Prospective validation of treatment accuracy using implanted fiducial markers for spinal stereotactic body radiation therapy.

In order to accurately assess positioning errors in spinal SBRT, many institutions employ bony-fusion based imaging techniques, such as the ExacTrac™ (Brain Lab) system, in conjunction with 3D verification (performed via CT-on-rails in our practice). We hypothesized that the use of implanted gold fiducial markers could improve the accuracy of patient positioning over bony fusion alone. We addressed this question prospectively, enrolling patients on an IRB-approved protocol.

Can the spinal instability neoplastic score prior to spinal radiosurgery predict compression fractures following stereotactic spinal radiosurgery for metastatic spinal tumor?: a post hoc analysis of prospective phase II single-institution trials.

The aim of this study was to determine the predictability of vertebral compression fracture (VCF) development applying the spinal instability neoplastic score (SINS) prior to delivery of stereotactic spinal radiosurgery (SSRS) for spinal metastases. From two prospective cohorts of SSRS for spinal metastases, we selected patients with a low degree of cord compression or cauda equine from C3 to S1 and analyzed 79 patients enrolled according to binary SINS criteria. The primary endpoint was the development of a de novo VCF or progression of an existing fracture after SSRS.

Adult patients with supratentorial pilocytic astrocytoma: long-term follow-up of prospective multicenter clinical trial NCCTG-867251 (Alliance).

Background: Pilocytic astrocytoma is a rare tumor in adults. This report is of a prospective clinical trial with long-term follow-up.

Methods: Between 1986 and 1994, 20 eligible adults with supratentorial pilocytic astrocytomas were enrolled in a prospective intergroup trial of radiotherapy (RT) after biopsy (3 patients) or observation after gross (11 patients) or subtotal (6 patients) resection.

Gamma Knife Stereotactic Radiosurgery for Brain Metastases Using Only 3 Pins.

Background: Removal of a pin during Gamma Knife stereotactic radiosurgery (GK-SRS) may be necessary to prevent collision and allow treatment.

Objective: To investigate outcomes after GK-SRS for treatment of brain metastases using a head frame immobilized to the skull with only 3 pins.

Methods: Between 2009 and 2014, we retrospectively reviewed the records of 1971 patients and identified 20 patients with multiple brain metastases treated with GK-SRS in which 1 anterior pin was removed immediately before treatment of a single posterior lesion.

Multiple-locus VNTR Analyses of Methicillin-resistant Staphylococcus aureus from Jamaica.

Background: This study assessed the antimicrobial susceptibilities and the presence of inducible macrolide-lincosamide-streptogramin B (iMLSB) resistance in methicillin-resistant Staphylococcus aureus (MRSA) of Jamaica as well as the relatedness using polymerase chain reaction-based staphylococcal cassette chromosome mec (SCCmec) and multiple-locus variable numbers of tandem repeat analyses (MLVAs).

Materials And Methods: Antimicrobial susceptibility, the presence of MLSB resistance, and SCCmec and MLVA patterns were assessed for 61 nonduplicate isolates of MRSA from hospitalized patients.

Results: While no isolate was resistant to vancomycin, 53 (86.

Response assessment criteria for brain metastases: proposal from the RANO group.

CNS metastases are the most common cause of malignant brain tumours in adults. Historically, patients with brain metastases have been excluded from most clinical trials, but their inclusion is now becoming more common. The medical literature is difficult to interpret because of substantial variation in the response and progression criteria used across clinical trials.

Neurocognitive Function Following Therapy for Low-Grade Gliomas.

Low-grade gliomas (LGGs) are a heterogenous group of primary brain neoplasms that most commonly occur in children and young adults, characterized by a slow, indolent course and overall favorable prognosis. Standard therapies used to treat LGGs have included surgical resection, radiotherapy, chemotherapy, or a combination thereof. Given the anticipated long survival and typical young age of patients with LGG, the long-term sequelae of therapy require special attention, especially as they affect neurocognitive function and quality of life.

