Brain metastases are a devastating sequela of common primary cancers (e.g., lung, breast, and skin) and have limited effective therapeutic options. Previously, systemic chemotherapy failed to demonstrate significant benefit in patients with brain metastases, but in recent decades, targeted therapies and more recently immune checkpoint inhibitors (ICIs) have yielded promising results in preclinical and clinical studies. Furthermore, there is significant interest in harnessing the immunomodulatory effects of radiotherapy (RT) to synergize with ICIs. Herein, we discuss studies evaluating the impact of RT dose and fractionation on the immune response, early studies supporting the synergistic interaction between RT and ICIs, and ongoing clinical trials assessing the benefit of combination therapy in patients with brain metastases.
We present a case of severe aortic coarctation in a 65-yearold man with a past medical history significant for resistant hypertension. Renal duplex ultrasounds provided no evidence of renovascular hypertension but demonstrated tardus parvus waveforms in the bilateral renal arteries, suggesting proximal vascular obstruction (left kidney: Panel A -top; right kidney: Panel A -bottom). Abdominal aorta spectral tracings revealed monophasic waveforms, again suggesting a more proximal obstruction. An abdominal CT angiogram (CTA) was subsequently ordered and demonstrated rib notching, abdominal collateral vessels, and left ventricular hypertrophy, highly suggestive of an aortic
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