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Ioakeim-Ioannidou M, Daartz J, Erfani P, Urell T, Lalonde A, Berv J, Leahy S, Fullerton B, Bolton R, Yock T, Tarbell N, Yeap B, MacDonald SM. Phantosmia during proton radiation and differences in frequency of phantosmia rates based on proton craniospinal irradiation technique for pediatric brain tumor patients. Pediatr Blood Cancer 2024; 71:e30927. [PMID: 38421306 DOI: 10.1002/pbc.30927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Unusual olfactory perception, often referred to as "phantosmia" or "cacosmia" has been reported during brain radiotherapy (RT), but is infrequent and does not typically interfere with the ability to deliver treatment. We seek to determine the rate of phantosmia for patients treated with proton craniospinal irradiation (CSI) and identify any potential clinical or treatment-related associations. METHODS We performed a retrospective review of 127 pediatric patients treated with CSI, followed by a boost to the brain for primary brain tumors in a single institution between 2016 and 2021. Proton CSI was delivered with passive scattering (PS) proton technique (n = 53) or pencil beam scanning technique (PBS) (n = 74). Within the PBS group, treatment delivery to the CSI utilized a single posterior (PA) field (n = 24) or two posterior oblique fields (n = 50). We collected data on phantom smell, nausea/vomiting, and the use of medical intervention. RESULTS Our cohort included 80 males and 47 females. The median age of patients was 10 years (range: 3-21). Seventy-one patients (56%) received concurrent chemotherapy. During RT, 104 patients (82%) developed worsening nausea, while 63 patients (50%) reported episodes of emesis. Of those patients who were awake during CSI (n = 59), 17 (29%) reported phantosmia. In the non-sedated group, we found a higher rate of phantosmia in patients treated with PBS (n = 16, 42%) than PS (n = 1, 4.7%) (p = .002). Seventy-eight patients (61%) required medical intervention after developing nausea/vomiting or phantosmia during RT. Two patients required sedation due to the malodorous smell during CSI. We did not find any significant difference in nausea/vomiting based on treatment technique. CONCLUSION Proton technique significantly influenced olfactory perception with greater rates of phantosmia with PBS compared to PS. Prospective studies should be performed to determine the cause of these findings and determine techniques to minimize phantosmia during radiation therapy.
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Affiliation(s)
- Myrsini Ioakeim-Ioannidou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Juliane Daartz
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Parsa Erfani
- Department of Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tobias Urell
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Arthur Lalonde
- Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | - Julia Berv
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Shannon Leahy
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Barbara Fullerton
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rachel Bolton
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Torunn Yock
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy Tarbell
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Beow Yeap
- Department of Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Shannon M MacDonald
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Evans SB, Blitzblau RC, Chapman CH, Chollet-Lipscomb C, Deville C, Ford E, Gibbs IC, Howell K, Peters GW, Ponce SB, Seldon C, Spector-Bagdady K, Tarbell N, Terezakis S, Vyfhius MAL, Wright J, Zietman A, Jagsi R. Restricted Access to Abortion, the Dobbs Ruling, and Radiation Oncology: Standing United Against Reproductive Injustice. Int J Radiat Oncol Biol Phys 2022; 114:385-389. [PMID: 35963470 DOI: 10.1016/j.ijrobp.2022.07.1843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 07/28/2022] [Accepted: 07/28/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Suzanne B Evans
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut.
| | - Rachel C Blitzblau
- Department of Radiation Oncology, Duke University, Durham, North Carolina; Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | | | | | - Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric Ford
- Department of Radiation Oncology, University Of Washington, Seattle, Washington
| | - Iris C Gibbs
- Stanford Medicine, School of Medicine, Stanford Cancer Institute, Stanford University, Stanford, California
| | - Krisha Howell
- Department of Radiation Oncology, Fox Chase Cancer Center, Temple Health, Philadelphia, Pennsylvania
| | - Gabrielle W Peters
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Sara Beltrán Ponce
- Medical College of Wisconsin Department of Radiation Oncology, Milwaukee, Wisconsin
| | - Crystal Seldon
- Department of Radiation Oncology, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Kayte Spector-Bagdady
- Center for Bioethics & Social Sciences in Medicine and the Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Nancy Tarbell
- Department of Radiation Oncology, Harvard Medical School and Mass General Hospital, Boston, Massachusetts
| | - Stephanie Terezakis
- University of Minnesota, Department of Radiation Oncology, Minneapolis, Minnesota
| | - Melissa A L Vyfhius
- University of Maryland School of Medicine, Chesapeake Oncology and Hematology Associates, Department of Radiation Oncology, Glen Burnie, Maryland
| | - Jean Wright
- Department of Radiation Oncology, University Of Washington, Seattle, Washington
| | - Anthony Zietman
- Department of Radiation Oncology, Harvard Medical School and Mass General Hospital, Boston, Massachusetts
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan
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Ioakeim-Ioannidou M, Erfani P, Urell T, Daartz J, Berv J, Leahy S, Fullerton B, Bolton R, Yock T, Tarbell N, Yeap B, MacDonald S. RONC-14. Olfactory Perception During Proton Radiation and Differences in Frequency of Olfactory Perceptions Based on Proton Craniospinal Irradiation Technique for Pediatric Brain Tumor Patients. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac079.668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND: Unusual olfactory perception has been reported during brain radiation treatments but is infrequent and does not typically interfere with the ability to deliver treatment or cause notable distress. Methods: We performed a retrospective review of 127 pediatric patients treated with proton radiation therapy (PRT) for primary brain tumors in a single institution between 2016-2021. Patients received PRT to the brain as part of craniospinal irradiation (CSI) followed by a boost to the brain. Proton CSI was delivered with 3D-CRT protons (n=53) or pencil beam scanning technique (PBS) (n=74). Within the PBS group, treatment delivery to the CSI utilized a single PA field (n=24) or two posterior oblique fields (n=50). We collected data on abnormal olfactory sensations, nausea/vomiting, and the use of medical intervention for those symptoms. Results: Our cohort included 80 males and 47 females. The median age of patients was 10 years old (range, 3 – 21). Seventy-one patients received concurrent chemotherapy. Prior to PRT, 31 patients were nauseous. During the radiation course, 104 patients developed worsening nausea while 63 patients reported emesis. Four patients vomited while receiving radiation. Seventeen patients reported olfactory perceptions during CSI. We found a higher rate of olfactory perception in patients treated with PBS (n=16, 22%) than 3D-CRT (n=1, 2%) (p=0.001) and, within the PBS group, patients treated with a single PA field (n=11, 46%) than two oblique fields (n=5, 10%) (p=0.002). Seventy-eight patients required intervention including addition of anti-emetic or anti-anxiety medication. Two patients required sedation due to the malodorous smell during CSI. We did not find any significant difference in nausea/vomiting based on treatment technique. Conclusions: PBS and PBS technique influence olfactory perceptions but not the occurrence of the rate of nausea/vomiting. Further studies should be performed to validate these findings and determine techniques to minimize unpleasant olfactory perceptions.
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Affiliation(s)
| | | | - Tobias Urell
- Department of Radiation Oncology, Massachusetts General Hospital , Boston, MA , USA
| | - Juliane Daartz
- Department of Radiation Oncology, Massachusetts General Hospital , Boston, MA , USA
| | - Julia Berv
- Department of Radiation Oncology, Massachusetts General Hospital , Boston, MA , USA
| | - Shannon Leahy
- Department of Radiation Oncology, Massachusetts General Hospital , Boston, MA , USA
| | - Barbara Fullerton
- Department of Radiation Oncology, Massachusetts General Hospital , Boston, MA , USA
| | - Rachel Bolton
- Department of Radiation Oncology, Massachusetts General Hospital , Boston, MA , USA
| | - Torunn Yock
- Department of Radiation Oncology, Massachusetts General Hospital , Boston, MA , USA
| | - Nancy Tarbell
- Department of Radiation Oncology, Massachusetts General Hospital , Boston, MA , USA
| | - Beow Yeap
- Department of Radiation Oncology, Massachusetts General Hospital , Boston, MA , USA
| | - Shannon MacDonald
- Department of Radiation Oncology, Massachusetts General Hospital , Boston, MA , USA
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Ioakeim-Ioannidou M, Erfani P, Urell T, Daartz J, Berv J, leahy S, Fullerton B, Bolton R, Yock T, Tarbell N, Yeap B, MacDonald S. RADT-34. OLFACTORY PERCEPTION DURING PROTON RADIATION AND DIFFERENCES IN FREQUENCY OF OLFACTORY PERCEPTIONS BASED ON PROTON CRANIOSPINAL IRRADIATION TECHNIQUE FOR PEDIATRIC BRAIN TUMOR PATIENTS. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Unusual olfactory perception has been reported during brain radiation treatments but is infrequent and does not typically interfere with the ability to deliver treatment or cause notable distress.
METHODS
We performed a retrospective review of 127 pediatric patients treated with proton radiation therapy (PRT) for primary brain tumors in a single institution between 2016-2021. Patients received PRT to the brain as part of craniospinal irradiation (CSI) followed by a boost to the brain. Proton CSI was delivered with 3D-CRT protons (n=53) or pencil beam scanning technique (PBS) (n=74). Within the PBS group, treatment delivery to the CSI utilized a single PA field (n=24) or two posterior oblique fields (n=50). We collected data on abnormal olfactory sensations, nausea/vomiting, and the use of medical intervention for those symptoms.
RESULTS
Our cohort included 80 males and 47 females. The median age of patients was 10 years old (range, 3 – 21). Seventy-one patients received concurrent chemotherapy. Prior to PRT, 31 patients were nauseous. During the radiation course, 104 patients developed worsening nausea while 63 patients reported episodes of emesis. Four patients vomited while receiving radiation. Seventeen patients reported olfactory perceptions during CSI. We found a higher rate of olfactory perception in patients treated with PBS (n=16, 22%) than 3D-CRT (n=1, 2%) (p=0.001) and, within the PBS group, patients treated with a single PA field (n=11, 46%) than two oblique fields (n=5, 10%) (p=0.002). Seventy-eight patients required intervention including addition of anti-emetic or anti-anxiety medication. Two patients required sedation due to the malodorous smell during CSI. We did not find any significant difference in nausea/vomiting based on treatment technique.
CONCLUSIONS
PBS and PBS technique influence olfactory perceptions but not the occurrence of the rate of nausea/vomiting. Further studies should be performed to validate these findings and determine techniques to minimize unpleasant olfactory perceptions.
