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Rutenberg MS, Hoppe BS, Starr JS, Awad Z, Thomas M, Morris CG, Johnson P, Henderson RH, Jones JC, Gharia B, Bowers S, Wolfsen HC, Krishnan S, Ko SJ, Babiker HM, Nichols RC. Proton Therapy With Concurrent Chemotherapy for Thoracic Esophageal Cancer: Toxicity, Disease Control, and Survival Outcomes. Int J Part Ther 2022; 9:18-29. [PMID: 36721483 PMCID: PMC9875824 DOI: 10.14338/ijpt-22-00021.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/26/2022] [Indexed: 12/23/2022] Open
Abstract
Purpose When treating esophageal cancer with radiation therapy, it is critical to limit the dose to surrounding structures, such as the lung and/or heart, as much as possible. Proton radiation therapy allows a reduced radiation dose to both the heart and lungs, potentially reducing the risk of cardiopulmonary toxicity. Here, we report disease control, survival, and toxicity outcomes among patients with esophageal cancer treated with proton radiation therapy and concurrent chemotherapy (chemoradiation therapy; CRT) with or without surgery. Materials and Methods We enrolled 17 patients with thoracic esophageal carcinoma on a prospective registry between 2010 and 2021. Patients received proton therapy to a median dose of 50.4-GyRBE (range, 50.4-64.8) in 1.8-Gy fractions.Acute and late toxicities were graded per the Common Terminology Criteria for Adverse Events, version 4.0 (US National Cancer Institute, Bethesda, Maryland). In addition, disease control, patterns of failure, and survival outcomes were collected. Results Nine patients received preoperative CRT, and 8 received definitive CRT. Overall, 88% of patients had adenocarcinoma, and 12% had squamous cell carcinoma. With a median follow-up of 2.1 years (range, 0.5-9.4), the 3-year local progression-free, disease-free, and overall survival rates were 85%, 66%, and 55%, respectively. Two patients (1 with adenocarcinoma and 1 with squamous cell carcinoma) recurred at the primary site after refusing surgery after a complete clinical response to CRT. The most common acute nonhematologic and hematologic toxicities, respectively, were grades 1 to 3 esophagitis and grades 1 to 4 leukopenia, both affecting 82% of patients. No acute cardiopulmonary toxicities were observed in the absence of surgical resection. Reagarding surgical complications, 3 postoperative cardiopulmonary complications occurred as follows: 1 grade 1 pleural effusion, 1 grade 3 pleural effusion, and 1 grade 2 anastomotic leak. Two severe late CRT toxicities occurred: 1 grade 5 tracheoesophageal fistula and 1 grade 3 esophageal stenosis requiring a feeding tube. Conclusion Proton radiation therapy is a safe, effective treatment for esophageal cancer with increasing evidence supporting its role in reducing cardiopulmonary toxicity.
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Affiliation(s)
| | - Bradford S. Hoppe
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Jason S. Starr
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Ziad Awad
- Department of Surgery, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Mathew Thomas
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Christopher G. Morris
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Perry Johnson
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Randal H. Henderson
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Jeremy C. Jones
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Bharatsinh Gharia
- Department of Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Steven Bowers
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Herbert C. Wolfsen
- Department of Gastroenterology and Hepatology, Mayo Clinic Jacksonville, FL, USA
| | - Sunil Krishnan
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Stephen J. Ko
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Hani M. Babiker
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Romaine C. Nichols
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
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Gao RW, Foote RL, Garces YI, Ma DJ, Neben-Wittich M, Routman DM, Patel SH, Ko SJ, McGee LA, Bible KC, Chintakuntlawar AV, Ryder M, Morris JC, Van Abel KM, Rivera M, Abraha F, Lester SC. Outcomes and Patterns of Recurrence for Anaplastic Thyroid Cancer Treated with Comprehensive Chemoradiotherapy. Pract Radiat Oncol 2021; 12:113-119. [PMID: 34715395 DOI: 10.1016/j.prro.2021.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/16/2021] [Accepted: 10/13/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE/OBJECTIVES Radiotherapy (RT) plays an important role in locoregional tumor control for anaplastic thyroid cancer (ATC). Due to its rarity, RT guidelines for ATC are lacking. We describe ATC patterns of nodal disease at presentation and progression and propose corresponding RT target volumes. MATERIALS/METHODS We identified all patients with ATC treated at our institution with definitive or adjuvant IMRT and concomitant chemotherapy from 2006 to 2020. We identified in-field, marginal, and out-of-field sites of locoregional recurrence and progression (LRR). RESULTS Forty-seven patients met inclusion. Median follow-up was 6.6 months (IQR: 1.9-19.6). Nodal levels involved at presentation included: IB (2.1%), II (23.4%), III (21.3%), IV (21.3%), V (12.8%), VI (34%), and mediastinal (6.4%). All patients received elective nodal RT to levels II-IV and VI. RT volumes also included: IA (23.4%), IB (44.7%), V (87.2%), retropharyngeal/retrostyloid (RP/RS) (27.7%), and mediastinal 1-6 (53.2%). Cumulative incidence of LRR at 3- and 12-months was 26.1% (95% CI: 15.9-42.8) and 35.7% (23.9-53.4). Isolated LRR risk at 3- and 12-months was 6.5% (2.2-19.8) and 8.9% (3.4-22.9). Fourteen (29.8%) patients experienced in-field LRR in the thyroid gland or postoperative tumor bed, II-IV, VI, and mediastinal 1 and 3A. Four (8.5%) patients had marginal LRRs, 3 of whom progressed in the mediastinum at 2, 3P, 4, and 6. Two (4.3%) patients experienced out-of-field LRRs. Throughout the pre-treatment and follow-up period, no patients had disease at IA and 1 (2.1%) patient each had disease at IB and RP/RS. No baseline or treatment characteristics, including RT dose (stratified by < or ≥66 Gy), were significant predictors of LRR on univariate analysis. CONCLUSIONS Isolated LRR risk in patients with ATC treated with comprehensive RT and chemotherapy is low. Aggressive multimodality therapy should be reserved for willing, fit patients with no or limited distant disease burden. When treating comprehensively, complete inclusion of mediastinal levels 1-6 may be warranted to avoid marginal disease progression. Omission of levels I and RP/RS can be considered.
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Affiliation(s)
- Robert W Gao
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Yolanda I Garces
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Stephen J Ko
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Lisa A McGee
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | | | | | | | | | | | | | - Feven Abraha
- Biostatistics & Information, Mayo Clinic, Rochester, Minnesota
| | - Scott C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
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Abousaida B, Seneviratne D, Hoppe BS, Ko SJ, Asaithamby A, Cucinotta FA, Kirwan JM, Mody K, Toskich B, Ashman JB, Hallemeier CL, Krishnan S. Carbon Ion Radiotherapy in the Management of Hepatocellular Carcinoma. J Hepatocell Carcinoma 2021; 8:1169-1179. [PMID: 34595139 PMCID: PMC8478421 DOI: 10.2147/jhc.s292516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/08/2021] [Indexed: 01/22/2023] Open
Abstract
Localized hepatocellular carcinoma (HCC) that is unresectable and non-transplantable can be treated by several liver-directed therapies. External beam radiation therapy (EBRT) is an increasingly accepted and widely utilized treatment modality in this setting. Accelerated charged particles such as proton beam therapy (PBT) and carbon ion radiation therapy (CIRT) offer technological advancements over conventional photon radiotherapy. In this review, we summarize the distinct advantages of CIRT use for HCC treatment, focusing on physical and biological attributes, and outline dosimetric and treatment planning caveats. Based on these considerations, we posit that HCC may be among the best indications for use of CIRT, as it allows for maximizing tumoricidal doses to the target volume while minimizing the dose to the organs at risk.
