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1.
J Am Chem Soc ; 146(13): 9285-9292, 2024 Apr 03.
Artículo en Inglés | MEDLINE | ID: mdl-38518125

RESUMEN

Photoinduced electron spin polarization (ESP) is reported in the electronic ground states of three Pt(II) complexes comprised of two S = 1/2 nitronyl nitroxide (NN) radicals attached through different length para-phenylethynyl bridges to the 3,6 positions of a catecholate (CAT, donor) and 4,4'-di-tert-butyl-2,2'-bipyridine (bpy, acceptor). Complexes 1-3 have from 17 to 41 bonds separating NN radicals and display cw-EPR spectra consistent with |JNN-NN| ≫ |aN|, |JNN-NN| ≥ |aN|, and |JNN-NN| < |aN|, respectively, where JNN-NN is the magnetic exchange coupling between NN radicals in the electronic ground state, and aN is the isotropic 14N hyperfine coupling constant. Light-induced transient EPR spectra characterized as enhanced ground-state absorption were observed for all three complexes using 532 nm pulsed laser excitation into the ligand-to-ligand charge transfer (LL'CT) band of the (CAT)Pt(bpy) chromophore. The magnitude of the observed ESP increases in the order 1 < 2 < 3 and is inversely correlated with the magnitude of ground-state JNN-NN. In addition to the experimental observation of net absorptive polarization in 1-3, light excitation also produces multiplet polarization in 2. Since the weak dipolar coupling leads to a strong spectral overlap of the absorptive and emissive components, the multiplet polarization is not observed in 1 and 3 and is very weak in 2. The ability to spin-polarize multiple radical spins with a single photon is anticipated to advance new photoinduced multi qubit/qudit ESP protocols for quantum information science applications.

2.
J Neurooncol ; 2024 May 13.
Artículo en Inglés | MEDLINE | ID: mdl-38740672

RESUMEN

BACKGROUND: Breast cancer (BC) is the second most common etiology of brain metastases (BrM). We aimed to examine the incidence of BrM among all BC patients presenting to a large tertiary cancer centre over one decade. METHODS: We included all BC patients presenting consecutively between 2009 and 2019 and cross referenced that cohort to a radiotherapy database, identifying patients treated for BrM at any time following their initial presentation. Cumulative incidences (CI) of BrM diagnoses were calculated using death as a competing risk and compared using the Fine-Gray method. Overall survival was estimated using the Kaplan Meier method. RESULTS: We identified 12,995 unique patients. The CI of BrM in patients who initially presented with Stage 0-4 disease was 2.1%, 3.7%, 9.4%, 10.6%, and 28.7%, respectively at 10 years. For 8,951 patients with available molecular subtype data, 6,470 (72%), 961 (11%), 1,023 (11%), and 497 (6%) had hormone-receptor (HR)-positive/ERBB2-, HR-negative/ERBB2-, HR-positive/ERBB2 + , and HR-negative/ERBB2 + disease, respectively; the CI of BrM in each was 7.6%, 25.3%, 24.1%, and 26.6%, at 10 years following BC diagnosis, respectively. Median overall survival (OS) following BC diagnosis and BrM diagnosis was 28 years 95% CI [25, 32] and 10 months 95% CI [9, 12], respectively. CONCLUSIONS: From a large, registry-based study, we observed that patients with ERBB2 + and triple negative BC have the highest incidence of BrM. Our data supports prospective surveillance brain MRI studies. Given advancements in BrM treatment, clinicians should have a low threshold for brain imaging in BC patients with high risk subtypes.

3.
Inorg Chem ; 63(14): 6493-6499, 2024 Apr 08.
Artículo en Inglés | MEDLINE | ID: mdl-38517353

RESUMEN

The electronic structure of the bis(dioxolene) bridging ligand -SQ2Th2- is responsive to metal-ligand magnetic exchange coupling. Comparison of the crystal structure of (NiSQ)2Th2 to that of (ZnSQ)2Th2 indicates an open-shell biradical ground state for the dinuclear Ni(II) complex compared to the closed-shell quinoidal character found in the dinuclear Zn(II) complex. Consistent with a comparison of bond lengths obtained by X-ray diffraction, the analysis of the variable-temperature magnetic susceptibility data for crystalline (NiSQ)2Th2 yields reduced SQ-SQ radical-radical magnetic exchange coupling (JSQ-SQ = -203 cm-1) compared to that of (ZnSQ)2Th2 (JSQ-SQ = -321 cm-1). The reduced SQ-SQ exchange coupling in (NiSQ)2Th2 derives from an attenuation of the SQ spin densities, which in turn is derived from the Ni-SQ antiferromagnetic exchange interactions. This reduction in SQ--SQ exchange that we observe for (NiSQ)2Th2 correlates with an effective lengthening of the bridge unit by ∼2.1 Šrelative to that of (ZnSQ)2Th2. This magnitude of the effective increase in the bridge distance is consistent with the (NiSQ)2Th2 JSQ-SQ value lying between those of (ZnSQ)2Th2 and (ZnSQ)2Th3. The ability to modulate spin populations on an organic radical via pairwise Ni-SQ magnetic exchange interactions is a general way to affect electronic coupling in the Th-Th bridge. Our results suggest that metal-radical exchange coupling represents a powerful mechanism for tuning organic molecular electronic structure, with important implications for molecular electronics and molecular electron transport.

