788 results on '"Gaspar, Laurie E."'
Search Results
2. Survival in Patients With Brain Metastases: Summary Report on the Updated Diagnosis-Specific Graded Prognostic Assessment and Definition of the Eligibility Quotient.
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Sperduto, Paul W, Mesko, Shane, Li, Jing, Cagney, Daniel, Aizer, Ayal, Lin, Nancy U, Nesbit, Eric, Kruser, Tim J, Chan, Jason, Braunstein, Steve, Lee, Jessica, Kirkpatrick, John P, Breen, Will, Brown, Paul D, Shi, Diana, Shih, Helen A, Soliman, Hany, Sahgal, Arjun, Shanley, Ryan, Sperduto, William A, Lou, Emil, Everett, Ashlyn, Boggs, Drexell H, Masucci, Laura, Roberge, David, Remick, Jill, Plichta, Kristin, Buatti, John M, Jain, Supriya, Gaspar, Laurie E, Wu, Cheng-Chia, Wang, Tony JC, Bryant, John, Chuong, Michael, An, Yi, Chiang, Veronica, Nakano, Toshimichi, Aoyama, Hidefumi, and Mehta, Minesh P
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Cancer ,Rare Diseases ,Brain Disorders ,Brain Cancer ,Detection ,screening and diagnosis ,4.2 Evaluation of markers and technologies ,Aged ,Aged ,80 and over ,Brain Neoplasms ,Female ,Humans ,Karnofsky Performance Status ,Male ,Middle Aged ,Multivariate Analysis ,Neoplasm Grading ,Neoplasms ,Precision Medicine ,Prognosis ,Proportional Hazards Models ,Clinical Sciences ,Oncology and Carcinogenesis ,Oncology & Carcinogenesis - Abstract
PurposeConventional wisdom has rendered patients with brain metastases ineligible for clinical trials for fear that poor survival could mask the benefit of otherwise promising treatments. Our group previously published the diagnosis-specific Graded Prognostic Assessment (GPA). Updates with larger contemporary cohorts using molecular markers and newly identified prognostic factors have been published. The purposes of this work are to present all the updated indices in a single report to guide treatment choice, stratify research, and define an eligibility quotient to expand eligibility.MethodsA multi-institutional database of 6,984 patients with newly diagnosed brain metastases underwent multivariable analyses of prognostic factors and treatments associated with survival for each primary site. Significant factors were used to define the updated GPA. GPAs of 4.0 and 0.0 correlate with the best and worst prognoses, respectively.ResultsSignificant prognostic factors varied by diagnosis and new prognostic factors were identified. Those factors were incorporated into the updated GPA with robust separation (P < .01) between subgroups. Survival has improved, but varies widely by GPA for patients with non-small-cell lung, breast, melanoma, GI, and renal cancer with brain metastases from 7-47 months, 3-36 months, 5-34 months, 3-17 months, and 4-35 months, respectively.ConclusionMedian survival varies widely and our ability to estimate survival for patients with brain metastases has improved. The updated GPA (available free at brainmetgpa.com) provides an accurate tool with which to estimate survival, individualize treatment, and stratify clinical trials. Instead of excluding patients with brain metastases, enrollment should be encouraged and those trials should be stratified by the GPA to ensure those trials make appropriate comparisons. Furthermore, we recommend the expansion of eligibility to allow for the enrollment of patients with previously treated brain metastases who have a 50% or greater probability of an additional year of survival (eligibility quotient > 0.50).
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- 2020
3. Estrogen/progesterone receptor and HER2 discordance between primary tumor and brain metastases in breast cancer and its effect on treatment and survival.
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Sperduto, Paul W, Mesko, Shane, Li, Jing, Cagney, Daniel, Aizer, Ayal, Lin, Nancy U, Nesbit, Eric, Kruser, Tim J, Chan, Jason, Braunstein, Steve, Lee, Jessica, Kirkpatrick, John P, Breen, Will, Brown, Paul D, Shi, Diana, Shih, Helen A, Soliman, Hany, Sahgal, Arjun, Shanley, Ryan, Sperduto, William, Lou, Emil, Everett, Ashlyn, Boggs, Drexell Hunter, Masucci, Laura, Roberge, David, Remick, Jill, Plichta, Kristin, Buatti, John M, Jain, Supriya, Gaspar, Laurie E, Wu, Cheng-Chia, Wang, Tony JC, Bryant, John, Chuong, Michael, Yu, James, Chiang, Veronica, Nakano, Toshimichi, Aoyama, Hidefumi, and Mehta, Minesh P
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Humans ,Breast Neoplasms ,Brain Neoplasms ,Receptor ,erbB-2 ,Receptors ,Progesterone ,Estrogens ,Retrospective Studies ,Biomarkers ,Tumor ,brain metastases ,breast cancer ,estrogen/progesterone/HER2 receptor discordance ,Receptor ,ErbB-2 ,Breast Cancer ,Cancer ,Clinical Trials and Supportive Activities ,Clinical Research ,2.1 Biological and endogenous factors ,Aetiology ,Good Health and Well Being ,Neurosciences ,Oncology and Carcinogenesis ,Oncology & Carcinogenesis - Abstract
BackgroundBreast cancer treatment is based on estrogen receptors (ERs), progesterone receptors (PRs), and human epidermal growth factor receptor 2 (HER2). At the time of metastasis, receptor status can be discordant from that at initial diagnosis. The purpose of this study was to determine the incidence of discordance and its effect on survival and subsequent treatment in patients with breast cancer brain metastases (BCBM).MethodsA retrospective database of 316 patients who underwent craniotomy for BCBM between 2006 and 2017 was created. Discordance was considered present if the ER, PR, or HER2 status differed between the primary tumor and the BCBM.ResultsThe overall receptor discordance rate was 132/316 (42%), and the subtype discordance rate was 100/316 (32%). Hormone receptors (HR, either ER or PR) were gained in 40/160 (25%) patients with HR-negative primary tumors. HER2 was gained in 22/173 (13%) patients with HER2-negative primary tumors. Subsequent treatment was not adjusted for most patients who gained receptors-nonetheless, median survival (MS) improved but did not reach statistical significance (HR, 17-28 mo, P = 0.12; HER2, 15-19 mo, P = 0.39). MS for patients who lost receptors was worse (HR, 27-18 mo, P = 0.02; HER2, 30-18 mo, P = 0.08).ConclusionsReceptor discordance between primary tumor and BCBM is common, adversely affects survival if receptors are lost, and represents a missed opportunity for use of effective treatments if receptors are gained. Receptor analysis of BCBM is indicated when clinically appropriate. Treatment should be adjusted accordingly.Key points1. Receptor discordance alters subtype in 32% of BCBM patients.2. The frequency of receptor gain for HR and HER2 was 25% and 13%, respectively.3. If receptors are lost, survival suffers. If receptors are gained, consider targeted treatment.
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- 2020
4. Beyond an Updated Graded Prognostic Assessment (Breast GPA): A Prognostic Index and Trends in Treatment and Survival in Breast Cancer Brain Metastases From 1985 to Today.
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Sperduto, Paul W, Mesko, Shane, Li, Jing, Cagney, Daniel, Aizer, Ayal, Lin, Nancy U, Nesbit, Eric, Kruser, Tim J, Chan, Jason, Braunstein, Steve, Lee, Jessica, Kirkpatrick, John P, Breen, Will, Brown, Paul D, Shi, Diana, Shih, Helen A, Soliman, Hany, Sahgal, Arjun, Shanley, Ryan, Sperduto, William, Lou, Emil, Everett, Ashlyn, Boggs, Drexell Hunter, Masucci, Laura, Roberge, David, Remick, Jill, Plichta, Kristin, Buatti, John M, Jain, Supriya, Gaspar, Laurie E, Wu, Cheng-Chia, Wang, Tony JC, Bryant, John, Chuong, Michael, Yu, James, Chiang, Veronica, Nakano, Toshimichi, Aoyama, Hidefumi, and Mehta, Minesh P
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Humans ,Breast Neoplasms ,Brain Neoplasms ,BRCA1 Protein ,Prognosis ,Survival Analysis ,Retrospective Studies ,Aged ,Aged ,80 and over ,Middle Aged ,Female ,Rare Diseases ,Clinical Research ,Cancer ,Breast Cancer ,Other Physical Sciences ,Clinical Sciences ,Oncology and Carcinogenesis ,Oncology & Carcinogenesis - Abstract
PurposeBrain metastases are a common sequelae of breast cancer. Survival varies widely based on diagnosis-specific prognostic factors (PF). We previously published a prognostic index (Graded Prognostic Assessment [GPA]) for patients with breast cancer with brain metastases (BCBM), based on cohort A (1985-2007, n = 642), then updated it, reporting the effect of tumor subtype in cohort B (1993-2010, n = 400). The purpose of this study is to update the Breast GPA with a larger contemporary cohort (C) and compare treatment and survival across the 3 cohorts.Methods and materialsA multi-institutional (19), multinational (3), retrospective database of 2473 patients with breast cancer with newly diagnosed brain metastases (BCBM) diagnosed from January 1, 2006, to December 31, 2017, was created and compared with prior cohorts. Associations of PF and treatment with survival were analyzed. Kaplan-Meier survival estimates were compared with log-rank tests. PF were weighted and the Breast GPA was updated such that a GPA of 0 and 4.0 correlate with the worst and best prognoses, respectively.ResultsMedian survival (MS) for cohorts A, B, and C improved over time (from 11, to 14 to 16 months, respectively; P < .01), despite the subtype distribution becoming less favorable. PF significant for survival were tumor subtype, Karnofsky Performance Status, age, number of BCBMs, and extracranial metastases (all P < .01). MS for GPA 0 to 1.0, 1.5-2.0, 2.5-3.0, and 3.5-4.0 was 6, 13, 24, and 36 months, respectively. Between cohorts B and C, the proportion of human epidermal receptor 2 + subtype decreased from 31% to 18% (P < .01) and MS in this subtype increased from 18 to 25 months (P < .01).ConclusionsMS has improved modestly but varies widely by diagnosis-specific PF. New PF are identified and incorporated into an updated Breast GPA (free online calculator available at brainmetgpa.com). The Breast GPA facilitates clinical decision-making and will be useful for stratification of future clinical trials. Furthermore, these data suggest human epidermal receptor 2-targeted therapies improve clinical outcomes in some patients with BCBM.
