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Morse R, Beaty B, Moon DH, Green R, Xu V, Weiss J, Sheth S, Patel S, Blumberg J, Hackman T, Lumley C, Patel S, Yarbrough W, Huff SB, Repka MC, Dagan R, Amdur RJ, Chera BS, Shen C, Chen X. Long-Term Outcomes of De-Intensified Chemoradiotherapy for Human Papillomavirus-Associated Oropharyngeal Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2023; 117:S123-S124. [PMID: 37784319 DOI: 10.1016/j.ijrobp.2023.06.464] [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) To report long-term oncologic outcomes among patients with human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) treated with definitive de-intensified chemoradiotherapy. MATERIALS/METHODS Major criteria for de-intensification were (1) AJCC 7th edition T0-T3, N0-N2c, M0 (AJCC 8th edition T0-T3, N0-N2, M0), (2) pathologically confirmed p16 positive, and (3) no or minimal/remote smoking history (non-mutated p53 if ≥30 pack-years). Treatment was 60 Gy intensity-modulated radiotherapy with first-choice concurrent cisplatin 30 mg/m2 once per week (alternative regimens permissible for cisplatin ineligible patients). Patients with T0-T2 N0-1 (AJCC 7th edition) were recommended 60 Gy radiation alone. Systemic therapy received included: cisplatin 30 mg/m2 (n = 122), cetuximab (n = 15), cisplatin 40 mg/m2 (n = 12), carboplatin/paclitaxel (n = 2), and radiation alone (n = 25). Kaplan Meier estimates for overall survival (OS), progression-free survival (PFS), locoregional control (LRC), and freedom from distant metastasis (FFDM) were calculated. Cox regression models were used for comparisons among subgroups. RESULTS A total 176 patients received de-intensified treatment (n = 153 prospective protocol, n = 23 off-protocol). Median follow-up was 52.6 months (range 5.3 - 102.0, 90.8% with minimum 2-year follow-up); 56.8% (n = 100) were never smokers and 43.2% (n = 76) former smokers; former smokers had median 9 pack-years smoking history (range 0.25 - 50) with 46% ≥10 pack-years. Outcomes were as follows: 2-year OS 99.4% and 5-year OS 91.8%; 2-year PFS 94.1% and 5-year PFS 84.3%; 2-year LRC 98.3% and 5-year LRC 95.8%; 2-year FFDM 95.8% and 5-year FFDM 93.2%. Median time to progression events were 21.1 months (range, 7.2 - 54.1) with 37.5% (6 of 16) of recurrences occurring after 24 months. Six total locoregional events occurred (five recurrences and one site of persistent disease), within the 60 Gy planning target volume. Twenty-three patients with T0-T2 N0-1 disease received radiation alone with 2-year PFS 92.9% (5-year 83.8%) and 2-year LRC 100% (5-year 95.2%). Outcomes for former smokers with ≥10 pack-years were comparable to patients with less or no smoking history (2-year PFS 94.1% vs 94.1%; 5-year PFS 90.6% vs 82.7%; HR 0.58, p = 0.38). Early results suggest similar oncologic outcomes among those treated off-protocol (median follow-up 25.6 months) with 1 of 23 patients experiencing locoregional recurrence. CONCLUSION Dose de-intensification of 60 Gy radiotherapy with weekly cisplatin results in favorable long-term tumor control in patients with HPV-associated OPSCC. De-intensified 60 Gy alone may be efficacious in carefully selected patients with T0-T2 N0-1 (AJCC 7th edition) disease. Inclusion of biologically favorable patients with more extensive former smoking history in de-intensification clinical trials may be warranted.
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Affiliation(s)
- R Morse
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - B Beaty
- Albert Einstein College of Medicine, Bronx, NY
| | - D H Moon
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - R Green
- University of North Carolina Hospitals, Chapel Hill, NC
| | - V Xu
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - J Weiss
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - S Sheth
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - S Patel
- University of North Carolina Hospitals, Chapel Hill, NC
| | | | - T Hackman
- Department of Otolaryngology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - C Lumley
- UNC School of Medicine, Chapel Hill, NC
| | - S Patel
- UNC School of Medicine, Chapel Hill, NC
| | | | - S B Huff
- University of Carolina, Chapel Hill, NC
| | - M C Repka
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - R Dagan
- University of Florida Health Proton Therapy Institute, Jacksonville, FL
| | - R J Amdur
- University of Florida Hospitals, Gainesville, FL
| | - B S Chera
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - C Shen
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - X Chen
- Case Western Reserve University School of Medicine, Cleveland, OH
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Augustin E, Holtzman AL, Dagan R, Bryant CM, Indelicato DJ, Morris CG, Deraniyagala RL, Fernandes R, Bunnell AM, Nedrud SM, Mendenhall WM. Challenging the Role of Subtotal Resection Following Proton Radiotherapy for Adenoid Cystic Carcinoma of the Head and Neck. Int J Radiat Oncol Biol Phys 2023; 117:e563-e564. [PMID: 37785726 DOI: 10.1016/j.ijrobp.2023.06.1885] [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) To report long-term outcomes of patients with adenoid cystic carcinoma (ACC) of the head and neck treated with proton radiotherapy. MATERIALS/METHODS On this IRB-approved, single institutional prospective outcomes registry, 56 patients were included with de novo, nonmetastatic adenoid carcinoma of the head and neck treated with primary (n = 9) or adjuvant