Browsing by Author "Chang, Susan M."

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Clinical outcome and prognostic factors for central neurocytoma: twenty year institutional experience
    (Springer, 2016-01) Imber, Brandon S.; Braunstein, Steve E.; Wu, Fred Y.; Nabavizadeh, Nima; Boehling, Nicholas; Weinberg, Vivian K.; Tihan, Tarik; Barnes, Michael; Mueller, Sabine; Butowski, Nicholas A.; Clarke, Jennifer L.; Chang, Susan M.; McDermott, Michael M.; Prados, Michael D.; Berger, Mitchel S.; Haas-Kogan, Daphne A.; Department of Medicine, IU School of Medicine
    Central neurocytomas are uncommon intraventricular neoplasms whose optimal management remains controversial due to their rarity. We assessed outcomes for a historical cohort of neurocytoma patients and evaluated effects of tumor atypia, size, resection extent, and adjuvant radiotherapy. Progression-free survival (PFS) was measured by Kaplan-Meier and Cox proportional hazards methods. A total of 28 patients (15 males, 13 females) were treated between 1995 and 2014, with a median age at diagnosis of 26 years (range 5-61). Median follow-up was 62.2 months and 3 patients were lost to follow-up postoperatively. Thirteen patients experienced recurrent/progressive disease and 2-year PFS was 75% (95% CI 53-88%). Two-year PFS was 48% for MIB-1 labeling >4% versus 90% for ≤4% (HR 5.4, CI 2.2-27.8, p = 0.0026). Nine patients (32%) had gross total resections (GTR) and 19 (68%) had subtotal resections (STR). PFS for >80% resection was 83 versus 67% for ≤80% resection (HR 0.67, CI 0.23-2.0, p = 0.47). Three STR patients (16%) received adjuvant radiation which significantly improved overall PFS (p = 0.049). Estimated 5-year PFS was 67% for STR with radiotherapy versus 53% for STR without radiotherapy. Salvage therapy regimens were diverse and resulted in stable disease for 54% of patients and additional progression for 38 %. Two patients with neuropathology-confirmed atypical neurocytomas died at 4.3 and 113.4 months after initial surgery. For central neurocytomas, MIB-1 labeling index >4% is predictive of poorer outcome and our data suggest that adjuvant radiotherapy after STR may improve PFS. Most patients requiring salvage therapy will be stabilized and multiple modalities can be effectively utilized.
  • Thumbnail Image
    Item
    The State of Neuro-Oncology During the COVID-19 Pandemic: A Worldwide Assessment
    (Oxford, 2020) Mrugala, Maciej M.; Ostrom, Quinn T.; Pressley, Shelley M.; Taylor, Jennie; Thomas, Alissa A.; Wefel, Jeffrey S.; Coven, Scott L.; Acquaye, Alvina A.; Haynes, Chas; Agnihotri, Sameer; Lim, Michael; Peters, Katherine B.; Sulman, Erik P.; Salcido, Joanne T.; Butowski, Nicholas A.; Hervey-Jumper, Shawn; Mansouri, Alireza; Oliver, Kathy R.; Porter, Alyx B.; Nassiri, F.; Schiff, D.; Dunbar, Erin M.; Hegi, Monika E.; Armstrong, Terri S.; van den Bent, Martin J.; Chang, Susan M.; Zadeh, Gelareh; Chheda, Milan G.; Pediatrics, School of Medicine
    To assess the impact of the pandemic on the field, we performed an international web-based survey of practitioners, scientists, and trainees from 21 neuro-oncology organizations across 6 continents from April 24 through May 17. Of 582 respondents, 258 (45%) were in the US, and 314 (55%) were international. 80.4% were affiliated with academic institutions. 94% respondents reported changes in clinical practice; 95% reported conversion to telemedicine for at least some appointments. However, almost 10% practitioners felt the need to see patients in person specifically because of billing concerns and perceived institutional pressure. Over 50% believed neuro-oncology patients were at increased risk of contracting COVID-19. 67% practitioners suspended enrollment for at least one clinical trial: 53% suspended phase II and 62% suspended phase III trial enrollment. 71% clinicians feared for their or their families’ safety, specifically because of their clinical duties. 20% percent said they did not have enough PPE to work safely; about the same percentage were unhappy with their institutions’ response to the pandemic. 43% believed the pandemic would negatively affect their academic career, and 52% fellowship program directors were worried about losing funding for their training programs. While 69% respondents reported increased stress, 44% were offered no psychosocial support. 37% had their salary reduced. 36% researchers had to temporarily close their laboratories. In contrast, the pandemic created positive changes in perceived patient and family satisfaction, quality of communication, and use of technology to deliver care and interactions with other practitioners. CONCLUSIONS: The pandemic has altered standard treatment schedules and limited investigational treatment options for patients. In some cases, clinicians felt institutional pressure to continue conducting billable in-person visits when telemedicine visits would have sufficed. A lack of institutional support created anxiety among clinicians and researchers. We make specific recommendations to guide clinical and scientific infrastructure moving forward.