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Horton, Janet Knight

Overview:

My primary clinical and research focus revolves around women with breast cancer. Specifically, I am interested in studying breast cancer subtype specific (luminal, basal) radiation response in human breast tumors and utilizing that information to design biologically based radiotherapy trials.

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. 2001

M.D. — Wake Forest University

Grants:

Preoperative Breast Radiotherapy: A Tool to Provide Individualized and Biologically-Based Radiation Therapy

Administered By
Radiation Oncology
AwardedBy
Gateway for Cancer Research
Role
Principal Investigator
Start Date
July 01, 2015
End Date
June 30, 2016

Publications:

Society of Surgical Oncology–American Society for Radiation Oncology–American Society of Clinical Oncology Consensus Guideline on Margins for Breast-Conserving Surgery with Whole-Breast Irradiation in Ductal Carcinoma In Situ

Authors
Morrow, M; Van Zee, KJ; Solin, LJ; Houssami, N; Chavez-MacGregor, M; Harris, JR; Horton, J; Hwang, S; Johnson, PL; Marinovich, ML; Schnitt, SJ; Wapnir, I; Moran, MS
MLA Citation
Morrow, M, Van Zee, KJ, Solin, LJ, Houssami, N, Chavez-MacGregor, M, Harris, JR, Horton, J, Hwang, S, Johnson, PL, Marinovich, ML, Schnitt, SJ, Wapnir, I, and Moran, MS. "Society of Surgical Oncology–American Society for Radiation Oncology–American Society of Clinical Oncology Consensus Guideline on Margins for Breast-Conserving Surgery with Whole-Breast Irradiation in Ductal Carcinoma In Situ." Annals of Surgical Oncology 23.12 (November 2016): 3801-3810.
Source
crossref
Published In
Annals of Surgical Oncology
Volume
23
Issue
12
Publish Date
2016
Start Page
3801
End Page
3810
DOI
10.1245/s10434-016-5449-z

Development of an Ultra-Fast, High-Quality Whole-Breast Radiation Therapy Treatment Planning System

Authors
Sheng, Y; Li, T; Yoo, S; Yin, FF; Blitzblau, RC; Sr, HJK; Palta, M; Hahn, CA; Ge, Y; Wu, QRJ
MLA Citation
Sheng, Y, Li, T, Yoo, S, Yin, FF, Blitzblau, RC, Sr, HJK, Palta, M, Hahn, CA, Ge, Y, and Wu, QRJ. "Development of an Ultra-Fast, High-Quality Whole-Breast Radiation Therapy Treatment Planning System." October 1, 2016.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2
Publish Date
2016
Start Page
S228
End Page
S228

Acute Toxicity in Patients With HER2-Positive Breast Cancer Treated With Adjuvant Radiation Therapy and Concurrent Trastuzumab and Pertuzumab

Authors
Spiegel, D; Marcom, K; Peterson, B; Force, J; Howie, L; Palta, M; Blitzblau, RC; Sr, HJK
MLA Citation
Spiegel, D, Marcom, K, Peterson, B, Force, J, Howie, L, Palta, M, Blitzblau, RC, and Sr, HJK. "Acute Toxicity in Patients With HER2-Positive Breast Cancer Treated With Adjuvant Radiation Therapy and Concurrent Trastuzumab and Pertuzumab." October 1, 2016.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2
Publish Date
2016
Start Page
E9
End Page
E10

Dosimetric Effect of the Breast Board and Couch Top for Whole-Breast Radiation Therapy in the Prone Position

Authors
Yoo, S; Sr, HJK; Yin, FF; Blitzblau, RC
MLA Citation
Yoo, S, Sr, HJK, Yin, FF, and Blitzblau, RC. "Dosimetric Effect of the Breast Board and Couch Top for Whole-Breast Radiation Therapy in the Prone Position." October 1, 2016.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2
Publish Date
2016
Start Page
E46
End Page
E47

Early-Stage Breast Radiation Therapy Assessment Using Transcytolemmal Water Exchange Analysis of DCE-Magnetic Resonance Imaging: Initial Results

Authors
Wang, C; Sr, HJK; Yin, FF; Subashi, E; Chang, Z
MLA Citation
Wang, C, Sr, HJK, Yin, FF, Subashi, E, and Chang, Z. "Early-Stage Breast Radiation Therapy Assessment Using Transcytolemmal Water Exchange Analysis of DCE-Magnetic Resonance Imaging: Initial Results." October 1, 2016.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2
Publish Date
2016
Start Page
E617
End Page
E617

Assessment of Treatment Response With Diffusion-Weighted MRI and Dynamic Contrast-Enhanced MRI in Patients With Early-Stage Breast Cancer Treated With Single-Dose Preoperative Radiotherapy: Initial Results.

Single-dose preoperative stereotactic body radiotherapy is a novel radiotherapy technique for the early-stage breast cancer, and the treatment response pattern of this technique needs to be investigated on a quantitative basis. In this work, dynamic contrast-enhanced magnetic resonance imaging and diffusion-weighted magnetic resonance imaging were used to study the treatment response pattern in a unique cohort of patients with early-stage breast cancer treated with preoperative radiation. Fifteen female qualified patients received single-dose preoperative radiotherapy with 1 of the 3 prescription doses: 15 Gy, 18 Gy, and 21 Gy. Magnetic resonance imaging scans including both diffusion-weighted magnetic resonance imaging and dynamic contrast-enhanced magnetic resonance imaging were acquired before radiotherapy for planning and after radiotherapy but before surgical resection. In diffusion-weighted magnetic resonance imaging, the regional averaged apparent diffusion coefficient was calculated. In dynamic contrast-enhanced magnetic resonance imaging, quantitative parameters K (trans) and v e were evaluated using the standard Tofts model based on the average contrast agent concentration within the region of interest, and the semiquantitative initial area under the concentration curve (iAUC6min) was also recorded. These parameters' relative changes after radiotherapy were calculated for gross tumor volume, clinical target volume, and planning target volume. The initial results showed that after radiotherapy, initial area under the concentration curve significantly increased in planning target volume (P < .006) and clinical target volume (P < .006), and v e significantly increased in planning target volume (P < .05) and clinical target volume (P < .05). Statistical studies suggested that linear correlations between treatment dose and the observed parameter changes exist in most examined tests, and among these tests, the change in gross tumor volume regional averaged apparent diffusion coefficient (P < .012) and between treatment dose and planning target volume K (trans) (P < .029) were found to be statistically significant. Although it is still preliminary, this pilot study may be useful to provide insights for future works.

Authors
Wang, C; Horton, JK; Yin, F-F; Chang, Z
MLA Citation
Wang, C, Horton, JK, Yin, F-F, and Chang, Z. "Assessment of Treatment Response With Diffusion-Weighted MRI and Dynamic Contrast-Enhanced MRI in Patients With Early-Stage Breast Cancer Treated With Single-Dose Preoperative Radiotherapy: Initial Results." Technology in cancer research & treatment 15.5 (October 2016): 651-660.
PMID
26134438
Source
epmc
Published In
Technology in cancer research & treatment
Volume
15
Issue
5
Publish Date
2016
Start Page
651
End Page
660
DOI
10.1177/1533034615593191

Development of an Ultra-Fast, High-Quality Whole-Breast Radiation Therapy Treatment Planning System.

Authors
Sheng, Y; Li, T; Yoo, S; Yin, FF; Blitzblau, RC; Horton, JK; Palta, M; Hahn, CA; Ge, Y; Wu, QR
MLA Citation
Sheng, Y, Li, T, Yoo, S, Yin, FF, Blitzblau, RC, Horton, JK, Palta, M, Hahn, CA, Ge, Y, and Wu, QR. "Development of an Ultra-Fast, High-Quality Whole-Breast Radiation Therapy Treatment Planning System." International journal of radiation oncology, biology, physics 96.2S (October 2016): S228-.
PMID
27675847
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2S
Publish Date
2016
Start Page
S228
DOI
10.1016/j.ijrobp.2016.06.566

Acute Toxicity in Patients With HER2-Positive Breast Cancer Treated With Adjuvant Radiation Therapy and Concurrent Trastuzumab and Pertuzumab.

Authors
Spiegel, D; Marcom, PK; Peterson, B; Force, J; Howie, L; Palta, M; Blitzblau, RC; Horton, JK
MLA Citation
Spiegel, D, Marcom, PK, Peterson, B, Force, J, Howie, L, Palta, M, Blitzblau, RC, and Horton, JK. "Acute Toxicity in Patients With HER2-Positive Breast Cancer Treated With Adjuvant Radiation Therapy and Concurrent Trastuzumab and Pertuzumab." International journal of radiation oncology, biology, physics 96.2S (October 2016): E9-E10.
PMID
27675495
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2S
Publish Date
2016
Start Page
E9
End Page
E10
DOI
10.1016/j.ijrobp.2016.06.619

Early-Stage Breast Radiation Therapy Assessment Using Transcytolemmal Water Exchange Analysis of DCE-Magnetic Resonance Imaging: Initial Results.

Authors
Wang, C; Horton, JK; Yin, FF; Subashi, E; Chang, Z
MLA Citation
Wang, C, Horton, JK, Yin, FF, Subashi, E, and Chang, Z. "Early-Stage Breast Radiation Therapy Assessment Using Transcytolemmal Water Exchange Analysis of DCE-Magnetic Resonance Imaging: Initial Results." International journal of radiation oncology, biology, physics 96.2S (October 2016): E617-.
PMID
27675176
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2S
Publish Date
2016
Start Page
E617
DOI
10.1016/j.ijrobp.2016.06.2176

Dosimetric Effect of the Breast Board and Couch Top for Whole-Breast Radiation Therapy in the Prone Position.

Authors
Yoo, S; Horton, JK; Yin, FF; Blitzblau, RC
MLA Citation
Yoo, S, Horton, JK, Yin, FF, and Blitzblau, RC. "Dosimetric Effect of the Breast Board and Couch Top for Whole-Breast Radiation Therapy in the Prone Position." International journal of radiation oncology, biology, physics 96.2S (October 2016): E46-E47.
PMID
27674749
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2S
Publish Date
2016
Start Page
E46
End Page
E47
DOI
10.1016/j.ijrobp.2016.06.710

Society of Surgical Oncology–American Society for Radiation Oncology–American Society of Clinical Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Ductal Carcinoma in Situ

Authors
Morrow, M; Van Zee, KJ; Solin, LJ; Houssami, N; Chavez-MacGregor, M; Harris, JR; Horton, J; Hwang, S; Johnson, PL; Marinovich, ML; Schnitt, SJ; Wapnir, I; Moran, MS
MLA Citation
Morrow, M, Van Zee, KJ, Solin, LJ, Houssami, N, Chavez-MacGregor, M, Harris, JR, Horton, J, Hwang, S, Johnson, PL, Marinovich, ML, Schnitt, SJ, Wapnir, I, and Moran, MS. "Society of Surgical Oncology–American Society for Radiation Oncology–American Society of Clinical Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Ductal Carcinoma in Situ." Practical Radiation Oncology 6.5 (September 2016): 287-295.
Source
crossref
Published In
Practical Radiation Oncology
Volume
6
Issue
5
Publish Date
2016
Start Page
287
End Page
295
DOI
10.1016/j.prro.2016.06.011

Whose Disease Will Recur After Mastectomy for Early Stage, Node-Negative Breast Cancer? A Systematic Review.

Effective local control is associated with improved overall survival, particularly for women with early-stage cancers. No other local therapy is typically offered to women with T1-2 N0 breast cancer after mastectomy, although in select women the 5-year local recurrence rate can be as high as 20%. Therefore, accurately predicting the women who are at highest risk for recurrence after mastectomy will identify those who might benefit from more aggressive adjuvant treatment. A systematic search was conducted identifying risk factors associated with locoregional recurrence, including age, menopausal status, receptor status, lymphovascular invasion (LVI), margin status, use of systemic therapy, size, grade, and genomic classifer score. Although associations varied among studies, the risk factors most consistently identified were age ≤ 40 years, LVI, positive/close margin, and larger tumor size. In women with multiple high risk factors, risk of local recurrence was as high as 20% at 10 years. Additional multicenter studies are needed to investigate risk factors for locoregional recurrence after mastectomy without radiotherapy in T1-2N0 breast cancer. Consideration of additional adjuvant local therapy might be warranted in a subset of women at high risk of local recurrence.

Authors
Kent, C; Horton, J; Blitzblau, R; Koontz, BF
MLA Citation
Kent, C, Horton, J, Blitzblau, R, and Koontz, BF. "Whose Disease Will Recur After Mastectomy for Early Stage, Node-Negative Breast Cancer? A Systematic Review." Clinical breast cancer 15.6 (December 2015): 403-412.
PMID
26198331
Source
epmc
Published In
Clinical Breast Cancer
Volume
15
Issue
6
Publish Date
2015
Start Page
403
End Page
412
DOI
10.1016/j.clbc.2015.06.008

Preoperative Partial Breast Radiation Therapy: Short-term Imaging Outcomes With Two Unique Treatment Regimens

Authors
Horton, JK; Baker, JA; Blitzblau, R; Georgiade, GS; Hwang, ES; Duffy, EA; Morgan, M; Feigenberg, SJ; Citron, W; Kesmodel, S; Bellavance, E; Drogula, C; Tkaczuk, K; Galandak, J; Nichols, EM
MLA Citation
Horton, JK, Baker, JA, Blitzblau, R, Georgiade, GS, Hwang, ES, Duffy, EA, Morgan, M, Feigenberg, SJ, Citron, W, Kesmodel, S, Bellavance, E, Drogula, C, Tkaczuk, K, Galandak, J, and Nichols, EM. "Preoperative Partial Breast Radiation Therapy: Short-term Imaging Outcomes With Two Unique Treatment Regimens." November 1, 2015.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
93
Issue
3
Publish Date
2015
Start Page
E46
End Page
E46

Induction of Gradual Changes in Blood Oxygen Levels in Post Lumpectomy Breast Tissue With Breath Holding: Results of a Pilot Study

Authors
Adamson, J; Chang, Z; Cai, J; Palta, M; Horton, JK; Yin, FF
MLA Citation
Adamson, J, Chang, Z, Cai, J, Palta, M, Horton, JK, and Yin, FF. "Induction of Gradual Changes in Blood Oxygen Levels in Post Lumpectomy Breast Tissue With Breath Holding: Results of a Pilot Study." November 1, 2015.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
93
Issue
3
Publish Date
2015
Start Page
E30
End Page
E30

Treatment Assessment Using Dynamic Fractal Signature Dissimilarity as a Novel Biomarker for Early-Stage Breast Cancer Radiation Therapy: A Feasibility Study

Authors
Wang, C; Horton, JK; Yin, FF; Chang, Z
MLA Citation
Wang, C, Horton, JK, Yin, FF, and Chang, Z. "Treatment Assessment Using Dynamic Fractal Signature Dissimilarity as a Novel Biomarker for Early-Stage Breast Cancer Radiation Therapy: A Feasibility Study." November 1, 2015.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
93
Issue
3
Publish Date
2015
Start Page
S5
End Page
S5

Preoperative External Beam APBI: Report of Acute Toxicities From 2 Prospective Clinical Trials Using Two Different Fractionation Schemes

Authors
Nichols, E; Feigenberg, SJ; Morgan, M; Citron, W; Kesmodel, S; Bellavance, E; Drogula, C; Tkaczuk, KH; Rosenblatt, P; Georgiade, GS; Hwang, ES; Broadwater, G; Duffy, EA; Blitzblau, R; Horton, JK
MLA Citation
Nichols, E, Feigenberg, SJ, Morgan, M, Citron, W, Kesmodel, S, Bellavance, E, Drogula, C, Tkaczuk, KH, Rosenblatt, P, Georgiade, GS, Hwang, ES, Broadwater, G, Duffy, EA, Blitzblau, R, and Horton, JK. "Preoperative External Beam APBI: Report of Acute Toxicities From 2 Prospective Clinical Trials Using Two Different Fractionation Schemes." November 1, 2015.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
93
Issue
3
Publish Date
2015
Start Page
E49
End Page
E49

Dosimetric Effect of the Prone Breast Board and the Couch Top for Whole-Breast Treatment in Prone Position

Authors
Yoo, S; Horton, JK; Yin, FF; Blitzblau, R
MLA Citation
Yoo, S, Horton, JK, Yin, FF, and Blitzblau, R. "Dosimetric Effect of the Prone Breast Board and the Couch Top for Whole-Breast Treatment in Prone Position." November 1, 2015.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
93
Issue
3
Publish Date
2015
Start Page
E610
End Page
E610

TBCRC 024 Initial Results: A Multicenter Phase 1 Study of Veliparib Administered Concurrently With Chest Wall and Nodal Radiation Therapy in Patients With Inflammatory or Locoregionally Recurrent Breast Cancer

Authors
Jagsi, R; Griffith, KA; Bellon, JR; Woodward, WA; Horton, JK; Ho, AY; Schott, A; Pierce, LJ
MLA Citation
Jagsi, R, Griffith, KA, Bellon, JR, Woodward, WA, Horton, JK, Ho, AY, Schott, A, and Pierce, LJ. "TBCRC 024 Initial Results: A Multicenter Phase 1 Study of Veliparib Administered Concurrently With Chest Wall and Nodal Radiation Therapy in Patients With Inflammatory or Locoregionally Recurrent Breast Cancer." November 1, 2015.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
93
Issue
3
Publish Date
2015
Start Page
S137
End Page
S137

FAS Death Receptor: A Breast Cancer Subtype-Specific Radiation Response Biomarker and Potential Therapeutic Target.