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- 2020
5. Estimating survival in patients with gastrointestinal cancers and brain metastases: An update of the graded prognostic assessment for gastrointestinal cancers (GI-GPA).
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Sperduto, Paul W, Fang, Penny, Li, Jing, Breen, William, Brown, Paul D, Cagney, Daniel, Aizer, Ayal, Yu, James B, Chiang, Veronica, Jain, Supriya, Gaspar, Laurie E, Myrehaug, Sten, Sahgal, Arjun, Braunstein, Steve, Sneed, Penny, Cameron, Brent, Attia, Albert, Molitoris, Jason, Wu, Cheng-Chia, Wang, Tony JC, Lockney, Natalie A, Beal, Kathryn, Parkhurst, Jessica, Buatti, John M, Shanley, Ryan, Lou, Emil, Tandberg, Daniel D, Kirkpatrick, John P, Shi, Diana, Shih, Helen A, Chuong, Michael, Saito, Hirotake, Aoyama, Hidefumi, Masucci, Laura, Roberge, David, and Mehta, Minesh P
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Brain metastases ,End-of-life ,Gastrointestinal cancers ,Prognosis ,Cancer ,Rare Diseases ,Brain Disorders ,Digestive Diseases ,Clinical Research - Abstract
BackgroundPatients with gastrointestinal cancers and brain metastases (BM) represent a unique and heterogeneous population. Our group previously published the Diagnosis-Specific Graded Prognostic Assessment (DS-GPA) for patients with GI cancers (GI-GPA) (1985-2007, n = 209). The purpose of this study is to update the GI-GPA based on a larger contemporary database.MethodsAn IRB-approved consortium database analysis was performed using a multi-institutional (18), multi-national (3) cohort of 792 patients with gastrointestinal (GI) cancers, with newly-diagnosed BM diagnosed between 1/1/2006 and 12/31/2017. Survival was measured from date of first treatment for BM. Multiple Cox regression was used to select and weight prognostic factors in proportion to their hazard ratios. These factors were incorporated into the updated GI-GPA.ResultsMedian survival (MS) varied widely by primary site and other prognostic factors. Four significant factors (KPS, age, extracranial metastases and number of BM) were used to formulate the updated GI-GPA. Overall MS for this cohort remains poor; 8 months. MS by GPA was 3, 7, 11 and 17 months for GPA 0-1, 1.5-2, 2.5-3.0 and 3.5-4.0, respectively. >30% present in the worst prognostic group (GI-GPA of ≤1.0).ConclusionsBrain metastases are not uncommon in GI cancer patients and MS varies widely among them. This updated GI-GPA index improves our ability to estimate survival for these patients and will be useful for therapy selection, end-of-life decision-making and stratification for future clinical trials. A user-friendly, free, on-line app to calculate the GPA score and estimate survival for an individual patient is available at brainmetgpa.com.
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- 2019
6. Survival and prognostic factors in patients with gastrointestinal cancers and brain metastases: have we made progress?
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Sperduto, Paul W, Fang, Penny, Li, Jing, Breen, William, Brown, Paul D, Cagney, Daniel, Aizer, Ayal, Yu, James, Chiang, Veronica, Jain, Supriya, Gaspar, Laurie E, Myrehaug, Sten, Sahgal, Arjun, Braunstein, Steve, Sneed, Penny, Cameron, Brent, Attia, Albert, Molitoris, Jason, Wu, Cheng-Chia, Wang, Tony JC, Lockney, Natalie, Beal, Kathryn, Parkhurst, Jessica, Buatti, John M, Shanley, Ryan, Lou, Emil, Tandberg, Daniel D, Kirkpatrick, John P, Shi, Diana, Shih, Helen A, Chuong, Michael, Saito, Hirotake, Aoyama, Hidefumi, Masucci, Laura, Roberge, David, and Mehta, Minesh P
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Humans ,Gastrointestinal Neoplasms ,Brain Neoplasms ,Prognosis ,Cohort Studies ,Adult ,Aged ,Aged ,80 and over ,Middle Aged ,Female ,Male ,Kaplan-Meier Estimate ,Cancer ,Rare Diseases ,Digestive Diseases ,Clinical Research ,4.1 Discovery and preclinical testing of markers and technologies ,Detection ,screening and diagnosis ,Clinical Sciences ,General Clinical Medicine - Abstract
The literature describing the prognosis of patients with gastrointestinal (GI) cancers and brain metastases (BM) is sparse. Our group previously published a prognostic index, the Graded Prognostic Assessment (GPA) for GI cancer patients with BM, based on 209 patients diagnosed from 1985-2005. The purpose of this analysis is to identify prognostic factors for GI cancer patients with newly diagnosed BM in a larger contemporary cohort. A multi-institutional retrospective IRB-approved database of 792 GI cancer patients with new BM diagnosed from 1/1/2006 to 12/31/2016 was created. Demographic data, clinical parameters, and treatment were correlated with survival and time from primary diagnosis to BM (TPDBM). Kaplan-Meier median survival (MS) estimates were calculated and compared with log-rank tests. The MS from time of first treatment for BM for the prior and current cohorts were 5 and 8 months, respectively (P < 0.001). Eight prognostic factors (age, stage, primary site, resection of primary tumor, Karnofsky Performance Status (KPS), extracranial metastases, number of BM and Hgb were found to be significant for survival, in contrast to only one (KPS) in the prior cohort. In this cohort, the most common primary sites were rectum (24%) and esophagus (23%). Median TPDBM was 22 months. Notably, 37% (267/716) presented with poor prognosis (GPA 0-1.0). Although little improvement in overall survival in this cohort has been achieved in recent decades, survival varies widely and multiple new prognostic factors were identified. Future work will translate these factors into a prognostic index to facilitate clinical decision-making and stratification of future clinical trials.
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- 2019
7. Safety and Efficacy of a Five-Fraction Stereotactic Body Radiotherapy Schedule for Centrally Located Non-Small-Cell Lung Cancer: NRG Oncology/RTOG 0813 Trial.
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Bezjak, Andrea, Paulus, Rebecca, Gaspar, Laurie E, Timmerman, Robert D, Straube, William L, Ryan, William F, Garces, Yolanda I, Pu, Anthony T, Singh, Anurag K, Videtic, Gregory M, McGarry, Ronald C, Iyengar, Puneeth, Pantarotto, Jason R, Urbanic, James J, Sun, Alexander Y, Daly, Megan E, Grills, Inga S, Sperduto, Paul, Normolle, Daniel P, Bradley, Jeffrey D, and Choy, Hak
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Biomedical and Clinical Sciences ,Clinical Sciences ,Oncology and Carcinogenesis ,Lung ,Clinical Research ,Lung Cancer ,Clinical Trials and Supportive Activities ,Cancer ,Evaluation of treatments and therapeutic interventions ,6.5 Radiotherapy and other non-invasive therapies ,Aged ,Aged ,80 and over ,Carcinoma ,Non-Small-Cell Lung ,Dose Fractionation ,Radiation ,Dose-Response Relationship ,Radiation ,Female ,Humans ,Lung Neoplasms ,Male ,Middle Aged ,Radiosurgery ,Treatment Outcome ,Oncology & Carcinogenesis ,Oncology and carcinogenesis - Abstract
PurposePatients with centrally located early-stage non-small-cell lung cancer (NSCLC) are at a higher risk of toxicity from high-dose ablative radiotherapy. NRG Oncology/RTOG 0813 was a phase I/II study designed to determine the maximum tolerated dose (MTD), efficacy, and toxicity of stereotactic body radiotherapy (SBRT) for centrally located NSCLC.Materials and methodsMedically inoperable patients with biopsy-proven, positron emission tomography-staged T1 to 2 (≤ 5 cm) N0M0 centrally located NSCLC were accrued into a dose-escalating, five-fraction SBRT schedule that ranged from 10 to 12 Gy/fraction (fx) delivered over 1.5 to 2 weeks. Dose-limiting toxicity (DLT) was defined as any treatment-related grade 3 or worse predefined toxicity that occurred within the first year. MTD was defined as the SBRT dose at which the probability of DLT was closest to 20% without exceeding it.ResultsOne hundred twenty patients were accrued between February 2009 and September 2013. Patients were elderly, there were slightly more females, and the majority had a performance status of 0 to 1. Most cancers were T1 (65%) and squamous cell (45%). Organs closest to planning target volume/most at risk were the main bronchus and large vessels. Median follow-up was 37.9 months. Five patients experienced DLTs; MTD was 12.0 Gy/fx, which had a probability of a DLT of 7.2% (95% CI, 2.8% to 14.5%). Two-year rates for the 71 evaluable patients in the 11.5 and 12.0 Gy/fx cohorts were local control, 89.4% (90% CI, 81.6% to 97.4%) and 87.9% (90% CI, 78.8% to 97.0%); overall survival, 67.9% (95% CI, 50.4% to 80.3%) and 72.7% (95% CI, 54.1% to 84.8%); and progression-free survival, 52.2% (95% CI, 35.3% to 66.6%) and 54.5% (95% CI, 36.3% to 69.6%), respectively.ConclusionThe MTD for this study was 12.0 Gy/fx; it was associated with 7.2% DLTs and high rates of tumor control. Outcomes in this medically inoperable group of mostly elderly patients with comorbidities were comparable with that of patients with peripheral early-stage tumors.
