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Magnuson WJ, Lester-Coll NH, Wu AJ, Yang TJ, Lockney NA, Gerber NK, Beal K, Amini A, Patil T, Kavanagh BD, Camidge DR, Braunstein SE, Boreta LC, Balasubramanian SK, Ahluwalia MS, Rana NG, Attia A, Gettinger SN, Contessa JN, Yu JB, Chiang VL. Management of Brain Metastases in Tyrosine Kinase Inhibitor-Naïve Epidermal Growth Factor Receptor-Mutant Non-Small-Cell Lung Cancer: A Retrospective Multi-Institutional Analysis. J Clin Oncol 2017; 35:1070-1077. [PMID: 28113019 DOI: 10.1200/jco.2016.69.7144] [Citation(s) in RCA: 305] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose Stereotactic radiosurgery (SRS), whole-brain radiotherapy (WBRT), and epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) are treatment options for brain metastases in patients with EGFR-mutant non-small-cell lung cancer (NSCLC). This multi-institutional analysis sought to determine the optimal management of patients with EGFR-mutant NSCLC who develop brain metastases and have not received EGFR-TKI. Materials and Methods A total of 351 patients from six institutions with EGFR-mutant NSCLC developed brain metastases and met inclusion criteria for the study. Exclusion criteria included prior EGFR-TKI use, EGFR-TKI resistance mutation, failure to receive EGFR-TKI after WBRT/SRS, or insufficient follow-up. Patients were treated with SRS followed by EGFR-TKI, WBRT followed by EGFR-TKI, or EGFR-TKI followed by SRS or WBRT at intracranial progression. Overall survival (OS) and intracranial progression-free survival were measured from the date of brain metastases. Results The median OS for the SRS (n = 100), WBRT (n = 120), and EGFR-TKI (n = 131) cohorts was 46, 30, and 25 months, respectively ( P < .001). On multivariable analysis, SRS versus EGFR-TKI, WBRT versus EGFR-TKI, age, performance status, EGFR exon 19 mutation, and absence of extracranial metastases were associated with improved OS. Although the SRS and EGFR-TKI cohorts shared similar prognostic features, the WBRT cohort was more likely to have a less favorable prognosis ( P = .001). Conclusion This multi-institutional analysis demonstrated that the use of upfront EGFR-TKI, and deferral of radiotherapy, is associated with inferior OS in patients with EGFR-mutant NSCLC who develop brain metastases. SRS followed by EGFR-TKI resulted in the longest OS and allowed patients to avoid the potential neurocognitive sequelae of WBRT. A prospective, multi-institutional randomized trial of SRS followed by EGFR-TKI versus EGFR-TKI followed by SRS at intracranial progression is urgently needed.
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Affiliation(s)
- William J Magnuson
- William J. Magnuson, Nataniel H. Lester-Coll, Scott N. Gettinger, Joseph N. Contessa, James B. Yu, and Veronica L. Chiang, Yale School of Medicine, New Haven, CT; Abraham J. Wu, T. Jonathan Yang, Natalie A. Lockney, Naamit K. Gerber, and Kathryn Beal, Memorial Sloan Kettering Cancer Center, New York, NY; Arya Amini, Tejas Patil, Brian D. Kavanagh, and D. Ross Camidge, University of Colorado School of Medicine, Denver, CO; Steven E. Braunstein and Lauren C. Boreta, University of California-San Francisco, San Francisco, CA; Suresh K. Balasubramanian and Manmeet S. Ahluwalia, Cleveland Clinic Foundation, Cleveland, OH; and Niteshkumar G. Rana and Albert Attia, Vanderbilt University School of Medicine, Nashville, TN
