Showing papers by "Hee-Won Jung published in 2012"

Radiosurgery for large brain metastases.

Abstract: Purpose To determine the efficacy and safety of radiosurgery in patients with large brain metastases treated with radiosurgery. Patients and Methods Eighty patients with large brain metastases (>14 cm3) were treated with radiosurgery between 1998 and 2009. The mean age was 59 ± 11 years, and 49 (61.3%) were men. Neurologic symptoms were identified in 77 patients (96.3%), and 30 (37.5%) exhibited a dependent functional status. The primary disease was under control in 36 patients (45.0%), and 44 (55.0%) had a single lesion. The mean tumor volume was 22.4 ± 8.8 cm3, and the mean marginal dose prescribed was 13.8 ± 2.2 Gy. Results The median survival time from radiosurgery was 7.9 months (95% confidence interval [CI], 5.343–10.46), and the 1-year survival rate was 39.2%. Functional improvement within 1–4 months or the maintenance of the initial independent status was observed in 48 (60.0%) and 20 (25.0%) patients after radiosurgery, respectively. Control of the primary disease, a marginal dose of ≥11 Gy, and a tumor volume ≥26 cm3 were significantly associated with overall survival (hazard ratio, 0.479; p = .018; 95% CI, 0.261–0.880; hazard ratio, 0.350; p = .004; 95% CI, 0.171–0.718; hazard ratio, 2.307; p = .006; 95% CI, 1.274–4.180, respectively). Unacceptable radiation-related toxicities (Radiation Toxicity Oncology Group central nervous system toxicity Grade 3, 4, and 5 in 7, 6, and 2 patients, respectively) developed in 15 patients (18.8%). Conclusion Radiosurgery seems to have a comparable efficacy with surgery for large brain metastases. However, the rate of radiation-related toxicities after radiosurgery should be considered when deciding on a treatment modality.

Brain metastasis from renal cell carcinoma.

Abstract: Renal cell carcinoma (RCC) is one of primary cancers which metastasis to the brain frequently, although RCC accounts for only 1% of all cancer. The metastatic tumor from RCC has the propensity of intratumoral hemorrhage and relatively massive surrounding edema compared with other metastatic tumors. These characteristics make an emphasis on the surgical resection in the management of metastatic tumor. However, the surgery is not always possible due to the characteristics of tumor and patient. The outcome of conventional whole brain radiotherapy is unsatisfactory due to the resistant feature of RCC to the radiation, although it plays an important role in other malignancies. The stereotactic radiosurgery (SRS) including various modalities have showed the excellent outcomes in the control of tumor itself and surrounding edema. The repeatability of SRS is also attractive merit, because the new brain metastasis can be encountered in anytime regardless of the first-line treatment modalities. A few adverse effects following SRS have been reported however, incidence and severity could be acceptable without severe morbidity. Therefore, SRS must be emphasized in the management of brain metastasis from RCC and individual various combined treatment strategies could be suggested.

Early Significant Tumor Volume Reduction After Radiosurgery in Brain Metastases From Renal Cell Carcinoma Results in Long-Term Survival

Abstract: Purpose To retrospectively evaluate survival of patients with brain metastasis from renal cell carcinoma (RCC) after radiosurgery. Patients and Methods Between 1998 and 2010, 46 patients were treated with radiosurgery, and the total number of lesions was 99. The mean age was 58.9 years (range, 33–78 years). Twenty-six patients (56.5%) had a single brain metastasis. The mean tumor volume was 3.0 cm 3 (range, 0.01–35.1 cm 3 ), and the mean marginal dose prescribed was 20.8 Gy (range, 12–25 Gy) at the 50% isodose line. A patient was classified into the good-response group when the sum of the volume of the brain metastases decreased to less than 75% of the original volume at a 1-month follow-up evaluation using MRI. Results As of December 28, 2010, 39 patients (84.8%) had died, and 7 (15.2%) survived. The overall median survival time was 10.0 ± 0.4 months (95% confidence interval, 9.1–10.8). After treatment, local tumor control was achieved in 72 (84.7%) of the 85 tumors assessed using MRI after radiosurgery. The good-response group survived significantly longer than the poor-response group (median survival times of 18.0 and 9.0 months, respectively; p = 0.025). In a multivariate analysis, classification in the good-response group was the only independent prognostic factor for longer survival ( p = 0.037; hazard ratio = 0.447; 95% confidence interval, 0.209–0.953). Conclusions Radiosurgery seems to be an effective treatment modality for patients with brain metastases from RCC. The early significant tumor volume reduction observed after radiosurgery seems to result in long-term survival in RCC patients with brain metastases.

