Try a new search

Format these results:

Searched for:

in-biosketch:true

person:kondzd01

Total Results:

1440


Stereotactic radiosurgery for haemorrhagic cerebral cavernous malformation: a multi-institutional, retrospective study

Dumot, Chloe; Mantziaris, Georgios; Dayawansa, Sam; Xu, Zhiyuan; Pikis, Stylianos; Peker, Selcuk; Samanci, Yavuz; Ardor, Gokce D; Nabeel, Ahmed M; Reda, Wael A; Tawadros, Sameh R; Abdelkarim, Khaled; El-Shehaby, Amr M N; Emad Eldin, Reem M; Elazzazi, Ahmed H; Moreno, Nuria Martínez; Martínez Álvarez, Roberto; Liscak, Roman; May, Jaromir; Mathieu, David; Tourigny, Jean-Nicolas; Tripathi, Manjul; Rajput, Akshay; Kumar, Narendra; Kaur, Rupinder; Picozzi, Piero; Franzini, Andrea; Speckter, Herwin; Hernandez, Wenceslao; Brito, Anderson; Warnick, Ronald E; Alzate, Juan; Kondziolka, Douglas; Bowden, Greg N; Patel, Samir; Sheehan, Jason
BACKGROUND:Cerebral cavernous malformations (CCMs) frequently manifest with haemorrhages. Stereotactic radiosurgery (SRS) has been employed for CCM not suitable for resection. Its effect on reducing haemorrhage risk is still controversial. The aim of this study was to expand on the safety and efficacy of SRS for haemorrhagic CCM. METHODS:This retrospective multicentric study included CCM with at least one haemorrhage treated with single-session SRS. The annual haemorrhagic rate (AHR) was calculated before and after SRS. Recurrent event analysis and Cox regression were used to evaluate factors associated with haemorrhage. Adverse radiation effects (AREs) and occurrence of new neurological deficits were recorded. RESULTS:The study included 381 patients (median age: 37.5 years (Q1-Q3: 25.8-51.9) with 414 CCMs. The AHR from diagnosis to SRS excluding the first haemorrhage was 11.08 per 100 CCM-years and was reduced to 2.7 per 100 CCM-years after treatment. In recurrent event analysis, SRS, HR 0.27 (95% CI 0.17 to 0.44), p<0.0001 was associated with a decreased risk of haemorrhage, and the presence of developmental venous anomaly (DVA) with an increased risk, HR 1.60 (95% CI 1.07 to 2.40), p=0.022. The cumulative risk of first haemorrhage after SRS was 9.4% (95% CI 6% to 12.6%) at 5 years and 15.6% (95% CI% 9 to 21.8%) at 10 years. Margin doses> 13 Gy, HR 2.27 (95% CI 1.20 to 4.32), p=0.012 and the presence of DVA, HR 2.08 (95% CI 1.00 to 4.31), p=0.049 were factors associated with higher probability of post-SRS haemorrhage. Post-SRS haemorrhage was symptomatic in 22 out of 381 (5.8%) patients, presenting with transient (15/381) or permanent (7/381) neurological deficit. ARE occurred in 11.1% (46/414) CCM and was responsible for transient neurological deficit in 3.9% (15/381) of the patients and permanent deficit in 1.1% (4/381) of the patients. Margin doses >13 Gy and CCM volume >0.7 cc were associated with increased risk of ARE. CONCLUSION/CONCLUSIONS:Single-session SRS for haemorrhagic CCM is associated with a decrease in haemorrhage rate. Margin doses ≤13 Gy seem advisable.
PMID: 37586775
ISSN: 2059-8696
CID: 5671382

Repeat Radiosurgery for Sporadic Vestibular Schwannoma After Primary Radiosurgical Failure: An International Multi-institutional Investigation