4.
J Neurooncol ; 164(1): 199-209, 2023 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-37552363

RESUMEN

PURPOSE: We aimed to assess the outcomes and patterns of toxicity in patients with melanoma brain metastases (MBM) treated with stereotactic radiosurgery (SRS) with or without immunotherapy (IO). METHODS: From a prospective registry, we reviewed MBM patients treated with single fraction Gamma Knife SRS between 2008 and 2021 at our center. We recorded all systemic therapies (chemotherapy, targeted therapy, or immunotherapy) administered before, during, or after SRS. Patients with prior brain surgery were excluded. We captured adverse events following SRS, including intralesional hemorrhage (IH), radiation necrosis (RN) and local failure (LF), as well as extracranial disease status. Distant brain failure (DBF), extracranial progression-free survival (PFS) and overall survival (OS) were determined using a cumulative Incidence function and the Kaplan-Meier method. RESULTS: Our analysis included 165 patients with 570 SRS-treated MBM. Median OS for patients who received IO was 1.41 years versus 0.79 years in patients who did not (p = 0.04). Ipilimumab monotherapy was the most frequent IO regimen (30%). In the absence of IO, the cumulative incidence of symptomatic (grade 2 +) RN was 3% at 24 months and remained unchanged with respect to the type or timing of IO. The incidence of post-SRS g2 + IH in patients who did not receive systemic therapy was 19% at 1- and 2 years compared to 7% at 1- and 2 years among patients who did (HR: 0.33, 95% CI 0.11-0.98; p = 0.046). Overall, neither timing nor type of IO correlated to rates of DBF, OS, or LF. Among patients treated with IO, the median time to extracranial PFS was 5.4 months (95% IC 3.2 - 9.1). CONCLUSION: The risk of g2 + IH exceeds that of g2 + RN in MBM patients undergoing SRS, with or without IO. IH should be considered a critical adverse event following MBM treatments.


Asunto(s)
Neoplasias Encefálicas , Melanoma , Traumatismos por Radiación , Radiocirugia , Humanos , Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/tratamiento farmacológico , Hemorragia/complicaciones , Hemorragia/cirugía , Melanoma/patología , Necrosis/etiología , Traumatismos por Radiación/epidemiología , Traumatismos por Radiación/etiología , Traumatismos por Radiación/cirugía , Radiocirugia/efectos adversos , Radiocirugia/métodos , Estudios Retrospectivos , Resultado del Tratamiento
5.
J Neurooncol ; 163(1): 269-279, 2023 May.
Artículo en Inglés | MEDLINE | ID: mdl-37165117

RESUMEN

PURPOSE: Neurosurgery (NS) is an essential modality for large brain metastases (BM). Postoperative stereotactic radiosurgery (SRS) is the standard of care adjuvant treatment. Pachymeningeal failure (PMF) is a newly described entity, distinct from classical leptomeningeal failure (LMF), that is uniquely observed in postoperative patients treated with adjuvant SRS. We sought to identify risk factors for PMF in patients treated with NS + SRS. METHODS: From a prospective registry (2009 to 2021), we identified all patients treated with NS + SRS. Clinical, imaging, pathological, and treatment factors were analyzed. PMF incidence was evaluated using a competing risks model. RESULTS: 144 Patients were identified. The median age was 62 (23-90). PMF occurred in 21.5% (31/144). Female gender [Hazard Ratio (HR) 2.65, p = 0.013], higher Graded Prognostic Assessment (GPA) index (HR 2.4, p < 0.001), absence of prior radiation therapy (HR N/A, p = 0.018), controlled extracranial disease (CED) (HR 3.46, p = 0.0038), and pia/dura contact (PDC) (HR 3.30, p = 0.0053) were associated with increased risk for PMF on univariate analysis. In patients with PDC, wider target volumes correlated with reduced risk of PMF. Multivariate analysis indicated PDC (HR 3.51, p = 0.0053), piecemeal resection (HR 2.38, p = 0.027), and CED (HR 3.97, p = 0.0016) independently correlated with PMF risk. PMF correlated with reduced OS (HR 2.90, p < 0.001) at a lower rate compared to LMF (HR 10.15, p < 0.001). CONCLUSION: PMF correlates with tumor PDC and piecemeal resection in patients treated with NS + SRS. For unclear reasons, it is also associated with CED. In tumors with PDC, wider dural radiotherapy coverage was associated with a lower risk of PMF.


