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Rusthoven CG, Staley AW, Gao D, Yomo S, Bernhardt D, Wandrey N, El Shafie R, Kraemer A, Padilla O, Chiang V, Faramand AM, Palmer JD, Zacharia BE, Wegner RE, Hattangadi-Gluth JA, Levy A, Bernstein K, Mathieu D, Cagney DN, Chan MD, Grills IS, Braunstein S, Lee CC, Sheehan JP, Kluwe C, Patel S, Halasz LM, Andratschke N, Deibert CP, Verma V, Trifiletti DM, Cifarelli CP, Debus J, Combs SE, Sato Y, Higuchi Y, Aoyagi K, Brown PD, Alami V, Niranjan A, Lunsford LD, Kondziolka D, Camidge DR, Kavanagh BD, Robin TP, Serizawa T, Yamamoto M. Comparison of first-line radiosurgery for small-cell and non-small cell lung cancer brain metastases (CROSS-FIRE). J Natl Cancer Inst 2023; 115:926-936. [PMID: 37142267 PMCID: PMC10407696 DOI: 10.1093/jnci/djad073] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/23/2023] [Accepted: 04/28/2023] [Indexed: 05/06/2023] Open
Abstract
INTRODUCTION Historical reservations regarding stereotactic radiosurgery (SRS) for small-cell lung cancer (SCLC) brain metastases include concerns for short-interval and diffuse central nervous system (CNS) progression, poor prognoses, and increased neurological mortality specific to SCLC histology. We compared SRS outcomes for SCLC and non-small cell lung cancer (NSCLC) where SRS is well established. METHODS Multicenter first-line SRS outcomes for SCLC and NSCLC from 2000 to 2022 were retrospectively collected (n = 892 SCLC, n = 4785 NSCLC). Data from the prospective Japanese Leksell Gamma Knife Society (JLGK0901) clinical trial of first-line SRS were analyzed as a comparison cohort (n = 98 SCLC, n = 814 NSCLC). Overall survival (OS) and CNS progression were analyzed using Cox proportional hazard and Fine-Gray models, respectively, with multivariable adjustment for cofactors including age, sex, performance status, year, extracranial disease status, and brain metastasis number and volume. Mutation-stratified analyses were performed in propensity score-matched retrospective cohorts of epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) positive NSCLC, mutation-negative NSCLC, and SCLC. RESULTS OS was superior for patients with NSCLC compared to SCLC in the retrospective dataset (median OS = 10.5 vs 8.6 months; P < .001) and in the JLGK0901 dataset. Hazard estimates for first CNS progression favoring NSCLC were similar in both datasets but reached statistical significance in the retrospective dataset only (multivariable hazard ratio = 0.82, 95% confidence interval = 0.73 to 0.92, P = .001). In the propensity score-matched cohorts, there were continued OS advantages for NSCLC patients (median OS = 23.7 [EGFR and ALK positive NSCLC] vs 13.6 [mutation-negative NSCLC] vs 10.4 months [SCLC], pairwise P values < 0.001), but no statistically significant differences in CNS progression were observed in the matched cohorts. Neurological mortality and number of lesions at CNS progression were similar for NSCLC and SCLC patients. Leptomeningeal progression was increased in patients with NSCLC compared to SCLC in the retrospective dataset only (multivariable hazard ratio = 1.61, 95% confidence interval = 1.14 to 2.26, P = .007). CONCLUSIONS After SRS, SCLC histology was associated with shorter OS compared to NSCLC. CNS progression occurred earlier in SCLC patients overall but was similar in patients matched on baseline factors. SCLC was not associated with increased neurological mortality, number of lesions at CNS progression, or leptomeningeal progression compared to NSCLC. These findings may better inform clinical expectations and individualized decision making regarding SRS for SCLC patients.
