28 results on '"Lee, Larissa"'
Search Results
2. Adjuvant Radiation Field Extent and Sites of Failure in Node Positive Endometrioid Endometrial Cancer.
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Yerramilli, Divya, Chen, Yu-Hui, Venkatachalam, Veena, Alban, Gabriela M., Buscariollo, Daniela L., Cheng, Teresa, King, Martin T., Pretz, Jennifer L., Russo, Andrea L., and Lee, Larissa J.
- Abstract
In patients with node-positive endometrial cancer, adjuvant radiation therapy with chemotherapy decreases local-regional recurrence compared with chemotherapy alone. However, the optimal radiation field borders and extent of nodal coverage have not been well studied. In a multi-institutional cohort, survival outcomes and sites of failure were analyzed for patients with International Federation of Gynaecology and Obstetrics (FIGO) stage IIIC endometrioid endometrial cancer treated with pelvic radiation therapy (PRT) versus extended-field radiation therapy (EFRT), which encompassed high para-aortic lymph nodes. In a multi-institutional retrospective study, 143 patients with FIGO stage IIIC1 or IIIC2 endometrioid endometrial cancer treated with adjuvant radiation therapy from 2000 to 2016 were identified. Patient subgroups were classified by substage and radiation field extent: stage IIIC1 received EFRT, stage IIIC1 received PRT, and stage IIIC2 received EFRT. Recurrence-free survival (RFS), overall survival (OS), and out-of-field recurrence were calculated by the Kaplan-Meier method. Multivariate analysis was performed using the Cox proportional hazards model. Sites of failure were categorized as within or outside the radiation field. The median follow-up was 59 months; 87% of patients received chemotherapy. The 5-year RFS and OS rates were 73% and 87%, respectively. By subgroup, 5-year RFS rates were 79% for stage IIIC1 EFRT, 73% for stage IIIC1 PRT, and 69% for stage IIIC2 EFRT (P =.4). On multivariate analysis, the recurrence risk was highest for stage IIIC2 EFRT, although this result was not statistically significant (adjusted hazard ratio, 2.0; P =.4). In-field vaginal and nodal recurrences were observed in 2 patients (1%) and 4 patients (3%), respectively. Of 78 patients with stage IIIC1 cancer treated with PRT, 5 (6%) had isolated para-aortic nodal relapse outside the radiation field; 3 were long-term survivors (more than 6 years after salvage therapy). For patients with para-aortic recurrence, 86% had lymphovascular invasion, 71% had myometrial invasion of ≥50%, and 57% had grade 3 disease. Adjuvant chemoradiation therapy resulted in excellent survival outcomes for patients with FIGO stage IIIC endometrioid endometrial cancer. For patients with positive pelvic nodes, isolated para-aortic relapse outside the PRT field was uncommon and amenable to salvage therapy. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
3. Definitive radiotherapy for vaginal recurrence of early-stage endometrial cancer: survival outcomes and effect of mismatch repair status.
- Author
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Alban, Gabriela, Cheng, Teresa, Adleman, Jenna, Buzurovic, Ivan, Pretz, Jennifer, Singer, Lisa, King, Martin, and Lee, Larissa
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SURVIVAL rate ,ENDOMETRIAL cancer ,EXTERNAL beam radiotherapy ,PROGNOSIS ,CANCER prognosis ,UTERINE hemorrhage - Abstract
Objective To evaluate clinical outcomes, prognostic factors, and toxicity in patients with vaginal recurrence of early-stage endometrial cancer treated with definitive radiotherapy. Methods Retrospective review identified 62 patients with stage I-II endometrial cancer and vaginal recurrence treated with external beam radiotherapy and imageguided brachytherapy with definitive intent from November 2004 to July 2017. All patients had prior hysterectomy without adjuvant radiotherapy and >3 months followup. Mismatch repair (MMR) status was determined by immunohistochemical staining of the four mismatch repair proteins (MLH1, MSH2, PMS2, and MSH6) when available in the pathology record. Rates of vaginal control, recurrence-free survival, and overall survival were calculated by Kaplan-Meier. Univariate and multivariate analyses were performed by Cox proportional hazards. Results Most patients had endometrioid histology (55, 89%), grade 1 or 2 tumor (53, 85%), and vaginal-only recurrence (55, 89%). With a median follow-up of 39 months (range, 3-167), 3-and 5-year rates of vaginal control, recurrence-free survival, and overall survival were 86% and 82%, 69% and 55%, and 80% and 61%, respectively. On multivariate analysis, non-endometrioid histology (HR 12.5, P<0.01) was associated with relapse when adjusted for chemotherapy use. Patients with nonendometrioid histology also had a 4.5-fold higher risk of death when adjusted for age (P=0.02). Twenty patients had known MMR status, all with grade 1-2 endometrioid tumors and 10 (50%) with MMR deficiency. The 3-year recurrence-free survival was 100% for MMR-proficient tumors and 52% for MMR-deficient (P=0.03). Late grade 2 and 3 gastrointestinal, genitourinary and vaginal toxicity was reported in 27% and 3%, 15% and 2%, and 16% and 2% of patients, respectively. Conclusion Definitive radiotherapy with image-guided brachytherapy resulted in 5-year local control rates exceeding 80% and late severe toxicity rates were under 3%. Distant recurrence was common and highest for those with grade 3 or non-endometrioid tumors and MMR deficient grade 1-2 disease. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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4. Effect of Mismatch Repair Status on Outcome of Early-Stage Grade 1 to 2 Endometrial Cancer Treated With Vaginal Brachytherapy
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Russo, Andrea L., Lee, Larissa J., Wo, Jennifer Y., Niemierko, Andrzej, Park, Diane, Alban, Gabriela, King, Martin, Philp, Lauren, Growdon, Whitfield B., Oliva, Esther, Spriggs, David R., and Yeku, Oladapo O.