proton therapy from June 2007 to December 2021. The cohort had 30 women and 26 men with a median age of 57 years (range, 10-81 years). Twenty-nine percent (n = 16) had intracranial extension, 23% (n = 13) had orbital extension, and 55% (n = 31) had clinical cranial nerve involvement at the time of radiotherapy. Thirty patients underwent gross total resection (GTR), 26 had gross disease at the time of treatment undergoing a subtotal resection (STR) (n = 17) or biopsy alone (n = 9). The median dose to the primary site was 72.6 GyRBE (range, 64-74.4 GyRBE) delivered in either once (n = 19) or twice (n = 37) daily treatments. Thirty patients received either elective nodal irradiation (ENI) in a node negative neck or concurrent chemotherapy. RESULTS With a median follow-up of 6.2 years (range, 0.9 - 14.7 years), the 5-year local-regional control (LRC), disease free survival (DFS), cause-specific survival (CCS) and overall survival (OS) were 88%, 85%, 89%, and 89%, respectively. Cranial extension (p = 0.003) and gross residual tumor (p = 0.0388) were factors associated with decreased LRC. While LRC for those with a GTR was 96%, those with STR or biopsy alone were 81% and 76%, respectively. T-stage (p = 0.0154), cranial extension (p = 0.0056), extent of resection (p = 0.0355), and gross residual tumor (p = 0.0094) were associated with decreased DFS. T-stage (p = 0.0099), extent of surgery (p = 0.029) and gross residual tumor (p.0071) were associated with decreased CCS. The 5-year cumulative incidence of clinically significant late grade ³3 toxicity was 15% and the crude incidence at most recent follow-up was 23% (n = 13). There was no LRC benefit with ENI (p = 0.94). CONCLUSION Proton therapy provides excellent disease control for head and neck ACC with acceptable toxicity. Gross residual disease at the time of treatment and intracranial involvement were significant prognostic features for worse outcomes. STR did not confer benefit over biopsy only at 5-years and may question the role of extensive and morbid operations if GTR is not technically feasible.
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Affiliation(s)
- E Augustin
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL
| | - A L Holtzman
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL
| | - R Dagan
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL
| | - C M Bryant
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL
| | - D J Indelicato
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL
| | - C G Morris
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL
| | - R L Deraniyagala
- Department of Radiation Oncology, Oakland University William Beaumont School of Medicine, Auburn Hills, MI
| | - R Fernandes
- Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine Jacksonville, Jacksonville, FL
| | - A M Bunnell
- Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine Jacksonville, Jacksonville, FL
| | - S M Nedrud
- Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine Jacksonville, Jacksonville, FL
| | - W M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL
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Huh SN, Indelicato DJ, Holtzman AL, Dagan R, Park JY, Brooks ED, Alghamdi A, Rutenberg MS. Low Tesla MR Imaging for Spine with Hardware. Int J Radiat Oncol Biol Phys 2023; 117:e674. [PMID: 37785987 DOI: 10.1016/j.ijrobp.2023.06.2124] [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) Acquiring MR images with minimized susceptibility artifacts is essential for spines with medical hardware to delineate clinical target volumes (CTVs) in radiation therapy for chordomas, chondrosarcomas, and other sarcomas. Since it can be more challenging to visualize the primary structures in high-tesla MR images due to metal-induced artifacts, we optimized imaging parameters to acquire high-quality, low-tesla MR images for clinical use. MATERIALS/METHODS OptimalMR imaging parameters were investigated under general guidelines for artifact reduction techniques by testing several 3D spin echo and gradient echo sequences in a 0.23-T MR scanner. A customized spine phantom was developed to acquire MR images for bony materials which included, 4-6 industrial titanium screws, an aluminum plate, and a superflab bolus. While the 3D b-FFE sequence was used to acquire MR images with a high signal-to-noise ratio, the other 3D T1-FFE, THRIVE, and DTSE sequences were applied to reduce susceptible artifacts to the medical hardware. The optimized parameters determined in the phantom test were applied to the 15 clinical cases, including patients with residual spinal tumors and fusion hardware. The low-tesla MR imaging technique was also used to scan sarcomas of the extremities and re-irradiation cases of spinal metastases. RESULTS The optimized low-tesla MR images in the spine were noticeably useful to guide CTV delineations for patients with medical hardware, especially for residual or recurrent tumors. The imaging technique to minimize susceptibility artifacts enabled a more defined separation of each hardware component from the spinal cord and CTVs. In spine metastasis cases, pre-irradiated target volumes were determined, reflecting property changes in the bone marrow. CONCLUSION The MR images acquired using the optimized parameters showed minimal artifacts to scan spine patients with hardware. By using the low-tesla MR images, spinal chordoma and chondrosarcoma patients could be treated to improve tumor control probabilities with minimized complications.
