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Song NJ, Chakravarthy KB, Jeon H, Bolyard C, Reynolds K, Weller KP, Reisinger S, Wang Y, Li A, Jiang S, Ma Q, Barouch DH, Rubinstein MP, Shields PG, Oltz EM, Chung D, Li Z. mRNA vaccines against SARS-CoV-2 induce divergent antigen-specific T-cell responses in patients with lung cancer. J Immunother Cancer 2024; 12:e007922. [PMID: 38177076 PMCID: PMC10773442 DOI: 10.1136/jitc-2023-007922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant is highly transmissible and evades pre-established immunity. Messenger RNA (mRNA) vaccination against ancestral strain spike protein can induce intact T-cell immunity against the Omicron variant, but efficacy of booster vaccination in patients with late-stage lung cancer on immune-modulating agents including anti-programmed cell death protein 1(PD-1)/programmed death-ligand 1 (PD-L1) has not yet been elucidated. METHODS We assessed T-cell responses using a modified activation-induced marker assay, coupled with high-dimension flow cytometry analyses. Peripheral blood mononuclear cells (PBMCs) were stimulated with various viral peptides and antigen-specific T-cell responses were evaluated using flow cytometry. RESULTS Booster vaccines induced CD8+ T-cell response against the ancestral SARS-CoV-2 strain and Omicron variant in both non-cancer subjects and patients with lung cancer, but only a marginal induction was detected for CD4+ T cells. Importantly, antigen-specific T cells from patients with lung cancer showed distinct subpopulation dynamics with varying degrees of differentiation compared with non-cancer subjects, with evidence of dysfunction. Notably, female-biased T-cell responses were observed. CONCLUSION We conclude that patients with lung cancer on immunotherapy show a substantial qualitative deviation from non-cancer subjects in their T-cell response to mRNA vaccines, highlighting the need for heightened protective measures for patients with cancer to minimize the risk of breakthrough infection with the Omicron and other future variants.
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Affiliation(s)
- No-Joon Song
- Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center Arthur G James Cancer Hospital and Richard J Solove Research Institute, Columbus, Ohio, USA
| | - Karthik B Chakravarthy
- Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center Arthur G James Cancer Hospital and Richard J Solove Research Institute, Columbus, Ohio, USA
| | - Hyeongseon Jeon
- Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center Arthur G James Cancer Hospital and Richard J Solove Research Institute, Columbus, Ohio, USA
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Chelsea Bolyard
- Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center Arthur G James Cancer Hospital and Richard J Solove Research Institute, Columbus, Ohio, USA
| | - Kelsi Reynolds
- Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center Arthur G James Cancer Hospital and Richard J Solove Research Institute, Columbus, Ohio, USA
| | - Kevin P Weller
- Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center Arthur G James Cancer Hospital and Richard J Solove Research Institute, Columbus, Ohio, USA
| | - Sarah Reisinger
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Yi Wang
- Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center Arthur G James Cancer Hospital and Richard J Solove Research Institute, Columbus, Ohio, USA
| | - Anqi Li
- Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center Arthur G James Cancer Hospital and Richard J Solove Research Institute, Columbus, Ohio, USA
| | - Sizun Jiang
- Department of Pathology, Stanford University, Stanford, California, USA
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Qin Ma
- Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center Arthur G James Cancer Hospital and Richard J Solove Research Institute, Columbus, Ohio, USA
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Dan H Barouch
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark P Rubinstein
- Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center Arthur G James Cancer Hospital and Richard J Solove Research Institute, Columbus, Ohio, USA
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Peter G Shields
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Eugene M Oltz
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, Ohio, USA
| | - Dongjun Chung
- Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center Arthur G James Cancer Hospital and Richard J Solove Research Institute, Columbus, Ohio, USA
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Zihai Li
- Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center Arthur G James Cancer Hospital and Richard J Solove Research Institute, Columbus, Ohio, USA
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Carroll DM, Tessier KM, Cummings KM, O'Connor RJ, Reisinger S, Shields PG, Stepanov IS, Luo X, Hatsukami DK, Rees VW. Risk perceptions and continued smoking as a function of cigarette filter ventilation level among US youth and young adults who smoke. Tob Control 2023; 32:473-479. [PMID: 34857645 PMCID: PMC9160200 DOI: 10.1136/tobaccocontrol-2021-056833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 11/11/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND While evidence demonstrates that the industry's marketing of cigarettes with higher filter ventilation (FV) misleads adults about their health risks, there is no research on the relationships between FV, risk perceptions and smoking trajectories among youth (ages 12-17) and young adults (ages 18-24). METHODS Data on FV levels of major US cigarette brands/sub-brands were merged with the Population Assessment of Tobacco and Health Study to examine whether FV level in cigarettes used by wave 1 youth/young adults (n=1970) predicted continued smoking at waves 2-4, and whether those relationships were mediated by perceived risk of their cigarette brand. FV was modelled based on tertiles (0.2%-11.8%, low; 11.9%-23.2%, moderate; 23.3%-61.1%, high) to predict daily smoking, past 30-day smoking and change in number of days smoking at successive waves. RESULTS The odds of perceiving one's brand as less harmful than other cigarette brands was 2.21 times higher in the high versus low FV group (p=0.0146). Relationships between FV and smoking outcomes at successive waves were non-significant (all p>0.05). CONCLUSION Youth and young adults who use higher FV cigarettes perceived their brand as less harmful compared with other brands. However, level of FV was not associated with continued smoking.