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Affiliation(s)
- Chad G Rusthoven
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Alyse W Staley
- University of Colorado Cancer Center, Biostatistics Core, Aurora, CO, USA
| | - Dexiang Gao
- University of Colorado Cancer Center, Biostatistics Core, Aurora, CO, USA
| | - Shoji Yomo
- Division of Radiation Oncology, Aizawa Comprehensive Cancer Center, Division of Radiation Oncology, Aizawa Hospital, Matsumoto, Japan
| | - Denise Bernhardt
- Department of Radiation Oncology, Technical University of Munich (TUM), Munich, Germany
| | - Narine Wandrey
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Rami El Shafie
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Department of Radiation Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Anna Kraemer
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Oscar Padilla
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, USA
| | - Veronica Chiang
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Andrew M Faramand
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Joshua D Palmer
- Department of Radiation Oncology, The James Comprehensive Cancer Center at The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Brad E Zacharia
- Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Rodney E Wegner
- Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | | | - Antonin Levy
- Department of Radiation Oncology, Gustave Roussy, Villejuif, Université Paris Saclay, France
| | - Kenneth Bernstein
- Department of Radiation Oncology, New York University Langone Medical Center, New York, NY, USA
| | - David Mathieu
- Division of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, QC, Canada
| | - Daniel N Cagney
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Michael D Chan
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Inga S Grills
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, USA
| | - Steve Braunstein
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA
| | - Cheng-Chia Lee
- Taipei Veterans General Hospital, Department of Neurosurgery, Neurological Institute, Taipei, Taiwan
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA
| | - Christien Kluwe
- Department of Radiation Oncology, Vanderbilt University, Nashville, TN, USA
| | - Samir Patel
- Division of Radiation Oncology, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Lia M Halasz
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich (USZ), The University of Zurich, Zurich, Switzerland
| | | | - Vivek Verma
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Daniel M Trifiletti
- Department of Radiation Oncology, Mayo Clinic Jacksonville, Jacksonville, FL, USA
| | | | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich (TUM), Munich, Germany
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Yoshinori Higuchi
- Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Kyoko Aoyagi
- Gamma Knife House, Chiba Cerebral and Cardiovascular Center, Chiba, Japan
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Vida Alami
- University of Colorado Cancer Center, Biostatistics Core, Aurora, CO, USA
| | - Ajay Niranjan
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - L Dade Lunsford
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Douglas Kondziolka
- Department of Neurosurgery and Radiation Oncology, New York University Langone Medical Center, New York, NY, USA
| | - D Ross Camidge
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Brian D Kavanagh
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Tyler P Robin
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Toru Serizawa
- Tokyo Gamma Unit Center, Tsukiji Neurological Clinic, Tokyo, Japan
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Ye ZPP, Ai XL, Faramand AM, Fang F. Macrophages as Nanocarriers for Drug Delivery: Novel Therapeutics for Central Nervous System Diseases. J Nanosci Nanotechnol 2021; 18:471-485. [PMID: 29768873 DOI: 10.1166/jnn.2018.15218] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Many central nervous system (CNS) diseases were thought to be untreatable due to the presence of the blood-brain barrier (BBB). The chemokine gradients secreted from CNS parenchyma can induce macrophage migration to the brain, induce firm adherence to the endothelium of BBB, and eventually to enter the brain parenchyma. Macrophages migrating into CNS can promote neuron regeneration, induce inflammation and angiogenesis. These properties can potentially allow macrophages to act as carriers for drug/nano formulations across the BBB, and reach the potential target sites. Many nanomaterials cannot be used for the management of CNS diseases because of their low carrying efficiency. Macrophage which transports nanomaterials to pathological sites is rendered as an attractive tool for the transportation of drugs to previously inaccessible regions within the brain parenchyma. Nanomaterials engulfed by macrophages can be released at target sites, and be used for therapeutic or diagnostic purposes. In this review, we focus on macrophages as the cell-carrier to deliver nano-drugs into CNS, describe the biological behavior of macrophages during pathological conditions and discuss the application of cell drug delivery system in recent years.