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Affiliation(s)
| | | | | | | | - julia Berv
- Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | - Torunn Yock
- Massachusetts General Hospital, Boston, MA, USA
| | | | - Beow Yeap
- Massachusetts General Hospital, Boston, MA, USA
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Indelicato DJ, Ioakeim-Ioannidou M, Bradley J, Mailhot-Vega R, Morris C, Tarbell N, Yock T, MacDonald S. RONC-24. PROTON THERAPY FOR PEDIATRIC EPENDYMOMA: MATURE OUTCOMES FROM THE UNIVERSITY OF FLORIDA AND MASSACHUSETTS GENERAL HOSPITAL. Neuro Oncol 2020. [PMCID: PMC7715246 DOI: 10.1093/neuonc/noaa222.793] [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
OBJECTIVE Report long-term efficacy and toxicity of proton therapy for pediatric ependymoma. MATERIALS AND METHODS Between 2000–2017, 318 children with nonmetastatic grade II/III intracranial ependymoma received proton therapy at Massachusetts General Hospital and the University of Florida. Median age was 3.5 years (range, 0.7–21.3 years); 56% were male. Most (69%) tumors were in the posterior fossa and classified as WHO grade III (64%). Eighty-four percent had a gross total or near total tumor resection before radiotherapy and 30% received chemotherapy. Median radiation dose was 55.8 CGE (range, 50.4–59.4 CGE). RESULTS Median follow-up was 6 years (range, 0.6–19.2 years). Seven-year local control, progression-free survival, and overall survival rates were 77.1% (95% CI 71.7–81.7%), 64.4% (95% CI 58.6–69.8%), and 82% (76.9–86.2%), respectively. Subtotal resection was associated with inferior local control (60% vs 80%; p<0.01), progression-free survival (49% vs 67%; p<0.01), and overall survival (69% vs 84%; p<0.05). Male gender was associated with inferior progression-free (59% vs 71%; p<0.01) and overall survival (77% vs 89%; p<0.05). Twenty patients (6.2%) require hearing aids; of these, 12/20 received cisplatin. Grade 3+ brainstem toxicity rate was 1.6% and more common in patients who received >54 CGE. The rate of second malignancy was 0.9%. CONCLUSION Proton therapy offers commensurate disease control to modern photon therapy without unexpected toxicity. The high rate of long-term survival justifies efforts to reduce radiation exposure in this young population with brain tumors. Independent of modality, this large series confirms extent of resection as the most important modifiable factor for survival.
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Affiliation(s)
| | | | | | | | | | | | - Torunn Yock
- Massachusetts General Hospital, Boston, MA, USA
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6
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Michalski J, Northcott P, Li Y, Billups C, Smith K, Burger P, Merchant T, Gajjar A, Fitzgerald TJ, Vezina G, Fouladi M, Packer R, Tarbell N, Janss A. MBCL-15. IMPACT OF MOLECULAR SUBGROUPS ON OUTCOMES FOLLOWING RADIATION TREATMENT RANDOMIZATIONS FOR AVERAGE RISK MEDULLOBLASTOMA: A PLANNED ANALYSIS OF CHILDREN’S ONCOLOGY GROUP (COG) ACNS0331. Neuro Oncol 2020. [PMCID: PMC7715222 DOI: 10.1093/neuonc/noaa222.491] [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: 11/13/2022] Open
Abstract
Abstract
The COG conducted a randomized trial for average-risk medulloblastoma (AR-MB). Patients age 3–21 years were randomized to a radiation boost to the whole posterior fossa (PFRT) or an involved field volume (IFRT) after receiving CSI. Patients age 3–7 years were also randomized to standard dose CSI (23.4Gy, SDCSI) or low dose CSI (18Gy, LDCSI). 464 evaluable patients were available to compare PFRT vs. IFRT and 226 for SDCSI vs. LDCSI. 380 cases had sufficient tissue for DNA methylation-based molecular classification: 362 confirmed medulloblastoma; 6 non-medulloblastoma; 12 inconclusive. Molecular subgrouping confirmed the following representation amongst the evaluable cohort: 156 Group 4 (43.1%), 76 Group 3 (21.0%), 66 SHH (18.2%), 64 WNT (17.7%). Five-year event-free survival (EFS) estimates were 82.5±2.7% and 80.5±2.7% for IFRT and PFRT, respectively (p=0.44). Five-year EFS estimates were 71.4±4.4% and 82.9±3.7% for LDCSI and SDCSI, respectively (p=0.028). EFS distributions differed significantly by subgroup (p<0.0001). Group 3 had the worst outcome, while WNT had the best outcome. There was a significant difference in EFS by RT group among SHH patients; SHH patients receiving IFRT arm had better EFS compared to PFRT (p=0.018). There was a significant difference in EFS distributions by CSI group in Group 4 patients; young Group 4 patients treated with SDCSI had better EFS compared to LDCSI (p=0.047). As previously reported, IFRT is noninferior to PFRT in all patients with AR-MB but LDCSI is worse than SDCSI in younger children. Significant differences in outcome by study randomization and molecular subgroup are observed.
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Affiliation(s)
- Jeff Michalski
- Washington University School of Medicine, St. Louis, MO, USA
| | | | - Yimei Li
- St. Jude’s Research Hospital, Memphis, TN, USA
| | | | - Kyle Smith
- St. Jude’s Research Hospital, Memphis, TN, USA
| | | | | | - Amar Gajjar
- St. Jude’s Research Hospital, Memphis, TN, USA
| | | | | | - Maryam Fouladi
- Cincinnati Children’s Medical Center, Cincinnati, OH, USA
| | - Roger Packer
- Children’s National Medical Center, Washington, DC, USA
| | | | - Anna Janss
- Children’s Healthcare of Atlanta, Atlanta, GA, USA
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Jabbour SK, Timmerman RD, Raben D, DeWeese TL, Donaldson SS, Thomas P, Laurie F, Bishop-Jodoin M, Tarbell N, Wolden S, Halperin E, Constine LS, Haas-Kogan D, Marcus K, Freeman C, Terezakis S, Million L, Smith MA, Mendenhall NP, Marcus RB, Cherlow J, Kalapurakal J, Breneman J, Yock T, MacDonald S, Laack N, Donahue B, Indelicato D, Michalski J, Perkins S, Kachnic L, Esiashvilli N, Roberts KB, FitzGerald TJ. Moody D. Wharam Jr, MD, FACR, FASTRO, July 22, 1941–August 10, 2018. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.01.004] [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: 10/27/2022]
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FitzGerald TJ, Donaldson SS, Wharam M, Laurie F, Bishop-Jodoin M, Moni J, Tarbell N, Shulkin B, McCarville E, Merchant T, Krasin M, Wolden S, Halperin E, Constine LS, Haas-Kogan D, Marcus K, Freeman C, Wilson JF, Hoppe R, Cox J, Terezakis S, Million L, Smith MA, Mendenhall NP, Marcus RB, Cherlow J, Kalapurakal J, Breneman J, Yock T, MacDonald S, Laack N, Donahue B, Indelicato D, Michalski J, Perkins S, Kachnic L, Choy H, Braunstein S, Esiashvilli N, Roberts KB. Larry Emanuel Kun, March 10, 1946-May 27, 2018. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2018.08.018] [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: 11/26/2022]
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Knoll MA, Glucksman E, Tarbell N, Jagsi R. Putting Women on the Escalator: How to Address the Ongoing Leadership Disparity in Radiation Oncology. Int J Radiat Oncol Biol Phys 2018; 103:5-7. [PMID: 30563666 DOI: 10.1016/j.ijrobp.2018.08.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 07/27/2018] [Accepted: 08/02/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Miriam A Knoll
- Department of Radiation Oncology, John Theurer Cancer Center, a HMH-MSKCC partnership, Hackensack, New Jersey
| | - Eitan Glucksman
- Department of Radiation Oncology, John Theurer Cancer Center, a HMH-MSKCC partnership, Hackensack, New Jersey
| | - Nancy Tarbell
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Waltham, Massachusetts
| | - Reshma Jagsi
- Department of Radiation Oncology, Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan.
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Hess C, Yeap B, Sahasakmontri J, Lawell M, Weyman E, Gallotto S, Bajaj B, Sieger K, MacDonald S, Marcus K, Kieran M, Huang M, Tarbell N, Ebb D, Yock T. RTHP-08. RE-EVALUATING THE SEQUENCING OF RADIOTHERAPY AND CHEMOTHERAPY IN PEDIATRIC MEDULLOBLASTOMA. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Mark Kieran
- Dana-Farber Cancer Institute / Boston Childrens Cancer and Blood Disorders Center / Boston Childrens Hospital, Boston, MA, USA, 5Massachusetts General Hospital, Boston, MA, USA
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Packer R, Li Y, Hardy K, Janss A, Billups C, Embry L, Han Y, Cullen P, Merchant T, Tarbell N, Pollack I, Gajjar A, Leary S, Fouladi M, Michalski J. MBCL-07. 5-YEAR EVENT-FREE SURVIVAL (EFS) AND NEUROCOGNITIVE OUTCOME IN CHILDREN WITH MEDULLOBLASTOMA (MB) BETWEEN 3 AND 5 YEARS OF AGE: RESULTS OF CHILDREN’S ONCOLOGY GROUP STUDY ACNS0331. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Roger Packer
- Children’s National Health System, Washington DC, USA
| | - Yimei Li
- St. Jude’s Children’s Hospital, Memphis, TN, USA
- Children’s Oncology Group, Arcadia, CA, USA
| | | | - Anna Janss
- Emory Children’s Hospital, Atlanta, GA, USA
| | - Catherine Billups
- St. Jude’s Children’s Hospital, Memphis, TN, USA
- Children’s Oncology Group, Arcadia, CA, USA
| | | | - Yuanyuan Han
- St. Jude’s Children’s Hospital, Memphis, TN, USA
- Children’s Oncology Group, Arcadia, CA, USA
| | | | | | | | - Ian Pollack
- Pittsburgh Children’s Hospital, Pittsburgh, PA, USA
| | - Amar Gajjar
- St. Jude’s Children’s Hospital, Memphis, TN, USA
| | - Sarah Leary
- Seattle Children’s Hospital, Seattle, WA, USA
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Michalski J, Vezina G, Burger P, Gajjar A, Pollack I, Merchant T, Fitzgerald TJ, Booth T, Tarbell N, Shieh I, Williams-Hughes C, Li Y, Billups C, Packer R, Janss A. MB-109PRELIMINARY RESULTS OF COG ACNS0331: A PHASE III TRIAL OF INVOLVED FIELD RADIOTHERAPY (IFRT) AND LOW DOSE CRANIOSPINAL IRRADIATION (LD-CSI) WITH CHEMOTHERAPY IN AVERAGE RISK MEDULLOBLASTOMA: A REPORT FROM THE CHILDREN'S ONCOLOGY GROUP. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now076.104] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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13
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Burgess L, Pulsifer MB, Yeap BY, Grieco JA, Weinstein ER, MacDonald SM, Tarbell N, Yock TI. Systematic difference between Estimated IQ (EIQ) and Full Scale IQ (FSIQ) in survivors irradiated for pediatric brain tumors. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.10557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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14
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Yock TI, Weyman EA, Goldberg S, Eaton BR, Kasper HB, MacDonald SM, Pulsifer MB, Ebb D, Srichankij SP, Delahaye J, Tarbell N, Kuhlthau K. HRQoL in medulloblastoma patients enrolled on a prospective phase II study of proton radiation. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e21029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - David Ebb
- Massachusetts General Hospital, Boston, MA
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Mailhot Vega R, Kim J, Bussière M, Hattangadi J, Hollander A, Michalski J, Tarbell N, Yock T, MacDonald S. Cost-Effectiveness of Proton Therapy Compared to Photon Therapy in the Management of Pediatric Medulloblastoma. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.020] [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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Mandeville H, Ladra M, Padera T, MacDonald S, Friedmann A, Tarbell N, Yock T. Local Failure in Parameningeal Rhabdomyosarcoma: Does Response to Induction Chemotherapy Matter? Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.182] [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: 11/27/2022]
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Ladra M, Szymonifka J, MacDonald S, Yong Yeap B, Friedmann A, Kasper H, Mahajan A, Grosshans D, Tarbell N, Yock T. Proton Radiation Therapy for Rhabdomyosarcoma: Preliminary Results From a Multicenter Prospective Study. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1582] [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: 11/29/2022]
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Mailhot R, Kim J, Hollander A, Michalski JM, Tarbell N, Yock TI, MacDonald SM. Cost-effectiveness analysis of proton versus photon therapy with respect to risk of growth hormone deficiency. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e17553] [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
