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Ledbetter D, de Almeida RAA, Wu X, Naveh A, Patel CB, Gonzalez Q, Beckham TH, North R, Rhines L, Li J, Ghia A, Aten D, Tatsui C, Alvarez-Breckenridge C. Tumor treating fields suppress tumor cell growth and neurologic decline in models of spinal metastases. JCI Insight 2024; 9:e176962. [PMID: 38512420 DOI: 10.1172/jci.insight.176962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 03/06/2024] [Indexed: 03/23/2024] Open
Abstract
Spinal metastases can result in severe neurologic compromise and decreased overall survival. Despite treatment advances, local disease progression is frequent, highlighting the need for novel therapies. Tumor treating fields (TTFields) impair tumor cell replication and are influenced by properties of surrounding tissue. We hypothesized that bone's dielectric properties will enhance TTFields-mediated suppression of tumor growth in spinal metastasis models. Computational modeling of TTFields intensity was performed following surgical resection of a spinal metastasis and demonstrated enhanced TTFields intensity within the resected vertebral body. Additionally, luciferase-tagged human KRIB osteosarcoma and A549 lung adenocarcinoma cell lines were cultured in demineralized bone grafts and exposed to TTFields. Following TTFields exposure, the bioluminescence imaging (BLI) signal decreased to 10%-80% of baseline, while control cultures displayed a 4.48- to 9.36-fold increase in signal. Lastly, TTFields were applied in an orthotopic murine model of spinal metastasis. After 21 days of treatment, control mice demonstrated a 5-fold increase in BLI signal compared with TTFields-treated mice. TTFields similarly prevented tumor invasion into the spinal canal and development of neurologic symptoms. Our data suggest that TTFields can be leveraged as a local therapy within minimally conductive bone of spinal metastases. This provides the groundwork for future studies investigating TTFields for patients with treatment-refractory spinal metastases.
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Affiliation(s)
- Daniel Ledbetter
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Xizi Wu
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | | | - Queena Gonzalez
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Robert North
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Laurence Rhines
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jing Li
- Department of Radiation Oncology, CNS/Pediatrics Section, and
| | - Amol Ghia
- Department of Radiation Oncology, CNS/Pediatrics Section, and
| | - David Aten
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Claudio Tatsui
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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2
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Tang C, Sherry AD, Haymaker C, Bathala T, Liu S, Fellman B, Cohen L, Aparicio A, Zurita AJ, Reuben A, Marmonti E, Chun SG, Reddy JP, Ghia A, McGuire S, Efstathiou E, Wang J, Wang J, Pilie P, Kovitz C, Du W, Simiele SJ, Kumar R, Borghero Y, Shi Z, Chapin B, Gomez D, Wistuba I, Corn PG. Addition of Metastasis-Directed Therapy to Intermittent Hormone Therapy for Oligometastatic Prostate Cancer: The EXTEND Phase 2 Randomized Clinical Trial. JAMA Oncol 2023; 9:825-834. [PMID: 37022702 PMCID: PMC10080407 DOI: 10.1001/jamaoncol.2023.0161] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [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: 08/28/2022] [Accepted: 12/20/2022] [Indexed: 04/07/2023]
Abstract
Importance Despite evidence demonstrating an overall survival benefit with up-front hormone therapy in addition to established synergy between hormone therapy and radiation, the addition of metastasis-directed therapy (MDT) to hormone therapy for oligometastatic prostate cancer, to date, has not been evaluated in a randomized clinical trial. Objective To determine in men with oligometastatic prostate cancer whether the addition of MDT to intermittent hormone therapy improves oncologic outcomes and preserves time with eugonadal testosterone compared with intermittent hormone therapy alone. Design, Setting, Participants The External Beam Radiation to Eliminate Nominal Metastatic Disease (EXTEND) trial is a phase 2, basket randomized clinical trial for multiple solid tumors testing the addition of MDT to standard-of-care systemic therapy. Men aged 18 years or older with oligometastatic prostate cancer who had 5 or fewer metastases and were treated with hormone therapy for 2 or more months were enrolled to the prostate intermittent hormone therapy basket at multicenter tertiary cancer centers from September 2018 to November 2020. The cutoff date for the primary analysis was January 7, 2022. Interventions Patients were randomized 1:1 to MDT, consisting of definitive radiation therapy to all sites of disease and intermittent hormone therapy (combined therapy arm; n = 43) or to hormone therapy only (n = 44). A planned break in hormone therapy occurred 6 months after enrollment, after which hormone therapy was withheld until progression. Main Outcomes and Measures The primary end point was disease progression, defined as death or radiographic, clinical, or biochemical progression. A key predefined secondary end point was eugonadal progression-free survival (PFS), defined as the time from achieving a eugonadal testosterone level (≥150 ng/dL; to convert to nanomoles per liter, multiply by 0.0347) until progression. Exploratory measures included quality of life and systemic immune evaluation using flow cytometry and T-cell receptor sequencing. Results The study included 87 men (median age, 67 years [IQR, 63-72 years]). Median follow-up was 22.0 months (range, 11.6-39.2 months). Progression-free survival was improved in the combined therapy arm (median not reached) compared with the hormone therapy only arm (median, 15.8 months; 95% CI, 13.6-21.2 months) (hazard ratio, 0.25; 95% CI, 0.12-0.55; P < .001). Eugonadal PFS was also improved with MDT (median not reached) compared with the hormone therapy only (6.1 months; 95% CI, 3.7 months to not estimable) (hazard ratio, 0.32; 95% CI, 0.11-0.91; P = .03). Flow cytometry and T-cell receptor sequencing demonstrated increased markers of T-cell activation, proliferation, and clonal expansion limited to the combined therapy arm. Conclusions and Relevance In this randomized clinical trial, PFS and eugonadal PFS were significantly improved with combination treatment compared with hormone treatment only in men with oligometastatic prostate cancer. Combination of MDT with intermittent hormone therapy may allow for excellent disease control while facilitating prolonged eugonadal testosterone intervals. Trial Registration ClinicalTrials.gov Identifier: NCT03599765.
