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Beckham TH, Rooney MK, McAleer MF, Ghia AJ, Tom MC, Perni S, McGovern S, Grosshans D, Chung C, Wang C, De B, Swanson T, Paulino A, Jiang W, Ferguson S, Patel CB, Li J, Yeboa DN. Hypofractionated radiotherapy for glioblastoma: A large institutional retrospective assessment of 2 approaches. Neurooncol Pract 2024; 11:266-274. [PMID: 38737610 PMCID: PMC11085842 DOI: 10.1093/nop/npae004] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Background Glioblastoma (GBM) poses therapeutic challenges due to its aggressive nature, particularly for patients with poor functional status and/or advanced disease. Hypofractionated radiotherapy (RT) regimens have demonstrated comparable disease outcomes for this population while allowing treatment to be completed more quickly. Here, we report our institutional outcomes of patients treated with 2 hypofractionated RT regimens: 40 Gy/15fx (3w-RT) and 50 Gy/20fx (4w-RT). Methods A single-institution retrospective analysis was conducted of 127 GBM patients who underwent 3w-RT or 4w-RT. Patient characteristics, treatment regimens, and outcomes were analyzed. Univariate and multivariable Cox regression models were used to estimate progression-free survival (PFS) and overall survival (OS). The impact of chemotherapy and RT schedule was explored through subgroup analyses. Results Median OS for the entire cohort was 7.7 months. There were no significant differences in PFS or OS between 3w-RT and 4w-RT groups overall. Receipt and timing of temozolomide (TMZ) emerged as the variable most strongly associated with survival, with patients receiving adjuvant-only or concurrent and adjuvant TMZ having significantly improved PFS and OS (P < .001). In a subgroup analysis of patients that did not receive TMZ, patients in the 4w-RT group demonstrated a trend toward improved OS as compared to the 3w-RT group (P = .12). Conclusions This study demonstrates comparable survival outcomes between 3w-RT and 4w-RT regimens in GBM patients. Receipt and timing of TMZ were strongly associated with survival outcomes. The potential benefit of dose-escalated hypofractionation for patients not receiving chemotherapy warrants further investigation and emphasizes the importance of personalized treatment approaches.
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Affiliation(s)
- Thomas H Beckham
- Department of Radiation Oncology, CNS/Pediatrics Section, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael K Rooney
- Department of Radiation Oncology, CNS/Pediatrics Section, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mary F McAleer
- Department of Radiation Oncology, CNS/Pediatrics Section, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Amol J Ghia
- Department of Radiation Oncology, CNS/Pediatrics Section, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Martin C Tom
- Department of Radiation Oncology, CNS/Pediatrics Section, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Subha Perni
- Department of Radiation Oncology, CNS/Pediatrics Section, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Susan McGovern
- Department of Radiation Oncology, CNS/Pediatrics Section, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David Grosshans
- Department of Radiation Oncology, CNS/Pediatrics Section, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Caroline Chung
- Department of Radiation Oncology, CNS/Pediatrics Section, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Chenyang Wang
- Department of Radiation Oncology, CNS/Pediatrics Section, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Brain De
- Department of Radiation Oncology, CNS/Pediatrics Section, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Todd Swanson
- Department of Radiation Oncology, CNS/Pediatrics Section, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Arnold Paulino
- Department of Radiation Oncology, CNS/Pediatrics Section, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Wen Jiang
- Department of Radiation Oncology, CNS/Pediatrics Section, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sherise Ferguson
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Chirag B Patel
- Department of Radiation Oncology, CNS/Pediatrics Section, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jing Li
- Department of Radiation Oncology, CNS/Pediatrics Section, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Debra N Yeboa
- Department of Radiation Oncology, CNS/Pediatrics Section, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Chung C, Choi S, Bae J, Jeong H, Lee J, Lee H. Developing and Validating a Korean Version of the Assessment of Children's Emotional Skills. Child Psychiatry Hum Dev 2024; 55:819-830. [PMID: 36229629 PMCID: PMC11061020 DOI: 10.1007/s10578-022-01452-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2022] [Indexed: 11/24/2022]
Abstract
In this study, a Korean Assessment of Children's Emotional Skills (ACES) was developed by modifying the original ACES which was initially introduced in the United States. Specifically, the original ACES was translated into Korean and revised to better fit the Korean cultural context. The content validity of the revised Korean ACES was established via expert reviews. To test its reliability, the revised Korean ACES was conducted on 286 six-year-old children. A confirmatory factor analysis indicated that our newly developed Korean ACES can be used as an appropriate tool to measure Korean children's emotional skills. The Korean ACES can stimulate further studies on these emotional skills and contribute to various international collaborative studies that seek to compare the emotional skills of children from diverse cultural backgrounds.
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Affiliation(s)
- C Chung
- School of Child Studies, Kyungpook National University, Daegu, South Korea
| | - S Choi
- Department of English Education, Kyungpook National University, Daegu, South Korea
| | - J Bae
- Department of English Education, Kyungpook National University, Daegu, South Korea
| | - H Jeong
- Department of Early Childhood Education, Keimyung College University, Daegu, South Korea
| | - J Lee
- School of Child Studies, Kyungpook National University, Daegu, South Korea
| | - H Lee
- Department of Home Economics Education, Kyungpook National University, Daegu, South Korea.
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Ene CI, Abi Faraj C, Beckham TH, Weinberg JS, Andersen CR, Haider AS, Rao G, Ferguson SD, Alvarez-Brenkenridge CA, Kim BYS, Heimberger AB, McCutcheon IE, Prabhu SS, Wang CM, Ghia AJ, McGovern SL, Chung C, McAleer MF, Tom MC, Perni S, Swanson TA, Yeboa DN, Briere TM, Huse JT, Fuller GN, Lang FF, Li J, Suki D, Sawaya RE. Response of treatment-naive brain metastases to stereotactic radiosurgery. Nat Commun 2024; 15:3728. [PMID: 38697991 PMCID: PMC11066027 DOI: 10.1038/s41467-024-47998-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 04/15/2024] [Indexed: 05/05/2024] Open
Abstract
With improvements in survival for patients with metastatic cancer, long-term local control of brain metastases has become an increasingly important clinical priority. While consensus guidelines recommend surgery followed by stereotactic radiosurgery (SRS) for lesions >3 cm, smaller lesions (≤3 cm) treated with SRS alone elicit variable responses. To determine factors influencing this variable response to SRS, we analyzed outcomes of brain metastases ≤3 cm diameter in patients with no prior systemic therapy treated with frame-based single-fraction SRS. Following SRS, 259 out of 1733 (15%) treated lesions demonstrated MRI findings concerning for local treatment failure (LTF), of which 202 /1733 (12%) demonstrated LTF and 54/1733 (3%) had an adverse radiation effect. Multivariate analysis demonstrated tumor size (>1.5 cm) and melanoma histology were associated with higher LTF rates. Our results demonstrate that brain metastases ≤3 cm are not uniformly responsive to SRS and suggest that prospective studies to evaluate the effect of SRS alone or in combination with surgery on brain metastases ≤3 cm matched by tumor size and histology are warranted. These studies will help establish multi-disciplinary treatment guidelines that improve local control while minimizing radiation necrosis during treatment of brain metastasis ≤3 cm.
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Affiliation(s)
- Chibawanye I Ene
- Department of Neurosurgery, The University of Texas M D Anderson Cancer Center, Houston, TX, USA.
| | - Christina Abi Faraj
- Department of Neurosurgery, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Thomas H Beckham
- Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey S Weinberg
- Department of Neurosurgery, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Clark R Andersen
- Department of Biostatistics, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Ali S Haider
- Department of Neurosurgery, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Ganesh Rao
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Sherise D Ferguson
- Department of Neurosurgery, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | | | - Betty Y S Kim
- Department of Neurosurgery, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Amy B Heimberger
- Department of Neurological Surgery, Malnati Brain Tumor Institute of the Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ian E McCutcheon
- Department of Neurosurgery, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Chenyang Michael Wang
- Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Amol J Ghia
- Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Susan L McGovern
- Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Mary Frances McAleer
- Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Martin C Tom
- Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Subha Perni
- Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Todd A Swanson
- Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Debra N Yeboa
- Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Tina M Briere
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Jason T Huse
- Department of Pathology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Gregory N Fuller
- Department of Pathology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Frederick F Lang
- Department of Neurosurgery, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Jing Li
- Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Dima Suki
- Department of Neurosurgery, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Raymond E Sawaya
- Faculty of Medicine and Medical Affairs, American University of Beirut, Beirut, Lebanon
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Yadav D, Upadhyay R, Kumar VA, Chen MM, Johnson JM, Langshaw H, Curl BJ, Farhat M, Talpur W, Beckham TH, Yeboa DN, Swanson TA, Ghia AJ, Li J, Chung C. Additive Value of MR Simulation Prior to Chemoradiation in Evaluating Treatment Response and Pseudoprogression in High-Grade Gliomas. Pract Radiat Oncol 2024:S1879-8500(24)00089-4. [PMID: 38685448 DOI: 10.1016/j.prro.2024.04.009] [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: 12/20/2023] [Revised: 04/08/2024] [Accepted: 04/18/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND A dedicated MRI Simulation(MRsim) for radiation treatment(RT) planning in high-grade glioma(HGG) patients can detect early radiological changes, including tumor progression after surgery and before standard of care chemoradiation. This study aimed to determine the impact of using post-op MRI vs. MRsim as the baseline for response assessment and reporting pseudo-progression on follow-up imaging at one month(FU1) after chemoradiation. METHODS Histologically confirmed HGG patients were planned for six weeks of RT in a prospective study for adaptive RT planning. All patients underwent post-op MRI, MRsim, and follow-up MRI scans every 2-3 months. Tumor response was assessed by three independent blinded reviewers using Response Assessment in Neuro-Oncology(RANO) criteria when baseline was either post-op MRI or MRsim. Interobserver agreement was calculated using light's kappa. RESULTS 30 patients (median age 60.5 years; IQR 54.5-66.3) were included. Median interval between surgery and RT was 34 days (IQR 27-41). Response assessment at FU1 differed in 17 patients (57%) when the baseline was post-op MRI vs. MRsim, including true progression vs. partial response(PR) or stable disease(SD) in 11 (37%) and SD vs. PR in 6 (20%) patients. True progression was reported in 19 patients (63.3%) on FU1 when the baseline was post-op MRI vs 8 patients (26.7%) when the baseline was MRsim (p=.004). Pseudo-progression was observed at FU1 in 12 (40%) vs. 4 (13%) patients, when the baseline was post-op MRI vs. MRsim (p=.019). Interobserver agreement between observers was moderate (κ = 0.579; p<0.001). CONCLUSIONS Our study demonstrates the value of acquiring an updated MR closer to RT in patients with HGG to improve response assessment, and accuracy in evaluation of pseudo-progression even at the early time point of first follow-up after RT. Earlier identification of patients with true progression would enable more timely salvage treatments including potential clinical trial enrolment to improve patient outcomes.
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Affiliation(s)
- Divya Yadav
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Rituraj Upadhyay
- Department of Radiation Oncology, James Comprehensive Cancer Hospital, The Ohio State University, Columbus, OH, USA
| | - Vinodh A Kumar
- Department of Radiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Melissa M Chen
- Department of Radiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Jason M Johnson
- Department of Radiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Holly Langshaw
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Brandon J Curl
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Maguy Farhat
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Wasif Talpur
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Thomas H Beckham
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Debra N Yeboa
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Todd A Swanson
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Amol J Ghia
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Jing Li
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
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5
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Muthusivarajan R, Celaya A, Yung JP, Long JP, Viswanath SE, Marcus DS, Chung C, Fuentes D. Evaluating the relationship between magnetic resonance image quality metrics and deep learning-based segmentation accuracy of brain tumors. Med Phys 2024. [PMID: 38640464 DOI: 10.1002/mp.17059] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 01/16/2024] [Accepted: 02/25/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) scans are known to suffer from a variety of acquisition artifacts as well as equipment-based variations that impact image appearance and segmentation performance. It is still unclear whether a direct relationship exists between magnetic resonance (MR) image quality metrics (IQMs) (e.g., signal-to-noise, contrast-to-noise) and segmentation accuracy. PURPOSE Deep learning (DL) approaches have shown significant promise for automated segmentation of brain tumors on MRI but depend on the quality of input training images. We sought to evaluate the relationship between IQMs of input training images and DL-based brain tumor segmentation accuracy toward developing more generalizable models for multi-institutional data. METHODS We trained a 3D DenseNet model on the BraTS 2020 cohorts for segmentation of tumor subregions enhancing tumor (ET), peritumoral edematous, and necrotic and non-ET on MRI; with performance quantified via a 5-fold cross-validated Dice coefficient. MRI scans were evaluated through the open-source quality control tool MRQy, to yield 13 IQMs per scan. The Pearson correlation coefficient was computed between whole tumor (WT) dice values and IQM measures in the training cohorts to identify quality measures most correlated with segmentation performance. Each selected IQM was used to group MRI scans as "better" quality (BQ) or "worse" quality (WQ), via relative thresholding. Segmentation performance was re-evaluated for the DenseNet model when (i) training on BQ MRI images with validation on WQ images, as well as (ii) training on WQ images, and validation on BQ images. Trends were further validated on independent test sets derived from the BraTS 2021 training cohorts. RESULTS For this study, multimodal MRI scans from the BraTS 2020 training cohorts were used to train the segmentation model and validated on independent test sets derived from the BraTS 2021 cohort. Among the selected IQMs, models trained on BQ images based on inhomogeneity measurements (coefficient of variance, coefficient of joint variation, coefficient of variation of the foreground patch) and the models trained on WQ images based on noise measurement peak signal-to-noise ratio (SNR) yielded significantly improved tumor segmentation accuracy compared to their inverse models. CONCLUSIONS Our results suggest that a significant correlation may exist between specific MR IQMs and DenseNet-based brain tumor segmentation performance. The selection of MRI scans for model training based on IQMs may yield more accurate and generalizable models in unseen validation.
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Affiliation(s)
| | - Adrian Celaya
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Computational and Applied Mathematics, Rice University, Houston, Texas, USA
| | - Joshua P Yung
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - James P Long
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Satish E Viswanath
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Daniel S Marcus
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David Fuentes
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Sujit SJ, Aminu M, Karpinets TV, Chen P, Saad MB, Salehjahromi M, Boom JD, Qayati M, George JM, Allen H, Antonoff MB, Hong L, Hu X, Heeke S, Tran HT, Le X, Elamin YY, Altan M, Vokes NI, Sheshadri A, Lin J, Zhang J, Lu Y, Behrens C, Godoy MCB, Wu CC, Chang JY, Chung C, Jaffray DA, Wistuba II, Lee JJ, Vaporciyan AA, Gibbons DL, Heymach J, Zhang J, Cascone T, Wu J. Enhancing NSCLC recurrence prediction with PET/CT habitat imaging, ctDNA, and integrative radiogenomics-blood insights. Nat Commun 2024; 15:3152. [PMID: 38605064 PMCID: PMC11009351 DOI: 10.1038/s41467-024-47512-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 03/21/2024] [Indexed: 04/13/2024] Open
Abstract
While we recognize the prognostic importance of clinicopathological measures and circulating tumor DNA (ctDNA), the independent contribution of quantitative image markers to prognosis in non-small cell lung cancer (NSCLC) remains underexplored. In our multi-institutional study of 394 NSCLC patients, we utilize pre-treatment computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) to establish a habitat imaging framework for assessing regional heterogeneity within individual tumors. This framework identifies three PET/CT subtypes, which maintain prognostic value after adjusting for clinicopathologic risk factors including tumor volume. Additionally, these subtypes complement ctDNA in predicting disease recurrence. Radiogenomics analysis unveil the molecular underpinnings of these imaging subtypes, highlighting downregulation in interferon alpha and gamma pathways in the high-risk subtype. In summary, our study demonstrates that these habitat imaging subtypes effectively stratify NSCLC patients based on their risk levels for disease recurrence after initial curative surgery or radiotherapy, providing valuable insights for personalized treatment approaches.
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Affiliation(s)
- Sheeba J Sujit
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Muhammad Aminu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tatiana V Karpinets
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Pingjun Chen
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maliazurina B Saad
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Morteza Salehjahromi
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John D Boom
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Mohamed Qayati
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - James M George
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Haley Allen
- Natural Sciences, Rice University, Houston, TX, USA
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lingzhi Hong
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xin Hu
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Simon Heeke
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hai T Tran
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xiuning Le
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yasir Y Elamin
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mehmet Altan
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Natalie I Vokes
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ajay Sheshadri
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Julie Lin
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jianhua Zhang
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yang Lu
- Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carmen Behrens
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Myrna C B Godoy
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carol C Wu
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joe Y Chang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Institute of Data Science in Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David A Jaffray
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Institute of Data Science in Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ignacio I Wistuba
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J Jack Lee
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ara A Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Don L Gibbons
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John Heymach
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jianjun Zhang
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Lung Cancer Genomics Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Lung Cancer Interception Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tina Cascone
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jia Wu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Institute of Data Science in Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Parker CC, Petersen PM, Cook AD, Clarke NW, Catton C, Cross WR, Kynaston H, Parulekar WR, Persad RA, Saad F, Bower L, Durkan GC, Logue J, Maniatis C, Noor D, Payne H, Anderson J, Bahl AK, Bashir F, Bottomley DM, Brasso K, Capaldi L, Chung C, Cooke PW, Donohue JF, Eddy B, Heath CM, Henderson A, Henry A, Jaganathan R, Jakobsen H, James ND, Joseph J, Lees K, Lester J, Lindberg H, Makar A, Morris SL, Oommen N, Ostler P, Owen L, Patel P, Pope A, Popert R, Raman R, Ramani V, Røder A, Sayers I, Simms M, Srinivasan V, Sundaram S, Tarver KL, Tran A, Wells P, Wilson J, Zarkar AM, Parmar MKB, Sydes MR. Timing of radiotherapy (RT) after radical prostatectomy (RP): long-term outcomes in the RADICALS-RT trial (NCT00541047). Ann Oncol 2024:S0923-7534(24)00105-4. [PMID: 38583574 DOI: 10.1016/j.annonc.2024.03.010] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND The optimal timing of radiotherapy (RT) after radical prostatectomy for prostate cancer has been uncertain. RADICALS-RT compared efficacy and safety of adjuvant RT versus an observation policy with salvage RT for prostate-specific antigen (PSA) failure. PATIENTS AND METHODS RADICALS-RT was a randomised controlled trial enrolling patients with ≥1 risk factor (pT3/4, Gleason 7-10, positive margins, preoperative PSA≥10 ng/ml) for recurrence after radical prostatectomy. Patients were randomised 1:1 to adjuvant RT ('Adjuvant-RT') or an observation policy with salvage RT for PSA failure ('Salvage-RT') defined as PSA≥0.1 ng/ml or three consecutive rises. Stratification factors were Gleason score, margin status, planned RT schedule (52.5 Gy/20 fractions or 66 Gy/33 fractions) and treatment centre. The primary outcome measure was freedom-from-distant-metastasis (FFDM), designed with 80% power to detect an improvement from 90% with Salvage-RT (control) to 95% at 10 years with Adjuvant-RT. Secondary outcome measures were biochemical progression-free survival, freedom from non-protocol hormone therapy, safety and patient-reported outcomes. Standard survival analysis methods were used; hazard ratio (HR)<1 favours Adjuvant-RT. RESULTS Between October 2007 and December 2016, 1396 participants from UK, Denmark, Canada and Ireland were randomised: 699 Salvage-RT, 697 Adjuvant-RT. Allocated groups were balanced with a median age of 65 years. Ninety-three percent (649/697) Adjuvant-RT reported RT within 6 months after randomisation; 39% (270/699) Salvage-RT reported RT during follow-up. Median follow-up was 7.8 years. With 80 distant metastasis events, 10-year FFDM was 93% for Adjuvant-RT and 90% for Salvage-RT: HR=0.68 [95% confidence interval (CI) 0.43-1.07, P=0.095]. Of 109 deaths, 17 were due to prostate cancer. Overall survival was not improved (HR=0.980, 95% CI 0.667-1.440, P=0.917). Adjuvant-RT reported worse urinary and faecal incontinence 1 year after randomisation (P=0.001); faecal incontinence remained significant after 10 years (P=0.017). CONCLUSION Long-term results from RADICALS-RT confirm adjuvant RT after radical prostatectomy increases the risk of urinary and bowel morbidity, but does not meaningfully improve disease control. An observation policy with salvage RT for PSA failure should be the current standard after radical prostatectomy. TRIAL IDENTIFICATION RADICALS, RADICALS-RT, ISRCTN40814031, NCT00541047.
