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Matthew M. Grabowski, Pablo F. Recinos, Amy S. Nowacki, Jason L. Schroeder, Lilyana Angelov, Gene H. Barnett, and Michael A. Vogelbaum

neurosurgical oncology practice (M.A.V.), thus representing a wide range of experience in the field. Determination of volumes was made without consideration of clinical outcome. The volumes taken by the attending neurosurgeon were considered the standard measurements that were used for all statistical calculations aside from those related to interobserver variability and correlations. T2/F-RV was assessed by the attending neurosurgeon only. All volumes were defined in three dimensions using preoperative and postoperative MR images obtained on 1.5-T scanners. Postoperative

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Jacob A. Miller, Ehsan H. Balagamwala, Samuel T. Chao, Todd Emch, John H. Suh, Toufik Djemil, and Lilyana Angelov

the context of myeloma-associated vertebral fractures, metastatic bone disease, and SRS. 10 , 23 , 41 BPI scores were recorded as the “worst,” “current,” and “average” pain (ranging from 0 to 10) at each treatment site throughout clinical follow-up. Pain relief and symptomatic failure were adjusted for narcotic usage per Radiation Therapy Oncology Group (RTOG) study 0631. 35 Any increase in narcotic utilization was considered pain progression. Pre-SRS BPI scores were compared with 1-month and 3-month post-SRS scores. Secondary outcome variables included the

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Ehsan H. Balagamwala, Lilyana Angelov, Shlomo A. Koyfman, John H. Suh, Chandana A. Reddy, Toufik Djemil, Grant K. Hunter, Ping Xia, and Samuel T. Chao

involvement of the epidural space or posterior elements as the disease progresses. Symptoms of metastasis to the spine can range from pain to motor dysfunction to severe neurological compromise due to spinal cord compression from progressive epidural disease. 8 Treatment of spinal metastases from RCC requires multispecialty management by medical, surgical, and radiation oncology teams. Patients with no neurological compromise benefit most from pain management using narcotic and/or nonnarcotic analgesics, as well as radiation therapy (CRT or SBRT). Surgical intervention is

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Michael A. Vogelbaum, Lilyana Angelov, Shih-Yuan Lee, Liang Li, Gene H. Barnett, and John H. Suh

College of Surgeons Oncology Group Z0300). The results and conclusions of this study are limited by the fact that it is a retrospective analysis of the experience at a single institution. Further prospective evaluation of the dose-dependent efficacy of SRS is necessary to confirm our findings, and additional studies should be combined with a dose-escalation strategy for certain situations (for example, radioresistant histological types or unresectable tumors). One difficulty with assessment of local control after radio-surgery is the similarity in the appearance of

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Jacob A. Miller, Ehsan H. Balagamwala, Lilyana Angelov, John H. Suh, Brian Rini, Jorge A. Garcia, Manmeet Ahluwalia, and Samuel T. Chao

carcinoma cells to radiotherapy and chemotherapy . Cancer Biol Ther 13 : 401 – 407 , 2012 Disclosures Dr. Suh reports receiving support for travel and lodging and/or research from Elekta and Varian Medical Systems. Dr. Rini reports a consultant relationship with Pfizer. Dr. Garcia reports a consultant relationship with Astellas Pharma US, Inc.; Bayer Healthcare Pharmaceuticals, Inc.; Pfizer, Inc.; and Sanofi S.A. Dr. Ahluwalia reports a consultant relationship with Incyte Corp. and PrIME Oncology, Inc. Dr. Chao reports honorarium receipt from Varian

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E. Emily Bennett, Camille Berriochoa, Ghaith Habboub, Scott Brigeman, Samuel T. Chao, and Lilyana Angelov

– 116 , 2012 13 Seung SK , Larson DA , Galvin JM , Mehta MP , Potters L , Schultz CJ , : American College of Radiology (ACR) and American Society for Radiation Oncology (ASTRO) Practice Guideline for the Performance of Stereotactic Radiosurgery (SRS) . Am J Clin Oncol 36 : 310 – 315 , 2013 14 Shin DA , Huh R , Chung SS , Rock J , Ryu S : Stereotactic spine radiosurgery for intradural and intramedullary metastasis . Neurosurg Focus 27 : 6 E10 , 2009 Disclosures The authors report no conflict of interest concerning

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Rupesh Kotecha, Lilyana Angelov, Gene H. Barnett, Chandana A. Reddy, John H. Suh, Erin S. Murphy, Gennady Neyman, and Samuel T. Chao

primary treatment of lesions localized in the calvaria or skull base. We also describe a novel bolus-based treatment technique that we developed to treat superficial lesions in the calvarial bones. Methods We reviewed databases from the Cleveland Clinic Burkhardt Brain Tumor and Neuro-Oncology Center and Department of Radiation Oncology and identified 21 patients who had undergone GKS for calvarial and skull base metastases during 2001–2013. The metastatic lesions were classified by their originating site: calvaria or skull base. Lesions in the frontal, parietal

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Jacob A. Miller, Ehsan H. Balagamwala, Camille A. Berriochoa, Lilyana Angelov, John H. Suh, Edward C. Benzel, Alireza M. Mohammadi, Todd Emch, Anthony Magnelli, Andrew Godley, Peng Qi, and Samuel T. Chao

excluded from the Radiation Therapy Oncology Group (RTOG) study 0631, which is currently randomizing patients to single-fraction SRS or single-fraction conventional radiotherapy in an effort to better evaluate the benefits of SRS. 19 In the postoperative setting, small retrospective studies have suggested that SRS is safe and effective. 5 , 12 , 16 These studies have generally been noncomparative, and therefore the ability to draw meaningful conclusions is limited. In particular, it is unclear whether SRS is safe and effective at instrumented sites given the

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Shireen Parsai, Aditya Juloori, Lilyana Angelov, Jacob G. Scott, Ajit A. Krishnaney, Inyang Udo-Inyang, Tingliang Zhuang, Peng Qi, Matthew Kolar, Peter Anderson, Stacey Zahler, Samuel T. Chao, John H. Suh, and Erin S. Murphy

historically been regarded as a relatively radioresistant histology. Thus, the Children’s Oncology Group seeks to explore the feasibility and local failure rates of using radiosurgery to treat osseous metastases using the AEWS1221 protocol (NCT02306161). Similarly, the Mayo Clinic, the St. Jude Children’s Research Hospital, and Johns Hopkins are leading a prospective multiinstitutional study on the efficacy of radiosurgery in patients with metastatic pediatric sarcoma, including Ewing sarcoma and osteosarcoma (NCT01763970). Stereotactic radiosurgery (SRS) has been commonly

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Mayur Sharma, Jason L. Schroeder, Paul Elson, Antonio Meola, Gene H. Barnett, Michael A. Vogelbaum, John H. Suh, Samuel T. Chao, Alireza M. Mohammadi, Glen H. J. Stevens, Erin S. Murphy, and Lilyana Angelov

the maximum dimension of the tumor, according to the Radiation Therapy Oncology Group (protocol 90-05) guidelines. 45 Following GKRS, 4–6 weeks after the procedure, patients underwent clinical examination and MRI and then every 3 months thereafter. The median follow-up duration in our study was 10.1 months (range 0.8–51.4 months). Outcomes and Endpoints Overall survival (OS) and progression-free survival (PFS) from the date of salvage SRS were the primary and secondary endpoints, respectively. OS and PFS were measured from the time of salvage SRS to death and the