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Kano H, Izumi K, Toriumi R, Nakagawa R, Aoyama S, Kamijima T, Shimada T, Naito R, Kadomoto S, Iwamoto H, Yaegashi H, Shigehara K, Nohara T, Nakata H, Kadono Y, Mizokami A. Suppression of androgen receptor signaling induces prostate cancer metastasis via activation of the CCL20–CCR6 axis. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00425-6] [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: 02/12/2023]
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Chen CJ, Ding D, Kumar JS, Kearns KN, Ironside N, Yang HC, Ogino A, Kano H, Liscak R, May J, Williams BJ, Gigliotti MJ, Cockroft K, McInerney J, Simon S, Lee CC, Sheehan JP. Hemorrhage and Recurrence of Obliterated Brain Arteriovenous Malformations Treated With Stereotactic Radiosurgery. Stroke 2022; 53:e363-e368. [PMID: 35616021 DOI: 10.1161/strokeaha.122.039213] [Citation(s) in RCA: 1] [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: 11/16/2022]
Abstract
BACKGROUND Although complete nidal obliteration of brain arteriovenous malformations (AVM) is generally presumed to represent durable cure, postobliteration hemorrhage, and AVM recurrence have become increasingly recognized phenomena. The goal of the study was to define hemorrhage and nidal recurrence risks of obliterated AVMs treated with stereotactic radiosurgery (SRS). METHODS This is a retrospective cohort study from the International Radiosurgery Research Foundation comprising AVM patients treated between 1987 and 2020. Patients with AVM obliteration on digital subtraction angiography (DSA) were included. Outcomes were (1) hemorrhage and (2) AVM recurrence. Follow-up duration began at the time of AVM obliteration and was censored at subsequent hemorrhage, AVM recurrence, additional AVM treatment, or loss to follow-up. Annualized risk and survival analyses were performed. A sensitivity analysis comprising patients with AVM obliteration on magnetic resonance imaging or DSA was also performed for postobliteration hemorrhage. RESULTS The study cohort comprised 1632 SRS-treated patients with AVM obliteration on DSA. Pediatric patients comprised 15% of the cohort, and 42% of AVMs were previously ruptured. The mean imaging follow-up after AVM obliteration was 22 months. Among 1607 patients with DSA-confirmed AVM obliteration, 16 hemorrhages (1.0%) occurred over 2223 patient-years of follow-up (0.72%/y). Of the 1543 patients with DSA-confirmed AVM obliteration, 5 AVM recurrences (0.32%) occurred over 2071 patient-years of follow-up (0.24%/y). Of the 16 patients with postobliteration hemorrhage, AVM recurrence was identified in 2 (12.5%). In the sensitivity analysis comprising 1939 patients with post-SRS AVM obliteration on magnetic resonance imaging or DSA, 16 hemorrhages (0.83%) occurred over 2560 patient-years of follow-up (0.63%/y). CONCLUSIONS Intracranial hemorrhage and recurrent arteriovenous shunting after complete nidal obliteration are rare in AVM patients treated with SRS, and each phenomenon harbors an annual risk of <1%. Although routine postobliteration DSA cannot be recommended to SRS-treated AVM patients, long-term neuroimaging may be advisable in these patients.
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Affiliation(s)
- Ching-Jen Chen
- Department of Neurosurgery, The University of Texas Health Science Center at Houston (C.-J.C.)
| | - Dale Ding
- Department of Neurosurgery, University of Louisville, KY (D.D., B.J.W.)
| | - Jeyan S Kumar
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville (J.S.K., K.N.K., N.I., J.P.S.)
| | - Kathryn N Kearns
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville (J.S.K., K.N.K., N.I., J.P.S.)
| | - Natasha Ironside
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville (J.S.K., K.N.K., N.I., J.P.S.)
| | - Huai-Che Yang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taiwan (H.-C.Y., C.-C.L.).,School of Medicine, National Yang-Ming University, Taipei, Taiwan (H.-C.Y., C.-C.L.)
| | - Akiyoshi Ogino
- Department of Neurological Surgery, University of Pittsburgh Medical Center, PA (A.O., H.K.)
| | - Hideyuki Kano
- Department of Neurological Surgery, University of Pittsburgh Medical Center, PA (A.O., H.K.)
| | - Roman Liscak
- Department of Neurosurgery, Na Homolce Hospital, Prague, Czech Republic (R.L., J. May)
| | - Jaromir May
- Department of Neurosurgery, Na Homolce Hospital, Prague, Czech Republic (R.L., J. May)
| | - Brian J Williams
- Department of Neurosurgery, University of Louisville, KY (D.D., B.J.W.)
| | - Michael J Gigliotti
- Department of Neurosurgery, Penn State Health-Hershey Medical Center, Hershey, PA (M.J.G., K.C., J. McInerney, S.S.)
| | - Kevin Cockroft
- Department of Neurosurgery, Penn State Health-Hershey Medical Center, Hershey, PA (M.J.G., K.C., J. McInerney, S.S.)
| | - James McInerney
- Department of Neurosurgery, Penn State Health-Hershey Medical Center, Hershey, PA (M.J.G., K.C., J. McInerney, S.S.)
| | - Scott Simon
- Department of Neurosurgery, Penn State Health-Hershey Medical Center, Hershey, PA (M.J.G., K.C., J. McInerney, S.S.)
| | - Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taiwan (H.-C.Y., C.-C.L.).,School of Medicine, National Yang-Ming University, Taipei, Taiwan (H.-C.Y., C.-C.L.)
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville (J.S.K., K.N.K., N.I., J.P.S.)
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Wehbi S, Mansuryan T, Krupa K, Fabert M, Tonello A, Zitelli M, Ferraro M, Mangini F, Sun Y, Vergnole S, Kano H, Wabnitz S, Couderc V. Continuous spatial self-cleaning in GRIN multimode fiber for self-referenced multiplex CARS imaging. Opt Express 2022; 30:16104-16114. [PMID: 36221462 DOI: 10.1364/oe.452384] [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] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 02/28/2022] [Indexed: 06/16/2023]
Abstract
We demonstrate how spatial beam self-cleaning and supercontinuum generation in graded-index multimode optical fibers can be directly applied in multiplex coherent anti-Stokes Raman Scattering (M-CARS) spectroscopy. Although supercontinuum generation causes pump depletion mainly in the center of the beam, the partial recovery of the pump brightness due to self-cleaning may enable self-referenced M-CARS, with no additional delay lines to synchronize pump and Stokes waves. As a proof-of-principle, we report examples of imaging of single chemical compounds and polystyrene beads. The new scheme paves the way towards simpler M-CARS systems based on multimode fiber sources.
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Cifarelli CP, Vargo JA, Fang W, Liscak R, Guseynova K, Warnick RE, Lee CC, Yang HC, Borghei-Razavi H, Maiti T, Siddiqui ZA, Yuan JC, Grills IS, Mathieu D, Touchette CJ, Cordeiro D, Chiang V, Hess J, Tien CJ, Faramand A, Kano H, Barnett GH, Sheehan JP, Lunsford LD. Role of Gamma Knife Radiosurgery in Small Cell Lung Cancer: A Multi-Institutional Retrospective Study of the International Radiosurgery Research Foundation (IRRF). Neurosurgery 2021. [DOI: 10.1093/neuros/nyz428_s020] [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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Chen CJ, Lee CC, Kano H, Kearns KN, Ding D, Tzeng SW, Atik AF, Joshi K, Huang PP, Kondziolka D, Ironside N, Mathieu D, Iorio-Morin C, Grills IS, Quinn TJ, Siddiqui ZA, Marvin K, Feliciano C, Starke RM, Faramand A, Barnett G, Lunsford LD, Sheehan JP. Radiosurgery for Unruptured Intervention-Naïve Pediatric Brain Arteriovenous Malformations. Neurosurgery 2021. [DOI: 10.1093/neuros/nyz558_s004] [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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Faramand A, Kano H, Niranjan A, Atik AF, Lee CC, Yang HC, Mohammed N, Liscak R, Hanuska J, Tripathi M, Kondziolka D, Sheehan J, Mathieu D, Flickinger JC, Lunsford LD. Stereotactic Radiosurgery for Choroid Plexus Tumors: A Report of the International Radiosurgery Research Foundation. Neurosurgery 2021. [DOI: 10.1093/neuros/nyaa538_s114] [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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Mehta GU, Lekovic GP, Slattery WH, Brackmann DE, Long H, Kano H, Kondziolka D, Mureb M, Bernstein K, Langlois AM, Mathieu D, Nabeel AM, Reda WA, Tawadros SR, Abdelkarim K, El-Shehaby AMN, Emad RM, Mohammed N, Urgosik D, Liscak R, Lee CC, Yang HC, Montazeripouragha A, Kaufmann AM, Joshi KC, Barnett GH, Trifiletti DM, Lunsford LD, Sheehan JP. Effect of Anatomic Segment Involvement on Stereotactic Radiosurgery for Facial Nerve Schwannomas: An International Multicenter Cohort Study. Neurosurgery 2021. [DOI: 10.1093/neuros/nyaa313_s078] [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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Shepard MJ, Xu Z, Kearns K, Li C, Chatrath A, Sheehan K, Sheehan D, Faramand A, Niranjan A, Kano H, Gurewitz J, Bernstein K, Liscak R, Guseynova K, Grills IS, Parzen JS, Cifarelli CP, Rehman AA, Atik A, Bakhsheshian J, Zada G, Chang E, Giannotta S, Speckter H, Wu HM, Kondziolka D, Golfinos JG, Mathieu D, Lee CC, Warnick RE, Lunsford LD, Sheehan JP. Stereotactic Radiosurgery for Atypical (World Health Organization II) and Anaplastic (World Health Organization III) Meningiomas: Results From a Multicenter, International Cohort Study. Neurosurgery 2021. [DOI: 10.1093/neuros/nyaa553_s121] [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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Pomeraniec IJ, Xu Z, Lee CC, Yang HC, Chytka T, Liscak R, Martinez-Alvarez R, Martinez-Moreno N, Attuati L, Picozzi P, Kondziolka D, Mureb M, Bernstein K, Mathieu D, Maillet M, Ogino A, Long H, Kano H, Lunsford LD, Zacharia BE, Mau C, Tuanquin LC, Cifarelli C, Arsanious D, Hack J, Warnick RE, Strickland BA, Zada G, Chang EL, Speckter H, Patel S, Ding D, Sheehan D, Sheehan K, Kvint S, Buch LY, Haber AR, Shteinhart J, Vance ML, Sheehan JP. Dose to neuroanatomical structures surrounding pituitary adenomas and the effect of stereotactic radiosurgery on neuroendocrine function: an international multicenter study. J Neurosurg 2021; 136:813-821. [PMID: 34560630 DOI: 10.3171/2021.3.jns203812] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 10/19/2020] [Accepted: 03/12/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Stereotactic radiosurgery (SRS) provides a safe and effective therapeutic modality for patients with pituitary adenomas. The mechanism of delayed endocrine deficits based on targeted radiation to the hypothalamic-pituitary axis remains unclear. Radiation to normal neuroendocrine structures likely plays a role in delayed hypopituitarism after SRS. In this multicenter study by the International Radiosurgery Research Foundation (IRRF), the authors aimed to evaluate radiation tolerance of structures surrounding pituitary adenomas and identify predictors of delayed hypopituitarism after SRS for these tumors. METHODS This is a retrospective review of patients with pituitary adenomas who underwent single-fraction SRS from 1997 to 2019 at 16 institutions within the IRRF. Dosimetric point measurements of 14 predefined neuroanatomical structures along the hypothalamus, pituitary stalk, and normal pituitary gland were made. Statistical analyses were performed to determine the impact of doses to critical structures on clinical, radiographic, and endocrine outcomes. RESULTS The study cohort comprised 521 pituitary adenomas treated with SRS. Tumor control was achieved in 93.9% of patients over a median follow-up period of 60.1 months, and 22.5% of patients developed new loss of pituitary function with a median treatment volume of 3.2 cm3. Median maximal radiosurgical doses to the hypothalamus, pituitary stalk, and normal pituitary gland were 1.4, 7.2, and 11.3 Gy, respectively. Nonfunctioning adenoma status, younger age, higher margin dose, and higher doses to the pituitary stalk and normal pituitary gland were independent predictors of new or worsening hypopituitarism. Neither the dose to the hypothalamus nor the ratio between doses to the pituitary stalk and gland were significant predictors. The threshold of the median dose to the pituitary stalk for new endocrinopathy was 10.7 Gy in a single fraction (OR 1.77, 95% CI 1.17-2.68, p = 0.006). CONCLUSIONS SRS for the treatment of pituitary adenomas affords a high tumor control rate with an acceptable risk of new or worsening endocrinopathy. This evaluation of point dosimetry to adjacent neuroanatomical structures revealed that doses to the pituitary stalk, with a threshold of 10.7 Gy, and doses to the normal gland significantly increased the risk of post-SRS hypopituitarism. In patients with preserved pre-SRS neuroendocrine function, limiting the dose to the pituitary stalk and gland while still delivering an optimal dose to the tumor appears prudent.
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Affiliation(s)
| | | | - Cheng-Chia Lee
- 4Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Huai-Che Yang
- 4Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Tomas Chytka
- 5Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Roman Liscak
- 5Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | | | | | - Luca Attuati
- 7Department of Neurosurgery, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Piero Picozzi
- 7Department of Neurosurgery, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | | | | | | | | | - Michel Maillet
- 11Endocrinology, Université de Sherbrooke, Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Quebec, Canada
| | - Akiyoshi Ogino
- 12Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Hao Long
- 12Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Hideyuki Kano
- 12Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - L Dade Lunsford
- 12Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | - Leonard C Tuanquin
- 14Radiation Oncology, Penn State Health-Hershey Medical Center, Hershey, Pennsylvania
| | | | | | - Joshua Hack
- 16Radiation Oncology, West Virginia University Medical Center, Morgantown, West Virginia
| | - Ronald E Warnick
- 17Gamma Knife Center, Jewish Hospital, Mayfield Clinic, Cincinnati, Ohio
| | | | | | - Eric L Chang
- 19Radiation Oncology, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Herwin Speckter
- 20Centro Gamma Knife Dominicano and Radiology Department, CEDIMAT, Santo Domingo, Dominican Republic
| | - Samir Patel
- 21Division of Radiation Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Dale Ding
- 22Department of Neurosurgery, University of Louisville Hospital, Louisville, Kentucky; and
| | | | | | - Svetlana Kvint
- 23Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Love Y Buch
- 23Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander R Haber
- 23Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jacob Shteinhart
- 23Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mary Lee Vance
- Departments of1Neurosurgery.,2Radiation Oncology, and.,3Medicine and Endocrinology, University of Virginia Health Science Center, Charlottesville, Virginia
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Niranjan A, Raju SS, Kano H, Flickinger JC, Lunsford LD. Clinical and Imaging Response to Trigeminal Schwannoma Radiosurgery: A Retrospective Analysis of a 28-Year Experience. J Neurol Surg B Skull Base 2021; 82:491-499. [PMID: 34513554 DOI: 10.1055/s-0040-1714110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/24/2020] [Accepted: 05/17/2020] [Indexed: 10/23/2022] Open
Abstract
Objective The purpose of this study was to evaluate long-term clinical outcomes and tumor control after stereotactic radiosurgery (SRS) for trigeminal schwannoma (TS). Methods During a 28-year period (1989-2017), 50 patients underwent SRS for TS. The median patient age was 51 years (range: 15-87 years). A total of 17 patients had a previous tumor resection: 10 had a single procedure, 5 had two procedures, and 2 had three procedures. The median and mean times between tumor resection and SRS were 12 and 24 months (range: 1-90 months), respectively. Four patients had neurofibromatosis II (NF2). Based on location, tumors were classified as root type (7), ganglion type (22), or dumbbell type (21). The median radiosurgery target volume was 3.4 cm 3 (range: 0.10-18 cm 3 ), median target dose was 14 Gy (range: 12-20 Gy), and the median number of isocenters was 6 (range: 1-15). The median and mean times to last follow-up was 36.9 and 55.2 months (range: 4-205 months), respectively. Eighteen patients (36%) had longer than 5-year follow-up, and seven patients (14%) had longer than 10-year follow-up. Results The tumor control rate was 92% and the clinical improvement or stabilization rate was 94%. After SRS, the rates of progression free survival (PFS) at 1, 5, and 10 years were 98, 84, and 84%, respectively. Factors associated with improved PFS were female sex ( p = 0.014) and smaller tumor volume ( p = 0.022). In this series, we did not find that tumor type (root, ganglion, and dumbbell) had a statistically significant correlation to PFS. Forty-seven patients had neurological signs or symptoms at presentation. At last follow-up, neurological signs or symptoms improved in 22/47 (47%), remained unchanged in 24/50 (48%), and worsened due to tumor progression in 3/50 (6%). One patient (2%) developed temporary symptomatic adverse radiation effect (ARE) and three additional patients (6%) had transient imaging evidence of peritumoral reactive edema but no new symptoms. Conclusion As a single outpatient procedure, SRS was associated with long-term freedom from additional management in 84% of patients. Nearly half the treated patients experienced improvement in neurological symptoms or signs.
