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Eustace N, Liu J, Ladbury C, Tam A, Glaser S, Liu A, Chen YJ. Current Status and Future Directions of Image-Guided Adaptive Brachytherapy for Locally Advanced Cervical Cancer. Cancers (Basel) 2024; 16:1031. [PMID: 38473388 DOI: 10.3390/cancers16051031] [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: 01/11/2024] [Revised: 02/26/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024] Open
Abstract
PURPOSE The standard of care for patients with locally advanced cervical cancer is definitive chemoradiation followed by a brachytherapy boost. This review describes the current status and future directions of image-guided adaptive brachytherapy for locally advanced cervical cancer. METHODS A systematic search of the PubMed and Clinicaltrials.gov databases was performed, focusing on studies published within the last 10 years. The search queried "cervical cancer [AND] image-guided brachytherapy [OR] magnetic resonance imaging (MRI) [OR] adaptive brachytherapy". DISCUSSION The retroEMBRACE and EMBRACE-I trials have established the use of MRI as the standard imaging modality for brachytherapy application and planning. Quantitative imaging and radiomics have the potential to improve outcomes, with three ongoing prospective studies examining the use of radiomics to further risk-stratify patients and personalize brachytherapy. Another active area of investigation includes utilizing the superior soft tissue contrast provided by MRI to increase the dose per fraction and decrease the number of fractions needed for brachytherapy, with several retrospective studies demonstrating the safety and feasibility of three-fraction courses. For developing countries with limited access to MRI, trans-rectal ultrasound (TRUS) appears to be an effective alternative, with several retrospective studies demonstrating improved target delineation with the use of TRUS in conjunction with CT guidance. CONCLUSIONS Further investigation is needed to continue improving outcomes for patients with locally advanced cervical cancer treated with image-guided brachytherapy.
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Affiliation(s)
- Nicholas Eustace
- Department of Radiation Oncology, City of Hope National Medical Center, 1500 E Duarte Rd., Duarte, CA 91105, USA
| | - Jason Liu
- Department of Radiation Oncology, City of Hope National Medical Center, 1500 E Duarte Rd., Duarte, CA 91105, USA
| | - Colton Ladbury
- Department of Radiation Oncology, City of Hope National Medical Center, 1500 E Duarte Rd., Duarte, CA 91105, USA
| | - Andrew Tam
- Department of Radiation Oncology, City of Hope National Medical Center, 1500 E Duarte Rd., Duarte, CA 91105, USA
| | - Scott Glaser
- Department of Radiation Oncology, City of Hope National Medical Center, 1500 E Duarte Rd., Duarte, CA 91105, USA
| | - An Liu
- Department of Radiation Oncology, City of Hope National Medical Center, 1500 E Duarte Rd., Duarte, CA 91105, USA
| | - Yi-Jen Chen
- Department of Radiation Oncology, City of Hope National Medical Center, 1500 E Duarte Rd., Duarte, CA 91105, USA
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Tam A, Eustace N, Kassardjian A, West H, Williams TM, Amini A. The Emerging Role of Radiotherapy in Oligoprogressive Non-Small Cell Lung Cancer. Surg Oncol Clin N Am 2023; 32:497-514. [PMID: 37182989 DOI: 10.1016/j.soc.2023.02.004] [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] [Indexed: 05/16/2023]
Abstract
Oligoprogressive disease (OPD) is an emerging concept that describes patients who have progression of disease in a limited number of metastatic sites while on systemic therapy. Growing evidence has suggested the integration of local ablative therapy with systemic agents in patients with OPD further improves survival. In oligoprogressive non-small cell lung cancer, stereotactic body radiotherapy may have an important role in the effective local control of selective progressing metastases, which may translate to better patient outcomes. This review explores the treatment paradigm of this subset of patients and provides an update on the current existing literature on this topic.
