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Yamei Tang - One of the best experts on this subject based on the ideXlab platform.
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The correlation between serum apolipoprotein B/apolipoprotein A1 ratio and Brain Necrosis in patients underwent radiotherapy for nasopharyngeal carcinoma.
Brain and behavior, 2020Co-Authors: Dong Zheng, Xiaohuang Zhuo, Xiaolong Huang, Fukang Xie, Jinpeng Lin, Yamei TangAbstract:INTRODUCTION The apolipoprotein B/apolipoprotein A1 (ApoB/ApoA1) ratio is recognized as a clinical indicator of cardiovascular disease and ischemic cerebral disease. Cerebrovascular dysfunction is also involved in head and neck radiotherapy. The aim of this study was to investigate the correlation between ApoB/ApoA1 ratio and the severity of radiation-induced Brain Necrosis (RN) in patients who underwent radiotherapy after nasopharyngeal carcinoma (NPC). METHODS In this retrospective study, 191 NPC patients diagnosed with RN were evaluated. Clinical characteristics, serum lipid, apolipoproteins, and Brain magnetic resonance imaging findings were collected. Serum lipid and apolipoproteins were quantified using standard diagnostic assays, and the quality of life (QOL) was assessed by the World Health Organization quality of life abbreviated instrument (WHOQOL-BREF). RESULTS ApoB/ApoA1 ratio was positively correlated with lesion volume (r = .18, p = .03) and negatively correlated with WHOQOL-BREF scores (r = -.28, p
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bevacizumab monotherapy reduces radiation induced Brain Necrosis in nasopharyngeal carcinoma patients a randomized controlled trial
International Journal of Radiation Oncology Biology Physics, 2018Co-Authors: Xiaoming Rong, Xiaolong Huang, Dong Zheng, Zhaoxi Cai, Zhiyi Zuo, Yamei TangAbstract:PURPOSE Studies have shown that addition of bevacizumab to corticosteroids improves outcome against radiation-induced Brain Necrosis (RN). Here, we aimed to evaluate the effectiveness and safety of bevacizumab monotherapy on RN in nasopharyngeal carcinoma (NPC) patients. METHODS AND MATERIALS In this multicenter open-label study, patients with RN were randomly assigned (1:1) into a bevacizumab group (5 mg/kg intravenously every 2 weeks, for 4 cycles) or a corticosteroid group (methylprednisolone 500 mg/day intravenously for 3 consecutive days and then gradually tapered, followed by 10 mg/day oral prednisone, for 2 months in total). Magnetic resonance imaging (MRI) was performed pre- and post-treatment to define the radiographic response. The primary outcome was a 2-month response rate as determined by MRI and clinical symptoms. All of the patients were followed up with for 6 months. The trial was registered at www.clinicaltrials.gov (NCT01621880). RESULTS Of 121 patients screened, 112 patients met the entry criteria. Thirty-eight (65.5%) patients in the bevacizumab group showed response, which was significantly higher than that in the corticosteroid group (65.5% vs 31.5%, P < .001). The mean percentage decrease in RN volume seen on T1 post-gadolinium and T2-weighted fluid-attenuated inversion recovery (FLAIR) MRI was 25.5% and 51.8%, respectively, in the bevacizumab group, versus 5.0% and 19.3%, respectively, in the corticosteroid group. Moreover, 36 patients (62.1%) on bevacizumab and 23 patients (42.6%) on corticosteroids demonstrated clinical improvement (P = .039). During the 6-month follow up, fourteen patients on bevacizumab and 13 patients on corticosteroids showed RN recurrence. The most frequent adverse event in the bevacizumab group was hypertension (20.6%). CONCLUSIONS Our study indicate that compared with corticosteroids, bevacizumab offers improved symptomatic relief and radiographic response.
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Bevacizumab Monotherapy Reduces Radiation-induced Brain Necrosis in Nasopharyngeal Carcinoma Patients: A Randomized Controlled Trial.
International journal of radiation oncology biology physics, 2018Co-Authors: Xiaoming Rong, Xiaolong Huang, Dong Zheng, Zhaoxi Cai, Zhiyi Zuo, Yamei TangAbstract:PURPOSE Studies have shown that addition of bevacizumab to corticosteroids improves outcome against radiation-induced Brain Necrosis (RN). Here, we aimed to evaluate the effectiveness and safety of bevacizumab monotherapy on RN in nasopharyngeal carcinoma (NPC) patients. METHODS AND MATERIALS In this multicenter open-label study, patients with RN were randomly assigned (1:1) into a bevacizumab group (5 mg/kg intravenously every 2 weeks, for 4 cycles) or a corticosteroid group (methylprednisolone 500 mg/day intravenously for 3 consecutive days and then gradually tapered, followed by 10 mg/day oral prednisone, for 2 months in total). Magnetic resonance imaging (MRI) was performed pre- and post-treatment to define the radiographic response. The primary outcome was a 2-month response rate as determined by MRI and clinical symptoms. All of the patients were followed up with for 6 months. The trial was registered at www.clinicaltrials.gov (NCT01621880). RESULTS Of 121 patients screened, 112 patients met the entry criteria. Thirty-eight (65.5%) patients in the bevacizumab group showed response, which was significantly higher than that in the corticosteroid group (65.5% vs 31.5%, P
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Effect of edaravone on radiation-induced Brain Necrosis in patients with nasopharyngeal carcinoma after radiotherapy: a randomized controlled trial.