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Affiliation(s)
- C C Parker
- Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Sutton, UK.
| | - P M Petersen
- Department of Oncology, Copenhagen Prostate Cancer Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - A D Cook
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - N W Clarke
- Department of Urology, The Christie NHS Foundation Trust, Manchester; Manchester Cancer Research Centre, The University of Manchester, Manchester; Department of Urology, Salford Royal NHS Foundation Trust, Manchester, UK, Department of Urology, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - C Catton
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - W R Cross
- Department of Urology, St James's University Hospital, Leeds
| | - H Kynaston
- Division of Cancer and Genetics, Cardiff University, Cardiff, UK
| | - W R Parulekar
- Canadian Cancer Trials Group, Queen's University, Kingston, Canada
| | - R A Persad
- Department of Urology, Bristol Urological Institute, Bristol, UK
| | - F Saad
- Department of Urology, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - L Bower
- Guy's and St Thomas' NHS Foundation Trust, London; Institute of Cancer Research, Royal Marsden NHS Foundation Trust, London, UK
| | - G C Durkan
- Department of Urology, University Hospital Galway, Galway, Ireland
| | - J Logue
- Department of Oncology, The Christie Hospital NHS FT, Wilmslow Road, Manchester
| | - C Maniatis
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - D Noor
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | | | | | - A K Bahl
- Bristol Haematology and Oncology Centre, University Hospitals Bristol & Weston NHS Trust, Bristol
| | - F Bashir
- Queen's Centre for Oncology, Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Cottingham, UK
| | | | - K Brasso
- Department of Urology, Copenhagen Prostate Cancer Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - L Capaldi
- Worcester Oncology Centre, Worcestershire Acute NHS Hospitals Trust, Worcester
| | - C Chung
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - P W Cooke
- Department of Urology, The Royal Wolverhampton NHS Trust, Wolverhampton
| | - J F Donohue
- Department of Urology, Maidstone and Tunbridge Wells NHS Trust, Maidstone
| | - B Eddy
- East Kent University Hospitals Foundation Trust, Kent
| | - C M Heath
- Department of Clinical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton
| | - A Henderson
- Department of Urology, Maidstone and Tunbridge Wells NHS Trust, Maidstone
| | - A Henry
- Leeds Institute of Medical Research, University of Leeds, Leeds
| | - R Jaganathan
- Department of Urology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - H Jakobsen
- Department of Urology, Herlev University Hospital, Herlev, Denmark
| | - N D James
- Institute of Cancer Research, Royal Marsden NHS Foundation Trust, London, UK
| | - J Joseph
- Leeds Teaching Hospitals; York and Scarborough Teaching Hospitals, York
| | - K Lees
- Kent Oncology Centre, Maidstone and Tunbridge Wells NHS Trust, Maidstone
| | - J Lester
- South West Wales Cancer Centre, Singleton Hospital, Swansea, UK
| | - H Lindberg
- Department of Oncology, Herlev University Hospital, Herlev, Denmark
| | - A Makar
- Department of Urology, Worcestershire Acute Hospitals Trust, Worcester
| | - S L Morris
- Guy's and St Thomas' NHS Foundation Trust, London
| | - N Oommen
- Wrexham Maelor Hospital, Wrexham
| | - P Ostler
- Department of Urology, Hillingdon Hospitals NHS Foundation Trust, Hillingdon, London
| | - L Owen
- Bradford Royal Infirmary, Bradford; Leeds Cancer Centre, Leeds
| | - P Patel
- Department of Urology, University College London Hospitals, London
| | - A Pope
- Department of Urology, Hillingdon Hospitals NHS Foundation Trust, Hillingdon, London
| | - R Popert
- Guy's and St Thomas' NHS Foundation Trust, London
| | - R Raman
- Kent Oncology Centre, Kent & Canterbury Hospital, Canterbury
| | - V Ramani
- Department of Urology, The Christie NHS Foundation Trust, Manchester
| | - A Røder
- Department of Urology, Copenhagen Prostate Cancer Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen
| | - I Sayers
- Deanesly Centre, New Cross Hospital, Wolverhampton
| | - M Simms
- Department of Urology, Hull University Hospitals NHS Trust, Hull
| | - V Srinivasan
- Glan Clwyd Hospital, Betsi Cadwaladr University Health Board, Rhyl
| | - S Sundaram
- Department of Urology, Mid Yorkshire Teaching Hospital, Wakefield
| | - K L Tarver
- Department of Oncology, Queen's Hospital, Romford
| | - A Tran
- Department of Oncology, The Christie Hospital NHS FT, Wilmslow Road, Manchester
| | - P Wells
- Barts Cancer Centre, St Bartholomews Hospital, London
| | | | - A M Zarkar
- Department of Oncology, University Hospitals Birmingham, Birmingham, UK
| | - M K B Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - M R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London.
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Butner JD, Dogra P, Chung C, Koay EJ, Welsh JW, Hong DS, Cristini V, Wang Z. Hybridizing mechanistic mathematical modeling with deep learning methods to predict individual cancer patient survival after immune checkpoint inhibitor therapy. Res Sq 2024:rs.3.rs-4151883. [PMID: 38586046 PMCID: PMC10996814 DOI: 10.21203/rs.3.rs-4151883/v1] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
We present a study where predictive mechanistic modeling is used in combination with deep learning methods to predict individual patient survival probabilities under immune checkpoint inhibitor (ICI) therapy. This hybrid approach enables prediction based on both measures that are calculable from mechanistic models (but may not be directly measurable in the clinic) and easily measurable quantities or characteristics (that are not always readily incorporated into predictive mechanistic models). The mechanistic model we have applied here can predict tumor response from CT or MRI imaging based on key mechanisms underlying checkpoint inhibitor therapy, and in the present work, its parameters were combined with readily-available clinical measures from 93 patients into a hybrid training set for a deep learning time-to-event predictive model. Analysis revealed that training an artificial neural network with both mechanistic modeling-derived and clinical measures achieved higher per-patient predictive accuracy based on event-time concordance, Brier score, and negative binomial log-likelihood-based criteria than when only mechanistic model-derived values or only clinical data were used. Feature importance analysis revealed that both clinical and model-derived parameters play prominent roles in neural network decision making, and in increasing prediction accuracy, further supporting the advantage of our hybrid approach. We anticipate that many existing mechanistic models may be hybridized with deep learning methods in a similar manner to improve predictive accuracy through addition of additional data that may not be readily implemented in mechanistic descriptions.
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Affiliation(s)
- Joseph D Butner
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Institute for Data Science in Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Master in Clinical Translation Management Program, The Cameron School of Business, University of St. Thomas, Houston, TX 77006, USA
| | - Prashant Dogra
- Mathematics in Medicine Program, Houston Methodist Research Institute, Houston, TX 77030, USA
- Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY 10065, USA
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Institute for Data Science in Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Eugene J Koay
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - James W Welsh
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - David S Hong
- Department of Investigational Cancer Therapeutics, University of Texas MD Anderson Cancer Center, Houston, Texas 77230, USA
| | - Vittorio Cristini
- Mathematics in Medicine Program, Houston Methodist Research Institute, Houston, TX 77030, USA
- Neal Cancer Center, Houston Methodist Research Institute, Houston, TX 77030, USA
- Physiology, Biophysics, and Systems Biology Program, Graduate School of Medical Sciences, Weill Cornell Medicine, New York, NY 10065, USA
- Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77230, USA
| | - Zhihui Wang
- Mathematics in Medicine Program, Houston Methodist Research Institute, Houston, TX 77030, USA
- Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY 10065, USA
- Neal Cancer Center, Houston Methodist Research Institute, Houston, TX 77030, USA
- Department of Medical Education, Texas A&M University School of Medicine, Bryan, TX 77807, USA
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Salehjahromi M, Karpinets TV, Sujit SJ, Qayati M, Chen P, Aminu M, Saad MB, Bandyopadhyay R, Hong L, Sheshadri A, Lin J, Antonoff MB, Sepesi B, Ostrin EJ, Toumazis I, Huang P, Cheng C, Cascone T, Vokes NI, Behrens C, Siewerdsen JH, Hazle JD, Chang JY, Zhang J, Lu Y, Godoy MCB, Chung C, Jaffray D, Wistuba I, Lee JJ, Vaporciyan AA, Gibbons DL, Gladish G, Heymach JV, Wu CC, Zhang J, Wu J. Synthetic PET from CT improves diagnosis and prognosis for lung cancer: Proof of concept. Cell Rep Med 2024; 5:101463. [PMID: 38471502 PMCID: PMC10983039 DOI: 10.1016/j.xcrm.2024.101463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 09/07/2023] [Accepted: 02/15/2024] [Indexed: 03/14/2024]
Abstract
[18F]Fluorodeoxyglucose positron emission tomography (FDG-PET) and computed tomography (CT) are indispensable components in modern medicine. Although PET can provide additional diagnostic value, it is costly and not universally accessible, particularly in low-income countries. To bridge this gap, we have developed a conditional generative adversarial network pipeline that can produce FDG-PET from diagnostic CT scans based on multi-center multi-modal lung cancer datasets (n = 1,478). Synthetic PET images are validated across imaging, biological, and clinical aspects. Radiologists confirm comparable imaging quality and tumor contrast between synthetic and actual PET scans. Radiogenomics analysis further proves that the dysregulated cancer hallmark pathways of synthetic PET are consistent with actual PET. We also demonstrate the clinical values of synthetic PET in improving lung cancer diagnosis, staging, risk prediction, and prognosis. Taken together, this proof-of-concept study testifies to the feasibility of applying deep learning to obtain high-fidelity PET translated from CT.
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Affiliation(s)
| | | | - Sheeba J Sujit
- Department of Imaging Physics, MD Anderson Cancer Center, Houston, TX, USA
| | - Mohamed Qayati
- Department of Imaging Physics, MD Anderson Cancer Center, Houston, TX, USA
| | - Pingjun Chen
- Department of Imaging Physics, MD Anderson Cancer Center, Houston, TX, USA
| | - Muhammad Aminu
- Department of Imaging Physics, MD Anderson Cancer Center, Houston, TX, USA
| | - Maliazurina B Saad
- Department of Imaging Physics, MD Anderson Cancer Center, Houston, TX, USA
| | | | - Lingzhi Hong
- Department of Imaging Physics, MD Anderson Cancer Center, Houston, TX, USA; Department of Thoracic/Head and Neck Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Ajay Sheshadri
- Department of Pulmonary Medicine, MD Anderson Cancer Center, Houston, TX USA
| | - Julie Lin
- Department of Pulmonary Medicine, MD Anderson Cancer Center, Houston, TX USA
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Edwin J Ostrin
- Department of General Internal Medicine, MD Anderson Cancer Center, Houston, TX, USA
| | - Iakovos Toumazis
- Department of Health Services Research, MD Anderson Cancer Center, Houston, TX, USA
| | - Peng Huang
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Chao Cheng
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | - Tina Cascone
- Department of Thoracic/Head and Neck Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Natalie I Vokes
- Department of Thoracic/Head and Neck Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Carmen Behrens
- Department of Thoracic/Head and Neck Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey H Siewerdsen
- Department of Imaging Physics, MD Anderson Cancer Center, Houston, TX, USA; Institute for Data Science in Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - John D Hazle
- Department of Imaging Physics, MD Anderson Cancer Center, Houston, TX, USA
| | - Joe Y Chang
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Jianhua Zhang
- Department of Genomic Medicine, MD Anderson Cancer Center, Houston, TX, USA
| | - Yang Lu
- Department of Nuclear Medicine, MD Anderson Cancer Center, Houston, TX, USA
| | - Myrna C B Godoy
- Department of Thoracic Imaging, MD Anderson Cancer Center, Houston, TX, USA
| | - Caroline Chung
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA; Institute for Data Science in Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - David Jaffray
- Department of Imaging Physics, MD Anderson Cancer Center, Houston, TX, USA; Institute for Data Science in Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Ignacio Wistuba
- Department of Translational Molecular Pathology, MD Anderson Cancer Center, Houston, TX, USA
| | - J Jack Lee
- Department of Biostatistics, MD Anderson Cancer Center, Houston, TX, USA
| | - Ara A Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Don L Gibbons
- Department of Thoracic/Head and Neck Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Gregory Gladish
- Department of Thoracic Imaging, MD Anderson Cancer Center, Houston, TX, USA
| | - John V Heymach
- Department of Thoracic/Head and Neck Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Carol C Wu
- Department of Thoracic Imaging, MD Anderson Cancer Center, Houston, TX, USA
| | - Jianjun Zhang
- Department of Genomic Medicine, MD Anderson Cancer Center, Houston, TX, USA; Department of Thoracic/Head and Neck Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA; Lung Cancer Genomics Program, MD Anderson Cancer Center, Houston, TX, USA; Lung Cancer Interception Program, MD Anderson Cancer Center, Houston, TX, USA
| | - Jia Wu
- Department of Imaging Physics, MD Anderson Cancer Center, Houston, TX, USA; Department of Thoracic/Head and Neck Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA; Institute for Data Science in Oncology, MD Anderson Cancer Center, Houston, TX, USA.
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Dogra P, Shinglot V, Ruiz-Ramírez J, Cave J, Butner JD, Schiavone C, Duda DG, Kaseb AO, Chung C, Koay EJ, Cristini V, Ozpolat B, Calin GA, Wang Z. Translational modeling-based evidence for enhanced efficacy of standard-of-care drugs in combination with anti-microRNA-155 in non-small-cell lung cancer. medRxiv 2024:2024.03.14.24304306. [PMID: 38559070 PMCID: PMC10980136 DOI: 10.1101/2024.03.14.24304306] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Elevated microRNA-155 (miR-155) expression in non-small-cell lung cancer (NSCLC) promotes cisplatin resistance and negatively impacts treatment outcomes. However, miR-155 can also boost anti-tumor immunity by suppressing PD-L1 expression. We developed a multiscale mechanistic model, calibrated with in vivo data and then extrapolated to humans, to investigate the therapeutic effects of nanoparticle-delivered anti-miR-155 in NSCLC, alone or in combination with standard-of-care drugs. Model simulations and analyses of the clinical scenario revealed that monotherapy with anti-miR-155 at a dose of 2.5 mg/kg administered once every three weeks has substantial anti-cancer activity. It led to a median progression-free survival (PFS) of 6.7 months, which compared favorably to cisplatin and immune checkpoint inhibitors. Further, we explored the combinations of anti-miR-155 with standard-of-care drugs, and found strongly synergistic two- and three-drug combinations. A three-drug combination of anti-miR-155, cisplatin, and pembrolizumab resulted in a median PFS of 13.1 months, while a two-drug combination of anti-miR-155 and cisplatin resulted in a median PFS of 11.3 months, which emerged as a more practical option due to its simple design and cost-effectiveness. Our analyses also provided valuable insights into unfavorable dose ratios for drug combinations, highlighting the need for optimizing dose regimen to prevent antagonistic effects. Thus, this work bridges the gap between preclinical development and clinical translation of anti-miR-155 and unravels the potential of anti-miR-155 combination therapies in NSCLC.
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Affiliation(s)
- Prashant Dogra
- Mathematics in Medicine Program, Department of Medicine, Houston Methodist Research Institute, Houston, TX, USA
- Department of Physiology and Biophysics, Weill Cornell Medical College, New York, NY, USA
| | - Vrushaly Shinglot
- Mathematics in Medicine Program, Department of Medicine, Houston Methodist Research Institute, Houston, TX, USA
| | | | - Joseph Cave
- Mathematics in Medicine Program, Department of Medicine, Houston Methodist Research Institute, Houston, TX, USA
- Physiology, Biophysics, and Systems Biology Program, Graduate School of Medical Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Joseph D. Butner
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carmine Schiavone
- Mathematics in Medicine Program, Department of Medicine, Houston Methodist Research Institute, Houston, TX, USA
- Department of Chemical, Materials and Industrial Production Engineering, University of Naples Federico II, Naples, Italy
| | - Dan G. Duda
- Edwin. L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ahmed O. Kaseb
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eugene J. Koay
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vittorio Cristini
- Mathematics in Medicine Program, Department of Medicine, Houston Methodist Research Institute, Houston, TX, USA
- Physiology, Biophysics, and Systems Biology Program, Graduate School of Medical Sciences, Weill Cornell Medicine, New York, NY, USA
- Neal Cancer Center, Houston Methodist Research Institute, Houston, TX, USA
- Department of Imaging Physics, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Bulent Ozpolat
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA
| | - George A. Calin
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zhihui Wang
- Mathematics in Medicine Program, Department of Medicine, Houston Methodist Research Institute, Houston, TX, USA
- Department of Physiology and Biophysics, Weill Cornell Medical College, New York, NY, USA
- Neal Cancer Center, Houston Methodist Research Institute, Houston, TX, USA
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11
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Elliott A, Villemoes E, Farhat M, Klingberg E, Langshaw H, Svensson S, Chung C. Development and benchmarking diffusion magnetic resonance imaging analysis for integration into radiation treatment planning. Med Phys 2024; 51:2108-2118. [PMID: 37633837 DOI: 10.1002/mp.16670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 02/20/2023] [Accepted: 04/28/2023] [Indexed: 08/28/2023] Open
Abstract
PURPOSE The rising promise in the utility of advanced multi-parametric magnetic resonance (MR) imaging in radiotherapy (RT) treatment planning creates a necessity for testing and enhancing the accuracy of quantitative imaging analysis. Standardizing the analysis of diffusion weighted imaging (DWI) and diffusion tensor imaging (DTI) to generate meaningful and reproducible apparent diffusion coefficient (ADC) and fractional anisotropy (FA) lays the requisite needed for clinical integration. The aim of the demonstrated work is to benchmark the generation of the ADC and FA parametric map analyses using integrated tools in a commercial treatment planning system against the currently used ones. METHODS Three software packages were used for generating ADC and FA maps in this study; one tool was developed within a commercial treatment planning system, another by the Functional Magnetic Resonance Imaging of the Brain (FMRIB) Software Library FSL (Analysis Group, FMRIB, Oxford, United Kingdom), and an in-house tool developed at the M.D. Anderson Cancer Center. The ADC and FA maps generated by all three packages for 35 subjects were subtracted from one another, and the standard deviation of the images' differences was used to compare the reproducibility. The reproducibility of the ADC maps was compared with the Quantitative Imaging Biomarkers Alliance (QIBA) protocol, while that of the FA maps was compared to data in published literature. RESULTS Results show that the discrepancies between the ADC maps calculated for each patient using the three different software algorithms are less than 2% which meets the 3.6% recommended QIBA requirement. Except for a small number of isolated points, the majority of differences in FA maps for each patient produced by the three methods did not exceed 0.02 which is 10 times lower than the differences seen in healthy gray and white matter. The results were also compared to the maps generated by existing MR Imaging consoles and showed that the robustness of console generated ADC and FA maps is largely dependent on the correct application of scaling factors, that only if correctly placed; the differences between the three tested methods and the console generated values were within the recommended QIBA guidelines. CONCLUSIONS Cross-comparison difference maps demonstrated that quantitative reproducibility of ADC and FA metrics generated using our tested commercial treatment planning system were comparable to in-house and established tools as benchmarks. This integrated approach facilitates the clinical utility of diffusion imaging in radiation treatment planning workflow.
