70 results on '"Steven J, Frank"'
Search Results
2. Long‐term outcomes of modern multidisciplinary management of sinonasal cancers: The <scp>M. D.</scp> Anderson experience
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Houda Bahig, Hanna Y. Ehab, Adam S. Garden, Sweet Ping Ng, Steven J. Frank, Theresa Nguyen, Gary B. Gunn, David I. Rosenthal, Clifton D. Fuller, Renata Ferrarotto, Diana Bell, Shirley Su, and Jack Phan
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Otorhinolaryngology - Published
- 2023
3. Definitive local therapy for <scp>T4</scp> prostate cancer associated with improved local control and survival
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Lauren M. Andring, Ibrahim Abu‐Gheida, Tharakeswara Bathala, Alison K. Yoder, Gohar S. Manzar, J. Alberto Maldonado, Steven J. Frank, Seungtaek Choi, Quynh‐Nhu Nguyen, Karen Hoffman, Sean Eric McGuire, Henry Mok, Ana Aparicio, Brian F. Chapin, and Chad Tang
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Urology - Published
- 2023
4. Intensity modulated proton arc therapy via geometry‐based energy selection for ependymoma
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Wenhua Cao, Yupeng Li, Xiaodong Zhang, Falk Poenisch, Pablo Yepes, Narayan Sahoo, David Grosshans, Susan McGovern, G. Brandon Gunn, Steven J. Frank, and Xiaorong R. Zhu
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Radiation ,Radiology, Nuclear Medicine and imaging ,Instrumentation - Published
- 2023
5. Risk stratification after recurrence of human papillomavirus ( <scp>HPV)</scp> ‐related and <scp>non‐HPV</scp> ‐related oropharyngeal cancer: Secondary analysis of <scp>NRG</scp> Oncology <scp>RTOG</scp> 0129 and 0522
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Craig Donaldson, Phuc Felix Nguyen-Tân, Yuhchyau Chen, David I. Rosenthal, Elaine Bigelow, Quynh-Thu Le, Suresh G. Nair Md, Houda Bahig, Michael J. Birrer, Steven J. Frank, Carole Fakhry, John A. Ridge, Maura L. Gillison, Bradley T. Clifford, Jimmy J. Caudell, George Shenouda, and Jonathan Harris
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Oncology ,medicine.medical_specialty ,business.industry ,Cancer ,Recursive partitioning ,medicine.disease ,Recurrent Oropharyngeal Cancer ,Clinical trial ,Risk groups ,Otorhinolaryngology ,Internal medicine ,Secondary analysis ,Risk stratification ,medicine ,Human papillomavirus ,business - Abstract
BACKGROUND No risk-stratification strategies exist for patients with recurrent oropharyngeal cancer (OPC). METHODS Retrospective analysis using data from prospective NRG Oncology clinical trials RTOG 0129 and 0522. Eligibility criteria included known p16 status and smoking history, and locoregional/distant recurrence. Overall survival (OS) was measured from date of recurrence. Recursive partitioning analysis was performed to produce mutually exclusive risk groups. RESULTS Hundred and fifty-four patients were included with median follow-up after recurrence of 3.9 years (range 0.04-9.0). The most important factors influencing survival were p16 status and type of recurrence, followed by surgical salvage and smoking history (≤20 vs. >20 pack-years). Three significantly different risk groups were identified. Patients in the low-, intermediate-, and high-risk groups had 2-year OS after recurrence of 81.1% (95%CI 68.5-93.7), 50.2% (95%CI 36.0-64.5), and 20.8% (95%CI 10.5-31.1), respectively. CONCLUSION Patient and tumor characteristics may be used to stratify patients into risk groups at the time of OPC recurrence.
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- 2021
6. Reactive Oxygen Species Generation in Human Cells by a Novel Magnetic Resonance Imaging Contrast Agent
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Li Wang, Eric Lin, Mary J. Johansen, Timothy Madden, Edward Felix, Karen S. Martirosyan, and Steven J. Frank
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Toxicology. Poisons ,RA1190-1270 - Abstract
The novel positive-contrast magnetic resonance imaging (MRI) marker C4 consists of an aqueous solution of cobalt chloride (CoCl2) complexed with the chelator N-acetylcysteine (NAC). We evaluated whether the presence of C4 or its components would produce reactive oxygen species (ROS, including hydroxyl, peroxyl, or other reactive oxygen species) in cultured cells. Human cancer or normal cells were incubated with 1% (w/v) CoCl2·6H2O or 2% NAC or a combination of both (1% CoCl2·6H2O : 2% NAC in an aqueous solution, abbreviated as Co : NAC) in the presence or absence of H2O2. Intracellular ROS levels were measured and quantified by change in relative fluorescence units. Student’s t-tests were used. In all cell lines exposed to 1000 μM H2O2, the Co : NAC led to ≥94.7% suppression of ROS at 5 minutes and completely suppressed ROS at 60 and 90 minutes; NAC suppressed ROS by ≥76.6% at 5 minutes and by ≥94.5% at 90 minutes; and CoCl2·6H2O suppressed ROS by ≥37.2% at 30 minutes and by ≥48.6% at 90 minutes. These results demonstrate that neither Co : NAC nor its components generated ROS; rather, they suppressed ROS production in cultured cells, suggesting that C4 would not enhance ROS production in clinical use.
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- 2018
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7. Toxicity Evaluation of a Novel Magnetic Resonance Imaging Marker, CoCl2-N-Acetylcysteine, in Rats
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Li Wang, Mihai Gagea, Karen Martirosyan, Mary Johansen, Timothy Madden, Lisa Norberg, Kirk S. Culotta, and Steven J. Frank
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Toxicology. Poisons ,RA1190-1270 - Abstract
C4 (cobalt dichloride-N-acetylcysteine [1% CoCl2:2% NAC]) is a novel magnetic resonance imaging contrast marker that facilitates visualization of implanted radioactive seeds in cancer brachytherapy. We evaluated the toxicity of C4. Rats were assigned to control (0% CoCl2:NAC), low-dose (0.1% CoCl2:2% NAC), reference-dose (C4), and high-dose (10% CoCl2:2% NAC) groups. Agent was injected into the left quadriceps femoris muscle of the rats. Endpoints were organ and body weights, hematology, and serum chemistry and histopathologic changes of tissues at 48 hours and 28 and 63 days after dosing. Student’s t tests were used. No abnormalities in clinical signs, terminal body and organ weights, or hematologic and serum chemistry were noted, and no gross or histopathologic lesions of systemic tissue toxicity were found in any treatment group at any time point studied. At the site of injection, concentration-dependent acute responses were observed in all treatment groups at 48 hours after dosing and were recovered by 28 days. No myofiber degeneration or necrosis was observed at 28 or 63 days in any group. In conclusion, a single intramuscular dose of C4 produced no acute or chronic systemic toxicity or inflammation in rats, suggesting that C4 may be toxicologically safe for clinical use in cancer brachytherapy.
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- 2018
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8. Stereotactic body ablative radiotherapy for reirradiation of small volume head and neck cancers is associated with prolonged survival: Large, single‐institution, modern cohort study
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Shalin J. Shah, David I. Rosenthal, Steven J. Frank, Clifton D. Fuller, Congjun Wang, Anna Lee, Shirley Y. Su, Xin A. Wang, Kevin Diao, Michael T. Spiotto, S. Tung, Amy C. Moreno, William H. Morrison, C. Wang, Jack Phan, Renata Ferrarotto, Theresa Nguyen, Adam S. Garden, Gary Brandon Gunn, and Jay Reddy
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medicine.medical_specialty ,Small volume ,business.industry ,medicine.medical_treatment ,Head and neck cancer ,Salvage therapy ,Radiosurgery ,medicine.disease ,Systemic therapy ,Article ,Re-Irradiation ,Cohort Studies ,Radiation therapy ,Otorhinolaryngology ,Head and Neck Neoplasms ,Ablative case ,medicine ,Humans ,Radiology ,Neoplasm Recurrence, Local ,Head and neck ,business ,Retrospective Studies ,Cohort study - Abstract
Background Recurrent head and neck cancer has poor prognosis. Stereotactic body radiotherapy (SBRT) may improve outcomes by delivering ablative radiation doses. Methods We reviewed patients who received definitive-intent SBRT reirradiation at our institution from 2013 to 2020. Patterns of failure, overall survival (OS), and toxicities were analyzed. Results One hundred and thirty-seven patients were evaluated. The median OS was 44.3 months. The median SBRT dose was 45 Gy and median target volume 16.9 cc. The 1-year local, regional, and distant control was 78%, 66%, and 83%, respectively. Systemic therapy improved regional (p = 0.004) and distant control (p = 0.04) in nonmetastatic patients. Grade 3+ toxicities were more common at mucosal sites (p = 0.001) and with concurrent systemic therapy (p = 0.02). Conclusions In a large cohort of SBRT reirradiation for recurrent, small volume head and neck cancers, a median OS of 44.3 months was observed. Systemic therapy improved regional and distant control. Toxicities were modulated by anatomic site and systemic therapy.
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- 2021
9. Outcomes of patients with oropharyngeal squamous cell carcinoma treated with induction chemotherapy followed by concurrent chemoradiation compared with those treated with concurrent chemoradiation
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J. Jack Lee, Jeffrey N. Myers, Julian Martinez, Kimberley L. Kiong, Amy C. Moreno, Faiez K. Saiyed, Frank E. Mott, David I. Rosenthal, Bonnie S. Glisson, Christopher M. K. L. Yao, Steven J. Frank, Theresa Guo, Renata Ferrarotto, Ruth Sacks, and Faye M. Johnson
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Oncology ,Cancer Research ,medicine.medical_specialty ,Lower risk ,03 medical and health sciences ,Tumor Status ,0302 clinical medicine ,Internal medicine ,Humans ,Medicine ,030212 general & internal medicine ,Cetuximab ,Squamous Cell Carcinoma of Head and Neck ,business.industry ,Hazard ratio ,Induction chemotherapy ,Chemoradiotherapy ,Induction Chemotherapy ,Concurrent chemoradiation ,medicine.disease ,Head and neck squamous-cell carcinoma ,Oropharyngeal Neoplasms ,Head and Neck Neoplasms ,030220 oncology & carcinogenesis ,Carcinoma, Squamous Cell ,T-stage ,business ,medicine.drug - Abstract
BACKGROUND Induction chemotherapy (IC) has been associated with a decreased risk of distant metastasis in locally advanced head and neck squamous cell carcinoma. However, its role in the treatment of oropharyngeal squamous cell carcinoma (OPSCC) is not well established. METHODS The outcomes of patients with OPSCC treated with IC followed by concurrent chemoradiation (CRT) were compared with the outcomes of those treated with CRT alone. The primary outcome was overall survival (OS), and the secondary end points were the times to locoregional and distant recurrence. RESULTS In an existing database, 585 patients met the inclusion criteria: 137 received IC plus CRT, and 448 received CRT. Most patients were positive for human papillomavirus (HPV; 90.9%). Patients receiving IC were more likely to present with a higher T stage, a higher N stage, and low neck disease. The 3-year OS rate was significantly lower in patients receiving IC (75.7%) versus CRT alone (92.9%). In a multicovariate analysis, receipt of IC (adjusted hazard ratio [aHR], 3.4; P < .001), HPV tumor status (aHR, 0.36; P = .002), and receipt of concurrent cetuximab (aHR, 2.7; P = .002) were independently associated with OS. The risk of distant metastasis was also significantly higher in IC patients (aHR, 2.8; P = .001), whereas an HPV-positive tumor status (aHR, 0.44; P = .032) and completion of therapy (aHR, 0.51; P = .034) were associated with a lower risk of distant metastasis. In HPV-positive patients, IC remained associated with distant metastatic progression (aHR, 2.6; P = .004) but not OS. CONCLUSIONS In contrast to prior studies, IC was independently associated with worse OS and a higher risk of distant metastasis in patients with OPSCC. Future studies are needed to validate these findings.