Journal of neuro-oncology, 2014Co-Authors: Yamei Tang, Xiaoming Rong, Xiaoxia Yang, Jianhua Yang, Jinjun LuoAbstract:Excessive generation of free radicals plays a critical role in the pathogenesis of radiation-induced Brain injury. This study was designed to evaluate the protective effect of edaravone, a free radical scavenger, on radiation-induced Brain Necrosis in patients with nasopharyngeal carcinoma. Eligible patients were randomized 1:1 to the control group and the edaravone group (intravenous 30 mg twice per day for 2 weeks). Both groups received intravenous conventional steroid therapy and were monitored by Brain MRI and LENT/SOMA scales prior to the entry of the trial and at 3-months after completing the trial. The primary end point was a 3-month response rate of the proportional changes determined by MRI. The trial is registered at Clinicaltrials.gov Identifier: NCT01865201. Between 2009 and 2012, we enrolled 154 patients. Of whom 137 were eligible for analysis. The volumes of Necrosis estimated on T(2)-weighted image showed that 55.6 % edaravone-treated patients (40 out of 72) showed edema decreases ≥25 %, which was significantly higher than that in the control group (35.4 %, 23 out of 65, p = 0.025). Forty-four patients treated with edaravone (61.1 %) reported improvement in neurologic symptoms and signs evaluated by LENT/SOMA scales, while the rate was 38.5 % in the control group (p = 0.006). MRI of the edaravone group showed a significant decrease in area of T(1)-weighted contrast enhancement (1.67 ± 4.69 cm(2), p = 0.004) and the T(2)-weighted edema (5.08 ± 10.32 cm(2), p = 0.000). Moreover, compared with those in control group, patients with edaravone exhibited significantly better radiological improvement measured by T(2)-weighted image (p = 0.042). Administration of edaravone, in adjunct to steroid regimen, might provide a better outcome in patients with radiation-induced Brain Necrosis.
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Efficacy of Bevacizumab monotherapy on radiation-induced brian Necrosis
Chinese journal of radiological medicine and protection, 2014Co-Authors: Xiaoming Rong, Yamei TangAbstract:Objective To explore the effects and safety of bevacizumab monotherapy on radiationinduced Brain Necrosis in patients with head and neck cancer.Methods Twenty-three patients with radiation-induced Brain Necrosis received intravenous injection of bevacizumab 5 mg/kg every 2 weeks for 4 cycles.Before and 2 weeks after the treatment LENT/SOMA scoring system,Montreal Cognitive Assessment (MoCA),and MRI were used to evaluate the scores of subjective and objective items,cognitive scores,and the extent of edema.Adverse effects were observed.Results Two patients suffered from grade 2 rhinorrhagia after the first dose and had to give up the therapy.Twenty-one patients received the full dose of bevacizumab and showed improvement in clinical signs and symptoms.The MoCA score after treatment was significantly higher than that before treatment (t =3.166,P ＜ 0.05).MRI T2-weighted image showed that the volume of Brain edema was decreased by (53.9 ± 22.13)％ on average (Z =-5.645,P ＜0.05).One patient showed mild exacerbation of the extent of focus on MRI after the second cycle therapy but still showed significant improvement at the end of four cycles.Of the 21 cases that successfully finished the whole treatment,one suffered from grade 2 rash and one had mild intracranial hemorrhage,however,no grade 3 to 5 adverse reactions were observed.Conclusions Bevacizumab monotherapy may have a rapid and safe therapeutic effect on radiation Necrosis. Key words: Radiation-induced Brain Necrosis; Bevacizumab; MRI; Efficacy; Sides effects
Vincenzo Esposito - One of the best experts on this subject based on the ideXlab platform.
