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Hortobagyi G, Weaver DL, Solin L, Connolly J, Mittendorf E, Winchester DJ, Rugo H, Edge SB, Giuliano A. Abstract P3-08-04: Withdrawn. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-08-04] [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
This abstract was withdrawn by the authors.
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Affiliation(s)
- G Hortobagyi
- The University of Texas MD Anderson Cancer Center, Houston, TX; University of Vermont, Burlington, VT; Albert Einstein Medical Center, Philadelphia, PA; Beth Israel Deaconess Medical Center, Boston, MA; NorthShore University Health System, Evanston, IL; University of California, San Francisco, San Francisco, CA; Roswell Park Cancer Institute, Buffalo, NY; Cedars Sinai Medical Center, Los Angeles, CA
| | - DL Weaver
- The University of Texas MD Anderson Cancer Center, Houston, TX; University of Vermont, Burlington, VT; Albert Einstein Medical Center, Philadelphia, PA; Beth Israel Deaconess Medical Center, Boston, MA; NorthShore University Health System, Evanston, IL; University of California, San Francisco, San Francisco, CA; Roswell Park Cancer Institute, Buffalo, NY; Cedars Sinai Medical Center, Los Angeles, CA
| | - L Solin
- The University of Texas MD Anderson Cancer Center, Houston, TX; University of Vermont, Burlington, VT; Albert Einstein Medical Center, Philadelphia, PA; Beth Israel Deaconess Medical Center, Boston, MA; NorthShore University Health System, Evanston, IL; University of California, San Francisco, San Francisco, CA; Roswell Park Cancer Institute, Buffalo, NY; Cedars Sinai Medical Center, Los Angeles, CA
| | - J Connolly
- The University of Texas MD Anderson Cancer Center, Houston, TX; University of Vermont, Burlington, VT; Albert Einstein Medical Center, Philadelphia, PA; Beth Israel Deaconess Medical Center, Boston, MA; NorthShore University Health System, Evanston, IL; University of California, San Francisco, San Francisco, CA; Roswell Park Cancer Institute, Buffalo, NY; Cedars Sinai Medical Center, Los Angeles, CA
| | - E Mittendorf
- The University of Texas MD Anderson Cancer Center, Houston, TX; University of Vermont, Burlington, VT; Albert Einstein Medical Center, Philadelphia, PA; Beth Israel Deaconess Medical Center, Boston, MA; NorthShore University Health System, Evanston, IL; University of California, San Francisco, San Francisco, CA; Roswell Park Cancer Institute, Buffalo, NY; Cedars Sinai Medical Center, Los Angeles, CA
| | - DJ Winchester
- The University of Texas MD Anderson Cancer Center, Houston, TX; University of Vermont, Burlington, VT; Albert Einstein Medical Center, Philadelphia, PA; Beth Israel Deaconess Medical Center, Boston, MA; NorthShore University Health System, Evanston, IL; University of California, San Francisco, San Francisco, CA; Roswell Park Cancer Institute, Buffalo, NY; Cedars Sinai Medical Center, Los Angeles, CA
| | - H Rugo
- The University of Texas MD Anderson Cancer Center, Houston, TX; University of Vermont, Burlington, VT; Albert Einstein Medical Center, Philadelphia, PA; Beth Israel Deaconess Medical Center, Boston, MA; NorthShore University Health System, Evanston, IL; University of California, San Francisco, San Francisco, CA; Roswell Park Cancer Institute, Buffalo, NY; Cedars Sinai Medical Center, Los Angeles, CA
| | - SB Edge
- The University of Texas MD Anderson Cancer Center, Houston, TX; University of Vermont, Burlington, VT; Albert Einstein Medical Center, Philadelphia, PA; Beth Israel Deaconess Medical Center, Boston, MA; NorthShore University Health System, Evanston, IL; University of California, San Francisco, San Francisco, CA; Roswell Park Cancer Institute, Buffalo, NY; Cedars Sinai Medical Center, Los Angeles, CA
| | - A Giuliano
- The University of Texas MD Anderson Cancer Center, Houston, TX; University of Vermont, Burlington, VT; Albert Einstein Medical Center, Philadelphia, PA; Beth Israel Deaconess Medical Center, Boston, MA; NorthShore University Health System, Evanston, IL; University of California, San Francisco, San Francisco, CA; Roswell Park Cancer Institute, Buffalo, NY; Cedars Sinai Medical Center, Los Angeles, CA
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Hortobagyi GN, Giuliano A, Winchester DJ, Mittendorf E, Edge S, Connolly J, Weaver D, Rugo H, Solin L. Abstract P6-09-06: Updating the AJCC TNM staging system a summary of changes. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-09-06] [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
This abstract was withdrawn by the authors.