Khandalavala, Karl R; Herberg, Hans A; Kay-Rivest, Emily; Moore, Lindsay S; Yancey, Kristen L; Marinelli, John P; Lund-Johansen, Morten; Kosaraju, Nikitha; Lohse, Christine M; Kutz, Walter; Santa Maria, Peter L; Golfinos, John G; Kondziolka, Douglas; Carlson, Matthew L; Tveiten, Øystein V; Link, Michael J
OBJECTIVE:To describe outcomes of patients with sporadic vestibular schwannoma (VS) who underwent repeat stereotactic radiosurgery (SRS) after primary SRS failure. STUDY DESIGN/METHODS:Multi-institutional historical cohort study. SETTING/METHODS:Five tertiary care referral centers. PATIENTS/METHODS:Adults ≥18 years old with sporadic VS. INTERVENTION/METHODS:Primary and repeat treatment with SRS. MAIN OUTCOME MEASURE/METHODS:Microsurgery-free survival after repeat SRS. RESULTS:Across institutions, 32 patients underwent repeat SRS after primary SRS. Most patients (74%) had tumors with cerebellopontine angle extension at primary SRS (median size, 13.5 mm [interquartile range, 7.5-18.8] mm). After primary SRS, patients underwent repeat SRS at a median of 4.8 years (interquartile range, 3.2-5.7 yr). For treatment modality, 30 (94%) patients received gamma knife for primary treatment and 31 (97%) patients received gamma knife as their repeat treatment. Median tumor volume increased from 0.970 cm3 at primary SRS to 2.200 cm3 at repeat SRS. Facial nerve function worsened in two patients after primary SRS and in two patients after repeat SRS. There were no instances of intracranial complications after repeat SRS. Microsurgery-free survival rates (95% confidence interval; number still at risk) at 1, 3, and 5 years after repeat SRS were 97% (90-100%, 24), 84% (71-100%, 13), and 68% (48-96%, 6), respectively. There was one occurrence of malignancy diagnosed after repeat radiosurgery. CONCLUSION/CONCLUSIONS:Overall, repeat SRS for sporadic VS has comparable risk profile, but lower rates of tumor control, compared with primary SRS.
PMID: 38728563
ISSN: 1537-4505
CID: 5656062

Pushing the Boundaries: Long-term Survival from Brain Metastases and the Path Ahead [Letter]

Mashiach, Elad; Alzate, Juan Diego; Schnurman, Zane; Berger, Assaf; De Nigris Vasconcellos, Fernando; Golfinos, John G; Kondziolka, Douglas
PMID: 38521224
ISSN: 1878-8769
CID: 5641132

Stereotactic radiosurgery for brain metastasis from cholangiocarcinoma

Düzkalir, Ali Haluk; Samanci, Yavuz; Lee, Cheng-Chia; Yang, Huai-Che; Niranjan, Ajay; Lunsford, L Dade; Wei, Zhishuo; Srinivasan, Priyanka N; Dayawansa, Samantha; Sheehan, Jason P; Patel, Samir; Mathieu, David; Zacharia, Brad E; Santhumayor, Brandon; Kondziolka, Douglas; Peker, Selcuk
OBJECTIVE:Accounting for approximately 15% of primary liver cancers and 3% of gastrointestinal malignancies, cholangiocarcinoma (CCA) poses a serious health concern given its high mortality rate. Managing brain metastases (BMs) from CCA is challenging because of their rarity and poor prognosis, with little guidance on treatment from the literature. In this study, the authors aimed to evaluate the safety and efficacy of stereotactic radiosurgery (SRS) in managing BMs from CCA. METHODS:This multicenter retrospective study included 13 CCA patients with 41 BMs treated with SRS from October 2006 to April 2022 at eight institutions affiliated with the International Radiosurgery Research Foundation. Inclusion criteria were a CCA diagnosis, an age over 18 years, no other malignancies, single-fraction SRS treatment for BMs, and at least one follow-up image. Data on demographics, tumor characteristics, treatment details, and outcomes were collected. The primary endpoints were local control (LC), intracranial progression-free survival (PFS), and overall survival (OS). The secondary endpoint was the development of adverse radiation effects (AREs). RESULTS:The median radiological follow-up was 5 months (range 1-18 months). At the last follow-up, LC was achieved in 39 (95.1%) of 41 BMs. New distant metastases were observed in 3 patients (23.1%), and the mean intracranial PFS was 9.4 months (95% CI 6.5-12.3 months). Six-month and 1-year OS rates were 38.5% and 11.5%, respectively, and the median OS was 6 months (95% CI 4.9-7.2 months). Concurrent immunotherapy was associated with a high risk of local failure (HR 29.665, 95% CI 1.799-489.206, p = 0.018), and the absence of systemic chemotherapy before SRS was linked to reduced OS (HR 6.658, 95% CI 1.173-37.776, p = 0.032). Regarding AREs, only 1 patient (7.7%) experienced right hemiparesis and was treated with corticosteroid therapy. CONCLUSIONS:SRS is an effective option for managing BMs in CCA patients, showing promise in LC and a high safety profile.
PMID: 38728764
ISSN: 1933-0693
CID: 5734052

