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Aden AA, Olawuni FO, Abdel-Halim CN, Zhu AQ, Haller TJ, O'Byrne TJ, Moore EJ, Price DL, Tasche KL, Ma DJ, Lester SC, Gamez M, Neben-Wittich MA, Price K, Fuentes-Bayne HE, Routman D, Van Abel KM. Association Between Social Determinants of Health, Distance from Treatment Center, and Treatment Type with Outcomes in Human Papillomavirus Associated Oropharyngeal cancer. Oral Oncol 2024; 149:106675. [PMID: 38211528 DOI: 10.1016/j.oraloncology.2023.106675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVES Social determinants of health (SDOH) can influence access to cancer care, clinical trials, and oncologic outcomes. We investigated the association between SDOH, distance from treatment center, and treatment type with outcomes in human papillomavirus associated oropharyngeal squamous cell carcinoma [HPV(+)OPSCC] patients treated at a tertiary care center. STUDY DESIGN Retrospective review. METHODS HPV(+)OPSCC patients treated surgically from 2006 to 2021 were selected from our departmental Oropharyngeal Cancer RedCap database. Demographic data, treatment, and oncologic outcomes were extracted. Distance was calculated in miles between the centroid of each patient zip code and our hospital zip code (zipdistance). RESULTS 874 patients (89 % male; mean age: 58 years) were identified. Most patients (96 %) reported Non-Hispanic White as their primary race. 204 patients (23 %) had a high-school degree or less, 217 patients (25 %) reported some college education or a 2-year degree, 153 patients (18 %) completed a four-year college degree, and 155 patients (18 %) had post-graduate degrees. Relative to those with a high-school degree, patients with higher levels of education were more likely to live further away from our institution (p < 0.0001). Patients who received adjuvant radiation therapy elsewhere lived, on average, 104 miles further away than patients receiving radiation at our institution (Estimate 104.3, 95 % CI 14.2-194.4, p-value = 0.02). In univariable Cox PH models, oncologic outcomes did not significantly differ by zipdistance. CONCLUSIONS Education level-and access to resources-varied proportionally to a patient's distance from our center. Patients travelling further distances for surgical management of OPSCC were more likely to pursue adjuvant radiation therapy at an outside institution. Distance traveled was not associated with oncologic outcomes. Breaking down barriers to currently excluded populations may improve access to clinical trials and improve oncologic outcomes for diverse patient populations.
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Affiliation(s)
- Aisha A Aden
- Mayo Clinic Alix School of Medicine, MN, United States.
| | - Felicia O Olawuni
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, MN, United States
| | - Chadi N Abdel-Halim
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, MN, United States
| | - Agnes Q Zhu
- Mayo Clinic Alix School of Medicine, MN, United States
| | - Travis J Haller
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, MN, United States
| | | | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, MN, United States
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, MN, United States
| | - Kendall L Tasche
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, MN, United States
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, MN, United States
| | - Scott C Lester
- Department of Radiation Oncology, Mayo Clinic, MN, United States
| | - Mauricio Gamez
- Department of Radiation Oncology, Mayo Clinic, MN, United States
| | | | - Katharine Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, MN, United States
| | | | - David Routman
- Department of Radiation Oncology, Mayo Clinic, MN, United States
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, MN, United States
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Foote RL, Harmsen WS, Amundson AC, Carr AB, Gamez ME, Garces YI, Lester SC, Ma DJ, McGee LA, Moore EJ, Neben Wittich MA, Patel SH, Routman DM, Rwigema JCM, Van Abel KM, Yin LX, Muller OM, Shiraishi S. Mean Oral Cavity Organ-at-Risk Dose Predicts Opioid Use and Hospitalization during Radiotherapy for Patients with Head and Neck Tumors. Cancers (Basel) 2024; 16:349. [PMID: 38254837 PMCID: PMC10814074 DOI: 10.3390/cancers16020349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/04/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Approximately 75% of all head and neck cancer patients are treated with radiotherapy (RT). RT to the oral cavity results in acute and late adverse events which can be severe and detrimental to a patient's quality of life and function. The purpose of this study was to explore associations between RT dose to a defined oral cavity organ-at-risk (OAR) avoidance structure, provider- and patient-reported outcomes (PROs), opioid use, and hospitalization. METHODS This was a retrospective analysis of prospectively obtained outcomes using multivariable modeling. The study included 196 patients treated with RT involving the oral cavity for a head and neck tumor. A defined oral cavity OAR avoidance structure was used in all patients for RT treatment planning. Validated PROs were collected prospectively. Opioid use and hospitalization were abstracted electronically from medical records. RESULTS Multivariable modeling revealed the mean dose to the oral cavity OAR was significantly associated with opioid use (p = 0.0082) and hospitalization (p = 0.0356) during and within 30 days of completing RT. CONCLUSIONS The findings of this study may be valuable in RT treatment planning for patients with tumors of the head and neck region to reduce the need for opioid use and hospitalization during treatment.
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Affiliation(s)
- Robert L. Foote
- Department of Radiation Oncology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (A.C.A.); (M.E.G.); (Y.I.G.); (S.C.L.); (D.J.M.); (M.A.N.W.); (D.M.R.)
| | - W. Scott Harmsen
- Department of Quantitative Health Sciences, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA;
| | - Adam C. Amundson
- Department of Radiation Oncology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (A.C.A.); (M.E.G.); (Y.I.G.); (S.C.L.); (D.J.M.); (M.A.N.W.); (D.M.R.)
| | - Alan B. Carr
- Department of Dental Specialties, Division of Esthetic and Prosthetic Dentistry, Department of Advanced Prosthodontics, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (A.B.C.); (O.M.M.)
| | - Mauricio E. Gamez
- Department of Radiation Oncology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (A.C.A.); (M.E.G.); (Y.I.G.); (S.C.L.); (D.J.M.); (M.A.N.W.); (D.M.R.)
| | - Yolanda I. Garces
- Department of Radiation Oncology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (A.C.A.); (M.E.G.); (Y.I.G.); (S.C.L.); (D.J.M.); (M.A.N.W.); (D.M.R.)
| | - Scott C. Lester
- Department of Radiation Oncology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (A.C.A.); (M.E.G.); (Y.I.G.); (S.C.L.); (D.J.M.); (M.A.N.W.); (D.M.R.)
| | - Daniel J. Ma
- Department of Radiation Oncology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (A.C.A.); (M.E.G.); (Y.I.G.); (S.C.L.); (D.J.M.); (M.A.N.W.); (D.M.R.)
| | - Lisa A. McGee
- Department of Radiation Oncology, Mayo Clinic Arizona, 5777 E. Mayo Blvd., Phoenix, AZ 85054, USA; (L.A.M.); (S.H.P.); (J.-C.M.R.)
| | - Eric J. Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (E.J.M.); (K.M.V.A.); (L.X.Y.)
| | - Michelle A. Neben Wittich
- Department of Radiation Oncology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (A.C.A.); (M.E.G.); (Y.I.G.); (S.C.L.); (D.J.M.); (M.A.N.W.); (D.M.R.)
| | - Samir H. Patel
- Department of Radiation Oncology, Mayo Clinic Arizona, 5777 E. Mayo Blvd., Phoenix, AZ 85054, USA; (L.A.M.); (S.H.P.); (J.-C.M.R.)
| | - David M. Routman
- Department of Radiation Oncology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (A.C.A.); (M.E.G.); (Y.I.G.); (S.C.L.); (D.J.M.); (M.A.N.W.); (D.M.R.)
| | - Jean-Claude M. Rwigema
- Department of Radiation Oncology, Mayo Clinic Arizona, 5777 E. Mayo Blvd., Phoenix, AZ 85054, USA; (L.A.M.); (S.H.P.); (J.-C.M.R.)
| | - Kathryn M. Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (E.J.M.); (K.M.V.A.); (L.X.Y.)
| | - Linda X. Yin
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (E.J.M.); (K.M.V.A.); (L.X.Y.)
| | - Olivia M. Muller
- Department of Dental Specialties, Division of Esthetic and Prosthetic Dentistry, Department of Advanced Prosthodontics, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (A.B.C.); (O.M.M.)
| | - Satomi Shiraishi
- Division of Medical Physics, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA;
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Bartemes KR, Gochanour BR, Routman DM, Ma DJ, Doering KA, Burger KN, Foote PH, Taylor WR, Mahoney DW, Berger CK, Cao X, Then SS, Haller TJ, Larish AM, Moore EJ, Garcia JJ, Graham RP, Bakkum-Gamez JN, Kisiel JB, Van Abel KM. Assessing the capacity of methylated DNA markers of cervical squamous cell carcinoma to discriminate oropharyngeal squamous cell carcinoma in human papillomavirus mediated disease. Oral Oncol 2023; 146:106568. [PMID: 37717549 PMCID: PMC10591712 DOI: 10.1016/j.oraloncology.2023.106568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/11/2023] [Accepted: 09/06/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE Early identification of human papillomavirus associated oropharyngeal squamous cell carcinoma (HPV(+)OPSCC) is challenging and novel biomarkers are needed. We hypothesized that a panel of methylated DNA markers (MDMs) found in HPV(+) cervical squamous cell carcinoma (CSCC) will have similar discrimination in HPV(+)OPSCC tissues. MATERIALS AND METHODS Formalin-fixed, paraffin-embedded tissues were obtained from patients with primary HPV(+)OPSCC or HPV(+)CSCC; control tissues included normal oropharynx palatine tonsil (NOP) and cervix (NCS). Using a methylation-specific polymerase chain reaction, 21 previously validated cervical MDMs were evaluated on tissue-extracted DNA. Discrimination between case and control cervical and oropharynx tissue was assessed using area under the curve (AUC). RESULTS 34 HPV(+)OPSCC, 36 HPV(+)CSCC, 26 NOP, and 24 NCS patients met inclusion criteria. Within HPV(+)CSCC, 18/21 (86%) of MDMs achieved an AUC ≥ 0.9 and all MDMs exhibited better than chance classifications relative to control cervical tissue (all p < 0.001). In contrast, within HPV(+)OPSCC only 5/21 (24%) MDMs achieved an AUC ≥ 0.90 but 19/21 (90%) exhibited better than chance classifications relative to control tonsil tissue (all p < 0.001). Overall, 13/21 MDMs had statistically significant lower AUCs in the oropharyngeal cohort compared to the cervical cohort, and only 1 MDM exhibited a statistically significant increase in AUC. CONCLUSIONS Previously validated MDMs exhibited robust performance in independent HPV(+)CSCC patients. However, most of these MDMs exhibited higher discrimination for HPV(+)CSCC than for HPV(+)OPSCC. This suggests that each SCC subtype requires a unique set of MDMs for optimal discrimination. Future studies are necessary to establish an MDM panel for HPV(+)OPSCC.
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Affiliation(s)
- Kathleen R Bartemes
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Daniel J Ma
- Department of Radiation Oncology, Rochester, MN, USA
| | | | - Kelli N Burger
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | | | - Douglas W Mahoney
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Xiaoming Cao
- Department of Gastroenterology, Rochester, MN, USA
| | - Sara S Then
- Department of Gastroenterology, Rochester, MN, USA
| | - Travis J Haller
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Alyssa M Larish
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Eric J Moore
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Joaquin J Garcia
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Rondell P Graham
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Kathryn M Van Abel
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA.
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Abdel-Halim CN, O'Byrne TJ, Graves JP, Akpala CO, Moore EJ, Price DL, Tasche KT, Ma DJ, Neben-Wittich MA, Lester SC, Gamez M, Price KA, Bayne HEF, Rwigema JCM, Patel SH, McGee LA, Janus JR, Nagel TH, Hinni ML, Savvides PS, Van Abel KM, Routman DM. Patterns and distribution of regional nodal involvement and recurrence in a surgically treated oropharyngeal squamous cell carcinoma cohort at a tertiary center. Oral Oncol 2023; 146:106569. [PMID: 37734203 DOI: 10.1016/j.oraloncology.2023.106569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/28/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVES To investigate and describe the patterns of regional metastases and recurrences after surgical treatment of oropharyngeal squamous cell cancer (OPSCC). MATERIALS AND METHODS Retrospective study of patients diagnosed with OPSCC from 2006 to 2021 at a tertiary referral center. Only patients treated with surgery including a neck dissection were included. Patients with unknown human papillomavirus (HPV) status, prior head and neck cancer, distant metastases, or synchronous head and neck cancer were excluded. RESULTS A total of 928 patients were included. 89% were males, the average age was 58.6 years (range: 25.2-87.5), 874 (94%) were HPV(+), and 513 (55.3%) had a tonsil cancer. Among cN + patients, the most commonly involved levels at presentation were level II (85.2%), level III (33.3%), and level IV (9.4%). In cN0 patients, metastases were only observed in level II (16.2%) and level III (9.2%). Nodal recurrence occurred in 48 (5.2%) patients after a median time of 1.0 years (interquartile range: 0.6-2.0). Nodal recurrence incidence was similar in HPV(+) and HPV(-) patients (5.0% vs. 7.4%, p = 0.44). The most common levels for regional recurrence were ipsilateral level II (45.8%), contralateral level II (43.8%), and ipsilateral level V (25.0%). Multivariable analysis revealed that pN was a significant predictor for regional recurrence (p = 0.02). CONCLUSION There is no difference in the distribution of regional metastases and recurrences in HPV(+) and HPV(-) OPSCC patients. Our findings align with the established understanding that regional metastases predominantly manifest in the ipsilateral level II-IV at presentation. Moreover, the data support the clinical recommendation to restrict elective neck dissection in cN0 patients to ipsilateral levels IIa and III, excluding level IIb. Regional recurrence is significantly associated with pN status.