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- 2019
8. Anticonvulsant prophylaxis and steroid use in adults with metastatic brain tumors: summary of SNO and ASCO endorsement of the Congress of Neurological Surgeons guidelines.
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Chang, Susan M, Messersmith, Hans, Ahluwalia, Manmeet, Andrews, David, Brastianos, Priscilla K, Gaspar, Laurie E, Gatson, Na Tosha N, Jordan, Justin T, Khasraw, Mustafa, Lassman, Andrew B, Maues, Julia, Mrugala, Maciej, Raizer, Jeffrey, Schiff, David, Stevens, Glen, Sumrall, Ashley, Van den Bent, Martin, and Vogelbaum, Michael A
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Brain Disorders ,Neurosciences ,Adrenal Cortex Hormones ,Adult ,Anticonvulsants ,Brain Neoplasms ,Female ,Humans ,Male ,Practice Guidelines as Topic ,Oncology and Carcinogenesis ,Oncology & Carcinogenesis - Abstract
BACKGROUND:The Congress of Neurological Surgeons (CNS) has developed a series of guidelines on the treatment of adults with metastatic brain tumors, including systemic therapy and supportive care topics. ASCO has a policy and set of procedures for endorsing clinical practice guidelines that have been developed by other professional organizations. METHODS:Two CNS Guidelines were reviewed for developmental rigor by methodologists and an independent multi-disciplinary Expert Panel was formed to review the content and assess agreement with the recommendations. The expert panel voted to endorse the two guidelines and ASCO and SNO independently reviewed and approved the ASCO/SNO guideline endorsement. RESULTS:The ASCO/SNO Expert Panel determined that the recommendations from the CNS anticonvulsants and steroids guidelines, published January 9, 2019, are clear, thorough, and based upon the most relevant scientific evidence. ASCO/SNO endorsed these two CNS guidelines, with minor alterations. CONCLUSIONS:Key recommendations include: prophylactic anti-epileptic drugs were not recommended for routine use; corticosteroids (specifically dexamethasone) were recommended for temporary symptomatic relief in patients with neurologic symptoms and signs related to mass effect from brain metastases.
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- 2019
9. Graded Prognostic Assessment (GPA) for Patients With Lung Cancer and Brain Metastases: Initial Report of the Small Cell Lung Cancer GPA and Update of the Non-Small Cell Lung Cancer GPA Including the Effect of Programmed Death Ligand 1 and Other Prognostic Factors
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Sperduto, Paul W., De, Brian, Li, Jing, Carpenter, David, Kirkpatrick, John, Milligan, Michael, Shih, Helen A., Kutuk, Tugce, Kotecha, Rupesh, Higaki, Hajime, Otsuka, Manami, Aoyama, Hidefumi, Bourgoin, Malie, Roberge, David, Dajani, Salah, Sachdev, Sean, Gainey, Jordan, Buatti, John M., Breen, William, Brown, Paul D., Ni, Lisa, Braunstein, Steve, Gallitto, Matthew, Wang, Tony J.C., Shanley, Ryan, Lou, Emil, Shiao, Jay, Gaspar, Laurie E., Tanabe, Satoshi, Nakano, Toshimichi, An, Yi, Chiang, Veronica, Zeng, Liang, Soliman, Hany, Elhalawani, Hesham, Cagney, Daniel, Thomas, Evan, Boggs, Drexell H., Ahluwalia, Manmeet S., and Mehta, Minesh P.
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- 2022
- Full Text
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10. Results of a Multi-Institutional Phase 2 Clinical Trial for 4DCT-Ventilation Functional Avoidance Thoracic Radiation Therapy
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Vinogradskiy, Yevgeniy, Castillo, Richard, Castillo, Edward, Schubert, Leah, Jones, Bernard L., Faught, Austin, Gaspar, Laurie E., Kwak, Jennifer, Bowles, Daniel W., Waxweiler, Timothy, Dougherty, Jingjing M., Gao, Dexiang, Stevens, Craig, Miften, Moyed, Kavanagh, Brian, Grills, Inga, Rusthoven, Chad G., and Guerrero, Thomas
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- 2022
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11. Estimating Survival in Melanoma Patients With Brain Metastases: An Update of the Graded Prognostic Assessment for Melanoma Using Molecular Markers (Melanoma-molGPA).
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Sperduto, Paul W, Jiang, Wen, Brown, Paul D, Braunstein, Steve, Sneed, Penny, Wattson, Daniel A, Shih, Helen A, Bangdiwala, Ananta, Shanley, Ryan, Lockney, Natalie A, Beal, Kathryn, Lou, Emil, Amatruda, Thomas, Sperduto, William A, Kirkpatrick, John P, Yeh, Norman, Gaspar, Laurie E, Molitoris, Jason K, Masucci, Laura, Roberge, David, Yu, James, Chiang, Veronica, and Mehta, Minesh
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Humans ,Melanoma ,Brain Neoplasms ,Proto-Oncogene Proteins B-raf ,Genetic Markers ,Prognosis ,Karnofsky Performance Status ,Regression Analysis ,Age Factors ,Aged ,Aged ,80 and over ,Middle Aged ,Clinical Decision-Making ,Brain Cancer ,Neurosciences ,Clinical Research ,Rare Diseases ,Patient Safety ,Cancer ,Brain Disorders ,Detection ,screening and diagnosis ,4.2 Evaluation of markers and technologies ,Other Physical Sciences ,Clinical Sciences ,Oncology and Carcinogenesis ,Oncology & Carcinogenesis - Abstract
PurposeTo update the Diagnosis-Specific Graded Prognostic Assessment (DS-GPA) for a markedly heterogeneous patient population, patients with melanoma and brain metastases, using a larger, more current cohort, including molecular markers.MethodsThe original Melanoma-GPA is based on data from 483 patients whose conditions were diagnosed between 1985 and 2005. This is a multi-institutional retrospective database analysis of 823 melanoma patients with newly diagnosed brain metastases from January 1, 2006, to December 31, 2015. Multivariable analyses identified significant prognostic factors, which were weighted and included in the updated index (Melanoma-molGPA). Multiple Cox regression was used to select and weight prognostic factors in proportion to their hazard ratios to design the updated Melanoma-molGPA in which scores of 4.0 and 0.0 are associated with the best and worst prognoses, as with all of the diagnosis-specific GPA indices. Log-rank tests were used to compare adjacent classes.ResultsThere were 5 significant prognostic factors for survival (age, Karnofsky performance status [KPS], extracranial metastases [ECM], number of brain metastases, and BRAF status), whereas only KPS and the number of brain metastases were significant in the original Melanoma-GPA. Median survival improved from 6.7 to 9.8 months between the 2 treatment eras, and the median survival times for patients with Melanoma-molGPA of 0 to 1.0, 1.5 to 2.0, 2.5 to 3.0, and 3.5 to 4.0 were 4.9, 8.3, 15.8, and 34.1 months (P
