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Suneja, Gita

Positions:

Associate Professor of Radiation Oncology

Radiation Oncology
School of Medicine

Associate Research Professor of Global Health

Duke Global Health Institute
Institutes and Provost's Academic Units

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 2008

M.D. — Brown University

Intern, Internal Medicine

University of Pennsylvania School of Medicine

Resident, Radiation Oncology

University of Pennsylvania School of Medicine

Chief Resident, Radiation Oncology

University of Pennsylvania School of Medicine

Clinical Instructor, Radiationoncology

University of Pennsylvania School of Medicine

Assistant Professor, Radiation Oncology

University of Utah School of Medicine

Grants:

A novel strategy to see and treat breast cancer: translation to intra-operative breast margin assessment

Administered By
Biomedical Engineering
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
September 15, 2017
End Date
July 31, 2019

Publications:

Risk of secondary malignancies after radiation therapy for breast cancer: Comprehensive results.

To assess risks of secondary malignancies in breast cancer patients who received radiation therapy compared to patients who did not.The SEER database was used to identify females with a primary diagnosis of breast cancer as their first malignancy, during 1973-2008. We excluded patients with metastatic disease, age <18 years, no definitive surgical intervention, ipsilateral breast cancer recurrence, or who developed a secondary malignancy within 1 year of diagnosis. Standardized incidence ratios and absolute excess risk were calculated using SEER*Stat, version 8.2.1 and SAS, version 9.4.There were 374,993 patients meeting the inclusion criteria, with 154,697 who received radiation therapy. With a median follow-up of 8.9 years, 13% of patients (49,867) developed a secondary malignancy. The rate of secondary malignancies was significantly greater than the endemic rate in breast cancer patients treated without radiation therapy, (O/E 1.2, 95% CI 1.19-1.22) and with radiation therapy (O/E 1.33, 95% CI 1.31-1.35). Approximately 3.4% of secondary malignancies were attributable to radiation therapy. The increased risk of secondary malignancies in breast cancer patients treated with radiation therapy compared to those without was significant regardless of age at breast cancer diagnosis (p < 0.01) and more pronounced with longer latency periods.There was an increased risk of secondary malignancies for breast cancer patients both with and without radiation therapy compared to the general population. There was an increased risk in specific sites for patients treated with radiation therapy. This risk was most evident in young patients and who had longer latency periods.

Authors
Burt, LM; Ying, J; Poppe, MM; Suneja, G; Gaffney, DK
MLA Citation
Burt, LM, Ying, J, Poppe, MM, Suneja, G, and Gaffney, DK. "Risk of secondary malignancies after radiation therapy for breast cancer: Comprehensive results." Breast (Edinburgh, Scotland) 35 (October 2017): 122-129.
PMID
28719811
Source
epmc
Published In
The Breast
Volume
35
Publish Date
2017
Start Page
122
End Page
129
DOI
10.1016/j.breast.2017.07.004

Risk factors for development of melanoma brain metastasis and disease progression: a single-center retrospective analysis.

Melanoma metastasis to the brain is associated with a poor prognosis. We sought to determine patient demographics and primary tumor factors associated with the development of brain metastasis (BM) and survival. We also investigated whether the BM detection setting (routine screening vs. symptomatic presentation) affected clinical outcomes. A database of melanoma patients seen from 1999 to 2015 at our institution was reviewed to identify patients who developed BM. Patients with BM were matched by initial stage with patients who did not develop BM as a control group. Patient demographics, primary tumor characteristics, and clinical outcomes were analyzed. A total of 123 patients with BM were matched by initial presenting stage to 237 patients without BM. The characteristics of the primary melanoma tumor associated with BM development included location on the scalp (P=0.030), nodular histologic type (P=0.020), and Breslow depth more than 4 mm (P=0.048), whereas location on the leg was associated with decreased BM risk (P=0.006). In patients with BM, time to first recurrence for melanomas of the scalp was significantly shorter (10.8 vs. 24.8 months, P=0.007) than nonscalp head and neck tumors. Patient stage, tumor depth, nodular type, and ulceration were also associated with worse clinical outcomes. There were no differences in the clinical outcomes between patients whose BM were detected upon routine screening versus those detected upon symptomatic presentation. In summary, factors predictive of development of BM included primary scalp location, nodular type, and depth. In BM patients, scalp location, stage, tumor depth, nodular type, and ulceration, but not detection setting, were associated with worse clinical outcomes.

Authors
Gardner, LJ; Ward, M; Andtbacka, RHI; Boucher, KM; Bowen, GM; Bowles, TL; Cohen, AL; Grossmann, K; Hitchcock, YJ; Holmen, SL; Hyngstrom, J; Khong, H; McMahon, M; Monroe, MM; Ross, CB; Suneja, G; Wada, D; Grossman, D
MLA Citation
Gardner, LJ, Ward, M, Andtbacka, RHI, Boucher, KM, Bowen, GM, Bowles, TL, Cohen, AL, Grossmann, K, Hitchcock, YJ, Holmen, SL, Hyngstrom, J, Khong, H, McMahon, M, Monroe, MM, Ross, CB, Suneja, G, Wada, D, and Grossman, D. "Risk factors for development of melanoma brain metastasis and disease progression: a single-center retrospective analysis." Melanoma research 27.5 (October 2017): 477-484.
PMID
28800031
Source
epmc
Published In
Melanoma Research
Volume
27
Issue
5
Publish Date
2017
Start Page
477
End Page
484
DOI
10.1097/cmr.0000000000000382

Cancer-specific mortality, cure fraction, and noncancer causes of death among diffuse large B-cell lymphoma patients in the immunochemotherapy era.

Survival after the diagnosis of diffuse large B-cell lymphoma (DLBCL) has been increasing since 2002 because of improved therapies; however, long-term outcomes for these patients in the modern treatment era are still unknown.Using Surveillance, Epidemiology, and End Results data, this study first assessed factors associated with DLBCL-specific mortality during 2002-2012. An epidemiologic risk profile, based on clinical and demographic characteristics, was used to stratify DLBCL cases into low-, medium-, and high-risk groups. The proportions of DLBCL cases that might be considered cured in these 3 risk groups was estimated. Risks of death due to various noncancer causes among DLBCL cases versus the general population were also calculated with standardized mortality ratios (SMRs).Overall, 8274 deaths were recorded among 18,047 DLBCL cases; 76% of the total deaths were attributed to DLBCL, and 24% were attributed to noncancer causes. The 10-year survival rates for the low-, medium-, and high-risk groups were 80%, 60%, and 36%, respectively. The estimated cure proportions for the low-, medium-, and high-risk groups were 73%, 49%, and 27%, respectively; however, these cure estimates were uncertain because of the need to extrapolate the survival curves beyond the follow-up time. Mortality risks calculated with SMRs were elevated for conditions including vascular diseases (SMR, 1.3), infections (SMR, 3.1), gastrointestinal diseases (SMR, 2.5), and blood diseases (SMR, 4.6). These mortality risks were especially high within the initial 5 years after the diagnosis and declined after 5 years.Some DLBCL patients may be cured of their cancer, but they continue to experience excess mortality from lymphoma and other noncancer causes. Cancer 2017;123:3326-34. © 2017 American Cancer Society.

Authors
Howlader, N; Mariotto, AB; Besson, C; Suneja, G; Robien, K; Younes, N; Engels, EA
MLA Citation
Howlader, N, Mariotto, AB, Besson, C, Suneja, G, Robien, K, Younes, N, and Engels, EA. "Cancer-specific mortality, cure fraction, and noncancer causes of death among diffuse large B-cell lymphoma patients in the immunochemotherapy era." Cancer 123.17 (September 2017): 3326-3334.
PMID
28464214
Source
epmc
Published In
Cancer
Volume
123
Issue
17
Publish Date
2017
Start Page
3326
End Page
3334
DOI
10.1002/cncr.30739

Disparities in care for elderly women with endometrial cancer adversely effects survival.

