Kenneth J. Niermann

Automatic selection of DBS target points using multiple electrophysiological atlases

In this paper we study and evaluate the influence of the choice of a particular reference volume as the electrophysiological atlas on the accuracy of the automatic predictions of optimal points for deep brain stimulator (DBS) implants. We refer to an electrophysiological atlas as a spatial map of electrophysiological information such as micro electrode recordings (MER), stimulation parameters, final implants positions, etc., which are acquired for each patient and then mapped onto a single reference volume using registration algorithms. An atlas-based prediction of the optimal point for a DBS surgery is made by registering a patients image volume to that reference volume, that is, by computing a correct coordinate mapping between the two; and then by projecting the optimal point from the atlas to the patient using the transformation from the registration algorithm. Different atlases, as well as different parameterizations of the registration algorithm, lead to different and somewhat independent atlas-based predictions. We show how the use of multiple reference volumes can improve the accuracy of prediction by combining the predictions from the multiple reference volumes weighted by the accuracy of the non-rigid registration between each of the corresponding atlases and the patient volume.

P13.12: Microbubble contrast-enhanced sonographic depiction of microvessel perfusion in an in vivo animal tumor model: implications for ovarian cancer

cystic ovarian cancer. We also present natural courses on serial follow-up sonogram and duplex Doppler sonographic findings of HOCs. The familiarity with characteristic and variable sonographic features of HOCs with appropriate clinical setting may not only be helpful for establishing the correct diagnosis but also for narrowing the range of differential diagnosis which can avoid unnecessary surgery.

Vanderbilt head and neck symptom survey, version 2.0: Clinical and research utility for identification of symptom clusters and changes in symptoms over time

OBJECTIVESnThe symptoms and functional defects following treatment for head and neck cancer (HNC) have been poorly defined. The purpose of this study was to examine the utility of the Vanderbilt Head and Neck Symptom Survey (VHNSS) version 2.0 to identify symptom clusters experienced by patients with HNC as well as assess reliability and sensitivity to change.nnnMATERIALS AND METHODSnThe VHNSS 2.0 questionnaire was completed by 150 patients over three studies. Two studies utilized the survey at multiple time points.nnnRESULTSnCluster analysis identified ten multi-item clusters and three single items. The internal consistency was good to excellent, with Cronbachs alpha coefficient above 0.90 in five symptom clusters and above 0.70 in remaining clusters. Clusters demonstrated convergent and divergent validity with other measures. Symptom burden was lowest at baseline, peaked at the end of treatment then subsided over the following months.nnnCONCLUSIONSnThe VHNSS 2.0 is a reliable and valid measure of acute and late toxicities in patients treated for HNC. The tool may be used in research and clinical practice to screen, to evaluate treatments, and to compare side effects of treatment regimens.

A phase I trial of concurrent sorafenib and stereotactic radiosurgery for patients with brain metastases

We hypothesized that sorafenib (BAY 43-9006), an oral multi-kinase inhibitor, used in combination with SRS will improve overall intracranial control. This Phase I study assesses the safety, tolerability, and maximal tolerated dose of sorafenib administered with SRS to treat 1–4 brain metastases. This was an open label phase I dose escalation study with an expansion cohort. Eligible adults had 1–4 brain metastases from solid malignancies. Sorafenib was begun 5–7 days prior to SRS and continued for 14 days thereafter. Dose escalation of sorafenib was conducted via a “3u2009+u20093” dose escalation design. Dose limiting toxicities (DLT) were determined 1 month after SRS and defined as ≥grade 3 neurologic toxicities. Twenty-three patients were enrolled. There were no DLTs at dose level 1 (400xa0mg per day) or dose level 2 (400xa0mg twice per day). An expansion cohort of 17 patients was treated at dose level 2. There were six grade 3 toxicities: hypertension (nu2009=u20092), rash (nu2009=u20091), lymphopenia (nu2009=u20091), hypokalemia (nu2009=u20091), fatigue (nu2009=u20091) and hand-foot syndrome (nu2009=u20091). All of these were attributable to sorafenib and not to the combination with SRS. The median time to CNS progression was 10xa0months, 1xa0year CNS progression-free survival was 46%, the median overall survival was 11.6 months and the 1 year overall survival was 46%. The use of sorafenib concurrent with SRS for the treatment of 1–4 brain metastases is safe and well tolerated at 400xa0mg twice a day. Our recommended phase II dose of concurrent sorafenib with SRS would be 400xa0mg twice daily.