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Affiliation(s)
- GN Hortobagyi
- The University of Texas MD Anderson Cancer Center, Houston, TX; Cedars Sinai Medical Center, Los Angeles, CA; NorthShore University Health System, Evanston, IL; UT MD Anderson Cancer Center, Houston, TX; Roswell Park Cancer Institute, Buffalo, NY; Beth Israel Deaconess Medical Center, Boston, MA; University of Vermont, Burlington, VT; University of California, San Francisco, San Francisco, CA; Albert Einstein Medical Center, Philadelphia, PA
| | - A Giuliano
- The University of Texas MD Anderson Cancer Center, Houston, TX; Cedars Sinai Medical Center, Los Angeles, CA; NorthShore University Health System, Evanston, IL; UT MD Anderson Cancer Center, Houston, TX; Roswell Park Cancer Institute, Buffalo, NY; Beth Israel Deaconess Medical Center, Boston, MA; University of Vermont, Burlington, VT; University of California, San Francisco, San Francisco, CA; Albert Einstein Medical Center, Philadelphia, PA
| | - DJ Winchester
- The University of Texas MD Anderson Cancer Center, Houston, TX; Cedars Sinai Medical Center, Los Angeles, CA; NorthShore University Health System, Evanston, IL; UT MD Anderson Cancer Center, Houston, TX; Roswell Park Cancer Institute, Buffalo, NY; Beth Israel Deaconess Medical Center, Boston, MA; University of Vermont, Burlington, VT; University of California, San Francisco, San Francisco, CA; Albert Einstein Medical Center, Philadelphia, PA
| | - E Mittendorf
- The University of Texas MD Anderson Cancer Center, Houston, TX; Cedars Sinai Medical Center, Los Angeles, CA; NorthShore University Health System, Evanston, IL; UT MD Anderson Cancer Center, Houston, TX; Roswell Park Cancer Institute, Buffalo, NY; Beth Israel Deaconess Medical Center, Boston, MA; University of Vermont, Burlington, VT; University of California, San Francisco, San Francisco, CA; Albert Einstein Medical Center, Philadelphia, PA
| | - S Edge
- The University of Texas MD Anderson Cancer Center, Houston, TX; Cedars Sinai Medical Center, Los Angeles, CA; NorthShore University Health System, Evanston, IL; UT MD Anderson Cancer Center, Houston, TX; Roswell Park Cancer Institute, Buffalo, NY; Beth Israel Deaconess Medical Center, Boston, MA; University of Vermont, Burlington, VT; University of California, San Francisco, San Francisco, CA; Albert Einstein Medical Center, Philadelphia, PA
| | - J Connolly
- The University of Texas MD Anderson Cancer Center, Houston, TX; Cedars Sinai Medical Center, Los Angeles, CA; NorthShore University Health System, Evanston, IL; UT MD Anderson Cancer Center, Houston, TX; Roswell Park Cancer Institute, Buffalo, NY; Beth Israel Deaconess Medical Center, Boston, MA; University of Vermont, Burlington, VT; University of California, San Francisco, San Francisco, CA; Albert Einstein Medical Center, Philadelphia, PA
| | - D Weaver
