2023
Selected-Lesion Stereotactic Radiosurgery in Treatment of Patients with Multiple Brain Metastases: A Single Institution Retrospective Study
Mange A, Singh C, Theriault B, Hansen J, An Y, Aneja S, Chiang V. Selected-Lesion Stereotactic Radiosurgery in Treatment of Patients with Multiple Brain Metastases: A Single Institution Retrospective Study. International Journal Of Radiation Oncology • Biology • Physics 2023, 117: e135. DOI: 10.1016/j.ijrobp.2023.06.939.Peer-Reviewed Original ResearchMultiple brain metastasesBrain metastasesStereotactic radiosurgeryMedian KPSCommon indicationTumor characteristicsClinical trialsSRS treatmentSingle-institution retrospective studySubsequent-line treatmentMethods Clinical dataPatient selection criteriaTreatment of patientsSubset of lesionsNumber of lesionsDiagnosis of melanomaCNS progressionCNS radiationPrior WBRTOverall survivalPalliative treatmentPatient characteristicsProgressive diseaseImmunotherapy trialsSurvival groupSelected-Lesion SRS as a Novel Strategy in Treatment of Patients with Multiple Brain Metastases
Singh C, Theriault B, An Y, Yu J, Knisely J, Shepard M, Wegner R, Warnick R, Peker S, Samanci Y, Trifiletti D, Lee C, Yang H, Bernstein K, Kondziolka D, Tripathi M, Mathieu D, Mantziaris G, Pikis S, Sheehan J, Chiang V. Selected-Lesion SRS as a Novel Strategy in Treatment of Patients with Multiple Brain Metastases. International Journal Of Radiation Oncology • Biology • Physics 2023, 117: e150-e151. DOI: 10.1016/j.ijrobp.2023.06.971.Peer-Reviewed Original ResearchWhole-brain radiation therapyTreatment of patientsSystemic diseaseBrain metastasesLesion locationIntracranial lesionsPrior whole-brain radiation therapyMultiple brain metastasesBrain radiation therapyUntreated brain metastasesBrain metastasis treatmentCurrent practice patternsSigns/symptomsPresence of symptomsMATERIAL/METHODSImmunotherapy optionsSystemic therapyUntreated lesionsMedical oncologyPerilesional edemaDrug optionsClinical trialsPractice patternsClinical indicationsMetastasis treatmentSelected-Lesion Stereotactic Radiosurgery (SL-SRS) as a Novel Strategy in the Treatment of Patients With Multiple Brain Metastases
Theriault B, Singh C, Yu J, Knisely J, Shepard M, Wegner R, Warnick R, Peker S, Samanci Y, Trifiletti D, Lee C, Yang H, Bernstein K, Kondziolka D, Tripathi M, Mathieu D, Mantziaris G, Pikis S, Sheehan J, Chiang V. Selected-Lesion Stereotactic Radiosurgery (SL-SRS) as a Novel Strategy in the Treatment of Patients With Multiple Brain Metastases. Cureus 2023, 15: e45457. PMID: 37859877, PMCID: PMC10583225, DOI: 10.7759/cureus.45457.Peer-Reviewed Original ResearchWhole brain radiotherapyInternational Radiosurgery Research FoundationPrior whole brain radiotherapyBrain metastasesStereotactic radiosurgeryCommon reasonAsymptomatic brain metastasesNon-eloquent locationsSystemic treatment optionsMultiple brain metastasesPoor functional statusTreatment of patientsCentral nervous systemAttributable symptomsExtracranial diseaseSystemic therapyUntreated lesionsMedical oncologySystemic diseaseFunctional statusTreatment optionsClinical trialsSingle lesionLesion locationIntracranial lesions
2021
Management of Brain Metastases
Collier E, Chiang V, Goldberg S. Management of Brain Metastases. Current Cancer Research 2021, 115-137. DOI: 10.1007/978-3-030-74028-3_6.Peer-Reviewed Original ResearchBrain metastasesSystemic therapyLocal therapyAsymptomatic brain metastasesNew systemic therapiesSource of morbidityInclusion of patientsMalignant brain tumorsQuality of lifeNew cancer treatmentsSignificant morbidityWorse prognosisPatient survivalCNS diseaseLung cancerClinical trialsBrain tumorsMetastasisNSCLCTherapyCancer treatmentSmall molecule drugsFrequent originMorbidityTreatmentSURG-02. Stereotactic Laser Ablation (SLA) followed by consolidation stereotactic radiosurgery (SRS) as a treatment strategy for brain metastasis that recurred locally after initial radiosurgery (BMRS): a collaborative institutional experience
Pena-Pino I, Ma J, Hori Y, Fomchenko E, Dusenbery K, Reynolds M, Wilke C, Yuan J, Barnett G, Chiang V, Mohammadi A, Chen C. SURG-02. Stereotactic Laser Ablation (SLA) followed by consolidation stereotactic radiosurgery (SRS) as a treatment strategy for brain metastasis that recurred locally after initial radiosurgery (BMRS): a collaborative institutional experience. Neuro-Oncology Advances 2021, 3: iii23-iii23. PMCID: PMC8351296, DOI: 10.1093/noajnl/vdab071.095.Peer-Reviewed Original ResearchStereotactic laser ablationStereotactic radiosurgeryOverall survivalTreatment strategiesLocal controlDays of SRSSymptomatic radiation necrosisMedian overall survivalSystemic disease progressionRepeat stereotactic radiosurgeryIndependent clinical trialsInitial radiosurgerySteroid therapyBrain metastasesClinical outcomesRadiation necrosisFavorable outcomeClinical trialsDisease progressionFLAIR volumeInstitutional experiencePatientsCE volumeRadiosurgeryLocal failure
2020
Survival in Patients With Brain Metastases: Summary Report on the Updated Diagnosis-Specific Graded Prognostic Assessment and Definition of the Eligibility Quotient.