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Affiliation(s)
- Dana Mowls Carroll
- Division of Environmental Health Sciences, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | | | - K Michael Cummings
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Sarah Reisinger
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Peter G Shields
- James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Irina S Stepanov
- Division of Environmental Health Sciences, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Xianghua Luo
- School of Public Health, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Dorothy K Hatsukami
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Vaughan W Rees
- Department of Social and Behavioral Sciences, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
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3
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Andersen BL, Myers J, Blevins T, Park KR, Smith RM, Reisinger S, Carbone DP, Presley CJ, Shields PG, Carson WE. Depression in association with neutrophil-to-lymphocyte, platelet-to-lymphocyte, and advanced lung cancer inflammation index biomarkers predicting lung cancer survival. PLoS One 2023; 18:e0282206. [PMID: 36827396 PMCID: PMC9956881 DOI: 10.1371/journal.pone.0282206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/07/2023] [Indexed: 02/26/2023] Open
Abstract
Lung cancer is a product of inflammation and a dysfunctional immune system, and depression has similar dysregulation. Depression disproportionately affects lung cancer patients, having the highest rates of all cancers. Systemic inflammation and depression are both predictive of non-small cell lung cancer (NSCLC) survival, but the existence and extent of any co-occurrence is unknown. Studied is the association between systemic inflammation ratio (SIR) biomarker levels and patients' depressive symptoms, with the hypothesis that depression severity would be significantly associated with prognostically poor inflammation. Newly diagnosed stage-IV non-small cell lung cancer (NSCLC; N = 186) patients were enrolled (ClinicalTrials.gov Identifier: NCT03199651) and blood draws and depression self-reports (Patient Health Questionnaire-9) were obtained. For SIRs, cell counts of neutrophils (N), lymphocytes (L), and platelets (P) were abstracted for ratio (R) calculations for NLR, PLR, and the Advanced Lung cancer Inflammation Index (ALI). Patients were followed and biomarkers were tested as predictors of 2-year overall survival (OS) to confirm their relevance. Next, multivariate linear regressions tested associations of depression with NLR, PLR, and ALI. Overall 2-year mortality was 61% (113/186). Cox model analyses confirmed higher NLR [hazard ratio (HR) = 1.91; p = 0.001] and PLR (HR = 2.08; p<0.001), along with lower ALI (HR = 0.53; p = 0.005), to be predictive of worse OS. Adjusting for covariates, depression was reliably associated with biomarker levels (p ≤ 0.02). Patients with moderate/severe depressive symptoms were 2 to 3 times more likely to have prognostically poor biomarker levels. Novel data show patients' depressive symptoms were reliably associated with lung-relevant systemic inflammation biomarkers, all assessed at diagnosis/pretreatment. The same SIRs were found prognostic for patients' 2-year OS. Intensive study of depression, combined with measures of cell biology and inflammation is needed to extend these findings to discover mechanisms of depression toxicity for NSCLC patients' treatment responses and survival.
