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1. Immune checkpoint inhibition and single fraction stereotactic radiosurgery in brain metastases from non-small cell lung cancer: an international multicenter study of 395 patients

Author

Lehrer, Eric J., Khosla, Atulya A., Ozair, Ahmad, Gurewitz, Jason, Bernstein, Kenneth, Kondziolka, Douglas, Niranjan, Ajay, Wei, Zhishuo, Lunsford, L. Dade, Mathieu, David, Trudel, Claire, Deibert, Christopher P., Malouff, Timothy D., Ruiz-Garcia, Henry, Peterson, Jennifer L., Patel, Samir, Bonney, Phillip, Hwang, Lindsay, Yu, Cheng, Zada, Gabriel, Picozzi, Piero, Franzini, Andrea, Attuati, Luca, Prasad, Rahul N., Raval, Raju R., Palmer, Joshua D., Lee, Cheng-chia, Yang, Huai-che, Fakhoury, Kareem R., Rusthoven, Chad G., Dickstein, Daniel R., Sheehan, Jason P., Trifiletti, Daniel M., and Ahluwalia, Manmeet S.

Published
2023
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4. A phase I/Ib trial and biological correlate analysis of neoadjuvant SBRT with single-dose durvalumab in HPV-unrelated locally advanced HNSCC

Author

Darragh, Laurel B., Knitz, Michael M., Hu, Junxiao, Clambey, Eric T., Backus, Jennifer, Dumit, Andrew, Samedi, Von, Bubak, Andrew, Greene, Casey, Waxweiler, Timothy, Mehrotra, Sanjana, Bhatia, Shilpa, Gadwa, Jacob, Bickett, Thomas, Piper, Miles, Fakhoury, Kareem, Liu, Arthur, Petit, Joshua, Bowles, Daniel, Thaker, Ashesh, Atiyeh, Kimberly, Goddard, Julie, Hoyer, Robert, Van Bokhoven, Adrie, Jordan, Kimberly, Jimeno, Antonio, D’Alessandro, Angelo, Raben, David, McDermott, Jessica D., and Karam, Sana D.

Published
2022
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5. Concurrent Administration of Immune Checkpoint Inhibitors and Single Fraction Stereotactic Radiosurgery in Patients With Non-Small Cell Lung Cancer, Melanoma, and Renal Cell Carcinoma Brain Metastases is Not Associated With an Increased Risk of Radiation Necrosis Over Nonconcurrent Treatment: An International Multicenter Study of 657 Patients

Author

Lehrer, Eric J., Kowalchuk, Roman O., Gurewitz, Jason, Bernstein, Kenneth, Kondziolka, Douglas, Niranjan, Ajay, Wei, Zhishuo, Lunsford, L. Dade, Fakhoury, Kareem R., Rusthoven, Chad G., Mathieu, David, Trudel, Claire, Malouff, Timothy D., Ruiz-Garcia, Henry, Bonney, Phillip, Hwang, Lindsay, Yu, Cheng, Zada, Gabriel, Patel, Samir, Deibert, Christopher P., Picozzi, Piero, Franzini, Andrea, Attuati, Luca, Prasad, Rahul N., Raval, Raju R., Palmer, Joshua D., Lee, Cheng-chia, Yang, Huai-che, Harmsen, William S., Jones, Brianna M., Sharma, Sonam, Ahluwalia, Manmeet S., Sheehan, Jason P., and Trifiletti, Daniel M.

Published
2023
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6. Stereotactic radiosurgery for clinoid meningiomas: a multi-institutional study

Author

Bunevicius, Adomas, Pikis, Stylianos, Anand, Rithika Kormath, Nabeel, Ahmed M., Reda, Wael A., Tawadros, Sameh R., Abdelkarim, Khaled, El-Shehaby, Amr M. N., Emad, Reem M., Chytka, Tomas, Liscak, Roman, Caceres, Marco Perez, Mathieu, David, Lee, Cheng-chia, Yang, Huai-che, Picozzi, Piero, Franzini, Andrea, Attuati, Luca, Speckter, Herwin, Olivo, Jeremy, Patel, Samir, Cifarelli, Christopher P., Cifarelli, Daniel T., Hack, Joshua D., Strickland, Ben A., Zada, Gabriel, Chang, Eric L., Fakhoury, Kareem R., Rusthoven, Chad G., Warnick, Ronald E., and Sheehan, Jason

