RESUMEN
The implementation of governmental Non-Pharmaceutical Interventions (NPIs) has been the primary means of controlling the spread of the COVID-19 disease. One of the intended effects of these NPIs has been to reduce population mobility. Due to the huge costs of implementing these NPIs, it is essential to have a good understanding of their efficacy. Using aggregated mobility data per country, released by Apple and Google we investigated the proportional contribution of NPIs to the magnitude and rate of mobility changes at a multi-national level. NPIs with the greatest impact on the magnitude of mobility change were lockdown measures; declaring a state of emergency; closure of businesses and public services and school closures. NPIs with the greatest effect on the rate of mobility change were implementation of lockdown measures and limitation of public gatherings. As confirmed by chi-square and cluster analysis, separately recorded NPIs like school closure and closure of businesses and public services were closely correlated with each other, both in timing and occurrence. This suggests that the observed significant NPI effects are mixed with and amplified by their correlated NPI measures. We observed direct and similar effects of NPIs on both Apple and Google mobility data. In addition, although Apple and Google data were obtained by different methods they were strongly correlated indicating that they are reflecting overall mobility on a country level. The availability of this data provides an opportunity for governments to build timely, uniform and cost-effective mechanisms to monitor COVID-19 or future pandemic countermeasures.
RESUMEN
PURPOSE: The objective of this study was to elucidate the impact on clinical outcomes resulting from re-irradiation for locally recurrent (LR) brain metastases (BM) using CyberKnife® stereotactic radiosurgery (SRS). MATERIALS AND METHODS: Seventy-seven patients with 254 LR BM lesions treated using SRS re-irradiation between January 2014 and December 2018 were analysed in this retrospective study. The local control (LC), overall survival (OS) rates, and adverse events were assessed. The adverse events were classified according to the Common terminology for adverse event (CTCAE) v5.0. RESULTS: The median follow-up duration was 8.9 months. The median age of the patients was 55 years (IQR: 47-62). The 3, 6, and 9-month LC and OS rates were 92.2%, 73.4%, and 73.4% and 79.2%, 61.0%, and 48.1%, respectively. On multivariate analysis the gender (male vs. female; HR, 1.79; 95% CI, 1.06-3.01; P=0.028), type of first brain radiation (WBI vs. SRS) followed by re-irradiation using SRS (HR, 9.32; 95% CI, 2.77-15.27; P<0.001) tumour volume (>12cc vs. ≤12cc; HR, 1.84; 95% CI, 1.10-3.11; P=0.02), and recursive partitioning analysis (RPA) (I vs. II & III; HR, 0.38; 95% CI, 0.19-0.70; P=0.001) were independent predictive factor for OS. Radionecrosis was reported in 3 patients. CONCLUSION: With acceptable toxicity, SRS re-irradiation for LR BM showed a favourable rate for LC and OS and reported better OS for the female gender, a patient undergoing first brain radiation with SRS, tumour volume ≤12cc, and RPA-I. This result needs to be further evaluated in future clinical studies.
