2023
Selected-Lesion SRS as a Novel Strategy in Treatment of Patients with Multiple Brain Metastases
Singh C, Theriault B, An Y, Yu J, Knisely J, Shepard M, Wegner R, Warnick R, Peker S, Samanci Y, Trifiletti D, Lee C, Yang H, Bernstein K, Kondziolka D, Tripathi M, Mathieu D, Mantziaris G, Pikis S, Sheehan J, Chiang V. Selected-Lesion SRS as a Novel Strategy in Treatment of Patients with Multiple Brain Metastases. International Journal Of Radiation Oncology • Biology • Physics 2023, 117: e150-e151. DOI: 10.1016/j.ijrobp.2023.06.971.Peer-Reviewed Original ResearchWhole-brain radiation therapyTreatment of patientsSystemic diseaseBrain metastasesLesion locationIntracranial lesionsPrior whole-brain radiation therapyMultiple brain metastasesBrain radiation therapyUntreated brain metastasesBrain metastasis treatmentCurrent practice patternsSigns/symptomsPresence of symptomsMATERIAL/METHODSImmunotherapy optionsSystemic therapyUntreated lesionsMedical oncologyPerilesional edemaDrug optionsClinical trialsPractice patternsClinical indicationsMetastasis treatment
2022
Stereotactic radiosurgery and local control of brain metastases from triple-negative breast cancer.
Kowalchuk R, Niranjan A, Hess J, Antonios J, Zhang M, Braunstein S, Ross R, Pikis S, Deibert C, Lee C, Yang H, Langlois A, Mathieu D, Peker S, Samanci Y, Rusthoven C, Chiang V, Wei Z, Lunsford L, Trifiletti D, Sheehan J. Stereotactic radiosurgery and local control of brain metastases from triple-negative breast cancer. Journal Of Neurosurgery 2022, 138: 1608-1614. PMID: 36433878, DOI: 10.3171/2022.10.jns221900.Peer-Reviewed Original ResearchTriple-negative breast cancerLocal tumor progressionStereotactic radiosurgeryBreast cancerOverall survivalMetastatic lesionsPerformance statusLocal controlTriple-negative breast cancer metastasisMedian Karnofsky performance statusTumor progressionWhole-brain radiation therapyFavorable performance statusMedian margin dosePrior stereotactic radiosurgerySymptomatic radiation necrosisKarnofsky performance statusIntracranial metastatic diseaseRetrospective chart reviewLocal tumor controlBreast cancer metastasisIntracranial metastatic lesionsMargin doseMultiinstitutional cohortBrain metastases
2021
Intracranial Complications From Immune Checkpoint Therapy in a Patient With NSCLC and Multiple Sclerosis: Case Report
Lu BY, Isitan C, Mahajan A, Chiang V, Huttner A, Mitzner JR, Wesley SF, Goldberg SB. Intracranial Complications From Immune Checkpoint Therapy in a Patient With NSCLC and Multiple Sclerosis: Case Report. JTO Clinical And Research Reports 2021, 2: 100183. PMID: 34590030, PMCID: PMC8474265, DOI: 10.1016/j.jtocrr.2021.100183.Peer-Reviewed Original ResearchImmune checkpoint inhibitorsMultiple sclerosisRadiation necrosisBrain lesionsWhole-brain radiation therapyImmune checkpoint therapyViable tumor cellsPaucity of dataBrain metastasesCheckpoint inhibitorsMetastatic NSCLCAdverse eventsCheckpoint therapyDurable responsesNeurologic declineRadiographic benefitIntracranial complicationsPathologic findingsAutoimmune disordersAutoimmune diseasesCase reportIntracranial diseaseRadiation therapyStereotactic radiosurgeryAnticancer benefits
2019
Initial SRS for Patients With 5 to 15 Brain Metastases: Results of a Multi-Institutional Experience
Hughes RT, Masters AH, McTyre ER, Farris MK, Chung C, Page BR, Kleinberg LR, Hepel J, Contessa JN, Chiang V, Ruiz J, Watabe K, Su J, Fiveash JB, Braunstein S, Chao S, Attia A, Ayala-Peacock DN, Chan MD. Initial SRS for Patients With 5 to 15 Brain Metastases: Results of a Multi-Institutional Experience. International Journal Of Radiation Oncology • Biology • Physics 2019, 104: 1091-1098. PMID: 30959122, DOI: 10.1016/j.ijrobp.2019.03.052.Peer-Reviewed Original ResearchConceptsDistant brain failureInitial stereotactic radiosurgerySalvage whole brain radiation therapyWhole-brain radiation therapySalvage stereotactic radiosurgeryBrain metastasesBrain radiation therapyOverall survivalStereotactic radiosurgeryBM groupCumulative incidenceRadiation therapyNumber of BMTwo-year cumulative incidenceMultivariable Cox proportional hazardsBrain metastasis velocityMedian overall survivalOutcomes of patientsKaplan-Meier methodLog-rank testMulti-institutional experienceRisk regression modelingCox proportional hazardsMultivariable analysisNew metastases