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- 2021
10. A prospective evaluation of health‐related quality of life after skull base re‐irradiation
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Gary Brandon Gunn, Jack Phan, Theresa Nguyen, Ehab Y. Hanna, William H. Morrison, Renata Ferrarotto, Courtney Pollard, Jay Reddy, Houda Bahig, Shirley Y. Su, Sweet Ping Ng, Steven J. Frank, David I. Rosenthal, Clifton D. Fuller, Franco DeMonte, and Adam S. Garden
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Re-Irradiation ,medicine.medical_specialty ,Skull Base Tumor ,Article ,Prospective evaluation ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,medicine ,Humans ,Prospective Studies ,Progression-free survival ,Skull Base ,MD Anderson Symptom Inventory - Brain Tumor ,Health related quality of life ,business.industry ,Surgery ,Skull ,Treatment Outcome ,medicine.anatomical_structure ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,Quality of Life ,business ,030217 neurology & neurosurgery - Abstract
PURPOSE: To report cancer control outcomes and health-related quality of life (HRQoL) outcomes after highly conformal skull-based re-irradiation (re-RT). METHODS: Patients planned for curative intent re-RT to a recurrent or new skull base tumor were enrolled. HRQoL were assessed using the MD Anderson Symptom Inventory Brain Tumor (MDASI-BT) and the anterior skull base surgery quality of life (ASBQ) questionnaires. RESULTS: Thirty-nine patients were treated with stereotactic body RT or intensity modulated RT. Median follow-up was 14 months. Progression free survival was 71% at 1-year. There was mild clinically significant worsening of fatigue, lack of appetite and drowsiness (MDASI-BT), and physical function (ASBQ) at the end of RT, followed by recovery to baseline on subsequent follow-ups. Subjective emotions were clinically improved at 12 months, with patients reporting feeling less tense/nervous. CONCLUSION: Conformal skull base re-RT is associated with mild immediate deterioration in physical function followed by rapid and sustained recovery.
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- 2019
11. Contemporary prostate cancer treatment choices in multidisciplinary clinics referenced to national trends
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Mark E. Augspurger, Sean E. McGuire, Curtis A. Pettaway, Molly Gabel, Seungtaek Choi, John W. Davis, Prabhakar Tripuraneni, Ashish Patel, Christopher J. Logothetis, Rachit Kumar, Karen E. Hoffman, Pamela K. Allen, Chad Tang, Jeffrey J. Tomaszewski, Deborah A. Kuban, Quynh Nhu Nguyen, Steven J. Frank, Mitchell S. Anscher, John F. Ward, Paul G. Corn, David Schreiber, Louis L. Pisters, Patrick W. Linson, Neema Navai, and Brian F. Chapin
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Male ,Cancer Research ,medicine.medical_specialty ,medicine.medical_treatment ,Brachytherapy ,Disease ,Article ,White People ,03 medical and health sciences ,Prostate cancer ,0302 clinical medicine ,Internal medicine ,Epidemiology ,Clinical endpoint ,Humans ,Medicine ,030212 general & internal medicine ,Aged ,Prostatectomy ,Univariate analysis ,business.industry ,Patient Selection ,Prostatic Neoplasms ,Cancer ,Middle Aged ,Prostate-Specific Antigen ,medicine.disease ,United States ,Black or African American ,Oncology ,030220 oncology & carcinogenesis ,business ,SEER Program - Abstract
BACKGROUND The purpose of this study was to assess treatment choices among men with prostate cancer who presented at The University of Texas MD Anderson Cancer Center multidisciplinary (MultiD) clinic compared with nationwide trends. METHODS In total, 4451 men with prostate cancer who presented at the MultiD clinic from 2004 to 2016 were analyzed. To assess nationwide trends, the authors analyzed 392,710 men with prostate cancer who were diagnosed between 2004 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. The primary endpoint was treatment choice as a function of pretreatment demographics. RESULTS Univariate analyses revealed similar treatment trends in the MultiD and SEER cohorts. The use of procedural forms of definitive therapy decreased with age, including brachytherapy and prostatectomy (all P
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- 2019
12. Usefulness of surveillance imaging in patients with head and neck cancer who are treated with definitive radiotherapy
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Renata Ferrarotto, Heath D. Skinner, Abdallah S.R. Mohamed, Joel Berends, Randal S. Weber, Amy C. Hessel, William H. Morrison, Scott B. Cantor, Erich M. Sturgis, Temitayo Ajayi, G. Brandon Gunn, Andrew J. Schaefer, Jack Phan, Steven J. Frank, Zeina Ayoub, Mona Kamal, Jason M. Johnson, Adam S. Garden, Courtney Pollard, Sweet Ping Ng, David I. Rosenthal, Stephen Y. Lai, Clifton D. Fuller, and Houda Bahig
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Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Salvage therapy ,Disease ,Asymptomatic ,Article ,Time-to-Treatment ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Early Detection of Cancer ,Aged ,Retrospective Studies ,Aged, 80 and over ,Salvage Therapy ,business.industry ,Head and neck cancer ,Odds ratio ,Middle Aged ,medicine.disease ,Survival Analysis ,Radiation therapy ,Oncology ,Head and Neck Neoplasms ,Population Surveillance ,030220 oncology & carcinogenesis ,Female ,Radiology ,Neoplasm Recurrence, Local ,medicine.symptom ,Surveillance imaging ,business - Abstract
Background The current study was performed to assess the efficacy of surveillance imaging in patients with head and neck cancer (HNC) who are treated definitively with radiotherapy. Methods Eligible patients included those with a demonstrable disease-free interval (≥1 follow-up imaging procedure without evidence of disease and a subsequent visit/imaging procedure) who underwent treatment of HNC from 2000 through 2010. Results A total of 1508 patients were included. The median overall survival was 99 months, with a median imaging follow-up period of 59 months. Of the 1508 patients, 190 patients (12.6%) experienced disease recurrence (107 patients had locoregional and 83 had distant disease recurrence). A total of 119 patients (62.6%) in the group with disease recurrence were symptomatic and/or had an adverse clinical finding associated with the recurrence. Approximately 80% of patients with locoregional disease recurrences presented with a clinical finding, whereas 60% of distant disease recurrences were detected by imaging in asymptomatic patients. Despite the earlier detection of disease recurrence via imaging, those patients in the group of patients with clinically detected disease recurrence were significantly more likely to undergo salvage therapy compared with those whose recurrence was detected on imaging (odds ratio, 0.35). There was no difference in overall survival noted between those patients with disease recurrences that were detected clinically or with imaging alone. Approximately 70% of disease recurrences occurred within the first 2 years. In those patients who developed disease recurrence after 2 years, the median time to recurrence was 51 months. After 2 years, the average number of imaging procedures per patient for the detection of a salvageable recurrence for the imaging-detected group was 1539. Conclusions Surveillance imaging in asymptomatic patients with HNC who are treated definitively with radiotherapy without clinically suspicious findings beyond 2 years has a low yield and a high cost. Physicians ordering these studies must use judicious consideration and discretion.
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- 2019
13. Long‐term quality of life after definitive treatment of sinonasal and nasopharyngeal malignancies
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Gary Brandon Gunn, Ehab Y. Hanna, Michael E. Kupferman, Joshua B. Smith, Shirley Y. Su, Steven J. Frank, Matthew A. Tyler, Abdallah S.R. Mohamed, Jeremy M. Aymard, Renata Ferrarotto, Jack Phan, and Clifton D. Fuller
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Cross-sectional study ,Visual analogue scale ,Population ,Disease ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Surveys and Questionnaires ,Internal medicine ,medicine ,Humans ,Combined Modality Therapy ,In patient ,education ,Aged ,education.field_of_study ,Nasopharyngeal Carcinoma ,business.industry ,Nasopharyngeal Neoplasms ,Evidence-based medicine ,Middle Aged ,Cross-Sectional Studies ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,Quality of Life ,Female ,business ,Paranasal Sinus Neoplasms ,030217 neurology & neurosurgery - Abstract
OBJECTIVE To evaluate long-term global and site-specific health-related quality of life (HRQoL) in patients treated for sinonasal and nasopharyngeal malignancies. STUDY DESIGN Cross-sectional. METHODS One hundred fourteen patients with sinonasal and nasopharyngeal malignancies received surgery, radiation, systemic chemotherapy, or a combination thereof, with curative intent. Validated global ([EuroQol-5D] Visual Analogue Scale [EQ-5D VAS]) and disease-specific instruments (MD Anderson Symptom Inventory-Head and Neck [MDASI-HN], Anterior Skull Base Questionnaire [ASBQ]) were administered to patients who were both free of disease and had completed treatment at least 12 months previously. Associations between instruments, instrument domains, and specific clinical parameters were analyzed. RESULTS The median age was 55 years. The mean EQ-5D VAS, MDASI-22 composite score, and ASBQ score were 74 (standard deviation [SD] 21), 48 (SD 36), and 130 (SD 27), respectively. The most frequently reported high-severity items in MDASI-HN were dry mouth and difficulty tasting food. The most frequently reported high-severity items in ASBQ were difficulty with smell and nasal secretions. Advanced Tumor (T) classification was associated with worse overall ASBQ sum score (P = 0.02). ASBQ performance at home and MDASI-HN drowsy symptom items independently predicted worse global HRQoL as measured by the EQ-5D VAS (P
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- 2019
14. Radiographic retropharyngeal lymph node involvement in HPV‐associated oropharyngeal carcinoma: Patterns of involvement and impact on patient outcomes
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Bonnie S. Glisson, David I. Rosenthal, Adam S. Garden, Clifton D. Fuller, Erich M. Sturgis, Baher Elgohari, Jay Reddy, William H. Morrison, G. Brandon Gunn, Jack Phan, J. Matthew Debnam, Timothy A. Lin, Heath D. Skinner, Amit Jethanandani, Abdallah S.R. Mohamed, Hesham Elhalawani, Sweet Ping Ng, and Steven J. Frank
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Adult ,Male ,Oncology ,Cancer Research ,medicine.medical_specialty ,medicine.medical_treatment ,Article ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Retropharyngeal lymph nodes ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Survival analysis ,Aged ,Neoplasm Staging ,Retrospective Studies ,Cancer staging ,Aged, 80 and over ,Squamous Cell Carcinoma of Head and Neck ,business.industry ,Incidence (epidemiology) ,Papillomavirus Infections ,Cancer ,Induction chemotherapy ,Chemoradiotherapy ,Middle Aged ,Prognosis ,medicine.disease ,Primary tumor ,Radiation therapy ,Oropharyngeal Neoplasms ,Treatment Outcome ,Head and Neck Neoplasms ,Lymphatic Metastasis ,030220 oncology & carcinogenesis ,Carcinoma, Squamous Cell ,Cervical Vertebrae ,Pharynx ,Female ,Lymph Nodes ,business - Abstract
BACKGROUND: The objective of the current study was to characterize the incidence, pattern, and impact on oncologic outcomes of retropharyngeal lymph node (RPLN) involvement in HPV-associated oropharyngeal cancer (OPC). METHODS: Data regarding patients with HPV-associated OPC who were treated at The University of Texas MD Anderson Cancer Center with intensity-modulated radiotherapy from 2004 through 2013 were analyzed retrospectively. RPLN status was determined by reviewing pretreatment imaging and/or reports. Outcomes analysis was restricted to patients with lymph node-positive (+) disease. Kaplan-Meier survival estimates were generated and survival curves were compared using the log-rank test. Bayesian information criterion assessed model performance changes with the addition of RPLN status to current American Joint Committee on Cancer staging. Competing risk analysis compared modes of disease recurrence. RESULTS: The incidence of radiographic RPLN involvement was 9% (73 of 796 patients) and was found to vary by primary tumor site. The 5-year rates of freedom from distant metastases (FDM) and overall survival were lower in patients with RPLN(+) status compared with those with RPLN-negative (−) status (84% vs 93% [P = .0327] and 74% vs 87% [P = .0078], respectively). RPLN(+) status was not found to be associated with outcomes on multivariate analysis. Bayesian information criterion analysis demonstrated that current American Joint Committee on Cancer staging was not improved with the inclusion of RPLN. Locoregional and distant disease recurrence probabilities for those patients with RPLN(+) status were 8% and 13%, respectively, compared with 10% and 6%, respectively, for those with RPLN(−) status. RPLN(+) status portended worse 5-year FDM in the low-risk subgroup (smoking history of
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- 2019
15. Erratum to: Development and clinical implementation of SeedNet: A sliding‐window convolutional neural network for radioactive seed identification in MRI‐assisted radiosurgery (MARS). Magn Reson Med . 2019;81:3888‐3900
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Jeremiah W. Sanders and Steven J. Frank
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Radiology, Nuclear Medicine and imaging - Published
- 2022
16. Outcomes of patients diagnosed with carcinoma metastatic to the neck from an unknown primary source and treated with intensity-modulated radiation therapy
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Steven J. Frank, William H. Morrison, David I. Rosenthal, Clifton D. Fuller, Jack Phan, Sweet Ping Ng, Erich M. Sturgis, G. Brandon Gunn, Abdallah S.R. Mohamed, Katherine A. Hutcheson, Heath D. Skinner, Renata Ferrarotto, Stefania Volpe, Mona Kamal, Adam S. Garden, and Faye M. Johnson
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Cancer Research ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Cancer ,Subgroup analysis ,Retrospective cohort study ,medicine.disease ,Dysphagia ,030218 nuclear medicine & medical imaging ,Radiation therapy ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,medicine ,Carcinoma ,Radiology ,medicine.symptom ,business ,Lymph node ,Survival analysis - Abstract
Background There are few published studies to guide the treatment of carcinoma metastatic to the neck from an unknown primary (CUP). In this regard, the objective of the current study was to share the authors' current experience treating patients with CUP using intensity-modulated radiation therapy (IMRT), which principally targeted both sides of the neck, the nasopharynx, and the oropharynx. Methods This was a retrospective study in which an institutional database search was conducted to identify patients with CUP who received IMRT. Data analysis included frequency tabulation, survival analysis, and multivariable analysis. Results Two-hundred sixty patients met inclusion criteria. The most common lymph node category was N2b (54%). IMRT volumes included the entire pharyngolaryngeal mucosa in 78 patients, the nasopharynx and oropharynx in 167 patients, and treatment limited to the involved neck in 11 patients. Eighty-four patients underwent neck dissections. The 5-year overall survival, regional control, and distant metastases-free survival rates were 84%, 91%, and 94%, respectively. Over 40% of patients had gastrostomy tubes during therapy, and 7% patients were diagnosed with chronic radiation-associated dysphagia. Higher lymph node burden was associated with worse disease-related outcomes, and in subgroup analysis, patients with human papillomavirus-associated disease had better outcomes. No therapeutic modality was statistically associated with either disease-related outcomes or toxicity. Conclusions Comprehensive IMRT with treatment to both sides of the neck and to the oropharyngeal and nasopharyngeal mucosa results in high rates of disease control and survival. The investigators were unable to demonstrate that treatment intensification with chemotherapy or surgery added benefit or excessive toxicity. Cancer 2018;124:1415-27. © 2018 American Cancer Society.
