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Taparra K, Vega RM, Suneja G, Siker ML, Winkfield KM, Gibbs IC, Jr CD, Woodhouse KD. Building a Diverse Pathway into Radiation Oncology: The Initial 12-Year Experience of the ASTRO Medical Student Fellowship Program for Underrepresented Populations. Int J Radiat Oncol Biol Phys 2023; 117:S15. [PMID: 37784379 DOI: 10.1016/j.ijrobp.2023.06.232] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Historic radiation oncology (RO) workforce trends reveal underrepresentation and lack of inclusion of racial and ethnic groups underrepresented in medicine (UIM). In 2010, ASTRO's Healthcare Access and Training Subcommittee - the predecessor of today's Committee on Health Equity, Diversity, and Inclusion - launched the Medical Student Fellowship (MSF), which provides an 8-week clinical and research experience, ASTRO mentorship, and a $5,000 stipend. Here, we premier 12-year MSF outcomes to 1) characterize the cohort, 2) identify predictors of successfully awarded applicants, and 3) determine predictors for entering RO residency. MATERIALS/METHODS Demographic characteristics of MSF applicants were retrospectively analyzed. Primary endpoints were awarded MSF and RO match. Applicant data were collected from the ASTRO registry, MSF database, and online searches. Race, gender, medical school rank/region, mentor research center rank/region, application year, research type, RO residency affiliation, and award outcomes were collected. Descriptive statistics were tabulated. Univariable and multivariable logistic regression models calculated adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) for factors associated with MSF award receipt and matching into RO residency for those who applied via the Match. RESULTS Between 2010 and 2022, there were 101 MSF applicants (74 Clinical and 27 Basic Science) for a total of 39 available funded MSF awards, with an overall MSF award rate of 39%. Applicants were 62% Black, 32% Hispanic, 3% Asian, 1% American Indian or Alaska Native (AIAN), and 1% Native Hawaiian or other Pacific Islander (NHPI). Women comprised 42% of applicants and 51% of awardees. Awardees were 72% Black, 26% Hispanic, and 3% NHPI. By region, awardees were from medical schools in the South (44%), Northeast (31%), Midwest (18%), West (5%), and Caribbean (2%). Since 2010, among applicants, 63% matched into residency and 40% matched to RO. Among the 21 MSF awardees eligible for the Match, 13 (62%) pursued RO with 100% matched into RO. On adjusted analysis, no significant factors predicted a successful MSF application. However, among those who entered residency the only variable that predicted matching into RO was a successful MSF award (aOR = 4.1; 95% CI = 1.1-11.2). To date, MSF awardees who completed RO residency entered academic careers post-residency. CONCLUSION The first 12 years of the MSF program demonstrate an overall high rate of recruitment and retention into RO. Retention of women and recruitment of Indigenous students in the MSF are an unmet need. Future efforts and increased funding are needed to further expand the MSF program, understand student barriers, provide longitudinal engagement, train mentors, and increase recruitment and retention of UIM groups in the field.
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Affiliation(s)
- K Taparra
- Stanford Cancer Institute, Stanford, CA
| | | | - G Suneja
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - M L Siker
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | | | - I C Gibbs
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, CA
| | - C Deville Jr
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - K D Woodhouse
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Altan M, Wang Y, Song J, Welsh J, Tang C, Guha-Thakurta N, Blumenschein GR, Carter BW, Wefel JS, Ghia AJ, Yeboa DN, McAleer MF, Chung C, Woodhouse KD, McGovern SL, Wang C, Kim BYS, Weinberg JS, Briere TM, Elamin YY, Lee X, Cascone T, Negrao MV, Skoulidis F, Ferrarotto R, Heymach JV, Li J. Nivolumab and ipilimumab with concurrent stereotactic radiosurgery for intracranial metastases from non-small cell lung cancer: analysis of the safety cohort for non-randomized, open-label, phase I/II trial. J Immunother Cancer 2023; 11:e006871. [PMID: 37402581 PMCID: PMC10335483 DOI: 10.1136/jitc-2023-006871] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Up to 20% of patients with non-small cell lung cancer (NSCLC) develop brain metastasis (BM), for which the current standard of care is radiation therapy with or without surgery. There are no prospective data on the safety of stereotactic radiosurgery (SRS) concurrent with immune checkpoint inhibitor therapy for BM. This is the safety cohort of the phase I/II investigator-initiated trial of SRS with nivolumab and ipilimumab for patients with BM from NSCLC. PATIENTS AND METHODS This single-institution study included patients with NSCLC with active BM amenable to SRS. Brain SRS and systemic therapy with nivolumab and ipilimumab were delivered concurrently (within 7 days). The endpoints were safety and 4-month intracranial progression-free survival (PFS). RESULTS Thirteen patients were enrolled in the safety cohort, 10 of whom were evaluable for dose-limiting toxicities (DLTs). Median follow-up was 23 months (range 9.7-24.3 months). The median interval between systemic therapy and radiation therapy was 3 days. Only one patient had a DLT; hence, predefined stopping criteria were not met. In addition to the patient with DLT, three patients had treatment-related grade ≥3 adverse events, including elevated liver function tests, fatigue, nausea, adrenal insufficiency, and myocarditis. One patient had a confirmed influenza infection 7 months after initiation of protocol treatment (outside the DLT assessment window), leading to pneumonia and subsequent death from hemophagocytic lymphohistiocytosis. The estimated 4-month intracranial PFS rate was 70.7%. CONCLUSION Concurrent brain SRS with nivolumab/ipilimumab was safe for patients with active NSCLC BM. Preliminary analyses of treatment efficacy were encouraging for intracranial treatment response.
