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  • 1
    Online Resource
    Online Resource
    RADT-18. LONG-TERM FOLLOW-UP OF PATIENTS TREATED WITH GAMMA KNIFE® STEREOTACTIC RADIOSURGERY (GK-SRS) FOR VESTIBULAR SCHWANNOMA (VS)
    Oxford University Press (OUP) ; 2020
    In:  Neuro-Oncology Vol. 22, No. Supplement_2 ( 2020-11-09), p. ii185-ii185
    Details
    In: Neuro-Oncology, Oxford University Press (OUP), Vol. 22, No. Supplement_2 ( 2020-11-09), p. ii185-ii185
    Abstract: GK-SRS is an accepted definitive treatment option for appropriately selected patients with VS. To assess long-term outcomes in VS patients treated with GK-SRS, we retrospectively evaluated all patients treated at our institution from 2007-2019. METHODS For VS patients treated with GK-SRS from 2007-2019, clinical data (symptoms, physical exams, audiograms, and imaging) was collected via retrospective chart review at pre-treatment and standard follow-up intervals (6 weeks, 6 months, 12 months, then annually). Descriptive analyses, including the proportions of patients in different grades of clinical parameters, are reported. For each clinical parameter, only patients with both pre- and post-treatment data were included in the evaluation set used for analysis. RESULTS Of 177 patients identified, 46 were excluded from the evaluable set (age & lt; 18 years, prior resection, NF-2, or no follow-up). Among the remaining 131, median follow-up was 42 months (6 weeks to 11 years), and 36.6% completed 5+ years of follow-up. At time of treatment, median age was 61 years, and median Karnofsky Performance Score was 90. 58.0% of lesions were left-sided, and 42.0% were right-sided. The majority were Koos grade II (37.4%) or III (38.2%); the remainder were grade I (13.0%) or IV (11.5%). Pre-treatment central necrosis and ventriculomegaly were present in 39.7% and 4.6%, respectively. Following treatment, audiogram analysis with Gardner-Robertson Hearing Score demonstrated no change in 48.9%, some level of decline in 47.8%, and improvement in 3.3% at last follow-up. 97.7% had House-Brackmann scores of I at diagnosis; the remainder were House-Brackmann II. House-Brackmann scores remained unchanged at last follow-up for 96.9%, improved for 1.6%, and worsened for 1.6%. Salvage therapy in the form of surgery (n=5) or repeat GK-SRS (n=2) was necessary in 5.3% (n=6 for progression; n=1 for trigeminal symptoms). CONCLUSION Long-term follow-up demonstrates that GK-SRS remains a well-tolerated, primary definitive treatment for VS.
    Type of Medium: Online Resource
    ISSN: 1522-8517 , 1523-5866
    URL: Article
    DOI: 10.1093/neuonc/noaa215.771
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
    detail.hit.zdb_id: 2028601-6
    detail.hit.zdb_id: 2094060-9
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  • 2
    Online Resource
    Online Resource
    BIOM-44. MAGNETIC RESONANCE IMAGING MAPPING OF BRAIN TUMOR BURDEN TO EVALUATE RESPONSE TO PULSED LOW-DOSE-RATE RADIOTHERAPY FOLLOWING RESECTION OF GLIOBLASTOMA MULTIFORME: A 4-PATIENT CASE SERIES
    Oxford University Press (OUP) ; 2022
    In:  Neuro-Oncology Vol. 24, No. Supplement_7 ( 2022-11-14), p. vii14-vii14
    Details
    In: Neuro-Oncology, Oxford University Press (OUP), Vol. 24, No. Supplement_7 ( 2022-11-14), p. vii14-vii14
    Abstract: Pulsed low-dose-rate radiotherapy (pLDR) is an accepted reirradiation technique for recurrent glioma, but its upfront use, concurrent with temozolomide (TMZ) following resection of high-grade glioma is currently under investigation. Evaluating the response to upfront radiation can be challenging and there is limited data on expected rates of pseudoprogression with pLDR. Standard magnetic resonance imaging (MRI) has limitations in differentiating pseudoprogression from tumor progression, sometimes necessitating surgery for pathologic confirmation. Advanced MRI can be used to create fractional tumor burden (FTB) maps that spatially distinguish active tumor from treatment-related effect (pseudoprogression), perhaps