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Lecler A, Obadia M, Savatovsky J, Picard H, Charbonneau F, Menjot de Champfleur N, Naggara O, Carsin B, Amor-Sahli M, Cottier JP, Bensoussan J, Auffray-Calvier E, Varoquaux A, De Gaalon S, Calazel C, Nasr N, Volle G, Jianu DC, Gout O, Bonneville F, Sadik JC. TIPIC Syndrome: Beyond the Myth of Carotidynia, a New Distinct Unclassified Entity. AJNR Am J Neuroradiol 2017; 38:1391-1398. [PMID: 28495942 DOI: 10.3174/ajnr.a5214] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 03/05/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE The differential diagnosis of acute cervical pain includes nonvascular and vascular causes such as carotid dissection, carotid occlusion, or vasculitis. However, some patients present with unclassified vascular and perivascular changes on imaging previously reported as carotidynia. The aim of our study was to improve the description of this as yet unclassified clinico-radiologic entity. MATERIALS AND METHODS From January 2009 through April 2016, 47 patients from 10 centers presenting with acute neck pain or tenderness and at least 1 cervical image showing unclassified carotid abnormalities were included. We conducted a systematic, retrospective study of their medical charts and diagnostic and follow-up imaging. Two neuroradiologists independently analyzed the blinded image datasets. RESULTS The median patient age was 48 years. All patients presented with acute neck pain, and 8 presented with transient neurologic symptoms. Imaging showed an eccentric pericarotidian infiltration in all patients. An intimal soft plaque was noted in 16 patients, and a mild luminal narrowing was noted in 16 patients. Interreader reproducibility was excellent. All patients had complete pain resolution within a median of 13 days. At 3-month follow-up, imaging showed complete disappearance of vascular abnormalities in 8 patients, and a marked decrease in all others. CONCLUSIONS Our study improved the description of an unclassified, clinico-radiologic entity, which could be described by the proposed acronym: TransIent Perivascular Inflammation of the Carotid artery (TIPIC) syndrome.
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Affiliation(s)
- A Lecler
- From the Departments of Radiology (A.L., J.S., F.C., J.C.S.)
| | | | - J Savatovsky
- From the Departments of Radiology (A.L., J.S., F.C., J.C.S.)
| | - H Picard
- Clinical Research Unit (H.P.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - F Charbonneau
- From the Departments of Radiology (A.L., J.S., F.C., J.C.S.)
| | - N Menjot de Champfleur
- Department of Neuroradiology (N.M.d.C.), Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
| | - O Naggara
- Department of Neuroradiology (O.N.), Centre Hospitalier Sainte-Anne, Paris, France
| | - B Carsin
- Department of Radiology (B.C.), Centre Hospitalier Régional Universitaire de Rennes, Rennes, France
| | - M Amor-Sahli
- Department of Neuroradiology (M.A.-S.), Pitié-Salpêtrière Hospital, Paris, France.,Centre D'imagerie Médicale Tourville (M.A.-S.), Paris, France
| | - J P Cottier
- Department of Radiology (J.P.C.), Centre Hospitalier Régional Universitaire de Tours, Tours, France.,Brain and Imaging Laboratory Unite Mixte de Recherche U930 (J.P.C.), Institut National de la Santé et de la Recherche Médicale, François-Rabelais University, Tours, France
| | - J Bensoussan
- Department of Radiology (J.B.), Hotel-Dieu Hospital, Paris, France
| | | | - A Varoquaux
- Department of Radiology (A.V.), Conception Hospital, Aix-Marseille University, Marseille, France
| | - S De Gaalon
- Neurology Department (S.D.G.), Hôpital René et Guillaume-Laënnec, Centre Hospitalier Universitaire de Nantes, Saint-Herblain, France
| | - C Calazel
- Departments of Neuroradiology (C.C., F.B.)
| | - N Nasr
- Neurology (N.N.), Hôpital Pierre-Paul-Riquet, Centre Hospitalier Universitaire Purpan, Toulouse, France
| | - G Volle
- Neurology (M.O., G.V., O.G.)
| | - D C Jianu
- Department of Neurology (D.C.J.), Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - O Gout
- Neurology (M.O., G.V., O.G.)
| | | | - J C Sadik
- From the Departments of Radiology (A.L., J.S., F.C., J.C.S.)
