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Liebenow B, Jiang A, DiMarco EK, Sands LP, Moya-Mendez M, Laxton AW, Siddiqui MS, Ul Haq I, Kishida KT. Subjective feelings associated with expectations and rewards during risky decision-making in impulse control disorder. Sci Rep 2024; 14:4627. [PMID: 38438386 PMCID: PMC10912783 DOI: 10.1038/s41598-024-53076-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/27/2024] [Indexed: 03/06/2024] Open
Abstract
Impulse Control Disorder (ICD) in Parkinson's disease is a behavioral addiction induced by dopaminergic therapies, but otherwise unclear etiology. The current study investigates the interaction of reward processing variables, dopaminergic therapy, and risky decision-making and subjective feelings in patients with versus without ICD. Patients with (n = 18) and without (n = 12) ICD performed a risky decision-making task both 'on' and 'off' standard-of-care dopaminergic therapies (the task was performed on 2 different days with the order of on and off visits randomized for each patient). During each trial of the task, participants choose between two options, a gamble or a certain reward, and reported how they felt about decision outcomes. Subjective feelings of 'pleasure' are differentially driven by expectations of possible outcomes in patients with, versus without ICD. While off medication, the influence of expectations about risky-decisions on subjective feelings is reduced in patients with ICD versus without ICD. While on medication, the influence of expected outcomes in patients with ICD versus without ICD becomes similar. Computational modeling of behavior supports the idea that latent decision-making factors drive subjective feelings in patients with Parkinson's disease and that ICD status is associated with a change in the relationship between factors associated with risky behavior and subjective feelings about the experienced outcomes. Our results also suggest that dopaminergic medications modulate the impact expectations have on the participants' subjective reports. Altogether our results suggest that expectations about risky decisions may be decoupled from subjective feelings in patients with ICD, and that dopaminergic medications may reengage these circuits and increase emotional reactivity in patients with ICD.
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Affiliation(s)
- Brittany Liebenow
- Neuroscience Graduate Program, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Translational Neuroscience, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Angela Jiang
- Department of Translational Neuroscience, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Emily K DiMarco
- Neuroscience Graduate Program, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Translational Neuroscience, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - L Paul Sands
- Neuroscience Graduate Program, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Translational Neuroscience, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Fralin Biomedical Research Institute, Virginia Tech, Roanoke, VA, 24016, USA
| | | | - Adrian W Laxton
- Department of Neurosurgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Mustafa S Siddiqui
- Department of Neurology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Ihtsham Ul Haq
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kenneth T Kishida
- Neuroscience Graduate Program, Wake Forest School of Medicine, Winston-Salem, NC, USA.
- Department of Translational Neuroscience, Wake Forest School of Medicine, Winston-Salem, NC, USA.
- Department of Neurosurgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
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Ressler HW, Cramer CK, Isom S, McCormack M, Ruiz J, Xing F, Li W, Whitlow CT, White JJ, Laxton AW, Tatter SB, Chan MD. Brain metastases from renal cell carcinoma: Effects of novel systemic agents on brain metastasis outcomes. Clin Neurol Neurosurg 2024; 238:108191. [PMID: 38422744 DOI: 10.1016/j.clineuro.2024.108191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE The objective of this study was to examine survival outcomes in 136 patients with renal cell carcinoma with metastases to the brain who were treated with radiation combined with immunotherapy or tyrosine kinase inhibitor compared to those who were treated with radiation therapy alone. METHODS The Wake Forest Gamma Knife prospective database was searched for all patients with renal cell carcinoma brain metastases. Outcome measurements included overall survival, determined via the Kaplan-Meier Method, and cumulative incidence of local and distant failure, determined using the Fine Gray competing risks analysis with death as a competing risk for the 136 patients included. RESULTS Overall survival for the entire population at 6 months, 12 months, and 24 months was 67%, 47% and 30%, respectively. For the TKI (non-immunotherapy-treated) population (n = 37), overall survival was 75%, 61%, and 40% at 6 months, 12 months, and 24 months, respectively. For the immunotherapy-treated population (n = 35), overall survival was 85%, 64%, and 50% at 6 months, 12 months, and 24 months, respectively. Overall survival was significantly increased for patients who received radiation with either immunotherapy or TKI (p < 0.0001). CONCLUSION Prior series of patients with brain metastases of multiple histologies have demonstrated an improvement in the local efficacy of stereotactic radiosurgery when combined with systemic agents. We found that patients treated with targeted agents and patients treated with immunotherapy demonstrated a trend towards improvement over patients treated in the era prior to the advent of either classes of novel therapies.
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Affiliation(s)
- Hadley W Ressler
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Christina K Cramer
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Scott Isom
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael McCormack
- Department of Medicine (Hematology & Oncology), Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jimmy Ruiz
- Department of Medicine (Hematology & Oncology), Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Fei Xing
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Wencheng Li
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Jaclyn J White
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Adrian W Laxton
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Stephen B Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael D Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Roeder BM, She X, Dakos AS, Moore B, Wicks RT, Witcher MR, Couture DE, Laxton AW, Clary HM, Popli G, Liu C, Lee B, Heck C, Nune G, Gong H, Shaw S, Marmarelis VZ, Berger TW, Deadwyler SA, Song D, Hampson RE. Developing a hippocampal neural prosthetic to facilitate human memory encoding and recall of stimulus features and categories. Front Comput Neurosci 2024; 18:1263311. [PMID: 38390007 PMCID: PMC10881797 DOI: 10.3389/fncom.2024.1263311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 01/19/2024] [Indexed: 02/24/2024] Open
Abstract
Objective Here, we demonstrate the first successful use of static neural stimulation patterns for specific information content. These static patterns were derived by a model that was applied to a subject's own hippocampal spatiotemporal neural codes for memory. Approach We constructed a new model of processes by which the hippocampus encodes specific memory items via spatiotemporal firing of neural ensembles that underlie the successful encoding of targeted content into short-term memory. A memory decoding model (MDM) of hippocampal CA3 and CA1 neural firing was computed which derives a stimulation pattern for CA1 and CA3 neurons to be applied during the encoding (sample) phase of a delayed match-to-sample (DMS) human short-term memory task. Main results MDM electrical stimulation delivered to the CA1 and CA3 locations in the hippocampus during the sample phase of DMS trials facilitated memory of images from the DMS task during a delayed recognition (DR) task that also included control images that were not from the DMS task. Across all subjects, the stimulated trials exhibited significant changes in performance in 22.4% of patient and category combinations. Changes in performance were a combination of both increased memory performance and decreased memory performance, with increases in performance occurring at almost 2 to 1 relative to decreases in performance. Across patients with impaired memory that received bilateral stimulation, significant changes in over 37.9% of patient and category combinations was seen with the changes in memory performance show a ratio of increased to decreased performance of over 4 to 1. Modification of memory performance was dependent on whether memory function was intact or impaired, and if stimulation was applied bilaterally or unilaterally, with nearly all increase in performance seen in subjects with impaired memory receiving bilateral stimulation. Significance These results demonstrate that memory encoding in patients with impaired memory function can be facilitated for specific memory content, which offers a stimulation method for a future implantable neural prosthetic to improve human memory.
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Affiliation(s)
- Brent M Roeder
- Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Xiwei She
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Alexander S Dakos
- Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Bryan Moore
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Robert T Wicks
- Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
- Johns Hopkins Children's Center, Baltimore, MD, United States
| | - Mark R Witcher
- Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
- Virginia Tech Carilion School of Medicine and Research Institute, Roanoke, VA, United States
| | - Daniel E Couture
- Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Adrian W Laxton
- Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | | | - Gautam Popli
- Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Charles Liu
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
- USC Keck Memorial Hospital, Los Angeles, CA, United States
| | - Brian Lee
- USC Keck Memorial Hospital, Los Angeles, CA, United States
| | - Christianne Heck
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
- USC Keck Memorial Hospital, Los Angeles, CA, United States
| | - George Nune
- USC Keck Memorial Hospital, Los Angeles, CA, United States
| | - Hui Gong
- Rancho Los Amigos National Rehabilitation Hospital, Los Angeles, CA, United States
| | - Susan Shaw
- Rancho Los Amigos National Rehabilitation Hospital, Los Angeles, CA, United States
| | - Vasilis Z Marmarelis
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Theodore W Berger
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Sam A Deadwyler
- Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Dong Song
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Robert E Hampson
- Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
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Williams MM, Sohrabi AK, Kittel CA, White JJ, Cramer CK, Lanier CM, Ruiz J, Xing F, Li W, Whitlow CT, Tatter SB, Chan MD, Laxton AW. Delayed Imaging Changes 18 Months or Longer After Stereotactic Radiosurgery for Brain Metastases: Necrosis or Progression. World Neurosurg 2024; 181:e453-e458. [PMID: 37865197 DOI: 10.1016/j.wneu.2023.10.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVE Imaging changes after stereotactic radiosurgery (SRS) can occur for years after treatment, although the available data on the incidence of tumor progression and adverse radiation effects (ARE) are generally limited to the first 2 years after treatment. METHODS A single-institution retrospective review was conducted of patients who had >18 months of imaging follow-up available. Patients who had ≥1 metastatic brain lesions treated with Gamma Knife SRS were assessed for the time to radiographic progression. Those with progression ≥18 months after the initial treatment were included in the present study. The lesions that progressed were characterized as either ARE or tumor progression based on the tissue diagnosis or imaging characteristics over time. RESULTS The cumulative incidence of delayed imaging radiographic progression was 35% at 5 years after the initial SRS. The cumulative incidence curves of the time to radiographic progression for lesions determined to be ARE and lesions determined to be tumor progression were not significantly different statistically. The cumulative incidence of delayed ARE and delayed tumor progression was 17% and 16% at 5 years, respectively. Multivariate analysis indicated that the number of metastatic brain lesions present at the initial SRS was the only factor associated with late radiographic progression. CONCLUSIONS The timing of late radiographic progression does not differ between ARE and tumor progression. The number of metastatic brain lesions at the initial SRS is a risk factor for late radiographic progression.
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Affiliation(s)
- Michelle M Williams
- Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Arian K Sohrabi
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Carol A Kittel
- Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Jaclyn J White
- Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Christina K Cramer
- Department of Medicine (Hematology & Oncology), Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Claire M Lanier
- Department of Medicine (Hematology & Oncology), Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Jimmy Ruiz
- Department of Cancer Biology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Fei Xing
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Wencheng Li
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Christopher T Whitlow
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Stephen B Tatter
- Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael D Chan
- Department of Medicine (Hematology & Oncology), Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Adrian W Laxton
- Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
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Sands LP, Jiang A, Liebenow B, DiMarco E, Laxton AW, Tatter SB, Montague PR, Kishida KT. Subsecond fluctuations in extracellular dopamine encode reward and punishment prediction errors in humans. Sci Adv 2023; 9:eadi4927. [PMID: 38039368 PMCID: PMC10691773 DOI: 10.1126/sciadv.adi4927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 11/03/2023] [Indexed: 12/03/2023]
Abstract
In the mammalian brain, midbrain dopamine neuron activity is hypothesized to encode reward prediction errors that promote learning and guide behavior by causing rapid changes in dopamine levels in target brain regions. This hypothesis (and alternatives regarding dopamine's role in punishment-learning) has limited direct evidence in humans. We report intracranial, subsecond measurements of dopamine release in human striatum measured, while volunteers (i.e., patients undergoing deep brain stimulation surgery) performed a probabilistic reward and punishment learning choice task designed to test whether dopamine release encodes only reward prediction errors or whether dopamine release may also encode adaptive punishment learning signals. Results demonstrate that extracellular dopamine levels can encode both reward and punishment prediction errors within distinct time intervals via independent valence-specific pathways in the human brain.
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Affiliation(s)
- L. Paul Sands
- Neuroscience Graduate Program, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
| | - Angela Jiang
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
| | - Brittany Liebenow
- Neuroscience Graduate Program, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
| | - Emily DiMarco
- Neuroscience Graduate Program, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
| | - Adrian W. Laxton
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
| | - Stephen B. Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
| | - P. Read Montague
- Wellcome Centre for Human Neuroimaging, University College London, WC1N 3BG London, UK
- Fralin Biomedical Research Institute, Virginia Tech, Roanoke, VA 24016, USA
- Department of Physics, Virginia Tech, Blacksburg, VA 24061, USA
| | - Kenneth T. Kishida
- Neuroscience Graduate Program, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
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Youngerman BE, Banu MA, Khan F, McKhann GM, Schevon CA, Jagid JR, Cajigas I, Theodotou CB, Ko A, Buckley R, Ojemann JG, Miller JW, Laxton AW, Couture DE, Popli GS, Buch VP, Halpern CH, Le S, Sharan AD, Sperling MR, Mehta AD, Englot DJ, Neimat JS, Konrad PE, Sheth SA, Neal EG, Vale FL, Holloway KL, Air EL, Schwalb JM, D'Haese PF, Wu C. Long-term outcomes of mesial temporal laser interstitial thermal therapy for drug-resistant epilepsy and subsequent surgery for seizure recurrence: a multi-centre cohort study. J Neurol Neurosurg Psychiatry 2023; 94:879-886. [PMID: 37336643 PMCID: PMC10776034 DOI: 10.1136/jnnp-2022-330979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/30/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a minimally invasive alternative to surgical resection for drug-resistant mesial temporal lobe epilepsy (mTLE). Reported rates of seizure freedom are variable and long-term durability is largely unproven. Anterior temporal lobectomy (ATL) remains an option for patients with MRgLITT treatment failure. However, the safety and efficacy of this staged strategy is unknown. METHODS This multicentre, retrospective cohort study included 268 patients consecutively treated with mesial temporal MRgLITT at 11 centres between 2012 and 2018. Seizure outcomes and complications of MRgLITT and any subsequent surgery are reported. Predictive value of preoperative variables for seizure outcome was assessed. RESULTS Engel I seizure freedom was achieved in 55.8% (149/267) at 1 year, 52.5% (126/240) at 2 years and 49.3% (132/268) at the last follow-up ≥1 year (median 47 months). Engel I or II outcomes were achieved in 74.2% (198/267) at 1 year, 75.0% (180/240) at 2 years and 66.0% (177/268) at the last follow-up. Preoperative focal to bilateral tonic-clonic seizures were independently associated with seizure recurrence. Among patients with seizure recurrence, 14/21 (66.7%) became seizure-free after subsequent ATL and 5/10 (50%) after repeat MRgLITT at last follow-up≥1 year. CONCLUSIONS MRgLITT is a viable treatment with durable outcomes for patients with drug-resistant mTLE evaluated at a comprehensive epilepsy centre. Although seizure freedom rates were lower than reported with ATL, this series represents the early experience of each centre and a heterogeneous cohort. ATL remains a safe and effective treatment for well-selected patients who fail MRgLITT.