Asunto(s)
Neoplasias Encefálicas , Radiocirugia , Humanos , Masculino , Femenino , Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/secundario , Neoplasias Encefálicas/cirugía , Complicaciones Posoperatorias , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Resultado del Tratamiento , Neoplasias Meníngeas/radioterapia , Neoplasias Meníngeas/secundario
6.
J Neurooncol ; 165(1): 29-39, 2023 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-37815737

RESUMEN

BACKGROUND: Pachymeningeal disease (PMD) is a newly recognized pattern of brain metastasis (BrM) failure that specifically occurs following surgery with adjuvant stereotactic radiosurgery (SRS) and has unique prognostic implications relative to leptomeningeal disease (LMD). Here, we report its prevalence, prognostic implications, and associated risk factors. METHODS: A literature search was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses on PUBMED and Cochrane from January 2000 to June 2023. RESULTS: We identified 12 studies that included a total of 3992 BrM patients, 659 (16.5%) of whom developed meningeal disease (MD) following surgery plus adjuvant SRS, including either PMD or LMD. The mean prevalence of MD across studies was 20.9% (7.9-38.0%), with PMD accounting for 54.6% of this prevalence and LMD comprising the remaining 45.4%. Mean of the median overall survivals following diagnosis of PMD and LMD was 10.6 months and 3.7 months p = 0.007, respectively, a significant difference. Only 2 risk factors for PMD were reported in ≥ 2 studies and also identified as statistically significant per our meta-analysis: infratentorial location and controlled systemic disease status. CONCLUSION: While PMD has a superior prognosis to LMD, it is nevertheless a critical oncologic event associated with significant mortality and remains poorly recognized. PMD is predominantly observed in patients with controlled systemic disease status and infratentorial location. Future treatment strategies should focus on reducing surgical seeding and sterilizing surgical cavities.


Asunto(s)
Neoplasias Encefálicas , Neoplasias Meníngeas , Radiocirugia , Humanos , Neoplasias Meníngeas/epidemiología , Neoplasias Meníngeas/terapia , Neoplasias Encefálicas/cirugía , Pronóstico , Factores de Riesgo , Radiocirugia/efectos adversos , Estudios Retrospectivos , Resultado del Tratamiento
7.
Inorg Chem ; 62(2): 739-747, 2023 Jan 16.
Artículo en Inglés | MEDLINE | ID: mdl-36598509

RESUMEN

A new donor-acceptor biradical complex, TpCum,MeZn(SQ-VD) (TpCum,MeZn+ = zinc(II) hydro-tris(3-cumenyl-5-methylpyrazolyl)borate complex cation; SQ = orthosemiquinone; VD = oxoverdazyl), which is a ground-state analogue of a charge-separated excited state, has been synthesized and structurally characterized. The magnetic exchange interaction between the S = 1/2 SQ and the S = 1/2 VD within the SQ-VD biradical ligand is observed to be ferromagnetic, with JSQ-VD = +77 cm-1 (H = -2JSQ-VDŜSQ·ŜVD) determined from an analysis of the variable-temperature magnetic susceptibility data. The pairwise biradical exchange interaction in TpCum,MeZn(SQ-VD) can be compared with that of the related donor-acceptor biradical complex TpCum,MeZn(SQ-NN) (NN = nitronyl nitroxide, S = 1/2), where JSQ-NN ≅ +550 cm-1. This represents a dramatic reduction in the biradical exchange by a factor of ∼7, despite the isolobal nature of the VD and NN acceptor radical SOMOs. Computations assessing the magnitude of the exchange were performed using a broken-symmetry density functional theory (DFT) approach. These computations are in good agreement with those computed at the CASSCF NEVPT2 level, which also reveals an S = 1 triplet ground state as observed in the magnetic susceptibility measurements. A combination of electronic absorption spectroscopy and CASSCF computations has been used to elucidate the electronic origin of the large difference in the magnitude of the biradical exchange coupling between TpCum,MeZn(SQ-VD) and TpCum,MeZn(SQ-NN). A Valence Bond Configuration Interaction (VBCI) model was previously employed to highlight the importance of mixing an SQSOMO → NNLUMO charge transfer configuration into the electronic ground state to facilitate the stabilization of the high-spin triplet (S = 1) ground state in TpCum,MeZn(SQ-NN). Here, CASSCF computations confirm the importance of mixing the pendant radical (e.g., VD, NN) LUMO (VDLUMO and NNLUMO) with the SOMO of the SQ radical (SQSOMO) for stabilizing the triplet, in addition to spin polarization and charge transfer contributions to the exchange. An important electronic structure difference between TpCum,MeZn(SQ-VD) and TpCum,MeZn(SQ-NN), which leads to their different exchange couplings, is the reduced admixture of excited states that promote ferromagnetic exchange into the TpCum,MeZn(SQ-VD) ground state, and the intrinsically weaker mixing between the VDLUMO and the SQSOMO compared to that observed for TpCum,MeZn(SQ-NN), where this orbital mixing is significant. The results of this comparative study contribute to a greater understanding of biradical exchange interactions, which are important to our understanding of excited-state singlet-triplet energy gaps, electron delocalization, and the generation of electron spin polarization in both the ground and excited states of (bpy)Pt(CAT-radical) complexes.

