1
|
Beltrán Ponce S, Katz LM, Seldon C. Achieving the Unachievable: Work-Life Balance in Radiation Oncology. Pract Radiat Oncol 2023; 13:486-487. [PMID: 37665310 DOI: 10.1016/j.prro.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 09/05/2023]
Abstract
As radiation oncologists, we often participate in discussions on work-life balance, are offered lectures and free meals, and complete hospital-mandated modules, all under the guise of physician wellness. But how often are these measures efficacious? How do we define being well in our demanding and fast-paced careers? What does it actually look like on a day-to-day basis to achieve work-life balance? Furthermore, is it even possible?
Collapse
Affiliation(s)
- Sara Beltrán Ponce
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Leah M Katz
- Department of Radiation Oncology, Columbia University Medical Center, New York, New York.
| | - Crystal Seldon
- Department of Radiation Oncology, Miller School of Medicine, University of Miami, Miami, Florida
| |
Collapse
|
2
|
Seldon C, Grossman JG, Shrivastava G, Fernandez M, Jin W, Conaway S, Rosenberg A, Livingstone A, Franceschi D, Jonczak E, Trent J, Subhawong T, Studenski MT, Yechieli R. CivaSheet® use for soft tissue sarcoma: A single institution experience. Brachytherapy 2023; 22:649-654. [PMID: 37271655 DOI: 10.1016/j.brachy.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 02/28/2023] [Accepted: 03/05/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE CivaSheet is a palladium-103, implantable, intraoperative radiation therapy device which emits unidirectional radiation that enables boost doses in patients who have otherwise received the maximum radiation dose. Here, we present our initial clinical experience with the first 10 cases using this new technology. METHODS AND MATERIALS A retrospective chart review of all patients with STS treated with surgical resection and CivaSheet placement at the University of Miami Hospital, a tertiary care center, from January 2018 to December 2019, was performed. Adjuvant radiation was administered by a palladium-103 implant, which delivered an average of 47 Gy (35-55) to a depth of 5 mm. RESULTS Nine patients underwent CivaSheet placement from January 2018 until December 2019 for a total of 10 CivaSheets placed (1 patient had 2 CivaSheets inserted) and followed for a mean of 27 months (4-45 months). Four tumors were located in the retroperitoneum, two in the chest, two in the groin, and two within the lower extremity. At the time of tumor resection and CivaSheet placement, tumor sizes ranged from 2.5 cm to 13.8 cm with an average of 7.6 cm. Four patients necessitated musculocutaneous tissue flaps for closure and reconstruction. All patients with Grade 4 complications had flap reconstruction and prior radiation. Four patients' tumors recurred locally for a local recurrence rate of 40%. Three patients had modified accordion Grade 4 complications necessitating additional surgery for CivaSheet removal. Extremity tumors unanimously developed modified accordion Grade 4 adverse events. CONCLUSIONS CivaSheet may be an acceptable alternative treatment modality compared to prior brachytherapy methods.
Collapse
Affiliation(s)
- Crystal Seldon
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Julie G Grossman
- Department of Surgical Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Gautam Shrivastava
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Melanie Fernandez
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - William Jin
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Sheila Conaway
- Department of Orthopedic Surgery, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Andrew Rosenberg
- Department of Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Alan Livingstone
- Department of Surgical Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Dido Franceschi
- Department of Surgical Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Emily Jonczak
- Department of Hematology Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Jonathan Trent
- Department of Hematology Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Ty Subhawong
- Department of Radiology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Matthew T Studenski
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Raphael Yechieli
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL.
| |
Collapse
|
3
|
De Ornelas M, Iorio GC, Bossart E, Ricardi U, Seldon C, Dal Pra A, Butkus M. Bone marrow sparing in prostate cancer patients treated with Post-operative pelvic nodal radiotherapy - A proton versus photon comparison. Phys Med 2023; 112:102644. [PMID: 37487297 DOI: 10.1016/j.ejmp.2023.102644] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 05/19/2023] [Accepted: 07/07/2023] [Indexed: 07/26/2023] Open
Abstract
PURPOSE Extending salvage radiotherapy to treat the pelvic lymph nodes (PLNRT) improves oncologic outcomes in prostate cancer (PCa). However, a larger treatment volume increases the extent of bone marrow (BM) exposure, which is associated with hematologic toxicity (HT). Given the potential long-term impact of BM dose in PCa, clinical studies on BM sparing (BMS) are warranted. Herein, we dosimetrically compared photon and proton plans for BMS. MATERIALS AND METHODS Treatment plans of 20 post-operative PCa patients treated with volumetric-modulated arc photon therapy (VMAT) PLNRT were retrospectively identified. Contours were added for the whole pelvis BM (WPBM) and BM sub-volumes: lumbar-sacral (LSBM), iliac (ILBM), and lower pelvis (LPBM). Three additional plans were created: VMAT_BMS, intensity-modulated proton therapy (IMPT), and IMPT_BMS. Normal tissue complication probabilities (NTCP) for grade >3 hematologic toxicity (HT3+) were calculated for the WPBM volumes. RESULTS Compared to the original VMAT plan, mean doses to all BM sub-volumes were statistically significantly lower for VMAT_BMS, IMPT, and IMPT_BMS resulting in average NTCP percentages of 20.5 ± 5.9, 10.7 ± 4.2, 6.1 ± 2.0, and 2.5 ± 0.6, respectively. IMPT_BMS had significantly lower low dose metrics (V300cGy-V2000cGy) for WPBM and sub-volumes except for LPBM V2000cGy compared to VMAT_BMS and ILBM V20Gy compared to IMPT. In most cases, V4000cGy and V5000cGy within ILBM and LSBM were significantly higher for IMPT plans compared to VMAT plans. CONCLUSIONS BMS plans are achievable with VMAT and IMPT without compromising target coverage or OARs constraints. IMPT plans were overall better at reducing mean and NTCP for HT3+ as well as low dose volumes to BM. However, IMPT had larger high dose volumes within LSBM and ILBM. Further studies are warranted to evaluate the clinical implications of these findings.
