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Chino, Junzo Paul

Overview:

Clinical Research in Gynecologic Malignancies, Breast Malignancies, Radiation Oncology Resident Education, Stereotactic Radiation Therapy, and Brachytherapy

Positions:

Associate Professor of Radiation Oncology

Radiation Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 2004

M.D. — Indiana University at Indianapolis

News:

Publications:

The Unique Issues With Brachytherapy in Low- and Middle-Income Countries

Authors
Grover, S; Longo, J; Einck, J; Puri, P; Brown, D; Chino, J; Mahantshetty, U; Yashar, C; Erickson, B
MLA Citation
Grover, S, Longo, J, Einck, J, Puri, P, Brown, D, Chino, J, Mahantshetty, U, Yashar, C, and Erickson, B. "The Unique Issues With Brachytherapy in Low- and Middle-Income Countries (Accepted)." Seminars in Radiation Oncology 27.2 (April 2017): 136-142.
Source
crossref
Published In
Seminars in Radiation Oncology
Volume
27
Issue
2
Publish Date
2017
Start Page
136
End Page
142
DOI
10.1016/j.semradonc.2016.11.005

Patterns of Failure After Surgery for Non-Small-cell Lung Cancer Invading the Chest Wall.

The patterns of failure after resection of non-small-cell lung cancer (NSCLC) invading the chest wall are not well documented, and the role of adjuvant radiation therapy (RT) is unclear, prompting the present analysis.The present institutional review board-approved study evaluated patients who had undergone surgery from 1995 to 2014 for localized NSCLC invading the chest wall. Patients with superior sulcus tumors were excluded. The clinical outcomes were estimated using the Kaplan-Meier method and compared using a log-rank test. The prognostic factors were assessed using a multivariate analysis, and the patterns of failure were scored.Seventy-four patients were evaluated. Most patients had undergone lobectomy or pneumonectomy (85%) with en bloc chest wall resection (80%) and had pathologically node negative findings (81%). The surgical margins were positive in 10 patients (14%) and most commonly involved the chest wall (7 of 10). Adjuvant treatment included RT in 21 (28%) and chemotherapy in 28 (38%). A total of 24 local recurrences developed. The chest wall was a component of local disease recurrence in 19 of 24 cases (79%). The local control rate at 5 years for the entire population was 60% (95% confidence interval, 46%-74%). The local control rate was 74% with adjuvant RT versus 55% without RT (P = .43). On multivariate analysis, only resection less than lobectomy or pneumonectomy was associated with worse local control. The overall survival rate was 38% with RT versus 34% without RT (P = .59).Positive surgical margins and local disease recurrence were common after resection of NSCLC invading the chest wall. The primary pattern of failure was local recurrence in the chest wall. Adjuvant RT was not associated with improved local control or survival.

Authors
Tandberg, DJ; Kelsey, CR; D'Amico, TA; Crawford, J; Chino, JP; Tong, BC; Ready, NE; Wright, A
MLA Citation
Tandberg, DJ, Kelsey, CR, D'Amico, TA, Crawford, J, Chino, JP, Tong, BC, Ready, NE, and Wright, A. "Patterns of Failure After Surgery for Non-Small-cell Lung Cancer Invading the Chest Wall." Clinical lung cancer (November 21, 2016).
PMID
27965012
Source
epmc
Published In
Clinical lung cancer
Publish Date
2016
DOI
10.1016/j.cllc.2016.11.008

Is age a prognostic biomarker for survival among women with locally advanced cervical cancer treated with chemoradiation? An NRG Oncology/Gynecologic Oncology Group ancillary data analysis

Authors
Moore, KN; Java, JJ; Slaughter, KN; Rose, PG; Lanciano, R; DiSilvestro, PA; Thigpen, JT; Lee, Y-C; Tewari, KS; Chino, J; Seward, SM; Miller, DS; Salani, R; Moore, DH; Stehman, FB
MLA Citation
Moore, KN, Java, JJ, Slaughter, KN, Rose, PG, Lanciano, R, DiSilvestro, PA, Thigpen, JT, Lee, Y-C, Tewari, KS, Chino, J, Seward, SM, Miller, DS, Salani, R, Moore, DH, and Stehman, FB. "Is age a prognostic biomarker for survival among women with locally advanced cervical cancer treated with chemoradiation? An NRG Oncology/Gynecologic Oncology Group ancillary data analysis." Gynecologic Oncology 143.2 (November 2016): 294-301.
Source
crossref
Published In
Gynecologic Oncology
Volume
143
Issue
2
Publish Date
2016
Start Page
294
End Page
301
DOI
10.1016/j.ygyno.2016.08.317

Definitive Chemoradiotherapy for Vulvar Cancer

Authors
Natesan, D; Susko, M; Havrilesky, L; Chino, J
MLA Citation
Natesan, D, Susko, M, Havrilesky, L, and Chino, J. "Definitive Chemoradiotherapy for Vulvar Cancer." International Journal of Gynecological Cancer 26.9 (November 2016): 1699-1705.
Source
crossref
Published In
International Journal of Gynecological Cancer
Volume
26
Issue
9
Publish Date
2016
Start Page
1699
End Page
1705
DOI
10.1097/IGC.0000000000000811

Vaginal Toxicity From Vaginal Brachytherapy and Capri-Based Systems

Authors
Susko, M; Craciunescu, OI; Meltsner, SG; Yang, Y; Steffey, B; Cai, J; Chino, JP
MLA Citation
Susko, M, Craciunescu, OI, Meltsner, SG, Yang, Y, Steffey, B, Cai, J, and Chino, JP. "Vaginal Toxicity From Vaginal Brachytherapy and Capri-Based Systems." October 1, 2016.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2
Publish Date
2016
Start Page
E287
End Page
E288

FDG Positron Emission Tomography (PET)/Computed Tomography Characteristics of Vulvar Cancer: Posttreatment PET Correlates With Clinical Outcomes

Authors
Natesan, D; Craciunescu, OI; Lee, PS; Chino, JP
MLA Citation
Natesan, D, Craciunescu, OI, Lee, PS, and Chino, JP. "FDG Positron Emission Tomography (PET)/Computed Tomography Characteristics of Vulvar Cancer: Posttreatment PET Correlates With Clinical Outcomes." October 1, 2016.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2
Publish Date
2016
Start Page
S52
End Page
S53

Simultaneous Integrated Boost (SIB) for Treatment of Gynecological Malignancies: Intensity Modulated Radiation Therapy (IMRT) Versus Volumetric Modulated Arc Therapy (VMAT)

Authors
Vergalasova, I; Light, K; Chino, JP; Craciunescu, OI
MLA Citation
Vergalasova, I, Light, K, Chino, JP, and Craciunescu, OI. "Simultaneous Integrated Boost (SIB) for Treatment of Gynecological Malignancies: Intensity Modulated Radiation Therapy (IMRT) Versus Volumetric Modulated Arc Therapy (VMAT)." October 1, 2016.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2
Publish Date
2016
Start Page
E677
End Page
E678

Computed Tomography Consensus Clinical Target Volume Contouring for Intensity Modulated Radiation Therapy in Intact Cervical Carcinoma

Authors
Yashar, CM; Petersen, IA; Bosch, WR; Albuquerque, KV; Beriwal, S; Chino, JP; Erickson, BA; Feddock, J; Gaffney, DK; Iyer, R; Klopp, AH; Kunos, C; Mayadev, JS; Portelance, L; Viswanathan, AN; Wolfson, AH; Jhingran, A; Mell, LK
MLA Citation
Yashar, CM, Petersen, IA, Bosch, WR, Albuquerque, KV, Beriwal, S, Chino, JP, Erickson, BA, Feddock, J, Gaffney, DK, Iyer, R, Klopp, AH, Kunos, C, Mayadev, JS, Portelance, L, Viswanathan, AN, Wolfson, AH, Jhingran, A, and Mell, LK. "Computed Tomography Consensus Clinical Target Volume Contouring for Intensity Modulated Radiation Therapy in Intact Cervical Carcinoma." October 1, 2016.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2
Publish Date
2016
Start Page
S13
End Page
S14

Total Treatment Duration for Cervical Cancer: Is 55 Days Still the Goal in the Era of Concurrent Chemotherapy?

Authors
Hong, JC; Foote, J; Broadwater, G; Sosa, J; Gaillard, S; Havrilesky, L; Chino, JP
MLA Citation
Hong, JC, Foote, J, Broadwater, G, Sosa, J, Gaillard, S, Havrilesky, L, and Chino, JP. "Total Treatment Duration for Cervical Cancer: Is 55 Days Still the Goal in the Era of Concurrent Chemotherapy?." October 1, 2016.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2
Publish Date
2016
Start Page
S15
End Page
S15

Evaluation of Dose-Volume Metrics of an 18F-FDG Positron Emission Tomography Adaptive Treatment Planning Protocol for Gynecological Malignancies

Authors
Rodrigues, A; Nawrocki, J; Light, K; Chino, JP; Craciunescu, OI
MLA Citation
Rodrigues, A, Nawrocki, J, Light, K, Chino, JP, and Craciunescu, OI. "Evaluation of Dose-Volume Metrics of an 18F-FDG Positron Emission Tomography Adaptive Treatment Planning Protocol for Gynecological Malignancies." October 1, 2016.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2
Publish Date
2016
Start Page
E296
End Page
E296

FDG Positron Emission Tomography as an Indicator of Myelosuppression in Women Undergoing Pelvic Chemoradiation Therapy

Authors
Brownstein, J; Chino, JP; Craciunescu, OI; Light, K
MLA Citation
Brownstein, J, Chino, JP, Craciunescu, OI, and Light, K. "FDG Positron Emission Tomography as an Indicator of Myelosuppression in Women Undergoing Pelvic Chemoradiation Therapy." October 1, 2016.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2
Publish Date
2016
Start Page
E293
End Page
E293

The Impact of Time to Treatment Initiation for Adjuvant Chemotherapy and Radiation Therapy in Stage III Endometrial Cancer: A National Cancer Data Base Study

Authors
Martella, A; Hong, JC; Foote, J; Havrilesky, L; Gaillard, S; Chino, JP
MLA Citation
Martella, A, Hong, JC, Foote, J, Havrilesky, L, Gaillard, S, and Chino, JP. "The Impact of Time to Treatment Initiation for Adjuvant Chemotherapy and Radiation Therapy in Stage III Endometrial Cancer: A National Cancer Data Base Study." October 1, 2016.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2
Publish Date
2016
Start Page
E287
End Page
E287

Levonorgestrel Intrauterine Device as an Endometrial Cancer Prevention Strategy in Obese Women: A Cost-Effectiveness Analysis.

To estimate the cost-effectiveness of the levonorgestrel intrauterine device (IUD) as an endometrial cancer prevention strategy in obese women.A modified Markov model was used to compare IUD placement at age 50 with usual care among women with a body mass index (BMI, kg/m) 40 or greater or BMI 30 or greater. The effects of obesity on incidence and survival were incorporated. The IUD was assumed to confer a 50% reduction in cancer incidence over 5 years. Costs of IUD and cancer care were included. Clinical outcomes were cancer diagnosis and deaths from cancer. Incremental cost-effectiveness ratios were calculated in 2015 U.S. dollars per year of life saved. One-way and two-way sensitivity analyses and Monte Carlo probabilistic analyses were performed.For a 50 year old with BMI 40 or greater, the IUD strategy is costlier and more effective than usual care with an incremental cost-effectiveness ratio of $74,707 per year of life saved. If the protective effect of the levonorgestrel IUD is assumed to be 10 years, the incremental cost-effectiveness ratio decreases to $37,858 per year of life saved. In sensitivity analysis, a levonorgestrel IUD that reduces cancer incidence by at least 68% in women with BMIs of 40 or greater or costs less than $500 is potentially cost-effective. For BMI 30 or greater, the incremental cost-effectiveness ratio of IUD strategy is $137,223 per year of life saved compared with usual care. In Monte Carlo analysis, IUD placement for BMI 40 or greater is cost-effective in 50% of simulations at a willingness-to-pay threshold of $100,000 per year of life saved.The levonorgestrel IUD is a potentially cost-effective strategy for prevention of deaths from endometrial cancer in obese women.

Authors
Dottino, JA; Hasselblad, V; Secord, AA; Myers, ER; Chino, J; Havrilesky, LJ
MLA Citation
Dottino, JA, Hasselblad, V, Secord, AA, Myers, ER, Chino, J, and Havrilesky, LJ. "Levonorgestrel Intrauterine Device as an Endometrial Cancer Prevention Strategy in Obese Women: A Cost-Effectiveness Analysis." Obstetrics and gynecology 128.4 (October 2016): 747-753.
PMID
27607867
Source
epmc
Published In
Obstetrics & Gynecology (Elsevier)
Volume
128
Issue
4
Publish Date
2016
Start Page
747
End Page
753
DOI
10.1097/aog.0000000000001616

FDG Positron Emission Tomography (PET)/Computed Tomography Characteristics of Vulvar Cancer: Posttreatment PET Correlates With Clinical Outcomes.

Authors
Natesan, D; Craciunescu, OI; Lee, PS; Chino, JP
MLA Citation
Natesan, D, Craciunescu, OI, Lee, PS, and Chino, JP. "FDG Positron Emission Tomography (PET)/Computed Tomography Characteristics of Vulvar Cancer: Posttreatment PET Correlates With Clinical Outcomes." International journal of radiation oncology, biology, physics 96.2S (October 2016): S52-S53.
PMID
27675950
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2S
Publish Date
2016
Start Page
S52
End Page
S53
DOI
10.1016/j.ijrobp.2016.06.137

Vaginal Toxicity From Vaginal Brachytherapy and Capri-Based Systems.

Authors
Susko, M; Craciunescu, OI; Meltsner, SG; Yang, Y; Steffey, B; Cai, J; Chino, JP
MLA Citation
Susko, M, Craciunescu, OI, Meltsner, SG, Yang, Y, Steffey, B, Cai, J, and Chino, JP. "Vaginal Toxicity From Vaginal Brachytherapy and Capri-Based Systems." International journal of radiation oncology, biology, physics 96.2S (October 2016): E287-E288.
PMID
27674278
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2S
Publish Date
2016
Start Page
E287
End Page
E288
DOI
10.1016/j.ijrobp.2016.06.1348

Total Treatment Duration for Cervical Cancer: Is 55 Days Still the Goal in the Era of Concurrent Chemotherapy?

Authors
Hong, JC; Foote, J; Broadwater, G; Sosa, J; Gaillard, S; Havrilesky, L; Chino, JP
MLA Citation
Hong, JC, Foote, J, Broadwater, G, Sosa, J, Gaillard, S, Havrilesky, L, and Chino, JP. "Total Treatment Duration for Cervical Cancer: Is 55 Days Still the Goal in the Era of Concurrent Chemotherapy?." International journal of radiation oncology, biology, physics 96.2S (October 2016): S15-.
PMID
27675648
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2S
Publish Date
2016
Start Page
S15
DOI
10.1016/j.ijrobp.2016.06.050

Simultaneous Integrated Boost (SIB) for Treatment of Gynecological Malignancies: Intensity Modulated Radiation Therapy (IMRT) Versus Volumetric Modulated Arc Therapy (VMAT).

Authors
Vergalasova, I; Light, K; Chino, JP; Craciunescu, OI
MLA Citation
Vergalasova, I, Light, K, Chino, JP, and Craciunescu, OI. "Simultaneous Integrated Boost (SIB) for Treatment of Gynecological Malignancies: Intensity Modulated Radiation Therapy (IMRT) Versus Volumetric Modulated Arc Therapy (VMAT)." International journal of radiation oncology, biology, physics 96.2S (October 2016): E677-E678.
PMID
27675334
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2S
Publish Date
2016
Start Page
E677
End Page
E678
DOI
10.1016/j.ijrobp.2016.06.2324

Computed Tomography Consensus Clinical Target Volume Contouring for Intensity Modulated Radiation Therapy in Intact Cervical Carcinoma.

Authors
Yashar, CM; Petersen, IA; Bosch, WR; Albuquerque, KV; Beriwal, S; Chino, JP; Erickson, BA; Feddock, J; Gaffney, DK; Iyer, R; Klopp, AH; Kunos, C; Mayadev, JS; Portelance, L; Viswanathan, AN; Wolfson, AH; Jhingran, A; Mell, LK
MLA Citation
Yashar, CM, Petersen, IA, Bosch, WR, Albuquerque, KV, Beriwal, S, Chino, JP, Erickson, BA, Feddock, J, Gaffney, DK, Iyer, R, Klopp, AH, Kunos, C, Mayadev, JS, Portelance, L, Viswanathan, AN, Wolfson, AH, Jhingran, A, and Mell, LK. "Computed Tomography Consensus Clinical Target Volume Contouring for Intensity Modulated Radiation Therapy in Intact Cervical Carcinoma." International journal of radiation oncology, biology, physics 96.2S (October 2016): S13-S14.
PMID
27675597
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2S
Publish Date
2016
Start Page
S13
End Page
S14
DOI
10.1016/j.ijrobp.2016.06.047

Evaluation of Dose-Volume Metrics of an 18F-FDG Positron Emission Tomography Adaptive Treatment Planning Protocol for Gynecological Malignancies.

Authors
Rodrigues, A; Nawrocki, J; Light, K; Chino, JP; Craciunescu, OI
MLA Citation
Rodrigues, A, Nawrocki, J, Light, K, Chino, JP, and Craciunescu, OI. "Evaluation of Dose-Volume Metrics of an 18F-FDG Positron Emission Tomography Adaptive Treatment Planning Protocol for Gynecological Malignancies." International journal of radiation oncology, biology, physics 96.2S (October 2016): E296-.
PMID
27674302
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2S
Publish Date
2016
Start Page
E296
DOI
10.1016/j.ijrobp.2016.06.1368

FDG Positron Emission Tomography as an Indicator of Myelosuppression in Women Undergoing Pelvic Chemoradiation Therapy.

Authors
Brownstein, J; Chino, JP; Craciunescu, OI; Light, K
MLA Citation
Brownstein, J, Chino, JP, Craciunescu, OI, and Light, K. "FDG Positron Emission Tomography as an Indicator of Myelosuppression in Women Undergoing Pelvic Chemoradiation Therapy." International journal of radiation oncology, biology, physics 96.2S (October 2016): E293-.
PMID
27674293
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2S
Publish Date
2016
Start Page
E293
DOI
10.1016/j.ijrobp.2016.06.1362

The Impact of Time to Treatment Initiation for Adjuvant Chemotherapy and Radiation Therapy in Stage III Endometrial Cancer: A National Cancer Data Base Study.

