1
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Shen H, Huang F, Zhang X, Ojo OA, Li Y, Trummell HQ, Anderson JC, Fiveash J, Bredel M, Yang ES, Willey CD, Chong Z, Bonner JA, Shi LZ. Selective suppression of melanoma lacking IFN-γ pathway by JAK inhibition depends on T cells and host TNF signaling. Nat Commun 2022; 13:5013. [PMID: 36008408 PMCID: PMC9411168 DOI: 10.1038/s41467-022-32754-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 08/16/2022] [Indexed: 11/09/2022] Open
Abstract
Therapeutic resistance to immune checkpoint blockers (ICBs) in melanoma patients is a pressing issue, of which tumor loss of IFN-γ signaling genes is a major underlying mechanism. However, strategies of overcoming this resistance mechanism have been largely elusive. Moreover, given the indispensable role of tumor-infiltrating T cells (TILs) in ICBs, little is known about how tumor-intrinsic loss of IFN-γ signaling (IFNγR1KO) impacts TILs. Here, we report that IFNγR1KO melanomas have reduced infiltration and function of TILs. IFNγR1KO melanomas harbor a network of constitutively active protein tyrosine kinases centered on activated JAK1/2. Mechanistically, JAK1/2 activation is mediated by augmented mTOR. Importantly, JAK1/2 inhibition with Ruxolitinib selectively suppresses the growth of IFNγR1KO but not scrambled control melanomas, depending on T cells and host TNF. Together, our results reveal an important role of tumor-intrinsic IFN-γ signaling in shaping TILs and manifest a targeted therapy to bypass ICB resistance of melanomas defective of IFN-γ signaling.
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Affiliation(s)
- Hongxing Shen
- Department of Radiation Oncology, Heersink School of Medicine, University of Alabama at Birmingham (UAB-SOM), Birmingham, AL, 35233, USA
| | - Fengyuan Huang
- Department of Genetics and Informatics Institute, UAB-SOM, Birmingham, AL, USA
| | - Xiangmin Zhang
- Department of Pharmaceutical Sciences, Wayne State University, Detroit, MI, 48201, USA
| | - Oluwagbemiga A Ojo
- Department of Radiation Oncology, Heersink School of Medicine, University of Alabama at Birmingham (UAB-SOM), Birmingham, AL, 35233, USA
| | - Yuebin Li
- Department of Radiation Oncology, Heersink School of Medicine, University of Alabama at Birmingham (UAB-SOM), Birmingham, AL, 35233, USA
| | - Hoa Quang Trummell
- Department of Radiation Oncology, Heersink School of Medicine, University of Alabama at Birmingham (UAB-SOM), Birmingham, AL, 35233, USA
| | - Joshua C Anderson
- Department of Radiation Oncology, Heersink School of Medicine, University of Alabama at Birmingham (UAB-SOM), Birmingham, AL, 35233, USA
| | - John Fiveash
- Department of Radiation Oncology, Heersink School of Medicine, University of Alabama at Birmingham (UAB-SOM), Birmingham, AL, 35233, USA.,O'Neal Comprehensive Cancer Center, UAB-SOM, Birmingham, AL, USA
| | - Markus Bredel
- Department of Radiation Oncology, Heersink School of Medicine, University of Alabama at Birmingham (UAB-SOM), Birmingham, AL, 35233, USA.,O'Neal Comprehensive Cancer Center, UAB-SOM, Birmingham, AL, USA
| | - Eddy S Yang
- Department of Radiation Oncology, Heersink School of Medicine, University of Alabama at Birmingham (UAB-SOM), Birmingham, AL, 35233, USA.,O'Neal Comprehensive Cancer Center, UAB-SOM, Birmingham, AL, USA
| | - Christopher D Willey
- Department of Radiation Oncology, Heersink School of Medicine, University of Alabama at Birmingham (UAB-SOM), Birmingham, AL, 35233, USA.,O'Neal Comprehensive Cancer Center, UAB-SOM, Birmingham, AL, USA
| | - Zechen Chong
- Department of Genetics and Informatics Institute, UAB-SOM, Birmingham, AL, USA. .,O'Neal Comprehensive Cancer Center, UAB-SOM, Birmingham, AL, USA.
| | - James A Bonner
- Department of Radiation Oncology, Heersink School of Medicine, University of Alabama at Birmingham (UAB-SOM), Birmingham, AL, 35233, USA. .,O'Neal Comprehensive Cancer Center, UAB-SOM, Birmingham, AL, USA.
| | - Lewis Zhichang Shi
- Department of Radiation Oncology, Heersink School of Medicine, University of Alabama at Birmingham (UAB-SOM), Birmingham, AL, 35233, USA. .,O'Neal Comprehensive Cancer Center, UAB-SOM, Birmingham, AL, USA. .,Department of Microbiology, UAB-SOM, Birmingham, AL, USA. .,Department of Pharmacology and Toxicology, UAB-SOM, Birmingham, AL, USA. .,Programs in Immunology, UAB-SOM, Birmingham, AL, USA.
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2
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Mooney J, Salehani A, Erickson N, Thomas E, Ilyas A, Rahm S, Eustace N, Maleknia P, Yousuf O, Bredel M, Fiveash J, Dobelbower C, Fisher W. Stereotactic radiosurgery for ruptured versus unruptured intracranial arteriovenous malformations. Surg Neurol Int 2022; 13:194. [PMID: 35673645 PMCID: PMC9168326 DOI: 10.25259/sni_86_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/22/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
There are a limited data examining the effects of prior hemorrhage on outcomes after stereotactic radiosurgery (SRS). The goal of this study was to identify risk factors for arteriovenous malformation (AVM) rupture and compare outcomes, including post-SRS hemorrhage, between patients presenting with ruptured and unruptured AVMs.
Methods:
A retrospective review of consecutive patients undergoing SRS for intracranial AVMs between 2009 and 2019 at our institution was conducted. Chi-square and multivariable logistic regression analyses were utilized to identify patient and AVM factors associated with AVM rupture at presentation and outcomes after SRS including the development of recurrent hemorrhage in both ruptured and unruptured groups.
Results:
Of 210 consecutive patients with intracranial AVMs treated with SRS, 73 patients (34.8%) presented with AVM rupture. Factors associated with AVM rupture included smaller AVM diameter, deep venous drainage, cerebellar location, and the presence of intranidal aneurysms (P < 0.05). In 188 patients with adequate follow-up time (mean 42.7 months), the overall post-SRS hemorrhage rate was 8.5% and was not significantly different between ruptured and unruptured groups (10.3 vs. 7.5%, P = 0.51). There were no significant differences in obliteration rate, time to obliteration, or adverse effects requiring surgery or steroids between unruptured and ruptured groups.
Conclusion:
Smaller AVM size, deep venous drainage, and associated intranidal aneurysms were associated with rupture at presentation. AVM rupture at presentation was not associated with an increased risk of recurrent hemorrhage or other complication after SRS when compared to unruptured AVM presentation. Obliteration rates were similar between ruptured and unruptured groups.
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Affiliation(s)
- James Mooney
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, United States,
| | - Arsalaan Salehani
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, United States,
| | - Nicholas Erickson
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, United States,
| | - Evan Thomas
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Adeel Ilyas
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, United States,
| | - Sage Rahm
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, United States,
| | - Nicholas Eustace
- Department of School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States,
| | - Pedram Maleknia
- Department of School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States,
| | - Omer Yousuf
- Department of School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States,
| | - Markus Bredel
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - John Fiveash
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Chris Dobelbower
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Winfield Fisher
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, United States,
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3
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Erickson N, Mooney J, Salehani A, Thomas E, Ilyas A, Rahm S, Maleknia P, Yousuf O, Fiveash J, Dobelbower C, Fisher WS. Predictive Factors for AVM Obliteration after Stereotactic Radiosurgery: A Single Center Study. World Neurosurg 2022; 160:e529-e536. [PMID: 35077887 DOI: 10.1016/j.wneu.2022.01.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/13/2022] [Accepted: 01/15/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND SRS is particularly useful for deep AVMs in eloquent territory with a high associated surgical risk. Prior studies have demonstrated high rates of AVM obliteration with SRS typically ranging 60-80% in a latency period of 2-4 years for complete obliteration. Studies have identified several factors associated with successful obliteration of the AVM nidus, however, these present inconsistent and conflicting data. OBJECTIVE To present a single center study examining factors associated with successful obliteration of AVMs treated with SRS. METHODS We performed a retrospective review of 210 consecutive patients undergoing SRS for brain AVMs between 2010 and 2019 at our institution. Chi square and logistic regression analyses were utilized to identify patient and AVM factors associated with successful obliteration. RESULTS Younger age (p=0.034) and prior embolization (p=0.012) were associated with complete obliteration. Figure 2 demonstrates survival curves for those with complete obliteration comparing those with prior embolization (n = 6) to those without prior embolization (n = 182). The presence of coronary artery disease (CAD) was associated with incomplete obliteration (p=0.04). There were no AVM characteristics statistically associated with complete obliteration although superficial venous drainage (p=0.08) and frontal location (p=0.06) trended towards significance. CONCLUSIONS Successful obliteration of the AVM nidus was significantly associated with younger age and prior embolization. The presence of coronary artery disease negatively affected obliteration rates. These results add to the mixed results seen in the literature and emphasize the need for continued studies to delineate more specific patient and AVM factors that contribute to successful obliteration.
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Affiliation(s)
- Nicholas Erickson
- Department of Neurosurgery, University of Alabama at Birmingham, AL, USA.
| | - James Mooney
- Department of Neurosurgery, University of Alabama at Birmingham, AL, USA
| | - Arsalaan Salehani
- Department of Neurosurgery, University of Alabama at Birmingham, AL, USA
| | - Evan Thomas
- Department of Radiation Oncology, University of Alabama at Birmingham, AL, USA
| | - Adeel Ilyas
- Department of Neurosurgery, University of Alabama at Birmingham, AL, USA
| | - Sage Rahm
- Department of Neurosurgery, University of Alabama at Birmingham, AL, USA
| | - Pedram Maleknia
- School of Medicine, University of Alabama at Birmingham, AL, USA
| | - Omer Yousuf
- School of Medicine, University of Alabama at Birmingham, AL, USA
| | - John Fiveash
- Department of Radiation Oncology, University of Alabama at Birmingham, AL, USA
| | - Chris Dobelbower
- Department of Radiation Oncology, University of Alabama at Birmingham, AL, USA
| | - Winfield S Fisher
- Department of Neurosurgery, University of Alabama at Birmingham, AL, USA
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4
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Mooney J, Erickson N, Salehani A, Thomas E, Ilyas A, Rahm S, Eustace N, Maleknia P, Yousuf O, Saccomano B, Bredel M, Fiveash J, Dobelbower C, Fisher WS. Seizure Rates After Stereotactic Radiosurgery for Cerebral AVMs: A Single Center Study. World Neurosurg 2021; 158:e583-e591. [PMID: 34775089 DOI: 10.1016/j.wneu.2021.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/05/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Seizure control after stereotactic radiosurgery (SRS) for arteriovenous malformations (AVMs) is an area of growing interest, with previous studies reporting up to 70% seizure freedom after treatment. The goals of this study were to identify specific patient and AVM characteristics associated with seizure presentation and seizure outcomes after SRS treatment. METHODS A retrospective review of consecutive patients undergoing SRS for brain AVMs between 2009 and 2019 at our institution was conducted. Chi-squared and logistic regression analyses were utilized to identify patient and AVM factors associated with preoperative seizure presentation and development of new onset seizures after SRS. RESULTS Two hundred ten consecutive patients presenting with AVMs treated with SRS were reviewed. Factors associated with seizure presentation included larger AVM size (P = 0.02), superficial venous drainage (P < 0.05), and parietal location (P = 0.04). Of 188 patients with follow-up (90%), 30 patients presented with seizures and 14 (47%) were seizure-free post-SRS. Of 158 patients presenting without seizure, 29 (18%) developed de novo seizures during follow-up. De novo post-SRS seizures were associated with prior craniotomy for resection of AVM (P = 0.04), post-treatment hemorrhage (P = 0.02), parietal location (P = 0.05), adverse effect requiring steroids (P < 0.01), and adverse effect requiring surgery (P < 0.01). CONCLUSIONS Seizures are a common presentation of brain AVMs and can be treated effectively with SRS. However, seizures can also be a complication of SRS and are associated with post-treatment hemorrhage, edema, and need for future open surgery.
