Brian Brigman

Positions:

Associate Professor of Orthopaedic Surgery

Orthopaedics
School of Medicine

Associate Professor of Pediatrics

Pediatrics
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1994

University of North Carolina at Chapel Hill

Intern, Surgery

University of Nebraska at Lincoln

Resident, Orthopaedic Surgery

University of Nebraska at Lincoln

Fellow, Orthopaedic Oncology

Boston University

Grants:

Fresh Tissue Lab Agreement

Administered By
Orthopaedics
Role
Principal Investigator
Start Date
End Date

Protocol Number: 14-03-PATHOLHUM-02

Administered By
Orthopaedics
Role
Principal Investigator
Start Date
End Date

Publications:

Revisiting the Role of Radiation Therapy in Chondrosarcoma: A National Cancer Database Study.

Background: Although chondrosarcomas (CS) are mostly considered radioresistant, advancements in radiotherapy have brought attention to its use in these patients. Using the largest registry of primary bone tumors, the National Cancer Database (NCDB), we sought to better characterize the current use of radiotherapy in CS patients and identify any potential survival benefit with higher radiation doses and advanced radiation therapies. Methods: We retrospectively analyzed CS patients in the NCDB from 2004 to 2015 who underwent radiotherapy. The Kaplan-Meier method with statistical comparisons was used to identify which individual variables related to dosage and delivery modality were associated with improved 5-year survival rates. Multivariate proportional hazards analyses were performed to determine independent predictors of survival. Results: Of 5,427 patients with a histologic diagnosis of chondrosarcoma, 680 received a form of radiation therapy (13%). The multivariate proportional hazards analysis controlling for various patient, tumor, and treatment variables, including RT dose and modality, demonstrated that while overall radiation therapy (RT) was not associated with improved survival (HR 0.96, 95% CI 0.76-1.20), when examining just the patient cohort with positive surgical margins, RT trended towards improved survival (HR 0.81, 95% CI 0.58-1.13). When comparing advanced and conventional RT modalities, advanced RT was associated with significantly decreased mortality (HR 0.55, 95% CI 0.38-0.80). However, advanced modality and high-dose RT both trended only toward improved survival compared to patients who did not receive any RT (HR 0.74, 95% CI 0.52-1.06 and HR 0.93, 95% CI 0.71-1.21, respectively). Conclusions: Despite the suggested radioresistance of CS, modern radiotherapies may present a treatment option for certain patients. Our results support a role for high-dose, advanced radiation therapies in selected high-risk CS patients with tumors in surgically challenging locations or unplanned positive margins. While there is an associated survival rate benefit, further, prospective studies are needed for validation.
Authors
Catanzano, AA; Kerr, DL; Lazarides, AL; Dial, BL; Lane, WO; Blazer, DG; Larrier, NA; Kirsch, DG; Brigman, BE; Eward, WC
MLA Citation
Catanzano, Anthony A., et al. “Revisiting the Role of Radiation Therapy in Chondrosarcoma: A National Cancer Database Study..” Sarcoma, vol. 2019, 2019. Pubmed, doi:10.1155/2019/4878512.
URI
https://scholars.duke.edu/individual/pub1418046
PMID
31736653
Source
pubmed
Published In
Sarcoma
Volume
2019
Published Date
Start Page
4878512
DOI
10.1155/2019/4878512

Epidemiologic and survival trends in adult primary bone tumors of the spine.

BACKGROUND CONTEXT: Malignant primary spinal tumors are rare making it difficult to perform large studies comparing epidemiologic, survival, and treatment trends. We investigated the largest registry of primary bone tumors, the National Cancer Database (NCDB), to compare epidemiologic and survival trends among these tumors. PURPOSE: To use the NCDB to describe current epidemiologic trends, treatment modalities, and overall survival rates in patients with chordomas, osteosarcomas, chondrosarcomas, and Ewing sarcomas of the mobile spine. The secondary objective was to determine prognostic factors that impact overall survival rates. STUDY DESIGN: Retrospective study. PATIENT SAMPLE: A total of 1,011 patients with primary bone tumors of the spine (377 chordomas, 223 chondrosarcomas, 278 Ewing sarcomas, and 133 osteosarcomas). OUTCOME MEASURES: Five-year survival. METHODS: We reviewed the records of 1,011 patients in the NCDB from 2004 through 2015 with histologically confirmed primary osteosarcoma, chondrosarcoma, Ewing sarcoma, or chordoma of the spine. Demographic, clinical, and outcomes data were compiled and compared using chi-squared tests and ANOVA. Long-term survival was compared using the Kaplan-Meier method with statistical comparisons based on the log-rank test. Multivariate analysis was performed to determine survival determinants. RESULTS: Surgical resection was the primary mode of treatment for chondrosarcoma (90%), chordoma (84%), and osteosarcoma (80%). The treatment for Ewing sarcoma was multimodal involving chemotherapy, radiation therapy, and surgical resection. Five-year survival rates varied significantly with chordomas and chondrosarcomas having the greatest survival (70% and 69%), osteosarcomas having the worse survival (38%), and Ewing having intermediate 5-year survival at 62% (overall log-rank p<.0001). Multivariate analysis demonstrated significantly improved 5-year survival rates with younger age at diagnosis, private insurance status, lower comorbidity score, lower tumor grade, smaller tumor size, surgical resection, and negative surgical margin. Radiation therapy only improved survival for Ewing sarcoma. CONCLUSIONS: This study provides the most comprehensive description of the epidemiologic, treatment, and survival trends of primary bone tumors of the mobile spine. Second, patient and tumor characteristics associated with improved 5-year survival were identified using a multivariate model.
Authors
Kerr, DL; Dial, BL; Lazarides, AL; Catanzano, AA; Lane, WO; Blazer, DG; Brigman, BE; Mendoza-Lattes, S; Eward, WC; Erickson, ME
MLA Citation
Kerr, David L., et al. “Epidemiologic and survival trends in adult primary bone tumors of the spine..” Spine J, vol. 19, no. 12, Dec. 2019, pp. 1941–49. Pubmed, doi:10.1016/j.spinee.2019.07.003.
URI
https://scholars.duke.edu/individual/pub1398171
PMID
31306757
Source
pubmed
Published In
Spine J
Volume
19
Published Date
Start Page
1941
End Page
1949
DOI
10.1016/j.spinee.2019.07.003

