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SBRT for Oligoprogressive Disease, Defining Low-Risk Breast Cancer, Oral Probiotics, and Ultrasound Axillary Lymph Node Staging for Breast Cancer. Pract Radiat Oncol 2024; 14:181-184. [PMID: 38702115 DOI: 10.1016/j.prro.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 05/06/2024]
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PROshot: Regional Nodal Irradiation, Prophylactic Radiation for Bone Metastases, Adaptive Therapy for Hodgkin Lymphoma, Immunoscore, and Heart Dosimetry. Pract Radiat Oncol 2024; 14:175-180. [PMID: 38702114 DOI: 10.1016/j.prro.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 05/06/2024]
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Neoadjuvant Chemotherapy and Surgery for Cervical Cancer, Timing of Surgery for Esophageal Cancer, Endometrial Cancer Molecular Classification, Vestibular Schwannoma, and Breast Boost Techniques. Pract Radiat Oncol 2024; 14:1-5. [PMID: 38182302 DOI: 10.1016/j.prro.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 01/07/2024]
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Neoadjuvant Therapy for Rectal Cancer, Regional Nodal Irradiation for Favorable Biology Breast Cancer, Head and Neck Toxicity, and Immunotherapy Plus Stereotactic Ablative Body Radiation Therapy for Lung Cancer. Pract Radiat Oncol 2023; 13:477-481. [PMID: 37923490 DOI: 10.1016/j.prro.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/20/2023] [Accepted: 08/21/2023] [Indexed: 11/07/2023]
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Spine Stereotactic Radiosurgery, Prostate Radiation Frequency, Adjuvant Chemotherapy for Cervical Cancer, Bacteria and Radiation Dermatitis, and Breast Conservation Therapy for Multifocal Disease. Pract Radiat Oncol 2023; 13:379-383. [PMID: 37652622 DOI: 10.1016/j.prro.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 09/02/2023]
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Prostate Stereotactic Body Radiation Therapy Margins, Accelerated Partial Breast Irradiation Techniques, Total Neoadjuvant Therapy Local Control, Hyperfractionated Reirradiation, Hyaluronic Acid Rectal Spacer, and Concurrent Docetaxel for Head and Neck Cancer. Pract Radiat Oncol 2023; 13:267-272. [PMID: 37391233 DOI: 10.1016/j.prro.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 07/02/2023]
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Building Better Patient Care in Mississippi Radiation Oncology: Why Mississippi Needs a Collaborative Quality Initiative. South Med J 2023; 116:415-418. [PMID: 37137476 DOI: 10.14423/smj.0000000000001549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVES Cancer is an insidious and devastating disease that affects many people. Progress in mortality rate has not been realized universally across the United States, and challenges remain in how to best make up the ground that has been lost in these areas, one of which is Mississippi. Radiation therapy is a significant contributor to cancer control rates and certain challenges exist specifically regarding this treatment modality. METHODS The challenges of radiation oncology in Mississippi have been reviewed and discussed, with the proposal of a potential collaboration between clinical practitioners and payors to provide optimal and cost-effective radiation therapy to patients in Mississippi. RESULTS A similar model to that proposed has been reviewed and evaluated. This model is discussed based on its potential validity and usefulness in Mississippi. CONCLUSIONS Significant barriers exist in the state of Mississippi to patients receiving a consistent standard of care, regardless of their location and socioeconomic status. A collaborative quality initiative has been shown to be a boon to this endeavor elsewhere and stands to have a similar impact in Mississippi.
