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82


Diagnostic sensitivity of serum and lumbar CSF bHCG in newly diagnosed CNS germinoma

Allen, J; Chacko, J; Donahue, B; Dhall, G; Kretschmar, C; Jakacki, R; Holmes, E; Pollack, I
BACKGROUND: Marked elevations of AFP and bHCG in serum or CSF may serve as surrogate diagnostic markers in lieu of histology for primary CNS mixed, malignant germ cell tumors. There is less information on the diagnostic sensitivity of bHCG assays in germinoma. PROCEDURE: We report baseline serum and lumbar CSF bHCG values in 58 newly diagnosed, histologically confirmed germinoma patients gathered from two prospective clinical trials which required that patients have a normal AFP and bHCG
PMCID:3356788
PMID: 22302772
ISSN: 1545-5009
CID: 160195

OUTCOMES OF RADIOTHERAPY ALONE VS. CHEMOTHERAPY FOLLOWED BY RESPONSE-BASED RADIOTHERAPY FOR NEWLY DIAGNOSED PRIMARY CNS GERMINOMA (COG ACNS 0232) [Meeting Abstract]

Tagliareni, Laura; Allen, Jeffrey; Kretschmar, Cynthia; Donahue, Bernadine; Sands, Stephen
ISI:000309754300488
ISSN: 1545-5009
CID: 183682

Ipitimumab in Melanoma With Limited Brain Metastasis Treated With Stereotactic Radiosurgery [Meeting Abstract]

Mathew, M.; Ott, P.; Pavlick, A. C.; Rush, S. C.; Donahue, B.; Golfinos, J. G.; Parker, E. C.; Huang, P.; Narayana, A.
ISI:000310542900759
ISSN: 0360-3016
CID: 204902

Radiologic and Clinical Outcomes for Acoustic Neuromas Treated With Gamma-knife Radiosurgery in the Lower Dose Ranges [Meeting Abstract]

Hardee, M. E.; Rush, S. C.; Rush, J.; Hammer, B.; Glidden, A.; Narayana, A.; Donahue, B.; Huang, P.; Parker, E. C.; Golfinos, J. G.
ISI:000310542900700
ISSN: 0360-3016
CID: 204752

Marginal Misses in Gamma-knife Radiosurgery for Meningiomas: Are Treatment Volume and Dose Adequate? [Meeting Abstract]

Sethi, R. A.; Rush, S. C.; Liu, S.; Huang, P.; Parker, E.; Donahue, B.; Narayana, A.; Golfinos, J.
ISI:000310542900701
ISSN: 0360-3016
CID: 204782

IPILIMUMAB IN MELANOMA WITH LIMITED BRAIN METASTASIS TREATED WITH STEREOTACTIC RADIOSURGERY [Meeting Abstract]

Mathew, Maya; Ott, Patrick; Rush, Stephen; Donahue, Bernadine; Pavlick, Anna; Golfinos, John; Parker, Erik; Huang, Paul; Narayana, Ashwatha
ISI:000310971300240
ISSN: 1522-8517
CID: 204952

Long-term Outcomes After Staged-Volume Stereotactic Radiosurgery for Large Arteriovenous Malformations

Huang, Paul P; Rush, Stephen C; Donahue, Bernadine; Narayana, Ashwatha; Becske, Tibor; Nelson, P Kim; Han, Kerry; Jafar, Jafar J
BACKGROUND: : Stereotactic radiosurgery is an effective treatment modality for small arteriovenous malformations (AVMs) of the brain. For larger AVMs, the treatment dose is often lowered to reduce potential complications, but this decreases the likelihood of cure. One strategy is to divide large AVMs into smaller anatomic volumes and treat each volume separately. OBJECTIVE: : To prospectively assess the long-term efficacy and complications associated with staged-volume radiosurgical treatment of large, symptomatic AVMs. METHODS: : Eighteen patients with AVMs larger than 15 mL underwent prospective staged-volume radiosurgery over a 13-year period. The median AVM volume was 22.9 mL (range, 15.7-50 mL). Separate anatomic volumes were irradiated at 3- to 9-month intervals (median volume, 10.9 mL; range, 5.3-13.4 mL; median marginal dose, 15 Gy; range, 15-17 Gy). The AVM was divided into 2 volumes in 10 patients, 3 volumes in 5 patients, and 4 volumes in 3 patients. Seven patients underwent retreatment for residual disease. RESULTS: : Actuarial rates of complete angiographic occlusion were 29% and 89% at 5 and 10 years. Five patients (27.8%) had a hemorrhage after radiosurgery. Kaplan-Meier analysis of cumulative hemorrhage rates after treatment were 12%, 18%, 31%, and 31% at 2, 3, 5, and 10 years, respectively. One patient died after a hemorrhage (5.6%). CONCLUSION: : Staged-volume radiosurgery for AVMs larger than 15 mL is a viable treatment strategy. The long-term occlusion rate is high, whereas the radiation-related complication rate is low. Hemorrhage during the lag period remains the greatest source of morbidity and mortality. ABBREVIATION:: AVM, arteriovenous malformation.
PMID: 22710381
ISSN: 0148-396x
CID: 175772

