Sample Report 3

unkindnesskindUrban and Civil

Nov 15, 2013 (3 years and 6 months ago)

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Medical Information

Retrieval
&

Management

Report



Topic


GAMMA KNIFE USED IN TREATMENT OF LUNG
CANCER
















Name


LAVANYA VODLAKONDA


I.D


313200500126028





Date

7
th

JULY 2008




Score








©
Department o
f Medical Information Science
,

SMU

April 2008

1



I

A n a l y z e t h e s u b j e c t &

D e v e l o p a s e a r c h s t r a t e g y

I d e n t i f y t h e ma j o r c o n c e p t s a s s o c i a t e d w i t h y o u r s u b j e c t
,
a n d t h e n

c o n s i d e r

t h e
k e y w o r d s y o u w i l l u s e.
N
o t i c e
p o s s i b l e s y n o n y ms, a l t e r n a t i v e s p e l l i n g s, p l u r a l s a n d
o t h e r e n d i n g s.




Ke y wo r d s:
“ GAMMA KNI FE”



LUNG

CANCER OR LUNG CARCI NOMA




II

C h o o s e t h e s u i t a b l e d a t a b a s e s
a n d o t h e r s e a r c h t o o l s

F
i r s t
l y, c h o o s e t h e d a t a b a s e
s

w h i c h
y o u

c a n u s e; S e c o n d l y, c h o o s e d a t a b a s e s a n d
s e a r c h t o o l s a s w i d e l y a s p o s s i b l e, f o r e x a mp l e:
t h e d a t a b a s e s o r d e r e d b
y S MU,
I n t e r n e t
R e s o u r c e s
,

j o u r n a l s o r b o o k s

c o l l e c t e d
by

SMU Library.


1.


1. Database I can use:



Full text databases : Science Direct, OVID LWW


Abstract databases: Biosis preview, Pubmed


Search Engine : Google advanced search (for papers and
books related to the
topic);hon



2. Use the SMU library

SMU library resources: Abstract databases such as Pubmed and Biosis Preview


Full
-
text databases such as
SD, OVID

etc.


OPAC search for books and jo
urnals related to the topic that
y o u c a n ’ t f i n d f r e e f u l l
-
瑥x 琠潮⁴桥= 琮
=
f 湴n 牮r 琠t e 獯畲c e 猺s g 潯杬攠獥a r c 栻h
桯渻
=
啓r T 伻⁐a 瑥湴汥湳

=










2

III

C a r r y o u t t h e s e a r c h &
ma k e a

f a i t h f u l
r e c o r d

P
l e a s e
w r i t e d o w n
y o u r s e a r c h p r o c e s s, i n c
l u d i n g t h e s e a r c h f i e l d
s
, s e a r c h s t r a t e g y,
limits
, etc.



Full text database:

a.

Science direct
: use basic search , first I use topic= “gamma knife” and
topic = lung cancer, .Then I found 12 articles. In order to narrow my
result I search for treatment or t
herapy{tw} and find 11 full text articles



b.
O V I D LWW

:u s e s e a r c h b o x , a n d s e a r c h f o r t h e k e y w o r d s “ g a mma k n i f e ”
lung cancer and use the Boolean connecters like AND , OR


Abstract databases:

a.

PUBMED:

I use the advanced search
and limit my search to free
full
articles, link to free full articles, humans ,English language,SMU
subscribed journals to find about 35 articles and inorder to narrow my
search to last 5 years.

b.

BIOSIS PREVIEW
:I search for the keywords in topic and limit my
search to last 10years.


G
OOGLE SEARCH

ENGINE
: here I use the google scholar search to
find the keywords in the title.



IV

B r o w s e t h e s e a r c h r e s u l t s & w r i t e d o w n t h e mo s t r e l a t e d
c i t a t i o n s

B r o w s e t h e s e a r c h r e s u l t s, a n a l y
z e a n d w r i t e d o w n t h o s e

r e l e v a n t

t o y o u r
s u b j e c t
.