Although a standardized approach to radiotherapy has been used to treat breast cancer, regardless of subtype (e.g., luminal, basal), recent clinical data suggest that radiation response may vary significantly among subtypes. We hypothesized that this clinical variability may be due, in part, to differences in cellular radiation response. In this study, we utilized RNA samples for microarray analysis from two sources: 1. Paired pre- and postirradiation breast tumor tissue from 32 early-stage breast cancer patients treated in our unique preoperative radiation Phase I trial; and 2. Sixteen biologically diverse breast tumor cell lines exposed to 0 and 5 Gy irradiation. The transcriptome response to radiation exposure was derived by comparing gene expression in samples before and after irradiation. Genes with the highest coefficient of variation were selected for further evaluation and validated at the RNA and protein level. Gene editing and agonistic antibody treatment were performed to assess the impact of gene modulation on radiation response. Gene expression in our cohort of luminal breast cancer patients was distinctly different before and after irradiation. Further, two distinct patterns of gene expression were observed in our biologically diverse group of breast cancer cell lines pre- versus postirradiation. Cell lines that showed significant change after irradiation were largely luminal subtype, while gene expression in the basal and HER2+ cell lines was minimally impacted. The 100 genes with the most significant response to radiation in patients were identified and analyzed for differential patterns of expression in the radiation-responsive versus nonresponsive cell lines. Fourteen genes were identified as significant, including FAS, a member of the tumor necrosis factor receptor family known to play a critical role in programed cell death. Modulation of FAS in breast cancer cell lines altered radiation response phenotype and enhanced radiation sensitivity in radioresistant basal cell lines. Our findings suggest that cell-type-specific, radiation-induced FAS contributes to subtype-specific breast cancer radiation response and that activation of FAS pathways may be exploited for biologically tailored radiotherapy.

Authors
Horton, JK; Siamakpour-Reihani, S; Lee, C-T; Zhou, Y; Chen, W; Geradts, J; Fels, DR; Hoang, P; Ashcraft, KA; Groth, J; Kung, H-N; Dewhirst, MW; Chi, J-TA
MLA Citation
Horton, JK, Siamakpour-Reihani, S, Lee, C-T, Zhou, Y, Chen, W, Geradts, J, Fels, DR, Hoang, P, Ashcraft, KA, Groth, J, Kung, H-N, Dewhirst, MW, and Chi, J-TA. "FAS Death Receptor: A Breast Cancer Subtype-Specific Radiation Response Biomarker and Potential Therapeutic Target." Radiation research 184.5 (November 2015): 456-469.
PMID
26488758
Source
epmc
Published In
Radiation Research
Volume
184
Issue
5
Publish Date
2015
Start Page
456
End Page
469
DOI
10.1667/rr14089.1

Prognostic significance of differential expression of angiogenic genes in women with high-grade serous ovarian carcinoma.

To identify angiogenic biomarkers associated with tumor angiogenesis and clinical outcome in high-grade serous ovarian cancer (HGSC).51 HGSC samples were analyzed using Affymetrix HG-U133A microarray. Microvessel density (MVD) counts were determined using CD31 and CD105. Associations between mRNA expression levels and overall survival were assessed using rank score statistic. Effect size was estimated as a hazard ratio (HR) under a proportional hazard model. The Storey q-value method was used to account for multiple testing within the false-discovery rate (FDR) framework. Publicly available databases including TCGA and GSE were used for external confirmation.Thirty-one angiogenic-related genes were significantly associated with survival (q≤0.05). Of these 31 genes, 4 were also associated with outcome in the TCGA data: AKT1 (q=0.02; TCGA p=0.01, HR=0.8), CD44 (q=0.003; TCGA p=0.05, HR=0.9), EPHB2 (q=0.01; TCGA p=0.05, HR=1.2), and ERBB2 (q=0.02; TCGA p=0.05, HR=1.2). While 5 were associated with outcome in the GSE database: FLT1 (q=0.03; GSE26712 p=0.01, HR=3.1); PF4 (q=0.02; GSE26712 p=0.01, HR=3.0); NRP1 (q=0.02; GSE26712 p<0.04, HR>1.4); COL4A3 (q=0.04; GSE26712 p=0.03, HR=1.3); and ANGPTL3 (q=0.02; GSE14764 p=0.02, HR=1.5). High AKT1 and CD44 were associated with longer survival. In contrast, high expression of EPHB2, ERBB2, FLT1; PF4, NRP1, COL4A3, and ANGPTL3 were associated with shorter survival. CD105-MVD and CD31-MVD were not significantly associated with angiogenic gene expression.Thirty-one angiogenic-related genes were associated with survival in advanced HGSC and nine of these genes were confirmed in independent publicly available databases.

Authors
Siamakpour-Reihani, S; Owzar, K; Jiang, C; Turner, T; Deng, Y; Bean, SM; Horton, JK; Berchuck, A; Marks, JR; Dewhirst, MW; Alvarez Secord, A
MLA Citation
Siamakpour-Reihani, S, Owzar, K, Jiang, C, Turner, T, Deng, Y, Bean, SM, Horton, JK, Berchuck, A, Marks, JR, Dewhirst, MW, and Alvarez Secord, A. "Prognostic significance of differential expression of angiogenic genes in women with high-grade serous ovarian carcinoma." Gynecologic oncology 139.1 (October 2015): 23-29.
PMID
26260910
Source
epmc
Published In
Gynecologic Oncology
Volume
139
Issue
1
Publish Date
2015
Start Page
23
End Page
29
DOI
10.1016/j.ygyno.2015.08.001

A phase 1 trial of preoperative partial breast radiation therapy: Patient selection, target delineation, and dose delivery.

Diffusion of accelerated partial breast irradiation into clinical practice is limited by the need for specialized equipment and training. The accessible external beam technique yields unacceptable complication rates, likely from large postoperative target volumes. We designed a phase 1 trial evaluating preoperative radiation therapy to the intact tumor using widely available technology.Patients received 15, 18, or 21 Gy in a single fraction to the breast tumor plus margin. Magnetic resonance imaging (MRI) was used in conjunction with standard computed tomography (CT)-based planning to identify contrast enhancing tumor. Skin markers and an intratumor biopsy marker were used for verification during treatment.MRI imaging was critical for target delineation because not all breast tumors were reliably identified on CT scan. Breast shape differences were consistently seen between CT and MRI but did not impede image registration or tumor identification. Target volumes were markedly smaller than historical postoperative volumes, and normal tissue constraints were easily met. A biopsy marker within the breast proved sufficient for setup localization.This single fraction linear accelerator-based partial breast irradiation approach can be easily incorporated at most treatment centers. In vivo targeting may improve accuracy and can reduce the dose to normal tissues.

Authors
Blitzblau, RC; Arya, R; Yoo, S; Baker, JA; Chang, Z; Palta, M; Duffy, E; Horton, JK
MLA Citation
Blitzblau, RC, Arya, R, Yoo, S, Baker, JA, Chang, Z, Palta, M, Duffy, E, and Horton, JK. "A phase 1 trial of preoperative partial breast radiation therapy: Patient selection, target delineation, and dose delivery." Practical radiation oncology 5.5 (September 2015): e513-e520.
PMID
25834942
Source
epmc
Published In
Practical Radiation Oncology
Volume
5
Issue
5
Publish Date
2015
Start Page
e513
End Page
e520
DOI
10.1016/j.prro.2015.02.002

Abstract 3331: Gene expression profiling after radiation in human breast cancer specimens and breast cancer cell lines

Authors
Siamakpour-Reihani, S; Chen, W; Lee, C-T; Zhou, Y; Owzar, K; Chi, J-T; Horton, JK
MLA Citation
Siamakpour-Reihani, S, Chen, W, Lee, C-T, Zhou, Y, Owzar, K, Chi, J-T, and Horton, JK. "Abstract 3331: Gene expression profiling after radiation in human breast cancer specimens and breast cancer cell lines." August 1, 2015.
Source
crossref
Published In
Cancer Research
Volume
75
Issue
15 Supplement
Publish Date
2015
Start Page
3331
End Page
3331
DOI
10.1158/1538-7445.AM2015-3331

Abstract 3302: Subtype-specific radiation response in a mouse model of human breast cancer

Authors
Lee, C-T; Zhou, Y; Siamakpour-Reihani, S; Choudhury, KR; Dewhirst, MW; Horton, JK
MLA Citation
Lee, C-T, Zhou, Y, Siamakpour-Reihani, S, Choudhury, KR, Dewhirst, MW, and Horton, JK. "Abstract 3302: Subtype-specific radiation response in a mouse model of human breast cancer." August 1, 2015.
Source
crossref
Published In
Cancer Research
Volume
75
Issue
15 Supplement
Publish Date
2015
Start Page
3302
End Page
3302
DOI
10.1158/1538-7445.AM2015-3302

Exercise behavior and patient-reported outcomes in women with early breast cancer receiving locoregional radiation therapy.

Radiation therapy is associated with acute treatment-related complications that can lead to decreased quality of life (QOL). Exercise has been shown in other cancer treatment settings to improve negative outcomes. We conducted a prospective pilot study to explore the association between exercise, patient-reported outcomes, and acute radiation therapy toxicities.Women receiving curative breast radiation therapy were enrolled. Each patient completed an exercise behavior/QOL survey before or during the first week of treatment and again during the last week of treatment. Exercise behavior was quantified with the Godin Leisure Time Exercise Questionnaire (metabolic equivalent [MET] hours per week). Measurements to evaluate upper extremity lymphedema and shoulder range of motion were completed. Skin toxicity was assessed weekly. Patient-reported outcomes were measured using standardized questionnaires.Forty-five patients were enrolled. Mean patient age was 54 (range, 28-73) years. Mean METs in the exercise cohort (≥9 METs/wk) was 21 per week (range, 11-38, n = 14); 3 per week (range, 0-8, n = 25) in the nonexercise cohort (<9 METs/wk). Women in the exercise cohort showed improvements in treatment-induced quality of life and fatigue (not significant) despite more extensive surgical, medical, and radiation treatment. No differences in treatment-related toxicities, pain, or sleep scores were noted. Lymphedema was mild (<3 cm) in the entire patient cohort.The vast majority of current exercise oncology literature implicates physical activity as an independent predictor of QOL in cancer patients. Our study noted similar trends, but they were not statistically significant. This may be due to our finding that patient-reported outcomes with radiation therapy are relatively high compared with other treatment modalities and remain stable throughout treatment. Thus, it may be that radiation therapy has a limited impact on QOL in breast cancer patients. Exercise may be best used as a targeted therapy in patients at high risk for poor QOL or radiation-related toxicities at baseline.

Authors
Arya, R; Siamakpour-Reihani, S; Palta, M; Massa, L; Broadwater, G; Blitzblau, RC; Horton, JK
MLA Citation
Arya, R, Siamakpour-Reihani, S, Palta, M, Massa, L, Broadwater, G, Blitzblau, RC, and Horton, JK. "Exercise behavior and patient-reported outcomes in women with early breast cancer receiving locoregional radiation therapy." Practical radiation oncology 5.4 (July 2015): e275-e281.
PMID
25731964
Source
epmc
Published In
Practical Radiation Oncology
Volume
5
Issue
4
Publish Date
2015
Start Page
e275
End Page
e281
DOI
10.1016/j.prro.2015.01.003

Preoperative Single-Fraction Partial Breast Radiation Therapy: A Novel Phase 1, Dose-Escalation Protocol With Radiation Response Biomarkers.

Women with biologically favorable early-stage breast cancer are increasingly treated with accelerated partial breast radiation (PBI). However, treatment-related morbidities have been linked to the large postoperative treatment volumes required for external beam PBI. Relative to external beam delivery, alternative PBI techniques require equipment that is not universally available. To address these issues, we designed a phase 1 trial utilizing widely available technology to 1) evaluate the safety of a single radiation treatment delivered preoperatively to the small-volume, intact breast tumor and 2) identify imaging and genomic markers of radiation response.Women aged ≥55 years with clinically node-negative, estrogen receptor-positive, and/or progesterone receptor-positive HER2-, T1 invasive carcinomas, or low- to intermediate-grade in situ disease ≤2 cm were enrolled (n=32). Intensity modulated radiation therapy was used to deliver 15 Gy (n=8), 18 Gy (n=8), or 21 Gy (n=16) to the tumor with a 1.5-cm margin. Lumpectomy was performed within 10 days. Paired pre- and postradiation magnetic resonance images and patient tumor samples were analyzed.No dose-limiting toxicity was observed. At a median follow-up of 23 months, there have been no recurrences. Physician-rated cosmetic outcomes were good/excellent, and chronic toxicities were grade 1 to 2 (fibrosis, hyperpigmentation) in patients receiving preoperative radiation only. Evidence of dose-dependent changes in vascular permeability, cell density, and expression of genes regulating immunity and cell death were seen in response to radiation.Preoperative single-dose radiation therapy to intact breast tumors is well tolerated. Radiation response is marked by early indicators of cell death in this biologically favorable patient cohort. This study represents a first step toward a novel partial breast radiation approach. Preoperative radiation should be tested in future clinical trials because it has the potential to challenge the current treatment paradigm and provide a path forward to identify radiation response biomarkers.