Authors
Martella, A; Hong, JC; Foote, J; Havrilesky, L; Gaillard, S; Chino, JP
MLA Citation
Martella, A, Hong, JC, Foote, J, Havrilesky, L, Gaillard, S, and Chino, JP. "The Impact of Time to Treatment Initiation for Adjuvant Chemotherapy and Radiation Therapy in Stage III Endometrial Cancer: A National Cancer Data Base Study." International journal of radiation oncology, biology, physics 96.2S (October 2016): E287-.
PMID
27674276
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2S
Publish Date
2016
Start Page
E287
DOI
10.1016/j.ijrobp.2016.06.1346

Real Time Dosimetry for Gynecologic Brachytherapy: Initial Results of a Prospective Clinical Trial (vol 93, pg S203, 2015)

Authors
Chino, JP; Belley, MD; Chang, Z; Langloss, B; Yoshizumi, TT; Therien, MJ; Craciunescu, OI
MLA Citation
Chino, JP, Belley, MD, Chang, Z, Langloss, B, Yoshizumi, TT, Therien, MJ, and Craciunescu, OI. "Real Time Dosimetry for Gynecologic Brachytherapy: Initial Results of a Prospective Clinical Trial (vol 93, pg S203, 2015)." INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 95.2 (June 1, 2016): 858-859.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
95
Issue
2
Publish Date
2016
Start Page
858
End Page
859

WE-DE-201-07: Measurement of Real-Time Dose for Tandem and Ovoid Brachytherapy Procedures Using a High Precision Optical Fiber Radiation Detector.

Development of a novel on-line dosimetry tool is needed to move toward patient-specific quality assurance measurements for Ir-192 HDR brachytherapy to verify accurate dose delivery to the intended location. This work describes the development and use of a nano-crystalline yttrium oxide inorganic scintillator based optical-fiber detector capable of acquiring real-time high-precision dose measurements during tandem and ovoid (T&O) gynecological (GYN) applicator Ir-192 HDR brachytherapy procedures.An optical-fiber detector was calibrated by acquiring light output measurements in liquid water at 3, 5, 7, and 9cm radial source-detector-distances from an Ir-192 HDR source. A regression model was fit to the data to describe the relative light output per unit dose (TG-43 derived) as a function of source-detector-distance. Next, the optical-fiber detector was attached to a vaginal balloon fixed to a Varian Fletcher-Suit-Delclos-style applicator (to mimic clinical setup), and localized by acquiring high-resolution computed tomography (CT) images. To compare the physical point dose to the TPS calculated values (TG-43 and Acuros-BV), a phantom measurement was performed, by submerging the T&O applicator in a liquid water bath and delivering a treatment template representative of a clinical T&O procedure. The fiber detector collected scintillation signal as a function of time, and the calibration data was applied to calculate both real-time dose rate, and cumulative dose.Fiber cumulative dose values were 100.0cGy, 94.3cGy, and 348.9cGy from the tandem, left ovoid, and right ovoid dwells, respectively (total of 443.2cGy). A plot of real time dose rate during the treatment was also acquired. The TPS values at the fiber location were 458.4cGy using TG-43, and 437.6cGy using Acuros-BV calculated as Dm,m (per TG-186).The fiber measured dose value agreement was 3% vs TG-43 and -1% vs Acuros-BV. This fiber detector opens up new possibilities for performing patient-specific quality assurance for Ir-192 HDR GYN procedures. Funding from Coulter Foundation, Duke Bio-medical Engineering. Company is being created around the detector technology. Duke holds patents on the technology.

Authors
Belley, MD; Faught, A; Moore, B; Subashi, E; Langloss, B; Therien, MJ; Yoshizumi, TT; Chino, JP; Craciunescu, O
MLA Citation
Belley, MD, Faught, A, Moore, B, Subashi, E, Langloss, B, Therien, MJ, Yoshizumi, TT, Chino, JP, and Craciunescu, O. "WE-DE-201-07: Measurement of Real-Time Dose for Tandem and Ovoid Brachytherapy Procedures Using a High Precision Optical Fiber Radiation Detector." Medical physics 43.6 (June 2016): 3809-3810.
PMID
28048361
Source
epmc
Published In
Medical physics
Volume
43
Issue
6
Publish Date
2016
Start Page
3809
End Page
3810
DOI
10.1118/1.4957812

Vaginal Dose Is Associated With Toxicity in Image Guided Tandem Ring or Ovoid-Based Brachytherapy.

To calculate vaginal doses during image guided brachytherapy with volume-based metrics and correlate with long-term vaginal toxicity.In this institutional review board-approved study, institutional databases were searched to identify women undergoing computed tomography and/or magnetic resonance-guided brachytherapy at the Duke Cancer Center from 2009 to 2015. All insertions were contoured to include the vagina as a 3-dimensional structure. All contouring was performed on computed tomography or magnetic resonance imaging and used a 0.4-cm fixed brush to outline the applicator and/or packing, expanded to include any grossly visible vagina. The surface of the cervix was specifically excluded from the contour. High-dose-rate (HDR) and low-dose-rate (LDR) doses were converted to the equivalent dose in 2-Gy fractions using an α/β of 3 for late effects. The parameters D0.1cc, D1cc, and D2cc were calculated for all insertions and summed with prior external beam therapy. Late and subacute toxicity to the vagina were determined by the Common Terminology Criteria for Adverse Events version 4.0 and compared by the median and 4th quartile doses, via the log-rank test. Univariate and multivariate hazard ratios were calculated via Cox regression.A total of 258 insertions in 62 women who underwent definitive radiation therapy including brachytherapy for cervical (n=48) and uterine cancer (n=14) were identified. Twenty HDR tandem and ovoid, 32 HDR tandem and ring, and 10 LDR tandem and ovoid insertions were contoured. The median values (interquartile ranges) for vaginal D0.1cc, D1cc, and D2cc were 157.9 (134.4-196.53) Gy, 112.6 (96.7-124.6) Gy, and 100.5 (86.8-108.4) Gy, respectively. At the 4th quartile cutoff of 108 Gy for D2cc, the rate of late grade 1 toxicity at 2 years was 61.2% (95% confidence interval [CI] 43.0%-79.4%) below 108 Gy and 83.9% (63.9%-100%) above (P=.018); grade 2 or greater toxicity was 36.2% (95% CI 15.8%-56.6%) below 108 Gy and 70.7% (95% CI 45.2%-96.2%) above (P=.004); and grade 3 or worse toxicity was 9.9% (95% CI 0.0%-23.6%) below 108 Gy and 30.0% (95% CI 4.7%-55.3%) above (P=.025). This association was maintained on multivariate analysis, independent of covariates such as applicator type, age, and dose rate.Vaginal dose was associated with all grades of vaginal toxicity. Confirmation at other sites using this methodology will be necessary to establish reproducibility; however, the integration of routine calculation of vaginal dose may be warranted.

Authors
Susko, M; Craciunescu, O; Meltsner, S; Yang, Y; Steffey, B; Cai, J; Chino, J
MLA Citation
Susko, M, Craciunescu, O, Meltsner, S, Yang, Y, Steffey, B, Cai, J, and Chino, J. "Vaginal Dose Is Associated With Toxicity in Image Guided Tandem Ring or Ovoid-Based Brachytherapy." International journal of radiation oncology, biology, physics 94.5 (April 2016): 1099-1105.
PMID
26883564
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
94
Issue
5
Publish Date
2016
Start Page
1099
End Page
1105
DOI
10.1016/j.ijrobp.2015.12.360

Adaptive planning using positron emission tomography for locally advanced lung cancer: A feasibility study.

To evaluate the feasibility of adaptive planning using positron emission tomography-computed tomography (PET-CT) in locally advanced non-small cell lung cancer.Patients with locally advanced non-small cell lung cancer receiving definitive radiation therapy (RT) were eligible. Initial planning PET-CT was performed and a conventional RT plan (2 Gy/fraction to 60 Gy) was designed. A second planning PET-CT was obtained at ~50 Gy. Dose escalation to ~70 Gy for residual fludeoxyglucose-avid disease was pursued at the discretion of the treating oncologists. The primary endpoint was feasibility of adaptive planning using interim PET-CT. Normal tissue dose-volume parameters were calculated for both adaptive and simulated nonadaptive plans.From 2012 to 2014, 33 eligible patients were enrolled and underwent planning PET-CT, 3 of which were found to have new distant metastases. Of 30 patients who initiated RT, interim PET-CT was obtained in 29. This showed complete response in 2 patients, partial response/stable disease in 24, and new distant metastases in 3. Selective dose escalation was performed in 17 patients. For those receiving a boost, the median gross tumor volumes pre-RT and at ~50 Gy were 78 mL and 29 mL, respectively (P = .01). Reasons for no dose escalation were normal tissue constraints (n = 3), poorly defined residual disease (n = 2), acute toxicity (n = 1), and refusal of further therapy (n = 1). Adaptive planning compared with a simulated nonadaptive approach allowed for significant dose reductions to the lungs, heart, and esophagus (all P < .01).Adaptive planning using PET-CT was feasible and allows for significant dose reductions to normal tissues compared with traditional planning techniques.

Authors
Kelsey, CR; Christensen, JD; Chino, JP; Adamson, J; Ready, NE; Perez, BA
MLA Citation
Kelsey, CR, Christensen, JD, Chino, JP, Adamson, J, Ready, NE, and Perez, BA. "Adaptive planning using positron emission tomography for locally advanced lung cancer: A feasibility study." Practical radiation oncology 6.2 (March 2016): 96-104.
PMID
26723555
Source
epmc
Published In
Practical Radiation Oncology
Volume
6
Issue
2
Publish Date
2016
Start Page
96
End Page
104
DOI
10.1016/j.prro.2015.10.009

An analysis of appropriate delivery of postoperative radiation therapy for endometrial cancer using the RAND/UCLA Appropriateness Method: Executive summary

Authors
Jones, E; Beriwal, S; Beyer, D; Chino, J; Jhingran, A; Lee, L; Michalski, J; Mundt, AJ; Patton, C; Petersen, I; Portelance, L; Schwarz, JK; McCloskey, S
MLA Citation
Jones, E, Beriwal, S, Beyer, D, Chino, J, Jhingran, A, Lee, L, Michalski, J, Mundt, AJ, Patton, C, Petersen, I, Portelance, L, Schwarz, JK, and McCloskey, S. "An analysis of appropriate delivery of postoperative radiation therapy for endometrial cancer using the RAND/UCLA Appropriateness Method: Executive summary." January 2016.
Source
crossref
Published In
Advances in Radiation Oncology
Volume
1
Issue
1
Publish Date
2016
Start Page
26
End Page
34
DOI
10.1016/j.adro.2015.10.001

Isolating Texture Features of Gynecological Tumors With High Variability in the Context of an F-18-FDG PET Adaptive Protocol

Authors
Nawrocki, J; Chino, JP; Craciunescu, OI
MLA Citation
Nawrocki, J, Chino, JP, and Craciunescu, OI. "Isolating Texture Features of Gynecological Tumors With High Variability in the Context of an F-18-FDG PET Adaptive Protocol." November 1, 2015.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
93
Issue
3
Publish Date
2015
Start Page
E614
End Page
E615

Stereotactic Radiosurgery for Recurrent High Grade Gliomas: Patterns of Failure

Authors
Boyle, JM; Chino, JP; Sampson, JH; Desjardins, A; Kirkpatrick, JP
MLA Citation
Boyle, JM, Chino, JP, Sampson, JH, Desjardins, A, and Kirkpatrick, JP. "Stereotactic Radiosurgery for Recurrent High Grade Gliomas: Patterns of Failure." November 1, 2015.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
93
Issue
3
Publish Date
2015
Start Page
E92
End Page
E92

Bariatric surgery as a means to decrease mortality in women with type I endometrial cancer - An intriguing option in a population at risk for dying of complications of metabolic syndrome.

To estimate the cost-effectiveness and utility of a strategy of offering weight loss surgery (WLS) to women with low risk stage I endometrial cancer (EC) and BMI≥40kg/m(2).A modified Markov state transition model was designed to compare routine care to WLS for women with low risk stage I endometrioid EC, age<70, with a mean BMI 40. A time horizon of 15years was used to simulate the overall survival (OS) of 96,232 women treated from 1988-2010 from SEER*Stat data. To simulate the effects of WLS on OS, a hazard ratio (0.76, 95% CI 0.59-0.99) representing the OS improvement achieved from this intervention (derived from a prospective trial) was modeled. We assumed that 90% of women undergoing bariatric procedures would experience a reduction in BMI. We assumed that 5% of women not undergoing WLS would achieve weight loss to a BMI of 35. Costs of treatment for obesity-related chronic diseases and quality of life (QOL)-related utilities were modeled from published reports.The mean cost-effectiveness for each strategy was: $69,295 and 8.10 quality-adjusted life years (QALYs) for routine care versus $100,675 and 9.30 QALYs for WLS. WLS had an incremental cost-effectiveness ratio (ICER) of $26,080/QALY compared to routine care. At a willingness to pay threshold of $50,000/QALY, WLS was the strategy of choice in 100% of simulations.WLS is a potentially cost-effective intervention in women with low risk, early stage EC, at least in part due to improved quality of life with weight reduction.

Authors
Neff, R; Havrilesky, LJ; Chino, J; O'Malley, DM; Cohn, DE
MLA Citation
Neff, R, Havrilesky, LJ, Chino, J, O'Malley, DM, and Cohn, DE. "Bariatric surgery as a means to decrease mortality in women with type I endometrial cancer - An intriguing option in a population at risk for dying of complications of metabolic syndrome." Gynecologic oncology 138.3 (September 2015): 597-602.
PMID
26232518
Source
epmc
Published In
Gynecologic Oncology
Volume
138
Issue
3
Publish Date
2015
Start Page
597
End Page
602
DOI
10.1016/j.ygyno.2015.07.002

Gemcitabine-induced radiation recall myositis.

Radiation recall is an uncommon phenomenon in which administration of a chemotherapeutic agent induces an acute inflammatory reaction in previously irradiated tissues, often weeks to years after completion of radiotherapy. This entity is well known to medical and radiation oncologists, however only three cases have been reported in radiology journals. We present a case of gemcitabine-induced radiation recall that manifested as myositis with associated dermatitis in the posterior thigh of a patient with remote history of localized radiotherapy for biopsy-proven breast cancer metastasis. We also present a brief literature review to update the topic of radiation recall in imaging, and emphasize the importance of knowledge of this phenomenon when considering the differential diagnosis of myositis/dermatitis in a patient who has received cancer treatment.

Authors
Delavan, JA; Chino, JP; Vinson, EN
MLA Citation
Delavan, JA, Chino, JP, and Vinson, EN. "Gemcitabine-induced radiation recall myositis." Skeletal radiology 44.3 (March 2015): 451-455.
PMID
25193536
Source
epmc
Published In
Skeletal Radiology
Volume
44
Issue
3
Publish Date
2015
Start Page
451
End Page
455
DOI
10.1007/s00256-014-1996-1

Smoking history predicts for increased risk of second primary lung cancer: a comprehensive analysis.

BACKGROUND: Tobacco use is the most important risk factor for the development of lung cancer. The objective of the current study was to determine the effect of smoking on the development of second primary lung cancers (SPLCs) and other clinical outcomes after surgery for non-small cell lung cancer (NSCLC). METHODS: All patients who underwent surgery for NSCLC at the study institution from 1995 through 2008 were identified. Rates of SPLC were analyzed based on smoking status and pack-year exposure. Multivariate analysis was performed to determine risk factors for SPLC. Overall survival, local control, distant metastases, and postoperative mortality were also examined. RESULTS: A total of 1484 patients were identified, including 98 never-smokers. The incidence of SPLC at 3 years, 5 years, and 8 years was 5%, 8%, and 16%, respectively. Only 1 never-smoker developed an SPLC. On multivariate analysis, which was restricted to ever-smokers with pack-years as a continuous variable, smoking history was found to be the only independent risk factor for SPLC (hazard ratio, 1.08; 95% confidence interval, 1.02-1.16 [P = .031]), corresponding to an 8% increased risk per 10 pack-year exposure. There were no differences in rates of local control or distant metastases based on smoking status. There was a trend toward lower postoperative mortality in never-smokers compared with ever-smokers (0% vs 3.3%; P = .069). Overall survival was found to be significantly worse for current smokers compared with former and never-smokers. CONCLUSIONS: SPLCs are rare in never-smokers. Increasing tobacco exposure is associated with a higher risk of SPLC in patients with a history of smoking. Current smokers have an increased risk of mortality whereas former and never-smokers have comparable survival.

Authors
Boyle, JM; Tandberg, DJ; Chino, JP; D'Amico, TA; Ready, NE; Kelsey, CR
MLA Citation
Boyle, JM, Tandberg, DJ, Chino, JP, D'Amico, TA, Ready, NE, and Kelsey, CR. "Smoking history predicts for increased risk of second primary lung cancer: a comprehensive analysis." Cancer 121.4 (February 2015): 598-604.
PMID
25283893
Source
epmc
Published In
Cancer
Volume
121
Issue
4
Publish Date
2015
Start Page
598
End Page
604
DOI
10.1002/cncr.29095

Methods, safety, and early clinical outcomes of dose escalation using simultaneous integrated and sequential boosts in patients with locally advanced gynecologic malignancies.

OBJECTIVE: To evaluate the safety of dose escalated radiotherapy using a simultaneous integrated boost technique in patients with locally advanced gynecological malignancies. METHODS: Thirty-nine women with locally advanced gynecological malignancies were treated with intensity modulated radiation therapy utilizing a simultaneous integrated boost (SIB) technique for gross disease in the para-aortic and/or pelvic nodal basins, sidewall extension, or residual primary disease. Women were treated to 45Gy in 1.8Gy fractions to elective nodal regions. Gross disease was simultaneously treated to 55Gy in 2.2Gy fractions (n=44 sites). An additional sequential boost of 10Gy in 2Gy fractions was delivered if deemed appropriate (n=29 sites). Acute and late toxicity, local control in the treated volumes (LC), overall survival (OS), and distant metastases (DM) were assessed. RESULTS: All were treated with a SIB to a dose of 55Gy. Twenty-four patients were subsequently treated with a sequential boost to a median dose of 65Gy. Median follow-up was 18months. Rates of acute>grade 2 gastrointestinal (GI), genitourinary (GU), and hematologic (heme) toxicities were 2.5%, 0%, and 30%, respectively. There were no grade 4 acute toxicities. At one year, grade 1-2 late GI toxicities were 24.5%. There were no grade 3 or 4 late GI toxicities. Rates of grade 1-2 late GU toxicities were 12.7%. There were no grade 3 or 4 late GU toxicities. CONCLUSION: Dose escalated radiotherapy using a SIB results in acceptable rates of acute toxicity.