Gamma knife stereotactic radiosurgery in the treatment of brainstem metastases: The MD Anderson experience.

Background: Brainstem metastases (BSMs) represent a significant treatment challenge. Stereotactic radiosurgery (SRS) is often used to treat BSM. We report our experience in the treatment of BSM with Gamma Knife SRS (GK_SRS).

Outcomes for Spine Stereotactic Body Radiation Therapy and an Analysis of Predictors of Local Recurrence.

Purpose: To investigate local control, survival outcomes, and predictors of local relapse for patients treated with spine stereotactic body radiation therapy.

Methods And Materials: We reviewed the records of 332 spinal metastases consecutively treated with stereotactic body radiation therapy between 2002 and 2012. The median follow-up for all living patients was 33 months (range, 0-111 months).

Therapeutic management of gliosarcoma in the temozolomide era.

Gliosarcoma (GS) is a malignant, uncommon variant of high-grade glioma comprised of infiltrative glial and atypical sarcomatous cells, identified in adult and pediatric populations. GS has been subcategorized into primary (de novo) and secondary tumors, with the latter typically arising in the setting of prior glioblastoma. Due to its rarity, the pathogenesis, epidemiology and optimal therapy of GS have been based on small retrospective cohort studies, with treatment presently utilizing regimens established for other high-grade gliomas, including combination of resection, radiotherapy and temozolomide-based chemotherapy.

Outcomes of stereotactic body radiotherapy (SBRT) treatment of multiple synchronous and recurrent lung nodules.

Background: Stereotactic body radiotherapy (SBRT) is evolving into a standard of care for unresectable lung nodules. Local control has been shown to be in excess of 90% at 3 years. However, some patients present with synchronous lung nodules in the ipsilateral or contralateral lobe or metasynchronous disease.

The relationship between corticosteroids and symptoms in patients with primary brain tumors: utility of the Dexamethasone Symptom Questionnaire-Chronic.

Background: Corticosteroids can have many side effects that impact the patient's quality of life and functional status. The Dexamethasone Symptom Questionnaire-Chronic (DSQ-C) was developed to report corticosteroid side effects. This study's objective was to evaluate the utility of the DSQ-C and report associated signs and symptoms in brain tumor patients.

Outcomes After Surgery and Radiotherapy for Papillary Tumor of the Pineal Region.

Background: Papillary tumor of the pineal region (PTPR) is a rare neuroectodermal tumor that was first described in 2003 and formally codified by the World Health Organization in 2007. Limited reports suggest surgical resection is the mainstay of treatment; however, the role of multimodality therapy is not well defined. We evaluated our institutional experience in the treatment of PTPR.

Dynamics of Gold Nanoparticles on Carbon Nanostructures Driven by van der Waals and Electrostatic Interactions.

Transmission electron microscopy studies on the assembly and growth of gold nanoparticles on carbon nanotubes supported on few-layer graphene and amorphous carbon reveal a competition between van der Waals forces and electrostatic interactions, enabling controlled positioning and sizing of adsorbed nanoparticles at the nanochannels formed between the carbon nanotube and the few-layer graph-ene surface.

Safety and Tolerability of SBRT after High-Dose External Beam Radiation to the Lung.

Purpose: Stereotactic body radiotherapy (SBRT) is commonly used to treat unresectable lung nodules. Given its relative safety and effective local control, SBRT has also been used to treat recurrent lung nodules after high-dose external beam radiation (EBRT) to the lung. The toxicity of such treatment is unknown.

Postoperative proton therapy for chordomas and chondrosarcomas of the spine: adjuvant versus salvage radiation therapy.

Study Design: Retrospective comparative cohort series.

Objective: The aim of this study was to evaluate patients treated with proton therapy for chordoma and chondrosarcoma of the spine in the postoperative setting and to report local control, relapse-free, and overall survival outcomes.

Summary Of Background Data: Margin-negative resection of spinal chordomas and chondrosarcomas can be challenging, so adjuvant radiotherapy is often recommended.

