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Nguyen PL, Huang HCR, Spratt DE, Davicioni E, Sandler HM, Shipley WU, Efstathiou JA, Simko JP, Pollack A, Dicker AP, Roach M, Rosenthal SA, Zeitzer KL, Mendez LC, Hartford AC, Hall WA, Desai AB, Rabinovitch RA, Peters CA, Rodgers JP, Tran P, Feng FY. Analysis of a Biopsy-Based Genomic Classifier in High-Risk Prostate Cancer: Meta-Analysis of the NRG Oncology/Radiation Therapy Oncology Group 9202, 9413, and 9902 Phase 3 Randomized Trials. Int J Radiat Oncol Biol Phys 2023; 116:521-529. [PMID: 36596347 PMCID: PMC10281690 DOI: 10.1016/j.ijrobp.2022.12.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 12/03/2022] [Accepted: 12/19/2022] [Indexed: 01/02/2023]
Abstract
PURPOSE Decipher is a genomic classifier (GC) prospectively validated postprostatectomy. We validated the performance of the GC in pretreatment biopsy samples within the context of 3 randomized phase 3 high-risk definitive radiation therapy trials. METHODS AND MATERIALS A prespecified analysis plan (NRG-GU-TS006) was approved to obtain formalin-fixed paraffin-embedded tissue from biopsy specimens from the NRG biobank from patients enrolled in the NRG/Radiation Therapy Oncology Group (RTOG) 9202, 9413, and 9902 phase 3 randomized trials. After central review, the highest-grade tumors were profiled on clinical-grade whole-transcriptome arrays and GC scores were obtained. The primary objective was to validate the independent prognostic ability for the GC for distant metastases (DM), and secondary for prostate cancer-specific mortality (PCSM) and overall survival (OS) with Cox univariable and multivariable analyses. RESULTS GC scores were obtained on 385 samples, of which 265 passed microarray quality control (69%) and had a median follow-up of 11 years (interquartile range, 9-13). In the pooled cohort, on univariable analysis, the GC was shown to be a prognostic factor for DM (per 0.1 unit; subdistribution hazard ratio [sHR], 1.29; 95% confidence interval [CI], 1.18-1.41; P < .001), PCSM (sHR, 1.28; 95% CI, 1.16-1.41; P < .001), and OS (hazard ratio [HR], 1.16; 95% CI, 1.08-1.22; P < .001). On multivariable analyses, the GC (per 0.1 unit) was independently associated with DM (sHR, 1.22; 95% CI, 1.09-1.36), PCSM (sHR, 1.23; 95% CI, 1.09-1.39), and OS (HR, 1.12; 95% CI, 1.05-1.20) after adjusting for age, Prostate Specific Antigen, Gleason score, cT stage, trial, and randomized treatment arm. GC had similar prognostic ability in patients receiving short-term or long-term androgen-deprivation therapy, but the absolute improvement in outcome varied by GC risk. CONCLUSIONS This is the first validation of a gene expression biomarker on pretreatment prostate cancer biopsy samples from prospective randomized trials and demonstrates an independent association of GC score with DM, PCSM, and OS. High-risk prostate cancer is a heterogeneous disease state, and GC can improve risk stratification to help personalize shared decision making.
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Affiliation(s)
- Paul L Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts; Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
| | - Huei-Chung Rebecca Huang
- GenomeDx Inc, Vancouver, British Columbia, Canada; Decipher Biosciences, San Diego, California; Veracyte, South San Francisco CA
| | - Daniel E Spratt
- Department of Radiation Oncology, UH Cleveland Medical Center, Cleveland, Ohio
| | - Elai Davicioni
- Decipher Biosciences, San Diego, California; Veracyte, South San Francisco CA
| | - Howard M Sandler
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - William U Shipley
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeffry P Simko
- Department of Pathology, UCSF Medical Center-Mount Zion, San Francisco, California
| | - Alan Pollack
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida
| | - Adam P Dicker
- Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Mack Roach
- Department of Pathology, UCSF Medical Center-Mount Zion, San Francisco, California
| | - Seth A Rosenthal
- Department of Radiation Oncology, Sutter Cancer Centers Radiation Oncology Services, Roseville, California
| | - Kenneth L Zeitzer
- Department of Radiation Oncology, Einstein Medical Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Lucas C Mendez
- Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Alan C Hartford
- Department of Radiation Oncology, Dartmouth-Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - William A Hall
- Department of Radiation Oncology, Froedtert and the Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anand B Desai
- Department of Radiation Oncology, Summa Health System, Akron, Ohio
| | - Rachel A Rabinovitch
- Department of Radiation Oncology, University of Colorado Denver, Aurora, Colorado
| | - Christopher A Peters
- Department of Radiation Oncology, Northeast Radiation Oncology Center, Dunmore, Pennsylvania
| | | | - Phuoc Tran
- Department of Radiation Oncology, University of Maryland, Baltimore, Maryland
| | - Felix Y Feng
- Department of Radiation Oncology, UCSF Medical Center-Mission Bay, San Francisco, California
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Affiliation(s)
- Rachel A Rabinovitch
- Department of Radiation Oncology, Comprehensive Cancer Center, University of Colorado, Aurora, Colorado.
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Shiao JC, Wolf AB, Rabinovitch RA, Smith C, Kleinschmidt-DeMasters B, Ney DE. Long-Term Control of Primary Cerebral ALH Amyloidoma With Focal Radiation Therapy. Adv Radiat Oncol 2022; 7:100831. [PMID: 34934868 PMCID: PMC8654634 DOI: 10.1016/j.adro.2021.100831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/13/2021] [Accepted: 09/30/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jay C. Shiao
- Department of Radiation Oncology, Aurora, Colorado
- University of Colorado Cancer Center, Aurora, Colorado
- Corresponding author: Jay Shiao, MD, MPH
| | | | - Rachel A. Rabinovitch
- Department of Radiation Oncology, Aurora, Colorado
- University of Colorado Cancer Center, Aurora, Colorado
| | - Clay Smith
- University of Colorado Cancer Center, Aurora, Colorado
- Division of Hematology, Department of Medicine, Aurora, Colorado
| | - B.K. Kleinschmidt-DeMasters
- University of Colorado Cancer Center, Aurora, Colorado
- Department of Pathology, University of Colorado School of Medicine, Aurora, Colorado
| | - Douglas E. Ney
- University of Colorado Cancer Center, Aurora, Colorado
- Department of Neurology, Aurora, Colorado
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Jimenez RB, Rabinovitch RA. Caring for the Whole Patient After Breast Cancer Therapy: A Survivorship Guide for Radiation Oncologists. Pract Radiat Oncol 2021; 12:e1-e6. [PMID: 34454104 DOI: 10.1016/j.prro.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/12/2021] [Accepted: 08/16/2021] [Indexed: 11/29/2022]
Abstract
With 5-year survival rates after breast cancer therapy exceeding 90%, comprehensive follow-up care is a vital component of the treatment plan for patients who have completed active therapy. Although radiation oncologists are generally comfortable with management of the locoregional toxicities of breast cancer radiation therapy, many may be less familiar with the toxicities and available interventions associated with surgery, chemotherapy, and antihormone therapy. For radiation oncologists to provide the greatest value to their patients and play a meaningful role in patients with breast cancer follow-up care, multisystem assessment and management, beyond the breast/chest and axilla, is key. This guide is intended as an educational and practical tool to assist any oncology caregiver with a thorough multisystem assessment and management of the most common survivorship issues for the treated breast cancer patient. Hyperlinks to published data supporting or summarizing the intervention are provided for further reading in the online version, along with sample "Follow-Up Note and After Visit Summary" templates.