Longitudinal analysis of visual outcomes after surgical treatment of adult craniopharyngiomas.

Abstract: BACKGROUND Craniopharyngiomas (CRPs) often cause visual deterioration (VD) due to the close vicinity of the optic apparatus. OBJECTIVE To evaluate longitudinal visual outcomes after surgery of CRP and determine the prognostic factors thereof. METHODS One hundred forty-six adult patients who underwent surgery for newly diagnosed CRP were retrospectively reviewed. There were 87 male patients (60%), and the median age was 41 years (range, 18-75). The mean follow-up duration was 88.7 months (range, 24-307). A visual impairment score was used to assess the short-term ( 2 years) visual outcomes. RESULTS Gross total removal was performed in 53 patients (36%), and tumor recurrence occurred in 40 patients (27%). The average preoperative, short- and long-term visual impairment scores were 44.4, 38.5, and 38.1, respectively, on a 0- to 100-point scale (with 100 indicating the worst vision). Short- and long-term VD occurred in 28 (19%) and 39 patients (27%), respectively. Subtotal removal (STR) alone (P = .010; OR = 4.8), short-term VD (P < .001; OR = 39.7), and tumor recurrence (P < .001; OR = 28.2) were significant risk factors for long-term VD in the multivariate analysis. Patients undergoing STR alone had higher tumor recurrence rates in comparison with those who underwent gross total removal or STR with adjuvant therapy (P < .001). CONCLUSION Short-term VD secondary to the surgical insult and the recurrence of the tumor were strong predictors of long-term visual outcomes after surgical treatment for CRP. STR alone may be an ineffective strategy for achieving tumor control and optimal visual outcomes in patients with CRP.

Stereotactic radiosurgery for large brain metastases.

Abstract: Surgical resection still remains the mainstay of treatments for large brain metastases if feasible. Recently, stereotactic radiosurgery (SRS) using low-dose, 11- to 12-Gy marginal prescription dose, w

Radiosurgery for atypical and anaplastic meningiomas: histopathological predictors of local tumor control.

Abstract: Objectives: We investigated the radiosurgical outcomes of patients with nonbenign meningiomas retrospectively and sought to identify prognostic factors for local

Hearing preservation in patients with unilateral vestibular schwannoma who undergo stereotactic radiosurgery: Reinterpretation of the auditory brainstem response.

