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Ciunci C, Reibel J, Evans T, Mick R, Bauml J, Aggarwal C, Marmarelis M, Singh A, D'Avella C, Cohen R, Langer C. Phase II trial of combination nab-paclitaxel and gemcitabine in non-squamous non-small cell lung cancer after progression on platinum and pemetrexed. Clin Lung Cancer 2022; 23:e310-e316. [DOI: 10.1016/j.cllc.2022.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/09/2022] [Accepted: 02/17/2022] [Indexed: 12/18/2022]
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Lukens J, Mick R, Huang A, Han N, Farwell M, Mitchell T, Amaravadi R, Schuchter L, Berman A, O'Hara M, Maity A, Miller D, Minn A, Vonderheide R, Wherry E, Maity A. Final Results of a Phase I “RadVax” Trial of Hypofractionated Radiation Combined With Pembrolizumab in Patients With Metastatic Solid Tumors. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.168] [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: 11/15/2022]
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3
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Bauml J, Mick R, Mccoach C, Weiss J, Marrone K, Nieva J, Villaruz L, Levy B, Moreno R, Murkherji R, Sun F, Schwartzman W, Shaverdashvili K, Wang X, Shah M, Woodley J, Miller N, Succe C, Ullah T, Lovly C, Doebele R, Iams W, Horn L, Dowell J, Liu G, Leighl N, Patil T, Liu S, Velcheti V, Aisner D, Camidge R. FP14.06 Multicenter Analysis of Mechanisms of Resistance to Osimertinib (O) in EGFR Mutated NSCLC: An ATOMIC Registry Study. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.149] [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: 10/21/2022]
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4
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Alexander E, Mick R, Pantel A, Katona B, Metz D, Pryma D, Soulen M. Abstract No. 708 Short-term toxicity of peptide receptor radionuclide therapy in patients with neuroendocrine tumors treated with prior transarterial liver-directed therapy. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.767] [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: 10/25/2022] Open
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Maity A, Mick R, Huang A, George S, Farwell M, Lukens J, Berman A, Mitchell T, Bauml J, Schuchter L, O'Hara M, Lin L, DeMichele A, Christodouleas J, Haas N, Patsch D, Hahn S, Minn A, Wherry E, Vonderheide R. A Phase I Trial of Pembrolizumab with Hypofractionated Radiation Therapy (HFRT) in Patients with Metastatic Cancers. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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6
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Rengan R, Mick R, Pryma D, Lin L, Plastaras J, Simone C, Gupta A, Evans T, Stevenson J, Langer C, Kucharczuk J, Friedberg J, Lam S, Patsch D, Hahn S, Maity A. Long-term Results of a Phase I/II Trial of Nelfinavir with Concurrent Chemoradiotherapy for Locally Advanced Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.135] [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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Bauml J, Mick R, Ciunci C, Aggarwal C, Davis C, Evans T, Deshpande C, Miller L, Patel P, Alley E, Knepley C, Mutale F, Cohen R, Langer C. OA07.01 Phase II Study of Pembrolizumab for Oligometastatic Non-Small Cell Lung Cancer (NSCLC) Following Completion of Locally Ablative Therapy (LAT). J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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8
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Bauml J, Mick R, Ciunci C, Aggarwal C, Evans T, Miller L, Muhammad N, Alley E, Knepley C, Mutale F, Cohen R, Langer C. OA 17.08 Phase II Study of Pembrolizumab for Oligometastatic Non-Small Cell Lung Cancer (NSCLC) Following Completion of Locally Ablative Therapy (LAT). J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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De La Cruz LM, McDonald ES, Mick R, Datta J, Nocera NF, Xu S, Fisher CS, Czerniecki BJ. Anti-HER2 CD4 + T-Helper Type 1 Immune Response is Superior to Breast MRI for Assessing Response to Neoadjuvant Therapy in Patients with HER2-Positive Breast Cancer. Ann Surg Oncol 2016; 24:1057-1063. [PMID: 27826664 DOI: 10.1245/s10434-016-5651-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND In human epidermal growth factor 2-positive breast cancer (HER2+BC), neoadjuvant chemotherapy and anti-HER2-targeted therapy (nCT) achieves a complete pathologic response (pCR) in 40-67% of patients. Posttreatment magnetic resonance imaging (pMRI) is considered the gold standard, with high specificity but lower sensitivity for assessing response. The authors previously determined that anti-HER2Th1 immune response is associated with pathologic response after nCT in HER2+BC patients. This study contrasted pMRI with anti-HER2Th1 response for assessing pCR in HER2+BC. METHODS A retrospective review of HER2+BC patients at the authors' institution was performed. Original pMRI reports were collected, and images were reviewed by a breast radiologist blinded to pCR and immune response. The post-nCT imaging-based tumor response was assessed by Response Evaluation Criteria in Solid Tumors. The anti-HER2Th1 response was determined by ex vivo stimulation of peripheral blood mononuclear cells with six major histocompatibility complex (MHC) class 2-derived HER2 peptides via enzyme-linked immunospot (ELISPOT). Posttreatment MRI and anti-HER2Th1 responses were cross-tabulated with pCR. Standard diagnostic metrics were computed. RESULTS For 30 patients, pMRI and anti-HER2Th1 immune response were measured, with 13 patients (43.3%) achieving pCR. The mean anti-HER2Th1 response in pCR was 167 (range 53-418), and <pCR was 24 (range 0.4-53). The distributions were nearly non-overlapping. The anti-HER2Th1 response was superior to the original pMRI and had higher accuracy than the blinded pMRI review (area under the curve 0.97 vs 0.55; sensitivity 100 vs 46.2%; specificity 94.1 vs 64.7%; overall accuracy 96.7 vs 56.7%). CONCLUSION The presence of a high anti-HER2Th1 response is superior to pMRI for the assessment of pCR in HER2+BC. This assay has considerable promise, and validation in a large-scale study is warranted.
