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Danish H, Dukelow T, Plant BJ, Curtin R, Henry MT, Kennedy MK, Murphy DM. Outcomes Post Thrombolysis for Acute Pulmonary Embolism. Ir Med J 2020; 113:103. [PMID: 32816438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Background Pulmonary embolism (PE) remains a significant cause of mortality in Europe1. Thrombolytic therapy is often utilised as a therapeutic strategy in massive and sub-massive PE. There is a dearth of research on short term complications and subsequent outcomes in patients who have received thrombolysis for PE in Ireland. Methods This retrospective study examined patients who underwent thrombolysis for acute sub massive PE whilst under the care of the respiratory service in Cork University Hospital (CUH) from 2010-2018. All patients had CTPA done for diagnosis of PE. Alteplase was used as a thrombolytic agent. Patient records were perused. Follow-up pulmonary functions tests (PFTs) and trans-thoracic echocardiogram (TTE) results were assessed for evidence of impairment of diffusing capacity (DLCO) and pulmonary hypertension (PH) respectively. Results Twenty five patients were included in the study. Nine patients (36%) were women and 64% men. Average age was 55.1 years. Four patients suffered complications related to thrombolysis (average age 63.3 years). Twenty-Two patients (88%) underwent a follow-up echocardiography (mean 30 weeks post PE). Three patients (13%) had echocardiographic evidence of possible mild PH (i.e. RVSP >40mmhg) at initial follow-up. Fourteen patients (56%) who underwent thrombolysis had follow-up PFTs (mean 11.8 months post PE). The diffusing capacity (DLCO) was normal in all patients. Conclusion Thrombolysis was a relatively safe intervention in this small study.
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Affiliation(s)
- H Danish
- The Department of Respiratory Medicine, Cork University Hospital, Wilton, Cork
| | - T Dukelow
- The Department of Respiratory Medicine, Cork University Hospital, Wilton, Cork
| | - B J Plant
- The Department of Respiratory Medicine, Cork University Hospital, Wilton, Cork
| | - R Curtin
- The Department of Cardiology, Cork University Hospital, Wilton, Cork
| | - M T Henry
- The Department of Respiratory Medicine, Cork University Hospital, Wilton, Cork
| | - M K Kennedy
- The Department of Respiratory Medicine, Cork University Hospital, Wilton, Cork
| | - D M Murphy
- The Department of Respiratory Medicine, Cork University Hospital, Wilton, Cork
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Madden N, Danish H, Cassidy R, Abugideiri M, Switchenko J, Rai A, Flowers C, Esiashvili N, Jegadeesh N, Khan M. In Patients Over 65, Consolidative Radiation for Early Stage Diffuse Large B Cell Lymphoma is Associated with Decreased Hematologic Toxicity and Hospitalizations after RCHOP Compared with RCHOP Alone. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Morgan TM, Danish H, Nanda RH, Esiashvili N, Meacham LR. Whole lung irradiation in stage IV Wilms tumor patients: Thyroid dosimetry and outcomes. Pediatr Blood Cancer 2018; 65. [PMID: 28960781 DOI: 10.1002/pbc.26843] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/11/2017] [Accepted: 09/11/2017] [Indexed: 11/06/2022]
Abstract
PURPOSE To report the thyroid dosimetry and long-term follow-up of childhood cancer survivors treated with whole lung irradiation (WLI) for Wilms tumor. METHODS Twenty-eight patients with pulmonary metastases from Wilms tumor who underwent WLI from 2000 TO 2012 at a single institution were reviewed. Radiation dose to the thyroid gland in each case was calculated. Postradiation thyroid function test (TFT) results and management of thyroid function abnormalities were extracted from the medical records. RESULTS Median age at treatment was 5 years (range: 1-9 years), and median follow-up time was 74.1 months (7.2-198.4). The male/female ratio was 1:1.8. Complete dosimetry data were available for 22 of the 28 patients receiving WLI. Mean thyroid volume was 3.3 cc (range: 1-6.8). The average mean and median mean dose to the thyroid was 6.7 and 7.1 Gy, respectively (range: 1.3-11.7 Gy). Average max dose to the thyroid was 12.4 Gy (range: 7.8-20.3 Gy). Two patients were found to have a thyroid stimulating hormone (TSH) above the normal range, managed with levothyroxine. Another patient was found to have an isolated elevation of TSH which normalized without treatment. A fourth patient was found to have an enlarged thyroid on examination with no palpable nodules or abnormal TFTs. CONCLUSIONS Average mean dose to the thyroid gland was 6.7 Gy for this population of stage IV Wilms tumor patients. There was a low rate of thyroid dysfunction, but limited follow-up. Attention to blocking the thyroid gland as much as possible when designing radiation fields can potentially mitigate the risks of long-term thyroid effects.