Collapse
Affiliation(s)
- Mariluz De Ornelas
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL, USA.
| | | | - Elizabeth Bossart
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Umberto Ricardi
- Department of Oncology, University of Torino, 10125 Torino, Italy
| | - Crystal Seldon
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Alan Dal Pra
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Michael Butkus
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL, USA
| |
Collapse
|
4
|
Baniel CC, Ponce SB, Lichter KE, Peters GW, Small C, Seldon C, Nguyen KT, Khan AF, Thomas CR, Small W, Kahn JM, Olivier KR, Masters AH, Barry PN, Pollom EL, Jagsi R. Society for Women in Radiation Oncology Consensus Statement on Family and Medical Leave. Int J Radiat Oncol Biol Phys 2023; 116:270-275. [PMID: 37179087 DOI: 10.1016/j.ijrobp.2022.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/15/2022] [Accepted: 12/12/2022] [Indexed: 05/15/2023]
Affiliation(s)
- Claire Christine Baniel
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California.
| | - Sara Beltrán Ponce
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Katie E Lichter
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Gabrielle W Peters
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Christina Small
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Crystal Seldon
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Katarina T Nguyen
- Department of Radiation Oncology, University of Rochester, Rochester, New York
| | | | - Charles R Thomas
- Department of Radiation Oncology, Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - William Small
- Department of Radiation Oncology, Stritch School of Medicine, Loyola University, Chicago, Illinois
| | - Jenna M Kahn
- Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon
| | | | - Adrianna Henson Masters
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Parul N Barry
- Department of Radiation Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Erqi L Pollom
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Reshma Jagsi
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| |
Collapse
|
5
|
Ponce SB, Seldon C, Yanagihara TK, Horowitz D, Yu JB, Kachnic L, Katz LM. Crazy Busy: The Blurring of Personal and Professional Boundaries as a Diversity, Equity, and Inclusion Issue. Int J Radiat Oncol Biol Phys 2023; 116:276-279. [PMID: 37179088 DOI: 10.1016/j.ijrobp.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 12/20/2022] [Accepted: 01/07/2023] [Indexed: 05/15/2023]
Affiliation(s)
- Sara Beltran Ponce
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Crystal Seldon
- Department of Radiation Oncology, University of Miami/Jackson Memorial Hospital Radiation Oncology, Miami, Florida
| | - Ted K Yanagihara
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - David Horowitz
- Department of Radiation Oncology, Columbia University Medical Center, New York, New York
| | - James B Yu
- Department of Radiation Oncology, Columbia University Medical Center, New York, New York
| | - Lisa Kachnic
- Department of Radiation Oncology, Columbia University Medical Center, New York, New York
| | - Leah M Katz
- Department of Radiation Oncology, Columbia University Medical Center, New York, New York.