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- 2018
17. Cognitive function and patient‐reported memory problems after radiotherapy for cancers at the skull base: A cross‐sectional survivorship study using the Telephone Interview for Cognitive Status and the MD Anderson Symptom Inventory‐Head and Neck Module
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David I. Rosenthal, Stephen Y. Lai, Marina Horiates, Clifton D. Fuller, Chase C. Hansen, Abdallah S.R. Mohamed, Ehab Y. Hanna, Sarah Floris, Beth M. Beadle, Collin F. Mulcahy, Adam S. Garden, Michael E. Kupferman, Jason M. Johnson, Jack Phan, Katherine A. Hutcheson, Conner Patrick, Joshua B. Smith, Shirley Y. Su, C. French, Heath D. Skinner, William H. Morrison, Blaine D. Smith, G. Brandon Gunn, Carol M. Lewis, Colton McCoy, Hillary Eichelberger, Kelsey Chrane, Steven J. Frank, Carthal Anderson, and Jeffrey S. Wefel
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education.field_of_study ,medicine.medical_specialty ,Tics ,Cross-sectional study ,business.industry ,Population ,Cognition ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Otorhinolaryngology ,Telephone interview ,030220 oncology & carcinogenesis ,Severity of illness ,medicine ,Physical therapy ,Young adult ,education ,Psychiatry ,business ,030217 neurology & neurosurgery ,Mass screening - Abstract
Background Using patient-reported and objective assessment tools, we sought to quantify cognitive symptoms and objective cognitive dysfunction in patients irradiated for skull base cancer. Methods Participants were assessed using the Telephone Interview for Cognitive Status (TICS) and the MD Anderson Symptom Inventory-Head and Neck module (MDASI-HN), with subsequent analysis. Results Of the 122 participants analyzed, the majority (63%) had no frank detectable cognitive impairment by TICS, with frank impairment in 6%. Overall, mean patient-reported problems with memory (MDASImemory) was 3.3 (SD ±2.66). On recursive partition analysis, the MDASImemory cutoff point of ≥5 was associated with detectable cognitive impairment by TICS (logworth 1.69; P = .02), yet no MDASImemory threshold was associated with unambiguous absence of impairment by TICS. Conclusion Approximately one third of patients had ambiguous results by TICS assessment, for whom more rigorous testing may be warranted. Moderate to severe levels of patient-reported memory complaints on the MDASI-HN module may have utility as a screening tool for cognitive dysfunction in this population.
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- 2017
18. Clinical outcomes after local field conformal reirradiation of patients with retropharyngeal nodal metastasis
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Theresa Nguyen, David I. Rosenthal, He Wang, Clifton D. Fuller, Sam Tung, Adam S. Garden, Steven J. Frank, Sweet Ping Ng, William H. Morrison, Beth M. Beadle, Lawrence D. Ginsberg, Ehab Y. Hanna, Courtney Pollard, Shirley Y. Su, Mark Zafereo, Conjun Wang, Shah J. Shah, Gary Brandon Gunn, Erich M. Sturgis, and Jack Phan
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Male ,medicine.medical_specialty ,Node metastasis ,medicine.medical_treatment ,Conformal radiotherapy ,Radiosurgery ,Re-Irradiation ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Proton Therapy ,medicine ,Humans ,Head and neck ,Proton therapy ,Retrospective Studies ,Chemotherapy ,business.industry ,Nodal metastasis ,Combined Modality Therapy ,Survival Rate ,Radiation therapy ,Treatment Outcome ,Otorhinolaryngology ,Head and Neck Neoplasms ,Lymphatic Metastasis ,030220 oncology & carcinogenesis ,Toxicity ,Female ,Lymph Nodes ,Radiology ,Neoplasm Recurrence, Local ,Radiotherapy, Conformal ,business - Abstract
Background The purpose of this study was to present our experience with retropharyngeal node reirradiation using highly conformal radiotherapy (RT). Methods A retrospective screen of 2504 consecutively irradiated patients with head and neck malignancies between 2005 and 2015 identified 19 patients who underwent reirradiation for retropharyngeal node metastasis. Clinical and toxicity outcomes were assessed in these patients. Results Thirteen patients (68%) had squamous cell carcinoma. Eleven patients (58%) received conventionally fractionated intensity-modulated radiotherapy (IMRT) or proton therapy, and 8 patients (42%) received single-fractionated or hypofractionated stereotactic RT. Fourteen patients (74%) received chemotherapy. Median follow-up was 14.7 months. The 1-year local control, locoregional control, overall survival, and progression-free survival rates were 100%, 94%, 92%, and 92%, respectively. Three patients (16%) experienced acute grade 3 toxicity and occurred in those treated with IMRT. There was no late grade ≥3 toxicity. Conclusion Retropharyngeal node reirradiation with conformal therapy is well tolerated and associated with excellent short-term disease control.
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- 2017
19. Outcomes for olfactory neuroblastoma treated with induction chemotherapy
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C. David Fuller, Diana Bell, Bonnie S. Glisson, Steven J. Frank, Ehab Y. Hanna, Michael E. Kupferman, Renata Ferrarotto, Shirley Y. Su, Merrill S. Kies, G. Brandon Gunn, Jack Phan, and Dianna B. Roberts
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Adult ,Male ,Oncology ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Esthesioneuroblastoma, Olfactory ,Improved survival ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Advanced disease ,Humans ,In patient ,Child ,Etoposide ,Aged ,Retrospective Studies ,Cisplatin ,Chemotherapy ,Olfactory Neuroblastoma ,business.industry ,Induction chemotherapy ,Induction Chemotherapy ,Middle Aged ,Combined Modality Therapy ,Magnetic Resonance Imaging ,Survival Analysis ,Otorhinolaryngology ,Lymphatic Metastasis ,030220 oncology & carcinogenesis ,Female ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
Background Oncologic outcomes for induction chemotherapy and its role in patients with advanced olfactory neuroblastoma (ONB) remain unclear. Methods A retrospective review of 15 consecutive patients with extensive local invasion and/or nodal disease treated with induction chemotherapy with curative intent followed by definitive local therapy. Results The majority of patients were treated with cisplatin and etoposide. The response to chemotherapy was 68% (10/15). Response was 78% (7/9) in the high Hyams high-grade group and 50% (3/6) in the Hyams low-grade group. Seven patients had complete response (CR) and 3 patients were able to avoid orbital exenteration. The 5-year disease-free survival (DFS) and overall survival (OS) were 71% and 78%, respectively, with a trend toward improved survival in patients with CR. Conclusion ONB is a chemosensitive tumor and induction chemotherapy is an acceptable strategy for aggressive and locoregional advanced disease. Hyams grade may predict chemosensitivity and CR may be associated with improved survival.
- Published
- 2017
20. Quantitative pretreatment CT volumetry: Association with oncologic outcomes in patients with T4a squamous carcinoma of the larynx
- Author
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Merrill S. Kies, Renata Ferrarotto, Donald F. Schomer, G. Brandon Gunn, Amy C. Hessel, Jack Phan, J.A. Messer, William H. Morrison, Randal S. Weber, Katherine A. Hutcheson, David I. Rosenthal, Stephen Y. Lai, Brian Pham, Jay C. Shiao, Clifton D. Fuller, Mark Zafereo, Benjamin W. Warren, Beth M. Beadle, Abdallah S.R. Mohamed, Jason M. Johnson, Heiko Enderling, Mona Kamal, Adam S. Garden, Steven J. Frank, and Jan S. Lewin
- Subjects
Larynx ,Oncology ,medicine.medical_specialty ,Multivariate analysis ,business.industry ,medicine.medical_treatment ,Urology ,Cancer ,medicine.disease ,Primary tumor ,Squamous carcinoma ,Radiation therapy ,Laryngectomy ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,Internal medicine ,Cohort ,medicine ,030223 otorhinolaryngology ,business - Abstract
Background The purpose of this study was to determine the impact of CT-determined pretreatment primary tumor volume on survival and disease control in T4a laryngeal squamous cell carcinoma (SCC). Methods We retrospectively reviewed 124 patients with T4a laryngeal cancer from 2000-2011. Tumor volume measurements were collected and correlated with outcomes. Results Five-year overall survival (OS) for patients with tumor volume ≥21 cm3 treated with larynx preservation (n = 26 of 41) was significantly inferior compared to
- Published
- 2017
21. Human papillomavirus status and the relative biological effectiveness of proton radiotherapy in head and neck cancer cells
- Author
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Xiaorong Ronald Zhu, Yining Yang, Li Wang, Xiaofang Wang, Xiaodong Zhang, Yuting Li, Shichao Han, Steven J. Frank, Xiaochun Wang, Pierre Blanchard, Michael Gillin, Jinming Zhu, Narayan Sahoo, Ruiping Zhang, David Molkentine, and Jeffrey N. Myers
- Subjects
0301 basic medicine ,Oncology ,medicine.medical_specialty ,Cell type ,DNA repair ,medicine.medical_treatment ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Relative biological effectiveness ,Radiosensitivity ,Papillomaviridae ,biology ,business.industry ,Head and neck cancer ,virus diseases ,biology.organism_classification ,medicine.disease ,female genital diseases and pregnancy complications ,Comet assay ,Radiation therapy ,030104 developmental biology ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,business - Abstract
BACKGROUND Human papillomavirus (HPV)-positive oropharyngeal carcinomas response better to X-ray therapy (XRT) than HPV-negative disease. Whether HPV status influences the sensitivity of head and neck cancer cells to proton therapy or the relative biological effectiveness (RBE) of protons versus XRT is unknown. METHODS Clonogenic survival was used to calculate the RBE; immunocytochemical analysis and neutral comet assay were used to evaluate unrepaired DNA double-strand breaks. RESULTS HPV-positive cells were more sensitive to protons and the unrepaired double-strand breaks were more numerous in HPV-positive cells than in HPV-negative cells (p 1.06). Cell line type and radiation fraction size influenced the RBE. CONCLUSION HPV-positive cells were more sensitive to protons than HPV-negative cells maybe through the effects of HPV on DNA damage and repair. The RBE for protons depends more on cell type and fraction size than on HPV status. © 2016 Wiley Periodicals, Inc. Head Neck 39: 708-715, 2017.
