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Journal of Neurosurgical Sciences 2021 May 03

DOI: 10.23736/S0390-5616.21.05304-2


language: English

A multidisciplinary central nervous system clinic model for radiation oncology and neurosurgery (RADIANS): three-year experience with brain and skull base lesions in a community hospital setting

Wencesley A. PAEZ 1, Rohi GHEEWALA 2, Shearwood McCLELLAND III 3, Brandon LUCKE-WOLD 4 , Jerry J. JABOIN 1, Charles R. THOMAS Jr. 1, Timur MITIN 1, Jeremy N. CIPOREN 5

1 Department of Radiation Medicine, Oregon Health & Science University, Portland, OR, USA; 2 School of Medicine, Oregon Health & Science University, Portland, OR, USA; 3 Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, USA; 4 Department of Neurosurgery, University of Florida, Gainesville, FL, USA; 5 Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, USA


BACKGROUND: Subspecialty, multidisciplinary care within community hospital settings are limited and remains a challenge. Improving outcomes for central nervous system (CNS) disease rely on integrated subspecialty care between radiation oncology (RadOnc) and neurosurgery (NS). Threeyear experience with simultaneous patient evaluation with RadOnc and NS physicians in a community hospital-based CNS clinic model (RADIANS) for brain and skull base lesions (BSBL) are reported.
METHODS: Clinical and demographic data were prospectively collected for patients evaluated in RADIANS. Surveys administered and three-year data reviewed. Descriptive statistics reported as mean and percentages for patient characteristics, diagnosis, treatment and outcomes.
RESULTS: Sixty-seven patients with confirmed BSBL were evaluated between August 2016 and August 2019. Mean age and distance traveled was 61.0 years and 66.5 miles, respectively. Female (n=39, 58.2%) and male (n=28, 41.8%) patients had mean Patient Satisfaction Score of 4.77 (0-5 Scale, 5-very satisfied; n=26 respondents). Forty-three patients had malignant disease (brain mets-28; both brain/spine-6; primary brain-9), and 24 had benign disease. Post-evaluation treatment: radiation therapy (RT) only (n=16), neurosurgery (NS) only (n=12), both RT and NS (n=15), and no RT/NS intervention (n=24). Fractionated stereotactic radiosurgery was most common RT delivered; craniotomy with tumor resection was most common NS performed. Treatment outcomes: local control=33/38 (86.8%); radiation necrosis=1/31 (3.2%).
CONCLUSIONS: The multidisciplinary community hospital-based CNS clinic continues its high patient approval at extended follow-up. Results demonstrate the clinic serves as a regional referral center where patients with BSBL with varying degrees of co-morbidities, systemic disease status, and oncologic staging can be treated with evidence-based treatment modalities yielding high rates of local control and low rates of grade 3 and 4 radiation-induced toxicity, while having access to on-going clinical trials.

KEY WORDS: Brain tumor; Central nervous system; Metastatic disease; Multidisciplinary clinic; Neurosurgery; RADIANS; Radiation oncology; Radiation therapy; Radiosurgery

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