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Wisdom AJ, Barker CA, Chang JY, Demaria S, Formenti S, Grassberger C, Gregucci F, Hoppe BS, Kirsch DG, Marciscano AE, Mayadev J, Mouw KW, Palta M, Wu CC, Jabbour SK, Schoenfeld JD. The Next Chapter in Immunotherapy and Radiation Combination Therapy: Cancer-Specific Perspectives. Int J Radiat Oncol Biol Phys 2024; 118:1404-1421. [PMID: 38184173 DOI: 10.1016/j.ijrobp.2023.12.046] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 12/20/2023] [Accepted: 12/30/2023] [Indexed: 01/08/2024]
Abstract
Immunotherapeutic agents have revolutionized cancer treatment over the past decade. However, most patients fail to respond to immunotherapy alone. A growing body of preclinical studies highlights the potential for synergy between radiation therapy and immunotherapy, but the outcomes of clinical studies have been mixed. This review summarizes the current state of immunotherapy and radiation combination therapy across cancers, highlighting existing challenges and promising areas for future investigation.
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Affiliation(s)
- Amy J Wisdom
- Harvard Radiation Oncology Program, Boston, Massachusetts
| | - Christopher A Barker
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joe Y Chang
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sandra Demaria
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York
| | - Silvia Formenti
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York
| | - Clemens Grassberger
- Department of Radiation Oncology, University of Washington, Fred Hutch Cancer Center, Seattle, Washington
| | - Fabiana Gregucci
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York
| | - Bradford S Hoppe
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - David G Kirsch
- Department of Radiation Oncology, University of Toronto, Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Ariel E Marciscano
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jyoti Mayadev
- Department of Radiation Oncology, UC San Diego School of Medicine, San Diego, California
| | - Kent W Mouw
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Manisha Palta
- Department of Radiation Oncology, Duke Cancer Center, Durham, North Carolina
| | - Cheng-Chia Wu
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.
| | - Jonathan D Schoenfeld
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts.
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2
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Tazhibi M, McQuillan N, Wei HJ, Gallitto M, Bendau E, Webster Carrion A, Berg X, Kokossis D, Zhang X, Zhang Z, Jan CI, Mintz A, Gartrell RD, Syed HR, Fonseca A, Pavisic J, Szalontay L, Konofagou EE, Zacharoulis S, Wu CC. Focused ultrasound-mediated blood-brain barrier opening is safe and feasible with moderately hypofractionated radiotherapy for brainstem diffuse midline glioma. J Transl Med 2024; 22:320. [PMID: 38555449 PMCID: PMC10981822 DOI: 10.1186/s12967-024-05096-9] [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: 03/22/2023] [Accepted: 03/15/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Diffuse midline glioma (DMG) is a pediatric tumor with dismal prognosis. Systemic strategies have been unsuccessful and radiotherapy (RT) remains the standard-of-care. A central impediment to treatment is the blood-brain barrier (BBB), which precludes drug delivery to the central nervous system (CNS). Focused ultrasound (FUS) with microbubbles can transiently and non-invasively disrupt the BBB to enhance drug delivery. This study aimed to determine the feasibility of brainstem FUS in combination with clinical doses of RT. We hypothesized that FUS-mediated BBB-opening (BBBO) is safe and feasible with 39 Gy RT. METHODS To establish a safety timeline, we administered FUS to the brainstem of non-tumor bearing mice concurrent with or adjuvant to RT; our findings were validated in a syngeneic brainstem murine model of DMG receiving repeated sonication concurrent with RT. The brainstems of male B6 (Cg)-Tyrc-2J/J albino mice were intracranially injected with mouse DMG cells (PDGFB+, H3.3K27M, p53-/-). A clinical RT dose of 39 Gy in 13 fractions (39 Gy/13fx) was delivered using the Small Animal Radiation Research Platform (SARRP) or XRAD-320 irradiator. FUS was administered via a 0.5 MHz transducer, with BBBO and tumor volume monitored by magnetic resonance imaging (MRI). RESULTS FUS-mediated BBBO did not affect cardiorespiratory rate, motor function, or tissue integrity in non-tumor bearing mice receiving RT. Tumor-bearing mice tolerated repeated brainstem BBBO concurrent with RT. 39 Gy/13fx offered local control, though disease progression occurred 3-4 weeks post-RT. CONCLUSION Repeated FUS-mediated BBBO is safe and feasible concurrent with RT. In our syngeneic DMG murine model, progression occurs, serving as an ideal model for future combination testing with RT and FUS-mediated drug delivery.
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Affiliation(s)
- Masih Tazhibi
- Department of Radiation Oncology, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, 10032, USA
| | - Nicholas McQuillan
- Department of Radiation Oncology, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, 10032, USA
| | - Hong-Jian Wei
- Department of Radiation Oncology, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, 10032, USA
| | - Matthew Gallitto
- Department of Radiation Oncology, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, 10032, USA
| | - Ethan Bendau
- Department of Biomedical Engineering, Columbia University, New York, NY, 10027, USA
| | - Andrea Webster Carrion
- Division of Pediatric Hematology Oncology and Stem Cell Transplant, Department of Pediatrics, Columbia University Irving Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Xander Berg
- Department of Radiation Oncology, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, 10032, USA
| | - Danae Kokossis
- Department of Radiation Oncology, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, 10032, USA
| | - Xu Zhang
- Division of Pediatric Hematology Oncology and Stem Cell Transplant, Department of Pediatrics, Columbia University Irving Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA
- Institute for Cancer Genetics, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Zhiguo Zhang
- Division of Pediatric Hematology Oncology and Stem Cell Transplant, Department of Pediatrics, Columbia University Irving Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA
- Institute for Cancer Genetics, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Chia-Ing Jan
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, 10032, USA
- Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, 813, Taiwan
| | - Akiva Mintz
- Department of Radiology, Columbia University, New York, NY, 10027, USA
| | - Robyn D Gartrell
- Division of Pediatric Hematology Oncology and Stem Cell Transplant, Department of Pediatrics, Columbia University Irving Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA
- Division of Pediatric Oncology, Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA
| | - Hasan R Syed
- Department of Neurosurgery, Children's National Hospital, Washington, DC, USA
- George Washington University, Washington, DC, USA
| | - Adriana Fonseca
- George Washington University, Washington, DC, USA
- Center for Cancer and Blood Disorders, Children's National Hospital, Washington, DC, USA
- The Brain Tumor Institute, Children's National Hospital, Washington, DC, USA
| | - Jovana Pavisic
- Division of Pediatric Hematology Oncology and Stem Cell Transplant, Department of Pediatrics, Columbia University Irving Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Luca Szalontay
- Division of Pediatric Hematology Oncology and Stem Cell Transplant, Department of Pediatrics, Columbia University Irving Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Elisa E Konofagou
- Department of Biomedical Engineering, Columbia University, New York, NY, 10027, USA
| | - Stergios Zacharoulis
- Division of Pediatric Hematology Oncology and Stem Cell Transplant, Department of Pediatrics, Columbia University Irving Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA.
- Bristol Myers Squibb, Princeton, NJ, 08901, USA.
| | - Cheng-Chia Wu
- Department of Radiation Oncology, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, 10032, USA.
- Herbert Irving Comprehensive Cancer Center, New York, NY, 10032, USA.
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3
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Fernández EC, Tomassoni L, Zhang X, Wang J, Obradovic A, Laise P, Griffin AT, Vlahos L, Minns HE, Morales DV, Simmons C, Gallitto M, Wei HJ, Martins TJ, Becker PS, Crawford JR, Tzaridis T, Wechsler-Reya RJ, Garvin J, Gartrell RD, Szalontay L, Zacharoulis S, Wu CC, Zhang Z, Califano A, Pavisic J. Elucidation and Pharmacologic Targeting of Master Regulator Dependencies in Coexisting Diffuse Midline Glioma Subpopulations. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.17.585370. [PMID: 38559080 PMCID: PMC10979998 DOI: 10.1101/2024.03.17.585370] [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: 04/04/2024]
Abstract
Diffuse Midline Gliomas (DMGs) are universally fatal, primarily pediatric malignancies affecting the midline structures of the central nervous system. Despite decades of clinical trials, treatment remains limited to palliative radiation therapy. A major challenge is the coexistence of molecularly distinct malignant cell states with potentially orthogonal drug sensitivities. To address this challenge, we leveraged established network-based methodologies to elucidate Master Regulator (MR) proteins representing mechanistic, non-oncogene dependencies of seven coexisting subpopulations identified by single-cell analysis-whose enrichment in essential genes was validated by pooled CRISPR/Cas9 screens. Perturbational profiles of 372 clinically relevant drugs helped identify those able to invert the activity of subpopulation-specific MRs for follow-up in vivo validation. While individual drugs predicted to target individual subpopulations-including avapritinib, larotrectinib, and ruxolitinib-produced only modest tumor growth reduction in orthotopic models, systemic co-administration induced significant survival extension, making this approach a valuable contribution to the rational design of combination therapy.
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4
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Padilla O, Minns HE, Wei HJ, Fan W, Webster-Carrion A, Tazhibi M, McQuillan NM, Zhang X, Gallitto M, Yeh R, Zhang Z, Hei TK, Szalontay L, Pavisic J, Tan Y, Deoli N, Garty G, Garvin JH, Canoll PD, Vanpouille-Box C, Menon V, Olah M, Rabadan R, Wu CC, Gartrell RD. Immune Response following FLASH and Conventional Radiation in Diffuse Midline Glioma. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00300-6. [PMID: 38364947 DOI: 10.1016/j.ijrobp.2024.01.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/15/2024] [Accepted: 01/28/2024] [Indexed: 02/18/2024]
Abstract
PURPOSE Diffuse midline glioma (DMG) is a fatal tumor traditionally treated with radiation therapy (RT) and previously characterized as having a noninflammatory tumor immune microenvironment (TIME). FLASH is a novel RT technique using ultra-high dose rate that is associated with decreased toxicity and effective tumor control. However, the effect of FLASH and conventional (CONV) RT on the DMG TIME has not yet been explored. METHODS AND MATERIALS Here, we performed single-cell RNA sequencing (scRNA-seq) and flow cytometry on immune cells isolated from an orthotopic syngeneic murine model of brainstem DMG after the use of FLASH (90 Gy/sec) or CONV (2 Gy/min) dose-rate RT and compared to unirradiated tumor (SHAM). RESULTS At day 4 post-RT, FLASH exerted similar effects as CONV in the predominant microglial (MG) population, including the presence of two activated subtypes. However, at day 10 post-RT, we observed a significant increase in the type 1 interferon α/β receptor (IFNAR+) in MG in CONV and SHAM compared to FLASH. In the non-resident myeloid clusters of macrophages (MACs) and dendritic cells (DCs), we found increased type 1 interferon (IFN1) pathway enrichment for CONV compared to FLASH and SHAM by scRNA-seq. We observed this trend by flow cytometry at day 4 post-RT in IFNAR+ MACs and DCs, which equalized by day 10 post-RT. DMG control and murine survival were equivalent between RT dose rates. CONCLUSIONS Our work is the first to map CONV and FLASH immune alterations of the DMG TIME with single-cell resolution. Although DMG tumor control and survival were similar between CONV and FLASH, we found that changes in immune compartments differed over time. Importantly, although both RT modalities increased IFN1, we found that the timing of this response was cell-type and dose-rate dependent. These temporal differences, particularly in the context of tumor control, warrant further study.
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Affiliation(s)
- Oscar Padilla
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York; Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hanna E Minns
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York; Oregon Health and Science University School of Medicine, Portland, Oregon
| | - Hong-Jian Wei
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
| | - Weijia Fan
- Mailman School of Public Health, Columbia University, New York, New York
| | | | - Masih Tazhibi
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
| | - Nicholas M McQuillan
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
| | - Xu Zhang
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York; Institute for Cancer Genetics, Columbia University Irving Medical Center, New York, New York; Department of Genetics and Development, Columbia University Irving Medical Center, New York, New York
| | - Matthew Gallitto
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
| | - Rebecca Yeh
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Zhiguo Zhang
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York; Institute for Cancer Genetics, Columbia University Irving Medical Center, New York, New York; Department of Genetics and Development, Columbia University Irving Medical Center, New York, New York
| | - Tom K Hei
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York; Center for Radiological Research, Columbia University Irving Medical Center, New York, New York
| | - Luca Szalontay
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Jovana Pavisic
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Yuewen Tan
- Radiological Research Accelerator Facility, Columbia University Irving Medical Center, Irvington, New York
| | - Naresh Deoli
- Radiological Research Accelerator Facility, Columbia University Irving Medical Center, Irvington, New York
| | - Guy Garty
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York; Center for Radiological Research, Columbia University Irving Medical Center, New York, New York; Radiological Research Accelerator Facility, Columbia University Irving Medical Center, Irvington, New York
| | - James H Garvin
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Peter D Canoll
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York
| | | | - Vilas Menon
- Department of Neurology, Columbia University Irving Medical Center, New York, New York; Center for Translational and Computational Neuroimmunology, Columbia University Irving Medical Center, New York, New York; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, New York
| | - Marta Olah
- Department of Neurology, Columbia University Irving Medical Center, New York, New York; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, New York
| | - Raul Rabadan
- Department of Systems Biology, Columbia University Irving Medical Center, New York, New York; Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York; Program for Mathematical Genomics, Columbia University Irving Medical Center, New York, New York
| | - Cheng-Chia Wu
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
| | - Robyn D Gartrell
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York; Department of Oncology, Division of Pediatric Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland.
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5
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Kinslow CJ, Brown PD, Iwamoto FM, Wu CC, Yu JB, Cheng SK, Wang TJC. Where Do We (INDI)GO From Here? Int J Radiat Oncol Biol Phys 2024; 118:330-333. [PMID: 38220255 DOI: 10.1016/j.ijrobp.2023.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/09/2023] [Indexed: 01/16/2024]
Affiliation(s)
- Connor J Kinslow
- Department of Radiation Oncology, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, New York; Herbert Irving Comprehensive Cancer Center, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, New York
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Fabio M Iwamoto
- Herbert Irving Comprehensive Cancer Center, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, New York; Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, New York
| | - Cheng-Chia Wu
- Department of Radiation Oncology, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, New York; Herbert Irving Comprehensive Cancer Center, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, New York
| | - James B Yu
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, New York
| | - Simon K Cheng
- Department of Radiation Oncology, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, New York; Herbert Irving Comprehensive Cancer Center, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, New York; Department of Radiation Oncology, James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - Tony J C Wang
- Department of Radiation Oncology, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, New York; Herbert Irving Comprehensive Cancer Center, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, New York.
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6
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Ivanov VN, Grabham PW, Wu CC, Hei TK. Retraction Note: Inhibition of autophagic flux differently modulates cannabidiol-induced death in 2D and 3D glioblastoma cell cultures. Sci Rep 2024; 14:1356. [PMID: 38228688 DOI: 10.1038/s41598-024-51877-z] [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: 01/18/2024] Open
Affiliation(s)
- Vladimir N Ivanov
- Center for Radiological Research, Department of Radiation Oncology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA.
| | - Peter W Grabham
- Center for Radiological Research, Department of Radiation Oncology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Cheng-Chia Wu
- Center for Radiological Research, Department of Radiation Oncology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Tom K Hei
- Center for Radiological Research, Department of Radiation Oncology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
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7
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Kline-Schoder AR, Chintamen S, Willner MJ, DiBenedetto MR, Noel RL, Batts AJ, Kwon N, Zacharoulis S, Wu CC, Menon V, Kernie SG, Konofagou EE. Characterization of the responses of brain macrophages to focused ultrasound-mediated blood-brain barrier opening. Nat Biomed Eng 2023:10.1038/s41551-023-01107-0. [PMID: 37857722 DOI: 10.1038/s41551-023-01107-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 09/16/2023] [Indexed: 10/21/2023]
Abstract
The opening of the blood-brain barrier (BBB) by focused ultrasound (FUS) coupled with intravenously injected microbubbles can be leveraged as a form of immunotherapy for the treatment of neurodegenerative disorders. However, how FUS BBB opening affects brain macrophages is not well understood. Here by using single-cell sequencing to characterize the distinct responses of microglia and central nervous system-associated macrophages (CAMs) to FUS-mediated BBB opening in mice, we show that the treatment remodels the immune landscape via the recruitment of CAMs and the proliferation of microglia and via population size increases in disease-associated microglia. Both microglia and CAMs showed early and late increases in population sizes, yet only the proliferation of microglia increased at both timepoints. The population of disease-associated microglia also increased, accompanied by the upregulation of genes associated with gliogenesis and phagocytosis, with the depletion of brain macrophages significantly decreasing the duration of BBB opening.
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Affiliation(s)
| | - Sana Chintamen
- Department of Neurobiology and Behaviour, Columbia University, New York, NY, USA
| | - Moshe J Willner
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | | | - Rebecca L Noel
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Alec J Batts
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Nancy Kwon
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | | | - Cheng-Chia Wu
- Department of Pediatrics, Columbia University, New York, NY, USA
| | - Vilas Menon
- Department of Neurology, Columbia University, New York, NY, USA
| | - Steven G Kernie
- Department of Pediatrics, Columbia University, New York, NY, USA
| | - Elisa E Konofagou
- Department of Biomedical Engineering, Columbia University, New York, NY, USA.
- Department of Radiology, Columbia University, New York, NY, USA.
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8
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Kokossis D, Wei HJ, Gallitto M, Yoh N, McQuillan N, Tazhibi M, Berg X, Zhang X, Szalontay L, Gartrell R, Jovana P, Zhang Z, Molotkov A, Mintz A, Konofagou EE, Wu CC. Focused Ultrasound for Blood-Brain Barrier Opening and Delivery of Anti-PD1 in Diffuse Midline Gliomas. Int J Radiat Oncol Biol Phys 2023; 117:e523-e524. [PMID: 37785629 DOI: 10.1016/j.ijrobp.2023.06.1796] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Diffuse midline glioma with H3K27 mutation is a fatal pediatric brain tumor, most commonly arising in the brainstem. This tumor remains universally fatal, despite a multitude of clinical trials, with a median overall survival of only 9-12 months. While immune-checkpoint inhibitors (ICIs) have transformed the treatment landscape of multiple solid tumors, delivery past the blood brain barrier (BBB) remains challenging. Programmed cell death protein 1 (PD1) is an immune checkpoint protein expressed on the surface of activated T cells; interaction with its ligand, PDL1, is tumor-protective, dampening T cell response. Recent phase I clinical trials have shown that ICIs targeting proteins along the PD1/PDL1 axis are well tolerated in patients with DMG; however, efficacy remains low. The blood-brain barrier (BBB) poses a major challenge to the efficacious delivery of therapeutic agents with large molecular size, such as anti-PD1. We hypothesize that BBB opening (BBBO) using focused ultrasound (FUS), a form of non-ionizing acoustic radiation, can enhance delivery and efficacy of anti-PD1 for treatment of DMG. MATERIALS/METHODS We established a syngeneic mouse DMG model with intracranial injection of cell line 4423 (PDGFB+, H3.3K27M, p53-/-). Magnetic resonance imaging (MRI) was utilized to evaluate BBBO and tumor progression. We measured delivery of anti-PD1 after BBBO using Western Blot and 3D in vivo optical fluorescent imaging/CT (OI/CT) of Cy7 labeled anti-PD1. RESULTS We demonstrate that delivery of anti-PD1 can be enhanced over 3.5-fold after reversible BBBO with FUS and concurrent microbubble administration. OI/CT revealed enhanced real-time antibody distribution peritumorally. Furthermore, we demonstrate that combined treatment of FUS and anti-PD1 led to benefit in local control of tumor growth using volumetric analysis of MRI. Preliminary survival studies suggest a positive trend for overall survival. CONCLUSION Our results support that FUS-mediated BBBO can increase treatment efficacy of anti-PD1 in a DMG murine model, due to improved targeted delivery to the tumoral region after systemic antibody administration. We consider these findings strong rationale for further investigation of the therapeutic effects of combinatorial treatment using FUS-mediated BBBO and ICIs for the treatment of DMG.