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- 2016
22. Recurrent oral cavity cancer: Patterns of failure after salvage multimodality therapy
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Heath D. Skinner, Beth M. Beadle, William H. Morrison, David I. Rosenthal, Clifton D. Fuller, Ann M. Gillenwater, Adam S. Garden, Jeffrey N. Myers, Faye M. Johnson, Sean R. Quinlan–Davidson, William N. William, Steven J. Frank, Gary Brandon Gunn, Jack Phan, and Mark Zafereo
- Subjects
Mouth neoplasm ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Salvage therapy ,Retrospective cohort study ,Multimodal therapy ,Multimodality Therapy ,Radiation therapy ,03 medical and health sciences ,0302 clinical medicine ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,medicine ,Combined Modality Therapy ,Medical physics ,Radiology ,030223 otorhinolaryngology ,business ,Survival analysis - Abstract
Background We focused on a cohort of radiation naive patients who had recurrent oral cavity cancer (recurrent OCC) to assess their outcomes with salvage multimodal therapy. Methods A retrospective single institutional study was performed of patients with recurrent OCC. Disease recurrence and survival outcomes were assessed. Results Seventy-eight patients were analyzed. All patients had salvage surgery and intensity-modulated radiotherapy (IMRT) and 74% had chemotherapy. Five-year overall survival, recurrence-free survival, and locoregional control rates were 59%, 60%, and 74%, respectively. Conclusion Outcomes of radiation naive patients with recurrent OCC are fair, and seem similar with patients with locally advanced nonrecurrent OCC treated with multimodal therapy. © 2016 Wiley Periodicals, Inc. Head Neck 39: 633–638, 2017
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- 2016
23. Long‐term outcomes after multidisciplinary management of T3 laryngeal squamous cell carcinomas: Improved functional outcomes and survival with modern therapeutic approaches
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Randal S. Weber, Lawrence E. Ginsberg, Collin F. Mulcahy, Abdallah S.R. Mohamed, G. Brandon Gunn, David I. Rosenthal, Stephen Y. Lai, Clifton D. Fuller, Beth M. Beadle, Jan S. Lewin, Adel K. El-Naggar, Adam S. Garden, Steven J. Frank, Jack Phan, Merril S. Kies, Esengul Kocak–Uzel, Mark Zafereo, William H. Morrison, and Katherine A. Hutcheson
- Subjects
Adult ,Male ,Oncology ,medicine.medical_specialty ,medicine.medical_treatment ,Laryngectomy ,Kaplan-Meier Estimate ,Cancer Care Facilities ,Disease-Free Survival ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Neoplasm Invasiveness ,030223 otorhinolaryngology ,Laryngeal Neoplasms ,Survival analysis ,Aged ,Neoplasm Staging ,Proportional Hazards Models ,Retrospective Studies ,Analysis of Variance ,Performance status ,Squamous Cell Carcinoma of Head and Neck ,business.industry ,Proportional hazards model ,Hazard ratio ,Retrospective cohort study ,Middle Aged ,Laryngeal Neoplasm ,Survival Analysis ,Texas ,Neoadjuvant Therapy ,Treatment Outcome ,Otorhinolaryngology ,Chemotherapy, Adjuvant ,Head and Neck Neoplasms ,030220 oncology & carcinogenesis ,Multivariate Analysis ,Cohort ,Carcinoma, Squamous Cell ,Female ,Radiotherapy, Adjuvant ,business ,Follow-Up Studies - Abstract
Background The purpose of this study was to evaluate the long-term outcomes after initial definitive or adjuvant radiotherapy (RT) for T3 laryngeal cancers. Methods We reviewed 412 patients treated for T3 laryngeal squamous cell cancer from 1985 to 2011. Results The 10-year overall survival (OS) was 35%; disease-specific-survival (DSS) was 61%; locoregional control was 76%; and freedom from distant metastasis was 83%. Chemotherapy, age, performance status
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- 2016
24. Biological responses of human solid tumor cells to X-ray irradiation within a 1.5-Tesla magnetic field generated by a magnetic resonance imaging-linear accelerator
- Author
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Steven J. Frank, K. Kian Ang, Zhifei Wen, Steven H. Lin, Niels Bovenschen, Jan Kok, Li Wang, Bas W. Raaymakers, Marco van Vulpen, Roel Broekhuizen, David Molkentine, and Stan J Hoogcarspel
- Subjects
Plating efficiency ,medicine.diagnostic_test ,Physiology ,Chemistry ,business.industry ,medicine.medical_treatment ,Cell ,Biophysics ,Cancer ,Magnetic resonance imaging ,General Medicine ,medicine.disease ,030218 nuclear medicine & medical imaging ,Radiation therapy ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,medicine ,Radiology, Nuclear Medicine and imaging ,Viability assay ,Radiosensitivity ,Lung cancer ,Nuclear medicine ,business - Abstract
Devices that combine magnetic resonance imaging with linear accelerators (MRL) represent a novel tool for MR-guided radiotherapy. However, whether magnetic fields (MFs) generated by these devices affect the radiosensitivity of tumors is unknown. We investigated the influence of a 1.5-T MF on cell viability and radioresponse of human solid tumors. Human head/neck cancer and lung cancer cells were exposed to single or fractionated 6-MV X-ray radiation; effects of the MF on cell viability were determined by cell plating efficiency and on radioresponsiveness by clonogenic cell survival. Doses needed to reduce the fraction of surviving cells to 37% of the initial value (D0s) were calculated for multiple exposures to MF and radiation. Results were analyzed using Student's t-tests. Cell viability was no different after single or multiple exposures to MRL than after exposure to a conventional linear accelerator (Linac, without MR-generated MF) in 12 of 15 experiments (all P > 0.05). Single or multiple exposures to MF had no influence on cell radioresponse (all P > 0.05). Cells treated up to four times with an MRL or a Linac further showed no changes in D0s with MF versus without MF (all P > 0.05). In conclusion, MF within the MRL does not seem to affect in vitro tumor radioresponsiveness as compared with a conventional Linac. Bioelectromagnetics. 37:471-480, 2016. © 2016 Wiley Periodicals, Inc.
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- 2016
25. Effect of pulse sequence parameter selection on signal strength in positive-contrast MRI markers for MRI-based prostate postimplant assessment
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Arvind Rao, R. Jason Stafford, Tze Yee Lim, Jihong Wang, Steven J. Frank, Christopher J. MacLellan, Rajat J. Kudchadker, and Geoffrey S. Ibbott
- Subjects
Contouring ,genetic structures ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Magnetic resonance imaging ,General Medicine ,Real-time MRI ,Imaging phantom ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Flip angle ,030220 oncology & carcinogenesis ,medicine ,Image noise ,Nuclear medicine ,business ,Fiducial marker ,Prostate brachytherapy - Abstract
Purpose: For postimplant dosimetric assessment, computed tomography (CT) is commonly used to identify prostate brachytherapy seeds, at the expense of accurate anatomical contouring. Magnetic resonance imaging (MRI) is superior to CT for anatomical delineation, but identification of the negative-contrast seeds is challenging. Positive-contrast MRI markers were proposed to replace spacers to assist seed localization on MRI images. Visualization of these markers under varying scan parameters was investigated. Methods: To simulate a clinical scenario, a prostate phantom was implanted with 66 markers and 86 seeds, and imaged on a 3.0T MRI scanner using a 3D fast radiofrequency-spoiled gradient recalled echo acquisition with various combinations of scan parameters. Scan parameters, including flip angle, number of excitations, bandwidth, field-of-view, slice thickness, and encoding steps were systematically varied to study their effects on signal, noise, scan time, image resolution, and artifacts. Results: The effects of pulse sequence parameter selection on the marker signal strength and image noise were characterized. The authors also examined the tradeoff between signal-to-noise ratio, scan time, and image artifacts, such as the wraparound artifact, susceptibility artifact, chemical shift artifact, and partial volume averaging artifact. Given reasonable scan time and managable artifacts, the authors recommended scan parameter combinations that can provide robust visualization of the MRI markers. Conclusions: The recommended MRI pulse sequence protocol allows for consistent visualization of the markers to assist seed localization, potentially enabling MRI-only prostate postimplant dosimetry.
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- 2016
26. Eye-sparing multidisciplinary approach for the management of lacrimal gland carcinoma
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Ehab Y. Hanna, Bita Esmaeli, Diana Bell, Merrill S. Kies, William N. William, Steven J. Frank, and Vivian T. Yin
- Subjects
medicine.medical_specialty ,Adenoid cystic carcinoma ,business.industry ,medicine.medical_treatment ,Lacrimal apparatus ,medicine.disease ,Eye neoplasm ,Surgery ,Radiation therapy ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Carcinoma ex pleomorphic adenoma ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,030221 ophthalmology & optometry ,medicine ,Adenocarcinoma ,business ,Lacrimal Gland Carcinoma ,Chemoradiotherapy - Abstract
Background We analyzed local control and early ocular toxicity after eye-sparing management of lacrimal gland carcinoma. Methods For consecutive patients with lacrimal gland carcinoma treated during 2007 to 2014, we reviewed tumor characteristics, treatment details, ocular toxic effects, and recurrence. Results Twenty patients, median age 55 years, were treated for lacrimal gland carcinoma during the study period; 11 had globe-sparing surgery. Seven patients had adenoid cystic carcinoma, 2 had carcinoma ex pleomorphic adenoma, and 1 each had high-grade and low-grade adenocarcinoma. Ten patients underwent postoperative radiotherapy, median 60 Gy (range, 52–64 Gy), 6 with concurrent chemotherapy. At a median of 30 months after radiation, all patients had dry eye syndrome, and 1 patient had severe corneal and conjunctival damage leading to enucleation. All 11 patients were disease free at last contact, median follow-up after surgery of 33 months. Conclusion An eye-sparing approach with surgery followed by adjuvant radiotherapy or chemoradiotherapy is feasible for selected patients with lacrimal gland carcinoma and is associated with a reasonable locoregional control and ocular toxicity profile. © 2016 Wiley Periodicals, Inc. Head Neck, 2016
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- 2016
27. Radiation therapy (with or without neck surgery) for phenotypic human papillomavirus-associated oropharyngeal cancer
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David I. Rosenthal, Clifton D. Fuller, Erich M. Sturgis, Faye M. Johnson, Gary Brandon Gunn, William H. Morrison, Jack Phan, William N. William, Merrill S. Kies, Adam S. Garden, Steven J. Frank, and Beth M. Beadle
- Subjects
Cancer Research ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Dose fractionation ,Cancer ,Retrospective cohort study ,medicine.disease ,Systemic therapy ,Surgery ,Radiation therapy ,03 medical and health sciences ,0302 clinical medicine ,Oropharyngeal Neoplasm ,Oncology ,030220 oncology & carcinogenesis ,medicine ,Clinical endpoint ,030223 otorhinolaryngology ,business ,Survival analysis - Abstract
BACKGROUND Favorable outcomes for human papillomavirus–associated oropharyngeal cancer have led to interest in identifying a subgroup of patients with the lowest risk of disease recurrence after therapy. De-intensification of therapy for this group may result in survival outcomes that are similar to those associated with current therapy but with less toxicity. To advance this effort, this study analyzed the outcomes of oropharyngeal cancer patients treated with or without systemic therapy. METHODS This was a retrospective study of patients with oropharyngeal cancer treated between 1985 and 2012. The criteria for inclusion were ≤10 pack-years of cigarette smoking and stage III/IVA cancer limited to T1-3, N1-N2b, and T3N0 disease. A survival analysis was performed with the primary endpoint of progression-free survival (PFS). RESULTS The cohort included 857 patients. Systemic therapy was given to 439 patients (51%). The median survival was 80 months. The 2-year PFS rate was 91%. When the analysis was limited to 324 patients irradiated without systemic therapy, the 2- and 5-year PFS rates were 90% and 85%, respectively. Furthermore, for these 324 patients, the 5-year PFS rates for T1, T2, and T3 disease were 90%, 83%, and 70%, respectively. The 5-year PFS rate for patients treated with systemic therapy for T3 disease was 77% (P = .07). CONCLUSIONS According to the low-risk definition currently established in cooperative trials, the patients had a 2-year PFS rate approximating 90%. When patients who were treated with radiation alone were evaluated, no compromise was observed in this high rate of PFS, which is higher than the 2-year PFS thresholds used in current cooperative trials. Cancer 2016. © 2016 American Cancer Society.