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Affiliation(s)
- Zeng-Pan-Pan Ye
- Department of Neurosurgery, West China Hospital of Sichuan University, 37 Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - Xiao-Lin Ai
- Department of Neurosurgery, West China Hospital of Sichuan University, 37 Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - Andrew M Faramand
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
| | - Fang Fang
- Department of Neurosurgery, West China Hospital of Sichuan University, 37 Guo Xue Xiang, Chengdu, Sichuan 610041, China
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Rusthoven CG, Yamamoto M, Bernhardt D, Smith DE, Gao D, Serizawa T, Yomo S, Aiyama H, Higuchi Y, Shuto T, Akabane A, Sato Y, Niranjan A, Faramand AM, Lunsford LD, McInerney J, Tuanquin LC, Zacharia BE, Chiang V, Singh C, Yu JB, Braunstein S, Mathieu D, Touchette CJ, Lee CC, Yang HC, Aizer AA, Cagney DN, Chan MD, Kondziolka D, Bernstein K, Silverman JS, Grills IS, Siddiqui ZA, Yuan JC, Sheehan JP, Cordeiro D, Nosaki K, Seto T, Deibert CP, Verma V, Day S, Halasz LM, Warnick RE, Trifiletti DM, Palmer JD, Attia A, Li B, Cifarelli CP, Brown PD, Vargo JA, Combs SE, Kessel KA, Rieken S, Patel S, Guckenberger M, Andratschke N, Kavanagh BD, Robin TP. Evaluation of First-line Radiosurgery vs Whole-Brain Radiotherapy for Small Cell Lung Cancer Brain Metastases: The FIRE-SCLC Cohort Study. JAMA Oncol 2021; 6:1028-1037. [PMID: 32496550 DOI: 10.1001/jamaoncol.2020.1271] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Although stereotactic radiosurgery (SRS) is preferred for limited brain metastases from most histologies, whole-brain radiotherapy (WBRT) has remained the standard of care for patients with small cell lung cancer. Data on SRS are limited. Objective To characterize and compare first-line SRS outcomes (without prior WBRT or prophylactic cranial irradiation) with those of first-line WBRT. Design, Setting, and Participants FIRE-SCLC (First-line Radiosurgery for Small-Cell Lung Cancer) was a multicenter cohort study that analyzed SRS outcomes from 28 centers and a single-arm trial and compared these data with outcomes from a first-line WBRT cohort. Data were collected from October 26, 2017, to August 15, 2019, and analyzed from August 16, 2019, to November 6, 2019. Interventions SRS and WBRT for small cell lung cancer brain metastases. Main Outcomes and Measures Overall survival, time to central nervous system progression (TTCP), and central nervous system (CNS) progression-free survival (PFS) after SRS were evaluated and compared with WBRT outcomes, with adjustment for performance status, number of brain metastases, synchronicity, age, sex, and treatment year in multivariable and propensity score-matched analyses. Results In total, 710 patients (median [interquartile range] age, 68.5 [62-74] years; 531 men [74.8%]) who received SRS between 1994 and 2018 were analyzed. The median overall survival was 8.5 months, the median TTCP was 8.1 months, and the median CNS PFS was 5.0 months. When stratified by the number of brain metastases treated, the median overall survival was 11.0 months (95% CI, 8.9-13.4) for 1 lesion, 8.7 months (95% CI, 7.7-10.4) for 2 to 4 lesions, 8.0 months (95% CI, 6.4-9.6) for 5 to 10 lesions, and 5.5 months (95% CI, 4.3-7.6) for 11 or more lesions. Competing risk estimates were 7.0% (95% CI, 4.9%-9.2%) for local failures at 12 months and 41.6% (95% CI, 37.6%-45.7%) for distant CNS failures at 12 months. Leptomeningeal progression (46 of 425 patients [10.8%] with available data) and neurological mortality (80 of 647 patients [12.4%] with available data) were uncommon. On propensity score-matched analyses comparing SRS with WBRT, WBRT was associated with improved TTCP (hazard ratio, 0.38; 95% CI, 0.26-0.55; P < .001), without an improvement in overall survival (median, 6.5 months [95% CI, 5.5-8.0] for SRS vs 5.2 months [95% CI, 4.4-6.7] for WBRT; P = .003) or CNS PFS (median, 4.0 months for SRS vs 3.8 months for WBRT; P = .79). Multivariable analyses comparing SRS and WBRT, including subset analyses controlling for extracranial metastases and extracranial disease control status, demonstrated similar results. Conclusions and Relevance Results of this study suggest that the primary trade-offs associated with SRS without WBRT, including a shorter TTCP without a decrease in overall survival, are similar to those observed in settings in which SRS is already established.