providing a more reliable imaging biomarker in the absence of additional surgery. METHODS We performed a retrospective chart review to report the responses of four patients with glioblastoma to upfront pLDR and TMZ following resection. Each patient received advanced surveillance MRI and redo surgery. Tumor pathology included IDH-wild type (n = 4) and O6-methylguanine-DNA methyltransferase (MGMT) methylated (n = 1) tumors. RESULTS The median age of patients was 57.5 years (range 55-60 years) and all were male. One patient experienced mortality and another was transitioned to hospice. In all four cases, there were concerns of tumor progression in postcontrast MRI. Pathologic diagnosis revealed either treatment effect (n = 2) or tumor (n = 2). FTB maps were predominantly indicative of lesion volumes being comprised of treatment effect (n = 3) and tumor (n = 1). From the three FTB maps in the former category, the median fraction of the enhancing tumor volume comprised of vascular tumor was 6.4% (range 1.8-6.8%). CONCLUSION This case series provides insight into response to upfront pLDR and TMZ following resection of glioblastoma and demonstrates the capacity for FTB mapping to spatially distinguish tumor progression from treatment effect in this patient population.
    Type of Medium: Online Resource
    ISSN: 1522-8517 , 1523-5866
    URL: Article
    DOI: 10.1093/neuonc/noac209.054
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2028601-6
    detail.hit.zdb_id: 2094060-9
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  • 3
    Online Resource
    Online Resource
    QOLP-01. OUTCOME ASSESSMENT OF MULTIDISCIPLINARY BRAIN TUMOR BOARD MEETING RECOMMENDATIONS FOR BRAIN METASTASIS: IS THERE A GAP?
    Oxford University Press (OUP) ; 2020
    In:  Neuro-Oncology Vol. 22, No. Supplement_2 ( 2020-11-09), p. ii174-ii174
    Details
    In: Neuro-Oncology, Oxford University Press (OUP), Vol. 22, No. Supplement_2 ( 2020-11-09), p. ii174-ii174
    Abstract: Brain metastasis (BM) is the most common form of brain cancer affecting 20-40% of cancer patients. Advancements in cancer therapy has prolonged survival but BM incidence has increased. BM management requires a multidisciplinary approach to individualize care via an ever-growing sum of surgical, radiation, and systemic therapy options. Consensus is achieved by multidisciplinary tumor board meeting (MTBm). Nevertheless, BM diagnosis predicts poor prognosis. Palliative Care (PC) is essential for proper BM management. Yet, formal PC assessment may not be available for MTBm. We evaluated whether MTBm consensus recommendations were followed. RESULTS Our weekly MTBm discussed 157 BM cases during 2019 (median age: 64 years [range 28-91], male/female: 82/75). The most common primary diagnosis was lung (n=49, 31%), breast (n=24, 15%), melanoma (n=16, 10%). The majority was newly diagnosed BM (n=143, 91%). MTBm recommendations were divided into three not-mutually-exclusive categories: surveillance/workup (n=78, 50%), BM-directed treatment (n=101, 64%) and GOC discussion (n=7, 4%). MTBm recommendations were fully followed in 113 cases (72%), partially in 13(8%), and not followed in 25(16%). Of the 38 patients whose recommendations were partially/not followed, the main reason was transition to hospice/death (n=26, 68%). Of the 101 patients recommended treatment, 68% (n=68) fully followed it, yet 31% (n=21) of them died within 3 months; for those living longer than 3 months (n=47, 69%), median KPS at 3 months was 70 (range 30-90). Of the entire cohort (n=157), only 20 (13%) established consistent PC follow-up ( & gt;1 outpatient visit) and 69 cases (44%) transitioned to hospice/died within 6 months, 30 of which (43%) still completed surgery (n=6) or radiotherapy (n=24) within this period. CONCLUSION Periodic assessment of MTBm recommendations is relevant for sensible BM management. Balancing treatment while focusing on QoL in a patient population with limited survival is challenging. PC assessment at MTBm could close this gap.