- The University of Texas MD Anderson Cancer Center, Houston, TX; Cedars Sinai Medical Center, Los Angeles, CA; NorthShore University Health System, Evanston, IL; UT MD Anderson Cancer Center, Houston, TX; Roswell Park Cancer Institute, Buffalo, NY; Beth Israel Deaconess Medical Center, Boston, MA; University of Vermont, Burlington, VT; University of California, San Francisco, San Francisco, CA; Albert Einstein Medical Center, Philadelphia, PA
| | - H Rugo
- The University of Texas MD Anderson Cancer Center, Houston, TX; Cedars Sinai Medical Center, Los Angeles, CA; NorthShore University Health System, Evanston, IL; UT MD Anderson Cancer Center, Houston, TX; Roswell Park Cancer Institute, Buffalo, NY; Beth Israel Deaconess Medical Center, Boston, MA; University of Vermont, Burlington, VT; University of California, San Francisco, San Francisco, CA; Albert Einstein Medical Center, Philadelphia, PA
| | - L Solin
- The University of Texas MD Anderson Cancer Center, Houston, TX; Cedars Sinai Medical Center, Los Angeles, CA; NorthShore University Health System, Evanston, IL; UT MD Anderson Cancer Center, Houston, TX; Roswell Park Cancer Institute, Buffalo, NY; Beth Israel Deaconess Medical Center, Boston, MA; University of Vermont, Burlington, VT; University of California, San Francisco, San Francisco, CA; Albert Einstein Medical Center, Philadelphia, PA
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Correa C, McGale P, Taylor C, Wang Y, Clarke M, Davies C, Peto R, Bijker N, Solin L, Darby S. Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast. J Natl Cancer Inst Monogr 2010; 2010:162-77. [PMID: 20956824 PMCID: PMC5161078 DOI: 10.1093/jncimonographs/lgq039] [Citation(s) in RCA: 418] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Individual patient data were available for all four of the randomized trials that began before 1995, and that compared adjuvant radiotherapy vs no radiotherapy following breast-conserving surgery for ductal carcinoma in situ (DCIS). A total of 3729 women were eligible for analysis. Radiotherapy reduced the absolute 10-year risk of any ipsilateral breast event (ie, either recurrent DCIS or invasive cancer) by 15.2% (SE 1.6%, 12.9% vs 28.1% 2 P <.00001), and it was effective regardless of the age at diagnosis, extent of breast-conserving surgery, use of tamoxifen, method of DCIS detection, margin status, focality, grade, comedonecrosis, architecture, or tumor size. The proportional reduction in ipsilateral breast events was greater in older than in younger women (2P < .0004 for difference between proportional reductions; 10-year absolute risks: 18.5% vs 29.1% at ages <50 years, 10.8% vs 27.8% at ages ≥ 50 years) but did not differ significantly according to any other available factor. Even for women with negative margins and small low-grade tumors, the absolute reduction in the 10-year risk of ipsilateral breast events was 18.0% (SE 5.5, 12.1% vs 30.1%, 2P = .002). After 10 years of follow-up, there was, however, no significant effect on breast cancer mortality, mortality from causes other than breast cancer, or all-cause mortality.
