Radiation Medicine Commons^™

Combined High-Dose Lattice Radiation Therapy And Immune Checkpoint Blockade For Advanced Bulky Tumors: The Concept And A Case Report, Liuqing Jiang, Xiaobo Li, Jianping Zhang, Wenyao Li, Fangfen Dong, Cheng Chen, Qingliang Lin, Chonglin Zhang, Fen Zheng, Weisi Yan, Yi Zheng, Xiaodong Wu, Benhua Xu

Department of Radiation Oncology Faculty Papers

Although the combination of immune checkpoint blockades with high dose of radiation has indicated the potential of co-stimulatory effects, consistent clinical outcome has been yet to be demonstrated. Bulky tumors present challenges for radiation treatment to achieve high rate of tumor control due to large tumor sizes and normal tissue toxicities. As an alternative, spatially fractionated radiotherapy (SFRT) technique has been applied, in the forms of GRID or LATTICE radiation therapy (LRT), to safely treat bulky tumors. When used alone in a single or a few fractions, GRID or LRT can be best classified as palliative or tumor de-bulking treatments. …

Safety And Efficacy Of Hypofractionated Stereotactic Radiosurgery For High-Grade Gliomas At First Recurrence: A Single-Center Experience., Yun Guan, Ji Xiong, Mingyuan Pan, Wenyin Shi, Jing Li, Huaguang Zhu, Xiu Gong, Chao Li, Guanghai Mei, Xiaoxia Liu, Li Pan, Jiazhong Dai, Yang Wang, Enmin Wang, Xin Wang

Department of Radiation Oncology Faculty Papers

BACKGROUND: The optimal treatment for recurrent high-grade gliomas (rHGGs) remains uncertain. This study aimed to investigate the efficacy and safety of hypofractionated stereotactic radiosurgery (HSRS) as a first-line salvage treatment for in-field recurrence of high-grade gliomas.

METHODS: Between January 2016 and October 2019, 70 patients with rHGG who underwent HSRS were retrospectively analysed. The primary endpoint was overall survival (OS), and secondary endpoints included both progression-free survival (PFS) and adverse events, which were assessed according to Common Toxicity Criteria Adverse Events (CTCAE) version 5. The prognostic value of key clinical features (age, performance status, planning target volume, dose, use of …

Computer Automation For Physics Chart Check Should Be Adopted In Clinic To Replace Manual Chart Checking For Radiotherapy, Edward L. Clouser, Quan Chen, Yi Rong

Radiation Medicine Faculty Publications

No abstract provided.

An Analytical Expression For R50% Dependent On Ptv Surface Area And Volume: A Cranial Srs Comparison, Dharmin D. Desai, Ellis Lee Johnson, Ivan L. Cordrey

Radiation Medicine Faculty Publications

The intermediate dose spill for a stereotactic radiosurgery (SRS) plan can be quantified with the metric R50%, defined as the 50% isodose cloud volume (V_IDC50%) divided by the volume of the planning target volume (PTV). By coupling sound physical principles with the basic definition of R50%, we derive an analytical expression for R50% for a spherical PTV. Our analytical expression depends on three quantities: the surface area of PTV (SA_PTV), the volume of PTV (V_PTV), and the distance of dose drop-off to 50% (Δr). The value of ∆r was obtained from a simple set …

A Multidisciplinary Approach To Triage Patients With Breast Disease During The Covid-19 Pandemic: Experience From A Tertiary Care Center In The Developing World, Abida K. Sattar, Hania Shahzad, Adnan Abdul Jabbar, Azmina Tajdin Valimohammad, Sadaf Khan, Yasmin Vellani, Romana Idrees, Nasir Ali, Imrana Masroor, Humera Saeed, Gulzar S. Lakhani, Nadia Ayoub, Atif Waqar, Muhammad Zia-Ul Islam, Salman Kirmani, Asad Latif, Ather Enam

Section of General Surgery

Background: The COVID-19 pandemic has created a need to prioritize care because of limitation of resources. Owing to the heterogeneity and high prevalence of breast cancers, the need to prioritize care in this vulnerable population is essential. While various medical societies have published recommendations to manage breast disease during the COVID-19 pandemic, most are focused on the Western world and do not necessarily address the challenges of a resource-limited setting.
Aim: In this article, we describe our institutional approach for prioritizing care for patients presenting with breast disease.
Methods and results: The breast disease management guidelines were developed and approved …