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Affiliation(s)
- Andrew Elliott
- Department Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | | | - Maguy Farhat
- Department Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | | | - Holly Langshaw
- Department Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | | | - Caroline Chung
- Department Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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12
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Qin K, Wang K, Li S, Hong L, Padmakumar P, Waree R, Hubert SM, Le X, Vokes N, Rai K, Vaporciyan A, Gibbons DL, Heymach JV, Lee JJ, Woodman SE, Chung C, Jaffray DA, Altan M, Lou Y, Zhang J. Clinical Benefit from Docetaxel +/- Ramucirumab Is Not Associated with Mutation Status in Metastatic Non-Small-Cell Lung Cancer Patients Who Progressed on Platinum Doublets and Immunotherapy. Cancers (Basel) 2024; 16:935. [PMID: 38473297 PMCID: PMC10931294 DOI: 10.3390/cancers16050935] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/07/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
Docetaxel +/- ramucirumab remains the standard-of-care therapy for patients with metastatic non-small-cell lung cancer (NSCLC) after progression on platinum doublets and immune checkpoint inhibitors (ICIs). The aim of our study was to investigate whether the cancer gene mutation status was associated with clinical benefits from docetaxel +/- ramucirumab. We also investigated whether platinum/taxane-based regimens offered a better clinical benefit in this patient population. A total of 454 patients were analyzed (docetaxel +/- ramucirumab n=381; platinum/taxane-based regimens n=73). Progression-free survival (PFS) and overall survival (OS) were compared among different subpopulations with different cancer gene mutations and between patients who received docetaxel +/- ramucirumab versus platinum/taxane-based regimens. Among patients who received docetaxel +/- ramucirumab, the top mutated cancer genes included TP53 (n=167), KRAS (n=127), EGFR (n=65), STK11 (n=32), ERBB2 (HER2) (n=26), etc. None of these cancer gene mutations or PD-L1 expression was associated with PFS or OS. Platinum/taxane-based regimens were associated with a significantly longer mQS (13.00 m, 95% Cl: 11.20-14.80 m versus 8.40 m, 95% Cl: 7.12-9.68 m, LogRank P=0.019) than docetaxel +/- ramcirumab. Key prognostic factors including age, histology, and performance status were not different between these two groups. In conclusion, in patients with metastatic NSCLC who have progressed on platinum doublets and ICIs, the clinical benefit from docetaxel +/- ramucirumab is not associated with the cancer gene mutation status. Platinum/taxane-based regimens may offer a superior clinical benefit over docetaxel +/- ramucirumab in this patient population.
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Affiliation(s)
- Kang Qin
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (K.Q.); (L.H.); (R.W.); (S.M.H.); (X.L.); (N.V.); (D.L.G.); (J.V.H.); (M.A.)
| | - Kaiwen Wang
- Division of Pharmacy, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Shenduo Li
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL 32224, USA;
| | - Lingzhi Hong
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (K.Q.); (L.H.); (R.W.); (S.M.H.); (X.L.); (N.V.); (D.L.G.); (J.V.H.); (M.A.)
- Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Priyadharshini Padmakumar
- Department of Enterprise Data Engineering and Analytics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Rinsurongkawong Waree
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (K.Q.); (L.H.); (R.W.); (S.M.H.); (X.L.); (N.V.); (D.L.G.); (J.V.H.); (M.A.)
| | - Shawna M. Hubert
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (K.Q.); (L.H.); (R.W.); (S.M.H.); (X.L.); (N.V.); (D.L.G.); (J.V.H.); (M.A.)
| | - Xiuning Le
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (K.Q.); (L.H.); (R.W.); (S.M.H.); (X.L.); (N.V.); (D.L.G.); (J.V.H.); (M.A.)
| | - Natalie Vokes
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (K.Q.); (L.H.); (R.W.); (S.M.H.); (X.L.); (N.V.); (D.L.G.); (J.V.H.); (M.A.)
| | - Kunal Rai
- Department of Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Ara Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Don L. Gibbons
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (K.Q.); (L.H.); (R.W.); (S.M.H.); (X.L.); (N.V.); (D.L.G.); (J.V.H.); (M.A.)
| | - John V. Heymach
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (K.Q.); (L.H.); (R.W.); (S.M.H.); (X.L.); (N.V.); (D.L.G.); (J.V.H.); (M.A.)
| | - J. Jack Lee
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Scott E. Woodman
- Department of Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Caroline Chung
- Department of Radiation Oncology and Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
- Institute for Data Science in Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - David A. Jaffray
- Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
- Institute for Data Science in Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Mehmet Altan
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (K.Q.); (L.H.); (R.W.); (S.M.H.); (X.L.); (N.V.); (D.L.G.); (J.V.H.); (M.A.)
| | - Yanyan Lou
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL 32224, USA;
| | - Jianjun Zhang
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (K.Q.); (L.H.); (R.W.); (S.M.H.); (X.L.); (N.V.); (D.L.G.); (J.V.H.); (M.A.)
- Department of Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
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13
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Yankeelov TE, Hormuth DA, Lima EA, Lorenzo G, Wu C, Okereke LC, Rauch GM, Venkatesan AM, Chung C. Designing clinical trials for patients who are not average. iScience 2024; 27:108589. [PMID: 38169893 PMCID: PMC10758956 DOI: 10.1016/j.isci.2023.108589] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
The heterogeneity inherent in cancer means that even a successful clinical trial merely results in a therapeutic regimen that achieves, on average, a positive result only in a subset of patients. The only way to optimize an intervention for an individual patient is to reframe their treatment as their own, personalized trial. Toward this goal, we formulate a computational framework for performing personalized trials that rely on four mathematical techniques. First, mathematical models that can be calibrated with patient-specific data to make accurate predictions of response. Second, digital twins built on these models capable of simulating the effects of interventions. Third, optimal control theory applied to the digital twins to optimize outcomes. Fourth, data assimilation to continually update and refine predictions in response to therapeutic interventions. In this perspective, we describe each of these techniques, quantify their "state of readiness", and identify use cases for personalized clinical trials.
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Affiliation(s)
- Thomas E. Yankeelov
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712, USA
- Department of Diagnostic Medicine, The University of Texas at Austin, Austin, TX 78712, USA
- Department of Oncology, The University of Texas at Austin, Austin, TX 78712, USA
- Oden Institute for Computational Engineering and Sciences, The University of Texas at Austin, Austin, TX 78712, USA
- Livestrong Cancer Institutes, The University of Texas at Austin, Austin, TX 78712, USA
- Division of Diagnostic Imaging, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - David A. Hormuth
- Oden Institute for Computational Engineering and Sciences, The University of Texas at Austin, Austin, TX 78712, USA
- Livestrong Cancer Institutes, The University of Texas at Austin, Austin, TX 78712, USA
| | - Ernesto A.B.F. Lima
- Oden Institute for Computational Engineering and Sciences, The University of Texas at Austin, Austin, TX 78712, USA
- Texas Advanced Computer Center, The University of Texas at Austin, Austin, TX 78712, USA
| | - Guillermo Lorenzo
- Oden Institute for Computational Engineering and Sciences, The University of Texas at Austin, Austin, TX 78712, USA
- Department of Civil Engineering and Architecture, University of Pavia, 27100 Pavia, Italy
| | - Chengyue Wu
- Oden Institute for Computational Engineering and Sciences, The University of Texas at Austin, Austin, TX 78712, USA
| | - Lois C. Okereke
- Oden Institute for Computational Engineering and Sciences, The University of Texas at Austin, Austin, TX 78712, USA
| | - Gaiane M. Rauch
- Department of Abdominal Imaging, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Aradhana M. Venkatesan
- Department of Abdominal Imaging, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
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14
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Chung C, Jeong D, Sohn H, Choi H, Kang YA. Low household income increases the risk of tuberculosis recurrence: a retrospective nationwide cohort study in South Korea. Public Health 2024; 226:228-236. [PMID: 38091811 DOI: 10.1016/j.puhe.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/14/2023] [Accepted: 11/08/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVES We assessed the impact of household income on tuberculosis (TB) recurrence and the long-term impact of TB on household income. STUDY DESIGN This was a retrospective nationwide cohort study of patients with drug-susceptible TB (DS-TB) and TB recurrence. METHODS Using the South Korean national TB cohort database, we identified a sub-set cohort of patients with newly diagnosed drug-susceptible TB between 2013 and 2016 and tracked their TB recurrence and longitudinal income data from 2007 to 2018. Income levels were evaluated as 'Medical aid' and quintile categories. To assess risk factors associated with TB recurrence, we used a sub-distribution hazard model, adjusting for the competing risks of death. RESULTS Of 66,690 patients successfully treated with DS-TB, 2095 (3.1 %) experienced recurrence during a median follow-up of 39 months. The incidence of TB recurrence was 982.1/100,000 person-years, with 50.3 % of the recurrences occurring within 1 year of treatment completion. The risk of TB recurrence increased with decreasing income levels, with the highest risk observed in the lowest income group. The effect of income on TB recurrence was prominent in males but not in females. Overall, patients with TB recurrence experienced a linear decline in income levels, compared with those without recurrence. CONCLUSIONS Household income during the initial TB episode was an important risk factor for TB recurrence, particularly in males.
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Affiliation(s)
- C Chung
- Department of Pulmonary and Critical Care Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - D Jeong
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - H Sohn
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - H Choi
- Department of Preventive Medicine, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Y A Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute for Immunology and Immunological Disease, Yonsei University College of Medicine, Seoul, Republic of Korea.
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15
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Guckenberger M, Andratschke N, Chung C, Fuller D, Tanadini-Lang S, Jaffray DA. The Future of MR-Guided Radiation Therapy. Semin Radiat Oncol 2024; 34:135-144. [PMID: 38105088 DOI: 10.1016/j.semradonc.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Magnetic resonance image guided radiation therapy (MRIgRT) is a relatively new technology that has already shown outcomes benefits but that has not yet reached its clinical potential. The improved soft-tissue contrast provided with MR, coupled with the immediacy of image acquisition with respect to the treatment, enables expansion of on-table adaptive protocols, currently at a cost of increased treatment complexity, use of human resources, and longer treatment slot times, which translate to decreased throughput. Many approaches are being investigated to meet these challenges, including the development of artificial intelligence (AI) algorithms to accelerate and automate much of the workflow and improved technology that parallelizes workflow tasks, as well as improvements in image acquisition speed and quality. This article summarizes limitations of current available integrated MRIgRT systems and gives an outlook about scientific developments to further expand the use of MRIgRT.
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Affiliation(s)
- Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland..
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Caroline Chung
- Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Dave Fuller
- Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - David A Jaffray
- Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
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16
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Hoebel KV, Bridge CP, Ahmed S, Akintola O, Chung C, Huang RY, Johnson JM, Kim A, Ly KI, Chang K, Patel J, Pinho M, Batchelor TT, Rosen BR, Gerstner ER, Kalpathy-Cramer J. Expert-centered Evaluation of Deep Learning Algorithms for Brain Tumor Segmentation. Radiol Artif Intell 2024; 6:e220231. [PMID: 38197800 PMCID: PMC10831514 DOI: 10.1148/ryai.220231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 09/13/2023] [Accepted: 11/01/2023] [Indexed: 01/11/2024]
Abstract
Purpose To present results from a literature survey on practices in deep learning segmentation algorithm evaluation and perform a study on expert quality perception of brain tumor segmentation. Materials and Methods A total of 180 articles reporting on brain tumor segmentation algorithms were surveyed for the reported quality evaluation. Additionally, ratings of segmentation quality on a four-point scale were collected from medical professionals for 60 brain tumor segmentation cases. Results Of the surveyed articles, Dice score, sensitivity, and Hausdorff distance were the most popular metrics to report segmentation performance. Notably, only 2.8% of the articles included clinical experts' evaluation of segmentation quality. The experimental results revealed a low interrater agreement (Krippendorff α, 0.34) in experts' segmentation quality perception. Furthermore, the correlations between the ratings and commonly used quantitative quality metrics were low (Kendall tau between Dice score and mean rating, 0.23; Kendall tau between Hausdorff distance and mean rating, 0.51), with large variability among the experts. Conclusion The results demonstrate that quality ratings are prone to variability due to the ambiguity of tumor boundaries and individual perceptual differences, and existing metrics do not capture the clinical perception of segmentation quality. Keywords: Brain Tumor Segmentation, Deep Learning Algorithms, Glioblastoma, Cancer, Machine Learning Clinical trial registration nos. NCT00756106 and NCT00662506 Supplemental material is available for this article. © RSNA, 2023.
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Affiliation(s)
- Katharina V. Hoebel
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (K.V.H., C.P.B., A.K., K.I.L., K.C., J.P., B.R.R., E.R.G., J.K.C.), and Stephen E. and Catherine Pappas Center for Neuro-Oncology (O.A., A.K., K.I.L., E.R.G.), Massachusetts General Hospital, 149 13th St, Charlestown, MA 02129; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Mass (K.V.H., K.C., J.P.); MGH and BWH Center for Clinical Data Science, Boston, Mass (C.P.B., J.K.C.); Department of Radiation Oncology, Division of Radiation Oncology (S.A., C.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging (C.C.), and Department of Neuroradiology (J.M.J.), Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex; Departments of Radiology (R.Y.H.) and Neurology (T.T.B.), Brigham and Women’s Hospital, Boston, Mass; Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (M.P.); and Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colo (J.K.C.)
| | - Christopher P. Bridge
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (K.V.H., C.P.B., A.K., K.I.L., K.C., J.P., B.R.R., E.R.G., J.K.C.), and Stephen E. and Catherine Pappas Center for Neuro-Oncology (O.A., A.K., K.I.L., E.R.G.), Massachusetts General Hospital, 149 13th St, Charlestown, MA 02129; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Mass (K.V.H., K.C., J.P.); MGH and BWH Center for Clinical Data Science, Boston, Mass (C.P.B., J.K.C.); Department of Radiation Oncology, Division of Radiation Oncology (S.A., C.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging (C.C.), and Department of Neuroradiology (J.M.J.), Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex; Departments of Radiology (R.Y.H.) and Neurology (T.T.B.), Brigham and Women’s Hospital, Boston, Mass; Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (M.P.); and Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colo (J.K.C.)
| | - Sara Ahmed
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (K.V.H., C.P.B., A.K., K.I.L., K.C., J.P., B.R.R., E.R.G., J.K.C.), and Stephen E. and Catherine Pappas Center for Neuro-Oncology (O.A., A.K., K.I.L., E.R.G.), Massachusetts General Hospital, 149 13th St, Charlestown, MA 02129; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Mass (K.V.H., K.C., J.P.); MGH and BWH Center for Clinical Data Science, Boston, Mass (C.P.B., J.K.C.); Department of Radiation Oncology, Division of Radiation Oncology (S.A., C.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging (C.C.), and Department of Neuroradiology (J.M.J.), Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex; Departments of Radiology (R.Y.H.) and Neurology (T.T.B.), Brigham and Women’s Hospital, Boston, Mass; Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (M.P.); and Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colo (J.K.C.)
| | - Oluwatosin Akintola
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (K.V.H., C.P.B., A.K., K.I.L., K.C., J.P., B.R.R., E.R.G., J.K.C.), and Stephen E. and Catherine Pappas Center for Neuro-Oncology (O.A., A.K., K.I.L., E.R.G.), Massachusetts General Hospital, 149 13th St, Charlestown, MA 02129; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Mass (K.V.H., K.C., J.P.); MGH and BWH Center for Clinical Data Science, Boston, Mass (C.P.B., J.K.C.); Department of Radiation Oncology, Division of Radiation Oncology (S.A., C.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging (C.C.), and Department of Neuroradiology (J.M.J.), Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex; Departments of Radiology (R.Y.H.) and Neurology (T.T.B.), Brigham and Women’s Hospital, Boston, Mass; Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (M.P.); and Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colo (J.K.C.)
| | - Caroline Chung
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (K.V.H., C.P.B., A.K., K.I.L., K.C., J.P., B.R.R., E.R.G., J.K.C.), and Stephen E. and Catherine Pappas Center for Neuro-Oncology (O.A., A.K., K.I.L., E.R.G.), Massachusetts General Hospital, 149 13th St, Charlestown, MA 02129; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Mass (K.V.H., K.C., J.P.); MGH and BWH Center for Clinical Data Science, Boston, Mass (C.P.B., J.K.C.); Department of Radiation Oncology, Division of Radiation Oncology (S.A., C.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging (C.C.), and Department of Neuroradiology (J.M.J.), Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex; Departments of Radiology (R.Y.H.) and Neurology (T.T.B.), Brigham and Women’s Hospital, Boston, Mass; Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (M.P.); and Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colo (J.K.C.)
| | - Raymond Y. Huang
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (K.V.H., C.P.B., A.K., K.I.L., K.C., J.P., B.R.R., E.R.G., J.K.C.), and Stephen E. and Catherine Pappas Center for Neuro-Oncology (O.A., A.K., K.I.L., E.R.G.), Massachusetts General Hospital, 149 13th St, Charlestown, MA 02129; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Mass (K.V.H., K.C., J.P.); MGH and BWH Center for Clinical Data Science, Boston, Mass (C.P.B., J.K.C.); Department of Radiation Oncology, Division of Radiation Oncology (S.A., C.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging (C.C.), and Department of Neuroradiology (J.M.J.), Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex; Departments of Radiology (R.Y.H.) and Neurology (T.T.B.), Brigham and Women’s Hospital, Boston, Mass; Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (M.P.); and Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colo (J.K.C.)
