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Tosefsky K, Rebchuk AD, Wang JZ, Ellenbogen Y, Drexler R, Ricklefs FL, Sauvigny T, Schüller U, Cutler CB, Lucke-Wold B, Mehkri Y, Lama S, Sutherland GR, Karsy M, Hoh BL, Westphal M, Zadeh G, Yip S, Makarenko S. Corrigendum: Grade 3 Meningioma Survival and Recurrence Outcomes in an International Multicenter Cohort. J Neurol Surg B Skull Base 2024; 85:e1. [PMID: 38495214 PMCID: PMC10940112 DOI: 10.1055/s-0044-1782669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Abstract
[This corrects the article DOI: 10.1055/s-0044-1779888.].
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Affiliation(s)
- Kira Tosefsky
- MD Undergraduate Program, University of British Columbia
| | | | - Justin Z Wang
- Division of Neurosurgery, University of Toronto, Ontario, Canada
| | - Yosef Ellenbogen
- Division of Neurosurgery, University of Toronto, Ontario, Canada
| | | | | | | | - Ulrich Schüller
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Germany
- Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf
- Research Institute Children's Cancer Center Hamburg, Germany
| | | | | | - Yusuf Mehkri
- Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Sanju Lama
- Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary
| | - Garnette R Sutherland
- Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary
- Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - Michael Karsy
- Department of Neurosurgery, Global Neuroscience Institute, Chester, Pennsylvania; and
| | - Brian L Hoh
- Department of Neurosurgery, University of Florida, Gainesville, Florida
| | | | - Gelareh Zadeh
- Division of Neurosurgery, University of Toronto, Ontario, Canada
| | - Stephen Yip
- Department of Pathology & Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Serge Makarenko
- Division of Neurosurgery, University of British Columbia, Vancouver
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Tosefsky K, Rebchuk AD, Wang JZ, Ellenbogen Y, Drexler R, Ricklefs FL, Sauvigny T, Schüller U, Cutler CB, Lucke-Wold B, Mehkri Y, Lama S, Sutherland GR, Karsy M, Hoh BL, Westphal M, Zadeh G, Yip S, Makarenko S. Grade 3 meningioma survival and recurrence outcomes in an international multicenter cohort. J Neurosurg 2024; 140:393-403. [PMID: 37877968 DOI: 10.3171/2023.6.jns23465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/08/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVE Grade 3 meningioma represents a rare meningioma subtype, for which limited natural history data are available. The objective of this study was to identify demographics and pathologic characteristics, clinical and functional status outcomes, and prognostic factors in an international cohort of grade 3 meningioma patients. METHODS Clinical and histopathological data were collected for patients treated at 7 sites across North America and Europe between 1991 and 2022. RESULTS A total of 103 patients (54% female, median age 65 [IQR 52, 72] years) were included. Sixty-seven (65%) patients had de novo grade 3 lesions, whereas 29 (28%) had malignant transformations of lower-grade meningiomas. All patients underwent initial resection of their tumor. Patients were followed for a median of 46 (IQR 24, 108) months, during which time there were 65 (73%) recurrences and 50 (49%) deaths. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 66% (95% CI 56%-77%) and 37% (95% CI 28%-48%), respectively. Age ≥ 65 years and male sex were independent predictors of worse OS and PFS in multivariate regression analysis, while postoperative radiotherapy was independently associated with improved OS. Karnofsky Performance Status (KPS) remained stable relative to baseline over 5 years postdiagnosis among participants who were alive at the end of the follow-up period. CONCLUSIONS This large multicenter study provides insight into the longitudinal outcomes of grade 3 meningioma, with respect to recurrence, survival, and functional status. This study affirms the survival benefit conferred by radiotherapy in this population and suggests good functional status outcomes for patients surviving to 5 years postoperatively.
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Affiliation(s)
- Kira Tosefsky
- 1MD Undergraduate Program, University of British Columbia
| | | | - Justin Z Wang
- 3Division of Neurosurgery, University of Toronto, Ontario, Canada
| | - Yosef Ellenbogen
- 3Division of Neurosurgery, University of Toronto, Ontario, Canada
| | | | | | | | - Ulrich Schüller
- 5Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Germany
- 6Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf
- 7Research Institute Children's Cancer Center Hamburg, Germany
| | | | - Brandon Lucke-Wold
- 9Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Yusuf Mehkri
- 9Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Sanju Lama
- 10Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary
| | - Garnette R Sutherland
- 10Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary
- 11Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - Michael Karsy
- 12Department of Neurosurgery, Global Neuroscience Institute, Chester, Pennsylvania; and
| | - Brian L Hoh
- 9Department of Neurosurgery, University of Florida, Gainesville, Florida
| | | | - Gelareh Zadeh
- 3Division of Neurosurgery, University of Toronto, Ontario, Canada
| | - Stephen Yip
- 13Department of Pathology & Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Serge Makarenko
- 2Division of Neurosurgery, University of British Columbia, Vancouver
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Jung Y, Ellenbogen Y, Pirouzmand F. Delayed neurological improvement in a patient with Duret hemorrhage secondary to an acute subdural hematoma: illustrative case. J Neurosurg Case Lessons 2023; 6:CASE23554. [PMID: 38109732 PMCID: PMC10732320 DOI: 10.3171/case23554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 10/24/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Duret hemorrhage is a rare phenomenon wherein rapid transtentorial herniation results in brainstem injury and hemorrhage. It is usually regarded as a poor prognostic factor representing irreversible and often catastrophic brain injury. The authors report an unusual case of Duret hemorrhage with spontaneous delayed neurological recovery postoperatively after surgical treatment of an acute subdural hematoma (SDH). OBSERVATIONS The authors present the case of a 65-year-old male who initially presented to the hospital with a large acute left-sided SDH causing 1.3 cm of midline shift. He was taken urgently for a craniotomy, with no significant intraoperative swelling or visible contusions. Postoperative imaging revealed an unexpected pontine hyperdensity concerning for a Duret hemorrhage. He initially had no neurological improvement; however, at 3 weeks postoperatively, he gradually recovered and was able to follow commands and was extubated. At 10 weeks after surgery, his Glasgow Coma Scale score improved to 15, with mild residual left hemiparesis. LESSONS This case challenges a classic dogma that Duret hemorrhage carries a universally poor outcome. In select cases, patients can make meaningful recoveries in a delayed fashion. The lack of intraoperative contusions and swelling may have contributed to this patient's recovery.
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Affiliation(s)
- Youngkyung Jung
- Department of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; and
| | - Yosef Ellenbogen
- Department of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; and
| | - Farhad Pirouzmand
- Department of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; and
- Department of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Ellenbogen Y, Hendriks EJ, Karadimas S, O'Reilly S, Itsekzon Hayosh Z, Alshahrani R, Agid R, Schaafsma J, Krings T, Nicholson P. Use of the neuroform atlas for stenting of intracranial atherosclerotic disease: Clinical and angiographic outcomes. Interv Neuroradiol 2023:15910199231195134. [PMID: 37817560 DOI: 10.1177/15910199231195134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Intracranial atherosclerotic disease (ICAD) is a potential cause of ischemic stroke. Treatment of ICAD can include intracranial stenting. There are specifically designed stents for this use-case; however, less is known about the off-label use of the Neuroform Atlas stent. In this study, we describe the outcomes of the Neuroform Atlas stent for treatment of ICAD. METHODS Adult patients with symptomatic ICAD failing best medical treatment undergoing elective intracranial stenting using the Neuroform Atlas stent between November 2018 and March 2021 were included. Patient demographics, procedure-related details and clinical and imaging outcomes were analyzed. RESULTS Eighteen patients met the inclusion criteria, with a mean follow-up duration of 9.6 ± 6.8 (standard deviation) months. There were two procedure-related mortalities (one massive intracranial hemorrhage and one groin site complication with sepsis). Fifteen patients were alive at the 6-month follow-up, all with satisfactory stent patency on follow-up imaging without any new ischemic events. Modified Rankin Scale at latest follow-up was 1.9 (interquartile range 5). CONCLUSION In this single-center consecutive series, intracranial stenting with the Neuroform Atlas stent was a safe and effective treatment for symptomatic ICAD patients failing best medical management.
