
Erin S MurphyCleveland Clinic · Department of Radiation Oncology
Erin S Murphy
Doctor of Medicine
About
292
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Publications (292)
Stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) have revolutionized how we treat malignant and benign tumors and disorders. Technological advancements enabling highly precise delivery of radiation with sharp dose fall off outside the target have accelerated the adoption of SRS and SBRT. Despite the high conformality o...
Neurosurgical resection is an important treatment modality for patients with brain metastases, especially those with large, symptomatic tumors. Adjuvant whole brain radiotherapy (WBRT) or stereotactic radiosurgery (SRS) to the resection cavity is important to maximize local control. Postoperative SRS has been shown to be an alternative to WBRT with...
Choroid plexus tumors (CPT) are rare tumors of the neuroepithelial tissue of the brain that are most common in young children. They account for <1% of all intracranial tumors. In adults, they arise most frequently in the fourth ventricle, often presenting with hydrocephalus due to overproduction of cerebrospinal fluid (CSF). There are three histopa...
Purpose
Existing literature on adjuvant radiation after subtotal resection (STR) of WHO II meningiomas is limited by heterogenous patient cohorts, combining adjuvant and salvage radiation, gross total resection (GTR) and STR, primary radiation treatment vs. re-treatment, or grade II and III meningiomas, all of which have different expected outcomes...
Background
There are limited data on the use of stereotactic radiosurgery (SRS) for pediatric patients. The aim of this systematic review was to summarize indications and outcomes specific to pediatric cranial SRS to inform consensus guidelines on behalf of the International Stereotactic Radiosurgery Society (ISRS).
Methods
A systematic review, us...
Purpose: Existing literature on adjuvant radiation after subtotal resection (STR) of WHO II meningiomas is limited by heterogenous patient cohorts, combining adjuvant and salvage radiation, gross total resection (GTR) and STR, primary radiation treatment vs re-treatment, or grade II and III meningiomas, all of which have different expected outcomes...
PURPOSE/OBJECTIVE(S)
We conducted a prospective phase I preoperative radiosurgery dose escalation trial for brain metastases greater than 2 cm. We report updated results with known prognostic variables.
MATERIALS/METHODS
Radiosurgery dose was escalated at 3 Gy increments for 3 cohorts based on maximum tumor diameter. Dose limiting toxicity (DLT) w...
BACKGROUND
ACNS1123 was a Phase 2 study to determine whether irradiation could be safely reduced without impacting survival in a subgroup of NGGCT patients.
METHODS
Patients with localized disease who achieved a complete (CR) or partial response (PR) to induction chemotherapy were eligible to receive reduced dose/volume of irradiation to 30.6Gy wh...
Background
Single-session stereotactic radiosurgery (SRS) or surgical resection alone for brain metastases larger than 2 cm results in unsatisfactory local control. We conducted a phase I trial for brain metastases(>2 cm) to determine the safety of preoperative SRS at escalating doses.
Methods
Radiosurgery dose was escalated at 3 Gy increments for...
The neutrophil to lymphocyte ratio (NTLR) and absolute lymphocyte count (ALC) recovery are prognostic across many cancers. We investigated whether NLTR predicts SBRT success or survival in a metastatic sarcoma cohort treated with SBRT from 2014 and 2020 (N = 42). Wilcox Signed Rank Test and Friedman Test compare NTLR changes with local failure vs....
BACKGROUND
Cobalt-60 stereotactic radiosurgery (SRS) typically involves single fraction treatment with frame immobilization. However, large tumor size, proximity to critical structures, and prior radiation treatment sometimes necessitate fractionated SRS with mask immobilization. We present a large institutional experience with fractionated mask-ba...
Ewing sarcoma (ES) is a malignant tumor of bone and soft tissue that most often occurs in adolescents and young adults. Despite an international coordinated approach, several nuances, discrepancies, and debates remain in defining the standard of care for treating ES. In this review, the authors leverage the expertise assembled by formation of the N...