Published
2021
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7. Author Correction: A phase I/Ib trial and biological correlate analysis of neoadjuvant SBRT with single-dose durvalumab in HPV-unrelated locally advanced HNSCC

Author

Darragh, Laurel B., Knitz, Michael M., Hu, Junxiao, Clambey, Eric T., Backus, Jennifer, Dumit, Andrew, Samedi, Von, Bubak, Andrew, Greene, Casey, Waxweiler, Timothy, Mehrotra, Sanjana, Bhatia, Shilpa, Gadwa, Jacob, Bickett, Thomas, Piper, Miles, Fakhoury, Kareem, Liu, Arthur, Petit, Joshua, Bowles, Daniel, Thaker, Ashesh, Atiyeh, Kimberly, Goddard, Julie, Hoyer, Robert, Van Bokhoven, Adrie, Jordan, Kimberly, Jimeno, Antonio, D’Alessandro, Angelo, Raben, David, McDermott, Jessica D., and Karam, Sana D.

Published
2023
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9. Safety and Efficacy of Accelerated Hypofractionation and Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma Patients With Varying Degrees of Hepatic Impairment

Author

Nabavizadeh, Nima, Waller, Joseph G., Fain, Robert, III, Chen, Yiyi, Degnin, Catherine R., Elliott, David A., Mullins, Brandon T., Patel, Ishan A., Dyer, Brandon A., Fakhoury, Kareem, Naugler, Willscott E., Farsad, Khashayar, Tanyi, James A., Fuss, Martin, Thomas, Charles R., Jr., and Hung, Arthur Y.

Published
2018
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11. Practical Implementation of Emergent After-Hours Radiation Treatment Process Using Remote Treatment Planning on Optimized Diagnostic CT Scans

Author

Fakhoury, Kareem R, primary, Schubert, Leah K, additional, Coyne, Mychaela D, additional, Aldridge, Wes, additional, Zeiler, Sabrina, additional, Stuhr, Kelly, additional, Waxweiler, Timothy V, additional, Robin, Tyler P, additional, Schefter, Tracey E, additional, Kavanagh, Brian D, additional, and Nath, Sameer K, additional

Published
2022
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12. Author Correction: A phase I/Ib trial and biological correlate analysis of neoadjuvant SBRT with single-dose durvalumab in HPV-unrelated locally advanced HNSCC

Author

Darragh, Laurel B., primary, Knitz, Michael M., additional, Hu, Junxiao, additional, Clambey, Eric T., additional, Backus, Jennifer, additional, Dumit, Andrew, additional, Samedi, Von, additional, Bubak, Andrew, additional, Greene, Casey, additional, Waxweiler, Timothy, additional, Mehrotra, Sanjana, additional, Bhatia, Shilpa, additional, Gadwa, Jacob, additional, Bickett, Thomas, additional, Piper, Miles, additional, Fakhoury, Kareem, additional, Liu, Arthur, additional, Petit, Joshua, additional, Bowles, Daniel, additional, Thaker, Ashesh, additional, Atiyeh, Kimberly, additional, Goddard, Julie, additional, Hoyer, Robert, additional, Van Bokhoven, Adrie, additional, Jordan, Kimberly, additional, Jimeno, Antonio, additional, D’Alessandro, Angelo, additional, Raben, David, additional, McDermott, Jessica D., additional, and Karam, Sana D., additional

Published
2022
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13. RADT-07. RADIOGRAPHIC “NECROSIS" FOLLOWING SINGLE-FRACTION SRS AND IMMUNE CHECKPOINT INHIBITION IS ASSOCIATED WITH IMPROVED SURVIVAL IN PATIENTS WITH BRAIN METASTASES: AN INTERNATIONAL MULTICENTER STUDY

