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Sidhu, Kulbir

Positions:

Associate Professor of Radiation Oncology

Radiation Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1995

M.D. — McMaster University

Radiation Oncology

University of Toronto (Canada)

Radiation Oncology

University of Toronto (Canada)

Radiation Oncology

Memorial Sloan Kettering Cancer Center

Publications:

Screening for depression in cancer patients receiving radiotherapy: Feasibility and identification of effective tools in the NRG Oncology RTOG 0841 trial.

Brief tools are needed to screen oncology outpatients for depressive symptoms.Patients starting radiotherapy for the first diagnosis of any tumor completed distress screening tools, including the 9-item Patient Health Questionnaire (PHQ-9), the 2-item Patient Health Questionnaire (PHQ-2), the National Comprehensive Cancer Network Distress Thermometer (NCCN-DT), and the Hopkins Symptom Checklist (HSCL) (25-item version). Patients exceeding validated cutoff scores and a systematic sample of patients whose screening was negative completed the Structured Clinical Interview for DSM-IV (SCID) mood disorder modules via telephone.Four hundred sixty-three patients from 35 community-based radiation oncology sites and 2 academic radiation oncology sites were recruited. Sixty-six percent of the 455 eligible patients (n = 299) were women, and the eligible patients had breast (45%), gastrointestinal (11%), lung (10%), gynecologic (6%), or other cancers (27%). Seventy-five (16.5%) exceeded screening cutoffs for depressive symptoms. Forty-two of these patients completed the SCID. Another 37 patients whose screening was negative completed the SCID. Among the 79 patients completing the SCID, 8 (10.1%) met the criteria for major depression, 2 (2.5%) met the criteria for dysthymia, and 6 (7.6%) met the criteria for an adjustment disorder. The PHQ-2 demonstrated good psychometric properties for screening for mood disorders with a cutoff score of ≥3 (receiver operating characteristic area under the curve [AUC], 0.83) and was comparable to the PHQ-9 ( > 9; AUC = 0.85). The NCCN-DT did not detect depression (AUC = 0.59).The PHQ-2 demonstrated good psychometric properties for screening for mood disorders, which were equivalent to the PHQ-9 and superior to the NCCN-DT. These findings support using the PHQ-2 to identify patients in need of further assessment for depression, which has a low prevalence but is a clinically significant comorbidity. These findings could inform the implementation of distress screening accreditation standards. Cancer 2017;123:485-493. © 2016 American Cancer Society.

Authors
Wagner, LI; Pugh, SL; Small, W; Kirshner, J; Sidhu, K; Bury, MJ; DeNittis, AS; Alpert, TE; Tran, B; Bloom, BF; Mai, J; Yeh, A; Sarma, K; Becker, M; James, J; Bruner, DW
MLA Citation
Wagner, LI, Pugh, SL, Small, W, Kirshner, J, Sidhu, K, Bury, MJ, DeNittis, AS, Alpert, TE, Tran, B, Bloom, BF, Mai, J, Yeh, A, Sarma, K, Becker, M, James, J, and Bruner, DW. "Screening for depression in cancer patients receiving radiotherapy: Feasibility and identification of effective tools in the NRG Oncology RTOG 0841 trial." Cancer 123.3 (February 2017): 485-493.
PMID
27861753
Source
epmc
Published In
Cancer
Volume
123
Issue
3
Publish Date
2017
Start Page
485
End Page
493
DOI
10.1002/cncr.29969

Active Breathing Coordinator reduces radiation dose to the heart and preserves local control in patients with left breast cancer: report of a prospective trial.

Incidental radiation dose to the heart and lung during breast radiation therapy (RT) has been associated with an increased risk of cardiopulmonary morbidity. We conducted a prospective trial to determine if RT with the Active Breathing Coordinator (ABC) can reduce the mean heart dose (MHD) by ≥20% and dose to the lung.Patients with stages 0-III left breast cancer (LBC) were enrolled and underwent simulation with both free breathing (FB) and ABC for comparison of dosimetry. ABC was used during the patient's RT course if the MHD was reduced by ≥5%. The median prescription dose was 50.4 Gy plus a boost in 77 patients (90%). The primary endpoint was the magnitude of MHD reduction when comparing ABC to FB. Secondary endpoints included dose reduction to the heart and lung, procedural success rate, and adverse events.A total of 112 patients with LBC were enrolled from 2002 to 2011 and 86 eligible patients underwent both FB and ABC simulation. Ultimately, 81 patients received RT using ABC, corresponding to 72% procedural success. The primary endpoint was achieved as use of ABC reduced MHD by 20% or greater in 88% of patients (P < .0001). The median values for absolute and relative reduction in MHD were 1.7 Gy and 62%, respectively. RT with ABC provided a statistically significant dose reduction to the left lung. After a median follow up of 81 months, 8-year estimates of locoregional relapse, disease-free, and overall survival were 7%, 90%, and 96%, respectively.ABC was well tolerated and significantly reduced MHD while preserving local control. Use of the ABC device during RT should be considered to reduce the risk of ischemic heart disease in populations at risk.

