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1. Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Author: Brauer, M, Roth, GA, Aravkin, AY, Zheng, P, Abate, KH, Abate, YH, Abbafati, C, Abbasgholizadeh, R, Abbasi, MA, Abbasian, M, Abbasifard, M, Abbasi-Kangevari, M, Abd ElHafeez, S, Abd-Elsalam, S, Abdi, P, Abdollahi, M, Abdoun, M, Abdulah, DM, Abdullahi, A, Abebe, M, Abedi, A, Abegaz, TM, Abeldaño Zuñiga, RA, Abiodun, O, Abiso, TL, Aboagye, RG, Abolhassani, H, Abouzid, M, Aboye, GB, Abreu, LG, Abualruz, H, Abubakar, B, Abu-Gharbieh, E, Abukhadijah, HJJ, Aburuz, S, Abu-Zaid, A, Adane, MM, Addo, IY, Addolorato, G, Adedoyin, RA, Adekanmbi, V, Aden, B, Adetunji, JB, Adeyeoluwa, TE, Adha, R, Adibi, A, Adnani, QES, Adzigbli, LA, Afolabi, AA, Afolabi, RF, Afshin, A, Afyouni, S, Afzal, MS, Afzal, S, Agampodi, SB, Agbozo, F, Aghamiri, S, Agodi, A, Agrawal, A, Agyemang-Duah, W, Ahinkorah, BO, Ahmad, A, Ahmad, D, Ahmad, F, Ahmad, N, Ahmad, S, Ahmad, T, Ahmed, A, Ahmed, LA, Ahmed, MB, Ahmed, S, Ahmed, SA, Ajami, M, Akalu, GT, Akara, EM, Akbarialiabad, H, Akhlaghi, S, Akinosoglou, K, Akinyemiju, T, Akkaif, MA, Akkala, S, Akombi-Inyang, B, Al Awaidy, S, Al Hasan, SM, Alahdab, F, AL-Ahdal, TMA, Alalalmeh, SO, Alalwan, TA, Al-Aly, Z, Alam, K, Alam, N, Alanezi, FM, Alanzi, TM, Albakri, A, AlBataineh, MT, Aldhaleei, WA, Aldridge, RW, Alemayohu, MA, Alemu, YM, Al-Fatly, B, Al-Gheethi, AAS, Al-Habbal, K, Alhabib, KF, Alhassan, RK, Ali, A, Ali, BA, Ali, I, Ali, L, Ali, MU, Ali, R, Ali, SSS, Ali, W, Alicandro, G, Alif, SM, Aljunid, SM, Alla, F, Al-Marwani, S, Al-Mekhlafi, HM, Almustanyir, S, Alomari, MA, Alonso, J, Alqahtani, JS, Alqutaibi, AY, Al-Raddadi, RM, Alrawashdeh, A, Al-Rifai, RH, Alrousan, SM, Al-Sabah, SK, Alshahrani, NZ, Altaany, Z, Altaf, A, Al-Tawfiq, JA, Altirkawi, KA, Aluh, DO, Alvis-Guzman, N, Alvis-Zakzuk, NJ, Alwafi, H, Al-Wardat, MS, Al-Worafi, YM, Aly, H, Aly, S, Alzoubi, KH, Al-Zyoud, W, Amaechi, UA, Aman Mohammadi, M, Amani, R, Amiri, S, Amirzade-Iranaq, MH, Ammirati, E, Amu, H, Amugsi, DA, Amusa, GA, Ancuceanu, R, Anderlini, D, Anderson, JA, Andrade, PP, Andrei, CL, Andrei, T, Anenberg, SC, Angappan, D, Angus, C, Anil, A, Anil, S, Anjum, A, Anoushiravani, A, Antonazzo, IC, Antony, CM, Antriyandarti, E, Anuoluwa, BS, Anvari, D, Anvari, S, Anwar, S, Anwar, SL, Anwer, R, Anyabolo, EE, Anyasodor, AE, Apostol, GLC, Arabloo, J, Arabzadeh Bahri, R, Arafat, M, Areda, D, Aregawi, BB, Aremu, A, Armocida, B, Arndt, MB, Ärnlöv, J, Arooj, M, Artamonov, AA, Artanti, KD, Aruleba, IT, Arumugam, A, Asbeutah, AM, Asgary, S, Asgedom, AA, Ashbaugh, C, Ashemo, MY, Ashraf, T, Askarinejad, A, Assmus, M, Astell-Burt, T, Athar, M, Athari, SS, Atorkey, P, Atreya, A, Aujayeb, A, Ausloos, M, Avila-Burgos, L, Awoke, AA, Ayala Quintanilla, BP, Ayatollahi, H, Ayestas Portugal, C, Ayuso-Mateos, JL, Azadnajafabad, S, Azevedo, RMS, Azhar, GS, Azizi, H, Azzam, AY, Backhaus, IL, Badar, M, Badiye, AD, Bagga, A, Baghdadi, S, Bagheri, N, Bagherieh, S, Bahrami Taghanaki, P, Bai, R, Baig, AA, Baker, JL, Bakkannavar, SM, Balasubramanian, M, Baltatu, OC, Bam, K, Bandyopadhyay, S, Banik, B, Banik, PC, Banke-Thomas, A, Bansal, H, Barchitta, M, Bardhan, M, Bardideh, E, Barker-Collo, SL, Bärnighausen, TW, Barone-Adesi, F, Barqawi, HJ, Barrero, LH, Barrow, A, Barteit, S, Basharat, Z, Basiru, A, Basso, JD, Bastan, M-M, Basu, S, Batchu, S, Batra, K, Batra, R, Baune, BT, Bayati, M, Bayileyegn, NS, Beaney, T, Behnoush, AH, Beiranvand, M, Béjot, Y, Bekele, A, Belgaumi, UI, Bell, AW, Bell, ML, Bello, MB, Bello, OO, Belo, L, Beloukas, A, Bendak, S, Bennett, DA, Bennitt, FB, Bensenor, IM, Benzian, H, Beran, A, Berezvai, Z, Bernabe, E, Bernstein, RS, Bettencourt, PJG, Bhagavathula, AS, Bhala, N, Bhandari, D, Bhardwaj, N, Bhardwaj, P, Bhaskar, S, Bhat, AN, Bhat, V, Bhatti, GK, Bhatti, JS, Bhatti, MS, Bhatti, R, Bhuiyan, MA, Bhutta, ZA, Bikbov, B, Bishai, JD, Bisignano, C, Biswas, A, Biswas, B, Biswas, RK, Bjørge, T, Boachie, MK, Boakye, H, Bockarie, MJ, Bodolica, V, Bodunrin, AO, Bogale, EK, Bolla, SR, Boloor, A, Bonakdar Hashemi, M, Boppana, SH, Bora Basara, B, Borhany, H, Botero Carvajal, A, Bouaoud, S, Boufous, S, Bourne, R, Boxe, C, Braithwaite, D, Brant, LC, Brar, A, Breitborde, NJK, Breitner, S, Brenner, H, Briko, AN, Britton, G, Brown, CS, Browne, AJ, Brunoni, AR, Bryazka, D, Bulamu, NB, Bulto, LN, Buonsenso, D, Burkart, K, Burns, RA, Busse, R, Bustanji, Y, Butt, NS, Butt, ZA, Caetano dos Santos, FL, Cagney, J, Cahuana-Hurtado, L, Calina, D, Cámera, LA, Campos, LA, Campos-Nonato, IR, Cao, C, Cao, F, Cao, Y, Capodici, A, Cárdenas, R, Carr, S, Carreras, G, Carrero, JJ, Carugno, A, Carvalho, F, Carvalho, M, Castaldelli-Maia, JM, Castañeda-Orjuela, CA, Castelpietra, G, Catalá-López, F, Catapano, AL, Cattaruzza, MS, Caye, A, Cederroth, CR, Cegolon, L, Cenderadewi, M, Cercy, KM, Cerin, E, Chadwick, J, Chakraborty, C, Chakraborty, PA, Chakraborty, S, Chan, JSK, Chan, RNC, Chandan, JS, Chandika, RM, Chaturvedi, P, Chen, A-T, Chen, CS, Chen, H, Chen, MX, Chen, M, Chen, S, Cheng, C-Y, Cheng, ETW, Cherbuin, N, Chi, G, Chichagi, F, Chimed-Ochir, O, Chimoriya, R, Ching, PR, Chirinos-Caceres, JL, Chitheer, A, Cho, WCS, Chong, B, Chopra, H, Chowdhury, R, Christopher, DJ, Chu, D-T, Chukwu, IS, Chung, E, Chung, S-C, Chutiyami, M, Cioffi, I, Cogen, RM, Cohen, AJ, Columbus, A, Conde, J, Corlateanu, A, Cortese, S, Cortesi, PA, Costa, VM, Costanzo, S, Criqui, MH, Cruz, JA, Cruz-Martins, N, Culbreth, GT, da Silva, AG, Dadras, O, Dai, X, Dai, Z, Daikwo, PU, Dalli, LL, Damiani, G, D'Amico, E, D'Anna, L, Darwesh, AM, Das, JK, Das, S, Dash, NR, Dashti, M, Dávila-Cervantes, CA, Davis Weaver, N, Davitoiu, DV, De la Hoz, FP, de la Torre-Luque, A, De Leo, D, Debopadhaya, S, Degenhardt, L, Del Bo', C, Delgado-Enciso, I, Delgado-Saborit, JM, Demoze, CK, Denova-Gutiérrez, E, Dervenis, N, Dervišević, E, Desai, HD, Desai, R, Devanbu, VGC, Dewan, SMR, Dhali, A, Dhama, K, Dhane, AS, Dhimal, ML, Dhimal, M, Dhingra, S, Dhulipala, VR, Dhungana, RR, Dias da Silva, D, Diaz, D, Diaz, LA, Diaz, MJ, Dima, A, Ding, DD, Dinu, M, Djalalinia, S, Do, TC, Do, THP, do Prado, CB, Dodangeh, M, Dohare, S, Dokova, KG, Dong, W, Dongarwar, D, D'Oria, M, Dorostkar, F, Dorsey, ER, Doshi, R, Doshmangir, L, Dowou, RK, Driscoll, TR, Dsouza, AC, Dsouza, HL, Dumith, SC, Duncan, BB, Duraes, AR, Duraisamy, S, Dushpanova, A, Dzianach, PA, Dziedzic, AM, Ebrahimi, A, Echieh, CP, Ed-Dra, A, Edinur, HA, Edvardsson, D, Edvardsson, K, Efendi, F, Eftekharimehrabad, A, Eini, E, Ekholuenetale, M, Ekundayo, TC, El Arab, RA, El Sayed Zaki, M, El-Dahiyat, F, Elemam, NM, Elgar, FJ, ElGohary, GMT, Elhabashy, HR, Elhadi, M, Elmehrath, AO, Elmeligy, OAA, Elshaer, M, Elsohaby, I, Emeto, TI, Esfandiari, N, Eshrati, B, Eslami, M, Esmaeili, SV, Estep, K, Etaee, F, Fabin, N, Fagbamigbe, AF, Fagbule, OF, Fahimi, S, Falzone, L, Fareed, M, Farinha, CSES, Faris, MEM, Faris, PS, Faro, A, Fasina, FO, Fatehizadeh, A, Fauk, NK, Fazylov, T, Feigin, VL, Feng, X, Fereshtehnejad, S-M, Feroze, AH, Ferrara, P, Ferrari, AJ, Ferreira, N, Fetensa, G, Feyisa, BR, Filip, I, Fischer, F, Fitriana, I, Flavel, J, Flohr, C, Flood, D, Flor, LS, Foigt, NA, Folayan, MO, Force, LM, Fortuna, D, Foschi, M, Franklin, RC, Freitas, A, Friedman, SD, Fux, B, G, S, Gaal, PA, Gaihre, S, Gajdács, M, Galali, Y, Gallus, S, Gandhi, AP, Ganesan, B, Ganiyani, MA, Garcia, V, Gardner, WM, Garg, RK, Gautam, RK, Gebi, TG, Gebregergis, MW, Gebrehiwot, M, Gebremariam, TBB, Gebremeskel, TG, Gerema, U, Getacher, L, Getahun, GKA, Getie, M, Ghadirian, F, Ghafarian, S, Ghaffari Jolfayi, A, Ghailan, KY, Ghajar, A, Ghasemi, M, Ghasempour Dabaghi, G, Ghasemzadeh, A, Ghassemi, F, Ghazy, RM, Gholami, A, Gholamrezanezhad, A, Gholizadeh, N, Ghorbani, M, Gil, AU, Gil, GF, Gilbertson, NM, Gill, PS, Gill, TK, Gindaba, EZ, Girmay, A, Glasbey, JC, Gnedovskaya, EV, Göbölös, L, Godinho, MA, Goel, A, Golechha, M, Goleij, P, Golinelli, D, Gomes, NGM, Gopalani, SV, Gorini, G, Goudarzi, H, Goulart, AC, Gouravani, M, Goyal, A, Graham, SM, Grivna, M, Grosso, G, Guan, S-Y, Guarducci, G, Gubari, MIM, Guha, A, Guicciardi, S, Gulati, S, Gulisashvili, D, Gunawardane, DA, Guo, C, Gupta, AK, Gupta, B, Gupta, M, Gupta, R, Gupta, RD, Gupta, S, Gupta, VB, Gupta, VK, Habibzadeh, F, Habibzadeh, P, Hadaro, TS, Hadian, Z, Haep, N, Haghi-Aminjan, H, Haghmorad, D, Hagins, H, Haile, D, Hailu, A, Hajj Ali, A, Halboub, ES, Halimi, A, Hall, BJ, Haller, S, Halwani, R, Hamadeh, RR, Hamdy, NM, Hameed, S, Hamidi, S, Hammoud, A, Hanif, A, Hanifi, N, Haq, ZA, Haque, MR, Harapan, H, Hargono, A, Haro, JM, Hasaballah, AI, Hasan, I, Hasan, MJ, Hasan, SMM, Hasani, H, Hasanian, M, Hashmeh, N, Hasnain, MS, Hassan, A, Hassan, I, Hassan Zadeh Tabatabaei, MS, Hassani, S, Hassanipour, S, Hassankhani, H, Haubold, J, Havmoeller, RJ, Hay, SI, Hebert, JJ, Hegazi, OE, Hegena, TY, Heidari, G, Heidari, M, Helfer, B, Hemmati, M, Henson, CA, Herbert, ME, Herteliu, C, Heuer, A, Hezam, K, Hinneh, TK, Hiraike, Y, Hoan, NQ, Holla, R, Hon, J, Hoque, ME, Horita, N, Hossain, S, Hosseini, SE, Hosseinzadeh, H, Hosseinzadeh, M, Hostiuc, M, Hostiuc, S, Hoven, H, Hsairi, M, Hsu, JM, Hu, C, Huang, J, Huda, MN, Hulland, EN, Hultström, M, Hushmandi, K, Hussain, J, Hussein, NR, Huynh, CK, Huynh, H-H, Ibitoye, SE, Idowu, OO, Ihler, AL, Ikeda, N, Ikuta, KS, Ilesanmi, OS, Ilic, IM, Ilic, MD, Imam, MT, Immurana, M, Inbaraj, LR, Irham, LM, Isa, MA, Islam, MR, Ismail, F, Ismail, NE, Iso, H, Isola, G, Iwagami, M, Iwu, CCD, Iwu-Jaja, CJ, J, V, Jaafari, J, Jacob, L, Jacobsen, KH, Jadidi-Niaragh, F, Jahankhani, K, Jahanmehr, N, Jahrami, H, Jain, A, Jain, N, Jairoun, AA, Jaiswal, A, Jakovljevic, M, Jalilzadeh Yengejeh, R, Jamora, RDG, Jatau, AI, Javadov, S, Javaheri, T, Jayaram, S, Jeganathan, J, Jeswani, BM, Jiang, H, Johnson, CO, Jokar, M, Jomehzadeh, N, Jonas, JB, Joo, T, Joseph, A, Joseph, N, Joshi, V, Joshua, CE, Jozwiak, JJ, Jürisson, M, Kaambwa, B, Kabir, A, Kabir, Z, Kadashetti, V, Kahn, EM, Kalani, R, Kaliyadan, F, Kalra, S, Kamath, R, Kanagasabai, T, Kanchan, T, Kandel, H, Kanmiki, EW, Kanmodi, KK, Kansal, SK, Kapner, DJ, Kapoor, N, Karagiannidis, E, Karajizadeh, M, Karakasis, P, Karanth, SD, Karaye, IM, Karch, A, Karim, A, Karimi, H, Karmakar, S, Kashoo, FZ, Kasraei, H, Kassahun, WD, Kassebaum, NJ, Kassel, MB, Katikireddi, SV, Kauppila, JH, Kawakami, N, Kaydi, N, Kayode, GA, Kazemi, F, Keiyoro, PN, Kemmer, L, Kempen, JH, Kerr, JA, Kesse-Guyot, E, Khader, YS, Khafaie, MA, Khajuria, H, Khalaji, A, Khalil, M, Khalilian, A, Khamesipour, F, Khan, A, Khan, MN, Khan, M, Khan, MJ, Khan, MAB, Khanmohammadi, S, Khatab, K, Khatatbeh, H, Khatatbeh, MM, Khatib, MN, Khavandegar, A, Khayat Kashani, HR, Khidri, FF, Khodadoust, E, Khormali, M, Khorrami, Z, Khosla, AA, Khosrowjerdi, M, Khreis, H, Khusun, H, Kifle, ZD, Kim, K, Kim, MS, Kim, YJ, Kimokoti, RW, Kisa, A, Kisa, S, Knibbs, LD, Knudsen, AKS, Koh, DSQ, Kolahi, A-A, Kompani, F, Kong, J, Koren, G, Korja, M, Korshunov, VA, Korzh, O, Kosen, S, Kothari, N, Koul, PA, Koulmane Laxminarayana, SL, Krishan, K, Krishnamoorthy, V, Krishnamoorthy, Y, Krishnan, B, Krohn, KJ, Kuate Defo, B, Kucuk Bicer, B, Kuddus, MA, Kuddus, M, Kugbey, N, Kuitunen, I, Kulimbet, M, Kulkarni, V, Kumar, A, Kumar, N, Kumar, V, Kundu, S, Kurmi, OP, Kusnali, A, Kusuma, D, Kutluk, T, La Vecchia, C, Ladan, MA, Laflamme, L, Lahariya, C, Lai, DTC, Lal, DK, Lallukka, T, Lám, J, Lan, Q, Lan, T, Landires, I, Lanfranchi, F, Langguth, B, Lansingh, VC, Laplante-Lévesque, A, Larijani, B, Larsson, AO, Lasrado, S, Lauriola, P, Le, H-H, Le, LKD, Le, NHH, Le, TTT, Leasher, JL, Ledda, C, Lee, M, Lee, PH, Lee, SW, Lee, SWH, Lee, YH, LeGrand, KE, Leigh, J, Leong, E, Lerango, TL, Lescinsky, H, Leung, J, Li, M-C, Li, W-Z, Li, W, Li, Y, Li, Z, Ligade, VS, Lim, L-L, Lim, SS, Lin, R-T, Lin, S, Liu, C, Liu, G, Liu, J, Liu, RT, Liu, S, Liu, W, Liu, X, Livingstone, KM, Llanaj, E, Lohiya, A, López-Bueno, R, Lopukhov, PD, Lorkowski, S, Lotufo, PA, Lozano, R, Lubinda, J, Lucchetti, G, Luo, L, lv, H, M Amin, HI, Ma, ZF, Maass, KL, Mabrok, M, Machairas, N, Machoy, M, Mafhoumi, A, Magdy Abd El Razek, M, Maghazachi, AA, Mahadeshwara Prasad, DR, Maharaj, SB, Mahmoud, MA, Mahmoudi, E, Majeed, A, Makram, OM, Makris, KC, Malasala, S, Maled, V, Malhotra, K, Malik, AA, Malik, I, Malinga, LA, Malta, DC, Mamun, AA, Manda, AL, Manla, Y, Mansour, A, Mansouri, B, Mansouri, P, Mansourian, M, Mansournia, MA, Mantovani, LG, Manu, E, Marateb, HR, Maravilla, JC, Marsh, E, Martinez, G, Martinez-Piedra, R, Martini, S, Martins-Melo, FR, Martorell, M, Marx, W, Maryam, S, Mathangasinghe, Y, Mathioudakis, AG, Matozinhos, FP, Mattumpuram, J, Maugeri, A, Maulik, PK, Mayeli, M, Mazidi, M, Mazzotti, A, McGrath, JJ, McKee, M, McKowen, ALW, McLaughlin, SA, McPhail, MA, McPhail, SM, Mechili, EA, Mehmood, A, Mehmood, K, Mehrabani-Zeinabad, K, Mehrabi Nasab, E, Meier, T, Mejia-Rodriguez, F, Mekene Meto, T, Mekonnen, BD, Menezes, RG, Mengist, B, Mensah, GA, Mensah, LG, Mentis, A-FA, Meo, SA, Meretoja, A, Meretoja, TJ, Mersha, AM, Mesfin, BA, Mestrovic, T, Mettananda, KCD, Mettananda, S, Miazgowski, T, Micha, G, Michalek, IM, Micheletti Gomide Nogueira de Sá, AC, Miller, TR, Mirarefin, M, Mirghafourvand, M, Mirica, A, Mirijello, A, Mirrakhimov, EM, Mirshahi, A, Mirzaei, M, Mishra, AK, Mishra, V, Mitchell, PB, Mithra, P, Mittal, C, Moazen, B, Moberg, ME, Mocciaro, G, Mohamadkhani, A, Mohamed, AZ, Mohamed, AI, Mohamed, J, Mohamed, MFH, Mohamed, NS, Mohammadi, E, Mohammadi, S, Mohammadian-Hafshejani, A, Mohammadifard, N, Mohammed, H, Mohammed, M, Mohammed, S, Mokdad, AH, Monasta, L, Mondello, S, Moni, MA, Moodi Ghalibaf, A, Moore, CE, Moradi, M, Moradi, Y, Moraga, P, Morawska, L, Moreira, RS, Morovatdar, N, Morrison, SD, Morze, J, Mosaddeghi Heris, R, Mossialos, E, Motappa, R, Mougin, V, Mousavi, P, Msherghi, A, Mubarik, S, Muccioli, L, Mueller, UO, Mulita, F, Mullany, EC, Munjal, K, Murillo-Zamora, E, Murlimanju, BV, Musina, A-M, Mustafa, G, Muthu, S, Muthupandian, S, Muthusamy, R, Muzaffar, M, Myung, W, Nafei, A, Nagarajan, AJ, Nagaraju, SP, Nagel, G, Naghavi, M, Naghavi, P, Naik, GR, Naik, G, Nainu, F, Nair, TS, Najdaghi, S, Nakhostin Ansari, N, Nanavaty, DP, Nangia, V, Narasimha Swamy, S, Narimani Davani, D, Nascimento, BR, Nascimento, GG, Nashwan, AJ, Natto, ZS, Nauman, J, Navaratna, SNK, Naveed, M, Nayak, BP, Nayak, VC, Ndejjo, R, Nduaguba, SO, Negash, H, Negoi, I, Negoi, RI, Nejadghaderi, SA, Nejjari, C, Nematollahi, MH, Nepal, S, Neupane, S, Ng, M, Nguefack-Tsague, G, Ngunjiri, JW, Nguyen, DH, Nguyen, NNY, Nguyen, PT, Nguyen, VT, Nguyen Tran Minh, D, Niazi, RK, Nicholson, SI, Nie, J, Nikoobar, A, Nikpoor, AR, Ningrum, DNA, Nnaji, CA, Noman, EA, Nomura, S, Noroozi, N, Norrving, B, Noubiap, JJ, Nri-Ezedi, CA, Ntaios, G, Ntsekhe, M, Nunemo, MH, Nurrika, D, Nutor, JJ, Oancea, B, O'Connell, EM, Odetokun, IA, O'Donnell, MJ, Oduro, MS, Ogunfowokan, AA, Ogunkoya, A, Oh, I-H, Okati-Aliabad, H, Okeke, SR, Okekunle, AP, Okonji, OC, Olagunju, AT, Olasupo, OO, Olatubi, MI, Oliveira, AB, Oliveira, GMM, Olorukooba, AA, Olufadewa, II, Olusanya, BO, Olusanya, JO, Oluwafemi, YD, Omar, HA, Omar Bali, A, Omer, GL, Ong, KL, Ong, S, Onwujekwe, OE, Onyedibe, KI, Oppong, AF, Ordak, M, Orish, VN, Ornello, R, Orpana, HM, Ortiz, A, Ortiz-Prado, E, Osman, WMS, Ostroff, SM, Osuagwu, UL, Otoiu, A, Otstavnov, N, Otstavnov, SS, Ouyahia, A, Owolabi, MO, Oyeyemi, IT, Oyeyemi, OT, P A, MP, Pacheco-Barrios, K, Padron-Monedero, A, Padubidri, JR, Pal, PK, Palicz, T, Pan, F, Pan, H-F, Pana, A, Panda, SK, Panda-Jonas, S, Pandey, A, Pandi-Perumal, SR, Pangaribuan, HU, Pantazopoulos, I, Pantea Stoian, AM, Papadopoulou, P, Parent, MC, Parija, PP, Parikh, RR, Park, S, Parsons, N, Pashaei, A, Pasovic, M, Passera, R, Patil, S, Patoulias, D, Patthipati, VS, Paudel, U, Pawar, S, Pazoki Toroudi, H, Peden, AE, Pedersini, P, Peng, M, Pensato, U, Pepito, VCF, Peprah, EK, Peprah, P, Peres, MFP, Perianayagam, A, Perico, N, Perna, S, Pesudovs, K, Petcu, I-R, Petermann-Rocha, FE, Pham, HT, Philip, AK, Phillips, MR, Pickering, BV, Pierannunzio, D, Pigeolet, M, Pigott, DM, Piracha, ZZ, Piradov, MA, 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YF, Wiangkham, T, Wickramasinghe, ND, Wilkerson, C, Willeit, P, Wilson, S, Wong, YJ, Wongsin, U, Wozniak, S, Wu, C, Wu, D, Wu, F, Wu, Z, Xia, J, Xiao, H, Xu, S, Xu, X, Xu, YY, Yadav, MK, Yaghoubi, S, Yamagishi, K, Yang, L, Yano, Y, Yaribeygi, H, Yasufuku, Y, Ye, P, Yesodharan, R, Yesuf, SA, Yezli, S, Yi, S, Yiğit, A, Yigzaw, ZA, Yin, D, Yip, P, Yismaw, MB, Yon, DK, Yonemoto, N, You, Y, Younis, MZ, Yousefi, Z, Yu, C, Yu, Y, Zadey, S, Zadnik, V, Zakham, F, Zaki, N, Zakzuk, J, Zamagni, G, Zaman, SB, Zandieh, GGZ, Zanghì, A, Zar, HJ, Zare, I, Zarimeidani, F, Zastrozhin, MS, Zeng, Y, Zhai, C, Zhang, AL, Zhang, H, Zhang, L, Zhang, M, Zhang, Y, Zhang, Z, Zhang, Z-J, Zhao, H, Zhao, JT, Zhao, X-JG, Zhao, Y, Zhong, C, Zhou, J, Zhou, S, Zhu, B, Zhu, L, Zhu, Z, Ziaeian, B, Ziafati, M, Zielińska, M, Zimsen, SRM, Zoghi, G, Zoller, T, Zumla, A, Zyoud, SH, Murray, CJL, and Gakidou, E
Published: 2024

2. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Author: Naghavi, M, Ong, KL, Aali, A, Ababneh, HS, Abate, YH, Abbafati, C, Abbasgholizadeh, R, Abbasian, M, Abbasi-Kangevari, M, Abbastabar, H, Abd ElHafeez, S, Abdelmasseh, M, Abd-Elsalam, S, Abdelwahab, A, Abdollahi, M, Abdollahifar, M-A, Abdoun, M, Abdulah, DM, Abdullahi, A, Abebe, M, Abebe, SS, Abedi, A, Abegaz, KH, Abhilash, ES, Abidi, H, Abiodun, O, Aboagye, RG, Abolhassani, H, Abolmaali, M, Abouzid, M, Aboye, GB, Abreu, LG, Abrha, WA, Abtahi, D, Abu Rumeileh, S, Abualruz, H, Abubakar, B, Abu-Gharbieh, E, Abu-Rmeileh, NME, Aburuz, S, Abu-Zaid, A, Accrombessi, MMK, Adal, TG, Adamu, AA, Addo, IY, Addolorato, G, Adebiyi, AO, Adekanmbi, V, Adepoju, AV, Adetunji, CO, Adetunji, JB, Adeyeoluwa, TE, Adeyinka, DA, Adeyomoye, OI, Admass, BAA, Adnani, QES, Adra, S, Afolabi, AA, Afzal, MS, Afzal, S, Agampodi, SB, Agasthi, P, Aggarwal, M, Aghamiri, S, Agide, FD, Agodi, A, Agrawal, A, Agyemang-Duah, W, Ahinkorah, BO, Ahmad, A, Ahmad, D, Ahmad, F, Ahmad, MM, Ahmad, S, Ahmad, T, Ahmadi, K, Ahmadzade, AM, Ahmed, A, Ahmed, H, Ahmed, LA, Ahmed, MS, Ahmed, MB, Ahmed, SA, Ajami, M, Aji, B, Akara, EM, Akbarialiabad, H, Akinosoglou, K, Akinyemiju, T, Akkaif, MA, Akyirem, S, Al Hamad, H, Al Hasan, SM, Alahdab, F, Alalalmeh, SO, Alalwan, TA, Al-Aly, Z, Alam, K, Alam, M, Alam, N, Al-amer, RM, Alanezi, FM, Alanzi, TM, Al-Azzam, S, Albakri, A, Albashtawy, M, AlBataineh, MT, Alcalde-Rabanal, JE, Aldawsari, KA, Aldhaleei, WA, Aldridge, RW, Alema, HB, Alemayohu, MA, Alemi, S, Alemu, YM, Al-Gheethi, AAS, Alhabib, KF, Alhalaiqa, FAN, Al-Hanawi, MK, Ali, A, Ali, L, Ali, MU, Ali, R, Ali, S, Ali, SSS, Alicandro, G, Alif, SM, Alikhani, R, Alimohamadi, Y, Aliyi, AA, Aljasir, MAM, Aljunid, SM, Alla, F, Allebeck, P, Al-Marwani, S, Al-Maweri, SAA, Almazan, JU, Al-Mekhlafi, HM, Almidani, L, Almidani, O, Alomari, MA, Al-Omari, B, Alonso, J, Alqahtani, JS, Alqalyoobi, S, Alqutaibi, AY, Al-Sabah, SK, Altaany, Z, Altaf, A, Al-Tawfiq, JA, Altirkawi, KA, Aluh, DO, Alvis-Guzman, N, Alwafi, H, Al-Worafi, YM, Aly, H, Aly, S, Alzoubi, KH, Amani, R, Amare, AT, Amegbor, PM, Ameyaw, EK, Amin, TT, Amindarolzarbi, A, Amiri, S, Amirzade-Iranaq, MH, Amu, H, Amugsi, DA, Amusa, GA, Ancuceanu, R, Anderlini, D, Anderson, DB, Andrade, PP, Andrei, CL, Andrei, T, Angus, C, Anil, A, Anil, S, Anoushiravani, A, Ansari, H, Ansariadi, A, Ansari-Moghaddam, A, Antony, CM, Antriyandarti, E, Anvari, D, Anvari, S, Anwar, S, Anwar, SL, Anwer, R, Anyasodor, AE, Aqeel, M, Arab, JP, Arabloo, J, Arafat, M, Aravkin, AY, Areda, D, Aremu, A, Aremu, O, Ariffin, H, Arkew, M, Armocida, B, Arndt, MB, Ärnlöv, J, Arooj, M, Artamonov, AA, Arulappan, J, Aruleba, RT, Arumugam, A, Asaad, M, Asadi-Lari, M, Asgedom, AA, Asghariahmadabad, M, Asghari-Jafarabadi, M, Ashraf, M, Aslani, A, Astell-Burt, T, Athar, M, Athari, SS, Atinafu, BTT, Atlaw, HW, Atorkey, P, Atout, MMW, Atreya, A, Aujayeb, A, Ausloos, M, Avan, A, Awedew, AF, Aweke, AM, Ayala Quintanilla, BP, Ayatollahi, H, Ayuso-Mateos, JL, Ayyoubzadeh, SM, Azadnajafabad, S, Azevedo, RMS, Azzam, AY, B, DB, Babu, AS, Badar, M, Badiye, AD, Baghdadi, S, Bagheri, N, Bagherieh, S, Bah, S, Bahadorikhalili, S, Bahmanziari, N, Bai, R, Baig, AA, Baker, JL, Bako, AT, Bakshi, RK, Balakrishnan, S, Balasubramanian, M, Baltatu, OC, Bam, K, Banach, M, Bandyopadhyay, S, Banik, PC, Bansal, H, Bansal, K, Barbic, F, Barchitta, M, Bardhan, M, Bardideh, E, Barker-Collo, SL, Bärnighausen, TW, Barone-Adesi, F, Barqawi, HJ, Barrero, LH, Barrow, A, Barteit, S, Barua, L, Basharat, Z, Bashiri, A, Basiru, A, Baskaran, P, Basnyat, B, Bassat, Q, Basso, JD, Basting, AVL, Basu, S, Batra, K, Baune, BT, Bayati, M, Bayileyegn, NS, Beaney, T, Bedi, N, Beghi, M, Behboudi, E, Behera, P, Behnoush, AH, Behzadifar, M, Beiranvand, M, Bejarano Ramirez, DF, Béjot, Y, Belay, SA, Belete, CM, Bell, ML, Bello, MB, Bello, OO, Belo, L, Beloukas, A, Bender, RG, Bensenor, IM, Beran, A, Berezvai, Z, Berhie, AY, Berice, BN, Bernstein, RS, Bertolacci, GJ, Bettencourt, PJG, Beyene, KA, Bhagat, DS, 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RG, Cramer, KM, Criqui, MH, Cruz-Martins, N, Cuadra-Hernández, SM, Culbreth, GT, Cullen, P, Cunningham, M, Curado, MP, Dadana, S, Dadras, O, Dai, S, Dai, X, Dai, Z, Dalli, LL, Damiani, G, Darega Gela, J, Das, JK, Das, S, Dascalu, AM, Dash, NR, Dashti, M, Dastiridou, A, Davey, G, Dávila-Cervantes, CA, Davis Weaver, N, Davletov, K, De Leo, D, de Luca, K, Debele, AT, Debopadhaya, S, Degenhardt, L, Dehghan, A, Deitesfeld, L, Del Bo', C, Delgado-Enciso, I, Demessa, BH, Demetriades, AK, Deng, K, Deng, X, Denova-Gutiérrez, E, Deravi, N, Dereje, N, Dervenis, N, Dervišević, E, Des Jarlais, DC, Desai, HD, Desai, R, Devanbu, VGC, Dewan, SMR, Dhali, A, Dhama, K, Dhimal, M, Dhingra, S, Dhulipala, VR, Dias da Silva, D, Diaz, D, Diaz, MJ, Dima, A, Ding, DD, Ding, H, Dinis-Oliveira, RJ, Dirac, MA, Djalalinia, S, Do, THP, do Prado, CB, Doaei, S, Dodangeh, M, Dohare, S, Dokova, KG, Dolecek, C, Dominguez, R-MV, Dong, W, Dongarwar, D, D'Oria, M, Dorostkar, F, Dorsey, ER, dos Santos, WM, Doshi, R, 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Zhu, L, Ziafati, M, Zielińska, M, Zitoun, OA, Zoladl, M, Zou, Z, Zuhlke, LJ, Zumla, A, Zweck, E, Zyoud, SH, Wool, EE, and Murray, CJL
Published: 2024

3. Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Author: Vollset, SE, Ababneh, HS, Abate, YH, Abbafati, C, Abbasgholizadeh, R, Abbasian, M, Abbastabar, H, Abd Al Magied, AHA, Abd ElHafeez, S, Abdelkader, A, Abdelmasseh, M, Abd-Elsalam, S, Abdi, P, Abdollahi, M, Abdoun, M, Abdullahi, A, Abebe, M, Abiodun, O, Aboagye, RG, Abolhassani, H, Abouzid, M, Aboye, GB, Abreu, LG, Absalan, A, Abualruz, H, Abubakar, B, Abukhadijah, HJJ, Addolorato, G, Adekanmbi, V, Adetunji, CO, Adetunji, JB, Adeyeoluwa, TE, Adha, R, Adhikary, RK, Adnani, QES, Adzigbli, LA, Afrashteh, F, Afzal, MS, Afzal, S, Agbozo, F, Agodi, A, Agrawal, A, Agyemang-Duah, W, Ahinkorah, BO, Ahlstrom, AJ, Ahmad, A, Ahmad, F, Ahmad, MM, Ahmad, S, Ahmed, A, Ahmed, H, Ahmed, S, Ahmed, SA, Akinosoglou, K, Akkaif, MA, Akrami, AE, Akter, E, Al Awaidy, S, Al Hasan, SM, Al Mosa, AS, Al Ta'ani, O, Al Zaabi, OAM, Alahdab, F, Alajlani, MM, Al-Ajlouni, Y, Alalalmeh, SO, Al-Aly, Z, Alam, K, Alam, N, Alam, T, Alam, Z, Al-amer, RM, Alanezi, FM, Alanzi, TM, Albakri, A, Aldhaleei, WA, Aldridge, RW, Alemohammad, SY, Alemu, YM, Al-Gheethi, AAS, Al-Hanawi, MK, Ali, A, Ali, I, Ali, MU, Ali, R, Ali, SSS, Ali, VE, Ali, W, Al-Ibraheem, A, Alicandro, G, Alif, SM, Aljunid, SM, Alla, F, Almazan, JU, Al-Mekhlafi, HM, Alqutaibi, AY, Alrawashdeh, A, Alrousan, SM, Al-Sabah, SK, Alsabri, MA, Altaany, Z, Al-Tammemi, AB, Al-Tawfiq, JA, Altirkawi, KA, Aluh, DO, Alvis-Guzman, N, Al-Wardat, MS, Al-Worafi, YM, Aly, H, Alyahya, MS, Alzoubi, KH, Al-Zyoud, W, Amani, R, Ameyaw, EK, Amin, TT, Amindarolzarbi, A, Amiri, S, Amirzade-Iranaq, MH, Amu, H, Amugsi, DA, Ancuceanu, R, Anderlini, D, Anderson, DB, Andrade, PP, Andrei, CL, Andrei, T, Andrews, EA, Anil, A, Anil, S, Anoushiravani, A, Antony, CM, Antriyandarti, E, Anuoluwa, BS, Anvari, S, Anyasodor, AE, Appiah, F, Aquilano, M, Arab, JP, Arabloo, J, Arafa, EA, Arafat, M, Aravkin, AY, Ardekani, A, Areda, D, Aregawi, BB, Aremu, A, Ariffin, H, Arkew, M, Armani, K, Artamonov, AA, Arumugam, A, Asghari-Jafarabadi, M, Ashbaugh, C, Astell-Burt, T, Athari, SS, 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Silva, AG, Dadras, O, Dai, X, Dai, Z, Dalton, BE, Damiani, G, Dandona, L, Dandona, R, Das, JK, Das, S, Dash, NR, Davletov, K, De la Hoz, FP, De Leo, D, Debopadhaya, S, Delgado-Enciso, I, Denova-Gutiérrez, E, Dervenis, N, Desai, HD, Devanbu, VGC, Dewan, SMR, Dhama, K, Dhane, AS, Dhingra, S, Dias da Silva, D, Diaz, D, Diaz, LA, Diaz, MJ, Dima, A, Ding, DD, Do, THP, do Prado, CB, Dodangeh, M, Doegah, PT, Dohare, S, Dong, W, D'Oria, M, Doshi, R, Dowou, RK, Dsouza, HL, Dsouza, V, Dube, J, Dumith, SC, Duncan, BB, Duraes, AR, Duraisamy, S, Durojaiye, OC, Dushpanova, A, Dutta, S, Dzianach, PA, Dziedzic, AM, Eboreime, E, Ebrahimi, A, Ebrahimi Kalan, M, Edinur, HA, Efendi, F, Eikemo, TA, Eini, E, Ekundayo, TC, El Arab, RA, El Sayed, I, Elamin, O, Elemam, NM, ElGohary, GMT, Elhadi, M, Elmeligy, OAA, Elmoselhi, AB, Elshaer, M, Elsohaby, I, Eltahir, ME, Emeto, TI, Eshrati, B, Eslami, M, Esmaeili, Z, Fabin, N, Fagbamigbe, AF, Fagbule, OF, Falzone, L, Fareed, M, Farinha, CSES, Faris, MEM, Faro, A, Fasihi, K, Fatehizadeh, A, Fauk, NK, Fazylov, T, Feigin, VL, Fekadu, G, Feng, X, Fereshtehnejad, S-M, Ferrara, P, Ferreira, N, Firew, BS, Fischer, F, Fitriana, I, Flavel, J, Flor, LS, Folayan, MO, Foley, KM, Fonzo, M, Force, LM, Foschi, M, Freitas, A, Fridayani, NKY, Fukutaki, KG, Furtado, JM, Fux, B, Gaal, PA, Gadanya, MA, Gallus, S, Ganesan, B, Ganiyani, MA, Gautam, RK, Gebi, TG, Gebregergis, MW, Gebrehiwot, M, Getacher, L, Getahun, GKA, Gething, PW, Ghadimi, DJ, Ghadirian, F, Ghafarian, S, Ghailan, KY, Ghasemi, M, Ghasempour Dabaghi, G, Ghazy, RM, Ghoba, S, Gholami, E, Gholamrezanezhad, A, Gholizadeh, N, Ghorbani, M, Ghorbani Vajargah, P, Ghotbi, E, Gil, AU, Gill, TK, Girmay, A, Glasbey, JC, Glushkova, EV, Gnedovskaya, EV, Göbölös, L, Goldust, M, Goleij, P, Golinelli, D, Gopalani, SV, Goulart, AC, Gouravani, M, Goyal, A, Grivna, M, Grosso, G, Guarducci, G, Gubari, MIM, Guicciardi, S, Guimarães, RA, Gulati, S, Gulisashvili, D, Gunawardane, DA, Guo, C, Gupta, AK, Gupta, R, Gupta, S, Gupta, VK, Haakenstad, A, Hadi, NR, Haep, N, Hafiz, A, Haghmorad, D, Haile, D, Hajj Ali, A, Haj-Mirzaian, A, Halboub, ES, Haller, S, Halwani, R, Hamagharib Abdullah, K, Hamdy, NM, Hamoudi, R, Hanifi, N, Hankey, GJ, Haq, ZA, Haque, MR, Harapan, H, Hargono, A, Haro, JM, Hasaballah, AI, Hasan, SMM, Hasanian, M, Hasnain, MS, Hassan, A, Haubold, J, Hay, SI, Hebert, JJ, Hegazi, OE, Heidari, M, Hemmati, M, Henson, CA, Herrera-Serna, BY, Herteliu, C, Heydari, M, Hezam, K, Hidayana, I, Hiraike, Y, Hoan, NQ, Holla, R, Hoogar, P, Horita, N, Hossain, MM, Hosseinzadeh, H, Hosseinzadeh, M, Hostiuc, M, Hostiuc, S, Hu, C, Huang, J, Hultström, M, Hundie, TG, Hunt, AJ, Hushmandi, K, Hussain, J, Hussain, MA, Hussein, NR, Huynh, H-H, Hwang, B-F, Ibitoye, SE, Iftikhar, PM, Ikiroma, AI, Ikwegbue, PC, Ilic, IM, Ilic, MD, Immurana, M, Isa, MA, Islam, MR, Islam, SMS, Ismail, F, Ismail, NE, Isola, G, Iwagami, M, Iyamu, IO, Jacob, L, Jacobsen, KH, Jafarinia, M, Jahankhani, K, Jahanmehr, N, Jain, N, Jairoun, AA, Jakhmola Mani, DR, Jamil, S, Jamora, RDG, Jatau, AI, Javadov, S, Javaheri, T, Jayaram, S, Jee, SH, Jeganathan, J, Jiang, H, Jokar, M, Jonas, JB, Joseph, N, Joshua, CE, Jürisson, M, K, V, Kabir, A, Kabir, Z, Kadashetti, V, Kalankesh, LR, Kalra, S, Kamath, A, Kamath, R, Kamireddy, A, Kanaan, M, Kanchan, T, Kanmiki, EW, Kanmodi, KK, Kansal, SK, Karim, A, Karkhah, S, Kashoo, FZ, Kasraei, H, Kassel, MB, Katikireddi, SV, Kauppila, JH, Kaur, H, Kayode, GA, Kazemi, F, Kazemian, S, Kebede, F, Kendal, ES, Kesse-Guyot, E, Khademvatan, S, Khajuria, H, Khalaji, A, Khalid, A, Khalid, N, Khalilian, A, Khamesipour, F, Khan, F, Khan, MJ, Khan, MAB, Khanmohammadi, S, Khatab, K, Khatatbeh, H, Khatatbeh, MM, Khatib, MN, Khayat Kashani, HR, Kheirallah, KA, Khokhar, M, Khormali, M, Khorrami, Z, Khosla, AA, Khosravi, M, Khosrowjerdi, M, Khubchandani, J, Kifle, ZD, Kim, G, Kim, JS, Kim, MS, Kim, YJ, Kimokoti, RW, Kisa, A, Kisa, S, Knibbs, LD, Knudsen, AKS, Kochhar, S, Kolahi, A-A, Kompani, F, Koren, G, Korzh, O, Krishan, K, Krishna, V, Krishnamoorthy, V, Kucuk Bicer, B, Kuddus, MA, Kuddus, M, Kuitunen, I, Kujan, O, Kulimbet, M, Kulkarni, V, Kumar, GA, Kumar, H, Kumar, N, Kumar, R, Kumar, V, Kundu, A, Kusuma, D, Kyei-Arthur, F, Kytö, V, Kyu, HH, La Vecchia, C, Lacey, B, Ladan, MA, Laflamme, L, Lahariya, C, Lai, DTC, Lalloo, R, Lallukka, T, Lám, J, Lan, Q, Lan, T, Landires, I, Lanfranchi, F, Langguth, B, Lansingh, VC, Laplante-Lévesque, A, Larijani, B, Larsson, AO, Lasrado, S, Lauriola, P, Lawlor, HR, Le, H-H, Le, LKD, Le, NHH, Le, TTT, Le, TDT, Leasher, JL, Lee, DW, Lee, M, Lee, PH, Lee, S-W, Lee, SW, Lee, SWH, Lee, YH, Leigh, J, Leong, E, Li, M-C, Libra, M, Ligade, VS, Lim, L-L, Lim, SS, Limenh, LW, Lindholm, D, Lindstedt, PA, Listl, S, Liu, G, Liu, S, Liu, X, Llanaj, E, López-Bueno, R, López-Gil, JF, Loreche, AM, Lotufo, PA, Lozano, R, Lubinda, J, Lucchetti, G, Luo, L, Lusk, JB, Lv, L, M Amin, HI, Ma, ZF, Maass, KL, Machairas, N, Machoy, M, Madureira-Carvalho, ÁM, Magdy Abd El 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Published: 2024

4. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Author: Ferrari, AJ, Santomauro, DF, Aali, A, Abate, YH, Abbafati, C, Abbastabar, H, Abd ElHafeez, S, Abdelmasseh, M, Abd-Elsalam, S, Abdollahi, A, Abdullahi, A, Abegaz, KH, Abeldaño Zuñiga, RA, Aboagye, RG, Abolhassani, H, Abreu, LG, Abualruz, H, Abu-Gharbieh, E, Abu-Rmeileh, NME, Ackerman, IN, Addo, IY, Addolorato, G, Adebiyi, AO, Adepoju, AV, Adewuyi, HO, Afyouni, S, Afzal, S, Agodi, A, Ahmad, A, Ahmad, D, Ahmad, F, Ahmad, S, Ahmed, A, Ahmed, LA, Ahmed, MB, Ajami, M, Akinosoglou, K, Akkaif, MA, Al Hasan, SM, Alalalmeh, SO, Al-Aly, Z, Albashtawy, M, Aldridge, RW, Alemu, MD, Alemu, YM, Alene, KA, Al-Gheethi, AAS, Alharrasi, M, Alhassan, RK, Ali, MU, Ali, R, Ali, SSS, Alif, SM, Aljunid, SM, Al-Marwani, S, Almazan, JU, Alomari, MA, Al-Omari, B, Altaany, Z, Alvis-Guzman, N, Alvis-Zakzuk, NJ, Alwafi, H, Al-Wardat, MS, Al-Worafi, YM, Aly, S, Alzoubi, KH, Amare, AT, Amegbor, PM, Ameyaw, EK, Amin, TT, Amindarolzarbi, A, Amiri, S, Amugsi, DA, Ancuceanu, R, Anderlini, D, Anderson, DB, Andrade, PP, Andrei, CL, Ansari, H, Antony, CM, Anwar, S, Anwar, SL, Anwer, R, Anyanwu, PE, Arab, JP, Arabloo, J, Arafat, M, Araki, DT, Aravkin, AY, Arkew, M, Armocida, B, Arndt, MB, Arooj, M, Artamonov, AA, Aruleba, RT, Arumugam, A, Ashbaugh, C, Ashemo, MY, Ashraf, M, Asika, MO, Askari, E, Astell-Burt, T, Athari, SS, Atorkey, P, Atout, MMW, Atreya, A, Aujayeb, A, Ausloos, M, Avan, A, Awotidebe, AW, Awuviry-Newton, K, Ayala Quintanilla, BP, Ayuso-Mateos, JL, Azadnajafabad, S, Azevedo, RMS, Babu, AS, Badar, M, Badiye, AD, Baghdadi, S, Bagheri, N, Bah, S, Bai, R, Baker, JL, Bakkannavar, SM, Bako, AT, Balakrishnan, S, Bam, K, Banik, PC, Barchitta, M, Bardhan, M, Bardideh, E, Barker-Collo, SL, Barqawi, HJ, Barrow, A, Barteit, S, Barua, L, Bashiri Aliabadi, S, Basiru, A, Basu, S, Bathini, PP, Batra, K, Baune, BT, Bayileyegn, NS, Behnam, B, Behnoush, AH, Beiranvand, M, Bejarano Ramirez, DF, Bell, ML, Bello, OO, Beloukas, A, Bensenor, IM, Berezvai, Z, Bernabe, E, Bernstein, RS, Bettencourt, PJG, Bhagavathula, AS, Bhala, N, Bhandari, D, Bhargava, A, Bhaskar, S, Bhat, V, Bhatti, GK, Bhatti, JS, Bhatti, MS, Bhatti, R, Bhutta, ZA, Bikbov, B, Bishai, JD, Bisignano, C, Bitra, VR, Bjørge, T, Bodolica, V, Bodunrin, AO, Bogale, EK, Bonakdar Hashemi, M, Bonny, A, Bora Basara, B, Borhany, H, Boxe, C, Brady, OJ, Bragazzi, NL, Braithwaite, D, Brant, LC, Brauer, M, Breitner, S, Brenner, H, Brown, J, Brugha, T, Bulamu, NB, Buonsenso, D, Burkart, K, Burns, RA, Busse, R, Bustanji, Y, Butt, ZA, Byun, J, Caetano dos Santos, FL, Calina, D, Cámera, LA, Campos-Nonato, IR, Cao, C, Capodici, A, Carr, S, Carreras, G, Carugno, A, Carvalho, M, Castaldelli-Maia, JM, Castañeda-Orjuela, CA, Castelpietra, G, Catapano, AL, Cattaruzza, MS, Caye, A, Cegolon, L, Cembranel, F, Cenderadewi, M, Cerin, E, Chakraborty, PA, Chan, JSK, Chan, RNC, Chandika, RM, Chandrasekar, EK, Charalampous, P, Chattu, VK, Chatzimavridou-Grigoriadou, V, Chen, AW, Chen, A-T, Chen, CS, Chen, H, Chen, NM, Cheng, ETW, Chimed-Ochir, 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Y, Yusuf, H, Zahid, MH, Zakham, F, Zaki, L, Zaki, N, Zaman, BA, Zamora, N, Zand, R, Zandieh, GGZ, Zar, HJ, Zarrintan, A, Zastrozhin, MS, Zhang, H, Zhang, N, Zhang, Y, Zhao, H, Zhong, C, Zhong, P, Zhou, J, Zhu, Z, Ziafati, M, Zielińska, M, Zimsen, SRM, Zoladl, M, Zumla, A, Zyoud, SH, Vos, T, and Murray, CJL
Published: 2024

5. Proton Therapy For Lymphomas: Current State Of The Art

Author: Ricardi U, Maraldo MV, Levis M, and Parikh RR
Subjects: Proton therapy, lymphoma, Hodgkin, radiotherapy, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract: Umberto Ricardi,1 Maja V Maraldo,2 Mario Levis,1 Rahul R Parikh3 1Department of Oncology, University of Torino, Torino, Italy; 2Department of Clinical Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; 3Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USACorrespondence: Mario LevisDepartment of Oncology, University of Torino, Via Genova 3, Torino 10125, ItalyTel +39 011 6334119Fax +39 011 6336614Email mario.levis@unito.itAbstract: The combination of brief chemo-radiotherapy provides high cure rates and represents the first line of treatment for many lymphoma patients. As a result, a high proportion of long-term survivors may experience treatment-related toxic events many years later. Excess and unintended radiation dose to organs at risk (particularly heart, lungs and breasts) may translate in an increased risk of cardiovascular events and second cancers after a few decades. Minimizing dose to organs at risk is thus pivotal to restrain the risk of long-term complications. Proton therapy, with its peculiar physic properties, may help to better spare organs at risk and consequently to reduce toxicities especially in patients receiving mediastinal radiotherapy. Herein, we review the physical basis of proton therapy and the rationale for its implementation in lymphoma patients, with a detailed description of the clinical data. We also discuss the potential disadvantages and uncertainties of protons that may limit their application and critically review the dosimetric studies comparing the risk of late complications between proton and photon radiotherapy.Keywords: proton therapy, lymphoma, Hodgkin, radiotherapy
Published: 2019

6. Association of left atrial function with frailty: The Atherosclerosis Risk in Communities (ARIC) study.

Author: Sun D, Parikh RR, Wang W, Eaton A, Lutsey PL, Windham BG, Inciardi RM, Solomon SD, Ballantyne CM, Shah AM, and Chen LY
Abstract: Background: Frailty is common in people with cardiovascular disease. Worse left atrial (LA) function is an independent risk factor for cardiovascular disease. However, whether worse LA function is associated with frailty is unclear., Methods: We included 3292 older adults from the Atherosclerosis Risk in Communities study who were non-frail at baseline (visit 5, 2011-2013) and had LA function (reservoir, conduit, and contractile strain) measured from two-dimensional speckle-tracking echocardiography. LA stiffness index was calculated as a ratio of E/e' to LA reservoir strain. Frailty was defined using the validated Fried frailty phenotype. Incident frailty was assessed between 2016 and 2019 during two follow-up visits. LA function was analyzed as quintiles. Multivariable logistic regression examined odds of incident frailty., Results: Median (interquartile range [IQR]) age was 74 (71-77) years, 58% were female, and 214 (7%) participants developed frailty during a median (IQR) follow-up of 6.3 (5.6-6.8) years. After adjusting for baseline confounders and incident cardiovascular events during follow-up, the odds of developing frailty was 2.42 (1.26-4.66) times greater among participants in the lowest (vs highest) quintile of LA reservoir strain and 2.41 (1.11-5.22) times greater among those in the highest (vs lowest) quintile of LA stiffness index. Worse LA function was significantly associated with the development of exhaustion, but not the other components of the Fried frailty phenotype., Conclusions: Worse LA function is associated with higher incidence of frailty and exhaustion component independent of LA size and left ventricular function. Future studies are needed to elucidate the underlying mechanisms that drive the observed association., (© 2024 The Author(s). Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.)
Published: 2024
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7. At the Cutting Edge: Novel Agents in Hodgkin Lymphoma and the Evolving Role of Radiation Therapy.

Author: Lo AC, Parikh RR, Kamdar M, and Milgrom SA
Subjects: Humans, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Antineoplastic Agents therapeutic use, Hodgkin Disease radiotherapy, Hodgkin Disease drug therapy, Hodgkin Disease pathology
Published: 2024
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8. Association of central arterial stiffness with atrial myopathy: the Atherosclerosis Risk in Communities (ARIC) study.

Author: Mascarenhas LA, Ji Y, Wang W, Inciardi RM, Parikh RR, Eaton AA, Cheng S, Alonso A, Matsushita K, Shah AM, Solomon SD, Meyer ML, Chen LY, and Zhang MJ
Abstract: Atrial myopathy-defined as abnormal left atrial (LA) size and function-is associated with an increased risk of atrial fibrillation, heart failure, and dementia. Central arterial stiffness is associated with increased atrial afterload and fibrosis and may be a risk factor for atrial myopathy. We examined the association of carotid-femoral pulse wave velocity (cfPWV) with LA function and assessed potential causal relationships. We included 2825 Atherosclerosis Risk in Communities (ARIC) study participants from Visit 5 (2011-2013). cfPWV was related to echocardiographic LA function continuously per 1-SD and categorically in quartiles. Mendelian randomization (MR) analysis was performed using U.K. Biobank-derived genetic variants associated with arterial stiffness index and cardiac magnetic resonance measures of LA function. When analyzed per SD increment (297.6 cm/s), higher cfPWV was significantly associated with lower LA reservoir and conduit strain (β = -0.53%, 95% CI [-0.81, -0.25] and β = -0.46%, 95% CI [-0.68, -0.25], respectively) after adjusting for demographics, clinical characteristics, systolic blood pressure, and left ventricular (LV) morphology and function. In MR analyses there was a non-significant inverse association of arterial stiffness index with LA total, passive, and active emptying fractions. Higher cfPWV is associated with lower LA reservoir and conduit strain, independent of systolic blood pressure and LV morphology and function. No evidence for a causal relationship between arterial stiffness index and alterations in LA function was found. Future studies should examine the prospective association of central arterial stiffness with LA function alterations., (© 2024. The Author(s), under exclusive licence to The Japanese Society of Hypertension.)
Published: 2024
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9. Racial Differences in Nursing Home Quality of Life Among Residents Living With Alzheimer's Disease and Related Dementias.

Author: Shippee TP, Parikh RR, Baker ZG, Bucy TI, Ng W, Jarosek S, Qin X, Woodhouse M, Nkimbeng M, and McCarthy T
Subjects: Humans, Race Factors, Nursing Homes, Skilled Nursing Facilities, Quality of Life, Alzheimer Disease
Abstract: ObjectivesAmong nursing home (NH) residents with Alzheimer's disease (AD) and AD-related dementias (AD/ADRD), racial/ethnic disparities in quality of care exist. However, little is known about quality of life (QoL). This study examines racial/ethnic differences in self-reported QoL among NH residents with AD/ADRD. Methods: Validated, in-person QoL surveys from 12,562 long-stay NH residents with AD/ADRD in Minnesota (2012-2015) were linked to Minimum Data Set assessments and facility characteristics. Hierarchical linear models assessed disparities in resident-reported mean QoL score (range, 0-100 points), adjusting for case-mix and facility factors. Results: Compared to White residents, racially/ethnically minoritized residents reported significantly lower total mean QoL scores (75.53 points vs. 80.34 points, p < .001). After adjustment for resident- and facility-level characteristics, significant racial/ethnic differences remained, with large disparities in food enjoyment, attention from staff, and engagement domains. Discussion: Policy changes and practice guidelines are needed to address racial/ethnic disparities in QoL of NH residents with AD/ADRD., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Published: 2024
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10. Reported Unmet Hearing Aid Need in Older People With Dementia: The US National Core Indicators Survey.

Author: Urbanski DP, Wolf JM, Langworthy BW, Parikh RR, Jutkowitz E, and Shippee TP
Subjects: Humans, Aged, Male, Female, United States, Cross-Sectional Studies, Aged, 80 and over, Hearing Loss therapy, Health Services Needs and Demand, Surveys and Questionnaires, Long-Term Care, Hearing Aids statistics & numerical data, Dementia therapy
Abstract: Objectives: Hearing aids have important health benefits for older adults with Alzheimer disease and related dementias (ADRD); however, hearing aid adoption in this group is low. This study aimed to determine where to target hearing aid interventions for American long-term care recipients with ADRD by examining the association of ADRD and residence type with respondent-reported unmet hearing aid need., Design, Setting, and Participants: This cross-sectional study used data from the United States National Core Indicators-Aging and Disabilities survey (2015-2019) for long-term care recipients aged ≥65 years., Methods: We used multivariable logistic regression to model the likelihood of reporting unmet hearing aid need conditional on ADRD status and residence type (own/family house or apartment, residential care, or nursing facility/home), adjusting for sociodemographic factors and response type (self vs proxy)., Results: Of the 25,492 respondents [median (IQR) age, 77 (71, 84) years; 7074 (27.8%) male], 5442 (21.4%) had ADRD and 3659 (14.4%) owned hearing aids. Residence types were 17,004 (66.8%) own/family house or apartment, 4966 (19.5%) residential care, and 3522 (13.8%) nursing home. Among non-hearing aid owners, ADRD [adjusted odds ratio (AOR) 0.90, 95% CI 0.80-1.0] and residence type were associated with respondent-reported unmet hearing aid need. Compared to the nursing home reference group, respondents in their own/family home (AOR 1.85, 95% CI 1.61-2.13) and residential care (AOR 1.30, 95% CI 1.10-1.53) were more likely to report unmet hearing aid need. This pattern was significantly more pronounced in people with ADRD than in those without, stemming from an interaction between ADRD and residence type., Conclusions and Implications: American long-term care recipients with ADRD living in their own/family home are more likely to report unmet hearing aid need than those with ADRD in institutional and congregate settings. This information can inform the design and delivery of hearing interventions for older adults with ADRD., Competing Interests: Disclosure E.J. is a co-founder and on the board of directors of Plans4Care Inc, a digital health company that provides personalized dementia care on-demand., (Copyright © 2024 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)
Published: 2024
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11. Pushing the CART to the Finish Line: Integrating Radiation Therapy Into Chimeric Antigen Receptor T-Cell Therapy Programs to Improve Outcomes for Patients With Relapsed/Refractory Diffuse Large B-Cell Lymphoma.

Author: Parikh RR, Milgrom SA, and Campbell BA
Subjects: Humans, Immunotherapy, Adoptive adverse effects, Cell- and Tissue-Based Therapy, Receptors, Chimeric Antigen, Lymphoma, Large B-Cell, Diffuse radiotherapy, Lymphoma, Non-Hodgkin
Published: 2024
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12. Radiation Therapy Use in Refractory and Relapsed Adolescent and Young Adult Hodgkin Lymphoma: A Report from the Children's Oncology Group.

Author: Mailhot Vega RB, Harker-Murray PD, Forlenza CJ, Cole P, Kelly KM, Milgrom SA, Parikh RR, Hodgson DC, Castellino SM, Kahn J, Roberts KB, Constine LS, and Hoppe BS
Subjects: Young Adult, Humans, Child, Adolescent, Antineoplastic Combined Chemotherapy Protocols, Hodgkin Disease drug therapy, Hematopoietic Stem Cell Transplantation
Published: 2023
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13. Measuring Nursing Home Quality of Life: Validated Measures Are Poorly Correlated With Proxies From MDS and Quality of Life Deficiency Citationsl.

Author: Pylypiv Shippee T, Parikh RR, Duan Y, Bowblis JR, Woodhouse M, and Lewis T
Subjects: Humans, Cross-Sectional Studies, Skilled Nursing Facilities, Surveys and Questionnaires, Quality of Life, Nursing Homes
Abstract: Objectives: Ensuring quality of life (QoL) is an important goal of person-centered nursing home care. The provision of person-centered care relies on information captured in the Minimum Data Set 3.0 (MDS). It is unclear to what extent MDS items or QoL-related facility deficiency citations correlate with validated measures of nursing home residents' QoL. This study evaluated correlation among MDS items, facility deficiency citations, and residents' QoL from 2 states that currently collect these measures., Design: Cross-sectional study., Setting and Participants: A total of 11,487 long-stay residents in 356 facilities in Minnesota and 13,835 long-stay residents in 851 facilities in Ohio in 2015., Methods: The outcome, QoL, was measured using validated instruments (Minnesota QoL survey and Ohio Resident Satisfaction Survey). Predictor variables included scores for Preference Assessment Tool (Section F), Patient Health Questionnaire-9 (Section D) for depressive symptoms from MDS, and count of QoL-related facility deficiency citations from the Certification and Survey Provider Enhanced Reporting database. Spearman's ranked test assessed correlation between predictor and outcome variables. Mixed effects models evaluated associations of QoL summary scores with predictor variables, adjusting for resident- and facility-level characteristics, accounting for clustering at the facility level., Results: In Minnesota and Ohio, predictor variables (Section F and D items, and facility deficiency citations) correlated significantly but poorly with QoL (coefficients ranging from 0.003 to 0.3, P < .001). In the fully adjusted mixed effects model, all predictor variables, demographics, and functional status explained <21% of the total variance in QoL among residents. These findings were consistent in sensitivity analyses stratified by 1-year length of stay and by diagnosis of dementia., Conclusions and Implications: MDS items and facility deficiency citations encapsulate a significant but very small proportion of variance in residents' QoL. This indicates the need to measure QoL directly among residents, to plan person-centered care, and to evaluate its performance in nursing home facilities., (Copyright © 2023 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)
Published: 2023
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14. Association of Physical Activity With Left Atrial Function in Older Adults: The ARIC Study.

