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Vo K, Ladbury C, Yoon S, Bazan J, Glaser S, Amini A. Omission of adjuvant radiotherapy in low-risk elderly males with breast cancer. Breast Cancer 2024; 31:485-495. [PMID: 38507145 PMCID: PMC11045584 DOI: 10.1007/s12282-024-01560-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/26/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE Randomized clinical trials demonstrate that lumpectomy + hormone therapy (HT) without radiation therapy (RT) yields equivalent survival and acceptable local-regional outcomes in elderly women with early-stage, node-negative, hormone-receptor positive (HR +) breast cancer. Whether these data apply to men with the same inclusion criteria remains unknown. METHODS The National Cancer Database was queried for male patients ≥ 65 years with pathologic T1-2N0 (≤ 3 cm) HR + breast cancer treated with breast-conserving surgery with negative margins from 2004 to 2019. Adjuvant treatment was classified as HT alone, RT alone, or HT + RT. Male patients were matched with female patients for OS comparison. Survival analysis was performed using Cox regression and Kaplan - Meier method. Inverse probability of treatment weighting (IPTW) was applied to adjust for confounding. RESULTS A total of 523 patients met the inclusion criteria, with 24.4% receiving HT, 16.3% receiving RT, and 59.2% receiving HT + RT. The median follow-up was 6.9 years (IQR: 5.0-9.4 years). IPTW-adjusted 5-yr OS rates in the HT, RT, and HT + RT cohorts were 84.0% (95% CI 77.1-91.5%), 81.1% (95% CI 71.1-92.5%), and 93.0% (95% CI 90.0-96.2%), respectively. On IPTW-adjusted MVA, relative to HT, receipt of HT + RT was associated with improvements in OS (HR: 0.641; p = 0.042). RT alone was not associated with improved OS (HR: 1.264; p = 0.420). CONCLUSION Among men ≥ 65 years old with T1-2N0 HR + breast cancer, RT alone did not confer an OS benefit over HT alone. Combination of RT + HT demonstrated significant improvements in OS. De-escalation of treatment through omission of either RT or HT at this point should be done with caution.
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Affiliation(s)
- Kim Vo
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, 309 E 2 ndSt, Pomona, CA, 91766, USA
| | - Colton Ladbury
- Department of Radiation Oncology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA.
| | - Stephanie Yoon
- Department of Radiation Oncology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Jose Bazan
- Department of Radiation Oncology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Scott Glaser
- Department of Radiation Oncology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Arya Amini
- Department of Radiation Oncology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA
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Williams TM, Miller E, Welliver M, Brownstein J, Otterson G, Owen D, Haglund K, Shields P, Bertino E, Presley C, He K, Jacob NK, Walston S, Pan J, Yang X, Knopp M, Essan JK, McElroy J, Mo X, McElroy S, Carbone D, Bazan J. A Phase 2 Trial of Primary Tumor Stereotactic Body Radiation Therapy Boost Before Concurrent Chemoradiation for Locally Advanced Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00324-9. [PMID: 38387808 DOI: 10.1016/j.ijrobp.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 01/30/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024]
Abstract
PURPOSE Primary tumor failure is common in patients treated with chemoradiation (CRT) for locally advanced NSCLC (LA-NSCLC). Stereotactic body radiation therapy (SBRT) yields high rates of primary tumor control (PTC) in early-stage NSCLC. This trial tested an SBRT boost to the primary tumor before the start of CRT to improve PTC. METHODS AND MATERIALS Patients with LA-NSCLC received an SBRT boost in 2 fractions (central location 12 Gy, peripheral location 16 Gy) to the primary tumor, followed by standard CRT (60 Gy in 30 fractions). The primary objective was PTC rate at 1 year, and the hypothesis was that the 1-year PTC rate would be ≥90%. Secondary objectives included objective response rate, regional and distant control, disease-free survival (DFS), and overall survival (OS). Correlative studies included functional magnetic resonance imaging and blood-based miRNA analysis. RESULTS The study enrolled 21 patients (10 men and 11 women); the median age was 62 years (range, 52-78). The median pretreatment primary tumor size was 5.0 cm (range, 1.0-8.3). The most common nonhematologic toxicities were pneumonitis, fatigue, esophagitis/dysphagia, dyspnea, and cough. Only 1 treatment-related grade 4 nonhematologic toxicity occurred (respiratory failure/radiation pneumonitis), and no grade 5 toxicities occurred. The objective response rate at 3 and 6 months was 72.7% and 80.0%, respectively, and PTC at 1 and 2 years was 100% and 92.3%, respectively. The 2-year regional and distant control rates were 81.6% and 70.3%, respectively. Disease-free survival and overall survival at 2 years were 46.1% and 50.3%, respectively, and median survival was 37.8 months. Functional magnetic resonance imaging detected a mean relative decrease in blood oxygenation level-dependent signal of -87.1% (P = .05), and miR.142.3p was correlated with increased risk of grade ≥3 pulmonary toxicity (P = .01). CONCLUSIONS Dose escalation to the primary tumor using upfront SBRT appears feasible and safe. PTC was high and other oncologic endpoints compared favorably to standard treatment. Functional magnetic resonance imaging suggested changes in oxygenation with the first SBRT boost dose, and miR.142.3p was correlated with pulmonary toxicity.
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Affiliation(s)
- Terence M Williams
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California.
| | - Eric Miller
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - Meng Welliver
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - Jeremy Brownstein
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - Gregory Otterson
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - Dwight Owen
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - Karl Haglund
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - Peter Shields
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - Erin Bertino
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - Carolyn Presley
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - Kai He
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - Naduparambil K Jacob
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - Steve Walston
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - Jeff Pan
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Xiangyu Yang
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Michael Knopp
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jean Koutou Essan
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - Joseph McElroy
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Xiaokui Mo
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Sohyun McElroy
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - David Carbone
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - Jose Bazan
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
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Ringwald B, Shawar S, Curren C, McCallister J, Bazan J, Mead C, Kman N. Electronic Health Record-based COVID-19 Interprofessional Case Collaboration. West J Emerg Med 2022; 23:789-791. [PMID: 36205668 PMCID: PMC9541986 DOI: 10.5811/westjem.22.2.53886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 02/16/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Bryce Ringwald
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Suhair Shawar
- The Ohio State University College of Medicine, Department of Internal Medicine, Columbus, Ohio
| | - Camilla Curren
- The Ohio State University College of Medicine, Department of Pharmacy, Columbus, Ohio
| | - Jennifer McCallister
- The Ohio State University College of Medicine, Department of Pharmacy, Columbus, Ohio
| | - Jose Bazan
- The Ohio State University College of Medicine, Department of Pharmacy, Columbus, Ohio
| | - Christopher Mead
- The Ohio State University College of Medicine, Department of Rehabilitation Sciences, Columbus, Ohio
| | - Nicholas Kman
- The Ohio State University College of Medicine, Department of Emergency Medicine, Columbus, Ohio
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Welliver M, Goyal A, Mo X, Dick S, Ma G, Bazan J, Brownstein J, Haglund K, Willimas T, DiCostanzo D, Grecula J, Addison D, Miller E. EP05.01-021 Radiation Dose to Cardiac Substructures and the Incidence of Cardiac Events in Patients with Stage III NSCLC Receiving CCRT. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.468] [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: 10/14/2022]
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Palmer JD, Prasad RN, Fabian D, Wei L, Yildiz VO, Tan Y, Grecula J, Welliver M, Williams T, Elder JB, Raval R, Blakaj D, Haglund K, Bazan J, Kendra K, Arnett A, Beyer S, Liebner D, Giglio P, Puduvalli V, Chakravarti A, Wuthrick E. Phase I study of trametinib in combination with whole brain radiation therapy for brain metastases. Radiother Oncol 2022; 170:21-26. [DOI: 10.1016/j.radonc.2022.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/15/2022] [Accepted: 03/25/2022] [Indexed: 11/25/2022]
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Beyer S, Smith T, Sekhon A, Bazan J, Jhawar S, Healy E, Wei L, Yildiz V, Mohamed M, Knopp M, White J. Abstract P3-19-03: Preliminary results of a feasibility study assessing radiation response with MRI/CT directed preoperative accelerated partial breast irradiation in the prone position for hormone responsive early stage breast cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p3-19-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: Accelerated partial breast irradiation (APBI) has emerged as an alternative to whole breast irradiation (WBI) following lumpectomy for select patients. However, the challenges to post-operative APBI include targeting inaccuracy and the inability to measure tumor response to radiation. We hypothesized that preoperative APBI (pAPBI) could reliably target the tumor using MRI-guidance that is acquired prone in combination with our established prone breast radiation delivery. We developed methodology for prone CT simulation to establish radiation position, MRI acquisition in treatment position, registration of MRI-CT data for treatment planning, and treatment delivery with daily cone-beam CT using the same immobilization platform. This study aimed to assess the reproducibility, toxicity and local control associated with MRI/CT-directed prone pAPBI. METHODS: This was a prospective, single arm study enrolling patients >50 yo with clinical (c) Stage IA ER+/PR+/HER2- breast cancer intending lumpectomy. Axillary US and MRI imaging to confirm clinical node negative disease was required. A planning CT in the prone position was followed by MRI using the same prone immobilization platform. Rigid registration of MRI-CT data was used for radiation planning. pAPBI of 3850 cGy was delivered in 10 fractions BID with the same prone immobilization technique. Another MRI was obtained 4 weeks post-APBI to assess tumor response. The intensity, kinetics and volume of the lesion on MRI was quantitatively assessed and an experienced reader evaluated MRI volume and kinetic changes in the tumor post-APBI. Lumpectomy was performed 4-6 weeks after APBI. Simon 2 stage design required assessment after accrual of 19 patients for assessment of feasibility. RESULTS: Nineteen cStage IA ER+/PR+/HER2- breast cancer patients with a median age of 65 (range 51-78) were enrolled on the study, completed APBI, lumpectomy, and adjuvant AI. Median follow up was 3.4 years. Mean clinical tumor size was 1.1 cm ± 0.4 and mean path tumor size was 0.94 cm ± 0.6. There was complete pathologic response in 10.5% (n=2) and an additional 36.8% (n=7) were downstaged from clinical stage (measured by mammogram/US) to pathologic stage, resulting in a total response of 47.4% (n=9). Six (31.6%) patients had stable disease after APBI. Four (21.0%) were upstaged from clinical stage to pathological stage. Tumor response detected by MRI significantly correlated with tumor response based on clinical to pathologic stage (p=0.03). Cosmesis was rated as excellent/good in 89.5% (n=17) patients post-APBI. Cosmesis worsened to fair in 2 patients post-APBI, one of which required adjuvant WBI after focal triple negative breast cancer was detected on pathology. Three patients had positive macrometastatic lymph nodes on final pathology despite clinically negative nodes on imaging. One in-breast recurrence outside the RT field was detected by MRI at 14 months, resulting in a locoregional recurrence rate of 5.4% at 3.4 years. Another patient developed metastases at 20 months. CONCLUSIONS: Using the same prone platform, all patients successfully underwent CT simulation, MRI acquisition, and completed pAPBI. Nearly half of enrolled patients had a measurable tumor response to pAPBI based on MRI and pathologic response, confirming the accuracy and reproducibility of defining tumor targets with our MRI/CT-directed pAPBI approach. While this methodology for prone pAPBI resulted in good cosmesis and local control and remains a promising approach for select patients, the challenge of excluding patients with subclinical lymph node positive disease remains. Correlative studies will determine whether Ki-67 and OncotypeDx pre- and post-APBI can help predict response to pAPBI.