Elderly women with endometrial cancer are at increased risk of local recurrence and cancer-specific death compared to younger women. We sought to investigate adjuvant radiotherapy (RT) practice patterns and effects on survival in elderly women with endometrial cancer.Women from the National Cancer Data Base (NCDB) with FIGO IA grade 3 to FIGO IVA endometrial cancer diagnosed from 2004-2013 were included. Chi square analysis was used to compare the elderly (80+) and non-elderly women (18-79) and women who received RT and those that did not. Univariate and multivariate logistic regression were used to determine predictors of receipt of oncologic surgery and adjuvant RT. Univariate and multivariate Cox survival analyses were performed to examine the effect of radiotherapy on survival. Propensity score matching and shared frailty analysis were done in the elderly cohort.We identified 48,871 women for analysis. Rates of oncologic surgery were higher in the women 80+ compared with rates of adjuvant RT (95% versus 34%). Rates of RT receipt were higher in non-elderly women (48% versus 34%, p<0.001). Age over 80 was a negative predictive factor (OR 0.62, p<0.001) for receipt of adjuvant RT and oncologic surgery (OR 0.81, p=0.03). Adjuvant RT was associated with a decreased risk of death in elderly (HR 0.79, p<0.001) and non-elderly women (HR 0.77, p<0.001).Endometrial cancer patients over age 80 have similar rates of oncologic surgery as younger women but are significantly less likely to receive adjuvant RT, and this negatively impacts their survival.

Authors
Torgeson, A; Boothe, D; Poppe, MM; Suneja, G; Gaffney, DK
MLA Citation
Torgeson, A, Boothe, D, Poppe, MM, Suneja, G, and Gaffney, DK. "Disparities in care for elderly women with endometrial cancer adversely effects survival." Gynecologic oncology (August 9, 2017).
PMID
28802765
Source
epmc
Published In
Gynecologic Oncology
Publish Date
2017
DOI
10.1016/j.ygyno.2017.08.005

Anaplastic meningioma: an analysis of the National Cancer Database from 2004 to 2012.

OBJECTIVE Anaplastic meningiomas represent 1%-2% of meningioma diagnoses and portend a poor prognosis. Limited information is available on practice patterns and optimal management. The purpose of this study was to define treatment patterns and outcomes by treatment modality using a large national cancer registry. METHODS The National Cancer Database was used to identify patients diagnosed with anaplastic meningioma from 2004 to 2012. Log-rank statistics were used to compare survival outcomes by extent of resection, use of adjuvant radiotherapy (RT), and use of adjuvant chemotherapy. Least-squares linear regression was used to evaluate the utilization of RT over time. Logistic regression modeling was used to identify predictors of receipt of RT. Cox proportional hazards modeling was used to evaluate the effect of RT, gross-total resection (GTR), and chemotherapy on survival. RESULTS A total of 755 adults with anaplastic meningioma were identified. The 5-year overall survival rate was 41.4%. Fifty-two percent of patients received RT, 7% received chemotherapy, and 58% underwent GTR. Older patients were less likely to receive RT (OR 0.98, p < 0.01). Older age (HR 1.04, p < 0.01), high comorbidity score (HR 1.33, p = 0.02), and subtotal resection (HR 1.57, p = 0.02) were associated with increased risk of death on multivariate modeling, while RT receipt was associated with decreased risk of death (HR 0.79, p = 0.04). Chemotherapy did not have a demonstrable effect on survival (HR 1.33, p = 0.18). CONCLUSIONS Anaplastic meningioma portends a poor prognosis. Gross-total resection and RT are associated with improved survival, but utilization of RT is low. Unless medically contraindicated, patients with anaplastic meningioma should be offered RT.

Authors
Orton, A; Frandsen, J; Jensen, R; Shrieve, DC; Suneja, G
MLA Citation
Orton, A, Frandsen, J, Jensen, R, Shrieve, DC, and Suneja, G. "Anaplastic meningioma: an analysis of the National Cancer Database from 2004 to 2012." Journal of neurosurgery (July 21, 2017): 1-6.
PMID
28731397
Source
epmc
Published In
Journal of neurosurgery
Publish Date
2017
Start Page
1
End Page
6
DOI
10.3171/2017.2.jns162282

Patterns of care and outcomes in gliosarcoma: an analysis of the National Cancer Database.

OBJECTIVE The authors compared presenting characteristics and survival for patients with gliosarcoma (GS) and glioblastoma (GBM). Additionally, they performed a survival analysis for patients who underwent GS treatments with the hypothesis that trimodality therapy (surgery followed by radiation and chemotherapy) would be superior to nontrimodality therapy (surgery alone or surgery followed by chemotherapy or radiation). METHODS Adults diagnosed with GS and GBM between the years 2004 and 2013 were queried from the National Cancer Database. Chi-square analysis was used to compare presenting characteristics. Kaplan-Meier, Cox regression, and propensity score analyses were employed for survival analyses. RESULTS In total, data from 1102 patients with GS and 36,658 patients with GBM were analyzed. Gliosarcoma had an increased rate of gross-total resection (GTR) compared with GBM (19% vs 15%, p < 0.001). Survival was not different for patients with GBM (p = 0.068) compared with those with GS. After propensity score analysis for GS, patients receiving trimodality therapy (surgery followed by radiation and chemotherapy) had improved survival (12.9 months) compared with those not receiving trimodality therapy (5.5 months). In multivariate analysis, GTR, female sex, fewer comorbidities, trimodality therapy, and age < 65 years were associated with improved survival. There was a trend toward improved survival with MGMT promoter methylation (p = 0.117). CONCLUSIONS In this large registry study, there was no difference in survival in patients with GBM compared with GS. Among GS patients, trimodality therapy significantly improved survival compared with nontrimodality therapy. Gross-total resection also improved survival, and there was a trend toward increased survival with MGMT promoter methylation in GS. The major potential confounder in this study is that patients with poor functional status may not have received aggressive radiation or chemotherapy treatments, leading to the observed outcome. This study should be considered hypothesis-generating; however, due to its rarity, conducting a clinical trial with GS patients alone may prove difficult.

Authors
Frandsen, J; Orton, A; Jensen, R; Colman, H; Cohen, AL; Tward, J; Shrieve, DC; Suneja, G
MLA Citation
Frandsen, J, Orton, A, Jensen, R, Colman, H, Cohen, AL, Tward, J, Shrieve, DC, and Suneja, G. "Patterns of care and outcomes in gliosarcoma: an analysis of the National Cancer Database." Journal of neurosurgery (June 16, 2017): 1-6.
PMID
28621623
Source
epmc
Published In
Journal of neurosurgery
Publish Date
2017
Start Page
1
End Page
6
DOI
10.3171/2016.12.jns162291

Adjuvant radiotherapy for atypical meningiomas.

OBJECTIVE The aim of this paper was to evaluate outcomes in patients with atypical meningiomas (AMs) treated with surgery alone compared with surgery and radiotherapy at initial diagnosis, or at the time of first recurrence. METHODS Patients with pathologically confirmed AMs treated at the University of Utah from 1991 to 2014 were retrospectively reviewed. Local control (LC), overall survival (OS), Karnofsky Performance Status (KPS), and toxicity were assessed. Outcomes for patients receiving adjuvant radiotherapy were compared with those for patients treated with surgery alone. Kaplan-Meier and the log-rank test for significance were used for LC and OS analyses. RESULTS Fifty-nine patients with 63 tumors were reviewed. Fifty-two patients were alive at the time of analysis with a median follow-up of 42 months. LC for all tumors was 57% with a median time to local failure (TTLF) of 48 months. The median TTLF following surgery and radiotherapy was 180 months, compared with 46 months following surgery alone (p = 0.02). Excluding Simpson Grade IV (subtotal) resections, there remained an LC benefit with the addition of radiotherapy for Simpson Grade I, II, and III resected tumors (median TTLF 180 months after surgery and radiotherapy compared with 46 months with surgery alone [p = 0.002]). Patients treated at first recurrence following any initial therapy (either surgery alone or surgery and adjuvant radiotherapy) had a median TTLF of 26 months compared with 48 months for tumors treated at first diagnosis (p = 0.007). There were 2 Grade 3 toxicities and 1 Grade 4 toxicity associated with radiotherapy. CONCLUSIONS Adjuvant radiotherapy improves LC for AMs. The addition of adjuvant radiotherapy following even a Simpson Grade I, II, or III resection was found to confer an LC benefit. Recurrent disease is difficult to control, underscoring the importance of aggressive initial treatment.

Authors
Bagshaw, HP; Burt, LM; Jensen, RL; Suneja, G; Palmer, CA; Couldwell, WT; Shrieve, DC
MLA Citation
Bagshaw, HP, Burt, LM, Jensen, RL, Suneja, G, Palmer, CA, Couldwell, WT, and Shrieve, DC. "Adjuvant radiotherapy for atypical meningiomas." Journal of neurosurgery 126.6 (June 2017): 1822-1828.
PMID
27611201
Source
epmc
Published In
Journal of neurosurgery
Volume
126
Issue
6
Publish Date
2017
Start Page
1822
End Page
1828
DOI
10.3171/2016.5.jns152809

The Addition of Adjuvant Chemotherapy to Radiation in Early-Stage High-Risk Endometrial Cancer: Survival Outcomes and Patterns of Care.