| | - Jason M. Johnson
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (K.V.H., C.P.B., A.K., K.I.L., K.C., J.P., B.R.R., E.R.G., J.K.C.), and Stephen E. and Catherine Pappas Center for Neuro-Oncology (O.A., A.K., K.I.L., E.R.G.), Massachusetts General Hospital, 149 13th St, Charlestown, MA 02129; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Mass (K.V.H., K.C., J.P.); MGH and BWH Center for Clinical Data Science, Boston, Mass (C.P.B., J.K.C.); Department of Radiation Oncology, Division of Radiation Oncology (S.A., C.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging (C.C.), and Department of Neuroradiology (J.M.J.), Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex; Departments of Radiology (R.Y.H.) and Neurology (T.T.B.), Brigham and Women’s Hospital, Boston, Mass; Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (M.P.); and Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colo (J.K.C.)
| | - Albert Kim
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (K.V.H., C.P.B., A.K., K.I.L., K.C., J.P., B.R.R., E.R.G., J.K.C.), and Stephen E. and Catherine Pappas Center for Neuro-Oncology (O.A., A.K., K.I.L., E.R.G.), Massachusetts General Hospital, 149 13th St, Charlestown, MA 02129; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Mass (K.V.H., K.C., J.P.); MGH and BWH Center for Clinical Data Science, Boston, Mass (C.P.B., J.K.C.); Department of Radiation Oncology, Division of Radiation Oncology (S.A., C.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging (C.C.), and Department of Neuroradiology (J.M.J.), Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex; Departments of Radiology (R.Y.H.) and Neurology (T.T.B.), Brigham and Women’s Hospital, Boston, Mass; Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (M.P.); and Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colo (J.K.C.)
| | - K. Ina Ly
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (K.V.H., C.P.B., A.K., K.I.L., K.C., J.P., B.R.R., E.R.G., J.K.C.), and Stephen E. and Catherine Pappas Center for Neuro-Oncology (O.A., A.K., K.I.L., E.R.G.), Massachusetts General Hospital, 149 13th St, Charlestown, MA 02129; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Mass (K.V.H., K.C., J.P.); MGH and BWH Center for Clinical Data Science, Boston, Mass (C.P.B., J.K.C.); Department of Radiation Oncology, Division of Radiation Oncology (S.A., C.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging (C.C.), and Department of Neuroradiology (J.M.J.), Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex; Departments of Radiology (R.Y.H.) and Neurology (T.T.B.), Brigham and Women’s Hospital, Boston, Mass; Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (M.P.); and Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colo (J.K.C.)
| | - Ken Chang
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (K.V.H., C.P.B., A.K., K.I.L., K.C., J.P., B.R.R., E.R.G., J.K.C.), and Stephen E. and Catherine Pappas Center for Neuro-Oncology (O.A., A.K., K.I.L., E.R.G.), Massachusetts General Hospital, 149 13th St, Charlestown, MA 02129; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Mass (K.V.H., K.C., J.P.); MGH and BWH Center for Clinical Data Science, Boston, Mass (C.P.B., J.K.C.); Department of Radiation Oncology, Division of Radiation Oncology (S.A., C.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging (C.C.), and Department of Neuroradiology (J.M.J.), Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex; Departments of Radiology (R.Y.H.) and Neurology (T.T.B.), Brigham and Women’s Hospital, Boston, Mass; Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (M.P.); and Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colo (J.K.C.)
| | - Jay Patel
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (K.V.H., C.P.B., A.K., K.I.L., K.C., J.P., B.R.R., E.R.G., J.K.C.), and Stephen E. and Catherine Pappas Center for Neuro-Oncology (O.A., A.K., K.I.L., E.R.G.), Massachusetts General Hospital, 149 13th St, Charlestown, MA 02129; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Mass (K.V.H., K.C., J.P.); MGH and BWH Center for Clinical Data Science, Boston, Mass (C.P.B., J.K.C.); Department of Radiation Oncology, Division of Radiation Oncology (S.A., C.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging (C.C.), and Department of Neuroradiology (J.M.J.), Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex; Departments of Radiology (R.Y.H.) and Neurology (T.T.B.), Brigham and Women’s Hospital, Boston, Mass; Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (M.P.); and Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colo (J.K.C.)
| | - Marco Pinho
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (K.V.H., C.P.B., A.K., K.I.L., K.C., J.P., B.R.R., E.R.G., J.K.C.), and Stephen E. and Catherine Pappas Center for Neuro-Oncology (O.A., A.K., K.I.L., E.R.G.), Massachusetts General Hospital, 149 13th St, Charlestown, MA 02129; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Mass (K.V.H., K.C., J.P.); MGH and BWH Center for Clinical Data Science, Boston, Mass (C.P.B., J.K.C.); Department of Radiation Oncology, Division of Radiation Oncology (S.A., C.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging (C.C.), and Department of Neuroradiology (J.M.J.), Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex; Departments of Radiology (R.Y.H.) and Neurology (T.T.B.), Brigham and Women’s Hospital, Boston, Mass; Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (M.P.); and Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colo (J.K.C.)
| | - Tracy T. Batchelor
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (K.V.H., C.P.B., A.K., K.I.L., K.C., J.P., B.R.R., E.R.G., J.K.C.), and Stephen E. and Catherine Pappas Center for Neuro-Oncology (O.A., A.K., K.I.L., E.R.G.), Massachusetts General Hospital, 149 13th St, Charlestown, MA 02129; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Mass (K.V.H., K.C., J.P.); MGH and BWH Center for Clinical Data Science, Boston, Mass (C.P.B., J.K.C.); Department of Radiation Oncology, Division of Radiation Oncology (S.A., C.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging (C.C.), and Department of Neuroradiology (J.M.J.), Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex; Departments of Radiology (R.Y.H.) and Neurology (T.T.B.), Brigham and Women’s Hospital, Boston, Mass; Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (M.P.); and Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colo (J.K.C.)
| | - Bruce R. Rosen
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (K.V.H., C.P.B., A.K., K.I.L., K.C., J.P., B.R.R., E.R.G., J.K.C.), and Stephen E. and Catherine Pappas Center for Neuro-Oncology (O.A., A.K., K.I.L., E.R.G.), Massachusetts General Hospital, 149 13th St, Charlestown, MA 02129; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Mass (K.V.H., K.C., J.P.); MGH and BWH Center for Clinical Data Science, Boston, Mass (C.P.B., J.K.C.); Department of Radiation Oncology, Division of Radiation Oncology (S.A., C.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging (C.C.), and Department of Neuroradiology (J.M.J.), Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex; Departments of Radiology (R.Y.H.) and Neurology (T.T.B.), Brigham and Women’s Hospital, Boston, Mass; Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (M.P.); and Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colo (J.K.C.)
| | - Elizabeth R. Gerstner
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (K.V.H., C.P.B., A.K., K.I.L., K.C., J.P., B.R.R., E.R.G., J.K.C.), and Stephen E. and Catherine Pappas Center for Neuro-Oncology (O.A., A.K., K.I.L., E.R.G.), Massachusetts General Hospital, 149 13th St, Charlestown, MA 02129; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Mass (K.V.H., K.C., J.P.); MGH and BWH Center for Clinical Data Science, Boston, Mass (C.P.B., J.K.C.); Department of Radiation Oncology, Division of Radiation Oncology (S.A., C.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging (C.C.), and Department of Neuroradiology (J.M.J.), Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex; Departments of Radiology (R.Y.H.) and Neurology (T.T.B.), Brigham and Women’s Hospital, Boston, Mass; Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (M.P.); and Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colo (J.K.C.)
| | - Jayashree Kalpathy-Cramer
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (K.V.H., C.P.B., A.K., K.I.L., K.C., J.P., B.R.R., E.R.G., J.K.C.), and Stephen E. and Catherine Pappas Center for Neuro-Oncology (O.A., A.K., K.I.L., E.R.G.), Massachusetts General Hospital, 149 13th St, Charlestown, MA 02129; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Mass (K.V.H., K.C., J.P.); MGH and BWH Center for Clinical Data Science, Boston, Mass (C.P.B., J.K.C.); Department of Radiation Oncology, Division of Radiation Oncology (S.A., C.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging (C.C.), and Department of Neuroradiology (J.M.J.), Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex; Departments of Radiology (R.Y.H.) and Neurology (T.T.B.), Brigham and Women’s Hospital, Boston, Mass; Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (M.P.); and Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colo (J.K.C.)
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Chung C, Jo KW, Shim TS. Treatment outcome, recurrence and safety of multidrug-resistant TB treated with low-dose linezolid. Int J Tuberc Lung Dis 2023; 27:918-924. [PMID: 38042970 DOI: 10.5588/ijtld.23.0068] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND: Linezolid (LZD) is a key treatment option for patients with multidrug-resistant/rifampicin-resistant TB (MDR/RR-TB). We investigated the long-term treatment outcomes and safety of MDR/RR-TB treatment using low-dose LZD.METHODS: Medical records of patients with MDR/RR-TB treated with LZD ≥4 weeks between 2004 and 2018 at the Asan Medical Center, Seoul, Republic of Korea, were reviewed. Standard-dose and low-dose LZD groups were defined as patients initially administered LZD ≥600 mg/day or 300 mg/day, respectively.RESULTS: Among 94 patients, 65 were included in the low-dose LZD group; mean age was 43.1 ± 15.6 years, 53 (56.4%) were men and 77 (83.7%) were resistant to fluoroquinolone. The low-dose LZD group showed features of less severe disease, such as limited MDR-TB history and less severe radiological findings. There was no difference in treatment outcomes, relapse and safety between groups. In the low-dose LZD group, 54 (83.1%) succeeded treatment, of whom 48 (88.9%) were followed-up for a median of 38 months; there was no recurrence. Adverse drug reactions were reported in 41 (63.1%); peripheral neuropathy was most frequently reported (n = 31, 47.7%), while myelosuppression was reported in 12 (18.5%).CONCLUSION: Low-dose LZD in selected patients with less severe disease is both effective in the long-term and safe for the treatment of MDR/RR-TB.
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Affiliation(s)
- C Chung
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Department of Pulmonary and Critical Care Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - K-W Jo
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - T S Shim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
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18
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Buszek SM, Tran B, Long JP, Luo D, Suki D, Li J, Ferguson S, Chung C. Postoperative Management of Recurrence After Radiosurgery and Surgical Resection for Brain Metastases and Predicting Benefit From Adjuvant Radiation. Pract Radiat Oncol 2023; 13:e499-e503. [PMID: 37295724 DOI: 10.1016/j.prro.2023.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/01/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023]
Abstract
Stereotactic radiosurgery (SRS) is often used as upfront treatment for brain metastases. Progression or radionecrosis after SRS is common and can prompt resection. However, postoperative management strategies after resection for SRS failure vary widely, and no standard practice has been established. In this approved study, we retrospectively reviewed patients who received SRS for a brain metastasis followed by resection of the same lesion. We extracted patient-, disease-, and treatment-related variables and information on disease-related outcomes. Univariate and multivariate analyses of clinicopathologic variables were used to create a model to predict factors associated with local failure (LF). A total of 225 patients with brain metastases treated with SRS from 2009 to 2017 followed by surgical resection were identified. Overall, 65% of cases had gross total resection (GTR) on postoperative imaging review. Twenty-one patients (9.3%) received adjuvant radiation therapy to the surgical cavity, and 204 (90.7%) were observed. Of these 204 patients, 118 had GTR with evidence of tumor within the pathology specimen. With a median follow-up of 13 months after resection, 47 patients (40%) developed LF after surgery. After salvage resection of a brain metastasis initially treated with SRS, the observed LF rate was 40% among those who had a GTR and evidence of tumor on pathologic examination. This LF rate is sufficiently high that adjuvant radiation to the surgical bed after salvage resection should be considered in these cases when there is tumor in the pathology, even after a GTR.
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Affiliation(s)
- Samantha M Buszek
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Benjamin Tran
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - James P Long
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dershan Luo
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dima Suki
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jing Li
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sherise Ferguson
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Caroline Chung
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
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19
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Aminu M, Daver N, Godoy MCB, Shroff G, Wu C, Torre-Sada LF, Goizueta A, Shannon VR, Faiz SA, Altan M, Garcia-Manero G, Kantarjian H, Ravandi-Kashani F, Kadia T, Konopleva M, DiNardo C, Pierce S, Naing A, Kim ST, Kontoyiannis DP, Khawaja F, Chung C, Wu J, Sheshadri A. Heterogenous lung inflammation CT patterns distinguish pneumonia and immune checkpoint inhibitor pneumonitis and complement blood biomarkers in acute myeloid leukemia: proof of concept. Front Immunol 2023; 14:1249511. [PMID: 37841255 PMCID: PMC10570510 DOI: 10.3389/fimmu.2023.1249511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Background Immune checkpoint inhibitors (ICI) may cause pneumonitis, resulting in potentially fatal lung inflammation. However, distinguishing pneumonitis from pneumonia is time-consuming and challenging. To fill this gap, we build an image-based tool, and further evaluate it clinically alongside relevant blood biomarkers. Materials and methods We studied CT images from 97 patients with pneumonia and 29 patients with pneumonitis from acute myeloid leukemia treated with ICIs. We developed a CT-derived signature using a habitat imaging algorithm, whereby infected lungs are segregated into clusters ("habitats"). We validated the model and compared it with a clinical-blood model to determine whether imaging can add diagnostic value. Results Habitat imaging revealed intrinsic lung inflammation patterns by identifying 5 distinct subregions, correlating to lung parenchyma, consolidation, heterogenous ground-glass opacity (GGO), and GGO-consolidation transition. Consequently, our proposed habitat model (accuracy of 79%, sensitivity of 48%, and specificity of 88%) outperformed the clinical-blood model (accuracy of 68%, sensitivity of 14%, and specificity of 85%) for classifying pneumonia versus pneumonitis. Integrating imaging and blood achieved the optimal performance (accuracy of 81%, sensitivity of 52% and specificity of 90%). Using this imaging-blood composite model, the post-test probability for detecting pneumonitis increased from 23% to 61%, significantly (p = 1.5E - 9) higher than the clinical and blood model (post-test probability of 22%). Conclusion Habitat imaging represents a step forward in the image-based detection of pneumonia and pneumonitis, which can complement known blood biomarkers. Further work is needed to validate and fine tune this imaging-blood composite model and further improve its sensitivity to detect pneumonitis.
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Affiliation(s)
- Muhammad Aminu
- Departments of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Naval Daver
- Departments of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Myrna C. B. Godoy
- Departments of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Girish Shroff
- Departments of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Carol Wu
- Departments of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Luis F. Torre-Sada
- Departments of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Alberto Goizueta
- Departments of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Vickie R. Shannon
- Departments of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Saadia A. Faiz
- Departments of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Mehmet Altan
- Departments of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Guillermo Garcia-Manero
- Departments of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Hagop Kantarjian
- Departments of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Farhad Ravandi-Kashani
- Departments of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Tapan Kadia
- Departments of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Marina Konopleva
- Departments of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Courtney DiNardo
- Departments of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sherry Pierce
- Departments of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Aung Naing
- Departments of Investigational Cancer Therapeutics, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sang T. Kim
- Departments of Rheumatology and Infectious Diseases, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Dimitrios P. Kontoyiannis
- Departments of Infectious Diseases, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Fareed Khawaja
- Departments of Infectious Diseases, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Caroline Chung
- Departments of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jia Wu
- Departments of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ajay Sheshadri
- Departments of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Noh S, Bertini C, Mira‐Avendano I, Kaous M, Patel B, Faiz SA, Shannon VR, Balachandran DD, Bashoura L, Adachi R, Evans SE, Dickey B, Wu C, Shroff GS, Manzano J, Granwehr B, Holloway S, Dickson K, Mohammed A, Muthu M, Song H, Chung C, Wu J, Lee L, Jiang Y, Khawaja F, Sheshadri A. Interstitial lung abnormalities after hospitalization for COVID-19 in patients with cancer: A prospective cohort study. Cancer Med 2023; 12:17753-17765. [PMID: 37592894 PMCID: PMC10524033 DOI: 10.1002/cam4.6396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/03/2023] [Accepted: 07/21/2023] [Indexed: 08/19/2023] Open
Abstract
INTRODUCTION Survivors of SARS-CoV-2 pneumonia often develop persistent respiratory symptom and interstitial lung abnormalities (ILAs) after infection. Risk factors for ILA development and duration of ILA persistence after SARS-CoV-2 infection are not well described in immunocompromised hosts, such as cancer patients. METHODS We conducted a prospective cohort study of 95 patients at a major cancer center and 45 patients at a tertiary referral center. We collected clinical and radiographic data during the index hospitalization for COVID-19 pneumonia and measured pneumonia severity using a semi-quantitative radiographic score, the Radiologic Severity Index (RSI). Patients were evaluated in post-COVID-19 clinics at 3 and 6 months after discharge and underwent comprehensive pulmonary evaluations (symptom assessment, chest computed tomography, pulmonary function tests, 6-min walk test). The association of clinical and radiological factors with ILAs at 3 and 6 months post-discharge was measured using univariable and multivariable logistic regression. RESULTS Sixty-six (70%) patients of cancer cohort had ILAs at 3 months, of whom 39 had persistent respiratory symptoms. Twenty-four (26%) patients had persistent ILA at 6 months after hospital discharge. In adjusted models, higher peak RSI at admission was associated with ILAs at 3 (OR 1.5 per 5-point increase, 95% CI 1.1-1.9) and 6 months (OR 1.3 per 5-point increase, 95% CI 1.1-1.6) post-discharge. Fibrotic ILAs (reticulation, traction bronchiectasis, and architectural distortion) were more common at 6 months post-discharge. CONCLUSIONS Post-COVID-19 ILAs are common in cancer patients 3 months after hospital discharge, and peak RSI and older age are strong predictors of persistent ILAs.