Citation Format: Sasha Beyer, Tamara Smith, Ashley Sekhon, Jose Bazan, Sachin Jhawar, Erin Healy, Lai Wei, Vedat Yildiz, Mohamed Mohamed, Michael Knopp, Julia White. Preliminary results of a feasibility study assessing radiation response with MRI/CT directed preoperative accelerated partial breast irradiation in the prone position for hormone responsive early stage breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-19-03.
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Affiliation(s)
- Sasha Beyer
- Stefanie Spielman Comprehensive Breast Center at The Ohio State University, Columbus, OH
| | - Tamara Smith
- Stefanie Spielman Comprehensive Breast Center at The Ohio State University, Columbus, OH
| | - Ashley Sekhon
- Stefanie Spielman Comprehensive Breast Center at The Ohio State University, Columbus, OH
| | - Jose Bazan
- Stefanie Spielman Comprehensive Breast Center at The Ohio State University, Columbus, OH
| | - Sachin Jhawar
- Stefanie Spielman Comprehensive Breast Center at The Ohio State University, Columbus, OH
| | - Erin Healy
- Stefanie Spielman Comprehensive Breast Center at The Ohio State University, Columbus, OH
| | - Lai Wei
- Center for Biostatistics at The Ohio State University, Columbus, OH
| | - Vedat Yildiz
- Center for Biostatistics at The Ohio State University, Columbus, OH
| | - Mohamed Mohamed
- Department of Radiology at The Ohio State University, Columbus, OH
| | - Michael Knopp
- Department of Radiology at The Ohio State University, Columbus, OH
| | - Julia White
- Stefanie Spielman Comprehensive Breast Center at The Ohio State University, Columbus, OH
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Skinner H, Hu C, Tsakiridis T, Santana-Davila R, Lu B, Erasmus JJ, Doemer AJ, Videtic GMM, Coster J, Yang AX, Lee RY, Werner-Wasik M, Schaner PE, McCormack SE, Esparaz BT, McGarry RC, Bazan J, Struve T, Paulus R, Bradley JD. Addition of Metformin to Concurrent Chemoradiation in Patients With Locally Advanced Non-Small Cell Lung Cancer: The NRG-LU001 Phase 2 Randomized Clinical Trial. JAMA Oncol 2021; 7:1324-1332. [PMID: 34323922 DOI: 10.1001/jamaoncol.2021.2318] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Non-small cell lung cancer (NSCLC) has relatively poor outcomes. Metformin has significant data supporting its use as an antineoplastic agent. Objective To compare chemoradiation alone vs chemoradiation and metformin in stage III NSCLC. Design, Setting, and Participants The NRG-LU001 randomized clinical trial was an open-label, phase 2 study conducted from August 24, 2014, to December 15, 2016. Patients without diabetes who were diagnosed with unresectable stage III NSCLC were stratified by performance status, histology, and stage. The setting was international and multi-institutional. This study examined prespecified endpoints, and data were analyzed on an intent-to-treat basis. Data were analyzed from February 25, 2019, to March 6, 2020. Interventions Chemoradiation and consolidation chemotherapy with or without metformin. Main Outcomes and Measures The primary outcome was 1-year progression-free survival (PFS), designed to detect 15% improvement in 1-year PFS from 50% to 65% (hazard ratio [HR], 0.622). Secondary end points included overall survival, time to local-regional recurrence, time to distant metastasis, and toxicity per Common Terminology Criteria for Adverse Events, version 4.03. Results A total of 170 patients were enrolled, with 167 eligible patients analyzed after exclusions (median age, 64 years [interquartile range, 58-72 years]; 97 men [58.1%]; 137 White patients [82.0%]), with 81 in the control group and 86 in the metformin group. Median follow-up was 27.7 months (range, 0.03-47.21 months) among living patients. One-year PFS rates were 60.4% (95% CI, 48.5%-70.4%) in the control group and 51.3% (95% CI, 39.8%-61.7%) in the metformin group (HR, 1.15; 95% CI, 0.77-1.73; P = .24). Clinical stage was the only factor significantly associated with PFS on multivariable analysis (HR, 1.79; 95% CI, 1.19-2.69; P = .005). One-year overall survival was 80.2% (95% CI, 69.3%-87.6%) in the control group and 80.8% (95% CI, 70.2%-87.9%) in the metformin group. There were no significant differences in local-regional recurrence or distant metastasis at 1 or 2 years. No significant difference in adverse events was observed between treatment groups. Conclusions and Relevance In this randomized clinical trial, the addition of metformin to concurrent chemoradiation was well tolerated but did not improve survival among patients with unresectable stage III NSCLC. Trial Registration ClinicalTrials.gov Identifier: NCT02186847.
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Affiliation(s)
- Heath Skinner
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Chen Hu
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania.,Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | | | - Bo Lu
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | | | | | | | | | | | | | | | - Steven E McCormack
- Metro-Minnesota Community Oncology Research Consortium, St Louis Park, Minnesota
| | | | | | - Jose Bazan
- Ohio State University Comprehensive Cancer Center, Columbus
| | - Timothy Struve
- University of Cincinnati/Barrett Cancer Center, Cincinnati, Ohio
| | - Rebecca Paulus
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
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Chmura S, Winter KA, Robinson C, Pisansky TM, Borges V, Al-Hallaq H, Matuszak M, Park SS, Yi S, Hasan Y, Bazan J, Wong P, Yoon HA, Horton J, Gan G, Milano MT, Sigurdson ER, Moughan J, Salama JK, White J. Evaluation of Safety of Stereotactic Body Radiotherapy for the Treatment of Patients With Multiple Metastases: Findings From the NRG-BR001 Phase 1 Trial. JAMA Oncol 2021; 7:845-852. [PMID: 33885704 PMCID: PMC8063134 DOI: 10.1001/jamaoncol.2021.0687] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Stereotactic body radiotherapy (SBRT) for oligometastases is hypothesized to improve survival and is increasingly used. Little evidence supports its safe use to treat patients with multiple metastases. OBJECTIVE To establish safety of SBRT dose schedules in patients with 3 to 4 metastases or 2 metastases in close proximity to each other. DESIGN, SETTING, AND PARTICIPANTS This phase 1 trial opened on August 4, 2014, and closed to accrual on March 20, 2018. Metastases to 7 anatomic locations were included: bone/osseous (BO), spinal/paraspinal (SP), peripheral lung (PL), central lung (CL), abdominal-pelvic (AP), mediastinal/cervical lymph node (MC), and liver (L). Six patients could be enrolled per anatomic site. The setting was a consortium of North American academic and community practice cancer centers participating in NRG Oncology trials. Patients with breast, prostate, or non-small cell lung cancer with 3 to 4 metastases or 2 metastases in close proximity (≤5 cm) amenable to SBRT were eligible for this phase 1 study. Statistical analyses were performed from December 31, 2017, to September 19, 2019. INTERVENTIONS The starting dose was 50 Gy in 5 fractions (CL, MC), 45 Gy in 3 fractions (PL, AP, L), and 30 Gy in 3 fractions (BO, SP). MAIN OUTCOMES AND MEASURES The primary end point was dose-limiting toxicity (DLT) defined by the Common Terminology Criteria for Adverse Events, version 4.0, as specific adverse events (AEs) of grades 3 to 5 (definite or probable per the protocol DLT definition) related to SBRT within 180 days of treatment. Dose levels were considered safe if DLTs were observed in no more than 1 of 6 patients per location; otherwise, the dose at that location would be de-escalated. RESULTS A total of 42 patients enrolled, 39 were eligible, and 35 (mean [SD] age, 63.1 [14.2] years; 20 men [57.1%]; 30 White patients [85.7%]) were evaluable for DLT. Twelve patients (34.3%) had breast cancer, 10 (28.6%) had non-small cell lung cancer, and 13 (37.1%) had prostate cancer; there was a median of 3 metastases treated per patient. Median survival was not reached. No protocol-defined DLTs were observed. When examining all AEs, 8 instances of grade 3 AEs, most likely related to protocol therapy, occurred approximately 125 to 556 days from SBRT initiation in 7 patients. CONCLUSIONS AND RELEVANCE This phase 1 trial demonstrated the safety of SBRT for patients with 3 to 4 metastases or 2 metastases in close proximity. There were no treatment-related deaths. Late grade 3 AEs demonstrate the need for extended follow-up in long-surviving patients with oligometastatic disease. Treatment with SBRT for multiple metastases has been expanded into multiple ongoing randomized phase 2/3 National Cancer Institute-sponsored trials (NRG-BR002, NRG-LU002). TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02206334.
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Affiliation(s)
- Steve Chmura
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
| | - Kathryn A Winter
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University in St Louis, St Louis, Missouri
| | - Thomas M Pisansky
- Department of Medicine-Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Hania Al-Hallaq
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
| | - Martha Matuszak
- Department of Radiation Oncology, University of Michigan, Ann Arbor
| | - Sean S Park
- Department of Medicine-Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Sun Yi
- Department of Radiation Oncology, University of Arizona Medical Center - University Campus, Tucson
| | - Yasmin Hasan
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
| | - Jose Bazan
- Ohio State University Comprehensive Cancer Center, Columbus
| | - Philip Wong
- Centre Hospitalier de L'Universite de Montréal, Hotel Dieu de Montréal, Montréal, Quebec, Canada
| | - Harold A Yoon
- Heartland Cancer Research National Cancer Institute Community Oncology Research Program, Decatur, Illinois
| | - Janet Horton
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Gregory Gan
- New Mexico Minority Underserved National Cancer Institute Community Oncology Research Program, Albuquerque
| | - Michael T Milano
- Department of Radiation Oncology, University of Rochester, Rochester, New York
| | | | - Jennifer Moughan
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | - Joseph K Salama
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Julia White
- Ohio State University Comprehensive Cancer Center, Columbus
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Miller E, Nalin A, Diaz Pardo D, Arnett A, Abushahin L, Husain S, Jin N, Williams T, Bazan J. Stage I Squamous Cell Carcinoma of the Anus: Is Radiation Therapy Alone Sufficient Treatment? Cancers (Basel) 2020; 12:cancers12113248. [PMID: 33158062 PMCID: PMC7694229 DOI: 10.3390/cancers12113248] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/28/2020] [Accepted: 11/02/2020] [Indexed: 12/30/2022] Open
Abstract
Simple Summary The optimal treatment of early stage anal cancer is unknown. This patient population was relatively under-represented on the trials, which defined radiation therapy with concurrent chemotherapy as the standard treatment for anal cancer, thus radiation therapy alone may be an effective alternative treatment. The aim of this study was to use a large national database of anal cancer patients to compare overall survival of patients treated with radiation therapy alone to those treated with radiation therapy with concurrent chemotherapy. We found that patients who received radiation therapy alone were more likely to be ≥70 years old and less likely to be female. Treatment with radiation and concurrent chemotherapy was associated with a 31% reduction in the risk of death compared to treatment with radiation alone. Our results suggest that radiation with concurrent chemotherapy should be the standard treatment for early stage anal cancer patients. Abstract The optimal treatment for stage I squamous cell carcinoma of the anus (SCCA) remains undefined. Recently, wide local excision alone was found to have comparable survival to those treated with chemoradiation (CRT). Given that local excision may be sufficient for the treatment of stage I SCCA, we hypothesized that radiation therapy (RT) alone, compared to CRT would result in equivalent overall survival (OS) in this population. We identified non-surgically treated patients with stage I SCCA from the National Cancer Database from 2004–2015. We included only patients treated either with CRT (45–59.4 Gy with chemotherapy initiated within 14 days of RT) or RT alone (45–59.4 Gy with no chemotherapy). The primary endpoint was OS between CRT and RT patients. Propensity-score matched (PSM) analysis was performed to determine the effect of concurrent chemotherapy on OS using a Cox proportional hazards model with robust standard error to account for clustering in matched pairs. We identified 3552 stage I patients treated with CRT and 287 treated with RT. Compared to patients treated with CRT, those that received RT were more likely to be ≥70 years old (33.1% vs. 19.7%, p < 0.001) and less likely to be female (63.1% vs. 71.0%, p < 0.001). The proportion of patients with a Charlson-Deyo score of 0 was similar in both groups (80.8% RT vs. 82.7% CRT, p = 0.164). The PSM cohort consisted of 287 pairs of patients with median follow-up 48.3 months (interquartile range, 24.4–85.1 months) and 151 deaths (86 RT, 65 CRT). CRT was associated with a 31% reduction in the risk of death (HR = 0.69, 95% CI 0.50–0.95, p = 0.023). We found that CRT was associated with improved OS, compared to RT alone, in patients with non-surgically treated stage I SCCA. These data suggest that de-intensification of therapy in stage I SCCA must be used with caution. However, given the retrospective nature of the data, prospective trials are required.
