; 2·55 (1·28–5·09); p = 0·008) is associated with worse overall survival. The local recurrence rate was 11·5 %. The distant brain metastasis rate was 53·4 %. Leptomeningeal metastasis was seen in 11 patients (7·4%). Symptomatic BN was seen in 19 patients (12·8 %). Bigger lesions (13 versus 23 mm diameter; p = 0·034) and cavity radiosurgery are associated with more BN (63·2 % versus 36·8%; p: 0·004).

    Conclusions:

    Distant BM is the leading cause of CNS recurrences and, salvage SRS is possible. Due to the increasing risk of developing BN routine metastasectomy should be made with caution.

  • Contribution of PET-CT to staging, gross tumour volume definition, planning and response assessment in IMRT for nasopharyngeal carcinoma

  • Metin Guden, Cemile Ceylan, Kezban Berberoglu, Semih Dogan, Nadir Kucuk, Hande Bas, Ayhan Kilic, Kayıhan Engin
  • Journal:
    Journal of Radiotherapy in Practice / Volume 10 / Issue 4 / December 2011
    Published online by Cambridge University Press:
    26 November 2010, pp. 272-282

  • The effectiveness of PET-CT (positron emission tomography–computed tomography) was investigated for staging target delineation compared with CT-MR (computed tomography–magnetic resonance) and early response of intensity-modulated radiotherapy (IMRT). Gross tumour volume–clinical target volume (GTV-CTV) differences between PET-CT and CT-MR for 14 nasopharyngeal carcinoma (NPC) patients were compared. Evaluation of doses of organs at risk (OARs) was done by IMRT plans. Responses of IMRT were evaluated with both sets. PET-CT changed MR-based TNM (Tumour Lymph Nodes Metastasis) in 11 of 14 patients. The median GTVNP (nasopharyx gross tumour volume) was 49.25 and 18.8 cm3 for CT-MR and PET-CT, respectively. In eight cases, GTVNP in the PET-CT was smaller than the CT-MR. The PET-CT presented a larger GTVNP than the CT-MR for six cases. Mean doses for the parotid glands were found to be higher than in CT-MR-based plan in one patient although he had smaller GTVNP at the PET-CT. The median follow-up was 16 months. Only one patient experienced recurrence in the CTVNP (nasopharyx clinical target volume). MR showed a decrease in the size-number of lymph nodes in four patients whereas PET-CT showed no uptake. All patients had positive responses to IMRT in their second control MR and PET-CT. PET-CT could improve tumour delineation. This enables an increase in dose inside the CTV. PET-CT provided significant information on the control scans for most of our patients whose MR imaging showed residual or recurrence.