#Ariel Lipson

[keshetaylonit]

Transcript: This transgender Jew is tired of the anti-Semitism in the LGBTI community. After the Chicago Dyke March fiasco, where three Jewish lesbians carrying a Pride flag featuring the Star of David were kicked off the march by organizers for ‘supporting Zionism,’ the issue of anti-Semitism in the LGBTI community has been coming to light. Most recently, the Chicago Dyke March Tweeted using the term ‘Zio,’ a derogatory term for Jews coined by David Duke of the KKK. Many LGBTI advocates, like the organizers of the Chicago Dyke March, are vehemently anti-Israel, claiming the country is participating in an ‘genocide’ of the Palestinian people. One such activist is Pauline Park, a transgender woman associated with the group NYC Queers Against Israeli Apartheid, who often posts publicly about her pro-Palestinian activism, using buzzwords like ‘genocide,’ ‘apartheid,’ and ‘occupation.’ ‘That Pauline has no clue as to what genocide actually is, or what apartheid actually means, is obvious, but it is just as clear that she understands that such terms are trigger words for many whom she claims she is trying to persuade,’ writes Dana Beyer for Huffington Post. ‘That she is willing to defend a terrorist government that, upon meeting her, would ask her to kneel to be beheaded because she is a trans woman is inexplicable.’ ‘Is Israel a paradise for the LGBT community? No, not by a long shot. But it is getting better, and Israeli gay and trans people don’t escape into the West Bank and Gaza; Palestinians do escape into Israel. What is going on in the Middle East — and that includes the terror in Libya, Syria and Iraq, to say nothing about all the other rabidly sexist and homophobic regimes in the Muslim world — is not comparable to several months of demonstration against the LGBT Center of New York. Talk of “homonationalism” and “pinkwashing” as tools to stifle dissent is not just absurd; it is insane.’ Meet the fed up, trans, queer Jew Ariel Lipson is a 20-year-old queer trans man from Seattle, Washington. Lipson identifies as ‘Ay’lonit,’ which is a Jewish term used to describe someone ‘identified as “female” at birth but develops “male” characteristics at puberty and is infertile.’ Lipson began noticing the anti-Semitism of the LGBTI community upon entering high school. ‘The high school I attended was predominantly LGBTQ+, both students and staff,’ he explains. ‘While at the time I was working through my own internalised anti-Semitism, I did notice that being a part of Judaism, and being open about it ostracised me. I had people interrogate me about [the Israel/Palestine conflict], refuse to let me enter the space, and accused me of being complicit in genocide,’ he continues. ‘At this time I was staunchly anti-Zionist. As I got older, I saw the community become more and more cold towards Jews. I joined a youth group, and when I would talk about it, and people found out I was Jewish, they would be startled, and avoid me. I went to a LGBTQ camp, and while it was in general ok, there were moments of Jew = Israel. The main hub of LGBTQ+ space in Seattle is also big on activism, and being Jewish, and not willing to put up with comparisons to Nazi Germany or that your fellows control media/government/etc means that you are not going to be all that welcome in much of the spaces there.’ One moment in particular that sticks out in Lipson’s mind is the day he decided to wear a Star of David to school. ‘I had just bought it, and was so happy to wear it. I went to school, and felt proud. Here I was, accepting myself,’ he recalls. He then remembers having the following dialogue with a classmate: ‘“Oh are you Jewish?” “Yes.” “I had no idea. Sorry to hear that.” “What?” “You’re Israeli, so that means you kill children”’ ‘From that moment on I was shunned by classmates, had my trans authenticity mocked, as being Jewish meant I could not be LGBTQ+ for some reason,’ he says. Now, Lipson is sick and tired of engaging with non-Jewish LGBTI activists who often conflate Zionism with Judaism and utilize anti-Semitic tropes in their activism, such as Pauline Park. After recently being in a heated Facebook argument with Park, who told Lipson and numerous other queer Jews that their perspectives on anti-Semitism were invalid, he has officially had enough. ‘Any activist who behave as Ms. Park does is not an activist,’ Lipson states. ‘If they refuse to listen to a minority asking them to stop using stereotypes, tropes or words that oppress them, then they are not really working towards equality or freedom.’ ‘In short, I am hurt. However I am unsurprised. We saw it in [the Chicago Dyke March], we see it with Pauline Park, we see it with countless activists across the United States, Canada and the Western world.’ ‘As Jews, we have come to expect anti-Semitism in activist and LGBTQ+ spaces. I used to hide that I was Jewish, now I don’t. Is that dangerous? Yes. But it is a way to not only find the spaces that I can feel safe in, but I should not have to hide who I am. I should not have to be a closeted Jew. Being LGBTQ+ is about being proud. How can I be my whole and authentic self if I cannot be open about my ethnicity, people, culture, faith and history.’ Doing better moving forward Lipson believes that one can be anti-Israel without being anti-Semitic. He recommends this guide for how to do so. As for advice for the LGBTI community to be more inclusive of Jewish voices, Lipson says the following: ‘First and foremost, see us a human. View us as peers. We, too, are a minority. We, too, are oppressed. Ours is not just a religious culture, but an ethno-religious culture that stretches back nearly 6,000 years. Throughout that time, we have been oppressed. Our oppression did not begin, nor end with the Shoah. It still permeates today in every corner of the globe. Jews are fleeing France in droves. The last remnants of Syrian Jewry fled their homes not even 5 years ago.’ ‘If you want to be more inclusive to the Jewish LGBTQ+ community, start by listening. Like any other minority that you do not belong to, you do not get to dictate what is, or is not anti-Semitic. You do not get to tell us what our oppression is, or is not. That is for Jews, and only Jews, to decide. Your job is to stop talking, listen, learn, and act upon what you have learned to make your spaces safer for Jews. You do not get to interrogate every person with a Magen David Necklace or a Kippah. You do not get to stop listening to a Jewish person because they are a Zionist. That is not how activism works.’ ‘We do not rule the world. We do not eat babies. We do not sacrifice virgins. We do not run the media. We are real, live human beings. Treat us with respect as you would any other person.’ By: Rafaella Gunz @tikkunolamorgtfo @littlegoythings