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Affiliation(s)
- Eric Miller
- Department of Radiation Oncology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (E.M.); (A.N.); (D.D.P.); (A.A.); (T.W.)
| | - Ansel Nalin
- Department of Radiation Oncology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (E.M.); (A.N.); (D.D.P.); (A.A.); (T.W.)
| | - Dayssy Diaz Pardo
- Department of Radiation Oncology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (E.M.); (A.N.); (D.D.P.); (A.A.); (T.W.)
| | - Andrea Arnett
- Department of Radiation Oncology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (E.M.); (A.N.); (D.D.P.); (A.A.); (T.W.)
| | - Laith Abushahin
- Department of Internal Medicine, Division of Medical Oncology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (L.A.); (N.J.)
| | - Syed Husain
- Colon and Rectal Surgery at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA;
| | - Ning Jin
- Department of Internal Medicine, Division of Medical Oncology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (L.A.); (N.J.)
| | - Terence Williams
- Department of Radiation Oncology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (E.M.); (A.N.); (D.D.P.); (A.A.); (T.W.)
| | - Jose Bazan
- Department of Radiation Oncology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (E.M.); (A.N.); (D.D.P.); (A.A.); (T.W.)
- Correspondence: ; Tel.: +1-614-688-7371
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Bazan J, Kuhn K, Healy E, Jhawar S, Beyer S, DiCostanzo D, White J. PH-0601: Dosimetric Parameters Associated with Esophagitis in Regional Nodal Irradiation for Breast Cancer. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00623-x] [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: 10/22/2022]
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Bazan J, Stephens J, Agnese D, Skoracki R, Reiland J, Arneson K, Gupta G, Gallagher K, McElroy S, Park K, Grignol V, Lee C, Sisk G, Schulz S, Chetta M, Jhawar S, Grecula J, Martin D, Carson W, Farrar W, Carlson M, Gupta N, White J. PO-0933: Prospective Evaulation Of Iort Boost In Women Undergoing Lumpectomy With Oncoplastic Reconstruction. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00950-6] [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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12
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Jhawar SR, Alpert N, Taioli E, Sayan M, Bazan J, Park KU, Stover D, Cherian M, White J, Haffty B, Ohri N. Adjuvant radiation therapy alone is associated with improved overall survival compared to hormonal therapy alone in older women with estrogen receptor positive early stage breast cancer. Cancer Med 2020; 9:8345-8354. [PMID: 32942344 PMCID: PMC7666745 DOI: 10.1002/cam4.3443] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 06/25/2020] [Revised: 07/03/2020] [Accepted: 08/19/2020] [Indexed: 01/04/2023] Open
Abstract
Background Breast conserving surgery (BCS) and adjuvant hormonal therapy (HT) without radiation therapy (RT) is an acceptable approach for older women with early stage, estrogen receptor (ER) positive breast cancer. Toxicity and compliance remain issues with HT. Adjuvant RT alone may have better compliance, but its efficacy in the absence of HT is unclear. We aim to assess patterns of adjuvant therapy and survival outcomes among older women with early stage, ER positive (ER+) breast cancer. Methods The National Cancer Data Base (NCDB) was used to identify 130,194 women age ≥65 years with invasive ER+, node negative breast cancer diagnosed between 2004 and 2015. All patients underwent BCS. Kaplan‐Meier survival curves were used to examine overall survival (OS). The association between adjuvant therapy and OS was assessed in multivariable Cox proportional hazards regression models. Results Unadjusted 5/10‐year OS rates were 90.0%/64.3% for HT and RT, 84.2%/54.9% for RT alone, 78.7%/44.5% for HT alone, and 71.6%/38.0% for no treatment; p<0.001 for all. Compared to HT alone, the 10‐year multivariable hazard ratio (HR) for death for RT alone was 0.86 (95% CI 0.82‐0.91). In propensity‐matched patients who received RT alone or HT alone (n=21,326), RT alone had significantly better survival at 5 (HRadj: 0.84) and 10 (HRadj: 0.87) years. Conclusions Older women with early stage ER+ breast cancer who undergo BCS and receive both HT and RT have the best survival, while RT as single‐modality therapy had higher rates of OS at 5 and 10 years compared to HT alone.
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Affiliation(s)
- Sachin R Jhawar
- Department of Radiation Oncology, Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Naomi Alpert
- Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emanuela Taioli
- Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mutlay Sayan
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Jose Bazan
- Department of Radiation Oncology, Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Ko Un Park
- Department of Surgical Oncology, Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Daniel Stover
- Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Mathew Cherian
- Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Julia White
- Department of Radiation Oncology, Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Bruce Haffty
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Nisha Ohri
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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Rinehardt H, Williams N, Morgan E, Kassem M, Palettas M, Miah A, Alnahhas I, Eibl PGP, Suresh A, Puduvalli V, Giglio P, Lustberg M, Wesolowski R, Sardesai S, Stover D, VanDeusen J, Bazan J, Ramswamy B, Noonan A. Abstract P2-20-07: Assessment of leptomeningeal carcinomatosis management and outcomes in patients with advanced breast cancer from 2005 to 2015: A single institution experience. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p2-20-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Leptomeningeal carcinomatosis (LMC) is a complication of advanced malignancies wherein metastatic disease invades the meninges of the central nervous system via contiguous spread from bone or brain metastases or hematogenous spread from systemic disease. Breast cancer is the most common solid tumor etiology of LMC. Approximately 5% of patients (pts) with breast cancer develop LMC. LMC has a median survival of 4 weeks when untreated and 8-16 weeks with treatment. The diagnosis of LMC remains challenging with only 60% of pts having cerebrospinal fluid (CSF) positive for malignant cells. There is no generally accepted standard of care for treatment of LMC but it may involve intrathecal or systemic chemotherapy, whole brain or spinal radiotherapy, or a combination of modalities. We aimed to assess detection and treatment strategies of LMC in pts with breast cancer treated at the Ohio State University Comprehensive Cancer Center-James (OSUCCC-James) to better characterize the disease and guide clinical care. Methods An IRB-approved single-institution retrospective protocol was developed. Medical records of 469 pts who had undergone a procedure related to LMC diagnosis or treatment were identified and reviewed to determine study eligibility. Comprehensive data was obtained through information warehouse and chart review was performed for the eligible 69 pts with breast cancer diagnosed with LMC and treated at the OSUCCC-James between January 1, 2005 and December 31, 2015. Descriptive statistics were used to summarize demographic and clinical characteristics. Overall survival (OS) was defined as time from LMC diagnosis to death or last known follow-up, and was generated using Kaplan Meier methods. Comparisons in OS between groups were analyzed using Log-rank tests. Results Sixty-nine female pts were included in the analysis with the following characteristics: median age 55.7 years (range: 48-60.6 years), Eastern Cooperative Oncology Group (ECOG) performance status of 0-2 (86%; N=59), and Caucasian (78%; N=54). They had the following subtypes hormone receptor positive (HR +), and human epidermal growth factor receptor (HER2) negative (61%, N=42), triple negative (25%, N=17) and HER2 positive (10%, N=7). The most common sites of metastases included bone (42%), brain (28%), and lung (12%). The median time between the diagnosis of first metastasis and LMC was 0.9 years (range: 0-3.2 years). Of the 40 (58%) pts who underwent lumbar puncture, 21 (52%) pts had positive CSF cytology. Sixty-eight pts (99%) had MRI findings suggestive of LMC. The most common treatment modalities were systemic chemotherapy (N=14, 41%), radiotherapy (N=12, 35%), and intrathecal chemotherapy (N=14, 35%). Fifty-six pts (81%) had a change in systemic chemotherapy agent after diagnosis. The median OS of all pts was 2.4 months (95% confidence interval: 1.2-4.4). Pts with ER+/PR+/HER2- had a better OS (4.4 months, 95%CI 1.5, 6.1)) compared to those with HER2+ (1.3 months, 95%CI 0.2, 1.9) or ER-/PR-/HER2- (0.6 months, 95%CI 0.0, 15.8) subtypes (p-value=0.004). Pts with negative CSF cytology had a greater OS compared to those with positive CSF cytology (9.8 vs. 0.7 months, p=0.026) and pts who had a change in systemic treatment had a greater OS compared with patients who had no new treatment (2.5 months vs. 1.2 months, p =0.039). No significant difference was seen in OS between ECOG performance status groups. Conclusions LMC is a relatively rare yet devastating complication of breast cancer. Based on our institutional experience, LMC remains a clinical challenge and is associated with poor OS. Pts with triple negative and HER2 positive disease and those with high disease burden fare worse. Pts who had change in systemic therapy fare better. Dedicated clinical trials are urgently needed to improve outcomes.
Citation Format: Hannah Rinehardt, Nicole Williams, Evan Morgan, Mahmooud Kassem, Marilly Palettas, Abdul Miah, Iyad Alnahhas, Pilar Guillermo Prieto Eibl, Anupama Suresh, Vinay Puduvalli, Pierre Giglio, Maryam Lustberg, Robert Wesolowski, Sagar Sardesai, Daniel Stover, Jeffrey VanDeusen, Jose Bazan, Bhuvaneswari Ramswamy, Anne Noonan. Assessment of leptomeningeal carcinomatosis management and outcomes in patients with advanced breast cancer from 2005 to 2015: A single institution experience [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-20-07.
