Geriatric patient outcomes in a multidisciplinary central nervous system community hospital clinic for radiation oncology and neurosurgery (RADIANS)

2021 ◽  
Author(s):  
Rohi Gheewala ◽  
Wencesley A. Paez ◽  
William Stadtlander ◽  
Brandon Lucke-Wold ◽  
Jerry J. Jaboin ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Patient Outcomes ◽  
Radiation Oncology ◽  
Geriatric Patient ◽  
Community Hospital ◽  
Hospital Clinic

Outcomes for geriatric patients evaluated in a same-day multidisciplinary central nervous system clinic for radiation oncology and neurosurgery in a community hospital setting.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e24034-e24034
Author(s):  
Wencesley A. Paez ◽  
Rohi Gheewala ◽  
Jerry J. Jaboin ◽  
Charles R. Thomas ◽  
Jeremy N. Ciporen ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Patient Satisfaction ◽  
Radiation Oncology ◽  
Patient Population ◽  
Geriatric Patients ◽  
Community Hospital ◽  
The United States ◽  
Cns Disease ◽  
Cns Malignancies

e24034 Background: The geriatric cancer population is rapidly increasing in the United States. Management of geriatric patients with central nervous system (CNS) disease requires a patient-centric, multidisciplinary approach together with meticulous assessment of their outcomes, as clinical studies guiding treatment recommendations are lacking in this patient population. We have previously reported the outcomes of our multidisciplinary community hospital-based CNS clinic, RADIANS, where both radiation oncology and neurosurgery specialists simultaneously evaluate patients in a same-day, single-setting clinic. We have sought to analyze the outcomes of the geriatric patient population of our RADIANS clinic. Methods: We identified patients 65 years and older in our IRB-approved RADIANS Prospective Patient Registry for CNS Disease. Descriptive statistics were used to report patient characteristics, diagnoses, treatments and outcomes, and patient satisfaction scores. Results: Between August 2016 and February 2020, 56 patients 65 years and older (mean age 74.6, range: 65-94; 32 women and 24 men) were evaluated in the RADIANS clinic. Mean distanced traveled by patients to clinic was 43.4 miles (med = 8.3; range = 0.6-341). Patient-reported Satisfaction Score was 4.81 (0-5 Scale, 5-very satisfied). The most common referral source was medical oncology. Forty-two patients had malignant CNS disease (brain mets-18; spine mets-12; both-4; primary brain-6; primary spine-2), 14 had benign CNS disease. Post-evaluation treatment: radiation therapy (RT) only (n = 20), neurosurgery (NS) only (n = 6), both RT and NS (n = 14), and no RT/NS intervention (n = 16). Fractionated stereotactic radiosurgery was most common RT delivered; craniotomy with tumor resection was most common NS performed. Treatment outcomes: local tumor control = 39/40 (97.5%); radiation necrosis/radiation-induced myelitis = 0/34 (0.0%). Conclusions: This is the first report of outcomes in geriatric patients with CNS malignancies treated in a community hospital-based multidisciplinary clinic. We show excellent outcomes comparable to younger patients with CNS malignancies, as well as patient satisfaction and ability to travel great distances to receive multidisciplinary care.

scholarly journals Modulation of the Endocannabinoid System Following Central Nervous System Injury

2019 ◽  
Vol 20 (2) ◽  
pp. 388 ◽  
Author(s):  
Juan Zhou ◽  
Haneen Noori ◽  
Ian Burkovskiy ◽  
J. Lafreniere ◽  
Melanie Kelly ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Immune Function ◽  
Patient Outcomes ◽  
Endocannabinoid System ◽  
Cns Injury ◽  
Inflammatory Phase ◽  
Neuro Inflammation ◽  
Later Phase

Central nervous system (CNS) injury, such as stroke or trauma, is known to increase susceptibility to various infections that adversely affect patient outcomes (CNS injury-induced immunodepression—CIDS). The endocannabinoid system (ECS) has been shown to have immunoregulatory properties. Therefore, the ECS might represent a druggable target to overcome CIDS. Evidence suggests that cannabinoid type 2 receptor (CB2R) activation can be protective during the early pro-inflammatory phase after CNS injury, as it limits neuro-inflammation and, therefore, attenuates CIDS severity. In the later phase post CNS injury, CB2R inhibition is suggested as a promising pharmacologic strategy to restore immune function in order to prevent infection.