Author

Lehrer, Eric, primary, Ahluwalia, Manmeet, additional, Gurewitz, Jason, additional, Bernstein, Kenneth, additional, Kondziolka, Douglas, additional, Wei, Zhishuo, additional, Niranjan, Ajay, additional, Lunsford, L Dade, additional, Fakhoury, Kareem, additional, Rusthoven, Chad, additional, Mathieu, David, additional, Trudel, Claire, additional, Malouff, Timothy, additional, Ruiz-Garcia, Henry, additional, Bonney, Phillip, additional, Hwang, Lindsay, additional, Yu, Cheng, additional, Zada, Gabriel, additional, Patel, Samir, additional, Deibert, Christopher, additional, Picozzi, Piero, additional, Franzini, Andrea, additional, Attuati, Luca, additional, Prasad, Rahul, additional, Raval, Raju, additional, Palmer, Joshua, additional, Lee, Cheng-Chia, additional, Yang, Huai-che, additional, Jones, Brianna, additional, Green, Sheryl, additional, Sheehan, Jason, additional, and Trifiletti, Daniel, additional

Published
2022
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14. Concurrent Administration of Immune Checkpoint Inhibitors and Stereotactic Radiosurgery Is Well-Tolerated in Patients With Melanoma Brain Metastases: An International Multicenter Study of 203 Patients

Author

Lehrer, Eric J., primary, Gurewitz, Jason, additional, Bernstein, Kenneth, additional, Kondziolka, Douglas, additional, Fakhoury, Kareem R., additional, Rusthoven, Chad G., additional, Niranjan, Ajay, additional, Wei, Zhishuo, additional, Lunsford, L. Dade, additional, Malouff, Timothy D., additional, Ruiz-Garcia, Henry, additional, Peterson, Jennifer L., additional, Bonney, Phillip, additional, Hwang, Lindsay, additional, Yu, Cheng, additional, Zada, Gabriel, additional, Deibert, Christopher P., additional, Prasad, Rahul N., additional, Raval, Raju R., additional, Palmer, Joshua D., additional, Patel, Samir, additional, Picozzi, Piero, additional, Franzini, Andrea, additional, Attuati, Luca, additional, Mathieu, David, additional, Trudel, Claire, additional, Lee, Cheng-chia, additional, Yang, Huai-che, additional, Jones, Brianna M., additional, Green, Sheryl, additional, Ahluwalia, Manmeet S., additional, Sheehan, Jason P., additional, and Trifiletti, Daniel M., additional

Published
2022
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15. Imaging-defined necrosis after treatment with single-fraction stereotactic radiosurgery and immune checkpoint inhibitors and its potential association with improved outcomes in patients with brain metastases: an international multicenter study of 697 patients

Author

Lehrer, Eric J., primary, Ahluwalia, Manmeet S., additional, Gurewitz, Jason, additional, Bernstein, Kenneth, additional, Kondziolka, Douglas, additional, Niranjan, Ajay, additional, Wei, Zhishuo, additional, Lunsford, L. Dade, additional, Fakhoury, Kareem R., additional, Rusthoven, Chad G., additional, Mathieu, David, additional, Trudel, Claire, additional, Malouff, Timothy D., additional, Ruiz-Garcia, Henry, additional, Bonney, Phillip, additional, Hwang, Lindsay, additional, Yu, Cheng, additional, Zada, Gabriel, additional, Patel, Samir, additional, Deibert, Christopher P., additional, Picozzi, Piero, additional, Franzini, Andrea, additional, Attuati, Luca, additional, Prasad, Rahul N., additional, Raval, Raju R., additional, Palmer, Joshua D., additional, Lee, Cheng-Chia, additional, Yang, Huai-Che, additional, Jones, Brianna M., additional, Green, Sheryl, additional, Sheehan, Jason P., additional, and Trifiletti, Daniel M., additional

Published
2022
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16. Imaging-defined necrosis after treatment with single-fraction stereotactic radiosurgery and immune checkpoint inhibitors and its potential association with improved outcomes in patients with brain metastases: an international multicenter study of 697...

