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Bashat DB, Blumenthal D, Limon D, Aizenstein O, Bressler I, Bokstein F, Artzi M. NIMG-05. DIFFERENCES IN VASCULARITY BETWEEN RECURRENT GLIOBLASTOMA AND BRAIN METASTASIS USING DYNAMIC CONTRAST ENHANCED MRI. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.505] [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: 11/13/2022] Open
Abstract
Abstract
In recent years, several automatic methods have been proposed to differentiate between brain tumor recurrence and treatment-related changes following radiotherapy, based on conventional and advanced MRI methods. Vascular parameters extracted from dynamic contrast-enhanced (DCE) were suggested as potential markers for disease progression. Yet, most studies that proposed machine-learning methods or relayed on threshold values of DCE for classification, did not analyze separately Glioblastoma (GBM) and brain metastasis, and often offer the same method/threshold values, neglecting the different vascularity of these two tumor types. Understanding and quantifying the differences between tumors type can improve early diagnosis of recurrence and may improve the reliability of identifying treatment-related changes. The aim of this study was to quantify vascular parameters of tumor recurrence and to assess differences between GBM and brain metastasis, specifically metastasis of breast cancer. METHOD: 41 MRI scans were included: 24 from patients with GBM: 20 with recurrence and 4 with treatment-related changes, and 17 scans from patients with brain metastasis of breast cancer: 10 with recurrence and 7 with treatment-related changes (diagnosis were based on radiological follow-up/histopathology, when available). MRIs were performed on a 3.0 Tesla MRI scanner (Siemens MAGNETOM Prisma) and included T1, T1+contrast, and DCE images. DCE analysis was performed using DUSTER and Ktrans, Vp and Kep pharmacokinetic parameters were compared between groups. RESULTS: Patients with GBM often demonstrated both tumor recurrence and areas with treatment-related changes. Significantly differences were detected between tumor recurrence and treatment-related changes, and higher Vp and Ktrans were detected in recurrent GBM as compared to recurrent breast cancer metastasis. Cutoff for differentiation between tumor recurrence and treatment-related changes will be presented specifically for each tumor type. To conclude, when defining quantitative threshold values for clinical decision-making, the inherent differences between primary and metastatic brain tumors should be taken into account.
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Affiliation(s)
| | | | - Dror Limon
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | | | | | - Moran Artzi
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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2
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Ligumsky H, Blumenthal D, Bokstein F. BIOM-22. RELEVANCE OF TUMOR MUTATION BURDEN (TMB) IN HIGH-GRADE GLIOMAS. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.053] [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: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Efforts have been directed toward searching for molecular biomarkers predicting response to immunotherapy in glial tumors. Recently, FDA granted accelerated approval of pembrolizumab for treatment patients with solid tumors with high mutational burden (TMB-H; ≥ 10 mut/Mb). There are conflicting results regarding the use of this parameter in glial tumors.
OBJECTIVE
to review NGS examinations of patients with glial tumors and high TMB and to analyze their response to immunotherapy.
METHODS
we retrospectively reviewed NGS examinations from patients with glial tumors treated in Tel-Aviv Medical Center from 2016-2021. Cases with TMB-H were retrieved and analyzed.
RESULTS
We identified nine high-grade glioma patients with TMB-H. The median age was 38 (19-65). There were 4 patients with glioblastoma; three with anaplastic oligodendroglioma; and two with anaplastic astrocytoma. All but one received radiation prior to the biopsy used for NGS examination, and all were treated with temozolomide. The median TMB was 54 (19-252). Only one glioblastoma patient with a family history of Lynch syndrome had microsatellite instability (MSI)-high; all other patients were MSI stable (MSS). Nevertheless, in all cases, mutated mismatch repair (MMR) genes were detected (MSH6 in 3 patients, MSH2 in one patient, MLH1 in one patient, PMS 2 in one patient, and both MSH2 and 6 in one patient). Six patients received immunotherapy. Only one patient with recurrent glioblastoma and the highest TMB in the group (252) demonstrated a near complete response to pembrolizumab and remains on treatment more than three years. All other patients did not respond to immunotherapy.
CONCLUSION
TMB-H in primary glioma is associated with mutations of MMR genes. It is typically associated with MSS in these patients (MSI-high was seen in only one syndromic patient). In contrast to systemic neoplasms with TMB-H, the majority of our patients did not respond to immunotherapy.
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3
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Bouffet E, Sudhaman S, Chung J, Kelly J, Coblentz A, Edwards M, Lipman T, Zhang C, Ercan AB, Sambira L, Bendel A, Bielack S, Koustenis E, Blumenthal D, Bowers D, Broniscer A, Bronsema A, Carroll S, Chiaravalli S, Cole K, Constantini S, De Mola RL, Dunn G, Fröjd C, Gass D, Gauvain K, George B, Hijiya N, Hoffman L, Knipstein J, Laetsch T, Larouche V, Lassaletta A, Lindhorst S, Lossos A, Luna-Fineman S, Magimairajan V, Mason G, Mason W, Massimino M, Mordechai O, Opocher E, Oren M, Osborn M, Reddy A, Remke M, Roy S, Sabel M, Samuel D, Schneider K, Sen S, Stearns D, Sumerauer D, Thomas G, Tomboc P, Van Damme A, Wierman M, Winer I, Yen LY, Zapotocky M, Ziegler D, Zimmermann S, Dvir R, Rechavi G, Durno C, Aronson M, Taylor M, Dirks P, Pugh T, Shlien A, Hawkins C, Morgenstern D, Tabori U. IMMU-18. FAVORABLE OUTCOME IN REPLICATION REPAIR DEFICIENT HYPERMUTANT BRAIN TUMORS TO IMMUNE CHECKPOINT INHIBITION: AN INTERNATIONAL RRD CONSORTIUM REGISTRY STUDY. Neuro Oncol 2020. [PMCID: PMC7715575 DOI: 10.1093/neuonc/noaa222.374] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pediatric brain tumors with replication repair deficiency (RRD) are hypermutant and may respond to immune checkpoint inhibition (ICI). We performed a consortium registry study of ICI in recurrent RRD cancers. Clinical and companion biomarkers were collected longitudinally on all patients. Biomarkers included tumor mutational burden (TMB), neoantigens and genetic signatures obtained from whole genome and exome sequencing. Immune inference was obtained by RNAseq and T cell rearrangement was collected in the tumor and in blood throughout treatment. Of the 46 tumors on the study, 32 were brain tumors with glioblastoma in 96%. Rapid, objective responses (>50%) were observed in 50% of glioblastomas. Three year overall survival for the whole cohort was 48+/-8% which compares favorably with historical controls. Brain tumors fared worse with OS of 39+/-10% and late recurrences observed even after 2 years of therapy (p=0.02). Tumor size and acute “flare” constitute poor outcome throughout all cancers. While all tumors are hypermutant, TMB and predicted neoantigens correlated with response to ICI (p=0.02). Specific signatures extracted from SNVs and total mutations predicted response to ICI and favorable outcome (p=0.005). RNA inference and TCR reveal that the FLARE phenotype is mostly acute nonspecific immune response and not true progression. Finally, glioblastomas (n=8) which failed single agent ICI had favorable responses to combinational immunotherapies with prolonged survival of 65%+/-8% at one year after failure vs 0 for other patients (p=0.01). RRD glioblastomas exhibit favorable outcome and responses to ICI. Combinational therapies based on tumor and immune signatures of these cancers are necessary.
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Affiliation(s)
- Eric Bouffet
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Jiil Chung
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | | | | | | | - Cindy Zhang
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | | | - Anne Bendel
- Children’s Minnesota Minneapolis Hospital, Minneapolis, MN, USA
| | | | | | | | | | | | - Annika Bronsema
- University Medical Centre of Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Kristina Cole
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | - Gavin Dunn
- Washington University School of Medicine, St, Louis, MO, USA
| | | | - David Gass
- Carolinas Healthcare System, Charlotte, NC, USA
| | - Karen Gauvain
- Washington University School of Medicine, St, Louis, MO, USA
| | - Ben George
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nobuko Hijiya
- Ann and Robert H, Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | | | | | - Ted Laetsch
- UT Southwestern Medical Centre, Dallas, TX, USA
| | - Valérie Larouche
- Centre Mère-Enfant Soleil du CHU de Québec, Sante-Foy, QC, Canada
| | | | | | | | | | | | - Gary Mason
- Children’s Hospital of Pittsburg of UPMC, Pittsburgh, PA, USA
| | | | - Maura Massimino
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | - Michal Oren
- The Chaim Sheba Medical Center, Tel HaShomer, Israel
| | - Michael Osborn
- Women’s and Children’s Hospital, North Adelaide, Australia
| | - Alyssa Reddy
- UCSF Benioff Children’s Hospital, San Francisco, CA, USA
| | - Mark Remke
- University Hospital Düsseldorf, Dusseldorf, Germany
| | - Sumita Roy
- Children’s Hospital of Michigan, Detroit, MI, USA
| | - Magnus Sabel
- Queen Silvia Children’s Hospital, Göteborg, Sweden
| | | | | | - Santanu Sen
- Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
| | - Duncan Stearns
- Rainbow Babies and Children’s Hospital, Cleveland, OH, USA
| | | | | | - Patrick Tomboc
- West Virginia University Children’s Hospital, Morgantown, WV, USA
| | | | | | - Ira Winer
- Wayne State University, Detroit, MI, USA
| | - Lee Yi Yen
- Taipei Veterans General Hospital, Taipei City, Taiwan
| | | | | | | | - Rina Dvir
- Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Gidi Rechavi
- The Chaim Sheba Medical Center, Tel HaShomer, Israel
| | - Carol Durno
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | | | - Peter Dirks
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Trevor Pugh
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Adam Shlien
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | | | - Uri Tabori
- The Hospital for Sick Children, Toronto, ON, Canada
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Huc-Mathis D, Guilbaud A, Fayolle N, Bosc V, Blumenthal D. Valorizing apple by-products as emulsion stabilizers: Experimental design for modeling the structure-texture relationships. J FOOD ENG 2020. [DOI: 10.1016/j.jfoodeng.2020.110115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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5
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Grossman R, Limon D, Bokstein F, Harosh CB, Blumenthal D, Ram Z. RTID-12. PHASE 2 TRIAL OF TUMOR TREATING FIELDS (TTFIELDS) PLUS RADIATION THERAPY (RT) PLUS TEMOZOLAMIDE (TMZ) COMPARED TO RT PLUS TEMOZOLOMIDE IN NEWLY DIAGNOSED GLIOBLASTOMA (ndGBM). Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.817] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVE
In the EF-14 phase 3 trial, TTFields 9200 kHz) added to maintenance TMZ increased median OS to 20.9 months versus 16.0 months with maintenance TMZ (p< 0.001) in ndGBM. Preclinical investigations showed that TTFields/RT have a synergistic effect. A pilot study (N=10) in ndGBM demonstrated the feasibility and safety of TTFields combined with RT/TMZ (Grossman Front Onc 2020). The only TTFields-related adverse event was array-associated skin toxicity. Median PFS was 8.9 months. Based on these encouraging results, this prospective, randomized phase 2 study [NCT03869242] in 60 patients further investigates if the addition of TTFields TMZ/RT treatment in ndGBM patients improves treatment efficacy and delays disease progression.
METHODS
Following debulking surgery or biopsy, 60 patients (≥18 years) with histologically confirmed GBM, KPS≥70 and life expectancy >3 months will be randomized 1:1 to: i) RT with concomitant TMZ/TTFields (200 kHz) for 6 weeks followed by up to 6 months of maintenance TMZ combined with TTFields (experimental arm) up to 24 months; or ii) RT with concomitant TMZ alone followed by maintenance TMZ combined with TTFields (control arm). Patients with early progressive disease, significant comorbidities precluding maintenance RT or TMZ or with implanted electronic devices will be excluded. The primary endpoint is the rate of progression free survival at 12 months (PFS12). Treatment with TTF will be continued until second progression or 24 months (the earlier of the two). All patients will be followed for survival. All adverse events will graded per CTCAE V5.0. The sample size of 60 patients provides 80% power with two-sided alpha level of 0.05 to detect a PFS12 of 46.5% with RT/TMZ/TTFields compared to 29.4% with RT/TMZ followed, respectively, by maintenance TMZ/TTFields (calculated from the RT/TMZ followed by maintenance TMZ/TTFields arm of the EF-14 trial). Follow-up will continue for >12 months from recruitment of the last patient.