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Affiliation(s)
- Chadi N Abdel-Halim
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States
| | - Thomas J O'Byrne
- Department of Quantitative Health Sciences, Rochester, MN, United States
| | - Jeffrey P Graves
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States
| | - Christeebella O Akpala
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States
| | - Eric J Moore
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States
| | - Daniel L Price
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States
| | - Kendall T Tasche
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | | | - Scott C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Mauricio Gamez
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Katharine A Price
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, United States
| | | | | | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States
| | - Lisa A McGee
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States
| | - Jeffrey R Janus
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Jacksonville, FL, United States
| | - Thomas H Nagel
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Scottsdale, AZ, United States
| | - Michael L Hinni
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Scottsdale, AZ, United States
| | | | - Kathryn M Van Abel
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States.
| | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
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Gunn HJ, DeWees TA, Voss MM, Corbin KS, Hallemeier CL, Stish BJ, Haddock MG, Petersen IA, Rule WG, Vallow LA, Brown PD, Olivier K, Trifiletti DM, Vargas CE, Ma DJ. Sensitivity of the PROMIS-10 for Capturing Radiation-Related Quality of Life Changes. Int J Radiat Oncol Biol Phys 2023; 117:e232-e233. [PMID: 37784929 DOI: 10.1016/j.ijrobp.2023.06.1149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Patient reported outcomes (PROs) are becoming more common when assessing the effects of radiotherapy (RT). The aim of this study was to assess the sensitivity of the Mental and Physical domains of the Patient-Reported Outcomes Measurement Information System 10 (PROMIS-10) to radiotherapy and determine what predictors were associated with change in quality of life. MATERIALS/METHODS Patients, regardless of cancer type, were enrolled on a multi-site prospective registry. Inclusion criteria included curative radiotherapy and completion of the PROMIS-10 prior to treatment (Baseline) and at End of Treatment (EOT). To assess the strongest predictors of change in the T score of mental and physical health, we included 14 demographic characteristics and treatment variables in a multivariable stepwise regression. RESULTS A total of 7,586 patients were eligible for the analysis. The median age was 65 (range 18-94), 54% were males, and 94% were white. A majority received photons (62.5%) and the others received protons (37.5%) with an average dose of 52.3 Gy (range 20-80 Gy) over an average of 22.6 fractions (range 1-66). Patient disease sites were sub-grouped into 12 categories: Breast (25.5%), GU (23.0%), H&N (11.1%), CNS (8.5%), Pancreas-Biliary (6.7%), Thoracic (5.7%), Soft Tissue/Bone (5.0%), Esophagus-Gastric (4.7%), Colorectal-Anus (4.4%), Heme/Lymph (2.6%), GYN (1.8%), and Skin/Melanoma (1.0%). For both outcomes, the model selected disease group as an important predictor and it explained the most variance in the outcome compared to the rest of the predictors. When probing the effect of disease group, H&N, Esophagus-Gastric, Skin/Melanoma, and Colorectal-Anus had the largest mean decrease in quality of life for both domains. For mental health, the model also selected radiation type. Patients treated with protons indicated a bigger decrease in mental health compared to patients treated with photons (b = 0.43, 95% CI: -0.01, 0.69). For physical health, the model selected total fractions, ethnicity, and T stage. As number of fractions increased, the physical health change scores became more negative, on average (b = -0.03, 95% CI: -0.05, -0.01). Hispanic/Latino patients indicated a smaller decrease in physical health compared to White (b = -1.50, 95% CI: -2.60, -0.40) and Unknown ethnicity patients (b = -1.82, 95% CI: -3.36, -0.27). Finally, patients with a T stage of 3 or greater indicated a smaller decrease in physical health than patients with a T stage less than 3 (b = 0.76, 95% CI: 0.35, 1.16). CONCLUSION The PROMIS-10 did not capture significant change for patients undergoing curative radiotherapy except for patients with Head & Neck, Esophagus-Gastric, Skin, and Colorectal-Anus cancer. Further analyses should explore which patients experience the greatest change in quality of life within disease group.
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Affiliation(s)
| | - T A DeWees
- Department of Qualitative Health Sciences, Section of Biostatistics, Mayo Clinic, Scottsdale, AZ
| | - M M Voss
- Department of Quantitative Health Sciences, Mayo Clinic, Arizona, Phoenix, AZ
| | - K S Corbin
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | | | - B J Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - M G Haddock
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - I A Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - W G Rule
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - L A Vallow
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
| | - P D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - K Olivier
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - D M Trifiletti
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
| | - C E Vargas
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - D J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
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Ebner DK, Evans JM, Christensen B, Breinholt J, Gamez ME, Lester SC, Routman DM, Ma DJ, Price K, Dong H, Park SS, Chintakuntlawar AV, Neben-Wittich MA, McGee LA, Garces Y, Patel SH, Foote RL, Evans JD. Unique T-cell Sub-Population Shifts after SBPT and Nivolumab in Platinum Refractory HNC: Biomarker Correlates from ROR1771. Int J Radiat Oncol Biol Phys 2023; 117:e580. [PMID: 37785763 DOI: 10.1016/j.ijrobp.2023.06.1920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) ROR1771 was a clinical trial investigating the use of stereotactic body proton radiotherapy (SBPT) and nivolumab in recurrent platinum refractory head and neck squamous cell carcinoma (HNSCC). The planned analysis of T-cell subpopulation and biomarker response is herein presented. MATERIALS/METHODS Patients with metastatic histologically confirmed HNSCC from any primary site received 2 cycles of nivolumab followed by SBPT to 1-2 selected target lesion(s) (hilar/lung: 8 of 12 patients), followed by maintenance nivolumab. Peripheral blood mononuclear cells were isolated pre-/post-treatment. Flow cytometry identified T-cell subpopulations. Single Cell 5' Gene Expression (GEX) and V(D)J T Cell Receptor libraries were prepared using Single Cell Immune Profiling. Seurat (v4.1.1) was used to identify cell type clusters, and differential expression post-filtration was evaluated using the Wilcoxon Rank Sum test. RESULTS A total of 12 patients were eligible for analysis, with one alive at time of analysis, 52 months from start of treatment. Median overall survival here was 12.5 months vs. 7.5-months on CheckMate 141. SBPT ranged from 35-50 Gy. Sequential changes in T-cell populations from baseline were noted with initiation of nivolumab, driving decrease in tumor-reactive (TTR; CD11ahighPD1+CD8+), central memory (TCM; CCR7+CD45RA-), and effector T-cells (TEF; CCR7-CD45RA-). TTR and TCM increased following SBPT, with greatest increase (3.5x TTR and 5.2x TCM) in the surviving patient. An average of 68 genes with significant differential expression between timepoints (p<0.0001) demonstrated RNA gene expression changes across all cell subtypes, including ribosomal (RPL and RPS) genes, ACTB, FTL, MALAT1, and others. This averaged 113 genes across all timepoints in the surviving patient, with peak following nivolumab induction. On T-cell receptor (TCR) analysis of this patient, the predominant clonotype diversity changed substantially following nivolumab. Following SBPT, clonotype diversity again changed to include a milieu seen neither at baseline nor with nivolumab alone. These TCRs persisted for approximately 2 weeks following SBPT before returning to resemble the nivolumab-induced TCR diversity alone, coinciding with disease recurrence. CONCLUSION ROR1771 demonstrated overall survival favorably comparable to CheckMate 141. Biomarker analysis of peripheral blood samples demonstrated significant shifts in T-cell subpopulations and underlying gene expression to nivolumab and then to SBPT administration. SBPT to a target lesion changed TCR clonotypes within the peripheral blood beyond those seen with nivolumab administration, with fading of these TCR clonotypes coinciding with recurrence. SBPT in combination with nivolumab may drive systemic immunologic change above that induced by nivolumab alone and warrants further investigation.
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Affiliation(s)
- D K Ebner
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - J M Evans
- Intermountain Precision Genomics, St George, UT
| | | | - J Breinholt
- Intermountain Precision Genomics, St George, UT
| | - M E Gamez
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - S C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - D M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - D J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - K Price
- Department of Medical Oncology, Mayo Clinic, Rochester, MN
| | - H Dong
- Department of Urology and Immunology, Mayo Clinic, Rochester, MN
| | - S S Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | | | | | - L A McGee
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - Y Garces
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - S H Patel
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ
| | - R L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - J D Evans
- Department of Radiation Oncology, Intermountain Healthcare, Murray, UT
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Yin LX, Rivera M, Garcia JJ, Bartemes KR, Lewis DB, Lohse CM, Routman DM, Ma DJ, Moore EJ, Van Abel KM. Impact of Tumor-Infiltrating Lymphocytes on Disease Progression in Human Papillomavirus-Related Oropharyngeal Carcinoma. Otolaryngol Head Neck Surg 2023; 169:539-547. [PMID: 36939471 DOI: 10.1002/ohn.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 11/13/2022] [Accepted: 12/17/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE We aim to explore the prognostic value of tumor-infiltrating lymphocytes (TILs) in the primary tumor and metastatic lymph nodes of patients with HPV(+)OPSCC. We hypothesize that TILS density at both sites is associated with disease-free survival in HPV(+)OPSCC. STUDY DESIGN Matched case-control study among HPV(+)OPSCC patients who underwent intent-to-cure surgery. Cases developed locoregional or distant recurrence. Controls were matched based on age, sex, pathologic T, N, and overall stage, year of surgery, type of adjuvant treatment received, and the Adult Comorbidity Evaluation-27 (ACE-27) score. SETTING Single tertiary care center, May 2007 to December 2016. METHODS Tumoral TILs (tTILs) density was defined as % TILs; stromal TILs (sTILs) density was defined as absent/sparse or moderate/dense crowding. Associations between TILs and time to disease progression were assessed using Cox regression models. RESULTS Forty-four case-control pairs (N = 88) were included: 42 (48%) AJCC pStage I, 39 (44%) pStage II, and 7 (8%) pStage III. tTILs density ≥10% (hazard ratio [HR] 0.41, 95% confidence interval [CI] 0.17-0.99, p = .048) and a moderate/dense sTILs density (HR 0.21, 95% CI 0.06-0.75, p = .016) in the primary tumor were significantly associated with decreased risk of progression. TILs density in the lymph node was associated with decreased risk of progression but did not reach statistical significance. The tTILs and sTILs density correlated strongly between the primary tumor and lymph node. Concordance between the pathologists' was moderate (60%-70%). CONCLUSIONS In HPV(+)OPSCC, a higher density of tumoral and stromal TILs in the primary tumor and possibly the lymph node may predict a lower risk of disease progression.
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Affiliation(s)
- Linda X Yin
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael Rivera
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Joaquin J Garcia
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathleen R Bartemes
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Derrick B Lewis
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Christine M Lohse
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Grams MP, Deufel CL, Kavanaugh JA, Corbin KS, Ahmed SK, Haddock MG, Lester SC, Ma DJ, Petersen IA, Finley RR, Lang KG, Spreiter SS, Park SS, Owen D. Clinical aspects of spatially fractionated radiation therapy treatments. Phys Med 2023; 111:102616. [PMID: 37311338 DOI: 10.1016/j.ejmp.2023.102616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/06/2023] [Accepted: 05/30/2023] [Indexed: 06/15/2023] Open
Abstract
PURPOSE To provide clinical guidance for centers wishing to implement photon spatially fractionated radiation therapy (SFRT) treatments using either a brass grid or volumetric modulated arc therapy (VMAT) lattice approach. METHODS We describe in detail processes which have been developed over the course of a 3-year period during which our institution treated over 240 SFRT cases. The importance of patient selection, along with aspects of simulation, treatment planning, quality assurance, and treatment delivery are discussed. Illustrative examples involving clinical cases are shown, and we discuss safety implications relevant to the heterogeneous dose distributions. RESULTS SFRT can be an effective modality for tumors which are otherwise challenging to manage with conventional radiation therapy techniques or for patients who have limited treatment options. However, SFRT has several aspects which differ drastically from conventional radiation therapy treatments. Therefore, the successful implementation of an SFRT treatment program requires the multidisciplinary expertise and collaboration of physicians, physicists, dosimetrists, and radiation therapists. CONCLUSIONS We have described methods for patient selection, simulation, treatment planning, quality assurance and delivery of clinical SFRT treatments which were built upon our experience treating a large patient population with both a brass grid and VMAT lattice approach. Preclinical research and patient trials aimed at understanding the mechanism of action are needed to elucidate which patients may benefit most from SFRT, and ultimately expand its use.
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Affiliation(s)
- Michael P Grams
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
| | - Christopher L Deufel
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - James A Kavanaugh
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Kimberly S Corbin
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Safia K Ahmed
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Michael G Haddock
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Scott C Lester
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Ivy A Petersen
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Randi R Finley
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Karen G Lang
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Sheri S Spreiter
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Sean S Park
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Dawn Owen
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
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Patel SH, Ma DJ, Van Abel KM. In Reply to Yigit et al. Int J Radiat Oncol Biol Phys 2023; 116:467-468. [PMID: 37179098 DOI: 10.1016/j.ijrobp.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 05/15/2023]
Affiliation(s)
- Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
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Nakkireddy SR, Jang I, Kim M, Yin LX, Rivera M, MD JJG, Bartemes KR, Routman DM, Moore EJ, Ma DJ, Van Abel KM, Hwang TH. Abstract 4638: Integrative spatial analysis of paired IHC and H&E images identifies Foxp3 enriched tumor-infiltrating lymphocytes associated with disease-free survival in human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-4638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Background: Recent studies support that high levels of tumor-infiltrating lymphocytes (TILs) were associated with better prognosis in HPV(+) oropharyngeal squamous cell carcinoma (OPSCC). While these studies provide a potential role for TILs as a prognostic biomarker, the analyses were relied on manual quantification performed by pathologists, resulting in inter-observer variability. Deep Learning (DL)-based whole slide hematoxylin and eosin (H&E) image analyses may overcome these challenges. However, this analysis only provides the presence of cell types without consideration for the functional roles of each cell within the tumor immune microenvironment (TME). In this work, we develop a computational pipeline to integrate paired H&E and immunohistochemistry (IHC) images to functionally characterize TILs and investigate their prognostic utility.
Methods: We analyzed 88 patients: 42 stage I, 39 stage II, and 7 stage III. Our data contain both H&E and IHCs examining FoxP3, CD3, PD-L1, CD20, etc. on serial sections of the tissue. In-house DL-based H&E analysis used to identify TILs, tumors, and stroma in each tumor, then performed registration between adjacent H&E and IHC images from the same tissue. The patients were then classified into three basic immune phenotypes: immune inflamed (IN; high TILs in the tumor region), immune excluded (EX; TILs are mostly localized in stroma), and immune desert (ID; few/no TILs) based on TIL enrichment in the TME. To functionally characterize TILs, we quantified protein expression from the adjacent IHCs. For example, we further classified each patient into different subtypes based on enriched protein expression (e.g., FoxP3 high IN, FoxP3 low IN). We used the Kaplan-Meier method and multivariate Cox analysis to evaluate the prognostic value of different subtypes enriched with different proteins to predict disease-free survival (DFS).
Results: The IN group with 43 patients was significantly associated with good prognosis. Interestingly, further stratification of the IN subgroup based on Foxp3 quantification on TIL regions (i.e., high FoxP3 IN and low FoxP3 IN) showed that high protein expression of FoxP3 in TILs in the IN subgroup is significantly associated with a better prognosis compared to other immune subgroups (HR, 0.16; p-value, 0.003). Multivariate analysis, including other clinical covariates showed that the immune subtypes associated with high FoxP3 are independently associated with DFS. These results demonstrate that DL-based integrative IHC and H&E image analysis could be used to identify subgroups with distinct clinical outcomes. Furthermore, our results reveal unknown roles for Foxp3 expression in the TILs in HPV(+) OPSCC as a prognostic biomarker, a finding which should be evaluated in a larger cohort.