Treatment Of Orbital Lesions Using Cyberknife Stereotactic Radiosurgery, Emily Morahan

Student Research Poster Presentations 2021

The purpose of the research done was to evaluate the use of CyberKnife Stereotactic Radiosurgery (SRS) for treating orbital lesions. Efficacy and tolerability of such treatment was analyzed with data drawn from multiple sources, regarding dose and fractionation, quality of life following treatment(s) and prognosis. CyberKnife SRS is the newest, most advanced model of radiation delivery systems, featuring a robotic arm capable of manipulating the linear accelerator into thousands of unique angles. The addition of new angles allows for a more precise concentration of radiation delivered to the lesions. In the case of optic lesions, it is crucial to minimize …

Targeting Accuracy Considerations For Simultaneous Tumor Treating Fields Antimitotic Therapy During Robotic Hypofractionated Radiation Therapy., Sharmi Biswas, Irina Kapitanova, Sabrina Divekar, Jimm Grimm, Ian J Butterwick, Daniel Garren, Lawrence R Kleinberg, Kristin J Redmond, Michel Lacroix, Anand Mahadevan, Kenneth M Forster

College of Health Professions Faculty Papers

Purpose: Tumor treating fields (TTFields) is a novel antimitotic treatment that was first proven effective for glioblastoma multiforme, now with trials for several extracranial indications underway. Several studies focused on concurrent TTFields therapy with radiation in the same time period, but were not given simultaneously. This study evaluates the targeting accuracy of simultaneous radiation therapy while TTFields arrays are in place and powered on, ensuring that radiation does not interfere with TTFields and TTFields does not interfere with radiation. This is one of several options to enable TTFields to begin several weeks sooner, and opens potential for synergistic effects of …

Development And Clinical Validation Of Knowledge-Based Planning Models For Stereotactic Body Radiotherapy Of Early-Stage Non-Small-Cell Lung Cancer Patients, Justin David Visak

Theses and Dissertations--Radiation Medicine

Lung stereotactic body radiotherapy (SBRT) is a viable alternative to surgical intervention for the treatment of early-stage non-small-cell lung cancer (NSCLC) patients. This therapy achieves strong local control rates by delivering ultra-high, conformal radioablative doses in typically one to five fractions. Historically, lung SBRT plans are manually generated using 3D conformal radiation therapy, dynamic conformal arcs (DCA), intensity-modulated radiation therapy, and more recently via volumetric modulated arc therapy (VMAT) on a C-arm linear accelerator (linac). Manually planned VMAT is an advanced technique to deliver high-quality lung SBRT due to its dosimetric capabilities and utilization of flattening-filter free beams to improve …

Development Of A Robust Linac-Based Radiosurgery Program For Multiple Brain Metastases & Estimation The Radiobiological Response Of Indirect Cell Kill, Allison Palmiero

Theses and Dissertations--Radiation Medicine

Accurate and precise delivery of Stereotactic Radiosurgery (SRS) using Gamma Knife (GK) unit by Leksell is a gold standard for multiple intracranial lesions. SRS provides less brain toxicity compared to whole brain radiotherapy techniques historically used. However, these treatments are limited in availability and are accompanied by long treatment times with painful, intolerable headframe fixation. With advancements in linear accelerator (Linac) based SRS, multiple brain lesions can be treated separately with individual isocenters or, more recently, altogether with a single isocenter multi-target (SIMT) volumetric modulated arc therapy (VMAT) technique. SIMT methods reduce the challenges of treating patients with GK by …

Dosimetric Comparison Of Rapidplan And Manually Optimized Plans For Hippocampus Avoidance Whole Brain Radiation Therapy, Laksamon Phimolasawakun

Chulalongkorn University Theses and Dissertations (Chula ETD)

Nowadays, whole-brain radiation therapy (WBRT) is a good method to cure brain metastases. However, it has been noted that whole-brain radiation therapy could be a cause to neurological toxicity which could damage the hippocampus that is an important part of forming long-term memories. The HA-WBRT is a complicated plan depending on planner skills, the researcher would like to simplify this problem using knowledge-based planning called RapidPlan. The objective of this study was to compare the dosimetric difference of RapidPlan and manually optimized plans for the treatment of HA-WBRT. The RapidPlan model was created for HA-WBRT. The PTV and OARs constraints …