Sperduto PW, Mesko S, Li J, Cagney D, Aizer A, Lin NU, Nesbit E, Kruser TJ, Chan J, Braunstein S, Lee J, Kirkpatrick JP, Breen W, Brown PD, Shi D, Shih HA, Soliman H, Sahgal A, Shanley R, Sperduto WA, Lou E, Everett A, Boggs DH, Masucci L, Roberge D, Remick J, Plichta K, Buatti JM, Jain S, Gaspar LE, Wu CC, Wang TJC, Bryant J, Chuong M, An Y, Chiang V, Nakano T, Aoyama H, Mehta MP. Survival in Patients With Brain Metastases: Summary Report on the Updated Diagnosis-Specific Graded Prognostic Assessment and Definition of the Eligibility Quotient. Journal Of Clinical Oncology 2020, 38: 3773-3784. PMID: 32931399, PMCID: PMC7655019, DOI: 10.1200/jco.20.01255.Peer-Reviewed Original ResearchConceptsGraded Prognostic AssessmentDiagnosis-Specific Graded Prognostic AssessmentBrain metastasesPrognostic factorsClinical trialsPrognostic assessmentLarge contemporary cohortSignificant prognostic factorsEnrollment of patientsNew prognostic factorsMulti-institutional databaseMedian survivalMultivariable analysisContemporary cohortWorse prognosisCell lungIndividualize treatmentTreatment choicePoor survivalRenal cancerPatientsPromising treatmentExpansion of eligibilityMetastasisPrimary site
2019
Complications associated with immunotherapy for brain metastases.
Tran TT, Jilaveanu LB, Omuro A, Chiang VL, Huttner A, Kluger HM. Complications associated with immunotherapy for brain metastases. Current Opinion In Neurology 2019, 32: 907-916. PMID: 31577604, PMCID: PMC7398556, DOI: 10.1097/wco.0000000000000756.Peer-Reviewed Original ResearchConceptsBrain metastasesNeurologic toxicityImmune therapyPhase 2 clinical trialCheckpoint inhibitor therapyImmune checkpoint inhibitorsMultiple phase 2 clinical trialsTreatment-related morbidityBrain metastatic diseaseSymptomatic edemaCheckpoint inhibitorsAdverse eventsDurable responsesMedian survivalMetastatic diseaseInhibitor therapyMore patientsIntracranial activityPatient groupRadiation necrosisClinical trialsTherapy trialsMultidisciplinary teamMetastasisPatientsFrequent Use of Local Therapy Underscores Need for Multidisciplinary Care in the Management of Patients With Melanoma Brain Metastases Treated With PD-1 Inhibitors
Qian JM, Yu JB, Mahajan A, Goldberg SB, Kluger HM, Chiang VLS. Frequent Use of Local Therapy Underscores Need for Multidisciplinary Care in the Management of Patients With Melanoma Brain Metastases Treated With PD-1 Inhibitors. International Journal Of Radiation Oncology • Biology • Physics 2019, 105: 1113-1118. PMID: 31479702, DOI: 10.1016/j.ijrobp.2019.08.053.Peer-Reviewed Original ResearchConceptsBrain metastasesLocal therapyNeurologic safetyMelanoma patientsProspective phase 2 trialProgressive brain metastasesSerial brain imagingMelanoma brain metastasesPD-1 inhibitorsPhase 2 trialRapid disease progressionManagement of patientsNeurologic symptomsMultidisciplinary careTrial enrollmentCystic changesClinical trialsDisease progressionPatientsLesion sizeMetastasisMultidisciplinary teamTumor growthTherapyClinical decisionBrain Metastasis From Renal-Cell Carcinoma: An Institutional Study
