2024
Patterns of CNS Failures in Relapse/Refractory Large B-Cell Lymphoma (LBCL) Patients with Secondary CNS Disease Following Chimeric Antigen Receptor T-Cell (CAR T) Therapy
Nakashima J, Khatri V, Cruz-Chamorro R, Zhou J, Patra P, Gaballa S, Khimani F, Mirza S, Shah B, Saeed H, Chavez J, Locke F, Nishihori T, Liu H, Dong N, Lazaryan A, Robinson T, Freeman C, Jain M, Figura N. Patterns of CNS Failures in Relapse/Refractory Large B-Cell Lymphoma (LBCL) Patients with Secondary CNS Disease Following Chimeric Antigen Receptor T-Cell (CAR T) Therapy. International Journal Of Radiation Oncology • Biology • Physics 2024, 120: e646-e647. DOI: 10.1016/j.ijrobp.2024.07.1421.Peer-Reviewed Original ResearchLarge B-cell lymphomaSecondary CNS lymphomaB-cell lymphomaCNS failureCNS recurrenceCNS diseaseCNS lymphomaCAR-TOverall survivalBridging therapyCNS diagnosisRelapsed/refractory large B-cell lymphomaChimeric antigen receptor T cellsCAR-T cell trialsPattern of failure analysisCAR-T cell therapyMedian age of patientsClinical outcomes of patientsCNS-only progressionSystemic disease recurrenceT-cell therapyCAR-T therapyCytokine-release syndromePatterns of recurrenceKaplan-Meier methodModern Photon-Based Craniospinal Irradiation in Leptomeningeal Disease
Keit E, Peterson J, Johnstone P, Robinson T, Figura N. Modern Photon-Based Craniospinal Irradiation in Leptomeningeal Disease. International Journal Of Radiation Oncology • Biology • Physics 2024, 120: e242. DOI: 10.1016/j.ijrobp.2024.07.542.Peer-Reviewed Original ResearchIntensity modulated radiotherapyCraniospinal irradiationLeptomeningeal diseaseHematologic malignanciesSolid tumorsOverall survivalProton therapyLocal failureAssociated with improved OSDelay systemic therapyG3+ toxicitySymptomatic leptomeningeal diseaseSite of spreadKaplan Meier methodPhoton-based treatmentsPrimary cancer typeAcute gradeG3 fatigueMedian OSModulated radiotherapyNeutropenic feverMedian followPalliative radiotherapyDisseminated diseaseSystemic therapyBSLM-03 BRANCHED-CHAIN KETO ACIDS PROMOTE AN IMMUNE-SUPPRESSIVE AND NEURODEGENERATIVE MICROENVIRONMENT IN LEPTOMENINGEAL DISEASE
Khaled M, Ren Y, Kundalia R, Alhaddad H, Chen Z, Wallace G, Evernden B, Ospina O, Hall M, Liu M, Darville L, Izumi V, Chen Y, Pilon-Thomas S, Stewart P, Koomen J, Corallo S, Jain M, Robinson T, Locke F, Forsyth P, Smalley I. BSLM-03 BRANCHED-CHAIN KETO ACIDS PROMOTE AN IMMUNE-SUPPRESSIVE AND NEURODEGENERATIVE MICROENVIRONMENT IN LEPTOMENINGEAL DISEASE. Neuro-Oncology Advances 2024, 6: i5-i5. PMCID: PMC11296858, DOI: 10.1093/noajnl/vdae090.014.Peer-Reviewed Original ResearchChimeric antigen receptorLeptomeningeal diseaseBranched-chain keto acidsSodium phenylbutyrateCerebrospinal fluidSurvival outcomesT cellsBreast cancerEfficacy of CAR T-cell therapyAnti-tumor immune environmentCAR-T cell therapyMurine model of breast cancerResponse to immune therapyModel of breast cancerFunction of T lymphocytesT-cell therapyDysfunctional T cellsComprehensive multi-omics analysisPoor survival outcomesCerebrospinal fluid of patientsAnalysis of cerebrospinal fluidPreclinical rationaleImmune therapyImmune environmentNeurological deteriorationPhase II Trial of Reduced-Intensity Fludarabine, Melphalan 70 Mg/m2, and Total Body Irradiation Conditioning Results in Favorable Outcomes with Haploidentical Donor Peripheral Blood Stem Cell Transplant