Author: Parikh RR, Inciardi RM, Wang W, Hegde SM, Norby FL, Zhang MJ, Reyes JL, Van't Hof JR, Alonso A, Shah AM, Solomon SD, and Chen LY
Subjects: Humans, Aged, Predictive Value of Tests, Risk Factors, Exercise, Atrial Function, Left, Atrial Fibrillation
Published: 2023
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15. Assessment of Lymphoma and Other Hematologic Malignancies Training Needs Among Radiation Oncology Residents: a Brief Report.

Author: Kahn JM, Yang JC, Yahalom J, Dabaja BS, Vapiwala N, Hoppe BS, Tseng YD, Pinnix CC, Parikh RR, Sim AJ, Plastaras JP, and Gunther JR
Subjects: Humans, Positron Emission Tomography Computed Tomography, Surveys and Questionnaires, Radiation Oncology education, Internship and Residency, Lymphoma, Hematologic Neoplasms radiotherapy
Abstract: The role of radiation therapy (RT) varies across hematologic malignancies (HM). Radiation oncology (RO) resident comfort with specific aspects of HM patient management is unknown. The International Lymphoma RO Group (ILROG) assessed resident HM training opportunities and interest in an HM away elective. RO residents (PGY2-5) in the Association of Residents in RO (ARRO) database (n = 572) were emailed an anonymous, web-based survey in January 2019 including binary, Likert-type scale (1 = not at all, 5 = extremely, reported as median [interquartile range]), and multiple-choice questions. Of 134 resident respondents (23%), 86 (64%) were PGY4/5 residents and 36 (27%) were in larger programs (≥ 13 residents). Residents reported having specialized HM faculty (112, 84%) and a dedicated HM rotation (95, 71%). Residents reported "moderate" preparedness to advocate for RT in multidisciplinary conferences (3 [2-3]); make HM-related clinical decisions (3 [2-4]); and critique treatment planning (3 [2-4]). They reported feeling "moderately" to "quite" prepared to contour HM cases (3.5 [3-4]) and "quite" prepared to utilize the PET-CT five-point scale (4 [3-5]). Overall, residents reported feeling "moderately" prepared to treat HM patients (3 [2-3]); 24 residents (23%) felt "quite" or "extremely" prepared. Sixty-six residents (49%) were potentially interested in an HM away elective, commonly to increase comfort with treating HM patients (65%). Therefore, HM training is an important component of RO residency, yet a minority of surveyed trainees felt quite or extremely well prepared to treat HM patients. Programs should explore alternative and additional educational opportunities to increase resident comfort with treating HM patients., (© 2021. American Association for Cancer Education.)
Published: 2023
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16. Systematic review for deep inspiration breath hold in proton therapy for mediastinal lymphoma: A PTCOG Lymphoma Subcommittee report and recommendations.

Author: Patel CG, Peterson J, Aznar M, Tseng YD, Lester S, Pafundi D, Flampouri S, Mohindra P, Parikh RR, Mailhot Vega R, Konig L, Plastaras JP, Bates JE, Loap P, Kirova YM, Orlandi E, Lütgendorf-Caucig C, Ntentas G, and Hoppe B
Subjects: Humans, Breath Holding, Organs at Risk, Radiotherapy Planning, Computer-Assisted, Protons, Heart, Radiotherapy Dosage, Proton Therapy, Mediastinal Neoplasms radiotherapy, Lymphoma, Unilateral Breast Neoplasms radiotherapy
Abstract: Purpose: To systematically review all dosimetric studies investigating the impact of deep inspiration breath hold (DIBH) compared with free breathing (FB) in mediastinal lymphoma patients treated with proton therapy as compared to IMRT (intensity-modulated radiation therapy)-DIBH., Materials and Methods: We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline using the PubMed database to identify studies of mediastinal lymphoma patients with dosimetric comparisons of proton-FB and/or proton-DIBH with IMRT-DIBH. Parameters included mean heart (MHD), lung (MLD), and breast (MBD) doses, among other parameters. Case reports were excluded. Absolute differences in mean doses > 1 Gy between comparators were considered to be clinically meaningful., Results: As of April 2021, eight studies fit these criteria (n = 8), with the following comparisons: proton-FB vs IMRT-DIBH (n = 5), proton-DIBH vs proton-FB (n = 5), and proton-DIBH vs IMRT-DIBH (n = 8). When comparing proton-FB with IMRT-DIBH in 5 studies, MHD was reduced with proton-FB in 2 studies, was similar (<1 Gy difference) in 2 studies, and increased in 1 study. On the other hand, MLD and MBD were reduced with proton-FB in 3 and 4 studies, respectively. When comparing proton-DIBH with proton-FB, MHD and MLD were reduced with proton DIBH in 4 and 3 studies, respectively, while MBD remained similar. Compared with IMRT-DIBH in 8 studies, proton-DIBH reduced the MHD in 7 studies and was similar in 1 study. Furthermore, MLD and MBD were reduced with proton-DIBH in 8 and 6 studies respectively. Integral dose was similar between proton-FB and proton-DIBH, and both were substantially lower than IMRT-DIBH., Conclusion: Accounting for heart, lung, breast, and integral dose, proton therapy (FB or DIBH) was superior to IMRT-DIBH. Proton-DIBH can lower dose to the lungs and heart even further compared with proton-FB, depending on disease location in the mediastinum, and organ-sparing and target coverage priorities., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Laila Konig reports personal fees from Accuray Inc. and Novocure GmbH outside the submitted work., (Copyright © 2022 Elsevier B.V. All rights reserved.)
Published: 2022
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17. Extensive stage small cell lung cancer (ES-SCLC) and palliative care disparities: a national cancer database study.

Author: Khullar K, Plascak JJ, Habib MH, Nagengast S, and Parikh RR
Abstract: Objectives: Literature on disparities in palliative care receipt among extensive stage small cell lung cancer (ES-SCLC) patients is scarce. The purpose of this study was to examine disparities in palliative care receipt among ES-SCLC patients., Methods: Patients aged 40 years or older diagnosed with ES-SCLC between 2004 and 2015 in the National Cancer DataBase (NCDB) were eligible. Two palliative care variables were created: (1) no receipt of any palliative care and (2) no receipt of pain management-palliative care. The latter variable indicated pain management receipt among those who received any palliative care. Log binomial regression models were constructed to calculate risk ratios by covariates. Unadjusted and mutually adjusted models were created for both variables., Results: Among 83 175 patients, the risk of no palliative care receipt was higher among Blacks compared with Whites in unadjusted and adjusted models (both model HRs 1.02; 95% CIs 1.00 to 1.03, p<0.05). Patients older than 59 years were at a higher risk of not receiving palliative care than younger patients (HR 1.02; 95% CI 1.01 to 1.03 for 59-66, HR 1.04; 95% CI 1.03 to 1.05 for 66-74, HR 1.06; 95% CI 1.05 to 1.08 for >74). Among 19 931 patients, the risk of no pain management-palliative care was higher among black patients on unadjusted analysis (HR 1.02; 95% CI 1.00 to 1.03, p<0.05). Patients between 66 and 74 years were at a higher risk of not receiving pain management-palliative care than patients younger than 59 years (HR 1.02; 95% CI 1.00 to 1.03, p<0.05)., Conclusions: Significant disparities exist in palliative care receipt among ES-SCLC patients., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)
Published: 2022
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18. Association of Right Ventricular Afterload With Atrial Fibrillation Risk in Older Adults: The Atherosclerosis Risk in Communities Study.

Author: Parikh RR, Norby FL, Wang W, Thenappan T, Prins KW, Van't Hof JR, Lutsey PL, Solomon SD, Shah AM, and Chen LY
Subjects: Aged, Female, Humans, Male, Antihypertensive Agents, Prospective Studies, Ventricular Remodeling, Atherosclerosis, Atrial Fibrillation complications, Atrial Fibrillation etiology, Tricuspid Valve Insufficiency
Abstract: Background: Atrial fibrillation (AF) is widely perceived to originate from the left atrium (LA). Whether increases in right ventricular (RV) afterload in older adults play an etiological role in AF genesis independent of LA and left ventricular (LV) remodeling is unknown., Research Question: Is higher RV afterload associated with greater AF risk independent of LA and LV remodeling?, Study Design and Methods: In this observational prospective study, we included 2,246 community-dwelling older adults (mean age, 75 years) without known cardiovascular disease, with LV ejection fraction > 50%, LA volume index < 34 mL/m 2 , and E/e' ratio < 14 and a measurable functional tricuspid regurgitation jet velocity. From 2D-echocardiograms, we estimated pulmonary artery systolic pressure (PASP) and pulmonary vascular resistance (PVR). We ascertained incident AF (through 2018) from hospital discharge codes and death certificates. We estimated hazard ratios (HR) by Cox regression., Results: During follow-up (median, 6.3 years; interquartile interval, 5.5-6.9 years), 215 participants developed AF. AF risk was significantly higher in the third (vs first) tertile of PASP (HR, 1.65; 95% CI, 1.08-2.54) and PVR (HR, 1.38; 95% CI, 1.00-2.08) independent of LA and LV structure and function, heart rate, BMI, prevalent sleep apnea, systemic BP, antihypertensive medications, and lung, kidney, and thyroid function. These associations persisted after further exclusion of participants with tricuspid regurgitation jet velocity > 2.8 m/s and lateral and septal mitral annular velocity above age- and sex-specific reference limits., Interpretation: In older adults, higher RV afterload is associated with greater AF risk independent of LA and LV remodeling. Future research should focus on confirming this novel association and elucidate underlying mechanisms., (Published by Elsevier Inc.)
Published: 2022
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19. The Use of Monoclonal Antibody-Based Proprotein Convertase Subtilisin-Kexin Type 9 (PCSK9) Inhibitors in the Treatment of Hypercholesterolemia.

Author: Parikh RR, Breve F, Magnusson P, Behzadi P, and Pergolizzi J
Abstract: In this review, we evaluated several studies in the literature to analyze the benefits and deleterious effects of the use of monoclonal antibodies (MABs)-based proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors in patients with hypercholesterolemia. Increased low-density lipoprotein cholesterol (LDL-C) levels lead to an increase in the risk of cardiovascular (CV) disease. Statins are the cornerstones of hypercholesterolemia treatment, but the patient response may often vary, and additional therapies may be needed to control the increased LDL-C levels. MABs bind to PCSK9 receptors, causing a reduction in LDL-C levels. MAB-based PCSK9 inhibitors such as alirocumab and evolocumab have been approved for use in hypercholesterolemia in combination with statins. Studies have suggested that both alirocumab and evolocumab are effective in lowering LDL-C levels, have favorable side effect profiles, and can be administered at convenient dosing intervals; however, further double-blind, randomized trials evaluating the long-term safety and efficacy of both the agents could assist with clinical decision-making., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Parikh et al.)
Published: 2022
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20. Patterns of Initial Relapse from a Phase 3 Study of Response-Based Therapy for High-Risk Hodgkin Lymphoma (AHOD0831): A Report from the Children's Oncology Group.

Author: Parikh RR, Kelly KM, Hodgson DC, Hoppe BS, McCarten KM, Karolczuk K, Pei Q, Wu Y, Cho SY, Schwartz C, Cole PD, and Roberts K
Subjects: Adult, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Bleomycin adverse effects, Child, Cyclophosphamide therapeutic use, Doxorubicin therapeutic use, Humans, Neoplasm Recurrence, Local pathology, Neoplasm Staging, Prednisone adverse effects, Retrospective Studies, Vincristine adverse effects, Young Adult, Hodgkin Disease diagnostic imaging, Hodgkin Disease drug therapy, Hodgkin Disease radiotherapy
Abstract: Purpose: The Children's Oncology Group protocol AHOD0831, for pediatric patients with high-risk classical Hodgkin lymphoma (cHL), used response-adapted radiation fields, rather than larger involved-field radiation therapy (IFRT) that were historically used. This retrospective analysis of patterns of relapse among patients enrolled in the study was conducted to study the potential effect of a reduction in RT exposure., Methods and Materials: From December 2009 to January 2012, 164 eligible patients under 22 years old with stage IIIB (43%) and stage IVB (57%) enrolled on AHOD0831. All patients received 4 cycles of doxorubicin, bleomycin, vincristine, etoposide, prednisone, and cyclophosphamide (ABVE-PC). Those patients with a slow early response (SER) after the first 2 ABVE-PC courses were nonrandomly assigned to 2 intensification cycles with ifosfamide/vinorelbine before the final 2 ABVE-PC cycles. Response-adapted RT (21 Gy) was prescribed to initial areas of bulky disease and SER sites. Rapid early response (RER) sites without bulk were not targeted. Imaging studies at the time of progression or relapse were reviewed centrally for this retrospective analysis. Relapses were characterized with respect to site (initial, new, or both; and initial bulk or initial nonbulk), initial chemotherapy response, and radiation field (in-field, out-of-field, or both)., Results: Of the entire cohort, 140 patients were evaluable for the patterns of failure analyses. To investigate the pattern of failure, this analysis focuses on 23 patients who followed protocol treatment and suffered relapses at a median 1.05 years with 7.97-year median follow-up time. These 23 patients (11 RER and 12 SER) experienced a relapse in 105 total sites (median, 4; range, 1-11). Of the 105 relapsed sites, 67 sites (64%) occurred within an initial site of involvement, with 12 of these 67 sites (18%) at an initial site of bulky disease and 63 of these 67 relapses (94%) occurring in sites that were not fluorodeoxyglucose (FDG)-avid after 2 cycles of ABVE-PC (PET2-negative). Of the 105 relapsed sites, 34 sites (32%) occurred in a new site of disease (that would not have been covered by RT); and, overall, only 4 of 140 patients (2.8%) (occurring in 3 RER and 1 SER) experienced isolated out-of-field relapses that would have been covered by historical IFRT., Conclusions: For a cohort of high-risk patients with cHL patients, most failures occurred in nonbulky, initially involved sites, largely due to response-based consolidation RT delivered to patients with bulky disease. In this analysis, we discovered low rates of failures outside of these modern risk-adapted radiation treatment volumes. Also, FDG uptake on PET2 did not identify most relapse sites., (Copyright © 2021 Elsevier Inc. All rights reserved.)
Published: 2022
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21. Effects of Digoxin in Heart Failure (HF) With Reduced Ejection Fraction (EF).

Author: Parikh RR, Patel KR, Pergolizzi JV Jr, Breve F, and Magnusson P
Abstract: In this review, we evaluated the literature on the benefits and deleterious effects of digoxin in heart failure (HF) with reduced ejection fraction (EF). Although digoxin was considered an effective treatment for HF, the supporting evidence is conflicting. Before the conventional use of modern HF therapies, digoxin was widely used for symptomatic relief on these patients. Further randomized trials are required to reach a definite conclusion about its efficacy and safety in patients experiencing HF with a reduced EF (HFrEF)., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Parikh et al.)
Published: 2022
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22. Acute lymphoblastic leukemia (ALL) in adults: disparities in treatment intervention based on access to treatment facility.