Risk of vertebral compression fracture specific to osteolytic renal cell carcinoma spinal metastases after stereotactic body radiotherapy: A multi-institutional study.

Purpose: Determine the risk of vertebral compression fracture (VCF) following stereotactic body radiotherapy (SBRT), specific to osteolytic renal cell carcinoma (RCC) spinal metastases, and associated predictive factors.

Methods: 187 RCC osteolytic spinal tumor segments in 116 patients obtained from a multi-institutional pooled database were reviewed. Each segment was evaluated according to the Spinal Instability Neoplastic Score (SINS).

Prognostic significance of EGFR and KRAS mutations in NSCLC patients with brain metastases treated with radiosurgery.

Purpose: Determine whether EGFR and KRAS mutations carry prognostic significance in non-small cell lung cancer (NSCLC) patients with brain metastases treated with stereotactic radiosurgery.

Methods And Materials: Ninety-four NSCLC patients with brain metastases initially treated with stereotactic radiosurgery were retrospectively reviewed. Both EGFR and KRAS mutation status were recorded in 67 patients: EGFR+/KRAS- status in 9 patients, EGFR-/KRAS+ in 15 patients, and EGFR-/KRAS- in 43 patients.

Interventions for preventing and ameliorating cognitive deficits in adults treated with cranial irradiation.

Background: Cognitive deficits are common in people who have received cranial irradiation and have a serious impact on daily functioning and quality of life. The benefit of pharmacological and non-pharmacological treatment of cognitive deficits in this population is unclear.

Objectives: To assess the effectiveness of interventions for preventing or ameliorating cognitive deficits in adult patients treated with cranial irradiation.

Stereotactic radiosurgery for intraventricular brain metastases.

Object: The authors' institution previously reported a 69% rate of crude local control for surgical management of lateral ventricle metastases at the University of Texas MD Anderson Cancer Center. For comparison, the authors here report their institutional experience with use of stereotactic radiosurgery (SRS) to treat intraventricular metastases.

Methods: To identify patients with intraventricular metastases for this retrospective review, the authors queried an institutional SRS database containing the medical records of 1962 patients with 5800 brain metastases who consecutively underwent SRS from June 2009 through October 2013.

Factors affecting survival in 37 consecutive patients undergoing de novo stereotactic radiosurgery for contiguous sites of vertebral body metastasis from renal cell carcinoma.

Object: Palliative resection of renal cell carcinoma (RCC) spinal metastasis is indicated in cases of neurological compromise or mechanical instability, whereas conventional external beam radiotherapy (EBRT) is commonly used for pain control. Recently, spinal stereotactic radiosurgery (SRS) has emerged as a safe alternative, delivering higher therapeutic doses of radiation to spinal metastases. To better understand factors affecting survival in patients undergoing spinal SRS for metastatic RCC, the authors performed a retrospective analysis of a consecutive series of cases at a tertiary cancer center.

Comparison of antibiotic resistance, virulence gene profiles, and pathogenicity of methicillin-resistant and methicillin-susceptible Staphylococcus aureus using a Caenorhabditis elegans infection model.

Objectives: This study compared the presence of 35 virulence genes, resistance phenotypes to 11 anti-staphylococcal antibiotics, and pathogenicity in methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA).

Methods: Multiplex PCR analysis was used to differentiate Staphylococcus aureus isolates (n = 102) based on characterization of the Staphylococcal Cassette Chromosome mec (SCCmec).

Spot scanning proton therapy for malignancies of the base of skull: treatment planning, acute toxicities, and preliminary clinical outcomes.

Purpose: To describe treatment planning techniques and early clinical outcomes in patients treated with spot scanning proton therapy for chordoma or chondrosarcoma of the skull base.

Methods And Materials: From June 2010 through August 2011, 15 patients were treated with spot scanning proton therapy for chordoma (n=10) or chondrosarcoma (n=5) at a single institution. Toxicity was prospectively evaluated and scored weekly and at all follow-up visits according to Common Terminology Criteria for Adverse Events, version 3.