Hepatic Lesion Detectability On Dual Energy Computed Tomography Imaging : Phantom Study, Hataipat Jantawong

Chulalongkorn University Theses and Dissertations (Chula ETD)

The purpose of this study is to determine the hepatic lesion detectability in abdomen from various phantom sizes by dual-energy computed tomography (DECT) imaging and to investigate the factors affecting the detectability of hepatic lesion in abdomen by dual-energy CT in phantom study. The anthropomorphic liver with nodule inserted phantom with extension rings simulating the small, medium, and large patients were scanned under DECT acquisitions by varying three kVp combinations (80/-,90/-, and 100/Sn150-kVp). The series of 40-,50-,60-, and 70-keV VMI were generated from DECT data set. All images were used to assess the task-based image quality; task transfer function (TTF), …

Determination Of Field Output Correction Factors In Elongated Small Field Photon Beams, Mananchaya Vimolnoch

Chulalongkorn University Theses and Dissertations (Chula ETD)

IAEA along with AAPM have published a code of practice TRS 483 for small field dosimetry. The field correction output factors of various detectors were introduced to correct detector response changes in relative dosimetry. However, the publication of TRS 483 has focused on symmetry field sizes, the correction factors for elongated small fields are not included in the protocol. The overall objective of this work is to determine the field output correction factor in elongated small field. The correction factors of IBA CC01, Sun nuclear EDGE, and Exradin W2 PSD for 6 MV photon beam were determined using Monte Carlo …

Evaluation Of Integral Depth-Dose Curves In Proton Pencil Beam Scanning Using Plane-Parallel Ionization Chambers, Phatthraporn Thasasi

Chulalongkorn University Theses and Dissertations (Chula ETD)

Proton therapy is an advanced form of radiation therapy treatment that can potentially decrease side effects and increase tumor control probability. The integral depth-dose curve is an essential parameter that has to be determined and introduced into the proton treatment planning system for the dose calculation. Besides the halo, the integral depth-dose curve measurements should be performed with a large-diameter plane-parallel ionization chamber. The purpose of this research is to determine the integral depth-dose curves and assess the geometrical collection efficiency at intermediate depths of different detector diameters in proton pencil beam scanning. The integral depth-dose curves with a proton …

Baselines Of Daily Quality Assurance For Proton Pencil Beam Scanning Using The Sphinx Compact, Tanapat Tiajaroen

Chulalongkorn University Theses and Dissertations (Chula ETD)

Quality assurance (QA) is a systematic process used to determine whether the product meets specified requirements. The American Association of Physicists in Medicine (AAPM) published a comprehensive proton therapy machine QA in TG-224 to provide confidence in use. King Chulalongkorn Memorial Hospital (KCMH) recently operated the first proton therapy center in Thailand, and the data of daily QA are not available or established. This study aims to apply the control chart for establishing the baselines of daily QA for the proton pencil beam scanning system using the Sphinx Compact detector. The Sphinx Compact was used to perform the proton daily …

Moderated Neutron Detector For Accumulated Ambient Dose Equivalent In Proton Therapy, Tanawat Tawonwong

Chulalongkorn University Theses and Dissertations (Chula ETD)

The Varian ProBeam compact was installed at Her Royal Highness Princess Maha Chakri Sirindhorn Proton Center. Since 2017, the project has started at the King Chulalongkorn Memorial Hospital and after 4 years, during Covid19 pandemic, the 1st patient treatment received proton therapy on August, 2021. The radiation safety of the center was accomplished through firstly, the shielding calculation and secondary, the radiation survey at the milestone points such as cyclotron installation and 1st Beam ON at the treatment room. The only one WENDI-II dosimeter was used in radiation survey. The main purpose of this study is to validate the in-house …

Dosimetric Impact Of Interplay Effects Instereotactic Body Radiation Therapy (Sbrt) Lung Cancer, Vanida Poolnapol

Chulalongkorn University Theses and Dissertations (Chula ETD)

Lung cancer patient breathing induced interplay effects in the volumetric modulated arc therapy (VMAT) together with stereotactic body radiation therapy (SBRT), which lead to non-uniform doses within the target volume and unwanted dose to the surrounding tissues. The purpose of this study was to investigate the dosimetric impact of interplay effects in 6 MV FFF of photon beams for lung cancer and to calculate the novel interplay effects factor (IEF) for VMAT-SBRT lung cancer. This study performed the static and dynamic measurements using two dimensions (2D) robotic platform and diode array for 3D-conformal radiation therapy (3D-CRT) plans, while using three …