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Affiliation(s)
- Lucy M De La Cruz
- Rena Rowan Breast Center, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Department of Endocrine and Oncologic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth S McDonald
- Rena Rowan Breast Center, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Department of Endocrine and Oncologic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - R Mick
- Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jashodeep Datta
- Rena Rowan Breast Center, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Department of Endocrine and Oncologic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Nadia F Nocera
- Rena Rowan Breast Center, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Department of Endocrine and Oncologic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Shuwen Xu
- Rena Rowan Breast Center, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Department of Endocrine and Oncologic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Carla S Fisher
- Rena Rowan Breast Center, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Department of Endocrine and Oncologic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Brian J Czerniecki
- Department of Breast Oncology, H Lee Moffitt Cancer Center, Tampa, FL, USA.
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Vapiwala N, Narayan V, Subramanian P, Christodouleas J, Bekelman J, Mick R, Rajendran R, Haas N. Phase I Trial of Everolimus in Combination with Salvage Radiation Therapy (RT) for Post-prostatectomy Biochemical Recurrence (BCR) in Prostate Cancer (PC) Patients. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.464] [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: 10/20/2022]
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Chao H, Berman A, Mick R, Ciunci C, Gabriel P, Lin H, Both S, Langer C, Lelionis K, Rengan R, Prabhu K, Hartsell W, Simone C, Plastaras J. Central Volume Target Overlap and Esophageal Dose Predict for Toxicity in a Prospective Study of Reirradiation for Non-Small Cell Lung Carcinoma Using Proton Therapy. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.433] [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: 10/20/2022]
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12
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Berman A, Barsky A, Mick R, Metz J, Ben-Josef E, Teitelbaum U, Williams N, Kucharczuk J, Margolis D, Plastaras J. Perioperative Complications After Neoadjuvant Chemoradiation for Locally Advanced Esophageal Cancer: A Comparison of Platinum/5-FU (PF) and Carboplatin/Paclitaxel (PT). Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.763] [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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Garfall AL, Dougherty AL, Vogl DT, Weiss BM, Cohen AD, Mick R, O'Doherty U, Stadtmauer EA. Association between mobilization regimen and PFS after auto-SCT for multiple myeloma. Bone Marrow Transplant 2014; 49:1439-41. [PMID: 25046220 DOI: 10.1038/bmt.2014.153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- A L Garfall
- Hematologic Malignancies Program, Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - A L Dougherty
- Hematologic Malignancies Program, Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - D T Vogl
- Hematologic Malignancies Program, Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - B M Weiss
- Hematologic Malignancies Program, Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - A D Cohen
- Hematologic Malignancies Program, Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - R Mick
- Center for Clinical Epidemiology & Biostatistics, Department of Biostatistics & Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - U O'Doherty
- Division of Transfusion Medicine, Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - E A Stadtmauer
- Hematologic Malignancies Program, Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
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Levy J, Shlansky-Goldberg R, Stavropoulos W, Trerotola S, Mondschein J, Dagli M, Sudheendra D, Teitelbaum U, Mick R, Soulen M. Is percutaneous biliary drainage effective in lowering serum bilirubin for chemotherapy? J Vasc Interv Radiol 2014. [DOI: 10.1016/j.jvir.2013.12.477] [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] Open
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Sanzari JK, Wan XS, Krigsfeld GS, King GL, Miller A, Mick R, Gridley DS, Wroe AJ, Rightnar S, Dolney D, Kennedy AR. Effects of solar particle event proton radiation on parameters related to ferret emesis. Radiat Res 2013; 180:166-76. [PMID: 23883319 PMCID: PMC3837533 DOI: 10.1667/rr3173.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The effectiveness of simulated solar particle event (SPE) proton radiation to induce retching and vomiting was evaluated in the ferret experimental animal model. The endpoints measured in the study included: (1) the fraction of animals that retched or vomited, (2) the number of retches or vomits observed, (3) the latency period before the first retch or vomit and (4) the duration between the first and last retching or vomiting events. The results demonstrated that γ ray and proton irradiation delivered at a high dose rate of 0.5 Gy/min induced dose-dependent changes in the endpoints related to retching and vomiting. The minimum radiation doses required to induce statistically significant changes in retching- and vomiting-related endpoints were 0.75 and 1.0 Gy, respectively, and the relative biological effectiveness (RBE) of proton radiation at the high dose rate did not significantly differ from 1. Similar but less consistent and smaller changes in the retching- and vomiting-related endpoints were observed for groups irradiated with γ rays and protons delivered at a low dose rate of 0.5 Gy/h. Since this low dose rate is similar to a radiation dose rate expected during a SPE, these results suggest that the risk of SPE radiation-induced vomiting is low and may reach statistical significance only when the radiation dose reaches 1 Gy or higher.