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Affiliation(s)
- Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Sudesh S Raju
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Hideyuki Kano
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - John C Flickinger
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Lawrence Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
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Seymour ZA, Chan JW, McDermott MW, Grills I, Ye H, Kano H, Lehocky CA, Jacobs RC, Lunsford LD, Chytka T, Liščák R, Lee CC, Yang HC, Ding D, Sheehan JP, Feliciano CE, Rodriguez-Mercado R, Chiang VL, Hess JA, Sommaruga S, McShane B, Lee JYK, Vasas LT, Kaufmann AM, Sneed PK. Adverse radiation effects in volume-staged radiosurgery for large arteriovenous malformations: a multiinstitutional study. J Neurosurg 2021; 136:503-511. [PMID: 34450589 DOI: 10.3171/2020.12.jns201866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/21/2020] [Accepted: 12/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The optimal treatment paradigm for large arteriovenous malformations (AVMs) is controversial. One approach is volume-staged stereotactic radiosurgery (VS-SRS). The authors previously reported efficacy of VS-SRS for large AVMs in a multiinstitutional cohort; here they focus on risk of symptomatic adverse radiation effects (AREs). METHODS This is a multicentered retrospective review of patients treated with a planned prospective volume staging approach to stereotactically treat the entire nidus of an AVM, with volume stages separated by intervals of 3-6 months. A total of 9 radiosurgical centers treated 257 patients with VS-SRS between 1991 and 2016. The authors evaluated permanent, transient, and total ARE events that were symptomatic. RESULTS Patients received 2-4 total volume stages. The median age was 33 years at the time of the first SRS volume stage, and the median follow-up was 5.7 years after VS-SRS. The median total AVM nidus volume was 23.25 cm3 (range 7.7-94.4 cm3), with a median margin dose per stage of 17 Gy (range 12-20 Gy). A total of 64 patients (25%) experienced an ARE, of which 19 were permanent. Rather than volume, maximal linear dimension in the Z (craniocaudal) dimension was associated with toxicity; a threshold length of 3.28 cm was associated with an ARE, with a 72.5% sensitivity and a 58.3% specificity. In addition, parietal lobe involvement for superficial lesions and temporal lobe involvement for deep lesions were associated with an ARE. CONCLUSIONS Size remains the dominant predictor of toxicity following SRS, but overall rates of AREs were lower than anticipated based on baseline features, suggesting that dose and size were relatively dissociated through volume staging. Further techniques need to be assessed to optimize outcomes.
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Affiliation(s)
- Zachary A Seymour
- 1Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan
| | - Jason W Chan
- 2Department of Radiation Oncology, University of California, San Francisco, California
| | - Michael W McDermott
- 3Department of Neurological Surgery, Miami Neuroscience Institute, Miami, Florida
| | - Inga Grills
- 1Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan
| | - Hong Ye
- 1Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan
| | - Hideyuki Kano
- 4Department of Neurosurgery, University of Pittsburgh
| | | | - Rachel C Jacobs
- 5Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Tomas Chytka
- 6Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Roman Liščák
- 6Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Cheng-Chia Lee
- 7Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Huai-Che Yang
- 7Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Dale Ding
- 8Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
| | - Jason P Sheehan
- 8Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
| | - Caleb E Feliciano
- 9Department of Neurosurgery, University of Puerto Rico, San Juan, Puerto Rico
| | | | - Veronica L Chiang
- 10Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Judith A Hess
- 10Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Samuel Sommaruga
- 10Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Brendan McShane
- 11Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - John Y K Lee
- 11Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Lucas T Vasas
- 12Department of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Anthony M Kaufmann
- 12Department of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Penny K Sneed
- 2Department of Radiation Oncology, University of California, San Francisco, California
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12
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Burke RM, Chen CJ, Ding D, Buell TJ, Sokolowski J, Sheehan KA, Lee CC, Sheehan DE, Kano H, Kearns KN, Tzeng SW, Yang HC, Huang PP, Kondziolka D, Ironside N, Mathieu D, Iorio-Morin C, Grills IS, Feliciano C, Barnett G, Starke RM, Lunsford LD, Sheehan JP. Effect of Prior Embolization on Outcomes After Stereotactic Radiosurgery for Pediatric Brain Arteriovenous Malformations: An International Multicenter Study. Neurosurgery 2021; 89:672-679. [PMID: 34333653 DOI: 10.1093/neuros/nyab245] [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: 09/10/2020] [Accepted: 05/08/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Pediatric brain arteriovenous malformations (AVMs) are a significant cause of morbidity but the role of multimodal therapy in the treatment of these lesions is not well understood. OBJECTIVE To compare the outcomes of stereotactic radiosurgery (SRS) with and without prior embolization for pediatric AVMs. METHODS We retrospectively evaluated the International Radiosurgery Research Foundation pediatric AVM database. AVMs were categorized, based on use of pre-embolization (E + SRS) or lack thereof (SRS-only). Outcomes were compared in unadjusted and inverse probability weight (IPW)-adjusted models. Favorable outcome was defined as obliteration without post-SRS hemorrhage or permanent radiation-induced changes (RIC). RESULTS The E + SRS and SRS-only cohorts comprised 91 and 448 patients, respectively. In unadjusted models, the SRS-only cohort had higher rates of obliteration (68.5% vs 43.3%, < .001) and favorable outcome (61.2% vs 36.3%, P < .001) but a lower rate of symptomatic RIC (9.0% vs 16.7%, P = .031). The IPW-adjusted rates of every outcome were similar between the 2 cohorts. However, cumulative obliteration rates at 3, 5, 8, and 10 yr remained higher in the absence of prior embolization (46.3%, 64.6%, 72.6%, and 77.4% for SRS-only vs 24.4%, 37.2%, 44.1%, and 48.7% for E + SRS cohorts, respectively; SHR = 0.449 [0.238-0.846], P = .013). CONCLUSION Embolization appears to decrease cumulative obliteration rates after SRS for pediatric AVMs without affecting the risk of post-treatment hemorrhage or adverse radiation effects arguing against the routine use of pre-SRS embolization. While endovascular therapy can be considered for occlusion of high-risk angioarchitectural features prior to SRS, future studies are necessary to clarify its role.
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Affiliation(s)
- Rebecca M Burke
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Ching-Jen Chen
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Dale Ding
- Department of Neurosurgery, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Thomas J Buell
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Jennifer Sokolowski
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Kimball A Sheehan
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Darrah E Sheehan
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Hideyuki Kano
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kathryn N Kearns
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Shih-Wei Tzeng
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Huai-Che Yang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Paul P Huang
- Department of Neurosurgery, New York University Langone Medical Center, New York, New York, USA
| | - Douglas Kondziolka
- Department of Neurosurgery, New York University Langone Medical Center, New York, New York, USA
| | - Natasha Ironside
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - David Mathieu
- Division of Neurosurgery, Centre de recherché du CHUS, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Christian Iorio-Morin
- Division of Neurosurgery, Centre de recherché du CHUS, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Inga S Grills
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan, USA
| | - Caleb Feliciano
- Section of Neurological Surgery, University of Puerto Rico, San Juan, Puerto Rico
| | - Gene Barnett
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Robert M Starke
- Department of Neurosurgery, University of Miami, Florida, USA
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
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13
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Ogino A, Niranjan A, Kano H, Flickinger JC, Lunsford LD. Optimizing stereotactic radiosurgery in patients with recurrent or residual craniopharyngiomas. J Neurooncol 2021; 154:113-120. [PMID: 34286414 DOI: 10.1007/s11060-021-03806-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/09/2021] [Accepted: 07/07/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Stereotactic radiosurgery (SRS) is an important management strategy for residual and recurrent craniopharyngiomas. The current study evaluated the factors which affected tumor control and complications in craniopharyngioma SRS. METHODS This study includes 53 consecutive patients who underwent single-session SRS for recurrent or residual craniopharyngiomas. The median age was 41 years with 28 male and 25 females. The median tumor volume was 0.63 cm3 and median margin dose was 12 Gy (range 9-25 Gy). RESULTS The overall 3-, 5-, and 10-year survival rates were 97.8%, 92.7% and 88.5%. The overall 3-, 5-, and 10-year tumor control rates were 81.0%, 72.1%, and 53.4%. In univariate analysis, ≥ 3 mm distance from optic structures (p = 0.002), only solid or cystic tumor type (p = 0.037), and ≥ 12 Gy to ≥ 85% of the tumor (p < 0.001) were significantly associated with improved tumor control. In multivariate analysis, only solid or cystic tumor type, (p = 0.034), and ≥ 85% of the tumor receiving ≥ 12 Gy (p = 0.004) were significantly associated with better tumor control. When ≥ 85% of the tumor received ≥ 12 Gy the tumor control rates at 3-, 5-, and 10-year were 100%, 93.3%, and 93.3%. Higher conformity index was not associated with better tumor control. CONCLUSIONS The tumor control rates after recurrent or residual craniopharyngiomas SRS were improved by ensuring that at least 85% of the tumor received ≥ 12 Gy even when the distance between the tumor and the optic system is < 3 mm. This concept refutes the conformity theory that a high conformity index is a critical feature of effective SRS.
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Affiliation(s)
- Akiyoshi Ogino
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. .,Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Hideyuki Kano
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - John C Flickinger
- Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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14
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Shepard MJ, Xu Z, Kearns K, Li C, Chatrath A, Sheehan K, Sheehan D, Faramand A, Niranjan A, Kano H, Gurewitz J, Bernstein K, Liscak R, Guseynova K, Grills IS, Parzen JS, Cifarelli CP, Rehman AA, Atik A, Bakhsheshian J, Zada G, Chang E, Giannotta S, Speckter H, Wu HM, Kondziolka D, Golfinos JG, Mathieu D, Lee CC, Warnick RE, Lunsford LD, Sheehan JP. Stereotactic Radiosurgery for Atypical (World Health Organization II) and Anaplastic (World Health Organization III) Meningiomas: Results From a Multicenter, International Cohort Study. Neurosurgery 2021; 88:980-988. [PMID: 33469655 DOI: 10.1093/neuros/nyaa553] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/04/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Atypical and anaplastic meningiomas have reduced progression-free/overall survival (PFS/OS) compared to benign meningiomas. Stereotactic radiosurgery (SRS) for atypical meningiomas (AMs) and anaplastic meningiomas (malignant meningiomas, MMs) has not been adequately described. OBJECTIVE To define clinical/radiographic outcomes for patients undergoing SRS for AM/MMs. METHODS An international, multicenter, retrospective cohort study was performed to define clinical/imaging outcomes for patients receiving SRS for AM/MMs. Tumor progression was assessed with response assessment in neuro-oncology (RANO) criteria. Factors associated with PFS/OS were assessed using Kaplan-Meier analysis and a Cox proportional hazards model. RESULTS A total of 271 patients received SRS for AMs (n = 233, 85.9%) or MMs (n = 38, 14.0%). Single-fraction SRS was most commonly employed (n = 264, 97.4%) with a mean target dose of 14.8 Gy. SRS was used as adjuvant treatment (n = 85, 31.4%), salvage therapy (n = 182, 67.2%), or primary therapy (1.5%). The 5-yr PFS/OS rate was 33.6% and 77.0%, respectively. Increasing age (hazard ratio (HR) = 1.01, P < .05) and a Ki-67 index > 15% (HR = 1.66, P < .03) negatively correlated with PFS. MMs (HR = 3.21, P < .05), increased age (HR = 1.04, P = .04), and reduced KPS (HR = 0.95, P = .04) were associated with shortened OS. Adjuvant versus salvage SRS did not impact PFS/OS. A shortened interval between surgery and SRS improved PFS for AMs (HR = 0.99, P = .02) on subgroup analysis. Radiation necrosis occurred in 34 (12.5%) patients. Five-year rates of repeat surgery/radiation were 33.8% and 60.4%, respectively. CONCLUSION AM/MMs remain challenging tumors to treat. Elevated proliferative indices are associated with tumor recurrence, while MMs have worse survival. SRS can control AM/MMs in the short term, but the 5-yr PFS rates are low, underscoring the need for improved treatment options for these patients.
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Affiliation(s)
- Matthew J Shepard
- Department of Neurologic Surgery, University of Virginia Health System, Charlottesville, Virginia.,MD Anderson Cancer Center, Houston, Texas
| | - Zhiyuan Xu
- Department of Neurologic Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Kathryn Kearns
- Department of Neurologic Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Chelsea Li
- Department of Neurologic Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Ajay Chatrath
- Department of Neurologic Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Kimball Sheehan
- Department of Neurologic Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Darrah Sheehan
- Department of Neurologic Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Andrew Faramand
- Center of Image Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ajay Niranjan
- Center of Image Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Hideyuki Kano
- Center of Image Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | - Roman Liscak
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Khumar Guseynova
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Inga S Grills
- Department of Radiation Oncology, Beaumont Health, Royal Oak, Michigan
| | - Jacob S Parzen
- Department of Radiation Oncology, Beaumont Health, Royal Oak, Michigan
| | | | - Azeem A Rehman
- Department of Neurologic Surgery, West Virginia University, Morgantown, West Virginia
| | - Ahmet Atik
- Department of Neurologic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Joshua Bakhsheshian
- Departments of Neurologic Surgery, University of Southern California, Los Angeles, California
| | - Gabriel Zada
- Departments of Neurologic Surgery, University of Southern California, Los Angeles, California
| | - Eric Chang
- Department of Radiation Oncology, University of Southern California, Los Angeles, California
| | - Steven Giannotta
- Departments of Neurologic Surgery, University of Southern California, Los Angeles, California
| | - Herwin Speckter
- Centro Gamma Knife Dominicano, CEDIMAT, Plaza de la Salud, Santo Domingo, Dominican Republic
| | - Hsiu-Mei Wu
- Department of Radiology, Taipei Veteran General Hospital, Taipei, Taiwan.,National Yang-Ming University School of Medicine, Taipei, Taiwan
| | | | | | - David Mathieu
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Québec, Canada
| | - Cheng-Chia Lee
- Department of Neurosurgery, Taipei Veteran General Hospital, Taipei, Taiwan.,National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ronald E Warnick
- Department of Neurologic Surgery, Mayfield Clinic, Cincinnati, Ohio
| | - L Dade Lunsford
- Center of Image Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jason P Sheehan
- Department of Neurologic Surgery, University of Virginia Health System, Charlottesville, Virginia
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15
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Faramand A, Kano H, Niranjan A, Atik AF, Lee CC, Yang HC, Mohammed N, Liscak R, Hanuska J, Tripathi M, Kondziolka D, Sheehan J, Mathieu D, Flickinger JC, Lunsford LD. Stereotactic Radiosurgery for Choroid Plexus Tumors: A Report of the International Radiosurgery Research Foundation. Neurosurgery 2021; 88:791-796. [PMID: 33372216 DOI: 10.1093/neuros/nyaa538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/22/2020] [Accepted: 09/28/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Choroid plexus tumors (CPT) are rare epithelial tumors of the choroid plexus. Gross total resection (GTR) may be curative, but it is not always possible. OBJECTIVE To evaluate the role of Gamma Knife stereotactic radiosurgery (GKSRS) as either a primary or adjuvant management option for WHO grade I-III CPT through a multicenter project. METHODS A total of 32 patients (20 females) with a total of 43 treated tumors were included in the analysis. A total of 25 patients (78%) had undergone initial surgical resection. The median total tumor volume was 2.2 cc, and the median margin and maximum doses were 13 and 25.5 Gy, respectively. RESULTS Local tumor control was achieved in 69% of cases. Local tumor progression-free survival (PFS) rate for low-grade tumors at 1, 3, and 5 yr was 90%, 77%, 58%, respectively. The actuarial local tumor PFS rate for high-grade tumors at 1, 3, and 5 yr was 77%, 62%, and 62%, respectively. There was no significant difference in local tumor control rates between low- and high-grade CPT (P = .3). Gender, age, and degree of resection were not associated with treated tumor PFS. Distant intracranial spread developed in 6 patients at a median of 22 mo after initial SRS. Actuarial distant brain tumor PFS rate at 1, 2, 5, and 10 yr was 93%, 88%, 78%, and 65%, respectively. Three patients (9%) developed persistent symptomatic adverse radiation effects at a median of 11 mo after the procedure. CONCLUSION GKSRS represents a minimally invasive alternative management strategy for imaging defined or surgically recurrent low- and high-grade CPT.
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Affiliation(s)
- Andrew Faramand
- Department of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Hideyuki Kano
- Department of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ajay Niranjan
- Department of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ahmet F Atik
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Huai-Che Yang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Nasser Mohammed
- Department of Neurological Surgery, University of Virginia Health Systems, Charlottesville, Virginia
| | - Roman Liscak
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Jaromir Hanuska
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Manjul Tripathi
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Douglas Kondziolka
- Department of Neurological Surgery, New York University Langone Medical Center, New York, New York
| | - Jason Sheehan
- Department of Neurological Surgery, University of Virginia Health Systems, Charlottesville, Virginia
| | - David Mathieu
- Department of Neurosurgery, Centre de Recherche du CHUS, Université de Sherbooke, Sherbooke, Quebec, Canada
| | - John C Flickinger
- Department of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - L Dade Lunsford
- Department of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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16
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Mehta GU, Lekovic GP, Slattery WH, Brackmann DE, Long H, Kano H, Kondziolka D, Mureb M, Bernstein K, Langlois AM, Mathieu D, Nabeel AM, Reda WA, Tawadros SR, Abdelkarim K, El-Shehaby AMN, Emad RM, Mohammed N, Urgosik D, Liscak R, Lee CC, Yang HC, Montazeripouragha A, Kaufmann AM, Joshi KC, Barnett GH, Trifiletti DM, Lunsford LD, Sheehan JP. Effect of Anatomic Segment Involvement on Stereotactic Radiosurgery for Facial Nerve Schwannomas: An International Multicenter Cohort Study. Neurosurgery 2021; 88:E91-E98. [PMID: 32687577 DOI: 10.1093/neuros/nyaa313] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 05/13/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Facial nerve schwannomas are rare, challenging tumors to manage due to their nerve of origin. Functional outcomes after stereotactic radiosurgery (SRS) are incompletely defined. OBJECTIVE To analyze the effect of facial nerve segment involvement on functional outcome for these tumors. METHODS Patients who underwent single-session SRS for facial nerve schwannomas with at least 3 mo follow-up at 11 participating centers were included. Preoperative and treatment variables were recorded. Outcome measures included radiological tumor response and neurological function. RESULTS A total of 63 patients (34 females) were included in the present study. In total, 75% had preoperative facial weakness. Mean tumor volume and margin dose were 2.0 ± 2.4 cm3 and 12.2 ± 0.54 Gy, respectively. Mean radiological follow-up was 45.5 ± 38.9 mo. Progression-free survival at 2, 5, and 10 yr was 98.1%, 87.2%, and 87.2%, respectively. The cumulative proportion of patients with regressing tumors at 2, 5, and 10 yr was 43.1%, 63.6%, and 63.6%, respectively. The number of involved facial nerve segments significantly predicted tumor progression (P = .04). Facial nerve function was stable or improved in 57 patients (90%). Patients with involvement of the labyrinthine segment of the facial nerve were significantly more likely to have an improvement in facial nerve function after SRS (P = .03). Hearing worsened in at least 6% of patients. Otherwise, adverse radiation effects included facial twitching (3 patients), facial numbness (2 patients), and dizziness (2 patients). CONCLUSION SRS for facial nerve schwannomas is effective and spares facial nerve function in most patients. Some patients may have functional improvement after treatment, particularly if the labyrinthine segment is involved.