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Affiliation(s)
- Belal Abousaida
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, FL, USA
| | | | - Bradford S Hoppe
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Stephen J Ko
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Aroumougame Asaithamby
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Francis A Cucinotta
- School of Integrated Health Sciences, University of Las Vegas, Las Vegas, NV, USA
| | - Jessica M Kirwan
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | - Kabir Mody
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Beau Toskich
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Jonathan B Ashman
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | | | - Sunil Krishnan
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, FL, USA
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Ko SJ, Cho J, Choi SM, Park YS, Lee CH, Lee SM, Yoo CG, Kim YW, Lee J. Phase Angle and Frailty Are Important Prognostic Factors in Critically Ill Medical Patients: A Prospective Cohort Study. J Nutr Health Aging 2021; 25:218-223. [PMID: 33491037 PMCID: PMC7548529 DOI: 10.1007/s12603-020-1487-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/27/2020] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To investigate whether phase angle (PhA) measured by bioelectrical impedance analysis (BIA) and frailty are associated with the outcomes of critical illnesses. DESIGN A single-center prospective cohort study. SETTING Medical intensive care unit (ICU) in Seoul National University Hospital, Seoul, Republic of Korea. PARTICIPANTS 97 patients who were admitted to the medical ICU. MEASUREMENTS On admission, PhA was measured by BIA, and frailty was assessed by the Korean Modified Barthel Index (KMBI) scoring system. Patients were classified according to PhA and KMBI scores, and their impact on the outcomes of critical illnesses was evaluated. RESULTS The patients' mean age was 62.4 ± 16.4 years, and 56 of the patients (57.7%) were men. Having a high PhA above 3.5 at the time of ICU admission was associated with lower in-hospital mortality (adjusted OR 0.42, p = .042), and a shorter duration of ICU stay (5.6 days vs. 9.8 days, p = .016) compared to those with a low PhA. Other indices measured by BIA were not significantly associated with outcomes of critical illnesses. Frailty (KMBI > 60) was associated with more mechanical ventilation days (2.3 days vs. 7.1 days; p = .018). CONCLUSION Both PhA and frailty are important prognostic factors predicting the outcomes of critical illnesses. Low PhA scores were associated with increased mortality and a longer duration of ICU stay, and frailty was associated with more mechanical ventilation days.
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Affiliation(s)
- S J Ko
- Jinwoo Lee, MD, Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Seoul, 03080, Republic of Korea; E-mail:
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Sio TT, Le-Rademacher JG, Leenstra JL, Loprinzi CL, Rine G, Curtis A, Singh AK, Martenson JA, Novotny PJ, Tan AD, Qin R, Ko SJ, Reiter PL, Miller RC. Effect of Doxepin Mouthwash or Diphenhydramine-Lidocaine-Antacid Mouthwash vs Placebo on Radiotherapy-Related Oral Mucositis Pain: The Alliance A221304 Randomized Clinical Trial. JAMA 2019; 321:1481-1490. [PMID: 30990550 PMCID: PMC6484809 DOI: 10.1001/jama.2019.3504] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [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] [Indexed: 01/19/2023]
Abstract
IMPORTANCE Oral mucositis causes substantial morbidity during head and neck radiotherapy. In a randomized study, doxepin mouthwash was shown to reduce oral mucositis-related pain. A common mouthwash comprising diphenhydramine-lidocaine-antacid is also widely used. OBJECTIVE To evaluate the effect of doxepin mouthwash or diphenhydramine-lidocaine-antacid mouthwash for the treatment of oral mucositis-related pain. DESIGN, SETTING, AND PARTICIPANTS A phase 3 randomized trial was conducted from November 1, 2014, to May 16, 2016, at 30 US institutions and included 275 patients who underwent definitive head and neck radiotherapy, had an oral mucositis pain score of 4 points or greater (scale, 0-10), and were followed up for a maximum of 28 days. INTERVENTIONS Ninety-two patients were randomized to doxepin mouthwash (25 mg/5 mL water); 91 patients to diphenhydramine-lidocaine-antacid; and 92 patients to placebo. MAIN OUTCOME AND MEASURES The primary end point was total oral mucositis pain reduction (defined by the area under the curve and adjusted for baseline pain score) during the 4 hours after a single dose of doxepin mouthwash or diphenhydramine-lidocaine-antacid mouthwash compared with a single dose of placebo. The minimal clinically important difference was a 3.5-point change. The secondary end points included drowsiness, unpleasant taste, and stinging or burning. All scales ranged from 0 (best) to 10 (worst). RESULTS Among the 275 patients randomized (median age, 61 years; 58 [21%] women), 227 (83%) completed treatment per protocol. Mucositis pain during the first 4 hours decreased by 11.6 points in the doxepin mouthwash group, by 11.7 points in the diphenhydramine-lidocaine-antacid mouthwash group, and by 8.7 points in the placebo group. The between-group difference was 2.9 points (95% CI, 0.2-6.0; P = .02) for doxepin mouthwash vs placebo and 3.0 points (95% CI, 0.1-5.9; P = .004) for diphenhydramine-lidocaine-antacid mouthwash vs placebo. More drowsiness was reported with doxepin mouthwash vs placebo (by 1.5 points [95% CI, 0-4.0]; P = .03), unpleasant taste (by 1.5 points [95% CI, 0-3.0]; P = .002), and stinging or burning (by 4.0 points [95% CI, 2.5-5.0]; P < .001). Maximum grade 3 adverse events for the doxepin mouthwash occurred in 3 patients (4%); diphenhydramine-lidocaine-antacid mouthwash, 3 (4%); and placebo, 2 (2%). Fatigue was reported by 5 patients (6%) in the doxepin mouthwash group and no patients in the diphenhydramine-lidocaine-antacid mouthwash group. CONCLUSIONS AND RELEVANCE Among patients undergoing head and neck radiotherapy, the use of doxepin mouthwash or diphenhydramine-lidocaine-antacid mouthwash vs placebo significantly reduced oral mucositis pain during the first 4 hours after administration; however, the effect size was less than the minimal clinically important difference. Further research is needed to assess longer-term efficacy and safety for both mouthwashes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02229539.
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Affiliation(s)
- Terence T. Sio
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, Arizona
| | | | | | | | - Grant Rine
- Wichita National Cancer Institute Community Oncology Research Program, Wichita, Kansas
| | - Amarinthia Curtis
- Southeast Clinical Oncology Research Consortium National Cancer Institute Community Oncology Research Program, Spartanburg, South Carolina
| | | | | | - Paul J. Novotny
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Angelina D. Tan
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Rui Qin
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Stephen J. Ko
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | | | - Robert C. Miller
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
- Now with the University of Maryland School of Medicine, Baltimore
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Lou Y, Dholaria B, Soyano A, Hodge D, Cochuyt J, Manochakian R, Ko SJ, Thomas M, Johnson MM, Patel NM, Miller RC, Adjei AA, Ailawadhi S. Survival trends among non-small-cell lung cancer patients over a decade: impact of initial therapy at academic centers. Cancer Med 2018; 7:4932-4942. [PMID: 30175515 PMCID: PMC6198232 DOI: 10.1002/cam4.1749] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/22/2018] [Accepted: 08/04/2018] [Indexed: 12/15/2022] Open
Abstract
Background Treatment of non‐small‐cell lung cancer (NSCLC) has been rapidly advancing over the last decade. Academic centers are considered equipped with better expertise. NSCLC outcome trends in novel therapeutic era and impact of initial treatment at academic centers have not been reported. Methods The National Cancer Database (NCDB) was used to identify NSCLC incident cases from 2004 to 2013. Overall survival (OS) was plotted by year of diagnosis and type of initial treatment center, accounting for several factors available in NCDB. Results A total of 1 150 722 NSCLC patients were included and separated by initial treatment center type (academic: 31.5%; nonacademic: 68.5%). Median follow‐up and OS for all patients were 11.8 months (range: 0‐133.6 months) and 13.1 months (95% CI: 13.08‐13.17), respectively. Median OS improved significantly for those diagnosed in 2010‐2013 (14.8 months [95% CI: 14.7‐14.9]) as compared to 2004‐2009 (12.4 months [95% CI: 12.3‐12.5]) (P < 0.001). Treatment at academic centers was associated with improved OS (multivariate HR for OS = 0.929 [95% CI: 0.92‐0.94], P < 0.0010). Four‐year OS for academic and nonacademic cohorts was 28.5%% and 22.1%, respectively (P < 0.001), and the difference was more pronounced in stage I to III NSCLC. Conclusion In this largest analysis, thus far, NSCLC survival has improved over time, and type of initial treatment center significantly influences survival. Identifying and removing barriers to obtaining initial treatment of NSCLC at academic medical centers could improve OS.