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Outcomes of postoperative stereotactic radiosurgery to the resection cavity versus stereotactic radiosurgery alone for melanoma Brain metastases
Journal of neuro-oncology, 2017Co-Authors: Giuseppe Minniti, Sergio Paolini, Gaetano Lanzetta, Francesco Cicone, Vincenzo Esposito, Giancarlo D'andrea, Veronica Confaloni, Alessandro Bozzao, Mattia Falchetto OstiAbstract:To investigate local control and radiation-induced Brain Necrosis in patients with melanoma Brain metastases who received complete resection plus fractionated stereotactic radiosurgery (fSRS, 3 × 9 Gy) or fSRS alone. Factors associated with the clinical outcomes and the development of Brain Necrosis have been assessed. One hundred and twenty consecutive patients with 137 melanoma Brain metastases who received surgery plus fSRS (S + fSRS) or fSRS alone were analyzed. All lesions evaluated in the study were treated with a dose of 27 Gy given in 3 fractions over three consecutive days. Cumulative incidence analysis was used to compare local failure (LF), distant Brain failure (DBF), and radiation-induced Brain Necrosis (RN) between groups from the time of SRS. At a median follow-up of 13 months, median OS times and 1-year survival rates were comparable: S + fSRS, 14 months and 85%; fSRS, 12 months and 85% (p = 0.2). Median DBF did not differ significantly by group, being 14 months for both groups. Nine patients who received S + fSRS and 20 patients treated with fSRS recurred locally (p = 0.03). Six-month and 1-year LF rates were 5 and 12% in S + fSRS group and 17 and 28% in fSRS group (p = 0.02). RN occurred in 21 patients (S + fSRS, n = 14; fSRS, n = 7; p = 0.1). The cumulative 1-year incidence of RN was 13% after S + fSRS and 8% after fSRS (p = 0.15). In conclusion, postoperative SRS (3 × 9 Gy) to the resection cavity is an effective treatment modality for melanoma Brain metastases associated with better local control as compared with fSRS alone.
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single fraction versus multifraction 3 9 gy stereotactic radiosurgery for large 2 cm Brain metastases a comparative analysis of local control and risk of radiation induced Brain Necrosis
International Journal of Radiation Oncology Biology Physics, 2016Co-Authors: Giuseppe Minniti, Claudia Scaringi, Sergio Paolini, Gaetano Lanzetta, Andrea Romano, Francesco Cicone, Mattia Falchetto Osti, Riccardo Maurizi Enrici, Vincenzo EspositoAbstract:Purpose To investigate the local control and radiation-induced Brain Necrosis in patients with Brain metastases >2 cm in size who received single-fraction or multifraction stereotactic radiosurgery (SRS); factors associated with clinical outcomes and the development of Brain radioNecrosis were assessed. Methods and Materials Two hundred eighty-nine consecutive patients with Brain metastases >2.0 cm who received SRS as primary treatment at Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy, were analyzed. Cumulative incidence analysis was used to compare local control and radiation-induced Brain Necrosis between groups from the time of SRS. To achieve a balanced distribution of baseline covariates between treatment groups, a propensity score analysis was used. Results The 1-year cumulative local control rates were 77% in the single-fraction SRS (SF-SRS) group and 91% in the multifraction SRS (MF-SRS) group ( P =.01). Recurrences occurred in 25 and 11 patients who received SF-SRS or MF-SRS ( P =.03), respectively. Thirty-one patients (20%) undergoing SF-SRS and 11 (8%) subjected to MF-SRS experienced Brain radioNecrosis ( P =.004); the 1-year cumulative incidence rate of radioNecrosis was 18% and 9% ( P =.01), respectively. Significant differences between the 2 groups in terms of local control and risk of radioNecrosis were maintained after propensity score adjustment. Conclusions Multifraction SRS at a dose of 27 Gy in 3 daily fractions seems to be an effective treatment modality for large Brain metastases, associated with better local control and a reduced risk of radiation-induced radioNecrosis as compared with SF-SRS.
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Single-Fraction Versus Multifraction (3 × 9 Gy) Stereotactic Radiosurgery for Large (>2 cm) Brain Metastases: A Comparative Analysis of Local Control and Risk of Radiation-Induced Brain Necrosis
International journal of radiation oncology biology physics, 2016Co-Authors: Giuseppe Minniti, Claudia Scaringi, Sergio Paolini, Gaetano Lanzetta, Andrea Romano, Francesco Cicone, Mattia Falchetto Osti, Riccardo Maurizi Enrici, Vincenzo EspositoAbstract:Purpose To investigate the local control and radiation-induced Brain Necrosis in patients with Brain metastases >2 cm in size who received single-fraction or multifraction stereotactic radiosurgery (SRS); factors associated with clinical outcomes and the development of Brain radioNecrosis were assessed. Methods and Materials Two hundred eighty-nine consecutive patients with Brain metastases >2.0 cm who received SRS as primary treatment at Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy, were analyzed. Cumulative incidence analysis was used to compare local control and radiation-induced Brain Necrosis between groups from the time of SRS. To achieve a balanced distribution of baseline covariates between treatment groups, a propensity score analysis was used. Results The 1-year cumulative local control rates were 77% in the single-fraction SRS (SF-SRS) group and 91% in the multifraction SRS (MF-SRS) group ( P =.01). Recurrences occurred in 25 and 11 patients who received SF-SRS or MF-SRS ( P =.03), respectively. Thirty-one patients (20%) undergoing SF-SRS and 11 (8%) subjected to MF-SRS experienced Brain radioNecrosis ( P =.004); the 1-year cumulative incidence rate of radioNecrosis was 18% and 9% ( P =.01), respectively. Significant differences between the 2 groups in terms of local control and risk of radioNecrosis were maintained after propensity score adjustment. Conclusions Multifraction SRS at a dose of 27 Gy in 3 daily fractions seems to be an effective treatment modality for large Brain metastases, associated with better local control and a reduced risk of radiation-induced radioNecrosis as compared with SF-SRS.