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Affiliation(s)
- Yosef Ellenbogen
- Division of Neurosurgery, Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Eef J Hendriks
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Spyros Karadimas
- Division of Neurosurgery, Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Sean O'Reilly
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Zeev Itsekzon Hayosh
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Rabab Alshahrani
- Division of Neurosurgery, Department of Surgery, University Health Network, Toronto, Ontario, Canada
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Ronit Agid
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Joanna Schaafsma
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Timo Krings
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Patrick Nicholson
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
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Yang K, Ellenbogen Y, Martyniuk A, Sourour M, Takroni R, Somji M, Gardiner E, Hui K, Odedra D, Larrazabal R, Algird A, Kachur E, Reddy K, Murty N, Farrokhyar F, Singh SK. Reoperation in adult patients with recurrent glioblastoma: A matched cohort analysis. Neurooncol Adv 2022; 4:vdac115. [PMID: 35990706 PMCID: PMC9389419 DOI: 10.1093/noajnl/vdac115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Despite maximal safe cytoreductive surgery and postoperative adjuvant therapies, glioblastoma (GBM) inevitably recurs and leads to deterioration of neurological status and eventual death. There is no consensus regarding the benefit of repeat resection for enhancing survival or quality of life in patients with recurrent GBM. We aimed to examine if reoperation for GBM recurrence incurs a survival benefit as well as examine its complication profile. Methods We performed a single-center retrospective chart review on all adult patients who underwent resection of supratentorial GBM between January 1, 2008 and December 1, 2013 at our center. Patients with repeat resection were manually matched for age, sex, tumor location, and Karnofsky Performance Status (KPS) with patients who underwent single resection to compare overall survival (OS), and postoperative morbidity. Results Of 237 patients operated with GBM, 204 underwent single resection and 33 were selected for repeat surgical resections. In a matched analysis there was no difference in the OS between groups (17.8 ± 17.6 months vs 17 ± 13.5 months, P = .221). In addition, repeat surgical resection had a higher rate of postoperative neurological complications compared to the initial surgery. Conclusions When compared with matched patients who underwent a single surgical resection, patients undergoing repeat surgical resection did not show significant increase in OS and may have incurred more neurological complications related to the repeat resection. Further studies are required to assess which patients would benefit from repeat surgical resection and optimize timing of the repeat resection in selected patients.
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Affiliation(s)
- Kaiyun Yang
- Division of Neurosurgery, McMaster University , Ontario , Canada
- Division of Neurosurgery, University of Toronto , Ontario , Canada
| | - Yosef Ellenbogen
- Division of Neurosurgery, McMaster University , Ontario , Canada
| | - Amanda Martyniuk
- Division of Neurosurgery, McMaster University , Ontario , Canada
| | - Michel Sourour
- Division of Neurosurgery, McMaster University , Ontario , Canada
- Division of Neurosurgery, University of Manitoba , Manitoba , Canada
| | - Radwan Takroni
- Division of Neurosurgery, McMaster University , Ontario , Canada
| | - Mohamed Somji
- Division of Neurosurgery, McMaster University , Ontario , Canada
| | - Emily Gardiner
- Division of General Surgery, University of Manitoba , Manitoba , Canada
| | - Katrina Hui
- Department of Psychiatry, University of Toronto , Ontario , Canada
| | - Devang Odedra
- Department of Radiology, McMaster University , Ontario , Canada
| | | | - Almunder Algird
- Division of Neurosurgery, McMaster University , Ontario , Canada
| | - Edward Kachur
- Division of Neurosurgery, McMaster University , Ontario , Canada
| | - Kesava Reddy
- Division of Neurosurgery, McMaster University , Ontario , Canada
| | - Naresh Murty
- Division of Neurosurgery, McMaster University , Ontario , Canada
| | - Forough Farrokhyar
- Department of Surgery, Department of Health, Evidence, Impact, McMaster University , Hamilton, Ontario , Canada
| | - Sheila K Singh
- Division of Neurosurgery, McMaster University , Ontario , Canada
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Taslimi S, Brar K, Ellenbogen Y, Deng J, Hou W, Moraes FY, Glantz M, Zacharia BE, Tan A, Ahluwalia MS, Khasraw M, Zadeh G, Mansouri A. Comparative Efficacy of Systemic Agents for Brain Metastases From Non-Small-Cell Lung Cancer With an EGFR Mutation/ALK Rearrangement: A Systematic Review and Network Meta-Analysis. Front Oncol 2021; 11:739765. [PMID: 34950579 PMCID: PMC8691653 DOI: 10.3389/fonc.2021.739765] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 11/15/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Brain metastases (BM) from non-small-cell lung cancer (NSCLC) are frequent and carry significant morbidity, and current management options include varying local and systemic therapies. Here, we performed a systematic review and network meta-analysis to determine the ideal treatment regimen for NSCLC BMs with targetable EGFR-mutations/ALK-rearrangements. METHODS We searched MEDLINE, EMBASE, Web of Science, ClinicalTrials.gov, CENTRAL and references of key studies for randomized controlled trials (RCTs) published from inception until June 2020. Comparative RCTs including ≥10 patients were selected. We used a frequentist random-effects model for network meta-analysis (NMA) and assessed the certainty of evidence using the GRADE approach. Our primary outcome of interest was intracranial progression-free survival (iPFS). RESULTS We included 24 studies representing 19 trials with 1623 total patients. Targeted tyrosine kinase inhibitors (TKIs) significantly improved iPFS, with second-and third- generation TKIs showing the greatest benefit (HR=0.25, 95%CI 0.15-0.40). Overall PFS was also improved compared to conventional chemotherapy (HR=0.47, 95%CI 0.36-0.61). In EGFR-mutant patients, osimertinib showed the greatest benefit in iPFS (HR=0.32, 95%CI 0.15-0.69) compared to conventional chemotherapy, while gefitinib + chemotherapy showed the greatest overall PFS benefit (HR=0.26, 95%CI 0.10-0.70). All ALKi improved overall PFS compared to conventional chemotherapy, with alectinib having the greatest benefit (HR=0.13, 95%CI 0.07-0.24). CONCLUSIONS In patients with NSCLC BMs and EGFR/ALK mutations, targeted TKIs improve intracranial and overall PFS compared to conventional modalities such as chemotherapy, with greater efficacy seen using newer generations of TKIs. This data is important for treatment selection and patient counseling, and highlights areas for future RCT research. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=179060.