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Affiliation(s)
| | - Dror Limon
- Tel Aviv Medical Center, Tel Aviv, Israel
| | | | | | | | - Zvi Ram
- Tel Aviv Medical Center, Tel Aviv, Israel
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6
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Shi W, Blumenthal D, Oberheim N, Kebir S, Lukas R, Muragaki Y, Zhu J, Glas M. Global Post-Marketing Safety Surveillance of Tumor Treating Fields (TTFields) in Patients With High-Grade Glioma in Clinical Practice. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.046] [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] [Indexed: 11/16/2022]
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7
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Bokstein F, Blumenthal D, Limon D, Harosh CB, Ram Z, Grossman R. Abstract CT206: Concurrent Tumor Treating Fields (TTFields) and radiation therapy for newly diagnosed glioblastoma: A safety and feasibility study. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-ct206] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Tumor Treating Fields (TTFields) are a non-invasive, loco-regional, anti-mitotic treatment comprising low-intensity alternating electric fields. In the phase III EF-14 study in newly diagnosed glioblastoma (ndGBM), TTFields in combination with temozolomide (TMZ) significantly improved survival compared with TMZ alone. In preclinical studies TTFields had a radiosensitizing effect and increased the efficacy of radiation therapy (RT). This pilot study [NCT03780569] evaluated the feasibility and safety of TTFields administered concurrently with RT and TMZ in ndGBM patients.
Methods: Patients with histologically confirmed ndGBM were treated with TTFields/RT/TMZ followed by adjuvant TMZ/TTFields. TTFields (200 kHz) were delivered for ≥18 hours/day with transducer arrays removed during RT delivery. RT was administered to the tumor bed in 30 fractions (total dose 60 Gy) in combination with daily TMZ (75 mg/m2). In the adjuvant phase, patients received monthly TMZ (150-200 mg/m2 for 5 days) plus TTFields. The primary outcome was safety of the combined therapies; secondary outcomes included progression-free survival (PFS) and overall survival (OS). Adverse events (AEs) were graded per CTCAE v4.0.
Results: Ten patients were enrolled at a single center between April and December 2017. Median age was 60.2 years, median Karnofsky Performance Score was 90.0, and eight (80%) patients were male. Five (50%) patients had undergone tumor resection while the remainder had biopsy only. Eight patients experienced ≥1 RT treatment delay; delays were unrelated to TTFields treatment. All patients experienced ≥1 AE. Three patients suffered from serious AEs (urinary tract infection, confusional state, and decubitus ulcer) that were considered unrelated to TTFields. The most common AE was skin toxicity, reported in eight (80%) patients; all were of low severity (CTCAE grade 1-2) and were reported as related to TTFields treatment. Median PFS from enrollment was 8.9 months; median OS was not reached at the time of study closure.
Conclusions: Eighty percent of patients experienced grade 1-2 TTFields-related skin toxicity. No other TTFields-related toxicities were observed and there was no increase in RT- or TMZ-related toxicities as a result of combining TTFields with these therapies. Based on the safety and preliminary efficacy results of this pilot study, a phase 2 randomized trial (N=60; NCT03869242) and the Phase 3 TRIDENT trial have been initiated to further investigate the efficacy of concomitant RT/TMZ/TTFields in ndGBM.
Citation Format: Felix Bokstein, Deborah Blumenthal, Dror Limon, Carmit Ben Harosh, Zvi Ram, Rachel Grossman. Concurrent Tumor Treating Fields (TTFields) and radiation therapy for newly diagnosed glioblastoma: A safety and feasibility study [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr CT206.
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Affiliation(s)
| | | | - Dror Limon
- Tel Aviv Medical Center, Tel Aviv, Israel
| | | | - Zvi Ram
- Tel Aviv Medical Center, Tel Aviv, Israel
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8
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Bokstein F, Blumenthal D, Limon D, Harosh CB, Ram Z, Grossman R. Concurrent Tumor Treating Fields (TTFields) and Radiation Therapy for Newly Diagnosed Glioblastoma: A Prospective Safety and Feasibility Study. Front Oncol 2020; 10:411. [PMID: 32373508 PMCID: PMC7186440 DOI: 10.3389/fonc.2020.00411] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 12/29/2019] [Accepted: 03/09/2020] [Indexed: 11/13/2022] Open
Abstract
Background: TTFields are a loco-regional, anti-mitotic treatment comprising low-intensity alternating electric fields. In the EF-14 study of newly diagnosed glioblastoma (ndGBM), TTFields in combination with temozolomide (TMZ) significantly improved survival vs. TMZ alone. In preclinical studies TTFields had a radiosensitizing effect and increased the efficacy of radiation therapy (RT). This study prospectively evaluated the feasibility and safety of TTFields administered concurrently with RT and TMZ in ndGBM patients. Methods: Patients with histologically confirmed ndGBM were treated with TTFields/RT/TMZ followed by adjuvant TMZ/TTFields. TTFields (200 kHz) were delivered for ≥18 hours/day with transducer arrays removed during RT delivery. RT was administered to the tumor bed in 30 fractions (total dose 60 Gy) combined with daily TMZ (75 mg/m2). In the adjuvant phase, patients received monthly TMZ (150-200 mg/m2 for 5 days) plus TTFields. Patients were followed for 24 months or until second disease progression. The primary outcome was safety of the combined therapies; secondary outcomes included progression-free survival (PFS) and overall survival (OS). Adverse events (AEs) were graded per CTCAE v4.0. Results: Ten patients were enrolled at a single center between April and December 2017. Median age was 60.2 years, median Karnofsky Performance Score was 90.0, and 80% patients were male. Five (50%) patients had undergone tumor resection while the remainder had biopsy only. Eight patients experienced ≥1 RT treatment delay; delays were unrelated to TTFields treatment. All patients experienced ≥1 AE. Three patients suffered from serious AEs (urinary tract infection, confusional state, and decubitus ulcer) that were considered unrelated to TTFields. The most common AE was skin toxicity, reported in eight (80%) patients; all were of low severity (CTCAE grade 1-2) and were reported as related to TTFields treatment. Median PFS from enrollment was 8.9 months; median OS was not reached at the time of study closure. Conclusions: Eighty percent of patients experienced grade 1-2 TTFields-related skin toxicity. No other TTFields-related toxicities were observed without an increase in RT- or TMZ-related toxicities as a result of combining TTFields with these therapies. Preliminary efficacy results are promising and warrant further investigation of concurrent TTFields/RT/TMZ treatment in ndGBM patients.
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Affiliation(s)
- Felix Bokstein
- Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.,Neuro-Oncology Service, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Deborah Blumenthal
- Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.,Neuro-Oncology Service, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Dror Limon
- Institute of Radiotherapy, Tel Aviv Medical Center, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Carmit Ben Harosh
- Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Zvi Ram
- Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Rachel Grossman
- Institute of Radiotherapy, Tel Aviv Medical Center, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
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Galiñanes Plaza A, Saulais L, Blumenthal D, Delarue J. Eating location as a reference point: Differences in hedonic evaluation of dishes according to consumption situation. Food Qual Prefer 2019. [DOI: 10.1016/j.foodqual.2019.103738] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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10
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Grossman R, Limon D, Bokstein F, Blumenthal D, Ben Harush C, Ram Z. ACTR-46. TUMOR TREATING FIELDS COMBINED WITH RADIOTHERAPY AND TEMOZOLOMIDE FOR THE TREATMENT OF NEWLY DIAGNOSED GLIOBLASTOMA: FINAL RESULTS FROM A PILOT STUDY. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Tumor Treating Fields (TTFields) are a non-invasive, loco-regional, anti-mitotic treatment comprising low intensity alternating electric fields approved for GBM. Preclinical data show that TTFields have a radio-sensitizing effect. This pilot study evaluated the safety and feasibility of TTFields/RT/TMZ in ndGBM patients.
METHODS
Patients with histologically confirmed ndGBM were treated with TTFields/RT/TMZ followed by maintenance TTFields and TMZ for up to 24 months. TTFields (200kHz) were delivered for >18 hours/day with removal of the transducer arrays during RT delivery. TMZ was administered at 75 mg/m2/daily for 6 weeks and RT at a total dose of 60 Gy. The primary endpoint was safety of the combined TTFields/RT/TMZ; secondary endpoints included progression-free survival (PFS), overall survival (OS) and toxicity. Adverse events (AEs) were graded per CTCAE V4.0.
RESULTS
Ten patients were enrolled at a single center in Israel between April and December 2017. All patients had recovered from maximal debulking surgery or biopsy. Five patients (50%) had undergone gross total resection; rest had biopsy only. Median age was 59 and median KPS was 80. Median dose of RT was 60 Gy. Six patients (60%) reported at least one AE. The most common AE was TTFields-related skin toxicity reported in 4 patients (40%), of Grade 1–2 in severity. Two patients reported serious AEs (seizures and general deterioration) considered unrelated to TTFields. Median PFS with RT/TMZ/TTFields was 10.5 months. Median OS has not been reached.
CONCLUSIONS
The proportion of patients with TTFields-related skin toxicity was similar to that reported in EF-14 phase 3 study (52%). No other TTFields-related toxicities were reported. There was no increase in RT- or TMZ-related toxicities with TTFields/RT/TMZ combination. A phase 2 randomized study has been initiated to investigate the efficacy of concomitant RT/TMZ/TTFields in 60 ndGBM patients.
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Affiliation(s)
| | - Dror Limon
- Tel Aviv Medical Center, Tel Aviv, Israel
| | | | | | | | - Zvi Ram
- Tel Aviv Medical Center, Tel Aviv, Israel
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11
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Limon D, Bokstein F, Blumenthal D, Ben Harush C, Ram Z, Grossman R. P14.79 Randomized phase II trial of Tumor Treating Fields plus radiation therapy plus temozolomide compared to radiation therapy plus temozolomide in patients with newly diagnosed glioblastoma. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.314] [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: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
In last decade, there were numerous attempts to improve the outcome of patients with glioblastoma (GBM), but even after maximal surgical resection, radiation therapy (RT) and temozolomide (TMZ), followed by maintenance TMZ for 6 months the median OS is 14.6 months. In the EF-14 Phase III trial, the addition of Tumor Treating Fields (TTFields) at 200 kHz to maintenance TMZ increased the median OS to 20.9 months, compared with 16.0 months with maintenance TMZ alone (HR, 0.63; 95% CI, 0.53–0.76; p<0.001). Based on these results, the currently accepted standard of care for newly diagnosed GBM (ndGBM) is surgical resection if safely feasible, followed by RT with concomitant TMZ, and then followed by maintenance TMZ in combination with TTFields. Preclinical investigations have shown a radio-sensitizing effect of TTFields on glioma cells, suggesting synergistic effects between TTFields and radiotherapy. In a pilot study of 10 patients with ndGBM, we demonstrated that there was no increased treatment-related toxicity when TTFields were given in combination with RT/TMZ. The only TTFields-related adverse event was skin toxicity below the arrays. Preliminary progression free survival (PFS) data was encouraging. Based on the results of the pilot study, we designed this prospective, randomized Phase II study to further investigate if the addition of TTFields TMZ/RT treatment in ndGBM patients improves treatment efficacy and delays disease progression.
MATERIAL AND METHODS
Following debulking surgery or biopsy, 60 adult patients (≥18 years) with histologically confirmed GBM, KPS≥70 and life expectancy of at least 3 months will be randomized 1:1 to either a) RT with concomitant TMZ and TTFields (200 kHz) for 6 weeks followed by up to 6 months of maintenance TMZ in combination with TTFields (experimental arm) up to 24 months; or b) RT with concomitant TMZ alone followed by maintenance TMZ in combination with TTFields (control arm). Exclusion criteria: patients with early progressive disease, significant comorbidities precluding maintenance RT or TMZ or patients with an implanted electronic device. The primary endpoint is progression free survival at 12 months (PFS12). Treatment with TTFields will be continued until second progression or 24 months (the earlier of the two). All patients will be followed for survival. Grading and severity of all adverse events will be recorded using CTCAE V5.0. The sample size of 60 patients provides 80% power with a two-sided alpha level of 0.05 to detect a PFS12 of 46.5% with RT/TMZ/TTFields compared to 29.4% with RT/TMZ followed, respectively, by maintenance TMZ/TTFields (calculated from the RT/TMZ followed by maintenance TMZ/TTFields arm of the EF-14 trial). It is forecasted to take 24 months to fully recruit. Follow-up will continue for >12 months from recruitment of the last patient.
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Affiliation(s)
- D Limon
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - F Bokstein
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - D Blumenthal
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - C Ben Harush
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Z Ram
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - R Grossman
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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12
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Grossman R, Bokstein F, Blumenthal D, Ben Harush C, Limon D, Ram Z. P14.71 Tumor Treating Fields combined with radiotherapy and temozolomide for newly diagnosed glioblastoma: final safety and efficacy results from a pilot study. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.306] [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: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Tumor Treating Fields (TTFields) are a non-invasive, loco-regional, anti-mitotic treatment consisting of low intensity alternating electric fields. The combination of TTFields with maintenance temozolomide significantly improved survival versus temozolomide alone in the phase 3 EF-14 study in newly diagnosed glioblastoma (ndGBM). In preclinical studies, TTFields increased the number of glioma cells undergoing cellular death following radiotherapy (RT) by inhibiting DNA damage repair, suggesting a radio-sensitizing effect of TTFields. This pilot study is the first to evaluate the safety and feasibility of administering TTFields concomitant to RT and TMZ in ndGBM patients.