Xiaolong Huang - One of the best experts on this subject based on the ideXlab platform.
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A nomogram to predict symptomatic epilepsy in patients with radiation-induced Brain Necrosis.
Neurology, 2020Co-Authors: Xiaolong Huang, Jinhua Cai, Xiaoming Rong, Xiaoni Zhang, Xicheng Wang, Jingru Jiang, Xiaohuang ZhuoAbstract:Objective: This study aimed to develop and validate a nomogram to predict epilepsy in patients with radiation-induced Brain Necrosis (RN). Methods: The nomogram was based on a retrospective analysis of 302 patients who were diagnosed with symptomatic RN from January 2005 to January 2016 in Sun Yat-sen Memorial Hospital using the Cox proportional hazards model. Discrimination of the nomogram was assessed by the concordance index (C-index) and the calibration curve. The results were internally validated using bootstrap resampling and externally validated using 128 RN patients from two additional hospitals. Results: A total of 302 RN patients with a median follow-up of 3.43 years (IQR 2.54-5.45) were included in the training cohort, among which 65 (21.5%) developed symptomatic epilepsy during follow-up. Seven variables remained significant predictors of epilepsy after multivariable analyses: MRI lesion volume, creatine phosphokinase, the maximum radiation dose to the temporal lobe, RN treatment, history of hypertension and/or diabetes, gender, and total cholesterol level. In the validation cohort, twenty-eight out of 128 (21.9%) patients had epilepsy after RN within a median follow-up of 3.2 years. The nomogram showed comparable discrimination between the training and validation cohort (corrected C-index 0.76 [training] vs. 0.72 [95% CI 0.62-0.81; validation]). Conclusion: Our study developed an easily applied nomogram for the prediction of RN-related epilepsy in a large RN cohort. Classification of Evidence: This study provides Class III evidence that a nomogram predicts post-RN epilepsy.
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The correlation between serum apolipoprotein B/apolipoprotein A1 ratio and Brain Necrosis in patients underwent radiotherapy for nasopharyngeal carcinoma.
Brain and behavior, 2020Co-Authors: Dong Zheng, Xiaohuang Zhuo, Xiaolong Huang, Fukang Xie, Jinpeng Lin, Yamei TangAbstract:INTRODUCTION The apolipoprotein B/apolipoprotein A1 (ApoB/ApoA1) ratio is recognized as a clinical indicator of cardiovascular disease and ischemic cerebral disease. Cerebrovascular dysfunction is also involved in head and neck radiotherapy. The aim of this study was to investigate the correlation between ApoB/ApoA1 ratio and the severity of radiation-induced Brain Necrosis (RN) in patients who underwent radiotherapy after nasopharyngeal carcinoma (NPC). METHODS In this retrospective study, 191 NPC patients diagnosed with RN were evaluated. Clinical characteristics, serum lipid, apolipoproteins, and Brain magnetic resonance imaging findings were collected. Serum lipid and apolipoproteins were quantified using standard diagnostic assays, and the quality of life (QOL) was assessed by the World Health Organization quality of life abbreviated instrument (WHOQOL-BREF). RESULTS ApoB/ApoA1 ratio was positively correlated with lesion volume (r = .18, p = .03) and negatively correlated with WHOQOL-BREF scores (r = -.28, p
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Comparison between high-dose and low-dose intravenous methylprednisolone therapy in patients with Brain Necrosis after radiotherapy for nasopharyngeal carcinoma.