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Affiliation(s)
- Brett E Youngerman
- Department of Neurological Surgery, Columbia University, New York, New York, USA
| | - Matei A Banu
- Department of Neurological Surgery, Columbia University, New York, New York, USA
| | - Farhan Khan
- Department of Neurological Surgery, Columbia University, New York, New York, USA
| | - Guy M McKhann
- Department of Neurological Surgery, Columbia University, New York, New York, USA
| | | | - Jonathan R Jagid
- Department of Neurological Surgery, Jackson Memorial Hospital, University of Miami, Miami, Florida, USA
| | - Iahn Cajigas
- Department of Neurological Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christian B Theodotou
- Department of Neurological Surgery, Jackson Memorial Hospital, University of Miami, Miami, Florida, USA
| | - Andrew Ko
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Robert Buckley
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Jeffrey G Ojemann
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - John W Miller
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Adrian W Laxton
- Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Daniel E Couture
- Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Gautam S Popli
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Vivek P Buch
- Department of Neurological Surgery, Stanford Neuroscience Health Center, Stanford, California, USA
| | - Casey H Halpern
- Department of Neurological Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Scheherazade Le
- Department of Neurology, Stanford Comprehensive Epilepsy Center, Stanford, California, USA
| | - Ashwini D Sharan
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael R Sperling
- Department of Neurology, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ashesh D Mehta
- Department of Neurological Surgery, Zucker School of Medicine at Hofstra Northwell, Hempstead, New York, USA
| | - Dario J Englot
- Department of Neurological Surgery, Vanderbilt University, Nashville, Nashville, Tennessee, USA
| | - Joseph S Neimat
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Peter E Konrad
- Department of Neurological Surgery, Vanderbilt University, Nashville, Nashville, Tennessee, USA
| | - Sameer A Sheth
- Department of Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Elliot G Neal
- Department of Neurological Surgery, University of South Florida Health South Tampa Center, Tampa, Florida, USA
| | - Fernando L Vale
- Department of Neurological Surgery, Medical College of Georgia-Augusta University, Augusta, Georgia, USA
| | - Kathryn L Holloway
- Department of Neurological Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Ellen L Air
- Department of Neurological Surgery, Henry Ford Health, Detroit, Michigan, USA
| | - Jason M Schwalb
- Department of Neurological Surgery, Henry Ford Health, Detroit, Michigan, USA
| | - Pierre-François D'Haese
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Chengyuan Wu
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Liebenow B, Wilson T, Maas B, Aladnani E, Moran RJ, White J, Lohrenz T, Haq IU, Siddiqui MS, Laxton AW, Tatter SB, Montague PR, Kishida KT. Sub-second Dopamine Signals during Risky Decision-Making in Patients with Impulse Control Disorder. bioRxiv 2023:2023.09.11.557178. [PMID: 37745618 PMCID: PMC10515865 DOI: 10.1101/2023.09.11.557178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Background Impulse Control Disorder (ICD) in Parkinson's disease is a behavioral addiction arising secondary to dopaminergic therapies, most often dopamine receptor agonists. Prior research implicates changes in striatal function and heightened dopaminergic activity in the dorsal striatum of patients with ICD. However, this prior work does not possess the temporal resolution required to investigate dopaminergic signaling during real-time progression through various stages of decision-making involving anticipation and feedback. Methods We recorded high-frequency (10Hz) measurements of extracellular dopamine in the striatum of patients with (N=3) and without (N=3) a history of ICD secondary to dopamine receptor agonist therapy for Parkinson's disease symptoms. These measurements were made using carbon fiber microelectrodes during awake DBS neurosurgery and while participants performed a sequential decision-making task involving risky investment decisions and real monetary gains and losses. Per clinical standard-of-care, participants withheld all dopaminergic medications prior to the procedure. Results Patients with ICD invested significantly more money than patients without ICD. On each trial, patients with ICD made smaller adjustments to their investment levels compared to patients without ICD. In patients with ICD, dopamine levels rose or fell on sub-second timescales in anticipation of investment outcomes consistent with increased or decreased confidence in a positive outcome, respectively; dopamine levels in patients without ICD were significantly more stable during this phase. After outcome revelation, dopamine levels in patients with ICD rose significantly more than in inpatients without ICD for better-than-expected gains. For worse-than-expected losses, dopamine levels in patients with ICD remained level whereas dopamine levels in patients without ICD fell. Conclusion We report significantly increased risky behavior and exacerbated phasic dopamine signaling, on sub-second timescales, anticipating and following the revelation of the outcomes of risky decisions in patients with ICD. Notably, these results were obtained when patients who had demonstrated ICD in the past but were, at the time of surgery, in an off-medication state. Thus, it is unclear whether observed signals reflect an inherent predisposition for ICD that was revealed when dopamine receptor agonists were introduced or whether these observations were caused by the introduction of dopamine receptor agonists and the patients having experienced ICD symptoms in the past. Regardless, future work investigating dopamine's role in human cognition, behavior, and disease should consider the signals this system generates on sub-second timescales.
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Liebenow B, Jiang A, DiMarco E, Wilson T, Siddiqui MS, Ul Haq I, Laxton AW, Tatter SB, Kishida KT. Intracranial subsecond dopamine measurements during a "sure bet or gamble" decision-making task in patients with alcohol use disorder suggest diminished dopaminergic signals about relief. Neurosurg Focus 2023; 54:E3. [PMID: 36724520 PMCID: PMC10368179 DOI: 10.3171/2022.11.focus22614] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/17/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To the authors' knowledge, no data have been reported on dopamine fluctuations on subsecond timescales in humans with alcohol use disorder (AUD). In this study, dopamine release was monitored in 2 patients with and 2 without a history of AUD during a "sure bet or gamble" (SBORG) decision-making task to begin to characterize how subsecond dopamine responses to counterfactual information, related to psychological notions of regret and relief, in AUD may be altered. METHODS Measurements of extracellular dopamine levels were made once every 100 msec using human voltammetric methods. Measurements were made in the caudate during deep brain stimulation electrode implantation surgeries (for treatment of movement disorders) in patients who did (AUD, n = 2) or did not (non-AUD, n = 2) have a history of AUD. Participants performed an SBORG decision-making task in which they made choices between sure bets and 50%-chance monetary gamble outcomes. RESULTS Fast changes were found in dopamine levels that appear to be modulated by "what could have been" and by patients' AUD status. Positive counterfactual prediction errors (related to relief) differentiated patients with versus without a history of AUD. CONCLUSIONS Dopaminergic encoding of counterfactual information appears to differ between patients with and without AUD. The current study has a major limitation of a limited sample size, but these data provide a rare insight into dopaminergic physiology during real-time decision-making in humans with an addiction disorder. The authors hope future work will expand the sample size and determine the generalizability of the current results.
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Affiliation(s)
- Brittany Liebenow
- 1Neuroscience Graduate Program.,2Department of Physiology and Pharmacology
| | | | - Emily DiMarco
- 1Neuroscience Graduate Program.,2Department of Physiology and Pharmacology
| | | | - Mustafa S Siddiqui
- 3Department of Neurosurgery, and.,4Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina; and
| | - Ihtsham Ul Haq
- 5Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida
| | | | | | - Kenneth T Kishida
- 1Neuroscience Graduate Program.,2Department of Physiology and Pharmacology.,3Department of Neurosurgery, and
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9
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Abdulhaleem M, Johnston H, D'Agostino R, Lanier C, Cramer CK, Triozzi P, Lo HW, Xing F, Li W, Whitlow C, White JJ, Tatter SB, Laxton AW, Su J, Chan MD, Ruiz J. Patterns of Failure Outcomes for Combination of Stereotactic Radiosurgery and Immunotherapy for Melanoma Brain Metastases. Neurosurgery Open 2023. [DOI: 10.1227/neuprac.0000000000000026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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10
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Pearce JB, Hsu FC, Lanier CM, Cramer CK, Ruiz J, Lo HW, Xing F, Smith M, Li W, Whitlow C, White JJ, Tatter SB, Laxton AW, Chan MD. Five-Year Survivors from Brain Metastases Treated with Stereotactic Radiosurgery: Biology, Improving Treatments or Just Plain Luck? Neurooncol Pract 2022; 10:195-202. [PMID: 36970170 PMCID: PMC10037943 DOI: 10.1093/nop/npac095] [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: 12/15/2022] Open
Abstract
Abstract
Background
Improvements in therapies have led to an increasing number of long-term survivors of brain metastases. The present series compares a population of five-year survivors of brain metastases to a generalized brain metastases population to assess for factors attributable to long-term survival.
Methods
A single institution retrospective review was performed to identify five-year survivors of brain metastases who received stereotactic radiosurgery (SRS). A historical control population of 737 patients with brain metastases was used to assess similarities and differences between the long-term survivor population and the general population treated with SRS.
Results
98 patients with brain metastases were found to have survived over 60 months. No differences between long term survivors and controls were identified with regards to age at first SRS (P=0.19), primary cancer distribution (P=0.80), and number of metastases at first SRS (P=0.90). Cumulative incidence of neurologic death at six, eight and ten years for the long-term survivor cohort was 4.8%, 16%, and 16% respectively. In the historical controls, cumulative incidence of neurologic death reached a plateau at 40% after 4.9 years. A significant difference in the distribution of burden of disease at the time of first SRS was found between the five-year survivors and the control (P=0.0049). 58% of five-year survivors showed no evidence of clinical disease at the last follow-up.
Conclusion
Five-year survivors of brain metastases represent a diverse histologic population, suggesting a small population of oligometastatic and indolent cancers exist for each cancer type.
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Affiliation(s)
- Jane B Pearce
- Department of Radiation Oncology, Wake Forest School of Medicine , Winston-Salem, NC
| | - Fang-Chi Hsu
- Department of Biostatistics and Data Science, Wake Forest School of Medicine , Winston-Salem, NC
| | - Claire M Lanier
- Department of Radiation Oncology, Wake Forest School of Medicine , Winston-Salem, NC
| | - Christina K Cramer
- Department of Radiation Oncology, Wake Forest School of Medicine , Winston-Salem, NC
| | - Jimmy Ruiz
- Department of Medicine (Hematology & Oncology), Wake Forest School of Medicine , Winston-Salem, NC
| | - Hui-Wen Lo
- Department of Cancer Biology, Wake Forest School of Medicine , Winston-Salem, NC
| | - Fei Xing
- Department of Cancer Biology, Wake Forest School of Medicine , Winston-Salem, NC
| | - Margaret Smith
- Department of Cancer Biology, Wake Forest School of Medicine , Winston-Salem, NC
| | - Wencheng Li
- Department of Pathology, Wake Forest School of Medicine , Winston-Salem, NC
| | | | - Jaclyn J White
- Department of Neurosurgery, Wake Forest School of Medicine , Winston-Salem, NC
| | - Stephen B Tatter
- Department of Neurosurgery, Wake Forest School of Medicine , Winston-Salem, NC
| | - Adrian W Laxton
- Department of Neurosurgery, Wake Forest School of Medicine , Winston-Salem, NC
| | - Michael D Chan
- Department of Radiation Oncology, Wake Forest School of Medicine , Winston-Salem, NC
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11
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Clark CC, Yoo KM, Sivakumar H, Strumpf K, Laxton AW, Tatter SB, Strowd RE, Skardal A. Immersion bioprinting of hyaluronan and collagen bioink-supported 3D patient-derived brain tumor organoids. Biomed Mater 2022; 18. [PMID: 36332268 DOI: 10.1088/1748-605x/aca05d] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 11/04/2022] [Indexed: 11/06/2022]
Abstract
Organoids, and in particular patient-derived organoids, have emerged as crucial tools for cancer research. Our organoid platform, which has supported patient-derived tumor organoids (PTOs) from a variety of tumor types, has been based on the use of hyaluronic acid (HA) and collagen, or gelatin, hydrogel bioinks. One hurdle to high throughput PTO biofabrication is that as high-throughput multi-well plates, bioprinted volumes have increased risk of contacting the sides of wells. When this happens, surface tension causes bioinks to fall flat, resulting in 2D cultures. To address this problem, we developed an organoid immersion bioprinting method-inspired by the FRESH printing method-in which organoids are bioprinted into support baths in well plates. The bath-in this case an HA solution-shields organoids from the well walls, preventing deformation. Here we describe an improvement to our approach, based on rheological assessment of previous gelatin baths versus newer HA support baths, combined with morphological assessment of immersion bioprinted organoids. HA print baths enabled more consistent organoid volumes and geometries. We optimized the printing parameters of this approach using a cell line. Finally, we deployed our optimized immersion bioprinting approach into a drug screening application, using PTOs derived from glioma biospecimens, and a lung adenocarcinoma brain metastasis. In these studies, we showed a general dose dependent response to an experimental p53 activator compound and temozolomide (TMZ), the drug most commonly given to brain tumor patients. Responses to the p53 activator compound were effective across all PTO sets, while TMZ responses were observed, but less pronounced, potentially explained by genetic and epigenetic states of the originating tumors. The studies presented herein showcase a bioprinting methodology that we hope can be used in increased throughput settings to help automate biofabrication of PTOs for drug development-based screening studies and precision medicine applications.
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Affiliation(s)
- Casey C Clark
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, 391 Technology Way, Winston-Salem, NC 27101, United States of America.,Department of Biomedical Engineering, Wake Forest School of Medicine, 575 Patterson Avenue, Winston-Salem, NC 27101, United States of America
| | - Kyung Min Yoo
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, 391 Technology Way, Winston-Salem, NC 27101, United States of America
| | - Hemamylammal Sivakumar
- Department of Biomedical Engineering, The Ohio State University, 140 W. 19th Avenue, Columbus, OH 43210, United States of America
| | - Kristina Strumpf
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, 391 Technology Way, Winston-Salem, NC 27101, United States of America
| | - Adrian W Laxton
- Department of Neurosurgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States of America.,Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, United States of America
| | - Stephen B Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States of America.,Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, United States of America
| | - Roy E Strowd
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, United States of America.,Department of Neurology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States of America
| | - Aleksander Skardal
- Department of Biomedical Engineering, The Ohio State University, 140 W. 19th Avenue, Columbus, OH 43210, United States of America.,The Ohio State University and Arthur G James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States of America
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12
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Lanier CM, Pearce J, Isom S, Xing F, Lo HW, Whitlow CT, Ruiz J, White JJ, Laxton AW, Tatter SB, Cramer CK, Chan MD. Long term survivors of stereotactic radiosurgery for brain metastases: do distant brain failures reach a plateau and what factors are associated with a brain metastasis velocity of zero? J Neurooncol 2022; 160:643-648. [DOI: 10.1007/s11060-022-04183-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/22/2022] [Indexed: 11/09/2022]
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13
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Farris JC, Steber CR, Black PJ, Chan MD, Ververs JD, Cramer CK, Browne JD, Waltonen JD, Sullivan CA, Patwa HS, Laxton AW, Tatter SB, Frizzell BA, Porosnicu M, Lycan TW, Greven KM, Hughes RT. Intensity-modulated radiotherapy with planned Gamma Knife radiosurgery boost for head and neck cancer with extensive disease in proximity to critical structures. Head Neck 2022; 44:2571-2578. [PMID: 36047613 PMCID: PMC9813854 DOI: 10.1002/hed.27176] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/14/2022] [Accepted: 08/16/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND To describe intensity-modulated radiotherapy (IMRT) with Gamma Knife Radiosurgery (GKRS) boost for locally advanced head and neck cancer (HNC) with disease near dose-limiting structures. METHODS Patients with HNC treated with IMRT/GKRS as part of a combined modality approach between 2011 and 2021 were reviewed. Local control, overall survival and disease-specific survival were estimated using the Kaplan Meier method. RESULTS Twenty patients were included. Nineteen patients had T3-4 tumors. Median follow-up was 26.3 months. GKRS site control was 95%. Two patients progressed at the treated primary site, one patient failed at the edge of the GKRS treatment volume, with no perineural or intracranial failure. 2-year OS was 94.7% (95% CI: 85.2%-100%). Concurrent chemotherapy was given in nine patients (45%). One patient (5%) received induction/concurrent chemotherapy. Brain radionecrosis occurred in three patients, one of which was biopsy-proven. CONCLUSIONS IMRT plus GKRS boost results in excellent disease control near critical structures with minimal toxicity.
