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Palta, Manisha

Overview:

Clinical research in gastrointestinal malignancies, lymphomas and breast malignancies.

Positions:

Assistant Professor of Radiation Oncology

Radiation Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 2007

M.D. — University of Florida College of Medicine

Intern, Internal Medicine

University of North Carolina at Chapel Hill

Resident, Radiation Oncology

Duke University School of Medicine

Publications:

Neoadjuvant long-course chemoradiation remains strongly favored over short-course radiotherapy by radiation oncologists in the United States.

Short-course radiotherapy (SC-RT) and long-course chemoradiotherapy (LC-CRT) are accepted neoadjuvant treatments of rectal cancer. In the current study, the authors surveyed US radiation oncologists to assess practice patterns and attitudes regarding SC-RT and LC-CRT for patients with rectal cancer.The authors distributed a survey to 1701 radiation oncologists regarding treatment of neoadjuvant rectal cancer. Respondents were asked questions regarding the number of patients with rectal cancer treated, preference for SC-RT versus LC-CRT, and factors influencing regimen choice.Of 1659 contactable physicians, 182 responses (11%) were received. Approximately 83% treated at least 5 patients with rectal cancer annually. The majority of responding radiation oncologists (96%) preferred neoadjuvant LC-CRT for the treatment of patients with locally advanced rectal cancer and 44% never used SC-RT. Among radiation oncologists using SC-RT, respondents indicated they would not recommend this regimen for patients with low (74%) or bulky tumors (70%) and/or concern for a positive circumferential surgical resection margin (69%). The most frequent reasons for not offering SC-RT were insufficient downstaging for sphincter preservation (53%) and a desire for longer follow-up (45%). Many radiation oncologists indicated they would prescribe SC-RT for patients not receiving chemotherapy (62%) or patients with a geographic barrier to receiving LC-CRT (82%). Patient comorbidities appeared to influence regimen preferences for 79% of respondents. Approximately 20% of respondents indicated that altered oncology care reimbursement using capitated payment by diagnosis would impact their consideration of SC-RT.US radiation oncologists rarely use neoadjuvant SC-RT despite 3 randomized controlled trials demonstrating no significant differences in outcome compared with LC-CRT. Further research is necessary to determine whether longer follow-up coupled with the benefits of lower cost, increased patient convenience, and lower acute toxicity will increase the adoption of SC-RT by radiation oncologists in the United States. Cancer 2016. © 2016 American Cancer Society.

Authors
Mowery, YM; Salama, JK; Zafar, SY; Moore, HG; Willett, CG; Czito, BG; Hopkins, MB; Palta, M
MLA Citation
Mowery, YM, Salama, JK, Zafar, SY, Moore, HG, Willett, CG, Czito, BG, Hopkins, MB, and Palta, M. "Neoadjuvant long-course chemoradiation remains strongly favored over short-course radiotherapy by radiation oncologists in the United States." Cancer (December 16, 2016).
PMID
27984651
Source
epmc
Published In
Cancer
Publish Date
2016
DOI
10.1002/cncr.30461

Radiation Oncologists' Practice Patterns and Attitudes Regarding Neoadjuvant Short-Course Radiation Therapy for Rectal Cancer in the United States

Authors
Mowery, YM; Salama, JK; Zafar, SY; Moore, HG; Willett, CG; Czito, B; Hopkins, MB; Palta, M
MLA Citation
Mowery, YM, Salama, JK, Zafar, SY, Moore, HG, Willett, CG, Czito, B, Hopkins, MB, and Palta, M. "Radiation Oncologists' Practice Patterns and Attitudes Regarding Neoadjuvant Short-Course Radiation Therapy for Rectal Cancer in the United States." October 1, 2016.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2
Publish Date
2016
Start Page
S203
End Page
S203

The Use of Reirradiation in Locally Recurrent, Nonmetastatic Rectal Cancer

Authors
Susko, M; Lee, J; Salama, JK; Thomas, S; Uronis, H; Hsu, D; Migaly, J; Willett, CG; Czito, B; Palta, M
MLA Citation
Susko, M, Lee, J, Salama, JK, Thomas, S, Uronis, H, Hsu, D, Migaly, J, Willett, CG, Czito, B, and Palta, M. "The Use of Reirradiation in Locally Recurrent, Nonmetastatic Rectal Cancer." October 1, 2016.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2
Publish Date
2016
Start Page
E192
End Page
E193

Triphasic Bolus Tracking Computed Tomography Simulation for Stereotactic Body Radiation Therapy of Locoregionally Advanced Pancreatic Cancer

Authors
Godfrey, DJ; Patel, BN; Adamson, J; Salama, JK; Palta, M
MLA Citation
Godfrey, DJ, Patel, BN, Adamson, J, Salama, JK, and Palta, M. "Triphasic Bolus Tracking Computed Tomography Simulation for Stereotactic Body Radiation Therapy of Locoregionally Advanced Pancreatic Cancer." October 1, 2016.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2
Publish Date
2016
Start Page
E200
End Page
E201

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

Interim Acute Toxicity Analysis and Surgical Outcomes of Neoadjuvant Gemcitabine/nab-Paclitaxel and Hypofractionated Image Guided Intensity Modulated Radiation Therapy in Resectable and Borderline Resectable Pancreatic Cancer (ANCHOR) Study

Authors
Palta, M; Czito, B; Abbruzzese, J; Uronis, H; Duffy, EA; Blazer, DT; Willett, CG
MLA Citation
Palta, M, Czito, B, Abbruzzese, J, Uronis, H, Duffy, EA, Blazer, DT, and Willett, CG. "Interim Acute Toxicity Analysis and Surgical Outcomes of Neoadjuvant Gemcitabine/nab-Paclitaxel and Hypofractionated Image Guided Intensity Modulated Radiation Therapy in Resectable and Borderline Resectable Pancreatic Cancer (ANCHOR) Study." October 1, 2016.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2
Publish Date
2016
Start Page
S204
End Page
S205

Interim FDG Positron Emission Tomography Imaging During Chemoradiation for Squamous Anal Canal Carcinoma

Authors
Hong, JC; Eng, J; Faught, A; Higgins, K; Cui, Y; Yin, FF; Das, SK; Czito, B; Willett, CG; Palta, M
MLA Citation
Hong, JC, Eng, J, Faught, A, Higgins, K, Cui, Y, Yin, FF, Das, SK, Czito, B, Willett, CG, and Palta, M. "Interim FDG Positron Emission Tomography Imaging During Chemoradiation for Squamous Anal Canal Carcinoma." October 1, 2016.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2
Publish Date
2016
Start Page
E183
End Page
E183

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

The Use of Re-irradiation in Locally Recurrent, Non-metastatic Rectal Cancer.

The optimal approach to patients with locally recurrent, non-metastatic rectal cancer is unclear. This study evaluates the outcomes and toxicity associated with pelvic re-irradiation.Patients undergoing re-irradiation for locally recurrent, non-metastatic, rectal cancer between 2000 and 2014 were identified. Acute and late toxicities were assessed using common terminology criteria for adverse events version 4.0. Disease-related endpoints included palliation of local symptoms, surgical outcomes, and local progression-free survival (PFS), distant PFS and overall survival (OS) using the Kaplan-Meier method.Thirty-three patients met the criteria for inclusion in this study. Two (6 %) experienced early grade 3+ toxicity and seven (21 %) experienced late grade 3+ toxicity. Twenty-three patients presented with symptomatic local recurrence and 18 (78 %) reported symptomatic relief. Median local PFS was 8.7 (95 % CI 3.8-15.2) months, with a 2-year rate of 15.7 % (4.1-34.2), and median time to distant progression was 4.4 (2.2-33.3) months, with a 2-year distant PFS rate of 38.9 % (20.1-57.3). Median OS time for patients was 23.1 (11.1-33.0) months. Of the 14 patients who underwent surgery, median survival was 32.3 (13.8-48.0) months compared with 13.3 (2.2-33.0) months in patients not undergoing surgery (p = 0.10). A margin-negative (R0) resection was achieved in 10 (71 %) of the surgeries. Radiation treatment modality (intensity-modulated radiation therapy, three-dimensional conformal radiotherapy, intraoperative radiation therapy) did not influence local or distant PFS or OS.Re-irradiation is a beneficial treatment modality for the management of locally recurrent, non-metastatic rectal cancer. It is associated with symptom improvement, low rates of toxicity, and similar benefits among radiation modalities.

Authors
Susko, M; Lee, J; Salama, J; Thomas, S; Uronis, H; Hsu, D; Migaly, J; Willett, C; Czito, B; Palta, M
MLA Citation
Susko, M, Lee, J, Salama, J, Thomas, S, Uronis, H, Hsu, D, Migaly, J, Willett, C, Czito, B, and Palta, M. "The Use of Re-irradiation in Locally Recurrent, Non-metastatic Rectal Cancer." Annals of surgical oncology 23.11 (October 2016): 3609-3615.
PMID
27169769
Source
epmc
Published In
Annals of Surgical Oncology
Volume
23
Issue
11
Publish Date
2016
Start Page
3609
End Page
3615
DOI
10.1245/s10434-016-5250-z

Radiation Oncologists' Practice Patterns and Attitudes Regarding Neoadjuvant Short-Course Radiation Therapy for Rectal Cancer in the United States.

Authors
Mowery, YM; Salama, JK; Zafar, SY; Moore, HG; Willett, CG; Czito, B; Hopkins, MB; Palta, M
MLA Citation
Mowery, YM, Salama, JK, Zafar, SY, Moore, HG, Willett, CG, Czito, B, Hopkins, MB, and Palta, M. "Radiation Oncologists' Practice Patterns and Attitudes Regarding Neoadjuvant Short-Course Radiation Therapy for Rectal Cancer in the United States." International journal of radiation oncology, biology, physics 96.2S (October 2016): S203-.
PMID
27675787
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2S
Publish Date
2016
Start Page
S203
DOI
10.1016/j.ijrobp.2016.06.505

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

The Use of Reirradiation in Locally Recurrent, Nonmetastatic Rectal Cancer.

Authors
Susko, M; Lee, J; Salama, JK; Thomas, S; Uronis, H; Hsu, D; Migaly, J; Willett, CG; Czito, B; Palta, M
MLA Citation
Susko, M, Lee, J, Salama, JK, Thomas, S, Uronis, H, Hsu, D, Migaly, J, Willett, CG, Czito, B, and Palta, M. "The Use of Reirradiation in Locally Recurrent, Nonmetastatic Rectal Cancer." International journal of radiation oncology, biology, physics 96.2S (October 2016): E192-E193.
PMID
27674024
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2S
Publish Date
2016
Start Page
E192
End Page
E193
DOI
10.1016/j.ijrobp.2016.06.1076

Triphasic Bolus Tracking Computed Tomography Simulation for Stereotactic Body Radiation Therapy of Locoregionally Advanced Pancreatic Cancer.

Authors
Godfrey, DJ; Patel, BN; Adamson, J; Salama, JK; Palta, M
MLA Citation
Godfrey, DJ, Patel, BN, Adamson, J, Salama, JK, and Palta, M. "Triphasic Bolus Tracking Computed Tomography Simulation for Stereotactic Body Radiation Therapy of Locoregionally Advanced Pancreatic Cancer." International journal of radiation oncology, biology, physics 96.2S (October 2016): E200-E201.
PMID
27674047
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2S
Publish Date
2016
Start Page
E200
End Page
E201
DOI
10.1016/j.ijrobp.2016.06.1095

Interim Acute Toxicity Analysis and Surgical Outcomes of Neoadjuvant Gemcitabine/nab-Paclitaxel and Hypofractionated Image Guided Intensity Modulated Radiation Therapy in Resectable and Borderline Resectable Pancreatic Cancer (ANCHOR) Study.