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Affiliation(s)
- S N Huh
- University of Florida Health Proton Therapy Institute, Jacksonville, FL; Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL
| | - D J Indelicato
- University of Florida Health Proton Therapy Institute, Jacksonville, FL; Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL
| | - A L Holtzman
- University of Florida Health Proton Therapy Institute, Jacksonville, FL; Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL
| | - R Dagan
- University of Florida Health Proton Therapy Institute, Jacksonville, FL; Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL
| | - J Y Park
- University of Florida Health Proton Therapy Institute, Jacksonville, FL; Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL
| | - E D Brooks
- University of Florida Health Proton Therapy Institute, Jacksonville, FL; Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL
| | - A Alghamdi
- Queen's University, Kingston, ON, Canada
| | - M S Rutenberg
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
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Drescher N, Indelicato DJ, Dagan R, Bradley JA, Holtzman AL, Vega RM, Aldana PR, Sandler ES, Morris CG, Mendenhall WM. Pediatric Esthesioneuroblastoma Treated with Proton Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:e509-e510. [PMID: 37785594 DOI: 10.1016/j.ijrobp.2023.06.1765] [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) Given its tendency to abut and infiltrate critical skull base anatomy, pediatric esthesioneuroblastoma (EN) presents a local control challenge, particularly given the high dose of radiation historically utilized in adult patients and the sensitivity of developing pediatric normal tissue. The purpose of this study was to report the outcomes of pediatric EN treated with proton radiotherapy. MATERIALS/METHODS Using an IRB-approved, single institutional prospective outcomes registry, we analyzed disease control and toxicity in pediatric patients with non-metastatic EN treated with a multimodality approach, including proton radiotherapy, between March 2008 and March 2022. Of the 15 patients, 8 were female, and 7 were male. The median age was 16 years (range, 3-21 years). Patients were Kadish stage B (n = 2), C (n = 8), and D (n = 5) and Hyams low-grade (n = 9), high-grade (n = 5), and not specified (n = 1). Six patients had intracranial involvement, 4 had cranial nerve deficits, and 4 had positive cervical lymph nodes. Prior to radiation, 2 patients had a subtotal resection and 13 had a gross total resection via either endoscopic (n = 8) or craniofacial (n = 7) approaches. Two patients underwent neck dissection (one unilateral and one bilateral). A total of 11 patients received chemotherapy before (n = 5), concurrent (n = 4) with radiation, or both (n = 2). The median total radiation dose delivered to the primary site was 66 Gy/CGE (range, 59.4-72.8 Gy/CGE) for patients with gross disease and 54 Gy/CGE (range, 54-74.4 Gy/CGE) for patients with microscopic disease. RESULTS With a median follow-up of 4.8 years (range, 0.1-12.2 years), both the 5-year disease free and overall survival rates were 86%. There were no local or regional recurrences. Two patients with Kadish D, high grade tumors developed vertebral metastases and died with disease. Serious acute toxicity included 2 patients requiring a temporary feeding tube for oral mucositis/dysphagia. Serious late toxicity included symptomatic retinopathy (n = 3), major reconstructive surgery (n = 2), cataracts requiring intervention (n = 2), chronic otitis media (n = 2), chronic keratoconjunctivitis (n = 2), hypothyroidism (n = 2), and in-field basal cell skin cancer (n = 1). CONCLUSION A multimodality approach to pediatric EN results in excellent local control. Despite the use of moderate dose proton therapy, serious radiation toxicity was observed and thus select patients may benefit from further dose and target volume reduction. Longer follow-up and comparative data from modern photon series are necessary to fully characterize any relative advantage of proton therapy.
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Affiliation(s)
- N Drescher
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL
| | - D J Indelicato
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL
| | - R Dagan
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL
| | - J A Bradley
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL
| | - A L Holtzman
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL
| | - R Mailhot Vega
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL
| | - P R Aldana
- Department of Neurosurgery, University of Florida College of Medicine Jacksonville, Jacksonville, FL
| | - E S Sandler
- Department of Pediatrics, Nemours Children's Health, Jacksonville, FL
| | - C G Morris
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL
| | - W M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL
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Peng J, Erler D, Chen H, Dagan R, Redmond K, Foote M, Badellino S, Biswas T, Louie A, Ricardi U, Sahgal A, Poon I. Outcomes of Extracranial Oligorecurrence after Prior Metastases Directed Stereotactic Body Radiotherapy for Oligometastatic Disease. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1646] [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: 10/31/2022]
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Brisson R, Mamalui-Hunter M, Rutenberg M, Morris C, Bolling J, Mashayekhi A, Khurshid S, Dagan R. Proton Therapy for Uveal Melanoma: A Single-Institution Experience. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1373] [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: 10/31/2022]
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Curry J, Holtzman A, Dagan R, Bryant C, Morris C, Mendenhall W. Impact of Mandated Online Prescription Drug Monitoring Programs on Opiate Analgesic Use and Patient-Reported Pain during Radiotherapy for Oropharyngeal Cancer. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Dagan R, Holtzman A, Bryant C, De Leo A, Morris C. CNS Necrosis after Proton Therapy for Sinonasal Carcinoma. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1338] [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: 10/31/2022]
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Song JY, Chang CJ, Andrews C, Diez-Domingo J, Oh MD, Dagan R, Musey L, Buchwald UK, Hartzel J, Pedley A, Li J, Sterling T, Tamms G, Chiarappa JA, Lutkiewicz J, Tu Y. 930 SAFETY, TOLERABILITY AND IMMUNOGENICITY OF 15-VALENT PNEUMOCOCCAL CONJUGATE VACCINE + PPV23 12 MONTHS LATER IN HEALTHY ADULTS ≥ 50. Age Ageing 2022. [DOI: 10.1093/ageing/afac126.003] [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: 11/15/2022] Open
Abstract
Abstract
Background
Older adults are at increased risk of pneumococcal disease (PD). V114, an investigational 15-valent Pneumococcal Conjugate Vaccine (PCV), contains all serotypes in 13-valent PCV (PCV13) plus serotypes 22F and 33F. This phase 3 trial evaluated the safety, tolerability and immunogenicity of V114 or PCV13 followed 12 months later by PPSV23 in healthy adults aged ≥50 years.
Materials/Method
652 eligible adults were randomised 1:1 to receive V114 or PCV13 followed by PPSV23 12 months later. Solicited and non-solicited adverse events (AEs) were collected after each vaccination. Serotype-specific opsonophagocytic activity (OPA) and immunoglobulin G (IgG) antibodies were measured at Day 1, Day 30, Month 12 and Month 13.
