114 results on '"Harris EE"'
Search Results
2. The impact of re-excision and residual disease on local recurrence after breast conservation treatment for patients with early stage breast cancer.
- Author
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Ali AN, Vapiwala N, Guo M, Hwang WT, Harris EE, and Solin LJ
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- 2011
- Full Text
- View/download PDF
3. Coronary artery findings after left-sided compared with right-sided radiation treatment for early-stage breast cancer.
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Correa CR, Litt HI, Hwang WT, Ferrari VA, Solin LJ, and Harris EE
- Published
- 2007
4. Concurrent chemotherapy and radiation for breast conservation treatment of early-stage breast cancer.
- Author
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Markiewicz DA, Fox KR, Schultz DJ, Harris EE, Haas JA, Glick JH, and Solin LJ
- Abstract
PURPOSE: The optimal sequencing of chemotherapy and radiation therapy in patients with early-stage breast cancer undergoing breast-conservation treatment remains controversial. The purpose of this study is to evaluate the outcome of patients treated with one specific sequence of concurrent chemoradiation followed by additional chemotherapy. METHODS: Between 1977 and 1992, 210 patients with stage I and II breast cancer underwent lumpectomy and axillary lymph node dissection followed by treatment with concurrent chemotherapy and radiation therapy, followed by further chemotherapy. Chemotherapy consisted of two 28-day cycles of CF (oral cyclophosphamide, 100 mg/m2 day 1 to 14, and intravenous 5-fluorouracil, 600 mg/m2 days 1 and 8) during radiation therapy, followed in general by six cycles of CMF (CF doses as above plus intravenous methotrexate 40 mg/m2 days 1 and 8) after the completion of radiation therapy. Fifty patients also received hormonal therapy, predominantly tamoxifen. One hundred ten patients had clinical T1 lesions, and 100 had T2 lesions. Fifty-three patients were pathologic N0, and 157 patients were pathologic N1 (123 patients had one to three positive nodes, and 34 patients had four or more positive nodes). Median follow-up for node-negative patients (5.2 years) is shorter than for node-positive patients (7.6 years). Therefore, outcome is reported at 5 and 10 years for node-positive patients but only at 5 years for node-negative patients. RESULTS: For node-positive patients, outcomes at 5 and 10 years, respectively, were 86% and 70% for overall survival, 78% and 67% for no evidence of disease survival, and 82% and 69% for freedom from distant metastases. For node-negative patients, outcomes at 5 years were 94% for overall survival, 94% for no evidence of disease survival, and 94% for freedom from distant metastases. Pathologic nodal status was predictive of outcome after treatment. Local failure in the treated breast was 5% at 5 years and 13% at 10 years for all patients. CONCLUSIONS: Concurrent CF with radiation therapy followed by six cycles of CMF after radiation therapy results in excellent survival, freedom from distant metastases, and local control for both node-negative and node-positive patients. This regimen of concurrent chemotherapy and radiation therapy is one option for sequencing, and it avoids the delays in administration of either modality that are associated with other sequencing regimens. [ABSTRACT FROM AUTHOR]
- Published
- 1998
5. Reply to G.B. Mann et al and S. Sorscher.
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Jagsi R, Griffith KA, Harris EE, Wright JL, Recht A, Taghian AG, Lee L, Moran MS, Small W Jr, Johnstone C, Rahimi A, Freedman G, Muzaffar M, Haffty B, Horst K, Powell SN, Sharp J, Sabel M, Schott A, and El-Tamer M
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- 2024
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6. Omission of Radiotherapy After Breast-Conserving Surgery for Women With Breast Cancer With Low Clinical and Genomic Risk: 5-Year Outcomes of IDEA.
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Jagsi R, Griffith KA, Harris EE, Wright JL, Recht A, Taghian AG, Lee L, Moran MS, Small W Jr, Johnstone C, Rahimi A, Freedman G, Muzaffar M, Haffty B, Horst K, Powell SN, Sharp J, Sabel M, Schott A, and El-Tamer M
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- Female, Humans, Aged, Middle Aged, Mastectomy, Segmental adverse effects, Neoplasm Recurrence, Local genetics, Neoplasm Recurrence, Local pathology, Radiotherapy, Adjuvant, Genomics, Breast Neoplasms genetics, Breast Neoplasms radiotherapy, Breast Neoplasms surgery
- Abstract
Purpose: Multiple studies have shown a low risk of ipsilateral breast events (IBEs) or other recurrences for selected patients age 65-70 years or older with stage I breast cancers treated with breast-conserving surgery (BCS) and endocrine therapy (ET) without adjuvant radiotherapy. We sought to evaluate whether younger postmenopausal patients could also be successfully treated without radiation therapy, adding a genomic assay to classic selection factors., Methods: Postmenopausal patients age 50-69 years with pT1N0 unifocal invasive breast cancer with margins ≥2 mm after BCS whose tumors were estrogen receptor-positive, progesterone receptor-positive, and human epidermal growth factor receptor 2-negative with Oncotype DX 21-gene recurrence score ≤18 were prospectively enrolled in a single-arm trial of radiotherapy omission if they consented to take at least 5 years of ET. The primary end point was the rate of locoregional recurrence 5 years after BCS., Results: Between June 2015 and October 2018, 200 eligible patients were enrolled. Among the 186 patients with clinical follow-up of at least 56 months, overall and breast cancer-specific survival rates at 5 years were both 100%. The 5-year freedom from any recurrence was 99% (95% CI, 96 to 100). Crude rates of IBEs for the entire follow-up period for patients age 50-59 years and age 60-69 years were 3.3% (2/60) and 3.6% (5/140), respectively; crude rates of overall recurrence were 5.0% (3/60) and 3.6% (5/140), respectively., Conclusion: This trial achieved a very low risk of recurrence using a genomic assay in combination with classic clinical and biologic features for treatment selection, including postmenopausal patients younger than 60 years. Long-term follow-up of this trial and others will help determine whether the option of avoiding initial radiotherapy can be offered to a broader group of women than current guidelines recommend.
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- 2024
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7. American Radium Society Appropriate Use Criteria Postmastectomy Radiation Therapy: Executive Summary of Clinical Topics.
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Novick K, Chadha M, Daroui P, Freedman G, Gao W, Hunt K, Park C, Rewari A, Suh W, Walker E, Wong J, and Harris EE
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- Humans, United States, Female, Mastectomy methods, Risk Factors, Radiotherapy, Adjuvant adverse effects, Radiotherapy, Adjuvant methods, Radium, Breast Neoplasms radiotherapy, Breast Neoplasms surgery, Mammaplasty methods
- Abstract
Purpose: To conduct an appropriate use criteria expert panel update on clinical topics relevant to current clinical practice regarding postmastectomy radiation therapy (PMRT)., Methods and Materials: An analysis of the medical literature from peer-reviewed journals was conducted from May 4, 2010 to May 4, 2022 using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to search the PubMed database to retrieve a comprehensive set of relevant articles. A well-established methodology (modified Delphi) was used by the expert panel to rate the appropriate use of procedures., Results: Evidence for key questions in PMRT regarding benefit in special populations and technical considerations for delivery was examined and described. Risk factors for local-regional recurrence in patients with intermediate-risk disease that indicate benefit of PMRT include molecular subtype, age, clinical stage, and pathologic response to neoadjuvant chemotherapy. Use of hypofractionated radiation in PMRT has been examined in several recent randomized trials and is under investigation for patients with breast reconstruction. The use of bolus varies significantly by practice region and has limited evidence for routine use. Adverse effects occurred with both PMRT preimplant and postimplant exchange in 2-staged breast reconstruction., Conclusions: Most patients with even limited nodal involvement will likely benefit from PMRT with significant reduction in local-regional recurrence and potential survival. Patients with initial clinical stage III disease and/or any residual disease after neoadjuvant chemotherapy should be strongly considered for PMRT. Growing evidence supports the use of hypofractionated radiation for PMRT with equivalent efficacy and decreased acute side effects, but additional evidence is needed for special populations. There is limited evidence to support routine use of bolus in all patients. Timing of PMRT regarding completion of 2-staged breast reconstruction requires a discussion of increased risks with radiation postimplant exchange compared with increased risk of failure of reconstruction or surgical complications with radiation preimplant exchange., (Copyright © 2023. Published by Elsevier Inc.)
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- 2024
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8. Reduced-Dose Radiation Therapy and Concurrent Paclitaxel Chemotherapy in Lymph Node-Positive Breast Cancer: Long-Term Follow-up of a Single-Institution Prospective Study.
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Pisano CE, Kharouta MZ, Harris EE, Shenk R, Martin J, Owusu C, and Lyons JA
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- 2023
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9. Reduced Survival Outcome After Receiving a New Cancer Diagnosis in the Emergency Department: Findings from a Hospital Network in Rural Eastern North Carolina.
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Conley HL, Lea CS, Delgado RV, Vos P, Harris EE, Ju A, and Rathbun KM
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- Male, Humans, North Carolina epidemiology, Retrospective Studies, Emergency Service, Hospital, Hospitals, Neoplasms diagnosis, Neoplasms therapy
- Abstract
Purpose: Patients whose cancer was found during an Emergency Department (ED) visit often present at later stages when survival outcomes are worse. Limited research has characterized the survival experience of cancer patients who receive their diagnosis through the ED versus those who do not., Methods: A retrospective cohort study identified all patients presenting to the ED between 2014 and 2015 in a rural, regional hospital system with a visit or resulting admission associated with an oncologic ICD-9 code. The chart was abstracted to determine a new cancer diagnosis versus an existing case. Cox proportional hazards (HR) estimated survival time. Patient and cancer characteristics were compared between those who were newly diagnosed through the ED and patients who were not., Findings: Thirty-nine percent of patients in our sample received their new cancer diagnosis as a result of an ED visit. The median survival was lower in cancer cases diagnosed through the ED (13 vs. 39 months, P < .001), men (20 vs. 32 months, P < .001), and patients aged ≥ 65 (22 months vs. 32 months, P < .001). Factors associated with lower survival were having a type of cancer location other than breast (HR = 1.96; P < .001), followed by being newly diagnosed with cancer through the ED (HR = 1.71; P < .001), and stage IV at diagnosis (HR = 1.70; P < .001)., Conclusions: Patients who received a new cancer diagnosis through the ED and required subsequent hospitalization had shorter overall survival and presented with advanced disease. Future research should address socioeconomic factors that may influence these patterns of cancer presentation., (© 2022. W. Montague Cobb-NMA Health Institute.)