Authors
Boyle, J; Craciunescu, O; Steffey, B; Cai, J; Chino, J
MLA Citation
Boyle, J, Craciunescu, O, Steffey, B, Cai, J, and Chino, J. "Methods, safety, and early clinical outcomes of dose escalation using simultaneous integrated and sequential boosts in patients with locally advanced gynecologic malignancies." Gynecologic oncology 135.2 (November 2014): 239-243.
PMID
25192879
Source
epmc
Published In
Gynecologic Oncology
Volume
135
Issue
2
Publish Date
2014
Start Page
239
End Page
243
DOI
10.1016/j.ygyno.2014.08.037

Tobacco Use and Secondary Lung Malignancies After Surgery for Non-Small Cell Lung Cancer

Authors
Boyle, JM; Chino, JP; Tandberg, D; Higgins, KA; Kelsey, CR
MLA Citation
Boyle, JM, Chino, JP, Tandberg, D, Higgins, KA, and Kelsey, CR. "Tobacco Use and Secondary Lung Malignancies After Surgery for Non-Small Cell Lung Cancer." September 1, 2014.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
90
Publish Date
2014
Start Page
S79
End Page
S80

Simultaneous Integrated Boost to Pelvic and Para-Aortic Nodes From Cervical Cancer Improves the Dosimetric Therapeutic Ratio

Authors
Boyle, JM; Dorth, JA; Craciunescu, OI; Light, K; Roper, JR; Chino, JP
MLA Citation
Boyle, JM, Dorth, JA, Craciunescu, OI, Light, K, Roper, JR, and Chino, JP. "Simultaneous Integrated Boost to Pelvic and Para-Aortic Nodes From Cervical Cancer Improves the Dosimetric Therapeutic Ratio." September 1, 2014.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
90
Publish Date
2014
Start Page
S482
End Page
S483

A Prospective Evaluation of FDG PET Adapted IMRT for Node-Positive Gynecologic Cancers

Authors
Chino, JP; Nawrocki, J; Vergalasova, I; Light, K; Craciunescu, O
MLA Citation
Chino, JP, Nawrocki, J, Vergalasova, I, Light, K, and Craciunescu, O. "A Prospective Evaluation of FDG PET Adapted IMRT for Node-Positive Gynecologic Cancers." September 1, 2014.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
90
Publish Date
2014
Start Page
S184
End Page
S184

Response to Dr Sabater.

Authors
Boyle, J; Chino, J
MLA Citation
Boyle, J, and Chino, J. "Response to Dr Sabater." Brachytherapy 13.5 (September 2014): 525-526.
PMID
24927923
Source
epmc
Published In
Brachytherapy
Volume
13
Issue
5
Publish Date
2014
Start Page
525
End Page
526
DOI
10.1016/j.brachy.2014.05.008

Body mass index, dose to organs at risk during vaginal brachytherapy, and the role of three-dimensional CT-based treatment planning.

To assess the effect of body mass index (BMI) on dose to organs at risk (OARs) during high-dose-rate vaginal brachytherapy and evaluate the role of three-dimensional dose evaluation during treatment planning.Three-dimensional dosimetric data for rectum, bladder, sigmoid colon, and small bowel for 125 high-dose-rate vaginal brachytherapy fractions were analyzed. Dose-volume histograms were generated for D0.1 cc and D2 cc of each OAR. Contributing factors including the use of urinary catheter and cylinder size were also recorded. As different dose fractionations were used, the OAR doses were tabulated as a percent dose prescribed to 0.5cm. All patients were treated to 4cm of the vaginal length.Median BMI in this cohort was 31.7kg/m(2). The BMI values had a weak inverse correlation with D0.1 cc to sigmoid colon (rs=-0.18, p=0.047) and D0.1 cc to bladder (rs=-0.19, p=0.038). There was a strong inverse correlation of D2 cc and increasing BMI (rs=-0.64, p=0.003). The median D2 cc was 25.1% for BMI higher than 31 and 61.9% for BMI of 31 or lower. For D0.1 cc, there was also a strong inverse correlation with increasing BMI (rs=-0.57, p<0.001). Median D1 cc was 33.5% for BMI >31 and 84.4% for BMI ≤ 31. On multivariate analysis higher BMI remained a significant predictor of lower small bowel D2 cc (p<0.001) and D0.1 cc (p<0.001).Women with a lower BMI receive higher doses to the bladder and small bowel compared with those with a higher BMI. Three-dimensional dose evaluation should be considered in patients with low BMI, particularly when combined with external beam radiation.

Authors
Boyle, JM; Craciunescu, O; Steffey, B; Cai, J; Chino, J
MLA Citation
Boyle, JM, Craciunescu, O, Steffey, B, Cai, J, and Chino, J. "Body mass index, dose to organs at risk during vaginal brachytherapy, and the role of three-dimensional CT-based treatment planning." Brachytherapy 13.4 (July 2014): 332-336.
PMID
24439964
Source
epmc
Published In
Brachytherapy
Volume
13
Issue
4
Publish Date
2014
Start Page
332
End Page
336
DOI
10.1016/j.brachy.2013.12.002

An investigation of a PRESAGE® in vivo dosimeter for brachytherapy.

Determining accurate in vivo dosimetry in brachytherapy treatment with high dose gradients is challenging. Here we introduce, investigate, and characterize a novel in vivo dosimeter and readout technique with the potential to address this problem. A cylindrical (4 mm × 20 mm) tissue equivalent radiochromic dosimeter PRESAGE® in vivo (PRESAGE®-IV) is investigated. Two readout methods of the radiation induced change in optical density (OD) were investigated: (i) volume-averaged readout by spectrophotometer, and (ii) a line profile readout by 2D projection imaging utilizing a high-resolution (50 micron) telecentric optical system. Method (i) is considered the gold standard when applied to PRESAGE® in optical cuvettes. The feasibility of both methods was evaluated by comparison to standard measurements on PRESAGE® in optical cuvettes via spectrophotometer. An end-to-end feasibility study was performed by a side-by-side comparison with TLDs in an (192)Ir HDR delivery. 7 and 8 Gy was delivered to PRESAGE®-IV and TLDs attached to the surface of a vaginal cylinder. Known geometry enabled direct comparison of measured dose with a commissioned treatment planning system. A high-resolution readout study under a steep dose gradient region showed 98.9% (5%/1 mm) agreement between PRESAGE®-IV and Gafchromic® EBT2 Film. Spectrometer measurements exhibited a linear dose response between 0-15 Gy with sensitivity of 0.0133 ± 0.0007 ΔOD/(Gy ⋅ cm) at the 95% confidence interval. Method (ii) yielded a linear response with sensitivity of 0.0132 ± 0.0006 (ΔOD/Gy), within 2% of method (i). Method (i) has poor spatial resolution due to volume averaging. Method (ii) has higher resolution (∼1 mm) without loss of sensitivity or increased noise. Both readout methods are shown to be feasible. The end-to-end comparison revealed a 2.5% agreement between PRESAGE®-IV and treatment plan in regions of uniform high dose. PRESAGE®-IV shows promise for in vivo dose verification, although improved sensitivity would be desirable. Advantages include high-resolution, convenience and fast, low-cost readout.

Authors
Vidovic, AK; Juang, T; Meltsner, S; Adamovics, J; Chino, J; Steffey, B; Craciunescu, O; Oldham, M
MLA Citation
Vidovic, AK, Juang, T, Meltsner, S, Adamovics, J, Chino, J, Steffey, B, Craciunescu, O, and Oldham, M. "An investigation of a PRESAGE® in vivo dosimeter for brachytherapy." Physics in medicine and biology 59.14 (July 2014): 3893-3905.
PMID
24957850
Source
epmc
Published In
Physics in Medicine and Biology
Volume
59
Issue
14
Publish Date
2014
Start Page
3893
End Page
3905
DOI
10.1088/0031-9155/59/14/3893

Body mass index, dose to organs at risk during vaginal brachytherapy, and the role of three-dimensional CT-based treatment planning

Purpose: To assess the effect of body mass index (BMI) on dose to organs at risk (OARs) during high-dose-rate vaginal brachytherapy and evaluate the role of three-dimensional dose evaluation during treatment planning. Methods and Materials: Three-dimensional dosimetric data for rectum, bladder, sigmoid colon, and small bowel for 125 high-dose-rate vaginal brachytherapy fractions were analyzed. Dose-volume histograms were generated for D0.1 cc and D2 cc of each OAR. Contributing factors including the use of urinary catheter and cylinder size were also recorded. As different dose fractionations were used, the OAR doses were tabulated as a percent dose prescribed to 0.5cm. All patients were treated to 4cm of the vaginal length. Results: Median BMI in this cohort was 31.7kg/m2. The BMI values had a weak inverse correlation with D0.1 cc to sigmoid colon (rs=-0.18, p=0.047) and D0.1 cc to bladder (rs=-0.19, p=0.038). There was a strong inverse correlation of D2 cc and increasing BMI (rs=-0.64, p=0.003). The median D2 cc was 25.1% for BMI higher than 31 and 61.9% for BMI of 31 or lower. For D0.1 cc, there was also a strong inverse correlation with increasing BMI (rs=-0.57, p<0.001). Median D1 cc was 33.5% for BMI >31 and 84.4% for BMI ≤ 31. On multivariate analysis higherBMI remained a significant predictor of lower small bowel D2 cc (p<0.001) and D0.1 cc (p<0.001). Conclusions: Women with a lower BMI receive higher doses to the bladder and small bowel compared with those with a higher BMI. Three-dimensional dose evaluation should be considered in patients with low BMI, particularly when combined with external beam radiation. © 2014 American Brachytherapy Society.

Authors
Boyle, JM; Craciunescu, O; Steffey, B; Cai, J; Chino, J
MLA Citation
Boyle, JM, Craciunescu, O, Steffey, B, Cai, J, and Chino, J. "Body mass index, dose to organs at risk during vaginal brachytherapy, and the role of three-dimensional CT-based treatment planning." Brachytherapy 13.4 (January 1, 2014): 332-336.
Source
scopus
Published In
Brachytherapy
Volume
13
Issue
4
Publish Date
2014
Start Page
332
End Page
336
DOI
10.1016/j.brachy.2013.12.002

The anatomy of radiation oncology residency training.

Authors
Chino, J; Doyle, S; Marks, LB
MLA Citation
Chino, J, Doyle, S, and Marks, LB. "The anatomy of radiation oncology residency training." International journal of radiation oncology, biology, physics 88.1 (January 2014): 3-4.
PMID
24331647
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
88
Issue
1
Publish Date
2014
Start Page
3
End Page
4
DOI
10.1016/j.ijrobp.2013.09.039

Response to Dr Sabater

Authors
Boyle, J; Chino, J
MLA Citation
Boyle, J, and Chino, J. "Response to Dr Sabater." Brachytherapy 13.5 (2014): 525-526.
Source
scival
Published In
Brachytherapy
Volume
13
Issue
5
Publish Date
2014
Start Page
525
End Page
526
DOI
10.1016/j.brachy.2014.05.008

Vaginal Dose and Toxicity With Image-Guided Brachytherapy

Authors
Chino, JP; Meltsner, S; Yang, Y; Steffey, B; Cai, J; Craciunescu, O
MLA Citation
Chino, JP, Meltsner, S, Yang, Y, Steffey, B, Cai, J, and Craciunescu, O. "Vaginal Dose and Toxicity With Image-Guided Brachytherapy." October 1, 2013.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
87
Issue
2
Publish Date
2013
Start Page
S31
End Page
S31

How much is another randomized trial of lymph node dissection in endometrial cancer worth? A value of information analysis.

OBJECTIVE: This study aimed to assess the value of a randomized controlled trial (RCT) of lymph node dissection (LND) at the time of hysterectomy for high-risk subsets of women with endometrial cancer. METHODS: A modified Markov decision model compared routine LND to no LND for women with grade 3 or grades 2-3 endometrial cancer. Inputs were modeled as distributions for Monte Carlo probabilistic sensitivity and value of information (VOI) analyses. Survival without LND was modeled from Surveillance, Epidemiology and End Results program data. A hazard ratio (HR) describing survival in the high-risk group undergoing LND (estimate 0.9, 95% CI 0.6-1.1), adverse event rates, probability and type of adjuvant therapy were modeled from published RCTs. Costs were obtained from national reimbursement data. VOI estimated the value of reducing uncertainty regarding the survival benefit of LND. RESULTS: For grade 3, LND had an incremental cost-effectiveness ratio of $40,183/quality-adjusted life year (QALY) compared to no LND. Acceptability curves revealed considerable uncertainty, with an expected value of perfect information of $4,195 per patient at societal willingness to pay of $50,000/QALY. The estimated value of partial perfect information regarding the HR was $3,702 per patient. Assuming 8,000 individuals annually with grade 3 endometrial cancer in the US, the upper limit of VOI for the HR was $29.6 million annually. For grades 2 and 3 combined, analysis revealed a much lower likelihood of finding LND cost-effective. CONCLUSION: A clinical trial defining the survival effect of LND in women with grade 3 endometrial cancer is a worthwhile use of resources.

Authors
Havrilesky, LJ; Chino, JP; Myers, ER
MLA Citation
Havrilesky, LJ, Chino, JP, and Myers, ER. "How much is another randomized trial of lymph node dissection in endometrial cancer worth? A value of information analysis." Gynecol Oncol 131.1 (October 2013): 140-146.
PMID
23800699
Source
pubmed
Published In
Gynecologic Oncology
Volume
131
Issue
1
Publish Date
2013
Start Page
140
End Page
146
DOI
10.1016/j.ygyno.2013.06.025

Local recurrence after surgery for non-small cell lung cancer: a recursive partitioning analysis of multi-institutional data.

OBJECTIVE: To define subgroups at high risk of local recurrence (LR) after surgery for non-small cell lung cancer using a recursive partitioning analysis (RPA). METHODS: This Institutional Review Board-approved study included patients who underwent upfront surgery for I-IIIA non-small cell lung cancer at Duke Cancer Institute (primary set) or at other participating institutions (validation set). The 2 data sets were analyzed separately and identically. Disease recurrence at the surgical margin, ipsilateral hilum, and/or mediastinum was considered an LR. Recursive partitioning was used to build regression trees for the prediction of local recurrence-free survival (LRFS) from standard clinical and pathological factors. LRFS distributions were estimated with the Kaplan-Meier method. RESULTS: The 1411 patients in the primary set had a 5-year LRFS rate of 77% (95% confidence interval [CI], 0.74-0.81), and the 889 patients in the validation set had a 5-year LRFS rate of 76% (95% CI, 0.72-0.80). The RPA of the primary data set identified 3 terminal nodes based on stage and histology. These nodes and their 5-year LRFS rates were as follows: (1) stage I/adenocarcinoma, 87% (95% CI, 0.83-0.90); (2) stage I/squamous or large cell, 72% (95% CI, 0.65-0.79); and (3) stage II-IIIA, 62% (95% CI, 0.55-0.69). The validation RPA identified 3 terminal nodes based on lymphovascular invasion (LVI) and stage: (1) no LVI/stage IA, 82% (95% CI, 0.76-0.88); (2) no LVI/stage IB-IIIA, 73% (95% CI, 0.69-0.80); and (3) LVI, 58% (95% CI, 0.47-0.69). CONCLUSIONS: The risk of LR was similar in the primary and validation patient data sets. There was discordance between the 2 data sets regarding the clinical factors that best segregate patients into risk groups.

Authors
Kelsey, CR; Higgins, KA; Peterson, BL; Chino, JP; Marks, LB; D'Amico, TA; Varlotto, JM
MLA Citation
Kelsey, CR, Higgins, KA, Peterson, BL, Chino, JP, Marks, LB, D'Amico, TA, and Varlotto, JM. "Local recurrence after surgery for non-small cell lung cancer: a recursive partitioning analysis of multi-institutional data." J Thorac Cardiovasc Surg 146.4 (October 2013): 768-773.e1.
PMID
23856204
Source
pubmed
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
146
Issue
4
Publish Date
2013
Start Page
768
End Page
773.e1
DOI
10.1016/j.jtcvs.2013.05.041

Are discordant positron emission tomography and pathological assessments of the mediastinum in non-small cell lung cancer significant?

OBJECTIVE: Many patients with non-small cell lung cancer have positive mediastinal lymph nodes on preoperative positron emission tomography (PET) but do not have mediastinal involvement after surgery. The prognostic significance of this discordance was assessed. METHODS: This Institutional Review Board-approved study evaluated patients treated with upfront surgery at Duke Cancer Institute (Durham, NC) for non-small cell lung cancer from 1995 to 2008. Those staged with PET with pN0-1 disease after negative invasive mediastinal assessment were included. Mediastinal lymph nodes were scored as positive or negative based on visual analysis of the preoperative PET. Clinical outcomes of the PET-positive and PET-negative cohorts were estimated using the Kaplan-Meier method and compared using a log-rank test. Prognostic factors were assessed using a multivariate analysis. RESULTS: A total of 547 patients were assessed, of whom 105 (19%) were PET positive in the mediastinum. The median number of mediastinal lymph node stations sampled was 4 (range, 1-9). The 5-year risk of local recurrence was 26% in PET-positive versus 21% in PET-negative patients (P = .50). Patterns of local failure were similar between the 2 groups. Distant recurrence (35% vs 29%; P = .63) and overall survival (44% vs 54%; P = .52) were comparable for PET-positive and PET-negative patients. On multivariate analysis, a positive PET was not significant for local recurrence (hazard ratio [HR], 1; P = 1), distant recurrence (HR, 0.82; P = .42), or overall survival (HR, 1.08; P = .62). CONCLUSIONS: Patients with positive mediastinal lymph nodes on preoperative PET, but negative on histologic analysis, are not at increased risk of disease recurrence. Pathologic staging remains the standard.

Authors
Tandberg, DJ; Gee, NG; Chino, JP; D'Amico, TA; Ready, NE; Coleman, RE; Kelsey, CR
MLA Citation
Tandberg, DJ, Gee, NG, Chino, JP, D'Amico, TA, Ready, NE, Coleman, RE, and Kelsey, CR. "Are discordant positron emission tomography and pathological assessments of the mediastinum in non-small cell lung cancer significant?." J Thorac Cardiovasc Surg 146.4 (October 2013): 796-801.
PMID
23870158
Source
pubmed
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
146
Issue
4
Publish Date
2013
Start Page
796
End Page
801
DOI
10.1016/j.jtcvs.2013.05.027

Diabetes mellitus: A significant co-morbidity in the setting of lung cancer?

Authors
Washington, I; Chino, JP; Marks, LB; D'Amico, TA; Berry, MF; Ready, NE; Higgins, KA; Yoo, DS; Kelsey, CR
MLA Citation
Washington, I, Chino, JP, Marks, LB, D'Amico, TA, Berry, MF, Ready, NE, Higgins, KA, Yoo, DS, and Kelsey, CR. "Diabetes mellitus: A significant co-morbidity in the setting of lung cancer?." THORACIC CANCER 4.2 (May 2013): 123-130.
Source
wos-lite
Published In
Thoracic Cancer
Volume
4
Issue
2
Publish Date
2013
Start Page
123
End Page
130
DOI
10.1111/j.1759-7714.2012.00162.x

Preoperative chemoradiotherapy for locally advanced gastric cancer.