Purpose
Distinguishing radiation necrosis from tumor progression among patients with brain metastases previously treated with stereotactic radiosurgery represents a common diagnostic challenge. We performed a prospective pilot study to determine whether PET/CT with ¹⁸F-fluciclovine, a widely available amino acid PET radiotracer, repurposed intracra...
Importance:
Preoperative stereotactic radiosurgery (SRS) has been demonstrated as a feasible alternative to postoperative SRS for resectable brain metastases (BMs) with potential benefits in adverse radiation effects (AREs) and meningeal disease (MD). However, mature large-cohort multicenter data are lacking.
Objective:
To evaluate preoperative...
Purpose
Volumetric‐modulated arc therapy for total body irradiation (VMAT‐TBI) is a novel radiotherapy technique that has been implemented at our institution. The purpose of this work is to investigate possible failure modes (FMs) in the treatment process and to develop a quality control (QC) program for VMAT‐TBI following TG‐100 guidelines.
Metho...
Simple Summary
Targeted therapies have emerged as newer systemic options for certain cancers. EGFR-directed Tyrosine Kinase Inhibitors (EGFR-TKIs), which have several generations, have been found effective in a type of lung cancer called non-small cell lung cancer (NSCLC) when compared to conventional, platinum-based chemotherapy. More recently, EG...
Purpose:
This study evaluates the quality of plans used for the treatment of patients in the Children's Oncology Group study ACNS1123. Plan quality is quantified based on a scoring system specific to the protocol. In this way, the distribution of plan quality scores is determined that can be used to identify plan quality issues for this study and...
In the United States, an individual's access to resources, insurance status, and wealth are critical social determinants that affect both the risk and outcomes of many diseases. One disease for which the correlation with socioeconomic status (SES) is less well-characterized is glioblastoma (GBM), a devastating brain malignancy. The aim of this stud...
The neutrophil to lymphocyte ratio (NTLR) and absolute lymphocyte count (ALC) recovery are prognostic across many cancers. We investigated whether NLTR predicts SBRT success or survival in a metastatic sarcoma cohort treated with SBRT from 2014 and 2020 (N = 42). Wilcox Signed Rank Test and Friedman Test compare NTLR changes with local failure vs....
PurposeCerebral radiation necrosis is a complication of radiation therapy that can be seen months to years following radiation treatment. Differentiating radiation necrosis from tumor progression on standard magnetic resonance imaging (MRI) is often difficult and advanced imaging techniques may be needed to make an accurate diagnosis. The purpose o...
Background
Limited data is currently available on clinical outcomes following stereotactic body radiation therapy (SBRT) for pediatric and AYA patients with cancer. We aimed to perform a systematic review and study-level meta-analysis to characterize associated local control (LC), progression-free survival (PFS), overall survival (OS), and toxicity...
Purpose/Objective(s)
Cobalt-60 stereotactic radiosurgery (SRS) conventionally involves frame-based immobilization and single-fraction treatment. However, certain anatomical and technical factors, including large lesion size, close proximity to critical structures, and prior radiation treatment, necessitate fractionated SRS, which requires mask-base...
Purpose/Objective(s)
Preoperative (preop) stereotactic radiosurgery (SRS) is a feasible alternative to postoperative (postop) SRS with potential benefits in adverse radiation effect (ARE) and meningeal disease compared to postop SRS. Most reported studies of preop SRS utilized single fraction (fx) SRS. The goal of this study was to compare outcomes...
Purpose/Objective(s)
Cobalt-60 stereotactic radiosurgery (SRS) typically employs frame-based immobilization and single-fraction treatment. In some circumstances, including close proximity to critical structures, large tumor size, and retreatment, SRS must be fractionated, with mask for immobilization. We present a large institutional experience wit...
Purpose/Objective(s)
Preoperative (preop) stereotactic radiosurgery (SRS) is a feasible alternative to postoperative (postop) SRS with potential benefits in adverse radiation effect (ARE) and meningeal disease (MD) compared to postop SRS. The goal of this study was to determine risk factors for progression and toxicity after preop SRS in an expande...