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Affiliation(s)
- Andrew Tam
- Department of Radiation Oncology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, USA
| | - Nicholas Eustace
- Department of Radiation Oncology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, USA
| | - Ari Kassardjian
- Department of Radiation Oncology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, USA
| | - Howard West
- Department of Medical Oncology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, USA
| | - Terence M Williams
- Department of Radiation Oncology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, USA
| | - Arya Amini
- Department of Radiation Oncology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, USA.
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Brady A, Moran P, McGrath B, Hunter K, McGarvey B, Eustace N, Duggan S, Walshe B. A Pelvic Osteotomy programme in a stand-alone orthopaedic centre: an early service evaluation. Ir Med J 2023; 116:749. [PMID: 37010525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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Ladbury C, Eustace N, Amini A, Dandapani S, Williams T. Biology-Guided Radiation Therapy. Surg Oncol Clin N Am 2023; 32:553-568. [PMID: 37182992 DOI: 10.1016/j.soc.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Biology-guided radiation therapy is an emerging field whereby delivery of external beam radiotherapy incorporates biological/molecular imaging to inform radiation treatment. At present, there is evidence for the use of functional imaging such as PET to evaluate treatment response in patients both during and after radiation treatment as well as to provide a method of adapting or selecting patient-specific treatments. Examples in thoracic, gastrointestinal, and hematologic malignancies are provided. Improvements in PET metrics, thresholds, and novel radiotracers will further move this novel field forward.
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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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Alrefai H, Beierle A, Nassour L, Eustace N, Patel Z, Anderson J, Hicks P, King P, Willey C. TMOD-21. A NOVEL IN-VITRO METHOD TO MODEL MACROPHAGES IN GLIOBLASTOMA. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.882] [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
The GBM tumor microenvironment (TME) is comprised of a plethora of cancerous and non-cancerous cells that contribute to GBM growth, invasion, and chemoresistance. In-vitro models of GBM typically fail to incorporate multiple cell types. Others have addressed this problem by employing 3D bioprinting to incorporate astrocytes and macrophages in an extracellular matrix; however, they used serum-containing media and classically polarized anti-inflammatory macrophages. Serum has been shown to cause GBM brain-tumor initiating cells to lose their stem-like properties, highlighting the importance of excluding it from these models. Additionally, tumor-associated macrophages (TAMs) do not adhere to the traditional M2 phenotype.
METHODS
THP-1 monocytes and normal human astrocytes (NHAs) were transitioned into serum-free HL-1 and neurobasal-based media, respectively. Monocytes were stimulated towards a macrophage-like state with PMA and polarized by co-culturing them with GBM patient-derived xenograft(PDX) lines, using a transwell insert. CD206 expression was used to validate polarization and a cytokine array was used to characterize the cells.
RESULTS
There was no difference in proliferation rates at 72 hours for THP-1 monocytes grown in serum-free HL-1 media compared to serum-containing RPMI 1640 (p > 0.95). Macrophages polarized via transwell inserts expressed the lymphocyte chemoattractant protein, CCL2, whereas resting(M0), pro-inflammatory(M1), and anti-inflammatory(M2) macrophages did not. Additionally, these macrophages expressed more CXCL1 and IL-1ß relative to M1 macrophages. We have also demonstrated a method to maintain a tri-culture model of GBM PDX cells, NHAs, and TAMs in a serum-free media that supports the growth/maintenance of all cell types.
CONCLUSIONS
We have demonstrated a novel method by which we can polarize macrophages towards a tumor-supportive phenotype that differs in cytokine expression from traditionally polarized macrophages. This higher-fidelity method of modeling TAMs in GBM can aid in the development of targeted therapeutics that may one day enter the clinic in hopes of improving outcomes in GBM.