MATERIAL AND METHODS
Patients diagnosed with ndGBM were treated with TTFields/RT/TMZ followed by maintenance TMZ and TTFields for up to 24 months. TTFields (200kHz) were delivered for >18 hours/day while the transducer arrays were removed during delivery of RT. TMZ was administered at a dose of 75 mg/m2/daily for 6 weeks and RT at a total dose of 60 Gy. The primary endpoint was safety of the combined TTFields/RT/TMZ; secondary endpoints included progression-free survival (PFS), overall survival (OS) and toxicity. Adverse events (AEs) were graded according to CTCAE V4.0.
RESULTS
10 ndGBM patients that recovered from maximal debulking surgery or biopsy were enrolled at a single center in Israel between April and December 2017. Five patients (50%) had undergone gross total resection while the rest had biopsy only. Eight of the patients were male, median age was 59, median KPS was 80 and median dose of RT was 60 Gy. Six patients (60%) reported at least one AE. The most common AE was TTFields-related skin toxicity, reported in four patients (40%), all of which were grade 1–2 in severity. Two patients reported serious AEs (seizures and general deterioration) that were considered unrelated to TTFields. Median PFS with RT/TMZ/TTFields was 10.5 months. Median OS has not yet been reached.
CONCLUSION
The proportion of patients with TTFields-related skin toxicity was similar to that reported in ndGBM patients in the randomized Phase III study (52%), where patients started TTFields at least 4 weeks after RT. No other TTFields-related toxicities were reported and there were no increase in RT- or TMZ-related toxicities as a result of combining TTFields with RT in addition to TMZ. Based on the safety and preliminary efficacy results of this pilot study, a phase II randomized study has been initiated to investigate the efficacy of concomitant RT/TMZ/TTFields in 60 ndGBM patients.
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Affiliation(s)
- R Grossman
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - F Bokstein
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - D Blumenthal
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - C Ben Harush
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - D Limon
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Z Ram
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Mardor Y, Last D, Daniels D, Tylim A, Nass D, Nissim O, Spiegelmann R, Tsarfaty G, Hoffmann C, Talianski A, Blumenthal D, Bukstein F, Limon D, Tzuk T, Shoshan Y, Cohen Z, Zach L, Guez D. Treatment Response Assessment Maps (TRAMs): Increased/Decreased Sensitivity to Tumor As a Function of Acquisition/Analysis Parameters. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2228] [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] [Indexed: 11/25/2022]
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Bouffet E, Sudhaman S, Chung J, Campbell B, Kelly J, Coblentz A, Edwards M, Lipman T, Zhang C, Ercan AB, Sambira L, Bendel A, Bielack S, Koustenis E, Blumenthal D, Bowers D, Nichols K, Bronsema A, Carroll S, Chiaravalli S, Cole K, Constantini S, De Mola RL, Dunn G, Fröjd C, Gass D, Gauvain K, George B, Hijiya N, Hoffman L, Knipstein J, Laetsch T, Larouche V, Lassaletta A, Lindhorst S, Lossos A, Luna-Fineman S, Magimairajan V, Mason G, Mason W, Massimino M, Mordechai O, Opocher E, Oren M, Osborn M, Reddy A, Remke M, Roy S, Sabel M, Samuel D, Schneider K, Sen S, Stearns D, Sumerauer D, Thomas G, Tomboc P, Damme AV, Wierman M, Winer I, Yen LY, Zapotocky M, Ziegler D, Zimmermann S, Dvir R, Rechavi G, Durno C, Aronson M, Taylor M, Dirks P, Pugh T, Shlien A, Hawkins C, Morgenstern D, Tabori U. IMMU-20. IMMUNE AND TUMOR BIOMARKERS OF OUTCOME IN REPLICATION REPAIR DEFICIENT BRAIN TUMORS TREATED WITH IMMUNE CHECKPOINT INHIBITORS: UPDATES FROM THE INTERNATIONAL REPLICATION REPAIR DEFICIENCY CONSORTIUM. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz036.139] [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: 11/13/2022] Open
Affiliation(s)
- Eric Bouffet
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Jiil Chung
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | | | | | | | | | - Cindy Zhang
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | | | - Anne Bendel
- Children’s Minnesota Minneapolis Hospital, Minneapolis, MN, USA
| | | | | | | | | | - Kim Nichols
- St. Jude’s Children’s Research Hospital, Memphis, TN, USA
| | - Annika Bronsema
- University Medical Centre of Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Kristina Cole
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | - Gavin Dunn
- Washington University School of Medicine, St, Louis, MO, USA
| | | | - David Gass
- Carolinas Healthcare System, Charlotte, NC, USA
| | - Karen Gauvain
- Washington University School of Medicine, St, Louis, MO, USA
| | - Ben George
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nobuko Hijiya
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | | | | | - Ted Laetsch
- UT Southwestern Medical Centre, Dallas, TX, USA
| | | | | | | | | | | | | | - Gary Mason
- Children’s Hospital of Pittsburg of UPMC, Pittsburgh, PA, USA
| | | | - Maura Massimino
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | - Michal Oren
- The Chaim Sheba Medical Center, Tel HaShomer, Israel
| | - Michael Osborn
- Women’s and Children’s Hospital, North Adelaide, Australia
| | - Alyssa Reddy
- UCSF Benioff Children’s Hospital, San Francisco, CA, USA
| | - Mark Remke
- University Hospital Düsseldorf, Dusseldorf, Germany
| | - Sumita Roy
- Children’s Hospital of Michigan, Detroit, MI, USA
| | - Magnus Sabel
- Queen Silvia Children’s Hospital, Göteborg, Sweden
| | | | | | - Santanu Sen
- Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
| | - Duncan Stearns
- Rainbow Babies and Children’s Hospital, Cleveland, OH, USA
| | | | | | - Patrick Tomboc
- West Virginia University Children’s Hospital, Morgantown, WV, USA
| | | | | | - Ira Winer
- Wayne State University, Detroit, MI, USA
| | - Lee Yi Yen
- Taipei Veterans General Hospital, Taipei City, Taiwan
| | | | | | | | - Rina Dvir
- Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Gidi Rechavi
- The Chaim Sheba Medical Center, Tel HaShomer, Israel
| | - Carol Durno
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | | | - Peter Dirks
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Trevor Pugh
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Adam Shlien
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | | | - Uri Tabori
- The Hospital for Sick Children, Toronto, ON, Canada
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Grossman R, Bokstein F, Blumenthal D, Harush CB, Limon D, Ram Z. INNV-30. TUMOR TREATING FIELDS AND RADIOTHERAPY FOR NEWLY DIAGNOSED GLIOBLASTOMA: SAFETY AND EFFICACY RESULTS FROM A PILOT STUDY. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.601] [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: 11/13/2022] Open
Affiliation(s)
- Rachel Grossman
- Division of Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Felix Bokstein
- Neuro-Oncology Service, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | | | - Dror Limon
- Tel Aviv Medical Center, Tel Aviv,, Israel
| | - Zvi Ram
- The Neurosurgery Dept, The Tel-Aviv Medical Center, Tel-Aviv, Israel
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Guez D, Zach L, Daniels D, Sharabi S, Nissim O, Spiegelmann R, Tylim A, Taliansky A, Shoshan Y, Blumenthal D, Bokstein F, Cohen Z, Mardor Y, Last D. NIMG-35. TREATMENT RESPONSE ASSESSMENT MAPS (TRAMs) SENSITIVITY TO TUMOR/TREATMENT-EFFECTS AS A FUNCTION OF DATA ACQUISITION PARAMETERS. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.761] [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: 11/12/2022] Open
Affiliation(s)
- David Guez
- Sheba Medical Center, Ramat-Gan, Tel Aviv, Israel
| | - Leor Zach
- Sheba Medical Center, Ramat-Gan, Tel Aviv, Israel
| | | | | | - Ouzi Nissim
- Sheba Medical Center, Ramat-Gan, Tel Aviv, Israel
| | | | | | | | - Yigal Shoshan
- Hadassah Medical Center, Jerusalem, Tel Aviv, Israel
| | | | | | - Zvi Cohen
- Sheba Medical Center, Ramat-Gan, Tel Aviv, Israel
| | - Yael Mardor
- Sheba Medical Center, Ramat-Gan, Tel Aviv, Israel
| | - David Last
- Sheba Medical Center, Ramat-Gan, Tel Aviv, Israel
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Aizenstein O, Bokstein F, Artzi M, Limon D, Ben Bashat D, Blumenthal D. NIMG-36. THE SIGNIFICANCE OF PUNCTATE CONTRAST-ENHANCING LESIONS IN TREATED HIGH GRADE GLIOMA. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.762] [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: 11/14/2022] Open
Affiliation(s)
| | - Felix Bokstein
- Neuro-Oncology Service, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Moran Artzi
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Dror Limon
- Tel Aviv Medical Center, Tel Aviv, Israel
| | - Dafna Ben Bashat
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Grossman R, Bokstein F, Ben Harosh C, Blumenthal D, Limon D, Ram Z. P01.028 Tumor treating fields and radiotherapy for newly diagnosed glioblastoma: Safety results from a pilot study. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.070] [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: 11/12/2022] Open
Affiliation(s)
- R Grossman
- Tel Aviv Medical Center, Tel Aviv, Israel
| | - F Bokstein
- Tel Aviv Medical Center, Tel Aviv, Israel
| | | | | | - D Limon
- Tel Aviv Medical Center, Tel Aviv, Israel
| | - Z Ram
- Tel Aviv Medical Center, Tel Aviv, Israel
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Marsset-Baglieri A, Théron M, Parizel O, Blumenthal D, Tomé D, Fromentin G. Expected satiation and actual food intake of applesauces varying in texture are only correlated for products expected as the least satiating. Appetite 2016. [DOI: 10.1016/j.appet.2016.02.125] [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] [Indexed: 11/29/2022]
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Masson M, Saint-Eve A, Delarue J, Blumenthal D. Identifying the ideal profile of French yogurts for different clusters of consumers. J Dairy Sci 2016; 99:3421-3433. [PMID: 26947290 DOI: 10.3168/jds.2015-10119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 07/15/2015] [Accepted: 12/22/2015] [Indexed: 11/19/2022]
Abstract
Identifying the sensory properties that affect consumer preferences for food products is an important feature of product development. Different methods, such as external preference mapping or partial least squares regression, are used to establish relationships between sensory data and consumer preferences and to identify sensory attributes that drive consumer preferences, by highlighting optimum products. Plain French yogurts were evaluated by a sensory profiling method performed by 12 trained judges. In parallel, 180 consumers were asked to score their overall liking and complete a cognitive restraint questionnaire. After hierarchical cluster analysis on the liking scores, preference mapping using a quadratic regression model was performed. Five clusters of consumers were identified as a function of different preference patterns. Contrary to our expectations, fat levels were not discriminating. For each cluster, the results of preference mapping enabled the identification of optimum products. A comparison of the 5 sensory profiles revealed numerous differences between key sensory attributes. For example, one consumer cluster had a strong preference for products perceived as very thick, grainy, but with a less flowing texture, less sticky, whey presence and color, in contrast to other clusters. In addition, each segment of consumers was characterized according to the results of the cognitive restraint questionnaire.
