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Cooper BT, Mayo CS, Milano MT, Olch AJ, Oh C, Keating GF, Hallstrom A, Constine LS, Laack NN. Predictive Factors Associated With Radiation Myelopathy in Pediatric Patients With Cancer: A PENTEC Comprehensive Review. Int J Radiat Oncol Biol Phys 2024; 119:494-506. [PMID: 38323945 DOI: 10.1016/j.ijrobp.2023.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 12/06/2023] [Accepted: 12/15/2023] [Indexed: 02/08/2024]
Abstract
PURPOSE Radiation myelitis (RM) is a rare complication of radiation therapy (RT). The Pediatric Normal Tissue Effects in the Clinic spinal cord task force aimed to identify RT dose effects and assess risk factors for RM in children. Through systematic review, we analyzed RT dose, fraction size, latency between completion of RT and toxicity, chemotherapy use, age when irradiated, and sex. METHODS AND MATERIALS We conducted literature searches of peer-reviewed manuscripts published from 1964 to June 2017 evaluating RM among children. Normality of variables was assessed with Kolmogorov-Smirnov or Shapiro-Wilk tests. Spearman's rank correlation coefficients were used to test correlations between RT dose/fraction size and latency between RT and development of toxicity. RESULTS Of 1329 identified and screened reports, 144 reports were fully reviewed and determined to have adequate data for analysis; 16 of these reports had a total of 33 cases of RM with a median age of 13 years (range, 0.2-18) at the time of RT. The most common primary tumor histologies were rhabdomyosarcoma (n = 9), medulloblastoma (n = 5), and Hodgkin lymphoma (n = 2); the most common chemotherapy agents given were vincristine (n = 15), intrathecal methotrexate (n = 12), and intrathecal cytarabine (n = 10). The median RT dose and fraction size were 40 Gy (range, 24-57.4 Gy) and 1.8 Gy (range, 1.3-2.6 Gy), respectively. RT dose resulting in RM in patients who also received chemotherapy was lower than in those not receiving chemotherapy (mean 39.6 vs 49.7 Gy; P = .04). There was no association of age with RT dose. The median latency period was 7 months (range, 1-29). Higher RT dose was correlated with longer latency periods (P = .03) to RM whereas sex, age, fraction size, and chemotherapy use were not. Two of 17 patients with adequate follow-up recovered from RM; unfortunately, it was fatal in 6 of 15 evaluable patients. Complication probability modeling was not possible because of the rarity of events. CONCLUSIONS This report demonstrates a relatively short latency from RT (with or without chemotherapy) to RM and a wide range of doses (including fraction sizes) associated with RM. No apparent association with age at the time of RT could be discerned. Chemotherapy appears to reduce spinal cord tolerance. Recovery from RM is rare, and it is often fatal.
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Affiliation(s)
- Benjamin T Cooper
- Department of Radiation Oncology, NYU Langone School of Medicine, New York, New York.