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Affiliation(s)
- Yanyan Lou
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida
| | | | - Aixa Soyano
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida
| | - David Hodge
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida
| | - Jordan Cochuyt
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida
| | - Rami Manochakian
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida
| | - Stephen J Ko
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Mathew Thomas
- Department of Cardiovascular Thoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Margaret M Johnson
- Division of Allergy and Pulmonary Medicine, Mayo Clinic, Jacksonville, Florida
| | - Neal M Patel
- Division of Allergy and Pulmonary Medicine, Mayo Clinic, Jacksonville, Florida
| | - Robert C Miller
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Alex A Adjei
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota
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Patel AB, Tzou KS, Single M, Hollant L, Smart B, Gaines K, Sherman CE, Peterson JL, Ko SJ, Vallow LA, Miller RC, Buskirk SJ. Radiation Therapy Prophylaxis for Heterotopic Ossification in Non-Hip Sites. ACTA ACUST UNITED AC 2018. [DOI: 10.4236/jct.2018.91001] [Citation(s) in RCA: 1] [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]
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Hobbs CJ, Ko SJ, Paryani NN, Accurso JM, Olivier KR, Garces YI, Park SS, Hallemeier CL, Schild SE, Vora SA, Ashman JB, Rule WG, Bowers JR, Heckman MG, Diehl NN, Miller RC. Stereotactic Body Radiotherapy for Medically Inoperable Stage I-II Non-Small Cell Lung Cancer: The Mayo Clinic Experience. Mayo Clin Proc Innov Qual Outcomes 2017; 2:40-48. [PMID: 30225431 PMCID: PMC6124323 DOI: 10.1016/j.mayocpiqo.2017.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective To examine disease control and survival after stereotactic body radiotherapy (SBRT) for medically inoperable, early-stage non-small cell lung cancer (NSCLC) and determine associations of pretreatment 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) maximum standardized uptake values (SUVmax), biologically effective dose, and mediastinal staging with disease control and survival outcomes. Patients and Methods We retrospectively reviewed the cases of consecutive patients with FDG-PET-staged, medically inoperable NSCLC treated with SBRT at our institution between January 1, 2008, and August 4, 2014. Cumulative incidences of recurrence were estimated, accounting for the competing risk of death. Associations of SUVmax, biologically effective dose, and mediastinal staging with outcomes were evaluated using Cox proportional hazards regression models. Results Among 282 patients, 2-year cumulative incidences of recurrence were 4.9% (95% CI, 2.6%-8.3%) for local, 9.8% (95% CI, 6.3%-14.2%) for nodal, 10.8% (95% CI, 7.0%-15.5%) for ipsilateral lung, 6.0% (3.3%-9.8%) for contralateral lung, 9.7% (95% CI, 6.3%-14.0%) for distant recurrence, and 26.1% (95% CI, 20.4%-32.0%) for any recurrence. The 2-year overall survival was 70.4% (95% CI, 64.5%-76.8%), and the 2-year disease-free survival was 51.2% (95% CI, 44.9%-58.5%). Risk of any recurrence was significantly higher for patients with higher SUVmax (hazard ratio [per each doubling], 1.29 [95% CI, 1.05-1.59]; P=.02). A similar association with SUVmax was observed when considering the composite outcome of any recurrence or death (hazard ratio, 1.23 [95% CI, 1.05-1.44]; P=.01). The SUVmax was not significantly associated with other outcomes (P≥0.69). Two-year cumulative incidences of local recurrence for patients receiving 48 Gy in 4 fractions, 54 Gy in 3 fractions, or 50 Gy in 5 fractions were 1.7% (95% CI, 0.3%-5.6%), 3.7% (95% CI, 0.7%-11.4%), and 15.3% (95% CI, 5.9%-28.9%), respectively (P=.02); this difference was independent of lesion size (P=.02). Conclusion Disease control was excellent for patients who received SBRT for early-stage NSCLC, and this series represents the largest single-institution experience from the United States on SBRT for early-stage inoperable NSCLC. Higher pretreatment FDG-PET SUVmax was associated with increased risk of any recurrence, and the 50 Gy in 5 fractions dose prescription was associated with increased risk of local recurrence.
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Key Words
- BED, biologically effective dose
- CT, computed tomography
- DFS, disease-free survival
- EBUS, endobronchial ultrasonography
- FDG-PET, 18F-fludeoxyglucose–positron emission tomography
- HR, hazard ratio
- ITV, internal target volume
- LC, local control
- NSCLC, non–small cell lung cancer
- OS, overall survival
- PET, positron emission tomography
- RTOG, Radiation Therapy Oncology Group
- SBRT, stereotactic body radiotherapy
- SUVmax, maximum standardized uptake value
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Affiliation(s)
- Corey J Hobbs
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
| | - Stephen J Ko
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
| | | | | | | | | | - Sean S Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | | | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, AZ
| | - Sujay A Vora
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, AZ
| | | | - William G Rule
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, AZ
| | - Johnny R Bowers
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, AZ
| | | | | | - Robert C Miller
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
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Gamez ME, Lal D, Halyard MY, Wong WW, Vargas C, Ma D, Ko SJ, Foote RL, Patel SH. Outcomes and patterns of failure for sinonasal undifferentiated carcinoma (SNUC): The Mayo Clinic Experience. Head Neck 2017; 39:1819-1824. [PMID: 28561906 DOI: 10.1002/hed.24834] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/02/2017] [Accepted: 04/18/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Sinonasal undifferentiated carcinoma (SNUC) is a rare aggressive disease arising in the nasal cavity and paranasal sinuses with poor prognosis and unclear optimal management. METHODS Forty patients were analyzed. Nasal cavity was the most common primary site. Most patients presented with T4 disease, received trimodality therapy, and were treated with intensity-modulated radiotherapy (IMRT). RESULTS Median follow-up was 6.9 years. Sixteen patients (40%) experienced recurrent disease, 5 local (12.5%), 1 regional (2.5%), and 10 distant (25%). The 5-year overall survival (OS), recurrence-free survival (RFS), and locoreginal control (LRC) were 44%, 39%, and 71%, respectively. Patients treated with trimodality therapy had better outcomes compared to single modality therapy. Improved OS was noted with IMRT and with doses ≥60 Gy. The most common cause of death was distant metastasis. CONCLUSION SNUC is an aggressive malignancy with a high tendency to metastasize. Better outcomes were obtained with a trimodality approach. Modern radiotherapy (RT) techniques and doses ≥ 60 Gy were associated with improved OS.