| | - Nataniel H Lester-Coll
- William J. Magnuson, Nataniel H. Lester-Coll, Scott N. Gettinger, Joseph N. Contessa, James B. Yu, and Veronica L. Chiang, Yale School of Medicine, New Haven, CT; Abraham J. Wu, T. Jonathan Yang, Natalie A. Lockney, Naamit K. Gerber, and Kathryn Beal, Memorial Sloan Kettering Cancer Center, New York, NY; Arya Amini, Tejas Patil, Brian D. Kavanagh, and D. Ross Camidge, University of Colorado School of Medicine, Denver, CO; Steven E. Braunstein and Lauren C. Boreta, University of California-San Francisco, San Francisco, CA; Suresh K. Balasubramanian and Manmeet S. Ahluwalia, Cleveland Clinic Foundation, Cleveland, OH; and Niteshkumar G. Rana and Albert Attia, Vanderbilt University School of Medicine, Nashville, TN
| | - Abraham J Wu
- William J. Magnuson, Nataniel H. Lester-Coll, Scott N. Gettinger, Joseph N. Contessa, James B. Yu, and Veronica L. Chiang, Yale School of Medicine, New Haven, CT; Abraham J. Wu, T. Jonathan Yang, Natalie A. Lockney, Naamit K. Gerber, and Kathryn Beal, Memorial Sloan Kettering Cancer Center, New York, NY; Arya Amini, Tejas Patil, Brian D. Kavanagh, and D. Ross Camidge, University of Colorado School of Medicine, Denver, CO; Steven E. Braunstein and Lauren C. Boreta, University of California-San Francisco, San Francisco, CA; Suresh K. Balasubramanian and Manmeet S. Ahluwalia, Cleveland Clinic Foundation, Cleveland, OH; and Niteshkumar G. Rana and Albert Attia, Vanderbilt University School of Medicine, Nashville, TN
| | - T Jonathan Yang
- William J. Magnuson, Nataniel H. Lester-Coll, Scott N. Gettinger, Joseph N. Contessa, James B. Yu, and Veronica L. Chiang, Yale School of Medicine, New Haven, CT; Abraham J. Wu, T. Jonathan Yang, Natalie A. Lockney, Naamit K. Gerber, and Kathryn Beal, Memorial Sloan Kettering Cancer Center, New York, NY; Arya Amini, Tejas Patil, Brian D. Kavanagh, and D. Ross Camidge, University of Colorado School of Medicine, Denver, CO; Steven E. Braunstein and Lauren C. Boreta, University of California-San Francisco, San Francisco, CA; Suresh K. Balasubramanian and Manmeet S. Ahluwalia, Cleveland Clinic Foundation, Cleveland, OH; and Niteshkumar G. Rana and Albert Attia, Vanderbilt University School of Medicine, Nashville, TN
| | - Natalie A Lockney
- William J. Magnuson, Nataniel H. Lester-Coll, Scott N. Gettinger, Joseph N. Contessa, James B. Yu, and Veronica L. Chiang, Yale School of Medicine, New Haven, CT; Abraham J. Wu, T. Jonathan Yang, Natalie A. Lockney, Naamit K. Gerber, and Kathryn Beal, Memorial Sloan Kettering Cancer Center, New York, NY; Arya Amini, Tejas Patil, Brian D. Kavanagh, and D. Ross Camidge, University of Colorado School of Medicine, Denver, CO; Steven E. Braunstein and Lauren C. Boreta, University of California-San Francisco, San Francisco, CA; Suresh K. Balasubramanian and Manmeet S. Ahluwalia, Cleveland Clinic Foundation, Cleveland, OH; and Niteshkumar G. Rana and Albert Attia, Vanderbilt University School of Medicine, Nashville, TN
| | - Naamit K Gerber
- William J. Magnuson, Nataniel H. Lester-Coll, Scott N. Gettinger, Joseph N. Contessa, James B. Yu, and Veronica L. Chiang, Yale School of Medicine, New Haven, CT; Abraham J. Wu, T. Jonathan Yang, Natalie A. Lockney, Naamit K. Gerber, and Kathryn Beal, Memorial Sloan Kettering Cancer Center, New York, NY; Arya Amini, Tejas Patil, Brian D. Kavanagh, and D. Ross Camidge, University of Colorado School of Medicine, Denver, CO; Steven E. Braunstein and Lauren C. Boreta, University of California-San Francisco, San Francisco, CA; Suresh K. Balasubramanian and Manmeet S. Ahluwalia, Cleveland Clinic Foundation, Cleveland, OH; and Niteshkumar G. Rana and Albert Attia, Vanderbilt University School of Medicine, Nashville, TN
