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Nguyen NP, Mohammadianpanah M, SunMyint A, Page BR, Vinh-Hung V, Gorobets O, Arenas M, Mazibuko T, Giap H, Vasileiou M, Dutheil F, Tuscano C, Karlsson ULFL, Dahbi Z, Natoli E, Li E, Kim L, Oboite J, Oboite E, Bose S, Vuong T. Immunotherapy and radiotherapy for older patients with locally advanced rectal cancer unfit for surgery or decline surgery: a practical proposal by the International Geriatric Radiotherapy Group. Front Oncol 2024; 14:1325610. [PMID: 38463223 PMCID: PMC10921228 DOI: 10.3389/fonc.2024.1325610] [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: 11/07/2023] [Accepted: 01/16/2024] [Indexed: 03/12/2024] Open
Abstract
The standard of care for locally advanced rectal cancer is total neoadjuvant therapy followed by surgical resection. Current evidence suggests that selected patients may be able to delay or avoid surgery without affecting survival rates if they achieve a complete clinical response (CCR). However, for older cancer patients who are too frail for surgery or decline the surgical procedure, local recurrence may lead to a deterioration of patient quality of life. Thus, for clinicians, a treatment algorithm which is well tolerated and may improve CCR in older and frail patients with rectal cancer may improve the potential for prolonged remission and potential cure. Recently, immunotherapy with check point inhibitors (CPI) is a promising treatment in selected patients with high expression of program death ligands receptor 1 (PD- L1). Radiotherapy may enhance PD-L1 expression in rectal cancer and may improve response rate to immunotherapy. We propose an algorithm combining immunotherapy and radiotherapy for older patients with locally advanced rectal cancer who are too frail for surgery or who decline surgery.
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Affiliation(s)
- Nam P. Nguyen
- Department of Radiation Oncology, Howard University, Washington, DC, United States
| | - Mohammad Mohammadianpanah
- Colorectal Research Center, Department of Radiation Oncology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arthur SunMyint
- Department of Radiation Oncology, Clatterbridge Cancer Center, Liverpool, United Kingdom
| | - Brandi R. Page
- Department of Radiation Oncology, Johns Hopkins University, Bethesda, MD, United States
| | - Vincent Vinh-Hung
- Department of Radiation Oncology, Institut Bergonie, Bordeaux, France
| | - Olena Gorobets
- Department of Oral Surgery, Martinique University, Fort de France, France
| | - Meritxell Arenas
- Department of Radiation Oncology, Sant Joan de Reus University, University of Rovira, I Virgili, Tarragona, Spain
| | - Thandeka Mazibuko
- Department of Radiation Oncology, International Geriatric Radiotherapy Group, Washington, DC, United States
| | - Huan Giap
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC, United States
| | - Maria Vasileiou
- Department of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Fabien Dutheil
- Department of Radiation Oncology, Clinique Sainte Clotilde, Saint Denis, La Reunion, Saint Denis, France
| | - Carmelo Tuscano
- Department of Radiation Oncology, A.O Bianchi Melacrino, Reggio Calabria, Italy
| | - ULF Lennart Karlsson
- Department of Radiation Oncology, International Geriatric Radiotherapy Group, Washington, DC, United States
| | - Zineb Dahbi
- Department of Radiation Oncology, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Elena Natoli
- Department of Radiation Oncology, University of Bologna, Bologna, Italy
| | - Eric Li
- Department of Pathology, Howard University, Washington, DC, United States
| | - Lyndon Kim
- Division of Neurooncology, Mt Sinai Hospital, New York, NY, United States
| | - Joan Oboite
- Department of Radiation Oncology, Howard University, Washington, DC, United States
| | - Eromosele Oboite
- Department of Radiation Oncology, Howard University, Washington, DC, United States
| | - Satya Bose
- Department of Radiation Oncology, Howard University, Washington, DC, United States
| | - Te Vuong
- Department of Radiation Oncology, Mc Gill University, Montreal, Canada
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2
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Nguyen NP, Thariat J, Gorobets O, Vinh-Hung V, Kim L, Blanco SC, Vasileiou M, Arenas M, Mazibuko T, Giap H, Vincent F, Chi A, Loganadane G, Mohammadianpanah M, Rembielak A, Karlsson U, Ali A, Bose S, Page BR. Immunotherapy and Hypofractionated Radiotherapy in Older Patients with Locally Advanced Cutaneous Squamous-Cell Carcinoma of the Head and Neck: A Proposed Paradigm by the International Geriatric Radiotherapy Group. Cancers (Basel) 2023; 15:4981. [PMID: 37894347 PMCID: PMC10605563 DOI: 10.3390/cancers15204981] [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: 09/07/2023] [Revised: 10/01/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
Cutaneous skin carcinoma is a disease of older patients. The prevalence of cutaneous squamous-cell carcinoma (cSCC) increases with age. The head and neck region is a frequent place of occurrence due to exposure to ultraviolet light. Surgical resection with adjuvant radiotherapy is frequently advocated for locally advanced disease to decrease the risk of loco-regional recurrence. However, older cancer patients may not be candidates for surgery due to frailty and/or increased risk of complications. Radiotherapy is usually advocated for unresectable patients. Compared to basal-cell carcinoma, locally advanced cSCC tends to recur locally and/or can metastasize, especially in patients with high-risk features such as poorly differentiated histology and perineural invasion. Thus, a new algorithm needs to be developed for older patients with locally advanced head and neck cutaneous squamous-cell carcinoma to improve their survival and conserve their quality of life. Recently, immunotherapy with checkpoint inhibitors (CPIs) has attracted much attention due to the high prevalence of program death ligand 1 (PD-L1) in cSCC. A high response rate was observed following CPI administration with acceptable toxicity. Those with residual disease may be treated with hypofractionated radiotherapy to minimize the risk of recurrence, as radiotherapy may enhance the effect of immunotherapy. We propose a protocol combining CPIs and hypofractionated radiotherapy for older patients with locally advanced cutaneous head and neck cancer who are not candidates for surgery. Prospective studies should be performed to verify this hypothesis.
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Affiliation(s)
- Nam P. Nguyen
- Department of Radiation Oncology, Howard University, Washington, DC 20059, USA;
| | - Juliette Thariat
- Department of Radiation Oncology, Francois Baclesse Cancer Center, 14000 Cain, France;
| | - Olena Gorobets
- Department of Oral Surgery, University of Martinique, 97213 Martinique, France;
| | - Vincent Vinh-Hung
- Department of Radiation Oncology, Institut Bergonie, 33076 Bordeaux, France;
| | - Lyndon Kim
- Division of Neuro-Oncology, Mount Sinai Hospital, New York, NY 10029, USA;
| | - Sergio Calleja Blanco
- Department of Oral and Maxillofacial Surgery, Howard University, Washington, DC 20059, USA;
| | - Maria Vasileiou
- Department of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, 15771 Athens, Greece
| | - Meritxell Arenas
- Department of Radiation Oncology, Sant Joan de Reus University Hospital, University of Rovira, I Virgili, 43204 Tarragona, Spain;
| | - Thandeka Mazibuko
- Department of Radiation Oncology, International Geriatric Radiotherapy Group, Washington, DC 20001, USA; (T.M.); (U.K.)
| | - Huan Giap
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Felix Vincent
- Department of Surgery, Southern Regional Health System, Lawrenceburg, TN 29425, USA;
| | - Alexander Chi
- Department of Radiation Oncology, Xuanwu Hospital, Capital Medical University, Beijing 101125, China;
| | | | - Mohammad Mohammadianpanah
- Colorectal Research Center, Department of Radiation Oncology, Shiraz University of Medical Sciences, Shiraz 71348-14336, Iran;
| | - Agata Rembielak
- Department of Radiation Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK;
- Division of Cancer Sciences, Faculty of Biomedicine and Health, School of Medical Sciences, The University of Manchester, Manchester M13 9PL, UK
| | - Ulf Karlsson
- Department of Radiation Oncology, International Geriatric Radiotherapy Group, Washington, DC 20001, USA; (T.M.); (U.K.)
| | - Ahmed Ali
- Division of Hematology Oncology, Howard University, Washington, DC 20059, USA;
| | - Satya Bose
- Department of Radiation Oncology, Howard University, Washington, DC 20059, USA;
| | - Brandi R. Page
- Department of Radiation Oncology, Johns Hopkins University, Baltimore 21218, MD, USA;
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3
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Shaaban SG, LeCompte MC, Kleinberg LR, Redmond KJ, Page BR. Recognition and Management of the Long-term Effects of Cranial Radiation. Curr Treat Options Oncol 2023:10.1007/s11864-023-01078-z. [PMID: 37145381 DOI: 10.1007/s11864-023-01078-z] [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] [Accepted: 03/08/2023] [Indexed: 05/06/2023]
Abstract
OPINION STATEMENT Cranial radiation is ubiquitous in the treatment of primary malignant and benign brain tumors as well as brain metastases. Improvement in radiotherapy targeting and delivery has led to prolongation of survival outcomes. As long-term survivorship improves, we also focus on prevention of permanent side effects of radiation and mitigating the impact when they do occur. Such chronic treatment-related morbidity is a major concern with significant negative impact on patient's and caregiver's respective quality of life. The actual mechanisms responsible for radiation-induced brain injury remain incompletely understood. Multiple interventions have been introduced to potentially prevent, minimize, or reverse the cognitive deterioration. Hippocampal-sparing intensity modulated radiotherapy and memantine represent effective interventions to avoid damage to regions of adult neurogenesis. Radiation necrosis frequently develops in the high radiation dose region encompassing the tumor and surrounding normal tissue. The radiographic findings in addition to the clinical course of the patients' symptoms are taken into consideration to differentiate between tissue necrosis and tumor recurrence. Radiation-induced neuroendocrine dysfunction becomes more pronounced when the hypothalamo-pituitary (HP) axis is included in the radiation treatment field. Baseline and post-treatment evaluation of hormonal profile is warranted. Radiation-induced injury of the cataract and optic system can develop when these structures receive an amount of radiation that exceeds their tolerance. Special attention should always be paid to avoid irradiation of these sensitive structures, if possible, or minimize their dose to the lowest limit.
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Affiliation(s)
- Sherif G Shaaban
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins Medicine, 401 North Broadway, Suite 1440, Baltimore, MD, 21287, USA
| | - Michael C LeCompte
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins Medicine, 401 North Broadway, Suite 1440, Baltimore, MD, 21287, USA
| | - Lawrence R Kleinberg
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins Medicine, 401 North Broadway, Suite 1440, Baltimore, MD, 21287, USA
| | - Kristin J Redmond
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins Medicine, 401 North Broadway, Suite 1440, Baltimore, MD, 21287, USA
| | - Brandi R Page
- Department of Radiation Oncology-National Capitol Region, Johns Hopkins Medicine, 6420 Rockledge Drive Suite 1200, Bethesda, MD, 20817, USA.
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4
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Nguyen NP, Karlsson UL, Lehrman D, Mazibuko T, Saghatelyan T, Thariat J, Baumert BG, Vinh-Hung V, Gorobets O, Giap H, Singh S, Chi A, Alessandrini G, Ahluwalia A, Durosinmi-Etti F, Zegarra Cárdenas J, Diabate K, Oboite J, Oboite E, Mehmood T, Vuong T, Kim L, Page BR. Impact of COVID-19 pandemic on older cancer patients: Proposed solution by the International Geriatric Radiotherapy Group. Front Oncol 2023; 13:1091329. [PMID: 36959795 PMCID: PMC10027708 DOI: 10.3389/fonc.2023.1091329] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 01/18/2023] [Indexed: 03/09/2023] Open
Abstract
Older cancer patients are disproportionally affected by the Coronavirus 19 (COVID-19) pandemic. A higher rate of death among the elderly and the potential for long-term disability have led to fear of contracting the virus in these patients. This fear can, paradoxically, cause delay in diagnosis and treatment that may lead to a poor outcome that could have been prevented. Thus, physicians should devise a policy that both supports the needs of older patients during cancer treatment, and serves to help them overcome their fear so they seek out to cancer diagnosis and treatment early. A combination of telemedicine and a holistic approach, involving prayers for older cancer patients with a high level of spirituality, may improve vaccination rates as well as quality of life during treatment. Collaboration between health care workers, social workers, faith-based leaders, and cancer survivors may be crucial to achieve this goal. Social media may be an important component, providing a means of sending the positive message to older cancer patients that chronological age is not an impediment to treatment.
