This case presents a 34-year-old man who had a huge parasagittal meningioma. Initial treatment consisted of preoperative external carotid artery embolization and partial tumor resection. During the resection, we found that the tumor invaded the adjacent calvarium, and due to massive hemorrhage, total removal of the tumor was impossible. The patient was treated with intraoperative radiation therapy (IORT) (25 Gy via 16 MeV) as an adjunctive therapy. Eight months after IORT, we were able to remove the tumor completely without surgical difficulties. IORT can be considered an useful adjunctive therapy for the superficially located, huge, and highly vascular meningioma.
Adult ; Journal Article ; Human ; Intraoperative Care* ; Magnetic Resonance Imaging ; Male ; Meningeal Neoplasms/surgery ; Meningeal Neoplasms/radiotherapy* ; Meningeal Neoplasms/pathology ; Meningioma/surgery ; Meningioma/radiotherapy* ; Meningioma/pathology ; Vascular Neoplasms/surgery ; Vascular Neoplasms/radiotherapy* ; Vascular Neoplasms/pathology

With a frame-based system, stereotactic dose of radiation is delivered to the target in one day. The patient is uncomfortable with a frame based system and the staff is forced to produce a treatment plan under time pressure. And then a single dose of radiation is delivered. Our frameless fractionated conformal stereotactic radiotherapy system uses markers, permanently placed in the head. There is more time to prepare and perform the treatment. The point reference system is a frameless system, allowing a separation in time between all of the steps in a stereotactic procedure. And these reference points allow physician precisely to set up the patient again and again. Our system is made to spare normal cells within target volume by fractionating the tumor dose. We have treated 43 patients with multifraction regimen using 6-MV linear accelerator. All patient tolerated the treatment well and no significant complication were seen. Although small in number experienced, this technique seems to be feasible and safe for treating brain tumor and vascular malformation.
Arteriovenous Malformations* ; Brain Neoplasms* ; Brain* ; Head ; Humans ; Particle Accelerators ; Radiotherapy ; Vascular Malformations

A complete surgical resection is the only proven therapeutic modality that prolongs the survival in patients with leiomyosarcoma of the inferior vena cava (IVC). Reconstruction of the IVC is not always necessary but is often required to facilitate venous drainage of the kidney for the tumors at the pararenal area of the IVC. Controversy exists in postoperative adjuvant therapy. Recently, we experienced four cases of pararenal leiomyosarcoma of the IVC, of which treatment consisted of a complete resection of the tumor, ringed polytetrafluoroethylene (PTFE) graft interposition, and bilateral renal vein reconstructions in all patients. Postoperative radiation therapy was instituted in 3 of 4 patients. One patient who did not receive the postoperative radiation therapy was treated with adjuvant chemotherapy. The kidneys were preserved in all patients and no deep vein thrombosis (DVT) or venous insufficiency of the lower extremity veins developed. Distant metastasis to the lung was noted in one patient at 18 months after surgery, who was not received the postoperative radiation therapy but chemotherapy. In conclusion, a complete resection of the tumor, IVC reconstruction, and bilateral renal vein reconstruction followed by adjuvant radiation therapy is recommended for the treatment of pararenal leiomyosarcoma of the IVC.
Adult ; Combined Modality Therapy ; Female ; Human ; Leiomyosarcoma/radiography/*radiotherapy/*surgery ; Middle Aged ; Neoplasm Recurrence, Local/radiography/radiotherapy/surgery ; Retroperitoneal Neoplasms/radiography/radiotherapy/surgery ; Retrospective Studies ; Treatment Outcome ; Vascular Neoplasms/radiography/*radiotherapy/*surgery ; *Vena Cava, Inferior

