Use of ipilimumab within 4 months of SRS seems to be safe, with no increase in radiation necrosis or hemorrhage; however, our retrospective institutional experience with this treatment regimen was not associated with improved outcomes.

2. With this view, a Flora consists of descript ions of all the wild or native plants Containe d in the country in question, so drawn up and arrange d that the student may coon with the corresp onding descript ion any individu al specime n which he may gather.3. These descriptions should be clear, concise, accurate, and characteristic, 80 us that each one should be readily adapted to the plant it relates to, and to no other one ; they should be as nearly as possible arranged under natural (184) divisions, so as to peilitate the comparison of each plant with those nearest allied to it ; and they should 2ccompanied by an artificial key or index, by means of which the student may be Guided step by step in the observation of such peculiarities or characters in his plant, "8 may lead him, with the least delay, to the individual description belonging to it.4. For descriptio ns to be clear and readily intelligible , they should be expressed as much as possible in ordinary well-estab lished language.But, for the purpose of accuracy, it is necessary not only to give a more precise technical meaning to many 8 used more or less vaguely in common conversation, but also to introduce purely technical names for such parts of plants or forms as are of little importance except to the botanist.In the present chapter it is proposed to define such technical or technically limited terms as are made use of in these Floras.5. At the same time mathematical accuracy must not be expected. The forms and "ppearances assumed by plants and their parts are infinite. Names cannot be invented or all; those even that have been proposed are too numerous for ordinary memories.any are deriv ed from suppo sed resem blanc es to wellknown forms or object s. These resem blanc es are differ ently appre ciate d by differ ent person s, and the same term is not only differ ently appli ed by two differ ent botani sts, but it frequ ently happe ns that the "ane writer is led on differ ent occas ions to give somew hat differ ent meani ngs to the Same word. The botani st's endea vours shoul d alway s be, on the one hand, to one as Hear an appro ach to preci sion as cireu mstan ces will allow ; and, on the other hand, to svoid that prolix ity of detail and overl oadin g with techni cal terms which tends rather confusion than clearness. In this he will be more or less successful. The aptness itt pOtanical description, like the beauty of a work of imagination, will always vary with the style and genius of the author. il OUTL INES OF § 1. The Plant in Genera l.6. The Plant, in its botanica l sense, includes every being which has vegetabl e life, from the loftiest tree which adorns our landscap es, to the humbles t moss whieh grows on its stem, to the mould or fungus which attacks our provisio ns, or the green scum that floats on our ponds.7. Every portion of a plant which has a distinct part or function to perform in the operation s or phenome na of vegetable life is called an Organ.8. What constitutes vegetable life, and what are the functions of each organ, belong...

The aim of this study was to compare outcomes of postoperative whole brain radiation therapy (WBRT) to stereotactic radiosurgery (SRS) alone in patients with resected brain metastases (BM). We reviewed records of patients who underwent surgical resection of BM followed by WBRT or SRS alone between 2003 and 2013. Local control (LC) of the treated resected cavity, distant brain control (DBC), leptomeningeal disease (LMD), overall survival (OS), and radiographic leukoencephalopathy rates were estimated by the Kaplan-Meier method. One-hundred thirty-two patients underwent surgical resection for 141 intracranial metastases: 36 (27 %) patients received adjuvant WBRT and 96 (73 %) received SRS alone to the resection cavity. One-year OS (56 vs. 55 %, p = 0.64) and LC (83 vs. 74 %, p = 0.31) were similar between patients receiving WBRT and SRS. After controlling for number of BM, WBRT was associated with higher 1-year DBC compared with SRS (70 vs. 48 %, p = 0.03); single metastasis and WBRT were the only significant predictors for reduced distant brain recurrence in multi-variate analysis. Freedom from LMD was higher with WBRT at 18 months (87 vs. 69 %, p = 0.045), while incidence of radiographic leukoencephalopathy was higher with WBRT at 12 months (47 vs. 7 %, p = 0.001). One-year freedom from WBRT in the SRS alone group was 86 %. Compared with WBRT for patients with resected BM, SRS alone demonstrated similar LC, higher rates of LMD and inferior DBC, after controlling for the number of BM. However, OS was similar between groups. The results of ongoing clinical trials are needed to confirm these findings.

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Melanoma is an aggressive malignancy with a deplorable penchant for spreading to the brain. While focal therapies such as surgery and stereotactic radiosurgery can help provide local control, the majority of patients still develop intracranial progression. Novel therapeutic combinations to improve outcomes for melanoma brain metastases (MBM) are clearly needed. Ipilimumab, the anticytotoxic T-lymphocyte-associated antigen 4 monoclonal antibody, has been shown to improve survival in patients with metastatic melanoma, but many of these trials either excluded or had very few patients with MBM. This article will review the efficacy and limitations of ipilimumab therapy for MBM, describe the current evidence for combining ipilimumab with radiation therapy, illustrate potential mechanisms for synergy, and discuss emerging clinical trials specifically investigating this combination in MBM.

Current guidelines are unclear as to the precise role of radiotherapy (RT) in patients with desmoplastic melanoma (DM). The purpose of this study was to evaluate our institutional outcomes in patients with DM, and to explore the roles of both adjuvant and salvage RT in these patients. We identified 100 patients with a histopathologic diagnosis of DM who received treatment at our institution from 2000 to 2014. Local control, distant metastasis-free survival, and overall survival (OS) were evaluated in the 95 patients managed surgically with or without adjuvant and/or salvage RT. The overall rate of local recurrence (LR) was 10%. There was no LR in either adjuvant or salvage RT cohort. Adjuvant RT did not significantly improve LR-free survival at 5 years (100 vs. 81%, P = 0.59), despite the RTpatients having worse pathological features. Four of seven (57%) salvage patients developed distant metastases, despite 100% local control. Adjuvant RT did not significantly impact 5-year overall survival (86 vs. 82%, P = 0.43). RT shows a trend towards improved local control in both the adjuvant and salvage settings for patients with DM, and likely overcomes adverse risk factors after surgery in appropriately selected patients. Future prospective studies are needed to better address the optimal management for these patients.

A 1-cm resection margins did not increase the risk of LR. Margin width did not make a significant difference in DSS or OS. Larger resection margins increase the need for a graft or flap closure.