Authors
Horton, JK; Blitzblau, RC; Yoo, S; Geradts, J; Chang, Z; Baker, JA; Georgiade, GS; Chen, W; Siamakpour-Reihani, S; Wang, C; Broadwater, G; Groth, J; Palta, M; Dewhirst, M; Barry, WT; Duffy, EA; Chi, J-TA; Hwang, ES
MLA Citation
Horton, JK, Blitzblau, RC, Yoo, S, Geradts, J, Chang, Z, Baker, JA, Georgiade, GS, Chen, W, Siamakpour-Reihani, S, Wang, C, Broadwater, G, Groth, J, Palta, M, Dewhirst, M, Barry, WT, Duffy, EA, Chi, J-TA, and Hwang, ES. "Preoperative Single-Fraction Partial Breast Radiation Therapy: A Novel Phase 1, Dose-Escalation Protocol With Radiation Response Biomarkers." International journal of radiation oncology, biology, physics 92.4 (July 2015): 846-855.
PMID
26104938
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
92
Issue
4
Publish Date
2015
Start Page
846
End Page
855
DOI
10.1016/j.ijrobp.2015.03.007

Genomic profiling in locally advanced and inflammatory breast cancer and its link to DCE-MRI and overall survival.

We have previously reported that dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) perfusion patterns obtained from locally advanced breast cancer (LABC) patients prior to neoadjuvant therapy predicted pathologic clinical response. Genomic analyses were also independently conducted on the same patient population. This retrospective study was performed to test two hypotheses: (1) gene expression profiles are associated with DCE-MRI perfusion patterns, and (2) association between long-term overall survival data and gene expression profiles can lead to the identification of novel predictive biomarkers.We utilised RNA microarray and DCE-MRI data from 47 LABC patients, including 13 inflammatory breast cancer (IBC) patients. Association between gene expression profile and DCE-MRI perfusion patterns (centrifugal and centripetal) was determined by Wilcoxon rank sum test. Association between gene expression level and survival was assessed using a Cox rank score test. Additional genomic analysis of the IBC subset was conducted, with a period of follow-up of up to 11 years. Associations between gene expression and overall survival were further assessed in The Cancer Genome Atlas Data Portal.Differences in gene expression profiles were seen between centrifugal and centripetal perfusion patterns in the sulphotransferase family, cytosolic, 1 A, phenol-preferring, members 1 and 2 (SULT1A1, SULT1A2), poly (ADP-ribose) polymerase, member 6 (PARP6), and metastasis tumour antigen1 (MTA1). In the IBC subset our analyses demonstrated that differential expression of 45 genes was associated with long-term survival.Here we have demonstrated an association between DCE-MRI perfusion patterns and gene expression profiles. In addition we have reported on candidate prognostic biomarkers in IBC patients, with some of the genes being significantly associated with survival in IBC and LABC.

Authors
Siamakpour-Reihani, S; Owzar, K; Jiang, C; Scarbrough, PM; Craciunescu, OI; Horton, JK; Dressman, HK; Blackwell, KL; Dewhirst, MW
MLA Citation
Siamakpour-Reihani, S, Owzar, K, Jiang, C, Scarbrough, PM, Craciunescu, OI, Horton, JK, Dressman, HK, Blackwell, KL, and Dewhirst, MW. "Genomic profiling in locally advanced and inflammatory breast cancer and its link to DCE-MRI and overall survival." International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group 31.4 (June 2015): 386-395.
PMID
25811737
Source
epmc
Published In
International Journal of Hyperthermia (Informa)
Volume
31
Issue
4
Publish Date
2015
Start Page
386
End Page
395
DOI
10.3109/02656736.2015.1016557

Abstract P2-12-07: The association between exercise behavior and patient-reported outcomes in women with early breast cancer receiving locoregional radiation therapy

Authors
Arya, R; Jones, LW; Blitzblau, RC; Palta, M; Massa, L; Broadwater, G; Horton, JK
MLA Citation
Arya, R, Jones, LW, Blitzblau, RC, Palta, M, Massa, L, Broadwater, G, and Horton, JK. "Abstract P2-12-07: The association between exercise behavior and patient-reported outcomes in women with early breast cancer receiving locoregional radiation therapy." May 1, 2015.
Source
crossref
Published In
Cancer Research
Volume
75
Issue
9 Supplement
Publish Date
2015
Start Page
P2-12-07
End Page
P2-12-07
DOI
10.1158/1538-7445.SABCS14-P2-12-07

Abstract P1-15-10: Low utilization of hypofractionated radiotherapy for the treatment of early-stage breast cancer in the US

Authors
Mowery, YM; Greenup, RA; Houck, K; Palta, M; Horton, JK; Hwang, E-SS; Sosa, JA; Blitzblau, RC
MLA Citation
Mowery, YM, Greenup, RA, Houck, K, Palta, M, Horton, JK, Hwang, E-SS, Sosa, JA, and Blitzblau, RC. "Abstract P1-15-10: Low utilization of hypofractionated radiotherapy for the treatment of early-stage breast cancer in the US." May 1, 2015.
Source
crossref
Published In
Cancer Research
Volume
75
Issue
9 Supplement
Publish Date
2015
Start Page
P1-15-10
End Page
P1-15-10
DOI
10.1158/1538-7445.SABCS14-P1-15-10

Oncology Scan—Quality of Life and Patient Perspectives During Breast Radiation Therapy

Authors
Horton, JK; Bellon, JR
MLA Citation
Horton, JK, and Bellon, JR. "Oncology Scan—Quality of Life and Patient Perspectives During Breast Radiation Therapy." International Journal of Radiation Oncology*Biology*Physics 91.2 (February 2015): 249-251.
Source
crossref
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
91
Issue
2
Publish Date
2015
Start Page
249
End Page
251
DOI
10.1016/j.ijrobp.2014.08.007

Dosimetric comparison of preoperative single-fraction partial breast radiotherapy techniques: 3D CRT, noncoplanar IMRT, coplanar IMRT, and VMAT.

The purpose of this study was to compare dosimetric parameters of treatment plans among four techniques for preoperative single-fraction partial breast radiotherapy in order to select an optimal treatment technique. The techniques evaluated were noncoplanar 3D conformal radiation therapy (3D CRT), noncoplanar intensity-modulated radiation therapy (IMRTNC), coplanar IMRT (IMRTCO), and volumetric-modulated arc therapy (VMAT). The planning CT scans of 16 patients in the prone position were used in this study, with the single-fraction prescription doses of 15 Gy for the first eight patients and 18 Gy for the remaining eight patients. Six (6) MV photon beams were designed to avoid the heart and contralateral breast. Optimization for IMRT and VMAT was performed to reduce the dose to the skin and normal breast. All plans were normalized such that 100% of the prescribed dose covered greater than 95% of the clinical target volume (CTV) consisting of gross tumor volume (GTV) plus 1.5 cm margin. Mean homogeneity index (HI) was the lowest (1.05 ± 0.02) for 3D CRT and the highest (1.11 ± 0.04) for VMAT. Mean conformity index (CI) was the lowest (1.42 ± 0.32) for IMRTNC and the highest (1.60 ± 0.32) for VMAT. Mean of the maximum point dose to skin was the lowest (73.7 ± 11.5%) for IMRTNC and the highest (86.5 ± 6.68%) for 3D CRT. IMRTCO showed very similar HI, CI, and maximum skin dose to IMRTNC (differences <1%). The estimated mean treatment delivery time, excluding the time spent for patient positioning and imaging, was 7.0 ± 1.0, 8.3 ± 1.1, 9.7 ± 1.0, and 11.0 ± 1.5min for VMAT, IMRTCO, IMRTNC and 3D CRT, respectively. In comparison of all four techniques for preoperative single-fraction partial breast radiotherapy, we can conclude that noncoplanar or coplanar IMRT were optimal in this study as IMRT plans provided homogeneous and conformal target coverage, skin sparing, and relatively short treatment delivery time.

Authors
Yoo, S; Blitzblau, R; Yin, F-F; Horton, JK
MLA Citation
Yoo, S, Blitzblau, R, Yin, F-F, and Horton, JK. "Dosimetric comparison of preoperative single-fraction partial breast radiotherapy techniques: 3D CRT, noncoplanar IMRT, coplanar IMRT, and VMAT." Journal of applied clinical medical physics 16.1 (January 8, 2015): 5126-.
PMID
25679170
Source
epmc
Published In
Journal of applied clinical medical physics / American College of Medical Physics
Volume
16
Issue
1
Publish Date
2015
Start Page
5126
DOI
10.1120/jacmp.v16i1.5126

The use of adjuvant radiotherapy in elderly patients with early-stage breast cancer: Changes in practice patterns after publication of Cancer and Leukemia Group B 9343

© 2014 American Cancer Society.BACKGROUND: The Cancer and Leukemia Group B (CALGB) 9343 randomized phase 3 trial established lumpectomy and adjuvant therapy with tamoxifen alone, rather than both radiotherapy and tamoxifen, as a reasonable treatment course for women aged >70 years with clinical stage I (AJCC 7th edition), estrogen receptor-positive breast cancer. An analysis of the Surveillance, Epidemiology, and End Results (SEER) registry was undertaken to assess practice patterns before and after the publication of this landmark study. METHODS: The SEER database from 2000 to 2009 was used to identify 40,583 women aged ≥70 years who were treated with breast-conserving surgery for clinical stage I, estrogen receptor-positive and/or progesterone receptor-positive breast cancer. The percentage of patients receiving radiotherapy and the type of radiotherapy delivered was assessed over time. Administration of radiotherapy was further assessed across age groups; SEER cohort; and tumor size, grade, and laterality. RESULTS: Approximately 68.6% of patients treated between 2000 and 2004 compared with 61.7% of patients who were treated between 2005 and 2009 received some form of adjuvant radiotherapy (P < .001). Coinciding with a decline in the use of external beam radiotherapy, there was an increase in the use of implant radiotherapy from 1.4% between 2000 and 2004 to 6.2% between 2005 to 2009 (P < .001). There were significant reductions in the frequency of radiotherapy delivery over time across age groups, tumor size, and tumor grade and regardless of laterality (P < .001 for all). CONCLUSIONS: Randomized phase 3 data support the omission of adjuvant radiotherapy in elderly women with early-stage breast cancer. Analysis of practice patterns before and after the publication of these data indicates a significant decline in radiotherapy use; however, nearly two-thirds of women continue to receive adjuvant radiotherapy.

Authors
Palta, M; Palta, P; Bhavsar, NA; Horton, JK; Blitzblau, RC
MLA Citation
Palta, M, Palta, P, Bhavsar, NA, Horton, JK, and Blitzblau, RC. "The use of adjuvant radiotherapy in elderly patients with early-stage breast cancer: Changes in practice patterns after publication of Cancer and Leukemia Group B 9343." Cancer 121.2 (January 1, 2015): 188-193.
Source
scopus
Published In
Cancer
Volume
121
Issue
2
Publish Date
2015
Start Page
188
End Page
193
DOI
10.1002/cncr.28937

Dosimetric comparison of preoperative single-fraction partial breast radiotherapy techniques: 3D CRT, noncoplanar IMRT, coplanar IMRT, and VMAT

The purpose of this study was to compare dosimetric parameters of treatment plans among four techniques for preoperative single-fraction partial breast radiotherapy in order to select an optimal treatment technique. The techniques evaluated were noncoplanar 3D conformal radiation therapy (3D CRT), noncoplanar intensity-modulated radiation therapy (IMRTNC), coplanar IMRT (IMRTCO), and volumetric-modulated arc therapy (VMAT). The planning CT scans of 16 patients in the prone position were used in this study, with the single-fraction prescription doses of 15 Gy for the first eight patients and 18 Gy for the remaining eight patients. Six (6) MV photon beams were designed to avoid the heart and contralateral breast. Optimization for IMRT and VMAT was performed to reduce the dose to the skin and normal breast. All plans were normalized such that 100% of the prescribed dose covered greater than 95% of the clinical target volume (CTV) consisting of gross tumor volume (GTV) plus 1.5 cm margin. Mean homogeneity index (HI) was the lowest (1.05 ± 0.02) for 3D CRT and the highest (1.11 ± 0.04) for VMAT. Mean conformity index (CI) was the lowest (1.42 ± 0.32) for IMRTNC and the highest (1.60 ± 0.32) for VMAT. Mean of the maximum point dose to skin was the lowest (73.7 ± 11.5%) for IMRTNC and the highest (86.5 ± 6.68%) for 3D CRT. IMRTCO showed very similar HI, CI, and maximum skin dose to IMRTNC (differences <1%). The estimated mean treatment delivery time, excluding the time spent for patient positioning and imaging, was 7.0 ± 1.0, 8.3 ± 1.1, 9.7 ± 1.0, and 11.0 ± 1.5min for VMAT, IMRTCO, IMRTNC and 3D CRT, respectively. In comparison of all four techniques for preoperative single-fraction partial breast radiotherapy, we can conclude that noncoplanar or coplanar IMRT were optimal in this study as IMRT plans provided homogeneous and conformal target coverage, skin sparing, and relatively short treatment delivery time.

Authors
Yoo, S; Blitzblau, R; Yin, FF; Horton, JK
MLA Citation
Yoo, S, Blitzblau, R, Yin, FF, and Horton, JK. "Dosimetric comparison of preoperative single-fraction partial breast radiotherapy techniques: 3D CRT, noncoplanar IMRT, coplanar IMRT, and VMAT." Journal of Applied Clinical Medical Physics 16.1 (January 1, 2015): 183-191.
Source
scopus
Published In
Journal of applied clinical medical physics / American College of Medical Physics
Volume
16
Issue
1
Publish Date
2015
Start Page
183
End Page
191

Preoperative partial breast

© Springer International Publishing Switzerland, 2016.Partial breast irradiation, treatment focused only on the surgical bed plus a variable margin, has evolved as an ultra-convenient alternative to whole breast irradiation for selected patients with early-stage breast cancer. A number of techniques are available for treatment delivery, ranging from a single intraoperative treatment to one week of twice daily treatments postoperatively. However, concerns of suboptimal cosmetic outcomes have been raised with the highly accessible external-beam technique and linked to large postoperative target volumes. Preoperative radiation, delivered prior to surgical resection, is under investigation as an alternative approach utilizing in situ targeting of a small intact breast tumor to identify the highest-risk regions and reduce the volume of uninvolved breast tissue receiving high radiation doses. Several commonly utilized technologies can be used to deliver preoperative radiation and early efficacy and toxicity reports for this treatment approach are promising. The rationale, treatment delivery techniques, available outcomes data, and ongoing investigations for preoperative partial breast irradiation are described in further depth in the accompanying chapter.

Authors
Mowery, YM; Yu, CX; Horton, JK
MLA Citation
Mowery, YM, Yu, CX, and Horton, JK. "Preoperative partial breast." Short Course Breast Radiotherapy: A Comprehensive Review of Hypofractionation, Partial Breast, and Intra-Operative Irradiation. January 1, 2015. 415-440.
Source
scopus
Publish Date
2015
Start Page
415
End Page
440
DOI
10.1007/978-3-319-24388-7_27

Surgical patterns of care in patients with invasive breast cancer treated with neoadjuvant systemic therapy and breast magnetic resonance imaging: results of a secondary analysis of TBCRC 017.

Neoadjuvant chemotherapy (NCT) downstages advanced primary tumors, with magnetic resonance imaging (MRI) being the most sensitive imaging predictor of response. However, the impact of MRI evaluation on surgical treatment decisions in the neoadjuvant setting has not been well described. We report surgical patterns of care across 8 National Cancer Institute comprehensive cancer centers in women receiving both NCT and MRI to evaluate the impact of MRI findings on surgical planning.Seven hundred seventy women from 8 institutions received NCT with MRI obtained both before and after systemic treatment. Univariate and multivariate analyses of imaging, patient-, and tumor-related covariates associated with choice of breast surgery were conducted.MRI and surgical data were available on 759 of 770 patients. A total of 345 of 759 (45 %) patients received breast-conserving surgery and 414 of 759 (55 %) received mastectomy. Mastectomy occurred more commonly in patients with incomplete MRI response versus complete (58 vs. 43 %) (p = 0.0003). On multivariate analysis, positive estrogen receptor status (p = 0.02), incomplete MRI response (p = 0.0003), higher baseline T classification (p < 0.0001), younger age (p < 0.0006), and institution (p = 0.003) were independent predictors of mastectomy. A statistically significant trend toward increasing use of mastectomy with increasing T stage at presentation (p < 0.0001) was observed in patients with incomplete response by MRI only. Among women with complete response on MRI, 43 % underwent mastectomy.Within a multi-institutional cohort of women undergoing neoadjuvant treatment for breast cancer, MRI findings were not clearly associated with extent of surgery. This study shows that receptor status, T stage at diagnosis, young age, and treating institution are more significant determinants of surgical treatment choice than MRI response data.