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Affiliation(s)
- Shervin Taslimi
- Division of Neurosurgery, Department of Surgery, Queen’s University, Kingston, ON, Canada
| | - Karanbir Brar
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Yosef Ellenbogen
- Division of Neurosurgery, Department of Surgery, Queen’s University, Kingston, ON, Canada
| | - Jiawen Deng
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Winston Hou
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Fabio Y. Moraes
- Department of Oncology, Queen’s University, Kingston, ON, Canada
| | - Michael Glantz
- Department of Neurosurgery, Penn State Health, Hershey, PA, United States
- Penn State Cancer Institute, Hershey, PA, United States
| | - Brad E. Zacharia
- Department of Neurosurgery, Penn State Health, Hershey, PA, United States
- Penn State Cancer Institute, Hershey, PA, United States
| | - Aaron Tan
- Division of Medical Oncology, National Cancer Center Singapore, Singapore, Singapore
| | - Manmeet S. Ahluwalia
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States
- Department of Hematology/Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Mustafa Khasraw
- The Preston Robert Tisch Brain Tumor Center, Duke University, Durham, NC, United States
| | - Gelareh Zadeh
- Division of Neurosurgery, Department of Surgery, Queen’s University, Kingston, ON, Canada
| | - Alireza Mansouri
- Department of Neurosurgery, Penn State Health, Hershey, PA, United States
- Penn State Cancer Institute, Hershey, PA, United States
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Ellenbogen Y, Al-Khotani A, Tang-Wai D, Fasano A, Agid R, Hodaie M. Bing-Neel Syndrome: A Rare Mimic of Secondary Normal Pressure Hydrocephalus. Neurology 2021; 97:1033-1034. [PMID: 34635562 DOI: 10.1212/wnl.0000000000012917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Yosef Ellenbogen
- From the Divisions of Neurosurgery (Y.E., A.A.-K., M.H.) and Neurology (D.T.-W., A.F.), University of Toronto; Krembil Brain Institute (D.T.-W., A.F., M.H.); Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic (A.F.) and Division of Neuroradiology, Joint Department of Medical Imaging (R.A.), Toronto Western Hospital, UHN, Toronto, Canada
| | - Afnan Al-Khotani
- From the Divisions of Neurosurgery (Y.E., A.A.-K., M.H.) and Neurology (D.T.-W., A.F.), University of Toronto; Krembil Brain Institute (D.T.-W., A.F., M.H.); Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic (A.F.) and Division of Neuroradiology, Joint Department of Medical Imaging (R.A.), Toronto Western Hospital, UHN, Toronto, Canada
| | - David Tang-Wai
- From the Divisions of Neurosurgery (Y.E., A.A.-K., M.H.) and Neurology (D.T.-W., A.F.), University of Toronto; Krembil Brain Institute (D.T.-W., A.F., M.H.); Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic (A.F.) and Division of Neuroradiology, Joint Department of Medical Imaging (R.A.), Toronto Western Hospital, UHN, Toronto, Canada
| | - Alfonso Fasano
- From the Divisions of Neurosurgery (Y.E., A.A.-K., M.H.) and Neurology (D.T.-W., A.F.), University of Toronto; Krembil Brain Institute (D.T.-W., A.F., M.H.); Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic (A.F.) and Division of Neuroradiology, Joint Department of Medical Imaging (R.A.), Toronto Western Hospital, UHN, Toronto, Canada
| | - Ronit Agid
- From the Divisions of Neurosurgery (Y.E., A.A.-K., M.H.) and Neurology (D.T.-W., A.F.), University of Toronto; Krembil Brain Institute (D.T.-W., A.F., M.H.); Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic (A.F.) and Division of Neuroradiology, Joint Department of Medical Imaging (R.A.), Toronto Western Hospital, UHN, Toronto, Canada
| | - Mojgan Hodaie
- From the Divisions of Neurosurgery (Y.E., A.A.-K., M.H.) and Neurology (D.T.-W., A.F.), University of Toronto; Krembil Brain Institute (D.T.-W., A.F., M.H.); Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic (A.F.) and Division of Neuroradiology, Joint Department of Medical Imaging (R.A.), Toronto Western Hospital, UHN, Toronto, Canada.
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Brar K, Taslimi S, Ellenbogen Y, Deng J, Hou W, Moraes FY, Glantz M, Zacharia BE, Tan A, Ahluwalia MS, Khasraw M, Zadeh G, Mansouri A. Comparative Efficacy of Treatments for Brain Metastases from Non-Small Cell Lung Cancer without an EGFR-Mutation/ALK-Rearrangement: A Systematic Review and Network Meta-Analysis. World Neurosurg 2021; 158:e87-e102. [PMID: 34688937 DOI: 10.1016/j.wneu.2021.10.113] [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: 08/21/2021] [Revised: 10/13/2021] [Accepted: 10/13/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION As many as 30% of patients with non-small cell lung cancer (NSCLC) will develop brain metastases (BMs) over the course of their illness. Here, we quantitatively compare the efficacy of the various emerging regimens for NSCLC BMs without a definitive targetable epidermal growth factor receptor mutation/ALK rearrangement. METHODS We searched MEDLINE, EMBASE, Web of Science, ClinicalTrials.gov, CENTRAL, and references of key studies for randomized controlled trials (RCTs) published from inception until June 2020. Comparative RCTs that included ≥10 patients were included. We used a frequentist fixed or random-effects model for network meta-analysis. The outcomes of interest included intracranial progression-free survival (iPFS), overall survival (OS), and overall progression-free survival. RESULTS In total, 18 studies representing 17 trials (n = 2726 patients) were identified. Immune checkpoint inhibitor regimens showed significant improvement in OS compared with chemotherapy alone, including pembrolizumab and chemotherapy (6 studies, hazard ratio [HR] 0.36, 95% confidence interval [CI] 0.21-0.62), atezolizumab alone (HR 0.54, 95% CI 0.33-0.89), and nivolumab and ipilimumab (HR 0.64, 95% CI 0.42-0.97). An improvement in overall PFS was seen with use of pembrolizumab and chemotherapy compared with chemotherapy alone (3 studies, HR 0.42, 95% CI 0.26-0.68). Studies evaluating checkpoint inhibitors did not report iPFS data, and we did not find improvement in iPFS or OS with the addition of any chemotherapy regimen to whole-brain radiation therapy. CONCLUSIONS In this network meta-analysis, we demonstrate the promising survival benefit with use of checkpoint inhibitor-based regimens in NSCLC BMs without a targetable epidermal growth factor receptor mutation/ALK rearrangement. Moving forward, large-scale BM-focused RCTs are necessary to establish the iPFS benefit of immune checkpoint inhibitor-based immunotherapy in this patient population.
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Affiliation(s)
- Karanbir Brar
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shervin Taslimi
- Division of Neurosurgery, Department of Surgery, Queen's University, Kingston, Ontario, Canada
| | - Yosef Ellenbogen
- Division of Neurosurgery, University Health Network, Toronto, Ontario, Canada
| | - Jiawen Deng
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Winston Hou
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Fabio Y Moraes
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - Michael Glantz
- Department of Neurosurgery, Penn State Health, Hershey, Pennsylvania, USA; Penn State Cancer Institute, Hershey, Pennsylvania, USA
| | - Brad E Zacharia
- Department of Neurosurgery, Penn State Health, Hershey, Pennsylvania, USA; Penn State Cancer Institute, Hershey, Pennsylvania, USA
| | - Aaron Tan
- Division of Medical Oncology, National Cancer Center Singapore, Singapore
| | - Manmeet S Ahluwalia
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA; Department of Hematology/Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mustafa Khasraw
- The Preston Robert Tisch Brain Tumor Center, Duke University, Durham, North Carolina, USA
| | - Gelareh Zadeh
- Division of Neurosurgery, University Health Network, Toronto, Ontario, Canada
| | - Alireza Mansouri
- Department of Neurosurgery, Penn State Health, Hershey, Pennsylvania, USA; Penn State Cancer Institute, Hershey, Pennsylvania, USA.
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Aljoghaiman M, Ellenbogen Y, Takroni R, Yang K, Farrokhyar F, Reddy K. Safety of Early Mobilization in Patients With Intraoperative Cerebrospinal Fluid Leak in Minimally Invasive Spine Surgery: A Case Series. Oper Neurosurg (Hagerstown) 2021; 21:1-5. [PMID: 33609122 DOI: 10.1093/ons/opab041] [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: 09/03/2020] [Accepted: 01/03/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Cerebrospinal fluid (CSF) leak is a common complication in spine surgery. Repairing durotomy is more difficult in the setting of minimally invasive spine surgery (MISS). Efficacy of postoperative bed rest in case of dural tear in MISS is not clear. OBJECTIVE To assess the safety and efficacy of our protocol of dura closure without changing access, early mobilization, and discharge in cases of intraoperative CSF leak in MISS. METHODS A retrospective review from 2006 to 2018 of patients who underwent MISS for degenerative and neoplastic diseases with documented accidental or intentional durotomy was conducted. The primary outcome of interest was readmission rate for repair of persistent CSF leak. Secondary outcomes captured included development of pseudomeningocele, positional headache, and subdural hematoma. RESULTS A total of 80 patients were identified out of 527 patients. Of these, intentional durotomy was performed in 28 patients and unintentional durotomy occurred in 52 patients. Mean follow-up period was 80.6 mo. Most of the patients were discharged on postoperative day 0 (within 4 h of surgery) without activity restrictions. A total of 2 (2.5%) patients required readmission and dural repair for continuous CSF leak and 3 patients (3.75%) developed pseudomeningocele. No lumbar drain insertion, meningitis, or subdural hematoma was reported. CONCLUSION Early mobilization and discharge in cases of intraoperative CSF leak in MISS appear to be safe and not associated with higher rate of complications than that of reported literature.