C I T A T I O N S F R O M S C I E N C E D I R E C T:


1.

TOPIC:

Promising clinical outcome of stereo tactic body radiation
therapy for patients with inoperable Stage I/II non

small
-
cell lung cancer

AUTHORS: Tingyi Xia M.D, Ph.D , Hongqi Li M.D., Qingxuan Sun
M.D.,

Yingjie Wang M.D., Naibin Fan M.D., Yong Yu M.D., Ping Li
M.D. and Joe Y. Chang M.D., Ph.D.


2
TOPIC
:
Role of stereotactic radiosurgery as a primary treatment

3

option in the management of newly diagnosed multiple (3
-
6) intracranial
metastases

AUTHORS: Aj
ay Jawahar MSc, MD, Mark Shaya MD, Peter Campbell
BS, Federico Ampil MD, Brian K. Willis MD, Donald Smith MD and
Anil Nanda MD


3
.

TOPIC

:A single istitutional outcome analysis of Gamma knife

radiosurgery for single or multiple metastases

Authors:Keiichi

Nakagawa, Masao Tago, Atsuro Terahara, Yukimasa
Aoki

Tomio Sasaki, Hiroki Kurita, MasahiShin, Syunsuke Kawamoto,
Takaaki Kirino, Kuni Otomo


Journals :
Clinical Neurology and Neurosurgery
,

Volume 102, Issue 4
,

1
December 2000
,
Pages 227
-
232



4
TOPIC:

Sol
itary brain metastases treated with gamma knife:
prognostic factors for patients

Authors: Gabriela imonová, Roman Liák, Josef NovotnýJr, Josef
Novotný


Journals:
Radiotherapy and Oncology
,

Volume 57, Issue 2
,

1 November
2000
,
Pages 207
-
213



CITATIONS FROM

OVID LWW:


1.
TOPIC:

Results of Recent Therapy for Non
-
Small
-
Cell Lung Cancer
With Brain Metastasis as the Initial Relapse


4


JOURNAL:
American Journal of Clinical Oncology. 25(5):476
-
479,
October 2002.

Authors :

Ohta, Yasuhiko M.D.; Oda, Makoto M.D.; Tsune
zuka, Yoshio
M.D.; Uchiyama, Naoyuki M.D.; Nishijima, Hiroshi M.D.; Takanaka,
Tsuyoshi M.D.; Ohnishi, Hiroaki M.D.; Kohda, Yukihiko M.D.;
Yamashita, Junkoh M.D.; Watanabe, Go M.D


2.
TOPIC
:
The benefit of functional
-
anatomical imaging with
[18F]fluorodeoxyg
lucose utilizing a dual
-
head coincidence gamma
camera with an integrated X
-
ray transmission system in non
-
small cell
lung cancer

JOURNAL:
Nuclear Medicine Communications. 25(9):909
-
915,
September 2004.

AUTHORS :Eschmann, Susanne M. ; Bitzer, Michael ; Pau
lsen, Frank ;
Friedel, Godehard ; Besenfelder, Hariolf ; Horger, Marius ; Reimold,
Matthias ; Dittmann, Helmut ; Pfannenberg, Anna C. ; Bares, Roland


3.
TOPIC

:
Comparative impact of standard approach, FDG PET and FDG
dual
-
head coincidence gamma camera imag
ing in preoperative staging of
patients with non
-
small
-
cell lung cancer

JOURNAL:
Nuclear Medicine Communications. 24(12):1215
-
1224,
December 2003.

AUTHORS :DELAHAYE, ; CRESTANI, ; RAKOTONIRINA, ;
LEBTAHI, ; SARDA, ; GIRARD, ; CHARPENTIER, ;

5

FERY
-
LEMONNIER
, ; SYROTA, ; AUBIER, ; LE GULUDEC.