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Affiliation(s)
- James Mooney
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama, USA.
| | - Nicholas Erickson
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama, USA
| | - Arsalaan Salehani
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama, USA
| | - Evan Thomas
- Department of Radiation Oncology, University of Alabama at Birmingham, Alabama, USA
| | - Adeel Ilyas
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama, USA
| | - Sage Rahm
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama, USA
| | - Nicholas Eustace
- School of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Pedram Maleknia
- School of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Omer Yousuf
- School of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Ben Saccomano
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama, USA
| | - Markus Bredel
- Department of Radiation Oncology, University of Alabama at Birmingham, Alabama, USA
| | - John Fiveash
- Department of Radiation Oncology, University of Alabama at Birmingham, Alabama, USA
| | - Chris Dobelbower
- Department of Radiation Oncology, University of Alabama at Birmingham, Alabama, USA
| | - Winfield S Fisher
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama, USA
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Willhelm G, Del Bene V, Aita S, Gammon M, Gerstenecker A, Fiveash J, Marotta D, Triebel K. NCOG-68. COMPARING COGNITIVE PROFILES OF PERSONS WITH BRAIN AND NON-BRAIN METASTATIC CANCER. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.606] [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
OBJECTIVE
Cognitive impairment in primary cancer and brain metastatic (BM) cancer has been well-documented. However, to date, there are no neuropsychological studies comparing the cognitive profiles of people with BM and non-brain metastatic cancer (NBM). The present study addressed this gap in the literature by comparing the cognitive profiles of participants with BM and NBM.
METHOD
The study sample consisted of 61 BM, 40 NBM, and 37 healthy control (HC) participants. All participants completed the same neuropsychological battery, including tests of processing speed, attention, working memory, expressive language, auditory-verbal memory, and executive functioning.
RESULTS
Both clinical groups showed reduced processing speed, verbal learning/memory, and executive functions. BM participants performed below HC participants across all neuropsychological tests, while NBM participants performed below control participants on tests of processing speed and executive functioning. The clinical groups differed in semantic verbal fluency (NBM > BM). Fifty-seven percent of BM participants had ≥ 3 impaired scores (i.e., ≤ 5th percentile), and 25% of NBM participants had the same level of cognitive impairment.
CONCLUSION
Over half of BM participants were cognitively impaired on at least three neuropsychological tests, and 25% of NBM participants also demonstrated this same level of cognitive impairment. In the BM group, the elevated rate of cognitive dysfunction is likely due to the greater neurologic disease burden posed by brain metastases, while in the NBM group, the cognitive deficits are possibly due to systemic illness and treatment effects.
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Affiliation(s)
| | | | - Stephen Aita
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - John Fiveash
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dario Marotta
- University of Alabama at Birmingham, Birmingham, AL, USA
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6
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Thomas E, Mullins C, Bredel M, Dobelbower M, Willey C, Spencer S, Guthrie B, Riley K, Markert J, Fiveash J, Boggs D. RADT-36. PROSPECTIVELY ASSESSED TUMOR CONTROL AND TOXICITY OF BENIGN INTRACRANIAL PATHOLOGIES TREATED WITH AUTOMATED VMAT RADIOSURGERY – INITIAL 2 YEAR EXPERIENCE WITH FIRST 100 PATIENTS. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.789] [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
HyperArc is a treatment planning technology that automates treatment planning and delivery of single-isocenter VMAT radiosurgery (SRS). The technique generates high quality, rapidly deliverable plans. It is unknown whether HyperArc is effective for commonly-encountered, benign, intracranial conditions managed with SRS. Under IRB-approved prospective registry, we collected data on treatment planning/delivery, and clinical outcomes of non-malignant conditions managed with single-fraction or fractionated SRS since deployment in October 2017.
METHODS
Patients received either single-fraction or fractionated SRS with HyperArc™ (Varian Medical Systems) between October 2017 & October 2019. Patients with < 3 months follow-up were censored. All patients treated received prescription dose to ≥ 99% of gross tumor volume without PTV expansion. All treatments were delivered on Varian Edge linac with 10MV flattening-filter free beam at 2400 MU/min with high-definition (2.5mm) multi-leaf collimator. Standard pathology-specific outcomes and toxicities were assessed. Significant CNS toxicity was defined as Grade 3 or higher event by CTCAE.
RESULTS
Total of 100 targets (min=0.13cc, max=58.9cc) were treated. 55 received single-fraction SRS (12-22Gy), two received 2-fraction fSRS boost (12Gy) following fractionated treatment, and 43 received 5-fraction fSRS (25-30Gy). The most common pathology was meningioma (n=55), followed by AVM (n=18), non-secretory pituitary adenoma (n=12), acoustic schwannoma (n=9), secretory pituitary adenoma (n=3), glomus tumor (n=2), pineocytoma (n=1), and paraganglioma (n=1). Follow-up ranged from 1.2 to 19.5 months (median 7.2). There were three local failures, all in atypical meningiomas. One patient in the cohort experienced ≥Gr3 toxicity. Each radiosurgery session used median of 3 arcs, with median treatment and beam-on time of 12.03 and 2.3 minutes. Plan quality was excellent; median RTOG conformity was 1.15, and median Paddick GI was 3.52.
CONCLUSION
Although HyperArc was developed for automated multiple-metastasis radiosurgery, we found it effective and efficient for benign intracranial indications too. Early clinical outcomes appear congruent with historical controls.
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Affiliation(s)
- Evan Thomas
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Markus Bredel
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Sharon Spencer
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Barton Guthrie
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kristen Riley
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - James Markert
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - John Fiveash
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Drexell Boggs
- University of Alabama at Birmingham, Birmingham, AL, USA
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Coffee E, Tucker Z, Lobbous M, Baskin M, Markert J, Fiveash J, Miller CR, Nabors L. EPID-14. RACIAL DIFFERENCES AND DISPARITIES IN PATIENTS WITH GLIOMAS: A SINGLE COMPREHENSIVE CANCER CENTER EXPERIENCE FROM 2008–2020. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Disparities in healthcare delivery in the United States based on race and socioeconomic status are well-documented. Our study examined these disparities along with demographic differences in patients with gliomas.
METHODS
Data was collected retrospectively from an NCI Comprehensive Cancer Center between 2008–2020; 163 African-American patients and 1207 non-Hispanic white patients were included. Demographic variables were entered as predictors of tumor grade and type in an ANOVA model and multinomial logistic regression, respectively. A MANOVA model was used to assess differences in treatments received. Predictors of outcome were determined using cox regression.
RESULTS
Significant differences (p< 0.05) were found between African-American and non-Hispanic white patient groups in; age at diagnosis (48.68 vs 56.12 years, respectively), male/female gender ratio (0.75 vs 1.22), annual household income ($29,442 vs $40,028), insurance type (53.1% private and 42% public vs 63.4% private and 33.6% public) and marital status (43% married vs 74.1%). When controlling for these, there were no significant differences in tumor grade, type, MGMT methylation or IDH1 alteration statuses. Race alone did not predict treatment received, however, two-way interactions between race and other variables did. While gender differences in resection were small for non-Hispanic white controls, resection took place more often in African-American females than males (F = 4.779, p = 0.029). The deleterious effect of increased age on overall survival was diminished in African-Americans (B = -0.033, p < 0.001), while the effect of tumor grade was more pronounced (B = 0.595, p < 0.001).
DISCUSSION
This study suggests that disparities in outcomes are identified when race is considered within the context of other demographic, socioeconomic, and clinical factors. Moreover, these observations demonstrate the need for further studies into intersectional effects on treatment access and clinical outcomes, along with aggressive countermeasures to ensure equity of care.
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Affiliation(s)
| | | | - Mina Lobbous
- University of Alabama Birmingham, Birmingham, AL, USA
| | - Monica Baskin
- University of Alabama Birmingham, Birmingham, AL, USA
| | - James Markert
- University of Alabama Birmingham, Birmingham, AL, USA
| | - John Fiveash
- University of Alabama Birmingham, Birmingham, AL, USA
| | - C Ryan Miller
- University of Alabama Birmingham, Birmingham, AL, USA
| | - Louis Nabors
- University of Alabama Birmingham, Birmingham, AL, USA
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8
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Bernstock JD, Bag AK, Fiveash J, Kachurak K, Elsayed G, Chagoya G, Gessler F, Valdes PA, Madan-Swain A, Whitley R, Markert JM, Gillespie GY, Johnston JM, Friedman GK. Design and Rationale for First-in-Human Phase 1 Immunovirotherapy Clinical Trial of Oncolytic HSV G207 to Treat Malignant Pediatric Cerebellar Brain Tumors. Hum Gene Ther 2020; 31:1132-1139. [PMID: 32657154 DOI: 10.1089/hum.2020.101] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Brain tumors represent the most common pediatric solid neoplasms and leading cause of childhood cancer-related morbidity and mortality. Although most adult brain tumors are supratentorial and arise in the cerebrum, the majority of pediatric brain tumors are infratentorial and arise in the posterior fossa, specifically the cerebellum. Outcomes from malignant cerebellar tumors are unacceptable despite aggressive treatments (surgery, radiation, and/or chemotherapy) that are harmful to the developing brain. Novel treatments/approaches such as oncolytic virotherapy are urgently needed. Preclinical and prior clinical studies suggest that genetically engineered oncolytic herpes simplex virus (HSV-1) G207 can safely target cerebellar malignancies and has potential to induce an antitumor immune response at local and distant sites of disease, including spinal metastases and leptomeningeal disease. Herein, we outline the rationale, design, and significance of a first-in-human immunotherapy Phase 1 clinical trial targeting recurrent cerebellar malignancies with HSV G207 combined with a single low-dose of radiation (5 Gy), designed to enhance virus replication and innate and adaptive immune responses. We discuss the unique challenges of inoculating virus through intratumoral catheters into cerebellar tumors. The trial utilizes a single arm open-label traditional 3 + 3 design with four dose cohorts. The primary objective is to assess safety and tolerability of G207 with radiation in recurrent/progressive malignant pediatric cerebellar tumors. After biopsy to prove recurrence/progression, one to four intratumoral catheters will be placed followed by a controlled-rate infusion of G207 for 6 h followed by the removal of catheters at the bedside. Radiation will be given within 24 h of virus inoculation. Patients will be monitored closely for toxicity and virus shedding. Efficacy will be assessed by measuring radiographic response, performance score, progression-free and overall survival, and quality of life. The data obtained will be invaluable in our efforts to produce more effective and less toxic therapies for children with high-grade brain tumors.