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Affiliation(s)
- Majid Aljoghaiman
- Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Canada.,Division of Neurosurgery, Department of Surgery, King Faisal University, Alahsa, Saudi Arabia
| | - Yosef Ellenbogen
- Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Canada
| | - Radwan Takroni
- Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Canada
| | - Kaiyun Yang
- Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Canada
| | - Forough Farrokhyar
- Department of Surgery, Department of Health, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Kesava Reddy
- Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Canada
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10
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Bruton K, Spill P, Vohra S, Baribeau O, Manzoor S, Gadkar S, Davidson M, Walker TD, Koenig JFE, Ellenbogen Y, Florescu A, Wen J, Chu DK, Waserman S, Jiménez-Saiz R, Epelman S, Robbins C, Jordana M. Interrupting reactivation of immunologic memory diverts the allergic response and prevents anaphylaxis. J Allergy Clin Immunol 2021; 147:1381-1392. [PMID: 33338539 DOI: 10.1016/j.jaci.2020.11.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 05/01/2020] [Revised: 10/02/2020] [Accepted: 11/06/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND IgE production against innocuous food antigens can result in anaphylaxis, a severe life-threatening consequence of allergic reactions. The maintenance of IgE immunity is primarily facilitated by IgG+ memory B cells, as IgE+ memory B cells and IgE+ plasma cells are extremely scarce and short-lived, respectively. OBJECTIVE Our aim was to investigate the critical requirements for an IgE recall response in peanut allergy. METHODS We used a novel human PBMC culture platform, a mouse model of peanut allergy, and various experimental readouts to assess the IgE recall response in the presence and absence of IL-4Rα blockade. RESULTS In human PBMCs, we have demonstrated that blockade of IL-4/IL-13 signaling aborted IgE production after activation of a recall response and skewed the cytokine response away from a dominant type 2 signature. TH2A cells, identified by single-cell RNA sequencing, expanded with peanut stimulation and maintained their pathogenic phenotype in spite of IL-4Rα blockade. In mice with allergy, anti-IL-4Rα provided long-lasting suppression of the IgE recall response beyond antibody treatment and fully protected against anaphylaxis. CONCLUSION The findings reported here advance our understanding of events mediating the regeneration of IgE in food allergy.
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Affiliation(s)
- Kelly Bruton
- McMaster Immunology Research Centre, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Paul Spill
- McMaster Immunology Research Centre, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Owen Baribeau
- McMaster Immunology Research Centre, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Saba Manzoor
- McMaster Immunology Research Centre, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Siyon Gadkar
- McMaster Immunology Research Centre, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Malcolm Davidson
- McMaster Immunology Research Centre, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Tina D Walker
- McMaster Immunology Research Centre, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Joshua F E Koenig
- McMaster Immunology Research Centre, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Yosef Ellenbogen
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Alexandra Florescu
- McMaster Immunology Research Centre, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jianping Wen
- McMaster Immunology Research Centre, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Derek K Chu
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Susan Waserman
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Rodrigo Jiménez-Saiz
- McMaster Immunology Research Centre, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada; Centro Nacional de Biotecnología-CSIC, Department of Immunology and Oncology, Madrid, Spain
| | | | | | - Manel Jordana
- McMaster Immunology Research Centre, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
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11
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Ellenbogen Y, Power RG, Martyniuk A, Engels PT, Sharma SV, Kasper EM. Pharmacoprophylaxis for Venous Thromboembolism in Spinal Surgery: A Systematic Review and Meta-analysis. World Neurosurg 2021; 150:e144-e154. [PMID: 33684581 DOI: 10.1016/j.wneu.2021.02.120] [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: 09/28/2020] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Venous thromboembolism (VTE) is a significant contributor to postoperative morbidity and mortality. Prophylactic regimens for VTE involve mechanical prophylaxis and pharmacoprophylaxis. This systematic review and meta-analysis aimed to determine the efficacy and safety of pharmacoprophylaxis in comparison with any nonpharmacoprophylaxis regimen for the prevention of postoperative VTE in patients undergoing spinal surgery. METHODS MEDLINE, Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and ICRCTN were searched for comparative studies including both pharmacoprophylaxis and nonpharmacoprophylaxis post spinal surgery. The primary outcome was the incidence of VTE within the postoperative hospitalized period. Secondary outcomes included the incidence of spinal epidural hematoma, significant bleeding events, and other adverse events associated with VTE. The data was pooled using random-effects models of meta-analysis and relative risk (RR) was calculated. RESULTS Four retrospective and 3 randomized controlled trials representing a total of 8373 patients were included. Overall, there was a significant decrease in postoperative deep venous thrombosis with pharmacoprophylaxis versus nonpharmacoprophylaxis (RR 0.42, 95% confidence interval 0.21-0.86, P = 0.02, I2 = 0%); however, there were no significant differences between the groups in the incidences of VTE (RR 0.31, 95% confidence interval 0.12-0.81, P = 0.02, I2 = 0%). The incidences of spinal epidural hematoma and significant bleeding events were rare and comparable in both groups. CONCLUSIONS This systematic review and meta-analysis found a potential benefit with pharmacoprophylaxis post spinal surgery in the prevention of deep venous thrombosis. However, there is a need for future randomized controlled trials to investigate the efficacy and safety of pharmacoprophylaxis in spinal surgery across various spinal procedures.
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Affiliation(s)
- Yosef Ellenbogen
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Robert G Power
- Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Amanda Martyniuk
- Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Paul T Engels
- Department of Critical Care, McMaster University, Hamilton, Ontario, Canada; Department of Surgery, Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Sunjay V Sharma
- Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada; Department of Critical Care, McMaster University, Hamilton, Ontario, Canada
| | - Ekkehard M Kasper
- Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada.
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12
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Ellenbogen Y, Yang K, Ajani O. Transition of Care for Children with High-Grade Central Nervous System Tumors. Journal of Pediatric Neurology 2020. [DOI: 10.1055/s-0040-1716909] [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: 10/23/2022]
Abstract
AbstractThe increase in survival rates of children with high-grade central nervous system tumors has highlighted the necessity for and challenges associated with transition of care as these children grow into adult life. Late recurrence and treatment effects are some of the conditions that require care after transition. Several models of transition have been proposed in the literature. An effective transition will not only ensure adequate continuity of care but will also include assessment of effectiveness of the transition by health care personnel and the patient/patient's family themselves.
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Affiliation(s)
- Yosef Ellenbogen
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kaiyun Yang
- Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Olufemi Ajani
- Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- McMaster University Medical Center and Children's Hospital, Hamilton, Ontario, Canada
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13
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Duda T, Sharma A, Ellenbogen Y, Martyniuk A, Kasper E, Engels PT, Sharma S. Outcomes of civilian pediatric craniocerebral gunshot wounds: A systematic review. J Trauma Acute Care Surg 2020; 89:1239-1247. [PMID: 32756261 DOI: 10.1097/ta.0000000000002900] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Pediatric craniocerebral gunshot injuries (CGIs) occur both in the context of accidental and intentional trauma. The incidence and physiology of pediatric CGIs merit reexamination of prognostic factors and treatment priorities. This study characterizes the current understanding of mortality and prognostic factors in this patient population. METHODS A systematic search was conducted. Selection criteria included all studies published since 2000, which described civilian isolated CGIs in pediatric patients. Data were analyzed qualitatively and quantitatively to identify factors prognostic for the primary outcome of mortality. Secondary outcomes included functional outcome status, requirement for surgery, and injury complications. Study quality was assessed with the Newcastle-Ottawa Scale. This study was registered with PROSPERO (CRD42019134231). RESULTS Initial search revealed 349 unique studies. Forty underwent full text screening, and eight studies were included in the final synthesis. The overall mortality rate was 44.8%. Most CGIs occurred in older teenagers. Aggressive surgical treatment was recommended by one author, while remaining studies emphasized clinical judgment. Reported prognostic factors include initial Glasgow Coma Scale, pupil reactivity, involvement of multiple lobes or deep nuclei, and bihemispheric injuries. Reported complications from CGIs included seizure, meningitis, abscess, cerebrospinal fluid leak, bullet migration, focal neurological deficits, endocrine abnormalities, cognitive deficits, and neuropsychological deficits. The Glasgow Outcome Scale was the predominant measure of function and demonstrated a moderate recovery in 17.4% and a good recovery in 27.3% of patients. CONCLUSION This systematic review analyzed the existing evidence for prognostic factors in the context of pediatric CGIs. Significant long-term clinical improvement is possible with interventions including urgent surgical therapy. Fixed bilateral pupils and low initial Glasgow Coma Scale correlate with mortality but do not predict all patient outcomes. Patients younger than 15 years are underreported and may have differences in outcome. The literature on pediatric CGIs is limited and requires further characterization. LEVEL OF EVIDENCE Systematic Review, level IV.