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Affiliation(s)
- Nam Phong Nguyen
- Department of Radiation Oncology, Howard University, Washington, DC, United States
| | - Ulf Lennart Karlsson
- Department of Radiation Oncology, International Geriatric Radiotherapy Group, Washington, DC, United States
| | - David Lehrman
- Department of Radiation Oncology, Howard University, Washington, DC, United States
| | - Thandeka Mazibuko
- Department of Radiation Oncology, Howard University, Washington, DC, United States
| | - Tatul Saghatelyan
- Department of Radiation Oncology, National Center of Oncology, Yerevan, Armenia
| | - Juliette Thariat
- Department of Radiation Oncology, Francois Baclesse Cancer Center, Cain, France
| | - Brigitta G. Baumert
- Institute of Radiation Oncology, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Vincent Vinh-Hung
- Department of Radiation Oncology, Centre Hospitalier de La Polynesie Francaise, Tahiti, French Polynesia
| | - Olena Gorobets
- Department of Oral Surgery, Centre Hospitalier Universitaire de Martinique, Martinique, France
| | - Huan Giap
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC, United States
| | - Sankalp Singh
- Department of Radiation Oncology, Army Hospital (Research & Referral), New Delhi, India
| | - Alexander Chi
- Department of Radiation Oncology, Beijing Chest Hospital, Beijing, China
| | | | - Abhinav Ahluwalia
- Department of Radiation Oncology, Advanced Care Oncology Center, Dubai, United Arab Emirates
| | | | - Jorge Zegarra Cárdenas
- Division of Medical Oncology, Regional Institute of Neoplastic Disease, Concepcion, Peru
| | | | - Joan Oboite
- Department of Radiation Oncology, Howard University, Washington, DC, United States
| | - Eromosele Oboite
- Department of Radiation Oncology, Howard University, Washington, DC, United States
| | - Tahir Mehmood
- Department of Radiation Oncology, Northampton General Hospital, Northampton, United Kingdom
| | - Te Vuong
- Department of Radiation Oncology, McGill University, Montreal, QC, Canada
| | - Lyndon Kim
- Division of Neuro-Oncology, Mount Sinai Hospital, New York, NY, United States
| | - Brandi R. Page
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD, United States
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5
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Carey AR, Page BR, Miller N. Radiation-induced optic neuropathy: a review. Br J Ophthalmol 2022; 107:743-749. [DOI: 10.1136/bjo-2022-322854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/24/2022]
Abstract
Radiation is a commonly used treatment modality for head and neck as well as CNS tumours, both benign and malignant. As newer oncology treatments such as immunotherapies allow for longer survival, complications from radiation therapy are becoming more common. Radiation-induced optic neuropathy is a feared complication due to rapid onset and potential for severe and bilateral vision loss. Careful monitoring of high-risk patients and early recognition are crucial for initiating treatment to prevent severe vision loss due to a narrow therapeutic window. This review discusses presentation, aetiology, recent advances in diagnosis using innovative MRI techniques and best practice treatment options based on the most recent evidence-based medicine.
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6
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Nguyen NP, Kim L, Thariat J, Baumert BG, Mazibuko T, Gorobets O, Vinh-Hung V, Giap H, Mehmood T, Vincent F, Chi A, Basu T, Loganadane G, Mohammadianpanah M, Karlsson U, Oboite E, Oboite J, Ali A, Page BR. Immunotherapy and Modern Radiotherapy Technique for Older Patients with Locally Advanced Head and Neck Cancer: A Proposed Paradigm by the International Geriatric Radiotherapy Group. Cancers (Basel) 2022; 14:5285. [PMID: 36358703 PMCID: PMC9654379 DOI: 10.3390/cancers14215285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 09/16/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 10/29/2023] Open
Abstract
The standard of care for locally advanced head and neck cancer is concurrent chemoradiation or postoperative irradiation with or without chemotherapy. Surgery may not be an option for older patients (70 years old or above) due to multiple co-morbidities and frailty. Additionally, the standard chemotherapy of cisplatin may not be ideal for those patients due to oto- and nephrotoxicity. Though carboplatin is a reasonable alternative for cisplatin in patients with a pre-existing hearing deficit or renal dysfunction, its efficacy may be inferior to cisplatin for head and neck cancer. In addition, concurrent chemoradiation is frequently associated with grade 3-4 mucositis and hematologic toxicity leading to poor tolerance among older cancer patients. Thus, a new algorithm needs to be developed to provide optimal local control while minimizing toxicity for this vulnerable group of patients. Recently, immunotherapy with check point inhibitors (CPI) has attracted much attention due to the high prevalence of program death-ligand 1 (PD-L1) in head and neck cancer. In patients with recurrent or metastatic head and neck cancer refractory to cisplatin-based chemotherapy, CPI has proven to be superior to conventional chemotherapy for salvage. Those with a high PD-L1 expression defined as 50% or above or a high tumor proportion score (TPS) may have an excellent response to CPI. This selected group of patients may be candidates for CPI combined with modern radiotherapy techniques, such as intensity-modulated image-guided radiotherapy (IM-IGRT), volumetric arc therapy (VMAT) or proton therapy if available, which allow for the sparing of critical structures, such as the salivary glands, oral cavity, cochlea, larynx and pharyngeal muscles, to improve the patients' quality of life. In addition, normal organs that are frequently sensitive to immunotherapy, such as the thyroid and lungs, are spared with modern radiotherapy techniques. In fit or carefully selected frail patients, a hypofractionated schedule may be considered to reduce the need for daily transportation. We propose a protocol combining CPI and modern radiotherapy techniques for older patients with locally advanced head and neck cancer who are not eligible for cisplatin-based chemotherapy and have a high TPS. Prospective studies should be performed to verify this hypothesis.
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Affiliation(s)
- Nam P Nguyen
- Department of Radiation Oncology, Howard University, 2041 Georgia Ave NW, Washington, DC 20060, USA
| | - Lyndon Kim
- Department of Neurology, Division of Neuro-Oncology, Mount Sinai Hospital, New York, NY 10029, USA
| | | | - Brigitta G Baumert
- Institute of Radiation Oncology, Cantonal Hospital Graubuenden, 7000 Chur, Switzerland
| | - Thandeka Mazibuko
- International Geriatric Radiotherapy Group, Department of Radiation Oncology, Washington, DC 20001, USA
| | - Olena Gorobets
- Department of Maxillofacial Surgery, Centre Hospitalier Universitaire de Martinique, 97213 Le Lamentin Martinique, France
| | - Vincent Vinh-Hung
- Department of Radiation Oncology, Centre Hospitalier de la Polynesie Francaise, 98716 Pirae, Tahiti, French Polynesia
| | - Huan Giap
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Tahir Mehmood
- Department of Radiation Oncology, Northampton General Hospital, Northampton NN1 5BD, UK
| | - Felix Vincent
- Department of Surgery, Southern Regional Health System-Lawrenceburg, Lawrenceburg, TN 38464, USA
| | - Alexander Chi
- Department of Radiation Oncology, Beijing Chest Hospital, Beijing 101149, China
| | - Trinanjan Basu
- Department of Radiation Oncology, HCG Cancer Center Borivali, and HCG ICS, Mumbai, Maharashtra 400092, India
| | | | | | - Ulf Karlsson
- International Geriatric Radiotherapy Group, Department of Radiation Oncology, Washington, DC 20001, USA
| | - Eromosele Oboite
- Department of Radiation Oncology, Howard University, 2041 Georgia Ave NW, Washington, DC 20060, USA
| | - Joan Oboite
- Department of Radiation Oncology, Howard University, 2041 Georgia Ave NW, Washington, DC 20060, USA
| | - Ahmed Ali
- Department of Hematology Oncology, Howard University, Washington, DC 20059, USA
| | - Brandi R Page
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD 21093, USA
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7
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Hill C, Deville C, Kiess A, Narang A, Ratnanather T, Bienstock J, Brinckerhoff L, Hodukavich A, Anderson R, Alcorn S, DeWeese T, Viswanathan A, Page BR. Establishing a Deaf and American Sign Language Inclusive Residency Program. Acad Med 2022; 97:357-363. [PMID: 34670241 DOI: 10.1097/acm.0000000000004469] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Improving diversity in residency programs has been increasingly emphasized as a means to address gender, racial, and ethnic disparities in medicine. However, limited attention has been given to the potential benefits of training physicians with differences other than gender or race and ethnicity. Americans with a disability represent about 27% of the U.S. population, whereas 1%-3% of physician trainees report having a disability. In 2013, a national survey identified only 86 physicians or trainees reporting deafness or hearing loss as a disability. To date, there are no published strategies on how to create an inclusive program for Deaf trainees. Herein, the authors report on the development of a Deaf and American Sign Language (ASL) inclusive residency program that can serve as an academic model for other programs, in any medical specialty, seeking to create an accessible training program for Deaf physicians and that can be adapted for trainees with other disabilities. In March 2017, the radiation oncology residency program at Johns Hopkins University matched an ASL-signing Deaf resident who would begin the program in July 2018. In preparation, department leadership engaged key stakeholders and leaders within the university's health system and among the department faculty, residents, and staff as well as the incoming resident to create an ASL inclusive program. A 5-step transition process for the training program was ultimately developed and implemented. The authors focused on engaging the Deaf trainee and interpreters, engaging health system and departmental leadership, contracting a training consultant and developing oral and written training materials for faculty and staff, and optimizing the workspace via accommodations. Through collaborative preparation, a Deaf and ASL-signing resident was successfully integrated into the residency program. The proposed 5-step transition process provides an effective, engaging model to encourage other institutions that are seeking to employ similar inclusivity initiatives.