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Affiliation(s)
- Joshua C. Farris
- Department of Radiation OncologyWake Forest School of MedicineWinston SalemNorth CarolinaUSA
| | - Cole R. Steber
- Department of Radiation OncologyWake Forest School of MedicineWinston SalemNorth CarolinaUSA
| | - Paul J. Black
- Department of Radiation OncologyWake Forest School of MedicineWinston SalemNorth CarolinaUSA
| | - Michael D. Chan
- Department of Radiation OncologyWake Forest School of MedicineWinston SalemNorth CarolinaUSA
| | - James D. Ververs
- Department of Radiation OncologyWake Forest School of MedicineWinston SalemNorth CarolinaUSA
| | - Christina K. Cramer
- Department of Radiation OncologyWake Forest School of MedicineWinston SalemNorth CarolinaUSA
| | - James D. Browne
- Department OtolaryngologyWake Forest School of MedicineWinston SalemNorth CarolinaUSA
| | - Joshua D. Waltonen
- Department OtolaryngologyWake Forest School of MedicineWinston SalemNorth CarolinaUSA
| | | | - Hafiz S. Patwa
- Department OtolaryngologyWake Forest School of MedicineWinston SalemNorth CarolinaUSA
| | - Adrian W. Laxton
- Department of NeurosurgeryWake Forest School of MedicineWinston SalemNorth CarolinaUSA
| | - Stephen B. Tatter
- Department of NeurosurgeryWake Forest School of MedicineWinston SalemNorth CarolinaUSA
| | - Bart A. Frizzell
- Department of Radiation OncologyWake Forest School of MedicineWinston SalemNorth CarolinaUSA
| | - Mercedes Porosnicu
- Department of Radiation OncologyWake Forest School of MedicineWinston SalemNorth CarolinaUSA,Department of Internal Medicine, Section of Hematology and OncologyWake Forest School of MedicineWinston SalemNorth CarolinaUSA
| | - Thomas W. Lycan
- Department of Radiation OncologyWake Forest School of MedicineWinston SalemNorth CarolinaUSA,Department of Internal Medicine, Section of Hematology and OncologyWake Forest School of MedicineWinston SalemNorth CarolinaUSA
| | - Kathryn M. Greven
- Department of Radiation OncologyWake Forest School of MedicineWinston SalemNorth CarolinaUSA
| | - Ryan T. Hughes
- Department of Radiation OncologyWake Forest School of MedicineWinston SalemNorth CarolinaUSA
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14
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Roeder BM, Riley MR, She X, Dakos AS, Robinson BS, Moore BJ, Couture DE, Laxton AW, Popli G, Munger Clary HM, Sam M, Heck C, Nune G, Lee B, Liu C, Shaw S, Gong H, Marmarelis VZ, Berger TW, Deadwyler SA, Song D, Hampson RE. Corrigendum: Patterned hippocampal stimulation facilitates memory in patients with a history of head impact and/or brain injury. Front Hum Neurosci 2022; 16:1039221. [PMID: 36277045 PMCID: PMC9583523 DOI: 10.3389/fnhum.2022.1039221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
- Brent M. Roeder
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Mitchell R. Riley
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Xiwei She
- Department Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| | - Alexander S. Dakos
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Brian S. Robinson
- Department Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| | - Bryan J. Moore
- Department Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| | - Daniel E. Couture
- Department of Neurosurgery, Wake Forest School of Medicine/Atrium Health Wake Forest Baptist, Winston-Salem, NC, United States
| | - Adrian W. Laxton
- Department of Neurosurgery, Wake Forest School of Medicine/Atrium Health Wake Forest Baptist, Winston-Salem, NC, United States
| | - Gautam Popli
- Department of Neurology, Wake Forest School of Medicine/Atrium Health Wake Forest Baptist, Winston-Salem, NC, United States
| | - Heidi M. Munger Clary
- Department of Neurology, Wake Forest School of Medicine/Atrium Health Wake Forest Baptist, Winston-Salem, NC, United States
| | - Maria Sam
- Department of Neurology, Wake Forest School of Medicine/Atrium Health Wake Forest Baptist, Winston-Salem, NC, United States
| | - Christi Heck
- Department of Neurology, W. M. Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - George Nune
- Department of Neurology, W. M. Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Brian Lee
- Department of Neurosurgery, W. M. Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Charles Liu
- Department of Neurosurgery, W. M. Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Susan Shaw
- Department of Neurology, Rancho Los Amigos National Rehabilitation Hospital, Los Angeles, CA, United States
| | - Hui Gong
- Department of Neurology, Rancho Los Amigos National Rehabilitation Hospital, Los Angeles, CA, United States
| | - Vasilis Z. Marmarelis
- Department Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| | - Theodore W. Berger
- Department Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| | - Sam A. Deadwyler
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Dong Song
- Department Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| | - Robert E. Hampson
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, United States
- Department of Neurology, Wake Forest School of Medicine/Atrium Health Wake Forest Baptist, Winston-Salem, NC, United States
- *Correspondence: Robert E. Hampson
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15
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Roeder BM, Riley MR, She X, Dakos AS, Robinson BS, Moore BJ, Couture DE, Laxton AW, Popli G, Munger Clary HM, Sam M, Heck C, Nune G, Lee B, Liu C, Shaw S, Gong H, Marmarelis VZ, Berger TW, Deadwyler SA, Song D, Hampson RE. Patterned Hippocampal Stimulation Facilitates Memory in Patients With a History of Head Impact and/or Brain Injury. Front Hum Neurosci 2022; 16:933401. [PMID: 35959242 PMCID: PMC9358788 DOI: 10.3389/fnhum.2022.933401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/13/2022] [Indexed: 11/24/2022] Open
Abstract
Rationale: Deep brain stimulation (DBS) of the hippocampus is proposed for enhancement of memory impaired by injury or disease. Many pre-clinical DBS paradigms can be addressed in epilepsy patients undergoing intracranial monitoring for seizure localization, since they already have electrodes implanted in brain areas of interest. Even though epilepsy is usually not a memory disorder targeted by DBS, the studies can nevertheless model other memory-impacting disorders, such as Traumatic Brain Injury (TBI). Methods: Human patients undergoing Phase II invasive monitoring for intractable epilepsy were implanted with depth electrodes capable of recording neurophysiological signals. Subjects performed a delayed-match-to-sample (DMS) memory task while hippocampal ensembles from CA1 and CA3 cell layers were recorded to estimate a multi-input, multi-output (MIMO) model of CA3-to-CA1 neural encoding and a memory decoding model (MDM) to decode memory information from CA3 and CA1 neuronal signals. After model estimation, subjects again performed the DMS task while either MIMO-based or MDM-based patterned stimulation was delivered to CA1 electrode sites during the encoding phase of the DMS trials. Each subject was sorted (post hoc) by prior experience of repeated and/or mild-to-moderate brain injury (RMBI), TBI, or no history (control) and scored for percentage successful delayed recognition (DR) recall on stimulated vs. non-stimulated DMS trials. The subject’s medical history was unknown to the experimenters until after individual subject memory retention results were scored. Results: When examined compared to control subjects, both TBI and RMBI subjects showed increased memory retention in response to both MIMO and MDM-based hippocampal stimulation. Furthermore, effects of stimulation were also greater in subjects who were evaluated as having pre-existing mild-to-moderate memory impairment. Conclusion: These results show that hippocampal stimulation for memory facilitation was more beneficial for subjects who had previously suffered a brain injury (other than epilepsy), compared to control (epilepsy) subjects who had not suffered a brain injury. This study demonstrates that the epilepsy/intracranial recording model can be extended to test the ability of DBS to restore memory function in subjects who previously suffered a brain injury other than epilepsy, and support further investigation into the beneficial effect of DBS in TBI patients.
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Affiliation(s)
- Brent M. Roeder
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Mitchell R. Riley
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Xiwei She
- Department Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| | - Alexander S. Dakos
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Brian S. Robinson
- Department Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| | - Bryan J. Moore
- Department Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| | - Daniel E. Couture
- Department of Neurosurgery, Wake Forest School of Medicine/Atrium Health Wake Forest Baptist, Winston-Salem, NC, United States
| | - Adrian W. Laxton
- Department of Neurosurgery, Wake Forest School of Medicine/Atrium Health Wake Forest Baptist, Winston-Salem, NC, United States
| | - Gautam Popli
- Department of Neurology, Wake Forest School of Medicine/Atrium Health Wake Forest Baptist, Winston-Salem, NC, United States
| | - Heidi M. Munger Clary
- Department of Neurology, Wake Forest School of Medicine/Atrium Health Wake Forest Baptist, Winston-Salem, NC, United States
| | - Maria Sam
- Department of Neurology, Wake Forest School of Medicine/Atrium Health Wake Forest Baptist, Winston-Salem, NC, United States
| | - Christi Heck
- Department of Neurology, W. M. Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - George Nune
- Department of Neurology, W. M. Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Brian Lee
- Department of Neurosurgery, W. M. Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Charles Liu
- Department of Neurosurgery, W. M. Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Susan Shaw
- Department of Neurology, Rancho Los Amigos National Rehabilitation Hospital, Los Angeles, CA, United States
| | - Hui Gong
- Department of Neurology, Rancho Los Amigos National Rehabilitation Hospital, Los Angeles, CA, United States
| | - Vasilis Z. Marmarelis
- Department Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| | - Theodore W. Berger
- Department Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| | - Sam A. Deadwyler
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Dong Song
- Department Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| | - Robert E. Hampson
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, United States
- Department of Neurology, Wake Forest School of Medicine/Atrium Health Wake Forest Baptist, Winston-Salem, NC, United States
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16
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Helis CA, Prim SN, Cramer CK, Strowd R, Lesser GJ, White JJ, Tatter SB, Laxton AW, Whitlow C, Lo HW, Debinski W, Ververs JD, Black PJ, Chan MD. Clinical Outcomes of Dose Escalated Re-Irradiation in Patients with Recurrent High Grade Glioma. Neurooncol Pract 2022; 9:390-401. [PMID: 36134018 PMCID: PMC9476990 DOI: 10.1093/nop/npac032] [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: 11/12/2022] Open
Abstract
Abstract
Background
Reirradiation for recurrent gliomas is a controversial treatment option with no clear standard dose or concurrent systemic therapy.
Methods
This series represents a single institution retrospective review of patients treated with re-irradiation for recurrent high grade glioma. After 2012, patients were commonly offered concurrent bevacizumab as a cytoprotective agent against radiation necrosis. Kaplan Meier method was used to estimate overall and progression-free survival. Cox proportional hazards regression was used to identify factors associated with overall and progression-free survival.
Results
Between 2001 and 2021, 52 patients underwent re-irradiation for a diagnosis of recurrent high grade glioma. 36 patients (69.2%) had a histologic diagnosis of glioblastoma at time of re-irradiation. The median BED10 (biologic equivalent dose 10 Gy) of re-irradiation was 53.1 Gy . Twenty-one patients (40.4%) received concurrent bevacizumab with re-irradiation. Median survival for the entire cohort and for glioblastoma at time of recurrence patients was 6.7 months and 6.0 months , respectively. For patients with glioblastoma at time of recurrence, completing re-irradiation (HR 0.03, p < 0.001), use of concurrent bevacizumab (HR 0.3, p=0.009), and the BED10 (HR 0.9, p=0.005) were predictive of overall survival. Nine patients developed Grade 3-5 toxicity; of these, 2 received concurrent bevacizumab and 7 did not (p=0.15).
Conclusion
High dose re-irradiation with concurrent bevacizumab is feasible in patients with recurrent gliomas. Concurrent bevacizumab and increasing radiation dose may improve survival in recurrent glioblastoma patients.
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Affiliation(s)
- Corbin A Helis
- Department of Radiation Oncology, Fort Belvoir Community Hospital, Fort Belvoir, VA
| | - Shih-Ni Prim
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Christina K Cramer
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Roy Strowd
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Glenn J Lesser
- Department of Medicine (Hematology & Oncology), Wake Forest School of Medicine, Winston-Salem, NC
| | - Jaclyn J White
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC
| | - Stephen B Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC
| | - Adrian W Laxton
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC
| | | | - Hui-Wen Lo
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Waldemar Debinski
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC
| | - James D Ververs
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Paul J Black
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Michael D Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC
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17
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de Groot JF, Kim AH, Prabhu S, Rao G, Laxton AW, Fecci PE, O’Brien BJ, Sloan A, Chiang V, Tatter SB, Mohammadi AM, Placantonakis DG, Strowd RE, Chen C, Hadjipanayis C, Khasraw M, Sun D, Piccioni D, Sinicrope KD, Campian JL, Kurz SC, Williams B, Smith K, Tovar-Spinoza Z, Leuthardt EC. Efficacy of Laser Interstitial Thermal Therapy (LITT) for Newly Diagnosed and Recurrent IDH Wild-type Glioblastoma. Neurooncol Adv 2022; 4:vdac040. [PMID: 35611270 PMCID: PMC9122789 DOI: 10.1093/noajnl/vdac040] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Treatment options for unresectable new and recurrent glioblastoma remain limited. Laser ablation has demonstrated safety as a surgical approach to treat primary brain tumors. The LAANTERN prospective multicenter registry (NCT02392078) data was analyzed to determine clinical outcomes for patients with new and recurrent IDH wild-type glioblastoma.
Methods
Demographics, intraprocedural data, adverse events, KPS, health-economics, and survival data were prospectively collected then analyzed on IDH wild-type newly diagnosed and recurrent glioblastoma patients who were treated with laser ablation at 14 US centers between January 2016 and May 2019. Data was monitored for accuracy. Statistical analysis included individual variable summaries, multivariable differences in survival, and median survival numbers.
Results
A total of 29 new and 60 recurrent IDH wild-type WHO grade 4 glioblastoma patients were treated. Positive MGMT promoter methylation status was present in 5/29 of new and 23/60 of recurrent patients. Median physician-estimated extent of ablation was 91-99%. Median overall-survival was 9.73 months (95% confidence interval: 5.16, 15.91) for newly diagnosed patients and median post-procedure survival was 8.97 (6.94, 12.36) months for recurrent patients. Median overall-survival for newly diagnosed patients receiving post-LITT chemo/radiation was 16.14 months (6.11, not reached). Factors associated with improved survival were MGMT promoter methylation, adjuvant chemotherapy within 12 weeks, and tumor volume <3cc.
Conclusions
Laser ablation is a viable option for patients with new and recurrent glioblastoma. Median overall survival for IDH wild type newly diagnosed glioblastoma is comparable to outcomes observed in other tumor resection studies when those patients undergo radiation and chemotherapy following LITT.
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Affiliation(s)
- John F de Groot
- Department of Neuro-Oncology
- UCSF Weill Institute for Neurosciences, San Francisco, CA
| | - Albert H Kim
- Department of Neurosurgery
- Washington University School of Medicine, St. Louis, MO
| | - Sujit Prabhu
- Department of Neurosurgery
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ganesh Rao
- Department of Neurosurgery
- Baylor College of Medicine, Houston, TX
| | - Adrian W Laxton
- Department of Neurosurgery
- Wake Forest Baptist Health, Winston-Salem, NC
| | - Peter E Fecci
- Department of Neurosurgery
- Duke University Medical Center, Durham, NC
| | - Barbara J O’Brien
- Department of Neuro-Oncology
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Andrew Sloan
- Department of Neurosurgery
- University Hospitals – Cleveland Medical Center & Seidman Cancer Center, Cleveland, OH
| | - Veronica Chiang
- Department of Neurosurgery
- Yale School of Medicine, New Haven, CT
| | - Stephen B Tatter
- Department of Neurosurgery
- Wake Forest Baptist Health, Winston-Salem, NC
| | - Alireza M Mohammadi
- Department of Neurosurgery
- Cleveland Clinic Lerner College of Medicine at CWRU, Cleveland, OH
| | | | - Roy E Strowd
- Department of Neuro-Oncology
- Wake Forest Baptist Health, Winston-Salem, NC
| | - Clark Chen
- Department of Neurosurgery
- University of Minnesota Medical Center, Minneapolis, MN
| | | | - Mustafa Khasraw
- Department of Neuro-Oncology
- Duke University Medical Center, Durham, NC
| | - David Sun
- Department of Neurosurgery
- Norton Neuroscience Institute, Louisville, KY
| | - David Piccioni
- Department of Neuro-Oncology
- University of California San Diego Health, La Jolla, CA
| | - Kaylyn D Sinicrope
- Department of Neuro-Oncology
- Norton Neuroscience Institute, Louisville, KY
| | | | - Sylvia C Kurz
- Department of Neuro-Oncology
- NYU Langone Perlmutter Cancer Center, New York, NY
| | - Brian Williams
- Department of Neurosurgery
- University of Louisville Health, Louisville, KY
| | - Kris Smith
- Department of Neurosurgery
- Barrow Neurological Institute, Phoenix, AZ
| | | | - Eric C Leuthardt
- Department of Neurosurgery
- Washington University School of Medicine, St. Louis, MO
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18
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Abdulhaleem M, Johnston H, D'Agostino R, Lanier C, LeCompte M, Cramer CK, Ruiz J, Lycan T, Lo HW, Watabe K, O'Neill S, Whitlow C, White JJ, Tatter SB, Laxton AW, Su J, Chan MD. Local control outcomes for combination of stereotactic radiosurgery and immunotherapy for non-small cell lung cancer brain metastases. J Neurooncol 2022; 157:101-107. [PMID: 35166988 DOI: 10.1007/s11060-022-03951-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 01/20/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Previous series have demonstrated CNS activity for immune checkpoint inhibitors, yet no prior data exists regarding whether this activity can improve outcomes of stereotactic radiosurgery. METHODS In this single institution retrospective series, the clinical outcomes of 80 consecutive lung cancer patients treated with concurrent immune checkpoint inhibitors and stereotactic radiosurgery were compared to 235 in the historical control cohort in which patients were treated prior to immune checkpoint inhibition being standard upfront therapy. Overall survival was estimated using the Kaplan Meier method. Cumulative incidence of local progression was estimated using a competing risk model. RESULTS Median overall survival time was improved in patients receiving upfront immunotherapy compared to the historical control group (40 months vs 8 months, p < 0.001). Factors affected overall survival include concurrent immunotherapy (HR 0.23, p < 0.0001) and KPS (HR 0.97, p = 0.0001). Cumulative incidence of local failure in the historical control group was 10% at 1 year, compared to 1.1% at 1 year in the concurrent immunotherapy group (p = 0.025). Factors affected local control included use of concurrent immunotherapy (HR 0.09, p = 0.012), and lowest margin dose delivered to a metastasis (HR 0.8, p = 0.0018). CONCLUSION Local control and overall survival were both improved in patients receiving concurrent immune checkpoint inhibitors with radiosurgery compared to historical controls. While these data remain to be validated, they suggest that brain metastasis patients may benefit from concurrent use of immunotherapy with SRS.