Authors
McGuire, KP; Hwang, ES; Cantor, A; Golshan, M; Meric-Bernstam, F; Horton, JK; Nanda, R; Amos, KD; Forero, A; Hudis, CA; Meszoely, I; De Los Santos, JF
MLA Citation
McGuire, KP, Hwang, ES, Cantor, A, Golshan, M, Meric-Bernstam, F, Horton, JK, Nanda, R, Amos, KD, Forero, A, Hudis, CA, Meszoely, I, and De Los Santos, JF. "Surgical patterns of care in patients with invasive breast cancer treated with neoadjuvant systemic therapy and breast magnetic resonance imaging: results of a secondary analysis of TBCRC 017." Annals of surgical oncology 22.1 (January 2015): 75-81.
PMID
25059792
Source
epmc
Published In
Annals of Surgical Oncology
Volume
22
Issue
1
Publish Date
2015
Start Page
75
End Page
81
DOI
10.1245/s10434-014-3948-3

Prognostic significance of differential expression of angiogenic genes in women with high-grade serous ovarian carcinoma

© 2015 Elsevier Inc. All rights reserved.Objectives To identify angiogenic biomarkers associated with tumor angiogenesis and clinical outcome in high-grade serous ovarian cancer (HGSC). Methods 51 HGSC samples were analyzed using Affymetrix HG-U133A microarray. Microvessel density (MVD) counts were determined using CD31 and CD105. Associations between mRNA expression levels and overall survival were assessed using rank score statistic. Effect size was estimated as a hazard ratio (HR) under a proportional hazard model. The Storey q-value method was used to account for multiple testing within the false-discovery rate (FDR) framework. Publicly available databases including TCGA and GSE were used for external confirmation. Results Thirty-one angiogenic-related genes were significantly associated with survival (q 0.05). Of these 31 genes, 4 were also associated with outcome in the TCGA data: AKT1 (q = 0.02; TCGA p = 0.01, HR = 0.8), CD44 (q = 0.003; TCGA p = 0.05, HR = 0.9), EPHB2 (q = 0.01; TCGA p = 0.05, HR = 1.2), and ERBB2 (q = 0.02; TCGA p = 0.05, HR = 1.2). While 5 were associated with outcome in the GSE database: FLT1 (q = 0.03; GSE26712 p = 0.01, HR = 3.1); PF4 (q = 0.02; GSE26712 p = 0.01, HR = 3.0); NRP1 (q = 0.02; GSE26712 p 0.04, HR 1.4); COL4A3 (q = 0.04; GSE26712 p = 0.03, HR = 1.3); and ANGPTL3 (q = 0.02; GSE14764 p = 0.02, HR = 1.5). High AKT1 and CD44 were associated with longer survival. In contrast, high expression of EPHB2, ERBB2, FLT1; PF4, NRP1, COL4A3, and ANGPTL3 were associated with shorter survival. CD105-MVD and CD31-MVD were not significantly associated with angiogenic gene expression. Conclusions Thirty-one angiogenic-related genes were associated with survival in advanced HGSC and nine of these genes were confirmed in independent publicly available databases.

Authors
Siamakpour-Reihani, S; Owzar, K; Jiang, C; Turner, T; Deng, Y; Bean, SM; Horton, JK; Berchuck, A; Marks, JR; Dewhirst, MW; Secord, AA
MLA Citation
Siamakpour-Reihani, S, Owzar, K, Jiang, C, Turner, T, Deng, Y, Bean, SM, Horton, JK, Berchuck, A, Marks, JR, Dewhirst, MW, and Secord, AA. "Prognostic significance of differential expression of angiogenic genes in women with high-grade serous ovarian carcinoma." Gynecologic Oncology 139.1 (2015): 23-29.
Source
scival
Published In
Gynecologic Oncology
Volume
139
Issue
1
Publish Date
2015
Start Page
23
End Page
29
DOI
10.1016/j.ygyno.2015.08.001

Changes in Gene Expression After Radiation in Human Breast Cancers: A Guide to Predicting and Modulating Radiation Response

Authors
Horton, JK; Dewhirst, MW; Siamakpour-Reihani, S; Zhou, Y; Geradts, J; Chi, J-TA; Chen, W
MLA Citation
Horton, JK, Dewhirst, MW, Siamakpour-Reihani, S, Zhou, Y, Geradts, J, Chi, J-TA, and Chen, W. "Changes in Gene Expression After Radiation in Human Breast Cancers: A Guide to Predicting and Modulating Radiation Response." JOURNAL OF WOMENS HEALTH 23.10 (October 1, 2014): 861-861.
Source
wos-lite
Published In
Journal of Women's Health
Volume
23
Issue
10
Publish Date
2014
Start Page
861
End Page
861

Preoperative Partial Breast Radiation Therapy: One Year Outcomes and Radiation-Induced Changes in Gene Expression

Authors
Horton, JK; Blitzblau, R; Yoo, S; Georgiade, G; Geradts, J; Baker, J; Chi, JA; Chang, Z; Palta, M; Siamakpour-Reihani, S; Groth, J; Chen, W; Broadwater, G; Barry, WT; Duffy, E; Hwang, S
MLA Citation
Horton, JK, Blitzblau, R, Yoo, S, Georgiade, G, Geradts, J, Baker, J, Chi, JA, Chang, Z, Palta, M, Siamakpour-Reihani, S, Groth, J, Chen, W, Broadwater, G, Barry, WT, Duffy, E, and Hwang, S. "Preoperative Partial Breast Radiation Therapy: One Year Outcomes and Radiation-Induced Changes in Gene Expression." September 1, 2014.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
90
Publish Date
2014
Start Page
S135
End Page
S135

Early Stage Breast Cancer Radiation Treatment Assessment Using Diffusion Weighted MRI and Dynamic Contrast Enhanced MRI

Authors
Wang, C; Horton, JK; Yin, F; Chang, Z
MLA Citation
Wang, C, Horton, JK, Yin, F, and Chang, Z. "Early Stage Breast Cancer Radiation Treatment Assessment Using Diffusion Weighted MRI and Dynamic Contrast Enhanced MRI." September 1, 2014.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
90
Publish Date
2014
Start Page
S43
End Page
S43

Delivered Dose for Preoperative Single Fraction Partial Breast Radiation Therapy

Authors
Yoo, S; Blitzblau, R; Yin, F; Horton, JK
MLA Citation
Yoo, S, Blitzblau, R, Yin, F, and Horton, JK. "Delivered Dose for Preoperative Single Fraction Partial Breast Radiation Therapy." September 1, 2014.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
90
Publish Date
2014
Start Page
S239
End Page
S239

Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer

Purpose: Controversy exists regarding the optimal margin width in breast-conserving surgery for invasive breast cancer. Methods: A multidisciplinary consensus panel used a meta-analysis of margin width and ipsilateral breast tumor recurrence (IBTR) from a systematic review of 33 studies including 28,162 patients as the primary evidence base for consensus. Results: Positive margins (ink on invasive carcinoma or ductal carcinoma in situ) are associated with a two-fold increase in the risk of IBTR compared with negative margins. This increased risk is not mitigated by favorable biology, endocrine therapy, or a radiation boost. More widely clear margins do not significantly decrease the rate of IBTR compared with no ink on tumor. There is no evidence that more widely clear margins reduce IBTR for young patients or for those with unfavorable biology, lobular cancers, or cancers with an extensive intraductal component. Conclusion: The use of no ink on tumor as the standard for an adequate margin in invasive cancer in the era of multidisciplinary therapy is associated with low rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcomes, and decrease health care costs. © 2014 by American Society of Clinical Oncology.

Authors
Moran, MS; Schnitt, SJ; Giuliano, AE; Harris, JR; Khan, SA; Horton, J; Klimberg, S; Chavez-MacGregor, M; Freedman, G; Houssami, N; Johnson, PL; Morrow, M
MLA Citation
Moran, MS, Schnitt, SJ, Giuliano, AE, Harris, JR, Khan, SA, Horton, J, Klimberg, S, Chavez-MacGregor, M, Freedman, G, Houssami, N, Johnson, PL, and Morrow, M. "Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer." Journal of Clinical Oncology 32.14 (May 10, 2014): 1507-1515.
Source
scopus
Published In
Journal of Clinical Oncology
Volume
32
Issue
14
Publish Date
2014
Start Page
1507
End Page
1515
DOI
10.1200/JCO.2013.53.3935

Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer.

PURPOSE: Controversy exists regarding the optimal margin width in breast-conserving surgery for invasive breast cancer. METHODS: A multidisciplinary consensus panel used a meta-analysis of margin width and ipsilateral breast tumor recurrence (IBTR) from a systematic review of 33 studies including 28,162 patients as the primary evidence base for consensus. RESULTS: Positive margins (ink on invasive carcinoma or ductal carcinoma in situ) are associated with a two-fold increase in the risk of IBTR compared with negative margins. This increased risk is not mitigated by favorable biology, endocrine therapy, or a radiation boost. More widely clear margins do not significantly decrease the rate of IBTR compared with no ink on tumor. There is no evidence that more widely clear margins reduce IBTR for young patients or for those with unfavorable biology, lobular cancers, or cancers with an extensive intraductal component. CONCLUSION: The use of no ink on tumor as the standard for an adequate margin in invasive cancer in the era of multidisciplinary therapy is associated with low rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcomes, and decrease health care costs. J Clin Oncol 32. 2014 American Society of Clinical Oncology®, American Society for Radiation Oncology®, and Society of Surgical Oncology®. All rights reserved. No part of this document may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission by the American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology.

Authors
Moran, MS; Schnitt, SJ; Giuliano, AE; Harris, JR; Khan, SA; Horton, J; Klimberg, S; Chavez-MacGregor, M; Freedman, G; Houssami, N; Johnson, PL; Morrow, M
MLA Citation
Moran, MS, Schnitt, SJ, Giuliano, AE, Harris, JR, Khan, SA, Horton, J, Klimberg, S, Chavez-MacGregor, M, Freedman, G, Houssami, N, Johnson, PL, and Morrow, M. "Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 32.14 (May 2014): 1507-1515.
PMID
24516019
Source
epmc
Published In
Journal of Clinical Oncology
Volume
32
Issue
14
Publish Date
2014
Start Page
1507
End Page
1515
DOI
10.1200/jco.2013.53.3935

Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer.

To convene a multidisciplinary panel of breast experts to examine the relationship between margin width and ipsilateral breast tumor recurrence (IBTR) and develop a guideline for defining adequate margins in the setting of breast conserving surgery and adjuvant radiation therapy.A multidisciplinary consensus panel used a meta-analysis of margin width and IBTR from a systematic review of 33 studies including 28,162 patients as the primary evidence base for consensus.Positive margins (ink on invasive carcinoma or ductal carcinoma in situ) are associated with a 2-fold increase in the risk of IBTR compared with negative margins. This increased risk is not mitigated by favorable biology, endocrine therapy, or a radiation boost. More widely clear margins than no ink on tumor do not significantly decrease the rate of IBTR compared with no ink on tumor. There is no evidence that more widely clear margins reduce IBTR for young patients or for those with unfavorable biology, lobular cancers, or cancers with an extensive intraductal component.The use of no ink on tumor as the standard for an adequate margin in invasive cancer in the era of multidisciplinary therapy is associated with low rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcomes, and decrease health care costs.

Authors
Moran, MS; Schnitt, SJ; Giuliano, AE; Harris, JR; Khan, SA; Horton, J; Klimberg, S; Chavez-MacGregor, M; Freedman, G; Houssami, N; Johnson, PL; Morrow, M
MLA Citation
Moran, MS, Schnitt, SJ, Giuliano, AE, Harris, JR, Khan, SA, Horton, J, Klimberg, S, Chavez-MacGregor, M, Freedman, G, Houssami, N, Johnson, PL, and Morrow, M. "Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer." International journal of radiation oncology, biology, physics 88.3 (March 2014): 553-564.
PMID
24521674
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
88
Issue
3
Publish Date
2014
Start Page
553
End Page
564
DOI
10.1016/j.ijrobp.2013.11.012

Society of Surgical Oncology–American Society for Radiation Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Stages I and II Invasive Breast Cancer

Authors
Moran, MS; Schnitt, SJ; Giuliano, AE; Harris, JR; Khan, SA; Horton, J; Klimberg, S; Chavez-MacGregor, M; Freedman, G; Houssami, N; Johnson, PL; Morrow, M
MLA Citation
Moran, MS, Schnitt, SJ, Giuliano, AE, Harris, JR, Khan, SA, Horton, J, Klimberg, S, Chavez-MacGregor, M, Freedman, G, Houssami, N, Johnson, PL, and Morrow, M. "Society of Surgical Oncology–American Society for Radiation Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Stages I and II Invasive Breast Cancer." Annals of Surgical Oncology 21.3 (March 2014): 704-716.
Source
crossref
Published In
Annals of Surgical Oncology
Volume
21
Issue
3
Publish Date
2014
Start Page
704
End Page
716
DOI
10.1245/s10434-014-3481-4

Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer.

PURPOSE: Controversy exists regarding the optimal margin width in breast-conserving surgery for invasive breast cancer. METHODS: A multidisciplinary consensus panel used a meta-analysis of margin width and ipsilateral breast tumor recurrence (IBTR) from a systematic review of 33 studies including 28,162 patients as the primary evidence base for consensus. RESULTS: Positive margins (ink on invasive carcinoma or ductal carcinoma in situ) are associated with a two-fold increase in the risk of IBTR compared with negative margins. This increased risk is not mitigated by favorable biology, endocrine therapy, or a radiation boost. More widely clear margins than no ink on tumor do not significantly decrease the rate of IBTR compared with no ink on tumor. There is no evidence that more widely clear margins reduce IBTR for young patients or for those with unfavorable biology, lobular cancers, or cancers with an extensive intraductal component. CONCLUSION: The use of no ink on tumor as the standard for an adequate margin in invasive cancer in the era of multidisciplinary therapy is associated with low rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcomes, and decrease health care costs.

Authors
Moran, MS; Schnitt, SJ; Giuliano, AE; Harris, JR; Khan, SA; Horton, J; Klimberg, S; Chavez-MacGregor, M; Freedman, G; Houssami, N; Johnson, PL; Morrow, M
MLA Citation
Moran, MS, Schnitt, SJ, Giuliano, AE, Harris, JR, Khan, SA, Horton, J, Klimberg, S, Chavez-MacGregor, M, Freedman, G, Houssami, N, Johnson, PL, and Morrow, M. "Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer." Annals of surgical oncology 21.3 (March 2014): 704-716.
PMID
24515565
Source
epmc
Published In
Annals of Surgical Oncology
Volume
21
Issue
3
Publish Date
2014
Start Page
704
End Page
716
DOI
10.1245/s10434-014-3481-4

Dosimetric comparison of 3D conformal, IMRT, and V-MAT techniques for accelerated partial-breast irradiation (APBI).