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Affiliation(s)
- M Masson
- AgroParisTech, UMR1145 Ingénierie Procédés Aliments, F-91300 Massy, France; INRA, UMR1145 Ingénierie Procédés Aliments, F-91300 Massy, France.
| | - A Saint-Eve
- AgroParisTech, UMR782 Génie et microbiologie des procédés Alimentaires, F-78850, Thiverval-Grignon, France; INRA, UMR782 Génie et microbiologie des procédés Alimentaires, F-78850, Thiverval-Grignon, France
| | - J Delarue
- AgroParisTech, UMR1145 Ingénierie Procédés Aliments, F-91300 Massy, France; INRA, UMR1145 Ingénierie Procédés Aliments, F-91300 Massy, France
| | - D Blumenthal
- AgroParisTech, UMR1145 Ingénierie Procédés Aliments, F-91300 Massy, France; INRA, UMR1145 Ingénierie Procédés Aliments, F-91300 Massy, France
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Brenner A, Cohen Y, Vredenburgh J, Peters K, Nayak L, Blumenthal D, Bokstein F, Breitbart E, Bangio L, Sher N, Harats D, Wen P. BMET-26PHASE 2 STUDY OF VB-111, AN ANTI-CANCER GENE THERAPY, AS MONOTHERAPY FOLLOWED BY COMBINATION OF VB-111 WITH BEVACIZUMAB, IN PATIENTS WITH RECURRENT GLIOBLASTOMA. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov208.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Shi W, Bryan M, Gilbert M, Mehta M, Blumenthal D, Brown P, Valeinis E, Hopkins K, Souhami L, Andrews D, Tzahala TS, Howard S, Youssef E, Lessard N, Dignam J, Werner-Wasik M. ATCT-29INVESTIGATING THE EFFECT OF REIRRADIATION OR SYSTEMIC THERAPY IN PATIENTS WITH GBM AFTER TUMOR PROGRESSION: A SECONDARY ANALYSIS OF THE NRG ONCOLOGY/RTOG 0525. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov206.29] [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] [Indexed: 11/14/2022] Open
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Davidenko O, Delarue J, Blumenthal D, Marsset-Baglieri A, Fromentin G, Darcel N, Tomé D, Nadkarni N. Two effects of sensory anticipation, assimilation and contrast, are on the same scale of anticipated-experienced pleasure divergence. Appetite 2014. [DOI: 10.1016/j.appet.2014.06.092] [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] [Indexed: 11/30/2022]
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Brenner A, Cohen Y, Vredenburgh J, Peters K, Blumenthal D, Bokstein F, Breitbart E, Bangio L, Sher N, Harats D, Wen P. NT-07 * PHASE 1-2 DOSE-ESCALATION STUDY OF VB-111, AN ANTI-ANGIOGENIC GENE THERAPY, AS MONOTHERAPY AND IN COMBINATION WITH BEVACIZUMAB, IN PATIENTS WITH RECURRENT GLIOBLASTOMA. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou265.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Blumenthal D, Bokstein F, Zelikovitsh B, Mordechai A, Lossos A, Taliansky A, Zach L, Tzuk-Shina T, Lavon I. GE-04 * MGMT METHYLATION IS A POSITIVE PROGNOSTIC MARKER IN PATIENTS WITH ANAPLASTIC ASTROCYTOMA TREATED WITH CONCURRENT TEMOZOLOMIDE AND RADIATION. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou256.4] [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] [Indexed: 11/14/2022] Open
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Zach L, Last D, Guez D, Daniels D, Grober Y, Nissim O, Hoffmann C, Nass D, Talianski A, Spiegelmann R, Salomon S, Kanner A, Blumenthal D, Bukshtein F, Yalon M, Zauberman J, Limon D, Tzuk T, Cohen Z, Mardor Y. NI-85 * DELAYED CONTRAST MRI FOR DIFFERENTIATING TUMOR/NON-TUMOR TISSUES IN BRAIN TUMOR PATIENTS - HISTOLOGICAL VALIDATION AND COMPARISON WITH DSC/DCE. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou264.83] [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] [Indexed: 11/14/2022] Open
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Ambady P, Holdhoff M, Ferrigno C, Grossman S, Anderson MD, Liu D, Conrad C, Penas-Prado M, Gilbert MR, Yung AWK, de Groot J, Aoki T, Nishikawa R, Sugiyama K, Nonoguchi N, Kawabata N, Mishima K, Adachi JI, Kurisu K, Yamasaki F, Tominaga T, Kumabe T, Ueki K, Higuchi F, Yamamoto T, Ishikawa E, Takeshima H, Yamashita S, Arita K, Hirano H, Yamada S, Matsutani M, Apok V, Mills S, Soh C, Karabatsou K, Arimappamagan A, Arya S, Majaid M, Somanna S, Santosh V, Schaff L, Armentano F, Harrison C, Lassman A, McKhann G, Iwamoto F, Armstrong T, Yuan Y, Liu D, Acquaye A, Vera-Bolanos E, Diefes K, Heathcock L, Cahill D, Gilbert M, Aldape K, Arrillaga-Romany I, Ruddy K, Greenberg S, Nayak L, Avgeropoulos N, Avgeropoulos G, Riggs G, Reilly C, Banerji N, Bruns P, Hoag M, Gilliland K, Trusheim J, Bekaert L, Borha A, Emery E, Busson A, Guillamo JS, Bell M, Harrison C, Armentano F, Lassman A, Connolly ES, Khandji A, Iwamoto F, Blakeley J, Ye X, Bergner A, Dombi E, Zalewski C, Follmer K, Halpin C, Fayad L, Jacobs M, Baldwin A, Langmead S, Whitcomb T, Jennings D, Widemann B, Plotkin S, Brandes AA, Mason W, Pichler J, Nowak AK, Gil M, Saran F, Revil C, Lutiger B, Carpentier AF, Milojkovic-Kerklaan B, Aftimos P, Altintas S, Jager A, Gladdines W, Lonnqvist F, Soetekouw P, van Linde M, Awada A, Schellens J, Brandsma D, Brenner A, Sun J, Floyd J, Hart C, Eng C, Fichtel L, Gruslova A, Lodi A, Tiziani S, Bridge CA, Baldock A, Kumthekar P, Dilfer P, Johnston SK, Jacobs J, Corwin D, Guyman L, Rockne R, Sonabend A, Cloney M, Canoll P, Swanson KR, Bromberg J, Schouten H, Schaafsma R, Baars J, Brandsma D, Lugtenburg P, van Montfort C, van den Bent M, Doorduijn J, Spalding A, LaRocca R, Haninger D, Saaraswat T, Coombs L, Rai S, Burton E, Burzynski G, Burzynski S, Janicki T, Marszalek A, Burzynski S, Janicki T, Burzynski G, Marszalek A, Cachia D, Smith T, Cardona AF, Mayor LC, Jimenez E, Hakim F, Yepes C, Bermudez S, Useche N, Asencio JL, Mejia JA, Vargas C, Otero JM, Carranza H, Ortiz LD, Cardona AF, Ortiz LD, Jimenez E, Hakim F, Yepes C, Useche N, Bermudez S, Asencio JL, Carranza H, Vargas C, Otero JM, Bartels C, Quintero A, Restrepo CE, Gomez S, Bernal-Vaca L, Lema M, Cardona AF, Ortiz LD, Useche N, Bermudez S, Jimenez E, Hakim F, Yepes C, Mejia JA, Bernal-Vaca L, Restrepo CE, Gomez S, Quintero A, Bartels C, Carranza H, Vargas C, Otero JM, Carlo M, Omuro A, Grommes C, Kris M, Nolan C, Pentsova E, Pietanza M, Kaley T, Carrabba G, Giammattei L, Draghi R, Conte V, Martinelli I, Caroli M, Bertani G, Locatelli M, Rampini P, Artoni A, Carrabba G, Bertani G, Cogiamanian F, Ardolino G, Zarino B, Locatelli M, Caroli M, Rampini P, Chamberlain M, Raizer J, Soffetti R, Ruda R, Brandsma D, Boogerd W, Taillibert S, Le Rhun E, Jaeckle K, van den Bent M, Wen P, Chamberlain M, Chinot OL, Wick W, Mason W, Henriksson R, Saran F, Nishikawa R, Carpentier AF, Hoang-Xuan K, Kavan P, Cernea D, Brandes AA, Hilton M, Kerloeguen Y, Guijarro A, Cloughsey T, Choi JH, Hong YK, Conrad C, Yung WKA, deGroot J, Gilbert M, Loghin M, Penas-Prado M, Tremont I, Silberman S, Picker D, Costa R, Lycette J, Gancher S, Cullen J, Winer E, Hochberg F, Sachs G, Jeyapalan S, Dahiya S, Stevens G, Peereboom D, Ahluwalia M, Daras M, Hsu M, Kaley T, Panageas K, Curry R, Avila E, Fuente MDL, Omuro A, DeAngelis L, Desjardins A, Sampson J, Peters K, Ranjan T, Vlahovic G, Threatt S, Herndon J, Boulton S, Lally-Goss D, McSherry F, Friedman A, Friedman H, Bigner D, Gromeier M, Prust M, Kalpathy-Cramer J, Poloskova P, Jafari-Khouzani K, Gerstner E, Dietrich J, Fabi A, Villani V, Vaccaro V, Vidiri A, Giannarelli D, Piludu F, Anelli V, Carapella C, Cognetti F, Pace A, Flowers A, Flowers A, Killory B, Furuse M, Miyatake SI, Kawabata S, Kuroiwa T, Garciarena P, Anderson MD, Hamilton J, Schellingerhout D, Fuller GN, Sawaya R, Gilbert MR, Gilbert M, Pugh S, Won M, Blumenthal D, Vogelbaum M, Aldape K, Colman H, Chakravarti A, Jeraj R, Dignam J, Armstrong T, Wefel J, Brown P, Jaeckle K, Schiff D, Brachman D, Werner-Wasik M, Tremont-Lukats I, Sulman E, Mehta M, Gill B, Yun J, Goldstein H, Malone H, Pisapia D, Sonabend AM, Mckhann GK, Sisti MB, Sims P, Canoll P, Bruce JN, Girvan A, Carter G, Li L, Kaltenboeck A, Chawla A, Ivanova J, Koh M, Stevens J, Lahn M, Gore M, Hariharan S, Porta C, Bjarnason G, Bracarda S, Hawkins R, Oudard S, Zhang K, Fly K, Matczak E, Szczylik C, Grossman R, Ram Z, Hamza M, O'Brien B, Mandel J, DeGroot J, Han S, Molinaro A, Berger M, Prados M, Chang S, Clarke J, Butowski N, Hashimoto N, Chiba Y, Tsuboi A, Kinoshita M, Hirayama R, Kagawa N, Oka Y, Oji Y, Sugiyama H, Yoshimine T, Hawkins-Daarud A, Jackson PR, Swanson KR, Sarmiento JM, Ly D, Jutla J, Ortega A, Carico C, Dickinson H, Phuphanich S, Rudnick J, Patil C, Hu J, Iglseder S, Nowosielski M, Nevinny-Stickel M, Stockhammer G, Jain R, Poisson L, Scarpace L, Mikkelsen T, Kirby J, Freymann J, Hwang S, Gutman D, Jaffe C, Brat D, Flanders A, Janicki T, Burzynski S, Burzynski G, Marszalek A, Jiang C, Wang H, Jo J, Williams B, Smolkin M, Wintermark M, Shaffrey M, Schiff D, Juratli T, Soucek S, Kirsch M, Schackert G, Kakkar A, Kumar S, Bhagat U, Kumar A, Suri A, Singh M, Sharma M, Sarkar C, Suri V, Kaley T, Barani I, Chamberlain M, McDermott M, Raizer J, Rogers L, Schiff D, Vogelbaum M, Weber D, Wen P, Kalita O, Vaverka M, Hrabalek L, Zlevorova M, Trojanec R, Hajduch M, Kneblova M, Ehrmann J, Kanner AA, Wong ET, Villano JL, Ram Z, Khatua S, Fuller G, Dasgupta S, Rytting M, Vats T, Zaky W, Khatua S, Sandberg D, Foresman L, Zaky W, Kieran M, Geoerger B, Casanova M, Chisholm J, Aerts I, Bouffet E, Brandes AA, Leary SES, Sullivan M, Bailey S, Cohen K, Mason W, Kalambakas S, Deshpande P, Tai F, Hurh E, McDonald TJ, Kieran M, Hargrave D, Wen PY, Goldman S, Amakye D, Patton M, Tai F, Moreno L, Kim CY, Kim T, Han JH, Kim YJ, Kim IA, Yun CH, Jung HW, Koekkoek JAF, Reijneveld JC, Dirven L, Postma TJ, Vos MJ, Heimans JJ, Taphoorn MJB, Koeppen S, Hense J, Kong XT, Davidson T, Lai A, Cloughesy T, Nghiemphu PL, Kong DS, Choi YL, Seol HJ, Lee JI, Nam DH, Kool M, Jones DTW, Jager N, Northcott PA, Pugh T, Hovestadt V, Markant S, Esparza LA, Bourdeaut F, Remke M, Taylor MD, Cho YJ, Pomeroy SL, Schuller U, Korshunov A, Eils R, Wechsler-Reya RJ, Lichter P, Pfister SM, Krel R, Krutoshinskaya Y, Rosiello A, Seidman R, Kowalska A, Kudo T, Hata Y, Maehara T, Kumthekar P, Bridge C, Patel V, Rademaker A, Helenowski I, Mrugala M, Rockhill J, Swanson K, Grimm S, Raizer J, Meletath S, Bennett M, Nestor VA, Fink KL, Lee E, Reardon D, Schiff D, Drappatz J, Muzikansky A, Hammond S, Grimm S, Norden A, Beroukhim R, McCluskey