8.
Can J Neurol Sci ; 50(4): 573-578, 2023 07.
Artículo en Inglés | MEDLINE | ID: mdl-35634744

RESUMEN

BACKGROUND: Cerebral radionecrosis, a subacute or late effect of radiotherapy, can be debilitating and difficult to treat. Steroids can reduce symptoms, but have significant long-term side effects. Bevacizumab has been shown to reduce edema and other radiologic features associated with radionecrosis and improve patient symptoms. We report our experience using bevacizumab for cerebral radionecrosis. METHODS: We retrospectively reviewed the charts of all patients treated at our institution with bevacizumab for non-glioma-associated cerebral radionecrosis. We recorded change in symptoms, change in steroids, change in performance status, time to tumor progression, and time to death. We delineated the volume of necrosis pre- and post-bevacizumab on T1-post-gadolinium and fluid-attenuated inversion recovery (FLAIR) MRI scans. RESULTS: We identified 15 patients, 8 with brain metastases, 6 with meningioma, and 1 with nasopharyngeal carcinoma. Most received four doses of bevacizumab, 7.5 mg/kg q 3 weeks × 4 doses. Neuroimaging demonstrated a reduced T1 gadolinium-enhancing volume and edema in 14/15 patients (the average reduction in T1-post-gadolinium volume was 3.0 cm3, and average reduction in FLAIR volume was 27.9 cm3). There was no appreciable change in patient performance status. Steroid doses decreased in five of nine patients. There was a high rate (26%) of adverse events, including pulmonary embolism, stroke, and wound dehiscence. The median progression-free survival was 6.5 months. CONCLUSION: Although bevacizumab is commonly prescribed for cerebral radionecrosis, in our retrospective cohort, the clinical benefits were modest and there was significant toxicity.


Asunto(s)
Neoplasias Encefálicas , Neoplasias Meníngeas , Traumatismos por Radiación , Humanos , Bevacizumab/uso terapéutico , Estudios Retrospectivos , Gadolinio/uso terapéutico , Anticuerpos Monoclonales Humanizados/efectos adversos , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/tratamiento farmacológico , Neoplasias Encefálicas/radioterapia , Traumatismos por Radiación/diagnóstico por imagen , Traumatismos por Radiación/tratamiento farmacológico , Traumatismos por Radiación/etiología , Necrosis/etiología , Imagen por Resonancia Magnética/métodos
9.
Pituitary ; 26(5): 538-550, 2023 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-37698666

RESUMEN

PURPOSE: To understand the natural history and optimal treatment strategy for pituitary gland metastasis. METHODS: We performed both a retrospective chart review of patients treated at our institution and a scoping review of the topic. RESULTS: The retrospective review identified seven patients with an average age of 59.6 years. Primary histologies included breast cancer (4), melanoma (1), renal cell carcinoma (1), and sarcoma (1). Two patients had anterior pituitary endocrine dysfunction, one of whom was the only patient with visual symptoms. All patients were treated with radiosurgery and two also underwent surgical resection. Overall survival ranged from 6.5 to 117 months. Literature review identified 166 patients from 71 studies. The most common primary cancer was lung (27.7%), followed by breast (18.7%) and renal (14.5%) cancer. 107 presented with endocrine dysfunction, including 41 cases of diabetes insipidus and 55 cases of hypopituitarism. 110 presented with visual compromise. 107 patients received radiotherapy, 96 underwent surgical resection and 44 received systemic chemotherapy/immunotherapy. Surgery was significantly associated with an increased likelihood of vision improvement and a decreased likelihood of endocrine normalization. Radiographic regression predicted visual improvement. Median overall survival was 9.9 months (range: 0.2-96). CONCLUSIONS: This scoping review showed that both radiosurgery and surgical resection have been frequently used to treat pituitary metastases with good response. Vision improvement is more likely to happen following surgical resection, likely at the expense of endocrine dysfunction. Despite treatment and radiographic response, patient survival remains less than a year.