| | - Kathryn Beal
- William J. Magnuson, Nataniel H. Lester-Coll, Scott N. Gettinger, Joseph N. Contessa, James B. Yu, and Veronica L. Chiang, Yale School of Medicine, New Haven, CT; Abraham J. Wu, T. Jonathan Yang, Natalie A. Lockney, Naamit K. Gerber, and Kathryn Beal, Memorial Sloan Kettering Cancer Center, New York, NY; Arya Amini, Tejas Patil, Brian D. Kavanagh, and D. Ross Camidge, University of Colorado School of Medicine, Denver, CO; Steven E. Braunstein and Lauren C. Boreta, University of California-San Francisco, San Francisco, CA; Suresh K. Balasubramanian and Manmeet S. Ahluwalia, Cleveland Clinic Foundation, Cleveland, OH; and Niteshkumar G. Rana and Albert Attia, Vanderbilt University School of Medicine, Nashville, TN
| | - Arya Amini
- William J. Magnuson, Nataniel H. Lester-Coll, Scott N. Gettinger, Joseph N. Contessa, James B. Yu, and Veronica L. Chiang, Yale School of Medicine, New Haven, CT; Abraham J. Wu, T. Jonathan Yang, Natalie A. Lockney, Naamit K. Gerber, and Kathryn Beal, Memorial Sloan Kettering Cancer Center, New York, NY; Arya Amini, Tejas Patil, Brian D. Kavanagh, and D. Ross Camidge, University of Colorado School of Medicine, Denver, CO; Steven E. Braunstein and Lauren C. Boreta, University of California-San Francisco, San Francisco, CA; Suresh K. Balasubramanian and Manmeet S. Ahluwalia, Cleveland Clinic Foundation, Cleveland, OH; and Niteshkumar G. Rana and Albert Attia, Vanderbilt University School of Medicine, Nashville, TN
| | - Tejas Patil
- William J. Magnuson, Nataniel H. Lester-Coll, Scott N. Gettinger, Joseph N. Contessa, James B. Yu, and Veronica L. Chiang, Yale School of Medicine, New Haven, CT; Abraham J. Wu, T. Jonathan Yang, Natalie A. Lockney, Naamit K. Gerber, and Kathryn Beal, Memorial Sloan Kettering Cancer Center, New York, NY; Arya Amini, Tejas Patil, Brian D. Kavanagh, and D. Ross Camidge, University of Colorado School of Medicine, Denver, CO; Steven E. Braunstein and Lauren C. Boreta, University of California-San Francisco, San Francisco, CA; Suresh K. Balasubramanian and Manmeet S. Ahluwalia, Cleveland Clinic Foundation, Cleveland, OH; and Niteshkumar G. Rana and Albert Attia, Vanderbilt University School of Medicine, Nashville, TN
| | - Brian D Kavanagh
- William J. Magnuson, Nataniel H. Lester-Coll, Scott N. Gettinger, Joseph N. Contessa, James B. Yu, and Veronica L. Chiang, Yale School of Medicine, New Haven, CT; Abraham J. Wu, T. Jonathan Yang, Natalie A. Lockney, Naamit K. Gerber, and Kathryn Beal, Memorial Sloan Kettering Cancer Center, New York, NY; Arya Amini, Tejas Patil, Brian D. Kavanagh, and D. Ross Camidge, University of Colorado School of Medicine, Denver, CO; Steven E. Braunstein and Lauren C. Boreta, University of California-San Francisco, San Francisco, CA; Suresh K. Balasubramanian and Manmeet S. Ahluwalia, Cleveland Clinic Foundation, Cleveland, OH; and Niteshkumar G. Rana and Albert Attia, Vanderbilt University School of Medicine, Nashville, TN
| | - D Ross Camidge