Suarez-Sarmiento A, Nguyen KA, Syed JS, Nolte A, Ghabili K, Cheng M, Liu S, Chiang V, Kluger H, Hurwitz M, Shuch B. Brain Metastasis From Renal-Cell Carcinoma: An Institutional Study. Clinical Genitourinary Cancer 2019, 17: e1163-e1170. PMID: 31519468, DOI: 10.1016/j.clgc.2019.08.006.Peer-Reviewed Original ResearchConceptsRCC brain metastasesRecurrence-free survivalRenal cell carcinomaBrain metastasesOverall survivalClinical trialsAdvanced renal cell carcinomaCentral nervous system treatmentClear cell renal cell carcinomaMedian overall survivalSingle institution experienceGood local controlKaplan-Meier methodAggressive therapyCNS recurrenceTreatment eraCumulative incidenceExtracranial metastasesMetastatic diseaseSystemic therapyInitial presentationLocal therapyClinical symptomsRCC patientsCell carcinomaEstimating survival in patients with gastrointestinal cancers and brain metastases: An update of the graded prognostic assessment for gastrointestinal cancers (GI-GPA)
Sperduto PW, Fang P, Li J, Breen W, Brown PD, Cagney D, Aizer A, Yu JB, Chiang V, Jain S, Gaspar LE, Myrehaug S, Sahgal A, Braunstein S, Sneed P, Cameron B, Attia A, Molitoris J, Wu CC, Wang TJC, Lockney NA, Beal K, Parkhurst J, Buatti JM, Shanley R, Lou E, Tandberg DD, Kirkpatrick JP, Shi D, Shih HA, Chuong M, Saito H, Aoyama H, Masucci L, Roberge D, Mehta MP. Estimating survival in patients with gastrointestinal cancers and brain metastases: An update of the graded prognostic assessment for gastrointestinal cancers (GI-GPA). Clinical And Translational Radiation Oncology 2019, 18: 39-45. PMID: 31341974, PMCID: PMC6612649, DOI: 10.1016/j.ctro.2019.06.007.Peer-Reviewed Original ResearchDiagnosis-Specific Graded Prognostic AssessmentBrain metastasesMedian survivalGastrointestinal cancerPrognostic factorsPrognostic assessmentGI cancer patientsOverall median survivalGraded Prognostic AssessmentMultiple Cox regressionFuture clinical trialsMulti-national cohortWorst prognostic groupLarge contemporary databaseGPA 0Hazard ratioCox regressionGI cancersPrognostic groupsCancer patientsClinical trialsIndividual patientsTherapy selectionPatientsFirst treatmentResults of a pilot/phase II study of gamma knife radiosurgery for brain metastases and implications for future prospective clinical trials
Yu J, Singh C, Bindra R, Contessa J, Husain Z, Hansen J, Park H, Roberts K, Bond J, Tien C, Guo F, Colaco R, Housri N, Magnuson W, Mahajan A, Omay S, Chiang V. Results of a pilot/phase II study of gamma knife radiosurgery for brain metastases and implications for future prospective clinical trials. Journal Of Radiation Oncology 2019, 8: 39-46. DOI: 10.1007/s13566-018-0370-7.Peer-Reviewed Original ResearchYale-New Haven HospitalPhase II studyBrain metastasesClinical trialsII studyKnife radiosurgeryLocal controlPre-defined primary endpointWhole-brain radiation treatmentFuture prospective clinical trialsEvaluable brain metastasesSymptomatic radiation necrosisMedian patient ageLocal control ratePhase 2 studyGood local controlProspective clinical trialsNumber of metastasesLarge clinical trialsProportional hazards regressionFuture clinical trialsGamma knife radiosurgeryImportant clinical variablesStandard clinical practiceNew Haven Hospital
2018
Single versus Multifraction Stereotactic Radiosurgery for Large Brain Metastases: An International Meta-analysis of 24 Trials
Lehrer EJ, Peterson JL, Zaorsky NG, Brown PD, Sahgal A, Chiang VL, Chao ST, Sheehan JP, Trifiletti DM. Single versus Multifraction Stereotactic Radiosurgery for Large Brain Metastases: An International Meta-analysis of 24 Trials. International Journal Of Radiation Oncology • Biology • Physics 2018, 103: 618-630. PMID: 30395902, DOI: 10.1016/j.ijrobp.2018.10.038.Peer-Reviewed Original ResearchConceptsLarge brain metastasesMF-SRSSF-SRSMultifraction stereotactic radiosurgeryBrain metastasesRandom effects estimatesStereotactic radiosurgeryLocal controlMeta-AnalysisEffect estimatesRates of radionecrosisProspective clinical trialsPreferred Reporting ItemsRadionecrosis ratePostoperative settingTumor sizeInternational Meta-AnalysisEpidemiology guidelinesClinical trialsObservational studyRandom effectsTumor volumeSummary estimatesReporting ItemsMetastasis
