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Mizutani A.,Hamamatsu University School of Medicine | Mizutani A.,Hamamatsu Medical Center | Yokota N.,Hamamatsu University School of Medicine | Yokota N.,Yokohama CyberKnife Center | And 4 more authors.
British Journal of Neurosurgery

Intraosseous schwannomas (IOS) of non-sacral vertebra are extremely rare; only 14 cases were reported previously. We described a case of IOS involving a cervical vertebral body, successfully treated by surgical resection, with a review of the literature and discussion of this extremely rare tumour. © 2010 The Neurosurgical Foundation. Source

Tokimura H.,Kagoshima University | Hirano H.,Kagoshima University | Yasuda S.,Shiroyama Hospital | Nagatomo Y.,Kouseikai Takai Hospital. | And 9 more authors.
Journal of Neurosurgery

Object With advancement of cancer treatment and development of neuroimaging techniques, contemporary clinical pictures of pituitary metastases (PMs) must have changed from past reports. The goal of this paper was to elucidate the clinical features of PMs and current clinical practice related to those lesions. In this retrospective study, questionnaires were sent to 87 physicians who had treated PMs in Japan. Results Between 1995 and 2010, 201 patients with PMs were treated by the participating physicians. The diagnosis of PM was histologically verified in 69 patients (34.3%). In the other 132 patients (65.7%), the PM was diagnosed by their physicians based on neuroimaging findings and clinical courses. The most frequent primary tumor was lung (36.8%), followed by breast (22.9%) and kidney (7.0%) cancer. The average interval between diagnosis of primary cancer and detection of PM was 2.8 ± 3.9 (SD) years. Major symptoms at diagnosis were visual disturbance in 30.3%, diabetes insipidus in 27.4%, fatigue in 25.4%, headache in 20.4%, and double vision in 17.4%. Major neuroimaging features were mass lesion in the pituitary stalk (63.3%), constriction of tumor at the diaphragmatic hiatus (44.7%), hypothalamic mass lesion (17.4%), and hyperintensity in the optic tract (11.4%). Surgical treatment was performed in 26.9% of patients, and 74.6% had radiation therapy; 80.0% of patients who underwent radiotherapy had stereotactic radiotherapy. The median survival time was 12.9 months in total. Contributing factors for good prognosis calculated by Cox proportional hazard analysis were younger age, late metastasis to the pituitary gland, smaller PM size, and radiation therapy. The Kaplan-Meier survival was significantly better in patients with breast cancer and renal cell cancer than in those with lung cancer. Conclusions At the time of this writing, approximately 60% (120/201) of PMs had been treated by stereotactic radiation therapy in Japan. The median survival time was much longer than that reported in past series. To confirm the changes of clinical features and medical practice, a prospective and population-based survey is mandatory. © AANS, 2015. Source

Murai T.,Nagoya City University | Murai T.,Yokohama CyberKnife Center | Ogino H.,Proton Therapy | Manabe Y.,Nagoya City University | And 6 more authors.
Clinical Oncology

Aims: To evaluate the toxicity and efficacy of fractionated stereotactic radiotherapy (FSRT) with doses of 18-30Gy in three fractions and 21-35Gy in five fractions against large brain metastases. Materials and methods: Between 2005 and 2012, 61 large brain metastases (≥2.5cm in maximum diameter) of a total of 102 in 54 patients were treated with FSRT as a first-line therapy. Neurological symptoms were observed in 47 of the 54 patients before FSRT. Three fractions were applied to tumours with a maximum diameter ≥2.5cm and <4cm, and five fractions were used for brain metastases ≥4cm. After ensuring that the toxicities were acceptable (≤grade 2), doses were escalated in steps. Doses to the large brain metastases were as follows: level I, 18-22Gy/three fractions or 21-25Gy/five fractions; level II, 22-27Gy/three fractions or 25-31Gy/five fractions; level III, 27-30Gy/three fractions or 31-35Gy/five fractions. Level III was the target dose level. Results: Overall survival rates were 52 and 31% at 6 and 12 months, respectively. Local tumour control rates of the 102 total brain metastases were 84 and 78% at 6 and 12 months, respectively. Local tumour control rates of the 61 large brain metastases were 77 and 69% at 6 and 12 months, respectively. Grade 3 or higher toxicities were not observed. Conclusions: The highest dose levels of 27-30Gy/three fractions and 31-35Gy/five fractions seemed to be tolerable and effective in controlling large brain metastases. These doses can be used in future studies on FSRT for large brain metastases. •With Cyberknife, 61 large brain metastases in 54 patients were treated.•Three levels of prescribed dose were used with the dose escalation design.•Dose levels of 27-30Gy/3 fractions, 31-35Gy/5 fractions were target dose levels.•The median survival was 6 months. Unacceptable toxicities were not observed.•The target dose levels can be used for large brain metastases. © 2013 The Royal College of Radiologists. Source

