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Kotecha R, McDermott MW, Chen C, Ferreira C, Hanft S, Shen C, Wanebo J, Smith K, Wardak Z, Patel T, Chamoun R, Hoang KB, Choutka O, Rodriguez A, Shah M, Brachman DG, Campbell L, Patel S. Surgically Targeted Radiation Therapy (STaRT) for Brain Metastases: Initial Experience from a Prospective Multi-Institutional Registry. Int J Radiat Oncol Biol Phys 2023; 117:e120. [PMID: 37784668 DOI: 10.1016/j.ijrobp.2023.06.908] [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) Resection and intraoperative brachytherapy for patients with large, operable brain metastasis allows for both relief of mass effect and the delivery of radiotherapy (RT) to the resection cavity with a favorable dosimetric profile. The objective of this study was to analyze early patterns-of-care and treatment-related toxicity outcomes for brain metastasis patients treated with surgically targeted radiation therapy (STaRT) using a novel brachytherapy carrier. MATERIALS/METHODS Patients with brain metastasis, de novo and recurrent disease, who enrolled onto a prospective multi-institutional observational study (NCT04427384) were the subject of this analysis. Patients underwent resection and immediate implantation of bioresorbable, conformable, 20 mm x 20 mm x 4 mm collagen tile brachytherapy device(s) containing four uniform-intensity Cesium-131 sources. Toxicities were categorized using the CTCAE v5.0 adverse event (AE) criteria. RESULTS From 10/2020 to 01/2023, 13 participating sites enrolled and treated 48 patients with 51 metastases (13 with de novo and 35 patients with recurrent brain metastases), and 3 patients had 2 lesions implanted at the same procedure. Median age was 61 years (range: 28-80), 52% were female, and the most common primary types were lung (56%) and breast (13%). The median maximum pre-operative dimension was 3.4 cm (range: 1.7-5.7) and median pre-operative tumor volume 13.7cm3 (range: 1.7-132). 64% had received prior RT with a median time from last RT to STaRT of 14.6 months range: 3.5-57.3). Median KPS at screening was 80 (range: 50-100), and remained stable at post op visit (80, range: 50-100), and at 3-months following treatment (80, range 50-100), respectively (p>0.05). The median time for implantation was 3 minutes (range: 0.4-30). At a median follow-up of 4 months (range: <1-18), no patient experienced a radiation-attributed AE, and only 1 attributable Gr >3 AE was noted (Gr 5 intracerebral hemorrhage deemed probably related to surgery and unrelated to the implanted device). CONCLUSION Early results from this prospective multi-center trial demonstrate the feasibility and safety of STaRT. The lack of radiation-related AE, even with short follow-up, is intriguing given the relatively large lesion size and proportion of patients treated for recurrent, previously irradiated disease. Additional follow-up will provide data on tumor control outcomes and radiation necrosis rates using this novel technique.
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Affiliation(s)
- R Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - M W McDermott
- Department of Neurosurgery, Miami Neuroscience Institute, Baptist Health South Florida, Miami, FL
| | - C Chen
- Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, MN
| | - C Ferreira
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN
| | - S Hanft
- Westchester Medical Center, Valhalla, NY
| | - C Shen
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - J Wanebo
- Honor Health Research Institute, Scottsdale, AZ
| | - K Smith
- Barrow Neurological Institute, Phoenix, AZ
| | - Z Wardak
- University of Texas Southwestern Medical Center, Dallas, TX
| | - T Patel
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - R Chamoun
- University of Kansas Medical Center, Kansas City, KS
| | - K B Hoang
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA
| | - O Choutka
- St. Alphonsus Regional Medical Center, Boise, ID
| | - A Rodriguez
- University of Arkansas for Medical Sciences, Director of Neurosurgical Oncology, Little Rock, AR
| | - M Shah
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN; Indiana University Health North Hospital, Indianapolis, IN
| | | | | | - S Patel
- GT Medical Technologies, Tempe, AZ
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Mallory M, Kauweloa K, Staecker H, Camarata P, Chamoun R, Badkul R, Tennapel M, Wang F. The Effect of Debulking Surgery on Brainstem Dosimetry and Toxicity for Large Vestibular Schwannomas Treated with Fractionated Stereotactic Radiation Therapy. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Objective: To evaluate the efficacy, safety, and clinical implication of betrixaban for prophylaxis of venous thromboembolism (VTE) in patients with acute medical illness. Data Sources: A search for clinical trials was performed from January 2006 to January 2017 in English language using Clinicaltrials.gov and PubMed/MEDLINE. The following search terms were used: betrixaban, pharmacokinetics, pharmacology, and drug safety. Study Selection: The following limits were used to access the clinical trials: controlled clinical trial, randomized clinical trial, clinical trial, clinical trial phase II, and clinical trial phase III. The search was narrowed to include only humans. Data Extraction: The search criteria resulted in 6 clinical trials assessing the safety and efficacy of betrixaban. Additionally, references from publications assessing the safety and efficacy of betrixaban in atrial fibrillation, treatment and prevention of VTE, and extended duration VTE prophylaxis were assessed. Data Synthesis: Prior to 2017, no anticoagulant therapy had been approved for extended VTE prophylaxis in acutely ill medical patients. Betrixaban is the first direct oral anticoagulant approved for VTE prophylaxis in adult, acutely ill patients at risk for thromboembolisms. Based on the APEX trial, betrixaban 80 mg administered daily for 35 to 42 days was compared to enoxaparin administered daily for 6 to 14 days. In 7441 patients, fewer VTEs were seen in the betrixaban compared to enoxaparin with no significant difference in adverse reactions. Conclusion: Based on clinical trials, betrixaban appears to be safe and effective in preventing VTE in acutely ill patients who are at risk of developing VTE.