Improved outcomes for triple negative breast cancer brain metastases patients after stereotactic radiosurgery and new systemic approaches

Mashiach, Elad; Alzate, Juan Diego; De Nigris Vasconcellos, Fernando; Adams, Sylvia; Santhumayor, Brandon; Meng, Ying; Schnurman, Zane; Donahue, Bernadine R; Bernstein, Kenneth; Orillac, Cordelia; Bollam, Rishitha; Kwa, Maryann J; Meyers, Marleen; Oratz, Ruth; Novik, Yelena; Silverman, Joshua S; Harter, David H; Golfinos, John G; Kondziolka, Douglas
PURPOSE/OBJECTIVE:Although ongoing studies are assessing the efficacy of new systemic therapies for patients with triple negative breast cancer (TNBC), the overwhelming majority have excluded patients with brain metastases (BM). Therefore, we aim to characterize systemic therapies and outcomes in a cohort of patients with TNBC and BM managed with stereotactic radiosurgery (SRS) and delineate predictors of increased survival. METHODS:We used our prospective patient registry to evaluate data from 2012 to 2023. We included patients who received SRS for TNBC-BM. A competing risk analysis was conducted to assess local and distant control. RESULTS:Forty-three patients with 262 tumors were included. The median overall survival (OS) was 16 months (95% CI 13-19 months). Predictors of increased OS after initial SRS include Breast GPA score > 1 (p < 0.001) and use of immunotherapy such as pembrolizumab (p = 0.011). The median time on immunotherapy was 8 months (IQR 4.4, 11.2). The median time to new CNS lesions after the first SRS treatment was 17 months (95% CI 12-22). The cumulative rate for development of new CNS metastases after initial SRS at 6 months, 1 year, and 2 years was 23%, 40%, and 70%, respectively. Thirty patients (70%) underwent multiple SRS treatments, with a median time of 5 months (95% CI 0.59-9.4 months) for the appearance of new CNS metastases after second SRS treatment. CONCLUSIONS:TNBC patients with BM can achieve longer survival than might have been previously anticipated with median survival now surpassing one year. The use of immunotherapy is associated with increased median OS of 23 months.
PMID: 38630386
ISSN: 1573-7373
CID: 5655852

Stereotactic radiosurgery for non-functioning pituitary tumor: a multicenter study of new pituitary hormone deficiency