| | - Charles S Mayo
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Michael T Milano
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Arthur J Olch
- Department of Radiation Oncology, University of Southern California, Los Angeles, California
| | - Cheongeun Oh
- Department of Population Health, NYU School of Medicine, New York, New York
| | | | - Anneka Hallstrom
- Department of Physics, Wellesley College, Wellesley, Massachusetts
| | - Louis S Constine
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Nadia N Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
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Cheung ATM, Kurland DB, Neifert S, Mandelberg N, Nasir-Moin M, Laufer I, Pacione D, Lau D, Frempong-Boadu AK, Kondziolka D, Golfinos JG, Oermann EK. Developing an Automated Registry (Autoregistry) of Spine Surgery Using Natural Language Processing and Health System Scale Databases. Neurosurgery 2023; 93:1228-1234. [PMID: 37345933 DOI: 10.1227/neu.0000000000002568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/25/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Clinical registries are critical for modern surgery and underpin outcomes research, device monitoring, and trial development. However, existing approaches to registry construction are labor-intensive, costly, and prone to manual error. Natural language processing techniques combined with electronic health record (EHR) data sets can theoretically automate the construction and maintenance of registries. Our aim was to automate the generation of a spine surgery registry at an academic medical center using regular expression (regex) classifiers developed by neurosurgeons to combine domain expertise with interpretable algorithms. METHODS We used a Hadoop data lake consisting of all the information generated by an academic medical center. Using this database and structured query language queries, we retrieved every operative note written in the department of neurosurgery since our transition to EHR. Notes were parsed using regex classifiers and compared with a random subset of 100 manually reviewed notes. RESULTS A total of 31 502 operative cases were downloaded and processed using regex classifiers. The codebase required 5 days of development, 3 weeks of validation, and less than 1 hour for the software to generate the autoregistry. Regex classifiers had an average accuracy of 98.86% at identifying both spinal procedures and the relevant vertebral levels, and it correctly identified the entire list of defined surgical procedures in 89% of patients. We were able to identify patients who required additional operations within 30 days to monitor outcomes and quality metrics. CONCLUSION This study demonstrates the feasibility of automatically generating a spine registry using the EHR and an interpretable, customizable natural language processing algorithm which may reduce pitfalls associated with manual registry development and facilitate rapid clinical research.
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Affiliation(s)
| | - David B Kurland
- Department of Neurosurgery, NYU Langone Health, New York , New York , USA
| | - Sean Neifert
- Department of Neurosurgery, NYU Langone Health, New York , New York , USA
| | | | - Mustafa Nasir-Moin
- Department of Neurosurgery, NYU Langone Health, New York , New York , USA
| | - Ilya Laufer
- Department of Neurosurgery, NYU Langone Health, New York , New York , USA
| | - Donato Pacione
- Department of Neurosurgery, NYU Langone Health, New York , New York , USA
| | - Darryl Lau
- Department of Neurosurgery, NYU Langone Health, New York , New York , USA
| | | | - Douglas Kondziolka
- Department of Neurosurgery, NYU Langone Health, New York , New York , USA
| | - John G Golfinos
- Department of Neurosurgery, NYU Langone Health, New York , New York , USA
| | - Eric Karl Oermann
- Department of Neurosurgery, NYU Langone Health, New York , New York , USA
- Department of Radiology, NYU Langone Health, New York , New York , USA
- Center for Data Science, New York University, New York , New York , USA
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Ghannam MM, Davies JM. Application of Big Data in Vascular Neurosurgery. Neurosurg Clin N Am 2022; 33:469-482. [DOI: 10.1016/j.nec.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Börcek AÖ, Çeltikçi E, Aksoğan Y, Rousseau MJ. Clinical Outcomes of Stereotactic Radiosurgery for Cerebral Arteriovenous Malformations in Pediatric Patients: Systematic Review and Meta-Analysis. Neurosurgery 2020; 85:E629-E640. [PMID: 31131849 DOI: 10.1093/neuros/nyz146] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 12/24/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Arteriovenous malformations (AVMs) in pediatric patients exhibit remarkable differences in terms of management and outcomes. Owing to a paucity of relevant data pertaining to AVMs in pediatric patients, special interest and investigation are required for an improved understanding of the available evidence by clinicians. OBJECTIVE To determine the clinical outcomes of single-session stereotactic radiosurgery (SRS) for AVMs in pediatric patients. METHODS A systematic literature review was performed to identify studies that reported the outcomes of SRS for AVMs in pediatric patients. Data pertaining to variables such as obliteration rate, post-SRS new hemorrhage rate, post-SRS new neurological deficit rate, and mortality rate were extracted and analyzed using meta-analysis techniques. RESULTS Based on pooled data from 20 studies with 1212 patients, single-session SRS resulted in complete obliteration in 65.9% (95% confidence interval [CI], 60.5%-71.1%; I2 = 66.5%) patients. Overall complication rate (including new hemorrhage, new neurodeficit, and mortality) was 8.0% (95% CI, 5.1%-11.5%; I2 = 66.4%). Post-SRS new neurological deficit rate was 3.1% (95% CI, 1.3%-5.4%; I2 = 59.7%), and post-SRS hemorrhage rate was 4.2% (95% CI, 2.5%-6.3%; I2 = 42.7%). There was no significant difference between studies disaggregated by treatment method (Gamma Knife [Elekta AB] vs other), treatment year (before year 2000 vs after year 2000), median AVM volume reported (≥3 vs <3 cm3), median dose reported (≥20 vs <20 Gy), or follow-up period (≥36 vs <36 mo). CONCLUSION Single-SRS is a safe treatment alternative that achieves high obliteration rates and acceptable complication rates for AVMs in pediatric patients.