C I TAT I ON S F R OM B I OS I S P R E V I E W
:

1.


Title:

Pulmonary r
esection in patients with nonsmall
-
cell lung
cancer treated with gamma
-
knife radiosurger
y for synchronous
brain metastases


Author(s): Yang, SY; Kim, DG; Lee, SH, et al.

Source:
CANCER



Volume:
112



Issue:
8



Pages:
1780
-
1786



Published:
2008

2.

Title:

The impact of definitive thoracic management on long
-
term
survival in patients with
synchronous, solitary brain metastases
from non
-
small
-
cell lung cancer treated with
stereotactic
radiosurgery

Author(s): Flannery, T; Kwok, Y; Krasna, M, et al.

Source: INTERNATIONAL JOURNAL OF RADIATION
ONCOLOGY BIOLOGY PHYSICS


Volume: 66


Issue:
3


Pages: S85
-
S85


Supplement: S


Published: 2006

Article Number: 152

3.

Title
:

Time trends in target

volumes for stage I non
-
small
-
cell lung
cancer after stereotactic
radiotherapy


Autho
r(s): Underberg, RWM; Lagerwaard, FJ; van Tinteren, H, et
al.

Source: INTERNATIONAL JOURNAL OF RADIATION

6

ONCOLOGY BIOLOGY PHYSICS


Volume:
64



Issue:
4



Pages:
1221
-
1228



Published:
MAR 15 2006


4.

Title
:

Long
-
term survival following multimodality treatment of
metachronous metastases
(parotid gland, adrenal gland, brain and
mediastinal lymph node) after resection of non
-
small cell lung
cancer; report of a case]

Author(s): Katsurago, Naoya; Shiraishi, Y; Hashizume, M, et al.

Source: Kyobu Geka


Volume:
59



Issue:
2



Pages:
168
-
71



Published:
2006 Feb



CITATIONS FROM BIOSIS:

1.


Title
:

Pulmonary resection

in patients with nonsmall
-
cell lung
cancer treated with gamma
-
knife radiosurgery for synchronous brain
metastases


Author(s): Yang, SY; Kim, DG; Lee, SH, et al.

Source:
CANCER



Volume:
112



Issue:
8



Pages:
1780
-
1786



Published:
2008.

2.

Title
:

The impact of definitive thoracic management on long
-
term
survival in patients with synchronous, solitary
brain metastases from
non
-
small
-
cell lung cancer treated with stereotactic radiosurgery


Author(s): Flannery, T; Kwok, Y; Krasna, M, et al.


7

Source:
INTERNATIONAL JOURNAL OF RADIATION
ONCOLOGY BIOLOGY PHYSICS



Volume:
66



Issue:
3



Pages:
S85
-
S85



Supp
lement:
S



Published:
2006

Article
Number:
152



V

L i t e r a t u r e
R e v i e w

A l i t e r a t u r e r e v i e w i s a n a c c o u n t o f w h a t h a s b e e n p u b l i s h e d o n a t o p i c b y a c c r e d i t e d s c h o l a r s a n d
r e s e a r c h e r s.

I t i s n o t j u s t a d e s c r i p t i v e l i s t o f t h e m a t e r i a l a v a i l
a b l e, o r a s e t o f s u m m a r i e s.
P
l e a s e
g i v e
a
literature
review about your
search title. Note:

N
o less than 2000 words.


INTRODUCTION:

A
gamma knife

(or
Leksell gamma knife
) is a device used to treat
brain
tumors

with a high dose of
radiation therapy

in one day. The device was
invented by
Lars Leksell
, a Swedish neurosurgeon, in 1967 at
the
Karolinska
Institute

in
Sweden
.