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Affiliation(s)
- Gautam U Mehta
- Division of Neurosurgery, House Ear Institute, Los Angeles, California
| | - Gregory P Lekovic
- Division of Neurosurgery, House Ear Institute, Los Angeles, California
| | | | | | - Hao Long
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Hideyuki Kano
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Douglas Kondziolka
- Department of Neurosurgery, New York University School of Medicine, New York, New York
| | - Monica Mureb
- Department of Neurosurgery, New York University School of Medicine, New York, New York
| | - Kenneth Bernstein
- Department of Radiation Oncology, NYU Langone Medical Center, New York, New York
| | - Anne-Marie Langlois
- Department of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Canada
| | - David Mathieu
- Department of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Canada
| | - Ahmed M Nabeel
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Neurosurgery Department, Benha University, Qalubya, Egypt
| | - Wael A Reda
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - Sameh R Tawadros
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - Khaled Abdelkarim
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Clinical Oncology Department, Ain Shams University, Cairo, Egypt
| | - Amr M N El-Shehaby
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - Reem M Emad
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Nasser Mohammed
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Dusan Urgosik
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Roman Liscak
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Cheng-Chia Lee
- Department of Neurosurgery, Neurologic Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Huai-Che Yang
- Department of Neurosurgery, Neurologic Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | | | | | - Krishna C Joshi
- Department of Neuro-oncology, Cleveland Clinic, Cleveland, Ohio
| | - Gene H Barnett
- Department of Neuro-oncology, Cleveland Clinic, Cleveland, Ohio
| | | | - L Dade Lunsford
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jason P Sheehan
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
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17
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Ogino A, Lunsford LD, Long H, Johnson S, Faramand A, Niranjan A, Flickinger JC, Kano H. Stereotactic radiosurgery as the primary management for patients with Koos grade IV vestibular schwannomas. J Neurosurg 2021; 135:1058-1066. [PMID: 33578383 DOI: 10.3171/2020.8.jns201832] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 05/15/2020] [Accepted: 08/13/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE While extensive long-term outcome studies support the role of stereotactic radiosurgery (SRS) for smaller-volume vestibular schwannomas (VSs), its role in the management for larger-volume tumors remains controversial. METHODS Between 1987 and 2017, the authors performed single-session SRS on 170 patients with previously untreated Koos grade IV VSs (volumes ranged from 5 to 20 cm3). The median tumor volume was 7.4 cm3. The median maximum extracanalicular tumor diameter was 27.5 mm. All tumors compressed the middle cerebellar peduncle and distorted the fourth ventricle. Ninety-three patients were male, 77 were female, and the median age was 61 years. Sixty-two patients had serviceable hearing (Gardner-Robertson [GR] grades I and II). The median margin dose was 12.5 Gy. RESULTS At a median follow-up of 5.1 years, the progression-free survival rates of VSs treated with a margin dose ≥ 12.0 Gy were 98.4% at 3 years, 95.3% at 5 years, and 90.7% at 10 years. In contrast, the tumor control rate after delivery of a margin dose < 12.0 Gy was 76.9% at 3, 5, and 10 years. The hearing preservation rates in patients with serviceable hearing at the time of SRS were 58.1% at 3 years, 50.3% at 5 years, and 35.9% at 7 years. Younger age (< 60 years, p = 0.036) and initial GR grade I (p = 0.006) were associated with improved serviceable hearing preservation rate. Seven patients (4%) developed facial neuropathy during the follow-up interval. A smaller tumor volume (< 10 cm3, p = 0.002) and a lower margin dose (≤ 13.0 Gy, p < 0.001) were associated with preservation of facial nerve function. The probability of delayed facial neuropathy when the margin dose was ≤ 13.0 Gy was 1.1% at 10 years. Nine patients (5%) required a ventriculoperitoneal shunt because of delayed symptomatic hydrocephalus. Fifteen patients (9%) developed detectable trigeminal neuropathy. Delayed resection was performed in 4% of patients. CONCLUSIONS Even for larger-volume VSs, single-session SRS prevented the need for delayed resection in almost 90% at 10 years. For patients with minimal symptoms of tumor mass effect, SRS should be considered an effective alternative to surgery in most patients, especially those with advanced age or medical comorbidities.
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Affiliation(s)
- Akiyoshi Ogino
- Departments of1Neurological Surgery and.,3Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and.,4Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - L Dade Lunsford
- Departments of1Neurological Surgery and.,3Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
| | - Hao Long
- Departments of1Neurological Surgery and.,3Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
| | | | - Andrew Faramand
- Departments of1Neurological Surgery and.,3Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
| | - Ajay Niranjan
- Departments of1Neurological Surgery and.,3Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
| | - John C Flickinger
- 2Radiation Oncology, and.,3Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
| | - Hideyuki Kano
- Departments of1Neurological Surgery and.,3Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
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18
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Ogino A, Lunsford LD, Long H, Johnson S, Faramand A, Niranjan A, Flickinger JC, Kano H. Stereotactic radiosurgery as the first-line treatment for intracanalicular vestibular schwannomas. J Neurosurg 2021; 135:1051-1057. [PMID: 34600434 DOI: 10.3171/2020.9.jns202818] [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: 07/20/2020] [Accepted: 09/14/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This report evaluates the outcomes of stereotactic radiosurgery (SRS) as the first-line treatment of intracanalicular vestibular schwannomas (VSs). METHODS Between 1987 and 2017, the authors identified 209 patients who underwent SRS as the primary intervention for a unilateral intracanalicular VS. The median patient age was 54 years (range 22-85 years); 94 patients were male and 115 were female. Three patients had facial neuropathy at the time of SRS. One hundred fifty-five patients (74%) had serviceable hearing (Gardner-Robertson [GR] grades I and II) at the time of SRS. The median tumor volume was 0.17 cm3 (range 0.015-0.63 cm3). The median margin dose was 12.5 Gy (range 11.0-25.0 Gy). The median maximum dose was 24.0 Gy (range 15.7-50.0 Gy). RESULTS The progression-free survival rates of all patients with intracanalicular VS were 97.5% at 3 years, 95.6% at 5 years, and 92.1% at 10 years. The rates of freedom from the need for any additional intervention were 99.4% at 3 years, 98.3% at 5 years, and 98.3% at 10 years. The serviceable hearing preservation rates in GR grade I and II patients at the time of SRS were 76.6% at 3 years, 63.5% at 5 years, and 27.3% at 10 years. In univariate analysis, younger age (< 55 years, p = 0.011), better initial hearing (GR grade I, p < 0.001), and smaller tumor volumes (< 0.14 cm3, p = 0.016) were significantly associated with improved hearing preservation. In multivariate analysis, better hearing (GR grade I, p = 0.001, HR 2.869, 95% CI 1.569-5.248) and smaller tumor volumes (< 0.14 cm3, p = 0.033, HR 2.071, 95% CI 1.059-4.047) at the time of SRS were significantly associated with improved hearing preservation. The hearing preservation rates of patients with GR grade I VS were 88.1% at 3 years, 77.9% at 5 years, and 38.1% at 10 years. The hearing preservation rates of patients with VSs smaller than 0.14 cm3 were 85.5% at 3 years, 77.7% at 5 years, and 42.6% at 10 years. Facial neuropathy developed in 1.4% from 6 to 156 months after SRS. CONCLUSIONS SRS provided sustained tumor control in more than 90% of patients with intracanalicular VS at 10 years and freedom from the need for additional intervention in more than 98% at 10 years. Patients with initially better hearing and smaller VSs had enhanced serviceable hearing preservation during an observation interval up to 10 years after SRS.
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Affiliation(s)
- Akiyoshi Ogino
- Departments of1Neurological Surgery and.,3Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and.,4Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - L Dade Lunsford
- Departments of1Neurological Surgery and.,3Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
| | - Hao Long
- Departments of1Neurological Surgery and.,3Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
| | | | - Andrew Faramand
- Departments of1Neurological Surgery and.,3Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
| | - Ajay Niranjan
- Departments of1Neurological Surgery and.,3Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
| | - John C Flickinger
- 2Radiation Oncology, and.,3Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
| | - Hideyuki Kano
- Departments of1Neurological Surgery and.,3Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
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19
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Kowalchuk RO, Shepard MJ, Sheehan K, Sheehan D, Faramand A, Niranjan A, Kano H, Gurewitz J, Bernstein K, Liscak R, Guseynova K, Grills IS, Parzen JS, Cifarelli CP, Rehman AA, Atik A, Bakhsheshian J, Zada G, Chang E, Giannotta S, Speckter H, Wu HM, Kondziolka D, Mathieu D, Lee CC, Warnick RE, Lunsford LD, Trifiletti DM, Sheehan JP. Treatment of WHO Grade 2 Meningiomas With Stereotactic Radiosurgery: Identification of an Optimal Group for SRS Using RPA. Int J Radiat Oncol Biol Phys 2021; 110:804-814. [PMID: 33548341 DOI: 10.1016/j.ijrobp.2021.01.048] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/12/2021] [Accepted: 01/23/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE This study assesses a large multi-institutional database to present the outcomes of World Health Organization grade 2 meningiomas treated with stereotactic radiosurgery (SRS). We also compare the 3-year progression-free survival (PFS) to that reported in the Radiation Therapy Oncology Group 0539 phase 2 cooperative group meningioma trial. METHODS AND MATERIALS From an international, multicenter group, data were collected for grade 2 meningioma patients treated with SRS for demonstrable tumor from 1994 to 2019. Statistical methods used included the Kaplan-Meier method, Cox proportional hazards analysis, and recursive partitioning analysis. RESULTS Two hundred thirty-three patients treated at 12 institutions were included. Patients presented at a median age of 60 years (range, 13-90), and many had at least 2 prior resections (30%) or radiation therapy (22%). Forty-eight percent of patients had prior gross total resection. At SRS, the median treatment volume was 6.1 cm3 (0.1-97.6). A median 15 Gy (10-30) was delivered to a median percent isodose of 50 (30-80), most commonly in 1 fraction (95%). A model was developed using recursive partitioning analysis, with one point attributed to age >50 years, treatment volume >11.5 cm3, and prior radiation therapy or multiple surgeries. The good-prognostic group (score, 0-1) had improved PFS (P < .005) and time to local failure (P < .005) relative to the poor-prognostic group (score, 2-3). Age >50 years (hazard ratio = 1.85 [95% confidence interval, 1.09-3.14]) and multiple prior surgeries (hazard ratio = 1.80 [1.09-2.99]) also portended reduced PFS in patients without prior radiation therapy. Two hundred eighteen of 233 patients in this study qualified for the high-risk group of Radiation Therapy Oncology Group 0539, and they demonstrated similar outcomes (3-year PFS: 53.9% vs 58.8%). The good-prognostic group of SRS patients demonstrated slightly improved outcomes (3-year PFS: 63.1% vs 58.8%). CONCLUSIONS SRS should be considered in carefully selected patients with atypical meningiomas. We suggest the use of our good-prognostic group to optimize patient selection, and we strongly encourage the initiation of a clinical trial to prospectively validate these outcomes.
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Affiliation(s)
- Roman O Kowalchuk
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
| | - Matthew J Shepard
- Department of Neurologic Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Kimball Sheehan
- Department of Neurologic Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Darrah Sheehan
- Department of Neurologic Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Andrew Faramand
- Center of Image Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ajay Niranjan
- Center of Image Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Hideyuki Kano
- Center of Image Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jason Gurewitz
- Department of Neurosurgery, NYU Langone Health System, New York, New York
| | - Kenneth Bernstein
- Department of Medical Physics, NYU Langone Health System, New York, New York
| | - Roman Liscak
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Khumar Guseynova
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Inga S Grills
- Department of Radiation Oncology, Beaumont Health, Royal Oak, Michigan
| | - Jacob S Parzen
- Department of Radiation Oncology, Beaumont Health, Royal Oak, Michigan
| | | | - Azeem A Rehman
- Department of Neurologic Surgery, West Virginia University, Morgantown, West Virginia
| | - Ahmet Atik
- Department of Neurologic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Joshua Bakhsheshian
- Department of Neurologic Surgery, University of Southern California, Los Angeles, California
| | - Gabriel Zada
- Department of Neurologic Surgery, University of Southern California, Los Angeles, California
| | - Eric Chang
- Department of Radiation Oncology, University of Southern California, Los Angeles, California
| | - Steven Giannotta
- Department of Neurologic Surgery, University of Southern California, Los Angeles, California
| | - Herwin Speckter
- Centro Gamma Knife Dominicano, CEDIMAT, Plaza de la Salud, Santo Domingo, Dominican Republic
| | - Hsiu-Mei Wu
- Department of Radiology, Taipei Veteran General Hospital, Taipei, Taiwan; National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Douglas Kondziolka
- Department of Neurosurgery, NYU Langone Health System, New York, New York
| | - David Mathieu
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Québec, Canada
| | - Cheng-Chia Lee
- National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Neurosurgery, Taipei Veteran General Hospital, Taipei, Taiwan
| | - Ronald E Warnick
- Department of Neurologic Surgery, Mayfield Clinic, Cincinnati, Ohio
| | - L Dade Lunsford
- Center of Image Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Daniel M Trifiletti
- Mayo Clinic, Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Jason P Sheehan
- Department of Neurologic Surgery, University of Virginia Health System, Charlottesville, Virginia
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20
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Cifarelli CP, Vargo JA, Fang W, Liscak R, Guseynova K, Warnick RE, Lee CC, Yang HC, Borghei-Razavi H, Maiti T, Siddiqui ZA, Yuan JC, Grills IS, Mathieu D, Touchette CJ, Cordeiro D, Chiang V, Hess J, Tien CJ, Faramand A, Kano H, Barnett GH, Sheehan JP, Lunsford LD. Role of Gamma Knife Radiosurgery in Small Cell Lung Cancer: A Multi-Institutional Retrospective Study of the International Radiosurgery Research Foundation (IRRF). Neurosurgery 2021; 87:664-671. [PMID: 31599324 DOI: 10.1093/neuros/nyz428] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 08/04/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Despite a high incidence of brain metastases in patients with small-cell lung cancer (SCLC), limited data exist on the use of stereotactic radiosurgery (SRS), specifically Gamma Knife™ radiosurgery (Elekta AB), for SCLC brain metastases. OBJECTIVE To provide a detailed analysis of SCLC patients treated with SRS, focusing on local failure, distant brain failure, and overall survival (OS). METHODS A multi-institutional retrospective review was performed on 293 patients undergoing SRS for SCLC brain metastases at 10 medical centers from 1991 to 2017. Data collection was performed according to individual institutional review boards, and analyses were performed using binary logistic regression, Cox-proportional hazard models, Kaplan-Meier survival analysis, and competing risks analysis. RESULTS Two hundred thirty-two (79%) patients received SRS as salvage following prior whole-brain irradiation (WBRT) or prophylactic cranial irradiation, with a median marginal dose of 18 Gy. At median follow-up after SRS of 6.4 and 18.0 mo for surviving patients, the 1-yr local failure, distant brain failure, and OS were 31%, 49%, and 28%. The interval between WBRT and SRS was predictive of improved OS for patients receiving SRS more than 1 yr after initial treatment (21%, <1 yr vs 36%, >1 yr, P = .01). On multivariate analysis, older age was the only significant predictor for OS (hazard ratio 1.63, 95% CI 1.16-2.29, P = .005). CONCLUSION SRS plays an important role in the management of brain metastases from SCLC, especially in salvage therapy following WBRT. Ongoing prospective trials will better assess the value of radiosurgery in the primary management of SCLC brain metastases and potentially challenge the standard application of WBRT in SCLC patients.