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Affiliation(s)
- Mehmet Altan
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yan Wang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Juhee Song
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - James Welsh
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Chad Tang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nandita Guha-Thakurta
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - George R Blumenschein
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Brett W Carter
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Amol J Ghia
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Debra N Yeboa
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mary Frances McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kristina D Woodhouse
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Susan L McGovern
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Chenyang Wang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Betty Y S Kim
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey S Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tina M Briere
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yasir Y Elamin
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Xiuning Lee
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tina Cascone
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Marcelo V Negrao
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ferdinandos Skoulidis
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Renata Ferrarotto
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - John V Heymach
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jing Li
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Maroongroge S, De B, Woodhouse KD, Bassett Jr RL, Lee P, Bloom ES, Smith GL, Frank SJ, Li J, Perkins G, Das P, Koong AC, Smith BD, Wang C. Physician Perspectives on Telemedicine in Radiation Oncology. Adv Radiat Oncol 2023; 8:101005. [PMID: 36311822 PMCID: PMC9598490 DOI: 10.1016/j.adro.2022.101005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 04/16/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose Telemedicine enthusiasm and uptake in radiation oncology rapidly increased during the COVID-19 pandemic, but it is unclear if and how telemedicine should be used after the COVID-19 public health emergency ends is unclear. Herein, we report on our institution's provider experience after the mature adoption of telemedicine. Methods and Materials We distributed a survey to all radiation oncology attending physicians at our institution in October 2021 to assess satisfaction, facilitators, and barriers to telemedicine implementation. We performed quantitative and qualitative analyses to characterize satisfaction and identify influencing factors whether telemedicine is employed. We calculated the average proportion of visits that providers expected to be appropriately performed with telemedicine for each disease site and visit type. Results A total of 60 of the 82 eligible radiation oncologists (73%) responded to the survey, of whom 78% were satisfied with telemedicine in the radiation oncology department and 83% wished to continue offering video visits after the COVID-19 public health emergency ends. Common patient factors influencing whether physicians offer telemedicine include the patient's travel burden, patient preferences, and whether a physical examination is required. Approximately 20% of new consultations and 50% of weekly management visits were estimated to be appropriate for telemedicine. The central nervous system/pediatrics and thoracic faculty considered telemedicine appropriate for the greatest proportion of new consultations, and 93% of respondents felt comfortable determining whether telemedicine was appropriate. Conclusions Surveyed radiation oncologists were satisfied with telemedicine in their practice, and wished to continue offering video visits in the future. Our data suggest that payers should continue to support this patient-centered technology.
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Affiliation(s)
- Sean Maroongroge
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Brian De
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kristina D. Woodhouse
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Roland L. Bassett Jr
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Percy Lee
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elizabeth S. Bloom
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Grace L. Smith
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steven J. Frank
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jing Li
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - George Perkins
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Prajnan Das
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Albert C. Koong
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Benjamin D. Smith
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Chenyang Wang
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
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McClelland III S, Murphy B, Woodhouse KD, Zellars RC. Progression of citation-based scholarly activity from postgraduate year one to postgraduate year two in a current resident class. Chin Clin Oncol 2022; 11:31. [DOI: 10.21037/cco-21-147] [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: 10/31/2021] [Accepted: 08/23/2022] [Indexed: 11/06/2022]
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Woodhouse KD, Devlin PM, Kollmeier M, Lin LL, Orio P, Ouhib Z, Song D, Viswanathan AN, Watanabe Y, Yu Y, Small W, Schechter NR. ACR-ABS-ASTRO Practice Parameter for the Performance of Low-Dose-Rate Brachytherapy. Am J Clin Oncol 2022; 45:243-248. [PMID: 35485607 DOI: 10.1097/coc.0000000000000912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM/OBJECTIVES/BACKGROUND The American College of Radiology (ACR), the American Brachytherapy Society (ABS), and the American Society for Radiation Oncology (ASTRO) have jointly developed the following practice parameter for the performance of low-dose-rate (LDR) brachytherapy. LDR brachytherapy is the application of radioactive sources in or on tumors in a clinical setting with therapeutic intent. The advantages of LDR brachytherapy include improving therapeutic ratios with lower doses to nontarget organs-at-risk and higher doses to a specific target. METHODS This practice parameter was developed according to the process described under the heading. The Process for Developing ACR Practice Parameters and Technical Standards on the ACR website (https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards) by the Committee on Practice Parameters-Radiation Oncology of the Commission on Radiation Oncology, in collaboration with ABS and ASTRO. RESULTS This practice parameter was developed to serve as a tool in the appropriate application of this evolving technology in the care of cancer patients or other patients with conditions where radiation therapy is indicated. It addresses clinical implementation of LDR brachytherapy including personnel qualifications, quality assurance standards, indications, and suggested documentation. This includes a contemporary literature search. CONCLUSIONS This practice parameter is a tool to guide the use of LDR brachytherapy and does not assess relative clinical indication for LDR brachytherapy when compared with other forms of brachytherapy or external beam therapy, but to focus on the best practices required to deliver LDR brachytherapy safely and effectively, when clinically indicated. Comparative costs of versus other modalities therapy may also need to be considered.
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Affiliation(s)
| | | | | | | | - Peter Orio
- Boca Raton Regional Hospital, Lynn Cancer Institute, Boca Raton, FL
| | - Zoubir Ouhib
- Boca Raton Regional Hospital, Lynn Cancer Institute, Boca Raton, FL
| | | | | | | | - Yan Yu
- Thomas Jefferson University, Woodbury, NJ
| | - William Small
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL
| | - Naomi R Schechter
- Keck Medical Center of USC, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
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De B, Fu S, Chen Y, Das P, Ku K, Maroongroge S, Woodhouse KD, Hoffman KE, Nguyen Q, Reed VK, Chen AB, Koong AC, Smith BD, Smith GL. Patient, physician, and policy factors underlying variation in use of telemedicine for radiation oncology cancer care. Cancer Med 2022; 11:2096-2105. [PMID: 35297210 PMCID: PMC9119354 DOI: 10.1002/cam4.4555] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/08/2021] [Revised: 12/10/2021] [Accepted: 12/17/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Oncology telemedicine was implemented rapidly after COVID-19. We examined multilevel correlates and outcomes of telemedicine use for patients undergoing radiotherapy (RT) for cancer. METHODS Upon implementation of a telemedicine platform at a comprehensive cancer center, we analyzed 468 consecutive patient RT courses from March 16, 2020 to June 1, 2020. Patients were categorized as using telemedicine during ≥1 weekly oncologist visits versus in-person oncologist management only. Temporal trends were evaluated with Cochran-Armitage tests; chi-squared test and multilevel multivariable logistic models identified correlates of use and outcomes. RESULTS Overall, 33% used telemedicine versus 67% in-person only oncologist management. Temporal trends (ptrend < 0.001) correlated with policy changes: uptake was rapid after local social-distancing restrictions, reaching peak use (35% of visits) within 4 weeks of implementation. Use declined to 15% after national "Opening Up America Again" guidelines. In the multilevel model, patients more likely to use telemedicine were White non-Hispanic versus Black or Hispanic (odds ratio [OR] = 2.20, 95% confidence interval [CI] 1.03-4.72; p = 0.04) or receiving ≥6 fractions of RT versus 1-5 fractions (OR = 4.49, 95% CI 2.29-8.80; p < 0.001). Model intraclass correlation coefficient demonstrated 43% utilization variation was physician-level driven. Treatment toxicities and 30-day emergency visits or unplanned hospitalizations did not differ for patients using versus not using telemedicine (p > 0.05, all comparisons). CONCLUSION Though toxicities were similar with telemedicine oncology management, there remained lower uptake among non-White patients. Continuing strategies for oncology telemedicine implementation should address multilevel patient, physician, and policy factors to optimize telemedicine's potential to surmount-and not exacerbate-barriers to quality cancer care.