| |
Collapse
|
6
|
Sivakumar S, Lee JK, Moore JA, Hopkins J, Newberg JY, Madison R, Graf R, Schrock AB, Kobetz E, Vince R, Franco I, Seldon C, Frampton GM, Mills J, Venstrom J, Mahal BA. Comprehensive genomic profiling and treatment patterns across ancestries in advanced prostate cancer: a large-scale retrospective analysis. Lancet Digit Health 2023; 5:e380-e389. [PMID: 37236698 DOI: 10.1016/s2589-7500(23)00053-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 01/31/2023] [Accepted: 02/28/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Men of African ancestry experience the greatest burden of prostate cancer globally, but they are under-represented in genomic and precision medicine studies. Therefore, we sought to characterise the genomic landscape, comprehensive genomic profiling (CGP) utilisation patterns, and treatment patterns across ancestries in a large, diverse, advanced prostate cancer cohort, to determine the impact of genomics on ancestral disparities. METHODS In this large-scale retrospective analysis, the CGP-based genomic landscape was evaluated in biopsy sections from 11 741 patients with prostate cancer, with ancestry inferred using a single nucleotide polymorphism-based approach. Admixture-derived ancestry fractions for each patient were also interrogated. Independently, clinical and treatment information was retrospectively reviewed for 1234 patients in a de-identified US-based clinicogenomic database. Prevalence of gene alterations, including actionable gene alterations, was assessed across ancestries (n=11 741). Furthermore, real-world treatment patterns and overall survival was assessed in the subset of patients with linked clincogenomic information (n=1234). FINDINGS The CGP cohort included 1422 (12%) men of African ancestry and 9244 (79%) men of European ancestry; the clinicogenomic database cohort included 130 (11%) men of African ancestry and 1017 (82%) men of European ancestry. Men of African ancestry received more lines of therapy before CGP than men of European ancestry (median of two lines [IQR 0-8] vs one line [0-10], p=0·029). In genomic analyses, ancestry-specific mutational landscapes were observed, but the prevalence of alterations in AR, the DNA damage response pathway, and other actionable genes were similar across ancestries. Similar genomic landscapes were observed in analyses that accounted for admixture-derived ancestry fractions. After undergoing CGP, men of African ancestry were less likely to receive a clinical study drug compared with men of European ancestry (12 [10%] of 118 vs 246 [26%] of 938, p=0·0005). INTERPRETATION Similar rates of gene alterations with therapy implications suggest that differences in actionable genes (including AR and DNA damage response pathway genes) might not be a main driver of disparities across ancestries in advanced prostate cancer. Later CGP utilisation and a lower rate of clinical trial enrolment observed in men of African ancestry could affect genomics, outcomes, and disparities. FUNDING American Society for Radiation Oncology, Department of Defense, Flatiron Health, Foundation Medicine, Prostate Cancer Foundation, and Sylvester Comprehensive Cancer Center.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Ryon Graf
- Foundation Medicine, Cambridge, MA, USA
| | | | - Erin Kobetz
- University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | | | | | - Crystal Seldon
- University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | | | | | | | - Brandon A Mahal
- University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA.
| |
Collapse
|
7
|
Alshalalfa M, Nguyen TT, Stopsack KH, Khan A, Franco I, Seldon C, Swami N, Jin W, Meiyappan K, Ton M, Venstrom JM, Dee EC, Mahal BA. Chromosome 8q arm overexpression is associated with worse prostate cancer prognosis. Urol Oncol 2023; 41:106.e17-106.e23. [PMID: 36400666 PMCID: PMC10700008 DOI: 10.1016/j.urolonc.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/23/2022] [Accepted: 10/03/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Chromosome 8q arm (chr8q) is the most amplified chromosomal segment in advanced metastatic castration-resistant prostate cancer after chXq12. These regions harbor important oncogenes driving prostate cancer progression, including MYC that plays a role in various hallmarks of cancer, including cell cycle progression and immune surveillance. Herein we characterize the co-expression patterns of chr8q genes and their clinical utility in more than 7,000 radical prostatectomy samples. MATERIALS AND METHODS Copy Number alterations of 336 genes on chr8q21 to chr8q24 were extracted from 2 primary prostate cancer cohorts (TCGA, n = 492; MSK-primary, n = 856) and 3 metastatic prostate cancer cohorts (MSK-met, N = 432; MSK-mCSPC, N = 424; SU2CPNAS, n = 444) from cBioPortal. Expression data for the 336 genes was extracted from 6,135 radical prostatectomy samples from Decipher GRID registry. For survival analysis, patients were grouped into top 10% and top 25% by band expression and were compared with the remaining cohort. Hazard ratios were calculated using Cox proportional hazards models. RESULTS Genes on chr8q were highly co-amplified and co-expressed. Copy number alterations and overexpression of chr8q genes in primary disease were associated with higher Gleason scores, increased risk of metastases, and increased prostate cancer specific mortality. Additionally, our data demonstrated high expression of MYC alone was not associated with differences in metastases free survival while high expression of other chr8q bands was associated with decreased metastases free survival. By combining chr8q data with an established genomic classifier like Decipher, we were able to develop a new model that was better at predicting metastases than Decipher alone. CONCLUSIONS Our findings highlight the clinical utility of chr8q data, which can be used to improve prognostication and risk prediction in localized prostate cancer.