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MESH Headings
- Adult
- Aged
- Antineoplastic Agents, Hormonal/therapeutic use
- Breast Neoplasms/drug therapy
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/prevention & control
- Carcinoma, Intraductal, Noninfiltrating/drug therapy
- Carcinoma, Intraductal, Noninfiltrating/radiotherapy
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Chemotherapy, Adjuvant
- Combined Modality Therapy
- Female
- Humans
- Mastectomy, Segmental
- Meta-Analysis as Topic
- Middle Aged
- Multicenter Studies as Topic/statistics & numerical data
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/prevention & control
- Neoplasms, Second Primary/epidemiology
- Neoplasms, Second Primary/prevention & control
- Radiotherapy, Adjuvant/statistics & numerical data
- Randomized Controlled Trials as Topic/statistics & numerical data
- Tamoxifen/therapeutic use
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Bar Ad V, Schultz D, Amin N, Booty J, Solin L, Harris E. 2012. Int J Radiat Oncol Biol Phys 2006. [DOI: 10.1016/j.ijrobp.2006.07.414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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5
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Wai E, Solin L, Fourquet A, Vincini F, Taylor M, Haffty B, Olivotto I, Strom E, Pierce L, Marks L, Bartelink H, Hwang W. Salvage treatment for local recurrence after breast-conserving surgery followed by radiation as initial treatment for mammographically-detected ductal carcinoma in situ of the breast. Int J Radiat Oncol Biol Phys 2004. [DOI: 10.1016/j.ijrobp.2004.06.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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6
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Wallner P, Arthur D, Bartelink H, Connolly J, Edmundson G, Giuliano A, Goldstein N, Hevezi J, Julian T, Kuske R, Lichter A, McCormick B, Orecchia R, Pierce L, Powell S, Solin L, Vicini F, Whelan T, Wong J, Coleman CN. Workshop on Partial Breast Irradiation: State of the Art and the Science, Bethesda, MD, December 8-10, 2002. J Natl Cancer Inst 2004; 96:175-84. [PMID: 14759984 DOI: 10.1093/jnci/djh023] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Breast conserving surgery followed by radiation therapy has been accepted as an alternative to mastectomy in the management of patients with early-stage breast cancer. Over the past decade there has been increasing interest in a variety of radiation techniques designed to treat only the portion of the breast deemed to be at high risk for local recurrence (partial-breast irradiation [PBI]) and to shorten the duration of treatment (accelerated partial-breast irradiation [APBI]). To consider issues regarding the equivalency of the various radiation therapy approaches and to address future needs for research, quality assurance, and training, the National Cancer Institute, Division of Cancer Treatment and Diagnosis, Radiation Research Program, hosted a Workshop on PBI in December 2002. Although 5- to 7-year outcome data on patients treated with PBI and APBI are now becoming available, many issues remain unresolved, including clinical and pathologic selection criteria, radiation dose and fractionation and how they relate to the standard fractionation for whole breast irradiation, appropriate target volume, local control within the untreated ipsilateral breast tissue, and overall survival. This Workshop report defines the issues in relation to PBI and APBI, recommends parameters for consideration in clinical trials and for reporting of results, serves to enhance dialogue among the advocates of the various radiation techniques, and emphasizes the importance of education and training in regard to results of PBI and APBI as they become emerging clinical treatments.
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Affiliation(s)
- P Wallner
- Radiation Research Program, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
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7
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Pierce L, Lew D, Hutchins L, Davidson N, Albain K, Fetting J, Solin L. Patterns of recurrence by sequence of chemotherapy and radiotherapy in early stage breast cancer. Int J Radiat Oncol Biol Phys 2003. [DOI: 10.1016/s0360-3016(03)00828-9] [Citation(s) in RCA: 3] [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: 10/27/2022]
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8
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Abstract
