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The Canadian Association of Radiation Oncology scope of practice guidelines for lung, liver and spine stereotactic body radiotherapy.

https://arctichealth.org/en/permalink/ahliterature124033
Source
Clin Oncol (R Coll Radiol). 2012 Nov;24(9):629-39
Publication Type
Article
Date
Nov-2012
Author
A. Sahgal
D. Roberge
D. Schellenberg
T G Purdie
A. Swaminath
J. Pantarotto
E. Filion
Z. Gabos
J. Butler
D. Letourneau
G L Masucci
L. Mulroy
A. Bezjak
L A Dawson
M. Parliament
The Canadian Association of Radiation Oncology-Stereotactic Body Radiotherapy Task Force
Author Affiliation
Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada. Arjun.sahgal@rmp.uhn.on.ca
Source
Clin Oncol (R Coll Radiol). 2012 Nov;24(9):629-39
Date
Nov-2012
Language
English
Publication Type
Article
Keywords
Canada
Humans
Liver Neoplasms - pathology - surgery
Lung Neoplasms - pathology - surgery
Radiation Oncology - methods - standards
Radiosurgery - methods - standards
Radiotherapy Dosage
Spinal Neoplasms - pathology - surgery
Abstract
The Canadian Association of Radiation Oncology-Stereotactic Body Radiotherapy (CARO-SBRT) Task Force was established in 2010. The aim was to define the scope of practice guidelines for the profession to ensure safe practice specific for the most common sites of lung, liver and spine SBRT.
A group of Canadian SBRT experts were charged by our national radiation oncology organisation (CARO) to define the basic principles and technologies for SBRT practice, to propose the minimum technological requirements for safe practice with a focus on simulation and image guidance and to outline procedural considerations for radiation oncology departments to consider when establishing an SBRT programme.
We recognised that SBRT should be considered as a specific programme within a radiation department, and we provide a definition of SBRT according to a Canadian consensus. We outlined the basic requirements for safe simulation as they pertain to spine, lung and liver tumours, and the fundamentals of image guidance. The roles of the radiation oncologist, medical physicist and dosimetrist have been detailed such that we strongly recommend the development of SBRT-specific teams. Quality assurance is a key programmatic aspect for safe SBRT practice, and we outline the basic principles of appropriate quality assurance specific to SBRT.
This CARO scope of practice guideline for SBRT is specific to liver, lung and spine tumours. The task force recommendations are designed to assist departments in establishing safe and robust SBRT programmes.
PubMed ID
22633542 View in PubMed
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Clinical practice guideline on the optimal radiotherapeutic management of brain metastases.

https://arctichealth.org/en/permalink/ahliterature175430
Source
BMC Cancer. 2005;5:34
Publication Type
Article
Date
2005
Author
May N Tsao
Nancy S Lloyd
Rebecca K S Wong
Author Affiliation
Department of Radiation Oncology, Toronto-Sunnybrook Regional Cancer Centre, Toronto, Ontario, Canada. may.tsao@sw.ca
Source
BMC Cancer. 2005;5:34
Date
2005
Language
English
Publication Type
Article
Keywords
Brain Neoplasms - pathology - radiotherapy
Canada
Cranial Irradiation - methods - standards
Humans
Neoplasm Metastasis
Questionnaires
Radiation-Sensitizing Agents - pharmacology
Radiosurgery - methods
Radiotherapy - methods - standards
Radiotherapy Dosage
Abstract
An evidence-based clinical practice guideline on the optimal radiotherapeutic management of single and multiple brain metastases was developed.
A systematic review and meta-analysis was performed. The Supportive Care Guidelines Group formulated clinical recommendations based on their interpretation of the evidence. External review of the report by Ontario practitioners was obtained through a mailed survey, and final approval was obtained from Cancer Care Ontario's Practice Guidelines Coordinating Committee (PGCC).
One hundred and nine Ontario practitioners responded to the survey (return rate 44%). Ninety-six percent of respondents agreed with the interpretation of the evidence, and 92% agreed that the report should be approved. Minor revisions were made based on feedback from external reviewers and the PGCC. The PGCC approved the final practice guideline report.
For adult patients with a clinical and radiographic diagnosis of brain metastases (single or multiple) we conclude that: surgical excision should be considered for patients with good performance status, minimal or no evidence of extracranial disease, and a surgically accessible single brain metastasis. Postoperative whole brain radiotherapy (WBRT) should be considered to reduce the risk of tumour recurrence for patients who have undergone resection of a single brain metastasis. Radiosurgery boost with WBRT may improve survival in select patients with unresectable single brain metastases. The whole brain should be irradiated for multiple brain metastases. Standard dose-fractionation schedules are 3000 cGy in 10 fractions or 2000 cGy in 5 fractions. Radiosensitizers are not recommended outside research studies. In select patients, radiosurgery may be considered as boost therapy with WBRT to improve local tumour control. Radiosurgery boost may improve survival in select patients. Chemotherapy as primary therapy or chemotherapy with WBRT remains experimental. Supportive care is an option but there is a lack of Level 1 evidence as to which subsets of patients should be managed with supportive care alone. Qualifying statements addressing factors to consider when applying these recommendations are provided in the full report. The rigorous development, external review and approval process has resulted in a practice guideline that is strongly endorsed by Ontario practitioners.
Notes
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PubMed ID
15807895 View in PubMed
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Cochlear implant rehabilitation for patients with vestibular schwannoma: report of two cases.