Elmariah H, Kim J, DiMaggio E, Gonzalez R, Kim J, Kim J, Mishra A, Faramand R, Perez L, Lazaryan A, Khimani F, Liu H, Ochoa L, Nieder M, Figura N, Robinson T, Nishihori T, Anasetti C, Pidala J, Bejanyan N. Phase II Trial of Reduced-Intensity Fludarabine, Melphalan 70 Mg/m2, and Total Body Irradiation Conditioning Results in Favorable Outcomes with Haploidentical Donor Peripheral Blood Stem Cell Transplant. Transplantation And Cellular Therapy 2024, 30: s58-s59. DOI: 10.1016/j.jtct.2023.12.093.Peer-Reviewed Original ResearchDisease-free survivalNon-relapse mortalityPost-transplant cyclophosphamidePhase II trialHaplo-PBSCTHematopoietic cell transplantationRate of relapseCumulative incidenceHCT-CIPrimary endpointCumulative incidence of grade II–IV acute GVHDCumulative incidence of non-relapse mortalityIncidence of grade II-IV acute GVHDGrade II-IV acute GVHDGVHD-free relapse-free survivalIncidence of non-relapse mortalityModerate to severe chronic GVHDHematopoietic cell transplantation comorbidity indexMedian follow-up timeChronic GVHD ratesGraft failure eventsHCT-CI scoreSevere chronic GVHDRelapse-free survivalRisk of relapse
2023
Phase II Trial of Reduced-Intensity Fludarabine, Melphalan, and Total Body Irradiation Conditioning Results in Favorable Outcomes with Haploidentical Donor Peripheral Blood Stem Cell Transplant
Elmariah H, Kim J, Mishra A, Faramand R, Perez L, Lazaryan A, Khimani F, Liu H, Ochoa-Bayona J, Nieder M, Figura N, Robinson T, Nishihori T, Anasetti C, Pidala J, Bejanyan N. Phase II Trial of Reduced-Intensity Fludarabine, Melphalan, and Total Body Irradiation Conditioning Results in Favorable Outcomes with Haploidentical Donor Peripheral Blood Stem Cell Transplant. Blood 2023, 142: 4900. DOI: 10.1182/blood-2023-187473.Peer-Reviewed Original ResearchDisease-free survivalPost-transplant cyclophosphamideHematopoietic cell transplantNon-relapse mortalityPhase II trialTotal body irradiationAllogeneic hematopoietic cell transplantReduced-intensity conditioningBone marrow graftsPrimary endpointII trialCumulative incidenceGVHD prophylaxisCell transplantHematologic malignanciesCyclophosphamide/total body irradiationGVHD-free relapse-free survivalHematopoietic cell transplant comorbidity indexPeripheral blood stem cell graftsSingle-center phase II trialPeripheral blood stem cell transplantBlood stem cell graftsHigh-risk hematologic malignanciesMonths disease free survivalDay 6Bridging Radiotherapy Prior to Chimeric Antigen Receptor T-Cell Therapy for B-Cell Lymphomas: An ILROG Multi-Institutional Study
Yegya-Raman N, Wright C, Ladbury C, Chew J, Zhang S, Sun S, Burke S, Baron J, Sim A, LaRiviere M, Yang J, Robinson T, Tseng Y, Terezakis S, Braunstein S, Dandapani S, Schuster S, Chong E, Plastaras J, Figura N. Bridging Radiotherapy Prior to Chimeric Antigen Receptor T-Cell Therapy for B-Cell Lymphomas: An ILROG Multi-Institutional Study. International Journal Of Radiation Oncology • Biology • Physics 2023, 117: s50-s51. DOI: 10.1016/j.ijrobp.2023.06.333.Peer-Reviewed Original ResearchImmune effector cell-associated neurotoxicity syndromeProgression-free survivalCytokine release syndromeB-cell lymphomaChimeric antigen receptor T-cell therapySuperior progression-free survivalLarge B-cell lymphomaCAR-T infusionT-cell therapyMulti-institutional studyOverall survivalCTCAE v5.0T infusionTisa-celCAR TRefractory aggressive B-cell lymphomasStage III/IV diseaseT-cell/histiocyte-rich large B-cell lymphomaFavorable progression-free survivalCentral nervous system involvementDiffuse large B-cell lymphomaAggressive B-cell lymphomasPrimary mediastinal B-cell lymphomaMediastinal B-cell lymphomaNervous system involvementEpstein‑Barr virus‑associated primary central nervous system lymphoma in an immunosuppressed patient with a comorbid autoimmune disorder: A case report