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Affiliation(s)
- Colin Hill
- C. Hill is a radiation oncology resident, Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Curtiland Deville
- C. Deville Jr is associate professor, Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ana Kiess
- A. Kiess is assistant professor, Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amol Narang
- A. Narang is assistant professor, Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tilak Ratnanather
- T. Ratnanather is associate research professor, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Jessica Bienstock
- J. Bienstock is associate dean of graduate medical education, Office of the Vice Dean for Education, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Loring Brinckerhoff
- L. Brinckerhoff is a disability and learning consultant, Learning Resources and Support Student Affairs, Harvard University, Boston, Massachusetts
| | - Aaron Hodukavich
- A. Hodukavich is an Americans with Disabilities Act compliance officer, Office of Institutional Equity, Johns Hopkins University, Baltimore, Maryland
| | - Roberta Anderson
- R. Anderson is director of nursing, Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sara Alcorn
- S. Alcorn is assistant professor, Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Theodore DeWeese
- T. DeWeese is vice dean for clinical affairs and president of the clinical practice association, Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Akila Viswanathan
- A. Viswanathan is professor and director, Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brandi R Page
- B.R. Page is assistant professor, Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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8
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Anakwenze Akinfenwa CP, Ibraheem A, Nwankwo K, Lasebikan N, Ali-Gombe M, Aliyu UM, Ikhile E, Adegboyega O, Abdullahi A, Klopp AH, Schmeler K, Lin LL, Jhingran A, Page BR, Leng J, Grover S, Ntekim A. Emerging Use of Public-Private Partnerships in Public Radiotherapy Facilities in Nigeria. JCO Glob Oncol 2021; 7:1260-1269. [PMID: 34351813 PMCID: PMC8389883 DOI: 10.1200/go.21.00066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Radiotherapy (RT) treatment at public hospitals in Nigeria is often interrupted by prolonged periods of machine breakdown because of insufficient funds for maintenance and repair. These delays have prompted the uptake of public-private partnerships (PPPs) to acquire and maintain RT equipment. This study aimed to understand Nigeria's current RT capacity and the impact of PPPs on RT availability and cost. METHODS Eleven radiation oncologists, each representing one of the 11 RT centers in Nigeria (eight public and three private), were invited to complete a survey on the type, status, acquisition, and maintenance plan of existing RT equipment, cost incurred by patients for external-beam radiation (EBRT) and brachytherapy treatment, and number of patients treated per year on each machine. Type and status of equipment at nonresponding facilities were obtained through literature review and confirmed with the facility. RESULTS A total of eight (81%) respondents completed the survey, all representing public centers, three of which reported PPP use. They reported 11 megavoltage units in total (seven linear accelerators [LINACs] and four Cobalt-60s) and 10 brachytherapy afterloaders. Of those, 57% (4/7) of the LINACs, 100% (4/4) of the Cobalt-60s, and 63% (7/11) of the afterloaders were in clinical use. All commissioned equipment supported by PPPs (three LINACs and one afterloader) were in operation. The public EBRT equipment were nonfunctional 35% of the year (resulting in 60% fewer patients treated per year). The PPP EBRT and afterloaders did not experience any periods of breakdown, but PPP costs were 338% higher than public equipment. CONCLUSION This study characterizes the use of PPP as a more reliable method of RT delivery in Nigeria, albeit at higher costs.
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Affiliation(s)
| | - Abiola Ibraheem
- Section of Hematology Oncology, University of Chicago, Chicago, IL
| | - Kenneth Nwankwo
- Department of Radiation Medicine, College of Medicine, University of Nigeria, Nsukka, Nigeria
| | - Nwamaka Lasebikan
- Department of Radiation Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Musa Ali-Gombe
- Radiology Department, Gombe State University, Gombe, Gombe State, Nigeria
| | - Usman Malami Aliyu
- Department of Radiotherapy and Oncology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Sokoto State, Nigeria
| | - Emmanuel Ikhile
- Department of Radiation Oncology, University of Benin Teaching Hospital, Benin, Edo State, Nigeria
| | | | - Adamu Abdullahi
- Department of Radiotherapy and Oncology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
| | - Ann H Klopp
- Division of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Kathleen Schmeler
- Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lilie L Lin
- Division of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Anuja Jhingran
- Division of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Brandi R Page
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jim Leng
- The University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Surbhi Grover
- Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania; Botswana-UPENN Partnership, Gaborone, Botswana
| | - Atara Ntekim
- Department of Radiation Oncology, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
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9
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Nicholas SE, Fu W, Liang AL, DeLuna R, Vujaskovic L, Bishop J, Page BR, Quon H, Gourin C, Fakhry C, Eisele D, Kiess AP. Radiation Therapy After Surgical Resection Improves Outcomes for Patients With Recurrent Pleomorphic Adenoma. Adv Radiat Oncol 2021; 6:100674. [PMID: 34195493 PMCID: PMC8233456 DOI: 10.1016/j.adro.2021.100674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 01/22/2021] [Accepted: 02/03/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose Pleomorphic adenoma is a benign salivary tumor that may recur multifocally. In case series, the benefit of radiation therapy (RT) for recurrent pleomorphic adenoma remains unclear. We hypothesized that the combination of surgery and adjuvant RT reduces risk of subsequent recurrence compared with surgery alone for recurrent pleomorphic adenoma. Methods and Materials Patients who received diagnoses of recurrent pleomorphic adenoma between 1980 and 2016 were identified using an institutional pathology database. Medical records were retrospectively reviewed to determine clinical, operative, pathologic, and imaging characteristics. Kaplan-Meier methods were used to estimate local control after surgery, stratified by completeness of resection and receipt of adjuvant RT. The association of variables with risk of subsequent local recurrence was analyzed using Cox proportional hazards model, and variance estimates were calculated to account for multiple recurrences in the same patient. Toxicities were prospectively recorded in a departmental database. Results A total of 49 patients presented with at least 1 recurrence, of which 28 were managed with surgery alone, and 21 were treated with surgery and RT. The median follow-up time after the initial recurrence was 48 months (range, 6-531 months). There were 35 subsequent recurrences; 34 after surgery alone and only 1 after surgery with RT. On multivariate analysis, adjuvant RT was associated with decreased risk of recurrence (hazard ratio, 0.09; 95% confidence interval, 0.02-0.41, P = .002), whereas increasing number of prior recurrences was associated with increased risk (hazard ratio, 1.23; 95% confidence interval, 1.13-1.35, P < .001). Common toxicities of RT included dermatitis, xerostomia, and mucositis. Conclusions For patients with recurrent pleomorphic adenoma, the addition of adjuvant RT after surgery is associated with a significant decrease in risk of subsequent tumor recurrence.
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Affiliation(s)
- Sarah E Nicholas
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Wei Fu
- Department of Biostatistics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Angela L Liang
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Regina DeLuna
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Luka Vujaskovic
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Justin Bishop
- Department of Pathology, University of Texas Southwestern, Dallas, Texas
| | - Brandi R Page
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Harry Quon
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christine Gourin
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Carole Fakhry
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David Eisele
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ana P Kiess
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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10
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Chaurasia AR, Page BR, Walker AJ, Salerno K, Camphausen K, Kwok Y, Bajaj GK, Ambrocio D, Erickson D. Lessons to Learn From a Successful Virtual Mock Oral Examination Pilot Experience. Adv Radiat Oncol 2020; 6:100534. [PMID: 32838071 PMCID: PMC7414305 DOI: 10.1016/j.adro.2020.07.011] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/09/2020] [Accepted: 07/16/2020] [Indexed: 11/15/2022] Open
Abstract
oronavirus (COVID-19) has caused marked impact on graduate medical education for all medical specialties. Radiation Oncology and the American Board of Radiology have also had to rapidly adapt to converting education and examinations to virtual platforms. We describe our small pilot experience in transitioning our in-person mock oral examinations to a virtual platform. Survey-based assessment revealed excellent feedback regarding ease of use and educational usefulness. Our mock oral examinations pilot experience adds to evidence that virtual mock oral examinations are an important considerationfor Radiation Oncology education and a feasible alternative to an in-person oral examination.
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Affiliation(s)
- Avinash R. Chaurasia
- National Capital Consortium Radiation Oncology Residency, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Radiation Oncology Service, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Brandi R. Page
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Amanda J. Walker
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Kilian Salerno
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Kevin Camphausen
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Young Kwok
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Gopal K. Bajaj
- Center for Advanced Radiation Oncology and Proton Therapy, Inova Schar Cancer Institute, Fairfax, Virginia
| | - Daisy Ambrocio
- National Capital Consortium Radiation Oncology Residency, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Delnora Erickson
- National Capital Consortium Radiation Oncology Residency, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Radiation Oncology Service, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Maryland
- Corresponding author: Delnora Erickson, MD
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11
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McTyre ER, Soike MH, Farris M, Ayala-Peacock DN, Hepel JT, Page BR, Shen C, Kleinberg L, Contessa JN, Corso C, Chiang V, Henson-Masters A, Cramer CK, Ruiz J, Pasche B, Watabe K, D'Agostino R, Su J, Laxton AW, Tatter SB, Fiveash JB, Ahluwalia M, Kotecha R, Chao ST, Braunstein SE, Attia A, Chung C, Chan MD. Multi-institutional validation of brain metastasis velocity, a recently defined predictor of outcomes following stereotactic radiosurgery. Radiother Oncol 2019; 142:168-174. [PMID: 31526671 DOI: 10.1016/j.radonc.2019.08.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Brain metastasis velocity (BMV) is a prognostic metric that describes the recurrence rate of new brain metastases after initial treatment with radiosurgery (SRS). We have previously risk stratified patients into high, intermediate, and low-risk BMV groups, which correlates with overall survival (OS). We sought to externally validate BMV in a multi-institutional setting. METHODS Patients from nine academic centers were treated with upfront SRS; the validation cohort consisted of data from eight institutions not previously used to define BMV. Patients were classified by BMV into low (<4 BMV), intermediate (4-13 BMV), and high-risk groups (>13 BMV). Time-to-event outcomes were estimated using the Kaplan-Meier method. Cox proportional hazards methods were used to estimate the effect of BMV and salvage modality on OS. RESULTS Of 2829 patients, 2092 patients were included in the validation dataset. Of these, 921 (44.0%) experienced distant brain failure (DBF). Median OS from initial SRS was 11.2 mo. Median OS for BMV < 4, BMV 4-13, and BMV > 13 were 12.5 mo, 7.0 mo, and 4.6 mo (p < 0.0001). After multivariate regression modeling, melanoma histology (β: 10.10, SE: 1.89, p < 0.0001) and number of initial brain metastases (β: 1.52, SE: 0.34, p < 0.0001) remained predictive of BMV (adjusted R2 = 0.06). CONCLUSIONS This multi-institutional dataset validates BMV as a predictor of OS following initial SRS. BMV is being utilized in upcoming multi-institutional randomized controlled trials as a stratification variable for salvage whole brain radiation versus salvage SRS after DBF.
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Affiliation(s)
- Emory R McTyre
- Department of Radiation Oncology, Greenville Health System Cancer Institute, USA
| | - Michael H Soike
- Hazelrig-Salter Radiation Oncology Center, University of Alabama at Birmingham, USA.