A 60-year-old female presented with abdominal pain and tenderness of five-day duration. Contrast enhanced CT showed a mass of 9 x 6 x 5.5 cm in size with almost complete obliteration of the inferior vena cava and massive extension to the extravascular space. CT-guided biopsy demonstrated a low-grade leiomyosarcoma. The patient underwent 125Iodine seeds implantation in two sessions, and another balloon cavoplasty. Abdominal pain and tenderness gradually improved and the patient continues to remain as disease free state for three years after the procedures.
Brachytherapy/*methods ; Contrast Media/diagnostic use ; Female ; Humans ; Iodine Radioisotopes/therapeutic use ; Leiomyosarcoma/radiography/*radiotherapy ; Middle Aged ; Tomography, X-Ray Computed ; Vascular Neoplasms/radiography/*radiotherapy ; *Vena Cava, Inferior

OBJECTIVETo observe the effect of Kang'ai Injection (KAI) on serum level of soluble interleukin-2 receptor (slL-2R) and vascular endothelial growth factor (VEGF) in patients with esophageal carcinoma (EC) during radiotherapy (RT), and to investigate its synergistic effect with RT and its influence on immunological function of the body.

METHODSOne hundred and seventy patients with EC, who had missed the chance of surgical operational therapy, were assigned to the treated group (90 cases) and the RT group (80 cases), and at the same time a control group consisting of 80 inpatients without tumors was set up. Patients in the RT group were treated with RT alone but KAI was given additionally to those in the treated group, with 50 ml given once per day via intravenous dripping, 15 days as one course, and 2 courses administered in total. The immediate therapeutic efficacy and changes of serum slL-2R and VEGF levels were observed, and the effect of KAI on patients' quality of life (QOF) was evaluated by Karnofsky scoring.

RESULTSIn 16 patients of the treated group it was completely remission (CR), in 54 partially remission (PR), in 18 it was stabilized disease (SD) and in 2 progressive disease (PD), with the total effective rate (CR + PR) as 77.8%, while in those of the control group it was 12, 46, 18, 4 and 72.5%, respectively, the immediate therapeutic efficacy in the treated group was somewhat better than that in the RT group, but showed no statistical significance (P>0.05). Serum levels of slL-2R and VEGF in all the patients before treatment were higher than those in the control group, which were decreased after treatment in both groups ( P<0.05), but the improvement in the treated group was better than that in the RT group, showing significant difference (P<0.05), and patients' QOF improved more significantly in the former as well (62.2% vs 40.0%, P< 0. 05).

CONCLUSIONKAI in combination with RT in treating patients with EC could enhance the immunological function of patients, improve their QOF and enhance their sensitivity to RT.

Adult ; Drugs, Chinese Herbal ; therapeutic use ; Esophageal Neoplasms ; blood ; radiotherapy ; Female ; Humans ; Injections ; Male ; Middle Aged ; Radiotherapy ; adverse effects ; Receptors, Interleukin-2 ; blood ; Vascular Endothelial Growth Factor A ; blood

5-Fluorouracil (5-FU) has been the main chemotherapeutic agent for the treatment of colorectal cancer for four decades with modest efficacy. Modulation of 5-FU by leucovorin or continuous infusion improves the response rate, but overall survival duration remains approximately 12 months. Many oral fluoropyrimidines have been studied, including capecitabine, UFT, S-1, and Eniluracil. Capecitabine has demonstrated equivalent efficacy with 5-FU and has been approved as first line treatment. CPT-11 demonstrated non-crossover resistance with 5-FU and was proven to be effective treatment for patients who received prior 5-FU. CPT-11 in combination with 5-FU has demonstrated improved response rate and overall survival duration over 5-FU or CPT-11. Oxaliplatin plus 5-FU has offered another effective treatment option for colorectal cancer. Both 5-FU plus leucovorin in combination with CPT-11 or oxaliplatin are widely used first-line chemotherapies for advanced colorectal cancer. The combinations of capecitabine with CPT-11 or oxaliplatin are being developed. Several molecular targeting agents such as EGFR inhibitors and antiangiogenic agents have developed. Cetuximab induces a broad range of cellular responses in tumors expressing EGFR, enhancing sensitivity to radiotherapy and chemotherapeutic agents. A key angiogenic pathway in the stimulation of tumour growth is the vascular endothelial growth factor (VEGF) pathway, inhibited by the monoclonal antibody bevacizumab. Phase II first line and phase III second line studies of oxaliplatin in combination with bevacizumab are now in progress. Optimal combinations and sequences of treatment are being studied, since several effective regimens have become available.
Angiogenesis Inhibitors ; Colorectal Neoplasms* ; Drug Therapy* ; Fluorouracil ; Humans ; Leucovorin ; Radiotherapy ; Vascular Endothelial Growth Factor A ; Bevacizumab ; Capecitabine ; Cetuximab