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Affiliation(s)
- Sungryong Noh
- Division of Critical Care, Pulmonary and Sleep MedicineMcGovern Medical SchoolHoustonTexasUSA
| | - Christopher Bertini
- Department of Internal MedicineMcGovern Medical School at UT HealthHoustonTexasUSA
| | - Isabel Mira‐Avendano
- Division of Critical Care, Pulmonary and Sleep MedicineMcGovern Medical SchoolHoustonTexasUSA
| | - Maryam Kaous
- Division of Critical Care, Pulmonary and Sleep MedicineMcGovern Medical SchoolHoustonTexasUSA
| | - Bela Patel
- Division of Critical Care, Pulmonary and Sleep MedicineMcGovern Medical SchoolHoustonTexasUSA
| | - Saadia A. Faiz
- Department of Pulmonary MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Vickie R. Shannon
- Department of Pulmonary MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Diwakar D. Balachandran
- Department of Pulmonary MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Lara Bashoura
- Department of Pulmonary MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Roberto Adachi
- Department of Pulmonary MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Scott E. Evans
- Department of Pulmonary MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Burton Dickey
- Department of Pulmonary MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Carol Wu
- Department of Thoracic ImagingThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Girish S. Shroff
- Department of Thoracic ImagingThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Joanna‐Grace Manzano
- Department of Hospital MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Bruno Granwehr
- Department of Infectious Diseases, Infection Control, and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Shannon Holloway
- Department of Infectious Diseases, Infection Control, and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Kodwo Dickson
- Department of Hospital MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Alyssa Mohammed
- Department of Hospital MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Mayoora Muthu
- Department of Hospital MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Hui Song
- Data‐Driven Determinants for COVID‐19 Oncology Discovery Effort (D3CODE) TeamThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Caroline Chung
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Jia Wu
- Department of Imaging Physics, Infection Control, and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Lyndon Lee
- Department of Internal MedicineMcGovern Medical School at UT HealthHoustonTexasUSA
| | - Ying Jiang
- Department of Infectious Diseases, Infection Control, and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Fareed Khawaja
- Department of Infectious Diseases, Infection Control, and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Ajay Sheshadri
- Department of Pulmonary MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
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21
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Bitterman DS, Gensheimer MF, Jaffray D, Pryma DA, Jiang SB, Morin O, Ginart JB, Upadhaya T, Vallis KA, Buatti JM, Deasy J, Hsiao HT, Chung C, Fuller CD, Greenspan E, Cloyd-Warwick K, Courdy S, Mao A, Barnholtz-Sloan J, Topaloglu U, Hands I, Maurer I, Terry M, Curran WJ, Le QT, Nadaf S, Kibbe W. Cancer Informatics for Cancer Centers: Sharing Ideas on How to Build an Artificial Intelligence-Ready Informatics Ecosystem for Radiation Oncology. JCO Clin Cancer Inform 2023; 7:e2300136. [PMID: 38055914 PMCID: PMC10703125 DOI: 10.1200/cci.23.00136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/15/2023] [Accepted: 10/16/2023] [Indexed: 12/08/2023] Open
Abstract
In August 2022, the Cancer Informatics for Cancer Centers brought together cancer informatics leaders for its biannual symposium, Precision Medicine Applications in Radiation Oncology, co-chaired by Quynh-Thu Le, MD (Stanford University), and Walter J. Curran, MD (GenesisCare). Over the course of 3 days, presenters discussed a range of topics relevant to radiation oncology and the cancer informatics community more broadly, including biomarker development, decision support algorithms, novel imaging tools, theranostics, and artificial intelligence (AI) for the radiotherapy workflow. Since the symposium, there has been an impressive shift in the promise and potential for integration of AI in clinical care, accelerated in large part by major advances in generative AI. AI is now poised more than ever to revolutionize cancer care. Radiation oncology is a field that uses and generates a large amount of digital data and is therefore likely to be one of the first fields to be transformed by AI. As experts in the collection, management, and analysis of these data, the informatics community will take a leading role in ensuring that radiation oncology is prepared to take full advantage of these technological advances. In this report, we provide highlights from the symposium, which took place in Santa Barbara, California, from August 29 to 31, 2022. We discuss lessons learned from the symposium for data acquisition, management, representation, and sharing, and put these themes into context to prepare radiation oncology for the successful and safe integration of AI and informatics technologies.
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Affiliation(s)
- Danielle S. Bitterman
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA
| | - Michael F. Gensheimer
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - David Jaffray
- Department of Radiation Physics, M.D. Anderson Cancer Center, Houston, TX
| | - Daniel A. Pryma
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Steve B. Jiang
- Medical Artificial Intelligence and Automation Laboratory and Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Olivier Morin
- Department of Radiation Oncology, MEDomics Laboratory, University of California San Francisco, San Francisco, CA
| | - Jorge Barrios Ginart
- Department of Radiation Oncology, MEDomics Laboratory, University of California San Francisco, San Francisco, CA
| | - Taman Upadhaya
- Department of Radiation Oncology, MEDomics Laboratory, University of California San Francisco, San Francisco, CA
| | - Katherine A. Vallis
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA
| | - John M. Buatti
- Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Joseph Deasy
- Department of Radiation Oncology, University of Iowa Carver College of Medicine, Iowa City, IA
| | - H. Timothy Hsiao
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Caroline Chung
- Department of Scientific Affairs, American Society for Radiation Oncology, Arlington, VA
| | - Clifton D. Fuller
- Department of Scientific Affairs, American Society for Radiation Oncology, Arlington, VA
| | - Emily Greenspan
- Department of Radiation Oncology, M.D. Anderson Cancer Center, Houston, TX
| | - Kristy Cloyd-Warwick
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, Rockville, MD
| | | | | | - Jill Barnholtz-Sloan
- Department of Radiation Oncology, M.D. Anderson Cancer Center, Houston, TX
- Center for Informatics, Digital Vertical, City of Hope National Comprehensive Cancer Center, Los Angeles, CA
| | - Umit Topaloglu
- Department of Radiation Oncology, M.D. Anderson Cancer Center, Houston, TX
| | - Isaac Hands
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
- Cancer Research Informatics Shared Resource Facility, University of Kentucky Markey Cancer Center, Lexington, NY
| | | | | | | | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Sorena Nadaf
- Department of Radiation Oncology, Emory University, Atlanta, GA
| | - Warren Kibbe
- Cancer Center Informatics Society, Los Angeles, CA
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22
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McGrath M, Hyde J, Nosewicz J, Kaffenberger B, Trinidad J, Chung C. Concordance of diagnostic modalities in atypical skin and soft tissue infections in hospitalized patients. Arch Dermatol Res 2023; 315:2139-2143. [PMID: 36369596 DOI: 10.1007/s00403-022-02437-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 08/19/2022] [Accepted: 10/13/2022] [Indexed: 11/13/2022]
Abstract
Skin and soft tissue infections (SSTIs) have high rates of morbidity and mortality worldwide but lack reliable standards for diagnostic workup. As a result, atypical infections, more prevalent among immunocompromised patients, can be missed due to deviance from classic features only to be revealed later through inconsistently performed ancillary studies. Our objectives included to evaluate the sensitivities of clinical impression, histopathology, tissue culture, and molecular and non-molecular ancillary tests in diagnosing inpatient SSTIs, as well as to qualitatively discuss the unusual features making a subset of infections "atypical." To do so, we retrospectively reviewed the histopathologic reports and charts of inpatient dermatologic consults at a single tertiary care institution over a 3-year period. We identified a total of 111 cases of SSTIs evaluated by the inpatient dermatology consultation service with concurrent skin or soft tissue biopsy, with 32.4% representing atypical infections. Among these, clinical impression suggested infection in 9(25.0%), routine histopathology in 21(58.3%), specialized stains for microorganisms in 22(68.8%), and tissue culture in 15(68.2%). Due to incomplete picture that each modality by itself creates, we conclude that clinicians and pathologists should carry a low threshold for including SSTIs in their differential diagnoses and should evaluate with skin biopsy, special stains for microorganisms, and ancillary studies, particularly in critically ill individuals who necessitate timely diagnoses.
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Affiliation(s)
- M McGrath
- The Ohio State University College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - J Hyde
- Department of Dermatology, Massachusetts General Hospital, Cambridge, MA, USA
| | - J Nosewicz
- Department of Dermatology, Massachusetts General Hospital, Cambridge, MA, USA
| | - B Kaffenberger
- Department of Dermatology, Massachusetts General Hospital, Cambridge, MA, USA
| | - J Trinidad
- Department of Dermatology, Massachusetts General Hospital, Cambridge, MA, USA
| | - C Chung
- Department of Dermatology, Massachusetts General Hospital, Cambridge, MA, USA.
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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23
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Farhat M, Fuller GN, Wintermark M, Chung C, Kumar VA, Chen M. Multifocal and multicentric glioblastoma: Imaging signature, molecular characterization, patterns of spread, and treatment. Neuroradiol J 2023:19714009231193162. [PMID: 37559514 DOI: 10.1177/19714009231193162] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Abstract
Multifocal and multicentric glioblastoma (GBM) or collectively, m-GBM, is an imaging diagnosis present in up to 34% of patients with GBM. Compared to unifocal disease, patients with m-GBM have worse outcomes owing to the enhanced aggressive nature of the disease and its resistance to currently available treatments. To improve the understanding of its complex behavior, many associations have been established between the radiologic findings of m-GBM and its gross histology, genetic composition, and patterns of spread. Additionally, the holistic knowledge of the exact mechanisms of m-GBM genesis and progression is crucial for identifying potential targets permitting enhanced diagnosis and treatment. In this review, we aim to provide a comprehensive summary of the cumulative knowledge of the unique molecular biology and behavior of m-GBM and the association of these features with neuroimaging.
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Affiliation(s)
- Maguy Farhat
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gregory N Fuller
- Section of Neuropathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Max Wintermark
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vinodh A Kumar
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Melissa Chen
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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24
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Kim MM, Mehta MP, Smart DK, Steeg PS, Hong JA, Espey MG, Prasanna PG, Crandon L, Hodgdon C, Kozak N, Armstrong TS, Morikawa A, Willmarth N, Tanner K, Boire A, Gephart MH, Margolin KA, Hattangadi-Gluth J, Tawbi H, Trifiletti DM, Chung C, Basu-Roy U, Burns R, Oliva ICG, Aizer AA, Anders CK, Davis J, Ahluwalia MS, Chiang V, Li J, Kotecha R, Formenti SC, Ellingson BM, Gondi V, Sperduto PW, Barnholtz-Sloan JS, Rodon J, Lee EQ, Khasraw M, Yeboa DN, Brastianos PK, Galanis E, Coleman CN, Ahmed MM. National Cancer Institute Collaborative Workshop on Shaping the Landscape of Brain Metastases Research: challenges and recommended priorities. Lancet Oncol 2023; 24:e344-e354. [PMID: 37541280 PMCID: PMC10681121 DOI: 10.1016/s1470-2045(23)00297-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/13/2023] [Accepted: 06/21/2023] [Indexed: 08/06/2023]
Abstract
Brain metastases are an increasing global public health concern, even as survival rates improve for patients with metastatic disease. Both metastases and the sequelae of their treatment are key determinants of the inter-related priorities of patient survival, function, and quality of life, mandating a multidimensional approach to clinical care and research. At a virtual National Cancer Institute Workshop in September, 2022, key stakeholders convened to define research priorities to address the crucial areas of unmet need for patients with brain metastases to achieve meaningful advances in patient outcomes. This Policy Review outlines existing knowledge gaps, collaborative opportunities, and specific recommendations regarding consensus priorities and future directions in brain metastases research. Achieving major advances in research will require enhanced coordination between the ongoing efforts of individual organisations and consortia. Importantly, the continual and active engagement of patients and patient advocates will be necessary to ensure that the directionality of all efforts reflects what is most meaningful in the context of patient care.
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Affiliation(s)
- Michelle M Kim
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
| | - Minesh P Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - DeeDee K Smart
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Patricia S Steeg
- Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Julie A Hong
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, MD, USA
| | - Michael G Espey
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, MD, USA
| | - Pataje G Prasanna
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, MD, USA
| | | | | | | | - Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Aki Morikawa
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Kirk Tanner
- National Brain Tumor Society, Newton, MA, USA
| | - Adrienne Boire
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Jona Hattangadi-Gluth
- Department of Radiation Oncology, University of California San Diego Health, La Jolla, CA, USA
| | - Hussein Tawbi
- Department of Melanoma Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Daniel M Trifiletti
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Caroline Chung
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Robyn Burns
- Melanoma Research Foundation, Washington, DC, USA
| | - Isabella C Glitza Oliva
- Department of Melanoma Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ayal A Aizer
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, USA
| | - Carey K Anders
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | | | - Manmeet S Ahluwalia
- Department of Medical Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Veronica Chiang
- Department of Neurosurgery and Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Jing Li
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Silvia C Formenti
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Benjamin M Ellingson
- UCLA Brain Tumor Imaging Laboratory, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Vinai Gondi
- Department of Radiation Oncology, Northwestern Medicine Cancer Center Warrenville and Proton Center, Warrenville, IL, USA
| | - Paul W Sperduto
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Jill S Barnholtz-Sloan
- Informatics and Data Science Program, Center for Biomedical Informatics and Information Technology, Trans-Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Jordi Rodon
- Department of Investigational Cancer Therapeutics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eudocia Q Lee
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Mustafa Khasraw
- Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
| | - Debra Nana Yeboa
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Priscilla K Brastianos
- Division of Hematology/Oncology and Division of Neuro-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Evanthia Galanis
- Department of Oncology, Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, MN, USA
| | - C Norman Coleman
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, MD, USA
| | - Mansoor M Ahmed
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, MD, USA.
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25
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Altan M, Wang Y, Song J, Welsh J, Tang C, Guha-Thakurta N, Blumenschein GR, Carter BW, Wefel JS, Ghia AJ, Yeboa DN, McAleer MF, Chung C, Woodhouse KD, McGovern SL, Wang C, Kim BYS, Weinberg JS, Briere TM, Elamin YY, Lee X, Cascone T, Negrao MV, Skoulidis F, Ferrarotto R, Heymach JV, Li J. Nivolumab and ipilimumab with concurrent stereotactic radiosurgery for intracranial metastases from non-small cell lung cancer: analysis of the safety cohort for non-randomized, open-label, phase I/II trial. J Immunother Cancer 2023; 11:e006871. [PMID: 37402581 PMCID: PMC10335483 DOI: 10.1136/jitc-2023-006871] [Citation(s) in RCA: 4] [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] [Accepted: 05/14/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Up to 20% of patients with non-small cell lung cancer (NSCLC) develop brain metastasis (BM), for which the current standard of care is radiation therapy with or without surgery. There are no prospective data on the safety of stereotactic radiosurgery (SRS) concurrent with immune checkpoint inhibitor therapy for BM. This is the safety cohort of the phase I/II investigator-initiated trial of SRS with nivolumab and ipilimumab for patients with BM from NSCLC. PATIENTS AND METHODS This single-institution study included patients with NSCLC with active BM amenable to SRS. Brain SRS and systemic therapy with nivolumab and ipilimumab were delivered concurrently (within 7 days). The endpoints were safety and 4-month intracranial progression-free survival (PFS). RESULTS Thirteen patients were enrolled in the safety cohort, 10 of whom were evaluable for dose-limiting toxicities (DLTs). Median follow-up was 23 months (range 9.7-24.3 months). The median interval between systemic therapy and radiation therapy was 3 days. Only one patient had a DLT; hence, predefined stopping criteria were not met. In addition to the patient with DLT, three patients had treatment-related grade ≥3 adverse events, including elevated liver function tests, fatigue, nausea, adrenal insufficiency, and myocarditis. One patient had a confirmed influenza infection 7 months after initiation of protocol treatment (outside the DLT assessment window), leading to pneumonia and subsequent death from hemophagocytic lymphohistiocytosis. The estimated 4-month intracranial PFS rate was 70.7%. CONCLUSION Concurrent brain SRS with nivolumab/ipilimumab was safe for patients with active NSCLC BM. Preliminary analyses of treatment efficacy were encouraging for intracranial treatment response.
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Affiliation(s)
- Mehmet Altan
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yan Wang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Juhee Song
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - James Welsh
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Chad Tang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nandita Guha-Thakurta
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - George R Blumenschein
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Brett W Carter
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Amol J Ghia
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Debra N Yeboa
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mary Frances McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kristina D Woodhouse
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Susan L McGovern
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Chenyang Wang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Betty Y S Kim
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey S Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tina M Briere
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yasir Y Elamin
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Xiuning Lee
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tina Cascone
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Marcelo V Negrao
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ferdinandos Skoulidis
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Renata Ferrarotto
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - John V Heymach
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jing Li
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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26
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Saad MB, Hong L, Aminu M, Vokes NI, Chen P, Salehjahromi M, Qin K, Sujit SJ, Lu X, Young E, Al-Tashi Q, Qureshi R, Wu CC, Carter BW, Lin SH, Lee PP, Gandhi S, Chang JY, Li R, Gensheimer MF, Wakelee HA, Neal JW, Lee HS, Cheng C, Velcheti V, Lou Y, Petranovic M, Rinsurongkawong W, Le X, Rinsurongkawong V, Spelman A, Elamin YY, Negrao MV, Skoulidis F, Gay CM, Cascone T, Antonoff MB, Sepesi B, Lewis J, Wistuba II, Hazle JD, Chung C, Jaffray D, Gibbons DL, Vaporciyan A, Lee JJ, Heymach JV, Zhang J, Wu J. Predicting benefit from immune checkpoint inhibitors in patients with non-small-cell lung cancer by CT-based ensemble deep learning: a retrospective study. Lancet Digit Health 2023; 5:e404-e420. [PMID: 37268451 PMCID: PMC10330920 DOI: 10.1016/s2589-7500(23)00082-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/28/2023] [Accepted: 04/04/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Only around 20-30% of patients with non-small-cell lung cancer (NCSLC) have durable benefit from immune-checkpoint inhibitors. Although tissue-based biomarkers (eg, PD-L1) are limited by suboptimal performance, tissue availability, and tumour heterogeneity, radiographic images might holistically capture the underlying cancer biology. We aimed to investigate the application of deep learning on chest CT scans to derive an imaging signature of response to immune checkpoint inhibitors and evaluate its added value in the clinical context. METHODS In this retrospective modelling study, 976 patients with metastatic, EGFR/ALK negative NSCLC treated with immune checkpoint inhibitors at MD Anderson and Stanford were enrolled from Jan 1, 2014, to Feb 29, 2020. We built and tested an ensemble deep learning model on pretreatment CTs (Deep-CT) to predict overall survival and progression-free survival after treatment with immune checkpoint inhibitors. We also evaluated the added predictive value of the Deep-CT model in the context of existing clinicopathological and radiological metrics. FINDINGS Our Deep-CT model demonstrated robust stratification of patient survival of the MD Anderson testing set, which was validated in the external Stanford set. The performance of the Deep-CT model remained significant on subgroup analyses stratified by PD-L1, histology, age, sex, and race. In univariate analysis, Deep-CT outperformed the conventional risk factors, including histology, smoking status, and PD-L1 expression, and remained an independent predictor after multivariate adjustment. Integrating the Deep-CT model with conventional risk factors demonstrated significantly improved prediction performance, with overall survival C-index increases from 0·70 (clinical model) to 0·75 (composite model) during testing. On the other hand, the deep learning risk scores correlated with some radiomics features, but radiomics alone could not reach the performance level of deep learning, indicating that the deep learning model effectively captured additional imaging patterns beyond known radiomics features. INTERPRETATION This proof-of-concept study shows that automated profiling of radiographic scans through deep learning can provide orthogonal information independent of existing clinicopathological biomarkers, bringing the goal of precision immunotherapy for patients with NSCLC closer. FUNDING National Institutes of Health, Mark Foundation Damon Runyon Foundation Physician Scientist Award, MD Anderson Strategic Initiative Development Program, MD Anderson Lung Moon Shot Program, Andrea Mugnaini, and Edward L C Smith.