https://arctichealth.org/en/permalink/ahliterature128974
Source
Cochlear Implants Int. 2012 May;13(2):124-7
Publication Type
Article
Date
May-2012
Author
Hosam A Amoodi
Fawaz M Makki
Jonathan Cavanagh
Heather Maessen
Manohar Bance
Author Affiliation
Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada. hosamamodi@hotmail.com
Source
Cochlear Implants Int. 2012 May;13(2):124-7
Date
May-2012
Language
English
Publication Type
Article
Keywords
Adult
Audiometry, Pure-Tone - methods
Cochlear Implantation - methods
Cochlear Implants
Combined Modality Therapy
Female
Follow-Up Studies
Hearing Loss, Bilateral - etiology - rehabilitation - surgery
Humans
Magnetic Resonance Imaging - methods
Male
Middle Aged
Neuroma, Acoustic - complications - diagnosis - rehabilitation - surgery
Nova Scotia
Preoperative Care - methods
Radiosurgery - methods
Risk assessment
Tomography, X-Ray Computed - methods
Treatment Outcome
Abstract
The objective of this paper is to highlight two main points. The primary aim is to demonstrate that cochlear implants can function in the presence of retrocochlear pathology, even after stereotactic radiosurgery (SRS), and hence to introduce this as a management option in selected patients with retrocochlear pathology, such as Neurofibromatosis type II (NFII) patients. A secondary aim is to act as a caveat that computed tomography (CT) scanning alone may not be sufficient imaging in subjects undergoing cochlear implantation (CI).
In this paper we report two patients who underwent cochlear implant despite the presence of a vestibular schwannoma (VS) on the same side. The first case is a 59-year-old male, diagnosed with VS after 9 months of good hearing with a cochlear implant. The second case is 26-year-old female known case of NFII, received a cochlear implant after controlling the tumor growth with a SRS.
We show the consequences of missing important pre-implant pathology prior to CI in one case. In both cases, we add to the literature showing that cochlear implants can work well in the presence of VS, even in the presence of previous SRS. This adds significantly to the management options available to NFII patients, and the results seem to be better than those expected for auditory brainstem implant (ABI), and with a much simpler and safer intervention.
PubMed ID
22152982 View in PubMed
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A comparison between ¹²5Iodine brachytherapy and stereotactic radiotherapy in the management of juxtapapillary choroidal melanoma.