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- 2017
12. The Prognostic Value of BRAF, C-KIT, and NRAS Mutations in Melanoma Patients With Brain Metastases.
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Sperduto, Paul W, Jiang, Wen, Brown, Paul D, Braunstein, Steve, Sneed, Penny, Wattson, Daniel A, Shih, Helen A, Bangdiwala, Ananta, Shanley, Ryan, Lockney, Natalie A, Beal, Kathryn, Lou, Emil, Amatruda, Thomas, Sperduto, William A, Kirkpatrick, John P, Yeh, Norman, Gaspar, Laurie E, Molitoris, Jason K, Masucci, Laura, Roberge, David, Yu, James, Chiang, Veronica, and Mehta, Minesh
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Humans ,Melanoma ,Brain Neoplasms ,Proto-Oncogene Proteins B-raf ,Antineoplastic Agents ,Prognosis ,Immunotherapy ,Linear Models ,Proportional Hazards Models ,Statistics ,Nonparametric ,Retrospective Studies ,Mutation ,Genes ,ras ,Time Factors ,Adult ,Aged ,Aged ,80 and over ,Middle Aged ,Female ,Male ,Proto-Oncogene Proteins c-kit ,Molecular Targeted Therapy ,Brain Cancer ,Cancer ,Brain Disorders ,Clinical Research ,Neurosciences ,Rare Diseases ,Other Physical Sciences ,Clinical Sciences ,Oncology and Carcinogenesis ,Oncology & Carcinogenesis - Abstract
PurposeBrain metastases are a common problem in patients with melanoma, but little is known about the effect of gene mutations on survival in these patients.Methods and materialsWe created a retrospective multi-institutional database of 823 patients with melanoma and brain metastases diagnosed between 2006 and 2015. Clinical parameters, gene mutation status (BRAF, C-KIT, NRAS), and treatment were correlated with survival. Treatment patterns and outcomes were compared with a prior era (1985-2005).ResultsBRAF status was known in 584 of 823 patients (71%). BRAF, NRAS, and C-KIT mutations were present in 51%, 22%, and 11% of tested patients, respectively. The median time from primary diagnosis to brain metastasis was 32 months, and overall median survival (MS) from the time of initial treatment of brain metastases was 10 months. MS for BRAF-positive and BRAF-negative patients was 13 months and 9 months, respectively (P=.02). There was no significant difference in MS in patients with or without NRAS or C-KIT mutations. The time from primary diagnosis to brain metastasis did not vary by mutation and was not associated with survival after the diagnosis of brain metastases. MS for the 1985 to 2005 and 2006 to 2015 cohorts was 6.7 months and 10.0 months, respectively (P
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- 2017
13. Evaluating Positron Emission Tomography-Based Functional Imaging Changes in the Heart After Chemo-Radiation for Patients With Lung Cancer
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Vinogradskiy, Yevgeniy, Diot, Quentin, Jones, Bernard, Castillo, Richard, Castillo, Edward, Kwak, Jennifer, Bowles, Daniel, Grills, Inga, Myziuk, Nicholas, Guerrero, Thomas, Stevens, Craig, Schefter, Tracey, Gaspar, Laurie E., Kavanagh, Brian, Miften, Moyed, and Rusthoven, Chad
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- 2020
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14. The Effect of Gene Alterations and Tyrosine Kinase Inhibition on Survival and Cause of Death in Patients With Adenocarcinoma of the Lung and Brain Metastases
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Sperduto, Paul W, Yang, T Jonathan, Beal, Kathryn, Pan, Hubert, Brown, Paul D, Bangdiwala, Ananta, Shanley, Ryan, Yeh, Norman, Gaspar, Laurie E, Braunstein, Steve, Sneed, Penny, Boyle, John, Kirkpatrick, John P, Mak, Kimberley S, Shih, Helen A, Engelman, Alex, Roberge, David, Arvold, Nils D, Alexander, Brian, Awad, Mark M, Contessa, Joseph, Chiang, Veronica, Hardie, John, Ma, Daniel, Lou, Emil, Sperduto, William, and Mehta, Minesh P
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Biomedical and Clinical Sciences ,Clinical Sciences ,Oncology and Carcinogenesis ,Cancer ,Lung Cancer ,Rare Diseases ,Lung ,Clinical Research ,Adenocarcinoma ,Aged ,Aged ,80 and over ,Anaplastic Lymphoma Kinase ,Antineoplastic Agents ,Brain Neoplasms ,ErbB Receptors ,Female ,Genetic Markers ,Genetic Predisposition to Disease ,Humans ,Incidence ,Lung Neoplasms ,Male ,Middle Aged ,Mutation ,Polymorphism ,Single Nucleotide ,Prevalence ,Protein-Tyrosine Kinases ,Receptor Protein-Tyrosine Kinases ,Retrospective Studies ,Risk Factors ,Survival Rate ,United States ,Other Physical Sciences ,Oncology & Carcinogenesis ,Oncology and carcinogenesis ,Theoretical and computational chemistry ,Medical and biological physics - Abstract
PurposeLung cancer remains the most common cause of both cancer mortality and brain metastases (BM). The purpose of this study was to assess the effect of gene alterations and tyrosine kinase inhibition (TKI) on median survival (MS) and cause of death (CoD) in patients with BM from lung adenocarcinoma (L-adeno).MethodsA multi-institutional retrospective database of patients with L-adeno and newly diagnosed BM between 2006 and 2014 was created. Demographics, gene alterations, treatment, MS, and CoD were analyzed. The treatment patterns and outcomes were compared with those in prior trials.ResultsOf 1521 L-adeno patients, 816 (54%) had known alteration status. The gene alteration rates were 29%, 10%, and 26% for EGFR, ALK, and KRAS, respectively. The time from primary diagnosis to BM for EGFR-/+ was 10/15 months (P=.02) and for ALK-/+ was 10/20 months (P
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- 2016
15. A Pilot Trial of Cisplatin/Etoposide/Radiotherapy Followed by Consolidation Docetaxel and the Combination of Bevacizumab (NSC-704865) in Patients With Inoperable Locally Advanced Stage III Non–Small-Cell Lung Cancer: SWOG S0533
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Wozniak, Antoinette J, Moon, James, Thomas, Charles R, Kelly, Karen, Mack, Philip C, Gaspar, Laurie E, Raben, David, Fitzgerald, Thomas J, Pandya, Kishan J, and Gandara, David R
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Biomedical and Clinical Sciences ,Clinical Sciences ,Oncology and Carcinogenesis ,Cancer ,Clinical Research ,Clinical Trials and Supportive Activities ,Patient Safety ,Orphan Drug ,Lung ,Rare Diseases ,Lung Cancer ,6.1 Pharmaceuticals ,Evaluation of treatments and therapeutic interventions ,6.5 Radiotherapy and other non-invasive therapies ,Adult ,Aged ,Antineoplastic Combined Chemotherapy Protocols ,Bevacizumab ,Carcinoma ,Non-Small-Cell Lung ,Cisplatin ,Cohort Studies ,Combined Modality Therapy ,Docetaxel ,Etoposide ,Female ,Humans ,Lung Neoplasms ,Male ,Middle Aged ,Neoplasm Staging ,Pilot Projects ,Taxoids ,Cisplatin/etoposide ,Concurrent chemoradiotherapy ,Locally advanced NSCLC ,Non-small-cell lung cancer ,Non–small-cell lung cancer ,Oncology & Carcinogenesis ,Clinical sciences ,Oncology and carcinogenesis - Abstract
BackgroundThe aim of this trial was to determine feasibility of incorporating bevacizumab (B) into concurrent chemoradiotherapy (CRT) for locally advanced non-small-cell lung cancer (NSCLC).Patients and methodsPatients with unresectable stage III NSCLC, performance status of 0 to 1, and adequate organ function were accrued in 2 strata, low- and high-risk (squamous histology, hemoptysis, tumor with cavitation and/or adjacent to a major vessel). Cohort 1 patients received cisplatin 50 mg/m(2) days (d) 1 and 8, etoposide 50 mg/m(2) (d 1-5) for 2 cycles concurrent with radiotherapy (64.8 Gy) followed by docetaxel (D) 75 mg/m(2) and B 15 mg/kg for 3 cycles. If safety was established, then accrual would continue to cohort 2 (B, d 15, 36, 57) and then subsequently to cohort 3 (B, d 1, 22, 43).ResultsTwenty-nine patients (17 low- and 12 high-risk) registered to cohort 1. Twenty-six patients (including 4 squamous, 1 adenosquamous) were assessable. Twenty-five completed CRT. Grade 3/4 toxicities during CRT included acceptable rates of hematologic toxicity, esophagitis, and pneumonitis. Of 21 assessable for safety with D/B consolidation, major adverse events were pneumonitis (2 Grade 3) and 2 episodes of fatal hemoptysis in the high-risk group, resulting in closure of this stratum. The low-risk stratum subsequently closed because of slow accrual. Median overall survival was 46 months for low-risk and 17 months for high-risk strata.ConclusionBevacizumab was not safely integrated into CRT for stage III NSCLC in patients considered at high risk for hemoptysis. In lower risk patients, data are insufficient to determine safety or efficacy.
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- 2015
16. Estimating survival in patients with gastrointestinal cancers and brain metastases: An update of the graded prognostic assessment for gastrointestinal cancers (GI-GPA)
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Sperduto, Paul W., Fang, Penny, Li, Jing, Breen, William, Brown, Paul D., Cagney, Daniel, Aizer, Ayal, Yu, James B., Chiang, Veronica, Jain, Supriya, Gaspar, Laurie E., Myrehaug, Sten, Sahgal, Arjun, Braunstein, Steve, Sneed, Penny, Cameron, Brent, Attia, Albert, Molitoris, Jason, Wu, Cheng-Chia, Wang, Tony J.C., Lockney, Natalie A., Beal, Kathryn, Parkhurst, Jessica, Buatti, John M., Shanley, Ryan, Lou, Emil, Tandberg, Daniel D., Kirkpatrick, John P., Shi, Diana, Shih, Helen A., Chuong, Michael, Saito, Hirotake, Aoyama, Hidefumi, Masucci, Laura, Roberge, David, and Mehta, Minesh P.
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- 2019
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17. Survival and prognostic factors in patients with gastrointestinal cancers and brain metastases: have we made progress?