The purpose is to dosimetrically compare the following 3 delivery techniques: 3-dimensional conformal radiation therapy (3D-CRT), intensity-modulated arc therapy (IMRT), and volumetric-modulated arc therapy (V-MAT) in the treatment of accelerated partial-breast irradiation (APBI). Overall, 16 patients with T1/2N0 breast cancer were treated with 3D-CRT (multiple, noncoplanar photon fields) on the RTOG 0413 partial-breast trial. These cases were subsequently replanned using static gantry IMRT and V-MAT technology to understand dosimetric differences among these 3 techniques. Several dosimetric parameters were used in plan quality evaluation, including dose conformity index (CI) and dose-volume histogram analysis of normal tissue coverage. Quality assurance studies including gamma analysis were performed to compare the measured and calculated dose distributions. The IMRT and V-MAT plans gave more conformal target dose distributions than the 3D-CRT plans (p < 0.05 in CI). The volume of ipsilateral breast receiving 5 and 10Gy was significantly less using the V-MAT technique than with either 3D-CRT or IMRT (p < 0.05). The maximum lung dose and the ipsilateral lung volume receiving 10 (V10) or 20Gy (V20) were significantly less with both V-MAT and IMRT (p < 0.05). The IMRT technique was superior to 3D-CRT and V-MAT of low dose distributions in ipsilateral lung (p < 0.05 in V5 and D5). The total mean monitor units (MUs) for V-MAT (621.0 ± 111.9) were 12.2% less than those for 3D-CRT (707.3 ± 130.9) and 46.5% less than those for IMRT (1161.4 ± 315.6) (p < 0.05). The average machine delivery time was 1.5 ± 0.2 minutes for the V-MAT plans, 7.0 ± 1.6 minutes for the 3D-CRT plans, and 11.5 ± 1.9 minutes for the IMRT plans, demonstrating much less delivery time for V-MAT. Based on this preliminary study, V-MAT and IMRT techniques offer improved dose conformity as compared with 3D-CRT techniques without increasing dose to the ipsilateral lung. In terms of MU and delivery time, V-MAT is significantly more efficient for APBI than for conventional 3D-CRT and static-beam IMRT.

Authors
Qiu, J-J; Chang, Z; Horton, JK; Wu, Q-RJ; Yoo, S; Yin, F-F
MLA Citation
Qiu, J-J, Chang, Z, Horton, JK, Wu, Q-RJ, Yoo, S, and Yin, F-F. "Dosimetric comparison of 3D conformal, IMRT, and V-MAT techniques for accelerated partial-breast irradiation (APBI)." Medical dosimetry : official journal of the American Association of Medical Dosimetrists 39.2 (January 27, 2014): 152-158.
PMID
24480375
Source
epmc
Published In
Medical Dosimetry
Volume
39
Issue
2
Publish Date
2014
Start Page
152
End Page
158
DOI
10.1016/j.meddos.2013.12.001

Dosimetric comparison of 3D conformal, IMRT, and V-MAT techniques for accelerated partial-breast irradiation (APBI)

The purpose is to dosimetrically compare the following 3 delivery techniques: 3-dimensional conformal radiation therapy (3D-CRT), intensity-modulated arc therapy (IMRT), and volumetric-modulated arc therapy (V-MAT) in the treatment of accelerated partial-breast irradiation (APBI). Overall, 16 patients with T1/2N0 breast cancer were treated with 3D-CRT (multiple, noncoplanar photon fields) on the RTOG 0413 partial-breast trial. These cases were subsequently replanned using static gantry IMRT and V-MAT technology to understand dosimetric differences among these 3 techniques. Several dosimetric parameters were used in plan quality evaluation, including dose conformity index (CI) and dose-volume histogram analysis of normal tissue coverage. Quality assurance studies including gamma analysis were performed to compare the measured and calculated dose distributions. The IMRT and V-MAT plans gave more conformal target dose distributions than the 3D-CRT plans (p < 0.05 in CI). The volume of ipsilateral breast receiving 5 and 10Gy was significantly less using the V-MAT technique than with either 3D-CRT or IMRT (p < 0.05). The maximum lung dose and the ipsilateral lung volume receiving 10 (V10) or 20Gy (V20) were significantly less with both V-MAT and IMRT (p < 0.05). The IMRT technique was superior to 3D-CRT and V-MAT of low dose distributions in ipsilateral lung (p < 0.05 in V5 and D5). The total mean monitor units (MUs) for V-MAT (621.0 ± 111.9) were 12.2% less than those for 3D-CRT (707.3 ± 130.9) and 46.5% less than those for IMRT (1161.4 ± 315.6) (p < 0.05). The average machine delivery time was 1.5 ± 0.2 minutes for the V-MAT plans, 7.0 ± 1.6 minutes for the 3D-CRT plans, and 11.5 ± 1.9 minutes for the IMRT plans, demonstrating much less delivery time for V-MAT. Based on this preliminary study, V-MAT and IMRT techniques offer improved dose conformity as compared with 3D-CRT techniques without increasing dose to the ipsilateral lung. In terms of MU and delivery time, V-MAT is significantly more efficient for APBI than for conventional 3D-CRT and static-beam IMRT. © 2014 American Association of Medical Dosimetrists.

Authors
Qiu, JJ; Chang, Z; Horton, JK; Wu, QRJ; Yoo, S; Yin, FF
MLA Citation
Qiu, JJ, Chang, Z, Horton, JK, Wu, QRJ, Yoo, S, and Yin, FF. "Dosimetric comparison of 3D conformal, IMRT, and V-MAT techniques for accelerated partial-breast irradiation (APBI)." Medical Dosimetry 39.2 (January 1, 2014): 152-158.
Source
scopus
Published In
Medical Dosimetry
Volume
39
Issue
2
Publish Date
2014
Start Page
152
End Page
158
DOI
10.1016/j.meddos.2013.12.001

Effect of local therapy on locoregional recurrence in postmenopausal women with breast cancer in the Tamoxifen Exemestane Adjuvant Multinational (TEAM) trial: Van Hezewijk M, Bastiaannet E, Putter H, et al (Leiden Univ Med Ctr, the Netherlands; Et al) Radiother Oncol 108:190-196, 2013

Authors
Horton, JK
MLA Citation
Horton, JK. "Effect of local therapy on locoregional recurrence in postmenopausal women with breast cancer in the Tamoxifen Exemestane Adjuvant Multinational (TEAM) trial: Van Hezewijk M, Bastiaannet E, Putter H, et al (Leiden Univ Med Ctr, the Netherlands; Et al) Radiother Oncol 108:190-196, 2013." Breast Diseases 25.2 (January 1, 2014): 179-180.
Source
scopus
Published In
Breast Diseases: A Year Book Quarterly
Volume
25
Issue
2
Publish Date
2014
Start Page
179
End Page
180
DOI
10.1016/j.breastdis.2014.04.037

Prospective Multicenter Trial Evaluating Balloon-Catheter Partial-Breast Irradiation for Ductal Carcinoma in Situ

Authors
Horton, JK
MLA Citation
Horton, JK. "Prospective Multicenter Trial Evaluating Balloon-Catheter Partial-Breast Irradiation for Ductal Carcinoma in Situ." Breast Diseases: A Year Book Quarterly 25.1 (2014): 80-81.
Source
crossref
Published In
Breast Diseases: A Year Book Quarterly
Volume
25
Issue
1
Publish Date
2014
Start Page
80
End Page
81
DOI
10.1016/j.breastdis.2014.01.015

Surgical Patterns of Care in Patients with Invasive Breast Cancer Treated with Neoadjuvant Systemic Therapy and Breast Magnetic Resonance Imaging: Results of a Secondary Analysis of TBCRC 017

© 2014, Society of Surgical Oncology.Background: Neoadjuvant chemotherapy (NCT) downstages advanced primary tumors, with magnetic resonance imaging (MRI) being the most sensitive imaging predictor of response. However, the impact of MRI evaluation on surgical treatment decisions in the neoadjuvant setting has not been well described. We report surgical patterns of care across 8 National Cancer Institute comprehensive cancer centers in women receiving both NCT and MRI to evaluate the impact of MRI findings on surgical planning.Methods: Seven hundred seventy women from 8 institutions received NCT with MRI obtained both before and after systemic treatment. Univariate and multivariate analyses of imaging, patient-, and tumor-related covariates associated with choice of breast surgery were conducted.Results: MRI and surgical data were available on 759 of 770 patients. A total of 345 of 759 (45 %) patients received breast-conserving surgery and 414 of 759 (55 %) received mastectomy. Mastectomy occurred more commonly in patients with incomplete MRI response versus complete (58 vs. 43 %) (p = 0.0003). On multivariate analysis, positive estrogen receptor status (p = 0.02), incomplete MRI response (p = 0.0003), higher baseline T classification (p < 0.0001), younger age (p < 0.0006), and institution (p = 0.003) were independent predictors of mastectomy. A statistically significant trend toward increasing use of mastectomy with increasing T stage at presentation (p < 0.0001) was observed in patients with incomplete response by MRI only. Among women with complete response on MRI, 43 % underwent mastectomy.Conclusions: Within a multi-institutional cohort of women undergoing neoadjuvant treatment for breast cancer, MRI findings were not clearly associated with extent of surgery. This study shows that receptor status, T stage at diagnosis, young age, and treating institution are more significant determinants of surgical treatment choice than MRI response data.

Authors
McGuire, KP; Hwang, ES; Cantor, A; Golshan, M; Meric-Bernstam, F; Horton, JK; Nanda, R; Amos, KD; Forero, A; Hudis, CA; Meszoely, I; Santos, JFDL
MLA Citation
McGuire, KP, Hwang, ES, Cantor, A, Golshan, M, Meric-Bernstam, F, Horton, JK, Nanda, R, Amos, KD, Forero, A, Hudis, CA, Meszoely, I, and Santos, JFDL. "Surgical Patterns of Care in Patients with Invasive Breast Cancer Treated with Neoadjuvant Systemic Therapy and Breast Magnetic Resonance Imaging: Results of a Secondary Analysis of TBCRC 017." Annals of Surgical Oncology 22.1 (2014): 75-81.
Source
scival
Published In
Annals of Surgical Oncology
Volume
22
Issue
1
Publish Date
2014
Start Page
75
End Page
81
DOI
10.1245/s10434-014-3948-3

Abstract P5-14-04: Preoperative single-fraction partial breast radiotherapy – Initial results from a novel phase I dose-escalation protocol with exploration of radiation response biomarkers

Authors
Horton, JK; Blitzblau, RC; Yoo, S; Georgiade, GS; Geradts, J; Baker, JA; Chang, Z; Broadwater, G; Barry, W; Duffy, EA; Hwang, ES
MLA Citation
Horton, JK, Blitzblau, RC, Yoo, S, Georgiade, GS, Geradts, J, Baker, JA, Chang, Z, Broadwater, G, Barry, W, Duffy, EA, and Hwang, ES. "Abstract P5-14-04: Preoperative single-fraction partial breast radiotherapy – Initial results from a novel phase I dose-escalation protocol with exploration of radiation response biomarkers." December 15, 2013.
Source
crossref
Published In
Cancer Research
Volume
73
Issue
24 Supplement
Publish Date
2013
Start Page
P5-14-04
End Page
P5-14-04
DOI
10.1158/0008-5472.SABCS13-P5-14-04

Preoperative Single:Fraction Partial Breast Radiation Therapy: A Novel Phase 1 Dose-Escalation Protocol and Exploration of Breast Cancer Radiation Response

Authors
Horton, JK; Blitzblau, RC; Yoo, S; Georgiade, GS; Geradts, J; Baker, JA; Chang, Z; Duffy, E; Hwang, ES
MLA Citation
Horton, JK, Blitzblau, RC, Yoo, S, Georgiade, GS, Geradts, J, Baker, JA, Chang, Z, Duffy, E, and Hwang, ES. "Preoperative Single:Fraction Partial Breast Radiation Therapy: A Novel Phase 1 Dose-Escalation Protocol and Exploration of Breast Cancer Radiation Response." October 1, 2013.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
87
Issue
2
Publish Date
2013
Start Page
S229
End Page
S229

Comparison of Preoperative Partial Breast Radiosurgery Treatment Techniques: 3D-CRT, Non-Coplanar IMRT, Coplanar IMRT, and VMAT

Authors
Yoo, S; Blitzblau, R; Yin, F; Horton, JK
MLA Citation
Yoo, S, Blitzblau, R, Yin, F, and Horton, JK. "Comparison of Preoperative Partial Breast Radiosurgery Treatment Techniques: 3D-CRT, Non-Coplanar IMRT, Coplanar IMRT, and VMAT." October 1, 2013.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
87
Issue
2
Publish Date
2013
Start Page
S215
End Page
S215

Up-regulation of Fas Expression in Human Breast Carcinomas Treated With Preoperative Radiation

Authors
Horton, JK; Chi, J-TA; Groth, J; Zhou, Y; Lee, C-T; Geradts, J
MLA Citation
Horton, JK, Chi, J-TA, Groth, J, Zhou, Y, Lee, C-T, and Geradts, J. "Up-regulation of Fas Expression in Human Breast Carcinomas Treated With Preoperative Radiation." JOURNAL OF WOMENS HEALTH 22.10 (October 1, 2013): 890-890.
Source
wos-lite
Published In
Journal of Women's Health
Volume
22
Issue
10
Publish Date
2013
Start Page
890
End Page
890

Multidisciplinary care of patients with early-stage breast cancer.

There is a compelling need for close coordination and integration of multiple specialties in the management of patients with early-stage breast cancer. Optimal patient care and outcomes depend on the sequential and often simultaneous participation and dialogue between specialists in imaging, pathologic and molecular diagnostic and prognostic stratification, and the therapeutic specialties of surgery, radiation oncology, and medical oncology. These are but a few of the various disciplines needed to provide modern, sophisticated management. The essential role for coordinated involvement of the entire health care team in optimal management of patients with early-stage breast cancer is likely to increase further.

Authors
Lyman, GH; Baker, J; Geradts, J; Horton, J; Kimmick, G; Peppercorn, J; Pruitt, S; Scheri, RP; Hwang, ES
MLA Citation
Lyman, GH, Baker, J, Geradts, J, Horton, J, Kimmick, G, Peppercorn, J, Pruitt, S, Scheri, RP, and Hwang, ES. "Multidisciplinary care of patients with early-stage breast cancer." Surg Oncol Clin N Am 22.2 (April 2013): 299-317. (Review)
PMID
23453336
Source
pubmed
Published In
Surgical Oncology Clinics of North America
Volume
22
Issue
2
Publish Date
2013
Start Page
299
End Page
317
DOI
10.1016/j.soc.2012.12.005

Radiotherapy After Mastectomy

Classic randomized trials documented the benefit of postmastectomy radiotherapy in women with node-positive or locally advanced breast cancer. Modern advances in surgical therapy, systemic therapy, and radiotherapy, however, along with an improved understanding of cancer biology, have called into question previously assumed recurrence risks and treatment benefits. This article explores the impact of tumor biology and genomic medicine on utilization of postmastectomy radiotherapy and how treatment decision making is moving beyond TNM-based predictors. © 2013 Elsevier Inc. All rights reserved.