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- 2023
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10. Partial Breast Reirradiation for Patients With Ipsilateral Breast Tumor Recurrence After Initial Treatment With Breast Conservation for Early Stage Breast Cancer.
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Pisano CE, Kharouta MZ, Harris EE, Shenk R, and Lyons JA
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- Humans, Female, Mastectomy, Neoplasm Recurrence, Local pathology, Prospective Studies, Mastectomy, Segmental methods, Treatment Outcome, Breast Neoplasms radiotherapy, Breast Neoplasms surgery, Breast Neoplasms pathology, Re-Irradiation, Brachytherapy methods
- Abstract
Purpose: Accelerated partial breast irradiation (APBI), including intraoperative radiation therapy (IORT), is an evidence-based treatment option in patients undergoing breast conserving surgery (BCS) for early-stage breast cancer. However, literature regarding reirradiation for patients with ipsilateral breast tumor recurrences (IBTR) is limited. This prospective study assessed the feasibility and efficacy of using APBI in patients who had prior whole breast irradiation., Methods and Materials: This was a single institution, prospective study of patients who were previously treated with BCS and adjuvant whole breast radiation. At the time of enrollment, all had unifocal IBTR, histologically confirmed invasive ductal carcinoma with negative margins after repeat BCS. Patients received either IORT in a single fraction at time of BCS or MammoSite brachytherapy twice daily over 5 days. Follow-up data and patient surveys were collected at 1, 3, 6, 9, and 12 months, then annually for at least a 5-year period., Results: From 2008 to 2014, 13 patients were enrolled. Median time to recurrence after initial course of radiation was 12.5 years. Median follow-up after retreatment was 7.8 years. One patient in the IORT group had a subsequent tumor bed recurrence, yielding a local control of 92%. One patient had distant recurrence. At baseline, 680 reported excellent-good cosmesis compared with 42% at 5 years. All patients indicated total satisfaction with overall treatment experience., Conclusions: APBI using IORT was well tolerated with excellent local control and may be a reasonable alternative to mastectomy for IBTR. Further study is needed to determine the most suitable candidates for this approach., (Copyright © 2022 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.)
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- 2022
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11. Navigator-assisted hypofractionation (NAVAH) to address radiation therapy access disparities facing African-Americans with breast cancer.
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McClelland S 3rd, Harris EE, Spratt DE, Cheatham C, Sun Y, Oliver AL, Jaboin JJ, Jagsi R, and Petereit DG
- Abstract
Background: African-Americans have the highest overall cancer death rate and shortest survival time of any racial or ethnic group in the United States. The most common cancer studied in African-American radiation therapy (RT) access disparities research is breast cancer. The goal of this study is to evaluate the impact of patient navigation on RT access for African-American breast cancer patients., Material and Methods: This study is a prospective survey-based evaluation of the impact of patient navigation on access to hypofractionated RT and financial toxicity in African-American breast cancer patients. The impact of patient navigation on RT access will be collated and analyzed from survey results pre-RT versus post-RT as well as for patients with versus without receipt of patient navigation. The validated COST-Functional Assessment of Chronic Illness Therapy score will be used to compare hypofractionation versus standard fractionated RT financial toxicity for patients with early-stage breast cancer who have received lumpectomy., Conclusion: This is the first study to investigate the impact of patient navigation on reducing RT access disparities facing African-American breast cancer patients. The natural progression of this work will be to expand this model to include additional breast cancer populations most vulnerable to suffering RT access disparities (Native American, Hispanic American, Appalachian) within the United States., Competing Interests: Conflict of interest None declared., (© 2022 Greater Poland Cancer Centre.)
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- 2022
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12. Genomically Guided Breast Radiation Therapy: A Review of the Current Data and Future Directions.
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Liveringhouse CL, Washington IR, Diaz R, Jimenez RB, Harris EE, Rabinovitch R, Woodward WA, Torres-Roca JF, and Ahmed KA
- Abstract
Purpose: To highlight the current evidence and the limitations in data to support a personalized approach in breast oncology radiation therapy management and define steps needed for clinical implementation., Methods and Materials: A critical review of the current literature on the use of genomics in breast radiation therapy was undertaken by a group of breast radiation oncologists to discuss current data, future directions, and challenges., Results: A summary of the existing data, ongoing clinical trials, and future directions is provided. The authors note many groups have developed radiation-specific genomic assays, which demonstrate promise in prediction of local control and benefit from radiation therapy; however, prospective validation of their utility is needed. Limitations continue to exist in our understanding of tumor biology and how it can be integrated into clinical practice., Conclusions: Given the relative ubiquity of breast radiation therapy, the variety of dose and fractionation approaches, and the current data to support a personalized approach, it is our belief that the delivery of breast radiation therapy is uniquely poised for a genomically personalized radiation therapy approach. Prospective clinical trials implementing genomic signatures are needed at this time to advance the field., (© 2021 The Author(s).)
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- 2021
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13. Molecular phylogenetic inference of the howler monkey radiation (Primates: Alouatta).
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Doyle ED, Prates I, Sampaio I, Koiffmann C, Silva WA Jr, Carnaval AC, and Harris EE
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- Alouatta genetics, Animals, Sequence Analysis, DNA, Alouatta classification, Biological Evolution, Phylogeny
- Abstract
Howler monkeys (Alouatta), comprising between nine and 14 species and ranging from southern Mexico to northern Argentina, are the most widely distributed platyrrhines. Previous phylogenetic studies of howlers have used chromosomal and morphological characters and a limited number of molecular markers; however, branching patterns conflict between studies or remain unresolved. We performed a new phylogenetic analysis of Alouatta using both concatenated and coalescent-based species tree approaches based on 14 unlinked non-coding intergenic nuclear regions. Our taxon sampling included five of the seven South American species (Alouatta caraya, Alouatta belzebul, Alouatta guariba, Alouatta seniculus, Alouatta sara) and the two recognized species from Mesoamerica (Alouatta pigra, Alouatta palliata). Similarly to previous studies, our phylogenies supported a Mesoamerican clade and a South American clade. For the South American howlers, both methods recovered the Atlantic Forest endemic A. guariba as sister to all remaining South American species, albeit with moderate support. Moreover, we found no support for the previously proposed sister relationship between A. guariba and A. belzebul. For the first time, a clade composed of A. sara and A. caraya was identified. The relationships among the other South American howlers, however, were not fully supported. Our estimates for divergence times within Alouatta are generally older compared to estimates in earlier studies. However, they conform to recent studies proposing a Miocene age for the Isthmus of Panama and for the uplift of the northern Andes. Our results also point to an early genetic isolation of A. guariba in the Atlantic Forest, in agreement with the hypothesis of biotic exchange across South American rain forests in the Miocene. Collectively, these findings contribute to a better understanding of the diversification processes among howler monkey species; however, they also suggest that further comprehension of the evolutionary history of the Alouatta radiation will rely on broadened taxonomic, geographic, and genomic sampling.
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- 2021
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14. Utilizing the genomically adjusted radiation dose (GARD) to personalize adjuvant radiotherapy in triple negative breast cancer management.
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Ahmed KA, Liveringhouse CL, Mills MN, Figura NB, Grass GD, Washington IR, Harris EE, Czerniecki BJ, Blumencranz PW, Eschrich SA, Scott JG, Diaz R, and Torres-Roca JF
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- Aged, Biomarkers, Tumor, Cohort Studies, Combined Modality Therapy, Female, Humans, Middle Aged, Neoplasm Metastasis, Neoplasm Staging, Prognosis, Triple Negative Breast Neoplasms diagnosis, Triple Negative Breast Neoplasms mortality, Radiation Dosage, Radiation Tolerance genetics, Radiotherapy, Adjuvant methods, Triple Negative Breast Neoplasms genetics, Triple Negative Breast Neoplasms radiotherapy
- Abstract
Background: Utilizing the linear quadratic model and the radiosensitivity index (RSI), we have derived an expression for the genomically adjusted radiation dose (GARD) to model radiation dose effect. We hypothesize GARD is associated with local recurrence and can be used to optimize individual triple negative breast cancer (TNBC) radiation dose., Methods: TN patients from two independent datasets were assessed. The first cohort consisted of 58 patients treated at 5 European centers with breast conservation surgery followed by adjuvant radiotherapy (RT). The second dataset consisted of 55 patients treated with adjuvant radiation therapy., Findings: In cohort 1, multivariable analysis revealed that as a dichotomous variable (HR: 2.5 95% CI 1-7.1; p = .05), GARD was associated with local control. This was confirmed in the second independent dataset where GARD was the only significant factor associated with local control (HR: 4.4 95% CI 1.1-29.5; p = .04). We utilized GARD to calculate an individualized radiation dose for each TN patient in cohort 2 by determining the physical dose required to achieve the GARD target value (GARD ≥ 21). While 7% of patients were optimized with a dose of 30 Gy, 91% of patients would be optimized with 70 Gy., Interpretation: GARD is associated with local control following whole breast or post-mastectomy radiotherapy (RT) in TN patients. By modeling RT dose effect with GARD, we demonstrate that no single dose is optimal for all patients and propose the first dose range to optimize RT at an individual patient level in TNBC., (Copyright © 2019. Published by Elsevier B.V.)
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- 2019
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15. Evaluation of Nurses' Knowledge and Attitude toward HIV-Infected Patients in Barbados.
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Huq KATME, Moriyama M, Harris EE, Shirin H, and Rahman MM
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- Adult, Barbados, Cross-Sectional Studies, Female, HIV Infections nursing, Hospitals, Humans, Male, Middle Aged, Nurses statistics & numerical data, Qualitative Research, Sex Factors, Surveys and Questionnaires, Young Adult, Attitude of Health Personnel, HIV Infections psychology, Health Knowledge, Attitudes, Practice, Nurses psychology
- Abstract
Background: Continued assessment of nurses' knowledge and attitude is necessary for improving their performance at workplace. We attempted to evaluate nurses' knowledge and attitude toward HIV-infected patients and their underlying factors., Methods: We conducted a descriptive, cross-sectional study participated by 218 nurses and collected relevant data., Results: Majority (57.3%) of the nurses had 1 to 5 years of experience in the nursing job, and 78.4% of them were involved in the provision of direct care to HIV-infected individuals for ≤5 years, and only 6.4% for ≥11 years. The overall knowledge and attitude of the participants were good (3.25/5 and 3.42/5 scores, respectively). The knowledge regarding appropriate care of HIV-infected patients was significantly better among the registered nurses compared to nursing assistants (NA) with limited years of formal education (odds ratio [OR] = 0.37; 95% confidence interval [CI] = 0.20-0.69; P <.001). In the provision of care to the HIV-infected patients, the attitude of female participants was significantly better than the males (unadjusted OR = 0.18; 95% CI = 0.05-0.60; P = .01)., Conclusion: Inclusion of relevant HIV- and AIDS-related topics in the curriculum for NAs and closely guided hands-on training of the nurses are likely to improve nurses' knowledge and attitude toward the provision of care to HIV-infected individuals.