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Affiliation(s)
- D Kokossis
- Columbia University Irving Medical Center, New York, NY
| | - H J Wei
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY
| | - M Gallitto
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY
| | - N Yoh
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, NY
| | - N McQuillan
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY
| | | | - X Berg
- Columbia University Irving Medical Center, New York, NY
| | - X Zhang
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - L Szalontay
- Department of Pediatrics Oncology, Columbia University Irving Medical Center, New York, NY
| | - R Gartrell
- Department of Pediatrics Oncology, Columbia University Irving Medical Center, New York, NY
| | - P Jovana
- Columbia University Irving Medical Center, New York, NY
| | - Z Zhang
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - A Molotkov
- Columbia University Irving Medical Center, New York, NY
| | - A Mintz
- Columbia University Irving Medical Center, New York, NY
| | - E E Konofagou
- Department of Biomedical Engineering, Columbia University, New York, NY
| | - C C Wu
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
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9
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Boboila S, Okochi S, Banerjee D, Barton S, Street C, Zenilman AL, Wang Q, Gartrell RD, Saenger YM, Welch D, Wu CC, Kadenhe-Chiweshe A, Yamashiro DJ, Connolly EP. Combining immunotherapy with high-dose radiation therapy (HDRT) significantly inhibits tumor growth in a syngeneic mouse model of high-risk neuroblastoma. Heliyon 2023; 9:e17399. [PMID: 37408891 PMCID: PMC10319189 DOI: 10.1016/j.heliyon.2023.e17399] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 06/11/2023] [Accepted: 06/15/2023] [Indexed: 07/07/2023] Open
Abstract
Purpose The mortality in patients with MYCN-amplified high-risk neuroblastoma remains greater than 50% despite advances in multimodal therapy. Novel therapies are urgently needed that requires preclinical evaluation in appropriate mice models. Combinatorial treatment with high-dose radiotherapy (HDRT) and immunotherapy has emerged as an effective treatment option in a variety of cancers. Current models of neuroblastoma do not recapitulate the anatomic and immune environment in which multimodal therapies can be effectively tested, and there is a need for an appropriate syngeneic neuroblastoma mice model to study interaction of immunotherapy with host immune cells. Here, we develop a novel syngeneic mouse model of MYCN-amplified neuroblastoma and report the relevance and opportunities of this model to study radiotherapy and immunotherapy. Materials and methods A syngeneic allograft tumor model was developed using the murine neuroblastoma cell line 9464D derived a tumor from TH-MYCN transgenic mouse. Tumors were generated by transplanting 1 mm3 portions of 9464D flank tumors into the left kidney of C57Bl/6 mice. We investigated the effect of combining HDRT with anti-PD1 antibody on tumor growth and tumor microenvironment. HDRT (8 Gy x 3) was delivered by the small animal radiation research platform (SARRP). Tumor growth was monitored by ultrasound. To assess the effect on immune cells tumors sections were co-imuunostained for six biomarkers using the Vectra multispectral imaging platform. Results Tumor growth was uniform and confined to the kidney in 100% of transplanted tumors. HDRT was largely restricted to the tumor region with minimal scattered out-of-field dose. Combinatorial treatment with HDRT and PD-1 blockade significantly inhibited tumor growth and prolonged mice survival. We observed augmented T-lymphocyte infiltration, especially CD3+CD8+ lymphocytes, in tumors of mice which received combination treatment. Conclusion We have developed a novel syngeneic mouse model of MYCN amplified high-risk neuroblastoma. We have utilized this model to show that combining immunotherapy with HDRT inhibits tumor growth and prolongs mice survival.
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Affiliation(s)
- Shuobo Boboila
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Shunpei Okochi
- Department of Surgery, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Debarshi Banerjee
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Sunjay Barton
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Cherease Street
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Ariela L. Zenilman
- Department of Surgery, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Qi Wang
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Robyn D. Gartrell
- Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Yvonne M. Saenger
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - David Welch
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Cheng-Chia Wu
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Angela Kadenhe-Chiweshe
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Darrell J. Yamashiro
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Pathology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Eileen P. Connolly
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY 10032, USA
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10
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Fernandez EC, Wang J, Zhang X, Wei HJ, Minns HE, Griffin AT, Vlahos L, Martins TJ, Becker PS, Crawford J, Gartrell RD, Szalontay L, Zacharoulis S, Zhang Z, Wechsler-Reya R, Wu CC, Califano A, Pavisic J. Abstract 4304: Network-based inference identifies cell state-specific drugs targeting master regulator vulnerabilities in diffuse midline glioma. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-4304] [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: 04/07/2023]
Abstract
Abstract
Diffuse Midline Glioma (DMG) are fatal pediatric brain tumors with no therapies. We leveraged network-based methodologies to dissect the heterogeneity of DMG tumors and to discover Master Regulator (MR) proteins representing pharmacologically accessible, mechanistic determinants of molecularly distinct cell states. We produced the first DMG regulatory network from 122 publicly available RNAseq profiles with ARACNe (Basso et al. Nat Genet 2005), and inferred sample-specific MR protein activity with VIPER (Alvarez et al. Nat Genet 2016) based on the differential expression of their targets. 7 of the top 25 most active MRs found comprise a well-characterized MR block (MRB2) (Paull et al.Cell 2021), frequently activated across aggressive tumors, and enriched in DMG patient MR signatures (Fisher’s Exact Test p=4.4 × 10−18). A CRISPR/Cas9 KO screen across 3 DMG patient cell lines identified a set of 73/77 essential genes that were enriched in the MR signature of 80% of patient samples (GSEA p=0.000034). FOXM1 emerged as an essential MR, significantly activated across virtually all patients.
We then generated RNAseq profiles following perturbation with ~300 oncology drugs in 2 DMG cell lines most representative of patient MR signatures, and used this to identify drugs that invert patient MR activity profiles using the NYS/CA Dept. of Health approved OncoTreat algorithm (Alvarez et al. Nat Genet 2018). OncoTreat predicted sensitivity to HDAC, MEK, CDK, PI3K, and proteosome inhibitors in subsets of patients, overlapping with published DMG drug screens. Importantly, 80% of OncoTreat-predicted drugs (p<10−5) from 3 DMG patient tumor biopsies showed in vitro sensitivity in cultured tumor cells from the respective patients, with overall 68% accuracy among 223 drugs evaluated by both OncoTreat and in vitro (Fisher’s Exact Test p=0.0449).
Further analysis of DMG intra-tumor heterogeneity via protein activity inference across DMG single cells from 6 published scRNAseq profiles identified 6 tumor clusters with unique MR signatures co-existing in virtually all patients representing distinct cellular states (2 astrocyte-, 1 oligodendrocyte-, and 3 oligodendrocyte precursor cell-like states). Targetable MRs and OncoTreat-predicted drugs were distinct between these states. Bulk RNAseq analysis recapitulated predictions seen in the more prevalent OPC-like states, but failed to capture MR and drug predictions for the AC-like states (e.g. JAK1/Ruxolitinib and STAT3/Napabucasin). We are currently validating cell state-specific drug predictions in vivo at single-cell resolution in subcutaneous patient-derived xenograft and orthotopic syngeneic DMG models that we have shown recapitulate patient tumor heterogeneity, including with focused ultrasound-mediated drug delivery. This provides a platform to nominate much-needed novel drugs and drug combinations to treat DMG.
Citation Format: Ester Calvo Fernandez, Junqiang Wang, Xu Zhang, Hong-Jian Wei, Hanna E. Minns, Aaron T. Griffin, Lukas Vlahos, Timothy J. Martins, Pamela S. Becker, John Crawford, Robyn D. Gartrell, Luca Szalontay, Stergios Zacharoulis, Zhiguo Zhang, Robert Wechsler-Reya, Cheng-Chia Wu, Andrea Califano, Jovana Pavisic. Network-based inference identifies cell state-specific drugs targeting master regulator vulnerabilities in diffuse midline glioma. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4304.
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Affiliation(s)
| | - Junqiang Wang
- 1Columbia University Irving Medical Center, New York, NY
| | - Xu Zhang
- 1Columbia University Irving Medical Center, New York, NY
| | - Hong-Jian Wei
- 1Columbia University Irving Medical Center, New York, NY
| | - Hanna E. Minns
- 1Columbia University Irving Medical Center, New York, NY
| | | | - Lukas Vlahos
- 1Columbia University Irving Medical Center, New York, NY
| | | | | | - John Crawford
- 3University of California Irvine & Children’s Hospital Orange County, Orange, CA
| | | | - Luca Szalontay
- 1Columbia University Irving Medical Center, New York, NY
| | | | - Zhiguo Zhang
- 1Columbia University Irving Medical Center, New York, NY
| | | | - Cheng-Chia Wu
- 1Columbia University Irving Medical Center, New York, NY
| | | | - Jovana Pavisic
- 1Columbia University Irving Medical Center, New York, NY
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11
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Lee PY, Wei HJ, Pouliopoulos AN, Forsyth BT, Yang Y, Zhang C, Laine AF, Konofagou EE, Wu CC, Guo J. Deep Learning Enables Reduced Gadolinium Dose for Contrast-Enhanced Blood-Brain Barrier Opening. ArXiv 2023:arXiv:2301.07248v1. [PMID: 36713234 PMCID: PMC9882566] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Focused ultrasound (FUS) can be used to open the blood-brain barrier (BBB), and MRI with contrast agents can detect that opening. However, repeated use of gadolinium-based contrast agents (GBCAs) presents safety concerns to patients. This study is the first to propose the idea of modeling a volume transfer constant (Ktrans) through deep learning to reduce the dosage of contrast agents. The goal of the study is not only to reconstruct artificial intelligence (AI) derived Ktrans images but to also enhance the intensity with low dosage contrast agent T1 weighted MRI scans. We successfully validated this idea through a previous state-of-the-art temporal network algorithm, which focused on extracting time domain features at the voxel level. Then we used a Spatiotemporal Network (ST-Net), composed of a spatiotemporal convolutional neural network (CNN)-based deep learning architecture with the addition of a three-dimensional CNN encoder, to improve the model performance. We tested the ST-Net model on ten datasets of FUS-induced BBB-openings aquired from different sides of the mouse brain. ST-Net successfully detected and enhanced BBB-opening signals without sacrificing spatial domain information. ST-Net was shown to be a promising method of reducing the need of contrast agents for modeling BBB-opening K-trans maps from time-series Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) scans.
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Affiliation(s)
- Pin-Yu Lee
- Department of Biomedical Engineering, The Fu Foundation of Engineering and Applied Science, Columbia University, New York, NY 10027 USA
| | - Hong-Jian Wei
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY 10032 USA
| | - Antonios N Pouliopoulos
- Department of Biomedical Engineering, Columbia University. He is now with the School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Britney T Forsyth
- Department of Biomedical Engineering, The Fu Foundation of Engineering and Applied Science, Columbia University, New York, NY 10027 USA
| | - Yanting Yang
- Department of Biomedical Engineering, The Fu Foundation of Engineering and Applied Science, Columbia University, New York, NY 10027 USA
| | - Chenghao Zhang
- Department of Biomedical Engineering, The Fu Foundation of Engineering and Applied Science, Columbia University, New York, NY 10027 USA
| | - Andrew F Laine
- Departments of Biomedical Engineering and Radiology (Physics), Columbia University, New York, NY 10027 USA
| | - Elisa E Konofagou
- Departments of Biomedical Engineering and Radiology (Physics), Columbia University, New York, NY 10027 USA
| | - Cheng-Chia Wu
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY 10032 USA
| | - Jia Guo
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032 USA
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12
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He JS, Duan JB, Li SC, Xiao ZL, Wang L, Li D, Ze F, Wu CC, Yuan CZ, Li XB. [Feasibility and safety of bridge therapy with active fixed electrodes connected to external permanent pacemakers for patients with infective endocarditis after lead removal and before permanent pacemaker implantation]. Zhonghua Xin Xue Guan Bing Za Zhi 2022; 50:1214-1219. [PMID: 36517443 DOI: 10.3760/cma.j.cn112148-20220523-00408] [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] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Objective: To analyze the feasibility and safety of bridge therapy with active fixed electrodes connected to external permanent pacemakers (AFLEP) for patients with infective endocarditis after lead removal and before permanent pacemaker implantation. Methods: A total of 44 pacemaker-dependent patients, who underwent lead removal due to infective endocarditis in our center from January 2015 to January 2020, were included. According to AFLEP or temporary pacemaker option during the transition period, patients were divided into AFLEP group or temporary pacemaker group. Information including age, sex, comorbidities, indications and types of cardial implantable electionic device (CIED) implantation, lead age, duration of temporary pacemaker or AFLEP use, and perioperative complications were collected through Haitai Medical Record System. The incidence of pacemaker perception, abnormal pacing function, lead perforation, lead dislocation, lead vegetation, cardiac tamponade, pulmonary embolism, death and newly infection of implanted pacemaker were compared between the two groups. Pneumothorax, hematoma and the incidence of deep vein thrombosis were also analyzed. Results: Among the 44 patients, 24 were in the AFLEP group and 20 in the temporary pacemaker group. Age was younger in the AFLEP group than in the temporary pacemaker group (57.5(45.5, 66.0) years vs. 67.0(57.3, 71.8) years, P=0.023). Male, prevalence of hypertension, diabetes mellitus, chronic renal dysfunction and old myocardial infarction were similar between the two groups (all P>0.05). Lead duration was 11.0(8.0,13.0) years in the AFLEP group and 8.5(7.0,13.0) years in the temporary pacemaker group(P=0.292). Lead vegetation diameter was (8.2±2.4)mm in the AFLEP group and (9.1±3.0)mm in the temporary pacemaker group. Lead removal was successful in all patients. The follow-up time in the AFLEP group was 23.0(20.5, 25.5) months, and the temporary pacemaker group was 17.0(14.5, 18.5) months. In the temporary pacemaker group, there were 2 cases (10.0%) of lead dislocation, 2 cases (10.0%) of sensory dysfunction, 2 cases (10.0%) of pacing dysfunction, and 2 cases (10.0%) of death. In the AFLEP group, there were 2 cases of abnormal pacing function, which improved after adjusting the output voltage of the pacemaker, there was no lead dislocation, abnormal perception and death. Femoral vein access was used in 8 patients (40.0%) in the temporary pacemaker group, and 4 patients developed lower extremity deep venous thrombosis. There was no deep venous thrombosis in the AFLEP group. The transition treatment time was significantly longer in the AFLEP group than in the temporary pacemaker group (19.5(16.0, 25.8) days vs. 14.0(12.0, 16.8) days, P=0.001). During the follow-up period, there were no reinfections with newly implanted pacemakers in the AFLEP group, and reinfection occurred in 2 patients (10.0%) in the temporary pacemaker group. Conclusions: Bridge therapy with AFLEP for patients with infective endocarditis after lead removal and before permanent pacemaker implantation is feasible and safe. Compared with temporary pacemaker, AFLEP is safer in the implantation process and more stable with lower lead dislocation rate, less sensory and pacing dysfunction.
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Affiliation(s)
- J S He
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - J B Duan
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - S C Li
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - Z L Xiao
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - L Wang
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - D Li
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - F Ze
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - C C Wu
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - C Z Yuan
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - X B Li
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
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13
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Mo Y, Duan S, Zhang X, Hua X, Zhou H, Wei HJ, Watanabe J, McQuillan N, Su Z, Gu W, Wu CC, Vakoc CR, Hashizume R, Chang K, Zhang Z. Epigenome Programming by H3.3K27M Mutation Creates a Dependence of Pediatric Glioma on SMARCA4. Cancer Discov 2022; 12:2906-2929. [PMID: 36305747 PMCID: PMC9722525 DOI: 10.1158/2159-8290.cd-21-1492] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 07/20/2022] [Accepted: 09/02/2022] [Indexed: 01/12/2023]
Abstract
Patients with diffuse midline gliomas that are H3K27 altered (DMG) display a dismal prognosis. However, the molecular mechanisms underlying DMG tumorigenesis remain poorly defined. Here we show that SMARCA4, the catalytic subunit of the mammalian SWI/SNF chromatin remodeling complex, is essential for the proliferation, migration, and invasion of DMG cells and tumor growth in patient-derived DMG xenograft models. SMARCA4 colocalizes with SOX10 at gene regulatory elements to control the expression of genes involved in cell growth and the extracellular matrix (ECM). Moreover, SMARCA4 chromatin binding is reduced upon depletion of SOX10 or H3.3K27M, a mutation occurring in about 60% DMG tumors. Furthermore, the SMARCA4 occupancy at enhancers marked by both SOX10 and H3K27 acetylation is reduced the most upon depleting the H3.3K27M mutation. Taken together, our results support a model in which epigenome reprogramming by H3.3K27M creates a dependence on SMARCA4-mediated chromatin remodeling to drive gene expression and the pathogenesis of H3.3K27M DMG. SIGNIFICANCE DMG is a deadly pediatric glioma currently without effective treatments. We discovered that the chromatin remodeler SMARCA4 is essential for the proliferation of DMG with H3K27M mutation in vitro and in vivo, identifying a potentially novel therapeutic approach to this disease. See related commentary by Beytagh and Weiss, p. 2730. See related article by Panditharatna et al., p. 2880. This article is highlighted in the In This Issue feature, p. 2711.