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- 2022
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5. Development and Evaluation of Habitat Suitability Criteria for Native Fishes in Three Arizona Streams.
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Nemec, Zach C., Lee, Larissa N., and Bonar, Scott A.
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NATIVE fishes ,FISH declines ,FISH habitats ,STREAM restoration ,LOGISTIC regression analysis - Abstract
Habitat loss is a main contributor to fish fauna declines in the southwestern USA. Several studies have defined stream‐specific habitat conditions that support the growth and survival of native fish in Arizona to inform stream restoration efforts, yet general habitat use of most individual species across the region is not established. Therefore, we evaluated habitat use of four native fishes, Speckled Dace Rhinichthys osculus, Sonora Sucker Catostomus insignis, Desert Sucker Catostomus clarkii, and Longfin Dace Agosia chrysogaster, across three Arizona streams through the development of habitat suitability criteria (HSC). We developed both stream‐specific and generalized HSC for each species. Generalized HSC were calculated as the combination of stream‐specific HSC for each species. We then assessed the utility of generalized HSC through transferability among study streams. Also, past HSC studies have not considered the occurrence of nonnative species, so we tested whether the presence of nonnative fishes influenced native fish habitat use through logistic regression models. Fish and habitat data were collected along the Mogollon Rim in Arizona during the 2017 summer field season at base flow conditions. We established minimum microhabitat use for four native Arizona fish species through developing HSC. Most generalized criteria did not transfer among study streams due to variation in habitat availability and fish community structure. Logistic regression analysis showed that the presence of nonnative fishes was inversely related to the presence of two native fish species, which could have influenced habitat use of both species. The lack of transferability across streams as demonstrated in this study confirms that only HSC developed in the stream of interest or in similar undegraded streams with comparable fish communities should be used for restoration efforts. For projects to restore native fishes in streams where nonnative competitors will not dominate, the least degraded similar streams without coexisting nonnative fishes can guide restoration efforts. [ABSTRACT FROM AUTHOR]
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- 2021
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6. Low-dose adjuvant vaginal cylinder brachytherapy for early-stage non-endometrioid endometrial cancer: recurrence risk and survival outcomes.
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Smart, Alicia, Buscariollo, Daniela, Alban, Gabriela, Buzurovic, Ivan, Cheng, Teresa, Pretz, Jennifer, Krechmer, Betty, King, Martin, and Lee, Larissa
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RADIOISOTOPE brachytherapy ,ENDOMETRIAL cancer ,HEALTH outcome assessment ,ADJUVANT chemotherapy ,CARCINOSARCOMAS - Abstract
Objective The aim of this study was to evaluate recurrence patterns and survival outcomes for patients with early-stage non-endometrioid endometrial adenocarcinoma treated with adjuvant high-dose rate vaginal brachytherapy with a low-dose scheme. Methods A retrospective review was performed of patients with International Federation of Gynecology and Obstetrics (FIGO) stage I--II non-endometrioid endometrial cancer who received adjuvant vaginal brachytherapy with a low-dose regimen of 24 Gy in six fractions from November 2005 to May 2017. All patients had >6 months of follow-up. Rates of recurrence-free survival, overall survival, vaginal, pelvic, and distant recurrence were calculated by the Kaplan--Meier method. Prognostic factors for recurrence and survival were evaluated by Cox proportional hazards modeling. Results A total of 106 patients were analyzed. Median follow-up was 49 months (range 9--119). Histologic subtypes were serous (47%, n=50), clear cell (10%, n=11), mixed (27%, n=29), and carcinosarcoma (15%, n=16). Most patients (79%) had stage IA disease, 94% had surgical nodal assessment, and 13% had lymphovascular invasion. Adjuvant chemotherapy was delivered to 75%. The 5-year recurrence-free and overall survival rates were 74% and 83%, respectively. By histology, 5-year recurrence-free/overall survival rates were: serous 73%/78%, clear cell 68%/88%, mixed 88%/100%, and carcinosarcoma 56%/60% (p=0.046 and p<0.01). On multivariate analysis, lymphovascular invasion was significantly associated with recurrence (HR 3.3, p<0.01). The 5-year vaginal, pelvic, and distant recurrence rates were 7%, 8%, and 21%, respectively. Vaginal and pelvic recurrence rates were highest for patients with carcinosarcoma, lymphovascular invasion and/or FIGO stage IB/II disease. At 5 years, vaginal and pelvic recurrence rates for patients with lymphovascular invasion were 33% and 40%, respectively. Patients with stage IA disease or no lymphovascular invasion had 5-year vaginal recurrence rates of 4% and pelvic recurrence rates of 6% and 3%, respectively. Conclusions Adjuvant high-dose rate brachytherapy with a low-dose scheme is effective for most patients with early-stage non-endometrioid endometrial cancer, particularly stage IA disease and no lymphovascular invasion. Pelvic radiation therapy should be considered for those with carcinosarcoma, lymphovascular invasion and/ or stage IB/II disease. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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7. Development and Evaluation of Habitat Suitability Criteria for Native Fishes in Three Arizona Streams
- Author
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Nemec, Zach C., Lee, Larissa N., and Bonar, Scott A.