The widespread use of breast-conserving therapy in the treatment of early-stage breast cancer has resulted in increasing numbers of reexcision specimens requiring histologic assessment for residual disease and margin status. Because many reexcisions are performed for only microscopically positive or close margins, reexcision specimens often appear grossly negative and directed tissue sampling cannot be performed. The issue of adequate sampling in these specimens has not been addressed in the literature. A multidisciplinary approach to identifying the clinically important lesions in breast reexcisions and a cost-effective approach to tissue sampling are needed. We reviewed 97 consecutive cases of grossly negative breast reexcisions in which all tissue had been embedded. Forty-seven specimens contained residual invasive or in situ carcinoma and 50 were histologically negative. Detailed histologic findings were presented to a medical oncologist, a radiation oncologist, and a surgeon, who assessed the clinical impact of each diagnosis. Of the 47 positive specimens, 30 resulted in a major change in patient management (recommendation for additional surgery), 10 resulted in minor changes (alteration in radiation dose or adjuvant chemotherapy regimen), and 7 did not alter management. A total of 1867 blocks were submitted. If one block per centimeter of maximal tissue dimension had been submitted and the remainder of the specimen examined only if initial sections revealed invasive or in situ carcinoma, then 901 blocks would have been processed (52% reduction), but we would have missed an average of 3.7 cases resulting in a major change in therapy, and 3.3 cases resulting in a minor change. In contrast, two blocks per centimeter would have missed an average of less than one case each of diagnoses resulting in major and minor therapy changes (0.9 and 0.8 cases, respectively), and 315 (17%) fewer tissue blocks would have been processed. We recommend submitting two blocks per centimeter in grossly benign reexcisions, and examining the remainder of the tissue only if carcinoma is detected on initial sections.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biopsy/economics
- Biopsy/methods
- Breast/pathology
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma in Situ/pathology
- Carcinoma in Situ/surgery
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/surgery
- Chemotherapy, Adjuvant
- Cost-Benefit Analysis
- Female
- Humans
- Mastectomy, Segmental
- Middle Aged
- Models, Statistical
- Neoplasm Invasiveness
- Patient Care Planning
- Probability
- Radiotherapy, Adjuvant
- Retrospective Studies
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Affiliation(s)
- S C Abraham
- Department of Pathology, University of Pennsylvania Medical Center, Philadelphia 55905, USA
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9
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Hoffman JP, Lipsitz S, Pisansky T, Weese JL, Solin L, Benson AB. Phase II trial of preoperative radiation therapy and chemotherapy for patients with localized, resectable adenocarcinoma of the pancreas: an Eastern Cooperative Oncology Group Study. J Clin Oncol 1998; 16:317-23. [PMID: 9440759 DOI: 10.1200/jco.1998.16.1.317] [Citation(s) in RCA: 273] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE A prospective, multiinstitutional trial was initiated in 1991 to examine the tolerance to and efficacy of a program of preoperative chemoradiotherapy (CTRT) and surgical resection for patients with localized adenocarcinoma of the pancreas. PATIENTS AND METHODS Fifty-three patients were assessable for analysis, with a median follow-up of 52 months for survivors. Radiation therapy (RT) totaling 5,040 cGy in 180 cGy fractions with mitomycin 10 mg/m2 day 2 and fluorouracil (5-FU) 1,000 mg/m2/d continuous infusion days 2 through 5 and 29 through 32 were given as preoperative adjuvant therapy. Twelve patients did not proceed to surgery (one death, one toxicity, three local progression, six distant metastases, one intercurrent illness), whereas 41 patients underwent surgery. Of these, 17 patients did not have resection (11, hepatic and/or peritoneal metastases and six local extension that precluded resection). Twenty-four patients had tumor resection (19 Whipple, four total pancreatectomy, one distal pancreatectomy). RESULTS Treatment toxicity was primarily hematologic, although a comparable number suffered biliary tract complications, either from obstruction or cholangitis as a result of an occluded stent or the primary tumor. There was one postoperative death. Median survival for the entire group and for the 24 patients with resection was 9.7 and 15.7 months. This survival rate reflected the advanced state of most resected cancers (positive peritoneal cytology, three patients; margins within 2 mm, 13 patients; involved lymph nodes, four patients; and need for superior mesenteric vein (SMV) resection, four patients). Tumor progression was most frequent at metastatic sites. CONCLUSION This preoperative CTRT protocol was feasible and safe in a cooperative group setting. Entry of patients with advanced tumors probably accounted for the suboptimal resectability and survival results.