Citation Format: Sumanth Reddy Nakkireddy, Inyeop Jang, Minji Kim, Linda X. Yin, Michael Rivera, Joaquin J. Garcia MD, Kathleen R. Bartemes, David M. Routman, Eric J. Moore, Daniel J. Ma, Kathryn M. Van Abel, Tae Hyun Hwang. Integrative spatial analysis of paired IHC and H&E images identifies Foxp3 enriched tumor-infiltrating lymphocytes associated with disease-free survival in human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4638.
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Affiliation(s)
| | | | - Minji Kim
- 1Mayo Clinic Florida, Jacksonville, FL
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11
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Laughlin BS, Ebrahimi S, Voss MM, Patel SH, Foote RL, McGee LA, Garcia J, Ma DJ, Garces YI, Wittich MAN, Price KA, Schmitt A, Zhai Q, May BC, Nagel TH, Hinni ML, Chintakuntlawar AV, DeWees TA, Rwigema JCM. Clinicopathologic factors and their association with outcomes of salivary ductal carcinoma: a multi-center experience. Adv Radiat Oncol 2023; 8:101204. [PMID: 37152485 PMCID: PMC10157113 DOI: 10.1016/j.adro.2023.101204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
Purpose This series reports long-term clinical outcomes of patients with salivary duct carcinoma (SDC), which is associated with a poor prognosis. Methods and Materials Eighty-nine patients with SDC were treated with curative intent from February 5, 1971, through September 15, 2018. Kaplan-Meier and competing risk analyses were used to estimate locoregional control, distant metastasis-free survival (DMFS), progression-free survival, and overall survival (OS). Cox regression analyses of disease and treatment characteristics were performed to discover predictors of locoregional control, DMFS, and OS. Results Median follow-up was 44.1 months (range, 0.23-356.67). The median age at diagnosis was 66 years (interquartile range, 57-75). Curative surgery followed by adjuvant radiation therapy was performed in 73 patients (82%). Chemotherapy was delivered in 26 patients (29.2%). The 5-year local recurrence and distant metastasis rates were 27% and 44%, respectively, with death as a competing risk. Distant metastasis was associated with lymph node-positive disease (hazard ratio [HR], 3.16; 95% confidence interval [CI], 1.38-7.23; P = .006), stage IV disease (HR, 4.78; 95% CI, 1.14-20.11; P = .033), perineural invasion (HR, 4.56; 95% CI, 1.74-11.97; P = .002), and positive margins (HR, 9.06; 95% CI, 3.88-21.14; P < .001). Median OS was 4.84 years (95% CI, 3.54-7.02). The 5-year OS was 42%. Reduced OS was associated with lymphovascular space invasion (HR, 3.49; 95% CI, 1.2-10.1; P = .022), perineural invasion (HR, 2.05; 95% CI, 1.06-3.97; P = .033), positive margins (HR, 2.7; 95% CI, 1.3-5.6; P = .011), N2 disease (HR, 1.88; 95% CI, 1.03-3.43; P = .04), and N3 disease (HR, 11.76; 95% CI, 3.19-43.3; P < .001). Conclusions In this single-institution, multicenter retrospective study, the 5-year survival was 42% in patients with SDC. Lymphovascular space invasion, lymph node involvement, and higher staging at diagnosis were associated with lower DMFS and OS.
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12
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Berlin E, Ma DJ, Bakst RL, Quon H, Lin A, Lukens JN. Close Margins After Transoral Robotic Surgery for Human Papillomavirus-Positive Oropharyngeal Carcinoma: A Review of the Literature and Practical Recommendations. Pract Radiat Oncol 2023; 13:251-255. [PMID: 36599392 DOI: 10.1016/j.prro.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/12/2022] [Indexed: 01/02/2023]
Abstract
The purpose of this article is to summarize the literature and practical recommendations from experienced centers for close margins after transoral robotic surgery for human papillomavirus-positive oropharyngeal carcinoma.
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Affiliation(s)
- Eva Berlin
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Pennsylvania
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Richard L Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Harry Quon
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alexander Lin
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Pennsylvania
| | - J Nicholas Lukens
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Pennsylvania.
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13
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Gao RW, Routman DM, Harmsen WS, Ebrahimi S, Foote RL, Ma DJ, Neben-Wittich M, McGee LA, Patel SH, Moore EJ, Choby GW, Tasche KK, Price KA, Gamez ME, Lester SC. Adenoid cystic carcinoma of the head and neck: Patterns of recurrence and implications for intensity-modulated radiotherapy. Head Neck 2023; 45:187-196. [PMID: 36222355 DOI: 10.1002/hed.27223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/13/2022] [Accepted: 10/04/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND We seek to inform radiotherapy (RT) delivery for adenoid cystic carcinoma of the head and neck (ACC) by evaluating RT techniques and recurrence patterns. METHODS We identified patients with ACC treated with curative-intent RT from 2005 to 2021. Imaging was reviewed to determine local recurrence (LR). RESULTS Ninety-one patients were included. The 5-year LR risk was 12.2% (6.6-22.7). One patient each experienced a marginal and out-of-field recurrence. Patients receiving >60 Gy postoperatively had a 5-year LR risk of 0% compared to 10.7% (4.2-27.2) with ≤60 Gy. Those receiving 70 and <70 Gy definitively had a 5-year LR risk of 15.2% (2.5-91.6) and 33.3% (6.7-100.0), respectively. No patients had regional nodal failure. CONCLUSIONS Modern, conformal RT for ACC results in low rates of LR. Doses >60 and 70 Gy may improve control in the postoperative and definitive settings, respectively. Elective nodal treatment can be omitted in well-selected patients.
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Affiliation(s)
- Robert W Gao
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - William S Harmsen
- Department of Biostatistics & Information, Mayo Clinic, Rochester, Minnesota, USA
| | - Sasha Ebrahimi
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Lisa A McGee
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Eric J Moore
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Garret W Choby
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kendall K Tasche
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Katharine A Price
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mauricio E Gamez
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Scott C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
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Yin LX, Routman DM, Day CN, Harmsen WS, Haller T, Bartemes K, Price DL, Moore EJ, Foote RL, Neben-Wittich M, Chintakuntlawar AV, Ma DJ, Price KA, Van Abel KM. Low postoperative lymphocyte count increases risk of progression in human papillomavirus associated oropharyngeal cancer. Head Neck 2022; 44:2760-2768. [PMID: 36129387 DOI: 10.1002/hed.27198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/04/2022] [Accepted: 08/30/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND We aim to explore the prognostic role of absolute lymphocyte count (ALC) before, during, and after treatment on oncologic outcomes in human papillomavirus associated oropharyngeal cancer (HPV(+)OPSCC). METHODS Retrospective cohort at a tertiary center, 2006-2018. Multivariable Cox regressions were used to determine the effect of ALC on risk of progression. Univariate linear regression was performed to determine clinical factors associated with lower ALC. RESULTS All 197 patients underwent primary surgery. Mean (SD) ALC nadirs (×109 cells/L) were: baseline (N = 149): 1.69 (0.56); postoperative (N = 126): 1.58 (0.59); post-RT (N = 141): 0.68 (0.35) and long-term (N = 105): 0.88 (0.37). Lower baseline ALC nadir was associated with worse overall survival (HR 3.85, 95%CI: 1.03-14.29, p = 0.04). Lower postoperative ALC nadir was associated with higher risk of progression (HR 2.63, 95%CI: 1.04-6.67, p = 0.04). CONCLUSIONS Lower baseline ALC is associated with worse survival, whereas lower postoperative ALC is associated with increased risk of progression in surgically treated HPV(+)OPSCC. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Linda X Yin
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Courtney N Day
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - William S Harmsen
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Travis Haller
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathleen Bartemes
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel L Price
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Moore
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Katharine A Price
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn M Van Abel
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Karp EE, Yin LX, O'Byrne TJ, Lu LY, Routman DM, Lester SC, Neben Wittich MA, Ma DJ, Price KA, Chintakuntlawar AV, Tasche KK, Price DL, Moore EJ, Van Abel KM. Diagnostic Delay in Human Papillomavirus Negative Oropharyngeal Squamous Cell Carcinoma. Laryngoscope 2022; 133:1394-1401. [PMID: 35851669 DOI: 10.1002/lary.30307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/26/2022] [Accepted: 07/04/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Failure to recognize symptoms of non-human papillomavirus-associated oropharyngeal squamous cell carcinoma (HPV(-)OPSCC) at presentation can delay diagnosis and treatment. We aim to identify patient factors and provider practice patterns that delay presentation and care in HPV(-)OPSCC. METHODS Retrospective review at a tertiary care center. Patients with HPV(-)OPSCC receiving treatment from 2006 to 2016. Patients were excluded if their date of symptom onset or diagnosis was unknown after thorough review of the electronic medical record or their tissue was not tested for HPV or p16. Clinical data, workup, and care timelines were abstracted. Univariate and multivariable linear regressions were performed to determine associations between patient and provider factors and delays in care. RESULTS Of 70 included patients, 52 (74%) were male and mean age was 60.5 (SD = 9.0). Median time to diagnosis was 69 days (IQR = 32-127 days), with a median latency of 30 days (IQR = 12-61 days) from symptom onset to first presentation and 19.5 days (IQR = 4-46 days) from the first presentation to diagnosis. Most patients visited at least 2 providers (n = 52, 74%) before diagnosis. Evaluation by 3 or more providers prior to diagnosis was associated with significant delays in diagnosis of nearly a year (357.7 days, p < 0.001) and being treated or prescribed analgesia prior to diagnosis was significantly associated with delays in diagnosis (p = 0.004) on univariate regression analysis. CONCLUSIONS Delays in care related to evaluations by multiple providers and misdiagnosis prolonged time to diagnosis in HPV(-)OPSCC. Improved patient and provider education is necessary to expedite the diagnosis of HPV(-)OPSCC. LEVEL OF EVIDENCE 4 Laryngoscope, 133:1394-1401, 2023.
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Affiliation(s)
- Emily E. Karp
- Department of Otolaryngology, Head and Neck Surgery Mayo Clinic Rochester Minnesota USA
| | - Linda X. Yin
- Department of Otolaryngology, Head and Neck Surgery Mayo Clinic Rochester Minnesota USA
| | | | - Lauren Y. Lu
- Alix School of Medicine Mayo Clinic Rochester Minnesota USA
| | - David M. Routman
- Department of Radiation Oncology Mayo Clinic Rochester Minnesota USA
| | - Scott C. Lester
- Department of Radiation Oncology Mayo Clinic Rochester Minnesota USA
| | | | - Daniel J. Ma
- Department of Radiation Oncology Mayo Clinic Rochester Minnesota USA
| | | | | | - Kendall K. Tasche
- Department of Otolaryngology, Head and Neck Surgery Mayo Clinic Rochester Minnesota USA
| | - Daniel L. Price
- Department of Otolaryngology, Head and Neck Surgery Mayo Clinic Rochester Minnesota USA
| | - Eric J. Moore
- Department of Otolaryngology, Head and Neck Surgery Mayo Clinic Rochester Minnesota USA
| | - Kathryn M. Van Abel
- Department of Otolaryngology, Head and Neck Surgery Mayo Clinic Rochester Minnesota USA
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McDowell L, Chua MLK, Beadle BM, Ma DJ, Mierzwa M, Thomson DJ, Margalit DN. A Bit More Here and a Little Less There: The Trials (and Tribulations) of Adjuvant and Neoadjuvant Head and Neck Studies in 2021. Int J Radiat Oncol Biol Phys 2022; 113:243-251. [PMID: 35569469 DOI: 10.1016/j.ijrobp.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/09/2022] [Indexed: 11/28/2022]
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17
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Grams MP, Tseung HSWC, Ito S, Zhang Y, Owen D, Park SS, Ahmed SK, Petersen IA, Haddock MG, Harmsen WS, Ma DJ. A Dosimetric Comparison of Lattice, Brass, and Proton Grid Therapy Treatment Plans. Pract Radiat Oncol 2022; 12:e442-e452. [DOI: 10.1016/j.prro.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 02/28/2022] [Accepted: 03/09/2022] [Indexed: 11/28/2022]
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18
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Ebner DK, Geno CS, Ma DJ. In Regard to Soyfer et al. Int J Radiat Oncol Biol Phys 2022; 112:834-835. [PMID: 35101198 PMCID: PMC8799919 DOI: 10.1016/j.ijrobp.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/01/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Daniel K Ebner
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Connie S Geno
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
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Routman DM, Kumar S, Chera BS, Jethwa KR, Van Abel KM, Frechette K, DeWees T, Golafshar M, Garcia JJ, Price DL, Kasperbauer JL, Patel SH, Neben-Wittich MA, Laack NL, Chintakuntlawar AV, Price KA, Liu MC, Foote RL, Moore EJ, Gupta GP, Ma DJ. Detectable Post-operative Circulating Tumor Human Papillomavirus (HPV) DNA And Association with Recurrence in Patients with HPV-Associated Oropharyngeal Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2022; 113:530-538. [PMID: 35157995 DOI: 10.1016/j.ijrobp.2022.02.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 01/22/2022] [Accepted: 02/06/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE To determine the rate of detectability of ctHPVDNA after surgery but before adjuvant therapy in patients with HPV-associated oropharyngeal squamous cell carcinoma (HPV(+)OPSCC) and to investigate whether detectable ctHPVDNA at this time point may be associated with risk of recurrence. METHODS AND MATERIALS Prospectively collected samples from patients with OPSCC were examined in a blinded fashion using a multi-analyte PCR assay. 45 samples were collected from HPV(+)OPSCC patients pre-op (prior to any treatment), and 159 samples post-op (before or at the start of adjuvant RT). Samples were identified via the radiation oncology biobank or via participation in a clinical trial. RT consisted of 60 Gy +/- cisplatin or de-escalation (30 Gy to 36 Gy in 20 b.i.d. fractions + docetaxel). 32 patients had paired samples available pre and post-op for the primary analysis. Additional exploratory analyses including associations of patient and tumor characteristics with recurrence were assessed using Cox proportional hazards models for all 159 post-op samples.. Detectability of ctHPVDNA was compared across groups utilizing logistic regression. Estimates of recurrence free survival (RFS) were made using Kaplan-Meier (KM). RESULTS In a paired analysis of 32 pre and post-op timepoints, 94% of patients had detectable ctHPVDNA pre-op and 41% post-op. RFS at 18 months was 83% (95% CI: 47-95%) for patients with detectable post-op ctHPVDNA compared to 100% for patients with undetectable post-op ctHPVDNA (p=.094).In an exploratory analysis of non-paired post-op samples, ctHPVDNA was detectable in 26% (41 of 159) of patients (median of 22 days post-op). Age (1.06, p=0.025), LVSI (OR 3.17, p=0.011) and ENE (OR=5.67, p=0.001) were associated with detectable ctHPVDNA after surgery. Detectable post-op ctHPVDNA was significantly associated with RFS (p<0.001). CONCLUSION Amongst patients with detectable pre-op ctHPVDNA, a significant proportion have detectable post-op ctHPVDNA in paired post-op samples, collected prior to the initiation of adjuvant radiation therapy. Future prospective study is warranted to investigate the association of detectable post-op ctHPVDNA with recurrence, including in comparison to established clinical and pathologic risk factors.