e17553 Background: Proton therapy has been endorsed as a radiotherapy (RT) modality with the potential to avert many RT associated comorbidities. Currently, few proton centers exist, and no evidence-based data as yet adequately informs allotment of care. Childhood cancer survivors of central nervous system (CNS) malignancies have high prevalences of growth hormone deficiency (GHD) after hypothalamic exposure, notable for its cost of treatment greater than $10,000/year. We propose methodology to help guide proton referral of pediatric patients with CNS tumors through cost-effective analysis comparisons for proton and photon hypothalamic received dose. Methods: A Markov cohort model was designed to assess the expected costs and effectiveness for specific RT doses to the hypothalamus. Patients entered the model receiving proton or photon RT for CNS tumors at four and twelve years of age and were followed for 60 more years of life. Patients could experience two health states: GHD or healthy. Risk of GHD was based on data by Merchant et al. Costs were measured in USD and captured cost of GHD and cost of RT. Cost of proton course relative to photon was estimated at $160K. Effectiveness was measured in quality-adjusted life years (QALYs). The main outcome measure used for comparison was the incremental cost-effectiveness ratio (ICER). We assumed a societal willingness to pay threshold of $50,000/QALY. Results: Data were used to generate tables incorporating the differential cost of proton RT to project ICERs for different combinations of hypothalamic RT dose as displayed in the Table below. Conclusions: Despite the high cost of proton therapy, the cost of GHD alone can yield proton RT a cost-effective (even cost-minimizing) strategy when compared to photon RT. This work provides a guide for identifying a set of patients for which proton therapy is particularly cost-effective. [Table: see text]
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Affiliation(s)
- Raymond Mailhot
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Jane Kim
- Harvard School of Public Health, Boston, MA
| | - Abby Hollander
- Saint Louis Children's Hospital, Washington University in Saint Louis School of Medicine, St. Louis, MO
| | - Jeff M. Michalski
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Nancy Tarbell
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Torunn I. Yock
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Shannon M. MacDonald
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Sethi RV, Shih HA, Kim D, Yeap BY, Mouw K, Marcus KC, Grabowski E, Yock TI, Tarbell N, Mukai S, MacDonald SM. Second non-ocular tumors among survivors of retinoblastoma treated with proton therapy. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.10018] [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
10018 Background: The leading cause of death for patients with hereditary retinoblastoma is second malignancy. Proton radiation allows for significant sparing of non-target tissue. We sought to determine the risk of second malignancy for the largest and oldest cohort of retinoblastoma patients treated with proton therapy. Methods: We performed a retrospective review of patients treated at the Massachusetts General Hospital (MGH) between 1986 and 2011. Results: Fifty-two patients were identified (see Table). Forty-four patients (85%) were hereditary survivors. Patients were followed for a median of 6.9 years from the start of radiation therapy (range, 11.3 months to 24.4 years). The median age at follow-up was 9.0 years (range, 31.3 months to 24.5 years). Fifteen patients had more than 10 years of follow-up from the start of radiation therapy, and 20 patients were more than 10 years old at last follow-up. With 417.2 person-years of follow-up, we identified one secondary malignancy, an osteosarcoma of the distal femur. The cumulative incidence of second tumor was 5% at 10 years. No radiation-associated malignancies were reported. Conclusions: Retinoblastoma is highly responsive to radiation. The central objection to the use of radiation—the risk of second malignancy—is founded on studies of patients treated with relatively non-conformal techniques. We present the first series of patients treated with the most conformal of current available modalities. While longer follow up is necessary, our preliminary data suggest that the risk of radiation-associated malignancy is minimal with proton therapy. [Table: see text]
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Affiliation(s)
| | | | - David Kim
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | | | - Kent Mouw
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Eric Grabowski
- Department of Pediatric Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Torunn I. Yock
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Nancy Tarbell
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Shizuo Mukai
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | - Shannon M. MacDonald
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Hattangadi J, Kuhlthau K, Szymonifka J, Yeap B, MacDonald S, Hurson J, Delahaye J, Tarbell N, Yock T. Health-related Quality of Life (HrQOL) in Children Treated With Proton Radiation Therapy for Extracranial Tumors: A Prospective Study. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.419] [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: 10/27/2022]
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Teicher B, Holden S, Ara G, Sotomayor E, Menon K, Tarbell N, Sallan S. Etanidazole as a modulator of combined modality therapy in the rat 9l-gliosarcoma. Int J Oncol 2012; 1:625-30. [PMID: 21584591 DOI: 10.3892/ijo.1.6.625] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The use of chemotherapy has led to improved treatment outcome for some pediatric patients with medulloblastoma. We have used a pre-radiation chemotherapy regimen consisting of vincristine and CDDP. The 9L gliosarcoma implanted intracranially and subcutaneously in the same animals was used as a preclinical model system to assess the efficacy of treatment combinations including: vincristine, CDDP, cyclo-phosphamide, etanidazole and radiation. The experimental endpoints were percent increase-in-lifespan, tumor growth delay and tumor cell survival. Both the tumor growth delay and percent increase-in-lifespan improved as the number of agents included in the chemotherapy regimen increased. so that the chemotherapy regimen including all four agents (ETA/VIN/CDDP/CTX) resulted in the greatest tumor growth delay (23.6 +/- 1.5 days) and the greatest increase-in-lifespan (35.8%). When radiation (20 Gray, single dose) was added to the treatment regimens the combinations of ETA/CTX/X-ray and ETA/VIN/CDDP/CTX/X-ray resulted in equivalent tumor growth delays (25.2 +/- 1.3 days and 25.8 +/- 1.7 days, respectively), while the greatest increase-in-lifespan (39.1%) was obtained with the five agent combination. The response of the 9L gliosarcoma to CDDP and cyclophosphamide over a dosage range was very similar to that of the murine FSaII fibrosarcoma. Our results indicate that etanidazole may be an effective chemosensitizer of combination chemotherapy and combined modality treatment regimens for brain tumors.
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Affiliation(s)
- B Teicher
- JOINT CTR RADIAT THERAPY,BOSTON,MA 02115
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Metzger ML, Weinstein HJ, Hudson MM, Billett AL, Larsen EC, Friedmann A, Howard SC, Donaldson SS, Krasin MJ, Kun LE, Marcus KJ, Yock TI, Tarbell N, Billups CA, Wu J, Link MP. Association between radiotherapy vs no radiotherapy based on early response to VAMP chemotherapy and survival among children with favorable-risk Hodgkin lymphoma. JAMA 2012; 307:2609-16. [PMID: 22735430 PMCID: PMC3526806 DOI: 10.1001/jama.2012.5847] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
CONTEXT More than 90% of children with favorable-risk Hodgkin lymphoma can achieve long-term survival, yet many will experience toxic effects from radiation therapy. Pediatric oncologists strive for maintaining excellent cure rates while minimizing toxic effects. OBJECTIVE To evaluate the efficacy of 4 cycles of vinblastine, Adriamycin (doxorubicin), methotrexate, and prednisone (VAMP) in patients with favorable-risk Hodgkin lymphoma who achieve a complete response after 2 cycles and do not receive radiotherapy. DESIGN, SETTING, AND PATIENTS Multi-institutional, unblinded, nonrandomized single group phase 2 clinical trial to assess the need for radiotherapy based on early response to chemotherapy. Eighty-eight eligible patients with Hodgkin lymphoma stage I and II (<3 nodal sites, no B symptoms, mediastinal bulk, or extranodal extension) enrolled between March 3, 2000, and December 9, 2008. Follow-up data are current to March 12, 2012. INTERVENTIONS The 47 patients who achieved a complete response after 2 cycles received no radiotherapy, and the 41 with less than a complete response were given 25.5 Gy-involved-field radiotherapy. MAIN OUTCOME MEASURES Two-year event-free survival was the primary outcome measure. A 2-year event-free survival of greater than 90% was desired, and 80% was considered to be unacceptably low. RESULTS Two-year event-free survival was 90.8% (95% CI, 84.7%-96.9%). For patients who did not require radiotherapy, it was 89.4% (95% CI, 80.8%-98.0%) compared with 92.5% (95% CI, 84.5%-100%) for those who did (P = .61). Most common acute adverse effects were neuropathic pain (2% of patients), nausea or vomiting (3% of patients), neutropenia (32% of cycles), and febrile neutropenia (2% of patients). Nine patients (10%) were hospitalized 11 times (3% of cycles) for febrile neutropenia or nonneutropenic infection. Long-term adverse effects after radiotherapy were asymptomatic compensated hypothyroidism in 9 patients (10%), osteonecrosis and moderate osteopenia in 2 patients each (2%), subclinical pulmonary dysfunction in 12 patients (14%), and asymptomatic left ventricular dysfunction in 4 patients (5%). No second malignant neoplasms were observed. CONCLUSIONS Among patients with favorable-risk Hodgkin lymphoma and a complete early response to chemotherapy, the use of limited radiotherapy resulted in a high rate of 2-year event-free survival. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00145600.
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Affiliation(s)
- Monika L Metzger
- Department of Oncology, St Jude Children's Research Hospital, and Health Sciences Center, University of Tennessee, Memphis, USA.
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Jakacki RI, Burger PC, Zhou T, Holmes EJ, Kocak M, Onar A, Goldwein J, Mehta M, Packer RJ, Tarbell N, Fitz C, Vezina G, Hilden J, Pollack IF. Outcome of children with metastatic medulloblastoma treated with carboplatin during craniospinal radiotherapy: a Children's Oncology Group Phase I/II study. J Clin Oncol 2012; 30:2648-53. [PMID: 22665539 DOI: 10.1200/jco.2011.40.2792] [Citation(s) in RCA: 133] [Impact Index Per Article: 11.1] [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
PURPOSE We evaluated the feasibility of administering carboplatin as a radiosensitizer during craniospinal radiation therapy (CSRT) to patients with high-risk medulloblastomas (MBs) and supratentorial primitive neuroectodermal tumors, and we report the outcome in the subset with metastatic (M+) MB. PATIENTS AND METHODS After surgery, patients received 36 Gy CSRT with boosts to sites of disease. During radiation, patients received 15 to 30 doses of carboplatin (30-45 mg/m(2)/dose), along with vincristine (VCR) once per week for 6 weeks. Patients on regimen A received 6 months of maintenance chemotherapy (MC) with cyclophosphamide and VCR. Once the recommended phase II dose (RP2D) of carboplatin was determined, cisplatin was added to the MC (regimen B). RESULTS In all, 161 eligible patients (median age, 8.7 years; range, 3.1 to 21.6 years) were enrolled. Myelosuppression was dose limiting and 35 mg/m(2)/dose × 30 was determined to be the RP2D of carboplatin. Twenty-nine (36%) of 81 patients with M+ MB had diffuse anaplasia. Four patients were taken off study within 11 months of completing radiotherapy for presumed metastatic progression and are long-term survivors following palliative chemotherapy. Excluding these four patients, 5-year overall survival ± SE and progression-free survival ± SE for M+ patients treated at the RP2D on regimen A was 82% ± 9% and 71% ± 11% versus 68% ± 10% and 59% ± 10% on regimen B (P = .36). There was no difference in survival by M stage. Anaplasia was a negative predictor of outcome. CONCLUSION The use of carboplatin as a radiosensitizer is a promising strategy for patients with M+ MB. Early progression should be confirmed by biopsy.