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Affiliation(s)
- J. K. Sanzari
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia Pennsylvania
| | - X. S. Wan
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia Pennsylvania
| | - G. S. Krigsfeld
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia Pennsylvania
| | - G. L. King
- Scientific Research Department, Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - A. Miller
- Scientific Research Department, Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - R. Mick
- Department of Biostatistics & Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia Pennsylvania
| | - D. S. Gridley
- Department of Radiation Medicine, Radiation Research Laboratories, Loma Linda University and Medical Center, Loma Linda, California
| | - A. J. Wroe
- Department of Radiation Medicine, Radiation Research Laboratories, Loma Linda University and Medical Center, Loma Linda, California
| | - S. Rightnar
- Department of Radiation Medicine, Radiation Research Laboratories, Loma Linda University and Medical Center, Loma Linda, California
| | - D. Dolney
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia Pennsylvania
| | - A. R. Kennedy
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia Pennsylvania
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Milby A, Mick R, Turowski J, Cengel K, Farnese-McFarlane N, Mesaros C, Lawson J, Christofidou-Solomidou M, Lee J, Rengan R. Phase I Randomized Trial of Dietary Flaxseed in Non-small Cell Lung Cancer Patients Receiving Chemoradiation. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1819] [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: 11/17/2022]
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Miller S, Ali A, Mick R, Moghanaki D, Furth E, Sohal D, Giantonio B, Plastaras J. Patterns of Failure after Trimodality Therapy for Pancreatic and Duodenal Cancers. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.1806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cengel K, Fernandes A, Mick R, Culligan M, Smith D, Stevenson J, Sterman D, Glatstein E, Hahn S, Friedberg J. Multimodality Management of Malignant Pleural Mesothelioma. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1177] [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: 10/19/2022]
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Cengel KA, Fernandes A, Mick R, Smith D, Culligan M, Stevenson J, Sterman D, Glatstein E, Hahn SM, Friedberg JS. A multimodality treatment for malignant pleural mesothelioma patients with or without lymph node metastases. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.7043] [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: 11/20/2022] Open
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Rech AJ, Mick R, Recio A, DeMichele A, Tweed CK, Fox KR, Domchek SM, Vonderheide RH. Phase I study of anti-CD25 mab daclizumab to deplete regulatory T cells prior to telomerase/survivin peptide vaccination in patients (pts) with metastatic breast cancer (MBC). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.2508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Preisser A, Manuwald U, Barbinova L, Mick R, Baur X. Blutgase unter Belastung im Vergleich mit der alveolo-arteriellen Sauerstoffdifferenz. Pneumologie 2010. [DOI: 10.1055/s-0030-1251127] [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: 10/19/2022]
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22
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Rengan R, Mick R, Pryma D, Lin L, Maity A, Gupta A, Evans T, Stevenson J, Langer C, Hahn S. A Phase I Trial of the HIV Protease Inhibitor Nelfinavir with Concurrent Chemoradiotherapy (CT-RT) for Stage IIIA/IIIB NSCLC: A Report of Toxicities and Metabolic Response. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Plastaras JP, Haynes JC, Mick R, Hertan LM, Urdaneta AI, Metz JM. Effect of nutritional status and support on survival in esophageal cancer patients undergoing combined modality therapy. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e20641] [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
e20641 Background: Baseline nutritional status is associated with clinical outcomes in esophageal cancer. Moreover, nutritional support during chemoradiation has been shown to improve outcomes in other disease sites. This retrospective study evaluated the impact of nutritional interventions and baseline nutritional status on outcomes in patients (pts) with locally advanced esophageal cancer. Methods: A retrospective review was performed of 132 pts treated with curative intent using radiation (RT) between 1986 and 2007 at the Hospital of the University of Pennsylvania. The median age of the population was 60 years (range: 33–86). Esophagectomy was performed in 70%, with adjuvant RT in 60% and neoadjuvant RT in 40%. Concurrent chemotherapy was given to 85% of the group. Nutritional counseling was provided to 83% of pts. During RT, oral or enteral nutritional supplements were provided to 77% of pts and intravenous fluids (IVF) were given to 38%. Median follow-up was 14.1 months. Results: Median survival from end of radiation was 1.5 yrs. Median absolute and percentage weight loss during RT were 6.2 lbs and 3.8%, respectively. Median percentage decrease in hemoglobin and albumin were 5.7% and 9.1%, respectively. Univariable Cox regression analysis demonstrated a statistically significant association between weight loss of ≥5 lbs during RT and worse survival (HR 1.74, 95% CI 1.09 - 2.79, p=0.02). Decrease in hemoglobin of 5% or more (HR 1.22, 95% CI 0.59 - 2.54) and decrease in albumin of 10% or more (HR 1.09, 95% CI 0.48 - 2.48) were not associated with survival. Patients who received only nutritional supplements during RT survived significantly longer (p=0.03) than pts who received IVF regardless of nutritional supplementation (HR 2.12, 95% CI 1.12 - 4.01) or pts who received neither nutritional supplements nor IVF (HR 1.8, 95% CI 1.03 - 3.14). Conclusions: Weight loss during RT predicted for worse survival. Nutritional factors before and during RT may be important in outcomes in patients with esophageal cancer and may be modifiable. The use of IVF may be a potential indicator of worse prognosis. Future prospective studies should consider these factors in trial design. No significant financial relationships to disclose.
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Affiliation(s)
- J. P. Plastaras
- University of Pennsylvania, Philadelphia, PA; Hospital of Saint Raphael, New Haven, CT
| | - J. C. Haynes
- University of Pennsylvania, Philadelphia, PA; Hospital of Saint Raphael, New Haven, CT
| | - R. Mick
- University of Pennsylvania, Philadelphia, PA; Hospital of Saint Raphael, New Haven, CT
| | - L. M. Hertan
- University of Pennsylvania, Philadelphia, PA; Hospital of Saint Raphael, New Haven, CT
| | - A. I. Urdaneta
- University of Pennsylvania, Philadelphia, PA; Hospital of Saint Raphael, New Haven, CT
| | - J. M. Metz
- University of Pennsylvania, Philadelphia, PA; Hospital of Saint Raphael, New Haven, CT
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Thukral A, Mick R, Bernhard E, Stevenson J, Friedberg J, Martin N, Smith D, Prendergast S, McKenna W, Hahn S. Dose-limiting Pneumonitis in a Phase I Trial of R115777 and Radiation Therapy (RT) for Patients (Pts) with Non-small Cell Lung Cancer (NSCLC). Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.404] [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: 10/21/2022]
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Salmon P, Moghanaki D, Mick R, Furth EE, Behbehani A, Morgans A, Drebin J, Rosato EF, Whittington R, Giantonio BJ. Number and percentage of pathologically involved lymph nodes (pLN) in patients (pts) with pancreatic adenocarcinoma (PA) predicts for overall survival (OS) in pts treated with postoperative adjuvant chemoradiotherapy (CRT). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.15509] [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: 11/20/2022] Open
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Morgans A, Moghanaki D, Mick R, Furth EE, Salmon P, Behbehani A, Drebin J, Rosato EF, Whittington R, Giantonio BJ. Survival following resection of pancreatic cancers may not be affected by length of hospital stay or delay to initiating adjuvant chemoradiation (CRT). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.4639] [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: 11/20/2022] Open
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Dolinsky CM, Mahmoud NN, Mick R, Sun W, Whittington RW, Solin LJ, Haller DG, Giantonio BJ, O'Dwyer PJ, Rosato EF, Fry RD, Metz JM. Effect of time interval between surgery and preoperative chemoradiotherapy with 5-fluorouracil or 5-fluorouracil and oxaliplatin on outcomes in rectal cancer. J Surg Oncol 2007; 96:207-12. [PMID: 17443718 DOI: 10.1002/jso.20815] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [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: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Preoperative chemoradiotherapy for locally advanced rectal cancer is now considered "standard of care." However, the optimal time interval for resection after neoadjuvant therapy is unknown. METHODS Between 11/90 and 11/04, 107 patients with rectal adenocarcinoma underwent preoperative chemo/RT at the University of Pennsylvania. Fifty-six percent had LAR and 40% had APR. Chemotherapy consisted of 5-FU/oxaliplatin in 28% and 5-FU in 72% of patients. All patients received preoperative RT. RESULTS A longer time interval between chemo/RT and surgery was associated with tumor downstaging (OR 1.24, P = 0.02). A longer time interval was not associated with: nodal downstaging (OR 1.00, P = 0.98); pathologic complete response (PCR) (OR 0.97, P = 0.80); likelihood of performing an LAR (OR 0.90, P = 0.47); improved disease free survival (DFS), local control, or distant control (HR 1.05, P = 0.49; HR 1.14, P = 0.22; HR 1.06, P = 0.52, respectively). The PCR rate was 34.5% in the 5-FU/oxaliplatin/radiation group, and 13.7% in the 5-FU/radiation group. If patients with microscopic CR were excluded, then the PCR rate for 5FU/OX was 21.4% and for 5-FU was 12.2%. CONCLUSIONS Time interval between surgery and chemo/RT appeared to have little effect on PCR or LAR rates. Patients receiving 5 FU/oxaliplatin/RT had a high PCR rate. A prospective randomized trial to test superiority of 5 FU/oxaliplatin is warranted.