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Affiliation(s)
- Christopher P Cifarelli
- Department of Neurosurgery, School of Medicine, West Virginia University, Morgantown, West Virginia.,Department of Radiation Oncology, School of Medicine, West Virginia University, Morgantown, West Virginia
| | - John A Vargo
- Department of Neurosurgery, School of Medicine, West Virginia University, Morgantown, West Virginia.,Department of Radiation Oncology, School of Medicine, West Virginia University, Morgantown, West Virginia
| | - Wei Fang
- West Virginia Clinical and Translational Science Institute, School of Medicine, West Virginia University, Morgantown, West Virginia
| | - Roman Liscak
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Khumar Guseynova
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | | | - Cheng-Chia Lee
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Huai-Che Yang
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Tonmoy Maiti
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
| | - Zaid A Siddiqui
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Justin C Yuan
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Inga S Grills
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - David Mathieu
- Division of Neurosurgery, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Canada
| | - Charles J Touchette
- Division of Neurosurgery, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Canada
| | - Diogo Cordeiro
- Department of Neurosurgery, School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Veronica Chiang
- Department of Neurosurgery, Yale School of Medicine, Yale University, New Haven, Connecticut.,Department of Radiation Oncology, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Judith Hess
- Department of Neurosurgery, Yale School of Medicine, Yale University, New Haven, Connecticut.,Department of Radiation Oncology, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Christopher J Tien
- Department of Neurosurgery, Yale School of Medicine, Yale University, New Haven, Connecticut.,Department of Radiation Oncology, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Andrew Faramand
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Hideyuki Kano
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Gene H Barnett
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
| | - Jason P Sheehan
- Department of Neurosurgery, School of Medicine, University of Virginia, Charlottesville, Virginia
| | - L Dade Lunsford
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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21
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Chen CJ, Lee CC, Kano H, Kearns KN, Ding D, Tzeng SW, Atik AF, Joshi K, Huang PP, Kondziolka D, Ironside N, Mathieu D, Iorio-Morin C, Grills IS, Quinn TJ, Siddiqui ZA, Marvin K, Feliciano C, Starke RM, Faramand A, Barnett G, Lunsford LD, Sheehan JP. Radiosurgery for Unruptured Intervention-Naïve Pediatric Brain Arteriovenous Malformations. Neurosurgery 2021; 87:368-376. [PMID: 31942635 DOI: 10.1093/neuros/nyz558] [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: 06/25/2019] [Accepted: 11/12/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Long-term data regarding stereotactic radiosurgery (SRS) as a standalone therapy for unruptured pediatric brain arteriovenous malformations (AVMs) are incompletely defined. OBJECTIVE To evaluate, in a multicenter, retrospective cohort study, the outcomes after SRS for unruptured, intervention-naïve pediatric AVMs. METHODS To retrospectively analyze the International Radiosurgery Research Foundation pediatric AVM database from 1987 to 2018. Pediatric patients with unruptured, previously untreated AVMs who underwent SRS were included. The primary endpoint was a composite of hemorrhagic stroke, death, or permanently symptomatic radiation-induced changes. RESULTS The study cohort comprised 101 patients (mean follow-up 80.8 mo). The primary endpoint occurred in 14%, comprising hemorrhagic stroke, death, and permanent radiation-induced changes in 6%, 3%, and 8%, respectively. Estimated probabilities of the primary endpoint were 5.2%, 10.8%, and 23.0% at 2, 5, and 10 yr, respectively. Estimated probabilities of AVM obliteration at 5 and 10 yr were 64% and 82%, respectively. Single SRS treatment (P = .007) and higher margin dose (P = .005) were predictors of obliteration. Subgroup analysis of Spetzler-Martin grade I-III AVMs estimated primary endpoint probabilities of 3.7%, 8.4%, and 18.7% at 2, 5, and 10 yr, respectively. CONCLUSION Treatment of unruptured, intervention-naïve AVMs in the pediatric population with SRS carries an approximately 2% annual risk of morbidity and mortality, which appears to plateau after 10 yr. The poorly described natural history of pediatric AVMs renders any comparison of SRS vs conservative management imperfect.
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Affiliation(s)
- Ching-Jen Chen
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hideyuki Kano
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kathryn N Kearns
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Dale Ding
- Department of Neurosurgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Shih-Wei Tzeng
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ahmet Fatih Atik
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Krishna Joshi
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Paul P Huang
- Department of Neurosurgery, New York University Langone Medical Center, New York, New York
| | - Douglas Kondziolka
- Department of Neurosurgery, New York University Langone Medical Center, New York, New York
| | - Natasha Ironside
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - David Mathieu
- Division of Neurosurgery, Centre de recherche du CHUS, University of Sherbrooke, Sherbrooke, Canada
| | - Christian Iorio-Morin
- Division of Neurosurgery, Centre de recherche du CHUS, University of Sherbrooke, Sherbrooke, Canada
| | - Inga S Grills
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Thomas J Quinn
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Zaid A Siddiqui
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Kim Marvin
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Caleb Feliciano
- Section of Neurological Surgery, University of Puerto Rico, San Juan, Puerto Rico
| | - Robert M Starke
- Department of Neurosurgery, University of Miami, Miami, Florida
| | - Andrew Faramand
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Gene Barnett
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
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22
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Bunevicius A, Suleiman M, Patel S, Martínez Álvarez R, Martinez Moreno NE, Liscak R, Hanuska J, Langlois AM, Mathieu D, Mau C, Caldwell C, Tuanquin LC, Zacharia BE, McInerney J, Lee CC, Yang HC, Peterson JL, Trifiletti DM, Ogino A, Kano H, Warnick RE, Saylany A, Buch LY, Lee JYK, Strickland BA, Zada G, Chang EL, Lunsford LD, Sheehan J. Stereotactic radiosurgery for treatment of radiation-induced meningiomas: a multiinstitutional study. J Neurosurg 2021; 135:862-870. [PMID: 33385995 DOI: 10.3171/2020.7.jns202064] [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: 05/29/2020] [Accepted: 07/14/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Radiation-induced meningiomas (RIMs) are associated with aggressive clinical behavior. Stereotactic radiosurgery (SRS) is sometimes considered for selected RIMs. The authors investigated the effectiveness and safety of SRS for the management of RIMs. METHODS From 12 institutions participating in the International Radiosurgery Research Foundation, the authors pooled patients who had prior cranial irradiation and were subsequently clinically diagnosed with WHO grade I meningiomas that were managed with SRS. RESULTS Fifty-two patients underwent 60 SRS procedures for histologically confirmed or radiologically suspected WHO grade I RIMs. The median ages at initial cranial radiation therapy and SRS for RIM were 5.5 years and 39 years, respectively. The most common reasons for cranial radiation therapy were leukemia (21%) and medulloblastoma (17%). There were 39 multiple RIMs (35%), the mean target volume was 8.61 ± 7.80 cm3, and the median prescription dose was 14 Gy. The median imaging follow-up duration was 48 months (range 4-195 months). RIM progressed in 9 patients (17%) at a median duration of 30 months (range 3-45 months) after SRS. Progression-free survival at 5 years post-SRS was 83%. Treatment volume ≥ 5 cm3 predicted progression (HR 8.226, 95% CI 1.028-65.857, p = 0.047). Seven patients (14%) developed new neurological symptoms or experienced SRS-related complications or T2 signal change from 1 to 72 months after SRS. CONCLUSIONS SRS is associated with durable local control of RIMs in the majority of patients and has an acceptable safety profile. SRS can be considered for patients and tumors that are deemed suboptimal, poor surgical candidates, and those whose tumor again progresses after removal.
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Affiliation(s)
- Adomas Bunevicius
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Mohand Suleiman
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Samir Patel
- 2Division of Radiation Oncology, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Roman Liscak
- 4Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Jaromir Hanuska
- 4Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Anne-Marie Langlois
- 5Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Québec, Canada
| | - David Mathieu
- 5Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Québec, Canada
| | - Christine Mau
- 6Penn State Health, Hershey Medical Center, Hershey, Pennsylvania
| | | | | | - Brad E Zacharia
- 6Penn State Health, Hershey Medical Center, Hershey, Pennsylvania
| | - James McInerney
- 6Penn State Health, Hershey Medical Center, Hershey, Pennsylvania
| | - Cheng-Chia Lee
- 7Neurological Institute, Taipei Veterans General Hospital, and National Yang-Ming University, Taipei, Taiwan
| | - Huai-Che Yang
- 7Neurological Institute, Taipei Veterans General Hospital, and National Yang-Ming University, Taipei, Taiwan
| | | | | | - Akiyoshi Ogino
- 9Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Hideyuki Kano
- 9Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Anissa Saylany
- 11Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Love Y Buch
- 11Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - John Y K Lee
- 11Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | | | - Gabriel Zada
- 12University of Southern California, Los Angeles, California
| | - Eric L Chang
- 12University of Southern California, Los Angeles, California
| | - L Dade Lunsford
- 9Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jason Sheehan
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
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23
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Mohammed N, Hung YC, Chen CJ, Xu Z, Schlesinger D, Kano H, Chiang V, Hess J, Lee J, Mathieu D, Kaufmann AM, Grills IS, Cifarelli CP, Vargo JA, Chytka T, Janouskova L, Feliciano CE, Mercado RR, Lunsford LD, Sheehan JP. A Proposed Grading Scale for Predicting Outcomes After Stereotactic Radiosurgery for Dural Arteriovenous Fistulas. Neurosurgery 2020; 87:247-255. [PMID: 31584074 DOI: 10.1093/neuros/nyz401] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 07/18/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND There are presently no grading scales that specifically address the outcomes of cranial dural arteriovenous fistula (dAVF) after stereotactic radiosurgery (SRS). OBJECTIVE To design a practical grading system that would predict outcomes after SRS for cranial dAVFs. METHODS From the International Radiosurgery Research Foundation (University of Pittsburgh [41 patients], University of Pennsylvania [6 patients], University of Sherbrooke [2 patients], University of Manitoba [1 patient], West Virginia University [2 patients], University of Puerto Rico [1 patient], Beaumont Health System 1 [patient], Na Homolce Hospital [13 patients], the University of Virginia [48 patients], and Yale University [6 patients]) centers, 120 patients with dAVF treated with SRS were included in the study. The factors predicting favorable outcome (obliteration without post-SRS hemorrhage) after SRS were assessed using logistic regression analysis. These factors were pooled with the factors that were found to be predictive of obliteration from 7 studies with 736 patients after a systematic review of literature. These were entered into stepwise multiple regression and the best-fit model was identified. RESULTS Based on the predictive model, 3 factors emerged to develop an SRS scoring system: cortical venous reflux (CVR), prior intracerebral hemorrhage (ICH), and noncavernous sinus location. Class I (score of 0-1 points) predicted the best favorable outcome of 80%. Class II patients (2 points score) had an intermediate favorable outcome of 57%, and class III (score 3 points) had the least favorable outcome at 37%. The ROC analysis showed better predictability to prevailing grading systems (AUC = 0.69; P = .04). Kaplan-Meier analysis showed statistically significant difference between the 3 subclasses of the proposed grading system for post-SRS dAVF obliteration (P = .001). CONCLUSION The proposed dAVF grading system incorporates angiographic, anatomic, and clinical parameters and improves the prediction of the outcomes following SRS for dAVF as compared to the existing scoring systems.
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Affiliation(s)
- Nasser Mohammed
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Yi-Chieh Hung
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Ching-Jen Chen
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Zhiyuan Xu
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - David Schlesinger
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Hideyuki Kano
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Judith Hess
- School of Medicine, Yale University, New Haven, Connecticut
| | - John Lee
- Department of Neurological Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Mathieu
- Department of Neurological Surgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Canada
| | - Anthony M Kaufmann
- Department of Neurological Surgery, University of Manitoba, Winnipeg, Canada
| | - Inga S Grills
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | | | - John A Vargo
- Department of Neurological Surgery, West Virginia University, Morgantown, West Virginia
| | - Tomas Chytka
- Department of Neurological Surgery, Na Homolce Hospital, Prague, Czech Republic
| | | | - Caleb E Feliciano
- Department of Neurological Surgery, University of Puerto Rico, San Juan, Puerto Rico
| | | | - L Dade Lunsford
- Department of Neurological Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
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24
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Ogino A, Kano H, Long H, Johnson S, Faramand AM, Niranjan A, Flickinger J, Lunsford LD. Stereotactic Radiosurgery as the Primary Management for Patients with Koos Grade IV Vestibular Schwannomas. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_620] [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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Ogino A, Kano H, Long H, Johnson S, Faramand AM, Niranjan A, Flickinger J, Lunsford LD. Stereotactic Radiosurgery as the First Line Treatment for Intracanalicular Vestibular Schwannomas. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_883] [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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26
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Kano H, Jacobs R, Yang HC, Lee CC"J, Nabeel A, Abdelkarim K, Emad R, El-Shehaby A, Reda W, Tawadros S, Khalil P, Liscak R, Guseynova K, Touchette C, Mathieu D, Ren L, Sheehan JP, Mohammed N, Speckter H, Almahariq M, Grills I, Feliciano CE, Rodriguez-Mercado R, Lunsford LD. Stereotactic Radiosurgery for Hemorrhagic Symptomatic Cerebral Cavernous Malformations. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_370] [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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27
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Parker T, Rigney G, Kallos J, Stefko ST, Kano H, Niranjan A, Green AL, Aziz T, Rath P, Lunsford LD. Gamma knife radiosurgery for uveal melanomas and metastases: a systematic review and meta-analysis. Lancet Oncol 2020; 21:1526-1536. [PMID: 33152286 DOI: 10.1016/s1470-2045(20)30459-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/29/2020] [Accepted: 07/15/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Gamma knife radiosurgery is regarded as the gold-standard stereotactic radiosurgery modality for the treatment of intracranial tumours, and its use has been expanded for the treatment of intraocular malignancies. The aim of this study was to systematically evaluate the efficacy, outcomes, and complications of gamma knife radiosurgery for uveal melanomas and metastases. METHODS We did a systematic review and meta-analysis to aggregate the clinical outcomes of patients with uveal melanomas or intraocular metastases treated primarily with gamma knife radiosurgery. We searched MEDLINE and Embase for studies published between Sept 1, 1960, and Feb 1, 2020, reporting the use of gamma knife radiosurgery as primary treatment for uveal melanoma or uveal metastases. The search was restricted to clinical studies and relevant grey literature published in English. Studies reporting treatment of benign tumours, extraocular tumours, or other forms of stereotactic radiosurgery were excluded to reduce heterogeneity. No restrictions were placed on participant criteria. Local tumour control and tumour regression were extracted as the primary outcomes and analysed via a random-effects meta-analysis of proportions using the DerSimonian and Laird method with a Freeman-Tukey double arcsine transformation. This study is registered with PROSPERO, CRD42019148165. FINDINGS Our search returned 454 studies, of which 109 were assessed for full-text eligibility. 52 studies, reporting on 1010 patients with uveal melanoma and 34 intraocular metastases, were eligible for systematic review. 28 studies were included in the meta-analysis. 840 of 898 patients (0·96, 95% CI 0·94-0·97; I2=16%) from 19 studies had local control, and 378 of 478 patients (0·81, 0·70-0·90; I2=83%) from 16 studies experienced tumour regression. INTERPRETATION Gamma knife radiosurgery is an efficacious primary method of treating uveal melanomas and intraocular metastases, with reliable tumour control rates. Randomised controlled trials should further evaluate the safety and efficacy of gamma knife radiosurgery in this setting. FUNDING The Rhodes Trust and the Howard Brain Sciences Foundation.
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Affiliation(s)
- Tariq Parker
- Nuffield Department of Surgery, University of Oxford, Oxford, UK.
| | - Grant Rigney
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Justiss Kallos
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - S Tonya Stefko
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Hideyuki Kano
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ajay Niranjan
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Tipu Aziz
- Nuffield Department of Surgery, University of Oxford, Oxford, UK
| | - Pamela Rath
- Everett and Hurite Ophthalmic Association, Pittsburgh, PA, USA
| | - L Dade Lunsford
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Taylor DG, Janssen A, Ding D, Xu Z, Mehta GU, Liscak R, Kano H, Kosak M, Martinez-Moreno N, Hobbs L, Chen CJ, Grills IS, Mathieu D, Lunsford LD, Vance ML, Sheehan JP. Whole Sella vs Targeted Stereotactic Radiosurgery for Acromegaly: A Multicenter Matched Cohort Study. Neurosurgery 2020; 86:656-664. [PMID: 31384920 DOI: 10.1093/neuros/nyz245] [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] [Received: 11/07/2018] [Accepted: 04/11/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Targeted stereotactic radiosurgery (SRS) with sparing of the residual pituitary is the traditional radiosurgical method for pituitary adenomas. Whole-sella SRS is an alternative choice for radiologically indeterminate or large adenomas, the safety and efficacy of which has yet to be determined. OBJECTIVE To determine if whole-sella SRS in acromegaly would have comparable radiographic and biochemical control to targeted SRS. We performed a multicenter, retrospective matched cohort study to compare outcomes between groups. METHODS We conducted a retrospective review of acromegalic patients who underwent SRS from 1990 to 2016 at 10 centers participating in the International Radiosurgery Research Foundation. Whole-sella and targeted SRS patients were then matched in a 1:1 ratio. RESULTS A total of 128 patients were eligible for inclusion. Whole-sella patients had a higher pre-SRS random serum growth hormone, larger treatment volume, and higher maximum point dose to the optic apparatus. The rates of initial/durable endocrine remission, new loss of pituitary function, and new cranial neuropathy were similar between groups. Mortality and new visual deficit were higher in the whole-sella cohort, though not statistically significant. CONCLUSION There was no difference in biochemical remission or recurrence between treatment groups. Although not statistically significant, the higher rates of tumor regression and lower rates of mortality and new visual deficit may suggest consideration of targeted SRS over whole-sella SRS in acromegaly treatment. Further research is needed to determine the association between visual deficits and mortality with whole-sella SRS.