Asunto(s)
Carcinoma de Células Renales , Diabetes Insípida , Neoplasias Renales , Neoplasias Hipofisarias , Radiocirugia , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Neoplasias Hipofisarias/cirugía , Neoplasias Renales/patología , Neoplasias Renales/cirugía , Resultado del Tratamiento
10.
J Am Chem Soc ; 144(28): 12781-12788, 2022 Jul 20.
Artículo en Inglés | MEDLINE | ID: mdl-35802385

RESUMEN

Photoinduced electron spin polarization (ESP) is reported in the ground state of a series of complexes consisting of an organic radical (nitronylnitroxide, NN) covalently attached to a donor-acceptor chromophore either directly or via para-phenylene bridges substituted with 0-4 methyl groups. These molecules represent a class of chromophores that undergo visible light excitation to produce an initial exchange-coupled, three-spin [bpy•-, CAT•+ (= semiquinone, SQ) and NN•], charge-separated doublet 2S1 (S = chromophore spin singlet configuration) excited state that rapidly decays by magnetic exchange-enhanced internal conversion to a 2T1 (T = chromophore excited spin triplet configuration) state. The 2T1 state equilibrates with chromophoric and NN radical-derived excited states, resulting in absorptive ESP of the recovered ground state, which persists for greater than a millisecond and can be measured by low-temperature time-resolved electron paramagnetic resonance spectroscopy. The magnitude of the ground state ESP is found to correlate with the excited state magnetic exchange interaction between the CAT+• and NN• radicals, which in turn is controlled by the structure of the bridge fragment.

11.
J Am Chem Soc ; 144(46): 21005-21009, 2022 Nov 23.
Artículo en Inglés | MEDLINE | ID: mdl-36373855

RESUMEN

Transient electron paramagnetic resonance spectroscopy has been used to probe photoinduced electron spin polarization of a stable exchange-coupled organic biradical in a Pt(II) complex comprising 4,4'-di-tert-butyl-2,2'-bipyridine (bpy) and 3,6-bis(ethynyl-para-phenyl-nitronyl nitroxide)-o-catecholate (CAT(o-C≡C-Ph-NN)2). Photoexcitation results in four unpaired spins in excited states of this complex, with spins being localized on each of the two radicals, CAT•+ and bpy•-. The four spins are all exchange-coupled in these excited states, and an off-diagonal matrix element in the CAT•+-NN exchange allows for exchange-enhanced intersystem crossing to the 3T1a state, which possesses (bpy•-)Pt(CAT•+) chromophoric triplet character. Fast mixing between this 3T1a state and thermally accessible excited LL'CT state(s) followed by fast relaxation provides spin polarization of the exchange-coupled NN radicals in the 3S0 ground state of the complex. Our results demonstrate that well-defined quantum states of a ground-state biradical can be initialized with single-photon excitation and have the potential for further spin manipulation directed toward quantum information science applications.

12.
Ann Surg Oncol ; 29(1): 522-532, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34409543

RESUMEN

BACKGROUND: Radiation-associated angiosarcoma (RAAS) of the breast is an aggressive malignancy affecting 1 in 1000 breast cancer patients. This study aimed to determine differences in treatments and outcomes for RAAS initially managed through a sarcoma multi-disciplinary team (SMDT) compared with an outside center (OC) and to describe outcomes after recurrence. METHODS: Patients with a diagnosis of breast RAAS between 2004 and 2019 were identified from our sarcoma database. Clinicopathologic characteristics, recurrence patterns, and factors predictive of survival were assessed. Differences in local recurrence-free survival (LRFS) and disease-specific survival (DSS) were estimated using Kaplan-Meier and compared using the log-rank test. RESULTS: Surgery was performed for 49 women with RAAS, who had a median age of 74 years (range 41-89 years). Primary management was performed by SMDT for 26 patients and by OC for 23 patients. Radical mastectomy and reconstruction were performed for 96% of the SMDT group versus 17% of the OC group (p = 0.00001). The proportion patients who received chemotherapy, radiation, or both was 42.3% in the SMDT group and 0% in the OC group. During a median follow-up period of 26 months, recurrence was experienced by 38% (10/26) of the SMDT cohort and 83% (19/23) of the OC cohort (p = 0.002). The 3-year LRFS was better in the SMDT cohort (59.3% vs 31.8%; p = 0.019). Of the 29 recurrences 16 received chemotherapy and 6 received radiation, surgery, or both. At the last follow-up visit, 20 patients were in first remission, 1 patient was in second remission, 8 patients were alive with disease, and 20 patients had died of disease. CONCLUSION: Initial treatment by SMDT was associated with more extensive surgery, multimodal treatments, and a better 3-year LRFS. Patients with breast RAAS likely benefit from early referral and treatment by an SMDT.