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Affiliation(s)
- Chad G Rusthoven
- University of Colorado School of Medicine, Department of Radiation Oncology, Aurora
| | | | - Denise Bernhardt
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Derek E Smith
- University of Colorado Cancer Center, Biostatistics Core, Aurora
| | - Dexiang Gao
- University of Colorado Cancer Center, Biostatistics Core, Aurora
| | - Toru Serizawa
- Tokyo Gamma Unit Center, Tsukiji Neurological Clinic, Tokyo, Japan
| | - Shoji Yomo
- Aizawa Comprehensive Cancer Center, Division of Radiation Oncology, Aizawa Hospital, Matsumoto, Japan
| | | | - Yoshinori Higuchi
- Chiba University Graduate School of Medicine, Department of Neurological Surgery, Chiba, Japan
| | - Takashi Shuto
- Yokohama Rosai Hospital, Department of Neurosurgery, Yokohama, Japan
| | - Atsuya Akabane
- Gamma Knife Center, NTT Medical Center Tokyo, Tokyo, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Ajay Niranjan
- Department of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Andrew M Faramand
- Department of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - L Dade Lunsford
- Department of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - James McInerney
- Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Leonard C Tuanquin
- Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Brad E Zacharia
- Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Veronica Chiang
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Charu Singh
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - James B Yu
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Steve Braunstein
- Department of Radiation Oncology, University of California, San Francisco, San Francisco
| | - David Mathieu
- Division of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Quebec, Canada
| | - Charles J Touchette
- Division of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Quebec, Canada
| | - Cheng-Chia Lee
- Taipei Veterans General Hospital, Department of Neurosurgery, Neurological Institute, Taipei, Taiwan
| | - Huai-Che Yang
- Taipei Veterans General Hospital, Department of Neurosurgery, Neurological Institute, Taipei, Taiwan
| | - Ayal A Aizer
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Daniel N Cagney
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Michael D Chan
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Douglas Kondziolka
- Department of Neurosurgery, New York University Langone Medical Center, New York
| | - Kenneth Bernstein
- Department of Neurosurgery, New York University Langone Medical Center, New York
| | - Joshua S Silverman
- Department of Neurosurgery, New York University Langone Medical Center, New York
| | - Inga S Grills
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Zaid A Siddiqui
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Justin C Yuan
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville
| | - Diogo Cordeiro
- Department of Neurological Surgery, University of Virginia, Charlottesville
| | - Kename Nosaki
- National Hospital Organization Kyushu Cancer Center, Department of Thoracic Oncology, Fukuoka, Japan
| | - Takahashi Seto
- National Hospital Organization Kyushu Cancer Center, Department of Thoracic Oncology, Fukuoka, Japan
| | | | - Vivek Verma
- Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Samuel Day
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle
| | - Lia M Halasz
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle
| | - Ronald E Warnick
- Department of Neurosurgery, Jewish Hospital-Mercy Health, Cincinnati, Ohio
| | - Daniel M Trifiletti
- Department of Radiation Oncology, Mayo Clinic Jacksonville, Jacksonville, Florida
| | - Joshua D Palmer
- Department of Radiation Oncology, Ohio State University, Columbus
| | - Albert Attia
- Department of Radiation Oncology, Vanderbilt University, Nashville, Tennessee
| | - Benjamin Li
- Department of Radiation Oncology, Vanderbilt University, Nashville, Tennessee
| | | | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - John A Vargo
- Department of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Neurosurgery, West Virginia University, Morgantown
| | - Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich, Munich, Germany
| | - Kerstin A Kessel
- Department of Radiation Oncology, Technical University of Munich, Munich, Germany
| | - Stefan Rieken
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Samir Patel
- Department of Radiation Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, The University of Zurich, Zurich, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, The University of Zurich, Zurich, Switzerland
| | - Brian D Kavanagh
- University of Colorado School of Medicine, Department of Radiation Oncology, Aurora
| | - Tyler P Robin
- University of Colorado School of Medicine, Department of Radiation Oncology, Aurora