Authors
Palta, M; Czito, B; Abbruzzese, J; Uronis, H; Duffy, EA; Blazer, DT; Willett, CG
MLA Citation
Palta, M, Czito, B, Abbruzzese, J, Uronis, H, Duffy, EA, Blazer, DT, and Willett, CG. "Interim Acute Toxicity Analysis and Surgical Outcomes of Neoadjuvant Gemcitabine/nab-Paclitaxel and Hypofractionated Image Guided Intensity Modulated Radiation Therapy in Resectable and Borderline Resectable Pancreatic Cancer (ANCHOR) Study." International journal of radiation oncology, biology, physics 96.2S (October 2016): S204-S205.
PMID
27675789
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2S
Publish Date
2016
Start Page
S204
End Page
S205
DOI
10.1016/j.ijrobp.2016.06.509

Interim FDG Positron Emission Tomography Imaging During Chemoradiation for Squamous Anal Canal Carcinoma.

Authors
Hong, JC; Eng, J; Faught, A; Higgins, K; Cui, Y; Yin, FF; Das, SK; Czito, B; Willett, CG; Palta, M
MLA Citation
Hong, JC, Eng, J, Faught, A, Higgins, K, Cui, Y, Yin, FF, Das, SK, Czito, B, Willett, CG, and Palta, M. "Interim FDG Positron Emission Tomography Imaging During Chemoradiation for Squamous Anal Canal Carcinoma." International journal of radiation oncology, biology, physics 96.2S (October 2016): E183-.
PMID
27673997
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2S
Publish Date
2016
Start Page
E183
DOI
10.1016/j.ijrobp.2016.06.1050

Role of Adjuvant Radiotherapy in Locally Advanced Colonic Carcinoma in the Modern Chemotherapy Era.

The role of adjuvant radiation therapy (RT) in the treatment of resected, locally advanced colon cancer is unclear. One randomized controlled trial (Intergroup-0130) addressed this question but failed to meet its accrual goals. Since this trial, few attempts have been made to reassess the role of RT in this clinical setting.Sixty-two patients with non-metastatic, American Joint Committee on Cancer 7th edition stage T4 colonic adenocarcinoma were treated at our institution between 2000 and 2013. All underwent curative-intent surgery. Sixteen patients underwent resection only, 33 patients received adjuvant chemotherapy (ChT), and 13 patients received adjuvant chemoradiation therapy (CRT).Patients receiving adjuvant CRT were more likely to have T4b (vs. T4a) disease and were more likely to undergo R1 or R2 resection compared with those receiving adjuvant ChT alone. Despite this, multivariate analysis demonstrated that treatment with adjuvant CRT (vs. adjuvant ChT) enhanced locoregional control and disease-free survival (hazard ratio 0.044 and 0.145, respectively; p < 0.05).Adjuvant RT for T4 colon cancers may be appropriate in select patients, specifically those with T4b lesions and/or residual disease following resection.

Authors
Ludmir, EB; Arya, R; Wu, Y; Palta, M; Willett, CG; Czito, BG
MLA Citation
Ludmir, EB, Arya, R, Wu, Y, Palta, M, Willett, CG, and Czito, BG. "Role of Adjuvant Radiotherapy in Locally Advanced Colonic Carcinoma in the Modern Chemotherapy Era." Annals of surgical oncology 23.3 (March 2016): 856-862.
PMID
26480849
Source
epmc
Published In
Annals of Surgical Oncology
Volume
23
Issue
3
Publish Date
2016
Start Page
856
End Page
862
DOI
10.1245/s10434-015-4907-3

Image Guided Hypofractionated Postprostatectomy Intensity Modulated Radiation Therapy for Prostate Cancer.

Hypofractionated radiation therapy (RT) has promising long-term biochemical relapse-free survival (bRFS) with comparable toxicity for definitive treatment of prostate cancer. However, data reporting outcomes after adjuvant and salvage postprostatectomy hypofractionated RT are sparse. Therefore, we report the toxicity and clinical outcomes after postprostatectomy hypofractionated RT.From a prospectively maintained database, men receiving image guided hypofractionated intensity modulated RT (HIMRT) with 2.5-Gy fractions constituted our study population. Androgen deprivation therapy was used at the discretion of the radiation oncologist. Acute toxicities were graded according to the Common Terminology Criteria for Adverse Events version 4.0. Late toxicities were scored using the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer scale. Biochemical recurrence was defined as an increase of 0.1 in prostate-specific antigen (PSA) from posttreatment nadir or an increase in PSA despite treatment. The Kaplan-Meier method was used for the time-to-event outcomes.Between April 2008 and April 2012, 56 men received postoperative HIMRT. The median follow-up time was 48 months (range, 21-67 months). Thirty percent had pre-RT PSA <0.1; the median pre-RT detectable PSA was 0.32 ng/mL. The median RT dose was 65 Gy (range, 57.5-65 Gy). Ten patients received neoadjuvant and concurrent hormone therapy. Posttreatment acute urinary toxicity was limited. There was no acute grade 3 toxicity. Late genitourinary (GU) toxicity of any grade was noted in 52% of patients, 40% of whom had pre-RT urinary incontinence. The 4-year actuarial rate of late grade 3 GU toxicity (exclusively gross hematuria) was 28% (95% confidence interval [CI], 16%-41%). Most grade 3 GU toxicity resolved; only 7% had persistent grade ≥3 toxicity at the last follow-up visit. Fourteen patients experienced biochemical recurrence at a median of 20 months after radiation. The 4-year bPFS rate was 75% (95% CI, 63%-87%).The biochemical control in this series appears promising, although relatively short follow-up may lead to overestimation. Late grade 3 GU toxicity was higher than anticipated with hypofractionated radiation of 65 Gy to the prostate bed, although most resolved.

Authors
Lewis, SL; Patel, P; Song, H; Freedland, SJ; Bynum, S; Oh, D; Palta, M; Yoo, D; Oleson, J; Salama, JK
MLA Citation
Lewis, SL, Patel, P, Song, H, Freedland, SJ, Bynum, S, Oh, D, Palta, M, Yoo, D, Oleson, J, and Salama, JK. "Image Guided Hypofractionated Postprostatectomy Intensity Modulated Radiation Therapy for Prostate Cancer." International journal of radiation oncology, biology, physics 94.3 (March 2016): 605-611.
PMID
26867889
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
94
Issue
3
Publish Date
2016
Start Page
605
End Page
611
DOI
10.1016/j.ijrobp.2015.11.025

In Reply to Fiorino and Cozzarini.

Authors
Lewis, SL; Patel, PR; Palta, M; Yoo, DS; Salama, JK
MLA Citation
Lewis, SL, Patel, PR, Palta, M, Yoo, DS, and Salama, JK. "In Reply to Fiorino and Cozzarini." International journal of radiation oncology, biology, physics 94.4 (March 2016): 860-861.
PMID
26972661
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
94
Issue
4
Publish Date
2016
Start Page
860
End Page
861
DOI
10.1016/j.ijrobp.2016.01.009

Effect of combined neoadjuvant chemoradiation on overall survival for patients with locally advanced rectal cancer.

Authors
Sun, Z; Adam, MA; Kim, J; Hsu, S-WD; Palta, M; Czito, BG; Migaly, J; Mantyh, C
MLA Citation
Sun, Z, Adam, MA, Kim, J, Hsu, S-WD, Palta, M, Czito, BG, Migaly, J, and Mantyh, C. "Effect of combined neoadjuvant chemoradiation on overall survival for patients with locally advanced rectal cancer." February 1, 2016.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
34
Issue
4
Publish Date
2016

Nonoperative management of rectal cancer.

Surgery has long been the primary curative modality for localized rectal cancer. Neoadjuvant chemoradiation has significantly improved local control rates and, in a significant minority, eradicated all disease. Patients who achieve a pathologic complete response to neoadjuvant therapy have an excellent prognosis, although the combination treatment is associated with long-term morbidity. Because of this, a nonoperative management (NOM) strategy has been pursued to preserve sphincter function in select patients. Clinical and radiographic findings are used to identify patients achieving a clinical complete response to chemoradiation, and they are then followed with intensive surveillance. Incomplete, nonresponding and those demonstrating local progression are referred for salvage with standard surgery. Habr-Gama and colleagues have published extensively on this treatment strategy and have laid the groundwork for this approach. This watch-and-wait strategy has evolved over time, and several groups have now reported their results, including recent prospective experiences. Although initial results appear promising, several significant challenges remain for NOM of rectal cancer. Further study is warranted before routine implementation in the clinic.

Authors
Torok, JA; Palta, M; Willett, CG; Czito, BG
MLA Citation
Torok, JA, Palta, M, Willett, CG, and Czito, BG. "Nonoperative management of rectal cancer." Cancer 122.1 (January 2016): 34-41.
PMID
26599064
Source
epmc
Published In
Cancer
Volume
122
Issue
1
Publish Date
2016
Start Page
34
End Page
41
DOI
10.1002/cncr.29735

A current perspective on stereotactic body radiation therapy for pancreatic cancer.

Pancreatic cancer is a formidable malignancy with poor outcomes. The majority of patients are unable to undergo resection, which remains the only potentially curative treatment option. The management of locally advanced (unresectable) pancreatic cancer is controversial; however, treatment with either chemotherapy or chemoradiation is associated with high rates of local tumor progression and metastases development, resulting in low survival rates. An emerging local modality is stereotactic body radiation therapy (SBRT), which uses image-guided, conformal, high-dose radiation. SBRT has demonstrated promising local control rates and resultant quality of life with acceptable rates of toxicity. Over the past decade, increasing clinical experience and data have supported SBRT as a local treatment modality. Nevertheless, additional research is required to further evaluate the role of SBRT and improve upon the persistently poor outcomes associated with pancreatic cancer. This review discusses the existing clinical experience and technical implementation of SBRT for pancreatic cancer and highlights the directions for ongoing and future studies.

Authors
Hong, JC; Czito, BG; Willett, CG; Palta, M
MLA Citation
Hong, JC, Czito, BG, Willett, CG, and Palta, M. "A current perspective on stereotactic body radiation therapy for pancreatic cancer." OncoTargets and therapy 9 (January 2016): 6733-6739. (Review)
Website
http://hdl.handle.net/10161/13277
PMID
27826200
Source
epmc
Published In
OncoTargets and Therapy
Volume
9
Publish Date
2016
Start Page
6733
End Page
6739

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

Prospective Study of Interim 18FDG-PET Response Assessment in Esophageal Cancer Patients Treated With Neoadjuvant Chemoradiation and Esophagectomy

Authors
Palta, M; Higgins, K; Wu, QRJ; Czito, B; Willett, CG; Das, SK
MLA Citation
Palta, M, Higgins, K, Wu, QRJ, Czito, B, Willett, CG, and Das, SK. "Prospective Study of Interim 18FDG-PET Response Assessment in Esophageal Cancer Patients Treated With Neoadjuvant Chemoradiation and Esophagectomy." November 1, 2015.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
93
Issue
3
Publish Date
2015
Start Page
E180
End Page
E181

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

Adjuvant radiation therapy for pancreatic cancer: a review of the old and the new.

Surgery represents the only potential curative treatment option for patients diagnosed with pancreatic adenocarcinoma. Despite aggressive surgical management for patients deemed to be resectable, rates of local recurrence and/or distant metastases remain high, resulting in poor long-term outcomes. In an effort to reduce recurrence rates and improve survival for patients having undergone resection, adjuvant therapies (ATs) including chemotherapy and chemoradiation therapy (CRT) have been explored. While adjuvant chemotherapy has been shown to consistently improve outcomes, the data regarding adjuvant radiation therapy (RT) is mixed. Although the ability of radiation to improve local control has been demonstrated, it has not always led to improved survival outcomes for patients. Early trials are flawed in their utilization of sub-optimal radiation techniques, limiting their generalizability. Recent and ongoing trials incorporate more optimized RT approaches and seek to clarify its role in treatment strategies. At the same time novel radiation techniques such as intensity modulated RT (IMRT) and stereotactic body RT (SBRT) are under active investigation. It is hoped that these efforts will lead to improved disease-related outcomes while reducing toxicity rates.