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- 2019
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16. Demic and cultural diffusion in prehistoric Europe in the age of ancient genomes.
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Harris EE
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- Anthropology, Physical, Biological Evolution, DNA, Ancient, Europe, Humans, Metagenomics, Cultural Evolution, Genome, Human genetics, Human Migration, Population Dynamics
- Abstract
Ancient genomes can help us detect prehistoric migrations, population contractions, and admixture among populations. Knowing the dynamics of demography is invaluable for understanding culture change in prehistory, particularly the roles played by demic and cultural diffusion in transformations of material cultures. Prehistoric Europe is a region where ancient genome analyses can help illuminate the interplay between demography and culture change. In Europe, there is more archeological evidence, in terms of detailed studies, radiometric dates, and explanatory hypotheses that can be evaluated, than in any other region of the world. Here I show some important ways that ancient genomes have given us insights into population movements in European prehistory. I also propose that studies might be increasingly focused on specific questions of culture change, for example in evaluating the makers of "transitional" industries as well as the origins of the Gravettian and spread of the Magdalenian. I also discuss genomic evidence supporting the large role that demic expansion has played in the Neolithization of Europe and the formation of the European population during the Bronze Age., (© 2017 Wiley Periodicals, Inc.)
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- 2017
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17. Accelerated Partial Breast Irradiation: Executive summary for the update of an ASTRO Evidence-Based Consensus Statement.
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Correa C, Harris EE, Leonardi MC, Smith BD, Taghian AG, Thompson AM, White J, and Harris JR
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- Adult, Evidence-Based Medicine, Female, Humans, Mastectomy, Segmental, Middle Aged, Neoplasm Recurrence, Local radiotherapy, Practice Guidelines as Topic, Prospective Studies, Randomized Controlled Trials as Topic, United States, Brachytherapy methods, Brachytherapy standards, Breast Neoplasms radiotherapy, Carcinoma, Ductal, Breast radiotherapy, Carcinoma, Intraductal, Noninfiltrating radiotherapy, Patient Selection
- Abstract
Purpose: To update the accelerated partial breast irradiation Consensus Statement published in 2009 and provide guidance on use of intraoperative radiation therapy (IORT) for partial breast irradiation in early-stage breast cancer, based on published evidence complemented by expert opinion., Methods and Materials: A systematic PubMed search using the same terms as the original Consensus Statement yielded 419 articles; 44 articles were selected. The authors synthesized the published evidence and, through a series of conference calls and e-mails, reached consensus regarding the recommendations., Results: The new recommendations include lowering the age in the "suitability group" from 60 to 50 years and in the "cautionary group" to 40 years for patients who meet all other elements of suitability (Table 1). Patients with low-risk ductal carcinoma in situ, as per Radiation Therapy Oncology Group 9804 criteria, were categorized in the "suitable" group. The task force agreed to maintain the current criteria based on margin status. Recommendations for the use of IORT for breast cancer patients include: counseling patients regarding the higher risk of ipsilateral breast tumor recurrence with IORT compared with whole breast irradiation; the need for prospective monitoring of long-term local control and toxicity with low-energy radiograph IORT given limited follow-up; and restriction of IORT to women with invasive cancer considered "suitable.", Conclusion: These recommendations will provide updated clinical guidance regarding use of accelerated partial breast irradiation for radiation oncologists and other specialists participating in the care of breast cancer patients., (Copyright © 2016 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.)
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- 2017
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18. Criminal Charges Prior to and After Enrollment in Opioid Agonist Treatment: A Comparison of Methadone Maintenance and Office-based Buprenorphine.
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Rastegar DA, Sharfstein Kawasaki S, King VL, Harris EE, and Brooner RK
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- Buprenorphine, Humans, Methadone, Opiate Substitution Treatment, Opioid-Related Disorders, Criminals
- Abstract
Background: Entry into methadone maintenance is associated with a reduction in criminal activity; less is known about the effects of office-based buprenorphine., Objective: To compare criminal charges before and after enrollment in methadone maintenance or office-based buprenorphine., Methods: Subjects were opioid-dependent adults who initiated either methadone maintenance (n = 252) or office-based buprenorphine (n = 252) between 2003 and 2007. Medical records were reviewed to gather demographic data and a state-maintained web-based database to collect data on criminal charges. Overall charges and drug charges in the 2 years prior to and after treatment enrollment were compared. Multivariable analysis was used to examine risk factors for charges after treatment enrollment., Results: In the 2 years after enrolling in treatment, subjects receiving methadone had a significant decline in the proportion of subjects with any charges (49.6% vs. 32.5%, p < .001) or drug charges (25.0% vs. 17.5%, p = .015), as well as the mean number of cases (0.97 vs. 0.63, p = .002) and drug cases (0.38 vs. 0.23, p = .008), while those who initiated buprenorphine did not have significant changes in any of these measures. On multivariable analysis, the strongest predictor of criminal charges in the 2 years after treatment enrollment was prior charges (adjusted odds ratio 3.35, 95% confidence interval, 2.24-5.01)., Conclusions: Enrollment in office-based buprenorphine treatment did not appear to have the same beneficial effect on subsequent criminal charges as methadone maintenance. If this observation is replicated in other settings, it may have implications for matching individuals to these treatment options.
- Published
- 2016
- Full Text
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19. Integration of a Radiosensitivity Molecular Signature Into the Assessment of Local Recurrence Risk in Breast Cancer.
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Torres-Roca JF, Fulp WJ, Caudell JJ, Servant N, Bollet MA, van de Vijver M, Naghavi AO, Harris EE, and Eschrich SA
- Subjects
- Breast Neoplasms pathology, Breast Neoplasms therapy, Confidence Intervals, Female, Follow-Up Studies, Gene Expression, Humans, Mastectomy, Segmental methods, Middle Aged, Multivariate Analysis, Neoplasms, Second Primary, Prognosis, Radiotherapy Dosage, Receptor, ErbB-2, Receptors, Estrogen, Receptors, Progesterone, Risk Assessment, Time Factors, Triple Negative Breast Neoplasms genetics, Triple Negative Breast Neoplasms pathology, Triple Negative Breast Neoplasms radiotherapy, Triple Negative Breast Neoplasms therapy, Breast Neoplasms genetics, Breast Neoplasms radiotherapy, Neoplasm Recurrence, Local, Radiation Tolerance genetics
- Abstract
Purpose: Recently, we developed radiosensitivity (RSI), a clinically validated molecular signature that estimates tumor radiosensitivity. In the present study, we tested whether integrating RSI with the molecular subtype refines the classification of local recurrence (LR) risk in breast cancer., Methods and Materials: RSI and molecular subtype were evaluated in 343 patients treated with breast-conserving therapy that included whole-breast radiation therapy with or without a tumor bed boost (dose range 45-72 Gy). The follow-up period for patients without recurrence was 10 years. The clinical endpoint was LR-free survival., Results: Although RSI did not uniformly predict for LR across the entire cohort, combining RSI and the molecular subtype identified a subpopulation with an increased risk of LR: triple negative (TN) and radioresistant (reference TN-radioresistant, hazard ratio [HR] 0.37, 95% confidence interval [CI] 0.15-0.92, P=.02). TN patients who were RSI-sensitive/intermediate had LR rates similar to those of luminal (LUM) patients (HR 0.86, 95% CI 0.47-1.57, P=.63). On multivariate analysis, combined RSI and molecular subtype (P=.004) and age (P=.001) were the most significant predictors of LR. In contrast, integrating RSI into the LUM subtype did not identify additional risk groups. We hypothesized that radiation dose escalation was affecting radioresistance in the LUM subtype and serving as a confounder. An increased radiation dose decreased LR only in the luminal-resistant (LUM-R) subset (HR 0.23, 95% CI 0.05-0.98, P=.03). On multivariate analysis, the radiation dose was an independent variable only in the LUMA/B-RR subset (HR 0.025, 95% CI 0.001-0.946, P=.046), along with age (P=.008), T stage (P=.004), and chemotherapy (P=.008)., Conclusions: The combined molecular subtype-RSI identified a novel molecular subpopulation (TN and radioresistant) with an increased risk of LR after breast-conserving therapy. We propose that the combination of RSI and molecular subtype could be useful in guiding radiation therapy-based decisions in breast cancer., (Copyright © 2015 Elsevier Inc. All rights reserved.)
- Published
- 2015
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20. In Regard to Hepel and Wazer.
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Harris EE, Small W Jr, Holmes D, Grobmyer S, Pavord D, Rice JS, and Alvarado M
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- Female, Humans, Breast Neoplasms radiotherapy, Carcinoma, Ductal, Breast radiotherapy
- Published
- 2015
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21. ACR Appropriateness Criteria® Ductal Carcinoma in Situ.
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Kaufman SA, Harris EE, Bailey L, Chadha M, Dutton SC, Freedman GM, Goyal S, Halyard MY, Horst KC, Novick KL, Park CC, Suh WW, Toppmeyer D, Zook J, and Haffty BG
- Subjects
- Antineoplastic Agents, Hormonal therapeutic use, Breast Neoplasms pathology, Carcinoma, Intraductal, Noninfiltrating pathology, Carcinoma, Lobular pathology, Carcinoma, Lobular therapy, Female, Humans, Magnetic Resonance Imaging, Mammography, Mastectomy, Mastectomy, Segmental, Neoplasm Invasiveness, Radiotherapy Dosage, Radiotherapy, Adjuvant, Sentinel Lymph Node Biopsy, Tamoxifen therapeutic use, Breast Neoplasms therapy, Carcinoma, Intraductal, Noninfiltrating therapy
- Abstract
Ductal carcinoma in situ (DCIS) is a breast neoplasm with potential for progression to invasive cancer. Management commonly involves excision, radiotherapy, and hormonal therapy. Surgical assessment of regional lymph nodes is rarely indicated except in cases of microinvasion or mastectomy. Radiotherapy is employed for local control in breast conservation, although it may be omitted for select low-risk situations. Several radiotherapy techniques exist beyond standard whole-breast irradiation (ie, partial-breast irradiation [PBI], hypofractionated whole-breast radiation); evidence for these is evolving. We present an update of the American College of Radiology (ACR) Appropriateness Criteria® for the management of DCIS. The ACR Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions, which are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review includes an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi technique) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
- Published
- 2015
22. ACR Appropriateness Criteria local-regional recurrence (LRR) and salvage surgery-breast cancer.
- Author
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Halyard MY, Harris EE, Bailey L, Bellon JR, Freedman GM, Goyal S, Horst KC, Moran MS, Park CC, Suh WW, Toppmeyer D, and Haffty BG
- Subjects
- Adult, Breast Neoplasms pathology, Breast Neoplasms surgery, Combined Modality Therapy, Female, Humans, Middle Aged, Neoplasm Recurrence, Local pathology, Practice Guidelines as Topic, Breast Neoplasms therapy, Neoplasm Recurrence, Local therapy, Salvage Therapy methods
- Abstract
Although both breast-conserving surgery and mastectomy generally provide excellent local-regional control of breast cancer, local-regional recurrence (LRR) does occur. Predictors for LRR include patient, tumor, and treatment-related factors. Salvage after LRR includes coordination of available modalities, including surgery, radiation, chemotherapy, and hormonal therapy, depending on the clinical scenario. Management recommendations for breast cancer LRR, including patient scenarios, are reviewed, and represent evidence-based data and expert opinion of the American College of Radiology Appropriateness Criteria Expert Panel on LRR.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel.The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
- Published
- 2014
23. Evaluation of bolus electron conformal therapy compared with conventional techniques for the treatment of left chest wall postmastectomy in patients with breast cancer.