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Yashar C, Butler E, Einck JP, Finkelstein SE, Graves YJ, Han B, Hong RL, Komarnicky LT, Lyden M, Mahalingam SB, Mantz CA, Nasr N, Nigh SS, Pollock J, Reiff JE, Scanderbeg D, Snyder MR, Strasser JF, Kuske RR. Abstract P5-14-06: Outcomes in 500 patients from a large, retrospective study of APBI with a strut-based breast brachytherapy applicator. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p5-14-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose/Objectives:
The SAVI Collaborative Research Group (SCRG) is a coalition of 14 institutions who have retrospectively compiled a large database of APBI patients treated with a strut-based brachytherapy device (SAVI). This report details the findings of statistical correlations between numerous dosimetric variables and cosmetic outcome.
Materials/Methods:
The SCRG study enrolled 1005 patients. A subset of patients with complete dosimetry and more than 1 year of follow-up by a radiation oncologist were analyzed for toxicity, cosmesis and recurrence/survival. Dosimetric parameters were tabulated for patients, including: V90, V95, V100, V150, V200, skin spacing (skin-bridge), maximum skin dose, tumor size, PTV-Eval volume and applicator size (model). Toxicity (e.g., telangiectasia, fibrosis, fat necrosis, seroma) were graded by physicians for patients with at least 1 year of follow-up (up to 6 years) using the CTCAE v3 Scale and fat necrosis using a simplified CTCAE scale (Grade 1 asymptomatic but seen on imaging, grade 2 symptomatic without intervention, & grade 3 required intervention).
Results:
Median follow up in this cohort was 29.2 months (range 2.4 to 72.2 months). Follow up was >2 yr and >3 yr for 323 and 191 subjects, respectively. Overall, in 500 subjects the late toxicity (grade ≥2) rates were less than 5% during follow up: telangiectasia 1.0%, fibrosis 4.1%, seroma 2.9% and fat necrosis 0.6%. Cosmesis was reported at various post-APBI follow-up visits following treatment completion (6, 12, 24, 36, 48 & 60+ months). For the 6 and 12 month intervals, 98% (n = 122) and 97% (n = 262) were reported excellent or good (E/G), respectively. At 24, 36, 48 and 60 month intervals, the E/G rates were 93% (n = 184), 90% (n = 98), 100% (n = 41) and 94% (n = 15), respectively. The raw rates of ipsilateral breast tumor recurrence (IBTR) and TR/MM were 1.6% (n = 8) and 1.2% (n = 6), respectively, in 500 patients with >1 year of follow up. The 1- and 2-year actuarial rates of overall survival and disease-free survival were: 1-year, 99.6% & 99.4%, resp. and 2-year, 99.2% & 96.7%.
Conclusions:
APBI treatment with the strut-based applicators was well-tolerated, demonstrated low toxicity rates, favorable cosmetic outcomes and excellent local control over the follow-up to date. Patients with challenging breast anatomy were successfully treated with strut-based devices.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-14-06.