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Affiliation(s)
- D M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA.
| | - S Kumar
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - B S Chera
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - K R Jethwa
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA; Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - K M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester MN, USA
| | - K Frechette
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - T DeWees
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Phoenix AZ, USA
| | - M Golafshar
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Phoenix AZ, USA
| | - J J Garcia
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester MN, USA
| | - D L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester MN, USA
| | - J L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester MN, USA
| | - S H Patel
- Department of Radiation Oncology, Mayo Clinic, Phoenix AZ, USA
| | | | - N L Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - K A Price
- Division of Medical Oncology, Mayo Clinic, Rochester MN, USA
| | - M C Liu
- Division of Medical Oncology, Mayo Clinic, Rochester MN, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester MN, USA
| | - R L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - E J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester MN, USA
| | - G P Gupta
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - D J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
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20
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Karp EE, Garcia JJ, Chan SA, Van Abel KM, Moore EJ, Janus JR, Kasperbauer JL, Olsen KD, Hinni ML, Price KA, Ma DJ, Foote RL, Neben Wittich MA, Price DL. The role of total parotidectomy in high-grade parotid malignancy: A multisurgeon retrospective review. Am J Otolaryngol 2022; 43:103194. [PMID: 34509079 DOI: 10.1016/j.amjoto.2021.103194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/09/2021] [Accepted: 08/26/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Determine rates of intra-parotid and neck nodal metastasis, identify risk factors for recurrence, and report outcomes in patients with primary high-grade parotid malignancy who undergo total parotidectomy and neck dissection. MATERIALS & METHODS Retrospective review of patients undergoing total parotidectomy and neck dissection for high-grade parotid malignancy between 2005 and 2015. The presence and number of parotid lymph nodes, superficial and deep, as well as cervical lymph nodes involved with metastatic disease were assessed. Risk factors associated with metastatic spread to the parotid deep lobe were identified and recurrence rates reported. RESULTS 75 patients with median follow-up time of 47 months. 35 patients (46.7%) had parotid lymph node metastasis. Seven patients (9.3%) had deep lobe nodal metastasis without metastasis to the superficial lobe nodes. Nine patients (12%) had positive intra-parotid nodes without positive cervical nodes. Cervical nodal disease was identified in 49.3% patients (37/75). Local, parotid-bed recurrence rate was 5.3% (4/75). Regional lymph node recurrence rate was also 5.3% (4/75). Rate of distant metastasis was 30.6% (23/75). The overall disease free survival rate for all patients at 2 and 5 years were 71% and 60% respectively. CONCLUSION Parotid lymph node metastasis occurred at a similar rate to cervical lymph node metastasis (46.7% and 49.3%, respectively). Deep lobe parotid nodal metastasis occurred in nearly a quarter of patients and can occur without superficial parotid nodal metastasis. Rate of recurrence in the parotid bed, which may represent local or regional recurrence, was similar to regional cervical lymph node recurrence. Total parotidectomy and neck dissection should be considered high-grade parotid malignancy regardless of clinical nodal status.
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21
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Jeans EB, Shiraishi S, Manzar G, Morris LK, Amundson A, McGee LA, Rwigema JC, Neben-Wittich M, Routman DM, Ma DJ, Patel SH, Foote RL, Lester SC. An comparison of acute toxicities and patient-reported outcomes between intensity-modulated proton therapy and volumetric-modulated arc therapy after ipsilateral radiation for head and neck cancers. Head Neck 2021; 44:359-371. [PMID: 34859516 DOI: 10.1002/hed.26937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 10/27/2021] [Accepted: 11/05/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Intensity-modulated proton therapy (IMPT) demonstrates superior dose distribution over volumetric-modulated arc therapy (VMAT) for sparing organs-at-risk (OARs) in ipsilateral radiotherapy. To determine a clinical benefit, assessment of patient-reported outcomes (PRO) and physician-reported toxicities alongside a dosimetric analysis is needed. METHODS Plans were analyzed for dosimetric differences. PROs were compared for patients undergoing ipsilateral curative-intent radiotherapy for tonsil and salivary gland cancers with VMAT or IMPT from 2015 to 2020. Physician-reported toxicities were compared. RESULTS In 40 patients, IMPT was associated with decreased dose to multiple OARs and less deterioration in the following PROs: pain, swallowing function, dry mouth, sticky saliva, sensory change, cough, speech, feeling ill, and social eating. Physician-reported toxicities demonstrated less oral pain. CONCLUSION IMPT is associated with decreased dose to OARs and less patient-reported acute deterioration in multiple head and neck domains. A strong consideration for IMPT in ipsilateral head and neck patients with cancer is warranted.
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Affiliation(s)
- Elizabeth B Jeans
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Satomi Shiraishi
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Gohar Manzar
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lindsay K Morris
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Adam Amundson
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lisa A McGee
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | | | | | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Scott C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
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22
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Gao RW, Foote RL, Garces YI, Ma DJ, Neben-Wittich M, Routman DM, Patel SH, Ko SJ, McGee LA, Bible KC, Chintakuntlawar AV, Ryder M, Morris JC, Van Abel KM, Rivera M, Abraha F, Lester SC. Outcomes and Patterns of Recurrence for Anaplastic Thyroid Cancer Treated with Comprehensive Chemoradiotherapy. Pract Radiat Oncol 2021; 12:113-119. [PMID: 34715395 DOI: 10.1016/j.prro.2021.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/16/2021] [Accepted: 10/13/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE/OBJECTIVES Radiotherapy (RT) plays an important role in locoregional tumor control for anaplastic thyroid cancer (ATC). Due to its rarity, RT guidelines for ATC are lacking. We describe ATC patterns of nodal disease at presentation and progression and propose corresponding RT target volumes. MATERIALS/METHODS We identified all patients with ATC treated at our institution with definitive or adjuvant IMRT and concomitant chemotherapy from 2006 to 2020. We identified in-field, marginal, and out-of-field sites of locoregional recurrence and progression (LRR). RESULTS Forty-seven patients met inclusion. Median follow-up was 6.6 months (IQR: 1.9-19.6). Nodal levels involved at presentation included: IB (2.1%), II (23.4%), III (21.3%), IV (21.3%), V (12.8%), VI (34%), and mediastinal (6.4%). All patients received elective nodal RT to levels II-IV and VI. RT volumes also included: IA (23.4%), IB (44.7%), V (87.2%), retropharyngeal/retrostyloid (RP/RS) (27.7%), and mediastinal 1-6 (53.2%). Cumulative incidence of LRR at 3- and 12-months was 26.1% (95% CI: 15.9-42.8) and 35.7% (23.9-53.4). Isolated LRR risk at 3- and 12-months was 6.5% (2.2-19.8) and 8.9% (3.4-22.9). Fourteen (29.8%) patients experienced in-field LRR in the thyroid gland or postoperative tumor bed, II-IV, VI, and mediastinal 1 and 3A. Four (8.5%) patients had marginal LRRs, 3 of whom progressed in the mediastinum at 2, 3P, 4, and 6. Two (4.3%) patients experienced out-of-field LRRs. Throughout the pre-treatment and follow-up period, no patients had disease at IA and 1 (2.1%) patient each had disease at IB and RP/RS. No baseline or treatment characteristics, including RT dose (stratified by < or ≥66 Gy), were significant predictors of LRR on univariate analysis. CONCLUSIONS Isolated LRR risk in patients with ATC treated with comprehensive RT and chemotherapy is low. Aggressive multimodality therapy should be reserved for willing, fit patients with no or limited distant disease burden. When treating comprehensively, complete inclusion of mediastinal levels 1-6 may be warranted to avoid marginal disease progression. Omission of levels I and RP/RS can be considered.
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Affiliation(s)
- Robert W Gao
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Yolanda I Garces
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Stephen J Ko
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Lisa A McGee
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | | | | | | | | | | | | | - Feven Abraha
- Biostatistics & Information, Mayo Clinic, Rochester, Minnesota
| | - Scott C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
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23
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Mierzwa M, Beadle BM, Chua MLK, Ma DJ, Thomson DJ, Margalit DN. Something for Everyone From Low-Risk to High-Risk: 5 Recent Studies to Improve Treatment and Surveillance for All Patients With Squamous Cell Carcinoma of the Head and Neck. Int J Radiat Oncol Biol Phys 2021; 111:1-8. [PMID: 34348102 DOI: 10.1016/j.ijrobp.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 11/18/2022]
Affiliation(s)
| | | | - Melvin L K Chua
- Divisions of Radiation Oncology and Medical Sciences, National Cancer Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | | | - David J Thomson
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
| | - Danielle N Margalit
- Brigham & Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
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Abstract
Human papillomavirus-associated oropharyngeal squamous cell carcinoma (HPV+OPSCC) constitutes the majority of head and neck diagnoses within the United States. Patients with HPV+OPSCC have biologically and demographically distinct disease, leading to high cure rates after standard treatments. This long survivorship period coupled with the toxicity of standard treatments makes de-intensification strategies an urgent research question. Surgery has generally been avoided for HPV+OPSCC as historical surgical techniques were invasive and morbid. With the advent of minimally invasive transoral techniques, definitive surgical options are becoming more popular. Minimally invasive surgery offers unique opportunities in a de-intensification paradigm, including more detailed patient selection, radiation volume reduction, and radiation dose de-intensification. Nevertheless, careful patient selection must be exercised as surgical defects may lead to quality of life decrements beyond what is gained through de-intensification. Ongoing phase III efforts will help clarify the patient cohorts best suited for surgically oriented de-intensification.
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Affiliation(s)
- Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN.
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25
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McMillan RA, Van Abel KM, Yin LX, Routman DM, Ma DJ, Neben Wittich MA, Price DL, Kasperbauer JL, Price KR, Chintakuntlawar AV, Moore EJ. Second Primary Tumors in Patients Presenting With Unilateral HPV-Associated Tonsillar Squamous Cell Carcinoma. Laryngoscope 2021; 132:332-338. [PMID: 34236086 DOI: 10.1002/lary.29741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/31/2021] [Accepted: 06/26/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To describe and compare rates of metachronous and synchronous second primaries of the contralateral tonsil in patients with primary HPV(+) tonsillar squamous cell carcinoma (SCC). STUDY DESIGN Retrospective cohort study. MATERIALS AND METHODS This is a single tertiary care center retrospective case series, from 2006 to 2019, of HPV(+) tonsillar SCC patients who underwent primary surgical resection with unilateral wide-field tonsillectomy or bilateral tonsillectomy for diagnostic or therapeutic purposes. A metachronous second primary is one diagnosed >6 months after completion of surgical treatment. A synchronous second primary is one diagnosed during bilateral tonsillectomy for unilateral HPV(+) tonsillar SCC. Rates of second primary and patient characteristics were compared using chi-square tests. RESULTS About 303 patients underwent unilateral surgical resection +/- adjuvant therapy for HPV(+) tonsillar SCC. One (0.3%) developed a metachronous second primary in the contralateral tonsil 11.9 years following treatment. Fifty-seven patients with HPV(+) tonsillar SCC underwent bilateral tonsillectomy, and 37/57 (65%) had no clinical signs for contralateral disease. Of these, only 1/37 (2.7%) was incidentally found to have a synchronous second primary. Twenty patients underwent bilateral tonsillectomy due to clinical concern for contralateral disease. Of these, 3/20 (15%) were found to have a synchronous HPV(+) SCC in the contralateral tonsil. CONCLUSIONS The prevalence of metachronous second primary after appropriate treatment of HPV(+) tonsillar SCC is very low (0.3%) and so is the chance of incidentally discovering a synchronous second primary during bilateral tonsillectomy (2.7%). We do not recommend bilateral tonsillectomy as a part of the routine algorithm in the surgical management of these patients. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Ryan A McMillan
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Linda X Yin
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | | | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Katharine R Price
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | | | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
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26
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Bridhikitti J, Viehman JK, Harmsen WS, Amundson AC, Shiraishi S, Mundy DW, Rwigema JCM, McGee LA, Patel SH, Routman DM, Lester SC, Neben-Wittich MA, Garces YI, Ma DJ, Foote RL. Oncologic Outcomes for Head and Neck Skin Malignancies Treated with Protons. Int J Part Ther 2021; 8:294-303. [PMID: 34285955 PMCID: PMC8270091 DOI: 10.14338/ijpt-20-00045.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 02/12/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Radiation therapy (RT) is the standard treatment for patients with inoperable skin malignancies of the head and neck region (H&N), and as adjuvant treatment post surgery in patients at high risk for local or regional recurrence. This study reports clinical outcomes of intensity-modulated proton therapy (IMPT) for these malignancies. Materials and Methods We retrospectively reviewed cases involving 47 patients with H&N malignancies of the skin (squamous cell, basal cell, melanoma, Merkel cell, angiosarcoma, other) who underwent IMPT for curative intent between July 2016 and July 2019. Overall survival was estimated via Kaplan-Meier analysis, and oncologic outcomes were reported as cumulative incidence with death as a competing risk. Results The 2-year estimated local recurrence rate, regional recurrence rate, local regional recurrence rate, distant metastasis rate, and overall survival were 11.1% (95% confidence interval [CI], 4.1%-30.3%), 4.4% (95% CI, 1.1%-17.4%), 15.5% (95% CI, 7%-34.3%), 23.4% (95% CI, 5.8%-95.5%), and 87.2% (95% CI, 75.7%-100%), respectively. No patient was reported to have a grade 3 or higher adverse event during the last week of treatment or at the 3-month follow-up visit. Conclusion IMPT is safe and effective in the treatment of skin malignancies of the H&N.