2018
Breast cancer patients with brain metastasis undergoing GKRS
Abu-Khalaf M, Muralikrishnan S, Hatzis C, Canchi D, Yu JB, Chiang V. Breast cancer patients with brain metastasis undergoing GKRS. Breast Cancer 2018, 26: 147-153. PMID: 30182250, DOI: 10.1007/s12282-018-0903-3.Peer-Reviewed Original ResearchConceptsWhole-brain radiation therapyGamma knife radiosurgeryKarnofsky performance statusBrain metastasesOverall survivalBackgroundBreast cancerSurgical resectionTime of GKRSFirst gamma knife radiosurgeryFirst GKRS treatmentBrain radiation therapyBreast cancer patientsComprehensive cancer centerGKRS treatmentNeurocognitive preservationResultsMedian agePerformance statusMethodsThe recordsNeurological deathSuch patientsMultivariable analysisRetrospective studySurvival outcomesSystemic diseaseCancer CenterEffect of Targeted Therapies on Prognostic Factors, Patterns of Care, and Survival in Patients With Renal Cell Carcinoma and Brain Metastases
Sperduto PW, Deegan BJ, Li J, Jethwa KR, Brown PD, Lockney N, Beal K, Rana NG, Attia A, Tseng CL, Sahgal A, Shanley R, Sperduto WA, Lou E, Zahra A, Buatti JM, Yu JB, Chiang V, Molitoris JK, Masucci L, Roberge D, Shi DD, Shih HA, Olson A, Kirkpatrick JP, Braunstein S, Sneed P, Mehta MP. Effect of Targeted Therapies on Prognostic Factors, Patterns of Care, and Survival in Patients With Renal Cell Carcinoma and Brain Metastases. International Journal Of Radiation Oncology • Biology • Physics 2018, 101: 845-853. PMID: 29976497, PMCID: PMC6925530, DOI: 10.1016/j.ijrobp.2018.04.006.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overAngiogenesis InhibitorsAntineoplastic AgentsBrain NeoplasmsCarcinoma, Renal CellCause of DeathCranial IrradiationCytokinesFemaleHemoglobinsHumansImmunotherapyKarnofsky Performance StatusKidney NeoplasmsMaleMiddle AgedMultivariate AnalysisPrognosisRadiosurgeryRetrospective StudiesYoung AdultConceptsPatterns of careNew brain metastasesBrain metastasesLarge contemporary cohortPrognostic factorsMedian survivalContemporary cohortRCC patientsDiagnosis of BMWhole-brain radiation therapyRenal cell carcinoma patientsRetrospective institutional review boardBrain metastasis therapySystemic treatment optionsAdditional prognostic factorsCell carcinoma patientsRenal cell carcinomaInstitutional review boardNonneurologic causesCarcinoma patientsImproved survivalNeurologic causesMultivariable analysisClinical parametersPresent cohort
2017
The Prognostic Value of BRAF, C-KIT, and NRAS Mutations in Melanoma Patients With Brain Metastases
Sperduto PW, Jiang W, Brown PD, Braunstein S, Sneed P, Wattson DA, Shih HA, Bangdiwala A, Shanley R, Lockney NA, Beal K, Lou E, Amatruda T, Sperduto WA, Kirkpatrick JP, Yeh N, Gaspar LE, Molitoris JK, Masucci L, Roberge D, Yu J, Chiang V, Mehta M. The Prognostic Value of BRAF, C-KIT, and NRAS Mutations in Melanoma Patients With Brain Metastases. International Journal Of Radiation Oncology • Biology • Physics 2017, 98: 1069-1077. PMID: 28721890, PMCID: PMC6925531, DOI: 10.1016/j.ijrobp.2017.03.030.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAged, 80 and overAntineoplastic AgentsBrain NeoplasmsFemaleGenes, rasHumansImmunotherapyLinear ModelsMaleMelanomaMiddle AgedMolecular Targeted TherapyMutationPrognosisProportional Hazards ModelsProto-Oncogene Proteins B-rafProto-Oncogene Proteins c-kitRetrospective StudiesStatistics, NonparametricTime FactorsConceptsBRAF-negative patientsBRAF-positive patientsBrain metastasesMedian survivalC-kit mutationsMelanoma patientsPrimary diagnosisWhole-brain radiation therapyOverall median survivalMulti-institutional databaseGene mutation statusOverall survivalInitial treatmentMedian timeTreatment patternsClinical parametersBRAF statusPrognostic valueNRAS mutationsRadiation therapyPatientsMutation statusMetastasisC-kitMEK inhibitors
2016
Cost-effectiveness of stereotactic radiosurgery versus whole-brain radiation therapy for up to 10 brain metastases.
