81 results on '"Venigalla, S."'
Search Results
2. Whole Exome-Sequencing Identifies Variants Associated with Harris Platelet Syndrome
- Author
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Das, A, primary, Naina, H V, additional, and Venigalla, S S, additional
- Published
- 2022
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3. Calculation of Vibrational Frequencies of Sulfur Dioxide by Lie Algebraic Framework
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Balla, M.R., primary, Venigalla, S., additional, and Jaliparthi, V., additional
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- 2021
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4. Development and Validation of a Clinical and Genomic Generalized Competing Event Model in HPV-Negative Head and Neck Cancer
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Carmona, R., primary, Venigalla, S., additional, Reddy, V.K., additional, Williams, G.R., additional, Lukens, J.N., additional, Swisher-McClure, S.D., additional, Ghiam, A. Fotouhi, additional, Lin, A., additional, and Mell, L.K., additional
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- 2019
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5. The Integration of Clinical and Genomic Information Improves Risk Stratification for Locoregional Failure in Bladder Cancer
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Carmona, R., primary, Mell, L.K., additional, Venigalla, S., additional, Mohiuddin, J.J., additional, Kegelman, T.P., additional, Gay, H.A., additional, Vapiwala, N., additional, Michalski, J.M., additional, Christodouleas, J.P., additional, and Baumann, B.C., additional
- Published
- 2019
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6. Variations in Patterns of Concurrent Androgen Deprivation Therapy (ADT) Use Based on Standard Dose Versus Dose-Escalated Radiation Therapy (DE RT) for Prostate Cancer
- Author
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Mohiuddin, J.J., primary, Narayan, V., additional, Venigalla, S., additional, and Vapiwala, N., additional
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- 2018
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7. Radiation Dose Escalation for Localized Ependymoma
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Vogel, J., primary, Venigalla, S., additional, Sharma, S., additional, Hill-Kayser, C.E., additional, and Shabason, J.E., additional
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- 2018
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8. Preliminary Outcomes Following Use of Concurrent Nab-Paclitaxel and Radiation Therapy—A Novel Regimen for Borderline Resectable or Unresectable Pancreatic Cancer
- Author
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Arscott, W.T., primary, Venigalla, S., additional, Nead, K.T., additional, Guttmann, D.M., additional, Shabason, J.E., additional, Lukens, J.N., additional, Plastaras, J.P., additional, Metz, J.M., additional, O'Hara, M., additional, Reiss, K.A., additional, Teitelbaum, U., additional, Loaiza-Bonilla, A., additional, and Ben-Josef, E., additional
- Published
- 2017
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9. Definitive Local Therapy Improves Overall Survival in Patients With Metastatic Cervical Cancer
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Venigalla, S., primary, Guttmann, D.M., additional, Horne, Z.D., additional, and Beriwal, S., additional
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- 2017
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10. Adjuvant Radiation Therapy for Positive Surgical Margins Following Radical Cystectomy for Bladder Cancer: A National Patterns of Care Assessment
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Venigalla, S., primary, Chowdhry, A.K., additional, Guttmann, D.M., additional, Baumann, B.C., additional, Cohen, A., additional, Mamtani, R., additional, and Christodouleas, J.P., additional
- Published
- 2017
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11. Non-Small Cell Lung Cancer (NSCLC) After Breast Cancer (BC): A Population-Based Analysis of Clinicopathologic Features and Overall Survival (OS) in 3529 Women
- Author
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Milano, M.T., primary, Strawderman, R.L., additional, Venigalla, S., additional, Ng, K., additional, and Travis, L.B., additional
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- 2013
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12. ChemInform Abstract: Preparation of Barium Titanate Films at 55 °C by an Electrochemical Method.
- Author
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BENDALE, P., primary, VENIGALLA, S., additional, AMBROSE, J. R., additional, VERINK, E. D. JUN., additional, and ADAIR, J. H., additional
- Published
- 2010
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13. ChemInform Abstract: Low Temperature Electrochemical Synthesis and Dielectric Characterization of Barium Titanate Films Using Nonalkali Electrolytes.
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VENIGALLA, S., primary, BENDALE, P., additional, and ADAIR, J. H., additional
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- 2010
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14. ChemInform Abstract: Preparation and Characterization of Barium Titanate Electrolytic Capacitors from Porous Titanium Anodes.
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VENIGALLA, S., primary, CHODELKA, R. E., additional, and ADAIR, J. H., additional
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- 2010
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15. Design and implementaion of a 2D-DCT architecture using coefficient distributed arithmetic [implementaion read implementation].
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Ghosh, S., Venigalla, S., and Bayoumi, M.
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- 2005
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16. Low Temperature Electrochemical Synthesis and Dielectric Characterization of Barium Titanate Films Using Nonalkali Electrolytes
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Venigalla, S., primary, Bendale, P., additional, and Adair, J. H., additional
- Published
- 1995
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17. Preparation and characterization of barium titanate electrolytic capacitors by anodic oxidation of porous titanium bodies.
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Venigalla, S., Bendale, P., Chodelka, R.E., Adair, J.H., and Costantino, S.A.
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- 1992
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18. Electrochemical Preparation of Barium Titanate Films at Ultra-Low Temperatures
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Venigalla, S., primary, Bendale, P., additional, Ambrose, J.R., additional, Verink, E.D., additional, and Adair, J.H., additional
- Published
- 1991
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19. Neonatal cholestasis
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Venigalla, S. and Gourley, G.R.
- Abstract
Any infant who is jaundiced beyond two to three weeks of life should be evaluated for neonatal cholestasis. Neonatal cholestasis is defined as accumulation of bile substances in blood due to impaired excretion. These infants should always have fractionated serum bilirubin levels checked to differentiate the conjugated hyperbilirubinemia of cholestasis from unconjugated hyperbilirubinemia that is usually benign and spontaneously resolves. Conjugated hyperbilirubinemia, pale stools and dark urine are the cardinal features of neonatal cholestasis. The differential diagnosis of cholestasis is extensive and a systematic approach is helpful to quickly establish the diagnosis. Biliary atresia is a common cause of neonatal cholestasis and affected infants need surgery before 60 days of life for better prognosis. Premature infants have multifactorial cholestasis and need a modified approach to the evaluation of cholestasis. Management of cholestasis is mostly supportive, consisting of medical management of complications of chronic cholestasis like pruritus and nutritional support for malabsorption and vitamin deficiency.
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- 2004
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20. Theoretical Modeling and Experimental Verification of Electrochemical Equilibria in the Ba−Ti−C−H<INF>2</INF>O System
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Venigalla, S. and Adair, J. H.
- Abstract
The thermodynamic principles controlling the electrochemical synthesis of barium titanate (BaTiO
3 ) films are discussed and explored. a variety of Eh −pH diagrams were generated for the Ba−Ti−C−H2 O system as a function of temperature and whether CO2 was in the system. Barium titanate is predicted to form at 25 °C and higher temperatures under alkaline conditions. It is demosnstrated that the phase field for BaTiO3 enlarges as a function of pH with increasing temperature in the absence of CO2 . The role of CO2 , although still important in controlling the phase stability of BaTiO3 via the formation of BaCO3 , becomes less important under solution pH conditions greater than pH ~13 and temperatures greater than 100 °C. The theoretical Eh −pH predictions compare favorably with experimentally determined regimes, where BaTiO3 and films in the Ba−Ti−C−H2 O system form through electrochemical reactions.- Published
- 1999
21. Design and Implementaion of a 2D-DCT Architecture Using Coefficient Distributed Arithmetic
- Author
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Ghosh, S., primary, Venigalla, S., additional, and Bayoumi, M., additional
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22. Electrochemical Preparation of Barium Titanate Films at Ultra-Low Temperatures.
- Author
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Venigalla, S., Bendale, P., Ambrose, J.R., Verink, E.D., and Adair, J.H.
- Published
- 1992
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23. ChemInform Abstract: Preparation and Characterization of Barium Titanate Electrolytic Capacitors from Porous Titanium Anodes.
- Author
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VENIGALLA, S., CHODELKA, R. E., and ADAIR, J. H.