BACKGROUND: To examine toxicity and outcomes for patients treated with preoperative chemoradiotherapy (CRT) for gastric cancer. METHODS: Patients with gastroesophageal (GE) junction (Siewert type II and III) or gastric adenocarcinoma who underwent neoadjuvant CRT followed by planned surgical resection at Duke University between 1987 and 2009 were reviewed. Overall survival (OS), local control (LC) and disease-free survival (DFS) were estimated using the Kaplan-Meier method. Toxicity was graded according to the Common Toxicity Criteria for Adverse Events version 4.0. RESULTS: Forty-eight patients were included. Most (73%) had proximal (GE junction, cardia and fundus) tumors. Median radiation therapy dose was 45 Gy. All patients received concurrent chemotherapy. Thirty-six patients (75%) underwent surgery. Pathologic complete response and R0 resection rates were 19% and 86%, respectively. Thirty-day surgical mortality was 6%. At 42 months median follow-up, 3-year actuarial OS was 40%. For patients undergoing surgery, 3-year OS, LC and DFS were 50%, 73% and 41%, respectively. CONCLUSIONS: Preoperative CRT for gastric cancer is well tolerated with acceptable rates of perioperative morbidity and mortality. In this patient cohort with primarily advanced disease, OS, LC and DFS rates in resected patients are comparable to similarly staged, adjuvantly treated patients in randomized trials. Further study comparing neoadjuvant CRT to standard treatment approaches for gastric cancer is indicated.

Authors
Pepek, JM; Chino, JP; Willett, CG; Palta, M; Blazer Iii, DG; Tyler, DS; Uronis, HE; Czito, BG
MLA Citation
Pepek, JM, Chino, JP, Willett, CG, Palta, M, Blazer Iii, DG, Tyler, DS, Uronis, HE, and Czito, BG. "Preoperative chemoradiotherapy for locally advanced gastric cancer. (Published online)" Radiat Oncol 8 (January 4, 2013): 6-.
PMID
23286735
Source
pubmed
Published In
Radiation Oncology
Volume
8
Publish Date
2013
Start Page
6
DOI
10.1186/1748-717X-8-6

How much is another randomized trial of lymph node dissection in endometrial cancer worth? A value of information analysis

Objective. This study aimed to assess the value of a randomized controlled trial (RCT) of lymph node dissection (LND) at the time of hysterectomy for high-risk subsets of women with endometrial cancer. Methods. A modified Markov decision model compared routine LND to no LND for women with grade 3 or grades 2-3 endometrial cancer. Inputs were modeled as distributions for Monte Carlo probabilistic sensitivity and value of information (VOI) analyses. Survival without LND was modeled from Surveillance, Epidemiology and End Results program data. A hazard ratio (HR) describing survival in the high-risk group undergoing LND (estimate 0.9, 95% CI 0.6-1.1), adverse event rates, probability and type of adjuvant therapy were modeled from published RCTs. Costs were obtained from national reimbursement data. VOI estimated the value of reducing uncertainty regarding the survival benefit of LND. Results. For grade 3, LND had an incremental cost-effectiveness ratio of $40,183/quality-adjusted life year (QALY) compared to no LND. Acceptability curves revealed considerable uncertainty, with an expected value of perfect information of $4,195 per patient at societal willingness to pay of $50,000/QALY. The estimated value of partial perfect information regarding the HR was $3,702 per patient. Assuming 8,000 individuals annually with grade 3 endometrial cancer in the US, the upper limit of VOI for the HR was $29.6 million annually. For grades 2 and 3 combined, analysis revealed a much lower likelihood of finding LND cost-effective. Conclusion. A clinical trial defining the survival effect of LND in women with grade 3 endometrial cancer is a worthwhile use of resources. © 2013 Elsevier Inc. All rights reserved.

Authors
Havrilesky, LJ; Chino, JP; Myers, ER
MLA Citation
Havrilesky, LJ, Chino, JP, and Myers, ER. "How much is another randomized trial of lymph node dissection in endometrial cancer worth? A value of information analysis." Gynecologic Oncology 131.1 (2013): 140-146.
Source
scival
Published In
Gynecologic Oncology
Volume
131
Issue
1
Publish Date
2013
Start Page
140
End Page
146
DOI
10.1016/j.ygyno.2013.06.025

Image-guided Brachytherapy for Gynecologic Surgeons

Brachytherapy is a fundamental component of the definitive treatment of many advanced gynecologic malignancies, most notably cancers of the uterine corpus and cervix, and allows high radiation doses to be delivered to the target while minimizing the normal tissue dose. However, dose specification has been based primarily on points visible on plain radiographs, with limited correlation to a patient's anatomy and extent of disease. Recent advances have allowed more customized volume-based specification of dose, which has allowed improvements in outcomes. This article reviews these advances using cervical cancer as a model, and looks to future directions with this promising treatment. © 2013 Elsevier Inc. All rights reserved.

Authors
Chino, J; Secord, AA
MLA Citation
Chino, J, and Secord, AA. "Image-guided Brachytherapy for Gynecologic Surgeons." Surgical Oncology Clinics of North America (2013).
PMID
23622076
Source
scival
Published In
Surgical Oncology Clinics of North America
Publish Date
2013
DOI
10.1016/j.soc.2013.02.002

Image-guided Brachytherapy for Gynecologic Surgeons

Brachytherapy is a fundamental component of the definitive treatment of many advanced gynecologic malignancies, most notably cancers of the uterine corpus and cervix, and allows high radiation doses to be delivered to the target while minimizing the normal tissue dose. However, dose specification has been based primarily on points visible on plain radiographs, with limited correlation to a patient's anatomy and extent of disease. Recent advances have allowed more customized volume-based specification of dose, which has allowed improvements in outcomes. This article reviews these advances using cervical cancer as a model, and looks to future directions with this promising treatment. © 2013 Elsevier Inc.

Authors
Chino, J; Secord, AA
MLA Citation
Chino, J, and Secord, AA. "Image-guided Brachytherapy for Gynecologic Surgeons." Surgical Oncology Clinics of North America 22.3 (2013): 495-509.
Source
scival
Published In
Surgical Oncology Clinics of North America
Volume
22
Issue
3
Publish Date
2013
Start Page
495
End Page
509
DOI
10.1016/j.soc.2013.02.002

Positron Emission Tomography in Radiation Treatment Planning. The Potential of Metabolic Imaging

Treatment planning and delivery of radiation therapy has benefited from new technology and techniques. Given the convergence of the improved ability to image active tumor and the delivery of radiation to very specific targets, the implications for a tighter integration of positron emission tomography (PET) imaging with radiation treatment planning are apparent. This article summarizes developments in radiation therapy technology and the application of various PET tracers in diseases treated by radiation therapy, and looks to future possibilities of combining them. © 2013 Elsevier Inc. All rights reserved.

Authors
Chino, J; Das, S; Wong, T
MLA Citation
Chino, J, Das, S, and Wong, T. "Positron Emission Tomography in Radiation Treatment Planning. The Potential of Metabolic Imaging." Radiologic Clinics of North America (2013).
PMID
24010913
Source
scival
Published In
Radiologic Clinics of North America
Publish Date
2013
DOI
10.1016/j.rcl.2013.05.007

Local recurrence after surgery for non-small cell lung cancer: A recursive partitioning analysis of multi-institutional data

Objective: To define subgroups at high risk of local recurrence (LR) after surgery for non-small cell lung cancer using a recursive partitioning analysis (RPA). Methods: This Institutional Review Board-approved study included patients who underwent upfront surgery for I-IIIA non-small cell lung cancer at Duke Cancer Institute (primary set) or at other participating institutions (validation set). The 2 data sets were analyzed separately and identically. Disease recurrence at the surgical margin, ipsilateral hilum, and/or mediastinum was considered an LR. Recursive partitioning was used to build regression trees for the prediction of local recurrence-free survival (LRFS) from standard clinical and pathological factors. LRFS distributions were estimated with the Kaplan-Meier method. Results: The 1411 patients in the primary set had a 5-year LRFS rate of 77% (95% confidence interval [CI], 0.74-0.81), and the 889 patients in the validation set had a 5-year LRFS rate of 76% (95% CI, 0.72-0.80). The RPA of the primary data set identified 3 terminal nodes based on stage and histology. These nodes and their 5-year LRFS rates were as follows: (1) stage I/adenocarcinoma, 87% (95% CI, 0.83-0.90); (2) stage I/squamous or large cell, 72% (95% CI, 0.65-0.79); and (3) stage II-IIIA, 62% (95% CI, 0.55-0.69). The validation RPA identified 3 terminal nodes based on lymphovascular invasion (LVI) and stage: (1) no LVI/stage IA, 82% (95% CI, 0.76-0.88); (2) no LVI/stage IB-IIIA, 73% (95% CI, 0.69-0.80); and (3) LVI, 58% (95% CI, 0.47-0.69). Conclusions: The risk of LR was similar in the primary and validation patient data sets. There was discordance between the 2 data sets regarding the clinical factors that best segregate patients into risk groups. Copyright © 2013 by The American Association for Thoracic Surgery.

Authors
Kelsey, CR; Higgins, KA; Peterson, BL; Chino, JP; Marks, LB; D'Amico, TA; Varlotto, JM
MLA Citation
Kelsey, CR, Higgins, KA, Peterson, BL, Chino, JP, Marks, LB, D'Amico, TA, and Varlotto, JM. "Local recurrence after surgery for non-small cell lung cancer: A recursive partitioning analysis of multi-institutional data." Journal of Thoracic and Cardiovascular Surgery 146.4 (2013): 768-773.e1.
Source
scival
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
146
Issue
4
Publish Date
2013
Start Page
768
End Page
773.e1
DOI
10.1016/j.jtcvs.2013.05.041

Are discordant positron emission tomography and pathological assessments of the mediastinum in non-small cell lung cancer significant?

Objective: Many patients with non-small cell lung cancer have positive mediastinal lymph nodes on preoperative positron emission tomography (PET) but do not have mediastinal involvement after surgery. The prognostic significance of this discordance was assessed. Methods: This Institutional Review Board-approved study evaluated patients treated with upfront surgery at Duke Cancer Institute (Durham, NC) for non-small cell lung cancer from 1995 to 2008. Those staged with PET with pN0-1 disease after negative invasive mediastinal assessment were included. Mediastinal lymph nodes were scored as positive or negative based on visual analysis of the preoperative PET. Clinical outcomes of the PET-positive and PET-negative cohorts were estimated using the Kaplan-Meier method and compared using a log-rank test. Prognostic factors were assessed using a multivariate analysis. Results: A total of 547 patients were assessed, of whom 105 (19%) were PET positive in the mediastinum. The median number of mediastinal lymph node stations sampled was 4 (range, 1-9). The 5-year risk of local recurrence was 26% in PET-positive versus 21% in PET-negative patients (P =.50). Patterns of local failure were similar between the 2 groups. Distant recurrence (35% vs 29%; P =.63) and overall survival (44% vs 54%; P =.52) were comparable for PET-positive and PET-negative patients. On multivariate analysis, a positive PET was not significant for local recurrence (hazard ratio [HR], 1; P = 1), distant recurrence (HR, 0.82; P =.42), or overall survival (HR, 1.08; P =.62). Conclusions: Patients with positive mediastinal lymph nodes on preoperative PET, but negative on histologic analysis, are not at increased risk of disease recurrence. Pathologic staging remains the standard. Copyright © 2013 by The American Association for Thoracic Surgery.

Authors
Tandberg, DJ; Gee, NG; Chino, JP; D'Amico, TA; Ready, NE; Coleman, RE; Kelsey, CR
MLA Citation
Tandberg, DJ, Gee, NG, Chino, JP, D'Amico, TA, Ready, NE, Coleman, RE, and Kelsey, CR. "Are discordant positron emission tomography and pathological assessments of the mediastinum in non-small cell lung cancer significant?." Journal of Thoracic and Cardiovascular Surgery 146.4 (2013): 796-801.
Source
scival
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
146
Issue
4
Publish Date
2013
Start Page
796
End Page
801
DOI
10.1016/j.jtcvs.2013.05.027

Positron emission tomography in radiation treatment planning: The potential of metabolic imaging

Treatment planning and delivery of radiation therapy has benefited from new technology and techniques. Given the convergence of the improved ability to image active tumor and the delivery of radiation to very specific targets, the implications for a tighter integration of positron emission tomography (PET) imaging with radiation treatment planning are apparent. This article summarizes developments in radiation therapy technology and the application of various PET tracers in diseases treated by radiation therapy, and looks to future possibilities of combining them. © 2013 Elsevier Inc.

Authors
Chino, J; Das, S; Wong, T
MLA Citation
Chino, J, Das, S, and Wong, T. "Positron emission tomography in radiation treatment planning: The potential of metabolic imaging." Radiologic Clinics of North America 51.5 (2013): 913-925.
Source
scival
Published In
Radiologic Clinics of North America
Volume
51
Issue
5
Publish Date
2013
Start Page
913
End Page
925
DOI
10.1016/j.rcl.2013.05.007

Multicatheter Vaginal Balloon Brachytherapy: One Year's Clinical Experience

Authors
Chino, JP; Steffey, B; Cai, J; Adamson, J; Craciunescu, O
MLA Citation
Chino, JP, Steffey, B, Cai, J, Adamson, J, and Craciunescu, O. "Multicatheter Vaginal Balloon Brachytherapy: One Year's Clinical Experience." November 1, 2012.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
84
Issue
3
Publish Date
2012
Start Page
S460
End Page
S460

Urinary Catheterization Increases the Dose to Bowel During Vaginal Brachytherapy

Authors
Zhu, L; Craciunescu, O; Cai, J; Steffey, B; Adamson, J; Chino, JP
MLA Citation
Zhu, L, Craciunescu, O, Cai, J, Steffey, B, Adamson, J, and Chino, JP. "Urinary Catheterization Increases the Dose to Bowel During Vaginal Brachytherapy." November 1, 2012.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
84
Issue
3
Publish Date
2012
Start Page
S455
End Page
S455

Prognosis and Patterns of Failure of Patients With Non-small Cell Lung Cancer Having Hypermetabolic Mediastinal Lymph Nodes on Preoperative PET but N0-N1 Disease on Pathological Analysis

Authors
Tandberg, D; Chino, JP; Yoo, DS; Gee, N; Kelsey, CR
MLA Citation
Tandberg, D, Chino, JP, Yoo, DS, Gee, N, and Kelsey, CR. "Prognosis and Patterns of Failure of Patients With Non-small Cell Lung Cancer Having Hypermetabolic Mediastinal Lymph Nodes on Preoperative PET but N0-N1 Disease on Pathological Analysis." November 1, 2012.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
84
Issue
3
Publish Date
2012
Start Page
S105
End Page
S105

Cost effectiveness of concurrent gemcitabine and cisplatin with radiation followed by adjuvant gemcitabine and cisplatin in patients with stages IIB to IVA carcinoma of the cervix.

OBJECTIVE: A recent phase III trial reported gemcitabine with cisplatin chemoradiation followed by 2 cycles of gemcitabine and cisplatin (G) significantly improved progression-free (PFS) and overall survival (OS) compared to standard cisplatin chemoradiation (C) for locally advanced cervix cancer. We evaluate the cost effectiveness (CE) of these treatment regimens. METHODS: A modified Markov model was constructed comparing CE between treatment arms using the published trial's five-year OS and treatment-related toxicity rates. Quality of life (QOL) utility scores during treatment were obtained from published literature and modeled for sensitivity analysis. Cost data was obtained from Medicare reimbursement figures and the Healthcare Cost and Utilization Project. One-way sensitivity analyses assessed variations in cost and adverse events. RESULTS: Mean cost was $41,330 (US$) for C versus $60,974 for G. Incremental cost-effectiveness ratio (ICER) for G compared to C was $33,080 per quality-adjusted life year (QALY). In sensitivity analyses (SA), the ICER increased to common willingness-to-pay thresholds of 50 K and 100 K when QOL utility scores during G active treatment declined to 0.64 and 0.53 (baseline 0.76), respectively. The model was insensitive to changes in adverse event rates, costs of treatment, or adverse event hospitalization costs. CONCLUSIONS: Gemcitabine with cisplatin chemoradiation followed by 2 cycles of adjuvant gemcitabine and cisplatin is a cost effective treatment for locally advanced cervix cancer compared to standard cisplatin chemoradiation. Common willingness to pay thresholds are exceeded during sensitivity analyses with realistic declines in QOL. Our results support ongoing investigations of novel adjuvants to standard cisplatin chemoradiation with potentially less toxicity.

Authors
Phippen, NT; Leath, CA; Chino, JP; Jewell, EL; Havrilesky, LJ; Barnett, JC
MLA Citation
Phippen, NT, Leath, CA, Chino, JP, Jewell, EL, Havrilesky, LJ, and Barnett, JC. "Cost effectiveness of concurrent gemcitabine and cisplatin with radiation followed by adjuvant gemcitabine and cisplatin in patients with stages IIB to IVA carcinoma of the cervix." Gynecol Oncol 127.2 (November 2012): 267-272.
PMID
22892361
Source
pubmed
Published In
Gynecologic Oncology
Volume
127
Issue
2
Publish Date
2012
Start Page
267
End Page
272
DOI
10.1016/j.ygyno.2012.08.002

Surgical staging for endometrial cancer in the elderly - is there a role for lymphadenectomy?

OBJECTIVES: We sought to evaluate the effect of systematic lymphadenectomy (LND) on endometrial cancer-specific survival in an elderly population. METHODS: Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) program from 1988 to 2006. Women who underwent primary hysterectomy for non-serous, non-clear cell endometrial carcinoma were included. Women were stratified by age (<70, 70-79, and ≥ 80) and disease-specific survival (DSS) was analyzed via the Kaplan-Meier method and stratified by postoperative grade. Cohorts were compared using the log-rank test. In a simulated population, the disease-specific survival of women with pre-operative grade 1 endometrial carcinoma was calculated using a weighted average survival accounting for those upgraded at final pathology. RESULTS: Endometrial cancer was identified in 5759 women ≥ 80 years old. Disease specific survival at 5 years for the LND and no LND groups was 93.4% and 94.5% (p=0.36) for grade 1, 84.4% and 85% (p=0.97) for grade 2, and 65.9% and 60.9% (p=0.002) for grade 3. In the simulated pre-operative grade 1 group, 5 year disease-specific survival (DSS) was 91% in the LND group and 92% in the no LND group. CONCLUSION: In women older than 80, systematic lymphadenectomy is associated with improved DSS for high grade, but similar DSS for low grade endometrial cancer, consistent with what is seen with younger women. As there is no clear survival benefit to lymphadenectomy in elderly women presenting with low grade disease, the surgeon should carefully weigh the surgical risks and benefits in this patient population, which may be at higher risk for morbidity.