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Affiliation(s)
- Brian De
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Shuangshuang Fu
- Department of Health Services ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Ying‐Shiuan Chen
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Prajnan Das
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Kimberly Ku
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Sean Maroongroge
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Kristina D. Woodhouse
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Karen E. Hoffman
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Quynh‐Nhu Nguyen
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Valerie K. Reed
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Aileen B. Chen
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- Department of Health Services ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Albert C. Koong
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Benjamin D. Smith
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- Department of Health Services ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Grace L. Smith
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- Department of Health Services ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
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Ahmed KA, Kim Y, DeJesus M, Beyer SJ, Williams NO, Palmer J, Woodhouse KD, Murthy RK, Li J, Armaghani AJ, Arrington JA, Costa RL, Czerniecki BJ, Etame AB, Forsyth PA, Khong HT, Oliver DE, Rosa M, Sahebjam S, Soliman HH, Soyano AE, Vogelbaum MA, Yu M, Han HS. Abstract OT2-09-01: Phase I/II study of stereotactic radiation and abemaciclib in the management of hormone receptor positive HER2 negative breast cancer brain metastases. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-ot2-09-01] [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
Background: Breast cancer patients with brain metastases have a high unmet clinical need and improved management strategies are needed. There has been interest in studying CDK 4/6 inhibitors in the management of breast cancer brain metastases. A phase II study has shown abemaciclib to have activity in the management of hormone receptor (HR)+/HER2- brain metastases. Pre-clinical data suggests a potential synergy with CDK inhibitors and radiation therapy. Stereotactic radiosurgery (SRS) is a cornerstone in the management of limited brain metastases. We hypothesize treatment with abemaciclib and SRS will be safe and improve intracranial progression free survival (PFS) compared to abemaciclib alone. Trial Design: The study is designed as a prospective, single-arm, nonrandomized, open-label, phase I/II trial of abemaciclib and endocrine therapy with SRS among patients with HR+/HER2- metastatic breast cancer brain metastases. Treatment will be initiated with one week of abemaciclib followed by stereotactic radiation to sites of brain metastases or post-operative cavities with continued abemaciclib. Safety will be monitored initially by a 3+3 design. If unexpected neurologic toxicities are noted, the dose of radiation therapy will be reduced. This will be followed by a phase II study to evaluate intracranial PFS. Eligibility: Eligible patients include those that are HR+/HER2-, ≥18, ECOG ≤2 with ≤15 breast cancer brain metastases with measurable disease per Response Assessment in Neuro-Oncology Brain Metastases (RANO-BM) criteria. Specific Aims: The primary objective of the phase I study is to evaluate the safety and feasibility of abemaciclib and SRS to sites of brain metastases in the management of HR+/HER2- metastatic breast cancer with brain metastases. The primary objective of the phase II portion is to determine PFS intracranially. Secondary objectives include evaluation of extracranial PFS, local and distant intracranial control, and overall survival. Statistical Methods: Safety and feasibility will be monitored in the phase I study using a 3 + 3 design followed by a phase II study to assess intracranial PFS. The phase II study is designed as a single-arm, two-stage trial using the Restricted-Kwak-and-Jung’s method. In the first stage, a total of 21 patients will be enrolled. If pre-specified endpoints are met, an additional 10 patients will be enrolled in the second stage. Patient Accrual: A total of up to 31 patients will be enrolled inclusive of patients in the phase I portion treated at the recommended phase II dose. Clinical trial information: NCT04923542.
Citation Format: Kamran A. Ahmed, Youngchul Kim, Michelle DeJesus, Sasha J. Beyer, Nicole O. Williams, Joshua Palmer, Kristina D. Woodhouse, Rashmi K. Murthy, Jing Li, Avan J. Armaghani, John A. Arrington, Ricardo L. Costa, Brian J. Czerniecki, Arnold B. Etame, Peter A. Forsyth, Hung T. Khong, Daniel E. Oliver, Marilin Rosa, Solmaz Sahebjam, Hatem H. Soliman, Aixa E. Soyano, Michael A. Vogelbaum, Michael Yu, Hyo S. Han. Phase I/II study of stereotactic radiation and abemaciclib in the management of hormone receptor positive HER2 negative breast cancer brain metastases [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr OT2-09-01.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jing Li
- MD Anderson Cancer Center, Houston, TX
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Nantavithya C, Paulino AC, Liao K, Woodhouse KD, McGovern SL, Grosshans DR, McAleer MF, Khatua S, Chintagumpala MM, Majd N, Zaky W, Yeboa DN. Observed-to-expected incidence ratios of second malignant neoplasms after radiation therapy for medulloblastoma: A Surveillance, Epidemiology, and End Results analysis. Cancer 2021; 127:2368-2375. [PMID: 33721338 DOI: 10.1002/cncr.33507] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/03/2021] [Accepted: 02/08/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND The authors analyzed the incidence and types of second malignant neoplasms (SMNs) in patients treated for medulloblastoma. METHODS The authors compared the incidence of SMNs after radiotherapy (RT) for medulloblastoma in patients treated in 1973-2014 with the incidence in the general population with the multiple primary-standardized incidence ratio function of Surveillance, Epidemiology, and End Results 9. Observed-to-expected incidence (O/E) ratios and 95% confidence intervals (CIs) were reported for the entire cohort and by disease site according to age at diagnosis, treatment era, and receipt of chemotherapy. P values < .05 were considered statistically significant. RESULTS Of the 1294 patients with medulloblastoma who received RT, 68 developed 75 SMNs. The O/E ratio for SMNs among all patients was 4.49 (95% CI, 3.53-5.62; P < .05). The site at highest risk was the central nervous system (CNS; O/E, 40.62; 95% CI, 25.46-61.51), which was followed by the endocrine system (O/E, 15.95; 95% CI, 9.12-25.91), bone (O/E, 14.45; 95% CI, 1.75-52.21), soft tissues (O/E, 9.01; 95% CI, 1.09-32.56), the digestive system (O/E, 5.03; 95% CI, 2.51-9.00), and the lymphatic/hematopoietic system (O/E, 3.37; 95% CI, 1.35-6.94). The O/E ratio was higher for patients given chemotherapy and RT (O/E, 5.52; 95% CI, 3.75-7.83) than for those given RT only (O/E, 3.96; 95% CI, 2.88-5.32). CONCLUSIONS Patients with medulloblastoma are at elevated risk for SMNs in comparison with the general population. Variations in O/E for SMNs by organ systems were found for treatment modality, age at diagnosis, and time of diagnosis. The most common site, the CNS, was involved more often in younger patients and those given chemotherapy with RT.