- Author
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Opp D, Forster K, Li W, Zhang G, and Harris EE
- Subjects
- Breast Neoplasms surgery, Female, Humans, Mastectomy, Radiotherapy Planning, Computer-Assisted, Radiotherapy, Adjuvant, Breast Neoplasms radiotherapy, Neoplasm Recurrence, Local prevention & control, Radiotherapy, Intensity-Modulated
- Abstract
Postmastectomy radiation (PMRT) lowers local-regional recurrence risk and improves survival in selected patients with breast cancer. The chest wall and lower axilla are technically challenging areas to treat with homogenous doses and normal tissue sparing. This study compares several techniques for PMRT to provide data to guide selection of optimal treatment techniques. Twenty-five consecutive left-sided patients treated postmastectomy were contoured using Radiation Therapy Oncology Group (RTOG) atlas guidelines then planned using 4 different PMRT techniques: opposed tangents with wedges (3-dimensional [3D] wedges), opposed tangents with field-in-field (FiF) modulation, 8-field intensity modulation radiotherapy (IMRT), and custom bolus electron conformal therapy (BolusECT, .decimal, Inc., Sanford, FL). Required planning target volume (PTV) coverage was held constant, and then dose homogeneity and normal tissue dose parameters were compared among the 4 techniques. BolusECT achieved clincally acceptable PTV coverage for 22 out of 25 cases. Compared with either tangential technique, IMRT and BolusECT provided the lowest heart V25 doses (3.3% ± 0.9% and 6.6% ± 3.2%, respectively with p < 0.0001). FiF had the lowest mean total lung dose (7.3 ± 1.1Gy, with p = 0.0013), IMRT had the lowest total lung V20 (10.3% ± 1.6%, p < 0.0001), and BolusECT had the lowest mean heart dose (7.3 ± 2.0Gy, p = 0.0002). IMRT provided the optimal dose homogeneity and normal tissue sparing compared with all other techniques for the cases in which BolusECT could not achieve acceptable PTV coverage. IMRT generally exposes contralateral breast and lung to slightly higher doses. Optimal PMRT technique depends upon patient anatomy. Patients whose maximal target volume depth is about 5.7cm or less can be treated with BolusECT-assisted 12 or 15MeV electron beams. At these energies, BolusECT has comparable dose-volume statistics as IMRT and lower heart V25 than opposed tangential beams. Patients with larger depths are best treated with IMRT, which provides significant advantages in both dose homogeneity and normal tissue sparing compared with all other techniques., (© 2013 American Association of Medical Dosimetrists.)
- Published
- 2013
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24. The impact of the size of nodal metastases on recurrence risk in breast cancer patients with 1-3 positive axillary nodes after mastectomy.
- Author
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Harris EE, Freilich J, Lin HY, Chuong M, and Acs G
- Subjects
- Analysis of Variance, Axilla, Breast Neoplasms mortality, Breast Neoplasms radiotherapy, Breast Neoplasms surgery, Female, Follow-Up Studies, Humans, Lymph Nodes pathology, Lymphatic Metastasis, Mastectomy, Middle Aged, Retrospective Studies, Survival Rate, Breast Neoplasms pathology, Neoplasm Recurrence, Local mortality, Neoplasm Recurrence, Local pathology, Tumor Burden
- Abstract
Purpose: Use of postmastectomy radiation therapy (PMRT) in breast cancer patients with 1-3 positive nodes is controversial. The objective of this study was to determine whether the size of nodal metastases in this subset could predict who would benefit from PMRT., Methods and Materials: We analyzed 250 breast cancer patients with 1-3 positive nodes after mastectomy treated with contemporary surgery and systemic therapy at our institution. Of these patients, 204 did not receive PMRT and 46 did receive PMRT. Local and regional recurrence risks were stratified by the size of the largest nodal metastasis measured as less than or equal to 5 mm or greater than 5 mm., Results: The median follow-up was 65.6 months. In the whole group, regional recurrences occurred in 2% of patients in whom the largest nodal metastasis measured 5 mm or less vs 6% for those with metastases measuring greater than 5 mm. For non-irradiated patients only, regional recurrence rates were 2% and 9%, respectively. Those with a maximal nodal size greater than 5 mm had a significantly higher cumulative incidence of regional recurrence (P=.013). The 5-year cumulative incidence of a regional recurrence in the non-irradiated group was 2.7% (95% confidence interval [CI], 0.7%-7.2%) for maximal metastasis size of 5 mm or less, 6.9% (95% CI, 1.7%-17.3%) for metastasis size greater than 5 mm, and 16% (95% CI, 3.4%-36.8%) for metastasis size greater than 10 mm. The impact of the maximal nodal size on regional recurrences became insignificant in the multivariable model., Conclusions: In patients with 1-3 positive lymph nodes undergoing mastectomy without radiation, nodal metastasis greater than 5 mm was associated with regional recurrence after mastectomy, but its effect was modified by other factors (such as tumor stage). The size of the largest nodal metastasis may be useful to identify high-risk patients who may benefit from radiation therapy after mastectomy., (Copyright © 2013 Elsevier Inc. All rights reserved.)
- Published
- 2013
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25. Accelerated partial breast irradiation: a review and description of an early North American surgical experience with the intrabeam delivery system.
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Deneve JL, Hoefer RA Jr, Harris EE, and Laronga C
- Subjects
- Aged, Breast Neoplasms pathology, Female, Humans, Intraoperative Care methods, Middle Aged, North America, Prospective Studies, Breast Neoplasms radiotherapy, Breast Neoplasms surgery
- Abstract
Background: Targeted intraoperative radiation therapy (IORT) as an alternative to whole breast irradiation (WBI) has been described for patients with early-stage breast cancer. The randomized phase III TARGiT trial demonstrated similar recurrence rates to WBI and a lower overall toxicity profile on short-term follow-up. We report on our early North American surgical experience using the Intrabeam radiotherapy delivery system and review the current literature., Methods: Prospectively gathered estrogen receptor-positive, clinically node-negative patients with invasive breast cancer < 3 cm receiving IORT using the Intrabeam system were reviewed. IORT-related effects and early postoperative outcome were assessed. A literature review was also performed., Results: Forty-two patients (median age 71 years) underwent lumpectomy, sentinel lymph node (SLN) biopsy, and concurrent IORT from January 2011 to July 2011. Ninety-one percent of patients had invasive ductal histology with a median tumor size of 1.0 cm. This review highlights the patient selection criteria, describes commercially available accelerated partial breast irradiation (APBI) treatment options, and discusses outcomes for the variety of APBI techniques currently utilized in clinical practice as well as an institutional review of our early surgical experience using the Intrabeam radiotherapy delivery system., Conclusions: While a variety of APBI techniques are currently available for clinical use, our early North American operative experience with IORT shows it is well tolerated with low morbidity. Delivery of IORT adds moderate operative time and may require creating subcutaneous tissue fl aps. The addition of WBI may be necessary in situations for positive residual margins or microscopic nodal disease in patients who do not undergo additional surgery.
- Published
- 2012
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26. Validation of a radiosensitivity molecular signature in breast cancer.
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Eschrich SA, Fulp WJ, Pawitan Y, Foekens JA, Smid M, Martens JW, Echevarria M, Kamath V, Lee JH, Harris EE, Bergh J, and Torres-Roca JF
- Subjects
- Adult, Aged, Aged, 80 and over, Breast Neoplasms mortality, Female, Humans, Menopause, Middle Aged, Neoplasm Staging, Prognosis, Transcriptome, Treatment Outcome, Breast Neoplasms genetics, Breast Neoplasms radiotherapy, Radiation Tolerance genetics
- Abstract
Purpose: Previously, we developed a radiosensitivity molecular signature [radiosensitivity index (RSI)] that was clinically validated in 3 independent datasets (rectal, esophageal, and head and neck) in 118 patients. Here, we test RSI in radiotherapy (RT)-treated breast cancer patients., Experimental Design: RSI was tested in 2 previously published breast cancer datasets. Patients were treated at the Karolinska University Hospital (n = 159) and Erasmus Medical Center (n = 344). RSI was applied as previously described., Results: We tested RSI in RT-treated patients (Karolinska). Patients predicted to be radiosensitive (RS) had an improved 5-year relapse-free survival when compared with radioresistant (RR) patients (95% vs. 75%, P = 0.0212), but there was no difference between RS/RR patients treated without RT (71% vs. 77%, P = 0.6744), consistent with RSI being RT-specific (interaction term RSI × RT, P = 0.05). Similarly, in the Erasmus dataset, RT-treated RS patients had an improved 5-year distant metastasis-free survival over RR patients (77% vs. 64%, P = 0.0409), but no difference was observed in patients treated without RT (RS vs. RR, 80% vs. 81%, P = 0.9425). Multivariable analysis showed RSI is the strongest variable in RT-treated patients (Karolinska, HR = 5.53, P = 0.0987, Erasmus, HR = 1.64, P = 0.0758) and in backward selection (removal α of 0.10), RSI was the only variable remaining in the final model. Finally, RSI is an independent predictor of outcome in RT-treated ER(+) patients (Erasmus, multivariable analysis, HR = 2.64, P = 0.0085)., Conclusions: RSI is validated in 2 independent breast cancer datasets totaling 503 patients. Including prior data, RSI is validated in 5 independent cohorts (621 patients) and represents, to our knowledge, the most extensively validated molecular signature in radiation oncology., (©2012 AACR.)