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Affiliation(s)
- Davis G Taylor
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Andrew Janssen
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Dale Ding
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky
| | - Zhiyuan Xu
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Gautam U Mehta
- Department of Neurosurgery, MD Anderson Cancer Center, Houston, Texas
| | - Roman Liscak
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Hideyuki Kano
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mikulas Kosak
- First Faculty of Medicine, 3rd Department of Medicine, Charles University, Prague, Czech Republic
| | | | - Landon Hobbs
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Ching-Jen Chen
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Inga S Grills
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - David Mathieu
- Centre de recherche du CHUS, Division of Neurosurgery, University of Sherbrooke, Sherbrooke, Canada
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mary Lee Vance
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia.,Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Jason P Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
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29
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Hung YC, Mohammed N, Kearns KN, Chen CJ, Starke RM, Kano H, Lee J, Mathieu D, Kaufmann AM, Wang WG, Grills IS, Cifarelli CP, Vargo J, Chytka T, Janouskova L, Feliciano CE, Rodriguez-Mercado R, Lunsford LD, Sheehan JP. Stereotactic Radiosurgery for Cavernous Sinus Versus Noncavernous Sinus Dural Arteriovenous Fistulas: Outcomes and Outcome Predictors. Neurosurgery 2020; 86:676-684. [PMID: 31384943 DOI: 10.1093/neuros/nyz260] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/16/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Dural arteriovenous fistulas (DAVFs) can be categorized based on location. OBJECTIVE To compare stereotactic radiosurgery (SRS) outcomes between cavernous sinus (CS) and non-CS DAVFs and to identify respective outcome predictors. METHODS This is a retrospective study of DAVFs treated with SRS between 1988 and 2016 at 10 institutions. Patients' variables, DAVF characters, and SRS parameters were included for analyses. Favorable clinical outcome was defined as angiography-confirmed obliteration without radiological radiation-induced changes (RIC) or post-SRS hemorrhage. Other outcomes were DAVFs obliteration and adverse events (including RIC, symptomatic RIC, and post-SRS hemorrhage). RESULTS The overall study cohort comprised 131 patients, including 20 patients with CS DAVFs (15%) and 111 patients with non-CS DAVFs (85%). Rates of favorable clinical outcome were comparable between the 2 groups (45% vs 37%, P = .824). Obliteration rate after SRS was higher in the CS DAVFs group, even adjusted for baseline difference (OR = 4.189, P = .044). Predictors of favorable clinical outcome included higher maximum dose (P = .014) for CS DAVFs. Symptomatic improvement was associated with obliteration in non-CS DAVFs (P = .005), but symptoms improved regardless of whether obliteration was confirmed in CS DAVFs. Non-CS DAVFs patients with adverse events after SRS were more likely to be male (P = .020), multiple arterial feeding fistulas (P = .018), and lower maximum dose (P = .041). CONCLUSION After SRS, CS DAVFs are more likely to obliterate than non-CS ones. Because these 2 groups have different total predictors for clinical and radiologic outcomes after SRS, they should be considered as different entities.
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Affiliation(s)
- Yi-Chieh Hung
- Division of Neurosurgery, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Recreation and Healthcare Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.,Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Nasser Mohammed
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Kathryn N Kearns
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Ching-Jen Chen
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Robert M Starke
- Department of Neurological Surgery, University of Miami, Miami, Florida
| | - Hideyuki Kano
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - John Lee
- Department of Neurological Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Mathieu
- Department of Neurological Surgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Canada
| | - Anthony M Kaufmann
- Department of Neurological Surgery, University of Manitoba, Winnipeg, Canada
| | - Wei Gang Wang
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Inga S Grills
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | | | - John Vargo
- Department of Radiation Oncology, West Virginia University, Morgantown, West Virginia
| | - Tomas Chytka
- Department of Neurological Surgery, Na Homolce Hospital, Prague, Czech Republic
| | | | - Caleb E Feliciano
- Department of Neurological Surgery, University of Puerto Rico, San Juan, Puerto Rico
| | | | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
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30
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Hirota N, Suzuki S, Arita T, Yagi N, Otsuka T, Semba H, Kano H, Matsuno S, Kato Y, Uejima T, Oikawa Y, Yajima J, Yamashita T. Prediction of atrial fibrillation by 12-lead electrocardiogram parameters in patients without structural heart disease. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0536] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Recently, the analysis of electrocardiogram (ECG) waveform by artificial intelligence has been reported to pick out those who have atrial fibrillation (AF) or have a high potential of developing AF, which, however, cannot explain the mechanisms or algorisms for the prediction from its nature.
Purpose
The purpose of this study is to conduct a comprehensive analysis to investigate the difference of weighting in predicting capability for AF among hundreds of automatically-measured ECG parameters using a single ECG at sinus rhythm.
Methods and results
Out of Shinken Database 2010–2017 (n=19170), 12825 patients were extracted, where those with ECG showing AF rhythm at the initial visit (including all persistent/permanent AF and a part of paroxysmal AF) and those with structural heart diseases were excluded. Out of 639 automatically-measured ECG parameters in MUSE data management system (GE Healthcare, USA), 438 were used. [Analysis 1] A predicting model for paroxysmal AF were determined by logistic regression analysis (Total, n=12825; paroxysmal AF, n=1138), showing a high predictive capability (AUC = 0.780, p<0.001). In this model, the relative contribution of ECG parameters (by coefficient of determination) according to the time phase were P:72.4%, QRS:32.7%, and ST-T:13.7%, respectively (Figure A). [Analysis 2] Excluding AF at baseline, a predicting model for new-developed AF were determined by Cox regression analysis (Total, n=11687; new-developed AF, n=87), showing a high predictive capability (AUC = 0.887, p<0.001). In this model, the relative contribution of parameters (by log likelihood) according to the time phase were P:40.8%, QRS:42.5%, and ST-T:24.9%, respectively (Figure B).
Conclusions
We determined ECG parameters that potentially contribute to picking up existing AF or predicting future development of AF, where the measurement of P wave strongly contributed in the former whereas all time phases were similarly important in the latter.
Weighting of parameters to predict AF
Funding Acknowledgement
Type of funding source: Private hospital(s). Main funding source(s): Self funding of the institute
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Affiliation(s)
- N Hirota
- Cardiovascular Institute Hospital, Tokyo, Japan
| | - S Suzuki
- Cardiovascular Institute Hospital, Tokyo, Japan
| | - T Arita
- Cardiovascular Institute Hospital, Tokyo, Japan
| | - N Yagi
- Cardiovascular Institute Hospital, Tokyo, Japan
| | - T Otsuka
- Cardiovascular Institute Hospital, Tokyo, Japan
| | - H Semba
- Cardiovascular Institute Hospital, Tokyo, Japan
| | - H Kano
- Cardiovascular Institute Hospital, Tokyo, Japan
| | - S Matsuno
- Cardiovascular Institute Hospital, Tokyo, Japan
| | - Y Kato
- Cardiovascular Institute Hospital, Tokyo, Japan
| | - T Uejima
- Cardiovascular Institute Hospital, Tokyo, Japan
| | - Y Oikawa
- Cardiovascular Institute Hospital, Tokyo, Japan
| | - J Yajima
- Cardiovascular Institute Hospital, Tokyo, Japan
| | - T Yamashita
- Cardiovascular Institute Hospital, Tokyo, Japan
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31
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Shibuya K, Tsuneyama A, Misawa S, Suichi T, Suzuki Y, Kojima Y, Nakamura K, Kano H, Prado M, Kuwabara S. Cranial nerve involvement in typical and atypical chronic inflammatory demyelinating polyneuropathies. Eur J Neurol 2020; 27:2658-2661. [PMID: 32876980 DOI: 10.1111/ene.14497] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 05/16/2020] [Accepted: 08/26/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Cranial nerve palsy is occasionally present in patients with chronic inflammatory demyelinating polyneuropathy (CIDP), but its prevalence, characteristics and relations with the CIDP subtypes have rarely been investigated. The aim of this study was to systematically assess cranial nerve involvement in typical and atypical CIDP. METHODS Clinical data were reviewed in 132 consecutive patients with CIDP, including typical CIDP (n = 89), multifocal acquired demyelinating sensory and motor neuropathy (MADSAM) (n = 31), distal acquired demyelinating symmetric (DADS) (n = 9) and others (n = 3). RESULTS The frequency of cranial nerve palsy was 11% in typical CIDP, 48% in MADSAM and 11% in DADS. Facial and bulbar palsy was most frequently present (9%), followed by ocular motor nerve palsy (5%). Bilateral involvement was seen in all typical CIDP and DADS patients, whereas 80% of MADSAM patients had unilateral palsy. The presence of cranial nerve involvement was associated with more severe limb muscle weakness in typical CIDP, but not in MADSAM. Cranial nerve palsy fully recovered in 90% of typical CIDP and in 67% of MADSAM patients. CONCLUSION Amongst the CIDP subtypes, cranial palsy is frequent and unilateral in MADSAM, and less frequent and bilateral in typical CIDP and DADS. In typical CIDP, facial and bulbar palsy reflects more severe and extensive inflammation.
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Affiliation(s)
- K Shibuya
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - A Tsuneyama
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - S Misawa
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - T Suichi
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Y Suzuki
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Y Kojima
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - K Nakamura
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - H Kano
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - M Prado
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - S Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
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32
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Yamada N, Saito C, Kano H, Fukuuchi T, Yamaoka N, Kaneko K, Asami Y. Lactobacillus gasseri PA-3 directly incorporates purine mononucleotides and utilizes them for growth. Nucleosides Nucleotides Nucleic Acids 2020; 41:221-230. [PMID: 32954967 DOI: 10.1080/15257770.2020.1815768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Lactococcus lactis has been reported unable to directly incorporate mononucleotides but instead requires their external dephosphorylation by nucleotidases to the corresponding nucleosides prior to their incorporation. Although Lactobacillus gasseri PA-3 (PA-3), a strain of lactic acid bacteria, has been found to incorporate purine mononucleotides such as adenosine 5'-monophosphate (AMP), it remains unclear whether these bacteria directly incorporate these mononucleotides or incorporate them after dephosphorylation to the corresponding nucleosides. This study evaluated whether PA-3 incorporated radioactively-labeled mononucleotides in the presence or absence of the 5'-nucleotidase inhibitor α,β-methylene ADP (APCP). PA-3 took up 14C-AMP in the presence of APCP, as well as incorporating 32P-AMP. Furthermore, radioactivity was detected in the RNA/DNA of bacterial cells cultured in the presence of 32P-AMP. Taken together, these findings indicated that PA-3 incorporated purine mononucleotides directly rather than after their dephosphorylation to purine nucleosides and that PA-3 utilizes these purine mononucleotides in the synthesis of RNA and DNA. Although additional studies are required to identify purine mononucleotide transporters in PA-3, this study is the first to show that some lactic acid bacteria directly incorporate purine mononucleotides and use them for growth.
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Affiliation(s)
- N Yamada
- Food Microbiology Research Laboratories, R&D Division, Meiji Co., Ltd, Tokyo, Japan.,Laboratory of Biomedical and Analytical Sciences, Faculty of Pharma Sciences, Teikyo University, Tokyo, Japan
| | - C Saito
- Food Microbiology Research Laboratories, R&D Division, Meiji Co., Ltd, Tokyo, Japan.,Laboratory of Biomedical and Analytical Sciences, Faculty of Pharma Sciences, Teikyo University, Tokyo, Japan
| | - H Kano
- Food Microbiology Research Laboratories, R&D Division, Meiji Co., Ltd, Tokyo, Japan.,Laboratory of Biomedical and Analytical Sciences, Faculty of Pharma Sciences, Teikyo University, Tokyo, Japan
| | - T Fukuuchi
- Laboratory of Biomedical and Analytical Sciences, Faculty of Pharma Sciences, Teikyo University, Tokyo, Japan
| | - N Yamaoka
- Laboratory of Biomedical and Analytical Sciences, Faculty of Pharma Sciences, Teikyo University, Tokyo, Japan
| | - K Kaneko
- Laboratory of Biomedical and Analytical Sciences, Faculty of Pharma Sciences, Teikyo University, Tokyo, Japan
| | - Y Asami
- Food Microbiology Research Laboratories, R&D Division, Meiji Co., Ltd, Tokyo, Japan
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33
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Ogino A, Tonetti D, Flickinger JC, Lunsford LD, Kano H. Clinico-Radiologic Outcomes After Stereotactic Radiosurgery for Patients with Complex High-Risk Multiple Arteriovenous Malformations. World Neurosurg 2020; 144:e244-e252. [PMID: 32822953 DOI: 10.1016/j.wneu.2020.08.099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/03/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The present study aims to define the outcome and risks of patients with multiple arteriovenous malformations (AVMs) treated by stereotactic radiosurgery (SRS). METHODS We retrospectively analyzed the records of 1232 patients with AVMs who underwent SRS at our center between 1987 and 2017. We identified 10 patients who had SRS for multiple AVMs (total of 25). Eight patients presented with intracranial hemorrhage before SRS. Four patients had hereditary hemorrhagic telangiectasia. A Spetzler-Martin grade I AVM was diagnosed in 11 AVMs, grade II in 7, grade III in 6, and grade IV in 1 AVM. The median maximum diameter was 12 mm, the median target volume was 1.1 cm3, and the median margin dose was 20 Gy. Twenty-four AVMs were treated with single-session SRS, and 1 AVM was treated with volume-staged SRS. RESULTS The angiographic complete obliteration rate of each AVM was 18.2%, 58.0%, and 66.4% at 3, 5, and 7 years, respectively. The angiographic complete obliteration rate of all treated AVMs in each patient was 11.1%, 51.4%, and 51.4% at 3, 5, and 7 years, respectively. In multivariate analysis, higher marginal dose (≥18 Gy, P = 0.031) was significantly associated with complete obliteration of AVMs. After obliteration of all their AVMs was confirmed no patient bled. CONCLUSIONS Patients with complex multiple AVMs often presented with a brain hemorrhage. Reduction in bleeding risk after SRS requires complete obliteration that is more likely if the initial AVM margin dose is ≥18 Gy for each AVM.
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Affiliation(s)
- Akiyoshi Ogino
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Daniel Tonetti
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - John C Flickinger
- Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Hideyuki Kano
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
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34
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Mureb M, Golub D, Benjamin C, Gurewitz J, Strickland BA, Zada G, Chang E, Urgošík D, Liščák R, Warnick RE, Speckter H, Eastman S, Kaufmann AM, Patel S, Feliciano CE, Carbini CH, Mathieu D, Leduc W, Nagel SJ, Hori YS, Hung YC, Ogino A, Faramand A, Kano H, Lunsford LD, Sheehan J, Kondziolka D. Earlier radiosurgery leads to better pain relief and less medication usage for trigeminal neuralgia patients: an international multicenter study. J Neurosurg 2020; 135:237-244. [PMID: 32619989 DOI: 10.3171/2020.4.jns192780] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 04/15/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Trigeminal neuralgia (TN) is a chronic pain condition that is difficult to control with conservative management. Furthermore, disabling medication-related side effects are common. This study examined how stereotactic radiosurgery (SRS) affects pain outcomes and medication dependence based on the latency period between diagnosis and radiosurgery. METHODS The authors conducted a retrospective analysis of patients with type I TN at 12 Gamma Knife treatment centers. SRS was the primary surgical intervention in all patients. Patient demographics, disease characteristics, treatment plans, medication histories, and outcomes were reviewed. RESULTS Overall, 404 patients were included. The mean patient age at SRS was 70 years, and 60% of the population was female. The most common indication for SRS was pain refractory to medications (81%). The median maximum radiation dose was 80 Gy (range 50-95 Gy), and the mean follow-up duration was 32 months. The mean number of medications between baseline (pre-SRS) and the last follow-up decreased from 1.98 to 0.90 (p < 0.0001), respectively, and this significant reduction was observed across all medication categories. Patients who received SRS within 4 years of their initial diagnosis achieved significantly faster pain relief than those who underwent treatment after 4 years (median 21 vs 30 days, p = 0.041). The 90-day pain relief rate for those who received SRS ≤ 4 years after their diagnosis was 83.8% compared with 73.7% in patients who received SRS > 4 years after their diagnosis. The maximum radiation dose was the strongest predictor of a durable pain response (OR 1.091, p = 0.003). Early intervention (OR 1.785, p = 0.007) and higher maximum radiation dose (OR 1.150, p < 0.0001) were also significant predictors of being pain free (a Barrow Neurological Institute pain intensity score of I-IIIA) at the last follow-up visit. New sensory symptoms of any kind were seen in 98 patients (24.3%) after SRS. Higher maximum radiation dose trended toward predicting new sensory deficits but was nonsignificant (p = 0.075). CONCLUSIONS TN patients managed with SRS within 4 years of diagnosis experienced a shorter interval to pain relief with low risk. SRS also yielded significant decreases in adjunct medication utilization. Radiosurgery should be considered earlier in the course of treatment for TN.