Dumot, Chloe; Mantziaris, Georgios; Dayawansa, Sam; Peker, Selcuk; Samanci, Yavuz; Nabeel, Ahmed M; Reda, Wael A; Tawadros, Sameh R; AbdelKarim, Khaled; El-Shehaby, Amr M N; Emad, Reem M; Abdelsalam, Ahmed Ragab; Liscak, Roman; May, Jaromir; Mashiach, Elad; De Nigris Vasconcellos, Fernando; Bernstein, Kenneth; Kondziolka, Douglas; Speckter, Herwin; Mota, Ruben; Brito, Anderson; Bindal, Shray Kumar; Niranjan, Ajay; Lunsford, L Dade; Benjamin, Carolina Gesteira; Abrantes de Lacerda Almeida, Timoteo; Mao, Jennifer; Mathieu, David; Tourigny, Jean-Nicolas; Tripathi, Manjul; Palmer, Joshua David; Matsui, Jennifer; Crooks, Joe; Wegner, Rodney E; Shepard, Matthew J; Vance, Mary Lee; Sheehan, Jason P
BACKGROUND:Stereotactic radiosurgery (SRS) is used to treat recurrent or residual nonfunctioning pituitary neuroendocrine tumors (NFPA). The objective of the study was to assess imaging and development of new pituitary hormone deficiency. METHODS:Patients treated with single-session SRS for a NFPA were included in this retrospective, multicenter study. Tumor control and new pituitary dysfunction were evaluated using Cox analysis and Kaplan-Meier curves. RESULTS:869 patients (male 476 [54.8%], median age at SRS 52.5 years [Interquartile range (IQR):18.9]) were treated using a median margin dose of 14Gy (IQR:4) for a median tumor volume of 3.4 cc (IQR: 4.3). With a median radiological follow-up of 3.7 years (IQR: 4.8), volumetric tumor reduction occurred in 451 patients (51.9%), stability in 364 (41.9%) and 54 patients (6.2%) showed tumor progression.The probability of tumor control was 95.5% (95% Confidence Interval [CI]: 93.8-97.3) and 88.8% (95%CI: 85.2-92.5) at 5 and 10 years, respectively. A margin dose >14 Gy was associated with tumor control (Hazard Ratio HR:0.33 [95%CI:0.18-0.60], p<0.001).The probability of new hypopituitarism was 9.9% (95% CI: 7.3-12.5) and 15.3% (95% CI:11-19.4) at 5 and 10 years, respectively.A maximum point dose >10 Gy in the pituitary stalk was associated with new pituitary hormone deficiency (HR:3.47, 95% CI:1.95-6.19). The cumulative probability of new cortisol, thyroid, gonadotroph and growth hormone deficiency was 8% (95% CI:3.9-11.9), 8.3% (95% CI:3.9-12.5), 3.5% (95% CI:1.7-5.2), and 4.7% (95% CI:1.9-7.4), respectively at 10 years. CONCLUSION/CONCLUSIONS:SRS provides long-term tumor control with a 15.3% risk of hypopituitarism at 10 years.
PMID: 38095431
ISSN: 1523-5866
CID: 5589352

Pediatric cerebral cavernous malformations and stereotactic radiosurgery: an analysis of 50 cases from a multicentric study

Mantziaris, Georgios; Dumot, Chloe; Pikis, Stylianos; Peker, Selcuk; Samanci, Yavuz; Ardor, Gokce D; Nabeel, Ahmed M; Reda, Wael A; Tawadros, Sameh R; Abdel Karim, Khaled; El-Shehaby, Amr M N; Emad Eldin, Reem M; Elazzazi, Ahmed H; Sheehan, Darrah; Sheehan, Kimball; Martínez Moreno, Nuria; Martínez Álvarez, Roberto; Liscak, Roman; May, Jaromir; Tripathi, Manjul; Rajput, Akshay; Kumar, Narendra; Kaur, Rupinder; Alzate, Juan Diego; Kondziolka, Douglas; Dayawansa, Sam; Sheehan, Jason P
OBJECTIVE:Cerebral cavernous malformations (CCMs) are the second most common vascular anomaly affecting the CNS in children. Although stereotactic radiosurgery (SRS) has been proposed as an alternative to microsurgery in the management of selected cases in adults, there is a paucity of studies focusing on pediatric patients. The aim of this study was to present the outcomes and associated risks of SRS in this subgroup of patients. METHODS:This retrospective multicenter study included pediatric patients treated with single-session SRS for CCMs. The annual hemorrhage rate (AHR) was calculated before and after SRS in hemorrhagic lesions. The Engel classification was used to describe post-SRS epileptic control. Adverse radiation effects (AREs) and the occurrence of new neurological deficits were recorded. RESULTS:The study included 50 patients (median age 15.1 [IQR 5.6] years) harboring 62 CCMs. Forty-two (84%) and 22 (44%) patients had a history of hemorrhage or epilepsy prior to SRS, respectively. The AHR from diagnosis to SRS excluding the first hemorrhage was 7.19 per 100 CCM-years, dropping to 3.15 per 100 CCM-years after treatment. The cumulative risk of first hemorrhage after SRS was 7.4% (95% CI 0%-14.3%) at 5 years and 23.6% (95% CI 0%-42.2%) at 10 years. Eight hemorrhagic events involving 6 CCMs in 6 patients were recorded in the post-SRS follow-up period; 4 patients presented with transient symptoms and 4 with permanent symptoms. Of the 22 patients with pre-SRS seizures, 11 were seizure free at the last follow-up (Engel class I), 6 experienced improvement (Engel class II or III), 5 had no improvement (Engel class IVA or IVB), and 1 experienced worsening (Engel class IVC). Radiographic AREs were documented in 14.5% (9/62) of CCMs, with 4 being symptomatic. CONCLUSIONS:Single-session SRS reduces the CCM hemorrhage rate in the pediatric population and provides adequate seizure control.
PMID: 38181511
ISSN: 1933-0715
CID: 5728872