Authors
Eldredge-Hindy, H; Lockamy, V; Crawford, A; Nettleton, V; Werner-Wasik, M; Siglin, J; Simone, NL; Sidhu, K; Anne, PR
MLA Citation
Eldredge-Hindy, H, Lockamy, V, Crawford, A, Nettleton, V, Werner-Wasik, M, Siglin, J, Simone, NL, Sidhu, K, and Anne, PR. "Active Breathing Coordinator reduces radiation dose to the heart and preserves local control in patients with left breast cancer: report of a prospective trial." Practical radiation oncology 5.1 (January 2015): 4-10.
PMID
25567159
Source
epmc
Published In
Practical Radiation Oncology
Volume
5
Issue
1
Publish Date
2015
Start Page
4
End Page
10
DOI
10.1016/j.prro.2014.06.004

Complication rates in patients with negative axillary nodes 10 years after local breast radiotherapy after either sentinel lymph node dissection or axillary clearance

BACKGROUND:: We assess complication rates in node negative breast cancer patients treated with breast radiotherapy (RT) only after sentinel lymph node dissection (SLND) or axillary lymph node dissection (ALND). MATERIALS AND METHODS:: Between 1995 and 2001, 226 women with AJCC stage I-II breast cancer were treated with lumpectomy, either SLND or SLND+ALND, and had available toxicities in follow-up: 111/136 (82%) and 115/129 (89%) in SLND and ALND groups, respectively. RT targeted the breast to median dose of 48.2 Gy (range, 46.0 to 50.4 Gy) without axillary RT. Chi-square tests compared complication rates of 2 groups for axillary web syndrome (AWS), seroma, wound infection, decreased range of motion of the ipsilateral shoulder, paresthesia, and lymphedema. RESULTS:: Median follow-up was 9.9 years (range, 8.3-15.3 y). Median number of nodes assessed was 2 (range, 1-5) in SLND and 18 (range, 7-36) in ALND (P < 0.0001). Acute complications occurred during the first 2 years and were AWS, seroma, and wound infection. Incidences of seroma 5/111 (4.5%) in SLND and 16/115 (13.9%) in ALND (P < 0.02, respectively) and wound infection 3/111 (2.7%) in SLND and 10/115 (8.7%) in ALND (P < 0.05, respectively) differed significantly. AWS was not statistically different between the groups. At 10 years, the only chronic complications decreased were range of motion of the shoulder 46/111 (41.4%) in SLND and 92/115 (80.0%) in ALND (P < 0.0001), paresthesia 12/111 (10.8%) in SLND and 39/115 (33.9%) in ALND (P < 0.0001), and lymphedema assessed by patients 10/111 (10.0%) in SLND and 39/115 (33.9%) in ALND (P < 0.0001). Chronic lymphedema, assessed by clinicians, occurred in 6/111 (5.4%) in SLND and 21/115 (18.3%) in ALND cohorts, respectively (P < 0.0001). CONCLUSIONS:: Our mature findings support that in patients with negative axillary nodal status SLND and breast RT provide excellent long-term cure rates while avoiding morbidities associated with ALND or addition of axillary RT field. Copyright © 2011 by Lippincott Williams & Wilkins.

Authors
Wernicke, AG; Shamis, M; Sidhu, KK; Turner, BC; Goltser, Y; Khan, I; Christos, PJ; Komarnicky-Kocher, LT
MLA Citation
Wernicke, AG, Shamis, M, Sidhu, KK, Turner, BC, Goltser, Y, Khan, I, Christos, PJ, and Komarnicky-Kocher, LT. "Complication rates in patients with negative axillary nodes 10 years after local breast radiotherapy after either sentinel lymph node dissection or axillary clearance." American Journal of Clinical Oncology: Cancer Clinical Trials 36.1 (2013): 12-19.
Source
scival
Published In
American Journal of Clinical Oncology: Cancer Clinical Trials
Volume
36
Issue
1
Publish Date
2013
Start Page
12
End Page
19
DOI
10.1097/COC.0b013e3182354bda

Complication rates in patients with negative axillary nodes 10 years after local breast radiotherapy after either sentinel lymph node dissection or axillary clearance