Author: Khullar K, Plascak JJ, and Parikh RR
Subjects: Adult, Health Services Accessibility, Humans, Retrospective Studies, Transplantation Conditioning, Whole-Body Irradiation, Precursor Cell Lymphoblastic Leukemia-Lymphoma diagnosis, Precursor Cell Lymphoblastic Leukemia-Lymphoma epidemiology, Precursor Cell Lymphoblastic Leukemia-Lymphoma therapy
Abstract: Adult acute lymphoblastic leukemia (ALL) is associated with poor outcomes. We evaluated differences by facility type in the parameters of 6766 adult ALL patients ≥ 40 years of age diagnosed from 2004 to 2015 in the National Cancer DataBase (NCDB) and survival outcomes using two-sample t -tests or chi-square tests and Cox proportional hazards models. Those treated in academic facilities were younger (mean 58.5 versus 61.7 years, p < 0.001), Black (8.1% versus 5.6%, p < 0.001), had private insurance (50.9% versus 44.0%, p < 0.001), and more likely to receive chemotherapy (93.2% versus 81.4%, p < 0.001), any radiotherapy (14.9% versus 7.3%, p < 0.001), stem cell transplant (9.4% versus 2.5%, p < 0.001), or total body irradiation (TBI) (11.3% versus 4.3%, p < 0.001). Patients treated at an academic facility had a higher hazard of death ( p <.05) while those that received any chemotherapy or TBI or CNS radiation had a lower risk of death (all p < 0.05). These parameters should be evaluated in future studies.
Published: 2022
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23. Association of Differential Leukocyte Count With Incident Abdominal Aortic Aneurysm Over 22.5 Years: The ARIC Study.

Author: Parikh RR, Folsom AR, Poudel K, Lutsey PL, Demmer RT, Pankow JS, Chen LY, and Tang W
Subjects: Aortic Aneurysm, Abdominal diagnostic imaging, Female, Humans, Incidence, Leukocyte Count, Male, Middle Aged, Predictive Value of Tests, Prognosis, Prospective Studies, Risk Assessment, Risk Factors, Time Factors, United States epidemiology, Aortic Aneurysm, Abdominal epidemiology, Aortic Aneurysm, Abdominal immunology, Leukocytes immunology
Abstract: OBJECTIVE: Leukocytes contribute to the development of abdominal aortic aneurysm (AAA). We evaluated whether associations of differential leukocyte counts with AAA persist after accounting for traditional risk factors of AAA. APPROACH AND RESULTS: Among 11 217 adults from the Atherosclerosis Risk in Communities Study, we evaluated associations of differential leukocyte counts at baseline (1987–1989) with incident AAAs over a median follow-up of 22.5 years, using Cox proportional hazards regression. Each differential leukocyte count was categorized into 5 groups—below normal, tertiles within the normal range, and above normal, with the first tertile serving as the referent. We identified 377 incident AAAs through 2011, using hospital discharge diagnoses, linked Medicare records, or death certificates. At baseline, higher neutrophil, monocyte, and eosinophil counts were associated with higher risk of AAA, independent of smoking, other differential leukocyte counts, and other traditional risk factors. The association with incident AAA was the strongest for above normal neutrophil count, with an adjusted hazard ratio (95% CI) of 2.17 (1.29–3.64). Below normal neutrophil, lymphocyte, eosinophil and basophil counts were associated with higher risk of AAA with adjusted hazard ratio (95% CI) between 1.86 (1.04–3.35) and 1.62 (1.10–2.39). CONCLUSIONS: Higher neutrophil, monocyte, and eosinophil counts in midlife are associated with higher risk of AAA, even after accounting for traditional risk factors such as smoking, obesity, and atherosclerosis. This suggests the need to identify nontraditional risk factors and treatment strategies to mitigate the residual risk of AAA conferred by midlife inflammation. Whether immunosuppression is associated with higher risk of AAA needs further investigation.
Published: 2021
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24. Observation with or without late radiotherapy is equivalent to early radiotherapy in high-risk prostate cancer after radical prostatectomy: A SEER-Medicare analysis on trends, survival outcomes, and complications.

Author: Kwon YS, Wang W, Srivastava A, Jang TL, Singer EA, Parikh RR, Kim WJ, and Kim IY
Abstract: Background: We aimed to illustrate national trends of post-radical prostatectomy (RP) radiotherapy (RT) and compare outcomes and toxicities in patients receiving eRT versus observation with or without late radiotherapy (lRT)., Methods: Utilizing the Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 2001 to 2011, we identified 7557 patients with high-risk pathologic features after RP (≥pT3N0 and/or positive surgical margins). Our study cohort consisted of patients receiving RT within 6 months of surgery (eRT), those receiving RT after 6 months (lRT), and those never receiving RT (observation). Another subcohort, delayed RT (dRT), encompassed both lRT and observation. Trends of post-RP RT were compared using the Cochran-Armitage trend test. Cox regression models identified factors predictive of worse survival outcomes. Kaplan-Meier analyses compared the eRT and the dRT groups., Results: Among those with pathologically confirmed high-risk prostate cancer (PCa) after RP, 12.7% (n = 959), 13.2% (n = 1710), and 74.1% (n = 4888) underwent eRT, lRT, and observation without RT, respectively. Of these strategies, the proportion of men on observation without RT increased significantly over time (p = 0.004). The multivariable Cox regression model demonstrated similar outcomes between the eRT and the dRT groups. At a median follow-up of 5.9 years, five-year overall and cancer-specific survival outcomes were more favorable in the dRT group, when compared to the eRT group., Conclusions: A blanket adoption of the eRT in high-risk PCa based on clinical trials with limited follow-up may result in overtreatment of a significant number of men and expose them to unnecessary radiation toxicity., Competing Interests: None of the contributing authors have any conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript., (© 2020 Asian Pacific Prostate Society. Publishing services by Elsevier B.V.)
Published: 2021
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25. Consensus Statement on Proton Therapy for Prostate Cancer.

Author: Bryant CM, Henderson RH, Nichols RC, Mendenhall WM, Hoppe BS, Vargas CE, Daniels TB, Choo CR, Parikh RR, Giap H, Slater JD, Vapiwala N, Barrett W, Nanda A, Mishra MV, Choi S, Liao JJ, and Mendenhall NP
Abstract: Proton therapy is a promising but controversial treatment in the management of prostate cancer. Despite its dosimetric advantages when compared with photon radiation therapy, its increased cost to patients and insurers has raised questions regarding its value. Multiple prospective and retrospective studies have been published documenting the efficacy and safety of proton therapy for patients with localized prostate cancer and for patients requiring adjuvant or salvage pelvic radiation after surgery. The Particle Therapy Co-Operative Group (PTCOG) Genitourinary Subcommittee intends to address current proton therapy indications, advantages, disadvantages, and cost effectiveness. We will also discuss the current landscape of clinical trials. This consensus report can be used to guide clinical practice and research directions., Competing Interests: Conflicts of Interest: Nancy P. Mendenhall, MD, and William M. Mendenhall, MD, are Editor-in-Chief and Operating Editor, respectively, of the International Journal of Particle Therapy (IJPT). Bradford S. Hoppe, MD, MPH, and Neha Vapiwala, MD, are IJPT Associate Editors. The authors have no additional conflicts of interest to disclose., (©Copyright 2021 The Author(s).)
Published: 2021
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26. Feeding the Controversy: When Pelvic Irradiation Improves Outcomes in High-Risk and Very High-Risk Prostate Cancer.

Author: Jan I and Parikh RR
Subjects: Humans, Male, Middle Aged, Risk Factors, Treatment Outcome, Pelvis radiation effects, Prostatic Neoplasms radiotherapy
Abstract: The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice., Competing Interests: Rahul R. ParikhHonoraria: Mevion Medical SystemsNo other potential conflicts of interest were reported.
Published: 2021
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27. Associations between race and survival in pediatric patients with diffuse large B-cell lymphoma.

Author: Khullar K, Plascak JJ, Drachtman R, Cole PD, and Parikh RR
Subjects: Adolescent, Adult, Databases, Factual, Humans, Lymphoma, Large B-Cell, Diffuse therapy, Prognosis, Retrospective Studies, Survival Rate, United States epidemiology, Young Adult, Black or African American, Black People statistics & numerical data, Healthcare Disparities statistics & numerical data, Lymphoma, Large B-Cell, Diffuse ethnology, Lymphoma, Large B-Cell, Diffuse mortality, White People statistics & numerical data
Abstract: Background: The purpose of this study was to examine the factors associated with disparities in overall survival (OS) by race in pediatric diffuse large B-cell lymphoma (DLBCL) patients., Methods: We evaluated clinical features and survival among patients ≤21 years of age diagnosed with stage I-IV DLBCL from 2004 to 2014 from the National Cancer Database (NCDB) using a multivariable Cox proportional hazards model., Results: Among 1386 pediatric patients with DLBCL, 1023 patients met eligibility criteria. In unadjusted analysis, Black patients had a significantly higher overall death rate than White patients (HR Black vs. White 1.51; 95% CI: 1.02-2.23, p = 0.041). The survival disparity did not remain significant in adjusted analysis, though controlling for covariates had little effect on the magnitude of the disparity (HR 1.46; 95% CI 0.93-2.31, p = 0.103). In adjusted models, presence of B symptoms, receipt of chemotherapy, stage of disease, and Other insurance were significantly associated with OS. Specifically, patients with B symptoms and those with Other insurance were more likely to die than those without B symptoms or private insurance, respectively (HR 1.75; 95% CI 1.22-2.50, p = 0.002) and (HR 2.56; 95% CI, 1.39-4.73, p = 0.0027), patients who did not receive chemotherapy were three times more likely to die than those who received chemotherapy (HR 3.10; CI 1.80-5.35, p < 0.001), and patients who presented with earlier stage disease were less likely to die from their disease than those with stage IV disease (stages I-III HR 0.34, CI 0.18-0.64, p < 0.001; HR 0.50, CI 0.30-0.82, p = 0.006, HR 0.72, CI 0.43-1.13, p = 0.152, respectively)., Conclusions: Our results suggest that racial disparities in survival may be mediated by clinical and treatment parameters., (© 2021 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)
Published: 2021
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28. Proton versus Photon Breath-Hold Radiation for Left-Sided Breast Cancer after Breast-Conserving Surgery: A Dosimetric Comparison.

Author: Mondal D, Jhawar SR, Millevoi R, Haffty BG, and Parikh RR
Abstract: Purpose: Radiation to breast, chest wall, and/or regional nodes is an integral component of breast cancer management in many situations. Irradiating left-sided breast and/or regional nodes may be technically challenging because of cardiac tolerance and subsequent risk of long-term cardiac complications. Deep inspiratory breath-hold (DIBH) technique physically separates cardiac structures away from radiation target volume, thus reducing cardiac dose with either photon (Ph) or proton beam therapy (PBT). The utility of combining PBT with DIBH is less well understood., Methods and Materials: We compared photon-DIBH (Ph-DIBH) versus proton DIBH (Pr-DIBH) for different planning parameters, including target coverage and organ at risk (OAR) sparing. Necessary ethical permission was obtained from the institutional review board. Ten previous patients with irradiated, intact, left-sided breast and Ph-DIBH were replanned with PBT for dosimetric comparison. Clinically relevant normal OARs were contoured, and Ph plans were generated with parallel, opposed tangent beams and direct fields for supraclavicular and/or axillae whenever required. For proton planning, all targets were delineated individually and best possible coverage of planning target volume was achieved. Dose-volume histogram was analyzed to determine the difference in doses received by different OARs. Minimum and maximum dose ( D min and D max ) as well as dose received by a specific volume of OAR were compared. Each patient's initial plan (Ph-DIBH) was used as a control for comparing newly devised PBT plan (Pr-DIBH). Matched, paired t tests were applied to determine any significant differences between the 2 plans., Results: Both the plans were adequate in target coverage. Dose to cardiac structure subunits and ipsilateral lung were significantly reduced with the proton breath-hold technique. Significant dose reduction with Pr-DIBH was observed in comparison to Ph-DIBH for mean dose ( D mean ) to the heart (0.23 Gy versus 1.19 Gy; P < .001); D mean to the left ventricle (0.25 Gy versus 1.7 Gy; P < .001); D mean , D max , and the half-maximal dose to the left anterior descending artery (1.15 Gy versus 5.54 Gy; P < .003; 7.7 Gy versus 22.15 Gy; P < .007; 1.61 Gy versus 4.42 Gy, P < .049); D max of the left circumflex coronary artery (0.13 Gy versus 1.35 Gy; P < .001) and D mean , the volume to the ipsilateral lung receiving 20 Gy and 5 Gy (2.28 Gy versus 8.04 Gy; P < .001; 2.36 Gy versus 15.54 Gy, P < .001; 13.9 Gy versus 30.28 Gy; P = .002). However, skin dose and contralateral breast dose were not significantly improved with proton., Conclusion: This comparative dosimetric study showed significant benefit of Pr-DIBH technique compared with Ph-DIBH in terms of cardiopulmonary sparing and may be the area of future clinical research., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to disclose., (©Copyright 2020 The Author(s).)
Published: 2020
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29. More Is Better, Especially When Radiation Is the Best Option….

Author: Parikh RR
Subjects: Central Nervous System, Humans, Central Nervous System Neoplasms, Lymphoma, Non-Hodgkin, Radiation
Published: 2020
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30. Long-Term Outcomes in 10-Year Survivors of Early-Stage Hodgkin Lymphoma.

Author: Bates JE, Parikh RR, Mendenhall NP, Morris CG, Hoppe RT, Constine LS, and Hoppe BS
Subjects: Adult, Chemoradiotherapy, Female, Humans, Male, Neoplasm Staging, Survival Analysis, Treatment Outcome, Young Adult, Hodgkin Disease pathology, Hodgkin Disease therapy
Abstract: Purpose: Although radiation therapy improves progression-free survival in early-stage Hodgkin lymphoma (HL), substantial concerns remain regarding the impact of delayed normal tissue effects on quality of life and survival. We hypothesized that treatment with combined-modality therapy (CMT; chemotherapy and radiation therapy) improves overall survival among 10-year survivors compared with treatment with radiation therapy or chemotherapy alone., Methods and Materials: We compared patients in the Surveillance, Epidemiology, and End Results database who received a diagnosis of stage I/II HL between 1983 and 2006 who received chemotherapy and/or external beam radiation and survived at least 10 years. Our primary study outcome was overall survival; we also analyzed cause-specific and other-cause-specific survival., Results: Of 10,443 ten-year survivors of stage I/II classical HL, 33.6% received chemotherapy alone, 23.8% radiation therapy alone, and 42.6% CMT. Median follow-up was 16.1 years. On multivariate analysis including race, stage, sex, age, and "modern" treatment in 1995 and later, 10-year survivors who received CMT had improved overall survival relative to survivors who received RT alone (hazard ratio, 1.41; 95% confidence interval, 1.21-1.64; P < .01) or chemotherapy alone (hazard ratio, 1.35; 95% confidence interval, 1.16-1.57; P < .01)., Conclusions: This survival difference was driven by an increase in death from both HL and non-HL causes in those treated with chemotherapy alone. Our analysis suggests that CMT offers optimal survivorship for patients with stage I/II HL., (Copyright © 2020 Elsevier Inc. All rights reserved.)
Published: 2020
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31. The Association of Radiation Dose-Fractionation and Immunotherapy Use With Overall Survival in Metastatic Melanoma Patients.

Author: Wang SJ, Jhawar SR, Rivera-Nunez Z, Silk AW, Byun J, Miller E, Blakaj D, Parikh RR, Weiner J, and Goyal S
Abstract: Objective Metastatic melanoma patients often receive palliative radiotherapy (RT) and immunotherapy (IT). However, the immunological interplay between RT dose-fractionation and IT is uncertain, and the optimal treatment strategy using RT and IT in metastatic melanoma remains unclear. Our main objective was to examine the effect of RT dose-fractionation on overall survival (OS). Methods Using the National Cancer Database (NCDB), we classified metastatic melanoma patients who received palliative RT into two dose-fractionation groups - conventionally fractionated RT (CFRT; <5 Gy/fraction) and hypofractionated RT (HFRT: ≥5 Gy/fraction) - with or without IT. Survival analysis was performed using the Cox regression model, Kaplan-Meier method, and propensity-score matching (PSM). Results A total of 5,281 metastatic melanoma patients were included, with a median follow-up of 5.9 months. The three-year OS was highest in patients who received HFRT+IT [37.3% (95% CI: 31.1-43.5)] compared to those who received HFRT alone [19.0% (95% CI: 16.2-21.9)], CFRT+IT [17.6 (95%CI: 13.9-21.6)], or CFRT alone [8.6% (95%CI: 7.6-9.7); p<0.0001]. The magnitude of OS benefit with the use of IT was greater in those who received HFRT (18.3%) compared with those who received CFRT (9.0%) (p<0.0001). The addition of IT to HFRT, compared to CFRT, was associated with greater OS benefit in patients treated with RT to the brain and soft tissue/visceral (STV) sites. On PSM analysis, HFRT+IT was associated with improved three-year OS compared to other treatments. Conclusion Metastatic melanoma patients who received HFRT+IT was associated with the greatest OS benefit. Our findings warrant further prospective evaluation as to whether higher RT dose-per-fraction improves clinical outcomes in metastatic melanoma patients receiving IT., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Wang et al.)
Published: 2020
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32. Retroperitoneal Lymph Node Dissection as Primary Treatment for Men With Testicular Seminoma: Utilization and Survival Analysis Using the National Cancer Data Base, 2004-2014.