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Sperduto, Paul W., Fang, Penny, Li, Jing, Breen, William, Brown, Paul D., Cagney, Daniel, Aizer, Ayal, Yu, James, Chiang, Veronica, Jain, Supriya, Gaspar, Laurie E., Myrehaug, Sten, Sahgal, Arjun, Braunstein, Steve, Sneed, Penny, Cameron, Brent, Attia, Albert, Molitoris, Jason, Wu, Cheng-Chia, Wang, Tony J.C., Lockney, Natalie, Beal, Kathryn, Parkhurst, Jessica, Buatti, John M., Shanley, Ryan, Lou, Emil, Tandberg, Daniel D., Kirkpatrick, John P., Shi, Diana, Shih, Helen A., Chuong, Michael, Saito, Hirotake, Aoyama, Hidefumi, Masucci, Laura, Roberge, David, and Mehta, Minesh P.
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- 2019
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18. An in-silico quality assurance study of contouring target volumes in thoracic tumors within a cooperative group setting
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Elhalawani, Hesham, Elgohari, Baher, Lin, Timothy A., Mohamed, Abdallah S.R., Fitzgerald, Thomas J., Laurie, Fran, Ulin, Kenneth, Kalpathy-Cramer, Jayashree, Guerrero, Thomas, Holliday, Emma B., Russo, Gregory, Patel, Abhilasha, Jones, William, Walker, Gary V., Awan, Musaddiq, Choi, Mehee, Dagan, Roi, Mahmoud, Omar, Shapiro, Anna, Kong, Feng-Ming (Spring), Gomez, Daniel, Zeng, Jing, Decker, Roy, Spoelstra, Femke O.B., Gaspar, Laurie E., Kachnic, Lisa A., Thomas, Charles R., Jr., Okunieff, Paul, and Fuller, Clifton D.
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- 2019
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19. Interim Analysis of a Two-Institution, Prospective Clinical Trial of 4DCT-Ventilation-based Functional Avoidance Radiation Therapy
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Vinogradskiy, Yevgeniy, Rusthoven, Chad G., Schubert, Leah, Jones, Bernard, Faught, Austin, Castillo, Richard, Castillo, Edward, Gaspar, Laurie E., Kwak, Jennifer, Waxweiler, Timothy, Dougherty, Michele, Gao, Dexiang, Stevens, Craig, Miften, Moyed, Kavanagh, Brian, Guerrero, Thomas, and Grills, Inga
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- 2018
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20. Physician Bias in Prophylactic Cranial Irradiation Decision Making—An Opportunity for a Patient Decision Aid
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Robin, Tyler P., Sannes, Timothy S., Spring Kong, Feng-Ming, Mornex, Francoise, Hirsch, Fred R., Rusthoven, Chad G., and Gaspar, Laurie E.
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- 2018
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21. A Pilot Study (SWOG S0429) of Weekly Cetuximab and Chest Radiotherapy for Poor-Risk Stage III Non-Small Cell Lung Cancer
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Chen, Yuhchyau, Moon, James, Pandya, Kishan J, Lau, Derick HM, Kelly, Karen, Hirsch, Fred R, Gaspar, Laurie E, Redman, Mary, and Gandara, David R
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Biomedical and Clinical Sciences ,Clinical Sciences ,Oncology and Carcinogenesis ,Clinical Research ,Cancer ,Lung Cancer ,Lung ,Evaluation of treatments and therapeutic interventions ,6.5 Radiotherapy and other non-invasive therapies ,cetuximab ,stage III non-small cell lung cancer ,EGFR ,performance status ,radiosensitization ,Clinical sciences ,Oncology and carcinogenesis - Abstract
PurposeStage III non-small cell lung cancer (NSCLC) patients with poor performance status (PS) or co-morbidities are often not candidates for standard chemoradiotherapy (chemoRT) due to poor tolerance to treatments. A pilot study for poor-risk stage III NSCLC patients was conducted combining cetuximab, a chimeric monoclonal antibody targeting epidermal growth factor receptor (EGFR), with chest radiation (RT).MethodsStage III NSCLC patients with Zubrod PS 2, or Zubrod PS 0-1 with poor pulmonary function and co-morbidities prohibiting chemoRT were eligible. A loading dose of cetuximab (400 mg/m(2)) was delivered week 1, followed by weekly cetuximab (250 mg/m(2))/RT to 64.8 Gy in 1.8 Gy daily fractions, and maintenance weekly cetuximab (250 mg/m(2)) for 2 years or until disease progression. H-score for EGFR protein expression was conducted in available tumors.ResultsTwenty-four patients were enrolled. Twenty-two were assessed for outcome and toxicity. Median survival was 14 months and median progression-free survival was 8 months. The response rate was 47% and disease control rate was 74%. Toxicity assessment revealed 22.7% overall ≥Grade 3 non-hematologic toxicities. Grade 3 esophagitis was observed in one patient (5%). The skin reactions were mostly Grade 1 or 2 except two of 22 (9%) had Grade 3 acne and one of 22 (5%) had Grade 3 radiation skin burn. Grade 3-4 hypomagnesemia was seen in four (18%) patients. One patient (5%) had elevated cardiac troponin and pulmonary emboli. H-score did not reveal prognostic significance. An initially planned second cohort of the study did not commence due to slow accrual, which would have added weekly docetaxel to cetuximab/RT after completion of the first cohort of patients.ConclusionConcurrent weekly cetuximab/chest RT followed by maintenance cetuximab for poor-risk stage III NSCLC was well tolerated. Further studies with larger sample sizes will be useful to establish the optimal therapeutic ratio of this regimen.
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- 2013
22. American College of Radiology–American Brachytherapy Society practice parameter for electronically generated low-energy radiation sources
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Devlin, Phillip M., Gaspar, Laurie E., Buzurovic, Ivan, Demanes, D. Jeffrey, Kasper, Michael E., Nag, Subir, Ouhib, Zoubir, Petit, Joshua H., Rosenthal, Seth A., Small, William, Jr., Wallner, Paul E., and Hartford, Alan C.
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- 2017
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23. Survival benefit of postoperative radiation in papillary meningioma: Analysis of the National Cancer Data Base
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Sumner, Whitney A., Amini, Arya, Hankinson, Todd C., Foreman, Nicholas K., Gaspar, Laurie E., Kavanagh, Brian D., Karam, Sana D., Rusthoven, Chad G., and Liu, Arthur K.
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- 2017
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24. The role of stereotactic radiosurgery in the management of patients with newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline
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Linskey, Mark E, Andrews, David W, Asher, Anthony L, Burri, Stuart H, Kondziolka, Douglas, Robinson, Paula D, Ammirati, Mario, Cobbs, Charles S, Gaspar, Laurie E, Loeffler, Jay S, McDermott, Michael, Mehta, Minesh P, Mikkelsen, Tom, Olson, Jeffrey J, Paleologos, Nina A, Patchell, Roy A, Ryken, Timothy C, and Kalkanis, Steven N
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Cancer ,Brain Disorders ,Neurosciences ,7.1 Individual care needs ,Management of diseases and conditions ,Brain Neoplasms ,Cranial Irradiation ,Evidence-Based Medicine ,Humans ,Practice Guidelines as Topic ,Radiosurgery ,Radiotherapy ,Adjuvant ,Brain metastases ,Stereotactic radiosurgery ,Surgical resection ,Radiotherapy ,Systematic review ,Practice guideline ,Oncology and Carcinogenesis ,Oncology & Carcinogenesis - Abstract
QuestionShould patients with newly-diagnosed metastatic brain tumors undergo stereotactic radiosurgery (SRS) compared with other treatment modalities? Target population These recommendations apply to adults with newly diagnosed solid brain metastases amenable to SRS; lesions amenable to SRS are typically defined as measuring less than 3 cm in maximum diameter and producing minimal (less than 1 cm of midline shift) mass effect. Recommendations SRS plus WBRT vs. WBRT alone Level 1 Single-dose SRS along with WBRT leads to significantly longer patient survival compared with WBRT alone for patients with single metastatic brain tumors who have a KPS > or = 70.Level 1 Single-dose SRS along with WBRT is superior in terms of local tumor control and maintaining functional status when compared to WBRT alone for patients with 1-4 metastatic brain tumors who have a KPS > or =70.Level 2 Single-dose SRS along with WBRT may lead to significantly longer patient survival than WBRT alone for patients with 2-3 metastatic brain tumors.Level 3 There is class III evidence demonstrating that single-dose SRS along with WBRT is superior to WBRT alone for improving patient survival for patients with single or multiple brain metastases and a KPS3 cm) or for those causing significant mass effect (>1 cm midline shift). Level 3: Underpowered class I evidence along with the preponderance of conflicting class II evidence suggests that SRS alone may provide equivalent functional and survival outcomes compared with resection + WBRT for patients with single brain metastases, so long as ready detection of distant site failure and salvage SRS are possible. SRS alone vs. WBRT alone Level 3 While both single-dose SRS and WBRT are effective for treating patients with brain metastases, single-dose SRS alone appears to be superior to WBRT alone for patients with up to three metastatic brain tumors in terms of patient survival advantage.