Asunto(s)
Neoplasias de la Mama , Hemangiosarcoma , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/terapia , Femenino , Hemangiosarcoma/etiología , Hemangiosarcoma/terapia , Humanos , Estudios Interdisciplinarios , Mastectomía , Persona de Mediana Edad
13.
Ann Surg Oncol ; 29(4): 2304-2314, 2022 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-35022902

RESUMEN

BACKGROUND: Retroperitoneal sarcoma (RPS)-specific nomograms provide estimates of survival and recurrence risk following resection in the individual patient. The effect of preoperative treatment on nomogram performance has not been previously examined. Our aim was to evaluate the predictive accuracy of existing RPS-specific nomograms in patients managed at our center, where the majority of patients received preoperative radiation. PATIENTS AND METHODS: All patients who underwent curative treatment for primary RPS at Mount Sinai Hospital/Princess Margaret Hospital between 1996 and 2016 were identified. The performance of four previously published nomograms was assessed by measuring the agreement between nomogram-predicted and observed outcomes using Harrell's C-Index and level of calibration. Outcomes included in each of the nomograms [overall survival (OS), disease-free survival (DFS), disease-specific death (DSD), local recurrence (LR), distant recurrence (DR)] at each of the specified post-resection timepoints were examined. RESULTS: In total, 253 patients were included. When observed outcomes were compared with those predicted by each of the four nomograms, the C-Index ranged from 0.60 to 0.81, representing a wide range of predictive accuracy. The lowest C-Index was for prediction of LR. Calibration plots revealed that the Memorial Sloan Kettering Cancer Center (MSKCC) nomogram predicted a 5-year LR of 45%, whereas the observed LR was 24%. Overprediction of LR was detected in patients who had undergone preoperative radiotherapy, but not in patients treated with surgery alone. CONCLUSIONS: Preoperative radiotherapy appeared to preclude the use of the LR component of existing nomograms for primary RPS. Updated nomograms should be created to reflect this variable, particularly in light of the recently published STRASS trial results.


Asunto(s)
Neoplasias Retroperitoneales , Sarcoma , Neoplasias de los Tejidos Blandos , Humanos , Recurrencia Local de Neoplasia/cirugía , Nomogramas , Neoplasias Retroperitoneales/cirugía , Sarcoma/cirugía
14.
J Neurooncol ; 157(1): 157-163, 2022 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-35092549

RESUMEN

BACKGROUND: Metastasis is the most common brain tumor in adults. It is the standard of care at most North American centers to obtain an early postoperative imaging after their resection. However, the necessity of this practice in the absence of a new postoperative deficit remains unclear. METHODS: We retrospectively reviewed our surgical cohort of patients who underwent resection of brain metastases from July 2018 to June 2019. We collected demographic data and reviewed results of routine postoperative CT scans and neurological morbidities to examine the diagnostic and therapeutic yield of an early postoperative scan. In addition, we performed a systematic review of the topic. RESULTS: Our review included 130 patients, all of whom underwent gross total resection of one or more brain metastases. On postoperative CT, none had unexpected findings such as cavity hematoma or new ischemia; no changes in management resulted from postoperative imaging. One patient required a higher dose of dexamethasone on postoperative day 4 for delayed hemiparesis and aphasia due to cerebral edema. Three additional patients underwent a wound washout for delayed infection during a subsequent admission. Our systematic review identified three additional studies; in a combined cohort of 450 patients (including our own), no patients had clinically actionable findings on routine postoperative CT. CONCLUSIONS: Following resection of brain metastases, a routine postoperative CT scan has low diagnostic yield and did not change patient management in any cases examined in this work.