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Affiliation(s)
| | - Jason K Viehman
- Division of Biomedical Statistics & Informatics, Mayo Clinic, Rochester, MN, USA
| | - W Scott Harmsen
- Department of Biostatistics and Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Adam C Amundson
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Satomi Shiraishi
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Daniel W Mundy
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - Lisa A McGee
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Scott C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - Yolanda I Garces
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
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27
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Yu NY, Khurana A, Ma DJ, Neben-Wittich MA, Golafshar MA, McGee LA, Rwigema JCM, Foote RL, Patel SH. Initial Experience with Proton Beam Therapy for Differentiated Thyroid Cancer. Int J Part Ther 2021; 8:311-318. [PMID: 34285957 PMCID: PMC8270099 DOI: 10.14338/ijpt-d-20-00053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 01/29/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose External beam radiotherapy is used in a subset of high-risk patients with differentiated thyroid cancer (DTC). Recurrent, radioactive iodine (RAI)-refractory DTC carries a poor prognosis. We report our initial experience of intensity-modulated proton therapy (IMPT) for recurrent, RAI-refractory DTC. Patients and Methods Fourteen patients with recurrent, RAI-refractory DTC were consecutively treated with IMPT from November 2016 to March 2020 at our multisite institution. Patient, tumor, and treatment characteristics were recorded. Overall survival and local-regional recurrence-free survival were recorded and estimated using the Kaplan-Meier method. Acute and late treatment-related toxicities were recorded based on the Common Terminology Criteria for Adverse Events version 5.0. Patients completed the European Organization for Research and Treatment of Cancer Quality of Life Head and Neck Module at baseline and after IMPT. Eleven patients were included in the final analysis. Results Median follow-up was 8 months (range, 3-40) for all patients. Median age at treatment with IMPT was 64 years (range, 40-77), and the majority were men (64%). Recurrent histologies included papillary (55%), Hurthle cell (36%), and poorly differentiated (9%) carcinoma; 1 patient had tall cell variant. Concurrent chemotherapy was not administered for any patient in this cohort. At 8 months, all patients were alive without local-regional failure. Acute grade 3 toxicities were limited to 1 patient with dysphagia, requiring feeding tube placement. Two patients experienced late grade 3 esophageal stenosis requiring dilation. There were no grade 4 or 5 toxicities. There were no differences in pretreatment versus posttreatment patient-reported outcomes in terms of dysphagia or hoarseness. Conclusion In our early experience, IMPT provided promising local-regional control for recurrent, RAI-refractory DTC. Further study is warranted to evaluate the long-term efficacy and safety of IMPT in this patient population.
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Affiliation(s)
- Nathan Y Yu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Aditya Khurana
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Lisa A McGee
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | | | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
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28
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Gamez ME, Ma DJ. Deintensification Strategies Using Proton Beam Therapy for HPV-Related Oropharyngeal Cancer. Int J Part Ther 2021; 8:223-233. [PMID: 34285949 PMCID: PMC8270104 DOI: 10.14338/ijpt-20-00073.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/09/2020] [Indexed: 12/13/2022] Open
Abstract
Oropharyngeal cancers related to the human papillomavirus are a growing segment of head and neck cancers throughout the world. These cancers are biologically and demographically unique with patients presenting at younger ages and with more curable disease. This combination of factors heightens the importance of normal tissue sparing because patients will live a long time with treatment sequelae. Proton therapy has demonstrated benefits in reducing normal tissue exposure, which may lead to less toxicity, a higher quality of life, less immunologic suppression, and lower cost. Research investigating deintensified radiation volumes and doses are also underway. These deintensification studies synergize well with the beam characteristics of proton beam therapy and can decrease that already reduced normal tissue exposure enabled by proton therapy. Future studies should refine patient selection to best allow for volume and dose reduction paired with proton therapy.
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Affiliation(s)
- Mauricio E. Gamez
- Department of Radiation Oncology, The Ohio State University, Columbus, OH, USA
| | - Daniel J. Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
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29
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Gamez ME, Patel SH, McGee LA, Sio TT, McDonald M, Phan J, Ma DJ, Foote RL, Rwigema JCM. A Systematic Review on Re-irradiation with Charged Particle Beam Therapy in the Management of Locally Recurrent Skull Base and Head and Neck Tumors. Int J Part Ther 2021; 8:131-154. [PMID: 34285942 PMCID: PMC8270105 DOI: 10.14338/ijpt-20-00064.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 03/25/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose To evaluate the clinical outcomes and treatment related toxicities of charged particle-based re-irradiation (reRT; protons and carbon ions) for the definitive management of recurrent or second primary skull base and head and neck tumors. Materials and Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied for the conduct of this systematic review. Published work in English language evaluating the role of definitive charged particle therapies in the clinical setting of reRT for recurrent or second primary skull base and head and neck tumors were eligible for this analysis. Results A total of 26 original studies (15 protons, 10 carbon ions, and 1 helium/neon studies) involving a total of 1,118 patients (437 with protons, 670 with carbon ions, and 11 with helium/neon) treated with curative-intent charged particle reRT were included in this systematic review. All studies were retrospective in nature, and the majority of them (n=23, 88 %) were reported as single institution experiences (87% for protons, and 90% for carbon ion-based studies). The median proton therapy reRT dose was 64.5 Gy (RBE 1.1) (range, 50.0 – 75.6 Gy ), while the median carbon ion reRT dose was 53.8 Gy (RBE 2.5 – 3.0) (range, 44.8 – 60 Gy ). Induction and/or concurrent chemotherapy was administered to 232 (53%) of the patients that received a course of proton reRT, and 122 (18%) for carbon ion reRT patients. ReRT with protons achieved 2-year local control rates ranging from 50% to 86%, and 41% to 92% for carbon ion reRT. The 2-year overall survival rates for proton and carbon ion reRT ranged from 33% to 80%, and 50% to 86% respectively. Late ≥ G3 toxicities ranged from 0% to 37%, with brain necrosis, ototoxicity, visual deficits, and bleeding as the most common complications. Grade 5 toxicities for all treated patients occurred in 1.4% (n= 16/1118) with fatal bleeding as the leading cause. Conclusions Based on current data, curative intent skull base and head and neck reRT with charged particle radiotherapy is feasible and safe in well-selected cases, associated with comparable or potentially improved local control and toxicity rates compared to historical reRT studies using photon radiotherapy. Prospective multi-institutional studies reporting oncologic outcomes, toxicity, and dosimetric treatment planning data are warranted to further validate these findings and to improve the understanding of the clinical benefits of charged particle radiotherapy in the reRT setting.
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Affiliation(s)
- Mauricio E Gamez
- Radiation Oncology, The Ohio State University - The James Cancer Center, Columbus, OH, USA
| | | | - Lisa A McGee
- Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | | | - Mark McDonald
- Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Jack Phan
- Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Daniel J Ma
- Radiation Oncology, Mayo Clinic, Rochester, MN, USA
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Yin LX, Karp EE, Elias A, O'Byrne TJ, Routman DM, Price DL, Kasperbauer JL, Neben-Wittich M, Chintakuntlawar AV, Price KA, Ma DJ, Foote RL, Moore EJ, Van Abel KM. Disease Profile and Oncologic Outcomes After Delayed Diagnosis of Human Papillomavirus-Associated Oropharyngeal Cancer. Otolaryngol Head Neck Surg 2021; 165:830-837. [PMID: 33752487 DOI: 10.1177/01945998211000426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Diagnostic delay in human papillomavirus-associated oropharynx squamous cell carcinoma (HPV(+)OPSCC) is common due to nonspecific symptoms. We aim to describe the disease burden and oncologic outcomes of patients with HPV(+)OPSCC diagnosed >12 months after symptom onset. STUDY DESIGN This is a retrospective cohort study of HPV(+)OPSCC patients receiving intent-to-cure treatment (including surgery ± adjuvant therapy or primary chemoradiation). SETTING 2006-2016, tertiary care center. METHODS Tumor stage was compared between patients with and without delayed diagnosis using χ2 tests. Kaplan-Meier survival analysis with univariate and multivariable Cox regressions were used to determine the effect of diagnostic delay on oncologic outcomes. RESULTS In total, 664 patients were included. Compared to patients diagnosed <12 months from symptom onset (n = 601), those diagnosed at >12 months (n = 63) were more likely to have T4 disease and higher overall American Joint Committee on Cancer (AJCC) clinical stage at presentation (P < .01 for both). At 5 years, rates of overall survival, cancer-specific survival, progression-free survival, and distant metastases-free survival in the delayed diagnosis cohort were 80%, 90%, 80%, and 89%, respectively. A >12-month delay in diagnosis did not significantly impact overall survival (adjusted hazard ratio [aHR], 1.16; 95% CI, 0.58-2.31), cancer-specific survival (aHR, 0.83; 95% CI, 0.29-2.39), progression-free survival (aHR, 1.15; 95% CI, 0.56-2.37), or distant metastases-free survival (aHR, 1.00; 95% CI, 0.42-2.40) after adjusting for age, sex, and clinical AJCC stage (P > .05 for all). CONCLUSIONS Delayed diagnosis of HPV(+)OPSCC is associated with greater burden of disease at presentation, but oncologic outcomes remain favorable across treatment modalities. When appropriate, intent-to-cure therapy should be pursued despite diagnostic delay. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Linda X Yin
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Emily E Karp
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Anna Elias
- Department of Pediatrics, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas J O'Byrne
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Katharine A Price
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Hazim AZ, Reed CT, Price KA, Foote RL, Ma DJ, Neben-Wittich M, DeLone DR, Jenkins SM, Smith CY, Chintakuntlawar AV. Survival outcomes in locally advanced cutaneous squamous cell carcinoma presenting with clinical perineural invasion alone. Head Neck 2021; 43:1995-2001. [PMID: 33644935 DOI: 10.1002/hed.26661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 01/11/2021] [Accepted: 02/19/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Cutaneous squamous cell carcinomas (CSCC) involving the head and neck are common, but initial presentation or recurrence limited to the cranial nerves is rare. METHODS We conducted a retrospective study of 21 patients with clinical perineural invasion (PNI) from CSCC and no measurable disease by RECIST 1.1. Patients treated with radiotherapy or chemoradiotherapy were included. RESULTS The median time from symptom onset until diagnosis was 13.0 months (2.6-83.1). All patients received radiotherapy. Fourteen received concurrent systemic therapy. The median follow-up time was 30.5 months (1.1-106.0). Ten patients recurred, with the majority being locoregional. The 2-year overall survival rate was 85%. The median progression-free survival (PFS) was 21.5 months with an estimated 2-year PFS of 44.5% (95%CI: 22.3-66.8). CONCLUSIONS CSCCs with clinical PNI alone are difficult to diagnose and can have a long interval between appearance of symptoms and diagnosis. They can successfully be treated with chemoradiotherapy. However, many patients still suffer from locoregional recurrences.
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Affiliation(s)
- Antonious Z Hazim
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Clay T Reed
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Katharine A Price
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - David R DeLone
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sarah M Jenkins
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Carin Y Smith
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
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Tew BY, Legendre C, Schroeder MA, Triche T, Gooden GC, Huang Y, Butry L, Ma DJ, Johnson K, Martinez RA, Pierobon M, Petricoin EF, O'shaughnessy J, Osborne C, Tapia C, Buckley DN, Glen J, Bernstein M, Sarkaria JN, Toms SA, Salhia B. Patient-derived xenografts of central nervous system metastasis reveal expansion of aggressive minor clones. Neuro Oncol 2021; 22:70-83. [PMID: 31433055 DOI: 10.1093/neuonc/noz137] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 08/08/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The dearth of relevant tumor models reflecting the heterogeneity of human central nervous system metastasis (CM) has hindered development of novel therapies. METHODS We established 39 CM patient-derived xenograft (PDX) models representing the histological spectrum, and performed phenotypic and multi-omic characterization of PDXs and their original patient tumors. PDX clonal evolution was also reconstructed using allele-specific copy number and somatic variants. RESULTS PDXs retained their metastatic potential, with flank-implanted PDXs forming spontaneous metastases in multiple organs, including brain, and CM subsequent to intracardiac injection. PDXs also retained the histological and molecular profiles of the original patient tumors, including retention of genomic aberrations and signaling pathways. Novel modes of clonal evolution involving rapid expansion by a minor clone were identified in 2 PDXs, including CM13, which was highly aggressive in vivo forming multiple spontaneous metastases, including to brain. These PDXs had little molecular resemblance to the patient donor tumor, including reversion to a copy number neutral genome, no shared nonsynonymous mutations, and no correlation by gene expression. CONCLUSIONS We generated a diverse and novel repertoire of PDXs that provides a new set of tools to enhance our knowledge of CM biology and improve preclinical testing. Furthermore, our study suggests that minor clone succession may confer tumor aggressiveness and potentiate brain metastasis.
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Affiliation(s)
- Ben Yi Tew
- Department of Translational Genomics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | | | - Mark A Schroeder
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Tim Triche
- Center of Epigenetics, Van Andel Research Institute, Grand Rapids, Michigan, USA
| | - Gerald C Gooden
- Department of Translational Genomics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Yizhou Huang
- Center of Epigenetics, Van Andel Research Institute, Grand Rapids, Michigan, USA
| | - Loren Butry
- Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kyle Johnson
- Translational Genomics Institute (TGEN), Phoenix, Arizona, USA
| | | | - Mariaelena Pierobon
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Fairfax, Virginia, USA
| | - Emanuel F Petricoin
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Fairfax, Virginia, USA
| | - Joyce O'shaughnessy
- Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, Texas, USA
| | - Cindy Osborne
- Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, Texas, USA
| | - Coya Tapia
- Department of Molecular Pathology, The MD Anderson Cancer Center, Houston, Texas, USA
| | - David N Buckley
- Department of Translational Genomics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | | | | | - Jann N Sarkaria
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Steven A Toms
- Geisinger Medical Center, Danville, Pennsylvania, USA.,Lifespan, Providence, RI
| | - Bodour Salhia
- Department of Translational Genomics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Translational Genomics Institute (TGEN), Phoenix, Arizona, USA.,Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Waddle MR, Ma DJ, Visscher SL, Borah BJ, May JM, Price KA, Moore EJ, Patel SH, Hinni ML, Chintakuntlawar AV, Garcia JJ, Graner DE, Neben-Wittich MA, Garces YI, Hallemeier CL, Price DL, Kasperbauer JL, Janus JR, Foote RL, Miller RC. Costs of Definitive Chemoradiation, Surgery, and Adjuvant Radiation Versus De-Escalated Adjuvant Radiation per MC1273 in HPV+ Cancer of the Oropharynx. Int J Radiat Oncol Biol Phys 2020; 110:396-402. [PMID: 33359567 DOI: 10.1016/j.ijrobp.2020.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 11/12/2020] [Accepted: 12/17/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE De-escalated treatment for human papillomavirus (HPV)+ oropharynx squamous cell carcinoma (OPSCC) has shown promising initial results. Health-care policy is increasingly focusing on high-value care. This analysis compares the cost of care for HPV+ OPSCC treated with definitive chemoradiation (CRT), surgery and adjuvant radiation (RT), and surgery and de-escalated CRT on MC1273. METHODS AND MATERIALS MC1273 is a prospective, phase 2 study evaluating adjuvant CRT to 30 to 36 Gy plus docetaxel for HPV+ OPSCC after surgery for high-risk patients. Matched standard-of-care control groups were retrospectively identified for patients treated with definitive CRT or adjuvant RT. Standardized costs were evaluated before radiation, during treatment (during RT), and at short-term (6 month) and long-term (7-24 month) follow-up periods. RESULTS A total of 56 definitive CRT, 101 adjuvant RT, and 66 MC1273 patients were included. The CRT arm had more T3-4 disease (63% vs 17-21%) and higher N2c-N3 disease (52% vs 20-24%) vs both other groups. The total treatment costs in the CRT, adjuvant RT, and MC1273 groups were $47,763 (standard deviation [SD], $19,060], $57,845 (SD, $17,480), and $46,007 (SD, $9019), respectively, and the chemotherapy and/or RT costs were $39,936 (SD, $18,480), $26,603 (SD, $12,542), and $17,864 (SD, $3288), respectively. The per-patient, per-month, average short-term follow-up costs were $3860 (SD, $10,525), $1072 (SD, $996), and $972 (SD, $833), respectively, and the long-term costs were $978 (SD, $2294), $485 (SD, $1156), and $653 (SD, $1107), respectively. After adjustment for age, T-stage, and N-stage, treatment costs remained lower for CRT and MC1273 versus adjuvant RT ($45,450 and $47,114 vs $58,590, respectively; P < .001), whereas the total per-patient, per-month follow-up costs were lower in the MC1273 study group and adjuvant RT versus CRT ($853 and $866 vs $2030, respectively; P = .03). CONCLUSIONS MC1273 resulted in 10% and 20% reductions in global costs compared with standard-of-care adjuvant RT and definitive CRT treatments. Substantial cost savings may be an added benefit to the already noted low toxicity and maintained quality of life of treatment per MC1273.