Impact of Multiple Sclerosis Subtypes on Pain Management in Patients With Trigeminal Neuralgia After Stereotactic Radiosurgery: An International Multicenter Analysis

De Nigris Vasconcellos, Fernando; Mashiach, Elad; Alzate, Juan Diego; Bernstein, Kenneth; Rotman, Lauren; Levy, Sarah; Qu, Tanxia; Wegner, Rodney E; Shepard, Matthew J; Patel, Samir; Warnick, Ronald E; Moreno, Nuria Martínez; Martínez Álvarez, Roberto; Picozzi, Piero; Franzini, Andrea; Peker, Selçuk; Samanci, Yavuz; Elguindy, Ahmed N; Palmer, Joshua D; Lunsford, L Dade; Jose, Shalini G; Wei, Zhishuo; Niranjan, Ajay; Blagui, Sarra; Iorio-Morin, Christian; Mathieu, David; Briggs, Robert G; Yu, Cheng; Zada, Gabriel; Dayawansa, Samantha; Sheehan, Jason; Schulder, Michael; Goenka, Anuj; Begley, Sabrina; Khilji, Hamza; Urgošík, Dušan; Liščák, Roman; Kondziolka, Douglas
BACKGROUND AND OBJECTIVES/OBJECTIVE:Trigeminal neuralgia affects approximately 2% of patients with multiple sclerosis (MS) and often shows higher rates of pain recurrence after treatment. Previous studies on the effectiveness of stereotactic radiosurgery (SRS) for trigeminal neuralgia did not consider the different MS subtypes, including remitting relapsing (RRMS), primary progressive (PPMS), and secondary progressive (SPMS). Our objective was to investigate how MS subtypes are related to pain control (PC) rates after SRS. METHODS:We conducted a retrospective multicenter analysis of prospectively collected databases. Pain status was assessed using the Barrow National Institute Pain Intensity Scales. Time to recurrence was estimated through the Kaplan-Meier method and compared groups using log-rank tests. Logistic regression was used to calculate the odds ratio (OR). RESULTS:Two hundred and fifty-eight patients, 135 (52.4%) RRMS, 30 (11.6%) PPMS, and 93 (36%) SPMS, were included from 14 institutions. In total, 84.6% of patients achieved initial pain relief, with a median time of 1 month; 78.7% had some degree of pain recurrence with a median time of 10.2 months for RRMS, 8 months for PPMS, 8.1 months for SPMS (P = .424). Achieving Barrow National Institute-I after SRS was a predictor for longer periods without recurrence (P = .028). Analyzing PC at the last available follow-up and comparing with RRMS, PPMS was less likely to have PC (OR = 0.389; 95% CI 0.153-0.986; P = .047) and SPMS was more likely (OR = 2.0; 95% CI 0.967-4.136; P = .062). A subgroup of 149 patients did not have other procedures apart from SRS. The median times to recurrence in this group were 11.1, 9.8, and 19.6 months for RRMS, PPMS, and SPMS, respectively (log-rank, P = .045). CONCLUSION/CONCLUSIONS:This study is the first to investigate the relationship between MS subtypes and PC after SRS, and our results provide preliminary evidence that subtypes may influence pain outcomes, with PPMS posing the greatest challenge to pain management.
PMID: 38051068
ISSN: 1524-4040
CID: 5595452

Unveiling the Spectrum: Exploring the Influence of Multiple Sclerosis Subtypes in Trigeminal Neuralgia Patients Undergoing Stereotactic Radiosurgery and Beyond [Letter]