Lester-Coll NH, Dosoretz AP, Magnuson WJ, Laurans MS, Chiang VL, Yu JB. Cost-effectiveness of stereotactic radiosurgery versus whole-brain radiation therapy for up to 10 brain metastases. Journal Of Neurosurgery 2016, 125: 18-25. PMID: 27903191, DOI: 10.3171/2016.7.gks161499.Peer-Reviewed Original ResearchConceptsWhole-brain radiation therapyIncremental cost-effectiveness ratioQuality-adjusted life yearsBrain metastasesStereotactic radiosurgeryProbabilistic sensitivity analysesJLGK0901 studyRadiation therapyEffective treatment optionMethods A Markov modelCost-effectiveness ratioHealth state utilitiesCost-effective relativeStandard gamble methodA Markov modelRecurrence ratePatient preferencesTreatment optionsPatientsMetastasisLife yearsEuropean OrganizationPay thresholdsEnd pointCost-effective strategyImpact of Deferring Radiation Therapy in Patients With Epidermal Growth Factor Receptor–Mutant Non-Small Cell Lung Cancer Who Develop Brain Metastases
Magnuson WJ, Yeung JT, Guillod PD, Gettinger SN, Yu JB, Chiang VL. Impact of Deferring Radiation Therapy in Patients With Epidermal Growth Factor Receptor–Mutant Non-Small Cell Lung Cancer Who Develop Brain Metastases. International Journal Of Radiation Oncology • Biology • Physics 2016, 95: 673-679. PMID: 27034176, DOI: 10.1016/j.ijrobp.2016.01.037.Peer-Reviewed Original ResearchConceptsWhole-brain radiation therapyUpfront EGFR-TKIIntracranial progression-free survivalUpfront radiation therapyProgression-free survivalBrain metastasesEGFR-TKI groupEGFR-TKIEGFR-mutant NSCLCOverall survivalRadiation therapyEpidermal Growth Factor Receptor–Mutant NonDisease-specific Graded Prognostic AssessmentUpfront EGFR tyrosine kinase inhibitorsEGFR-TKI resistance mutationSmall cell lung cancerEGFR tyrosine kinase inhibitorsEGFR-TKI useMedian overall survivalSimilar overall survivalUpfront RT groupInferior overall survivalCell lung cancerMutant lung adenocarcinomaEpidermal growth factor receptorCeritinib enables stereotactic radiosurgery to a previously untreatable symptomatic brain metastasis in a patient with ALK rearranged non-small cell lung cancer
Qian J, Yu J, Gettinger S, Chiang V. Ceritinib enables stereotactic radiosurgery to a previously untreatable symptomatic brain metastasis in a patient with ALK rearranged non-small cell lung cancer. Cancer Treatment And Research Communications 2016, 6: 17-19. DOI: 10.1016/j.ctrc.2016.02.002.Peer-Reviewed Original ResearchNon-small cell lung cancerAnaplastic lymphoma kinaseWhole-brain radiation therapySymptomatic brain metastasesBrain radiation therapyCell lung cancerBrain metastasesStereotactic radiosurgerySystemic therapyLung cancerRadiation therapyActive small-molecule tyrosine kinase inhibitorLarge symptomatic brain metastasisNext-generation ALK inhibitorsSmall molecule tyrosine kinase inhibitorsYear old Caucasian femaleMolecule tyrosine kinase inhibitorsGeneration ALK inhibitorsALK inhibitor crizotinibOld Caucasian femaleKey driver mutationsTyrosine kinase inhibitorsLocal therapyInhibitor crizotinibALK inhibitorsA contemporary dose selection algorithm for stereotactic radiosurgery in the treatment of brain metastases - An initial report.
