scholarly journals Radiation therapy for the prevention of heterotopic ossification: Efficacy and toxicity of single fraction radiotherapy

2020 ◽  
Vol 12 (2) ◽  
Author(s):  
Ioannis Georhakopoulos ◽  
Vasilios Kouloulias ◽  
Andromachi Kougiountzopoulou ◽  
Kalliopi Platoni ◽  
Christos Antypas ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Heterotopic Ossification ◽  
Cost Effective ◽  
Impaired Wound Healing ◽  
Benign Condition ◽  
Single Fraction ◽  
Post Surgery ◽  
Dose Ranging ◽  
Therapeutic Irradiation

Numerous nonmalignant diseases can be treated with radiation therapy (RT). Among them, Heterotopic Ossification (HO) is a benign condition resulting from several causes that can be successfully managed with ionizing radiation. More often seen in the hip area after major surgical procedures, HO is of major concern as it can lead to functional disorders, pain and even to joint ankylosis. We retrospectively analyzed the outcome of therapeutic irradiation for the prevention of HO in 14 patients treated in our hospital between 2005 and 2011. All patients were irradiated with a dose ranging from 7 to10 Gy in a single fraction for prevention of HO after surgery. After a median follow up of 126 months (range 96 – 156 months) none of our patients developed HO. Impaired wound healing or other post surgery complications like trochanteric nonunion were not observed. A single fraction of RT seems to be a sufficient, cost effective and safe treatment regimen. In our study we report excellent results as none of our patients developed HO.

The use of single-fraction radiation therapy in cutaneous T-cell lymphoma

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e19505-e19505
Author(s):  
A. M. Babbo ◽  
M. Chokshi ◽  
A. Rademaker ◽  
B. Mittal
Keyword(s):  
Radiation Therapy ◽  
T Cell ◽  
Cell Lymphoma ◽  
The United States ◽  
T Cell Lymphoma ◽  
Response To Treatment ◽  
Cutaneous T Cell Lymphoma ◽  
Single Fraction ◽  
Cutaneous Lymphomas

e19505 Background: Primary cutaneous lymphomas occur in 0.5 to 1 per 100,000 people every year in developed countries. Less than 1,000 cases of Mycosis Fungoides are diagnosed each year in the United States, with approximately 3 cases per 1,000,000 per year. Cutaneous T-cell lymphomas are responsive to radiation therapy, and local radiation therapy, total skin electron beam therapy, phototherapy (with UVB or PUVA), chemotherapy agents (nitrogen mustards, BCNU), retinoids, and steroids have all been used with varying degrees of success. Methods: This is a retrospective review of all cases of histology-proven cutaneous T-cell lymphoma treated with single-fraction radiation therapy at Northwestern Memorial Hospital in the Department of Radiation Oncology since 1990. We looked at response to treatment and local control. We reviewed the charts of 67 patients with cutaneous T-cell lymphoma, of which 40 patients and a total of 130 sites of disease received single-fraction radiation therapy and had available follow-up data. Results: Of the 130 lesions receiving a single-fraction of radiation, 86 (66%) received 800cGy in 1 fraction and 38 (29%) received 700cGy. 4 patients (3%) received 750cGy, 1 (<1%) received 550cGy and 1 (<1%) received 500cGy. Patients were treated with electron energies ranging from 6–18 MeV or photon energies ranging from 4–10 MV. Out of 130 lesions, 119 (92%) achieved a complete response (CR) to single-fraction radiation and 11 (8%) achieved a partial response (PR). There were 2 sites of relapse out of 130 treated sites, involving 2 patients. The median follow-up time was 4 months, mean follow-up time was 14 months, and 44% of patients had greater than 6 months of follow-up. Conclusions: This review of the experience at our institution since 1990 shows single-fraction radiation therapy to be an effective treatment for cutaneous T-cell lymphoma, with high response rates and very low relapse rates. No significant financial relationships to disclose.

scholarly journals Spine stereotactic radiosurgery for the treatment of multiple myeloma

