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:

A protocol to reduce self-reported pain scores and adverse events following lumbar punctures in older adults.

OBJECTIVE: Lumbar punctures (LPs) are important for obtaining CSF in neurology studies but are associated with adverse events and feared by many patients. We determined adverse event rates and pain scores in patients prospectively enrolled in two cohort studies who underwent LPs using a standardized protocol and 25 g needle. METHODS: Eight hundred and nine LPs performed in 262 patients age ≥ 60 years in the MADCO-PC and INTUIT studies were analyzed. Medical records were monitored for LP-related adverse events, and patients were queried about subjective complaints. We analyzed adverse event rates, including headaches and pain scores. RESULTS: There were 22 adverse events among 809 LPs performed, a rate of 2.72% (95% CI 1.71-4.09%). Patient hospital stay did not increase due to adverse events. Four patients (0.49%) developed a post-lumbar puncture headache (PLPH). Twelve patients (1.48%) developed nausea, vasovagal responses, or headaches that did not meet PLPH criteria. Six patients (0.74%) reported lower back pain at the LP site not associated with muscular weakness or paresthesia. The median pain score was 1 [0, 3]; the mode was 0 out of 10. CONCLUSIONS: The LP protocol described herein may reduce adverse event rates and improve patient comfort in future studies.
Authors
Nobuhara, CK; Bullock, WM; Bunning, T; Colin, B; Cooter, M; Devinney, MJ; Ferrandino, MN; Gadsden, J; Garrigues, G; Habib, AS; Moretti, E; Moul, J; Ohlendorf, B; Sandler, A; Scheri, R; Sharma, B; Thomas, JP; Young, C; Mathew, JP; Berger, M; MADCO-PC and INTUIT Investigators Teams,
MLA Citation
Nobuhara, Chloe K., et al. “A protocol to reduce self-reported pain scores and adverse events following lumbar punctures in older adults.J Neurol, Mar. 2020. Pubmed, doi:10.1007/s00415-020-09797-1.
URI
https://scholars.duke.edu/individual/pub1434663
PMID
32198714
Source
pubmed
Published In
J Neurol
Published Date
DOI
10.1007/s00415-020-09797-1

Does facility volume influence survival in patients with primary malignant bone tumors of the vertebral column? A comparative cohort study.

BACKGROUND CONTEXT: Facility volume has been correlated with survival in many cancers. This relationship has not been established in primary malignant bone tumors of the vertebral column (BTVC). PURPOSE: To investigate whether facility patient volume is associated with overall survival in patients with primary malignant BTVCs. STUDY DESIGN: Retrospective comparative cohort. PATIENT SAMPLE: Adult patients with chordomas, chondrosarcomas, or osteosarcomas of the mobile spine. OUTCOME MEASURES: Five-year survival. METHODS: We retrospectively analyzed 733 patients with primary malignant BTVCs in the national cancer database from 2004 through 2015. Univariate and multivariate analyses were used to correlate specific outcome measures with facility volume. Volume was stratified based on cumulative martingale residuals to determine the inflection point of negative to positive impact on survival based on the patient cohort. Long-term survival was compared between patients treated at high and low volume using the Kaplan-Meier method. Only patients with malignant primary tumors were considered eligible for inclusion; patients with incomplete treatment data or benign tumors were excluded. RESULTS: Patients treated at high-volume centers (HVCs) were younger (p=.0003) and more likely to be insured (p<.0001). There were no significant differences in tumor characteristics. Patients treated at high-volume facilities had improved 5-year survival of 71% versus 58% at low-volume centers (p<.0001). Patients treated at HVCs were more likely to receive surgical treatment (91% vs. 80%, p<.0001); if surgery was performed, they were more likely to undergo an en bloc resection (48% vs. 30%, p<.0001). However, there were no differences in margin status or utilization of radiotherapy or chemotherapy between HVCs and low-volume centers. In a multivariate analysis, facility volume was independently associated with improved survival overall (HR 0.75 [0.58-0.97], p=.03). CONCLUSIONS: Primary malignant BTVCs are rare, even for HVCs. Despite this, patient survival was significantly improved when treatment was performed at HVCs.
Authors
Lazarides, AL; Kerr, DL; Dial, BL; Steele, JR; Lane, WO; Blazer, DG; Brigman, BE; Mendoza-Lattes, S; Erickson, MM; Eward, WC
MLA Citation
Lazarides, Alexander L., et al. “Does facility volume influence survival in patients with primary malignant bone tumors of the vertebral column? A comparative cohort study.Spine J, Mar. 2020. Pubmed, doi:10.1016/j.spinee.2020.02.020.
URI
https://scholars.duke.edu/individual/pub1433959
PMID
32145357
Source
pubmed
Published In
Spine J
Published Date
DOI
10.1016/j.spinee.2020.02.020

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, p. 4878512. 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

Flow Cytometry Characterization of Cerebrospinal Fluid Monocytes in Patients With Postoperative Cognitive Dysfunction: A Pilot Study.

Animal models suggest postoperative cognitive dysfunction may be caused by brain monocyte influx. To study this in humans, we developed a flow cytometry panel to profile cerebrospinal fluid (CSF) samples collected before and after major noncardiac surgery in 5 patients ≥60 years of age who developed postoperative cognitive dysfunction and 5 matched controls who did not. We detected 12,654 ± 4895 cells/10 mL of CSF sample (mean ± SD). Patients who developed postoperative cognitive dysfunction showed an increased CSF monocyte/lymphocyte ratio and monocyte chemoattractant protein 1 receptor downregulation on CSF monocytes 24 hours after surgery. These pilot data demonstrate that CSF flow cytometry can be used to study mechanisms of postoperative neurocognitive dysfunction.
Authors
Berger, M; Murdoch, DM; Staats, JS; Chan, C; Thomas, JP; Garrigues, GE; Browndyke, JN; Cooter, M; Quinones, QJ; Mathew, JP; Weinhold, KJ; MADCO-PC Study Team,
MLA Citation
Berger, Miles, et al. “Flow Cytometry Characterization of Cerebrospinal Fluid Monocytes in Patients With Postoperative Cognitive Dysfunction: A Pilot Study.Anesth Analg, vol. 129, no. 5, Nov. 2019, pp. e150–54. Pubmed, doi:10.1213/ANE.0000000000004179.
URI
https://scholars.duke.edu/individual/pub1385799
PMID
31085945
Source
pubmed
Published In
Anesth Analg
Volume
129
Published Date
Start Page
e150
End Page
e154
DOI
10.1213/ANE.0000000000004179

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