Authors
Lowery, WJ; Gehrig, PA; Ko, E; Secord, AA; Chino, J; Havrilesky, LJ
MLA Citation
Lowery, WJ, Gehrig, PA, Ko, E, Secord, AA, Chino, J, and Havrilesky, LJ. "Surgical staging for endometrial cancer in the elderly - is there a role for lymphadenectomy?." Gynecol Oncol 126.1 (July 2012): 12-15.
PMID
22588178
Source
pubmed
Published In
Gynecologic Oncology
Volume
126
Issue
1
Publish Date
2012
Start Page
12
End Page
15
DOI
10.1016/j.ygyno.2012.05.003

Commissioning a CT-compatible LDR tandem and ovoid applicator using Monte Carlo calculation and 3D dosimetry.

PURPOSE: To determine the geometric and dose attenuation characteristics of a new commercially available CT-compatible LDR tandem and ovoid (T&O) applicator using Monte Carlo calculation and 3D dosimetry. METHODS: For geometric characterization, we quantified physical dimensions and investigated a systematic difference found to exist between nominal ovoid angle and the angle at which the afterloading buckets fall within the ovoid. For dosimetric characterization, we determined source attenuation through asymmetric gold shielding in the buckets using Monte Carlo simulations and 3D dosimetry. Monte Carlo code MCNP5 was used to simulate 1.5 × 10(9) photon histories from a (137)Cs source placed in the bucket to achieve statistical uncertainty of 1% at a 6 cm distance. For 3D dosimetry, the distribution about an unshielded source was first measured to evaluate the system for (137)Cs, after which the distribution was measured about sources placed in each bucket. Cylindrical PRESAGE(®) dosimeters (9.5 cm diameter, 9.2 cm height) with a central channel bored for source placement were supplied by Heuris Inc. The dosimeters were scanned with the Duke Large field of view Optical CT-Scanner before and after delivering a nominal dose at 1 cm of 5-8 Gy. During irradiation the dosimeter was placed in a water phantom to provide backscatter. Optical CT scan time lasted 15 min during which 720 projections were acquired at 0.5° increments, and a 3D distribution was reconstructed with a (0.05 cm)(3) isotropic voxel size. The distributions about the buckets were used to calculate a 3D distribution of transmission rate through the bucket, which was applied to a clinical CT-based T&O implant plan. RESULTS: The systematic difference in bucket angle relative to the nominal ovoid angle (105°) was 3.1°-4.7°. A systematic difference in bucket angle of 1°, 5°, and 10° caused a 1% ± 0.1%, 1.7% ± 0.4%, and 2.6% ± 0.7% increase in rectal dose, respectively, with smaller effect to dose to Point A, bladder, sigmoid, and bowel. For 3D dosimetry, 90.6% of voxels had a 3D γ-index (criteria = 0.1 cm, 3% local signal) below 1.0 when comparing measured and expected dose about the unshielded source. Dose transmission through the gold shielding at a radial distance of 1 cm was 85.9% ± 0.2%, 83.4% ± 0.7%, and 82.5% ± 2.2% for Monte Carlo, and measurement for left and right buckets, respectively. Dose transmission was lowest at oblique angles from the bucket with a minimum of 56.7% ± 0.8%, 65.6% ± 1.7%, and 57.5% ± 1.6%, respectively. For a clinical T&O plan, attenuation from the buckets leads to a decrease in average Point A dose of ∼3.2% and decrease in D(2cc) to bladder, rectum, bowel, and sigmoid of 5%, 18%, 6%, and 12%, respectively. CONCLUSIONS: Differences between dummy and afterloading bucket position in the ovoids is minor compared to effects from asymmetric ovoid shielding, for which rectal dose is most affected. 3D dosimetry can fulfill a novel role in verifying Monte Carlo calculations of complex dose distributions as are common about brachytherapy sources and applicators.

Authors
Adamson, J; Newton, J; Yang, Y; Steffey, B; Cai, J; Adamovics, J; Oldham, M; Chino, J; Craciunescu, O
MLA Citation
Adamson, J, Newton, J, Yang, Y, Steffey, B, Cai, J, Adamovics, J, Oldham, M, Chino, J, and Craciunescu, O. "Commissioning a CT-compatible LDR tandem and ovoid applicator using Monte Carlo calculation and 3D dosimetry." Med Phys 39.7 (July 2012): 4515-4523.
PMID
22830783
Source
pubmed
Published In
Medical physics
Volume
39
Issue
7
Publish Date
2012
Start Page
4515
End Page
4523
DOI
10.1118/1.4730501

Lymphovascular invasion in non-small-cell lung cancer: implications for staging and adjuvant therapy.

BACKGROUND: Lymphovascular space invasion (LVI) is an established negative prognostic factor and an indication for postoperative radiation therapy in many malignancies. The purpose of this study was to evaluate LVI in patients with early-stage non-small-cell lung cancer, undergoing surgical resection. METHODS: All patients who underwent initial surgery for pT1-3N0-2 non-small-cell lung cancer at Duke University Medical Center from 1995 to 2008 were identified. A multivariate ordinal regression was used to assess the relationship between LVI and pathologic hilar and/or mediastinal lymph node (LN) involvement. A multivariate Cox regression analysis was used to evaluate the relationship of LVI and other clinical and pathologic factors on local failure (LF), freedom from distant metastasis (FFDM), and overall survival (OS). Kaplan-Meier methods were used to generate estimates of LF, FFDM, and OS in patients with and without LVI. RESULTS: One thousand five hundred and fifty-nine patients were identified. LVI was independently associated with the presence of regional LN involvement (p < 0.001) along with lobar (versus sublobar) resections (p < 0.001), and an open thoracotomy (versus video-assisted thoracoscopic surgery). LVI was not independently associated with LF on multivariate analysis (hazard ratio [HR] = 1.23, p = 0.25), but was associated with a lower FFDM (HR 1.52, p = 0.005) and OS (HR 1.26, p = 0.015). In addition, multivariate analysis showed that LVI was strongly associated with increased risk of developing distant metastases (HR = 1.75, p = 0.006) and death (HR = 1.53, p = 0.003) in adenocarcinomas but not in squamous carcinomas. CONCLUSIONS: LVI is associated with an increased risk of harboring regional LN involvement. LVI is also an adverse prognostic factor for the development of distant metastases and long-term survival.

Authors
Higgins, KA; Chino, JP; Ready, N; D'Amico, TA; Berry, MF; Sporn, T; Boyd, J; Kelsey, CR
MLA Citation
Higgins, KA, Chino, JP, Ready, N, D'Amico, TA, Berry, MF, Sporn, T, Boyd, J, and Kelsey, CR. "Lymphovascular invasion in non-small-cell lung cancer: implications for staging and adjuvant therapy." J Thorac Oncol 7.7 (July 2012): 1141-1147.
PMID
22617241
Source
pubmed
Published In
Journal of Thoracic Oncology
Volume
7
Issue
7
Publish Date
2012
Start Page
1141
End Page
1147
DOI
10.1097/JTO.0b013e3182519a42

Local failure in resected N1 lung cancer: implications for adjuvant therapy.

PURPOSE: To evaluate actuarial rates of local failure in patients with pathologic N1 non-small-cell lung cancer and to identify clinical and pathologic factors associated with an increased risk of local failure after resection. METHODS AND MATERIALS: All patients who underwent surgery for non-small-cell lung cancer with pathologically confirmed N1 disease at Duke University Medical Center from 1995-2008 were identified. Patients receiving any preoperative therapy or postoperative radiotherapy or with positive surgical margins were excluded. Local failure was defined as disease recurrence within the ipsilateral hilum, mediastinum, or bronchial stump/staple line. Actuarial rates of local failure were calculated with the Kaplan-Meier method. A Cox multivariate analysis was used to identify factors independently associated with a higher risk of local recurrence. RESULTS: Among 1,559 patients who underwent surgery during the time interval, 198 met the inclusion criteria. Of these patients, 50 (25%) received adjuvant chemotherapy. Actuarial (5-year) rates of local failure, distant failure, and overall survival were 40%, 55%, and 33%, respectively. On multivariate analysis, factors associated with an increased risk of local failure included a video-assisted thoracoscopic surgery approach (hazard ratio [HR], 2.5; p = 0.01), visceral pleural invasion (HR, 2.1; p = 0.04), and increasing number of positive N1 lymph nodes (HR, 1.3 per involved lymph node; p = 0.02). Chemotherapy was associated with a trend toward decreased risk of local failure that was not statistically significant (HR, 0.61; p = 0.2). CONCLUSIONS: Actuarial rates of local failure in pN1 disease are high. Further investigation of conformal postoperative radiotherapy may be warranted.

Authors
Higgins, KA; Chino, JP; Berry, M; Ready, N; Boyd, J; Yoo, DS; Kelsey, CR
MLA Citation
Higgins, KA, Chino, JP, Berry, M, Ready, N, Boyd, J, Yoo, DS, and Kelsey, CR. "Local failure in resected N1 lung cancer: implications for adjuvant therapy." Int J Radiat Oncol Biol Phys 83.2 (June 1, 2012): 727-733.
PMID
22208965
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
83
Issue
2
Publish Date
2012
Start Page
727
End Page
733
DOI
10.1016/j.ijrobp.2011.07.018

The influence of radiation modality and lymph node dissection on survival in early-stage endometrial cancer.

BACKGROUND: The appropriate uses of lymph node dissection (LND) and adjuvant radiation therapy (RT) for Stage I endometrial cancer are controversial. We explored the impact of specific RT modalities (whole pelvic RT [WPRT], vaginal brachytherapy [VB]) and LND status on survival. MATERIALS AND METHODS: The Surveillance Epidemiology and End Results dataset was queried for all surgically treated International Federation of Gynecology and Obstetrics (FIGO) Stage I endometrial cancers; subjects were stratified into low, intermediate and high risk cohorts using modifications of Gynecologic Oncology Group (GOG) protocol 99 and PORTEC (Postoperative Radiation Therapy in Endometrial Cancer) trial criteria. Five-year overall survival was estimated, and comparisons were performed via the log-rank test. RESULTS: A total of 56,360 patients were identified: 70.4% low, 26.2% intermediate, and 3.4% high risk. A total of 41.6% underwent LND and 17.6% adjuvant RT. In low-risk disease, LND was associated with higher survival (93.7 LND vs. 92.7% no LND, p < 0.001), whereas RT was not (91.6% RT vs. 92.9% no RT, p = 0.23). In intermediate-risk disease, LND (82.1% LND vs. 76.5% no LND, p < 0.001) and RT (80.6% RT vs. 74.9% no RT, p < 0.001) were associated with higher survival without differences between RT modalities. In high-risk disease, LND (68.8% LND vs. 54.1% no LND, p < 0.001) and RT (66.9% RT vs. 57.2% no RT, p < 0.001) were associated with increased survival; if LND was not performed, VB alone was inferior to WPRT (p = 0.01). CONCLUSION: Both WPRT and VB alone are associated with increased survival in the intermediate-risk group. In the high-risk group, in the absence of LND, only WPRT is associated with increased survival. LND was also associated with increased survival.

Authors
Chino, JP; Jones, E; Berchuck, A; Secord, AA; Havrilesky, LJ
MLA Citation
Chino, JP, Jones, E, Berchuck, A, Secord, AA, and Havrilesky, LJ. "The influence of radiation modality and lymph node dissection on survival in early-stage endometrial cancer." Int J Radiat Oncol Biol Phys 82.5 (April 1, 2012): 1872-1879.
PMID
21640502
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
82
Issue
5
Publish Date
2012
Start Page
1872
End Page
1879
DOI
10.1016/j.ijrobp.2011.03.054

Adjuvant radiotherapy in the treatment of invasive intraductal papillary mucinous neoplasm of the pancreas: an analysis of the surveillance, epidemiology, and end results registry.

BACKGROUND: Management and outcomes of patients with invasive intraductal papillary mucinous neoplasm (IPMN) of the pancreas are not well established. We investigated whether adjuvant radiotherapy (RT) improved cancer-specific survival (CSS) and overall survival (OS) among patients undergoing surgical resection for invasive IPMN. METHODS: The Surveillance, Epidemiology, and End Results (SEER) registry was used in this retrospective cohort study. All adult patients with resection of invasive IPMN from 1988 to 2007 were included. CSS and OS were analyzed using Kaplan-Meier curves. Unadjusted and propensity-score-adjusted Cox proportional-hazards modeling were used for subgroup analyses. RESULTS: 972 patients were included. Adjuvant RT was administered to 31.8% (n=309) of patients. There was no difference in overall median CSS or OS in patients who received adjuvant RT (5-year CSS: 26.5 months; 5-year OS: 23.5 months) versus those who did not (CSS: 28.5 months, P=0.17; OS: 23.5 months, P=0.23). Univariate predictors of survival were lymph node (LN) involvement, T4-classified tumors, and poorly differentiated tumor grade (all P<0.05). In the propensity-score-adjusted analysis, adjuvant RT was associated with improved 5-year CSS [hazard ratio (HR): 0.67, P=0.004] and 5-year OS (HR: 0.73, P=0.014) among all patients with LN involvement, though further analysis by T-classification demonstrated no survival differences among patients with T1/T2 disease; patients with T3/T4-classified tumors had improved CSS (HR: 0.71, P=0.022) but no difference in OS (HR: 0.76, P=0.06). CONCLUSION: On propensity-score-adjusted analysis, adjuvant RT was associated with improved survival in selected subsets of patients with invasive IPMN, particularly those with T3/T4 tumors and LN involvement.

Authors
Worni, M; Akushevich, I; Gloor, B; Scarborough, J; Chino, JP; Jacobs, DO; Hahn, SM; Clary, BM; Pietrobon, R; Shah, A
MLA Citation
Worni, M, Akushevich, I, Gloor, B, Scarborough, J, Chino, JP, Jacobs, DO, Hahn, SM, Clary, BM, Pietrobon, R, and Shah, A. "Adjuvant radiotherapy in the treatment of invasive intraductal papillary mucinous neoplasm of the pancreas: an analysis of the surveillance, epidemiology, and end results registry." Annals of surgical oncology 19.4 (April 2012): 1316-1323.
PMID
22002799
Source
epmc
Published In
Annals of Surgical Oncology
Volume
19
Issue
4
Publish Date
2012
Start Page
1316
End Page
1323
DOI
10.1245/s10434-011-2088-2

Analysis of pretreatment FDG-PET SUV parameters in head-and-neck cancer: tumor SUVmean has superior prognostic value.

PURPOSE: To evaluate the prognostic significance of different descriptive parameters in head-and-neck cancer patients undergoing pretreatment [F-18] fluoro-D-glucose-positron emission tomography (FDG-PET) imaging. PATIENTS AND METHODS: Head-and-neck cancer patients who underwent FDG-PET before a course of curative intent radiotherapy were retrospectively analyzed. FDG-PET imaging parameters included maximum (SUV(max)), and mean (SUV(mean)) standard uptake values, and total lesion glycolysis (TLG). Tumors and lymph nodes were defined on co-registered axial computed tomography (CT) slices. SUV(max) and SUV(mean) were measured within these anatomic regions. The relationships between pretreatment SUV(max), SUV(mean), and TLG for the primary site and lymph nodes were assessed using a univariate analysis for disease-free survival (DFS), locoregional control (LRC), and distant metastasis-free survival (DMFS). Kaplan-Meier survival curves were generated and compared via the log-rank method. SUV data were analyzed as continuous variables. RESULTS: A total of 88 patients was assessed. Two-year OS, LRC, DMFS, and DFS for the entire cohort were 85%, 78%, 81%, and 70%, respectively. Median SUV(max) for the primary tumor and lymph nodes was 15.4 and 12.2, respectively. Median SUV(mean) for the primary tumor and lymph nodes was 7 and 5.2, respectively. Median TLG was 770. Increasing pretreatment SUV(mean) of the primary tumor was associated with decreased disease-free survival (p = 0.01). Neither SUV(max) in the primary tumor or lymph nodes nor TLG was prognostic for any of the clinical endpoints. Patients with pretreatment tumor SUV(mean) that exceeded the median value (7) of the cohort demonstrated inferior 2-year DFS relative to patients with SUV(mean) ≤ the median value of the cohort, 58% vs. 82%, respectively, p = 0.03. CONCLUSION: Increasing SUV(mean) in the primary tumor was associated with inferior DFS. Although not routinely reported, pretreatment SUV(mean) may be a useful prognostic FDG-PET parameter and should be further evaluated prospectively.

Authors
Higgins, KA; Hoang, JK; Roach, MC; Chino, J; Yoo, DS; Turkington, TG; Brizel, DM
MLA Citation
Higgins, KA, Hoang, JK, Roach, MC, Chino, J, Yoo, DS, Turkington, TG, and Brizel, DM. "Analysis of pretreatment FDG-PET SUV parameters in head-and-neck cancer: tumor SUVmean has superior prognostic value." Int J Radiat Oncol Biol Phys 82.2 (February 1, 2012): 548-553.
PMID
21277108
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
82
Issue
2
Publish Date
2012
Start Page
548
End Page
553
DOI
10.1016/j.ijrobp.2010.11.050

Primary radiation therapy for medically inoperable patients with clinical stage I and II endometrial carcinoma.

OBJECTIVE: To determine the outcomes associated with primary radiation therapy for medically inoperable, clinical stage I and II, endometrial adenocarcinoma (EAC). METHODS: A multi-institution, retrospective chart review from January 1997 to January 2009 was performed. Overall survival (OS), disease-specific survival (DSS), progression-free survival (PFS) and time to progression (TTP) were assessed using the Kaplan-Meier method. Disease-specific survival was analyzed using a competing risks approach. RESULTS: Seventy-four patients were evaluable. The median age and BMI were 65 years (range 36-92 years) and 46 kg/m(2) (range 23-111 kg/m(2)), respectively. 85.1% had severe systemic disease, most frequently cardiopulmonary risk and morbid obesity. With a mean follow-up of 31 months, 13 patients (17.6%) experienced a recurrence. The median PFS and OS were 43.5 months and 47.2 months, respectively. Overall, 35 women died, including 4 women who died of unknown cause. Of the remaining 31 women, 7 patients (9.5%) died of disease, while 24 died of other causes (32.4%). The hazard ratio comparing the risk of death due to other causes to the risk of death due to disease was 3.4 (95% CI 1.4-9.4, p=0.003). Among patients who are alive three years after diagnosis, 14% recurred and the conditional recurrence estimate did not exceed 16%. CONCLUSIONS: Primary radiation therapy for clinical stage I and II EAC is a feasible option for medically inoperable patients and provides disease control, with fewer than 16% of surviving patients experiencing recurrence.