    Type of Medium: Online Resource
    ISSN: 1522-8517 , 1523-5866
    URL: Article
    DOI: 10.1093/neuonc/noaa215.726
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
    detail.hit.zdb_id: 2028601-6
    detail.hit.zdb_id: 2094060-9
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  • 4
    Online Resource
    Online Resource
    LMAP-14 EFFECT OF TRANSLATIONAL VARIATION ON DOSE CHANGE ADOPTED FOR CONE-BEAM CT GUIDED FRAME BASED STEREOTACTIC RADIOSURGERY OF BRAIN TUMORS
    Oxford University Press (OUP) ; 2023
    In:  Neuro-Oncology Advances Vol. 5, No. Supplement_3 ( 2023-08-04), p. iii12-iii12
    Details
    In: Neuro-Oncology Advances, Oxford University Press (OUP), Vol. 5, No. Supplement_3 ( 2023-08-04), p. iii12-iii12
    Abstract: Gamma knife (GK) is a highly precise form of stereotactic radiosurgery (SRS) that delivers high doses of radiation to small, well-defined targets in a variety of tumor and vascular abnormalities. In some frame-based cases, a small translation can occur between the planning MRI and the cone-beam CT acquired at the time of treatment. Measuring the effect of patient translation on the dose distribution may be useful for informing clinical decisions. Materials/ METHODS This retrospective study of 113 planning target volumes (PTV) from 33 patients investigates the effect of translational variation on dose metrics recalculated based on cone-beam CT guided for frame based GK radiosurgery. The approved dose adjustments after the original treatment plan in terms of change in mean dose and dose coverage were compared with corresponding translation variation and the volume of PTV. The magnitude of translational variation was compared with the change in dose distribution. RESULTS We observed about 53% of cases have at least 0.1 Gy to max 1.2 Gy change in mean dose approved for the translation variation of patients while about 20% of cases have dose coverage fraction change in the range of 2-10%. Furthermore, the change in mean dose and coverage fraction is not linear with the translation variation, but a significant number of dose changes is observed when the variation magnitude is & gt;0.5 mm. PTV volume varied between 0.04 to 22 cm3 and the dose change has been most often adopted when the volume is & lt;2.5 cm3 and the change increases for the decreasing PTV volume. CONCLUSION This work provides new insights identifying the suitable tolerance level for translational variations of patients and the resulting impact on the prescribed dose for frame-based SRS.
    Type of Medium: Online Resource
    ISSN: 2632-2498
    URL: Article
    DOI: 10.1093/noajnl/vdad070.045
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 3009682-0
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  • 5
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    Online Resource
    38. INNOVATIVE USE OF A CUSTOM MOBILE APPLICATION (APP) BY A BRAIN METASTASES PROGRAM FACILITATES MULTIDISCIPLINARY MANAGEMENT OF PATIENTS AND DECREASED LENGTH OF HOSPITAL STAY (LOS)
    Oxford University Press (OUP) ; 2020
    In:  Neuro-Oncology Advances Vol. 2, No. Supplement_2 ( 2020-08-04), p. ii7-ii7
    Details
    In: Neuro-Oncology Advances, Oxford University Press (OUP), Vol. 2, No. Supplement_2 ( 2020-08-04), p. ii7-ii7
    Abstract: Patients with Brain Metastases (BM) are complex, mandating multidisciplinary care. Our BM patients are discussed at in-person, weekly Brain Tumor Boards (BTB). However, BM patients diagnosed outside weekly BTBs wait several days for the next BTB, causing delays in generating multidisciplinary plans-of-care, prolonging LOS. We created a custom mobile app for our Brain Metastases Program to have a ‘Brain Metastases Virtual Tumor Board’ (BMVTB) discussion, in real-time, resulting in faster plans-of-care, decreasing LOS. METHODS The current pathway for navigating multidisciplinary discussions for patients with BM was examined by members of our