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Affiliation(s)
- Chad Tang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston
| | - Alexander D. Sherry
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Cara Haymaker
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Tharakeswara Bathala
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston
| | - Suyu Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
| | - Bryan Fellman
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
| | - Lorenzo Cohen
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Ana Aparicio
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Amado J. Zurita
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Alexandre Reuben
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Enrica Marmonti
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Stephen G. Chun
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Jay P. Reddy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Amol Ghia
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Sean McGuire
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Eleni Efstathiou
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Jennifer Wang
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Jianbo Wang
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Patrick Pilie
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Craig Kovitz
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Weiliang Du
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston
| | - Samantha J. Simiele
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston
| | - Rachit Kumar
- Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, Arizona
| | - Yerko Borghero
- Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, Arizona
| | - Zheng Shi
- Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio
| | - Brian Chapin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston
| | - Daniel Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ignacio Wistuba
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Paul G. Corn
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
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3
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Bishop AJ, Amini B, Lin H, Raza SM, Patel S, Grosshans DR, Ghia A, Farooqi A, Guadagnolo BA, Mitra D, Akdemir KC, Lazar AJ, Wang WL, Alvarez-Breckenridge C, Bird J, Rhines LD, Somaiah N, Conley AP. Immune Checkpoint Inhibitors Have Clinical Activity in Patients With Recurrent Chordoma. J Immunother 2022; 45:374-378. [PMID: 35943386 PMCID: PMC9452485 DOI: 10.1097/cji.0000000000000431] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/16/2022] [Indexed: 11/25/2022]
Abstract
The aim of this study is to evaluate the outcomes and tolerance of immune checkpoint inhibitors (ICIs) for patients with recurrent chordoma. We reviewed the records of 17 patients with recurrent chordomas who received ICIs for progressing disease as part of their treatment between 2016 and 2020. Response was assessed using response evaluation criteria in solid tumors 1.1 criteria. The Kaplan-Meier method was used to estimate the duration of response, progression-free survival (PFS), and overall survival (OS). Clinical benefit was defined as having stable disease (SD), a partial response, or a complete response. The median follow-up from the start of ICIs was 29 months [interquartile range (IQR): 13-35 m]. The majority received pembrolizumab (n=9, 53%), and the median number of cycles delivered was 8 (IQR: 7-12). The 1-year OS was 87%, and the 1-year PFS was 56% with a median PFS of 14 months (95% CI, 5-17 mo). After ICI initiation, most patients (n=15, 88%) had clinical benefit consisting of a complete response (n=1, 6%), partial response (n=3, 18%), and stable disease (n=11, 65%). Among all responders (n=15), the median duration of response was 12 months. Toxicities were limited: 2 (12%) patients having grade 3/4 immune-related toxicities (colitis, grade 3; myocarditis, grade 4). We observed a high rate of clinical benefit and favorable durability from ICI use for patients with recurrent chordoma. These data provide support for the integration of ICIs as a standard first-line systemic therapy option for patients with recurrent chordoma. Prospective studies are warranted to further evaluate efficacy and enhance response rates.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Justin Bird
- Orthopedic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
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4
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Upadhyay R, Khose S, Pokhylevych H, Paulino AC, McAleer MF, Ghia A, Li J, Yeboa DN, Loghin M, Harrison R, O’Brien B, Kamiya-Matsuoka C, De Groot J, Puduvalli VK, Tatsui C, Alvarez-Breckenridge C, Prabhu S, Rhines L, Zaky W, Lin F, Weinberg JS, Fuller G, Sandberg DI, Johnson JM, McGovern SL. Patterns of failure after radiation therapy in primary spinal high-grade gliomas: A single institutional analysis. Neurooncol Adv 2022; 4:vdac129. [PMID: 36128585 PMCID: PMC9476222 DOI: 10.1093/noajnl/vdac129] [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] [Indexed: 12/01/2022] Open
Abstract
Background Primary spinal high-grade gliomas (S-HGG) are rare aggressive tumors; radiation therapy (RT) often plays a dominant role in management. We conducted a single-institution retrospective review to study the clinicopathological features and management of S-HGGs. Methods Patients with biopsy-proven S-HGG who received RT from 2001 to 2020 were analyzed for patient, tumor, and treatment characteristics. Kaplan–Meier estimates were used for survival analyses. Results Twenty-nine patients were identified with a median age of 25.9 years (range 1–74 y). Four patients had GTR while 25 underwent subtotal resection or biopsy. All patients were IDH wildtype and MGMT-promoter unmethylated, where available. H3K27M mutation was present in 5 out of 10 patients tested, while one patient harbored p53 mutation. Median RT dose was 50.4 Gy (range 39.6–54 Gy) and 65% received concurrent chemotherapy, most commonly temozolomide. Twenty-three (79%) of patients had documented recurrence. Overall, 16 patients relapsed locally, 10 relapsed in the brain and 8 developed leptomeningeal disease; only 8 had isolated local relapse. Median OS from diagnosis was 21.3 months and median PFS was 9.7 months. On univariate analysis, age, gender, GTR, grade, RT modality, RT dose and concurrent chemotherapy did not predict for survival. Patients with H3K27M mutation had a poorer PFS compared to those without mutation (10.1 m vs 45.1 m) but the difference did not reach statistical significance (P = .26). Conclusions The prognosis of patients with spinal HGGs remains poor with two-thirds of the patients developing distant recurrence despite chemoradiation. Survival outcomes were similar in patients ≤ 29 years compared to adults > 29 years. A better understanding of the molecular drivers of spinal HGGs is needed to develop more effective treatment options.
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Affiliation(s)
- Rituraj Upadhyay
- Department of Radiation Oncology, The James Cancer Centre, Ohio State University , Columbus, Ohio , USA
| | - Swapnil Khose
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Halyna Pokhylevych
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Arnold C Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Mary Frances McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Amol Ghia
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Jing Li
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Debra Nana Yeboa
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Monica Loghin
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Rebecca Harrison
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Barbara O’Brien
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Carlos Kamiya-Matsuoka
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - John De Groot
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Vinay K Puduvalli
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Claudio Tatsui
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | | | - Sujit Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Larry Rhines
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Wafik Zaky
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Frank Lin
- Texas Children’s Cancer Center, Baylor College of Medicine , Houston, Texas , USA
| | - Jeffery S Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Gregory Fuller
- Department of Neuro-pathology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA (G.F.)
| | - David I Sandberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Jason Michael Johnson
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Susan L McGovern
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
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5
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Upadhyay R, Khose S, Pokhylevych H, Paulino ADC, McAleer MF, Ghia A, Li J, Yeboa DN, Loghin M, Harrison R, O'Brien B, Kamiya-Matsuoka C, DeGroot J, Puduvalli V, Tatsui C, Prabhu S, Zaky W, Lin F, Weinberg J, Rhines L, Fuller G, Sandberg D, Johnson JM, McGovern S. RADT-09. ROLE OF RADIOTHERAPY IN MANAGEMENT OF PRIMARY SPINAL HIGH GRADE GLIOMA: A SINGLE INSTITUTION RETROSPECTIVE ANALYSIS. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.167] [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
BACKGROUND
Primary spinal high-grade gliomas(S-HGG) are rare, aggressive tumors and radiation therapy(RT) plays a dominant role in the management given their infiltrative nature. We conducted a single-institution retrospective review to study the clinicopathological features and management of S-HGGs.
METHODS
Patients with biopsy-proven S-HGG who received RT from 2001-2020 were analyzed for patient, tumor, and treatment characteristics. Kaplan-Meier estimate and Cox proportional hazard regression method were used for survival analyses.