PURPOSE: The present study was designed to analyze the relationship between vascular endothelial growth factor (VEGF) and p53, and their impact on clinical outcome in squamous cell carcinoma of the cervix treated with radiation therapy. MATERIALS AND METHODS: This immunohistochemical study involved 23 patients with available paraffin blocks among 46 patients who were treated during the period from 1994 to 1997 in Eulji University Hospital in Korea. Anti-VEGF mouse monoclonal antibody and DO-7 anti- p53 mouse monoclonal antibody were used as the primary antibodies. Antibody binding was detected with a LSAB kit. Staining was defined as positive for VEGF and p53, when more than 10% and 5% of the tumor cells were stained out of 500 cells counted, respectively. RESULTS: FIGO stage (p=0.05) and tumor size (p=0.04) were significant prognostic factors for survival. p53 expression was present in 17 (77%) cases. There was no significant relationship between p53 staining and the clinicopathologic factors, such as FIGO stage (p=0.98), tumor size (p=0.43), lymph node status (p=0.82), parametrial invasion (p=0.96), and age (p=0.18). The five year survival rates according to the p53 expression status were 80% for the p53 negative group and 66% for the p53 positive group (p=0.58). Positive VEGF expression was observed in 11 (47%) of the total of 23 patients. Statistical evaluation of VEGF expression according to stage (p=0.36), tumor size(p=0.11), lymph node status (p=0.82), parametrial invasion (p=0.49), and age (p=0.55) revealed no significant difference in any of these parameters. The five year survival rates according to the VEGF expression status were 89% for the VEGF negative group and 41% for the VEGF positive group (p=0.07). CONCLUSION: We suggest that VEGF expression may have an effect on the prognosis of cervix cancer patients treated with radiation therapy, and further evaluation with a large sample size is warranted.
Animals ; Antibodies ; Carcinoma, Squamous Cell* ; Cervix Uteri* ; Female ; Humans ; Korea ; Lymph Nodes ; Mice ; Paraffin ; Prognosis ; Radiotherapy ; Sample Size ; Survival Rate ; Uterine Cervical Neoplasms ; Vascular Endothelial Growth Factor A*

PURPOSE: We investigated the effect of chemoradiotherapy with PP2 and temozolomide (TMZ) on malignant glioma cells using clonogenic assays and in vivo brain tumor model. MATERIALS AND METHODS: The effect of PP2 on radiosensitivity of U251 and T98G cells was investigated using clonogenic assays. The expression of E-cadherin, matrix metalloproteinases 2 (MMP2), Ephrin type-A receptor 2 (EphA2), and vascular endothelial growth factor (VEGF) was measured by Western blotting and an accumulation of γH2AX foci 6 hours after radiotherapy was measured after PP2 treatment. The effect of PP2 on migration, invasion, and vasculogenic mimicry formation (VMF) of U251 cells was evaluated. In an orthotopical brain tumor model with U251 cells, PP2 was injected intraperitoneally with or without oral TMZ before, during and after whole brain radiotherapy. Bioluminescence images were taken to visualize in vivo tumors and immunohistochemical staining of VEGF, CD31, EphA2, and hypoxia-inducible factor 1a was performed. RESULTS: PP2 increased radiosensitivity of U251 and T98G cells without decreasing survival of normal human astrocytes. Chemoradiotherapy with PP2 and TMZ resulted in increased accumulation of γH2AX foci. PP2 induced overexpression of E-cadherin and suppression of MMP2, VEGF, and EphA2. PP2 also compromised invasion, migration, and VMF of U251 cells. In brain tumors, chemoradiotherapy with PP2 and TMZ decreased tumor volume best, but not statistically significantly compared with chemoradiotherapy with TMZ. The expression of VEGF and CD31 was suppressed in PP2-treated tumors. CONCLUSION: PP2 enhances radiosensitivity of malignant glioma cells and suppresses invasion and migration of U251 cells. Chemoradiotherapy with PP2 and TMZ resulted in non-significant tumor volume decrease.
Astrocytes ; Blotting, Western ; Brain ; Brain Neoplasms ; Cadherins ; Chemoradiotherapy* ; Glioblastoma ; Glioma* ; Humans ; Matrix Metalloproteinases ; Protein-Tyrosine Kinases* ; Radiation Tolerance ; Radiotherapy ; Tumor Burden ; Tyrosine* ; Vascular Endothelial Growth Factor A