[eretzyisrael]

‘Any activist who behave as Ms. Park does is not an activist,’ Lipson states. ‘If they refuse to listen to a minority asking them to stop using stereotypes, tropes or words that oppress them, then they are not really working towards equality or freedom.’

‘Using Trans, Jewish and Palestinian bodies to push hate towards a minority is lazy, and false activism. It is oppression. I see so many activists leave Jews out of their speeches, out of their activism.’

‘In short, I am hurt. However I am unsurprised. We saw it in [the Chicago Dyke March], we see it with Pauline Park, we see it with countless activists across the United States, Canada and the Western world.’

‘As Jews, we have come to expect anti-Semitism in activist and LGBTQ+ spaces. I used to hide that I was Jewish, now I don’t. Is that dangerous? Yes. But it is a way to not only find the spaces that I can feel safe in, but I should not have to hide who I am. I should not have to be a closeted Jew. Being LGBTQ+ is about being proud. How can I be my whole and authentic self if I cannot be open about my ethnicity, people, culture, faith and history.’

[neitherlandslibrary]

Happy International Women’s Day

to all the female-identifying people! 

As we could not put everyone on the gifset, we also want to shout out to all the woman inside and outside the show

Character in the show: Callie, Camille, Carol, Cindy Gaines, Copy Girl, Crying Woman, Dr. Jennifer London, Dragon, Emily Greenstreet, Etta, Eve, Female Professor, Fray, Genji, Gretchen, Harriet, Healer Faye, Hedge #1,  Homicide Detective  #1, Irene McAllistair, Iris, Kimber D'Antoni, Kira, Lia, Librarian Rona, Mackenzie, Old Woman, Orgy Girl #1, Orgy Girl #2, Phyllis, Prof. Pearl Sunderland, Poppy, Professor Bigby, Psychic Girl #2, Rainbow Girl, Receptionist, Sam Cunningham, Shelia, Stone Queen, Sylvia, The Prophet, The White Lady, Whitley, Young Hedge, AD, Arielle, Arleen, Ashley the Bookie, Baba Yaga (and the girl she posess), Beatrice McAllister,Beatrix, Becky, Dana, Doctor Meers, Dr. Higgins, Evelyn,Fairy Queen, Fillorian Mother, Goldie, Hanna, Harriet, Healer Tara, Heloise,Homeless Lady, Jane Chatwin,Marina Andrieski,Mellony, Napster, Natural Student #1,Nurse#1, Nurse#2, Persephone, Physical Kid #1, Poppy, Professor Lipson, Prudence Plover, Quentin's Mother, Rhona, Scared Woman 36,Shara,Shoshana, Silver, Skye, Sonia 36, Spectre, Stephanie Quinn, Stephanie's Friend, Suzie, TV Crew, Victoria, Water Dragon,Zal, Zelda and all uncredited characters!

