One of the treatment options for recurrent brain metastases is surgical resection combined with intracranial brachytherapy. GammaTile® (GT) (GT Medical Technologies, Tempe, Arizona) is a tile-shaped permanent brachytherapy device with cesium 131 ( 131 Cs) seeds embedded within a collagen carrier. We report a case of treating a patient with recurrent brain metastases with GT and demonstrate a dosimetric modeling method.

Limited brain metastases refer to an oligometastatic state in the brain for which focal therapy with stereotactic radiosurgery (SRS) is appropriate. The definition of what is considered "limited" for brain metastases, however, is not well defined. Multiple recent randomized trials show that metastasis-directed therapy with surgery or stereotactic radiation can prolong survival for patients with 1-5 metastases from various primary tumors, but patients with untreated brain metastases were largely excluded from these trials.Stereotactic radiosurgery allows for the treatment of multiple brain metastases while avoiding whole brain radiation (WBRT), which has a known negative impact on neurocognitive function. Randomized trials have shown that stereotactic radiation alone is effective for the treatment of up to 4 brain metastases with decreased neurocognitive side effects and no detriment to overall survival (OS). These data have led to our current definition of "limited" brain metastases. However, more recent data suggests that patients with up to 10 brain metastases can benefit from SRS. Ongoing trials are investigating if patients with up to 15-20 brain metastases may similarly benefit from SRS alone. Advances in systemic therapies which penetrate the bloodbrain barrier and have greater activity in central nervous system (CNS) may also expand the population for whom radiosurgery is an appropriate treatment. Immunotherapy may also be synergistic with radiosurgery in some cases. This narrative review will discuss the evolving definition and management of limited brain metastases.

Objectives: Transplant centers often recommend, but not necessarily require, screening colonoscopies for people over 50 years of age in accordance with the US Preventative Services Task Force guidelines for the general population. We sought to identify risk factors affecting colonoscopy results in renal failure patients undergoing kidney transplant evaluation. Materials and Methods: We retrospectively examined patients undergoing kidney transplant evaluation from 2009 to 2012 (n = 469 patients). Comparisons were made between colonoscopy reports categorized as normal (no finding or hyperplastic polyp) or abnormal (adenomatous polyp or carcinoma). Results: Of 469 patients who met the study criteria, 303 (64.6%) had normal colonoscopies and 166 (35.4%) had abnormal colonoscopies. Logistic regression analysis showed that male sex (odds ratio = 2.09; 95% confidence interval, 1.37-3.20; P = .001) and increasing age (odds ratio = 1.04; 95% confidence interval, 1.01-1.08; P = .019) were more likely to correspond to abnormal findings. Those with dialysis vintage (length of time on dialysis) up to 3 years (odds ratio = 2.10; 95% confidence interval, 1.09-4.06; P = .027) and hypertension as the cause of renal failure (odds ratio = 1.79; 95% confidence interval, 1.05-2.87; P = .002) had more abnormal findings. No differences in length of evaluation, rate of being listed for transplant, and rate of transplant were shown. Conclusions:The overall rate of adenomatous findings on colonoscopy was higher among patients with pretransplant end-stage renal disease than in the general population, as shown in other studies. Age, sex, dialysis vintage up to 3 years, and hypertensive renal failure were associated with adenomatous polyps of the colon in this study population. Because adenomatous polyp rates are high in patients with chronic kidney disease who are undergoing transplant evaluation and colonoscopic findings do not appear to delay transplant evaluations or listing rates, screening colonoscopies should be encouraged.