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Affiliation(s)
- Regina I Jakacki
- Children's Hospital of Pittsburgh, 4401 Penn Ave., Pittsburgh, PA 15224, USA.
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Li KKW, Pang JCS, Ng HK, Massimino M, Gandola L, Biassoni V, Spreafico F, Schiavello E, Poggi G, Casanova M, Pecori E, De Pava MV, Ferrari A, Meazza C, Terenziani M, Polastri D, Luksch R, Podda M, Modena P, Antonelli M, Giangaspero F, Ahmed S, Zaghloul MS, Mousa AG, Eldebawy E, Elbeltagy M, Awaad M, Massimino M, Gandola L, Biassoni V, Antonelli M, Schiavello E, Buttarelli F, Spreafico F, Collini P, Pollo B, Patriarca C, Giangaspero F, MacDonald T, Liu J, Munson J, Park J, Wang K, Fei B, Bellamkonda R, Arbiser J, Gomi A, Yamaguchi T, Mashiko T, Oguro K, Somasundaram A, Neuberg R, Grant G, Fuchs H, Driscoll T, Becher O, McLendon R, Cummings T, Gururangan S, Bourdeaut F, Grison C, Doz F, Pierron G, Delattre O, Couturier J, Cho YJ, Pugh T, Weeraratne SD, Archer T, Krummel DP, Auclair D, Cibulkis K, Lawrence M, Greulich H, McKenna A, Ramos A, Shefler E, Sivachenko A, Amani V, Pierre-Francois J, Teider N, Northcott P, Taylor M, Meyerson M, Pomeroy S, Potts C, Cline H, Rotenberry R, Guldal C, Bhatia B, Nahle Z, Kenney A, Fan YN, Pizer B, See V, Makino K, Nakamura H, Kuratsu JI, Grahlert J, Ma M, Fiaschetti G, Shalaby T, Grotzer M, Baumgartner M, Clifford S, Gustafsson G, Ellison D, Figarella-Branger D, Doz F, Rutkowski S, Lannering B, Pietsch T, Fiaschetti G, Shalaby T, Baumgartner M, Grotzer M, Fleischhack G, Siegler N, Zimmermann M, Rutkowski S, Warmuth-Metz M, Kortmann RD, Pietsch T, Faldum A, Bode U, Yoon JH, Kang HJ, Park KD, Park SH, Phi JH, Kim SK, Wang KC, Kim IH, Shin HY, Ahn HS, Faria C, Golbourn B, Smith C, Rutka J, Greene BD, Whitton A, Singh S, Scheinemann K, Hill R, Lindsey J, Howell C, Ryan S, Shiels K, Shrimpton E, Bailey S, Clifford S, Schwalbe E, Lindsey J, Williamson D, Hamilton D, Northcott P, O'Toole K, Nicholson SL, Lusher M, Gilbertson R, Hauser P, Taylor M, Taylor R, Ellison D, Bailey S, Clifford S, Kool M, Jones DTW, Jager N, Hovestadt V, Schuller U, Jabado N, Perry A, Cowdrey C, Croul S, Collins VP, Cho YJ, Pomeroy S, Eils R, Korshunov A, Lichter P, Pfister S, Northcott P, Shih D, Taylor M, Darabi A, Sanden E, Visse E, Siesjo P, Harris P, Venkataraman S, Alimova I, Birks D, Cristiano B, Donson A, Foreman N, Vibhakar R, Bertin D, Vallero S, Basso ME, Romano E, Peretta P, Morra I, Mussano A, Fagioli F, Kunkele A, De Preter K, Heukamp L, Thor T, Pajtler K, Hartmann W, Mittelbronn M, Grotzer M, Deubzer H, Speleman F, Schramm A, Eggert A, Schulte J, Bandopadhayay P, Kieran M, Manley P, Robison N, Chi S, Thor T, Mestdagh P, Vandesomple J, Fuchs H, Durner VG, de Angelis MH, Heukamp L, Kunkele A, Pajtler K, Eggert A, Schramm A, Schulte JH, Ohe N, Yano H, Nakayama N, Iwama T, Lastowska M, Perek-Polnik M, Grajkowska W, Malczyk K, Cukrowska B, Dembowska-Baginska B, Perek D, Othman RT, Storer L, Grundy R, Kerr I, Coyle B, Hulleman E, Lagerweij T, Biesmans D, Crommentuijn MHW, Cloos J, Tannous BA, Vandertop WP, Noske DP, Kaspers GJL, Wurdinger T, Bergthold G, El Kababri M, Varlet P, Dhermain F, Sainte-Rose C, Raquin MA, Valteau-Couanet D, Grill J, Dufour C, Burchill C, Hii H, Dallas P, Cole C, Endersby R, Gottardo N, Gevorgian A, Morozova E, Kazantsev I, Youhta T, Safonova S, Kozlov A, Punanov Y, Afanasyev B, Zheludkova O, Packer R, Gajjar A, Michalski J, Jakacki R, Gottardo N, Tarbell N, Vezina G, Olson J, Friedrich C, von Bueren AO, von Hoff K, Gerber NU, Benesch M, Faldum A, Pietsch T, Warmuth-Metz M, Kuehl J, Kortmann RD, Rutkowski S, Malbari F, Atlas M, Friedman G, Kelly V, Bray A, Cassady K, Markert J, Gillespie Y, Taylor R, Howman A, Brogden E, Robinson K, Jones D, Gibson M, Bujkiewicz S, Mitra D, Saran F, Michalski A, Pizer B, Jones DTW, Jager N, Kool M, Zichner T, Hutter B, Sultan M, Cho YJ, Pugh TJ, Warnatz HJ, Reifenberger G, Northcott PA, Taylor MD, Meyerson M, Pomeroy SL, Yaspo ML, Korbel JO, Korshunov A, Eils R, Pfister SM, Lichter P, Pajtler KW, Weingarten C, Thor T, Kuenkele A, Fleischhack G, Heukamp LC, Buettner R, Kirfel J, Eggert A, Schramm A, Schulte JH, Friedrich C, von Bueren AO, von Hoff K, Gerber NU, Benesch M, Kwiecien R, Pietsch T, Warmuth-Metz M, Faldum A, Kuehl J, Kortmann RD, Rutkowski S, Lupo P, Scheurer M, Martin A, Nirschl C, Polanczyk M, Cohen KJ, Pardoll DM, Drake CG, Lim M, Manoranjan B, Hallett R, Wang X, Venugopal C, McFarlane N, Sheinemann K, Hassell J, Singh S, Venugopal C, Manoranjan B, McFarlane N, Whitton A, Delaney K, Scheinemann K, Singh S, Manoranjan B, Hallett R, Venugopal C, McFarlane N, Hassell J, Scheinemann K, Dunn S, Singh S, Garcia I, Crowther AJ, Gama V, Miller CR, Deshmukh M, Gershon TR, Garcia I, Crowther AJ, Gershon TR, Gerber NU, von Hoff K, Friedrich C, von Bueren AO, Treulieb W, Benesch M, Faldum A, Pietsch T, Warmuth-Metz M, Rutkowski S, Kortmann RD, Zin A, De Bortoli M, Bonvini P, Viscardi E, Perilongo G, Rosolen A, Connolly E, Zhang C, Anderson R, Feldstein N, Stark E, Garvin J, Shing MMK, Lee V, Cheng FWT, Leung AWK, Zhu XL, Wong HT, Kam M, Li CK, Ward S, Sengupta R, Kroll K, Rubin J, Dallas P, Milech N, Longville B, Hopkins R, Vergiliana JVD, Endersby R, Gottardo N, von Bueren AO, Gerss J, Hagel C, Cai H, Remke M, Hasselblatt M, Feuerstein BG, Pernet S, Delattre O, Korshunov A, Rutkowski S, Pfister SM, Baudis M, Lee C, Fotovati A, Triscott J, Dunn S, Valdora F, Freier F, Seyler C, Brady N, Bender S, Northcott P, Kool M, Jones D, Coco S, Tonini GP, Scheurlen W, Boutros M, Taylor M, Katus H, Kulozik A, Zitron E, Korshunov A, Lichter P, Pfister S, Remke M, Shih DJH, Northcott PA, Van Meter T, Pollack IF, Van Meir E, Eberhart CG, Fan X, Dellatre O, Collins VP, Jones DTW, Clifford SC, Pfister SM, Taylor MD, Pompe R, von Bueren AO, von Hoff K, Friedrich C, Treulieb W, Lindow C, Deinlein F, Kuehl J, Rutkowski S, Gupta T, Krishnatry R, Shirsat N, Epari S, Kunder R, Kurkure P, Vora T, Moiyadi A, Jalali R, Cohen K, Perek D, Perek-Polnik M, Dembowska-Baginska B, Drogosiewicz M, Grajkowska W, Lastowska M, Chojnacka M, Filipek I, Tarasinska M, Roszkowski M, Hauser P, Jakab Z, Bognar L, Markia B, Gyorsok Z, Ottoffy G, Nagy K, Cservenyak J, Masat P, Turanyi E, Vizkeleti J, Krivan G, Kallay K, Schuler D, Garami M, Lacroix J, Schlund F, Adolph K, Leuchs B, Bender S, Hielscher T, Pfister S, Witt O, Schlehofer JR, Rommelaere J, Witt H, Leskov K, Ma N, Eberhart C, Stearns D, Dagri JN, Torkildson J, Evans A, Ashby LS, Zakotnik B, Brown RJ, Dhall G, Portnow J, Finlay JL, McCabe M, Pizer B, Marino AM, Baryawno N, Ekstrom TP, Ostman A, Johnsen JI, Robinson G, Parker M, Kranenburg T, Lu C, Pheonix T, Huether R, Easton J, Onar A, Lau C, Bouffet E, Gururangan S, Hassall T, Cohn R, Gajjar A, Ellison D, Mardis E, Wilson R, Downing J, Zhang J, Gilbertson R, Robinson G, Dalton J, O'Neill T, Yong W, Chingtagumpala M, Bouffet E, Bowers D, Kellie S, Gururangan S, Fisher P, Bendel A, Fisher M, Hassall T, Wetmore C, Broniscer A, Clifford S, Gilbertson R, Gajjar A, Ellison D, Zhukova N, Martin D, Lipman T, Castelo-Branco P, Zhang C, Fraser M, Baskin B, Ray P, Bouffet E, Alman B, Ramaswamy V, Dirks P, Clifford S, Rutkowski S, Pfister S, Bristow R, Taylor M, Malkin D, Hawkins C, Tabori U, Dhall G, Ji L, Haley K, Gardner S, Sposto R, Finlay J, Leary S, Strand A, Ditzler S, Heinicke G, Conrad L, Richards A, Pedro K, Knoblaugh S, Cole B, Olson J, Yankelevich M, Budarin M, Konski A, Mentkevich G, Stefanits H, Ebetsberger-Dachs G, Weis S, Haberler C, Milosevic J, Baryawno N, Sveinbjornsson B, Martinsson T, Grotzer M, Johnsen JI, Kogner P, Garzia L, Morrisy S, Jelveh S, Lindsay P, Hill R, Taylor M, Marks A, Zhang H, Rood B, Williamson D, Clifford S, Aurtenetxe O, Gaffar A, Lopez JI, Urberuaga A, Navajas A, O'Halloran K, Hukin J, Singhal A, Dunham C, Goddard K, Rassekh SR, Davidson TB, Fangusaro JR, Ji L, Sposto R, Gardner SL, Allen JC, Dunkel IJ, Dhall G, Finlay JL, Trivedi M, Tyagi A, Goodden J, Chumas P, O'kane R, Crimmins D, Elliott M, Picton S, Silva DS, Viana-Pereira M, Stavale JN, Malheiro S, Almeida GC, Clara C, Jones C, Reis RM, Spence T, Sin-Chan P, Picard D, Ho KC, Lu M, Huang A, Bochare S, Khatua S, Gopalakrishnan V, Chan TSY, Picard D, Pfister S, Hawkins C, Huang A, Chan TSY, Picard D, Ho KC, Huang A, Picard D, Millar S, Hawkins C, Rogers H, Kim SK, Ra YS, Fangusaro J, Toledano H, Nakamura H, Van Meter T, Pomeroy S, Ng HK, Jones C, Gajjar A, Clifford S, Pfister S, Eberhart C, Bouffet E, Grundy R, Huang A, Sengupta S, Weeraratne SD, Phallen J, Sun H, Rallapalli S, Amani V, Pierre-Francois J, Teider N, Cook J, Jensen F, Lim M, Pomeroy S, Cho YJ. MEDULLOBLASTOMA. Neuro Oncol 2012; 14:i82-i105. [PMCID: PMC3483339 DOI: 10.1093/neuonc/nos093] [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: 08/15/2023] Open