off cameras woman : Adela Baborova, Aeryn Gray, Alexandra Rojek, Allison Gordin, Alma Kuttruff, Alyssa Jacobson, Amber Crombach, Amber Waters, Ana Lossada, Ana Lossada, Angie Kennedy, Anna Register, Annalese Tilling, Anne Grennan, Ashley Biggs, Ashley Mason, Athena Wong,Audrey Himmer-Jude, Aylwin Fernando, Barbara Jansen, Beth Williams, Blair Richmond, Blythe Bickham, Breanna Watkins, Bree Brincat, Briana Skye, Brittney Diez, Caitlin Groves, Candice Harvey, Cara Doell, Carmen Lavender, Carole Appleby, Caroline Milliard, Carolyn McCauley, Carolyn Williams,Carrie Audino ,Cassandra Parigian, Cathy Darby, Chere Theriot, Cherie Bessette, Cherie Smid, Cheryl Callihoo, Christina Nakhvat, Clara George, Clarinda Wong, Coreen Mayrs, Crystal Mudry, Danielle White, Debbie Douglas, Deborah Burns, Deborah Burns, Deneen McArthur, Denya McLean-Adhya, Desiree J. Cadena, Donna Stocker, Elie Smolkin, Elizabeth Rainey, Elle Lipson, Emily Nomland, Emily Upham, Emily Weston, Emmanuelle Charlier, Errin Clutton, Eunice Yeung, Eva Abramycheva, Gilda Longoria, Ginge Cox, Grace Delahanty, Heike Brandstatter, Helen Geier, Irina Berdyanskaya, Irwin Figuera, Janene Carleton, Janet D. Munro, Janice MacIsaac,Janice Williams, Jayne Dancose, Jenni Macdonald, Jennifer Gilevich, Jennifer Kaminski, Jennifer Machnee, Jennifer Nelson, Jesse Toves, Jessica Goodwin, Jessica Williams, Juli Van Brown, Julia Holt, June E. Watson, Justin Coulter, Kai Lesack, Kara Bowman, Karen Lorena Parker, Karina Partington, Karley Stroscher, Karly Paranich, Kate Marshall, katerina Motylova, Kathie Singh, Katie Letien,  Katrissa 'Kat' Peterson, Kelli Dunsmore, Kendelle Elliott, Kristy Jelinek, Kyla Rose Tremblay, Kyle Landry, Laura Dickinson, Laura Schiff, Lauren Aspden, Lauren Beason, Laurie Lieser, Leslie Cairns, Lisa Blaxley, Lisa Chandler, Lisa Godwin, Lisa Pouliot, Lisa Pouliot, Lisle Fehlauer, Liz Goldwyn, Lucie Elwes, Luisa Abuchaibe, Lyne Talbot, Lynn Werner, Madeline Jensen, Madison Mah, Madison Penland, Magali Guidasci, Maisie Lucas, Margot Ready, Maria Gleeson, Marie Marolle, Marijke Richman, Martha Dietsche, Mary Hubert, Meghan Kelly, Michelle Kabatoff, Michelle Kee, Michelle Yu, Miluette Nalin, Mimi Dejene, Nadia Alaskari, Natasha Wehn, Nicole Bivens, Nina Göldner, Patricia Jagger, Patti Henderson, Paula Antil, Polina Nikolai, Pricilla Rodgers,Priya Ayengar, Rachel O'Toole,Rita K. Sanders, Rudy Jones, Sam Ochotta, Sarah McLauchlan, Sera Gamble, Shae Salmon, Shae Salmon, Shailey Horton, Shannon Courte, Shannon Kohli, Shannon McArthur, Sharon Dever, Shelly Goldsack, Shelly Shaw, Sina Nazarian, Sondra Durkse, Sonia V. Torres, Sophia Delgiglio, Stephane Bourgeault, Stephanie Plett, Sue Blainey, Sumner Boissiere III, Sunil Pant, Taja Perkins, Tamara Daroshin, Teresa Brauer, Tracey McLean,Tracie Hansen, Tracie Leaphart, Tracy Craigen, Vanja Cernjul, Wendy Foster, Wendy Snowdon, Wendy Talley 