Kawaguchi K.,Tsurumi University | Sato K.,Yokohama CyberKnife Center | Yamada H.,Tsurumi University | Horie A.,Tsurumi University | And 6 more authors.
Journal of Oral and Maxillofacial Surgery

Purpose: The purpose of this study was to investigate the effect of stereotactic radiosurgery on local control and organ preservation in cases of primary head and neck cancer. Patients and Methods: In this retrospective study, 14 patients with a mean age of 73 years were treated between March 2006 and September 2007 with stereotactic radiosurgery for the management of primary head and neck cancer. The patients had biopsy confirmation of disease before treatment and all patients were confirmed with squamous cell carcinoma. The staging consisted of T2 (5 cases), T3 (3 cases), T4 (6 cases), N0 (13 cases), and N1 (1 case). Marginal doses were 3,500 to 4,200 cGy in 3 or 5 fractions. The outcome was assessed according to Response Evaluation Criteria in Solid Tumors criteria based on magnetic resonance imaging and positron emission tomography/computed tomography. Results: Significant tumor reduction was noted at the third month of follow-up with 5 complete responses and 9 partial responses. At a mean follow-up of 36 months (range, 14-40 mo) the local control and overall survival rates were 71.4% (10/14) and 78.6% (11/14), respectively. Conclusions: These results show the feasibility of using stereotactic radiosurgery for primary head and neck cancer and its potential benefit in local control and organ preservation. © 2012 American Association of Oral and Maxillofacial Surgeons. Source

Kawaguchi K.,Tsurumi University | Sato K.,Yokohama CyberKnife Center | Horie A.,Tsurumi University | Iketani S.,Toshiba Rinkan Hospital | And 4 more authors.
Radiation Oncology

Background: The aim of this study is to examine the effect of stereotactic radiosurgery (SRS) in the treatment of advanced, recurrent lesions for head and neck carcinoma both with and without lymph node involvement.Methods: Between April 2006 and July 2007, 22 patients (mean age 67 years) with advanced, recurrent head and neck carcinoma were treated with stereotactic radiosurgery. All of the patients except one had biopsy confirmed disease prior to stereotactic radiosurgery. Patients included 3 rT2, 8 rT3, and 9 rT4; 8 of the patients had lymph node metastases. Marginal SRS doses were 20-42 Gy delivered in two to five fractions. Starting one month after SRS, all patients received S-1 oral chemotherapy for one year.Results: At an overall median follow-up of 24 months (range, 4-39 months), for the 14 locally recurrent patients without lymph node metastases, 9 patients (64.3%) had a complete response (CR), 1 patient (7.1%) had a partial response (PR), 1 patient (7.1%) had stable disease (SD), and 3 patients (21.4%) had progressive disease (PD). For the 8 patients with lymph node metastases, 1 patient with a single retropharyngeal (12.5%) had CR; the remaining 7 patients (87.5%) all progressed. Nine patients have died from their cancer. The overall actuarial 2-year survival for the patients with and without lymph node metastases is 12.5% and 78.6%, respectively.Conclusions: These results show the benefit of stereotactic radiosurgery salvage treatment for advanced, recurrent lesions, without lymph node metastases in previously irradiated head and neck cancer. © 2010 Kawaguchi et al; licensee BioMed Central Ltd. Source

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