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- 1998
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24. ChemInform Abstract: Low Temperature Electrochemical Synthesis and Dielectric Characterization of Barium Titanate Films Using Nonalkali Electrolytes.
- Author
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VENIGALLA, S., BENDALE, P., and ADAIR, J. H.
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- 1995
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25. ChemInform Abstract: Preparation of Barium Titanate Films at 55 °C by an Electrochemical Method.
- Author
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BENDALE, P., VENIGALLA, S., AMBROSE, J. R., VERINK, E. D. JUN., and ADAIR, J. H.
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- 1994
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26. Effects of HMGCR deficiency on skeletal muscle development.
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Gunasekaran M, Littel HR, Wells NM, Turner J, Campos G, Venigalla S, Estrella EA, Ghosh PS, Daugherty AL, Stafki SA, Kunkel LM, Foley AR, Donkervoort S, Bönnemann CG, Toledo-Bravo de Laguna L, Nascimento A, Benito DN, Draper I, Bruels CC, Pacak CA, and Kang PB
- Abstract
Pathogenic variants in HMGCR were recently linked to a limb-girdle muscular dystrophy (LGMD) phenotype. The protein product HMG CoA reductase (HMGCR) catalyzes a key component of the cholesterol synthesis pathway. The two other muscle diseases associated with HMGCR, statin-associated myopathy (SAM) and autoimmune anti-HMGCR myopathy, are not inherited in a Mendelian pattern. The mechanism linking pathogenic variants in HMGCR with skeletal muscle dysfunction is unclear. We knocked down Hmgcr in mouse skeletal myoblasts, knocked down hmgcr in Drosophila, and expressed three pathogenic HMGCR variants (c.1327C>T, p.Arg443Trp; c.1522_1524delTCT, p.Ser508del; and c.1621G>A, p.Ala541Thr) in Hmgcr knockdown mouse myoblasts. Hmgcr deficiency was associated with decreased proliferation, increased apoptosis, and impaired myotube fusion. Transcriptome sequencing of Hmgcr knockdown versus control myoblasts revealed differential expression involving mitochondrial function, with corresponding differences in cellular oxygen consumption rates. Both ubiquitous and muscle-specific knockdown of hmgcr in Drosophila led to lethality. Overexpression of reference HMGCR cDNA rescued myotube fusion in knockdown cells, whereas overexpression of the pathogenic variants of HMGCR cDNA did not. These results suggest that the three HMGCR-related muscle diseases share disease mechanisms related to skeletal muscle development.
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- 2024
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27. SMAD4 loss predicts worse overall and distant metastasis-free survival in patients with resected pancreatic adenocarcinoma.
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Anstadt EJ, Carmona R, Berlin E, Yegya-Raman N, Venigalla S, Reddy V, Williams GR, Leibensperger MR, Wojcieszynski A, Baumann BC, Lee MK, Plastaras JP, Furth EE, Mell LK, Metz JM, and Ben-Josef E
- Subjects
- Humans, Smad4 Protein genetics, Proportional Hazards Models, Biomarkers, Tumor genetics, Biomarkers, Tumor metabolism, Prognosis, Pancreatic Neoplasms genetics, Pancreatic Neoplasms surgery, Pancreatic Neoplasms metabolism, Adenocarcinoma genetics, Adenocarcinoma surgery
- Abstract
Background: In select patients, pancreatic adenocarcinoma remains a local disease, yet there are no validated biomarkers to predict this behavior and who may benefit from aggressive local treatments. This study sought to determine if SMAD4 (mothers against decapentaplegic homolog 4) messenger RNA-sequencing (RNA-seq) expression is a robust method for predicting overall survival (OS) and distant metastasis-free survival (DMFS) in patients with resected pancreatic adenocarcinoma., Methods: Utilizing The Cancer Genome Atlas (TCGA) and the International Cancer Genome Consortium (ICGC), 322 patients with resected stage I-III pancreatic adenocarcinoma were identified. In TCGA, multivariable proportional hazards models were used to determine the association of SMAD4 genomic aberrations and RNA-seq expression with OS and DMFS. In the ICGC, analysis sought to confirm the predictive performance of RNA-seq via multivariable models and receiver operator characteristic curves., Results: In TCGA, the presence of SMAD4 genomic aberrations was associated with worse OS (hazard ratio [HR], 1.55; 95% CI, 1.00-2.40; p = .048) but not DMFS (HR, 1.33; 95% CI, .87-2.03; p = .19). Low SMAD4 RNA-seq expression was associated with worse OS (HR, 1.83; 95% CI, 1.17-2.86; p = .008) and DMFS (HR, 1.70; 95% CI, 1.14-2.54; p = .009). In the ICGC, increased SMAD4 RNA-seq expression correlated with improved OS (area under the curve [AUC], .92; 95% CI, .86-.94) and DMFS (AUC, .84; 95% CI, .82-.87)., Conclusions: In patients with resected pancreatic adenocarcinoma, SMAD4 genomic aberrations are associated with worse OS but do not predict for DMFS. Increased SMAD4 RNA-seq expression is associated with improved OS and DMFS in patients with resected pancreatic adenocarcinoma. This reproducible finding suggests SMAD4 RNA-seq expression may be a useful marker to predict metastatic spread., (© 2023 American Cancer Society.)
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- 2024
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28. Interleaved configurations of percutaneous epidural stimulation enhanced overground stepping in a person with chronic paraplegia.
- Author
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Gorgey AS, Venigalla S, Rehman MU, George B, Rejc E, and Gouda JJ
- Abstract
Descending motor signals are disrupted after complete spinal cord injury (SCI) resulting in loss of standing and walking. We previously restored standing and trunk control in a person with a T3 complete SCI following implantation of percutaneous spinal cord epidural stimulation (SCES). We, hereby, present a step-by-step procedure on configuring the SCES leads to initiate rhythmic lower limb activation (rhythmic-SCES) resulting in independent overground stepping in parallel bars and using a standard walker. Initially, SCES was examined in supine lying at 2 Hz before initiating stepping-like activity in parallel bars using 20 or 30 Hz; however, single lead configuration (+2, -5) resulted in lower limb adduction and crossing of limbs, impairing the initiation of overground stepping. After 6 months, interleaving the original rhythmic-SCES with an additional configuration (-12, +15) on the opposite lead, resulted in a decrease of the extensive adduction tone and allowed the participant to initiate overground stepping up to 16 consecutive steps. The current paradigm suggests that interleaving two rhythmic-SCES configurations may improve the excitability of the spinal circuitry to better interpret the residual descending supraspinal signals with the ascending proprioceptive inputs, resulting in a stepping-like motor behavior after complete SCI., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2023 Gorgey, Venigalla, Rehman, George, Rejc and Gouda.)
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- 2023
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29. MED12 Regulates Human Adipose-Derived Stem Cell Adipogenesis and Mediator Kinase Subunit Expression in Murine Adipose Depots.
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Venigalla S, Straub J, Idigo O, Rinderle C, Stephens JM, and Newman JJ
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- 3T3-L1 Cells, Adipocytes metabolism, Adipose Tissue metabolism, Animals, Humans, Mediator Complex genetics, Mediator Complex metabolism, Mice, Stem Cells metabolism, Transcription Factors metabolism, Adipogenesis genetics, PPAR gamma genetics
- Abstract
The mediator kinase module plays a critical role in the regulation of transcription during metabolic processes. Here we demonstrate that in human adipose-derived stem cells (hASCs), kinase module subunits have distinct mRNA and protein expression profiles during different stages of adipogenesis. In addition, siRNA-mediated loss of MED12 results in decreased adipogenesis as evident through decreased lipid accumulation and decreased expression of PPARγ, a master regulator of adipogenesis. Moreover, the decrease in adipogenesis and reduced PPARγ expression are observed only during the early stages of MED12 knockdown. At later stages, knockdown of MED12 did not have any significant effects on adipogenesis or PPARγ expression. We also observed that MED12 was present in a protein complex with PPARγ and C/EBPα during all stages of adipogenesis in hASCs. In 3T3-L1 preadipocytes and adipocytes, MED12 is present in protein complexes with PPARγ1, C/EBPα, and STAT5A. CDK8, another member of the kinase module, was only found to interact with C/EBPα. We found that the expression of all kinase module subunits decreased in inguinal, gonadal, and retroperitoneal white adipose tissue (WAT) depots in the fed state after an overnight fast, whereas the expression of kinase module subunits remained consistent in mesenteric WAT (mWAT) and brown adipose tissue. These data demonstrate that the kinase module undergoes physiologic regulation during fasting and feeding in specific mouse adipose tissue depots, and that MED12 likely plays a specific role in initiating and maintaining adipogenesis.