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Affiliation(s)
- Maliazurina B Saad
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lingzhi Hong
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Muhammad Aminu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Natalie I Vokes
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Pingjun Chen
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Morteza Salehjahromi
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kang Qin
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sheeba J Sujit
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xuetao Lu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elliana Young
- Department of Enterprise Data Engineering and Analytics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Qasem Al-Tashi
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rizwan Qureshi
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carol C Wu
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brett W Carter
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven H Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Percy P Lee
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Radiation Oncology, City of Hope National Medical Center, Los Angeles, CA, USA
| | - Saumil Gandhi
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joe Y Chang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ruijiang Li
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Michael F Gensheimer
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Heather A Wakelee
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cancer Institute, Stanford, CA, USA
| | - Joel W Neal
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cancer Institute, Stanford, CA, USA
| | - Hyun-Sung Lee
- Systems Onco-Immunology Laboratory, David J Sugarbaker Division of Thoracic Surgery, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Chao Cheng
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | - Vamsidhar Velcheti
- Department of Hematology and Oncology, New York University Langone Health, New York, NY, USA
| | - Yanyan Lou
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Milena Petranovic
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Waree Rinsurongkawong
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xiuning Le
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vadeerat Rinsurongkawong
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amy Spelman
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yasir Y Elamin
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marcelo V Negrao
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ferdinandos Skoulidis
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carl M Gay
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tina Cascone
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeff Lewis
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ignacio I Wistuba
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John D Hazle
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David Jaffray
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Don L Gibbons
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ara Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J Jack Lee
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John V Heymach
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Jianjun Zhang
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Jia Wu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Chakrabarty S, Abidi SA, Mousa M, Mokkarala M, Hren I, Yadav D, Kelsey M, LaMontagne P, Wood J, Adams M, Su Y, Thorpe S, Chung C, Sotiras A, Marcus DS. Integrative Imaging Informatics for Cancer Research: Workflow Automation for Neuro-Oncology (I3CR-WANO). JCO Clin Cancer Inform 2023; 7:e2200177. [PMID: 37146265 PMCID: PMC10281444 DOI: 10.1200/cci.22.00177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/25/2023] [Accepted: 03/06/2023] [Indexed: 05/07/2023] Open
Abstract
PURPOSE Efforts to use growing volumes of clinical imaging data to generate tumor evaluations continue to require significant manual data wrangling, owing to data heterogeneity. Here, we propose an artificial intelligence-based solution for the aggregation and processing of multisequence neuro-oncology MRI data to extract quantitative tumor measurements. MATERIALS AND METHODS Our end-to-end framework (1) classifies MRI sequences using an ensemble classifier, (2) preprocesses the data in a reproducible manner, (3) delineates tumor tissue subtypes using convolutional neural networks, and (4) extracts diverse radiomic features. Moreover, it is robust to missing sequences and adopts an expert-in-the-loop approach in which the segmentation results may be manually refined by radiologists. After the implementation of the framework in Docker containers, it was applied to two retrospective glioma data sets collected from the Washington University School of Medicine (WUSM; n = 384) and The University of Texas MD Anderson Cancer Center (MDA; n = 30), comprising preoperative MRI scans from patients with pathologically confirmed gliomas. RESULTS The scan-type classifier yielded an accuracy of >99%, correctly identifying sequences from 380 of 384 and 30 of 30 sessions from the WUSM and MDA data sets, respectively. Segmentation performance was quantified using the Dice Similarity Coefficient between the predicted and expert-refined tumor masks. The mean Dice scores were 0.882 (±0.244) and 0.977 (±0.04) for whole-tumor segmentation for WUSM and MDA, respectively. CONCLUSION This streamlined framework automatically curated, processed, and segmented raw MRI data of patients with varying grades of gliomas, enabling the curation of large-scale neuro-oncology data sets and demonstrating high potential for integration as an assistive tool in clinical practice.
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Affiliation(s)
- Satrajit Chakrabarty
- Department of Electrical and Systems Engineering, Washington University in St Louis, St Louis, MO
| | - Syed Amaan Abidi
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
| | - Mina Mousa
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
| | - Mahati Mokkarala
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
| | - Isabelle Hren
- Department of Computer Science & Engineering, Washington University in St Louis, St Louis, MO
| | - Divya Yadav
- Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Matthew Kelsey
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
| | - Pamela LaMontagne
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
| | - John Wood
- Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael Adams
- Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yuzhuo Su
- Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sherry Thorpe
- Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Caroline Chung
- Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Aristeidis Sotiras
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
- Institute for Informatics, Washington University School of Medicine, St Louis, MO
| | - Daniel S. Marcus
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
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28
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Celaya A, Actor JA, Muthusivarajan R, Gates E, Chung C, Schellingerhout D, Riviere B, Fuentes D. PocketNet: A Smaller Neural Network for Medical Image Analysis. IEEE Trans Med Imaging 2023; 42:1172-1184. [PMID: 36427285 PMCID: PMC10882585 DOI: 10.1109/tmi.2022.3224873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Medical imaging deep learning models are often large and complex, requiring specialized hardware to train and evaluate these models. To address such issues, we propose the PocketNet paradigm to reduce the size of deep learning models by throttling the growth of the number of channels in convolutional neural networks. We demonstrate that, for a range of segmentation and classification tasks, PocketNet architectures produce results comparable to that of conventional neural networks while reducing the number of parameters by multiple orders of magnitude, using up to 90% less GPU memory, and speeding up training times by up to 40%, thereby allowing such models to be trained and deployed in resource-constrained settings.
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29
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Xiao Y, Cardenas C, Rhee DJ, Netherton T, Zhang L, Nguyen C, Douglas R, Mumme R, Skett S, Patel T, Trauernicht C, Chung C, Simonds H, Aggarwal A, Court L. Customizable landmark-based field aperture design for automated whole-brain radiotherapy treatment planning. J Appl Clin Med Phys 2023; 24:e13839. [PMID: 36412092 PMCID: PMC10018662 DOI: 10.1002/acm2.13839] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/09/2022] [Revised: 10/18/2022] [Accepted: 10/21/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To develop and evaluate an automated whole-brain radiotherapy (WBRT) treatment planning pipeline with a deep learning-based auto-contouring and customizable landmark-based field aperture design. METHODS The pipeline consisted of the following steps: (1) Auto-contour normal structures on computed tomography scans and digitally reconstructed radiographs using deep learning techniques, (2) locate the landmark structures using the beam's-eye-view, (3) generate field apertures based on eight different landmark rules addressing different clinical purposes and physician preferences. Two parallel approaches for generating field apertures were developed for quality control. The performance of the generated field shapes and dose distributions were compared with the original clinical plans. The clinical acceptability of the plans was assessed by five radiation oncologists from four hospitals. RESULTS The performance of the generated field apertures was evaluated by the Hausdorff distance (HD) and mean surface distance (MSD) from 182 patients' field apertures used in the clinic. The average HD and MSD for the generated field apertures were 16 ± 7 and 7 ± 3 mm for the first approach, respectively, and 17 ± 7 and 7 ± 3 mm, respectively, for the second approach. The differences regarding HD and MSD between the first and the second approaches were 1 ± 2 and 1 ± 3 mm, respectively. A clinical review of the field aperture design, conducted using 30 patients, achieved a 100% acceptance rate for both the first and second approaches, and the plan review achieved a 100% acceptance rate for the first approach and a 93% acceptance rate for the second approach. The average acceptance rate for meeting lens dosimetric recommendations was 80% (left lens) and 77% (right lens) for the first approach, and 70% (both left and right lenses) for the second approach, compared with 50% (left lens) and 53% (right lens) for the clinical plans. CONCLUSION This study provided an automated pipeline with two field aperture generation approaches to automatically generate WBRT treatment plans. Both quantitative and qualitative evaluations demonstrated that our novel pipeline was comparable with the original clinical plans.
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Affiliation(s)
- Yao Xiao
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Carlos Cardenas
- Department of Radiation Oncology, The University of Alabama-Birmingham, Birmingham, Alabama, USA
| | - Dong Joo Rhee
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tucker Netherton
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lifei Zhang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Callistus Nguyen
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Raphael Douglas
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Raymond Mumme
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Stephen Skett
- Department of Medical Physics, Guy's & St Thomas NHS Foundation Trust, London, UK
| | - Tina Patel
- Department of Medical Physics, Guy's & St Thomas NHS Foundation Trust, London, UK
| | - Chris Trauernicht
- Division of Medical Physics, Stellenbosch University and Tygerberg Academic Hospital, Stellenbosch, South Africa
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hannah Simonds
- Division of Radiation Oncology, Stellenbosch University and Tygerberg Academic Hospital, Stellenbosch, South Africa
| | - Ajay Aggarwal
- Department of Medical Physics, Guy's & St Thomas NHS Foundation Trust, London, UK
| | - Laurence Court
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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30
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Baroudi H, Brock KK, Cao W, Chen X, Chung C, Court LE, El Basha MD, Farhat M, Gay S, Gronberg MP, Gupta AC, Hernandez S, Huang K, Jaffray DA, Lim R, Marquez B, Nealon K, Netherton TJ, Nguyen CM, Reber B, Rhee DJ, Salazar RM, Shanker MD, Sjogreen C, Woodland M, Yang J, Yu C, Zhao Y. Automated Contouring and Planning in Radiation Therapy: What Is 'Clinically Acceptable'? Diagnostics (Basel) 2023; 13:diagnostics13040667. [PMID: 36832155 PMCID: PMC9955359 DOI: 10.3390/diagnostics13040667] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [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: 12/18/2022] [Revised: 01/21/2023] [Accepted: 01/30/2023] [Indexed: 02/12/2023] Open
Abstract
Developers and users of artificial-intelligence-based tools for automatic contouring and treatment planning in radiotherapy are expected to assess clinical acceptability of these tools. However, what is 'clinical acceptability'? Quantitative and qualitative approaches have been used to assess this ill-defined concept, all of which have advantages and disadvantages or limitations. The approach chosen may depend on the goal of the study as well as on available resources. In this paper, we discuss various aspects of 'clinical acceptability' and how they can move us toward a standard for defining clinical acceptability of new autocontouring and planning tools.
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Affiliation(s)
- Hana Baroudi
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, USA
| | - Kristy K. Brock
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Imaging Physics, Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Wenhua Cao
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Xinru Chen
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, USA
| | - Caroline Chung
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Laurence E. Court
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Correspondence:
| | - Mohammad D. El Basha
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, USA
| | - Maguy Farhat
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Skylar Gay
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, USA
| | - Mary P. Gronberg
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, USA
| | - Aashish Chandra Gupta
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, USA
- Department of Imaging Physics, Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Soleil Hernandez
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, USA
| | - Kai Huang
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, USA
| | - David A. Jaffray
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Imaging Physics, Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Rebecca Lim
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, USA
| | - Barbara Marquez
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, USA
| | - Kelly Nealon
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, USA
| | - Tucker J. Netherton
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Callistus M. Nguyen
- Department of Imaging Physics, Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Brandon Reber
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, USA
- Department of Imaging Physics, Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Dong Joo Rhee
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ramon M. Salazar
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Mihir D. Shanker
- The University of Queensland, Saint Lucia 4072, Australia
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Carlos Sjogreen
- Department of Physics, University of Houston, Houston, TX 77004, USA
| | - McKell Woodland
- Department of Imaging Physics, Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Computer Science, Rice University, Houston, TX 77005, USA
| | - Jinzhong Yang
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Cenji Yu
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, USA
| | - Yao Zhao
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, USA
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Chung C, Shin JE, Jeon D, Kang H, Yim JJ, Jo KW, Shim TS. Treatment outcomes and safety of bedaquiline, delamanid, and linezolid in multidrug-resistant TB. Int J Tuberc Lung Dis 2023; 27:151-153. [PMID: 36853109 DOI: 10.5588/ijtld.22.0466] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- C Chung
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - J E Shin
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - D Jeon
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - H Kang
- Department of Chest Medicine, Masan National Tuberculosis Hospital, Masan, Republic of Korea
| | - J-J Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - K-W Jo
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - T S Shim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Cata JP, Hu J, Feng L, Chung C, Woodman SE, Meyer LA. Association between COVID-19 and Postoperative Neurological Complications and Antipsychotic Medication Use after Cancer Surgery: A Retrospective Study. J Pers Med 2023; 13:jpm13020274. [PMID: 36836508 PMCID: PMC9959979 DOI: 10.3390/jpm13020274] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/26/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Millions of Americans infected with the severe acute respiratory syndrome-associated coronavirus-19 (COVID-19) need oncologic surgery. Patients with acute or resolved COVID-19 illness complain of neuropsychiatric symptoms. How surgery affects postoperative neuropsychiatric outcomes such as delirium is unknown. We hypothesize that patients with a history of COVID-19 could have an exaggerated risk of developing postoperative delirium after undergoing major elective oncologic surgery. METHODS We conducted a retrospective study to determine the association between COVID-19 status and antipsychotic drugs during postsurgical hospitalization as a surrogate of delirium. Secondary outcomes included 30 days of postoperative complications, length of stay, and mortality. Patients were grouped into pre-pandemic non-COVID-19 and COVID-19-positive groups. A 1:2 propensity score matching was used to minimize bias. A multivariable logistic regression model estimated the effects of important covariates on the use of postoperative psychotic medication. RESULTS A total of 6003 patients were included in the study. Pre- and post-propensity score matching demonstrated that a history of preoperative COVID-19 did not increase the risk of antipsychotic medications postoperatively. However, respiratory and overall 30-day complications were higher in COVID-19 individuals than in pre-pandemic non-COVID-19 patients. The multivariate analysis showed that the odds of using postoperative antipsychotic medication use for the patients who had COVID-19 compared to those who did not have the infection were not significantly different. CONCLUSION A preoperative diagnosis of COVID-19 did not increase the risk of postoperative antipsychotic medication use or neurological complications. More studies are needed to reproduce our results due to the increased concern of neurological events post-COVID-19 infection.
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Affiliation(s)
- Juan P. Cata
- Department of Anesthesiology and Perioperative Medicine, The University of Texas—MD Anderson Cancer Centre, Houston, TX 77030, USA
- Anesthesiology and Surgical Oncology Research Group, Houston, TX 77030, USA
- Correspondence:
| | - Jian Hu
- Department of Cancer Biology, The University of Texas—MD Anderson Cancer Centre, Houston, TX 77030, USA
| | - Lei Feng
- Department of Biostatistics, The University of Texas—MD Anderson Cancer Centre, Houston, TX 77030, USA
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas—MD Anderson Cancer Centre, Houston, TX 77030, USA
- Data-Driven Determinants for COVID-19 Oncology Discovery Effort (D3CODE) Team, University of Texas—MD Anderson Cancer Centre, Houston, TX 77030, USA
| | - Scott E. Woodman
- Data-Driven Determinants for COVID-19 Oncology Discovery Effort (D3CODE) Team, University of Texas—MD Anderson Cancer Centre, Houston, TX 77030, USA
- Department of Genomic Medicine, The University of Texas—MD Anderson Cancer Centre, Houston, TX 77030, USA
| | - Larissa A. Meyer
- Department of Gynecology Oncology and Reproductive Medicine, The University of Texas—MD Anderson Cancer Centre, Houston, TX 77030, USA
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33
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Li W, Bootsma G, Shultz D, Laperriere N, Millar BA, Cho YB, Jaffray DA, Chung C, Coolens C. Assessment of intra-fraction motion during frameless image guided Gamma Knife stereotactic radiosurgery. Phys Imaging Radiat Oncol 2023; 25:100415. [PMID: 36718356 PMCID: PMC9883231 DOI: 10.1016/j.phro.2023.100415] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023] Open
Abstract
As frameless stereotactic radiosurgery increase in use, the aim of this study was to evaluate intra-fraction motion through cone-beam CT (CBCT) and high-definition motion management (HDMM) systems. Intra-fraction motion measured between localization, repeat localization and post-treatment CBCTs were correlated to intra-faction motion indicated by the HDMM files using the Pearson coefficient (r). A total of 302 plans were reviewed from 263 patients (114 male, 149 female); 216 pairs of localization-repeat localization, and 260 localization-post-treatment CBCTs were analyzed against HDMM logs. We found the magnitude of intra-fraction motion detected by the HDMM system were larger than the corresponding CBCT results.
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Affiliation(s)
- Winnie Li
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada,Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada,Corresponding author at: Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Avenue, Level 2B, Cobalt Lounge, Toronto, ON, Canada.
| | - Gregory Bootsma
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - David Shultz
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada,Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Normand Laperriere
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada,Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Barbara-Ann Millar
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada,Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Young Bin Cho
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada,Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - David A. Jaffray
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada,Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Caroline Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada,Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Catherine Coolens
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada,Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
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Lu SC, Swisher CL, Chung C, Jaffray D, Sidey-Gibbons C. On the importance of interpretable machine learning predictions to inform clinical decision making in oncology. Front Oncol 2023; 13:1129380. [PMID: 36925929 PMCID: PMC10013157 DOI: 10.3389/fonc.2023.1129380] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/14/2023] [Indexed: 03/04/2023] Open
Abstract
Machine learning-based tools are capable of guiding individualized clinical management and decision-making by providing predictions of a patient's future health state. Through their ability to model complex nonlinear relationships, ML algorithms can often outperform traditional statistical prediction approaches, but the use of nonlinear functions can mean that ML techniques may also be less interpretable than traditional statistical methodologies. While there are benefits of intrinsic interpretability, many model-agnostic approaches now exist and can provide insight into the way in which ML systems make decisions. In this paper, we describe how different algorithms can be interpreted and introduce some techniques for interpreting complex nonlinear algorithms.