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Affiliation(s)
- Rachel B Jimenez
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
| | - Rachel A Rabinovitch
- Department of Radiation Oncology, University of Colorado Hospital, Denver, Colorado
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Vicini FA, Cecchini RS, White JR, Arthur DW, Julian TB, Rabinovitch RA, Kuske RR, Ganz PA, Parda DS, Scheier MF, Winter KA, Paik S, Kuerer HM, Vallow LA, Pierce LJ, Mamounas EP, McCormick B, Costantino JP, Bear HD, Germain I, Gustafson G, Grossheim L, Petersen IA, Hudes RS, Curran WJ, Bryant JL, Wolmark N. Long-term primary results of accelerated partial breast irradiation after breast-conserving surgery for early-stage breast cancer: a randomised, phase 3, equivalence trial. Lancet 2019; 394:2155-2164. [PMID: 31813636 PMCID: PMC7199428 DOI: 10.1016/s0140-6736(19)32514-0] [Citation(s) in RCA: 280] [Impact Index Per Article: 56.0] [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] [Received: 07/22/2019] [Revised: 08/20/2019] [Accepted: 10/01/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Whole-breast irradiation after breast-conserving surgery for patients with early-stage breast cancer decreases ipsilateral breast-tumour recurrence (IBTR), yielding comparable results to mastectomy. It is unknown whether accelerated partial breast irradiation (APBI) to only the tumour-bearing quadrant, which shortens treatment duration, is equally effective. In our trial, we investigated whether APBI provides equivalent local tumour control after lumpectomy compared with whole-breast irradiation. METHODS We did this randomised, phase 3, equivalence trial (NSABP B-39/RTOG 0413) in 154 clinical centres in the USA, Canada, Ireland, and Israel. Adult women (>18 years) with early-stage (0, I, or II; no evidence of distant metastases, but up to three axillary nodes could be positive) breast cancer (tumour size ≤3 cm; including all histologies and multifocal breast cancers), who had had lumpectomy with negative (ie, no detectable cancer cells) surgical margins, were randomly assigned (1:1) using a biased-coin-based minimisation algorithm to receive either whole-breast irradiation (whole-breast irradiation group) or APBI (APBI group). Whole-breast irradiation was delivered in 25 daily fractions of 50 Gy over 5 weeks, with or without a supplemental boost to the tumour bed, and APBI was delivered as 34 Gy of brachytherapy or 38·5 Gy of external bream radiation therapy in 10 fractions, over 5 treatment days within an 8-day period. Randomisation was stratified by disease stage, menopausal status, hormone-receptor status, and intention to receive chemotherapy. Patients, investigators, and statisticians could not be masked to treatment allocation. The primary outcome of invasive and non-invasive IBTR as a first recurrence was analysed in the intention-to-treat population, excluding those patients who were lost to follow-up, with an equivalency test on the basis of a 50% margin increase in the hazard ratio (90% CI for the observed HR between 0·667 and 1·5 for equivalence) and a Cox proportional hazard model. Survival was assessed by intention to treat, and sensitivity analyses were done in the per-protocol population. This trial is registered with ClinicalTrials.gov, NCT00103181. FINDINGS Between March 21, 2005, and April 16, 2013, 4216 women were enrolled. 2109 were assigned to the whole-breast irradiation group and 2107 were assigned to the APBI group. 70 patients from the whole-breast irradiation group and 14 from the APBI group withdrew consent or were lost to follow-up at this stage, so 2039 and 2093 patients respectively were available for survival analysis. Further, three and four patients respectively were lost to clinical follow-up (ie, survival status was assessed by phone but no physical examination was done), leaving 2036 patients in the whole-breast irradiation group and 2089 in the APBI group evaluable for the primary outcome. At a median follow-up of 10·2 years (IQR 7·5-11·5), 90 (4%) of 2089 women eligible for the primary outcome in the APBI group and 71 (3%) of 2036 women in the whole-breast irradiation group had an IBTR (HR 1·22, 90% CI 0·94-1·58). The 10-year cumulative incidence of IBTR was 4·6% (95% CI 3·7-5·7) in the APBI group versus 3·9% (3·1-5·0) in the whole-breast irradiation group. 44 (2%) of 2039 patients in the whole-breast irradiation group and 49 (2%) of 2093 patients in the APBI group died from recurring breast cancer. There were no treatment-related deaths. Second cancers and treatment-related toxicities were similar between the two groups. 2020 patients in the whole-breast irradiation group and 2089 in APBI group had available data on adverse events. The highest toxicity grade reported was: grade 1 in 845 (40%), grade 2 in 921 (44%), and grade 3 in 201 (10%) patients in the APBI group, compared with grade 1 in 626 (31%), grade 2 in 1193 (59%), and grade 3 in 143 (7%) in the whole-breast irradiation group. INTERPRETATION APBI did not meet the criteria for equivalence to whole-breast irradiation in controlling IBTR for breast-conserving therapy. Our trial had broad eligibility criteria, leading to a large, heterogeneous pool of patients and sufficient power to detect treatment equivalence, but was not designed to test equivalence in patient subgroups or outcomes from different APBI techniques. For patients with early-stage breast cancer, our findings support whole-breast irradiation following lumpectomy; however, with an absolute difference of less than 1% in the 10-year cumulative incidence of IBTR, APBI might be an acceptable alternative for some women. FUNDING National Cancer Institute, US Department of Health and Human Services.