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Affiliation(s)
| | - Devyani Lal
- Department of Otolaryngology, Mayo Clinic, Phoenix, Arizona
| | | | - William W Wong
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Carlos Vargas
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Daniel Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Stephen J Ko
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
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Habboush Y, Shannon RP, Niazi SK, Hollant L, Single M, Gaines K, Smart B, Chimato NT, Heckman MG, Buskirk SJ, Vallow LA, Tzou KS, Ko SJ, Peterson JL, Biers HA, Day AB, Nelson KA, Sloan JA, Halyard MY, Miller RC. Patient-reported distress and survival among patients receiving definitive radiation therapy. Adv Radiat Oncol 2017; 2:211-219. [PMID: 28740934 PMCID: PMC5514245 DOI: 10.1016/j.adro.2017.03.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 03/09/2017] [Accepted: 03/13/2017] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Patient-reported distress (PRD) has not been well assessed in association with survival after radiation therapy (RT). The aims of this study were to evaluate the association between PRD level and survival after definitive RT and to identify the main causes of distress in definitive RT patients. METHODS AND MATERIALS A total of 678 consecutive patients receiving definitive RT at our institution from April 2012 through May 2015 were included. All patients answered a PRD questionnaire that contained 30 items related to possible causes of distress, which could be rated from 1 (no distress) to 5 (high distress). Additionally, patients were asked to rate their overall distress level from 0 (no distress) to 10 (extreme distress). This overall distress level was our primary patient-reported distress measure and was examined as a continuous variable and as a categorical variable with 3 PRD levels (low, 0-3 [n = 295]; moderate, 4-6 [n = 222]; and high, 7-10 [n = 161]). RESULTS As a continuous variable in multivariable Cox regression analysis, a higher overall PRD level was associated with poorer survival after RT (hazard ratio [HR], 1.39; P = .004). As a categorical variable, compared with patients with low distress, survival was poorer for patients with moderate distress (HR, 1.62; P = .038) or high distress (HR, 1.49; P = .12), but the latter difference was not significant. When the moderate and high distress levels were combined, survival was significantly poorer compared with the low distress level (HR, 1.57; P = .034). The top 5 specific causes of distress that patients mentioned were "How I feel during treatment," "Fatigue," "Out-of-pocket medical costs," "Pain that affects my daily functioning," and "Sleep difficulties." CONCLUSIONS PRD before or during RT is a prognostic factor associated with decreased survival. Distress screening guidelines and interventions should be implemented for patients receiving definitive RT.
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Affiliation(s)
- Yacob Habboush
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | | | | | - Laeticia Hollant
- Visiting students, Mayo School of Health Sciences, Mayo Clinic College of Medicine, Jacksonville, Florida
| | - Megan Single
- Visiting students, Mayo School of Health Sciences, Mayo Clinic College of Medicine, Jacksonville, Florida
| | - Katherine Gaines
- Visiting students, Mayo School of Health Sciences, Mayo Clinic College of Medicine, Jacksonville, Florida
| | - Bridget Smart
- Visiting students, Mayo School of Health Sciences, Mayo Clinic College of Medicine, Jacksonville, Florida
| | | | | | - Steven J. Buskirk
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Laura A. Vallow
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Katherine S. Tzou
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Stephen J. Ko
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | | | - Heather A. Biers
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Atiya B. Day
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Kimberly A. Nelson
- Division of Hematology/Oncology/Cancer Center/Breast Clinic, Mayo Clinic, Jacksonville, Florida
| | - Jeff A. Sloan
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Michele Y. Halyard
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, Arizona
| | - Robert C. Miller
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
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Miller DH, Peterson JL, Buskirk SJ, Vallow LA, Ta R, Joseph R, Krishna M, Ko SJ, Tzou KS. Management of Metastatic Apocrine Hidradenocarcinoma with Chemotherapy and Radiation. Rare Tumors 2015; 7:6082. [PMID: 26500736 PMCID: PMC4600998 DOI: 10.4081/rt.2015.6082] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 06/25/2015] [Indexed: 11/30/2022] Open
Abstract
Hidradenocarcinoma is a rare aggressive form of cutaneous adnexal skin carcinoma originating from the sweat gland. Due to its low incidence, prognostic and treatment strategies are still being explored both for primary and advanced disease. This tumor most often presents as either solid or cystic appearing subcutaneous nodules, which may be associated with pruritus or ulceration. To date the mainstay of treatment for local disease has been surgical excision; however, the paucity of historical data available has shown that these tumors often behave aggressively with high rates of local recurrence, metastasis, and poor overall outcomes. There are few case reports describing the utility of radiation therapy in the treatment of hidradenocarcinoma. Herein, we present a case of metastatic apocrine hidradenocarcinoma in a 32-year-old Caucasian male. The patient initially underwent excisional biopsy which confirmed the diagnosis of poorly differentiated, highly infiltrative, apocrine hidradenocarcinoma. He received systemic chemotherapy for metastatic disease, followed by radiation therapy to areas of grossly palpable adenopathy. Prior to radiation therapy the patient had an enlarged hypermetabolic conglomerate of lymph nodes in the right axilla, and borderline enlarged low activity nodes within the left axilla. He received 3 cycles of chemotherapy followed by tamoxifen and radiation therapy (50.4 Gy in 28 fractions) to areas of progressive disease in the bilateral axilla, lower neck, and axillary skin. Following treatment, the patient had complete resolution of skin nodules and improvement of his pruritus. While the role of radiation therapy in the treatment of hidradenocarcinoma has not been well established, this case report demonstrated the potential benefit of external beam radiotherapy in the management of this rare disease.
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Affiliation(s)
- Daniel H Miller
- Department of Radiation Oncology, Mayo Clinic , Jacksonville, FL, USA
| | | | - Steven J Buskirk
- Department of Radiation Oncology, Mayo Clinic , Jacksonville, FL, USA
| | - Laura A Vallow
- Department of Radiation Oncology, Mayo Clinic , Jacksonville, FL, USA
| | - Randy Ta
- University of Minnesota , Minneapolis, MN, USA
| | - Richard Joseph
- Department of Hematology/Oncology, Mayo Clinic , Jacksonville, FL, USA
| | - Murli Krishna
- Department of Laboratory Medicine and Pathology, Mayo Clinic , Jacksonville, FL, USA
| | - Stephen J Ko
- Department of Radiation Oncology, Mayo Clinic , Jacksonville, FL, USA
| | - Katherine S Tzou
- Department of Radiation Oncology, Mayo Clinic , Jacksonville, FL, USA
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12
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Lee RJ, Tzou KS, Heckman MG, Hobbs CJ, Rawal B, Diehl NN, Peterson JL, Paryani NN, Ko SJ, Daugherty LC, Vallow LA, Wong W, Schild S, Pisansky TM, Buskirk SJ. Proposed prognostic scoring system evaluating risk factors for biochemical recurrence of prostate cancer after salvage radiation therapy. BJU Int 2015; 118:236-42. [PMID: 26190356 DOI: 10.1111/bju.13229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To update a previously proposed prognostic scoring system that predicts risk of biochemical recurrence (BCR) after salvage radiation therapy (SRT) for recurrent prostate cancer when using additional patients and a PSA value of 0.2 ng/mL and rising as the definition of BCR. PATIENTS AND METHODS We included 577 patients who received SRT for a rising PSA after radical prostatectomy in this retrospective cohort study. Clinical, pathological, and SRT characteristics were evaluated for association with BCR using relative risks (RRs) from multivariable Cox regression models. RESULTS With a median follow-up of 5.5 years after SRT, 354 patients (61%) experienced BCR. At 5 years after SRT, 40% of patients were free of BCR. Independent associations with BCR were identified for the PSA level before SRT (RR [doubling]: 1.25, P < 0.001), pathological tumour stage (RR [T3a vs T2] 1.21, P = 0.19; RR [T3b/T4 vs T2] 2.09, P < 0.001; overall P < 0.001), Gleason score (RR [7 vs <7] 1.63, P < 0.001; RR [8-10 vs <7] 2.28, P < 0.001; overall P < 0.001), and surgical margin status (RR [positive vs negative] 0.71, P = 0.003). We combined these four variables to create a prognostic scoring system that predicted BCR risk with a c-index of 0.66. Scores ranged from 0 to 7, and 5-year freedom from BCR for different levels of the score was as follows: Score = 0-1: 66%, Score = 2: 46%, Score = 3: 28%, Score = 4: 19%, and Score = 5-7: 15%. CONCLUSION We developed a scoring system that provides an estimation of the risk of BCR after SRT. These findings will be useful for patients and physicians in decision making for radiation therapy in the salvage setting.