A Deep Learning U-Net For Detecting And Segmenting Liver Tumors, Vidhya Cardozo

Theses and Dissertations

Visualization of liver tumors on simulation CT scans is challenging even with contrast-enhancement, due to the sensitivity of the contrast enhancement to the timing of the CT acquisition. Image registration to magnetic resonance imaging (MRI) can be helpful for delineation, but differences in patient position, liver shape and volume, and the lack of anatomical landmarks between the two image sets makes the task difficult. This study develops a U-Net based neural network for automated liver and tumor segmentation for purposes of radiotherapy treatment planning. Non-contrast simulation based abdominal CT axial scans of 52 patients with primary liver tumors were utilized. …

Use Of A Cancer Registry To Evaluate Patient-Reported Outcomes Of Immune Checkpoint Inhibitors., Heather S L Jim, Sarah L Eisel, Aasha I Hoogland, Sandra Shaw, Jennifer C King, Adam P Dicker

Department of Radiation Oncology Faculty Papers

Immune checkpoint inhibitors (ICIs) are increasingly used for advanced lung cancer, butfew studies have reported on patient-reported outcomes (PROs) outside the context of a clinicaltrial. The goal of the current study was to assess PROs in participants of a lung cancer registry whohad been treated with an ICI. Patients participating in the GO2Foundation’s Lung Cancer Registrywho reported receiving atezolizumab, durvalumab, nivolumab, or pembrolizumab were invited toparticipate in a survey about their experiences during treatment. Quality of life was evaluated usingthe Functional Assessment of Cancer Therapy–General (FACT-G). Common symptomatic adverseevents were evaluated using an item bank generated for ICIs. Internationally, 226 …

Fluoroscopic Demonstration Of Thoracic Tumor Immobilization With High Frequency Percussive Ventilation, Ina M Sala, Beverly Maurer, Cristian Solano, Ronald Levitin, Thomas M Guerrero

Articles

Purpose: The purpose of this first-in-man study is to directly measure thoracic tumor immobilization by high frequency percussive ventilation (HFPV).

Methods: In an IRB approved protocol (IRB # 2017-046) we screened patients with conspicuous lung tumors that exhibited motion >10 mm to undergo kV fluoroscopy with HFPV. Two sets of consecutive AP (anterior posterior) fluoroscopy frames were acquired during multiple breathing cycles for free- and HFPV- breathing. All images were acquired using our kV source/panel of the therapeutic linear accelerator. Percussions were delivered via the intrapulmonary percussive ventilation device (IPV-2C) and phasitron (Percussionaire Corp., Sagle, Idaho). The baseline settings for …

Let-Dependent Low Dose And Synergistic Inhibition Of Human Angiogenesis By Charged Particles: Validation Of Mirnas That Drive Inhibition, Amber M. Paul, Yen-Ruh Wuu, Burong Hu, Hazeem Okunola, Elizabeth A. Blaber, Margareth Cheng-Campbell, Afshin Beheshti, Peter Grabham

Publications

Space radiation inhibits angiogenesis by two mechanisms depending on the linear energy transfer (LET). Using human 3D micro-vessel models, blockage of the early motile stage of angiogenesis was determined to occur after exposure to low LET ions (/AMU), whereas inhibition of the later stages occurs after exposure to high LET ions (>8 KeV/AMU). Strikingly, the combined effect is synergistic, detectible as low as 0.06 Gy making mixed ion space radiation more potent. Candidates for bystander transmission are microRNAs (miRNAs), and analysis on miRNA-seq data from irradiated mice shows that angiogenesis would in theory be downregulated. Further analysis of three …

Burden Of Care As Perceived By Informal Caregivers Of The Patients Receiving Chemotherapy In Tertiary Care Hospital Of Karachi, Pakistan, Asher Ghori, Rubina Barolia, Naghma Rizvi, Ghulam Qadir