Collapse
Affiliation(s)
- Mohammed Alshalalfa
- University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL
| | - Tiffany T Nguyen
- University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL
| | - Konrad H Stopsack
- Harvard T.H. Chan School of Public Health, Boston, MA; Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Anwar Khan
- University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL
| | - Idalid Franco
- Department of Radiation Oncology, Dana Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
| | - Crystal Seldon
- Department of Radiation Oncology, University of Miami/Jackson Memorial Hospital, Miami, FL
| | - Nishwant Swami
- Harvard T.H. Chan School of Public Health, Boston, MA; University of Massachusetts Chan Medical School, Worcester, MA
| | - William Jin
- Department of Radiation Oncology, University of Miami/Jackson Memorial Hospital, Miami, FL
| | - Karthik Meiyappan
- University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL
| | - Minh Ton
- University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL
| | | | | | - Brandon A Mahal
- Department of Radiation Oncology, University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL.
| |
Collapse
|
8
|
Seldon C, Gamwo B, Jaboin J, Iheagwara U, Barry P, McClelland S. In Regard to Papadakos et al. Int J Radiat Oncol Biol Phys 2023; 115:259-260. [PMID: 36526393 DOI: 10.1016/j.ijrobp.2022.09.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/24/2022] [Accepted: 09/08/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Crystal Seldon
- Department of Radiation Oncology, University of Miami/Jackson Memorial Hospital Radiation Oncology, Miami, Florida
| | - Bryan Gamwo
- College of Medicine, Drexel University, Philadelphia, Pennsylvania
| | - Jerry Jaboin
- Department of Radiation Oncology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | - Uzoma Iheagwara
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Parul Barry
- Department of Radiation Oncology, UPMC Hillman Cancer Center Pittsburgh, Pennsylvania
| | - Shearwood McClelland
- Departments of Radiation Oncology and Neurosurgery, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio
| |
Collapse
|
9
|
Seldon C, Gamwo B, Jaboin J, Iheagwara U, Barry P, McClelland S. In Reply to Onal et al. Int J Radiat Oncol Biol Phys 2023; 115:254-255. [DOI: 10.1016/j.ijrobp.2022.10.006] [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: 10/02/2022] [Accepted: 10/03/2022] [Indexed: 12/15/2022]
|
10
|
Ogunmuyiwa J, Ponce SB, Seldon C, Paradis K, Khan A, Dyer M, Barry PN, Saeed H, Kahn JM, Yorke AA. WeWhoCurie: An Initiative to Advocate for Those Underrepresented in Radiation Oncology. Adv Radiat Oncol 2022; 8:101136. [PMID: 36632090 PMCID: PMC9827353 DOI: 10.1016/j.adro.2022.101136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 11/16/2022] [Indexed: 12/14/2022] Open
Abstract
Purpose An initiative to advocate for those underrepresented in radiation oncology. Methods and Materials Inspired by the success of the #ILookLikeAnEngineer and #ILookLikeASurgeon campaigns, this initiative aimed to break down stereotypes in traditionally male-dominated fields. In honor of Marie Curie's birthday, on November 7, 2018, the Society for Women in Radiation Oncology launched a social media campaign called #WomenWhoCurie day. However, as the popularity of the social media campaign increased, it become evident that members of the wider radiation community, in particular women of color, nonbinary and transgender people did not feel supported by the #WomenWhoCurie movement. In November 2021, after consultation with diversity and inclusion leaders and members of other national radiation oncology organizations, Society for Women in Radiation Oncology launched #WeWhoCurie alongside the #WomenWhoCurie campaign for women and gender minorities in radiation oncology. Radiation oncologists, physicists, dosimetrist, therapists, nurses, and other professionals from around the world gathered and shared photos and social media posts throughout the day on multiple platforms including Facebook, Instagram, and Twitter. Results In the year #WeWhoCurie, #WomenWhoCurie, #_______ WhoCurie campaign launched, we saw an increase in participation across the globe from 9 countries: the United States, Canada, Mexico, Brazil, Italy, Spain, China, New Zealand, and Australia. There were over 720 tweets contributing to the campaign with over 2000 messages, representing 3,365,444 "potential impacts", or the number of times someone saw the hashtag. Conclusions Through this campaign we aim to celebrate the incredible women, gender minorities, and allies who are "Curie-ing" patients with cancer and conducting cutting edge research to improve cancer care across the globe. As an organization we believe adding our voices to the masses will foster a culture of inclusion for everyone. Afterall, what good is the practice of radiation oncology if all are not equally welcome?