Author

Lehrer, Eric J., Ahluwalia, Manmeet S., Gurewitz, Jason, Bernstein, Kenneth, Kondziolka, Douglas, Niranjan, Ajay, Zhishuo Wei, Lunsford, L. Dade, Fakhoury, Kareem R., Rusthoven, Chad G., Mathieu, David, Trudel, Claire, Malouff, Timothy D., Ruiz-Garcia, Henry, Bonney, Phillip, Hwang, Lindsay, Cheng Yu, Zada, Gabriel, Patel, Samir, and Deibert, Christopher P.

Published
2023
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17. Clinical and radiologic outcomes after stereotactic radiosurgery for meningiomas in direct contact with the optic apparatus: an international multicenter study

Author

Asuzu, David T., primary, Bunevicius, Adomas, additional, Kormath Anand, Rithika, additional, Suleiman, Mohanad, additional, Nabeel, Ahmed M., additional, Reda, Wael A., additional, Tawadros, Sameh R., additional, Abdel Karim, Khaled, additional, El-Shehaby, Amr M. N., additional, Emad Eldin, Reem M., additional, Chytka, Tomas, additional, Liščák, Roman, additional, Sheehan, Kimball, additional, Sheehan, Darrah, additional, Perez Caceres, Marco, additional, Mathieu, David, additional, Lee, Cheng-chia, additional, Yang, Huai-che, additional, Picozzi, Piero, additional, Franzini, Andrea, additional, Attuati, Luca, additional, Speckter, Herwin, additional, Olivo, Jeremy, additional, Patel, Samir, additional, Cifarelli, Christopher P., additional, Cifarelli, Daniel T., additional, Hack, Joshua D., additional, Strickland, Ben A., additional, Zada, Gabriel, additional, Chang, Eric L., additional, Fakhoury, Kareem R., additional, Rusthoven, Chad G., additional, Warnick, Ronald E., additional, and Sheehan, Jason P., additional

Published
2022
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18. Radiation necrosis in renal cell carcinoma brain metastases treated with checkpoint inhibitors and radiosurgery: An international multicenter study

Author

Lehrer, Eric J., primary, Gurewitz, Jason, additional, Bernstein, Kenneth, additional, Patel, Dev, additional, Kondziolka, Douglas, additional, Niranjan, Ajay, additional, Wei, Zhishuo, additional, Lunsford, L. Dade, additional, Malouff, Timothy D., additional, Ruiz‐Garcia, Henry, additional, Patel, Samir, additional, Bonney, Phillip A., additional, Hwang, Lindsay, additional, Yu, Cheng, additional, Zada, Gabriel, additional, Mathieu, David, additional, Trudel, Claire, additional, Prasad, Rahul N., additional, Palmer, Joshua D., additional, Jones, Brianna M., additional, Sharma, Sonam, additional, Fakhoury, Kareem R., additional, Rusthoven, Chad G., additional, Deibert, Christopher P., additional, Picozzi, Piero, additional, Franzini, Andrea, additional, Attuati, Luca, additional, Lee, Cheng‐Chia, additional, Yang, Huai‐Che, additional, Ahluwalia, Manmeet S., additional, Sheehan, Jason P., additional, and Trifiletti, Daniel M., additional

Published
2022
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19. Stereotactic Radiosurgery for Perioptic Meningiomas: An International, Multicenter Study

Author

Bunevicius, Adomas, primary, Anand, Rithika Kormath, additional, Suleiman, Mohanad, additional, Nabeel, Ahmed M, additional, Reda, Wael A, additional, Tawadros, Sameh R, additional, Abdelkarim, Khaled, additional, El-Shehaby, Amr M N, additional, Emad, Reem M, additional, Chytka, Tomas, additional, Liscak, Roman, additional, Sheehan, Kimball, additional, Sheehan, Darrah, additional, Caceres, Marco Perez, additional, Mathieu, David, additional, Lee, Cheng-chia, additional, Yang, Huai-che, additional, Picozzi, Piero, additional, Franzini, Andrea, additional, Attuati, Luca, additional, Speckter, Herwin, additional, Olivo, Jeremy, additional, Patel, Samir, additional, Cifarelli, Christopher P, additional, Cifarelli, Daniel T, additional, Hack, Joshua D, additional, Strickland, Ben A, additional, Zada, Gabriel, additional, Chang, Eric L, additional, Fakhoury, Kareem R, additional, Rusthoven, Chad G, additional, Warnick, Ronald E, additional, and Sheehan, Jason, additional