Results
The most common solicited AEs following PCV were injection-site pain, fatigue and myalgia; higher proportions of participants with solicited AEs were observed in the V114 group; however, the differences were not clinically significant, as most AEs were mild and of short duration. The most common solicited AEs following PPSV23 were injection-site pain, injection-site swelling, fatigue and myalgia; these events were comparable across both intervention groups. The proportion of participants with serious AEs were low in both groups and none reported to be vaccine related. No deaths occurred during the study. Serotype-specific OPA geometric mean titres (GMTs) and IgG geometric mean concentrations (GMCs) were comparable between the groups for all 15 serotypes 30 days post-vaccination with PPSV23. OPA GMTs and IgG GMCs were comparable between PCV groups for the 13 shared serotypes and higher in V114 than PCV13 for serotypes 22F and 33F 30 days and 12 months post-vaccination with PCV. V114 elicited an immune response that persisted for at least 12 months.
Conclusion
Sequential administration of V114 and PPSV23 is well tolerated, immunogenic and generally comparable to PCV13 followed by PPSV23 in healthy adults ≥50 years of age.
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Affiliation(s)
- J-Y Song
- Korea University College of Medicine , Seoul, South Korea
| | - C-J Chang
- National Cheng Kung University , Tainan, Taiwan
| | - C Andrews
- Diagnostics Research Group , San Antonio, Texas, USA
| | | | - M-d Oh
- Seoul National University College of Medicine , Seoul, South Korea
| | - R Dagan
- Ben-Gurion University , Beer-Sheva, Israel
| | - L Musey
- Merck & Co., Inc. , Kenilworth, New Jersey, USA
| | | | - J Hartzel
- Merck & Co., Inc. , Kenilworth, New Jersey, USA
| | - A Pedley
- Merck & Co., Inc. , Kenilworth, New Jersey, USA
| | - J Li
- Merck & Co., Inc. , Kenilworth, New Jersey, USA
| | - T Sterling
- Merck & Co., Inc. , Kenilworth, New Jersey, USA
| | - G Tamms
- Merck & Co., Inc. , Kenilworth, New Jersey, USA
| | | | | | - Y Tu
- Merck & Co., Inc. , Kenilworth, New Jersey, USA
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De Leo A, Dagan R, Morris C, Holtzman A, Hitchcock K, Bryant C, Amdur R, Mendenhall W. Have We Made Progress in Early Stage Vocal Cord Cancer with Impaired Cord Mobility? Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2021.12.042] [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: 11/16/2022]
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Baydoun A, Chen H, Poon I, Badellino S, Dagan R, Erler D, Foote M, Louie A, Redmond K, Ricardi U, Sahgal A, Biswas T. Outcomes and toxicities in oligometastatic patients treated with stereotactic body radiotherapy for adrenal gland metastases: A multi-institutional retrospective study. Clin Transl Radiat Oncol 2022; 33:159-164. [PMID: 35243027 PMCID: PMC8885400 DOI: 10.1016/j.ctro.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/22/2021] [Accepted: 09/06/2021] [Indexed: 11/29/2022] Open
Abstract
SBRT to adrenal gland oligometastases achieves a satisfactory local control and OS. A minimum PTV dose BED10 > 46 Gy was associated with an improved OS and LRFS. A prescribed BED10 > 70 Gy was correlated with improved local control. High adrenal metastases volume should not preclude the delivery of SBRT.
Background Studies reporting SBRT outcomes in oligometastatic patients with adrenal gland metastases (AGM) are limited. Herein, we present a multi-institutional analysis of oligometastatic patients treated with SBRT for AGM. Material/methods The Consortium for Oligometastases Research (CORE) is among the largest retrospective series of patients with oligometastases. Among CORE patients, those treated with SBRT for AGM were included. Clinical and dosimetric data were collected. Adrenal metastatic burden (AMB) was defined as the sum of all adrenal GTV if more than one oligometastases is present. Competing risk analysis was used to estimate actuarial cumulative local recurrence (LR) and widespread progression (WP). Kaplan-Meier method was used to report overall survival (OS), local recurrence-free survival (LRFS), and progression-free survival (PFS). Treatment related toxicities were also reported. Results The analysis included 47 patients with 57 adrenal lesions. Median follow-up was 18.2 months. Median LRFS, PFS, and OS were 15.3, 5.3, and 19.1 months, respectively. A minimum PTV dose BED10 > 46 Gy was associated with an improved OS and LRFS. A prescribed BED10 > 70 Gy was an independent predictor of a lower LR probability. AMB>10 cc was an independent predictor of a lower risk for WP. Only one patient developed an acute Grade 3 toxicity consisting of abdominal pain. Conclusion SBRT to AGM achieved a satisfactory local control and OS in oligometastatic patients. High minimum PTV dose and BED10 prescription doses were predictive of improved LR and OS, respectively. Prospective studies are needed to determine comprehensive criteria for patients SBRT eligibility and dosimetric planning.