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Affiliation(s)
- Yan Mo
- Institute for Cancer Genetics, Columbia University Irving Medical Center, New York, NY 10032, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Pediatrics, Columbia University Medical Center, New York, NY 10032, USA
- Department of Genetics and Development, Columbia University Medical Center, New York, NY 10032, USA
| | - Shoufu Duan
- Institute for Cancer Genetics, Columbia University Irving Medical Center, New York, NY 10032, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Pediatrics, Columbia University Medical Center, New York, NY 10032, USA
- Department of Genetics and Development, Columbia University Medical Center, New York, NY 10032, USA
| | - Xu Zhang
- Institute for Cancer Genetics, Columbia University Irving Medical Center, New York, NY 10032, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Pediatrics, Columbia University Medical Center, New York, NY 10032, USA
- Department of Genetics and Development, Columbia University Medical Center, New York, NY 10032, USA
| | - Xu Hua
- Institute for Cancer Genetics, Columbia University Irving Medical Center, New York, NY 10032, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Pediatrics, Columbia University Medical Center, New York, NY 10032, USA
- Department of Genetics and Development, Columbia University Medical Center, New York, NY 10032, USA
| | - Hui Zhou
- Institute for Cancer Genetics, Columbia University Irving Medical Center, New York, NY 10032, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Pediatrics, Columbia University Medical Center, New York, NY 10032, USA
- Department of Genetics and Development, Columbia University Medical Center, New York, NY 10032, USA
| | - Hong-Jian Wei
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Jun Watanabe
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Nicholas McQuillan
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Zhenyi Su
- Institute for Cancer Genetics, Columbia University Irving Medical Center, New York, NY 10032, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Wei Gu
- Institute for Cancer Genetics, Columbia University Irving Medical Center, New York, NY 10032, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Cheng-Chia Wu
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | | | - Rintaro Hashizume
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Kenneth Chang
- Cold Spring Harbor Laboratory, Cold Spring Harbor, NY 11724, USA
| | - Zhiguo Zhang
- Institute for Cancer Genetics, Columbia University Irving Medical Center, New York, NY 10032, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Pediatrics, Columbia University Medical Center, New York, NY 10032, USA
- Department of Genetics and Development, Columbia University Medical Center, New York, NY 10032, USA
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14
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Duan JB, He JS, Wu CC, Wang L, Li D, Ze F, Zhou X, Yuan CZ, Yang DD, Li XB. [Safety and efficacy of high-power, short-duration superior vena cava isolation in combination with conventional radiofrequency ablation in patients with paroxysmal atrial fibrillation: a randomized controlled trial]. Zhonghua Xin Xue Guan Bing Za Zhi 2022; 50:1069-1073. [PMID: 36418274 DOI: 10.3760/cma.j.cn112148-20220501-00338] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Objective: For patients with paroxysmal atrial fibrillation, superior vena cava isolation on the basis of pulmonary vein isolation may further improve the long-term success rate of radiofrequency ablation. We aimed to explore the efficacy and safety of superior vena cava isolation by high-power and short-duration (HPSD) ablation plus conventional radiofrequency ablation (RA) in patients with paroxysmal atrial fibrillation. Methods: It was a prospective randomized controlled study. From January 1, 2019 to June 1, 2020, 180 patients who underwent radiofrequency ablation for paroxysmal atrial fibrillation in our center were consecutively screened. Patients were eligible if there was a trigger potential and the muscle sleeve length was greater than 3 cm. A total of 60 eligible patients were finally included and randomly divided into HPSD group (HPSD plus RA) and common power and duration (CPD) group (CPD plus RA) by random number table method (n=30 in each group). Efficacy was evaluated by ablation points, isolation time and ablation time. Safety was evaluated by the incidence of POP, cardiac tamponade, phrenic nerve injury, sinoatrial node injury and all-cause. Results: Superior vena cava isolation was achieved by 14 (13, 15) points in the HPSD group, which was significantly less than that in the CPD group (20(18, 22), P<0.001). The superior vena cava isolation time was 8 (7, 9) minutes in the HPSD group, which was significantly shorter than in the CPD group (17(14, 20) minutes, P<0.001). The average ablation time significantly shorter in HPSD group than in CPD group (78.0(71.1, 80.0) s vs. 200(167.5, 212.5)s, P<0.001). The average impedance drop was more significant in the HPSD group than in the CPD group (20.00(18.75, 21.00)Ω (and the percentage of impedance drop was 15%) vs. 12.00(11.75, 13.25)Ω (the percentage of impedance decrease was 12%), P<0.001). There was 1 POP (3.3%) in the HPSD group, and 3 POPs (10.0%) in the CPD group (P>0.05). There was no cardiac tamponade, phrenic nerve injury, sinoatrial node injury and death in both groups. Conclusions: HPSD technique for the isolation of superior vena cava is safe and effective in patients with paroxysmal atrial fibrillation undergoing conventional radiofrequency ablation.
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Affiliation(s)
- J B Duan
- Electrophysiology Lab of Cardiovascular Department, Peking University People's Hospital, Beijing 100044, China
| | - J S He
- Electrophysiology Lab of Cardiovascular Department, Peking University People's Hospital, Beijing 100044, China
| | - C C Wu
- Electrophysiology Lab of Cardiovascular Department, Peking University People's Hospital, Beijing 100044, China
| | - L Wang
- Electrophysiology Lab of Cardiovascular Department, Peking University People's Hospital, Beijing 100044, China
| | - D Li
- Electrophysiology Lab of Cardiovascular Department, Peking University People's Hospital, Beijing 100044, China
| | - F Ze
- Electrophysiology Lab of Cardiovascular Department, Peking University People's Hospital, Beijing 100044, China
| | - X Zhou
- Electrophysiology Lab of Cardiovascular Department, Peking University People's Hospital, Beijing 100044, China
| | - C Z Yuan
- Electrophysiology Lab of Cardiovascular Department, Peking University People's Hospital, Beijing 100044, China
| | - D D Yang
- Electrophysiology Lab of Cardiovascular Department, Peking University People's Hospital, Beijing 100044, China
| | - X B Li
- Electrophysiology Lab of Cardiovascular Department, Peking University People's Hospital, Beijing 100044, China
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15
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Minns H, Padilla O, Wei HJ, Webster-Carrion A, Tazhibi M, McQuillan N, Zhang X, Yeh R, Zhang Z, Szalontay L, Pavisic J, Garty G, Garvin J, Canoll P, Vanpouille-Box C, Menon V, Olah M, Rabadan R, Wu CC, Gartrell R. TMIC-68. EVALUATING FLASH AND CONVENTIONAL DOSE-RATE RADIATION AND IMMUNE RESPONSE WITH SINGLE-CELL SEQUENCING IN DIFFUSE MIDLINE GLIOMA (DMG). Neuro Oncol 2022. [PMCID: PMC9661257 DOI: 10.1093/neuonc/noac209.1111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Diffuse Midline Glioma – H3K27M mutant (DMG), is a fatal and inoperable pediatric brain tumor with limited treatment options as radiation provides only temporary reprieve, leaving the median survival between 9-15 months. Conventional dose-rate radiation (2Gray/minute, CONV) has been shown in other cancers to recruit an immune component, however, this has not been studied in DMG. Ultra-high dose-rate radiation given at 90 Gray/second (FLASH), is a novel technique associated with decreased toxicity and effective tumor control. Using a syngeneic model of brainstem DMG, we performed single-cell RNA sequencing on CD45+ immune cells isolated from tumors irradiated with 15Gray using FLASH or CONV, and compared to unirradiated tumor and normal brainstem. Isolation of 33,308 immune cells revealed 17 unique clusters, most abundant of which was microglia (73.8%), present in four distinct subtypes representing a spectrum from homeostatic to activated. In the most activated microglia, both FLASH and CONV showed an enrichment in type 1 interferon (IFN1) pathway scores compared to untreated tumors (p< 0.001 and p< 0.001, respectively). The most differential response was found in macrophages (MAC) and dendritic cells (DC) with a robust enrichment of IFN1 pathway scores for CONV compared to FLASH (p< 0.001, MAC and p< 0.001 DC). FLASH showed an increase in anti-inflammatory MAC markers such as Mrc1, Cd163, and Maf and an enrichment of myeloid-derived suppressor cell (MDSC) signature in monocytes, not seen in CONV (p< 0.001). Finally, we correlated our data with publicly available single-cell data taken from the cerebrospinal fluid of DMG patients treated with anti-GD2 CAR T Cell therapy and found similar inflammatory markers characteristic of our unirradiated murine tumors. In summary, our work is the first to study immune alterations comparing different dose-rates of radiation with single-cell resolution in DMG, highlighting the potential for combining radiation and immunotherapy in these tumors.
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Affiliation(s)
- Hanna Minns
- Columbia University Irving Medical Center , New York , USA
| | - Oscar Padilla
- Columbia University Irving Medical Center , New York , USA
| | - Hong-Jian Wei
- Columbia University Irving Medical Center , New York , USA
| | | | - Masih Tazhibi
- Columbia University Irving Medical Center , New York , USA
| | | | - Xu Zhang
- Columbia University Irving Medical Center , New York , USA
| | - Rebecca Yeh
- Columbia University Irving Medical Center , New York , USA
| | - Zhiguo Zhang
- Columbia University Irving Medical Center , New York , USA
| | - Luca Szalontay
- Columbia University Irving Medical Center , New York , USA
| | - Jovana Pavisic
- Columbia University Irving Medical Center , New York , USA
| | - Guy Garty
- Columbia University Irving Medical Center , New York , USA
| | - James Garvin
- Columbia University Irving Medical Center , New York , USA
| | | | - Claire Vanpouille-Box
- Department of Radiation Oncology, Weill Cornell Medicine, Sandra and Edward Meyer Cancer Center , New York , USA
| | - Vilas Menon
- Columbia University Irving Medical Center , New York , USA
| | - Marta Olah
- Columbia University Irving Medical Center , New York , USA
| | - Raul Rabadan
- Columbia University Irving Medical Center , New York , USA
| | - Cheng-Chia Wu
- Columbia University Irving Medical Center , New York , USA
| | - Robyn Gartrell
- Columbia University Irving Medical Center , New York , USA
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Shih ML, Lee JC, Cheng SY, Lawal B, Ho CL, Wu CC, Tzeng DTW, Chen JH, Wu ATH. Transcriptomic discovery of a theranostic signature (SERPINE1/MMP3/COL1A1/SPP1) for head and neck squamous cell carcinomas and identification of antrocinol as a candidate drug. Comput Biol Med 2022; 150:106185. [PMID: 37859283 DOI: 10.1016/j.compbiomed.2022.106185] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 07/29/2022] [Revised: 09/04/2022] [Accepted: 10/08/2022] [Indexed: 11/03/2022]
Abstract
Head and neck squamous cell carcinomas (HNSCC) are prevalent malignancies with a disappointing prognosis, necessitating the search for theranostic biomarkers for better management. Based on a meta-analysis of transcriptomic data containing ten clinical datasets of HNSCC and matched nonmalignant samples, we identified SERPINE1/MMP3/COL1A1/SPP1 as essential hub genes as the potential theranostic biomarkers. Our analysis suggests these hub genes are associated with the extracellular matrix, peptidoglycans, cell migration, wound-healing processes, complement and coagulation cascades, and the AGE-RAGE signaling pathway within the tumor microenvironment. Also, these hub genes were associated with tumor-immune infiltrating cells and immunosuppressive phenotypes of HNSCC. Further investigation of The Cancer Genome Atlas (TCGA) cohorts revealed that these hub genes were associated with staging, metastasis, and poor survival in HNSCC patients. Molecular docking simulations were performed to evaluate binding activities between the hub genes and antrocinol, a novel small-molecule derivative of an anticancer phytochemical antrocin previously discovered by our group. Antrocinol showed high affinities to MMP3 and COL1A1. Notably, antrocinol presented satisfactory drug-like and ADMET properties for therapeutic applications. These results hinted at the potential of antrocinol as an anti-HNSCC candidate via targeting MMP3 and COL1A1. In conclusion, we identified hub genes: SERPINE1/MMP3/COL1A1/SPP1 as potential diagnostic biomarkers and antrocinol as a potential new drug for HNSCC.
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Affiliation(s)
- Ming-Lang Shih
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, 11490, Taiwan
| | - Jih-Chin Lee
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, 325, Section 2, Chenggong Road, Taipei, 114, Taiwan
| | - Sheng-Yao Cheng
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, 325, Section 2, Chenggong Road, Taipei, 114, Taiwan
| | - Bashir Lawal
- UPMC Hillman Cancer Center, Department of Pathology, University of Pittsburgh, Pittsburgh, PA, 15213, USA; Graduate Institute for Cancer Biology & Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei, 11031, Taiwan.
| | - Ching-Liang Ho
- Division of Hematology and Oncology Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, 114, Taiwan
| | - Cheng-Chia Wu
- Department of Radiation Oncology, Columbia Irving University Medical Center, Manhattan, NY, USA
| | - David T W Tzeng
- School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, 999077, China
| | - Jia-Hong Chen
- Division of Hematology and Oncology Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, 114, Taiwan
| | - Alexander T H Wu
- The PhD Program of Translational Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, 110, Taiwan; TMU Research Center of Cancer Translational Medicine, Taipei Medical University, Taipei, 110, Taiwan; Clinical Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, 110, Taiwan; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, 110, Taiwan.
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17
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He JS, Duan JB, Li SC, Wang L, Li D, Ze F, Wu CC, Zhou X, Yuan CZ, Li XB. [Effect of Li's catheter in the cardiac resynchronization therapy implantation]. Zhonghua Xin Xue Guan Bing Za Zhi 2022; 50:799-804. [PMID: 35982013 DOI: 10.3760/cma.j.cn112148-20220309-00168] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To evaluate the effect of Li's catheter in cardiac resynchronization therapy (CRT) implantation. Methods: This study was a retrospective cohort study. Patients with indications for CRT implantation who visited the Department of Cardiology, Peking University People's Hospital from January 1, 2016 to January 1, 2022 were enrolled. Patients were divided into Li's catheter group (CRT implantation with Li's catheter) and control group (CRT implantation with the traditional method). The general clinical data of the patients were obtained through the electronic medical record system. Li's catheter is a new type of coronary sinus angiography balloon catheter independently developed by Dr. Li Xuebin (patent number: 201320413174.1). The primary outcome was the success rate of CRT device implantation, and the secondary outcomes included efficacy and safety parameters. Efficacy indicators included operation time, coronary sinus angiography time, left ventricular lead implantation time, X-ray exposure time, left ventricular lead threshold, and diaphragm stimulation. Safety outcomes included incidence of coronary sinus dissection, cardiac tamponade, and pericardial effusion. Results: A total of 170 patients were enrolled in this study, including 90 in Li's catheter group and 80 in control group. Age, male proportion of patients, proportion of patients with ischemic cardiomyopathy, hypertension, diabetes mellitus, chronic renal insufficiency, New York Heart Association (NYHA) functional classification, left ventricular ejection fraction, left ventricular end-diastolic diameter, proportion of left bundle branch block, and preoperative QRS wave width were similar between the two groups (all P>0.05). In Li's catheter group, 34 cases (37.8%) implanted with CRT defibrillators, and 28 cases (35.0%) implanted with CRT defibrillators in control group, the difference was not statistically significant (P=0.710). The success rate of CRT device implantation in Li's catheter group was 100% (90/90), which was significantly higher than that in control group (93.8%, 75/80, P=0.023).The operation time was 57.0 (52.0, 62.3) minutes, the time to complete coronary sinus angiography was 8.0 (6.0, 9.0) minutes, and the time of left ventricular electrode implantation was 8.0 (7.0, 9.0) minutes in Li's catheter group, and was 91.3 (86.3, 97.0), 18.0 (16.0, 20.0), 25.0 (22.0, 27.7) minutes respectively in control group, all significantly shorter in Li's catheter group (all P<0.05). The exposure time of X-ray was 15.0 (14.0, 17.0) minutes in Li's catheter group, which was also significantly shorter than that in control group (32.5 (29.0, 36.0) minutes, P<0.001). There was no coronary sinus dissection and cardiac tamponade in Li's catheter group, and 1 patient (1.1%) had diaphragmatic stimulation in Li's catheter group. In control group, 6 patients (6.7%) had coronary sinus dissection, and 1 patient (1.1%) developed pericardial effusion, and 3 patients (3.3%) had diaphragmatic stimulation. The incidence of coronary sinus dissection in Li's catheter group was significantly lower than that in control group (P=0.011). The postoperative left ventricular thresholds in Li's catheter group and control group were similar (1.80 (1.60, 2.38) V/0.5 ms vs. 1.80 (1.60, 2.40) V/0.5 ms, P=0.120). Conclusions: Use of Li's catheter is associated with higher success rate of CRT implantation, short time of coronary sinus angiography and left ventricular electrode implantation, reduction of intraoperative X-ray exposure, and lower incidence of coronary vein dissection in this patient cohort.
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Affiliation(s)
- J S He
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - J B Duan
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - S C Li
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - L Wang
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - D Li
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - F Ze
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - C C Wu
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - X Zhou
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - C Z Yuan
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - X B Li
- Electrophysiology Lab, Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
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18
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Nakata M, Miwa, Wu CC, Chambers JK, Uchida K, Shiga, Nakayama H, Sasaki. Spontaneous intranasal tumours in degus (Octodon degus): 20 cases (2007-2020). J Small Anim Pract 2022; 63:829-833. [PMID: 35965417 DOI: 10.1111/jsap.13535] [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] [Received: 10/16/2021] [Revised: 04/04/2022] [Accepted: 06/14/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this retrospective study was to describe the clinical and histopathological findings associated with intranasal tumours in degus. MATERIALS AND METHODS Medical records of degus diagnosed with intranasal neoplasms on histopathological examination between the years 2007 and 2020 at one hospital were included in the study. RESULTS MEDICAL RECORDS OF DEGUS Twenty degus (10 males and 10 females) were eligible for inclusion. Initial clinical signs included sneezing, abnormal nasal sounds, and nasal discharge, followed by anorexia and frequent nose rubbing. On radiography, 15 out of 20 animals showed space-occupying lesions in the nasal cavity. CT was performed in 16 animals and revealed various degrees of changes, including abnormal radiopacity within the nasal cavity and damaged nasal septum. Rhinostomy and excisional biopsy was performed in all 20 animals. Six out of 20 patients died during the perioperative period. Six and seven degus survived for 3 months and 1 year, respectively. One animal was lost to follow-up. In 16 cases the histological diagnosis was consistent with fibromas, while in 4 cases with osteomas. CLINICAL SIGNIFICANCE Intranasal neoplasms in degus are mostly benign mesenchymal tumours with various degrees of bone formation, which is unique to this animal species. This occurrence should be considered as an important differential diagnosis for upper respiratory tract disease in degus.