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- 2010
25. The role of steroids in the management of brain metastases: a systematic review and evidence-based clinical practice guideline
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Ryken, Timothy C, McDermott, Michael, Robinson, Paula D, Ammirati, Mario, Andrews, David W, Asher, Anthony L, Burri, Stuart H, Cobbs, Charles S, Gaspar, Laurie E, Kondziolka, Douglas, Linskey, Mark E, Loeffler, Jay S, Mehta, Minesh P, Mikkelsen, Tom, Olson, Jeffrey J, Paleologos, Nina A, Patchell, Roy A, and Kalkanis, Steven N
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Clinical Trials and Supportive Activities ,Rare Diseases ,Clinical Research ,Orphan Drug ,Brain Disorders ,Neurosciences ,Cancer ,6.1 Pharmaceuticals ,Evaluation of treatments and therapeutic interventions ,Brain Neoplasms ,Databases ,Factual ,Evidence-Based Medicine ,Humans ,Practice Guidelines as Topic ,Steroids ,Treatment Outcome ,Brain metastases ,Neurologic symptoms ,Steroid dosage ,Systematic review ,Practice guideline ,Oncology and Carcinogenesis ,Oncology & Carcinogenesis - Abstract
QuestionDo steroids improve neurologic symptoms in patients with metastatic brain tumors compared to no treatment? If steroids are given, what dose should be used? Comparisons include: (1) steroid therapy versus none. (2) comparison of different doses of steroid therapy.Target populationThese recommendations apply to adults diagnosed with brain metastases.RecommendationsSteroid therapy versus no steroid therapy Asymptomatic brain metastases patients without mass effect Insufficient evidence exists to make a treatment recommendation for this clinical scenario. Brain metastases patients with mild symptoms related to mass effect Level 3 Corticosteroids are recommended to provide temporary symptomatic relief of symptoms related to increased intracranial pressure and edema secondary to brain metastases. It is recommended for patients who are symptomatic from metastatic disease to the brain that a starting dose of 4-8 mg/day of dexamethasone be considered. Brain metastases patients with moderate to severe symptoms related to mass effect Level 3 Corticosteroids are recommended to provide temporary symptomatic relief of symptoms related to increased intracranial pressure and edema secondary to brain metastases. If patients exhibit severe symptoms consistent with increased intracranial pressure, it is recommended that higher doses such as 16 mg/day or more be considered. Choice of Steroid Level 3 If corticosteroids are given, dexamethasone is the best drug choice given the available evidence. Duration of Corticosteroid Administration Level 3 Corticosteroids, if given, should be tapered slowly over a 2 week time period, or longer in symptomatic patients, based upon an individualized treatment regimen and a full understanding of the long-term sequelae of corticosteroid therapy. Given the very limited number of studies (two) which met the eligibility criteria for the systematic review, these are the only recommendations that can be offered based on this methodology. Please see "Discussion" and "Summary" section for additional details.
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- 2010
26. The role of chemotherapy in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline
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Mehta, Minesh P, Paleologos, Nina A, Mikkelsen, Tom, Robinson, Paula D, Ammirati, Mario, Andrews, David W, Asher, Anthony L, Burri, Stuart H, Cobbs, Charles S, Gaspar, Laurie E, Kondziolka, Douglas, Linskey, Mark E, Loeffler, Jay S, McDermott, Michael, Olson, Jeffrey J, Patchell, Roy A, Ryken, Timothy C, and Kalkanis, Steven N
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Cancer ,Brain Disorders ,Neurosciences ,Rare Diseases ,Lung ,Lung Cancer ,Clinical Research ,Clinical Trials and Supportive Activities ,Brain Cancer ,6.1 Pharmaceuticals ,Evaluation of treatments and therapeutic interventions ,Brain Neoplasms ,Drug Therapy ,Evidence-Based Medicine ,Humans ,Practice Guidelines as Topic ,Brain metastases ,Chemotherapy ,Whole brain radiation therapy ,Targeted agents ,Systematic review ,Practice guideline ,Oncology and Carcinogenesis ,Oncology & Carcinogenesis - Abstract
Target populationThis recommendation applies to adults with newly diagnosed brain metastases; however, the recommendation below does not apply to the exquisitely chemosensitive tumors, such as germinomas metastatic to the brain.RecommendationShould patients with brain metastases receive chemotherapy in addition to whole brain radiotherapy (WBRT)? Level 1 Routine use of chemotherapy following WBRT for brain metastases has not been shown to increase survival and is not recommended. Four class I studies examined the role of carboplatin, chloroethylnitrosoureas, tegafur and temozolomide, and all resulted in no survival benefit. Two caveats are provided in order to allow the treating physician to individualize decision-making: First, the majority of the data are limited to non small cell lung (NSCLC) and breast cancer; therefore, in other tumor histologies, the possibility of clinical benefit cannot be absolutely ruled out. Second, the addition of chemotherapy to WBRT improved response rates in some, but not all trials; response rate was not the primary endpoint in most of these trials and end-point assessment was non-centralized, non-blinded, and post-hoc. Enrollment in chemotherapy-related clinical trials is encouraged.
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- 2010
27. The role of prophylactic anticonvulsants in the management of brain metastases: a systematic review and evidence-based clinical practice guideline
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Mikkelsen, Tom, Paleologos, Nina A., Robinson, Paula D., Ammirati, Mario, Andrews, David W., Asher, Anthony L., Burri, Stuart H., Cobbs, Charles S., Gaspar, Laurie E., Kondziolka, Douglas, Linskey, Mark E., Loeffler, Jay S., McDermott, Michael, Mehta, Minesh P., Olson, Jeffrey J., Patchell, Roy A., Ryken, Timothy C., and Kalkanis, Steven N.
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Medicine & Public Health ,Neurology ,Oncology ,Brain metastases ,Anticonvulsant ,Prophylaxis ,Seizures ,Systematic review ,Practice guideline - Abstract
Do prophylactic anticonvulsants decrease the risk of seizure in patients with metastatic brain tumors compared with no treatment? Target population These recommendations apply to adults with solid brain metastases who have not experienced a seizure due to their metastatic brain disease. Recommendation Level 3 For adults with brain metastases who have not experienced a seizure due to their metastatic brain disease, routine prophylactic use of anticonvulsants is not recommended.Only a single underpowered randomized controlled trial (RCT), which did not detect a difference in seizure occurrence, provides evidence for decision-making purposes.
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- 2010
28. The role of retreatment in the management of recurrent/progressive brain metastases: a systematic review and evidence-based clinical practice guideline
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Ammirati, Mario, Cobbs, Charles S., Linskey, Mark E., Paleologos, Nina A., Ryken, Timothy C., Burri, Stuart H., Asher, Anthony L., Loeffler, Jay S., Robinson, Paula D., Andrews, David W., Gaspar, Laurie E., Kondziolka, Douglas, McDermott, Michael, Mehta, Minesh P., Mikkelsen, Tom, Olson, Jeffrey J., Patchell, Roy A., and Kalkanis, Steven N.
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Medicine & Public Health ,Neurology ,Oncology ,Recurrent/progressive brain metastases ,Surgical resection ,Whole brain radiotherapy ,Stereotactic radiosurgery ,Chemotherapy ,Histopathology ,Retreatment ,Systematic review ,Practice guideline - Abstract
What evidence is available regarding the use of whole brain radiation therapy (WBRT), stereotactic radiosurgery (SRS), surgical resection or chemotherapy for the treatment of recurrent/progressive brain metastases? Target population This recommendation applies to adults with recurrent/progressive brain metastases who have previously been treated with WBRT, surgical resection and/or radiosurgery. Recurrent/progressive brain metastases are defined as metastases that recur/progress anywhere in the brain (original and/or non-original sites) after initial therapy. Recommendation Level 3 Since there is insufficient evidence to make definitive treatment recommendations in patients with recurrent/progressive brain metastases, treatment should be individualized based on a patient’s functional status, extent of disease, volume/number of metastases, recurrence or progression at original versus non-original site, previous treatment and type of primary cancer, and enrollment in clinical trials is encouraged. In this context, the following can be recommended depending on a patient’s specific condition: no further treatment (supportive care), re-irradiation (either WBRT and/or SRS), surgical excision or, to a lesser extent, chemotherapy. Question If WBRT is used in the setting of recurrent/progressive brain metastases, what impact does tumor histopathology have on treatment outcomes? No studies were identified that met the eligibility criteria for this question.
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- 2010
29. The role of emerging and investigational therapies for metastatic brain tumors: a systematic review and evidence-based clinical practice guideline of selected topics
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Olson, Jeffrey J., Paleologos, Nina A., Gaspar, Laurie E., Robinson, Paula D., Morris, Rachel E., Ammirati, Mario, Andrews, David W., Asher, Anthony L., Burri, Stuart H., Cobbs, Charles S., Kondziolka, Douglas, Linskey, Mark E., Loeffler, Jay S., McDermott, Michael, Mehta, Minesh P., Mikkelsen, Tom, Patchell, Roy A., Ryken, Timothy C., and Kalkanis, Steven N.