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Affiliation(s)
- Tiffany M Morgan
- Department of Radiation Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Hasan Danish
- Department of Radiation Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Ronica H Nanda
- Department of Radiation Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Natia Esiashvili
- Department of Radiation Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Lillian R Meacham
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
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Patel KR, Prabhu RS, Switchenko JM, Chowdhary M, Craven C, Mendoza P, Danish H, Grossniklaus HE, Aaberg TM, Aaberg T, Reddy S, Butker E, Bergstrom C, Crocker IR. Visual acuity, oncologic, and toxicity outcomes with 103Pd vs. 125I plaque treatment for choroidal melanoma. Brachytherapy 2017; 16:646-653. [PMID: 28262517 DOI: 10.1016/j.brachy.2017.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 01/09/2017] [Accepted: 01/09/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate outcomes of choroidal melanoma patients treated with 125I or 103Pd plaque brachytherapy. METHODS AND MATERIALS From 1993 to 2012, our institution treated 160 patients with 103Pd (56.1%) and 125 patients with 125I (43.9%) plaque brachytherapy. Tumor outcomes, visual acuity (VA), and toxicity were compared. Multivariate analyses (MVAs) and propensity score analysis were used to help address differences in baseline characteristics. RESULTS Median followup was longer for 125I patients, 52.7 vs. 43.5 months (p < 0.01). At baseline, 103Pd patients had lower rates of VA worse than 20/200 (4.4% vs. 16%, p = 0.002), T3-T4 tumors (17.5% vs. 32.8%, p = 0.03), and transpupillary thermotherapy use (3.1% vs. 9.6%, p = 0.001). Both 103Pd and 125I provided >90% 3-year overall survival and >93% 5-year secondary enucleation-free survival. On MVA, radionuclide was not predictive for tumor outcomes. A higher percentage maintained vision better than 20/40 with 103Pd (63% vs. 35%, p = 0.007) at 3 years. MVA demonstrated 103Pd radionuclide (odds ratio [OR]: 2.12, p = 0.028) and tumor height ≤5 mm (OR: 2.78, p = 0.017) were associated with VA better than 20/40. Propensity score analysis matched 23 125I with 107 103Pd patients. 103Pd continued to predict better VA at 3 years (OR: 8.10, p = 0.014). On MVA for the development of VA worse than 20/200 or degree of vision loss, radionuclide was not significant. Lower rates of radiation retinopathy were seen with 103Pd than 125I (3 years: 47.3% vs. 63.9%, p = 0.016), with radionuclide significant in MVA. CONCLUSIONS Both 125I and 103Pd achieve excellent tumor control. An increased probability of long-term VA better than 20/40 and reduced risk of radiation retinopathy is associated with 103Pd.
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Affiliation(s)
- Kirtesh R Patel
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA.
| | - Roshan S Prabhu
- Southeast Radiation Oncology Group, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC
| | - Jeffrey M Switchenko
- Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Mudit Chowdhary
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA; Department of Radiation Oncology, Rush University Medical Center, Chicago, IL
| | - Caroline Craven
- Department of Ophthalmology and Winship Cancer Institute, Emory University, Atlanta, GA
| | - Pia Mendoza
- Department of Ophthalmology and Winship Cancer Institute, Emory University, Atlanta, GA
| | - Hasan Danish
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA
| | - Hans E Grossniklaus
- Department of Ophthalmology and Winship Cancer Institute, Emory University, Atlanta, GA
| | - Thomas M Aaberg
- Department of Ophthalmology and Winship Cancer Institute, Emory University, Atlanta, GA
| | - Thomas Aaberg
- Department of Ophthalmology and Winship Cancer Institute, Emory University, Atlanta, GA
| | - Sahitya Reddy
- Department of Ophthalmology and Winship Cancer Institute, Emory University, Atlanta, GA
| | - Elizabeth Butker
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA
| | - Chris Bergstrom
- Department of Ophthalmology and Winship Cancer Institute, Emory University, Atlanta, GA
| | - Ian R Crocker
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA
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Ferris MJ, Danish H, Switchenko JM, Deng C, George BA, Goldsmith KC, Wasilewski KJ, Cash WT, Khan MK, Eaton BR, Esiashvili N. Favorable Local Control From Consolidative Radiation Therapy in High-Risk Neuroblastoma Despite Gross Residual Disease, Positive Margins, or Nodal Involvement. Int J Radiat Oncol Biol Phys 2016; 97:806-812. [PMID: 28244417 DOI: 10.1016/j.ijrobp.2016.11.043] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/27/2016] [Accepted: 11/21/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To report the influence of radiation therapy (RT) dose and surgical pathology variables on disease control and overall survival (OS) in patients treated for high-risk neuroblastoma at a single institution. METHODS AND MATERIALS We conducted a retrospective study of 67 high-risk neuroblastoma patients who received RT as part of definitive management from January 2003 until May 2014. RESULTS At a median follow-up of 4.5 years, 26 patients (38.8%) failed distantly; 4 of these patients also failed locally. One patient progressed locally without distant failure. Local control was 92.5%, and total disease control was 59.5%. No benefit was demonstrated for RT doses over 21.6 Gy with respect to local relapse-free survival (P=.55), disease-free survival (P=.22), or OS (P=.72). With respect to local relapse-free survival, disease-free survival, and OS, no disadvantage was seen for positive lymph nodes on surgical pathology, positive surgical margins, or gross residual disease. Of the patients with gross residual disease, 75% (6 of 8) went on to have no evidence of disease at time of last follow-up, and the 2 patients who failed did so distantly. CONCLUSIONS Patients with high-risk neuroblastoma in this series maintained excellent local control, with no benefit demonstrated for radiation doses over 21.6 Gy, and no disadvantage demonstrated for gross residual disease after surgery, positive surgical margins, or pathologic lymph node positivity. Though the limitations of a retrospective review for an uncommon disease must be kept in mind, with small numbers in some of the subgroups, it seems that dose escalation should be considered only in exceptional circumstances.
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Affiliation(s)
- Matthew J Ferris
- Department of Radiation Oncology, Emory University, Atlanta, Georgia; Winship Cancer Institute, Emory University, Atlanta, Georgia.
| | - Hasan Danish
- Department of Radiation Oncology, Emory University, Atlanta, Georgia; Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Jeffrey M Switchenko
- Winship Cancer Institute, Emory University, Atlanta, Georgia; Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia
| | - Claudia Deng
- Department of Radiation Oncology, Emory University, Atlanta, Georgia; Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Bradley A George
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Kelly C Goldsmith
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Karen J Wasilewski
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - W Thomas Cash
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Mohammad K Khan
- Department of Radiation Oncology, Emory University, Atlanta, Georgia; Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Bree R Eaton
- Department of Radiation Oncology, Emory University, Atlanta, Georgia; Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Natia Esiashvili
- Department of Radiation Oncology, Emory University, Atlanta, Georgia; Winship Cancer Institute, Emory University, Atlanta, Georgia
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Danish H, Patel K, Switchenko J, Gillespie T, Jhaveri J, Chowdhary M, Abugideiri M, Delman K, Lawson D, Khan M. The Influence of Postoperative Lymph Node Radiation Therapy on Overall Survival of Patients With Stage III Melanoma: A National Cancer Data Base Analysis. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jhaveri J, Danish H, Liu S, Flowers C, Lechwoicz M, Patel K, Esiashvili N, Khan M. Validation of Cutaneous Lymphoma International Prognostic Index (CLIPI) for Mycosis Fungoides and Sezary Syndrome. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ferris M, Danish H, Switchenko J, Deng C, Esiashvili N. Excellent Local Control for Consolidative Radiation Therapy Without Dose Escalation in High-Risk Neuroblastoma. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Danish H, Cassidy R, Switchenko J, Rai A, Jegadeesh N, Flowers C, Esiashvili N, Khan M. Consolidative Radiation for Early-Stage Diffuse Large B Cell Lymphoma After CHOP or RCHOP: A Surveillance, Epidemiology, and End Results (SEER) Database Analysis. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Liao A, Danish H, Stoff B, Khan MK. First case of Merkel cell carcinoma in a young patient with Sweet syndrome. Adv Radiat Oncol 2016; 1:122-126. [PMID: 28740879 PMCID: PMC5506742 DOI: 10.1016/j.adro.2016.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 03/27/2016] [Accepted: 03/28/2016] [Indexed: 11/19/2022] Open
Affiliation(s)
- Albert Liao
- Winship Cancer Institute of Emory University, Department of Radiation Oncology, Atlanta, Georgia
| | - Hasan Danish
- Winship Cancer Institute of Emory University, Department of Radiation Oncology, Atlanta, Georgia
| | - Benjamin Stoff
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Mohammad K. Khan