- Abstract
Habitat loss is a main contributor to fish fauna declines in the southwestern USA. Several studies have defined stream‐specific habitat conditions that support the growth and survival of native fish in Arizona to inform stream restoration efforts, yet general habitat use of most individual species across the region is not established. Therefore, we evaluated habitat use of four native fishes, Speckled Dace Rhinichthys osculus, Sonora Sucker Catostomus insignis, Desert Sucker Catostomus clarkii, and Longfin Dace Agosia chrysogaster, across three Arizona streams through the development of habitat suitability criteria (HSC). We developed both stream‐specific and generalized HSC for each species. Generalized HSC were calculated as the combination of stream‐specific HSC for each species. We then assessed the utility of generalized HSC through transferability among study streams. Also, past HSC studies have not considered the occurrence of nonnative species, so we tested whether the presence of nonnative fishes influenced native fish habitat use through logistic regression models. Fish and habitat data were collected along the Mogollon Rim in Arizona during the 2017 summer field season at base flow conditions. We established minimum microhabitat use for four native Arizona fish species through developing HSC. Most generalized criteria did not transfer among study streams due to variation in habitat availability and fish community structure. Logistic regression analysis showed that the presence of nonnative fishes was inversely related to the presence of two native fish species, which could have influenced habitat use of both species. The lack of transferability across streams as demonstrated in this study confirms that only HSC developed in the stream of interest or in similar undegraded streams with comparable fish communities should be used for restoration efforts. For projects to restore native fishes in streams where nonnative competitors will not dominate, the least degraded similar streams without coexisting nonnative fishes can guide restoration efforts.
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- 2021
- Full Text
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8. Low-Dose Adjuvant Cylinder Brachytherapy for Endometrioid Endometrial Cancer.
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Alban, Gabriela M., Buscariollo, Daniela L., Cheng, Teresa, Pretz, Jennifer, Krechmer, Betty, Buzurovic, Ivan, Singer, Lisa, King, Martin, and Lee, Larissa
- Abstract
Our purpose was to evaluate outcomes and sites of failure for women with early stage endometrial adenocarcinoma treated with adjuvant high-dose-rate (HDR) vaginal brachytherapy (VB) with a low dose scheme. Retrospective review identified 318 patients with International Federation of Gynecology and Obstetrics (FIGO) stage I-II endometrioid endometrial cancer who received adjuvant HDR VB to a dose of 24 Gray (Gy) in 6 fractions from 2005 to 2017. Patients with <6 months follow-up were excluded. Dose was prescribed to cylinder surface and computerized tomography (CT) imaging was performed before each fraction to assess cylinder placement. Rates of vaginal relapse (VR), pelvic nodal relapse, distant metastasis, recurrence-free survival, and overall survival were calculated by Kaplan-Meier method. Univariate analysis was performed by log rank test or Cox proportional hazards. Pretreatment CT images were analyzed for patients with VR. Median follow-up was 42 months for 243 patients. The 3-year rates of VR, pelvic nodal relapse, distant metastasis, recurrence-free survival, and overall survival were 1.9%, 1.5%, 4.3%, 94.1%, and 98.9%, respectively. The 3-year VR rates by Gynecologic Oncology (GOG)-99 risk groups were 0%, 1.4%, and 3.2% for low risk, low-intermediate risk, and high-intermediate risk (HIR) disease (P =.5). By Post-operative Radiation Therapy in Endometrial Carcinoma (PORTEC) risk stratification, 3-year VR rate was 1.3% for HIR disease. On review of pretreatment CT images of the 6 patients with VR, 3 patients had relapse at the introitus outside of the treated vaginal length, and 3 had in-field recurrence at the vaginal apex. Higher body mass index (BMI) was associated with VR, with a 14% increase in risk per BMI unit (kg/m
2 , P =.02). There were no reported grade 2 GI or any grade 3 toxicities. Adjuvant HDR VB with a low-dose regimen results in excellent clinical outcomes for patients with early stage endometrioid endometrial cancer. Patients with higher BMI may be at increased risk of VR, and additional study is needed to optimize brachytherapy treatment parameters. [ABSTRACT FROM AUTHOR]- Published
- 2020
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9. External Beam, Brachytherapy, or Chemotherapy? Defining Adjuvant Therapy for Early-Stage and High- and High-Intermediate-Risk Endometrial Cancer.