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Affiliation(s)
- Mohammed Abdulhaleem
- Department of Medicine, Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA. .,Department of Medicine, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA.
| | - Hannah Johnston
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ralph D'Agostino
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Claire Lanier
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael LeCompte
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Christina K Cramer
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jimmy Ruiz
- Department of Medicine, Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Thomas Lycan
- Department of Medicine, Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Hui-Wen Lo
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kuonosuke Watabe
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Stacey O'Neill
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Christopher Whitlow
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jaclyn J White
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Stephen B Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Adrian W Laxton
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jing Su
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael D Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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19
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Abdulhaleem M, Scott E, Johnston H, Isom S, Lanier C, LeCompte M, Cramer CK, Ruiz J, Lo HW, Watabe K, O’Neill S, Whitlow C, Tatter SB, W. Laxton A, Su J, Chan MD. Upfront immunotherapy leads to lower brain metastasis velocity in patients undergoing stereotactic radiosurgery for brain metastases. J Radiosurg SBRT 2022; 8:77-83. [PMID: 36275134 PMCID: PMC9489075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/19/2022] [Indexed: 01/03/2023]
Abstract
Background While immunotherapy has been shown to improve survival and decrease neurologic death in patients with brain metastases, it remains unclear whether this improvement is due to prevention of new metastasis to the brain. Method We performed a retrospective review of patients presenting with brain metastases simultaneously with the first diagnosis of metastatic disease and were treated with upfront immunotherapy as part of their treatment regimen and stereotactic radiosurgery (SRS) to the brain metastases. We compared this cohort with a historical control population (prior to the immunotherapy era) who were treated with pre-immunotherapy standard of care systemic therapy and with SRS to the brain metastases. Results Median overall survival time was improved in the patients receiving upfront immunotherapy compared to the historical cohort (48 months vs 8.4 months, p=0.001). Median time to distant brain failure was statistically equivalent (p=0.3) between the upfront immunotherapy cohort and historical control cohort (10.3 vs 12.6 months). Brain metastasis velocity was lower in the upfront immunotherapy cohort (median 3.72 metastases per year) than in the historical controls (median 9.48 metastases per year, p=0.001). Cumulative incidence of neurologic death at one year was 12% in the upfront immunotherapy cohort and 28% in the historical control cohort (p=0.1). Conclusions Upfront immunotherapy appears to improve overall survival and decrease BMV compared to historical controls. While these data remain to be validated, they suggest that brain metastasis patients may benefit from concurrent immunotherapy with SRS.
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Affiliation(s)
- Mohammed Abdulhaleem
- Department of Medicine, Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Emmanuel Scott
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Hannah Johnston
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Scott Isom
- Deparment of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Claire Lanier
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael LeCompte
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Christina K. Cramer
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jimmy Ruiz
- Department of Medicine, Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Hui-Wen Lo
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kuonosuke Watabe
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Stacey O’Neill
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Christopher Whitlow
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Stephen B. Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Adrian W. Laxton
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jing Su
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael D Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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20
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Lanier CM, Lecompte M, Glenn C, Hughes RT, Isom S, Jenkins W, Cramer CK, Chan M, Tatter SB, Laxton AW. A Single-Institution Retrospective Study of Patients Treated With Laser-Interstitial Thermal Therapy for Radiation Necrosis of the Brain. Cureus 2021; 13:e19967. [PMID: 34984127 PMCID: PMC8714182 DOI: 10.7759/cureus.19967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2021] [Indexed: 11/05/2022] Open
Abstract
Object Laser-interstitial thermal therapy (LITT) has been proposed as an alternative treatment to surgery for radiation necrosis (RN) in patients treated with stereotactic radiosurgery (SRS) for brain metastases. The present study sought to retrospectively analyze LITT outcomes in patients with RN from SRS. Methods This was a single-institution retrospective study of 30 patients treated from 2011-2018 with pathologically-proven RN after SRS for brain metastases (n=28) or proximally treated extracranial lesions treated with external beam radiotherapy (n=2). Same-day biopsy was performed in all cases. Patients were prospectively followed with Functional Assessment of Cancer Therapy - Brain (FACT-Br), EuroQol-5 Dimension (EQ-5D), Hopkins Verbal Learning Test (HVLT) and clinical history and examination. Adjusted means, standard errors and tests comparing visits to pre-LITT were generated. Kaplan-Meier method was used to estimate time overall survival. Competing risk analysis was used to estimate cumulative incidence of LITT failure. Results In our patient population, median time from radiotherapy to LITT was 13.1 months. Median SRS dose and median LITT treatment target volume were 20 Gy (IQR 18-22) and 3.5 cc (IQR 2.2-4.6), respectively. Seventy-seven percent of our patients tapered off steroids within one month. There were only two instances of RN recurrence after LITT, with recurrence defined as recurrence of symptoms after initial improvement. These recurrences occurred at 1.9 and 3.4 months. The three-, six- and nine-month freedom from recurrence rates were 95.7%, 90.9%, and 90.9%. Median survival in our patient population with pathologically confirmed RN treated with LITT was 2.1 years. Regarding the quality of life questionnaires with which some patients were followed as part of different prospective studies, completion rates were 22/30 for FACT-Br, 16/30 for the EQ-5D and 8/30 for HVLT. Quality of life questionnaire results were overall stable from baseline. Mean FACT-Br scores were stable from baseline (17.9, 16.6, 21.4 and 22.8) to three months (18.8, 15.4, 18.4 and 23.4) (p=0.38, 0.53, 0.09 and 0.59). The mean EQ-5D Aggregate score was stable from baseline (7.1) to one month (7.6) (p=0.25). Mean HVLT-R Total Recall was stable from baseline (20.6) to three months (18.4) (p=0.09). There was a statistically significant decrease in mean Karnofsky Performance Scale (KPS) score from baseline (84) to three-month follow-up (75) (p=0.03). Conclusions LITT represents a safe and durably effective treatment option for RN in the brain. Results demonstrate a median survival of 2.1 years from LITT with only two recurrences, both within four months of treatment and salvageable. Patient-reported outcomes showed no severe declines after LITT. Quality of life questionnaires demonstrated stable well-being and functionality from baseline. LITT should be considered for definitive treatment of RN, especially in cases where patients have significant side effects from standards medical therapies such as steroids or if steroids are minimally effective.
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21
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Su J, Song Q, Qasem S, O'Neill S, Lee J, Furdui CM, Pasche B, Metheny-Barlow L, Masters AH, Lo HW, Xing F, Watabe K, Miller LD, Tatter SB, Laxton AW, Whitlow CT, Chan MD, Soike MH, Ruiz J. Multi-Omics Analysis of Brain Metastasis Outcomes Following Craniotomy. Front Oncol 2021; 10:615472. [PMID: 33889540 PMCID: PMC8056216 DOI: 10.3389/fonc.2020.615472] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/18/2020] [Indexed: 01/27/2023] Open
Abstract
Background The incidence of brain metastasis continues to increase as therapeutic strategies have improved for a number of solid tumors. The presence of brain metastasis is associated with worse prognosis but it is unclear if distinctive biomarkers can separate patients at risk for CNS related death. Methods We executed a single institution retrospective collection of brain metastasis from patients who were diagnosed with lung, breast, and other primary tumors. The brain metastatic samples were sent for RNA sequencing, proteomic and metabolomic analysis of brain metastasis. The primary outcome was distant brain failure after definitive therapies that included craniotomy resection and radiation to surgical bed. Novel prognostic subtypes were discovered using transcriptomic data and sparse non-negative matrix factorization. Results We discovered two molecular subtypes showing statistically significant differential prognosis irrespective of tumor subtype. The median survival time of the good and the poor prognostic subtypes were 7.89 and 42.27 months, respectively. Further integrated characterization and analysis of these two distinctive prognostic subtypes using transcriptomic, proteomic, and metabolomic molecular profiles of patients identified key pathways and metabolites. The analysis suggested that immune microenvironment landscape as well as proliferation and migration signaling pathways may be responsible to the observed survival difference. Conclusion A multi-omics approach to characterization of brain metastasis provides an opportunity to identify clinically impactful biomarkers and associated prognostic subtypes and generate provocative integrative understanding of disease.
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Affiliation(s)
- Jing Su
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, United States.,Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Qianqian Song
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Shadi Qasem
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Stacey O'Neill
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Jingyun Lee
- Proteomics and Metabolomics Shared Resource, Comprehensive Cancer Center, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Cristina M Furdui
- Proteomics and Metabolomics Shared Resource, Comprehensive Cancer Center, Wake Forest University School of Medicine, Winston-Salem, NC, United States.,Department of Internal Medicine, Section on Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Boris Pasche
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Linda Metheny-Barlow
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Adrianna H Masters
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Hui-Wen Lo
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Fei Xing
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Kounosuke Watabe
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Lance D Miller
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Stephen B Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Adrian W Laxton
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Christopher T Whitlow
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Michael D Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Michael H Soike
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, United States.,Department of Radiation Oncology, University of Alabama-Birmingham, Birmingham, AL, United States
| | - Jimmy Ruiz
- Department of Medicine (Hematology & Oncology), Wake Forest School of Medicine, Winston-Salem, NC, United States.,Section of Hematology & Oncology, W.G. (Bill) Hefner Veterans Affair Medial Center (VAMC), Salisbury, NC, United States
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22
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Bang D, Kishida KT, Lohrenz T, White JP, Laxton AW, Tatter SB, Fleming SM, Montague PR. Sub-second Dopamine and Serotonin Signaling in Human Striatum during Perceptual Decision-Making. Neuron 2020; 108:999-1010.e6. [PMID: 33049201 PMCID: PMC7736619 DOI: 10.1016/j.neuron.2020.09.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/30/2020] [Accepted: 09/10/2020] [Indexed: 01/16/2023]
Abstract
Recent animal research indicates that dopamine and serotonin, neuromodulators traditionally linked to appetitive and aversive processes, are also involved in sensory inference and decisions based on such inference. We tested this hypothesis in humans by monitoring sub-second striatal dopamine and serotonin signaling during a visual motion discrimination task that separates sensory uncertainty from decision difficulty in a factorial design. Caudate nucleus recordings (n = 4) revealed multi-scale encoding: in three participants, serotonin tracked sensory uncertainty, and, in one participant, both dopamine and serotonin tracked deviations from expected trial transitions within our factorial design. Putamen recordings (n = 1) supported a cognition-action separation between caudate nucleus and putamen—a striatal sub-division unique to primates—with both dopamine and serotonin tracking decision times. These first-of-their-kind observations in the human brain reveal a role for sub-second dopamine and serotonin signaling in non-reward-based aspects of cognition and action. Dopamine and serotonin are measured in human striatum during awake decision-making Serotonin tracks sensory uncertainty in caudate nucleus Dopamine and serotonin track sensory statistics in caudate nucleus Dopamine and serotonin track decision times in putamen
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Affiliation(s)
- Dan Bang
- Wellcome Centre for Human Neuroimaging, University College London, London WC1N 3AR, UK; Department of Experimental Psychology, University of Oxford, Oxford OX2 6GG, UK.
| | - Kenneth T Kishida
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA; Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA.
| | - Terry Lohrenz
- Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA 24016, USA
| | - Jason P White
- Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA 24016, USA
| | - Adrian W Laxton
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
| | - Stephen B Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
| | - Stephen M Fleming
- Wellcome Centre for Human Neuroimaging, University College London, London WC1N 3AR, UK; Department of Experimental Psychology, University College London, London WC1H 0AP, UK; Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, WC1B 5EH, UK
| | - P Read Montague
- Wellcome Centre for Human Neuroimaging, University College London, London WC1N 3AR, UK; Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA 24016, USA; Department of Physics, Virginia Tech, Blacksburg, VA 24061, USA
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23
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Renfrow JJ, Soike MH, West JL, Ramkissoon SH, Metheny-Barlow L, Mott RT, Kittel CA, D'Agostino RB, Tatter SB, Laxton AW, Frenkel MB, Hawkins GA, Herpai D, Sanders S, Sarkaria JN, Lesser GJ, Debinski W, Strowd RE. Attenuating hypoxia driven malignant behavior in glioblastoma with a novel hypoxia-inducible factor 2 alpha inhibitor. Sci Rep 2020; 10:15195. [PMID: 32938997 PMCID: PMC7495485 DOI: 10.1038/s41598-020-72290-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/27/2020] [Indexed: 12/31/2022] Open
Abstract
Hypoxia inducible factor (HIFs) signaling contributes to malignant cell behavior in glioblastoma (GBM). We investigated a novel HIF2α inhibitor, PT2385, both in vitro, with low-passage patient-derived cell lines, and in vivo, using orthotopic models of glioblastoma. We focused on analysis of HIF2α expression in situ, cell survival/proliferation, and survival in brain tumor-bearing mice treated with PT2385 alone and in combination with standard of care chemoradiotherapy. HIF2α expression increased with glioma grade, with over half of GBM specimens HIF2α positive. Staining clustered in perivascular and perinecrotic tumor regions. Cellular phenotype including proliferation, viability, migration/invasion, and also gene expression were not altered after PT2385 treatment. In the animal model, PT2385 single-agent treatment did improve median overall survival compared to placebo (p = 0.04, n = 21) without a bioluminescence correlate (t = 0.67, p = 0.52). No difference in animal survival was seen in combination treatment with radiation (RT)/temozolomide (TMZ)/PT2385 (p = 0.44, n = 10) or mean tumor bioluminescence (t 1.13, p = 0.32). We conclude that HIF2α is a reasonable novel therapeutic target as expressed in the majority of glioblastomas in our cohort. PT2385 as a single-agent was efficacious in vivo, however, an increase in animal survival was not seen with PT2385 in combination with RT/TMZ. Further study for targeting HIF2α as a therapeutic approach in GBM is warranted.
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Affiliation(s)
- Jaclyn J Renfrow
- Department of Neurological Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
- Brain Tumor Center of Excellence, Wake Forest Comprehensive Cancer Center, Winston-Salem, NC, USA.
- One Medical Center Drive, Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, NC, 27157, USA.
| | - Michael H Soike
- Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - James L West
- Department of Neurological Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Shakti H Ramkissoon
- Department of Pathology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
- Foundation Medicine, Inc., Morrisville, NC, USA
| | - Linda Metheny-Barlow
- Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
- Brain Tumor Center of Excellence, Wake Forest Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Ryan T Mott
- Department of Pathology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
- Brain Tumor Center of Excellence, Wake Forest Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Carol A Kittel
- Department of Biostatistical Sciences, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Ralph B D'Agostino
- Brain Tumor Center of Excellence, Wake Forest Comprehensive Cancer Center, Winston-Salem, NC, USA
- Department of Biostatistical Sciences, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Stephen B Tatter
- Department of Neurological Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
- Brain Tumor Center of Excellence, Wake Forest Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Adrian W Laxton
- Department of Neurological Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
- Brain Tumor Center of Excellence, Wake Forest Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Mark B Frenkel
- Department of Neurological Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Gregory A Hawkins
- Department of Biochemistry, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Denise Herpai
- Brain Tumor Center of Excellence, Wake Forest Comprehensive Cancer Center, Winston-Salem, NC, USA
- Department of Cancer Biology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Stephanie Sanders
- Brain Tumor Center of Excellence, Wake Forest Comprehensive Cancer Center, Winston-Salem, NC, USA
- Department of Cancer Biology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Jann N Sarkaria
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Glenn J Lesser
- Brain Tumor Center of Excellence, Wake Forest Comprehensive Cancer Center, Winston-Salem, NC, USA
- Department of Internal Medicine - Section on Hematology and Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Waldemar Debinski
- Brain Tumor Center of Excellence, Wake Forest Comprehensive Cancer Center, Winston-Salem, NC, USA
- Department of Cancer Biology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Roy E Strowd
- Brain Tumor Center of Excellence, Wake Forest Comprehensive Cancer Center, Winston-Salem, NC, USA
- Department of Internal Medicine - Section on Hematology and Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
- Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
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24
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Helis CA, Hughes RT, Glenn CW, Lanier CM, Masters AH, Dohm A, Ahmed T, Ruiz J, Triozzi P, Gondal H, Cramer CK, Tatter SB, Laxton AW, Xing F, Lo HW, Su J, Watabe K, Wang G, Whitlow CT, Chan MD. Predictors of Adverse Radiation Effect in Brain Metastasis Patients Treated With Stereotactic Radiosurgery and Immune Checkpoint Inhibitor Therapy. Int J Radiat Oncol Biol Phys 2020; 108:295-303. [DOI: 10.1016/j.ijrobp.2020.06.057] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 12/19/2022]
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25
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Wicks RT, Witcher MR, Couture DE, Laxton AW, Popli G, Whitlow CT, Fetterhoff D, Dakos AS, Roeder BM, Deadwyler SA, Hampson RE. Hippocampal CA1 and CA3 neural recording in the human brain: validation of depth electrode placement through high-resolution imaging and electrophysiology. Neurosurg Focus 2020; 49:E5. [PMID: 32610296 DOI: 10.3171/2020.4.focus20164] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/16/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intracranial human brain recordings typically utilize recording systems that do not distinguish individual neuron action potentials. In such cases, individual neurons are not identified by location within functional circuits. In this paper, verified localization of singly recorded hippocampal neurons within the CA3 and CA1 cell fields is demonstrated. METHODS Macro-micro depth electrodes were implanted in 23 human patients undergoing invasive monitoring for identification of epileptic seizure foci. Individual neurons were isolated and identified via extracellular action potential waveforms recorded via macro-micro depth electrodes localized within the hippocampus. A morphometric survey was performed using 3T MRI scans of hippocampi from the 23 implanted patients, as well as 46 normal (i.e., nonepileptic) patients and 26 patients with a history of epilepsy but no history of depth electrode placement, which provided average dimensions of the hippocampus along typical implantation tracks. Localization within CA3 and CA1 cell fields was tentatively assigned on the basis of recording electrode site, stereotactic positioning of the depth electrode in comparison with the morphometric survey, and postsurgical MRI. Cells were selected as candidate CA3 and CA1 principal neurons on the basis of waveform and firing rate characteristics and confirmed within the CA3-to-CA1 neural projection pathways via measures of functional connectivity. RESULTS Cross-correlation analysis confirmed that nearly 80% of putative CA3-to-CA1 cell pairs exhibited positive correlations compatible with feed-forward connection between the cells, while only 2.6% exhibited feedback (inverse) connectivity. Even though synchronous and long-latency correlations were excluded, feed-forward correlation between CA3-CA1 pairs was identified in 1071 (26%) of 4070 total pairs, which favorably compares to reports of 20%-25% feed-forward CA3-CA1 correlation noted in published animal studies. CONCLUSIONS This study demonstrates the ability to record neurons in vivo from specified regions and subfields of the human brain. As brain-machine interface and neural prosthetic research continues to expand, it is necessary to be able to identify recording and stimulation sites within neural circuits of interest.