C, Chi A, Batchelor T, Smith K, Gaffey S, Gerard M, Snodgras S, Raizer J, Wen P, Leeper H, Johnson D, Lima J, Porensky E, Cavaliere R, Lin A, Liu J, Evans J, Leuthardt E, Dacey R, Dowling J, Kim A, Zipfel G, Grubb R, Huang J, Robinson C, Simpson J, Linette G, Chicoine M, Tran D, Liubinas SV, D'Abaco GM, Moffat B, Gonzales M, Feleppa F, Nowell CJ, Gorelick A, Drummond KJ, Morokoff AP, O'Brien TJ, Kaye AH, Loghin M, Melhem-Bertrandt A, Penas-Prado M, Zaidi T, Katz R, Lupica K, Stevens G, Ly I, Hamilton S, Rostomily R, Rockhill J, Mrugala M, Mandel J, Yust-Katz S, de Groot J, Yung A, Gilbert M, Burzynski S, Janicki T, Burzynski G, Marszalek A, Pachow D, Kliese N, Kirches E, Mawrin C, McNamara MG, Lwin Z, Jiang H, Chung C, Millar BA, Sahgal A, Laperriere N, Mason WP, Megyesi J, Salehi F, Merker V, Slusarz K, Muzikansky A, Francis S, Plotkin S, Mishima K, Adachi JI, Suzuki T, Uchida E, Yanagawa T, Watanabe Y, Fukuoka K, Yanagisawa T, Wakiya K, Fujimaki T, Nishikawa R, Moiyadi A, Kannan S, Sridhar E, Gupta T, Shetty P, Jalali R, Alshami J, Lecavalier-Barsoum M, Guiot MC, Tampieri D, Kavan P, Muanza T, Nagane M, Kobayashi K, Takayama N, Shiokawa Y, Nakamura H, Makino K, Hideo T, Kuroda JI, Shinojima N, Yano S, Kuratsu JI, Nambudiri N, Arrilaga I, Dunn I, Folkerth R, Chi S, Reardon D, Nayak L, Omuro A, DeAngelis L, Robins HI, Govindan R, Gadgeel S, Kelly K, Rigas J, Reimers HJ, Peereboom D, Rosenfeld S, Garst J, Ramnath N, Wing P, Zheng M, Urban P, Abrey L, Wen P, Nayak L, DeAngelis LM, Wen PY, Brandes AA, Soffietti R, Peereboom DM, Lin NU, Chamberlain M, Macdonald D, Galanis E, Perry J, Jaeckle K, Mehta M, Stupp R, van den Bent M, Reardon DA, Norden A, Hammond S, Drappatz J, Phuphanich S, Reardon D, Wong E, Plotkin S, Lesser G, Raizer J, Batchelor T, Lee E, Kaley T, Muzikansky A, Doherty L, LaFrankie D, Ruland S, Smith K, Gerard M, McCluskey C, Wen P, Norden A, Schiff D, Ahluwalia M, Lesser G, Nayak L, Lee E, Muzikansky A, Dietrich J, Smith K, Gaffey S, McCluskey C, Ligon K, Reardon D, Wen P, Bush NAO, Kesari S, Scott B, Ohno M, Narita Y, Miyakita Y, Arita H, Matsushita Y, Yoshida A, Fukushima S, Ichimura K, Shibui S, Okamura T, Kaneko S, Omuro A, Chinot O, Taillandier L, Ghesquieres H, Soussain C, Delwail V, Lamy T, Gressin R, Choquet S, Soubeyran P, Maire JP, Benouaich-Amiel A, Lebouvier-Sadot S, Gyan E, Barrie M, del Rio MS, Gonzalez-Aguilar A, Houllier C, Tanguy ML, Hoang-Xuan K, Omuro A, Abrey L, Raizer J, Paleologos N, Forsyth P, DeAngelis L, Kaley T, Louis D, Cairncross JG, Matasar M, Mehta J, Grimm S, Moskowitz C, Sauter C, Opinaldo P, Torcuator R, Ortiz LD, Cardona AF, Hakim F, Jimenez E, Yepes C, Useche N, Bermudez S, Mejia JA, Asencio JL, Carranza H, Vargas C, Otero JM, Lema M, Pace A, Villani V, Fabi A, Carapella CM, Patel A, Allen J, Dicker D, Sheehan J, El-Deiry W, Glantz M, Tsyvkin E, Rauschkolb P, Pentsova E, Lee M, Perez A, Norton J, Uschmann H, Chamczuck A, Khan M, Fratkin J, Rahman R, Hempfling K, Norden A, Reardon DA, Nayak L, Rinne M, Doherty L, Ruland S, Rai A, Rifenburg J, LaFrankie D, Wen P, Lee E, Ranjan T, Peters K, Vlahovic G, Friedman H, Desjardins A, Reveles I, Brenner A, Ruda R, Bello L, Castellano A, Bertero L, Bosa C, Trevisan E, Riva M, Donativi M, Falini A, Soffietti R, Saran F, Chinot OL, Henriksson R, Mason W, Wick W, Nishikawa R, Dahr S, Hilton M, Garcia J, Cloughesy T, Sasaki H, Nishiyama Y, Yoshida K, Hirose Y, Schwartz M, Grimm S, Kumthekar P, Fralin S, Rice L, Drawz A, Helenowski I, Rademaker A, Raizer J, Schwartz K, Chang H, Nikolai M, Kurniali P, Olson K, Pernicone J, Sweeley C, Noel M, Sharma M, Gupta R, Suri V, Singh M, Sarkar C, Shibahara I, Sonoda Y, Saito R, Kanamori M, Yamashita Y, Kumabe T, Watanabe M, Suzuki H, Watanabe T, Ishioka C, Tominaga T, Shih K, Chowdhary S, Rosenblatt P, Weir AB, Shepard G, Williams JT, Shastry M, Hainsworth JD, Singer S, Riely GJ, Kris MG, Grommes C, Sanders MWCB, Arik Y, Seute T, Robe PAJT, Leijten FSS, Snijders TJ, Sturla L, Culhane JJ, Donahue J, Jeyapalan S, Suchorska B, Jansen N, Wenter V, Eigenbrod S, Schmid-Tannwald C, Zwergal A, Niyazi M, Bartenstein P, Schnell O, Kreth FW, LaFougere C, Tonn JC, Taillandier L, Wittwer B, Blonski M, Faure G, De Carvalho M, Le Rhun E, Tanaka K, Sasayama T, Nishihara M, Mizukawa K, Kohmura E, Taylor S, Newell K, Graves L, Timmer M, Cramer C, Rohn G, Goldbrunner R, Turner S, Gergel T, Lacroix M, Toms S, Ueki K, Higuchi F, Sakamoto S, Kim P, Salgado MAV, Rueda AG, Urzaiz LL, Villanueva MG, Millan JMS, Cervantes ER, Pampliega RA, de Pedro MDA, Berrocal VR, Mena AC, van Zanten SV, Jansen M, van Vuurden D, Huisman M, Hoekstra O, van Dongen G, Kaspers GJ, Schlamann A, von Bueren AO, Hagel C, Kramm C, Kortmann RD, Muller K, Friedrich C, Muller K, von Hoff K, Kwiecien R, Pietsch T, Warmuth-Metz M, Gerber NU, Hau P, Kuehl J, Kortmann RD, von Bueren AO, Rutkowski S, von Bueren AO, Friedrich C, von Hoff K, Kwiecien R, Muller K, Pietsch T, Warmuth-Metz M, Kuehl J, Kortmann RD, Rutkowski S, Walker J, Tremont I, Armstrong T, Wang H, Jiang C, Wang H, Jiang C, Warren P, Robert S, Lahti A, White D, Reid M, Nabors L, Sontheimer H, Wen P, Yung A, Mellinghoff I, Lamborn K, Ramkissoon S, Cloughesy T, Rinne M, Omuro A, DeAngelis L, Gilbert M, Chi A, Batchelor T, Colman H, Chang S, Nayak L, Massacesi C, DiTomaso E, Prados M, Reardon D, Ligon K, Wong ET, Elzinga G, Chung A, Barron L, Bloom J, Swanson KD, Elzinga G, Chung A, Wong ET, Wu W, Galanis E, Wen P, Das A, Fine H, Cloughesy T, Sargent D, Yoon WS, Yang SH, Chung DS, Jeun SS, Hong YK, Yust-Katz S, Milbourne A, Diane L, Gilbert M, Armstrong T, Zaky W, Weinberg J, Fuller G, Ketonen L, McAleer MF, Ahmed N, Khatua S, Zaky W, Olar A, Stewart J, Sandberg D, Foresman L, Ketonen L, Khatua S. NEURO/MEDICAL ONCOLOGY. Neuro Oncol 2013; 15:iii98-iii135. [PMCID: PMC3823897 DOI: 10.1093/neuonc/not182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/14/2023] Open
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Adachi K, Sasaki H, Nagahisa S, Yoshida K, Hattori N, Nishiyama Y, Kawase T, Hasegawa M, Abe M, Hirose Y, Alentorn A, Marie Y, Poggioli S, Alshehhi H, Boisselier B, Carpentier C, Mokhtari K, Capelle L, Figarella-Branger D, Hoang-Xuan K, Sanson M, Delattre JY, Idbaih A, Yust-Katz S, Anderson M, Olar A, Eterovic A, Ezzeddine N, Chen K, Zhao H, Fuller G, Aldape K, de Groot J, Andor N, Harness J, Lopez SG, Fung TL, Mewes HW, Petritsch C, Arivazhagan A, Somasundaram K, Thennarasu K, Pandey P, Anandh B, Santosh V, Chandramouli B, Hegde A, Kondaiah P, Rao M, Bell R, Kang R, Hong C, Song J, Costello J, Bell R, Nagarajan R, Zhang B, Diaz A, Wang T, Song J, Costello J, Bie L, Li Y, Li Y, Liu H, Luyo WFC, Carnero MH, Iruegas MEP, Morell AR, Figueiras MC, Lopez RL, Valverde CF, Chan AKY, Pang JCS, Chung NYF, Li KKW, Poon WS, Chan DTM, Wang Y, Ng HAK, Chaumeil M, Larson P, Yoshihara H, Vigneron D, Nelson S, Pieper R, Phillips J, Ronen S, Clark V, Omay ZE, Serin A, Gunel J, Omay B, Grady C, Youngblood M, Bilguvar K, Baehring J, Piepmeier J, Gutin P, Vortmeyer A, Brennan C, Pamir MN, Kilic T, Krischek B, Simon M, Yasuno K, Gunel M, Cohen AL, Sato M, Aldape KD, Mason C, Diefes K, Heathcock L, Abegglen L, Shrieve D, Couldwell W, Schiffman JD, Colman H, D'Alessandris QG, Cenci T, Martini M, Ricci-Vitiani L, De Maria R, Larocca LM, Pallini R, de Groot J, Theeler B, Aldape K, Lang F, Rao G, Gilbert M, Sulman E, Luthra R, Eterovic K, Chen K, Routbort M, Verhaak R, Mills G, Mendelsohn J, Meric-Bernstam F, Yung A, MacArthur K, Hahn S, Kao G, Lustig R, Alonso-Basanta M, Chandrasekaran S, Wileyto EP, Reyes E, Dorsey J, Fujii K, Kurozumi K, Ichikawa T, Onishi M, Ishida J, Shimazu Y, Kaur B, Chiocca EA, Date I, Geisenberger C, Mock A, Warta R, Schwager C, Hartmann C, von Deimling A, Abdollahi A, Herold-Mende C, Gevaert O, Achrol A, Gholamin S, Mitra S, Westbroek E, Loya J, Mitchell L, Chang S, Steinberg G, Plevritis S, Cheshier S, Gevaert O, Mitchell L, Achrol A, Xu J, Steinberg G, Cheshier S, Napel S, Zaharchuk G, Plevritis S, Gevaert O, Achrol A, Chang S, Harsh G, Steinberg G, Cheshier S, Plevritis S, Gutman D, Holder C, Colen R, Dunn W, Jain R, Cooper L, Hwang S, Flanders A, Brat D, Hayes J, Droop A, Thygesen H, Boissinot M, Westhead D, Short S, Lawler S, Bady P, Kurscheid S, Delorenzi M, Hegi ME, Crosby C, Faulkner C, Smye-Rumsby T, Kurian K, Williams M, Hopkins K, Faulkner C, Palmer A, Williams H, Wragg C, Haynes HR, Williams M, Hopkins K, Kurian KM, Haynes HR, Crosby C, Williams H, White P, Hopkins K, Williams M, Kurian KM, Ishida J, Kurozumi K, Ichikawa T, Onishi M, Fujii K, Shimazu Y, Oka T, Date I, Jalbert L, Elkhaled A, Phillips J, Chang S, Nelson S, Jensen R, Salzman K, Schabel M, Gillespie D, Mumert M, Johnson B, Mazor T, Hong C, Barnes M, Yamamoto S, Ueda H, Tatsuno K, Aihara K, Jalbert L, Nelson S, Bollen A, Hirst M, Marra M, Mukasa A, Saito N, Aburatani H, Berger M, Chang S, Taylor B, Costello J, Popov S, Mackay A, Ingram W, Burford A, Jury A, Vinci M, Jones C, Jones DTW, Hovestadt V, Picelli S, Wang W, Northcott PA, Kool M, Reifenberger G, Pietsch T, Sultan M, Lehrach H, Yaspo ML, Borkhardt A, Landgraf P, Eils R, Korshunov A, Zapatka M, Radlwimmer B, Pfister SM, Lichter P, Joy A, Smirnov I, Reiser M, Shapiro W, Mills G, Kim S, Feuerstein B, Jungk C, Mock A, Geisenberger C, Warta R, Friauf S, Unterberg A, Herold-Mende C, Juratli TA, McElroy J, Meng W, Huebner A, Geiger KD, Krex D, Schackert G, Chakravarti A, Lautenschlaeger T, Kim BY, Jiang W, Beiko J, Prabhu S, DeMonte F, Lang F, Gilbert M, Aldape K, Sawaya R, Cahill D, McCutcheon I, Lau C, Wang L, Terashima K, Yamaguchi S, Burstein M, Sun J, Suzuki T, Nishikawa R, Nakamura H, Natsume A, Terasaka S, Ng HK, Muzny D, Gibbs R, Wheeler D, Lautenschlaeger T, Juratli TA, McElroy J, Meng W, Huebner A, Geiger KD, Krex D, Schackert G, Chakravarti A, Zhang XQ, Sun S, Lam KF, Kiang KMY, Pu JKS, Ho ASW, Leung GKK, Loebel F, Curry WT, Barker FG, Lelic N, Chi AS, Cahill DP, Lu D, Yin J, Teo C, McDonald K, Madhankumar A, Weston C, Slagle-Webb B, Sheehan J, Patel A, Glantz M, Connor J, Maire C, Francis J, Zhang CZ, Jung J, Manzo V, Adalsteinsson V, Homer H, Blumenstiel B, Pedamallu CS, Nickerson E, Ligon A, Love C, Meyerson M, Ligon