| | - Michael Farris
- Department of Radiation Oncology, Wake Forest School of Medicine, USA
| | | | - Jaroslaw T Hepel
- Department of Radiation Oncology, Brown University Alpert Medical School, USA
| | - Brandi R Page
- Department of Radiation Oncology, Johns Hopkins School of Medicine, USA
| | - Colette Shen
- Department of Radiation Oncology, University of North Carolina, USA
| | | | | | | | | | | | | | - Jimmy Ruiz
- Department of Medicine, Wake Forest School of Medicine, USA
| | - Boris Pasche
- Department of Medicine, Wake Forest School of Medicine, USA
| | - Kounosuke Watabe
- Department of Cancer Biology, Wake Forest School of Medicine, USA
| | - Ralph D'Agostino
- Department of Biostatistical Sciences, Wake Forest School of Medicine, USA
| | - Jing Su
- Department of Biostatistical Sciences, Wake Forest School of Medicine, USA
| | - Adrian W Laxton
- Department of Neurosurgery, Wake Forest School of Medicine, USA
| | | | - John B Fiveash
- Hazelrig-Salter Radiation Oncology Center, University of Alabama at Birmingham, USA
| | - Manmeet Ahluwalia
- Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic Foundation, USA
| | - Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, USA
| | - Samuel T Chao
- Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic Foundation, USA
| | - Steve E Braunstein
- Department of Radiation Oncology, University of California San Francisco, USA
| | - Albert Attia
- Department of Radiation Oncology, Vanderbilt University School of Medicine, USA
| | - Caroline Chung
- Department of Radiation Oncology, M.D. Anderson Cancer Center, USA
| | - Michael D Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, USA
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12
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Hughes RT, Masters AH, McTyre ER, Farris MK, Chung C, Page BR, Kleinberg LR, Hepel J, Contessa JN, Chiang V, Ruiz J, Watabe K, Su J, Fiveash JB, Braunstein S, Chao S, Attia A, Ayala-Peacock DN, Chan MD. Initial SRS for Patients With 5 to 15 Brain Metastases: Results of a Multi-Institutional Experience. Int J Radiat Oncol Biol Phys 2019; 104:1091-1098. [DOI: 10.1016/j.ijrobp.2019.03.052] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/05/2019] [Accepted: 03/25/2019] [Indexed: 01/24/2023]
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13
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Han P, Lakshminarayanan P, Jiang W, Shpitser I, Hui X, Lee SH, Cheng Z, Guo Y, Taylor RH, Siddiqui SA, Bowers M, Sheikh K, Kiess A, Page BR, Lee J, Quon H, McNutt TR. Dose/Volume histogram patterns in Salivary Gland subvolumes influence xerostomia injury and recovery. Sci Rep 2019; 9:3616. [PMID: 30837617 PMCID: PMC6401158 DOI: 10.1038/s41598-019-40228-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 01/28/2019] [Indexed: 01/29/2023] Open
Abstract
Xerostomia is a common consequence of radiotherapy in head and neck cancer. The objective was to compare the regional radiation dose distribution in patients that developed xerostomia within 6 months of radiotherapy and those recovered from xerostomia within 18 months post-radiotherapy. We developed a feature generation pipeline to extract dose volume histogram features from geometrically defined ipsilateral/contralateral parotid glands, submandibular glands, and oral cavity surrogates for each patient. Permutation tests with multiple comparisons were performed to assess the dose difference between injury vs. non-injury and recovery vs. non-recovery. Ridge logistic regression models were applied to predict injury and recovery using clinical features along with dose features (D10-D90) of the subvolumes extracted from oral cavity and salivary gland contours + 3 mm peripheral shell. Model performances were assessed by the area under the receiver operating characteristic curve (AUC) using nested cross-validation. We found that different regional dose/volume metrics patterns exist for injury vs. recovery. Compared to injury, recovery has increased importance to the subvolumes receiving lower dose. Within the subvolumes, injury tends to have increased importance towards D10 from D90. This suggests that different threshold for xerostomia injury and recovery. Injury is induced by the subvolumes receiving higher dose, and the ability to recover can be preserved by further reducing the dose to subvolumes receiving lower dose.
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Affiliation(s)
- Peijin Han
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA.
| | - Pranav Lakshminarayanan
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Wei Jiang
- Department of Civil Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Ilya Shpitser
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
| | - Xuan Hui
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Sang Ho Lee
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Zhi Cheng
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Yue Guo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Russell H Taylor
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
| | - Sauleh A Siddiqui
- Department of Civil Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Michael Bowers
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Khadija Sheikh
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Ana Kiess
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Brandi R Page
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Junghoon Lee
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Harry Quon
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Todd R McNutt
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
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14
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Rao AD, Nicholas SE, Kachniarz B, Hu C, Redmond KJ, Deville C, Wright JL, Page BR, Terezakis S, Viswanathan AN, DeWeese TL, Fivush BA, Alcorn SR. Association of a Simulated Institutional Gender Equity Initiative With Gender-Based Disparities in Medical School Faculty Salaries and Promotions. JAMA Netw Open 2018; 1:e186054. [PMID: 30646313 PMCID: PMC6324345 DOI: 10.1001/jamanetworkopen.2018.6054] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Despite progress in narrowing gender-based salary gaps, notable disparities persist in the scientific community. The significance of pay difference may be underestimated, with little data evaluating its effect on lifetime wealth after accounting for factors like time to promotion and savings. OBJECTIVES To characterize gender disparities in salary and assess the outcomes associated with a gender equity initiative (GEI). DESIGN, SETTING, AND PARTICIPANTS Quality improvement study with simulations of salary and additional accumulated wealth (AAW) using retrospectively reviewed Johns Hopkins University School of Medicine annual salary and promotion data. All academic faculty were included in the faculty salary analysis from 2005 (n = 1481) and 2016 (n = 1885). MAIN OUTCOMES AND MEASURES Salary and longitudinal promotion data from 2005 to 2016 were used to estimate gender-based differences in salary and time to promotion. The effect of these differences on total salary and AAW, including retirement and salary-based investments, was simulated for a representative male and female faculty member over a 30-year career in 3 scenarios: (1) pre-GEI, (2) post-GEI, and (3) in real time for GEI, beginning with and progressing through these initiatives. RESULTS Analyses of salaries of 1481 faculty (432 women) in 2005 and 1885 faculty (742 women) in 2016 revealed that a decade after GEI implementation, the overall mean (SE) salary gap by gender decreased from -2.6% (1.2%) (95% CI, -5.6% to -0.3%) to -1.9% (1.1%) (95% CI, -4.1% to 0.3%). Simulation of pre-GEI disparities correlated with male faculty collecting an average lifetime AAW of $501 416 more than the equivalent woman, with disparities persisting past retirement. The AAW gap decreased to $210 829 in the real-time GEI simulation and to $66 104 using post-GEI conditions, reflecting success of GEI efforts. CONCLUSIONS AND RELEVANCE Even small gender-based salary gaps are associated with substantial differences in lifetime wealth, but an institutional commitment to achieving equitable promotion and compensation for women can appreciably reduce these disparities. The findings of this study support broad implementation of similar initiatives without delay, as results may take more than a decade to emerge. A modifiable version of the simulation is provided so that external users may assess the potential disparities present within their own institutions.
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Affiliation(s)
- Avani D. Rao
- Department of Radiation and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sarah E. Nicholas
- Department of Radiation and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bartlomiej Kachniarz
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chen Hu
- Department of Oncology—Biostatistics and Bioinformatics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kristin J. Redmond
- Department of Radiation and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Curtiland Deville
- Department of Radiation and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jean L. Wright
- Department of Radiation and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brandi R. Page
- Department of Radiation and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephanie Terezakis
- Department of Radiation and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Akila N. Viswanathan
- Department of Radiation and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Theodore L. DeWeese
- Department of Radiation and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Barbara A. Fivush
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sara R. Alcorn
- Department of Radiation and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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15
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Cheng Z, Nakatsugawa M, Hu C, Robertson SP, Hui X, Moore JA, Bowers MR, Kiess AP, Page BR, Burns L, Muse M, Choflet A, Sakaue K, Sugiyama S, Utsunomiya K, Wong JW, McNutt TR, Quon H. Evaluation of classification and regression tree (CART) model in weight loss prediction following head and neck cancer radiation therapy. Adv Radiat Oncol 2018; 3:346-355. [PMID: 30197940 PMCID: PMC6127872 DOI: 10.1016/j.adro.2017.11.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 10/02/2017] [Accepted: 11/30/2017] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE We explore whether a knowledge-discovery approach building a Classification and Regression Tree (CART) prediction model for weight loss (WL) in head and neck cancer (HNC) patients treated with radiation therapy (RT) is feasible. METHODS AND MATERIALS HNC patients from 2007 to 2015 were identified from a prospectively collected database Oncospace. Two prediction models at different time points were developed to predict weight loss ≥5 kg at 3 months post-RT by CART algorithm: (1) during RT planning using patient demographic, delineated dose data, planning target volume-organs at risk shape relationships data and (2) at the end of treatment (EOT) using additional on-treatment toxicities and quality of life data. RESULTS Among 391 patients identified, WL predictors during RT planning were International Classification of Diseases diagnosis; dose to masticatory and superior constrictor muscles, larynx, and parotid; and age. At EOT, patient-reported oral intake, diagnosis, N stage, nausea, pain, dose to larynx, parotid, and low-dose planning target volume-larynx distance were significant predictive factors. The area under the curve during RT and EOT was 0.773 and 0.821, respectively. CONCLUSIONS We demonstrate the feasibility and potential value of an informatics infrastructure that has facilitated insight into the prediction of WL using the CART algorithm. The prediction accuracy significantly improved with the inclusion of additional treatment-related data and has the potential to be leveraged as a strategy to develop a learning health system.
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Affiliation(s)
- Zhi Cheng
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Minoru Nakatsugawa
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
- Toshiba America Research, Inc., Baltimore, Maryland
| | - Chen Hu
- Oncology Center—Biostatistics/Bioinformatics, Johns Hopkins University, Baltimore, Maryland
| | - Scott P. Robertson
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Xuan Hui
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Joseph A. Moore
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Michael R. Bowers
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Ana P. Kiess
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Brandi R. Page
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Laura Burns
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Mariah Muse
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Amanda Choflet
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | | | | | | | - John W. Wong
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Todd R. McNutt
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Harry Quon
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
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16
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McClelland S, Page BR, Jaboin JJ, Chapman CH, Deville C, Thomas CR. (P49) The Pervasive Crisis of Diminishing Radiotherapy Access for African-Americans in the United States. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.02.137] [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: 10/17/2022]
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17
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Alphonse-Sullivan N, Taksler GB, Lycan T, Weaver KE, McTyre ER, Shenker RF, Page BR, Isom S, Johnson A, Munley MT, Laxton AW, Tatter SB, Watabe K, Chan MD, Ruiz J. Sociodemographic predictors of patients with brain metastases treated with stereotactic radiosurgery. Oncotarget 2017; 8:101005-101011. [PMID: 29254141 PMCID: PMC5731851 DOI: 10.18632/oncotarget.22291] [Citation(s) in RCA: 7] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 10/13/2017] [Indexed: 11/26/2022] Open
Abstract
Background Patient sociodemographic factors such income, race, health insurance coverage, and rural residence impact a variety of outcomes in patients with cancer. The role of brain metastasis at presentation and its subsequent outcomes have not been well characterized in this patient population. Results Multivariate analysis revealed that median income lower than $50,000 was associated with higher presenting symptom grade for brain metastasis (mean RTOG grade 1.2 vs 1.0, SE = 0.1, p = 0.04) and higher chronic symptom grade (mean RTOG grade 1.3 vs 0.9, SE = 0.1, p = 0.002). Higher area-level median income was associated with a lower symptom grade at diagnosis of brain metastasis (p = 0.0008) and likelihood of hospitalization (p = 0.004). Other sociodemographic factors were not significantly associated with survival, neurologic death, or patterns of failure after stereotactic radiosurgery for brain metastases. Conclusions Lower median income was associated with a greater symptom burden at the time of diagnosis and need for hospitalization for patients with brain metastases, suggesting a delayed time to presentation. These differences in symptom burden persisted during treatment. Methods Between January 2000 and December 2013, we identified 737 patients treated with stereotactic radiosurgery for brain metastases. They were characterized by 4 sociodemographic factors: median income, race, rural-urban residence, and health insurance status. Clinical outcomes included stage at diagnosis, symptom grade at presentation, likelihood of hospitalization from brain metastasis, overall survival, local failure, distant brain failure, and neurologic death. Multivariate cox proportional hazards model for each outcome was performed controlling for age, sex, number of brain metastases, and dose to brain metastases.