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Affiliation(s)
| | - Nicole Williams
- 2The Ohio State University Wenxer Medical Center, Columbus, OH
| | - Evan Morgan
- 3The Ohio State Comprehensive Cancer Center, Columbus, OH
| | | | | | - Abdul Miah
- 4The Ohio State University Wexner Medicine Center, Columbus, OH
| | - Iyad Alnahhas
- 5The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Anupama Suresh
- 1The Ohio State University College of Medicine, Columbus, OH
| | - Vinay Puduvalli
- 5The Ohio State University Wexner Medical Center, Columbus, OH
| | - Pierre Giglio
- 5The Ohio State University Wexner Medical Center, Columbus, OH
| | - Maryam Lustberg
- 5The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Sagar Sardesai
- 5The Ohio State University Wexner Medical Center, Columbus, OH
| | - Daniel Stover
- 5The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Jose Bazan
- 5The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Anne Noonan
- 5The Ohio State University Wexner Medical Center, Columbus, OH
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Skinner H, Hu C, Tsakiridis T, Santana-Davila R, Lu B, Erasmus J, Doemer A, Videtic G, Coster J, Yang A, Lee R, Wasik MW, Schaner P, Mccormack S, Esparaz B, Mcgarry R, Bazan J, Stuve T, Bradley J. OA12.03 Initial Reporting of NRG-LU001, Randomized Phase II Trial of Concurrent Chemoradiotherapy +/- Metformin HCL in Locally Advanced NSCLC. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.473] [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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15
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Williams N, Rinehardt H, Morgan E, Kassem M, Palettas M, Puduvalli V, Giglo P, Lustberg M, Wesolowski R, Sardesai S, Stover D, Vandeusen J, Bazan J, Ramaswamy B, Noonan A. LPTO-10. ASSESSMENT OF LEPTOMENINGEAL CARCINOMATOSIS DIAGNOSIS AND OUTCOMES FROM 2005 TO 2015 AT THE OHIO STATE UNIVERSITY. Neurooncol Adv 2019. [PMCID: PMC7213376 DOI: 10.1093/noajnl/vdz014.033] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND: Leptomeningeal carcinomatosis (LMC) is a complication of solid tumor malignancies where tumors metastasize to the leptomeninges. LMC complicates 4–15% of malignancies with incidence increasing as survival of patients with advanced cancer improves. Diagnostic methods include magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) cytology. We assessed detection methods, incidence, and outcomes of LMC at The Ohio State University Comprehensive Cancer Center from 2005–2015. METHODS: This was a single-institution retrospective study of 160 patients with confirmed diagnosis of LMC. Patients with hematologic and central nervous system malignancies were excluded. Descriptive statistics were used to summarize demographic and clinical characteristics. Overall survival (OS) was defined as time from LMC diagnosis to death or last known follow-up, and was generated using Kaplan-Meier methods. RESULTS: Median age of LMC diagnosis was 55.8 years (range: 48, 62.5). 69 (43%) patients had primary breast cancer, 41 (26%) had lung cancer, and 17 (11%) had melanoma. 73 patients (46%) presented with stage IV disease at initial diagnosis of the primary cancer, 41 (26%) with stage III disease, and 26 (16%) with stage II disease. Median time from diagnosis of primary cancer to diagnosis of LMC was 2 years (range: 0, 31.2). 158 (99%) patients had metastases at the time of LMC diagnosis, predominantly in bone (36%) or brain (36%). Median OS was 1.9 months (CI: 1.3, 2.5). 160 (100%) patients had an MRI of the brain or spine and 155 (97%) had MRI findings consistent with LMC. 75 (47%) patients underwent lumbar puncture, and 39 (52%) had CSF cytology positive for malignancy. CONCLUSIONS: Despite treatment, prognosis remains poor and confirmation of diagnosis can be challenging. This study highlights the need for novel therapeutics and improved diagnostic techniques for patients with LMC.
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Sebastian N, Wu T, Bazan J, Driscoll E, Willers H, Yegya-Raman N, Bond L, Dwivedi A, Mo X, Tan Y, Xu-Welliver M, Haglund K, Jabbour SK, Keane FK, Williams TM. Pre-treatment neutrophil-lymphocyte ratio is associated with overall mortality in localized non-small cell lung cancer treated with stereotactic body radiotherapy. Radiother Oncol 2019; 134:151-157. [PMID: 31005209 PMCID: PMC10905623 DOI: 10.1016/j.radonc.2019.01.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/12/2019] [Accepted: 01/25/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Neutrophil-lymphocyte ratio (NLR) has been associated with mortality in several disease sites. We hypothesized that NLR is associated with inferior outcomes in localized non-small cell lung cancer (NSCLC) treated with stereotactic body radiotherapy (SBRT). METHODS We evaluated the association of pre-treatment NLR, obtained within 6 months of starting SBRT, with overall survival, as well as primary tumor, regional, and distant recurrence. Multivariate Cox regression was then used to assess pre-treatment NLR as a predictor of mortality. We validated our findings in an independent cohort of patients treated at two other institutions. In a secondary analysis, we also evaluated the association of post-treatment NLR with mortality in the training cohort. RESULTS A total of 156 patients and 166 tumors were included in the training cohort with a median follow-up of 13.4 months. After dichotomization by median, NLR > 3.6 was associated with mortality on univariate (p = 0.010) and multivariate analysis (p = 0.023). In the validation cohort, NLR > 3.6 was similarly associated with mortality on univariate (p = 0.031) and multivariate (p = 0.007) analysis. In a secondary analysis in the training cohort, we found post-treatment NLR was significantly increased compared to pre-treatment NLR (p < 0.001) and associated with mortality on univariate analysis (p = 0.005) and multivariate analysis (p = 0.010). CONCLUSIONS Pre-treatment NLR > 3.6 is associated with mortality in patients treated with SBRT. This finding was validated in an independent cohort of patients treated at two other institutions. Additionally, post-treatment NLR was significantly increased from pre-treatment and associated with overall survival.
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Affiliation(s)
- Nikhil Sebastian
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, USA
| | - Trudy Wu
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, USA
| | - Jose Bazan
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, USA
| | - Erin Driscoll
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, USA
| | - Henning Willers
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, USA
| | - Nikhil Yegya-Raman
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, USA
| | - Laura Bond
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, USA
| | - Abhishek Dwivedi
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, USA
| | - Xiaokui Mo
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, USA
| | - Yubo Tan
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, USA
| | - Meng Xu-Welliver
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, USA
| | - Karl Haglund
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, USA
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, USA
| | - Florence K Keane
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, USA
| | - Terence M Williams
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, USA.
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Prionas ND, von Eyben R, Yi E, Aggarwal S, Shaffer J, Bazan J, Eastham D, Maxim PG, Graves EE, Diehn M, Gensheimer MF, Loo BW. Increases in Serial Pretreatment 18F-FDG PET-CT Metrics Predict Survival in Early Stage Non-Small Cell Lung Cancer Treated With Stereotactic Ablative Radiation Therapy. Adv Radiat Oncol 2019; 4:429-437. [PMID: 31011689 PMCID: PMC6460103 DOI: 10.1016/j.adro.2018.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 11/14/2018] [Indexed: 12/25/2022] Open
Abstract
Purpose Quantitative changes in positron emission tomography with computed tomography imaging metrics over serial scans may be predictive biomarkers. We evaluated the relationship of pretreatment metabolic tumor growth rate (MTGR) and standardized uptake value velocity (SUVV) with disease recurrence or death in patients with early-stage non-small cell lung cancer treated with stereotactic ablative radiation therapy (SABR). Methods and Materials Under institutional review board approval, we retrospectively identified patients who underwent positron emission tomography with computed tomography at diagnosis and staging and simulation for SABR. Two cohorts underwent SABR between November 2005 to October 2012 (discovery) and January 2012 to April 2016 (validation). MTGR and SUVV were calculated as the daily change in metabolic tumor volume and maximum standardized uptake value, respectively. Cox proportional hazard models identified predictors of local, regional, and distant recurrence and death for the combined cohort. MTGR and SUVV thresholds dichotomizing risk of death in the discovery cohort were applied to the validation cohort. Results A total of 152 lesions were identified in 143 patients (92 lesions in 83 discovery cohort patients). In multivariable models, increasing MTGR trended toward increased hazard of distant recurrence (hazard ratio, 6.98; 95% confidence interval, 0.67-72.61; P = .10). In univariable models, SUVV trended toward risk of death (hazard ratio, 11.8, 95% confidence interval, 0.85-165.1, P = .07). MTGR greater than 0.04 mL/d was prognostic of decreased survival in discovery (P = .048) and validation cohorts (P < .01). Conclusions MTGR greater than 0.04 mL/d is prognostic of death in patients with non-small cell lung cancer treated with SABR. Increasing SUVV trends, nonsignificantly, toward increased risk of recurrence and death. MTGR and SUVV may be candidate imaging biomarkers to study in trials evaluating systemic therapy with SABR for patients at high risk of out-of-field recurrence.
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Affiliation(s)
- Nicolas D Prionas
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California.,Stanford Cancer Institute, Stanford, California
| | - Rie von Eyben
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Esther Yi
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Sonya Aggarwal
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Jenny Shaffer
- St. Anthony's Radiation Oncology Specialists, St. Anthony's Medical Center, St Louis, Missouri
| | - Jose Bazan
- Department of Radiation Oncology, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| | - David Eastham
- David Grant Medical Center Radiation Oncology, Travis Air Force Base, Fairfield, California
| | - Peter G Maxim
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California.,Stanford Cancer Institute, Stanford, California
| | - Edward E Graves
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California.,Stanford Cancer Institute, Stanford, California
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California.,Stanford Cancer Institute, Stanford, California.,Stanford Institute for Stem Cell Biology and Regenerative Medicine, Stanford, California
| | - Michael F Gensheimer
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California.,Stanford Cancer Institute, Stanford, California
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California.,Stanford Cancer Institute, Stanford, California
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Healy E, Pan X, Beyer S, Washington I, Bazan J, White J. Abstract P1-12-13: Initial report of a prospective, pilot study of patient-reported upper extremity dysfunction in women undergoing radiation for breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-12-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objectives: Upper extremity dysfunction (UED) is a known side effect of breast cancer treatment. It is unclear, however, to what degree radiation contributes to this morbidity. We aimed to characterize the level of UED using patient-reported outcomes (PROs) prior to, during, and after treatment with radiation for breast cancer. Our secondary aims were to evaluate the association of UED with pain scores.
Methods: This is a single-institution, prospective, longitudinal cohort study of patients treated with radiation for breast cancer. The validated patient-reported outcome measure, Quick Disabilities of the Arm, Shoulder and Hand (QD) was used to capture UED prior to radiation, at the end of radiation, and 1 month following the completion of radiation. Pain scores were also collected at these intervals using the numeric pain reporting scale (NPRS) from 0 (no pain) to 10 (worst pain).
