Delayed Imaging Changes 18 Months or Longer After Stereotactic Radiosurgery for Brain Metastases: Necrosis or Progression

OBJECTIVE

Imaging changes after stereotactic radiosurgery (SRS) can occur for years after treatment, although the available data on the incidence of tumor progression and adverse radiation effects (ARE) are generally limited to the first 2 years after treatment.

METHODS

A single-institution retrospective review was conducted of patients who had >18 months of imaging follow-up available. Patients who had ≥1 metastatic brain lesions treated with Gamma Knife SRS were assessed for the time to radiographic progression. Those with progression ≥18 months after the initial treatment were included in the present study. The lesions that progressed were characterized as either ARE or tumor progression based on the tissue diagnosis or imaging characteristics over time.

RESULTS

The cumulative incidence of delayed imaging radiographic progression was 35% at 5 years after the initial SRS. The cumulative incidence curves of the time to radiographic progression for lesions determined to be ARE and lesions determined to be tumor progression were not significantly different statistically. The cumulative incidence of delayed ARE and delayed tumor progression was 17% and 16% at 5 years, respectively. Multivariate analysis indicated that the number of metastatic brain lesions present at the initial SRS was the only factor associated with late radiographic progression.

CONCLUSIONS

The timing of late radiographic progression does not differ between ARE and tumor progression. The number of metastatic brain lesions at the initial SRS is a risk factor for late radiographic progression.

[Nocturnal long-term monitoring of lung sounds in patients with gastro-oesophageal reflux disease]

Gastro-oesophageal reflux disease (GERD) is one of the most common clinical conditions in the developed countries. Particular interest in pulmonary manifestations of this disease has arisen over the last few years. Although the high coincidence between reflux and chronic cough is unquestioned, the proof of a causal correlation is still lacking. In this paper we present the Marburger Lung-Sound-Monitoring as a new method for the detection of nocturnal respiratory symptoms such as cough, wheezing and throat clearing and their temporal correlation with reflux. This method will in future allow us to precisely record and to evaluate the extent and duration of reflux events and their correlation with respiratory symptoms.

Spectrum of clinical manifestations of familial adenomatous polyposis

Familial adenomatous polyposis is an autosomal dominant disease that primarily involves the colon, but may involve other organs such as the central nervous system, ampulla of Vater, liver, soft tissue and the remainder of the gastrointestinal tract. In this report we present the adenocarcinoma of the uterus and adenocarcinoma of the ovary as a new addition to the clinical spectrum of familial adenomatous polyposis. Due to the tendency for development of multiple primary carcinomas in patients with familial adenomatous polyposis, these patients need to be followed very closely for detection of new malignancies. If diagnosed early and treated accordingly, they could have a long-term postoperative survival.

Gynecological malignancies, brain tumors, and familial adenomatous polyposis

The syndrome of familial adenomatous polyposis has a wide spectrum of clinical manifestations including adenomatous polyps of the colon and small bowel, adenocarcinoma of ampulla of Vater, tumors of the central nervous system, bone lesions, and various soft tissue tumors. The one common denominator is colonic polyposis. It is not known whether this phenotypic heterogeneity is due to various genotypes, or if the entire clinical spectrum is due to one genetic defect. We are reporting the association of gynecologic malignancies with familial adenomatous polyposis as an additional variant of this disease. This report is on two sisters from a family with familial polyposis coli who developed adenomatous polyposis of the colon, central nervous system tumors, and cancers of the ovary and uterus. The gynecological malignancies add another variant to this clinical syndrome.