De Nigris Vasconcellos, Fernando; Mashiach, Elad; Alzate, Juan Diego; Santhumayor, Brandon; Bernstein, Kenneth; Kondziolka, Douglas
PMID: 38368151
ISSN: 1878-8769
CID: 5636182

Long-term radiographic and endocrinological outcomes of stereotactic radiosurgery for recurrent or residual nonfunctioning pituitary adenomas

Shaaban, Ahmed; Dumot, Chloé; Mantziaris, Georgios; Dayawansa, Sam; Peker, Selcuk; Samanci, Yavuz; Nabeel, Ahmed M; Reda, Wael A; Tawadros, Sameh R; Abdel Karim, Khaled; El-Shehaby, Amr M N; Emad Eldin, Reem M; Ragab Abdelsalam, Ahmed; Liscak, Roman; May, Jaromir; Mashiach, Elad; De Nigris Vasconcellos, Fernando; Bernstein, Kenneth; Kondziolka, Douglas; Speckter, Herwin; Mota, Ruben; Brito, Anderson; Bindal, Shray K; Niranjan, Ajay; Lunsford, L Dade; Benjamin, Carolina Gesteira; Almeida, Timoteo; Mao, Jennifer Z; Mathieu, David; Tourigny, Jean-Nicolas; Tripathi, Manjul; Palmer, Joshua David; Matsui, Jennifer; Crooks, Joseph; Wegner, Rodney E; Shepard, Matthew J; Sheehan, Jason P
OBJECTIVE:Stereotactic radiosurgery (SRS) is used for the treatment of residual/recurrent nonfunctional pituitary adenoma (NFPA). The aim of this study was to evaluate the factors related to long-term tumor control and delayed endocrinopathies following SRS. METHODS:This retrospective, multicenter study included patients with recurrent/residual NFPA treated with single-fraction SRS; they were then divided into two arms. The first arm included patients with at least 5 years of radiographic follow-up and all patients with local tumor progression. The second arm included patients with at least 5 years of endocrinological follow-up and all patients who developed endocrinopathy. Study endpoints were tumor control and new or worsening hypopituitarism after SRS and were analyzed using Cox regression and Kaplan-Meier methodology. RESULTS:There were 360 patients in the tumor control arm (median age 52.7 [IQR 42.9-61] years, 193 [53.6%] males) and 351 patients in the hypopituitarism arm (median age 52.5 [IQR 43-61] years, 186 [53.0%] males). The median follow-up in the tumor control evaluation group was 7.95 (IQR 5.7-10.5) years. Tumor control rates at 5, 8, 10, and 15 years were 93% (95% CI 90%-95%), 87% (95% CI 83%-91%), 86% (95% CI 82%-90%), and 69% (95% CI 59%-81%), respectively. The median follow-up in the endocrinopathy evaluation group was 8 (IQR 5.9-10.7) years. Pituitary function preservation rates at 5, 8, 10, and 15 years were 83% (95% CI 80%-87%), 81% (95% CI 77%-85%), 78% (95% CI 74%-83%), and 71% (95% CI 63%-79%), respectively. A margin dose > 15 Gy (HR 0.8, 95% CI 0.7-0.9; p < 0.001) and a delay from last resection to SRS > 1 year (HR 0.9, 95% CI 0.7-0.9; p = 0.04) were significant factors related to tumor control in multivariable analysis. A maximum dose to the pituitary stalk ≤ 10 Gy (HR 1.1, 95% CI 1.09-1.2; p < 0.001) was associated with pituitary function preservation. New visual deficits after SRS occurred in 7 (1.94%) patients in the tumor control group and 8 (2.3%) patients in the endocrinopathy group. Other new cranial nerve deficits post-SRS occurred in 4 of 160 patients with data in the tumor control group and 3 of 140 patients with data in the endocrinopathy group. CONCLUSIONS:SRS affords favorable and durable tumor control for the vast majority of NFPAs. Post-SRS hypopituitarism occurs in a minority of patients, but this risk increases with time and warrants long-term follow-up.
PMID: 38518285
ISSN: 1933-0693
CID: 5640862