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Affiliation(s)
| | | | | | | | | | | | - Dustin Fetterhoff
- 6Program in Neuroscience, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Alexander S Dakos
- 6Program in Neuroscience, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Brent M Roeder
- 6Program in Neuroscience, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Sam A Deadwyler
- 5Physiology and Pharmacology, and.,6Program in Neuroscience, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Robert E Hampson
- 2Neurology.,5Physiology and Pharmacology, and.,6Program in Neuroscience, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
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Helis CA, Hughes RT, Munley MT, Bourland JD, Jacobson T, Lucas JT, Cramer CK, Tatter SB, Laxton AW, Chan MD. Results of a third Gamma Knife radiosurgery for trigeminal neuralgia. J Neurosurg 2020; 134:1237-1243. [PMID: 32330887 DOI: 10.3171/2020.2.jns192876] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/18/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Gamma Knife radiosurgery (GKRS) is a commonly used procedure for medically refractory trigeminal neuralgia (TN), with repeat GKRS routinely done in cases of pain relapse. The results of a third GKRS in cases of further pain relapse have not been well described. In this study, the authors report the largest series of patients treated with a third GKRS for TN to date. METHODS Retrospective review of institutional electronic medical records and a GKRS database was performed to identify patients who had been treated with a third GKRS at the authors' institution in the period from 2010 to 2018. Telephone interviews were used to collect long-term follow-up data. Pain outcomes were measured using the Barrow Neurological Institute (BNI) pain intensity scale, with a score ≤ IIIb indicating successful treatment. RESULTS Twenty-two nerves in 21 patients had sufficient follow-up to determine BNI pain score outcomes. Eighteen of 22 cases had a successful third GKRS, with a median durability of pain relief of 3.88 years. There was no significant difference in the durability of pain relief after a third GKRS compared with those of institutional historical controls of prior series of first and second GKRS procedures. Ten cases had new or worsening facial numbness, with 1 case being bothersome. Four cases of toxicity other than facial numbness were reported, including 1 case of corneal abrasions and possible neurotrophic keratopathy. No cases of anesthesia dolorosa were reported. No factors predicting treatment success or the durability of pain relief were identified. Nonnumbness toxicity was more common in those with a proximally placed shot at the third GKRS. CONCLUSIONS A third GKRS is an effective treatment option for TN patients who have pain relapse after repeat GKRS. Pain outcomes of a third GKRS are similar to those following a first or second GKRS. Toxicity is tolerable in patients with a distally placed shot at the third GKRS.
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Affiliation(s)
| | | | | | | | | | - John T Lucas
- 3Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Stephen B Tatter
- 2Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina; and
| | - Adrian W Laxton
- 2Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina; and
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Hughes RT, McTyre ER, LeCompte M, Cramer CK, Munley MT, Laxton AW, Tatter SB, Ruiz J, Pasche B, Watabe K, Chan MD. Clinical Outcomes of Upfront Stereotactic Radiosurgery Alone for Patients With 5 to 15 Brain Metastases. Neurosurgery 2020; 85:257-263. [PMID: 29982831 DOI: 10.1093/neuros/nyy276] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 05/30/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The role of primary stereotactic radiosurgery (SRS) for patients with >4 brain metastases (BM) remains controversial. OBJECTIVE To compare the outcomes of patients treated with upfront SRS alone for 1, 2 to 4, and 5 to 15 BM and assess for predictors of clinical outcomes in the 5 to 15 BM group. METHODS A total of 478 patients treated with upfront SRS were stratified by number of lesions: 220 had 1 BM, 190 had 2 to 4 BM, and 68 patients had 5 to 15 BM. Overall survival and whole brain radiotherapy-free survival were estimated using the Kaplan-Meier method. The cumulative incidences of local failure and distant brain failure (DBF) were estimated using competing risks methodology. Clinicopathologic and dosimetric parameters were evaluated as predictors of survival and DBF in patients with 5 to 15 BM using Cox proportional hazards. RESULTS Median overall survival was 8.0, 6.3, and 4.7 mo for patients with 1, 2 to 4, and 5 to 15 BM, respectively (P = .14). One-year DBF was 27%, 44%, and 40%, respectively (P = .01). Salvage SRS and whole brain radiotherapy rates did not differ. Progressive extracranial disease and gastrointestinal primary were associated with poor survival while RCC primary was associated with increased risk of DBF. No evaluated dose-volume parameters predicted for death, neurologic death or toxicity. CONCLUSION SRS for 5 to 15 BM is well tolerated without evidence of an associated increase in toxicity, treatment failure, or salvage therapy. Further prospective, randomized studies are warranted to clarify the role of SRS for these patients.
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Affiliation(s)
- Ryan T Hughes
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Emory R McTyre
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Michael LeCompte
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Christina K Cramer
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Michael T Munley
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Adrian W Laxton
- Department of Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Stephen B Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Jimmy Ruiz
- Department of Medicine (Hematology & Oncology), Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Boris Pasche
- Department of Medicine (Hematology & Oncology), Wake Forest School of Medicine, Winston Salem, North Carolina.,Department of Cancer Biology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Kounosuke Watabe
- Department of Cancer Biology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Michael D Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, North Carolina
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West JL, Soike MH, Renfrow JJ, Chan MD, Laxton AW, Tatter SB. Successful application of stereotactic radiosurgery for multiply recurrent Rathke’s cleft cysts. J Neurosurg 2020; 132:832-836. [DOI: 10.3171/2018.9.jns181703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 09/28/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVERathke’s cleft cysts (RCCs) are benign lesions of the sella turcica that usually come to neurosurgical attention due to compression of the optic apparatus (OA) and headaches. Treatment options for these lesions include observation, aspiration of cyst contents, or open resection of the cyst with the cyst wall. All of these options involve the potential for cyst recurrence or enlargement. In this study the authors report on a potential new therapeutic option for RCCs, i.e., stereotactic radiosurgery (SRS).METHODSA retrospective review was conducted of 5 patients with histologically confirmed, multiply recurrent RCCs who were treated with single-fraction SRS at a tertiary referral academic medical center.RESULTSThe total cohort consisted of 5 female patients with an average age of 31.8 years. The most common presenting symptom was headache followed by blurry vision. The symptoms were present on average for 7 months before intervention. The median number of surgeries prior to radiosurgery was 2. The average volume of lesion treated was 0.34 cm3. The median SRS dose was 12.5 Gy prescribed to the 50% isodose line with an average prescription coverage of 96.6%. The median dose to the OA was 5 Gy. At last follow-up, 3 of 5 cysts had completely regressed, 1 had regressed by more than 50% but was still present, and 1 was stable, with an overall mean follow-up duration of 34.2 months. There were no neurological, endocrinological, or visual complications attributable to SRS during the follow-up period.CONCLUSIONSRCCs can be a challenging clinical entity to treat, especially when they are multiply recurrent. In patients with an average of 2 previous surgeries for resection, a single SRS session prevented recurrence universally, with an average follow-up of almost 3 years. These results indicate that further investigation of the treatment of RCCs with SRS is indicated.
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Affiliation(s)
| | - Michael H. Soike
- Radiation Oncology, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | | | - Michael D. Chan
- Radiation Oncology, Wake Forest Baptist Health, Winston-Salem, North Carolina
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Maloney E, Clark C, Sivakumar H, Yoo K, Aleman J, Rajan SAP, Forsythe S, Mazzocchi A, Laxton AW, Tatter SB, Strowd RE, Votanopoulos KI, Skardal A. Immersion Bioprinting of Tumor Organoids in Multi-Well Plates for Increasing Chemotherapy Screening Throughput. Micromachines (Basel) 2020; 11:E208. [PMID: 32085455 PMCID: PMC7074680 DOI: 10.3390/mi11020208] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/14/2020] [Accepted: 02/17/2020] [Indexed: 12/22/2022]
Abstract
The current drug development pipeline takes approximately fifteen years and $2.6 billion to get a new drug to market. Typically, drugs are tested on two-dimensional (2D) cell cultures and animal models to estimate their efficacy before reaching human trials. However, these models are often not representative of the human body. The 2D culture changes the morphology and physiology of cells, and animal models often have a vastly different anatomy and physiology than humans. The use of bioengineered human cell-based organoids may increase the probability of success during human trials by providing human-specific preclinical data. They could also be deployed for personalized medicine diagnostics to optimize therapies in diseases such as cancer. However, one limitation in employing organoids in drug screening has been the difficulty in creating large numbers of homogeneous organoids in form factors compatible with high-throughput screening (e.g., 96- and 384-well plates). Bioprinting can be used to scale up deposition of such organoids and tissue constructs. Unfortunately, it has been challenging to 3D print hydrogel bioinks into small-sized wells due to well-bioink interactions that can result in bioinks spreading out and wetting the well surface instead of maintaining a spherical form. Here, we demonstrate an immersion printing technique to bioprint tissue organoids in 96-well plates to increase the throughput of 3D drug screening. A hydrogel bioink comprised of hyaluronic acid and collagen is bioprinted into a viscous gelatin bath, which blocks the bioink from interacting with the well walls and provides support to maintain a spherical form. This method was validated using several cancerous cell lines, and then applied to patient-derived glioblastoma (GBM) and sarcoma biospecimens for drug screening.
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Affiliation(s)
- Erin Maloney
- Department of Biomedical Engineering, Cornell University, Ithaca, NY 14853, USA;
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, NC 27101, USA; (C.C.); (K.Y.); (J.A.); (S.A.P.R.); (S.F.); (A.M.)
| | - Casey Clark
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, NC 27101, USA; (C.C.); (K.Y.); (J.A.); (S.A.P.R.); (S.F.); (A.M.)
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC 27101, USA
| | - Hemamylammal Sivakumar
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH 43210, USA;
- The Ohio State University Comprehensive Cancer Center, Ohio State University Wexner Medical Center, Columbus, OH 43420, USA
| | - KyungMin Yoo
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, NC 27101, USA; (C.C.); (K.Y.); (J.A.); (S.A.P.R.); (S.F.); (A.M.)
| | - Julio Aleman
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, NC 27101, USA; (C.C.); (K.Y.); (J.A.); (S.A.P.R.); (S.F.); (A.M.)
| | - Shiny A. P. Rajan
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, NC 27101, USA; (C.C.); (K.Y.); (J.A.); (S.A.P.R.); (S.F.); (A.M.)
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC 27101, USA
| | - Steven Forsythe
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, NC 27101, USA; (C.C.); (K.Y.); (J.A.); (S.A.P.R.); (S.F.); (A.M.)
- Department of Cancer Biology, Wake Forest School of Medicine, Winston Salem, NC 27101, USA
| | - Andrea Mazzocchi
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, NC 27101, USA; (C.C.); (K.Y.); (J.A.); (S.A.P.R.); (S.F.); (A.M.)
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC 27101, USA
| | - Adrian W. Laxton
- Comprehensive Cancer Center at Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA; (A.W.L.); (S.B.T.); (R.E.S.); (K.I.V.)
- Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA
| | - Stephen B. Tatter
- Comprehensive Cancer Center at Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA; (A.W.L.); (S.B.T.); (R.E.S.); (K.I.V.)
- Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA
| | - Roy E. Strowd
- Comprehensive Cancer Center at Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA; (A.W.L.); (S.B.T.); (R.E.S.); (K.I.V.)
- Department of Neuroscience, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA
| | - Konstantinos I. Votanopoulos
- Comprehensive Cancer Center at Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA; (A.W.L.); (S.B.T.); (R.E.S.); (K.I.V.)
- Department of Surgery–Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA
| | - Aleksander Skardal
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH 43210, USA;
- The Ohio State University Comprehensive Cancer Center, Ohio State University Wexner Medical Center, Columbus, OH 43420, USA
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LeCompte MC, Hughes RT, Farris M, Masters A, Soike MH, Lanier C, Glenn C, Cramer CK, Watabe K, Su J, Ruiz J, Whitlow CT, Wang G, Laxton AW, Tatter SB, Chan MD. Impact of brain metastasis velocity on neurologic death for brain metastasis patients experiencing distant brain failure after initial stereotactic radiosurgery. J Neurooncol 2020; 146:285-292. [PMID: 31894518 DOI: 10.1007/s11060-019-03368-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 12/09/2019] [Accepted: 12/11/2019] [Indexed: 01/04/2023]
Abstract
PURPOSE Patients with high rates of developing new brain metastases have an increased likelihood of dying of neurologic death. It is unclear, however, whether this risk is affected by treatment choice following failure of primary stereotactic radiosurgery (SRS). METHODS From July 2000 to March 2017, 440 patients with brain metastasis were treated with SRS and progressed to have a distant brain failure (DBF). Eighty-seven patients were treated within the immunotherapy era. Brain metastasis velocity (BMV) was calculated for each patient. In general, the institutional philosophy for use of salvage SRS vs whole brain radiotherapy (WBRT) was to postpone the use of WBRT for as long as possible and to treat with salvage SRS when feasible. No further treatment was reserved for patients with poor life expectancy and who were not expected to benefit from salvage treatment. RESULTS Two hundred and eighty-five patients were treated with repeat SRS, 91 patients were treated with salvage WBRT, and 64 patients received no salvage radiation therapy. One-year cumulative incidence of neurologic death after salvage SRS vs WBRT was 15% vs 23% for the low- (p = 0.06), 30% vs 37% for the intermediate- (p < 0.01), and 31% vs 48% (p < 0.01) for the high-BMV group. Salvage WBRT was associated with increased incidence of neurologic death on multivariate analysis (HR 1.64, 95% CI 1.13-2.39, p = 0.01) when compared to repeat SRS. One-year cumulative incidence of neurologic death for patients treated within the immunotherapy era was 9%, 38%, and 38% for low-, intermediate-, and high-BMV groups, respectively (p = 0.01). CONCLUSION Intermediate and high risk BMV groups are predictive of neurologic death. The association between BMV and neurologic death remains strong for patients treated within the immunotherapy era.