Published
2021
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25. Perioperative Oral Nutrition Supplementation Reduces Prevalence of Sarcopenia following Radical Cystectomy: Results of a Prospective Randomized Controlled Trial

Author

Ritch, Chad R., primary, Cookson, Michael S., additional, Clark, Peter E., additional, Chang, Sam S., additional, Fakhoury, Kareem, additional, Ralls, Veronica, additional, Thu, Muang H., additional, Penson, David F., additional, Smith, Joseph A., additional, and Silver, Heidi J., additional

Published
2019
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29. RADIOGRAPHIC 'NECROSIS' FOLLOWING SINGLE-FRACTION SRS AND IMMUNE CHECKPOINT INHIBITION IS ASSOCIATED WITH IMPROVED SURVIVAL IN PATIENTS WITH BRAIN METASTASES: AN INTERNATIONAL MULTICENTER STUDY

Author

Lehrer, Eric, Ahluwalia, Manmeet, Gurewitz, Jason, Bernstein, Kenneth, Kondziolka, Douglas, Wei, Zhishuo, Niranjan, Ajay, Lunsford, L. Dade, Fakhoury, Kareem, Rusthoven, Chad, Mathieu, David, Trudel, Claire, Malouff, Timothy, Ruiz-Garcia, Henry, Bonney, Phillip, Hwang, Lindsay, Yu, Cheng, Zada, Gabriel, Patel, Samir, Deibert, Christopher, Picozzi, Piero, Andrea Franzini, Attuati, Luca, Prasad, Rahul, Raval, Raju, Palmer, Joshua, Lee, Cheng-Chia, Yang, Huai-Che, Jones, Brianna, Green, Sheryl, Sheehan, Jason, and Trifiletti, Daniel

31. Does pre-irradiation gross tumor volume predict the risk of progression after radiation therapy in pediatric patients with adamantinomatous craniopharyngioma?

Author

Brooks T, Gao D, Dorris K, Boone K, Mirsky DM, Staulcup S, Prince E, Moskalenko M, Ignowski E, Wandrey N, Fakhoury K, Hankinson TC, and Milgrom SA

Abstract

Objective: In a cohort of patients who were treated with resection and adjuvant radiotherapy (RT) for adamantinomatous craniopharyngioma (ACP), the authors aimed to determine whether gross tumor volume (GTV) at the initiation of RT was associated with the risk of progressive disease (PD) following treatment., Methods: Pediatric and adolescent patients who received surgery and RT for ACP at a single institution from 1998 to 2021 were identified. Univariable Cox regression analyses (UVAs) were performed to assess the association between pre-RT GTV and PD after RT. Multivariable analyses (MVAs) were used to control for potential confounders. Two different endpoints were used to define PD. The first definition was based on radiographic tumor growth, with or without progression of clinical symptoms. The second definition was the requirement for an additional tumor-directed intervention following the completion of RT., Results: Forty-eight patients were eligible for inclusion. The median age at diagnosis was 7.9 years (range 2.1-17.4 years). All patients were treated with surgery and RT with a median dose of 52.2 Gy (range 45-55.8 Gy) and median GTV of 9.86 cm3 (range 0.7-117.7 cm3). After a median follow-up of 66.4 months, 8 patients experienced PD based on both definitions. The 5-year event-free survival rate was 85.4% (95% CI 74.1%-98.3%). On both UVA and MVA, GTV was significantly associated with an increased likelihood of PD (UVA: HR 1.02, 95% CI 1.00-1.04, p = 0.02; MVA: HR 1.10, 95% CI 1.02-1.19, p = 0.01). However, after exclusion of a single outlier with a GTV of 117.7 cm3 prior to RT (remainder of the cohort: range 0.7-37.3 cm3), a second analysis identified no significant association between GTV and PD (UVA: HR 1.03, 95% CI 0.96-1.10, p = 0.4; MVA: HR 1.06, 95% CI 0.96-1.17, p = 0.24)., Conclusions: The authors conclude that for most children and adolescents with ACP, the GTV at the initiation of RT is not associated with the risk of PD. This finding may influence surgical practice, because it suggests that aggressive tumor debulking for the purpose of improving the efficacy of RT may not be necessary. In the case of giant tumors, however, novel strategies may be needed for tumor control.