2017 ◽  
Vol 26 (3) ◽  
pp. 282-290 ◽  
Author(s):  
Jacob A. Miller ◽  
Ehsan H. Balagamwala ◽  
Samuel T. Chao ◽  
Todd Emch ◽  
John H. Suh ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Radiation Therapy ◽  
Vertebral Fracture ◽  
Pain Relief ◽  
Stereotactic Radiosurgery ◽  
Median Time ◽  
Cumulative Incidence ◽  
Single Fraction ◽  
Pain Scores

OBJECTIVE The objective of this study was to define symptomatic and radiographic outcomes following spine stereotactic radiosurgery (SRS) for the treatment of multiple myeloma. METHODS All patients with pathological diagnoses of myeloma undergoing spine SRS at a single institution were included. Patients with less than 1 month of follow-up were excluded. The primary outcome measure was the cumulative incidence of pain relief after spine SRS, while secondary outcomes included the cumulative incidences of radiographic failure and vertebral fracture. Pain scores before and after treatment were prospectively collected using the Brief Pain Inventory (BPI), a validated questionnaire used to assess severity and impact of pain upon daily functions. RESULTS Fifty-six treatments (in 38 patients) were eligible for inclusion. Epidural disease was present in nearly all treatment sites (77%). Moreover, preexisting vertebral fracture (63%), thecal sac compression (55%), and neural foraminal involvement (48%) were common. Many treatment sites had undergone prior local therapy, including external beam radiation therapy (EBRT; 30%), surgery (23%), and kyphoplasty (21%). At the time of consultation for SRS, the worst, current, and average BPI pain scores at these treatment sites were 6, 4, and 4, respectively. The median prescription dose was 16 Gy in a single fraction. The median clinical follow-up duration after SRS was 26 months. The 6- and 12-month cumulative incidences of radiographic failure were 6% and 9%, respectively. Among painful treatment sites, 41% achieved pain relief adjusted for narcotic usage, with a median time to relief of 1.6 months. The 6- and 12-month cumulative incidences of adjusted pain progression were 13% and 15%, respectively. After SRS, 1-month and 3-month worst, current, and average BPI scores all significantly decreased (p < 0.01). Vertebral fracture occurred following 12 treatments (21%), with an 18% cumulative incidence of fracture at 6 and 12 months. Two patients (4%) developed pain flare following spine SRS. CONCLUSIONS This study reports the largest series of myeloma lesions treated with spine SRS. A rapid and durable symptomatic response was observed, with a median time to pain relief of 1.6 months. This response was durable among 85% of patients at 12 months following treatment, with 91% local control. The efficacy and minimal toxicity of spine SRS is likely related to the delivery of ablative and conformal radiation doses to the target. SRS should be considered with doses of 14–16 Gy in a single fraction for patients with multiple myeloma and limited spinal disease, myelosuppression requiring “marrow-sparing” radiation therapy, or recurrent disease after EBRT.

scholarly journals Total Ankylosis by Heterotopic Ossification in an Adolescent Anterior Trans-olecranon Fracture Dislocation: A Case Report

2019 ◽  
Vol 22 (3) ◽  
pp. 154-158
Author(s):  
Beom-Soo Kim ◽  
Kwang-Soon Song ◽  
Ki-Cheor Bae ◽  
Si-Wook Lee ◽  
Sang-Hyun Um ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Case Report ◽  
Heterotopic Ossification ◽  
Full Range ◽  
Surgical Excision ◽  
Fracture Dislocation ◽  
Complete Surgical Excision ◽  
Female Total ◽  
Bony Ankylosis

The incidence of heterotopic ossification in adolescents appears to be lower than in adults. There exist very few reports of heterotopic ossification with total bony ankylosis in child or adolescent populations. We describe a case of total bony ankylosis of the elbow secondary to heterotopic ossification, in a 14-year-old female. Total ankylosis of the elbow at 45 degrees of flexion was noted 6 months postsurgery, and complete surgical excision of the heterotopic mass was performed. After an additional one-time dose of radiation therapy and nonsteroidal anti-inflammatory drug medication, full range of motion was obtained without any recurrence or other complications, up to the last follow-up of 30 months.