Asunto(s)
Neoplasias Encefálicas , Tomografía Computarizada por Rayos X , Adulto , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/cirugía , Craneotomía , Humanos , Periodo Posoperatorio , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/métodos
15.
Can J Surg ; 65(4): E512-E518, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35926885

RESUMEN

BACKGROUND: There are limited published data on population estimates of survival after spinal surgery for metastatic disease. We performed a population-based study to evaluate survival and complications among patients with cancer who underwent surgery for spinal metastases in Ontario, Canada, between 2006 and 2016. METHODS: We used health administrative databases to identify all patients who underwent surgery for spinal metastases in Ontario between Jan. 1, 2006, and Dec. 31, 2016. We assessed overall survival, mortality rates according to primary cancer lesion and complications after surgery. We contrast the results to those for a comparable cohort from 1991 to 1998. RESULTS: A total of 2646 patients (1194 women [45.1%]; mean age 62.5 yr [standard deviation 12.2 yr]) were identified. The median survival time was 236 (interquartile range 84-740) days. Mortality was highest for patients with melanoma, upper gastrointestinal cancer and lung cancer, with 50% dying within 90 days of surgery. The longest median survival times were observed for primary cancers of the thyroid (906 d) and breast (644 d), and myeloma (830 d). Overall 90-day and 1-year mortality rates were 29% and 59%, respectively. CONCLUSION: We identified differential survivorship based on primary tumour type and a shift in the distribution of operations performed for specific primary cancers over the past 2 decades in Ontario. Overall reductions in mortality associated with this shift in treatment may reflect the use of adjuvant therapies and more personalized treatment approaches.


Asunto(s)
Neoplasias Pulmonares , Neoplasias de la Columna Vertebral , Estudios de Cohortes , Terapia Combinada , Femenino , Humanos , Neoplasias Pulmonares/patología , Persona de Mediana Edad , Ontario/epidemiología , Estudios Retrospectivos , Neoplasias de la Columna Vertebral/complicaciones , Neoplasias de la Columna Vertebral/secundario , Tasa de Supervivencia
16.
J Am Chem Soc ; 143(28): 10519-10523, 2021 Jul 21.
Artículo en Inglés | MEDLINE | ID: mdl-34251803

RESUMEN

Both the sign and intensity of photoinduced electron spin polarization (ESP) in the electronic ground state doublet (2S0/D0) of chromophore-radical complexes can be controlled by changing the nature of the metal ion. The complexes consist of an organic radical (nitronyl nitroxide, NN) covalently attached to a donor-acceptor chromophore via a m-phenylene bridge, (bpy)M(CAT-m-Ph-NN) (1) (bpy = 4,4'-di-tert-butyl-2,2'-bipyridine, M = PdII (1-Pd) or PtII (1-Pt), CAT = 3-tert-butylcatecholate, m-Ph = meta-phenylene). In both complexes, photoexcitation with visible light produces an initial exchange-coupled, three-spin (bpy•-, CAT•+ = semiquinone (SQ), and NN•), charge-separated doublet 2S1 (S = chromophore excited spin singlet configuration) excited state that rapidly decays to the ground state via a 2T1 (T = chromophore excited spin triplet configuration) state. This process is not expected to be spin selective, and only very weak emissive ESP is found for 1-Pd. In contrast, strong absorptive ESP is generated in 1-Pt. It is postulated that zero-field-splitting-induced transitions between the chromophoric 2T1 and 4T1 states (1-Pd and 1-Pt) and spin-orbit-induced transitions between 2T1 and NN-based quartet states (1-Pt) account for the differences in polarization.

17.
J Neurooncol ; 155(3): 325-333, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34689307

RESUMEN

PURPOSE: Differentiation of radiation necrosis from tumor progression in brain metastases treated with stereotactic radiosurgery (SRS) is challenging. For this, we assessed the performance of the centrally restricted diffusion sign. METHODS: Patients with brain metastases treated with SRS who underwent a subsequent intervention (biopsy/resection) for a ring-enhancing lesion on preoperative MRI between 2000 and 2020 were included. Excluded were lesions containing increased susceptibility limiting assessment of DWI. Two neuroradiologists classified the location of the diffusion restriction with respect to the post-contrast T1 images as centrally within the ring-enhancement (the centrally restricted diffusion sign), peripherally correlating to the rim of contrast enhancement, both locations, or none. Measures of diagnostic accuracy and 95% CI were calculated for the centrally restricted diffusion sign. Cohen's kappa was calculated to identify the interobserver agreement. RESULTS: Fifty-nine patients (36 female; mean age 59, range 40 to 80) were included, 36 with tumor progression and 23 with radiation necrosis based on histopathology. Primary tumors included 34 lung, 12 breast, 5 melanoma, 3 colorectal, 2 esophagus, 1 head and neck, 1 endometrium, and 1 thyroid. The centrally restricted diffusion sign was seen in 19/23 radiation necrosis cases (sensitivity 83% (95% CI 63 to 93%), specificity 64% (95% CI 48 to 78%), PPV 59% (95% CI 42 to 74%), NPV 85% (95% CI 68 to 94%)) and 13/36 tumor progression cases (difference p < 0.001). Interobserver agreement was substantial, at 0.61 (95% CI 0.45 to 70.8). CONCLUSION: We found a low probability of radiation necrosis in the absence of the centrally restricted diffusion sign.