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Affiliation(s)
- Chonnipa Nantavithya
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Division of Radiation and Oncology, Department of Radiology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Arnold C Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kaiping Liao
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kristina D Woodhouse
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Susan L McGovern
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David R Grosshans
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mary F McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Soumen Khatua
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Murali M Chintagumpala
- Department of Pediatrics, Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Nazanin Majd
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wafik Zaky
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Debra N Yeboa
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
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9
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Liu SM, Brooks ED, Rubin ML, Grosshans DR, Frank SJ, McAleer MF, McGovern SL, Paulino AC, Woodhouse KD. Referral Patterns and Treatment Delays in Medulloblastoma: A Large Academic Proton Center Experience. Int J Part Ther 2020; 7:1-10. [PMID: 33604411 PMCID: PMC7886269 DOI: 10.14338/ijpt-20-00038.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 08/13/2020] [Indexed: 12/04/2022] Open
Abstract
Purpose Patient travel time can cause treatment delays when providers and families decide to seek proton therapy. We examined whether travel distance or referral pattern (domestic versus international) affects time to radiation therapy and subsequent disease outcomes in patients with medulloblastoma at a large academic proton center. Patients and Methods Children with medulloblastoma treated at MD Anderson (MDA) with a protocol of proton beam therapy (PBT) between January 4, 2007, and June 25, 2014, were included in the analysis. The Wilcoxon rank-sum test was used to study the association between time to start of radiation and distance. Classification- and regression-tree analyses were used to explore binary thresholds for continuous covariates (ie, distance). Failure-free survival was defined as the time interval between end of radiation and failure or death. Results 96 patients were included in the analysis: 17 were international (18%); 19 (20%) were from Houston, Texas; 21 were from other cities inside Texas (21%); and 39 (41%) were from other US states. The median time from surgery to start of radiation was not significantly different for international patients (median = 1.45 months) compared with US patients (median = 1.15 months; P = .13). However, time from surgery to start of radiation was significantly longer for patients residing > 1716 km (> 1066 miles) from MDA (median = 1.31 months) than for patients residing ≤ 1716 km (≤ 1066 miles) from MDA (median = 1.05 months; P = .01). This 1- to 2-week delay (median = 7.8 days) did not affect failure-free survival (hazard ratio = 1.34; P = .43). Conclusion We found that short delays in proton access can exist for patients traveling long distances to proton centers. However, in this study, treatment delays did not affect outcomes. This highlights the appropriateness of PBT in the face of travel coordination. Investment by proton centers in a rigorous intake process is justified to offer timely access to curative PBT.
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Affiliation(s)
- Sean M Liu
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eric D Brooks
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Proton Therapy Center, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,University of Florida Health Proton Therapy Institute, Jacksonville, FL, USA
| | - M Laura Rubin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - David R Grosshans
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Proton Therapy Center, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Proton Therapy Center, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mary Frances McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Proton Therapy Center, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susan L McGovern
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Proton Therapy Center, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Arnold C Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Proton Therapy Center, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kristina D Woodhouse
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Proton Therapy Center, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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10
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Lin TA, Ludmir EB, Liao KP, McAleer MF, Bishop AJ, Grosshans D, McGovern S, Woodhouse KD, Paulino AC, Yeboa DN. Relationship between treatment center case volume and survival for localized Ewing sarcoma: The role of radiotherapy timing. Pediatr Blood Cancer 2020; 67:e28685. [PMID: 32881378 DOI: 10.1002/pbc.28685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 11/06/2022]
Abstract
In the treatment of localized Ewing sarcoma (EWS), delays in local therapy are known to adversely impact overall survival (OS). However, the role of treatment center volume in EWS outcomes, and the interaction between center volume and local therapy timing with definitive radiotherapy, remains unknown. Using the National Cancer Database, we demonstrate that treatment at the lowest EWS volume centers is associated with reduced OS, explained partly by higher rates of delayed local therapy. Treatment at the highest volume centers results in improved OS, but appears independent of radiotherapy timing. Future efforts to improve care for EWS patients across treatment centers are imperative.