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- 2016
28. Outcomes for hypopharyngeal carcinoma treated with organ-preservation therapy
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William H. Morrison, Randal S. Weber, Bonnie S. Glisson, Jack Phan, Randa Tao, Beth M. Beadle, Mark A. Edson, Adam S. Garden, Vinita Takiar, Shalin J. Shah, Steven J. Frank, David I. Rosenthal, Clifton D. Fuller, William N. William, and Gary Brandon Gunn
- Subjects
0301 basic medicine ,Chemotherapy ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Medical record ,Urology ,Induction chemotherapy ,Hypopharyngeal cancer ,medicine.disease ,Surgery ,Radiation therapy ,Hypopharyngeal Carcinoma ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Concurrent chemotherapy ,Laryngeal preservation ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,medicine ,business - Abstract
Background This study assessed outcomes of patients with hypopharyngeal carcinoma treated with organ-preservation therapy utilizing intensity-modulated radiation therapy (IMRT). Methods The medical records of 98 patients treated with definitive IMRT +/- chemotherapy from 2001 to 2013 for nonmetastatic hypopharyngeal cancer were retrospectively reviewed. Results Patients were treated to doses of 66 to 72 Gy. Eighty-three patients (85%) received chemotherapy. With median follow-up of 35 months, 2-year overall survival (OS), locoregional control, progression-free survival (PFS), and laryngectomy-free survival rates were 74%, 77%, 67%, and 65%, respectively. Functional laryngeal preservation rate was 76% at 2 years. N3 disease correlated with worse OS (p < .01). Concurrent chemotherapy correlated with improved locoregional control (p = .03) and complete response to induction chemotherapy correlated with improved OS and PFS (p = .02). Actuarial 2-year and 5-year grade 3 treatment toxicities were 17% and 21%, respectively. Conclusion Favorable disease outcomes and functional laryngeal preservation rates can be achieved with IMRT for patients with hypopharyngeal cancer. © 2016 Wiley Periodicals, Inc. Head Neck, 2016
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- 2016
29. Intensity-modulated proton therapy for nasopharyngeal carcinoma: Decreased radiation dose to normal structures and encouraging clinical outcomes
- Author
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Emma B. Holliday, Mike Hernandez, David I. Rosenthal, Steven J. Frank, Adam S. Garden, Esengul Kocak-Uzel, and Gary D. Lewis
- Subjects
medicine.medical_specialty ,Chemotherapy ,Imrt plan ,business.industry ,medicine.medical_treatment ,Radiation dose ,medicine.disease ,030218 nuclear medicine & medical imaging ,Intensity (physics) ,Radiation therapy ,03 medical and health sciences ,0302 clinical medicine ,Otorhinolaryngology ,Nasopharyngeal carcinoma ,030220 oncology & carcinogenesis ,Toxicity ,medicine ,Medical physics ,Nuclear medicine ,business ,Proton therapy - Abstract
Background Intensity-modulated proton therapy (IMPT) has the potential to spare dose to organs at risk (OAR) when compared to intensity-modulated radiotherapy (IMRT) while maintaining excellent clinical outcomes. Methods Ten patients with nasopharyngeal carcinoma (NPC) were identified for whom IMPT was planned; 9 patients also had a comparison photon-based IMRT plan generated. Dosimetric comparison of mean radiation dose to 29 adjacent OAR was performed. Disease control, survival, and toxicity outcomes were collected from the medical records. Results There were significant differences in mean doses in 15 of the 29 OAR; 13 OAR received lower mean dose with proton-based plans. Median follow-up was 24.5 months (range, 19–32 months). Two-year locoregional control was 100% and the 2-year overall survival was 88.9%. Conclusion We observed dosimetric advantages conferred by IMPT compared to IMRT. Further study is needed to determine if these translate into reduced toxicity and/or improved disease control. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
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- 2015
30. Comparison of systemic therapies used concurrently with radiation for the treatment of human papillomavirus-associated oropharyngeal cancer
- Author
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Jack Phan, William H. Morrison, Hsin Hua Nien, Beth M. Beadle, Steven J. Frank, Faye M. Johnson, Erich M. Sturgis, David I. Rosenthal, Clifton D. Fuller, Merrill S. Kies, Kathryn A. Gold, Adel K. El-Naggar, Adam S. Garden, Heath D. Skinner, and Gary Brandon Gunn
- Subjects
Oncology ,medicine.medical_specialty ,Chemotherapy ,Cetuximab ,business.industry ,medicine.medical_treatment ,Cancer ,Retrospective cohort study ,medicine.disease ,Carboplatin ,Surgery ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Oropharyngeal Neoplasm ,Otorhinolaryngology ,chemistry ,030220 oncology & carcinogenesis ,Internal medicine ,medicine ,Mucositis ,030212 general & internal medicine ,business ,Survival rate ,medicine.drug - Abstract
Background This was a retrospective study of patients with human papillomavirus (HPV)-associated oropharyngeal cancer treated with concurrent systemic therapy and radiation. Methods Data were extracted through chart review, and statistical analyses included frequency tabulation, chi-square, and Kaplan–Meier tests. Results Three hundred thirty-nine patients were analyzed; 166 received neoadjuvant chemotherapy. One hundred thirty-six patients were treated with cisplatin, 123 with cetuximab, and 59 with carboplatin. The 2-, 3-, and 5-year actuarial overall survival rates were 92%, 88%, and 78%, respectively. There were no significant differences in survival or disease control when analyzed by systemic agent. Platin-treated patients had greater hematologic toxicity, and required more intravenous hydration. The incidence of confluent mucositis was highest among patients treated with cetuximab. Conclusion Platin and cetuximab seem to have similar efficacy when delivered concurrently with radiation in our retrospective population study. Although platin did cause greater hematologic toxicity, radiation-specific side effects seemed relatively comparable. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
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- 2015
31. Definitive proton radiation therapy and concurrent cisplatin for unresectable head and neck adenoid cystic carcinoma: A series of 9 cases and a critical review of the literature
- Author
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William H. Morrison, C. David Fuller, Adam S. Garden, Emma B. Holliday, X. Ronald Zhu, Merrill S. Kies, David I. Rosenthal, G. Brandon Gunn, O. Bhattasali, Ehab Y. Hanna, and Steven J. Frank
- Subjects
Cisplatin ,medicine.medical_specialty ,Chemotherapy ,Base of skull ,business.industry ,Adenoid cystic carcinoma ,medicine.medical_treatment ,Proton radiation therapy ,medicine.disease ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,medicine ,030223 otorhinolaryngology ,business ,Head and neck ,Optic nerve disorder ,Chemoradiotherapy ,medicine.drug - Abstract
Background The primary treatment for head and neck adenoid cystic carcinoma (ACC) is surgery. Infrequently, however, ACC's propensity for perineural and base of skull invasion can preclude definitive surgical management. We present our experience with proton radiation therapy (RT) and concurrent platinum-based chemotherapy. Methods Nine patients with unresectable node-negative, nonmetastatic head and neck ACC received definitive proton RT and concurrent cisplatin. Outcomes and toxicities were recorded. A systematic review of the literature was performed. Results Median follow-up was 27 months (range, 9.2–48.3 months). Four patients achieved complete response at the primary site, and an additional 4 patients achieved stabilization of local disease. Only 1 patient developed local disease progression. Four patients had 5 acute grade 3 (G3) toxicities, and 1 patient developed a chronic G4 optic nerve disorder. Conclusion Our preliminary results suggest proton RT and concurrent chemotherapy is a definitive treatment option for select patients with head and neck ACC. © 2015 Wiley Periodicals, Inc. Head Neck, 2015
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- 2015
32. Prognostic value of p16 expression in Epstein-Barr virus-positive nasopharyngeal carcinomas
- Author
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Erich M. Sturgis, Diana Bell, Jack Phan, Steven J. Frank, Bonnie S. Glisson, Emily J. Lo, Beth M. Beadle, Dominic Ma, G. Brandon Gunn, Betty Y.S. Kim, Adel K. El-Naggar, Adam S. Garden, William H. Morrison, David I. Rosenthal, Clifton D. Fuller, Wen Jiang, and Paul D. Chamberlain
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Pathology ,business.industry ,Cancer ,Epstein-Barr Virus Positive ,In situ hybridization ,medicine.disease ,Gastroenterology ,Virus ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Otorhinolaryngology ,Oropharyngeal Carcinoma ,Nasopharyngeal carcinoma ,030220 oncology & carcinogenesis ,Internal medicine ,Medicine ,Immunohistochemistry ,business ,Nasopharyngeal cancer - Abstract
Background Overexpression of p16 is associated with improved outcomes among patients with oropharyngeal carcinoma. However, its role in the outcomes of patients with nasopharyngeal cancer (NPC) remains unclear. Methods Eighty-six patients with NPC treated at MD Anderson Cancer Center from 2000 to 2014 were identified. Epstein-Barr virus (EBV) and human papillomavirus (HPV) status were determined by in situ hybridization (ISH) and p16 by immunohistochemical staining. Results EBV positivity was associated with extended overall survival (OS; median, 95.0 vs 44.9 months; p < .004), progression-free survival (PFS; median, 80.4 vs 28.1 months; p < .013), and locoregional control (median, 104.4 vs 65.5 months; p < .043). In patients with EBV-positive tumors, p16 overexpression correlated with improved PFS (median, 106.3 vs 27.1 months; p < .02) and locoregional control (median, 93.6 vs 64.5 months; p < .02). Conclusion P16 overexpression is associated with improved PFS and locoregional control in patients with EBV-positive NPC. P16 expression may complement EBV status in predicting treatment outcomes for patients with NPC. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1459–E1466, 2016
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- 2015
33. Intravoxel incoherent motion imaging kinetics during chemoradiotherapy for human papillomavirus-associated squamous cell carcinoma of the oropharynx: preliminary results from a prospective pilot study
- Author
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John D. Hazle, G. Brandon Gunn, Yao Ding, Abdallah S.R. Mohamed, Rivka R. Colen, Jayashree Kalpathy-Cramer, David I. Rosenthal, Stephen Y. Lai, Steven J. Frank, Clifton D. Fuller, Brian P. Hobbs, Jihong Wang, and Adam S. Garden
- Subjects
Pathology ,medicine.medical_specialty ,Multivariate analysis ,medicine.diagnostic_test ,biology ,business.industry ,Magnetic resonance imaging ,biology.organism_classification ,Confidence interval ,Molecular Medicine ,Medicine ,Effective diffusion coefficient ,Radiology, Nuclear Medicine and imaging ,Papillomaviridae ,business ,Nuclear medicine ,Perfusion ,Spectroscopy ,Intravoxel incoherent motion ,Chemoradiotherapy - Abstract
This study aims to identify the temporal kinetics of intravoxel incoherent motion (IVIM) MRI in patients with human papillomavirus-associated (HPV+) oropharyngeal squamous cell carcinoma. Patients were enrolled under an Institutional Review Board (IRB)-approved protocol as part of an ongoing prospective clinical trial. All patients underwent two MRI studies: a baseline scan before chemoradiotherapy and a mid-treatment scan 3-4 weeks after treatment initiation. Parametric maps representing pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (f) and apparent diffusion coefficient (ADC) were generated. The Mann-Whitney U-test was used to assess the temporal variation of IVIM metrics. Bayesian quadratic discriminant analysis (QDA) was used to evaluate the extent to which mid-treatment changes in IVIM metrics could be combined to predict sites that would achieve complete response (CR) in multivariate analysis. Thirty-one patients were included in the final analysis with 59 lesions. Pretreatment ADC and D values of the CR lesions (n = 19) were significantly lower than those of non-CR lesions (n = 33). Mid-treatment ADC, D and f values were significantly higher (p
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- 2015
34. Evaluation of the MIM Symphony treatment planning system for low-dose-rate- prostate brachytherapy
- Author
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S. Dhanesar, Tze Yee Lim, Weiliang Du, Rajat J. Kudchadker, Teresa L. Bruno, and Steven J. Frank
- Subjects
Task group ,medicine.medical_specialty ,Radiation ,business.industry ,medicine.medical_treatment ,Brachytherapy ,Imaging phantom ,medicine ,Symphony ,Dosimetry ,Radiology, Nuclear Medicine and imaging ,Medical physics ,Low dose rate ,Nuclear medicine ,business ,Radiation treatment planning ,Instrumentation ,Prostate brachytherapy ,Mathematics - Abstract
MIM Symphony is a recently introduced low-dose-rate prostate brachytherapy treatment planning system (TPS). We evaluated the dosimetric and planning accuracy of this new TPS compared to the universally used VariSeed TPS. For dosimetric evaluation of the MIM Symphony version 5.4 TPS, we compared dose calculations from the MIM Symphony TPS with the formalism recommended by the American Association of Physicists in Medicine Task Group 43 report (TG-43) and those generated by the VariSeed version 8.0 TPS for iodine-125 (I-125; Models 6711 and IAI-125A), palladium-103 (Pd-103; Model 200), and cesium-131 (Cs-131; Model Cs-1). Validation was performed for both line source and point source approximations. As part of the treatment planning validation, first a QA phantom (CIRS Brachytherapy QA Phantom Model 045 SN#D7210-3) containing three ellipsoid objects with certified volumes was scanned in order to check the volume accuracy of the contoured structures in MIM Symphony. Then the DICOM data containing 100 patient plans from the VariSeed TPS were imported into the MIM Symphony TPS. The 100 plans included 25 each of I-125 pre-implant plans, Pd-103 pre-implant plans, I-125 Day 30 plans (i.e., from 1 month after implantation), and Pd-103 Day 30 plans. The dosimetric parameters (including prostate volume, prostate D90 values, and rectum V100 values) of the 100 plans were calculated independently on the two TPSs. Other TPS tests that were done included verification of source input and geometrical accuracy, data transfer between different planning systems, text printout, 2D dose plots, DVH printout, and template grid accuracy. According to the line source formalism, the dosimetric results between the MIM Symphony TPS and TG-43 were within 0.5% (0.02 Gy) for r > 1 cm. In the line source approximation validation, MIM Symphony TPS values agreed with VariSeed TPS values to within 0.5% (0.09 Gy) for r > 1 cm. Similarly, in point source approximation validation, the MIM Symphony values agreed to within 1% of the TG-43 and VariSeed values for r > 1 cm. The volume calculations obtained from the MIM Symphony TPS for the CIRS Brachytherapy QA Phantom were within 1% of the actual volume of the phantom. For the clinical cases, the volume and dosimetric parameter calculations for the prostate and rectum did not differ substantially between the pre-implant and Day 30 plans. Overall, our investigations showed negligible differences in dosimetry calculations and planning parameters between the two TPSs. The tests done to check the performance of the MIM Symphony TPS, such as the library data, data transfer, isodose and DVH printout, were found to be satisfactory. On the basis of these results, we conclude that the MIM Symphony TPS can be used as an alternative to the VariSeed TPS for low-dose-rate prostate brachytherapy.