Published
2024
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32. Prospective surveillance of patients after palliative radiation for painful bone metastases: a feasibility study.

Author

McLean-Thomas L, Fakhoury K, Ross RB, Mahoney R, Gortmaker N, Hu J, and Karam SD

Abstract

Background: Bone metastasis is the most common cause of cancer-related pain. Radiation therapy (RT) can provide successful palliation but there is currently no consensus for surveillance after palliative radiation. This study aimed to assess the feasibility of surveillance after RT for painful bone metastases., Methods: The study took place in an academic cancer center. Patient feasibility measures included % of calls answered, ease of recruitment and study retention. Clinician measures included % of calls made within 3 days, call time and qualitative feedback. Patients were identified with a painful bone metastasis treated with RT. The bone metastasis had a worst pain score of at least 4 (0-10 scale), with pain localized to a radiographically confirmed lesion. Patients were called at weeks 1, 4 and 8 following RT. Pain response and opioid use were assessed. Quality of life was assessed using a validated questionnaire. Descriptive statistics were used to assess if these metrics were met for patients and clinicians over 8 weeks post-RT., Results: Twenty patients were consented: 14 participants completed treatment and were not hospitalized or deceased prior to week 1. The patients were 50% male and 50% female. Recruitment was completed quickly, with no patients withdrawing. Response rate was week 1: 85% week 4: 83% and week 8: 83%. Six patients were referred back to their provider for pain management. Calls were made to patients within 3 days a median of 63% of the time (range, 40-82%), with a median call time of 16 (range, 8-42) minutes. Call lengths were longer for patients who required interpretation. Nurse feedback highlighted length of call and nursing time available as limitations., Conclusions: All patient feasibility measures were met. Six patients required further pain management, highlighting a need for improved follow up post-RT for bone metastases. Staffing challenges for this intervention must be overcome.

Published
2024
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33. Publisher Correction: A phase I/Ib trial and biological correlate analysis of neoadjuvant SBRT with single-dose durvalumab in HPV-unrelated locally advanced HNSCC.

Author

Darragh LB, Knitz MM, Hu J, Clambey ET, Backus J, Dumit A, Samedi V, Bubak A, Greene C, Waxweiler T, Mehrotra S, Bhatia S, Gadwa J, Bickett T, Piper M, Fakhoury K, Liu A, Petit J, Bowles D, Thaker A, Atiyeh K, Goddard J, Hoyer R, Van Bokhoven A, Jordan K, Jimeno A, D'Alessandro A, Raben D, McDermott JD, and Karam SD

Published
2024
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34. An Integrative Medicine Educational Program for Radiation Oncology Patients: Patient-Reported Outcomes.

Author

Fakhoury KR, Hu J, Kim E, Hansen KA, Koval TR, Wolff K, Foote-Pearce MC, Karam SD, and Stavas MJ