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Affiliation(s)
- Michael C LeCompte
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA.
| | - Ryan T Hughes
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Michael Farris
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Adrianna Masters
- Department of Radiation Oncology, University Radiologists, S.C., Southern Illinois School of Medicine, Springfield, IL, 62781, USA
| | - Michael H Soike
- Hazelrig-Salter Radiation Oncology Center, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Claire Lanier
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Chase Glenn
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Christina K Cramer
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Kounosuke Watabe
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Jing Su
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA.,Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Jimmy Ruiz
- Department of Medicine (Hematology & Oncology), Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA.,W.G. (Bill) Hefner Veteran Administration Medical Center, Cancer Center, Salisbury, NC, 28144, USA
| | - Christopher T Whitlow
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Ge Wang
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, 12180, USA
| | - Adrian W Laxton
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Stephen B Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Michael D Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
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Helis CA, McTyre E, Munley MT, Bourland JD, Lucas JT, Cramer CK, Tatter SB, Laxton AW, Chan MD. Gamma Knife radiosurgery for bilateral trigeminal neuralgia. J Neurosurg 2019. [DOI: 10.3171/2018.6.jns172646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEA small subset of patients with trigeminal neuralgia (TN) will experience bilateral symptoms. Treatment in these patients is controversial because the population is heterogeneous and patients may have nonvascular etiologies of their pain. This study reports treatment outcomes in the largest cohort of patients with bilateral TN who have undergone Gamma Knife radiosurgery (GKRS) to date.METHODSA retrospective chart review identified 51 individual nerves in 34 patients with bilateral TN who were treated with GKRS at the authors’ institution between 2001 and 2015, with 12 nerves in 11 patients undergoing repeat GKRS for recurrent or persistent symptoms. Long-term follow-up was obtained by telephone interview. Pain outcomes were measured using the Barrow Neurological Institute (BNI) pain scale, with BNI IIIb or better considered a successful treatment.RESULTSThere was sufficient follow-up to determine treatment outcomes for 48 individual nerves in 33 patients. Of these nerves, 42 (88%) achieved at least BNI IIIb pain relief. The median duration of pain relief was 1.9 years, and 1-, 3-, and 5-year pain relief rates were 64%, 44%, and 44%, respectively. No patients experienced bothersome facial numbness, and 1 case of anesthesia dolorosa and 2 cases of corneal dryness were reported. Patients with a history of definite or possible multiple sclerosis were significantly more likely to experience BNI IV–V relapse. There was no statistically significant difference in treatment outcomes between patients in this series versus a large cohort of patients with unilateral TN treated at the authors’ institution. There was sufficient follow-up to determine treatment outcomes for 11 individual nerves in 10 patients treated with repeat GKRS. Ten nerves (91%) improved to at least BNI IIIb after treatment. The median duration of pain relief was 2.8 years, with 1-, 3-, and 5-year rates of pain relief of 79%, 53%, and 53%, respectively. There was no statistically significant difference in outcomes between initial and repeat GKRS. One case of bothersome facial numbness and 1 case of corneal dryness were reported, with no patients developing anesthesia dolorosa with retreatment.CONCLUSIONSGKRS is a safe, well-tolerated treatment for patients with medically refractory bilateral TN. Efficacy of treatment appears similar to that in patients with unilateral TN. GKRS can be safely repeated in this population if necessary.
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Affiliation(s)
| | | | | | | | - John T. Lucas
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | | | - Stephen B. Tatter
- Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina; and
| | - Adrian W. Laxton
- Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina; and
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Helis CA, McTyre E, Munley MT, Bourland JD, Lucas JT, Cramer CK, Tatter SB, Laxton AW, Chan MD. Gamma Knife Radiosurgery for Multiple Sclerosis-Associated Trigeminal Neuralgia. Neurosurgery 2019; 85:E933-E939. [PMID: 31173108 PMCID: PMC8786494 DOI: 10.1093/neuros/nyz182] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 01/29/2019] [Indexed: 12/09/2023] Open
Abstract
BACKGROUND Trigeminal neuralgia in the setting of multiple sclerosis (MS-TN) is a challenging condition to manage that is commonly treated with Gamma Knife radiosurgery (GKRS; Elekta AB). However, data regarding the efficacy of this treatment are somewhat limited, particularly for repeat GKRS. OBJECTIVE To report outcomes of GKRS for MS-TN from a cohort study. METHODS Retrospective review of our GKRS database identified 77 cases of unilateral MS-TN (UMSTN) in 74 patients treated with GKRS between 2001 and 2016, with 37 cases undergoing repeat GKRS. Background medical history, treatment outcomes and complications, and dosimetric data were obtained by retrospective chart reviews and telephone interviews. RESULTS Eighty-two percent of UMSTN cases achieved Barrow Neurological Institute (BNI) IIIb or better pain relief following initial GKRS for a median duration of 1.1 yr. Estimated rates of pain relief at 1, 3, and 5 yr were 51, 39, and 29% respectively. Eighty-eight percent achieved BNI IIIb or better pain relief after repeat GKRS for a median duration of 4.0 yr. Estimated rates of pain relief at 1 and 3 yr were 70 and 54%, respectively. Median doses for initial and repeat GKRS were 85 and 80 Gy to the 100% isodose line, respectively. Those with MS-TN had a shorter duration of BNI IIIb or better pain relief after initial (4.6 vs 1.1 yr), but not repeat GKRS (3.8 vs 4.0 yr) compared to a historical cohort from our institution. CONCLUSION GKRS is an effective, well-tolerated treatment for patients with MS-TN. More durable relief is often achieved with repeat GKRS.
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Affiliation(s)
- Corbin A Helis
- Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Emory McTyre
- Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Michael T Munley
- Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - J Daniel Bourland
- Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - John T Lucas
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Christina K Cramer
- Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Stephen B Tatter
- Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Adrian W Laxton
- Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Michael D Chan
- Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
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McTyre ER, Soike MH, Farris M, Ayala-Peacock DN, Hepel JT, Page BR, Shen C, Kleinberg L, Contessa JN, Corso C, Chiang V, Henson-Masters A, Cramer CK, Ruiz J, Pasche B, Watabe K, D'Agostino R, Su J, Laxton AW, Tatter SB, Fiveash JB, Ahluwalia M, Kotecha R, Chao ST, Braunstein SE, Attia A, Chung C, Chan MD. Multi-institutional validation of brain metastasis velocity, a recently defined predictor of outcomes following stereotactic radiosurgery. Radiother Oncol 2019; 142:168-174. [PMID: 31526671 DOI: 10.1016/j.radonc.2019.08.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Brain metastasis velocity (BMV) is a prognostic metric that describes the recurrence rate of new brain metastases after initial treatment with radiosurgery (SRS). We have previously risk stratified patients into high, intermediate, and low-risk BMV groups, which correlates with overall survival (OS). We sought to externally validate BMV in a multi-institutional setting. METHODS Patients from nine academic centers were treated with upfront SRS; the validation cohort consisted of data from eight institutions not previously used to define BMV. Patients were classified by BMV into low (<4 BMV), intermediate (4-13 BMV), and high-risk groups (>13 BMV). Time-to-event outcomes were estimated using the Kaplan-Meier method. Cox proportional hazards methods were used to estimate the effect of BMV and salvage modality on OS. RESULTS Of 2829 patients, 2092 patients were included in the validation dataset. Of these, 921 (44.0%) experienced distant brain failure (DBF). Median OS from initial SRS was 11.2 mo. Median OS for BMV < 4, BMV 4-13, and BMV > 13 were 12.5 mo, 7.0 mo, and 4.6 mo (p < 0.0001). After multivariate regression modeling, melanoma histology (β: 10.10, SE: 1.89, p < 0.0001) and number of initial brain metastases (β: 1.52, SE: 0.34, p < 0.0001) remained predictive of BMV (adjusted R2 = 0.06). CONCLUSIONS This multi-institutional dataset validates BMV as a predictor of OS following initial SRS. BMV is being utilized in upcoming multi-institutional randomized controlled trials as a stratification variable for salvage whole brain radiation versus salvage SRS after DBF.
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Affiliation(s)
- Emory R McTyre
- Department of Radiation Oncology, Greenville Health System Cancer Institute, USA
| | - Michael H Soike
- Hazelrig-Salter Radiation Oncology Center, University of Alabama at Birmingham, USA.
| | - Michael Farris
- Department of Radiation Oncology, Wake Forest School of Medicine, USA
| | | | - Jaroslaw T Hepel
- Department of Radiation Oncology, Brown University Alpert Medical School, USA
| | - Brandi R Page
- Department of Radiation Oncology, Johns Hopkins School of Medicine, USA
| | - Colette Shen
- Department of Radiation Oncology, University of North Carolina, USA
| | | | | | | | | | | | | | - Jimmy Ruiz
- Department of Medicine, Wake Forest School of Medicine, USA
| | - Boris Pasche
- Department of Medicine, Wake Forest School of Medicine, USA
| | - Kounosuke Watabe
- Department of Cancer Biology, Wake Forest School of Medicine, USA
| | - Ralph D'Agostino
- Department of Biostatistical Sciences, Wake Forest School of Medicine, USA
| | - Jing Su
- Department of Biostatistical Sciences, Wake Forest School of Medicine, USA
| | - Adrian W Laxton
- Department of Neurosurgery, Wake Forest School of Medicine, USA
| | | | - John B Fiveash
- Hazelrig-Salter Radiation Oncology Center, University of Alabama at Birmingham, USA
| | - Manmeet Ahluwalia
- Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic Foundation, USA
| | - Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, USA
| | - Samuel T Chao
- Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic Foundation, USA
| | - Steve E Braunstein
- Department of Radiation Oncology, University of California San Francisco, USA
| | - Albert Attia
- Department of Radiation Oncology, Vanderbilt University School of Medicine, USA
| | - Caroline Chung
- Department of Radiation Oncology, M.D. Anderson Cancer Center, USA
| | - Michael D Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, USA
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Strowd RE, Russell G, Hsu FC, Carter AF, Chan M, Tatter SB, Laxton AW, Alexander-Miller MA, High K, Lesser GJ. Immunogenicity of high-dose influenza vaccination in patients with primary central nervous system malignancy. Neurooncol Pract 2019; 5:176-183. [PMID: 31385974 DOI: 10.1093/nop/npx035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background For cancer patients, rates of influenza-associated hospitalization and death are 4 times greater than that of the general population. Previously, we reported reduced immunogenicity to the standard-dose influenza vaccine in patients with central nervous system malignancy. In other poorly responding populations (eg, elderly patients), high-dose vaccination has improved efficacy and immunogenicity. Methods A prospective cohort study was designed to evaluate the immunogenicity of the Fluzone® high-dose influenza vaccine in brain tumor patients. Data on diagnosis, active oncologic treatment, and immunologic status (eg, CD4 count, CD8 count, CD4:CD8 ratio) were collected. All patients received the high-dose vaccine (180 µg). Hemagglutination inhibition titers were measured at baseline, day 28, and 3 months following vaccination to determine seroconversion (≥4-fold rise) and seroprotection (titer ≥1:40), which were compared to our prior results. Results Twenty-seven patients enrolled. Diagnoses included high-grade glioma (85%), CNS lymphoma (11%), and meningioma (4%). Treatment at enrollment included glucocorticoids (n = 8, 30%), radiation (n = 2, 7%), and chemotherapy (n = 9, 33%). Posttreatment lymphopenia (PTL, CD4 ≤ 200) was observed in 4 patients (15%). High-dose vaccination was well tolerated with no grade III-IV toxicity. Overall, seroconversion rates for the A/H1N1, A/H3N2, and B vaccine strains were significantly higher than in our prior study: 65% vs 37%, 69% vs 23%, and 50% vs 23%, respectively (all P < .04). Seroconversion was universally poor in patients with PTL. While seroprotection at 3 months declined in our prior study, no drop was observed following high-dose vaccination in this cohort. Conclusions The immunologic response to HD influenza vaccination was higher in this cohort than standard-dose influenza vaccination in our prior report. These findings mirror those in elderly patients where high-dose vaccination is the standard of care and raise the possibility of an immunosenescence phenotype.
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Affiliation(s)
- Roy E Strowd
- Department of Neurology and Internal Medicine Section on Hematology and Oncology, Wake Forest School of Medicine, Winston Salem, NC
| | - Gregory Russell
- Department of Biostatistics, Wake Forest School of Public Health, Wake Forest University Health Sciences, 1 Medical Center Boulevard, Winston Salem, NC
| | - Fang-Chi Hsu
- Department of Biostatistics, Wake Forest School of Public Health, Wake Forest University Health Sciences, 1 Medical Center Boulevard, Winston Salem, NC
| | - Annette F Carter
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston Salem, NC
| | - Michael Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston Salem, NC
| | - Stephen B Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston Salem, NC
| | - Adrian W Laxton
- Department of Neurosurgery, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston Salem, NC
| | | | - Kevin High
- Department of Internal Medicine, Section on Infectious Disease, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston Salem NC
| | - Glenn J Lesser
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston Salem, NC
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Wu C, Jermakowicz WJ, Chakravorti S, Cajigas I, Sharan AD, Jagid JR, Matias CM, Sperling MR, Buckley R, Ko A, Ojemann JG, Miller JW, Youngerman B, Sheth SA, McKhann GM, Laxton AW, Couture DE, Popli GS, Smith A, Mehta AD, Ho AL, Halpern CH, Englot DJ, Neimat JS, Konrad PE, Neal E, Vale FL, Holloway KL, Air EL, Schwalb J, Dawant BM, D'Haese PF. Effects of surgical targeting in laser interstitial thermal therapy for mesial temporal lobe epilepsy: A multicenter study of 234 patients. Epilepsia 2019; 60:1171-1183. [PMID: 31112302 DOI: 10.1111/epi.15565] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/23/2019] [Accepted: 04/23/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Laser interstitial thermal therapy (LITT) for mesial temporal lobe epilepsy (mTLE) has reported seizure freedom rates between 36% and 78% with at least 1 year of follow-up. Unfortunately, the lack of robust methods capable of incorporating the inherent variability of patient anatomy, the variability of the ablated volumes, and clinical outcomes have limited three-dimensional quantitative analysis of surgical targeting and its impact on seizure outcomes. We therefore aimed to leverage a novel image-based methodology for normalizing surgical therapies across a large multicenter cohort to quantify the effects of surgical targeting on seizure outcomes in LITT for mTLE. METHODS This multicenter, retrospective cohort study included 234 patients from 11 centers who underwent LITT for mTLE. To investigate therapy location, all ablation cavities were manually traced on postoperative magnetic resonance imaging (MRI), which were subsequently nonlinearly normalized to a common atlas space. The association of clinical variables and ablation location to seizure outcome was calculated using multivariate regression and Bayesian models, respectively. RESULTS Ablations including more anterior, medial, and inferior temporal lobe structures, which involved greater amygdalar volume, were more likely to be associated with Engel class I outcomes. At both 1 and 2 years after LITT, 58.0% achieved Engel I outcomes. A history of bilateral tonic-clonic seizures decreased chances of Engel I outcome. Radiographic hippocampal sclerosis was not associated with seizure outcome. SIGNIFICANCE LITT is a viable treatment for mTLE in patients who have been properly evaluated at a comprehensive epilepsy center. Consideration of surgical factors is imperative to the complete assessment of LITT. Based on our model, ablations must prioritize the amygdala and also include the hippocampal head, parahippocampal gyrus, and rhinal cortices to maximize chances of seizure freedom. Extending the ablation posteriorly has diminishing returns. Further work is necessary to refine this analysis and define the minimal zone of ablation necessary for seizure control.