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Affiliation(s)
- A. Baydoun
- Department of Radiation Oncology, University Hospitals of Cleveland, Cleveland, OH 44106, USA
| | - H. Chen
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario M4N 3M5, Canada
| | - I. Poon
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario M4N 3M5, Canada
| | - S. Badellino
- Radiation Oncology Unit, Department of Oncology, University of Turin and Città della Salute e della Scienza Hospital, Via Genova 3, Turin 10126, Italy
| | - R. Dagan
- Department of Radiation Oncology, University of Florida Health Proton Therapy Institute, Jacksonville, FL 32206, United States
| | - D. Erler
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario M4N 3M5, Canada
| | - M.C. Foote
- Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, QLD 4120, Australia
| | - A.V. Louie
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario M4N 3M5, Canada
| | - K.J. Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University, Baltimore, MD 21218, United States
| | - U. Ricardi
- Radiation Oncology Unit, Department of Oncology, University of Turin and Città della Salute e della Scienza Hospital, Via Genova 3, Turin 10126, Italy
| | - A. Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario M4N 3M5, Canada
| | - T. Biswas
- Department of Radiation Oncology, University Hospitals of Cleveland, Cleveland, OH 44106, USA
- Corresponding author at: Department of Radiation Oncology, University Hospitals, Cleveland Medical Center, 11100 Euclid Avenue, Cleveland OH 44106, United States.
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Baydoun A, Chen H, Poon I, Badellino S, Dagan R, Erler D, Foote M, Louie A, Redmond K, Ricardi U, Sahgal A, Biswas T. Outcomes and Toxicities in Oligometastatic Patients Treated With Stereotactic Body Radiotherapy for Adrenal Gland Metastases: A Multi-Institutional Study. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cao Y, Chen H, Sahgal A, Erler D, Badellino S, Biswas T, Dagan R, Foote M, Louie A, Poon I, Ricardi U, Redmond K. Impact of Volumetric Burden of Metastatic Lesions on Outcomes in Extracranial Oligometastatic Patients: A Multi-Institutional Study. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.153] [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: 11/16/2022]
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De Leo A, Mendenhall W, Dagan R, Hitchcock K, Dziegielewski P, Amdur R. Sparing the Larynx and Hypopharynx With Radiotherapy for Squamous Cell Carcinoma of Unknown Primary Site and Predominant Adenopathy in Level IIA. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chen H, Atenafu E, Erler D, Poon I, Dagan R, Redmond K, Foote M, Badellino S, Biswas T, Ricardi U, Sahgal A, Louie A. A Prognostic Model for Patients With Oligometastatic Disease Treated With Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sheikh S, Chen H, Sahgal A, Poon I, Erler D, Badellino S, Dagan R, Foote M, Louie A, Redmond K, Ricardi U, Biswas T. Role of Stereotactic Body Radiotherapy (SBRT) in the Treatment of Oligo Metastatic Colorectal Cancer: Analysis of a Large Multi-Institutional Database. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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Chen H, Sahgal A, Erler D, Badellino S, Biswas T, Dagan R, Foote M, Poon I, Redmond K, Ricardi U, Louie A. Conditional Survival of Extracranial Oligometastatic Patients Treated with Stereotactic Body Radiation Therapy (SBRT): An International Consortium Study. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Dagan R, Uezono H, Bryant C, Holtzman A, Morris C. Long-Term Follow-Up Of Primary And Adjuvant Proton Therapy For Sinonasal Cancer. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.320] [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: 11/25/2022]
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Cao Y, Chen H, Sahgal A, Erler D, Badellino S, Biswas T, Dagan R, Foote M, Louie A, Poon I, Ricardi U, Redmond K. SBRT for Oligometastatic Non-Spine Bone Metastases: A Multi-Institutional Study. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1356] [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: 11/25/2022]
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Greenberg D, Dagan R, Shany E, Ben-Shimol S, Givon-Lavi N. Incidence of respiratory syncytial virus bronchiolitis in hospitalized infants born at 33–36 weeks of gestational age compared with those born at term: a retrospective cohort study. Clin Microbiol Infect 2020; 26:256.e1-256.e5. [DOI: 10.1016/j.cmi.2019.05.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/15/2019] [Accepted: 05/19/2019] [Indexed: 10/26/2022]
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Bradley J, Liang X, Rutenberg M, Dagan R, Mailhot-Vega R, Lockney N, Jasra B, Spiguel L, Zuberi L, Pembroke M, Mendenhall N, Cain N. Three Year Outcomes of Proton Therapy for Regional Nodal Irradiation in Breast Cancer. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Poon I, Erler D, Dagan R, Janson K, Foote M, Badellino S, Louie A, Baswas T, Ricardo U, Lo S, Lee Y, Sahgal A. A Multi-Institutional Retrospective Clinical and Dosimetric Analyses of 1033 Oligometastatic Patients Treated with SBRT from the Consortium for Oligometastases Research - CORE. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Smith G, Ning M, Shah A, Fu S, Busse P, Cantor S, Dagan R, Foote R, Fuller C, Garden A, Gunn G, Katz S, Lin A, Mohammed N, Morrison W, Patel S, Phan J, Reddy J, Rosenthal D, Snider J, Frank S. Impact of Intensity-Modulated Proton Therapy vs. Intensity-Modulated Photon Therapy on Preserving Work and Productivity in Oropharyngeal Cancer Patients: Outcomes of a Multi-Institution Randomized Trial. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Dagan R, Bryant C, Bates J, De Leo A, Oester A, Morris C, Okunieff P. Stereotactic Ablative Radiotherapy (SABR) May Reduce the Need for Long-Term Androgen Deprivation Therapy (ADT) in Patients with Oligometastatic Prostate Cancer. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Gupta G, Kumar S, Shen C, Amdur R, Dagan R, Weiss J, Grilley-Olson J, Zanation A, Hackman T, Blumberg J, Patel S, Thorp B, Weissler M, Sheets N, Mendenhall W, Chera B. Plasma Circulating Tumor HPV DNA for Early Detection of Cancer Recurrence in HPV-associated Oropharyngeal Cancer. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.05.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Slopsema RL, Mamalui M, Bolling J, Flampouri S, Yeung D, Li Z, Rutenberg MS, Dagan R. Can CT imaging improve targeting accuracy in clip-based proton therapy of ocular melanoma? Phys Med Biol 2019; 64:035010. [PMID: 30566923 DOI: 10.1088/1361-6560/aaf9c9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
To evaluate the benefit of adding CT imaging to the simulation process of clip-based proton therapy of ocular melanomas. For thirty ocular melanoma cases, the clip position in the eye model was determined based on orthogonal radiographs as well as on a CT image set. The geometrical shift of the clips between the standard simulation process and standard simulation process with addition of CT imaging (CT-guided) was determined. The dosimetric impact was evaluated by developing treatment plans based on both the standard-process model and the CT-guided model. In 40% of the studied cases, the difference in clip position between eye models created with and without CT was less than 0.5 mm. This difference was more than 1 mm in 17% of cases. The dosimetric impact of shifts below 1 mm was low because these shifts did not exceed the planning margins. For the four cases with a shift of more than 1 mm a reduction in target coverage (ΔV99%) of -3% to -6% was observed. Changes in macula and optic-disc mean dose of up to 16% and 35% of the prescribed dose were seen when these structures abutted the target. Adding CT imaging to the simulation process is beneficial in select cases where discrepancies between the eye model and ophthalmology measurements occur or where a critical structure is located close to the target and improved localization accuracy is wanted. For the majority of patients, addition of CT imaging does not result in quantifiable changes in dosimetry. Nevertheless, CT imaging is a valuable tool in the quality control of the modeling and treatment-planning process of clip-based eye treatments.