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Affiliation(s)
- Timothy A Lin
- The University of Texas MD Anderson Cancer Center, Houston, Texas.,The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ethan B Ludmir
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kai-Ping Liao
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Andrew J Bishop
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David Grosshans
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Susan McGovern
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Arnold C Paulino
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Debra Nana Yeboa
- The University of Texas MD Anderson Cancer Center, Houston, Texas
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11
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Maroongroge S, Smith B, Bloom ES, Ning MS, Wang C, Das P, Koong AC, McAleer MF, Woodhouse KD. Telemedicine for Radiation Oncology in a Post-COVID World. Int J Radiat Oncol Biol Phys 2020; 108:407-410. [PMID: 32890522 PMCID: PMC7462809 DOI: 10.1016/j.ijrobp.2020.06.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/21/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Sean Maroongroge
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Benjamin Smith
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elizabeth S Bloom
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Matthew S Ning
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Chenyang Wang
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Prajnan Das
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Albert C Koong
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mary Frances McAleer
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kristina D Woodhouse
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
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12
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Nantavithya C, Paulino AC, Liao K, McGovern SL, Grosshans DR, McAleer MF, Woodhouse KD, Khatua S, Chintagumpala MM, Majd NK, Yeboa DN. Development of second primary tumors and outcomes in medulloblastoma by treatment modality: A Surveillance, Epidemiology, and End Results analysis. Pediatr Blood Cancer 2020; 67:e28373. [PMID: 32453481 DOI: 10.1002/pbc.28373] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 03/30/2020] [Accepted: 04/12/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND As treatment modalities for medulloblastoma have developed and overall survival (OS) has improved, there are relatively limited data on the impact of long-term effects such as risk of second primary tumors (SPT). To address the knowledge gap, we analyzed factors associated with the risk of SPT and OS by treatment modality for medulloblastoma. METHODS We queried the Surveillance, Epidemiology, and End Results (SEER)-18 database for patients diagnosed with medulloblastoma in 1973-2014. Patients were then grouped by age, gender, race, geographic region, histology, adjuvant treatment (no radiation [RT] and no chemotherapy [CT], RT and CT, RT alone, or CT alone), era of diagnosis (1973-1994 or 1995-2014), and survival time. Cumulative incidence, factors associated with SPT and OS were analyzed. RESULTS Of 2271 patients, 146 developed SPT, of which 42 were benign. The incidence of SPT was 3.1% and 4.9% at 10 and 15 years, respectively. The incidence of SPT was 3.1% with RT + CT versus 3.7% with RT alone at 10 years. The most common site for an SPT was the central nervous system. Female gender (P = 0.01) and longer OS of ≥21 years (P < 0.01) were associated with higher risk of SPT. RT + CT led to better OS than RT only (66.1% and 61.4% vs 55.6% and 49.7% at 10 and 15 years) (P < 0.01). CONCLUSIONS Medulloblastoma patients have a relatively low risk of SPT at 10 years with treatment. Use of RT + CT led to better OS with no statistical difference in SPT compared with the RT alone.
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Affiliation(s)
- Chonnipa Nantavithya
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Division of Radiation and Oncology, Department of Radiology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Arnold C Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kaiping Liao
- Departments of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Susan L McGovern
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David R Grosshans
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mary F McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kristina D Woodhouse
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Soumen Khatua
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Murali M Chintagumpala
- Department of Pediatrics, Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Nazanin K Majd
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Debra N Yeboa
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Departments of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
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13
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Noticewala SS, Ludmir EB, Bishop AJ, Chung C, Ghia AJ, Grosshans D, McGovern S, Paulino ADLC, Wang C, Woodhouse KD, Yeboa DN, Prabhu SS, Weathers SP, Das P, Koong AC, McAleer MF, Li J. Radiation for Glioblastoma in the Era of Coronavirus Disease 2019 (COVID-19): Patient Selection and Hypofractionation to Maximize Benefit and Minimize Risk. Adv Radiat Oncol 2020; 5:743-745. [PMID: 32775785 PMCID: PMC7251361 DOI: 10.1016/j.adro.2020.04.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 04/14/2020] [Revised: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 11/16/2022] Open
Abstract
We describe the institutional guidelines of a major tertiary cancer center with regard to using hypofractionated radiation regimens to treat glioblastoma as a measure to minimize exposure to coronavirus disease 2019 (COVID-19) while not sacrificing clinical outcomes. Our guidelines review level one evidence of various hypofractionated regimens, and recommend a multidisciplinary approach while balancing the risk of morbidity and mortality among individuals at high risk for severe illness from COVID-19 infection. We also briefly outline strategies our department is taking in mitigating risk among our cancer patients undergoing radiation.
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Affiliation(s)
- Sonal S Noticewala
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ethan B Ludmir
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Andrew J Bishop
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Caroline Chung
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Amol J Ghia
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David Grosshans
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Susan McGovern
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Chenyang Wang
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kristina D Woodhouse
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Debra N Yeboa
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shiao-Pei Weathers
- Department of Neurooncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Prajnan Das
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Albert C Koong
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mary Frances McAleer
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jing Li
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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14
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Li J, Wang Y, Tang C, Welsh JW, Guha- Thakurta N, Carter BW, Wefel JS, Ghia AJ, Yeboa D, McAleer MF, Chung C, Woodhouse KD, Elamin Y, Le X, Cascone T, Negrao MV, Skoulidis F, Ferrarotto R, Heymach J, Altan M. Concurrent nivolumab and ipilimumab with brain stereotactic radiosurgery for brain metastases from non-small cell lung cancer: A phase I trial. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.2531] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2531 Background: Nivolumab (nivo) and ipilimumab (ipi) were found in the recent phase III CheckMate 227 trial to have an overall survival benefit over chemotherapy for advanced non-small cell lung cancer (NSCLC). However, patients (pts) with untreated brain metastasis (mets) were excluded from that trial. Because 30% of NSCLC pts develop brain mets, we tested nivo/ipi with concurrent stereotactic radiosurgery (SRS) for NSCLC pts with active brain mets. Methods: We report the safety data from the phase I portion of an ongoing phase I/II single-institution trial in which one treatment group was given SRS with nivo (3 mg/kg) every 2 weeks (wks) plus ipi (1 mg/kg) every 6 wks x 4 cycles, followed by maintenance nivo (480 mg) every 4 wks until disease progression, unacceptable toxicity, or withdrawal of consent. Brain SRS was delivered within 7 days of initiation of nivo/ipi. The primary endpoints were safety and 4-month (mo) intracranial progression-free survival (PFS). Dose-limiting toxicity (DLT) was defined as > 15% intracranial toxicity (>G3 hypophysitis / neurologic toxicity) or > 30% extracranial toxicity (>G3 non-dermatologic non-lab toxicity or >G4 dermatologic / lab toxicity), refractory to medical management, assessed at 8 wks after treatment initiation. Target accrual for phase I was 10 evaluable pts, with enrollment suspended after every 5 pts for DLT assessment. Results: Since June 15, 2018, 13 pts were enrolled and 10 were evaluable for DLT. The median follow-up time was 6.8 mo (range 1.2‒18). As of January 6, 2020, only 1 pt had DLT-defined toxicity and thus the predefined stopping criteria were not met. This pt had G3 seizure right after SRS that resolved within a week, and then had increased but asymptomatic CNS edema 4 wks later. Aside from DLTs, 3 pts (25%) developed treatment-related G3 (elevated liver function tests, fatigue, nausea, adrenal insufficiency, and myocarditis) or G4 events (pneumonitis/acute respiratory distress syndrome in 1 pt with confirmed influenza at 7 mos after treatment initiation). This pt subsequently died of hemophagocytic lymphohistiocytosis (considered possibly related to the study drugs). Median intracranial PFS time was 9.7 mo, and the 4-mo intracranial PFS rate was 75%. Extracranial objective response rate was 33% in the 12 evaluable pts with a median response duration of 9.1 mo. Conclusions: Concurrent SRS withnivo/ipi was safe for pts with active NSCLC brain mets. Preliminary analyses of efficacy were encouraging for durable intracranial and extracranial response. Clinical trial information: NCT02696993 .