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Jang, Joanne Wei-un and Lee, Larissa Janeen
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- 2019
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10. Salvage radiation therapy for localized recurrent ovarian cancer.
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Smart, Alicia, Chen, Yu-Hui, Cheng, Teresa, King, Martin, and Lee, Larissa
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OVARIAN cancer ,RADIOTHERAPY ,CYTOREDUCTIVE surgery ,MUCINOUS adenocarcinoma ,HISTOLOGY - Abstract
Introduction: To evaluate clinical outcomes for patients with localized recurrent ovarian cancer treated with salvage radiotherapy. Methods: In a retrospective single institutional analysis, we identified 40 patients who received salvage radiotherapy for localized ovarian cancer recurrence from January 1995 to June 2011. Recurrent disease was categorized as: pelvic peritoneal (45%, 18), extraperitoneal/nodal (35%, 14), or vaginal (20%, eight). Actuarial disease-free and overall survival estimates were calculated by Kaplan–Meier and prognostic factors evaluated by the Cox proportional hazards model. Results: Median follow-up was 42 months. Median patient age was 54 years (range, 27–78). Histologic subtypes were: serous (58%, 23), endometrioid (15%, six), clear cell (13%, five), mucinous (8%, three), and other (8%, three). At the time of salvage radiotherapy, surgical cytoreduction was performed in 60% (24) and 68% (27) had platinum-sensitive disease. Most patients (63%, 25) received salvage radiotherapy at the time of first recurrence. Relapse after salvage radiotherapy occurred in 29 patients at a median time of 16 months and was outside the radiotherapy field in 62%. 18 At 3 years, disease-free and overall survival rates were 18% and 80%, respectively. On multivariate analysis, non-serous histology (hazards ratio 0.3, 95% CI 0.1–0.7) and platinum-sensitivity (hazards ratio 0.2, 95% CI 0.1–0.5) were associated with lower relapse risk. Platinum-sensitivity was also associated with overall survival (hazards ratio 0.4, 95% CI 0.1–1.0). Four patients (10%) were long-term survivors without recurrence 5 years after salvage radiotherapy. Of the five patients with clear cell histology, none experienced relapse at the time of last follow-up. Discussion: Patients with non-serous and/or platinum-sensitive ovarian cancer had the greatest benefit from salvage radiotherapy for localized recurrent disease. Although relapse was common, radiotherapy prolonged recurrence for > 1 year in most patients and four were long-term survivors. [ABSTRACT FROM AUTHOR]
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- 2019
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11. Palliative Radiation Therapy for Recurrent Ovarian Cancer: Efficacy and Predictors of Clinical Response.
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Jiang, Ginger, Balboni, Tracy, Taylor, Allison, Liu, Joyce, and Lee, Larissa J.
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Objective: This study aimed to report response rates and predictors of response to palliative radiotherapy (RT) for recurrent ovarian cancer. Methods/Materials: Database review identified 64 patients with symptomatic ovarian cancer recurrence who received a total of 76 courses of RT for 103 indications from March 2003 to August 2014. Radiotherapy indications were pain (44%), bleeding (32%), obstruction (15%), and other (9%). Responses were categorized as complete, partial, or none; all response (AR)was the sum of complete and partial responses. Response rates were compared using a χ² test. Multivariate analysis was performed using logistic regression. Patients were followed up for symptom recurrence and death. Results: Response rates were significantly higher for pain (AR, 87%) and bleeding (93%) than for obstruction (62%) and other (60%; P < 0.01). Patients treated for pain at nonbony sites had higher response rates (AR 96%) compared with those treated at bony sites (75%; P = 0.04). Patients with clear cell histology had the lowest response rates (AR, 60%) compared with those with serous (82%), endometrioid (95%), or other Müllerian histology (85%; P = 0.01). Platinum status at diagnosis or the time of RT was not associated with response, nor was tumor size or number of prior chemotherapy regimens. On multivariate analysis, histology, RT indication, and RT dose were independent predictors of response (all P < 0.01). Conclusions: Palliative RT provides relief of pain and bleeding in most patients with ovarian cancer recurrence. Patients with symptomatic obstruction, bony involvement, and clear cell histology may experience lower clinical response rates. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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12. Differentiated exophytic vulvar intraepithelial lesions are genetically distinct from keratinizing squamous cell carcinomas and contain mutations in PIK3CA
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Watkins, Jaclyn C, Howitt, Brooke E, Horowitz, Neil S, Ritterhouse, Lauren L, Dong, Fei, MacConaill, Laura E, Garcia, Elizabeth, Lindeman, Neal I, Lee, Larissa J, Berkowitz, Ross S, Nucci, Marisa R, and Crum, Christopher P
- Abstract