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Affiliation(s)
- Joshua D Bernstock
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA
| | - Asim K Bag
- Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - John Fiveash
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kara Kachurak
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Galal Elsayed
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gustavo Chagoya
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Florian Gessler
- Department for Neurosurgery, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Pablo A Valdes
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA
| | - Avi Madan-Swain
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Richard Whitley
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - James M Markert
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - G Yancey Gillespie
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - James M Johnston
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gregory K Friedman
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
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9
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Gerstenecker A, Gammon M, Marotta D, Fiveash J, Nabors B, Mulhauser K, Triebel K. Clinical correlates of the ability to consent to research participation in brain metastasis. Psychooncology 2020; 29:1655-1661. [PMID: 33463869 DOI: 10.1002/pon.5487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 06/30/2020] [Accepted: 07/07/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Impairment in the ability to provide informed consent is common in persons with brain metastasis. However, little is known about what factors contribute to this impairment in the patient group. Our objective is to determine if the associations between demographic, cognitive, and clinical variables correlate with the ability to provide informed consent in persons with brain metastasis. METHODS We administered a comprehensive neuropsychological battery to a group of 61 persons with brain metastasis. Demographic and clinical information was also collected. All diagnoses were made by board-certified oncologists and were verified histologically. Statistical analyses included Pearson's product-moment correlations, point biserial correlations, and linear regression. RESULTS Results indicated that combinations of education, verbal memory, executive function, whole brain radiation therapy, and chemotherapy affected various aspects of the ability to provide informed consent. Subsequent regression models demonstrated that these variables contributed a significant amount of shared variance to the ability to provide informed consent. CONCLUSION We found that the ability of persons with brain metastasis to provide informed consent is a cognitively complex ability that is also affected by education and treatment variables. This information can help clinical researchers in identifying persons with brain metastasis at risk of an impaired ability to provide informed consent and aid in the consenting process.
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Affiliation(s)
- Adam Gerstenecker
- Department of Neurology, Division of Neuropsychology, University of Alabama, Birmingham, Alabama, USA.,Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Alzheimer's Disease Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Meredith Gammon
- Department of Neurology, Division of Neuropsychology, University of Alabama, Birmingham, Alabama, USA
| | - Dario Marotta
- Department of Neurology, Division of Neuropsychology, University of Alabama, Birmingham, Alabama, USA
| | - John Fiveash
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Burt Nabors
- Department of Neurology, Division of Neuropsychology, University of Alabama, Birmingham, Alabama, USA.,O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kyler Mulhauser
- Department of Neurology, Division of Neuropsychology, University of Alabama, Birmingham, Alabama, USA
| | - Kristen Triebel
- Department of Neurology, Division of Neuropsychology, University of Alabama, Birmingham, Alabama, USA.,Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham, Birmingham, Alabama, USA.,O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
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10
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Mulhauser K, Marotta DA, Gerstenecker A, Wilhelm G, Myers T, Gammon M, Vance DE, Nabors B, Fiveash J, Triebel K. Capacity to consent to research participation in adults with metastatic cancer: comparisons of brain metastasis, non-CNS metastasis, and healthy controls. Neurooncol Pract 2020; 7:439-445. [PMID: 32765894 DOI: 10.1093/nop/npaa008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background To evaluate the ability of individuals with metastatic cancer to provide informed consent to research participation, we used a structured vignette-based interview to measure 4 consenting standards across 3 participant groups. Methods Participants included 61 individuals diagnosed with brain metastasis, 41 individuals diagnosed with non-CNS metastasis, and 17 cognitively intact healthy controls. All groups were evaluated using the Capacity to Consent to Research Instrument (CCRI), a performance-based measure of research consent capacity. The ability to provide informed consent to participate in research was evaluated across 4 consent standards: expressing choice, appreciation, reasoning, and understanding. Capacity performance ratings (intact, mild/moderate impairment, severe impairment) were identified based on control group performance. Results Results revealed that the brain metastasis group performed significantly lower than healthy controls on the consent standard of understanding, while both metastatic cancer groups performed below controls on the consent standard of reasoning. Both metastatic cancer groups performed similar to controls on the standards of appreciation and expressing choice. Approximately 60% of the brain metastasis group, 54% of the non-CNS metastasis group, and 18% of healthy controls showed impaired research consent capacity. Conclusions Our findings, using a performance-based assessment, are consistent with other research indicating that the research consent process may be overly cumbersome and confusing. This, in turn, may lead to research consent impairment not only in patient groups but also in some healthy adults with intact cognitive ability.
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Affiliation(s)
- Kyler Mulhauser
- Department of Neurology, Division of Neuropsychology, University of Alabama at Birmingham, US.,O'Neal Comprehensive Cancer Center at UAB, Birmingham, Alabama, US
| | - Dario A Marotta
- Department of Neurology, Division of Neuropsychology, University of Alabama at Birmingham, US.,O'Neal Comprehensive Cancer Center at UAB, Birmingham, Alabama, US.,Alabama College of Osteopathic Medicine, Dothan, Alabama, US
| | - Adam Gerstenecker
- Department of Neurology, Division of Neuropsychology, University of Alabama at Birmingham, US
| | - Gabrielle Wilhelm
- Department of Neurology, Division of Neuropsychology, University of Alabama at Birmingham, US.,O'Neal Comprehensive Cancer Center at UAB, Birmingham, Alabama, US
| | - Terina Myers
- Department of Neurology, Division of Neuropsychology, University of Alabama at Birmingham, US.,O'Neal Comprehensive Cancer Center at UAB, Birmingham, Alabama, US
| | - Meredith Gammon
- Department of Neurology, Division of Neuropsychology, University of Alabama at Birmingham, US.,O'Neal Comprehensive Cancer Center at UAB, Birmingham, Alabama, US
| | - David E Vance
- Department of Neurology, Division of Neuropsychology, University of Alabama at Birmingham, US.,O'Neal Comprehensive Cancer Center at UAB, Birmingham, Alabama, US
| | - Burt Nabors
- Department of Neurology, Division of Neuropsychology, University of Alabama at Birmingham, US.,O'Neal Comprehensive Cancer Center at UAB, Birmingham, Alabama, US
| | - John Fiveash
- O'Neal Comprehensive Cancer Center at UAB, Birmingham, Alabama, US.,Department of Radiation Oncology, University of Alabama at Birmingham, US
| | - Kristen Triebel
- Department of Neurology, Division of Neuropsychology, University of Alabama at Birmingham, US.,O'Neal Comprehensive Cancer Center at UAB, Birmingham, Alabama, US
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11
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Gerstenecker A, Gammon M, Marotta D, Fiveash J, Nabors B, Mulhauser K, Triebel K. Using cognition to predict the ability to understand medical treatment in brain and metastatic cancer. Psychooncology 2019; 29:406-412. [DOI: 10.1002/pon.5277] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/21/2019] [Accepted: 10/27/2019] [Indexed: 01/20/2023]
Affiliation(s)
- Adam Gerstenecker
- Department of Neurology, Division of Neuropsychology University of Alabama at Birmingham Birmingham Alabama
- Evelyn F. McKnight Brain Institute University of Alabama at Birmingham Birmingham Alabama
- Alzheimer's Disease Center University of Alabama at Birmingham Birmingham Alabama
| | - Meredith Gammon
- Department of Neurology, Division of Neuropsychology University of Alabama at Birmingham Birmingham Alabama
| | - Dario Marotta
- Department of Neurology, Division of Neuropsychology University of Alabama at Birmingham Birmingham Alabama
| | - John Fiveash
- O'Neal Comprehensive Cancer Center University of Alabama at Birmingham Birmingham Alabama
| | - Burt Nabors
- O'Neal Comprehensive Cancer Center University of Alabama at Birmingham Birmingham Alabama
| | - Kyler Mulhauser
- Department of Neurology, Division of Neuropsychology University of Alabama at Birmingham Birmingham Alabama
| | - Kristen Triebel
- Department of Neurology, Division of Neuropsychology University of Alabama at Birmingham Birmingham Alabama
- Evelyn F. McKnight Brain Institute University of Alabama at Birmingham Birmingham Alabama
- O'Neal Comprehensive Cancer Center University of Alabama at Birmingham Birmingham Alabama
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12
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Hartgerink D, Swinnen A, Roberge D, Nichol A, Zygmanski P, Yin FF, Deblois F, Hurkmans C, Ong CL, Bruynzeel A, Aizer A, Fiveash J, Kirckpatrick J, Guckenberger M, Andratschke N, de Ruysscher D, Popple R, Zindler J. LINAC based stereotactic radiosurgery for multiple brain metastases: guidance for clinical implementation. Acta Oncol 2019; 58:1275-1282. [PMID: 31257960 DOI: 10.1080/0284186x.2019.1633016] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Introduction: Stereotactic radiosurgery (SRS) is a promising treatment option for patients with multiple brain metastases (BM). Recent technical advances have made LINAC based SRS a patient friendly technique, allowing for accurate patient positioning and a short treatment time. Since SRS is increasingly being used for patients with multiple BM, it remains essential that SRS be performed with the highest achievable quality in order to prevent unnecessary complications such as radionecrosis. The purpose of this article is to provide guidance for high-quality LINAC based SRS for patients with BM, with a focus on single isocenter non-coplanar volumetric modulated arc therapy (VMAT). Methods: The article is based on a consensus statement by the study coordinators and medical physicists of four trials which investigated whether patients with multiple BM are better palliated with SRS instead of whole brain radiotherapy (WBRT): A European trial (NCT02353000), two American trials and a Canadian CCTG lead intergroup trial (CE.7). This manuscript summarizes the quality assurance measures concerning imaging, planning and delivery. Results: To optimize the treatment, the interval between the planning-MRI (gadolinium contrast-enhanced, maximum slice thickness of 1.5 mm) and treatment should be kept as short as possible (< two weeks). The BM are contoured based on the planning-MRI, fused with the planning-CT. GTV-PTV margins are minimized or even avoided when possible. To maximize efficiency, the preferable technique is single isocenter (non-)coplanar VMAT, which delivers high doses to the target with maximal sparing of the organs at risk. The use of flattening filter free photon beams ensures a lower peripheral dose and shortens the treatment time. To bench mark SRS treatment plan quality, it is advisable to compare treatment plans between hospitals. Conclusion: This paper provides guidance for quality assurance and optimization of treatment delivery for LINAC-based radiosurgery for patients with multiple BM.
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Affiliation(s)
- Dianne Hartgerink
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ans Swinnen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - David Roberge
- Department of Radiation Oncology, CHUM, Montreal, QC, Canada
| | - Alan Nichol
- Department of Radiation Oncology, CHUM, Montreal, QC, Canada
| | - Piotr Zygmanski
- Brigham and Women’s Hospital, Dana Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Fang-Fang Yin
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Coen Hurkmans
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | - Chin Loon Ong
- Department of Radiation Oncology, HagaZiekenhuis, Den Haag, The Netherlands
| | - Anna Bruynzeel
- Department of Radiotherapy, Cancer Center Amsterdam, VU University medical center, Amsterdam, The Netherlands
| | - Ayal Aizer
- Brigham and Women’s Hospital, Dana Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - John Fiveash
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - John Kirckpatrick
- Brigham and Women’s Hospital, Dana Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zürich, Zürich, Switzerland
| | - Dirk de Ruysscher
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Richard Popple
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jaap Zindler
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Radiation Oncology, Erasmus MC, Rotterdam, The Netherlands
- Holland Proton Therapy Center, Delft, The Netherlands
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13
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Thomas E, Travis R, Boggs DH, Marcrom S, Markert J, Spencer S, Riley K, Strickler S, Bredel M, Willey C, Guthrie B, Fiveash J. RADI-18. STEREOTACTIC RADIOSURGERY OR FRACTIONATED STEREOTACTIC RADIOSURGERY FOR BRAIN METASTASES FROM SMALL CELL LUNG CANCER. Neurooncol Adv 2019. [PMCID: PMC7213255 DOI: 10.1093/noajnl/vdz014.110] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND: Current standard of care (SOC) management of the brain differs between non-small cell lung cancer (NSCLC) & small cell lung cancer (SCLC). For SCLC, WBRT is considered SOC, even for solitary metastasis. In the setting of no-known metastases, prophylactic cranial irradiation (PCI) is considered SOC. SRS is occasionally utilized in SCLC, e.g. in setting of limited metastasis after WBRT/PCI, or limited metastasis after excellent systemic response to extracranial therapy, or if patient declines WBRT. In this study, we sought to understand more about the nature and outcomes of patients with SCLC who received intracranial SRS at our institution. METHODS: We reviewed radiosurgery treatments from 2005 thru 2019 for patients with SCLC who received SRS. Variables included were: time interval between diagnosis/SRS and death, prior WBRT/ PCI, number of targets, performance status, modality (GK or linac), prior surgery, and available follow-up. RESULTS: We identified 92 SRS treatments among 74 patients. 30 received upfront SRS, the remainder as post-WBRT/PCI salvage. Median survival after initial diagnosis was 22.0 months (min = 6.6, max 55.4). Median survival after first SRS was 6.1 months (min = 0.5, max = 40.4). Median recorded KPS was 75.6. Mean number of mets treated was 3.4 (min = 1, max = 12). Prescription dose range was 12 to 20Gy in single fraction, and 25 to 30Gy in five fraction treatment. 53 treatments were performed on Gamma Knife, 37 with linear accelerator. Four patients were treated post-operatively, one patient was treated pre-operatively. CONCLUSIONS: Survival in our cohort of SCLC patients receiving intracranial SRS compared favorably with historical SCLC controls (8-13mo after dx). Future work will seek to clarify whether there is a difference in brain metastasis velocity between patients treated with upfront PCI/WBRT or SRS, and also seek to address the minimum necessary dose to control SCLC metastases.