- Published
- 2012
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27. Molecular evolution of a malaria resistance gene (DARC) in primates.
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Oliveira TY, Harris EE, Meyer D, Jue CK, and Silva WA Jr
- Subjects
- Amino Acid Sequence, Animals, Binding Sites, Duffy Blood-Group System metabolism, GATA1 Transcription Factor metabolism, Humans, Malaria genetics, Malaria parasitology, Molecular Sequence Data, Phylogeny, Receptors, Cell Surface metabolism, Regulatory Sequences, Nucleic Acid, Selection, Genetic, Sequence Alignment, Disease Resistance genetics, Duffy Blood-Group System genetics, Evolution, Molecular, Plasmodium vivax pathogenicity, Primates genetics, Receptors, Cell Surface genetics
- Abstract
Genes involved in host-pathogen interactions are often strongly affected by positive natural selection. The Duffy antigen, coded by the Duffy antigen receptor for chemokines (DARC) gene, serves as a receptor for Plasmodium vivax in humans and for Plasmodium knowlesi in some nonhuman primates. In the majority of sub-Saharan Africans, a nucleic acid variant in GATA-1 of the gene promoter is responsible for the nonexpression of the Duffy antigen on red blood cells and consequently resistance to invasion by P. vivax. The Duffy antigen also acts as a receptor for chemokines and is expressed in red blood cells and many other tissues of the body. Because of this dual role, we sequenced a ~3,000-bp region encompassing the entire DARC gene as well as part of its 5' and 3' flanking regions in a phylogenetic sample of primates and used statistical methods to evaluate the nature of selection pressures acting on the gene during its evolution. We analyzed both coding and regulatory regions of the DARC gene. The regulatory analysis showed accelerated rates of substitution at several sites near known motifs. Our tests of positive selection in the coding region using maximum likelihood by branch sites and maximum likelihood by codon sites did not yield statistically significant evidence for the action of positive selection. However, the maximum likelihood test in which the gene was subdivided into different structural regions showed that the known binding region for P. vivax/P. knowlesi is under very different selective pressures than the remainder of the gene. In fact, most of the gene appears to be under strong purifying selection, but this is not evident in the binding region. We suggest that the binding region is under the influence of two opposing selective pressures, positive selection possibly exerted by the parasite and purifying selection exerted by chemokines.
- Published
- 2012
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28. Time-course of arm lymphedema and potential risk factors for progression of lymphedema after breast conservation treatment for early stage breast cancer.
- Author
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Bar Ad V, Dutta PR, Solin LJ, Hwang WT, Tan KS, Both S, Cheville A, and Harris EE
- Subjects
- Adult, Age Factors, Aged, Aged, 80 and over, Arm surgery, Axilla pathology, Axilla radiation effects, Breast Neoplasms radiotherapy, Breast Neoplasms therapy, Disease Progression, Female, Follow-Up Studies, Humans, Lymph Node Excision adverse effects, Mastectomy, Segmental, Middle Aged, Multivariate Analysis, Retrospective Studies, Risk Factors, Arm pathology, Breast Neoplasms complications, Breast Neoplasms surgery, Lymphedema etiology
- Abstract
The objective of this study was to describe the progression of arm lymphedema (ALE) after the initial presentation among patients receiving breast conservation therapy for early stage breast cancer and to identify potential risk factors contributing to ALE progression. The study sample was the 266 stage I or II breast cancer patients with documented ALE who underwent breast conservation therapy that included lumpectomy, axillary staging followed by radiation therapy. ALE were graded according to a difference of 0.5-2 cm (mild), 2.1-3 cm (moderate), and >3 cm (severe) in the circumference between the upper extremities for the treated and untreated sides. ALE at presentation was scored as mild, moderate, and severe in 109 (41%), 125 (47%), and 32 (12%) patients, respectively. One third of patients with ALE progressed to a more severe grade of lymphedema at 5 years of follow-up. Age older than 65 years at the time of breast cancer treatment was associated with higher risk of ALE progression when compared 65 year age or younger (p = 0.04). The patients who had regional lymph node irradiation including posterior axillary boost were at higher risk of lymphedema progression than the patients treated with whole breast irradiation only (p = 0.001). Progression of ALE is a common occurrence. The current study provides support for the utility of routine arm measurements after breast cancer treatment to facilitate timely diagnosis and treatment of ALE., (© 2012 Wiley Periodicals, Inc.)
- Published
- 2012
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29. ACR Appropriateness Criteria® local-regional recurrence (LR) and salvage surgery: breast cancer.
- Author
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Halyard MY, Wasif N, Harris EE, Arthur DW, Bailey L, Bellon JR, Carey L, Goyal S, Horst KC, Moran MS, MacDonald SM, and Haffty BG
- Subjects
- Antineoplastic Agents therapeutic use, Biomarkers, Tumor analysis, Breast Neoplasms chemistry, Breast Neoplasms drug therapy, Breast Neoplasms radiotherapy, Chemotherapy, Adjuvant, Clinical Trials as Topic, Evidence-Based Medicine, Female, Humans, Neoadjuvant Therapy methods, Practice Guidelines as Topic, Predictive Value of Tests, Risk Factors, Survival Analysis, Treatment Failure, Breast Neoplasms pathology, Breast Neoplasms surgery, Mastectomy, Modified Radical, Mastectomy, Segmental, Neoplasm Recurrence, Local prevention & control, Salvage Therapy methods
- Abstract
Despite the success of both breast conserving surgery and mastectomy, some women will experience a local-regional recurrence (LRR) of their breast cancer. Predictors for LRR after breast-conserving therapy or mastectomy have been identified, including patient, tumor, and treatment-related factors. The role of surgery, radiation, and chemotherapy as treatment has evolved over time and many patients now have the potential for salvage after LRR. This review of LRR of breast cancer and management recommendations, including the use of common clinical scenarios, represents a compilation of evidence-based data and expert opinion of the American College of Radiology Appropriateness Criteria Expert Panel on local-regional recurrence. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
- Published
- 2012
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30. Continuous localization technologies for radiotherapy delivery: Report of the American Society for Radiation Oncology Emerging Technology Committee.
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D'Ambrosio DJ, Bayouth J, Chetty IJ, Buyyounouski MK, Price RA Jr, Correa CR, Dilling TJ, Franklin GE, Xia P, Harris EE, and Konski A
- Published
- 2012
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31. An evidence based review of proton beam therapy: the report of ASTRO's emerging technology committee.
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Allen AM, Pawlicki T, Dong L, Fourkal E, Buyyounouski M, Cengel K, Plastaras J, Bucci MK, Yock TI, Bonilla L, Price R, Harris EE, and Konski AA
- Subjects
- Humans, Neoplasms radiotherapy, Proton Therapy
- Abstract
Proton beam therapy (PBT) is a novel method for treating malignant disease with radiotherapy. The purpose of this work was to evaluate the state of the science of PBT and arrive at a recommendation for the use of PBT. The emerging technology committee of the American Society of Radiation Oncology (ASTRO) routinely evaluates new modalities in radiotherapy and assesses the published evidence to determine recommendations for the society as a whole. In 2007, a Proton Task Force was assembled to evaluate the state of the art of PBT. This report reflects evidence collected up to November 2009. Data was reviewed for PBT in central nervous system tumors, gastrointestinal malignancies, lung, head and neck, prostate, and pediatric tumors. Current data do not provide sufficient evidence to recommend PBT in lung cancer, head and neck cancer, GI malignancies, and pediatric non-CNS malignancies. In hepatocellular carcinoma and prostate cancer and there is evidence for the efficacy of PBT but no suggestion that it is superior to photon based approaches. In pediatric CNS malignancies PBT appears superior to photon approaches but more data is needed. In large ocular melanomas and chordomas, we believe that there is evidence for a benefit of PBT over photon approaches. PBT is an important new technology in radiotherapy. Current evidence provides a limited indication for PBT. More robust prospective clinical trials are needed to determine the appropriate clinical setting for PBT., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2012
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32. Criminal charges prior to and after initiation of office-based buprenorphine treatment.
- Author
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Harris EE, Jacapraro JS, and Rastegar DA
- Subjects
- Adolescent, Adult, Aged, Cohort Studies, Female, Humans, Male, Middle Aged, Buprenorphine therapeutic use, Crime statistics & numerical data, Narcotic Antagonists therapeutic use, Opiate Substitution Treatment statistics & numerical data, Opioid-Related Disorders rehabilitation, Primary Health Care statistics & numerical data
- Abstract
Background: There is little data on the impact of office-based buprenorphine therapy on criminal activity. The goal of this study was to determine the impact of primary care clinic-based buprenorphine maintenance therapy on rates of criminal charges and the factors associated with criminal charges in the 2 years after initiation of treatment., Methods: We collected demographic and outcome data on 252 patients who were given at least one prescription for buprenorphine. We searched a public database of criminal charges and recorded criminal charges prior to and after enrollment. We compared the total number of criminal cases and drug cases 2 years before versus 2 years after initiation of treatment., Results: There was at least one criminal charge made against 38% of the subjects in the 2 years after initiation of treatment; these subjects were more likely to have used heroin, to have injected drugs, to have had any prior criminal charges, and recent criminal charges. There was no significant difference in the number of subjects with any criminal charge or a drug charge before and after initiation of treatment. Likewise, the mean number of all cases and drug cases was not significantly different between the two periods. However, among those who were opioid-negative for 6 or more months in the first year of treatment, there was a significant decline in criminal cases. On multivariable analysis, having recent criminal charges was significantly associated with criminal charges after initiation of treatment (adjusted odds ratio 3.92); subjects who were on opioid maintenance treatment prior to enrollment were significantly less likely to have subsequent criminal charges (adjusted odds ratio 0.52)., Conclusions: Among subjects with prior criminal charges, initiation of office-based buprenorphine treatment did not appear to have a significant impact on subsequent criminal charges.
- Published
- 2012
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33. Validating fiducial markers for image-guided radiation therapy for accelerated partial breast irradiation in early-stage breast cancer.