T h e b a s i c p h y s i c s o f t h e G a mma K n i f e h a s r e ma i n e d
substantially the same since its conception. The device uses 60Cobalt as a
radiation source. 60Co decays through beta decay to a stable isotope of nickel
(60Ni) with a half life of 5.26 years.
As a part of the decay process, one
electron with an energy of up to 315 keV and two gamma rays with energies of
1.17 MeV and 1.33 MeV are emitted. It is the gamma radiation that is used to
clinical effect in the gamma knife and contributes to the naming o
f the device.


The details of the internal design of the gamma knife changes slightly among
the four models currently in use around the world (the U, B, and C models, and
the new Perfexion model). Inside the gamma knife unit are an array of 60Co
sources (2
01 sources in the U, B, and C models, 192 in the Perfexion) which
are alligned with a collimation system. The collimation system (described in
more detail below) focuses the inividual beams of gamma radiation to a very
precise focus point. While an individ
ual beam has a relatively low dose rate
and causes minimal biological effect, the superposition of all beams at the
focus point have a much higher dose rate. The Gamma Knife can therefore
target very precise areas of tissue without causing significant coll
ateral damage
to areas outside of the targeted area.


In the U, B, and C models of the Gamma Knife, the beam collimation in split
between an internal collimation and a removable external helmet
-
based
collimation system.


Each external collimator helmet has

an array of

8

removable tungsten collimators (one per source) with circular apertures that are
used to create different diameter fields at the focus point. 4mm, 8mm, 14mm,
and 18mm collimator helmets are available. A subset of the collimators may be
removed

and replaced with solid

tungsten “plugs” to block individual beams in
cases where additional shielding is required. Modification of the isodose
distribution is achieved by using combinations of isocenters using different
collimators, different stereotacti
c locations, and differing dwell times.

In the new Gamma Knife Perfexion, the external helmet collimators have been
replaced by a single internal collimation system. In the Perfexion, the 60Co
sources move along the collimator body to locations where 4mm,
8mm, and
16mm apertures have been created.


DISCUSSION:




The Gamma Knife operates on the principles of stereotaxy to achieve a high
level of precision in localization. A stereotactic head frame is affixed to the
patient’s head

before the Gamma Knife proc
edure. This frame defines a
reference coordinate system that allows points in the brain to be located with
high precision. During imaging procedures, a system of fiducal markers is used
with the frame to allow the location of all areas of interest within t
he images to
be known relative to this stereotactic space.


A computerized planning system
developed for the Gamma Knife then allows detailed and precise dose
distributions to be created that help ensure the target of interest is covered by a
clinically si
gnificant dose while sparing normal brain tissue.


A mu l t i d i s c i p l i n a r y t e a m o f n e u r o l o g i c a l s u r g e o n s,
radiation oncologists, medical physicists, radiologists, nurses, computer
specialists, and physician assistants unite to provide the patien
t with
comprehensive, advanced care before, during, and after the procedure. Patients
are selected for treatment after thorough review of all prior records and
imaging studies. After admission to the hospital, the patient undergoes
placement of a stereotac
tic frame, a mechanical guidance device, to the head.
During frame placement, the patient receives a mild sedative administered in
the OR by an anesthesiologist. As such, the frame placement is pain
free.


Then, the patient's condition and the location and

type of tumor or AVM
are evaluated with advanced imaging technology, such as computed
tomography (CT), angiography, or magnetic resonance imaging (MRI). Next,
the patient's head is placed within a large helmet
-
like device with small
openings called "colli
mator ports." Radiation beams are adjusted through these
ports to direct the appropriate amount of energy precisely at the target tissue.


The Lars Leksell Gamma Knife suite at the University of Virginia consists of
patient preparation areas and rooms for
imaging evaluation and computer dose
planning. The Gamma Knife is housed in specially shielded room equipped

9

with television monitoring and two
-
way voice contact. The suite also contains
equipment to anesthetize the patient if necessary.