School of Nursing & Midwifery

Background: Almost 32.5 million people are diagnosed with cancer annually. The huge number of cancer patients with deteriorating health renders a far greater number of informal caregivers bearing the burden of care in different forms and magnitude. The main purpose of the study was to explore the types of burden perceived by the informal caregivers and the factors associated with the caregiving burden.
Methods: A quantitative descriptive cross-sectional study design was adopted to answer the research questions from April to May 2016. Around 200 informal caregivers were recruited from one of the tertiary hospitals of Karachi, Pakistan. The modified ZBIS …

A Systematic Review Of Home-Based Dietary Interventions During Radiation Therapy For Cancer., Taylor H Allenby, Megan L Crenshaw, Katlynn Mathis, Colin E Champ, Nicole L Simone, Kathryn H Schmitz, Leila T Tchelebi, Nicholas G Zaorsky

Department of Radiation Oncology Faculty Papers

Purpose: Our objectives are to assess (1) the acceptability and feasibility of dietary interventions for patients undergoing radiation therapy (RT), and (2) the impact of dietary interventions on patient reported outcomes, toxicities, and survival.

Methods: A PICOS/PRISMA/MOOSE selection protocol was used to include articles that evaluate adding dietary interventions to patients receiving RT. Acceptability was defined as (# accepting/# approached); feasibility was (# completing/# approached). Patient-reported outcomes were reported based on questionnaires used in each study and survival was measured from the date of diagnosis until death in each study. Level of evidence was assessed with Center for Evidence-Based Medicine …

Target Treatment With Stereotactic Radiation For Recurrent Gliomas, Ayesha Ali, Victor E. Chen, Claire Zurlo, James M Taylor, Christian Fernandez, Wenyin Shi

Department of Radiation Oncology Faculty Papers

High grade gliomas (HGG) have a propensity to recur locally and have poor outcomes. As such, safe and effective treatment is paramount. Target treatment with stereotactic radiation allows safe re-irradiation through minimizing normal brain tissue radiation due to its high precision. In this review, we evaluated the clinical experiences using SRS and FSRT for re-irradiation in HGG. We report the radiobiological advantages and disadvantages of both modalities as well as the safety and efficacy published in current literature.

Analysis Of Racial/Ethnic Disparities And Language Barriers In Radiation Therapy, Carrie Warner

Honors Projects

It is important for every patient within healthcare to have access to and receive quality care no matter their race, ethnicity, and/or primary language. Focusing on cancer care in the United States, there are racial and ethnic disparities as well as language barriers, both within the English language itself and with foreign languages, that prevent patients from receiving high quality care. This meta-analysis provides evidence of current disparities within healthcare that can be applied to the radiation oncology department and reveals suggestions for advancements including the use of language-concordant physicians and medical interpreters. Some of the policies, plans, and resources …

Nuclear-Targeted Gold Nanoparticles Enhance The Effects Of Radiation Therapy With And Without Liposomal Delivery, Maureen Aliru

Dissertations and Theses (Open Access)

Less that 10% of pancreatic cancer patients are eligible for curative resection, and clinical trials evaluating chemoradiation in locally advanced patients with unresectable disease have been largely disappointing. New and creative therapeutic approaches are needed to address the unment need for treatment options. The objective of this thesis is to advance radiosensitization of treatment-resistant densely desmoplastic pancreatic cancer using nanoparticles to surmount biological barriers to effective particle distribution for DNA-targeting.

Clinical translation of radiosensitizing nanoparticles has stalled owing to technical challenges. Current strategies to use AuNPs for radiosensitization require large quantities of gold, kilovoltage x-rays, immediate irradiation after intravenous administration, …

Low-Dose Radiation Therapy (Ldrt) For Covid-19: Benefits Or Risks?, Pataje G. Prasanna, Gayle E. Woloschak, Andrea L. Dicarlo, Jeffrey C. Buchsbaum, Dörthe Schaue, Arnab Chakravarti, Francis A. Cucinotta, Silvia C. Formenti, Chandan Guha, Dale J. Hu, Mohammad K. Khan, David G. Kirsch, Sunil Krishnan, Wolfgang W. Leitner, Brian Marples, William Mcbride, Minesh P. Mehta, Shahin Rafii, Elad Sharon, Julie M. Sullivan, Ralph R. Weichselbaum, Mansoor M. Ahmed, Bhadrasain Vikram, C. Norman Coleman, Kathryn D. Held