(Source IMDB) 

[the-3rd-key]

Prompt: Queliot, 31. "If you sing that song one more time, I will kill you." Your last one with the Hallmark movie was gorgeous, btw!

Thank you!! I’m glad you liked it. Sorry it took so long to finish this. I got stuck, and then it ended up being twice as long as my last one… so I should probably just throw it up on AO3.

The cottage is dark as Eliot helps a stumbling Quentin through the front door. Eliot wonders why everyone is asleep already, then remembers that it’s three AM on a Tuesday, and it’s not like they have a lot of parties anymore. Even though magic is back and stronger than ever, the cottage smells of dust and cleaning supplies. And when Eliot flicks on a light switch, the warm light does little to change the fact that it feels… empty.

At least Quentin is here, hanging on to Eliot’s shoulders for dear life.

“Shit. Am I putting too much weight on you?” Quentin’s speech is relaxed, but not slurred, as lets go of Eliot and balances himself against the wall. Hesmirks, eyebrows raised.

Warmth floods Eliot, and he can’t tell whether his fingers are tingling from too many Old Fashioneds, or too much Quentin Coldwater. Like there’s such a thing as too much Quentin Coldwater.

Laughing, Eliot takes Quentin’s hand and pulls him away from the wall, but Quentin stops short of Eliot’s embrace.

“What’s wrong?” Eliot asks.

Quentin’s brows stitch together as he looks down at Eliot’s stomach. “I don’t want to—”

“I told you.” Eliot squeezes Quentin’s hand. “Lipson cleared me for most activities as long as I’m careful.”

Quentin smiles, lacing his fingers with Eliot’s and pulling him closer. “Most activities?”

The scent of gin wafts between them and floods Eliot with warmth. “How many Tom Collins did you have again?”

“It was your idea to go to a Prohibition bar,” Quentin mumbles into Eliot’s neck.

Quentin’s lips send shivers up Eliot's neck. God, he needs to stop that.

“I’m just saying.” Eliot takes a step back and grips Quentin’s shoulders. “You reek of Beefeater. Go sit down, and I’ll bring you some water. You’ll keep us both awake if you’re getting out of bed to puke every fifteen minutes.”

With a sigh, Quentin stumbles toward the living room. His foot catches on the rug as he falls face-first into the couch with an “Oof…” 

Eliot rushes to help him, but Quentin gives a thumbs up before he can get there.

“Okay. So you’re… good?” Eliot looks rapidly back and forth between Quentin and the kitchen. “Um. Water. Right. You should sit up.”

Quentin makes a noncommittal noise.

Half amused, half annoyed, Eliot hurries to the kitchen, rummages through the cabinets for the largest glass he can find, and fills it up.

When Eliot returns, Quentin is still lying face down on the couch, head buried in a throw pillow. And he‘s mumbling to himself. No, not mumbling. Singing?

The tune sounds familiar, but Quentin is off key as usual, so Eliot can’t quite place it.

“What are you singing?”

Quentin turns his head, cheek smashed against the pillow so that his lips stick out.

Eliot’s heart jumps. Adorable.

“You didn’t recognize it?” Quentin asks.

Eliot shrugs. Don’t make me say you can’t sing, Q.