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Affiliation(s)
- Evan Thomas
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Roman Travis
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - D Hunter Boggs
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sam Marcrom
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - James Markert
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sharon Spencer
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kristen Riley
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Markus Bredel
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Bart Guthrie
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - John Fiveash
- University of Alabama at Birmingham, Birmingham, AL, USA
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14
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Chan M, McTyre E, Soike M, Ayala-Peacock D, Hepel J, Page B, Contessa J, Chiang V, Attia A, Braunstein S, Chung C, Ruiz J, Fiveash J, Chao S, Farris M. RADI-31. MULTI-INSTITUTIONAL VALIDATION OF BRAIN METASTASIS VELOCITY, A RECENTLY DEFINED PREDICTOR OF OUTCOMES FOLLOWING STEREOTACTIC RADIOSURGERY. Neurooncol Adv 2019. [PMCID: PMC7213264 DOI: 10.1093/noajnl/vdz014.123] [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: 11/25/2022] Open
Abstract
INTRODUCTION: Brain metastasis velocity (BMV) is a prognostic metric that describes the recurrence rate of new brain metastases after initial treatment with radiosurgery (SRS). We have previously risk stratified patients into high, intermediate, and low-risk BMV groups, which correlates with overall survival (OS). We sought to externally validate BMV in a multi-institutional setting. METHODS: Patients from nine academic centers were treated with upfront SRS; the validation cohort consisted of data from eight institutions not previously used to define BMV. Patients were classified by BMV into low (< 4 BMV), intermediate (4–13 BMV), and high-risk groups (>13 BMV). Time-to-event outcomes were estimated using the Kaplan-Meier method. Cox proportional hazards methods were used to estimate the effect of BMV and salvage modality on OS. RESULTS: Of 2829 patients, 2092 patients were included in the validation dataset. Of these, 921 (44.0%) experienced distant brain failure (DBF). Median OS from initial SRS was 11.2 mo. Median OS for BMV < 4, BMV 4–13, and BMV > 13 were 12.5 mo, 7.0 mo, and 4.6 mo (p < 0.0001). Compared to initial salvage with WBRT, salvage SRS was associated with improved OS following DBF for BMV < 4 (p = 0.05), BMV 4–13 (p = 0.002) and BMV > 13 (p = 0.0001). CONCLUSIONS: This multi-institutional dataset validates BMV as a predictor of OS following initial SRS. BMV is being utilized in upcoming multi-institutional randomized controlled trials as a stratification variable for salvage whole brain radiation vs salvage SRS after DBF.
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Affiliation(s)
| | | | | | | | | | - Brandi Page
- Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | | | | - Jimmy Ruiz
- Wake Forest University, Winston-Salem, NC, USA
| | - John Fiveash
- University of Alabama at Birmingham, Birmingham, AL, USA
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15
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Triebel K, Mulhauser K, Gammon M, Gerstenecker A, Nabors LB, Fiveash J. OTHR-05. THE ABILITY TO MAKE INFORMED TREATMENT DECISIONS IS COMPROMISED IN ADULTS WITH ADVANCED STAGE CANCER. Neurooncol Adv 2019. [PMCID: PMC7213359 DOI: 10.1093/noajnl/vdz014.082] [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: 11/21/2022] Open
Abstract
OBJECTIVE: To investigate medical decision-making capacity (MDC) in patients with advanced stage cancer. METHODS: Participants were 113 newly diagnosed adults with brain metastases and 41 adults with metastatic cancer without brain metastases who were recruited from an academic medical center and 40 demographically-matched healthy controls recruited from the community. We evaluated MDC using the Capacity to Consent to Treatment Instrument (CCTI) Vignette B and its four clinically relevant consent standards (expressing a treatment choice, appreciation, reasoning, and understanding). Capacity impairment ratings (no impairment, mild/moderate impairment, and severe impairment) on the consent standards were also assigned to each participant using cutoff scores derived statistically from the performance of the control group. RESULTS: Both of the metastatic cancer groups (with and without brain metastasis) performed significantly below controls on consent standards of understanding and reasoning. The brain metastasis group performed below the non-metastatic cancer group on understanding. Capacity compromise was defined as performance ≤1.5 standard deviations (SD) below the control group mean. Using this definition, approximately 65% of the participants with brain metastases and 51% of participants with metastatic cancer without brain metastases were impaired on at least one MDC standard. CONCLUSION: Over half of participants with metastatic cancer regardless of whether they have brain disease have reduced capacity to make treatment decisions. The finding of impaired MDC in patients without brain metastases is surprising and suggests this group likely exhibits cognitive deficits that impact their ability to understand and reason about different treatment options. The reasons underlying this impairment will be investigated. This highlights the importance of routine clinical assessment of MDC in all patients with metastatic cancer when important treatment decisions are being discussed. These results also indicate a need for the development and investigation of interventions to support or improve MDC in this patient population.
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Affiliation(s)
| | | | | | | | - L Burt Nabors
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - John Fiveash
- University of Alabama at Birmingham, Birmingham, AL, USA
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16
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Fiveash J, Riley K, Markert J, Guthrie B, Foreman P, Popple R, Marcrom S, Strickler S, Willey C, McDonald A, Thomas E, Stewart J, Bredel M. RADI-12. LEPTOMENINGEAL FAILURE AFTER PREOPERATIVE VERSUS POSTOPERATIVE RADIOSURGERY. Neurooncol Adv 2019. [PMCID: PMC7213450 DOI: 10.1093/noajnl/vdz014.105] [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: 11/13/2022] Open
Abstract
INTRODUCTION: Postoperative stereotactic radiosurgery (postop SRS) is potentially complicated by difficulty defining the target volume and the risk of leptomeningeal seeding at the time of surgery. It is hypothesized that preop SRS may render cells less viable to disseminate in the leptomeningeal space. This retrospective study compares the leptomeningeal dissemination (LMD) rate for preop versus postop radiosurgery METHODS: We identified 140 patients with brain metastases who underwent resection and radiosurgery at the University of Alabama at Birmingham including 91 postop patients (2005–2015) and 49 preop patients (2011–2018). The preop group included 19 patients enrolled in a phase I trial of preoperative radiosurgery (12–15 Gy) for tumors 2–6 cm in greatest diameter. In that study 15 Gy was found to be safe in the preop setting but further escalation was not attempted. An additional 30 patients received preop SRS off-study (median dose 15 Gy). The median postop dose was 16 Gy. LMD recurrence was defined as focal pachymeningeal or diffuse leptomeningeal enhancement of the brain, spinal cord, or cauda equina, dural enhancement beyond 5 mm from the index metastasis, subependymal enhancement, or enhancement of cranial nerves. This definition is not limited to carcinomatosis. All events were categorized and confirmed by at least two physicians. RESULTS: 40/140 (29%) patients developed new focal or diffuse LMD. Preop SRS was associated with a higher freedom from leptomeningeal recurrence (84% vs 60% at one year, p=0.021 Breslow, p=0.128 log-rank). Since later LMD may not be related to surgery, a second analysis censoring follow-up at one year was performed and confirmed this trend (p=0.008 Breslow, p=0.014 log-rank). CONCLUSIONS: Preoperative SRS is associated with a reduction in the risk of LMD compared to postop SRS. Focal pachymeningeal dissemination may not always be recognized as related to surgery. A randomized trial of preop vs postop SRS is warranted.
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Affiliation(s)
- John Fiveash
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kristen Riley
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - James Markert
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bart Guthrie
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Paul Foreman
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Richard Popple
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sam Marcrom
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | - Evan Thomas
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - John Stewart
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Markus Bredel
- University of Alabama at Birmingham, Birmingham, AL, USA
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17
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Shen H, Yang ESH, Conry M, Fiveash J, Contreras C, Bonner JA, Shi LZ. Predictive biomarkers for immune checkpoint blockade and opportunities for combination therapies. Genes Dis 2019; 6:232-246. [PMID: 32042863 PMCID: PMC6997608 DOI: 10.1016/j.gendis.2019.06.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/07/2019] [Accepted: 06/16/2019] [Indexed: 12/30/2022] Open
Abstract
Immune checkpoint blockade therapies (ICBs) are a prominent breakthrough in cancer immunotherapy in recent years (named the 2013 “Breakthrough of the Year” by the Science magazine). Thus far, FDA-approved ICBs primarily target immune checkpoints CTLA-4, PD-1, and PD-L1. Notwithstanding their impressive long-term therapeutic benefits, their efficacy is limited to a small subset of cancer patients. In addition, ICBs induce inadvertent immune-related adverse events (irAEs) and can be costly for long-term use. To overcome these limitations, two strategies are actively being pursued: identification of predictive biomarkers for clinical response to ICBs and multi-pronged combination therapies. Biomarkers will allow clinicians to practice a precision medicine approach in ICBs (biomarker-based patient selection) such as treating triple-negative breast cancer patients that exhibit PD-L1 staining of tumor-infiltrating immune cells in ≥1% of the tumor area with nanoparticle albumin-bound (nab)–paclitaxel plus anti-PD-L1 and treating patients of MSI-H or MMR deficient unresectable or metastatic solid tumors with pembrolizumab (anti-PD-1). Importantly, the insights gained from these biomarker studies can guide rational combinatorial strategies such as CDK4/6 inhibitor/fractionated radiotherapy/HDACi in conjunction with ICBs to maximize therapeutic benefits. Further, with the rapid technological advents (e.g., ATCT-Seq), we predict more reliable biomarkers will be identified, which in turn will inspire more promising combination therapies.
