BACKGROUND: This intervention pilot case series assessed 40-Gy stereotactic radiosurgery (SRS) neuromodulation applied to the bilateral stellate ganglion (SG) as a bailout procedure for patients with refractory angina pectoris (RAP). MATERIALS AND METHODS: The local institutional review board approved this feasibility study. In three patients with RAP, after repeated good response, symptoms were temporarily relieved after anaesthetic blockade of the left SG under ultrasound guidance. Radiosurgical neuromodulation with a dose of 40 Gy in one fraction was used for more permanent pain control. When RAP recurred after the initial SRS, right-sided procedures were considered after a confirmed positive response to right SG anesthetic block. RESULTS: No acute or late radiation-related toxicities were observed. Two patients (67%) responded to bilateral SRS (follow-up: 60 and 48 months, respectively). From baseline to 24 months, their average prescribed nitrate package count decreased from 5.5 to 0 and remained low. Daily emergency nitrates declined from 20 to 30 to 1-2 applications, and walking distance improved from 10 to 20 m to 200-400 m and remained stable. Quality of life as measured with the EQ-5D and all domains of the Seattle Angina Questionnaire improved. The third patient received only unilateral SRS, had a temporary improvement for 6 months before a return to baseline, and died after 42 months of follow-up. CONCLUSIONS: Bilateral radiosurgical neuromodulation at 40 Gy appears to be feasible, safe, and effective as a bailout procedure for RAP.
- MeSH
- angina pectoris * terapie MeSH
- ganglion stellatum MeSH
- kvalita života MeSH
- lidé středního věku MeSH
- lidé MeSH
- pilotní projekty MeSH
- radiochirurgie * metody MeSH
- senioři MeSH
- studie proveditelnosti MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Background: This retrospective analysis evaluated the long-term outcome of spinal stereotactic body radiotherapy (SBRT) treatment for hemangioblastomas. Materials and methods: Between 2010 and 2018, 5 patients with 18 Von-Hippel Lindau-related pial-based spinal hemangioblastomas were treated with fractionated SBRT. After precisely registering images of all relevant datasets, we delineated the gross tumor volume, spinal cord (including intramedullary cysts and/or syrinxes), and past radiotherapy regions. A sequential optimization algorithm was used for dose determinations, and patients received 25-26 Gy in five fractions or 24 Gy in three fractions. On-line image guidance, based on spinal bone structures, and two orthogonal radiographs were provided. The actuarial nidus control, surgery-free survival, cyst/syrinx changes, and progression-free survival were calculated with the Kaplan-Meier method. Toxicities were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events v5.0. Results: The median follow-up was 5 years after SBRT. Patients displayed one nidus progression, one need of neurosurgery, and two cyst/syrinx progressions directly connected to symptom worsening. No SBRT-related complications or acute adverse radiation-related events occurred. However, one asymptomatic radiological sign of myelopathy occurred two years after SBRT. All tumors regressed; the one-year equivalent tumor volume reduction was 0.2 mL and the median volume significantly decreased by 28% (p = 0.012). Tumor volume reductions were not correlated with the mean (p = 0.19) or maximum (p = 0.16) dose. Conclusions: SBRT for pial-based spinal hemangioblastomas was an effective, safe, viable alternative to neurosurgery in asymptomatic patients. Escalating doses above the conventional dose-volume limits of spinal cord tolerance showed no additional benefit.
- Publikační typ
- časopisecké články MeSH