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Zaghloul M, Elbeltagy M, Mousa A, Eldebawy E, Amin A, Pavelka Z, Vranova V, Valaskova I, Tomasikova L, Oltova A, Ventruba J, Mackerle Z, Kren L, Skotakova J, Zitterbart K, Sterba J, Milde T, Kleber S, Korshunov A, Witt H, Hielscher T, Koch P, Koch HG, Jugold M, Deubzer HE, Oehme I, Lodrini M, Grone HJ, Benner A, Brustle O, Gilbertson RJ, von Deimling A, Kulozik AE, Pfister SM, Ana MV, Witt O, Milde T, Hielscher T, Witt H, Kool M, Mack SC, Deubzer HE, Oehme I, Lodrini M, Benner A, Taylor MD, von Deimling A, Kulozik AE, Pfister SM, Witt O, Korshunov A, Fouyssac F, Schmitt E, Mansuy L, Marchal JC, Coffinet L, Bernier V, Chastagner P, Sperl D, Zacharoulis S, Massimino M, Schiavello E, Pizer B, Piette C, Kitanovski L, von Hoff K, Quehenberger F, Rutkowski S, Benesch M, Tzaridis TD, Witt H, Milde T, Bender S, Pfaff E, Barbus S, Bageritz J, Jones DTW, Kulozik A, Lichter P, Korshunov A, Witt O, Pfister SM, Song SH, Kang CW, Kim SH, Bandopadhayay P, Ullrich N, Goumnerova L, Scott RM, Silvera VM, Ligon KL, Marcus KJ, Robison N, Manley PE, Chi S, Kieran MW, Schiavello E, Biassoni V, Pierani P, Cesaro S, Maura M, Witt H, Mack S, Jager N, Jones DTW, Bender S, Stutz A, Milde T, Northcott PA, Fults DW, Gupta N, Karajannis M, Kulozik AE, von Deimling A, Witt O, Rutka JT, Lichter P, Korbel J, Korshunov A, Taylor MD, Pfister SM, de Rezende ACP, Chen MJ, da Silva NS, Cappellano A, Cavalheiro S, Weltman E, Currle S, Thiruvenkatam R, Murugesan M, Kranenburg T, Phoenix T, Gupta K, Gilbertson R, Rogers H, Kilday JP, Mayne C, Ward J, Adamowicz-Brice M, Schwalbe E, Clifford S, Coyle B, Grundy R, Rogers H, Mayne C, Kilday JP, Coyle B, Grundy R, Kilday JP, Mitra B, Domerg C, Ward J, Andreiuolo F, Osteso-Ibanez T, Mauguen A, Varlet P, Le Deley MC, Lowe J, Ellison DW, Gilbertson RJ, Coyle B, Grill J, Grundy RG, Fleischhack G, Pajtler K, Zimmermann M, Rutkowski S, Warmuth-Metz M, Kortmann RD, Pietsch T, Faldum A, Bode U, Gandola L, Pecori E, Scarzello G, Barra S, Mascarin M, Scoccianti S, Mussano A, Garre ML, Jacopo S, Pierani P, Viscardi E, Balter R, Bertin D, Giangaspero F, Massimino M, Pearlman M, Khatua S, Van Meter T, Koul D, Yung A, Paulino A, Su J, Dauser R, Whitehead W, Teh B, Chintagumpala M, Perek D, Drogosiewicz M, Filipek I, Polnik MP, Baginska BD, Wachowiak J, Kazmierczak B, Sobol G, Musiol K, Kowalczyk J, Slusarz HW, Peregud-Pogorzelski J, Grajkowska W, Roszkowski M, Teo WY, Chintagumpala M, Okcu F, Dauser R, Mahajan A, Adesina A, Whitehead W, Jea A, Bollo R, Paulino AC, Velez-Char N, Doerner E, Muehlen AZ, Vladimirova V, Warmuth-Metz M, Kortmann R, von Hoff K, Friedrich C, Rutkowski S, von Bueren AO, Pietsch T, Barszczyk M, Buczkowicz P, Morrison A, Tabori U, Hawkins C, Krajewski K, von Hoff K, Kammler G, Friedrich C, von Bueren A, Kortmann RD, Krauss J, Warmuth-Metz M, Rutkowski S, Ferreira C, Dieffenbach G, Barbosa C, Cuny P, Grill J, Piccinin E, Massimino M, Giangaspero F, Brenca M, Lorenzetto E, Sardi I, Genitori L, Pollo B, Bertin D, Maestro R, Modena P, MacDonald S, Ebb D, Lavally B, Yeap B, Marcus K, Tarbell N, Yock T, Schittone S, Donson A, Birks D, Amani V, Griesinger A, Handler M, Madey M, Merchant T, Foreman N, Hukin J, Ailon T, Dunham C, Carret AS, Tabori U, McNeely PD, Zelcer S, Wilson B, Lafay-Cousin L, Johnston D, Eisenstat D, Silva M, Jabado N, Yip S, Goddard K, Fryer C, Hendson G, Hawkins C, Dunn S, Singhal A, Lassen-Ramshad Y, Vestergaard A, Seiersen K, Schultz HP, Hoeyer M, Petersen JB, Moreno L, Popov S, Jury A, Al Sarraj S, Jones C, Zacharoulis S, Bowers D, Gargan L, Horton CJ, Rakheja D, Margraf L, Yeung J, Hamilton R, Okada H, Jakacki R, Pollack I, Fleming A, Jabado N, Saint-Martin C, Freeman C, Albrecht S, Montes JL. EPENDYMOMA. Neuro Oncol 2012; 14:i33-i42. [PMCID: PMC3483345 DOI: 10.1093/neuonc/nos099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
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DuBois SG, Krailo MD, Gebhardt MC, Donaldson SS, Marcus KC, Dormans JP, Shamberger RC, Sailer SL, Nicholas RW, Healey JH, Tarbell N, Devidas M, Meyer JS, Granowetter L, Womer R, Bernstein ML, Marina N, Grier HE. Evaluation of local control strategies in patients with localized Ewing sarcoma of bone: A report from the Children’s Oncology Group. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.9537] [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
9537 Background: Patients (pts) with Ewing sarcoma (EWS) require local control, either with surgery alone (S), radiation alone (R), or a combination of surgery + radiation (S+R). Optimal choice of local control for disease control remains unclear. Our primary aim was to determine the mode of local control associated with the highest event-free survival (EFS). Methods: Pts with localized EWS of bone treated on INT0091, INT0154, or AEWS0031 phase III trials were included if they had complete local control data, did not have cranial tumors, received local control starting 2-6 months after enrollment, and were randomized to receive standard dose 5-drug chemotherapy every 3 weeks. We used propensity scores to control for differences in age, tumor site, and year of diagnosis between local control groups. We constructed Cox models controlling for local control propensity scores to assess the impact of local control type on EFS and overall survival (OS) from the start of local control. Results: 465 pts were included. Pts selected for S were treated more recently (p < 0.001), more likely to have appendicular tumors (p < 0.001), and younger (p = 0.02). Pts treated with R, compared to S, had higher unadjusted risk of any event (HR 1.70; 95% CI 1.18 - 2.44; p = 0.004) or death (HR 1.84; 95% CI 1.18 – 2.85; p = 0.006). Pts treated with S+R, compared to S, had higher unadjusted risk of death (HR 1.75; 95% CI 1.10 – 2.76; p = 0.02). After adjusting for propensity scores, there was a trend of higher risk of any event for pts treated with R (HR 1.42; 95% CI 0.94 – 2.14; p = 0.10) compared to S, though this was not statistically significant. No other differences in adjusted risk of event or death between local control groups were statistically significant. We confirmed these results with standard Cox models using age, tumor site, and year of diagnosis as covariates. Conclusions: In this large group of uniformly treated pts, investigator choice of local control approach was not significantly related to EFS. These data support current practice of surgical resection when feasible, while validating radiotherapy as a reasonable alternative in selected pts.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Neyssa Marina
- Stanford University School of Medicine, Palo Alto, CA
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Yock TI, Szymonifka J, Friedmann AM, Mahajan A, Yeap BY, MacDonald SM, Kasper HB, Grosshans D, Marcus KC, Tarbell N. Proton radiotherapy for rhabomyosarcoma: Preliminary results from a multicenter prospective study. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.9585] [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
9585 Background: Pediatric rhabdomyosarcoma (RMS) is commonly cured with chemotherapy and radiation. However, late effects of radiotherapy (RT) can be disabling. Proton RT irradiates less normal tissue, which should result in fewer late side effects of treatment. The purpose of this study was to describe the disease control and side effect profile of proton RT in RMS patients (pts). Methods: Eligible pts included those with localized disease and metastatic embryonal RMS if age 2-10. All pts were treated with VAC (vincristine, actinomycin, cyclophosphamide) based chemotherapy and proton RT, median dose 50.4 Gy (36-50.4 GyRBE). Concurrent enrollment in COG protocols was allowed. All pathology/imaging was reviewed at the treating institution. Results: 47 pts with RMS were prospectively enrolled from January 2005 to June 2011 and evaluable for analysis. Median age was 3.1 yrs, (range 0.6-15.6 years; M/F ratio 23:24). There were 1, 7, 37, and 2 Group I, II, III and IV and 14, 12, 19 and 2, Stage I-IV pts respectively, and 33 with embryonal 14 with alveolar/other. Most common sites included PM (48.9%), orbital (23.4%) bladder/prostate (6.4%), H&N non-PM (6.4%), extremities (4.3%), trunk/abdomen 2.1%), perineal/anal region (2.1%) and other (6.4%). Median follow-up is 15.2 months. One/two-year overall survival (OS) and progression-free survival (PFS) for the entire group is 94/81% (OS) and 79/73% (PFS). 2-year OS for stage I,II/III,IV pts is 91/66% (OS, p=0.114) and two-year PFS for these pts is 86/57%, respectively, (p=0.083. 16 (34%) had grade 3/4 acute toxicities attributable to the radiation during treatment, the most common of which was mucositis/oral pain (12.8%), anorexia (4.3%), and erythema (4.3%). Among the 24 pts analyzable for late toxicities with at least 2 yrs of follow up, there were no grade 3 or 4 late toxicities attributable to radiation. Conclusions: Early results of this prospective trial demonstrate comparable disease outcomes and thus far limited late effects in a young pediatric RMS population. However, additional follow up is needed to determine if protons truly reduce rates and severity of late effects compared with photon cohorts published in the literature.