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Affiliation(s)
- C Yashar
- University of California San Diego, La Jolla, CA; Schiffler Cancer Center, Wheeling, WV; 21st Century Oncology Translational Research Center (TRC), Scottsdale, AZ; South Florida Radiation Oncology, Boynton Beach, FL; Virginia Hospital Center, Arlington, VA; Drexel University College of Medicine, Philadelphia, PA; BioStat International, Inc., Tampa, FL; The Christ Hospital Cancer Center, Cincinnati, OH; 21st Century Oncology, Fort Myers, FL; Northwest Community Hospital, Arlington Heights, IL; Christiana Care Health System, Newark, DE; Arizona Breast Cancer Specialists, Phoenix, AZ
| | - E Butler
- University of California San Diego, La Jolla, CA; Schiffler Cancer Center, Wheeling, WV; 21st Century Oncology Translational Research Center (TRC), Scottsdale, AZ; South Florida Radiation Oncology, Boynton Beach, FL; Virginia Hospital Center, Arlington, VA; Drexel University College of Medicine, Philadelphia, PA; BioStat International, Inc., Tampa, FL; The Christ Hospital Cancer Center, Cincinnati, OH; 21st Century Oncology, Fort Myers, FL; Northwest Community Hospital, Arlington Heights, IL; Christiana Care Health System, Newark, DE; Arizona Breast Cancer Specialists, Phoenix, AZ
| | - JP Einck
- University of California San Diego, La Jolla, CA; Schiffler Cancer Center, Wheeling, WV; 21st Century Oncology Translational Research Center (TRC), Scottsdale, AZ; South Florida Radiation Oncology, Boynton Beach, FL; Virginia Hospital Center, Arlington, VA; Drexel University College of Medicine, Philadelphia, PA; BioStat International, Inc., Tampa, FL; The Christ Hospital Cancer Center, Cincinnati, OH; 21st Century Oncology, Fort Myers, FL; Northwest Community Hospital, Arlington Heights, IL; Christiana Care Health System, Newark, DE; Arizona Breast Cancer Specialists, Phoenix, AZ
| | - SE Finkelstein
- University of California San Diego, La Jolla, CA; Schiffler Cancer Center, Wheeling, WV; 21st Century Oncology Translational Research Center (TRC), Scottsdale, AZ; South Florida Radiation Oncology, Boynton Beach, FL; Virginia Hospital Center, Arlington, VA; Drexel University College of Medicine, Philadelphia, PA; BioStat International, Inc., Tampa, FL; The Christ Hospital Cancer Center, Cincinnati, OH; 21st Century Oncology, Fort Myers, FL; Northwest Community Hospital, Arlington Heights, IL; Christiana Care Health System, Newark, DE; Arizona Breast Cancer Specialists, Phoenix, AZ
| | - YJ Graves
- University of California San Diego, La Jolla, CA; Schiffler Cancer Center, Wheeling, WV; 21st Century Oncology Translational Research Center (TRC), Scottsdale, AZ; South Florida Radiation Oncology, Boynton Beach, FL; Virginia Hospital Center, Arlington, VA; Drexel University College of Medicine, Philadelphia, PA; BioStat International, Inc., Tampa, FL; The Christ Hospital Cancer Center, Cincinnati, OH; 21st Century Oncology, Fort Myers, FL; Northwest Community Hospital, Arlington Heights, IL; Christiana Care Health System, Newark, DE; Arizona Breast Cancer Specialists, Phoenix, AZ
| | - B Han
- University of California San Diego, La Jolla, CA; Schiffler Cancer Center, Wheeling, WV; 21st Century Oncology Translational Research Center (TRC), Scottsdale, AZ; South Florida Radiation Oncology, Boynton Beach, FL; Virginia Hospital Center, Arlington, VA; Drexel University College of Medicine, Philadelphia, PA; BioStat International, Inc., Tampa, FL; The Christ Hospital Cancer Center, Cincinnati, OH; 21st Century Oncology, Fort Myers, FL; Northwest Community Hospital, Arlington Heights, IL; Christiana Care Health System, Newark, DE; Arizona Breast Cancer Specialists, Phoenix, AZ
| | - RL Hong