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Affiliation(s)
- Barbara L. Andersen
- Department of Psychology, Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, United States of America
| | - John Myers
- Department of Biomedical Informatics and Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Tessa Blevins
- Department of Psychology, Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, United States of America
| | - Kylie R. Park
- Department of Psychology, Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, United States of America
| | - Rachel M. Smith
- Department of Biomedical Informatics and Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Sarah Reisinger
- Department of Internal Medicine, Division of Medical Oncology, College of Medicine, Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, United States of America
| | - David P. Carbone
- Department of Internal Medicine, Division of Medical Oncology, College of Medicine, Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, United States of America
| | - Carolyn J. Presley
- Department of Internal Medicine, Division of Medical Oncology, College of Medicine, Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, United States of America
| | - Peter G. Shields
- Department of Internal Medicine, Division of Medical Oncology, College of Medicine, Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, United States of America
| | - William E. Carson
- Department of Surgery, Division of Surgical Oncology, College of Medicine, Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, United States of America
- * E-mail:
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4
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Zeng C, Evans JP, Chakravarthy K, Qu P, Reisinger S, Song NJ, Rubinstein MP, Shields PG, Li Z, Liu SL. COVID-19 mRNA booster vaccines elicit strong protection against SARS-CoV-2 Omicron variant in patients with cancer. Cancer Cell 2022; 40:117-119. [PMID: 34986328 PMCID: PMC8716174 DOI: 10.1016/j.ccell.2021.12.014] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Cong Zeng
- Center for Retrovirus Research, Ohio State University, Columbus, OH 43210, USA; Department of Veterinary Biosciences, Ohio State University, Columbus, OH 43210, USA
| | - John P Evans
- Center for Retrovirus Research, Ohio State University, Columbus, OH 43210, USA; Department of Veterinary Biosciences, Ohio State University, Columbus, OH 43210, USA; Molecular, Cellular and Developmental Biology Program, Ohio State University, Columbus, OH 43210, USA
| | - Karthik Chakravarthy
- Division of Medical Oncology, Department of Internal Medicine, Pelotonia Institute for Immuno-Oncology, Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA
| | - Panke Qu
- Center for Retrovirus Research, Ohio State University, Columbus, OH 43210, USA; Department of Veterinary Biosciences, Ohio State University, Columbus, OH 43210, USA
| | - Sarah Reisinger
- Comprehensive Cancer Center, James Cancer Hospital, Ohio State University, Columbus, OH 43210, USA
| | - No-Joon Song
- Division of Medical Oncology, Department of Internal Medicine, Pelotonia Institute for Immuno-Oncology, Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA
| | - Mark P Rubinstein
- Division of Medical Oncology, Department of Internal Medicine, Pelotonia Institute for Immuno-Oncology, Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA
| | - Peter G Shields
- Comprehensive Cancer Center, James Cancer Hospital, Ohio State University, Columbus, OH 43210, USA.
| | - Zihai Li
- Division of Medical Oncology, Department of Internal Medicine, Pelotonia Institute for Immuno-Oncology, Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA.
| | - Shan-Lu Liu
- Center for Retrovirus Research, Ohio State University, Columbus, OH 43210, USA; Department of Veterinary Biosciences, Ohio State University, Columbus, OH 43210, USA; Viruses and Emerging Pathogens Program, Infectious Diseases Institute, Ohio State University, Columbus, OH 43210, USA; Department of Microbial Infection and Immunity, Ohio State University, Columbus, OH 43210, USA.
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5
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Zeng C, Evans JP, Reisinger S, Woyach J, Liscynesky C, Boghdadly ZE, Rubinstein MP, Chakravarthy K, Saif L, Oltz EM, Gumina RJ, Shields PG, Li Z, Liu SL. Impaired neutralizing antibody response to COVID-19 mRNA vaccines in cancer patients. Cell Biosci 2021; 11:197. [PMID: 34802457 PMCID: PMC8606166 DOI: 10.1186/s13578-021-00713-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/13/2021] [Indexed: 01/12/2023] Open
Abstract
There is currently a critical need to determine the efficacy of SARS-CoV-2 vaccination for immunocompromised patients. In this study, we determined the neutralizing antibody response in 160 cancer patients diagnosed with chronic lymphocytic leukemia (CLL), lung cancer, breast cancer, and various non-Hodgkin’s lymphomas (NHL), after they received two doses of mRNA vaccines. Serum from 46 mRNA vaccinated health care workers (HCWs) served as healthy controls. We discovered that (1) cancer patients exhibited reduced neutralizing antibody titer (NT50) compared to HCWs; (2) CLL and NHL patients exhibited the lowest NT50 levels, with 50-60% of them below the detection limit; (3) mean NT50 levels in patients with CLL and NHL was ~2.6 fold lower than those with solid tumors; and (4) cancer patients who received anti-B cell therapy exhibited significantly reduced NT50 levels. Our results demonstrate an urgent need for novel immunization strategies for cancer patients against SARS-CoV-2, particularly those with hematological cancers and those on anti-B cell therapies.
