Publications by authors named "Paul D Brown"

Article Synopsis
  • The study aims to evaluate how different cochlear dose parameters affect hearing outcomes in patients with sporadic vestibular schwannoma (VS) who have serviceable hearing after undergoing stereotactic radiosurgery (SRS).
  • A total of 205 patients were analyzed over a period from 2007 to 2022, revealing that 62% of patients maintained serviceable hearing at 2 years, while this dropped to 15% by 10 years post-treatment.
  • Results showed a significant association between increased minimum cochlear dose and faster decline in hearing, indicating that this dose parameter should be a key consideration in planning radiosurgery for VS patients.
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  • As cancer patients with brain metastases live longer, managing recurring brain lesions becomes more complex and requires careful assessment of various factors.
  • Clinicians must distinguish between actual disease progression and side effects from previous radiation, and classify the recurrence based on its location and characteristics.
  • Treatment options range from surgeries and various forms of radiotherapy to investigating systemic therapies, requiring a thorough, interdisciplinary approach tailored to individual patient factors.
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Purpose: The Prognostic Index for Spinal Metastasis (PRISM) is a scoring system derived from prospective data from a single institution that stratifies patients undergoing spine stereotactic radiosurgery (SSRS) for spinal metastases into subgroups by overall (OS). We sought to further demonstrate its generalizability by performing validation with a large dataset from a second high-volume institution, Mayo Clinic.

Methods And Materials: Eight hundred seventy-nine patients-424 from Mayo Clinic and 455 from MD Anderson Cancer Center (MDACC)-who received SSRS between 2007 and 2019 were identified.

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Background: Minimal clinically important differences (MCIDs) quantify the clinical relevance of quality of life results at the individual patient and group level. The aim of this study was to estimate the MCID for the Brief Fatigue Inventory (BFI) and the Worst and Usual Fatigue items in patients with brain or CNS cancer undergoing curative radiotherapy.

Methods: Data from a multi-site prospective registry was used.

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Leptomeningeal disease (LMD) is a devastating sequelae of metastatic spread that affects approximately 5% of cancer patients. The incidence of LMD is increasing due to advancements in systemic therapy and enhanced detection methods. The purpose of this review is to provide a detailed overview of the evidence in the detection, prognostication, and treatment of LMD.

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Objective: Chordomas are rare tumors that originate from undifferentiated remnants of the notochord. Currently, there are no established guidelines regarding the choice of adjuvant radiation modality for patients surgically treated for chordomas. Using a nationwide, multicenter database, the authors aimed to compare long-term survival outcomes associated with the use of proton or photon adjuvant therapy for the management of chordomas of skull base and spine.

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The crystal structure of the title compound was determined at 120 K. It crystallizes in the triclinic space group with four independent mol-ecules in the asymmetric unit. In the crystal, each symmetry-unique mol-ecule forms π-π stacks on itself, giving four unique π-π stacking inter-actions.

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  • * A meta-analysis of 6 randomized trials involving 1,204 patients found that alkylating chemotherapy improves progression-free survival (PFS) for IDH-wt tumors when combined with radiotherapy, but shows no significant overall survival (OS) benefit.
  • * In contrast, IDH-mutant gliomas benefit significantly from alkylating chemotherapy, with substantial improvements in both PFS and OS, indicating a key difference in treatment effectiveness between the two glioma types
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Mutations in isocitrate dehydrogenase (IDH) genes, an early step in the ontogeny of lower-grade gliomas, induce global epigenetic changes characterized by a hypermethylation phenotype and are critical to tumor classification, treatment decision making, and estimation of patient prognosis. The introduction of IDH inhibitors to block the oncogenic neomorphic function of the mutated protein has resulted in new therapeutic options for these patients. To appreciate the implications of these recent IDH inhibitor results, it is important to juxtapose historical outcomes with chemoradiotherapy.

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Background: This study aimed to determine whether proton craniospinal irradiation (CSI) decreased the dose to normal tissue and resulted in less toxicity than photon CSI for adult patients.

Methods: This single-institution retrospective analyzed differences in radiation doses, acute toxicity, and cost between proton and CSI for adult medulloblastoma patients.

Results: Of 39 total patients, 20 were treated with photon CSI prior to 2015, and 19 were treated with proton CSI thereafter.