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Affiliation(s)
- R L Slopsema
- University of Florida Health Proton Therapy Institute, 2015 North Jefferson Street, Jacksonville, FL 32206, United States of America. Author to whom any correspondence should be addressed
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Chera B, Kumar S, Shen C, Amdur R, Dagan R, Weiss J, Grilley-Olson J, Zanation A, Hackman T, Blumberg J, Patel S, Thorp B, Weissler M, Sheets N, Mendenhall W, Gupta G. Plasma Circulating Tumor HPV DNA for the Surveillance of Cancer Recurrence in HPV-associated Oropharyngeal Cancer. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.08.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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28
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Coindreau O, Jäckel B, Rocchi F, Alcaro F, Angelova D, Bandini G, Barnak M, Behler M, Da Cruz D, Dagan R, Drai P, Ederli S, Herranz L, Hollands T, Horvath G, Kaliatka A, Kljenak I, Kotsuba O, Lind T, López C, Mancheva K, Matejovic P, Matkovič M, Steinbrück M, Stempniewicz M, Thomas R, Vileiniskis V, Visser D, Vokáč P, Vorobyov Y, Zhabin O. Severe accident code-to-code comparison for two accident scenarios in a spent fuel pool. ANN NUCL ENERGY 2018. [DOI: 10.1016/j.anucene.2018.06.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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29
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Dagan R, Bryant C, Mendenhall W, Amdur R, Morris C, Dziegielewski P, Boyce B, Justice J, Lanza D, Fernandes R, Pirgousis P, Tavanaiepour D. Isolated Leptomeningeal Progression from Sinonasal Carcinomas: Implications for Staging Workup and Treatment. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2017.12.195] [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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30
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Anikeev AV, Dagan R, Fischer U. Numerical Model of the Fusion-Fission Hybrid System Based on Gas Dynamic Trap for Transmutation of Radioactive Wastes. Fusion Science and Technology 2017. [DOI: 10.13182/fst11-1t5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- A. V. Anikeev
- Budker Institute of Nuclear Physics, 630090, Novosibirsk, Russia,
- Novosibirsk State University, 630090, Novosibirsk, Russia
- Karlsruhe Institute of Technology, KIT, Karlsruhe, Germany
| | - R. Dagan
- Karlsruhe Institute of Technology, KIT, Karlsruhe, Germany
| | - U. Fischer
- Karlsruhe Institute of Technology, KIT, Karlsruhe, Germany
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31
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Kropp L, Dagan R, Morris CG, Bryant C, Werning JW, Dziegielewski P, Mendenhall WM, Amdur RJ. Postoperative Radiotherapy for High-risk Laryngeal or Hypopharyngeal Squamous Cell Carcinoma. Hong Kong J Radiol 2017. [DOI: 10.12809/hkjr1715373] [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: 11/05/2022] Open
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Romanets Y, Abderrahim HA, De Bruyn D, Dagan R, Gonçalves I, Maschek W, Rimpault G, Struwe D, Van den Eynde G, Vaz P, Vicente C. XT-ADS: Neutronics, Shielding, and Radiation Damage Calculations. NUCL TECHNOL 2017. [DOI: 10.13182/nt09-a9240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Y. Romanets
- ITN - Estrada Nacional 10, 2686-953, Sacavém, Portugal
| | | | | | - R. Dagan
- Forschungzentrum Karlsruhe, 76227 Karlsruhe, Germany
| | - I. Gonçalves
- ITN - Estrada Nacional 10, 2686-953, Sacavém, Portugal
| | - W. Maschek
- Forschungzentrum Karlsruhe, 76227 Karlsruhe, Germany
| | - G. Rimpault
- Commissariat à l’Energie Atomique, Cadarache Center, 13108 Saint Paul lez Durance, France
| | - D. Struwe
- Forschungzentrum Karlsruhe, 76227 Karlsruhe, Germany
| | | | - P. Vaz
- ITN - Estrada Nacional 10, 2686-953, Sacavém, Portugal
| | - C. Vicente
- CIEMAT, Avda. Complutense, 22 — 28040, Madrid, Spain
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Dagan R, Jianu A, Rimpault G, Weisenburger A, Schikorr M. The Consequences of a Sharp Temperature Change in the Fuel Pins of an Accelerator-Driven Subcritical System. NUCL TECHNOL 2017. [DOI: 10.13182/nt13-a22316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- R. Dagan
- KIT, INR, Karlsruhe Research Center, P.O.B 3640, D-76344 Karlsruhe, Germany
| | - A. Jianu
- KIT, INR, Karlsruhe Research Center, P.O.B 3640, D-76344 Karlsruhe, Germany
| | - G. Rimpault
- CEA, DEN, DER, SPRC, Cadarache Center, 13108 Saint Paul Lez Durance Cedex, France
| | - A. Weisenburger
- KIT, INR, Karlsruhe Research Center, P.O.B 3640, D-76344 Karlsruhe, Germany
| | - M. Schikorr
- KIT, INR, Karlsruhe Research Center, P.O.B 3640, D-76344 Karlsruhe, Germany
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Rimpault G, Darde P, Mellier F, Dagan R, Schikorr M, Weisenburger A, Maes D, Sobolev V, Arien B, Lamberts D, Bruyn DD, Mueller AC, Biarrotte JL. The Issue of Accelerator Beam Trips for Efficient ADS Operation. NUCL TECHNOL 2017. [DOI: 10.13182/nt12-75] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- G. Rimpault
- CEA, DEN, DER, F-13108 Saint Paul Lez Durance, France
| | - Ph. Darde
- CEA, DEN, DER, F-13108 Saint Paul Lez Durance, France
| | - F. Mellier
- CEA, DEN, DER, F-13108 Saint Paul Lez Durance, France