Author: Tabakin AL, Shinder BM, Kim S, Rivera-Nunez Z, Polotti CF, Modi PK, Sterling JA, Farber NJ, Radadia KD, Parikh RR, Kim IY, Saraiya B, Mayer TM, Singer EA, and Jang TL
Subjects: Adolescent, Adult, Follow-Up Studies, Humans, Kaplan-Meier Estimate, Lymphatic Metastasis prevention & control, Male, Middle Aged, Neoplasm Staging, Orchiectomy, Registries statistics & numerical data, Retrospective Studies, Seminoma mortality, Seminoma pathology, Survival Rate, Testicular Neoplasms mortality, Testicular Neoplasms pathology, Testis pathology, Testis surgery, Treatment Outcome, United States epidemiology, Young Adult, Lymph Node Excision statistics & numerical data, Lymph Nodes surgery, Retroperitoneal Space surgery, Seminoma surgery, Testicular Neoplasms surgery
Abstract: Background: The role of retroperitoneal lymph node dissection (RPLND) as first-line treatment for testicular seminoma is less well defined than for testicular nonseminomatous germ-cell tumors. We describe utilization of primary RPLND in the United States and report on overall survival (OS) after surgery for these men., Patients and Methods: Using 2004-2014 data from the National Cancer Data Base, we identified 62,727 men with primary testicular cancer, 31,068 of whom were diagnosed as having seminoma. After excluding men with benign, non-germ cell, and nonseminomatous germ-cell tumor histologies, those who did not undergo RPLND, those where clinical stage and survival data were unavailable, and those with testicular seminoma who underwent RPLND in the postchemotherapy setting (n = 47), 365 men comprised our final cohort. Descriptive statistics were used to summarize clinical and demographic factors. The Kaplan-Meier method was used to determine OS., Results: A total of 365 men with testicular seminoma underwent primary RPLND. At a median follow-up of 4.1 years, there were 16 deaths in the entire cohort. Five-year OS was 94.2%. Subset analysis of men with stage I and IIA/B disease who underwent primary RPLND revealed 5-year OS rates of 97.3% and 92.0%, respectively (P = .035). OS did not significantly differ in patients with stage IIA versus IIB disease (91.8% vs. 92.3%, respectively, P = .907)., Conclusion: Although RPLND is rarely used as primary therapy in testicular seminoma, OS rates appear to be comparable to rates reported in the literature for primary chemotherapy or radiotherapy. Ongoing prospective trials will clarify the role of RPLND in the management of testicular seminoma., (Copyright © 2019 Elsevier Inc. All rights reserved.)
Published: 2020
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33. Pediatric hodgkin lymphoma: disparities in survival by race.

Author: Khullar K, Rivera-Núñez Z, Jhawar SR, Drachtman R, Cole PD, Hoppe BS, and Parikh RR
Subjects: Adolescent, Black or African American, Child, Healthcare Disparities, Humans, Proportional Hazards Models, Hodgkin Disease diagnosis, Hodgkin Disease epidemiology, Hodgkin Disease therapy
Abstract: The purpose of this study was to examine factors associated with disparities in overall survival (OS) by race in pediatric Hodgkin Lymphoma (HL) patients. We evaluated clinical features and survival among patients ≤21 years of age diagnosed with stage I-IV HL from 2004 to 2015 from the National Cancer DataBase (NCDB) using a multivariable Cox proportional hazards model. Among 11,546 patients with pediatric HL, 9285 patients met eligibility criteria. Black patients experienced a 5-year OS of 91.5% vs 95.9% in White patients ( p < .0001). After adjusting for confounders, Black race was associated with a significantly decreased OS (HR = 1.50; 95% CI: 1.12-1.99; p < .01). In stratified analysis by ages ≤15 years, 16-18 years, and >18 years, Black race was associated with poorer OS among compared to Whites with rates of 95.4% vs 97.7%, 87.1% vs 96.1%, and 91.6% vs 94.6% respectively. Overall, Black pediatric HL patients had lower overall survival in this study.
Published: 2020
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34. A novel approach to Verify air gap and SSD for proton radiotherapy using surface imaging.

Author: Wang X, Ma C, Davis R, Parikh RR, Jabbour SK, Haffty BG, Yue NJ, Nie K, and Zhang Y
Subjects: Air, Calibration, Female, Humans, Image Processing, Computer-Assisted methods, Male, Neoplasms diagnostic imaging, Neoplasms pathology, Radiotherapy Dosage, Radiotherapy Planning, Computer-Assisted methods, Retrospective Studies, Algorithms, Neoplasms radiotherapy, Phantoms, Imaging, Proton Therapy instrumentation, Proton Therapy methods, Radiotherapy Setup Errors prevention & control, Tomography, X-Ray Computed methods
Abstract: Purpose: To develop a novel approach to accurately verify patient set up in proton radiotherapy, especially for the verification of the nozzle - body surface air gap and source-to-skin distance (SSD), the consistency and accuracy of which is extremely important in proton treatment., Methods: Patient body surfaces can be captured and monitored with the optical surface imaging system during radiation treatment for improved intrafraction accuracy. An in-house software package was developed to reconstruct the patient body surface in the treatment position from the optical surface imaging reference capture and to calculate the corresponding nozzle - body surface air gap and SSD. To validate this method, a mannequin was scanned on a CT simulator and proton plans were generated for a Mevion S250 Proton machine with 20 gantry/couch angle combinations, as well as two different snout sizes, in the Varian Eclipse Treatment Planning Systems (TPS). The surface generated in the TPS from the CT scan was imported into the optical imaging system as an RT Structure for the purpose of validating and establishing a benchmark for ground truth comparison. The optical imaging surface reference capture was acquired at the treatment setup position after orthogonal kV imaging to confirm the positioning. The air gaps and SSDs calculated with the developed method from the surface captured at the treatment setup position (VRT surface) and the CT based surface imported from the TPS were compared to those calculated in TPS. The same approach was also applied to 14 clinical treatment fields for 10 patients to further validate the methodology., Results: The air gaps and SSDs calculated from our program agreed well with the corresponding values derived from the TPS. For the phantom results, using the CT surface, the absolute differences in the air gap were 0.45 mm ± 0.33 mm for the small snout, and 0.51 mm ± 0.49 mm for the large snout, and the absolute differences in SSD were 0.68 mm ± 0.42 mm regardless of snout size. Using the VRT surface, the absolute differences in air gap were 1.17 mm ± 1.17 mm and 2.1 mm ± 3.09 mm for the small and large snouts, respectively, and the absolute differences in SSD were 0.81 mm ± 0.45 mm. Similarly, for patient data, using the CT surface, the absolute differences in air gap were 0.42 mm ± 0.49 mm, and the absolute differences in SSD were 1.92 mm ± 1.4 mm. Using the VRT surface, the absolute differences in the air gap were 2.35 mm ± 2.3 mm, and the absolute differences in SSD were 2.7 mm ± 2.17 mm., Conclusion: These results showed the feasibility and robustness of using an optical surface imaging approach to conveniently determine the air gap and SSD in proton treatment, providing an accurate and efficient way to confirm the target depth at treatment.
Published: 2019
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35. Prospective study of plasma high molecular weight kininogen and prekallikrein and incidence of coronary heart disease, ischemic stroke and heart failure.

Author: Parikh RR, Folsom AR, Misialek JR, Rosamond WD, Chang PP, Tang W, and Cushman M
Subjects: Brain Ischemia epidemiology, Coronary Disease epidemiology, Female, Heart Failure epidemiology, Humans, Incidence, Male, Middle Aged, Prospective Studies, Stroke epidemiology, Brain Ischemia blood, Coronary Disease blood, Heart Failure blood, Kininogen, High-Molecular-Weight blood, Prekallikrein analysis, Stroke blood
Abstract: Introduction: High molecular weight kininogen (HK) and prekallikrein (PK) are proteins in the kallikrein/kinin system of the coagulation cascade. They play an important role in the contact activation system of the intrinsic coagulation pathway, renin-angiotensin activation, and inflammation. Hence these proteins have been posited to affect the occurrence of cardiovascular events and thus to be potential therapeutic targets. Previous case-control studies have provided inconsistent evidence for an association of HK and PK with cardiovascular disease., Methods: In the prospective population-based Atherosclerosis Risk in Communities(ARIC) Study, we used Cox proportional hazards regression models to investigate the association in 4195 middle-aged adults of plasma HK and PK concentrations in 1993-95 (linearly and in quartiles) with incident coronary heart disease, ischemic stroke, and heart failure through 2016., Results: Over a mean of 18 years follow-up, we identified incident cardiovascular events (coronary heart disease and ischemic stroke) in 618 participants and heart failure in 667. We observed no significant relation between HK or PK and cardiovascular disease or heart failure, before and after adjusting for several potential confounding variables., Conclusions: We found no compelling evidence to support an association of plasma HK or PK concentrations with incident CHD, ischemic stroke, or heart failure., (Copyright © 2019 Elsevier Ltd. All rights reserved.)
Published: 2019
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36. Results of Phase 1 study on cytoreductive radical prostatectomy in men with newly diagnosed metastatic prostate cancer.

Author: Yuh BE, Kwon YS, Shinder BM, Singer EA, Jang TL, Kim S, Stein MN, Mayer T, Ferrari A, Lee N, Parikh RR, Ruel N, Kim WJ, Horie S, Byun SS, Ahlering TE, and Kim IY
Abstract: Background: Preclinical and retrospective data suggest that cytoreductive radical prostatectomy may benefit a subset of men who present with metastatic prostate cancer (mPCa). Herein, we report the results of the first planned Phase 1 study on cytoreductive surgery., Methods: From four institutions, 36 patients consented to the study. However, four did not complete surgery because of rapid disease progression (n = 3) and another because of an intraoperatively discovered pericolonic abscess. Men with newly diagnosed clinical mPCa to lymph nodes or bones were eligible. The primary endpoint was the rate of major perioperative complications (Clavien-Dindo Grade 3 or higher) occurring within 90 days of surgery., Results: The mean age at surgery was 64.0 years. The 90-day overall complication rate was 31.2% (n = 10), of which two (6.25%) were considered major complications: one acute tubular necrosis requiring temporary dialysis and one death. In men with more than 6 months of follow-up, 67.9% had prostate specific antigen nadir ≤0.2 ng/mL, while one patient experienced a rapid rise in prostate specific antigen and another a widely disseminated disease that resulted in death 5 months after surgery. Altogether, these results demonstrate that cytoreductive radical prostatectomy is safe and surgically feasible in selected patients who present with mPCa . Yet, there may be a small subset of patients in whom surgery may cause a significant harm., Conclusion: Therefore, cytoreductive surgery in men with mPCa should be limited to clinical trials until robust data are available.
Published: 2019
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37. Insurance Approval for Proton Beam Therapy and its Impact on Delays in Treatment.

Author: Gupta A, Khan AJ, Goyal S, Millevoi R, Elsebai N, Jabbour SK, Yue NJ, Haffty BG, and Parikh RR
Subjects: Adolescent, Adult, Aged, Aged, 80 and over, Child, Female, Humans, Insurance Claim Review statistics & numerical data, Male, Medicare statistics & numerical data, Middle Aged, Proton Therapy statistics & numerical data, Regression Analysis, Retrospective Studies, United States, Young Adult, Insurance Coverage statistics & numerical data, Insurance, Health, Reimbursement statistics & numerical data, Neoplasms radiotherapy, Prior Authorization statistics & numerical data, Proton Therapy economics, Time-to-Treatment statistics & numerical data
Abstract: Purpose: Prior authorization (PA) has been widely implemented for proton beam therapy (PBT). We sought to determine the association between PA determination and patient characteristics, practice guidelines, and potential treatment delays., Methods and Materials: A single-institution retrospective analysis was performed of all patients considered for PBT between 2015 and 2018 at a National Cancer Institute-designated Comprehensive Cancer Center. Differences in treatment start times and denial rates over time were compared, and multivariable logistic regression was used to identify predictors of initial denial., Results: A total of 444 patients were considered for PBT, including 396 adult and 48 pediatric patients. The American Society for Radiation Oncology model policy supported PBT coverage for 77% of the cohort. Of adult patients requiring PA, 64% were initially denied and 32% remained denied after appeal. In patients considered for reirradiation or randomized phase 3 trial enrollment, initial denial rates were 57% and 64%, respectively. Insurance coverage was not related to diagnosis, reirradiation, trial enrollment, or the American Society for Radiation Oncology model policy guidelines, but it was related to insurance category on multivariable analysis (P < .001). Over a 3-year timespan, initial denial rates increased from 55% to 74% (P = .034). PA delayed treatment start by an average of 3 weeks (and up to 4 months) for those requiring appeal (P < .001) and resulted in 19% of denied patients abandoning radiation treatment altogether. Of pediatric patients, 9% were initially denied, all of whom were approved after appeal, and PA requirement did not delay treatment start (P = .47)., Conclusions: PA requirements in adults represent a significant burden in initiating PBT and cause significant delays in patient care. Insurance approval is arbitrary and has become more restrictive over time, discordant with national clinical practice guidelines. Payors and providers should seek to streamline coverage policies in alignment with established guidelines to ensure appropriate and timely patient care., (Copyright © 2018 Elsevier Inc. All rights reserved.)
Published: 2019
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38. Multidisciplinary Care in High-Risk Prostate Cancer Is the New Standard of Care.

Author: Parikh RR and Saraiya B
Subjects: Humans, Male, Medical Oncology, Standard of Care, Docetaxel, Prostatic Neoplasms
Published: 2019
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39. Association of Combined Modality Therapy vs Chemotherapy Alone With Overall Survival in Early-Stage Pediatric Hodgkin Lymphoma.

Author: Jhawar SR, Rivera-Núñez Z, Drachtman R, Cole PD, Hoppe BS, and Parikh RR
Subjects: Adolescent, Adult, Chemoradiotherapy, Child, Child, Preschool, Combined Modality Therapy, Female, Hodgkin Disease mortality, Humans, Infant, Male, Survival Analysis, Young Adult, Hodgkin Disease drug therapy, Hodgkin Disease radiotherapy
Abstract: Importance: To date, there is no well-defined standard of care for early-stage pediatric Hodgkin lymphoma (HL), which may include chemotherapy alone or combined modality therapy (CMT) with chemotherapy followed by radiotherapy. Although the use of radiotherapy in pediatric HL is decreasing, this strategy remains controversial., Objective: To examine the use of CMT in pediatric HL and its association with improved overall survival using data from a large cancer registry., Design, Setting, and Participants: This observational cohort study used data from the National Cancer Database to evaluate clinical features and survival outcomes among 5657 pediatric patients (age, 0.1-21 years) who received a diagnosis of stage I or II HL in the United States from January 1, 2004, to December 31, 2015. Statistical analysis was conducted from May 1 to November 1, 2018., Exposures: Patients received definitive treatment with chemotherapy or CMT, defined as chemotherapy followed by radiotherapy., Main Outcomes and Measures: Kaplan-Meier survival curves were used to examine overall survival. The association between CMT use, covariables, and overall survival was assessed in multivariable Cox proportional hazards regression models. Use of radiotherapy was assessed over time., Results: Among the 11 546 pediatric patients with HL in the National Cancer Database, 5657 patients (3004 females, 2596 males, and 57 missing information on sex; mean [SD] age, 17.1 [3.6] years) with stage I or II classic HL were analyzed. Of these patients, 2845 (50.3%) received CMT; use of CMT vs chemotherapy alone was associated with younger age (<16 years, 1102 of 2845 [38.7%] vs 856 of 2812 [30.4%]; P < .001), male sex (1369 of 2845 [48.1%] vs 1227 of 2812 [43.6%]; P < .001), stage II disease (2467 of 2845 [86.7%] vs 2376 of 2812 [84.5%]; P = .02), and private health insurance (2065 of 2845 [72.6%] vs 1949 of 2812 [69.3%]; P = .002). The 5-year overall survival was 94.5% (confidence limits, 93.8%, 95.8%) for patients who received chemotherapy alone and 97.3% (confidence limits, 96.4%, 97.9%) for those who received CMT, which remained significant in the intention-to-treat analysis and multivariate analysis (adjusted hazard ratio for CMT, 0.57; 95% CI, 0.42-0.78; P < .001). In the sensitivity analysis, the low-risk cohort (stage I-IIA) and adolescent and young adult patients had the greatest benefit from CMT (adjusted hazard ratio, 0.47; 95% CI, 0.40-0.56; P < .001). The use of CMT decreased by 24.8% from 2004 to 2015 (from 59.7% [271 of 454] to 34.9% [153 of 438])., Conclusions and Relevance: In this study, pediatric patients with early-stage HL receiving CMT experienced improved overall survival 5 years after treatment. There is a nationwide decrease in the use of CMT, perhaps reflecting the bias of ongoing clinical trials designed to avoid consolidation radiotherapy. This study represents the largest data set to date examining the role of CMT in pediatric HL.
Published: 2019
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40. The role of radiotherapy in metastatic prostate cancer.