To determine factors associated with overall survival (OS) in non-metastatic Merkel cell carcinoma. Materials/Methods: 2689 patients with pathologically confirmed nonmetastatic Merkel cell carcinoma (AJCC 6 th ed. Stage I-III) who were diagnosed in 2004-2015 were identified in the SEER 18 database. Patients who survived less than 4 months from diagnosis were excluded (nZ183), as well as patients who did not receive local therapy (surgery and/or radiation therapy (RT); nZ59). 2447 patients who met inclusion and exclusion criteria were included in this analysis. Median age was 75 years (range 34-98), and median follow-up was 31 months (range 4-143). 60.2% male, 39.8% female. Surgery was performed in 92.6% of patients. There were 58.6% patients (nZ1435) received RT; 46.3% in stage I (502 of 1085), 58.2% in stage II (270 of 464), and 73.8% in stage III (663 of 898). There were 11.4% patients (nZ279) received chemotherapy; 2.6% in stage I (28 of 1085), 6.9% in stage II (32 of 464), and 24.4% in stage III (219 of 898). Overall survival (OS) from the date of diagnosis was estimated using Kaplan-Meier survival analysis. Logistic regression multivariate analysis was performed for comparisons of hazard ratio (HR) among subgroups. Results: The P value Z0.006), and stage II (5 yr OS: 60.3% vs 41.6%; pZ0.0002), but not in stage III (5 yr OS: 43.1% vs 41.9%; pZ0.17). However there was no association between chemotherapy and overall survival in stage I (5 yr OS: 45.0% vs 62.2%; pZ0.055), stage II (5 yr OS: 51.1% vs 63.5%; pZ0.23), or stage III (5 yr OS: 41.3% vs 43.0%; pZ0.71). Multivariate analysis demonstrated improved overall survival was associated with later year of diagnosis (0.75 per year, range 0.72-0.77), female sex (HR 0.52, range 0.42-0.64) and Asian race (HR 0.47, range 0.24-0.92). Worse overall survival was associated increasing stage (

In this multi-institutional study, we sought to investigate the contemporary treatment patterns of patients at initial and during first and second progression diagnosed with primary stage III NSCLC in Turkey. Materials/Methods: The patient characteristics, disease burden, treatment patterns and patient journey of stage III NSCLC patients were revealed. The clinical data of 492 patients treated between 2013 and 2017 were collected from geographically diverse set of ten community oncology centers in Turkey. The initial treatment included all treatment facilities after diagnosis. It includes chemotherapy (ChT) and radiotherapy (RT) delivered either sequentially or concurrently. These treatment patterns are analyzed at first treatment period, and during first and second progression periods. Results: Median age was 64 years (range, 40 e 90 years). Most of the patients were male (434 patients, 88.2%) and were either past smoker or current smoker (462 patients, 93.9%). More than half of the patients (56.1%) had squamous cell carcinoma (SCC) and mean tumor size was 5.1AE2.1 cm. According to the American Joint Committee on Cancer (AJCC) staging system 7 th edition clinical stage IIIA (311 patients, 63.2%) was more frequently seen, and stage IIIB (278 patients, 56.5%) was most frequent when patients were staged according to AJCC 8 th edition. For initial treatment 429 patients (89.2%) received ChT and RT, either concurrently (393 patients, 79.9%) or sequentially (46 patients, 9.3%), and only 53 patients (10.8%) were treated with RT only. Most frequently used RT technique was 3-dimensional conformal RT (3DCRT) (276 patients, 56.0%), while only 3 patients (0.6%) were treated with stereotactic radiotherapy (SBRT). Median 9.3 months after completion of initial treatment 288 patients (58.4%) had disease progression, and 166 patients (64.6%) received treatment). The main treatment modality at first progression was systemic treatment (121 patients, 72.9%), while 65 patients (37.1%) were treated with RT only. The RT treatment sites were mostly to the metastatic sites. The SBRT technique was used in 25 patients (22.2%). Disease progression was observed in 30 patients median 4.2 months (range, 0.8 e 11.4 months) after completion of treatment of first progression. Of these patients 20 patients (66.7%) received systemic therapy. The use of TKI and immunotherapeutic agent was quite limited in this cohort during initial treatment, first and second progression time. In the initial treatment period, none of the patients received TKI and immunotherapy. Only 7 patients (5.8%) received TKI and 3 patients (2.5%) had immunotherapeutics during first progression interval. At second progression only 2 patients (1%) received TKI and immunotherapy separately. Conclusion: This national observational study showed that the majority of patients with unresectable stage III NSCLC received cCRT as the first therapy, and this practice was consistent with guidelines.