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Affiliation(s)
- Alp Özgün Börcek
- Division of Pediatric Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Emrah Çeltikçi
- Department of Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Yiğit Aksoğan
- Department of Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey
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Registries and Big Data. Stereotact Funct Neurosurg 2020. [DOI: 10.1007/978-3-030-34906-6_38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Coffey R, Penny R, Jones L, Bailey JK. One center's experience developing a burn outpatient registry. Burns 2019; 46:836-841. [PMID: 31771902 DOI: 10.1016/j.burns.2019.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 10/17/2019] [Accepted: 10/26/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Recent advances in burn care have resulted in the transition of care from inpatient to outpatient. There is a growing appreciation that with improved survival, meaningful markers of quality need to include recovery of form, function, and reconstruction. Capture of the data describing care delivered in the outpatient setting is being missed. METHODS Development of our outpatient database included providers, registrar, program manager, and outpatient nursing staff. Data points were included if they described the population, and epidemiology of our patients, were useful for programmatic changes and improvements as well as anticipated research focus areas. RESULTS The database platform chosen was Midas+™ because it was in use by hospital quality and integrated with the electronic medical record. Fields were customized based on changing program needs and are updated for new programs or outcomes measures. Reports can be easily built and both outpatients and inpatients are included. This allows for longitudinal tracking of burn patients. Ongoing additions to original data points include variables to track outcomes related to laser therapy for scar management, time to custom garment donning, and to track functional outcomes. Epidemiologic data collected is used to target high-risk populations for prevention and outreach efforts. Outcome data is used for evaluation of programs and care. CONCLUSIONS High quality databases serve to measure effectiveness of care and offer insight for areas of improvement. There is a clear need for inclusion of outpatient activity in the National Burn Registry (NBR).
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Affiliation(s)
- Rebecca Coffey
- The Ohio State University Wexner Medical Center, 410 W. Tenth Avenue, Columbus, OH 43210 United States.
| | - Rachel Penny
- The Ohio State University Wexner Medical Center, 410 W. Tenth Avenue, Columbus, OH 43210 United States.
| | - Larry Jones
- Division of Trauma, Critical Care, and Burn, Department of Surgery, 395 W. 12(th) Avenue, 6th Floor, Columbus, OH 43210 United States.
| | - J Kevin Bailey
- Division of Trauma, Critical Care, and Burn, Department of Surgery, 395 W. 12(th) Avenue, 6th Floor, Columbus, OH 43210 United States.
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The NQRN Registry Maturational Framework: Evaluating the Capability and Use of Clinical Registries. EGEMS 2019; 7:29. [PMID: 31346544 PMCID: PMC6640257 DOI: 10.5334/egems.278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Clinical registries are increasingly used as national performance measurement platforms. In 2018, nearly 70 percent of the more than 50 specialty society registries in the United States were used by the Centers for Medicare & Medicaid Services (CMS) to measure the quality of clinical care. Private payers and evaluating organizations also use or desire to use registry information to inform quality improvement programs and value-based payment models. The requirements for an entity to become a CMS Qualified Clinical Data Registry (QCDR) constitute a minimum set of standards for the purpose of reporting to the CMS Quality Payment Program. Models and frameworks exist that can help classify registries by purpose and use, and maturity models are available for evaluating health IT systems generally. However, there is currently no framework that describes the capability that should be expected from a registry at different phases of its development and maturity. In response, the National Quality Registry Network (NQRN) has developed a registry maturational framework. The framework models early, intermediate and mature development phases, the capabilities anticipated during these phases and 17 domains across which registry programs support those capabilities. The framework was developed and refined by NQRN registry stewards, users and other stakeholders between 2013–2018. It is intended to be used as a developmental guide or for registry evaluation. The successful use of registry information to execute value-based payment models is a critical need in U.S. health care. The NQRN framework can help ensure that our national system of registries is rising to the occasion.