Collapse
Affiliation(s)
- Joy Ogunmuyiwa
- New York-Presbyterian Brooklyn Methodist Hospital, Department of Radiation Oncology, Brooklyn, New York
| | - Sara Beltrán Ponce
- Medical College of Wisconsin, Department of Radiation Oncology, Milwaukee, Wisconsin
| | - Crystal Seldon
- University of Miami/Sylvester Comprehensive Cancer Center, Department of Radiation Oncology, Miami, Florida
| | - Kelly Paradis
- Michigan Medicine, Department of Radiation Oncology, Ann Arbor, Michigan
| | - Amanda Khan
- Tom Baker Cancer Center, University of Calgary, Alberta, Canada
| | - Michael Dyer
- Dana-Farber/Brigham & Women's Cancer Center, Department of Radiation Oncology and Harvard Medical School, Boston, Massachusetts
| | - Parul N. Barry
- UPMC Hillman Cancer Center, Department of Radiation Oncology, Pittsburgh, Pennsylvania
| | - Hina Saeed
- Lynn Cancer Institute, Department of Radiation Oncology, Baptist Health South Florida, Boca Raton, Florida
| | - Jenna M. Kahn
- Oregon Health and Science University, Department of Radiation Medicine, Portland, Oregon
| | - Afua A. Yorke
- University of Washington, Department of Radiation Oncology, Seattle, Washington.,Corresponding author: Afua A. Yorke, PhD
| |
Collapse
|
11
|
Ponce SB, Bajaj A, Baniel C, Seldon C, Sim A, Franco I, Pinnix C, Fields E, Jimenez RB. Protecting our Patients and Trainees: The Complex Consequences of the Dobbs v. Jackson Women's Health Organization Ruling. Int J Radiat Oncol Biol Phys 2022; 114:393-395. [PMID: 35963469 DOI: 10.1016/j.ijrobp.2022.07.1846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 07/30/2022] [Indexed: 10/31/2022]
Affiliation(s)
- Sara Beltrán Ponce
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Amishi Bajaj
- Department of Radiation Oncology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Claire Baniel
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, California
| | - Crystal Seldon
- Department of Radiation Oncology, University of Miami/Jackson Memorial Hospital Radiation Oncology, Miami, Florida
| | - Austin Sim
- Department of Radiation Oncology, Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Idalid Franco
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Chelsea Pinnix
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Emma Fields
- Department of Radiation Oncology, Virginia Commonwealth University Health Sciences, Richmond, Virginia
| | - Rachel B Jimenez
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
| |
Collapse
|
12
|
Evans SB, Blitzblau RC, Chapman CH, Chollet-Lipscomb C, Deville C, Ford E, Gibbs IC, Howell K, Peters GW, Ponce SB, Seldon C, Spector-Bagdady K, Tarbell N, Terezakis S, Vyfhius MAL, Wright J, Zietman A, Jagsi R. Restricted Access to Abortion, the Dobbs Ruling, and Radiation Oncology: Standing United Against Reproductive Injustice. Int J Radiat Oncol Biol Phys 2022; 114:385-389. [PMID: 35963470 DOI: 10.1016/j.ijrobp.2022.07.1843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 07/28/2022] [Accepted: 07/28/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Suzanne B Evans
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut.
| | - Rachel C Blitzblau
- Department of Radiation Oncology, Duke University, Durham, North Carolina; Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | | | | | - Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric Ford
- Department of Radiation Oncology, University Of Washington, Seattle, Washington
| | - Iris C Gibbs
- Stanford Medicine, School of Medicine, Stanford Cancer Institute, Stanford University, Stanford, California
| | - Krisha Howell
- Department of Radiation Oncology, Fox Chase Cancer Center, Temple Health, Philadelphia, Pennsylvania
| | - Gabrielle W Peters
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Sara Beltrán Ponce
- Medical College of Wisconsin Department of Radiation Oncology, Milwaukee, Wisconsin
| | - Crystal Seldon
- Department of Radiation Oncology, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Kayte Spector-Bagdady
- Center for Bioethics & Social Sciences in Medicine and the Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Nancy Tarbell
- Department of Radiation Oncology, Harvard Medical School and Mass General Hospital, Boston, Massachusetts
| | - Stephanie Terezakis
- University of Minnesota, Department of Radiation Oncology, Minneapolis, Minnesota
| | - Melissa A L Vyfhius
- University of Maryland School of Medicine, Chesapeake Oncology and Hematology Associates, Department of Radiation Oncology, Glen Burnie, Maryland
| | - Jean Wright
- Department of Radiation Oncology, University Of Washington, Seattle, Washington
| | - Anthony Zietman
- Department of Radiation Oncology, Harvard Medical School and Mass General Hospital, Boston, Massachusetts
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan
| |
Collapse
|
13
|
Jin WH, Seldon C, Butkus M, Sauerwein W, Giap HB. A Review of Boron Neutron Capture Therapy: Its History and Current Challenges. Int J Part Ther 2022; 9:71-82. [PMID: 35774489 PMCID: PMC9238127 DOI: 10.14338/ijpt-22-00002.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/21/2022] [Indexed: 11/25/2022] Open
Abstract
Mechanism of Action External beam, whether with photons or particles, remains as the most common type of radiation therapy. The main drawback is that radiation deposits dose in healthy tissue before reaching its target. Boron neutron capture therapy (BNCT) is based on the nuclear capture and fission reactions that occur when 10B is irradiated with low-energy (0.0025 eV) thermal neutrons. The resulting 10B(n,α)7Li capture reaction produces high linear energy transfer (LET) α particles, helium nuclei (4He), and recoiling lithium-7 (7Li) atoms. The short range (5-9 μm) of the α particles limits the destructive effects within the boron-containing cells. In theory, BNCT can selectively destroy malignant cells while sparing adjacent normal tissue at the cellular levels by delivering a single fraction of radiation with high LET particles. History BNCT has been around for many decades. Early studies were promising for patients with malignant brain tumors, recurrent tumors of the head and neck, and cutaneous melanomas; however, there were certain limitations to its widespread adoption and use. Current Limitations and Prospects Recently, BNCT re-emerged owing to several developments: (1) small footprint accelerator-based neutron sources; (2) high specificity third-generation boron carriers based on monoclonal antibodies, nanoparticles, among others; and (3) treatment planning software and patient positioning devices that optimize treatment delivery and consistency.