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Affiliation(s)
- Monica Mureb
- 1Department of Neurosurgery, New York University Langone Medical Center, New York, New York
| | - Danielle Golub
- 1Department of Neurosurgery, New York University Langone Medical Center, New York, New York
| | - Carolina Benjamin
- 1Department of Neurosurgery, New York University Langone Medical Center, New York, New York
| | - Jason Gurewitz
- 1Department of Neurosurgery, New York University Langone Medical Center, New York, New York
| | | | | | - Eric Chang
- 3Radiation Oncology, University of Southern California, Los Angeles, California
| | - Dušan Urgošík
- 4Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Roman Liščák
- 4Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Ronald E Warnick
- 5Gamma Knife Center, Jewish Hospital, Mayfield Clinic, Cincinnati, Ohio
| | - Herwin Speckter
- 6Centro Gamma Knife Dominicano, CEDIMAT, Santo Domingo, Dominican Republic
| | - Skyler Eastman
- 7Section of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Anthony M Kaufmann
- 7Section of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Samir Patel
- 8Department of Oncology, Division of Radiation Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Caleb E Feliciano
- 9Department of Neurosurgery, University of Puerto Rico, School of Medicine, San Juan, Puerto Rico
| | - Carlos H Carbini
- 10Administración de Servicios Médicos de Puerto Rico, Centro Gamma Knife de Puerto Rico y El Caribe, San Juan, Puerto Rico
| | - David Mathieu
- 11Division of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Québec, Canada
| | | | - Sean J Nagel
- 12Center for Neuro-Restoration, Cleveland Clinic, Cleveland, Ohio
| | - Yusuke S Hori
- 12Center for Neuro-Restoration, Cleveland Clinic, Cleveland, Ohio
| | - Yi-Chieh Hung
- 13Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia; and
| | - Akiyoshi Ogino
- 14Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Andrew Faramand
- 14Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Hideyuki Kano
- 14Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - L Dade Lunsford
- 14Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jason Sheehan
- 13Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia; and
| | - Douglas Kondziolka
- 1Department of Neurosurgery, New York University Langone Medical Center, New York, New York
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Burke RM, Chen CJ, Ding D, Buell TJ, Sokolowski JD, Lee CC, Kano H, Kearns KN, Tzeng SW, Yang HC, Huang PP, Kondziolka D, Ironside N, Mathieu D, Iorio-Morin C, Grills IS, Feliciano C, Barnett GH, Starke RM, Lunsford LD, Sheehan JP. Early obliteration of pediatric brain arteriovenous malformations after stereotactic radiosurgery: an international multicenter study. J Neurosurg Pediatr 2020; 26:398-405. [PMID: 32590353 DOI: 10.3171/2020.4.peds19738] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 04/16/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Stereotactic radiosurgery (SRS) is a treatment option for pediatric brain arteriovenous malformations (AVMs), and early obliteration could encourage SRS utilization for a subset of particularly radiosensitive lesions. The objective of this study was to determine predictors of early obliteration after SRS for pediatric AVMs. METHODS The authors performed a retrospective review of the International Radiosurgery Research Foundation AVM database. Obliterated pediatric AVMs were sorted into early (obliteration ≤ 24 months after SRS) and late (obliteration > 24 months after SRS) responders. Predictors of early obliteration were identified, and the outcomes of each group were compared. RESULTS The overall study cohort was composed of 345 pediatric patients with obliterated AVMs. The early and late obliteration cohorts were made up of 95 (28%) and 250 (72%) patients, respectively. Independent predictors of early obliteration were female sex, a single SRS treatment, a higher margin dose, a higher isodose line, a deep AVM location, and a smaller AVM volume. The crude rate of post-SRS hemorrhage was 50% lower in the early (3.2%) than in the late (6.4%) obliteration cohorts, but this difference was not statistically significant (p = 0.248). The other outcomes of the early versus late obliteration cohorts were similar, with respect to symptomatic radiation-induced changes (RICs), cyst formation, and tumor formation. CONCLUSIONS Approximately one-quarter of pediatric AVMs that become obliterated after SRS will achieve this radiological endpoint within 24 months of initial SRS. The authors identified multiple factors associated with early obliteration, which may aid in prognostication and management. The overall risks of delayed hemorrhage, RICs, cyst formation, and tumor formation were not statistically different in patients with early versus late obliteration.
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Affiliation(s)
- Rebecca M Burke
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Ching-Jen Chen
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Dale Ding
- 5Department of Neurosurgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Thomas J Buell
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Jennifer D Sokolowski
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Cheng-Chia Lee
- 2Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital.,3School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hideyuki Kano
- 4Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
| | - Kathryn N Kearns
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Shih-Wei Tzeng
- 2Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
| | - Huai-Che Yang
- 2Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
| | - Paul P Huang
- 7Department of Neurosurgery, New York University Langone Medical Center, New York, New York
| | - Douglas Kondziolka
- 7Department of Neurosurgery, New York University Langone Medical Center, New York, New York
| | - Natasha Ironside
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - David Mathieu
- 8Division of Neurosurgery, Centre de recherché du CHUS, University of Sherbrooke, Quebec, Canada
| | - Christian Iorio-Morin
- 8Division of Neurosurgery, Centre de recherché du CHUS, University of Sherbrooke, Quebec, Canada
| | - Inga S Grills
- 9Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Caleb Feliciano
- 10Section of Neurological Surgery, University of Puerto Rico, San Juan, Puerto Rico; and
| | - Gene H Barnett
- 6Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | - L Dade Lunsford
- 4Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
| | - Jason P Sheehan
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
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McDowell MM, Agarwal N, Mao G, Johnson S, Kano H, Lunsford LD, Greene S. Long-term outcomes of pediatric arteriovenous malformations: the 30-year Pittsburgh experience. J Neurosurg Pediatr 2020; 26:275-282. [PMID: 32413859 DOI: 10.3171/2020.3.peds19614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 10/22/2019] [Accepted: 03/06/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The study of pediatric arteriovenous malformations (pAVMs) is complicated by the rarity of the entity. Treatment choice has often been affected by the availability of different modalities and the experience of the providers present. The University of Pittsburgh experience of multimodality treatment of pAVMs is presented. METHODS The authors conducted a retrospective cohort study examining 212 patients with pAVM presenting to the University of Pittsburgh between 1988 and 2018, during which patients had access to surgical, endovascular, and radiosurgical options. Univariate analysis was performed comparing good and poor outcomes. A poor outcome was defined as a modified Rankin Scale (mRS) score of ≥ 3. Multivariate analysis via logistic regression was performed on appropriate variables with a p value of ≤ 0.2. Seventy-five percent of the cohort had at least 3 years of follow-up. RESULTS Five patients (2.4%) did not receive any intervention, 131 (61.8%) had GKRS alone, 14 (6.6%) had craniotomies alone, and 2 (0.9%) had embolization alone. Twenty-two (10.4%) had embolization and Gamma Knife radiosurgery (GKRS); 20 (9.4%) had craniotomies and GKRS; 8 (3.8%) had embolization and craniotomies; and 10 (4.7%) had embolization, craniotomies, and GKRS. Thirty-one patients (14.6%) were found to have poor outcome on follow-up. The multivariate analysis performed in patients with poor outcomes was notable for associations with no treatment (OR 18.9, p = 0.02), hemorrhage requiring craniotomy for decompression alone (OR 6, p = 0.03), preoperative mRS score (OR 2.1, p = 0.004), and Spetzler-Martin score (OR 1.8, p = 0.0005). The mean follow-up was 79.7 ± 62.1 months. The confirmed radiographic obliteration rate was 79.4% and there were 5 recurrences found on average 9.5 years after treatment. CONCLUSIONS High rates of long-term functional independence (mRS score of ≤ 2) can be achieved with comprehensive multimodality treatment of pAVMs. At this center there was no difference in outcome based on treatment choice when accounting for factors such as Spetzler-Martin grade and presenting morbidity. Recurrences are rare but frequently occur years after treatment, emphasizing the need for long-term screening after obliteration.
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Affiliation(s)
- Michael M McDowell
- 1Division of Neurological Surgery, Children's Hospital of Pittsburgh.,2Department of Neurological Surgery, University of Pittsburgh Medical Center; and
| | - Nitin Agarwal
- 2Department of Neurological Surgery, University of Pittsburgh Medical Center; and
| | - Gordon Mao
- 3Department of Neurological Surgery, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Stephen Johnson
- 2Department of Neurological Surgery, University of Pittsburgh Medical Center; and
| | - Hideyuki Kano
- 2Department of Neurological Surgery, University of Pittsburgh Medical Center; and
| | - L Dade Lunsford
- 2Department of Neurological Surgery, University of Pittsburgh Medical Center; and
| | - Stephanie Greene
- 1Division of Neurological Surgery, Children's Hospital of Pittsburgh.,2Department of Neurological Surgery, University of Pittsburgh Medical Center; and
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Kano H, Saito C, Yamada N, Fukuuchi T, Yamaoka N, Kaneko K, Asami Y. Species-dependent patterns of incorporation of purine mononucleotides and nucleosides by lactic acid bacteria. Nucleosides Nucleotides Nucleic Acids 2020; 39:1440-1448. [PMID: 32397874 DOI: 10.1080/15257770.2020.1733604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Although most lactic acid bacteria do not directly incorporate purine nucleotides, the strain Lactobacillus gasseri PA-3 was found to incorporate purine mononucleotides. To determine whether the direct uptake of purine mononucleotides is dependent on the species or strain of lactic acid bacteria, incorporation of purine mononucleotides was assessed in L. gasseri, Lactcoccus lactis sbsp. lactis, Streptococcus thermophilus and other species of lactic acid bacteria. Each bacterial strain was incubated with 32P-AMP or 14C-adenosine and the incorporation of each purine was evaluated by measuring their radioactivity. All investigated strains of L. gasseri incorporated 32P-AMP, whereas strains of S. thermophilus and most strains of L. lactis did not. Incorporation of 32P-AMP into strains of Pediococcus was dependent on the strain or species of that genus of bacteria. All investigated strains, except for one strain of L. gasseri, incorporated 14C-adenosine, with S. thermophilus, L. lactis and Pediococcus generally displaying greater incorporation of 14C-adenosine than L. gasseri. Although most lactic acid bacteria such as S. thermophiles and L. lactis do not incorporate purine mononucleotides, some species such as L. gasseri directly incorporate purine mononucleotides. These findings indicate that the preferential incorporation of purine mononucleotides or nucleosides by lactic acid bacteria is dependent on the species or strain.
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Affiliation(s)
- H Kano
- Food Microbiology Research Laboratories, R&D Division, Meiji Co., Ltd, Tokyo, Japan
| | - C Saito
- Food Microbiology Research Laboratories, R&D Division, Meiji Co., Ltd, Tokyo, Japan
| | - N Yamada
- Food Microbiology Research Laboratories, R&D Division, Meiji Co., Ltd, Tokyo, Japan
| | - T Fukuuchi
- Faculty of Pharma Sciences, Teikyo University, Tokyo, Japan
| | - N Yamaoka
- Faculty of Pharma Sciences, Teikyo University, Tokyo, Japan
| | - K Kaneko
- Faculty of Pharma Sciences, Teikyo University, Tokyo, Japan
| | - Y Asami
- Food Microbiology Research Laboratories, R&D Division, Meiji Co., Ltd, Tokyo, Japan
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Iorio-Morin C, Liscak R, Vladyka V, Kano H, Jacobs RC, Lunsford LD, Cohen-Inbar O, Sheehan J, Emad R, Karim KA, El-Shehaby A, Reda WA, Lee CC, Pai FY, Wolf A, Kondziolka D, Grills I, Lee KC, Mathieu D. Repeat Stereotactic Radiosurgery for Progressive or Recurrent Vestibular Schwannomas. Neurosurgery 2020; 85:535-542. [PMID: 30189018 DOI: 10.1093/neuros/nyy416] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 02/20/2018] [Accepted: 08/07/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Stereotactic radiosurgery (SRS) is a highly effective management approach for patients with vestibular schwannomas (VS), with 10-yr control rates up 98%. When it fails, however, few data are available to guide management. OBJECTIVE To perform a retrospective analysis of patients who underwent 2 SRS procedures on the same VS to assess the safety and efficacy of this practice. METHODS This study was opened to centers of the International Gamma Knife Research Foundation (IGKRF). Data collected included patient characteristics, clinical symptoms at the time of SRS, radiosurgery dosimetric data, imaging response, clinical evolution, and survival. Actuarial analyses of tumor responses were performed. RESULTS Seventy-six patients from 8 IGKRF centers were identified. Median follow-up from the second SRS was 51.7 mo. Progression after the first SRS occurred at a median of 43 mo. Repeat SRS was performed using a median dose of 12 Gy. Actuarial tumor control rates at 2, 5, and 10 yr following the second SRS were 98.6%, 92.2%, and 92.2%, respectively. Useful hearing was present in 30%, 8%, and 5% of patients at first SRS, second SRS, and last follow-up, respectively. Seventy-five percent of patients reported stable or improved symptoms following the second SRS. Worsening of facial nerve function attributable to SRS occurred in 7% of cases. There were no reports of radionecrosis, radiation-associated edema requiring corticosteroids, radiation-related neoplasia, or death attributable to the repeat SRS procedure. CONCLUSION Patients with progressing VS after radiosurgery can be safely and effectively managed using a second SRS procedure.
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Affiliation(s)
- Christian Iorio-Morin
- Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Québec, Canada
| | | | | | - Hideyuki Kano
- Department of Neurological Surgery, Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Rachel C Jacobs
- Department of Neurological Surgery, Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - L Dade Lunsford
- Department of Neurological Surgery, Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Or Cohen-Inbar
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Jason Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Reem Emad
- National Cancer Institute, Cairo University, Gamma Knife Center Cairo, Cairo, Egypt
| | - Khalid Abdel Karim
- Clinical Oncology Department, Ain Shams University, Gamma Knife Center Cairo, Cairo, Egypt
| | - Amr El-Shehaby
- Neurosurgery Department, Ain Shams University, Gamma Knife Center Cairo, Cairo, Egypt
| | - Wael A Reda
- Neurosurgery Department, Ain Shams University, Gamma Knife Center Cairo, Cairo, Egypt
| | - Cheng-Chia Lee
- Taipei Veterans General Hospital Neurological Institute, Taipei, Taiwan
| | - Fu-Yuan Pai
- Taipei Veterans General Hospital Neurological Institute, Taipei, Taiwan
| | - Amparo Wolf
- New York University Langone Medical Center, New York, New York
| | | | - Inga Grills
- Beaumont Gamma Knife Center, Royal Oak, Michigan
| | - Kuei C Lee
- Beaumont Gamma Knife Center, Royal Oak, Michigan
| | - David Mathieu
- Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Québec, Canada
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Bunevicius A, Kano H, Lee CC, Krsek M, Nabeel AM, El-Shehaby A, Abdel Karim K, Martinez-Moreno N, Mathieu D, Lee JYK, Grills I, Kondziolka D, Martinez-Alvarez R, Reda WA, Liscak R, Su YH, Lunsford LD, Lee Vance M, Sheehan JP. Early versus late Gamma Knife radiosurgery for Cushing's disease after prior resection: results of an international, multicenter study. J Neurosurg 2020; 134:807-815. [PMID: 32084634 DOI: 10.3171/2019.12.jns192836] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 12/13/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The optimal time to perform stereotactic radiosurgery after incomplete resection of adrenocorticotropic hormone (ACTH)-producing pituitary adenoma in patients with Cushing's disease (CD) remains unclear. In patients with persistent CD after resection of ACTH-producing pituitary adenoma, the authors evaluated the association of the interval between resection and Gamma Knife radiosurgery (GKRS) with outcomes. METHODS Pooled data from 10 institutions participating in the International Radiosurgery Research Foundation were used in this study. RESULTS Data from 255 patients with a mean follow-up of 65.59 ± 49.01 months (mean ± SD) were analyzed. Seventy-seven patients (30%) underwent GKRS within 3 months; 46 (18%) from 4 to 6 months; 34 (13%) from 7 to 12 months; and 98 (38%) at > 12 months after the resection. Actuarial endocrine remission rates were higher in patients who underwent GKRS ≤ 3 months than when treatment was > 3 months after the resection (78% and 65%, respectively; p = 0.017). Endocrine remission rates were lower in patients who underwent GKRS at > 12 months versus ≤ 12 months after the resection (57% vs 76%, respectively; p = 0.006). In multivariate Cox regression analyses adjusted for clinical and treatment characteristics, early GKRS was associated with increased probability of endocrine remission (hazard ratio [HR] 1.518, 95% CI 1.039-2.218; p = 0.031), whereas late GKRS (HR 0.641, 95% CI 0.448-0.919; p = 0.015) was associated with reduced probability of endocrine remission. The incidence of some degree of new pituitary deficiency (p = 0.922), new visual deficits (p = 0.740), and other cranial nerve deficits (p = 0.610) was not significantly related to time from resection to GKRS. CONCLUSIONS Early GKRS is associated with an improved endocrine remission rate, whereas later GKRS is associated with a lower rate of endocrine remission after pituitary adenoma resection. Early GKRS should be considered for patients with CD after incomplete pituitary adenoma resection.