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Affiliation(s)
- C M Dolinsky
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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Du KL, Mick R, Busch TM, Zhu TC, Finlay JC, Yu G, Yodh AG, Malkowicz SB, Smith D, Whittington R, Stripp D, Hahn SM. Preliminary results of interstitial motexafin lutetium-mediated PDT for prostate cancer. Lasers Surg Med 2007; 38:427-34. [PMID: 16788929 DOI: 10.1002/lsm.20341] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES Interstitial photodynamic therapy (PDT) is an emerging modality for the treatment of solid organ disease. Our group at the University of Pennsylvania has performed extensive studies that demonstrate the feasibility of interstitial PDT for prostate cancer. Our preclinical and clinical experience is herein detailed. STUDY DESIGN/MATERIALS AND METHODS We have treated 16 canines in preclinical studies, and 16 human subjects in a Phase I study, using motexafin lutetium-mediated PDT for recurrent prostate adenocarcinoma. Dosimetry of light fluence, drug level and oxygen distribution for these patients were performed. RESULTS We demonstrate the safe and comprehensive treatment of the prostate using PDT. However, there is significant variability in the dose distribution and the subsequent tissue necrosis throughout the prostate. CONCLUSIONS PDT is an attractive option for the treatment of prostate adenocarcinoma. However, the observed variation in PDT dose distribution translates into uncertain therapeutic reproducibility. Our future focus will be on the development of an integrated system that is able to both detect and compensate for dose variations in real-time, in order to deliver a consistent overall PDT dose distribution.
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Affiliation(s)
- K L Du
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA
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Bui C, Womer R, Mick R, Dormans J, Tochner Z, Maity A. 2574. Int J Radiat Oncol Biol Phys 2006. [DOI: 10.1016/j.ijrobp.2006.07.987] [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: 10/24/2022]
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30
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Metz J, Smith D, Mick R, Lustig R, Stea B, Mitchell J, Cherakuri M, Glatstein E, Hahn S. 2588. Int J Radiat Oncol Biol Phys 2006. [DOI: 10.1016/j.ijrobp.2006.07.1001] [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: 11/24/2022]
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31
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Dolinsky CM, Mahmoud NN, Mick R, Sun W, Whittington RW, Solin LJ, Haller DG, Giantonio BJ, O’Dwyer PJ, Fry RD, Metz JM. Evidence for improved pathologic complete response (PCR) rate after preoperative chemoradiotherapy with 5-FU/oxaliplatin (5FU/OX) for rectal cancer. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.3567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3567 Background: The use of preoperative chemoradiotherapy (chemo/RT) with 5-FU for locally advanced rectal cancer has increased dramatically. The addition of oxaliplatin (OX) to preoperative 5-FU may be a more active regimen than 5-FU alone. This retrospective study was undertaken to describe clinical outcomes in patients (pts) with rectal cancer treated with 5FU/OX or 5-FU alone. Methods: Between 11/90 and 4/05, 114 pts with rectal adenocarcinoma underwent preoperative chemo/RT at the University of Pennsylvania. Chemotherapy consisted of 5FU/OX in 36 (32%) pts and 78 (68%) pts received 5-FU. All pts received preoperative RT (median dose 5040 cGy). The two groups were balanced in terms of demographic and tumor related factors including tumor size, stage and distance from the anal verge. Median follow-up from preoperative chemo/RT was 24 months (range 2–125 months). A total of 105 (92%) pts had surgical resections; 61 (58%) with LAR, 44 (42%) with APR. PCR was defined as either no evidence of viable malignant cells in specimen or scattered, isolated malignant cells without gross residual disease. Non-surgical pts were counted as treatment failures. Results: The PCR rate was 36.1% (95% CI 20.4–51.8%) in 5FU/OX pts and 12.8% (95% CI 5.4–20.2%) in 5-FU pts. The probability of observing 13 PCRs in 36 5FU/OX pts if the actual PCR rate was 15% is equal to 0.001. Rates of any grade III/IV toxicity were similar between each regimen (20% 5FU/OX vs. 17% 5FU). Long term outcomes (2yr rate±SE) of local control, freedom from distant failure and progression-free survival in 23 pts who achieved a PCR were: 100%, 94%±6% and 94%±6%, respectively. In 85 pts with gross residual disease, these rates were: 87%±5, 77%±5% and 71%±6%, respectively. Conclusion: In this retrospective study, patients receiving 5FU/OX with radiation had a higher rate of PCR than those receiving 5FU alone. Overall, a PCR may lead to improved long-term outcomes. A prospective randomized trial to test superiority of the 5FU/OX regimen is warranted. [Table: see text]
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Affiliation(s)
- C. M. Dolinsky
- University of Pennsylvania School of Medicine, Philadelphia, PA
| | - N. N. Mahmoud
- University of Pennsylvania School of Medicine, Philadelphia, PA
| | - R. Mick
- University of Pennsylvania School of Medicine, Philadelphia, PA
| | - W. Sun
- University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - L. J. Solin
- University of Pennsylvania School of Medicine, Philadelphia, PA
| | - D. G. Haller
- University of Pennsylvania School of Medicine, Philadelphia, PA