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Affiliation(s)
- Frank A Vicini
- NRG Oncology, Pittsburgh, PA, USA; MHP Radiation Oncology Institute, St Joseph Mercy Hospital Campus, Pontiac, MI, USA.
| | - Reena S Cecchini
- NRG Oncology, Pittsburgh, PA, USA; University of Pittsburgh, Pittsburgh, PA, USA
| | - Julia R White
- NRG Oncology, Pittsburgh, PA, USA; Ohio State University Comprehensive Cancer Center-Arthur G James Cancer Hospital and Richard J Solove Research Institute, Columbus, OH, USA
| | - Douglas W Arthur
- NRG Oncology, Pittsburgh, PA, USA; Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Thomas B Julian
- NRG Oncology, Pittsburgh, PA, USA; Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Rachel A Rabinovitch
- NRG Oncology, Pittsburgh, PA, USA; University of Colorado Cancer Center, Aurora, CO, USA
| | - Robert R Kuske
- NRG Oncology, Pittsburgh, PA, USA; Arizona Breast Cancer Specialists, Arizona Center for Cancer Care, Scottsdale, AZ, USA
| | - Patricia A Ganz
- NRG Oncology, Pittsburgh, PA, USA; University of California at Los Angeles, Los Angeles, CA, USA
| | - David S Parda
- NRG Oncology, Pittsburgh, PA, USA; Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | | | - Kathryn A Winter
- NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, PA, USA
| | - Soonmyung Paik
- NRG Oncology, Pittsburgh, PA, USA; Yonsei University College of Medicine, Seoul, Korea
| | - Henry M Kuerer
- NRG Oncology, Pittsburgh, PA, USA; MD Anderson Cancer Center, Houston, TX, USA
| | | | - Lori J Pierce
- Southwest Oncology Group Cancer Research Network, Hope Foundation for Cancer Research, Portland, OR, USA; Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Eleftherios P Mamounas
- NRG Oncology, Pittsburgh, PA, USA; Orlando Health, UF Health Cancer Center, Orlando, FL, USA
| | - Beryl McCormick
- NRG Oncology, Pittsburgh, PA, USA; Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joseph P Costantino
- NRG Oncology, Pittsburgh, PA, USA; University of Pittsburgh, Pittsburgh, PA, USA
| | - Harry D Bear
- NRG Oncology, Pittsburgh, PA, USA; Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Isabelle Germain
- NRG Oncology, Pittsburgh, PA, USA; Centre Hospitalier Universitaire de Québec-Université Laval, Pavillon Hôtel-Dieu de Québec, Québec City, QC, Canada
| | - Gregory Gustafson
- NRG Oncology, Pittsburgh, PA, USA; Community Clinical Oncology Program, William Beaumont Hospital, Sterling Heights, MI, USA
| | - Linda Grossheim
- NRG Oncology, Pittsburgh, PA, USA; Summit Cancer Center, Post Falls, ID, USA
| | - Ivy A Petersen
- NRG Oncology, Pittsburgh, PA, USA; Mayo Clinic, Rochester, MN, USA
| | - Richard S Hudes
- NRG Oncology, Pittsburgh, PA, USA; Saint Agnes Hospital, Baltimore, MD, USA; Thomas Jefferson University, Baltimore, MD, USA
| | - Walter J Curran
- NRG Oncology, Pittsburgh, PA, USA; Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - John L Bryant
- NRG Oncology, Pittsburgh, PA, USA; University of Pittsburgh, Pittsburgh, PA, USA
| | - Norman Wolmark
- NRG Oncology, Pittsburgh, PA, USA; University of Pittsburgh, Pittsburgh, PA, USA; Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
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Vicini FA, Cecchini RS, White JR, Julian TB, Arthur DW, Rabinovitch RA, Kuske RR, Parda DS, Ganz PA, Scheier MF, Winter KA, Paik S, Kuerer HM, Vallow LA, Pierce LJ, Mamounas EP, Costantino JP, Bear HD, Germaine I, Gustafson G, Grossheim L, Petersen IA, Hudes RS, Curran WJ, Wolmark N. Abstract GS4-04: Primary results of NSABP B-39/RTOG 0413 (NRG Oncology): A randomized phase III study of conventional whole breast irradiation (WBI) versus partial breast irradiation (PBI) for women with stage 0, I, or II breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-gs4-04] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Conventional WBI after lumpectomy for early-stage breast cancer decreases ipsilateral breast tumor recurrence (IBTR), yielding comparable results to mastectomy. Accelerated PBI appears effective in reducing IBTR by treating only the tumor bed area. As the majority of IBTR occur at or in the vicinity of the tumor bed, we hypothesized that PBI would be as effective as WBI in controlling IBTR. The primary aim of NSABP B-39/RTOG 0413 was to determine if PBI provides equivalent local tumor control post lumpectomy compared to WBI in pts with early-stage breast cancer. The equivalency test was based on a 50% margin of increase in the hazard ratio (HR=1.5). Secondary endpoints included: overall survival (OS), recurrence-free interval (RFI), distant disease-free interval (DDFI), and toxicity.
Methods: Eligible pts had lumpectomy with histologically-free margins and 0-3 positive axillary nodes. Pts were stratified by stage, menopausal status, hormone receptor status, and intent to receive chemotherapy and then randomized to PBI or WBI. PBI was 10 fractions of 3.4-3.85 Gy, given twice daily with either brachytherapy or 3D external beam radiation. WBI was 50 Gy in 2 Gy fractions given daily with a sequential boost to the surgical cavity. Follow-up was every 6 mos for 5 yrs and then annually. All analyses were by intent-to-treat.
Results: From 3-21-05 to 4-16-13, 4216 pts were randomized: 2107 PBI; 2109 WBI. 61% were postmenopausal; 81% were hormone receptor-positive; 29% intended to receive chemotherapy. Stage distribution was: DCIS, 24%; invasive pN0, 65%; invasive pN1, 10%. As of 7-31-18, median follow-up was 10.2 yrs. There were 161 IBTRs as first events: 90 PBI v 71 WBI (HR 1.22; 90%CI 0.94-1.58). Per protocol-defined margin, to declare PBI and WBI equivalent regarding IBTR risk, the 90% CI for the observed HR had to lie entirely between 0.667 and 1.5. The percent of pts IBTR-free at 10 yrs was 95.2% PBI v 95.9% WBI. A statistically significant difference in the 10-yr RFI rate favored WBI (91.9% PBI v 93.4% WBI; HR 1.32; 95%CI 1.04-1.68; p=0.02). No statistically significant differences existed between PBI and WBI in DDFI (HR 1.31; 95%CI 0.91-1.91; p=0.15), OS (HR 1.10; 95%CI 0.90-1.35; p=0.35), or DFS (HR 1.12; 95%CI 0.98-1.29; p=0.11). Grade 3 toxicity was 9.6% PBI v 7.1% WBI, and grade 4-5 toxicity was 0.5% v 0.3%, respectively.
Discussion: PBI did not meet the criteria for equivalence to WBI in controlling IBTR based on the upper limit of the hazard ratio confidence interval. However, the absolute difference in 10-yr rate of IBTR was <1% (4.8% PBI v 4.1% WBI). The risk of an RFI event was statistically significantly higher for PBI compared to WBI, but the absolute difference in 10-yr RFI rate was also small (8.1% PBI v 6.6% WBI). DDFI, OS, and DFS were not statistically different for PBI v WBI. Grade 3-5 toxicities, although low, were more common for PBI than WBI. The trial population was heterogeneous, ranging from Stage 0-2 breast cancer, and outcome by risk categories are being analyzed.
Support: U10CA180868, -180822, UG1CA189867.