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Habibi A, Wu SP, Gorovets D, Sansosti A, Kryger M, Beaudreault C, Chung WY, Shelton G, Silverman J, Lowy J, Kondziolka D. Early Palliative Care for Patients With Brain Metastases Decreases Inpatient Admissions and Need for Imaging Studies. Am J Hosp Palliat Care 2018; 35:1069-1075. [DOI: 10.1177/1049909118765405] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Early encounters with palliative care (PC) can influence health-care utilization, clinical outcome, and cost. Aim: To study the effect of timing of PC encounters on brain metastasis patients at an academic medical center. Setting/Participants: All patients diagnosed with brain metastases from January 2013 to August 2015 at a single institution with inpatient and/or outpatient PC records available for review (N = 145). Design: Early PC was defined as having a PC encounter within 8 weeks of diagnosis with brain metastases; late PC was defined as having PC after 8 weeks of diagnosis. Propensity score matched cohorts of early (n = 46) and late (n = 46) PC patients were compared to control for differences in age, gender, and Karnofsky Performance Status (KPS) at diagnosis. Details of the palliative encounter, patient outcomes, and health-care utilization were collected. Results: Early PC versus late PC patients had no differences in baseline KPS, age, or gender. Early PC patients had significantly fewer number of inpatient visits per patient (1.5 vs 2.9; P = .004), emergency department visits (1.2 vs 2.1; P = .006), positron emission tomography/computed tomography studies (1.2 vs 2.7, P = .005), magnetic resonance imaging scans (5.8 vs 8.1; P = .03), and radiosurgery procedures (0.6 vs 1.3; P < .001). There were no differences in overall survival (median 8.2 vs 11.2 months; P = .2). Following inpatient admissions, early PC patients were more likely to be discharged home (59% vs 35%; P = .04). Conclusions: Timely PC consultations are advisable in this patient population and can reduce health-care utilization.
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Affiliation(s)
- Akram Habibi
- Department of Radiation Oncology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York, USA
- Department of Neurosurgery, NYU Medical School, New York, USA
| | - S. Peter Wu
- Department of Radiation Oncology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York, USA
| | - Daniel Gorovets
- Department of Radiation Oncology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York, USA
| | - Alexandra Sansosti
- Department of Radiation Oncology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York, USA
- Department of Neurosurgery, NYU Medical School, New York, USA
| | - Marc Kryger
- Department of Radiation Oncology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York, USA
| | - Cameron Beaudreault
- Department of Radiation Oncology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York, USA
| | - Wei-Yi Chung
- Department of Population Health, NYU Medical School, New York, USA
| | - Gary Shelton
- Department of Medicine, NYU Medical School, New York, USA
| | - Joshua Silverman
- Department of Radiation Oncology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York, USA
- Department of Neurosurgery, NYU Medical School, New York, USA
| | - Joseph Lowy
- Department of Medicine, NYU Medical School, New York, USA
| | - Douglas Kondziolka
- Department of Radiation Oncology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York, USA
- Department of Neurosurgery, NYU Medical School, New York, USA
