Publications by authors named "W C Broaddus"

114 Publications

The Effect of Radiation on Meningioma Volume Change.

World Neurosurg 2021 Jun 21. Epub 2021 Jun 21.

Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia, USA; Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia, USA. Electronic address:

Background: Radiation therapy is a common treatment for meningiomas. Volume changes of meningiomas in response to radiation are not well characterized. This study seeks to quantify the volume change of meningiomas following radiation.

Methods: Data were collected from a retrospective single-institution database of cases from 2005-2015. Tumors were measured using T1-weighted post-contrast magnetic resonance imaging. Volumes were calculated using the ABC/2 ellipsoidal approximation.

Results: A total of 63 patients fit the inclusion criteria; 37 patients (59%) received radiation following resection, 19 (30%) received radiation alone, 4 (6%) received radiation following a biopsy, and 3 (5%) had unknown surgical status. A total of 39 patients (62%) had skull base meningiomas; 43 tumors were World Health Organization (WHO) grade I, and 12 tumors were WHO grade II. Thirteen patients received radiosurgery, 43 received radiotherapy, and 7 received an unknown number of treatments. Eight patients did not attain local control and were excluded from volume analyses. WHO grade I meningiomas saw an average of 33% ± 19% decrease in tumor volume; WHO grade II tumor volumes decreased by an average 30% ± 23%. Radiosurgery saw an average volume decrease of 34% ± 13%, while radiotherapy resulted in volume decrease of 31% ± 21%. For those who achieved local control, there was an average decrease in tumor size of 30% ± 19%, 30% ± 22%, and 41% ± 19% over 0.5-1.5, 2.5-3.5, and >5 years, respectively.

Conclusions: Meningiomas treated with radiation exhibit nonlinear decrease in size over time. The greatest decrease in tumor volume occurs within the first year and begins to plateau 5 years post-radiation treatment.
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http://dx.doi.org/10.1016/j.wneu.2021.06.080DOI Listing
June 2021

Connexin43 Expression and Associated Chronic Inflammation Presages the Development of Cerebral Radiation Necrosis.

J Neuropathol Exp Neurol 2020 07;79(7):791-799

Department of Pharmacology and Clinical Pharmacology, School of Medical Sciences, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.

Cerebral radiation necrosis (CRN) is a delayed complication of radiosurgery that can result in severe neurological deficits. The biological changes leading to necrotic damage may identify therapeutic targets for this complication. Connexin43 expression associated with chronic inflammation may presage the development of CRN. A mouse model of delayed CRN was used. The left hemispheres of adult female mice were irradiated with single-fraction, high-dose radiation using a Leksell Gamma Knife. The brains were collected 1 and 4 days, and 1-3 weeks after the radiation. The expression of connexin43, interleukin-1β (IL-1β), GFAP, isolectin B-4, and fibrinogen was evaluated using immunohistochemical staining and image analysis. Compared with the baseline, the area of connexin43 and IL-1β staining was increased in ipsilateral hemispheres 4 days after radiation. Over the following 3 weeks, the density of connexin43 gradually increased in parallel with progressive increases in GFAP, isolectin B-4, and fibrinogen labeling. The overexpression of connexin43 in parallel with IL-1β spread into the affected brain regions first. Further intensified upregulation of connexin43 was associated with escalated astrocytosis, microgliosis, and blood-brain barrier breach. Connexin43-mediated inflammation may underlie radiation necrosis and further investigation of connexin43 hemichannel blockage is merited for the treatment of CRN.
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http://dx.doi.org/10.1093/jnen/nlaa037DOI Listing
July 2020

Comorbid Medical Conditions as Predictors of Overall Survival in Glioblastoma Patients.

Sci Rep 2019 12 27;9(1):20018. Epub 2019 Dec 27.

Department of Neurosurgery, Virginia Commonwealth University, Richmond, VA, USA.

Glioblastoma (GBM) is an aggressive central nervous system tumor with a poor prognosis. This study was conducted to determine any comorbid medical conditions that are associated with survival in GBM. Data were collected from medical records of all patients who presented to VCU Medical Center with GBM between January 2005 and February 2015. Patients who underwent surgery/biopsy were considered for inclusion. Cox proportional hazards regression modeling was performed to assess the relationship between survival and sex, race, and comorbid medical conditions. 163 patients met inclusion criteria. Comorbidities associated with survival on individual-characteristic analysis included: history of asthma (Hazard Ratio [HR]: 2.63; 95% Confidence Interval [CI]: 1.24-5.58; p = 0.01), hypercholesterolemia (HR: 1.95; 95% CI: 1.09-3.50; p = 0.02), and incontinence (HR: 2.29; 95% CI: 0.95-5.57; p = 0.07). History of asthma (HR: 2.22; 95% CI: 1.02-4.83; p = 0.04) and hypercholesterolemia (HR: 1.99; 95% CI: 1.11-3.56; p = 0.02) were associated with shorter survival on multivariable analysis. Surgical patients with GBM who had a prior history of asthma or hypercholesterolemia had significantly higher relative risk for mortality on individual-characteristic and multivariable analyses.
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http://dx.doi.org/10.1038/s41598-019-56574-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6934684PMC
December 2019

Comparison of ABC/2 estimation and a volumetric computerized method for measurement of meningiomas using magnetic resonance imaging.