| | - B. J. Giantonio
- University of Pennsylvania School of Medicine, Philadelphia, PA
| | - P. J. O’Dwyer
- University of Pennsylvania School of Medicine, Philadelphia, PA
| | - R. D. Fry
- University of Pennsylvania School of Medicine, Philadelphia, PA
| | - J. M. Metz
- University of Pennsylvania School of Medicine, Philadelphia, PA
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Martin N, Mick R, Hahn S, Bernhard E, Gupta A, Schiller J, Keller S, Johnson D, McKenna W, Farber J. 176 P27 is a molecular tumor marker prognostic for survival in 118 NSCLC patients (PTS) treated with radiation t chemotherapy on ECOG3590. Radiother Oncol 2006. [DOI: 10.1016/s0167-8140(06)80654-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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33
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Czerniecki B, Koldovsky U, Xu S, Mick R, Nisenbaum H, Orel S, Fox K, Zhang P. Immunoediting breast cancer using HER-2/neu pulsed autologous dendritic cell vaccines. J Surg Res 2006. [DOI: 10.1016/j.jss.2005.11.100] [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: 11/24/2022]
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34
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Gupta A, Cerniglia G, Mick R, McKenna W, Muschel R. Down-Regulation of Akt Signaling with HIV-1 Protease Inhibitors. Int J Radiat Oncol Biol Phys 2005. [DOI: 10.1016/j.ijrobp.2005.07.250] [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: 10/25/2022]
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35
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Dolinsky C, Mahmoud N, Mick R, Sun W, Whittington R, Solin L, Haller D, Fry R, Metz J. Effect of Time Interval Between Surgery and Preoperative Chemoradiotherapy with 5-Fluorouracil (5-FU) or 5-FU/Oxaliplatin (5FU/OX) for Rectal Cancer. Int J Radiat Oncol Biol Phys 2005. [DOI: 10.1016/j.ijrobp.2005.07.472] [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: 10/25/2022]
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36
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Vapiwala N, DeNittis A, Mick R, Hampshire M, Metz J. P-850 Patient initiation of complementary and alternative medicaltherapies (CAM) during conventional lung cancer treatment. Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)81343-1] [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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37
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Wilson JJ, Mick R, Wei SJ, Hampshire M, Metz JM. Clinical trial resources on the Internet must be designed to reach underrepresented minorities. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.6114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - R. Mick
- Univ of Pennsylvania, Philadelphia, PA
| | - S. J. Wei
- Univ of Pennsylvania, Philadelphia, PA
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38
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Vapiwala N, Mick R, Hampshire M, Metz J. Patient initiation of complementary and alternative medical therapies (CAM) during conventional cancer treatment. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.8131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - R. Mick
- Univ of PA, Philadelphia, PA
| | | | - J. Metz
- Univ of PA, Philadelphia, PA
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39
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Santiago R, Shu H, Rheingold S, Belasco J, Lange B, Mick R, D’Angio G, Maity A. Low-dose, monthly craniospinal irradiation for central nervous system relapse of pre B-cell acute lymphoblastic leukemia in children: The University of Pennsylvania experience. Int J Radiat Oncol Biol Phys 2004. [DOI: 10.1016/j.ijrobp.2004.07.550] [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: 10/26/2022]
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40
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Hahn SM, Fraker DL, Mick R, Metz J, Zhu T, Menon C, Busch TM, Shin D, Evans SM, Glatstein E. Photosensitizer uptake, tumor oxygenation and clinical outcome in a phase II trial of photofrin (PF)-mediated intraperitoneal photodynamic therapy (IP PDT). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- S. M. Hahn
- University of Pennsylvania, Philadelphia, PA
| | | | - R. Mick
- University of Pennsylvania, Philadelphia, PA
| | - J. Metz
- University of Pennsylvania, Philadelphia, PA
| | - T. Zhu
- University of Pennsylvania, Philadelphia, PA
| | - C. Menon
- University of Pennsylvania, Philadelphia, PA
| | - T. M. Busch
- University of Pennsylvania, Philadelphia, PA
| | - D. Shin
- University of Pennsylvania, Philadelphia, PA
| | - S. M. Evans
- University of Pennsylvania, Philadelphia, PA
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41
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Czarneski J, Meyers J, Peng T, Abraham V, Mick R, Ross SR. Interleukin-4 up-regulates mouse mammary tumor virus expression yet is not required for in vivo virus spread. J Virol 2001; 75:11886-90. [PMID: 11689671 PMCID: PMC114776 DOI: 10.1128/jvi.75.23.11886-11890.2001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The mouse mammary tumor virus (MMTV) superantigen induces T-cell production of cytokines, such as interleukin-4, which in turn increase MMTV transcription. However, interleukin-4 is not required for in vivo virus spread, because mice lacking interleukin-4 or the STAT6 transcription factor showed wild-type infection of lymphoid and mammary tissue. In spite of this, mammary tumor incidence was decreased in STAT6 null mice.