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- 2022
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30. Palliative Radiotherapy for Diffuse Large B-cell Lymphoma.
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Wright CM, Koroulakis AI, Baron JA, Chong EA, Tseng YD, Kurtz G, LaRiviere M, Venigalla S, Jones JA, Maity A, Mohindra P, Plastaras JP, and Paydar I
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- Humans, Lymphoma, Large B-Cell, Diffuse mortality, Progression-Free Survival, Lymphoma, Large B-Cell, Diffuse radiotherapy, Palliative Care methods
- Abstract
Recent improvements in chemoimmunotherapies, targeted agents, hematopoietic stem cell transplants, and cellular therapies have revolutionized treatment paradigms for patients with diffuse large B-cell lymphoma (DLBCL). Even in the relapsed or refractory setting, contemporary treatment options are delivered with curative intent and can lead to lasting remissions. Although such therapies have improved overall outcomes, they have increasingly led to a wide variety of presentations of recurrent tumors in need of palliation. Here, we review the use of radiotherapy (RT) in the palliation of DLBCL. We draw particular attention to the evolving role for hypofractionated RT and low-dose RT for DLBCL. We review the available literature on these topics and focus on commonly encountered clinical scenarios., (Copyright © 2021. Published by Elsevier Inc.)
- Published
- 2021
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31. Concurrent Nab-paclitaxel and Radiotherapy: Novel Radiosensitization for Borderline Resectable or Unresectable Pancreatic Cancer.
- Author
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Arscott WT, Nead KT, Bear A, Venigalla S, Shabason J, Lukens JN, Plastaras JP, Wojcieszynski A, Metz J, O'Hara M, Reiss KA, Teitelbaum U, Loaiza-Bonilla A, Drebin J, Lee MK 4th, Shroff SG, and Ben-Josef E
- Subjects
- Aged, Aged, 80 and over, Albumins adverse effects, Carcinoma, Pancreatic Ductal drug therapy, Carcinoma, Pancreatic Ductal mortality, Carcinoma, Pancreatic Ductal surgery, Chemoradiotherapy, Deoxycytidine analogs & derivatives, Deoxycytidine therapeutic use, Female, Fluorouracil therapeutic use, Humans, Male, Middle Aged, Paclitaxel adverse effects, Pancreatic Neoplasms drug therapy, Pancreatic Neoplasms mortality, Pancreatic Neoplasms surgery, Radiation-Sensitizing Agents adverse effects, Treatment Outcome, Gemcitabine, Albumins therapeutic use, Carcinoma, Pancreatic Ductal radiotherapy, Paclitaxel therapeutic use, Pancreatic Neoplasms radiotherapy, Radiation-Sensitizing Agents therapeutic use
- Abstract
Purpose: This study evaluates the toxicity and tumor response with concurrent nab-paclitaxel chemoradiotherapy (CRT) compared with standard (5-fluorouracil or gemcitabine) CRT., Materials and Methods: Fifty patients with borderline resectable or unresectable pancreatic adenocarcinoma from 2014 to 2017 were divided into 2 groups: concurrent nab-paclitaxel (100 to 125 mg/m2 weekly) CRT (median: 2.1 Gy fraction size and 52.5 Gy total) or standard CRT (median: 1.8 Gy fraction size, 54.5 Gy total). The primary endpoint was toxicity, and secondary endpoints were local failure and conversion to resectability. Comparisons were made using rank-sum or Fisher exact test and multivariable competing risk regression for the cumulative incidence of local failure., Results: There were 28 patients in the nab-paclitaxel CRT group and 22 in the standard CRT group; 88% had the unresectable disease. The median follow-up was 18 months. The median duration of chemotherapy before concurrent CRT was 1.9 and 2.3 months in the nab-paclitaxel and standard CRT groups (P=0.337), and radiotherapy dose was 52.5 Gy (range, 52.5 to 59.4 Gy) and 54.5 Gy (range, 45.0 to 59.4 Gy), respectively. There were no statistically significant grade ≥2 toxicities. The nab-paclitaxel CRT group experienced a nonstatistically significant lower incidence of local failure (hazard ratio=0.91, 95% confidence interval: 0.27-3.03, P=0.536). More patients in the nab-paclitaxel CRT group proceeded to surgery (9/28 compared with 3/22 in the standard CRT, P=0.186); of which 6 (25%) in the nab-paclitaxel CRT and 2 (10%) in the standard CRT groups were initially unresectable., Conclusions: Nab-paclitaxel CRT had similar toxicity compared with standard CRT in the treatment of borderline resectable or unresectable pancreatic cancer. Its use was associated with an arithmetically lower cumulative incidence of local failure and an arithmetically higher conversion to resectability, both of which were not statistically significant., Competing Interests: A.L.-B. reports personal fees from Celgene outside the submitted work. The other authors declare no conflicts of interest., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.)
- Published
- 2021
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32. Definitive Local Therapy Is Associated with Improved Survival in Metastatic Soft Tissue Sarcomas.
- Author
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Reddy VK, Jain V, Venigalla S, Nimgaokar V, Amurthur A, Lee DY, Sebro RA, Maki RG, Wilson RJ 2nd, Weber KL, and Shabason JE
- Abstract
Background: Definitive local therapy is often utilized in patients with metastatic soft tissue sarcomas (STS) to reduce morbidity associated with local tumor progression. We hypothesize that it is associated with improved overall survival (OS). Methods: Patients with newly diagnosed metastatic STS treated with chemotherapy were identified from the National Cancer Database and dichotomized into cohorts: 1. definitive local therapy (defined as either definitive dose radiotherapy, definitive surgery, or surgery with perioperative radiotherapy) or 2. conservative therapy (defined as systemic therapy with or without palliative therapy). The association between definitive local therapy and OS, and factors associated with the receipt of definitive local therapy were assessed. Results: Total of 4180 patients were identified. Compared with the conservative therapy, receipt of any definitive local therapy was associated with improved OS (median 17.9 vs. 10.1 months). The survival benefit remained on multivariate analyses and propensity-score matched analyses, with a stepwise improvement with surgery and combined modality local therapy, specifically radiotherapy (HR: 0.77; p < 0.001), surgery (HR: 0.67; p < 0.001), and combined surgery and radiotherapy (HR: 0.42; p < 0.001). Conclusions: Analysis of a large national cancer registry of patients with metastatic STS suggests that chemotherapy plus definitive local therapy is associated with a significant survival benefit compared to the standard chemotherapy alone.
- Published
- 2021
- Full Text
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33. Radiotherapy Remains Underused in the Treatment of Soft-Tissue Sarcomas: Disparities in Practice Patterns in the United States.