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Affiliation(s)
- M Nakata
- Miwa Exotic Animal Hospital, Tokyo, 170003, Japan.,VISION VETS GROUP Lab, Tokyo, 1510051, Japan
| | - Miwa
- Miwa Exotic Animal Hospital, Tokyo, 170003, Japan.,VISION VETS GROUP Lab, Tokyo, 1510051, Japan
| | - C C Wu
- Miwa Exotic Animal Hospital, Tokyo, 170003, Japan
| | - J K Chambers
- Laboratory of Veterinary Pathology, Graduate School of Agricultural and Life Science, The University of Tokyo, Tokyo, 1138657, Japan
| | - K Uchida
- Laboratory of Veterinary Pathology, Graduate School of Agricultural and Life Science, The University of Tokyo, Tokyo, 1138657, Japan
| | - Shiga
- VISION VETS GROUP Lab, Tokyo, 1510051, Japan
| | - H Nakayama
- VISION VETS GROUP Lab, Tokyo, 1510051, Japan
| | - Sasaki
- VISION VETS GROUP Lab, Tokyo, 1510051, Japan
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19
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Liu C, Zhu N, Sun H, Zhang J, Feng X, Gjerswold-Selleck S, Sikka D, Zhu X, Liu X, Nuriel T, Wei HJ, Wu CC, Vaughan JT, Laine AF, Provenzano FA, Small SA, Guo J. Deep learning of MRI contrast enhancement for mapping cerebral blood volume from single-modal non-contrast scans of aging and Alzheimer's disease brains. Front Aging Neurosci 2022; 14:923673. [PMID: 36034139 PMCID: PMC9407020 DOI: 10.3389/fnagi.2022.923673] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
While MRI contrast agents such as those based on Gadolinium are needed for high-resolution mapping of brain metabolism, these contrast agents require intravenous administration, and there are rising concerns over their safety and invasiveness. Furthermore, non-contrast MRI scans are more commonly performed than those with contrast agents and are readily available for analysis in public databases such as the Alzheimer's Disease Neuroimaging Initiative (ADNI). In this article, we hypothesize that a deep learning model, trained using quantitative steady-state contrast-enhanced structural MRI datasets, in mice and humans, can generate contrast-equivalent information from a single non-contrast MRI scan. The model was first trained, optimized, and validated in mice, and was then transferred and adapted to humans. We observe that the model can substitute for Gadolinium-based contrast agents in approximating cerebral blood volume, a quantitative representation of brain activity, at sub-millimeter granularity. Furthermore, we validate the use of our deep-learned prediction maps to identify functional abnormalities in the aging brain using locally obtained MRI scans, and in the brain of patients with Alzheimer's disease using publicly available MRI scans from ADNI. Since it is derived from a commonly-acquired MRI protocol, this framework has the potential for broad clinical utility and can also be applied retrospectively to research scans across a host of neurological/functional diseases.
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Affiliation(s)
- Chen Liu
- Department of Electrical Engineering, Columbia University, New York, NY, United States
| | - Nanyan Zhu
- Department of Biological Sciences, Columbia University, New York, NY, United States
| | - Haoran Sun
- Department of Biomedical Engineering, Columbia University, New York, NY, United States
| | - Junhao Zhang
- Department of Biomedical Engineering, Columbia University, New York, NY, United States
| | - Xinyang Feng
- Department of Biomedical Engineering, Columbia University, New York, NY, United States
| | | | - Dipika Sikka
- Department of Biomedical Engineering, Columbia University, New York, NY, United States
| | - Xuemin Zhu
- Department of Pathology and Cell Biology, Columbia University, New York, NY, United States
| | - Xueqing Liu
- Department of Biomedical Engineering, Columbia University, New York, NY, United States
| | - Tal Nuriel
- Department of Radiation Oncology, Columbia University, New York, NY, United States
| | - Hong-Jian Wei
- Department of Radiation Oncology, Columbia University, New York, NY, United States
| | - Cheng-Chia Wu
- Department of Radiation Oncology, Columbia University, New York, NY, United States
| | - J. Thomas Vaughan
- Department of Biomedical Engineering, Columbia University, New York, NY, United States
| | - Andrew F. Laine
- Department of Biomedical Engineering, Columbia University, New York, NY, United States
| | | | - Scott A. Small
- Department of Neurology, Columbia University, New York, NY, United States
- Department of Psychiatry, Columbia University, New York, NY, United States
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, United States
| | - Jia Guo
- Department of Psychiatry, Columbia University, New York, NY, United States
- The Mortimer B. Zuckerman Mind Brain Behavior Institute, Columbia University, New York, NY, United States
- *Correspondence: Jia Guo
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Genecin I, Fullwood D, Moisander-Joyce H, Padilla O, Minns H, Garvin J, Szalontay L, Wu CC, Kahn J, Gartrell RD. EPID-07. Outcome disparities in children, adolescents and young adults with medulloblastoma: A population-based analysis. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac079.175] [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
Medulloblastoma (MB) is the most common high-grade primary pediatric brain tumor. Recent registry-based studies in children with central nervous system (CNS) tumors have demonstrated that survival outcomes differ by race/ethnicity in multivariable analyses, with Hispanic patients having highest hazard of death overall. To investigate this finding in MB patients, we examined survival in children (0-14 years) and adolescent/young adults (15-39 years) with MB from 2007-2016 in the 2018 Surveillance Epidemiology and End Results Program database, using Kaplan Meier analysis, log-rank test and Cox proportional hazard ratios (HR) with 95% confidence intervals (CI). Race and ethnicity were categorized according to the U.S. Census, with Hispanic ethnicity (yes/no) analyzed separately from race (Black, White, Asian, Other). Among 1612 patients, 81% were White, 9% were Black, 8% were Asian or Pacific Islander, and 2% were from “other” or unknown racial groups. 28% of the cohort was of Hispanic ethnicity. Univariate analysis found that Black patients had a significantly higher hazard of death than White patients (HR=1.55, CI: 1.16 – 2.08, p=0.003). In contrast, Hispanic ethnicity was not significantly associated with outcome (HR=0.98, CI: 0.79-1.21, p=0.8). Medicaid or no insurance (vs. private) were each significantly associated with higher risk of death; Medicaid (HR =1.23, CI = 1.01 - 1.51, p=0.041); Uninsured (HR=2.07, CI=1.41-3.02, p=<0.001). Of the treatment modalities analyzed, patients who received neither chemotherapy nor radiation experienced higher hazard of death than patients who received both treatments (HR=3.63, CI 2.78-4.76, p=<0.001). Consistent with observations in other cancers, racial disparities are observed in patients with MB, with Black race conferring increased risk of death. Public insurance was also significantly associated with death, as was not receiving combined-modality therapy. Further work is needed to understand the multilevel factors impacting diagnosis, treatment and outcome among children and AYAs with MB and prospective studies are warranted.
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Affiliation(s)
- Isabel Genecin
- Columbia Vagelos College of Physicians and Surgeons, New York , New York , USA
| | - Dottington Fullwood
- University of Florida College of Medicine, Department of Aging and & Geriatric Research , Gainesville, Florida , USA
| | - Hanna Moisander-Joyce
- Columbia University Irving Medial Center, Department of Pediatrics - Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, New York , New York , USA
| | - Oscar Padilla
- Columbia University Irving Medical Center, Department of Radiation Oncology, New York , New York , USA
| | - Hanna Minns
- Columbia University Irving Medial Center, Department of Pediatrics - Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, New York , New York , USA
| | - James Garvin
- Columbia University Irving Medial Center, Department of Pediatrics - Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, New York , New York , USA
| | - Luca Szalontay
- Columbia University Irving Medial Center, Department of Pediatrics - Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, New York , New York , USA
| | - Cheng-Chia Wu
- Columbia University Irving Medical Center, Department of Radiation Oncology, New York , New York , USA
- Herbert Irving Comprehensive Cancer Center, New York , New York , USA
| | - Justine Kahn
- Columbia University Irving Medial Center, Department of Pediatrics - Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, New York , New York , USA
| | - Robyn D Gartrell
- Columbia University Irving Medial Center, Department of Pediatrics - Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, New York , New York , USA
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Webster Carrion A, Wei HJ, McQuillan N, Tazhibi M, Kokossis D, Berg X, Minns H, Zhang X, Zhang Z, Wang J, Fernandez EC, Jan CI, Padilla O, Gartrell RD, Becher O, Jr JHG, Pavisic J, Szalontay L, Konofagou EE, Zacharoulis S, Wu CC. MODL-24. Focused ultrasound-mediated blood-brain barrier opening and panobinostat in a thalamic syngeneic murine DMG model is feasible and safe. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac079.647] [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: 11/13/2022] Open
Abstract
Abstract
Diffuse Midline Glioma with H3K27M mutation (DMG) is an aggressive unresectable central nervous system tumor of the brainstem, midline thalamus, or spine. Prognosis is poor and systemic agents have been ineffective partially due to limited permeability of the blood brain barrier (BBB). Non-invasive low intensity focused ultrasound (FUS) can be used for BBB opening (BBBO). Our preclinical studies showed safety and feasibility of targeting and BBBO in the brainstem; however, to our knowledge, FUS-guided BBBO for thalamic DMG has yet to be reported. RNA-seq was performed on mouse syngeneic DMG cells 4423 (PDGFB+, H3.3K27M, p53−/−) and results recapitulated molecular programs seen in human tumors. 4423 cells were injected into the thalamus of male B6 (Cg)-Tyrc-2J/J mice at 1.6mm lateral and 1.8mm posterior to the bregma at a depth of 3.2mm. MRI at 14-21 days post injection confirmed thalamic tumor growth. Histological analysis with Hematoxylin and Eosin stain was consistent with thalamic DMG. Tumor implantation rate was 85% and median survival was 38 days post injection. To test safety and feasibility of BBBO for thalamic tumors, a 1.5 MHz FUS transducer was used with concurrent microbubble injection. BBBO assessed by contrast-enhanced MRI. FUS achieved BBBO targeting the thalamic tumor without increased morbidity or mortality and BBB closure was observed on day 3 post-sonication. Next we tested the tolerance of drug delivery with panobinostat post-FUS at a dose of 20mg/kg weekly. The results are preliminary at this time; however, animals tolerated the combination therapy without morbidity or mortality. Preclinical models are crucial to improve the development of new therapeutic strategies. Establishing this syngeneic thalamic DMG murine model provides the opportunity to test FUS as a non-invasive drug delivery technology for thalamic DMG compared to brainstem DMG, and to re-visit therapeutic agents previously considered ineffective due to limited penetration of the BBB.
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Affiliation(s)
- Andrea Webster Carrion
- Department of Pediatrics, Columbia University Irving Medical Center., New York , New York , USA
| | - Hong-Jian Wei
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York , New York , USA
| | - Nicholas McQuillan
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York , New York , USA
| | - Masih Tazhibi
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York , New York , USA
| | - Danae Kokossis
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York , New York , USA
| | - Xander Berg
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York , New York , USA
| | - Hanna Minns
- Department of Pediatrics, Columbia University Irving Medical Center., New York , New York , USA
| | - Xu Zhang
- Institute for Cancer Genetics, Columbia University Irving Medical Center, New York , New York , USA
| | - Zhiguo Zhang
- Institute for Cancer Genetics, Columbia University Irving Medical Center, New York , New York , USA
- Department of Genetics and Development, Columbia University Irving Medical Center, New York , New York , USA
| | - Junqiang Wang
- Department of Systems Biology, Columbia University Irving Medical Center, New York , New York , USA
| | - Ester Calvo Fernandez
- Department of Systems Biology, Columbia University Irving Medical Center, New York , New York , USA
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York , New York , USA
| | - Chia-Ing Jan
- Division of Molecular Pathology, China Medical University and Hospital , Taichung , Taiwan
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York , New York , USA
| | - Oscar Padilla
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York , New York , USA
| | - Robyn D Gartrell
- Department of Pediatrics, Columbia University Irving Medical Center., New York , New York , USA
| | - Oren Becher
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York , New York , USA
| | - James H Garvin Jr
- Department of Pediatrics, Columbia University Irving Medical Center., New York , New York , USA
| | - Jovana Pavisic
- Department of Pediatrics, Columbia University Irving Medical Center., New York , New York , USA
| | - Luca Szalontay
- Department of Pediatrics, Columbia University Irving Medical Center., New York , New York , USA
| | - Elisa E Konofagou
- Department of Biomedical Engineering, Columbia University Irving Medical Center, New York , New York , USA
| | - Stergios Zacharoulis
- Department of Pediatrics, Columbia University Irving Medical Center., New York , New York , USA
| | - Cheng-Chia Wu
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York., USA
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22
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McQuillan N, Tazhibi M, Wei HJ, Pouliopoulos A, Bendau E, Carrion AW, Berg A, Kokossis D, Zhang X, Zhang Z, Englander Z, Yoh N, Jan CI, Gartrell RD, Garvin J, Szalontay L, Konofagou E, Zacharoulis S, Wu CC. MODL-25. Radiation and focused ultrasound–mediated blood–brain barrier opening for DMG: safety and feasibility of combinatorial therapy. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac079.648] [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: 11/14/2022] Open
Abstract
Abstract
Diffuse midline glioma (DMG) is a pediatric tumor with dismal prognosis. Systemic therapeutic strategies have been unsuccessful to date and radiotherapy (RT) remains the standard of care. A central impediment to systemic therapy is the blood-brain barrier (BBB), which precludes drug delivery to the tumor site. Focused ultrasound (FUS) with intravenous microbubbles can transiently and non-invasively circumvent the BBB to enhance drug delivery. Nevertheless, it remains unclear whether FUS is safe at the brainstem in combination with clinical doses of RT. In this study, we hypothesized that FUS-mediated BBB-opening (BBBO) is safe and feasible with 39 Gy RT. To establish a safety timeline, we administered FUS to the brainstem of nontumor bearing mice concurrent with or adjuvant to radiation; then, we validated our findings in a syngeneic orthotopic xenograft DMG model which received repeated sonication concurrent with RT. Male B6 (Cg)-Tyrc-2J/J albino mice received intracranial injection of 4423 mouse DMG cells (PDGFB+, H3.3K27M, p53−/−) at a location posterior and lateral to the lambda. A clinical RT dose of 39 Gy in 13 fractions was delivered to the brainstem with the Small Animal Radiation Research Platform (SARRP) or the XRAD-320 irradiator. FUS was administered with a 0.5 MHz transducer, and both BBBO and tumor volume were monitored with MRI. FUS-mediated BBBO in nontumor bearing mice receiving RT did not affect cardiorespiratory rate, motor function, and tissue integrity. Moreover, tumor bearing mice tolerated repeated brainstem BBBO concurrent with RT. 39 Gy over 13 fractions offered local control, although disease progression occurred in all animals approximately 3-4 weeks post-RT. Ultimately, repeated FUS-mediated BBB opening concurrent with RT is safe and feasible. In our brainstem DMG model, relapse occurs, making it ideal for future tests of combinatorial RT and FUS-mediated drug delivery.
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Affiliation(s)
- Nicholas McQuillan
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York , NY , USA
| | - Masih Tazhibi
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York , NY , USA
| | - Hong-Jian Wei
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York , NY , USA
| | - Antonios Pouliopoulos
- Department of Surgical & Interventional Engineering, King's College London , London , United Kingdom
| | - Ethan Bendau
- Department of Biomedical Engineering, Columbia University, New York , NY , USA
| | - Andrea Webster Carrion
- Department of Pediatrics, Columbia University Irving Medical Center, New York , NY , USA
| | - Alexander Berg
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York , NY , USA
| | - Danae Kokossis
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York , NY , USA
| | - Xu Zhang
- Department of Pediatrics, Columbia University Irving Medical Center, New York , NY , USA
| | - Zhiguo Zhang
- Department of Pediatrics, Columbia University Irving Medical Center, New York , NY , USA
| | - Zachary Englander
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York , NY , USA
| | - Nina Yoh
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York , NY , USA
| | - Chia-Ing Jan
- Division of Molecular Pathology, China Medical University and Hospital , Taichung , Taiwan
| | - Robyn D Gartrell
- Department of Pediatrics Oncology, Columbia University Irving Medical Center, New York , NY , USA
| | - James Garvin
- Department of Pediatrics Oncology, Columbia University Irving Medical Center, New York , NY , USA
| | - Luca Szalontay
- Department of Pediatrics Oncology, Columbia University Irving Medical Center, New York , NY , USA
| | - Elisa Konofagou
- Department of Biomedical Engineering, Columbia University, New York , NY , USA
| | - Stergios Zacharoulis
- Department of Pediatrics, Columbia University Irving Medical Center, New York , NY , USA
| | - Cheng-Chia Wu
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York , NY , USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York , NY , USA
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Minns HE, Padilla O, Wei HJ, Webster-Carrion A, Tazhibi M, McQuillan N, Zhang X, Yeh R, Zhang Z, Szalontay L, Pavisic J, Garty G, Garvin J, Zacharoulis S, Canoll P, Vanpouille-Box CI, Menon V, Olah M, Rabadan R, Wu CC, Gartrell RD. DIPG-45. Radiation induces a robust interferon response in Diffuse Midline Glioma (DMG), improving the potential for combination immunotherapy. Neuro Oncol 2022. [PMCID: PMC9164968 DOI: 10.1093/neuonc/noac079.102] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Diffuse Midline Glioma (DMG), H3K27M altered, confers a dismal survival of 9-15 months and has a non-inflammatory tumor immune microenvironment (TIME). Radiation therapy (RT) is the mainstay treatment for DMG and has been shown in other cancers to recruit an immune component. However, the effect of RT on the DMG TIME has not been explored. In a syngeneic murine model of pontine DMG (PDGFB+, H3.3K27M, p53−/−), mice were treated with single fraction 15Gy RT or sham control, four mice per group. We performed single cell sequencing after CD45 isolation to evaluate the TIME 4 days post RT and compare to untreated tumor (sham control). Unsupervised clustering of 14,848 CD45+ cells revealed 16 immune cell subsets, most abundantly microglia at 75% of cells, with four subtypes representing a spectrum of homeostatic to activated. Microglia from RT are more concentrated in the activated subtypes with an upregulation of interferon response (i.e. Isg15, Ifit3) compared to untreated tumor with an increase in several interferon pathways using REACTOME. Consistent with RT response, RT treated tumors have increase in cell cycle regulatory genes such as Cdkn1a, across all clusters. In non-resident myeloid cells, compared to untreated tumor, RT is associated with a robust upregulation of interferon response genes in both macrophages (Isg15 Fold Change (FC) 2.30; Ifit1 FC 1.64; Ifit3 FC 2.02; Cxcl10 FC 2.29) and dendritic cells (Isg15 FC 2.67; Ifit1 FC 1.72; Ifit3 FC 2.06; Cxcl10 FC 1.50). We also find differential expression of immune checkpoints in RT-treated versus untreated tumor with decreased expression of Lag3, Tim3 (Havcr2), and Csf1R and increased expression of Cd47, Sirpa and Gitr (Tnfrsf18) post RT. In summary, RT stimulates a pro-inflammatory TIME response and alters immune checkpoints in DMG, highlighting the potential for combining RT and immunotherapy in these tumors.