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Affiliation(s)
- Grazia Murphy
- Palm Beach Atlantic University, West Palm Beach, FL, USA
| | - Yasmin Grace
- Palm Beach Atlantic University, West Palm Beach, FL, USA
| | - Sadaf Chaudry
- Palm Beach Atlantic University, West Palm Beach, FL, USA
| | - Rita Chamoun
- Palm Beach Atlantic University, West Palm Beach, FL, USA
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Mallory M, Wang F, Badkul R, Tennapel M, Camarata P, Staecker H, Chamoun R. Fractionated Stereotactic Radiation Therapy for Large Vestibular Schwannomas. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.810] [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: 10/18/2022]
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Essehli R, Belharouak I, Ben Yahia H, Chamoun R, Orayech B, El Bali B, Bouziane K, Zhou XL, Zhou Z. α-Na2Ni2Fe(PO4)3: a dual positive/negative electrode material for sodium ion batteries. Dalton Trans 2015; 44:4526-32. [DOI: 10.1039/c5dt00021a] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The low temperature polymorph of Na2Ni2Fe(PO4)3, crystallizing with a stuffed α-CrPO4-type structure, plays a dual anode/cathode behaviour.
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Affiliation(s)
- R. Essehli
- Qatar Environment and Energy Research Institute
- Qatar Foundation
- Doha
- Qatar
| | - I. Belharouak
- Qatar Environment and Energy Research Institute
- Qatar Foundation
- Doha
- Qatar
| | - H. Ben Yahia
- Qatar Environment and Energy Research Institute
- Qatar Foundation
- Doha
- Qatar
| | - R. Chamoun
- Qatar Environment and Energy Research Institute
- Qatar Foundation
- Doha
- Qatar
| | - B. Orayech
- Departamento de Física de la Materia Condensada
- Universidad del País Vasco
- Bilbao
- Spain
| | - B. El Bali
- Laboratory of Mineral Solid and Analytical Chemistry “LCSMA”
- Department of Chemistry
- Faculty of Sciences
- University Mohamed I
- 60050 Oujda
| | - K. Bouziane
- Pôle Energies Renouvelables et Etudes Pétrolières
- Université Internationale de Rabat
- Technopolis
- Morocco
| | - X. L. Zhou
- Institute of New Energy Material Chemistry
- Nankai University
- Tianjin 300071
- China
| | - Z. Zhou
- Institute of New Energy Material Chemistry
- Nankai University
- Tianjin 300071
- China
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Xu R, Belharouak I, Zhang X, Chamoun R, Yu C, Ren Y, Nie A, Shahbazian-Yassar R, Lu J, Li JCM, Amine K. Insight into sulfur reactions in Li-S batteries. ACS Appl Mater Interfaces 2014; 6:21938-21945. [PMID: 25425055 DOI: 10.1021/am504763p] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Understanding and controlling the sulfur reduction species (Li2Sx, 1 ≤ x ≤ 8) under realistic battery conditions are essential for the development of advanced practical Li-S cells that can reach their full theoretical capacity. However, it has been a great challenge to probe the sulfur reduction intermediates and products because of the lack of methods. This work employed various ex situ and in situ methods to study the mechanism of the Li-S redox reactions and the properties of Li2Sx and Li2S. Synchrotron high-energy X-ray diffraction analysis used to characterize dry powder deposits from lithium polysulfide solution suggests that the new crystallite phase may be lithium polysulfides. The formation of Li2S crystallites with a polyhedral structure was observed in cells with both the conventional (LiTFSI) electrolyte and polysulfide-based electrolyte. In addition, an in situ transmission electron microscopy experiment observed that the lithium diffusion to sulfur during discharge preferentially occurred at the sulfur surface and formed a solid Li2S crust. This may be the reason for the capacity fade in Li-S cells (as also suggested by EIS experiment in Supporting Information ). The results can be a guide for future studies and control of the sulfur species and meanwhile a baseline for approaching the theoretical capacity of the Li-S battery.
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Affiliation(s)
- Rui Xu
- Chemical Sciences and Engineering Division, Argonne National Laboratory , 9700 South Cass Avenue, Argonne, Illinois 60439, United States
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Chamoun R, Couldwell WT. Practical and technical aspects of trans-sphenoidal surgery. J Neurosurg Sci 2011; 55:265-275. [PMID: 21968589] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Trans-sphenoidal surgery was first described more than a century ago. Today, this approach occupies a crucial place in the armamentarium of the neurosurgeon for the management of sellar, suprasellar, and parasellar pathological conditions. Over the years, the procedure has witnessed multiple modifications, benefitting from technological advances and from innovative ideas of pioneering neurosurgeons and otolaryngologists. The introduction of the microscope and then the endoscope allowed progressive improvement of visualization, illumination, and magnification in this restricted surgical corridor. With enhanced knowledge and understanding of the surgical anatomy of the skull base, the application of extended transsphenoidal approaches became possible, thus widening significantly the anatomical area that can be reached through this approach. In addition, the continuous improvement in imaging, image guidance, and microinstruments allowed better planning and precision during surgery. In sum, thanks to recent technological advance, trans-sphenoidal surgery can now be applied to a large area of the skull base and for a wide range of pathological conditions. With growing experience, the procedure is performed with enhanced safety and greater efficacy. In this paper, we review the historical evolution of trans-sphenoidal surgery and describe the modern applications and modifications of the procedure.
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Affiliation(s)
- R Chamoun
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
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