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Affiliation(s)
| | | | | | - Anita Mahajan
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | | | | | | | - David Grosshans
- University of Texas M. D. Anderson Cancer Center, Houston, TX
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Metzger M, Weinstein HJ, Hudson MM, Billett A, Larsen EC, Friedmann AM, Donaldson SS, Krasin MJ, Kun LE, Marcus KC, Yock TI, Tarbell N, Billups C, Wu J, Link MP. Results of a prospective clinical trial for VAMP alone without irradiation for pediatric favorable, early-stage Hodgkin lymphoma patients who achieve an early complete response. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.9503] [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: 11/20/2022] Open
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Yock TI, Yeap BY, Ebb D, MacDonald SM, Pulsifer MB, Marcus KC, Tarbell N. A phase II trial of proton radiotherapy for medulloblastoma: Preliminary results. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.18_suppl.cra9507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
CRA9507 Background: Pediatric medulloblastoma (MB) is commonly cured with surgery, chemotherapy and radiation. However, the late effects of radiotherapy can be disabling. Proton radiotherapy irradiates less normal tissue, which should result in fewer late side effects of treatment. The purpose of this study was to describe the clinical outcomes of proton radiotherapy. Methods: All patients had surgery of the primary tumor followed by proton radiotherapy with or without concurrent chemotherapy and adjuvant platinum based chemotherapy. CSI doses ranged from 18-36 GyE, median dose 23.4 GyE. The tumor bed or posterior fossa was brought to 54 GyE. Concurrent enrollment in COG or other protocols was allowed. All pathology and imaging was reviewed at MGH to confirm the diagnosis. Results: 60 patients with MB were prospectively enrolled from May 2003 to December 2009 and 59 were evaluable for this analysis. Median age 6.6 yrs, range 3.5 - 22 years; M/F ratio 1.3; standard risk (SR, 45) or high risk (HR, 14). The median follow-up is 16 months. Two-year overall survival (OS) and progression-free survival (PFS) for the entire group is 91% and 87%. Two-year OS for SR MB and HR MB is 92% and 87%. 54 pts have baseline (BL) neurocognitive testing and 19 pts (14 SR, 5 HR) have follow-up (FU) evaluations including FSIQ spanning at an average of 2 years. Mean FSIQ at BL and FU are 107 and 102 (paired t-test: 0.046). Endocrine late effects include 4 patients with growth hormone deficiency, 1 patient with central hypothyroidism and 2 other endocrinopathies. Audiology information will be presented. Conclusions: Early results of this prospective trial are promising for improving clinical outcomes in patients with medulloblastoma. [Table: see text]
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Affiliation(s)
- T. I. Yock
- Massachusetts General Hospital, Boston, MA; Children's Hospital Medical Center, Boston, MA; Harvard Medical School, Boston, MA
| | - B. Y. Yeap
- Massachusetts General Hospital, Boston, MA; Children's Hospital Medical Center, Boston, MA; Harvard Medical School, Boston, MA
| | - D. Ebb
- Massachusetts General Hospital, Boston, MA; Children's Hospital Medical Center, Boston, MA; Harvard Medical School, Boston, MA
| | - S. M. MacDonald
- Massachusetts General Hospital, Boston, MA; Children's Hospital Medical Center, Boston, MA; Harvard Medical School, Boston, MA
| | - M. B. Pulsifer
- Massachusetts General Hospital, Boston, MA; Children's Hospital Medical Center, Boston, MA; Harvard Medical School, Boston, MA
| | - K. C. Marcus
- Massachusetts General Hospital, Boston, MA; Children's Hospital Medical Center, Boston, MA; Harvard Medical School, Boston, MA
| | - N. Tarbell
- Massachusetts General Hospital, Boston, MA; Children's Hospital Medical Center, Boston, MA; Harvard Medical School, Boston, MA
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Pulsifer MB, Delgado I, Tarbell N, Kuhlthau K, MacDonald SM, Yock TI. Neurocognitive outcomes after proton radiation for pediatric brain tumors. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.9508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Constine LS, Tarbell N, Hudson MM, Schwartz C, Fisher SG, Muhs AG, Basu SK, Kun LE, Ng A, Mauch P, Sandhu A, Culakova E, Lyman G, Mendenhall N. Subsequent malignancies in children treated for Hodgkin's disease: associations with gender and radiation dose. Int J Radiat Oncol Biol Phys 2008; 72:24-33. [PMID: 18722263 DOI: 10.1016/j.ijrobp.2008.04.067] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Revised: 04/02/2008] [Accepted: 04/08/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE Subsequent malignant neoplasms (SMNs) are a dominant cause of morbidity and mortality in children treated for Hodgkin's disease (HD). We evaluated select demographic and therapeutic factors associated with SMNs, specifically gender and radiation dose. METHODS AND MATERIALS A total of 930 children treated for HD at five institutions between 1960 and 1990 were studied. Mean age at diagnosis was 13.6 years, and mean follow-up was 16.8 years (maximum, 39.4 years). Treatment included radiation alone (43%), chemotherapy alone (9%), or both (48%). RESULTS We found that SMNs occurred in 102 (11%) patients, with a 25-year actuarial rate of 19%. With 15,154 patient years of follow-up, only 7.18 cancers were expected (standardized incidence ratio [SIR] = 14.2; absolute excess risk [AER] = 63 cases/10,000 years). The SIR for female subjects, 19.93, was significantly greater than for males, 8.41 (p < 0.0001). After excluding breast cancer, the SIR for female patients was 15.4, still significantly greater than for male patients (p = 0.0012). Increasing radiation dose was associated with an increasing SIR (p = 0.0085). On univariate analysis, an increased risk was associated with female gender, increasing radiation dose, and age at treatment (12-16 years). Using logistic regression, mantle radiation dose increased risk, and this was 2.5-fold for female patients treated with more than 35 Gy primarily because of breast cancer. CONCLUSIONS Survivors of childhood HD are at risk for SMNs, and this risk is greater for female individuals even after accounting for breast cancer. Although SMNs occur in the absence of radiation therapy, the risk increases with RT dose.
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Affiliation(s)
- Louis S Constine
- Department of Radiation Oncology, University of Rochester, Rochester, NY 14642, USA.
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Basu SK, Schwartz C, Fisher SG, Hudson MM, Tarbell N, Muhs A, Marcus KJ, Mendenhall N, Mauch P, Kun LE, Constine LS. Unilateral and bilateral breast cancer in women surviving pediatric Hodgkin's disease. Int J Radiat Oncol Biol Phys 2008; 72:34-40. [PMID: 18722264 DOI: 10.1016/j.ijrobp.2008.04.068] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Revised: 04/02/2008] [Accepted: 04/14/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE To define demographic and therapeutic associations with the risk of breast cancer in children treated for Hodgkin's disease (HD), particularly the frequency and interval to the development of contralateral breast cancer. METHODS AND MATERIALS All 398 female patients (<19 years) treated for HD in five institutions during the accrual period were evaluated. Mean follow-up was 16.9 years. The standardized incidence ratio (SIR) was calculated as the ratio of the observed number of cases to the expected number of cases, estimated using age-matched controls from the Surveillance, Epidemiology, and End Results database. RESULTS A total of 29 women developed breast cancer (25 invasive, 4 ductal carcinoma in situ; SIR, 37.25; 95% confidence interval, 24.96-53.64). Time to diagnosis was 9.4 to 36.1 years. Cumulative incidence was 24% at 30 years. Ten patients (34%) had bilateral disease (9 metachronous, 1 synchronous). The interval to contralateral breast cancer was 12 to 34 months. On univariate analysis, significant variables included stage of HD, mantle radiation dose, pelvic radiation (protective), and follow-up time. On multivariate analysis, early stage and older age at diagnosis of HD (<or=12 vs. >12 years) were significant predictors of secondary breast cancer. CONCLUSIONS Women surviving pediatric HD were found to have a 37-fold increase in the risk of breast cancer and a high likelihood of rapidly developing bilateral disease. Early-stage HD and age greater than 12 years at diagnosis of HD were independent risk factors. Higher radiation doses may augment risk, and pelvic radiation may be protective. Breast cancer screening methodology and frequency, plus the role of prophylaxis in patients with unilateral disease, require definition.
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Affiliation(s)
- Swati K Basu
- Department of Community and Preventive Medicine, James P Wilmot Cancer Center at the University of Rochester, Rochester, NY 14642, USA
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Leavey PJ, Mascarenhas L, Marina N, Chen Z, Krailo M, Miser J, Brown K, Tarbell N, Bernstein ML, Granowetter L, Gebhardt M, Grier HE. Prognostic factors for patients with Ewing sarcoma (EWS) at first recurrence following multi-modality therapy: A report from the Children's Oncology Group. Pediatr Blood Cancer 2008; 51:334-8. [PMID: 18506764 PMCID: PMC2728357 DOI: 10.1002/pbc.21618] [Citation(s) in RCA: 139] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The prognosis for patients with recurrent Ewing sarcoma (EWS) is very poor with 5-year survival of 13%. METHODS To evaluate prognostic factors for these patients we studied patients initially treated on the multi-institutional study INT0091. RESULTS Two hundred sixty-two patients experienced disease recurrence. The median time to first recurrence was 1.3 years (0-7.4 years), 1.4 years (0-7.4 years) for patients with initially localized disease and 1 year (0-6 years) for patients with initially metastatic disease. Time to first recurrence from date of initial diagnosis was a predictor of post-recurrence survival (P < 0.0001). Twenty-one percent of patients, with recurrent or progressive disease >or=2 years from initial diagnosis, had an estimated 5-year survival of 30% (vs. 7% estimated 5-year survival with an earlier recurrence). No statistical difference was detected between patients whose disease recurred <1 year and between 1 and 2 years from initial diagnosis. A stepwise relative risk model and backwards stepwise regression was used to explore factors significantly associated with risk for post-recurrence death. Significant risk factors for death after recurrence included recurrence at combined local and distant sites, elevated LDH at initial diagnosis and initial recurrence less than 2 years after diagnosis. Isolated pulmonary recurrence was not predictive of survival after recurrence. CONCLUSION Patients with a longer disease control interval represent the subset of patients most likely to survive following recurrence of EWS. All patients with recurrence would benefit from collaborative trials to investigate new therapeutic options.