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Affiliation(s)
- Hanna E Minns
- Columbia University Irving Medical Center, New York , NY , USA
| | - Oscar Padilla
- Columbia University Irving Medical Center, New York , NY , USA
| | - Hong-Jian Wei
- Columbia University Irving Medical Center, New York , NY , USA
| | | | - Masih Tazhibi
- Columbia University Irving Medical Center, New York , NY , USA
| | | | - Xu Zhang
- Columbia University Irving Medical Center, New York , NY , USA
| | | | - Zhiguo Zhang
- Columbia University Irving Medical Center, New York , NY , USA
| | - Luca Szalontay
- Columbia University Irving Medical Center, New York , NY , USA
| | - Jovana Pavisic
- Columbia University Irving Medical Center, New York , NY , USA
| | - Guy Garty
- Columbia University Irving Medical Center, New York , NY , USA
| | - James Garvin
- Columbia University Irving Medical Center, New York , NY , USA
| | | | - Peter Canoll
- Columbia University Irving Medical Center, New York , NY , USA
| | | | - Vilas Menon
- Columbia University Irving Medical Center, New York , NY , USA
| | - Marta Olah
- Columbia University Irving Medical Center, New York , NY , USA
| | - Raul Rabadan
- Columbia University Irving Medical Center, New York , NY , USA
| | - Cheng-Chia Wu
- Columbia University Irving Medical Center, New York , NY , USA
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Wu CC, Li XB, Duan JB, He JS, Zhu TG, Yu C, Li D, Ze F, Guo JH, Wang L. [Value of D-dimer and left atrial size combined with CHA 2DS 2-VASc score in excluding left atrial thrombosis in patients with non-valvular atrial fibrillation]. Zhonghua Yi Xue Za Zhi 2021; 101:3938-3943. [PMID: 34954995 DOI: 10.3760/cma.j.cn112137-20210608-01303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the related factors of thrombosis in patients with non-valvular atrial fibrillation (NVAF), and whether the combination of D-dimer, left atrial anteroposterior diameter and CHA2DS2-VASc score can be used to exclude left atrial thrombosis. Methods: A total of 75 NVAF patients with left atrial thrombosis confirmed by transesophageal echocardiography in Peking University People's Hospital from January 1, 2015 to December 31, 2019 were enrolled as the thrombus group. From January 1 to October 31, 2019, 80 patients with NVAF without left atrial thrombosis were enrolled as the control group. The clinical data, CHA2DS2-VASc score, hematological biomarkers, ultrasound data of two groups were compared. The independent factors associated with left atrial thrombosis were screened by univariate analysis and multivariate logistic regression analysis. The positive predictive value and negative predictive value for the diagnosis of left atrial thrombosis were gained by the score calculated based on the independent related factors. Results: There were no significant differences in age, gender, proportion of persistent atrial fibrillation and duration of atrial fibrillation between the two groups. The CHA2DS2-VASc score [M (Q1, Q3)] of the thrombus group was higher than that of the control group [2.5 (1.0, 3.0) vs 1.8 (1.0, 3.0), P=0.012]. The prothrombin time activity [M (Q1, Q3)] of the thrombus group was 81.1 (72.0, 93.0)%, which was lower than that of the control group 88.8 (83.0,96.0)% (P=0.008). The activated partial thromboplastin time (APTT) of the thrombus group was longer than that of the control group [(32.1±4.8) s vs (30.2±3.7) s, P=0.006]. D-dimer [M (Q1, Q3)] of the thrombus group was 231.0 (71.5, 272.2) ng/ml, which was higher than that of the control group 121.7 (49.0, 140.0) ng/ml (P<0.001). The left atrial anteroposterior diameter in thrombus group was larger [(44.6±6.6) mm vs (38.9±5.3) mm, P<0.001], the proportion of mitral regurgitation was higher (58.1% vs 26.8%, P<0.001). The left ventricular ejection fraction [M (Q1, Q3)] of the thrombus group was 56.7% (45.8%, 66.3%), which was lower than that of the control group 63.3% (60.5%, 70.2%) (P=0.003). Multivariate logistic regression analysis showed that the factor related to left atrial thrombosis was left atrial anteroposterior diameter (OR=4.480, 95%CI: 1.616-12.423). The negative predictive value of the new scoring system combined with D-dimer, left atrial anteroposterior diameter and CHA2DS2-VASc score for left atrial thrombosis was 100%. Conclusions: In NVAF patients, the factor independently associating with left atrial thrombosis is left atrial anteroposterior diameter. The combination of D-dimer, left atrial anteroposterior diameter, and CHA2DS2-VASc score can help exclude left atrial thrombosis before ablation of NVAF.
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Affiliation(s)
- C C Wu
- Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - X B Li
- Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - J B Duan
- Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - J S He
- Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - T G Zhu
- Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - C Yu
- Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - D Li
- Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - F Ze
- Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - J H Guo
- Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
| | - L Wang
- Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
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Tazhibi M, McQuillan N, Wei HJ, Pouliopoulos A, Bendau E, Englander Z, Webster A, Yoh N, Zacharoulis S, Konofagou E, Wu CC. RADT-17. FOCUSED ULTRASOUND MEDIATED BLOOD–BRAIN BARRIER OPENING IS SAFE AND FEASIBLE CONCURRENT WITH AND ADJUVANT TO A CLINICAL RADIATION SCHEME FOR BRAINSTEM DMG. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.175] [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: 11/14/2022] Open
Abstract
Abstract
Diffuse midline gliomas (DMG) are pediatric tumors with dismal prognosis. When these tumors emerge in the brainstem, there exists no feasible method of surgical resection or systemic intervention, making ionizing radiation the sole therapeutic avenue to date. However, radiotherapy (RT) provides only marginal survival benefit as the topographically diffuse and highly infiltrative tumors spread in areas in which the blood-brain barrier (BBB) is relatively intact. Focused ultrasound (FUS) with intravenous microbubbles provides a compelling solution, transiently and non-invasively opening the BBB to allow drug delivery across the cerebrovasculature. Nonetheless, it remains unclear whether FUS can be safely administered at the brainstem in patients receiving RT. Therefore, the goal of this study was to assess the safety and feasibility of FUS administered concurrent with and adjuvant to a clinical hypofractionated radiation scheme for brainstem DMG. Non-tumor bearing B6 albino mice were randomly assorted into control, RT, FUS, and RT+FUS groups. Mice designated RT+FUS received 39Gy/13fx (hypofractionated RT scheme) to the brainstem with two sessions of FUS approximately 1 week apart. A single-element, spherical-segment FUS transducer driven by a function generator through a power amplifier was used with concomitant microbubble injection to sonicate the brainstem. Magnetic resonance imaging (MRI) was used to confirm BBB opening and cardiopulmonary measures were recorded throughout sonication. Vitals were assessed daily, and all treatment animals underwent Kondziela inverted screen testing and sequential weight lifting to assess brainstem-related strength and motor coordination deficits. In both FUS and RT+FUS mice, MRI confirmed brainstem BBB opening and subsequent closure within 96 hours. Mouse weights were stable, with slight drops (mean=5.5%) following FUS that resolved within three days. No attenuation in cardiorespiratory, strength, and motor coordination measurements was observed from FUS. FUS is a safe and feasible technique for brainstem BBB opening concurrent with and adjuvant to clinical hypofractionated RT.
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Affiliation(s)
| | | | | | | | | | | | | | - Nina Yoh
- Columbia University, New York, NY, USA
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Padilla O, Minns H, Wei HJ, Webster-Carrion A, Tazhibi M, McQuillan N, Zhang X, Zhang Z, Rabadan R, Canoll P, Szalontay L, Pavisic J, Garty G, Zacharoulis S, Vanpouille-Box C, Menon V, Olah M, Wu CC, Gartrell R. 91 Impact of ultra-fast ‘FLASH’ radiotherapy on single cell immunogenomics in diffuse intrinsic pontine glioma (DIPG). J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.091] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BackgroundDiffuse intrinsic pontine gliomas (DIPG’s) are immunologically inert tumors with a median survival of 9–15 months. Radiation therapy (RT) is the mainstay treatment for DIPG but is associated with immunodepletion of the tumor microenvironment (TME) at high dose ranges. FLASH, or ultra-fast dose rate RT, represents a novel ablative technique that may spare TME immune responses while decreasing tumor burden. Here, we present single-cell immune profiling of DIPG tumors treated with FLASH, conventional dose rate RT (CONV) or no RT (SHAM).MethodsMurine H3.3K27M mutant DIPG cells were stereotactically injected and tumor induction confirmed by magnetic resonance imaging (MRI) 15 days later. DIPG-bearing mice were randomly assigned to one of three treatment groups (n=4/group), FLASH, CONV or SHAM. A fourth group with no tumor (NML) was included as a negative biological control. A modified linear accelerator was used to deliver 15 Gy of electron RT to the brainstem at dose rates of 90 Gy/second and 2 Gy/minute, for the FLASH and CONV groups, respectively. Four days post-RT, mice brainstems were harvested, homogenized, stained for CD45 and tagged with a hashtag antibody specific to each group. CD45+ immune cells were isolated and sequenced using the 10X Genomics chromium single-cell 3’ platform. After processing and alignment of the reads using CellRanger with default parameters, the data was quality checked and filtered before hashtag demultiplexing, unsupervised clustering and downstream analysis was implemented following the Seurat R package. Differential expression evaluated based on the non-parametric Wilcoxon rank sum test. Key genes determine by an adjusted p value of < 0.05 based on bonferroni correction and |avg log2FC| > 0.8.ResultsPreliminary analysis identifies 15 clusters with distinct CD45 immune phenotypes (figure 1). Differential gene expression analysis by hashtag antibody (treatment group) reveals 14 clusters differentially expressing key genes, including 3 clusters upregulated in DIPG compared to NML, and 2 clusters upregulated in irradiated tumors compared to SHAM and NML (figure 2). Notably, analysis demonstrates an individual cluster upregulated in FLASH versus all other groups (p = 3.07E-171). Further deconvolution of specific immune phenotypes represented by each cluster is ongoing.Abstract 91 Figure 1tSNE plot based on clustering of RNA signatures, grouped by RNAAbstract 91 Figure 2tSNE plot based on clustering of RNA signatures, grouped by hashtag antibodyConclusionsOur preliminary analysis shows differential immune responses among DIPG tumors compared to NML. We also find several immune cell subsets that are unique to DIPG treated with CONV or FLASH compared to unirradiated samples. Most notably, we identify a single immune cell subset that is exclusive to FLASH alone, indicating that FLASH elicits a unique immune response in murine DIPG.
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Wu CC, Krasin MJ. Management of Pediatric Nasopharyngeal Carcinoma: A Role for RT Dose De-escalation. Int J Radiat Oncol Biol Phys 2021; 111:11. [PMID: 34348104 DOI: 10.1016/j.ijrobp.2020.11.029] [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] [Received: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 10/20/2022]
Affiliation(s)
- Cheng-Chia Wu
- Department of Radiation Oncology, Columbia University Irving Medical Center, Herbert Irving Comprehensive Cancer Center, New York City, New York
| | - Matthew J Krasin
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
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Saraf A, Gallitto M, Franco I, Milligan M, Perni S, Larios D, Boyd G, Wu CC, Jimenez R. Teaching Mentoring: Utilizing a Resident-Student Peer Mentorship Program as a Tool to Educate Residents About the Core Components of Mentoring. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.05.152] [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: 10/20/2022]
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Ahrar K, Tam AL, Kuban JD, Wu CC. Imaging of the thorax after percutaneous thermal ablation of lung malignancies. Clin Radiol 2021; 77:31-43. [PMID: 34384562 DOI: 10.1016/j.crad.2021.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/22/2021] [Indexed: 01/25/2023]
Abstract
Image-guided thermal ablation is a minimally invasive treatment option for patients with early stage non-small cell lung cancer or metastatic disease to the lungs. Percutaneous ablation treats malignant tumours in situ, which precludes histopathological evaluation of the ablated tumours. Imaging studies are used as surrogates to assess technical and clinical success. Although it is not universally accepted, a common protocol for surveillance imaging includes contrast-enhanced computed tomography (CT) at 1, 3, 6, 9, 12, 18, 24 months, and yearly thereafter. Integrated 2-[18F]-fluoro-2-deoxy-d-glucose positron-emission tomography (PET)/CT imaging is recommended at 3 and 12 months and when recurrent disease is suspected. There is a complex evolution of the ablation zone on CT and PET imaging studies. The zone of ablation, initially larger than the ablated tumour, undergoes gradual involution. In the process, it may cavitate and resemble a lung abscess. Different contrast-enhancement and radionuclide uptake patterns in and around the ablation zone may indicate a wide range of diagnostic possibilities from a normal physiological response to local progression. Ultimately, the zone of ablation may be replaced by a variety of findings including linear bands of density, pleural thickening, or residual necrotic tumour. Diagnostic and interventional radiologists interpreting post-ablation imaging studies must have a clear understanding of the ablation process and imaging findings on surveillance studies. Accurate and timely recognition of complications and/or local recurrence is necessary to guide further therapy. The purpose of this article is to review imaging protocols and salient imaging findings after thermal ablation of lung malignancies.
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Affiliation(s)
- K Ahrar
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Centre, Houston, TX 77030, USA.
| | - A L Tam
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Centre, Houston, TX 77030, USA
| | - J D Kuban
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Centre, Houston, TX 77030, USA
| | - C C Wu
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Centre, Houston, TX 77030, USA
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Rassiah P, Esiashvili N, Olch AJ, Hua CH, Ulin K, Molineu A, Marcus K, Gopalakrishnan M, Pillai S, Kovalchuk N, Liu A, Niyazov G, Peñagarícano JA, Cheung F, Olson AC, Wu CC, Malhotra H, MacEwan IJ, Faught J, Breneman JC, Followill DS, FitzGerald TJ, Kalapurakal JA. Practice patterns of pediatric total body irradiation techniques: A Children's Oncology Group survey. Int J Radiat Oncol Biol Phys 2021; 111:1155-1164. [PMID: 34352289 DOI: 10.1016/j.ijrobp.2021.07.1715] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 02/23/2021] [Revised: 06/30/2021] [Accepted: 07/28/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE The aim of this study was to examine current practice patterns in pediatric total body irradiation (TBI) techniques among xxx member institutions. METHODS AND MATERIALS Between Nov 2019 and Feb 2020 a questionnaire, containing 52 questions related to the technical aspects of TBI was sent to medical physicists at 152 xxx institutions. The questions were designed to obtain technical information on commonly used TBI treatment techniques. Another set of 9 questions related to the clinical management of patients undergoing TBI was sent to 152 xxx member radiation oncologists at the same institutions. RESULTS Twelve institutions were excluded because TBI was not performed in their institutions. A total of 88 physicists from 88 institutions (63% response rate) and 96 radiation oncologists from 96 institutions responded (69% response rate). The AP/PA technique was the most common (49 institutions - 56%); 44 institutions (50%) used the lateral technique and 14 institutions (16%) used volumetric modulated arc therapy (VMAT)/Tomotherapy. Mid-plane dose rates of 6-15 cGy/min were most commonly used. The most common specification for lung dose was the mid lung dose for both AP/PA (71%) and lateral (63%) techniques. All physician responders agreed with the need to refine current TBI techniques and 79% supported the investigation of new TBI techniques to further lower the lung dose. CONCLUSION There is no consistency in the practice patterns, methods for dose measurement and reporting of TBI doses among xxx institutions. The lack of a standardization precludes meaningful correlation between TBI doses and clinical outcomes including disease control and normal tissue toxicity. The xxx radiation oncology discipline is currently undertaking several steps to standardize the practice and dose reporting of pediatric TBI using detailed questionnaires and phantom-based credentialing for all xxx centers.
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Affiliation(s)
- P Rassiah
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT.
| | - N Esiashvili
- Department of Radiation Oncology, Emory University, Atlanta, GA
| | - A J Olch
- Department of Radiation Oncology, University of Southern California and Children's Hospital of Los Angeles, Los Angeles, CA
| | - C H Hua
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - K Ulin
- Imaging and Radiation Oncology Core, Rhode Island QA Center, University of Massachusetts Medical School, Lincoln, RI
| | - A Molineu
- Imaging and Radiation Oncology Core, Houston QA Center, MD Anderson Cancer Center, Houston, TX
| | - K Marcus
- Department of Radiation Oncology, Harvard Medical School, Boston, MA
| | - M Gopalakrishnan
- Department of Radiation Oncology, Northwestern University, Chicago, IL
| | - S Pillai
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR
| | - N Kovalchuk
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - A Liu
- Department of Radiation Oncology, City of Hope, Los Angeles, CA
| | - G Niyazov
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - J A Peñagarícano
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - F Cheung
- Medical Physics division, Princess Margaret Cancer Center, Toronto, Canada
| | - A C Olson
- Department of Radiation Oncology, Children's Hospital of Pittsburgh, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine Pittsburgh, PA
| | - C C Wu
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY
| | - H Malhotra
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - I J MacEwan
- Department of Radiation Medicine and Applied Sciences, UC San Diego, La Jolla, CA
| | - J Faught
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - J C Breneman
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH
| | - D S Followill
- Imaging and Radiation Oncology Core, Houston QA Center, MD Anderson Cancer Center, Houston, TX
| | - T J FitzGerald
- Department of Radiation Oncology, University of Massachusetts, Worcester, MA
| | - J A Kalapurakal
- Department of Radiation Oncology, Northwestern University, Chicago, IL
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Upadhyayula PS, Higgins DM, Argenziano MG, Spinazzi EF, Wu CC, Canoll P, Bruce JN. The Sledgehammer in Precision Medicine: Dexamethasone and Immunotherapeutic Treatment of Glioma. Cancer Invest 2021; 40:554-566. [PMID: 34151678 DOI: 10.1080/07357907.2021.1944178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Understanding dexamethasone's effect on the immune microenvironment in glioma patients is of key importance. We performed a comprehensive literature review using the NCBI PubMed database for all articles meeting the following search criteria. ((dexamethasone[All Fields]) AND (glioma or glioblastoma)[Title/Abstract]) AND (immune or T cell or B cell or monocyte or neutrophil or macrophage). Forty-three manuscripts were deemed relevant to the topic at hand. Multiple clinical studies have linked dexamethasone use to decreased overall survival while preclinical studies in murine glioma models have demonstrated decreased tumor-infiltrating lymphocytes after dexamethasone administration.