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Affiliation(s)
- Sheng-Chieh Lu
- Section of Patient-Centered Analytics, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Christine L Swisher
- The Ronin Project, San Mateo, CA, United States.,The Lawrence J. Ellison Institute for Transformative Medicine, Los Angeles, CA, United States
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Institute for Data Science in Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - David Jaffray
- Institute for Data Science in Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Chris Sidey-Gibbons
- Section of Patient-Centered Analytics, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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35
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Dhanaskeara CS, Caballero B, Moolupuri A, Chung C, Puckett Y, Santos A, Estrada M, Alhaj Saleh A, Ronaghan CA, Dissanaike S, Richmond RE. Patient Outcomes in Laparoscopic Appendectomy With Acute Surgical Care Model Compared to Traditional Call. J Surg Res 2023; 281:282-288. [PMID: 36219940 DOI: 10.1016/j.jss.2022.08.036] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/16/2022] [Accepted: 08/15/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Shift-based models for acute surgical care (ACS), where surgical emergencies are treated by a dedicated team of surgeons working shifts, without a concurrent elective practice, are becoming more common nationwide. We compared the outcomes for appendectomy, one of the most common emergency surgical procedures, between the traditional (TRAD) call and ACS model at the same institution during the same time frame. METHODS A retrospective review of patients who underwent laparoscopic appendectomy for acute appendicitis during 2017-2018. ACS and TRAD-patient demographics, clinical presentation, operative details, and outcomes were compared using independent sample t-tests, Wilcoxon rank-sum tests and Fisher's exact or χ2 tests. Multiple exploratory regression models were constructed to examine the effects of confounding variables. RESULTS Demographics, clinical presentation, and complication rates were similar between groups except for a longer duration of symptoms prior to arrival in the TRAD group (Δ = 0.5 d, P = 0.006). Time from admission to operating room (Δ = -1.85 h, P = 0.003), length of hospital stay (Δ = -2.0 d, P < 0.001), and total cost (Δ = $ -2477.02, P < 0.001) were significantly lower in the ACS group compared to the TRAD group. Furthermore, perforation rates were lower in ACS (8.3% versus 28.6%, P = 0.003). Differences for the outcomes remained significant even after controlling for duration of symptoms prior to arrival (P < 0.05). CONCLUSIONS Acute appendicitis managed using the ACS shift-based model seems to be associated with reduced time to operation, hospital stay, and overall cost, with equivalent success rates, compared to TRAD.
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Affiliation(s)
| | - Beatrice Caballero
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Abhi Moolupuri
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Caroline Chung
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Yana Puckett
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Ariel Santos
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Michelle Estrada
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Adel Alhaj Saleh
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Catherine A Ronaghan
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Sharmila Dissanaike
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Robyn E Richmond
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas.
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McGovern SL, Luo D, Johnson J, Nguyen K, Li J, McAleer MF, Yeboa D, Grosshans DR, Ghia AJ, Chung C, Bishop AJ, Song J, Thall PF, Brown PD, Mahajan A. A Prospective Study of Conventionally Fractionated Dose Constraints for Reirradiation of Primary Brain Tumors in Adults. Pract Radiat Oncol 2022; 13:231-238. [PMID: 36596356 DOI: 10.1016/j.prro.2022.12.006] [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: 09/01/2022] [Revised: 12/22/2022] [Accepted: 12/26/2022] [Indexed: 01/01/2023]
Abstract
PURPOSE Dose constraints for reirradiation of recurrent primary brain tumors are not well-established. This study was conducted to prospectively evaluate composite dose constraints for conventionally fractionated brain reirradiation. METHODS AND MATERIALS A single-institution, prospective study of adults with previously irradiated, recurrent brain tumors was performed. For 95% of patients, electronic dosimetry records from the first course of radiation (RT1) were obtained and deformed onto the simulation computed tomography for the second course of radiation (RT2). Conventionally fractionated treatment plans for RT2 were developed that met protocol-assigned dose constraints for RT2 alone and the composite dose of RT1 + RT2. Prospective composite dose constraints were based on histology, interval since RT1, and concurrent bevacizumab. Patients were followed with magnetic resonance imaging including spectroscopy and perfusion studies. Primary endpoint was the rate of symptomatic brain necrosis at 6 months after RT2. RESULTS Patients were enrolled from March 2017 to May 2018; 20 were evaluable. Eighteen had glioma, 1 had atypical choroid plexus papilloma, and 1 had hemangiopericytoma. Nineteen patients were treated with volumetric modulated arc therapy, and one was treated with protons. Median RT1 dose was 57 Gy (range, 50-60 Gy). Median RT1-RT2 interval was 49 months (range, 9-141 months). Median RT2 dose was 42.4 Gy (range, 36-60 Gy). Median planning target volume was 186 cc (range, 8-468 cc). Nineteen of 20 patients (95%) were free of grade 3+ central nervous system necrosis. One patient had grade 3+ necrosis 2 months after RT2; the patient recovered fully and lived another 18 months until dying of disease progression. Median overall survival from RT2 start for all patients was 13.3 months (95% credible interval, 6.3-20.7); for patients with glioblastoma, 11.5 months (95% credible interval, 6.1-20.1). CONCLUSIONS Brain reirradiation can be safely performed with conventionally fractionated regimens tailored to previous dose distributions. The prospective composite dose constraints described here are a starting point for future studies of conventionally fractionated reirradiation.
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Affiliation(s)
- Susan L McGovern
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Dershan Luo
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason Johnson
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kham Nguyen
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jing Li
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mary Frances McAleer
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Debra Yeboa
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David R Grosshans
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Amol J Ghia
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Caroline Chung
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Andrew J Bishop
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Juhee Song
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Peter F Thall
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
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Hasanov M, Milton DR, Bea Davies A, Sirmans E, Saberian C, Posada EL, Opusunju S, Gershenwald JE, Torres-Cabala CA, Burton EM, Colen R, Huse JT, Glitza Oliva IC, Chung C, McAleer MF, McGovern SL, Yeboa DN, Kim BYS, Prabhu SS, McCutcheon IE, Weinberg J, Lang FF, Tawbi HA, Li J, Haydu LE, Davies MA, Ferguson SD. Changes In Outcomes And Factors Associated With Survival In Melanoma Patients With Brain Metastases. Neuro Oncol 2022:6889653. [PMID: 36510640 DOI: 10.1093/neuonc/noac251] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUD Treatment options for patients with melanoma brain metastasis (MBM) have changed significantly in the last decade. Few studies have evaluated changes in outcomes and factors associated with survival in MBM patients over time. The aim of this study is to evaluate changes in clinical features and overall survival (OS) for MBM patients. METHODS Patients diagnosed with MBMs from 1/1/2009-12/31/2013 (Prior Era; PE) and 1/1/2014-12/31/2018 (Current Era; CE) at The University of Texas MD Anderson Cancer Center were included in this retrospective analysis. The primary outcome measure was OS. Log-rank test assessed differences between groups; multivariable analyses were performed with Cox proportional hazards models and recursive partitioning analysis (RPA). RESULTS 791 MBM patients (PE, n=332; CE, n=459) were included in analysis. Median OS from MBM diagnosis was 10.3 months (95% CI, 8.9 - 12.4) and improved in the CE versus PE (14.4 vs. 10.3 months, P < .001). Elevated serum LDH was the only factor associated with worse OS in both PE and CE patients. Factors associated with survival in CE MBM patients included patient age, primary tumor Breslow thickness, prior immunotherapy, leptomeningeal disease (LMD), symptomatic MBMs, and whole brain radiation therapy (WBRT). Several factors associated with OS in the PE were not significant in the CE. RPA demonstrated that elevated serum LDH and prior immunotherapy treatment are the most important determinants of survival in CE MBM patients. CONCLUSIONS OS and factors associated with OS have changed for MBM patients. This information can inform contemporary patient management and clinical investigations.
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Affiliation(s)
- Merve Hasanov
- Department of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Denái R Milton
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Alicia Bea Davies
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elizabeth Sirmans
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Chantal Saberian
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eliza L Posada
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sylvia Opusunju
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeffrey E Gershenwald
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Elizabeth M Burton
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rivka Colen
- Center for Artificial Intelligence Innovation in Medical Imaging, University of Pittsburg, Pittsburg, PA
| | - Jason T Huse
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Isabella C Glitza Oliva
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mary Frances McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Susan L McGovern
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Debra N Yeboa
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Betty Y S Kim
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ian E McCutcheon
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeffrey Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Frederick F Lang
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hussein A Tawbi
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jing Li
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lauren E Haydu
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael A Davies
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sherise D Ferguson
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX
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Guran E, Hu J, Wefel JS, Chung C, Cata JP. Perioperative considerations in patients with chemotherapy-induced cognitive impairment: a narrative review. Br J Anaesth 2022; 129:909-922. [PMID: 36270848 DOI: 10.1016/j.bja.2022.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 08/01/2022] [Accepted: 08/23/2022] [Indexed: 11/02/2022] Open
Abstract
Patients with cancer may suffer from a decline in their cognitive function after various cancer therapies, including surgery, radiation, and chemotherapy, and in some cases, this decline in cognitive function persists even years after completion of treatment. Chemobrain or chemotherapy-induced cognitive impairment, a well-established clinical syndrome, has become an increasing concern as the number of successfully treated cancer patients has increased significantly. Chemotherapy-induced cognitive impairment can originate from direct neurotoxicity, neuroinflammation, and oxidative stress, resulting in alterations in grey matter volume, white matter integrity, and brain connectivity. Surgery has been associated with exacerbating the inflammatory response associated with chemotherapy and predisposes patients to develop postoperative cognitive dysfunction. As the proportion of patients living longer after these therapies increases, the magnitude of impact and growing concern of post-treatment cognitive dysfunction in these patients has also come to the fore. We review the clinical presentation, potential mechanisms, predisposing factors, diagnostic methods, neuropsychological testing, and imaging findings of chemotherapy-induced cognitive impairment and its intersection with postoperative cognitive dysfunction.
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Affiliation(s)
- Ekin Guran
- Department of Anaesthesiology and Reanimation, University of Health Sciences, Ankara Oncology Training and Research Hospital, Ankara, Turkey; Anaesthesiology and Surgical Oncology Research Group, Houston, TX, USA
| | - Jian Hu
- Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Caroline Chung
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Juan P Cata
- Anaesthesiology and Surgical Oncology Research Group, Houston, TX, USA; Department of Anaesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Butner JD, Dogra P, Chung C, Pasqualini R, Arap W, Lowengrub J, Cristini V, Wang Z. Mathematical modeling of cancer immunotherapy for personalized clinical translation. Nat Comput Sci 2022; 2:785-796. [PMID: 38126024 PMCID: PMC10732566 DOI: 10.1038/s43588-022-00377-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 11/14/2022] [Indexed: 12/23/2023]
Abstract
Encouraging advances are being made in cancer immunotherapy modeling, especially in the key areas of developing personalized treatment strategies based on individual patient parameters, predicting treatment outcomes and optimizing immunotherapy synergy when used in combination with other treatment approaches. Here we present a focused review of the most recent mathematical modeling work on cancer immunotherapy with a focus on clinical translatability. It can be seen that this field is transitioning from pure basic science to applications that can make impactful differences in patients' lives. We discuss how researchers are integrating experimental and clinical data to fully inform models so that they can be applied for clinical predictions, and present the challenges that remain to be overcome if widespread clinical adaptation is to be realized. Lastly, we discuss the most promising future applications and areas that are expected to be the focus of extensive upcoming modeling studies.
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Affiliation(s)
- Joseph D. Butner
- Mathematics in Medicine Program, Houston Methodist Research Institute, Houston, TX, USA
| | - Prashant Dogra
- Mathematics in Medicine Program, Houston Methodist Research Institute, Houston, TX, USA
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Renata Pasqualini
- Rutgers Cancer Institute of New Jersey, Newark, NJ, USA
- Department of Radiation Oncology, Division of Cancer Biology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Wadih Arap
- Rutgers Cancer Institute of New Jersey, Newark, NJ, USA
- Department of Medicine, Division of Hematology/Oncology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - John Lowengrub
- Department of Mathematics, University of California at Irvine, Irvine, CA, USA
| | - Vittorio Cristini
- Mathematics in Medicine Program, Houston Methodist Research Institute, Houston, TX, USA
- Neal Cancer Center, Houston Methodist Research Institute, Houston, TX, USA
- Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Physiology, Biophysics, and Systems Biology Program, Graduate School of Medical Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Zhihui Wang
- Mathematics in Medicine Program, Houston Methodist Research Institute, Houston, TX, USA
- Neal Cancer Center, Houston Methodist Research Institute, Houston, TX, USA
- Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY, USA
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40
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Butner JD, Farhat M, Cristini V, Chung C, Wang Z. Protocol for mathematical prediction of patient response and survival to immune checkpoint inhibitor immunotherapy. STAR Protoc 2022; 3:101886. [PMID: 36595890 PMCID: PMC9719106 DOI: 10.1016/j.xpro.2022.101886] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/03/2022] [Accepted: 11/03/2022] [Indexed: 12/03/2022] Open
Abstract
This protocol describes the application of a mechanistic mathematical model of immune checkpoint inhibitor (ICI) immunotherapy to patient tumor imaging data for predicting solid tumor response and patient survival under ICI intervention. We describe steps for data collection and processing, data pipelines, and approaches to increase precision. The protocol is highly predictive as early as the first restaging after treatment start and can be used with standard-of-care imaging measures. For complete details on the use and execution of this protocol, please refer to Butner et al. (2020)1 and Butner et al. (2021).2.
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Affiliation(s)
- Joseph D. Butner
- Mathematics in Medicine Program, Houston Methodist Research Institute, Houston, TX 77030, USA,Corresponding author
| | - Maguy Farhat
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Vittorio Cristini
- Mathematics in Medicine Program, Houston Methodist Research Institute, Houston, TX 77030, USA,Neal Cancer Center, Houston Methodist Research Institute, Houston, TX 77030, USA,Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77230, USA,Physiology, Biophysics, and Systems Biology Program, Graduate School of Medical Sciences, Weill Cornell Medicine, New York, NY 10065, USA
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA,Corresponding author
| | - Zhihui Wang
- Mathematics in Medicine Program, Houston Methodist Research Institute, Houston, TX 77030, USA,Neal Cancer Center, Houston Methodist Research Institute, Houston, TX 77030, USA,Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY 10065, USA,Department of Medical Education, Texas A&M University School of Medicine, Bryan, TX 77807, USA,Corresponding author
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Farhat M, Hormuth D, Langshaw H, Bronk J, Curl B, Yadav D, Upadhyay R, Elliot A, Goldman J, Erickson L, Talpur W, Lee M, Yankeelov T, Chung C. NIMG-79. SPATIALLY MAPPED PREDICTIONS OF EVOLVING TUMOR RESPONSE OF HIGH-GRADE GLIOMA VIA IMAGE-DRIVEN MATHEMATICAL MODELING. Neuro Oncol 2022. [PMCID: PMC9660934 DOI: 10.1093/neuonc/noac209.697] [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] Open
Abstract
Abstract
Timely treatment response assessment of high-grade gliomas (HGG), crucial for driving therapeutic decisions, remains a challenge; as HGGs exhibit variable response to treatment within different sub-regions. Current assessment using multi-parametric MRI (mpMRI) depends largely upon follow-up (FU) imaging timepoints for achieving diagnostic certainty, which delays therapeutic interventions. Mathematical modeling (MM) of tumor growth and treatment response can provide spatiotemporal information of HGG evolution in response to treatment, thus allowing for prospective early identification of resilient tumor subregions. AIMS: We aim to initialize and calibrate an image-driven MM framework to forecast HGG response, both at the end of chemoradiotherapy (CRT) and at 3-month FU.
METHODS
In a prospective clinical study, weekly mpMRIs (post-contrast T1, T2 FLAIR, and diffusion) for patients with HGG receiving CRT were used to describe tumor extent and cellularity. This data collected from baseline (pre-CRT) till week 3 (mid-CRT) was used to calibrate a model family to forecast HGG response for each individual patient at week 6 (end CRT) and at 3-month FU.
RESULTS
Error between the forecasted and observed responses was assessed globally using percent error in tumor volume, and at the local level by Pearson correlation coefficient (PCC). In an initial cohort of 11 patients, our MM framework predictions had a percent error in tumor volume of less than 8.6% and at week 6 RT and less than 20% at 3 months FU. The PCCs were 0.84 at week 6 RT and 0.72 at 3 months FU.
CONCLUSIONS
Temporal consistency across this early evaluation of the model predictions show promise of image-driven MM for HGG response forecasting to guide timely personalized assessment and adjustment of treatment.
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Affiliation(s)
- Maguy Farhat
- The University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | | | - Holly Langshaw
- The University of Texas MD Anderson Cancer Center , houston , USA
| | - Juliana Bronk
- The University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Brandon Curl
- The University of Texas MD Anderson Cancer Center , Austin, TX , USA
| | - Divya Yadav
- The University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Rituraj Upadhyay
- The University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Andrew Elliot
- The University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Jodi Goldman
- The University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Lily Erickson
- The University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Wasif Talpur
- The University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Maggie Lee
- The University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | | | - Caroline Chung
- The University of Texas MD Anderson Cancer Center , Houston, TX , USA
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Bronk J, Muir M, Michener H, Calbat C, Mackin D, Mitchell D, Train B, Farhat M, Elliot A, Prabhu S, Prinsloo S, Chung C. NEIM-05 FEASIBILITY OF NAVIGATED TRANSCRANIAL MAGNETIC STIMULATION (NTMS) BASED DIFFUSION TENSOR IMAGING (DTI) TRACTOGRAPHY OF MOTOR PATHWAYS IN PATIENTS UNDERGOING STEREOTACTIC RADIOSURGERY: A CROSS-SECTIONAL DOSIMETRIC AND PATIENT OUTCOMES ANALYSIS. Neurooncol Adv 2022. [PMCID: PMC9354208 DOI: 10.1093/noajnl/vdac078.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND No current dose limitations exist for the motor tracts during stereotactic radiosurgery (SRS) planning due to challenges in localizing this region of interest by conventional imaging. Navigated Transcranial Magnetic Stimulation (nTMS) is a non-invasive tool that utilizes electromyographic signal combined with magnetic resonance diffusion tensor imaging (DTI) to functionally map cortical motor tracts. Although nTMS is utilized for functional mapping prior to brain tumor resection, it has not been implemented in SRS planning. OBJECTIVES To determine the feasibility of performing nTMS-based DTI in patients treated with SRS and examine the relationship between dose to functionally-defined motor tracts and patient outcomes measured by objective hand function testing and patient reported outcomes (PROs). METHODS 16 patients treated with SRS to a brain metastasis located near anatomically-defined motor tracts were enrolled on an IRB-approved clinical trial. At median follow-up of 5.4m after SRS, patients underwent nTMS testing, brain MRI with DTI, functional outcomes testing (Pinch Dynamometer,9-Hole Peg Test), and quality-of-life (QOL) PROs (EQ-5D-5L, MDASI-BT). nTMS-seeded DTI tractography was generated (Brainlab iPlan) and imported into GammaPlan for dosimetric evaluation. RESULTS Tractography reconstitution was attempted for 8/16 patients and successful in 7/8 (87.5%). One patient who had prior resection of a lesion in the right pre-central gyrus failed to map in the right cortex and was unable to complete functional testing for the affected extremity. Median Dmax to the treated motor tracts was 4.6Gy [0.5-13.4Gy]. Median Dmean was 0.9Gy [0-1.2Gy]. Increased Dmax correlated with deficits in lateral pinch strength (R2=0.76) and 9-Hole Peg testing time (R2=0.61). Increased Dmean correlated with increased MDASI-BT interference scores (R2=0.93) and EQ5D5L score (R2=0.94) indicating worsened QOL. CONCLUSIONS nTMS testing was feasible and dose to nTMS-defined motor tracts correlated with subjective and objective patient outcomes. Future steps will include characterization of motor tract dose tolerance for SRS.