Authors
Boyle, J; Czito, B; Willett, C; Palta, M
MLA Citation
Boyle, J, Czito, B, Willett, C, and Palta, M. "Adjuvant radiation therapy for pancreatic cancer: a review of the old and the new." Journal of gastrointestinal oncology 6.4 (August 2015): 436-444. (Review)
PMID
26261730
Source
epmc
Published In
Journal of Gastrointestinal Oncology
Volume
6
Issue
4
Publish Date
2015
Start Page
436
End Page
444
DOI
10.3978/j.issn.2078-6891.2015.014

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

Human papillomavirus tumor infection in esophageal squamous cell carcinoma.

The association between human papillomavirus (HPV) and esophageal squamous cell carcinoma (ESCC) has been recognized for over three decades. Recently, multiple meta-analyses have drawn upon existing literature to assess the strength of the HPV-ESCC linkage. Here, we review these analyses and attempt to provide a clinically-relevant overview of HPV infection in ESCC. HPV-ESCC detection rates are highly variable across studies. Geographic location likely accounts for a majority of the variation in HPV prevalence, with high-incidence regions including Asia reporting significantly higher HPV-ESCC infection rates compared with low-incidence regions such as Europe, North America, and Oceania. Based on our examination of existing data, the current literature does not support the notion that HPV is a prominent carcinogen in ESCC. We conclude that there is no basis to change the current clinical approach to ESCC patients with respect to tumor HPV status.

Authors
Ludmir, EB; Stephens, SJ; Palta, M; Willett, CG; Czito, BG
MLA Citation
Ludmir, EB, Stephens, SJ, Palta, M, Willett, CG, and Czito, BG. "Human papillomavirus tumor infection in esophageal squamous cell carcinoma." Journal of gastrointestinal oncology 6.3 (June 2015): 287-295. (Review)
PMID
26029456
Source
epmc
Published In
Journal of Gastrointestinal Oncology
Volume
6
Issue
3
Publish Date
2015
Start Page
287
End Page
295
DOI
10.3978/j.issn.2078-6891.2015.001

TH-CD-207-09: Retrospective 4D-MRI with a Novel Image-Based Surrogate: A Sagittal-Coronal-Diaphragm Point of Intersection (SCD-PoI) Motion Tracking Method.

PURPOSE: The unreliable stability of internal respiratory surrogates and inconvenience of external respiratory surrogates for current retrospective 4D-MRI techniques largely affects the image quality of 4D-MRI. This study aims at developing image-based surrogate, a sagittal-coronal-diaphragm point of intersection (SCD-PoI) motion tracking method for retrospective 4D-MRI reconstruction. METHODS/MATERIALS: As a pre-estimate of respiratory motion pattern, single-slice sagittal cines (FIESTA) were acquired at a location near the dome of the diaphragm. Subsequently, multi-slice coronal cines (FIESTA) were acquired and used for 4D-MRI reconstruction with phase sorting. Diaphragm motion trajectories were measured from the point of intersection between sagittal MRI cine plane, coronal MRI cine plain and the diaphragm dome surface. This point is defined as sagittal-coronal-diaphragm point of intersection (SCD-PoI). We pre-estimate respiraotyr motion by tracking SCD-PoI on sagitall cine. Then coronal images were then re-binned to different phased bins according to SCD-PoI motion tracking on coronal cine. This 4D-MRI technique was evaluated on a 4D Digital Extended Cardiac-Torso (XCAT) human phantom with a hypothesized moving tumor, six healthy voluneteers and two cancer patients under an IRB-approved study. Region of interest (ROI: tumor for XCAT and patients, dome of left kidney for healthy volunteers) trajectories on 4D-MRI were measured and compared with the reference (input respiratory curve for XCAT and ROI trajectories extracted from reference single-slice MRI cine (FIESTA) for human subjects). Superior-inferior (SI) mean absolute amplitude difference (D) and cross-correlation coefficient (CC) were calculated. RESULTS: 4D-MRI on XCAT demonstrated highly accurate motion information with a low D (1.13mm) and a high CC (0.98) in the SI direction. Minimal artifacts were observed in human participants' 4D-MRI, and images were adequate to reveal the respiratory motion of organs and tumor (D=1.08±1.03mm; CC=0.96). CONCLUSION: A novel 4D-MRI technique with image-based respiratory surrogate has been developed and tested on a digital phantom and human subjects.

Authors
Liu, Y; Yin, F; Czito, B; Bashir, M; Palta, M; Cai, J
MLA Citation
Liu, Y, Yin, F, Czito, B, Bashir, M, Palta, M, and Cai, J. "TH-CD-207-09: Retrospective 4D-MRI with a Novel Image-Based Surrogate: A Sagittal-Coronal-Diaphragm Point of Intersection (SCD-PoI) Motion Tracking Method." Medical physics 42.6 (June 2015): 3736-.
PMID
26129566
Source
epmc
Published In
Medical physics
Volume
42
Issue
6
Publish Date
2015
Start Page
3736
DOI
10.1118/1.4926267

SU-F-303-13: Initial Evaluation of Four Dimensional Diffusion- Weighted MRI (4D-DWI) and Its Effect On Apparent Diffusion Coefficient (ADC) Measurement.

PURPOSE: Diffusion-weighted imaging(DWI) has been shown to have superior tumor-to-tissue contrast for cancer detection.This study aims at developing and evaluating a four dimensional DWI(4D-DWI) technique using retrospective sorting method for imaging respiratory motion for radiotherapy planning,and evaluate its effect on Apparent Diffusion Coefficient(ADC) measurement. MATERIALS/METHODS: Image acquisition was performed by repeatedly imaging a volume of interest using a multi-slice single-shot 2D-DWI sequence in the axial planes and cine MRI(served as reference) using FIESTA sequence.Each 2D-DWI image were acquired in xyz-diffusion-directions with a high b-value(b=500s/mm2).The respiratory motion was simultaneously recorded using bellows.Retrospective sorting was applied in each direction to reconstruct 4D-DWI.The technique was evaluated using a computer simulated 4D-digital human phantom(XCAT),a motion phantom and a healthy volunteer under an IRB-approved study.Motion trajectories of regions-of-interests(ROI) were extracted from 4D-DWI and compared with reference.The mean motion trajectory amplitude differences(D) between the two was calculated.To quantitatively analyze the motion artifacts,XCAT were controlled to simulate regular motion and the motions of 10 liver cancer patients.4D-DWI,free-breathing DWI(FB- DWI) were reconstructed.Tumor volume difference(VD) of each phase of 4D-DWI and FB-DWI from the input static tumor were calculated.Furthermore, ADC was measured for each phase of 4D-DWI and FB-DWI data,and mean tumor ADC values(M-ADC) were calculated.Mean M-ADC over all 4D-DWI phases was compared with M-ADC calculated from FB-DWI. RESULTS: 4D-DWI of XCAT,the motion phantom and the healthy volunteer demonstrated the respiratory motion clearly.ROI D values were 1.9mm,1.7mm and 2.0mm,respectively.For motion artifacts analysis,XCAT 4D-DWI images show much less motion artifacts compare to FB-DWI.Mean VD for 4D-WDI and FB-DWI were 8.5±1.4% and 108±15%,respectively.Mean M-ADC for ADC measured from 4D-DWI and M-ADC measured from FB-DWI were (2.29±0.04)*0.001*mm2/s and (3.80±0.01)*0.001*mm2/s,respectively.ADC value ground-truth is 2.24*0.001*mm2/s from the input of the simulation. CONCLUSION: A respiratory correlated 4D-DWI technique has been initially evaluated in phantoms and a human subject.Comparing to free breathing DWI,4D-DWI can lead to more accurate measurement of ADC.

Authors
Liu, Y; Yin, F; Czito, B; Bashir, M; Palta, M; Zhong, X; Dale, B; Cai, J
MLA Citation
Liu, Y, Yin, F, Czito, B, Bashir, M, Palta, M, Zhong, X, Dale, B, and Cai, J. "SU-F-303-13: Initial Evaluation of Four Dimensional Diffusion- Weighted MRI (4D-DWI) and Its Effect On Apparent Diffusion Coefficient (ADC) Measurement." Medical physics 42.6 (June 2015): 3540-.
PMID
26128539
Source
epmc
Published In
Medical physics
Volume
42
Issue
6
Publish Date
2015
Start Page
3540
DOI
10.1118/1.4925240

SU-E-J-223: A BOLD Contrast Imaging Sequence to Evaluate Oxygenation Changes Due to Breath Holding for Breast Radiotherapy: A Pilot Study.

PURPOSE: To develop a robust MRI sequence to measure BOLD breath hold induced contrast in context of breast radiotherapy. METHODS: Two sequences were selected from prior studies as candidates to measure BOLD contrast attributable to breath holding within the breast: (1) T2* based Gradient Echo EPI (TR/TE = 500/41ms, flip angle = 60°), and (2) T2 based Single Shot Fast Spin Echo (SSFSE) (TR/TE = 3000/60ms). We enrolled ten women post-lumpectomy for breast cancer who were undergoing treatment planning for whole breast radiotherapy. Each session utilized a 1.5T GE MRI and 4 channel breast coil with the subject immobilized prone on a custom board. For each sequence, 1-3 planes of the lumpectomy breast were imaged continuously during a background measurement (1min) and intermittent breath holds (20-40s per breath hold, 3-5 holds per sequence). BOLD contrast was quantified as correlation of changes in per-pixel intensity with the breath hold schedule convolved with a hemodynamic response function. Subtle motion was corrected using a deformable registration algorithm. Correlation with breath-holding was considered significant if p<0.001. RESULTS: The percentage of the breast ROI with positive BOLD contrast measured by the two sequences were in agreement with a correlation coefficient of R=0.72 (p=0.02). While both sequences demonstrated areas with strong BOLD response, the response was more systematic throughout the breast for the SSFSE (T2) sequence (% breast with response in the same direction: 51.2%±0.7% for T2* vs. 68.1%±16% for T2). In addition, the T2 sequence was less prone to magnetic susceptibility artifacts, especially in presence of seroma, and provided a more robust image with little distortion or artifacts. CONCLUSION: A T2 SSFSE sequence shows promise for measuring BOLD contrast in the context of breast radiotherapy utilizing a breath hold technique. Further study in a larger patient cohort is warranted to better refine this novel technique.