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Affiliation(s)
- Cong Zeng
- Center for Retrovirus Research, The Ohio State University, Columbus, OH, 43210, USA.,Department of Veterinary Biosciences, The Ohio State University, Columbus, OH, 43210, USA
| | - John P Evans
- Center for Retrovirus Research, The Ohio State University, Columbus, OH, 43210, USA.,Department of Veterinary Biosciences, The Ohio State University, Columbus, OH, 43210, USA.,Molecular, Cellular and Developmental Biology Program, The Ohio State University, 43210, Columbus, OH, USA
| | - Sarah Reisinger
- Comprehensive Cancer Center, James Cancer Hospital, The Ohio State University, Columbus, OH, 43210, USA
| | - Jennifer Woyach
- Division of Hematology, James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, 43210, USA
| | - Christina Liscynesky
- Internal Medicine, Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University, Columbus, OH, 43210, USA
| | - Zeinab El Boghdadly
- Internal Medicine, Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University, Columbus, OH, 43210, USA
| | - Mark P Rubinstein
- Division of Medical Oncology, Department of Internal Medicine, Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210, USA
| | - Karthik Chakravarthy
- Division of Medical Oncology, Department of Internal Medicine, Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210, USA
| | - Linda Saif
- Center for Food Animal Health, Animal Sciences Department, OARDC, College of Food, Agricultural and Environmental Sciences,, Wooster, OH, 44691, USA.,Veterinary Preventive Medicine Department, College of Veterinary Medicine, The Ohio State University, 44691, Wooster, OH, USA.,Viruses and Emerging Pathogens Program, Infectious Diseases Institute, The Ohio State University, Columbus, OH, 43210, USA
| | - Eugene M Oltz
- Department of Microbial Infection and Immunity, The Ohio State University, 43210, Columbus, OH, USA
| | - Richard J Gumina
- Department of Medicine, The Ohio State University, Columbus, OH, 43210, USA
| | - Peter G Shields
- Comprehensive Cancer Center, James Cancer Hospital, The Ohio State University, Columbus, OH, 43210, USA.
| | - Zihai Li
- Division of Medical Oncology, Department of Internal Medicine, Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210, USA.
| | - Shan-Lu Liu
- Center for Retrovirus Research, The Ohio State University, Columbus, OH, 43210, USA. .,Department of Veterinary Biosciences, The Ohio State University, Columbus, OH, 43210, USA. .,Viruses and Emerging Pathogens Program, Infectious Diseases Institute, The Ohio State University, Columbus, OH, 43210, USA. .,Department of Microbial Infection and Immunity, The Ohio State University, 43210, Columbus, OH, USA.
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6
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Zeng C, Evans JP, Reisinger S, Woyach J, Liscynesky C, Boghdadly ZE, Rubinstein MP, Chakravarthy K, Saif L, Oltz EM, Gumina RJ, Shields PG, Li Z, Liu SL. Impaired Neutralizing Antibody Response to COVID-19 mRNA Vaccines in Cancer Patients. medRxiv 2021. [PMID: 34704093 PMCID: PMC8547525 DOI: 10.1101/2021.10.20.21265273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
There is currently a critical need to determine the efficacy of SARS-CoV-2 vaccination for immunocompromised patients. In this study, we determined the neutralizing antibody response in 160 cancer patients diagnosed with chronic lymphocytic leukemia (CLL), lung cancer, breast cancer, and various non-Hodgkin’s lymphomas (NHL), after they received two doses of mRNA vaccines. Serum from 46 mRNA vaccinated health care workers (HCWs) served as healthy controls. We discovered that (1) cancer patients exhibited reduced neutralizing antibody titer (NT
50
) compared to HCWs; (2) CLL and NHL patients exhibited the lowest NT
50
levels, with 50-60% of them below the detection limit; (3) mean NT
50
levels in patients with CLL and NHL was ∼2.6 fold lower than those with solid tumors; and (4) cancer patients who received anti-B cell therapy exhibited significantly reduced NT
50
levels. Our results demonstrate an urgent need for novel immunization strategies for cancer patients against SARS-CoV-2, particularly those with hematological cancers and those on anti-B cell therapies.
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Bernardo BM, Gross AL, Young G, Baltic R, Reisinger S, Blot WJ, Paskett ED. Predictors of Colorectal Cancer Screening in Two Underserved U.S. Populations: A Parallel Analysis. Front Oncol 2018; 8:230. [PMID: 29971216 PMCID: PMC6018201 DOI: 10.3389/fonc.2018.00230] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/05/2018] [Indexed: 01/05/2023] Open
Abstract
Background Despite declining colorectal cancer (CRC) incidence and mortality rates in the U.S., significant geographic and racial disparities in CRC death rates remain. Differences in guideline-concordant CRC screening rates may explain some of these disparities. We aim to assess individual and neighborhood-level predictors of guideline-concordant CRC screening within two cohorts of individuals located within CRC mortality geographic hotspot regions in the U.S. Methods A total of 36,901 participants from the Southern Community Cohort Study and 4,491 participants from the Ohio Appalachia CRC screening study were included in this study. Self-reported date of last CRC screening was used to determine if the participant was within guidelines for screening. Logistic regression models were utilized to determine the association of individual-level predictors, neighborhood deprivation, and residence in hotspot regions on the odds of being within guidelines for CRC screening. Results Lower household income, lack of health insurance, and being a smoker were each associated with lower odds of being within guidelines for CRC screening in both cohorts. Area-level associations were less evident, although up to 15% lower guideline adherence was associated with residence in neighborhoods of greater deprivation and in the Lower Mississippi Delta, one of the identified CRC mortality hotspots. Conclusion These results reveal the adverse effects of lower area-level and individual socioeconomic status on adherence to CRC guideline screening.