Quentin clears his throat. “Just a small town boy…”

Eliot’s laugh is louder and more high-pitched than he intended. Because Quentin is singing Journey. Journey, of all things.

“It’s a small town girl. Not a small town boy.” The laughter keeps overflowing from Eliot‘s chest. “Boy doesn’t rhyme with world.”

“Neither does girl,” Quentin says.

“It’s a slant—”

“I know it’s a slant rhyme. I passed my lit classes.” As Quentin looks up, his hair—which is now as long as it was when Eliot first met him—flops over his face.

Quentin blows a stray strand of hair out of his eyes, and Eliot’s mind is buzzing from expensive cocktails and some long-forgotten feeling from a lifetime he spent breathing in opium and laying tiles and playing tag with Quentin’s—with their son.

Eliot sits cross-legged on the floor next to Quentin. And before he knows what he’s doing, before he can stop himself, Eliot’s hand is moving toward Quentin, and it’s resting on Quentin’s cheek. And his thumb is rubbing at the stubble on Quentin’s jawline. And somewhere in the back of his mind, Eliot realizes Quentin is placing his hand over Eliot’s, and bringing Eliot’s hands to his lips. Pressing his lips to Eliot’s hand.

Eliot’s heart thrums, and he’s certain Quentin knows exactly what he’s thinking. What he’s feeling.

Eliot clears his throat. Tries to sort out the fifty years of thoughts that rise out of his chest like smoke. Fifty years of emotion that twist and whirl as Quentin sing-screeches out the next line.

“Just a city boy. Born and raised in North New Jersey…”

Eliot realizes then… Quentin is drunkenly changing the lyrics of a fucking Journey song to be about them.

“I know I can’t sing, El,” Quentin grins. “But I’m too drunk to care.”

And Eliot says, in a voice that’s bursting at the seams with an affection he doesn’t want to hide anymore, “If you sing that song one more time, I will kill you.”

“I could sing some Tom Petty. About how you grew up in an Indiana town.”

“C’mon, Q.” Eliot taps his shoulder. “You need to hydrate.”

Quentin grins. He’s been doing that a lot more recently. “Since when do you care about hydration?”

Since we almost died like two months ago?

When Quentin concedes and sits up, Eliot hands him the glass of water.

He drinks in seconds and lets the glass fall limp in his hand. “Do you remember?”

Eliot raises an eyebrow. “Remember what?”

Quentin looks down at the floor. Takes in a deep breath. “How we used to sing Earth songs.”

Earth songs. Eliot’s limbs are weak. Shaking. Quentin remembers a lot more than he lets on. They both do. And when Eliot stops and thinks about it for long enough, it all comes flooding back.

Eyes glazed over, Quentin stares off in the distance. Eliot lays his head in Quentin’s lap and takes his hand, stroking his thumb over Quentin’s palm. Memories recollected in intimate moments are the only reminder Eliot has from that lifetime.

Quentin gulps. His gaze flickers to Eliot. “You used to sing Blackbird to Teddy after Arielle died.”

When Eliot speaks, it comes out as a whisper that scrapes against the lump swelling in his throat. “I remember.”

Quentin looks down again, and says in a voice so soft—so unsure—that it wrenches Eliot’s heart, “Do you think we’ll ever have that again?”

Eliot looks around the cottage. It’s theirs, but it’s not theirs. There’s no mosaic to build. No orchards with peach and plum trees nearby. And it’s got modern appliances and expensive booze and cable, not a fireplace and a dirt floor and wooden shutters.

Quentin clears his throat, and Eliot realizes it’s Quentin who’s putting his heart on the line again—like he always does. So Eliot pulls himself off the floor and plops down next to Quentin. Drunk, adorable Quentin, who loves him. Who’s looking down at his feet because Eliot’s already broken his heart once.

Eliot’s working hard on making amends every day, but he’s got a long way to go. When he lays a hand on Quentin’s thigh, Quentin looks at him with some mixture of hope and apprehension. And Eliot brings his hand to Quentin’s neck like he has so many times before and pulls him close. Quentin’s kisses are soft. Careful. Familiar. And somehow, he tastes not of gin, but of fresh juniper.