Early-stage high-risk endometrial cancer (HREC) treated with adjuvant radiotherapy (aRT) alone has been associated with an increased risk of distant relapse. The addition of chemotherapy to radiotherapy (aCRT) may benefit overall survival (OS). We investigated the patterns-of-care and OS benefit of aCRT in HREC by analyzing a large national registry.Our query was limited to patients with the International Federation of Gynecology and Obstetrics stage IB and II HREC with either papillary serous, clear cell, or grade 3 adenocarcinoma, diagnosed between 2004 and 2012. Logistic and Cox regression analyses were utilized to identify predictors of aCRT use and OS, respectively. Survival analysis was performed with Kaplan Meier and log-rank methods. Propensity score matching was employed to decrease the potential influence of selection bias.A total of 11,746 patients were identified for analysis with 8206 (69.9%) receiving aCRT, and 3540 (30.1%) received aRT. Predictors of aCRT included International Federation of Gynecology and Obstetrics stage II (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.22-1.57), papillary serous (OR, 9.44; 95% CI, 8.22-10.85) or clear cell (OR, 3.21; 95% CI, 2.59-3.97) histology, lymph nodes removed (OR, 1.48; 95% CI, 1.31-1.69), and receipt of brachytherapy alone (OR, 1.55; 95% CI, 1.36-1.78). Estimated 5-year OS was 75.2% for patients receiving aRT only and 79.2% for those receiving aCRT (P < 0.001). When compared with aRT, aCRT was associated with improved OS on multivariate (hazard ratio, 0.78; 95% CI, 0.61-0.99) analysis. A univariate shared-frailty Cox regression after propensity score matching revealed persistence of the OS benefit with aCRT (hazard ratio, 0.74; 95% CI, 0.65-0.84).The addition of adjuvant chemotherapy to radiation in HREC is associated with improved OS. Multiple demographic and clinical factors significantly influence the choice of adjuvant therapy in this setting.

Authors
Boothe, D; Williams, N; Odei, B; Poppe, MM; Werner, TL; Suneja, G; Gaffney, DK
MLA Citation
Boothe, D, Williams, N, Odei, B, Poppe, MM, Werner, TL, Suneja, G, and Gaffney, DK. "The Addition of Adjuvant Chemotherapy to Radiation in Early-Stage High-Risk Endometrial Cancer: Survival Outcomes and Patterns of Care." International journal of gynecological cancer : official journal of the International Gynecological Cancer Society 27.5 (June 2017): 912-922.
PMID
28498257
Source
epmc
Published In
International Journal of Gynecological Cancer
Volume
27
Issue
5
Publish Date
2017
Start Page
912
End Page
922
DOI
10.1097/igc.0000000000000963

Chemoradiation Versus Chemotherapy in Uterine Carcinosarcoma: Patterns of Care and Impact on Overall Survival.

Uterine carcinosarcoma (UCS) is a rare and aggressive cancer with poor survival. Our purpose was to evaluate the patterns-of-care and overall survival (OS) benefit of adjuvant chemoradiation (aCRT) compared with adjuvant chemotherapy (aCT) among UCS patients.A query was made in the National Cancer Database to identify patients with UCS diagnosed between 2004 and 2012. Factors predictive of OS were determined using univariate and multivariate Cox regression analysis, as well as Kaplan-Meier and log-rank analysis. Propensity-score matching was employed to decrease the potential influence of selection bias.A total of 3538 patients were identified for analysis, consisting of 1787 patients (50.5%) receiving aCT and 1751 (49.5%) receiving aCRT. The median age of patients was 65 years. The majority of patients in our cohort were white (68.6%), on Medicare insurance (47.9%), with >5 cm tumor size (59.9%), and received a lymph node surgery (87.9%). The following factors were predictive of aCRT use: undergoing lymph node surgery (odds ratio, 1.59, P=0.01), and FIGO stage II (odds ratio, 1.71, P=0.01). Median survival for the aCT and aCRT groups was 24 months and 31.3 months, respectively. When compared with aCT alone, aCRT was associated with a benefit in OS on multivariate analysis (hazard ratio, 0.65, P<0.01).When compared with aCT alone, the use of aCRT in UCS patients was associated with a significant OS benefit. Multiple demographic and clinical factors significantly influence the choice of adjuvant therapy in this setting.

Authors
Odei, B; Boothe, D; Suneja, G; Werner, TL; Gaffney, DK
MLA Citation
Odei, B, Boothe, D, Suneja, G, Werner, TL, and Gaffney, DK. "Chemoradiation Versus Chemotherapy in Uterine Carcinosarcoma: Patterns of Care and Impact on Overall Survival." American journal of clinical oncology (January 24, 2017).
PMID
28121642
Source
epmc
Published In
American Journal of Clinical Oncology: Cancer Clinical Trials
Publish Date
2017
DOI
10.1097/coc.0000000000000360

Cancer care disparities in people with HIV in the United States.

Cancer is a growing problem in the HIV population, in large part because of aging of HIV-infected people treated with antiretroviral therapy. Overall and cancer-specific survival is worse in HIV-infected cancer patients compared with uninfected patients. One potential reason for the observed survival deficit is differences in cancer treatment.Recent population-based data suggest that HIV-infected cancer patients are less likely to receive cancer treatment compared with uninfected patients. This review describes these treatment disparities and their impact on patient outcomes, explores reasons for the disparity and highlights areas for future research.Cancer is the leading cause of non-AIDS death in HIV-infected individuals. Understanding the underlying cancer treatment disparity between HIV-infected patients and their uninfected counterparts, and developing solutions to address the problem, is of great importance to improve cancer outcomes in this growing patient population.

Authors
Suneja, G; Coghill, A
MLA Citation
Suneja, G, and Coghill, A. "Cancer care disparities in people with HIV in the United States." Current opinion in HIV and AIDS 12.1 (January 2017): 63-68. (Review)
PMID
27753654
Source
epmc
Published In
Current Opinion in HIV and AIDS
Volume
12
Issue
1
Publish Date
2017
Start Page
63
End Page
68
DOI
10.1097/coh.0000000000000320

American Brachytherapy Society: Brachytherapy treatment recommendations for locally advanced cervix cancer for low-income and middle-income countries.

Most cervix cancer cases occur in low-income and middle-income countries (LMIC), and outcomes are suboptimal, even for early stage disease. Brachytherapy plays a central role in the treatment paradigm, improving both local control and overall survival. The American Brachytherapy Society (ABS) aims to provide guidelines for brachytherapy delivery in resource-limited settings.A panel of clinicians and physicists with expertise in brachytherapy administration in LMIC was convened. A survey was developed to identify practice patterns at the authors' institutions and was also extended to participants of the Cervix Cancer Research Network. The scientific literature was reviewed to identify consensus papers or review articles with a focus on treatment of locally advanced, unresected cervical cancer in LMIC.Of the 40 participants invited to respond to the survey, 32 responded (response rate 80%). Participants were practicing in 14 different countries including both high-income (China, Singapore, Taiwan, United Kingdom, and United States) and low-income or middle-income countries (Bangladesh, Botswana, Brazil, India, Malaysia, Pakistan, Philippines, Thailand, and Vietnam). Recommendations for modifications to existing ABS guidelines were reviewed by the panel members and are highlighted in this article.Recommendations for treatment of locally advanced, unresectable cervical cancer in LMIC are presented. The guidelines comment on staging, external beam radiotherapy, use of concurrent chemotherapy, overall treatment duration, use of anesthesia, applicator choice and placement verification, brachytherapy treatment planning including dose and prescription point, recommended reporting and documentation, physics support, and follow-up.

Authors
Suneja, G; Brown, D; Chang, A; Erickson, B; Fidarova, E; Grover, S; Mahantshetty, U; Nag, S; Narayan, K; Bvochora-Nsingo, M; Viegas, C; Viswanathan, AN; Lin, MY; Gaffney, D
MLA Citation
Suneja, G, Brown, D, Chang, A, Erickson, B, Fidarova, E, Grover, S, Mahantshetty, U, Nag, S, Narayan, K, Bvochora-Nsingo, M, Viegas, C, Viswanathan, AN, Lin, MY, and Gaffney, D. "American Brachytherapy Society: Brachytherapy treatment recommendations for locally advanced cervix cancer for low-income and middle-income countries." Brachytherapy 16.1 (January 2017): 85-94.
PMID
27919654
Source
epmc
Published In
Brachytherapy
Volume
16
Issue
1
Publish Date
2017
Start Page
85
End Page
94
DOI
10.1016/j.brachy.2016.10.007

Corrigendum to "Chemoradiation versus chemotherapy or radiation alone in stage III endometrial cancer: Patterns of care and impact on overall survival" [Gynecol. Oncol. 141 (2016) 421-427].