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Affiliation(s)
- Chengyuan Wu
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Walter J Jermakowicz
- Department of Neurological Surgery, Jackson Memorial Hospital, University of Miami, Miami, Florida
| | - Srijata Chakravorti
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee
| | - Iahn Cajigas
- Department of Neurological Surgery, Jackson Memorial Hospital, University of Miami, Miami, Florida
| | - Ashwini D Sharan
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jonathan R Jagid
- Department of Neurological Surgery, Jackson Memorial Hospital, University of Miami, Miami, Florida
| | - Caio M Matias
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael R Sperling
- Department of Neurology, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Robert Buckley
- Department of Neurological Surgery, Harborview Medical Center, University of Washington, Seattle, Washington
| | - Andrew Ko
- Department of Neurological Surgery, Harborview Medical Center, University of Washington, Seattle, Washington
| | - Jeffrey G Ojemann
- Department of Neurological Surgery, Harborview Medical Center, University of Washington, Seattle, Washington
| | - John W Miller
- Department of Neurology, Harborview Medical Center, University of Washington, Seattle, Washington
| | - Brett Youngerman
- Department of Neurological Surgery, Neurological Institute of New York, Columbia University Medical Center, New York, New York
| | - Sameer A Sheth
- Department of Neurological Surgery, Baylor College of Medicine, Houston, Texas
| | - Guy M McKhann
- Department of Neurological Surgery, Neurological Institute of New York, Columbia University Medical Center, New York, New York
| | - Adrian W Laxton
- Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Daniel E Couture
- Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Gautam S Popli
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Alexander Smith
- Department of Neurological Surgery, Zucker School of Medicine at Hofstra Northwell, Hempstead, New York
| | - Ashesh D Mehta
- Department of Neurological Surgery, Zucker School of Medicine at Hofstra Northwell, Hempstead, New York
| | - Allen L Ho
- Department of Neurological Surgery, Stanford Neuroscience Health Center, Stanford, California
| | - Casey H Halpern
- Department of Neurological Surgery, Stanford Neuroscience Health Center, Stanford, California
| | - Dario J Englot
- Department of Neurological Surgery, Vanderbilt University, Nashville, Tennessee
| | - Joseph S Neimat
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky
| | - Peter E Konrad
- Department of Neurological Surgery, Vanderbilt University, Nashville, Tennessee
| | - Elliot Neal
- Department of Neurological Surgery, University of South Florida Health South Tampa Center, Tampa, Florida
| | - Fernando L Vale
- Department of Neurological Surgery, University of South Florida Health South Tampa Center, Tampa, Florida
| | - Kathryn L Holloway
- Department of Neurological Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Ellen L Air
- Department of Neurological Surgery, Henry Ford Health System, Detroit, Michigan
| | - Jason Schwalb
- Department of Neurological Surgery, Henry Ford Health System, Detroit, Michigan
| | - Benoit M Dawant
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee.,Department of Neurological Surgery, Vanderbilt University, Nashville, Tennessee
| | - Pierre-Francois D'Haese
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee.,Department of Neurological Surgery, Vanderbilt University, Nashville, Tennessee
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Ahluwalia M, Barnett GH, Deng D, Tatter SB, Laxton AW, Mohammadi AM, Leuthardt E, Chamoun R, Judy K, Asher A, Essig M, Dietrich J, Chiang VL. Laser ablation after stereotactic radiosurgery: a multicenter prospective study in patients with metastatic brain tumors and radiation necrosis. J Neurosurg 2019; 130:804-811. [DOI: 10.3171/2017.11.jns171273] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 11/04/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVELaser Ablation After Stereotactic Radiosurgery (LAASR) is a multicenter prospective study of laser interstitial thermal (LITT) ablation in patients with radiographic progression after stereotactic radiosurgery for brain metastases.METHODSPatients with a Karnofsky Performance Scale (KPS) score ≥ 60, an age > 18 years, and surgical eligibility were included in this study. The primary outcome was local progression-free survival (PFS) assessed using the Response Assessment in Neuro-Oncology Brain Metastases (RANO-BM) criteria. Secondary outcomes were overall survival (OS), procedure safety, neurocognitive function, and quality of life.RESULTSForty-two patients—19 with biopsy-proven radiation necrosis, 20 with recurrent tumor, and 3 with no diagnosis—were enrolled. The median age was 60 years, 64% of the subjects were female, and the median baseline KPS score was 85. Mean lesion volume was 6.4 cm3 (range 0.4–38.6 cm3). There was no significant difference in length of stay between the recurrent tumor and radiation necrosis patients (median 2.3 vs 1.7 days, respectively). Progression-free survival and OS rates were 74% (20/27) and 72%, respectively, at 26 weeks. Thirty percent of subjects were able to stop or reduce steroid usage by 12 weeks after surgery. Median KPS score, quality of life, and neurocognitive results did not change significantly for either group over the duration of survival. Adverse events were also similar for the two groups, with no significant difference in the overall event rate. There was a 12-week PFS and OS advantage for the radiation necrosis patients compared with the recurrent tumor or tumor progression patients.CONCLUSIONSIn this study, in which enrolled patients had few alternative options for salvage treatment, LITT ablation stabilized the KPS score, preserved quality of life and cognition, had a steroid-sparing effect, and was performed safely in the majority of cases.Clinical trial registration no.: NCT01651078 (clinicaltrials.gov)
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Affiliation(s)
| | - Gene H. Barnett
- 1Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
| | - Di Deng
- 2Department of Neurosurgery, Yale University, New Haven, Connecticut
| | - Stephen B. Tatter
- 3Department of Neurosurgery, Wake Forest Medical Center, Winston-Salem, North Carolina
| | - Adrian W. Laxton
- 3Department of Neurosurgery, Wake Forest Medical Center, Winston-Salem, North Carolina
| | | | - Eric Leuthardt
- 4Department of Neurosurgery, Washington University, St. Louis, Missouri
| | - Roukoz Chamoun
- 5Department of Neurosurgery, Kansas University, Kansas City, Kansas
| | - Kevin Judy
- 6Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Anthony Asher
- 7Carolina Neurosurgery and Spine, Charlotte, North Carolina
| | - Marco Essig
- 8Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada; and
| | - Jorg Dietrich
- 9Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
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Lanier CM, Hughes R, Ahmed T, LeCompte M, Masters AH, Petty WJ, Ruiz J, Triozzi P, Su J, O'Neill S, Watabe K, Cramer CK, Laxton AW, Tatter SB, Wang G, Whitlow C, Chan MD. Immunotherapy is associated with improved survival and decreased neurologic death after SRS for brain metastases from lung and melanoma primaries. Neurooncol Pract 2019; 6:402-409. [PMID: 31555455 DOI: 10.1093/nop/npz004] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background The effect of immunotherapy on brain metastasis patients remains incompletely understood. Our goal was to evaluate its effect on survival, neurologic death, and patterns of failure after stereotactic radiosurgery (SRS) without prior whole-brain radiation therapy (WBRT) in patients with lung and melanoma primaries metastatic to the brain. Methods We performed a retrospective analysis of 271 consecutive lung or melanoma patients treated with upfront SRS for brain metastases between 2013 and 2018. Of these patients, 101 (37%) received immunotherapy and 170 (63%) did not. Forty-three percent were treated with nivolumab. Thirty-seven percent were treated with pembrolizumab. Fifteen percent were treated with ipilimumab. One percent were treated with a combination of nivolumab and ipilimumab. One percent were treated with atezolizumab. Three percent were treated with another immunotherapy regimen. Survival was estimated by the Kaplan-Meier method and cumulative incidences of neurologic death, and local and distant brain failure were estimated using death as a competing risk. Results The median overall survival (OS) of patients treated with immunotherapy vs without was 15.9 (95% CI: 13.3 to 24.8) vs 6.1 (95% CI: 5.1 to 8.8) months (P < .01). The 1-year cumulative incidence of neurologic death was 9% in patients treated with immunotherapy vs 23% in those treated without (P = .01), while nonneurologic death was not significantly different (29% vs 41%, P = .51). Median brain metastasis velocity (BMV) did not differ between groups, and rates of salvage SRS and WBRT were similar. Conclusions The use of immunotherapy in patients with lung cancer or melanoma metastatic to the brain treated with SRS is associated with improved OS and decreased incidence of neurologic death.
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Affiliation(s)
- Claire M Lanier
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Ryan Hughes
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Tamjeed Ahmed
- Department of Medicine (Hematology & Oncology), Wake Forest School of Medicine, Winston-Salem, NC
| | - Michael LeCompte
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Adrianna H Masters
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC
| | - William J Petty
- Department of Medicine (Hematology & Oncology), Wake Forest School of Medicine, Winston-Salem, NC
| | - Jimmy Ruiz
- Department of Medicine (Hematology & Oncology), Wake Forest School of Medicine, Winston-Salem, NC.,W.G. (Bill) Hefner Veteran Administration Medical Center, Cancer Center, Salisbury, NC
| | - Pierre Triozzi
- Department of Medicine (Hematology & Oncology), Wake Forest School of Medicine, Winston-Salem, NC
| | - Jing Su
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Stacy O'Neill
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kuonosuke Watabe
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Christina K Cramer
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Adrian W Laxton
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC
| | - Stephen B Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC
| | - Ge Wang
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY
| | | | - Michael D Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC
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Dohm A, McTyre ER, Okoukoni C, Henson A, Cramer CK, LeCompte MC, Ruiz J, Munley MT, Qasem S, Lo HW, Xing F, Watabe K, Laxton AW, Tatter SB, Chan MD. Staged Stereotactic Radiosurgery for Large Brain Metastases: Local Control and Clinical Outcomes of a One-Two Punch Technique. Neurosurgery 2018; 83:114-121. [PMID: 28973432 DOI: 10.1093/neuros/nyx355] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 06/11/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Treatment options are limited for large, unresectable brain metastases. OBJECTIVE To report a single institution series of staged stereotactic radiosurgery (SRS) that allows for tumor response between treatments in order to optimize the therapeutic ratio. METHODS Patients were treated with staged SRS separated by 1 mo with a median dose at first SRS of 15 Gy (range 10-21 Gy) and a median dose at second SRS of 14 Gy (range 10-18 Gy). Overall survival was evaluated using the Kaplan-Meier method. Cumulative incidences were estimated for neurological death, radiation necrosis, local failure (marginal or central), and distant brain failure. Absolute cumulative dose-volume histogram was created for each treated lesion. Logistic regression and competing risks regression were performed for each discrete dose received by a certain volume. RESULTS Thirty-three patients with 39 lesions were treated with staged radiosurgery. Overall survival at 6 and 12 mo was 65.0% and 60.0%, respectively. Cumulative incidence of local failure at 6 and 12 mo was 3.2% and 13.3%, respectively. Of the patients who received staged therapy, 4 of 33 experienced local failure. Radiation necrosis was seen in 4 of 39 lesions. Two of 33 patients experienced a Radiation Therapy Oncology Group toxicity grade > 2 (2 patients had grade 4 toxicities). Dosimetric analysis revealed that dose (Gy) received by volume of brain (ie, VDose(Gy)) was associated with radiation necrosis, including the range V44.5Gy to V87.8Gy. CONCLUSION Staged radiosurgery is a safe and effective option for large, unresectable brain metastases. Prospective studies are required to validate the findings in this study.
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Affiliation(s)
- Ammoren Dohm
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Emory R McTyre
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Catherine Okoukoni
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Adrianna Henson
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Christina K Cramer
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Michael C LeCompte
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jimmy Ruiz
- Department of Medicine (Hematology and Oncology), Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Michael T Munley
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Shadi Qasem
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Hui-Wen Lo
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Fei Xing
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kounosuke Watabe
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Adrian W Laxton
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Stephen B Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Michael D Chan
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Bower AS, Yelton C, Cramer C, Soike MH, McTyre E, Wicks R, Merrill R, Azagba S, Tatter SB, Laxton AW, Lesser GJ, Chan MD, Strowd RE. Community socioeconomic status to identify higher-risk patients with malignant glioma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.2060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Caleb Yelton
- Wake Forest Baptist Medical Center, Winston-Salem, NC
| | | | | | - Emory McTyre
- Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Robert Wicks
- Wake Forest School of Medicine, Winston-Salem, NC
| | | | - Sunday Azagba
- Wake Forest Baptist Medical Center, Winston-Salem, NC
| | | | | | | | | | - Roy E. Strowd
- Johns Hopkins University School of Medicine, Baltimore, MD
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Soike MH, Ruiz J, McTyre E, O'Neill S, Qasem S, Furdui CM, Lee J, Lycan T, Rodman C, Watabe K, Tatter SB, Laxton AW, Chan MD, Su J. Discovery of a predictive protein biomarker for leptomeningeal disease after craniotomy and radiation. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.2068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Jimmy Ruiz
- Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Emory McTyre
- Wake Forest Baptist Medical Center, Winston-Salem, NC
| | | | - Shadi Qasem
- University of Kentucky School of Medicine, Lexington, KY
| | | | - Jingyun Lee
- Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Thomas Lycan
- Wake Forest Baptist Medical Center, Winston-Salem, NC
| | | | | | | | | | | | - Jing Su
- Wake Forest Baptist Medical Center, Winston-Salem, NC
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Soike MH, McTyre ER, Hughes RT, Farris M, Cramer CK, LeCompte MC, Lanier CM, Ruiz J, Su J, Watabe K, Bourland JD, Munley MT, O'Neill S, Laxton AW, Tatter SB, Chan MD. Initial brain metastasis velocity: does the rate at which cancers first seed the brain affect outcomes? J Neurooncol 2018; 139:461-467. [PMID: 29740743 DOI: 10.1007/s11060-018-2888-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 04/12/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE/OBJECTIVE(S) Brain metastasis velocity (BMV) is a metric that describes the rate of development of new brain metastases (BM) after initial stereotactic radiosurgery (SRS). A limitation in the application of BMV is it cannot be applied until time of first BM failure after SRS. We developed initial BM velocity (iBMV), a new metric that accounts for the number of BM at first SRS and the time since initial cancer diagnosis. MATERIALS/METHODS We reviewed patients with BM treated at our institution with upfront SRS without WBRT. iBMV was calculated as the number of BM at initial SRS divided by time (years) from initial cancer diagnosis to first SRS. We performed a linear regression to correlate BMV as a continuous variable and with low, intermediate, and high BMV risk groups. Kaplan-Meier estimation of OS was calculated from time of first SRS to death. iBMV was not calculated for patients who presented with BM at initial cancer diagnosis. RESULTS 994 patients were treated with upfront SRS without WBRT between 2000 and 2017. Median OS was 8.5 mos. 595 (60%) patients developed BM after cancer diagnosis and median time to first SRS from time of initial diagnosis was 2.2 years. Median iBMV was 0.79 BM/year. iBMV correlated with BMV (β = 1.57 p = 0.021) and independently predicted for mortality [Cox proportional hazard ratio (HR) 1.11, p = 0.036] after accounting for histology, number of initial brain metastases (HR 1.03, p = 0.32), time from cancer diagnosis to SRS (HR 0.98, p = 0.157) in a multivariate model. CONCLUSION iBMV correlates with BMV and OS. With further validation, iBMV could serve as a metric to risk stratify patients for WBRT or SRS at time of first BM presentation.
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Affiliation(s)
- Michael H Soike
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA.
- Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC, 27103, USA.
| | - Emory R McTyre
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Ryan T Hughes
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Michael Farris
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Christina K Cramer
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Michael C LeCompte
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Claire M Lanier
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Jimmy Ruiz
- Department of Medicine (Hematology & Oncology), Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Jing Su
- Department of Diagnostic Radiology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Kounosuke Watabe
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - J Daniel Bourland
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Michael T Munley
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Stacey O'Neill
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Adrian W Laxton
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Stephen B Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Michael D Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
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Moran RJ, Kishida KT, Lohrenz T, Saez I, Laxton AW, Witcher MR, Tatter SB, Ellis TL, Phillips PEM, Dayan P, Montague PR. The Protective Action Encoding of Serotonin Transients in the Human Brain. Neuropsychopharmacology 2018; 43:1425-1435. [PMID: 29297512 PMCID: PMC5916372 DOI: 10.1038/npp.2017.304] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 10/01/2017] [Accepted: 11/28/2017] [Indexed: 01/14/2023]
Abstract
The role of serotonin in human brain function remains elusive due, at least in part, to our inability to measure rapidly the local concentration of this neurotransmitter. We used fast-scan cyclic voltammetry to infer serotonergic signaling from the striatum of 14 brains of human patients with Parkinson's disease. Here we report these novel measurements and show that they correlate with outcomes and decisions in a sequential investment game. We find that serotonergic concentrations transiently increase as a whole following negative reward prediction errors, while reversing when counterfactual losses predominate. This provides initial evidence that the serotonergic system acts as an opponent to dopamine signaling, as anticipated by theoretical models. Serotonin transients on one trial were also associated with actions on the next trial in a manner that correlated with decreased exposure to poor outcomes. Thus, the fluctuations observed for serotonin appear to correlate with the inhibition of over-reactions and promote persistence of ongoing strategies in the face of short-term environmental changes. Together these findings elucidate a role for serotonin in the striatum, suggesting it encodes a protective action strategy that mitigates risk and modulates choice selection particularly following negative environmental events.
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Affiliation(s)
- Rosalyn J Moran
- Department of Engineering Mathematics, School of Computer Science, Electrical and Electronic Engineering, and Engineering Mathematics, University of Bristol, Bristol, UK
| | - Kenneth T Kishida
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, USA,Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Terry Lohrenz
- Virginia Tech Carilion Research Institute, Virginia Tech, Roanoke, VA, USA
| | - Ignacio Saez
- Helen Wills Neuroscience Institute, University of California, Berkeley, CA, USA
| | - Adrian W Laxton
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Mark R Witcher
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Stephen B Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Thomas L Ellis
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Paul EM Phillips
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, USA,Department of Pharmacology, University of Washington, Seattle, WA, USA
| | - Peter Dayan
- The Gatsby Computational Neuroscience Unit, University College London, London, UK
| | - P Read Montague
- Virginia Tech Carilion Research Institute, Virginia Tech, Roanoke, VA, USA,Department of Physics, Virginia Tech, Blacksburg, VA, USA,Wellcome Trust Centre for Neuroimaging, University College London, London, UK,Virginia Tech Carilion, Research Institute, 2 Riverside Circle, Roanoke, VA 24016, USA, Tel: +1 540 526 2006, Fax: +1 540 982 3805, E-mail:
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43
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Taylor JM, McTyre ER, Tatter SB, Laxton AW, Munley MT, Chan MD, Cramer CK. Gamma Knife Stereotactic Radiosurgery for the Treatment of Brain Metastases from Primary Tumors of the Urinary Bladder. Stereotact Funct Neurosurg 2018; 96:108-112. [PMID: 29698968 DOI: 10.1159/000488151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 03/05/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Brain metastases from bladder cancer are rare and published outcomes data are sparse. To date, no institutions have reported a series of patients with brain metastases from bladder cancer treated with stereotactic radiosurgery (SRS). Our aim was to identify patients with brain metastases from bladder primaries treated with SRS with or without surgical resection and report the clinical outcomes. METHODS Patients meeting eligibility criteria at our institution between 2000 and 2017 were included. The clinical variables of interest, including overall survival (OS), local recurrence, V12, distant brain failure (DBF), and initial brain metastases velocity, were calculated. Cox proportional hazards analysis was performed to identify predictors of time-to-event outcomes. RESULTS A total of 14 patients were included. The median OS from the time of treatment was 2.1 months. Factors predictive of OS include intracranial resection (HR 0.21, p = 0.03). The cumulative incidence of local failure was 21% at 6 months and 30% at 12 months. The cumulative incidence of DBF at 6 and 12 months was 23 and 31%, respectively. CONCLUSIONS The prognosis in this patient population remains guarded. Factors associated with improved survival include intracranial resection. Future, prospective work is needed to further define optimal management.