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PROshot: Mepitel Film, Daily Versus Twice-Daily Radiation Therapy for Small Cell Lung Cancer, POLAR, Decipher, and Patterns of Failure After Magnetic Resonance Imaging-Guided Brachytherapy for Cervical Cancer. Pract Radiat Oncol 2023; 13:167-171. [PMID: 37080639 DOI: 10.1016/j.prro.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/21/2023] [Indexed: 04/22/2023]
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9
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PROshot: SABR for Oligometastases, SABR for Renal Cell Carcinoma, Glioblastoma Multiforme Reirradiation, and Esophageal Squamous Cell Carcinoma. Pract Radiat Oncol 2023; 13:83-87. [PMID: 36868723 DOI: 10.1016/j.prro.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 03/05/2023]
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PROshot: Borderline Resectable Pancreas SBRT, Surrogate Endpoints, Axillary Dissection, Genomic Classifiers, and Spine SBRT. Pract Radiat Oncol 2022; 12:459-463. [PMID: 36334933 DOI: 10.1016/j.prro.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/01/2022] [Accepted: 09/01/2022] [Indexed: 06/16/2023]
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11
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PROshot: Weekly Cisplatin Versus Every-3-Weeks Cisplatin, Screening Spine Magnetic Resonance Imaging in Prostate Cancer, Total Neoadjuvant Therapy for Rectal Cancer, and Omitting the Elective Low Neck in Nasopharyngeal Cancer. Pract Radiat Oncol 2022; 12:261-264. [PMID: 35717039 DOI: 10.1016/j.prro.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 04/22/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022]
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12
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PROshot: Locoregional Therapy for Metastatic Breast Cancer, Abiraterone in Very High-Risk Prostate Cancer, Neoadjuvant Chemoradiation for Resectable Pancreatic Cancer, Radiation for Oligometastatic EGFR-mutated Lung Cancer, and PORT for N2 Lung Cancer. Pract Radiat Oncol 2022; 12:179-184. [PMID: 35512988 DOI: 10.1016/j.prro.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 10/18/2022]
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Long-term Follow-up of Short-course Androgen Deprivation, Long-term Effects of Regional Nodal Irradiation, the Benefits of Pelvic IMRT, and Single-fraction SBRT for Lung Oligometastases. Pract Radiat Oncol 2022; 12:3-6. [PMID: 34991856 DOI: 10.1016/j.prro.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/09/2021] [Accepted: 11/09/2021] [Indexed: 11/09/2022]
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14
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PROshot News: A Novel Avenue for Continuing Radiation Oncology Education. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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15
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PROshot: Five Practice Pearls Based on Recent Publications. Pract Radiat Oncol 2021; 11:305-309. [PMID: 34479657 DOI: 10.1016/j.prro.2021.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 06/28/2021] [Indexed: 11/17/2022]
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Stereotactic Radiosurgery for Prostate Cancer Following Magnetic Resonance Imaging Directed Biopsy: A Multidisciplinary Approach with Case Examples. Cureus 2018; 10:e2524. [PMID: 29942727 PMCID: PMC6015993 DOI: 10.7759/cureus.2524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Classically, prostate cancer has been diagnosed via systematic, transrectal ultrasound-guided biopsy prompted by an abnormal digital rectal exam or elevated serum prostate-specific antigen (PSA) level. The development of multi-parametric magnetic resonance imaging (MRI) has led to improved detection of prostate cancer foci. For patients with clinically localized prostate cancer seeking definitive therapy through radiation therapy, external beam radiation has been a mainstay with a movement toward hypofractionation, notably prostate stereotactic body radiotherapy (SBRT). We aim to describe the practical aspects of establishing a multidisciplinary, MRI-based prostate SBRT program by means of case examples. The prostate SBRT team at the University of Alabama at Birmingham has been performing prostate SBRT for over four years using a multidisciplinary workflow. We have additionally completed a phase II trial of prostate SBRT with additional targeting of intraprostatic lesions with higher doses of radiation using a simultaneous integrated boost technique. While there have been no reported randomized trials of prostate SBRT, this treatment has been proven safe and effective for properly selected patients with low and intermediate-risk prostate cancer. We present our multidisciplinary approach to prostate SBRT with two clinical cases targeting high-risk [MAM1] lesions in different anatomic zones of the prostate highlighting pertinent clinical challenges in successfully delivering prostate SBRT and managing potential side effects. In conclusion, we report a multidisciplinary, MRI-based approach to treating patients with ultra hyperfractionated stereotactic radiosurgery as primary definitive treatment for prostate cancer.
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ACTR-40. STEREOTACTIC RADIOSURGERY AND TUMOR TREATING FIELDS IN SMALL CELL LUNG CANCER PATIENTS WITH LIMITED BRAIN METASTASES: A PILOT AND FEASIBILITY TRIAL. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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CMET-13. RADIATION THERAPY PATTERNS OF CARE FOR NON-SMALL CELL LUNG CANCER BRAIN METASTASES: AN ANALYSIS OF THE NATIONAL CANCER DATABASE. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Volume of Irradiated Brain is Associated With Severe Lymphopenia in Patients With Glioblastoma Multiforme. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Quality of Information Addressing Prostate Specific Antigen Screening on NCI Cancer Center and Public Health Organization Websites. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Oral Electrolyte Solution Improves Dysuria During Prostate Radiotherapy. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Implementation of a Structured Scheduling Template to Reduce Wait Time, Optimize Room Utilization, and Reduce Cost. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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End-of-life healthcare utilization among Medicare beneficiaries with malignant brain tumors. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.8_suppl.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