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Wolf A, Kvint S, Chachoua A, Pavlick A, Wilson M, Donahue B, Golfinos JG, Silverman J, Kondziolka D. Toward the complete control of brain metastases using surveillance screening and stereotactic radiosurgery. J Neurosurg 2018; 128:23-31. [DOI: 10.3171/2016.10.jns161036] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe incidence of brain metastases is increasing with improved systemic therapies, many of which have a limited impact on intracranial disease. Stereotactic radiosurgery (SRS) is a first-line management option for brain metastases. The purpose of this study was to determine if there is a threshold tumor size below which local control (LC) rates approach 100%, and to relate these findings to the use of routine surveillance brain imaging.METHODSFrom a prospective registry, 200 patients with 1237 brain metastases were identified who underwent SRS between December 2012 and May 2015. The median imaging follow-up duration was 7.9 months, and the median margin dose was 18 Gy. The maximal diameter and volume of tumors were measured. Histological analysis included 96 patients with non–small cell lung cancers (NSCLCs), 40 with melanoma, 35 with breast cancer, and 29 with other histologies.RESULTSAlmost 50% of brain metastases were NSCLCs and commonly measured less than 6 mm in maximal diameter or 70 mm3 in volume. Thirty-three of 1237 tumors had local progression at a median of 8.8 months. The 1- and 2-year actuarial LC rates were 97% and 93%, respectively. LC of 100% was achieved for all intracranial metastases less than 100 mm3 in volume or 6 mm in diameter. Patients whose tumors at first SRS were less than 10 mm maximal diameter or a volume of 250 mm3 had improved overall survival.CONCLUSIONSSRS can achieve LC rates approaching 100% for subcentimeter metastases. The earlier initial detection and prompt treatment of small intracranial metastases may prevent the development of neurological symptoms and the need for resection, and improve overall survival. To identify tumors when they are small, routine surveillance brain imaging should be considered as part of the standard of care for lung, breast, and melanoma metastases.■ CLASSIFICATION OF EVIDENCE Type of question: prognostic; study design: retrospective cohort; evidence: Class II.
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Affiliation(s)
| | | | | | | | | | - Bernadine Donahue
- 3Radiation Oncology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York University, New York, New York
| | | | - Joshua Silverman
- 3Radiation Oncology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York University, New York, New York
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Abstract
Introduction The use of information from clinical registries for improvement and value-based payment is increasing, yet information about registry use is not widely available. We conducted a landscape survey to understand registry uses, focus areas and challenges. The survey addressed the structure and organization of registry programs, as well as their purpose and scope. Setting The survey was conducted by the National Quality Registry Network (NQRN), a community of organizations interested in registries. NQRN is a program of the PCPI, a national convener of medical specialty and professional societies and associations, which constitute a majority of registry stewards in the United States. Methods We surveyed 152 societies and associations, asking about registry programs, governance, number of registries, purpose and data uses, data collection, expenses, funding and interoperability. Results The response rate was 52 percent. Many registries were self-funded, with 39 percent spending less than $1 million per year, and 32 percent spending $1-9.9 million. The typical registry had three full-time equivalent staff. Registries were frequently used for quality improvement, benchmarking and clinical decision support. 85 percent captured outpatient data. Most registries collected demographics, treatments, practitioner information and comorbidities; 53 percent captured patient-reported outcomes. 88 percent used manual data entry and 18 percent linked to external secondary data sources. Cost, interoperability and vendor management were barriers to continued registry development. Conclusions Registries captured data across a broad scope, audited data quality using multiple techniques, and used a mix of automated and manual data capture methods. Registry interoperability was still a challenge, even among registries using nationally accepted data standards.