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Affiliation(s)
- Julianna Bronk
- University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Matthew Muir
- University of Texas MD Anderson Cancer Center , Houston, TX , USA
- Baylor College of Medicine , Houston, TX , USA
| | - Hayley Michener
- University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Courtney Calbat
- University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Dennis Mackin
- University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Drew Mitchell
- University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Benjamin Train
- University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Maguy Farhat
- University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Andrew Elliot
- University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Sujit Prabhu
- University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Sarah Prinsloo
- University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Caroline Chung
- University of Texas MD Anderson Cancer Center , Houston, TX , USA
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Tran B, Buszek S, Mitchell D, Long J, Elliott A, Langshaw H, Erickson L, Farhat M, Bronk J, Ferguson S, Chung C. NEIM-06 COMBINING CLINICAL VARIABLES AND RADIOMIC FEATURES TO HELP DISTINGUISH RADIATION NECROSIS FROM TUMOR IN PATIENTS WITH MELANOMA BRAIN METASTASES TREATED WITH RADIOSURGERY. Neurooncol Adv 2022. [DOI: 10.1093/noajnl/vdac078.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Following Gamma Knife SRS (GK-SRS), the conventional imaging characteristics of radiation necrosis (RN) mimic those of tumor progression, introducing considerable uncertainty in diagnosis. Previous studies have identified clinical variables associated with RN; however, diagnosis primarily relied on interpretation of imaging with only a minority confirmed using the gold standard of pathological examination. Furthermore, the cohorts of these studies included a mix of primary histologies.
PURPOSE
To identify the combination of clinical variables and radiomic features most predictive of RN in patients with melanoma brain metastasis (BM) with GK-SRS in order to train a machine learning classifier to distinguish RN from tumor progression.
METHODS
We retrospectively studied 86 patients with a melanoma BM that received initial GK-SRS followed by resection, thereby pathologically confirming tumor or RN. Clinical variables including lesion volume, age at surgery, GK-SRS dose, lesion hemorrhage, lesion location, gender, BM velocity, and drug therapy type were obtained from chart review. We extracted radiomic features from contrast-enhanced T1-weighted MR images using PyRadiomics. A consensus clustering algorithm identified representative radiomic features. Non-parametric hypothesis testing was performed on the clinical variables and representative radiomic features.
RESULTS
Of the 86 patients, 17 (19.8%) patients exhibited RN and 69 exhibited tumor progression. Lesion volume was associated with development of RN (p = 0.038<0.05) with a median volume of 1.5 cc (0.01-26.71 cc). Clustering analysis identified seven representative radiomic features; five were found to have statistically significant association with development of RN.
CONCLUSION
In this dataset with pathologically confirmed diagnoses in a histologically homogeneous patient cohort, we reproduced previously reported findings that the clinical variable of lesion volume is associated with RN and we identified several radiomic features associated with RN in patients with melanoma BM. We are using these variables and features to train a machine learning classifier to distinguish RN from tumor.
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Affiliation(s)
- Benjamin Tran
- McGovern Medical School at The University of Texas Health Science Center at Houston , Houston, TX , USA
- University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Samantha Buszek
- University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Drew Mitchell
- University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - James Long
- University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Andrew Elliott
- University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Holly Langshaw
- University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Lily Erickson
- University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Maguy Farhat
- University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Julianna Bronk
- University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Sherise Ferguson
- University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Caroline Chung
- University of Texas MD Anderson Cancer Center , Houston, TX , USA
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MD JKB, Amer A, Khose S, Flint D, Adair A, Yepes P, Grosshans D, Johnson J, Chung C. Brain Radionecrosis Outside the Target Volume after Proton Radiotherapy: Analyses of Multiparametric Imaging and Proton Biological Effectiveness. Adv Radiat Oncol 2022; 7:101044. [DOI: 10.1016/j.adro.2022.101044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/27/2022] [Indexed: 11/17/2022] Open
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Ellingson BM, Gerstner ER, Lassman AB, Chung C, Colman H, Cole PE, Leung D, Allen JE, Ahluwalia MS, Boxerman J, Brown M, Goldin J, Nduom E, Hassan I, Gilbert MR, Mellinghoff IK, Weller M, Chang S, Arons D, Meehan C, Selig W, Tanner K, Alfred Yung WK, van den Bent M, Wen PY, Cloughesy TF. Hypothetical generalized framework for a new imaging endpoint of therapeutic activity in early phase clinical trials in brain tumors. Neuro Oncol 2022; 24:1219-1229. [PMID: 35380705 PMCID: PMC9340639 DOI: 10.1093/neuonc/noac086] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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] [Indexed: 11/13/2022] Open
Abstract
Imaging response assessment is a cornerstone of patient care and drug development in oncology. Clinicians/clinical researchers rely on tumor imaging to estimate the impact of new treatments and guide decision making for patients and candidate therapies. This is important in brain cancer, where associations between tumor size/growth and emerging neurological deficits are strong. Accurately measuring the impact of a new therapy on tumor growth early in clinical development, where patient numbers are small, would be valuable for decision making regarding late-stage development activation. Current attempts to measure the impact of a new therapy have limited influence on clinical development, as determination of progression, stability or response does not currently account for individual tumor growth kinetics prior to the initiation of experimental therapies. Therefore, we posit that imaging-based response assessment, often used as a tool for estimating clinical effect, is incomplete as it does not adequately account for growth trajectories or biological characteristics of tumors prior to the introduction of an investigational agent. Here, we propose modifications to the existing framework for evaluating imaging assessment in primary brain tumors that will provide a more reliable understanding of treatment effects. Measuring tumor growth trajectories prior to a given intervention may allow us to more confidently conclude whether there is an anti-tumor effect. This updated approach to imaging-based tumor response assessment is intended to improve our ability to select candidate therapies for later-stage development, including those that may not meet currently sought thresholds for "response" and ultimately lead to identification of effective treatments.
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Affiliation(s)
- Benjamin M Ellingson
- UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Elizabeth R Gerstner
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew B Lassman
- Division of Neuro-Oncology, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, Herbert Irving Comprehensive Cancer Center, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Caroline Chung
- University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Howard Colman
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | | | - David Leung
- Bristol Myers Squibb, Princeton, New Jersey, USA
| | | | | | - Jerrold Boxerman
- Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Matthew Brown
- UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Jonathan Goldin
- UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Edjah Nduom
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Islam Hassan
- Servier Pharmaceuticals, Boston, Massachusetts, USA
| | - Mark R Gilbert
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ingo K Mellinghoff
- Department of Neurology and Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Switzerland
| | - Susan Chang
- Division of Neuro-Oncology, University of California San Francisco, San Francisco, California, USA
| | - David Arons
- National Brain Tumor Society, Newton, Massachusetts, USA
| | - Clair Meehan
- National Brain Tumor Society, Newton, Massachusetts, USA
| | | | - Kirk Tanner
- National Brain Tumor Society, Newton, Massachusetts, USA
| | - W K Alfred Yung
- University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Martin van den Bent
- Brain Tumor Center at Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Patrick Y Wen
- Dana Farber Cancer Institute, Harvard University, Boston, Massachusetts, USA
| | - Timothy F Cloughesy
- UCLA Neuro Oncology Program, Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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Hormuth DA, Farhat M, Christenson C, Curl B, Chad Quarles C, Chung C, Yankeelov TE. Opportunities for improving brain cancer treatment outcomes through imaging-based mathematical modeling of the delivery of radiotherapy and immunotherapy. Adv Drug Deliv Rev 2022; 187:114367. [PMID: 35654212 DOI: 10.1016/j.addr.2022.114367] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 03/10/2022] [Revised: 04/25/2022] [Accepted: 05/25/2022] [Indexed: 11/01/2022]
Abstract
Immunotherapy has become a fourth pillar in the treatment of brain tumors and, when combined with radiation therapy, may improve patient outcomes and reduce the neurotoxicity. As with other combination therapies, the identification of a treatment schedule that maximizes the synergistic effect of radiation- and immune-therapy is a fundamental challenge. Mechanism-based mathematical modeling is one promising approach to systematically investigate therapeutic combinations to maximize positive outcomes within a rigorous framework. However, successful clinical translation of model-generated combinations of treatment requires patient-specific data to allow the models to be meaningfully initialized and parameterized. Quantitative imaging techniques have emerged as a promising source of high quality, spatially and temporally resolved data for the development and validation of mathematical models. In this review, we will present approaches to personalize mechanism-based modeling frameworks with patient data, and then discuss how these techniques could be leveraged to improve brain cancer outcomes through patient-specific modeling and optimization of treatment strategies.
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Affiliation(s)
- David A Hormuth
- Oden Institute for Computational Engineering and Sciences, The University of Texas at Austin, Austin, TX 78712, USA; Departments of Livestrong Cancer Institutes, The University of Texas at Austin, Austin, TX 78712, USA.
| | - Maguy Farhat
- Departments of Radiation Oncology, MD Anderson Cancer Center, Houston, TX 77230, USA
| | - Chase Christenson
- Departments of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712, USA
| | - Brandon Curl
- Departments of Radiation Oncology, MD Anderson Cancer Center, Houston, TX 77230, USA
| | - C Chad Quarles
- Barrow Neuroimaging Innovation Center, Barrow Neurological Institute, Phoenix, AZ 85013, USA
| | - Caroline Chung
- Departments of Radiation Oncology, MD Anderson Cancer Center, Houston, TX 77230, USA
| | - Thomas E Yankeelov
- Oden Institute for Computational Engineering and Sciences, The University of Texas at Austin, Austin, TX 78712, USA; Departments of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712, USA; Departments of Diagnostic Medicine, The University of Texas at Austin, Austin, TX 78712, USA; Departments of Oncology, The University of Texas at Austin, Austin, TX 78712, USA; Departments of Livestrong Cancer Institutes, The University of Texas at Austin, Austin, TX 78712, USA; Departments of Imaging Physics, MD Anderson Cancer Center, Houston, TX 77230, USA
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Tsang DS, Khandwala MM, Liu ZA, Richard N, Shen G, Sekely A, Bernstein LJ, Simpson R, Mason W, Chung C, de Moraes FY, Murray L, Shultz D, Laperriere N, Millar BA, Edelstein K. Neurocognitive performance in adults treated with radiation for a primary brain tumour. Adv Radiat Oncol 2022; 7:101028. [DOI: 10.1016/j.adro.2022.101028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 07/05/2022] [Indexed: 10/31/2022] Open
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Subbiah IM, Daftary U, Peek A, Christensen S, Small F, Vincitore B, Ali S, Subbiah V, Roszik J, Mendoza TR, Gibbons C, Chung C, Williams LA. Association between telehealth and adherence with patient-reported outcomes (PRO)-based remote symptom monitoring among adolescent/young adults (AYA), middle age, and older adults with cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.1513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1513 Background: PRO-based remote symptom monitoring favorably impacts quality of life, healthcare utilization, and overall survival in patients (pts) with cancer. However remote PRO completion rates outside of a clinical trial remained widely varied. With the wide adoption of telehealth in cancer care during the pandemic, telehealth’s impact on health behaviors such adherence w remote PROs is not fully characterized. To that end, we investigated PRO completion patterns in routine cancer care, pre- and during the pandemic. Methods: We queried a prospectively maintained institutional database of all PROs remotely delivered to pts at our institution from 1/1/18 to 12/31/21. Pts were divided into 2 time cohorts (“pre-pandemic” 1/1/18 to 3/31/20, “during pandemic” 4/1/20 to 12/31/21) and 3 age cohorts (AYA 15-39y, midage 40-64y, older adults 65y+). We calculated descriptive statistics and compared (t-test, ANOVA) between time and age cohorts and independent variables. Results: Overall 93,875 unique patients over 4 years received 1+ remote PROs as a part of their routine cancer care. PRO response rate increased from 35% prepandemic (12011 of 34742 pts responding) to 67% during pandemic (p <0.00001). To understand patient-level response patterns, we selected one representative global health PRO tool used widely across clinics in our institution and analyzed completion in a representative month over 4 years, 2 before (Oct ’18, ‘19) and 2 mid-pandemic (Oct ’20, ‘21). Overall 2738 pts (median age 60y, range 17-94y; 290 AYA 15-39y, 1444 midage 40-64y, 1004 older adults 65y+) were sent 3249 PROs during these 4m, 1378 PROs to 1075 pts in 2 pre-pandemic months & 1871 to 1663 pts in 2 mid-pandemic months. Overall, PRO response rate increased from 52% pre-pandemic to 81% during, non-responders dropping from 48% to 19%, and response rate without any reminder from the team increasing from 13% pre-pandemic to 79% during. Across all 3 age cohorts, overall PRO response rates increased (AYA up 21%, midage up 27%, seniors up 35%, p 0.012), PRO non-response rate decreased (AYA by 21%, midage by 27%, seniors by 35%, p 0.01), and PRO response rate without reminders from clinic team increased significantly (AYA, by 71%, midage by 78%, senior by 61%, p <0.00001). When further analyzing by visit type during pandemic, the improvements in overall PRO response rates are driven almost exclusively by telehealth where in-person PRO completion decreased by 19% (pre-pandemic 52%, during 33%) while pts who had an upcoming virtual visit had 94% PRO response rate (p < 0.00001). Conclusions: Substantially higher adherence with PRO-based remote symptom monitoring was seen during the pandemic with virtual visits accounting substantially for this broad adherence and the highest increases seen in older adults, highlighting the implications of telehealth on cancer care.
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Affiliation(s)
| | - Utpala Daftary
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Angela Peek
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Fernando Small
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Sara Ali
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vivek Subbiah
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jason Roszik
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tito R. Mendoza
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Caroline Chung
- University of Texas MD Anderson Cancer Center, Houston, TX
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Wu C, Lorenzo G, Hormuth DA, Lima EABF, Slavkova KP, DiCarlo JC, Virostko J, Phillips CM, Patt D, Chung C, Yankeelov TE. Integrating mechanism-based modeling with biomedical imaging to build practical digital twins for clinical oncology. Biophys Rev (Melville) 2022; 3:021304. [PMID: 35602761 PMCID: PMC9119003 DOI: 10.1063/5.0086789] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/29/2022] [Indexed: 12/11/2022]
Abstract
Digital twins employ mathematical and computational models to virtually represent a physical object (e.g., planes and human organs), predict the behavior of the object, and enable decision-making to optimize the future behavior of the object. While digital twins have been widely used in engineering for decades, their applications to oncology are only just emerging. Due to advances in experimental techniques quantitatively characterizing cancer, as well as advances in the mathematical and computational sciences, the notion of building and applying digital twins to understand tumor dynamics and personalize the care of cancer patients has been increasingly appreciated. In this review, we present the opportunities and challenges of applying digital twins in clinical oncology, with a particular focus on integrating medical imaging with mechanism-based, tissue-scale mathematical modeling. Specifically, we first introduce the general digital twin framework and then illustrate existing applications of image-guided digital twins in healthcare. Next, we detail both the imaging and modeling techniques that provide practical opportunities to build patient-specific digital twins for oncology. We then describe the current challenges and limitations in developing image-guided, mechanism-based digital twins for oncology along with potential solutions. We conclude by outlining five fundamental questions that can serve as a roadmap when designing and building a practical digital twin for oncology and attempt to provide answers for a specific application to brain cancer. We hope that this contribution provides motivation for the imaging science, oncology, and computational communities to develop practical digital twin technologies to improve the care of patients battling cancer.
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Affiliation(s)
- Chengyue Wu
- Oden Institute for Computational Engineering and Sciences, The University of Texas at Austin, Austin, Texas 78712, USA
| | | | | | | | - Kalina P. Slavkova
- Department of Physics, The University of Texas at Austin, Austin, Texas 78712, USA
| | | | | | - Caleb M. Phillips
- Oden Institute for Computational Engineering and Sciences, The University of Texas at Austin, Austin, Texas 78712, USA
| | - Debra Patt
- Texas Oncology, Austin, Texas 78731, USA
| | - Caroline Chung
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, Houston, Texas 77030, USA
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50
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Goldman J, Hagiwara A, Yao J, Raymond C, Ong C, Bakhti R, Kwon E, Farhat M, Torres C, Erickson LG, Curl BJ, Lee M, Pope WB, Salamon N, Nghiemphu PL, Ji M, Eldred BS, Liau LM, Lai A, Cloughesy TF, Chung C, Ellingson BM. Paradoxical Association Between Relative Cerebral Blood Volume Dynamics Following Chemoradiation and Increased Progression-Free Survival in Newly Diagnosed IDH Wild-Type MGMT Promoter Methylated Glioblastoma With Measurable Disease. Front Oncol 2022; 12:849993. [PMID: 35371980 PMCID: PMC8964348 DOI: 10.3389/fonc.2022.849993] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/07/2022] [Indexed: 11/15/2022] Open
Abstract
Background and Purpose While relative cerebral blood volume (rCBV) may be diagnostic and prognostic for survival in glioblastoma (GBM), changes in rCBV during chemoradiation in the subset of newly diagnosed GBM with subtotal resection and the impact of MGMT promoter methylation status on survival have not been explored. This study aimed to investigate the association between rCBV response, MGMT methylation status, and progression-free (PFS) and overall survival (OS) in newly diagnosed GBM with measurable enhancing lesions. Methods 1,153 newly diagnosed IDH wild-type GBM patients were screened and 53 patients (4.6%) had measurable post-surgical tumor (>1mL). rCBV was measured before and after patients underwent chemoradiation. Patients with a decrease in rCBV >10% were considered rCBV Responders, while patients with an increase or a decrease in rCBV <10% were considered rCBV Non-Responders. The association between change in enhancing tumor volume, change in rCBV, MGMT promotor methylation status, and PFS or OS were explored. Results A decrease in tumor volume following chemoradiation trended towards longer OS (p=0.12; median OS=26.8 vs. 16.3 months). Paradoxically, rCBV Non-Responders had a significantly improved PFS compared to Responders (p=0.047; median PFS=9.6 vs. 7.2 months). MGMT methylated rCBV Non-Responders exhibited a significantly longer PFS compared to MGMT unmethylated rCBV Non-Responders (p<0.001; median PFS=0.5 vs. 7.1 months), and MGMT methylated rCBV Non-Responders trended towards longer PFS compared to methylated rCBV Responders (p=0.089; median PFS=20.5 vs. 13.8 months). Conclusions This preliminary report demonstrates that in newly diagnosed IDH wild-type GBM with measurable enhancing disease after surgery (5% of patients), an enigmatic non-response in rCBV was associated with longer PFS, particularly in MGMT methylated patients.
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Affiliation(s)
- Jodi Goldman
- UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Akifumi Hagiwara
- UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jingwen Yao
- UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Catalina Raymond
- UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Christian Ong
- UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Rojin Bakhti
- UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Elizabeth Kwon
- UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Maguy Farhat
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Carlo Torres
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Lily G Erickson
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Brandon J Curl
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Maggie Lee
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Whitney B Pope
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Noriko Salamon
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Phioanh L Nghiemphu
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Matthew Ji
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Blaine S Eldred
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Linda M Liau
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Albert Lai
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Timothy F Cloughesy
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Benjamin M Ellingson
- UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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