RESULTS
Twenty-nine patients were identified with a median age of 25.9 years (range 1-74y). Four patients had gross total resection(GTR) while 25 underwent subtotal resection or biopsy. Nineteen patients had WHO grade 4 tumor. IDH1 mutation and MGMT promoter methylation were analyzed in 14 and four patients respectively; all were IDH wildtype and MGMT-promoter unmethylated. H3K27M mutation was present in five out of 10 patients tested. Twenty-two patients received photon-based radiation and 7 received proton therapy. Median RT dose was 50.4 Gy (range 39.6-54Gy) with 79% receiving >45Gy. 65% patients received concurrent chemotherapy, most commonly temozolomide. Twenty-three (79%) patients had documented recurrence. Overall, 16 patients relapsed locally, 10 relapsed in the brain and 8 developed leptomeningeal disease; only 8(35%) had isolated local relapse. Median OS from diagnosis was 21.3 months and median PFS after RT was 9.7 months. On univariate analysis, age, sex, GTR, grade, RT modality, RT dose and concurrent chemotherapy did not predict for survival. Patients with H3K27M mutation had a poorer median PFS after RT compared to those without the mutation but the difference did not reach statistical significance (p = 0.26).
CONCLUSIONS
Although 86% of patients had gross disease at RT and received a lower median RT dose than typically used in cerebral high-grade gliomas, only 55% of patients failed locally. H3K27M mutation may portend worse survival; future studies to improve the therapeutic approach in these patients are warranted.
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Affiliation(s)
- Rituraj Upadhyay
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Swapnil Khose
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | | | - Amol Ghia
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jing Li
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Debra Nana Yeboa
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Monica Loghin
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rebecca Harrison
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Barbara O'Brien
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - John DeGroot
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vinay Puduvalli
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Claudio Tatsui
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sujit Prabhu
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wafik Zaky
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Frank Lin
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey Weinberg
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Laurence Rhines
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Greg Fuller
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David Sandberg
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Susan McGovern
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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6
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Woodhouse K, Alvarez VA, Boyce D, Li J, Yeboa D, Grosshans D, Briere T, Tatsui C, Rhines L, Behrang A, McGovern S, Paulino A, McAleer MF, Ghia A. RONC-17. STEREOTACTIC RADIOSURGERY FOR SPINE METASTASES IN PEDIATRIC MALIGNANCIES. Neuro Oncol 2020. [PMCID: PMC7715826 DOI: 10.1093/neuonc/noaa222.786] [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
BACKGROUND
Spine stereotactic radiosurgery (SSRS) is a non-invasive technique that delivers ablative radiotherapy for optimal control of bony disease. While SSRS is known to provide excellent local control (LC) and minimal toxicity in adults, the role of SSRS in pediatrics is less clear.
PURPOSE
To evaluate SSRS in pediatric patients with spinal metastases.
METHODS
A retrospective review of patients (<18 yrs) treated with SSRS at MDACC was performed after IRB approval. Descriptive statistics were utilized for analysis.
RESULTS
From 2011–2019, 12 metastatic osseous sites (3 cervical, 4 thoracic, 5 lumbar-sacral) in 9 patients were treated. Median follow-up was 9 months (range 2–41). Six males (67%) and 3 females (33%) all KPS ≥70, received radiation to ≤3 contiguous vertebral bodies. Median age was 16 yrs (range 8–18). No patients required sedation. Histologies included 7 osteosarcomas, one rhabdomyosarcoma and one Ewing’s sarcoma. Metastatic epidural spinal cord compression scores ranged from 0 (6), 1b (3) and 3 (3). No sites had surgery prior to SSRS and one site received prior conventional radiation. SSRS doses included 24 Gy in 1 fraction (7), 24–27 Gy in 3 fractions (4) and 50 Gy in 5 fractions (1). Six-month LC was 83% with one local failure following 27 Gy. OS at 6 and 12 mo were 55% and 23%. There was no grade ≥3 acute toxicity, no radiation myelopathy or vertebral compression fractures.
CONCLUSION
In this initial report, SSRS represents a promising modality that is well tolerated and provides excellent LC. However, further follow-up is warranted in the pediatric setting.
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Affiliation(s)
| | - Victor Albornoz Alvarez
- MD Anderson Cancer Center, University of Texas, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - David Boyce
- MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Jing Li
- MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Debra Yeboa
- MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - David Grosshans
- MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Tina Briere
- MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Claudio Tatsui
- MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Laurence Rhines
- MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Amini Behrang
- MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Susan McGovern
- MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Arnold Paulino
- MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | | | - Amol Ghia
- MD Anderson Cancer Center, University of Texas, Houston, TX, USA
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7
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Augustyn A, Patel R, Ludmir E, Haydu L, Guha-Thakurta N, Bishop A, Chung C, Ghia A, McAleer MF, McGovern S, Wang C, Woodhouse K, Yeboa D, Ferguson S, Kim B, Glitza I, Li J. RADT-13. EARLY CONCURRENT IMMUNOTHERAPY WITH STEREOTACTIC RADIOSURGERY IS ASSOCIATED WITH PROLONGED SURVIVAL AND DECREASED DISTANT BRAIN FAILURE IN PATIENTS WITH NEWLY DIAGNOSED MELANOMA BRAIN METASTASES (MBM). Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.766] [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
INTRODUCTION
We evaluated outcomes of patients with newly diagnosed MBM treated with concurrent immune checkpoint inhibition (ICI) and stereotactic radiosurgery (SRS) (concurrentTx), defined as treatment delivery within 30 days of each other.
METHODS
Screening of 2,617 melanoma patients who received ICI (anti-CTLA4/anti-PD1/both) between 2011-2019 identified 151 pts who received concurrentTx for MBM. Among these, 51 had newly-diagnosed MBM and received no prior ICI or SRS, and were included in the current study. Overall survival (OS) and distant brain failure (DBF) were estimated using the Kaplan-Meier method. Incidence of radiation necrosis (RN) was captured.
RESULTS
Median follow up from treatment initiation (either ICI or SRS, whichever occurred first) was 37 months. Median OS was 30 months. Median interval between ICI/SRS was 12 days (range: 1-29). Twenty-two patients received ICI first and 29 received SRS first, without differences in OS (p=0.22), DBF (p=0.91), or development of RN (p=0.86). However, the interval between ICI and SRS was significant. Patients who received concurrentTx 1-11 days apart (n=25, “early”) experienced a significant improvement in OS and DBF compared to 12-29 days apart (n=26, “delayed”) (p=0.01, HR 2.8; 95%CI 1.3-6.2 for OS and p=0.02, HR 2.5; 95%CI 1.2-5.6 for DBF). OS and DBF at 36 months were 67% vs. 26% and 60% vs. 27%, respectively, for the early vs. delayed groups. Time to concurrentTx as a continuous variable was significantly associated with DBF (p=0.02), but not OS (p=0.06). Although not significant, more patients developed RN in the early (26.0%) versus delayed (3.8%) group (p=0.07). No additional patient or treatment differences were identified.