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2019Co-Authors: Xiaohuang Zhuo, Jinhua Cai, Xiaoming Rong, Xiaolong Huang, Jinpeng Lin, Maosheng Yan, Fukang XieAbstract:Abstract Background Radiotherapy is the standard radical treatment for nasopharyngeal carcinoma (NPC) and may cause radiation-induced Brain Necrosis (RN). Intravenous steroids have been considered as an effective treatment for RN. However, evidence concerning the efficacy of different doses of intravenous steroid therapy remains insufficient to establish the optimal regimen for NPC patients with RN. Methods We retrospectively reviewed charts of 169 patients who were diagnosed with RN after radiotherapy for NPC, treated with low-dose or high-dose intravenous methylprednisolone (IVMP) and followed up for 12 months. We collected the clinical data, including the Late Effects of Normal Tissue (LENT)/Subjective, Objective, Management, Analytic (SOMA) scales score and Montreal Cognitive Assessment (MoCA) score. Magnetic resonance imaging (MRI) was performed pre- and post-treatment to define the radiographic response. Results There were no significant differences in the treatment response based on MRI, or changes in clinical symptoms and cognitive function between low and high-dose groups. Thirty of 93 low-dose patients (32.3%) and 21 of 76 high-dose patients (27.6%) presented effective response in MRI, with no significant differences between groups (P = 0.515). Neither group showed a significant difference in the effective rate based on the MoCA total score and LENT/SOMA score. The most commonly reported grade 3 adverse events in the high-dose group (n = 76) were infections and infestations (3 [3.9%] vs. none for low-dose group). Conclusions We found low-dose IVMP was not inferior to high-dose IVMP for NPC patients with RN. In addition, treatment-related infections and infestations were likewise more common with high-dose steroid than low-dose steroid.
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A nomogram for the prediction of cerebrovascular disease among patients with Brain Necrosis after radiotherapy for nasopharyngeal carcinoma
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2018Co-Authors: Jinhua Cai, Jinping Cheng, Wei-jye Lin, Xiaohuang Zhuo, Xiaolong Huang, Charles B. Simone, Wilbert S. Aronow, Edward ChowAbstract:Abstract Background and purpose This study sought to develop and validate a nomogram to predict cerebrovascular disease (CVD) among patients with Brain Necrosis after radiotherapy for nasopharyngeal carcinoma (NPC). Materials and methods A total of 346 eligible patients with Brain Necrosis after radiotherapy for NPC were divided into a training set (n = 231) and a validation set (n = 115). A multivariate Cox proportional hazards regression model was used to select the significant variables for CVD prediction in the training set. Then, a nomogram was developed based on the regression model. The performance of the nomogram was assessed with respect to discrimination and calibration. All patients were classified into high- or low-risk groups based on the risk scores derived from the nomogram. Moreover, a decision curve analysis was performed with the combined training and validation sets to evaluate the clinical usefulness of the nomogram. Results Four significant predictors were identified: hypertension, statin treatment, serum level of high-density lipoprotein, and interval between radiotherapy and Brain Necrosis. The nomogram incorporating these four predictors showed favorable calibration and discrimination regarding the training set, with a C-index of 0.763 (95% CI, 0.694 to 0.832), which was confirmed using the validation set (C-index 0.768; 95% CI, 0.675 to 0.861). Furthermore, the nomogram successfully stratified patients into high- and low-risk groups. The decision curve indicated that our nomogram was clinically useful. Conclusion The nomogram showed favorable predictive accuracy for CVD among patients with Brain Necrosis after radiotherapy for NPC and might aid in clinical decision making.
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bevacizumab monotherapy reduces radiation induced Brain Necrosis in nasopharyngeal carcinoma patients a randomized controlled trial
International Journal of Radiation Oncology Biology Physics, 2018Co-Authors: Xiaoming Rong, Xiaolong Huang, Dong Zheng, Zhaoxi Cai, Zhiyi Zuo, Yamei TangAbstract:PURPOSE Studies have shown that addition of bevacizumab to corticosteroids improves outcome against radiation-induced Brain Necrosis (RN). Here, we aimed to evaluate the effectiveness and safety of bevacizumab monotherapy on RN in nasopharyngeal carcinoma (NPC) patients. METHODS AND MATERIALS In this multicenter open-label study, patients with RN were randomly assigned (1:1) into a bevacizumab group (5 mg/kg intravenously every 2 weeks, for 4 cycles) or a corticosteroid group (methylprednisolone 500 mg/day intravenously for 3 consecutive days and then gradually tapered, followed by 10 mg/day oral prednisone, for 2 months in total). Magnetic resonance imaging (MRI) was performed pre- and post-treatment to define the radiographic response. The primary outcome was a 2-month response rate as determined by MRI and clinical symptoms. All of the patients were followed up with for 6 months. The trial was registered at www.clinicaltrials.gov (NCT01621880). RESULTS Of 121 patients screened, 112 patients met the entry criteria. Thirty-eight (65.5%) patients in the bevacizumab group showed response, which was significantly higher than that in the corticosteroid group (65.5% vs 31.5%, P < .001). The mean percentage decrease in RN volume seen on T1 post-gadolinium and T2-weighted fluid-attenuated inversion recovery (FLAIR) MRI was 25.5% and 51.8%, respectively, in the bevacizumab group, versus 5.0% and 19.3%, respectively, in the corticosteroid group. Moreover, 36 patients (62.1%) on bevacizumab and 23 patients (42.6%) on corticosteroids demonstrated clinical improvement (P = .039). During the 6-month follow up, fourteen patients on bevacizumab and 13 patients on corticosteroids showed RN recurrence. The most frequent adverse event in the bevacizumab group was hypertension (20.6%). CONCLUSIONS Our study indicate that compared with corticosteroids, bevacizumab offers improved symptomatic relief and radiographic response.