Human papillomavirus-negative keratinizing vulvar cancers typically harbor TP53mutations as do their precursors, differentiated vulvar intraepithelial neoplasia. However, atypical verruciform proliferations are also associated with these malignancies and their pathogenesis is poorly understood. This study compared 11 atypical verruciform lesions, including atypical verruciform hyperplasia, vulvar acanthosis with altered differentiation, and verruciform lichen simplex chronicus, with 14 human papillomavirus-negative keratinizing squamous cell carcinomas. Extracted tissue DNA was subjected to targeted massively parallel sequencing of the exonic regions of 300 genes. Eight (73%) and six (55%) of eleven atypical verruciform lesions contained mutations in PIK3CAand ARID2, respectively. No TP53mutations were identified. Eleven (79%) and five (36%) of fourteen keratinizing squamous cell carcinomas tested contained TP53and CDKN2Amutations, respectively. Keratinizing squamous cell carcinomas displayed the majority of copy number variations with some variations (7p gain and 8p loss) shared by some cases in both groups. One patient developed atypical verruciform lesions with PIK3CAmutations followed by a keratinizing carcinoma with mutations in both PIK3CAand TP53. This study, for the first time segregates atypical verruciform lesions by virtue of a unique genotype (PIK3CAmutant/TP53wild type) illustrating an example of progression to a TP53-mutated keratinizing carcinoma. The findings indicate that although PIK3CAmutations are found in <10% of vulvar squamous cell carcinomas, they may be specific for a particular pathway involving atypical verruciform lesions, which could function as either a direct precursor or a risk factor for vulvar squamous cell carcinoma. Given the presence of a molecular signature, we propose the term ‘differentiated exophytic vulvar intraepithelial lesion’ for this group. Whether they function as direct precursors to a less common form of squamous cell carcinoma will require further study, but carcinomas associated with these lesions might warrant testing for PIK3CAmutations to address this question.
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- 2017
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13. Differentiated exophytic vulvar intraepithelial lesions are genetically distinct from keratinizing squamous cell carcinomas and contain mutations in PIK3CA
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Watkins, Jaclyn C, Howitt, Brooke E, Horowitz, Neil S, Ritterhouse, Lauren L, Dong, Fei, MacConaill, Laura E, Garcia, Elizabeth, Lindeman, Neal I, Lee, Larissa J, Berkowitz, Ross S, Nucci, Marisa R, and Crum, Christopher P
- Abstract
Human papillomavirus-negative keratinizing vulvar cancers typically harbor TP53 mutations as do their precursors, differentiated vulvar intraepithelial neoplasia. However, atypical verruciform proliferations are also associated with these malignancies and their pathogenesis is poorly understood. This study compared 11 atypical verruciform lesions, including atypical verruciform hyperplasia, vulvar acanthosis with altered differentiation, and verruciform lichen simplex chronicus, with 14 human papillomavirus-negative keratinizing squamous cell carcinomas. Extracted tissue DNA was subjected to targeted massively parallel sequencing of the exonic regions of 300 genes. Eight (73%) and six (55%) of eleven atypical verruciform lesions contained mutations in PIK3CA and ARID2, respectively. No TP53 mutations were identified. Eleven (79%) and five (36%) of fourteen keratinizing squamous cell carcinomas tested contained TP53 and CDKN2A mutations, respectively. Keratinizing squamous cell carcinomas displayed the majority of copy number variations with some variations (7p gain and 8p loss) shared by some cases in both groups. One patient developed atypical verruciform lesions with PIK3CA mutations followed by a keratinizing carcinoma with mutations in both PIK3CA and TP53. This study, for the first time segregates atypical verruciform lesions by virtue of a unique genotype (PIK3CA mutant/TP53 wild type) illustrating an example of progression to a TP53-mutated keratinizing carcinoma. The findings indicate that although PIK3CA mutations are found in <10% of vulvar squamous cell carcinomas, they may be specific for a particular pathway involving atypical verruciform lesions, which could function as either a direct precursor or a risk factor for vulvar squamous cell carcinoma. Given the presence of a molecular signature, we propose the term ‘differentiated exophytic vulvar intraepithelial lesion’ for this group. Whether they function as direct precursors to a less common form of squamous cell carcinoma will require further study, but carcinomas associated with these lesions might warrant testing for PIK3CA mutations to address this question.
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- 2017
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14. ACR Appropriateness Criteria®Management of Recurrent Endometrial Cancer
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Elshaikh, Mohamed A., Vance, Sean, Gaffney, David K., Biagioli, Matthew, Jhingran, Anuja, Jolly, Shruti, Kidd, Elizabeth, Lee, Larissa J., Li, Linna, Moore, David H., Rao, Gautam G., Wahl, Andrew O., Williams, Ned L., Yashar, Catheryn M., and Small, William
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- 2016
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15. Postoperative Radiation Therapy for Endometrial Cancer: American Society of Clinical Oncology Clinical Practice Guideline Endorsement of the American Society for Radiation Oncology Evidence-Based Guideline.