J Neurooncol 2019 Sep 10;144(2):275-282. Epub 2019 Aug 10.

Department of Neurosurgery, Virginia Commonwealth University, 417 North 11th Street, Sixth Floor, P.O. Box 980631, Richmond, VA, 23219-0631, USA.

Introduction: Measurement of tumor growth rates over time for patients with meningiomas has important prognostic and therapeutic implications. Our objective was to compare two methods of measuring meningioma volume: (1) the simplified ellipsoid (ABC/2) method; and (2) perimetric volume measurements using imaging software modules.

Methods: Patients with conservatively managed meningiomas for at least 1.5 years were retrospectively identified from the VCU Brain and Spine Tumor Registry over a 10-year period (2005-2015). Tumor volumes were independently measured using the simplified ellipsoid and computerized perimetric methods. Intra class correlations (CC) and Bland-Altman analyses were performed.

Results: A total of 26 patients representing 29 tumors were identified. Across 146 images, there were 24 (16%) images that were non-measurable using standard application commands with the computerized perimetric method. The mean volume obtained using the ABC/2 and computerized perimetric methods were 3.2 ± 3.4 cm and 3.4 ± 3.5 cm, respectively. The mean volume difference was 0.2 cm (SE = 0.12; p = 0.10) across measurement methods. The concordance correlation coefficient (CCC) between methods was 0.95 (95% CI 0.91, 0.98).

Conclusions: There is excellent correlation between the simplified ellipsoid and computerized perimetric methods of volumetric analysis for conservatively managed meningiomas. The simplified ellipsoid method remains an excellent method for meningioma volume assessment and had an advantage over the perimetric method which failed to allow measurement of roughly one in six tumors on imaging.
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http://dx.doi.org/10.1007/s11060-019-03205-zDOI Listing
September 2019

Outcomes after craniotomy for resection of craniopharyngiomas in adults: analysis of the National Surgical Quality Improvement Program (NSQIP).

J Neurooncol 2019 Aug 21;144(1):117-125. Epub 2019 Jun 21.

Department of Neurosurgery, Virginia Commonwealth University, 417 North 11th Street, Sixth Floor, P.O. Box 980631, Richmond, VA, 23219-0631, USA.

Purpose: Craniopharyngiomas occur in suprasellar locations that pose challenges for surgical management. This study evaluates the incidence of complications following craniotomy for craniopharyngioma in adults and investigates risk factors for these complications.

Methods: Patients who underwent craniotomy for excision of craniopharyngioma were identified from the 2005-2016 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Incidence of 30-day postoperative complications was determined. Multivariable logistic regression identified demographic, comorbid and perioperative characteristics associated with any complication and major (Clavien IV) complications.  RESULTS: There were 143 cases identified. Fifty-one (35.7%) had a complication, twenty (14.0%) experienced a major complication and there were four (2.8%) deaths. The most common complications were: unplanned readmission (13.3%), prolonged ventilation > 48 h (9.8%), and unplanned reoperation (9.3%). In multivariable analysis, variables significantly associated with any complication were: black race (OR 0.16; 95% CI 0.03-0.84; p = 0.03), hypertension (OR 5.04; 95% CI 1.79-14.17; p = 0.002) and longer duration of surgery (OR 1.27; 95% CI 1.01-1.58; p = 0.04). Hypertension (OR 9.33; 95% CI 1.61-54.21; p = 0.01) and longer duration of surgery (OR 1.51; 95% CI 1.05-2.17; p = 0.03) were also significant predictors for major complications.

Conclusion: One-third of patients undergoing craniotomy for craniopharyngioma resection experienced a postoperative complication. While high, this contrasts previously reported rates of two-thirds. Prolonged operative time and hypertension are positive predictors of major complications. This information can assist in counseling patients and decision-making for management. We note that other treatment approaches, such as endoscopic surgical techniques, radiosurgery and radiation therapy likely have different profiles and predictors of complications.
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http://dx.doi.org/10.1007/s11060-019-03209-9DOI Listing
August 2019