| | - R. Dagan
- KIT, INR, Karlsruhe Research Center, P.O.B 3640, D-76344 Karlsruhe, Germany
| | - M. Schikorr
- KIT, INR, Karlsruhe Research Center, P.O.B 3640, D-76344 Karlsruhe, Germany
| | - A. Weisenburger
- KIT, INR, Karlsruhe Research Center, P.O.B 3640, D-76344 Karlsruhe, Germany
| | - D. Maes
- SCK•CEN, Boeretang 200, 2400 Mol, Belgium
| | - V. Sobolev
- SCK•CEN, Boeretang 200, 2400 Mol, Belgium
| | - B. Arien
- SCK•CEN, Boeretang 200, 2400 Mol, Belgium
| | | | | | - A. C. Mueller
- CNRS, IN2P3, IPNO, 15, Rue G. Clemenceau, 91406 Orsay Cedex, France
| | - J. L. Biarrotte
- CNRS, IN2P3, IPNO, 15, Rue G. Clemenceau, 91406 Orsay Cedex, France
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Trifiletti D, Dagan R, Bolling J, Slopsema R, Mamalui-Hunter M, Yeung D, Helow K, Rutenberg M. Acute Side Effects of Proton Beam Therapy for Uveal Melanoma. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1511] [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: 11/25/2022]
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Jyoti B, Dagan R, Rutenberg M, Morris C, Mendenhall N, Bradley J. Trends in Cardiac Biomarkers Following Adjuvant Proton Therapy for Breast Cancer. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.2047] [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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Abstract
The materials used up to now for grafting arteries have not proved entirely satisfactory. It was the purpose of the project described here to find a more satisfactory method for replacing arteries. Previous experience has shown that glutaraldehyde-treated grafts are non-viable, avascular, and known to pre serve their general structure. In this study small bowel taken from a cat and treated with glutaraldehyde was used to replace the aorta in dogs.Ten dogs were used. The G.A. treated graft in a length of 10 cm bypassed the abdominal aorta. The dogs were sacrificed from 20 days up to one year. Repeated angiographies showed the patency of the graft. After sacrificing the dogs, the grafts were examined macroscopically and microscopically. The site of the anastomosis was strong and no aneurysms were seen. The graft is easy to handle and can be tailored to size.
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Affiliation(s)
- R. Dagan
- From the Department of Plastic Surgery, Chilewitz Chair of Plastic Surgery
| | - I. Kott
- From the Department of Surgery B, Beilinson Medical Center, Petah Tiqva, Israel
| | | | - M. Ben Bassat
- J Casper Department of Pathology, Tel Aviv University Medical School, Tel Aviv, Israel
| | - I. Kaplan
- From the Department of Plastic Surgery, Chilewitz Chair of Plastic Surgery
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Ben-Shimol S, Greenberg D, Givon-Lavi N, Schlesinger Y, Miron D, Aviner S, Dagan R. Impact of PCV7/PCV13 introduction on invasive pneumococcal disease (IPD) in young children: Comparison between meningitis and non-meningitis IPD. Vaccine 2016; 34:4543-4550. [PMID: 27475471 DOI: 10.1016/j.vaccine.2016.07.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 05/29/2016] [Revised: 07/18/2016] [Accepted: 07/19/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The worldwide introduction of pneumococcal conjugate vaccines (PCV) into National Immunization Programs resulted in rapid and substantial reduction of invasive pneumococcal disease (IPD) rates in children. However, the reduction of meningitis vs. non-meningitis IPD (nm-IPD) was not yet fully elucidated. We compared 7-valent and 13-valent PCV (PCV7 and PCV13) impact on pneumococcal-meningitis vs. nm-IPD in Israeli children <5years. METHODS We conducted an ongoing nationwide, prospective, population-based, active surveillance. PCV7 and PCV13 were implemented in Israel in July 2009 and November 2010, respectively. All pneumococcal isolates (blood and/or CSF) from IPD episodes in children <5years from July 2000 through June 2015 were included. Extrapolation for missing serotypes (34.7% of all isolates) was conducted. RESULTS 4163 IPD cases were identified; 3739nm-IPD (89.8%) and 424 meningitis (10.2%). During the pre-PCV period (2000-2008), children <12months constituted 52.1% and 33.7% of meningitis and nm-IPD, respectively (p<0.001). The respective proportions of non-PCV13 serotypes (non-VT) were 18.2% vs. 10.1%, (p<0.001). Comparing the last study year (2014-2015) to the mean of pre-PCV period, meningitis incidence in children <5years decreased non-significantly by 27%, while nm-IPD decreased significantly by 69%. Dynamic rates of meningitis and nm-IPD caused by PCV13 serotypes were similar, with 93% and 95% overall reductions, respectively. However, non-VT increased in meningitis relatively to nm-IPD, mainly in children <24months. Serotype 12F rose sharply and significantly since 2009-2010 through 2014-2015 (28.6% of all non-VT meningitis in children <24m). CONCLUSIONS The overall impact of PCV7/PCV13 in children <5years in Israel was less prominent in meningitis than in nm-IPD. This could be attributed to the younger age of children with meningitis and differences in causative serotypes between the two groups, as the decline of the incidence of meningitis and nm-IPD caused by vaccine-serotypes is similar. Continuous monitoring of meningitis and nm-IPD is warranted.