Is prophylaxis for heterotopic ossification with radiation therapy after THR associated with early loosening or carcinogenesis?

2019 ◽  
Vol 30 (5) ◽  
pp. 559-563 ◽  
Author(s):  
Emilios E Pakos ◽  
Dimitrios V Papadopoulos ◽  
Ioannis D Gelalis ◽  
Andreas G Tsantes ◽  
Ioannis Gkiatas ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
High Risk ◽  
Heterotopic Ossification ◽  
Implant Loosening ◽  
High Risk Patients ◽  
Risk Patients ◽  
Group A ◽  
Radiation Induced ◽  
Group B

Introduction: Heterotopic ossification may develop after major hip surgeries, thus preventive strategies including radiation therapy and non steroid anti-inflammatory drugs are commonly employed. There are certain concerns regarding the effects of radiation therapy on implant loosening and carcinogenesis. Our study aims to evaluate whether radiation therapy results in implant loosening or radiation-induced tumours in the long term. Patients and methods: This was a prospective study including 97 high-risk patients for heterotopic ossification who underwent total hip arthroplasty. Patients were divided into 2 groups and received either a combination of radiation therapy and indomethacin (Group A), or indomethacin alone (Group B). Evaluated outcomes included implant loosening or development of radiation-induced tumours during the follow-up period. Results: The follow-up period of the study was 10 years. Group A consisted of 50 patients, while Group B consisted of 47 patients. 3 patients died during the follow-up. There were 2 cases of implant loosening, 1 from each of the 2 groups at 9 and 10 years after surgery respectively; thus, no statistically significant difference regarding implant loosening was found ( p < 0.05). During the follow-up period no cases of radiation-induced tumours were identified. Conclusion: Our results are consistent with those of other studies supporting the safety of radiation therapy as a preventive strategy for heterotopic ossification following major surgeries in high risk patients. Further studies with even longer follow-up may be required to definitely exclude the possibility of adverse outcomes linked with radiation therapy.

Patient outcomes and tumor control in single-fraction versus hypofractionated stereotactic body radiation therapy for spinal metastases

2020 ◽  
pp. 1-10
Author(s):  
Christine Park ◽  
Elizabeth P. Howell ◽  
Vikram A. Mehta ◽  
Luis Ramirez ◽  
Meghan J. Price ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Total Dose ◽  
Stereotactic Body Radiation Therapy ◽  
Spinal Metastases ◽  
Local Tumor Control ◽  
Tumor Control ◽  
Local Tumor ◽  
Single Fraction ◽  
Median Total Dose

OBJECTIVEStereotactic body radiation therapy (SBRT) offers efficient, noninvasive treatment of spinal neoplasms. Single-fraction (SF) high-dose SBRT has a relatively narrow therapeutic window, while hypofractionated delivery of SBRT may have an improved safety profile with similar efficacy. Because the optimal approach of delivery is unknown, the authors examined whether hypofractionated SBRT improves pain and/or functional outcomes and results in better tumor control compared with SF-SBRT.METHODSThis is a single-institution retrospective study of adult patients with spinal metastases treated with SF- or three-fraction (3F) SBRT from 2008 to 2019. Demographics and baseline characteristics, radiographic data, and posttreatment outcomes at a minimum follow-up of 3 months are reported.RESULTSOf the 156 patients included in the study, 70 (44.9%) underwent SF-SBRT (median total dose 1700 cGy) and 86 (55.1%) underwent 3F-SBRT (median total dose 2100 cGy). At baseline, a higher proportion of patients in the 3F-SBRT group had a worse baseline profile, including severity of pain (p < 0.05), average use of pain medication (p < 0.001), and functional scores (p < 0.05) compared with the SF-SBRT cohort. At the 3-month follow-up, the 3F-SBRT cohort experienced a greater frequency of improvement in pain compared with the SF-SBRT group (p < 0.05). Furthermore, patients treated with 3F-SBRT demonstrated a higher frequency of improved Karnofsky Performance Scale (KPS) scores (p < 0.05) compared with those treated with SF-SBRT, with no significant difference in the frequency of improvement in modified Rankin Scale scores. Local tumor control did not differ significantly between the two cohorts.CONCLUSIONSPatients who received spinal 3F-SBRT more frequently achieved significant pain relief and an increased frequency of improvement in KPS compared with those treated with SF-SBRT. Local tumor control was similar in the two groups. Future work is needed to establish the relationship between fractionation schedule and clinical outcomes.

