Clinical Outcomes of Stereotactic Radiosurgery-Related Radiation Necrosis in Patients with Intracranial Metastasis from Melanoma

Background:

Radiation necrosis (RN) is a clinically relevant complication of stereotactic radiosurgery (SRS) for intracranial metastasis (ICM) treatments. Radiation necrosis development is variable following SRS. It remains unclear if risk factors for and clinical outcomes following RN may be different for melanoma patients. We reviewed patients with ICM from metastatic melanoma to understand the potential impact of RN in this patient population.

Methods:

Patients who received SRS for ICM from melanoma at Mayo Clinic Arizona between 2013 and 2018 were retrospectively reviewed. Data collected included demographics, tumor characteristics, radiation parameters, prior surgical and systemic treatments, and patient outcomes. Radiation necrosis was diagnosed by clinical evaluation including brain magnetic resonance imaging (MRI) and, in some cases, tissue evaluation.

Results:

Radiation necrosis was diagnosed in 7 (27%) of 26 patients at 1.6 to 38 months following initial SRS. Almost 92% of all patients received systemic therapy and 35% had surgical resection prior to SRS. Patients with RN trended toward having larger ICM and a prior history of surgical resection, although statistical significance was not reached. Among patients with resection, those who developed RN had a longer period between surgery and SRS start (mean 44 vs 33 days). Clinical improvement following treatment for RN was noted in 2 (29%) patients.

Conclusions:

Radiation necrosis is relatively common following SRS for treatment of ICM from metastatic melanoma and clinical outcomes are poor. Further studies aimed at mitigating RN development and identifying novel approaches for treatment are warranted.

Pregnancy and Motherhood for Trainees in Anesthesiology: A Survey of the American Society of Anesthesiologists

BACKGROUND

Although approximately half of US medical students are now women, anesthesiology training programs have yet to achieve gender parity. Women trainees' experiences and needs, including those related to motherhood, are increasingly timely concerns for the field of anesthesiology. At present, limited data exists on the childbearing experiences of women physicians in anesthesiology training.

METHODS

In March of 2018, we surveyed women members of the American Society of Anesthesiologists via email. Questions addressed pregnancy, maternity leave, lactation, and motherhood. We analyzed data from a subset of respondents who were pregnant or had children during training and graduated in the year 2000 or later.

RESULTS

A total of 542 respondents who completed training in the year 2000 or after reported 752 pregnancies during anesthesia training. A maternity leave had a median length of 7 weeks and did not change significantly over time. During many pregnancies, women felt their leave was inadequate (59.6%) or felt discouraged from taking more time off (65.7%). Pregnancy and associated leave extended graduation from training in 64.1% of cases. In approximately half of pregnancies (51.3%), women met desired breastfeeding duration, with access to designated lactation space decreasing significantly over time (false-discovery adjusted P = .0004). Trainee mothers often felt discouraged from having children (51.6%) or perceived negative stigma surrounding pregnancy (60.3%). These attitudes did not change over time or in relation to female program leadership.

CONCLUSIONS

Women anesthesiology trainees commonly face obstacles when attempting to balance work and motherhood. Recent policy changes have addressed some of the challenges identified in our study. Future studies will need to evaluate how these changes have impacted anesthesiology trainees.