CONCLUSIONS
Early concurrentTx was associated with prolonged OS and improved DBF in newly diagnosed MBM patients who did not receive prior CNS-directed therapy. This finding suggests therapeutic synergism related to combined early treatment and should be validated in a prospective clinical trial.
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Affiliation(s)
| | - Roshal Patel
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ethan Ludmir
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lauren Haydu
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Andrew Bishop
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Caroline Chung
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amol Ghia
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Susan McGovern
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chenyang Wang
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Debra Yeboa
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Betty Kim
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Isabella Glitza
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jing Li
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
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8
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Maroongroge S, Sosa A, Rhines L, Amini B, Phan J, Ghia A. Stereotactic Spinal Radiosurgery (SSRS) for Metastatic Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.02.595] [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: 11/26/2022]
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9
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Anakwenze C, McGovern S, Taku N, Liao K, Boyce-Fappiano D, Kamiya-Matsuoka C, Ghia A, Chung C, Li J, Yeboa DN. Association between Facility Volume and Overall Survival for Patients with Grade II Meningioma after Gross Total Resection. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.02.477] [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: 11/25/2022]
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10
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Anakwenze CP, McGovern S, Taku N, Liao K, Boyce-Fappiano DR, Kamiya-Matsuoka C, Ghia A, Chung C, Trifiletti D, Ferguson SD, Li J, Yeboa DN. Association Between Facility Volume and Overall Survival for Patients with Grade II Meningioma after Gross Total Resection. World Neurosurg 2020; 141:e133-e144. [PMID: 32407910 DOI: 10.1016/j.wneu.2020.05.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 05/02/2020] [Accepted: 05/04/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The role of adjuvant radiation after gross total resection (GTR) for grade II meningioma is evolving, prompting further evaluation in NRG-BN003, a phase 3 national trial. Furthermore, the relationship between facility volume and outcomes in patients with grade II meningioma after GTR has not been examined at a national level. We aim to assess overall survival (OS) of patients with grade II meningioma after GTR by surgical case volume and OS by receipt of adjuvant radiation. METHODS We used the National Cancer Database to identity 2823 patients diagnosed with grade II meningioma who underwent GTR. Propensity score matching was applied to balance covariates in patients with grade II meningioma after GTR stratified by adjuvant radiation status. Multivariable logistic regression was used to assess factors associated with radiation receipt. Kaplan-Meier and log-rank tests were used to assess OS by facility volume. RESULTS As facility volume increased, OS increased, with a 5-year OS of 72.8% for facilities with GTR grade II meningioma volumes of ≤8 cases per decade and 87.5% for >8 cases per decade (P < 0.0001). There was no difference in 5-year OS between GTR alone and GTR with adjuvant radiation (84.8% vs. 86.4%; P = 0.151). Covariates significantly associated with radiation receipt included facility location, facility volume, distance, and tumor size. CONCLUSIONS Treatment at higher surgical case volume facilities is associated with improved OS for GTR grade II meningioma. These facilities also have more patients receiving adjuvant radiation. However, we observed no difference in OS between adjuvant radiation and surgery alone.
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Affiliation(s)
- Chidinma P Anakwenze
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Susan McGovern
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nicolette Taku
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kaiping Liao
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David R Boyce-Fappiano
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Carlos Kamiya-Matsuoka
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Amol Ghia
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Caroline Chung
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Daniel Trifiletti
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - Sherise D Ferguson
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jing Li
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Debra Nana Yeboa
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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11
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McGovern S, Luo D, Johnson M, Nguyen K, Li J, McAleer M, Yeboa D, Grosshans D, Ghia A, Chung C, Thall P, Sulman E, Brown P, Mahajan A. RTHP-23. PROSPECTIVE TRIAL OF CONVENTIONALLY FRACTIONATED DOSE CONSTRAINTS FOR RE-IRRADIATION OF PRIMARY BRAIN TUMORS. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.894] [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
PURPOSE/OBJECTIVE
Dose constraints for re-irradiation of recurrent primary brain tumors are not well-established, especially for treatment volumes too large for stereotactic radiotherapy. This prospective trial was performed to test dose constraints for conventionally-fractionated re-irradiation of recurrent primary brain tumors
MATERIALS/METHODS
A single-institution, prospective trial of 21 adults with recurrent brain tumors was performed. Electronic dosimetry records from the first course of radiation (RT1) were obtained and deformed onto the simulation CT for the second course of radiation (RT2). Treatment plans for RT2 were developed that met protocol-assigned dose constraints for RT2 alone and the composite dose of RT1+RT2. Dose constraints were also based on histology and interval since RT1. The primary endpoint was the rate of symptomatic brain necrosis after RT2.
RESULTS
Twenty one adults enrolled from March 2017 to May 2018. Twelve had glioblastoma, four had oligodendroglioma, two had anaplastic astrocytoma, and one each had choroid plexus papilloma, hemangiopericytoma, and pleomorphic xanthroastrocytoma (PXA). Twenty patients were treated with VMAT and one was treated with proton CSI. Median RT1-RT2 interval was 45 months (range, 9–141 months). Median RT2 dose was 42.8 Gy (range, 17.5–60 Gy). Median PTV volume was 208 cc (range, 7–1537 cc). Median imaging followup was 9 months (range, 1–20 months). Two months after RT2, the patient with PXA developed a trapped temporal horn adjacent to the RT2 treatment volume; pathology from emergent resection revealed necrotic brain tissue. The patient recovered fully and lived another 18 months until dying of disease progression. No other patient developed symptomatic radionecrosis. Median overall survival from RT2 for all patients was 11 months (range, 3–20 months).
CONCLUSION
Re-irradiation can be performed with conventionally fractionated schemes. Given the low rate of symptomatic radionecrosis, the dose constraints described here are a starting point for future studies of conventionally fractionated re-irradiation.
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Affiliation(s)
- Susan McGovern
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dershan Luo
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Johnson
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kham Nguyen
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jing Li
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mary McAleer
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Debra Yeboa
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David Grosshans
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amol Ghia
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Caroline Chung
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peter Thall
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Erik Sulman
- NYU Langone School of Medicine, New York, NY, USA
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Al Feghali K, Randall J, Wefel J, Guha-Thakurta N, Grosshans D, Dibaj S, McAvoy S, Li J, McGovern S, McAleer M, Ghia A, Paulino A, Sulman E, Penas-Prado M, Wang J, DeGroot J, Heimberger A, Armstrong T, Gilbert M, Mahajan A, Brown P, Chung C. NIMG-03. PROSPECTIVE PHASE II RANDOMIZED TRIAL COMPARING PROTON THERAPY VS. PHOTON IMRT FOR GBM: SECONDARY ANALYSIS COMPARISON OF PROGRESSION FREE SURVIVAL BETWEEN RANO VS. CLINICAL AND RADIOLOGICAL ASSESSMENT. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.675] [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: 11/15/2022] Open
Abstract
Abstract
PURPOSE
To compare tumor progression based on clinical radiological assessment and on Response Assessment in Neuro-Oncology (RANO) criteria between GBM patients treated with proton radiotherapy (PT) vs. photon intensity modulated radiotherapy (IMRT).