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Medicine & Public Health ,Neurology ,Oncology ,Brain metastases ,Radiation sensitizers ,Interstitial modalities ,New chemotherapeutic agents ,Molecular targeted agents ,Anti-angiogenesis agents ,Systematic review ,Practice guideline - Abstract
What evidence is available regarding the emerging and investigational therapies for the treatment of metastatic brain tumors? Target population These recommendations apply to adults with brain metastases. Recommendations New radiation sensitizers Level 2 A subgroup analysis of a large prospective randomized controlled trial (RCT) suggested a prolongation of time to neurological progression with the early use of motexafin-gadolinium (MGd). Nonetheless this was not borne out in the overall study population and therefore an unequivocal recommendation to use the currently available radiation sensitizers, motexafin-gadolinium and efaproxiral (RSR 13) cannot be provided. Interstitial modalities There is no evidence to support the routine use of new or existing interstitial radiation, interstitial chemotherapy and or other interstitial modalities outside of approved clinical trials. New chemotherapeutic agents Level 2 Treatment of melanoma brain metastases with whole brain radiation therapy and temozolomide is reasonable based on one class II study. Level 3 Depending on individual circumstances there may be patients who benefit from the use of temozolomide or fotemustine in the therapy of their brain metastases. Molecular targeted agents Level 3 The use of epidermal growth factor receptor inhibitors may be of use in the management of brain metastases from non-small cell lung carcinoma.
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- 2010
30. The role of surgical resection in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline
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Kalkanis, Steven N., Kondziolka, Douglas, Gaspar, Laurie E., Burri, Stuart H., Asher, Anthony L., Cobbs, Charles S., Ammirati, Mario, Robinson, Paula D., Andrews, David W., Loeffler, Jay S., McDermott, Michael, Mehta, Minesh P., Mikkelsen, Tom, Olson, Jeffrey J., Paleologos, Nina A., Patchell, Roy A., Ryken, Timothy C., and Linskey, Mark E.
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Medicine & Public Health ,Neurology ,Oncology ,Brain metastases ,Surgical resection ,Stereotactic radiosurgery ,Radiotherapy ,Systematic review ,Practice guideline - Abstract
Should patients with newly-diagnosed metastatic brain tumors undergo open surgical resection versus whole brain radiation therapy (WBRT) and/or other treatment modalities such as radiosurgery, and in what clinical settings? Target population These recommendations apply to adults with a newly diagnosed single brain metastasis amenable to surgical resection. Recommendations Surgical resection plus WBRT versus surgical resection alone Level 1 Surgical resection followed by WBRT represents a superior treatment modality, in terms of improving tumor control at the original site of the metastasis and in the brain overall, when compared to surgical resection alone. Surgical resection plus WBRT versus SRS ± WBRT Level 2 Surgical resection plus WBRT, versus stereotactic radiosurgery (SRS) plus WBRT, both represent effective treatment strategies, resulting in relatively equal survival rates. SRS has not been assessed from an evidence-based standpoint for larger lesions (>3 cm) or for those causing significant mass effect (>1 cm midline shift). Level 3 Underpowered class I evidence along with the preponderance of conflicting class II evidence suggests that SRS alone may provide equivalent functional and survival outcomes compared with resection + WBRT for patients with single brain metastases, so long as ready detection of distant site failure and salvage SRS are possible. Note The following question is fully addressed in the WBRT guideline paper within this series by Gaspar et al. Given that the recommendation resulting from the systematic review of the literature on this topic is also highly relevant to the discussion of the role of surgical resection in the management of brain metastases, this recommendation has been included below. Question Does surgical resection in addition to WBRT improve outcomes when compared with WBRT alone? Target population This recommendation applies to adults with a newly diagnosed single brain metastasis amenable to surgical resection; however, the recommendation does not apply to relatively radiosensitive tumors histologies (i.e., small cell lung cancer, leukemia, lymphoma, germ cell tumors and multiple myeloma). Recommendation Surgical resection plus WBRT versus WBRT alone Level 1 Class I evidence supports the use of surgical resection plus post-operative WBRT, as compared to WBRT alone, in patients with good performance status (functionally independent and spending less than 50% of time in bed) and limited extra-cranial disease. There is insufficient evidence to make a recommendation for patients with poor performance scores, advanced systemic disease, or multiple brain metastases.
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- 2010
31. The role of whole brain radiation therapy in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline
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Gaspar, Laurie E., Mehta, Minesh P., Patchell, Roy A., Burri, Stuart H., Robinson, Paula D., Morris, Rachel E., Ammirati, Mario, Andrews, David W., Asher, Anthony L., Cobbs, Charles S., Kondziolka, Douglas, Linskey, Mark E., Loeffler, Jay S., McDermott, Michael, Mikkelsen, Tom, Olson, Jeffrey J., Paleologos, Nina A., Ryken, Timothy C., and Kalkanis, Steven N.
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Medicine & Public Health ,Neurology ,Oncology ,Brain metastases ,Whole brain radiation therapy ,Radiotherapy ,Surgical resection ,Fractionation ,Histopathology ,Systematic review ,Practice guideline - Abstract
Target population This recommendation applies to adults with newly diagnosed single brain metastases amenable to surgical resection; however, the recommendation does not apply to relatively radiosensitive tumors histologies (i.e., small cell lung cancer, leukemia, lymphoma, germ cell tumors and multiple myeloma). Recommendation Surgical resection plus WBRT versus WBRT alone Level 1 Class I evidence supports the use of surgical resection plus post-operative WBRT, as compared to WBRT alone, in patients with good performance status (functionally independent and spending less than 50% of time in bed) and limited extra-cranial disease. There is insufficient evidence to make a recommendation for patients with poor performance scores, advanced systemic disease, or multiple brain metastases. If WBRT is used, is there an optimal dosing/fractionation schedule? Target population This recommendation applies to adults with newly diagnosed brain metastases. Recommendation Level 1 Class I evidence suggests that altered dose/fractionation schedules of WBRT do not result in significant differences in median survival, local control or neurocognitive outcomes when compared with “standard” WBRT dose/fractionation. (i.e., 30 Gy in 10 fractions or a biologically effective dose (BED) of 39 Gy10). If WBRT is used, what impact does tumor histopathology have on treatment outcomes? Target population This recommendation applies to adults with newly diagnosed brain metastases. Recommendation Given the extremely limited data available, there is insufficient evidence to support the choice of any particular dose/fractionation regimen based on histopathology.The following question is fully addressed in the surgery guideline paper within this series by Kalkanis et al. Given that the recommendation resulting from the systematic review of the literature on this topic is also highly relevant to the discussion of the role of WBRT in the management of brain metastases, this recommendation has been included below. Does the addition of WBRT after surgical resection improve outcomes when compared with surgical resection alone? Target population This recommendation applies to adults with newly diagnosed single brain metastases amenable to surgical resection. Recommendation Surgical resection plus WBRT versus surgical resection alone Level 1 Surgical resection followed by WBRT represents a superior treatment modality, in terms of improving tumor control at the original site of the metastasis and in the brain overall, when compared to surgical resection alone.
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- 2010
32. Report from the Radiation Therapy Committee of the Southwest Oncology Group (SWOG): Research Objectives Workshop 2008
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Okunieff, Paul, Kachnic, Lisa A, Constine, Louis S, Fuller, Clifton D, Gaspar, Laurie E, Hayes, Daniel F, Hooks, Jean, Ling, Clifton, Meyskens, Frank L, Philip, Philip A, Raben, David, Smalley, Stephen R, Swanson, Gregory P, Teicher, Beverly A, Thomas, Charles R, Vikram, Bhadrasain, Zelefsky, Michael J, and Baker, Laurence H
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Biomedical and Clinical Sciences ,Clinical Sciences ,Oncology and Carcinogenesis ,Cancer ,Detection ,screening and diagnosis ,4.2 Evaluation of markers and technologies ,Good Health and Well Being ,Antineoplastic Agents ,Biomedical Research ,Clinical Trials as Topic ,Combined Modality Therapy ,Female ,Humans ,Neoplasms ,Quality Assurance ,Health Care ,Radiation Oncology ,Radiotherapy Dosage ,Radiotherapy Planning ,Computer-Assisted ,Translational Research ,Biomedical ,Oncology & Carcinogenesis ,Clinical sciences ,Oncology and carcinogenesis - Abstract
Strategic planning for the Radiation Therapy Committee of the Southwest Oncology Group (SWOG) is comprehensively evaluated every six years in an effort to maintain a current and relevant scientific focus, and to provide a standard platform for future development of protocol concepts. Participants in the 2008 Strategic Planning Workshop included clinical trial experts from multiple specialties, industry representatives from both pharmaceuticals and equipment manufacturers, and basic scientists. High-priority research areas such as image-guided radiation therapy for control of limited metastatic disease, analysis of biomarkers for treatment response and late toxicity, assessment of novel agents in combination with radiation, standardization of radiation target delineation, and the assessment of new imaging techniques to individualize cancer therapy, were discussed. Research priorities included clinical study designs featuring translational end points that identify patients most likely to benefit from combined modality therapy; intervention including combination radiation with standard chemotherapy; radiation with radiosensitizing molecular-targeted therapies; and stereotactic radiation for treatment of patients with regard to asymptomatic metastasis and radiation-induced tumor autoimmunity. The Committee concluded that the future research opportunities are among the most exciting to have developed in the last decade, and work is in progress to embark on these plans.