Authors
Boothe, D; Orton, A; Odei, B; Stoddard, G; Suneja, G; Poppe, MM; L Werner, T; Gaffney, DK
MLA Citation
Boothe, D, Orton, A, Odei, B, Stoddard, G, Suneja, G, Poppe, MM, L Werner, T, and Gaffney, DK. "Corrigendum to "Chemoradiation versus chemotherapy or radiation alone in stage III endometrial cancer: Patterns of care and impact on overall survival" [Gynecol. Oncol. 141 (2016) 421-427]." Gynecologic oncology 143.3 (December 2016): 690-691.
PMID
27726921
Source
epmc
Published In
Gynecologic Oncology
Volume
143
Issue
3
Publish Date
2016
Start Page
690
End Page
691
DOI
10.1016/j.ygyno.2016.09.023

Avoiding severe toxicity from combined BRAF inhibitor and radiation treatment: Consensus guidelines from the Eastern Cooperative Oncology Group (ECOG) (vol 95, pg 632, 2016)

Authors
Anker, CJ; Grossmann, KF; Atkins, MB; Suneja, G; Tarhini, AA; Kirkwood, JM
MLA Citation
Anker, CJ, Grossmann, KF, Atkins, MB, Suneja, G, Tarhini, AA, and Kirkwood, JM. "Avoiding severe toxicity from combined BRAF inhibitor and radiation treatment: Consensus guidelines from the Eastern Cooperative Oncology Group (ECOG) (vol 95, pg 632, 2016)." INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 96.2 (October 1, 2016): 486-486.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2
Publish Date
2016
Start Page
486
End Page
486
DOI
10.1016/j.ijrobp.2016.01

Patterns of Care and Outcomes Analysis for Gliosarcoma: A National Cancer Data Base Project

Authors
Frandsen, J; Orton, A; Shrieve, DC; Jensen, RL; Colman, H; Cohen, A; Suneja, G
MLA Citation
Frandsen, J, Orton, A, Shrieve, DC, Jensen, RL, Colman, H, Cohen, A, and Suneja, G. "Patterns of Care and Outcomes Analysis for Gliosarcoma: A National Cancer Data Base Project." October 1, 2016.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2
Publish Date
2016
Start Page
E96
End Page
E96

Anaplastic (Malignant) Meningioma: A Patterns-of-Care and Outcomes Analysis of the National Cancer Data Base

Authors
Orton, A; Frandsen, J; Shrieve, DC; Jensen, RL; Suneja, G
MLA Citation
Orton, A, Frandsen, J, Shrieve, DC, Jensen, RL, and Suneja, G. "Anaplastic (Malignant) Meningioma: A Patterns-of-Care and Outcomes Analysis of the National Cancer Data Base." October 1, 2016.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2
Publish Date
2016
Start Page
E76
End Page
E76

Chemoradiation Versus Chemotherapy or Radiation Alone in Stage III Endometrial Cancer: Patterns of Care and Impact on Overall Survival

Authors
Boothe, D; Orton, A; Odei, B; Suneja, G; Werner, T; Gaffney, DK
MLA Citation
Boothe, D, Orton, A, Odei, B, Suneja, G, Werner, T, and Gaffney, DK. "Chemoradiation Versus Chemotherapy or Radiation Alone in Stage III Endometrial Cancer: Patterns of Care and Impact on Overall Survival." October 1, 2016.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2
Publish Date
2016
Start Page
E286
End Page
E286

Patterns of Care and Outcomes Analysis for Gliosarcoma: A National Cancer Data Base Project.

Authors
Frandsen, J; Orton, A; Shrieve, DC; Jensen, RL; Colman, H; Cohen, A; Suneja, G
MLA Citation
Frandsen, J, Orton, A, Shrieve, DC, Jensen, RL, Colman, H, Cohen, A, and Suneja, G. "Patterns of Care and Outcomes Analysis for Gliosarcoma: A National Cancer Data Base Project." International journal of radiation oncology, biology, physics 96.2S (October 2016): E96-.
PMID
27675512
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2S
Publish Date
2016
Start Page
E96
DOI
10.1016/j.ijrobp.2016.06.834

Anaplastic (Malignant) Meningioma: A Patterns-of-Care and Outcomes Analysis of the National Cancer Data Base.

Authors
Orton, A; Frandsen, J; Shrieve, DC; Jensen, RL; Suneja, G
MLA Citation
Orton, A, Frandsen, J, Shrieve, DC, Jensen, RL, and Suneja, G. "Anaplastic (Malignant) Meningioma: A Patterns-of-Care and Outcomes Analysis of the National Cancer Data Base." International journal of radiation oncology, biology, physics 96.2S (October 2016): E76-.
PMID
27675458
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2S
Publish Date
2016
Start Page
E76
DOI
10.1016/j.ijrobp.2016.06.782

Chemoradiation Versus Chemotherapy or Radiation Alone in Stage III Endometrial Cancer: Patterns of Care and Impact on Overall Survival.

Authors
Boothe, D; Orton, A; Odei, B; Suneja, G; Werner, T; Gaffney, DK
MLA Citation
Boothe, D, Orton, A, Odei, B, Suneja, G, Werner, T, and Gaffney, DK. "Chemoradiation Versus Chemotherapy or Radiation Alone in Stage III Endometrial Cancer: Patterns of Care and Impact on Overall Survival." International journal of radiation oncology, biology, physics 96.2S (October 2016): E286-.
PMID
27674275
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2S
Publish Date
2016
Start Page
E286
DOI
10.1016/j.ijrobp.2016.06.1344

A phase I study of intratumoral ipilimumab and interleukin-2 in patients with advanced melanoma.

Intratumoral interleukin-2 (IL-2) is effective but does not generate systemic immunity. Intravenous ipilimumab produces durable clinical response in a minority of patients, with potentially severe toxicities. Circulating anti-tumor T cells activated by ipilimumab may differ greatly from tumor-infiltrating lymphocytes activated by intratumoral ipilimumab in phenotypes and functionality. The objective of this study was to primarily assess the safety of intratumoral ipilimumab/IL-2 combination and to obtain data on clinical efficacy.There was no dose limiting toxicity. While local response of injected lesions was observed in 67% patients (95% CI, 40%-93%), an abscopal response was seen in 89% (95% CI, 68%-100%). The overall response rate and clinical benefit rate by immune-related response criteria (irRC) was 40% (95% CI, 10%-70%) and 50% (95% CI, 19%-81%), respectively. Enhanced systemic immune response was observed in most patients and correlated with clinical responses.Twelve patients with unresectable stages III/IV melanoma were enrolled. A standard 3+3 design was employed to assess highest tolerable intratumoral dose of ipilimumab and IL-2 based on toxicity during the first three weeks. Escalated doses of ipilimumab was injected into only one lesion weekly for eight weeks in cohorts of three patients. A fixed dose of IL-2 was injected three times a week into the same lesion for two weeks, followed by two times a week for six weeks.Intratumoral injection with the combination of ipilimumab/IL-2 is well tolerated and generates responses in both injected and non-injected lesions in the majority of patients.

Authors
Ray, A; Williams, MA; Meek, SM; Bowen, RC; Grossmann, KF; Andtbacka, RHI; Bowles, TL; Hyngstrom, JR; Leachman, SA; Grossman, D; Bowen, GM; Holmen, SL; VanBrocklin, MW; Suneja, G; Khong, HT
MLA Citation
Ray, A, Williams, MA, Meek, SM, Bowen, RC, Grossmann, KF, Andtbacka, RHI, Bowles, TL, Hyngstrom, JR, Leachman, SA, Grossman, D, Bowen, GM, Holmen, SL, VanBrocklin, MW, Suneja, G, and Khong, HT. "A phase I study of intratumoral ipilimumab and interleukin-2 in patients with advanced melanoma." Oncotarget 7.39 (September 2016): 64390-64399.
PMID
27391442
Source
epmc
Published In
Oncotarget
Volume
7
Issue
39
Publish Date
2016
Start Page
64390
End Page
64399
DOI
10.18632/oncotarget.10453

HIV Infection and Survival Among Women With Cervical Cancer.