Authors
Adamson, J; Chang, Z; Cai, J; Palta, M; Horton, J; Yin, F; Blitzblau, R
MLA Citation
Adamson, J, Chang, Z, Cai, J, Palta, M, Horton, J, Yin, F, and Blitzblau, R. "SU-E-J-223: A BOLD Contrast Imaging Sequence to Evaluate Oxygenation Changes Due to Breath Holding for Breast Radiotherapy: A Pilot Study." Medical physics 42.6 (June 2015): 3317-.
PMID
26127614
Source
epmc
Published In
Medical physics
Volume
42
Issue
6
Publish Date
2015
Start Page
3317
DOI
10.1118/1.4924309

A BOLD Contrast Imaging Sequence to Evaluate Oxygenation Changes Due to Breath Holding for Breast Radiotherapy: A Pilot Study

Authors
Adamson, J; Chang, Z; Cai, J; Palta, M; Horton, J; Yin, F; Blitzblau, R
MLA Citation
Adamson, J, Chang, Z, Cai, J, Palta, M, Horton, J, Yin, F, and Blitzblau, R. "A BOLD Contrast Imaging Sequence to Evaluate Oxygenation Changes Due to Breath Holding for Breast Radiotherapy: A Pilot Study." June 2015.
Source
wos-lite
Published In
Medical physics
Volume
42
Issue
6
Publish Date
2015
Start Page
3317
End Page
3317

Initial Evaluation of Four Dimensional Diffusion-Weighted MRI (4D-DWI) and Its Effect On Apparent Diffusion Coefficient (ADC) Measurement

Authors
Liu, Y; Yin, F; Czito, B; Bashir, M; Palta, M; Zhong, X; Dale, B; Cai, J
MLA Citation
Liu, Y, Yin, F, Czito, B, Bashir, M, Palta, M, Zhong, X, Dale, B, and Cai, J. "Initial Evaluation of Four Dimensional Diffusion-Weighted MRI (4D-DWI) and Its Effect On Apparent Diffusion Coefficient (ADC) Measurement." June 2015.
Source
wos-lite
Published In
Medical physics
Volume
42
Issue
6
Publish Date
2015
Start Page
3540
End Page
3540

Retrospective 4D-MRI with a Novel Image-Based Surrogate: A Sagittal-Coronal-Diaphragm Point of Intersection (SCD-PoI) Motion Tracking Method

Authors
Liu, Y; Yin, F; Czito, B; Bashir, M; Palta, M; Cai, I
MLA Citation
Liu, Y, Yin, F, Czito, B, Bashir, M, Palta, M, and Cai, I. "Retrospective 4D-MRI with a Novel Image-Based Surrogate: A Sagittal-Coronal-Diaphragm Point of Intersection (SCD-PoI) Motion Tracking Method." June 2015.
Source
wos-lite
Published In
Medical physics
Volume
42
Issue
6
Publish Date
2015
Start Page
3736
End Page
3736

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

Abstract P1-10-02: Adjuvant radiation after lumpectomy: A cost comparison of treatment patterns in 43,247 women from the National Cancer Data Base

Authors
Greenup, RA; Blitzblau, R; Houck, K; Horton, J; Howie, L; Palta, M; Mackey, A; Scheri, R; Sosa, JA; Taghian, AG; Peppercorn, J; Smith, BL; Hwang, ES
MLA Citation
Greenup, RA, Blitzblau, R, Houck, K, Horton, J, Howie, L, Palta, M, Mackey, A, Scheri, R, Sosa, JA, Taghian, AG, Peppercorn, J, Smith, BL, and Hwang, ES. "Abstract P1-10-02: Adjuvant radiation after lumpectomy: A cost comparison of treatment patterns in 43,247 women from the National Cancer Data Base." May 1, 2015.
Source
crossref
Published In
Cancer Research
Volume
75
Issue
9 Supplement
Publish Date
2015
Start Page
P1-10-02
End Page
P1-10-02
DOI
10.1158/1538-7445.SABCS14-P1-10-02

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

Anal canal cancer

© Springer Japan 2015.Radiation therapy with concurrent chemotherapy is the standard treatment for patients with nonmetastatic squamous cell carcinoma of the anal canal. In the studies that established this approach, high rates of locoregional control have been reported, but the incidence of acute and late toxicity has been significant. Moreover, treatment-related acute toxicity may cause treatment interruptions that are potentially detrimental to locoregional control and colostomy-free survival. Intensity-modulated radiation therapy (IMRT) has recently been instituted as an alternative to conventional two-dimensional (2D) or three-dimensional (3D) conformal radiotherapy. Multiple institutional experiences, as well as a single phase II multi-institution prospective study, have demonstrated improved acute toxicity rates with IMRT, potentially minimizing treatment interruptions and improving treatment outcomes. Pilot studies evaluating IMRT show no reduction in overall or colostomy-free survival versus historical studies. Due to its high precision, the use of IMRT in anal cancer requires thorough understanding of the patterns of spread of anal cancer with thoughtful delineation of target volumes and organs at risk. In this chapter, we highlight the available data on the use of IMRT for anal cancer and summarize established approaches for IMRT planning in this disease.

Authors
Perez, BA; Willett, CG; Czito, BG; Palta, M
MLA Citation
Perez, BA, Willett, CG, Czito, BG, and Palta, M. "Anal canal cancer." Intensity-Modulated Radiation Therapy: Clinical Evidence and Techniques. January 1, 2015. 337-354.
Source
scopus
Publish Date
2015
Start Page
337
End Page
354
DOI
10.1007/978-4-431-55486-8_18

The multidisciplinary management 11 of early stage cervical esophageal cancer

© Springer International Publishing Switzerland 2015.Cancer development in the cervical portion of the esophagus presents a unique challenge to management given the close proximity of critical structures in the head and neck. Cervical esophageal cancer (CEC) was historically approached with primarysurgery, pharyngo-laryngo-esophagectomy (PLE), but a paradigm shift has occurred suchthat functional organ preservation with concurrent chemotherapy and radiation (CRT)isnow preferred. This chapter will review anatomical considerations pertinent to themanagement of CEC as well as the risk factors and multidisciplinary treatment approach to this disease.

Authors
Salama, JK; Palta, M; Torok, JA
MLA Citation
Salama, JK, Palta, M, and Torok, JA. "The multidisciplinary management 11 of early stage cervical esophageal cancer." Esophageal Cancer: Prevention, Diagnosis and Therapy. January 1, 2015. 173-185.
Source
scopus
Publish Date
2015
Start Page
173
End Page
185
DOI
10.1007/978-3-319-20068-2_11

Intraoperative radiotherapy in the treatment of gastrointestinal malignancies

Intraoperative radiotherapy (IORT) is a technique that allows delivery of a single high dose of radiation to a target volume during surgery. Where conventional external beam radiation therapy (EBRT) is limited by the normal tissue tolerance of abdominal and pelvic organs, IORT has an advantage that surrounding organs can be shielded or moved. This approach permits delivery of a biologically potent dose of radiation with minimal toxicity. Many gastrointestinal malignancies are characterized by high rates of local failure, thus IORT has been investigated as a means to improve local control either alone or as part of a combined modality approach. In pancreatic, gastric and rectal cancers, available data suggest that the addition of IORT consistently improves local control. The effect on survival has been variable in these cancers with a significant competing risk of distant failure. As EBRT techniques improve, the utility of IORT will need to be further validated in prospective trials.

Authors
Torok, JA; Palta, M; Czito, BG; Willett, CG
MLA Citation
Torok, JA, Palta, M, Czito, BG, and Willett, CG. "Intraoperative radiotherapy in the treatment of gastrointestinal malignancies." Translational Cancer Research 3.6 (December 1, 2014): 537-540.
Source
scopus
Published In
Translational cancer research
Volume
3
Issue
6
Publish Date
2014
Start Page
537
End Page
540
DOI
10.3978/j.issn.2218-676X.2014.04.05

Patterns of failure for stage I ampulla of Vater adenocarcinoma: a single institutional experience.

Ampullary adenocarcinoma is a rare malignancy associated with a relatively favorable prognosis. Given high survival rates in stage I patients reported in small series with surgery alone, adjuvant chemoradiotherapy (CRT) has traditionally been recommended only for patients with high risk disease. Recent population-based data have demonstrated inferior outcomes to previous series. We examined disease-related outcomes for stage I tumors treated with pancreaticoduodenectomy, with and without CRT.All patients with stage I ampullary adenocarcinoma treated from 1976 to 2011 at Duke University were reviewed. Disease-related endpoints including local control (LC), metastasis-free survival (MFS), disease-free survival (DFS) and overall survival (OS) were analyzed using the Kaplan-Meier method.Forty-four patients were included in this study. Thirty-one patients underwent surgery alone, while 13 also received adjuvant CRT. Five-year LC, MFS, DFS and OS for patients treated with surgery only and surgery with CRT were 56% and 83% (P=0.13), 67% and 83% (P=0.31), 56% and 83% (P=0.13), and 53% and 68% (P=0.09), respectively.The prognosis for patients diagnosed with stage I ampullary adenocarcinoma may not be as favorable as previously described. Our data suggests a possible benefit of adjuvant CRT delivery.

Authors
Zhong, J; Palta, M; Willett, CG; McCall, SJ; McSherry, F; Tyler, DS; Uronis, HE; Czito, BG
MLA Citation
Zhong, J, Palta, M, Willett, CG, McCall, SJ, McSherry, F, Tyler, DS, Uronis, HE, and Czito, BG. "Patterns of failure for stage I ampulla of Vater adenocarcinoma: a single institutional experience." Journal of gastrointestinal oncology 5.6 (December 2014): 421-427.
PMID
25436120
Source
epmc
Published In
Journal of Gastrointestinal Oncology
Volume
5
Issue
6
Publish Date
2014
Start Page
421
End Page
427
DOI
10.3978/j.issn.2078-6891.2014.084

Is diaphragm motion a good surrogate for liver tumor motion?

To evaluate the relationship between liver tumor motion and diaphragm motion.Fourteen patients with hepatocellular carcinoma (10 of 14) or liver metastases (4 of 14) undergoing radiation therapy were included in this study. All patients underwent single-slice cine-magnetic resonance imaging simulations across the center of the tumor in 3 orthogonal planes. Tumor and diaphragm motion trajectories in the superior-inferior (SI), anterior-posterior (AP), and medial-lateral (ML) directions were obtained using an in-house-developed normalized cross-correlation-based tracking technique. Agreement between the tumor and diaphragm motion was assessed by calculating phase difference percentage, intraclass correlation coefficient, and Bland-Altman analysis (Diff). The distance between the tumor and tracked diaphragm area was analyzed to understand its impact on the correlation between the 2 motions.Of all patients, the mean (±standard deviation) phase difference percentage values were 7.1% ± 1.1%, 4.5% ± 0.5%, and 17.5% ± 4.5% in the SI, AP, and ML directions, respectively. The mean intraclass correlation coefficient values were 0.98 ± 0.02, 0.97 ± 0.02, and 0.08 ± 0.06 in the SI, AP, and ML directions, respectively. The mean Diff values were 2.8 ± 1.4 mm, 2.4 ± 1.1 mm, and 2.2 ± 0.5 mm in the SI, AP, and ML directions, respectively. Tumor and diaphragm motions had high concordance when the distance between the tumor and tracked diaphragm area was small.This study showed that liver tumor motion had good correlation with diaphragm motion in the SI and AP directions, indicating diaphragm motion in the SI and AP directions could potentially be used as a reliable surrogate for liver tumor motion.

Authors
Yang, J; Cai, J; Wang, H; Chang, Z; Czito, BG; Bashir, MR; Palta, M; Yin, F-F
MLA Citation
Yang, J, Cai, J, Wang, H, Chang, Z, Czito, BG, Bashir, MR, Palta, M, and Yin, F-F. "Is diaphragm motion a good surrogate for liver tumor motion?." International journal of radiation oncology, biology, physics 90.4 (November 2014): 952-958.
PMID
25223297
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
90
Issue
4
Publish Date
2014
Start Page
952
End Page
958
DOI
10.1016/j.ijrobp.2014.07.028

Investigation of sagittal image acquisition for 4D-MRI with body area as respiratory surrogate.