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Affiliation(s)
- Hongxing Shen
- Department of Radiation Oncology, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, 35233, USA.,O'Neal Comprehensive Cancer Center, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, 35233, USA
| | - Eddy Shih-Hsin Yang
- Department of Radiation Oncology, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, 35233, USA.,O'Neal Comprehensive Cancer Center, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, 35233, USA
| | - Marty Conry
- O'Neal Comprehensive Cancer Center, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, 35233, USA.,Department of Medical Oncology, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, 35233, USA
| | - John Fiveash
- Department of Radiation Oncology, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, 35233, USA.,O'Neal Comprehensive Cancer Center, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, 35233, USA
| | - Carlo Contreras
- O'Neal Comprehensive Cancer Center, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, 35233, USA.,Department of Surgical Oncology, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, 35233, USA
| | - James A Bonner
- Department of Radiation Oncology, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, 35233, USA.,O'Neal Comprehensive Cancer Center, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, 35233, USA
| | - Lewis Zhichang Shi
- Department of Radiation Oncology, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, 35233, USA.,O'Neal Comprehensive Cancer Center, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, 35233, USA.,Department of Microbiology, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, 35233, USA.,Program in Immunology, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, 35233, USA
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18
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Fathallah-Shaykh HM, DeAtkine A, Coffee E, Khayat E, Bag AK, Han X, Warren PP, Bredel M, Fiveash J, Markert J, Bouaynaya N, Nabors LB. Diagnosing growth in low-grade gliomas with and without longitudinal volume measurements: A retrospective observational study. PLoS Med 2019; 16:e1002810. [PMID: 31136584 PMCID: PMC6538148 DOI: 10.1371/journal.pmed.1002810] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/22/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Low-grade gliomas cause significant neurological morbidity by brain invasion. There is no universally accepted objective technique available for detection of enlargement of low-grade gliomas in the clinical setting; subjective evaluation by clinicians using visual comparison of longitudinal radiological studies is the gold standard. The aim of this study is to determine whether a computer-assisted diagnosis (CAD) method helps physicians detect earlier growth of low-grade gliomas. METHODS AND FINDINGS We reviewed 165 patients diagnosed with grade 2 gliomas, seen at the University of Alabama at Birmingham clinics from 1 July 2017 to 14 May 2018. MRI scans were collected during the spring and summer of 2018. Fifty-six gliomas met the inclusion criteria, including 19 oligodendrogliomas, 26 astrocytomas, and 11 mixed gliomas in 30 males and 26 females with a mean age of 48 years and a range of follow-up of 150.2 months (difference between highest and lowest values). None received radiation therapy. We also studied 7 patients with an imaging abnormality without pathological diagnosis, who were clinically stable at the time of retrospective review (14 May 2018). This study compared growth detection by 7 physicians aided by the CAD method with retrospective clinical reports. The tumors of 63 patients (56 + 7) in 627 MRI scans were digitized, including 34 grade 2 gliomas with radiological progression and 22 radiologically stable grade 2 gliomas. The CAD method consisted of tumor segmentation, computing volumes, and pointing to growth by the online abrupt change-of-point method, which considers only past measurements. Independent scientists have evaluated the segmentation method. In 29 of the 34 patients with progression, the median time to growth detection was only 14 months for CAD compared to 44 months for current standard of care radiological evaluation (p < 0.001). Using CAD, accurate detection of tumor enlargement was possible with a median of only 57% change in the tumor volume as compared to a median of 174% change of volume necessary to diagnose tumor growth using standard of care clinical methods (p < 0.001). In the radiologically stable group, CAD facilitated growth detection in 13 out of 22 patients. CAD did not detect growth in the imaging abnormality group. The main limitation of this study was its retrospective design; nevertheless, the results depict the current state of a gold standard in clinical practice that allowed a significant increase in tumor volumes from baseline before detection. Such large increases in tumor volume would not be permitted in a prospective design. The number of glioma patients (n = 56) is a limitation; however, it is equivalent to the number of patients in phase II clinical trials. CONCLUSIONS The current practice of visual comparison of longitudinal MRI scans is associated with significant delays in detecting growth of low-grade gliomas. Our findings support the idea that physicians aided by CAD detect growth at significantly smaller volumes than physicians using visual comparison alone. This study does not answer the questions whether to treat or not and which treatment modality is optimal. Nonetheless, early growth detection sets the stage for future clinical studies that address these questions and whether early therapeutic interventions prolong survival and improve quality of life.
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Affiliation(s)
- Hassan M. Fathallah-Shaykh
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Department of Mathematics, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- * E-mail:
| | - Andrew DeAtkine
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Elizabeth Coffee
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Elias Khayat
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Asim K. Bag
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States of America
| | - Xiaosi Han
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Paula Province Warren
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Markus Bredel
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - John Fiveash
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - James Markert
- Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Nidhal Bouaynaya
- Department of Electrical Engineering, Rowan University, Glassboro, New Jersey, United States of America
| | - Louis B. Nabors
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
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Brezovich IA, Wu X, Popple RA, Covington E, Cardan R, Shen S, Fiveash J, Bredel M, Guthrie B. Stereotactic radiosurgery with MLC-defined arcs: Verification of dosimetry, spatial accuracy, and end-to-end tests. J Appl Clin Med Phys 2019; 20:84-98. [PMID: 30977297 PMCID: PMC6522994 DOI: 10.1002/acm2.12583] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/25/2019] [Accepted: 03/05/2019] [Indexed: 12/14/2022] Open
Abstract
Purpose To measure dosimetric and spatial accuracy of stereotactic radiosurgery (SRS) delivered to targets as small as the trigeminal nerve (TN) using a standard external beam treatment planning system (TPS) and multileaf collimator‐(MLC) equipped linear accelerator without cones or other special attachments or modifications. Methods Dosimetric performance was assessed by comparing computed dose distributions to film measurements. Comparisons included the γ‐index, beam profiles, isodose lines, maximum dose, and spatial accuracy. Initially, single static 360° arcs of MLC‐shaped fields ranging from 1.6 × 5 to 30 × 30 mm2 were planned and delivered to an in‐house built block phantom having approximate dimensions of a human head. The phantom was equipped with markings that allowed accurate setup using planar kV images. Couch walkout during multiple‐arc treatments was investigated by tracking a ball pointer, initially positioned at cone beam computed tomography (CBCT) isocenter, as the couch was rotated. Tracks were mapped with no load and a 90 kg stack of plastic plates simulating patient treatment. The dosimetric effect of walkout was assessed computationally by comparing test plans that corrected for walkout to plans that neglected walkout. The plans involved nine 160° arcs of 2.4 × 5 mm2 fields applied at six different couch angles. For end‐to‐end tests that included CT simulation, target contouring, planning, and delivery, a cylindrical phantom mimicking a 3 mm lesion was constructed and irradiated with the nine‐arc regimen. The phantom, lacking markings as setup aids was positioned under CBCT guidance by registering its surface and internal structures with CTs from simulation. Radiochromic film passing through the target center was inserted parallel to the coronal and the sagittal plane for assessment of spatial and dosimetric accuracy. Results In the single‐arc block phantom tests computed maximum doses of all field sizes agreed with measurements within 2.4 ± 2.0%. Profile widths at 50% maximum agreed within 0.2 mm. The largest targeting error was 0.33 mm. The γ‐index (3%, 1 mm) averaged over 10 experiments was >1 in only 1% of pixels for field sizes up to 10 × 10 mm2 and rose to 4.4% as field size increased to 20 × 20 mm2. Table walkout was not affected by load. Walkout shifted the target up to 0.6 mm from CBCT isocenter but, according to computations shifted the dose cloud of the nine‐arc plan by only 0.16 mm. Film measurements verified the small dosimetric effect of walkout, allowing walkout to be neglected during planning and treatment. In the end‐to‐end tests average and maximum targeting errors were 0.30 ± 0.10 and 0.43 mm, respectively. Gamma analysis of coronal and sagittal dose distributions based on a 3%/0.3 mm agreement remained <1 at all pixels. To date, more than 50 functional SRS treatments using MLC‐shaped static field arcs have been delivered. Conclusion Stereotactic radiosurgery (SRS) can be planned and delivered on a standard linac without cones or other modifications with better than 0.5 mm spatial and 5% dosimetric accuracy.
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Affiliation(s)
- Ivan A Brezovich
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Xingen Wu
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Richard A Popple
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth Covington
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rex Cardan
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sui Shen
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - John Fiveash
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Markus Bredel
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Barton Guthrie
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
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20
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McTyre E, Ayala-Peacock D, Contessa J, Corso C, Chiang V, Chung C, Fiveash J, Ahluwalia M, Kotecha R, Chao S, Attia A, Henson A, Hepel J, Braunstein S, Chan M. Multi-institutional competing risks analysis of distant brain failure and salvage patterns after upfront radiosurgery without whole brain radiotherapy for brain metastasis. Ann Oncol 2019; 29:497-503. [PMID: 29161348 DOI: 10.1093/annonc/mdx740] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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
Background In this study, we use a competing risks analysis to assess factors predictive of early-salvage whole brain radiotherapy (WBRT) and early death after upfront stereotactic radiosurgery (SRS) alone for brain metastases in an attempt to identify populations that benefit less from upfront SRS. Patients and methods Patients from eight academic centers were treated with SRS for brain metastasis. Competing risks analysis was carried out for distant brain failure (DBF) versus death prior to DBF as well as for salvage SRS versus salvage WBRT versus death prior to salvage. Linear regression was used to determine predictors of the number of brain metastases at initial DBF (nDBF). Results A total of 2657 patients were treated with upfront SRS alone. Multivariate analysis (MVA) identified an increased hazard of DBF associated with increasing number of brain metastases (P < 0.001), lowest SRS dose received (P < 0.001), and melanoma histology (P < 0.001), while there was a decreased hazard of DBF associated with increasing age (P < 0.001), KPS < 70 (P < 0.001), and progressive systemic disease (P = 0.004). MVA for first salvage SRS versus WBRT versus death prior to salvage revealed an increased hazard of first salvage WBRT seen with increasing number of brain metastases (P < 0.001) and a decreased hazard with widespread systemic disease (P = 0.002) and increasing age (P < 0.001). Variables associated with nDBF included age (P = 0.02), systemic disease status (P = 0.03), melanoma histology (P = 0.05), and initial number of brain metastases (P < 0.001). Conclusions Patients with a higher initial number of brain metastases were more likely to experience DBF, have a higher nDBF, and receive early-salvage WBRT, while patients who were older, had lower KPS, or had more systemic disease were more likely to experience death prior to DBF or salvage WBRT.
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Affiliation(s)
- E McTyre
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, USA.
| | - D Ayala-Peacock
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, USA; Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, USA
| | - J Contessa
- Department of Therapeutic Radiology/Southeast Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - C Corso
- Department of Therapeutic Radiology/Southeast Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - V Chiang
- Department of Therapeutic Radiology/Southeast Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, USA; Department of Neurosurgery, Yale University School of Medicine, New Haven, USA
| | - C Chung
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, USA; Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada, USA
| | - J Fiveash
- Department of Radiation Oncology, University of Alabama-Birmingham, Birmingham, USA
| | - M Ahluwalia
- Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic Foundation, Cleveland, USA
| | - R Kotecha
- Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic Foundation, Cleveland, USA
| | - S Chao
- Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic Foundation, Cleveland, USA
| | - A Attia
- Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, USA
| | - A Henson
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, USA
| | - J Hepel
- Department of Radiation Oncology, Brown University Alpert Medical School, Providence, USA
| | - S Braunstein
- Department of Radiation Oncology, University of California San Francisco, San Francisco, USA
| | - M Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, USA
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21
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Fisher B, Zhang P, Macdonald D, Chakravarti A, Lesser G, Fox S, Coons S, Rogers L, Werner-Wasik M, Doyle T, Bahary JP, Fiveash J, Bovi J, Howard S, Yu M, Dsouza D, Laack N, Roach M, Kwok Y, Wahl D, Stasser J, Won M, Mehta MP. ACTR-02. NRG ONCOLOGY/RTOG 0424: LONG-TERM RESULTS OF A PHASE II STUDY OF TEMOZOLOMIDE-BASED CHEMORADIOTHERAPY REGIMEN FOR HIGH-RISK LOW-GRADE GLIOMAS. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | | | - Glenn Lesser
- Wake Forest School of Medicine, Winston-Salem, NC, NC, USA
| | - Sherry Fox
- Cullather Brain Tumor Quality of Life Center, Richmond, VA, USA
| | - Stephen Coons
- St Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | | | | | | | | | | | - Joseph Bovi
- Froedtert and the Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Michael Yu
- H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - David Dsouza
- London Regional Cancer Program, London, ON, Canada
| | | | - Mack Roach
- University of California at San Francisco, San Francisco, CA, USA
| | - Young Kwok
- University of Maryland, Baltimore, MD, USA
| | | | - John Stasser
- Christiana Care Health Services, Delaware, MD, USA
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22
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Krauze AV, Attia A, Braunstein S, Chan M, Combs SE, Fietkau R, Fiveash J, Flickinger J, Grosu A, Howard S, Nieder C, Niyazi M, Rowe L, Smart DD, Tsien C, Camphausen K. Correction to expert consensus on re-irradiation for recurrent glioma. Radiat Oncol 2018; 13:8. [PMID: 29347964 PMCID: PMC5774123 DOI: 10.1186/s13014-018-0955-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Andra V Krauze
- Radiation Oncology Branch, National Cancer Institute NIH, Bethesda, MD, USA.