- Winship Cancer Institute of Emory University, Department of Radiation Oncology, Atlanta, Georgia
- Corresponding author. Winship Cancer Institute of Emory University, Department of Radiation Oncology, 1365 Clifton Road NE, Office A-1312, Atlanta, GA 30322Winship Cancer Institute of Emory UniversityDepartment of Radiation Oncology1365 Clifton Road NEOffice A-1312AtlantaGA30322
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Cassidy RJ, Jegadeesh N, Switchenko J, Danish H, Esiashvili N, Flowers CR, Khan MK. The role of radiotherapy for patients over age 60 with diffuse large B-cell lymphoma in the rituximab era. Leuk Lymphoma 2016; 57:1876-82. [PMID: 26759182 DOI: 10.3109/10428194.2015.1120866] [Citation(s) in RCA: 8] [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] [Indexed: 01/22/2023]
Abstract
The role of consolidative radiotherapy (RT) in patients ≥60 years old with DLBCL in the rituximab era is controversial. We examined the impact on disease control and overall survival by the addition of consolidative RT after completion of chemotherapy, while adjusting for known adverse risk factors. Retrospective chart review from 2004 to 2012 of 83 consecutive patients ≥60 years old with DLBCL treated in the rituximab era, 68 of which had a complete response to chemotherapy, was performed. Amongst patients with a complete response, consolidative RT use was associated with 100% 5-year local control, improved progression-free survival (p = 0.047), and a trend for overall survival (p = .098) on multivariate analysis. Amongst all patients, the use of consolidative RT was associated with improved overall survival (p = 0.03). The use of consolidative RT should be considered for patients ≥60 years old independent of stage and response to chemotherapy.
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Affiliation(s)
- R J Cassidy
- a Department of Radiation Oncology , Winship Cancer Institute of Emory University , Atlanta , GA , USA
| | - N Jegadeesh
- a Department of Radiation Oncology , Winship Cancer Institute of Emory University , Atlanta , GA , USA
| | - J Switchenko
- b Biostatistics Shared Core Resource, Winship Cancer Institute , Atlanta , GA , USA
| | - H Danish
- a Department of Radiation Oncology , Winship Cancer Institute of Emory University , Atlanta , GA , USA
| | - N Esiashvili
- a Department of Radiation Oncology , Winship Cancer Institute of Emory University , Atlanta , GA , USA
| | - C R Flowers
- c Department of Hematology and Medical Oncology , Winship Cancer Institute of Emory University , Atlanta , GA , USA
| | - M K Khan
- a Department of Radiation Oncology , Winship Cancer Institute of Emory University , Atlanta , GA , USA
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Danish H, Schreibmann E, Holder C, Vincentelli C, Hao C, Curran W, Fox T, Crocker I, Shu H. Postradiation Diffusion MRIs May Distinguish True Progression from Pseudoprogression in GBM Patients. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Goyal S, Shah S, Khan AJ, Danish H, Haffty BG. Evaluation of acute locoregional toxicity in patients with breast cancer treated with adjuvant radiotherapy in combination with pazopanib. ISRN Oncol 2012; 2012:896202. [PMID: 23304555 PMCID: PMC3523562 DOI: 10.5402/2012/896202] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 10/31/2012] [Indexed: 11/23/2022]
Abstract
Purpose. The purpose of this study was to analyze acute locoregional toxicity in patients with breast cancer receiving concurrent pazopanib and RT. Materials and Methods. Patients with breast cancer who received pazopanib in combination with radiation were identified and matched (2 : 1) to patients with breast cancer who did not receive pazopanib by use of chemotherapy, radiation field design, and radiation dose. Toxicity was scored by the Common Terminology Criteria for Adverse Events and statistical analysis was performed. Results. Grade 1 or 2 radiation dermatitis was seen in 100% and 84% of pazopanib and RT patients and matched controls respectively (P = NS). None of the patients receiving pazopanib and RT experienced ≥ grade 3 toxicity within the irradiated volume; three (16%) matched patients experienced a grade 3 skin reaction (P = 0.05). Interestingly, grade 1 or 2 hyperpigmentation was seen in 17% of pazopanib and RT patients and 60% of matched controls (P = 0.005). Conclusion. The addition of concurrent pazopanib and RT when treating the intact breast, chest wall, and associated nodal regions in breast cancer seems to be safe and well tolerated.
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Affiliation(s)
- Sharad Goyal
- Department of Radiation Oncology, The Cancer Institute of New Jersey, Robert Wood Johnson Medical School, UMDNJ 195 Little Albany Street, New Brunswick, NJ 08903, USA
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