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Affiliation(s)
- S Ben-Shimol
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - D Greenberg
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - N Givon-Lavi
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Y Schlesinger
- Pediatric Infectious Diseases Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - D Miron
- Pediatric Infectious Diseases Service, Emek Medical Center, Afula, Israel
| | - S Aviner
- Department of Pediatrics, The Barzilai University Medical Center, Ashkelon, Israel
| | - R Dagan
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Dagan R. Prevention of childhood pneumonia through vaccination. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Dagan R, Bryant C, Mendenhall W. Improving Local Control for Unresectable/Incompletely Resected Sinonasal Cancer With Hyperfractionated Proton Therapy and Concurrent Chemotherapy. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2015.12.294] [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: 11/29/2022]
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Bradley J, Ho M, Dagan R, Rutenberg M, Li Z, Mendenhall N. Combined Proton-Photon Technique for Regional Nodal Irradiation in Breast Cancer. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.2133] [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: 10/22/2022]
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Smith T, Bryant C, Bradley J, Indelicato D, Morris C, Dagan R. Outcomes After Proton Therapy for Salivary Gland Cancer. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1363] [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: 10/22/2022]
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Dagan R, Bryant C, Morris C, Mendenhall W. Proton Therapy for Sinonasal Cancer. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1318] [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: 10/22/2022]
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Bradley J, Dagan R, Ho M, Rutenberg M, Morris C, Li Z, Mendenhall N. Two Year Outcomes of a Prospective Study of Proton Therapy for Breast Cancer Regional Nodal Irradiation. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.551] [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: 10/22/2022]
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Slopsema R, Mamalui M, Rutenberg M, Yeung D, Li Z, Bolling J, Flampouri S, Dagan R. TH-CD-BRA-01: The Benefit of Adjunct CT Imaging in Clip-Based Treatment of Ocular Melanoma with Protons. Med Phys 2015. [DOI: 10.1118/1.4926217] [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: 11/07/2022] Open
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Su Z, Dagan R, Li Z. SU-E-T-686: SBRT 4-Dimensional Treatment Planning for Vero Dynamic Tumor Tracking Lung Patients. Med Phys 2015. [DOI: 10.1118/1.4925049] [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: 11/07/2022] Open
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Affiliation(s)
- E Leibovitz
- Pediatric Infectious Disease Unit, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Levine H, Kopel E, Anis E, Givon-Lavi N, Dagan R. The impact of a national routine immunisation programme initiated in 1999 on Hepatitis A incidence in Israel, 1993 to 2012. ACTA ACUST UNITED AC 2015; 20:3-10. [PMID: 25719962 DOI: 10.2807/1560-7917.es2015.20.7.21040] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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]
Abstract
Data on long-term impact of universal national vaccination programmes against hepatitis A are lacking. We aimed at evaluating the impact on hepatitis A incidence of the Israeli toddlers-only universal routine two-dose vaccination programme against hepatitis A initiated in 1999. All hepatitis A episodes reported to the national surveillance system from 1993 to 2012 were analysed in relation to the vaccination programme and coverage. Mean vaccine coverage in Israel between 2003 and 2010 was 92% for the first dose, given at 18 months of age, and 88% for the second dose, given at 24 months. The annual hepatitis A incidence declined from a mean of 50.4 per 100,000 in the period between 1993 and 1998 to a mean of?<1.0, during the period from 2008 to 2012, representing a reduction of?>98%. The decline was evident in all ages and ethnicity groups, including unvaccinated populations. Of the 1,247 cases reported nationwide between 2002 and 2012, the vaccination status could be ascertained in 1,108 (89%). Among them, only 20 (2%) were reported be vaccinated with one dose and three (<1%) received two doses. The sustained results of this long-term impact study suggest that a toddlers-only universal routine two-dose vaccination programme is highly effective and practical. These findings underscore the importance of sustainability in both the surveillance systems and vaccination programmes and will aid to determine vaccination policies.
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Affiliation(s)
- H Levine
- Braun School of Public Health and Community Medicine, Hebrew University-Hadassah, Jerusalem, Israel
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