Mo s t l u n
g c a n c e r s b e g i n t o g r o w s i l e n t l y, w i t h o u t a n y
s y mp t o ms. P a t i e n t s w i t h l u n g c a n c e r o f t e n d o n o t d e v e l o p s y mp t o ms u n t i l t h e
cancer is in an advanced stage. The actual time from when one cell becomes
cancerous until it is large enough to be diagnosed or produ
ce symptoms may
take as long as 10 to 40 years. Since the majority of lung cancer is diagnosed at
a relatively late
stage, when

the cancer has metastasized and only about 10% of
all lung cancer patients are ultimately cured.


Wi t h a d v a n c e s i n s y s t e mi c t h e
r a p y, p a t i e n t s w i t h me t a s t a t i c c a n c e r n o w h a v e
increased survival, leading to an increase in the incidence of brain
metastases.
The management of brain metastases is evolving with multimodality therapy,
including biologic therapies, chemotherapy, surgery,
WBRT, and radiosurgery,
Currently,

a number of controversies exist about the use of radiosurgery and
WBRT and whether to use them in combination for initial management of brain
metastases, or whether to withhold one of these treatments and reserve it for
progressive/recurrent intracranial
metastases.
Radiosurgery has several
advantages over surgical resection. It can be performed in any brain location.
Radiosurgery can treat multiple metastases in one procedure, and concomitant
medical illness or coagulopathy are not a major issue

. present

management strategy for patients with brain metastases includes the
following:

1. Surgical resection followed by fractionated radiotherapy or radiosurgery
when the average tumor diameter is larger than 3 cm and the tumor is located in
an appropriate area

2. WBRT with a radiosurgical boost for smaller tumors when the patient has
more than two metastases

3. Radiosurgery alone when the patient has one or two metastases less than 3
cm in maximum diameter

4.

Karnofsky performance score (KPS) of 50 or higher.

C
riteria for controlled primary disease depended on the histology of the cancer
but in general required that the patients (
a
) had received and completed the
treatments (surgery, radiation, chemotherapy, or a combination) considered as
“standard of care with

an intent to cure” for the particular carcinoma; (
b
)
demonstrated improvement in clinical symptoms and signs associated with the
primary cancer; and (
c
) did not demonstrate clinical or radiological evidence of
progression of the primary tumor.


10

PROGNOSIS A
ND SURVIVAL:



The 3
-
year local control and overall survival rates seem to be much better
than those for conventional radiotherapy, and the toxicity is minimal. This
technology provides a novel approach to treating early
-
stage NSCLC, and
further dos
e escalation with better tumor
-
motion
-
tracking techniques may
further improve clinical outcomes, particularly in patients with peripheral
lesions. Radiation oncologists should administer this procedure to patients with
central lung lesions only after caref
ul selection. Although exposure of normal
lung tissue to low doses of radiation is a concern, our patient selection criteria
and body gamma
-
knife technique do not seem to result in significant acute or
chronic toxic effects in the lung

RESULT:

Published tu
mor control rates and overall survival after treatment with the
Gamma Knife include:


Nonsmall cell and small cell lung cancer


Tumor control rate
-
greater than 90%


Overall median survival 14
-
18 months

CONCLUSION:

Stereotactic body gamma
-
knife radiosurge
ry with delivery of 50 Gy to the 50%
isodose line is feasible and safe in the treatment of inoperable Stage I/II
NSCLC. The 3
-
year local control and overall survival rates seem to be much
better than those for conventional radiotherapy, and the toxicity is

minimal.
This technology provides a novel approach to treating early
-
stage NSCLC, and
further dose escalation with better tumor
-
motion
-
tracking techniques may
further improve clinical outcomes, particularly in patients with peripheral
lesions. Radiation o
ncologists should administer this procedure to patients with
central lung lesions only after careful selection. Although exposure of normal
lung tissue to low doses of radiation is a concern, our patient selection criteria
and body gamma
-
knife technique do

not seem to result in significant acute or
chronic toxic effects in the lung.


11