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- 2015
35. Disease control and toxicity outcomes for T4 carcinoma of the nasopharynx treated with intensity-modulated radiotherapy
- Author
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Dominic Ma, Michael E. Kupferman, William H. Morrison, Jing Li, Vinita Takiar, Adel K. El-Naggar, Gary Brandon Gunn, Adam S. Garden, Steven J. Frank, David I. Rosenthal, Kathryn A. Gold, Clifton D. Fuller, Jack Phan, Beth M. Beadle, and Katherine A. Hutcheson
- Subjects
0301 basic medicine ,Oncology ,medicine.medical_specialty ,Chemotherapy ,business.industry ,medicine.medical_treatment ,Medical record ,Common Terminology Criteria for Adverse Events ,medicine.disease ,Surgery ,Radiation therapy ,03 medical and health sciences ,Temporal lobe necrosis ,030104 developmental biology ,0302 clinical medicine ,Otorhinolaryngology ,Nasopharyngeal carcinoma ,030220 oncology & carcinogenesis ,Internal medicine ,Toxicity ,medicine ,Carcinoma ,business - Abstract
Background Treatment of T4 nasopharyngeal carcinoma (NPC) is challenging because of the proximity of the tumor to the central nervous system. The purpose of this study was to present our evaluation of disease control and toxicity outcomes for patients with T4 NPC treated with intensity-modulated radiation therapy (IMRT) and chemotherapy. Methods The medical records of 66 patients with T4 NPC treated from 2002 to 2012 with IMRT were reviewed. Endpoints included tumor control and toxicity outcomes (Common Terminology Criteria for Adverse Events [CTCAE v4.0]). Results Median follow-up was 38 months. Five-year rates of locoregional control, distant metastasis-free survival, progression-free survival (PFS), and overall survival (OS) were 80%, 62%, 57%, and 69%, respectively. Nodal involvement was associated with worse PFS (p = .015). Gross target volume (GTV) volume >100 cm and planning target volume (PTV) volume >400 cm were associated with worse OS (p = .038 and p = .004, respectively). Four patients had significant cognitive impairment, and 9 had MRI evidence of brain necrosis. Conclusion For patients with T4 NPC treated with IMRT and chemotherapy, survival and locoregional disease control rates have improved; however, late treatment toxicity remains a concern. © 2015 Wiley Periodicals, Inc. Head Neck 38: E925–E933, 2016
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- 2015
36. Merkel cell carcinoma of the head and neck: Favorable outcomes with radiotherapy
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Jack Phan, G. Brandon Gunn, Adam S. Garden, William H. Morrison, Steven J. Frank, Ann M. Gillenwater, Andrew J. Bishop, Lawrence B. Levy, Beth M. Beadle, David I. Rosenthal, Clifton D. Fuller, Merrill S. Kies, and Bita Esmaeli
- Subjects
medicine.medical_specialty ,business.industry ,Merkel cell carcinoma ,medicine.medical_treatment ,Hazard ratio ,Neck dissection ,medicine.disease ,Nodal disease ,Surgery ,Radiation therapy ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,Adjuvant therapy ,Medicine ,business ,Head and neck ,Survival rate - Abstract
Background The purpose of this study was to report the outcomes of patients with Merkel cell carcinoma (MCC) of the head and neck using a radiation-based treatment approach. Methods We reviewed records of 106 consecutive patients with MCC of the head and neck treated with radiation therapy (RT) at our institution between 1988 and 2011. The Kaplan–Meier method was used to estimate outcomes and hazard ratios (HRs) were calculated. Results The 5-year actuarial local and regional control rates were 96% and 96%, respectively. There were no regional recurrences in 22 patients treated with RT to gross nodal disease without neck dissection. The 5-year cause-specific survival rate was 76%. Lymphadenopathy at presentation impacted distant metastatic-free survival outcomes (p
- Published
- 2015
37. Disease reclassification risk with stringent criteria and frequent monitoring in men with favourable-risk prostate cancer undergoing active surveillance
- Author
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Louis L. Pisters, John W. Davis, Seungtaek Choi, Mary Achim, John F. Ward, Deborah A. Kuban, Surena F. Matin, Karen E. Hoffman, John Papadopoulos, Jeri Kim, Xuemei Wang, Patricia Troncoso, Thomas J. Pugh, Curtis A. Pettaway, Steven J. Frank, Andrew K. Lee, Brian F. Chapin, Jay B. Shah, Christopher J. Logothetis, and Jose A. Karam
- Subjects
Male ,medicine.medical_specialty ,Urology ,030232 urology & nephrology ,Risk Assessment ,Article ,03 medical and health sciences ,Prostate cancer ,0302 clinical medicine ,Prostate ,Interquartile range ,Internal medicine ,Biopsy ,Humans ,Medicine ,Prospective Studies ,Watchful Waiting ,Prospective cohort study ,Aged ,Gynecology ,medicine.diagnostic_test ,business.industry ,Hazard ratio ,Prostatic Neoplasms ,Cancer ,Middle Aged ,medicine.disease ,Confidence interval ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,business - Abstract
Objectives To determine the frequency of disease reclassification and to identify clinicopathological variables associated with it in patients with favourable-risk prostate cancer undergoing active surveillance (AS). Patients and Methods We assessed 191 men, selected by what may be the most stringent criteria used in AS studies yet conducted, who were enrolled in a prospective cohort AS trial. Clinicopathological characteristics were analysed in a multivariate Cox proportional hazards regression model. Key features were an extended biopsy with a single core positive for Gleason score (GS) 3 + 3 (
- Published
- 2015
38. Phase I study of vandetanib with radiation therapy with or without cisplatin in locally advanced head and neck squamous cell carcinoma
- Author
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David Raben, Ezra W.E. Cohen, Elizabeth S. Lowe, Vasiliki A. Papadimitrakopoulou, Heather Lin, Lucien A. Nedzi, Fred R. Hirsch, Joseph R. Vasselli, Steven J. Frank, Antonio Jimeno, Changhu R. Chen, Jeffrey N. Myers, Hai T. Tran, and John V. Heymach
- Subjects
0301 basic medicine ,Oncology ,medicine.medical_specialty ,medicine.medical_treatment ,Urology ,Vandetanib ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Epidermal growth factor receptor ,Adverse effect ,Stomatitis ,Cisplatin ,biology ,business.industry ,medicine.disease ,Head and neck squamous-cell carcinoma ,Radiation therapy ,Regimen ,030104 developmental biology ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,biology.protein ,business ,medicine.drug - Abstract
Background Vandetanib, added to cisplatin and radiation therapy (RT) overcomes chemoradiation therapy (CRT) and epidermal growth factor receptor (EGFR) inhibitor resistance in head and neck squamous cell carcinoma (HNSCC) lines and models. Methods Patients with previously untreated HNSCC received vandetanib daily for 14 days (starting dose 100 mg) and then vandetanib + RT (2.2 Gy/day, 5 days/week) for 6 weeks (regimen 1) or vandetanib + RT (2 Gy/day, 5 days/week) + cisplatin (30 mg/m2 weekly) for 7 weeks (regimen 2). The primary objective was the maximum tolerated dose (MTD) of vandetanib with RT +/- cisplatin. Results Of 33 treated patients, 30 completed therapy (regimen 1, n = 12; regimen 2, n = 18). MTD in regimen 2 was 100 mg (3 dose limiting toxicities [DLTs] at 200 mg), whereas regimen 1 was stopped because of poor recruitment (1 DLT at 200 mg). Most common grade ≥3 adverse events (AEs) were dysphagia (30%), stomatitis (33%), and mucosal inflammation (27%). Five patients discontinued vandetanib because of AEs. Conclusion Vandetanib with CRT was feasible. © 2014 Wiley Periodicals, Inc. Head Neck, 2015
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- 2015
39. Relationship between illness uncertainty, anxiety, fear of progression and quality of life in men with favourable-risk prostate cancer undergoing active surveillance
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George Baum, Deborah A. Kuban, David M. Latini, Xuemei Wang, John W. Davis, Patricia A. Parker, Christopher J. Logothetis, Andrew K. Lee, John F. Ward, Jeri Kim, and Steven J. Frank
- Subjects
Adult ,Male ,Gerontology ,medicine.medical_specialty ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Psychological intervention ,Article ,03 medical and health sciences ,Prostate cancer ,0302 clinical medicine ,Quality of life ,Risk Factors ,Humans ,Medicine ,Prospective Studies ,Watchful Waiting ,Psychiatry ,Prospective cohort study ,Aged ,Aged, 80 and over ,business.industry ,Uncertainty ,Prostatic Neoplasms ,Fear ,Middle Aged ,medicine.disease ,Anxiety Disorders ,030220 oncology & carcinogenesis ,Disease Progression ,Quality of Life ,Anxiety ,medicine.symptom ,Sexual function ,business ,Watchful waiting ,Cohort study - Abstract
To evaluate prospectively the associations between illness uncertainty, anxiety, fear of progression and general and disease-specific quality of life (QoL) in men with favourable-risk prostate cancer undergoing active surveillance (AS).After meeting stringent enrollment criteria for an AS cohort study at a single tertiary care cancer centre, 180 men with favourable-risk prostate cancer completed questionnaires at the time of enrollment and every 6 months for up to 30 months. Questionnaires assessed illness uncertainty, anxiety, prostate-specific QoL (using the Expanded Prostate Cancer Index Composite [EPIC] scale) and general QoL (using the 12-time short-form health survey [SF-12]) and fear of progression. We used linear mixed-model analyses and multilevel mediation analyses.Sexual scores on the EPIC scale significantly declined over time (P0.05). Illness uncertainty was a significant predictor of all EPIC summary scores, SF-12 physical component summary (PCS) scores, mental component summary (MCS) scores and fear of progression scores (all P0.05), after controlling for demographic and clinicopathological factors. Anxiety predicted all EPIC summary, MCS and fear of progression scores (all P0.05) but not PCS scores (P = 0.08). Scores on PCS, MCS, EPIC summary scales (except sexual scale), and fear of progression did not change significantly over the study period (all P0.10).Over the 2.5-year follow-up, QoL remained stable; only sexual function scores significantly declined. Illness uncertainty and anxiety were significant predictors of general and prostate-specific QoL and fear of progression. Interventions to reduce uncertainty and anxiety may enhance QoL for men with prostate cancer on AS.