244 Background: Patterns of end-of-life healthcare utilization for patients with primary and secondary malignant brain tumors (PMBT, SMBT) are poorly understood. The primary objective of this study was to compare end-of-life healthcare utilization and expenditures between patients with PMBT and SMBT. The secondary objective was to determine risk factors for low-quality healthcare utilization at the end-of-life. Methods: We analyzed Medicare administrative claims data for decedents with a diagnosis of PMBT or SMBT within a community cancer network in the southeastern US from 2012-2015. Outcomes included hospital-based care (ED visit, hospitalization, and ICU admission), cancer therapy (chemo- or radiotherapy), hospice care, and total cost to Medicare in the last 30 days of life. We performed regression analyses to determine risk factors for each of the outcomes. Results: 1323 patients had a diagnosis of PMBT (383) or SMBT (940). Patients with SMBT received more hospital-based care (57% v 49%, p < 0.01) and more cancer therapy (25% v 18%, p < 0.01) than those with PMBT. Male gender (RR 1.28, p = 0.03) and decreasing age (RR 1.09, p = 0.02) were risk factors for PMBT and SMBT hospital-based care, respectively. While the majority of PMBT (81%) and SMBT patients (78%) utilized hospice care, those with SMBT were more likely to enroll ≤ 3 days prior to death (10% v 5%, p < 0.01). Hospital-based care (RR 5.22, p < 0.01 (PMBT); RR 5.24, p < 0.01 (SMBT)), and non-white race (RR 1.59, p = 0.04 (PMBT); RR 1.56, p < 0.01 (SMBT)) were risk factors for no hospice utilization. Mean expenditures in the last 30 days of life were similar between PMBT and SMBT ($8592 v $9964). Hospital-based care increased the average cost by $16,303 (PMBT, p<0.001) and $13,132 (SMBT, p<0.001). Conclusions: Hospitalization at the end-of-life is common in patients with PMBT or SMBT and is associated with lower rates of hospice care and increased expenditure.
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Quality of information addressing treatment options for women with breast cancer on NCI cancer center websites. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.8_suppl.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
135 Background: The internet is increasingly utilized by cancer patients for information that may influence treatment decisions. National Cancer Institute (NCI)-designated cancer center websites and nationally recognized cancer research agencies are trusted sources of information, however little data exists regarding the quality of information on these sites. We evaluated the quality and accessibility of breast cancer treatment information on cancer center websites addressing therapeutic options. Methods: Websites of all NCI cancer centers, the NCI, and Susan G. Komen were reviewed. Quality was measured using 33 questions from three validated Breast Cancer Decision Quality Instruments (DQI). Two blinded reviewers determined if websites provided information to answer each question. Number of clicks to reach the breast-specific webpage, evaluation time, and Spanish and mobile accessibility were recorded. Kappa coefficient was used to measure inter-observer variability. Correlation between evaluation time and questions answered was measured using Pearson coefficient. Results: Of the 63 cancer center websites evaluated, 94% had breast cancer webpages reached in a median of 2 clicks. Average evaluation time was 11 minutes. 24% were Spanish accessible. 59% were mobile friendly. No site provided information that addressed all questions. The most informative cancer center site addressed 76% of questions. On average, 21% of questions were addressed per site. 16% of sites did not have sufficient information to answer any question. In comparison, the NCI and Komen sites covered higher proportions of questions than cancer center sites (85 and 88%). Inter-observer variability was fair to moderate (avg. Kappa 0.37). Evaluation time strongly correlated with number of questions answered (r = 0.75). Conclusions: NCI cancer center websites provided informative feedback for breast cancer patients across an average 21% of key knowledge points in a validated DQI. This information is less accessible to Spanish speaking patients and patients using mobile devices. Website improvements represent an opportunity to enhance knowledge that may improve shared decision making for women with breast cancer.
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Abstract
Health is not defined by the absence of disease or suffering, but by response to a series of life events that can markedly alter the quality and quantity of life. Patients with cancer experience significant but dynamic physical, psychosocial, and financial challenges. With the increasing number of patients with early stage cancers transitioning to survivorship, there is a critical need to address health promotion and overall well-being. For those with advanced cancer, discussion about prognosis and early integration of palliative care can have a profound impact on the quality of life. Effective communication between healthcare providers and patients is important in aligning treatment recommendations with patient goals and preferences throughout cancer therapy. This review provides a dynamic definition of health and proposes actionable guidelines for health promotion at any point along the cancer continuum: survivorship after early cancer or when goals of care transition to improve quality at the end of life.
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Poly(ADP-ribose) polymerase activity and inhibition in cancer. Semin Cell Dev Biol 2017; 63:144-153. [PMID: 28087320 DOI: 10.1016/j.semcdb.2017.01.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 01/03/2017] [Accepted: 01/09/2017] [Indexed: 12/20/2022]
Abstract
Genomic instability resultant from defective DNA repair mechanisms is a fundamental hallmark of cancer. The poly(ADP-ribose) polymerase (PARP) proteins 1, 2 and 3 catalyze the polymerization of poly(ADP-ribose) and covalent attachment to proteins in a phylogenetically ancient form of protein modification. PARPs play a role in base excision repair, homologous recombination, and non-homologous end joining. The discovery that loss of PARP activity had cytotoxic effects in cells deficient in homologous recombination has sparked a decade of translational research efforts that culminated in the FDA approval of an oral PARP inhibitor for clinical use in patients with ovarian cancer and defective homologous recombination. Five PARP inhibitors are now in late-stage development in clinical trials that are seeking to expand the understanding of targeted therapies and DNA repair defects in human cancer. This review examines the cell biology of PARP, the discovery of synthetic lethality with HR deficiency, the clinical development of PARP inhibitors, and the role of PARP inhibitors in ongoing clinical trials and clinical practice.