| | - Albert Attia
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Steve Braunstein
- Department of Radiation Oncology, University of California, San Francisco, USA
| | - Michael Chan
- Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich (TUM), Munich, Germany.,Institute of Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK) Partner Size, Munich, Germany
| | | | - John Fiveash
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Anca Grosu
- Department of Radiation Oncology, University of Freiburg, Freiburg, Germany
| | - Steven Howard
- Department of Human Oncology, University of Wisconsin, Madison, WI, USA
| | - Carsten Nieder
- Department of Oncology and Palliative Medicine, Hospital Trust, 8092, Bodø, Nordland, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, 9038, Tromsø, Norway
| | - Maximilian Niyazi
- Department of Radiation Oncology, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lindsay Rowe
- Radiation Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Dee Dee Smart
- Radiation Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Christina Tsien
- Department of Radiation Oncology, Washington University, St. Louis, MO, USA
| | - Kevin Camphausen
- Radiation Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
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23
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Krauze AV, Attia A, Braunstein S, Chan M, Combs SE, Fietkau R, Fiveash J, Flickinger J, Grosu A, Howard S, Nieder C, Niyazi M, Rowe L, Smart DD, Tsien C, Camphausen K. Expert consensus on re-irradiation for recurrent glioma. Radiat Oncol 2017; 12:194. [PMID: 29195507 PMCID: PMC5709844 DOI: 10.1186/s13014-017-0928-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 11/17/2017] [Indexed: 02/06/2023] Open
Abstract
Purpose To investigate radiation oncologists’ opinions on important considerations to offering re-irradiation (re-RT) as a treatment option for recurrent glioma. Materials and methods A survey was conducted with 13 radiation oncologists involved in the care of central nervous system tumor patients. The survey was comprised of 49 questions divided into 2 domains: a demographic section (10 questions) and a case section (5 re-RT cases with 5 to 6 questions representing one or several re-RT treatment dilemmas as may be encountered in the clinic). Respondents were asked to rate the relevance of various factors to offering re-RT, respond to the cases with a decision to offer re-RT vs. not, volume to be treated, margins to be employed, dose/fractionation suggested and any additional comments with respect to rationale in each scenario. Results Sixty nine percent of responders have been practicing for greater than 10 years and 61% have re-RT 20 to 100 patients to date, with 54% seeing 2–5 re-RT cases per month and retreating 1–2 patients per month. Recurrent tumor volume, time since previous radiation therapy, previously administered dose to organs at risk and patient performance status were rated by the majority of responders (85%, 92%, 77%, and 69% respectively) as extremely relevant or very relevant to offering re-RT as an option. Conclusion The experts’ practice of re-RT is still heterogeneous, reflecting the paucity of high-quality prospective data available for decision-making. Nevertheless, practicing radiation oncologists can support own decisions by referring to the cases found suitable for re-RT in this survey. Electronic supplementary material The online version of this article (10.1186/s13014-017-0928-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andra V Krauze
- Radiation Oncology Branch, National Cancer Institute NIH, Bethesda, MD, USA.
| | - Albert Attia
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Steve Braunstein
- Department of Radiation Oncology, University of California, San Francisco, USA
| | - Michael Chan
- Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich (TUM), Munich, Germany.,Institute of Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Size, Munich, Germany
| | | | - John Fiveash
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Anca Grosu
- Department of Radiation Oncology, University of Freiburg, Freiburg, Germany
| | - Steven Howard
- Department of Human Oncology, University of Wisconsin, Madison, WI, USA
| | - Carsten Nieder
- Department of Oncology and Palliative Medicine, Hospital Trust, 8092, Bodø, Nordland, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, 9038, Tromsø, Norway
| | - Maximilian Niyazi
- Department of Radiation Oncology, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lindsay Rowe
- Radiation Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Dee Dee Smart
- Radiation Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Christina Tsien
- Department of Radiation Oncology, Washington University, St. Louis, MO, USA
| | - Kevin Camphausen
- Radiation Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
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Dulaney C, Fiveash J, Li P, Boggs H. ACTR-40. STEREOTACTIC RADIOSURGERY AND TUMOR TREATING FIELDS IN SMALL CELL LUNG CANCER PATIENTS WITH LIMITED BRAIN METASTASES: A PILOT AND FEASIBILITY TRIAL. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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25
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Dulaney C, Fiveash J, Li P, Boggs H. CMET-13. RADIATION THERAPY PATTERNS OF CARE FOR NON-SMALL CELL LUNG CANCER BRAIN METASTASES: AN ANALYSIS OF THE NATIONAL CANCER DATABASE. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.162] [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: 11/12/2022] Open
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26
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Waters AM, Johnston JM, Reddy AT, Fiveash J, Madan-Swain A, Kachurak K, Bag AK, Gillespie GY, Markert JM, Friedman GK. Rationale and Design of a Phase 1 Clinical Trial to Evaluate HSV G207 Alone or with a Single Radiation Dose in Children with Progressive or Recurrent Malignant Supratentorial Brain Tumors. HUM GENE THER CL DEV 2017; 28:7-16. [PMID: 28319448 DOI: 10.1089/humc.2017.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Primary central nervous system tumors are the most common solid neoplasm of childhood and the leading cause of cancer-related death in pediatric patients. Survival rates for children with malignant supratentorial brain tumors are poor despite aggressive treatment with combinations of surgery, radiation, and chemotherapy, and survivors often suffer from damaging lifelong sequelae from current therapies. Novel innovative treatments are greatly needed. One promising new approach is the use of a genetically engineered, conditionally replicating herpes simplex virus (HSV) that has shown tumor-specific tropism and potential efficacy in the treatment of malignant brain tumors. G207 is a genetically engineered HSV-1 lacking genes essential for replication in normal brain cells. Safety has been established in preclinical investigations involving intracranial inoculation in the highly HSV-sensitive owl monkey (Aotus nancymai), and in three adult phase 1 trials in recurrent/progressive high-grade gliomas. No dose-limiting toxicities were seen in the adult studies and a maximum tolerated dose was not reached. Approximately half of the 35 treated adults had radiographic or neuropathologic evidence of response at a minimum of one time point. Preclinical studies in pediatric brain tumor models indicate that a variety of pediatric tumor types are highly sensitive to killing by G207. This clinical protocol outlines a first in human children study of intratumoral inoculation of an oncolytic virus via catheters placed directly into recurrent or progressive supratentorial malignant tumors.
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Affiliation(s)
- Alicia M Waters
- 1 Department of Surgery, Division of Pediatric Surgery, University of Alabama at Birmingham , Birmingham, Alabama
| | - James M Johnston
- 2 Department of Neurosurgery, University of Alabama at Birmingham , Birmingham, Alabama
| | - Alyssa T Reddy
- 3 Department of Pediatrics, Division of Hematology/Oncology, University of Alabama at Birmingham , Birmingham, Alabama
| | - John Fiveash
- 4 Department of Radiation Oncology, University of Alabama at Birmingham , Birmingham, Alabama
| | - Avi Madan-Swain
- 3 Department of Pediatrics, Division of Hematology/Oncology, University of Alabama at Birmingham , Birmingham, Alabama
| | - Kara Kachurak
- 5 Division of Hematology/Oncology, Children's of Alabama , Birmingham, Alabama
| | - Asim K Bag
- 6 Department of Radiology, University of Alabama at Birmingham , Birmingham, Alabama
| | - G Yancey Gillespie
- 2 Department of Neurosurgery, University of Alabama at Birmingham , Birmingham, Alabama
| | - James M Markert
- 2 Department of Neurosurgery, University of Alabama at Birmingham , Birmingham, Alabama.,3 Department of Pediatrics, Division of Hematology/Oncology, University of Alabama at Birmingham , Birmingham, Alabama
| | - Gregory K Friedman
- 3 Department of Pediatrics, Division of Hematology/Oncology, University of Alabama at Birmingham , Birmingham, Alabama
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27
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Dulaney CR, McDonald AM, Wallace AS, Fiveash J. Gait Speed and Survival in Patients With Brain Metastases. J Pain Symptom Manage 2017; 54:105-109. [PMID: 28479417 DOI: 10.1016/j.jpainsymman.2017.03.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 02/16/2017] [Accepted: 03/01/2017] [Indexed: 01/02/2023]
Abstract
CONTEXT Accurate estimation of life expectancy in patients with brain metastases is critical for counseling and choosing appropriate therapy. Performance status is the single greatest determinant of overall survival in this population. However, current measures of performance status are subjective and often based on brief clinical encounters. Gait speed is an objective, reliable predictor of overall health and survival. OBJECTIVE The purpose of this study was to evaluate the relationship between gait speed and survival in patients with brain metastases. METHODS We conducted a retrospective review of all patients with documented gait speed and Karnofsky performance status seen in consultation for newly diagnosed brain metastases from 2014 to 2015. Gait speed was measured during neurological examination over 4 m at normal pace. Graded prognostic assessment scores were calculated from clinical information. The primary outcomes were overall survival and 30-day mortality. RESULTS Eighty-five of 88 patients (97%) met inclusion criteria. Overall, the median gait speed was 0.7 m/s (range 0-1.0 m/s). Gait speed was associated with increased overall survival in addition to graded prognostic assessment score. Median survival was longer in patients with normal gait speed (>0.6 m/s, 11.9 months) compared to those with slow gait speed (≤0.6 m/s, 4.5 months, P < 0.001) or who were nonambulatory (1.1 months, P < 0.001). Thirty-day mortality for normal, slow, and nonambulatory patients was 0%, 15%, and 42%, respectively. The graded prognostic assessment overestimated actual survival for nonambulatory patients (2.2 vs. 1.1 months) and underestimated for those with normal gait speed (4.4 vs. 11.9 months). CONCLUSION Gait speed is associated with overall survival in patients with newly diagnosed brain metastases. Gait speed assessment is simple, objective, and may provide additional prognostic information to improve life expectancy estimation and management decisions.
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Affiliation(s)
- Caleb R Dulaney
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
| | - Andrew M McDonald
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Audrey S Wallace
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - John Fiveash
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Cardan RA, Popple RA, Fiveash J. A priori patient-specific collision avoidance in radiotherapy using consumer grade depth cameras. Med Phys 2017; 44:3430-3436. [PMID: 28474757 DOI: 10.1002/mp.12313] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 03/19/2017] [Revised: 04/25/2017] [Accepted: 04/25/2017] [Indexed: 11/06/2022] Open
Abstract
PURPOSE In this study, we demonstrate and evaluate a low cost, fast, and accurate avoidance framework for radiotherapy treatments. Furthermore, we provide an implementation which is patient specific and can be implemented during the normal simulation process. METHODS Four patients and a treatment unit were scanned with a set of consumer depth cameras to create a polygon mesh of each object. Using a fast polygon interference algorithm, the models were virtually collided to map out feasible treatment positions of the couch and gantry. The actual physical collision space was then mapped in the treatment room by moving the gantry and couch until a collision occurred with either the patient or hardware. The physical and virtual collision spaces were then compared to determine the accuracy of the system. To improve the collision predictions, a buffer geometry was added to the scanned gantry mesh and performance was assessed as a function of buffer thickness. RESULTS Each patient was optically scanned during simulation in less than 1 min. The average time to virtually map the collision space for 64, 800 gantry/couch states was 5.40 ± 2.88 s. The system had an average raw accuracy and negative prediction rate (NPR) across all patients of 97.3% ± 2.4% and 96.9% ± 2.2% respectively. Using a polygon buffer of 6 cm over the gantry geometry, the NPR was raised to unity for all patients, signifying the detection of all collision events. However, the average accuracy fell from 95.3% ± 3.1% to 91.5% ± 3.6% between the 3 and 6 cm buffer as more false positives were detected. CONCLUSIONS We successfully demonstrated a fast and low cost framework which can map an entire collision space a priori for a given patient during the time of simulation. All collisions can be avoided using polygon interference, but a polygon buffer may be required to account for geometric uncertainties of scanned objects.