Collapse
Affiliation(s)
- Will H Jin
- Department of Radiation Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami Health Systems, Miami, FL, USA
| | - Crystal Seldon
- Department of Radiation Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami Health Systems, Miami, FL, USA
| | - Michael Butkus
- Department of Radiation Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami Health Systems, Miami, FL, USA
| | - Wolfgang Sauerwein
- Deutsche Gesellschaft für Bor-Neutroneneinfangtherapie (DGBNCT), Universitätsklinikum Essen, Essen, Germany
| | - Huan B Giap
- Department of Radiation Oncology, Nancy N. and J. C. Lewis Cancer & Research Pavilion, Savannah, GA, USA
| |
Collapse
|
14
|
Soni YS, Rich BJ, Kwon D, Zhao W, John DL, Seldon C, Meshman J, Benveniste R, Komotar RJ, de la Fuente M, Guillermo Prieto MDP, Azzam G, Mellon EA, Benjamin CG, Diwanji T. Factors associated with the use of salvage whole brain radiation therapy versus salvage stereotactic radiosurgery after initial stereotactic radiosurgery for brain metastases. J Radiosurg SBRT 2022; 8:85-94. [PMID: 36275132 PMCID: PMC9489072] [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: 02/11/2022] [Accepted: 06/29/2022] [Indexed: 01/03/2023]
Abstract
Objectives Patients undergoing stereotactic radiosurgery (SRS) for brain metastases require additional radiation for relapse. Our objective is to determine the factors associated with salvage SRS versus whole brain radiation therapy (WBRT) for salvage of first intracranial failure (ICF) after upfront SRS. Method We identified a cohort of 110 patients with brain metastases treated with SRS in the definitive or postoperative setting followed by subsequent salvage WBRT or SRS at least one month after initial SRS. Clinical and demographic characteristics were retrospectively recorded. Results 78 Patients received SRS and 32 patients received WBRT at the time of first ICF. On multivariate analysis (MVA) factors associated with decreased use of salvage SRS were male gender (p=0.044) and local progression (p<0.001). Conclusions Local progression and male gender were the strongest factors associated with selection of salvage WBRT. Possible etiologies of this difference could be provider or patient driven, but warrant further exploration.
Collapse
Affiliation(s)
- Yash S. Soni
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Benjamin J. Rich
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Deukwoo Kwon
- Department of Public Health Sciences, Biostatistics and Bioinformatics Shared Resource, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Wei Zhao
- Department of Public Health Sciences, Biostatistics and Bioinformatics Shared Resource, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Danny L. John
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Crystal Seldon
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jessica Meshman
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ronald Benveniste
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ricardo J. Komotar
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Macarena de la Fuente
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Gregory Azzam
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eric A. Mellon
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Carolina G. Benjamin
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tejan Diwanji
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA, Department of Radiation Oncology, Mid-Atlantic Permanente Medical Group, Halethorpe, MD, USA
| |
Collapse
|
15
|
Odei BC, Seldon C, Fernandez M, Rooney MK, Bae J, Acheampong J, Ahmed A. Representation of Women in the Leadership Structure of the US Health Care System. JAMA Netw Open 2021; 4:e2136358. [PMID: 34842928 PMCID: PMC8630566 DOI: 10.1001/jamanetworkopen.2021.36358] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This cross-sectional study evaluates the gender distribution among chief executives and senior leaders at US health care organizations.