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Affiliation(s)
- Brittany M Bernardo
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Amy L Gross
- Vanderbilt Institute for Clinical and Translational Research, International Epidemiology Field Station, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Gregory Young
- Center for Biostatistics, The Ohio State University, Columbus, OH, United States
| | - Ryan Baltic
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Sarah Reisinger
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - William J Blot
- Vanderbilt Institute for Clinical and Translational Research, International Epidemiology Field Station, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Medicine, Division of Epidemiology, School of Medicine, Vanderbilt University, Nashville, TN, United States
| | - Electra Diane Paskett
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States.,Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States.,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, United States
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8
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Reisinger S, Ressel G, Eck S, Marsoner S. Differentiation of grain orientation with corrosive and colour etching on a granular bainitic steel. Micron 2017; 99:67-73. [PMID: 28458104 DOI: 10.1016/j.micron.2017.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 04/05/2017] [Accepted: 04/06/2017] [Indexed: 11/24/2022]
Abstract
This study presents a detailed verification of the etching methods with Nital and Klemm on a granular bainitic steel. It is shown that both methods allow the identification of the crystal orientation, whereas Klemm etching enables also a quantification of the apparent phases, as also retained austenite can be distinguished from the other bainitic microstructures. A combination of atom probe tomography with electron-back-scattered-diffraction showed that both etching methods emphasize the bainitic {100} crystal orientation. However, a cross-section produced by focused ion beam evidenced that Klemm etching leads to the formation of a topography of the different oriented bainitic crystals that directly affects the thickness and therefore the apparent colour of the deposited layer formed during etching.
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Affiliation(s)
- S Reisinger
- Materials Center Leoben Forschung GmbH, Austria.
| | - G Ressel
- Materials Center Leoben Forschung GmbH, Austria.
| | - S Eck
- Materials Center Leoben Forschung GmbH, Austria.
| | - S Marsoner
- Materials Center Leoben Forschung GmbH, Austria.
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9
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Song MA, Marian C, Brasky TM, Reisinger S, Djordjevic M, Shields PG. Chemical and toxicological characteristics of conventional and low-TSNA moist snuff tobacco products. Toxicol Lett 2016; 245:68-77. [PMID: 26802282 DOI: 10.1016/j.toxlet.2016.01.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 01/05/2016] [Accepted: 01/18/2016] [Indexed: 01/06/2023]
Abstract
Use of smokeless tobacco products (STPs) is associated with oral cavity cancer and other health risks. Comprehensive analysis for chemical composition and toxicity is needed to compare conventional and newer STPs with lower tobacco-specific nitrosamines (TSNAs) yields. Seven conventional and 12 low-TSNA moist snuff products purchased in the U.S., Sweden, and South Africa were analyzed for 18 chemical constituents (International Agency for Research on Cancer classified carcinogens), pH, nicotine, and free nicotine. Chemicals were compared in each product using Wilcoxon rank-sum test and principle component analysis (PCA). Conventional compared to low-TSNA moist snuff products had higher ammonia, benzo[a]pyrene, cadmium, nickel, nicotine, nitrate, and TSNAs and had lower arsenic in dry weight content and per mg nicotine. Lead and chromium were significantly higher in low-TSNA moist snuff products. PCA showed a clear difference for constituents between conventional and low-TSNA moist snuff products. Differences among products were reduced when considered on a per mg nicotine basis. As one way to contextualize differences in constituent levels, probabilistic lifetime cancer risk was estimated for chemicals included in The University of California's carcinogenic potency database (CPDB). Estimated probabilistic cancer risks were 3.77-fold or 3-fold higher in conventional compared to low-TSNA moist snuff products under dry weight or under per mg nicotine content, respectively. In vitro testing for the STPs indicated low level toxicity and no substantial differences. The comprehensive chemical characterization of both conventional and low-TSNA moist snuff products from this study provides a broader assessment of understanding differences in carcinogenic potential of the products. In addition, the high levels and probabilistic cancer risk estimates for certain chemical constituents of smokeless tobacco products will further inform regulatory decision makers and aid them in their efforts to reduce carcinogen exposure in smokeless tobacco products.
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Affiliation(s)
- Min-Ae Song
- Division of Epidemiology, The Ohio State University, The College of Public Health, Columbus, OH, USA; Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH, USA
| | - Catalin Marian
- Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH, USA; Biochemistry and Pharmacology Department, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Theodore M Brasky
- Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH, USA
| | - Sarah Reisinger
- Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH, USA
| | - Mirjana Djordjevic
- Tobacco Control Research Branch, National Cancer Institute, Rockville, MD, USA
| | - Peter G Shields
- Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH, USA.