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Affiliation(s)
- Mark R Waddle
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Sue L Visscher
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Bijan J Borah
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Jackson M May
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | | | - Eric J Moore
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota
| | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona
| | - Michael L Hinni
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota
| | | | - Joaquin J Garcia
- Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota; Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Yolanda I Garces
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | | | - Daniel L Price
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota
| | | | - Jeffrey R Janus
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Robert C Miller
- Division of Radiation Oncology, University of Tennessee, Knoxville, Tennessee.
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Grams MP, Owen D, Park SS, Petersen IA, Haddock MG, Jeans EB, Finley RR, Ma DJ. VMAT Grid Therapy: A Widely Applicable Planning Approach. Pract Radiat Oncol 2020; 11:e339-e347. [PMID: 33130318 DOI: 10.1016/j.prro.2020.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/26/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To describe a novel and practical volumetric modulated arc therapy (VMAT) planning approach for grid therapy. METHODS AND MATERIALS Dose is prescribed to 1.5-cm diameter spherical contours placed throughout the gross tumor volume (GTV). Placement of spheres is variable, but they must maintain at least a 3-cm (center to center) separation, and the edge of any sphere must be at least 1 cm from any organ at risk (OAR). Three concentric ring structures are used during optimization to confine the highest doses to the center of the spheres and maximize dose sparing between them. The end result is alternating regions of high and low dose throughout the GTV and minimal dose to OARs. High-intensity flattening filter-free (FFF) modes are used to efficiently deliver the plans, and entire treatments typically take only 15 to 20 minutes. RESULTS The approach is illustrated with 2 examples treated at our institution. Patient #1 had a 1703-cm3 mediastinal mass and was prescribed 20 Gray (Gy) to 24 spherical regions within the GTV. Patient #2 had a 3680-cm3 abdominal tumor and was prescribed 18 Gy to 32 spherical regions within the GTV. Both patients received additional consolidative radiation approximately 1 week after the initial VMAT grid treatment. Each patient experienced marked reduction in tumor size and symptomatic relief without treatment-related complications. CONCLUSIONS We have described in detail a planning approach for VMAT grid therapy treatments that can typically be delivered in a clinically practical time span. The VMAT approach is especially useful for tumors that are surrounded by sensitive critical structures. As many centers offer VMAT treatments, the approach is widely accessible and can be readily implemented once appropriate patient selection and delivery processes are established.
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Affiliation(s)
- Michael P Grams
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
| | - Dawn Owen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Sean S Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Ivy A Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Randi R Finley
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
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Jeans EB, Beard TB, Boon AL, Brown PD, Ma DJ, Petersen IA, Laack NN, Foote RL, Corbin KS, Olivier KR. Empowering Residents into Independent Practice: A Single-Institutional Endeavor Aimed at Developing Resident Autonomy Through Implementation of a Chief Resident Service in Radiation Oncology. Int J Radiat Oncol Biol Phys 2020; 107:23-26. [PMID: 32277921 DOI: 10.1016/j.ijrobp.2020.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/02/2020] [Accepted: 01/03/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | - Teresa B Beard
- Department of Medicare Regulation and Reimbursement, Mayo Clinic, Rochester, Minnesota
| | - Ashton L Boon
- Department of Legal Counsel, Mayo Clinic, Rochester, Minnesota
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Ivy A Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Nadia N Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Kenneth R Olivier
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
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Evans JD, Harper RH, Petersen M, Harmsen WS, Anand A, Hunzeker A, Deiter NC, Schultz H, Jethwa KR, Lester SC, Routman DM, Ma DJ, Garces YI, Neben-Wittich MA, Laack NN, Beltran CJ, Patel SH, McGee LA, Rwigema JCM, Mundy DW, Foote RL. The Importance of Verification CT-QA Scans in Patients Treated with IMPT for Head and Neck Cancers. Int J Part Ther 2020; 7:41-53. [PMID: 33094135 PMCID: PMC7574830 DOI: 10.14338/ijpt-20-00006.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/15/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose To understand how verification computed tomography-quality assurance (CT-QA) scans influenced clinical decision-making to replan patients with head and neck cancer and identify predictors for replanning to guide intensity-modulated proton therapy (IMPT) clinical practice. Patients and Methods We performed a quality-improvement study by prospectively collecting data on 160 consecutive patients with head and neck cancer treated using spot-scanning IMPT who underwent weekly verification CT-QA scans. Kaplan-Meier estimates were used to determine the cumulative probability of a replan by week. Predictors for replanning were determined with univariate (UVA) and multivariate (MVA) Cox model hazard ratios (HRs). Logistic regression was used to determine odds ratios (ORs). P < .05 was considered statistically significant. Results Of the 160 patients, 79 (49.4%) had verification CT-QA scans, which prompted a replan. The cumulative probability of a replan by week 1 was 13.7% (95% confidence interval [CI], 8.82-18.9), week 2, 25.0% (95% CI, 18.0-31.4), week 3, 33.1% (95% CI, 25.4-40.0), week 4, 45.6% (95% CI, 37.3-52.8), and week 5 and 6, 49.4% (95% CI, 41.0-56.6). Predictors for replanning were sinonasal disease site (UVA: HR, 1.82, P = .04; MVA: HR, 3.64, P = .03), advanced stage disease (UVA: HR, 4.68, P < .01; MVA: HR, 3.10, P < .05), dose > 60 Gy equivalent (GyE; relative biologic effectiveness, 1.1) (UVA: HR, 1.99, P < .01; MVA: HR, 2.20, P < .01), primary disease (UVA: HR, 2.00 versus recurrent, P = .01; MVA: HR, 2.46, P = .01), concurrent chemotherapy (UVA: HR, 2.05, P < .01; MVA: not statistically significant [NS]), definitive intent treatment (UVA: HR, 1.70 versus adjuvant, P < .02; MVA: NS), bilateral neck treatment (UVA: HR, 2.07, P = .03; MVA: NS), and greater number of beams (5 beam UVA: HR, 5.55 versus 1 or 2 beams, P < .02; MVA: NS). Maximal weight change from baseline was associated with higher odds of a replan (≥3 kg: OR, 1.97, P = .04; ≥ 5 kg: OR, 2.13, P = .02). Conclusions Weekly verification CT-QA scans frequently influenced clinical decision-making to replan. Additional studies that evaluate the practice of monitoring IMPT-treated patients with weekly CT-QA scans and whether that improves clinical outcomes are warranted.
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Affiliation(s)
- Jaden D Evans
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA.,Department of Radiation Oncology and Precision Genomics, Intermountain Healthcare, Ogden, UT, USA
| | - Riley H Harper
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Molly Petersen
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - William S Harmsen
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Aman Anand
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Ashley Hunzeker
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Noelle C Deiter
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Heather Schultz
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Krishan R Jethwa
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA.,Department of Therapeutic Radiology, Yale Comprehensive Cancer Center, New Haven, CT, USA
| | - Scott C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Yolanda I Garces
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - Nadia N Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Chris J Beltran
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Lisa A McGee
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | | | - Daniel W Mundy
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
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Van Abel KM, Routman DM, Moore EJ, Ma DJ, Yin LX, Fields PA, Schofield M, Bartemes KR, Chatzopoulos K, Price DL, Janus JR, Kasperbauer JL, Price KA, Chintakuntlawar AV, Neben-Wittich MA, Foote RL, Garcia JJ. T cell fraction impacts oncologic outcomes in human papillomavirus associated oropharyngeal squamous cell carcinoma. Oral Oncol 2020; 111:104894. [PMID: 32712575 DOI: 10.1016/j.oraloncology.2020.104894] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/22/2020] [Accepted: 07/01/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND We investigated T cell clonality (TCC) and T cell fraction (TCF) in human papilloma virus associated oropharyngeal squamous cell carcinoma (HPV(+)OPSCC) progressors [cases] vs. non-progressors [controls]. METHODS This nested case-control study included patients undergoing intent-to-cure surgery ± adjuvant therapy from 6/1/2007-10/3/2016. Patients experiencing local/regional/distant disease (progressors), and a consecutive sample of non-progressors were matched (2 controls: 1 case) on tumor subsite, T-stage and number of metastatic lymph nodes. We performed imunosequencing of the CDR3 regions of human TCRβ chains. RESULTS 34 progressors and 65 non-progressors were included. There was no statistically significant difference in baseline TCF (range: 0.039-1.084) and TCC (range: 0.007-0.240) (p > 0.05). Female sex was associated with higher TCF (p = 0.03), while extranodal extension (ENE) was associated with lower TCF (p = 0.01). There was a positive correlation between tumor size and clonality (R = 0.34, p < 0.01). The strongest predictor of progression-free survival (PFS) was TCF (HR 0.80, 95%CI 0.66-0.96, p = 0.02). The strongest predictors of cancer specific survival (CSS) were TCF (HR0.69, 95%CI 0.47-1.00, p < 0.05) and Adult Comorbidity Evaluation-27 (ACE-27) score (p < 0.05). Similarly, the strongest predictors of overall survival (OS) were TCF (HR 0.62, 95%CI 0.43-0.91, p = 0.01) and ACE-27 score (p = 0.03). On multivariable modeling, TCF ≥ 0.4 was independently associated with PFS (HR 0.34, 95%CI 0.14-0.85, p = 0.02) while an ACE-27 score of ≥ 2 independently predicted CSS (HR 3.85, 95%CI 1.07-13.85, p = 0.04) and OS (HR 3.51, 95%CI 1.10-11.20, p = 0.03). CONCLUSIONS In patients with HPV(+)OPSCC, TCF was higher in female patients and those without ENE, suggesting differential immune responses. Lower TCF was significantly and independently associated with disease progression. Better ACE-27 scores appear to predict improved oncologic control.
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Affiliation(s)
- Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA.
| | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Linda X Yin
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Paul A Fields
- Adaptive Biotechnologies, Seattle, WA 98102, USA; Department of Pathology and Clinical Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Matt Schofield
- Adaptive Biotechnologies, Seattle, WA 98102, USA; Department of Pathology and Clinical Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Kathleen R Bartemes
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Kyriakos Chatzopoulos
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Jeffrey R Janus
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Katharine A Price
- Department of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Joaquin J Garcia
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Ma DJ, Cao Z, Wang BS, Sun YL. [Effect of silencing hepatocyte growth factor receptor c-Met expression on biological characteristics of colon cancer cells]. Zhonghua Zhong Liu Za Zhi 2020; 42:362-368. [PMID: 32482024 DOI: 10.3760/cma.j.cn112152-112152-20191106-00714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Objective: To investigate the effect of silencing hepatocyte growth factor receptor (c-Met) expression on the biological characteristics of HCT116 colon cancer cells. Methods: Cellular model of c-Met transient transfection was established by using small interfering RNA (siRNA), the expression of c-Met in colon cancer cells was detected by real-time fluorescence quantitative polymerase chain reaction (RT-qPCR) and western blot. The apoptosis assay, cell invasion assay, cell migration and other experiments were conducted to observe the effects of silencing c-Met on the biological characteristics of colon cancer cells. Results: RT-qPCR results showed that the relative expression levels of c-Met mRNA in siRNA-Met group, blank control group and siRNA negative control (siRNA-NC) group were 0.32±0.26, 1.01±0.03 and 1.05±0.23, respectively, and the difference was statistically significant (P<0.05). Western blot analysis showed that the expression level of c-Met protein in the siRNA-Met group was 0.24±0.03, significantly lower than 1.23±0.06 in the blank control group and 1.18±0.11 in the siRNA-NC group (P<0.05). The cell counting kit-8 (CCK8) results showed that the 72-hour absorbance (A) values of the siRNA-Met group, blank control group and the siRNA-NC group were 1.13±0.05, 1.48±0.08 and 1.53±0.07, respectively, and the difference was statistically significant (P<0.01). Cell cycle results showed that the proportion of cells in G(2)/M phase was (14.65±1.41)% in siRNA-Met group , (5.07±0.70)% in blank control group and (5.63±0.71)% in siRNA-NC group, and the difference was statistically significant (P<0.05). The expression levels of cell cycle regulatory proteins Cdc25c and cyclin B1 in siRNA-Met group were significantly decreased. The apoptotic rate in siRNA-Met group was (5.85±0.35)%, significantly higher than (1.00±0.17)% in blank control group and (0.91±1.14)% in siRNA-NC group (P<0.05). The expression level of apoptosis-related protein Bcl-2 in the siRNA-Met group was significantly decreased while Bcl-2 associated X protein (BAX) expression level was significantly increased. The cell scratching result showed that the cell migration abilities of the siRNA-Met group, blank control group and the siRNA-NC group were (51.33±8.62)%, (100.00±3.72)% and (102.33±6.43)%, respectively, and the difference was statistically significant (P<0.05). The number of cell penetrating into the basement membrane of the siRNA-Met group, blank control group and the siRNA-NC group were 47.50±10.60, 100.00±5.33 and 102.50±10.61, respectively, and the difference was statistically significant (P<0.05). The expressions of invasion related proteins including MMP-2 and MMP-9 in siRNA-Met group were decreased significantly. Conclusions: c-Met plays an important role in maintaining the biological characteristics of colon cancer cells. Inhibition of c-Met may have important values in the treatment of colon cancer.
