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A. Gabriella Wernicke, Andrew W. Smith, Shoshana Taube, Menachem Z. Yondorf, Bhupesh Parashar, Samuel Trichter, Lucy Nedialkova, Albert Sabbas, Paul Christos, Rohan Ramakrishna, Susan C. Pannullo, Philip E. Stieg and Theodore H. Schwartz

Frontal 20 1.98 3.10 39.60 62.00 15 Lung 3 1.3 1.6 SRS Lt Temporal 20 1.98 3.10 39.60 62.00 UN = unknown. Survival At the time of analysis, 4 patients were still alive, 3 with primary lung cancer and 1 with primary gastric cancer. The median duration of follow-up subsequent to salvage treatment was 5 months for the whole cohort (range 0.6–18 months). Five lesions were previously treated with both WBRT and SRS, and 10 lesions were previously treated with SRS. Among the 9 patients who died, there were 4 with primary lung

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Daniel H. Fulkerson, Todd D. Vogel, Abdul A. Baker, Neal B. Patel, Laurie L. Ackerman, Jodi L. Smith and Joel C. Boaz

lessen some of the problems associated with cyst-peritoneal shunting. A stent may be placed stereotactically with one catheter as in Case 3 or in a construct as in Cases 1 and 2. All of our patients had clinical benefits after this procedure. Its long-term efficacy is still a matter of study, as 1 of the 3 patients did have recurrence of symptoms 2 years later. While open or endoscopic fenestration may still be the initial procedure of choice, we consider cyst-ventricle stenting to be a valuable option, either as a primary or a salvage treatment, in this difficult and

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Douglas Kondziolka, Hideyuki Kano, Gillian L. Harrison, Huai-che Yang, Donald N. Liew, Ajay Niranjan, Adam M. Brufsky, John C. Flickinger and L. Dade Lunsford

Object

To evaluate the role of stereotactic radiosurgery (SRS) in the management of brain metastases from breast cancer, the authors assessed clinical outcomes and prognostic factors for survival.

Methods

The records from 350 consecutive female patients who underwent SRS for 1535 brain metastases from breast cancer were reviewed. The median patient age was 54 years (range 19–84 years), and the median number of tumors per patient was 2 (range 1–18 lesions). One hundred seventeen patients (33%) had a single metastasis to the brain, and 233 patients (67%) had multiple brain metastases. The median tumor volume was 0.7 cm3 (range 0.01–48.9 cm3), and the median total tumor volume for each patient was 4.9 cm3 (range 0.09–74.1 cm3).

Results

Overall survival after SRS was 69%, 49%, and 26% at 6, 12, and 24 months, respectively, with a median survival of 11.2 months. Factors associated with a longer survival included controlled extracranial disease, a lower recursive partitioning analysis (RPA) class, a higher Karnofsky Performance Scale score, a smaller number of brain metastases, a smaller total tumor volume per patient, the presence of deep cerebral or brainstem metastases, and HER2/neu overexpression. Sustained local tumor control was achieved in 90% of the patients. Factors associated with longer progression-free survival included a better RPA class, fewer brain metastases, a smaller total tumor volume per patient, and a higher tumor margin dose. Symptomatic adverse radiation effects occurred in 6% of patients. Overall, the condition of 82% of patients improved or remained neurologically stable.

Conclusions

Stereotactic radiosurgery was safe and effective in patients with brain metastases from breast cancer and should be considered for initial treatment.

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Mayur Sharma, Jason L. Schroeder, Paul Elson, Antonio Meola, Gene H. Barnett, Michael A. Vogelbaum, John H. Suh, Samuel T. Chao, Alireza M. Mohammadi, Glen H. J. Stevens, Erin S. Murphy and Lilyana Angelov

G lioblastoma (GBM) is the most malignant subtype constituting approximately 55% of all glial brain tumors. 10 , 31 Despite aggressive management, these tumors tend to recur within 6 months of treatment initiation, and the prognosis remains dismal. 52 , 54 Patients with recurrent GBM (rGBM) pose significant clinical management challenges, as no standard salvage treatment is currently available for these patients. 42 Options such as repeat resection, 57 , 58 laser interstitial thermal therapy (LITT), 46 , 47 , 60 repeat external-beam radiotherapy (EBRT) alone