Xiaoming Rong - One of the best experts on this subject based on the ideXlab platform.
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A Radiomics Model for Predicting the Response to Bevacizumab in Brain Necrosis after Radiotherapy.
Clinical cancer research : an official journal of the American Association for Cancer Research, 2020Co-Authors: Jinhua Cai, Zhiyong Yuan, Junjiong Zheng, Jun Shen, Mingwei Xie, Miaomiao Gao, Hongqi Tan, Zhong-guo Liang, Xiaoming RongAbstract:Purpose: Bevacizumab is considered a promising therapy for Brain Necrosis after radiotherapy, while some patients fail to derive benefit or even worsen. Hence, we developed and validated a radiomics model for predicting the response to bevacizumab in patients with Brain Necrosis after radiotherapy. Experimental Design: A total of 149 patients (with 194 Brain lesions; 101, 51, and 42 in the training, internal, and external validation sets, respectively) receiving bevacizumab were enrolled. In total, 1,301 radiomic features were extracted from the pretreatment MRI images of each lesion. In the training set, a radiomics signature was constructed using the least absolute shrinkage and selection operator algorithm. Multivariable logistic regression analysis was then used to develop a radiomics model incorporated in the radiomics signature and independent clinical predictors. The performance of the model was assessed by its discrimination, calibration, and clinical usefulness with internal and external validation. Results: The radiomics signature consisted of 18 selected features and showed good discrimination performance. The model, which integrates the radiomics signature, the interval between radiotherapy and diagnosis of Brain Necrosis, and the interval between diagnosis of Brain Necrosis and treatment with bevacizumab, showed favorable calibration and discrimination in the training set (AUC 0.916). These findings were confirmed in the validation sets (AUC 0.912 and 0.827, respectively). Decision curve analysis confirmed the clinical utility of the model. Conclusions: The presented radiomics model, available as an online calculator, can serve as a user-friendly tool for individualized prediction of the response to bevacizumab in patients with Brain Necrosis after radiotherapy.
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A nomogram to predict symptomatic epilepsy in patients with radiation-induced Brain Necrosis.
Neurology, 2020Co-Authors: Xiaolong Huang, Jinhua Cai, Xiaoming Rong, Xiaoni Zhang, Xicheng Wang, Jingru Jiang, Xiaohuang ZhuoAbstract:Objective: This study aimed to develop and validate a nomogram to predict epilepsy in patients with radiation-induced Brain Necrosis (RN). Methods: The nomogram was based on a retrospective analysis of 302 patients who were diagnosed with symptomatic RN from January 2005 to January 2016 in Sun Yat-sen Memorial Hospital using the Cox proportional hazards model. Discrimination of the nomogram was assessed by the concordance index (C-index) and the calibration curve. The results were internally validated using bootstrap resampling and externally validated using 128 RN patients from two additional hospitals. Results: A total of 302 RN patients with a median follow-up of 3.43 years (IQR 2.54-5.45) were included in the training cohort, among which 65 (21.5%) developed symptomatic epilepsy during follow-up. Seven variables remained significant predictors of epilepsy after multivariable analyses: MRI lesion volume, creatine phosphokinase, the maximum radiation dose to the temporal lobe, RN treatment, history of hypertension and/or diabetes, gender, and total cholesterol level. In the validation cohort, twenty-eight out of 128 (21.9%) patients had epilepsy after RN within a median follow-up of 3.2 years. The nomogram showed comparable discrimination between the training and validation cohort (corrected C-index 0.76 [training] vs. 0.72 [95% CI 0.62-0.81; validation]). Conclusion: Our study developed an easily applied nomogram for the prediction of RN-related epilepsy in a large RN cohort. Classification of Evidence: This study provides Class III evidence that a nomogram predicts post-RN epilepsy.
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Comparison between high-dose and low-dose intravenous methylprednisolone therapy in patients with Brain Necrosis after radiotherapy for nasopharyngeal carcinoma.