METHODS
Eligible patients were enrolled on the described prospective phase II trial and had MR imaging at baseline and follow-up beyond 12 weeks from treatment completion. ‘Clinical’ progression was based on a radiology report of progression in combination with changes in treatment due to suspected disease progression. A single blinded observer applied RANO criteria to determine the RANO-based tumor progression.
RESULTS
Of 90 enrolled patients, 66 were evaluable, with median follow-up of 19.8 (Range: 3.2–65.1) months; median of 22.6 months for PT (n=25) vs. 18.9 months for IMRT (n=41). Median time to progression (TTP) was 7.9 months based on clinical progression criteria (8.1 months IMRT, 6.3 months PT) and 7.2 months (7.3 months IMRT, 5.7 months PT) by RANO criteria (p=ns for all). Median ‘clinical’ progression-free survival (PFS) was 8.7 (Range: 6.4–11.1) months; 8.9 months IMRT vs. 8.7 months PT (p=0.065). Median RANO PFS was 8.3 (range, 5.8–11.6) months: 8.3 months IMRT vs. 6.9 months PT (p=0.226). There were 14 discrepant cases: 3 had progression based on ‘clinical’ but not RANO criteria, and 11 had progression based on RANO but not ‘clinical’ criteria.
CONCLUSION
Based on this secondary analysis of a randomized trial of PT vs. IMRT for GBM, there was no difference in tumor progression relative to treatment technique used. There was no statistical difference in PFS noted between clinical and RANO-based assessments, but RANO criteria identified progression more often than clinical assessment, and TTP was shortened with the use of RANO criteria alone. Further development of tumor assessment tools that improve consistency and accuracy of determining tumor progression are needed to guide therapeutic trials in GBM.
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Affiliation(s)
| | - James Randall
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey Wefel
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - David Grosshans
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Seyedeh Dibaj
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sarah McAvoy
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jing Li
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susan McGovern
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mary McAleer
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amol Ghia
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Arnold Paulino
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Erik Sulman
- NYU Langone School of Medicine, New York, NY, USA
| | - Marta Penas-Prado
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jihong Wang
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John DeGroot
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amy Heimberger
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Terri Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark Gilbert
- NCI Center for Cancer Research, Bethesda, MD, USA
| | | | | | - Caroline Chung
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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13
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Randall J, Al Feghali K, Wefel J, Grosshans D, Dibaj S, Milton D, McAvoy S, Li J, McGovern S, McAleer M, Ghia A, Paulino A, Sulman E, Penas-Prado M, Wang J, DeGroot J, Heimberger A, Armstrong T, Gilbert M, Mahajan A, Brown P, Chung C. RTHP-18. PROSPECTIVE PHASE II RANDOMIZED TRIAL COMPARING PROTON THERAPY VS. PHOTON IMRT FOR NEWLY DIAGNOSED GBM: SECONDARY ANALYSIS COMPARISON OF GENDER AND NEUTROPHIL-LYMPHOCYTE RATIO (NLR) IN GBM OUTCOMES. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.889] [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
BACKGROUND
While glioblastoma (GBM) is more prevalent in males, studies show that females with GBM tend to have longer overall survival (OS) than males. Pretreatment neutrophil to lymphocyte ratio (NLR) has also proven to be prognostic in GBM, with lower NLR having favorable outcomes. This secondary analysis of a prospective randomized trial of proton vs. photon intensity modulated radiotherapy aims to explore the interaction of gender and NLR on GBM outcomes.
METHODS
Analysis was performed on the full patient population. Kaplan-Meier methods estimated OS with censoring at last follow-up for those who were alive. Univariate (UVA) and multivariate (MVA)Cox proportional hazards models assessed predictors of OS.
RESULTS
Of 90 patients, 77 were included (43 males; 34 females) with median age of 52 years (range: 26–82 years). Median OS was longer for females than males (30.7 vs 18.2 months, p=0.004). On UVA, patients with NLR below median value (NLR= 3.1) tended to have longer OS than those above median, though not meeting statistical significance (23.1 vs. 17.9 months, p=0.051). Difference in OS was statistically significant in females (OS 36.4 months NLR >median vs. 16.7 months NLR< median, p=0.002), but not in males (OS 17.8 months NLR >median vs. 19.1 NLR< median, p=0.95). MVA analysis was consistent, with female gender predicting reduced hazard ratio (HR) (0.28, p=0.034) and females with below median NLR showing a reduced HR over those with above median (0.28, p=0.005). Again, males did not benefit (HR 0.90, p=0.77).
CONCLUSION
Consistent with prior publications, females and all patients with lower pre-treatment NLR with newly diagnosed GBM had longer OS. However, combining these two factors revealed that the benefits from lower pre-treatment NLR were conferred only in females with no impact on males. This different impact of NLR between genders may suggest innate immune differences in gender during response to malignancy.