Purpose/Objective(s)
The hypothesis is that dose to normal CNS structures is lower for children treated with proton therapy, as compared to photon therapy for children receiving whole ventricular radiotherapy (WVRT) for non-germinomatous germ cell tumors (NGGCT). We present data from patients enrolled in stratum 1 of the Children's Oncology Group s...
A variety of benign intracranial tumors are encountered in a radiation oncology practice, including low-grade primary glial neoplasms, meningiomas, vestibular and non-vestibular schwannomas, pituitary adenomas, and glomus tumors/paragangliomas. The primary management for most benign intracranial tumors is maximum safe resection, which provides an a...
Malignant primary brain tumors are approached in a multi-modality setting, with upfront maximum safe resection and adjuvant radiation therapy, with chemotherapy used in certain tumor subtypes. Since these patients undergo multi-modality treatments, extensive review of pre-operative and post-operative imaging is key to understanding and identifying...
Background
Amino acid PET radiopharmaceutical, 18F-fluciclovine, shows increased uptake in brain tumors relative to normal tissue and may be a useful tool for detecting recurrent brain metastases. Here, we report results from a prospective pilot study evaluating the use of 18F-fluciclovine PET/CT to distinguish radiation necrosis from tumour progre...
Approximately 30% of patients with solid tumours develop brain metastases, which have historically been approached as a single entity with poor prognosis. The advancement in our understanding of the biologic and molecular underpinnings of different diseases, as well as the advancement in technologies and surgical approaches, has led to numerous tre...
Purpose
We sought to evaluate the effects of concurrent temozolomide-based chemoradiation therapy on neurocognitive function in patients with low-grade glioma (LGG).
Materials/methods
We included adult patients with LGG who were treated postoperatively with radiotherapy (RT) with concurrent and adjuvant temozolomide (TMZ). Patients were evaluated...
INTRODUCTION: Endoscopic third ventriculostomy and endoscopic tumor biopsy have become integral to the surgical management of children with primary CNS GCTs. Observing ependymal tumor dissemination at the time of endoscopic surgery has been anecdotally reported. The incidence and impact of this finding in CNS GCT has not been reported. METHODS: Bas...
BACKGROUND: ETV and tumor biopsy are central to the surgical management of children with primary CNS GCT. An ETV creates a communication between the intraventricular compartment and the subarachnoid spaces and decompartmentalizes the ventricular system. “Tumor spill” or shedding may result from surgical interventions, such as biopsy. ETV with simul...
Purpose
In addition to established prognostic factors in low-grade glioma (LGG), studies suggest a sexual dimorphism with male sex portending worse prognosis. Our objective was to identify the impact of sex on presentation and outcomes in LGG.
Methods
We conducted a retrospective cohort study of adults (aged ≥ 18 years) diagnosed with LGG (WHO 201...
Purpose:
To determine if proton therapy reduces doses to cranial organs at risk (OARs) as compared to photon therapy in children with non-germinomatous germ cell tumors (NGGCT) receiving whole ventricular radiotherapy (WVRT).
Methods and materials:
Dosimetric data for patients with NGGCT prospectively enrolled in stratum 1 of the Children's Onco...
Background and objective:
Brainstem metastases comprise fewer than 7% of all brain metastases. Nonetheless, they present clinicians with unique clinical challenges in symptom management and treatment. No comprehensive review summarizing the management of brainstem metastases exists. This review aims to summarize epidemiology, anatomy, clinical cor...
Radiation therapy is one of the main treatment approaches for primary and secondary malignancies of the central nervous system (CNS). Prophylactic radiation to the brain or craniospinal axis is also performed in cancers with propensity to spread into the neuraxis, in order to prevent development of future brain or spinal metastasis. Radiation to th...
