Browsing by Author "Aoun, Salah G."

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    Primary and radiation induced skull base osteosarcoma: a systematic review of clinical features and treatment outcomes
    (Springer, 2021) Alamer, Othman Bin; Haider, Ali S.; Haider, Maryam; Sagoo, Navraj S.; Robertson, Faith C.; Arrey, Eliel N.; Aoun, Salah G.; Yu, Kenny; Cohen-Gadol, Aaron A.; El Ahmadieh, Tarek Y.; Neurological Surgery, School of Medicine
    Purpose: We aim to systematically review and summarize the demographics, clinical features, management strategies, and clinical outcomes of primary and radiation-induced skull-base osteosarcoma (SBO). Methods: PubMed, Scopus, and Cochrane databases were used to identify relevant articles. Papers including SBO cases and sufficient clinical outcome data were included. A comprehensive clinical characteristic review and survival analysis were also conducted. Results: Forty-one studies describing 67 patients were included. The median age was 31 years (male = 59.7%). The middle skull-base was most commonly involved (52.7%), followed by anterior (34.5%) and posterior (12.7%) skull-base. Headache (27%), exophthalmos (18%), and diplopia (10%) were common presenting symptoms. Sixty-eight percent of patients had primary SBO, while 25% had radiation-induced SBO. Surgery was the main treatment modality in 89% of cases. Chemotherapy was administered in 65.7% and radiotherapy in 50%. Median progression-free survival (PFS) was 12 months, and the overall 5-year survival was 22%. The five-year survival rates of radiation-induced SBO and primary SBO were 39% and 16%, respectively (P < 0.05). Conclusion: SBO is a malignant disease with poor survival outcomes. Surgical resection is the primary management modality, in conjunction with chemotherapy and radiotherapy. Radiation-induced SBO has a superior survival outcome as compared to its primary counterpart. Complete surgical resection showed a statistically insignificant survival benefit as compared to partial resection.
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    The Role of Immune Checkpoint Inhibitors in Leptomeningeal Disease: A Systematic Review
    (International Institute of Anticancer Research, 2021) Palmisciano, Paolo; Haider, Ali S.; Nwagwu, Chibueze D.; Wahood, Waseem; Yu, Kenny; Ene, Chibawanye I.; O'Brien, Barbara J.; Aoun, Salah G.; Cohen-Gadol, Aaron A.; El Ahmadieh, Tarek Y.; Neurological Surgery, School of Medicine
    Background/aim: Leptomeningeal disease (LMD) is a debilitating complication of advanced malignancies. Immune-checkpoint inhibitors (ICIs) may alter disease course. We analyzed the role and toxicity of ICIs in LMD. Materials and methods: We systematically reviewed the literature reporting on outcome data of patients with LMD treated with ICIs. Results: We included 14 studies encompassing 61 patients. Lung-cancer (44.3%), breast-cancer (27.9%), and melanoma (23.0%) were the most frequent primary tumors. Median duration of ICI-treatment was 7-months (range=0.5-58.0): pembrolizumab (49.2%), nivolumab (32.8%), ipilimumab (18.0%). Radiological responses included complete response (33.3%), partial response (12.5%), stable disease (33.3%), progressive disease (20.8%). Twenty-two patients developed ICI-related adverse-events, mild (100%) and/or severe (15.6%). Median progression-free and overall survival were 5.1 and 6.3 months, and 12-month survival was 32.1%. Survival correlated with ICI agents (p=0.042), but not with primary tumors (p=0.144). Patients receiving concurrent steroids showed worse survival (p=0.040). Conclusion: ICI therapy is well-tolerated in patients with LMD, but concurrent steroids may worsen survival.