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Affiliation(s)
- James Randall
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Jeffrey Wefel
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David Grosshans
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Seyedeh Dibaj
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Denai Milton
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sarah McAvoy
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jing Li
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susan McGovern
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mary McAleer
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amol Ghia
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Arnold Paulino
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Erik Sulman
- NYU Langone School of Medicine, New York, NY, USA
| | - Marta Penas-Prado
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jihong Wang
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John DeGroot
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amy Heimberger
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Terri Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | | | - Caroline Chung
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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14
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Chung C, Brown P, Liu D, Grosshans D, Dibaj S, Guha-Thakurta N, Li J, McGovern S, McAleer M, Ghia A, Paulino A, Sulman E, Penas-Prado M, De Groot J, Heimberger A, Wang J, Armstrong T, Gilbert M, Mahajan A, Wefel J. EP-1239: Ph II randomized trial comparing cognitive outcomes of proton vs. photon radiation for glioblastoma. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31549-4] [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: 10/14/2022]
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15
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Chung C, Brown PD, McAvoy S, Grosshans DR, Dibaj S, Guha-Thakurta N, Li J, McGovern SL, Mcaleer MF, Ghia A, Paulino A, Sulman E, Penas-Prado M, Wang J, de Groot J, Heimberger A, Armstrong TS, Gilbert MR, Mahajan A, Wefel J. ACTR-72. A PROSPECTIVE PHASE II RANDOMIZED TRIAL TO COMPARE INTENSITY MODULATED PROTON RADIOTHERAPY (IMPT) VS. INTENSITY MODULATED RADIOTHERAPY (IMRT) FOR NEWLY DIAGNOSED GLIOBLASTOMA (GBM). Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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Mahajan A, Wang X, Ahmed S, Mcaleer MF, Weinberg JS, Li J, Brown PD, Prabhu SS, Lang FF, McGovern SL, Mccutcheon I, Sulman E, Heimberger A, Ferguson S, Ghia A, Guha-Thakurta N, Sawaya R, Rao G. RTHP-35. LOCAL RECURRENCE PATTERN OF PATIENTS ENROLLED ON A RANDOMIZED STUDY OF POST-OPERATIVE STEREOTACTIC RADIOSURGERY VS OBSERVATION FOR COMPLETELY RESECTED BRAIN METASTASIS. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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17
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Mahajan A, Ahmed S, McAleer MF, Weinberg JS, Li J, Brown P, Settle S, Prabhu SS, Lang FF, Levine N, McGovern S, Sulman E, McCutcheon IE, Azeem S, Cahill D, Tatsui C, Heimberger AB, Ferguson S, Ghia A, Demonte F, Raza S, Guha-Thakurta N, Yang J, Sawaya R, Hess KR, Rao G. Post-operative stereotactic radiosurgery versus observation for completely resected brain metastases: a single-centre, randomised, controlled, phase 3 trial. Lancet Oncol 2017; 18:1040-1048. [PMID: 28687375 PMCID: PMC5560102 DOI: 10.1016/s1470-2045(17)30414-x] [Citation(s) in RCA: 445] [Impact Index Per Article: 63.6] [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: 03/01/2017] [Revised: 04/26/2017] [Accepted: 04/28/2017] [Indexed: 12/13/2022]
Abstract
Background After brain metastasis resection, whole-brain radiation therapy (WBRT) decreases local recurrence but may cause cognitive decline. We performed this study to determine if stereotactic radiosurgery (SRS) to the surgical cavity improved local tumor tumor-free recurrence rates compared to surgical resection alone as an alternative to the need for immediate WBRT. Methods The main entry criteria for the study included patients >3 years of age, with a Karnofsky Performance Score ≥ 70, who were able to undergo an MRI scan and who had a complete resection of 1–3 brain metastases (the maximum diameter of the resection cavity had to be ≤4cm). Patients were assigned randomly to either SRS treatment of the resection cavity (within 30 days of surgery) or observation (OBS). Patients were stratified by histology, tumor size, and number of metastases. Patients were recruited at a single tertiary cancer center. The primary endpoint was time to local recurrence in the resection cavity assessed by blinded central review of brain MRI scans in the intention-to-treat population. The trial was registered at clinicaltrials.gov (Trial NCT00950001, status: closed to new participants). Findings Between 8/13/2009 and 2/16/2016, 132 patients were randomized to OBS (N=68) or SRS (N=64), with 128 patients available for analysis. We stratified by metastasis size (maximum diameter of ≥3 cm vs. <3 cm), histology (melanoma vs. other), and number of metastases (one vs. two or three). The 12-month local tumor recurrence-free rate was 43% (OBS) (95% CI 31%–59%) and 72% (SRS) (95% CI 60%–87%) (hazard ratio [HR] 0.46, 95% confidence interval [CI] 0.24–0.88, p=0.015). Interpretation This prospective randomized trial of patients undergoing surgical resection for 1–3 brain metastases indicates that SRS administered to the resection cavity significantly lowers local recurrence compared to observation alone. Thus, the use of SRS after brain metastasis resection is an alternative to WBRT.
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Affiliation(s)
- Anita Mahajan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Salmaan Ahmed
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mary Frances McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey S Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jing Li
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paul Brown
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen Settle
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Frederick F Lang
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nicholas Levine
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susan McGovern
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Erik Sulman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ian E McCutcheon
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Syed Azeem
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Daniel Cahill
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Claudio Tatsui
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amy B Heimberger
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sherise Ferguson
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amol Ghia
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Franco Demonte
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shaan Raza
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nandita Guha-Thakurta
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - James Yang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Raymond Sawaya
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kenneth R Hess
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ganesh Rao
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Jensen G, Tang C, Hess KR, Bishop AJ, Pan HY, Li J, Yang JN, Tannir NM, Amini B, Tatsui C, Rhines L, Brown PD, Ghia A. (S049) Internal Validation of the Prognostic Index for Spine Metastasis (PRISM) for Stratifying Survival in Patients Treated With Spinal Stereotactic Radiosurgery. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.02.085] [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: 10/19/2022]
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19
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Fang P, Jiang W, Allen P, Glitza I, Guha N, Hwu P, Ghia A, Phan J, Mahajan A, Tawbi H, Li J. Radiation necrosis with stereotactic radiosurgery combined with CTLA-4 blockade and PD-1 inhibition for treatment of intracranial disease in metastatic melanoma. J Neurooncol 2017; 133:595-602. [DOI: 10.1007/s11060-017-2470-4] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 05/06/2017] [Indexed: 12/01/2022]
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20
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Redmond KJ, Robertson S, Lo SS, Soltys SG, Ryu S, McNutt T, Chao ST, Yamada Y, Ghia A, Chang EL, Sheehan J, Sahgal A. Consensus Contouring Guidelines for Postoperative Stereotactic Body Radiation Therapy for Metastatic Solid Tumor Malignancies to the Spine. Int J Radiat Oncol Biol Phys 2016; 97:64-74. [PMID: 27843035 DOI: 10.1016/j.ijrobp.2016.09.014] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 08/31/2016] [Accepted: 09/10/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To develop consensus contouring guidelines for postoperative stereotactic body radiation therapy (SBRT) for spinal metastases. METHODS AND MATERIALS Ten spine SBRT specialists representing 10 international centers independently contoured the clinical target volume (CTV), planning target volume (PTV), spinal cord, and spinal cord planning organ at risk volume (PRV) for 10 representative clinical scenarios in postoperative spine SBRT for metastatic solid tumor malignancies. Contours were imported into the Computational Environment for Radiotherapy Research. Agreement between physicians was calculated with an expectation minimization algorithm using simultaneous truth and performance level estimation with κ statistics. Target volume definition guidelines were established by finding optimized confidence level consensus contours using histogram agreement analyses. RESULTS Nine expert radiation oncologists and 1 neurosurgeon completed contours for all 10 cases. The mean sensitivity and specificity were 0.79 (range, 0.71-0.89) and 0.94 (range, 0.90-0.99) for the CTV and 0.79 (range, 0.70-0.95) and 0.92 (range, 0.87-0.99) for the PTV), respectively. Mean κ agreement, which demonstrates the probability that contours agree by chance alone, was 0.58 (range, 0.43-0.70) for CTV and 0.58 (range, 0.37-0.76) for PTV (P<.001 for all cases). Optimized consensus contours were established for all patients with 80% confidence interval. Recommendations for CTV include treatment of the entire preoperative extent of bony and epidural disease, plus immediately adjacent bony anatomic compartments at risk of microscopic disease extension. In particular, a "donut-shaped" CTV was consistently applied in cases of preoperative circumferential epidural extension, regardless of extent of residual epidural extension. Otherwise more conformal anatomic-based CTVs were determined and described. Spinal instrumentation was consistently excluded from the CTV. CONCLUSIONS We provide consensus contouring guidelines for common scenarios in postoperative SBRT for spinal metastases. These consensus guidelines are subject to clinical validation.