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Affiliation(s)
- D J Ma
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan 250062, China
| | - Z Cao
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan 250062, China
| | - B S Wang
- Department of Gastrointestinal Cancer Surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, China
| | - Y L Sun
- Department of Gastrointestinal Cancer Surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, China
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Chua MLK, Ma DJ, Anderson CM, Karam SD, Margalit DN, Kimple RJ. Follow-Up and Management of Patients With Head and Neck Cancer During the 2019 Novel Coronavirus (SARS-CoV-2) Disease Pandemic. Adv Radiat Oncol 2020; 5:631-636. [PMID: 32426556 PMCID: PMC7227497 DOI: 10.1016/j.adro.2020.04.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Melvin L K Chua
- Divisions of Radiation Oncology and Medical Sciences, National Cancer Centre Singapore and Oncology Academic Programme, Duke-NUS Medical School, Singapore
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Carryn M Anderson
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Sana D Karam
- Department of Radiation Oncology, University of Colorado Anschutz Cancer Center, Aurora, Colorado
| | - Danielle N Margalit
- Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Randall J Kimple
- Department of Human Oncology, UW Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Manzar GS, Lester SC, Routman DM, Harmsen WS, Petersen MM, Sloan JA, Mundy DW, Hunzeker AE, Amundson AC, Anderson JL, Patel SH, Garces YI, Halyard MY, McGee LA, Neben-Wittich MA, Ma DJ, Frank SJ, Whitaker TJ, Foote RL. Comparative analysis of acute toxicities and patient reported outcomes between intensity-modulated proton therapy (IMPT) and volumetric modulated arc therapy (VMAT) for the treatment of oropharyngeal cancer. Radiother Oncol 2020; 147:64-74. [PMID: 32234612 DOI: 10.1016/j.radonc.2020.03.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/12/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND PURPOSE IMPT improves normal tissue sparing compared to VMAT in treating oropharyngeal cancer (OPC). Our aim was to assess if this translates into clinical benefits. MATERIALS AND METHODS OPC patients treated with definitive or adjuvant IMPT or VMAT from 2013 to 2018 were included. All underwent prospective assessment using patient-reported-outcomes (PROs) (EORTC-QLQ-H&N35) and provider-assessed toxicities (CTCAEv4.03). End-of-treatment and pretreatment scores were compared. PEG-tube use, hospitalization, and narcotic use were retrospectively collected. Statistical analysis used the Wilcoxon Rank-Sum Test with propensity matching for PROs/provider-assessed toxicities, and t-tests for other clinical outcomes. RESULTS 46 IMPT and 259 VMAT patients were included; median follow-up was 12 months (IMPT) and 30 months (VMAT). Baseline characteristics were balanced except for age (p = 0.04, IMPT were older) and smoking (p < 0.01, 10.9% IMPT >20PYs, 29.3% VMAT). IMPT was associated with lower PEG placement (OR = 0.27; 95% CI: 0.12-0.59; p = 0.001) and less hospitalization ≤60 days post-RT (OR = 0.21; 95% CI:0.07-0.6, p < 0.001), with subgroup analysis revealing strongest benefits in patients treated definitively or with concomitant chemoradiotherapy (CRT). IMPT was associated with a relative risk reduction of 22.3% for end-of-treatment narcotic use. Patients reported reduced cough and dysgeusia with IMPT (p < 0.05); patients treated definitively or with CRT also reported feeling less ill, reduced feeding tube use, and better swallow. Provider-assessed toxicities demonstrated less pain and mucositis with IMPT, but more mucosal infection. CONCLUSION IMPT is associated with improved PROs, reduced PEG-tube placement, hospitalization, and narcotic requirements. Mucositis, dysphagia, and pain were decreased with IMPT. Benefits were predominantly seen in patients treated definitively or with CRT.
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Affiliation(s)
- Gohar S Manzar
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, USA
| | - Scott C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, USA
| | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, USA
| | - William S Harmsen
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, USA
| | - Molly M Petersen
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, USA
| | - Jeff A Sloan
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, USA
| | - Daniel W Mundy
- Department of Radiation Oncology, Mayo Clinic, Rochester, USA
| | | | - Adam C Amundson
- Department of Radiation Oncology, Mayo Clinic, Rochester, USA
| | | | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, Phoenix, USA
| | | | | | - Lisa A McGee
- Department of Radiation Oncology, Mayo Clinic, Phoenix, USA
| | | | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, USA
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | | | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, USA.
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Vaubel RA, Tian S, Remonde D, Schroeder MA, Mladek AC, Kitange GJ, Caron A, Kollmeyer TM, Grove R, Peng S, Carlson BL, Ma DJ, Sarkar G, Evers L, Decker PA, Yan H, Dhruv HD, Berens ME, Wang Q, Marin BM, Klee EW, Califano A, LaChance DH, Eckel-Passow JE, Verhaak RG, Sulman EP, Burns TC, Meyer FB, O'Neill BP, Tran NL, Giannini C, Jenkins RB, Parney IF, Sarkaria JN. Genomic and Phenotypic Characterization of a Broad Panel of Patient-Derived Xenografts Reflects the Diversity of Glioblastoma. Clin Cancer Res 2020; 26:1094-1104. [PMID: 31852831 PMCID: PMC7056576 DOI: 10.1158/1078-0432.ccr-19-0909] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/25/2019] [Accepted: 12/12/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Glioblastoma is the most frequent and lethal primary brain tumor. Development of novel therapies relies on the availability of relevant preclinical models. We have established a panel of 96 glioblastoma patient-derived xenografts (PDX) and undertaken its genomic and phenotypic characterization. EXPERIMENTAL DESIGN PDXs were established from glioblastoma, IDH-wildtype (n = 93), glioblastoma, IDH-mutant (n = 2), diffuse midline glioma, H3 K27M-mutant (n = 1), and both primary (n = 60) and recurrent (n = 34) tumors. Tumor growth rates, histopathology, and treatment response were characterized. Integrated molecular profiling was performed by whole-exome sequencing (WES, n = 83), RNA-sequencing (n = 68), and genome-wide methylation profiling (n = 76). WES data from 24 patient tumors was compared with derivative models. RESULTS PDXs recapitulate many key phenotypic and molecular features of patient tumors. Orthotopic PDXs show characteristic tumor morphology and invasion patterns, but largely lack microvascular proliferation and necrosis. PDXs capture common and rare molecular drivers, including alterations of TERT, EGFR, PTEN, TP53, BRAF, and IDH1, most at frequencies comparable with human glioblastoma. However, PDGFRA amplification was absent. RNA-sequencing and genome-wide methylation profiling demonstrated broad representation of glioblastoma molecular subtypes. MGMT promoter methylation correlated with increased survival in response to temozolomide. WES of 24 matched patient tumors showed preservation of most genetic driver alterations, including EGFR amplification. However, in four patient-PDX pairs, driver alterations were gained or lost on engraftment, consistent with clonal selection. CONCLUSIONS Our PDX panel captures the molecular heterogeneity of glioblastoma and recapitulates many salient genetic and phenotypic features. All models and genomic data are openly available to investigators.
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Affiliation(s)
| | | | - Dioval Remonde
- Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | | | | | | | | | | | | | - Sen Peng
- Translational Genomics Research Institute, Phoenix, Arizona
| | | | | | | | - Lisa Evers
- Translational Genomics Research Institute, Phoenix, Arizona
| | | | | | | | | | | | | | | | | | | | | | - Roel G Verhaak
- Jackson Laboratory for Genomic Medicine, Farmington, Connecticut
| | - Erik P Sulman
- New York University Langone Health, New York, New York
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Waddle MR, Stross WC, Vallow LA, Naessens JM, White L, Meier S, Spaulding AC, Buskirk SJ, Trifiletti DM, Keole SR, Ma DJ, Bajaj GK, Laack NN, Miller RC. Impact of Patient Stage and Disease Characteristics on the proposed Radiation Oncology Alternative Payment Model (RO-APM). Int J Radiat Oncol Biol Phys 2020; 106:905-911. [PMID: 32001382 DOI: 10.1016/j.ijrobp.2019.12.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/02/2019] [Accepted: 12/14/2019] [Indexed: 01/30/2023]
Abstract
PURPOSE The proposed Radiation Oncology Alternative Payment Model (RO-APM) released on July 10, 2019, represents a dramatic shift from fee-for-service (FFS) reimbursement in radiation therapy (RT). This study compares historical revenue at Mayo Clinic to the RO-APM and quantifies the effect that disease characteristics may have on reimbursement. METHODS AND MATERIALS FFS Medicare reimbursements were determined for patients undergoing RT at Mayo Clinic from 2015 to 2016. Disease categories and payment episodes were defined as per the RO-APM. Average RT episode reimbursements were reported for each disease site, except for lymphoma and metastases, and stratified by stage and disease subcategory. Comparisons with RO-APM reimbursements were made via descriptive statistics. RESULTS A total of 2098 patients were identified, of whom 1866 (89%) were categorized per the RO-APM; 840 (45%) of those were aged >65 years. Breast (33%), head and neck (HN) (14%), and prostate (11%) cancer were most common. RO-APM base rate reimbursements and sensitivity analysis range were lower than historical reimbursement for bladder (-40%), cervical (-34%), lung (-28%), uterine (-26%), colorectal (-24%), upper gastrointestinal (-24%), HN (-23%), pancreatic (-20%), prostate (-16%), central nervous system (-13%), and anal (-10%) and higher for liver (+24%) and breast (+36%). Historical reimbursement varied with stage (stage III vs stage I) for breast (+57%, P < .01), uterine (+53%, P = .01), lung (+50%, P < .01), HN (+24%, P = .01), and prostate (+13%, P = .01). Overall, for patients older than 65 years of age, the RO-APM resulted in a -9% reduction in total RT reimbursement compared with historical FFS (-2%, -15%, and -27% for high, mid, and low adjusted RO-APM rates). CONCLUSIONS Our findings indicate that the RO-APM will result in significant reductions in reimbursement at our center, particularly for cancers more common in underserved populations. Practices that care for socioeconomically disadvantaged populations may face significant reductions in revenue, which could further reduce access for this vulnerable population.
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Affiliation(s)
- Mark R Waddle
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - William C Stross
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Laura A Vallow
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - James M Naessens
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida
| | - Launia White
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida
| | - Sarah Meier
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida
| | - Aaron C Spaulding
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida
| | - Steven J Buskirk
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | | | - Sameer R Keole
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Gopal K Bajaj
- Center for Advanced Radiation Oncology and Proton Therapy, Inova Schar Cancer Institute, Fairfax, Virginia
| | - Nadia N Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Robert C Miller
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland.
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Ma DJ, Price KA, Moore EJ, Patel SH, Hinni ML, Garcia JJ, Graner DE, Neben-Wittich M, Garces YI, Chintakuntlawar AV, Price DL, Van Abel KM, Kasperbauer JL, Janus JR, Waddle M, Miller RC, Shiraishi S, Mutter RW, Corbin KS, Park SS, Foote RL. Reply to A.S. Garden. J Clin Oncol 2019; 37:3559-3560. [PMID: 31557088 DOI: 10.1200/jco.19.02144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Daniel J Ma
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Katharine A Price
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Eric J Moore
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Samir H Patel
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Michael L Hinni
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Joaquin J Garcia
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Darlene E Graner
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Michelle Neben-Wittich
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Yolanda I Garces
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Ashish V Chintakuntlawar
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Daniel L Price
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Kathryn M Van Abel
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Jan L Kasperbauer
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Jeffrey R Janus
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Mark Waddle
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Robert C Miller
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Satomi Shiraishi
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Robert W Mutter
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Kimberly S Corbin
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Sean S Park
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Robert L Foote
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
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Chintakuntlawar AV, Yin J, Foote RL, Kasperbauer JL, Rivera M, Asmus E, Garces NI, Janus JR, Liu M, Ma DJ, Moore EJ, Morris JC, Neben-Wittich M, Price DL, Price KA, Ryder M, Van Abel KM, Hilger C, Samb E, Bible KC. A Phase 2 Study of Pembrolizumab Combined with Chemoradiotherapy as Initial Treatment for Anaplastic Thyroid Cancer. Thyroid 2019; 29:1615-1622. [PMID: 31595822 DOI: 10.1089/thy.2019.0086] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Anaplastic thyroid cancer (ATC) has poor prognosis with median overall survival (OS) of ∼6 months. We previously reported high PD-1/PDL-1 staining in ATC, raising the possibility of the productive application of the immunotherapeutic pembrolizumab. However, having found pembrolizumab to anecdotally have limited single-agent activity in ATC, we sought to alternatively define whether pembrolizumab might synergistically combine with chemoradiotherapy as initial ATC therapy. Methods: An investigator-initiated therapeutic phase 2 trial of pembrolizumab, 200 mg intravenously (IV) every 3 weeks, combined with chemoradiotherapy (docetaxel/doxorubicin, 20 mg/m2 each IV weekly plus volumetric modulated arc therapy) was initiated as frontline therapy (with or without surgery) in ATC to assess efficacy and toxicities. Six-month OS was selected as the primary endpoint using a Simon's optimal design with interim analysis (targeting accrual of 25 patients; Cohort A: prior resection, Cohort B: no resection). Based on a prior patient cohort-treated similarly, but without pembrolizumab, the design was such that, if 6-month true survival is 75%, the probability of declaring the approach worthy of further pursuit would be 91%. Results: Three patients were enrolled, two with rapidly enlarging unresectable neck masses. Early tumor responses were favorable in all three, and all three satisfactorily completed: intended radiotherapy, preceding and radiotherapy-concurrent pembrolizumab, and concurrent chemoradiotherapy. However, all three patients died <6 months following therapy initiation-one from pulmonary metastases and two from otherwise unexpected fatal pulmonary complications occurring subsequent to chemoradiotherapy completion-prompting study closure. Conclusions: Although initially tolerated and effective in terms of locoregional disease control, disappointing survival outcomes compared with historical controls raise uncertainty that the piloted approach merits further pursuit in ATC.