Collapse
Affiliation(s)
| | - Crystal Seldon
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | | | | | - Junu Bae
- The Ohio State University School of Medicine, Columbus
| | | | - Awad Ahmed
- MultiCare Tacoma General Hospital, Tacoma, Washington
| |
Collapse
|
16
|
Seldon C, Shrivastava G, Al-Awady A, Asher D, Ramey S, Fernandez M, Dooley S, Kwon D, Zhao W, Goel N, Diwanji T, Subhawong T, Trent J, Yechieli R. Variation in Management of Extremity Soft-Tissue Sarcoma in Younger vs Older Adults. JAMA Netw Open 2021; 4:e2120951. [PMID: 34415314 PMCID: PMC8379652 DOI: 10.1001/jamanetworkopen.2021.20951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE A large proportion of extremity soft-tissue sarcomas (ESS) occur among young adults, yet this group is underrepresented in clinical trials, resulting in limited data on this population. Younger patients present many complex challenges that affect clinical management. OBJECTIVE To investigate variations in treatment management in young adults vs older adults with ESS. DESIGN, SETTING, AND PARTICIPANTS This multicenter retrospective cohort study used the National Cancer Data Base (NCDB) to identify patients 18 years and older with ESS who received definitive treatment (ie, limb-sparing surgery [LSS] or amputation) between 2004 and 2014. Data analysis was conducted in November 2019. EXPOSURES Treatment regimen received among young adults (aged 18-39 years) and older adults (≥40 years) after diagnosis with ESS. MAIN OUTCOMES AND MEASURES To detect unique factors associated with treatment decisions in young adults with ESS, multivariable analyses used logistic regressions for patterns of treatment and their association with demographic factors and tumor characteristics. RESULTS Overall, 8953 patients were identified, and among these, 1280 (14.3%) were young adults. From the full cohort, 4796 patients (53.6%) identified as male and 6615 (73.9%) identified as non-Hispanic White. More young adults than older adults underwent amputation (age 18-39 years, 104 of 1280 [8.1%]; age 40-64 years, 217 of 3937 [5.5%]; aged ≥65 years, 199 of 3736 [5.3%]), but the association was not statistically significant (age ≥65 years, odds ratio [OR], 1.49; 95% CI, 1.00-2.23; P = .05). Young adults were more likely to receive chemotherapy than older patients (age 40-65 years, OR, 0.52; 95% CI, 0.45-0.60; P = .001; ≥65 years, OR, 0.16; 95% CI, 0.12-0.20; P = .001). Conversely, young adults were less likely to receive radiation therapy compared with older patients (age 40-65 years, OR, 1.40; 95% CI, 1.22-1.61; P = .001; ≥65 years, OR, 1.33; 95% CI, 1.10-1.61; P = .003). Unique to younger adults, clinical stage II disease vs stage I and positive surgical margins were not associated with use of radiation therapy (stage II disease: OR, 1.25; 95% CI, 0.81-1.91; P = .31; positive surgical margins: OR, 1.43; 95% CI, 0.93-2.22; P = .11). White Hispanic young adults were less likely than non-Hispanic White young adults to receive radiation therapy (OR, 0.53; 95% CI, 0.36-0.78; P = .002). CONCLUSIONS AND RELEVANCE In this study, young adults with ESS were more likely to receive chemotherapy and less likely to receive radiation therapy than older adults. Further study is warranted to identify the clinical outcomes of these practice disparities.
Collapse
Affiliation(s)
- Crystal Seldon
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Gautam Shrivastava
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | | | - David Asher
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Stephen Ramey
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Melanie Fernandez
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Sarah Dooley
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Deukwoo Kwon
- Biostatistics and Bioinformatics Shared Resource, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Wei Zhao
- Biostatistics and Bioinformatics Shared Resource, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Neha Goel
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Tejan Diwanji
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Ty Subhawong
- Department of Radiology, University of Miami, Miami, Florida
| | - Jonathan Trent
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Raphael Yechieli
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| |
Collapse
|
17
|
Grosso J, Subhawong T, Stoyanova R, Yechieli R, Seldon C, Prosperi B. Abstract PO-027: Associations of radiomics features with tumor necrosis following chemotherapy and/or radiation therapy in patients with extremity soft tissue sarcoma. Clin Cancer Res 2021. [DOI: 10.1158/1557-3265.adi21-po-027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introductory sentence: The purpose of this study is to identify MRI radiomic features of sarcomas pre and post treatment with radiation and/or chemotherapy that correlate with the level of necrosis demonstrated on pathology report upon tumor excision. Experimental procedures: Patients with soft tissue upper and lower extremity sarcomas and available pre- and post-treatment MRI exams were included in the study. For the purposes of this study we utilized T2 fat saturated imaging sequences. We employed MINT Lesion radiomics software for extraction of quantitative imaging data. The lesions Regions of Interest (ROIs) were manually contoured MRI scans before and after chemotherapy and/or radiation therapy. Following treatment, patients had their tumors excised with corresponding tumor necrosis data recorded. Using Pearson correlation statistics, the percent necrosis was compared to radiomic changes (delta-radiomics). Summary of data: Fifty-two patients, treated between 2012 and 2020 were included in the study. The clinical characteristics were: male – (56%) and female- (44%); type of sarcomas ranged from Liposarcoma, Leiomyosarcoma, Myxofibrosarcoma, among others; Grade 2-3; Treatment with radiation and/or chemotherapy of different doses and regimens. MRIs were acquired within 3 months before initiation of treatment and within 2 months after treatment. Surgery was subsequently performed within 2 months of last MRI scan. The average necrosis on final pathology was 68% +/- 33% std. Total of 41 radiomic features were extracted from the ROIs. Five of the delta-radiomics parameters were significantly correlated with necrosis (p-value < 0.05) and sixteen were marginally associated (p-value < 0.1). The significantly correlated radiomic features includes first and second order values representing the distribution of voxel intensities within the segmented image regions and the statistical inter-relationships between neighboring voxels, respectively. Conclusions: In this pilot study we identified delta-radiomics features, related to first order radiomic data, or increased voxel intensity, and second order radiomics, or increased vowel heterogeneity, associated with the level of necrosis within sarcomas post radiation and/or chemotherapy. This data will be followed up with larger patient samples and including additional sequences for delta-radiomics analysis, such as Diffusion Weighted Imaging and Dynamic Enhanced Contrast to develop prediction models for necrosis levels.