Colaco RJ, Yu JB, Bond JS, Bindra RS, Contessa JN, Knisely JPS, Chiang VL. A contemporary dose selection algorithm for stereotactic radiosurgery in the treatment of brain metastases - An initial report. Journal Of Radiosurgery And SBRT 2016, 4: 43-52. PMID: 29296425, PMCID: PMC5658834.Peer-Reviewed Original ResearchWhole brain radiotherapyDistant intracranial recurrenceLocal recurrenceBrain metastasesRTOG 90Overall local recurrence ratePrevious whole-brain radiotherapyProspective phase 2 trialWhole-brain radiation therapyBrain radiation therapyLocal recurrence rateMonths overall survivalPhase 2 trialRisk regression analysisGuideline dosesBrain radiotherapyPrimary endpointIntracranial recurrenceOverall survivalFine-GrayPrescription dosesRecurrence rateRetrospective outcomesMedical recordsLesion volume
2013
Stereotactic laser induced thermotherapy (LITT): a novel treatment for brain lesions regrowing after radiosurgery
Torres-Reveron J, Tomasiewicz HC, Shetty A, Amankulor NM, Chiang VL. Stereotactic laser induced thermotherapy (LITT): a novel treatment for brain lesions regrowing after radiosurgery. Journal Of Neuro-Oncology 2013, 113: 495-503. PMID: 23677747, DOI: 10.1007/s11060-013-1142-2.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedBrain NeoplasmsFeasibility StudiesFemaleFollow-Up StudiesHumansHyperthermia, InducedImaging, Three-DimensionalLaser TherapyMagnetic Resonance ImagingMaleMiddle AgedNeoplasm Recurrence, LocalNeoplasmsPostoperative ComplicationsPrognosisRadiation InjuriesRadiosurgerySurvival RateConceptsNeurological symptomsBrain metastasesTreatment optionsStereotactic radiosurgeryWhole-brain radiation therapyGamma Knife stereotactic radiosurgeryBrain radiation therapyInitial favorable responseProgressive neurological symptomsAdverse radiation effectsNovel treatment optionsCases steroidsOngoing steroidsSymptom controlPatient comorbiditiesSurgical resectionSymptomatic reliefMetastatic lesionsRecurrent edemaRadiation necrosisBiopsy resultsDisease burdenMinimal morbidityBrain lesionsThermocoagulation proceduresRole of stereotactic radiosurgery in patients with more than four brain metastases
Jairam V, Chiang V, Yu JB, Knisely J. Role of stereotactic radiosurgery in patients with more than four brain metastases. CNS Oncology 2013, 2: 181-193. PMID: 24273642, PMCID: PMC3835313, DOI: 10.2217/cns.13.4.Peer-Reviewed Original ResearchConceptsWhole-brain radiation therapyBrain metastasesStereotactic radiosurgeryIntracranial relapseUse of SRSFirst-line therapyFirst-line treatmentNeurocognitive side effectsTreatment of patientsMultiple small dosesUndetected metastasesMedical CenterRadiation therapyHigh doseInstitutional trialsSide effectsPatientsMetastasisWhole brainSmall dosesTarget volumeEarly dementiaMemory lossRadiation treatmentRelapse
2011
Stereotactic radiosurgery with or without whole-brain radiotherapy for brain metastases: an update
Park HS, Chiang VL, Knisely JP, Raldow AC, Yu JB. Stereotactic radiosurgery with or without whole-brain radiotherapy for brain metastases: an update. Expert Review Of Anticancer Therapy 2011, 11: 1731-1738. PMID: 22050022, DOI: 10.1586/era.11.165.Peer-Reviewed Original ResearchConceptsWhole-brain radiation therapyStereotactic radiosurgeryBrain metastasesAddition of SRSUse of SRSMD Anderson Cancer CenterWhole brain radiotherapyLocal tumor controlStandard of careAnderson Cancer CenterNormal brain tissueNonrandomized evidenceLimited metastasesOligometastatic diseaseCancer CenterTumor controlRelative sparingRadiation therapyBrain tissueMetastasisSingle fractionNormal tissuesPatientsRadiosurgeryTrials
2008
Gamma Knife surgery for the treatment of melanoma metastases: the effect of intratumoral hemorrhage on survival.
Redmond AJ, DiLuna ML, Hebert R, Moliterno JA, Desai R, Knisely JP, Chiang VL. Gamma Knife surgery for the treatment of melanoma metastases: the effect of intratumoral hemorrhage on survival. Journal Of Neurosurgery 2008, 109 Suppl: 99-105. PMID: 19123895, DOI: 10.3171/jns/2008/109/12/s16.Peer-Reviewed Original ResearchConceptsGamma Knife surgeryMelanoma metastasesIntratumoral bleedingTime of GKSWhole-brain radiation therapyPost-GKS hemorrhageMelanoma brain metastasesRate of hemorrhageConnecticut Tumor RegistryMalignant melanoma metastaticSurvival of patientsTotal tumor volumeTreatment-specific factorsMelanoma metastaticPosttreatment bleedingAntithrombotic medicationBrain metastasesMetastasis locationOverall survivalSolitary metastasisTumor RegistryTumor burdenWorse prognosisIntracranial metastasesPatient survival