Objective(s) This is the first clinical outcomes report of NRG Oncology RTOG 0539, detailing the primary endpoint, 3-year progression-free survival (3yPFS), compared to a predefined historical control for intermediate-risk meningioma, and secondarily evaluating overall survival (OS), local failure, and prospectively scored adverse events (AEs). Methods NRG Oncology RTOG 0539 was a phase II clinical trial allocating meningioma patients to 1 of 3 prognostic groups and management strategies according to WHO grade, recurrence status, and resection extent. For the intermediate-risk group (Group 2), eligible patients had either newly diagnosed WHO grade II meningioma with gross total resection (GTR, Simpson I-III) or recurrent WHO grade I of any resection extent. Pathology and imaging were centrally reviewed. Patients were treated with radiation therapy (RT), either intensity modulated (IMRT) or 3D conformal (3DCRT), 54 Gy in 30 fractions. The RT target volume was defined as the tumor bed and any nodular enhancement (e.g. recurrent WHO grade I patients) with a minimum 8 mm and maximum 15 mm margin, depending upon tumor locale and set-up reproducibility of RT method. The primary endpoint was 3yPFS. Results were compared to historical controls (3yPFS 70% following GTR alone and 90% with GTR + RT). AEs were scored using NCI Common Toxicity Criteria. Results Fifty-six patients enrolled in the intermediate-risk group; 3 were ineligible. Additionally, 1 did not receive RT, and 4 withdrew without recurrence before 3 years. Thus 52 patients received protocol therapy, and 48 were evaluable for the primary endpoint, 3y PFS which was 93.8% (p=.0003). Within 3 years there were 3 PFS events: 1 WHO grade II patient died of disease, 1 WHO grade II patient progressed and remained alive, and 1 recurrent WHO grade I patient died from undetermined cause without progression. Three-year local failure was 4.1%, and 3-year OS 96%. After 3 years 2 additional patients progressed: 1 recurrent WHO grade I, and the other WHO grade II; both remain alive. Among 52 evaluable patients who received protocol treatment, 36 (69.2%) were WHO II with GTR, and 16 (30.8%) recurrent WHO I. There was no significant difference in PFS between these subgroups (p=.52, HR 0.56, 95% CI 0.09 to 3.35), validating their consolidation. Of the 52 evaluable patients, 44 (84.6%) received IMRT, and 50 (96.2%) were treated per protocol or with acceptable variation. AEs (definitely, probably or possibly related to protocol treatment) were limited to grade 1 or 2, with no reported grade 3 events. Conclusion This is the first clinical outcomes report from NRG Oncology RTOG 0539. Patients with intermediate-risk meningioma treated with RT experienced excellent 3yPFS with a low rate of local failure, and a low risk of adverse events. These results support the use of post-operative RT for newly diagnosed gross totally resected WHO grade II, or recurrent WHO grade I meningioma irrespective of resection extent. They also document minimal toxicity and high rates of tumor contr...

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HSV-1 is the leading cause of sporadic viral encephalitis with mortality rates approaching 30% despite treatment with the antiviral drug of choice, acyclovir. Permanent neurological deficits are common in patients that survive but the mechanism leading to this pathology is poorly understood impeding clinical advancements in treatment to reduce central nervous system (CNS) morbidity. Using magnetic resonance imaging and type I IFN receptor deficient mouse chimeras, we demonstrate HSV-1 gains access to the murine brain stem and subsequently brain ependymal cells leading to enlargement of the cerebral lateral ventricle and infection of the brain parenchyma. A similar enlargement in the lateral ventricles is found in a subpopulation of herpes simplex encephalitic patients. Associated with encephalitis is an increase in CXCL1 and CXCL10 levels in the cerebral spinal fluid, TNF-α expression in the ependymal region and the influx of neutrophils of encephalitic mouse brains. Reduction in lateral ventricle enlargement using the anti-secretory factor peptide, AF-16, reduces mortality significantly in HSV-1 infected mice without any effect on expression of inflammatory mediators, infiltration of leukocytes, or changes in viral titer. Microglial cells but not infiltrating leukocytes or other resident glial cells or neurons are the principal source of resistance in the CNS during the first 5 days post infection through a TRIF-dependent, type I IFN pathway. Our results implicate lateral ventricle enlargement as a major cause of mortality in mice and speculate such an event transpires in a subpopulation of human herpes simplex virus encephalitic patients.

(Q1, 0.25; Q3, 0.44) for metastatic lesions, P < .0001. Significant differences were noted based on the site of breast metastases. The median RSIs for metastases in descending order of radioresistance were bone (0.50), brain (0.44), skin (0.44), ovary (0.43), liver (0.34), lung (0.32), and lymph nodes (0.31), P < .0001. When we restricted our analysis to patients with both a primary and metastatic lesion available for analysis (n Z 99), similar differences in radiosensitivity were noted. Primary lesions continued to be more resistant than metastatic lesions 0.38 (Q1, 0.31; Q3, 0.45) versus 0.36 (Q1, 0.21; Q3, 0.44), P Z .002. The median RSIs in descending order of radioresistance, when restricting the analysis to this subgroup, also revealed significant differences: skin (0.44), brain (0.43), ovary (0.42), lymph nodes (0.35), lung (0.29), and liver (0.26); P Z .007. Conclusion: In this novel analysis assessing radiosensitivity between primary and metastatic tissues of breast cancer histology, significant differences were noted based on anatomical location. Validation with clinical endpoints is needed but these findings could have implications on radiation dose selection based upon tumor location.