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- 2009
33. High-Dose Once-Daily Thoracic Radiotherapy in Limited-Stage Small-Cell Lung Cancer: CALGB 30610 (Alliance)/RTOG 0538
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Bogart, Jeffrey, primary, Wang, Xiaofei, additional, Masters, Gregory, additional, Gao, Junheng, additional, Komaki, Ritsuko, additional, Gaspar, Laurie E., additional, Heymach, John, additional, Bonner, James, additional, Kuzma, Charles, additional, Waqar, Saiama, additional, Petty, William, additional, Stinchcombe, Thomas E., additional, Bradley, Jeffrey D., additional, and Vokes, Everett, additional
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- 2023
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34. Brain Metastases
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Sperduto, Paul W., Gaspar, Laurie E., Brady, Luther W., Series editor, Molls, Michael, Series editor, Nieder, Carsten, Series editor, and Gaspar, Laurie E., editor
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- 2014
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35. The Impact of Postoperative Radiotherapy for Thymoma and Thymic Carcinoma
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Jackson, Matthew W., Palma, David A., Camidge, D. Ross, Jones, Bernard L., Robin, Tyler P., Sher, David J., Koshy, Matthew, Kavanagh, Brian D., Gaspar, Laurie E., and Rusthoven, Chad G.
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- 2017
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36. Local consolidative therapy versus maintenance therapy or observation for patients with oligometastatic non-small-cell lung cancer without progression after first-line systemic therapy: a multicentre, randomised, controlled, phase 2 study
- Author
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Gomez, Daniel R, Blumenschein, George R, Jr, Lee, J Jack, Hernandez, Mike, Ye, Rong, Camidge, D Ross, Doebele, Robert C, Skoulidis, Ferdinandos, Gaspar, Laurie E, Gibbons, Don L, Karam, Jose A, Kavanagh, Brian D, Tang, Chad, Komaki, Ritsuko, Louie, Alexander V, Palma, David A, Tsao, Anne S, Sepesi, Boris, William, William N, Zhang, Jianjun, Shi, Qiuling, Wang, Xin Shelley, Swisher, Stephen G, and Heymach, John V
- Published
- 2016
- Full Text
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37. Immune checkpoint inhibitors and radiosurgery for newly diagnosed melanoma brain metastases
- Author
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Robin, Tyler P., Breeze, Robert E., Smith, Derek E., Rusthoven, Chad G., Lewis, Karl D., Gonzalez, Rene, Brill, Amanda, Saiki, Robin, Stuhr, Kelly, Gaspar, Laurie E., Karam, Sana D., Raben, David, Kavanagh, Brian D., Nath, Sameer K., and Liu, Arthur K.
- Published
- 2018
- Full Text
- View/download PDF
38. Repeat reirradiation of the spinal cord: multi-national expert treatment recommendations
- Author
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Nieder, Carsten, Gaspar, Laurie E., Ruysscher, Dirk De, Guckenberger, Matthias, Mehta, Minesh P., Rusthoven, Chad G., Sahgal, Arjun, and Gkika, Eleni
- Published
- 2018
- Full Text
- View/download PDF
39. Supplementary Data from Combination of Trastuzumab Emtansine and Stereotactic Radiosurgery Results in High Rates of Clinically Significant Radionecrosis and Dysregulation of Aquaporin-4
- Author
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Stumpf, Priscilla K., primary, Cittelly, Diana M., primary, Robin, Tyler P., primary, Carlson, Julie A., primary, Stuhr, Kelly A., primary, Contreras-Zarate, Maria Jose, primary, Lai, Steven, primary, Ormond, D. Ryan, primary, Rusthoven, Chad G., primary, Gaspar, Laurie E., primary, Rabinovitch, Rachel, primary, Kavanagh, Brian D., primary, Liu, Arthur, primary, Diamond, Jennifer R., primary, Kabos, Peter, primary, and Fisher, Christine M., primary
- Published
- 2023
- Full Text
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40. Radiotherapeutic Management of Non–Small Cell Lung Cancer in the Minimal Resource Setting
- Author
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Rodin, Danielle, Grover, Surbhi, Xu, Melody J., Hanna, Timothy P., Olson, Robert, Schreiner, L. John, Munshi, Anusheel, Mornex, Francoise, Palma, David, and Gaspar, Laurie E.
- Published
- 2016
- Full Text
- View/download PDF
41. Management of patients with brain metastases from non-small cell lung cancer and adverse prognostic features: multi-national radiation treatment recommendations are heterogeneous
- Author
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Nieder, Carsten, Guckenberger, Matthias, Gaspar, Laurie E., Rusthoven, Chad G., De Ruysscher, Dirk, Sahgal, Arjun, Nguyen, Timothy, Grosu, Anca L., and Mehta, Minesh P.
- Published
- 2019
- Full Text
- View/download PDF
42. Response assessment criteria for brain metastases: proposal from the RANO group
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Lin, Nancy U, Lee, Eudocia Q, Aoyama, Hidefumi, Barani, Igor J, Barboriak, Daniel P, Baumert, Brigitta G, Bendszus, Martin, Brown, Paul D, Camidge, D Ross, Chang, Susan M, Dancey, Janet, de Vries, Elisabeth G E, Gaspar, Laurie E, Harris, Gordon J, Hodi, F Stephen, Kalkanis, Steven N, Linskey, Mark E, Macdonald, David R, Margolin, Kim, Mehta, Minesh P, Schiff, David, Soffietti, Riccardo, Suh, John H, van den Bent, Martin J, Vogelbaum, Michael A, and Wen, Patrick Y
- Published
- 2015
- Full Text
- View/download PDF
43. Clinical Validation of 4-Dimensional Computed Tomography Ventilation With Pulmonary Function Test Data
- Author
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Brennan, Douglas, Schubert, Leah, Diot, Quentin, Castillo, Richard, Castillo, Edward, Guerrero, Thomas, Martel, Mary K., Linderman, Derek, Gaspar, Laurie E., Miften, Moyed, Kavanagh, Brian D., and Vinogradskiy, Yevgeniy
- Published
- 2015
- Full Text
- View/download PDF
44. Reirradiation of recurrent node-positive non-small cell lung cancer after previous stereotactic radiotherapy for stage I disease: A multi-institutional treatment recommendation
- Author
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Nieder, Carsten, De Ruysscher, Dirk, Gaspar, Laurie E., Guckenberger, Matthias, Mehta, Minesh P., Cheung, Patrick, and Sahgal, Arjun
- Published
- 2017
- Full Text
- View/download PDF
45. The Impact of Adjuvant Radiation Therapy for High-Grade Gliomas by Histology in the United States Population
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Rusthoven, Chad G., Carlson, Julie A., Waxweiler, Timothy V., Dally, Miranda J., Barón, Anna E., Yeh, Norman, Gaspar, Laurie E., Liu, Arthur K., Ney, Douglas E., Damek, Denise M., Lillehei, Kevin O., and Kavanagh, Brian D.
- Published
- 2014
- Full Text
- View/download PDF
46. Comparison of 4-Dimensional Computed Tomography Ventilation With Nuclear Medicine Ventilation-Perfusion Imaging: A Clinical Validation Study
- Author
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Vinogradskiy, Yevgeniy, Koo, Phillip J., Castillo, Richard, Castillo, Edward, Guerrero, Thomas, Gaspar, Laurie E., Miften, Moyed, and Kavanagh, Brian D.
- Published
- 2014
- Full Text
- View/download PDF
47. Stereotactic Radiation Therapy can Safely and Durably Control Sites of Extra-Central Nervous System Oligoprogressive Disease in Anaplastic Lymphoma Kinase-Positive Lung Cancer Patients Receiving Crizotinib
- Author
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Gan, Gregory N., Weickhardt, Andrew J., Scheier, Benjamin, Doebele, Robert C., Gaspar, Laurie E., Kavanagh, Brian D., and Camidge, D. Ross
- Published
- 2014
- Full Text
- View/download PDF
48. Patterns of practice in radiation therapy for non-small cell lung cancer among members of the American Society for Radiation Oncology
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Kong, Feng-Ming (Spring), Cuneo, Kyle C., Wang, Li, Bonner, James A., Gaspar, Laurie E., Komaki, Ritsuko, Sun, Alexander, Morris, David E., Sandler, Howard M., and Movsas, Benjamin
- Published
- 2014
- Full Text
- View/download PDF
49. Resident-reported brachytherapy experience in ACGME-accredited radiation oncology training programs
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Compton, Julia J., Gaspar, Laurie E., Shrieve, Dennis C., Wilson, Lynn D., Griem, Katherine L., Amdur, Robert J., and Lee, W. Robert
- Published
- 2013
- Full Text
- View/download PDF
50. Outcomes of symptomatic compared to asymptomatic recurrences in patients with glioblastoma multiforme (GBM)
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Amini, Arya, Altoos, Basel, Karam, Sana D., Waxweiler, Timothy V., Rusthoven, Chad G., Gaspar, Laurie E., Honce, Justin M., Damek, Denise M., Ney, Douglas E., Ormond, D. Ryan, Lillehei, Kevin O., Chen, Changhu, Kavanagh, Brian D., and Liu, Arthur K.
- Published
- 2016
- Full Text
- View/download PDF
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