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Affiliation(s)
- Jing Li
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yan Wang
- UT M.D.Anderson Cancer Center, Houston, TX
| | - Chad Tang
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Brett W. Carter
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Amol J. Ghia
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Debra Yeboa
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | - Xiuning Le
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tina Cascone
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - John Heymach
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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15
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Ludmir EB, Mahajan A, Ahern V, Ajithkumar T, Alapetite C, Bernier-Chastagner V, Bindra RS, Bishop AJ, Bolle S, Brown PD, Carrie C, Chalmers AJ, Chang EL, Chung C, Dieckmann K, Esiashvili N, Gandola L, Ghia AJ, Gondi V, Grosshans DR, Harrabi SB, Horan G, Indelicato DJ, Jalali R, Janssens GO, Krause M, Laack NN, Laperriere N, Laprie A, Li J, Marcus KJ, McGovern SL, Merchant TE, Merrell KW, Padovani L, Parkes J, Paulino AC, Schwarz R, Shih HA, Souhami L, Sulman EP, Taylor RE, Thorp N, Timmermann B, Wheeler G, Wolden SL, Woodhouse KD, Yeboa DN, Yock TI, Kortmann RD, McAleer MF. Assembling the brain trust: the multidisciplinary imperative in neuro-oncology. Nat Rev Clin Oncol 2019; 16:521-522. [PMID: 31150024 DOI: 10.1038/s41571-019-0235-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Ethan B Ludmir
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Verity Ahern
- Sydney West Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
| | | | - Claire Alapetite
- Department of Radiation Oncology, Institut Curie, Paris and Orsay, France
| | | | - Ranjit S Bindra
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Andrew J Bishop
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephanie Bolle
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Christian Carrie
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
| | | | - Eric L Chang
- Department of Radiation Oncology, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Caroline Chung
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Karin Dieckmann
- Department of Radiation Oncology, Universität Klinik für Strahlentherapie und Strahlenbiologie, Vienna, Austria
| | - Natia Esiashvili
- Department of Radiation Oncology, Emory University Winship Cancer Institute, Atlanta, GA, USA
| | - Lorenza Gandola
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Amol J Ghia
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vinai Gondi
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David R Grosshans
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Semi B Harrabi
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Gail Horan
- Department of Oncology, Cambridge University Hospitals, Cambridge, UK
| | - Danny J Indelicato
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Rakesh Jalali
- Department of Radiation Oncology, Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India
| | - Geert O Janssens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Mechthild Krause
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Nadia N Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Normand Laperriere
- Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anne Laprie
- Department of Radiation Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Jing Li
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Karen J Marcus
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Susan L McGovern
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Laetitia Padovani
- Department of Radiation Oncology, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Jeannette Parkes
- Department of Radiation Oncology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Arnold C Paulino
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rudolf Schwarz
- Department of Radiation Oncology, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Helen A Shih
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Luis Souhami
- Department of Radiation Oncology, McGill University Health Centre, Cedars Cancer Centre, Montréal, Quebec, Canada
| | - Erik P Sulman
- Department of Radiation Oncology, New York University Langone School of Medicine, New York, NY, USA
| | | | - Nicola Thorp
- Department of Oncology, The Clatterbridge Cancer Centre, Liverpool, UK
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen, West German Cancer Center, German Cancer Consortium, Essen, Germany
| | - Greg Wheeler
- Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Suzanne L Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kristina D Woodhouse
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Debra N Yeboa
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Torunn I Yock
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Mary Frances McAleer
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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16
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McClelland S, Woodhouse KD, Jaboin JJ, Zellars RC. Analysis of pre-residency research productivity, dual degree status, and gender distribution of underrepresented minorities among a current United States radiation oncology junior resident class. Rep Pract Oncol Radiother 2019; 24:284-287. [PMID: 30996695 DOI: 10.1016/j.rpor.2019.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 01/24/2019] [Accepted: 03/20/2019] [Indexed: 11/27/2022] Open
Abstract
Background Among the most competitive medical subspecialties, representation of underrepresented minorities (African-American race and/or Hispanic ethnicity) among resident trainees has historically been low compared to their United States Census general population representation. Research productivity and dual degree status may impact residency applicant competitiveness. To date, such an analysis has yet to be performed in Radiation Oncology. Methods A list of radiation oncology residents from the graduating class of 2022 was obtained through internet searches. Demographics included were gender and dual degree status. Research productivity was calculated using the number of pre-residency peer-reviewed publications (PRP). Fisher's exact test was used for statistical analysis. Results Of the 179 residents evaluated from the 2022 class, eleven (6.1%) were underrepresented minorities. Compared to the remainder of the class, underrepresented minorities had a lower proportion of men (63.6% versus 69.3%), a higher proportion of dual degrees (45.5% versus 28.6%), and a lower proportion of MD-PhD degrees (9.1% versus 17.2%). Underrepresented minorities had a higher proportion of residents with at least two PRP (72.7% versus 57.1%) and a lower proportion of residents with no PRP (18.2% versus 24.4%). None of these differences reached statistical significance (p > 0.05). Conclusion Underrepresented minorities were comparable to the remainder of their Radiation Oncology resident class regarding gender distribution, dual degrees status, and likelihood of having at least two peer-reviewed publications cited in PubMed during the calendar year of residency application. Further studies will be needed to determine how these findings translate into future scholarly activity and post-graduate career choice.