Authors
Blitzblau, RC; Horton, JK
MLA Citation
Blitzblau, RC, and Horton, JK. "Radiotherapy After Mastectomy." Surgical Oncology Clinics of North America (2013).
PMID
23622080
Source
scival
Published In
Surgical Oncology Clinics of North America
Publish Date
2013
DOI
10.1016/j.soc.2013.02.012

Magnetic resonance imaging as a predictor of pathologic response in patients treated with neoadjuvant systemic treatment for operable breast cancer: Translational Breast Cancer Research Consortium trial 017

Background: Increased pathologic complete response (pCR) rates observed with neoadjuvant chemotherapy (NCT) for some subsets of patients with invasive breast cancer have prompted interest in whether patients who achieved a pCR can be identified preoperatively and potentially spared the morbidity of surgery. The objective of this multicenter, retrospective study was to estimate the accuracy of preoperative magnetic resonance imaging (MRI) in predicting a pCR in the breast. Methods: MRI studies at baseline and after the completion of NCT plus data regarding pathologic response were collected retrospectively from 746 women who received treatment at 8 institutions between 2002 and 2011. Tumors were characterized by immunohistochemical phenotype into 4 categories based on receptor expression: hormone (estrogen and progesterone) receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative (n = 327), HR-positive/HER2-positive, (n = 148), HR-negative/HER2-positive, (n = 101), and triple-negative (HR-negative/HER2 negative; n = 155). In all, 194 of 249 patients (78%) with HER2-positive tumors received trastuzumab. Univariate and multivariate analyses of factors associated with radiographic complete response (rCR) and pCR were performed. Result: For the total group, the rCR and pCR rates were 182 of 746 patients (24%) and 179 of 746 patients (24%), respectively, and the highest pCR rate was observed for the triple-negative subtype (57 of 155 patients; 37%) and the HER2-positive subtype (38 of 101 patients; 38%). The overall accuracy of MRI for predicting pCR was 74%. The variables sensitivity, negative predictive value, positive predictive value, and accuracy differed significantly among tumor subtypes, and the greatest negative predictive value was observed in the triple-negative (60%) and HER2-positive (62%) subtypes. Conclusions: The overall accuracy of MRI for predicting pCR in invasive breast cancer patients who were receiving NCT was 74%. The performance of MRI differed between subtypes, possibly influenced by differences in pCR rates between groups. Future studies will determine whether MRI in combination with directed core biopsy improves the predictive value of MRI for pathologic response. © 2013 American Cancer Society.

Authors
Santos, JFDL; Cantor, A; Amos, KD; Forero, A; Golshan, M; Horton, JK; Hudis, CA; Hylton, NM; Mcguire, K; Meric-Bernstam, F; al, E
MLA Citation
Santos, JFDL, Cantor, A, Amos, KD, Forero, A, Golshan, M, Horton, JK, Hudis, CA, Hylton, NM, Mcguire, K, Meric-Bernstam, F, and al, E. "Magnetic resonance imaging as a predictor of pathologic response in patients treated with neoadjuvant systemic treatment for operable breast cancer: Translational Breast Cancer Research Consortium trial 017." Cancer (2013).
PMID
23436342
Source
scival
Published In
Cancer
Publish Date
2013
DOI
10.1002/cncr.27995

Oncology scan - Breast cancers

Authors
Horton, JK; Jagsi, R
MLA Citation
Horton, JK, and Jagsi, R. "Oncology scan - Breast cancers." International Journal of Radiation Oncology Biology Physics 85.5 (2013): 1151-1152.
Source
scival
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
85
Issue
5
Publish Date
2013
Start Page
1151
End Page
1152
DOI
10.1016/j.ijrobp.2013.01.007

Radiotherapy After Mastectomy

Classic randomized trials documented the benefit of postmastectomy radiotherapy in women with node-positive or locally advanced breast cancer. Modern advances in surgical therapy, systemic therapy, and radiotherapy, however, along with an improved understanding of cancer biology, have called into question previously assumed recurrence risks and treatment benefits. This article explores the impact of tumor biology and genomic medicine on utilization of postmastectomy radiotherapy and how treatment decision making is moving beyond TNM-based predictors. © 2013 Elsevier Inc.

Authors
Blitzblau, RC; Horton, JK
MLA Citation
Blitzblau, RC, and Horton, JK. "Radiotherapy After Mastectomy." Surgical Oncology Clinics of North America 22.3 (2013): 563-577.
Source
scival
Published In
Surgical Oncology Clinics of North America
Volume
22
Issue
3
Publish Date
2013
Start Page
563
End Page
577
DOI
10.1016/j.soc.2013.02.012

Magnetic resonance imaging as a predictor of pathologic response in patients treated with neoadjuvant systemic treatment for operable breast cancer: Translational Breast Cancer Research Consortium trial 017

BACKGROUND: Increased pathologic complete response (pCR) rates observed with neoadjuvant chemotherapy (NCT) for some subsets of patients with invasive breast cancer have prompted interest in whether patients who achieved a pCR can be identified preoperatively and potentially spared the morbidity of surgery. The objective of this multicenter, retrospective study was to estimate the accuracy of preoperative magnetic resonance imaging (MRI) in predicting a pCR in the breast. METHODS: MRI studies at baseline and after the completion of NCT plus data regarding pathologic response were collected retrospectively from 746 women who received treatment at 8 institutions between 2002 and 2011. Tumors were characterized by immunohistochemical phenotype into 4 categories based on receptor expression: hormone (estrogen and progesterone) receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative (n = 327), HR-positive/HER2-positive, (n = 148), HR-negative/HER2-positive, (n = 101), and triple-negative (HR-negative/HER2 negative; n = 155). In all, 194 of 249 patients (78%) with HER2-positive tumors received trastuzumab. Univariate and multivariate analyses of factors associated with radiographic complete response (rCR) and pCR were performed. RESULT: For the total group, the rCR and pCR rates were 182 of 746 patients (24%) and 179 of 746 patients (24%), respectively, and the highest pCR rate was observed for the triple-negative subtype (57 of 155 patients; 37%) and the HER2-positive subtype (38 of 101 patients; 38%). The overall accuracy of MRI for predicting pCR was 74%. The variables sensitivity, negative predictive value, positive predictive value, and accuracy differed significantly among tumor subtypes, and the greatest negative predictive value was observed in the triple-negative (60%) and HER2-positive (62%) subtypes. CONCLUSIONS: The overall accuracy of MRI for predicting pCR in invasive breast cancer patients who were receiving NCT was 74%. The performance of MRI differed between subtypes, possibly influenced by differences in pCR rates between groups. Future studies will determine whether MRI in combination with directed core biopsy improves the predictive value of MRI for pathologic response. Cancer 2013. © 2013 American Cancer Society.

Authors
Santos, JFDL; Cantor, A; Amos, KD; Forero, A; Golshan, M; Horton, JK; Hudis, CA; Hylton, NM; McGuire, K; Meric-Bernstam, F; Meszoely, IM; Nanda, R; Hwang, ES
MLA Citation
Santos, JFDL, Cantor, A, Amos, KD, Forero, A, Golshan, M, Horton, JK, Hudis, CA, Hylton, NM, McGuire, K, Meric-Bernstam, F, Meszoely, IM, Nanda, R, and Hwang, ES. "Magnetic resonance imaging as a predictor of pathologic response in patients treated with neoadjuvant systemic treatment for operable breast cancer: Translational Breast Cancer Research Consortium trial 017." Cancer 119.10 (2013): 1776-1783.
Source
scival
Published In
Cancer
Volume
119
Issue
10
Publish Date
2013
Start Page
1776
End Page
1783
DOI
10.1002/cncr.27995

Treatment planning technique in patients receiving postmastectomy radiation therapy

Many of the technical subtleties involved in postmastectomy radiation treatment planning will never be addressed in a robust clinical trial setting. However, these issues are faced daily by practicing radiation oncologists with little to guide them in the published literature. The purpose of this study was to survey a small number of breast care providers in both academic and private practice settings on practical aspects of postmastectomy radiation treatment planning. Topics addressed included the use of sophisticated dose-modulation algorithms, hypofractionation, bolus material, and dose-volume histogram (DVH) constraints. Fifty-two people responded to the survey, 50% in academics and 50% in private practice. As expected, wide variation in clinical practice was seen although a few general trends emerged. We include here, with the survey results, a review of the relevant literature for a number of different treatment-related issues. Although the use of postmastectomy radiation therapy is common, literature guiding the reader on technical aspects of delivery is sparse. The data presented here provide a general framework of what is considered acceptable by currently practicing radiation oncologists in many different practice settings. © 2013 American Society for Radiation Oncology.

Authors
Blitzblau, RC; Horton, JK
MLA Citation
Blitzblau, RC, and Horton, JK. "Treatment planning technique in patients receiving postmastectomy radiation therapy." Practical Radiation Oncology 3.4 (2013): 241-248.
Source
scival
Published In
Practical Radiation Oncology
Volume
3
Issue
4
Publish Date
2013
Start Page
241
End Page
248
DOI
10.1016/j.prro.2012.09.004

Gene Expression Response to Ionizing Radiation in Luminal and Basal Breast Cancer Cell Lines

Authors
Horton, JK; Fels, DR; Kung, H; Ashcraft, K; Dewhirst, MW; Chi, JA
MLA Citation
Horton, JK, Fels, DR, Kung, H, Ashcraft, K, Dewhirst, MW, and Chi, JA. "Gene Expression Response to Ionizing Radiation in Luminal and Basal Breast Cancer Cell Lines." November 1, 2012.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
84
Issue
3
Publish Date
2012
Start Page
S710
End Page
S710

Use of Adjuvant Radiation Therapy in Elderly Patients With Early Stage Breast Cancer: Changes in Practice Patterns After Publication of Cancer and Leukemia Group B (CALGB) 9343

Authors
Palta, M; Palta, P; Horton, J; Blitzblau, R
MLA Citation
Palta, M, Palta, P, Horton, J, and Blitzblau, R. "Use of Adjuvant Radiation Therapy in Elderly Patients With Early Stage Breast Cancer: Changes in Practice Patterns After Publication of Cancer and Leukemia Group B (CALGB) 9343." November 1, 2012.
PMID
25488523
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
84
Issue
3
Publish Date
2012
Start Page
S256
End Page
S256

Differential Activation of Cell Death Pathways After Ionizing Radiation in Luminal and Basal Breast Cancer Cell Lines

Authors
Horton, JK; Fels, DR; Kung, H-N; Zhou, Y; Ashcraft, K; Dewhirst, MW; Chi, J-TA
MLA Citation
Horton, JK, Fels, DR, Kung, H-N, Zhou, Y, Ashcraft, K, Dewhirst, MW, and Chi, J-TA. "Differential Activation of Cell Death Pathways After Ionizing Radiation in Luminal and Basal Breast Cancer Cell Lines." JOURNAL OF WOMENS HEALTH 21.10 (October 2012): 992-992.
Source
wos-lite
Published In
Journal of Women's Health
Volume
21
Issue
10
Publish Date
2012
Start Page
992
End Page
992

Oncology scan - breast cancer.

Authors
Moran, MS; Horton, JK
MLA Citation
Moran, MS, and Horton, JK. "Oncology scan - breast cancer." International journal of radiation oncology, biology, physics 84.1 (September 2012): 1-3. (Academic Article)
Source
manual
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
84
Issue
1
Publish Date
2012
Start Page
1
End Page
3
DOI
10.1016/S0360-3016(12)00929-7

Risk of invasive breast cancer and ductal carcinoma in situ in women with atypical papillary lesions of the breast.

Benign papillary lesions of the breast include papilloma and papillomatosis. A retrospective analysis of patients with a papillary breast lesion diagnosed between October 1992 and December 2009 was performed. Patients were excluded if they had a previous or concurrent diagnosis of invasive or in situ cancer or less than 6 months of follow-up. The Kaplan-Meier method was used to determine the risk of developing subsequent malignancy. The log rank test was used to compare groups of patients. Median follow-up for the 167 patients included in the study was 4.6 years. Fifty-one patients had a papillary lesion with atypia and 116 patients had a papillary lesion without atypia. Patients with a papillary lesion with atypia were more likely to develop invasive or in situ breast cancer with a 5 year risk of 13.0% versus 4.6% in patients with no atypia (p = 0.03).

Authors
Cuneo, KC; Dash, RC; Wilke, LG; Horton, JK; Koontz, BF
MLA Citation
Cuneo, KC, Dash, RC, Wilke, LG, Horton, JK, and Koontz, BF. "Risk of invasive breast cancer and ductal carcinoma in situ in women with atypical papillary lesions of the breast." Breast J 18.5 (September 2012): 475-478.
PMID
22776070
Source
pubmed
Published In
The Breast Journal
Volume
18
Issue
5
Publish Date
2012
Start Page
475
End Page
478
DOI
10.1111/j.1524-4741.2012.01276.x

Comparison of 3D conformal breast radiation treatment plans using the anisotropic analytical algorithm and pencil beam convolution algorithm.

PURPOSE: To investigate (1) dosimetric differences between plans calculated using the anisotropic analytical algorithm (AAA) and pencil beam convolution (PBC) algorithm, (2) the plan quality achieved using AAA compared to PBC based on dosimetric parameters and (3) discrepancies with an independent MU verification calculation for breast treatment planning. MATERIALS AND METHODS: This study included 10 lumpectomy (Group I) and 10 mastectomy (Group II) cases. Target volumes were defined as breast for Group I and chest-wall for Group II based on the isodose distribution of PBC plans in order to evaluate plans. All plans were initially calculated with PBC. For study aim (1), plans were re-calculated using AAA with the same monitor units (MUs). For study aim (2), plans were calculated using AAA with modifications of wedges, subfields and beam weightings from the original plans to achieve optimal coverage. For study aim (3), independent MU verification was performed. A 3% difference between primary MUs and verification MUs was considered an action level. RESULTS: (1) Plans using PBC overestimate the dose to the target volume compared to plans using AAA (Group I V(95%)=90.4%:84.4%; Group II V(95%)=83.0%:74.5%; PBC:AAA). (2) The new plans using AAA achieved similar target coverage to the original PBC plans based on dose-volume histograms (DVHs). Yet, the high-dose volume (V(105%)) was significantly larger in AAA plans than PBC plans for Group II (V(105%)=19.5%:24.0%). For both groups, there was a significant increase in the ipsilateral lung volume receiving low dose with AAA plans (Group I V(5 Gy)=23.6%:39.9%; Group II V(5 Gy)=21.2%:33.6%). Isodose distributions of AAA plans displayed insufficient coverage in the superior area. (3) In Group I, all PBC cases passed MU verification versus 30% of AAA cases. In Group II, 80% of PBC plans versus 65% of AAA plans were within the action level. CONCLUSIONS: Plans using AAA calculation can achieve a similar level of target coverage based on DVH as PBC calculation. Nevertheless, the dose distribution shows insufficient coverage in the superior area with AAA plans compared to PBC plans. The lung volume receiving the low-dose (i.e. 5 Gy) is larger and the dose to the skin is greater in AAA plans than PBC plans. Compared with PBC calculation, a larger tolerance in discrepancy between AAA and independent MU verification should be allowed to account for the inadequate heterogeneity corrections in the latter.

Authors
Yoo, S; Wu, Q; O'Daniel, J; Horton, J; Yin, F-F
MLA Citation
Yoo, S, Wu, Q, O'Daniel, J, Horton, J, and Yin, F-F. "Comparison of 3D conformal breast radiation treatment plans using the anisotropic analytical algorithm and pencil beam convolution algorithm." Radiother Oncol 103.2 (May 2012): 172-177.
PMID
22349127
Source
pubmed
Published In
Radiotherapy and Oncology
Volume
103
Issue
2
Publish Date
2012
Start Page
172
End Page
177
DOI
10.1016/j.radonc.2012.01.010

Carbonic anhydrase IX is a predictive marker of doxorubicin resistance in early-stage breast cancer independent of HER2 and TOP2A amplification.