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Affiliation(s)
- James M Taylor
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Emory R McTyre
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Stephen B Tatter
- Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Adrian W Laxton
- Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael T Munley
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael D Chan
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Christina K Cramer
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Renfrow JJ, Strowd RE, Laxton AW, Tatter SB, Geer CP, Lesser GJ. Surgical Considerations in the Optimal Management of Patients with Malignant Brain Tumors. Curr Treat Options Oncol 2018; 18:46. [PMID: 28681208 DOI: 10.1007/s11864-017-0487-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OPINION STATEMENT Advances in technology are revolutionizing medicine and the limits of what we can offer to our patients. In neurosurgery, technology continues to reduce morbidity, increase surgical accuracy, facilitate tissue acquisition, and promote novel techniques for prolonging survival in patients with neuro-oncologic disease. Surgery has been the backbone of glioma diagnosis and treatment by providing adequate, high quality material for precise histologic diagnosis, and genomic characterization in the setting of significant intratumoral heterogeneity, thus allowing personalized treatment selection in the clinic. The ability to obtain and accurately measure the maximal extent of resection in glioma surgery also remains a central role of the neurosurgeon in managing this cancer. To meet these goals, today's operating room has transformed from the traditional operating table and anesthesia machine to include neuronavigation instrumentation, intraoperative computed tomography, and magnetic resonance imaging scanners, advanced surgical microscopes fitted with fluorescent light filters, and electrocorticography machines. While surgeons, oncologists, and radiation oncologists all play unique critical roles in the care of patients with malignant gliomas, familiarity with developing techniques in complimentary subspecialties can enhance coordination of patient care, research productivity, professional interactions, and patient confidence and comfort with the physician team. Herein, we provide a summary of the advances in the field of neurosurgical oncology which allow more precise and optimal surgical resection for patients with malignant gliomas.
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Affiliation(s)
- Jaclyn J Renfrow
- Department of Neurosurgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1082, USA.
| | - Roy E Strowd
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Department of Internal Medicine - Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Adrian W Laxton
- Department of Neurosurgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1082, USA
| | - Stephen B Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1082, USA
| | - Carol P Geer
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Glenn J Lesser
- Department of Internal Medicine - Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Hampson RE, Song D, Robinson BS, Fetterhoff D, Dakos AS, Roeder BM, She X, Wicks RT, Witcher MR, Couture DE, Laxton AW, Munger-Clary H, Popli G, Sollman MJ, Whitlow CT, Marmarelis VZ, Berger TW, Deadwyler SA. Developing a hippocampal neural prosthetic to facilitate human memory encoding and recall. J Neural Eng 2018; 15:036014. [PMID: 29589592 DOI: 10.1088/1741-2552/aaaed7] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE We demonstrate here the first successful implementation in humans of a proof-of-concept system for restoring and improving memory function via facilitation of memory encoding using the patient's own hippocampal spatiotemporal neural codes for memory. Memory in humans is subject to disruption by drugs, disease and brain injury, yet previous attempts to restore or rescue memory function in humans typically involved only nonspecific, modulation of brain areas and neural systems related to memory retrieval. APPROACH We have constructed a model of processes by which the hippocampus encodes memory items via spatiotemporal firing of neural ensembles that underlie the successful encoding of short-term memory. A nonlinear multi-input, multi-output (MIMO) model of hippocampal CA3 and CA1 neural firing is computed that predicts activation patterns of CA1 neurons during the encoding (sample) phase of a delayed match-to-sample (DMS) human short-term memory task. MAIN RESULTS MIMO model-derived electrical stimulation delivered to the same CA1 locations during the sample phase of DMS trials facilitated short-term/working memory by 37% during the task. Longer term memory retention was also tested in the same human subjects with a delayed recognition (DR) task that utilized images from the DMS task, along with images that were not from the task. Across the subjects, the stimulated trials exhibited significant improvement (35%) in both short-term and long-term retention of visual information. SIGNIFICANCE These results demonstrate the facilitation of memory encoding which is an important feature for the construction of an implantable neural prosthetic to improve human memory.
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Affiliation(s)
- Robert E Hampson
- Wake Forest Baptist Medical Center, Winston-Salem, NC, United States of America
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Lanier CM, McTyre E, LeCompte M, Cramer CK, Hughes R, Watabe K, Lo HW, O'Neill S, Munley MT, Laxton AW, Tatter SB, Ruiz J, Chan MD. The number of prior lines of systemic therapy as a prognostic factor for patients with brain metastases treated with stereotactic radiosurgery: Results of a large single institution retrospective analysis. Clin Neurol Neurosurg 2018; 165:24-28. [PMID: 29289917 DOI: 10.1016/j.clineuro.2017.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 11/25/2017] [Accepted: 12/25/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES It is presently unknown whether patients with brain metastases from heavily pre-treated cancers have a significantly different prognosis than those with less pre-treatment. In this study we sought to identify whether the number of prior lines of systemic therapy are associated with clinical outcomes in patients with brain metastases who received stereotactic radiosurgery (SRS). PATIENTS AND METHODS Between July 2000 and July 2017, 377 patients with brain metastases were treated with upfront SRS. We performed a large, single institution retrospective analysis of these patients. Kaplan Meier analysis was used to estimate survival times. Competing risk analysis was used to estimate times to local failure (LF) and distant brain failure (DBF). Multivariate analysis was performed to estimate the hazard ratios (HRs) for overall survival (OS), neurologic and non-neurologic death for patients with 1, 2 and 3+ lines of prior systemic therapy. RESULTS Of the 1077 patients with brain metastases treated with SRS, 377 received prior systemic therapy with a median of 1 (range: 1-9) lines of prior therapy. Median OS was 8.70 months (95% CI, 7.9-9.5). Median OS for patients with 1 prior line of therapy, 2 prior lines of therapy and 3 or greater lines of therapy were 9.93-, 9.05-, and 6.18-months, respectively (log rank p = .04). Lines of therapy as a continuous variable was not associated with LF or DBF on competing risk analysis. The percentage of patients that died of neurological death was 36%. Greater prior lines of therapy (1 vs. 2 vs. 3 and greater) was associated with a greater likelihood of dying of non-neurologic death (gray's p = .01), but was not associated with likelihood of dying of neurologic death (p = .57). CONCLUSION Lines of therapy are associated with OS and non-neurologic death but are not associated with neurologic death, LF or DBF.
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Affiliation(s)
- Claire M Lanier
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States.
| | - Emory McTyre
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States
| | - Michael LeCompte
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States
| | - Christina K Cramer
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States
| | - Ryan Hughes
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States
| | - Kounosuke Watabe
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States
| | - Hui-Wen Lo
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States
| | - Stacey O'Neill
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States
| | - Michael T Munley
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States
| | - Adrian W Laxton
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States
| | - Stephen B Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States
| | - Jimmy Ruiz
- Department of Medicine (Hematology & Oncology), Wake Forest School of Medicine, Winston-Salem, NC 27157, United States; W.G. (Bill) Hefner Veteran Administration Medical Center, Cancer Center, Salisbury, NC, 28144, United States
| | - Michael D Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States
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Shenker RF, Hughes RT, McTyre ER, Lanier C, Lo HW, Metheny-Barlow L, Su J, Thomas A, Brown DR, Avery T, Pasche B, Cramer CK, Laxton AW, Tatter SB, Watabe K, Chan MD. Potential prognostic markers for survival and neurologic death in patients with breast cancer brain metastases who receive upfront SRS alone. J Radiosurg SBRT 2018; 5:277-283. [PMID: 30538888 PMCID: PMC6255726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/26/2018] [Indexed: 06/09/2023]
Abstract
PURPOSE/OBJECTIVES Stereotactic radiosurgery (SRS) is used as a treatment option for breast cancer brain metastases. It is unclear what factors predict neurologic death for these patients. MATERIALS/METHODS A total of 128 patients with breast cancer brain metastases were treated with upfront SRS alone in this study. Survival was estimated using the Kaplan-Meier method. Clinicopathologic factors evaluated included age, ER/PR status, Her2 status, numbers of brain metastases treated, minimum SRS dose, disease-specific GPA, extracranial disease status and systemic disease burden. RESULTS ER or PR positivity was associated with a trend towards decreased neurologic death (subdistribution hazard ratio (sHR) = 0.54, p=0.06). Factors associated with non-neurologic death include extracranial disease status (sHR = 2.02, p=0.02) and dose (sHR = 1.11, p=0.02); Her2-positivity was associated with reduced hazard of non-neurologic death (sHR 0.52, p=0.05). CONCLUSIONS ER/PR positivity was associated with a trend towards less neurologic death. HER2 positivity was associated with a trend towards less non-neurologic death.
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Affiliation(s)
- Rachel F Shenker
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Ryan T Hughes
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Emory R McTyre
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Claire Lanier
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Hui-Wen Lo
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Linda Metheny-Barlow
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Jing Su
- Department of Biostatistics, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Alexandra Thomas
- Department of Medicine (Hematology & Oncology), Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Doris R Brown
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Tiffany Avery
- Department of Medicine (Hematology & Oncology), Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Boris Pasche
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
- Department of Medicine (Hematology & Oncology), Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Christina K Cramer
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Adrian W Laxton
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Stephen B Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Kounosuke Watabe
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Michael D Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
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LeCompte MC, McTyre ER, Strowd RE, Lanier C, Soike MH, Hughes RT, Masters AH, Cramer CK, Farris M, Ruiz J, Watabe K, Laxton AW, Tatter SB, Winkfield KM, Chan MD. Impact of diabetes mellitus on outcomes in patients with brain metastasis treated with stereotactic radiosurgery. J Radiosurg SBRT 2018; 5:285-291. [PMID: 30538889 PMCID: PMC6255719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 09/06/2018] [Indexed: 06/09/2023]
Abstract
PURPOSE To determine the influence of diabetes mellitus (DM) on outcomes in patients with brain metastasis treated with stereotactic radiosurgery (SRS). METHODS We retrospectively reviewed 498 patients with brain metastasis treated at our institution with SRS between January 2012 and March 2017. RESULTS Eight-four patients (16.9%) held a diagnosis of DM prior to SRS treatment. Diabetics compared to nondiabetics had worse overall survival (OS). DM was found to be a significant predictor of OS on multivariate analysis (HR: 1.41, CI: 1.03-1.92, p = 0.03). When stratified by DM diagnosis, there were no significant differences in incidence of radiation necrosis (p = 0.82), radiation-induced edema (p = 0.88), cerebrospinal fluid leak (p = 0.49), or postoperative infection (p = 0.68). CONCLUSIONS DM diagnosis was a significant predictor of poorer OS in patients treated for brain metastasis with SRS. Diabetics and nondiabetics experienced similar rates of radiation-associated brain toxicities.
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Affiliation(s)
- Michael C LeCompte
- Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Emory R McTyre
- Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Roy E Strowd
- Department of Neurology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27517, USA
| | - Claire Lanier
- Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Michael H Soike
- Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Ryan T Hughes
- Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Adrianna H Masters
- Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Christina K Cramer
- Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Michael Farris
- Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Jimmy Ruiz
- Department of Medicine (Hematology and Oncology), Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
- W.G. (Bill) Hefner Veteran Administration Medical Center, Cancer Center, 1601 Brenner Ave, Salisbury, NC, 28144, USA
| | - Kounosuke Watabe
- Department of Cancer Biology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Adrian W Laxton
- Department of Neurosurgery, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Stephen B Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Karen M Winkfield
- Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Michael D Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
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McTyre E, Helis CA, Farris M, Wilkins L, Sloan D, Hinson WH, Bourland JD, Dezarn WA, Munley MT, Watabe K, Xing F, Laxton AW, Tatter SB, Chan MD. Emerging Indications for Fractionated Gamma Knife Radiosurgery. Neurosurgery 2017; 80:210-216. [PMID: 28536486 DOI: 10.1227/neu.0000000000001227] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Gamma Knife radiosurgery (GKRS) allows for the treatment of intracranial tumors with a high degree of dose conformality and precision. There are, however, certain situations wherein the dose conformality of GKRS is desired, but single session treatment is contraindicated. In these situations, a traditional pin-based GKRS head frame cannot be used, as it precludes fractionated treatment. OBJECTIVE To report our experience in treating patients with fractionated GKRS using a relocatable, noninvasive immobilization system. METHODS Patients were considered candidates for fractionated GKRS if they had one or more of the following indications: a benign tumor >10 cc in volume or abutting the optic pathway, a vestibular schwannoma with the intent of hearing preservation, or a tumor previously irradiated with single fraction GKRS. The immobilization device used for all patients was the Extend system (Leksell Gamma Knife Perfexion, Elekta, Kungstensgatan, Stockholm). RESULTS We identified 34 patients treated with fractionated GKRS between August 2013 and February 2015. There were a total of 37 tumors treated including 15 meningiomas, 11 pituitary adenomas, 6 brain metastases, 4 vestibular schwannomas, and 1 hemangioma. At last follow-up, all 21 patients treated for perioptic tumors had stable or improved vision and all 4 patients treated for vestibular schwannoma maintained serviceable hearing. No severe adverse events were reported. CONCLUSION Fractionated GKRS was well-tolerated in the treatment of large meningiomas, perioptic tumors, vestibular schwannomas with intent of hearing preservation, and in reirradiation of previously treated tumors.
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Affiliation(s)
- Emory McTyre
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Corbin A Helis
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Michael Farris
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Lisa Wilkins
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Darrell Sloan
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - William H Hinson
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - J Daniel Bourland
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - William A Dezarn
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Michael T Munley
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kounosuke Watabe
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Fei Xing
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Adrian W Laxton
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Stephen B Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Michael D Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
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McTyre ER, Johnson AG, Ruiz J, Isom S, Lucas JT, Hinson WH, Watabe K, Laxton AW, Tatter SB, Chan MD. Predictors of neurologic and nonneurologic death in patients with brain metastasis initially treated with upfront stereotactic radiosurgery without whole-brain radiation therapy. Neuro Oncol 2017; 19:558-566. [PMID: 27571883 DOI: 10.1093/neuonc/now184] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 07/22/2016] [Indexed: 11/13/2022] Open
Abstract
Background In this study we attempted to discern the factors predictive of neurologic death in patients with brain metastasis treated with upfront stereotactic radiosurgery (SRS) without whole brain radiation therapy (WBRT) while accounting for the competing risk of nonneurologic death. Methods We performed a retrospective single-institution analysis of patients with brain metastasis treated with upfront SRS without WBRT. Competing risks analysis was performed to estimate the subdistribution hazard ratios (HRs) for neurologic and nonneurologic death for predictor variables of interest. Results Of 738 patients treated with upfront SRS alone, neurologic death occurred in 226 (30.6%), while nonneurologic death occurred in 309 (41.9%). Multivariate competing risks analysis identified an increased hazard of neurologic death associated with diagnosis-specific graded prognostic assessment (DS-GPA) ≤ 2 (P = .005), melanoma histology (P = .009), and increased number of brain metastases (P<.001), while there was a decreased hazard associated with higher SRS dose (P = .004). Targeted agents were associated with a decreased HR of neurologic death in the first 1.5 years (P = .04) but not afterwards. An increased hazard of nonneurologic death was seen with increasing age (P =.03), nonmelanoma histology (P<.001), presence of extracranial disease (P<.001), and progressive systemic disease (P =.004). Conclusions Melanoma, DS-GPA, number of brain metastases, and SRS dose are predictive of neurologic death, while age, nonmelanoma histology, and more advanced systemic disease are predictive of nonneurologic death. Targeted agents appear to delay neurologic death.
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Affiliation(s)
- Emory R McTyre
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Adam G Johnson
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jimmy Ruiz
- Department of Medicine (Hematology & Oncology), Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,W. G. (Bill) Hefner Veteran Administration Medical Center, Cancer Center, Salisbury, North Carolina, USA
| | - Scott Isom
- Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, North Carolina, USA
| | - John T Lucas
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - William H Hinson
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Kounosuke Watabe
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Adrian W Laxton
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Stephen B Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael D Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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