The authors have recently developed a novel 4D-MRI technique for imaging organ respiratory motion employing cine acquisition in the axial plane and using body area (BA) as a respiratory surrogate. A potential disadvantage associated with axial image acquisition is the space-dependent phase shift in the superior-inferior (SI) direction, i.e., different axial slice positions reach the respiratory peak at different respiratory phases. Since respiratory motion occurs mostly in the SI and anterior-posterior (AP) directions, sagittal image acquisition, which embeds motion information in these two directions, is expected to be more robust and less affected by phase-shift than axial image acquisition. This study aims to develop and evaluate a 4D-MRI technique using sagittal image acquisition.The authors evaluated axial BA and sagittal BA using both 4D-CT images (11 cancer patients) and cine MR images (6 healthy volunteers and 1 cancer patient) by comparing their corresponding space-dependent phase-shift in the SI direction (δSPS (SI)) and in the lateral direction (δSPS (LAT)), respectively. To evaluate sagittal BA 4D-MRI method, a motion phantom study and a digital phantom study were performed. Additionally, six patients who had cancer(s) in the liver were prospectively enrolled in this study. For each patient, multislice sagittal MR images were acquired for 4D-MRI reconstruction. 4D retrospective sorting was performed based on respiratory phases. Single-slice cine MRI was also acquired in the axial, coronal, and sagittal planes across the tumor center from which tumor motion trajectories in the SI, AP, and medial-lateral (ML) directions were extracted and used as references from comparison. All MR images were acquired in a 1.5 T scanner using a steady-state precession sequence (frame rate ∼ 3 frames/s).4D-CT scans showed that δSPS (SI) was significantly greater than δSPS (LAT) (p-value: 0.012); the median phase-shift was 16.9% and 7.7%, respectively. Body surface motion measurement from axial and sagittal MR cines also showed δSPS (SI) was significantly greater than δSPS (LAT). The median δSPS (SI) and δSPS (LAT) was 11.0% and 9.2% (p-value = 0.008), respectively. Tumor motion trajectories from 4D-MRI matched with those from single-slice cine MRI: the mean (±SD) absolute differences in tumor motion amplitude between the two were 1.5 ± 1.6 mm, 2.1 ± 1.9 mm, and 1.1 ± 1.0 mm in the SI, ML, and AP directions from this patient study.Space-dependent phase shift is less problematic for sagittal acquisition than for axial acquisition. 4D-MRI using sagittal acquisition was successfully carried out in patients with hepatic tumors.

Authors
Liu, Y; Yin, F-F; Chang, Z; Czito, BG; Palta, M; Bashir, MR; Qin, Y; Cai, J
MLA Citation
Liu, Y, Yin, F-F, Chang, Z, Czito, BG, Palta, M, Bashir, MR, Qin, Y, and Cai, J. "Investigation of sagittal image acquisition for 4D-MRI with body area as respiratory surrogate." Medical physics 41.10 (October 2014): 101902-.
PMID
25281954
Source
epmc
Published In
Medical physics
Volume
41
Issue
10
Publish Date
2014
Start Page
101902
DOI
10.1118/1.4894726

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

Definitive Chemoradiation Therapy for Cervical Esophageal Carcinoma: A Single-Institution Experience

Authors
Ludmir, EB; Palta, M; Wu, Y; Willett, CG; Czito, BG
MLA Citation
Ludmir, EB, Palta, M, Wu, Y, Willett, CG, and Czito, BG. "Definitive Chemoradiation Therapy for Cervical Esophageal Carcinoma: A Single-Institution Experience." September 1, 2014.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
90
Publish Date
2014
Start Page
S348
End Page
S348

Intensity Modulated Radiation Therapy Utilization in the Treatment of Gastrointestinal Malignancies Between 2000 and 2009 in the SEER-Medicare population

Authors
Palta, M; Czito, BG; Willett, CG; Dirian, MA
MLA Citation
Palta, M, Czito, BG, Willett, CG, and Dirian, MA. "Intensity Modulated Radiation Therapy Utilization in the Treatment of Gastrointestinal Malignancies Between 2000 and 2009 in the SEER-Medicare population." September 1, 2014.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
90
Publish Date
2014
Start Page
S401
End Page
S402

Low-Dose Consolidation Radiation Therapy for Early-Stage Unfavorable Hodgkin Lymphoma

Authors
Torok, J; Prosnitz, LR; Palta, M; Wu, Y; Beaven, A; Diehl, L; Kelsey, CR
MLA Citation
Torok, J, Prosnitz, LR, Palta, M, Wu, Y, Beaven, A, Diehl, L, and Kelsey, CR. "Low-Dose Consolidation Radiation Therapy for Early-Stage Unfavorable Hodgkin Lymphoma." September 1, 2014.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
90
Publish Date
2014
Start Page
S672
End Page
S673

Short-course versus long-course chemoradiation in rectal cancer--time to change strategies?

OPINION STATEMENT: There is significant debate regarding the optimal neoadjuvant regimen for resectable rectal cancer patients. Short-course radiotherapy, a standard approach throughout most of northern Europe, is generally defined as 25 Gy in 5 fractions over the course of 1 week without the concurrent administration of chemotherapy. Long-course radiotherapy is typically defined as 45 to 50.4 Gy in 25-28 fractions with the administration of concurrent 5-fluoropyrimidine-based chemotherapy and is the standard approach in other parts of Europe and the United States. At present, two randomized trials have compared outcomes for short course radiotherapy with long-course chemoradiation showing no difference in respective study endpoints. Late toxicity data are lacking given limited follow-up. Although the ideal neoadjuvant regimen is controversial, our current bias is long-course chemoradiation to treat patients with locally advanced, resectable rectal cancer.

Authors
Palta, M; Willett, CG; Czito, BG
MLA Citation
Palta, M, Willett, CG, and Czito, BG. "Short-course versus long-course chemoradiation in rectal cancer--time to change strategies?." Current treatment options in oncology 15.3 (September 1, 2014): 421-428. (Review)
Source
scopus
Published In
Current Treatment Options in Oncology
Volume
15
Issue
3
Publish Date
2014
Start Page
421
End Page
428
DOI
10.1007/s11864-014-0296-2

Short-course versus long-course chemoradiation in rectal cancer--time to change strategies?

OPINION STATEMENT: There is significant debate regarding the optimal neoadjuvant regimen for resectable rectal cancer patients. Short-course radiotherapy, a standard approach throughout most of northern Europe, is generally defined as 25 Gy in 5 fractions over the course of 1 week without the concurrent administration of chemotherapy. Long-course radiotherapy is typically defined as 45 to 50.4 Gy in 25-28 fractions with the administration of concurrent 5-fluoropyrimidine-based chemotherapy and is the standard approach in other parts of Europe and the United States. At present, two randomized trials have compared outcomes for short course radiotherapy with long-course chemoradiation showing no difference in respective study endpoints. Late toxicity data are lacking given limited follow-up. Although the ideal neoadjuvant regimen is controversial, our current bias is long-course chemoradiation to treat patients with locally advanced, resectable rectal cancer.

Authors
Palta, M; Willett, CG; Czito, BG
MLA Citation
Palta, M, Willett, CG, and Czito, BG. "Short-course versus long-course chemoradiation in rectal cancer--time to change strategies?." Current treatment options in oncology 15.3 (September 2014): 421-428.
PMID
24915746
Source
epmc
Published In
Current Treatment Options in Oncology
Volume
15
Issue
3
Publish Date
2014
Start Page
421
End Page
428
DOI
10.1007/s11864-014-0296-2

Results of the FFCD 9901 trial in early-stage esophageal carcinoma: is it really about neoadjuvant therapy?

Authors
Czito, BG; Palta, M; Willett, CG
MLA Citation
Czito, BG, Palta, M, and Willett, CG. "Results of the FFCD 9901 trial in early-stage esophageal carcinoma: is it really about neoadjuvant therapy?." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 32.23 (August 2014): 2398-2400.
PMID
24982460
Source
epmc
Published In
Journal of Clinical Oncology
Volume
32
Issue
23
Publish Date
2014
Start Page
2398
End Page
2400
DOI
10.1200/jco.2014.55.7231

Patterns of recurrence after trimodality therapy for esophageal cancer.

Patterns of failure after neoadjuvant chemoradiotherapy and surgery for esophageal cancer are poorly defined.All patients in the current study were treated with trimodality therapy for nonmetastatic esophageal cancer from 1995 to 2009. Locoregional failure included lymph node failure (NF), anastomotic failure, or both. Abdominal paraaortic failure (PAF) was defined as disease recurrence at or below the superior mesenteric artery.Among 155 patients, the primary tumor location was the upper/middle esophagus in 18%, the lower esophagus in 32%, and the gastroesophageal junction in 50% (adenocarcinoma in 79% and squamous cell carcinoma in 21%) of patients. Staging methods included endoscopic ultrasound (73%), computed tomography (46%), and positron emission tomography/computed tomography (54%). Approximately 40% of patients had American Joint Committee on Cancer stage II disease and 60% had stage III disease. The median follow-up was 1.3 years. The 2-year locoregional control, event-free survival, and overall survival rates were 86%, 36%, and 48%, respectively. The 2-year NF rate was 14%, the isolated NF rate was 3%, and the anastomotic failure rate was 6%. The 2-year PAF rate was 9% and the isolated PAF rate was 5%. PAF was found to be increased among patients with gastroesophageal junction tumors (12% vs 6%), especially for the subset with ≥ 2 clinically involved lymph nodes at the time of diagnosis (19% vs 4%).Few patients experience isolated NF or PAF as their first disease recurrence. Therefore, it is unlikely that targeting additional regional lymph node basins with radiotherapy would significantly improve clinical outcomes.

Authors
Dorth, JA; Pura, JA; Palta, M; Willett, CG; Uronis, HE; D'Amico, TA; Czito, BG
MLA Citation
Dorth, JA, Pura, JA, Palta, M, Willett, CG, Uronis, HE, D'Amico, TA, and Czito, BG. "Patterns of recurrence after trimodality therapy for esophageal cancer." Cancer 120.14 (July 2014): 2099-2105.
PMID
24711267
Source
epmc
Published In
Cancer
Volume
120
Issue
14
Publish Date
2014
Start Page
2099
End Page
2105
DOI
10.1002/cncr.28703

Radiotherapy for Gastrointestinal Malignancies

© 2014 John Wiley and Sons, Inc..This chapter talks about four case studies of radiotherapy for gastrointestinal malignancies. One of the case study, a 65-year-old female presents with painless jaundice and diarrhea for 1 month. Labs show an elevation in liver function tests and total bilirubin of 13.4. Computed tomography (CT) scan reveals a 2 cm lesion in the pancreatic head. CT scan confirms no involvement of major vessels and no evidence of distant metastases. The patient undergoes pancreaticoduodenectomy, revealing pT1N0 poorly differentiated adenocarcinoma with negative margins. The chapter talks about multiple questions and answers for the gastrointestinal malignancies.

Authors
Palta, M; Willett, C; Czito, B
MLA Citation
Palta, M, Willett, C, and Czito, B. "Radiotherapy for Gastrointestinal Malignancies." Cancer Consult: Expertise for Clinical Practice. June 20, 2014. 785-788.
Source
scopus
Publish Date
2014
Start Page
785
End Page
788
DOI
10.1002/9781118589199.ch121

Colorectal cancer: adjuvant chemotherapy for rectal cancer-an unresolved issue.

Authors
Palta, M; Czito, BG; Willett, CG
MLA Citation
Palta, M, Czito, BG, and Willett, CG. "Colorectal cancer: adjuvant chemotherapy for rectal cancer-an unresolved issue." Nature reviews. Clinical oncology 11.4 (April 2014): 182-184.
PMID
24642673
Source
epmc
Published In
Nature Reviews Clinical Oncology
Volume
11
Issue
4
Publish Date
2014
Start Page
182
End Page
184
DOI
10.1038/nrclinonc.2014.43

The role of intraoperative radiation therapy in patients with pancreatic cancer.

Intraoperative radiation therapy (IORT) techniques allow for the delivery of high doses of radiation therapy while excluding part or all of the nearby dose-limiting sensitive structures. Therefore, the effective radiation dose is increased and local tumor control potentially improved. This is pertinent in the case of pancreatic cancer because local failure rates are as high as 50%-80% in patients with resected and locally advanced disease. Available data in patients receiving IORT after pancreaticoduodenectomy reveal an improvement in local control, though overall survival benefit is unclear. Series of patients with locally advanced pancreatic cancer also suggest pain relief, and in select studies, improved survival associated with the inclusion of IORT. At present, no phase III data clearly supports the use of IORT in the management of pancreatic cancer.