- Published
- 2015
40. Nomogram for Predicting Symptom Severity during Radiation Therapy for Head and Neck Cancer
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Tito R. Mendoza, Charles Lu, G. Brandon Gunn, Beth M. Beadle, Ehab Y. Hanna, Jack Phan, Tommy Sheu, Steven J. Frank, Charles S. Cleeland, Adam S. Garden, David I. Rosenthal, Clifton D. Fuller, and William H. Morrison
- Subjects
Male ,Oncology ,medicine.medical_specialty ,medicine.medical_treatment ,Risk Assessment ,Severity of Illness Index ,Article ,Predictive Value of Tests ,Internal medicine ,Severity of illness ,Humans ,Medicine ,Longitudinal Studies ,Prospective Studies ,Radiation Injuries ,Prospective cohort study ,Radiotherapy ,business.industry ,Head and neck cancer ,Cancer ,Middle Aged ,Nomogram ,medicine.disease ,Surgery ,Patient Outcome Assessment ,Radiation therapy ,Nomograms ,Otorhinolaryngology ,Head and Neck Neoplasms ,Predictive value of tests ,Female ,Patient-reported outcome ,Self Report ,business - Abstract
Radiation therapy (RT), with or without chemotherapy, can cause significant acute toxicity among patients treated for head and neck cancer (HNC), but predicting, before treatment, who will experience a particular toxicity or symptom is difficult. We created and evaluated 2 multivariate models and generated a nomogram to predict symptom severity during RT based on a patient-reported outcome (PRO) instrument, the MD Anderson Symptom Inventory-Head and Neck Module (MDASI-HN).This was a prospective, longitudinal, questionnaire-based study.Tertiary cancer care center.Subjects were 264 patients with HNC (mostly oropharyngeal) who had completed the MDASI-HN before and during therapy. Pretreatment variables were correlated with MDASI-HN symptom scores during therapy with multivariate modeling and then were correlated with the composite MDASI-HN score during week 5 of therapy.A multivariate model incorporating pretreatment PROs better predicted MDASI-HN symptom scores during treatment than did a model based on clinical variables and physician-rated patient performance status alone (Akaike information criterion = 1442.5 vs 1459.9). In the most parsimonious model, pretreatment MDASI-HN symptom severity (P.001), concurrent chemotherapy (P = .006), primary tumor site (P = .016), and receipt of definitive (rather than adjuvant) RT (P = .044) correlated with MDASI-HN symptom scores during week 5. That model was used to construct a nomogram.Our model demonstrates the value of incorporating baseline PROs, in addition to disease and treatment characteristics, to predict patient symptom burden during therapy. Although additional investigation and validation are required, PRO-inclusive prediction tools can be useful for improving symptom interventions and expectations for patients being treated for HNC.
- Published
- 2014
41. Management of the lymph node-positive neck in the patient with human papillomavirus-associated oropharyngeal cancer
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Jack Phan, Beth M. Beadle, Erich M. Sturgis, William H. Morrison, Merrill S. Kies, Gary Brandon Gunn, Amy C. Hessel, Salmaan Ahmed, David I. Rosenthal, Clifton D. Fuller, Steven J. Frank, Adel K. El-Naggar, Adam S. Garden, and Lauren Averett Byers
- Subjects
Cancer Research ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Cancer ,Retrospective cohort study ,Neck dissection ,medicine.disease ,Surgery ,Radiation therapy ,medicine.anatomical_structure ,Oncology ,Positron emission tomography ,medicine ,Lymph ,Stage (cooking) ,business ,Lymph node - Abstract
BACKGROUND The goal of the current study was to assess the rates of recurrence in the neck for patients with lymph node-positive human papillomavirus-associated cancer of the oropharynx who were treated with definitive radiotherapy (with or without chemotherapy). METHODS This is a single-institution retrospective study. Methodology included database search, and statistical testing including frequency analysis, Kaplan-Meier tests, and comparative tests including chi-square, logistic regression, and log-rank. RESULTS The cohort consisted of 401 patients with lymph node-positive disease who underwent radiotherapy between January 2006 and June 2012. A total of 388 patients had computed tomography restaging, and 251 had positron emission tomography and/or ultrasound as a component of their postradiation staging. Eighty patients (20%) underwent neck dissection, and 21 patients (26%) had a positive specimen. The rate of neck dissection increased with increasing lymph node stage, and was lower in patients who had positron emission tomography scans or ultrasound in addition to computed tomography restaging. The median follow-up was 30 months. The 2-year actuarial neck recurrence rate was 7% and 5%, respectively, in all patients and those with local control. Lymph node recurrence rates were greater in current smokers (P = .008). There was no difference in lymph node recurrence rates noted between patients who did and those who did not undergo a neck dissection (P = .4) CONCLUSIONS A treatment strategy of (chemo)radiation with neck dissection performed based on response resulted in high rates of regional disease control in patients with human papillomavirus-associated oropharyngeal cancer. Cancer 2014;120:3082–3088. © 2014 American Cancer Society.
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- 2014
42. Long-term outcomes for men with high-risk prostate cancer treated definitively with external beam radiotherapy with or without androgen deprivation
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Karen E. Hoffman, Lawrence B. Levy, Thomas J. Pugh, Steven J. Frank, Sean E. McGuire, Quynh Nhu Nguyen, Deborah A. Kuban, Seungtaek S. Choi, and Andrew K. Lee
- Subjects
Cancer Research ,medicine.medical_specialty ,business.industry ,medicine.drug_class ,medicine.medical_treatment ,External beam radiation ,Urology ,Local failure ,Androgen ,medicine.disease ,Disease control ,Surgery ,Androgen deprivation therapy ,Prostate cancer ,Oncology ,medicine ,Long term outcomes ,External beam radiotherapy ,business - Abstract
Background: Men with high-risk prostate cancer are often thought to have very poor outcomes in terms of disease control and survival even after definitive treatment. However, results after external beam radiotherapy have improved significantly through dose escalation and the use of androgen deprivation therapy (ADT). This report describes long-term findings after low-dose (< 75.6 Gy) or high-dose (≥ 75.6 Gy) external beam radiation, with or without ADT. Methods: This analysis included 741 men with high-risk prostate cancer (clinical classification ≥ T3, Gleason score ≥ 8, or prostate-specific antigen level ≥ 20 ng/mL) treated with external beam radiotherapy at a single tertiary institution from 1987 through 2004. The radiation dose ranged from 60 to 79.3 Gy (median, 70 Gy); 295 men had received ADT for ≥ 2 years, and the median follow-up time was 8.3 years. Results: The 5- and 10-year actuarial overall survival rates were significantly better for men treated with the higher radiation dose (no ADT plus ≥ 75.6 Gy, 87.3% and 72.0%, respectively; and ADT plus ≥ 75.6 Gy, 92.3% and 72%, respectively) (P = .0035). The corresponding 5- and 10-year biochemical failure-free survival rates were significantly better for patients treated with both ADT and higher radiation dose (82% and 77%, P < .0001). At 5 years, men who had not received ADT and had received radiation dose < 75.6 Gy had higher clinical local failure rates than those given ADT and radiation dose ≥ 75.6 Gy (24.2% versus 0%, P < .0001). The 10-year symptomatic local failure rate was only 2% for all patients. Conclusions: Contrary to lingering historical perceptions, treatment of high-risk prostate cancer with modern, high-dose, external beam radiotherapy and ADT can produce better biochemical, clinical, and survival outcomes over those from previous eras. Specifically, symptomatic local failure is uncommon, and few men die of prostate cancer even 10 or more years after treatment.
- Published
- 2013
43. The impact of radiographic retropharyngeal adenopathy in oropharyngeal cancer
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Bonnie S. Glisson, Adam S. Garden, Beth M. Beadle, Steven J. Frank, Jack Phan, David I. Rosenthal, Clifton D. Fuller, G. Brandon Gunn, J. Matthew Debnam, William H. Morrison, and Erich M. Sturgis
- Subjects
Cancer Research ,medicine.medical_specialty ,Univariate analysis ,business.industry ,medicine.medical_treatment ,Incidence (epidemiology) ,Cancer ,medicine.disease ,Gastroenterology ,Radiation therapy ,Retropharyngeal lymph nodes ,Oncology ,Internal medicine ,Cohort ,medicine ,Radiology ,Stage (cooking) ,business ,Cohort study - Abstract
BACKGROUND We performed this study to define the incidence of radiographic retropharyngeal lymph node (RPLN) involvement in oropharyngeal cancer (OPC) and its impact on clinical outcomes, neither of which has been well established to date. METHODS Our departmental database was queried for patients irradiated for OPC between 2001 and 2007. Analyzable patients were those with imaging data available for review to determine radiographic RPLN status. Demographic, clinical, and outcome data were retrieved and analyzed. RESULTS The cohort consisted of 981 patients. The median follow-up was 69 months. The base of the tongue (47%) and the tonsil (46%) were the most common primary sites. The majority of patients had stage T1 to T2 primary tumors (64%), and 94% had stage 3 to 4B disease. Intensity-modulated radiation therapy was used in 77% of patients, and systemic therapy was administered in 58% of patients. The incidence of radiographic RPLN involvement was 10% and was highest for the pharyngeal wall (23%) and lowest for the base of the tongue (6%). RPLN adenopathy correlated with several patient and tumor factors. RPLN involvement was associated with poorer 5-year outcomes on univariate analysis (P
- Published
- 2013
44. Comparative analysis of prostate-specific antigen free survival outcomes for patients with low, intermediate and high risk prostate cancer treatment by radical therapy. Results from the Prostate Cancer Results Study Group
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Stacy Wentworth, Robyn Vera, Richard G. Stock, Ed Weber, Mira Keyes, Brian J. Moran, Michael J. Zelefsky, W. Robert Lee, Peter D. Grimm, Katsuto Shinohara, Stefann Machtens, Jeremy Millar, Jason Wong, Stephen E.M. Langley, Ignace Billiet, Adam P. Dicker, Patrick A. Kupelian, Steven J. Frank, Jos Immerzeel, Gregory S. Merrick, Anthony L. Zietman, Jyoti Mayadev, Mack Roach, David Bostwick, and Mark Scholz
- Subjects
Oncology ,medicine.medical_specialty ,business.industry ,Prostatectomy ,Urology ,medicine.medical_treatment ,Pathological staging ,Brachytherapy ,medicine.disease ,High-intensity focused ultrasound ,law.invention ,Surgery ,Androgen deprivation therapy ,Radiation therapy ,Prostate cancer ,Randomized controlled trial ,law ,Internal medicine ,medicine ,business - Abstract
What's known on the subject? and What does the study add? Very few comparative studies to date evaluate the results of treatment options for prostate cancer using the most sensitive measurement tools. PSA has been identified as the most sensitive tool for measuring treatment effectiveness. To date, comprehensive unbiased reviews of all the current literature are limited for prostate cancer. This is the first large scale comprehensive review of the literature comparing risk stratified patients by treatment option and with long-term follow-up. The results of the studies are weighted, respecting the impact of larger studies on overall results. The study identified a lack of uniformity in reporting results amongst institutions and centres. A large number of studies have been conducted on the primary therapy of prostate cancer but very few randomized controlled trials have been conducted. The comparison of outcomes from individual studies involving surgery (radical prostatectomy or robotic radical prostatectomy), external beam radiation (EBRT) (conformal, intensity modulated radiotherapy, protons), brachytherapy, cryotherapy or high intensity focused ultrasound remains problematic due to the non-uniformity of reporting results and the use of varied disease outcome endpoints. Technical advances in these treatments have also made long-term comparisons difficult. The Prostate Cancer Results Study Group was formed to evaluate the comparative effectiveness of prostate cancer treatments. This international group conducted a comprehensive literature review to identify all studies involving treatment of localized prostate cancer published during 2000-2010. Over 18,000 papers were identified and a further selection was made based on the following key criteria: minimum/median follow-up of 5 years; stratification into low-, intermediate- and high-risk groups; clinical and pathological staging; accepted standard definitions for prostate-specific antigen failure; minimum patient number of 100 in each risk group (50 for high-risk group). A statistical analysis (standard deviational ellipse) of the study outcomes suggested that, in terms of biochemical-free progression, brachytherapy provides superior outcome in patients with low-risk disease. For intermediate-risk disease, the combination of EBRT and brachytherapy appears equivalent to brachytherapy alone. For high-risk patients, combination therapies involving EBRT and brachytherapy plus or minus androgen deprivation therapy appear superior to more localized treatments such as seed implant alone, surgery alone or EBRT. It is anticipated that the study will assist physicians and patients in selecting treatment for men with newly diagnosed prostate cancer.