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Affiliation(s)
- Richard J Lee
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Katherine S Tzou
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Michael G Heckman
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - Corey J Hobbs
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Bhupendra Rawal
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - Nancy N Diehl
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | | | - Nitesh N Paryani
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Stephen J Ko
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Larry C Daugherty
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Laura A Vallow
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - William Wong
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | - Steven Schild
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Steven J Buskirk
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA
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Patel SH, Hayden RE, Hinni ML, Wong WW, Foote RL, Milani S, Wu Q, Ko SJ, Halyard MY. Angiosarcoma of the Scalp and Face. JAMA Otolaryngol Head Neck Surg 2015; 141:335-40. [DOI: 10.1001/jamaoto.2014.3584] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [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]
Affiliation(s)
- Samir H. Patel
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona
| | - Richard E. Hayden
- Department of Otolaryngology–Head and Neck Surgery/Audiology, Mayo Clinic Hospital, Phoenix, Arizona
| | - Michael L. Hinni
- Department of Otolaryngology–Head and Neck Surgery/Audiology, Mayo Clinic Hospital, Phoenix, Arizona
| | - William W. Wong
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona
| | - Robert L. Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Shadi Milani
- medical student at Midwestern University, Phoenix, Arizona
| | - Qing Wu
- Division of Health Sciences Research, Mayo Clinic, Scottsdale, Arizona
| | - Stephen J. Ko
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
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14
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Kim S, Kim T, Ko SJ, Serago C, Smith A, Vallow LA, Peterson JL, Lee R. Negative margin technique - a novel planning strategy to improve dose conformation in SBRT using dynamic conformal arc delivery. J Appl Clin Med Phys 2013; 14:79-89. [PMID: 24036861 PMCID: PMC5714574 DOI: 10.1120/jacmp.v14i5.4283] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 04/25/2013] [Accepted: 04/22/2013] [Indexed: 12/31/2022] Open
Abstract
The purpose of this study was to introduce a planning strategy for dynamic conformal arc therapy (DCAT), named negative margin technique (NMT), and evaluate its dosimetric gain in lung stereotactic body radiation therapy (SBRT). In DCAT, the field aperture is continuously conformed to the planning target volume (PTV) with an aperture margin (AM) to compensate for the penumbra effect with gantry rotation. It is a common belief the AM should be positive (or at least 'zero'). However, the radial penumbra width becomes significantly wider because of continuously overlapped beams in arc delivery. Therefore, we hypothesize if the 'negative margin' is applied in the radial direction, it would improve the PTV dose conformation while reducing normal tissue dose. For verification, trial plans were made using the NMT and compared with 'zero margin (ZM)' plans for five lung SBRT cases representing different situations depending on the location of the PTV and organs at risk. All plans met 95% PTV coverage with the prescription dose and spared the spinal cord below the tolerance. Two conventional conformation indices (the ratio of prescription isodose volume to the PTV (CI100) and the ratio of 50% prescription isodose volume to the PTV (CI50)) and a modified conformation index were investigated. The maximum dose at 2 cm from the PTV (Dmax-2cm) and the percent of lung volume receiving 20 Gy (V20) were also evaluated. Another planning simulation was performed with a total of ten randomly selected lung SBRT cases to mimic actual practice. In this simulation, optimization with ZM was first performed and further optimization using the NMT was processed for cases that could not meet a goal of CI100 = 1.2 with the ZM optimization. In all cases, both the CI100 and CI50 values were significantly reduced (overall, 9.4% ± 4.1% and 5.9%± 3.1% for CI100 and CI50, respectively). The modified conformation index values also showed similar improvement (overall, 10.1% ± 5.7% increase). Reduction of Dmax-2cm was also observed in all cases (4.5% ± 2.2%). V20 values decreased in all cases but one (5.7% ± 3.9%, excluding the increased case). In the random group simulation, it was possible to achieve the goal with just one NMT trial for five out of six cases that did not meet the goal in the ZM optimization. Interestingly, however, one case needed as many as six iterations to get the CI100 = 1.2 goal. The NMT turned out to be an effective planning strategy that could bring significant improvement of dose conformation. The NMT can be easily implemented in most clinics with no prerequisite.
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15
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Heckman MG, Parker AS, Wu KJ, Hilton TW, Ko SJ, Pisansky TM, Schild SE, Khor LY, Hammond EH, Pollack A, Buskirk SJ. Evaluation of MDM2, p16, and p53 staining levels as biomarkers of biochemical recurrence following salvage radiation therapy for recurrent prostate cancer. Prostate 2012; 72:1757-66. [PMID: 22513981 DOI: 10.1002/pros.22528] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Accepted: 03/24/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE The selection of appropriate candidates for salvage radiation therapy (SRT) to address a rising PSA following radical prostatectomy remains challenging. Herein, we provide the first evaluation of the ability of staining levels of the tumor based biomarkers MDM2, p16, and p53 to aid in prediction of biochemical recurrence (BCR) among men undergoing SRT for recurrent prostate cancer. MATERIAL AND METHODS We identified 152 patients who were treated with SRT between July 1987 and July 2003. Staining levels of MDM2, p16, and p53 in primary tumor samples removed during prostatectomy were detected using monoclonal antibodies and quantified by use of a computer-assisted method. Associations of staining levels with BCR were evaluated using Cox proportional hazards regression models; relative risks (RRs) and 95% confidence intervals (CIs) were estimated. RESULTS Compared to patients with low staining (≤median) as measured by percentage of cells with nuclear staining, there was no significant difference in risk of BCR for patients with high MDM2 staining (RR: 0.90, 95% CI: 0.57-1.45, P = 0.67), high p16 staining (RR: 0.88, 95% CI: 0.54-1.44, P = 0.62), or high p53 staining (RR: 1.33, 95% CI: 0.84-2.11, P = 0.23) in multivariable analysis. These results were consistent when considering alternate percentile cutpoints and alternate quantifications of biomarker staining. CONCLUSIONS Our results provide evidence that MDM2, p16, and p53 staining levels are not useful in the prediction of BCR after SRT. As such, these biomarkers are of little clinical use in the selection of appropriate candidates for SRT.
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Affiliation(s)
- Michael G Heckman
- Biostatistics Unit, Mayo Clinic Florida, Jacksonville, Florida 32224, USA.