- University of California San Diego, La Jolla, CA; Schiffler Cancer Center, Wheeling, WV; 21st Century Oncology Translational Research Center (TRC), Scottsdale, AZ; South Florida Radiation Oncology, Boynton Beach, FL; Virginia Hospital Center, Arlington, VA; Drexel University College of Medicine, Philadelphia, PA; BioStat International, Inc., Tampa, FL; The Christ Hospital Cancer Center, Cincinnati, OH; 21st Century Oncology, Fort Myers, FL; Northwest Community Hospital, Arlington Heights, IL; Christiana Care Health System, Newark, DE; Arizona Breast Cancer Specialists, Phoenix, AZ
| | - LT Komarnicky
- University of California San Diego, La Jolla, CA; Schiffler Cancer Center, Wheeling, WV; 21st Century Oncology Translational Research Center (TRC), Scottsdale, AZ; South Florida Radiation Oncology, Boynton Beach, FL; Virginia Hospital Center, Arlington, VA; Drexel University College of Medicine, Philadelphia, PA; BioStat International, Inc., Tampa, FL; The Christ Hospital Cancer Center, Cincinnati, OH; 21st Century Oncology, Fort Myers, FL; Northwest Community Hospital, Arlington Heights, IL; Christiana Care Health System, Newark, DE; Arizona Breast Cancer Specialists, Phoenix, AZ
| | - M Lyden
- University of California San Diego, La Jolla, CA; Schiffler Cancer Center, Wheeling, WV; 21st Century Oncology Translational Research Center (TRC), Scottsdale, AZ; South Florida Radiation Oncology, Boynton Beach, FL; Virginia Hospital Center, Arlington, VA; Drexel University College of Medicine, Philadelphia, PA; BioStat International, Inc., Tampa, FL; The Christ Hospital Cancer Center, Cincinnati, OH; 21st Century Oncology, Fort Myers, FL; Northwest Community Hospital, Arlington Heights, IL; Christiana Care Health System, Newark, DE; Arizona Breast Cancer Specialists, Phoenix, AZ
| | - SB Mahalingam
- University of California San Diego, La Jolla, CA; Schiffler Cancer Center, Wheeling, WV; 21st Century Oncology Translational Research Center (TRC), Scottsdale, AZ; South Florida Radiation Oncology, Boynton Beach, FL; Virginia Hospital Center, Arlington, VA; Drexel University College of Medicine, Philadelphia, PA; BioStat International, Inc., Tampa, FL; The Christ Hospital Cancer Center, Cincinnati, OH; 21st Century Oncology, Fort Myers, FL; Northwest Community Hospital, Arlington Heights, IL; Christiana Care Health System, Newark, DE; Arizona Breast Cancer Specialists, Phoenix, AZ
| | - CA Mantz
- University of California San Diego, La Jolla, CA; Schiffler Cancer Center, Wheeling, WV; 21st Century Oncology Translational Research Center (TRC), Scottsdale, AZ; South Florida Radiation Oncology, Boynton Beach, FL; Virginia Hospital Center, Arlington, VA; Drexel University College of Medicine, Philadelphia, PA; BioStat International, Inc., Tampa, FL; The Christ Hospital Cancer Center, Cincinnati, OH; 21st Century Oncology, Fort Myers, FL; Northwest Community Hospital, Arlington Heights, IL; Christiana Care Health System, Newark, DE; Arizona Breast Cancer Specialists, Phoenix, AZ
| | - N Nasr
- University of California San Diego, La Jolla, CA; Schiffler Cancer Center, Wheeling, WV; 21st Century Oncology Translational Research Center (TRC), Scottsdale, AZ; South Florida Radiation Oncology, Boynton Beach, FL; Virginia Hospital Center, Arlington, VA; Drexel University College of Medicine, Philadelphia, PA; BioStat International, Inc., Tampa, FL; The Christ Hospital Cancer Center, Cincinnati, OH; 21st Century Oncology, Fort Myers, FL; Northwest Community Hospital, Arlington Heights, IL; Christiana Care Health System, Newark, DE; Arizona Breast Cancer Specialists, Phoenix, AZ
| | - SS Nigh
- University of California San Diego, La Jolla, CA; Schiffler Cancer Center, Wheeling, WV; 21st Century Oncology Translational Research Center (TRC), Scottsdale, AZ; South Florida Radiation Oncology, Boynton Beach, FL; Virginia Hospital Center, Arlington, VA; Drexel University College of Medicine, Philadelphia, PA; BioStat International, Inc., Tampa, FL; The Christ Hospital Cancer Center, Cincinnati, OH; 21st Century Oncology, Fort Myers, FL; Northwest Community Hospital, Arlington Heights, IL; Christiana Care Health System, Newark, DE; Arizona Breast Cancer Specialists, Phoenix, AZ