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Affiliation(s)
- Hasan Alrefai
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andee Beierle
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lauren Nassour
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Zeel Patel
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Patricia Hicks
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Peter King
- University of Alabama at Birmingham, Birmingham, AL, USA
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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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Aryanpour Z, Asban A, Boyd C, Herring B, Eustace N, Carmona Matos DM, McCaw T, Ramonell KM, Fazendin JM, Lindeman B, Iyer P, Chen H. A single institution experience with papillary thyroid cancer: Are outcomes better at comprehensive cancer centers? Am J Surg 2021; 222:802-805. [PMID: 33676725 DOI: 10.1016/j.amjsurg.2021.02.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 02/05/2021] [Accepted: 02/17/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Papillary thyroid cancer (PTC) is the most common form of thyroid cancer. Although the survival rate is excellent, recurrence is as high as 20%. The mainstay of therapy is thyroidectomy and lymph node dissection based on risk factors. Data from other cancers suggest that surgical outcomes are most optimal at comprehensive cancer centers. We hypothesize that patients with PTC who had their initial operation at a comprehensive cancer center would have a better oncologic outcome. METHODS We utilized an IRB-approved cancer care registry database of patients with thyroid cancer who were seen at our institution between 2000 and 2018. Patient records were updated with cancer-specific outcomes including recurrence and need for re-intervention. Clinical and surgical outcomes were then compared between patients who had their initial operation at a comprehensive cancer center (CCC group, n = 503) versus those who did not (non-CCC group, n = 72). RESULTS Mean patient age was 49 ± 16 years and 70% were female. Average tumor size was 1.6 ± 1.6 cm. There was no difference in tumor size, age, gender or race between groups. Pre-operative ultrasound was more frequently performed at the CCC (89%) than at non-CCC's (51%, p < 0.001). CCC patients were more likely to undergo initial total thyroidectomies compared to non-CCC patients (76% vs. 21%, p < 0.001). Positive surgical margins were more frequently found in patients at non-CCC's (19%) than at the CCC (9.7%, p = 0.016). Finally, CCC patients had a significantly lower cancer recurrence rate (5.0% vs. 37.5%, p < 0.001). Therefore, the need for additional cancer operations was much greater in patients who had initial thyroid surgery at non-CCC (31.9% vs. 1.4%, p < 0.001). CONCLUSIONS Patients with PTC who have their initial thyroidectomy at non-CCC have higher recurrence rates, higher rates of positive tumor margins on pathology, and increased need for additional operations. These data suggest that patients who have their initial procedure at a CCC for PTC have better long-term outcomes.
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Affiliation(s)
- Zain Aryanpour
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Ammar Asban
- University of Alabama at Birmingham, Department of Surgery, Birmingham, AL, USA
| | - Carter Boyd
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Brendon Herring
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Nicholas Eustace
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | | | - Tyler McCaw
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Kimberly M Ramonell
- University of Alabama at Birmingham, Department of Surgery, Birmingham, AL, USA
| | - Jessica M Fazendin
- University of Alabama at Birmingham, Department of Surgery, Birmingham, AL, USA
| | - Brenessa Lindeman
- University of Alabama at Birmingham, Department of Surgery, Birmingham, AL, USA
| | - Pallavi Iyer
- University of Alabama at Birmingham, Department of Pediatrics, Division of Endocrinology and Diabetes, Birmingham, AL, USA
| | - Herbert Chen
- University of Alabama at Birmingham, Department of Surgery, Birmingham, AL, USA.