Citation Format: Vicini FA, Cecchini RS, White JR, Julian TB, Arthur DW, Rabinovitch RA, Kuske RR, Parda DS, Ganz PA, Scheier MF, Winter KA, Paik S, Kuerer HM, Vallow LA, Pierce LJ, Mamounas EP, Costantino JP, Bear HD, Germaine I, Gustafson G, Grossheim L, Petersen IA, Hudes RS, Curran, Jr. WJ, Wolmark N. Primary results of NSABP B-39/RTOG 0413 (NRG Oncology): A randomized phase III study of conventional whole breast irradiation (WBI) versus partial breast irradiation (PBI) for women with stage 0, I, or II breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr GS4-04.
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Affiliation(s)
- FA Vicini
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - RS Cecchini
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - JR White
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - TB Julian
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - DW Arthur
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - RA Rabinovitch
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - RR Kuske
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - DS Parda
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - PA Ganz
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - MF Scheier
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - KA Winter
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - S Paik
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - HM Kuerer
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - LA Vallow
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - LJ Pierce
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - EP Mamounas
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - JP Costantino
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - HD Bear
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - I Germaine
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - G Gustafson
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - L Grossheim
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - IA Petersen
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - RS Hudes
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - WJ Curran
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - N Wolmark
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
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8
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Seider MJ, Pugh SL, Langer C, Wyatt G, Demas W, Rashtian A, Clausen CL, Derdel JD, Cleary SF, Peters CA, Ramalingam A, Clarkson JE, Tomblyn M, Rabinovitch RA, Kachnic LA, Berk LB. Randomized phase III trial to evaluate radiopharmaceuticals and zoledronic acid in the palliation of osteoblastic metastases from lung, breast, and prostate cancer: report of the NRG Oncology RTOG 0517 trial. Ann Nucl Med 2018; 32:553-560. [PMID: 30094545 DOI: 10.1007/s12149-018-1278-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 07/11/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Skeletal-related events (SREs), common sequelae of metastatic cancer, are reduced by bisphosphonates. In this study, it was postulated that radiopharmaceuticals, added to bisphosphonates, could further decrease the incidence of SREs. METHODS NRG Oncology RTOG 0517 randomized patients with breast, lung, and prostate cancer and blastic bone metastases to either zoledronic acid (ZA) alone or ZA plus radiopharmaceuticals (Sr-89 or Sm-153). The primary endpoint was time to development of SREs. Secondary objectives included quality of life (QOL), pain control, overall survival (OS), and toxicity. RESULTS 261 patients (median age 68; 62% male; 55% prostate, 35% breast, 10% lung) were accrued between July 2006 and February 2011. The study closed early due to a lower than expected rate of SREs. 52 (42%) patients in the ZA arm and 49 (40%) in the radiopharmaceutical arm experienced an SRE. Median time free of SREs was 29.9 and 27.4 months, respectively (p = 0.84). Median OS in the ZA arm and radiopharmaceutical arms was 32.1 and 26.9 months, respectively (p = 0.37). Cox proportional hazards regression model showed that primary disease site (lung) and number of bone metastases (> 2) had a negative impact on OS (p < 0.0001, p = 0.01, respectively). The addition of radiopharmaceuticals to ZA led to a significant reduction in pain at 1 month based on BPI worst score (p = 0.02). No other group differences were noted for QOL or toxicity. CONCLUSION The addition of radiopharmaceuticals to bisphosphonates did not alter time to SREs or OS for patients with breast, lung, prostate cancers and blastic bone metastases, although it was associated with significant pain reduction at 1 month. CLINICAL TRIAL REGISTRY This protocol (RTOG 0517) is registered with ClinicalTrials.gov (NCT00365105), and may be viewed online at http://www.clinicaltrials.gov/ct2/show/NCT00365105?term=RTOG+0517&rank=1 .
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Affiliation(s)
| | - Stephanie L Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA, USA
| | - Corey Langer
- University of Pennsylvania, Philadelphia, PA, USA
| | - Gwen Wyatt
- Michigan State University, East Lansing, MI, USA
| | | | - Afshin Rashtian
- University of Southern California-Los Angeles, Los Angeles, CA, USA
| | | | - Jerome David Derdel
- Mount Nittany Medical Center Penn State Cancer Institute, State College, PA, USA
| | | | | | | | - James E Clarkson
- Singing River Hospital Regional Cancer Center, Pascagoula, MS, USA
| | - Michael Tomblyn
- University of South Florida Morsani School of Medicine, Tampa, FL, USA
| | | | - Lisa A Kachnic
- Boston Medical Center MBCCOP, Boston, MA, USA.,Vanderbilt Ingram Cancer Center, Vanderbilt University, Nashville, TN, USA
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9
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Stokes WA, Amini A, Jackson MW, Plimpton SR, Kounalakis N, Kabos P, Rabinovitch RA, Rusthoven CG, Fisher CM. Patterns of Fractionation and Boost Usage in Adjuvant External Beam Radiotherapy for Ductal Carcinoma in Situ in the United States. Clin Breast Cancer 2017; 18:220-228. [PMID: 28797765 DOI: 10.1016/j.clbc.2017.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 06/06/2017] [Accepted: 06/23/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND While the roles of hypofractionated (HFxn) radiotherapy and lumpectomy boost in the adjuvant management of invasive breast cancer are supported by the results of clinical trials, randomized data supporting their use for ductal carcinoma in situ (DCIS) are forthcoming. We sought to evaluate current national trends and identify factors associated with HFxn and boost usage using the National Cancer Database. PATIENTS AND METHODS We queried the National Cancer Database for women diagnosed with DCIS from 2004 to 2014 undergoing external beam radiotherapy after breast conservation surgery. Patients were categorized as receiving either conventional fractionation (CFxn) or HFxn and as either receiving or not receiving a boost. Multiple logistic regression was performed to identify demographic, clinical, and treatment factor associations. RESULTS A total of 101,615 women were identified, with 87,641 (86.2%) receiving CFxn, 13,974 (13.8%) receiving HFxn, and most patients in each group (84.9% and 57.7%, respectively) receiving a boost. Implementation of HFxn increased from 4.3% in 2004 to 33.0% in 2014, and the use of a boost declined from 83.3% to 74.6%. HFxn receipt was independently associated with later year of diagnosis, older age, higher income, greater distance from treatment facility, greater facility volume, academic facility type, Western residence, smaller lesions, and nonreceipt of a boost. Factors associated with boost receipt included earlier year of diagnosis, younger age, higher income, community facility type, adverse pathologic features, and nonreceipt of HFxn. CONCLUSION Although CFxn with a boost remains the most common external beam radiotherapy strategy for DCIS, implementation of HFxn without a boost appears to be increasing. Practice patterns at present seem to be driven by guidelines for invasive breast cancer and nonclinical factors.
