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For instance, hair loss, which is one of the major concerns for some patients, such as a young lady with BM of breast cancer, is a less frequently encountered problem with SRS than WBRT as a result of the smaller irradiated field size and focalized dose papillomatosis epidermal Figure 2. All the aforementioned advantages of SRS are provided by utilization of multiple convergent narrow beams to deliver high dose focal irradiation in a single fraction by using multiple cobalt sources, linear accelerators or cyclotrons 37, Similar with neurosurgery, SRS alone or in combination with WBRT has been exhibited to associate with prolonged overall survival, local control and also better neurologic status in these patients compared to WBRT alone 33, However, SRS differs from neurosurgery by offering a chance of ablative treatment to those patients who are not appropriate candidates for neurosurgery due to various reasons.

Albeit such papillomatosis epidermal approach may be beneficial in a select group of patients, prerequisites for close monitorization with monthly or bimonthly magnetic resonance imaging MRI and risk for unavoidable repeat SRS procedures for newly emerging BM, both increasing the total cost of overall treatment, should be carefully considered Moreover, contrasted with SRS and WBRT combination, the risk for a plausibility of inferior survival outcomes with SRS alone in patients with controlled primary and no extracranial disease should be kept in mind, as it has been accentuated previously by various authors 41, Although local- and distant papillomatosis epidermal control rates were reported to be better with enterobius vermicularis fisiologia addition of WBRT, this distinction did not translate into a notable survival advantage in any study.

Papillomatosis epidermal, in the study by Chang et al.

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It is unfortunate to point out that the results of these RCTs ought to be interpreted with caution because of their insufficient design to explicitly concentrate on survival endpoints, such as significant imbalances between the study groups with regards to the prognostic factors and utilization of salvage WBRT in SRS alone cohorts papillomatosis epidermal, First meta-analysis was performed by Duan et al. In the second meta-analysis, Hasan et al. Thirdly, the meta-analysis by Soon et al.

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In the fourth and most recent meta-analysis, by Sahgal et al. Additionally omission of WBRT in this subgroup was not identified to relate with increased rates of distant brain relapses.

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In a recent systematic review of 14 studies incorporating BM patients, Gans et al. Therefore, although the concept of TC-SRS is relatively new, with its acceptable toxicity rates the results appear to be encouraging for irradiation of a limited area with ablative doses of radiotherapy.

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In a study by Pinkham et al. Verbal memory and fine motor functions were the commonest parameters to be impaired in this study Papillomatosis epidermal, restriction of the irradiated brain volume with local therapies like surgery and SRS papillomatosis epidermal prove beneficial in preservation of neurocognitive functions without any scarification in tumor control rates.

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Although results of some studies appear to support this idea 35others reported poorer neurocognitive outcomes with omission of WBRT. In one such study, with the end goal of preserving neurocognitive functions with maximum BM control rates, Aoyoma et al.

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papillomatosis epidermal Because many of the traditionally argued WBRT toxicity data is derived from small-cell lung carcinoma patients treated with chemotherapy prior to prophylactic cranial irradiation, caution is advised when diagnosing WBRT toxicity. Therefore, as the side effects evoked by cranial irradiation are largely similar, it is not astounding that the impacts were preferably ascribed to the radiation than to chemotherapy.

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This information is papillomatosis epidermal foremost significance for radiation oncologists considering the way that almost all toxicities following therapeutic WBRT are almost constantly ascribed to cranial irradiation by the other oncologic disciplines.

Deteriorations in neurocognitive functions papillomatosis epidermal also be already present before papillomavirus et lesions initiation of WBRT.

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This issue has been addressed in two key studies by Meyers et al. In the second study by Komaki et al. The authors pointed out that roughly half of all eligible patients had neurocognitive shortages before the onset of cranial prophylaxis, and observed a somewhat noteworthy decay in executive function and language after one year, which turned inconsequential in later evaluations.

These two excellent studies strongly papillomatosis epidermal the paramount importance of implementation of neurocognitive function tests prior to WBRT in order to reflect the actual impact of therapeutic WBRT on neurocognitive domains.

Moreover, the negative neurocognitive impact papillomatosis epidermal progressive BM may further be ameliorated or even improved by WBRT in some patients groups with resultant enhancement in executive functions and fine motor co-ordination as neurologic deterioration is reported to directly papillomatosis epidermal with disease progression in the brain 51, Management of this regretful complication of cancer involves neurosurgery, WBRT, SRS, chemotherapy, and targeted agents individually or as any combination of them, regarding the prognostic factors.

Curr Probl Surg J Clin Oncol Cancer Oncologist Cancer Metastasis Rev J Cell Biochem Berk L: An overview of radiotherapy trials for the treatment of brain metastases. Oncology Williston Park ; discussion, Radiother Oncol Sperduto PW, Kased N, Roberge D, et al: Summary report on the graded prognostic assessment: an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases.

Abrahams JM, Torchia M, Putt M, et al: Risk factors affecting survival after brain papillomatosis epidermal from non-small cell lung carcinoma: a follow-up study of 70 patients.

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J Papillomatosis epidermal Chin Clin Oncol BMC Cancer Strahlenther Onkol Rades D, Dziggel L, Haatanen T, et al: Scoring systems to estimate intracerebral control and survival rates of patients irradiated for brain metastases.

Topkan E, Parlak C, Kotek A, et al: Impact of prophylactic cranial irradiation timing on brain relapse rates in patients with stage IIIB non-small-cell lung carcinoma papillomatosis epidermal with two different chemoradiotherapy regimens.

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Coia LR: The role of radiation therapy in the treatment of brain metastases. Cancer Res Biomater Artif Cells Immobilization Biotechnol Mehta MP, Rodrigus Papillomatosis epidermal, Terhaard CH, et al: Survival and neurologic outcomes in a randomized trial of motexafin gadolinium and whole-brain radiation therapy in brain metastases.

Scott C, Suh J, Stea B, et al: Improved survival, quality of life, and qualityadjusted survival in breast cancer patients treated with efaproxiral Efaproxyn plus whole-brain radiation therapy for brain metastases. Am J Clin Oncol Quantin X, Khial F, Reme-Saumon M, et al: Concomitant brain radiotherapy and vinorelbine-ifosfamide-cisplatin chemotherapy in brain metastases of non-small cell lung papillomatosis epidermal.