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Affiliation(s)
| | - Glen B Taksler
- Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Thomas Lycan
- Department of Medicine (Hematology and Oncology), Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Emory R McTyre
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Brandi R Page
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Scott Isom
- Division of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Adam Johnson
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael T Munley
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Adrian W Laxton
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Stephen B Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kounosuke Watabe
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael D Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jimmy Ruiz
- Department of Medicine (Hematology and Oncology), Wake Forest School of Medicine, Winston-Salem, NC, USA
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Ayala-Peacock DN, Attia A, Braunstein SE, Ahluwalia MS, Hepel J, Chung C, Contessa J, McTyre E, Peiffer AM, Lucas JT, Isom S, Pajewski NM, Kotecha R, Stavas MJ, Page BR, Kleinberg L, Shen C, Taylor RB, Onyeuku NE, Hyde AT, Gorovets D, Chao ST, Corso C, Ruiz J, Watabe K, Tatter SB, Zadeh G, Chiang VLS, Fiveash JB, Chan MD. Prediction of new brain metastases after radiosurgery: validation and analysis of performance of a multi-institutional nomogram. J Neurooncol 2017; 135:403-411. [PMID: 28828698 DOI: 10.1007/s11060-017-2588-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 07/23/2017] [Indexed: 11/27/2022]
Abstract
Stereotactic radiosurgery (SRS) without whole brain radiotherapy (WBRT) for brain metastases can avoid WBRT toxicities, but with risk of subsequent distant brain failure (DBF). Sole use of number of metastases to triage patients may be an unrefined method. Data on 1354 patients treated with SRS monotherapy from 2000 to 2013 for new brain metastases was collected across eight academic centers. The cohort was divided into training and validation datasets and a prognostic model was developed for time to DBF. We then evaluated the discrimination and calibration of the model within the validation dataset, and confirmed its performance with an independent contemporary cohort. Number of metastases (≥8, HR 3.53 p = 0.0001), minimum margin dose (HR 1.07 p = 0.0033), and melanoma histology (HR 1.45, p = 0.0187) were associated with DBF. A prognostic index derived from the training dataset exhibited ability to discriminate patients' DBF risk within the validation dataset (c-index = 0.631) and Heller's explained relative risk (HERR) = 0.173 (SE = 0.048). Absolute number of metastases was evaluated for its ability to predict DBF in the derivation and validation datasets, and was inferior to the nomogram. A nomogram high-risk threshold yielding a 2.1-fold increased need for early WBRT was identified. Nomogram values also correlated to number of brain metastases at time of failure (r = 0.38, p < 0.0001). We present a multi-institutionally validated prognostic model and nomogram to predict risk of DBF and guide risk-stratification of patients who are appropriate candidates for radiosurgery versus upfront WBRT.
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Affiliation(s)
- Diandra N Ayala-Peacock
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
- Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, TN, USA.
| | - Albert Attia
- Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Steve E Braunstein
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Manmeet S Ahluwalia
- Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Jaroslaw Hepel
- Department of Radiation Oncology, Brown University Alpert Medical School, Providence, RI, USA
| | - Caroline Chung
- Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, ON, Canada
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Joseph Contessa
- Department of Therapeutic Radiology/Radiation Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - Emory McTyre
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ann M Peiffer
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - John T Lucas
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Scott Isom
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Nicholas M Pajewski
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Rupesh Kotecha
- Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Mark J Stavas
- Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Brandi R Page
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - Lawrence Kleinberg
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - Colette Shen
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - Robert B Taylor
- Department of Radiation Oncology, University of Alabama-Birmingham, Birmingham, AL, USA
| | - Nasarachi E Onyeuku
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Andrew T Hyde
- Department of Radiation Oncology, University of Alabama-Birmingham, Birmingham, AL, USA
| | - Daniel Gorovets
- Department of Radiation Oncology, Brown University Alpert Medical School, Providence, RI, USA
| | - Samuel T Chao
- Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Christopher Corso
- Department of Therapeutic Radiology/Radiation Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - Jimmy Ruiz
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kounosuke Watabe
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Stephen B Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Gelareh Zadeh
- Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
| | - Veronica L S Chiang
- Department of Therapeutic Radiology/Radiation Oncology, Yale University School of Medicine, New Haven, CT, USA
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - John B Fiveash
- Department of Radiation Oncology, University of Alabama-Birmingham, Birmingham, AL, USA
| | - Michael D Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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McClelland S, Page BR, Jaboin JJ, Chapman CH, Deville C, Thomas CR. The pervasive crisis of diminishing radiation therapy access for vulnerable populations in the United States, part 1: African-American patients. Adv Radiat Oncol 2017; 2:523-531. [PMID: 29204518 PMCID: PMC5707425 DOI: 10.1016/j.adro.2017.07.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/03/2017] [Accepted: 07/11/2017] [Indexed: 01/05/2023] Open
Abstract
Introduction African Americans experience the highest burden of cancer incidence and mortality in the United States and have been persistently less likely to receive interventional care, even when such care has been proven superior to conservative management by randomized controlled trials. The presence of disparities in access to radiation therapy (RT) for African American cancer patients has rarely been examined in an expansive fashion. Methods and materials An extensive literature search was performed using the PubMed database to examine studies investigating disparities in RT access for African Americans. Results A total of 55 studies were found, spanning 11 organ systems. Disparities in access to RT for African Americans were most prominently study in cancers of the breast (23 studies), prostate (7 studies), gynecologic system (5 studies), and hematologic system (5 studies). Disparities in RT access for African Americans were prevalent regardless of organ system studied and often occurred independently of socioeconomic status. Fifty of 55 studies (91%) involved analysis of a population-based database such as Surveillance, Epidemiology and End Result (SEER; 26 studies), SEER-Medicare (5 studies), National Cancer Database (3 studies), or a state tumor registry (13 studies). Conclusions African Americans in the United States have diminished access to RT compared with Caucasian patients, independent of but often in concert with low socioeconomic status. These findings underscore the importance of finding systemic and systematic solutions to address these inequalities to reduce the barriers that patient race provides in receipt of optimal cancer care.
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Affiliation(s)
- Shearwood McClelland
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon
| | - Brandi R Page
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Jerry J Jaboin
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon
| | - Christina H Chapman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon
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Abstract
OBJECTIVE Review of the literature regarding hearing loss in patients with head and neck cancer treated with chemoradiation. DESIGN Studies in the literature are reviewed that pertain to hearing loss sustained in head and neck cancer patients receiving cisplatin-based chemoradiation. Personal observations noted while treating these patients are also detailed. STUDY SAMPLE PubMed was searched for pertinent articles regarding hearing loss in head and neck cancer patients receiving cisplatin chemotherapy and/or radiation. RESULTS Studies on the incidence and severity of hearing loss in head and neck cancer patients are limited, but those studies suggest that the risk of hearing loss is greater with higher-dose regimens. CONCLUSIONS Newer cisplatin chemotherapy regimens using lower, weekly doses may be associated with a lower incidence and severity of hearing loss; however, large prospective studies are needed. Such information will be paramount to effective pre-treatment counselling of head and neck cancer patients.
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Affiliation(s)
- Nicole C Schmitt
- a Office of the Clinical Director , National Institute on Deafness and Other Communication Disorders, National Institutes of Health , Bethesda , MD , USA.,b Department of Otolaryngology - Head and Neck Surgery , Johns Hopkins University , Baltimore , MD , USA , and
| | - Brandi R Page
- c Department of Radiation Oncology and Molecular Sciences , Johns Hopkins University , Baltimore , MD , USA
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21
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Chen L, Shen C, Redmond KJ, Page BR, Kummerlowe M, Mcnutt T, Bettegowda C, Rigamonti D, Lim M, Kleinberg L. Use of Stereotactic Radiosurgery in Elderly and Very Elderly Patients With Brain Metastases to Limit Toxicity Associated With Whole Brain Radiation Therapy. Int J Radiat Oncol Biol Phys 2017; 98:939-947. [DOI: 10.1016/j.ijrobp.2017.02.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 02/02/2017] [Accepted: 02/14/2017] [Indexed: 11/30/2022]
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22
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Anakwenze CP, Ntekim A, Trock B, Uwadiae IB, Page BR. Barriers to radiotherapy access at the University College Hospital in Ibadan, Nigeria. Clin Transl Radiat Oncol 2017; 5:1-5. [PMID: 29594210 PMCID: PMC5833915 DOI: 10.1016/j.ctro.2017.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 05/20/2017] [Accepted: 05/28/2017] [Indexed: 11/28/2022] Open
Abstract
Introduction Nigeria has the biggest gap between radiotherapy availability and need, with one machine per 19.4 million people, compared to one machine per 250,000 people in high-income countries. This study aims to identify its patient-level barriers to radiotherapy access. Material and methods This was a cross sectional study consisting of patient questionnaires (n = 50) conducted in January 2016 to assess patient demographics, types of cancers seen, barriers to receiving radiotherapy, health beliefs and practices, and factors leading to treatment delay. Results Eighty percent of patients could not afford radiotherapy without financial assistance and only 6% of the patients had federal insurance, which did not cover radiotherapy services. Of the patients who had completed radiotherapy treatment, 91.3% had experienced treatment delay or often cancellation due to healthcare worker strike, power failure, machine breakdown, or prolonged wait time. The timeliness of a patient’s radiotherapy care correlated with their employment status and distance from radiotherapy center (p < 0.05). Conclusions Barriers to care at a radiotherapy center in a low- and middle-income country (LMIC) have previously not been well characterized. These findings can be used to inform efforts to expand the availability of radiotherapy and improve current treatment capacity in Nigeria and in other LMICs.
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Affiliation(s)
- Chidinma P Anakwenze
- University of Alabama Birmingham School of Medicine, Birmingham, AL, United States.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Atara Ntekim
- College of Medicine, University of Ibadan, Ibadan, Nigeria.,University College Hospital, Ibadan, Nigeria
| | - Bruce Trock
- James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD, United States
| | | | - Brandi R Page
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
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23
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Wang EC, Huang AJ, Huang KE, McTyre ER, Lo HW, Watabe K, Metheny-Barlow L, Laxton AW, Tatter SB, Strowd RE, Chan MD, Page BR. Leptomeningeal failure in patients with breast cancer receiving stereotactic radiosurgery for brain metastases. J Clin Neurosci 2017; 43:6-10. [PMID: 28511975 DOI: 10.1016/j.jocn.2017.04.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 04/22/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Prior studies suggest a high incidence of leptomeningeal failure (LMF) in breast cancer metastatic to brain. This study examines breast cancer-specific variables affecting development of LMF and survival after Gamma-Knife Radiosurgery (GKS). METHODS Between 2000-2010, 149 (breast) and 658 other-histology patients were treated with GKS. Hormone/HER2, age, local/distant brain failure, prior craniotomy, and prior whole-brain radiotherapy (WBRT) were assessed. Median follow-up was 54months (range, 0-106). Serial MRI determined local and distant-brain failure and LMF. Statistical analysis with categorical/continuous data comparisons were done with Fisher's-exact, Wilcoxon rank-sum, log-rank tests, and Cox-Proportional Hazard models. RESULTS Of 149 patients, 21 (14%) developed LMF (median time of 11.9months). None of the following predicted for LMF: Her2-status (HR=0.49, p=0.16), hormone-receptor status (HR=1.15, p=0.79), prior craniotomy (HR=1.58, p=0.42), prior WBRT (HR=1.36, p=0.55). Non-significant factors between patients that did (n=21) and did not (n=106) develop LMF included neurologic death (p=0.34) and median survival (8.6 vs 14.2months, respectively). Breast patients who had distant-failure after GKS (65/149; 43.6%) were more likely to later develop LMF (HR 4.2, p=0.005); including 15/65 (23%) patients who had distant-failure and developed LMF. Median time-to-death for patients experiencing LMF was 6.1months (IQR 3.4-7.8) from onset of LMF. Median survival from LMF to death was much longer in breast (6.1months) than in other (1.7months) histologies CONCLUSION: Breast cancer patients had a longer survival after diagnosis of LMF versus other histologies. Neither ER/PR/HER2 status, nor prior surgery or prior WBRT predicted for development of LMF in breast patients.