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Affiliation(s)
- William A Stokes
- Department of Radiation Oncology, University of Colorado Denver School of Medicine, Aurora, CO
| | - Arya Amini
- Department of Radiation Oncology, University of Colorado Denver School of Medicine, Aurora, CO
| | - Matthew W Jackson
- Department of Radiation Oncology, University of Colorado Denver School of Medicine, Aurora, CO
| | - S Reed Plimpton
- Department of Radiation Oncology, University of California, Irvine, School of Medicine, Irvine, CA
| | - Nicole Kounalakis
- Department of Surgery, University of Colorado Denver School of Medicine, Aurora, CO
| | - Peter Kabos
- Department of Medicine, University of Colorado Denver School of Medicine, Aurora, CO
| | - Rachel A Rabinovitch
- Department of Radiation Oncology, University of Colorado Denver School of Medicine, Aurora, CO
| | - Chad G Rusthoven
- Department of Radiation Oncology, University of Colorado Denver School of Medicine, Aurora, CO
| | - Christine M Fisher
- Department of Radiation Oncology, University of Colorado Denver School of Medicine, Aurora, CO.
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10
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Brown RJ, Sams S, Wolverton DE, Chong T, Borges VF, Rabinovitch RA, Murphy CD. Don't Be Fooled by DCIS. Oncology (Williston Park) 2017; 31:549-561. [PMID: 28712099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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11
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Overholser L, Shagisultanova E, Rabinovitch RA, Kounalakis N, Diamond J, Finlayson CA, Fisher CM, Kabos P, Elias AD, Borges VF, Mayordomo J. Breast Cancer Following Radiation for Hodgkin Lymphoma: Clinical Scenarios and Risk-Reducing Strategies. Oncology (Williston Park) 2016; 30:1063-1070. [PMID: 27987198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Since most patients with Hodgkin lymphoma survive their disease, long-term issues such as development of second primary malignancies arise, especially in patients treated with multimodal therapy including radiation therapy plus chemotherapy. The risk of breast cancer is significantly elevated in women exposed to high-dose ionizing radiation to the chest before age 40. The case of a 48-year-old patient with a lump in her right breast is presented as a clinical scenario in this article. We review available strategies for screening and risk reduction through chemoprevention or risk-reducing surgery, as well as challenges for management of breast cancer in patients with prior exposure to radiation for Hodgkin lymphoma. The Children's Oncology Group clinical practice guidelines for long-term follow-up care of pediatric cancer survivors provide recommendations that have been endorsed by American and European oncologists.
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12
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Brown RJ, Murphy CD, Lisella GH, Libby AL, Njiaju UO, Rabinovitch RA, Borges VF. A 40-Year-Old Woman With a New Triple-Negative Breast Mass, Shown on Biopsy to Be Metaplastic Carcinoma. Oncology (Williston Park) 2016; 30:628-652. [PMID: 27432366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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13
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Rusthoven CG, Rabinovitch RA, Jones BL, Koshy M, Amini A, Yeh N, Jackson MW, Fisher CM. The impact of postmastectomy and regional nodal radiation after neoadjuvant chemotherapy for clinically lymph node-positive breast cancer: a National Cancer Database (NCDB) analysis. Ann Oncol 2016; 27:818-27. [PMID: 26861597 DOI: 10.1093/annonc/mdw046] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 01/26/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Following neoadjuvant chemotherapy (NAC), the optimal strategies for postmastectomy radiotherapy (PMRT) and regional nodal irradiation (RNI) after breast-conserving surgery (BCS) are controversial. In this analysis, we evaluate the impact of these radiotherapy (RT) approaches for women with clinically node-positive breast cancer treated with NAC in the National Cancer Database (NCDB). PATIENTS AND METHODS Women with cT1-3 cN1 M0 breast cancer treated with NAC were divided into four cohorts by surgery [Mastectomy (Mast) versus BCS] and post-chemotherapy pathologic nodal status (ypN0 versus ypN+). Overall survival (OS) was estimated using the Kaplan-Meier method and RT approaches were analyzed using the log-rank test, multivariate Cox models, and propensity score-matched analyses. RESULTS From 2003 to 2011, 15 315 cases were identified including 3040 Mast-ypN0, 7243 Mast-ypN+, 2070 BCS-ypN0, and 2962 BCS-ypN+ patients. On univariate analysis, PMRT was associated with improved OS for both Mast-ypN0 (P = 0.019) and Mast-ypN+ (P < 0.001) patients. On multivariate analyses adjusted for factors including age, comorbidity score, cT stage, in-breast pathologic complete response, axillary surgery, ypN stage, estrogen receptor status and hormone therapy, PMRT remained independently associated with improved OS among Mast-ypN0 [hazard ratio (HR) = 0.729, 95% confidence interval (CI) 0.566-0.939, P = 0.015] and Mast-ypN+ patients (HR = 0.772, 95% CI 0.689-0.866, P < 0.001). No differences in OS were observed with the addition of RNI to breast RT for BCS-ypN0 or BCS-ypN+ patients. Propensity score-matched analyses demonstrated identical patterns of significance. On subset analysis, OS was improved with PMRT in each pathologic nodal subgroup (ypN0, ypN1, and ypN2-3) (all P < 0.05). CONCLUSIONS In the largest reported analysis of RT for cN1 patients treated with NAC, PMRT was associated with improved OS for all pathologic nodal subgroups. No OS differences were observed with the addition of RNI to breast RT.
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Affiliation(s)
- C G Rusthoven
- Department of Radiation Oncology, The University of Colorado School of Medicine, Aurora
| | - R A Rabinovitch
- Department of Radiation Oncology, The University of Colorado School of Medicine, Aurora
| | - B L Jones
- Department of Radiation Oncology, The University of Colorado School of Medicine, Aurora
| | - M Koshy
- Department of Radiation Oncology Department of Radiation and Cellular Oncology, The University of Chicago School of Medicine, Chicago, USA
| | - A Amini
- Department of Radiation Oncology, The University of Colorado School of Medicine, Aurora
| | - N Yeh
- Department of Radiation Oncology, The University of Colorado School of Medicine, Aurora
| | - M W Jackson
- Department of Radiation Oncology, The University of Colorado School of Medicine, Aurora
| | - C M Fisher
- Department of Radiation Oncology, The University of Colorado School of Medicine, Aurora
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14
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Fisher CM, Diamond JR, Kounalakis N, Kabos P, Mayordomo J, Rabinovitch RA, Murphy C, Finlayson C, Borges VF, Elias AD. The integration of locoregional with systemic adjuvant therapy for early-stage breast cancer: the shifting sands of decision-making. Breast Cancer Management 2014. [DOI: 10.2217/bmt.13.83] [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: 11/21/2022] Open
Abstract
SUMMARY Given the generally excellent outcomes for modern breast cancer treatment, the recognition that overtreatment is commonplace is the driving force to reduce the treatment impact of surgery, radiation therapy and chemotherapy. Many recent trials have demonstrated that fewer axillary lymph node dissections, smaller radiation field sizes and less administration of chemotherapy are all feasible without compromising the long-term outcomes. However, each of these trials has studied a single modality while maintaining the intensities of the other modalities. There is a natural tendency, albeit controversial, to reduce more than one modality at a time. We review the literature, and counsel the breast cancer oncologist to work as a multimodality team to decide with the patient which modality can be reduced, and which should be preserved in its intensity.