Results: Forty-four patients were enrolled on this study and 43 (97.7%) had completed radiation at the time of analysis. Thirteen patients (29.5%) were treated with mastectomy, axillary lymph node dissection and regional nodal irradiation in the supine position. The other 31 (70.5%) patients underwent lumpectomy and sentinel lymph node biopsy. Of these patients, 26 (83.9%) were treated in the prone position and 30 (96.8%) received whole breast irradiation. Median time from surgery to radiation was 69 days (range 35 – 212 days), 76 days for mastectomy and 68 days for lumpectomy. Median time from start to end of radiation was 38 days for mastectomy and 28 days for lumpectomy. Pre-treatment median QD score prior to radiation was 12.5 (11.4 for lumpectomy, 15.9 for mastectomy), 9.1 at the end of radiation (9.1 for lumpectomy, 18.2 for mastectomy), and 2.4 at 1 month after radiation (2.3 for lumpectomy, 2.5 for mastectomy). Median NPRS scores at pre-treatment, post-treatment and 1 month follow-up were 1, 1, and 1 for lumpectomy and 0, 1, 0 for mastectomy patients, respectively.
Conclusion: In this initial pilot study with 1 month of follow up, patient-reported UED as demonstrated by QD scores were higher pre-radiation and decreased by one month after. This likely reflects recuperation after surgical procedure. Median average pain scores were low at all time points. Further evaluation of UED over time to characterize the long-term effect of radiation and correlation with quality of life and other clinical factors is planned.
Citation Format: Healy E, Pan X, Beyer S, Washington I, Bazan J, White J. Initial report of a prospective, pilot study of patient-reported upper extremity dysfunction in women undergoing radiation for breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-12-13.
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Affiliation(s)
- E Healy
- The Ohio State University Medical Center, Columbus, OH; The Ohio State University, Columbus, OH
| | - X Pan
- The Ohio State University Medical Center, Columbus, OH; The Ohio State University, Columbus, OH
| | - S Beyer
- The Ohio State University Medical Center, Columbus, OH; The Ohio State University, Columbus, OH
| | - I Washington
- The Ohio State University Medical Center, Columbus, OH; The Ohio State University, Columbus, OH
| | - J Bazan
- The Ohio State University Medical Center, Columbus, OH; The Ohio State University, Columbus, OH
| | - J White
- The Ohio State University Medical Center, Columbus, OH; The Ohio State University, Columbus, OH
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Goldstein P, Buffomante A, Hussain C, Bazan J, Namdam K, Combs J, Petke C, Koletar S, Dick M, Malvestutto C. 1492. Chlamydia, Gonorrhea, Syphilis and HIV Screening among Men Presenting with STI-Related Complaints at a Community-Based Emergency Department in Columbus, Ohio: A 5-Year Retrospective Study. Open Forum Infect Dis 2018. [PMCID: PMC6252948 DOI: 10.1093/ofid/ofy210.1321] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Sexually transmitted infections (STIs) disproportionally affect individuals living in poor and underserved areas of the United States. Emergency Departments (ED) are often the only point of healthcare access for these at-risk individuals. As such, the ED often serves a key role in STI screening. The purpose of this study was to review STI screening practices for men at an urban and community-based ED affiliated with a large academic medical center in Columbus, Ohio. Methods Retrospective review of all ED visits from January 2012 to December 2017. A total of 279,929 patient-visits were analyzed for male patients by (1) exposure to an STI (2) STI-related symptoms (penile discharge/pain, scrotal/testicular pain/swelling). We analyzed the demographic characteristics of men who presented to the ED with an STI-related complaint and compared those who underwent STI screening (chlamydia, gonorrhea, syphilis or HIV) to those that did not. Results Conclusion Over a 5-year period, screening for chlamydia, gonorrhea for men presenting with STI-related complaints was adequate. However, syphilis and HIV screening was very low among men presenting to an urban and community-based ED with an STI-related complaint. A separate analysis for women is being done. There is an urgent need to identify and eliminate barriers to syphilis and HIV screening in ED’s that serve at-risk populations. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Philip Goldstein
- Division of Infectious Disease, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Cory Hussain
- Department of Internal Medicine, Division of Infectious Diseases, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jose Bazan
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Kushal Namdam
- Ohio State University Medical Center, Columbus, Ohio
| | - Julie Combs
- Ohio State University Medical Center, Columbus, Ohio
| | - Carol Petke
- Ohio State University Medical Center, Columbus, Ohio
| | - Susan Koletar
- Division of Infectious Diseases, The Ohio State University College of Medicine, Columbus, Ohio
| | - Michael Dick
- Ohio State University Medical Center, Columbus, Ohio
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Gerlach A, Bazan J. 292. Ceftolozane/Tazobactam for Treatment of Osteomyelitis due to Multi-Drug-Resistant Pseudomonas aeruginosa. Open Forum Infect Dis 2018. [PMCID: PMC6253306 DOI: 10.1093/ofid/ofy210.303] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Ceftolozane/tazobactam (C/T) has potent activity against Pseudomonas aeruginosa (PA). Clinical data describing the use of C/T for PA osteomyelitis are limited. Our purpose is to describe clinical and microbiologic outcomes of adult patients treated with C/T for multidrug-resistant (MDR-PA) osteomyelitis. Methods This was a retrospective study of hospitalized patients who received C/T ≥48 hours for MDR-PA osteomyelitis between June 2015 and July 2017. MDR-PA was defined as resistance to ≥1 antibiotic from ≥3 antibiotic classes. Osteomyelitis was diagnosed by imaging, presence of systemic inflammatory signs and symptoms, elevated C-reactive protein, and positive culture for MDR-PA. Combination antibiotic therapy was defined as systemic antibiotics susceptible to MDR-PA for ≥48 hours with C/T. Clinical cure was defined as complete or partial resolution of signs and symptoms of infection without need for escalation of antimicrobials during inpatient and outpatient therapy. Microbiological success is defined as eradication of MDR-PA in follow-up bone cultures. Descriptive statistics were used and presented at percent or median [Interquartile range]. Results Eighteen patients met inclusion and four patients were lost to follow-up. Demographics were male (81.2%), age 58.5 [53.5–68.5] years, 61.1% admitted to ICU, Charlson Comorbidity Index 5.5 [4–8] and APACHE II score 13.5 [11–21]. Site of osteomyelitis was pelvic in 55.6%, sacral in 22.2% and other sites in 22.2%. Surgical debridement occurred in 22.2%, and osteomyelitis was polymicrobial in 77.8%. Duration of hospitalization was 23.5 [12–37] days and all cause in-patient mortality was 16.7%. The median mean inhibitory concentration of C/T was 2 [2–4] μg/mL. Median total duration of C/T was 42 [27–42] days. Combination antibiotics were used in 27.8% (16.7% polymyxins, 11.1% aminoglycosides, 5.6% ciprofloxacin) and 2 patients on polymyxins developed renal insufficiency. No patient developed hypersensitivity, neurologic events or C. difficile infections. Overall, clinical cure was 64.3% and 4 patients had repeat cultures with 75% achieving a microbiologic cure. Conclusion These preliminary data suggest C/T maybe an option for treating patients with MDR-PA osteomyelitis, but more data are needed. Disclosures A. Gerlach, Merck: Grant Investigator, Grant recipient
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Affiliation(s)
- Anthony Gerlach
- Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jose Bazan
- The Ohio State University College of Medicine, Columbus, Ohio
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Quilter L, Cyr SS, Abitria V, Ancharski A, Bautista I, Bazan J, Carifo K, Ervin M, Harrison R, Hoogenboom A, Peterson A, Pham C, Snyder B, Turner AN, Torrone E. 125. eGISP: Enhanced Surveillance of Neisseria gonorrhoeae Antimicrobial Susceptibility in the United States. Open Forum Infect Dis 2018. [PMCID: PMC6253014 DOI: 10.1093/ofid/ofy209.015] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background The Gonococcal Isolate Surveillance Project (GISP), which monitors trends in N. gonorrhoeae susceptibility among men with gonococcal urethritis in sexually transmitted disease (STD) clinics, has informed treatment recommendations for 3 decades. However, it has been speculated that susceptibility patterns may differ in women, as well as in the pharynx and rectum. We describe preliminary findings from the enhanced GISP (eGISP), which expands surveillance to pharyngeal, rectal, and endocervical isolates. Methods In August 2017, select jurisdictions were funded to collect urogenital and extragenital specimens from men and women seen in participating STD clinics. Positive gonorrhea cultures were sent to regional laboratories for antimicrobial susceptibility testing (AST) by agar dilution. Isolates with elevated minimum inhibitory concentration (MIC) to azithromycin (AZI) (MIC ≥2.0 μg/mL), cefixime (CFX) (MIC ≥0.25 μg/mL), and/or ceftriaxone (CRO) (MIC ≥0.125 μg/mL) were designated as Alert isolates. Clinical and epidemiological data were linked to AST results. Results From August 2017 to February 2018, 4 clinics in 4 jurisdictions submitted 468 positive gonococcal specimens for AST; 36.1% were from men who have sex with men (MSM), 51.9% from men who have sex with women (MSW), and 12.0% from women. Overall, 71.8% were urethral, 7.9% endocervical, 7.1% rectal, and 13.2% pharyngeal. Seventy-two isolates (15.4%) were Alerts: 97.2% (N = 70) had elevated MICs to AZI, 2.8% (N = 2) had elevated MICs to CFX, and none had elevated MICs to CRO. No isolate had elevated MICs to both AZI and CFX. Among MSM, 15.9% of urogenital isolates and 16.1% of extragenital isolates had an elevated AZI MIC. Among MSW, 11.8% of urogenital isolates and 14.3% of pharyngeal isolates had an elevated AZI MIC. Among women, 24.3% of endocervical isolates and 26.3% of extragenital isolates had an elevated AZI MIC. Conclusion Preliminary eGISP data suggest that enhanced surveillance of pharyngeal, rectal, and endocervical isolates is feasible and that elevated MICs to azithromycin are common among males and females. Including isolates from extragenital anatomic sites and women may help strengthen N. gonorrhoeae surveillance capacity. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Laura Quilter
- Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, Georgia
| | - Sancta St Cyr
- Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, Georgia
| | | | - Andrew Ancharski
- Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | - Ilene Bautista
- Southern Nevada Public Health Laboratory, Las Vegas, Nevada
| | - Jose Bazan
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Karen Carifo
- Southern Nevada Public Health Laboratory, Las Vegas, Nevada
| | | | - Rebecca Harrison
- Kalamazoo County Health and Community Services, Kalamazoo, Michigan
| | - Aaron Hoogenboom
- Kalamazoo County Health and Community Services, Kalamazoo, Michigan
| | - Amy Peterson
- Michigan Department of Community Health, Lansing, Michigan
| | - Cau Pham
- Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, Georgia
| | - Brandon Snyder
- The Ohio State University College of Medicine, Columbus, Ohio
| | | | - Elizabeth Torrone
- Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, Georgia
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Welliver M, Mo X, Gunderson D, Dicostanzo D, Wald P, Bazan J, Williams T, Haglund K, Grecula J, Otterson G, Carbone D. P3.17-20 Impact of Significant Primary Tumor Size Reduction on Radiation Dose to Normal Structures in Patients Receiving Definitive Chemoradiotherapy. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1976] [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: 11/28/2022]
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White J, McElroy S, Sekhon A, Wei L, Bazan J, Yang X, DiCostanzo D, Kuhn K, Gupta N, Knopp M. Abstract OT2-03-04: Feasibility of assessing radiation response with MRI/CT directed preoperative accelerated partial breast irradiation in the prone position for hormone responsive early stage breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot2-03-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Accelerated partial breast irradiation (APBI) delivers adjuvant radiation (RT) to the 1-2 cm of the breast at highest risk for recurrence surrounding the lumpectomy (L) cavity over 5-8 days and is an alternative to standard whole breast irradiation for hormone sensitive (HS) stage 1 (T1, N0) breast cancer (BC) based on 2 randomized controlled trials. External beam methods for APBI are common but have notable inherent drawbacks that include: inter-fraction inaccuracy due to patient setup based on anatomy, intra fraction error related to patient or respiratory motion, and inaccurate geometric targeting by relying on L cavity position instead of the tumor position. Postoperative RT has other limitations including delivery in the setting of disrupted blood or lymphatic supply that may be suboptimal for radio sensitivity and it eliminates observation of radiation-induced tumor response. MRI is an established tool for measuring BC extent and response from neoadjuvant systemic therapy. It's hypothesized that MRI directed pre-operative APBI using intensity modulated radiotherapy (IMRT) with image guidance (IGRT) will improve RT delivery, and that MRI features can be identified to correlate with pathologic radiation response.