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PALL-04. RACE AND GENDER DIFFERENCES IN HOSPICE ENROLLMENT OF MEDICARE BENEFICIARIES WITH PRIMARY BRAIN TUMORS. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now212.602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Lymphocyte Trends During Neoadjuvant Chemoradiation Predict Pathologic Complete Response at Time of Surgical Resection of Locally Advanced Rectal Cancers. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Clinical and Radiographic Correlates of Canonical Cancer Pathway Deregulation in Malignant Intraprostatic Lesions. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Quality of information addressing treatment options for women with breast cancer on NCI cancer center websites. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e18002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
INTRODUCTION Cancer center websites are trusted sources of internet information about treatment options for prostate cancer. The quality of information on these websites is unknown. The objective of this study was to evaluate the quality of information on cancer center websites addressing prostate cancer treatment options, outcomes, and toxicity. MATERIALS AND METHODS We evaluated the websites of all National Cancer Institute-designated cancer centers to determine if sufficient information was provided to address eleven decision-specific knowledge questions from the validated Early Prostate Cancer Treatment Decision Quality Instrument. We recorded the number of questions addressed, the number of clicks to reach the prostate cancer-specific webpage, evaluation time, and Spanish and mobile accessibility. Correlation between evaluation time and questions addressed were calculated using the Pearson coefficient. RESULTS Sixty-three websites were reviewed. Eighty percent had a prostate cancer-specific webpage reached in a median of three clicks. The average evaluation time was 6.5 minutes. Information was available in Spanish on 24% of sites and 59% were mobile friendly. Websites provided sufficient information to address, on average, 19% of questions. No website addressed all questions. Evaluation time correlated with the number of questions addressed (R(2) = 0.42, p < 0.001). CONCLUSIONS Cancer center websites provide insufficient information for men with localized prostate cancer due to a lack of information about and direct comparison of specific treatment outcomes and toxicities. Information is also less accessible in Spanish and on mobile devices. These data can be used to improve the quality and accessibility of prostate cancer treatment information on cancer center websites.
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Gait Speed Correlates With Performance Status and Predicts Survival in Patients With Newly Diagnosed Brain Metastases. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Treatment outcomes of radiotherapy versus prostatectomy for localized prostate cancer with Gleason 8 or more on biopsy. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.7_suppl.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
120 Background: There have been no prospective randomized controlled trials comparing current treatment options for patients with high-risk localized prostate cancer. This study seeks to compare the biochemical and metastatic outcomes of patients that received definitive radiotherapy (dRT) or radical prostatectomy (RP) for localized prostate cancer with Gleason score ≥ 8 on initial biopsy. Methods: A total of 106 patients met the inclusion criteria of Gleason score ≥ 8 on initial biopsy and biochemical follow-up ≥ 1 year. Seventy-one patients were initially treated with dRT (96% also receiving androgen deprivation therapy) and 35 patients were initially treated with RP (with or without postoperative RT). Our primary endpoint was biochemical failure (BF). For dRT patients, BF was recorded according to the Phoenix Consensus or if extranodal metastasis was diagnosed. For surgical patients, BF was recorded according to American Urological Association guidelines or if extranodal metastasis occurred. If adjuvant/salvage RT was given postoperatively, BF was recorded if PSA ≥ 0.5 on two consecutive measures after completion of RT. Pretreatment characteristics were compared using Pearson Chi-square method and independent samples Mann-Whitney U test. Actuarial rates of BF and metastasis were calculated using the Kaplan-Meier method. Results: Median follow-up for all patients was 5.3 years. There was no statistical difference in clinical T-stage, initial PSA, or months of follow up between patients treated initially with radiotherapy vs. prostatectomy. Patients initially treated with dRT were significantly older than those treated with RP. The dRT group had a lower rate of BF compared to the RP group, p < 0.001. The Kaplan-Meier estimate of BF at 5 years was 7.6% in the dRT group compared to 34.5% in the RP group. Additionally, the Kaplan-Meier estimate of distant metastasis at 10 years was 22.7% in the dRT group compared to 55.9% of the RP group, p = 0.01. Conclusions: For our sample of patients with Gleason score ≥ 8 on initial biopsy, initial treatment with dRT was associated with lower rates of biochemical failure and extranodal metastasis when compared to initial treatment with prostatectomy.
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