| | - J Pollock
- University of California San Diego, La Jolla, CA; Schiffler Cancer Center, Wheeling, WV; 21st Century Oncology Translational Research Center (TRC), Scottsdale, AZ; South Florida Radiation Oncology, Boynton Beach, FL; Virginia Hospital Center, Arlington, VA; Drexel University College of Medicine, Philadelphia, PA; BioStat International, Inc., Tampa, FL; The Christ Hospital Cancer Center, Cincinnati, OH; 21st Century Oncology, Fort Myers, FL; Northwest Community Hospital, Arlington Heights, IL; Christiana Care Health System, Newark, DE; Arizona Breast Cancer Specialists, Phoenix, AZ
| | - JE Reiff
- University of California San Diego, La Jolla, CA; Schiffler Cancer Center, Wheeling, WV; 21st Century Oncology Translational Research Center (TRC), Scottsdale, AZ; South Florida Radiation Oncology, Boynton Beach, FL; Virginia Hospital Center, Arlington, VA; Drexel University College of Medicine, Philadelphia, PA; BioStat International, Inc., Tampa, FL; The Christ Hospital Cancer Center, Cincinnati, OH; 21st Century Oncology, Fort Myers, FL; Northwest Community Hospital, Arlington Heights, IL; Christiana Care Health System, Newark, DE; Arizona Breast Cancer Specialists, Phoenix, AZ
| | - D Scanderbeg
- University of California San Diego, La Jolla, CA; Schiffler Cancer Center, Wheeling, WV; 21st Century Oncology Translational Research Center (TRC), Scottsdale, AZ; South Florida Radiation Oncology, Boynton Beach, FL; Virginia Hospital Center, Arlington, VA; Drexel University College of Medicine, Philadelphia, PA; BioStat International, Inc., Tampa, FL; The Christ Hospital Cancer Center, Cincinnati, OH; 21st Century Oncology, Fort Myers, FL; Northwest Community Hospital, Arlington Heights, IL; Christiana Care Health System, Newark, DE; Arizona Breast Cancer Specialists, Phoenix, AZ
| | - MR Snyder
- University of California San Diego, La Jolla, CA; Schiffler Cancer Center, Wheeling, WV; 21st Century Oncology Translational Research Center (TRC), Scottsdale, AZ; South Florida Radiation Oncology, Boynton Beach, FL; Virginia Hospital Center, Arlington, VA; Drexel University College of Medicine, Philadelphia, PA; BioStat International, Inc., Tampa, FL; The Christ Hospital Cancer Center, Cincinnati, OH; 21st Century Oncology, Fort Myers, FL; Northwest Community Hospital, Arlington Heights, IL; Christiana Care Health System, Newark, DE; Arizona Breast Cancer Specialists, Phoenix, AZ
| | - JF Strasser
- University of California San Diego, La Jolla, CA; Schiffler Cancer Center, Wheeling, WV; 21st Century Oncology Translational Research Center (TRC), Scottsdale, AZ; South Florida Radiation Oncology, Boynton Beach, FL; Virginia Hospital Center, Arlington, VA; Drexel University College of Medicine, Philadelphia, PA; BioStat International, Inc., Tampa, FL; The Christ Hospital Cancer Center, Cincinnati, OH; 21st Century Oncology, Fort Myers, FL; Northwest Community Hospital, Arlington Heights, IL; Christiana Care Health System, Newark, DE; Arizona Breast Cancer Specialists, Phoenix, AZ
| | - RR Kuske
- University of California San Diego, La Jolla, CA; Schiffler Cancer Center, Wheeling, WV; 21st Century Oncology Translational Research Center (TRC), Scottsdale, AZ; South Florida Radiation Oncology, Boynton Beach, FL; Virginia Hospital Center, Arlington, VA; Drexel University College of Medicine, Philadelphia, PA; BioStat International, Inc., Tampa, FL; The Christ Hospital Cancer Center, Cincinnati, OH; 21st Century Oncology, Fort Myers, FL; Northwest Community Hospital, Arlington Heights, IL; Christiana Care Health System, Newark, DE; Arizona Breast Cancer Specialists, Phoenix, AZ
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