Purpose
Low-grade glioma (LGG) exhibits longer median survival than high-grade brain tumors, and thus impact of our therapies on patient quality of life remains a crucial consideration. This study evaluated the effects of concurrent temozolomide-based chemoradiation (RT + TMZ) or observation on quality of life (QOL) in patients with low-grade gliom...
Background: XX study tested the efficacy of reduced dose and field of radiation therapy (RT) for localized nongerminomatous germ cell tumor (NGGCT) patients who achieved a complete (CR) or partial response (PR) to chemotherapy. Here, we evaluate the quality of RT and patterns of failure for patients eligible for reduced-RT on this phase 2 trial.
Me...
Purpose:
Competing radiosurgery plans are compared based on their conformity and gradient of dose distribution to the target volume (TV). Most widely used quality metrics such as new conformity index (NCI) and gradient index (GI) are known to have strong volume dependency on the TV of interest. A simple quality measure without the volume dependenc...
Introduction:
Stereotactic body radiation therapy (SBRT) is increasingly utilized for patients with recurrent and metastatic sarcoma. SBRT affords the potential to overcome the relative radioresistance of sarcomas through delivery of a focused high biological effective dose (BED) as an alternative to invasive surgery. We report local control outco...
BACKGROUND
The study aimed to evaluate whether simplified chemotherapy followed by dose-reduced irradiation was effective for treating patients (ages 3-21 years) with localized germinoma. The primary endpoint was 3-year progression free survival (PFS) rate.
METHODS
Patients with a complete response to chemotherapy with carboplatin and etoposide re...
Purpose/Objective(s)
Prolactinoma is the most common type (∼40%) of functional pituitary adenoma. Patients with prolactinoma generally have a good prognosis with appropriate treatment. However, disparities in insurance and socioeconomic status can influence the outcomes of illnesses that have good prognoses. This study aims to analyze the impact of...
Purpose/Objective(s)
Low-grade glioma (LGG) is a heterogeneous group of brain tumors for which accurate determination of prognosis and optimal therapeutics remains challenging. Recent evidence suggests a correlation between female biological sex and favorable survival in patients with high-grade glioma. However, in patients with LGG, the impact of...
Purpose/Objective(s)
Melanoma is the third most common cause of metastatic brain tumors. A mutation of the BRAF protein, a kinase implicated in cell differentiation and growth, is present in approximately 50% of patients with melanoma. BRAF inhibitors, such as Vemurafenib, have been used as treatment for BRAF mutant melanoma brain metastasis (MBM)....
Purpose/Objective(s)
Non-small cell lung cancer (NSCLC) is the leading cause of brain metastases. Systemic therapies and radiation therapy are both potential treatment options for NSCLCBM patients. ICIs have been designated as a promising alternative in patients without targetable molecular alterations, while SRS has also grown into favor, as it is...
Purpose/Objective(s)
RTOG 0424 demonstrated that high-risk low-grade glioma (LGG) patients treated with concurrent temozolomide (TMZ) and radiotherapy (RT) followed by adjuvant TMZ (RT+TMZ) had a survival longer than that reported for historical controls. The impact of this treatment strategy on short term neurocognitive outcomes is not well establ...
Purpose/Objective(s)
Preoperative (pre-op) SRS has been demonstrated to be a feasible alternative to postoperative (post-op) SRS primarily based on single institution studies with potential benefits in adverse radiation effect (ARE) and leptomeningeal disease (LMD) compared to post-op SRS. This study (Preoperative Radiosurgery for Brain Metastases...
Purpose/Objective(s)
The use of multi-isocentric volumetric mediated arc therapy (VMAT) for total body irradiation (TBI) improves dose uniformity and organ-at-risk avoidance and offers better patient comfort, but is limited by time-intensive planning and positioning errors at treatment delivery. We present a system that utilizes automated contourin...