Authors
Palta, M; Willett, C; Czito, B
MLA Citation
Palta, M, Willett, C, and Czito, B. "The role of intraoperative radiation therapy in patients with pancreatic cancer." Seminars in radiation oncology 24.2 (April 2014): 126-131.
PMID
24635869
Source
epmc
Published In
Seminars in Radiation Oncology
Volume
24
Issue
2
Publish Date
2014
Start Page
126
End Page
131
DOI
10.1016/j.semradonc.2013.11.004

Stereotactic body radiotherapy: A critical review for nonradiation oncologists

Stereotactic body radiotherapy (SBRT) involves the treatment of extracranial primary tumors or metastases with a few, high doses of ionizing radiation. In SBRT, tumor kill is maximized and dose to surrounding tissue is minimized, by precise and accurate delivery of multiple radiation beams to the target. This is particularly challenging, because extracranial lesions often move with respiration and are irregular in shape, requiring careful treatment planning and continual management of this motion and patient position during irradiation. This review presents the rationale, process workflow, and technology for the safe and effective administration of SBRT, as well as the indications, outcome, and limitations for this technique in the treatment of lung cancer, liver cancer, and metastatic disease. © 2013 American Cancer Society.

Authors
Kirkpatrick, JP; Kelsey, CR; Palta, M; Cabrera, AR; Salama, JK; Patel, P; Perez, BA; Lee, J; Yin, FF
MLA Citation
Kirkpatrick, JP, Kelsey, CR, Palta, M, Cabrera, AR, Salama, JK, Patel, P, Perez, BA, Lee, J, and Yin, FF. "Stereotactic body radiotherapy: A critical review for nonradiation oncologists." Cancer 120.7 (January 1, 2014): 942-954. (Review)
Source
scopus
Published In
Cancer
Volume
120
Issue
7
Publish Date
2014
Start Page
942
End Page
954
DOI
10.1002/cncr.28515

Patterns of recurrence after trimodality therapy for esophageal cancer

BACKGROUND Patterns of failure after neoadjuvant chemoradiotherapy and surgery for esophageal cancer are poorly defined. METHODS All patients in the current study were treated with trimodality therapy for nonmetastatic esophageal cancer from 1995 to 2009. Locoregional failure included lymph node failure (NF), anastomotic failure, or both. Abdominal paraaortic failure (PAF) was defined as disease recurrence at or below the superior mesenteric artery. RESULTS Among 155 patients, the primary tumor location was the upper/middle esophagus in 18%, the lower esophagus in 32%, and the gastroesophageal junction in 50% (adenocarcinoma in 79% and squamous cell carcinoma in 21%) of patients. Staging methods included endoscopic ultrasound (73%), computed tomography (46%), and positron emission tomography/computed tomography (54%). Approximately 40% of patients had American Joint Committee on Cancer stage II disease and 60% had stage III disease. The median follow-up was 1.3 years. The 2-year locoregional control, event-free survival, and overall survival rates were 86%, 36%, and 48%, respectively. The 2-year NF rate was 14%, the isolated NF rate was 3%, and the anastomotic failure rate was 6%. The 2-year PAF rate was 9% and the isolated PAF rate was 5%. PAF was found to be increased among patients with gastroesophageal junction tumors (12% vs 6%), especially for the subset with ≥ 2 clinically involved lymph nodes at the time of diagnosis (19% vs 4%). CONCLUSIONS Few patients experience isolated NF or PAF as their first disease recurrence. Therefore, it is unlikely that targeting additional regional lymph node basins with radiotherapy would significantly improve clinical outcomes. © 2014 American Cancer Society.

Authors
Dorth, JA; Pura, JA; Palta, M; Willett, CG; Uronis, HE; D'Amico, TA; Czito, BG
MLA Citation
Dorth, JA, Pura, JA, Palta, M, Willett, CG, Uronis, HE, D'Amico, TA, and Czito, BG. "Patterns of recurrence after trimodality therapy for esophageal cancer." Cancer 120.14 (January 1, 2014): 2099-2105.
Source
scopus
Published In
Cancer
Volume
120
Issue
14
Publish Date
2014
Start Page
2099
End Page
2105
DOI
10.1002/cncr.28703

Colorectal cancer: adjuvant chemotherapy for rectal cancer-an unresolved issue.

Authors
Palta, M; Czito, BG; Willett, CG
MLA Citation
Palta, M, Czito, BG, and Willett, CG. "Colorectal cancer: adjuvant chemotherapy for rectal cancer-an unresolved issue." Nature reviews. Clinical oncology 11.4 (January 1, 2014): 182-184.
Source
scopus
Published In
Nature Reviews Clinical Oncology
Volume
11
Issue
4
Publish Date
2014
Start Page
182
End Page
184
DOI
10.1038/nrclinonc.2014.43

Incidence and prognostic impact of high-risk HPV tumor infection in cervical esophageal carcinoma

© Pioneer Bioscience Publishing Company. All rights reserved.Background: Cervical esophageal carcinoma (CEC) is an uncommon malignancy. Limited data supports the use of definitive chemoradiotherapy (CRT) as primary treatment. Furthermore, the role of human papillomavirus (HPV) tumor infection in CEC remains unknown. This study retrospectively analyzes both outcomes of CEC patients treated with CRT and the incidence and potential role of HPV tumor infection in CEC lesions. Methods: A total of 37 CEC patients were treated with definitive CRT at our institution between 1987 and 2013. Of these, 19 had tumor samples available for high-risk HPV (types 16 and 18) pathological analysis. Results: For all patients (n=37), 5-year overall survival (OS), disease-free survival (DFS), and loco-regional control (LRC) rates were 34.1%, 40.2%, and 65.6%, respectively. On pathological analysis, 1/19 (5.3%) patients had an HPV-positive lesion. Conclusions: Definitive CRT provides disease-related outcomes comparable to surgery. Moreover, HPV tumor infection in CEC is uncommon and its prognostic role is unclear. Our data contribute to the construction of an anatomical map of HPV tumor infection in squamous cell carcinomas (SCC) of the upper aerodigestive tract, and suggest a steep drop in viral infection rates at sites distal to the oropharynx, including the cervical esophagus.

Authors
Ludmir, EB; Palta, M; Zhang, X; Wu, Y; Willett, CG; Czito, BG
MLA Citation
Ludmir, EB, Palta, M, Zhang, X, Wu, Y, Willett, CG, and Czito, BG. "Incidence and prognostic impact of high-risk HPV tumor infection in cervical esophageal carcinoma." Journal of Gastrointestinal Oncology 5.6 (January 1, 2014): 401-407.
Source
scopus
Published In
Journal of Gastrointestinal Oncology
Volume
5
Issue
6
Publish Date
2014
Start Page
401
End Page
407
DOI
10.3978/j.issn.2078-6891.2014.05

Radiosensitive orbital metastasis as presentation of occult colonic adenocarcinoma.

An 82-year-old man presented with progressive right frontal headaches. The patient's history was significant for benign polyps on surveillance colonoscopy 2 years prior, without high-grade dysplasia or carcinoma. MRI revealed an enhancing lesion arising within the superomedial aspect of the right orbit. Lesion biopsy demonstrated histological appearance and immunophenotype suggestive of colonic adenocarcinoma. Staging positron emission tomography/CT showed visceral metastases and diffuse activity in the posterior rectosigmoid, consistent with metastatic colon cancer. Treatment of the orbital lesion with external beam radiotherapy to 30 Gy resulted in significant palliation of the patient's headaches. The patient expired 2 months following treatment completion due to disease progression. Orbital metastasis as the initial presentation of an occult colorectal primary lesion is exceedingly rare, and occurred in this patient despite surveillance colonoscopy. Radiotherapy remains an efficacious modality for treatment of orbital metastases.

Authors
Ludmir, EB; McCall, SJ; Czito, BG; Palta, M
MLA Citation
Ludmir, EB, McCall, SJ, Czito, BG, and Palta, M. "Radiosensitive orbital metastasis as presentation of occult colonic adenocarcinoma." BMJ case reports 2014 (January 2014).
PMID
25240005
Source
epmc
Published In
BMJ Case Reports
Volume
2014
Publish Date
2014
DOI
10.1136/bcr-2014-206407

Stereotactic body radiotherapy: A critical review for non-radiation oncologists

Authors
Kirkpatrick, JP; Kelsey, CR; Palta, M; Cabrera, AR; Salama, JK; Patel, P; Perez, BA; Lee, J; Yin, F-F
MLA Citation
Kirkpatrick, JP, Kelsey, CR, Palta, M, Cabrera, AR, Salama, JK, Patel, P, Perez, BA, Lee, J, and Yin, F-F. "Stereotactic body radiotherapy: A critical review for non-radiation oncologists." Cancer (2014).
PMID
24382744
Source
scopus
Published In
Cancer
Publish Date
2014

Incidence and Prognostic Impact of High-Risk HPV Tumor Infection in Cervical Esophageal Carcinoma

Authors
Ludmir, E; Palta, M; Zhang, X; Wu, Y; Willett, C; Czito, B
MLA Citation
Ludmir, E, Palta, M, Zhang, X, Wu, Y, Willett, C, and Czito, B. "Incidence and Prognostic Impact of High-Risk HPV Tumor Infection in Cervical Esophageal Carcinoma." Journal of Gastrointestinal Oncology 5.6 (2014): 401-407.
PMID
25436117
Source
manual
Published In
Journal of Gastrointestinal Oncology
Volume
5
Issue
6
Publish Date
2014
Start Page
401
End Page
407
DOI
10.3978/j.issn.2078-6891.2014.053

Reduced Volume Irradiation for Head-and-Neck Cancer of Unknown Primary (HNCUP)

Authors
Patel, PR; Palta, M; Clough, R; Yoo, D; Brizel, DM
MLA Citation
Patel, PR, Palta, M, Clough, R, Yoo, D, and Brizel, DM. "Reduced Volume Irradiation for Head-and-Neck Cancer of Unknown Primary (HNCUP)." October 1, 2013.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
87
Issue
2
Publish Date
2013
Start Page
S482
End Page
S482

Patterns of Failure for Stage I Ampulla of Vater Adenocarcinoma: A Single Institutional Experience

Authors
Zhong, J; Palta, M; Willett, CG; McCall, SJ; McSherry, F; Uronis, HE; Tyler, DS; Czito, BG
MLA Citation
Zhong, J, Palta, M, Willett, CG, McCall, SJ, McSherry, F, Uronis, HE, Tyler, DS, and Czito, BG. "Patterns of Failure for Stage I Ampulla of Vater Adenocarcinoma: A Single Institutional Experience." October 1, 2013.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
87
Issue
2
Publish Date
2013
Start Page
S317
End Page
S317

Early Results of a Randomized Trial to Identify an Optimal PTV in Stereotactic Radiosurgery of Brain Metastases

Authors
Kirkpatrick, JP; Wang, Z; Sampson, J; Kelsey, C; Allen, K; Duffy, E; Green, S; Cabrera, A; Palta, M; Yin, F
MLA Citation
Kirkpatrick, JP, Wang, Z, Sampson, J, Kelsey, C, Allen, K, Duffy, E, Green, S, Cabrera, A, Palta, M, and Yin, F. "Early Results of a Randomized Trial to Identify an Optimal PTV in Stereotactic Radiosurgery of Brain Metastases." October 1, 2013.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
87
Issue
2
Publish Date
2013
Start Page
S50
End Page
S50

ACT II: treatment of anal cancer comes full circle.

Authors
Willett, CG; Czito, BG; Palta, M
MLA Citation
Willett, CG, Czito, BG, and Palta, M. "ACT II: treatment of anal cancer comes full circle." Lancet Oncol 14.6 (May 2013): 443-445.
PMID
23578723
Source
pubmed
Published In
The Lancet Oncology
Volume
14
Issue
6
Publish Date
2013
Start Page
443
End Page
445
DOI
10.1016/S1470-2045(13)70121-9

The role of local excision in invasive adenocarcinoma of the ampulla of Vater.