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Affiliation(s)
- Christine M Fisher
- Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, CO, USA
| | - Jennifer R Diamond
- Department of Medical Oncology, University of Colorado Cancer Center, Anschutz Medical Campus, Mailstop 8117, 12801 East 17th Avenue, Aurora, CO 80045, USA
| | - Nicole Kounalakis
- Department of Surgery, University of Colorado Cancer Center, Aurora, CO, USA
| | - Peter Kabos
- Department of Medical Oncology, University of Colorado Cancer Center, Anschutz Medical Campus, Mailstop 8117, 12801 East 17th Avenue, Aurora, CO 80045, USA
| | - Jose Mayordomo
- Department of Medical Oncology, University of Colorado Cancer Center, Anschutz Medical Campus, Mailstop 8117, 12801 East 17th Avenue, Aurora, CO 80045, USA
| | - Rachel A Rabinovitch
- Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, CO, USA
| | - Colleen Murphy
- Department of Surgery, University of Colorado Cancer Center, Aurora, CO, USA
| | - Christina Finlayson
- Department of Surgery, University of Colorado Cancer Center, Aurora, CO, USA
| | - Virginia F Borges
- Department of Medical Oncology, University of Colorado Cancer Center, Anschutz Medical Campus, Mailstop 8117, 12801 East 17th Avenue, Aurora, CO 80045, USA
| | - Anthony D Elias
- Department of Medical Oncology, University of Colorado Cancer Center, Anschutz Medical Campus, Mailstop 8117, 12801 East 17th Avenue, Aurora, CO 80045, USA
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15
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Cobleigh MA, Anderson SJ, Juilan TB, Siziopikou KP, Arthur DW, Rabinovitch RA, Zheng P, Mamounas EP, Wolmark N. Abstract OT2-3-02: NSABP B-43: A phase III clinical trial to compare trastuzumab (T) given concurrently with radiation therapy (RT) to RT alone for women with HER2+ DCIS resected by lumpectomy (Lx). Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-ot2-3-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: A significant amount of DCIS is ER negative and/or overexpresses HER2. This provides an opportunity to test targeted therapy in DCIS. In xenograft models and cell lines, T boosts RT effectiveness. In T-treated HER2+ patients, apoptosis occurs within 1 wk of single agent T use, with T found in ductal aspirates. Ample safety evidence for T exists. T given during whole breast irradiation (WBI) may improve results for lumpectomy (Lx) resected HER2+ DCIS. A trial to examine this question will enhance the understanding of breast tumor biology and the prevention of such tumors and could possibly extend breast-conserving surgery benefits for women with DCIS.
Method: After Lx for pure DCIS, each patient's DCIS lesion is centrally tested for HER2 by IHC analysis. HER2 2+ tumors undergo FISH analysis. HER2 3+ or FISH+ patients can be randomly assigned to 2 doses of T, 3 weeks apart during WBI or to WBI alone.
Women ≥18 yrs. with a margin-clear Lx for pure DCIS, with ECOG status 0/1 who are clinically or pathologically node negative are eligible. Centrally tested DCIS must be HER2 +. ER and/or PR status must be known before randomization.
Primary aims are to determine if T decreases ipsilateral breast cancer recurrence, ipsilateral skin cancer recurrence, or ipsilateral DCIS. Secondary aims are to determine the benefit of T in preventing regional or distant recurrence and contralateral invasive breast cancer or DCIS. NSABP B-43 will determine if DFS, recurrence-free interval, and OS can be improved with the use of T. 2000 patients will be accrued over 7.9 yrs, with a definitive analysis of primary endpoints performed at 163 ipsilateral breast cancer events (7.5 - 8 yrs. after protocol initiation) with an 80% power to detect a hazard reduction of 36%, from 1.73 ipsilateral breast cancer events per 100 pt-yrs to 1.11 events per 100 pt-yrs. The 36% observed reduction in the hazard of IIBCR-SCR-DCIS on the T arm is based on a projection of 40% hazard reduction if the compliance were perfect, with a 10% noncompliance rate. As of 5-31-13, 1,349 patients have been randomized.
NCT00769379
Support: PHS NCI-U10-CA-69651, -12027; NCI P30-CA-14599; Genentech, Inc.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr OT2-3-02.
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Affiliation(s)
- MA Cobleigh
- National Surgical Adjuvant Breast and Bowel Project (NSABP); Rush University; University of Pittsburgh Graduate School of Public Health; Allegheny Cancer Center at Allegheny General Hospital; Northwestern University Feinberg School of Medicine; Virginia Commonwealth University; University of Colorado Denver; MD Anderson Cancer Center, Orlando
| | - SJ Anderson
- National Surgical Adjuvant Breast and Bowel Project (NSABP); Rush University; University of Pittsburgh Graduate School of Public Health; Allegheny Cancer Center at Allegheny General Hospital; Northwestern University Feinberg School of Medicine; Virginia Commonwealth University; University of Colorado Denver; MD Anderson Cancer Center, Orlando
| | - TB Juilan
- National Surgical Adjuvant Breast and Bowel Project (NSABP); Rush University; University of Pittsburgh Graduate School of Public Health; Allegheny Cancer Center at Allegheny General Hospital; Northwestern University Feinberg School of Medicine; Virginia Commonwealth University; University of Colorado Denver; MD Anderson Cancer Center, Orlando
| | - KP Siziopikou
- National Surgical Adjuvant Breast and Bowel Project (NSABP); Rush University; University of Pittsburgh Graduate School of Public Health; Allegheny Cancer Center at Allegheny General Hospital; Northwestern University Feinberg School of Medicine; Virginia Commonwealth University; University of Colorado Denver; MD Anderson Cancer Center, Orlando
| | - DW Arthur
- National Surgical Adjuvant Breast and Bowel Project (NSABP); Rush University; University of Pittsburgh Graduate School of Public Health; Allegheny Cancer Center at Allegheny General Hospital; Northwestern University Feinberg School of Medicine; Virginia Commonwealth University; University of Colorado Denver; MD Anderson Cancer Center, Orlando
| | - RA Rabinovitch
- National Surgical Adjuvant Breast and Bowel Project (NSABP); Rush University; University of Pittsburgh Graduate School of Public Health; Allegheny Cancer Center at Allegheny General Hospital; Northwestern University Feinberg School of Medicine; Virginia Commonwealth University; University of Colorado Denver; MD Anderson Cancer Center, Orlando
| | - P Zheng
- National Surgical Adjuvant Breast and Bowel Project (NSABP); Rush University; University of Pittsburgh Graduate School of Public Health; Allegheny Cancer Center at Allegheny General Hospital; Northwestern University Feinberg School of Medicine; Virginia Commonwealth University; University of Colorado Denver; MD Anderson Cancer Center, Orlando
| | - EP Mamounas
- National Surgical Adjuvant Breast and Bowel Project (NSABP); Rush University; University of Pittsburgh Graduate School of Public Health; Allegheny Cancer Center at Allegheny General Hospital; Northwestern University Feinberg School of Medicine; Virginia Commonwealth University; University of Colorado Denver; MD Anderson Cancer Center, Orlando
| | - N Wolmark
- National Surgical Adjuvant Breast and Bowel Project (NSABP); Rush University; University of Pittsburgh Graduate School of Public Health; Allegheny Cancer Center at Allegheny General Hospital; Northwestern University Feinberg School of Medicine; Virginia Commonwealth University; University of Colorado Denver; MD Anderson Cancer Center, Orlando
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16
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Erickson BA, Demanes DJ, Ibbott GS, Hayes JK, Hsu ICJ, Morris DE, Rabinovitch RA, Tward JD, Rosenthal SA. American Society for Radiation Oncology (ASTRO) and American College of Radiology (ACR) Practice Guideline for the Performance of High-Dose-Rate Brachytherapy. Int J Radiat Oncol Biol Phys 2011; 79:641-9. [DOI: 10.1016/j.ijrobp.2010.08.046] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Accepted: 08/30/2010] [Indexed: 10/18/2022]