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Affiliation(s)
- J Czarneski
- Department of Microbiology, Cancer Center, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104-6142, USA
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42
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Wildemore JK, Schuchter L, Mick R, Synnestvedt M, Elenitsas R, Bedrosian I, Czerniecki BJ, Guerry D, Lessin SR, Elder DE, Bucky LP. Locally recurrent malignant melanoma characteristics and outcomes: a single-institution study. Ann Plast Surg 2001; 46:488-94. [PMID: 11352421 DOI: 10.1097/00000637-200105000-00006] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Despite improvements in the identification and treatment of melanoma, local recurrence continues to challenge the success of current melanoma therapy. A retrospective analysis of 1,996 patients presenting from 1990 to 1997 at the Pigmented Lesion Group of the University of Pennsylvania was performed to assess clinical characteristics and outcomes of locally recurrent melanoma. The cases were analyzed by chart and pathological slide review. A control group was identified for statistical comparison. The incidence of locally recurrent melanoma during the study period was 2.2%. Lentigo maligna melanoma (LMM) accounted for 37% of the local recurrences. Increased tumor thickness and microsatellites were associated with "early" local recurrence and decreased survival from time of recurrence. Nineteen percent of the local recurrences occurred more than 5 years after the initial definitive treatment. The preponderance of locally recurrent LMM suggests the need for refinements in the techniques of margin identification and surgical excision of LMM. Tumors with increased thickness and microsatellites should receive particularly close attention. Lastly, with nearly 20% of the local recurrences occurring more than 5 years after the initial date of treatment, the authors suggest extending the follow-up time for all melanoma lesions beyond 5 years.
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Affiliation(s)
- J K Wildemore
- Department of Surgery, University of Pennsylvania Medical Center, Philadelphia, USA
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43
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Baldassano RN, Han PD, Jeshion WC, Berlin JA, Piccoli DA, Lautenbach E, Mick R, Lichtenstein GR. Pediatric Crohn's disease: risk factors for postoperative recurrence. Am J Gastroenterol 2001; 96:2169-76. [PMID: 11467649 DOI: 10.1111/j.1572-0241.2001.03876.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Postoperative recurrence of Crohn's disease in adults has been extensively studied; however, the course of Crohn's disease after surgery in children has not been well defined. The aim of this study was to examine the postoperative course of pediatric Crohn's disease and the factors that may predict early postoperative recurrence. METHODS We identified 100 resective surgeries in 79 children with Crohn's disease seen at the Children's Hospital of Philadelphia between 1978 and 1996. A retrospective, multivariable analysis of factors potentially influencing postoperative clinical recurrence was performed. Preoperative and postoperative height measurements were compared, and z scores were computed for height-for-age. Two-tailed t test was used for the analysis. RESULTS Clinical recurrence rates were 17% at 1 yr, 38% at 3 yr, and 60% at 5 yr. Patients with colonic Crohn's disease had a significantly shorter postoperative recurrence-free interval (median 1.2 yr) than patients with ileocecal (median 4.4 yr) or diffuse disease (median 3.0 yr) (p = 0.01). On multivariable analysis, a high Pediatric Crohn's Disease Activity Index at the time of surgery (p = 0.01) and preoperative use of 6-mercaptopurine (6-MP) (p < 0.005) were also independently associated with higher postoperative recurrence rates. There was a significant improvement in z scores for height (p = 0.04) after surgery. CONCLUSIONS In children undergoing resective surgery for Crohn's disease, high rates of postoperative Crohn's disease recurrence are associated with severe disease at the time of surgery, colonic Crohn's disease, and the preoperative use of 6-MP. Patients who require preoperative use of 6-MP are likely to suffer from a more aggressive disease and would benefit from postoperative 6-MP prophylaxis. Height growth was improved after intestinal resection for Crohn's disease.
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Affiliation(s)
- R N Baldassano
- Children's Hospital of Philadelphia, Department of Pediatrics, Pennsylvania 19104-4283, USA
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44
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Dai CY, Furth EE, Mick R, Koh J, Takayama T, Niitsu Y, Enders GH. p16(INK4a) expression begins early in human colon neoplasia and correlates inversely with markers of cell proliferation. Gastroenterology 2000; 119:929-42. [PMID: 11040180 DOI: 10.1053/gast.2000.17952] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS p16(INK4a) is a cell cycle inhibitor and a major tumor-suppressor protein, but the regulation of p16(INK4a) is poorly understood and the physiologic settings in which it exerts its antiproliferative effects are unknown. A role for p16(INK4a) in intestinal neoplasia is suggested by the observation that the promoter region is methylated in a subset of human colon tumors. We examined the expression of the protein in specimens representing the full spectrum of neoplastic progression in the human colon and determined whether expressing cells showed evidence of cell cycle inhibition. METHODS We studied p16(INK4a) expression by immunoprecipitation, immunoblotting, reverse-transcription polymerase chain reaction (RT-PCR), immunohistochemistry, and immunofluorescence in matched normal and neoplastic colonic tissue from 70 patients. RESULTS p16(INK4a) expression was very low in normal mucosa, with staining observed in rare epithelial cells at the base of crypts. A distinctly higher expression was found in 4 of 7 aberrant crypt foci, 32 of 36 adenomas, 18 of 28 primary carcinomas, and 5 of 5 metastatic carcinomas. Within each neoplasm p16(INK4a) staining was heterogeneous, with higher expression commonly seen in areas bordering normal tissue. p16(INK4a) staining correlated inversely with that of Ki67, cyclin A, and the retinoblastoma protein, suggesting that cell cycle progression was inhibited. CONCLUSIONS These results suggest that p16(INK4a) expression begins in the earliest detectable stages of neoplastic progression in the human colon and exerts a continuous, piecemeal constraint on tumor growth.
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Affiliation(s)
- C Y Dai
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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45
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Cohen-Jonathan E, Muschel RJ, Gillies McKenna W, Evans SM, Cerniglia G, Mick R, Kusewitt D, Sebti SM, Hamilton AD, Oliff A, Kohl N, Gibbs JB, Bernhard EJ. Farnesyltransferase inhibitors potentiate the antitumor effect of radiation on a human tumor xenograft expressing activated HRAS. Radiat Res 2000; 154:125-32. [PMID: 10931682 DOI: 10.1667/0033-7587(2000)154[0125:fiptae]2.0.co;2] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Successful radiosensitization requires that tumor cells become more radiosensitive without causing an equivalent reduction in the survival of cells of the surrounding normal tissues. Since tumor cell radiosensitivity can be influenced by RAS oncogene activation, we have hypothesized that inhibition of oncogenic RAS activity would lead to radiosensitization of tumors with activated RAS. We previously showed in tissue culture that prenyltransferase treatment of cells with activated RAS resulted in radiosensitization, whereas treatment of cells with wild-type RAS had no effect on radiation survival. Here we ask whether the findings obtained in vitro have applicability in vivo. We found that treatment of nude mice bearing T24 tumor cell xenografts with farnesyltransferase inhibitors resulted in a significant and synergistic reduction in tumor cell survival after irradiation. The regrowth of T24 tumors expressing activated RAS was also significantly prolonged by the addition of treatment with farnesyltransferase inhibitors compared to the regrowth after irradiation alone. In contrast, there was no effect on the radiosensitivity of HT-29 tumors expressing wild-type RAS. These results demonstrate that specific radiosensitization of tumors expressing activated RAS oncogenes can be obtained in vivo.