scholarly journals Long-term outcomes of metacarpal fractures surgically treated using bioabsorbable plates: a retrospective study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Kenji Kosugi ◽  
Yukichi Zenke ◽  
Takafumi Tajima ◽  
Yoshiaki Yamanaka ◽  
Kunitaka Menuki ◽  
...  
Keyword(s):  
Grip Strength ◽  
Cost Effective ◽  
Metacarpal Fractures ◽  
Clinical Procedures ◽  
Side Ratio ◽  
Post Surgery ◽  
The Mean ◽  
Grip Strength Ratio

Abstract Background Implants made from bioabsorbable unsintered hydroxyapatite and poly-L-lactate composites (u-HA/PLLA) are widely used in the oral, maxillofacial, and orthopedic fields. This study assess the long-term (> 5 years) outcomes of patients with metacarpal fractures who were surgically treated using bioabsorbable plates and screws (Super-Fixsorb MX40 mesh; Teijin Medical Technology, Osaka, Japan). Methods A retrospective analysis of six patients with eight metacarpal fractures treated with bioabsorbable plates was done. All patients were followed for more than 5 years post-surgery. The clinical outcomes were evaluated using Q-DASH scores and the grip strength (GS): opposite side ratio. The resorption status of implants was assessed on plain computed tomography (CT) scans at final follow-up appointments. Results The mean age of the patients at the time of surgery was 29.5 years (16–54), and the median follow-up period was 81.8 months (68–101). All fractures united without displacement after an average of 3.5 months, and there were no implant specific complications associated with the use of absorbable plates. The mean grip strength ratio was 85.1% (56.8–104.5). The mean Q-DASH scores of 11.36 points (0–34.09) was good in all but two patients. We also observed that it took more than 8 years for the plates to be absorbed completely. Conclusions This study demonstrates that the process of bioabsorption in metacarpal fractures might be completed in about 8 years, and the absorption speeds were different inside and outside of the bone. The bioabsorbable plates are more cost-effective than metallic implants. The potential for bioabsorbable plates to be used in various clinical procedures is promising.

ASTRO suitability criteria assessment in early-stage breast cancer patients treated with intraoperative radiation therapy (IORT) plus 21 gene recurrence score (RS) assay result guided adjuvant medical therapy.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e12598-e12598
Author(s):  
Barbara Stewart Schwartzberg ◽  
Kathryn T. Howell ◽  
Joyce A Moore ◽  
Devchand Paul
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Cancer Patients ◽  
Endocrine Therapy ◽  
Medical Therapy ◽  
Early Stage ◽  
Breast Cancer Patients ◽  
Single Institution ◽  
Single Fraction