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Affiliation(s)
- Adomas Bunevicius
- 1Department of Neurologic Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Hideyuki Kano
- 2Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Cheng-Chia Lee
- 3Department of Neurosurgery, Neurologic Institute, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
| | - Michal Krsek
- 4Third Department of Internal Medicine, First Faculty of Medicine of the Charles University and General Teaching Hospital, Prague, Czech Republic
| | - Ahmed M Nabeel
- 5Neurosurgery Department, Gamma Knife Center Cairo-Nasser Institute, Benha University, Benha, Egypt
| | - Amr El-Shehaby
- 6Neurosurgery Department, Gamma Knife Center Cairo-Nasser Institute, Ain Shams University, Cairo, Egypt
| | - Khaled Abdel Karim
- 7Clinical Oncology Department, Gamma Knife Center Cairo-Nasser Institute, Ain Shams University, Cairo, Egypt
| | - Nuria Martinez-Moreno
- 8Department of Functional Neurosurgery and Radiosurgery, Ruber International Hospital, Madrid, Spain
| | - David Mathieu
- 9Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
| | - John Y K Lee
- 10Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Inga Grills
- 11Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Douglas Kondziolka
- 12Department of Neurosurgery, New York University Langone Medical Center, New York, New York
| | - Roberto Martinez-Alvarez
- 8Department of Functional Neurosurgery and Radiosurgery, Ruber International Hospital, Madrid, Spain
| | - Wael A Reda
- 6Neurosurgery Department, Gamma Knife Center Cairo-Nasser Institute, Ain Shams University, Cairo, Egypt
| | - Roman Liscak
- 13Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic; and
| | - Yan-Hua Su
- 3Department of Neurosurgery, Neurologic Institute, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
| | - L Dade Lunsford
- 2Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mary Lee Vance
- 1Department of Neurologic Surgery, University of Virginia Health System, Charlottesville, Virginia.,14Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Jason P Sheehan
- 1Department of Neurologic Surgery, University of Virginia Health System, Charlottesville, Virginia
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40
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Chen CJ, Lee CC, Kano H, Kearns KN, Ding D, Tzeng SW, Atik A, Joshi K, Barnett GH, Huang PP, Kondziolka D, Mathieu D, Iorio-Morin C, Grills IS, Quinn TJ, Siddiqui ZA, Marvin K, Feliciano C, Faramand A, Lunsford LD, Sheehan JP. Stereotactic radiosurgery for pediatric brain arteriovenous malformations: long-term outcomes. J Neurosurg Pediatr 2020; 25:497-505. [PMID: 32032957 DOI: 10.3171/2019.12.peds19595] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 10/07/2019] [Accepted: 12/12/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Contrary to the better described obliteration- and hemorrhage-related data after stereotactic radiosurgery (SRS) of brain arteriovenous malformations (AVMs) in pediatric patients, estimates of the rarer complications, including cyst and tumor formation, are limited in the literature. The aim of the present study was to assess the long-term outcomes and risks of SRS for AVMs in pediatric patients (age < 18 years). METHODS The authors retrospectively analyzed the International Radiosurgery Research Foundation pediatric AVM database for the years 1987 to 2018. AVM obliteration, post-SRS hemorrhage, cyst formation, and tumor formation were assessed. Cumulative probabilities, adjusted for the competing risk of death, were calculated. RESULTS The study cohort comprised 539 pediatric AVM patients (mean follow-up 85.8 months). AVM obliteration was observed in 64.3% of patients, with cumulative probabilities of 63.6% (95% CI 58.8%-68.0%), 77.1% (95% CI 72.1%-81.3%), and 88.1% (95% CI 82.5%-92.0%) over 5, 10, and 15 years, respectively. Post-SRS hemorrhage was observed in 8.4% of patients, with cumulative probabilities of 4.9% (95% CI 3.1%-7.2%), 9.7% (95% CI 6.4%-13.7%), and 14.5% (95% CI 9.5%-20.5%) over 5, 10, and 15 years, respectively. Cyst formation was observed in 2.1% of patients, with cumulative probabilities of 5.5% (95% CI 2.3%-10.7%) and 6.9% (95% CI 3.1%-12.9%) over 10 and 15 years, respectively. Meningiomas were observed in 2 patients (0.4%) at 10 and 12 years after SRS, with a cumulative probability of 3.1% (95% CI 0.6%-9.7%) over 15 years. CONCLUSIONS AVM obliteration can be expected after SRS in the majority of the pediatric population, with a relatively low risk of hemorrhage during the latency period. Cyst and benign tumor formation after SRS can be observed in 7% and 3% of patients over 15 years, respectively. Longitudinal surveillance for delayed neoplasia is prudent despite its low incidence.
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Affiliation(s)
- Ching-Jen Chen
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Cheng-Chia Lee
- 2Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 3School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hideyuki Kano
- 4Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kathryn N Kearns
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Dale Ding
- 5Department of Neurosurgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Shih-Wei Tzeng
- 2Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
| | - Ahmet Atik
- 6Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Krishna Joshi
- 6Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Gene H Barnett
- 6Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Paul P Huang
- 7Department of Neurosurgery, New York University Langone Medical Center, New York, New York
| | - Douglas Kondziolka
- 7Department of Neurosurgery, New York University Langone Medical Center, New York, New York
| | - David Mathieu
- 8Division of Neurosurgery, Centre de recherché du CHUS, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Christian Iorio-Morin
- 8Division of Neurosurgery, Centre de recherché du CHUS, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Inga S Grills
- 9Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan; and
| | - Thomas J Quinn
- 9Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan; and
| | - Zaid A Siddiqui
- 9Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan; and
| | - Kim Marvin
- 9Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan; and
| | - Caleb Feliciano
- 10Section of Neurological Surgery, University of Puerto Rico, San Juan, Puerto Rico
| | - Andrew Faramand
- 4Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - L Dade Lunsford
- 4Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jason P Sheehan
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
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Chen CJ, Lee CC, Kano H, Kearns K, Ding D, Kondziolka D, Ironside N, Starke R, Lunsford D, Sheehan J. Abstract 127: Radiosurgery for Unruptured Intervention-Naïve Pediatric Brain Arteriovenous Malformations. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.127] [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
Background and Purpose:
To evaluate, in a multicenter, retrospective cohort study, the outcomes after stereotactic radiosurgery (SRS) for unruptured, intervention-naïve pediatric brain arteriovenous malformations (AVM).
Methods:
We retrospectively analyzed the International Radiosurgery Research Foundation pediatric AVM database from 1987-2018. Pediatric patients with unruptured, previously untreated AVMs who underwent SRS were included. The primary endpoint was a composite of hemorrhagic stroke, death, or permanently symptomatic radiation-induced changes (RIC).
Results:
The study cohort comprised 101 patients (mean follow-up 80.8 months). The primary endpoint occurred in 14%, comprising hemorrhage stroke, death, and permanent RIC in 6%, 3%, and 8%, respectively. Estimated probabilities of the primary endpoint were 5.2%, 10.8%, and 23.0% at 2, 5, and 10 years, respectively (Figure 1). Estimated probabilities of AVM obliteration at 5 and 10 years were 64% and 82%, respectively (Figure 2). Single SRS treatment (p=0.007) and higher margin dose (p=0.005) were predictors of obliteration. Subgroup analysis of Spetzler-Martin grade I-III AVMs estimated primary endpoint probabilities of 3.7%, 8.4%, and 18.7% at 2, 5 and 10 years, respectively.
Conclusion:
Treatment of unruptured, intervention-naïve AVMs in the pediatric population with SRS carries an approximately 2% annual risk of morbidity and mortality, which appears to plateau after 10 years. The poorly described natural history of pediatric AVMs makes any comparison of SRS versus conservative management imperfect. However, due to the young age at diagnosis and excessive cumulative life hemorrhage risk of an untreated AVM in a child, SRS is likely to have a favorable long-term risk-benefit profile for appropriately selected unruptured pediatric AVMs.
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Ding D, Mehta GU, Patibandla MR, Lee CC, Liscak R, Kano H, Pai FY, Kosak M, Sisterson ND, Martinez-Alvarez R, Martinez-Moreno N, Mathieu D, Grills IS, Blas K, Lee K, Cifarelli CP, Katsevman GA, Lee JYK, McShane B, Kondziolka D, Lunsford LD, Vance ML, Sheehan JP. Stereotactic Radiosurgery for Acromegaly: An International Multicenter Retrospective Cohort Study. Neurosurgery 2020; 84:717-725. [PMID: 29757421 DOI: 10.1093/neuros/nyy178] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [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: 10/18/2017] [Accepted: 04/05/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Stereotactic radiosurgery (SRS) is a treatment option for persistent or recurrent acromegaly secondary to a growth hormone secreting pituitary adenoma, but its efficacy is inadequately defined. OBJECTIVE To assess, in a multicenter, retrospective cohort study, the outcomes of SRS for acromegaly and determine predictors. METHODS We pooled and analyzed data from 10 participating institutions of the International Gamma Knife Research Foundation for patients with acromegaly who underwent SRS with endocrine follow-up of ≥6 mo. RESULTS The study cohort comprised 371 patients with a mean endocrine follow-up of 79 mo. IGF-1 lowering medications were held in 56% of patients who were on pre-SRS medical therapy. The mean SRS treatment volume and margin dose were 3.0 cm3 and 24.2 Gy, respectively. The actuarial rates of initial and durable endocrine remission at 10 yr were 69% and 59%, respectively. The mean time to durable remission after SRS was 38 mo. Biochemical relapse after initial remission occurred in 9%, with a mean time to recurrence of 17 mo. Cessation of IGF-1 lowering medication prior to SRS was the only independent predictor of durable remission (P = .01). Adverse radiation effects included the development of ≥1 new endocrinopathy in 26% and ≥1 cranial neuropathy in 4%. CONCLUSION SRS is a definitive treatment option for patients with persistent or recurrent acromegaly after surgical resection. There appears to be a statistical association between the cessation of IGF-1 lowering medications prior to SRS and durable remission.
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Affiliation(s)
- Dale Ding
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Gautam U Mehta
- Department of Neurosurgery, MD Anderson Cancer Center, Houston, Texas
| | | | - Cheng-Chia Lee
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Roman Liscak
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Hideyuki Kano
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Fu-Yuan Pai
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mikulas Kosak
- 3rd Department of Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Nathaniel D Sisterson
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - David Mathieu
- Division of Neurosurgery, Centre de recherche du CHUS, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Inga S Grills
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Kevin Blas
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Kuei Lee
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | | | | | - John Y K Lee
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brendan McShane
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Douglas Kondziolka
- Department of Neurosurgery, New York University Langone Medical Center, New York, New York
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mary Lee Vance
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia.,Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Jason P Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
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Xu Z, Mathieu D, Heroux F, Abbassy M, Barnett G, Mohammadi AM, Kano H, Caruso J, Shih HH, Grills IS, Lee K, Krishnan S, Kaufmann AM, Lee JYK, Alonso-Basanta M, Kerr M, Pierce J, Kondziolka D, Hess JA, Gerrard J, Chiang V, Lunsford LD, Sheehan JP. Stereotactic Radiosurgery for Trigeminal Neuralgia in Patients With Multiple Sclerosis: A Multicenter Study. Neurosurgery 2019; 84:499-505. [PMID: 29688562 DOI: 10.1093/neuros/nyy142] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 03/20/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Facial pain response (PR) to various surgical interventions in patients with multiple sclerosis (MS)-related trigeminal neuralgia (TN) is much less optimal. No large patient series regarding stereotactic radiosurgery (SRS) has been published. OBJECTIVE To evaluate the clinical outcomes of MS-related TN treated with SRS. METHODS This is a retrospective cohort study. A total of 263 patients contributed by 9 member tertiary referral Gamma Knife centers (2 in Canada and 7 in USA) of the International Gamma Knife Research Consortium (IGKRF) constituted this study. RESULTS The median latency period of PR after SRS was 1 mo. Reasonable pain control (Barrow Neurological Institute [BNI] Pain Scores I-IIIb) was achieved in 232 patients (88.2%). The median maintenance period from SRS was 14.1 months (range, 10 days to 10 years). The actuarial reasonable pain control maintenance rates at 1 yr, 2 yr, and 4 yr were 54%, 35%, and 24%, respectively. There was a correlation between the status of achieving BNI-I and the maintenance of facial pain recurrence-free rate. The median recurrence-free rate was 36 mo and 12.2 mo in patients achieving BNI-I and BNI > I, respectively (P = .046). Among 210 patients with known status of post-SRS complications, the new-onset of facial numbness (BNI-I or II) after SRS occurred in 21 patients (10%). CONCLUSION In this largest series SRS offers a reasonable benefit to risk profile for patients who have exhausted medical management. More favorable initial response to SRS may predict a long-lasting pain control.
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Affiliation(s)
- Zhiyuan Xu
- Department of Neurosurgery, Univer-sity of Virginia, Charlottesville, Virginia
| | - David Mathieu
- Division of Neurosurgery, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - France Heroux
- Division of Neurosurgery, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mahmoud Abbassy
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
| | - Gene Barnett
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Hideyuki Kano
- Dep-artment of Neurological Surgery, Univer-sity of Pittsburgh, Pittsburgh, Pennsyl-vania
| | - James Caruso
- Department of Neurosurgery, Univer-sity of Virginia, Charlottesville, Virginia
| | - Han-Hsun Shih
- Department of Neurosurgery, Univer-sity of Virginia, Charlottesville, Virginia.,Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China
| | - Inga S Grills
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Kuei Lee
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Sandeep Krishnan
- Section of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Anthony M Kaufmann
- Section of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - John Y K Lee
- Department of Neurosurgery, Otolaryngology, Univer-sity of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Marie Kerr
- Department of Neurosurgery, Otolaryngology, Univer-sity of Pennsylvania, Philadelphia, Pennsylvania
| | - John Pierce
- Department of Neurosurgery, Otolaryngology, Univer-sity of Pennsylvania, Philadelphia, Pennsylvania
| | - Douglas Kondziolka
- Depart-ment of Neurosurgery, New York University Langone Medical Center, New York, New York
| | - Judith A Hess
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Jason Gerrard
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Veronica Chiang
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - L Dade Lunsford
- Dep-artment of Neurological Surgery, Univer-sity of Pittsburgh, Pittsburgh, Pennsyl-vania
| | - Jason P Sheehan
- Department of Neurosurgery, Univer-sity of Virginia, Charlottesville, Virginia
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44
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Seymour ZA, Chan JW, Sneed PK, Kano H, Lehocky CA, Jacobs RC, Ye H, Chytka T, Liscak R, Lee CC, Yang HC, Ding D, Sheehan J, Feliciano CE, Rodriguez-Mercado R, Chiang VL, Hess JA, Sommaruga S, McShane B, Lee J, Vasas LT, Kaufmann AM, Grills I, McDermott MW. Dose response and architecture in volume staged radiosurgery for large arteriovenous malformations: A multi-institutional study. Radiother Oncol 2019; 144:180-188. [PMID: 31835173 DOI: 10.1016/j.radonc.2019.09.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 03/31/2019] [Revised: 08/13/2019] [Accepted: 09/24/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Optimal treatment paradigm for large arteriovenous malformations (AVMs) is controversial. Volume-staged stereotactic radiosurgery (VS-SRS) provides an effective option for these high-risk lesions, but optimizing treatment for these recalcitrant and rare lesions has proven difficult. METHODS This is a multi-centered retrospective review of patients treated with a planned prospective volume staging approach to stereotactically treat the entire nidus of an AVM with volume stages separated by intervals of 3-6 months. A total of 9 radiosurgical centers treated 257 patients with VS-SRS between 1991 and 2016. We evaluated near complete response (nCR), obliteration, cure, and overall survival. RESULTS With a median age of 33 years old at the time of first SRS volume stage, patients received 2-4 total volume stages and a median follow up of 5.7 years after VS-SRS. The median total AVM nidus volume was 23.25 cc (range: 7.7-94.4 cc) with a median margin dose per stage of 17 Gy (range: 12-20 Gy). Total AVM volume, margin dose per stage, compact nidus, lack of prior embolization, and lack of thalamic location involvement were all associated with improved outcomes. Dose >/= 17.5 Gy was strongly associated with improved rates of nCR, obliteration, and cure. With dose >/= 17.5 Gy, 5- and 10-year cure rates were 33.7% and 76.8% in evaluable patients compared to 23.7% and 34.7% of patients with 17 Gy and 6.4% and 20.6% with <17 Gy per volume-stage (p = 0.004). Obliteration rates in diffuse nidus architecture with <17 Gy were particularly poor with none achieving obliteration compared to 32.3% with doses >/= 17 Gy at 5 years (p = 0.007). Comparatively, lesions with a compact nidus architecture exhibited obliteration rates at 5 years were 10.7% vs 9.3% vs 26.6% for dose >17 Gy vs 17 Gy vs >/=17.5 Gy. CONCLUSION VS-SRS is an option for upfront treatment of large AVMs. Higher dose was associated with improved rates of nCR, obliteration, and cure suggesting that larger volumetric responses may facilitate salvage therapy and optimize the chance for cure.
