Browsing by Author "Faruqi, Salman"

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    A phase III, multicenter, randomized controlled trial of preoperative versus postoperative stereotactic radiosurgery for patients with surgically resectable brain metastases
    (2022-12-30) Das, Subhadip; Faruqi, Salman; Nordal, Robert; Starreveld, Yves; Kelly, John; Bowden, Gregory; Amanie, John; Fairchild, Alysa; Lim, Gerald; Loewen, Shaun; Rowe, Lindsay; Wallace, Carla; Ghosh, Sunita; Patel, Samir
    Abstract Background Postoperative stereotactic radiosurgery (SRS) is a standard management option for patients with resected brain metastases. Preoperative SRS may have certain advantages compared to postoperative SRS, including less uncertainty in delineation of the intact tumor compared to the postoperative resection cavity, reduced rate of leptomeningeal dissemination postoperatively, and a lower risk of radiation necrosis. The recently published ASCO-SNO-ASTRO consensus statement provides no recommendation for the preferred sequencing of radiotherapy and surgery for patients receiving both treatments for their brain metastases. Methods This multicenter, randomized controlled trial aims to recruit 88 patients with resectable brain metastases over an estimated three-year period. Patients with ten or fewer brain metastases with at least one resectable, fulfilling inclusion criteria will be randomized to postoperative SRS (standard arm) or preoperative SRS (investigational arm) in a 1:1 ratio. Randomization will be stratified by age (< 60 versus ≥60 years), histology (melanoma/renal cell carcinoma/sarcoma versus other), and number of metastases (one versus 2–10). In the standard arm, postoperative SRS will be delivered within 3 weeks of surgery, and all unresected metastases will receive primary SRS. In the investigational arm, enrolled patients will receive SRS of all brain metastases followed by surgery of resectable metastases within one week of SRS. In either arm, single fraction or hypofractionated SRS in three or five fractions is permitted. The primary endpoint is to assess local control at 12 months in both arms. Secondary endpoints include local control at other time points, regional/distant brain recurrence rates, leptomeningeal recurrence rates, overall survival, neurocognitive outcomes, and adverse radiation events including radiation necrosis rates in both arms. Discussion This trial addresses the unanswered question of the optimal sequencing of surgery and SRS in the management of patients with resectable brain metastases. No randomized data comparing preoperative and postoperative SRS for patients with brain metastases has been published to date. Trial registration Clinicaltrials.gov , NCT04474925; registered on July 17, 2020. Protocol version 1.0 (January 31, 2020). Sponsor: Alberta Health Services, Edmonton, Canada (Samir Patel, MD).
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    Impact of abdominal compression on heart and stomach motion for stereotactic arrhythmia radioablation
    (2023-09-07) Cecchi, Daniel; Morrison, Hali; Ploquin, Nicolas; Hudson, Alana; Davidson, Joern; Faruqi, Salman
    Stereotactic arrhythmia radioablation (STAR) is a promising novel treatment using radiotherapy to treat heart arrhythmias, particularly ventricular tachycardia. Similar to other radiotherapy techniques, the cardiac and respiratory-induced motion throughout the treatment of the target and surrounding organs-at-risk is a common concern for treatment planning and delivery; this may lead to increased radiation exposure to healthy tissue, causing negative side-effects if proper management or mitigation is not considered. Reducing respiratory-induced motion of targets via abdominal compression (AC) is well established as an effective target motion management method for liver patients, which can lead to reduced healthy tissue exposure. However, AC has yet to be studied for its effect on the respiratory-induced motion of cardiac structures. Furthermore, the impact of AC on the motion of the stomach, the primary organ-at-risk for STAR, is also undocumented. The purpose of this thesis is to evaluate motion differences of STAR targets between patients treated with AC against those without (free-breathing) using relative centre of mass translations of contoured cardiac structures as well as the stomach. Motion comparisons were performed in magnitude and range of motion in the three cardinal directions to evaluate the effect of AC on anisotropic treatment margins. The relative motion of potential target locations and the stomach were evaluated to observe possible treatment volume overlap with the stomach, which could cause stomach overexposure. This research indicates that AC has a patient-specific effect on STAR target motion and does not significantly affect the likelihood of stomach overlap with the treatment volume. The primary contribution of this thesis is to recommend that AC not be employed as a respiratory motion management method during future STAR treatments.