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Affiliation(s)
- Pavan S Upadhyayula
- Department of Neurological Surgery, Columbia Irving University Medical Center, Manhattan, NY, USA
| | - Dominique M Higgins
- Department of Neurological Surgery, Columbia Irving University Medical Center, Manhattan, NY, USA
| | - Michael G Argenziano
- Department of Neurological Surgery, Columbia Irving University Medical Center, Manhattan, NY, USA
| | - Eleonora F Spinazzi
- Department of Neurological Surgery, Columbia Irving University Medical Center, Manhattan, NY, USA
| | - Cheng-Chia Wu
- Department of Radiation Oncology, Columbia Irving University Medical Center, Manhattan, NY, USA
| | - Peter Canoll
- Department of Neurological Surgery, Columbia Irving University Medical Center, Manhattan, NY, USA.,Department of Pathology and Cell Biology, Columbia University Irving Medical Center, Manhattan, NY, USA
| | - Jeffrey N Bruce
- Department of Neurological Surgery, Columbia Irving University Medical Center, Manhattan, NY, USA
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Ahuja J, de Groot PM, Shroff GS, Strange CD, Vlahos I, Rajaram R, Truong MT, Wu CC. The postoperative chest in lung cancer. Clin Radiol 2021; 77:6-18. [PMID: 34154835 DOI: 10.1016/j.crad.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/05/2021] [Indexed: 12/17/2022]
Abstract
Most of the complications following lung cancer surgery occur in the early postoperative period and can result in significant morbidity and mortality. Delayed complications can also occur. Diagnosing these complications can be challenging because clinical manifestations are non-specific. Imaging plays an important role in detecting these complications in a timely manner and facilitates prompt interventions. Hence, it is important to have knowledge of the expected anatomical alterations following lung cancer surgeries, and the spectrum of post-surgical complications and their respective imaging findings to avoid misinterpretations or delay in diagnosis.
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Affiliation(s)
- J Ahuja
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - P M de Groot
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - G S Shroff
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C D Strange
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - I Vlahos
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - R Rajaram
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M T Truong
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C C Wu
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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33
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Wei HJ, Pouliopoulos A, Yoh N, Tazhibi M, McQuillan N, Zhang X, Szalontay L, Gartrell R, Pavisic J, Zhang Z, Feldstein N, Becher O, Zacharoulis S, Konofagou E, Wu CC. EPCT-23 PRE-CLINICAL STUDY OF FOCUSED ULTRASOUND-MEDIATED BLOOD-BRAIN BARRIER OPENING AND PANOBINOSTAT FOR DIFFUSE INTRINSIC PONTINE GLIOMA TREATMENT. Neuro Oncol 2021. [PMCID: PMC8168249 DOI: 10.1093/neuonc/noab090.209] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Diffuse intrinsic pontine glioma (DIPG) is the lethal high-grade brain tumor in children with no effective treatment options to date. Despite excessive clinical trials, the prognosis remains poor, with a median overall survival (mOS) of less than 1 year. Genomic studies of DIPG tissue have identified highly recurrent mutations in genes encoding histone H3 resulting in the substitution of lysine to methionine at position 27 (K27M), which is found in approximately 80% of DIPG. Recent drug screening studies identified the histone deacetylase (HDAC) inhibitors panobinostat as a highly effective drug against DIPG in vitro. However, due to the poor Blood-Brain Barrier (BBB) penetration of systemic administration, to enhance the delivery of panobinostat to improve treatment efficacy is needed. Focused ultrasound (FUS) has been shown to be able to safely and non-invasively open BBB to enhance drug delivery. Hence, in this study, we hypothesize that FUS-mediated BBBO (BBBO) can enhance the delivery of panobinostat for a therapeutic benefit in DIPG. Herein we established the syngeneic DIPG model by intracranially injecting mouse DIPG cells (PDGFB+, H3.3K27M, p53−/−) and used FUS and microbubbles to open BBB and enhance the panobinostat delivery. Magnetic resonance (MR) imaging was utilized to evaluate BBBO and tumor progression. We first demonstrated that FUS-mediated BBB-opening is safe and feasible to mice with DIPG tumors by MR imaging and passive cavitation detection. Moreover, this DIPG cell line is very sensitive to panobinostat in in vitro cytotoxicity assay. The combined treatment of FUS-mediated BBBO and panobinostat showed benefits in both local control and overall survival. The current results demonstrated FUS could increase the treatment efficacy of panobinostat to DIPG animals may be due to the increase of targeted delivery of systemic panobinostat to DIPG tumors in brainstem.
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Affiliation(s)
- Hong-Jian Wei
- Columbia University Medical Center, New York, NY, USA
| | | | - Nina Yoh
- Columbia University Medical Center, New York, NY, USA
| | | | | | - Xu Zhang
- Columbia University Medical Center, New York, NY, USA
| | | | | | | | - Zhiguo Zhang
- Columbia University Medical Center, New York, NY, USA
| | | | | | | | | | - Cheng-Chia Wu
- Columbia University Medical Center, New York, NY, USA
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34
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De Martino M, Padilla O, Daviaud C, Wu CC, Gartrell RD, Vanpouille-Box C. Exploiting Radiation Therapy to Restore Immune Reactivity of Glioblastoma. Front Oncol 2021; 11:671044. [PMID: 34094969 PMCID: PMC8173136 DOI: 10.3389/fonc.2021.671044] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/13/2021] [Indexed: 02/06/2023] Open
Abstract
Glioblastoma (GBM) is among the most aggressive of brain tumors and confers a dismal prognosis despite advances in surgical technique, radiation delivery methods, chemotherapy, and tumor-treating fields. While immunotherapy (IT) has improved the care of several adult cancers with previously dismal prognoses, monotherapy with IT in GBM has shown minimal response in first recurrence. Recent discoveries in lymphatics and evaluation of blood brain barrier offer insight to improve the use of ITs and determine the best combinations of therapies, including radiation. We highlight important features of the tumor immune microenvironment in GBM and potential for combining radiation and immunotherapy to improve prognosis in this devastating disease.
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Affiliation(s)
- Mara De Martino
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, United States
| | - Oscar Padilla
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, United States
| | - Camille Daviaud
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, United States
| | - Cheng-Chia Wu
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, United States.,Herbert Irving Comprehensive Cancer Center, New York, NY, United States
| | - Robyn D Gartrell
- Department of Pediatrics, Pediatric Hematology/Oncology/SCT, Columbia University Irving Medical Center, New York, NY, United States
| | - Claire Vanpouille-Box
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, United States.,Sandra and Edward Meyer Cancer Center, New York, NY, United States
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35
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Sperduto PW, Mesko S, Li J, Cagney D, Aizer A, Lin NU, Nesbit E, Kruser TJ, Chan J, Braunstein S, Lee J, Kirkpatrick JP, Breen W, Brown PD, Shi D, Shih HA, Soliman H, Sahgal A, Shanley R, Sperduto W, Lou E, Everett A, Boggs DH, Masucci L, Roberge D, Remick J, Plichta K, Buatti JM, Jain S, Gaspar LE, Wu CC, Wang TJC, Bryant J, Chuong M, Yu J, Chiang V, Nakano T, Aoyama H, Mehta MP. Estrogen/progesterone receptor and HER2 discordance between primary tumor and brain metastases in breast cancer and its effect on treatment and survival. Neuro Oncol 2021; 22:1359-1367. [PMID: 32034917 PMCID: PMC7523450 DOI: 10.1093/neuonc/noaa025] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Breast cancer treatment is based on estrogen receptors (ERs), progesterone receptors (PRs), and human epidermal growth factor receptor 2 (HER2). At the time of metastasis, receptor status can be discordant from that at initial diagnosis. The purpose of this study was to determine the incidence of discordance and its effect on survival and subsequent treatment in patients with breast cancer brain metastases (BCBM). METHODS A retrospective database of 316 patients who underwent craniotomy for BCBM between 2006 and 2017 was created. Discordance was considered present if the ER, PR, or HER2 status differed between the primary tumor and the BCBM. RESULTS The overall receptor discordance rate was 132/316 (42%), and the subtype discordance rate was 100/316 (32%). Hormone receptors (HR, either ER or PR) were gained in 40/160 (25%) patients with HR-negative primary tumors. HER2 was gained in 22/173 (13%) patients with HER2-negative primary tumors. Subsequent treatment was not adjusted for most patients who gained receptors-nonetheless, median survival (MS) improved but did not reach statistical significance (HR, 17-28 mo, P = 0.12; HER2, 15-19 mo, P = 0.39). MS for patients who lost receptors was worse (HR, 27-18 mo, P = 0.02; HER2, 30-18 mo, P = 0.08). CONCLUSIONS Receptor discordance between primary tumor and BCBM is common, adversely affects survival if receptors are lost, and represents a missed opportunity for use of effective treatments if receptors are gained. Receptor analysis of BCBM is indicated when clinically appropriate. Treatment should be adjusted accordingly. KEY POINTS 1. Receptor discordance alters subtype in 32% of BCBM patients.2. The frequency of receptor gain for HR and HER2 was 25% and 13%, respectively.3. If receptors are lost, survival suffers. If receptors are gained, consider targeted treatment.
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Affiliation(s)
- Paul W Sperduto
- Minneapolis Radiation Oncology and University of Minnesota Gamma Knife Center, Minneapolis, Minnesota, USA
| | - Shane Mesko
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jing Li
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Daniel Cagney
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Ayal Aizer
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Nancy U Lin
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Eric Nesbit
- Northwestern University, Chicago, Illinois, USA
| | | | - Jason Chan
- University of California San Francisco, San Francisco, California, USA
| | - Steve Braunstein
- University of California San Francisco, San Francisco, California, USA
| | - Jessica Lee
- Duke University, Durham, North Carolina, USA
| | | | | | | | - Diana Shi
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Helen A Shih
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hany Soliman
- Sunnybrook Odette Cancer Centre University of Toronto, Toronto, Canada
| | - Arjun Sahgal
- Sunnybrook Odette Cancer Centre University of Toronto, Toronto, Canada
| | - Ryan Shanley
- University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Emil Lou
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Ashlyn Everett
- University of Alabama Birmingham, Birmingham, Alabama, USA
| | | | - Laura Masucci
- Centre Hospitalier de l' Université de Montréal, Montreal, Canada
| | - David Roberge
- Centre Hospitalier de l' Université de Montréal, Montreal, Canada
| | - Jill Remick
- University of Maryland, Baltimore, Maryland, USA
| | | | | | - Supriya Jain
- University of Colorado Denver, Denver, Colorado, USA
| | | | | | | | | | | | - James Yu
- Yale University, New Haven, Connecticut, USA
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36
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Holt DE, Hiniker SM, Kalapurakal JA, Breneman JC, Shiao JC, Boik N, Cooper BT, Dorn PL, Hall MD, Logie N, Lucas JT, MacEwan IJ, Olson AC, Palmer JD, Patel S, Pater LE, Surgener S, Tsang DS, Vogel JH, Wojcik A, Wu CC, Milgrom SA. Improving the Pediatric Patient Experience During Radiation Therapy-A Children's Oncology Group Study. Int J Radiat Oncol Biol Phys 2021; 109:505-514. [PMID: 32931864 PMCID: PMC9092316 DOI: 10.1016/j.ijrobp.2020.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 06/19/2020] [Revised: 08/25/2020] [Accepted: 09/01/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Treatment with radiation therapy (RT) can cause anxiety and distress for pediatric patients and their families. Radiation oncology teams have developed strategies to reduce the negative psychological impact. This survey study aimed to characterize these methods. METHODS AND MATERIALS A 37-item questionnaire was sent to all radiation oncology members of the Children's Oncology Group to explore strategies to improve the pediatric patient experience. The Wilcoxon rank-sum test was used to assess factors associated with use of anesthesia for older children. RESULTS Surveys were completed by 106 individuals from 84/210 institutions (40%). Respondents included 89 radiation oncologists and 17 supportive staff. Sixty-one percent of centers treated ≤50 children per year. Respondents described heterogenous interventions. The median age at which most children no longer required anesthesia was 6 years (range: ≤3 years to ≥8 years). Routine anesthesia use at an older age was associated with physicians' lack of awareness of these strategies (P = .04) and <10 years of pediatric radiation oncology experience (P = .04). Fifty-two percent of respondents reported anesthesia use added >45 minutes in the radiation oncology department daily. Twenty-six percent of respondents planned to implement new strategies, with 65% focusing on video-based distraction therapy and/or augmented reality/virtual reality. CONCLUSIONS Many strategies are used to improve children's experience during RT. Lack of awareness of these interventions is a barrier to their implementation and is associated with increased anesthesia use. This study aims to disseminate these methods with the goal of raising awareness, facilitating implementation, and, ultimately, improving the experience of pediatric cancer patients and their caregivers.
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Affiliation(s)
- Douglas E Holt
- Department of Radiation Oncology, University of Colorado, Aurora, Colorado.
| | - Susan M Hiniker
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - John A Kalapurakal
- Department of Radiation Oncology, Northwestern University, Chicago, Illinois
| | - John C Breneman
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio
| | - Jay C Shiao
- Department of Radiation Oncology, University of Colorado, Aurora, Colorado
| | - Nicole Boik
- Department of Radiation Oncology, Miami Cancer Institute, Miami, Florida
| | - Benjamin T Cooper
- Department of Radiation Oncology, NYU Langone Health, New York City, New York
| | - Paige L Dorn
- Department of Radiation Oncology, Rocky Mountain Hospital for Children, Denver, Colorado
| | - Matthew D Hall
- Department of Radiation Oncology, Miami Cancer Institute, Miami, Florida
| | - Natalie Logie
- Department of Radiation Oncology, University of Calgary, Calgary, Alberta, Canada
| | - John T Lucas
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Iain J MacEwan
- Department of Radiation Oncology, University of California San Diego, La Jolla, California
| | - Adam C Olson
- Department of Radiation Oncology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Joshua D Palmer
- Department of Radiation Oncology, Ohio State University, Columbus, Ohio
| | - Samir Patel
- Division of Radiation Oncology, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Luke E Pater
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio
| | - Stephanie Surgener
- Department of Oncology, Children's Hospital of Colorado, Aurora, Colorado
| | - Derek S Tsang
- Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Jennifer H Vogel
- Department of Radiation Oncology Johns Hopkins University Medical Center, Baltimore, Maryland
| | - Alyssa Wojcik
- Department of Oncology, Children's Hospital of Colorado, Aurora, Colorado
| | - Cheng-Chia Wu
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York City, New York
| | - Sarah A Milgrom
- Department of Radiation Oncology, University of Colorado, Aurora, Colorado
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37
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Wei HJ, Upadhyayula PS, Pouliopoulos AN, Englander ZK, Zhang X, Jan CI, Guo J, Mela A, Zhang Z, Wang TJC, Bruce JN, Canoll PD, Feldstein NA, Zacharoulis S, Konofagou EE, Wu CC. Focused Ultrasound-Mediated Blood-Brain Barrier Opening Increases Delivery and Efficacy of Etoposide for Glioblastoma Treatment. Int J Radiat Oncol Biol Phys 2020; 110:539-550. [PMID: 33346092 DOI: 10.1016/j.ijrobp.2020.12.019] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/22/2020] [Accepted: 12/13/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Glioblastoma (GBM) is a devastating disease. With the current treatment of surgery followed by chemoradiation, outcomes remain poor, with median survival of only 15 months and a 5-year survival rate of 6.8%. A challenge in treating GBM is the heterogeneous integrity of the blood-brain barrier (BBB), which limits the bioavailability of systemic therapies to the brain. There is a growing interest in enhancing drug delivery by opening the BBB with the use of focused ultrasound (FUS). We hypothesize that an FUS-mediated BBB opening can enhance the delivery of etoposide for a therapeutic benefit in GBM. METHODS AND MATERIALS A murine glioma cell line (Pdgf+, Pten-/-, P53-/-) was orthotopically injected into B6(Cg)-Tyrc-2J/J mice to establish the syngeneic GBM model for this study. Animals were treated with FUS and microbubbles to open the BBB to enhance the delivery of systemic etoposide. Magnetic resonance (MR) imaging was used to evaluate the BBB opening and tumor progression. Liquid chromatography tandem mass spectrometry was used to measure etoposide concentrations in the intracranial tumors. RESULTS The murine glioma cell line is sensitive to etoposide in vitro. MR imaging and passive cavitation detection demonstrate the safe and successful BBB opening with FUS. The combined treatment of an FUS-mediated BBB opening and etoposide decreased tumor growth by 45% and prolonged median overall survival by 6 days: an approximately 30% increase. The FUS-mediated BBB opening increased the brain tumor-to-serum ratio of etoposide by 3.5-fold and increased the etoposide concentration in brain tumor tissue by 8-fold compared with treatment without ultrasound. CONCLUSIONS The current study demonstrates that BBB opening with FUS increases intratumoral delivery of etoposide in the brain, resulting in local control and overall survival benefits.
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Affiliation(s)
- Hong-Jian Wei
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
| | - Pavan S Upadhyayula
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, New York
| | | | - Zachary K Englander
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, New York
| | - Xu Zhang
- Institute for Cancer Genetics, Columbia University Irving Medical Center, New York, New York; Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Chia-Ing Jan
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York; Division of Molecular Pathology, Department of Pathology, China Medical University and Hospital, Taichung, Taiwan; Department of Medicine, China Medical University, Taichung, Taiwan; Translational Cell Therapy Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Jia Guo
- Department of Psychiatry, Columbia University, New York, New York
| | - Angeliki Mela
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York
| | - Zhiguo Zhang
- Institute for Cancer Genetics, Columbia University Irving Medical Center, New York, New York; Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Tony J C Wang
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York; Department of Neurological Surgery, Columbia University Irving Medical Center, New York, New York; Herbert Irving Comprehensive Cancer Center, New York, New York
| | - Jeffrey N Bruce
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, New York; Herbert Irving Comprehensive Cancer Center, New York, New York
| | - Peter D Canoll
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York; Herbert Irving Comprehensive Cancer Center, New York, New York
| | - Neil A Feldstein
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, New York
| | - Stergios Zacharoulis
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Elisa E Konofagou
- Department of Biomedical Engineering, Columbia University, New York, New York
| | - Cheng-Chia Wu
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York; Herbert Irving Comprehensive Cancer Center, New York, New York.