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2019Co-Authors: Xiaohuang Zhuo, Jinhua Cai, Xiaoming Rong, Xiaolong Huang, Jinpeng Lin, Maosheng Yan, Fukang XieAbstract:Abstract Background Radiotherapy is the standard radical treatment for nasopharyngeal carcinoma (NPC) and may cause radiation-induced Brain Necrosis (RN). Intravenous steroids have been considered as an effective treatment for RN. However, evidence concerning the efficacy of different doses of intravenous steroid therapy remains insufficient to establish the optimal regimen for NPC patients with RN. Methods We retrospectively reviewed charts of 169 patients who were diagnosed with RN after radiotherapy for NPC, treated with low-dose or high-dose intravenous methylprednisolone (IVMP) and followed up for 12 months. We collected the clinical data, including the Late Effects of Normal Tissue (LENT)/Subjective, Objective, Management, Analytic (SOMA) scales score and Montreal Cognitive Assessment (MoCA) score. Magnetic resonance imaging (MRI) was performed pre- and post-treatment to define the radiographic response. Results There were no significant differences in the treatment response based on MRI, or changes in clinical symptoms and cognitive function between low and high-dose groups. Thirty of 93 low-dose patients (32.3%) and 21 of 76 high-dose patients (27.6%) presented effective response in MRI, with no significant differences between groups (P = 0.515). Neither group showed a significant difference in the effective rate based on the MoCA total score and LENT/SOMA score. The most commonly reported grade 3 adverse events in the high-dose group (n = 76) were infections and infestations (3 [3.9%] vs. none for low-dose group). Conclusions We found low-dose IVMP was not inferior to high-dose IVMP for NPC patients with RN. In addition, treatment-related infections and infestations were likewise more common with high-dose steroid than low-dose steroid.
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Hyponatremia is a potential predictor of progression in radiation-induced Brain Necrosis: a retrospective study.
BMC neurology, 2018Co-Authors: Huan Liao, Xiaoming Rong, Zhuoting Zhu, Hongxuan Wang, Ying PengAbstract:To investigate the prognostic value of hyponatremia, defined as serum sodium level
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bevacizumab monotherapy reduces radiation induced Brain Necrosis in nasopharyngeal carcinoma patients a randomized controlled trial
International Journal of Radiation Oncology Biology Physics, 2018Co-Authors: Xiaoming Rong, Xiaolong Huang, Dong Zheng, Zhaoxi Cai, Zhiyi Zuo, Yamei TangAbstract:PURPOSE Studies have shown that addition of bevacizumab to corticosteroids improves outcome against radiation-induced Brain Necrosis (RN). Here, we aimed to evaluate the effectiveness and safety of bevacizumab monotherapy on RN in nasopharyngeal carcinoma (NPC) patients. METHODS AND MATERIALS In this multicenter open-label study, patients with RN were randomly assigned (1:1) into a bevacizumab group (5 mg/kg intravenously every 2 weeks, for 4 cycles) or a corticosteroid group (methylprednisolone 500 mg/day intravenously for 3 consecutive days and then gradually tapered, followed by 10 mg/day oral prednisone, for 2 months in total). Magnetic resonance imaging (MRI) was performed pre- and post-treatment to define the radiographic response. The primary outcome was a 2-month response rate as determined by MRI and clinical symptoms. All of the patients were followed up with for 6 months. The trial was registered at www.clinicaltrials.gov (NCT01621880). RESULTS Of 121 patients screened, 112 patients met the entry criteria. Thirty-eight (65.5%) patients in the bevacizumab group showed response, which was significantly higher than that in the corticosteroid group (65.5% vs 31.5%, P < .001). The mean percentage decrease in RN volume seen on T1 post-gadolinium and T2-weighted fluid-attenuated inversion recovery (FLAIR) MRI was 25.5% and 51.8%, respectively, in the bevacizumab group, versus 5.0% and 19.3%, respectively, in the corticosteroid group. Moreover, 36 patients (62.1%) on bevacizumab and 23 patients (42.6%) on corticosteroids demonstrated clinical improvement (P = .039). During the 6-month follow up, fourteen patients on bevacizumab and 13 patients on corticosteroids showed RN recurrence. The most frequent adverse event in the bevacizumab group was hypertension (20.6%). CONCLUSIONS Our study indicate that compared with corticosteroids, bevacizumab offers improved symptomatic relief and radiographic response.
Giuseppe Minniti - One of the best experts on this subject based on the ideXlab platform.
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Outcomes of postoperative stereotactic radiosurgery to the resection cavity versus stereotactic radiosurgery alone for melanoma Brain metastases
Journal of neuro-oncology, 2017Co-Authors: Giuseppe Minniti, Sergio Paolini, Gaetano Lanzetta, Francesco Cicone, Vincenzo Esposito, Giancarlo D'andrea, Veronica Confaloni, Alessandro Bozzao, Mattia Falchetto OstiAbstract:To investigate local control and radiation-induced Brain Necrosis in patients with melanoma Brain metastases who received complete resection plus fractionated stereotactic radiosurgery (fSRS, 3 × 9 Gy) or fSRS alone. Factors associated with the clinical outcomes and the development of Brain Necrosis have been assessed. One hundred and twenty consecutive patients with 137 melanoma Brain metastases who received surgery plus fSRS (S + fSRS) or fSRS alone were analyzed. All lesions evaluated in the study were treated with a dose of 27 Gy given in 3 fractions over three consecutive days. Cumulative incidence analysis was used to compare local failure (LF), distant Brain failure (DBF), and radiation-induced Brain Necrosis (RN) between groups from the time of SRS. At a median follow-up of 13 months, median OS times and 1-year survival rates were comparable: S + fSRS, 14 months and 85%; fSRS, 12 months and 85% (p = 0.2). Median DBF did not differ significantly by group, being 14 months for both groups. Nine patients who received S + fSRS and 20 patients treated with fSRS recurred locally (p = 0.03). Six-month and 1-year LF rates were 5 and 12% in S + fSRS group and 17 and 28% in fSRS group (p = 0.02). RN occurred in 21 patients (S + fSRS, n = 14; fSRS, n = 7; p = 0.1). The cumulative 1-year incidence of RN was 13% after S + fSRS and 8% after fSRS (p = 0.15). In conclusion, postoperative SRS (3 × 9 Gy) to the resection cavity is an effective treatment modality for melanoma Brain metastases associated with better local control as compared with fSRS alone.