Bricoune O, Kareem S, Wallace G, Iacono D, Macaulay R, Etame A, Pina Y, Robinson T, Mokhtari S. Epstein‑Barr virus‑associated primary central nervous system lymphoma in an immunosuppressed patient with a comorbid autoimmune disorder: A case report. Experimental And Therapeutic Medicine 2023, 26: 410. PMID: 37522053, PMCID: PMC10375448, DOI: 10.3892/etm.2023.12109.Peer-Reviewed Original ResearchPrimary central nervous system lymphomaEpstein-Barr virusCentral nervous system lymphomaDiffuse large B-cell lymphomaNervous system lymphomaMycophenolate mofetilMemory lossSystem lymphomaPeriventricular lesionsEnhancing lesionsBrain MRIEpstein-Barr virus-associated primary central nervous system lymphomaAcetylcholine receptor antibody-positive myasthenia gravisNon-focal neurological symptomsSubsequent chronic kidney diseaseVaricella zoster virus (VZV) vasculopathyAntibody-positive myasthenia gravisWhole-brain radiation therapyLarge B-cell lymphomaComorbid autoimmune disordersLeft eye visionRepeat brain MRIHigh-dose methotrexateVaricella zoster infectionChronic kidney diseaseFeasibility and Toxicity of Full-Body Volumetric Modulated Arc Therapy Technique for High-Dose Total Body Irradiation
Keit E, Liveringhouse C, Figura N, Weygand J, Sandoval M, Garcia G, Peters J, Nieder M, Faramand R, Khimani F, Kim S, Robinson T, Johnstone P, Penagaricano J, Latifi K. Feasibility and Toxicity of Full-Body Volumetric Modulated Arc Therapy Technique for High-Dose Total Body Irradiation. Technology In Cancer Research & Treatment 2023, 22: 15330338231180779. PMID: 37287260, PMCID: PMC10272663, DOI: 10.1177/15330338231180779.Peer-Reviewed Original ResearchConceptsHigh-dose total body irradiationTotal body irradiationHelical tomotherapyBody irradiationDosimetric outcomesLower lung dosesMucosal sparing techniquesArc therapy (VMAT) techniqueMucosal sparingHead-first positionMyeloablative conditioningDaily fractionsLung dosesAcute leukemiaPrescription doseHT plansDose goalsFFS plansOAR sparingPatientsLow dosesArc therapyUnique protocolDosesVMAT plans
2022
Radiation therapy prior to CAR T-cell therapy in lymphoma: impact on patient outcomes
Figura N, Sim A, Jain M, Chavez J, Robinson T. Radiation therapy prior to CAR T-cell therapy in lymphoma: impact on patient outcomes. Expert Review Of Hematology 2022, 15: 1023-1030. PMID: 36369950, DOI: 10.1080/17474086.2022.2147919.Peer-Reviewed Original ResearchConceptsCAR T-cell therapyT-cell therapySalvage radiotherapyPatient outcomesAnti-CD19 chimeric antigen receptor (CAR) T-cell therapyChimeric antigen receptor T-cell therapyLarge B-cell lymphomaCurrent retrospective dataHigh tumor burdenClinical risk factorsAblative radiation dosesHypothesis-driven clinical trialsB-cell lymphomaMost patientsR DLBCLLocal recurrenceTumor burdenClinical evidenceRisk factorsTreatment paradigmClinical trialsTreatment outcomesRadiation therapyElevated riskPatientsMulti-Institutional Review of Bridging Radiotherapy Prior to Chimeric Antigen Receptor T-Cell Therapy for B-Cell Lymphomas
Yegya-Raman N, Wright C, Figura N, Zhang S, Chew J, Burke S, Sim A, LaRiviere M, Baron J, Sinha S, Yang J, Robinson T, Jain M, Maity A, Paydar I, Tseng Y, Braunstein S, Schuster S, Chong E, Plastaras J. Multi-Institutional Review of Bridging Radiotherapy Prior to Chimeric Antigen Receptor T-Cell Therapy for B-Cell Lymphomas. Blood 2022, 140: 10900-10901. DOI: 10.1182/blood-2022-157540.Peer-Reviewed Original ResearchClinical outcomes of non-small cell lung cancer brain metastases treated with stereotactic radiosurgery and immune checkpoint inhibitors, EGFR tyrosine kinase inhibitors, chemotherapy and immune checkpoint inhibitors, or chemotherapy alone.