Asunto(s)
Neoplasias Encefálicas , Traumatismos por Radiación , Radiocirugia , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/cirugía , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Necrosis/diagnóstico por imagen , Necrosis/etiología , Necrosis/patología , Traumatismos por Radiación/diagnóstico por imagen , Traumatismos por Radiación/etiología , Traumatismos por Radiación/cirugía , Radiocirugia/efectos adversos , Radiocirugia/métodos , Estudios Retrospectivos
18.
J Org Chem ; 86(21): 15577-15587, 2021 Nov 05.
Artículo en Inglés | MEDLINE | ID: mdl-34644082

RESUMEN

Electronic coupling through organic bridges facilitates magnetic exchange interactions and controls electron transfer and single-molecule device electron transport. Electronic coupling through alternant π-systems (e.g., benzene) is better understood than the corresponding coupling through nonalternant π-systems (e.g., azulene). Herein, we examine the structure, spectroscopy, and magnetic exchange coupling in two biradicals (1,3-SQ2Az and 1,3-SQ-Az-NN; SQ = the zinc(II) complex of spin-1/2 semiquinone radical anion, NN = spin-1/2 nitronylnitroxide; Az = azulene) that possess nonalternant azulene π-system bridges. The SQ radical spin density in both molecules is delocalized into the Az π-system, while the NN spin is effectively localized onto the five-atom ONCNO π-system of NN radical. The spin distributions and interactions are probed by EPR spectroscopy and magnetic susceptibility measurements. We find that J = +38 cm-1 for 1,3-SQ2Az and J = +9 cm-1 for 1,3-SQ-Az-NN (H=-2JS^SQ·S^SQorNN). Our results highlight the differences in exchange coupling mediated by azulene compared to exchange coupling mediated by alternant π-systems.

19.
Inorg Chem ; 60(12): 8665-8671, 2021 Jun 21.
Artículo en Inglés | MEDLINE | ID: mdl-34085813

RESUMEN

The mononuclear cobalt complex of 3,5-di-tert-butylcathecolate and cyan-pyridine (Co(diox)2(4-CN-py)2) is a very versatile compound that displays valence tautomerism (VT) in the solid state, which is induced by temperature, light, and hard X-rays, and modulated by solvent in the crystal lattice. In our work, we used single crystal X-ray diffraction as a probe for the light-induced VT in solid state and demonstrate the controlled use of hard X-rays via attenuation to avoid X-ray-induced VT interconversion. We report photoinduced VT in benzene solvated crystals of Co(diox)2(4-CN-py)2 illuminated with blue 450 nm light at 30 K with a very high yield (80%) of metastable hs-CoII states, and we also show evidence of the de-excitation of these photoinduced metastable states using red 660 nm light. Such high-yield light-induced VT had never been experimentally observed in molecular crystals of cobalt tautomers, proving that the 450 nm light illumination is triggering a chain of events that leads to the ls-CoIII to hs-CoII interconversion.

20.
Can J Neurol Sci ; 48(2): 189-197, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33040758

RESUMEN

Brain metastases (BM) are the most common intracranial neoplasm and represent a major clinical challenge across many medical disciplines. The incidence of BM is increasing, largely due to improvements in primary disease therapeutics conferring greater systemic control, and advancements in neuroimaging techniques and availability leading to earlier diagnosis. In recent years, the landscape of BM treatment has changed significantly with the advent of personalized targeted chemotherapies and immunotherapy, the adoption of focal radiotherapy (RT) for higher intracranial disease burden, and the implementation of new surgical strategies. The increasing permutations of options available for the treatment of patients diagnosed with BM necessitate coordinated care by a multidisciplinary team. This review discusses the current treatment regimens for BM as well as examines the salient features of a modern multidisciplinary approach.


Asunto(s)
Neoplasias Encefálicas , Neoplasias Encefálicas/terapia , Humanos , Inmunoterapia , Incidencia
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