BACKGROUND: Ampulla of Vater carcinomas are rare malignancies that have been traditionally treated with radical surgical resection. Given the mortality associated with pancreaticoduodenectomy, some patients may benefit from local resection. A single-institution outcomes analysis was performed to define the role of local resection. METHODS: Patients undergoing local resection (ampullectomy) for ampullary carcinomas at Duke University between 1976 and 2010 were analyzed retrospectively. Time-to-event analysis was conducted analyzing all patients undergoing surgery, with and without adjuvant chemoradiation therapy (CRT). Overall survival (OS), local control (LC), metastases-free survival (MFS), and disease-free survival (DFS) were studied using Kaplan-Meier analysis. RESULTS: A total of 17 patients with invasive carcinoma underwent ampullectomy. The 3-and 5-year LC, MFS, DFS and OS rates were 36% and 24%, 68% and 54%, 31% and 21%, and 35% and 21%, respectively. Patients receiving adjuvant CRT did not appear to have improved outcomes compared with surgery alone, although this group tended to have poorer histological grade, more advanced tumor staging and involved surgical margins. CONCLUSIONS: Ampullectomy for invasive ampullary adenocarcinomas is a safe procedure but does not offer satisfactory long-term results, mostly due to high local failure rates. Adjuvant CRT therapy does not appear to offer increased local control or survival benefit following ampullectomy, although these results may suffer from selection bias and small sample size. Local resection should be limited to benign ampullary lesions or patients with very small, early tumors with favorable histologic features where radical resection is not feasible.

Authors
Zhong, J; Palta, M; Willett, CG; McCall, SJ; Bulusu, A; Tyler, DS; White, RR; Uronis, HE; Pappas, TN; Czito, BG
MLA Citation
Zhong, J, Palta, M, Willett, CG, McCall, SJ, Bulusu, A, Tyler, DS, White, RR, Uronis, HE, Pappas, TN, and Czito, BG. "The role of local excision in invasive adenocarcinoma of the ampulla of Vater." J Gastrointest Oncol 4.1 (March 2013): 8-13.
PMID
23450004
Source
pubmed
Published In
Journal of Gastrointestinal Oncology
Volume
4
Issue
1
Publish Date
2013
Start Page
8
End Page
13
DOI
10.3978/j.issn.2078-6891.2012.055

Preoperative chemoradiotherapy for locally advanced gastric cancer.

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

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

ACT II: Treatment of anal cancer comes full circle

Authors
Willett, CG; Czito, BG; Palta, M
MLA Citation
Willett, CG, Czito, BG, and Palta, M. "ACT II: Treatment of anal cancer comes full circle." The Lancet Oncology 14.6 (2013): 443-445.
Source
scival
Published In
The Lancet Oncology
Volume
14
Issue
6
Publish Date
2013
Start Page
443
End Page
445
DOI
10.1016/S1470-2045(13)70121-9

A Phase I/II Study of Capecitabine (Cape), Oxatiplatin (Ox), Panitumumab (Pmab), and External Beam Radiation Therapy (RI) for Patients With Esophagogastric Carcinoma (EC)

Authors
Czito, B; Willett, C; Palta, M; Kennedy-Newton, P; Uronis, H
MLA Citation
Czito, B, Willett, C, Palta, M, Kennedy-Newton, P, and Uronis, H. "A Phase I/II Study of Capecitabine (Cape), Oxatiplatin (Ox), Panitumumab (Pmab), and External Beam Radiation Therapy (RI) for Patients With Esophagogastric Carcinoma (EC)." November 1, 2012.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
84
Issue
3
Publish Date
2012
Start Page
S42
End Page
S42

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

Carcinoma of the ampulla of Vater: patterns of failure following resection and benefit of chemoradiotherapy.

BACKGROUND: Ampullary carcinoma is a rare malignancy. Despite radical resection, survival rates remain low with high rates of local failure. We performed a single-institution outcomes analysis to define the role of concurrent chemoradiotherapy (CRT) in addition to surgery. METHODS: A retrospective analysis was performed of all patients undergoing potentially curative pancreaticoduodenectomy for adenocarcinoma of the ampulla of Vater at Duke University Hospitals between 1976 and 2009. Time-to-event analysis was performed comparing all patients who underwent surgery alone to the cohort of patients receiving CRT in addition to surgery. Local control (LC), disease-free survival (DFS), overall survival (OS), and metastases-free survival (MFS) were estimated using the Kaplan-Meier method. RESULTS: A total of 137 patients with ampullary carcinoma underwent Whipple procedure. Of these, 61 patients undergoing resection received adjuvant (n = 43) or neoadjuvant (n = 18) CRT. Patients receiving chemoradiotherapy were more likely to have poorly differentiated tumors (P = .03). Of 18 patients receiving neoadjuvant therapy, 67% were downstaged on final pathology with 28% achieving pathologic complete response (pCR). With a median follow-up of 8.8 years, 3-year local control was improved in patients receiving CRT (88% vs 55%, P = .001) with trend toward 3-year DFS (66% vs 48%, P = .09) and OS (62% vs 46%, P = .074) benefit in patients receiving CRT. CONCLUSIONS: Long-term survival rates are low and local failure rates high following radical resection alone. Given patterns of relapse with surgery alone and local control benefit in patients receiving CRT, the use of chemoradiotherapy in selected patients should be considered.

Authors
Palta, M; Patel, P; Broadwater, G; Willett, C; Pepek, J; Tyler, D; Zafar, SY; Uronis, H; Hurwitz, H; White, R; Czito, B
MLA Citation
Palta, M, Patel, P, Broadwater, G, Willett, C, Pepek, J, Tyler, D, Zafar, SY, Uronis, H, Hurwitz, H, White, R, and Czito, B. "Carcinoma of the ampulla of Vater: patterns of failure following resection and benefit of chemoradiotherapy." Ann Surg Oncol 19.5 (May 2012): 1535-1540.
PMID
22045467
Source
pubmed
Published In
Annals of Surgical Oncology
Volume
19
Issue
5
Publish Date
2012
Start Page
1535
End Page
1540
DOI
10.1245/s10434-011-2117-1

A phase I/II study of capecitabine (Cape), oxaliplatin (Ox), panitumumab (Pmab), and external beam radiation therapy (RT) for patients with esophagogastric carcinoma (EC).

68 Background: EC is commonly managed with concurrent chemoradiotherapy, with or without surgical resection. The optimal combination and dose of agents is the subject of continued investigation. This study examines chemotherapeutic agents with known efficacy in EC in combination with the EGFR inhibitor panitumumab.Eligible pts received RT (1.8 Gy qd to 50.4 Gy) combined with concurrent chemotherapy. Dose-level (DL) 1 was cape (625 mg/m2/bid RT days), ox (40 mg/m2 weekly X 6 weeks), and pmab (3.6 mg/kg, weeks 1, 3 and 5). Chemotherapy doses were escalated barring dose limiting toxicity (DLT). The primary endpoint was defining the maximally tolerated dose with this combination. Secondary endpoints included toxicity and radiographic/pathologic response rates.Twenty-nine pts were enrolled. Twenty-five had adenocarcinoma, 24 (83%) were cN+ and 9 (31%) had M1a/b disease. DLT was not encountered in DL 1. Two of 6 patients at DL 2 (cape 825 mg/m2/bid RT days, ox 50 mg/m2 weekly, pmab 4.8 mg/kg, weeks 1, 3 and 5) developed DLT (one hospitalization due to dehydration; one with drug reaction requiring hospitalization). Twenty additional pts were enrolled at DL1. Primary toxicities were EGFR-rash, esophagitis, nausea/vomiting and fatigue. On repeat endoscopy, 16 (55%) had CR, 10 (35%) PR and 2 (7%) SD. Using PERCIST criteria, 12 (41%), 11 (38%), 2 (7%) and 3 (10%) had CR, PR, SD and PD response on restaging PET, respectively. Twenty pts underwent esophagectomy, revealing Gr 0 response (no residual disease) in 9 (45%), Gr 1 (single/microscopic cells) in 3 (15%), Gr 2 (fibrosis > gross disease) in 4 (20%) and Gr 3 (gross residual > fibrosis or no evident response) in 4 (20%). Seven pts (35%) experienced anastomotic leak (2 requiring reoperation and 3 stent placement).Concurrent chemoradiotherapy utilizing capecitabine, oxaliplatin, panitumumab is reasonably well-tolerated and associated with high rates of radiographic, endoscopic and pathologic response. Postoperative anastomotic leak rates were higher than expected. Further study of this regimen in the operative and nonoperative settings is warranted.

Authors
Czito, BG; Willett, C; Palta, M; McCall, S; Gee, N; Hurwitz, H; Coleman, RE; Zafar, Y; Kennedy-Newton, P; Uronis, H
MLA Citation
Czito, BG, Willett, C, Palta, M, McCall, S, Gee, N, Hurwitz, H, Coleman, RE, Zafar, Y, Kennedy-Newton, P, and Uronis, H. "A phase I/II study of capecitabine (Cape), oxaliplatin (Ox), panitumumab (Pmab), and external beam radiation therapy (RT) for patients with esophagogastric carcinoma (EC)." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 30.4_suppl (February 2012): 68-.
PMID
27982872
Source
epmc
Published In
Journal of Clinical Oncology
Volume
30
Issue
4_suppl
Publish Date
2012
Start Page
68

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

Role of radiation therapy in patients with resectable pancreatic cancer.

The 5-year overall survival of patients with pancreatic cancer is approximately 5%, with potentially resectable disease representing the curable minority. Although surgical resection remains the cornerstone of treatment, local and distant failure rates are high after complete resection, and debate continues as to the appropriate adjuvant therapy. Many oncologists advocate for adjuvant chemotherapy alone, given that high rates of systemic metastases are the primary cause of patient mortality. Others, however, view locoregional failure as a significant contributor to morbidity and mortality, thereby justifying the use of adjuvant chemoradiation. As in other gastrointestinal malignancies, neoadjuvant chemoradiotherapy offers potential advantages in resectable patients, and clinical investigation of this approach has shown promising results; however, phase III data are lacking. Further therapeutic advances and prospective trials are needed to better define the optimal role of adjuvant and neoadjuvant treatment in patients with resectable pancreatic cancer.

Authors
Palta, M; Willett, C; Czito, B
MLA Citation
Palta, M, Willett, C, and Czito, B. "Role of radiation therapy in patients with resectable pancreatic cancer." Oncology (Williston Park) 25.8 (July 2011): 715-727. (Review)
PMID
21874833
Source
pubmed
Published In
Oncology
Volume
25
Issue
8
Publish Date
2011
Start Page
715
End Page
727

Carcinoma of the ampulla of Vater: Patterns of failure after resection and benefit of adjuvant radiotherapy.

Authors
Palta, M; Willett, CG; Patel, P; Tyler, DS; Uronis, HE; Czito, BG
MLA Citation
Palta, M, Willett, CG, Patel, P, Tyler, DS, Uronis, HE, and Czito, BG. "Carcinoma of the ampulla of Vater: Patterns of failure after resection and benefit of adjuvant radiotherapy." JOURNAL OF CLINICAL ONCOLOGY 29.4 (February 1, 2011).
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
29
Issue
4
Publish Date
2011

Carcinoma of the ampulla of Vater: Patterns of failure after resection and benefit of adjuvant radiotherapy.