Health Physics and Diagnostic Sciences Faculty Research

©2020 by Radiation Research Society. All rights of reproduction in any form reserved. The limited impact of treatments for COVID-19 has stimulated several phase 1 clinical trials of whole-lung low-dose radiation therapy (LDRT; 0.3-1.5 Gy) that are now progressing to phase 2 randomized trials worldwide. This novel but unconventional use of radiation to treat COVID-19 prompted the National Cancer Institute, National Council on Radiation Protection and Measurements and National Institute of Allergy and Infectious Diseases to convene a workshop involving a diverse group of experts in radiation oncology, radiobiology, virology, immunology, radiation protection and public health policy. The workshop was …

A Reference Data Set For Image Registration Of The Pelvis Using Combinatorial Rigid Registration Optimization (Corro)., Afua A Yorke, David Solis Jr, Thoas Guerrero

Articles

Purpose Clinical image pairs provide the most realistic test data for image registration evaluation. However, the optimal registration is unknown. Using combinatorial rigid registration optimization (CORRO) we demonstrate a method to estimate the optimal alignment for rigid-registration of clinical image pairs.

Methods Expert selected landmark pairs were selected for each CT/CBCT image pair for six cases representing head and neck, thoracic, and pelvic anatomic regions. Combination subsets of a k number of landmark pairs (k-combination set) were generated without repeat to form a large set of k-combination sets (k-set) for k = 4,8,12. The rigid transformation between the image pairs …

The Impact Of Prostate Cancer Treatment On Quality Of Life: A Narrative Review With A Focus On Randomized Data., James M Taylor, Victor E. Chen, Ryan C. Miller, Benjamin A. Greenberger

Department of Radiation Oncology Faculty Papers

Despite excellent oncologic outcomes, the management of localized prostate cancer remains complex and is dependent on multiple factors, including patient life expectancy, medical comorbidities, tumor characteristics, and genetic risk factors. Decades of iterative clinical trials have improved the optimization and utilization of surgical and radiation-based modalities, as well as their combinatorial use with anti-androgen and systemic therapies. While cure rates are high and converging on equivalent disease control should an upfront surgical or radiotherapeutic approach be optimized, the long-term side effects of surgical and radiation-based treatments can differ significantly in nature. Decisions regarding the selection of therapy are therefore best …

Feasibility Of Removable Balloon Implant For Simultaneous Magnetic Nanoparticle Heating And Hdr Brachytherapy Of Brain Tumor Resection Cavities., Paul R. Stauffer, Dario B. Rodrigues, Robert Goldstein, Thinh Nguyen, Yan Yu, Shuying Wan, Richard Woodward, Michael Gibbs, Ilya L. Vasilchenko, Alexey M. Osintsev, Voichita Bar-Ad, Dennis B. Leeper, Wenyin Shi, Kevin D. Judy, Mark D. Hurwitz

Department of Radiation Oncology Faculty Papers

AIM: Hyperthermia (HT) has been shown to improve clinical response to radiation therapy (RT) for cancer. Synergism is dramatically enhanced if HT and RT are combined simultaneously, but appropriate technology to apply treatments together does not exist. This study investigates the feasibility of delivering HT with RT to a 5-10mm annular rim of at-risk tissue around a tumor resection cavity using a temporary thermobrachytherapy (TBT) balloon implant.

METHODS: A balloon catheter was designed to deliver radiation from High Dose Rate (HDR) brachytherapy concurrent with HT delivered by filling the balloon with magnetic nanoparticles (MNP) and immersing it in a radiofrequency …

Breast Carcinoma Metastasis In A Resected Meningioma With Early Diagnosis Of Oligometastatic Disease: A Case Report., Christian Fernandez, Louis Cappelli, Sara Chapin,, Lawrence Kenyon, Christopher J Farrell, Wenyin Shi

Department of Radiation Oncology Faculty Papers

Tumor-to-tumor metastasis describes the ability of primary tumors to metastasize to other primary tumors. These events generally occur in aggressive and widely-metastatic disease, with the appropriate management and significance of these events unknown. A 56-year-old woman with a history of bilateral, localized, invasive lobular breast carcinoma treated with surgery, systemic therapy, and adjuvant radiation presented five and two years post-treatment with progressive neurological symptoms. Imaging revealed an intracranial meningioma, and the patient underwent resection. Pathology revealed metastatic invasive lobular carcinoma cells within the resected meningioma, and the patient was treated with postoperative radiation without sequelae. Subsequent staging scans revealed a …