Abstract

Purpose: Complementary health approaches (CHAs) equip patients to self-manage radiation therapy (RT)-related symptoms and fulfill unmet needs, but few disclose CHA use to their radiation oncologist. An integrative medicine educational program (IMEP) was developed to assess its ability to improve patient self-efficacy for symptom management and CHA use disclosure., Methods and Materials: The IMEP included 4 1-hour sessions covering topics of (1) meditation, (2) yoga, (3) massage therapy, and (4) nutrition. Individuals over age 18 years and actively receiving RT were administered presession and postsession surveys. The primary outcomes were intention to disclose CHA use and self-efficacy. Qualitative data were assessed with a thematic approach., Results: Overall, 23 patients attended 1 or more sessions, yielding 43 completed surveys. Compared with 35.9% of participants who had disclosed CHA use before the session, 67.4% intended to disclose after the session. Of the 5 self-efficacy statements, there were significant improvements in "I have ownership over my health" (increase of 0.42; 95% CI, 0.07-0.77; P = .01), "I have tools to manage my disease on my own" (1.14; 95% CI, 0.42-1.87; P = .001), and "I have control over my cancer" (0.96; 95% CI, 0.39-1.53; P < .001). Barriers to involvement included transportation, timing relative to RT appointment, and poor performance status., Conclusions: A radiation-specific IMEP resulted in a high rate of intention to disclose CHA use and improvements in patients' reported self-efficacy to manage radiation-related symptoms. However, substantial resources were needed to deliver the IMEP. Future work must focus on increasing accessibility through telehealth and flexible timing., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Published
2023
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35. Clinical and radiologic outcomes after stereotactic radiosurgery for meningiomas in direct contact with the optic apparatus: an international multicenter study.

Author

Asuzu DT, Bunevicius A, Kormath Anand R, Suleiman M, Nabeel AM, Reda WA, Tawadros SR, Abdel Karim K, El-Shehaby AMN, Emad Eldin RM, Chytka T, Liščák R, Sheehan K, Sheehan D, Perez Caceres M, Mathieu D, Lee CC, Yang HC, Picozzi P, Franzini A, Attuati L, Speckter H, Olivo J, Patel S, Cifarelli CP, Cifarelli DT, Hack JD, Strickland BA, Zada G, Chang EL, Fakhoury KR, Rusthoven CG, Warnick RE, and Sheehan JP

Subjects
Follow-Up Studies, Humans, Retrospective Studies, Treatment Outcome, Meningeal Neoplasms diagnostic imaging, Meningeal Neoplasms radiotherapy, Meningeal Neoplasms surgery, Meningioma diagnostic imaging, Meningioma radiotherapy, Meningioma surgery, Radiosurgery adverse effects, Radiosurgery methods
Abstract

Objective: Resection of meningiomas in direct contact with the anterior optic apparatus carries risk of injury to the visual pathway. Stereotactic radiosurgery (SRS) offers a minimally invasive alternative. However, its use is limited owing to the risk of radiation-induced optic neuropathy. Few SRS studies have specifically assessed the risks and benefits of treating meningiomas in direct contact with the optic nerve, chiasm, or optic tract. The authors hypothesized that SRS is safe for select patients with meningiomas in direct contact with the anterior optic apparatus., Methods: The authors performed an international multicenter retrospective analysis of 328 patients across 11 institutions. All patients had meningiomas in direct contract with the optic apparatus. Patients were followed for a median duration of 56 months after SRS. Neurological examinations, including visual function evaluations, were performed at follow-up visits. Clinical and treatment variables were collected at each site according to protocol. Tumor volumes were assessed with serial MR imaging. Variables predictive of visual deficit were identified using univariable and multivariable logistic regression., Results: SRS was the initial treatment modality for 64.6% of patients, and 93% of patients received SRS as a single fraction. Visual information was available for 302 patients. Of these patients, visual decline occurred in 29 patients (9.6%), of whom 12 (41.4%) had evidence of tumor progression. Visual decline in the remaining 17 patients (5.6%) was not associated with tumor progression. Pre-SRS Karnofsky Performance Status predicted visual decline in adjusted analysis (adjusted OR 0.9, 95% CI 0.9-1.0, p < 0.01). Follow-up imaging data were available for 322 patients. Of these patients, 294 patients (91.3%) had radiographic evidence of stability or tumor regression at last follow up. Symptom duration was associated with tumor progression in adjusted analysis (adjusted OR 1.01, adjusted 95% CI 1.0-1.02, adjusted p = 0.02)., Conclusions: In this international multicenter study, the vast majority of patients exhibited tumor control and preservation of visual function when SRS was used to treat meningioma in direct contact with the anterior optic pathways. SRS is a relatively safe treatment modality for select patients with perioptic meningiomas in direct contact with the optic apparatus.

Published
2021
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