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Affiliation(s)
- Zachary A Seymour
- Beaumont Health, Oakland University William Beaumont School of Medicine, Department of Radiation Oncology, United States.
| | - Jason W Chan
- University of California - San Francisco School of Medicine, Department of Radiation Oncology, United States
| | - Penny K Sneed
- University of California - San Francisco School of Medicine, Department of Radiation Oncology, United States
| | - Hideyuki Kano
- University of Pittsburgh, School of Medicine, Department of Neurosurgery, United States
| | - Craig A Lehocky
- University of Pittsburgh, School of Medicine, Department of Neurosurgery, United States
| | - Rachel C Jacobs
- University of Pittsburgh, School of Medicine, Department of Neurosurgery, United States
| | - Hong Ye
- Beaumont Health, Department of Radiation Oncology, United States
| | - Tomas Chytka
- Na Homolce Hospital, Department of Stereotactic Radioneurosurgery, Prague, Czech Republic
| | - Roman Liscak
- Na Homolce Hospital, Department of Stereotactic Radioneurosurgery, Prague, Czech Republic
| | - Cheng-Chia Lee
- Taipei General Hospital, Department of Neurosurgery, Taiwan
| | - Huai-Che Yang
- Taipei General Hospital, Department of Neurosurgery, Taiwan
| | - Dale Ding
- University of Virginia School of Medicine, Department of Neurosurgery, United States
| | - Jason Sheehan
- University of Virginia School of Medicine, Department of Neurosurgery, United States
| | - Caleb E Feliciano
- University of Puerto Rico School of Medicine, Department of Neurosurgery, United States
| | | | - Veronica L Chiang
- Yale University School of Medicine, Department of Neurosurgery, United States
| | - Judith A Hess
- Yale University School of Medicine, Department of Neurosurgery, United States
| | - Samuel Sommaruga
- Yale University School of Medicine, Department of Neurosurgery, United States
| | - Brendan McShane
- University of Pennsylvania School of Medicine, Department of Neurosurgery, United States
| | - John Lee
- University of Pennsylvania School of Medicine, Department of Neurosurgery, United States
| | - Lucas T Vasas
- University of Manitoba School of Medicine, Department of Neurosurgery, Canada
| | - Anthony M Kaufmann
- University of Manitoba School of Medicine, Department of Neurosurgery, Canada
| | - Inga Grills
- Beaumont Health, Oakland University William Beaumont School of Medicine, Department of Radiation Oncology, United States
| | - Michael W McDermott
- University of California - San Francisco School of Medicine, Department of Neurosurgery, United States
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45
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Murphy ES, Parsai S, Kano H, Sheehan JP, Martinez-Alvarez R, Martinez-Moreno N, Kondziolka D, Simonova G, Liscak R, Mathieu D, Lee CC, Yang HC, Lee JY, McShane BJ, Fang F, Trifiletti DM, Sharma M, Barnett GH. Outcomes of stereotactic radiosurgery for pilocytic astrocytoma: an international multiinstitutional study. J Neurosurg 2019; 134:162-170. [PMID: 31783364 DOI: 10.3171/2019.9.jns191335] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 09/13/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The current standard initial therapy for pilocytic astrocytoma is maximal safe resection. Radiation therapy is considered for residual, recurrent, or unresectable pilocytic astrocytomas. However, the optimal radiation strategy has not yet been established. Here, the authors describe the outcomes of stereotactic radiosurgery (SRS) for pilocytic astrocytoma in a large multiinstitutional cohort. METHODS An institutional review board-approved multiinstitutional database of patients treated with Gamma Knife radiosurgery (GKRS) between 1990 and 2016 was queried. Data were gathered from 9 participating International Radiosurgery Research Foundation (IRRF) centers. Patients with a histological diagnosis of pilocytic astrocytoma treated using a single session of GKRS and with at least 6 months of follow-up were included in the analysis. RESULTS A total of 141 patients were analyzed in the study. The median patient age was 14 years (range 2-84 years) at the time of GKRS. The median follow-up was 67.3 months. Thirty-nine percent of patients underwent SRS as the initial therapy, whereas 61% underwent SRS as salvage treatment. The median tumor volume was 3.45 cm3. The tumor location was the brainstem in 30% of cases, with a nonbrainstem location in the remainder. Five- and 10-year overall survival rates at the last follow-up were 95.7% and 92.5%, respectively. Five- and 10-year progression-free survival (PFS) rates were 74.0% and 69.7%, respectively. On univariate analysis, an age < 18 years, tumor volumes < 4.5 cm3, and no prior radiotherapy or chemotherapy were identified as positive prognostic factors for improved PFS. On multivariate analysis, only prior radiotherapy was significant for worse PFS. CONCLUSIONS This represents the largest study of single-session GKRS for pilocytic astrocytoma to date. Favorable long-term PFS and overall survival were observed with GKRS. Further prospective studies should be performed to evaluate appropriate radiosurgery dosing, timing, and sequencing of treatment along with their impact on toxicity and the quality of life of patients with pilocytic astrocytoma.
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Affiliation(s)
- Erin S Murphy
- 1Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
- 13Rose-Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland, Ohio
| | - Shireen Parsai
- 1Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Hideyuki Kano
- 2Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jason P Sheehan
- 3Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Roberto Martinez-Alvarez
- 4Department of Functional Neurosurgery and Radiosurgery, Ruber International Hospital, Madrid, Spain
| | - Nuria Martinez-Moreno
- 4Department of Functional Neurosurgery and Radiosurgery, Ruber International Hospital, Madrid, Spain
| | - Douglas Kondziolka
- 5Department of Neurosurgery, New York University Langone Medical Center, New York, New York
| | - Gabriela Simonova
- 6Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Roman Liscak
- 6Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - David Mathieu
- 7Division of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Québec, Canada
| | - Cheng-Chia Lee
- 8Department of Neurosurgery, Neurologic Institute, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
| | - Huai-Che Yang
- 8Department of Neurosurgery, Neurologic Institute, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
| | - John Y Lee
- 9Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brendan J McShane
- 9Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fang Fang
- 10Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | | | - Mayur Sharma
- 12Department of Neurosurgery, University of Louisville, Kentucky; and
| | - Gene H Barnett
- 13Rose-Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland, Ohio
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46
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Kano H. Erratum. Predicting hearing outcomes before primary radiosurgery for vestibular schwannomas. J Neurosurg 2019; 133:1261. [PMID: 31628291 DOI: 10.3171/2019.9.jns182765a] [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: 11/06/2022]
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Chen CJ, Lee CC, Ding D, Tzeng SW, Kearns KN, Kano H, Atik A, Ironside N, Joshi K, Huang PP, Kondziolka D, Mathieu D, Iorio-Morin C, Grills IS, Quinn TJ, Siddiqui Z, Marvin K, Feliciano C, Faramand A, Starke RM, Barnett G, Lunsford LD, Sheehan JP. Stereotactic Radiosurgery for Unruptured Versus Ruptured Pediatric Brain Arteriovenous Malformations. Stroke 2019; 50:2745-2751. [DOI: 10.1161/strokeaha.119.026211] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
The effects of prior hemorrhage on stereotactic radiosurgery (SRS) outcomes for pediatric arteriovenous malformations (AVMs) are not well defined. The aim of this multicenter, retrospective cohort study is to compare the SRS outcomes for unruptured versus ruptured pediatric AVMs.
Methods—
The International Radiosurgery Research Foundation pediatric AVM database from 1987 to 2018 was reviewed retrospectively. Favorable outcome was defined as AVM obliteration, no post-SRS hemorrhage, and no permanently symptomatic radiation-induced changes. Associations between prior hemorrhage and outcomes were adjusted for baseline differences, inverse probability weights, and competing risks.
Results—
The study cohort comprised 153 unruptured and 386 ruptured AVMs. Favorable outcome was achieved in 48.4% and 60.4% of unruptured and ruptured AVMs, respectively (adjusted odds ratio, 1.353;
P
=0.190). Cumulative AVM obliteration probabilities were 51.2%, 59.4%, 64.2%, and 70.0% for unruptured and 61.0%, 69.3%, 74.0%, and 79.3% for ruptured AVMs at 4, 6, 8, and 10 years, respectively (subhazard ratio, 1.311;
P
=0.020). Cumulative post-SRS hemorrhage probabilities were 4.5%, 5.6%, 5.6%, and 9.8% for unruptured and 4.7%, 6.1%, 6.1%, and 10.6% for ruptured AVMs at 4, 6, 8, and 10 years, respectively (subhazard ratio, 1.086;
P
=0.825). Probabilities of AVM obliteration (adjusted subhazard ratio, 0.968;
P
=0.850) and post-SRS hemorrhage (adjusted subhazard ratio, 1.663;
P
=0.251) were comparable between the 2 cohorts after inverse probability weight adjustments. Symptomatic (15.8% versus 8.1%; adjusted odds ratio, 0.400;
P
=0.008) and permanent (9.2% versus 5.0%; adjusted odds ratio, 0.441;
P
=0.045) radiation-induced change were more common in unruptured AVMs.
Conclusions—
The overall outcomes after SRS for unruptured versus ruptured pediatric AVMs are comparable. However, symptomatic and permanent radiation-induced change occur more frequently in pediatric patients with unruptured AVMs.
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Affiliation(s)
- Ching-Jen Chen
- From the Department of Neurological Surgery, University of Virginia Health System, Charlottesville (C.-J.C., K.N.K., N.I., J.P.S.)
| | - Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taiwan (C.-C.L., S.-W.T.)
- School of Medicine, National Yang-Ming University, Taipei, Taiwan (C.-C.L.)
| | - Dale Ding
- Department of Neurosurgery, University of Louisville School of Medicine, KY (D.D., A.F., L.D.L.)
| | - Shih-Wei Tzeng
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taiwan (C.-C.L., S.-W.T.)
| | - Kathryn N. Kearns
- From the Department of Neurological Surgery, University of Virginia Health System, Charlottesville (C.-J.C., K.N.K., N.I., J.P.S.)
| | - Hideyuki Kano
- Department of Neurological Surgery, University of Pittsburgh, PA (H.K.)
| | - Ahmet Atik
- Department of Neurosurgery, Cleveland Clinic Foundation, OH (A.A., K.J., G.B.)
| | - Natasha Ironside
- From the Department of Neurological Surgery, University of Virginia Health System, Charlottesville (C.-J.C., K.N.K., N.I., J.P.S.)
| | - Krishna Joshi
- Department of Neurosurgery, Cleveland Clinic Foundation, OH (A.A., K.J., G.B.)
| | - Paul P. Huang
- Department of Neurosurgery, New York University Langone Medical Center (P.P.H., D.K.)
| | - Douglas Kondziolka
- Department of Neurosurgery, New York University Langone Medical Center (P.P.H., D.K.)
| | - David Mathieu
- Division of Neurosurgery, Centre de recherché du CHUS, University of Sherbrooke, Quebec, Canada (D.M., C.I.-M.)
| | - Christian Iorio-Morin
- Division of Neurosurgery, Centre de recherché du CHUS, University of Sherbrooke, Quebec, Canada (D.M., C.I.-M.)
| | - Inga S. Grills
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI (I.S.G., T.J.Q., Z.S., K.M.)
| | - Thomas J. Quinn
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI (I.S.G., T.J.Q., Z.S., K.M.)
| | - Zaid Siddiqui
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI (I.S.G., T.J.Q., Z.S., K.M.)
| | - Kim Marvin
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI (I.S.G., T.J.Q., Z.S., K.M.)
| | - Caleb Feliciano
- Section of Neurological Surgery, University of Puerto Rico, San Juan (C.F.)
| | - Andrew Faramand
- Department of Neurosurgery, University of Louisville School of Medicine, KY (D.D., A.F., L.D.L.)
| | | | - Gene Barnett
- Department of Neurosurgery, Cleveland Clinic Foundation, OH (A.A., K.J., G.B.)
| | - L. Dade Lunsford
- Department of Neurosurgery, University of Louisville School of Medicine, KY (D.D., A.F., L.D.L.)
| | - Jason P. Sheehan
- From the Department of Neurological Surgery, University of Virginia Health System, Charlottesville (C.-J.C., K.N.K., N.I., J.P.S.)
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Alonso CE, Bunevicius A, Trifiletti DM, Larner J, Lee CC, Pai FY, Liscak R, Kosak M, Kano H, Sisterson ND, Mathieu D, Lunsford LD, Sheehan JP. Safety and efficacy of repeat radiosurgery for acromegaly: an International Multi-Institutional Study. J Neurooncol 2019; 145:301-307. [PMID: 31541405 DOI: 10.1007/s11060-019-03296-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 09/17/2019] [Indexed: 01/18/2023]
Abstract
PURPOSE Surgical resection is the first line treatment for growth hormone (GH) secreting tumors. Stereotactic radiosurgery (SRS) is recommended for patients who do not achieve endocrine remission after resection. The purpose of this study was to evaluate safety and efficacy of repeat radiosurgery for acromegaly. METHODS Three hundred and ninety-eight patients with acromegaly treated with the Gamma Knife radiosurgery (Elekta AB, Stockholm) were identified from the International Gamma Knife Research Foundation database. Among these, 21 patients underwent repeated SRS with sufficient endocrine follow-up and 18 patients had sufficient imaging follow-up. Tumor control was defined as lack of adenoma progression on imaging. Endocrine remission was defined as a normal IGF-1 concentration while off medical therapy. RESULTS Median time from initial SRS to repeat SRS was 5.0 years. The median imaging and endocrine follow-up duration after repeat SRS was 3.4 and 3.8 years, respectively. The median initial marginal dose was 17 Gy, and the median repeat marginal dose was 23 Gy. Of the 18 patients with adequate imaging follow up, 15 (83.3%) patients had tumor control and of 21 patients with endocrine follow-up, 9 (42.9%) patients had endocrine remission at last follow-up visit. Four patients (19.0%) developed new deficits after repeat radiosurgery. Of these, 3 patients had neurologic deficits and 1 patient had endocrine deficit. CONCLUSIONS Repeat radiosurgery for persistent acromegaly offers a reasonable benefit to risk profile for this challenging patient cohort. Further studies are needed to identify patients best suited for this type of approach.
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Affiliation(s)
- Clayton E Alonso
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA, USA
| | - Adomas Bunevicius
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
| | | | - James Larner
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA, USA
| | - Cheng-Chia Lee
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Fu-Yuan Pai
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Roman Liscak
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Mikulas Kosak
- 3rd Department of Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Hideyuki Kano
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - David Mathieu
- Division of Neurosurgery, Centre de Recherche du CHUS, University of Sherbrooke, Sherbrooke, QC, Canada
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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Johnson S, Kano H, Faramand A, Pease M, Nakamura A, Hassib M, Spencer D, Sisterson N, Faraji AH, Arai Y, Monaco E, Niranjan A, Flickinger JC, Lunsford LD. Long term results of primary radiosurgery for vestibular schwannomas. J Neurooncol 2019; 145:247-255. [PMID: 31535315 DOI: 10.1007/s11060-019-03290-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 05/06/2019] [Accepted: 09/06/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Stereotactic radiosurgery (SRS) has become a primary option for management for both newly diagnosed vestibular schwannomas (VS), as well as VS that enlarge after initial observation. METHODS A retrospective review of our prospectively maintained data base found 871 patients who underwent Gamma knife® SRS as their initial (primary) management between 1987 and 2008. Follow-up ranged from 1-25 years (median = 5.2 years) Median tumor volume was 0.9 cc (0.02-36) and median margin dose was 13 Gy (12-25). RESULTS Progression free survival (PFS) after SRS was 97% at 3 years, 95% at 5 years, and 94% at 10 years. Freedom from delayed surgical resection was found in 98.7% of patients. Smaller tumor volume was significantly associated with improved PFS. There were 326 patients with serviceable hearing (Gardner-Robertson 1 or 2) at the time of SRS with audiological follow-up of ≥ 1 year. Serviceable hearing preservation rates after SRS were 89.8% at 1 year, 76.9% at 3 years, 68.4% at 5 years, 62.5% at 7 years, and 51.4% at 10 years. Factors associated with improved serviceable hearing preservation included younger age, Gardner-Robertson grade 1 at SRS, and absence of subjective complaints of dysequilibrium or vertigo (vestibulopathy). Fifty-one patients (5.8%) developed trigeminal neuropathy. Fourteen (1.6%) developed a transient House-Brackmann grade 2 or 3 facial neuropathy. CONCLUSIONS In this report with extended follow-up, primary SRS achieved tumor growth control in 94% of patients. Optimization of long- term cranial nerve outcomes remains an important achievement of this management strategy for VS.
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Affiliation(s)
- Stephen Johnson
- Departments of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA.,The Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Hideyuki Kano
- Departments of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA. .,The Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA. .,Neurological Surgery, University of Pittsburgh, UPMC Presbyterian, Suite B-400, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
| | - Andrew Faramand
- Departments of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA.,The Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Matthew Pease
- Departments of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA.,The Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Aya Nakamura
- Departments of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA.,The Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Mohab Hassib
- Departments of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA.,The Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - David Spencer
- Departments of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA.,The Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Nathaniel Sisterson
- Departments of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA.,The Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Amir H Faraji
- Departments of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA.,The Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Yoshio Arai
- Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA.,The Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Edward Monaco
- Departments of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA.,The Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Ajay Niranjan
- Departments of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA.,The Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - John C Flickinger
- Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA.,The Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - L Dade Lunsford
- Departments of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA.,The Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
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Johnson S, Kano H, Faramand A, Niranjan A, Flickinger JC, Lunsford LD. Predicting hearing outcomes before primary radiosurgery for vestibular schwannomas. J Neurosurg 2019; 133:1235-1241. [PMID: 31491764 DOI: 10.3171/2019.5.jns182765] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 10/23/2018] [Accepted: 05/30/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Optimizing outcomes in the management of patients with vestibular schwannomas (VSs) requires consideration of the patient's goals. Earlier recognition of VS by imaging has led to an evolution in management. Stereotactic radiosurgery (SRS) has emerged as a frequently used strategy designed to reduce management risks, obtain long-term tumor control, and preserve current neurological function. The authors analyzed features that impact hearing preservation rates in patients with serviceable hearing prior to SRS. METHODS The study included 307 patients who had serviceable hearing (Gardner-Robertson hearing scale [GR] grade 1 or 2, speech discrimination score ≥ 50%, pure tone average ≤ 50 dB) at the time of SRS. The authors evaluated parameters that included age, tumor volume, hearing status, disequilibrium, tinnitus, Koos class, sex, and tumor margin dose. The Pittsburgh Hearing Prediction Score (PHPS) was evaluated as a method to predict long-term hearing outcomes in these cases. RESULTS At a median of 7.6 years after SRS (range 1-23 years), tumor control was achieved in 95% of patients. The overall serviceable hearing preservation rate was 77.8% at 3 years, 68.8% at 5 years, and 51.8% at 10 years. The PHPS assigns a total of 5 points based on patient age (1 point if < 45 years, 2 points if 45-59 years, and 3 points if ≥ 60 years), tumor volume (0 points if < 1.2 cm3, 1 point if ≥ 1.2 cm3), and GR grade (0 points if grade 1 hearing, 1 point if grade 2 hearing) The serviceable hearing preservation rate was 92.3% at 10 years in patients whose score total was 1. In contrast, none of the patients whose PHPS was 5 maintained serviceable hearing at 10 years (p < 0.001). CONCLUSIONS SRS resulted in a high rate of long-term tumor control and cranial nerve preservation. The PHPS helped to predict long-term hearing preservation rates in patients who underwent SRS when they still had serviceable hearing. The best long-term hearing preservation rates were found in younger patients with smaller tumor volumes.
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Affiliation(s)
- Stephen Johnson
- Departments of1Neurological Surgery and
- 3Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Hideyuki Kano
- Departments of1Neurological Surgery and
- 3Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Andrew Faramand
- Departments of1Neurological Surgery and
- 3Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ajay Niranjan
- Departments of1Neurological Surgery and
- 3Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - John C Flickinger
- 2Radiation Oncology, and
- 3Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - L Dade Lunsford
- Departments of1Neurological Surgery and
- 3Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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