This study represents the largest retrospective series of colonic stent placement for LBO in ECM patients in the literature. Our technical success rate of 75.9%, clinical success rate of 54.5%, and 3-month stent occlusion rate of 14.7% suggest that stent placement is a viable palliative option for patients with advanced disease because of ECM. Patients with peritoneal carcinomatosis and multifocal disease have reduced technical and clinical success. However, these factors should not dissuade an attempt at stent placement, if risk-to-benefit analysis is favorable.
Glioblastoma is not only the most common primary brain tumor, but also the most aggressive. Currently, the most effective treatment of surgery, chemotherapy and radiation therapy allows for a modest median survival of 15 months. Here, we report a case of a 57-year-old male with histologically confirmed glioblastoma with unfavorable prognostic characteristics (poor performance status and persistent neurological symptoms after surgery), whose expected 5-year survival is 0%. Further genetic analysis offered a mixed prognostic picture with positive methylation of 0-6-methylguinine-DNA (deoxyribonucleic acid) methyltransferase (MGMT; favorable prognosis) and wild-type isocitrate dehydrogenase 1 (IDH-1; unfavorable prognosis). Remarkably, the patient showed a progression-free survival of 5.5 years and a total survival of 6.5 years. In the context of recently published literature, the authors hypothesize that the patient's use of the antipsychotic medication risperidone may have had a potential antitumor effect. Risperidone antagonizes the dopamine-2 receptor and the serotonin-7 receptor, both of which have been individually implicated in the growth and progression of glioblastoma. To the authors' knowledge, this is the first clinical case in the literature to explore this association.
Detailed information on the initial endoscopic assessment is essential in today's age of multidisciplinary care. Identification and adoption of QIs for endoscopic reporting is warranted to ensure the provision of appropriate treatment.
Purpose: To compare treatment plans and evaluate dosimetric characteristics of permanent cesium-131 (131 Cs) vs. iodine-125 (125 I) implants used in brain brachytherapy. Material and methods: Twenty-four patients with 131 Cs implants from a prospective phase I/II trial were re-planned with 125 I implants. In order to evaluate the volume of brain tissue exposed to radiation therapy (RT), the dose volume histogram was generated for both radioisotopes. To evaluate the dosimetric differences of the two radioisotopes we compared homogeneity (HI) and conformity indices (CI), and dose covering 100% (D 100), 90% (D 90), 80% (D 80), and 50% (D 50) of the clinical target volume (CTV). Results: At the 100%, 90%, 80%, and 50% isodose lines, the 131 Cs plans exposed less mean volume of brain tissue than the 125 I plans (p < 0.001). The D 100 , D 90 , D 80 , and D 50 were smaller for 131 Cs (p < 0.001). The HI and CI for 131 Cs vs. 125 I were 19.71 vs. 29.04 and 1.31 vs. 1.92, respectively (p < 0.001). Conclusions: Compared to 125 I, 131 Cs exposed smaller volumes of brain tissue to equivalent doses of radiation and delivered lower radiation doses to equivalent volumes of the CTV. 131 Cs exhibited a higher HI, indicating increased uniformity of doses within the CTV. Lastly, 131 Cs presented a CI closer to 1, indicating that the total volume receiving the prescription dose was closer to the desired CTV volume. These results suggest that 131 Cs is dosimetrically superior to 125 I and may explain the reason for the 0% incidence of radiation necrosis (RN) in our previously published prospective study using 131 Cs.
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