Authors
Podzielinski, I; Randall, ME; Breheny, PJ; Escobar, PF; Cohn, DE; Quick, AM; Chino, JP; Lopez-Acevedo, M; Seitz, JL; Zook, JE; Seamon, LG
MLA Citation
Podzielinski, I, Randall, ME, Breheny, PJ, Escobar, PF, Cohn, DE, Quick, AM, Chino, JP, Lopez-Acevedo, M, Seitz, JL, Zook, JE, and Seamon, LG. "Primary radiation therapy for medically inoperable patients with clinical stage I and II endometrial carcinoma." Gynecol Oncol 124.1 (January 2012): 36-41.
PMID
22015042
Source
pubmed
Published In
Gynecologic Oncology
Volume
124
Issue
1
Publish Date
2012
Start Page
36
End Page
41
DOI
10.1016/j.ygyno.2011.09.022

Surgical staging for endometrial cancer in the elderly - Is there a role for lymphadenectomy?

Authors
Lowery, WJ; Gehrig, PA; Ko, E; Secord, AA; Chino, J; Havrilesky, LJ
MLA Citation
Lowery, WJ, Gehrig, PA, Ko, E, Secord, AA, Chino, J, and Havrilesky, LJ. "Surgical staging for endometrial cancer in the elderly - Is there a role for lymphadenectomy?." Obstetrical and Gynecological Survey 67.11 (2012): 702-703.
Source
scival
Published In
Obstetrical and Gynecological Survey
Volume
67
Issue
11
Publish Date
2012
Start Page
702
End Page
703
DOI
10.1097/OGX.0b013e31827681f1

Severe pulmonary toxicity after myeloablative conditioning using total body irradiation: an assessment of risk factors.

PURPOSE: To assess factors associated with severe pulmonary toxicity after myeloablative conditioning using total body irradiation (TBI) followed by allogeneic stem cell transplantation. METHODS AND MATERIALS: A total of 101 adult patients who underwent TBI-based myeloablative conditioning for hematologic malignancies at Duke University between 1998 and 2008 were reviewed. TBI was combined with high-dose cyclophosphamide, melphalan, fludarabine, or etoposide, depending on the underlying disease. Acute pulmonary toxicity, occurring within 90 days of transplantation, was scored using Common Terminology Criteria for Adverse Events version 3.0. Actuarial overall survival and the cumulative incidence of acute pulmonary toxicity were calculated via the Kaplan-Meier method and compared using a log-rank test. A binary logistic regression analysis was performed to assess factors independently associated with acute severe pulmonary toxicity. RESULTS: The 90-day actuarial risk of developing severe (Grade 3-5) pulmonary toxicity was 33%. Actuarial survival at 90 days was 49% in patients with severe pulmonary toxicity vs. 94% in patients without (p < 0.001). On multivariate analysis, the number of prior chemotherapy regimens was the only factor independently associated with development of severe pulmonary toxicity (odds ratio, 2.7 per regimen). CONCLUSIONS: Severe acute pulmonary toxicity is prevalent after TBI-based myeloablative conditioning regimens, occurring in approximately 33% of patients. The number of prior chemotherapy regimens appears to be an important risk factor.

Authors
Kelsey, CR; Horwitz, ME; Chino, JP; Craciunescu, O; Steffey, B; Folz, RJ; Chao, NJ; Rizzieri, DA; Marks, LB
MLA Citation
Kelsey, CR, Horwitz, ME, Chino, JP, Craciunescu, O, Steffey, B, Folz, RJ, Chao, NJ, Rizzieri, DA, and Marks, LB. "Severe pulmonary toxicity after myeloablative conditioning using total body irradiation: an assessment of risk factors." Int J Radiat Oncol Biol Phys 81.3 (November 1, 2011): 812-818.
PMID
20932682
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
81
Issue
3
Publish Date
2011
Start Page
812
End Page
818
DOI
10.1016/j.ijrobp.2010.06.058

Radiotherapy in the treatment of patients with unresectable extrahepatic cholangiocarcinoma.

PURPOSE: Extrahepatic cholangiocarcinoma is an uncommon but lethal malignancy. We analyzed the role of definitive chemoradiotherapy for patients with nonmetastatic, locally advanced extrahepatic cholangiocarcinoma treated at a single institution. METHODS AND MATERIALS: This retrospective analysis included 37 patients who underwent external beam radiation therapy (EBRT) with concurrent chemotherapy and/or brachytherapy (BT) for locally advanced extrahepatic cholangiocarcinoma. Local control (LC) and overall survival (OS) were assessed, and univariate regression analysis was used to evaluate the effects of patient- and treatment-related factors on clinical outcomes. RESULTS: Twenty-three patients received EBRT alone, 8 patients received EBRT plus BT, and 6 patients received BT alone (median follow-up of 14 months). Two patients were alive without evidence of recurrence at the time of analysis. Actuarial OS and LC rates at 1 year were 59% and 90%, respectively, and 22% and 71%, respectively, at 2 years. Two patients lived beyond 5 years without evidence of recurrence. On univariate analysis, EBRT with or without BT improved LC compared to BT alone (97% vs. 56% at 1 year; 75% vs. 56% at 2 years; p = 0.096). Patients who received EBRT alone vs. BT alone also had improved LC (96% vs. 56% at 1 year; 80% vs. 56% at 2 years; p = 0.113). Age, gender, tumor location (proximal vs. distal), histologic differentiation, EBRT dose (≤ or >50 Gy), EBRT planning method (two-dimensional vs. three-dimensional), and chemotherapy were not associated with patient outcomes. CONCLUSIONS: Patients with locally advanced extrahepatic cholangiocarcinoma have poor survival. Long-term survival is rare. The majority of patients treated with EBRT had local control at the time of death, suggesting that symptoms due to the local tumor effect might be effectively controlled with radiation therapy, and EBRT is an important element of treatment. Novel treatment approaches are indicated in the therapy for this disease.

Authors
Ghafoori, AP; Nelson, JW; Willett, CG; Chino, J; Tyler, DS; Hurwitz, HI; Uronis, HE; Morse, MA; Clough, RW; Czito, BG
MLA Citation
Ghafoori, AP, Nelson, JW, Willett, CG, Chino, J, Tyler, DS, Hurwitz, HI, Uronis, HE, Morse, MA, Clough, RW, and Czito, BG. "Radiotherapy in the treatment of patients with unresectable extrahepatic cholangiocarcinoma." Int J Radiat Oncol Biol Phys 81.3 (November 1, 2011): 654-659.
PMID
20864265
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
81
Issue
3
Publish Date
2011
Start Page
654
End Page
659
DOI
10.1016/j.ijrobp.2010.06.018

Persistent N2 disease after neoadjuvant chemotherapy for non-small-cell lung cancer.

OBJECTIVES: Patients achieving a mediastinal pathologic complete response with neoadjuvant chemotherapy have improved outcomes compared with patients with persistent N2 disease. How to best manage this latter group of patients is unknown, prompting a review of our institutional experience. METHODS: All patients who initiated neoadjuvant therapy for non-small-cell lung cancer from 1995 to 2008 were evaluated. The patients were excluded if they had received preoperative radiotherapy, had had a mediastinal pathologic complete response, or had evidence of disease progression after neoadjuvant chemotherapy. The clinical endpoints were calculated using the Kaplan-Meier product-limit method and compared using a log-rank test. RESULTS: A total of 28 patients were identified. The median follow-up period was 24 months. Several neoadjuvant chemotherapy regimens were used, most commonly carboplatin with vinorelbine (36%) or paclitaxel (32%). A partial response to chemotherapy was noted in 23 (82%) and stable disease was noted in 5 (18%) on postchemotherapy imaging. Resection was performed in 22 of 28 patients, consisting of lobectomy in 14, pneumonectomy in 2, and wedge/segmentectomy in 6 (21/22 R0, 1/22 R1). There were no postoperative deaths. Postoperative therapy (radiotherapy and/or additional chemotherapy) was administered to 12 patients (55%). The remaining 6 patients generally received definitive radiotherapy with or without additional chemotherapy. The overall and disease-free survival rate at 1, 3, and 5 years was 75%, 37%, and 37% and 50%, 23%, and 19%, respectively. The survival rate at 5 years was similar between patients undergoing resection (34%) and those receiving definitive radiotherapy with or without chemotherapy (40%; P = .73). CONCLUSIONS: Disease-free and overall survival was sufficiently high to warrant aggressive local therapy (surgery or radiotherapy) in patients with persistent N2 disease after neoadjuvant chemotherapy.

Authors
Higgins, KA; Chino, JP; Ready, N; Onaitis, MW; Berry, MF; D'Amico, TA; Kelsey, CR
MLA Citation
Higgins, KA, Chino, JP, Ready, N, Onaitis, MW, Berry, MF, D'Amico, TA, and Kelsey, CR. "Persistent N2 disease after neoadjuvant chemotherapy for non-small-cell lung cancer." J Thorac Cardiovasc Surg 142.5 (November 2011): 1175-1179.
PMID
22014344
Source
pubmed
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
142
Issue
5
Publish Date
2011
Start Page
1175
End Page
1179
DOI
10.1016/j.jtcvs.2011.07.059

Adjuvant radiotherapy improves overall survival in advanced invasive IPMN of the pancreas - a propensity score adjusted, national analysis of 972 patients

Authors
Worni, M; Akushevich, I; Gloor, B; Chino, JP; Pietrobon, R; Clary, BM; Shah, A
MLA Citation
Worni, M, Akushevich, I, Gloor, B, Chino, JP, Pietrobon, R, Clary, BM, and Shah, A. "Adjuvant radiotherapy improves overall survival in advanced invasive IPMN of the pancreas - a propensity score adjusted, national analysis of 972 patients." June 2011.
Source
wos-lite
Published In
British Journal of Surgery
Volume
98
Publish Date
2011
Start Page
3
End Page
3

Incorporating gross anatomy education into radiation oncology residency: a 2-year curriculum with evaluation of resident satisfaction.

PURPOSE: Radiation oncologists require a thorough understanding of anatomy, but gross anatomy is not part of the standard residency curriculum. "Oncoanatomy" is an educational program for radiation oncology residents at Duke University that integrates cadaver dissection into the instruction of oncologic anatomy, imaging, and treatment planning. In this report, the authors document their experience with a 2-year curriculum. METHODS: Nineteen radiation oncology residents from Duke University and the University of North Carolina participated during academic years 2008-2009 and 2009-2010. Monthly modules, based on anatomic site, consisted of one or two clinically oriented hour-long lectures, followed by a 1-hour gross anatomy session. Clinical lectures were case based and focused on radiographic anatomy, image segmentation, and field design. Gross anatomy sessions centered on cadaver prosections, with small groups rotating through stations at which anatomists led cadaver exploration. Adjacent monitors featured radiologic imaging to facilitate synthesis of gross anatomy with imaging anatomy. Satisfaction was assessed on a 10-point scale via anonymous survey. RESULTS: Twenty modules were held over the 2-year period. Participants gave the course a median rating of 8 (interquartile range, 7-9), with 1 signifying "as effective as the worst educational activities" and 10 "as effective as the best educational activities." High resident satisfaction was seen with all module components. CONCLUSIONS: Incorporating a structured, 2-year gross anatomy-based curriculum into radiation oncology residency is feasible and associated with high resident satisfaction.

Authors
Cabrera, AR; Lee, WR; Madden, R; Sims, E; Hoang, JK; White, LE; Marks, LB; Chino, JP
MLA Citation
Cabrera, AR, Lee, WR, Madden, R, Sims, E, Hoang, JK, White, LE, Marks, LB, and Chino, JP. "Incorporating gross anatomy education into radiation oncology residency: a 2-year curriculum with evaluation of resident satisfaction." J Am Coll Radiol 8.5 (May 2011): 335-340.
PMID
21531310
Source
pubmed
Published In
Journal of the American College of Radiology
Volume
8
Issue
5
Publish Date
2011
Start Page
335
End Page
340
DOI
10.1016/j.jacr.2010.10.005

How well does the new lung cancer staging system predict for local/regional recurrence after surgery?: A comparison of the TNM 6 and 7 systems.

INTRODUCTION: To evaluate how well the tumor, node, metastasis (TNM) 6 and TNM 7 staging systems predict rates of local/regional recurrence (LRR) after surgery alone for non-small cell lung cancer. METHODS: All patients who underwent surgery for non-small cell lung cancer at Duke between 1995 and 2005 were reviewed. Those undergoing sublobar resections, with positive margins or involvement of the chest wall, or those who received any chemotherapy or radiation therapy (RT) were excluded. Disease recurrence at the surgical margin, or within ipsilateral hilar and/or mediastinal lymph nodes, was considered as a LRR. Stage was assigned based on both TNM 6 and TNM 7. Rates of LRR were estimated using the Kaplan-Meier method. A Cox regression analysis evaluated the hazard ratio of LRR by stage within TNM 6 and TNM 7. RESULTS: A total of 709 patients were eligible for the analysis. Median follow-up was 32 months. For all patients, the 5-year actuarial risk of LRR was 23%. Conversion from TNM 6 to TNM 7 resulted in 21% stage migration (upstaging in 13%; downstaging in 8%). Five-year rates of LRR for stages IA, IB, IIA, IIB, and IIIA disease using TNM 6 were 16%, 26%, 43%, 35%, and 40%, respectively. Using TNM 7, corresponding rates were 16%, 23%, 37%, 39%, and 30%, respectively. The hazard ratios for LRR were statistically different for IA and IB in both TNM 6 and 7 but were also different for IB and IIA in TNM 7. CONCLUSIONS: LRR risk increases monotonically for stages IA to IIB in the new TNM 7 system. This information might be valuable when designing future studies of postoperative RT.

Authors
Pepek, JM; Chino, JP; Marks, LB; D'amico, TA; Yoo, DS; Onaitis, MW; Ready, NE; Hubbs, JL; Boyd, J; Kelsey, CR
MLA Citation
Pepek, JM, Chino, JP, Marks, LB, D'amico, TA, Yoo, DS, Onaitis, MW, Ready, NE, Hubbs, JL, Boyd, J, and Kelsey, CR. "How well does the new lung cancer staging system predict for local/regional recurrence after surgery?: A comparison of the TNM 6 and 7 systems." J Thorac Oncol 6.4 (April 2011): 757-761.
PMID
21325975
Source
pubmed
Published In
Journal of Thoracic Oncology
Volume
6
Issue
4
Publish Date
2011
Start Page
757
End Page
761
DOI
10.1097/JTO.0b013e31821038c0

Teaching the anatomy of oncology: evaluating the impact of a dedicated oncoanatomy course.

PURPOSE: Anatomic considerations are often critical in multidisciplinary cancer care. We developed an anatomy-focused educational program for radiation oncology residents integrating cadaver dissection into the didactic review of diagnostic, surgical, radiologic, and treatment planning, and herein assess its efficacy. METHODS AND MATERIALS: Monthly, anatomic-site based educational modules were designed and implemented during the 2008-2009 academic year at Duke University Medical Center. Ten radiation oncology residents participated in these modules consisting of a 1-hour didactic introduction followed by a 1-hour session in the gross anatomy lab with cadavers prepared by trained anatomists. Pretests and posttests were given for six modules, and post-module feedback surveys were distributed. Additional review questions testing knowledge from prior sessions were integrated into the later testing to evaluate knowledge retention. Paired analyses of pretests and postests were performed by Wilcoxon signed-rank test. RESULTS: Ninety tests were collected and scored with 35 evaluable pretest and posttest pairs for six site-specific sessions. Posttests had significantly higher scores (median percentage correct 66% vs. 85%, p<0.001). Of 47 evaluable paired pretest and review questions given 1-3 months after the intervention, correct responses rates were significantly higher for the later (59% vs. 86%, p=0.008). Resident course satisfaction was high, with a median rating of 9 of 10 (IQR 8-9); with 1 being "less effective than most educational interventions" and 10 being "more effective than most educational interventions." CONCLUSIONS: An integrated oncoanatomy course is associated with improved scores on post-intervention tests, sustained knowledge retention, and high resident satisfaction.

Authors
Chino, JP; Lee, WR; Madden, R; Sims, EL; Kivell, TL; Doyle, SK; Mitchell, TL; Hoppenworth, EJ; Marks, LB
MLA Citation
Chino, JP, Lee, WR, Madden, R, Sims, EL, Kivell, TL, Doyle, SK, Mitchell, TL, Hoppenworth, EJ, and Marks, LB. "Teaching the anatomy of oncology: evaluating the impact of a dedicated oncoanatomy course." Int J Radiat Oncol Biol Phys 79.3 (March 1, 2011): 853-859.
PMID
20418025
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
79
Issue
3
Publish Date
2011
Start Page
853
End Page
859
DOI
10.1016/j.ijrobp.2009.10.054

Single-institution experience of preoperative chemoradiotherapy for locally advanced gastric cancer

Authors
Pepek, JM; Chino, JP; Willett, CG; Tyler, DS; Uronis, HE; Czito, BG
MLA Citation
Pepek, JM, Chino, JP, Willett, CG, Tyler, DS, Uronis, HE, and Czito, BG. "Single-institution experience of preoperative chemoradiotherapy for locally advanced gastric cancer." JOURNAL OF CLINICAL ONCOLOGY 29.4 (February 1, 2011).
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
29
Issue
4
Publish Date
2011

Development of an ovarian cancer screening decision model that incorporates disease heterogeneity: implications for potential mortality reduction.

BACKGROUND: Pathologic and genetic data suggest that epithelial ovarian cancer may consist of indolent and aggressive phenotypes. The objective of the current study was to estimate the impact of a 2-phenotype paradigm of epithelial ovarian cancer on the mortality reduction achievable using available screening technologies. METHODS: The authors modified a Markov model of ovarian cancer natural history (the 1-phenotype model) to incorporate aggressive and indolent phenotypes (the 2-phenotype model) based on histopathologic criteria. Stage distribution, incidence, and mortality were calibrated to data from the Surveillance, Epidemiology, and End Results Program of the US National Cancer Institute. For validation, a Monte Carlo microsimulation (1000,000 events) of the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) multimodality prevalence screen was performed. Mortality reduction and positive predictive value (PPV) were estimated for annual screening. RESULTS: In validation against UKCTOCS data, the model-predicted percentage of screen-detected cancers diagnosed at stage I and II was 41% compared with 47% (UKCTOCS data), and the model-predicted PPV of screening was 27% compared with 35% (UKCTOCS data). The model-estimated PPV of a strategy of annual population-based screening in the United States at ages 50 to 85 years was 14%. The mortality reduction using annual postmenopausal screening was 14.7% (1-phenotype model) and 10.9% (2-phenotype model). Mortality reduction was lower with the 2-phenotype model than with the 1-phenotype model regardless of screening frequency or test sensitivity; 68% of cancer deaths are accounted for by the aggressive phenotype. CONCLUSIONS: The current analysis suggested that reductions in ovarian cancer mortality using available screening technologies on an annual basis are likely to be modest. A model that incorporated 2 clinical phenotypes of ovarian carcinoma into its natural history predicted an even smaller potential reduction in mortality because of the more frequent diagnosis of indolent cancers at early stages.