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17
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Nieto Y, Bearman SI, Shpall EJ, Jones RB, Cagnoni PJ, Rabinovitch RA, McSweeney PA. Intensive chemotherapy for progressive chronic lymphocytic leukemia administered early after a nonmyeloablative allograft. Bone Marrow Transplant 2001; 28:1083-6. [PMID: 11781620 DOI: 10.1038/sj.bmt.1703293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2001] [Accepted: 09/25/2001] [Indexed: 11/09/2022]
Abstract
A 51-year-old patient with refractory CLL elected to participate in a trial of nonmyeloablative trans- plantation from an HLA-matched unrelated donor. He received low-dose fludarabine/TBI, with infusion of donor PBPC and cyclosporin (CsA)/MMF. Early post transplant he experienced explosive tumor growth with respiratory insufficiency. After immunosuppression discontinuation and rituximab administration, no response was observed. This prompted treatment with cyclophosphamide (2 g/m(2)/day x 2), paclitaxel (250 mg/m(2) over 24 h), doxorubicin (50 mg/m(2)), solumedrol (500 mg/day), and a second dose of rituximab, from days +11 to +14. A rapid response was achieved. Chemotherapy did not cause an obvious compromise of donor stem cell engraftment or establishment of stable donor chimerism.
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MESH Headings
- Anti-Bacterial Agents/therapeutic use
- Antineoplastic Agents/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Combined Modality Therapy/methods
- Hematopoietic Stem Cell Transplantation/adverse effects
- Humans
- Immunosuppressive Agents/administration & dosage
- Immunosuppressive Agents/therapeutic use
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Male
- Middle Aged
- Transplantation, Heterologous
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Affiliation(s)
- Y Nieto
- University of Colorado Bone Marrow Transplant Program, Denver, CO 80262, USA
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18
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Taylor ME, Haffty BG, Shank BM, Halberg FE, Martinez AA, McCormick B, McNeese MD, Mendenhall NP, Mitchell SE, Rabinovitch RA, Solin LJ, Singletary SE, Leibel S, Recht A. Postmastectomy radiotherapy. American College of Radiology. ACR Appropriateness Criteria. Radiology 2000; 215 Suppl:1153-70. [PMID: 11037539] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- M E Taylor
- Mallinckrodt Institute of Radiology, St. Louis, Mo., USA
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19
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Rabinovitch RA, Solin LJ, Shank BM, Haffty BG, Halberg FE, Martinez AA, McCormick B, McNeese MD, Mendenhall NP, Mitchell SE, Taylor ME, Singletary SE, Leibel S. Ductal carcinoma in situ and microinvasive disease. American College of Radiology. ACR Appropriateness Criteria. Radiology 2000; 215 Suppl:1137-52. [PMID: 11037538] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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20
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McCormick B, Mendenhall NP, Shank BM, Haffty BG, Halberg FE, Martinez AA, McNeese MD, Mitchell SE, Rabinovitch RA, Solin LJ, Taylor ME, Singletary SE, Leibel S. Local regional recurrence and salvage surgery. American College of Radiology. ACR Appropriateness Criteria. Radiology 2000; 215 Suppl:1181-92. [PMID: 11037541] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
MESH Headings
- Adult
- Aged
- Breast Neoplasms/mortality
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Combined Modality Therapy
- Female
- Humans
- Middle Aged
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/radiotherapy
- Neoplasm Recurrence, Local/surgery
- Practice Guidelines as Topic
- Radiotherapy, Adjuvant
- Reoperation
- Salvage Therapy
- Survival Rate
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Affiliation(s)
- B McCormick
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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21
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McNeese MD, Mitchell SE, Shank BM, Haffty BG, Halberg FE, Martinez AA, McCormick B, Mendenhall NP, Rabinovitch RA, Solin LJ, Taylor ME, Singletary SE, Leibel S. Locally advanced breast cancer. American College of Radiology. ACR Appropriateness Criteria. Radiology 2000; 215 Suppl:1171-80. [PMID: 11037540] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- M D McNeese
- University of Texas, M.D. Anderson Cancer Center, Houston, USA
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22
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Halberg FE, Shank BM, Haffty BG, Martinez AA, McCormick B, McNeese MD, Mendenhall NP, Mitchell SE, Rabinovitch RA, Solin LJ, Taylor ME, Singletary SE, Leibel S. Conservative surgery and radiation in the treatment of stage I and II carcinoma of the breast. American College of Radiology. ACR Appropriateness Criteria. Radiology 2000; 215 Suppl:1193-205. [PMID: 11037542] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
MESH Headings
- Adult
- Aged
- Breast Neoplasms/pathology
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/radiotherapy
- Carcinoma, Lobular/surgery
- Combined Modality Therapy
- Female
- Humans
- Mastectomy, Segmental
- Middle Aged
- Neoplasm Staging
- Randomized Controlled Trials as Topic
- Treatment Outcome
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Affiliation(s)
- F E Halberg
- Marin Cancer Institute, Greenbrae, Calif., USA
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23
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Rabinovitch RA, Zelefsky MJ, Gaynor JJ, Fuks Z. Patterns of failure following surgical resection of renal cell carcinoma: implications for adjuvant local and systemic therapy. J Clin Oncol 1994; 12:206-12. [PMID: 8270978 DOI: 10.1200/jco.1994.12.1.206] [Citation(s) in RCA: 150] [Impact Index Per Article: 5.0] [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: 01/29/2023] Open
Abstract
PURPOSE This report is a patterns-of-failure analysis of resected renal cell carcinoma (RCC) performed to determine the relative incidences of local failure (LF) and distant failure, to identify the pathologic features predicting for each using a multivariate analysis, and to assess the relative impact of each form of failure on overall survival (OS). In this way, the potential value of and selection of patients for adjuvant local and/or systemic therapy can be better evaluated. MATERIALS AND METHODS The records of 172 patients with unilateral, nonmetastatic RCC who were treated with definitive surgery between 1978 and 1988, and who had a minimum follow-up duration of 1 year, were identified through the Memorial Sloan-Kettering tumor registry. Distribution by stage included T1, 10 patients; T2, 102; T3a, 32; T3b, 27; and T4, one. The incidences of positive lymph nodes (LNs) and positive margins were 5.8% and 6.4%, respectively. RESULTS LF developed in only six patients, yielding a 7-year actuarial incidence of 5%. In this subset, four patients developed distant metastases (DM), three occurring concurrently with or before LF. DM developed in 30 patients, yielding a 7-year actuarial incidence of 26%. Among the variables that had an impact on the development of DM according to univariate log-rank tests, only positive LNs (P = .026) and renal vein extension (P = .001) remained as significant independent prognosticators. The overall 7-year actuarial survival rate was 80%. Eleven patients died of RCC during follow-up, nine of whom (82%) died of metastatic disease. CONCLUSION LF is rare following surgical management of RCC, and shows no clear causal relationship with the development of DM. Patients die of DM, and not LF. These data do not support the role of adjuvant radiation therapy in this disease. Patients with LN involvement or renal vein extension have a significantly increased risk for developing DM, and are therefore appropriate candidates for trials investigating systemic therapy.