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Eustace N, Warram J, Widden H, Anderson J, Hicks P, Troelsgaard R, Placzek W, Hjelmeland A, Gillespie Y, Willey C. EXTH-52. USE OF A PHOSPHOLIPID BINDING MARCKS MIMETIC FOR TARGETED KILLING OF GLIOBLASTOMA CELLS. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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)
| | - Jason Warram
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hayley Widden
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Patricia Hicks
- University of Alabama at Birmingham, Birmingham, AL, USA
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Eustace N, Anderson J, Langford C, Hicks P, Hjelmeland A, Willey C, Jarboe J. CSIG-10. MYRISTOYLATED ALANINE-RICH C-KINASE SUBSTRATE PHOSPHORYLATION ENHANCES THE GROWTH AND RADIATION RESISTANCE OF GLIOBLASTOMA. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.205] [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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Smith A, Dunne E, Mannion M, O'Connor C, Knerr I, Monavari AA, Hughes J, Eustace N, Crushell E. A review of anaesthetic outcomes in patients with genetically confirmed mitochondrial disorders. Eur J Pediatr 2017; 176:83-88. [PMID: 27885500 DOI: 10.1007/s00431-016-2813-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 11/09/2016] [Accepted: 11/14/2016] [Indexed: 12/18/2022]
Abstract
UNLABELLED Mitochondrial disorders are a clinically and biochemically diverse group of disorders which may involve multiple organ systems. General anaesthesia (GA) poses a potential risk of decompensation in children with mitochondrial disorders, and there is little guidance for anaesthetists and other clinicians regarding the optimal anaesthetic agents and perioperative management to provide to patients with mitochondrial disease[15]. The aim of this review was to document adverse events and perioperative complications from GA in patients with genetically confirmed mitochondrial disorders. A retrospective chart review of patients with genetically confirmed mitochondrial disorders who had undergone GA was undertaken. The indication for GA, anaesthetic agents utilised, length of admission and post anaesthetic complications were documented and analysed. Twenty-six patients with genetically proven mitochondrial disease underwent 65 GAs. Thirty-four (52%), received propofol as their induction agent. Thirty-three (51%) patients received sevoflurane for the maintenance of anaesthesia, while 8 (12%) received isoflurane and 24 (37%) received propofol. The duration of most GAs was short with 57 (87%) lasting less than 1 h. Perioperative complications occurred in five patients while under GA including ST segment depression, hypotension and metabolic acidosis in one. All five patients were stabilised successfully and none required ICU admission as a consequence of their perioperative complications. The duration of hospital stay post GA was <24 h in 25 (38%) patients. CONCLUSION No relationship between choice of anaesthetic agent and subsequent perioperative complication was observed. It is likely that individual optimisation on a case-by-case basis is more important overall than choice of any one particular technique. What is Known: • General anaesthesia (GA) poses a potential risk of decompensation in children with mitochondrial disorders. • There is a great diversity in the anaesthetic approaches undertaken in this cohort, and little guidance exists for anaesthetists and other clinicians regarding the optimal anaesthetic agents and perioperative management to provide to patients with mitochondrial disease. What is New: • In this study of 26 patients with genetically confirmed mitochondrial disease who underwent 65 GAs, no relationship between choice of anaesthetic agent and subsequent perioperative complication was observed • It is likely that individual optimisation on a case-by-case basis is more important overall than choice of any one particular technique.
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Affiliation(s)
- A Smith
- National Centre for Inherited Metabolic Disorders, Temple Street Children's University Hospital, Dublin, Ireland.
| | - E Dunne
- Department of Anaesthesia, Temple Street Children's University Hospital, Dublin, Ireland
| | - M Mannion
- National Centre for Inherited Metabolic Disorders, Temple Street Children's University Hospital, Dublin, Ireland
| | - C O'Connor
- Department of Metabolic Medicine, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - I Knerr
- National Centre for Inherited Metabolic Disorders, Temple Street Children's University Hospital, Dublin, Ireland
| | - A A Monavari
- National Centre for Inherited Metabolic Disorders, Temple Street Children's University Hospital, Dublin, Ireland
| | - J Hughes