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Reddy VK, Jain V, Venigalla S, Levin WP, Wilson RJ, Weber KL, Kalbasi A, Sebro RA, and Shabason JE
- Abstract
Background: Practice patterns of radiation therapy (RT) use for soft-tissue sarcoma (STS) remain quite variable, despite clinical practice guidelines recommending the addition of RT to surgery for patients with high-grade STS, particularly for larger tumors. Using the National Cancer Database (NCDB), we assessed patterns of overall RT use, neoadjuvant versus adjuvant treatment, and specific RT modalities in this population., Patients and Methods: Patients aged ≥18 years with stage II/III STS in 2004 through 2015 were identified from the NCDB. Patterns of care were assessed using multivariable logistic regression analysis., Results: Of 27,426 total patients, 11,654 (42%) were treated with surgery alone versus 15,772 (58%) with RT in addition to surgery, with no overall increase in RT use over the study period. Notable clinical predictors of receipt of RT included tumor size (>5 cm), grade III, and tumors arising in the extremities. Conversely, female sex, older age (≥70 years), Black race, noncommercial insurance coverage, farther distance to treatment, and poor performance status were negative predictors of RT use. Of those receiving RT, 27% were treated with neoadjuvant RT and 73% with adjuvant RT. The proportion of those receiving neoadjuvant RT increased over time. Relevant factors associated with neoadjuvant RT included treatment at academic centers, larger tumor size, and extremity tumors. Of those who received RT with a modality specified as either intensity-modulated RT (IMRT) or 3D conformal RT (3DCRT), 61% were treated with IMRT and 39% with 3DCRT. The proportion of patients treated with IMRT increased over time. Relevant factors associated with IMRT use included treatment at academic centers, commercial insurance coverage, and larger and nonextremity tumors., Conclusions: Although use of neoadjuvant RT and IMRT has increased over time, a significant number of patients with STS are not receiving adjuvant or neoadjuvant RT. Our findings also note potential sociodemographic disparities and highlight the concern that not all patients with STS are being equally considered for RT.
- Published
- 2021
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34. Mediator's Kinase Module: A Modular Regulator of Cell Fate.
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Straub J, Venigalla S, and Newman JJ
- Subjects
- Animals, Cell Lineage genetics, Cell Self Renewal genetics, Enhancer Elements, Genetic genetics, Humans, Transcription, Genetic, Mediator Complex metabolism, Protein Kinases metabolism
- Abstract
Selective gene expression is crucial in maintaining the self-renewing and multipotent properties of stem cells. Mediator is a large, evolutionarily conserved, multi-subunit protein complex that modulates gene expression by relaying signals from cell type-specific transcription factors to RNA polymerase II. In humans, this complex consists of 30 subunits arranged in four modules. One critical module of the Mediator complex is the kinase module consisting of four subunits: MED12, MED13, CDK8, and CCNC. The kinase module exists in variable association with the 26-subunit Mediator core and affects transcription through phosphorylation of transcription factors and by controlling Mediator structure and function. Many studies have shown the kinase module to be a key player in the maintenance of stem cells that is distinct from a general role in transcription. Genetic studies have revealed that dysregulation of this kinase subunit contributes to the development of many human diseases. In this review, we discuss the importance of the Mediator kinase module by examining how this module functions with the more recently identified transcriptional super-enhancers, how changes in the kinase module and its activity can lead to the development of human disease, and the role of this unique module in directing and maintaining cell state. As we look to use stem cells to understand human development and treat human disease through both cell-based therapies and tissue engineering, we need to remain aware of the on-going research and address critical gaps in knowledge related to the molecular mechanisms that control cell fate.
- Published
- 2020
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35. Gender-based Disparities in Receipt of Care and Survival in Malignant Pleural Mesothelioma.
- Author
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Barsky AR, Ahern CA, Venigalla S, Verma V, Anstadt EJ, Wright CM, Ludmir EB, Berlind CG, Lindsay WD, Grover S, Cengel KA, and Simone CB 2nd
- Subjects
- Aged, Aged, 80 and over, Combined Modality Therapy, Female, Follow-Up Studies, Humans, Male, Mesothelioma, Malignant pathology, Mesothelioma, Malignant therapy, Pleural Neoplasms pathology, Pleural Neoplasms therapy, Prognosis, Retrospective Studies, Sex Factors, Survival Rate, Delivery of Health Care standards, Health Status Disparities, Mesothelioma, Malignant mortality, Pleural Neoplasms mortality
- Abstract
Background: Despite accounting for a minority of malignant pleural mesothelioma (MPM) diagnoses, females may experience differential survival relative to males. It is unclear if there are gender-based differences in receipt of treatment or disease-related outcomes for patients with MPM. We therefore utilized the National Cancer Database (NCDB) to assess patterns-of-care and overall survival (OS) among patients with MPM by gender., Materials and Methods: Patients with histologically confirmed MPM treated from 2004 to 2013 were identified from the NCDB. The association between female gender and OS was assessed using multivariable Cox proportional hazards models with propensity score matching. Patterns-of-care were assessed using multivariable logistic regression. The overall treatment effect was tested in subsets of patients by treatment strategy, histology, and clinical stage., Results: A total of 18,799 patients were identified, of whom 14,728 (78%) were male and 4071 (22%) were female. Females were statistically more likely to present at a younger age, with fewer comorbidities, and with epithelioid histology. Despite these favorable prognostic features, women were less likely to receive surgery (P ≤ .001) or chemotherapy (P ≤ .001) compared with males. On multivariable analysis, female gender was associated with improved OS (hazard ratio, 0.83; 95% confidence interval, 0.80-0.86; P ≤ .001). Gender-based survival differences were seen across all stages, but only among patients with epithelioid (P ≤ .001) and not biphasic (P = .17) or sarcomatoid (P = 1.00) histology., Conclusions: Surgery and chemotherapy are disproportionately underutilized in female patients with MPM. Despite this concerning disparity, female gender is independently associated with improved survival relative to males. Further research to understand factors that lead to gender disparities in MPM is warranted., (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Published
- 2020
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36. Low Rates of Chemotherapy Use for Primary, High-Grade Soft Tissue Sarcoma: A National Cancer Database Analysis.
- Author
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Graham DS, Onyshchenko M, Eckardt MA, DiPardo BJ, Venigalla S, Nelson SD, Chmielowski B, Singh AS, Shabason JE, Eilber FC, and Kalbasi A
- Subjects
- Adult, Chemotherapy, Adjuvant, Databases, Factual, Humans, Neoadjuvant Therapy, Retrospective Studies, United States epidemiology, Sarcoma drug therapy, Sarcoma epidemiology
- Abstract
Background: There is conflicting evidence regarding the role of chemotherapy for high-grade soft tissue sarcoma (STS) in adults. We sought to characterize patterns of chemotherapy use, including multiagent and neoadjuvant chemotherapy, in the United States., Patients and Methods: Using the National Cancer Database, we identified 19,969 adult patients who underwent surgical resection for primary high-grade STS from 2004 to 2016. Using logistic regression, we examined factors associated with overall, multiagent, and neoadjuvant chemotherapy use., Results: Chemotherapy was administered to 22% (n=4,377) of the study population. Among patients treated using chemotherapy, 85% received multiagent treatment and 47% received neoadjuvant treatment. On multivariate analysis, factors associated with chemotherapy use included tumor size, depth, histology, and primary site; receipt of radiation treatment; younger age; higher patient income; and academic treatment facility. Factors associated with multiagent chemotherapy use included tumor histology, tumor primary site, and younger age. Factors associated with neoadjuvant chemotherapy use included tumor size, depth, margin status, and primary site; receipt of radiation treatment; higher patient income; academic treatment facility type; and distance to treatment facility. Treatment at a high-volume facility was the only factor associated with overall, multiagent, and neoadjuvant chemotherapy use. No significant temporal trend was seen in overall, multiagent, or neoadjuvant chemotherapy use., Conclusions: Overall chemotherapy use was low (22%). The variability in chemotherapy use was driven by clinical, patient, demographic, and facility factors. Among patients treated with chemotherapy, the use of multiagent chemotherapy was high (85%), and nearly half received neoadjuvant therapy. There was a discrepancy in the use of chemotherapy-including neoadjuvant and multiagent chemotherapy-between high- and low-volume treatment centers.
- Published
- 2020
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37. Association of Age with Efficacy of Immunotherapy in Metastatic Melanoma.