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38
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Campbell AA, Silverman AM, Moisander-Joyce H, Wu CC, Mansukhani M, Zanazzi G, Turk A, Canoll PD, Garvin JH, Kazim M, Gartrell-Corrado RD. LGG-22. EVALUATION OF IMMUNE AND GENOMIC CHARACTERISTICS IN PEDIATRIC OPTIC NERVE GLIOMA (ONG). Neuro Oncol 2020. [PMCID: PMC7715187 DOI: 10.1093/neuonc/noaa222.404] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Pediatric optic nerve glioma (ONG) is a rare, sight-threatening tumor. We previously reported clinical, radiologic, histopathologic, and molecular characteristics of pediatric ONG patients treated at Columbia University Medical Center between 2000–2017. Here we evaluate this cohort and one additional patient using quantitative multiple immunofluorescence (qmIF) and next generation sequencing (NGS) using the Columbia Combined Cancer Panel (CCCP). For qmIF, 4 micron immuno-blank slides were stained for CD3, CD8, CD68, CD163, HLA-DR, and Olig2. QmIF images were analyzed and data were processed in R studio and compared based on tumor mutation and treatment history. QmIF failed in 1 case and CCCP failed in 2 cases. CCCP confirmed KIAA1549:BRAF fusions in 2 patients, identified NF1 in 2 patients, and demonstrated both a KIAA1549:BRAF fusion and SETD2 mutation in the added case. Qualitative analysis showed immune infiltrate across cases included macrophages (CD68+, 1.6–6.5% of all cells) and T cells (CD3+, 0.4% to 1.5%). Non-cytotoxic T cells (CD3+CD8-) comprised 60.7–100% of the T cell compartment. There was no difference when comparing mutation groups. However, patients who previously received radiation had increased CD3+, specifically CD3+CD8- cells compared to non-irradiated patients (p=0.01 and p<0.01, respectively) while CD3+CD8+ and CD68+ cells were not different between groups (p=0.49 and p=0.27, respectively). In summary, qmIF analysis showed increased tumor infiltration by non-cytotoxic T cells in previously irradiated pediatric ONG patients compared to non-irradiated patients, while there was no difference in macrophages of cytotoxic T cells. This type of analysis may be useful in designing immunotherapeutic strategies for pediatric ONG.
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Affiliation(s)
- Ashley A Campbell
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Columbia University Irving Medical Center, Department of Ophthalmology, New York, NY, USA
| | - Andrew M Silverman
- Columbia University Irving Medical Center, Department of Pediatrics, New York, NY, USA
| | - Hanna Moisander-Joyce
- Columbia University Irving Medical Center, Department of Pediatrics, New York, NY, USA
| | - Cheng-Chia Wu
- Columbia University Irving Medical Center, Department of Radiation, New York, NY, USA
| | - Mahesh Mansukhani
- Columbia University Irving Medical Center, Department of Pathology, New York, NY, USA
| | - George Zanazzi
- Columbia University Irving Medical Center, Department of Pathology, New York, NY, USA
| | - Andrew Turk
- Columbia University Irving Medical Center, Department of Pathology, New York, NY, USA
| | - Peter D Canoll
- Columbia University Irving Medical Center, Department of Pathology, New York, NY, USA
| | - James H Garvin
- Columbia University Irving Medical Center, Department of Pediatrics, New York, NY, USA
| | - Michael Kazim
- Columbia University Irving Medical Center, Department of Ophthalmology, New York, NY, USA
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39
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Englander Z, Wei HJ, Pouliopoulos A, Upadhyayula P, Jan CI, Spinazzi E, Canoll P, Bruce J, Feldstein N, Zacharoulis S, Konofagou E, Wu CC. DDEL-13. FOCUSED ULTRASOUND MEDIATED BLOOD BRAIN BARRIER DISRUPTION IN A MURINE MODEL OF PONTINE GLIOMA: A SAFETY AND FEASIBILITY STUDY. Neuro Oncol 2020. [PMCID: PMC7715592 DOI: 10.1093/neuonc/noaa222.048] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Drug delivery remains a major obstacle in DIPG, as the blood brain barrier (BBB) limits the penetration of systemic therapies to the brainstem. Focused ultrasound (FUS) is an exciting new technology that, when combined with microbubbles, can open the BBB permitting the entry of drugs across the cerebrovasculature. Given that the utility of FUS in brainstem tumors remains unknown, the purpose of our study was to determine the safety and feasibility of this technique in a murine pontine glioma model.
METHODS
A syngeneic orthotopic model was established by stereotactic injection of PDGF-B+PTEN-/-p53-/- murine glioma cells (10,000/1ul) into the pons of B6 albino mice. A single-element, spherical-segment FUS transducer (center frequency=1.5MHz) driven by a function generator through a power amplifier (acoustic pressure=0.7MPa) was used with concurrent intravenous microbubble injection (FUS+MB) to sonicate the tumor on post-injection day 14. BBB opening was confirmed with gadolinium-enhanced MRI and Evans blue. Kondziela inverted screen (KIS) testing was completed to measure motor function. Mice were either immediately sacrificed for histopathological assessment or serially monitored for survival.
RESULTS
In mice treated with FUS (n=11), there was no measured deficit in KIS testing. Additionally, the degree of intra-tumoral hemorrhage and inflammation on H&E in control (n=5) and treated mice (n=5) was similar. Lastly, there was no difference in survival between the groups (control, n=6, median=26 days; FUS, n=6, median=25 days, p>0.05).
CONCLUSION
FUS+MB is a safe and feasible technique to open the BBB in a preclinical pontine glioma model.
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Affiliation(s)
- Zachary Englander
- Department of Neurosurgery, Columbia University Medical Center, New York, NY, USA
| | - Hong-Jian Wei
- Department of Radiation Oncology, Columbia University Medical Center, New York, NY, USA
| | | | - Pavan Upadhyayula
- Department of Neurosurgery, Columbia University Medical Center, New York, NY, USA
| | - Chia-Ing Jan
- Department of Pathology, Columbia University Medical Center, New York, NY, USA
| | - Eleonora Spinazzi
- Department of Neurosurgery, Columbia University Medical Center, New York, NY, USA
| | - Peter Canoll
- Department of Pathology, Columbia University Medical Center, New York, NY, USA
| | - Jeffrey Bruce
- Department of Neurosurgery, Columbia University Medical Center, New York, NY, USA
| | - Neil Feldstein
- Department of Neurosurgery, Columbia University Medical Center, New York, NY, USA
| | | | - Elisa Konofagou
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Cheng-Chia Wu
- Department of Radiation Oncology, Columbia University Medical Center, New York, NY, USA
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40
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Sperduto PW, Mesko S, Li J, Cagney D, Aizer A, Lin NU, Nesbit E, Kruser TJ, Chan J, Braunstein S, Lee J, Kirkpatrick JP, Breen W, Brown PD, Shi D, Shih HA, Soliman H, Sahgal A, Shanley R, Sperduto WA, Lou E, Everett A, Boggs DH, Masucci L, Roberge D, Remick J, Plichta K, Buatti JM, Jain S, Gaspar LE, Wu CC, Wang TJ, Bryant J, Chuong M, An Y, Chiang V, Nakano T, Aoyama H, Mehta MP. Survival in Patients With Brain Metastases: Summary Report on the Updated Diagnosis-Specific Graded Prognostic Assessment and Definition of the Eligibility Quotient. J Clin Oncol 2020; 38:3773-3784. [PMID: 32931399 PMCID: PMC7655019 DOI: 10.1200/jco.20.01255] [Citation(s) in RCA: 191] [Impact Index Per Article: 47.8] [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] [Accepted: 08/15/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Conventional wisdom has rendered patients with brain metastases ineligible for clinical trials for fear that poor survival could mask the benefit of otherwise promising treatments. Our group previously published the diagnosis-specific Graded Prognostic Assessment (GPA). Updates with larger contemporary cohorts using molecular markers and newly identified prognostic factors have been published. The purposes of this work are to present all the updated indices in a single report to guide treatment choice, stratify research, and define an eligibility quotient to expand eligibility. METHODS A multi-institutional database of 6,984 patients with newly diagnosed brain metastases underwent multivariable analyses of prognostic factors and treatments associated with survival for each primary site. Significant factors were used to define the updated GPA. GPAs of 4.0 and 0.0 correlate with the best and worst prognoses, respectively. RESULTS Significant prognostic factors varied by diagnosis and new prognostic factors were identified. Those factors were incorporated into the updated GPA with robust separation (P < .01) between subgroups. Survival has improved, but varies widely by GPA for patients with non-small-cell lung, breast, melanoma, GI, and renal cancer with brain metastases from 7-47 months, 3-36 months, 5-34 months, 3-17 months, and 4-35 months, respectively. CONCLUSION Median survival varies widely and our ability to estimate survival for patients with brain metastases has improved. The updated GPA (available free at brainmetgpa.com) provides an accurate tool with which to estimate survival, individualize treatment, and stratify clinical trials. Instead of excluding patients with brain metastases, enrollment should be encouraged and those trials should be stratified by the GPA to ensure those trials make appropriate comparisons. Furthermore, we recommend the expansion of eligibility to allow for the enrollment of patients with previously treated brain metastases who have a 50% or greater probability of an additional year of survival (eligibility quotient > 0.50).
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Affiliation(s)
- Paul W. Sperduto
- Minneapolis Radiation Oncology and University of Minnesota Gamma Knife Center, Minneapolis, MN
| | | | - Jing Li
- MD Anderson Cancer Center, Houston, TX
| | | | - Ayal Aizer
- Dana-Farber Cancer Institute, Boston, MA
| | | | | | | | - Jason Chan
- University of California, San Francisco, San Francisco, CA
| | | | | | | | | | | | - Diana Shi
- Massachusetts General Hospital, Boston, MA
| | | | - Hany Soliman
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Emil Lou
- University of Minnesota, Minneapolis, MN
| | | | | | - Laura Masucci
- Centre Hospitalier de l'Université de Montreal, Montreal, Quebec, Canada
| | - David Roberge
- Centre Hospitalier de l'Université de Montreal, Montreal, Quebec, Canada
| | | | | | | | | | | | | | | | | | | | - Yi An
- Yale University, New Haven, CT
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Nanda T, Sanchez A, Purswani J, Wu CC, Kazim M, Wang TJC. Contour Variability in Thyroid Eye Disease with Compressive Optic Neuropathy Treated with Radiation Therapy. Adv Radiat Oncol 2020; 5:804-808. [PMID: 33089016 PMCID: PMC7560569 DOI: 10.1016/j.adro.2020.02.005] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 02/11/2020] [Indexed: 12/03/2022] Open
Abstract
Purpose Few studies have evaluated the methodology by which radiation therapy (RT) for thyroid eye disease and compressive optic neuropathy is performed. The objective of this study was to retrospectively review our experience from a radiation planning standpoint and to determine whether current treatment methods provide adequate dose to target and collateral structures. Methods A retrospective review of 52 patients (104 orbits) with bilateral thyroid eye disease and compressive optic neuropathy treated with RT (20 Gy in 10 fractions) at our institution. RT plans were analyzed for target volumes and doses. Visual fields, color plates, and visual acuity were assessed pretreatment and at last available follow-up post RT. A standardized, anatomic contour of the retro-orbital space was applied to these retrospective plans to determine dose to the entire space, rather than the self-selected target structure. Results Compared with the anatomic retro-orbital space, the original contour overlapped by only 68%. Maximum and mean dose was 2134 cGy and 1910 cGy to the anatomic retro-orbital space. Consequently, 39.8% of the orbits had a mean dose <19 Gy (<17 Gy 16.4%, <18 Gy 27.6% <19 Gy 37.8%, <20 Gy 59.2%, 20-21 Gy 35.8%, >21 Gy 5%). There was no significant association of improvement in color plates (P = .07), visual fields (P = .77), and visual acuity (P = .62), based on these dose differences. When beam placement was retrospectively adjusted to include a space of 0.5 cm between the lens and the anterior beam edge, there was a 39.4% and 20.3% decrease in max and mean dose to the lens. Conclusions Without a standardized protocol for contouring in thyroid eye disease, target delineation was found to be rather varied, even among the same practitioner. Differences in dose to the anatomic retro-orbital space did not affect outcomes in the follow-up period. Although precise contouring of the retro-orbital space may be of little clinical consequence overall, a >0.5 cm space from the lens may significantly reduce or delay cataractogenesis.
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Affiliation(s)
- Tavish Nanda
- Columbia University Irving Medical Center Harkness Eye Institute, New York, New York
| | - Andrew Sanchez
- Columbia University College of Physicians and Surgeons, New York, New York
| | - Juhi Purswani
- Department of Radiation Oncology, New York University, New York, New York
| | - Cheng-Chia Wu
- Department of Radiation Oncology, Columbia University Medical Center, New York, New York
| | - Michael Kazim
- Columbia University Irving Medical Center Harkness Eye Institute, New York, New York.,Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Tony J C Wang
- Department of Radiation Oncology, Columbia University Medical Center, New York, New York
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42
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Yanagihara TK, McFaline-Figueroa JR, Giacalone NJ, Lee AW, Soni V, Hwang ME, Hsieh KT, Saraf A, Wu CC, Yang D, Wen PY, Ashamalla H, Aizer AA, Wang TJC, Huang RY. A low percentage of metastases in deep brain and temporal lobe structures. Neuro Oncol 2020; 21:640-647. [PMID: 30715520 DOI: 10.1093/neuonc/noz023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 11/14/2022] Open
Abstract
BACKGROUND Whole-brain radiotherapy (WBRT) in patients with brain metastases (BM) is associated with neurocognitive decline. Given its crucial role in learning and memory, efforts to mitigate this toxicity have mostly focused on sparing radiation to the hippocampus. We hypothesized that BM are not evenly distributed across the brain and that several additional areas may be avoided in WBRT based on a low risk of developing BM. METHODS We contoured 2757 lesions in a large, single-institution database of patients with newly diagnosed BM. BM centroids were mapped onto a standard brain atlas of 55 anatomic subunits and the observed percentage of BM was compared with what would be expected based on that region's volume. A region of interest (ROI) analysis was performed in a validation cohort of patients from 2 independent institutions using equivalence and one-sample hypothesis tests. RESULTS The brainstem and bilateral thalami, hippocampi, parahippocampal gyri, amygdala, and temporal poles had a cumulative risk of harboring a BM centroid of 4.83% in the initial cohort. This ROI was tested in 157 patients from the validation cohort and was found to have a 4.1% risk of developing BM, which was statistically equivalent between the 2 groups (P < 1 × 10-6, upper bound). CONCLUSION Several critical brain structures are at a low risk of developing BM. A risk-adapted approach to WBRT is worthy of further investigation and may mitigate the toxicities of conventional radiation.
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Affiliation(s)
- Ted K Yanagihara
- Department of Radiation Oncology, Weill Cornell Medical College, New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, New York
| | - J Ricardo McFaline-Figueroa
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Nicholas J Giacalone
- Department of Radiation Oncology, Kaiser Permanente Oakland Medical Center, Oakland, California
| | - Albert W Lee
- State University of New York Downstate Medical Center, Brooklyn, New York
| | - Vikram Soni
- Department of Radiation Oncology, New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, New York
| | - Mark E Hwang
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
| | - Kristin T Hsieh
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Anurag Saraf
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
| | - Cheng-Chia Wu
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
| | - Daniel Yang
- Department of Radiology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Hani Ashamalla
- Department of Radiation Oncology, New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, New York
| | - Ayal A Aizer
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Tony J C Wang
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
| | - Raymond Y Huang
- Department of Radiation Oncology, Weill Cornell Medical College, New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, New York.,Department of Radiology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
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43
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Sperduto PW, Mesko S, Li J, Cagney D, Aizer A, Lin NU, Nesbit E, Kruser TJ, Chan J, Braunstein S, Lee J, Kirkpatrick JP, Breen W, Brown PD, Shi D, Shih HA, Soliman H, Sahgal A, Shanley R, Sperduto W, Lou E, Everett A, Boggs DH, Masucci L, Roberge D, Remick J, Plichta K, Buatti JM, Jain S, Gaspar LE, Wu CC, Wang TJC, Bryant J, Chuong M, Yu J, Chiang V, Nakano T, Aoyama H, Mehta MP. Beyond an Updated Graded Prognostic Assessment (Breast GPA): A Prognostic Index and Trends in Treatment and Survival in Breast Cancer Brain Metastases From 1985 to Today. Int J Radiat Oncol Biol Phys 2020; 107:334-343. [PMID: 32084525 PMCID: PMC7276246 DOI: 10.1016/j.ijrobp.2020.01.051] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [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: 10/25/2019] [Revised: 01/28/2020] [Accepted: 01/31/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Brain metastases are a common sequelae of breast cancer. Survival varies widely based on diagnosis-specific prognostic factors (PF). We previously published a prognostic index (Graded Prognostic Assessment [GPA]) for patients with breast cancer with brain metastases (BCBM), based on cohort A (1985-2007, n = 642), then updated it, reporting the effect of tumor subtype in cohort B (1993-2010, n = 400). The purpose of this study is to update the Breast GPA with a larger contemporary cohort (C) and compare treatment and survival across the 3 cohorts. METHODS AND MATERIALS A multi-institutional (19), multinational (3), retrospective database of 2473 patients with breast cancer with newly diagnosed brain metastases (BCBM) diagnosed from January 1, 2006, to December 31, 2017, was created and compared with prior cohorts. Associations of PF and treatment with survival were analyzed. Kaplan-Meier survival estimates were compared with log-rank tests. PF were weighted and the Breast GPA was updated such that a GPA of 0 and 4.0 correlate with the worst and best prognoses, respectively. RESULTS Median survival (MS) for cohorts A, B, and C improved over time (from 11, to 14 to 16 months, respectively; P < .01), despite the subtype distribution becoming less favorable. PF significant for survival were tumor subtype, Karnofsky Performance Status, age, number of BCBMs, and extracranial metastases (all P < .01). MS for GPA 0 to 1.0, 1.5-2.0, 2.5-3.0, and 3.5-4.0 was 6, 13, 24, and 36 months, respectively. Between cohorts B and C, the proportion of human epidermal receptor 2 + subtype decreased from 31% to 18% (P < .01) and MS in this subtype increased from 18 to 25 months (P < .01). CONCLUSIONS MS has improved modestly but varies widely by diagnosis-specific PF. New PF are identified and incorporated into an updated Breast GPA (free online calculator available at brainmetgpa.com). The Breast GPA facilitates clinical decision-making and will be useful for stratification of future clinical trials. Furthermore, these data suggest human epidermal receptor 2-targeted therapies improve clinical outcomes in some patients with BCBM.