Citation Format: James Grosso, Ty Subhawong, Radka Stoyanova, Raphael Yechieli, Crystal Seldon, Blase Prosperi. Associations of radiomics features with tumor necrosis following chemotherapy and/or radiation therapy in patients with extremity soft tissue sarcoma [abstract]. In: Proceedings of the AACR Virtual Special Conference on Artificial Intelligence, Diagnosis, and Imaging; 2021 Jan 13-14. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(5_Suppl):Abstract nr PO-027.
Collapse
|
18
|
Seldon C, Shrivastava G, Jarboe J, Fine J, Conway S, Pretell J, Freedman L, Wolfson A, Zhao W, Kwon D, Rosenberg A, Trent J, Yechieli R. Tumor Necrosis Following Multi-Modality Neoadjuvant Therapy for Sarcoma: A Single Institution Series. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
19
|
Seldon C, Ahmed A, Llorente R, Yoo S, Holliday E, Thomas C, Jagsi R, Deville C. Gender Diversity in Academic Oncology Programs in the United States and Abroad. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
20
|
Zettervall SL, Soden PA, Ultee KHJ, Seldon C, Oh J, McGann K, Schermerhorn ML, Guzman RJ. Elevated serum phosphate levels are associated with decreased amputation-free survival after interventions for critical limb ischemia. J Vasc Surg 2016; 65:431-437. [PMID: 27667151 DOI: 10.1016/j.jvs.2016.06.097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/03/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Elevated serum phosphate levels have been associated with increased risks of cardiovascular events and death in several patient populations. The effects of serum phosphate on outcomes in patients with critical limb ischemia (CLI) have not been evaluated. In this study, we assessed the effect of abnormal phosphate levels on mortality and major limb events after surgical intervention for CLI. METHODS A retrospective review was undertaken to identify all patients at a single institution who underwent a first-time open or endovascular intervention for CLI between 2005 and 2014. Patients without recorded postoperative phosphate levels were excluded. Postoperative phosphate levels ≤30 days of the initial operation were recorded, and the mean was calculated. Patients were stratified according to mean phosphate levels (low: <2.5 mg/dL, normal: 2.5-4.5 mg/dL, and high: >4.5 mg/dL). Patient demographics, comorbidities, and operative details were compared in univariate analysis. Multivariable regression and Cox proportional hazard modeling were used to account for patient demographics and comorbid conditions. RESULTS We identified 941 patients, including 42 (5%) with low phosphate, 768 (82%) with normal phosphate, and 131 (14%) with high phosphate. Patients with elevated phosphate were younger and had higher rates of congestive heart failure, diabetes, and dialysis dependence. Bypass was more common among patients with normal phosphate compared with high or low phosphate levels. There was no difference in the Wound, ischemia, and Foot infection (WiFi) classification or TransAtlantic Inter-Society Consensus classification among the cohorts. There were significant differences in 1-year mortality (low: 19%, normal: 17%, high: 33%; P < .01) and 3-year mortality (low: 38%, normal: 34%, high: 56%; P < .01) between phosphate cohorts. Major amputation (low: 12%, normal: 12%, high: 15%) and restenosis (low: 21%, normal: 24%, high: 28%) tended toward worse outcomes among patients with elevated phosphate levels but did not reach statistical significance. After adjustment for baseline characteristics, mortality was higher (hazard ratio [HR], 1.7; 95% confidence interval [CI], 1.3-2.2) and amputation-free survival was lower (HR, 1.5; 95% CI, 1.2-1.9) among patients with elevated compared with normal phosphate levels. A subgroup analysis was then performed to assess dialysis and nondialysis patients separately. Patients with elevated serum phosphate levels maintained a significantly higher risk of mortality in each group (dialysis: HR, 1.8; 95% CI, 1.2-2.6; nondialysis: HR, 1.5; 95% CI, 1.04-2.10). CONCLUSIONS Elevated phosphate levels are associated with increased mortality and decreased amputation-free survival after interventions for CLI. Future studies evaluating the effects of phosphate reduction in patients with CLI are warranted.
Collapse
Affiliation(s)
- Sara L Zettervall
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass; Department of Surgery, George Washington University Medical Center, Washington, D.C
| | - Peter A Soden
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass
| | - Klaas H J Ultee
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass
| | - Crystal Seldon
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass
| | - Jinhee Oh
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass
| | - Kevin McGann
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass
| | - Marc L Schermerhorn
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass
| | - Raul J Guzman
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass.
| |
Collapse
|