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Affiliation(s)
- Patrick J. Leavey
- Department of Pediatrics UT Southwestern Medical Center at Dallas and Children’s Medical Center Dallas, Dallas TX
| | - Leo Mascarenhas
- Keck School of Medicine, University of Southern California, Los Angeles CA,Children’s Hospital Los Angeles, Los Angeles CA
| | - Neyssa Marina
- Stanford University Medical Center & Lucile Packard Children’s Hospital, Palo Alto CA
| | - Zhengjia Chen
- Children's Oncology Group - Operations Center, Arcadia CA
| | - Mark Krailo
- Keck School of Medicine, University of Southern California, Los Angeles CA,Children's Oncology Group - Operations Center, Arcadia CA
| | - James Miser
- City of Hope National Medical Center, Duarte CA
| | - Ken Brown
- British Columbia's Children's Hospital, Vancouver, Canada
| | | | | | | | - Mark Gebhardt
- Dana-Farber Cancer Institute and Children's Hosp, Boston MA
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Dey BR, Shaffer J, Yee AJ, McAfee S, Caron M, Power K, Ting DT, Colby C, Preffer F, Ballen K, Attar E, Saidman S, Tarbell N, Sachs D, Sykes M, Spitzer TR. Comparison of outcomes after transplantation of peripheral blood stem cells versus bone marrow following an identical nonmyeloablative conditioning regimen. Bone Marrow Transplant 2007; 40:19-27. [PMID: 17468773 DOI: 10.1038/sj.bmt.1705688] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This is the first study to examine the outcomes in 54 patients with hematologic malignancies who received an HLA-matched related donor bone marrow (BM, n = 42) or GCSF-mobilized peripheral blood stem cells (PBSC, n = 12) following identical nonmyeloablative conditioning with the intention of induction of mixed chimerism (MC) followed by prophylactic donor leukocyte infusion (pDLI) to convert MC to full donor chimerism (FDC) and capture a graft-versus-tumor effect without clinical graft-versus-host disease (GVHD). Neutrophil and platelet recovery were faster and transfusion requirement was less in PBSC recipients (P < 0.05). A total of 48% of BMT recipients achieved FDC with a median conversion time of 84 days, including 13 following pDLI. In contrast, 83% (P = 0.04) in the PBSC group had spontaneous FDC at a median of 14 days, precluding the administration of pDLI. There was no significant difference in the incidences of acute or chronic GVHD, though the rates of chronic GVHD were considerably higher in PBSC group than in the BM group (6/7, 86% vs 10/24, 42%). CD4 and CD8 T-cell recovery was faster in PBSC recipients. In PBSC recipients, a higher number of CD34+ cells was associated with increased rates of severe, grade III-IV acute GVHD.
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Affiliation(s)
- B R Dey
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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Marcus K, Astrakas L, Zurakowski D, Zarifi M, Mintzopoulos D, Poussaint T, Anthony D, De Girolami U, Black P, Tarbell N, Tzika A. Predicting survival of children with CNS tumors using proton magnetic resonance spectroscopic imaging biomarkers. Int J Oncol 2007. [DOI: 10.3892/ijo.30.3.651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Donaldson S, Tarbell N, Weinstein H, Link M, Kun L, Billett A, Marcus K, Hurwitz C, Young J, Brain S, Hudson M. End Results of a Prospective Clinical Trial with VAMP and Low-Dose, Involved-Field Radiation for Pediatric Patients with Favorable, Early-Stage Hodgkin’s Disease. Int J Radiat Oncol Biol Phys 2005. [DOI: 10.1016/j.ijrobp.2005.07.042] [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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Yock T, Schneider R, Friedmann A, Adams J, Fullerton B, Tarbell N. Proton radiotherapy for orbital rhabdomyosarcoma: clinical outcome and a dosimetric comparison with photons. Int J Radiat Oncol Biol Phys 2005; 63:1161-8. [PMID: 15950401 DOI: 10.1016/j.ijrobp.2005.03.052] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2005] [Revised: 03/21/2005] [Accepted: 03/22/2005] [Indexed: 11/20/2022]
Abstract
BACKGROUND Over 85% of pediatric orbital rhabdomyosarcoma (RMS) are cured with combined chemotherapy and radiation. However, the late effects of photon radiation compromise function and cosmetic outcome. Proton radiation can provide excellent tumor dose distributions while sparing normal tissues better than photon irradiation. METHODS AND MATERIALS Conformal 3D photon and proton radiotherapy plans were generated for children treated with proton irradiation for orbital RMS at Massachusetts General Hospital. Dose-volume histograms (90%, 50%, 10%) were generated and compared for important orbital and central nervous system structures. Average percentages of total dose prescribed were calculated based on the 3 dose-volume histogram levels for normal orbital structures for both the proton and photon plans. The percent of normal tissue spared by using protons was calculated. RESULTS Seven children were treated for orbital rhabdomyosarcoma with proton irradiation and standard chemotherapy. The median follow-up is 6.3 years (range, 3.5-9.7 years). Local and distant controls compare favorably to those in other published accounts. There was an advantage in limiting the dose to the brain, pituitary, hypothalamus, temporal lobes, and ipsilateral and contralateral orbital structures. Tumor size and location affect the degree of sparing of normal structures. CONCLUSIONS Fractionated proton radiotherapy is superior to 3D conformal photon radiation in the treatment of orbital RMS. Proton therapy maintains excellent tumor coverage while reducing the radiation dose to adjacent normal structures. Proton radiation therapy minimizes long-term side effects.
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Affiliation(s)
- Torunn Yock
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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Laver JH, Kraveka JM, Hutchison RE, Chang M, Kepner J, Schwenn M, Tarbell N, Desai S, Weitzman S, Weinstein HJ, Murphy SB. Advanced-stage large-cell lymphoma in children and adolescents: results of a randomized trial incorporating intermediate-dose methotrexate and high-dose cytarabine in the maintenance phase of the APO regimen: a Pediatric Oncology Group phase III trial. J Clin Oncol 2005; 23:541-7. [PMID: 15659500 DOI: 10.1200/jco.2005.11.075] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The Pediatric Oncology Group adopted a histology-based approach to non-Hodgkin's lymphoma and treated patients with advanced large-cell lymphoma on a separate protocol (doxorubicin, vincristine, prednisone, 6-mercaptopurin, and methotrexate; APO regimen). In this study, we assessed the effects of an intense antimetabolite therapy alternating with APO on overall survival (OS) and event-free survival (EFS) and looked into biologic correlates. PATIENTS AND METHODS From December 1994 to April 2000, we enrolled 180 eligible pediatric patients with stage III/IV large-cell lymphoma (LCL); 90 patients were randomly assigned to the intermediate-dose methotrexate (IDM) and high-dose cytarabine (HiDAC) arm, 85 patients to the APO arm, and five patients directly to the APO arm by study design due to CNS involvement. Planned therapy duration was 12 months. RESULTS The 4-year EFS for all patients was 67.4% (SE, 4.2%), and OS was 80.1% (SE, 3.6%) without any significant difference between the two arms. The 4-year EFS and OS were 71.8% (SE, 6.1%) and 88.1% (SE, 4.4%), respectively, for patients with anaplastic large-cell lymphoma, and 63.8% (SE, 10.3%) and 70.3% (SE, 9.0%), respectively, for patients with diffuse large B-cell lymphoma. Only 11 patients required radiation (due to unresponsive bulky disease or CNS involvement). The IDM/HiDAC arm was associated with more toxicity. CONCLUSION The efficacy of incorporating IDM/HiDAC in the treatment plan of pediatric and adolescent patients with advanced-stage LCL was inconclusive as to its effect on EFS, regardless of the lymphoma phenotype. It cannot be excluded that with a higher number of patients, one treatment could prove superior and future studies will build on these data.
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Affiliation(s)
- Joseph H Laver
- Department of Pediatrics, Medical College of Virginia, PO Box 980646, Richmond, VA 23298-0646, USA.
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Dey BR, McAfee S, Colby C, Cieply K, Caron M, Saidman S, Preffer F, Shaffer J, Tarbell N, Sackstein R, Sachs D, Sykes M, Spitzer TR. Anti-tumour response despite loss of donor chimaerism in patients treated with non-myeloablative conditioning and allogeneic stem cell transplantation. Br J Haematol 2005; 128:351-9. [PMID: 15667537 DOI: 10.1111/j.1365-2141.2004.05328.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Based on a murine model, we conducted a series of trials of m-myeloablative human leucocyte antigen (HLA)-matched or mismatched related donor stem cell transplantation (SCT) with the intention of inducing mixed chimaerism (MC), then administering prophylactic donor lymphocyte infusions (DLIs), for the treatment of advanced haematologic malignancies. Preparative therapy consisted of cyclophosphamide, equine anti-thymocyte globulin (ATG) or MEDI-507 (an anti-CD2 monoclonal antibody) for in-vivo T-cell depletion, thymic irradiation on day -1 and cyclosporine alone for graft-versus-host disease (GVHD) prophylaxis. DLIs were given as early as 5 weeks post-SCT in patients with MC without evidence of GVHD. Twenty-two patients ultimately lost their graft (<1% donor cells) that could no be rescued by DLIs. Nine of 22 (41%) patients who lost donor chimaerism achieved an objective response, including three patients who showed evidence of disease regression following DLI, despite continued absence of macrochimaerism. Six patients were alive at 2.5-5.5 years following SCT, including four in continuous complete remission. In summary, it is possible to achieve sustained remission in patients with chemorefractory malignancies following non-myeloablative allogeneic SCT, even in the absence of sustained donor macrochimaerism; DLI may contribute to an ongoing anti-tumour effect in these patients. Immunological mechanisms that correlated with rejection of the graft may have a role in anti-tumour responses via a cell or cytokine-mediated pathway.