Principles of paediatric radiation oncology

2013 ◽  
Author(s):  
Roger E Taylor
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Hodgkin Lymphoma ◽  
Radiation Oncology ◽  
Intensity Modulated Radiotherapy ◽  
Primitive Neuroectodermal Tumour ◽  
Paediatric Tumours ◽  
Intensity Modulated ◽  
Non Hodgkin Lymphoma ◽  
Central Nervous System Tumours

Chapter 15 discusses the principles of paediatric radiation oncology, and addresses quality assurance, chemotherapy/radiotherapy interactions, Leukaemia, Hodgkin lymphoma, Non-Hodgkin lymphoma, Neuroblastoma, Rhabdomyosarcoma, Ewing’s sarcoma/peripheral primitive neuroectodermal tumour, Osteosarcoma, central nervous system tumours, Intensity-modulated radiotherapy, and proton therapy for paediatric tumours.

scholarly journals INNV-45. RADIANS: A MULTIDISCIPLINARY CENTRAL NERVOUS SYSTEM CLINIC MODEL FOR RADIATION ONCOLOGY AND NEUROSURGERY PRACTICE

2018 ◽  
Vol 20 (suppl_6) ◽  
pp. vi147-vi147
Author(s):  
Shearwood McClelland ◽  
Timur Mitin ◽  
Jerry Jaboin ◽  
Jeremy Ciporen
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Radiation Oncology

scholarly journals Hierarchy of evidence referring to the central nervous system in a high-impact radiation oncology journal: a 10-year assessment. Descriptive critical appraisal study

2015 ◽  
Vol 133 (4) ◽  
pp. 307-313 ◽  
Author(s):  
Fabio Ynoe Moraes ◽  
Lorine Arias Bonifacio ◽  
Gustavo Nader Marta ◽  
Samir Abdallah Hanna ◽  
Álvaro Nagib Atallah ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Radiation Oncology ◽  
Critical Appraisal ◽  
Randomized Clinical Trials ◽  
Geographical Location ◽  
Case Series ◽  
Level Of Evidence ◽  
Systematic Assessment ◽  
The Central Nervous System

CONTEXT AND OBJECTIVE: To the best of our knowledge, there has been no systematic assessment of the classification of scientific production within the scope of radiation oncology relating to central nervous system tumors. The aim of this study was to systematically assess the status of evidence relating to the central nervous system and to evaluate the geographic origins and major content of these published data.DESIGN AND SETTING: Descriptive critical appraisal study conducted at a private hospital in São Paulo, Brazil.METHODS: We evaluated all of the central nervous system studies published in the journal Radiotherapy & Oncology between 2003 and 2012. The studies identified were classified according to their methodological design and level of evidence. Information regarding the geographical location of the study, the institutions and authors involved in the publication, main condition or disease investigated and time of publication was also obtained.RESULTS: We identified 3,004 studies published over the 10-year period. Of these, 125 (4.2%) were considered eligible, and 66% of them were case series. Systematic reviews and randomized clinical trials accounted for approximately 10% of all the published papers. We observed an increase in high-quality evidence and a decrease in low-quality published papers over this period (P = 0.036). The inter-rater reliability demonstrated significant agreement between observers in terms of the level of evidence.CONCLUSIONS: Increases in high-level evidence and in the total number of central nervous system papers were clearly demonstrated, although the overall number of such studies remained relatively small.

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