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Affiliation(s)
- E Cohen-Jonathan
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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46
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Mick R, Crowley JJ, Carroll RJ. Phase II clinical trial design for noncytotoxic anticancer agents for which time to disease progression is the primary endpoint. Control Clin Trials 2000; 21:343-59. [PMID: 10913809 DOI: 10.1016/s0197-2456(00)00058-1] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Phase II evaluation is a critical screening step in the development of new cancer treatments. Historically, anticancer agents have been cytotoxic; they kill existing cells. As such, the primary endpoint for phase II evaluation has been tumor response rate, the percentage of patients whose tumors shrink > 50%. Biotechnology has led to promising new anticancer agents that are cytostatic. In contrast to cytotoxics, these agents modulate tumor environments and/or cellular targets and are expected to delay tumor growth. Phase II evaluation of such agents may instead focus on failure-time endpoints, such as time to disease progression. We examine a phase II trial design that evaluates clinical benefit by comparing sequentially measured paired failure times within each treated patient. Clinical efficacy is defined by a hazard ratio. Assuming patients eligible for a phase II study of a new cytostatic agent have failed previous cancer treatment, their most recent prior time to progression interval, TTP(1), is uncensored. Time to progression after the cytostatic agent, TTP(2), may or may not be censored at analysis. The design is motivated by a "growth modulation index" (TTP(2)/TTP(1)) and the proposition that a cytostatic agent be considered effective if the index is greater than 1.33. A chi(2) test statistic is employed to evaluate the paired failure-time data (TTP(1), TTP(2)). The degree of correlation between the paired failure times is a key feature of this design. Power of the test was evaluated through simulation of trials. Assuming a null hazard ratio equal to 1.0, a trial designed to detect an alternative hazard ratio equal to 1.3, based on accrual of 25 patients/year for 2 years (50 patients total) and with an additional 2 years of follow-up, has 25%, 46%, and 83% power based on correlations of 0.3, 0.5 and 0.7, respectively. These results demonstrate efficiency of the trial design, given moderate to strong correlations between paired failure times.
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Affiliation(s)
- R Mick
- Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
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47
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Zimmerman TM, Michelson GC, Mick R, Grinblatt DL, Williams SF. Timing of platelet recovery is associated with adequacy of leukapheresis product yield after cyclophosphamide and G-CSF in patients with lymphoma. J Clin Apher 2000; 14:31-4. [PMID: 10355661 DOI: 10.1002/(sici)1098-1101(1999)14:1<31::aid-jca6>3.0.co;2-c] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A subgroup of patients with refractory Hodgkin's (HD) or non-Hodgkin's (NHL) lymphoma may be cured with high-dose chemotherapy and peripheral blood progenitor cell rescue. To investigate the relationship of adequate leukapheresis yield and time course of platelet recovery after mobilization chemotherapy, we retrospectively analyzed the leukapheresis yields in seven patients with Hodgkin's disease and fifteen patients with non-Hodgkin's lymphoma undergoing high-dose chemotherapy. Our goal was to develop a rule to determine when to initiate leukapheresis and then to prospectively validate this rule. All patients were mobilized with cyclophosphamide and G-CSF (granulocyte-colony stimulating factor). A total of 144 leukaphereses were completed and analyzed. Based on the CD34 content in the initial harvest product, fifteen patients were defined as poor mobilizers (CD34 < 0.15 x 10(6)/kg) and seven were good mobilizers. The platelet count on the first day of harvesting was significantly associated with the poor mobilizers (P = .03). Age, sex, marrow involvement, disease (HD vs. NHL), prior radiation, time since last chemotherapy, and total number of cycles of prior chemotherapy were not predictive of poor mobilizers. By using a platelet count cut off of 35 x 10(9)/L, we retrospectively analyzed 144 individual leukapheresis products, to test whether CD34 yield was predicted by the peripheral blood platelet count on the day of leukapheresis. This rule had an excellent sensitivity, 91%, and a specificity of 67%. Subsequently, we validated this rule with the next twenty-four patients undergoing leukapheresis of which there were 143 leukaphereses. The prediction rule exhibited a sensitivity of 72% and a specificity of 68% in the validation set. There does appear to be utility in using the platelet count to guide the initiation of leukapheresis after chemotherapy and G-CSF mobilization.