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single fraction versus multifraction 3 9 gy stereotactic radiosurgery for large 2 cm Brain metastases a comparative analysis of local control and risk of radiation induced Brain Necrosis
International Journal of Radiation Oncology Biology Physics, 2016Co-Authors: Giuseppe Minniti, Claudia Scaringi, Sergio Paolini, Gaetano Lanzetta, Andrea Romano, Francesco Cicone, Mattia Falchetto Osti, Riccardo Maurizi Enrici, Vincenzo EspositoAbstract:Purpose To investigate the local control and radiation-induced Brain Necrosis in patients with Brain metastases >2 cm in size who received single-fraction or multifraction stereotactic radiosurgery (SRS); factors associated with clinical outcomes and the development of Brain radioNecrosis were assessed. Methods and Materials Two hundred eighty-nine consecutive patients with Brain metastases >2.0 cm who received SRS as primary treatment at Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy, were analyzed. Cumulative incidence analysis was used to compare local control and radiation-induced Brain Necrosis between groups from the time of SRS. To achieve a balanced distribution of baseline covariates between treatment groups, a propensity score analysis was used. Results The 1-year cumulative local control rates were 77% in the single-fraction SRS (SF-SRS) group and 91% in the multifraction SRS (MF-SRS) group ( P =.01). Recurrences occurred in 25 and 11 patients who received SF-SRS or MF-SRS ( P =.03), respectively. Thirty-one patients (20%) undergoing SF-SRS and 11 (8%) subjected to MF-SRS experienced Brain radioNecrosis ( P =.004); the 1-year cumulative incidence rate of radioNecrosis was 18% and 9% ( P =.01), respectively. Significant differences between the 2 groups in terms of local control and risk of radioNecrosis were maintained after propensity score adjustment. Conclusions Multifraction SRS at a dose of 27 Gy in 3 daily fractions seems to be an effective treatment modality for large Brain metastases, associated with better local control and a reduced risk of radiation-induced radioNecrosis as compared with SF-SRS.
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Single-Fraction Versus Multifraction (3 × 9 Gy) Stereotactic Radiosurgery for Large (>2 cm) Brain Metastases: A Comparative Analysis of Local Control and Risk of Radiation-Induced Brain Necrosis
International journal of radiation oncology biology physics, 2016Co-Authors: Giuseppe Minniti, Claudia Scaringi, Sergio Paolini, Gaetano Lanzetta, Andrea Romano, Francesco Cicone, Mattia Falchetto Osti, Riccardo Maurizi Enrici, Vincenzo EspositoAbstract:Purpose To investigate the local control and radiation-induced Brain Necrosis in patients with Brain metastases >2 cm in size who received single-fraction or multifraction stereotactic radiosurgery (SRS); factors associated with clinical outcomes and the development of Brain radioNecrosis were assessed. Methods and Materials Two hundred eighty-nine consecutive patients with Brain metastases >2.0 cm who received SRS as primary treatment at Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy, were analyzed. Cumulative incidence analysis was used to compare local control and radiation-induced Brain Necrosis between groups from the time of SRS. To achieve a balanced distribution of baseline covariates between treatment groups, a propensity score analysis was used. Results The 1-year cumulative local control rates were 77% in the single-fraction SRS (SF-SRS) group and 91% in the multifraction SRS (MF-SRS) group ( P =.01). Recurrences occurred in 25 and 11 patients who received SF-SRS or MF-SRS ( P =.03), respectively. Thirty-one patients (20%) undergoing SF-SRS and 11 (8%) subjected to MF-SRS experienced Brain radioNecrosis ( P =.004); the 1-year cumulative incidence rate of radioNecrosis was 18% and 9% ( P =.01), respectively. Significant differences between the 2 groups in terms of local control and risk of radioNecrosis were maintained after propensity score adjustment. Conclusions Multifraction SRS at a dose of 27 Gy in 3 daily fractions seems to be an effective treatment modality for large Brain metastases, associated with better local control and a reduced risk of radiation-induced radioNecrosis as compared with SF-SRS.