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Affiliation(s)
- Taylor Duda
- From the Division of Neurosurgery, McMaster University, Ontario, Canada
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14
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Brar K, Ellenbogen Y, Sadeghirad B, Deng J, Hou W, Wang X, Taslimi S, Mansouri A. 60. IDEAL TREATMENT REGIMEN FOR PATIENTS WITH ≥1 BRAIN METASTASIS FROM PRIMARY NON-SMALL-CELL LUNG CANCER – A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS. Neurooncol Adv 2020. [PMCID: PMC7401406 DOI: 10.1093/noajnl/vdaa073.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Brain metastases (BM) are common in non-small cell lung cancer (NSCLC). The aim of this study was to assess the comparative effectiveness of treatments for BM from NSCLC. METHODS We searched MEDLINE, EMBASE, Web of Science, ClinicalTrials.gov, CENTRAL and references of key studies for randomized controlled trials (RCTs) published until October 2018. We also searched the Chinese databases Wanfang Data, Wanfang Med Online, China National Knowledge Infrastructure, and Chongqing VIP Information for RCTs published until September 2019. Trials including > 10 patients were selected. The primary outcomes were overall survival (OS) and intracranial progression-free survival (PFS). We used a frequentist random-effects model for network meta-analysis and assessed the certainty of evidence using the GRADE approach. RESULTS Among 8798 abstracts, 106 RCTs (9452 patients) met inclusion criteria. Median sample size was 67 (range 25–554). All trials included adult patients with histologically proven NSCLC and >1 BM proven on CT/MRI. Of trials that reported performance status (e.g. ECOG or KPS, n=67), 63/67 excluded patients with non-favorable performance status. Interventions assessed included surgery, WBRT, SRS, targeted therapies (i.e. EGFR/ALK inhibitors), and chemotherapy. Compared to WBRT alone, several interventions demonstrated a statistically significant increase in median OS, including non-targeted chemotherapy + surgery (MD: 415.3 days, 95% CI: 31.3–799.4), WBRT + EGFRi (MD: 200.2 days, 95% CI:146.3–254.1), and EGFRi alone (MD: 169.7 days, 95% CI: 49.7–289.7). Among all interventions, only WBRT + EGFRi showed a significant improvement in median PFS (MD: 108.0 days, 95%CI: 48.5–167.5). CONCLUSIONS Our preliminary analyses indicate an OS and PFS benefit on the addition of EGFR inhibitors to WBRT for the treatment of BMs from NSCLC. Further analyses of hazard ratios for OS/PFS are underway, and subgroup analyses are planned. These data support the growing role of targeted therapies in the treatment of BMs, particularly in susceptible mutant tumours.
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Affiliation(s)
- Karanbir Brar
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Yosef Ellenbogen
- Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
| | - Behnam Sadeghirad
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Jiawen Deng
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Winston Hou
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | | | - Shervin Taslimi
- Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
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15
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Ellenbogen Y, Brar K, Yang K, Lee Y, Ajani O. Comparison of endoscopic third ventriculostomy with or without choroid plexus cauterization in pediatric hydrocephalus: a systematic review and meta-analysis. J Neurosurg Pediatr 2020; 26:371-378. [PMID: 32619979 DOI: 10.3171/2020.4.peds19720] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 04/13/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Pediatric hydrocephalus is a significant contributor to infant morbidity and mortality, particularly in developing countries. The mainstay of treatment has long been shunt placement for CSF diversion, but recent years have seen the rise of alternative procedures such as endoscopic third ventriculostomy (ETV), which provides similar efficacy in selected patients. The addition of choroid plexus cauterization (CPC) to ETV has been proposed to increase efficacy, but the evidence of its utility is limited. This systematic review and meta-analysis aimed to determine the efficacy and safety of ETV+CPC in comparison to ETV alone for the treatment of pediatric all-cause hydrocephalus. METHODS MEDLINE, Embase, Cochrane CENTRAL, ClinicalTrials.gov, and ICRCTN databases were searched from conception through to October 2018 for comparative studies including both ETV+CPC and ETV in a pediatric population. The primary outcome was success rate, defined as no secondary procedure required for CSF diversion; secondary outcomes included time to failure, mortality, and complications. Data were pooled using random-effects models of meta-analysis, and relative risk (RR) was calculated. RESULTS Five studies were included for final qualitative and quantitative analysis, including 2 prospective and 3 retrospective studies representing a total of 963 patients. Overall, there was no significant difference in success rates between ETV and ETV+CPC (RR 1.24, 95% CI 0.88-1.75, p = 0.21). However, a subgroup analysis including the 4 studies focusing on African cohorts demonstrated a significant benefit of ETV+CPC (RR 1.38, 95% CI 1.08-1.78, p = 0.01). There were no notable differences in complication rates among studies. CONCLUSIONS This systematic review and meta-analysis failed to find an overall benefit to the addition of CPC to ETV; however, a subgroup analysis showed efficacy in sub-Saharan African populations. This points to the need for future randomized clinical trials investigating the efficacy of ETV+CPC versus ETV in varied patient populations and geographic locales.
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Affiliation(s)
- Yosef Ellenbogen
- 1Michael G. DeGroote School of Medicine, McMaster University, Hamilton
| | | | - Kaiyun Yang
- 3Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Yung Lee
- 1Michael G. DeGroote School of Medicine, McMaster University, Hamilton
| | - Olufemi Ajani
- 3Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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16
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Badhiwala JH, Leung SN, Ellenbogen Y, Akbar MA, Martin AR, Jiang F, Wilson JRF, Nassiri F, Witiw CD, Wilson JR, Fehlings MG. A comparison of the perioperative outcomes of anterior surgical techniques for the treatment of multilevel degenerative cervical myelopathy. J Neurosurg Spine 2020; 33:433-440. [PMID: 32534484 DOI: 10.3171/2020.4.spine191094] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 04/06/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in adults. Multilevel ventral compressive pathology is routinely managed through anterior decompression and reconstruction, but there remains uncertainty regarding the relative safety and efficacy of multiple discectomies, multiple corpectomies, or hybrid corpectomy-discectomy. To that end, using a large national administrative healthcare data set, the authors sought to compare the perioperative outcomes of anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), and hybrid corpectomy-discectomy for multilevel DCM. METHODS Patients with a primary diagnosis of DCM who underwent an elective anterior cervical decompression and reconstruction operation over 3 cervical spinal segments were identified from the 2012-2017 National Surgical Quality Improvement Program database. Patients were separated into those undergoing 3-level discectomy, 2-level corpectomy, or a hybrid procedure (single-level corpectomy plus additional single-level discectomy). Outcomes included 30-day mortality, major complication, reoperation, and readmission, as well as operative duration, length of stay (LOS), and routine discharge home. Outcomes were compared between treatment groups by multivariable regression, adjusting for age and comorbidities (modified Frailty Index). Effect sizes were reported by adjusted odds ratio (aOR) or mean difference (aMD) and associated 95% confidence interval. RESULTS The study cohort consisted of 1298 patients; of these, 713 underwent 3-level ACDF, 314 2-level ACCF, and 271 hybrid corpectomy-discectomy. There was no difference in 30-day mortality, reoperation, or readmission among the 3 procedures. However, on both univariate and adjusted analyses, compared to 3-level ACDF, 2-level ACCF was associated with significantly greater risk of major complication (aOR 2.82, p = 0.005), longer hospital LOS (aMD 0.8 days, p = 0.002), and less frequent discharge home (aOR 0.59, p = 0.046). In contrast, hybrid corpectomy-discectomy had comparable outcomes to 3-level ACDF but was associated with significantly shorter operative duration (aMD -16.9 minutes, p = 0.002). CONCLUSIONS The authors found multiple discectomies and hybrid corpectomy-discectomy to have a comparable safety profile in treating multilevel DCM. In contrast, multiple corpectomies were associated with a higher complication rate, longer hospital LOS, and lower likelihood of being discharged directly home from the hospital, and may therefore be a higher-risk operation.