K, Mazor T, Johnson B, Hong C, Barnes M, Jalbert LE, Nelson SJ, Bollen AW, Smirnov IV, Song JS, Olshen AB, Berger MS, Chang SM, Taylor BS, Costello JF, Mehta S, Armstrong B, Peng S, Bapat A, Berens M, Melendez B, Mollejo M, Mur P, Hernandez-Iglesias T, Fiano C, Ruiz J, Rey JA, Mock A, Stadler V, Schulte A, Lamszus K, Schichor C, Westphal M, Tonn JC, Unterberg A, Herold-Mende C, Morozova O, Katzman S, Grifford M, Salama S, Haussler D, Nagarajan R, Zhang B, Johnson B, Bell R, Olshen A, Fouse S, Diaz A, Smirnov I, Kang R, Wang T, Costello J, Nakamizo S, Sasayama T, Tanaka H, Tanaka K, Mizukawa K, Yoshida M, Kohmura E, Northcott P, Hovestadt V, Jones D, Kool M, Korshunov A, Lichter P, Pfister S, Otani R, Mukasa A, Takayanagi S, Saito K, Tanaka S, Shin M, Saito N, Ozawa T, Riester M, Cheng YK, Huse J, Helmy K, Charles N, Squatrito M, Michor F, Holland E, Perrech M, Dreher L, Rohn G, Goldbrunner R, Timmer M, Pollo B, Palumbo V, Calatozzolo C, Patane M, Nunziata R, Farinotti M, Silvani A, Lodrini S, Finocchiaro G, Lopez E, Rioscovian A, Ruiz R, Siordia G, de Leon AP, Rostomily C, Rostomily R, Silbergeld D, Kolstoe D, Chamberlain M, Silber J, Roth P, Keller A, Hoheisel J, Codo P, Bauer A, Backes C, Leidinger P, Meese E, Thiel E, Korfel A, Weller M, Saito K, Mukasa A, Nagae G, Nagane M, Aihara K, Takayanagi S, Tanaka S, Aburatani H, Saito N, Salama S, Sanborn JZ, Grifford M, Brennan C, Mikkelsen T, Jhanwar S, Chin L, Haussler D, Sasayama T, Tanaka K, Nakamizo S, Nishihara M, Tanaka H, Mizukawa K, Kohmura E, Schliesser M, Grimm C, Weiss E, Claus R, Weichenhan D, Weiler M, Hielscher T, Sahm F, Wiestler B, Klein AC, Blaes J, Weller M, Plass C, Wick W, Stragliotto G, Rahbar A, Soderberg-Naucler C, Sulman E, Won M, Ezhilarasan R, Sun P, Blumenthal D, Vogelbaum M, Colman H, Jenkins R, Chakravarti A, Jeraj R, Brown P, Jaeckle K, Schiff D, Dignam J, Atkins J, Brachman D, Werner-Wasik M, Gilbert M, Mehta M, Aldape K, Terashima K, Shen J, Luan J, Yu A, Suzuki T, Nishikawa R, Matsutani M, Liang Y, Man TK, Lau C, Trister A, Tokita M, Mikheeva S, Mikheev A, Friend S, Rostomily R, van den Bent M, Erdem L, Gorlia T, Taphoorn M, Kros J, Wesseling P, Dubbink H, Ibdaih A, Sanson M, French P, van Thuijl H, Mazor T, Johnson B, Fouse S, Heimans J, Wesseling P, Ylstra B, Reijneveld J, Taylor B, Berger M, Chang S, Costello J, Prabowo A, van Thuijl H, Scheinin I, van Essen H, Spliet W, Ferrier C, van Rijen P, Veersema T, Thom M, Meeteren ASV, Reijneveld J, Ylstra B, Wesseling P, Aronica E, Kim H, Zheng S, Mikkelsen T, Brat DJ, Virk S, Amini S, Sougnez C, Chin L, Barnholtz-Sloan J, Verhaak RGW, Watts C, Sottoriva A, Spiteri I, Piccirillo S, Touloumis A, Collins P, Marioni J, Curtis C, Tavare S, Weiss E, Grimm C, Schliesser M, Hielscher T, Claus R, Sahm F, Wiestler B, Klein AC, Blaes J, Tews B, Weiler M, Weichenhan D, Hartmann C, Weller M, Plass C, Wick W, Yeung TPC, Al-Khazraji B, Morrison L, Hoffman L, Jackson D, Lee TY, Yartsev S, Bauman G, Zheng S, Fu J, Vegesna R, Mao Y, Heathcock LE, Torres-Garcia W, Ezhilarasan R, Wang S, McKenna A, Chin L, Brennan CW, Yung WKA, Weinstein JN, Aldape KD, Sulman EP, Chen K, Koul D, Verhaak RGW. OMICS AND PROGNSTIC MARKERS. Neuro Oncol 2013; 15:iii136-iii155. [PMCID: PMC3823898 DOI: 10.1093/neuonc/not183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
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Strauss I, Jonas-Kimchi T, Bokstein F, Blumenthal D, Roth J, Sitt R, Wilson J, Ram Z. Gliomas of the posterior fossa in adults. J Neurooncol 2013; 115:401-9. [PMID: 23979683 DOI: 10.1007/s11060-013-1231-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 08/18/2013] [Indexed: 11/25/2022]
Abstract
Infratentorial gliomas are relatively rare tumors compared to their supratentorial counterparts. As such they have not been extensively characterized as a group and are usually excluded from clinical studies. Using our database we aimed to characterize adult gliomas involving the posterior fossa with respect to their clinical behavior and prognostic factors. We reviewed our neurosurgical and neuro-oncological data bases for adult patients diagnosed with gliomas involving the posterior fossa between 1996 and 2010. Of 1,283 glioma patients, 57 patients with gliomas involving the posterior fossa were identified (4.4 %). Tumors were further classified by location as primary brainstem (n = 21) and primary cerebellar (n = 18) tumors. On univariate analysis survival was correlated to tumor grade and KPS. In addition we have identified a unique group of patients (n = 18) with previously diagnosed supratentorial gliomas who subsequently developed noncontiguous secondary infratentorial extension of their tumors with subsequent rapid clinical deterioration. Gliomas of the posterior fossa comprise a heterogeneous group of tumors. Histological grade of the tumor was found to be the main prognostic factor. Survival of primary cerebellar gliomas is comparable to supra-tentorial gliomas, while brainstem gliomas in adults fare better than in the pediatric population. Secondary extension of supratentorial gliomas to the posterior fossa signifies a grave prognosis.
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Affiliation(s)
- Ido Strauss
- Department of Neurosurgery, Tel Aviv Medical Center, 6 Weizman Street, 64239, Tel Aviv, Israel
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Maimon S, Nossek E, Strauss I, Blumenthal D, Frolov V, Ram Z. Transarterial treatment with Onyx of intracranial dural arteriovenous fistula with cortical drainage in 17 patients. AJNR Am J Neuroradiol 2011; 32:2180-4. [PMID: 21998110 DOI: 10.3174/ajnr.a2728] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Intracranial DAVFs with cortical venous drainage have a high tendency to bleed. Complete closure of these lesions is essential to prevent clinically deleterious events. We describe our experience using Onyx in an arterial approach for treatment of DAVFs in 17 patients. MATERIALS AND METHODS Between 2006 and 2010, we used Onyx for performing transarterial embolization in 17 patients with intracranial DAVFs and cortical venous drainage. Clinical assessment was performed before and after every treatment at discharge and at follow-up. Fourteen patients underwent follow-up MR imaging and MRA, 8 of them also underwent follow-up diagnostic angiography. RESULTS Fifteen patients (88%) underwent 1 procedure. Complete obliteration by embolization with Onyx was achieved in 16 patients (94% acute obliteration). The mean amount of Onyx injected was 2.3 mL (range, 0.4-4.8 mL). The sole technical complication was an embolus to a branch of the MCA, which was resolved by intra-arterial tPA injection. A clinical complication of transient trochlear nerve palsy in the same patient due to mass effect of Onyx resolved spontaneously within 3 months. CONCLUSIONS Intra-arterial embolization of cranial DAVFs with cortical venous drainage by using Onyx results in a high rate of complete obliteration (94%) with low morbidity (6%). Follow-up DSA in 8 patients revealed no evidence of reopening.
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Affiliation(s)
- S Maimon
- Department of Neurosurgery, Tel-Aviv Medical Center, Tel Aviv, Israel.
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Mehta M, Wang M, Aldape K, Sulman E, Stupp R, Jaeckle K, Blumenthal D, Erridge S, Curran W, Gilbert M. Clinical, Molecular, and Molecular-Clinical Profile (MCP) Exploratory Subset Analysis of RTOG 0525: a Phase III Trial Comparing Standard (std) Adjuvant Temozolomide (TMZ) with a Dose-dense (dd) Schedule for Glioblastoma (GBM). Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)70117-4] [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] [Indexed: 11/16/2022]
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Varkevisser R, Nalos L, Jonsson MKB, Duker G, De Boer TP, Van Veen TAB, Van Der Heyden MAG, Vos MA, Milberg P, Frommeyer G, Ghezelbash S, Eckardt L, Bingen BO, Askar SFA, Ypey DL, Van Der Laarse A, Schalij MJ, Pijnappels DA, Mor M, Beharier O, Blumenthal D, Gheber LA, Peretz A, Katz A, Moran A, Etzion Y, Uldry L, Virag N, Vesin JM, Kappenberger L, Marques-Neto SR, Pimenta MC, Marocolo-Junior M, Maior AS, Nascimento JHM, Flevari P, Theodorakis G, Leftheriotis D, Kroupis C, Kolokathis F, Dima K, Kremastinos D, Anastasiou-Nana M, Jowhari H, Jaydari F, Taati M, Manteghi A, Liew R, Katwadi KB, Gu Y, Mohamed Atan MSB, Moe KT, Urbanek B, Ruta J, Kudrynski K, Kaczmarek K, Chudzik M, Ptaszynski P, Wranicz JK. Basic Science. Europace 2011. [DOI: 10.1093/europace/eur230] [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] [Indexed: 11/13/2022] Open
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Nossek E, Ram Z, Bokstein F, Blumenthal D. Antiangiogenesis in recurrent glioblastoma: proof of principle. Neurol Int 2009; 1:e21. [PMID: 21577359 PMCID: PMC3093229 DOI: 10.4081/ni.2009.e21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Revised: 04/12/2009] [Accepted: 04/17/2009] [Indexed: 11/23/2022] Open
Abstract
Glioblastoma multiforme, a neoplasm with variable histological and biological features, is characterized by diverse imaging features, including highly heterogeneous enhancement. This reflects variable disruption of the blood brain barrier and inherent differences in the vascularity of the tumor. Experience in treating malignant glioma with antiangiogenic drugs is growing, and the most commonly used, in combination with irinotecan or other cytotoxic agents as salvage therapy, is bevacizumab, a monoclonal antibody against vascular endothelial growth factor. A 42-year-old, right-handed person with recurrent glioblastoma multiforme presented with two synchronous foci of recurrent disease in follow-up: one area with enhancement and another one nonenhancing and infiltrative, which responded differently to treatment with bevacizumab and irinotecan. Our example demonstrates the heterogeneous nature of glioblastoma multiforme and is proof of principle for antiangiogenic treatment in selected enhancing, presumably angiogenic forms of glioblastoma multiforme. Antiangiogenic treatment may be ineffective in more infiltrative, biologically different lesions.