Brain Metastases Program. We identified the need for all disciplines to participate in a BMVTB, outside of our in-person, weekly BTB. We developed a secure app that can be downloaded on any provider’s mobile device. The app includes a digital BM treatment algorithm for providers to understand comprehensive, data-driven, BM management. The app also gives our multidisciplinary Brain Metastases Program access to a BMVTB messenging tool to securely communicate and generate real-time consensus plans-of-care. Using a Vizient Clinical Database, we retrospectively calculated LOS index (observed LOS/expected LOS) for 184 BM patients over 21 months, creating a baseline. After launching our app and BMVTB workflow we prospectively evaluated LOS index in 45 BM patients over 6 months. RESULTS Over 21-months, 184 patients demonstrated baseline LOS index of 1.073. After launching our mobile app and BMVTB workflow, 45 patient admissions over 6-months demonstrated LOS index of 0.850. Using Levene’s test for equal variances, LOS variance with the app and BMVTB was lower than LOS variance at baseline (p = 0.049). This demonstrates a 38% reduction in LOS when the app and BMVTB generated real-time plans-of-care. CONCLUSION We demonstrated utility of a custom BM app coupled with a BMVTB to generate real-time plans-of-care for BM patients, reducing LOS.
    Type of Medium: Online Resource
    ISSN: 2632-2498
    URL: Article
    DOI: 10.1093/noajnl/vdaa073.026
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
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  • 6
    Online Resource
    Online Resource
    LMAP-11 CYSTIC BRAIN METASTASES OUTCOMES FOLLOWING GAMMA KNIFE RADIOTHERAPY
    Oxford University Press (OUP) ; 2023
    In:  Neuro-Oncology Advances Vol. 5, No. Supplement_3 ( 2023-08-04), p. iii11-iii11
    Details
    In: Neuro-Oncology Advances, Oxford University Press (OUP), Vol. 5, No. Supplement_3 ( 2023-08-04), p. iii11-iii11
    Abstract: The response of cystic brain metastases (BMets) to radiotherapy is poorly understood, with conflicting results regarding local control (LC), overall survival (OS), and treatment-related toxicity. This study aims to examine the role of Gamma Knife (GK) in managing cystic BMets. METHODS Volumetric analysis was conducted to measure tumor and edema volume at the time of GK and follow-up MRI studies. We evaluated the association of 4 variables with survival using Cox regression analysis and used the Kaplan-Meier method to estimate median survival times (MST). RESULTS Between 2016 and 2021, 54 patients with 83 cystic BMets were treated with GK at our institution. Lung cancer was the most common pathology (51.9%), followed by breast (13.0%). The mean target volume was 2.7 cc (range, 0.1-39.0 cc) and the mean edema volume was 13.9 cc (range, 0-165.5 cc). The median prescription dose of single fraction and fractionated GK was 20 Gy (range, 14-27.5 Gy). With a median follow-up of 8.9 months, MST was 11.1 months, OS was 33.3%, and the one-year LC rate was 75.9%. GK was associated with decreased tumor and edema volumes over time, although 68.5% of patients required steroids post-GK. Patients whose tumors grew beyond baseline following GK received significantly more pre-GK whole-brain radiation therapy (WBRT) than those whose tumors declined following GK. Higher age at diagnosis of BMets and pre-GK systemic therapy were associated with worse survival, with an MST of 7.8 months in patients who received it compared to 23.3 months in those who did not. CONCLUSIONS Pre-GK WBRT may select for BMets with increased radioresistance. This study highlights the ability of GK to control cystic BMets with the cost of high post-treatment steroid use.
    Type of Medium: Online Resource
    ISSN: 2632-2498
    URL: Article
    DOI: 10.1093/noajnl/vdad070.042
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 3009682-0
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