Dohm A, Tang J, Mills M, Liveringhouse C, Sandoval M, Perez B, Robinson T, Creelan B, Gray J, Etame A, Vogelbaum M, Forsyth P, Yu H, Oliver D, Ahmed K. Clinical outcomes of non-small cell lung cancer brain metastases treated with stereotactic radiosurgery and immune checkpoint inhibitors, EGFR tyrosine kinase inhibitors, chemotherapy and immune checkpoint inhibitors, or chemotherapy alone. Journal Of Neurosurgery 2022, 138: 1600-1607. PMID: 36681988, DOI: 10.3171/2022.9.jns221896.Peer-Reviewed Original ResearchEpidermal growth factor receptor tyrosine kinase inhibitorsImmune checkpoint inhibitorsDistant intracranial controlNon-small cell lung cancer brain metastasesCell lung cancer brain metastasesLung cancer brain metastasesCancer brain metastasesSystemic therapyBrain metastasesStereotactic radiosurgeryCheckpoint inhibitorsLocal controlGrowth factor receptor tyrosine kinase inhibitorsSingle-fraction stereotactic radiosurgeryReceptor tyrosine kinase inhibitorsEGFR tyrosine kinase inhibitorsKinase inhibitorsChemotherapy-alone groupNSCLC BM patientsNSCLC brain metastasesTyrosine kinase inhibitorsBM diagnosisIntracranial controlBM patientsOverall survivalOral Mucosal Sparing in High-Dose Total Body Irradiation (TBI) prior to Stem Cell Transplantation (SCT) for Acute Leukemia
Liveringhouse C, Sandoval M, Dohm A, Weygand J, Garcia G, Peters J, Nieder M, Faramand R, Jain M, Locke F, Bejanyan N, Kim S, Robinson T, Latifi K. Oral Mucosal Sparing in High-Dose Total Body Irradiation (TBI) prior to Stem Cell Transplantation (SCT) for Acute Leukemia. International Journal Of Radiation Oncology • Biology • Physics 2022, 114: e353. DOI: 10.1016/j.ijrobp.2022.07.1462.Peer-Reviewed Original ResearchNon-relapse mortalityTotal body irradiationStem cell transplantationHigh-grade oral mucositisPlanning target volumeOral mucositisAcute oral mucositisAcute lymphocytic leukemiaAcute leukemiaMucosal sparingOral mucosaExact testRisk of NRMHigh-dose total body irradiationDose total body irradiationHost disease (GVHD) prophylaxisResults 25 patientsMedian patient ageSevere oral mucositisFatal respiratory failureFisher's exact testNon-significant trendIMRT/VMATConditioning chemotherapyFatal GVHDPatient-Level Disease Burden as a Predictor of In-Field Failures in Patients Undergoing Bridging Radiotherapy for CD19-Directed Chimeric Antigen Receptor (CAR) T-Cell Therapy for Recurrent/Refractory Large B-Cell Lymphomas
Figura N, Sim A, Chavez J, Shah B, Khimani F, Lazaryan A, Davila M, Bachmeier C, Nishihori T, Liu H, Christopherson K, Kim S, Locke F, Jain M, Robinson T. Patient-Level Disease Burden as a Predictor of In-Field Failures in Patients Undergoing Bridging Radiotherapy for CD19-Directed Chimeric Antigen Receptor (CAR) T-Cell Therapy for Recurrent/Refractory Large B-Cell Lymphomas. International Journal Of Radiation Oncology • Biology • Physics 2022, 114: s85. DOI: 10.1016/j.ijrobp.2022.07.491.Peer-Reviewed Original ResearchMedian metabolic tumor volumeT-cell therapyRefractory large B-cell lymphomaCAR T-cell therapyLarge B-cell lymphomaBRT patientsDisease burdenTotal disease burdenB-cell lymphomaField progressionRadiation therapyLocal controlClinical outcomesExact testChimeric antigen receptor T-cell therapyCAR T-cell infusionDistant-only failureDurable local controlLocal-only failureWorse disease burdenFuture prospective trialsT-cell infusionHigh-risk patientsKaplan-Meier methodLow disease burdenPD01-09 PROTEOGENOMIC AND CLINICAL IMPLICATIONS OF RECURRENT SPLICE VARIANTS IN CLEAR CELL RENAL CELL CARCINOMA