Trial Design: There are 2 cohorts to this single arm prospective trial. The first cohort is for establishing and verifying patient flow and image fusion between MRI, CT and RT planning. In the second cohort eligible patients will receive preoperative APBI 38.5 Gy in 10 fractions BID with IMRT, IGRT in the prone position using MRI defined targets fused to CT treatment planning.
Eligibility: For cohort 1 it is HS Stage 1 BC that has completed CT in prone position for RT planning. Eligibility for cohort 2 requires: age > 50 yo, clinical stage 1 BC, HS, HER2 negative, intending L, clinically negative axilla verified by ultrasound, able to tolerate the prone position, and MRI with contrast.
Specific aims: To determine the reproducibility of MRI directed preoperative APBI based on meeting 3 criteria: ability to define RT targets by MRI, quality of RT plans and completion of treatment (APBI and surgery). Additional aims include assessing toxicity, cosmetic outcome, local regional cancer control and collection of tissue for correlative studies.
Statistical methods: The optimal two-stage design by Simon is used. Sample size for cohort 2 is based on the first endpoint. 19 eligible patients will be required in the first stage; if 3 or more treatments are scored unacceptable, then early stopping will be recommended. Otherwise, accrual will continue to a total accrual of 30. If > 4 of 30 treatments are scored unacceptable, the technique will be considered not reproducible, and a Phase II study will not be pursued. Under the null hypothesis of an 80% reproducibility rate, this two-stage design has an expected sample size of 24.4.
Patient accrual to cohort 1 has completed the targeted accrual of 3. Patient accrual to Cohort 2 is 5/30.
Contact information: Soyhun Mc Elroy (Sohyun.McElroy@osumc.edu) or Julia White (Julia.White@osumc.edu)
Funding source: Susan G Komen Breast Cancer Foundation Grant # GRT00035216
Citation Format: White J, McElroy S, Sekhon A, Wei L, Bazan J, Yang X, DiCostanzo D, Kuhn K, Gupta N, Knopp M. Feasibility of assessing radiation response with MRI/CT directed preoperative accelerated partial breast irradiation in the prone position for hormone responsive early stage breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT2-03-04.
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Affiliation(s)
- J White
- Ohio State University, Columbus, OH; Ohio State University, Center for Biostatistics, Columbus, OH
| | - S McElroy
- Ohio State University, Columbus, OH; Ohio State University, Center for Biostatistics, Columbus, OH
| | - A Sekhon
- Ohio State University, Columbus, OH; Ohio State University, Center for Biostatistics, Columbus, OH
| | - L Wei
- Ohio State University, Columbus, OH; Ohio State University, Center for Biostatistics, Columbus, OH
| | - J Bazan
- Ohio State University, Columbus, OH; Ohio State University, Center for Biostatistics, Columbus, OH
| | - X Yang
- Ohio State University, Columbus, OH; Ohio State University, Center for Biostatistics, Columbus, OH
| | - D DiCostanzo
- Ohio State University, Columbus, OH; Ohio State University, Center for Biostatistics, Columbus, OH
| | - K Kuhn
- Ohio State University, Columbus, OH; Ohio State University, Center for Biostatistics, Columbus, OH
| | - N Gupta
- Ohio State University, Columbus, OH; Ohio State University, Center for Biostatistics, Columbus, OH
| | - M Knopp
- Ohio State University, Columbus, OH; Ohio State University, Center for Biostatistics, Columbus, OH
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Wald P, Mo X, Barney C, Gunderson D, Haglund AK, Bazan J, Grecula J, Chakravarti A, Williams T, Carbone DP, Xu-Welliver M. Prognostic Value of Primary Tumor Volume Changes on kV-CBCT during Definitive Chemoradiotherapy for Stage III Non-Small Cell Lung Cancer. J Thorac Oncol 2017; 12:1779-1787. [PMID: 28843360 DOI: 10.1016/j.jtho.2017.08.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/01/2017] [Accepted: 08/04/2017] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Kilovoltge cone beam computed tomography (kV-CBCT) allows for tumor localization and response assessment during definitive chemoradiotherapy for locally advanced NSCLC. We hypothesize that significant tumor volume loss occurs early during radiotherapy and that the extent of volume loss correlates with clinical outcomes. METHODS A total of 52 patients with locally advanced NSCLC treated with definitive chemoradiotherapy were reviewed. kV-CBCT images were used to contour primary gross tumor volumes at four time points during treatment. Patients were dichotomized according to absolute and relative volume changes at each time point. Statistical analyses were performed to evaluate correlations between volume changes and clinical outcomes. RESULTS The median gross tumor volumes were 77.1, 48.3, 42.5, and 29.9 cm3 for fractions 1, 11, 21, and final, respectively. Greater relative volume loss between fractions 1 and 21 correlated with improved distant control (hazard ratio [HR] = 0.35, 95% confidence interval [CI]: 0.13-0.94, p = 0.038) and overall survival (HR = 0.40, 95% CI: 0.16-0.98, p = 0.046). Greater relative volume loss between fractions 11 and 21 correlated with improved progression-free survival (HR = 0.39, 95% CI: 0.17-0.88, p = 0.02) and trended toward improved overall survival (HR = 0.43, 95% CI: 0.17-1.06, p = 0.07). On multivariate analysis, greater relative volume loss between fractions 11 and 21 correlated with improved progression-free survival (HR = 0.39, 95% CI: 0.16-0.97, p = 0.041) and overall survival (HR = 0.31, 95% CI: 0.11-0.88, p = 0.027). CONCLUSIONS Significant primary tumor volume loss occurs early during radiotherapy for locally advanced NSCLC. Greater relative tumor volume loss during treatment correlates with improved disease control and overall survival. Thus, kV-CBCT has potential to be used as a practical prognostic imaging marker.
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Affiliation(s)
- Patrick Wald
- Department of Radiation Oncology, Division of Medical Oncology, The Ohio State University Wexner Medical Center, Arthur G. James Comprehensive Cancer Center and Richard J. Solove Research Institute, Columbus, Ohio
| | - Xiaokui Mo
- Center For Biostatistics, Division of Medical Oncology, The Ohio State University Wexner Medical Center, Arthur G. James Comprehensive Cancer Center and Richard J. Solove Research Institute, Columbus, Ohio
| | - Christian Barney
- Department of Radiation Oncology, Division of Medical Oncology, The Ohio State University Wexner Medical Center, Arthur G. James Comprehensive Cancer Center and Richard J. Solove Research Institute, Columbus, Ohio
| | - Daniel Gunderson
- Department of Radiation Oncology, Division of Medical Oncology, The Ohio State University Wexner Medical Center, Arthur G. James Comprehensive Cancer Center and Richard J. Solove Research Institute, Columbus, Ohio
| | - A Karl Haglund
- Department of Radiation Oncology, Division of Medical Oncology, The Ohio State University Wexner Medical Center, Arthur G. James Comprehensive Cancer Center and Richard J. Solove Research Institute, Columbus, Ohio
| | - Jose Bazan
- Department of Radiation Oncology, Division of Medical Oncology, The Ohio State University Wexner Medical Center, Arthur G. James Comprehensive Cancer Center and Richard J. Solove Research Institute, Columbus, Ohio
| | - John Grecula
- Department of Radiation Oncology, Division of Medical Oncology, The Ohio State University Wexner Medical Center, Arthur G. James Comprehensive Cancer Center and Richard J. Solove Research Institute, Columbus, Ohio
| | - Arnab Chakravarti
- Department of Radiation Oncology, Division of Medical Oncology, The Ohio State University Wexner Medical Center, Arthur G. James Comprehensive Cancer Center and Richard J. Solove Research Institute, Columbus, Ohio
| | - Terence Williams
- Department of Radiation Oncology, Division of Medical Oncology, The Ohio State University Wexner Medical Center, Arthur G. James Comprehensive Cancer Center and Richard J. Solove Research Institute, Columbus, Ohio
| | - David P Carbone
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Wexner Medical Center, Arthur G. James Comprehensive Cancer Center and Richard J. Solove Research Institute, Columbus, Ohio
| | - Meng Xu-Welliver
- Department of Radiation Oncology, Division of Medical Oncology, The Ohio State University Wexner Medical Center, Arthur G. James Comprehensive Cancer Center and Richard J. Solove Research Institute, Columbus, Ohio.
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White J, McElroy S, Seykon A, Wei L, Bazan J, Yang X, DiCostanzo D, Gupta N, Knopp M. Abstract OT2-03-02: Feasibility of assessing radiation response with MRI/CT directed preoperative accelerated partial breast irradiation in the prone position for hormone sensitive early stage breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-ot2-03-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Accelerated partial breast irradiation (APBI) delivers adjuvant radiation (RT) to the 1-2 cm of the breast at highest risk for recurrence surrounding the lumpectomy (L) cavity over 5-8 days and is an alternative to standard whole breast irradiation for hormone sensitive (HS) stage 1 (T1, N0) breast cancer (BC) based on 2 randomized controlled trials. External beam methods for APBI are common but have notable inherent drawbacks that include: inter-fraction inaccuracy due to patient setup based on anatomy, intra fraction error related to patient or respiratory motion, and inaccurate geometric targeting by relying on L cavity position instead of the tumor position. Postoperative RT has other limitations including delivery in the setting of disrupted blood or lymphatic supply that may be suboptimal for radio sensitivity and it eliminates observation of radiation-induced tumor response. MRI is an established tool for measuring BC extent and response from neoadjuvant systemic therapy. It's hypothesized that MRI directed pre-operative APBI using intensity modulated radiotherapy (IMRT) with image guidance (IGRT) will improve RT delivery, and that MRI features can be identified to correlate with pathologic radiation response.