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16
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Panjala C, Nguyen JH, Al-Hajjaj AN, Rosser BA, Nakhleh RE, Bridges MD, Ko SJ, Buskirk SJ, Kim GP, Harnois DM. Impact of neoadjuvant chemoradiation on the tumor burden before liver transplantation for unresectable cholangiocarcinoma. Liver Transpl 2012; 18:594-601. [PMID: 22140024 DOI: 10.1002/lt.22462] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [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: 12/23/2022]
Abstract
The very early experience with liver transplantation (LT) for cholangiocarcinoma (CC) was dismal because of the poor survival outcomes and the high recurrence rates. However, LT for CC in conjunction with neoadjuvant chemoradiation recently has shown encouraging results, although the data are extremely limited. At our institution between 2001 and 2008, 22 CC patients underwent protocol orthotopic LT at a median age of 45 years (range = 24-63 years). At a median follow-up of 601.5 days (range = 111-1388 days), the median survival time of the cohort was 3.3 years. The 1-, 2-, and 3-year Kaplan-Meier survival probabilities were 90%, 70%, and 63%, respectively, whereas the historical 5-year survival rates were 0% to 18% for intrahepatic CC and 23% to 26% for extrahepatic CC when patients underwent transplantation without neoadjuvant therapy. These encouraging survival rates for patients with this type of tumor, which is difficult to diagnose and treat, are no less significant when they are compared to the national 1- and 3-year survival rates (86% and 68%, respectively) of patients undergoing deceased donor LT for malignant neoplasms of the liver (as reported by the United Network for Organ Sharing). In our series, disease recurrence was significantly associated with a larger residual tumor [6.3 versus 2.0 cm (mean values), P = 0.008] and with a shorter waiting time for LT after the chemoradiation protocol [18 versus 56 days (mean values), P = 0.04]. Our LT protocol for CC was found to be promising for patients with truly extrahepatic CC and for patients within stages I to IIB of the American Joint Committee on Cancer Staging system (100% survival at a median follow-up of 2.2 years), but the results were notably poor for patients with stage III extrahepatic CC (median survival = 1.2 years). These observations highlight the need for accurate preoperative staging of CC for ideal LT recipient selection and the importance of a low tumor burden and a longer wait after neoadjuvant therapy. More effective chemoradiation regimens for reducing the tumor burden and the appropriate timing of LT after neoadjuvant chemoradiation require further research.
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Affiliation(s)
- Chakri Panjala
- Divisions of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
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17
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Kim I, Kang ES, Yim YS, Ko SJ, Jeong SH, Rim JH, Kim YS, Ahn CW, Cha BS, Lee HC, Kim CH. A low-risk ZnT-8 allele (W325) for post-transplantation diabetes mellitus is protective against cyclosporin A-induced impairment of insulin secretion. Pharmacogenomics J 2010; 11:191-8. [PMID: 20351753 DOI: 10.1038/tpj.2010.22] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
SLC30A8 encodes the β-cell-specific zinc transporter-8 (ZnT-8) expressed in insulin secretory granules. The single-nucleotide polymorphism rs13266634 of SLC30A8 is associated with susceptibility to post-transplantation diabetes mellitus (PTDM). We tested the hypothesis that the polymorphic residue at position 325 of ZnT-8 determines the susceptibility to cyclosporin A (CsA) suppression of insulin secretion. INS (insulinoma)-1E cells expressing the W325 variant showed enhanced glucose-stimulated insulin secretion (GSIS) and were less sensitive to CsA suppression of GSIS. A reduced number of insulin granule fusion events accompanied the decrease in insulin secretion in CsA-treated cells expressing ZnT-8 R325; however, ZnT-8 W325-expressing cells exhibited resistance to the dampening of insulin granule fusion by CsA, and transported zinc ions into secretory vesicles more efficiently. Both tacrolimus and rapamycin caused similar suppression of GSIS in cells expressing ZnT-8 R325. However, cells expressing ZnT-8 W325 were resistant to tacrolimus, but not to rapamycin. The Down's syndrome candidate region-1 (DSCR1), an endogenous calcineurin inhibitor, overexpression and subsequent calcineurin inhibition significantly reduced GSIS in cells expressing the R325 but not the W325 variant, suggesting that differing susceptibility to CsA may be due to different interactions with calcineurin. These data suggest that the ZnT-8 W325 variant is protective against CsA-induced suppression of insulin secretion. Tolerance of ZnT-8 W325 to calcineurin activity may account for its protective effect in PTDM.
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Affiliation(s)
- I Kim
- Department of Pharmacology, Yonsei University College of Medicine, Seoul, Korea
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18
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Bernard JR, Buskirk SJ, Heckman MG, Diehl NN, Ko SJ, Macdonald OK, Schild SE, Pisansky TM. Salvage radiotherapy for rising prostate-specific antigen levels after radical prostatectomy for prostate cancer: dose-response analysis. Int J Radiat Oncol Biol Phys 2009; 76:735-40. [PMID: 19464818 DOI: 10.1016/j.ijrobp.2009.02.049] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Accepted: 02/16/2009] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate the association between external beam radiotherapy (EBRT) dose and biochemical failure (BcF) of prostate cancer in patients who received salvage prostate bed EBRT for a rising prostate-specific antigen (PSA) level after radical prostatectomy. METHODS AND MATERIALS We evaluated patients with a rising PSA level after prostatectomy who received salvage EBRT between July 1987 and October 2007. Patients receiving pre-EBRT androgen suppression were excluded. Cox proportional hazards models were used to investigate the association between EBRT dose and BcF. Dose was considered as a numeric variable and as a categoric variable (low, <64.8 Gy; moderate, 64.8-66.6 Gy; high, >66.6 Gy). RESULTS A total of 364 men met study selection criteria and were followed up for a median of 6.0 years (range, 0.1-19.3 years). Median pre-EBRT PSA level was 0.6 ng/mL. The estimated cumulative rate of BcF at 5 years after EBRT was 50% overall and 57%, 46%, and 39% for the low-, moderate-, and high-dose groups, respectively. In multivariable analysis adjusting for potentially confounding variables, there was evidence of a linear trend between dose and BcF, with risk of BcF decreasing as dose increased (relative risk [RR], 0.77 [5.0-Gy increase]; p = 0.05). Compared with the low-dose group, there was evidence of a decreased risk of BcF for the high-dose group (RR, 0.60; p = 0.04), but no difference for the moderate-dose group (RR, 0.85; p = 0.41). CONCLUSIONS Our results suggest a dose response for salvage EBRT. Doses higher than 66.6 Gy result in decreased risk of BcF.
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Affiliation(s)
- Johnny Ray Bernard
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL 32224, USA
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Ko SJ, Liao XY, Molloi S, Elmore E, Redpath JL. Neoplastic TransformationIn Vitroafter Exposure to Low Doses of Mammographic-Energy X Rays: Quantitative and Mechanistic Aspects. Radiat Res 2004; 162:646-54. [PMID: 15548114 DOI: 10.1667/rr3277] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [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: 11/03/2022]
Abstract
The induction of neoplastic transformation in vitro after exposure of HeLa x skin fibroblast hybrid cells to low doses of mammography-energy (28 kVp) X rays has been studied. The data indicate no evidence of an increase in transformation frequency over the range 0.05 to 22 cGy, and doses in the range 0.05 to 1.1 cGy may result in suppression of transformation frequencies to levels below that seen spontaneously. This finding is not consistent with a linear, no-threshold dose- response curve. The dose range at which possible suppression is evident includes doses typically experienced in mammographic examination of the human breast. Experiments are described that attempt to elucidate any possible role of bystander effects in modulating this low-dose radiation response. Not unexpectedly, inhibition of gap junction intercellular communication (GJIC) with the inhibitor lindane did not result in any significant alteration of transformation frequencies seen at doses of 0.27 or 5.4 cGy in these subconfluent cultures. Furthermore, no evidence of a bystander effect associated with factors secreted into the extracellular medium was seen in medium transfer experiments. Thus, in this system and under the experimental conditions used, bystander effects would not appear to be playing a major role in modulating the shape of the dose-response curve.