https://arctichealth.org/en/permalink/ahliterature117095
Source
Br J Ophthalmol. 2013 Mar;97(3):327-32
Publication Type
Article
Date
Mar-2013
Author
Hatem Krema
Mostafa Heydarian
Akbar Beiki-Ardakani
Daniel Weisbrod
Wei Xu
E Rand Simpson
Arjun Sahgal
Author Affiliation
Department of Ocular Oncology, University of Toronto, Toronto, Ontario, Canada. htmkrm19@yahoo.com
Source
Br J Ophthalmol. 2013 Mar;97(3):327-32
Date
Mar-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Brachytherapy - methods
Choroid Neoplasms - diagnosis - therapy
Female
Follow-Up Studies
Humans
Incidence
Iodine Radioisotopes - therapeutic use
Male
Melanoma - diagnosis - therapy
Middle Aged
Neoplasm Recurrence, Local - epidemiology
Ontario - epidemiology
Radiosurgery - methods
Retrospective Studies
Survival Rate - trends
Treatment Outcome
Abstract
To compare the treatment efficacy and radiation complications between (125)Iodine brachytherapy and stereotactic radiotherapy in the management of juxtapapillary choroidal melanoma.
Consecutive juxtapapillary melanoma patients treated with radiotherapy were included. Patients were divided into two cohorts: patients treated with (125)Iodine brachytherapy and patients with stereotactic radiotherapy. Comparison included the rates postradiotherapy local recurrence, secondary enucleation, metastasis and radiotherapy complications. Kaplan-Meier estimates were used to determine the actuarial rates, and logrank test to compare between the estimates.
We included 94 patients with juxtapapillary melanoma treated with radiotherapy. The brachytherapy cohort included 30 patients and stereotactic radiotherapy was 64. The median follow-up was 46 months in both cohorts. No statistically significant differences existed between the two cohorts on comparing pretreatment clinical data and tumour characteristics. On comparing treatment efficacy, the actuarial rates at 50 months for tumour recurrence were 11% and 7% (p=0.61), secondary enucleation was 11% and 21% (p=0.30) and for metastasis were 4% and 16% (p=0.11), respectively. On comparing treatment complications, the actuarial rates at 50 months for cataracts were 62% and 75% (p=0.1), for neovascular glaucoma 8% and 47% (p=0.002), for radiation retinopathy 59% and 89% (p=0.0001), and for radiation papillopathy 39% and 74% (p=0.003), respectively.
Both (125)Iodine brachytherapy and stereotactic radiotherapy demonstrate comparable efficacy in the management of juxtapapillary choroidal melanoma. However, stereotactic radiotherapy shows statistically significant higher radiation-induced ocular morbidities at 4 years postradiotherapy.
PubMed ID
23335213 View in PubMed
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A comparison between surgical resection in combination with WBRT or hypofractionated stereotactic irradiation in the treatment of solitary brain metastases.

https://arctichealth.org/en/permalink/ahliterature151346
Source
Acta Neurochir (Wien). 2009 Sep;151(9):1053-9
Publication Type
Article
Date
Sep-2009
Author
Peter Lindvall
Per Bergström
Per-Olov Löfroth
A. Tommy Bergenheim
Author Affiliation
Department of Neurosurgery, Umeå University Hospital, SE-901 85, Umeå, Sweden. peter_lindvall_nkk@hotmail.com
Source
Acta Neurochir (Wien). 2009 Sep;151(9):1053-9
Date
Sep-2009
Language
English
Publication Type
Article
Keywords
Aged
Brain Neoplasms - secondary - surgery
Female
Humans
Male
Middle Aged
Neurosurgical Procedures - methods - statistics & numerical data
Outcome Assessment (Health Care) - methods
Postoperative Complications - epidemiology - prevention & control
Radiosurgery - methods - statistics & numerical data
Recurrence - prevention & control
Retrospective Studies
Survival Rate
Treatment Outcome
Abstract
The standard treatment of solitary brain metastases previously has been tumour resection in combination with whole-brain radiation therapy (WBRT). Stereotactic radiotherapy has emerged as a non-invasive treatment option especially for small brain metastases. We now report our results on resection + WBRT or hypofractionated stereotactic irradiation (HCSRT) in the treatment of solitary brain metastases.
Between 1993 and 2004 patients with metastatic cancer and solitary brain metastases were selected for surgical resection + WBRT or HCSRT alone at the Umeå University Hospital. Fifty-nine patients were treated with surgical resection + WBRT (34 male, 25 female, mean age 63.3 years). Forty-seven patients were treated with HCSRT alone (15 male, 32 female, mean age 64.9 years).
In patients followed radiologically, 28% treated with resection + WBRT showed a local recurrence after a median time of 8.0 months, whereas there was a lack of local control in 16% in the HCSRT group after a median time of 3.0 months. There was a significantly longer survival time for patients treated with resection + WBRT (median 7.9, mean 12.9 months) compared to HCSRT (median 5.0, mean 7.6 months). Even in patients with a tumour volume
PubMed ID
19390775 View in PubMed
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Computed tomography-guided ? knife stereotactic radiosurgery for trigeminal neuralgia.