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Affiliation(s)
- J P Hoffman
- Fox Chase Cancer Center, and Graduate Hospital, University of Pennsylvania, Philadelphia, USA
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Nioka S, Yung Y, Shnall M, Zhao S, Orel S, Xie C, Chance B, Solin L. Optical imaging of breast tumor by means of continuous waves. Adv Exp Med Biol 1997; 411:227-32. [PMID: 9269431 DOI: 10.1007/978-1-4615-5865-1_27] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- S Nioka
- Department of Biochemistry/Biophysics, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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11
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Hsi R, Torosian M, Solin L. An improved operative technique for placement of brachytherapy catheters in treatment of soft tissue sarcomas. Oncol Rep 1996; 3:453-455. [PMID: 21594391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Two patients with malignant soft tissue sarcomas were treated with local excision followed by a combination of brachytherapy and external beam radiation therapy. The involved areas were large resulting in extensive and irregular sites of resection. The individual placement of multiple brachytherapy catheters in such large, irregular contours can be a time-consuming and technically difficult task often resulting in an uneven distribution of the catheters within the sites of resection. We therefore describe a technique of catheter distribution.
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Affiliation(s)
- R Hsi
- UNIV PENN,SCH MED,DEPT RADIAT ONCOL,PHILADELPHIA,PA 19104. UNIV PENN,SCH MED,DEPT SURG,PHILADELPHIA,PA 19104
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12
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Hsi R, Torosian M, Solin L. An improved operative technique for placement of brachytherapy catheters in treatment of soft tissue sarcomas. Oncol Rep 1996. [DOI: 10.3892/or.3.3.453] [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: 11/06/2022] Open
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13
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Corn B, Solin L, Schnall M, King S. 1171 Signal characteristics on high resolution MRI may predict outcome among patients with bulky cervix cancer treated by irradiation. Eur J Cancer 1995. [DOI: 10.1016/0959-8049(95)96417-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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14
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Coia L, Hoffman J, Scher R, Weese J, Solin L, Weiner L, Eisenberg B, Paul A, Hanks G. Preoperative chemoradiation for adenocarcinoma of the pancreas and duodenum. Int J Radiat Oncol Biol Phys 1994; 30:161-7. [PMID: 8083109 DOI: 10.1016/0360-3016(94)90531-2] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.1] [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: 01/28/2023]
Abstract
PURPOSE This study was designed to evaluate the effects of preoperative chemoradiation on resectability, response, local control, and survival in patients with local or local-regional involvement from carcinoma of the pancreas or cancer of the duodenum and to assess the associated toxicity of such treatment. METHODS AND MATERIALS This prospective pilot study of preoperative chemoradiation was initiated in 1986 for patients with clinical evidence of adenocarcinoma of the pancreas or duodenum without evidence of distant metastases. Radiation was given at 1.8 Gy per day to a total dose of 50.4 Gy. Two cycles of chemotherapy were given concurrent with radiation. On days 2-5 and 29-32, 5-fluorouracil (1 gm/m2/24 h x 4 days) was given, while mitomycin-C (10 mg/m2) was given on day 2 only. Surgical resection was 4-6 weeks following completion of chemoradiation. Thirty-one patients (17 male and 14 female) were entered on the protocol with a median potential follow-up of 4.5 years (range 6 months to 7.5 years). The median age was 64 years (range 32-73 years). Twenty-seven patients had pancreatic cancer (25 head, two body), while four patients had carcinoma arising from the duodenum. Twenty-one patients were initially judged to be unresectable and ten potentially resectable prior to chemoradiation. RESULTS Twenty-nine of 31 patients completed the entire course of radiation and both cycles of chemotherapy. Acute toxicity from chemoradiation consisted of nausea, vomiting, diarrhea, stomatitis, or hematologic suppression which was moderate to severe (Grade 3 or 4) in seven patients (23%). One patient died of sepsis following the first week of therapy. Seventeen patients (55%) underwent curative resection with subtotal or total pancreatectomy or Whipple resection (four duodenum, 13 pancreas) and