A Multidisciplinary Central Nervous System Clinic Model for Radiation Oncology and Neurosurgery (RADIANS): three-year experience with brain and skull base lesions in a community hospital setting.

BACKGROUND: Subspecialty, multidisciplinary care within community hospital settings are limited and remains a challenge. Improving outcomes for central nervous system (CNS) disease rely on integrated subspecialty care between radiation oncology (RadOnc) and neurosurgery (NS). Three-year experience with simultaneous patient evaluation with RadOnc and NS physicians in a community hospital-based CNS clinic model (RADIANS) for brain and skull base lesions (BSBL) are reported. METHODS: Clinical and demographic data were prospectively collected for patients evaluated in RADIANS. Surveys administered and three-year data reviewed. Descriptive statistics reported as mean and percentages for patient characteristics, diagnosis, treatment and outcomes. RESULTS: Sixty-seven patients with confirmed BSBL were evaluated between August 2016 and August 2019. Mean age and distance traveled was 61.0 years and 66.5 miles, respectively. Female (N.=39, 58.2%) and male (N.=28, 41.8%) patients had mean Patient Satisfaction Score of 4.77 (0-5 Scale, where 5 is very satisfied; 26 respondents). Forty-three patients had malignant disease (28 brain mets; six with both brain/spine; nine with primary brain), and 24 had benign disease. Post-evaluation treatment: radiation therapy (RT) only (N.=16), neurosurgery (NS) only (N.=12), both RT and NS (N.=15), and no RT/NS intervention (N.=24). Fractionated stereotactic radiosurgery was most common RT delivered; craniotomy with tumor resection was most common NS performed. Treatment outcomes: local control in 33 of 38 (86.8%); radiation necrosis in one of 31 (3.2%). CONCLUSIONS: The multidisciplinary community hospital-based CNS clinic continues its high patient approval at extended follow-up. Results demonstrate the clinic serves as a regional referral center where patients with BSBL with varying degrees of co-morbidities, systemic disease status, and oncologic staging can be treated with evidence-based treatment modalities yielding high rates of local control and low rates of grade 3 and 4 radiation-induced toxicity, while having access to on-going clinical trials.

Geriatric patient outcomes in a multidisciplinary central nervous system community hospital clinic for radiation oncology and neurosurgery (RADIANS).

INTRODUCTION: Management of older adult patients with central nervous system (CNS) cancers requires a patient-centric, multidisciplinary approach. Assessment of neurosurgical and radiation treatment outcomes can assist in establishing guidelines for this patient population. We previously reported on the RADIANS clinic, a novel community hospital-based multidisciplinary clinic (MDC) for CNS cancer care, providing simultaneous radiation oncology and neurosurgery evaluation in a same-day, single-setting clinic. We now provide a focused analysis of our older adult patient population and recommendations for triage and standardization of care. METHODS: Consecutive older adult patients (age ≥ 65) evaluated at the RADIANS clinic for CNS disease were identified and retrospectively reviewed. Observed 30-day neurosurgical outcomes were compared to predicted outcomes determined by the American College of Physicians NSQIP Surgical Risk Calculator. One-sample binomial exact tests were used to evaluate binary outcome measures. A two-sample t-test was used to evaluate the length of hospital stay. Brier Scores were calculated to assess the deviation between predicted probabilities and observed outcomes for binary outcome measures. Overall survival at 90 days was reported. RESULTS: Fifty-six older adult patients with malignant (42/56) and benign (14/56) CNS disease were evaluated. Mean distance traveled for multidisciplinary evaluation at the RADIANS clinic was 43.4 miles. There was no incidence of radiation-induced toxicity. Mean length of hospital stay for RADIANS patients was significantly shorter by about 1.5 to 3.5 days (95% CI). There was no statistically significant difference for other outcome measures, however, Brier Scores demonstrated that NSQIP was not a good predictive tool for any or serious complications, UTI, venous thromboembolism, return to OR, readmission, or death in our cohort. Local tumor control rate and progression-free survival at 90 days were 97.4% and 76.9%, respectively. CONCLUSIONS: This is the first report of CNS disease outcomes in older adult patients evaluated by radiation oncology and neurosurgery at a community hospital-based MDC. We observed minimal adverse radiation outcomes and high tumor control in our cohort. Findings show significantly shorter postoperative hospital stay for patients evaluated and managed at the RADIANS clinic.