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Meyer, Larissa A., Bohlke, Kari, Powell, Matthew A., Fader, Amanda N., Franklin, Gregg E., Lee, Larissa J., Matei, Daniela, Coallier, Lourie, and Wright, Alexi A.
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- 2015
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16. Adjuvant Chemotherapy With External BeamRadiation Therapy for High-Grade, Node-Positive Endometrial Cancer.
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Lee, Larissa J., Bu, Paula, Feltmate, Colleen, and Viswanathan, Akila N.
- Abstract
The objective of this study was to evaluate clinical outcomes including disease-free survival (DFS) and overall survival (OS) for women with node-positive, high-grade adenocarcinoma of the uterus.Database review identified 73 patients with International Federation of Gynecology and Obstetrics stage IIIC 1/2 grade 3 endometrial cancer diagnosed from 1995 to 2009. Study inclusion required total abdominal hysterectomy/bilateral salpingo-oophorectomy and negative chest imaging. Histologic subtypes were endometrioid (22, 30%), papillary serous (20, 27%), clear cell (9, 12%), mixed (21, 29%), and undifferentiated (1, 1%). Adjuvant treatment was chemotherapy with external beam radiation therapy (EBRT) in 55 patients (75%), EBRT alone in 14 (19%), chemotherapy in 2 (3%), and no adjuvant therapy in 2 (3%).With a median follow-up of 50 months, DFS/OS rates at 5 years were 44%/53%, respectively. Intraperitoneal relapse was more common in patients with positive cytology (30% vs 6%, P = 0.02) and nonendometrioid histology (16% vs 4%, P = 0.3). By histologic subtype, 5-year DFS/OS rates were 59%/82% for grade 3 endometrioid, 25%/30% for serous, 22%/17% for clear cell, and 50%/51% for mixed histology (P = 0.1/P < 0.001). The 5-year DFS/OS rates were 56%/68% for those who received both chemotherapy and EBRT. Among patients treated with adjuvant EBRT, pelvic control was 93%.For node-positive, high-grade endometrial cancer, patients with endometrioid and mixed histologic subtypes had better clinical outcomes than did those with serous and clear cell cancers. Distinct patterns of relapse were observed with a greater risk of intraperitoneal failure for nonendometrioid histologic subtypes. Future studies are needed to define the optimal chemotherapy regimen and radiation fields. [ABSTRACT FROM AUTHOR]
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- 2014
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17. Genetic Basis for PD-L1 Expression in Squamous Cell Carcinomas of the Cervix and Vulva
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Howitt, Brooke E., Sun, Heather H., Roemer, Margaretha G. M., Kelley, Alyssa, Chapuy, Bjoern, Aviki, Emeline, Pak, Christine, Connelly, Courtney, Gjini, Evisa, Shi, Yunling, Lee, Larissa, Viswanathan, Akila, Horowitz, Neil, Neuberg, Donna, Crum, Christopher P., Lindeman, Neal L., Kuo, Frank, Ligon, Azra H., Freeman, Gordon J., Hodi, F. Stephen, Shipp, Margaret A., and Rodig, Scott J.
- Abstract
IMPORTANCE: Patients with squamous cell carcinoma (SCC) of the cervix or vulva have limited therapeutic options, and the potential for immunotherapy for this population has not been evaluated. Recent trials suggest that tumors with a genetic basis for PD-1 (programmed cell death protein 1) ligand expression are highly sensitive to therapeutic antibodies targeting PD-1. OBJECTIVE: To determine the genetic status of CD274 (encoding PD-L1 [programmed cell death 1 ligand 1]) and PDCD1LG2 (encoding PD-L2 [programmed cell death 1 ligand 2]) in SCCs of the cervix and vulva and to correlate the findings with PD-L1 protein expression. DESIGN, SETTING, AND PARTICIPANTS: We performed fluorescence in situ hybridization (FISH) using probes targeting CD274, PDCD1LG2, and the centromeric portion of chromosome 9, and immunohistochemistry (IHC) using an antibody recognizing PD-L1 on formalin-fixed, paraffin-embedded (FFPE) biopsy specimens from 48 cervical SCCs and 23 vulvar SCCs. MAIN OUTCOMES AND MEASURES: Tumors were categorized according to the genetic abnormality in CD274 and PDCD1LG2 (coamplification > cogain > polysomy > disomy) as detected by FISH, and evaluated on a semiquantitative scale (modified H score, the product of the percentage of tumor cells with positive staining and the maximum intensity of positive staining) for PD-L1 protein expression as detected by IHC. RESULTS: Overall, 71 samples of FFPE tissue from cases of cervical SCCs (n = 48) and vulvar SCCs (n = 23) were retrieved from the archives of Brigham and Women’s Hospital and included in this study. We observed cogain or coamplification of CD274 and PDCD1LG2 in 32 of 48 cervical SCCs (67%) and 10 of 23 vulvar SCCs (43%). Median PD-L1 protein expression was highest among tumors with CD274 and PDCD1LG2 coamplification and lowest among tumors with disomy. CONCLUSIONS AND RELEVANCE: Recurrent copy number gain of the genes encoding the PD-1 ligands provides a genetic basis for PD-L1 expression in a subset of cervical and vulvar SCCs and identifies a class of patients that are rational candidates for therapies targeting PD-1.