- William J. Magnuson, Nataniel H. Lester-Coll, Scott N. Gettinger, Joseph N. Contessa, James B. Yu, and Veronica L. Chiang, Yale School of Medicine, New Haven, CT; Abraham J. Wu, T. Jonathan Yang, Natalie A. Lockney, Naamit K. Gerber, and Kathryn Beal, Memorial Sloan Kettering Cancer Center, New York, NY; Arya Amini, Tejas Patil, Brian D. Kavanagh, and D. Ross Camidge, University of Colorado School of Medicine, Denver, CO; Steven E. Braunstein and Lauren C. Boreta, University of California-San Francisco, San Francisco, CA; Suresh K. Balasubramanian and Manmeet S. Ahluwalia, Cleveland Clinic Foundation, Cleveland, OH; and Niteshkumar G. Rana and Albert Attia, Vanderbilt University School of Medicine, Nashville, TN
| | - Steven E Braunstein
- William J. Magnuson, Nataniel H. Lester-Coll, Scott N. Gettinger, Joseph N. Contessa, James B. Yu, and Veronica L. Chiang, Yale School of Medicine, New Haven, CT; Abraham J. Wu, T. Jonathan Yang, Natalie A. Lockney, Naamit K. Gerber, and Kathryn Beal, Memorial Sloan Kettering Cancer Center, New York, NY; Arya Amini, Tejas Patil, Brian D. Kavanagh, and D. Ross Camidge, University of Colorado School of Medicine, Denver, CO; Steven E. Braunstein and Lauren C. Boreta, University of California-San Francisco, San Francisco, CA; Suresh K. Balasubramanian and Manmeet S. Ahluwalia, Cleveland Clinic Foundation, Cleveland, OH; and Niteshkumar G. Rana and Albert Attia, Vanderbilt University School of Medicine, Nashville, TN
| | - Lauren C Boreta
- William J. Magnuson, Nataniel H. Lester-Coll, Scott N. Gettinger, Joseph N. Contessa, James B. Yu, and Veronica L. Chiang, Yale School of Medicine, New Haven, CT; Abraham J. Wu, T. Jonathan Yang, Natalie A. Lockney, Naamit K. Gerber, and Kathryn Beal, Memorial Sloan Kettering Cancer Center, New York, NY; Arya Amini, Tejas Patil, Brian D. Kavanagh, and D. Ross Camidge, University of Colorado School of Medicine, Denver, CO; Steven E. Braunstein and Lauren C. Boreta, University of California-San Francisco, San Francisco, CA; Suresh K. Balasubramanian and Manmeet S. Ahluwalia, Cleveland Clinic Foundation, Cleveland, OH; and Niteshkumar G. Rana and Albert Attia, Vanderbilt University School of Medicine, Nashville, TN
| | - Suresh K Balasubramanian
- William J. Magnuson, Nataniel H. Lester-Coll, Scott N. Gettinger, Joseph N. Contessa, James B. Yu, and Veronica L. Chiang, Yale School of Medicine, New Haven, CT; Abraham J. Wu, T. Jonathan Yang, Natalie A. Lockney, Naamit K. Gerber, and Kathryn Beal, Memorial Sloan Kettering Cancer Center, New York, NY; Arya Amini, Tejas Patil, Brian D. Kavanagh, and D. Ross Camidge, University of Colorado School of Medicine, Denver, CO; Steven E. Braunstein and Lauren C. Boreta, University of California-San Francisco, San Francisco, CA; Suresh K. Balasubramanian and Manmeet S. Ahluwalia, Cleveland Clinic Foundation, Cleveland, OH; and Niteshkumar G. Rana and Albert Attia, Vanderbilt University School of Medicine, Nashville, TN
| | - Manmeet S Ahluwalia
- William J. Magnuson, Nataniel H. Lester-Coll, Scott N. Gettinger, Joseph N. Contessa, James B. Yu, and Veronica L. Chiang, Yale School of Medicine, New Haven, CT; Abraham J. Wu, T. Jonathan Yang, Natalie A. Lockney, Naamit K. Gerber, and Kathryn Beal, Memorial Sloan Kettering Cancer Center, New York, NY; Arya Amini, Tejas Patil, Brian D. Kavanagh, and D. Ross Camidge, University of Colorado School of Medicine, Denver, CO; Steven E. Braunstein and Lauren C. Boreta, University of California-San Francisco, San Francisco, CA; Suresh K. Balasubramanian and Manmeet S. Ahluwalia, Cleveland Clinic Foundation, Cleveland, OH; and Niteshkumar G. Rana and Albert Attia, Vanderbilt University School of Medicine, Nashville, TN