Chang A, Stewart P, Chakiryan N, Soupir A, Tian Y, Du D, Teer J, Kim Y, Spiess P, Chahoud J, Zhang Y, Koomen J, Berglund A, Robinson T, Wang L, Manley B. PD01-09 PROTEOGENOMIC AND CLINICAL IMPLICATIONS OF RECURRENT SPLICE VARIANTS IN CLEAR CELL RENAL CELL CARCINOMA. Journal Of Urology 2022, 207: e33. DOI: 10.1097/ju.0000000000002516.09.Peer-Reviewed Original ResearchPredicting Stereotactic Radiosurgery Dose Maps from Pre-Therapy MR Images using a Deep Neural Network
Pandey S, Kutuk T, Mills M, Abdalah M, Stringfield O, Latifi K, Robinson T, Moreno W, Ahmed K, Raghunand N. Predicting Stereotactic Radiosurgery Dose Maps from Pre-Therapy MR Images using a Deep Neural Network. Proceedings Of The International Society For Magnetic Resonance In Medicine ... Scientific Meeting And Exhibition. 2022 DOI: 10.58530/2022/4966.Peer-Reviewed Original ResearchDose mapsStereotactic radiosurgeryPre-RTMR imagingRadiation treatmentAsymptomatic brain metastasesMR images of patientsImages of patientsDoses of radiation treatmentVoxel intensitiesTumor controlBrain metastasesTumor responsePre-therapyTumorHealthy brainBrainRadiosurgeryMetastasizingMetastasisPatientsBreastDoseProteogenomic and clinical implications of unique recurrent splice variants in clear cell renal cell carcinoma.
Chang A, Stewart P, Chakiryan N, Soupir A, Tian Y, Du D, Teer J, Kim Y, Spiess P, Chahoud J, Zhang Y, Koomen J, Berglund A, Wang L, Robinson T, Manley B. Proteogenomic and clinical implications of unique recurrent splice variants in clear cell renal cell carcinoma. Journal Of Clinical Oncology 2022, 40: 380-380. DOI: 10.1200/jco.2022.40.6_suppl.380.Peer-Reviewed Original ResearchGenotype-Tissue Expression (GTEx) projectRNA-seq dataClear cell renal cell carcinomaSplice variantsClinical Proteomic Tumor Analysis ConsortiumBulk RNA-seq dataCell renal cell carcinomaAlternative mRNA splicingAberrant splice variantsCancer Cell Line EncyclopediaProteomic diversityProteogenomic analysisCancer Genome AtlasMRNA splicingExpression projectPathway enrichmentSplicing processTumor suppressorNew pathogenic mechanismGenomic mutationsNovel pipelineAnalysis ConsortiumOncogenic pathwaysCancer-specific survivalGenome AtlasUpfront Treatment With Osimertinib vs. Osimertinib and Radiotherapy for Patients With EGFR-Positive Non-Small Cell Lung Cancer Brain Metastases
Dohm A, Tang J, Mills M, Perez B, Robinson T, Creelan B, Yu H, Oliver D, Ahmed K. Upfront Treatment With Osimertinib vs. Osimertinib and Radiotherapy for Patients With EGFR-Positive Non-Small Cell Lung Cancer Brain Metastases. International Journal Of Radiation Oncology • Biology • Physics 2022, 112: e14. DOI: 10.1016/j.ijrobp.2021.10.186.Peer-Reviewed Original ResearchDistant intracranial controlEGFR-positive NSCLCBrain metastasesRadiation therapyBM diagnosisOverall survivalLocal controlMultivariate analysisSingle-institution retrospective analysisGeneration tyrosine kinase inhibitorsCentral nervous system penetrationUpfront radiation therapyKaplan-Meier methodProportional hazards modelTyrosine kinase inhibitorsMATERIAL/METHODSIntracranial radiation therapyIntracranial controlUpfront treatmentDS-GPAClinical outcomesResults MedianRetrospective analysisTreatment groupsHazards model