OBJECTIVE: To determine the effect of Ad-E1A gene therapy on the radiosensitivity of nasopharyngeal carcinoma cell by downregulating the expression of VEGF in vitro. METHOD: The human nasopharyngeal carcinoma CNE-2Z cell lines were investigated. The recombinant adenovirus vector containing E1A gene was used for this study. After CNE-2Z cells was treated with PBS, Ad-beta-gal and Ad-E1A for 48 h, the three groups were irradiated in different doses at 0, 2.4, 6, 8 and 10 Gy, the cytotoxicity was determined by MTT assay and cell cycle was analysis by flow cytometry. The VEGF expression were evaluated by RT-PCR assay and immunocytochemical analysis. RESULT: Significant cell deaths by IR were observed in a dose dependent manner in the three group CNE-2Z cells. After transduction of the E1A gene into CNE-2Z cells, the sensitivity of these cells to radiation was enhanced than the PBS treated group and Ad-beta-gal treated group. Cell growth inhibition in Ad-E1A group by IR was strongly enhanced than Ad-beta-gal treated group and PBS treated group. RT-PCR assay and immunocytochemical analysis showed VEGF expression was downregulated in Ad-E1A treated group. CONCLUSION E1A gene therapy can effectively enhance the nasopharyngeal carcinoma cell sensitivity to the radiotherapy by down-regulating VEGF expression. These findings may pave the way for efficient radiation-gene therapy to NPC in future.
Adenoviridae ; genetics ; Cell Line, Tumor ; Gene Expression Regulation, Neoplastic ; Genetic Therapy ; Genetic Vectors ; Humans ; Nasopharyngeal Neoplasms ; genetics ; metabolism ; radiotherapy ; Radiation Tolerance ; Vascular Endothelial Growth Factor A ; metabolism

We investigated the relationship between vascular endothelial growth factor (VEGF) expression and clinical outcome in squamous cell carcinoma of the cervix treated with radiotherapy alone. The immunohistochemical study was performed for fortytwo paraffin embedded specimens with anti-VEGF mouse monoclonal antibody. Staining was defined as positive for VEGF when more than 10% of the tumor cells were stained from 500 cells counted. Positive VEGF expression was observed in twenty-one among forty-two patients. VEGF expression according to stage (p=0.101), lymph node status (p=0.621), parametrial invasion (p=0.268), and age (p=0.5) revealed no significant difference. But the VEGF expression was significantly higher in tumors larger than 4 cm (p=0.031). Five year survival rates according to VEGF expression status were 89% for VEGF negative group and 47% for VEGF positive group (p=0.02). FIGO stage (p=0.007), tumor size (p=0.025) and the duration of external beam radiation therapy (p=0.006) were also significant prognostic factors for overall survival. We suggest that VEGF expression may be a prognotic factor of the cervix cancer patients treated with radiation therapy alone.
Carcinoma, Squamous Cell/*metabolism/mortality/*radiotherapy ; Cervix Neoplasms/*metabolism/mortality/*radiotherapy ; Female ; Humans ; Immunohistochemistry ; Predictive Value of Tests ; Prognosis ; Regression Analysis ; Survival Rate ; Tumor Markers, Biological/metabolism ; Vascular Endothelial Growth Factor A/*metabolism