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Jain V, Hwang WT, Venigalla S, Nead KT, Lukens JN, Mitchell TC, and Shabason JE
- Subjects
- Humans, Immune Checkpoint Inhibitors, Immunotherapy, Melanoma drug therapy, Neoplasms, Second Primary
- Abstract
Management of melanoma has been revolutionized by the use of immune checkpoint inhibitors. Immune system changes associated with aging may affect the efficacy of immune-based therapies. Using the National Cancer Database, we evaluated the impact of age on the receipt and efficacy of modern immunotherapies in patients with metastatic melanoma. We identified 11,944 patients from 2011-2015, of whom 25% received immunotherapy. Older (≥60 years), compared with younger, patients were less likely to receive immunotherapy (odds ratio, 0.69; 95% confidence interval [CI], 0.61-0.78; p < .001). Immunotherapy was associated with a survival benefit in both younger and older patients (<60 years: hazard ratio [HR], 0.64; 95% CI, 0.57-0.72; p < .001; ≥60 years: HR, 0.55; 95% CI, 0.50-0.60; p < .001). Importantly, there was a statistically significant interaction between age and survival with immunotherapy, where a greater benefit was observed for older patients (p
interaction = 0.013). Further work studying the age-related response to immunotherapy is warranted., (© AlphaMed Press 2019.)- Published
- 2020
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38. Association of Insurance Status With Presentation, Treatment, and Survival in Melanoma in the Era of Immune Checkpoint Inhibitors.
- Author
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Jain V, Venigalla S, Reddy VK, Lukens JN, Mitchell TC, and Shabason JE
- Subjects
- Aged, Delivery of Health Care methods, Delivery of Health Care standards, Female, Health Services Accessibility, Humans, Immune Checkpoint Inhibitors therapeutic use, Male, Melanoma diagnosis, Melanoma mortality, Melanoma therapy, Middle Aged, Molecular Targeted Therapy, Neoplasm Grading, Neoplasm Staging, Odds Ratio, Outcome Assessment, Health Care, Risk Factors, Survival Analysis, Insurance Coverage, Insurance, Health, Melanoma epidemiology
- Abstract
The effect of health insurance on management and outcomes in melanoma is unclear. Using the National Cancer Database (NCDB), we evaluated the effect of insurance on (1) stage at diagnosis, (2) receipt of immunotherapy, and (3) overall survival (OS) among patients with melanoma. We included patients with stage I-IV melanoma diagnosed from 2011 to 2015. Patients were stratified by age (below 65 vs. 65 y or above) and insurance (commercial, Medicare, Medicaid and uninsured). We evaluated the association between insurance and (1) stage at diagnosis (stage I-III vs. IV) and (2) receipt of immunotherapy (stage IV) using multivariable logistic regression. The association of insurance status with OS in metastatic patients who received immunotherapy was assessed using Kaplan-Meier and Cox proportional hazards analyses. The study included 167,130 patients; 52% had commercial insurance, 43% had Medicare, 3% had Medicaid and 2% were uninsured. In patients below 65 years, those with Medicaid and the uninsured had a higher likelihood of presenting with metastatic melanoma and were less likely to receive immunotherapy compared with those with commercial insurance. Further among those who received immunotherapy, patients with Medicaid (hazard ratio: 1.51, P=0.001) and no insurance (hazard ratio: 1.37, P=0.046) had an inferior OS. In patients 65 years or above, whereas Medicare was associated with an increased likelihood of presenting with metastatic disease, there was no significant difference in receipt of immunotherapy or OS as compared with commercial insurance. In this large modern cohort, insurance was associated with stage at diagnosis, receipt of immunotherapy, and OS for patients below 65 years old with melanoma.
- Published
- 2020
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39. Association of health insurance status with presentation, treatment and outcomes in soft tissue sarcoma.
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Jain V, Venigalla S, Sebro RA, Karakousis GC, Wilson RJ 2nd, Weber KL, and Shabason JE
- Subjects
- Aged, Aged, 80 and over, Combined Modality Therapy, Databases, Factual, Disease Management, Female, Humans, Male, Middle Aged, Neoplasm Staging, Prognosis, Registries, Sarcoma diagnosis, Sarcoma therapy, Symptom Assessment, Treatment Outcome, United States epidemiology, Insurance Coverage, Insurance, Health, Sarcoma epidemiology
- Abstract
Background: Numerous studies across a variety of malignancies have demonstrated that health insurance status is associated with differences in clinical presentation, type of treatments received, and survival. The effect of insurance status on the management of soft tissue sarcoma is unknown. We assessed the association of insurance on (a) stage at diagnosis, (b) receipt of neoadjuvant/adjuvant radiation therapy, and (c) overall survival (OS) in patients with soft tissue sarcoma., Methods: The study cohort was identified from the National Cancer Database (NCDB) and consisted of patients with stage I-IV soft tissue sarcoma of various histologies diagnosed from 2004 to 2015. The patients were stratified by age (<65 and ≥65 years) and by insurance status (commercial, Medicare, Medicaid and uninsured). Using multivariable logistic regression analysis, we evaluated the association between insurance status and (a) stage at diagnosis (Stage I-III vs IV), and (b) receipt of neoadjuvant/adjuvant radiation therapy in patients with locally advanced disease. The association of insurance status on OS was assessed using Kaplan-Meier and multivariable Cox proportional hazards analyses. A propensity score matched survival analysis was performed to account for measured confounders., Results: 49 754 patients were identified of whom 23 677 (48%) had commercial insurance, 20 867 (42%) had Medicare, 3229 (6%) had Medicaid, and 1981 (4%) were uninsured. In patients <65 years, those with Medicaid (OR = 1.74, 95% CI: 1.57-1.93, P < .001) and the uninsured (OR = 1.71, 95% CI: 1.51-1.94, P < .001) were more likely to present with stage IV vs Stage I-III disease. Furthermore, among patients with locally advanced disease treated with limb sparing surgery, those with Medicaid (OR = 0.87, 95% CI: 0.77- 0.98, P = .021) and the uninsured (OR = 0.73, 95% CI: 0.63-0.85, P < .001) were less likely to receive neoadjuvant or adjuvant radiotherapy as compared to those with commercial insurance. Lastly, having Medicaid (HR = 1.26, 95% CI: 1.17-1.34, P < .001) and no insurance (HR = 1.30, 95% CI: 1.20-1.41, P < .001) was associated with worse OS compared to having commercial insurance, a finding which remained significant after propensity score matching. In contrast, in patients ≥65 years, there were no statistically significant differences between those with Medicare and commercial insurance with regards to disease presentation, receipt of radiotherapy, or survival., Conclusions: In a large modern cohort identified from the NCDB, commercial insurance status in patients <65 years was associated early diagnosis, receipt of neoadjuvant/adjuvant radiation therapy, and overall survival for patients with soft tissue sarcoma. Further efforts are warranted to understand disparities in care based on health insurance in the United States., (© 2019 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)
- Published
- 2019
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40. Variations in patterns of concurrent androgen deprivation therapy use based on dose escalation with external beam radiotherapy vs. brachytherapy boost for prostate cancer.
- Author
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Mohiuddin JJ, Narayan V, Venigalla S, and Vapiwala N
- Subjects
- Adult, Aged, Aged, 80 and over, Databases, Factual, Humans, Male, Middle Aged, Prostate-Specific Antigen blood, Prostatic Neoplasms pathology, Radiotherapy Dosage, Retrospective Studies, Androgen Antagonists therapeutic use, Brachytherapy, Prostatic Neoplasms therapy
- Abstract
Purpose: Retrospective data suggest less benefit from androgen deprivation therapy (ADT) in the setting of dose-escalated definitive radiation for prostate cancer, especially when a combination of external beam radiotherapy (EBRT) and brachytherapy approaches are used. This study aimed to test the hypothesis that patients with prostate cancer with intermediate- or high-risk disease undergoing extreme dose escalation with a brachytherapy boost are less likely to receive ADT., Methods and Materials: Data from the National Cancer Database were extracted for men aged 40-90 years diagnosed with node-negative, non-metastatic prostate cancer from 2004 to 2015. Only patients with intermediate- or high-risk disease who were treated with definitive radiotherapy were included. The association and patterns of care between dose escalated radiotherapy and ADT receipt were assessed using multivariable logistic regression., Results: Patients with unfavorable intermediate- and high-risk prostate cancer were significantly less likely to receive ADT if they underwent dose escalation with a combination of EBRT and brachytherapy (odds ratio 0.67, p < 0.0001). Over time, this decrease in ADT utilization has widened for patients with unfavorable intermediate-risk disease. There was no difference in ADT utilization when comparing patients treated with non-dose-escalated EBRT to those treated with dose-escalated EBRT (without brachytherapy)., Conclusion: In this large national database, patients with unfavorable intermediate- and high-risk prostate cancer were significantly less likely to receive guideline-indicated ADT if they underwent extreme dose escalation with combined radiation modalities. As we await prospective data guiding the utility of ADT with dose escalated radiation, these findings suggest potential underutilization of ADT in patients at higher risk of advanced disease., (Copyright © 2019 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
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41. A Case Report of the Clinico-radiologic Challenges of Assessing Treatment Response after Stereotactic Radiation of Oligometastases Preceded by Immunotherapy: Pseudoprogression, Mixed Response Patterns, and Opportunities for Precision Radiation.