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Affiliation(s)
- Kristin J Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland.
| | - Scott Robertson
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Simon S Lo
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Scott G Soltys
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford University, Stanford, California
| | - Samuel Ryu
- Department of Radiation Oncology, Stony Brook Cancer Center, Stony Brook, New York
| | - Todd McNutt
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Samuel T Chao
- Department of Radiation Oncology, Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Cleveland Clinic, Cleveland, Ohio
| | - Yoshiya Yamada
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Amol Ghia
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Eric L Chang
- Department of Radiation Oncology, Norris Cancer Center and Keck School of Medicine at University of Southern California, Los Angeles, California
| | - Jason Sheehan
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
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Yang J, Wang X, Zhao Z, Yang J, Zhang Y, Court L, Li J, Brown P, Ghia A. SU-F-J-128: Dosimetric Impact of Esophagus Motion in Spine Stereotactic Body Radiotherapy. Med Phys 2016. [DOI: 10.1118/1.4956036] [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: 11/07/2022] Open
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Wang X, Zhao Z, Yang J, Yang J, McAleer M, Brown P, Li J, Ghia A. SU-F-T-642: Sub Millimeter Accurate Setup of More Than Three Vertebrae in Spinal SBRT with 6D Couch. Med Phys 2016. [DOI: 10.1118/1.4956827] [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: 11/07/2022] Open
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Phan J, Brown P, Nandita GT, David R, Garden A, Gunn G, Fuller C, Li J, Ghia A, Yang J, Luo D, Su S, Hanna E, DeMonte F. Gamma Knife Stereotactic Radiosurgery for Trigeminal Neuralgia Secondary to Recurrent Skull Base Malignancies. J Neurol Surg B Skull Base 2016. [DOI: 10.1055/s-0036-1579906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Tang C, Hess K, Bishop AJ, Pan HY, Christensen EN, Yang JN, Tannir N, Amini B, Tatsui C, Rhines L, Brown P, Ghia A. Creation of a Prognostic Index for Spine Metastasis to Stratify Survival in Patients Treated With Spinal Stereotactic Radiosurgery: Secondary Analysis of Mature Prospective Trials. Int J Radiat Oncol Biol Phys 2015; 93:118-25. [PMID: 26130231 DOI: 10.1016/j.ijrobp.2015.04.050] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 04/25/2015] [Accepted: 04/28/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE There exists uncertainty in the prognosis of patients following spinal metastasis treatment. We sought to create a scoring system that stratifies patients based on overall survival. METHODS AND MATERIALS Patients enrolled in 2 prospective trials investigating stereotactic spine radiation surgery (SSRS) for spinal metastasis with ≥ 3-year follow-up were analyzed. A multivariate Cox regression model was used to create a survival model. Pretreatment variables included were race, sex, age, performance status, tumor histology, extent of vertebrae involvement, previous therapy at the SSRS site, disease burden, and timing of diagnosis and metastasis. Four survival groups were generated based on the model-derived survival score. RESULTS Median follow-up in the 206 patients included in this analysis was 70 months (range: 37-133 months). Seven variables were selected: female sex (hazard ratio [HR] = 0.7, P=.02), Karnofsky performance score (HR = 0.8 per 10-point increase above 60, P = .007), previous surgery at the SSRS site (HR = 0.7, P=.02), previous radiation at the SSRS site (HR = 1.8, P=.001), the SSRS site as the only site of metastatic disease (HR = 0.5, P=.01), number of organ systems involved outside of bone (HR = 1.4 per involved system, P<.001), and >5 year interval from initial diagnosis to detection of spine metastasis (HR = 0.5, P < .001). The median survival among all patients was 25.5 months and was significantly different among survival groups (in group 1 [excellent prognosis], median survival was not reached; group 2 reached 32.4 months; group 3 reached 22.2 months; and group 4 [poor prognosis] reached 9.1 months; P < .001). Pretreatment symptom burden was significantly higher in the patient group with poor survival than in the group with excellent survival (all metrics, P < .05). CONCLUSIONS We developed the prognostic index for spinal metastases (PRISM) model, a new model that identified patient subgroups with poor and excellent prognoses.