2021
NCMP-08. CHALLENGING DIAGNOSIS AND MANAGEMENT OF PCNSL IN AN IMMUNOSUPPRESSED PATIENT ON MYCOPHENOLATE MOFETIL FOR MYASTHENIA GRAVIS
Bricoune O, Mokhtari S, Etame A, Robinson T, Pina Y, Macaulay R. NCMP-08. CHALLENGING DIAGNOSIS AND MANAGEMENT OF PCNSL IN AN IMMUNOSUPPRESSED PATIENT ON MYCOPHENOLATE MOFETIL FOR MYASTHENIA GRAVIS. Neuro-Oncology 2021, 23: vi148-vi149. DOI: 10.1093/neuonc/noab196.581.Peer-Reviewed Original ResearchPrimary CNS lymphomaDiffuse large B-cell lymphomaMycophenolate mofetilMyasthenia gravisEnhancing lesionsBrain MRIAcetylcholine receptor antibody-positive myasthenia gravisDiagnosis of PCNSLManagement of PCNSLAntibody-positive myasthenia gravisLarge B-cell lymphomaLeft eye visionRepeat brain MRIFocal neurological deficitsCerebrospinal fluid analysisPositive myasthenia gravisGross total resectionPeriventricular white matterLeft frontal lesionNew enhancing lesionsAdditional diagnostic testsB-cell lymphomaLeft medullaOral prednisoneRituximab IVImmune Cell Infiltrates of the Tumor Microenvironment and Radiosensitivity of Recurrent Glioblastomas and Their Association With Outcome
Rishi A, Mohammadi H, Martir D, Welsh E, Robinson T, Oliver D, Eschrich S, Torres-Roca J, Yu H, Grass D, Ahmed K. Immune Cell Infiltrates of the Tumor Microenvironment and Radiosensitivity of Recurrent Glioblastomas and Their Association With Outcome. International Journal Of Radiation Oncology • Biology • Physics 2021, 111: s123. DOI: 10.1016/j.ijrobp.2021.07.281.Peer-Reviewed Original ResearchImmune cell infiltratesProgression-free survivalAffected overall survivalOverall survivalHelper T cellsRadiosensitivity indexCell infiltrateClinical trialsT cellsPrimary GBMMedian progression-free survivalLack of monocytesNLR/PLRHigh expressionPoor prognostic factorCurrent smoking statusKaplan-Meier estimatesLog-rank testLow-grade gliomasMATERIAL/METHODSAssociation of factorsICI subtypesRGBM patientsAdjuvant radiotherapyFree survivalClinical Outcomes of Non-Small Cell Lung Cancer Brain Metastases Treated With Stereotactic Radiosurgery and Immune Checkpoint Inhibitors, EGFR Tyrosine Kinase Inhibitors, Chemotherapy and Immune Checkpoint Inhibitors, or Chemotherapy Alone
Dohm A, Tang J, Mills M, Perez B, Robinson T, Creelan B, Gray J, Etame A, Vogelbaum M, Forsyth P, Yu H, Oliver D, Ahmed K. Clinical Outcomes of Non-Small Cell Lung Cancer Brain Metastases Treated With Stereotactic Radiosurgery and Immune Checkpoint Inhibitors, EGFR Tyrosine Kinase Inhibitors, Chemotherapy and Immune Checkpoint Inhibitors, or Chemotherapy Alone. International Journal Of Radiation Oncology • Biology • Physics 2021, 111: e567. DOI: 10.1016/j.ijrobp.2021.07.1531.Peer-Reviewed Original ResearchEpidermal growth factor receptor tyrosine kinase inhibitorsImmune checkpoint inhibitorsDistant intracranial controlNon-small cell lung cancer brain metastasesCell lung cancer brain metastasesLung cancer brain metastasesTiming of SRSChemotherapy-alone groupNSCLC BM patientsNSCLC brain metastasesBrain metastasesCancer brain metastasesSystemic therapyRadiation necrosisStereotactic radiosurgeryCheckpoint inhibitorsOverall survivalTreatment groupsLocal controlMultivariate analysisBM patientsAlone groupClinical outcomesConventional chemotherapyGrowth factor receptor tyrosine kinase inhibitors