- Published
- 2012
45. Outcomes of malignant tumors of the lacrimal apparatus
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K. Kian Ang, Bita Esmaeli, David I. Rosenthal, Adam S. Garden, Heath D. Skinner, William H. Morrison, Chelsea C. Pinnix, and Steven J. Frank
- Subjects
Adult ,Male ,Cancer Research ,medicine.medical_specialty ,medicine.medical_treatment ,Visual Acuity ,Lacrimal gland ,Cancer Care Facilities ,Lacrimal apparatus ,Tumor Status ,medicine ,Humans ,Combined Modality Therapy ,Neoplasm Metastasis ,Lacrimal Apparatus Diseases ,business.industry ,Eye Neoplasms ,Cancer ,Middle Aged ,medicine.disease ,Texas ,Lacrimal sac ,Surgery ,Radiation therapy ,medicine.anatomical_structure ,Oncology ,Female ,business ,Rare disease - Abstract
BACKGROUND: Malignant epithelial neoplasms of the lacrimal apparatus are rare and are typically treated with surgery and occasionally adjuvant radiation therapy (RT). The purpose of this study was to assess treatment outcomes by type of surgery (orbital exenteration vs eye-sparing surgery) and clarify the role of adjuvant RT for this rare disease. METHODS: Forty-six patients with malignant epithelial neoplasms of the lacrimal apparatus were treated at a single institution from 1945 through 2008. Twenty-seven patients (59%) were treated with orbital exenteration and 19 (41%) with eye-sparing surgery; 64% of the orbital exenteration group and 83% of the eye-sparing surgery group also received adjuvant RT (median dose, 60 grays). Median follow-up time for all patients was 38 months (range, 3-460 months). RESULTS: For the orbital exenteration and eye-sparing surgery groups, the 5-year overall survival (OS) rates were 59% and 62%, and the 5-year disease-free survival (DFS) rates were 49% and 39%, respectively (P = .56, P = .35). Tumor status (T1-2 vs T3-4) was associated with OS (P = .02), and tumor size ( 3.5 cm) with DFS (P = .015). Median time to locoregional recurrence was 85 months for orbital exenteration, and 123 months for eye-sparing surgery. All patients who did not receive RT experienced local recurrence, and RT extended time to locoregional recurrence (median 460 vs 30 months, P = .009). Seven grade ≥3 complications were experienced after adjuvant RT. CONCLUSIONS: For appropriately selected patients, an eye-sparing surgery for lacrimal apparatus tumors can achieve similar survival outcomes to those in patients treated with an orbital exenteration. Adjuvant RT should be considered for all patients presenting with these rare tumors. Cancer 2011. © 2011 American Cancer Society.
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- 2011
46. Variations in proton scanned beam dose delivery due to uncertainties in magnetic beam steering
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G. Ciangaru, S Peterson, Al Smith, Jerimy C. Polf, Steven J. Frank, and Martin Bues
- Subjects
Dose-volume histogram ,Materials science ,business.industry ,Beam steering ,Nozzle ,General Medicine ,equipment and supplies ,Magnetic field ,Optics ,Magnet ,Dosimetry ,business ,human activities ,Proton therapy ,Beam (structure) - Abstract
The purpose of this work was to develop a method to calculate and study the impact of fluctuations in the magnetic field strengths within the steering magnets in a proton scanning beam treatment nozzle on the dosedelivered to the patient during a proton therapytreatment. First, an analytical relationship between magnetic field uncertainties in the steering magnets and the resulting lateral displacements in the position of the delivered scanned beam “dose spot” was established. Next, using a simple 3D dose calculation code and data from a validated Monte Carlo model of the proton scanning beam treatment nozzle, the uniform dosedelivery to a 3D treatment volume was calculated. The dose distribution was then recalculated using the calculated lateral displacements due to magnetic field fluctuations to the proton pencil beam position. Using these two calculated dose distributions, the clinical effects of the magnetic field fluctuations were determined. A deliberate displacement of four adjacent spots either toward or away from each other was used to determine the “maximum” dose impact, while a random displacement of all spots was used to establish a more realistic clinical dose impact. Changes in the dose volume histogram (DVH) and the presence of hot and cold spots in the treatment volume were used to quantify the impact of dose-spot displacement. A general analytical relationship between magnetic field uncertainty and final dose-spot position is presented. This analytical relationship was developed such that it can be applied to study magnetic beam steering for any scanned beam nozzle design. Using this relationship the authors found for the example beam steering nozzle used in this study that deliberate lateral displacements of 0.5 mm or random lateral displacements of up to 1.0 mm produced a noticeable dose impact (5% hot spot) in the treatment volume. A noticeable impact (3% decrease in treatment volume coverage) on the DVH was observed for random displacements of up to 1.5 mm. For the scanning nozzle studied in this work, these displacement values correlated with an uncertainty value of 2.04% in the magnetic field values of the nozzle steering magnets. The authors conclude that fluctuations in the dose-spotdelivery caused by uncertainty in the magnet fields used for beam steering could have clinically significant effects on the delivereddose distribution. Due to differences in the design and implementation of proton beam scanning nozzles at different treatment facilities, the effects of magnetic field fluctuations of dosedelivery should be evaluated and understood for each specific nozzle design during clinical commissioning of the treatment nozzle.
- Published
- 2009
47. Late rectal complications after prostate brachytherapy for localized prostate cancer
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Lawrence B. Levy, Steven J. Frank, Jack Phan, Teresa L. Bruno, Rajat J. Kudchadker, and David A. Swanson
- Subjects
Male ,Cancer Research ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Brachytherapy ,Colonoscopy ,Rectum ,Guidelines as Topic ,Argon plasma coagulation ,Prostate cancer ,Risk Factors ,medicine ,Humans ,Radiation Injuries ,medicine.diagnostic_test ,business.industry ,Incidence ,Prostatic Neoplasms ,Cancer ,medicine.disease ,Surgery ,Radiation therapy ,Rectal Diseases ,medicine.anatomical_structure ,Oncology ,Gastrointestinal Hemorrhage ,business ,Prostate brachytherapy - Abstract
This review of the literature on late rectal complications after prostate brachytherapy indicated that it is a highly effective treatment modality for patients with clinically localized prostate cancer but can cause chronic radiation proctitis. The most common manifestation of chronic radiation proctitis was anterior rectal wall bleeding, which often occurred within the first 2 years after brachytherapy. It is interesting to note that the rates of late rectal morbidity appear to have declined over time, which may reflect improvements in implantation techniques and imaging. Rectal biopsy as part of the workup to evaluate rectal bleeding can lead to rectal fistula and the need for colostomy, a rare but major complication. The authors recommend 1) screening colonoscopy before brachytherapy for patients who have not had a screening colonoscopy within the preceding 3 years to rule out colorectal malignancies and, thus, facilitate conservative management should rectal bleeding occur; 2) lifestyle modifications during treatment to limit exposure of the rectum to radiation; and 3) conservative management for rectal bleeding that occurs within 2 years after brachytherapy. Cancer 2009. (c) 2009 American Cancer Society.
- Published
- 2009
48. Outcomes after radiotherapy for squamous cell carcinoma of the eyelid
- Author
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David L. Schwartz, David I. Rosenthal, K.S.Clifford Chao, Adam S. Garden, William H. Morrison, Janjira Petsuksiri, Anesa Ahamad, K. Kian Ang, Steven J. Frank, and Bita Esmaeli
- Subjects
Adult ,Male ,Cancer Research ,medicine.medical_specialty ,medicine.medical_treatment ,Eyelid Neoplasms ,Malignancy ,medicine ,Carcinoma ,Humans ,Survival rate ,Aged ,Aged, 80 and over ,Radiotherapy ,business.industry ,Wide local excision ,Cancer ,Middle Aged ,medicine.disease ,Surgery ,Survival Rate ,Radiation therapy ,Treatment Outcome ,medicine.anatomical_structure ,Oncology ,Epidermoid carcinoma ,Carcinoma, Squamous Cell ,Female ,Radiotherapy, Adjuvant ,Eyelid ,business ,Follow-Up Studies - Abstract
BACKGROUND. Squamous cell carcinoma (SCC) of the eyelid is a rare malignancy with metastatic potential. In the current study, the outcomes of patients with SCC of the eyelid were evaluated after definitive and postoperative radiation therapy. METHODS. The medical records of all patients treated with radiotherapy for SCC of the eyelid at 1 institution between 1950 and 2005 were reviewed. Patient records were analyzed for clinical characteristics, pathologic features, radiation techniques, and outcomes. Survival rates were calculated using the Kaplan-Meier method; factors affecting survival were assessed using the log-rank test. RESULTS. During the study period, 39 patients with 42 eyelid SCCs were treated with radiotherapy. Thirty-two tumors were treated with primary radiotherapy and 10 were treated with postoperative radiotherapy after wide local excision. Surviving patients were followed for a median of 76 months. The 5-year disease-specific and overall survival rates for all patients were 86% and 71%, respectively. At 5 years, local, regional, and distant disease control rates for all tumors were 88%, 95%, and 97%, respectively. There were no significant differences in the 5-year local, regional, and distant control rates between tumors treated with definitive and those treated with postoperative radiotherapy. There were no grade 3 or 4 complications. CONCLUSIONS. Primary radiotherapy for SCC of the eyelid provides excellent locoregional control with reasonable complication rates and should be considered an alternative to surgery in selected patients. Cancer 2008. © 2007 American Cancer Society.
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- 2007
49. Primary intestinal-like adenocarcinoma of major salivary glands: 2 instances of previously undocumented phenotype
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Adel K. El-Naggar, Hanadi Fatani, Ann M. Gillenwater, and Steven J. Frank
- Subjects
Aged, 80 and over ,Male ,Pathology ,medicine.medical_specialty ,business.industry ,Sublingual Gland Neoplasms ,Adenocarcinoma ,Middle Aged ,Histogenesis ,medicine.disease ,Occult ,Metastasis ,Submandibular Gland Neoplasms ,medicine.anatomical_structure ,Otorhinolaryngology ,Major Salivary Gland ,medicine ,Humans ,Immunohistochemistry ,Differential diagnosis ,business ,Respiratory tract - Abstract
Background Primary intestinal-like adenocarcinoma of the major salivary glands has not previously been reported. Methods The clinical and radiological findings of 2 patients with primary submandibular and sublingual tumors are presented. Histopathologic and immunohistochemical examinations of tumor sections were performed. Metastatic workup for distant occult primary was carried out. Results The light-optic and the immunomarkers revealed intestinal-like adenocarcinoma consistent with upper respiratory tract origin. Metastatic workup of both patients was negative for primary gastro-intestinal primary. Conclusion Primary intestinal-like adenocarcinoma can develop in major salivary glands and should be considered in the differential diagnosis. © 2012 Wiley Periodicals, Inc. Head Neck, 2012
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- 2012
50. Reply to radiotherapy for human papillomavirus-positive oropharyngeal cancers in the National Cancer Data Base
- Author
-
William H. Morrison, Beth M. Beadle, Jack Phan, Adam S. Garden, Steven J. Frank, David I. Rosenthal, Clifton D. Fuller, William N. William, Gary Brandon Gunn, Faye M. Johnson, Erich M. Sturgis, and Merrill S. Kies
- Subjects
Human Papillomavirus Positive ,Oncology ,Cancer Research ,medicine.medical_specialty ,biology ,business.industry ,medicine.medical_treatment ,biology.organism_classification ,Cancer data ,Radiation therapy ,03 medical and health sciences ,0302 clinical medicine ,Oropharyngeal Neoplasm ,030220 oncology & carcinogenesis ,Internal medicine ,medicine ,030212 general & internal medicine ,Papillomaviridae ,Base (exponentiation) ,business ,Oropharyngeal Cancers - Published
- 2016
Catalog
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