Purpose/Objective(s)
Renal cell carcinoma is the fourth most common cause of metastatic brain tumors. Both Immune Checkpoint Inhibitors (ICIs) and Stereotactic Radiosurgery (SRS) have been used as first line treatment for renal cell carcinoma brain metastasis (RCCBM). The efficacy of ICIs alone, SRS alone, or SRS and ICIs combined as treatment is b...
Purpose/Objective(s)
Stereotactic body radiation therapy (SBRT) is increasingly utilized for treatment of patients with recurrent and metastatic tumors. Considering the relative radioresistance of some sarcoma histologies, SBRT may allow for higher biological effectiveness compared to conventional radiotherapy. We report local control outcomes afte...
Purpose/Objective(s)
Medulloblastoma is the most common malignant pediatric brain neoplasm, but its pattern of care among adult patients has not been standardized. Recent studies demonstrated that disparity in socioeconomic factors could influence treatment decision and prognosis in many cancers. This study aims to analyze the impact of insurance a...
Purpose/Objective(s)
Lung cancer is the leading cause of cancer-related deaths worldwide. Non-small cell lung cancer (NSCLC) also accounts for the highest number of brain metastases. Recent advances have been made from standard platinum-based chemotherapy to gene-directed therapies. EGFR and ALK mutations are the most well-studied directed therapie...
Purpose/Objective(s)
Adult pineoblastoma is a rare but aggressive tumor with poor prognosis despite multimodality treatment. The impact of sociodemographic factors on care and outcome is poorly understood, and prior studies were limited by small sample sizes. Emerging evidence implicates the role of sex differences in the prognosis of aggressive br...
Purpose/Objective(s)
The relationship between immune parameters and oncologic outcomes after stereotactic body radiotherapy (SBRT) is an area of active investigation. The neutrophil to lymphocyte ratio (NTLR) has been observed to be a prognostic marker in cancer survival across many cancers. We hypothesized that the NLTR is prognostic for patients...
Purpose/Objective(s)
Pulsed Reduced-Dose Rate (PRDR) Re-irradiation with Intensity Modulated Radiation Therapy (IMRT) for recurrent primary Central Nervous System (CNS) malignancies was previously reported to be a feasible and well tolerated treatment option. We report our IMRT PRDR outcomes and toxicities for 55 patients with KPS ≥ 70 treated at o...
Purpose/Objective(s)
To report results from a prospective pilot study evaluating the use of ¹⁸F Fluciclovine PET CT to distinguish radiation necrosis (RN) from tumor progression (TP) among patients (pts) with brain metastases (BM) treated with stereotactic radiosurgery (SRS).
Materials/Methods
The primary objective was to estimate the accuracy of...
Purpose/Objective(s)
Melanoma is the third most common cause of metastatic brain tumors. Both Immune Checkpoint Inhibitors (ICIs) and Stereotactic Radiosurgery (SRS) have been used as first line treatment for melanoma brain metastasis (MBM). The efficacy of ICIs alone, SRS alone, or SRS and ICIs combined as treatment is being evaluated. We hypothes...
Objective:
After gross-total resection (GTR) of a newly diagnosed WHO grade II meningioma, the decision to treat with radiation upfront or at initial recurrence remains controversial. A comparison of progression-free survival (PFS) between observation and adjuvant radiation fails to account for the potential success of salvage radiation, and a dir...
Immune checkpoint inhibitors (ICIs) have resulted in improved outcomes in non-small cell lung cancer (NSCLC) patients. However, data demonstrating the efficacy of ICIs in NSCLC brain metastases (NSCLCBM) is limited. We analyzed overall survival (OS) in patients with NSCLCBM treated with ICIs within 90 days of NSCLCBM diagnosis (ICI-90) and compared...
Introduction:
Using multi-isocenter volumetric-modulated arc therapy (VMAT) for total body irradiation (TBI) may improve dose uniformity and vulnerable tissue protection compared with classical whole-body field technique. Two drawbacks limit its application: (1) VMAT-TBI planning is time consuming; (2) VMAT-TBI plans are sensitive to patient posit...