https://arctichealth.org/en/permalink/ahliterature134833
Source
Acta Neurochir (Wien). 2011 Aug;153(8):1601-9
Publication Type
Article
Date
Aug-2011
Author
Kyung-Jae Park
Hideuki Kano
Oren Berkowitz
Nasir R Awan
John C Flickinger
L Dade Lunsford
Douglas Kondziolka
Author Affiliation
Department of Neurological Surgery, University of Pittsburgh, Center for Image-Guided Neurosurgery, Suite B-400, UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
Source
Acta Neurochir (Wien). 2011 Aug;153(8):1601-9
Date
Aug-2011
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Female
Humans
Male
Middle Aged
Radiation Dosage
Radiosurgery - methods
Retrospective Studies
Stereotaxic Techniques - instrumentation
Tomography, X-Ray Computed - methods
Treatment Outcome
Trigeminal Nerve - radiography - surgery
Trigeminal Neuralgia - surgery
Abstract
Gamma knife stereotactic radiosurgery (GKSR) is an effective minimally invasive option for the treatment of medically refractory trigeminal neuralgia (TN). Optimal targeting of the retrogasserian trigeminal nerve target requires thin-slice, high-definition stereotactic magnetic resonance imaging (MRI). The purpose of this study was to evaluate management outcomes in TN patients ineligible for MRI and who instead underwent GKSR using computed tomography (CT).
The authors reviewed their experience with CT-guided GKSR in 21 patients (median age: 75 years) with idiopathic TN. Contraindications to MRI included implanted pacemakers (n?=?16), aneurysm clips (n?=?2), cochlea implants (n?=?1), metallic vascular stents (n?=?1) or severe obesity (weight of 163 kg, n?=?1). Contrast-enhanced CT at 1- or 1.25-mm intervals was acquired in all patients. One patient also underwent CT cisternography. The median target dose for GKSR was 80 Gy. The median follow-up was 35 months after GKSR. Treatment outcomes were compared to 459 patients who underwent MRI-guided GKSR for TN at our institute in the same time interval.
Targeting of the trigeminal nerve guided by CT scan was feasible in all patients. Stereotactic frame titanium pin-related artifacts that interfered with full visualization of the trigeminal nerve were found in one patient who had the ipsilateral posterior pin placed near the inion. After GKSR, 90% of patients achieved initial pain relief that was adequate or better, with or without medication (Barrow Neurological Institute pain scores I-IIIb). Median time to pain relief was 2.6 weeks. Pain relief was maintained in 81% at 1 year, 66% at 2 years, and 46% at 5 years. Eight (42%) of 19 patients who achieved initial pain relief reported some recurrent pain at a median of 18 months after GKSR. Some degree of facial sensory dysfunction occurred in 19% of patients within 24 months of GKSR. These results are comparable to those of patients who had MRI-guided GKSR.
CT-guided GKSR provides a similar rate of pain relief as MRI-guided radiosurgery. The posterior pins should be placed at least 1 cm away from the inion to reduce pin and frame-related artifacts on the targeting CT scan. This study indicates that GKSR using CT targeting is appropriate for patients with medically refractory TN who are unsuitable for MRI.
PubMed ID
21538196 View in PubMed
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CT-only planning for Gamma Knife radiosurgery in the treatment of trigeminal neuralgia: methodology and outcomes from a single institution.

https://arctichealth.org/en/permalink/ahliterature121715
Source
J Med Imaging Radiat Oncol. 2012 Aug;56(4):490-4
Publication Type
Article
Date
Aug-2012
Author
Albert Attia
Stephen B Tatter
Michael Weller
Kopriva Marshall
James F Lovato
J Daniel Bourland
Thomas L Ellis
Kevin P McMullen
Edward G Shaw
Michael D Chan
Author Affiliation
Department of Radiation Oncology Neurosurgery Biostatistics, Wake Forest University-Baptist Medical Center, Winston-Salem, NC, USA. aattia@wakehealth.edu
Source
J Med Imaging Radiat Oncol. 2012 Aug;56(4):490-4
Date
Aug-2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Female
Humans
Male
Middle Aged
Radiosurgery - methods
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted - methods
Radiotherapy, Computer-Assisted - methods
Retrospective Studies
Surgery, Computer-Assisted - methods
Tomography, X-Ray Computed - methods
Treatment Outcome
Trigeminal Neuralgia - radiography - surgery
Abstract
Gamma Knife radiosurgery (GKRS) has been established as a safe and effective treatment option for trigeminal neuralgia. Some patients have contraindications to magnetic resonance imaging (MRI), the standard stereotactic imaging used for GKRS treatment planning. Computerized tomography (CT) imaging may be used as an alternative in this scenario. We sought to evaluate the outcomes of our patients treated using this technique.
Between August 2001 and November 2009, 19 patients with trigeminal neuralgia were treated with GKRS using CT-only planning. The course of the trigeminal nerve was determined based upon anatomical landmarks when the nerve was not directly visualized on the treatment-planning CT. Median dose used was 90 Gy (range 85-90 Gy). Follow-up data based on Barrow Neurological Institute (BNI) pain score and toxicity were obtained using electronic medical records and by telephone interview.
With median follow-up time of 18 months (range 4-36 months), improvement in quality of life after GKRS was reported in 17 of 19 patients. Freedom from BNI IV-V pain relapse was 82% at 24 months. By 3 months post-GKRS, 50% of patients were able to discontinue medications completely. Three patients reported numbness after GKRS; none of these patients described bothersome numbness. Use of contrast did not affect treatment outcome (P = 0.31).
Stereotactic CT-only treatment planning of GKRS for the treatment of trigeminal neuralgia is feasible and safe. Further studies are necessary to determine if the long-term durability of pain relief is comparable to that of MRI-based GKRS planning.
PubMed ID
22883661 View in PubMed
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Defining treatment for brain metastases patients: nihilism versus optimism.