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- 2016
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18. Radiation dose escalation using intensity modulated radiation therapy for gross unresected node-positive endometrial cancer.
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Townamchai, Kanokpis, Poorvu, Philip D., Damato, Antonio L., DeMaria, Rebecca, Lee, Larissa J., Berlin, Suzanne, Feltmate, Colleen, and Viswanathan, Akila N.
- Abstract
Abstract: Purpose: To determine rates of nodal control and survival in patients with endometrial cancer treated with intensity modulated radiation therapy (IMRT) with dose escalation to unresected nodal disease. Methods and Materials: Between November 2005 and April 2011, 22 endometrial-cancer patients received IMRT with dose escalation to gross nodal disease with curative intent. Twelve were treated for recurrent disease (RD) and 10 in the primary setting, of whom 5 had a hysterectomy. The boost area included pelvic nodes in 9 patients (41%), paraaortic nodes (PAN) in 6 (27%) and both pelvic and PAN in 7 (32%). The median gross nodal dose was 63 Gy (range, 55-65). Rates of local control, disease-free survival (DFS) and overall survival (OS) were determined using the Kaplan-Meier method. Results: Median follow-up time was 37.6 months (range, 10-88). Median nodal size was 2.25 cm (range, 1-6.9). The median time to first relapse after IMRT was 12 months (range, 6-49). Relapses occurred in 5/12 RD (42%), 1/5 hysterectomy (20%), and 5/5 inoperable cases. Nodal relapses occurred in-field in 3/12 RD and 1/5 hysterectomy patients. At 3 years, nodal control was 86%, DFS was 58% and OS was 68%. Three patients experienced grade 3 late hematologic toxicity (anemia). No late grade ≥3 gastrointestinal or genitourinary toxicity occurred. Conclusions: In endometrial cancer, the use of IMRT for dose escalation to gross nodal disease is feasible with acceptable rates of toxicity. Patients with nodal recurrence or unresectable nodal disease after a hysterectomy may benefit from radiation dose escalation. [Copyright &y& Elsevier]
- Published
- 2014
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19. Expression of the Oct-1 Transcription Factor and Characterization of Its Interactions with the...
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Lee, Larissa, Stollar, Elliott, JuFang Chang, Grossmann, J. Gunter, O'Brien, Ronan, Ladbury, John, Carpenter, Brian, Roberts, Stefan, and Luisi, Ben
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- 2001
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20. ACR Appropriateness Criteria®Pretreatment Evaluation and Follow-Up of Endometrial Cancer
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Lalwani, Neeraj, Dubinsky, Theodore, Javitt, Marcia C., Gaffney, David K., Glanc, Phyllis, Elshaikh, Mohamed A., Kim, Young Bae, Lee, Larissa J., Pannu, Harpreet K., Royal, Henry D., Shipp, Thomas D., Siegel, Cary Lynn, Simpson, Lynn, Wahl, Andrew O., Wolfson, Aaron H., and Zelop, Carolyn M.
- Abstract
Endometrial cancer is the most common gynecologic and the fourth most common malignancy in women in the United States. Cross-sectional imaging plays a vital role in pretreatment assessment of endometrial cancers and should be viewed as a complementary tool for surgical evaluation and planning of these patients. Although transvaginal US remains the preferred examination for the screening purposes, MRI has emerged as the modality of choice for the staging of endometrial cancer and imaging assessment of recurrence or treatment response. A combination of dynamic contrast-enhanced and diffusion weighted MRI provides the highest accuracy for the staging. Both CT and MRI perform equivalently for assessing nodal involvement or distant metastasis. PET-CT is more appropriate for assessing lymphadenopathy in high-grade FDG-avid tumors or for clinically suspected recurrence after treatment. An appropriate use and guidelines of imaging techniques in diagnosis, staging, and detection of endometrial cancer and treatment of recurrent disease are reviewed.
- Published
- 2014
- Full Text
- View/download PDF
21. ACR Appropriateness Criteria®Management of Locoregionally Advanced Squamous Cell Carcinoma of the Vulva
- Author
-
Kidd, Elizabeth, Moore, David, Varia, Mahesh A., Gaffney, David K., Elshaikh, Mohamed A., Erickson, Beth, Jhingran, Anuja, Lee, Larissa J., Mayr, Nina A., Puthawala, Ajmel A., Rao, Gautam G., Small, William, Wahl, Andrew O., Wolfson, Aaron H., Yashar, Catheryn M., Yuh, William, and Cardenes, Higinia Rosa
- Abstract
Locoregionally advanced vulvar cancer (LRAVC) is a rare disease that presents many challenging medical decisions. An expert panel was convened to reach consensus on the most appropriate pretreatment assessment and therapeutic interventions in LRAVC patients.