| | - Niteshkumar G Rana
- William J. Magnuson, Nataniel H. Lester-Coll, Scott N. Gettinger, Joseph N. Contessa, James B. Yu, and Veronica L. Chiang, Yale School of Medicine, New Haven, CT; Abraham J. Wu, T. Jonathan Yang, Natalie A. Lockney, Naamit K. Gerber, and Kathryn Beal, Memorial Sloan Kettering Cancer Center, New York, NY; Arya Amini, Tejas Patil, Brian D. Kavanagh, and D. Ross Camidge, University of Colorado School of Medicine, Denver, CO; Steven E. Braunstein and Lauren C. Boreta, University of California-San Francisco, San Francisco, CA; Suresh K. Balasubramanian and Manmeet S. Ahluwalia, Cleveland Clinic Foundation, Cleveland, OH; and Niteshkumar G. Rana and Albert Attia, Vanderbilt University School of Medicine, Nashville, TN
| | - Albert Attia
- William J. Magnuson, Nataniel H. Lester-Coll, Scott N. Gettinger, Joseph N. Contessa, James B. Yu, and Veronica L. Chiang, Yale School of Medicine, New Haven, CT; Abraham J. Wu, T. Jonathan Yang, Natalie A. Lockney, Naamit K. Gerber, and Kathryn Beal, Memorial Sloan Kettering Cancer Center, New York, NY; Arya Amini, Tejas Patil, Brian D. Kavanagh, and D. Ross Camidge, University of Colorado School of Medicine, Denver, CO; Steven E. Braunstein and Lauren C. Boreta, University of California-San Francisco, San Francisco, CA; Suresh K. Balasubramanian and Manmeet S. Ahluwalia, Cleveland Clinic Foundation, Cleveland, OH; and Niteshkumar G. Rana and Albert Attia, Vanderbilt University School of Medicine, Nashville, TN
| | - Scott N Gettinger
- William J. Magnuson, Nataniel H. Lester-Coll, Scott N. Gettinger, Joseph N. Contessa, James B. Yu, and Veronica L. Chiang, Yale School of Medicine, New Haven, CT; Abraham J. Wu, T. Jonathan Yang, Natalie A. Lockney, Naamit K. Gerber, and Kathryn Beal, Memorial Sloan Kettering Cancer Center, New York, NY; Arya Amini, Tejas Patil, Brian D. Kavanagh, and D. Ross Camidge, University of Colorado School of Medicine, Denver, CO; Steven E. Braunstein and Lauren C. Boreta, University of California-San Francisco, San Francisco, CA; Suresh K. Balasubramanian and Manmeet S. Ahluwalia, Cleveland Clinic Foundation, Cleveland, OH; and Niteshkumar G. Rana and Albert Attia, Vanderbilt University School of Medicine, Nashville, TN
| | - Joseph N Contessa
- William J. Magnuson, Nataniel H. Lester-Coll, Scott N. Gettinger, Joseph N. Contessa, James B. Yu, and Veronica L. Chiang, Yale School of Medicine, New Haven, CT; Abraham J. Wu, T. Jonathan Yang, Natalie A. Lockney, Naamit K. Gerber, and Kathryn Beal, Memorial Sloan Kettering Cancer Center, New York, NY; Arya Amini, Tejas Patil, Brian D. Kavanagh, and D. Ross Camidge, University of Colorado School of Medicine, Denver, CO; Steven E. Braunstein and Lauren C. Boreta, University of California-San Francisco, San Francisco, CA; Suresh K. Balasubramanian and Manmeet S. Ahluwalia, Cleveland Clinic Foundation, Cleveland, OH; and Niteshkumar G. Rana and Albert Attia, Vanderbilt University School of Medicine, Nashville, TN
| | - James B Yu