Postoperative Intraperitoneal 5-Fluoro-2'-Deoxyuridine Added to Chemoradiation in Patients Curatively Resected (R0) for Locally Advanced Gastric and Gastroesophageal Junction Adenocarcinoma

Cohen DJ; Newman E; Iqbal S; Chang RY; Potmesil M; Ryan T; Donahue B; Chandra A; Liu M; Utate M; Hiotis S; Pachter LH; Hochster H; Muggia F
PURPOSE: Chemoradiation after surgery for locally advanced gastric cancer improves overall and relapse-free survival compared with observation. However, locoregional recurrences remain high. Accordingly, we instituted this pilot/feasibility study, including intraperitoneal 5-fluoro-2'-deoxyuridine (IP FUDR) as part of the treatment. METHODS: Gastric/gastroesophageal junction adenocarcinoma stage Ib-IV (M0) patients who underwent R(0) resection were eligible and had IP catheters inserted at time of surgery. IP FUDR (3 g/dose/day) was given during study days 1-3 and 15-17 before combined 5-fluorouracil, leucovorin, and external beam radiation (45 Gy). Endpoints included toxicity, completion rate, locoregional recurrence, and survival. RESULTS: Twenty-eight patients (22 men) were enrolled from 2002-2006 at two institutions; their median age was 59.5 years. After R(0) resection, a median 22 (range, 8-102) lymph nodes were examined, and 22 patients had positive nodes. AJCC stages were IB (n = 8), II (n = 10), IIIA (n = 5), IIIB (n = 1), and IV (n = 4). Full-dose IP FUDR and chemoradiation treatment was completed in 20 and 25 patients, respectively. At nearly 4-year median follow-up, 11 patients were disease-free, 5 were alive with disease, 7 were dead of disease, and 1 was dead from other cause; 4 have been lost to follow-up. Recurrences were local in one, intra-abdominal in six, distant in two, multiple sites in two, and unknown in one. The median relapse-free survival is 65.3 months, and the median overall survival has not yet been reached. CONCLUSIONS: IP FUDR before chemoradiation after R(0) gastric cancer resection is well tolerated without compromising completion of postoperative adjuvant treatment. Larger randomized trials studying IP FUDR as part of gastric cancer multidisciplinary treatment are needed to prove efficacy in reducing regional recurrence and improving survival
PMID: 21769462
ISSN: 1534-4681
CID: 135531

Radiation therapy quality in CCG/POG intergroup 9961: implications for craniospinal irradiation and the posterior fossa boost in future medulloblastoma trials

Donahue, Bernadine; Marymont, Mary A H; Kessel, Sandra; Iandoli, Matthew K; Fitzgerald, Thomas; Holmes, Emiko; Kocak, Mehmet; Boyett, James M; Gajjar, Amar; Packer, Roger J
Purpose: Associations of radiation therapy (RT) deviations and outcomes in medulloblastoma have not been defined well, particularly in the era of reduced-dose craniospinal irradiation and chemotherapy. The aim of this study is to evaluate the quality of RT on Children's Cancer Group/Pediatric Oncology Group 9961 and analyze associations of RT deviations with outcome. Materials and Methods: Major volume deviations were assessed based on the distance from specified anatomical region to field edge. We investigated associations of RT deviations with progression-free survival (PFS), overall survival (OS), and explored associations with demographics and clinical variables. Results: Of the 308 patients who were evaluable for volume deviations, 101 patients (33%) did not have any. Of the remaining 207 patients, 50% had only minor deviations, 29% had only major deviations, and 21% had both minor and major deviations. Of the patients with major deviations, 73% had a single major deviation. The most common major deviation was in the cribriform plate region, followed by the posterior fossa (PF); PF deviations resulted from treating less than whole PF. There were no significant differences in PFS or OS between patients with deviations and those without. There was no evidence of associations of deviations with patient age. Conclusions: Approximately one-third of patients had major volume deviations. There was no evidence of a significant association between these and outcome. This lack of correlation likely reflects the current high quality of RT delivered in Children's Oncology Group institutions, our strict definition of volume deviations, and the relatively few instances of multiple major deviations in individual patients. In is noteworthy that the types of PF volume deviations observed in this study were not adversely associated with outcome. As we move forward, quality assurance will continue to play an important role to ensure that deviations on study do not influence study outcome.
PMCID:3540930
PMID: 23316474
ISSN: 2234-943x
CID: 213392

Role of HER2 status in the treatment of brain metastases arising from breast cancer by stereotactic radiosurgery. [Meeting Abstract]

Novik, Y.; Kunnakkat, S.; Donahue, B.; Rush, S.; Golfinos, J.; Parker, E.; Narayana, A.
ISI:000208880600114
ISSN: 0732-183x
CID: 3589682