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Barthel D, Fischer KI, Nolte S, Otto C, Meyrose AK, Reisinger S, Dabs M, Thyen U, Klein M, Muehlan H, Ankermann T, Walter O, Rose M, Ravens-Sieberer U. Implementation of the Kids-CAT in clinical settings: a newly developed computer-adaptive test to facilitate the assessment of patient-reported outcomes of children and adolescents in clinical practice in Germany. Qual Life Res 2016; 25:585-94. [PMID: 26790429 DOI: 10.1007/s11136-015-1219-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the implementation process of a computer-adaptive test (CAT) for measuring health-related quality of life (HRQoL) of children and adolescents in two pediatric clinics in Germany. The study focuses on the feasibility and user experience with the Kids-CAT, particularly the patients' experience with the tool and the pediatricians' experience with the Kids-CAT Report. METHODS The Kids-CAT was completed by 312 children and adolescents with asthma, diabetes or rheumatoid arthritis. The test was applied during four clinical visits over a 1-year period. A feedback report with the test results was made available to the pediatricians. To assess both feasibility and acceptability, a multimethod research design was used. To assess the patients' experience with the tool, the children and adolescents completed a questionnaire. To assess the clinicians' experience, two focus groups were conducted with eight pediatricians. RESULTS The children and adolescents indicated that the Kids-CAT was easy to complete. All pediatricians reported that the Kids-CAT was straightforward and easy to understand and integrate into clinical practice; they also expressed that routine implementation of the tool would be desirable and that the report was a valuable source of information, facilitating the assessment of self-reported HRQoL of their patients. CONCLUSIONS The Kids-CAT was considered an efficient and valuable tool for assessing HRQoL in children and adolescents. The Kids-CAT Report promises to be a useful adjunct to standard clinical care with the potential to improve patient-physician communication, enabling pediatricians to evaluate and monitor their young patients' self-reported HRQoL.
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Affiliation(s)
- D Barthel
- Research Unit Child Public Health, Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - K I Fischer
- Department of Psychosomatic Medicine, Center of Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - S Nolte
- Department of Psychosomatic Medicine, Center of Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,Public Health Innovation, Population Health Strategic Research Centre, School of Health and Social Development, Deakin University, Burwood, VIC, 3125, Australia
| | - C Otto
- Research Unit Child Public Health, Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - A-K Meyrose
- Research Unit Child Public Health, Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - S Reisinger
- Research Unit Child Public Health, Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - M Dabs
- Research Unit Child Public Health, Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - U Thyen
- Hospital for Pediatrics and Adolescent Medicine, University Medical Center Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - M Klein
- Department of General Pediatrics, University Medical Center Schleswig-Holstein, Arnold-Heller-Straße 3, House 9, 24105, Kiel, Germany
| | - H Muehlan
- Department Health and Prevention, Ernst-Moritz-Arndt University, Robert-Blum-Str. 13, 17487, Greifswald, Germany
| | - T Ankermann
- Department of General Pediatrics, University Medical Center Schleswig-Holstein, Arnold-Heller-Straße 3, House 9, 24105, Kiel, Germany
| | - O Walter
- Department of Psychosomatic Medicine, Center of Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - M Rose
- Department of Psychosomatic Medicine, Center of Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - U Ravens-Sieberer
- Research Unit Child Public Health, Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Patierno SR, Shields P, Hijaz S, Reisinger S. Abstract A1: NCI CRCHD Geographic Management Program (GMaP): Catalyzing inter-institutional collaboration for enhanced cancer health disparity (CHD) research and outreach. Cancer Epidemiol Biomarkers Prev 2010. [DOI: 10.1158/1055-9965.disp-10-a1] [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] Open
Abstract
Abstract
In 2009 the NCI Center to Reduce Cancer Health Disparities launched its Geographic Management Program (GMaP) initiative, which groups cancer health disparity (CHD) research/outreach efforts according to geographic region. Region 1 (DC, MD, VA) includes: Bowie State University, Georgetown University, George Washington University, Hampton University, Howard University, Johns Hopkins University, Morgan State University, University of the District of Columbia, University of Maryland-Baltimore, University of Maryland-Eastern Shore, University of Virginia, Washington Hospital Center, Virginia Commonwealth University.
The George Washington University Cancer Institute (GWCI) was selected as the Region 1 coordinating hub. Region 1 also includes additional funding for BMaP which is focused on Biospecimen Banking for CHD research. The Georgetown Lombardi Cancer Center is the BMaP coordinating hub.