Authors
Havrilesky, LJ; Sanders, GD; Kulasingam, S; Chino, JP; Berchuck, A; Marks, JR; Myers, ER
MLA Citation
Havrilesky, LJ, Sanders, GD, Kulasingam, S, Chino, JP, Berchuck, A, Marks, JR, and Myers, ER. "Development of an ovarian cancer screening decision model that incorporates disease heterogeneity: implications for potential mortality reduction." Cancer 117.3 (February 1, 2011): 545-553.
PMID
21254049
Source
pubmed
Published In
Cancer
Volume
117
Issue
3
Publish Date
2011
Start Page
545
End Page
553
DOI
10.1002/cncr.25624

Single-institution experience of preoperative chemoradiotherapy for locally advanced gastric cancer.

99 Background: To examine acute toxicity and outcomes for patients treated with preoperative chemoradiotherapy (CRT) for gastric cancer.Patients with gastroesophageal (GE) junction (Siewert type II and III) or stomach adenocarcinoma who underwent curative intent CRT followed by planned surgical resection at Duke University between 1987 and 2009 were reviewed. Tumors were staged according to AJCC 6th edition. Local recurrence was defined as radiographic or biopsy- proven disease within the radiation treatment field. Overall survival (OS), local control (LC) and disease-free survival (DFS) were estimated using the Kaplan-Meier method. Toxicity was graded according to CTCAE v4.0.Forty-eight patients (60% stage III, 8% stage IV) were included. Most (73%) had proximal (GE junction, cardia and fundus) tumors. Thirty-five percent had signet ring histology, 52% had poorly differentiated tumors and 10% had linitis plastica. Median age was 60 years and median RT dose was 45 Gy. All patients received concurrent chemotherapy (CT) with 40 (83%) receiving 5-FU-based CT. Rates of acute > grade 2 hematologic and non-hematologic toxicity were 38% and 10%, respectively. Six patients (13%) required treatment break and two (4%) were unable to complete the prescribed treatment course. Thirty-six patients (75%) underwent surgery. Patients did not undergo surgery due to distant metastases at laparotomy or restaging (n=9), patient refusal (n=2) or poor performance status (n=1). Pathologic complete response and R0 resection rates were 19% and 86%, respectively. Thirty-day surgical mortality was 6%. At 42 months median follow-up, 3-year actuarial OS for all patients was 40%. For those undergoing surgery, 3-year OS, LC and DFS were 50%, 73% and 41%, respectively.Preoperative CRT for gastric cancer is reasonably well tolerated with acceptable rates of perioperative morbidity and mortality. In this patient cohort with advanced disease, LC, DFS and OS rates in resected patients are comparable to similarly staged, adjuvantly treated historic controls. Further study comparing neoadjuvant CRT to standard treatment approaches for gastric cancer is indicated. No significant financial relationships to disclose.

Authors
Pepek, JM; Chino, JP; Willett, CG; Tyler, DS; Uronis, HE; Czito, BG
MLA Citation
Pepek, JM, Chino, JP, Willett, CG, Tyler, DS, Uronis, HE, and Czito, BG. "Single-institution experience of preoperative chemoradiotherapy for locally advanced gastric cancer." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 29.4_suppl (February 2011): 99-.
PMID
27985467
Source
epmc
Published In
Journal of Clinical Oncology
Volume
29
Issue
4_suppl
Publish Date
2011
Start Page
99

The impact of radiation therapy in patients with diffuse large B-cell lymphoma with positive post-chemotherapy FDG-PET or gallium-67 scans.

BACKGROUND: 2-[fluorine-18]fluoro-2-deoxy-D-glucose-positron emission tomography (PET) and gallium-67 citrate (gallium) response after chemotherapy are powerful prognostic factors in diffuse large B-cell lymphoma (DLBCL). However, clinical outcomes when consolidation radiation therapy (RT) is administered are less defined. PATIENTS AND METHODS: We reviewed 99 patients diagnosed with DLBCL from 1996 to 2007 at Duke University who had a post-chemotherapy response assessment with either PET or gallium and who subsequently received consolidation RT. Clinical outcomes were estimated using the Kaplan-Meier method and compared using the log-rank test. RESULTS: Median follow-up was 4.4 years. Stage distribution was I-II in 70% and III-IV in 30%. Chemotherapy was R-CHOP or CHOP in 88%. Median RT dose was 30 Gy. Post-chemotherapy PET (n = 79) or gallium (n = 20) was positive in 21 of 99 patients and negative in 78 of 99 patients. Five-year in-field control was 95% with a negative PET/gallium scan versus 71% with a positive scan (P < 0.01). Five-year event-free survival (EFS; 83% versus 65%, P = 0.04) and overall survival (89% versus 73%, P = 0.04) were also significantly better when the post-chemotherapy PET/gallium was negative. CONCLUSIONS: A positive PET/gallium scan after chemotherapy is associated with an increased risk of local failure and death. Consolidation RT, however, still results in long-term EFS in 65% of patients.

Authors
Dorth, JA; Chino, JP; Prosnitz, LR; Diehl, LF; Beaven, AW; Coleman, RE; Kelsey, CR
MLA Citation
Dorth, JA, Chino, JP, Prosnitz, LR, Diehl, LF, Beaven, AW, Coleman, RE, and Kelsey, CR. "The impact of radiation therapy in patients with diffuse large B-cell lymphoma with positive post-chemotherapy FDG-PET or gallium-67 scans." Ann Oncol 22.2 (February 2011): 405-410.
PMID
20675560
Source
pubmed
Published In
Annals of Oncology
Volume
22
Issue
2
Publish Date
2011
Start Page
405
End Page
410
DOI
10.1093/annonc/mdq389

Incorporating gross anatomy education into radiation oncology residency: A 2-year curriculum with evaluation of resident satisfaction

Purpose: Radiation oncologists require a thorough understanding of anatomy, but gross anatomy is not part of the standard residency curriculum. "Oncoanatomy" is an educational program for radiation oncology residents at Duke University that integrates cadaver dissection into the instruction of oncologic anatomy, imaging, and treatment planning. In this report, the authors document their experience with a 2-year curriculum. Methods: Nineteen radiation oncology residents from Duke University and the University of North Carolina participated during academic years 2008-2009 and 2009-2010. Monthly modules, based on anatomic site, consisted of one or two clinically oriented hour-long lectures, followed by a 1-hour gross anatomy session. Clinical lectures were case based and focused on radiographic anatomy, image segmentation, and field design. Gross anatomy sessions centered on cadaver prosections, with small groups rotating through stations at which anatomists led cadaver exploration. Adjacent monitors featured radiologic imaging to facilitate synthesis of gross anatomy with imaging anatomy. Satisfaction was assessed on a 10-point scale via anonymous survey. Results: Twenty modules were held over the 2-year period. Participants gave the course a median rating of 8 (interquartile range, 7-9), with 1 signifying "as effective as the worst educational activities" and 10 "as effective as the best educational activities." High resident satisfaction was seen with all module components. Conclusions: Incorporating a structured, 2-year gross anatomy-based curriculum into radiation oncology residency is feasible and associated with high resident satisfaction. © 2011 American College of Radiology.

Authors
Cabrera, AR; Lee, WR; Madden, R; Sims, E; Hoang, JK; White, LE; Marks, LB; Chino, JP
MLA Citation
Cabrera, AR, Lee, WR, Madden, R, Sims, E, Hoang, JK, White, LE, Marks, LB, and Chino, JP. "Incorporating gross anatomy education into radiation oncology residency: A 2-year curriculum with evaluation of resident satisfaction." Journal of the American College of Radiology 8.5 (2011): 335-340.
Source
scopus
Published In
Journal of the American College of Radiology
Volume
8
Issue
5
Publish Date
2011
Start Page
335
End Page
340
DOI
10.1016/j.jacr.2010.10.005

What Are The Causes Of Death For Women With Early-stage Endometrial Cancer?

Authors
Chino, JP; Berchuck, A; Havrilesky, L
MLA Citation
Chino, JP, Berchuck, A, and Havrilesky, L. "What Are The Causes Of Death For Women With Early-stage Endometrial Cancer?." INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 81.2 (2011): S470-S470.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
81
Issue
2
Publish Date
2011
Start Page
S470
End Page
S470

Accuracy of PET in Identifying Hilar (N1) Lymph Node Involvement in Non-small Cell Lung Cancer: Implications for the Radiation Oncologist

Authors
Pepek, JM; Higgins, KA; Chino, JP; Yoo, DS; Kelsey, CR
MLA Citation
Pepek, JM, Higgins, KA, Chino, JP, Yoo, DS, and Kelsey, CR. "Accuracy of PET in Identifying Hilar (N1) Lymph Node Involvement in Non-small Cell Lung Cancer: Implications for the Radiation Oncologist." INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 81.2 (2011): S53-S53.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
81
Issue
2
Publish Date
2011
Start Page
S53
End Page
S53

Lymphovascular Invasion in Non-small Cell Lung Cancer: Implications for Staging and Adjuvant Therapy

Authors
Higgins, KA; Chino, JP; Yoo, DS; Kelsey, CR
MLA Citation
Higgins, KA, Chino, JP, Yoo, DS, and Kelsey, CR. "Lymphovascular Invasion in Non-small Cell Lung Cancer: Implications for Staging and Adjuvant Therapy." INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 81.2 (2011): S573-S573.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
81
Issue
2
Publish Date
2011
Start Page
S573
End Page
S573

Does SUVmax of the Primary Tumor Predict Regional Lymph Node Involvement or Local/Regional Recurrence in Resected Non-small Cell Lung Cancer?

Authors
Pepek, JM; Chino, JP; Higgins, KA; Yoo, DS; Kelsey, CR
MLA Citation
Pepek, JM, Chino, JP, Higgins, KA, Yoo, DS, and Kelsey, CR. "Does SUVmax of the Primary Tumor Predict Regional Lymph Node Involvement or Local/Regional Recurrence in Resected Non-small Cell Lung Cancer?." INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 81.2 (2011): S581-S582.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
81
Issue
2
Publish Date
2011
Start Page
S581
End Page
S582

Factors associated with the development of brain metastases: analysis of 975 patients with early stage nonsmall cell lung cancer.

BACKGROUND: The risk of developing brain metastases after definitive treatment of locally advanced nonsmall cell lung cancer (NSCLC) is approximately 30%-50%. The risk for patients with early stage disease is less defined. The authors sought to investigate this further and to study potential risk factors. METHODS: The records of all patients who underwent surgery for T1-T2 N0-N1 NSCLC at Duke University between the years 1995 and 2005 were reviewed. The cumulative incidence of brain metastases and distant metastases was estimated by using the Kaplan-Meier method. A multivariate analysis assessed factors associated with the development of brain metastases. RESULTS: Of 975 consecutive patients, 85% were stage I, and 15% were stage II. Adjuvant chemotherapy was given to 7%. The 5-year actuarial risk of developing brain metastases and distant metastases was 10%(95% confidence interval [CI], 8-13) and 34%(95% CI, 30-39), respectively. Of patients developing brain metastases, the brain was the sole site of failure in 43%. On multivariate analysis, younger age (hazard ratio [HR], 1.03 per year), larger tumor size (HR, 1.26 per cm), lymphovascular space invasion (HR, 1.87), and hilar lymph node involvement (HR, 1.18) were associated with an increased risk of developing brain metastases. CONCLUSIONS: In this large series of patients treated surgically for early stage NSCLC, the 5-year actuarial risk of developing brain metastases was 10%. A better understanding of predictive factors and biological susceptibility is needed to identify the subset of patients with early stage NSCLC who are at particularly high risk.

Authors
Hubbs, JL; Boyd, JA; Hollis, D; Chino, JP; Saynak, M; Kelsey, CR
MLA Citation
Hubbs, JL, Boyd, JA, Hollis, D, Chino, JP, Saynak, M, and Kelsey, CR. "Factors associated with the development of brain metastases: analysis of 975 patients with early stage nonsmall cell lung cancer." Cancer 116.21 (November 1, 2010): 5038-5046.
PMID
20629035
Source
pubmed
Published In
Cancer
Volume
116
Issue
21
Publish Date
2010
Start Page
5038
End Page
5046
DOI
10.1002/cncr.25254

Influence of radiation modality and nodal dissection on survival in high-risk early-stage endometrial cancer

Authors
Chino, JP; Jones, E; Berchuck, A; Havrilesky, L
MLA Citation
Chino, JP, Jones, E, Berchuck, A, and Havrilesky, L. "Influence of radiation modality and nodal dissection on survival in high-risk early-stage endometrial cancer." JOURNAL OF CLINICAL ONCOLOGY 28.15 (May 20, 2010).
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
28
Issue
15
Publish Date
2010

Does the revised TNM staging system for lung cancer better estimate actuarial rates of local/regional recurrence after surgery?

Authors
Pepek, JM; Chino, JP; Onaitis, MW; Marks, LB; Ready, N; Crawford, J; D'Amico, TA; Hubbs, JL; Kelsey, CR
MLA Citation
Pepek, JM, Chino, JP, Onaitis, MW, Marks, LB, Ready, N, Crawford, J, D'Amico, TA, Hubbs, JL, and Kelsey, CR. "Does the revised TNM staging system for lung cancer better estimate actuarial rates of local/regional recurrence after surgery?." May 20, 2010.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
28
Issue
15
Publish Date
2010

Biologically effective dose (BED) correlation with biochemical control after low-dose rate prostate brachytherapy for clinically low-risk prostate cancer.

PURPOSE: To assess the correlation of postimplant dosimetric quantifiers with biochemical control of prostate cancer after low-dose rate brachytherapy. METHODS AND MATERIALS: The biologically effective dose (BED), dose in Gray (Gy) to 90% of prostate (D(90)), and percent volume of the prostate receiving 100% of the prescription dose (V(100)) were calculated from the postimplant dose-volume histogram for 140 patients undergoing low-dose rate prostate brachytherapy from 1997 to 2003 at Durham Regional Hospital and the Durham VA Medical Center (Durham, NC). RESULTS: The median follow-up was 50 months. There was a 7% biochemical failure rate (10 of 140), and 91% of patients (127 of 140) were alive at last clinical follow-up. The median BED was 148 Gy (range, 46-218 Gy). The median D(90) was 139 Gy (range, 45-203 Gy). The median V(100) was 85% (range, 44-100%). The overall 5-year biochemical relapse-free survival (bRFS) rate was 90.1%. On univariate Cox proportional hazards modeling, no pretreatment characteristic (Gleason score sum, age, baseline prostate-specific antigen, or clinical stage) was predictive of bRFS. The BED, D(90), and V(100) were all highly correlated (Pearson coefficients >92%), and all were strongly correlated with bRFS. Using the Youden method, we identified the following cut points for predicting freedom from biochemical failure: D(90) >or= 110 Gy, V(100) >or= 74%, and BED >or= 115 Gy. None of the covariates significantly predicted overall survival. CONCLUSIONS: We observed significant correlation between BED, D(90), and V(100) with bRFS. The BED is at least as predictive of bRFS as D(90) or V(100). Dosimetric quantifiers that account for heterogeneity in tumor location and dose distribution, tumor repopulation, and survival probability of tumor clonogens should be investigated.

Authors
Miles, EF; Nelson, JW; Alkaissi, AK; Das, S; Clough, RW; Broadwater, G; Anscher, MS; Chino, JP; Oleson, JR
MLA Citation
Miles, EF, Nelson, JW, Alkaissi, AK, Das, S, Clough, RW, Broadwater, G, Anscher, MS, Chino, JP, and Oleson, JR. "Biologically effective dose (BED) correlation with biochemical control after low-dose rate prostate brachytherapy for clinically low-risk prostate cancer." Int J Radiat Oncol Biol Phys 77.1 (May 1, 2010): 139-146.
PMID
19836161
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
77
Issue
1
Publish Date
2010
Start Page
139
End Page
146
DOI
10.1016/j.ijrobp.2009.04.052

Secondary Malignancy after Radiation for Endometrial Cancer: Comparing No Radiation, External Beam, and Brachytherapy

Authors
Chino, JP; Havrilesky, L; Berchuck, A; Jones, E
MLA Citation
Chino, JP, Havrilesky, L, Berchuck, A, and Jones, E. "Secondary Malignancy after Radiation for Endometrial Cancer: Comparing No Radiation, External Beam, and Brachytherapy." 2010.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
78
Issue
3
Publish Date
2010
Start Page
S404
End Page
S404

Incorporating Gross Anatomy Education into Radiation Oncology Residency

Authors
Cabrera, AR; Lee, WR; Madden, R; Hoppenworth, EJ; Marks, LB; Chino, JP
MLA Citation
Cabrera, AR, Lee, WR, Madden, R, Hoppenworth, EJ, Marks, LB, and Chino, JP. "Incorporating Gross Anatomy Education into Radiation Oncology Residency." 2010.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
78
Issue
3
Publish Date
2010
Start Page
S483
End Page
S484

Neoadjuvant Chemoradiotherapy for Locally Advanced Gastric Adenocarcinoma: A Single Institution Experience

Authors
Pepek, JM; Chino, JP; Willett, CG; Tyler, DS; Uronis, HE; Czito, BG
MLA Citation
Pepek, JM, Chino, JP, Willett, CG, Tyler, DS, Uronis, HE, and Czito, BG. "Neoadjuvant Chemoradiotherapy for Locally Advanced Gastric Adenocarcinoma: A Single Institution Experience." 2010.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
78
Issue
3
Publish Date
2010
Start Page
S73
End Page
S73

Preoperative chemotherapy versus preoperative chemoradiotherapy for stage III (N2) non-small-cell lung cancer.

PURPOSE: To compare preoperative chemotherapy (ChT) and preoperative chemoradiotherapy (ChT-RT) in operable Stage III non-small-cell lung cancer. METHODS AND MATERIALS: This retrospective study analyzed all patients with pathologically confirmed Stage III (N2) non-small-cell lung cancer who initiated preoperative ChT or ChT-RT at Duke University between 1995 and 2006. Mediastinal pathologic complete response (pCR) rates were compared using a chi-square test. The actuarial overall survival, disease-free survival, and local control were estimated using the Kaplan-Meier method and compared using the log-rank test. Multivariate Cox regression analysis was also performed. RESULTS: A total of 101 patients who initiated preoperative therapy with planned resection were identified. The median follow-up was 20 months for all patients and 38 months for survivors. The mediastinal lymph nodes were reassessed after preoperative therapy in 88 patients (87%). Within this group, a mediastinal pCR was achieved in 35% after preoperative ChT vs. 65% after preoperative ChT-RT (p = 0.01). Resection was performed in 69% after ChT and 84% after ChT-RT (p = 0.1). For all patients, the overall survival, disease-free survival, and local control rate at 3 years was 40%, 27%, and 66%, respectively. No statistically significant differences were found in the clinical endpoints between the ChT and ChT-RT subgroups. On multivariate analysis, a mediastinal pCR was associated with improved disease-free survival (p = 0.03) and local control (p = 0.03), but not overall survival (p = 0.86). CONCLUSION: Preoperative ChT-RT was associated with higher mediastinal pCR rates but not improved survival.