two (2/17) had pathologic nodal involvement, while (0/17) none had involved margins. A complete pathologic response was seen in all four (4/4) patients with duodenal cancer and in none (0/13) with pancreatic cancer who underwent resection. The median postoperative hospitalization stay was 22 days (range 4-144 days). Of 17 patients who underwent curative resection, there were two postoperative mortalities (12%). Late complications have included abscess, one; and nonmalignant ascites, five. Ten of the 31 patients are alive. For patients with pancreatic cancer the median survival is 9 months, while survival at 1 year and 3 years are 36% and 19% overall and 60% and 43% at 1 and 3 years for those undergoing resection. Six of the 27 patients (22%) with pancreatic cancer are alive without recurrence. All four patients with duodenal cancer are alive without recurrence (12 months, 23 months, 35 months, 90 months). CONCLUSION Preoperative chemoradiation for cancer of the pancreas and duodenal region was relatively well-tolerated and enhanced resectability and downstaging of nodal metastases were suggested. The 3-year survival, particularly in patients who underwent resection, was high. For these reasons the applicability of this treatment regimen for pancreatic cancer is presently being studied in a group-wide multi-institutional Phase II trial. Chemoradiation for duodenal cancer has produced a complete pathologic response in all patients and survival has been excellent, suggesting efficacy of this regimen for duodenal cancer.
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Affiliation(s)
- L Coia
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111
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15
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Foble B, Schultz D, Overmoyer B, Jardines L, Solin L, Glick J. The influence of age on outcome in early state breast cancer. Int J Radiat Oncol Biol Phys 1993. [DOI: 10.1016/0360-3016(93)90664-h] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Solin L, Fourquet A, McCormick B, Haffty B, Recht A, Schultz D, Barrett W, Fowble B, Taylor M, Kuske R, McNeese M, Kurtz J. Intraductal carcinoma of the breast: Long-term results with breast-conserving surgery and definitive irradiation. Eur J Cancer 1993. [DOI: 10.1016/0959-8049(93)90956-g] [Citation(s) in RCA: 4] [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: 11/29/2022]
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17
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Fowble B, Solin L, LaGuette J, Schultz D, Weiss M. The role of mastectomy in patients with stage I–II breast carcinoma presenting with gross multicentric disease or diffuse microcalcifications. Int J Radiat Oncol Biol Phys 1992. [DOI: 10.1016/0360-3016(92)90146-9] [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: 11/26/2022]
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Chu J, Solin L, Hwang C, Kessler H, Hanks G. Three dimensional dosimetric comparison of radiation therapy treatment techniques for carcinoma of pancreas. Int J Radiat Oncol Biol Phys 1989. [DOI: 10.1016/0360-3016(89)90684-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
Eighty-eight patients with localized unresectable carcinoma of the pancreas were treated at Thomas Jefferson University Hospital between 1974 and 1981. Four treatment regimens were used which were sequential modifications of the technique based on the experience in the preceding group of patients. Each treatment changed the course of the disease, and as patterns of failure were identified, the treatment was altered to deal with them. Initially, all patients were treated with external beam radiation. Subsequently, Iodine-125 implantation was added to improve local control; low-dose preoperative radiotherapy to reduce the risk of peritoneal seeding; and adjuvant chemotherapy to reduce the risks of distant metastases. The addition of 125I implantation increased the local control from 22% to 81%, but did not increase the median survival, which was unchanged from 7 months. The addition of adjuvant chemotherapy increased the median survival from 7 months to 14 months, but had no impact on the control of the pancreatic tumor. Adjunctive chemotherapy and low-dose preoperative radiotherapy appear synergistic in reducing the risk of peritoneal seeding. The combination of 125I implantation, external beam radiation, and adjunctive chemotherapy is safe and effective. This regimen produces excellent local control with acceptable morbidity. This regimen produced a 30% survival at 18 months. The patterns of failure among these patients suggest future modifications of the technique.
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