NCCN Guidelines Insights: Bone Cancer, Version 2.2017.

The NCCN Guidelines for Bone Cancer provide interdisciplinary recommendations for treating chordoma, chondrosarcoma, giant cell tumor of bone, Ewing sarcoma, and osteosarcoma. These NCCN Guidelines Insights summarize the NCCN Bone Cancer Panel's guideline recommendations for treating Ewing sarcoma. The data underlying these treatment recommendations are also discussed.
Authors
Biermann, JS; Chow, W; Reed, DR; Lucas, D; Adkins, DR; Agulnik, M; Benjamin, RS; Brigman, B; Budd, GT; Curry, WT; Didwania, A; Fabbri, N; Hornicek, FJ; Kuechle, JB; Lindskog, D; Mayerson, J; McGarry, SV; Million, L; Morris, CD; Movva, S; O'Donnell, RJ; Randall, RL; Rose, P; Santana, VM; Satcher, RL; Schwartz, H; Siegel, HJ; Thornton, K; Villalobos, V; Bergman, MA; Scavone, JL
MLA Citation
Biermann, J. Sybil, et al. “NCCN Guidelines Insights: Bone Cancer, Version 2.2017..” J Natl Compr Canc Netw, vol. 15, no. 2, Feb. 2017, pp. 155–67. Pubmed, doi:10.6004/jnccn.2017.0017.
URI
https://scholars.duke.edu/individual/pub1244435
PMID
28188186
Source
pubmed
Published In
J Natl Compr Canc Netw
Volume
15
Published Date
Start Page
155
End Page
167
DOI
10.6004/jnccn.2017.0017

The Use of Radiation Therapy in Well-Differentiated Soft Tissue Sarcoma of the Extremities: An NCDB Review.

Objective. This study investigated patterns of utilization of radiation therapy (RT) and correlated this with overall survival by assessing patients with well-differentiated soft tissue sarcoma of the extremity (STS-E) in the National Cancer Database (NCDB). Methods. All patients diagnosed with well-differentiated STS-E between 1998 and 2006 were identified in the NCDB. Patients were stratified by use of surgery alone versus use of adjuvant RT after surgery and analyzed using multivariate analysis, Kaplan-Meier analysis, and propensity matching. Results. 2113 patients with well-differentiated STS-E were identified in the NCDB for inclusion with a mean follow-up time of 74 months. 69% of patients were treated with surgery alone, while 26% were treated with surgery followed by adjuvant RT. Patients undergoing amputation were less likely to receive adjuvant RT. There was no difference in overall survival between patients with well-differentiated STS treated with surgery alone and those patients who received adjuvant RT. Conclusions. In the United States, adjuvant RT is being utilized in a quarter of patients being treated for well-differentiated STS-E. While the use of adjuvant RT may be viewed as a means to facilitate limb salvage, this large national database review confirms no survival benefit, regardless of tumor size or margin status.
Authors
Lazarides, AL; Eward, WC; Speicher, PJ; Hou, C-H; Nussbaum, DP; Green, C; Blazer, DG; Kirsch, DG; Brigman, BE
MLA Citation
Lazarides, Alexander L., et al. “The Use of Radiation Therapy in Well-Differentiated Soft Tissue Sarcoma of the Extremities: An NCDB Review..” Sarcoma, vol. 2015, 2015. Pubmed, doi:10.1155/2015/186581.
URI
https://scholars.duke.edu/individual/pub1074452
PMID
26064077
Source
pubmed
Published In
Sarcoma
Volume
2015
Published Date
Start Page
186581
DOI
10.1155/2015/186581

Effects of Radiation Therapy on the Detection of Microscopic Residual Cancer in the Surgical Bed using a Protease-activated Fluorescent Probe in a Primary Soft Tissue Sarcoma Model

Authors
Cuneo, KC; Mito, JK; Brigman, BE; Ferrer, JM; Lee, C; Eward, WC; Carter, JE; Kirsch, DG
MLA Citation
Cuneo, K. C., et al. “Effects of Radiation Therapy on the Detection of Microscopic Residual Cancer in the Surgical Bed using a Protease-activated Fluorescent Probe in a Primary Soft Tissue Sarcoma Model.” International Journal of Radiation Oncology*Biology*Physics, vol. 81, no. 2, Elsevier BV, Oct. 2011, pp. S729–30. Crossref, doi:10.1016/j.ijrobp.2011.06.1300.
URI
https://scholars.duke.edu/individual/pub867094
Source
crossref
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
81
Published Date
Start Page
S729
End Page
S730
DOI
10.1016/j.ijrobp.2011.06.1300