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Affiliation(s)
- Edina C Wang
- Department of Radiation Oncology, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston Salem, NC 27157, USA
| | - Andrew J Huang
- Department of Radiation Oncology, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston Salem, NC 27157, USA
| | - Karen E Huang
- Department of Radiation Oncology, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston Salem, NC 27157, USA
| | - Emory R McTyre
- Department of Radiation Oncology, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston Salem, NC 27157, USA
| | - Hui-Wen Lo
- Department of Cancer Biology, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston Salem, NC 27157, USA
| | - Kounosuke Watabe
- Department of Cancer Biology, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston Salem, NC 27157, USA
| | - Linda Metheny-Barlow
- Department of Radiation Oncology, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston Salem, NC 27157, USA
| | - Adrian W Laxton
- Department of Neurosurgery, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston Salem, NC 27157, USA
| | - Stephen B Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston Salem, NC 27157, USA
| | - Roy E Strowd
- Department of Neurology, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston Salem, NC 27157, USA
| | - Michael D Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston Salem, NC 27157, USA
| | - Brandi R Page
- Department of Radiation Oncology, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston Salem, NC 27157, USA.
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24
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Page BR, Wang EC, White L, McTyre E, Peiffer A, Alistar A, Mu F, Loganathan A, Bourland JD, Laxton AW, Tatter SB, Chan MD. Gamma Knife radiosurgery for brain metastases from gastrointestinal primary. J Med Imaging Radiat Oncol 2017; 61:522-527. [PMID: 28139076 DOI: 10.1111/1754-9485.12584] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 07/02/2015] [Accepted: 12/11/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In this study, we assessed clinical outcomes of patients with brain metastases from a gastrointestinal (GI) primary cancer and patterns of failure after stereotactic radiosurgery including failure within the radiosurgical volume, distant failure and leptomeningeal failure (LMF). We also assessed other factors associated with the patients' neurologic and extraneuraxial disease that may affect clinical outcomes. METHODS We reviewed our institutional series of 62 consecutive patients with brain metastases treated with stereotactic radiosurgery, which included 17 patients with oesophageal, 44 patients with colorectal and one patient with anal canal primary. The median marginal dose to the radiosurgery volume was 17 Gy (range 10-24 Gy). Thirteen patients were treated with whole-brain radiotherapy (WBRT) prior to GKS. RESULTS The median dose delivered to the margin of the tumour was 17 Gy (range: 10-24 Gy). The median largest tumour diameter was 2.7 cm (range: 0.60-6.1 cm). The median overall survival (OS) was 7.1 months with a median follow-up of 6.1 months and a range of 0-31.7 months. Freedom from local failure was 86.5% and 62.2% at 6 and 12 months respectively. Freedom from distant failure was 73.2% and 42.2% at 6 and 12 months, respectively, and 40% of patients died of neurologic death. LMF occurred in seven patients, all of whom had colorectal primaries. Multivariate analysis revealed that craniotomy for resection of brain metastasis (HR = 2.63, P < 0.02), an absence of extracranial disease (HR = 2.28, P < 0.03), and prolonged time to distant brain failure (HR = 2.85, P < 0.01) predicted for improved survival. CONCLUSIONS Colorectal cancer metastases tend to have a higher rate of leptomeningeal failure than other types of GI cancer metastases. Radiosurgical management of brain metastases from GI primary represents an acceptable management option. Neurologic death remains problematic.
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Affiliation(s)
- Brandi R Page
- Department of Radiation Oncology and Molecular Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Edina C Wang
- Department of Radiation Oncology, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Lance White
- Department of Neurosurgery, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Emory McTyre
- Department of Radiation Oncology, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Ann Peiffer
- Department of Radiation Oncology, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA.,Brain Tumor Center of Excellence, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Angela Alistar
- Division of Hematology and Oncology, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Frank Mu
- Department of Radiation Oncology, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA
| | | | - John Daniel Bourland
- Department of Radiation Oncology, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA.,Brain Tumor Center of Excellence, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Adrian W Laxton
- Department of Neurosurgery, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Stephen B Tatter
- Department of Neurosurgery, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA.,Brain Tumor Center of Excellence, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Michael D Chan
- Department of Radiation Oncology, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA.,Brain Tumor Center of Excellence, Wake Forest University, Winston-Salem, North Carolina, USA
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25
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Johnson AG, Ruiz J, Hughes R, Page BR, Isom S, Lucas JT, McTyre ER, Houseknecht KW, Ayala-Peacock DN, Bourland DJ, Hinson WH, Laxton AW, Tatter SB, Debinski W, Watabe K, Chan MD. Impact of systemic targeted agents on the clinical outcomes of patients with brain metastases. Oncotarget 2016; 6:18945-55. [PMID: 26087184 PMCID: PMC4662466 DOI: 10.18632/oncotarget.4153] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [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: 01/29/2015] [Accepted: 05/18/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To determine the clinical benefits of systemic targeted agents across multiple histologies after stereotactic radiosurgery (SRS) for brain metastases. METHODS Between 2000 and 2013, 737 patients underwent upfront SRS for brain metastases. Patients were stratified by whether or not they received targeted agents with SRS. 167 (23%) received targeted agents compared to 570 (77%) that received other available treatment options. Time to event data were summarized using Kaplan-Meier plots, and the log rank test was used to determine statistical differences between groups. RESULTS Patients who received SRS with targeted agents vs those that did not had improved overall survival (65% vs. 30% at 12 months, p < 0.0001), improved freedom from local failure (94% vs 90% at 12 months, p = 0.06), improved distant failure-free survival (32% vs. 18% at 12 months, p = 0.0001) and improved freedom from whole brain radiation (88% vs. 77% at 12 months, p = 0.03). Improvement in freedom from local failure was driven by improvements seen in breast cancer (100% vs 92% at 12 months, p < 0.01), and renal cell cancer (100% vs 88%, p = 0.04). Multivariate analysis revealed that use of targeted agents improved all cause mortality (HR = 0.6, p < 0.0001). CONCLUSIONS Targeted agent use with SRS appears to improve survival and intracranial outcomes.
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Affiliation(s)
- Adam G Johnson
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jimmy Ruiz
- Department of Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA.,W.G. (Bill) Hefner Veteran Administration Medical Center, Cancer Center, Salisbury, NC, USA
| | - Ryan Hughes
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Brandi R Page
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Scott Isom
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - John T Lucas
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Emory R McTyre
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kristin W Houseknecht
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Daniel J Bourland
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - William H Hinson
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Adrian W Laxton
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Stephen B Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Waldemar Debinski
- Brain Tumor Center of Excellence, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kounosuke Watabe
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael D Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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26
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Devoid HM, McTyre ER, Page BR, Metheny-Barlow L, Ruiz J, Chan MD. Recent advances in radiosurgical management of brain metastases. Front Biosci (Schol Ed) 2016; 8:203-14. [PMID: 26709908 DOI: 10.2741/s458] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Stereotactic radiosurgery (SRS) has become a widely available treatment option for patients with brain metastases. Recent clinical trials suggest that SRS can be used without upfront whole brain radiotherapy (WBRT), resulting in several clinical dilemmas in the current daily practice of SRS. The proper patient selection for SRS or WBRT continues to evolve. Statistical models to predict when new brain metastases will occur as well as who will experience neurologic death have been developed. The optimization of imaging continues for both detection of brain metastases and response assessment. Larger brain metastases continue to pose a challenge to practitioners to find options to optimize the therapeutic ratio. The current review addresses the current state of the scientific literature for these clinical dilemmas.
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Affiliation(s)
- Hannah-Marie Devoid
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157
| | - Emory R McTyre
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157
| | - Brandi R Page
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157
| | - Linda Metheny-Barlow
- Department of Breast Cancer Center of Excellence, Wake Forest University School of Medicine, Winston-Salem, NC27157, Wake Forest University School of Medicine, Winston-Salem, NC27157
| | - Jimmy Ruiz
- Department of Medicine, Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael D Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA,
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27
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Hughes RT, Black PJ, Page BR, Lucas JT, Qasem SA, Watabe K, Ruiz J, Laxton AW, Tatter SB, Debinski W, Chan MD. Local control of brain metastases after stereotactic radiosurgery: the impact of whole brain radiotherapy and treatment paradigm. J Radiosurg SBRT 2016; 4:89-96. [PMID: 29296433 PMCID: PMC5658880] [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] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 12/04/2015] [Indexed: 06/07/2023]
Abstract
PURPOSE We investigate clinical, pathologic, and treatment paradigm-related factors affecting local control of brain metastases after stereotactic radiosurgery (SRS) with or without whole brain radiotherapy (WBRT). METHODS AND MATERIALS Patients with brain metastases treated with SRS alone, before or after WBRT were considered to determine predictors of local failure (LF), time to failure and survival. RESULTS Among 137 patients, 411 brain metastases were analyzed. 23% of patients received SRS alone, 51% received WBRT prior to SRS, and 26% received SRS followed by WBRT. LF occurred in 125 metastases: 63% after SRS alone, 20% after WBRT then SRS, and 22% after SRS then WBRT. Median time to local failure was significantly less after SRS alone compared to WBRT then SRS (12.1 v. 22.7 months, p=0.003). Tumor volume was significantly associated with LF (HR:5.2, p<0.001, 95% CI:3.4-7.8). CONCLUSIONS WBRT+SRS results in reduced LF. Local control was not significantly different after SRS as salvage therapy versus upfront SRS.
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Affiliation(s)
- Ryan T. Hughes
- Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA
| | - Paul J. Black
- Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA
| | - Brandi R. Page
- Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA
| | - John T. Lucas
- Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA
| | - Shadi A. Qasem
- Department of Pathology, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA
| | - Kounosuke Watabe
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Jimmy Ruiz
- Department of Internal Medicine-Hematology/Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA
| | - Adrian W. Laxton
- Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA
| | - Stephen B. Tatter
- Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA
| | - Waldemar Debinski
- Brain Tumor Center of Excellence, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA
| | - Michael D. Chan
- Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA
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Page BR, Shaw EG, Lu L, Bryant D, Grisell D, Lesser GJ, Monitto DC, Naughton MJ, Rapp SR, Savona SR, Shah S, Case D, Chan MD. Phase II double-blind placebo-controlled randomized study of armodafinil for brain radiation-induced fatigue. Neuro Oncol 2015; 17:1393-401. [PMID: 25972454 DOI: 10.1093/neuonc/nov084] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [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: 01/14/2015] [Accepted: 04/07/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Common acute-term side effects of brain radiotherapy (RT) include fatigue, drowsiness, decreased physical functioning, and decreased quality of life (QOL). We hypothesized that armodafinil (a wakefulness-promoting drug known to reduce fatigue and increase cognitive function in breast cancer patients receiving chemotherapy) would result in reduced fatigue and sleepiness for patients receiving brain RT. METHODS A phase II, multi-institutional, placebo-controlled randomized trial assessed feasibility of armodafinil 150 mg/day in participants receiving brain RT, from whom we obtained estimates of variability for fatigue, sleepiness, QOL, cognitive function, and treatment effect. RESULTS From September 20, 2010, to October 20, 2012, 54 participants enrolled with 80% retention and 94% self-reported compliance. There were no grade 4-5 toxicities, and the incidence of grade 2-3 toxicities was similar between treatment arms, the most common of which were anxiety and nausea (15%), headaches (19%), and insomnia (20%). There were no statistically significant differences in end-RT or 4 week post-RT outcomes between armodafinil and placebo in any outcomes (Functional Assessment of Chronic Illness Therapy [FACIT]-Fatigue, Brief Fatigue Inventory, Epworth Sleepiness Scale, FACT-Brain, and FACIT-cognitive function). However, in participants with more baseline fatigue, those treated with armodafinil did better than those who received the placebo on the end-RT assessments for several outcomes. CONCLUSION Armodafinil 150 mg/day was well tolerated in primary brain tumor patients undergoing RT with good compliance. While there was no overall significant effect on fatigue, those with greater baseline fatigue experienced improved QOL and reduced fatigue when using armodafinil. These data suggest that a prospective, phase III randomized trial is warranted for patients with greater baseline fatigue.