- Author
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Rashid AS, Venigalla S, Dzeda M, and Masters GA
- Abstract
As immunotherapy continues to translate to the clinic and is combined with existing modalities, such as radiation therapy, novel treatment response patterns have been observed which complicate conventional clinical assessment and management. Herein, we describe a case study of a patient with non-small cell lung cancer treated initially with definitive chemoradiation who subsequently developed oligorecurrent disease which was managed with nivolumab and then comprehensive salvage stereotactic radiation. Serial radiographic assessment had shown worsening at these limited sites of disease after initiating immunotherapy, improvement after radiation, and then heterogeneous response behavior across sites during longer-term follow-up. Given the dual effects ablative radiation may have in the context of global immune checkpoint inhibition, both cytotoxic and synergistic immune-related, assessment of treatment response to such treatment is complicated. Such assessment is further complicated by novel immunotherapy response phenomena, e.g. pseudoprogression, which are being uncovered and are not fully characterized. Current clinical and radiologic assessment strategies are inadequate to interrogate and discern between immunomodulation-influenced response behavior and further diagnostic innovation is warranted to meet the needs of evolving clinical practice in the era of immunotherapy., Competing Interests: The authors have declared that no competing interests exist.
- Published
- 2019
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42. Definitive local therapy is associated with improved overall survival in metastatic cervical cancer.
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Venigalla S, Guttmann DM, Horne ZD, Carmona R, Shabason JE, and Beriwal S
- Subjects
- Adenocarcinoma secondary, Adenocarcinoma therapy, Aged, Carcinoma, Squamous Cell secondary, Carcinoma, Squamous Cell therapy, Combined Modality Therapy, Female, Follow-Up Studies, Humans, Middle Aged, Prognosis, Survival Rate, Uterine Cervical Neoplasms pathology, Uterine Cervical Neoplasms therapy, Adenocarcinoma mortality, Carcinoma, Squamous Cell mortality, Uterine Cervical Neoplasms mortality
- Abstract
Purpose: Definitive local therapy is often used in metastatic cervical cancer to reduce morbidity associated with local tumor progression. However, the potential benefit of this therapeutic approach has not been rigorously investigated. We hypothesized that definitive local therapy is associated with improved overall survival (OS) in metastatic cervical cancer., Methods and Materials: Patients aged ≥18 years with newly diagnosed metastatic cervical cancer who were treated with chemotherapy were identified from the National Cancer Database. Patients were dichotomized into the following cohorts: definitive local therapy (defined as either concurrent chemoradiation therapy or definitive surgery) or conservative therapy (defined as systemic therapy with or without palliative radiation therapy). The association between definitive local therapy and OS was assessed using propensity score-weighted Cox proportional hazards models. Potential unmeasured confounding was assessed through sensitivity analyses. Factors associated with the receipt of definitive local therapy were identified with multivariable logistic regression., Results: A total of 2838 patients were identified, of whom 1194 (42%) and 1644 (58%) were treated with definitive local and conservative therapy, respectively. Receipt of definitive local therapy was statistically significant, associated with less comorbidity, lower clinical T stage, and node negative disease. Compared with conservative therapy, definitive local therapy was associated with improved OS (hazard ratio: 0.57; 95% confidence interval, 0.52-0.62; P ≤ .001). The median OS rate was 19.2 months in the definitive local therapy cohort and 10.1 months in the conservative therapy cohort. These findings were robust to potential unmeasured confounding in sensitivity analyses and on landmark analyses of patients who survived at least 12 months (hazard ratio: 0.71; 95% confidence interval, 0.62-0.82; P ≤ .001)., Conclusions: Definitive local therapy is associated with improved OS in patients with metastatic cervical cancer. These findings suggest a novel setting for the use of definitive local therapy in the metastatic setting., (Copyright © 2018. Published by Elsevier Inc.)
- Published
- 2018
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43. Use and Effectiveness of Adjuvant Endocrine Therapy for Hormone Receptor-Positive Breast Cancer in Men.
- Author
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Venigalla S, Carmona R, Guttmann DM, Jain V, Freedman GM, Clark AS, and Shabason JE
- Subjects
- Adolescent, Adult, Aged, Breast Neoplasms drug therapy, Breast Neoplasms metabolism, Breast Neoplasms, Male metabolism, Chemotherapy, Adjuvant methods, Female, Humans, Male, Middle Aged, Retrospective Studies, Survival Analysis, Young Adult, Antineoplastic Agents, Hormonal therapeutic use, Breast Neoplasms, Male drug therapy, Receptors, Steroid metabolism
- Abstract
Importance: Although adjuvant endocrine therapy confers a survival benefit among females with hormone receptor (HR)-positive breast cancer, the effectiveness of this treatment among males with HR-positive breast cancer has not been rigorously investigated., Objective: To investigate trends, patterns of use, and effectiveness of adjuvant endocrine therapy among men with HR-positive breast cancer., Design, Setting, and Participants: This retrospective cohort study identified patients in the National Cancer Database with breast cancer who had received treatment from 2004 through 2014. Inclusion criteria for the primary study cohort were males at least 18 years old with nonmetastatic HR-positive invasive breast cancer who underwent surgery with or without adjuvant endocrine therapy. A cohort of female patients was also identified using the same inclusion criteria for comparative analyses by sex. Data analysis was conducted from October 1, 2017, to December 15, 2017., Exposures: Receipt of adjuvant endocrine therapy., Main Outcomes and Measures: Patterns of adjuvant endocrine therapy use were assessed using multivariable logistic regression analyses. Association between adjuvant endocrine therapy use and overall survival was assessed using propensity score-weighted multivariable Cox regression models., Results: The primary study cohort comprised 10 173 men with HR-positive breast cancer (mean [interquartile range] age, 66 [57-75] years). The comparative cohort comprised 961 676 women with HR-positive breast cancer (mean [interquartile range] age, 62 [52-72] years). The median follow-up for the male cohort was 49.6 months (range, 0.1-142.5 months). Men presented more frequently than women with HR-positive disease (94.0% vs 84.3%, P < .001). However, eligible men were less likely than women to receive adjuvant endocrine therapy (67.3% vs 79.0%; OR, 0.61; 95% CI, 0.58-0.63; P < .001). Treatment at academic facilities (odds ratio, 1.13; 95% CI, 1.02-1.25; P = .02) and receipt of adjuvant radiotherapy (odds ratio, 2.83; 95% CI, 2.55-3.15; P < .001) or chemotherapy (odds ratio, 1.20; 95% CI, 1.07-1.34; P < .001) were statistically significantly associated with adjuvant endocrine therapy use in men. A propensity score-weighted analysis indicated that relative to no use, adjuvant endocrine therapy use in men was associated with improved overall survival (hazard ratio, 0.70; 95% CI, 0.63-0.77; P < .001)., Conclusions and Relevance: There is a sex disparate underuse of adjuvant endocrine therapy among men with HR-positive breast cancer despite the use of this treatment being associated with improved overall survival. Further research and interventions may be warranted to bridge gaps in care in this population.
- Published
- 2018
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44. Trends and Patterns of Utilization of Hypofractionated Postmastectomy Radiotherapy: A National Cancer Database Analysis.