Authors
Higgins, K; Chino, JP; Marks, LB; Ready, N; D'Amico, TA; Clough, RW; Kelsey, CR
MLA Citation
Higgins, K, Chino, JP, Marks, LB, Ready, N, D'Amico, TA, Clough, RW, and Kelsey, CR. "Preoperative chemotherapy versus preoperative chemoradiotherapy for stage III (N2) non-small-cell lung cancer." Int J Radiat Oncol Biol Phys 75.5 (December 1, 2009): 1462-1467.
PMID
19467798
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
75
Issue
5
Publish Date
2009
Start Page
1462
End Page
1467
DOI
10.1016/j.ijrobp.2009.01.069

Robot-assisted laparoscopic prostatectomy is not associated with early postoperative radiation therapy.

OBJECTIVE: To compare open radical prostatectomy (RP) and robot-assisted laparoscopic prostatectomy (RALP), and to determine whether RALP is associated with a higher risk of features that determine recommendations for postoperative radiation therapy (RT). PATIENTS AND METHODS: Patients undergoing RP from 2003 to 2007 were stratified into two groups: open RP and RALP. Preoperative (PSA level, T stage and Gleason score), pathological factors (T stage, Gleason score, extracapsular extension [ECE] and the status of surgical margins and seminal vesicle invasion [SVI]) and early treatment with RT or referral for RT within 6 months were compared between the groups. Multivariate analysis was used to control for selection bias in the RALP group. RESULTS: In all, 904 patients were identified; 368 underwent RALP and 536 underwent open RP (retropubic or perineal). Patients undergoing open RP had a higher pathological stage with ECE present in 24.8% vs 19.3% in RALP (P = 0.05) and SVI in 10.3% vs 3.8% (P < 0.001). In the RALP vs open RP group, there were positive surgical margins in 31.5% vs 31.9% (P = 0.9) and there were postoperative PSA levels of (3) 0.2 ng/mL in 5.7% vs 6.3% (P = 0.7), respectively. On multivariate analysis to control for selection bias, RALP was not associated with indication for RT (odds ratio (OR) 1.10, P = 0.55), or referral for RT (OR 1.04, P = 0.86). CONCLUSION: RALP was not associated with an increase in either indication or referral for early postoperative RT.

Authors
Chino, J; Schroeck, FR; Sun, L; Lee, WR; Albala, DM; Moul, JW; Koontz, BF
MLA Citation
Chino, J, Schroeck, FR, Sun, L, Lee, WR, Albala, DM, Moul, JW, and Koontz, BF. "Robot-assisted laparoscopic prostatectomy is not associated with early postoperative radiation therapy." BJU Int 104.10 (November 2009): 1496-1500.
PMID
19388991
Source
pubmed
Published In
Bju International
Volume
104
Issue
10
Publish Date
2009
Start Page
1496
End Page
1500
DOI
10.1111/j.1464-410X.2009.08588.x

Paraganglioma of the head and neck: long-term local control with radiotherapy.

OBJECTIVES: Paragangliomas are rare neuroendocrine neoplasms of the head and neck. Treatment strategies include resection, definitive external beam radiation therapy (EBRT), stereotactic radiosurgery (SRS), or observation alone. Due to their rarity and indolent clinical behavior, the optimal management for long-term control is unknown. METHODS: This Institutional Review Board-approved retrospective study identified all paragangliomas of the head and neck treated with definitive fractionated radiotherapy at Duke University Medical Center from 1963 to 2005 with minimum 2-year follow-up. Local control (LC) was calculated using the Kaplan-Meier method. RESULTS: Thirty-one patients were identified and treated with EBRT (median dose: 54 Gy, range: 38-65 Gy). Twelve patients were treated with megavoltage photon; 19 were treated with either cobalt-60 or cesium-137. Fourteen (45%) had undergone resection preceding radiation. Median follow-up was 9 years (range: 2-35 years), with 10 patients having greater than 15-year follow-up. LC at 5, 10, and 15 years was 96%, 90%, and 90%, respectively. There were no failures in the group treated with megavoltage photons, although this was not statistically significant (P = 0.28). There was no difference in LC between salvage radiation therapy (RT) used after surgical failure and definitive RT alone (10-year LC, 73% vs. 100%, respectively, P = 0.31). The incidence of acute toxicity greater than grade 2 was 3%, and there were no late toxicities greater than grade 2. CONCLUSIONS: RT is an effective and well-tolerated treatment for paragangliomas of the head and neck.

Authors
Chino, JP; Sampson, JH; Tucci, DL; Brizel, DM; Kirkpatrick, JP
MLA Citation
Chino, JP, Sampson, JH, Tucci, DL, Brizel, DM, and Kirkpatrick, JP. "Paraganglioma of the head and neck: long-term local control with radiotherapy." Am J Clin Oncol 32.3 (June 2009): 304-307.
PMID
19433962
Source
pubmed
Published In
American Journal of Clinical Oncology: Cancer Clinical Trials
Volume
32
Issue
3
Publish Date
2009
Start Page
304
End Page
307
DOI
10.1097/COC.0b013e318187dd94

Morbidity and prostate-specific antigen control of external beam radiation therapy plus low-dose-rate brachytherapy boost for low, intermediate, and high-risk prostate cancer.

PURPOSE: Dose escalation has been shown beneficial in prostate cancer. Brachytherapy (BT) provides an opportunity for dose escalation beyond what can be safely delivered using only teletherapy methods. The purpose of this study was to determine cancer control and morbidity of external beam radiation therapy (EBRT) plus low-dose-rate (LDR) BT boost in patients with prostate cancer treated at Duke University Health System. METHODS: Between June 1997 and August 2007, 199 patients were consecutively treated at our facility with 46Gy EBRT followed by 100Gy palladium-103 ((103)Pd) or 120Gy iodine-125 ((125)I) LDR prostate implant. Treatment characteristics and followup data were retrospectively analyzed. Intermediate risk was defined as T2b-c, Gleason score 7 (GS 7), or prostate-specific antigen (PSA) of 10.1-19.9ng/mL. High risk was defined as GS 8-10, PSA>20, T3+, or two intermediate risk factors. The Radiation Therapy Oncology Group toxicity scale was used to report morbidity for gastrointestinal (GI) and genitourinary (GU) effects. PSA recurrence was defined as nadir+2ng/mL. RESULTS: Median followup was 4.2 years for all patients, 4.8 years for high-risk patients. Risk categories were as follows: 20% low risk, 47% intermediate risk, and 33% high risk. Forty five percent of patients received adjuvant androgen deprivation therapy (ADT). The median length of time since end of ADT to last followup was 2.7 years in all patients, 2.0 years for high-risk patients. Five-year biochemical relapse-free survival was 87% for all, 81% for high-risk patients. PSA control was similar at 92% for all and 86% for high-risk patients. Five-year actuarial risk of any and Grade 3 late GI morbidity was 38% and 7% respectively, and any and Grade 3 late GU morbidity was 21% and 3%, respectively. There were no significant differences in risk of Grade 2+GI or GU morbidity with choice of isotope. CONCLUSIONS: EBRT plus LDR BT has acceptable morbidity and, with 5-year followup, provides excellent cancer control even in high-risk patients.

Authors
Koontz, BF; Chino, J; Lee, WR; Hahn, CA; Buckley, N; Huang, S; Kim, J; Reagan, R; Joyner, R; Anscher, MS
MLA Citation
Koontz, BF, Chino, J, Lee, WR, Hahn, CA, Buckley, N, Huang, S, Kim, J, Reagan, R, Joyner, R, and Anscher, MS. "Morbidity and prostate-specific antigen control of external beam radiation therapy plus low-dose-rate brachytherapy boost for low, intermediate, and high-risk prostate cancer." Brachytherapy 8.2 (April 2009): 191-196.
PMID
19433320
Source
pubmed
Published In
Brachytherapy
Volume
8
Issue
2
Publish Date
2009
Start Page
191
End Page
196
DOI
10.1016/j.brachy.2009.01.002

Prognostic Value of Pre- and Post-treatment FDG PET in Head-and-Neck Cancer

Authors
Higgins, KA; Hoang, JK; Chino, JP; Brizel, DM
MLA Citation
Higgins, KA, Hoang, JK, Chino, JP, and Brizel, DM. "Prognostic Value of Pre- and Post-treatment FDG PET in Head-and-Neck Cancer." 2009.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
75
Issue
3
Publish Date
2009
Start Page
S18
End Page
S18

Positive PET Prior to Consolidative Radiation Therapy Increases Risk of In-field Failure in Diffuse Large B-cell Lymphoma

Authors
Dorth, JA; Chino, JP; Prosnitz, LR; Kelsey, CR
MLA Citation
Dorth, JA, Chino, JP, Prosnitz, LR, and Kelsey, CR. "Positive PET Prior to Consolidative Radiation Therapy Increases Risk of In-field Failure in Diffuse Large B-cell Lymphoma." 2009.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
75
Issue
3
Publish Date
2009
Start Page
S64
End Page
S64

Daily Cone Beam CT Soft-tissue Matching by Radiation Therapists: A Prospective Credentialing and Validation Study

Authors
Chino, JP; Oleson, JR
MLA Citation
Chino, JP, and Oleson, JR. "Daily Cone Beam CT Soft-tissue Matching by Radiation Therapists: A Prospective Credentialing and Validation Study." 2009.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
75
Issue
3
Publish Date
2009
Start Page
S641
End Page
S642

Prone positioning causes the heart to be displaced anteriorly within the thorax: implications for breast cancer treatment.

INTRODUCTION: Prone positioning has been suggested as an alternative to the conventional supine position for patients receiving breast radiotherapy, but few data exist on how this may alter heart location. We herein quantitatively compare the intrathoracic location of the heart in the prone and supine positions in patients treated for breast cancer. METHODS AND MATERIALS: In 16 patients treated with tangent photons for breast cancer, the computed tomography planning images (obtained in the supine position) and diagnostic magnetic resonance images (obtained in the prone position) were studied. For each case, the distance between the anterior pericardium and the anterior chest wall was measured at nine specific points; three points at each of three axial levels. The differences in the measurements between the prone and supine positions were compared with the Wilcoxon signed-rank test. RESULTS: There is a systematic displacement of the lateral and superior aspect of the heart closer to the chest wall in the prone vs. supine position (mean displacement 19 mm (95% confidence interval 13.7-25.1 mm, p < 0.001); the medial and inferior aspects remain fixed. There was also a reduction in volume of lung interposed between the heart and chest wall when prone (mean decrease of 22 mL, p < 0.001 for difference). CONCLUSIONS: The superior and lateral aspects of the heart typically move anteriorly during prone positioning compared with the supine position. This may have negative consequences in situations in which the high-risk target tissues include the chest wall or deep breast.

Authors
Chino, JP; Marks, LB
MLA Citation
Chino, JP, and Marks, LB. "Prone positioning causes the heart to be displaced anteriorly within the thorax: implications for breast cancer treatment." Int J Radiat Oncol Biol Phys 70.3 (March 1, 2008): 916-920.
PMID
18262103
Source
pubmed
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
70
Issue
3
Publish Date
2008
Start Page
916
End Page
920
DOI
10.1016/j.ijrobp.2007.11.001

In Reply to Drs. Lymberis and Formenti

Authors
Chino, J; Marks, LB
MLA Citation
Chino, J, and Marks, LB. "In Reply to Drs. Lymberis and Formenti." International Journal of Radiation Oncology Biology Physics 72.1 (2008): 302--.
Source
scival
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
72
Issue
1
Publish Date
2008
Start Page
302-
DOI
10.1016/j.ijrobp.2008.05.018

In Reply to Dr. Hama

Authors
Chino, J; Marks, L
MLA Citation
Chino, J, and Marks, L. "In Reply to Dr. Hama." International Journal of Radiation Oncology Biology Physics 72.1 (2008): 302--.
Source
scival
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
72
Issue
1
Publish Date
2008
Start Page
302-
DOI
10.1016/j.ijrobp.2008.05.015

Does robotic prostatectomy increase the need for adjuvant radiation therapy? The impact of choice of surgery and pretreatment disease characteristics on adjuvant indications

Authors
Chino, JP; Schroeck, FR; Sun, L; Lee, W; Albala, DM; Moul, JW; Koontz, BF
MLA Citation
Chino, JP, Schroeck, FR, Sun, L, Lee, W, Albala, DM, Moul, JW, and Koontz, BF. "Does robotic prostatectomy increase the need for adjuvant radiation therapy? The impact of choice of surgery and pretreatment disease characteristics on adjuvant indications." 2008.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
72
Issue
1
Publish Date
2008
Start Page
S304
End Page
S304
DOI
10.1016/j.ijrobp.2008.06.1065

Duodenal adenocarcinoma: patterns of failure after resection and the role of chemoradiotherapy.

PURPOSE: To report patterns of disease recurrence after resection of adenocarcinoma of the duodenum and compare outcomes between patients undergoing surgery only vs. surgery with concurrent chemotherapy and radiation therapy (CT-RT). METHODS AND MATERIALS: This was a retrospective analysis of all patients undergoing potentially curative therapy for adenocarcinoma of the duodenum at Duke University Medical Center and affiliated hospitals between 1975 and 2005. Overall survival (OS), disease-free survival (DFS), and local control (LC) were estimated using the Kaplan-Meier method. Univariate regression analysis evaluated the effect of CT-RT on clinical endpoints. RESULTS: Thirty-two patients were identified (23 M, 9 F). Median age was 60 years (range, 32-77 years). Surgery alone was performed in 16 patients. An additional 16 patients received either preoperative (n = 11) or postoperative (n = 5) CT-RT. Median RT dose was 50.4 Gy (range, 12.6-54 Gy). All patients treated with RT also received concurrent 5-fluorouracil-based CT. Two patients treated preoperatively had a pathologic complete response (18%), and none had involved lymph nodes at resection. Five-year OS, DFS, and LC for the entire group were 48%, 47%, and 55%, respectively. Five-year survival did not differ between patients receiving CT-RT vs. surgery alone (57% vs. 44%, p = 0.42). However, in patients undergoing R0 resection, CT-RT appeared to improve OS (5-year 83% vs. 53%, p = 0.07). CONCLUSIONS: Local failure after surgery alone is high. Given the patterns of relapse with surgery alone and favorable outcomes in patients undergoing complete resection with CT-RT, the use of CT-RT in selected patients should be considered.

Authors
Kelsey, CR; Nelson, JW; Willett, CG; Chino, JP; Clough, RW; Bendell, JC; Tyler, DS; Hurwitz, HI; Morse, MA; Clary, BM; Pappas, TN; Czito, BG
MLA Citation
Kelsey, CR, Nelson, JW, Willett, CG, Chino, JP, Clough, RW, Bendell, JC, Tyler, DS, Hurwitz, HI, Morse, MA, Clary, BM, Pappas, TN, and Czito, BG. "Duodenal adenocarcinoma: patterns of failure after resection and the role of chemoradiotherapy." Int J Radiat Oncol Biol Phys 69.5 (December 1, 2007): 1436-1441.
PMID
17689032
Source
pubmed
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
69
Issue
5
Publish Date
2007
Start Page
1436
End Page
1441
DOI
10.1016/j.ijrobp.2007.05.006

Paclitaxel-based chemoradiotherapy in the treatment of patients with operable esophageal cancer.

PURPOSE: To compare a neoadjuvant regimen of cisplatin/5-fluorouracil (5-FU) and concurrent radiation therapy (RT) with paclitaxel-based regimens and RT in the management of operable esophageal (EC)/gastroesophageal junction (GEJ) cancer. METHODS AND MATERIALS: All patients receiving neoadjuvant chemotherapy (CT) and RT for EC/GEJ cancer at Duke University between January 1995 and December 2004 were included. Clinical end points were compared for patients receiving paclitaxel-based regimens (TAX) vs. alternative regimens (non-TAX). Local control (LC), disease-free survival (DFS), and overall survival (OS) were estimated using the Kaplan-Meier method. Chi-square analysis was performed to test the effect of TAX on pathologic complete response (pCR) rates and toxicity. RESULTS: A total of 109 patients received CT-RT followed by esophagectomy (95 M; 14 F). Median RT dose was 45 Gy (range, 36-66 Gy). The TAX and non-TAX groups comprised 47% and 53% of patients, respectively. Most (83%) TAX patients received three drug regimens including platinum and a fluoropyrimidine. In the non-TAX group, 89% of the patients received cisplatin and 5-FU. The remainder received 5-FU or capecitabine alone. Grade 3-4 toxicity occurred in 41% of patients receiving TAX vs. 24% of those receiving non-TAX (p = 0.19). Overall pCR rate was 39% (39% with TAX vs. 40% with non-TAX, p = 0.9). Overall LC, DFS, and OS at 3 years were 80%, 34%, and 37%, respectively. At 3 years, there were no differences in LC (75% vs. 85%, p = 0.33) or OS (37% vs. 37%, p = 0.32) between TAX and non-TAX groups. CONCLUSIONS: In this large experience, paclitaxel-containing regimens did not improve pCR rates or clinical end points compared to non-paclitaxel-containing regimens.

Authors
Kelsey, CR; Chino, JP; Willett, CG; Clough, RW; Hurwitz, HI; Morse, MA; Bendell, JC; D'Amico, TA; Czito, BG
MLA Citation
Kelsey, CR, Chino, JP, Willett, CG, Clough, RW, Hurwitz, HI, Morse, MA, Bendell, JC, D'Amico, TA, and Czito, BG. "Paclitaxel-based chemoradiotherapy in the treatment of patients with operable esophageal cancer." Int J Radiat Oncol Biol Phys 69.3 (November 1, 2007): 770-776.
PMID
17889266
Source
pubmed
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
69
Issue
3
Publish Date
2007
Start Page
770
End Page
776
DOI
10.1016/j.ijrobp.2007.03.035

Prone positioning causes the heart to be displaced anteriorly within the thorax: Implications for breast cancer treatment

Authors
Chino, JP; Marks, LB
MLA Citation
Chino, JP, and Marks, LB. "Prone positioning causes the heart to be displaced anteriorly within the thorax: Implications for breast cancer treatment." 2007.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
69
Issue
3
Publish Date
2007
Start Page
S73
End Page
S74
DOI
10.1016/j.ijrobp.2007.07.132

Neoadjuvant chemoradiotherapy for operable esophageal cancer: Is paclitaxel necessary?

Authors
Chino, JP; Kelsey, CR; Willett, CG; Clough, R; Bendell, JC; Hurwitz, HI; D'Amico, T; Czito, BG
MLA Citation
Chino, JP, Kelsey, CR, Willett, CG, Clough, R, Bendell, JC, Hurwitz, HI, D'Amico, T, and Czito, BG. "Neoadjuvant chemoradiotherapy for operable esophageal cancer: Is paclitaxel necessary?." 2006.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
66
Issue
3
Publish Date
2006
Start Page
S292
End Page
S293
DOI
10.1016/j.ijrobp.2006.07.552
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