Cervical cancer is the leading cause of cancer death among the 20 million women with HIV worldwide. We sought to determine whether HIV infection affected survival in women with invasive cervical cancer.We enrolled sequential patients with cervical cancer in Botswana from 2010 to 2015. Standard treatment included external beam radiation and brachytherapy with concurrent cisplatin chemotherapy. The effect of HIV on survival was estimated by using an inverse probability weighted marginal Cox model.A total of 348 women with cervical cancer were enrolled, including 231 (66.4%) with HIV and 96 (27.6%) without HIV. The majority (189 [81.8%]) of women with HIV received antiretroviral therapy before cancer diagnosis. The median CD4 cell count for women with HIV was 397 (interquartile range, 264 to 555). After a median follow-up of 19.7 months, 117 (50.7%) women with HIV and 40 (41.7%) without HIV died. One death was attributed to HIV and the remaining to cancer. Three-year survival for the women with HIV was 35% (95% CI, 27% to 44%) and 48% (95% CI, 35% to 60%) for those without HIV. In an adjusted analysis, HIV infection significantly increased the risk for death among all women (hazard ratio, 1.95; 95% CI, 1.20 to 3.17) and in the subset that received guideline-concordant curative treatment (hazard ratio, 2.63; 95% CI, 1.05 to 6.55). The adverse effect of HIV on survival was greater for women with a more-limited stage cancer (P = .035), those treated with curative intent (P = .003), and those with a lower CD4 cell count (P = .036). Advanced stage and poor treatment completion contributed to high mortality overall.In the context of good access to and use of antiretroviral treatment in Botswana, HIV infection significantly decreases cervical cancer survival.

Authors
Dryden-Peterson, S; Bvochora-Nsingo, M; Suneja, G; Efstathiou, JA; Grover, S; Chiyapo, S; Ramogola-Masire, D; Kebabonye-Pusoentsi, M; Clayman, R; Mapes, AC; Tapela, N; Asmelash, A; Medhin, H; Viswanathan, AN; Russell, AH; Lin, LL; Kayembe, MKA; Mmalane, M; Randall, TC; Chabner, B; Lockman, S
MLA Citation
Dryden-Peterson, S, Bvochora-Nsingo, M, Suneja, G, Efstathiou, JA, Grover, S, Chiyapo, S, Ramogola-Masire, D, Kebabonye-Pusoentsi, M, Clayman, R, Mapes, AC, Tapela, N, Asmelash, A, Medhin, H, Viswanathan, AN, Russell, AH, Lin, LL, Kayembe, MKA, Mmalane, M, Randall, TC, Chabner, B, and Lockman, S. "HIV Infection and Survival Among Women With Cervical Cancer." Journal of clinical oncology : official journal of the American Society of Clinical Oncology (August 29, 2016).
PMID
27573661
Source
epmc
Published In
Journal of Clinical Oncology
Publish Date
2016

Disparities in cancer treatment among patients infected with the human immunodeficiency virus.

Patients with cancer who are infected with the human immunodeficiency virus (HIV) are less likely to receive cancer treatment compared with HIV-uninfected individuals. However, to the authors' knowledge, the impact of insurance status and comorbidities is unknown.Data from the National Cancer Data Base were used to study nonelderly adults diagnosed with several common cancers from 2003 to 2011. Cancer treatment was defined as chemotherapy, surgery, radiotherapy, or any combination during the first course of treatment. Multivariate logistic regression was used to examine associations between HIV status and lack of cancer treatment, and identify predictors for lack of treatment among HIV-infected patients.A total of 10,265 HIV-infected and 2,219,232 HIV-uninfected cases were included. In multivariate analysis, HIV-infected patients with cancer were found to be more likely to lack cancer treatment for cancers of the head and neck (adjusted odds ratio [aOR], 1.48; 95% confidence interval [95% CI], 1.09-2.01), upper gastrointestinal tract (aOR, 2.62; 95% CI, 2.04-3.37), colorectum (aOR, 1.70; 95% CI, 1.17-2.48), lung (aOR, 2.46; 95% CI, 2.19-2.76), breast (aOR, 2.14; 95% CI, 1.16-3.98), cervix (aOR, 2.81; 95% CI, 1.77-4.45), prostate (aOR, 2.16; 95% CI, 1.69-2.76), Hodgkin lymphoma (aOR, 1.92; 95% CI, 1.66-2.22), and diffuse large B-cell lymphoma (aOR, 1.82; 95% CI, 1.65-2.00). Predictors of a lack of cancer treatment among HIV-infected individuals varied by tumor type (solid tumor vs lymphoma), but black race and a lack of private insurance were found to be predictors for both groups.In the United States, HIV-infected patients with cancer appear to be less likely to receive cancer treatment regardless of insurance and comorbidities. To the authors' knowledge, the current study is the largest study of cancer treatment in HIV-infected patients with cancer in the United States and provides evidence of cancer treatment disparities even after controlling for differences with regard to insurance status and comorbidities. Further work should focus on addressing differential cancer treatment. Cancer 2016;122:2399-2407. © 2016 American Cancer Society.

Authors
Suneja, G; Lin, CC; Simard, EP; Han, X; Engels, EA; Jemal, A
MLA Citation
Suneja, G, Lin, CC, Simard, EP, Han, X, Engels, EA, and Jemal, A. "Disparities in cancer treatment among patients infected with the human immunodeficiency virus." Cancer 122.15 (August 2016): 2399-2407.
PMID
27187086
Source
epmc
Published In
Cancer
Volume
122
Issue
15
Publish Date
2016
Start Page
2399
End Page
2407
DOI
10.1002/cncr.30052

Trends in primary central nervous system lymphoma incidence and survival in the U.S.

It is suspected that primary central nervous system lymphoma (PCNSL) rates are increasing among immunocompetent people. We estimated PCNSL trends in incidence and survival among immunocompetent persons by excluding cases among human immunodeficiency virus (HIV)-infected persons and transplant recipients. PCNSL data were derived from 10 Surveillance, Epidemiology and End Results (SEER) cancer registries (1992-2011). HIV-infected cases had reported HIV infection or death due to HIV. Transplant recipient cases were estimated from the Transplant Cancer Match Study. We estimated PCNSL trends overall and among immunocompetent individuals, and survival by HIV status. A total of 4158 PCNSLs were diagnosed (36% HIV-infected; 0·9% transplant recipients). HIV prevalence in PCNSL cases declined from 64·1% (1992-1996) to 12·7% (2007-2011), while the prevalence of transplant recipients remained low. General population PCNSL rates were strongly influenced by immunosuppressed cases, particularly in 20-39 year-old men. Among immunocompetent people, PCNSL rates in men and women aged 65+ years increased significantly (1·7% and 1·6%/year), but remained stable in other age groups. Five-year survival was poor, particularly among HIV-infected cases (9·0%). Among HIV-uninfected cases, 5-year survival increased from 19·1% (1992-1994) to 30·1% (2004-2006). In summary, PCNSL rates have increased among immunocompetent elderly adults, but not in younger individuals. Survival remains poor for both HIV-infected and HIV-uninfected PCNSL patients.

Authors
Shiels, MS; Pfeiffer, RM; Besson, C; Clarke, CA; Morton, LM; Nogueira, L; Pawlish, K; Yanik, EL; Suneja, G; Engels, EA
MLA Citation
Shiels, MS, Pfeiffer, RM, Besson, C, Clarke, CA, Morton, LM, Nogueira, L, Pawlish, K, Yanik, EL, Suneja, G, and Engels, EA. "Trends in primary central nervous system lymphoma incidence and survival in the U.S." British journal of haematology 174.3 (August 2016): 417-424.
PMID
27018254
Source
epmc
Published In
British Journal of Haematology
Volume
174
Issue
3
Publish Date
2016
Start Page
417
End Page
424
DOI
10.1111/bjh.14073

Avoiding Severe Toxicity From Combined BRAF Inhibitor and Radiation Treatment: Consensus Guidelines from the Eastern Cooperative Oncology Group (ECOG).