- William J. Magnuson, Nataniel H. Lester-Coll, Scott N. Gettinger, Joseph N. Contessa, James B. Yu, and Veronica L. Chiang, Yale School of Medicine, New Haven, CT; Abraham J. Wu, T. Jonathan Yang, Natalie A. Lockney, Naamit K. Gerber, and Kathryn Beal, Memorial Sloan Kettering Cancer Center, New York, NY; Arya Amini, Tejas Patil, Brian D. Kavanagh, and D. Ross Camidge, University of Colorado School of Medicine, Denver, CO; Steven E. Braunstein and Lauren C. Boreta, University of California-San Francisco, San Francisco, CA; Suresh K. Balasubramanian and Manmeet S. Ahluwalia, Cleveland Clinic Foundation, Cleveland, OH; and Niteshkumar G. Rana and Albert Attia, Vanderbilt University School of Medicine, Nashville, TN
| | - Veronica L Chiang
- William J. Magnuson, Nataniel H. Lester-Coll, Scott N. Gettinger, Joseph N. Contessa, James B. Yu, and Veronica L. Chiang, Yale School of Medicine, New Haven, CT; Abraham J. Wu, T. Jonathan Yang, Natalie A. Lockney, Naamit K. Gerber, and Kathryn Beal, Memorial Sloan Kettering Cancer Center, New York, NY; Arya Amini, Tejas Patil, Brian D. Kavanagh, and D. Ross Camidge, University of Colorado School of Medicine, Denver, CO; Steven E. Braunstein and Lauren C. Boreta, University of California-San Francisco, San Francisco, CA; Suresh K. Balasubramanian and Manmeet S. Ahluwalia, Cleveland Clinic Foundation, Cleveland, OH; and Niteshkumar G. Rana and Albert Attia, Vanderbilt University School of Medicine, Nashville, TN
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Gerber NK, Goenka A, Turcan S, Reyngold M, Makarov V, Kannan K, Beal K, Omuro A, Yamada Y, Gutin P, Brennan CW, Huse JT, Chan TA. Transcriptional diversity of long-term glioblastoma survivors. Neuro Oncol 2014; 16:1186-95. [PMID: 24662514 DOI: 10.1093/neuonc/nou043] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Glioblastoma (GBM) is a highly aggressive type of glioma with poor prognosis. However, a small number of patients live much longer than the median survival. A better understanding of these long-term survivors (LTSs) may provide important insight into the biology of GBM. METHODS We identified 7 patients with GBM, treated at Memorial Sloan-Kettering Cancer Center (MSKCC), with survival >48 months. We characterized the transcriptome of each patient and determined rates of MGMT promoter methylation and IDH1 and IDH2 mutational status. We identified LTSs in 2 independent cohorts (The Cancer Genome Atlas [TCGA] and NCI Repository for Molecular Brain Neoplasia Data [REMBRANDT]) and analyzed the transcriptomal characteristics of these LTSs. RESULTS The median overall survival of our cohort was 62.5 months. LTSs were distributed between the proneural (n = 2), neural (n = 2), classical (n = 2), and mesenchymal (n = 1) subtypes. Similarly, LTS in the TCGA and REMBRANDT cohorts demonstrated diverse transcriptomal subclassification identities. The majority of the MSKCC LTSs (71%) were found to have methylation of the MGMT promoter. None of the patients had an IDH1 or IDH2 mutation, and IDH mutation occurred in a minority of the TCGA LTSs as well. A set of 60 genes was found to be differentially expressed in the MSKCC and TCGA LTSs. CONCLUSIONS While IDH mutant proneural tumors impart a better prognosis in the short-term, survival beyond 4 years does not require IDH mutation and is not dictated by a single transcriptional subclass. In contrast, MGMT methylation continues to have strong prognostic value for survival beyond 4 years. These findings have substantial impact for understanding GBM biology and progression.