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17
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Yang K, Ellenbogen Y, Algird AR, Sommer DD, Reddy K. Visual Outcomes After Endoscopic Endonasal Resection of Orbital Lesions. World Neurosurg 2020; 139:e501-e507. [PMID: 32311560 DOI: 10.1016/j.wneu.2020.04.050] [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: 02/29/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The endoscopic endonasal approach (EEA) has been increasing in popularity as an alternative to traditional transcranial and transorbital approaches in the treatment of orbital pathological entities. The purpose of the present study was to examine the outcomes of patients who had undergone EEA resection of orbital lesions at our center. METHODS We performed a retrospective medical record review of patients who had undergone the EEA for resection of orbital lesions and orbital apex decompression from January 1, 2006 to December 1, 2019. For all the patients, the demographic data, presenting symptoms, symptom duration, imaging data, operative details, and postoperative outcomes were collected and reviewed. RESULTS Nine patients underwent endoscopic endonasal resection of orbital lesions and orbital apex decompression at our center, including 6 male patients and 3 female patients. The mean age was 49.4 years, and the mean follow-up period was 3.8 years (range, 1-13.5 years). The orbital pathological lesions that were treated included nasopharyngeal carcinoma, hemangioma, fibrous dysplasia, IgG4 pseudotumor, inverted papilloma, angioleiomyoma, adenocarcinoma, and neuroendocrine paraganglioma metastasis. All the patients presented with exophthalmos of the affected orbit. Of the 9 patients, 5 presented with decreased visual acuity on examination. Postoperatively, 1 of these 5 patients had improved to baseline visual acuity, 3 had stable vision, and 1 had brief improvement before experiencing progressive visual decline 1 month postoperatively. Two patients presented with diplopia, and both improved postoperatively. Three patients experienced new, transient, and self-limiting postoperative diplopia. CONCLUSIONS For patients with orbital lesions causing compressive optic neuropathy, the endoscopic endonasal approach can be used as an alternative strategy in appropriately selected patients.
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Affiliation(s)
- Kaiyun Yang
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Yosef Ellenbogen
- Michael DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Almunder R Algird
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Doron D Sommer
- Division of Otolaryngology and Head and Neck Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Kesava Reddy
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada.
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18
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Yang K, Ellenbogen Y, Dong S, Kim J, Larrazabal R, Rodriguez AR, Algird AR, Sommer DD, Reddy K. The expanded endoscopic endonasal approach for suprasellar meningiomas: long-term outcomes in a single-center series of 27 patients. Acta Neurochir (Wien) 2020; 162:623-629. [PMID: 31836932 DOI: 10.1007/s00701-019-04113-x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 10/21/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND The endoscopic endonasal approach (EEA) has become increasingly employed in the treatment of suprasellar meningiomas. These tumors often cause visual symptoms due to compression of the anterior visual pathway. We aimed to examine long-term visual outcomes after EEA for optic nerve decompression and resection of suprasellar meningioma at our center, and to identify preoperative factors predictive of postoperative visual improvement. METHODS We performed a retrospective cohort study on 27 patients who underwent the EEA for resection of meningiomas extending into the suprasellar cistern and decompression of anterior visual pathway between January 1, 2005, and March 1, 2019. RESULTS We treated 8 male and 19 female patients, with a mean follow-up of 7.6 years. The mean age of our patients at initial presentation was 60.1 years. Eighteen patients (66.7%) presented with visual acuity deficits, and 12 (44.4%) patients presented with visual field deficits. Postoperatively, 11 patients had improved visual acuity, 6 had stable visual acuity, and 1 patient had slow and progressive decline of visual acuity; 5 patients had improved visual field, 6 had stable visual field, and 1 patient had slow and progressive decline in visual field. Patients less likely to have postoperative improvement of visual acuity were those with longer than 6-month duration of visual symptoms (P = 0.024*) as well as patients with the presence of a relative afferent pupillary defect (RAPD) (P = 0.023*). CONCLUSION The EEA can achieve good visual outcomes in patients harboring suprasellar meningiomas. Symptom duration of less than 6 months and lack of a RAPD were positive predictors of postoperative visual acuity.
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Affiliation(s)
- Kaiyun Yang
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Yosef Ellenbogen
- Michael DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Shaowei Dong
- Department of Cell and System Biology, University of Toronto, Toronto, Ontario, Canada
| | - Jeehyun Kim
- Division of Otolaryngology and Head and Neck Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Ramiro Larrazabal
- Division of Neuroradiology, McMaster University, Hamilton, Ontario, Canada
| | - Amadeo R Rodriguez
- Division of Ophthalmology, McMaster University, Hamilton, Ontario, Canada
| | - Almunder R Algird
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Doron D Sommer
- Division of Otolaryngology and Head and Neck Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Kesava Reddy
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada.
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19
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Jiménez-Saiz R, Anipindi VC, Galipeau H, Ellenbogen Y, Chaudhary R, Koenig JF, Gordon ME, Walker TD, Mandur TS, Abed S, Humbles A, Chu DK, Erjefält J, Ask K, Verdú EF, Jordana M. Microbial Regulation of Enteric Eosinophils and Its Impact on Tissue Remodeling and Th2 Immunity. Front Immunol 2020; 11:155. [PMID: 32117293 PMCID: PMC7033414 DOI: 10.3389/fimmu.2020.00155] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/21/2020] [Indexed: 12/16/2022] Open
Abstract
Eosinophils have emerged as multifaceted cells that contribute to tissue homeostasis. However, the impact of the microbiota on their frequency and function at mucosal sites remains unclear. Here, we investigated the role of the microbiota in the regulation of enteric eosinophils. We found that small intestinal (SI) eosinophilia was significantly greater in germ-free (GF) mice compared to specific pathogen free (SPF) controls. This was associated with changes in the production of enteric signals that regulate eosinophil attraction and survival, and was fully reversed by complex colonization. Additionally, SI eosinophils of GF mice exhibited more cytoplasmic protrusions and less granule content than SPF controls. Lastly, we generated a novel strain of eosinophil-deficient GF mice. These mice displayed intestinal fibrosis and were less prone to allergic sensitization as compared to GF controls. Overall, our study demonstrates that commensal microbes regulate intestinal eosinophil frequency and function, which impacts tissue repair and allergic sensitization to food antigens. These data support a critical interplay between the commensal microbiota and intestinal eosinophils in shaping homeostatic, innate, and adaptive immune processes in health and disease.