BACKGROUND: We assess complication rates in node negative breast cancer patients treated with breast radiotherapy (RT) only after sentinel lymph node dissection (SLND) or axillary lymph node dissection (ALND). MATERIALS AND METHODS: Between 1995 and 2001, 226 women with AJCC stage I-II breast cancer were treated with lumpectomy, either SLND or SLND+ALND, and had available toxicities in follow-up: 111/136 (82%) and 115/129 (89%) in SLND and ALND groups, respectively. RT targeted the breast to median dose of 48.2 Gy (range, 46.0 to 50.4 Gy) without axillary RT. Chi-square tests compared complication rates of 2 groups for axillary web syndrome (AWS), seroma, wound infection, decreased range of motion of the ipsilateral shoulder, paresthesia, and lymphedema. RESULTS: Median follow-up was 9.9 years (range, 8.3-15.3 y). Median number of nodes assessed was 2 (range, 1-5) in SLND and 18 (range, 7-36) in ALND (P < 0.0001). Acute complications occurred during the first 2 years and were AWS, seroma, and wound infection. Incidences of seroma 5/111 (4.5%) in SLND and 16/115 (13.9%) in ALND (P < 0.02, respectively) and wound infection 3/111 (2.7%) in SLND and 10/115 (8.7%) in ALND (P < 0.05, respectively) differed significantly. AWS was not statistically different between the groups. At 10 years, the only chronic complications decreased were range of motion of the shoulder 46/111 (41.4%) in SLND and 92/115 (80.0%) in ALND (P < 0.0001), paresthesia 12/111 (10.8%) in SLND and 39/115 (33.9%) in ALND (P < 0.0001), and lymphedema assessed by patients 10/111 (10.0%) in SLND and 39/115 (33.9%) in ALND (P < 0.0001). Chronic lymphedema, assessed by clinicians, occurred in 6/111 (5.4%) in SLND and 21/115 (18.3%) in ALND cohorts, respectively (P < 0.0001). CONCLUSIONS: Our mature findings support that in patients with negative axillary nodal status SLND and breast RT provide excellent long-term cure rates while avoiding morbidities associated with ALND or addition of axillary RT field.

Authors
Wernicke, AG; Shamis, M; Sidhu, KK; Turner, BC; Goltser, Y; Khan, I; Christos, PJ; Komarnicky-Kocher, LT
MLA Citation
Wernicke, AG, Shamis, M, Sidhu, KK, Turner, BC, Goltser, Y, Khan, I, Christos, PJ, and Komarnicky-Kocher, LT. "Complication rates in patients with negative axillary nodes 10 years after local breast radiotherapy after either sentinel lymph node dissection or axillary clearance." American Journal of Clinical Oncology (2011).
PMID
22134519
Source
scival
Published In
American Journal of Clinical Oncology: Cancer Clinical Trials
Publish Date
2011
DOI
10.1097/COC.0b013e3182354bda

Early postoperative paclitaxel followed by concurrent paclitaxel and cisplatin with radiation therapy for patients with resected high-risk head and neck squamous cell carcinoma: Report of the phase II trial RTOG 0024

Purpose: We sought to improve outcomes for patients with high-risk head and neck squamous cell cancer (HNSCC) after surgical resection by testing the feasibility and safety of early postoperative chemotherapy followed by concurrent chemoradiotherapy. Patients and Methods: Eligible patients had resected, stages III to IV HNSCC with positive margins, extracapsular nodal extension, or multiple positive nodes. Paclitaxel (80 mg/m2) was given once weekly during postoperative weeks 2, 3, and 4 and was given before radiation therapy (RT). Paclitaxel (30 mg/m2) and cisplatin (20 mg/m2) were given once weekly during the last 3 weeks of RT (60 Gy over 6 weeks, beginning 4 to 5 weeks after surgery). The primary end points were treatment safety and tolerability compared with concurrent cisplatin (100 mg/m2 every 3 weeks) and RT, as tested in Radiation Therapy Oncology Group trial RTOG 9501. Results: The median follow-up time for the 70 patients enrolled was 3.3 years (range, 0.6 to 4.4 years) for surviving patients. Tolerability of all treatment components was comparable to that of RTOG 9501 treatment, which is the current standard of care (compliance rate, 75%; 95% CI, 63% to 85%). One patient died, and seven patients experienced grade 4 nonhematologic toxicities. Rates of locoregional control, disease-free survival, and overall survival exceeded those of RTOG 9501 after adjustment for important prognostic variables (ie, positive margins, extracapsular extension, primary site, and performance status). Conclusion: Chemotherapy soon after surgery followed by concurrent chemoradiotherapy therapy was feasible; tolerance was in line with standard postoperative chemoradiotherapy; and this regimen led to excellent rates of locoregional control and disease-free survival. Copyright © 2009 by the American Society of Clinical Oncology. All rights reserved.