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Affiliation(s)
- Naamit K Gerber
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (N.K.G., A.G., M.R., K.B., Y.Y., T.A.C.); Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York (S.T., V.M., K.K., T.A.C.); Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York (A.O.); Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York (P.G., C.W.B.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (J.T.H.)
| | - Anuj Goenka
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (N.K.G., A.G., M.R., K.B., Y.Y., T.A.C.); Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York (S.T., V.M., K.K., T.A.C.); Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York (A.O.); Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York (P.G., C.W.B.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (J.T.H.)
| | - Sevin Turcan
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (N.K.G., A.G., M.R., K.B., Y.Y., T.A.C.); Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York (S.T., V.M., K.K., T.A.C.); Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York (A.O.); Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York (P.G., C.W.B.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (J.T.H.)
| | - Marsha Reyngold
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (N.K.G., A.G., M.R., K.B., Y.Y., T.A.C.); Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York (S.T., V.M., K.K., T.A.C.); Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York (A.O.); Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York (P.G., C.W.B.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (J.T.H.)
| | - Vladimir Makarov
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (N.K.G., A.G., M.R., K.B., Y.Y., T.A.C.); Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York (S.T., V.M., K.K., T.A.C.); Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York (A.O.); Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York (P.G., C.W.B.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (J.T.H.)
| | - Kasthuri Kannan
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (N.K.G., A.G., M.R., K.B., Y.Y., T.A.C.); Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York (S.T., V.M., K.K., T.A.C.); Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York (A.O.); Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York (P.G., C.W.B.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (J.T.H.)
| | - Kathryn Beal
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (N.K.G., A.G., M.R., K.B., Y.Y., T.A.C.); Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York (S.T., V.M., K.K., T.A.C.); Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York (A.O.); Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York (P.G., C.W.B.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (J.T.H.)
| | - Antonio Omuro
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (N.K.G., A.G., M.R., K.B., Y.Y., T.A.C.); Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York (S.T., V.M., K.K., T.A.C.); Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York (A.O.); Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York (P.G., C.W.B.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (J.T.H.)
| | - Yoshiya Yamada
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (N.K.G., A.G., M.R., K.B., Y.Y., T.A.C.); Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York (S.T., V.M., K.K., T.A.C.); Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York (A.O.); Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York (P.G., C.W.B.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (J.T.H.)
| | - Phillip Gutin
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (N.K.G., A.G., M.R., K.B., Y.Y., T.A.C.); Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York (S.T., V.M., K.K., T.A.C.); Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York (A.O.); Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York (P.G., C.W.B.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (J.T.H.)
| | - Cameron W Brennan
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (N.K.G., A.G., M.R., K.B., Y.Y., T.A.C.); Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York (S.T., V.M., K.K., T.A.C.); Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York (A.O.); Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York (P.G., C.W.B.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (J.T.H.)
| | - Jason T Huse
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (N.K.G., A.G., M.R., K.B., Y.Y., T.A.C.); Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York (S.T., V.M., K.K., T.A.C.); Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York (A.O.); Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York (P.G., C.W.B.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (J.T.H.)
| | - Timothy A Chan
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (N.K.G., A.G., M.R., K.B., Y.Y., T.A.C.); Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York (S.T., V.M., K.K., T.A.C.); Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York (A.O.); Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York (P.G., C.W.B.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (J.T.H.)
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