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Affiliation(s)
- Rodrigo Jiménez-Saiz
- Department of Pathology & Molecular Medicine, McMaster Immunology Research Centre (MIRC), McMaster University, Hamilton, ON, Canada
- Department of Immunology & Oncology, National Center for Biotechnology (CNB)-CSIC, Madrid, Spain
| | - Varun C. Anipindi
- Department of Pathology & Molecular Medicine, McMaster Immunology Research Centre (MIRC), McMaster University, Hamilton, ON, Canada
| | - Heather Galipeau
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Yosef Ellenbogen
- Department of Pathology & Molecular Medicine, McMaster Immunology Research Centre (MIRC), McMaster University, Hamilton, ON, Canada
| | - Roopali Chaudhary
- Department of Pathology & Molecular Medicine, McMaster Immunology Research Centre (MIRC), McMaster University, Hamilton, ON, Canada
| | - Joshua F. Koenig
- Department of Pathology & Molecular Medicine, McMaster Immunology Research Centre (MIRC), McMaster University, Hamilton, ON, Canada
| | - Melissa E. Gordon
- Department of Pathology & Molecular Medicine, McMaster Immunology Research Centre (MIRC), McMaster University, Hamilton, ON, Canada
| | - Tina D. Walker
- Department of Pathology & Molecular Medicine, McMaster Immunology Research Centre (MIRC), McMaster University, Hamilton, ON, Canada
| | - Talveer S. Mandur
- Department of Pathology & Molecular Medicine, McMaster Immunology Research Centre (MIRC), McMaster University, Hamilton, ON, Canada
| | - Soumeya Abed
- Department of Pathology & Molecular Medicine, McMaster Immunology Research Centre (MIRC), McMaster University, Hamilton, ON, Canada
| | - Alison Humbles
- Department of Respiratory, Inflammation and Autoimmunity, MedImmune, Gaithersburg, MD, United States
| | - Derek K. Chu
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jonas Erjefält
- Department of Experimental Medical Science, Lund University, Lund, Sweden
- Department of Respiratory Medicine and Allergology, Lund University Hospital, Lund, Sweden
| | - Kjetil Ask
- Department of Pathology & Molecular Medicine, McMaster Immunology Research Centre (MIRC), McMaster University, Hamilton, ON, Canada
| | - Elena F. Verdú
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Manel Jordana
- Department of Pathology & Molecular Medicine, McMaster Immunology Research Centre (MIRC), McMaster University, Hamilton, ON, Canada
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20
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Badhiwala JH, Ellenbogen Y, Khan O, Nouri A, Jiang F, Wilson JR, Jaja B, Witiw CD, Nassiri F, Fehlings MG, Wilson JR. Comparison of the Inpatient Complications and Health Care Costs of Anterior versus Posterior Cervical Decompression and Fusion in Patients with Multilevel Degenerative Cervical Myelopathy: A Retrospective Propensity Score–Matched Analysis. World Neurosurg 2020; 134:e112-e119. [DOI: 10.1016/j.wneu.2019.09.132] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
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21
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Brar K, Ellenbogen Y, Deng J, Warsi N, Mansouri A. CMET-25. COMPARATIVE EFFICACY OF TREATMENT PARADIGMS FOR BRAIN METASTASES – A SYSTEMATIC REVIEW. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Brain metastases (BM) are prevalent in several primary cancers and are the most commonly diagnosed intracranial tumours in adults. The aim of this systematic review was to critically evaluate and compare existing management paradigms for BMs from all primary tumour sites.
METHODS
We searched MEDLINE, EMBASE, Web of Science, ClinicalTrials.gov, and CENTRAL for randomized controlled trials (RCTs) published until October 2018 and selected comparative RCTS with >50 patients. The primary outcomes of interest were overall survival (OS) and progression-free survival (PFS).
RESULTS
A screen of 3188 abstracts yielded 49 RCTs with 8122 patients. The median sample size was 103 (range 39–779). 17/49 RCTs included lung cancer patients, 3/49 breast cancer, 2/49 melanoma, and 27/49 all primary tumour sites. Most studies were phase II/III superiority, open-label, parallel trials. All included patients >18 years of age with at least 1 BM proven on CT/MRI. Most included patients with favorable performance status (KPS >70 or ECOG 0–2). Interventions compared included targeted therapies (e.g. EGFR inhibitors, 7/49), chemotherapeutic regimens (28/49), WBRT (43/49), SRS (12/49), and surgical resection (3/49). A statistically significant difference in OS was reported by 7 studies, and in PFS by 8 studies. Of these, 3 showed improved PFS or OS on addition of temozolomide to WBRT, and 2 showed improved PFS in EGFR-positive patients treated with EGFR inhibitors. The incidence of serious adverse events was not substantially different between treatment arms in most studies.
CONCLUSIONS
Though the majority of studies did not report a benefit to OS or PFS, temozolomide + WBRT showed a benefit in 3 studies, and improvement in PFS was seen in EGFR-positive patients treated with EGFRi. Given the varying treatment approaches in practice today, these data support the need for a meta-analysis to accurately characterize the efficacy of existing treatment options for specific patient populations.
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22
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Ellenbogen Y, Brar K, Warsi N, Badhiwala J, Mansouri A. MLTI-14. A SYSTEMATIC REVIEW OF TREATMENT PARADIGMS FOR PATIENTS WITH BREAST CANCER AND ONE OR MORE BRAIN METASTASES. Neurooncol Adv 2019. [PMCID: PMC7213232 DOI: 10.1093/noajnl/vdz014.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND: Upwards of 50% of patients with advanced breast cancer are diagnosed with brain metastases (BM). Treatment options for these patients have been rapidly evolving due to increased understanding of the tumor pathophysiology and its genetic underpinnings. This systematic review of randomized controlled trials (RCTs) aims to clarify the evidence guiding the treatment of brain metastases from breast cancer. METHODS: MEDLINE, EMBASE, Cochrane Controlled Register of Trials, ClincialTrials.gov, and Web of Science were searched from inception to October 2018 for RCTs comparing treatments for breast cancer BM. We screened studies, extracted data, and assessed risk of bias independently and in duplicate. Outcomes assessed were overall survival (OS), progression-free survival (PFS), and adverse events (Grade 3+). RESULTS: Among 3188 abstracts, only 3 RCTs (N=412; mean sample size per group N=54.7) meeting inclusion criteria were identified. The studies were phase II or III open-label parallel superiority trials. Inclusion criteria among these trials consisted of age >18 with radiologic evidence of >1 BM. Exclusion criteria consisted of poor-performance functional status (ECOG >2 or KPS < 70). The treatment groups included whole-brain radiation therapy (WBRT) vs WBRT + Temozolomide, WBRT vs WBRT + Efaproxiral, and Afatinib vs Vinorelbine vs investigators’ choice (86% of these patients received WBRT or SRS prior to study enrolment). While two trials found no significant difference in OS, one trial found significant improvement in OS with Efaproxiral in addition to WBRT compared to WBRT alone (HR 0.52; 95%CI 0.332–0.816). No significant differences were found with PFS or rate of adverse events amongst treatment groups. CONCLUSION: Considering the high prevalence of breast cancer BM and our improved understanding of genomic/molecular features of these tumors, a greater number of RCTs dedicated at this disease are needed.
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Brar K, Ellenbogen Y, Warsi N, Badhiwala J, Mansouri A. MLTI-04. EVOLUTION OF TREATMENT PARADIGMS FOR PATIENTS WITH ≥1 BRAIN METASTASES FROM PRIMARY NON-SMALL-CELL LUNG CANCER – A SYSTEMATIC REVIEW. Neurooncol Adv 2019. [PMCID: PMC7213167 DOI: 10.1093/noajnl/vdz014.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND: Brain metastases (BM) are common in non-small cell lung cancer (NSCLC), with approximately 10% of patients presenting with BM at the time of diagnosis. The aim of this systematic review was to critically evaluate the evolution of management paradigms for BM from NSCLC. METHODS: We searched MEDLINE, EMBASE, Web of Science, ClinicalTrials.gov, and CENTRAL for randomized controlled trials (RCTs) published until October 2018. Comparative RCTs based on ≥ 50 patients were selected. The primary outcomes of interest were overall survival (OS) and progression-free survival (PFS). RESULTS: Among 3188 abstracts, 14 RCTs (2494 patients) met inclusion criteria. Median sample size was 97 (range 59–538). Most trials were open-label, parallel, superiority trials. All included patients aged ≥18 with histologically proven NSCLC and ≥1 BM proven on CT/MRI. The majority of trials (11/14) excluded patients with non-favorable performance status (ECOG, KPS, or WHO scales), prior SRS or WBRT, and/or leptomeningeal metastases. Interventions assessed included WBRT (11/14), SRS (3/14), targeted therapies (e.g. EGFR inhibitors, 5/14), and various chemotherapeutic regimens (12/14). Most trials (12/13) reported no significant difference in OS between interventions. 4/10 trials reported a difference in PFS, two of which only included patients with EGFR-mutant NSCLC; these showed a significant increase in PFS in patients managed with EGFR inhibitors. The other two trials reported longer PFS with sodium glycididazole + WBRT vs. WBRT alone (p=0.038) and temozolomide + SRS vs. SRS alone (p=0.003). The incidence of adverse events was consistent across most treatment groups. CONCLUSIONS: Most trials showed no significant improvement in OS; however, improvement in PFS was seen in several trials, most notably in EGFR-positive patients treated with EGFR inhibitors. Given the long-standing merit of radiation-based therapies for BM management, these data support the need for an in-depth meta-analysis assessing the comparative efficacy of current management paradigms for specific patient populations.