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Affiliation(s)
- Brandi R Page
- Department of Radiation Oncology, Medical Center Blvd, Wake Forest School of Medicine, Winston-Salem, North Carolina (B.R.P., E.G.S., M.D.C.); Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina (L.L., D.C.); Department of Medical Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (G.J.L.); Via Christi Cancer Center, Witchita, Kansas (D.B.); Greenville Health System Cancer Institute, Greenville, South Carolina (D.G.); Spartanburg Regional Healthcare System, Spartanburg, South Carolina (D.C.M.); Hofstra Northshore-LIJ School of Medicine, New Hyde Park, New York (S.R.S.); Christiana Care CCOP, Newark, Delaware (S.S.); Wake Forest University Department of Geriatric Medicine, Memory Assessment Clinic Counseling Center, Winston-Salem, North Carolina (E.G.S.); Department of Medicine, Ohio State University, Columbus, Ohio (M.J.N.); Department of Psychiatry, Wake Forest School of Medicine, Winston-Salem, North Carolina (S.R.R.)
| | - Edward G Shaw
- Department of Radiation Oncology, Medical Center Blvd, Wake Forest School of Medicine, Winston-Salem, North Carolina (B.R.P., E.G.S., M.D.C.); Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina (L.L., D.C.); Department of Medical Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (G.J.L.); Via Christi Cancer Center, Witchita, Kansas (D.B.); Greenville Health System Cancer Institute, Greenville, South Carolina (D.G.); Spartanburg Regional Healthcare System, Spartanburg, South Carolina (D.C.M.); Hofstra Northshore-LIJ School of Medicine, New Hyde Park, New York (S.R.S.); Christiana Care CCOP, Newark, Delaware (S.S.); Wake Forest University Department of Geriatric Medicine, Memory Assessment Clinic Counseling Center, Winston-Salem, North Carolina (E.G.S.); Department of Medicine, Ohio State University, Columbus, Ohio (M.J.N.); Department of Psychiatry, Wake Forest School of Medicine, Winston-Salem, North Carolina (S.R.R.)
| | - Lingyi Lu
- Department of Radiation Oncology, Medical Center Blvd, Wake Forest School of Medicine, Winston-Salem, North Carolina (B.R.P., E.G.S., M.D.C.); Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina (L.L., D.C.); Department of Medical Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (G.J.L.); Via Christi Cancer Center, Witchita, Kansas (D.B.); Greenville Health System Cancer Institute, Greenville, South Carolina (D.G.); Spartanburg Regional Healthcare System, Spartanburg, South Carolina (D.C.M.); Hofstra Northshore-LIJ School of Medicine, New Hyde Park, New York (S.R.S.); Christiana Care CCOP, Newark, Delaware (S.S.); Wake Forest University Department of Geriatric Medicine, Memory Assessment Clinic Counseling Center, Winston-Salem, North Carolina (E.G.S.); Department of Medicine, Ohio State University, Columbus, Ohio (M.J.N.); Department of Psychiatry, Wake Forest School of Medicine, Winston-Salem, North Carolina (S.R.R.)
| | - David Bryant
- Department of Radiation Oncology, Medical Center Blvd, Wake Forest School of Medicine, Winston-Salem, North Carolina (B.R.P., E.G.S., M.D.C.); Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina (L.L., D.C.); Department of Medical Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (G.J.L.); Via Christi Cancer Center, Witchita, Kansas (D.B.); Greenville Health System Cancer Institute, Greenville, South Carolina (D.G.); Spartanburg Regional Healthcare System, Spartanburg, South Carolina (D.C.M.); Hofstra Northshore-LIJ School of Medicine, New Hyde Park, New York (S.R.S.); Christiana Care CCOP, Newark, Delaware (S.S.); Wake Forest University Department of Geriatric Medicine, Memory Assessment Clinic Counseling Center, Winston-Salem, North Carolina (E.G.S.); Department of Medicine, Ohio State University, Columbus, Ohio (M.J.N.); Department of Psychiatry, Wake Forest School of Medicine, Winston-Salem, North Carolina (S.R.R.)
| | - David Grisell
- Department of Radiation Oncology, Medical Center Blvd, Wake Forest School of Medicine, Winston-Salem, North Carolina (B.R.P., E.G.S., M.D.C.); Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina (L.L., D.C.); Department of Medical Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (G.J.L.); Via Christi Cancer Center, Witchita, Kansas (D.B.); Greenville Health System Cancer Institute, Greenville, South Carolina (D.G.); Spartanburg Regional Healthcare System, Spartanburg, South Carolina (D.C.M.); Hofstra Northshore-LIJ School of Medicine, New Hyde Park, New York (S.R.S.); Christiana Care CCOP, Newark, Delaware (S.S.); Wake Forest University Department of Geriatric Medicine, Memory Assessment Clinic Counseling Center, Winston-Salem, North Carolina (E.G.S.); Department of Medicine, Ohio State University, Columbus, Ohio (M.J.N.); Department of Psychiatry, Wake Forest School of Medicine, Winston-Salem, North Carolina (S.R.R.)
| | - Glenn J Lesser
- Department of Radiation Oncology, Medical Center Blvd, Wake Forest School of Medicine, Winston-Salem, North Carolina (B.R.P., E.G.S., M.D.C.); Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina (L.L., D.C.); Department of Medical Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (G.J.L.); Via Christi Cancer Center, Witchita, Kansas (D.B.); Greenville Health System Cancer Institute, Greenville, South Carolina (D.G.); Spartanburg Regional Healthcare System, Spartanburg, South Carolina (D.C.M.); Hofstra Northshore-LIJ School of Medicine, New Hyde Park, New York (S.R.S.); Christiana Care CCOP, Newark, Delaware (S.S.); Wake Forest University Department of Geriatric Medicine, Memory Assessment Clinic Counseling Center, Winston-Salem, North Carolina (E.G.S.); Department of Medicine, Ohio State University, Columbus, Ohio (M.J.N.); Department of Psychiatry, Wake Forest School of Medicine, Winston-Salem, North Carolina (S.R.R.)
| | - Drew C Monitto
- Department of Radiation Oncology, Medical Center Blvd, Wake Forest School of Medicine, Winston-Salem, North Carolina (B.R.P., E.G.S., M.D.C.); Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina (L.L., D.C.); Department of Medical Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (G.J.L.); Via Christi Cancer Center, Witchita, Kansas (D.B.); Greenville Health System Cancer Institute, Greenville, South Carolina (D.G.); Spartanburg Regional Healthcare System, Spartanburg, South Carolina (D.C.M.); Hofstra Northshore-LIJ School of Medicine, New Hyde Park, New York (S.R.S.); Christiana Care CCOP, Newark, Delaware (S.S.); Wake Forest University Department of Geriatric Medicine, Memory Assessment Clinic Counseling Center, Winston-Salem, North Carolina (E.G.S.); Department of Medicine, Ohio State University, Columbus, Ohio (M.J.N.); Department of Psychiatry, Wake Forest School of Medicine, Winston-Salem, North Carolina (S.R.R.)
| | - Michelle J Naughton
- Department of Radiation Oncology, Medical Center Blvd, Wake Forest School of Medicine, Winston-Salem, North Carolina (B.R.P., E.G.S., M.D.C.); Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina (L.L., D.C.); Department of Medical Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (G.J.L.); Via Christi Cancer Center, Witchita, Kansas (D.B.); Greenville Health System Cancer Institute, Greenville, South Carolina (D.G.); Spartanburg Regional Healthcare System, Spartanburg, South Carolina (D.C.M.); Hofstra Northshore-LIJ School of Medicine, New Hyde Park, New York (S.R.S.); Christiana Care CCOP, Newark, Delaware (S.S.); Wake Forest University Department of Geriatric Medicine, Memory Assessment Clinic Counseling Center, Winston-Salem, North Carolina (E.G.S.); Department of Medicine, Ohio State University, Columbus, Ohio (M.J.N.); Department of Psychiatry, Wake Forest School of Medicine, Winston-Salem, North Carolina (S.R.R.)
| | - Stephen R Rapp
- Department of Radiation Oncology, Medical Center Blvd, Wake Forest School of Medicine, Winston-Salem, North Carolina (B.R.P., E.G.S., M.D.C.); Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina (L.L., D.C.); Department of Medical Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (G.J.L.); Via Christi Cancer Center, Witchita, Kansas (D.B.); Greenville Health System Cancer Institute, Greenville, South Carolina (D.G.); Spartanburg Regional Healthcare System, Spartanburg, South Carolina (D.C.M.); Hofstra Northshore-LIJ School of Medicine, New Hyde Park, New York (S.R.S.); Christiana Care CCOP, Newark, Delaware (S.S.); Wake Forest University Department of Geriatric Medicine, Memory Assessment Clinic Counseling Center, Winston-Salem, North Carolina (E.G.S.); Department of Medicine, Ohio State University, Columbus, Ohio (M.J.N.); Department of Psychiatry, Wake Forest School of Medicine, Winston-Salem, North Carolina (S.R.R.)
| | - Steven R Savona
- Department of Radiation Oncology, Medical Center Blvd, Wake Forest School of Medicine, Winston-Salem, North Carolina (B.R.P., E.G.S., M.D.C.); Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina (L.L., D.C.); Department of Medical Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (G.J.L.); Via Christi Cancer Center, Witchita, Kansas (D.B.); Greenville Health System Cancer Institute, Greenville, South Carolina (D.G.); Spartanburg Regional Healthcare System, Spartanburg, South Carolina (D.C.M.); Hofstra Northshore-LIJ School of Medicine, New Hyde Park, New York (S.R.S.); Christiana Care CCOP, Newark, Delaware (S.S.); Wake Forest University Department of Geriatric Medicine, Memory Assessment Clinic Counseling Center, Winston-Salem, North Carolina (E.G.S.); Department of Medicine, Ohio State University, Columbus, Ohio (M.J.N.); Department of Psychiatry, Wake Forest School of Medicine, Winston-Salem, North Carolina (S.R.R.)
| | - Sunjay Shah
- Department of Radiation Oncology, Medical Center Blvd, Wake Forest School of Medicine, Winston-Salem, North Carolina (B.R.P., E.G.S., M.D.C.); Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina (L.L., D.C.); Department of Medical Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (G.J.L.); Via Christi Cancer Center, Witchita, Kansas (D.B.); Greenville Health System Cancer Institute, Greenville, South Carolina (D.G.); Spartanburg Regional Healthcare System, Spartanburg, South Carolina (D.C.M.); Hofstra Northshore-LIJ School of Medicine, New Hyde Park, New York (S.R.S.); Christiana Care CCOP, Newark, Delaware (S.S.); Wake Forest University Department of Geriatric Medicine, Memory Assessment Clinic Counseling Center, Winston-Salem, North Carolina (E.G.S.); Department of Medicine, Ohio State University, Columbus, Ohio (M.J.N.); Department of Psychiatry, Wake Forest School of Medicine, Winston-Salem, North Carolina (S.R.R.)
| | - Doug Case
- Department of Radiation Oncology, Medical Center Blvd, Wake Forest School of Medicine, Winston-Salem, North Carolina (B.R.P., E.G.S., M.D.C.); Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina (L.L., D.C.); Department of Medical Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (G.J.L.); Via Christi Cancer Center, Witchita, Kansas (D.B.); Greenville Health System Cancer Institute, Greenville, South Carolina (D.G.); Spartanburg Regional Healthcare System, Spartanburg, South Carolina (D.C.M.); Hofstra Northshore-LIJ School of Medicine, New Hyde Park, New York (S.R.S.); Christiana Care CCOP, Newark, Delaware (S.S.); Wake Forest University Department of Geriatric Medicine, Memory Assessment Clinic Counseling Center, Winston-Salem, North Carolina (E.G.S.); Department of Medicine, Ohio State University, Columbus, Ohio (M.J.N.); Department of Psychiatry, Wake Forest School of Medicine, Winston-Salem, North Carolina (S.R.R.)
| | - Michael D Chan
- Department of Radiation Oncology, Medical Center Blvd, Wake Forest School of Medicine, Winston-Salem, North Carolina (B.R.P., E.G.S., M.D.C.); Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina (L.L., D.C.); Department of Medical Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (G.J.L.); Via Christi Cancer Center, Witchita, Kansas (D.B.); Greenville Health System Cancer Institute, Greenville, South Carolina (D.G.); Spartanburg Regional Healthcare System, Spartanburg, South Carolina (D.C.M.); Hofstra Northshore-LIJ School of Medicine, New Hyde Park, New York (S.R.S.); Christiana Care CCOP, Newark, Delaware (S.S.); Wake Forest University Department of Geriatric Medicine, Memory Assessment Clinic Counseling Center, Winston-Salem, North Carolina (E.G.S.); Department of Medicine, Ohio State University, Columbus, Ohio (M.J.N.); Department of Psychiatry, Wake Forest School of Medicine, Winston-Salem, North Carolina (S.R.R.)