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Oravec CS, Motiwala M, Reed K, Kondziolka D, Barker FG, Michael LM, Klimo P. Big Data Research in Neurosurgery: A Critical Look at this Popular New Study Design. Neurosurgery 2017; 82:728-746. [DOI: 10.1093/neuros/nyx328] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 05/17/2017] [Indexed: 01/10/2023] Open
Affiliation(s)
- Chesney S Oravec
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Mustafa Motiwala
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Kevin Reed
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Douglas Kondziolka
- Department of Neurosurgery, New York University Langone Medical Center, New York, New York
| | - Fred G Barker
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
- Semmes Murphey Clinic, Memphis, Tennessee
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
- Semmes Murphey Clinic, Memphis, Tennessee
- Department of Neurosurgery, Le Bonheur Children's Hospital, Memphis, Tennessee
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Niranjan A, Layne D, Briercheck M, Trofimova S, Monaco EA, Kano H, Lunsford LD. Implementation of a New UPMC Gamma Knife Radiosurgery Quality Assurance Registry. Stereotact Funct Neurosurg 2017; 95:49-59. [PMID: 28135704 DOI: 10.1159/000454893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 12/02/2016] [Indexed: 11/19/2022]
Abstract
OBJECT In this report, we discuss the development of a new, comprehensive, Health Insurance Portability and Accountability Act-compliant electronic quality assurance (QA) registry for Gamma Knife (GK) radiosurgery patients. This registry can be used to query outcomes, link with current hospital electronic medical records, and share data with future corporate or national professional society registries under development. METHODS A clinical task force comprising physicians and regulatory, legal, and information technology (IT) experts was created to define the nomenclature, regulatory requirements, hosting site, and required capabilities of the proposed system. A team of physicians and IT experts defined the clinical parameters and designed the query functions for the registry. RESULTS The UPMC GK Registry was established as a QA registry exempt from Institutional Review Board oversight. In order to facilitate subsequent query functions (analytics), data entry was created for 3 main categories: brain tumors, vascular malformations, and functional disorders. A Microsoft SQL-based database infrastructure was employed. CONCLUSIONS We developed a new UPMC GK QA registry and successfully migrated our previous data on 13,000 patients into the registry. This simplified and user-friendly registry offers clinicians the opportunity to participate in national registries and to contribute to multicenter evidence-based outcome analyses.
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Affiliation(s)
- Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Impact on overall survival of the combination of BRAF inhibitors and stereotactic radiosurgery in patients with melanoma brain metastases. J Neurooncol 2016; 127:607-15. [PMID: 26852222 DOI: 10.1007/s11060-016-2072-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 01/26/2016] [Indexed: 12/21/2022]
Abstract
The aim of this study was to evaluate the impact of BRAF inhibitors on survival outcomes in patients receiving stereotactic radiosurgery (SRS) for melanoma brain metastases. We prospectively collected treatment parameters and outcomes for 80 patients with melanoma brain metastases who underwent SRS. Thirty-five patients harbored the BRAF mutation (BRAF-M) and 45 patients did not (BRAF-WT). Univariate and multivariate analyses were performed to identify predictors of overall survival. The median overall survival from first SRS procedure was 6.7, 11.2 months if treated with a BRAF inhibitor and 4.5 months for BRAF-WT. Actuarial survival rates for BRAF-M patients on an inhibitor were 54 % at 6 months and 41 % at 12 months from the time of SRS. In contrast, BRAF-WT had overall survival rates of 28 % at 6 months and 19 % at 12 months. Overall survival was extended for patients on a BRAF inhibitor at or after the first SRS. The median time to intracranial progression was 3.9 months on a BRAF inhibitor and 1.7 months without. The local control rate for all treated tumors was 92.5 %, with no difference based on BRAF status. Patients with higher KPS, fewer treated intracranial metastases, controlled systemic disease, RPA Class 1 and BRAF-M patients had extended overall survival. Overall, patients with BRAF-M treated with both SRS and BRAF inhibitors, at or after SRS, have increased overall survival from the time of SRS. As patients live longer as a result of more effective systemic and local therapies, close surveillance and early management of intracranial disease with SRS will become increasingly important.
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Shin SM, Cooper BT, Chachoua A, Butler J, Donahue B, Silverman JS, Kondziolka D. Survival but not brain metastasis response relates to lung cancer mutation status after radiosurgery. J Neurooncol 2015; 126:483-91. [DOI: 10.1007/s11060-015-1986-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022]
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