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Affiliation(s)
- Paul W Sperduto
- Minneapolis Radiation Oncology & University of Minnesota Gamma Knife Center, Minneapolis, Minnesota.
| | | | - Jing Li
- MD Anderson Cancer Center, Houston, Texas
| | | | - Ayal Aizer
- Dana Farber Cancer Institute, Boston, Massachusetts
| | - Nancy U Lin
- Dana Farber Cancer Institute, Boston, Massachusetts
| | | | | | - Jason Chan
- University of California San Francisco, San Francisco, California
| | - Steve Braunstein
- University of California San Francisco, San Francisco, California
| | | | | | | | | | - Diana Shi
- Massachusetts General Hospital, Massachusetts, Boston, Massachusetts
| | - Helen A Shih
- Massachusetts General Hospital, Massachusetts, Boston, Massachusetts
| | - Hany Soliman
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada
| | - Arjun Sahgal
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada
| | | | | | - Emil Lou
- University of Minnesota, Minneapolis, Minnesota
| | | | | | - Laura Masucci
- Centre Hospitalier de l' Université de Montréal, Montreal, Quebec, Canada
| | - David Roberge
- Centre Hospitalier de l' Université de Montréal, Montreal, Quebec, Canada
| | | | | | | | | | | | | | | | | | | | - James Yu
- Yale University, New Haven, Connecticut
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44
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Wang S, Wu CC, Zhang H, Karakatsani ME, Wang YF, Han Y, Chaudhary KR, Wuu CS, Konofagou E, Cheng SK. Focused ultrasound induced-blood-brain barrier opening in mouse brain receiving radiosurgery dose of radiation enhances local delivery of systemic therapy. Br J Radiol 2020; 93:20190214. [PMID: 31999201 DOI: 10.1259/bjr.20190214] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Investigate the temporal effects of focused ultrasound (FUS)-induced blood-brain barrier (BBB) opening in post-radiotherapy mouse brains. METHODS AND MATERIALS C57B6 mice without tumors were used to simulate the scenario after gross total resection (GTR) of brain tumor. Radiation dose of 6 Gy x 5 was delivered to one-hemisphere of the mouse brain. FUS-induced BBB-opening was delivered to the irradiated and non-irradiated brain and was confirmed with MRI. Dynamic MRI was performed to evaluate blood vessel permeability. Two time points were selected: acute (2 days after radiation) and chronic (31 days after radiation). RESULTS BBB opening was achieved after FUS in the irradiated field as compared to the contralateral non-irradiated brain without any decrease in permeability. In the acute group, a trend for higher gadolinium concentration was observed in radiated field. CONCLUSION Localized BBB-opening can be successfully achieved without loss of efficacy by FUS as early as 2 days after radiotherapy. ADVANCES IN KNOWLEDGE Adjuvant radiation after GTR is commonly used for brain tumors. Focused ultrasound facilitated BBB-opening can be achieved without loss of efficacy in the post-irradiated brain as early as 2 days after radiation therapy. This allows for further studies on early application of FUS-mediated BBB-opening.
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Affiliation(s)
- Shutao Wang
- Icahn School of Medicine at Mount Sinai, New York, USA.,Department of Radiation Oncology, Columbia University Medical Center, New York, USA
| | - Cheng-Chia Wu
- Department of Radiation Oncology, Columbia University Medical Center, New York, USA
| | - Hairong Zhang
- Department of Biomedical Engineering, Columbia University, New York, USA
| | | | - Yi-Fang Wang
- Department of Radiation Oncology, Columbia University Medical Center, New York, USA
| | - Yang Han
- Department of Biomedical Engineering, Columbia University, New York, USA
| | - Kunal R Chaudhary
- Department of Radiation Oncology, Columbia University Medical Center, New York, USA
| | - Cheng-Shie Wuu
- Department of Radiation Oncology, Columbia University Medical Center, New York, USA
| | - Elisa Konofagou
- Department of Biomedical Engineering, Columbia University, New York, USA
| | - Simon K Cheng
- Department of Radiation Oncology, Columbia University Medical Center, New York, USA
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45
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Mitchell KG, Nelson DB, Corsini EM, Vaporciyan AA, Antonoff MB, Mehran RJ, Rice DC, Roth JA, Sepesi B, Walsh GL, Bhutani MS, Maru DM, Wu CC, Nguyen QN, Ajani JA, Swisher SG, Hofstetter WL. Morbidity following salvage esophagectomy for squamous cell carcinoma: the MD Anderson experience. Dis Esophagus 2020; 33:5532833. [PMID: 31313820 DOI: 10.1093/dote/doz067] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/05/2019] [Accepted: 06/25/2019] [Indexed: 12/11/2022]
Abstract
The survival advantage associated with the addition of surgical therapy in esophageal squamous cell carcinoma (ESCC) patients who demonstrate a complete clinical response to chemoradiotherapy is unclear, and many institutions have adopted an organ-preserving strategy of selective surgery in this population. We sought to characterize our institutional experience of salvage esophagectomy (for failure of definitive bimodality therapy) and planned esophagectomy (as a component of trimodality therapy) by retrospectively analyzing patients with ESCC of the thoracic esophagus and GEJ who underwent esophagectomy following chemoradiotherapy between 2004 and 2016. Of 76 patients who met inclusion criteria, 46.1% (35) underwent salvage esophagectomy. Major postoperative complications (major cardiovascular and pulmonary events, anastomotic leak [grade ≥ 2], and 90-day mortality) were frequent and occurred in 52.6% of the cohort (planned resection: 36.6% [15/41]; salvage esophagectomy: 71.4% [25/35]). Observed rates of 30- and 90-day mortality for the entire cohort were 7.9% (planned: 7.3% [3/41]; salvage: 8.6% [3/35]) and 13.2% (planned: 9.8% [4/41]; salvage: 17.1% [6/35]), respectively. In summary, esophagectomy following chemoradiotherapy for ESCC at our institution has been associated with frequent postoperative morbidity and considerable rates of mortality in both planned and salvage settings. Although a selective approach to surgery may permit organ preservation in many patients with ESCC, these results highlight that salvage esophagectomy for failure of definitive-intent treatment of ESCC may also constitute a difficult clinical undertaking in some cases.
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Affiliation(s)
- K G Mitchell
- Department of Thoracic and Cardiovascular Surgery
| | - D B Nelson
- Department of Thoracic and Cardiovascular Surgery
| | - E M Corsini
- Department of Thoracic and Cardiovascular Surgery
| | | | - M B Antonoff
- Department of Thoracic and Cardiovascular Surgery
| | - R J Mehran
- Department of Thoracic and Cardiovascular Surgery
| | - D C Rice
- Department of Thoracic and Cardiovascular Surgery
| | - J A Roth
- Department of Thoracic and Cardiovascular Surgery
| | - B Sepesi
- Department of Thoracic and Cardiovascular Surgery
| | - G L Walsh
- Department of Thoracic and Cardiovascular Surgery
| | - M S Bhutani
- Department of Gastroenterology Hepatology and Nutrition
| | | | - C C Wu
- Department of Diagnostic Radiology
| | | | - J A Ajani
- Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - S G Swisher
- Department of Thoracic and Cardiovascular Surgery
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Ivanov VN, Grabham PW, Wu CC, Hei TK. Inhibition of autophagic flux differently modulates cannabidiol-induced death in 2D and 3D glioblastoma cell cultures. Sci Rep 2020; 10:2687. [PMID: 32060308 PMCID: PMC7021896 DOI: 10.1038/s41598-020-59468-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 07/29/2019] [Accepted: 12/19/2019] [Indexed: 02/06/2023] Open
Abstract
Radiotherapy combined with chemotherapy is the major treatment modality for human glioblastoma multiforme (GBM). GBMs eventually relapse after treatment and the average survival of GBM patients is less than two years. There is some evidence that cannabidiol (CBD) can induce cell death and increases the radiosensitivity of GBM by enhancing apoptosis. Beside initiation of death, CBD has been demonstrated as an inducer of autophagy. In the present study, we address the question whether CBD simultaneously induces a protective effect in GBM by upregulating autophagy. Addition of chloroquine that suppressed autophagic flux to 2D GBM cultures increased CBD-induced cell death, presenting proof for the protective autophagy. Blockage of autophagy upregulated radiation-induced cytotoxicity but only modestly affected the levels of cell death in CBD- or CBD/γ-irradiated 3D GBM cultures. Furthermore, CBD enhanced the pro-apoptotic activities of JNK1/2 and MAPK p38 signaling cascades while partially downregulated the pro-survival PI3K-AKT cascade, thereby changing a balance between cell death and survival. Suppression of JNK activation partially reduced CBD-induced cell death in 3D GBM cultures. In contrast, co-treatment of CBD-targeted cells with inhibitors of PI3K-AKT-NF-κB, IKK-NF-κB or JAK2-STAT3 pathways killed surviving GBM cells in both 2D and 3D cultures, potentially improving the therapeutic ratio of GBM.
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Affiliation(s)
- Vladimir N Ivanov
- Center for Radiological Research, Department of Radiation Oncology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA.
| | - Peter W Grabham
- Center for Radiological Research, Department of Radiation Oncology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Cheng-Chia Wu
- Center for Radiological Research, Department of Radiation Oncology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Tom K Hei
- Center for Radiological Research, Department of Radiation Oncology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
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Smith DR, Saadatmand HJ, Wu CC, Black PJ, Wuu YR, Lesser J, Horan M, Isaacson SR, Wang TJC, Sisti MB. Treatment Outcomes and Dose Rate Effects Following Gamma Knife Stereotactic Radiosurgery for Vestibular Schwannomas. Neurosurgery 2019; 85:E1084-E1094. [PMID: 31270543 PMCID: PMC6855984 DOI: 10.1093/neuros/nyz229] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 03/08/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Gamma Knife radiosurgery (GKRS; Elekta AB) remains a well-established treatment modality for vestibular schwannomas. Despite highly effective tumor control, further research is needed toward optimizing long-term functional outcomes. Whereas dose-rate effects may impact post-treatment toxicities given tissue dose-response relationships, potential effects remain largely unexplored. OBJECTIVE To evaluate treatment outcomes and potential dose-rate effects following definitive GKRS for vestibular schwannomas. METHODS We retrospectively reviewed 419 patients treated at our institution between 1998 and 2015, characterizing baseline demographics, pretreatment symptoms, and GKRS parameters. The cohort was divided into 2 dose-rate groups based on the median value (2.675 Gy/min). Outcomes included clinical tumor control, radiographic progression-free survival, serviceable hearing preservation, hearing loss, and facial nerve dysfunction (FND). Prognostic factors were assessed using Cox regression. RESULTS The study cohort included 227 patients with available follow-up. Following GKRS 2-yr and 4-yr clinical tumor control rates were 98% (95% CI: 95.6%-100%) and 96% (95% CI: 91.4%-99.6%), respectively. Among 177 patients with available radiographic follow-up, 2-yr and 4-yr radiographic progression-free survival rates were 97% (95% CI: 94.0%-100.0%) and 88% (95% CI: 81.2%-95.0%). The serviceable hearing preservation rate was 72.2% among patients with baseline Gardner-Robertson class I/II hearing and post-treatment audiological evaluations. Most patients experienced effective relief from prior headaches (94.7%), tinnitus (83.7%), balance issues (62.7%), FND (90.0%), and trigeminal nerve dysfunction (79.2%), but not hearing loss (1.0%). Whereas GKRS provided effective tumor control independently of dose rate, GKRS patients exposed to lower dose rates experienced significantly better freedom from post-treatment hearing loss and FND (P = .044). CONCLUSION Whereas GKRS provides excellent tumor control and effective symptomatic relief for vestibular schwannomas, dose-rate effects may impact post-treatment functional outcomes. Further research remains warranted.
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Affiliation(s)
- Deborah Ruth Smith
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
| | - Heva Jasmine Saadatmand
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
| | - Cheng-Chia Wu
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
| | - Paul J Black
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
| | - Yen-Ruh Wuu
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
| | - Jeraldine Lesser
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
| | - Maryellen Horan
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
| | - Steven R Isaacson
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
| | - Tony J C Wang
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, New York
- Herbert Irving Comprehensive Cancer Center, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Michael B Sisti
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, New York
- Herbert Irving Comprehensive Cancer Center, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York
- Department of Otolaryngology: Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York
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Abstract
T cells and dendritic cells (DCs) that are positive for the tissue-resident marker CD103 play a vital role in antitumor immunity. In this study, multiplexed immunohistochemistry was applied to stain CD103 and the T-cell marker CD8 as well as the DC marker CD11c on formalin-fixed, paraffin-embedded oral squamous cell carcinoma (OSCC) tissues. Then, the density of CD103+CD8+ and CD103+CD11c+ tumor-infiltrating lymphocytes (TILs) in the intratumoral and stromal regions was calculated, and the correlation of CD103+CD8+ TIL and CD103+CD11c+ TIL density with OSCC patient prognosis was analyzed. The results revealed that CD103+CD8+ TILs and CD103+CD11c+ TILs were abundant in the stromal region and that increased stromal CD103+CD8+ TIL and intratumoral CD103+CD11c+ TIL density indicated a favorable prognosis. Moreover, we freshly isolated TILs from OSCC samples and performed flow cytometry to verify that CD103+CD8+ TILs display a tissue-resident memory T-cell (Trm) phenotype, and we discriminated CD103+CD11c+ TILs from tumor-associated macrophages.
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Affiliation(s)
- Y Xiao
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - H Li
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - L Mao
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Q C Yang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - L Q Fu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - C C Wu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - B Liu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China.,Department of Oral Maxillofacial-Head Neck Oncology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Z J Sun
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China.,Department of Oral Maxillofacial-Head Neck Oncology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
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Hsuan CF, Lin FJ, Tseng WK, Wu YW, Yin WH, Yeh HI, Chen JW, Wu CC. P6428The waist-to-body mass index ratio is a better predictor for cardiovascular outcome in patients with established atherosclerotic cardiovascular disease - No u-shaped phenomenon. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1022] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Many studies have observed an “obesity paradox” in patients with established atherosclerotic cardiovascular disease (ASCVD), in which the body mass index (BMI)-mortality curve is U-shaped.
Purpose
To search a better anthropometric parameter to predict the cardiovascular events in patients with ASCVD.
Methods
The study was conducted from the Taiwanese Secondary Prevention for patients with AtheRosCLErotic disease (T-SPARCLE) Registry. Adult patients with stable ASCVD were enrolled. The primary composite endpoint of this study is the time of the first major cardiovascular event, defined as cardiovascular death, nonfatal myocardial infarction or stroke, or cardiac arrest with resuscitation. Dose response association between primary outcome events and various traditional anthropometric parameters and a new parameter, the waist-to-BMI ratio, was examined using the Cox proportional hazards regression model. We used restricted cubic spline regression to investigate the potential nonlinear relationship between each anthropometric measure and primary outcome events.
Results
A total of 6921 patients with ASCVD were included in this analysis, and were followed up for a median of 2.5 years. Multivariable Cox proportional hazards regression showed a significant positive association between the waist-to-BMI ratio and the primary outcome events (adjusted hazard ratio 1.67, 95% CI 1.12–2.49, p=0.01). Other traditional anthropometric parameters, such as BMI, weight, waist and waist-hip ratio, did not showed significant associations (p=0.10, 0.31, 0.90, and 0.52, respectively). In the restricted cubic spline regression, the positive dose response association between the primary outcome and the waist-to-BMI ratio persisted across all the waist-to-BMI ratio, and was non-linear (the likelihood ratio test for nonlinearity was statistically significant, p<0.001) with a much steeper increase in the major cardiovascular event for the waist-to-BMI ratio >3.6 cm m2/kg.
Dose response curve of waist/BMI ratio
Conclusion
This study found the waist-to-BMI ratio to be a better predictor for major adverse cardiovascular events in established ASCVD patients than other traditional anthropometric parameters.
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Affiliation(s)
- C F Hsuan
- E-Da Dachang Hospital, Division of Cardiology, Department of Internal Medicaine, Kaohsiung, Taiwan
| | - F J Lin
- National Taiwan University, Graduate Institute of Clinical Pharmacy, Taipei, Taiwan
| | - W K Tseng
- E-Da Hospital, Division of Cardiology, Department of Internal Medicaine, Kaohsiung, Taiwan
| | - Y W Wu
- Far Eastern Memorial Hospital, Department of Cardiology, New Taipei City, Taiwan
| | - W H Yin
- Cheng-Hsin General Hospital, Division of Cardiology, Heart Center, Taipei, Taiwan
| | - H I Yeh
- Mackay Memorial Hospital, Cardiology, Taipei, Taiwan
| | - J W Chen
- Taipei Veterans General Hospital, Department of Medical Research and Education, Taipei, Taiwan
| | - C C Wu
- National Taiwan University Hospital, Division of Cardiology, Department of Internal Medicain, Taipei, Taiwan
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50
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Vulpe H, Save A, Xu Y, Elliston C, Garrett M, Wu CC, Cheng S, Jani A, Bruce J, McKhann G, Sisti M, Wang T. RADI-14. FRAMELESS STEREOTACTIC RADIOSURGERY ON THE GAMMA KNIFE ICON: EARLY EXPERIENCE FROM 42 PATIENTS WITH BRAIN METASTASES. Neurooncol Adv 2019. [PMCID: PMC7213152 DOI: 10.1093/noajnl/vdz014.107] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND: The Gamma Knife (GK) Icon uses a Cone-Beam CT (CBCT) scanner and an infrared camera system to support the delivery of frameless radiosurgery. There are limited data on patients treated with frameless GK radiosurgery (GKRS) for brain metastases. OBJECTIVE: To describe the early experience, process, technical details, and short-term outcomes with frameless GKRS for brain metastases at our institution. METHODS: We describe our patient selection and workflow for frameless GKRS in detail. Because of the short interval of follow-up, we provide crude rates of local control. RESULTS: 42 patients had a total of 96 brain metastases. Median age was 69. 77 intact lesions were treated definitively, 18 cavities postoperatively, and 1 had GKRS for recurrence after resection. 11 patients underwent repeat GKRS to the same area. Median dose was 20Gy in 1 fraction (range: 14–21), 24Gy in 3 fractions (range: 19.5–27), and 25Gy in 5 fractions (Range: 25–30). Median treatment time was 23.7 minutes (Range: 7.3 – 85.5). 29 patients had a follow-up MRI in our records after completing GKRS. Median follow-up time was 105 days (Range: 16 – 314). 16 local recurrences (LR) were identified in 9 patients. An additional 6 patients had distant brain recurrence without LR. Crude mean time between GKRS and LR was 101 days (range 44–161 days). There were 6 patients with grade 1, 3 with grade 2, 2 with grade 3, and 1 with grade 4 toxicity. We found an improvement in workflow and a greater number of patients eligible for GKRS due to the ability to fractionate treatments. CONCLUSION: We report a large cohort of consecutive patients with brain metastases treated with frameless GKRS. We look forward to studies with longer follow-up to provide valuable data on clinical outcomes and to further our understanding of the radiobiology of hypofractionation in the brain.
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Affiliation(s)
- Horia Vulpe
- Columbia University Medical Center, Columbia, NY, USA
| | - Akshay Save
- Columbia University Medical Center, Columbia, NY, USA
| | - Yuanguang Xu
- Columbia University Medical Center, Columbia, NY, USA
| | - Carl Elliston
- Columbia University Medical Center, Columbia, NY, USA
| | | | - Cheng-Chia Wu
- Columbia University Medical Center, Columbia, NY, USA
| | - Simon Cheng
- Columbia University Medical Center, Columbia, NY, USA
| | - Ashish Jani
- Columbia University Medical Center, Columbia, NY, USA
| | - Jeffrey Bruce
- Columbia University Medical Center, Columbia, NY, USA
| | - Guy McKhann
- Columbia University Medical Center, Columbia, NY, USA
| | - Michael Sisti
- Columbia University Medical Center, Columbia, NY, USA
| | - Tony Wang
- Columbia University Medical Center, Columbia, NY, USA
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