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Affiliation(s)
- Bimalangshu R Dey
- Department of Medicine Harvard Medical School Boston, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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Dey BR, McAfee S, Colby C, Sackstein R, Saidman S, Tarbell N, Sachs DH, Sykes M, Spitzer TR. Impact of prophylactic donor leukocyte infusions on mixed chimerism, graft-versus-host disease, and antitumor response in patients with advanced hematologic malignancies treated with nonmyeloablative conditioning and allogeneic bone marrow transplantation. Biol Blood Marrow Transplant 2003; 9:320-9. [PMID: 12766882 DOI: 10.1016/s1083-8791(03)00077-6] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.8] [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: 11/19/2022]
Abstract
In an attempt to capture graft-versus-tumor effects without graft-versus-host disease (GVHD), the authors initiated a trial of nonmyeloablative allogeneic bone marrow transplantation (BMT) in patients with advanced hematologic malignancies, with the majority of patients having chemotherapy-refractory disease. Forty-two patients received an HLA-matched related donor BMT after a cyclophosphamide and antithymocyte globulin-based conditioning that also included thymic irradiation for patients who had not received prior mediastinal radiotherapy. Prophylactic donor leukocyte infusion (pDLI) at a dose of 1 x 10(7) CD3(+) cells per kilogram were given beginning 5 weeks post-BMT to 16 patients with mixed chimerism (MC) but without GVHD, whereas 26 patients did not receive pDLI, either because of GVHD or early relapse. Twelve of 16 patients (75%) receiving pDLI had T cell chimerism at the time of pDLI >/=40%. These patients, by day 100 post-BMT, either converted to full donor chimerism (FDC) (n = 10) or had an increase in or stable donor chimerism (n = 2) after pDLI. Four of 4 patients whose T cell chimerism was </=20% at the time of pDLI, lost the graft. In contrast, only 5 of 18 evaluable patients (28%) not receiving a pDLI converted to FDC by day 100 post-BMT, 7 maintained MC, and 10 of an evaluable 22 lost the graft. Patients who had undergone a previous autologous stem cell transplant had a higher rate of conversion to FDC (69% v 31%) and higher incidence of GVHD (69% v 34%) compared with those who did not have a previous autologous SCT. Eleven of 16 patients (69%) who received a pDLI achieved a remission with 50% 1-year progression-free survival rate and 44% 3-year overall survival rate. Nineteen of 42 patients (45%) had >/=grade II acute GVHD, including 12 after BMT and 7 after pDLI. Approximately one third of patients, after having initial MC, eventually lost their donor graft. The authors conclude that (1) pDLI has the potential to convert MC to FDC; (2) sustained remissions can be achieved in patients with chemorefractory hematologic malignancies who receive a pDLI, albeit with a significant risk of acute GVHD; and (3) the degree of donor T cell chimerism at the time of pDLI is predictive of the fate of MC, ie, donor T cell chimerism >/=40% or </=20% at the time of pDLI correlates with conversion of MC or loss of the graft, respectively.
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Affiliation(s)
- Bimalangshu R Dey
- Bone Marrow Transplantation Program/Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, USA.
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Manson J, Rockhill B, Resnick M, Shore E, Nadelson C, Horner M, Tarbell N, Carr P. Sex differences in career progress and satisfaction in an academic medical center. J Am Med Womens Assoc (1972) 2002; 57:194. [PMID: 12405234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Affiliation(s)
- JoAnn Manson
- Division of Preventative Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA.
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Manson J, Rockhill B, Resnick M, Shore E, Nadelson C, Horner M, Tarbell N, Carr P. Gender differences in career progress and satisfaction in an academic medical center. ACTA ACUST UNITED AC 2002. [DOI: 10.1053/cjwh.2002.130406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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LeClerc JM, Billett AL, Gelber RD, Dalton V, Tarbell N, Lipton JM, Barr R, Clavell LA, Asselin B, Hurwitz C, Schorin M, Lipshultz SE, Declerck L, Silverman LB, Cohen HJ, Sallan SE. Treatment of childhood acute lymphoblastic leukemia: results of Dana-Farber ALL Consortium Protocol 87-01. J Clin Oncol 2002; 20:237-46. [PMID: 11773175 DOI: 10.1200/jco.2002.20.1.237] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [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: 01/19/2023] Open
Abstract
PURPOSE To improve efficacy and reduce toxicity of treatment for children with acute lymphoblastic leukemia. PATIENTS AND METHODS Patients from all risk groups, including infants and those with T-cell disease, were treated between 1987 and 1991. Standard-risk (SR) patients did not receive cranial irradiation, whereas high-risk (HR) and very high-risk (VHR) patients participated in a randomized comparison of 18 Gy of cranial irradiation conventionally fractionated versus two fractions per day (hyperfractionated). RESULTS At a median follow-up of 9.2 years, the 9-year event-free survival (EFS +/- SE) was 75% +/- 2% for all 369 patients, 77% +/- 4% for the 142 SR patients, and 73% +/- 3% for the 227 HR/VHR patients (P =.37 comparing SR and HR/VHR). The CNS, with or without concomitant bone marrow involvement, was the first site of relapse in 19 (13%) of the 142 SR patients: 16 (20%) of 79 SR boys and three (5%) of 63 SR girls. This high incidence of relapses necessitated a recall of SR boys for additional therapy. CNS relapse occurred in only two (1%) of 227 HR and VHR patients. There were no outcome differences found among randomized treatment groups. Nine-year overall survival was 84% +/- 2% for the entire population, 93% +/- 2% for SR children, and 79% +/- 3% for HR and VHR children (P <.01 comparing SR and HR/VHR). CONCLUSION A high overall survival outcome was obtained for SR patients despite the high risk of CNS relapse for SR boys, which was presumed to be associated with eliminating cranial radiation without intensifying systemic or intrathecal chemotherapy. For HR/VHR patients, inability to salvage after relapse (nearly all of which were in the bone marrow) remains a significant clinical problem.
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Affiliation(s)
- Jean Marie LeClerc
- Division of Hematology/Oncology, Hopital Sainte Justine, Montreal, Quebec, Canada
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Smith R, Chen Q, Hudson M, Link M, Kun L, Weinstein H, Tarbell N, Billett A, Marcus K, Donaldson S. Prognostic factors in pediatric Hodgkin’s disease. Int J Radiat Oncol Biol Phys 2001. [DOI: 10.1016/s0360-3016(01)02041-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Viswanathan A, Grier H, Litman H, Perez-Atayde A, Shamberger R, Tarbell N, Marcus K. Local therapy for children with rhabdomyosarcoma. Int J Radiat Oncol Biol Phys 2001. [DOI: 10.1016/s0360-3016(01)02038-7] [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: 10/17/2022]
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Constine L, Tarbell N, Hudson M, Schwartz C, Sandhu A, Rubin P, Marcus R, Kun L, Mauch P, Mendenhall N. 172 Second malignant neoplasms in children treated for hodgkin's disease. Int J Radiat Oncol Biol Phys 1999. [DOI: 10.1016/s0360-3016(99)90190-6] [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: 11/29/2022]
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Wong FL, Boice JD, Abramson DH, Tarone RE, Kleinerman RA, Stovall M, Goldman MB, Seddon JM, Tarbell N, Fraumeni JF, Li FP. Cancer incidence after retinoblastoma. Radiation dose and sarcoma risk. JAMA 1997; 278:1262-7. [PMID: 9333268 DOI: 10.1001/jama.278.15.1262] [Citation(s) in RCA: 175] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CONTEXT There is a substantial risk of a second cancer for persons with hereditary retinoblastoma, which is enhanced by radiotherapy. OBJECTIVE To examine long-term risk of new primary cancers in survivors of childhood retinoblastoma and quantify the role of radiotherapy in sarcoma development. DESIGN Cohort incidence study of patients with retinoblastoma followed for a median of 20 years, and nested case-control study of a radiation dose-response relationship for bone and soft tissue sarcomas. SETTING/PARTICIPANTS A total of 1604 patients with retinoblastoma who survived at least 1 year after diagnosis, identified from hospital records in Massachusetts and New York during 1914 to 1984. RESULTS Incidence of subsequent cancers was statistically significantly elevated only in the 961 patients with hereditary retinoblastoma, in whom 190 cancers were diagnosed, vs 6.3 expected in the general population (relative risk [RR], 30 [95% confidence interval, 26-47]). Cumulative incidence (+/-SE) of a second cancer at 50 years after diagnosis was 51.0% (+/-6.2%) for hereditary retinoblastoma, and 5.0% (+/-3.0%) for nonhereditary retinoblastoma. All 114 sarcomas of diverse histologic types occurred in patients with hereditary retinoblastoma. For soft tissue sarcomas, the RRs showed a stepwise increase at all dose categories, and were statistically significant at 10 to 29.9 Gy and 30 to 59.9 Gy. A radiation risk for all sarcomas combined was evident at doses above 5 Gy, rising to 10.7-fold at doses of 60 Gy or greater (P<.05). CONCLUSIONS Genetic predisposition has a substantial impact on risk of subsequent cancers in retinoblastoma patients, which is further increased by radiation treatment. A radiation dose-response relationship is demonstrated for all sarcomas and, for the first time in humans, for soft tissue sarcomas. Retinoblastoma patients should be examined for new cancers and followed into later life to determine whether their extraordinary cancer risk extends to common cancers of adulthood.
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Affiliation(s)
- F L Wong
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Md 20892, USA
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Propper P, Lew C, Levy J, Tarbell N, Hansen C. The role of child life intervention in pediatric radiation oncology. Eur J Cancer 1997. [DOI: 10.1016/s0959-8049(97)84732-6] [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: 10/18/2022]
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Molrine DC, George S, Tarbell N, Mauch P, Diller L, Neuberg D, Shamberger RC, Anderson EL, Phillips NR, Kinsella K, Ambrosino DM. Antibody responses to polysaccharide and polysaccharide-conjugate vaccines after treatment of Hodgkin disease. Ann Intern Med 1995; 123:828-34. [PMID: 7486464 DOI: 10.7326/0003-4819-123-11-199512010-00003] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To compare the immunogenicity of polysaccharide-conjugate vaccines with that of polysaccharide vaccines in patients previously treated for Hodgkin disease. DESIGN All patients were immunized with Haemophilus influenzae type b (HIB)-conjugate and 4-valent meningococcal polysaccharide vaccines. Subgroups of patients were randomly assigned to receive either 23-valent pneumococcal polysaccharide vaccine or a 7-valent pneumococcal-conjugate vaccine that links seven pneumococcal serotypes to the outer membrane protein complex of Neisseria meningitidis. PATIENTS 144 patients who had completed treatment for Hodgkin disease, which had been diagnosed at least 2 years before the study. MEASUREMENTS Antigen-specific antibody concentrations before and 3 to 6 weeks after immunization; number of persons who achieved anti-HIB antibody concentrations considered to be in the protective range. RESULTS The geometric mean anti-HIB antibody concentration increased from 1.79 micrograms/mL before immunization to 54.1 micrograms/mL after; the percentage of persons with antibody concentrations in the protective range increased from 62% before immunization to 99% after. Patients immunized with 23-valent pneumococcal vaccine had a geometric mean pneumococcal antibody concentration after immunization (9.15 micrograms/mL) that was similar to that of healthy controls (10.0 micrograms/mL) for the seven serotypes measured. In contrast, patients who received 7-valent pneumococcal-conjugate vaccine had a significantly lower mean response compared with patients who received 23-valent; their geometric mean antibody concentration after immunization was 4.95 micrograms/mL (P = 0.005). CONCLUSION A single dose of HIB-conjugate vaccine was immunogenic in patients who had completed treatment for Hodgkin disease diagnosed at least 2 years before immunization. In addition, responses to the 23-valent pneumococcal and 4-valent meningococcal vaccines were equivalent to those seen in healthy controls. Finally, patients had a significantly lower response to a single dose of 7-valent pneumococcal-conjugate vaccine than to 23-valent vaccine.
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Affiliation(s)
- D C Molrine
- Laboratory of Infectious Diseases, Dana-Farber Cancer Institute, Boston, MA 02115, USA
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