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Page BR, Abdel-Wahab M. In Reply to Ravichandran and Ravikumar. Int J Radiat Oncol Biol Phys 2015; 91:1111. [DOI: 10.1016/j.ijrobp.2014.12.058] [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: 12/30/2014] [Accepted: 12/31/2014] [Indexed: 11/17/2022]
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Black PJ, Page BR, Lucas JT, Hughes RT, Laxton AW, Tatter SB, Munley MT, Chan MD. Factors that determine local control with gamma knife radiosurgery: The role of primary histology. J Radiosurg SBRT 2015; 3:281-286. [PMID: 26478823 PMCID: PMC4605606] [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] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 04/30/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Stereotactic radiosurgery for the treatment of brain metastases is commonly delivered without regard to primary cancer histology. This study sought to determine if the primary site of origin for brain metastases affected the propensity for local failure. METHODS A total of 83 patients with 200 brain metastases were examined retrospectively for predictors of infield failure. Tumor, patient, and treatment characteristics were analyzed including primary tumor histology, radiosurgical dose and age. Cox proportional hazards models, univariate and multivariate analyses were used to identify predictors of local failure. RESULTS Freedom from local failure for the entire population was 83% and 65% at 6 and 12 months, respectively. Multivariate analysis revealed that breast cancer brain metastases have a significantly lower risk of local failure than melanoma (HR = 0.31, p< 0.001). Additionally, multivariate analysis revealed that increasing dose lowered risk for local failure (HR = 0.87, p<0.001). CONCLUSIONS Melanoma histology leads to a higher rate of local failure. Higher prescription dose results in higher incidence of local control.
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Affiliation(s)
- Paul J. Black
- Department of Radiation Oncology, Wake Forest University, Winston-Salem, NC, USA
| | - Brandi R. Page
- Department of Radiation Oncology, Wake Forest University, Winston-Salem, NC, USA
| | - John T. Lucas
- Department of Radiation Oncology, Wake Forest University, Winston-Salem, NC, USA
| | - Ryan T. Hughes
- School of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Adrian W. Laxton
- Department of Neurosurgery, Wake Forest University, Winston-Salem, NC, USA
| | - Stephen B. Tatter
- Department of Neurosurgery, Wake Forest University, Winston-Salem, NC, USA
| | - Michael T. Munley
- Department of Radiation Oncology, Wake Forest University, Winston-Salem, NC, USA
| | - Michael D. Chan
- Department of Radiation Oncology, Wake Forest University, Winston-Salem, NC, USA
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Huang AJ, Huang KE, Page BR, Ayala-Peacock DN, Lucas JT, Lesser GJ, Laxton AW, Tatter SB, Chan MD. Risk factors for leptomeningeal carcinomatosis in patients with brain metastases who have previously undergone stereotactic radiosurgery. J Neurooncol 2014; 120:163-9. [PMID: 25048529 DOI: 10.1007/s11060-014-1539-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 07/06/2014] [Indexed: 10/25/2022]
Abstract
Our objective was to explore the hypothesis that the risk of leptomeningeal dissemination (LMD) in patients who underwent stereotactic radiosurgery (SRS) for brain metastases is influenced by the site of the primary cancer, the addition of whole brain radiation therapy (WBRT), surgical resection, and control over their systemic disease. We conducted a retrospective cohort analysis of 805 patients who were treated with SRS for brain metastases between 1999 and 2012 at the Wake Forest Baptist Medical Center, and excluded all patients with evidence of LMD before SRS. The primary outcome was LMD. Forty-nine of 795 patients developed LMD with a cumulative incidence of 6.2% (95% Confidence Interval (CI), 4.7-8.0). Median time from SRS to LMD was 7.4 months (Interquartile Range (IQR), 3.3-15.4). A colorectal primary site (Hazard Ratio (HR), 4.5; 95% CI 2.5-8.0; p < 0.0001), distant brain failure (HR, 2.0; 95% CI 1.2-3.2; p = 0.007), breast primary site (HR, 1.6; 95% CI 1.0-2.7; p = 0.05), the number of intracranial metastases at time of initial SRS (HR, 1.1; 95% CI 1.0-1.2; p = 0.02), and age (by 5-year interval) (HR, 0.9; 95% CI 0.8, 0.9; p = 0.0006) were independent factors associated with LMD. There was no evidence that surgical resection before SRS altered the risk of LMD (HR, 1.1; 95 % CI 0.6-2.0, p = 0.78). In patients who underwent SRS for brain metastases, a colorectal or breast primary site, distant brain failure, younger age, and an increased number of intracranial metastases were independently associated with LMD. Given its relative rarity as an outcome, multi-institutional prospective studies will likely be necessary to validate and quantify these relationships.
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Affiliation(s)
- Andrew J Huang
- Department of Radiation Oncology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA,
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Page BR, Hudson AD, Brown DW, Shulman AC, Abdel-Wahab M, Fisher BJ, Patel S. Cobalt, Linac, or Other: What Is the Best Solution for Radiation Therapy in Developing Countries? Int J Radiat Oncol Biol Phys 2014; 89:476-80. [DOI: 10.1016/j.ijrobp.2013.12.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 12/08/2013] [Accepted: 12/16/2013] [Indexed: 10/25/2022]
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Ayer A, Page BR, Lucas JT, Bourland JD, Oliver ER, Tatter SB, Ellis TL, Chan MD. Cavernous sinus metastases treated with gamma knife TM stereotactic radiosurgery. J Radiosurg SBRT 2014; 3:131-137. [PMID: 29296394 PMCID: PMC5675485] [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] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 04/22/2014] [Indexed: 06/07/2023]
Abstract
BACKGROUND Cavernous sinus metastases represent difficult clinical scenarios because of the lack of surgical options. We investigate the use of Gamma Knife stereotactic radiosurgery (GKRS) as a treatment option of these metastases. OBJECTIVES To determine the patterns of failure for cavernous sinus metastases and to identify factors that predict for improved outcomes. METHODS This is a retrospective review of 19 patients treated with GKRS for cavernous sinus metastases over a 9-year period between May 2002 and October 2011. The median marginal tumor dose was 18 Gy. Patients were followed with serial imaging. Kaplan Meier analysis was used to estimate local control and overall survival. Fischer exact test was used to determine any predictive factors for local control or survival. RESULTS Median follow-up time was 22.4 months. Kaplan Meier estimate of overall survival at 1, 2, and 4 years was 76%, 44%, and 44% survival, respectively. 11 patients experienced intracranial failure. Of these, 7 (64%) were local and 4 (36%) were distant intracranial failures. Local control was 76%, 44%, and 44% at 1, 2 and 4 years, respectively. Six of seven local failures in the series were considered to be marginal failures because they were abutting the 50% isodose volume. Head and neck primary tumors were associated with 86% of local failures (P = 0.017) and was the only factor that predicted for local failure. CONCLUSIONS GKRS appears to be a feasible and safe modality for treatment of cavernous sinus metastases. Local failures appear to be due to a marginal miss of microscopically occult disease.
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Affiliation(s)
- Amit Ayer
- Department of Neurosurgery, Northwestern University, Chicago, Illinois, USA
| | - Brandi R. Page
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - John T. Lucas
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - J. Daniel Bourland
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Eric R. Oliver
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Stephen B. Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Thomas L. Ellis
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael D. Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Abstract
OBJECTIVE Hajdu-Cheney syndrome (HCS), first described in 1948 by Hajdu and independently in 1965 by Cheney, is an extremely rare disorder characterized by severe and excessive bone resorption leading to osteoporosis, with a wide range of other systemic complications from connective tissue and bone dysplasia. Currently there are approximately 50 distinct cases reported in the literature. There have been several reports associating polycystic kidneys with HCS and several other connective tissue disorders, suggesting a possibility of a hyperproliferative component to the syndrome. No articles exist in the current literature describing a case of HCS with concurrent carcinoma. Here, we present a case of a 54-year-old nonimmune compromised woman with multiple stigmata of HCS and recently diagnosed anal squamous cell carcinoma. METHOD This is a case report of HCS and stage T3N0 squamous cell carcinoma of the anus. RESULTS This is the first report of a patient with HCS with malignancy. CONCLUSIONS We present a patient with HCS who developed anal squamous cell carcinoma. The mechanism of HCS, which is still unknown, may either make patients more susceptible to carcinoma or may just be a reflection of the normal incidence of anal squamous cell carcinoma given attributable risk factors.
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Affiliation(s)
- B R Page
- Radiation Medicine, Oregon Health and Science University, Portland, Oregon 97239-3098 , USA
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Gagnon PJ, Galderisi C, Page BR, Holland JM. Angiosarcoma developing after curative induction chemotherapy and radiotherapy for locally advanced squamous cell carcinoma of the larynx. Head Neck 2008; 31:829-32. [PMID: 18853452 DOI: 10.1002/hed.20929] [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: 11/07/2022] Open
Abstract
BACKGROUND Angiosarcoma arising after radiation is described in breast cancer but occurs elsewhere. Here, we present an angiosarcoma of the neck occurring after curative chemoradiation. METHODS This is a case of angiosarcoma developing 5 years after curative therapy for T3N0 squamous cell carcinoma of the supraglottic larynx. Therapy consisted of 3 cycles of induction cisplatin/5-fluorouracil chemotherapy followed by radiotherapy. The patient did well until developing a rapidly progressive lesion of the left neck. Examination showed a 7-cm mass and biopsy revealed angiosarcoma. CT scans assessed the local extent of the tumor and ruled out metastatic disease prior to initiating therapy. RESULTS Therapy consisted of 4 cycles of paclitaxel chemotherapy. At completion, examination revealed mild induration of the neck with near-complete resolution of the mass. Imaging confirmed this excellent response. CONCLUSION This rare therapy-related second malignancy developed after curative larynx-preserving treatment. Paclitaxel was an effective therapy in this setting.
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Affiliation(s)
- Patrick J Gagnon
- Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon, USA
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Page BR. Streamlining mail services. Leadersh Health Serv 1993; 2:47. [PMID: 10125213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Affiliation(s)
- B R Page
- Chedoke-McMaster Hospitals, Hamilton, Ontario
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Page BR. A joint venture of a different kind. Dimens Health Serv 1990; 67:29-30. [PMID: 2262096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- B R Page
- Chedoke-McMaster Hospital, Hamilton, Ont
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