Abstract: BACKGROUND: The objective of this study was to identify the prognostic factors for hearing preservation that would allow the more accurate stratification of patients who undergo stereotactic radiosurgery (SRS) for unilateral, sporadic vestibular schwannoma (VS). METHODS: In total, 119 patients with VS who had serviceable hearing underwent SRS as primary treatment. The mean (±standard deviation) patient age was 48 ± 11 years, and the mean (±standard deviation) follow-up duration was 55.2 ± 35.7 months. The median marginal radiotherapy dose was 12.0 grays (Gy), and the mean (±standard deviation) tumor volume was 1.95 ± 2.24 cm3. The mean (±standard deviation) pure tone average (PTA) score was 26 ± 12 decibels (dB) (range, 4-50 dB), and the mean (±standard deviation) maximum speech discrimination score was 91 ± 12% (range, 52-100%). The mean (±standard deviation) baseline values for the interlatency (IL) of waves I and III (IL I-III) and the IL of waves I through V (IL I-V) on auditory brainstem response were 2.58 ± 0.60 milliseconds (mS) (range, 1.92-4.30 mS) and 4.80 ± 0.61 mS (range, 3.80-6.40 mS), respectively. RESULTS: In multivariate analysis, the PTA score and IL I-V were significant and independent prognostic factors (hazard ratio, 1.072; 95% confidence interval, 1.046-1.098; P < .001; and hazard ratio, 1.534; 95% confidence interval, 1.008-2.336; P = .046, respectively). By using the PTA score and IL I-V, the patients were classified into 4 groups. The ratios of patients with serviceable hearing after SRS were 89.6%, 64.0%, 25.8%, and 6.7%, respectively, in Groups A through D (P < .001). CONCLUSIONS: The current results indicated that the classification system based on using the PTA score and the IL I-V of the auditory brainstem response may be useful and specific for predicting the rate of hearing preservation in each individual. Cancer 2012. © 2012 American Cancer Society.

Radiosurgery for para-IAC meningiomas: the effect of radiation dose to the cochlea on hearing outcome.

Abstract: Purpose This study was performed to assess the radiosurgical results of meningiomas extending into the internal acoustic canal (para-IAC meningiomas), with a particular focus on the effect of radiation dose to the cochlea on hearing outcome. Methods and Materials A total of 50 patients who underwent radiosurgery for para-IAC meningiomas between 1998 and 2009, which were followed for 2 years, were enrolled. The mean age was 55.8 years (range, 15–75). The mean tumor volume was 6.1 cm 3 (range, 1.0–19.0), the mean tumor length in the IAC was 6.9 mm (range, 1.3–13.3), and the mean prescribed marginal dose was 13.1 Gy (range, 10–15) at an isodose line of 50%. The mean follow-up duration was 46 months (range, 24–122). Results Eight (16.0%) patients had nonserviceable hearing at the time of surgery. At the last follow-up, the tumor control rate was 94%; unchanged in 17 patients, decreased in 30 patients, and increased in 3 patients. Among 42 patients with serviceable hearing at the time of radiosurgery, it was preserved in 41 (97.6%) patients at the last follow-up. The maximal and mean radiation doses to the cochleae of these 41 patients were 5.8 Gy ± 0.3 (range, 3.1–11.5) and 4.3 Gy ± 0.2 (range, 2.2–7.5), respectively. The maximal dose to the cochlea of the patient who lost hearing after radiosurgery was 4.7 Gy. Conclusions The radiation dose to the cochlea may have the minimal toxic effect on the hearing outcome in patients who undergo radiosurgery for para-IAC meningiomas.

The Risk Factors of Symptomatic Communicating Hydrocephalus After Stereotactic Radiosurgery for Unilateral Vestibular Schwannoma: The Implication of Brain Atrophy

Abstract: Purpose To identify the effect of brain atrophy on the development of symptomatic communicating hydrocephalus (SCHCP) after stereotactic radiosurgery (SRS) for sporadic unilateral vestibular schwannomas (VS). Methods and Materials A total of 444 patients with VS were treated with SRS as a primary treatment. One hundred eighty-one patients (40.8%) were male, and the mean age of the patients was 53 ± 13 years (range, 11–81 years). The mean follow-up duration was 56.8 ± 35.8 months (range, 12–160 months). The mean tumor volume was 2.78 ± 3.33 cm 3 (range, 0.03–23.30 cm 3 ). The cross-sectional area of the lateral ventricles (CALV), defined as the combined area of the lateral ventricles at the level of the mammillary body, was measured on coronal T1-weighted magnetic resonance images as an indicator of brain atrophy. Results At distant follow-up, a total of 25 (5.6%) patients had SCHCP. The median time to symptom development was 7 months (range, 1–48 months). The mean CALV was 334.0 ± 194.0 mm 2 (range, 44.70–1170 mm 2 ). The intraclass correlation coefficient was 0.988 (95% confidence interval [CI], 0.976–0.994; p p p p p = 0.364). Conclusion Brain atrophy may be related to de novo SCHCP after SRS, especially in female patients with a large VS. Follow-up surveillance should be individualized, considering the risk factors involved for each patient, for prompt diagnosis of SCHCP.