BRAF kinase gene V600 point mutations drive approximately 40% to 50% of all melanomas, and BRAF inhibitors (BRAFi) have been found to significantly improve survival outcomes. Although radiation therapy (RT) provides effective symptom palliation, there is a lack of toxicity and efficacy data when RT is combined with BRAFi, including vemurafenib and dabrafenib. This literature review provides a detailed analysis of potential increased dermatologic, pulmonary, neurologic, hepatic, esophageal, and bowel toxicity from the combination of BRAFi and RT for melanoma patients described in 27 publications. Despite 7 publications noting potential intracranial neurotoxicity, the rates of radionecrosis and hemorrhage from whole brain RT (WBRT), stereotactic radiosurgery (SRS), or both do not appear increased with concurrent or sequential administration of BRAFis. Almost all grade 3 dermatitis reactions occurred when RT and BRAFi were administered concurrently. Painful, disfiguring nondermatitis cutaneous reactions have been described from concurrent or sequential RT and BRAFi administration, which improved with topical steroids and time. Visceral toxicity has been reported with RT and BRAFi, with deaths possibly related to bowel perforation and liver hemorrhage. Increased severity of radiation pneumonitis with BRAFi is rare, but more concerning was a potentially related fatal pulmonary hemorrhage. Conversely, encouraging reports have described patients with leptomeningeal spread and unresectable lymphadenopathy rendered disease free from combined RT and BRAFi. Based on our review, the authors recommend holding RT ≥3 days before and after fractionated RT and ≥1 day before and after SRS. No fatal reactions have been described with a dose <4 Gy per fraction, and time off systemic treatment should be minimized. Future prospective data will serve to refine these recommendations.

Authors
Anker, CJ; Grossmann, KF; Atkins, MB; Suneja, G; Tarhini, AA; Kirkwood, JM
MLA Citation
Anker, CJ, Grossmann, KF, Atkins, MB, Suneja, G, Tarhini, AA, and Kirkwood, JM. "Avoiding Severe Toxicity From Combined BRAF Inhibitor and Radiation Treatment: Consensus Guidelines from the Eastern Cooperative Oncology Group (ECOG)." International journal of radiation oncology, biology, physics 95.2 (June 2016): 632-646. (Review)
PMID
27131079
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
95
Issue
2
Publish Date
2016
Start Page
632
End Page
646
DOI
10.1016/j.ijrobp.2016.01.038

Brachytherapy improves survival in primary vaginal cancer.

Prospective, randomized data does not exist to guide treatment in primary vaginal cancer (PVC). We evaluated the impact of brachytherapy on survival in women with PVC.Women who received radiotherapy for PVC were identified using the Surveillance, Epidemiology, and End Result database. Two retrospective cohorts were created; women who received external beam radiotherapy (EBRT) alone and those who received brachytherapy (alone or in combination of EBRT). Nearest-neighbor propensity score matching was used to balance the groups according to measured covariates. Cox proportional hazard regression modeling was used to estimate the effect of receipt of brachytherapy on survival.Two thousand five hundred seventeen vaginal cancer patients were identified. Squamous cell carcinoma made up 75% of tumors. Median overall survival (OS) for patients receiving EBRT alone was 3.6years (95% CI, 3.0-4.2years) versus 6.1years (95% CI 5.2-7.2years) for patients receiving brachytherapy (p=<0.001). Cox proportional hazard model revealed decrease risk of death among patients that received brachytherapy in the matched cohort (HR 0.77; 95% CI 0.68-0.86). Brachytherapy reduced risk of death among patients in all stage groups. No patient demographic or tumor variables favored the use of EBRT alone. Brachytherapy was associated with a decreased risk of death for all FIGO stages. Brachytherapy benefited patients with squamous cell carcinoma (HR 0.80; 95% CI 0.70-0.92) and adenocarcinoma (HR 0.69; 95% CI 0.49-0.95). Tumors larger than 5cm had the greatest benefit from brachytherapy (HR 0.68; 95% CI 0.50-0.91).Brachytherapy should be encouraged for all suitable patients with PVC.

Authors
Orton, A; Boothe, D; Williams, N; Buchmiller, T; Huang, YJ; Suneja, G; Poppe, M; Gaffney, D
MLA Citation
Orton, A, Boothe, D, Williams, N, Buchmiller, T, Huang, YJ, Suneja, G, Poppe, M, and Gaffney, D. "Brachytherapy improves survival in primary vaginal cancer." Gynecologic oncology 141.3 (June 2016): 501-506.
PMID
27036631
Source
epmc
Published In
Gynecologic Oncology
Volume
141
Issue
3
Publish Date
2016
Start Page
501
End Page
506
DOI
10.1016/j.ygyno.2016.03.011

Predictors of Timely Access of Oncology Services and Advanced-Stage Cancer in an HIV-Endemic Setting.

Three-quarters of cancer deaths occur in resource-limited countries, and delayed presentation contributes to poor outcome. In Botswana, where more than half of cancers arise in HIV-infected individuals, we sought to explore predictors of timely oncology care and evaluate the hypothesis that engagement in longitudinal HIV care improves access.Consenting patients presenting for oncology care from October 2010 to September 2014 were interviewed and their records were reviewed. Cox and logistic models were used to examine the effect of HIV and other predictors on time to oncology care and presentation with advanced cancer (stage III or IV).Of the 1,146 patients analyzed, 584 (51%) had HIV and 615 (54%) had advanced cancer. The initial clinic visit occurred a mean of 144 days (median 29, interquartile range 0-185) after symptom onset, but subsequent mean time to oncology care was 406 days (median 160, interquartile range 59-653). HIV status was not significantly associated with time to oncology care (adjusted hazard ratio [aHR] 0.91, 95% confidence interval [CI] 0.79-1.06). However, patients who reported using traditional medicine/healers engaged in oncology care significantly faster (aHR 1.23, 95% CI 1.09-1.40) and those with advanced cancer entered care earlier (aHR 1.48, 95% CI 1.30-1.70). Factors significantly associated with advanced cancer included income <$50 per month (adjusted odds ratio [aOR] 1.35, 95% CI 1.05-1.75), male sex (aOR 1.45, 95% CI 1.12-1.87), and pain as the presenting symptom (aOR 1.39, 95% CI 1.03-1.88).Longitudinal HIV care did not reduce the substantial delay to cancer treatment. Research focused on reducing health system delay through coordination and navigation is needed.The majority (54%) of patients in this large cohort from Botswana presented with advanced-stage cancer despite universal access to free health care. Median time from first symptom to specialized oncology care was 13 months. For HIV-infected patients (51% of total), regular longitudinal contact with the health system, through quarterly doctor visits for HIV management, was not successful in providing faster linkages into oncology care. However, patients who used traditional medicine/healers engaged in cancer care faster, indicating potential for leveraging traditional healers as partners in early cancer detection. New strategies are urgently needed to facilitate diagnosis and timely treatment of cancer in low- and middle-income countries.

Authors
Brown, CA; Suneja, G; Tapela, N; Mapes, A; Pusoentsi, M; Mmalane, M; Hodgeman, R; Boyer, M; Musimar, Z; Ramogola-Masire, D; Grover, S; Nsingo-Bvochora, M; Kayembe, M; Efstathiou, J; Lockman, S; Dryden-Peterson, S
MLA Citation
Brown, CA, Suneja, G, Tapela, N, Mapes, A, Pusoentsi, M, Mmalane, M, Hodgeman, R, Boyer, M, Musimar, Z, Ramogola-Masire, D, Grover, S, Nsingo-Bvochora, M, Kayembe, M, Efstathiou, J, Lockman, S, and Dryden-Peterson, S. "Predictors of Timely Access of Oncology Services and Advanced-Stage Cancer in an HIV-Endemic Setting." The oncologist 21.6 (June 2016): 731-738.
PMID
27053501
Source
epmc
Published In
The oncologist
Volume
21
Issue
6
Publish Date
2016
Start Page
731
End Page
738
DOI
10.1634/theoncologist.2015-0387

Chemoradiation versus chemotherapy or radiation alone in stage III endometrial cancer: Patterns of care and impact on overall survival.