- Published
- 2013
- Full Text
- View/download PDF
22. ACR Appropriateness Criteria®Definitive Therapy for Early-Stage Cervical Cancer
- Author
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Small, William, Strauss, Jonathan B., Jhingran, Anuja, Yashar, Catheryn M., Cardenes, Higinia R., Erickson-Wittmann, Beth A., Gullett, Norleena, Kidd, Elizabeth, Lee, Larissa J., Mayr, Nina A., Moore, David, Puthawala, Ajmel A., Rao, Gautam G., Varia, Mahesh A., Wahl, Andrew O., Wolfson, Aaron H., Yuh, William, and Gaffney, David K.
- Abstract
The definitive treatment of early-stage cervical cancer involves multidisciplinary decision making. This expert panel was convened to reach consensus on the selection of appropriate therapies based on patient and disease characteristics at presentation.
- Published
- 2012
- Full Text
- View/download PDF
23. Cleaning Solutions.
- Author
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Lee, Larissa
- Abstract
Focuses on household cleaning solution for mothers in the U.S. Tips on cleaning and scheduling; Importance of support from other mothers on balancing housework; Lists of Web sites on home organization.
- Published
- 2002
24. Ages and Stages.
- Author
-
Lee, Larissa
- Abstract
Presents comments from readers of the magazine 'New Beginnings,' about problems that a mother has with her three-year old child. Belief that the third year is a time of emotional and mental growth; Importance of discipline and teaching better behavior; Helpfulness of knowing what is age-appropriate behavior.
- Published
- 2002
25. Dealing with the Mess.
- Author
-
Lee, Larissa
- Abstract
Presents suggestions for a mother who is overwhelmed with housekeeping and taking care of her toddler. Techniques for managing housekeeping schedules; Importance of squeezing in short periods for home upkeep.
- Published
- 2002
26. Innovations in radiation therapy (RT) for breast cancer.
- Author
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Lee, Larissa J. and Harris, Jay R.
- Subjects
BREAST cancer treatment ,CANCER radiotherapy ,MEDICAL innovations ,LUMPECTOMY ,CANCER-related mortality ,ADJUVANT treatment of cancer ,CANCER tomography - Abstract
Summary: The EBCTCG has clearly demonstrated that the use of RT after either breast conserving surgery (BCS) or after mastectomy in node-positive patients not only reduces local recurrence (LR), but also improves long-term survival. The EBCTCG specifically found that the absolute reduction in the 5-year rate of LR was proportional to the absolute reduction in 15-year breast cancer mortality with a 4:1 ratio. Studies from the EBCTCG have also clearly shown that when RT for breast cancer inadvertently delivers ‘excessive’ dose to the heart, there is an increased rate of late cardiac deaths. Over time, LR rates with RT have decreased, particularly after BCS, and this is largely due to a favorable interaction of RT with adjuvant systemic therapy. There is new information emerging about the effectiveness of RT based on newer biologic classification of breast cancer and about how the 4:1 ratio might change in the face of increasingly effective systemic therapy and with a better understanding of the importance of biologic classification and of the competing risks of local and distant recurrence. Technical innovations in RT include the development of techniques that minimize cardiac irradiation. It is critical that CT simulation be done during which the heart should be contoured and the radiation dose-cardiac volume relationship be determined. In the EBCTCG''s preliminary analysis, increased late cardiac deaths were most closely linked to mean cardiac doses >5 Gy. A number of techniques are available to minimize cardiac dose both after BCS and mastectomy and these will be described. There has also been development of fractionation and treatment techniques to complete RT faster for purposes of patient convenience and to assure its optimal level of use. There are now 10-year results from a Canadian trial showing equivalent LR and cosmetic outcome with RT using the convential 25 treatments to the whole breast compared to 16 treatments using a higher dose per day. Few randomized patients, however, were treated with adjuvant chemotherapy and a boost was not used. The generalizability of the Canadian trial results to patients treated with adjuvant chemotherapy or requiring a boost is not known. For patients treated after BCS, there has been great interest in the use of accelerated partial breast irradiation (APBI), which can be accomplished using interstitial, intracavitary, external-beam or intraoperative techniques. Clinical trials are now underway to compare APBI to conventional techniques, but mature results from these trials will not be available for some time. In the U.S., ASTRO has developed a consensus statement based on an expert panel as to when APBI can be reasonably used outside of a clinical trial and this will be described. [Copyright &y& Elsevier]
- Published
- 2009
- Full Text
- View/download PDF
27. Breastfeeding Is A Contact Sport.
- Author
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Lee, Larissa
- Published
- 1999
28. PJ Sheehan drink-drive shame must be probed, demands McGrath.
- Author
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John Lee; Larissa Nolan
- Abstract
ANY hopes disgraced Fine Gael deputy PJ Sheehan may have harboured that his drink-driving scandal would blow over have vanished. [ABSTRACT FROM PUBLISHER]
- Published
- 2010
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