Author: Khullar K and Parikh RR
Abstract: The current standard of care for patients with metastatic prostate cancer includes ADT with a palliative intent. Recent studies have investigated the role of local therapy in metastatic prostate cancer. While retrospective data has shown some benefit with regard to survival and delay in initiation of ADT, there has been limited prospective Randomized data. To date, there has only been one recent randomized trial revealing a survival benefit with local radiotherapy, largely benefiting patients with the lowest burden of disease. The purpose of this review is to summarize the evidence and ongoing clinical trials regarding the role of radiotherapy in metastatic prostate cancer patients., Competing Interests: None.
Published: 2019

41. Patterns of proton therapy use in pediatric cancer management in 2016: An international survey.

Author: Journy N, Indelicato DJ, Withrow DR, Akimoto T, Alapetite C, Araya M, Chang A, Chang JH, Chon B, Confer ME, Demizu Y, Dendale R, Doyen J, Ermoian R, Gurtner K, Hill-Kayser C, Iwata H, Kim JY, Kwok Y, Laack NN, Lee C, Lim DH, Loredo L, Mangona VS, Mansur DB, Murakami M, Murayama S, Ogino T, Ondrová B, Parikh RR, Paulino AC, Perkins S, Ramakrishna NR, Richter R, Rombi B, Shibata S, Shimizu S, Timmermann B, Vern-Gross T, Wang CJ, Weber DC, Wilkinson JB, Witt Nyström P, Yock TI, Kleinerman RA, and Berrington de Gonzalez A
Subjects: Adolescent, Adult, Child, Child, Preschool, Female, Humans, Infant, Male, Neoplasms epidemiology, Pediatrics methods, Pediatrics statistics & numerical data, Proton Therapy methods, Radiotherapy Dosage, Surveys and Questionnaires, Young Adult, Neoplasms radiotherapy, Proton Therapy statistics & numerical data
Abstract: Purpose: To facilitate the initiation of observational studies on late effects of proton therapy in pediatric patients, we report on current patterns of proton therapy use worldwide in patients aged less than 22 years., Materials & Methods: Fifty-four proton centers treating pediatric patients in 2016 in 11 countries were invited to respond to a survey about the number of patients treated during that year by age group, intent of treatment, delivery technique and tumor types., Results: Among the 40 participating centers (participation rate: 74%), a total of 1,860 patients were treated in 2016 (North America: 1205, Europe: 432, Asia: 223). The numbers of patients per center ranged from 1 to 206 (median: 29). Twenty-four percent of the patients were <5 years of age, and 50% <10 years. More than 30 pediatric tumor types were identified, mainly treated with curative intent: 48% were CNS, 25% extra-cranial sarcomas, 7% neuroblastoma, and 5% hematopoietic tumors. About half of the patients were treated with pencil beam scanning. Treatment patterns were broadly similar across the three continents., Conclusion: To our knowledge, this survey provides the first worldwide assessment of proton therapy use for pediatric cancer management. Since previous estimates in the United States and Europe, CNS tumors remain the cancer types most commonly treated with protons in 2016. However, the proportion of extra-cranial tumors is growing worldwide. The typically low numbers of patients treated in each center indicate the need for international research collaborations to assess long-term outcomes of proton therapy in pediatric patients., (Copyright © 2018 Elsevier B.V. All rights reserved.)
Published: 2019
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42. Aggressive Focal Therapy.

Author: Parikh RR
Subjects: Humans, Infant, Male, Skull, Ependymoma, Prostatic Neoplasms
Published: 2019
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43. Primary Renal Ewing Sarcoma: A Case Report and Review of the Literature.

Author: Findlay BL, Shinder BM, Fatima A, Sadimin E, Drachtman R, Parikh RR, and Singer EA
Abstract: Primary Ewing sarcoma of the kidney is an extremely rare and aggressive tumor affecting young adults. We present the case of a 22-year-old male with primary Ewing sarcoma/primitive neuroectodermal tumor (EWS/PNET) of the kidney who underwent right radical nephrectomy and adjuvant chemo-radiation.
Published: 2019

44. Radiation Therapy for Solitary Plasmacytoma and Multiple Myeloma: Guidelines From the International Lymphoma Radiation Oncology Group.

Author: Tsang RW, Campbell BA, Goda JS, Kelsey CR, Kirova YM, Parikh RR, Ng AK, Ricardi U, Suh CO, Mauch PM, Specht L, and Yahalom J
Subjects: Aged, Bone Neoplasms diagnosis, Bone Neoplasms pathology, Diagnostic Imaging methods, Female, Humans, Male, Middle Aged, Multiple Myeloma diagnosis, Multiple Myeloma pathology, Neoplasm Staging standards, Palliative Care methods, Plasmacytoma diagnosis, Plasmacytoma pathology, Radiotherapy Dosage, Soft Tissue Neoplasms diagnosis, Soft Tissue Neoplasms pathology, Bone Neoplasms radiotherapy, Consensus, Multiple Myeloma radiotherapy, Plasmacytoma radiotherapy, Radiation Oncology standards, Soft Tissue Neoplasms radiotherapy
Abstract: Purpose: To develop guidelines for the work-up and radiation therapy (RT) management of patients with plasma cell neoplasms., Methods and Materials: A literature review was conducted covering staging, work-up, and RT management of plasma cell neoplasms. Guidelines were developed through consensus by an international panel of radiation oncologists with expertise in these diseases, from the International Lymphoma Radiation Oncology Group. RT volume definitions are based on the International Commission on Radiation Units and Measurements., Results: Plasma cell neoplasms account for approximately one-fifth of mature B-cell neoplasms in the United States. The majority (∼95%) are diagnosed as multiple myeloma, in which there has been tremendous progress in systemic therapy approaches with novel drugs over the last 2 decades, resulting in improvements in disease control and survival. In contrast, a small proportion of patients with plasma cell neoplasms present with a localized plasmacytoma in the bone, or in extramedullary (extraosseous) soft tissues, and definitive RT is the standard treatment. RT provides long-term local control in the solitary bone plasmacytomas and is potentially curative in the extramedullary cases. This guideline reviews the diagnostic work-up, principles, and indications for RT, target volume definition, treatment planning, and follow-up procedures for solitary plasmacytoma. Specifically, detailed recommendations for RT volumes and dose/fractionation are provided, illustrated with specific case scenarios. The role of palliative RT in multiple myeloma is also discussed., Conclusions: The International Lymphoma Radiation Oncology Group presents a standardized approach to the use and implementation of definitive RT in solitary plasmacytomas. The modern principles outlining the supportive role of palliative RT in multiple myeloma in an era of novel systemic therapies are also discussed., (Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.)
Published: 2018
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45. Utilization of Pelvic Lymph Node Dissection for Patients With Low-Risk Prostate Cancer Treated With Robot-Assisted Radical Prostatectomy.

Author: Modi PK, Bock M, Kim S, Singer EA, and Parikh RR
Subjects: Aged, Aged, 80 and over, Databases, Factual, Humans, Male, Middle Aged, Pelvis, Prostatic Neoplasms pathology, Robotic Surgical Procedures, Treatment Outcome, Lymph Node Excision methods, Prostatectomy methods, Prostatic Neoplasms surgery
Abstract: Introduction: Pelvic lymph node dissection (PLND) is not recommended for low-risk prostate cancer (PCa) patients. However, the rate of PLND in this population is unknown., Methods: We queried the National Cancer Data Base for PCa patients who underwent robot-assisted radical prostatectomy from 2010 to 2013 and stratified them by D'Amico risk classification. We identified the frequency of PLND in low-risk patients and identified factors associated with receipt of PLND. Further, we determined the number of lymph nodes evaluated (quality) and proportion of patients with detected nodal metastatic disease (utility) in each risk group., Results: Of 51,971 patients with low-risk PCa who underwent robot-assisted radical prostatectomy, 19,059 (36.7%) received PLND. Predictors of PLND in low-risk patients included rural residence (odds ratio [OR], 1.157; 95% confidence interval [CI], 1.009-1.327), treatment at an academic center (OR, 1.492; 95% CI 1.188-1.874), and high-volume facility (OR, 1.327; 95% CI, 1.078-1.633). The mean number of lymph nodes obtained in low-risk patients was lower than in intermediate/high-risk patients (4.74 vs. 5.86, P < .0001). Lymph node positivity was identified in 0.4% of low-risk patients and 4.6% of intermediate/high-risk patients., Conclusion: While PLND is not recommended for low-risk PCa by clinical practice guidelines, it was performed frequently (36.7%) in a large hospital-based data set. PLND in this population was of lower quality (nodal yield) and had less utility of detecting nodal metastatic disease than PLND in intermediate/high-risk PCa. Treatment at a high-volume or academic center was associated with increased use of PLND. Reasons for the variation in practice patterns should be investigated to improve the value of PCa care., (Copyright © 2017 Elsevier Inc. All rights reserved.)
Published: 2017
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46. Patient-reported Quality of Life After Proton Beam Therapy for Prostate Cancer: The Effect of Prostate Size.

Author: Goenka A, Newman NB, Fontanilla H, Cahlon O, Chon B, Tsai H, Hug E, Brown C, Vargas C, and Parikh RR
Subjects: Dose Fractionation, Radiation, Humans, Male, Prospective Studies, Prostatic Neoplasms pathology, Prostatic Neoplasms psychology, Surveys and Questionnaires, Treatment Outcome, Prostate pathology, Prostatic Neoplasms radiotherapy, Proton Therapy methods, Quality of Life psychology
Abstract: Background: In the present study, we assessed the effect of prostate gland size on patient-assessed genitourinary and gastrointestinal (GI) quality of life (QOL) after definitive treatment of prostate adenocarcinoma with proton beam therapy., Patients and Methods: As a part of a prospective outcome tracking protocol, 81 patients treated at a single center between with proton beam therapy completed the Expanded Prostate Cancer Index Composite (EPIC) questionnaire before treatment and at the follow-up examinations. We reviewed the dosimetric data, reported as V x (volume of organ receiving x Gy), and patient-reported QOL at 6 months. Genitourinary QOL was assessed using the American Urological Association symptom score and EPIC urinary domain score. GI QOL was assessed using the EPIC GI domain score., Results: Larger prostate glands were associated with greater bladder V 70 (P < .01) and rectal V 70 (P < .01). The rectal V 70 was < 15% for all patients (range, 4%-13.8%) with the planned treatment volume coverage (percentage of the prescription dose covering 95% of the volume > 95%) maintained. Patients with larger prostates did not have a greater change in their American Urological Association symptom index scores (< 30 cm 3 , +2.3; 30-49 cm 3 , +3.2; ≥ 50 cm 3 , 0.2; P = .06) or urinary domain score (< 30 cm 3 , -3.6; 30-49 cm 3 , -3.1; ≥ 50 cm 3 , +3.8; P = .76) at 6 months after treatment. Also, prostate size was not associated with a change in the EPIC GI domain score at 6 months after treatment (< 30 cm 3 , -3.7; 30-49 cm 3 , -1.1; ≥ 50 cm 3 , -0.55; P = .67)., Conclusion: Definitive proton beam therapy for prostate cancer to a dose of 79.2 Gy resulted in excellent patient-reported urinary and GI QOL, independently of the baseline prostate size. This single-institution finding should be tested further in a multi-institutional study to confirm the potential limited role of androgen deprivation therapy., (Copyright © 2017 Elsevier Inc. All rights reserved.)
Published: 2017
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47. Evidence-based Review on the Use of Proton Therapy in Lymphoma From the Particle Therapy Cooperative Group (PTCOG) Lymphoma Subcommittee.

Author: Tseng YD, Cutter DJ, Plastaras JP, Parikh RR, Cahlon O, Chuong MD, Dedeckova K, Khan MK, Lin SY, McGee LA, Shen EY, Terezakis SA, Badiyan SN, Kirova YM, Hoppe RT, Mendenhall NP, Pankuch M, Flampouri S, Ricardi U, and Hoppe BS
Subjects: Breast Neoplasms etiology, Diabetes Mellitus etiology, Female, Gastrointestinal Neoplasms etiology, Humans, Hypothyroidism etiology, Lung Neoplasms etiology, Male, Neoplasms, Radiation-Induced etiology, Neoplasms, Second Primary etiology, Organs at Risk radiation effects, Radiotherapy Dosage, Hodgkin Disease radiotherapy, Lymphoma, Non-Hodgkin radiotherapy, Proton Therapy adverse effects
Published: 2017
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48. Trends in active surveillance for very low-risk prostate cancer: do guidelines influence modern practice?

Author: Parikh RR, Kim S, Stein MN, Haffty BG, Kim IY, and Goyal S
Subjects: Adult, Aged, Databases, Factual, Early Detection of Cancer, Humans, Male, Middle Aged, Neoplasm Grading, Neoplasm Staging, Outcome Assessment, Health Care, Population Surveillance, Practice Guidelines as Topic, Practice Patterns, Physicians', Prostatic Neoplasms pathology, Risk Assessment, Risk Factors, Socioeconomic Factors, Prostatic Neoplasms diagnosis, Prostatic Neoplasms epidemiology
Abstract: As recommended by current NCCN guidelines, patients with very low-risk prostate cancer may be treated with active surveillance (AS), but this may be underutilized. Using the National Cancer Database (NCDB), we identified men (2010-2013) with biopsy-proven, very low-risk prostate cancer that met AS criteria as suggested by Epstein (stage ≤ T1c; Gleason score (GS) ≤ 6; PSA < 10; and ≤2 [or <33%] positive biopsy cores) and aged ≤76, and low comorbidity index (Charlson-Deyo score = 0). For those patients meeting this criteria, we performed generalized estimation equation (GEE) method with incorporation of correlation in patients clustered within facility to determine the likelihood of undergoing AS. Among the 448 773 patients in the NCDB with low-risk prostate cancer, 40 839 patients met the inclusion criteria. AS was utilized in 5798 patients (14.2%), while within the very low-risk patients receiving treatment, up to 52.2% received radical prostatectomy. In univariate analyses, AS utilization was associated with older age, uninsured status (compared to private insurance), farther distance from facility, academic/research institutions and particularly in the New England region (all P < 0.01). After adjustments of other predictors in multivariate analysis, patients preferentially received AS if they were older (all OR's > 1 compared to younger groups), uninsured (vs. any insurance type, OR's > 1); or treated at academic/research center (OR > 1). The overall use of AS increased from 11.6% (2010) to 27.3% (2013). We found a low, but rising rate of AS in a nationally representative group of very low-risk prostate cancer patients. Disparities in the use of AS may be targeted to improve adherence to national guidelines., (© 2017 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)
Published: 2017
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49. In Reply to Zhang.

Author: Parikh RR, Grossbard ML, Harrison LB, and Yahalom J
Published: 2017
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50. Underutilization of proton therapy in the treatment of pediatric central nervous system tumors: an analysis of the National Cancer Database.

Author: Khan AJ, Kann BH, Pan W, Drachtman R, Roberts K, and Parikh RR
Subjects: Adolescent, Age of Onset, Child, Child, Preschool, Choice Behavior, Cranial Irradiation methods, Cranial Irradiation statistics & numerical data, Databases, Factual statistics & numerical data, Female, Humans, Infant, Infant, Newborn, Male, Patient Selection, Proton Therapy methods, Socioeconomic Factors, Survival Analysis, United States epidemiology, Central Nervous System Neoplasms epidemiology, Central Nervous System Neoplasms radiotherapy, Proton Therapy statistics & numerical data
Published: 2017
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