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Affiliation(s)
- S J Ko
- Department of Radiation Oncology, University of California Irvine, Irvine, California 92697, USA
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Kwak HH, Ko SJ, Jung HS, Park HD, Chung IH, Kim HJ. Topographic anatomy of the deep temporal nerves, with references to the superior head of lateral pterygoid. Surg Radiol Anat 2003; 25:393-9. [PMID: 14504814 DOI: 10.1007/s00276-003-0171-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2002] [Accepted: 11/10/2002] [Indexed: 10/26/2022]
Abstract
Commonly, the nerve branches from the anterior mandibular nerve trunk pass between the roof of infratemporal fossa and the superior head of lateral pterygoid. However, varied courses of the mandibular nerve branches can be frequently observed. The purpose of this study was to clarify the positional relationships and the clinical relevance of the course variations of the branches of the anterior mandibular nerve trunk with reference to the surrounding anatomical structures. Thirty-six hemi-sectioned heads were studied in detail. In 20 cases, the posterior deep temporal nerve had a common trunk with the masseteric nerve and was then divided anteriorly (15 cases) or posteriorly (five cases). In 16 cases, the posterior deep temporal nerve arose from the mandibular nerve trunk independently. Based on the branching patterns of the middle deep temporal nerve, type A (one twig of the middle deep temporal nerve) was most frequent and occurred in 41.7%. Similarly, type B (two twigs), type C (three twigs) and type D (four twigs) were observed in 36.1%, 16.7%, and 5.5%, respectively. The twigs of the middle deep temporal nerve, which pierced the muscle fibers of the superior head of lateral pterygoid, were found in 21 cases (58.3%). Cases in which the middle deep temporal nerve pierced through all areas of the superior head were most frequent (56.5%). These results suggest that the piercing patterns of the middle deep temporal nerve show there is a possibility that it may be compressed during the actions of the superior head of lateral pterygoid.
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Affiliation(s)
- H H Kwak
- Division in Anatomy and Histology, Department of Oral Biology, College of Dentistry, Oral Science Research Center, Brain Korea 21 Project for Medical Sciences, Yonsei University, Seoul, Korea
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21
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Syed AM, Puthawala A, Sharma A, Gamie S, Londrc A, Cherlow JM, Damore SJ, Nazmy N, Sheikh KM, Ko SJ. High-dose-rate brachytherapy in the treatment of carcinoma of the prostate. Cancer Control 2001; 8:511-21. [PMID: 11807421 DOI: 10.1177/107327480100800606] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Although radical prostatectomy for localized disease is considered as a standard of care, external-beam radiotherapy and brachytherapy are equally effective. We report on the technique and preliminary results of high-dose-rate (HDR) brachytherapy using a temporary iridium-192 implant technique. METHODS The authors reviewed the literature on the techniques, treatment protocols, and results of HDR brachytherapy in the treatment of carcinoma of the prostate, and they report their own protocols, technique, and results. RESULTS The combination of HDR brachytherapy and external irradiation has been well tolerated by all 200 patients in our series, with less than 3% grade 3 late complications and with 95% PSA relapse-free survival with a median follow-up of 24 months. CONCLUSIONS HDR brachytherapy may be the most conformal type of irradiation in the treatment of carcinoma of the prostate regardless of tumor size, anatomical distortion, and organ mobility.
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Affiliation(s)
- A M Syed
- Department of Radiation Oncology, Long Beach Memorial Medical Center, 2801 Atlantic Avenue, Long Beach, CA 90806-1737, USA.
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22
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Chung KR, Oh MY, Ko SJ. Corticotomy-assisted orthodontics. J Clin Orthod 2001; 35:331-9. [PMID: 11475544] [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: 04/16/2023]
Affiliation(s)
- K R Chung
- Department of Orthodontics, Kyung-Hee University, Seoul, Korea
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23
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Yang SJ, Ko SJ, Tsai YR, Jiang SS, Kuo SY, Hung SH, Pan RL. Subunit interaction of vacuolar H+-pyrophosphatase as determined by high hydrostatic pressure. Biochem J 1998; 331 ( Pt 2):395-402. [PMID: 9531476 PMCID: PMC1219367 DOI: 10.1042/bj3310395] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Vacuolar H+-pyrophosphatase (H+-PPase) from etiolated hypocotyls of mung bean (Vigna radiata L.) is a homodimer with a molecular mass of 145 kDa. The vacuolar H+-PPase was subjected to high hydrostatic pressure to investigate its structure and function. The inhibition of H+-PPase activity by high hydrostatic pressure has a pressure-, time- and protein-concentration-dependent manner. The Vmax value of vacuolar H+-PPase was dramatically decreased by pressurization from 293.9 to 70.2 micromol of PPi (pyrophosphate) consumed/h per mg of protein, while the Km value decreased from 0.35 to 0.08 mM, implying that the pressure treatment increased the affinity of PPi to vacuolar H+-PPase but decreased its hydrolysis. The physiological substrate and its analogues enhance high pressure inhibition of vacuolar H+-PPase. The HPLC profile reveals high pressure treatment of H+-PPase provokes the subunit dissociation from an active into inactive form. High hydrostatic pressure also induces the conformational change of vacuolar H+-PPase as determined by spectroscopic techniques. Our results indicate the importance of protein-protein interaction for this novel proton-translocating enzyme. Working models are proposed to interpret the pressure inactivation of vacuolar H+-PPase. We also suggest that association of identical subunits of vacuolar H+-PPase is not random but proceeds in a specific manner.
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Affiliation(s)
- S J Yang
- Institute of Radiation Biology, College of Nuclear Science, National Tsing Hua University, Hsin Chu 30043, Taiwan, Republic of China
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24
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Tsai YR, Yang SJ, Jiang SS, Ko SJ, Hung SH, Kuo SY, Pan RL. High-pressure effects on vacuolar H+-ATPase from etiolated mung bean seedlings. J Protein Chem 1998; 17:161-72. [PMID: 9535278 DOI: 10.1023/a:1022535701279] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A high-hydrostatic-pressure technique was employed to study the structure-function relationship of plant vacuolar H+-ATPase from etiolated mung bean seedlings (Vigna radiata L.). When isolated vacuolar H+-ATPase was subjected to hydrostatic pressure, the activity of ATP hydrolysis was markedly inhibited in a time-, protein concentration- and pressure-dependent manner. The pressure treatment decreased both Vmax and Km of solubilized vacuolar H+-ATPase, implying an increase in ATP binding affinity, but a decrease in the ATP hydrolysis activity. Physiological substrate, Mg2+-ATP, augmented the loss of enzymatic activity upon pressure treatment. However, ADP, AMP, and Pi exerted substantial protective effects against pressurization. Steady-state ATP hydrolysis was more sensitive to pressurization than single-site ATPase activity. The inactivation of solubilized vacuolar H+-ATPase by pressure may result from changes in protein-protein interaction. The conformational change of solubilized vacuolar H+-ATPase induced by hydrostatic pressure was further determined by spectroscopic techniques. The inhibition of vacuolar H+-ATPase under pressurization involved at least two steps. Taken together, our work indicates that subunit-subunit interaction is crucial for the integrity and the function of plant vacuolar H+-ATPase. It is also suggested that the assembly of the vacuolar H+-ATPase complex is probably not random, but follows a sequestered pathway.