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Affiliation(s)
| | - Jun Yin
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Robert L Foote
- Department of Radiation Oncology and Mayo Clinic, Rochester, Minnesota
| | - Jan L Kasperbauer
- Division of Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Michael Rivera
- Department of Laboratory and Anatomical Pathology, Mayo Clinic, Rochester, Minnesota
| | - Erik Asmus
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Nina I Garces
- Department of Radiation Oncology and Mayo Clinic, Rochester, Minnesota
| | - Jeffrey R Janus
- Division of Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Minetta Liu
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Daniel J Ma
- Department of Radiation Oncology and Mayo Clinic, Rochester, Minnesota
| | - Eric J Moore
- Division of Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - John C Morris
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota
| | | | - Daniel L Price
- Division of Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Mabel Ryder
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota
| | | | - Crystal Hilger
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Eleyna Samb
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Keith C Bible
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
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Waddle MR, Kaleem TA, Stross WC, Malouff TD, White L, Li Z, Naessens J, Spaulding A, Aljabri D, Ma DJ, Keole S, Miller RC. Identifying the Most Costly Patients in Radiation Oncology and Predicting the Top Spenders. J Oncol Pract 2019; 15:e704-e716. [DOI: 10.1200/jop.18.00627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2019] [Indexed: 08/30/2023] Open
Abstract
PURPOSE: Quality payment programs aim to adjust payments on the basis of quality and cost; however, few quality metrics exist in radiation oncology. This study evaluates and predicts the top spenders (TS) after radiation therapy (RT). MATERIALS AND METHODS: Patient characteristics, cancer details, treatments, toxicity, and survival data were collected for patients treated with RT at Mayo Clinic from 2007 to 2016. Standardized costs were obtained and adjusted for inflation. TSs were identified as those with greater than 93rd percentile costs (≥ $120,812). Prediction models were developed to predict TSs using training and validation sets using information available at consultation, after RT, and at last follow-up. RESULTS: A total of 15,131 patients were included and 1,065 TSs identified. Mean cost overall was $55,290 (median, $39,996) for all patients. Prediction models 1, 2, and 3 had concordance statistics of 0.83 to 0.83, 0.85 to 0.85, and 0.87 to 0.88, respectively in training and validation, indicating excellent prediction of TSs. Factors that were most predictive of TSs included stage N/A and stage 4 ( v stage 0; odds ratio [OR], 18.23 and 8.44, respectively; P < .001); hematologic, upper GI, skin and lung cancers ( v breast; OR, 11.45, 7.69, 3.81, and 2.43, respectively; P < .01); immunotherapy, surgery, and chemotherapy use (OR, 4.36, 2.51, and 1.61, respectively; P < .01); hospitalizations within 90 days of RT (OR, 2.26; P < .01); or death during the episode (OR, 1.56; P < .01). CONCLUSION: This is the first study of its kind to predict with high accuracy the highest spenders in radiation oncology. These patients may benefit from pre-emptive management to mitigate costs, or may require exclusion or adjustment from quality payment programs.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Duaa Aljabri
- Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Ma DJ, Price KA, Moore EJ, Patel SH, Hinni ML, Garcia JJ, Graner DE, Foster NR, Ginos B, Neben-Wittich M, Garces YI, Chintakuntlawar AV, Price DL, Olsen KD, Van Abel KM, Kasperbauer JL, Janus JR, Waddle M, Miller R, Shiraishi S, Foote RL. Phase II Evaluation of Aggressive Dose De-Escalation for Adjuvant Chemoradiotherapy in Human Papillomavirus-Associated Oropharynx Squamous Cell Carcinoma. J Clin Oncol 2019; 37:1909-1918. [PMID: 31163012 DOI: 10.1200/jco.19.00463] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The purpose of this study was to determine if dose de-escalation from 60 to 66 Gy to 30 to 36 Gy of adjuvant radiotherapy (RT) for selected patients with human papillomavirus-associated oropharyngeal squamous cell carcinoma could maintain historical rates for disease control while reducing toxicity and preserving swallow function and quality of life (QOL). PATIENTS AND METHODS MC1273 was a single-arm phase II trial testing an aggressive course of RT de-escalation after surgery. Eligibility criteria included patients with p16-positive oropharyngeal squamous cell carcinoma, smoking history of 10 pack-years or less, and negative margins. Cohort A (intermediate risk) received 30 Gy delivered in 1.5-Gy fractions twice per day over 2 weeks along with 15 mg/m2 docetaxel once per week. Cohort B included patients with extranodal extension who received the same treatment plus a simultaneous integrated boost to nodal levels with extranodal extension to 36 Gy in 1.8-Gy fractions twice per day. The primary end point was locoregional tumor control at 2 years. Secondary end points included 2-year progression-free survival, overall survival, toxicity, swallow function, and patient-reported QOL. RESULTS Accrual was from September 2013 to June 2016 (N = 80; cohort A, n = 37; cohort B, n = 43). Median follow-up was 36 months, with a minimum follow-up of 25 months. The 2-year locoregional tumor control rate was 96.2%, with progression-free survival of 91.1% and overall survival of 98.7%. Rates of grade 3 or worse toxicity at pre-RT and 1 and 2 years post-RT were 2.5%, 0%, and 0%. Swallowing function improved slightly between pre-RT and 12 months post-RT, with one patient requiring temporary feeding tube placement. CONCLUSION Aggressive RT de-escalation resulted in locoregional tumor control rates comparable to historical controls, low toxicity, and little decrement in swallowing function or QOL.
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Sio TT, Atherton PJ, Pederson LD, Zhen WK, Mutter RW, Garces YI, Ma DJ, Leenstra JL, Rwigema JCM, Dakhil S, Bearden JD, van der Veen SJ, Ganti AK, Schild SE, Miller RC. Daily Lisinopril vs Placebo for Prevention of Chemoradiation-Induced Pulmonary Distress in Patients With Lung Cancer (Alliance MC1221): A Pilot Double-Blind Randomized Trial. Int J Radiat Oncol Biol Phys 2018; 103:686-696. [PMID: 30395904 DOI: 10.1016/j.ijrobp.2018.10.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/20/2018] [Accepted: 10/24/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE Chemoradiation (CRT) is an integral treatment modality for patients with locally advanced lung cancer. It has been hypothesized that current use of an angiotensin-converting enzyme inhibitor during CRT may be protective for treatment-related lung damage and pneumonitis. METHODS AND MATERIALS We conducted a pilot, double-blind, placebo-controlled, randomized trial. Study-eligible patients receiving curative thoracic radiation therapy (RT) were randomly assigned to 20 mg of lisinopril or placebo once daily during and up to 3 months after RT. All patients received concurrent chemotherapy. The primary endpoint was adverse event profiling. Multiple patient-reported outcome (PRO) surveys, including the Lung Cancer Symptom Scale, Function Assessment of Cancer Therapy-Lung, and the European Organisation for Research and Treatment of Cancer Lung Cancer Questionnaire, were applied with a symptom experience questionnaire. Exploratory comparative statistics were used to detect differences between arms with χ2 and Kruskal-Wallis testing. RESULTS Five institutions enrolled 23 patients. However, accrual was less than expected. Eleven and 12 patients were in the placebo and lisinopril arms, respectively (mean age, 63.5 years; male, 62%). Baseline characteristics were balanced. Eighteen patients (86%) were former or current smokers. The primary endpoint was met; neither arm had grade 3 or higher hypotension, acute kidney injury, allergic reaction (medication-induced cough), or anaphylaxis (medication-related angioedema). Few PRO measures suggested that compared with the placebo arm, patients receiving lisinopril had less cough, less shortness of breath, fewer symptoms from lung cancer, less dyspnea with both walking and climbing stairs, and better overall quality of life (for all, P < .05). CONCLUSIONS Although underpowered because of low accrual, our results suggest that there was a clinical signal for safety-and possibly beneficial by limited PRO measures-in concurrently administering lisinopril during thoracic CRT to mitigate or prevent RT-induced pulmonary distress. Our results showed that a definitive, larger-scale, randomized phase 3 trial is needed in the future.
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Affiliation(s)
- Terence T Sio
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, Arizona.
| | - Pamela J Atherton
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Levi D Pederson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - W Ken Zhen
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Robert W Mutter
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Yolanda I Garces
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - James L Leenstra
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Shaker Dakhil
- Department of Radiation Oncology, Cancer Center of Kansas, Wichita, Kansas
| | - James D Bearden
- Department of Radiation Oncology, Spartanburg Medical Center, Spartanburg, South Carolina
| | - Sonja J van der Veen
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Apar K Ganti
- Division of Oncology-Hematology, Department of Internal Medicine, VA Nebraska Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, Nebraska
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, Arizona
| | - Robert C Miller
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
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Kim M, Ma DJ, Calligaris D, Zhang S, Feathers RW, Vaubel RA, Meaux I, Mladek AC, Parrish KE, Jin F, Barriere C, Debussche L, Watters J, Tian S, Decker PA, Eckel-Passow JE, Kitange GJ, Johnson AJ, Parney IF, Anastasiadis PZ, Agar NYR, Elmquist WF, Sarkaria JN. Efficacy of the MDM2 Inhibitor SAR405838 in Glioblastoma Is Limited by Poor Distribution Across the Blood-Brain Barrier. Mol Cancer Ther 2018; 17:1893-1901. [PMID: 29970480 DOI: 10.1158/1535-7163.mct-17-0600] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 10/24/2017] [Accepted: 06/25/2018] [Indexed: 01/12/2023]
Abstract
Controversy exists surrounding whether heterogeneous disruption of the blood-brain barrier (BBB), as seen in glioblastoma (GBM), leads to adequate drug delivery sufficient for efficacy in GBM. This question is especially important when using potent, targeted agents that have a poor penetration across an intact BBB. Efficacy of the murine double minute-2 (MDM2) inhibitor SAR405838 was tested in patient-derived xenograft (PDX) models of GBM. In vitro efficacy of SAR405838 was evaluated in PDX models with varying MDM2 expression and those with high (GBM108) and low (GBM102) expression were evaluated for flank and orthotopic efficacy. BBB permeability, evaluated using TexasRed-3 kDa dextran, was significantly increased in GBM108 through VEGFA overexpression. Drug delivery, MRI, and orthotopic survival were compared between BBB-intact (GBM108-vector) and BBB-disrupted (GBM108-VEGFA) models. MDM2-amplified PDX lines with high MDM2 expression were sensitive to SAR405838 in comparison with MDM2 control lines in both in vitro and heterotopic models. In contrast with profound efficacy observed in flank xenografts, SAR405838 was ineffective in orthotopic tumors. Although both GBM108-vector and GBM108-VEGFA readily imaged on MRI following gadolinium contrast administration, GBM108-VEGFA tumors had a significantly enhanced drug and gadolinium accumulation, as determined by MALDI-MSI. Enhanced drug delivery in GBM108-VEGFA translated into a marked improvement in orthotopic efficacy. This study clearly shows that limited drug distribution across a partially intact BBB may limit the efficacy of targeted agents in GBM. Brain penetration of targeted agents is a critical consideration in any precision medicine strategy for GBM. Mol Cancer Ther; 17(9); 1893-901. ©2018 AACR.
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Affiliation(s)
- Minjee Kim
- University of Minnesota, Minneapolis, Minnesota
| | | | - David Calligaris
- Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | | | - Fang Jin
- Mayo Clinic, Rochester, Minnesota
| | | | | | | | | | | | | | | | | | | | | | - Nathalie Y R Agar
- Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Dana Farber Cancer Institute, Boston, Massachusetts
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Tew BY, Legendre C, Triche T, Gooden GC, Johnson KN, Martinez RA, Petricoin EF, Pierobon M, O'Shaughnessy J, Osborne C, Schroeder MA, Ma DJ, Bernstein M, Sarkaria JN, Toms SA, Salhia B. Abstract 991: Development and characterization of patient derived xenografts from central nervous system metastasis reveal minor clone expansion linked with aggressive tumor behavior. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Despite recent advances in cancer therapy, options for central nervous system metastasis (CM) remain limited and patient outcomes are dismal. The lack of tumor models that reflect the heterogeneity and complexity of human CM tumors is a barrier to understanding the underlying biology and to developing novel therapies. Here, we report the development and characterization of 39 patient derived xenograft (PDX) models of CM tumors with histological subtypes representing the disease spectrum. The PDX models successfully grew both in the flank and brains of mice, and retained their histology regardless of the site of implantation. Brain metastasis also formed in 5/12 models after intra-cardiac injection. Multi-omic analysis of the PDX tumor and the patient-matched CM tumor showed that PDXs largely retained the molecular profiles of the tumor from which they were derived, including the retention of aberrations in key driver genes and signaling pathways. PDXs differed primarily from the ungrafted patient tumors by a downregulation in immunity-related pathways, which was expected due to the use of an immuno-compromised host, arguing for the validity of using the flank as a site of implantation. Integrated analysis of mutations and gene expression changes in CM revealed an upregulation of neuronal signaling and DNA damage response, and downregulation of calcium signaling and inflammation. We also assessed the clonal evolution of the PDX from the original patient CM by tracing variant allele frequencies in copy number neutral regions. We found that the PDX tumors were heterogeneous and comprised of multiple tumor clones that were either unique or in common with the original tumor, and displayed evidence of clonal expansion. Two PDXs that underwent phylogeny assessment showed evidence of minor clone expansion. One such PDX was a tumor from a Her2+ breast cancer (CM13), which largely did not molecularly resemble its matched patient tumor but was confirmed to have some shared expressed variants. The PDX was nearly copy number neutral, which included loss of the Her2 amplicon, and had few mutations compared with its parent tumor. Most noteworthy, is that CM13 displayed unique molecular patterns, aggressive growth and was highly metastatic in vivo. From the flank, it led to multiple metastases, including micrometastasis in the brain. This suggests that minor clone takeover may confer tumor aggressiveness and potentiate brain metastasis. The large and diverse repertoire of PDXs developed and characterized in this study provides a new set of tools that will help deepen our understanding of CM and improve preclinical testing for CM therapies. Our data also show that expansion of minor clones could confer aggressive tumor behavior and may be important in tumor evolution in PDX models and human cancers.
Citation Format: Ben Yi Tew, Christophe Legendre, Tim Triche, Gerald C. Gooden, Kyle N. Johnson, Rae Anne Martinez, Emanuel F. Petricoin, Mariaelena Pierobon, Joyce O'Shaughnessy, Cindy Osborne, Mark A. Schroeder, Daniel J. Ma, Mark Bernstein, Jann N. Sarkaria, Steven A. Toms, Bodour Salhia. Development and characterization of patient derived xenografts from central nervous system metastasis reveal minor clone expansion linked with aggressive tumor behavior [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 991.
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Affiliation(s)
- Ben Yi Tew
- 1University of Southern California, Los Angeles, CA
| | | | - Tim Triche
- 3Van Andel Research Institute, Grand Rapids, MI
| | | | | | | | | | | | | | - Cindy Osborne
- 5Baylor University Medical Center, Texas Oncology, Dallas, TX
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