Department of Radiation Medicine, Oregon Health and Science University, Portland, OR, USA.
Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA.
J Neurosurg Sci. 2023 Aug;67(4):408-413. doi: 10.23736/S0390-5616.21.05304-2. Epub 2021 May 3.
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). Three-year 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.
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.
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, where 5 is very satisfied; 26 respondents). Forty-three patients had malignant disease (28 brain mets; six with both brain/spine; nine with primary brain), 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 in 33 of 38 (86.8%); radiation necrosis in one of 31 (3.2%).
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.
社区医院的专科、多学科治疗受到限制，仍然是一个挑战。改善中枢神经系统 (CNS) 疾病的预后依赖于放射肿瘤学 (RadOnc) 和神经外科 (NS) 之间的综合专科治疗。报告了在社区医院为脑和颅底病变 (BSBL) 设立的中枢神经系统 (CNS) 诊所模式 (RADIANS) 中，放射肿瘤学和神经外科医生同时对患者进行评估的三年经验。
前瞻性收集在 RADIANS 接受评估的患者的临床和人口统计学数据。进行调查并审查三年数据。描述性统计数据以患者特征、诊断、治疗和结果的平均值和百分比报告。
2016 年 8 月至 2019 年 8 月期间，共评估了 67 例确诊为 BSBL 的患者。平均年龄和行驶距离分别为 61.0 岁和 66.5 英里。女性（N=39，58.2%）和男性（N=28，41.8%）患者的患者满意度评分为 4.77（0-5 分制，其中 5 分为非常满意；26 名受访者）。43 例为恶性疾病（28 例脑转移瘤；6 例脑/脊柱均有转移；9 例原发性脑肿瘤），24 例为良性疾病。评估后的治疗：单纯放射治疗（RT）（N=16）、单纯神经外科治疗（NS）（N=12）、RT 和 NS 联合治疗（N=15）和无 RT/NS 干预（N=24）。最常见的 RT 是分次立体定向放射外科治疗；最常见的 NS 是开颅肿瘤切除术。治疗结果：38 例中的 33 例（86.8%）达到局部控制；31 例中的 1 例（3.2%）出现放射性坏死。
多学科社区医院为基础的中枢神经系统诊所继续得到患者的高度认可，随访时间延长。结果表明，该诊所是一个区域转诊中心，可为具有不同程度合并症、全身疾病状态和肿瘤分期的 BSBL 患者提供循证治疗，可获得高局部控制率和低 3 级和 4 级放射性诱导毒性率，同时可参加正在进行的临床试验。