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Affiliation(s)
- Y R Tsai
- Kao-Hsiung Medical College, Taiwan, Republic of China
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25
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Youn HS, Kim JD, Koo YB, Ko SJ, Chang MU. Coat protein gene and 3'-noncoding region of a new Korean isolate of cymbidium mosaic virus. Mol Cells 1997; 7:34-9. [PMID: 9085262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
A new Korean isolate of cymbidium mosaic virus (denoted as CymMV-K2), a member of potexviruses, was identified and isolated from a Korean cultivar of Cymbidium species When the nucleotide sequence of the 3'-terminal region of the viral RNA was compared with those of the corresponding regions of two Singaporean isolates (denoted as CymMV-S1 and CymMV-S2) and a Korean isolate (denoted as CymMV-K1), the nucleotide sequence of the coat protein gene of CymMV-K2 was highly homologous to other cymbidium mozaic viruses (92.9%-96.7% homology). The coat protein of CymMV-K2 and CymMV-S2 consists of 223 amino acids, while the coat protein of CymMV-K1 and CymMV-S1 consists of 220 amino acids. This difference was caused by deletions of 5 nucleotides in the coat protein open reading frame (ORF) of CymMV-S1 and CymMV-K1, when compared with CymMV-K2 and CymMV-S2. These deletions result in changes of the deduced amino acid sequence and the length of the coat protein. The 3'-noncoding region of the CymMV-K2, which contains sequences involved in the replication and polyadenylation of viral RNA, was compared with those of other cymbidium mosaic viruses. No canonical polyadenylation signal was found in the 3'-noncoding region of CymMV-K2, whereas in other CymMVs AAUAAA boxes, are present at the end of RNA with their AAA portions as the first A residue of the poly(A) tail.
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Affiliation(s)
- H S Youn
- Department of Microbiology, College of Natural Sciences, Inje University, Kimhae, Korea
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26
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Lee KH, Morales A, Ko SJ. Adaptive basis matrix for the morphological function processing opening and closing. IEEE Trans Image Process 1997; 6:769-774. [PMID: 18282971 DOI: 10.1109/83.568935] [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] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
A method for adaptation of the basis matrix of the gray-scale function processing (FP) opening and closing under the least mean square (LMS) error criterion is presented. We previously proposed the basis matrix for efficient representation of opening and closing (see IEEE Trans. Signal Processing, vol.43, p.3058-61, Dec. 1995 and IEEE Signal Processing Lett., vol.2, p.7-9, Jan. 1995). With this representation, the opening and closing operations are accomplished by a local matrix operation rather than cascade operation. Moreover, the analysis of the basis matrix shows that the basis matrix is skew symmetric, permitting to derive a simpler matrix representation for opening and closing operators. Furthermore, we propose an adaptation algorithm of the basis matrix for both opening and closing. The LMS and backpropagation algorithms are utilized for adaptation of the basis matrix. At each iteration of the adaptation process, the elements of the basis matrix are updated using the estimation of gradient to decrease the mean square error (MSE) between the desired signal and the actual filter output. Some results of optimal morphological filters applied to two-dimensional (2-D) images are presented.
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Affiliation(s)
- K H Lee
- Dept. of Electron. Eng., Korea Univ., Seoul
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Ko SJ, Chien CY, Lin CT, Lin YJ, Tsai CL. Phrenic nerve transfer in the repair of brachial plexus injuries: an animal model. CHINESE J PHYSIOL 1997; 40:51-5. [PMID: 9170556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
UNLABELLED Ten young mongrel dogs underwent unilateral denervation of the brachial plexus. In six dogs, a 2-cm segment of phrenic nerve autograft was sutured to either the resected musculocutaneous nerve or the radial nerve. A hemoclip was applied to either musculocutaneous or radial nerve in the control groups. Five months postoperatively, the grafted musculocutaneous nerve demonstrated less fibrous tissue and less muscle atrophy of the biceps when compared to the control group with clipped nerve. In the group with the grafted radial nerve, the electromyographic findings of multiphasic action potential and muscle contraction from electric stimulation suggested reinnervation of the radial nerve. IN CONCLUSION phrenic nerve transfer may be used to repair specific damages to nerve trunk with histological, electromyographic and clinical recovery.
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Affiliation(s)
- S J Ko
- Laboratory Animal Center, College of Medicine, National Taiwan University, Taipei, ROC
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Ko SJ, Morales A, Lee KH. Fast recursive algorithms for morphological operators based on the basis matrix representation. IEEE Trans Image Process 1996; 5:1073-1077. [PMID: 18285195 DOI: 10.1109/83.503923] [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] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
A real-time implementation method for the most general morphological system, the so-called grayscale function processing (FP) system is presented. The proposed method is an extension of our previous works (1993, 1995) using the matrix representation of the FP system with a basis matrix (BM) and a block basis matrix (BBM) composed of grayscale structuring elements (GSE). In order to further improve the computational efficiency of the basis matrix representation, we propose recursive algorithms based on the observation of the BM and BBM. The efficiency of the proposed algorithms is gained by avoiding redundant steps in computing overlapping local maximum or minimum operations. It is shown that, with the proposed scheme, both opening and closing can be determined in real time by 2N-2 additions and 2N-2 comparisons, and OC and CO by 4N-4 additions and 4N-4 comparisons, when the size of the GSE is equal to N. It is also shown that the proposed recursive opening and closing require only 3N-3 memory elements.
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Affiliation(s)
- S J Ko
- Dept. of Electron. Eng., Korea Univ., Seoul
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Abstract
The aim of this paper is to find a relationship between alternating sequential filters (ASF) and the morphological sampling theorem (MST) developed by Haralick et al. (1987). The motivation behind this approach is to take advantage of the computational efficiency offered by the MST to implement morphological operations. First, we show alternative proofs for opening and closing in the sampled and unsampled domain using the basis functions. These proofs are important because they show that it possible to obtain any level of a morphological pyramid in one step rather than the traditional two-step procedure. This decomposition is then used to show the relationship of the open-closing in the sampled and unsampled domain. An upper and a lower bound, for the above relationships, are presented. Under certain circumstances, an equivalence is shown for open-closing between the sampled and the unsampled domain. An extension to more complicated algorithms using a union of openings and an intersection of closings is also proposed. Using the Hausdorff metric, it is shown that a morphologically reconstructed image cannot have a better accuracy than twice the radius of the reconstruction structuring element. Binary and gray scale examples are presented.
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Affiliation(s)
- A Morales
- Coll. of Eng., Pennsylvania State Univ., DuBois, PA
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Lam CY, Nancollas GH, Ko SJ. The kinetics of formation and dissolution of uric acid crystals. Invest Urol 1978; 15:473-7. [PMID: 649297] [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: 12/23/2022]
Abstract
The kinetics of crystallization and dissolution of uric acid have been studied at temperatures from 15 to 45 C, using a highly reproducbile seeding technique. The rates of reaction have been followed by a precision conductometric method. The mineralization rate follows an equation second-order in relative supersaturation and the experimental evidence points to a surface controlled crystal growth. In contrast, the rapid dissolution of seed crystals into undersaturated uric acid solutions seems to be controlled by diffusion of electrolyte through the hydrodynamic boundary layer at the crystal surface. The activation energy for dissolution, 13.1 +/- 2.6 kJ/mole, is close to that expected for bulk diffusion. Values are reported for the solubility product and dissociation constant for uric acid from 15 to 45 C.
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