e12598 Background: A patient subset consented in an institutional review board-approved single institution clinical trial designed to determine the efficacy and outcome of single fraction IORT received adjuvant medical therapy recommendations based on their RS results. Patients were categorized according to American Society for Radiation Oncology (ASTRO) suitability criteria for accelerated partial breast irradiation. Comparison was made between ASTRO suitability criteria, RS and post-IORT outcomes. Methods: Outcome of pts completing single fraction (20Gy) IORT per protocol using disposable balloon electronic brachytherapy and RS assessment were reviewed. Data collection included demographics, pathology, RS, medical therapy, local (LR) and axillary (AR) recurrences, and survival. Results: From Nov 2011 – Jan 2016, 115 pts (aged 43 – 84, mean 63 years) completed both IORT per protocol and RS assessment. Pts with estrogen receptor positive invasive carcinomas (range 0.2 – 2.4 cm, median size 0.9 cm) and RS results were categorized by ASTRO suitability criteria, LR and AR, as shown in Table 1. The recurrence rate at mean follow-up of 6.8 years was 3.5%. There were 3 LR (RS 0, 17, 18) and 1 AR (RS 19). There has been no breast cancer related death. Adjuvant endocrine therapy was recommended to all pts. Twenty-three (20%) patients received chemotherapy, including 12 (71%) pts in the high RS (RS >25) groups. Chemotherapy was not given to any pt with a RS <18. One LR (RS 0, ASTRO Suitable, age 65, 1.5 cm) declined endocrine therapy. Ten (19%) pts with RS of 11 – 25 received chemotherapy. One LR (RS 17, ASTRO suitable, age 64, 1.5 cm) and 1 axillary recurrence (RS 19, ASTRO Suitable, age 66, 1.3 cm), neither receiving chemotherapy, were compliant with endocrine therapy. One LR (RS 18, ASTRO Suitable, age 51, 0.6 cm) was treated with cyclophosphamide and docetaxel. Seven (78%) pts with RS of 26 - 30 and 5 (63%) pts with RS >30 received chemotherapy, with no recurrences in these groups. Conclusions: One hundred fifteen pts treated with single fraction IORT per protocol and RS guided adjuvant medical therapy at a single institution were found to have a 3.5% recurrence rate at mean follow-up of 6.8 years. ASTRO suitability criteria and high RS results (RS > 25) did not correlate with recurrence. The success of IORT observed in this trial as local therapy for early-stage breast cancer patients was independent of genomic factors or patient suitability criteria. Recurrence rates were comparable to those reported in IORT peer-reviewed published data and treatments using breast conserving surgery plus whole breast radiation therapy. [Table: see text]

Single-Fraction Radiosurgery Using Conservative Doses for Brain Metastases: Durable Responses in Select Primaries With Limited Toxicity

Neurosurgery ◽  
2017 ◽  
Vol 83 (3) ◽  
pp. 437-444 ◽  
Author(s):  
Michael Cummings ◽  
Paul Youn ◽  
Derek P Bergsma ◽  
Kenneth Y Usuki ◽  
Kevin Walter ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Brain Metastases ◽  
Whole Brain Radiation Therapy ◽  
Suboptimal Control ◽  
Lesion Volume ◽  
Whole Brain ◽  
Single Fraction ◽  
Whole Brain Radiation ◽  
Brain Radiation

Abstract BACKGROUND Optimal doses for single-fraction stereotactic radiosurgery (SRS) in the treatment of brain metastases are not well established. Our institution utilized conservative dosing compared to maximum-tolerated doses from the Radiation Therapy Oncology Group 90-05 Phase I study. OBJECTIVE To report individual lesion control (LC) from conservative single-fraction doses and determine factors affecting LC. METHODS From 2003 to 2015, patients who underwent linear accelerator-based single-fraction SRS for cerebral/cerebellar metastases and receiving at least 1 follow-up magnetic resonance imaging (MRI) were identified. Lesion response was assessed by a size-based rating system and modified “Response Assessment in Neuro-Oncology Brain Metastases” (RANO-BM) criteria. RESULTS Among 188 patients with 519 lesions, median survival was 13.1 mo; median follow-up time with MRI was 9.6 mo per course. Median tumor-periphery dose was 15 Gy (range: 7.5-20.7). Median lesion volume was 0.5 cc and diameter was 9 mm (range: 2-45). Concordance between RANO-BM and size-based system was 93%. Crude 1-yr LC was 80%, 73%, 56%, and 38% for lesions 1 to 10, 11 to 20, 21 to 30, &gt;31 mm, respectively. On multivariate analysis, increased size, melanoma and colorectal histology, and progression after whole brain radiation therapy predicted worse LC. When excluding lesions treated as a boost, dose was a significant predictor of LC in multivariate models (hazard ratio 0.89, P = .01). Symptomatic radiation necrosis occurred in 10 lesions in 10 patients. CONCLUSION Histology predicts LC after conservative SRS doses with evidence of a dose–response relationship. Conservative single-fraction SRS doses confer minimal toxicity and acceptable control in certain subgroups (breast cancer, &lt;5 mm), with suboptimal control in larger lesions and in combination with whole brain radiation therapy.