- National Centre for Inherited Metabolic Disorders, Temple Street Children's University Hospital, Dublin, Ireland.,Department of Metabolic Medicine, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - N Eustace
- Department of Anaesthesia, Temple Street Children's University Hospital, Dublin, Ireland
| | - E Crushell
- National Centre for Inherited Metabolic Disorders, Temple Street Children's University Hospital, Dublin, Ireland.,Department of Metabolic Medicine, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
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Eustace N, Anderson J. CBIO-13. THE DYNAMIC ROLE OF MARCKS IN THE GROWTH AND PROLIFERATION OF GLIOBLASTOMA. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now212.151] [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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13
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Gilbert AN, Shevin RS, Anderson JC, Langford CP, Eustace N, Gillespie GY, Singh R, Willey CD. Generation of Microtumors Using 3D Human Biogel Culture System and Patient-derived Glioblastoma Cells for Kinomic Profiling and Drug Response Testing. J Vis Exp 2016. [PMID: 27341166 DOI: 10.3791/54026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The use of patient-derived xenografts for modeling cancers has provided important insight into cancer biology and drug responsiveness. However, they are time consuming, expensive, and labor intensive. To overcome these obstacles, many research groups have turned to spheroid cultures of cancer cells. While useful, tumor spheroids or aggregates do not replicate cell-matrix interactions as found in vivo. As such, three-dimensional (3D) culture approaches utilizing an extracellular matrix scaffold provide a more realistic model system for investigation. Starting from subcutaneous or intracranial xenografts, tumor tissue is dissociated into a single cell suspension akin to cancer stem cell neurospheres. These cells are then embedded into a human-derived extracellular matrix, 3D human biogel, to generate a large number of microtumors. Interestingly, microtumors can be cultured for about a month with high viability and can be used for drug response testing using standard cytotoxicity assays such as 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and live cell imaging using Calcein-AM. Moreover, they can be analyzed via immunohistochemistry or harvested for molecular profiling, such as array-based high-throughput kinomic profiling, which is detailed here as well. 3D microtumors, thus, represent a versatile high-throughput model system that can more closely replicate in vivo tumor biology than traditional approaches.
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Rohrbach TD, Hull TD, Jarboe JS, Eustace N, Wang Y, Deshane JS, Willey CD. Abstract A87: Myristoylated alanine rich C-kinase substrate (MARCKS) expression in lung cancer cells influences immune cell populations in tumor microenvironment in murine models. Cancer Immunol Res 2015. [DOI: 10.1158/2326-6074.tumimm14-a87] [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: 11/16/2022]
Abstract
Abstract
Purpose: To determine if MARCKS expression in lung cancer cells alters the recruitment of immune cells to the tumor microenvironment while influencing outcome in in vivo models.
Background: Lung cancer is the leading cause of cancer related deaths in the United States. There is increasing support that aberrant immune cell recruitment and activation in the tumor microenvironment leads to pro-tumor behavior. Myristoylated Alanine Rich C-Kinase Substrate (MARCKS) is an intracellular protein that has been described to alter cellular proliferation as well as be involved in lung epithelial cytokine secretion and immune cell migration. Depending on the type of cancer, MARCKS has either pro-tumor or anti-tumor properties. Currently, it is unknown whether MARCKS expression is beneficial or detrimental in lung cancer. We wanted to investigate if MARCKS expression was able to delay tumor burden as well as influence the immune cell populations being recruited to the tumor microenvironment.
Methods: The C57BL/6 murine lung cancer cell line Lewis Lung Carcinoma (LLC) was engineered with lentiviral particles to over-express MARCKS (LLC-MARCKS). Western blot confirmed over-expression of MARCKS. Tumors were implanted into the flank of C57BL/6 mice and survival data was collected comparing LLC-MARCKS over-expression tumors versus empty lentiviral plasmid containing LLC tumors (LLC-Ctrl). Survival data was graphed by Kaplan-Meier and statistics calculated with log-rank survival test. To analyze immune cells in the tumor microenvironment, orthotopic lung nodules were established by tail-vein injections. Three weeks after tail-vein injections, lungs were resected from LLC-MARCKS and LLC-Ctrl tumors bearing mice for flow cytometry analysis. Differences in immune cells between groups were calculated by student's t-test.