Trial Design: There are 2 cohorts to this single arm prospective trial. The first cohort is for establishing and verifying patient flow and image fusion between MRI, CT and RT planning. In the second cohort eligible patients will receive preoperative APBI 38.5 Gy in 10 fractions BID with IMRT, IGRT in the prone position using MRI defined targets fused to CT treatment planning.
Eligibility: For cohort 1 it is HS Stage 1 BC that has completed CT in prone position for RT planning. Eligibility for cohort 2 requires: age > 60 yo, clinical stage 1 BC, HS, HER2 negative, intending L, clinically negative axilla verified by ultrasound, able to tolerate the prone position, and MRI with contrast.
Specific aims: To determine the reproducibility of MRI directed preoperative APBI based on meeting 3 criteria: ability to define RT targets by MRI, quality of RT plans and completion of treatment (APBI and surgery). Additional aims include assessing toxicity, cosmetic outcome, local regional cancer control and collection of tissue for correlative studies.
Statistical methods: The optimal two-stage design by Simon is used. Sample size for cohort 2 is based on the first endpoint. 19 eligible patients will be required in the first stage; if 3 or more treatments are scored unacceptable, then early stopping will be recommended. Otherwise, accrual will continue to a total accrual of 30. If > 4 of 30 treatments are scored unacceptable, the technique will be considered not reproducible, and a Phase II study will not be pursued. Under the null hypothesis of an 80% reproducibility rate, this two-stage design has an expected sample size of 24.4.
Patient accrual to cohort 1 is 2 and targeted accrual is 3. Patient accrual to Cohort 2 is 0 and targeted accrual is 30.
Contact information: Soyhun Mc Elroy ( Sohyun.McElroy@osumc.edu) or Julia White (Julia.White@osumc.edu)
Funding source: Susan G Komen Breast Cancer Foundation Grant # GRT00035216.
Citation Format: White J, McElroy S, Seykon A, Wei L, Bazan J, Yang X, DiCostanzo D, Gupta N, Knopp M. Feasibility of assessing radiation response with MRI/CT directed preoperative accelerated partial breast irradiation in the prone position for hormone sensitive early stage breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT2-03-02.
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Affiliation(s)
- J White
- The Ohio State University Comprehensive Cancer Center, Columbus, OH; Center for Biostatistics, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Wright Center for Innovation, The Ohio State Universtiy, Columbus, OH
| | - S McElroy
- The Ohio State University Comprehensive Cancer Center, Columbus, OH; Center for Biostatistics, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Wright Center for Innovation, The Ohio State Universtiy, Columbus, OH
| | - A Seykon
- The Ohio State University Comprehensive Cancer Center, Columbus, OH; Center for Biostatistics, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Wright Center for Innovation, The Ohio State Universtiy, Columbus, OH
| | - L Wei
- The Ohio State University Comprehensive Cancer Center, Columbus, OH; Center for Biostatistics, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Wright Center for Innovation, The Ohio State Universtiy, Columbus, OH
| | - J Bazan
- The Ohio State University Comprehensive Cancer Center, Columbus, OH; Center for Biostatistics, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Wright Center for Innovation, The Ohio State Universtiy, Columbus, OH
| | - X Yang
- The Ohio State University Comprehensive Cancer Center, Columbus, OH; Center for Biostatistics, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Wright Center for Innovation, The Ohio State Universtiy, Columbus, OH
| | - D DiCostanzo
- The Ohio State University Comprehensive Cancer Center, Columbus, OH; Center for Biostatistics, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Wright Center for Innovation, The Ohio State Universtiy, Columbus, OH
| | - N Gupta
- The Ohio State University Comprehensive Cancer Center, Columbus, OH; Center for Biostatistics, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Wright Center for Innovation, The Ohio State Universtiy, Columbus, OH
| | - M Knopp
- The Ohio State University Comprehensive Cancer Center, Columbus, OH; Center for Biostatistics, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Wright Center for Innovation, The Ohio State Universtiy, Columbus, OH
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Bazan J, DiCostanzo D, Kuhn K, Majithia L, Quick A, Gupta N, White J. Likelihood of unacceptable normal tissue doses in breast cancer patients undergoing regional nodal irradiation in routine clinical practice. Pract Radiat Oncol 2016; 7:154-160. [PMID: 28094211 DOI: 10.1016/j.prro.2016.10.012] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 10/12/2016] [Accepted: 10/15/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE As indications for regional nodal irradiation (RNI) for breast cancer have expanded, so too has scrutiny over potential late toxicity from radiotherapy. This emphasizes the need for careful radiation treatment planning to maximize the therapeutic ratio. We sought to evaluate how often unacceptable doses (UDs) to organs at risk (OARs) occur and the associated factors for patients receiving RNI in daily practice. METHODS AND MATERIALS Treatment records of patients who received RNI from February 2012 to May 2015 were studied. The NSABP B51/RTOG 1304 clinical dose-volume constraints for targets/OARs receiving RNI were used as the benchmark. Dose-volume histograms were analyzed for the rate of ≥1 UD delivered to the following organs: heart, mean >5 Gy; ipsilateral lung, V20 >35%, V10 >60%, V5 >70%; contralateral lung (CL), V5 >15%; and contralateral breast, V4.1 >5%. Logistic regression was used to test the association between UDs to OAR and key variables. RESULTS Two hundred three consecutive cases received RNI (105 left, 98 right), to the chest wall in 171 (84%) and to the internal mammary nodes in 170 (84%); 77.4% of cases met all OAR constraints. The most common OAR UDs were delivered to the contralateral breast (n = 32, 15.7%) and ipsilateral lung V5 (n = 22, 10.8%). On multivariate analysis, use of intensity modulated radiation therapy (odds ratio [OR], 64.7; 95% confidence interval, 20.8-201.5; P < .001) and use of nodal boost (OR, 5.5; 95% confidence interval, 1.1-27.1; P = .04), but not internal mammary node irradiation (OR, 2.7; P = .35) or reconstruction (OR, 0.62; P = .33), were independently associated with higher OAR UD rate. For 3-dimensional conformal radiation therapy plans, 7.9% had OAR UDs. CONCLUSION The OAR UD rate with 3-dimensional conformal radiation therapy ± deep inspiration breath-hold in routine clinical practice is low and not independently associated with internal mammary node irradiation or reconstruction presence. Women treated with intensity modulated radiation therapy had a significantly higher overall OAR UD rate, and clinicians should be aware of this as they initiate RNI treatment planning.
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Affiliation(s)
- Jose Bazan
- Department of Radiation Oncology, Ohio State University, Columbus, Ohio.
| | | | - Karla Kuhn
- Department of Radiation Oncology, Ohio State University, Columbus, Ohio
| | - Lonika Majithia
- Department of Radiation Oncology, Ohio State University, Columbus, Ohio
| | - Allison Quick
- Department of Radiation Oncology, Ohio State University, Columbus, Ohio
| | - Nilendu Gupta
- Department of Radiation Oncology, Ohio State University, Columbus, Ohio
| | - Julia White
- Department of Radiation Oncology, Ohio State University, Columbus, Ohio
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Majithia L, Bazan J, Quick AM, Terando AM, Agnese DM, Mrozek E, Farrar WB, White JR. Locoregional failure rates after mastectomy for breast cancer patients with T1-2 tumors and axillary nodal microscopic metastases. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.28_suppl.64] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
64 Background: The indications for postmastectomy radiotherapy (PMRT) are expanding to include patients 1-3 axillary nodal metastases (ALN). Improvements in diagnostic evaluation have led to increasing numbers of breast cancer (BC) patients who are found to have microscopic nodal metastases (N1mic). The challenge today is whether these BC patients have risk that warrants the routine delivery of PMRT. Methods: We reviewed patients with pathologic T1-2N1 BC treated with initial mastectomy (mast) and adjuvant systemic therapy (ST) from 2000-2013. The primary endpoint was locoregional failure (LRF), defined as a recurrence in either the ipsilateral chestwall or regional lymphatics (axillary, internal mammary, or supraclavicular). Secondary endpoints were disease-free survival (DFS, failure or death) and overall survival (OS). The log-rank test was used to compare survival between groups. Results: We identified 550 eligible patients from our prospectively maintained cancer registry with 5 year median follow-up. 95 patients (17%) had N1mic disease. Baseline characteristics include: median age 53 yrs, 61% pathologic T2, 39% grade 3, 72% hormone receptor positive, 16% HER2+, 12% triple-negative. Treatment included chemotherapy in 78% (n = 428), PMRT in 15% (n = 82), and anti-endocrine therapy in 70% (n = 385). A median of 18 ALN (range, 1-68) were removed. Among the patients with N1mic disease, 81 had 1+ node, 13 had 2+ nodes, and 1 had 3+ nodes. The 5 yr LRF was 0% for patients with N1mic disease vs. 4.6% in those macro metastases (p = 0.84). The 5 yr LRF rate for the entire cohort was 3.9%; patients with 1+, 2+, and 3+ nodes had 5 yr LRF of 2.6%, 4.7% and 6.4%, respectively (p = 0.79). Patients with N1mic disease had a trend towards improved DFS (91.6% vs. 82.3%, p = 0.07) and significantly improved OS (96.9% vs. 87.6%, p = 0.03) compared to patients with macrometastases. Conclusions: In a cohort of patients with T1-2,N1 BC treated with modern therapy, we found overall low rates of LRF. Patients with N1mic disease had no LRF events and improved OS compared to patients with macrometastases. These findings support that PMRT should not be routinely recommended for N1mic BC patients with T1-2 tumors.
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Affiliation(s)
- Lonika Majithia
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | | | | | | | - Ewa Mrozek
- The Ohio State University Medical Center James CCC, Columbus, OH
| | | | - Julia R. White
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
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Bazan J, DiCostanzo D, Majithia L, Quick AM, Gupta N, White JR. Rates of unacceptable variation (UV) of normal tissue constraints in patients undergoing chest wall/breast and regional nodal irradiation (RNI) in a routine clinical practice. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.28_suppl.67] [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: 11/20/2022] Open
Abstract
67 Background: TheNSABP B51/RTOG 1304 clinical trial defines dose-volume constraints for targets/normal tissue receiving RNI. We sought to evaluate UV rate in normal tissue based on the NSABP B51/RTOG 1304 protocol in patients receiving chestwall/breast (CW/B) and RNI in daily practice. Methods: Treatment records of CW/B+RNI patients from 2/2012-5/2015 were studied for: CW or B radiotherapy (RT), RT type (intensity modulated [IMRT] or 3D conformal [3DCRT]), internal mammary node (IMN) inclusion, primary site boost, and nodal boost. No case is enrolled on B51/1304. Dose volume histogram (DVH) was analyzed for the rate of ≥ 1 UV for the following normal tissue constraints: Heart mean dose ≤ 5 Gy; ipsilateral lung (IL): V20 ≤ 35%, V10 ≤ 60%, V5 ≤ 70%; contralateral lung (CL) V5 ≤ 15%; contralateral breast (CB) V4.1 ≤ 5%. Logistic regression is used to test the association between UV and key variables. Results: 203 consecutive cases received CW/B+RNI (105 left, 98 right). RT was to CW in 170 (84%), B in 33 (16%), primary site boost 133 (66%), and IMN 170 (84%). 38 (19%) received IMRT and 14 (6.9%) had a nodal boost. 46 patients (22.6%) had ≥ 1 UV. 19 patients (9.4%) had ≥ 2 UV, all in IMRT patients. 2 patients (1.0%) had a heart UV at 5.2 Gy and 5.6 Gy. The most common UV was CB (n = 32, 15.7%) and IL V5 (n = 22, 10.8%). Higher UV rates are associated with use of IMRT (vs. 3DCRT): 86.8% vs. 7.9%, OR = 77.2 (95% CI 25.7-231.4, p < 0.0001); IMN irradiation: OR = 11.5 (95% CI 1.5-86.8, p = 0.02); and use of nodal boost: OR = 7.4 (95% CI 2.3-23.4, p = 0.001). The most common UVs in IMRT cases are CB (n = 27, 71%), IL V5 (n = 19, 50%), CL V5 (n = 14, 37%) and for 3DCRT are IL V20 (n = 5, 3%), CB (n = 5, 3%) and IL V5 (n = 3, 1.8%). On multivariate analysis, use of IMRT (OR = 64.7, 95% CI 20.8-201.5, p < 0.001) and use of nodal boost (OR = 5.5, 95% CI 1.1-27.1, p = 0.04) but not IMN irradiation (OR = 2.7, 95% CI 0.3-22.0, p = 0.35) were independently associated with higher UV rate. Conclusions: The rate of UV per B51/1304 criteria with 3DCRT in routine clinical practice is low (7.9%). Women treated with IMRT had a significantly higher overall UV rate and clinicians should be aware of this as they initiate treatment planning for RNI.