The GMaP goal is to create a regional network wherein resources can be pooled to facilitate progress through inter-institutional collaborations with large-scale funding. There are six regions across the country.
A vital aspect of the Region 1 infrastructure are its Core/Elective Groups, which each have the goal of assessing research/outreach potential in the following fields: Administration and Communication, Training, Bioinformatics, Biospecimen Banking (BMaP), Clinical Trials, Community Translation, Emerging Technology, Evaluation, Social and Behavioral Oncology.
To begin cataloging institutional resources, two survey tools were circulated to Region 1 institutions. The first is the NCI's Readiness Assessment Tool (RAT), which collects institutional data on: communication abilities, bioinformatics, biospecimen banking, clinical trials, emerging technology, training programs. Region 1 institutional data has been organized and submitted to the NCI.
The second survey tool, the Resource Assessment Database (RAD), is Region 1-specific. While the RAD aims to obtain a more thorough understanding of institutional resources, including community translation and social and behavioral oncology programs, it crucially is also meant to identify cooperation potential. The RAD is considered a “living document” that is to be modified as GMaP progresses in order to best capture developing research/outreach data interests. The first RAD draft was circulated to all participants, and the resulting data is being organized. All RAT/RAD data will be used to assess and plan collaborative efforts within the Region.
The BMaP Group also surveyed three Region 1 institutions on metabolomics specimens by type and race. Further information on tissue type, disease state, was culled for specimens located at Georgetown University. BMaP also plans to host a meeting to discuss the feasibility and interest of a virtual repository for CHD biospecimens. Specific discussions will focus on shared access, universal consents, logistics, as well as institutional and other barriers.
Leaders from Region 1 participants have met to initiate more detailed discussions of potential inter-institutional collaborative research/outreach projects. The RAT/RAD data submitted thus far indicates a wide variety of resources that can be brought together to meet its goal of addressing CHDs as a whole.
Funded by grant NIH 5U01-CA-116937.
Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A1.
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Affiliation(s)
| | - Peter Shields
- 2Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC
| | - Sarah Hijaz
- 1George Washington University Cancer Institute, Washington, DC
| | - Sarah Reisinger
- 2Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC
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12
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Reisinger S, Schiavon M, Terry N, Pilon-Smits EAH. Heavy metal tolerance and accumulation in Indian mustard (Brassica juncea L.) expressing bacterial gamma-glutamylcysteine synthetase or glutathione synthetase. Int J Phytoremediation 2008; 10:440-54. [PMID: 19260225 DOI: 10.1080/15226510802100630] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The overexpression of either gamma-glutamylcysteine synthetase (gamma-ECS) or glutathione synthetase (GS) in Brassica juncea transgenics was shown previously to result in higher accumulation of glutathione (GSH) and phytochelatins (PCs), as well as enhanced Cd tolerance and accumulation. The present study was aimed at analyzing the effects of gamma-ECS or GS overexpression on tolerance to and accumulation of other metal/loids supplied individually in agar medium (seedlings) or in hydroponics (mature plants). Also, as pollution in nature generally consists of mixtures of metals, glutamylcysteine synthetase (ECS) and GS seedlings were tested on combinations of metals. Compared to wild-type plants, ECS and GS transgenics exhibited a significantly higher capacity to tolerate and accumulate a variety of metal/loids (particularly As, Cd, and Cr) as well as mixed-metal combinations (As, Cd, Zn/As, Pb, and Zn). This enhanced metal tolerance and accumulation of the ECS and GS transgenics may be attributable to enhanced production of PCs, sustained by a greater availability of GSH as substrate, as suggested by their higher concentrations of GSH, PC2, PC3, and PC4 as compared to wild-type plants. Overexpression of GS and gamma-ECS may represent a promising strategy for the development of plants with an enhanced phytoremediation capacity for mixtures of metals.