Progression of the lung cancer primary correlates with the identification of new brain metastases after initial radiosurgery

Abstract: We retrospectively evaluated the relationship between the response of lung lesions and distant progression-free survival (DPFS) after radiosurgery in patients with brain metastases. A total of 47 consecutive patients were treated with radiosurgery for brain metastases. Distant progression was defined as a new enhancing intracranial tumor or leptomeningeal enhancement noted on follow-up magnetic resonance imaging. Progression of lung lesions was defined as follows: (1) a 20% increase in the summed diameter of the target lesions; (2) an absolute increase of 5 mm when the summed diameter was very small; or (3) detection of new lesions in the lung. Distant progression after radiosurgery was observed for twenty-one (44.7%) patients; we observed development of new distant metastases in nine patients, development of leptomeningeal seeding in eight patients, and combined failure of distant progression and local control failure in four patients. Forty-two (89.4%) patients had lung lesions at the time of radiosurgery, and progression of their lung lesions during the post-radiosurgery follow-up period was observed for 18 (38.3%) of these. The median DPFS was 7.00 months (95% CI, 6.153–7.847). Actuarial DPFS 3, 6, and 12 months after radiosurgery was 81.5, 61.3, and 36.7%, respectively. In multivariate analysis, only the criterion progression of lung lesions reached statistical and independent significance (P = 0.021, OR = 3.372, 95% CI, 1.200–9.480). The response of lung lesions after radiosurgery is likely to be a good predictor of DPFS after radiosurgery in patients with brain metastases.

Concurrent treatment with BCNU and Gamma Knife radiosurgery in the rat malignant glioma model.

Abstract: Background Radiosurgery has been shown in a randomized trial not to provide any survival benefit for newly diagnosed glioblastoma multiforme (GBM). Nevertheless, several institutional retrospective series have supported the role of radiosurgery as an adjuvant therapy in GBM. The purpose of this study was to investigate the efficacy of concurrent therapy with 1,3 bis[2-chloroethyl]-1-nitrosourea (BCNU; carmustine) and Gamma Knife radiosurgery (GKRS; Gamma Knife ® Model C, Elekta AB, Stockholm, Sweden) in the C6 rat glioma model. Taken together, new therapeutic strategies other than the simple addition of radiosurgery deserve to be investigated in the interest of enhancing the effects of radiosurgery. Material and Methods C6 glioma cells of 5 × 10 5 were stereotactically implanted into Sprague-Dawley rats. Tumor volume was measured 2 weeks later using brain magnetic resonance (MR) imaging and rats were treated with BCNU (7 mg/kg, intraperitonial injection), GKRS (20 Gy at 50% isodose line), or BCNU followed by GKRS at a 1.5-hour interval. The six surviving rats in each group were sacrificed, 2 weeks after treatment. Tumor volume was measured in the tissue sections and compared with that measured via MR imaging. Percent volume growth was calculated and categorized into one of four groups: progressive disease, stable disease, partial response, or complete response. Results Tumor volume significantly increased in all six rats in the control group and decreased in all six rats in the BCNU + GKRS group after treatment. Better tumor control was observed in the BCNU + GKRS group compared with the control, BCNU, and GKRS groups on linear-by-linear association analysis and Fischer's exact test. Conclusions We suggest that concurrent treatment with BCNU and GKRS is more effective in local tumor control compared with GKRS or BCNU alone, in the C6 rat glioma model.