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Affiliation(s)
- T M Zimmerman
- Section of Hematology/Oncology, University of Chicago, Illinois, USA
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Mathias C, Mick R, Grupp S, Duffy K, Harris F, Laport G, Stadtmauer E, Luger S, Schuster S, Wasik MA, Porter DL. Soluble interleukin-2 receptor concentration as a biochemical indicator for acute graft-versus-host disease after allogeneic bone marrow transplantation. J Hematother Stem Cell Res 2000; 9:393-400. [PMID: 10894361 DOI: 10.1089/15258160050079506] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
When interleukin-2 (IL-2) binds to the IL-2 receptor (IL2-R) on activated T cells, a soluble portion of the receptor (sIL2-R) is released. After allogeneic bone marrow transplantation (BMT), the serum concentration of sIL2-R may, therefore, be a useful surrogate marker for T cell activation that results in acute graft-versus-host disease (aGVHD). To determine if the sIL2-R concentration is a useful marker to help establish a diagnosis of aGVHD, serial sIL2-R concentrations were measured weekly for 4 weeks in 43 patients after allogeneic BMT. Grafts were from HLA-matched siblings (n = 33), 5/6 HLA-matched siblings (n = 3) or matched unrelated donors (n = 7). GVHD prophylaxis included cyclosporine A (CSA)/methotrexate (MTX) (n = 25), solumedrol/CSA (n = 15), or T cell depletion (n = 3). Twenty-three patients developed aGVHD (Grade I, 7; Grade II, 12; Grade III, 4) a median of 28 days after transplant. There was a significant association between a clinical diagnosis of aGVHD and an increase in the sIL2-R concentration (p < 0.001). The mean percent increase (+/-SE) over baseline for patients with a clinical diagnosis of aGVHD was 294% (+/-57%) by week 2 (n = 12), 431% (+/-116%) by week 3 (n = 14), and 650% (+/-315%) by week 4 (n = 9) after BMT. For each 100% increase over baseline, the likelihood of having aGVHD increased by 18%. Six of 20 patients without aGVHD became critically ill and exhibited marked increases in sIL2-R concentrations, similar to patients with a clinical diagnosis of aGVHD who never became critically ill. Fourteen patients without aGVHD who did not become critically ill exhibited negligible increases of sIL2-R in 2- to 4-week period after BMT. These data suggest that serial measurements sIL2-R concentration are helpful in establishing the diagnosis of aGVHD, but are not useful in the most acutely ill patients.
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Affiliation(s)
- C Mathias
- Department of Medicine, University of Pennsylvania Medical Center, Philadelphia 19104, USA
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Bedrosian I, Reynolds C, Mick R, Callans LS, Grant CS, Donohue JH, Farley DR, Heller R, Conant E, Orel SG, Lawton T, Fraker DL, Czerniecki BJ. Accuracy of sentinel lymph node biopsy in patients with large primary breast tumors. Cancer 2000; 88:2540-5. [PMID: 10861431 DOI: 10.1002/1097-0142(20000601)88:11<2540::aid-cncr16>3.0.co;2-a] [Citation(s) in RCA: 148] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patients with large breast tumors are increasingly undergoing neoadjuvant treatment to downstage local disease; however, accurate staging of the axilla before the initiation of chemotherapy remains problematic. In the current study, the authors report on the accuracy of sentinel lymph node (SLN) biopsy in such patients to determine the feasibility of applying this technique before induction chemotherapy. METHODS One hundred three patients with 104 tumors classified as American Joint Committee on Cancer (AJCC) T2 (tumor >/= 2 cm but </= 5 cm) or larger were recruited at the University of Pennsylvania and the Mayo Clinic. In the majority of cases, combined blue dye and radiotracer was used for SLN identification. After SLN identification, a completion axillary lymph node dissection was performed in 87 cases. The SLN was evaluated with hematoxylin and eosin and immunohistochemistry. RESULTS The SLN was identified in 99% of cases. The overall rate of lymph node metastasis was 59% (95% exact confidence interval [95% CI], 49-68%) (61 of 104 cases). The SLN false-negative rate was 2% (95% exact CI, < 1-11.5%) (2 patients). In 56 tumors >/= 3 cm, 1 false-negative result (2% [95% exact CI, < 1-15%]) was identified, and the rate of lymph node metastasis was 62.5% (95% exact CI, 48. 5-75%) (35 of 56 tumors). Within 30 SLN positive patients with tumors >/= 3 cm and complete axillary lymph node dissection, 3 of 8 patients (37.5% [95% exact CI, 8.5-75.5%]) with micrometastasis (</= 2 mm) to the SLN had positive non-SLN compared with 21 of 22 patients (95.5% [95% exact CI, 77-100%]) with macrometastasis (> 2 mm) to the SLN (P = 0.002). CONCLUSIONS SLN biopsy for patients with large breast tumors is technically feasible and highly accurate. SLN biopsy should be considered for the staging of clinically negative axilla in patients scheduled to receive neoadjuvant chemotherapy.
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Affiliation(s)
- I Bedrosian
- Department of Surgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania 19104, USA
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Bedrosian I, Faries MB, Guerry D, Elenitsas R, Schuchter L, Mick R, Spitz FR, Bucky LP, Alavi A, Elder DE, Fraker DL, Czerniecki BJ. Incidence of sentinel node metastasis in patients with thin primary melanoma (< or = 1 mm) with vertical growth phase. Ann Surg Oncol 2000; 7:262-7. [PMID: 10819365 DOI: 10.1007/s10434-000-0262-z] [Citation(s) in RCA: 128] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients with thin primary melanomas (< or = 1 mm) generally have an excellent prognosis. However, the presence of a vertical growth phase (VGP) adversely impacts the survival rate. We report on the rate of occurrence of nodal metastasis in patients with thin primary melanomas with a VGP who are offered sentinel lymph node (SLN) biopsy. METHODS Among 235 patients with clinically localized cutaneous melanomas who underwent successful SLN biopsy, 71 had lesions 1 mm or smaller with a VGP. The SLN was localized by using blue dye and a radiotracer. If negative for tumor by using hematoxylin and eosin staining, the SLN was further examined by immunohistochemistry. RESULTS The rate of occurrence of SLN metastasis was 15.2% in patients with melanomas deeper than 1 mm and 5.6% in patients with thin melanomas. Three patients with thin melanomas and a positive SLN had low-risk lesions, based on a highly accurate six-variable multivariate logistic regression model for predicting 8-year survival in stage I/II melanomas. The fourth patient had a low- to intermediate-risk lesion based on this model. At the time of the lymphadenectomy, one patient had two additional nodes with metastasis. CONCLUSIONS VGP in a melanoma 1 mm or smaller seems to be a risk factor for nodal metastasis. The risk of nodal disease may not be accurately predicted by the use of a multivariate logistic regression model that incorporates thickness, mitotic rate, regression, tumor-infiltrating lymphocytes, sex, and anatomical site. Patients with thin lesions having VGP should be evaluated for SLN biopsy and trials of adjuvant therapy when stage III disease is found.
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Affiliation(s)
- I Bedrosian
- Department of Surgery, University of Pennsylvania, Philadelphia 19104, USA
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