Authors
Rosenthal, DI; Harris, J; Forastiere, AA; Weber, RS; Ridge, JA; Myers, JN; Garden, AS; Kuettel, MR; Sidhu, K; Schultz, CJ; Trotti, A; Ang, KK
MLA Citation
Rosenthal, DI, Harris, J, Forastiere, AA, Weber, RS, Ridge, JA, Myers, JN, Garden, AS, Kuettel, MR, Sidhu, K, Schultz, CJ, Trotti, A, and Ang, KK. "Early postoperative paclitaxel followed by concurrent paclitaxel and cisplatin with radiation therapy for patients with resected high-risk head and neck squamous cell carcinoma: Report of the phase II trial RTOG 0024." Journal of Clinical Oncology 27.28 (2009): 4727-4732.
PMID
19720915
Source
scival
Published In
Journal of Clinical Oncology
Volume
27
Issue
28
Publish Date
2009
Start Page
4727
End Page
4732
DOI
10.1200/JCO.2008.21.4197

Neck dissection followed by chemoradiotherapy for stage IV (N+) oropharynx cancer

Purpose: This study evaluated the strategy of performing neck dissection (ND) without primary tumor resection prior to definitive chemoradiotherapy (CRT) for N2+ oropharynx cancer. Methods: We analyzed records of 25 patients who underwent ND before concurrent CRT with weekly low-dose concurrent paclitaxel and a platinum compound. The extent of ND was highly customized (1 to 39 nodes) and median radiotherapy dose was 70 Gy. Results: Median follow-up was 36 months. Two-year and 3-year actuarial locoregional control rates were 95% and 88%. No patient had regional neck nodal failure. Two-year rate of freedom from distant metastases was 91%. The 2- and 3-year event-free survival rates were 88% and 75%. Fifteen percent had Grade 3+ late toxicity; none had permanent gastrostomy tube dependence. Conclusions: Neck dissection without primary tumor resection before definitive chemoradiotherapy for oropharynx cancer is a safe and effective management program and warrants further exploration. © 2007 American Academy of Otolaryngology-Head and Neck Surgery Foundation.

Authors
Cupino, A; Axelrod, R; Anne, PR; Sidhu, K; Lavarino, J; Kung, B; Rosen, M; Keane, W; Machtay, M
MLA Citation
Cupino, A, Axelrod, R, Anne, PR, Sidhu, K, Lavarino, J, Kung, B, Rosen, M, Keane, W, and Machtay, M. "Neck dissection followed by chemoradiotherapy for stage IV (N+) oropharynx cancer." Otolaryngology - Head and Neck Surgery 137.3 (2007): 416-421.
PMID
17765768
Source
scival
Published In
Otolaryngology - Head and Neck Surgery
Volume
137
Issue
3
Publish Date
2007
Start Page
416
End Page
421
DOI
10.1016/j.otohns.2007.03.021

The activity of letrozole in patients with advanced or recurrent endometrial cancer and correlation with biological markers - A study of the National Cancer Institute of Canada Clinical Trials Group

A multicenter phase II trial was conducted to define the activity of letrozole in postmenopausal women with recurrent or advanced endometrial carcinoma, who had no more than one prior line of progestins and never had chemotherapy (except adjuvant). Archival paraffin-embedded tumor samples were retrieved to determine the expression level of estrogen (ER) and progesterone receptor (PgR), p53, HER-2, bcl-2 and PTEN protein, and phosphorylation status of protein kinase B (PKB/Akt). Thirty-two eligible patients were treated with letrozole at 2.5 mg daily continuously, of whom 10 (31%) had prior progestins. Of the 28 patients evaluated for response, one complete and two partial responses were noted; overall response was 9.4% (95% confidence interval 2-25%). Eleven patients had stable disease for a median duration of 6.7 months (range 3.7-19.3 months). Amongst 22 patients who had tumor blocks available, the proportion showing positive expression of the following markers includes: PgR (86%), ER (86%), PTEN (82%), phosphorylated PKB/Akt (59%), bcl-2 (45%), p53 (32%), and HER-2 (0%). None of these markers correlated with response to letrozole or disease progression. In conclusion, letrozole is well tolerated but has little overall activity in this cohort of women with endometrial cancer.

Authors
Ma, BBY; Oza, A; Eisenhauer, E; Stanimir, G; Carey, M; Chapman, W; Latta, E; Sidhu, K; Powers, J; Walsh, W; Fyles, A
MLA Citation
Ma, BBY, Oza, A, Eisenhauer, E, Stanimir, G, Carey, M, Chapman, W, Latta, E, Sidhu, K, Powers, J, Walsh, W, and Fyles, A. "The activity of letrozole in patients with advanced or recurrent endometrial cancer and correlation with biological markers - A study of the National Cancer Institute of Canada Clinical Trials Group." International Journal of Gynecological Cancer 14.4 (2004): 650-658.
PMID
15304161
Source
scival
Published In
International Journal of Gynecological Cancer
Volume
14
Issue
4
Publish Date
2004
Start Page
650
End Page
658
DOI
10.1111/j.1048-891X.2004.14419.x
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