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Affiliation(s)
| | | | - Lonika Majithia
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Nilendu Gupta
- NRG Oncology/RTOG, and Ohio State University, Columbus, OH
| | - Julia R. White
- NRG Oncology and The Ohio State University, Columbus, OH
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Gomes C, Silva W, Tinco C, Martinez-Puchol S, Pons M, Bazan J, del Valle Mendoza J, Ruiz J. Evaluation of three PCR schemes for detection of Bartonella bacilliformis in blood samples: sensitivity, specificity and applicability. Int J Infect Dis 2014. [DOI: 10.1016/j.ijid.2014.03.1177] [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: 11/17/2022] Open
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Mates JM, Kumar SB, Bazan J, Mefford M, Voronkin I, Handelman S, Mwapasa V, Ackerman W, Janies D, Kwiek JJ. Genotypic and phenotypic heterogeneity in the U3R region of HIV type 1 subtype C. AIDS Res Hum Retroviruses 2014; 30:102-12. [PMID: 23826737 PMCID: PMC3887403 DOI: 10.1089/aid.2013.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Approximately 20% of all HIV-1 mother-to-child transmission (MTCT) occurs in utero (IU). In a chronic HIV infection, HIV-1 exists as a complex swarm of genetic variants, and following IU MTCT, viral genomic diversity is restricted through a mechanism that remains to be described. The 5' U3R region of the HIV-1 long terminal repeat (LTR) contains multiple transcription factor (TF) binding sites and regulates viral transcription. In this study, we tested the hypothesis that sequence polymorphisms in the U3R region of LTR are associated with IU MTCT. To this end, we used single template amplification to isolate 517 U3R sequences from maternal, placental, and infant plasma derived from 17 HIV-infected Malawian women: eight whose infants remained HIV uninfected (NT) and nine whose infants became HIV infected IU. U3R sequences show pairwise diversities ranging from 0.2% to 2.3%. U3R sequences from one participant contained two, three, or four putative NF-κB binding sites. Phylogenetic reconstructions indicated that U3R sequences from eight of nine IU participants were consistent with placental compartmentalization of HIV-1 while only one of eight NT cases was consistent with such compartmentalization. Specific TF sequence polymorphisms were not significantly associated with IU MTCT. To determine if replication efficiency of the U3R sequences was associated with IU MTCT, we cloned 90 U3R sequences and assayed promoter activity in multiple cell lines. Although we observed significant, yet highly variable promoter activity and TAT induction of promoter activity in the cell lines tested, there was no association between measured promoter activity and MTCT status. Thus, we were unable to detect a promoter genotype or phenotype associated with IU MTCT.
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Affiliation(s)
- Jessica M. Mates
- Department of Microbiology, The Ohio State University, Columbus, Ohio
| | - Surender B. Kumar
- College of Veterinary Biosciences and Center for Retrovirus Research, The Ohio State University, Columbus, Ohio
| | - Jose Bazan
- The Division of Infectious Diseases, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Megan Mefford
- Center for Microbial Interface Biology, Department of Microbial Infection and Immunity, and Center for Retrovirus Research, The Ohio State University, Columbus, Ohio
| | - Igor Voronkin
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio
| | - Samuel Handelman
- Department of Pharmacology, The Ohio State University, Columbus, Ohio
| | - Victor Mwapasa
- Department of Community Health, Malawi College of Medicine, Blantyre, Malawi
| | - William Ackerman
- Department of Obstetrics and Gynecology (Division of Maternal-Fetal Medicine and Laboratory of Perinatal Research), The Ohio State University, Columbus, Ohio
| | - Daniel Janies
- Department of Bioinformatics and Genomics, The University of North Carolina at Charlotte, Charlotte, North Carolina
| | - Jesse J. Kwiek
- Center for Microbial Interface Biology, Department of Microbial Infection and Immunity, and Center for Retrovirus Research, The Ohio State University, Columbus, Ohio
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Calkosinski I, Rosinczuk-Tonderys J, Dobrzynski M, Palka L, Bazan J. Occurrence of disseminated intravascular coagulation in 2,3,7,8-tetrachlorodibenzo-p-dioxin-induced pneumonia in the rat. Adv Exp Med Biol 2013; 788:283-92. [PMID: 23835989 DOI: 10.1007/978-94-007-6627-3_39] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Intensity of inflammatory reaction in tissue or organ structures depends on the efficiency of homeostatic mechanisms of the organism which limit the extent of this reaction. In studies on the dynamics of inflammatory reaction in induced pneumonia after exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), the occurrence of disseminated intravascular coagulation (DIC) has been observed. In this article we evaluated the DIC syndrome in regard to histopathological assessment and laboratory diagnostics of blood. The evaluation indicates that some hematologic indicators (RBC, HCT, and HGB) decreased in the experimental inflammatory reaction, which might be associated with erythrocyte hemolysis in the inflammatory focus and erythrocyte elimination from circulation as a result of DIC. There also were shifts in the number of various leukocyte forms due likely to the accumulation of particular cells in the inflammatory focus. Histopathological assessment of the inflammatory focus revealed the process of hepatization and the occurrence of DIC.
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Affiliation(s)
- I Calkosinski
- Department of Nervous System Diseases, Faculty of Health Science, Wroclaw Medical University, 5 Bartla St., 51-618, Wroclaw, Poland
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Ruiz J, Silva W, Tinco C, Pons M, del Valle L, Gomez C, Bazan J, Vargas M, Champin D, Mendoza JDV. Etiological and molecular diagnostic of Carrion's disease in patients from Cajamarca - Perú. Int J Infect Dis 2012. [DOI: 10.1016/j.ijid.2012.05.889] [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: 10/28/2022] Open
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Hernandez JE, Adiga R, Armstrong R, Bazan J, Bonilla H, Bradley J, Dretler R, Ison MG, Mangino JE, Maroushek S, Shetty AK, Wald A, Ziebold C, Elder J, Hollister AS, Sheridan W. Clinical experience in adults and children treated with intravenous peramivir for 2009 influenza A (H1N1) under an Emergency IND program in the United States. Clin Infect Dis 2011; 52:695-706. [PMID: 21367722 PMCID: PMC3049340 DOI: 10.1093/cid/cir001] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Peramivir, an investigational intravenous neuraminidase inhibitor in Phase 3 trials for hospitalized patients, was made available during the 2009 H1N1 influenza pandemic under the Emergency Investigational New Drug (eIND) regulations. We describe the clinical characteristics and outcomes of all patients for whom peramivir was requested under the eIND. METHODS After obtaining eIND approval from the Food and Drug Administration and local institutional review board approval, clinicians caring for hospitalized patients with influenza administered intravenous peramivir and collected information on demographic characteristics, clinical characteristics, and outcomes. RESULTS From April through October 2009, peramivir was requested for 42 patients and administered to 20 adults and 11 children. At hospitalization, all patients had rapidly progressing, radiographically confirmed viral pneumonia with respiratory failure, and all but 1 patient required mechanical ventilation. In most patients, including 1 person with documented oseltamivir-resistant infection, the illness had progressed despite oseltamivir treatment. Peramivir was administered for 1-14 days (median duration, 10 days). The 14-day, 28-day, and 56-day survival rates were 76.7%, 66.7%, and 59.0%, respectively. Peramivir was generally well tolerated. CONCLUSIONS Intravenous peramivir was well tolerated and was associated with recovery in most patients hospitalized with severe 2009 H1N1 influenza viral pneumonia and treated under an eIND.
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Affiliation(s)
- Jaime E Hernandez
- ID Clinical Development, Clinical Pharmacology, and Clinical Development, BioCryst Pharmaceuticals, Durham, NC, USA.
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Niedziółka J, Bazan J, Chaberski M, Lachowicz W. [Selected aspects of treatment of trochanteric fractures by the Ender method]. Chir Narzadow Ruchu Ortop Pol 1999; 64:189-93. [PMID: 10423914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Basing on the 963 patients treated for trochanteric fractures with Ender nailing in the years 1974-1995, some remarks concerning operational technic and complications have been presented. Among the injured there were 641 females--average 75 y and 322 men--average 71 y. Two fractures of metaphysis occurred during the operation procedure treated successfully with plastic splint. Infection rate--superficial--1.3% and deep one 0.7% was noted. The most common complication proved to be distal migration of nails estimated 5-10%. If they penetrate the skin the nails should be changed to shorter ones. The patients tolerate that procedure quite well. In two cases the nails have been broken, before fracture united. The distal portion of them have been removed and replaced with those of full length, with success. In conclusion the authors regard the method as satisfactory for treatment the stable or relatively stable trochanteric fractures.
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Affiliation(s)
- J Niedziółka
- Oddział Ortopedyczno-Urazowy, Szpital PKP i Zakład Wypadkowości CNMK w Warszawie
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Bazan J, Niedziółka J, Lachowicz W, Daab W. [Osteosynthesis with elastic nailing for treatment of tibial fracture]. Chir Narzadow Ruchu Ortop Pol 1998; 63:31-8. [PMID: 9607280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Results of treatment of 163 tibial fractures in 47 females and 116 males aged 15-76 operated with closed elastic intramedullary osteosynthesis are presented. A bundle of universal intramedullary nails preshaped depending on fracture pattern served for osteosynthesis in 144 closed fractures, 18 open fractures of first degree and 1 second degree open fracture. In all cases but one fracture healed. Late results were assessed in 70 cases. There were 46 good results, 23 fair and 1 poor result. Simple surgical technique, good stability, stimulating of bone healing by compression and minor risk of infection constitute advantages of this method.
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Affiliation(s)
- J Bazan
- Oddziału Ortopedyczno-Urazowego Szpitala PKP, Warszawie
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