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Affiliation(s)
- Erez Nossek
- Tel Aviv Medical Center Neurosurgery Department
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Abstract
Although global change is known to influence plant invasion, little is known about interactions between altered precipitation and invasion. In the North American mixedgrass prairie, invasive species are often abundant in wet and nitrogen (N)-rich areas, suggesting that predicted changes in precipitation and N deposition could exacerbate invasion. Here, this possibility was tested by seeding six invasive species into experimental plots of mixedgrass prairie treated with a factorial combination of increased snow, summer irrigation, and N addition. Without added snow, seeded invasive species were rarely observed. Snow addition increased average above-ground biomass of Centaurea diffusa from 0.026 to 66 g m(-2), of Gypsophila paniculata from 0.1 to 7.3 g m(-2), and of Linaria dalmatica from 5 to 101 g m(-2). Given added snow, summer irrigation increased the density of G. paniculata, and N addition increased the density and biomass of L. dalmatica. Plant density responses mirrored those of plant biomass, indicating that increases in biomass resulted, in part, from increases in recruitment. In contrast to seeded invasive species, resident species did not respond to snow addition. These results suggest that increases in snowfall or variability of snowfall may exacerbate forb invasion in the mixedgrass prairie.
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Affiliation(s)
- D Blumenthal
- USDA ARS Rangeland Resources Research Unit, 1701 Center Avenue, Fort Collins, CO 80526, USA
| | - R A Chimner
- Natural Resource Ecology Laboratory, Colorado, State University, Fort Collins, CO 80523, USA
| | - J M Welker
- Natural Resource Ecology Laboratory, Colorado, State University, Fort Collins, CO 80523, USA
- Environment and Natural Resources Institute and Biology Department, University of Alaska Anchorage, Anchorage, AK, USA
| | - J A Morgan
- USDA ARS Rangeland Resources Research Unit, 1701 Center Avenue, Fort Collins, CO 80526, USA
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Sullivan A, Camargo C, Cleary P, Gordon J, Kaushal R, Magid D, Rao S, Blumenthal D. Do Emergency Physicians and Nurses Differently Perceive Safety-related Factors? The National ED Safety Study. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.1310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Vogelbaum MA, Berkey B, Peereboom D, Giannini C, Jenkins R, Suh J, Brown P, Blumenthal D, Biggs C, Mehta M. RTOG 0131: Phase II trial of pre-irradiation and concurrent temozolomide in patients with newly diagnosed anaplastic oligodendrogliomas and mixed anaplastic oligodendrogliomas: Relationship between 1p/19q status and progression-free survival. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.1517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1517 Background: In a previous report, we showed in patients with newly diagnosed anaplastic oligodendrogliomas (AOs) and mixed anaplastic oligoastrocytomas (MAOs) that temozolomide (TMZ) can be given concurrently with radiation therapy (RT) with acceptable toxicity. We have now evaluated the efficacy of this regimen and correlated durability of response with tumor 1p/19q genotype. Methods: A phase II study was performed to evaluate the use of pre-RT TMZ followed by concurrent RT and TMZ in patients with newly diagnosed AO or MAO. The primary endpoint was to determine the pre-RT TMZ six-month progression rate, and secondary endpoints included progression-free survival and overall survival. Results: 40 eligible patients were entered into the trial. Thirty-two patients completed 6 months of pre-RT TMZ and concurrent RT and TMZ. Of the remaining eight patients, 4 withdrew due to toxicity and 4 other patients withdrew from study without evidence of toxicity or pre-RT progression. 1p/19q data are available in 37 cases; 23 tumors had loss of heterozygosity (LOH) of both 1p and 19q (double-deleted) while 14 tumors had LOH of either 1p or 19q (n = 3), or no LOH (n = 11). To date, 11 patients have experienced tumor progression; 1p/19q data are available for 10 of these cases (2 are double-deleted (2/23 = 9%), 8 have at least one intact chromosome (8/14 = 57%). Kaplan-Meier analysis demonstrates that progression free survival is significantly better for the double-deleted group (median time to progression not reached) than for the intact group (median time to progression = 15.2 months, p = 0.001). Overall survival is 98% (39/40) with a median follow-up of 17.5 months (2.8 - 31.1 months). Conclusions: LOH of both 1p and 19q is strongly correlated with a durable response of AO and MAO to a combined regimen of chemotherapy and radiation therapy. Tumors that are intact at 1p and/or 19q progress early despite an aggressive therapeutic regimen. These results suggest that future clinical trials should be prospectively stratified by tumor 1p/19q genotype. [Table: see text]
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Affiliation(s)
- M. A. Vogelbaum
- Cleveland Clinic, Cleveland, OH; Radiation Therapy Oncology Group, Philadelphia, PA; Mayo Clinic, Rochester, MN; University of Utah, Salt Lake City, UT; Arizona Oncology Services, Phoneix, AZ; University of Wisconsin, Madison, WI
| | - B. Berkey
- Cleveland Clinic, Cleveland, OH; Radiation Therapy Oncology Group, Philadelphia, PA; Mayo Clinic, Rochester, MN; University of Utah, Salt Lake City, UT; Arizona Oncology Services, Phoneix, AZ; University of Wisconsin, Madison, WI
| | - D. Peereboom
- Cleveland Clinic, Cleveland, OH; Radiation Therapy Oncology Group, Philadelphia, PA; Mayo Clinic, Rochester, MN; University of Utah, Salt Lake City, UT; Arizona Oncology Services, Phoneix, AZ; University of Wisconsin, Madison, WI
| | - C. Giannini
- Cleveland Clinic, Cleveland, OH; Radiation Therapy Oncology Group, Philadelphia, PA; Mayo Clinic, Rochester, MN; University of Utah, Salt Lake City, UT; Arizona Oncology Services, Phoneix, AZ; University of Wisconsin, Madison, WI
| | - R. Jenkins
- Cleveland Clinic, Cleveland, OH; Radiation Therapy Oncology Group, Philadelphia, PA; Mayo Clinic, Rochester, MN; University of Utah, Salt Lake City, UT; Arizona Oncology Services, Phoneix, AZ; University of Wisconsin, Madison, WI
| | - J. Suh
- Cleveland Clinic, Cleveland, OH; Radiation Therapy Oncology Group, Philadelphia, PA; Mayo Clinic, Rochester, MN; University of Utah, Salt Lake City, UT; Arizona Oncology Services, Phoneix, AZ; University of Wisconsin, Madison, WI
| | - P. Brown
- Cleveland Clinic, Cleveland, OH; Radiation Therapy Oncology Group, Philadelphia, PA; Mayo Clinic, Rochester, MN; University of Utah, Salt Lake City, UT; Arizona Oncology Services, Phoneix, AZ; University of Wisconsin, Madison, WI
| | - D. Blumenthal
- Cleveland Clinic, Cleveland, OH; Radiation Therapy Oncology Group, Philadelphia, PA; Mayo Clinic, Rochester, MN; University of Utah, Salt Lake City, UT; Arizona Oncology Services, Phoneix, AZ; University of Wisconsin, Madison, WI
| | - C. Biggs
- Cleveland Clinic, Cleveland, OH; Radiation Therapy Oncology Group, Philadelphia, PA; Mayo Clinic, Rochester, MN; University of Utah, Salt Lake City, UT; Arizona Oncology Services, Phoneix, AZ; University of Wisconsin, Madison, WI
| | - M. Mehta
- Cleveland Clinic, Cleveland, OH; Radiation Therapy Oncology Group, Philadelphia, PA; Mayo Clinic, Rochester, MN; University of Utah, Salt Lake City, UT; Arizona Oncology Services, Phoneix, AZ; University of Wisconsin, Madison, WI
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Vogelbaum MA, Berkey B, Peereboom D, Giannini C, Suh J, Brown P, Blumenthal D, Biggs C, Schultz C, Mehta M. RTOG 0131: Phase II trial of pre-irradiation and concurrent temozolomide in patients with newly diagnosed anaplastic oligodendrogliomas and mixed anaplastic oligodendrogliomas. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.1520] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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)
- M. A. Vogelbaum
- Cleveland Clinic, Cleveland, OH; Radiation Therapy Oncology Group, Philadelphia, PA; Mayo Clinic, Rochester, MN; Univ of Utah, Salt Lake City, UT; Arizona Oncology Services, Phoenix, AZ; Medcl Coll of Wisconsin, Milwaukee, WI; Univ of Wisconsin, Madison, WI
| | - B. Berkey
- Cleveland Clinic, Cleveland, OH; Radiation Therapy Oncology Group, Philadelphia, PA; Mayo Clinic, Rochester, MN; Univ of Utah, Salt Lake City, UT; Arizona Oncology Services, Phoenix, AZ; Medcl Coll of Wisconsin, Milwaukee, WI; Univ of Wisconsin, Madison, WI
| | - D. Peereboom
- Cleveland Clinic, Cleveland, OH; Radiation Therapy Oncology Group, Philadelphia, PA; Mayo Clinic, Rochester, MN; Univ of Utah, Salt Lake City, UT; Arizona Oncology Services, Phoenix, AZ; Medcl Coll of Wisconsin, Milwaukee, WI; Univ of Wisconsin, Madison, WI
| | - C. Giannini
- Cleveland Clinic, Cleveland, OH; Radiation Therapy Oncology Group, Philadelphia, PA; Mayo Clinic, Rochester, MN; Univ of Utah, Salt Lake City, UT; Arizona Oncology Services, Phoenix, AZ; Medcl Coll of Wisconsin, Milwaukee, WI; Univ of Wisconsin, Madison, WI
| | - J. Suh
- Cleveland Clinic, Cleveland, OH; Radiation Therapy Oncology Group, Philadelphia, PA; Mayo Clinic, Rochester, MN; Univ of Utah, Salt Lake City, UT; Arizona Oncology Services, Phoenix, AZ; Medcl Coll of Wisconsin, Milwaukee, WI; Univ of Wisconsin, Madison, WI
| | - P. Brown
- Cleveland Clinic, Cleveland, OH; Radiation Therapy Oncology Group, Philadelphia, PA; Mayo Clinic, Rochester, MN; Univ of Utah, Salt Lake City, UT; Arizona Oncology Services, Phoenix, AZ; Medcl Coll of Wisconsin, Milwaukee, WI; Univ of Wisconsin, Madison, WI
| | - D. Blumenthal
- Cleveland Clinic, Cleveland, OH; Radiation Therapy Oncology Group, Philadelphia, PA; Mayo Clinic, Rochester, MN; Univ of Utah, Salt Lake City, UT; Arizona Oncology Services, Phoenix, AZ; Medcl Coll of Wisconsin, Milwaukee, WI; Univ of Wisconsin, Madison, WI
| | - C. Biggs
- Cleveland Clinic, Cleveland, OH; Radiation Therapy Oncology Group, Philadelphia, PA; Mayo Clinic, Rochester, MN; Univ of Utah, Salt Lake City, UT; Arizona Oncology Services, Phoenix, AZ; Medcl Coll of Wisconsin, Milwaukee, WI; Univ of Wisconsin, Madison, WI
| | - C. Schultz
- Cleveland Clinic, Cleveland, OH; Radiation Therapy Oncology Group, Philadelphia, PA; Mayo Clinic, Rochester, MN; Univ of Utah, Salt Lake City, UT; Arizona Oncology Services, Phoenix, AZ; Medcl Coll of Wisconsin, Milwaukee, WI; Univ of Wisconsin, Madison, WI
| | - M. Mehta
- Cleveland Clinic, Cleveland, OH; Radiation Therapy Oncology Group, Philadelphia, PA; Mayo Clinic, Rochester, MN; Univ of Utah, Salt Lake City, UT; Arizona Oncology Services, Phoenix, AZ; Medcl Coll of Wisconsin, Milwaukee, WI; Univ of Wisconsin, Madison, WI
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Dalmau J, Graus F, Villarejo A, Posner JB, Blumenthal D, Thiessen B, Saiz A, Meneses P, Rosenfeld MR. Clinical analysis of anti-Ma2-associated encephalitis. ACTA ACUST UNITED AC 2004; 127:1831-44. [PMID: 15215214 DOI: 10.1093/brain/awh203] [Citation(s) in RCA: 419] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Increasing experience indicates that anti-Ma2-associated encephalitis differs from classical paraneoplastic limbic or brainstem encephalitis, and therefore may be unrecognized. To facilitate its diagnosis we report a comprehensive clinical analysis of 38 patients with anti-Ma2 encephalitis. Thirty-four (89%) patients presented with isolated or combined limbic, diencephalic or brainstem dysfunction, and four with other syndromes. Considering the clinical and MRI follow-up, 95% of the patients developed limbic, diencephalic or brainstem encephalopathy. Only 26% had classical limbic encephalitis. Excessive daytime sleepiness affected 32% of the patients, sometimes with narcolepsy-cataplexy and low CSF hypocretin. Additional hormonal or MRI abnormalities indicated diencephalic-hypothalamic involvement in 34% of the patients. Eye movement abnormalities were prominent in 92% of the patients with brainstem dysfunction, but those with additional limbic or diencephalic deficits were most affected; 60% of these patients had vertical gaze paresis that sometimes evolved to total external ophthalmoplegia. Three patients developed atypical parkinsonism, and two a severe hypokinetic syndrome with a tendency to eye closure and dramatic reduction of verbal output. Neurological symptoms preceded the tumour diagnosis in 62% of the patients. Brain MRI abnormalities were present in 74% of all patients and 89% of those with limbic or diencephalic dysfunction. Among the 34 patients with cancer, 53% had testicular germ-cell tumours. Two patients without evidence of cancer had testicular microcalcification and one cryptorchidism, risk factors for testicular germ-cell tumours. After neurological syndrome development, 17 of 33 patients received oncological treatment (nine also immunotherapy), 10 immunotherapy alone, and six no treatment. Overall, 33% of the patients had neurological improvement, three with complete recovery; 21% had long-term stabilization, and 46% deteriorated. Features significantly associated with improvement or stabilization included, male gender, age <45 years, testicular tumour with complete response to treatment, absence of anti-Ma1 antibodies and limited CNS involvement. Immunosuppression was not found to be associated with improvement but was clearly effective in some patients. Fifteen patients (10 women, five men) had additional antibodies to Ma1. These patients were more likely to have tumours other than testicular cancer and to develop ataxia, and had a worse prognosis than patients with only anti-Ma2 antibodies (two women, 21 men); 67% of deceased patients had anti-Ma1 antibodies. Anti-Ma2 encephalitis (with or without anti-Ma1 antibodies) should be suspected in patients with limbic, diencephalic or brainstem dysfunction, MRI abnormalities in these regions, and inflammatory changes in the CSF. In young male patients, the primary tumour is usually in the testis, in other patients the leading neoplasm is lung cancer.