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Ogino A, Kano H, Long H, Johnson S, Faramand AM, Niranjan A, Flickinger J, Lunsford LD. Stereotactic Radiosurgery as the Primary Management for Patients with Koos Grade IV Vestibular Schwannomas. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_620] [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: 11/13/2022] Open
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Ogino A, Kano H, Long H, Johnson S, Faramand AM, Niranjan A, Flickinger J, Lunsford LD. Stereotactic Radiosurgery as the First Line Treatment for Intracanalicular Vestibular Schwannomas. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_883] [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: 11/13/2022] Open
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Abou-Al-Shaar H, Faramand AM, Zhang X, Algattas H, Lunsford LD. Chronic Encapsulated Expanding Hematoma After Stereotactic Radiosurgery of Intracranial Arteriovenous Malformation. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_677] [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: 11/14/2022] Open
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Faramand AM, Kano H, Johnson S, Niranjan A, Flickinger JC, Lunsford LD. CT versus MR Imaging in Estimating Cochlear Radiation Dose during Gamma Knife Surgery for Vestibular Schwannomas. AJNR Am J Neuroradiol 2018; 39:1907-1911. [PMID: 30213806 DOI: 10.3174/ajnr.a5808] [Citation(s) in RCA: 3] [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: 12/07/2017] [Accepted: 07/01/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Leksell stereotactic radiosurgery is an effective option for patients with vestibular schwannomas. Some centers use a combination of stereotactic CT fused with stereotactic MR imaging to achieve an optimal target definition as well as minimize the radiation dose delivered to adjacent structures that correlate with hearing outcomes. The present prospective study was designed to determine whether there is cochlear dose variability between MR imaging and CT. MATERIALS AND METHODS Fifty consecutive patients underwent stereotactic radiosurgery for vestibular schwannomas. Dose-planning was performed using high-definition fused stereotactic MR imaging and stereotactic CT images. The 3D cochlear volume was determined by delineating the cochlea on both CT and T2-weighted MR imaging. The mean radiation dose, maximum dose, and 3- and 4.20-Gy cochlear volumes were identified using standard Leksell Gamma Knife software. RESULTS The median mean radiation dose delivered to the cochlea was 3.50 Gy (range, 1.20-6.80 Gy) on CT and 3.40 Gy (range, 1-6.70 Gy) on MR imaging (concordance correlation coefficient = 0.86, r 2 = 0.9, P ≤ .001). The median maximum dose delivered to the cochlea was 6.7 Gy on CT and 6.6 Gy on MR imaging (concordance correlation coefficient = 0.89, r 2 = 0.90, P ≤ .001). Dose-volume histograms generated from CT and MR imaging demonstrated a strong level of correlation in estimating the 3- and 4.20-Gy volumes (concordance correlation coefficient = 0.81, r 2 = 0.82, P ≤ .001 and concordance correlation coefficient = 0.87, r 2 = 0.89, P ≤ .001). CONCLUSIONS Both MR imaging and CT provide similar cochlear dose parameters. Despite the reported superiority of CT in identifying bony structures, high-definition MR imaging alone is sufficient to identify the radiation doses delivered to the cochlea.
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Affiliation(s)
- A M Faramand
- From the Department of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - H Kano
- From the Department of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | - S Johnson
- From the Department of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - A Niranjan
- From the Department of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - J C Flickinger
- From the Department of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - L D Lunsford
- From the Department of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Faramand AM, Barnes N, Harrison S, Gunny R, Jacques T, Tahir MZ, Varadkar SM, Cross HJ, Harkness W, Tisdall MM. Seizure and cognitive outcomes after resection of glioneuronal tumors in children. Epilepsia 2017; 59:170-178. [DOI: 10.1111/epi.13961] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2017] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Sue Harrison
- Great Ormond Street Hospital; London United Kingdom
| | | | - Tom Jacques
- UCL Great Ormond Street Institute of Child Health; London United Kingdom
| | | | - Sophia M. Varadkar
- Great Ormond Street Hospital; London United Kingdom
- UCL Great Ormond Street Institute of Child Health; London United Kingdom
| | - Helen J. Cross
- Great Ormond Street Hospital; London United Kingdom
- UCL Great Ormond Street Institute of Child Health; London United Kingdom
- National Centre for Young People with Epilepsy; Lingfield United Kingdom
| | | | - Martin M. Tisdall
- Great Ormond Street Hospital; London United Kingdom
- UCL Great Ormond Street Institute of Child Health; London United Kingdom
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