Pelvic excision of large aggressive angiomyxoma in a woman: irradiation for recurrent disease

2006 ◽  
Vol 16 (Suppl 1) ◽  
pp. 356-360 ◽  
Author(s):  
M. Suleiman ◽  
C. Duc ◽  
S. Ritz ◽  
S. Bieri
Keyword(s):  
Radiation Therapy ◽  
Radiation Treatment ◽  
Recurrent Disease ◽  
Complete Resection ◽  
Palliative Resection ◽  
Aggressive Angiomyxoma ◽  
Time To Progression ◽  
Therapeutic Irradiation ◽  
Surgical Excisions

Aggressive angiomyxoma (AAM) is a rare tumor that preferentially involves the pelvis and perineal regions and arises from the connective tissue. Its cause and pathogenesis are unknown at present. Treatment typically involves surgery, and despite apparently complete resection, local recurrences are common. We describe a case of a large angiomyxoma of the left pelvis in a 59-year-old woman who underwent two surgical excisions. The first had been done in May 1998. She developed a local recurrence in December 1998. A palliative resection with macroscopic residuals was performed in February 2001, followed by radiation therapy with a total dose of 60 Gy. The diagnosis was revised at the time of the second operation. Initially, the tumor was diagnosed as angiomyofibroblastoma. Follow-up 3 years after the radiation treatment revealed no recurrence. The time of the local control achieved as yet is already longer than the former time to progression between the first two surgical procedures. This is, to our knowledge, the second description of a therapeutic irradiation of a recurrent AAM. Radiation therapy is able to control a recurrent AAM for at least 3 years.

Outcome of patients treated with a single-fraction dose of radiation for lymphomatoid papulosis.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e18523-e18523
Author(s):  
Michelle Sara Gentile ◽  
Tarita O. Thomas ◽  
Priya Agrawal ◽  
Joan Guitart ◽  
Steven T. Rosen ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Cost Effective ◽  
Patient Characteristics ◽  
Complete Response ◽  
Lymphomatoid Papulosis ◽  
Single Fraction ◽  
Palliative Radiation ◽  
Palliative Radiation Therapy ◽  
Male Patients ◽  
Fraction Dose

e18523 Background: Lymphomatoid Papulosis (LYP) is a primary cutaneous CD30+ lymphoproliferative disorder and a radiosensitive tumor. Treatment with radiation is typically given in multiple fractions for patients presenting with symptomatic unilesional or multilesional disease. However, a single fraction of radiation is more convenient to the patient. The purpose of this retrospective review was to evaluate the clinical response to a single fraction of radiation for palliation of symptomatic LYP lesions. Methods: The records of 8 (5 female, 3 male) patients with LYP, treated with a single or multi-fractionated palliative radiation therapy between 10/2001 and 9/2011, were reviewed. All patients had received multiple previous treatments such as chemotherapy, PUVA, topical nitrogen mustard, and UVB. A total of 19 sites with disease were given the following single doses: 700 (n=3) and 800 (n=16). In the earlier years, a total of 6 sites with disease were given 250 cGy in 18 fractions for a total dose of 4500 cGy. Radiation therapy was administered with electrons to 20 sites and with photons to 5. A bolus was used in most cases to increase the radiation dosage to the skin. Results: Minimum and median follow-up were 1 and 43 months (range, 1 - 120), respectively. Median age of the patients was 65 (range, 24 - 83). For disease sites receiving a single fraction therapy, a complete response (CR) was seen in 17 of the 19 sites (89.5%), and a partial response (PR) was seen in an additional 2 of the 19 sites (10.5%). Therefore, the overall response rate was 100%. For the disease sites receiving multi-fractionated therapy, a CR was seen in 6 of the 6 sites (100%). Evaluation of patient characteristics and treatment did not reveal any differences between patients achieving a CR or PR. Conclusions: For previously treated, radiation-naıve LYP lesions, palliative radiation therapy with single fractions of 700 - 800 cGy is associated with an excellent CR and is a convenient and cost effective strategy.

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