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Jiménez-Saiz R, Ellenbogen Y, Bruton K, Spill P, Sommer DD, Lima H, Waserman S, Patil SU, Shreffler WG, Jordana M. Human BCR analysis of single-sorted, putative IgE + memory B cells in food allergy. J Allergy Clin Immunol 2019; 144:336-339.e6. [PMID: 30959060 DOI: 10.1016/j.jaci.2019.04.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/13/2019] [Accepted: 04/02/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Rodrigo Jiménez-Saiz
- McMaster Immunology Research Centre (MIRC), Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada; Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Mass
| | - Yosef Ellenbogen
- McMaster Immunology Research Centre (MIRC), Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada; Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Mass
| | - Kelly Bruton
- McMaster Immunology Research Centre (MIRC), Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Paul Spill
- McMaster Immunology Research Centre (MIRC), Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Doron D Sommer
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Hermenio Lima
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Susan Waserman
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sarita U Patil
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Mass
| | - Wayne G Shreffler
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Mass
| | - Manel Jordana
- McMaster Immunology Research Centre (MIRC), Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
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25
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Lee Y, Ellenbogen Y, Doumouras AG, Gmora S, Anvari M, Hong D. Single- or double-anastomosis duodenal switch versus Roux-en-Y gastric bypass as a revisional procedure for sleeve gastrectomy: A systematic review and meta-analysis. Surg Obes Relat Dis 2019; 15:556-566. [PMID: 30837111 DOI: 10.1016/j.soard.2019.01.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/31/2018] [Accepted: 01/28/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (SG) is one of the most commonly performed bariatric procedure worldwide. There is currently no consensus on which revisional procedure is best after an initial SG. OBJECTIVES To compare the efficacy and safety between single-anastomosis duodeno-ileal bypass (SADI) or biliopancreatic diversion with duodenal switch (BPD-DS) versus Roux-en-Y gastric bypass (RYGB) as a revisional procedure for SG. SETTING University Hospital, Canada. METHODS MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and PubMed were searched up to August 2018. Studies were eligible for inclusion if they compared SADI or BPD-DS with RYGB as a revisional bariatric procedure for SG. Primary outcome was absolute percentage of total weight loss. Secondary outcomes were length of stay, adverse events, and improvement or resolution of co-morbidities (diabetes, hypertension, or hypercholesterolemia). Pooled mean differences were calculated using random effects meta-analysis. RESULTS Six retrospective cohort studies involving 377 patients met the inclusion criteria. The SADI/BPD-DS group achieved a significantly higher percentage of total weight loss compared with RYGB by 10.22% (95% confidence interval, -17.46 to -2.97; P = .006). However, there was significant baseline equivalence bias with 4 studies reporting higher initial body mass index (BMI) in the SADI/BPD-DS group. There were no significant differences in length of stay, adverse events, or improvement of co-morbidities between the 2 groups. CONCLUSION SADI, BPD-DS, and RYGB are safe and efficacious revisional surgeries for SG. Both SADI and RYGB are efficacious in lowering initial BMI but there is more evidence for excellent weight loss outcomes with the conversion to BPD-DS when the starting BMI is high. Further randomized trials are required for definitive conclusions.
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Affiliation(s)
- Yung Lee
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada; Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Yosef Ellenbogen
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Aristithes G Doumouras
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Scott Gmora
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Mehran Anvari
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Dennis Hong
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
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26
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Jiménez‐Saiz R, Ellenbogen Y, Koenig JFE, Gordon ME, Walker TD, Rosace D, Spill P, Bruton K, Kong J, Monteiro K, Wen J, Tuomanen EI, Kolbeck R, Chu DK, Waserman S, Jordana M. IgG1 + B-cell immunity predates IgE responses in epicutaneous sensitization to foods. Allergy 2019; 74:165-175. [PMID: 29790165 DOI: 10.1111/all.13481] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND The generation of IgE-mediated food allergy in humans is silent and only diagnosed upon manifestation of clinical symptoms. While experimental models have been used to investigate some mechanisms of allergic sensitization, the generation of humoral immunity and memory remains to be elucidated. Here, we defined the evolution of allergen-specific B-cell responses during epicutaneous sensitization to foods. METHODS Wild-type and genetic knockout animals, and drug or antibody strategies for cell depletion and immunoglobulin signaling blockade were used to investigate epicutaneous sensitization and disease progression; we analyzed allergen-specific germinal centers and IgG1+ memory B cells by flow cytometry, evaluated humoral responses, and determined clinical reactivity (anaphylaxis). RESULTS Epicutaneous sensitization caused microscopic skin damage, inflammation, and recruitment of activated dendritic cells to the draining lymph nodes. This process generated allergen-specific IgG1+ germinal center B cells, serum IgG1, and anaphylaxis that was mediated by the alternative pathway. Whether we used peanut and/or ovalbumin from the egg white for sensitization, the allergen-specific IgG1+ memory compartment predominantly exhibited an immature, pro-germinal center phenotype (PDL-2- CD80- CD35+ CD73+ ). Subsequent subclinical exposures to the allergen induced IgE+ germinal center B cells, serum IgE, and likely activated the classical pathway of anaphylaxis. CONCLUSIONS Our data demonstrate that IgG1+ B-cell immunity against food allergens in epicutaneous sensitization precedes the generation of IgE responses. Therefore, the assessment of allergen-specific cellular and humoral IgG1+ immunity may help to identify individuals at risk of developing IgE-mediated food allergy and hence provide a window for therapeutic interventions.
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Affiliation(s)
- R. Jiménez‐Saiz
- Department of Pathology & Molecular Medicine McMaster Immunology Research Centre (MIRC) McMaster University Hamilton ON Canada
| | - Y. Ellenbogen
- Department of Pathology & Molecular Medicine McMaster Immunology Research Centre (MIRC) McMaster University Hamilton ON Canada
| | - J. F. E. Koenig
- Department of Pathology & Molecular Medicine McMaster Immunology Research Centre (MIRC) McMaster University Hamilton ON Canada
| | - M. E. Gordon
- Department of Pathology & Molecular Medicine McMaster Immunology Research Centre (MIRC) McMaster University Hamilton ON Canada
| | - T. D. Walker
- Department of Pathology & Molecular Medicine McMaster Immunology Research Centre (MIRC) McMaster University Hamilton ON Canada
| | - D. Rosace
- Department of Pathology & Molecular Medicine McMaster Immunology Research Centre (MIRC) McMaster University Hamilton ON Canada
| | - P. Spill
- Department of Pathology & Molecular Medicine McMaster Immunology Research Centre (MIRC) McMaster University Hamilton ON Canada
| | - K. Bruton
- Department of Pathology & Molecular Medicine McMaster Immunology Research Centre (MIRC) McMaster University Hamilton ON Canada
| | - J. Kong
- Department of Pathology & Molecular Medicine McMaster Immunology Research Centre (MIRC) McMaster University Hamilton ON Canada
| | - K. Monteiro
- Department of Pathology & Molecular Medicine McMaster Immunology Research Centre (MIRC) McMaster University Hamilton ON Canada
| | - J. Wen
- Department of Pathology & Molecular Medicine McMaster Immunology Research Centre (MIRC) McMaster University Hamilton ON Canada
| | - E. I. Tuomanen
- Department of Infectious Diseases St. Jude Children's Research Hospital Memphis TN USA
| | - R. Kolbeck
- Department of Respiratory, Inflammation & Autoimmunity MedImmune LLC Gaithersburg MA USA
| | - D. K. Chu
- Department of Medicine McMaster University Hamilton ON Canada
| | - S. Waserman
- Department of Medicine McMaster University Hamilton ON Canada
| | - M. Jordana
- Department of Pathology & Molecular Medicine McMaster Immunology Research Centre (MIRC) McMaster University Hamilton ON Canada
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