- Author
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Venigalla S, Guttmann DM, Jain V, Sharma S, Freedman GM, and Shabason JE
- Subjects
- Aged, Breast Neoplasms pathology, Breast Neoplasms surgery, Cohort Studies, Dose Fractionation, Radiation, Female, Humans, Logistic Models, Middle Aged, Radiation Dosage, Radiotherapy, Adjuvant statistics & numerical data, Radiotherapy, Adjuvant trends, United States, Breast Neoplasms radiotherapy, Mastectomy, Practice Patterns, Physicians' statistics & numerical data, Practice Patterns, Physicians' trends, Radiation Dose Hypofractionation, Registries statistics & numerical data
- Abstract
Background: The acceptance of hypofractionated radiotherapy in treating breast cancer in the breast conservation therapy setting has stimulated interest in hypofractionated postmastectomy radiotherapy (PMRT). We assessed national trends and patterns of utilization of hypofractionated PMRT., Patients and Methods: Women 18 years of age or older with breast cancer treated with mastectomy and PMRT to the chest wall with or without regional lymph nodes from 2004 to 2014 were identified from the National Cancer Database. A standard fractionation cohort was defined as patients receiving 180 to 200 cGy per fraction to a total dose of 4500 to 7000 cGy over 5 to 7 weeks, and a hypofractionation cohort was defined as those receiving 250 to 400 cGy per fraction to a total dose of 3000 to 6000 cGy over 2 to 5 weeks. Multivariable logistic regression was used to determine factors associated with hypofractionated PMRT use., Results: We identified 113,981 patients who met study criteria. Overall, hypofractionated PMRT use was low (1.1%) although utilization increased over time (P ≤ .001). Older age, greater comorbidity, further distance from treatment facility, treatment at academic facilities, less extensive disease, and recent treatment year were statistically significant predictors of hypofractionation use compared with standard fractionation. Conversely, breast reconstruction and receipt of chemotherapy were negative predictors., Conclusion: Because of the absence of high-level evidence to support its use, hypofractionated PMRT was uncommonly utilized in the United States from 2004 to 2014, although a small increase in use was noted over time. Findings from this study might be useful in designing future studies, and might serve as a baseline for evaluation of future changes in practice patterns., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2018
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45. Disparities in Perioperative Radiation Therapy Use in Elderly Patients With Soft-Tissue Sarcoma.
- Author
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Venigalla S, Carmona R, VanderWalde N, Sebro R, Sharma S, Simone CB 2nd, Wilson RJ 2nd, Weber KL, and Shabason JE
- Subjects
- Aged, Aged, 80 and over, Female, Humans, Male, Neoplasm Grading, Retrospective Studies, Sarcoma pathology, Survival Analysis, Perioperative Care statistics & numerical data, Sarcoma radiotherapy
- Abstract
Purpose: The benefit of perioperative radiation therapy in elderly patients with soft-tissue sarcoma (STS) is unclear due to the underrepresentation of elderly patients in clinical trials. We assessed patterns of care and overall survival (OS) associated with perioperative radiation therapy use in this population., Methods and Materials: Elderly patients (≥70 years) with high-grade STS who underwent surgery with or without perioperative radiation therapy from 2004 to 2013 were identified from the National Cancer Database. A nonelderly cohort (<70 years) was also identified for secondary comparative analyses. The association between perioperative radiation therapy use and OS was assessed using propensity score-weighted Cox proportional hazards analyses. Relative survival was calculated using national life tables to assess the impact of radiation therapy on estimated sarcoma-specific survival in elderly and nonelderly patients. Patterns of care were assessed using multivariable logistic regression analyses., Results: Of 6978 elderly patients, 3549 (51%) underwent surgery alone, and 740 (11%) and 2,679 (38%) received pre- and postoperative radiation therapy, respectively. Elderly patients received radiation therapy less commonly than did nonelderly patients (49% vs 52%, P < .001) despite presenting with higher grade tumors (grade 3, 86% vs 80%, P < .001) and experiencing more frequent positive surgical margins (23% vs 16%, P < .001). On propensity score-weighted analyses, preoperative (hazard ratio = 0.64, 95% confidence interval: 0.54-0.77, P < .001) and postoperative (hazard ratio = 0.72, 95% confidence interval: 0.67-0.77, P < .001) radiation therapy use was associated with improved OS compared with surgery alone. These associations were robust to landmark analyses of patients surviving at least 12 months. Radiation therapy use resulted in a greater magnitude of 5-year relative survival improvement in elderly than nonelderly patients., Conclusions: There is an overall and an age-disparate underuse of perioperative radiation therapy in elderly patients with high-grade STS despite radiation therapy being associated with improved OS. Further research is warranted to minimize gaps in care for elderly patients., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2018
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46. Comparative Effectiveness of Neoadjuvant Chemoradiation Versus Upfront Surgery in the Management of Recto-Sigmoid Junction Cancer.
- Author
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Venigalla S, Chowdhry AK, Wojcieszynski AP, Lukens JN, Plastaras JP, Metz JM, Ben-Josef E, Mahmoud NN, Reiss KA, and Shabason JE
- Subjects
- Adenocarcinoma mortality, Adenocarcinoma pathology, Adult, Aged, Colectomy methods, Colon, Sigmoid pathology, Colon, Sigmoid surgery, Colorectal Neoplasms mortality, Colorectal Neoplasms pathology, Female, Follow-Up Studies, Humans, Kaplan-Meier Estimate, Male, Margins of Excision, Middle Aged, Neoadjuvant Therapy methods, Proctectomy methods, Rectum pathology, Rectum surgery, Treatment Outcome, United States epidemiology, Young Adult, Adenocarcinoma therapy, Antineoplastic Agents therapeutic use, Chemoradiotherapy, Adjuvant methods, Colorectal Neoplasms therapy, Registries statistics & numerical data
- Abstract
Introduction: The optimal management of locally advanced recto-sigmoid cancer is unclear. Although some experts advocate for upfront surgery, others recommend neoadjuvant chemoradiation followed by surgery. We used the National Cancer Database to characterize patterns-of-care and overall survival (OS) associated with these treatment strategies., Patients and Methods: Patients with clinical stage II or III recto-sigmoid cancer who underwent surgery with or without adjunctive chemotherapy and/or radiotherapy from 2006 to 2014 were identified, and dichotomized into: (1) upfront surgery, and (2) neoadjuvant chemoradiation cohorts. Patterns-of-care were assessed using multivariable logistic regression. The association between neoadjuvant chemoradiation use and OS was assessed using Cox proportional hazards analysis with propensity score-matching., Results: Of 9313 identified patients, 6756 (73%) underwent upfront surgery and 2557 (27%) received neoadjuvant chemoradiation. Treatment at academic facilities and higher clinical T stage were predictors of neoadjuvant chemoradiation use. Compared with upfront surgery, neoadjuvant chemoradiation resulted in fewer positive circumferential resection margins (384 [11%] patients vs. 108 [8%] patients; P = .001), and 478 [18.7%] patients achieved a pathologic complete response at surgery. In propensity score-matched analysis, neoadjuvant chemoradiation use was associated with improved OS (hazard ratio, 0.79; 95% confidence interval, 0.69-0.90) compared with upfront surgery; 5-year estimated OS was 77.0% versus 72.0%, respectively. The improvement in OS persisted in landmark analysis of patients who survived at least 12 months., Conclusion: Only a small percentage of patients with locally advanced recto-sigmoid cancer receive neoadjuvant chemoradiation even though its use might result in improved OS relative to upfront surgery. Prospective research is warranted to validate and standardize therapeutic strategies in patients with recto-sigmoid cancer., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2018
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47. Survival implications of staging lymphadenectomy for non-endometrioid endometrial cancers.