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Affiliation(s)
- Shearwood McClelland
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, United States.,Department of Radiation Medicine, Oregon Health and Science University, Portland, OR, United States
| | - Kristina D Woodhouse
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jerry J Jaboin
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR, United States
| | - Richard C Zellars
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, United States
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17
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Lin TA, Ludmir EB, Liao KP, McAleer MF, Grosshans DR, McGovern SL, Bishop AJ, Woodhouse KD, Paulino AC, Yeboa DN. Timing of Local Therapy Affects Survival in Ewing Sarcoma. Int J Radiat Oncol Biol Phys 2018; 104:127-136. [PMID: 30593906 DOI: 10.1016/j.ijrobp.2018.12.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 09/14/2018] [Revised: 12/16/2018] [Accepted: 12/17/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE We aimed to investigate the relationship between survival and time to local therapy after initiation of up-front chemotherapy in the treatment of patients with localized Ewing sarcoma. METHODS AND MATERIALS The National Cancer Database was queried for patients with localized Ewing sarcoma treated with primary chemotherapy and subsequent local therapy. Kaplan-Meier survival curves were generated for patients initiating local therapy 6 to 15 weeks and ≥16 weeks after chemotherapy initiation. Multivariable binomial logistic regression was used to identify factors associated with prolonged time to local therapy. A multivariable Cox proportional hazards model was used to identify factors associated with overall survival (OS). RESULTS The final cohort included 1318 patients. A higher proportion of patients initiating local therapy 6 to 15 weeks after chemotherapy initiation versus ≥16 weeks after chemotherapy initiation were ≤21 years old (79.5% vs 72.0%; P = .004). Age >21 years (P < .001; hazard ratio, 1.65; 95% confidence interval, 1.28-2.12), tumor size >8 cm (P = .016), and time to local therapy ≥16 weeks (P = .005; hazard ratio, 1.41; 95% confidence interval, 1.11-1.80) were associated with reduced OS; after review of margin status, negative margins were associated with improved OS compared with gross disease (P = .029). Patients initiating local therapy at 6 to 15 weeks versus ≥16 weeks had a 5-year OS of 78.7% versus 70.4% and a 10-year OS of 70.3% versus 57.1%, respectively (P < .001). The difference in OS according to time to local therapy was particularly more important in patients receiving radiation therapy alone. Age >21 years and treatment by radiation therapy alone were associated with delayed time (>16 weeks) to local therapy, whereas private insurance and income >$48,000 were less likely to be associated with delayed local therapy. CONCLUSIONS Delayed time to local therapy ≥16 weeks after chemotherapy initiation was independently associated with worse survival in patients with localized Ewing sarcoma.
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Affiliation(s)
- Timothy A Lin
- Department of Radiation Oncology, Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas; Baylor College of Medicine, Houston, Texas
| | - Ethan B Ludmir
- Department of Radiation Oncology, Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kai-Ping Liao
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mary Frances McAleer
- Department of Radiation Oncology, Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David R Grosshans
- Department of Radiation Oncology, Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Susan L McGovern
- Department of Radiation Oncology, Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Andrew J Bishop
- Department of Radiation Oncology, Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kristina D Woodhouse
- Department of Radiation Oncology, Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Arnold C Paulino
- Department of Radiation Oncology, Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Debra Nana Yeboa
- Department of Radiation Oncology, Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas
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Deville C, Jain A, Hwang WT, Woodhouse KD, Both S, Wang S, Gabriel PE, Christodouleas JP, Bekelman J, Tochner Z, Vapiwala N. Initial report of the genitourinary and gastrointestinal toxicity of post-prostatectomy proton therapy for prostate cancer patients undergoing adjuvant or salvage radiotherapy. Acta Oncol 2018; 57:1506-1514. [PMID: 30028227 DOI: 10.1080/0284186x.2018.1487583] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE To report acute and late genitourinary (GU) and gastrointestinal (GI) toxicities associated with post-prostatectomy proton therapy (PT). METHODS The first 100 consecutive patients from 2010 to 2016 were retrospectively assessed. Baseline characteristics, prospectively graded CTCAE v4.0 toxicities, and patient-reported outcomes were reported. Late outcomes were reported for 79 patients with 3 months minimum follow up. Toxicity-free survival Kaplan-Meier curves were estimated. Logistic regression assessed associations between toxicities and clinical and treatment characteristics (p < .05 significance). RESULTS Median age, months after surgery, and months of follow-up were respectively 64 years (range 42-77), 25 (5-216), and 25 (0-47). PT received was 70.2 Gy (RBE) (89%), salvage (93%), prostate bed only (80%), pencil beam scanning (86%), with IMRT (31%), and with androgen deprivation (34%). Acute and late maximum toxicities, respectively were: GU grade 0 (14%; 18%), 1 (71%; 62%), 2 (15%; 20%), ≥3 (0), and GI: grade 0 (66%; 73%), 1 (34%; 27%), ≥2 (0). Toxicity-free survival at 24 months was GU grade 2 (83%) and GI grade 1 (74%). Mean (±std dev) baseline International Prostate Symptom Score (IPSS), International Index of Erectile Function, and Expanded Prostate Cancer Index Composite bowel function and bother were 6.6 ± 6.1, 10.5 ± 7.3, 90.9 ± 10.8, 93.3 ± 11.2, respectively, and largely unchanged at 2 years: 6.3 ± 3.6, 11.1 ± 6.3, 92.8 ± 5.8, and 90.9 ± 10.3. On multivariate analysis, baseline IPSS (p = .009) associated with GU grade 2 acute toxicity. Bladderless-CTV median dose, V30, and V40 associated with GU grade 2 acute toxicity and maximum dose with late (Ps <0.05). For GI, on multivariate analysis, baseline bowel function (p = .033) associated with acute grade 1 toxicity. Rectal minimum and median dose, V10, and V20, and anterior rectal wall median dose and V10 through V65 associated with acute grade 1 GI toxicity (Ps < .05). CONCLUSIONS Post-prostatectomy PT for prostate cancer is feasible with a favorable GU and GI toxicity profile acutely and through early follow up.