When they break, Eliot presses his forehead to Quentin’s. “I think we’re already on our way.”

[vm4vm0]

Settle Down | Taylor Phelan from Ariel Fish on Vimeo.

Settle Down - Taylor Phelan (Official Video)

Directed by: Ariel Fisher Director of Photography: Christopher Ripley Production Company: Anthem Films EP: DJay Brawner & Blake Greenbaum Producer: Victoria Fayad Choreography by: Erin Murray Video Commissioner: Steve Gottlieb Video Rep: Doug Klinger | Reprobates.tv

Settle Down: Written by: Taylor Phelan & Joshua Niles Performed by: Taylor Phelan Record Label: Native Nine

Cast: Antoine Renaut, Austyn Rich, Ben Lipson, Bruce Wildstein, Clark Long, Erin Durand, Jack Lipson, Jay Lenhert, Jessica Gadzinski, Junji Dezaki, Kathleen Roy, Ken Murphy, Marc Livingood, Maria Margarita Chon, Meredith Adelaide, Miriam Malabel, Natalie Turner, Nikki Phelan, Renato Gamez, Rob James, Sam Teaford, Simone Thompson

Crew: 1st AD: Jesse Hays Art Direction: Ariel Fisher Production Designer: Kalie Acheson 1st AC: Megan Johnson Key Grip: Pablo Ruff-Berganza Art Assistant: Samuel Raymond Steadicam: Parker Brooks Behind the Scenes Video by: Mike Windle Gaffer: Jake Kaster Grip: Pierre Habib Best Boy Electric: David Engle Hair and Makeup: Meg Wilbur Wardrobe & Stylist: Alyssa Sutter Wardrobe Assistant: Jessica Schwartz Title Design by: Alex Souetre Edited by: Chad Sarahina Dancer Casting: Erin S. Murray & Ania Catherine Color: Christopher Ripley Coordinator: Natasha Stephenson Key PA: Zac Weathers Art PA: Sellers Thomas PA's: Cass Vogel, Rachel Blumberg, Vincent Delorenzi

SPECIAL THANKS DJay Brawner, Ania Catherine, Gabriel Younes, Alex Souetre, Native Nine Records, Mike Windle, Sinziana Velicescu

[antisemitism-us]

Ariel Lipson is a 20-year-old queer trans man from Seattle, Washington. Lipson identifies as ‘Ay’lonit,’ which is a Jewish term used to describe someone ‘identified as “female” at birth but develops “male” characteristics at puberty and is infertile.’

Lipson began noticing the anti-Semitism of the LGBTI community upon entering high school.

‘The high school I attended was predominantly LGBTQ+, both students and staff,’ he explains.

‘While at the time I was working through my own internalised anti-Semitism, I did notice that being a part of Judaism, and being open about it ostracised me. I had people interrogate me about [the Israel/Palestine conflict], refuse to let me enter the space, and accused me of being complicit in genocide,’ he continues.

‘At this time I was staunchly anti-Zionist. As I got older, I saw the community become more and more cold towards Jews. I joined a youth group, and when I would talk about it, and people found out I was Jewish, they would be startled, and avoid me. I went to a LGBTQ camp, and while it was in general ok, there were moments of Jew = Israel. The main hub of LGBTQ+ space in Seattle is also big on activism, and being Jewish, and not willing to put up with comparisons to Nazi Germany or that your fellows control media/government/etc means that you are not going to be all that welcome in much of the spaces there.’

One moment in particular that sticks out in Lipson’s mind is the day he decided to wear a Star of David to school.

‘I had just bought it, and was so happy to wear it. I went to school, and felt proud. Here I was, accepting myself,’ he recalls. He then remembers having the following dialogue with a classmate:

‘“Oh are you Jewish?”

“Yes.”

“I had no idea. Sorry to hear that.”

“What?”

“You’re Israeli, so that means you kill children”’

‘From that moment on I was shunned by classmates, had my trans authenticity mocked, as being Jewish meant I could not be LGBTQ+ for some reason,’ he says.