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Affiliation(s)
- Josep Dalmau
- Department of Neurology, 3 W. Gates, Division of Neuro-oncology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Ferri T, Chang Y, Blumenthal D, Pearson S. Leaving gatekeeping behind—effects of opening access to specialists for adults in a health maintenance organization. Am J Ophthalmol 2002. [DOI: 10.1016/s0002-9394(01)01384-8] [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] [Indexed: 10/18/2022]
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Weingarten MA, Yaphe J, Blumenthal D, Oren M, Margalit A. A comparison of videotape and audiotape assessment of patient-centredness in family physicians' consultations. Patient Educ Couns 2001; 45:107-110. [PMID: 11687323 DOI: 10.1016/s0738-3991(00)00199-3] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The aim of this study was to compare videotape and audiotape assessments of doctors' patient-centred behaviour in primary care consultations. The patient-centredness scale of Henbest and Stewart was used to measure the quality of 856 doctor-patient interactions in 258 consultations performed by 47 primary care physicians recorded on videotape. Assessments were performed once using only the sound track and a second time using both the sound and video-tracks. On a nominal quality scale of 0-3, the average score for all consultations was 1.94 (S.D. 0.63) by audio assessment, and 1.94 (S.D. 0.59) by video assessment (P<0.8). There was excellent agreement between audio and video scores over a wide range of scores. Little information (<5%) was lost when using audiotape compared to videotape. It was technically easier to assess the video recordings. Audio recording is equivalent to video recording for the assessment of patient-centredness using the scale of Henbest and Stewart in primary care consultations.
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Affiliation(s)
- M A Weingarten
- Department of Family Medicine, Rabin Medical Centre and Sackler Faculty of Medicine, Tel-Aviv, Israel.
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Blumenthal D. Leaders need followers to improve quality of care. Health Aff (Millwood) 2001; 20:311-2. [PMID: 11816679 DOI: 10.1377/hlthaff.20.6.311] [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] [Indexed: 11/05/2022]
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Abstract
BACKGROUND Gatekeeping refers to the prior approval of referrals to specialists by a primary care physician. Although many health plans view gatekeeping as an essential tool for controlling costs and coordinating care, many patients and physicians object to it. METHODS On April 1, 1998, Harvard Vanguard Medical Associates, a large, multispecialty, capitated group practice previously known as Harvard Community Health Plan, eliminated a gatekeeping system that had been in place for over 25 years. We determined the effects of opening access to specialists on visits to primary care physicians and specialists by adults. In randomly selected cohorts of 10,000 members each, we analyzed visits during 6-month periods for the 3 years before and 18 months after gatekeeping was eliminated. RESULTS Adults visited a primary care physician an average of 1.21 times and 1.19 times per six-month period before and after the elimination of gatekeeping, respectively (P=0.05); the average number of visits to a specialist was 0.78 per six-month period both before and after its elimination (P=0.35). There was little change in the percentage of visits to specialists included in the analysis as a proportion of all visits (39.1 percent before the elimination of gatekeeping and 39.5 percent afterward). The percentage of first visits to specialists as a proportion of all visits to specialists included in the analysis increased from 24.7 to 28.2 percent (P<0.001). There were small increases in the numbers of visits to orthopedists and physical or occupational therapists. The proportion of visits to specialists for low back pain that were new consultations increased from 26.6 to 32.9 percent (P=0.01). CONCLUSIONS In a capitated, multispecialty group practice, we found little evidence of substantial changes in the use of specialty services by adults in the first 18 months after the elimination of gatekeeping.
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Affiliation(s)
- T G Ferris
- Institute for Health Policy, Division of General Internal Medicine, Massachusetts General Hospital-Partners Health Care System and Harvard Medical School, Boston, USA
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Campbell EG, Weissman JS, Causino N, Blumenthal D. Market competition and patient-oriented research: the results of a national survey of medical school faculty. Acad Med 2001; 76:1119-1126. [PMID: 11704515 DOI: 10.1097/00001888-200111000-00016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE To understand the effect of market competition on patient-oriented research at U.S. medical schools and teaching hospitals. METHOD From a multi-stage stratified, random sample, the authors surveyed 3,804 research faculty at 117 U.S. medical schools. The questionnaire assessed five variables, the type of research conducted by the respondent, changes in patient-oriented and non-clinical research in the preceding three years, amount of time spent on patient care, market stage of the respondent's institution, and research productivity. RESULTS Of the 2,336 faculty who responded (62%), 84% of those conducting patient-oriented research and 80% of those engaged in non-clinical research reported conducting the same amount of research or more in 1996-1997 than in the preceding three years. However, both patient-oriented and non-clinical researchers in the most competitive health care markets and those with high levels of patient care duties were most likely to report decreases in the amounts of such research conducted in the previous three years. Further, researchers reporting such decreases had been as productive in recent years and over their careers as had those who did not report a decrease. CONCLUSIONS This study provides additional evidence of the negative relationships that exist between high levels of market competition and patient care services on the patient-oriented and non-clinical research missions of teaching hospitals.
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Affiliation(s)
- E G Campbell
- Institute for Health Care Policy, Boston, MA 02114, USA
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Blumenthal D. Lee County, Ark.: building a base for reform. South Expos 2001; 6:83-9. [PMID: 11633234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Amiel A, Elis A, Blumenthal D, Gaber E, Fejgin MD, Dubinsky R, Lishner M. Modified order of allelic replication in lymphoma patients at different disease stages. ACTA ACUST UNITED AC 2001; 125:156-60. [PMID: 11369060 DOI: 10.1016/s0165-4608(00)00381-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Asynchronous replication of homologous loci was reported in lymphocytes of patients with lymphoma, ovarian and renal cancer as well as in lymphocytes of patients with premalignant conditions, for example, essential mixed cryoglobulinemia associated with hepatitis C virus and in monoclonal gammopathy of unknown significance. In the present study we evaluated the replication pattern in lymphocytes of four groups of patients with intermediate grade of non-Hodgkin lymphoma at various stages of their disease: 1) at diagnosis; 2) during cytotoxic treatment; 3) in remission; and 4) in relapse. A significantly higher proportion of the asynchronous pattern of replication at diagnosis, during cytotoxic treatment, and in relapse was noted as compared to healthy controls and to patients who achieved remission of their lymphoma. Also, the frequency of the two doublets (DD) pattern in every group studied was significantly lower than in the controls. If our findings can be confirmed in larger, long-term prospective studies, it may allow the use of a simple and inexpensive tool to closely observe patients with lymphoma who are at high risk for relapse.
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Affiliation(s)
- A Amiel
- Genetic Institute and Department of Medicine and Hematology, Meir Hospital, Sapir Medical Center, Kfar-Saba, Israel.
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Abstract
CONTEXT Medical educators are seeking improved measures to assess the clinical competency of residents as they complete their graduate medical education. OBJECTIVE To assess residents' perceptions of their preparedness to provide common clinical services during their last year of graduate medical education. DESIGN, SETTING, AND PARTICIPANTS A 1998 national survey of residents completing their training in 8 specialties (internal medicine, pediatrics, family practice, obstetrics/gynecology, general surgery, orthopedic surgery, psychiatry, and anesthesiology) at academic health centers in the United States. A total of 2626 residents responded (response rate, 65%). MAIN OUTCOME MEASURES Residents' reports of their preparedness to perform clinical and nonclinical tasks relevant to their specialties. RESULTS Residents in all specialties rated themselves as prepared to manage most of the common conditions they would encounter in their clinical career. However, more than 10% of residents in each specialty reported that they felt unprepared to undertake 1 or more tasks relevant to their disciplines, such as caring for patients with human immunodeficiency virus/acquired immunodeficiency syndrome or substance abuse (family practice) or nursing home patients (internal medicine); performance of spinal surgery (orthopedic surgery) or abdominal aortic aneurysm repair (general surgery); and management of chronic pain (anesthesiology). CONCLUSIONS Overall, residents in their last year of training at academic health centers rate their clinical preparedness as high. However, opportunities for improvement exist in preparing residents for clinical practice.
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Affiliation(s)
- D Blumenthal
- Institute for Health Policy, Massachusetts General Hospital, 50 Staniford St, 9th Floor, Suite 901, Boston, MA 02114, USA.
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Affiliation(s)
- D Blumenthal
- Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
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Abstract
Access to care by low-income persons and residents of rural and poor inner-city areas is a persistent problem, yet physicians tend to be maldistributed relative to need. The objectives were to describe preferences of resident physicians to locate in underserved areas and to assess their preparedness to provide service to low-income populations. A national survey was made of residents completing their training in eight specialties at 162 US academic health center hospitals in 1998, with 2,626 residents responding. (Of 4,832 sampled, 813 had invalid addresses or were no longer in the residency program. Among the valid sample of 4,019, the response rate was 65%.) The percentage of residents ranking public hospitals, rural areas, and poor inner-city areas as desirable employment locations and the percentage feeling prepared to provide specified services associated with indigent populations were ascertained. Logistic regressions were used to calculate adjusted percentages, controlling for sex, race/ethnicity, international medical graduate (IMG) status, plans to subspecialize, ownership of hospital, specialty, and exposure to underserved patients during residency. Only one third of residents rated public hospitals as desirable settings, although there were large variations by specialty. Desirability was not associated with having trained in a public hospital or having greater exposure to underserved populations. Only about one quarter of respondents ranked rural (26%) or poor inner-city (25%) areas as desirable. Men (29%, P <.01) and noncitizen IMGs (43%, P <.01) were more likely than others to prefer rural settings. Residents who were more likely to rate poor inner-city settings as desirable included women (28%, P =.03), noncitizen IMGs (35%, P =.01), and especially underrepresented minorities (52%, P <.01). Whereas about 90% or more of residents felt prepared to treat common clinical conditions, only 67% of residents in four primary care specialties felt prepared to counsel patients about domestic violence or to care for human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) or substance abuse patients (all 67%). Women were more likely than men to feel prepared to counsel patients about domestic violence (70% vs. 63%, P =.002) and depression (83% vs. 75%, P <.01). Underrepresented minority residents were more likely than other residents to feel prepared to counsel patients about domestic violence (P <.01) and compliance with care (P =.04). Residents with greater exposure to underserved groups were more prepared to counsel patients about domestic violence (P =.01), substance abuse (P =.01), and to treat patients with HIV/AIDS (P =.01) or with substance abuse problems (P <.01). This study demonstrates the need to expose graduate trainees to underserved populations and suggests a continuing role of minorities, women, and noncitizen physicians in caring for low-income populations.
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Affiliation(s)
- J S Weissman
- The Department of Medicine, Harvard Medical School, Boston, MA 02114, USA.
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