- Author
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Park CK, Pritz J, Zhang GG, Forster KM, and Harris EE
- Subjects
- Aged, Aged, 80 and over, Algorithms, Anatomic Landmarks diagnostic imaging, Breast Neoplasms diagnostic imaging, Breast Neoplasms pathology, Breast Neoplasms surgery, Feasibility Studies, Female, Four-Dimensional Computed Tomography methods, Gold, Humans, Mastectomy, Segmental, Middle Aged, Neoplasm Staging, Prospective Studies, Respiration, Seroma diagnostic imaging, Breast Neoplasms radiotherapy, Fiducial Markers, Movement, Radiotherapy, Conformal methods, Radiotherapy, Image-Guided
- Abstract
Purpose: Image-guided radiation therapy (IGRT) may be beneficial for accelerated partial breast irradiation (APBI). The goal was to validate the use of intraparenchymal textured gold fiducials in patients receiving APBI., Methods and Materials: Twenty-six patients were enrolled on this prospective study that had three or four textured gold intraparenchymal fiducials placed at the periphery of the lumpectomy cavity and were treated with three-dimensional (3D) conformal APBI. Free-breathing four-dimensional computed tomography image sets were obtained pre- and posttreatment, as were daily online megavoltage (MV) orthogonal images. Intrafraction motion, variations in respiratory motion, and fiducial marker migration were calculated using the 3D coordinates of individual fiducials and a calculated center of mass (COM) of the fiducials. We also compared the relative position of the fiducial COM with the geometric center of the seroma., Results: There was less than 1 mm of intrafraction respiratory motion, variation in respiratory motion, or fiducial marker migration. The change in seroma position relative to the fiducial COM was 1 mm ± 1 mm. The average position of the geometric seroma relative to the fiducial COM pretreatment compared with posttreatment was 1 mm ± 1 mm. The largest daily variation in displacement when using bony landmark was in the anteroposterior direction and two standard deviations (SD) of this variation was 10 mm. The average variation in daily separation between the fiducial pairs from daily MV images was 3 mm ± 3 mm therefore 2 SD is 6 mm., Conclusion: Fiducial markers are stable throughout the course of APBI. Planning target volume margins when using bony landmarks should be 10 mm and can be reduced to 6 mm if using fiducials., (Copyright © 2012 Elsevier Inc. All rights reserved.)
- Published
- 2012
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34. ACR appropriateness criteria(®) ductal carcinoma in situ.
- Author
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Moran MS, Bai HX, Harris EE, Arthur DW, Bailey L, Bellon JR, Carey L, Goyal S, Halyard MY, Horst KC, MacDonald SM, and Haffty BG
- Subjects
- Antineoplastic Agents, Hormonal therapeutic use, Breast Neoplasms diagnosis, Breast Neoplasms pathology, Carcinoma, Intraductal, Noninfiltrating diagnosis, Carcinoma, Intraductal, Noninfiltrating pathology, Combined Modality Therapy, Female, Humans, Mastectomy, Neoplasm Recurrence, Local prevention & control, Tamoxifen therapeutic use, Breast Neoplasms therapy, Carcinoma, Intraductal, Noninfiltrating therapy, Mastectomy, Segmental
- Abstract
Ductal carcinoma in situ (DCIS) describes a wide spectrum of non-invasive tumors which carry a significant risk of invasive relapse, thus prevention of local recurrence is vital. For appropriate patients with limited disease, management with breast conserving surgery (BCS) followed by whole-breast radiation (RT) is supported by multiple Phase III studies, but mastectomy may be appropriate in selected patients. Omission of RT may also be reasonable in some patients, though which criteria are to be utilized remain unclear, and the existing data are contradictory with limited follow-up. Various RT techniques such as boost to the tumor bed, partial breast radiation or hypofractionated, whole-breast RT are increasingly utilized but the data to support their use specifically in DCIS is limited. Tamoxifen also increases local control for ER + DCIS, adding to the complexity of the local treatment management. This article reviews the existing scientific evidence, the controversies surrounding local management, and clinical guidelines for DCIS based on the group consensus by the ACR Breast Expert Panel. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment., (© 2011 American College of Radiology.)
- Published
- 2012
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35. Assessment of organ motion in postoperative endometrial and cervical cancer patients treated with intensity-modulated radiation therapy.
- Author
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Harris EE, Latifi K, Rusthoven C, Javedan K, and Forster K
- Subjects
- Endometrial Neoplasms diagnostic imaging, Female, Humans, Radiography, Radiotherapy, Image-Guided methods, Retrospective Studies, Tumor Burden, Uterine Cervical Neoplasms diagnostic imaging, Endometrial Neoplasms radiotherapy, Fiducial Markers, Movement, Radiotherapy, Intensity-Modulated methods, Uterine Cervical Neoplasms radiotherapy, Vagina diagnostic imaging
- Abstract
Purpose: Intensity-modulated radiation therapy (IMRT) may be useful to reduce toxicity in gynecologic cancer patients requiring postoperative pelvic irradiation. This study was undertaken to quantify vaginal wall organ motion during the course of postoperative pelvic irradiation using pelvic IMRT., Methods and Materials: Twenty-two consecutive patients treated with postoperative pelvic IMRT on helical tomotherapy had fiducial markers placed at the vaginal apex prior to simulation then daily megavoltage computed tomography (CT) scans for positioning. The daily positions of the fiducials were registered and measured in reference to the initial CT scan to quantify the degree of vaginal wall organ motion during the entire course of therapy., Results: The total motion of the fiducials center of mass (COM) was a median of 5.8 mm (range, 0.6-20.2 mm), and 95% of all COM positions fell within 15.7 mm of their original position. Directional margins of 3.1 mm along the right-left axis, 9.5 mm along the superoinferior axis, and of 12.1 mm along the anteroposterior axis encompassed the vaginal fiducials in 95% of treatments. Mean organ deformation for all patients was 3.9 mm, (range, 0-27.5 mm; standard deviation, 3.1 mm), with significant distortions of greater than 10 mm in 17% of secondary image sets., Conclusions: These data suggest a planning target volume margin of 16 mm will account for maximal organ motion in the majority of gynecologic patients undergoing postoperative pelvic IMRT, and it may be possible to incorporate directional motion into the planning target volume margin., (Copyright © 2011 Elsevier Inc. All rights reserved.)
- Published
- 2011
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36. ACR appropriateness criteria® locally advanced breast cancer.
- Author
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Macdonald SM, Harris EE, Arthur DW, Bailey L, Bellon JR, Carey L, Goyal S, Halyard MY, Horst KC, Moran MS, and Haffty BG
- Subjects
- Adult, Aged, Aged, 80 and over, Breast Neoplasms mortality, Combined Modality Therapy, Female, Humans, Mammaplasty, Mastectomy, Segmental, Middle Aged, Breast Neoplasms therapy, Evidence-Based Medicine, Practice Guidelines as Topic
- Abstract
Locally advanced breast cancer (LABC) is a disease that is heterogeneous in its presentation, potentially curable, and generally necessitating multidisciplinary management. Radiation therapy (RT) plays an important role in the management of LABC. The integration of radiation with surgery, chemotherapy, and sometimes breast reconstruction can be complex. The American College of Radiology Appropriateness Criteria Breast Committee aims to provide guidance for the management of a variety of LABC cases. The American College of Radiology Appropriateness Criteria is evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is either lacking or not definitive, expert opinion may be used to recommend imaging or treatment., (© 2011 American College of Radiology.)
- Published
- 2011
- Full Text
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37. ACR Appropriateness Criteria® conservative surgery and radiation--stage I and II breast carcinoma: expert panel on radiation oncology: breast.
- Author
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Bellon JR, Harris EE, Arthur DW, Bailey L, Carey L, Goyal S, Halyard MY, Horst KC, Moran MS, MacDonald SM, and Haffty BG
- Subjects
- Breast Neoplasms pathology, Breast Neoplasms surgery, Carcinoma pathology, Carcinoma surgery, Contraindications, Female, Humans, Mastectomy, Segmental, Neoplasm Staging, Radiotherapy, Adjuvant standards, Breast Neoplasms radiotherapy, Carcinoma radiotherapy, Organ Sparing Treatments standards
- Abstract
Breast conservation is a safe and effective alternative to mastectomy for the majority of women with early-stage breast cancer. Adjuvant radiation therapy lowers the risk of recurrence within the breast and also confers a survival benefit. Although acute side effects of radiation therapy are generally well tolerated; efforts are ongoing to minimize the long-term side effects of radiation, most prominently atherosclerotic heart disease. Efforts to minimize radiation therapy are also underway. They include omitting treatment altogether in the elderly and using accelerated, hypofractionated whole-breast irradiation, and accelerated partial-breast irradiation. Several randomized studies are ongoing to determine the efficacy, safety, and appropriate patients for these shorter treatments., (© 2011 American College of Radiology.)
- Published
- 2011
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38. Cardiac morbidity and mortality in women with ductal carcinoma in situ of the breast treated with breast conservation therapy.
- Author
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Park CK, Li X, Starr J, and Harris EE
- Subjects
- Adult, Aged, Aged, 80 and over, Breast Neoplasms surgery, Carcinoma, Intraductal, Noninfiltrating surgery, Disease-Free Survival, Female, Follow-Up Studies, Heart Diseases etiology, Humans, Kaplan-Meier Estimate, Middle Aged, Organ Sparing Treatments, Radiotherapy Dosage, Retrospective Studies, Breast Neoplasms radiotherapy, Carcinoma, Intraductal, Noninfiltrating radiotherapy, Heart Diseases mortality, Radiotherapy, Adjuvant adverse effects
- Abstract
Left-sided breast irradiation has been associated with increased risk of cardiac morbidity and mortality in some studies. This study examines the cardiac toxicity of irradiation in left- versus right-sided patients with ductal carcinoma in situ (DCIS). The medical records of 129 patients with DCIS treated with breast conservation therapy (BCT) at the Moffitt Cancer Center from 1986 to 2002 were reviewed and data regarding subsequent breast cancer and cardiac events were recorded. There were 59 left-sided and 70 right-sided patients treated. Mean age was 55 years. At 8 years, there was no significant difference observed between right- and left-sided breast cancer patients in the development of coronary artery disease, myocardial infarction, congestive heart failure, arrhythmia, valvular disease, cardiomyopathy, or cardiac-related death. Among those patients with left-sided breast cancer, 13.5% of patients developed a cardiovascular event compared to 7% of right-sided patients (p = 0.25). The overall survival at 8 years was 96% and the relapse-free survival was 85%. There were no significant differences in cardiac mortality or morbidity between right- and left-sided DCIS patients treated with BCT. Longer follow-up will be required to ascertain whether late events are more prevalent in left-sided patients., (© 2011 Wiley Periodicals, Inc.)