Now, Lipson is sick and tired of engaging with non-Jewish LGBTI activists who often conflate Zionism with Judaism and utilize anti-Semitic tropes in their activism, such as Pauline Park. After recently being in a heated Facebook argument with Park, who told Lipson and numerous other queer Jews that their perspectives on anti-Semitism were invalid, he has officially had enough.

‘Any activist who behave as Ms. Park does is not an activist,’ Lipson states. ‘If they refuse to listen to a minority asking them to stop using stereotypes, tropes or words that oppress them, then they are not really working towards equality or freedom.’

[cancersfakianakis1]

Concurrent Immune Checkpoint Inhibitors and Stereotactic Radiosurgery for Brain Metastases in Non-Small Cell Lung Cancer, Melanoma, and Renal Cell Carcinoma

Publication date: Available online 5 December 2017 Source:International Journal of Radiation Oncology*Biology*Physics Author(s): Linda Chen, Jacqueline Douglass, Lawrence Kleinberg, Xiaobu Ye, Ariel E. Marciscano, Patrick M. Forde, Julie Brahmer, Evan Lipson, William Sharfman, Hans Hammers, Jarushka Naidoo, Chetan Bettegowda, Michael Lim, Kristin J. Redmond PurposeTo characterize the effect of concurrent stereotactic radiosurgery/stereotactic radiotherapy (SRS/SRT) and immune checkpoint inhibitors (ICI) on patient outcome and safety in patients with brain metastases (BM).Materials/Methods: We retrospectively identified metastatic non-small cell lung cancer (NSCLC), melanoma, and renal cell carcinoma (RCC) patients who had BM treated with SRS/SRT from 2010-2016 without prior whole brain radiotherapy (WBRT). We included SRS/SRT patients who were treated with anti-CTLA4 (ipilimumab) and anti-PD-1 (nivolumab, pembrolizumab). Patients who were given ICI on active or unreported clinical trials were excluded, and concurrent ICI was defined as given within 2 weeks of SRS/SRT. Patients were managed with SRS/SRT, SRS/SRT with non-concurrent ICI, and SRS/SRT with concurrent ICI. Progression free survival (PFS) and overall survival (OS) were estimated using Kaplan-Meier survival curves, and cox proportional hazard models were used for multivariate analysis. Logistic regression was used to identify predictors of acute neurologic toxicity, immune-related adverse events (irAEs), and new BM.Results260 patients were treated with SRS/SRT to 623 brain metastases. 181 were treated with SRS/SRT only and 79 with SRS/SRT and ICI, with 35% of patients treated with concurrent SRS/SRT and ICI. Concurrent ICI was not associated with increased rates of irAEs or acute neurologic toxicity and predicted for a decreased likelihood of developing ≥ 3 new BM following SRS/SRT (p=0.045, OR 0.337). Median OS for patients treated with SRS/SRT, SRS/SRT and non-concurrent ICI, and SRS/SRT with concurrent ICI was 12.9, 14.5, and 24.7 months respectively. Concurrent SRS/SRT and ICI was associated with improved OS compared to SRS/SRT only (p=0.002, HR 2.69) and compared to non-concurrent SRS/SRT and ICI (p=0.006, HR 2.40) on multivariate analyses. The OS benefit of Concurrent SRS/SRT and ICI was significant in comparison to patients treated with SRS/SRT pre (p=0.002, HR 3.82) or post (p=0.021, HR 2.64) ICI.ConclusionDelivering SRS/SRT with concurrent ICI may be associated with decreased incidence of new BM and favorable survival outcomes without increased rates of adverse events.

Teaser

Radiation is hypothesized to augment the immunogenicity of tumor cells. We retrospectively evaluated survival outcomes, incidence of new brain metastases, and treatment-related adverse events in patients who received stereotactic radiosurgery for brain metastases with concurrent immune checkpoint inhibition, with non-concurrent immune checkpoint inhibition, and with stereotactic radiosurgery alone. Delivering SRS with concurrent ICI may be associated with decreased incidence of new BM and favorable survival outcomes without increased rates of adverse events. http://ift.tt/2nzD4wJ

[apexart-journal]

Mimi Lipson in Montevideo, Day 8

Today felt like an extra “free day”. Because it’s Labor Day (May Day) and not much goes on in Montevideo, I was treated to a day in the country. Javier picked me up in the morning and we drove about an hour and a half east to the village of Solís de Mataojo, where Valentina’s family is from. Gorgeous drive.