254 Background: Ampullary carcinoma is a rare malignancy. Despite radical resection, survival rates remain low with high rates of local failure. To define the role of radiation therapy and chemotherapy with surgery, we performed a single institution analysis of treatment- related outcomes.A retrospective analysis was performed of all patients undergoing potentially curative therapy for adenocarcinoma of the ampulla of Vater at Duke University Hospitals between 1975 and 2009. Local control (LC), overall survival (OS), disease-free survival (DFS), and metastases-free survival (MFS) were estimated using the Kaplan-Meier Method.One hundred thirty-seven patients with ampullary carcinoma underwent potentially curative pancreaticoduodenectomy. Sixty-one patients undergoing resection received adjuvant (n= 43) or neoadjuvant (n=18) radiation therapy with concurrent chemotherapy (CRT). Patients receiving radiotherapy were more likely to have poorly differentiated tumors. Median radiation dose was 50 Gy. Median follow up was 8.8 years. Of patients receiving neoadjuvant therapy, 67% were downstaged on final pathology with 28% achieving pathologic complete response. Three-year local control was significantly improved in patients receiving CRT (88% vs. 55% p= 0.001) with trend toward a 3-year OS benefit in patients receiving CRT (62% vs. 46% p=0.074). Despite this, there was no significant difference in 3-year DFS (66% CRT vs 48% surgery alone p=0.09) or MFS (69% CRT vs 63% surgery alone p=0.337).Long term survival rates are low. Local failure rates are high following radical resection alone and improved with CRT. Despite more adverse pathologic features in patients receiving CRT, survival outcomes were at least equivalent with a trend toward statistical significance. Given the patterns of relapse with surgery alone and local control benefit in patients receiving CRT, the use of chemoradiotherapy in selected patients should be considered. No significant financial relationships to disclose.

Authors
Palta, M; Willett, CG; Patel, P; Tyler, DS; Uronis, HE; Czito, BG
MLA Citation
Palta, M, Willett, CG, Patel, P, Tyler, DS, Uronis, HE, and Czito, BG. "Carcinoma of the ampulla of Vater: Patterns of failure after resection and benefit of adjuvant radiotherapy." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 29.4_suppl (February 2011): 254-.
PMID
27985514
Source
epmc
Published In
Journal of Clinical Oncology
Volume
29
Issue
4_suppl
Publish Date
2011
Start Page
254

Primary meningeal rhabdomyosarcoma.

Primary meningeal rhabdomyosarcoma is a rare primary brain malignancy, with scant case reports. While most reports of primary intracranial rhabdomyosarcoma occur in pediatric patients, a handful of cases in adult patients have been reported in the medical literature. We report the case of a 44-year-old male who developed primary meningeal rhabdomyosarcoma. After developing episodes of right lower extremity weakness, word finding difficulty, and headaches, a brain magnetic resonance imaging (MRI) demonstrated a vertex lesion with radiographic appearance of a meningeal-derived tumor. Subtotal surgical resection was performed due to sagittal sinus invasion and initial pathology was interpreted as an anaplastic meningioma. Re-review of pathology demonstrated rhabdomyosarcoma negative for alveolar translocation t(2;13). Staging studies revealed no evidence of disseminated disease. He was treated with stereotactic radiotherapy with concurrent temozolamide to be followed by vincristine, actinomycin-D, and cyclophosphamide (VAC) systemic therapy.

Authors
Palta, M; Riedel, RF; Vredenburgh, JJ; Cummings, TJ; Green, S; Chang, Z; Kirkpatrick, JP
MLA Citation
Palta, M, Riedel, RF, Vredenburgh, JJ, Cummings, TJ, Green, S, Chang, Z, and Kirkpatrick, JP. "Primary meningeal rhabdomyosarcoma." Sarcoma 2011 (2011): 312802-.
PMID
21772793
Source
pubmed
Published In
Sarcoma
Volume
2011
Publish Date
2011
Start Page
312802
DOI
10.1155/2011/312802

Role of radiation therapy in patients with resectable pancreatic cancer

The 5-year overall survival of patients with pancreatic cancer is approximately 5%, with potentially resectable disease representing the curable minority. Although surgical resection remains the cornerstone of treatment, local and distant failure rates are high after complete resection, and debate continues as to the appropriate adjuvant therapy. Many oncologists advocate for adjuvant chemotherapy alone, given that high rates of systemic metastases are the primary cause of patient mortality. Others, however, view locoregional failure as a significant contributor to morbidity and mortality, thereby justifying the use of adjuvant chemoradiation. As in other gastrointestinal malignancies, neoadjuvant chemoradiotherapy offers potential advantages in resectable patients, and clinical investigation of this approach has shown promising results; however, phase III data are lacking. Further therapeutic advances and prospective trials are needed to better define the optimal role of adjuvant and neoadjuvant treatment in patients with resectable pancreatic cancer.

Authors
Palta, M; Willett, C; Czito, B
MLA Citation
Palta, M, Willett, C, and Czito, B. "Role of radiation therapy in patients with resectable pancreatic cancer." Oncology 25.8 (2011): 1-11.
Source
scival
Published In
Oncology
Volume
25
Issue
8
Publish Date
2011
Start Page
1
End Page
11

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

The development of oncology treatment guidelines: An analysis of the National Guidelines Clearinghouse

Purpose: In the last 2 decades, guidelines have been developed to improve quality of patient care. A recent editorial of guideline development procedures suggested the process has significant limitations that affect their scientific validity.1 This prompted us to review oncology treatment guidelines to determine if such limitations are widespread. Methods and Materials: We performed a review of oncology treatment guidelines registered at the National Guidelines Clearinghouse (www.guideline.gov). Each guideline was independently reviewed by 2 authors and the following criteria were assessed: coordinating organization, guideline panel composition, reporting conflict of interest, peer review, dissent, expiration date, PubMed citation, and evidence-based scoring and grading of recommendations. Disagreements were resolved by consensus in subsequent discussions. Results: Sixty-four guidelines were reviewed (39 [61%] were developed by a medical specialty society and 25 [39%] were developed by government agencies). Fifty (78%) guideline panels were multidisciplinary and 44 (69%) included individuals with epidemiologic and health services research expertise. Potential conflicts of interest were disclosed in 43 (67%) guidelines. Sixty (94%) guidelines underwent peer review, with external review in 31 (48%). Seventeen (27%) guidelines are indexed by PubMed. Fifty-one (80%) guidelines included evidence-based methodologies and 46 (72%) used evidence-based scoring of recommendations. Significant differences were observed according to coordinating organization (eg, disclosure of conflict of interest in 46% of guidelines developed by medical specialty societies versus 100% authored by government agencies [. P < .0001]). Conclusions: The majority of oncology-related treatment guidelines registered at the National Guidelines Clearinghouse satisfy most of the criteria for sound guideline development. Significant differences in these criteria were observed according to the coordinating organization that developed the guideline. © 2011 American Society for Radiation Oncology.

Authors
Palta, M; Lee, WR
MLA Citation
Palta, M, and Lee, WR. "The development of oncology treatment guidelines: An analysis of the National Guidelines Clearinghouse." Practical Radiation Oncology 1.1 (2011): 33-37.
PMID
24673867
Source
scival
Published In
Practical Radiation Oncology
Volume
1
Issue
1
Publish Date
2011
Start Page
33
End Page
37
DOI
10.1016/j.prro.2010.09.003

Dosimetric Comparison Of Radiotherapy For Left Sided Breast Cancer: Breath-hold versus Free Breathing

Authors
Zagar, TM; Palta, M; Catalano, S; O'Neill, L; Yoo, S; Leonard, P; Horton, J
MLA Citation
Zagar, TM, Palta, M, Catalano, S, O'Neill, L, Yoo, S, Leonard, P, and Horton, J. "Dosimetric Comparison Of Radiotherapy For Left Sided Breast Cancer: Breath-hold versus Free Breathing." INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 81.2 (2011): S780-S781.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
81
Issue
2
Publish Date
2011
Start Page
S780
End Page
S781

Twenty Year Experience with Chemoradiotherapy for Locally Advanced Squamous Cell Carcinoma of the Oropharynx

Authors
Palta, M; Clough, R; Yoo, D; Scher, R; Ready, N; Brizel, D
MLA Citation
Palta, M, Clough, R, Yoo, D, Scher, R, Ready, N, and Brizel, D. "Twenty Year Experience with Chemoradiotherapy for Locally Advanced Squamous Cell Carcinoma of the Oropharynx." INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 81.2 (2011): S503-S504.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
81
Issue
2
Publish Date
2011
Start Page
S503
End Page
S504

Dosimetric Comparison of Radiotherapy for Left Sided Breast Cancer: Breath-Hold Versus Free-Breathing

Authors
Zagar, TM; Palta, M; Catalano, S; O'Neill, L; Yoo, S; Horton, J; Prosnitz, LR
MLA Citation
Zagar, TM, Palta, M, Catalano, S, O'Neill, L, Yoo, S, Horton, J, and Prosnitz, LR. "Dosimetric Comparison of Radiotherapy for Left Sided Breast Cancer: Breath-Hold Versus Free-Breathing." CANCER RESEARCH 70 (December 15, 2010).
Source
wos-lite
Published In
Cancer Research
Volume
70
Publish Date
2010
DOI
10.1158/1538-7445.AM2012-P4-11-21

Angiosarcoma after breast-conserving therapy: Long-term outcomes with hyperfractionated radiotherapy

BACKGROUND: With breast-conserving therapy (BCT) as the standard of care for patients with noninvasive and early stage invasive breast cancer, a small incidence of post-BCT angiosarcoma has emerged. The majority of therapeutic interventions have been unsuccessful. To the authors' knowledge, there is no consensus in the medical literature to date regarding the treatment of this malignancy. The current study was conducted to report the long-term outcomes of a novel approach using hyperfractionated and accelerated radiotherapy (HART) for angiosarcoma developing after BCT. METHODS: The authors retrospectively reviewed the outcomes of 14 patients treated with HART with or without surgery at the University of Florida between November 1997 and March 2006 for angiosarcoma that developed after BCT. RESULTS: At the time of last follow-up, 9 patients had remained continuously without evidence of disease for a median of 61 months after HART (range, 36-127 months). Five patients had further manifestations of angiosarcoma after HART at a median of 1 month (range, 1-28 months): 3 with progressive pulmonary and/or mediastinal disease that was likely present before HART and 2 with local or regional disease extension. Progression-free survival rates for the 14 patients at 2 years and 5 years were 71% and 64%, respectively. The overall and cause-specific survival rates were both 86% at 2 years and 5 years. CONCLUSIONS: To the best of the authors' knowledge, HART with or without subsequent surgery, as documented in the current series, is the first approach to provide a high rate of local control, disease-free survival, and overall survival after the development of post-BCT angiosarcoma. The authors believe the success noted with this approach is related to both the hyperfractionation and acceleration of the RT. © 2010 American Cancer Society.

Authors
Palta, M; Morris, CG; Grobmyer, SR; III, EMC; Mendenhall, NP
MLA Citation
Palta, M, Morris, CG, Grobmyer, SR, III, EMC, and Mendenhall, NP. "Angiosarcoma after breast-conserving therapy: Long-term outcomes with hyperfractionated radiotherapy." Cancer 116.8 (2010): 1872-1878.
PMID
20162708
Source
scival
Published In
Cancer
Volume
116
Issue
8
Publish Date
2010
Start Page
1872
End Page
1878
DOI
10.1002/cncr.24995

Carcinoma of the Ampulla of Vater: Patterns of Failure after Resection and Possible Benefit of Adjuvant Radiotherapy

Authors
Palta, M; Willett, C; Patel, P; Uronis, H; Tyler, D; Czito, B
MLA Citation
Palta, M, Willett, C, Patel, P, Uronis, H, Tyler, D, and Czito, B. "Carcinoma of the Ampulla of Vater: Patterns of Failure after Resection and Possible Benefit of Adjuvant Radiotherapy." 2010.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
78
Issue
3
Publish Date
2010
Start Page
S195
End Page
S196

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

A Systematic Review of Oncology Treatment Guidelines: A Passing Grade with Government Agencies Receiving the Highest Marks

Authors
Palta, M; Lee, W
MLA Citation
Palta, M, and Lee, W. "A Systematic Review of Oncology Treatment Guidelines: A Passing Grade with Government Agencies Receiving the Highest Marks." 2009.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
75
Issue
3
Publish Date
2009
Start Page
S90
End Page
S91
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