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  • Metastasis-directed spine SBRT has been shown to improve local control and overall survival in selected patients, with a focus on clinical and dosimetric factors influencing local failure rates.
  • A study analyzed 522 treatments, highlighting that a minimum dose of 15.3 Gy in single-fraction deliveries significantly improves local control, with local failure rates being lower when this dose is achieved.
  • Epidural and soft tissue involvement are significant predictors of local failure, emphasizing the importance of targeting and dosing in SBRT for better treatment outcomes.
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Meningeal solitary fibrous tumors (SFT) are rare and have a high frequency of local recurrence and distant metastasis. In a cohort of 126 patients (57 female, 69 male; mean age at surgery 53.0 years) with pathologically confirmed meningeal SFTs with extended clinical follow-up (median 9.

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Stereotactic radiosurgery (SRS) is an important weapon in the management of brain metastases. Single-fraction SRS is associated with local control rates ranging from approximately 70% to 100%, which are largely dependent on lesion and postoperative cavity size. The rates of local control and improved neurocognitive outcomes compared with conventional whole-brain radiation therapy have led to increased adoption of SRS in these settings.

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Background And Objectives: Almost one third of cancer patients in the United States will develop brain metastases on an annual basis. Surgical resection is indicated in the setting of brain metastases for reasons, such as maximizing local control in select patients, decompression of mass effect, and/or tissue diagnosis. The current standard of care following resection of a brain metastasis has shifted from whole brain radiation therapy to post-operative stereotactic radiosurgery (SRS).

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Introduction: Proton craniospinal irradiation (pCSI) is a treatment option for leptomeningeal disease (LMD), which permits whole neuroaxis treatment while minimizing toxicity. Despite this, patients inevitably experience progression. Adding systemic therapy to pCSI may improve outcomes.

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  • The EuroQoL EQ-5D-5L is a health-related quality of life measurement commonly used in clinical trials, but its effectiveness in showing changes in neurocognitive function after brain radiation is uncertain.
  • A study analyzed data from patients with varying cognitive function and intracranial progression to assess changes in EQ-5D-5L scores and associated symptoms over time.
  • Results indicated that EQ-5D-5L scores did not reflect neurocognitive changes, while visual analog scale scores showed sensitivity to intracranial progression, suggesting that EQ-5D may not be appropriate for brain metastases trials focused on cognitive health.
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Single-atom dynamics of noble-gas elements have been investigated using time-resolved transmission electron microscopy (TEM), with direct observation providing for a deeper understanding of chemical bonding, reactivity, and states of matter at the nanoscale. We report on a nanoscale system consisting of endohedral fullerenes encapsulated within single-walled carbon nanotubes ((Kr@C)@SWCNT), capable of the delivery and release of krypton atoms on-demand, via coalescence of host fullerene cages under the action of the electron beam () or heat (). The state and dynamics of Kr atoms were investigated by energy dispersive X-ray spectroscopy (EDS), electron energy loss spectroscopy (EELS), and X-ray photoelectron spectroscopy (XPS).

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Dietary cadmium (Cd) intake is implicated in the pathogenesis of hypertension and anaemia, but there is a paucity of information on the haematological changes in hypertensive conditions. This study, therefore, aims to evaluate the effects of Cd on blood pressure (BP) and haematological indices in the Sprague-Dawley rat model. Three cohorts (n = 10 each) of control and Cd-fed male Sprague-Dawley rats were selected.

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Purpose: Whole-brain radiation therapy (WBRT) is a common treatment for brain metastases and is frequently associated with decline in neurocognitive functioning (NCF). The e4 allele of the apolipoprotein E (APOE) gene is associated with increased risk of Alzheimer disease and NCF decline associated with a variety of neurologic diseases and insults. APOE carrier status has not been evaluated as a risk factor for onset time or extent of NCF impairment in patients with brain metastases treated with WBRT.

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  • The study aims to find subgroups of patients who respond differently to hippocampal avoidant whole brain radiotherapy (HA-WBRT) for brain metastases, analyzing existing data from a clinical trial.
  • Results show that patients who live longer than 4 months benefit significantly from HA-WBRT in terms of reducing neurocognitive function failure, while those with shorter survival show no significant benefits.
  • It also highlights that patients with lower cognitive impairment scores and those with lung cancer histology experience greater neuroprotective effects from HA-WBRT compared to others.
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Stereotactic radiation therapy yields high rates of local control for brain metastases, but patients in rural or suburban areas face geographic and socioeconomic barriers to its access. We conducted a phase II clinical trial of frameless, fractionated stereotactic radiation therapy for brain metastases in an integrated academic satellite network for patients 18 years of age or older with 4 or fewer brain metastases. Dose was based on gross tumor volume: less than 3.

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