Those hills are the highest place in Uruguay, which is mostly prairie (or, I guess, pampas. There was pampas grass growing along the side of the road.)

Valentina and their daughter were already there spending the weekend in the country just outside the village, where Valentina’s father, Don Filipe, has a cattle ranch and vineyard.

Here is Filipe with a certificate. They sell his beef in the U.S., so you might have had some.

Filipe’s house is built on the land of his father, Don Pepe—the family patriarch. Pepe’s house is at the end of a long lane of eucalyptus trees. 

Here is the homestead--or part of it. The long breezeway connecting to the other half (which is now a separate building) was burned in a fire. This is where Valentina lived for her first 12 years.

The house is 250 years old! The exterior walls are a meter thick. Valentina’s family has lived here since Christmas Eve, 1919.

This cart belonged to Pepe’s father, who was the first in the family to live on this beautiful land. He was a seller of caldrons like the one hanging underneath.

This is the water tower and cistern. I don’t know--I just dig them.

Here is Pepe. 

He is 96 years old, and I think he will easily make it to 106. I am envious of the figure he cuts in his Levis. He just recently remarried!

Pepe has traveled all over the world. When he was 92, he spent two months in China--the first month with his daughter, the second on his own. And the world has traveled to his ranch (including Ariel Sharon when he was Minister of Agriculture). I had the honor of signing his visitor’s log. 

Here are Javier and Valentina in the hall where Pepe displays some of the fascinating tools and other things he’s found on his ranch over the years. 

Inez, one of Pepe’s seven children, showed me a fossil that is only found here and in South Africa—left over from when they were one continent. There were also some guns from the 19th century.

I met so many members of Valentina’s extended family, and every one kissed me hello. They had gathered for the holiday, and for the Festival of San Silviano. So I hope I get this right. In the 1950s, Don Pepe welcomed five Italian refugee families to live on his ranch. He was visiting one of the families, and he saw a statue of San Silviano, so he put up a shrine for it and built a chapel. The chapel came down twice in the strong winds that blow through this part of the country. This is the third chapel, built in the 1960s.

This is the shrine, where the statue usually lives, when it’s not being fêted.

It’s on the side of the road near one of Filipe’s grape orchards. That’s the driveway that leads, eventually, to Don Pepe’s ranch house.

The festival began with the raising of the flags of Italy and Uruguay, and everyone sang the national anthem. 

Then was the mass, which was standing room only. 

The priest told the story of San Silviano—a priest from North Africa who fled the Vandals. He went to Italy and helped the farmers there establish vineyards. San Silviano is the patron saint of vineyards. Here Filipe points to the grapes in the statue’s hand. 

After the mass was a very brief procession—a few hundred yards up the road and back. Like something you’d see in Little Italy. 

There was even a midway game.

The traditional lunch was already cooking: grilled sausage, and an unusual preparation of beef which is oven-cooked in the skin. 

We ate at Filipe’s house. 

Traditionally, the skin (which is still hairy) is the plate. You put a piece of bread in your hand to use as an oven mitt. But we used plates. It was very delicious, flavored by the thick layer of fat under the skin. For dessert I had some of these tiny guavas from a bush in the yard. Tart and lovely.

Then we loafed around and drank coffee and watched the cousins playing in the blissful afternoon.

These pink flowers were all over the lawn.

This is a one-year-old playing soccer. (Valentina’s nephew.)

Back at the church, a singer sang gaucho songs, and everyone was eating tortas fritas.

The whole festival—the cooking and games and everything—is a community effort. The lovely lady on the right, is Lucia, Filipe’s wife. I will see her again later in the week. 

What a spectacular day. I feel so lucky and grateful. 

We drove back to Montevideo in the last light of the day, and there was a lot of jawing about narratives and identity and psychoanalysis, cargo cults, God, Gurdjieff, and Bruce Lee. Javier tried to explain Foucault to me, but I am too dumb still. One day, one day.