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Affiliation(s)
- Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Akansha Jain
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Wei-Ting Hwang
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Stefan Both
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - Shiyu Wang
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter E. Gabriel
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Justin Bekelman
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Zelig Tochner
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
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Berman AT, Rosenthal SA, Moghanaki D, Woodhouse KD, Movsas B, Vapiwala N. Focusing on the "Person" in Personalized Medicine: The Future of Patient-Centered Care in Radiation Oncology. J Am Coll Radiol 2017; 13:1571-1578. [PMID: 27888944 DOI: 10.1016/j.jacr.2016.09.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 09/13/2016] [Revised: 09/13/2016] [Accepted: 09/15/2016] [Indexed: 11/25/2022]
Abstract
Numerous efforts in radiation oncology aim to improve the value of clinical care. To evaluate the success of these efforts, outcome measures must be well defined and incorporate the beliefs of the patients they affect. These outcomes have historically centered on rates of tumor control, overall survival, and adverse events as perceived and reported by providers. However, the future of patient-centered care in radiation oncology is increasingly focusing on the "person" in the population and the individual in the studies to more closely reflect the ideals of personalized medicine. Formally known as patient-centered outcomes, this metric encompasses parameters of patient satisfaction, engagement, and treatment compliance. Evaluations that investigate the safety and efficacy of treatments are increasingly soliciting participation from patients within a model of shared decision making that improves patients' knowledge, satisfaction, physical and emotional well-being, and trust in providers. Modern clinical trials that embrace this approach may even focus on patient-reported outcomes as the primary end point, as opposed to time-honored physician-reported events. The authors explore the growing role of patient-centered care, the incorporation of shared decision making, and the relevant body of existing and developing literature on this topic in radiation oncology. The authors report recent discoveries from this area of study and describe how they can not only support high-quality, high-value patient care but also enhance recruitment to clinical oncology trials, both of which are challenging to achieve in today's relatively resource-strapped environment.
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Affiliation(s)
- Abigail T Berman
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Seth A Rosenthal
- Sutter Medical Group and Sutter Cancer Center, Sacramento, California
| | | | - Kristina D Woodhouse
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
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Jain A, Vapiwala N, Woodhouse KD, Both S, Gabriel P, Tochner Z, Deville C. (P037) Acute and Late Toxicity Report of Post-Prostatectomy Proton Therapy for Prostate Cancer Patients Undergoing Adjuvant or Salvage Radiotherapy. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.02.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Woodhouse KD, Hwang WT, Vapiwala N, Jain A, Wang X, Both S, Shah M, Frazier M, Gabriel P, Christodouleas JP, Tochner Z, Deville C. Sociodemographic disparities in the utilization of proton therapy for prostate cancer at an urban academic center. Adv Radiat Oncol 2017; 2:132-139. [PMID: 28740924 PMCID: PMC5514248 DOI: 10.1016/j.adro.2017.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 01/10/2017] [Accepted: 01/10/2017] [Indexed: 11/04/2022] Open
Abstract
Purpose Despite increasing use, proton therapy (PT) remains a relatively limited resource. The purpose of this study was to assess clinical and demographic differences in PT use for prostate cancer compared to intensity modulated radiation therapy (IMRT) at a single institution. Methods and materials All patients with low- and intermediate-risk prostate cancer (N = 633) who underwent definitive radiation therapy between 2010 and 2015 were divided into PT (n = 508) and IMRT (n = 125) comparison groups and compared using χ2 and independent sample t tests. Univariable and multivariable logistic regression analyses were conducted to assess the associations between PT use and demographic, clinical, and treatment characteristics. Results The PT and IMRT cohorts varied by age, race, poverty, distance, treatment year, and treating physician. Patients who underwent IMRT were more likely to be older (mean age, 66 vs. 68 years), black (51% vs. 75%), and living in poverty or close to the facility (mean distance between residence and facility, 90 vs. 21 miles; P < .05). Prostate-specific antigen, prostate volume, and International Index of Erectile Function were significantly higher in the IMRT cohort (P < .05), but insurance type, risk group, tumor stage, Gleason score, and patient-reported urinary and bowel scores did not differ significantly (P > .05). Patients who underwent PT were more likely to receive hypofractionated therapy and less likely to receive androgen deprivation therapy (P < .01). On multivariable analysis, black (odds ratio [OR], 0.29; 95% confidence interval [CI], 0.15-0.57) and other race (OR, 0.42; 95% CI, 0.20-0.90); distance (OR, 1.14; 95% CI, 1.06-1.24); treatment years 2011 (OR, 4.87; 95% CI, 2.23-10.6), 2012 (OR, 8.27; 95% CI, 3.43-19.9), and 2014 (OR, 4.44; 95% CI, 1.94-10.2) relative to 2010; and a single treating physician (OR, 0.38; 95% CI, 0.18-0.81) relative to the reference physician with the highest rate of use were associated with PT use, whereas clinical factors such as prostate-specific antigen, prostate volume, International Index of Erectile Function, and androgen deprivation therapy were not. Conclusion Sociodemographic disparities exist in PT use for prostate cancer at an urban academic institution. Further investigation of potential barriers to access is warranted to ensure equitable distribution across all demographic groups.
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Affiliation(s)
- Kristina D Woodhouse
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Wei-Ting Hwang
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Akansha Jain
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Xingmei Wang
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stefan Both
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Meera Shah
- Emory University School of Medicine, Atlanta, Georgia
| | - Marquise Frazier
- Department of Radiation Therapy, Howard University, Washington, District of Columbia
| | - Peter Gabriel
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John P Christodouleas
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Zelig Tochner
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
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Gabriel PE, Woodhouse KD, Lin A, Finlay JC, Young RB, Volz E, Hahn SM, Metz JM, Maity A. An automated electronic system for managing radiation treatment plan peer review reduces missed reviews at a large, high-volume academic center. Pract Radiat Oncol 2016; 6:e307-e314. [DOI: 10.1016/j.prro.2016.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/03/2016] [Accepted: 03/09/2016] [Indexed: 11/28/2022]
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23
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Woodhouse KD, Volz E, Bellerive M, Bergendahl HW, Gabriel PE, Maity A, Hahn SM, Vapiwala N. The implementation and assessment of a quality and safety culture education program in a large radiation oncology department. Pract Radiat Oncol 2016; 6:e127-e134. [DOI: 10.1016/j.prro.2015.11.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/10/2015] [Accepted: 11/12/2015] [Indexed: 11/27/2022]
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