https://arctichealth.org/en/permalink/ahliterature138084
Source
Support Care Cancer. 2012 Feb;20(2):279-85
Publication Type
Article
Date
Feb-2012
Author
Peter S Craighead
Alexander Chan
Author Affiliation
Department of Oncology, University of Calgary and Alberta Radiosurgery Centre, Calgary, AB, Canada. peterch@cancerboard.ab.ca
Source
Support Care Cancer. 2012 Feb;20(2):279-85
Date
Feb-2012
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Alberta
Brain Neoplasms - radiotherapy - secondary - surgery
Combined Modality Therapy
Decision Making
Humans
Middle Aged
Neoplasms - pathology
Prognosis
Quality of Life
Radiosurgery - methods
Retrospective Studies
Survival Rate
Treatment Outcome
Abstract
Treatment of brain metastases patients has included whole brain radiotherapy (WBRT) for over 50 years, and there is much data showing this to be associated with short-term gains. The integration of resection and radiosurgery to these patients allows some better prognostic groups to experience long-term local control and improvement in quality of life. The recursive partitioning analysis of the Radiation Therapy Oncology Group (RTOG) has been used as a predictive model for over a decade to identify three classes of patients. Number of lesions has been used to define treatment for a good prognostic subgroup that is eligible for surgery or radiosurgery, but there are few prospective studies of poorer prognosis brain metastases patients to evaluate the influence of number of lesions on the prediction of outcome. We examined patient, treatment and outcome parameters of all brain metastases patients in a 5-year period so that we could measure outcome and evaluate various factors on survival.
This was a population-based study of all brain metastases patients in Southern Alberta between 2000 and 2005. It used an Excel spreadsheet database and STATA 8 software to analyze outcomes. The study included 568 patients representing 4.4% of our radiotherapy population. Median age, performance status and distribution of primary disease sites were comparable with other large series. Overall survival for the whole group was 3.05 months. Independent factors predicting for improved overall survival included younger age, KPS
PubMed ID
21212987 View in PubMed
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Doses greater than 85 Gy and two isocenters in Gamma Knife surgery for trigeminal neuralgia: updated results.

https://arctichealth.org/en/permalink/ahliterature166322
Source
J Neurosurg. 2006 Dec;105 Suppl:107-11
Publication Type
Article
Date
Dec-2006
Author
Stefania Morbidini-Gaffney
Chung-Taik Chung
Tracy Erin Alpert
Nancy Newman
Seung Shin Hahn
Hemangini Shah
Lisa Mitchell
Daniel Bassano
Aneela Darbar
Saeed Ahmed Bajwa
Charles Hodge
Author Affiliation
Department of Radiation Oncology, State University of New York Upstate Medical University, Syracuse, New York 13210, USA. smorbidini@yahoo.com
Source
J Neurosurg. 2006 Dec;105 Suppl:107-11
Date
Dec-2006
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Cohort Studies
Dose-Response Relationship, Radiation
Humans
Middle Aged
Multiple Sclerosis - complications
Pain - etiology - pathology - prevention & control
Radiosurgery - methods
Radiotherapy Dosage
Retrospective Studies
Treatment Outcome
Trigeminal Neuralgia - etiology - pathology - surgery
Young Adult
Abstract
The purpose of this study was to assess the efficacy of Gamma Knife surgery (GKS) in treating patients with trigeminal neuralgia (TN). Preliminary results of this study were previously reported. The updated results are reported in this paper.
Ninety seven patients with TN refractory to medical or surgical management underwent GKS between September 1998 and October 2005. Fifteen patients had multiple sclerosis (MS). The radiation dose was escalated from 70 to 99 Gy. The Barrow Neurological Institute Pain Scale (BNIPS) was used to assess pain before and after GKS. Eighty-four patients were available for evaluation with a mean follow up of 8.9 months. The overall response and complete response rates were 70.2% and 36.9%, respectively. At 12 months, there was a greater improvement in BNIPS scores for patients who were treated with two isocenters compared with those treated with a single isocenter. The mean percentage of pain decrease was 56.26% compared with 11.53% (p
PubMed ID
18503341 View in PubMed
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39 records – page 1 of 4.