We aimed to investigate the patterns-of-care and overall survival (OS) benefit of aCRT versus adjuvant monotherapy (aMT), defined as either chemotherapy or radiation alone, utilizing a large national registry of patients.Adult patients with stage III endometrial adenocarcinoma diagnosed from 2004 to 2013 were included. Logistic and Cox regression modeling was used to identify factors predictive of receipt of aCRT and OS, respectively. Survival analysis was performed with Kaplan Meier and log-rank analysis. Propensity score matching and sensitivity analysis was performed to address selection bias and presence of potential confounding variables.A total of 21,027 patients were identified: 11,435 (54.4%) patients received aMT, while 9592 (45.6%) received aCRT. Utilization of aCRT increased over the study period (p<0.01). Factors predictive of receiving aCRT include private insurance (OR: 1.67, 95% CI: 1.30-2.14), Medicare (OR: 1.33, 95% CI: 1.01-1.75), FIGO stage IIIC disease (OR: 1.36, 95% CI: 1.19-1.54), lymphovascular space invasion (OR: 1.14, 95% CI: 1.03-1.27), and lymph node surgery performed (OR: 1.42, 95% CI: 1.15-1.74). Median survival in years for aCRT, RT, and CT was 10.3, 7.1, and 5.6, respectively (p<0.001). Compared to aMT, aCRT was associated with a decrease risk of death on multivariate analysis (HR: 0.62, 95% CI: 0.56-0.70). The benefit of aCRT over aMT persisted after propensity score matching.The use of aCRT for stage III endometrial cancer is increasing. Multiple clinical and demographic factors were predictive of aCRT use. When compared to chemotherapy or radiation alone, aCRT is associated with an OS benefit.

Authors
Boothe, D; Orton, A; Odei, B; Stoddard, G; Suneja, G; Poppe, MM; Werner, TL; Gaffney, DK
MLA Citation
Boothe, D, Orton, A, Odei, B, Stoddard, G, Suneja, G, Poppe, MM, Werner, TL, and Gaffney, DK. "Chemoradiation versus chemotherapy or radiation alone in stage III endometrial cancer: Patterns of care and impact on overall survival." Gynecologic oncology 141.3 (June 2016): 421-427.
PMID
27005441
Source
epmc
Published In
Gynecologic Oncology
Volume
141
Issue
3
Publish Date
2016
Start Page
421
End Page
427
DOI
10.1016/j.ygyno.2016.03.021

The addition of adjuvant chemotherapy to radiation in high-risk endometrial cancer: Survival outcomes and patterns of care.

Authors
Boothe, D; Williams, N; Odei, B; Poppe, M; Werner, TL; Suneja, G; Gaffney, DK
MLA Citation
Boothe, D, Williams, N, Odei, B, Poppe, M, Werner, TL, Suneja, G, and Gaffney, DK. "The addition of adjuvant chemotherapy to radiation in high-risk endometrial cancer: Survival outcomes and patterns of care." May 20, 2016.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
34
Issue
15
Publish Date
2016

Radiation Therapy Regimens in Patients With Nonmelanoma Head and Neck Skin Cancers

Authors
Dundar, Y; Cannon, R; Monroe, M; Hunt, J; Suneja, G; Hitchcock, YJ
MLA Citation
Dundar, Y, Cannon, R, Monroe, M, Hunt, J, Suneja, G, and Hitchcock, YJ. "Radiation Therapy Regimens in Patients With Nonmelanoma Head and Neck Skin Cancers." March 15, 2016.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
94
Issue
4
Publish Date
2016
Start Page
952
End Page
952

Reply to L. Dal Maso et al.

Authors
Coghill, AE; Shiels, MS; Suneja, G; Engels, EA
MLA Citation
Coghill, AE, Shiels, MS, Suneja, G, and Engels, EA. "Reply to L. Dal Maso et al." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 34.4 (February 2016): 390-391. (Letter)
PMID
26598741
Source
epmc
Published In
Journal of Clinical Oncology
Volume
34
Issue
4
Publish Date
2016
Start Page
390
End Page
391
DOI
10.1200/jco.2015.64.6026

Establishing and Delivering Quality Radiation Therapy in Resource-Constrained Settings: The Story of Botswana.

There is a global cancer crisis, and it is disproportionately affecting resource-constrained settings, especially in low- and middle-income countries (LMICs). Radiotherapy is a critical and cost-effective component of a comprehensive cancer control plan that offers the potential for cure, control, and palliation of disease in greater than 50% of patients with cancer. Globally, LMICs do not have adequate access to quality radiation therapy and this gap is particularly pronounced in sub-Saharan Africa. Although there are numerous challenges in implementing a radiation therapy program in a low-resource setting, providing more equitable global access to radiotherapy is a responsibility and investment worth prioritizing. We outline a systems approach and a series of key questions to direct strategy toward establishing quality radiation services in LMICs, and highlight the story of private-public investment in Botswana from the late 1990s to the present. After assessing the need and defining the value of radiation, we explore core investments required, barriers that need to be overcome, and assets that can be leveraged to establish a radiation program. Considerations addressed include infrastructure; machine choice; quality assurance and patient safety; acquisition, development, and retention of human capital; governmental engagement; public-private partnerships; international collaborations; and the need to critically evaluate the program to foster further growth and sustainability.

Authors
Efstathiou, JA; Heunis, M; Karumekayi, T; Makufa, R; Bvochora-Nsingo, M; Gierga, DP; Suneja, G; Grover, S; Kasese, J; Mmalane, M; Moffat, H; von Paleske, A; Makhema, J; Dryden-Peterson, S
MLA Citation
Efstathiou, JA, Heunis, M, Karumekayi, T, Makufa, R, Bvochora-Nsingo, M, Gierga, DP, Suneja, G, Grover, S, Kasese, J, Mmalane, M, Moffat, H, von Paleske, A, Makhema, J, and Dryden-Peterson, S. "Establishing and Delivering Quality Radiation Therapy in Resource-Constrained Settings: The Story of Botswana." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 34.1 (January 2016): 27-35. (Review)
PMID
26578607
Source
epmc
Published In
Journal of Clinical Oncology
Volume
34
Issue
1
Publish Date
2016
Start Page
27
End Page
35
DOI
10.1200/jco.2015.62.8412

In the Modern Treatment Era, Is Breast Conservation Equivalent to Mastectomy in Women Younger Than 40 Years of Age? A Multi-Institution Study.

Mastectomy is often recommended for women ≤40 years of age with breast cancer, as young women were under-represented in the landmark trials comparing breast conservation therapy (BCT) to mastectomy. We hypothesized that, in the modern treatment era, BCT and mastectomy result in equivalent local control rates in young women.Breast cancer cases arising between 1975 and 2013 in women ≤40 years old were collected from the tumor registries of 2 large healthcare systems in Utah. Kaplan-Meier estimates and Cox proportional hazards models were used to analyze freedom from locoregional recurrence (FFLR), overall survival (OS), and relapse-free survival (RFS).This analysis identified 853 BCT candidates. A comparison of BCT to mastectomy after 2000 showed FFLR, RFS, and OS were all similar. Rate for FFLR at 10 years was 94.9% versus 92.1% for BCT and mastectomy, respectively (P=.57). For women whose cancer was diagnosed after 2000, who received BCT, FFLR and RFS rates were improved compared to those whose cancer was diagnosed prior to 2000 (P<.05), whereas OS (P=.46) rates were similar. Among those who underwent mastectomy, FFLR, OS, and RFS were significantly improved (P<.05) with diagnosis after 2000.FFLR rates for young women, ≤40 years of age, have significantly improved for BCT and mastectomy over time. If patients were treated after 2000, BCT appears to be safe and equivalent to mastectomy at 10 years in terms of FFLR, OS, and RFS.

Authors
Frandsen, J; Ly, D; Cannon, G; Suneja, G; Matsen, C; Gaffney, DK; Wright, M; Kokeny, KE; Poppe, MM
MLA Citation
Frandsen, J, Ly, D, Cannon, G, Suneja, G, Matsen, C, Gaffney, DK, Wright, M, Kokeny, KE, and Poppe, MM. "In the Modern Treatment Era, Is Breast Conservation Equivalent to Mastectomy in Women Younger Than 40 Years of Age? A Multi-Institution Study." International journal of radiation oncology, biology, physics 93.5 (December 2015): 1096-1103.
PMID
26581146
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
93
Issue
5
Publish Date
2015
Start Page
1096
End Page
1103
DOI
10.1016/j.ijrobp.2015.08.044

Use of Adjuvant Radiation Therapy in Node-positive Melanoma in the United States

Authors
Orton, A; Hyngstrom, J; Andtbacka, RHI; Bowles, T; Grossmann, K; Khong, H; Grossman, D; Bowen, G; Hitchcock, YJ; Bilimoria, K; Suneja, G
MLA Citation
Orton, A, Hyngstrom, J, Andtbacka, RHI, Bowles, T, Grossmann, K, Khong, H, Grossman, D, Bowen, G, Hitchcock, YJ, Bilimoria, K, and Suneja, G. "Use of Adjuvant Radiation Therapy in Node-positive Melanoma in the United States." November 1, 2015.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
93
Issue
3
Publish Date
2015
Start Page
E369
End Page
E370