2017
Estimating Survival in Patients With Lung Cancer and Brain Metastases: An Update of the Graded Prognostic Assessment for Lung Cancer Using Molecular Markers (Lung-molGPA)
Sperduto PW, Yang TJ, Beal K, Pan H, Brown PD, Bangdiwala A, Shanley R, Yeh N, Gaspar LE, Braunstein S, Sneed P, Boyle J, Kirkpatrick JP, Mak KS, Shih HA, Engelman A, Roberge D, Arvold ND, Alexander B, Awad MM, Contessa J, Chiang V, Hardie J, Ma D, Lou E, Sperduto W, Mehta MP. Estimating Survival in Patients With Lung Cancer and Brain Metastases: An Update of the Graded Prognostic Assessment for Lung Cancer Using Molecular Markers (Lung-molGPA). JAMA Oncology 2017, 3: 827-831. PMID: 27892978, PMCID: PMC5824323, DOI: 10.1001/jamaoncol.2016.3834.Peer-Reviewed Original ResearchConceptsDiagnosis-Specific Graded Prognostic AssessmentBrain metastasesGraded Prognostic AssessmentFuture clinical trialsLung cancerLung-molGPAMedian survivalPrognostic factorsHazard ratioClinical trialsMAIN OUTCOMEPrognostic assessmentLung-molGPA scoreOverall median survivalKarnofsky performance statusMultiple Cox regressionSignificant prognostic factorsCell lung cancerRetrospective database analysisCancer-related mortalityLog-rank testHeterogeneous patient populationClinical decision makingExtracranial metastasesOverall survivalComparing available criteria for measuring brain metastasis response to immunotherapy
Qian JM, Mahajan A, Yu JB, Tsiouris AJ, Goldberg SB, Kluger HM, Chiang VL. Comparing available criteria for measuring brain metastasis response to immunotherapy. Journal Of Neuro-Oncology 2017, 132: 479-485. PMID: 28275886, DOI: 10.1007/s11060-017-2398-8.Peer-Reviewed Original ResearchConceptsRECIST 1.1Brain lesionsBrain metastasesDurable responsesAdditional patientsNeuro-Oncology Working GroupBrain metastasis responseBrain metastasis patientsUntreated brain metastasesStandardized response criteriaBrain lesion sizeHigh-grade gliomasSimilar clinical trialsHigh-resolution MRIMetastasis patientsMetastasis responseOngoing trialsClinical trialsNovel therapiesResponse assessmentDiscordant casesLesion sizePatientsResponse rateLongest diameter
2011
Summary Report on the Graded Prognostic Assessment: An Accurate and Facile Diagnosis-Specific Tool to Estimate Survival for Patients With Brain Metastases
Sperduto PW, Kased N, Roberge D, Xu Z, Shanley R, Luo X, Sneed PK, Chao ST, Weil RJ, Suh J, Bhatt A, Jensen AW, Brown PD, Shih HA, Kirkpatrick J, Gaspar LE, Fiveash JB, Chiang V, Knisely JP, Sperduto CM, Lin N, Mehta M. Summary Report on the Graded Prognostic Assessment: An Accurate and Facile Diagnosis-Specific Tool to Estimate Survival for Patients With Brain Metastases. Journal Of Clinical Oncology 2011, 30: 419-425. PMID: 22203767, PMCID: PMC3269967, DOI: 10.1200/jco.2011.38.0527.Peer-Reviewed Original ResearchConceptsGraded Prognostic AssessmentKarnofsky performance scoreBrain metastasesSignificant prognostic factorsPrognostic factorsPrognostic indexPrognostic assessmentMulti-institutional retrospective databasePerformance scoresPrognostic assessment indexOnly prognostic factorMedian survival timeRenal cell cancerSingle tumor typeExtracranial metastasesBetter prognosisCell cancerWorse prognosisGI cancersRetrospective databaseLung cancerClinical trialsAppropriate treatmentBreast cancerSurvival time