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Affiliation(s)
- Chad Tang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kenneth Hess
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Andrew J Bishop
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hubert Y Pan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eva N Christensen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - James N Yang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nizar Tannir
- Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Behrang Amini
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Claudio Tatsui
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Laurence Rhines
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Paul Brown
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Amol Ghia
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Farnia B, Allen P, Brown P, Khatua S, Levine N, Mahajan A, Ghia A. Clinical Outcomes and Patterns of Failure in Pineoblastoma: A 30-Year Single Institution Experience. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.661] [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: 11/28/2022]
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Anwar M, Lupo J, Molinaro A, Clarke J, Butowski N, Prados M, Chang S, HaasKogan D, Nelson S, Ashman J, Drazkowski J, Zimmerman R, Lidner T, Giannini C, Porter A, Patel N, Atean I, Shin N, Toltz A, Laude C, Freeman C, Seuntjens J, Roberge D, Back M, Kastelan M, Guo L, Wheeler H, Beauchesne P, Faure G, Noel G, Schmitt T, Martin L, Jadaud E, Carnin C, Bowers J, Bennion N, Lomas H, Spencer K, Richardson M, McAllister W, Sheehan J, Schlesinger D, Kersh R, Brower J, Gans S, Hartsell W, Goldman S, Chang JHC, Mohammed N, Siddiqui M, Gondi V, Christensen E, Klawikowski S, Garg A, McAleer M, Rhines L, Yang J, Brown P, Chang E, Settle S, Ghia A, Edson M, Fuller GN, Allen P, Li J, Garsa A, Badiyan S, Simpson J, Dowling J, Rich K, Chicoine M, Leuthardt E, Kim A, Robinson C, Gill B, Peskorski D, Lalonde R, Huq MS, Flickinger J, Graff A, Clerkin P, Smith H, Isaak R, Dinh J, Grosshans D, Allen P, de Groot J, McGovern S, McAleer M, Gilbert M, Brown P, Mahajan A, Gupta T, Mohanty S, Kannan S, Jalali R, Hardie J, Laack N, Kizilbash S, Buckner J, Giannini C, Uhm J, Parney I, Jenkins R, Decker P, Voss J, Hiramatsu R, Kawabata S, Furuse M, Niyatake SI, Kuroiwa T, Suzuki M, Ono K, Hobbs C, Vallow L, Peterson J, Jaeckle K, Heckman M, Bhupendra R, Horowitz D, Wuu CS, Feng W, Drassinower D, Lasala A, Lassman A, Wang T, Indelicato D, Rotondo R, Bradley J, Sandler E, Aldana P, Mendenhall N, Marcus R, Kabarriti R, Mourad WF, Mejia DM, Glanzman J, Patel S, Young R, Bernstein M, Hong L, Fox J, LaSala P, Kalnicki S, Garg M, Khatua S, Hou P, Wolff J, Hamilton J, Zaky W, Mahajan A, Ketonen L, Kim SH, Lee SR, Ji, Oh Y, Krishna U, Shah N, Pathak R, Gupta T, Lila A, Menon P, Goel A, Jalali R, Lall R, Lall R, Smith T, Schumacher A, McCaslin A, Kalapurakal J, Chandler J, Magnuson W, Robins HI, Mohindra P, Howard S, Mahajan A, Manfredi D, Rogers CL, Palmer M, Hillebrandt E, Bilton S, Robinson G, Velasco K, Mehta M, McGregor J, Grecula J, Ammirati M, Pelloski C, Lu L, Gupta N, Bell S, Moller S, Law I, Rosenschold PMA, Costa J, Poulsen HS, Engelholm SA, Morrison A, Cuglievan B, Khatib Z, Mourad WF, Kabarriti R, Young R, Santiago T, Blakaj DM, Welch M, Graber J, Patel S, Hong LX, Patel A, Tandon A, Bernstein MB, Shourbaji RA, Glanzman J, Kinon MD, Fox JL, Lasala P, Kalnicki S, Garg MK, Nicholas S, Salvatori R, Lim M, Redmond K, Quinones A, Gallia G, Rigamonti D, Kleinberg L, Patel S, Mourad W, Young R, Kabarriti R, Santiago T, Glanzman J, Bernstein M, Patel A, Yaparpalvi R, Hong L, Fox J, LaSala P, Kalnicki S, Garg M, Redmond K, Mian O, Degaonkar M, Sair H, Terezakis S, Kleinberg L, McNutt T, Wharam M, Mahone M, Horska A, Rezvi U, Melian E, Surucu M, Mescioglu I, Prabhu V, Clark J, Anderson D, Robbins J, Yechieli R, Ryu S, Ruge MI, Suchorska B, Hamisch C, Mahnkopf K, Lehrke R, Treuer H, Sturm V, Voges J, Sahgal A, Al-Omair A, Masucci L, Masson-Cote L, Atenafu E, Letourneau D, Yu E, Rampersaud R, Lewis S, Yee A, Thibault I, Fehlings M, Shi W, Palmer J, Li J, Kenyon L, Glass J, Kim L, Werner-wasik M, Andrews D, Susheela S, Revannasiddaiah S, Muzumder S, Mallarajapatna G, Basavalingaiah A, Gupta M, Kallur K, Hassan M, Bilimagga R, Tamura K, Aoyagi M, Ando N, Ogishima T, Yamamoto M, Ohno K, Maehara T, Xu Z, Vance ML, Schlesinger D, Sheehan J, Young R, Blakaj D, Kinon MD, Mourad W, LaSala PA, Hong L, Kalnicki S, Garg M, Young R, Mourad W, Patel S, Fox J, LaSala PA, Hong L, Graber JJ, Santiago T, Kalnicki S, Garg M, Zimmerman AL, Vogelbaum MA, Barnett GH, Murphy ES, Suh JH, Angelov L, Reddy CA, Chao ST. RADIATION THERAPY. Neuro Oncol 2013; 15:iii178-iii188. [PMCID: PMC3823902 DOI: 10.1093/neuonc/not187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023] Open
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Gondi V, Tome W, Marsh J, Struck A, Ghia A, Turian J, Bentzen S, Kuo J, Khuntia D, Mehta M. Estimated Risk of Perihippocampal Disease Progression after Hippocampal Avoidance during Whole-brain Radiotherapy: Comprehensive Multi-institution Review of 371 Patients with 1133 Brain Metastases. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ghia A, Tomé WA, Thomas S, Cannon G, Khuntia D, Kuo JS, Mehta MP. Distribution of Brain Metastases in Relation to the Hippocampus: Implications for Neurocognitive Functional Preservation. Int J Radiat Oncol Biol Phys 2007; 68:971-7. [PMID: 17446005 DOI: 10.1016/j.ijrobp.2007.02.016] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.4] [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: 11/09/2006] [Revised: 02/09/2007] [Accepted: 02/09/2007] [Indexed: 01/24/2023]
Abstract
PURPOSE With the advent of intensity-modulated radiotherapy, the ability to limit the radiation dose to normal tissue offers an avenue to limit side effects. This study attempted to delineate the distribution of brain metastases with relation to the hippocampus for the purpose of exploring the viability of tomotherapy-guided hippocampal sparing therapy potentially to reduce neurocognitive deficits from radiation. METHODS AND MATERIALS The pre-radiotherapy T1-weighted, postcontrast axial MR images of 100 patients who received whole brain radiotherapy, stereotactic radiosurgery, or a radiosurgical boost following whole brain radiotherapy between 2002 and 2006 were examined. We contoured brain metastases as well as hippocampi with 5-, 10-, and 15-mm expansion envelopes. RESULTS Of the 272 identified metastases, 3.3% (n = 9) were within 5 mm of the hippocampus, and 86.4% of metastases were greater than 15 mm from the hippocampus (n = 235). The most common location for metastatic disease was the frontal lobe (31.6%, n = 86). This was followed by the cerebellum (24.3%, n = 66), parietal lobe (16.9%, n = 46), temporal lobe (12.9%, n = 35), occipital lobe (7.7%, n = 21), deep brain nuclei (4.0%, n = 11), and brainstem (2.6%, n = 7). CONCLUSIONS Of the 100 patients, 8 had metastases within 5 mm of the hippocampus. Hence, a 5-mm margin around the hippocampus for conformal avoidance whole brain radiotherapy represents an acceptable risk, especially because these patients in the absence of any other intracranial disease could be salvaged using stereotactic radiosurgery. Moreover, we developed a hippocampal sparing tomotherapy plan as proof of principle to verify the feasibility of this therapy in the setting of brain metastases.
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Affiliation(s)
- Amol Ghia
- Department of Human Oncology, University of Wisconsin, Madison, WI 53792, USA
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