Background and Purpose-Cerebral ischemia is ensued by a cellular immune depression syndrome. The postischemic functional capacity of T lymphocytes is controversial, and interactions between leukocyte subsets are largely unknown. Understanding the immunologic interplay between antigen-presenting cells and lymphocytes as well as between distinct lymphocyte subsets after stroke might be of clinical/therapeutic significance because animal data argue for a cerebroprotective effect of, for example, CD4ϩCD25ϩ regulatory T cells. Methods-Ex vivo CD4ϩ T cell proliferation was analyzed in experimental and human stroke using fluorescence activated cell sorter analysis. To investigate suppressive effects of CD4ϩCD25ϩ regulatory T cells as well as the influence of costimulatory cells on CD4ϩ T cell proliferation, subsets were magnetically sorted before proliferation assay setup. Results-After stroke: (1) proliferation of mouse and human CD4ϩ T cells on T cell receptor stimulation was unaltered;(2) the suppressive effect of CD4ϩCD25ϩ regulatory T cells in mouse and man was unaltered; and (3)
Post-operative SRS (poSRS) local control (LC) rates decrease with increasing resection cavity size. Intracavitary Cesium-131 (Cs-131) brachytherapy may prevent tumor cell repopulation, increase LC, and reduce radiation necrosis (RN). This is the first direct clinical comparison between Cs-131and poSRS for resected brain metastases. Materials/Methods: After IRB approval, 21 patients prospectively underwent Cs-131 brachytherapy from 2010-2014. A match-pair analysis was performed using poSRS patients as controls (n Z 50 treated with poSRS from 2010-2014) were identified and separated into categories based on histology (lung vs other) and tumor size (<2.4cm vs >2.5cm). Tumor size was dichotomized at 2.4 cm because this was the median tumor size of both poSRS and Cs-131 patients, and this binary cutoff best allowed for a feasible matching dichotomy given the small sample size. Then, we randomly selected a control subject from the defined histology/tumor size strata of this larger potential control (poSRS) group to match each Cs-131 patient (case) in question (via a random number generator). This process resulted in the selection of a group of 19 patients who received poSRS during the same time period and who met the above inclusion criteria as controls. LC, distant recurrence (DR), overall survival (OS), and RN rates were compared. Results: Median follow-up was 15.0 months (range, 6-34 months) for Cs-131 and17.0 months (range, 6-41 months) for poSRS. LC rates were 91% and 68% in Cs-131 and poSRS cohorts, respectively (P Z 0.01). Median pre-operative tumor was 2.4cm (range, 1.5-4.4 cm SD Z 0.8) versus 2.4cm (range, 1.4-5.1 cm SD Z 0.73) in the Cs-131 and poSRS patients, respectively (P Z 0.2). PoSRS patients were more likely to require salvage therapy than the Cs-131 patients (P Z 0.01) and was associated with median preoperative tumor size of 3.05cm. There were no significant differences in DR and OS between the two cohorts (P>0.4). RN incidence was 15.7% with poSRS versus 0% with Cs-131 group (P Z 0.04). Conclusion: In patients with large resection cavities, implantation with Cs-131 achieves superior LC and no incidence of RN as compared to their counterparts treated with poSRS.
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