- Published
- 2011
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39. Coalescent analysis of mtDNA indicates Pleistocene divergence among three species of howler monkey (Alouatta spp.) and population subdivision within the Atlantic Coastal Forest species, A. guariba.
- Author
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de Mello Martins F, Gifalli-Iughetti C, Koiffman CP, and Harris EE
- Subjects
- Alouatta classification, Animals, Brazil, Phylogeography, Alouatta genetics, Biological Evolution, Cytochromes b genetics, DNA, Mitochondrial genetics, Genetic Speciation
- Abstract
We have used coalescent analysis of mtDNA cytochrome b (cyt b) sequences to estimate times of divergence of three species of Alouatta--A. caraya, A. belzebul, and A. guariba--which are in close geographic proximity. A. caraya is inferred to have diverged from the A. guariba/A. belzebul clade approximately 3.83 million years ago (MYA), with the later pair diverging approximately 1.55 MYA. These dates are much more recent than previous dates based on molecular-clock methods. In addition, analyses of new sequences from the Atlantic Coastal Forest species A. guariba indicate the presence of two distinct haplogroups corresponding to northern and southern populations with both haplogroups occurring in sympatry within Sao Paulo state. The time of divergence of these two haplogroups is estimated to be 1.2 MYA and so follows quite closely after the divergence of A. guariba and A. belzebul. These more recent dates point to the importance of Pleistocene environmental events as important factors in the diversification of A. belzebul and A. guariba. We discuss the diversification of the three Alouatta species in the context of recent models of climatic change and with regard to recent molecular phylogeographic analyses of other animal groups distributed in Brazil.
- Published
- 2011
- Full Text
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40. Optimization of Adjuvant Radiation in Breast Conservation Therapy: Can We Minimize without Compromise?
- Author
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Edwards-Bennett SM, Correa CR, and Harris EE
- Abstract
Adjuvant breast radiation therapy after breast conservation surgery is recommended as it yields significant reduction in the risk of local recurrence, and confers a potential overall survival benefit. Although the standard breast radiation regimen has historically been delivered over 5-7 weeks; more novel, shorter courses of breast radiation are currently being employed, offering the advantage of more convenience and less time-commitment. Herein, we review the recent literature substantiating these abbreviated radiation treatment approaches and the methods of delivery thereof. In addition, we discuss imaged guided techniques currently being utilized to further refine the delivery of adjuvant breast radiation therapy.
- Published
- 2011
- Full Text
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41. Stereotactic body radiotherapy for early-stage non-small-cell lung cancer: report of the ASTRO Emerging Technology Committee.
- Author
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Buyyounouski MK, Balter P, Lewis B, D'Ambrosio DJ, Dilling TJ, Miller RC, Schefter T, Tomé W, Harris EE, Price RA Jr, Konski AA, and Wallner PE
- Subjects
- Carcinoma, Non-Small-Cell Lung pathology, Clinical Trials as Topic, Four-Dimensional Computed Tomography, Humans, Lung Neoplasms pathology, Movement, Neoplasm Staging, Radiosurgery adverse effects, Radiosurgery instrumentation, Radiosurgery trends, Radiotherapy Dosage, Respiration, Respiratory-Gated Imaging Techniques methods, Risk, Technology, Radiologic instrumentation, Technology, Radiologic trends, Tumor Burden, Carcinoma, Non-Small-Cell Lung surgery, Lung Neoplasms surgery, Radiosurgery methods
- Published
- 2010
- Full Text
- View/download PDF
42. Accelerated partial breast irradiation: potential roles following breast-conserving surgery.
- Author
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Biagioli MC and Harris EE
- Subjects
- Breast Neoplasms surgery, Clinical Trials as Topic, Female, Humans, Mastectomy, Segmental, Radiotherapy, Adjuvant methods, Breast Neoplasms radiotherapy, Radiotherapy methods
- Abstract
Background: Multiple randomized trials comparing mastectomy to lumpectomy and whole breast irradiation (WBI) have shown equivalent survival outcomes in early-stage breast cancer. WBI requires a treatment course of several weeks, which has resulted in limited access to breast-conserving therapy in certain populations. A shorter accelerated course of partial breast irradiation (APBI) has been investigated recently., Methods: This article reviews the current medical literature, including randomized trials and prospective institutional studies of APBI and the current recommendations regarding the use of this emerging technique., Results: Several APBI techniques have been developed, including brachytherapy and external beam methods. The longest follow-up data are available for multicatheter interstitial brachytherapy, a technique that is not commonly used. Other methods, including balloon brachytherapy and external beam three-dimensional conformal techniques, have limited follow-up that shows similar local control rates to whole breast irradiation in highly selected patients. Guidelines for the appropriate use of APBI have been published., Conclusions: While APBI may increase access to breast conservation therapy for some women with early-stage breast cancer, follow-up data demonstrating the efficacy of this relatively new treatment approach are limited. Therefore, strict evidence-based selection criteria should be applied when evaluating patients who may be appropriate for APBI.
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- 2010
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- View/download PDF
43. Stereotactic body radiotherapy for primary management of early-stage, low- to intermediate-risk prostate cancer: report of the American Society for Therapeutic Radiology and Oncology Emerging Technology Committee.
- Author
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Buyyounouski MK, Price RA Jr, Harris EE, Miller R, Tomé W, Schefter T, Parsai EI, Konski AA, and Wallner PE
- Subjects
- Clinical Trials as Topic, Dose Fractionation, Radiation, Equipment Design, Forecasting, Humans, Male, Prostatic Neoplasms pathology, Radiation Injuries etiology, Radiation Oncology instrumentation, Radiation Oncology methods, Radiation Tolerance, Radiosurgery instrumentation, Radiotherapy, Conformal, Rectum radiation effects, Societies, Medical, Technology, Radiologic instrumentation, Technology, Radiologic methods, United States, Prostatic Neoplasms surgery, Radiosurgery methods
- Published
- 2010
- Full Text
- View/download PDF
44. Role of anemia prior to radiation treatment in local recurrence and survival after breast conservation treatment for early-stage breast cancer.
- Author
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Harris EE, Kasi S, Hwang WT, Vapiwala N, and Solin LJ
- Subjects
- Adult, Anemia epidemiology, Breast Neoplasms radiotherapy, Combined Modality Therapy, Disease-Free Survival, Female, Hemoglobins analysis, Hemoglobins radiation effects, Humans, Mastectomy, Segmental, Middle Aged, Neoplasm Recurrence, Local radiotherapy, Neoplasm Staging, Treatment Outcome, Anemia complications, Breast Neoplasms complications, Breast Neoplasms mortality, Neoplasm Recurrence, Local complications, Neoplasm Recurrence, Local mortality
- Abstract
Background: Anemia is common among patients with newly diagnosed cancer, may be exacerbated by cancer therapies, and leads to radioresistance by lowering oxygen levels in the tumor microenvironment. Herein, the effect of breast irradiation on hemoglobin levels and outcomes in breast conservation therapy is reported., Patients and Methods: Medical records of 1368 women with stage 0, I, and II breast cancer treated with breast conservation therapy from 1977-2002 were reviewed. Hemoglobin levels at baseline as well as during and after radiation were recorded. Patterns of hemoglobin changes and the effect of anemia on local control and survival outcomes were assessed. Median follow-up time was 8 years for the normal group and 6 years for the anemic group., Results: Baseline anemia was seen in 18% of the patients, 90% of whom had mild anemia (hemoglobin, 11.9-10.0 g/dL). Anemia was recorded in 21% during radiation. Among patients with normal baseline hemoglobin levels, 6.5% of the patients became anemic during radiation. Of those with baseline anemia, 72% had stable to improved hemoglobin levels during radiation, and 22% declined by a median of 0.3 g/dL. There were no significant differences in local or regional recurrence, overall, disease-free, cause-specific, or distant disease-free survival between patients with baseline anemia or with normal hemoglobin., Conclusion: Radiation does not contribute significantly to anemia during breast conservation treatment, and mild anemia does not affect outcomes. It is unnecessary to obtain routine hemoglobin levels during radiation therapy. There is no difference in outcomes based on hemoglobin levels; thus, there is no reason to transfuse or provide erythropoiesis-stimulating agents for hemoglobin levels > 10 g/dL during radiation treatment of the breast.
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- 2010
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45. Nonadaptive processes in primate and human evolution.
- Author
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Harris EE
- Subjects
- Adaptation, Biological genetics, Animals, Humans, Mutation, Polymorphism, Genetic, Evolution, Molecular, Primates genetics
- Abstract
Evolutionary biology has tended to focus on adaptive evolution by positive selection as the primum mobile of evolutionary trajectories in species while underestimating the importance of nonadaptive evolutionary processes. In this review, I describe evidence that suggests that primate and human evolution has been strongly influenced by nonadaptive processes, particularly random genetic drift and mutation. This is evidenced by three fundamental effects: a relative relaxation of selective constraints (i.e., purifying selection), a relative increase in the fixation of slightly deleterious mutations, and a general reduction in the efficacy of positive selection. These effects are observed in protein-coding, regulatory regions, and in gene expression data, as well as in an augmentation of fixation of large-scale mutations, including duplicated genes, mobile genetic elements, and nuclear mitochondrial DNA. The evidence suggests a general population-level explanation such as a reduction in effective population size (N(e)). This would have tipped the balance between the evolutionary forces of natural selection and random genetic drift toward genetic drift for variants having small selective effects. After describing these proximate effects, I describe the potential consequences of these effects for primate and human evolution. For example, an increase in the fixation of slightly deleterious mutations could potentially have led to an increase in the fixation rate of compensatory mutations that act to suppress the effects of slightly deleterious substitutions. The potential consequences of compensatory evolution for the evolution of novel gene functions and in potentially confounding the detection of positively selected genes are explored. The consequences of the passive accumulation of large-scale genomic mutations by genetic drift are unclear, though evidence suggests that new gene copies as well as insertions of transposable elements into genes can potentially lead to adaptive phenotypes. Finally, because a decrease in selective constraint at the genetic level is expected to have effects at the morphological level, I review studies that compare rates of morphological change in various mammalian and island populations where N(e) is reduced. Furthermore, I discuss evidence that suggests that craniofacial morphology in the Homo lineage has shifted from an evolutionary rate constrained by purifying selection toward a neutral evolutionary rate., (Copyright © 2010 Wiley-Liss, Inc.)
- Published
- 2010
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46. Time course of mild arm lymphedema after breast conservation treatment for early-stage breast cancer.