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Marc C. Chamberlain

✓ Following the seminal trial conducted by the European Organisation for Research and Treatment of Cancer (EORTC) and the National Cancer Institute of Canada (NCIC), concurrent temozolomide and radiotherapy has become the new standard of care for patients with newly diagnosed glioblastoma multiforme (GBM). Investigation of emerging therapies (which are now used as salvage therapy) such as small-molecule inhibitors (for example, epidermal growth factor receptor inhibitors) and convection-enhanced delivery (CED) of targeted toxins (for example, interleukin-13/pseudo-monas exotoxin) is likely to build on the EORTC/NCIC treatment platform and will, it is hoped, improve survival rates in patients with GBM. The majority of adjuvant Phase I and II trials being conducted by the brain tumor consortia are based on the EORTC/NCIC treatment platform and have added a targeted therapy in an effort to find a promising synergistic treatment. Furthermore, researchers in the consortia are continuing to explore treatments for recurrent GBM, not otherwise eligible for local therapies, such as CED. The treatments under study include novel cytotoxic chemotherapy as well as small-molecule inhibitors; these are being assessed in a variety of Phase I or II trials.

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Ling-Wei Wang, Cheng-Ying Shiau, Wen-Yuh Chung, Hsiu-Mei Wu, Wan-Yuo Guo, Kang-Du Liu, Donald Ming-tak Ho, Tai-Tong Wong and David Hung-Chi Pan

primary, adjuvant, or salvage treatment. Low-grade astrocytomas are relatively circumscribed, as demonstrated on MR images. 20 Hence, patients harboring these tumors may be good candidates for GKS. There were a few reports on treating astrocytomas with GKS, which have appeared in the literature. 2,9,10,13 At our hospital we started in 1993 to treat some selected patients with astrocytomas by using GKS. This study is aimed at reviewing our treatment results and presenting our experience in performing GKS in this group of patients. Clinical Material and Methods Patient

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Alireza Mohammad Mohammadi, Pablo F. Recinos, Gene H. Barnett, Robert J. Weil, Michael A. Vogelbaum, Samuel T. Chao, John H. Suh, Nicholas F. Marko, Paul Elson, Gennady Neyman and Lilyana Angelov

analysis to identify independent prognostic factors. Data analyses were performed using SAS version 9.2 (SAS Inc.). Results In patients with ≥ 5 brain metastases, GKS was used as the sole upfront treatment in 32 patients (19%), as a boost to upfront WBRT in 28 patients (16%), and as salvage treatment in 110 patients (65%). Whole-brain radiation therapy had been performed previously in 92 patients (54%). Of those patients who had received WBRT, 22 patients (13%) received both GKS and WBRT. In addition, in 16 patients (9%) GKS was the sole treatment. The median

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Toru Serizawa, Yoshinori Higuchi, Junichi Ono, Shinji Matsuda, Osamu Nagano, Yasuo Iwadate and Naokatsu Saeki

disease (Table 2 ). The NLFS curves based on tumor number are shown in Fig. 4 . Among the 729 patients who died, the number of salvage GKS treatments for new distant lesions was zero in 470, one in 134, two in 62, three in 26, and more than four in 37. Salvage WBRT was subsequently performed in 30 patients with cerebral dissemination or CSF dissemination, which had been uncontrolled after aggressive GKS salvage treatment. Discussion A few retrospective, randomized, controlled studies in which radiosurgery and radiosurgery plus initial adjuvant WBRT were compared have

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Colin J. Przybylowski, Tyler S. Cole, Jacob F. Baranoski, Andrew S. Little, Kris A. Smith and Andrew G. Shetter

Salvage therapies are listed in Table 2 . Twenty-eight (67%) of the 42 patients underwent salvage therapy over the study period at a median of 13 months (range 2–84 months) after the first treatment. This includes patients who had no response to the initial GKRS. Typically, we waited at least 2 months to see if the patients had a positive response to the initial GKRS, in conjunction with medication adjustments. Patients were thereafter considered for salvage treatment if they never reached a BNI pain score of IIIb or if their pain level at any point regressed beyond

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Daniel C. Bowers, Lynn Gargan, Bradley E. Weprin, Arlynn F. Mulne, Roy D. Elterman, Louis Munoz, Cole A. Giller and Naomi J. Winick

.2) 7 (23.3) 3.19 ± 0.85 interval from diagnosis to progression  0.0–1.99 yrs 26 (63.4) 10 (38.5) 5.43 ± 1.38 0.521  2.0–18.0 yrs 15 (36.6) 1 (6.7) 2.72 ± 0.65 sites of progression  primary site only 21 (51.2) 9 (42.9) 6.26 ± 1.46 0.008 primary site & distant or distant only 20 (48.8) 2 (10.0) 2.0 ± 0.69 salvage treatment ‡  chemotherapy 21 (52.5) 2 (9.5) 2.50 ± 0.86 0.015  RT or chemotherapy & RT 19 (47.5) 9 (47.4) 5.84 ± 1.38 high-dose chemotherapy & HSCT  yes 2 (4