Results: Mice with LLC-MARCKS tumors had an increase in median survival time compared to LLC-Ctrl tumors (31 days vs. 26 days) and a trend toward increase survival (p=0.058). While collecting lungs, it was grossly apparent that mice with LLC-Ctrl tumors had greater tumor burden and signs of disease, such as bloody exudates, compared to mice with LLC-MARCKS tumors. H & E staining confirmed that LLC-Ctrl tumors had higher tumor burden then LLC-MARCKS tumors. Flow cytometry identified a decrease in F4/80+ macrophages (p<0.05) and neutrophils (p<0.05) in LLC-MARCKS cells compared to LLC-Ctrl. There was no difference in MDSC, DC subpopulations, CD4 T-cells, CD8 T-cells, B-cells, or T-regs.
Conclusion: MARCKS expression in the murine lung cancer LLC cell line prolonged survival while also decreasing F4/80+ macrophages and neutrophils in the tumor microenvironment.
Citation Format: Timothy D. Rohrbach, Travis D. Hull, John S. Jarboe, Nicholas Eustace, Yong Wang, Jessy S. Deshane, Christopher D. Willey. Myristoylated alanine rich C-kinase substrate (MARCKS) expression in lung cancer cells influences immune cell populations in tumor microenvironment in murine models. [abstract]. In: Proceedings of the AACR Special Conference: Tumor Immunology and Immunotherapy: A New Chapter; December 1-4, 2014; Orlando, FL. Philadelphia (PA): AACR; Cancer Immunol Res 2015;3(10 Suppl):Abstract nr A87.
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Affiliation(s)
| | | | | | | | - Yong Wang
- University of Alabama at Birmingham, Birmingham, AL
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15
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Eustace N, O'Hare B. Use of nonsteroidal anti-inflammatory drugs in infants. A survey of members of the Association of Paediatric Anaesthetists of Great Britain and Ireland. Paediatr Anaesth 2007; 17:464-9. [PMID: 17474954 DOI: 10.1111/j.1460-9592.2007.02135.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used as perioperative analgesics. Many are currently used off label. Diclofenac is currently licensed for use in children over 1 year of age for the treatment of juvenile rheumatoid arthritis, while ibuprofen is licensed for use in children weighing over 7 kg. The dose and interval in children is currently extrapolated from adult studies, as the pharmacokinetic (PK) and pharmacodynamic (PD) data are lacking in infants. METHODS A postal questionnaire was sent to members of the Association of Paediatric Anaesthetist of Great Britain and Ireland seeking to clarify members' prescribing patterns of NSAIDs, especially in infants. Information regarding the choice of NSAIDS, route of administration, lower age limit, dose interval, dose and practice in two specific perioperative contexts (adenotonsillectomy and open heart surgery) was sought. RESULTS The response rate was 80%. NSAIDs are used by 86% of responders in infants. Diclofenac is most commonly used intraoperatively (78%); while ibuprofen (73%) was used more frequently postoperatively. NSAIDs are used by 21% of respondents in ICU. Commonest routes of administration were oral (81%) and rectal (80%), rarely intravenously (9%). The commonest dose for diclofena is 1 mg x kg(-1) (59%); the dosing schedule employed being 8 hourly in 53% of cases. NSAIDs are used by 57% of responders as part of their analgesic regime for adenotonsillectomies. CONCLUSION Members of the Association of Paediatric Anaesthetists of Great Britain and Ireland commonly prescribe NSAIDs in infants. This is despite the dearth of PK and PD data in this age group.