- Author
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Venigalla S, Chowdhry AK, and Shalowitz DI
- Subjects
- Adenocarcinoma, Clear Cell mortality, Adenocarcinoma, Clear Cell pathology, Adenocarcinoma, Clear Cell surgery, Aged, Carcinosarcoma mortality, Carcinosarcoma pathology, Carcinosarcoma surgery, Cohort Studies, Cystadenocarcinoma, Serous mortality, Cystadenocarcinoma, Serous pathology, Cystadenocarcinoma, Serous surgery, Endometrial Neoplasms pathology, Female, Humans, Lymph Node Excision methods, Lymph Node Excision statistics & numerical data, Lymph Nodes pathology, Middle Aged, Neoplasm Staging, Registries, Retrospective Studies, Survival Rate, United States epidemiology, Endometrial Neoplasms mortality, Endometrial Neoplasms surgery, Lymph Nodes surgery
- Abstract
Purpose: To determine, in patients with non-endometrioid endometrial carcinoma, 1) survival benefit associated with pelvic lymphadenectomy (LND), 2) survival benefit for para-aortic lymphadenectomy performed in addition to pelvic lymphadenectomy, and 3) association between number of lymph nodes removed and survival., Methods: Patients with clinical stage I serous carcinoma, clear cell carcinoma, or carcinosarcoma who underwent hysterectomy from 2010 to 2013 were identified from the National Cancer Database. Hazard ratio (HR) for death was assessed using propensity score-weighted multivariable Cox regression models. Subgroup analyses assessed for differences in risk of death among histologic subtypes., Results: 7250 patients met study criteria. 930 (13%) did not undergo LND; 2177 (30%) underwent pelvic LND alone; 4143 (57%) underwent pelvic+para-aortic LND. On propensity score-weighted analysis, pelvic LND was associated with decreased risk of death (HR=0.65, 95% CI: 0.59-0.71) compared to no LND. Pelvic+para-aortic LND was associated with decreased risk of death (HR=0.85, 95% CI: 0.79-0.91) compared to pelvic LND for patients with serous carcinoma. Removal of >15 nodes was independently associated with decreased HR for death (HR=0.86, 95% CI: 0.77-0.96); this association persisted when analysis was limited to patients with node-positive disease (HR=0.78, 95% CI: 0.63-0.95)., Conclusions: LND is associated with survival benefit in patients with non-endometrioid endometrial cancers. Addition of para-aortic LND to pelvic LND may be most beneficial for patients with serous carcinoma. Systematic lymphadenectomy may be associated with survival benefit through detection and microscopic cytoreduction of occult disease., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2018
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48. Radiomics-guided therapy for bladder cancer: Using an optimal biomarker approach to determine extent of bladder cancer invasion from t2-weighted magnetic resonance images.
- Author
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Tong Y, Udupa JK, Wang C, Chen J, Venigalla S, Guzzo TJ, Mamtani R, Baumann BC, Christodouleas JP, and Torigian DA
- Abstract
Background: Current clinical staging methods are unable to accurately define the extent of invasion of localized bladder cancer, which affects the proper use of systemic therapy, surgery, and radiation. Our purpose was to test a novel radiomics approach to identify optimal imaging biomarkers from T2-weighted magnetic resonance imaging (MRI) scans that accurately classify localized bladder cancer into 2 tumor stage groups (≤T2 vs >T2) at both the patient level and within bladder subsectors., Method and Materials: Preoperative T2-weighted MRI scans of 65 consecutive patients followed by radical cystectomy were identified. A 3-layer, shell-like volume of interest (VOI) was defined on each MRI slice: Inner (lumen), middle (bladder wall), and outer (perivesical tissue). An optimal biomarker method was used to identify features from 15,834 intensity and texture properties that maximized the classification of patients into ≤T2 versus >T2 groups. A leave-one-out strategy was used to cross-validate the performance of the identified biomarker feature set at the patient level. The performance of the feature set was then evaluated at the subsector level of the bladder by dividing the VOIs into 8 radial sectors., Results: A total of 9 optimal biomarker features were derived and demonstrated a sensitivity, specificity, accuracy of prediction, and area under a receiver operating characteristic curve of 0.742, 0.824, 0.785, and 0.806, respectively, at the patient level and 0.681, 0.788, 0.763, and 0.813, respectively, at the radial sector level. All 9 selected features were extracted from the middle shell of the VOI and based on texture properties., Conclusions: An approach to select a small, highly independent feature set that is derived from T2-weighted MRI scans that separate patients with bladder cancer into ≤T2 versus >T2 groups at both the patient level and within subsectors of the bladder has been developed and tested. With external validation, this radiomics approach could improve the clinical staging of bladder cancer and optimize therapeutic management.
- Published
- 2018
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49. Utilization of Neoadjuvant Intensity-modulated Radiation Therapy for Rectal Cancer in the United States.
- Author
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Cushman TR, Venigalla S, Brooks ED, Lin C, and Verma V
- Subjects
- Humans, Retrospective Studies, United States, Neoadjuvant Therapy statistics & numerical data, Radiotherapy, Adjuvant statistics & numerical data, Radiotherapy, Intensity-Modulated statistics & numerical data, Rectal Neoplasms radiotherapy
- Abstract
Background/aim: Advances in technology have expanded the use of intensity-modulated radiotherapy (IMRT). The goal of this study was to investigate trends in the utilization of IMRT for rectal cancer (RC) in USA., Materials and Methods: The National Cancer Database was queried for RC patients receiving neoadjuvant chemoradiotherapy with either IMRT or three-dimensional conformal radiation therapy (3DCRT). Differences in factors associated with receipt of 3DCRT versus IMRT were determined and temporal trends were analyzed., Results: From 2005 to 2009, IMRT utilization increased, but remained constant and roughly equivalent to 3DCRT from 2010 to 2014. Patients who received IMRT were more likely to have T4 disease (p=0.014), while patients diagnosed in 2004-2006 (p<0.0001) and 2007-2008 (p=0.015) were less likely to receive IMRT. There were no significant differences in postoperative outcomes between patients receiving 3DCRT and IMRT., Conclusion: IMRT utilization initially increased, but is now used at similar frequencies to 3DCRT and offers similar short-term postoperative outcomes., (Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)
- Published
- 2018
- Full Text
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50. Association Between Treatment at High-Volume Facilities and Improved Overall Survival in Soft Tissue Sarcomas.
- Author
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Venigalla S, Nead KT, Sebro R, Guttmann DM, Sharma S, Simone CB 2nd, Levin WP, Wilson RJ 2nd, Weber KL, and Shabason JE
- Subjects
- Adult, Age Factors, Aged, Databases, Factual, Educational Status, Female, Humans, Insurance Coverage statistics & numerical data, Insurance, Health, Male, Margins of Excision, Middle Aged, Propensity Score, Proportional Hazards Models, Sarcoma pathology, Sarcoma radiotherapy, Sarcoma surgery, Socioeconomic Factors, Tumor Burden, Hospitals, High-Volume statistics & numerical data, Hospitals, Low-Volume statistics & numerical data, Sarcoma mortality
- Abstract
Purpose: Soft tissue sarcomas (STS) are rare malignancies that require complex multidisciplinary management. Therefore, facilities with high sarcoma case volume may demonstrate superior outcomes. We hypothesized that STS treatment at high-volume (HV) facilities would be associated with improved overall survival (OS)., Methods and Materials: Patients aged ≥18 years with nonmetastatic STS treated with surgery and radiation therapy at a single facility from 2004 through 2013 were identified from the National Cancer Database. Facilities were dichotomized into HV and low-volume (LV) cohorts based on total case volume over the study period. OS was assessed using multivariable Cox regression with propensity score-matching. Patterns of care were assessed using multivariable logistic regression analysis., Results: Of 9025 total patients, 1578 (17%) and 7447 (83%) were treated at HV and LV facilities, respectively. On multivariable analysis, high educational attainment, larger tumor size, higher grade, and negative surgical margins were statistically significantly associated with treatment at HV facilities; conversely, black race and non-metropolitan residence were negative predictors of treatment at HV facilities. On propensity score-matched multivariable analysis, treatment at HV facilities versus LV facilities was associated with improved OS (hazard ratio, 0.87, 95% confidence interval, 0.80-0.95; P = .001). Older age, lack of insurance, greater comorbidity, larger tumor size, higher tumor grade, and positive surgical margins were associated with statistically significantly worse OS., Conclusions: In this observational cohort study using the National Cancer Database, receipt of surgery and radiation therapy at HV facilities was associated with improved OS in patients with STS. Potential sociodemographic disparities limit access to care at HV facilities for certain populations. Our findings highlight the importance of receipt of care at HV facilities for patients with STS and warrant further study into improving access to care at HV facilities., (Copyright © 2017 Elsevier Inc. All rights reserved.)
- Published
- 2018
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