- Author
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Bar Ad V, Cheville A, Solin LJ, Dutta P, Both S, and Harris EE
- Subjects
- Adult, Aged, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Arm, Axilla, Breast Neoplasms pathology, Disease Progression, Early Detection of Cancer, Female, Humans, Lymphatic Irradiation methods, Lymphatic Metastasis pathology, Lymphedema etiology, Middle Aged, Neoplasm Staging, Proportional Hazards Models, Radiotherapy Dosage, Retrospective Studies, Sentinel Lymph Node Biopsy statistics & numerical data, Breast Neoplasms therapy, Lymph Node Excision adverse effects, Lymphedema pathology
- Abstract
Purpose: Arm lymphedema is a potential consequence of the treatment for breast carcinoma. The objective of this retrospective study was to characterize the progression of mild arm lymphedema after breast conservation treatment for breast cancer., Methods and Materials: The study cohort was drawn from 1,713 consecutive Stage I or II breast cancer patients who underwent breast conservation therapy, including axillary staging followed by radiation. Arm lymphedema was documented in 266 (16%) of 1,713 patients. One hundred nine patients, 6% of the overall group and 40% of the patients with arm lymphedema, presented with mild arm lymphedema, defined as a difference of 2 cm or less between the measured circumferences of the affected and unaffected arms., Results: Among the 109 patients with mild arm lymphedema at the time of arm lymphedema diagnosis, the rate of freedom from progression to more severe lymphedema was 79% at 1 year, 66% at 3 years, and 52% at 5 years. The patients who were morbidly obese, had positive axillary lymph nodes, or received supraclavicular irradiation at the time of breast cancer treatment were at higher risk of progression from mild arm lymphedema to more severe edema., Conclusions: Mild arm lymphedema, generally considered to be a minor complication after breast conservation treatment for breast cancer, was associated with a risk of progression to a more severe grade of arm lymphedema in a substantial fraction of patients.
- Published
- 2010
- Full Text
- View/download PDF
47. Results of the Association of Directors of Radiation Oncology Programs (ADROP) survey of radiation oncology residency program directors.
- Author
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Harris EE, Abdel-Wahab M, Spangler AE, Lawton CA, and Amdur RJ
- Subjects
- Accreditation, Curriculum standards, Curriculum statistics & numerical data, Data Collection, Financial Support, Personnel Management, Program Evaluation, Radiation Oncology standards, Radiation Oncology statistics & numerical data, Time Factors, United States, Administrative Personnel, Education, Medical, Graduate organization & administration, Education, Medical, Graduate standards, Education, Medical, Graduate statistics & numerical data, Internship and Residency organization & administration, Internship and Residency standards, Internship and Residency statistics & numerical data, Radiation Oncology education
- Abstract
Purpose: To survey the radiation oncology residency program directors on the topics of departmental and institutional support systems, residency program structure, Accreditation Council for Graduate Medical Education (ACGME) requirements, and challenges as program director., Methods: A survey was developed and distributed by the leadership of the Association of Directors of Radiation Oncology Programs to all radiation oncology program directors. Summary statistics, medians, and ranges were collated from responses., Results: Radiation oncology program directors had implemented all current required aspects of the ACGME Outcome Project into their training curriculum. Didactic curricula were similar across programs nationally, but research requirements and resources varied widely. Program directors responded that implementation of the ACGME Outcome Project and the external review process were among their greatest challenges. Protected time was the top priority for program directors., Conclusions: The Association of Directors of Radiation Oncology Programs recommends that all radiation oncology program directors have protected time and an administrative stipend to support their important administrative and educational role. Departments and institutions should provide adequate and equitable resources to the program directors and residents to meet increasingly demanding training program requirements.
- Published
- 2009
- Full Text
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48. Pathophysiological levels of soluble P-selectin mediate adhesion of leukocytes to the endothelium through Mac-1 activation.
- Author
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Woollard KJ, Suhartoyo A, Harris EE, Eisenhardt SU, Jackson SP, Peter K, Dart AM, Hickey MJ, and Chin-Dusting JP
- Subjects
- Animals, Aorta metabolism, Aorta pathology, Atherosclerosis pathology, Atherosclerosis physiopathology, Cell Adhesion drug effects, Dose-Response Relationship, Drug, Endothelium, Vascular pathology, Female, Gene Expression Regulation, Humans, Male, Mice, Neutrophils pathology, P-Selectin pharmacology, Veins metabolism, Veins pathology, Atherosclerosis metabolism, Endothelium, Vascular metabolism, Leukocyte Rolling drug effects, Macrophage-1 Antigen metabolism, Neutrophils metabolism, P-Selectin metabolism
- Abstract
Plasma soluble P-selectin (sP-selectin) levels are increased in pathologies associated with atherosclerosis, including peripheral arterial occlusive disease (PAOD). However, the role of sP-selectin in regulating leukocyte-endothelial adhesion is unclear. The aim of this study was to assess the ability of exogenous and endogenous sP-selectin to induce leukocyte responses that promote their adhesion to various forms of endothelium. In flow chamber assays, sP-selectin dose-dependently increased neutrophil adhesion to resting human iliac artery endothelial cells. Similarly, sP-selectin induced neutrophil adhesion to the endothelial surface of murine aortae and human radial venous segments in ex vivo flow chamber experiments. Using intravital microscopy to examine postcapillary venules in the mouse cremaster muscle, in vivo administration of sP-selectin was also found to significantly increase leukocyte rolling and adhesion in unstimulated postcapillary venules. Using a Mac-1-specific antibody and P-selectin knockout mouse, it was demonstrated that this finding was dependent on a contribution of Mac-1 to leukocyte rolling and endothelial P-selectin expression. This was confirmed in an ex vivo perfusion model using viable mouse aorta and human radial vessels. In contrast, with tumor necrosis factor-alpha-activated endothelial cells and intact endothelium, where neutrophil adhesion was already elevated, sP-selectin failed to further increase adhesion. Plasma samples from PAOD patients containing pathologically elevated concentrations of sP-selectin also increased neutrophil adhesion to the endothelium in a sP-selectin-dependent manner, as demonstrated by immunodepletion of sP-selectin. These studies demonstrate that raised plasma sP-selectin may influence the early progression of vascular disease by promoting leukocyte adhesion to the endothelium in PAOD, through Mac-1-mediated rolling and dependent on endothelial P-selectin expression.
- Published
- 2008
- Full Text
- View/download PDF
49. Association between tangential beam treatment parameters and cardiac abnormalities after definitive radiation treatment for left-sided breast cancer.
- Author
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Correa CR, Das IJ, Litt HI, Ferrari V, Hwang WT, Solin LJ, and Harris EE
- Subjects
- Breast Neoplasms pathology, Case-Control Studies, Coronary Artery Disease diagnosis, Coronary Artery Disease etiology, Coronary Circulation, Echocardiography, Female, Heart anatomy & histology, Heart Failure diagnosis, Heart Failure etiology, Humans, Lung anatomy & histology, Middle Aged, Myocardial Infarction diagnosis, Myocardial Infarction etiology, Retrospective Studies, Breast Neoplasms radiotherapy, Heart radiation effects, Radiation Injuries complications
- Abstract
Purpose: To examine the association between radiation treatment (RT) parameters, cardiac diagnostic test abnormalities, and clinical cardiovascular diagnoses among patients with left-sided breast cancer after breast conservation treatment with tangential beam RT., Methods and Materials: The medical records of 416 patients treated between 1977 and 1995 with RT for primary left-sided breast cancer were reviewed for myocardial perfusion imaging and echocardiograms. Sixty-two patients (62/416, 15%) underwent these cardiac diagnostic tests for cardiovascular symptoms and were selected for further study. Central lung distance and maximum heart width and length in the treatment field were determined for each patient. Medical records were reviewed for cardiovascular diagnoses and evaluation of cardiac risk factors., Results: At a median of 12 years post-RT the incidence of cardiac diagnostic test abnormalities among symptomatic left-sided irradiated women was significantly higher than the predicted incidence of cardiovascular disease in the patient population, 6/62 (9%) predicted vs. 24/62 (39%) observed, p = 0.001. As compared with patients with normal tests, patients with cardiac diagnostic test abnormalities had a larger median central lung distance (2.6 cm vs. 2.2 cm, p = 0.01). Similarly, patients with vs. without congestive heart failure had a larger median central lung distance (2.8 cm vs. 2.3 cm, p = 0.008)., Conclusions: Contemporary RT for early breast cancer may be associated with a small, but potentially avoidable, risk of cardiovascular morbidity that is associated with treatment technique.
- Published
- 2008
- Full Text
- View/download PDF
50. Cardiac morbidity and mortality after breast conservation treatment in patients with early-stage breast cancer and preexisting cardiac disease.
- Author
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Gutt R, Correa CR, Hwang WT, Solin LJ, Litt HI, Ferrari VA, and Harris EE
- Subjects
- Adult, Aged, Aged, 80 and over, Breast Neoplasms mortality, Combined Modality Therapy, Female, Functional Laterality, Humans, Mastectomy, Segmental, Middle Aged, Radiotherapy, Adjuvant adverse effects, Breast Neoplasms complications, Breast Neoplasms radiotherapy, Heart radiation effects, Heart Diseases complications
- Abstract
Background: This study was undertaken to determine the risk of late cardiac morbidity and mortality in patients with preexisting cardiac disease treated with contemporary radiation techniques for early-stage breast cancer., Patients and Methods: Medical records were reviewed for 41 patients with early-stage breast cancer and a history of myocardial infarction, congestive heart failure (CHF), and/or coronary artery disease before radiation therapy. Data were recorded on baseline cardiac disease and tumor characteristics, cardiac morbidity during and after treatment, and survival status of each patient. Patients were stratified for right- versus left-sided breast cancer and compared., Results: There was no significant difference in overall survival (OS) between the right- and left-sided groups (log-rank test; P = .19). The left-sided group had a higher incidence of cardiac deaths (right side, 2 of 26 [9%]; left side, 4 of 15 [27%]; hazard ratio, 4.2; P = .08) 10 years after treatment, including deaths secondary to myocardial infarction, CHF, or coronary artery disease. On the other hand, the right-sided group had a higher proportion of deaths secondary to breast cancer (right, 8 of 26 [31%]; left, 2 of 15 [13%]) and non-breast cancer/noncardiac causes (right, 7 of 26 [27%]; left, 1 of 15 [7%])., Conclusion: Although OS was similar in both groups, radiation was associated with a higher incidence of cardiac death in patients with left-sided breast cancer. Efforts should be made to minimize cardiac exposure and also to promote more vigilant risk factor modification in this group of women.
- Published
- 2008
- Full Text
- View/download PDF
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