BACKGROUND: In early-stage breast cancer, adjuvant chemotherapy is associated with significant systemic toxicity with only a modest survival benefit. Therefore, there is considerable interest in identifying predictive markers of response to therapy. Doxorubicin, one of the most common drugs used to treat breast cancer, is an anthracycline chemotherapeutic agent, a class of drugs known to be affected by hypoxia. Accordingly, we examined whether expression of the endogenous hypoxia marker carbonic anhydrase IX (CA IX) is predictive of outcome in early-stage breast cancer patients treated with doxorubicin. METHODS: We obtained 209 early-stage pre-treatment surgically-resected breast tumours from patients, who received doxorubicin in their chemotherapeutic regimen and had >10 years of follow-up. Immunohistochemistry was used to detect CA IX, and we used fluorescence in situ hybridisation to detect both human epidermal growth factor receptor (HER2) and DNA topoisomerase II-alpha (TOP2A) gene amplification. RESULTS: Carbonic anhydrase IX intensity was significantly correlated with progression-free survival (PFS) and overall survival (OS) in patients receiving 300 mg m(-2) of doxorubicin (HR=1.82 and 3.77; P=0.0014 and 0.010, respectively). There was a significant, inverse correlation between CA IX score and oestrogen receptor expression, but no significant correlations were seen with either HER2 or TOP2A ratio. CONCLUSION: We demonstrate that CA IX expression is correlated with worse PFS and OS for breast cancer patients treated with doxorubicin, independent of HER2 or TOP2A gene amplification. This study provides evidence that using CA IX to detect hypoxia in surgically-resected breast tumours may be of clinical use in choosing an appropriate chemotherapy regimen.

Authors
Betof, AS; Rabbani, ZN; Hardee, ME; Kim, SJ; Broadwater, G; Bentley, RC; Snyder, SA; Vujaskovic, Z; Oosterwijk, E; Harris, LN; Horton, JK; Dewhirst, MW; Blackwell, KL
MLA Citation
Betof, AS, Rabbani, ZN, Hardee, ME, Kim, SJ, Broadwater, G, Bentley, RC, Snyder, SA, Vujaskovic, Z, Oosterwijk, E, Harris, LN, Horton, JK, Dewhirst, MW, and Blackwell, KL. "Carbonic anhydrase IX is a predictive marker of doxorubicin resistance in early-stage breast cancer independent of HER2 and TOP2A amplification." Br J Cancer 106.5 (February 28, 2012): 916-922.
PMID
22333602
Source
pubmed
Published In
British Journal of Cancer
Volume
106
Issue
5
Publish Date
2012
Start Page
916
End Page
922
DOI
10.1038/bjc.2012.32

Preoperative single fraction partial breast radiotherapy for early-stage breast cancer.

PURPOSE: Several recent series evaluating external beam accelerated partial breast irradiation (PBI) have reported adverse cosmetic outcomes, possibly related to large volumes of normal tissue receiving near-prescription doses. We hypothesized that delivery of external beam PBI in a single fraction to the preoperative tumor volume would be feasible and result in a decreased dose to the uninvolved breast compared with institutional postoperative PBI historical controls. METHODS AND MATERIALS: A total of 17 patients with unifocal Stage T1 breast cancer were identified. Contrast-enhanced subtraction magnetic resonance images were loaded into an Eclipse treatment planning system and used to define the target volumes. A "virtual plan" was created using four photon beams in a noncoplanar beam arrangement and optimized to deliver 15 Gy to the planning target volume. RESULTS: The median breast volume was 1,713 cm(3) (range: 1,014-2,140), and the median clinical target volume was 44 cm(3) (range: 26-73). In all cases, 100% of the prescription dose covered 95% of the clinical target volume. The median conformity index was 0.86 (range: 0.70-1.12). The median percentage of the ipsilateral breast volume receiving 100% and 50% of the prescribed dose was 3.8% (range: 2.2-6.9) and 13.3% (range: 7.5-20.8) compared with 18% (range: 3-42) and 53% (range: 24-65) in the institutional historical controls treated with postoperative external beam PBI (p = .002). The median maximum skin dose was 9 Gy. The median dose to 1 and 10 cm(3) of skin was 6.7 and 4.9 Gy. The doses to the heart and ipsilateral lung were negligible. CONCLUSION: Preoperative PBI resulted in a substantial reduction in ipsilateral breast tissue dose compared with postoperative PBI. The skin dose appeared reasonable, given the small volumes. A prospective Phase I trial evaluating this technique is ongoing.

Authors
Palta, M; Yoo, S; Adamson, JD; Prosnitz, LR; Horton, JK
MLA Citation
Palta, M, Yoo, S, Adamson, JD, Prosnitz, LR, and Horton, JK. "Preoperative single fraction partial breast radiotherapy for early-stage breast cancer." Int J Radiat Oncol Biol Phys 82.1 (January 1, 2012): 37-42.
PMID
21093166
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
82
Issue
1
Publish Date
2012
Start Page
37
End Page
42
DOI
10.1016/j.ijrobp.2010.09.041

Phase I study and biomarker analysis of lapatinib and concurrent radiation for locally advanced breast cancer.

PURPOSE: This phase I study assessed the toxicity and safety of combining daily lapatinib with radiation therapy. Sequential tumor biopsies were obtained to evaluate changes in biomarkers, such as epidermal growth factor receptor (EGFR) and human EGFR-2 (HER2) signaling pathways. METHODS: Eligibility for this dose-escalation study included unresectable and locally recurrent or chemotherapy-refractory and locally advanced breast cancer, and adequate organ function. Patients underwent three serial biopsies: at baseline, after 1 week of lapatinib alone, and after 1 week of lapatinib and radiation. Endpoints included determination of toxicity, maximum tolerated dose, and analysis of the effect of lapatinib with or without radiation on EGFR and HER2 signaling pathways by immunohistochemistry. RESULTS: Doses of lapatinib up to 1,500 mg/day were well tolerated. Toxicity of grade 3 or more was limited to radiation dermatitis and pain. Out of 19 patients treated, in field responses per response evaluation criteria in solid tumors criteria were complete in four patients and partial in six patients. Serial biopsies were obtained in 16 patients with no complications. Total Her2 was relatively unchanged while phospho-Her2, phospho-Akt, and phospho-ERK showed variable responses to both lapatinib alone and dual therapy with lapatinib and radiation. CONCLUSIONS: The combination of lapatinib and radiation was well tolerated in this patient cohort. Overall local response rates were comparable to those reported in other studies in this patient population. Biopsies were safely performed at all time points. Inhibition of HER2 and downstream signaling pathways was identified, although no strong correlation with response was seen.

Authors
Kimple, RJ; Horton, JK; Livasy, CA; Shields, JM; Lawrence, JA; Chiu, WM; Ivanova, A; Ollila, DW; Carey, LA; Halle, JS; Sartor, CI; Dees, EC
MLA Citation
Kimple, RJ, Horton, JK, Livasy, CA, Shields, JM, Lawrence, JA, Chiu, WM, Ivanova, A, Ollila, DW, Carey, LA, Halle, JS, Sartor, CI, and Dees, EC. "Phase I study and biomarker analysis of lapatinib and concurrent radiation for locally advanced breast cancer." Oncologist 17.12 (2012): 1496-1503.
PMID
23006498
Source
pubmed
Published In
The oncologist
Volume
17
Issue
12
Publish Date
2012
Start Page
1496
End Page
1503
DOI
10.1634/theoncologist.2012-0256

Treatment planning technique in patients receiving postmastectomy radiation therapy

Many of the technical subtleties involved in postmastectomy radiation treatment planning will never be addressed in a robust clinical trial setting. However, these issues are faced daily by practicing radiation oncologists with little to guide them in the published literature. The purpose of this study was to survey a small number of breast care providers in both academic and private practice settings on practical aspects of postmastectomy radiation treatment planning. Topics addressed included the use of sophisticated dose-modulation algorithms, hypofractionation, bolus material, and dose-volume histogram (DVH) constraints. Fifty-two people responded to the survey, 50% in academics and 50% in private practice. As expected, wide variation in clinical practice was seen although a few general trends emerged. We include here, with the survey results, a review of the relevant literature for a number of different treatment-related issues. Although the use of postmastectomy radiation therapy is common, literature guiding the reader on technical aspects of delivery is sparse. The data presented here provide a general framework of what is considered acceptable by currently practicing radiation oncologists in many different practice settings. © 2012 American Society for Radiation Oncology.

Authors
Blitzblau, RC; Horton, JK
MLA Citation
Blitzblau, RC, and Horton, JK. "Treatment planning technique in patients receiving postmastectomy radiation therapy." Practical Radiation Oncology (2012).
PMID
24674393
Source
scival
Published In
Practical Radiation Oncology
Publish Date
2012
DOI
10.1016/j.prro.2012.09.004

Evaluation of single nucleotide polymorphisms (SNPs) in the p53 binding protein 1 (TP53BP1) gene in breast cancer patients treated with breast-conserving surgery and whole-breast irradiation (BCS + RT)

Authors
Blitzblau, RC; Horton, JK
MLA Citation
Blitzblau, RC, and Horton, JK. "Evaluation of single nucleotide polymorphisms (SNPs) in the p53 binding protein 1 (TP53BP1) gene in breast cancer patients treated with breast-conserving surgery and whole-breast irradiation (BCS + RT)." Breast Diseases 23.1 (2012): 44-45.
Source
scival
Published In
Breast Diseases: A Year Book Quarterly
Volume
23
Issue
1
Publish Date
2012
Start Page
44
End Page
45
DOI
10.1016/j.breastdis.2012.01.001

Gene Expression Response of Luminal and Basal Breast Cancer Cell Lines to Ionizing Radiation

Authors
Horton, JK; Fels, DR; Kung, H-N; Dewhirst, MW; Chi, J-TA
MLA Citation
Horton, JK, Fels, DR, Kung, H-N, Dewhirst, MW, and Chi, J-TA. "Gene Expression Response of Luminal and Basal Breast Cancer Cell Lines to Ionizing Radiation." JOURNAL OF WOMENS HEALTH 20.10 (October 2011): 1404-1405.
Source
wos-lite
Published In
Journal of Women's Health
Volume
20
Issue
10
Publish Date
2011
Start Page
1404
End Page
1405

Age-related disparities in the use of radiotherapy for treatment of localized soft tissue sarcoma.

BACKGROUND: Many elderly patients with cancer experience increased cancer-related morbidity and mortality compared with younger patients. In soft tissue sarcoma, adjuvant radiotherapy is an integral part of definitive therapy for limb preservation. The authors of this report hypothesized that age-related disparities exist in the use of radiation. METHODS: Surveillance, Epidemiology, and End Results (SEER) data were used to conduct a retrospective cohort study among patients aged ≥ 25 years who were diagnosed from 1998 to 2004 with nonmetastatic, biopsy-proven, high-grade soft tissue sarcoma of the extremities and underwent a limb-sparing procedure. Patients were stratified according to age (ages < 50 years, 50-70 years, and > 70 years). Logistic regression was used to determine the association between age and the receipt of radiotherapy adjusting for histology, tumor location, tumor size, surgery, sex, race, and marital status. A Cox proportional hazards model was used to compare disease-specific and all-cause mortality. RESULTS: Among 1354 eligible patients; 37.1% were aged > 70 years, 44.3% were women, and 84.4% were Caucasian. Although 73.8% of the cohort received radiotherapy, receipt decreased from 78.2% among patients aged < 50 years to 69.6% among patients aged >70 years (test for trend; P = .006). After adjusting for demographic and tumor factors, older patients remained less likely to receive radiotherapy (odds ratio, 0.66; 95% confidence interval, 0.47-0.92) and more likely to experience disease-specific death (hazard ratio, 2.4; 95% confidence interval, 1.4-4.1) compared with the youngest group. CONCLUSIONS: Older adults appeared to be less likely to receive definitive therapy for soft tissue sarcoma of the extremities. In the absence of clinical trials and treatment guidelines tailored to this population, under treatment may disadvantage elderly patients, who have increased cancer-related morbidity and mortality.

Authors
Horton, JK; Gleason, JF; Klepin, HD; Isom, S; Fried, DB; Geiger, AM
MLA Citation
Horton, JK, Gleason, JF, Klepin, HD, Isom, S, Fried, DB, and Geiger, AM. "Age-related disparities in the use of radiotherapy for treatment of localized soft tissue sarcoma." Cancer 117.17 (September 1, 2011): 4033-4040.
PMID
21387267
Source
pubmed
Published In
Cancer
Volume
117
Issue
17
Publish Date
2011
Start Page
4033
End Page
4040
DOI
10.1002/cncr.25996

Five-Year Analysis of Treatment Efficacy and Cosmesis by the American Society of Breast Surgeons MammoSite Breast Brachytherapy Registry Trial in Patients Treated with Accelerated Partial Breast Irradiation

Authors
Horton, JK
MLA Citation
Horton, JK. "Five-Year Analysis of Treatment Efficacy and Cosmesis by the American Society of Breast Surgeons MammoSite Breast Brachytherapy Registry Trial in Patients Treated with Accelerated Partial Breast Irradiation." Breast Diseases: A Year Book Quarterly 22.3 (January 2011): 299-300.
Source
crossref
Published In
Breast Diseases: A Year Book Quarterly
Volume
22
Issue
3
Publish Date
2011
Start Page
299
End Page
300
DOI
10.1016/j.breastdis.2011.06.040

A comparison of clinical and dosimetric outcomes in patients receiving partial breast irradiation with photon-only versus mixed photon/electron treatment plans.

Several series evaluating external-beam partial breast irradiation (PBI) have linked negative cosmetic outcomes to large normal tissue treatment volumes. We compared patients treated with PBI whose treatment plans included only photons to those whose plans incorporated electrons. Twenty-seven patients were identified: median age 67 years, pT1 82%, pN0 56%, margin negative 100%. All received 38.5 Gy using 3-5 noncoplanar photon beams (6-15X). Electrons (9-20 MeV) were included in 59%. Median follow-up was 22 months. Ninety percent experienced good/excellent cosmetic outcomes. Two patients had fair cosmesis, and both were treated with a mixed photon/electron approach. Median conformity index for photon-only treatment plans was 1.7 (range, 0.9-2.0) and for photon/electron plans, 1.0 (0.3-1.4). Median percent ipsilateral breast volume receiving 100% and 50% of prescription dose was 19 and 50 for photon-only plans vs. 10 and 38 for photon/electron plans (p < 0.05). Median percent target volume receiving 100% and 95% of prescription dose was 93 and 98 for photon-only plans vs. 75 and 94 for photon/electron plans (p < 0.05). A mixed photon/electron, noncoplanar technique decreases the volume of treated normal breast tissue at the cost of slightly decreased tumor bed coverage. Further study is needed to determine whether this results in a more favorable therapeutic ratio than photon-only approaches.

Authors
Shah, MM; Horton, JK; Yoo, S; Hubbs, JL; Demirci, S; Light, KL; Temple, K; Patrone, M; Marks, LB
MLA Citation
Shah, MM, Horton, JK, Yoo, S, Hubbs, JL, Demirci, S, Light, KL, Temple, K, Patrone, M, and Marks, LB. "A comparison of clinical and dosimetric outcomes in patients receiving partial breast irradiation with photon-only versus mixed photon/electron treatment plans." Med Dosim 36.4 (2011): 423-428.
PMID
21440433
Source
pubmed
Published In
Medical Dosimetry
Volume
36
Issue
4
Publish Date
2011
Start Page
423
End Page
428
DOI
10.1016/j.meddos.2010.10.004

In response to Drs. Kim and Shaitelman

Authors
Palta, M; Horton, JK
MLA Citation
Palta, M, and Horton, JK. "In response to Drs. Kim and Shaitelman." International Journal of Radiation Oncology Biology Physics 80.1 (2011): 315--.
Source
scival
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
80
Issue
1
Publish Date
2011
Start Page
315-
DOI
10.1016/j.ijrobp.2010.12.036

Protein Pathway Activation after Ionizing Radiation in Luminal and Basal Breast Cancer Cell Lines

Authors
Horton, JK; Fels, DR; Chi, JA; Kung, H; Kirkpatrick, JP; Dewhirst, M
MLA Citation
Horton, JK, Fels, DR, Chi, JA, Kung, H, Kirkpatrick, JP, and Dewhirst, M. "Protein Pathway Activation after Ionizing Radiation in Luminal and Basal Breast Cancer Cell Lines." INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 81.2 (2011): S160-S161.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
81
Issue
2
Publish Date
2011
Start Page
S160
End Page
S161

Impact of volumetric modulated arc therapy technique on treatment with partial breast irradiation.