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Affiliation(s)
- R A Rabinovitch
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY
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24
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Rabinovitch RA, Koethe SM, Kalbfleisch JH, Preheim LC, Rytel MW. Relationships between alternative complement pathway activation, C-reactive protein, and pneumococcal infection. J Clin Microbiol 1986; 23:56-61. [PMID: 3700607 PMCID: PMC268572 DOI: 10.1128/jcm.23.1.56-61.1986] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
In the absence of specific antibody, opsonization of Streptococcus pneumoniae may be mediated by the alternative complement pathway (AP) or by C-reactive protein (CRP) via C1 binding. To determine the role of these mechanisms in pneumococcal (PNC) disease, we studied 19 patients with differing severities of PNC infection. C4 and CRP levels and zymosan-induced consumption of 50% hemolytic complement (CH50) were measured in specimens obtained acutely and then weekly. In patients with complicated illness, the modified mean CH50 in acute sera was 178 +/- 57 U/ml, significantly lower than the mean CH50 of 331 +/- 80 U/ml in patients with uncomplicated illness (P less than 0.05). The values of the two groups on a given day approximated each other on days 7, 14, and 23. Consumption of complement by zymosan was also lower in acute sera of patients with complicated illness, with a mean value of 19 +/- 18 U/ml compared with 58 +/- 30 U/ml in those with uncomplicated illness (P less than 0.05). This difference was also seen on day 7 (P less than 0.05). Disease involving lower-numbered PNC serotypes (less than 10) correlated with reduced availability of AP factors in acute sera, independent of illness severity. Mean CRP levels were inversely related to zymosan-induced complement activation in patients with complicated illness. These data suggest that in vivo depletion of AP factors is significantly greater in patients with complicated illness and is associated with high CRP levels. CRP may enhance AP activation via C3 convertase generation and function with it as a preantibody host defense mechanism.
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25
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Jones RB, Rabinovitch RA, Katz BP, Batteiger BE, Quinn TS, Terho P, Lapworth MA. Chlamydia trachomatis in the pharynx and rectum of heterosexual patients at risk for genital infection. Ann Intern Med 1985; 102:757-62. [PMID: 3888022 DOI: 10.7326/0003-4819-102-6-757] [Citation(s) in RCA: 63] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Although urogenital infections with Chlamydia trachomatis are well recognized, less is known about infection at other body sites in adults. Pharyngeal specimens obtained from 706 heterosexual men and 686 women, and rectal specimens obtained from 1223 women who were at risk for chlamydia infection were cultured for C. trachomatis. Urogenital specimens were obtained from all patients. Chlamydia trachomatis was isolated from the pharynx in 3.7% of men and 3.2% of women. Recovery of chlamydiae was not associated with the presence of pharyngeal symptoms, but in women, but not men, it was associated with a history of oral-genital sex. The organism was also recovered from the rectum of 5.2% of the women. Rectal isolation did not correlate with a history of rectal symptoms or rectal sex but did correlate with concurrent genital infection. Infection at these sites may be important in the transmission or persistence of C. trachomatis infections.
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26
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Rabinovitch RA, Chusid MJ, Nathan R. A nosocomial pneumococcal wound infection. Wis Med J 1984; 83:27-8. [PMID: 6516438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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27
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Duthie EH, Rabinovitch RA, Rose HD, Tsitouras P, Gambert SR. Effectiveness of influenza vaccination in a long-term care setting. Wis Med J 1984; 83:11-2. [PMID: 6424343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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28
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Rabinovitch RA, Duthie EH, Gambert SR, Priefer B, Rytel MW. Pneumococcal antigen and pneumococcal infection. Ann Intern Med 1983; 98:113-4. [PMID: 6848036 DOI: 10.7326/0003-4819-98-1-113_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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29
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Zeller JR, Cerletty JM, Rabinovitch RA, Daniels D. Spontaneous regression of a postpartum pituitary mass demonstrated by computed tomography. Arch Intern Med 1982; 142:373-4. [PMID: 7059262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
An 18-year-old woman had postpartum thyrotoxicosis, hypercalcemia, and secondary adrenocortical insufficiency. A pituitary mass with suprasellar extension was demonstrated on computed axial tomography (CT). The patient subsequently became hypothyroid and normocalcemic, and repeated CT scanning showed that the pituitary mass had undergone a spontaneous regression in size. Computed axial tomographic scanning is an important modality for the evaluation of postpartum pituitary masses and their natural history. This case suggests that some patients with postpartum hypopituitarism and a pituitary mass need not have early surgical intervention but may be closely observed and treated by hormone replacement alone.
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Abstract
The incidence of bacterial infections occurring in 132 residents in a Veterans Administration hospital-based nursing home care unit (VA NHCU) was studied retrospectively over a 1 yr period. There were a total of 35 non-Foley-catheter-related bacterial infections documented during this time, occurring in 21 residents. Of these infections, 14 were pulmonary, 18 urinary and 3 of the integument. Of the 23 residents having indwelling urinary catheters, 47.8% became clinically symptomatic due to a urinary infection at least one time during the year. Thirty-six per cent of these infections were due to Pseudomonas aeruginosa and 48% were due to E. coli and Proteus mirabilis. Eighteen of 23 residents (78.3%) with Foley catheters had more than one predominant organism cultured from their urine during the year, making the practice of monthly cultures not very useful in considering treatment. If one grouped all urinary tract infections on the NHCU, the major pathogens were Pseudomonas (19.5%), Klebsiella (17.1%). Proteus (17.1%) and E. coli (14.6%). Documented pulmonary infections were predominantly due to Streptococcus pneumonia (50.0%) and Hemophilus influenza (35.7%). Our data suggest that the location of the institutional setting must be considered in caring for the elderly resident in a skilled nursing facility. Future plans to establish hospital based nursing home units must consider the benefits resulting from easy access to acute health care and educational programs against problems of hospital bacterial flora.
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