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Affiliation(s)
- Nicholas Eustace
- Department of Anaesthesia and Critical Care Medicine, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland
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Harmon D, Eustace N, Ghori K, Butler M, O'Callaghan S, O'Donnell A, Moore-Groarke GM, Shorten G. Plasma concentrations of nitric oxide products and cognitive dysfunction following coronary artery bypass surgery. Eur J Anaesthesiol 2005; 22:269-76. [PMID: 15892404 DOI: 10.1017/s0265021505000451] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE Prospective longitudinal studies now indicate that cognitive dysfunction following coronary artery bypass surgery (CABG) is both common and persistent. This dysfunction is due in part to the inflammatory response and cerebral ischaemia-reperfusion, with nitric oxide (NO) as an important mediator of both. We hypothesized that a clinically significant association exists between plasma concentrations of nitrate/nitrite (NO3-/NO2-) and cognitive dysfunction after CABG. METHODS Cognitive assessment was performed on 36 adult patients the day before CABG, on the fourth postoperative day and 3 months postoperatively. Patient spouses (n = 10) were also studied. RESULTS A new cognitive deficit was present in 22/36 (62%) 4 days postoperatively and in 16/35 (49%) of patients, 3 months postoperatively. Patients who had cognitive dysfunction 3 months postoperatively were more likely to have cognitive dysfunction and increased plasma NO3-/NO2- concentrations compared to the non-deficit group preoperatively (22.6 (9.2) vs. 27.6 (8.4)) (P = 0.002). Plasma NOx (NO3- plus NO2-) concentrations were greater in patients with cognitive dysfunction 3 months postoperatively, 2 h (24.2 (6.3) vs. 19.1 (5.2)) (P = 0.002), and 12 h postoperatively (24.8 (7.6) vs. 18.8 (5.6)) (P = 0.001). There was, however, a time course similarity in NOx elevations for both deficit and non-deficit groups. CONCLUSIONS Perioperative plasma NOx concentrations do not serve as an effective biomarker of cognitive deficit after CABG.
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Affiliation(s)
- D Harmon
- Walton Centre for Neurology and Neurosurgery, Liverpool, UK.
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17
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Eustace N, Gardiner C, Eustace P, Marsh B. Nebulised ipratropium causing a unilateral fixed dilated pupil in the critically ill patient: a report of two cases. CRIT CARE RESUSC 2004; 6:268-70. [PMID: 16556105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2004] [Accepted: 07/01/2004] [Indexed: 05/08/2023]
Abstract
We describe two cases of a unilateral fixed dilated pupil secondary to the ocular instillation of nebulised ipratropium bromide. In one patient there was no other neurological abnormality. The second patient was unconscious following a cardiac arrest. While a fixed dilated pupil is an alarming sign, if it is caused by ocular instillation of ipratropium bromide the condition will resolve, although it may take up to 24 hours. The differential diagnosis of a unilateral dilated pupil includes partial third nerve palsy, tonic pupil, direct trauma to the eye and pharmacological mydriasis. The diagnosis can often be determined using pilocarpine eye drops.
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Affiliation(s)
- N Eustace
- Department of Critical Care Medicine, Mater Hospital, Dublin, Ireland
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18
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Eustace N, Hennessy A, Gardiner J. The management of dural puncture in obstetrics and the efficacy of epidural blood patches. Ir Med J 2004; 97:298-300. [PMID: 15696874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Epidural blood patch is the definitive treatment for post dural puncture headaches (PDH), providing acceptable short-term relief. Disappointingly however debate exists as to their long-term success. To investigate their efficacy in our practice, a retrospective audit of all epidural blood patches performed over a four year period was performed. Patients were subsequently followed up using a postal questionnaire and persistent symptom relief and patient satisfaction was measured. During the study period 87 patients required an epidural blood patch, 11 required repeat patches. 71.26% of patients had complete symptom resolution on discharge. The response rate to follow up survey was 73.26% with the majority, 57.44%, replying that their symptoms returned following their discharge home. Only 25.53% said they would have an epidural or spinal anaesthetic for future deliveries. Epidural blood patches provide excellent short-term relief but long-term results are disappointing. Patients receiving epidural blood patches need improved long-term follow up.
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Affiliation(s)
- N Eustace
- Dept of Anaesthesia, Rotunda Hospital, Dublin 1, Ireland
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19
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Hennessy A, Lane A, Eustace N, Gardiner J. Long-term headache following epidural analgesia. Ir Med J 2002; 95:26. [PMID: 11928789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Epidural analgesia is widely used in modern obstetric practice. Complications are uncommon but if they occur may result in significant morbidity. Post dural puncture headache (PDPH), in particular, may be particularly incapacitating especially if left untreated. In this report we describe the management of a case of unrecognised and undiagnosed PDPH.
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