Browsing by Author "Randazzo, Dina M"

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    ItemOpen Access
    Adjuvant Radiation in Older Patients With Glioblastoma: A Retrospective Single Institution Analysis.
    (Frontiers in oncology, 2021-01) Lee, Jessica W; Kirkpatrick, John P; McSherry, Frances; Herndon, James E; Lipp, Eric S; Desjardins, Annick; Randazzo, Dina M; Friedman, Henry S; Ashley, David M; Peters, Katherine B; Johnson, Margaret O

    Objectives

    Standard 6-week and hypofractionated 3-week courses of adjuvant radiation therapy (RT) are both options for older patients with glioblastoma (GBM), but deciding the optimal regimen can be challenging. This analysis explores clinical factors associated with selection of RT course, completion of RT, and outcomes following RT.

    Materials and methods

    This IRB-approved retrospective analysis identified patients ≥70 years old with GBM who initiated adjuvant RT at our institution between 2004 and 2016. We identified factors associated with standard or hypofractionated RT using the Cochran-Armitage trend test, estimated time-to-event endpoints using the Kaplan-Meier method, and found predictors of overall survival (OS) using Cox proportional hazards models.

    Results

    Sixty-two patients with a median age of 74 (range 70-90) initiated adjuvant RT, with 43 (69%) receiving standard RT and 19 (31%) receiving hypofractionated RT. Selection of short-course RT was associated with older age (p = 0.04) and poor KPS (p = 0.03). Eight (13%) patients did not complete RT, primarily for hospice care due to worsening symptoms. After a median follow-up of 37 months, median OS was 12.3 months (95% CI 9.0-15.1). Increased age (p < 0.05), poor KPS (p < 0.0001), lack of MGMT methylation (p < 0.05), and lack of RT completion (p < 0.0001) were associated with worse OS on multivariate analysis. In this small cohort, GTV size and receipt of standard or hypofractionated RT were not associated with OS.

    Conclusions

    In this cohort of older patients with GBM, age and KPS was associated with selection of short-course or standard RT. These regimens had similar OS, though a subset of patients experienced worsening symptoms during RT and discontinued treatment. Further investigation into predictors of RT completion and survival may help guide adjuvant therapies and supportive care for older patients.
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    Primary brain tumor patients admitted to a US intensive care unit: a descriptive analysis.
    (CNS oncology, 2021-09-21) Kang, Jennifer H; Swisher, Christa B; Buckley, Evan D; Herndon, James E; Lipp, Eric S; Kirkpatrick, John P; Desjardins, Annick; Friedman, Henry S; Johnson, Margaret O; Randazzo, Dina M; Ashley, David M; Peters, Katherine B
    Purpose: To describe our population of primary brain tumor (PBT) patients, a subgroup of cancer patients whose intensive care unit (ICU) outcomes are understudied. Methods: Retrospective analysis of PBT patients admitted to an ICU between 2013 to 2018 for an unplanned need. Using descriptive analyses, we characterized our population and their outcomes. Results: Fifty-nine PBT patients were analyzed. ICU mortality was 19% (11/59). The most common indication for admission was seizures (n = 16, 27%). Conclusion: Our ICU mortality of PBT patients was comparable to other solid tumor patients and the general ICU population and better than patients with hematological malignancies. Further study of a larger population would inform guidelines for triaging PBT patients who would most benefit from ICU-level care.
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    The role of chemotherapy in the treatment of central neurocytoma.
    (CNS oncology, 2019-11-05) Johnson, Margaret O; Kirkpatrick, John P; Patel, Mallika P; Desjardins, Annick; Randazzo, Dina M; Friedman, Henry S; Ashley, David M; Peters, Katherine B
    Aim: Central neurocytoma (CN) is a rare WHO grade II central nervous system (CNS) tumor. This is an update on chemotherapeutic agents used in its treatment. Patients & methods: An institutional review board-approved, chart review of patients seen at our institution resulted in a single case treated with chemotherapy and is herein included. We proceeded with a comprehensive literature review. Results: We identified 18 citations, representing 39 cases of adult and pediatric CN treated with chemotherapy. With the addition of our single case, the total number of recurrent CN patients treated with temozolomide (TMZ) is nine. Conclusion: There exists marked heterogeneity in chemotherapy used to treat CN. TMZ is incorporated into treatment regimens in the setting of tumor recurrence: its role merits further study.