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Affiliation(s)
- Rex A Cardan
- Department of Radiation Oncology, University of Alabama at Birmingham, 2145 Bonner Way, Birmingham, AL, 35243, USA
| | - Richard A Popple
- Department of Radiation Oncology, University of Alabama at Birmingham, 1700 6th Ave S, Birmingham, AL, 35233, USA
| | - John Fiveash
- Department of Radiation Oncology, University of Alabama at Birmingham, 1700 6th Ave S, Birmingham, AL, 35233, USA
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Waters AM, Johnston JM, Reddy AT, Fiveash J, Madan-Swain A, Kachurak K, Bag AK, Gillespie GY, Markert JM, Friedman GK. Rationale and Design of a Phase I Clinical Trial to Evaluate HSV G207 Alone or with a Single Radiation Dose in Children with Progressive or Recurrent Malignant Supratentorial Brain Tumors. HUM GENE THER CL DEV 2017. [DOI: 10.1089/hum.2017.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alicia M Waters
- University of Alabama at Birmingham, Surgery, Birmingham, Alabama, United States
| | - James M Johnston
- University of Alabama at Birmingham, Neurosurgery, Birmingham, Alabama, United States
| | - Alyssa T Reddy
- University of Alabama at Birmingham, Pediatrics, Birmingham, Alabama, United States
| | - John Fiveash
- University of Alabama at Birmingham, Radiation Oncology, Birmingham, Alabama, United States
| | - Avi Madan-Swain
- University of Alabama at Birmingham, Pediatrics, Birmingham, Alabama, United States
| | - Kara Kachurak
- Benjamin Russell Hospital for Children, 22078, Birmingham, Alabama, United States
| | - Asim K Bag
- University of Alabama at Birmingham, Radiology, Birmingham, Alabama, United States
| | - G. Yancey Gillespie
- University of Alabama at Birmingham, Cell Biology and Anatomy, Birmingham, Alabama, United States
| | - James M Markert
- University of Alabama at Birmingham, Neurosurgery, Birmingham, Alabama, United States
| | - Gregory K Friedman
- University of Alabama at Birmingham, Pediatrics, 1600 7th Avenue South, Lowder 512, Birmingham, Alabama, United States, 35233
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Alva E, Friedman G, Li R, Rozzelle C, Rocque B, Blount J, Johnston J, Fiveash J, Reddy A. EPT-23TREATMENT OF HIGH-GRADE CENTRAL NERVOUS SYSTEM TUMORS WITH HIGH-DOSE METHOTREXATE IN COMBINATION WITH MULTI-AGENT CHEMOTHERAPY: A SINGLE INSTITUTION EXPERIENCE. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now069.22] [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: 11/12/2022] Open
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Popple R, Bredel M, Brezovich I, Dobelbower M, Fisher W, Fiveash J, Guthrie B, Riley K, Wu X. SU-F-J-96: Comparison of Frame-Based and Mutual Information Registration Techniques for CT and MR Image Sets. Med Phys 2016. [DOI: 10.1118/1.4956004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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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Kraus J, Thomas E, Wu X, Fiveash J, Popple R. SU-F-T-629: Effect of Multi-Leaf Collimator (MLC) Width On Plan Quality of Single-Isocenter VMAT Intracranial Stereotactic Radiosurgery for Multiple Metastases. Med Phys 2016. [DOI: 10.1118/1.4956814] [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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Cardan R, Popple R, Smith H, Fiveash J. SU-F-T-101: Insight into Dosimetry Workload and Planning Timelines: A 6 Year Review at One Institution. Med Phys 2016. [DOI: 10.1118/1.4956237] [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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Schulz R, Thomas E, Popple R, Fiveash J, Jacobsen E. SU-F-E-07: Web-Based Training for Radiosurgery: Methods and Metrics for Global Reach. Med Phys 2016. [DOI: 10.1118/1.4955693] [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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Reddy A, Johnston J, Madan-Swain A, Fiveash J, Bag A, Gillespie GY, Markert J, Friedman G. EPT-10PHASE I CLINICAL TRIAL OF HSV G207 ALONE OR WITH A SINGLE RADIATION DOSE IN CHILDREN WITH RECURRENT SUPRATENTORIAL BRAIN TUMORS (NCT02457845). Neuro Oncol 2016. [DOI: 10.1093/neuonc/now069.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Brezovich I, Wu X, Popple R, Shen S, Cardan R, Bolding M, Fiveash J, Kraus J, Spencer S. SU-F-T-645: To Test Spatial Anddosimetric Accuracy of Small Cranial Target Irradiation Based On 1.5 T MRIscans Using Static Arcs with MLCDefined Fields. Med Phys 2016. [DOI: 10.1118/1.4956830] [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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Cardan R, Popple R, Dobelbower M, De Los Santos J, Fiveash J. SU-F-T-235: Optical Scan Based Collision Avoidance Using Multiple Stereotactic Cameras During Simulation. Med Phys 2016. [DOI: 10.1118/1.4956374] [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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Abstract
INTRODUCTION Cancer center websites are trusted sources of internet information about treatment options for prostate cancer. The quality of information on these websites is unknown. The objective of this study was to evaluate the quality of information on cancer center websites addressing prostate cancer treatment options, outcomes, and toxicity. MATERIALS AND METHODS We evaluated the websites of all National Cancer Institute-designated cancer centers to determine if sufficient information was provided to address eleven decision-specific knowledge questions from the validated Early Prostate Cancer Treatment Decision Quality Instrument. We recorded the number of questions addressed, the number of clicks to reach the prostate cancer-specific webpage, evaluation time, and Spanish and mobile accessibility. Correlation between evaluation time and questions addressed were calculated using the Pearson coefficient. RESULTS Sixty-three websites were reviewed. Eighty percent had a prostate cancer-specific webpage reached in a median of three clicks. The average evaluation time was 6.5 minutes. Information was available in Spanish on 24% of sites and 59% were mobile friendly. Websites provided sufficient information to address, on average, 19% of questions. No website addressed all questions. Evaluation time correlated with the number of questions addressed (R(2) = 0.42, p < 0.001). CONCLUSIONS Cancer center websites provide insufficient information for men with localized prostate cancer due to a lack of information about and direct comparison of specific treatment outcomes and toxicities. Information is also less accessible in Spanish and on mobile devices. These data can be used to improve the quality and accessibility of prostate cancer treatment information on cancer center websites.
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Affiliation(s)
- Caleb Dulaney
- Department of Radiation Oncology, University of Alabama at Birmingham
| | | | | | - Daniel Wakefield
- College of Medicine, University of Tennessee Health Sciences Center
| | - John Fiveash
- Department of Radiation Oncology, University of Alabama at Birmingham
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Harris D, McDonald A, Fiveash J. Comparing CBCT Alignment to Fiducial Alignment in Terms of Necessity and Organ at Risk Dosimetry in Prostate Radiation Therapy. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1151] [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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Dulaney C, McDonald A, Wallace A, Bredel M, Willey C, Fiveash J. Gait Speed Correlates With Performance Status and Predicts Survival in Patients With Newly Diagnosed Brain Metastases. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1753] [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: 10/22/2022]
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Fiveash J, Willey C, Bredel M, Popple R, Spencer S, Dempsey K, Markert J, Riley K, Dobelbower M. KV and Cone Beam CT 6DOF Localization With Automated Registration for Frameless CNS Radiosurgery. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.804] [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: 10/22/2022]
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Huang M, Brezovich I, Duan J, Wu X, Shen S, Cardan R, Fiveash J, Popple R. SU-E-T-453: Image-Guided Patient-Specific Quality Assurance for Multi-Target Single Isocenter Intracranial VMAT Radiosurgery. Med Phys 2015. [DOI: 10.1118/1.4924815] [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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Tannazi F, Huang M, Thomas E, Duan J, Wu X, Shen S, Cardan R, Fiveash J, Brezovich I, Popple R. SU-E-T-291: Dosimetric Accuracy of Multitarget Single Isocenter Radiosurgery. Med Phys 2015. [DOI: 10.1118/1.4924653] [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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Bag AK, Kim H, Gao Y, Bolding M, Warren PP, Fathallah-Shaykh HM, Gurler D, Markert JM, Fiveash J, Beasley TM, Khawaja A, Friedman GK, Chapman PR, Nabors LB, Han X. Prolonged treatment with bevacizumab is associated with brain atrophy: a pilot study in patients with high-grade gliomas. J Neurooncol 2015; 122:585-93. [PMID: 25711673 DOI: 10.1007/s11060-015-1751-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 02/17/2015] [Indexed: 12/17/2022]
Abstract
Bevacizumab is widely used for treatment of high-grade gliomas and other malignancies. Because bevacizumab has been shown to be associated with neurocognitive decline, this study is designed to investigate whether prolonged treatment with bevacizumab is also associated with brain atrophy. We identified 12 high-grade glioma patients who received bevacizumab for 12 months at the first recurrence and 13 matched controls and blindly compared the volumes of the contralateral hemispheres and contralateral ventricle in these two groups at baseline and after 12 ± 2 months of the baseline scan by two independent analyses. The volumes of the contralateral hemispheres and ventricles did not differ significantly between the two groups at baseline. Whereas, in the control group the volumes of the contralateral hemisphere changed subtly from baseline to follow-up (p = 0.23), in the bevacizumab-treated group the volumes significantly decreased from baseline to follow-up (p = 0.03). There was significant increase in the contralateral ventricle volume from base line to follow-up scans in both the control group (p = 0.01) and in the bevacizumab group (p = 0.005). Both the absolute and the percentage changes of contralateral hemisphere volumes and contralateral ventricular volumes between the two patient groups were statistically significant (p < 0.05). Results of this study demonstrate prolonged treatment with bevacizumab is associated with atrophy of the contralateral brain hemisphere.
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Affiliation(s)
- Asim K Bag
- Department of Radiology, The University of Alabama at Birmingham, Birmingham, USA
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Ayala-Peacock D, Attia A, Hepel J, Lucas J, Onyeuku N, Stavas M, Taylor R, Chung C, Fiveash J, Chan M. A Multi-institutional Predictive Nomogram for Distant Brain Failure in Patients Treated with Upfront Stereotactic Radiosurgery Without Whole Brain Radiation Therapy. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.568] [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: 10/24/2022]
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Popple R, Brezovich I, Wu X, Fiveash J. SU-E-T-425: Spherical Dose Distributions for Radiosurgery Using a Standardized MLC Plan. Med Phys 2014. [DOI: 10.1118/1.4888758] [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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Abstract
Virtually all malignant gliomas recur. Treatment options at recurrence have relied upon surgical intervention, radiation therapy or cytotoxic chemotherapy. Unfortunately, none are associated with significant improvements in survival. Advances in treatment options at recurrence have been dependent upon the combination of surgical resection, focal radiation and chemotherapy. Despite aggressive interventions, few patients have meaningful improvements. Current research focuses on novel targeted molecular therapy that will hopeful be able to take advantage of advances in our understanding of the biology of glial neoplasms.
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Affiliation(s)
- L Burt Nabors
- Department of Neurology, University of Alabama at Birmingham, 510 20 Street South, FOT 1020, Birmingham, AL, USA.