PURPOSE: To investigate the technical feasibility of volumetric modulated arc therapy (V-MAT) in the delivery of partial breast irradiation (PBI). METHODS AND MATERIALS: V-MAT and the standard, three-dimensional conformal radiotherapy (3D-CRT), were compared retrospectively in 8 patients previously treated with PBI. These patients' plans were replanned with a single partial arc using V-MAT that included partial blocking to minimize normal tissue dose. Dosimetric parameters were calculated to evaluate plan quality. Quality assurance studies included verifying both the point and the multiple planar doses. Total monitor units and delivery time were also evaluated, and collision clearance was analyzed. RESULTS: Volumes of ipsilateral lung irradiated to 10 Gy (V10) and 20 Gy (V20) by V-MAT were significantly less than those of 3D-CRT (p = 0.03 for V10 and p = 0.025 for V20). The volume of ipsilateral breast irradiated to 5 Gy was significantly less by using V-MAT than with 3D-CRT (p = 0.02), with a ratio of integrated dose of <1.00. The total mean monitor units (489 +/- 38) for V-MAT were significantly less than those for 3D-CRT (634 +/- 123) (p = 0.017), with a 23% reduction. The average machine delivery time was 1.21 +/- 0.10 min for the V-MAT plans and 6.28 +/- 1.40 min for the 3D-CRT plans, resulting in a reduction factor of 80.1%. The conformity indexes were 1.3 in the V-MAT plans and 1.5 in the 3D-CRT plans (p = 0.102). CONCLUSIONS: V-MAT technology is feasible for PBI patients. Compared to a conventional 3D-CRT technique, it is more efficient, offers equivalent or better dose conformity, delivers lower doses to the ipsilateral lung and breast, and may potentially reduce intrafractional motion.

Authors
Qiu, J-J; Chang, Z; Wu, QJ; Yoo, S; Horton, J; Yin, F-F
MLA Citation
Qiu, J-J, Chang, Z, Wu, QJ, Yoo, S, Horton, J, and Yin, F-F. "Impact of volumetric modulated arc therapy technique on treatment with partial breast irradiation." Int J Radiat Oncol Biol Phys 78.1 (September 1, 2010): 288-296.
PMID
20444558
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
78
Issue
1
Publish Date
2010
Start Page
288
End Page
296
DOI
10.1016/j.ijrobp.2009.10.036

Radiosensitization of chemotherapy-refractory, locally advanced or locally recurrent breast cancer with trastuzumab: a phase II trial.

PURPOSE: Trastuzumab (Herceptin), an anti-human epidermal growth factor receptor 2 (HER2) antibody, has been shown to be an effective radiosensitizer in preclinical studies. The present Phase II trial evaluated trastuzumab plus radiotherapy in patients with HER2-positive, chemotherapy-refractory, locally advanced or locoregionally recurrent breast cancer. METHODS AND MATERIALS: Eligible patients had measurable disease, normal cardiac function, and biopsy-confirmed residual HER2-positive disease. Patients received weekly trastuzumab (2 mg/kg intravenously), concurrent with radiotherapy (50 Gy) to the breast and regional lymph nodes for 5 weeks. If feasible, surgery followed radiotherapy. The primary endpoint was safety, and the secondary endpoint was efficacy (pathologic response and interval to symptomatic local progression). RESULTS: Of the 19 patients enrolled, 7 were ineligible and received radiotherapy alone and 12 received therapy per protocol. Of these 12 patients, 11 had a Stage T4 diagnosis. Grade 3 toxicities included skin (n = 2) and lymphopenia (n = 1). One patient experienced delayed wound healing after surgery. No patients developed symptomatic cardiac dysfunction. Of the 7 patients who had undergone mastectomy, 3 (43%) had a substantial pathologic response (complete response or microscopic residual disease), significantly more than a comparison cohort (2 of 38 or 5%, p = .02). The median interval to symptomatic local progression was not reached. The median overall survival was 39 months. CONCLUSION: This is the first prospective trial providing evidence for a radiosensitizing effect of trastuzumab in breast cancer. The combination of trastuzumab and radiotherapy was well tolerated.

Authors
Horton, JK; Halle, J; Ferraro, M; Carey, L; Moore, DT; Ollila, D; Sartor, CI
MLA Citation
Horton, JK, Halle, J, Ferraro, M, Carey, L, Moore, DT, Ollila, D, and Sartor, CI. "Radiosensitization of chemotherapy-refractory, locally advanced or locally recurrent breast cancer with trastuzumab: a phase II trial." Int J Radiat Oncol Biol Phys 76.4 (March 15, 2010): 998-1004.
PMID
19560883
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
76
Issue
4
Publish Date
2010
Start Page
998
End Page
1004
DOI
10.1016/j.ijrobp.2009.03.027

Impact of a Photograph-based Educational Tool on Patient Knowledge and Satisfaction Regarding Cosmetic Outcomes after Breast Conservation Therapy: A Pilot Study

Authors
Shah, MM; Peppercorn, J; Lee, CN; Broadwater, G; Horton, JK
MLA Citation
Shah, MM, Peppercorn, J, Lee, CN, Broadwater, G, and Horton, JK. "Impact of a Photograph-based Educational Tool on Patient Knowledge and Satisfaction Regarding Cosmetic Outcomes after Breast Conservation Therapy: A Pilot Study." 2010.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
78
Issue
3
Publish Date
2010
Start Page
S232
End Page
S233

Feasibility of Preoperative Single Fraction Partial Breast Radiotherapy for Early Stage Breast Cancer

Authors
Palta, M; Yoo, S; Horton, JK
MLA Citation
Palta, M, Yoo, S, and Horton, JK. "Feasibility of Preoperative Single Fraction Partial Breast Radiotherapy for Early Stage Breast Cancer." December 15, 2009.
Source
wos-lite
Published In
Cancer Research
Volume
69
Issue
24
Publish Date
2009
Start Page
741S
End Page
741S

Accelerated partial breast irradiation: caution and concern from an ASTRO task force.

Authors
Prosnitz, LR; Horton, J; Wallner, PE
MLA Citation
Prosnitz, LR, Horton, J, and Wallner, PE. "Accelerated partial breast irradiation: caution and concern from an ASTRO task force." Int J Radiat Oncol Biol Phys 74.4 (July 15, 2009): 981-984.
PMID
19545782
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
74
Issue
4
Publish Date
2009
Start Page
981
End Page
984
DOI
10.1016/j.ijrobp.2009.03.046

Recurrence after mastectomy for ductal carcinoma in situ.

Mastectomy has long been a standard option for patients with ductal carcinoma in situ (DCIS). It is preferentially chosen by some women and may be suggested for individuals with recurrent, multifocal, or multicentric disease. We chose to evaluate our recent experience with mastectomy for DCIS. A retrospective review was conducted of 83 patients (87 breasts) from 1995 to 2006 who underwent mastectomy for DCIS. Mastectomy for DCIS was performed in 49 postmenopausal, 33 premenopausal, and one male patient. The average age was 53 years and the mean follow up was 4.5 years. Sentinel lymph node (SLN) biopsy was performed on 44 cases; positive nodes were identified in two. Intraoperative analyses of SLN were all negative. Only one patient had ipsilateral recurrence of the skin (1.1%). DCIS with microinvasion was noted in 32 per cent of the patients; none of these patients had ipsilateral recurrence. Three patients had positive microscopic margins; none have recurred to date. These results confirm the usefulness of mastectomy for patients with DCIS. We recommend SLN biopsy without intraoperative touch prep analysis. Additional treatment may not be required in patients with microinvasion, positive or close margins because our series shows no local recurrence in these patients.

Authors
Godat, LN; Horton, JK; Shen, P; Stewart, JH; Wentworth, S; Levine, EA
MLA Citation
Godat, LN, Horton, JK, Shen, P, Stewart, JH, Wentworth, S, and Levine, EA. "Recurrence after mastectomy for ductal carcinoma in situ." Am Surg 75.7 (July 2009): 592-595.
PMID
19655603
Source
pubmed
Published In
The American surgeon
Volume
75
Issue
7
Publish Date
2009
Start Page
592
End Page
595

Trends in the outcomes for patients with limited stage small cell lung cancer: An analysis of the Surveillance, Epidemiology, and End Results database.

We used the Surveillance, Epidemiology, and End Results (SEER) database to examine the outcomes of patients with limited stage small cell lung cancer (LS-SCLC) over time and to determine if any trends were present with respect to the publication of significant clinical trials. We assembled a cohort of 6271 patients aged 21 years and older with LS-SCLC diagnosed from 1983 to 1998 and followed through 2005. Potential covariates included patient age at diagnosis, sex, race, year of diagnosis, laterality, tumor size, and location (upper lobe, middle lobe, lower lobe, or main bronchus). In multivariate analysis, older age, male sex, African American race, and main bronchus location were all associated with a statistically significant increase in the mortality hazard. When compared to patients diagnosed in 1983-1987 who did not receive radiotherapy, the hazard for mortality was significantly reduced for patients diagnosed in 1988-1992 regardless of whether they received radiotherapy (HR=0.59; CI 0.52-0.65; p<0.0001) or not (HR=0.67; CI 0.60-0.75; p<0.0001). Patients who were diagnosed in 1993-1998 and received radiotherapy had similarly improved survival (HR=0.53; CI 0.47-0.58; p<0.0001), which was better than patients from the same time era who did not receive radiotherapy (HR=0.77; CI 0.69-0.85; p<0.0001). In conclusion, the survival for patients with LS-SCLC has improved over time. Many factors are likely involved, however we believe that part of this improvement was the result of clinical trials which investigated and subsequently defined chemoradiotherapy as the standard of care. In order to continue to improve clinical outcomes, clinical trials investigating new treatment paradigms are needed.

Authors
Lally, BE; Geiger, AM; Urbanic, JJ; Butler, JM; Wentworth, S; Perry, MC; Wilson, LD; Horton, JK; Detterbeck, FC; Miller, AA; Thomas, CR; Blackstock, AW
MLA Citation
Lally, BE, Geiger, AM, Urbanic, JJ, Butler, JM, Wentworth, S, Perry, MC, Wilson, LD, Horton, JK, Detterbeck, FC, Miller, AA, Thomas, CR, and Blackstock, AW. "Trends in the outcomes for patients with limited stage small cell lung cancer: An analysis of the Surveillance, Epidemiology, and End Results database." Lung Cancer 64.2 (May 2009): 226-231.
PMID
18835059
Source
pubmed
Published In
Lung Cancer
Volume
64
Issue
2
Publish Date
2009
Start Page
226
End Page
231
DOI
10.1016/j.lungcan.2008.08.010

Treatment Volume and Toxicity Outcomes: The Duke Partial Breast Experience

Authors
Horton, JK; Shaw, MM; Hubbs, J; Demirci, S; Patrone, M; Light, KL; Temple, K; Marks, LB
MLA Citation
Horton, JK, Shaw, MM, Hubbs, J, Demirci, S, Patrone, M, Light, KL, Temple, K, and Marks, LB. "Treatment Volume and Toxicity Outcomes: The Duke Partial Breast Experience." 2009.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
75
Issue
3
Publish Date
2009
Start Page
S207
End Page
S208

Comparison of three concomitant boost techniques for early-stage breast cancer.

PURPOSE: Whole breast radiotherapy (RT) followed by a tumor bed boost typically spans 5-6 weeks of treatment. Interest is growing in RT regimens, such as concomitant boost, that decrease overall treatment time, lessening the time/cost burden to patients and facilities. METHODS AND MATERIALS: Computed tomography (CT) scans from 20 cases were selected for this retrospective, dosimetric study to compare three different techniques of concomitant boost delivery: (1) standard tangents plus an electron boost, (2) intensity-modulated RT (IMRT) tangents using custom compensators plus an electron boost, and (3) IMRT tangents plus a conformal photon boost. The equivalent uniform dose model was used to compare the plans. RESULTS: The average breast equivalent uniform dose value for the three techniques (standard, IMRT plus electrons, and IMRT plus photons) was 48.6, 47.9, and 48.3, respectively. The plans using IMRT more closely approximated the prescribed dose of 46 Gy to the whole breast. The breast volume receiving >110% of the dose was less with the IMRT tangents than with standard RT (p = 0.037), but no significant difference in the maximal dose or other evaluated parameters was noted. CONCLUSION: Although the IMRT techniques delivered the prescribed dose with better dose uniformity, the small improvement seen did not support a goal of improved resource use.

Authors
Horton, JK; Halle, JS; Chang, SX; Sartor, CI
MLA Citation
Horton, JK, Halle, JS, Chang, SX, and Sartor, CI. "Comparison of three concomitant boost techniques for early-stage breast cancer." Int J Radiat Oncol Biol Phys 64.1 (January 1, 2006): 168-175.
PMID
16198507
Source
pubmed
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
64
Issue
1
Publish Date
2006
Start Page
168
End Page
175
DOI
10.1016/j.ijrobp.2005.07.004

Staging of colorectal cancer: past, present, and future.

Since the inception of staging for colorectal cancer (CRC), anatomic extent of disease has provided a solid foundation for predicting prognosis and guiding treatment in patients with CRC. However, the rapid advances in biologic and genetic technology have provided many new possibilities for enhancing the predictive power of the staging system. In this article, we will briefly discuss the history of CRC staging, identify the current parameters for American Joint Committee on Cancer staging including recent changes, and offer guidelines for future staging modifications. Although anatomic parameters have served us well for many years, their continued use as sole contributors to CRC staging is questionable. Staging in the future is likely to be a complicated combination of anatomic and biologic markers used together in mathematic modeling to group patients into prognostic risk groups, which can be used to guide tailored therapy.

Authors
Horton, JK; Tepper, JE
MLA Citation
Horton, JK, and Tepper, JE. "Staging of colorectal cancer: past, present, and future." Clin Colorectal Cancer 4.5 (January 2005): 302-312. (Review)
PMID
15663833
Source
pubmed
Published In
Clinical colorectal cancer
Volume
4
Issue
5
Publish Date
2005
Start Page
302
End Page
312

Hospice. Care when there is no cure.

Authors
Horton, JK
MLA Citation
Horton, JK. "Hospice. Care when there is no cure." N C Med J 62.2 (March 2001): 86-90.
PMID
11270310
Source
pubmed
Published In
North Carolina Medical Journal
Volume
62
Issue
2
Publish Date
2001
Start Page
86
End Page
90

Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Ductal Carcinoma In Situ

Authors
Morrow, M; Van Zee, KJ; Solin, LJ; Houssami, N; Chavez-MacGregor, M; Harris, JR; Horton, J; Hwang, S; Johnson, PL; Marinovich, ML; Schnitt, SJ; Wapnir, I; Moran, MS
MLA Citation
Morrow, M, Van Zee, KJ, Solin, LJ, Houssami, N, Chavez-MacGregor, M, Harris, JR, Horton, J, Hwang, S, Johnson, PL, Marinovich, ML, Schnitt, SJ, Wapnir, I, and Moran, MS. "Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Ductal Carcinoma In Situ (Published online)." Journal of Clinical Oncology.
Source
crossref
Published In
Journal of Clinical Oncology
DOI
10.1200/JCO.2016.68.3573
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