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Affiliation(s)
- Sarah Reisinger
- Department of Plant and Microbial Biology, University of California, Berkeley, California, USA
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13
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Werner-Wasik M, Whittington R, Malkowicz SB, Corn BW, Arger P, Reisinger S, Langlotz C, Alexander A, D'Amico AV, Hyslop T, Gomella L, Brownstein K, Wein AJ. Prostate imaging may not be necessary in nonpalpable carcinoma of the prostate. Urology 1997; 50:385-9. [PMID: 9301702 DOI: 10.1016/s0090-4295(97)00225-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [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: 02/05/2023]
Abstract
OBJECTIVES Stage T1c carcinoma of the prostate is defined as a nonpalpable carcinoma (NPC-P) that is not visible by imaging and is identified by needle biopsy performed because of elevated prostate-specific antigen (PSA) concentrations. The purpose of this study was to define the incidence of normal findings on transrectal ultrasound (TRUS) and/or endorectal coil magnetic resonance imaging (EMRI) among patients with NPC-P, as well as to investigate the value of differentiating patients with Stage T1c disease from all other patients with NPC-P. METHODS The records of 2211 patients diagnosed with prostate carcinoma between 1988 and 1995 were reviewed to identify 291 men with NPC-P. TRUS and EMRI reports were analyzed with regard to the presence and laterality of hypoechoic nodules or low-signal areas reported on T2-weighted images, respectively. Ninety percent of patients (n = 262) had at least six prostate biopsies, 185 patients (64%) underwent both TRUS and EMRI, 224 (77%) had TRUS, and 251 (86%) had an EMRI study. RESULTS Results were considered normal in 101 (47%) of 214 patients undergoing TRUS, in 58 (23%) of 249 undergoing EMRI, and in 22 (12%) of 185 undergoing both TRUS and EMRI. For the side of the prostate with positive biopsy results, correlation with imaging abnormalities was better for EMRI than for TRUS (39% versus 24%). There was no significant difference in mean PSA value, distribution of Gleason score, or unilateral versus bilateral positive biopsy results among patients with normal versus abnormal findings on both TRUS and EMRI. CONCLUSIONS (1) Only 12% of men with NPC-P have no TRUS or EMRI abnormalities, fulfilling the criteria for Stage T1c prostate carcinoma. (2) Those patients with Stage T1c disease do not differ from patients with NPC-P up-staged by TRUS or EMRI, with regard to pretreatment PSA levels, Gleason scores, and the probability of having bilateral rather than unilateral positive biopsy results. (3) The value of classifying patients with NPC-P into Stage T1c versus higher stages of prostate carcinoma on the basis of imaging should be questioned.
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Affiliation(s)
- M Werner-Wasik
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA
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14
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Waterman FM, Yue N, Reisinger S, Dicker A, Corn BW. Effect of edema on the post-implant dosimetry of an I-125 prostate implant: a case study. Int J Radiat Oncol Biol Phys 1997; 38:335-9. [PMID: 9226320 DOI: 10.1016/s0360-3016(97)00114-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.2] [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: 02/04/2023]
Abstract
PURPOSE To investigate the effect of post-implant edema on the CT-based calculation of the total dose delivered by an I-125 prostate implant. MATERIALS AND METHODS CT scans of a transperineal I-125 prostate implant were obtained 1 and 39-days post-implant. Changes in the prostate dimensions were determined from changes in the spatial distribution of the I-125 seeds. The total dose delivered to the target volume was computed from each CT scan, and the results compared. RESULTS The volume of the prostate decreased by approximately 17% during the 38-day interval between the first and second CT scans. As a result, the radiation dose computed from the second CT scan was 13% higher. CONCLUSION Post-implant edema can cause a significant underestimation of the radiation dose delivered by an I-125 prostate implant. Similar analysis should be carried out among a larger cohort of patients to confirm or refute these observations.
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Affiliation(s)
- F M Waterman
- Department of Radiation Oncology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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15
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Randall ME, Reisinger S. Radiation therapy and combined chemo-irradiation in advanced and recurrent endometrial carcinoma. Semin Oncol 1994; 21:91-9. [PMID: 8310315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The advent of surgical staging for endometrial carcinoma has identified multiple combinations and degrees of various risk factors. Therefore, it is obvious that questions regarding adjuvant treatment in advanced disease must be generally stated and the answers, when available, may not be specifically applicable to individual patients. Hopefully ongoing and future prospective trials will help to resolve questions about the proper role of RT and/or chemo-irradiation and the proper technique and treatment volume when RT is used.
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Affiliation(s)
- M E Randall
- Department of Radiology (Radiation Oncology), Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC 27157
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Abstract
Following local excision and definitive irradiation of 163 breast cancers in 160 women, alterations in mammographic patterns were observed for up to 7 years. Skin thickening was observed in 96% of mammograms obtained within 1 year of completing therapy and was most pronounced in women treated with iridium implant, chemotherapy, or axillary dissection. In 76% of mammograms, alterations in the parenchymal pattern, including coarsening of stroma and increased breast density, were seen at 1 year. Neither skin nor parenchymal changes progressed after 1 year. Within 3 years of treatment the parenchymal density, which usually regressed, did not change in all patients. At 3 years skin thickness and the parenchymal pattern had returned to normal in less than 50% of the breasts of these women. Scars developed in approximately one-quarter of women. They were present on the initial post-treatment mammogram and remained unchanged on serial studies. Coarse, benign calcifications also developed in the breasts of about one-quarter of women. Microcalcifications developed in 11 breasts; biopsy specimens of six were benign. Benign microcalcifications may be related to therapy.
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