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Thompson J, Fiveash J, Keene K, Popple R. Trajectory-Based Radiation Therapy With Linear Couch Motion for Extended Spinal Treatments. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.2001] [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: 10/26/2022]
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Park CK, Kim YH, Kim JW, Kim TM, Choi SH, Kim YJ, Choi BS, Lee SH, Kim CY, Kim IH, Lee DZ, Kheder A, Forbes M, Craven I, Hadjivassiliou M, Shonka NA, Kessinger A, Aizenberg MR, Weller M, Meisner C, Platten M, Simon M, Nikkhah G, Papsdorf K, Sabel M, Braun C, Reifenberger G, Wick W, Alexandru D, Haghighi B, Muhonen MG, Chamberlain MC, Sumrall AL, Burri S, Brick W, Asher A, Murillo-Medina K, Guerrero-Maldonado A, Ramiro AJ, Cervantes-Sanchez G, Erazo-Valle-Solis AA, Garcia-Navarro V, Sperduto PW, Shanley R, Luo X, Kased N, Sneed PK, Roberge D, Chao S, Weil R, Suh J, Bhatt A, Jensen A, Brown PD, Shih H, Kirkpatrick J, Gaspar LE, Fiveash J, Chiang V, Knisely J, Sperduto CM, Lin N, Mehta MP, Anderson MD, Raghunathan A, Aldape KD, Fuller GN, Gilbert MR, Robins HI, Wang M, Gilbert MR, Chakravarti A, Grimm S, Penas-Prado M, Chaudhary R, Anderson PJ, Elinzano H, Gilbert RA, Mehta M, Aoki T, Ueba T, Arakawa Y, Miyatake SI, Tsukahara T, Miyamoto S, Nozaki K, Taki W, Matsutani M, Shakur SF, Bit-Ivan E, Watkin WG, Farhat HI, Merrell RT, Zwinkels H, Dorr J, Kloet A, Taphoorn MJ, Vecht CJ, Bogdahn U, Stockhammer G, Mahapatra A, Hau P, Schuknecht B, van den Bent M, Heinrichs H, Yust-Katz S, Liu V, Sanghee K, Groves M, Puduvalli V, Levin V, Conrad C, Colman H, Hsu S, Yung AW, Gilbert MR, Kunz M, Armbruster L, Thon N, Jansen N, Lutz J, Herms J, Egensperger R, Eigenbrod S, Kretzschmar H, La CF, Tonn JC, Kreth FW, Brandes AA, Franceschi E, Agati R, Poggi R, Dall'Occa P, Bartolotti M, Di Battista M, Marucci G, Girardi F, Ermani M, Sherman W, Raizer J, Grimm S, Ruckser R, Tatzreiter G, Pfisterer W, Oberhauser G, Honigschnabel S, Aboul-Enein F, Ausch C, Kitzweger E, Hruby W, Sebesta C, Green RM, Woyshner EA, Suchorska B, Jansen NL, Janssen H, Kretzschmar H, Simon M, Hentschel B, Poepperl G, Kreth FW, Linn J, LaFougere C, Weller M, Tonn JC, Suchorska B, Jansen NL, Graute V, Eigenbrod S, Bartenstein P, Kreth FW, LaFougere C, Tonn JC, Hassanzadeh B, Tohidi V, Levacic D, Landolfi JC, Singer S, DeBraganca K, Omuro A, Grommes C, Omar AI, Jalan P, Pandav V, Bekker S, Fuente MIDL, Kaley T, Zhao S, Chen X, Soffietti R, Magistrello M, Bertero L, Bosa C, Crasto SG, Garbossa D, Lolli I, Trevisan E, Ruda R, Ruda R, Bertero L, Bosa C, Trevisan E, Pace A, Carapella C, Dealis C, Caroli M, Faedi M, Bomprezzi C, Thomas AA, Dalmau J, Gresa-Arribas N, Fadul CE, Kumthekar PU, Raizer J, Grimm S, Herrada J, Antony N, Richards M, Gupta A, Landeros M, Arango C, Campos-Gines AF, Friedman P, Wilson H, Streeter JC, Cohen A, Gilreath J, Sageser D, Ye X, Bell SD, McGregor J, Bourekas E, Cavaliere R, Newton H, Sul J, Odia Y, Zhang W, Shih J, Butman JA, Hammoud D, Kreisl TN, Iwamoto F, Fine HA, Berriel LG, Santos FN, Levy AC, Fanelli MF, Chinen LT, da Costa AA, Bourekas E, Wayne Slone H, Bell SD, McGregor J, Bokstein F, Blumenthal DT, Shpigel S, Phishniak L, Yust-Katz S, Garciarena P, Liue D, Yuan Y, Groves MD, Wong ET, Villano JL, Engelhard HH, Ram Z, Sahebjam S, Millar BA, Sahgal A, Laperriere N, Mason W, Levin VA, Hess KR, Choucair AK, Flynn PJ, Jaeckle KA, Kyritsis AP, Yung WKA, Prados MD, Bruner JM, Ictech S, Nghiemphu PL, Lai A, Green RM, Cloughesy TF, Zaky W, Gilles F, Grimm J, Bluml S, Dhall G, Rosser T, Randolph L, Wong K, Olch A, Krieger M, Finlay J, Capellades J, Verger E, Medrano S, Gonzalez S, Gil M, Reynes G, Ribalta T, Gallego O, Segura PP, Balana C, Gwak HS, Joo J, Kim S, Yoo H, Shin SH, Han JY, Kim HT, Yun T, Lee JS, Lee SH, Kim W, Vogelbaum MA, Wang M, Peereboom DM, Macdonald DR, Giannini C, Suh JH, Jenkins RB, Laack NN, Brackman DG, Shrieve DC, Souhami L, Mehta MP, Leibetseder A, Wohrer A, Ackerl M, Flechl B, Sax C, Spiegl-Kreinecker S, Pichler J, Widhalm G, Dieckmann K, Preusser M, Marosi C, Sebastian C, Alejandro M, Bernadette C, Naomi A, Kavan P, Sahebjam S, Garoufalis E, Guiot MC, Muanza T, Del Maestro R, Petrecca K, Sharma R, Curry R, Joyce J, Rosenblum M, Jaffe E, Matasar M, Lin O, Fisher R, Omuro A, Yin C, Iwamoto FM, Fraum TJ, Nayak L, Diamond EL, DeAngelis LM, Pentsova E, Vera-Bolanos E, Gilbert MR, Aldape K, Necesito-Reyes MJ, Fouladi M, Gajjar A, Goldman S, Metellus P, Mikkelsen T, Omuro A, Packer R, Partap S, Pollack IF, Prados M, Ian Robins H, Soffietti R, Wu J, Armstrong TS, Nakada M, Hayashi Y, Miyashita K, Kinoshita M, Furuta T, Sabit H, Kita D, Hayashi Y, Uchiyam N, Kawakami K, Minamoto T, Hamada JI, Diamond EL, Rosenblum M, Heaney M, Carrasquillo J, Krauthammer A, Nolan C, Kaley TJ, Gil MJ, Fuster J, Balana C, Benavides M, Mesia C, Etxaniz O, Canellas J, Perez-Martin X, Hunter K, Johnston SK, Bridge CA, Rockne RC, Guyman L, Baldock AL, Rockhill JK, Mrugala MM, Beard BC, Adair JE, Kiem HP, Swanson KR, Ranjan T, Desjardins A, Peters KB, Alderson L, Kirkpatrick J, Herndon J, Bailey L, Sampson J, Friedman AH, Friedman H, Vredenburgh JJ, Theeler BJ, Ellezam B, Melguizo-Gavilanes I, Shonka NA, Bruner JM, Puduvalli VK, Taylor JW, Flanagan E, O'Neill B, Seigal T, Omuro A, DeAngelis L, Baerhing J, Hoang-Xuan K, Chamberlain M, Batchelor T, Nishikawa R, Pinto F, Blay JY, Korfel A, Schiff D, Fu BD, Kong XT, Bota D, Omuro A, Beal K, Ivy P, Gutin P, Wu N, Kaley T, Karimi S, DeAngelis L, Pentsova H, Nolan C, Grommes C, Chan T, Mathew R, Droms L, Shimizu F, Tabar V, Grossman S, Yovino S, Campian J, Wild A, Herman J, Brock M, Balmanoukian A, Ye X, Portnow J, Badie B, Synold T, Lacey S, D'Apuzzo M, Frankel P, Chen M, Aboody K, Letarte N, Gabay MP, Bressler LR, Stachnik JM, Villano JL, Jaeckle KA, Anderson SK, Willson A, Moreno-Aspitia A, Colon-Otero G, Patel T, Perez E, Peters KB, Reardon DA, Vredenburgh JJ, Desjardins A, Herndon JE, Coan A, McSherry F, Lipp E, Brickhouse A, Massey W, Friedman HS, Alderson LM, Desjardins A, Ranjan T, Peters KB, Friedman HS, Vredenburgh JJ, Ranjan T, Desjardins A, Peters KB, Alderson L, Kirkpatrick J, Herndon J, Bailey L, Sampson J, Friedman AH, Friedman H, Vredenburgh J, Welch MR, Omuro A, Grommes C, Westphal M, Bach F, Reuter D, Ronellenfitsch M, Steinbach J, Pietsch T, Connelly J, Hamza MA, Puduvalli V, Neal ML, Trister AD, Ahn S, Bridge C, Lange J, Baldock A, Rockne R, Mrugala M, Rockhill JK, Lai A, Cloughesy T, Swanson KR, Neuwelt AJ, Nguyen TM, Tyson RM, Nasseri M, Neuwelt EA, Bubalo JS, Barnes PD, Phuphanich S, Hu J, Rudnick J, Chu R, Yu J, Naruse R, Ljubimova J, Sanchez C, Guevarra A, Naor R, Black K, Mahta A, Bhavsar TM, Herath K, Huang C, McClain J, Rizzo K, Sheehan J, Chamberlain M, Glantz M, McClain J, Glantz MJ, Zoccoli C, Nicholas MK, Xie T, White D, Liker S, Gajewski T, Selfridge J, Piccioni DE, Zurayk M, Mody R, Quan J, Li S, Chen W, Chou A, Liau L, Green R, Cloughesy T, Lai A, Gomez-Molinar V, Ruiz-Gonzalez S, Valdez-Vazquez R, Arrieta O, Stenner JI. CLIN-NEURO/MEDICAL ONCOLOGY. Neuro Oncol 2012. [DOI: 10.1093/neuonc/nos229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Menendez JY, Bauer DF, Shannon CN, Fiveash J, Markert JM. Stereotactic radiosurgical treatment of brain metastasis of primary tumors that rarely metastasize to the central nervous system. J Neurooncol 2012; 109:513-9. [PMID: 22870850 DOI: 10.1007/s11060-012-0916-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 06/14/2012] [Indexed: 12/12/2022]
Abstract
We evaluated the local control of gamma knife stereotactic radiosurgery (GKSRS) in the treatment of cerebral metastases from primary tumors that rarely metastasize to the central nervous system (CNS). There is little published data on this subject with very few series on specific primary tumors. We present our experience treating these lesions with GKSRS combined with a review of the salient literature. A retrospective study of 36 patients who collectively underwent 44 GKSRS procedures for CNS metastatic disease was undertaken. Our series includes four patients with sarcoma, two with prostate cancer, three with thyroid cancer, five with endometrial cancer, seven with ovarian cancer, two with cervical cancer, six with esophageal cancer, two with bladder cancer, one with liver cancer, one with pancreatic cancer, and three with testicular cancer. With 44 gamma knife sessions treating 74 tumors, 63 tumors showed no radiographic evidence of progression, and 13 tumors demonstrated radiographic progression between one and 12 months after gamma knife treatment. In six patients in the population, further treatment with GKSRS was necessary due to enlargement of untreated lesions or new metastatic disease. GKSRS for uncommon CNS metastases is appears to be efficacious in controlling the treated tumor. The majority of tumors treated in our study did not progress post gamma knife.
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Affiliation(s)
- Joshua Y Menendez
- Division of Neurosurgery, Department of Surgery, University of Alabama at Birmingham, FOT 1060, 1530 3rd Avenue South, Birmingham, AL 35294, USA.
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