Examining Patient Perceptions of Quality and Safety in a Large Radiation Oncology Department

Authors
DeCesaris, CM; Woodhouse, KD; Volz, E; Gabriel, PE; Suneja, G; Maity, A; Hahn, SM
MLA Citation
DeCesaris, CM, Woodhouse, KD, Volz, E, Gabriel, PE, Suneja, G, Maity, A, and Hahn, SM. "Examining Patient Perceptions of Quality and Safety in a Large Radiation Oncology Department." November 1, 2015.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
93
Issue
3
Publish Date
2015
Start Page
E496
End Page
E496

Risk of Secondary Malignancies after Radiation Therapy for Breast Cancer: Comprehensive Results

Authors
Burt, LM; Ying, J; Poppe, MM; Suneja, G; Gaffney, DK
MLA Citation
Burt, LM, Ying, J, Poppe, MM, Suneja, G, and Gaffney, DK. "Risk of Secondary Malignancies after Radiation Therapy for Breast Cancer: Comprehensive Results." November 1, 2015.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
93
Issue
3
Publish Date
2015
Start Page
S107
End Page
S108

Correction: Cancer incidence following expansion of HIV treatment in Botswana (PLoS ONE (2015) 10:9 (PLoS ONE) DOI:10.1371/journal.pone.0138742)

Authors
Dryden-Peterson, S; Medhin, H; Kebabonye-Pusoentsi, M; Seage, GR; Suneja, G; Kayembe, MKA; Mmalane, M; Rebbeck, T; Rider, JR; Essex, M; Lockman, S
MLA Citation
Dryden-Peterson, S, Medhin, H, Kebabonye-Pusoentsi, M, Seage, GR, Suneja, G, Kayembe, MKA, Mmalane, M, Rebbeck, T, Rider, JR, Essex, M, and Lockman, S. "Correction: Cancer incidence following expansion of HIV treatment in Botswana (PLoS ONE (2015) 10:9 (PLoS ONE) DOI:10.1371/journal.pone.0138742)." PLoS ONE 10.9 (September 16, 2015).
Source
scopus
Published In
PloS one
Volume
10
Issue
9
Publish Date
2015

Local Recurrence and Ocular Adnexal Complications Following Electronic Surface Brachytherapy for Basal Cell Carcinoma of the Lower Eyelid.

Various treatment options exist for nonmelanoma skin cancer (NMSC), including topical agents, surgery, or definitive or adjuvant radiation therapy. Recently, electronic surface brachytherapy (ESB) has been described as a noninvasive option for NMSC. We report a case of local recurrence of basal cell carcinoma (BCC) and ocular complications following ESB to the lower eyelid.A man in his 60s presented with a recurrent BCC within the radiation field 10 months after undergoing ESB for a biopsy-proven BCC. In addition to the recurrence, he had contracture of the conjunctiva in the socket of his previously enucleated eye, as well as lower eyelid ectropion, resulting in displacement and loss of retention of his ocular prosthesis.Electronic surface brachytherapy should be used with caution, particularly in the periocular region because the late effects of hypofractionated radiation may cause ocular and orbital complications. To our knowledge, this is the first reported case of ocular complications with this modality. This case highlights a local recurrence following use of this new treatment modality, suggesting further investigation is warranted to determine the safety and efficacy of ESB.

Authors
Eftekhari, K; Anderson, RL; Suneja, G; Bowen, A; Oberg, TJ; Bowen, GM
MLA Citation
Eftekhari, K, Anderson, RL, Suneja, G, Bowen, A, Oberg, TJ, and Bowen, GM. "Local Recurrence and Ocular Adnexal Complications Following Electronic Surface Brachytherapy for Basal Cell Carcinoma of the Lower Eyelid." JAMA dermatology 151.9 (September 2015): 1002-1004.
PMID
26267892
Source
epmc
Published In
JAMA Dermatology
Volume
151
Issue
9
Publish Date
2015
Start Page
1002
End Page
1004
DOI
10.1001/jamadermatol.2015.2613

Elevated Cancer-Specific Mortality Among HIV-Infected Patients in the United States.

Despite advances in the treatment of HIV, HIV-infected people remain at increased risk for many cancers, and the number of non-AIDS-defining cancers is increasing with the aging of the HIV-infected population. No prior study has comprehensively evaluated the effect of HIV on cancer-specific mortality.We identified cases of 14 common cancers occurring from 1996 to 2010 in six US states participating in a linkage of cancer and HIV/AIDS registries. We used Cox regression to examine the association between patient HIV status and death resulting from the presenting cancer (ascertained from death certificates), adjusting for age, sex, race/ethnicity, year of cancer diagnosis, and cancer stage. We included 1,816,461 patients with cancer, 6,459 (0.36%) of whom were HIV infected.Cancer-specific mortality was significantly elevated in HIV-infected compared with HIV-uninfected patients for many cancers: colorectum (adjusted hazard ratio [HR], 1.49; 95% CI, 1.21 to 1.84), pancreas (HR, 1.71; 95% CI, 1.35 to 2.18), larynx (HR, 1.62; 95% CI, 1.06 to 2.47), lung (HR, 1.28; 95% CI, 1.17 to 1.39), melanoma (HR, 1.72; 95% CI, 1.09 to 2.70), breast (HR, 2.61; 95% CI, 2.06 to 3.31), and prostate (HR, 1.57; 95% CI, 1.02 to 2.41). HIV was not associated with increased cancer-specific mortality for anal cancer, Hodgkin lymphoma, or diffuse large B-cell lymphoma. After further adjustment for cancer treatment, HIV remained associated with elevated cancer-specific mortality for common non-AIDS-defining cancers: colorectum (HR, 1.40; 95% CI, 1.09 to 1.80), lung (HR, 1.28; 95% CI, 1.14 to 1.44), melanoma (HR, 1.93; 95% CI, 1.14 to 3.27), and breast (HR, 2.64; 95% CI, 1.86 to 3.73).HIV-infected patients with cancer experienced higher cancer-specific mortality than HIV-uninfected patients, independent of cancer stage or receipt of cancer treatment. The elevation in cancer-specific mortality among HIV-infected patients may be attributable to unmeasured stage or treatment differences as well as a direct relationship between immunosuppression and tumor progression.

Authors
Coghill, AE; Shiels, MS; Suneja, G; Engels, EA
MLA Citation
Coghill, AE, Shiels, MS, Suneja, G, and Engels, EA. "Elevated Cancer-Specific Mortality Among HIV-Infected Patients in the United States." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 33.21 (July 2015): 2376-2383.
PMID
26077242
Source
epmc
Published In
Journal of Clinical Oncology
Volume
33
Issue
21
Publish Date
2015
Start Page
2376
End Page
2383
DOI
10.1200/jco.2014.59.5967

The Cervix Cancer Research Network: A Global Outreach Effort on Behalf of the Gynecologic Cancer InterGroup.

Authors
Gaffney, DK; Suneja, G; Ryu, SY; McCormick, M; Plante, M; Mileshkin, L; Small, W; Bacon, M; Stuart, G; Kitchener, H
MLA Citation
Gaffney, DK, Suneja, G, Ryu, SY, McCormick, M, Plante, M, Mileshkin, L, Small, W, Bacon, M, Stuart, G, and Kitchener, H. "The Cervix Cancer Research Network: A Global Outreach Effort on Behalf of the Gynecologic Cancer InterGroup." International journal of radiation oncology, biology, physics 92.3 (July 2015): 506-508.
PMID
26068483
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
92
Issue
3
Publish Date
2015
Start Page
506
End Page
508
DOI
10.1016/j.ijrobp.2015.02.054

Disparities in cancer treatment among HIV-infected individuals

Authors
Suneja, G; Lin, CC; Simard, EP; Han, X; Engels, EA; Jemal, A
MLA Citation
Suneja, G, Lin, CC, Simard, EP, Han, X, Engels, EA, and Jemal, A. "Disparities in cancer treatment among HIV-infected individuals." May 20, 2015.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
33
Issue
15
Publish Date
2015

Cancer Treatment in Patients With HIV Infection and Non-AIDS-Defining Cancers: A Survey of US Oncologists.

HIV-infected individuals with non-AIDS-defining cancers are less likely to receive cancer treatment compared with uninfected individuals. We sought to identify provider-level factors influencing the delivery of oncology care to HIV-infected patients.A survey was mailed to 500 randomly selected US medical and radiation oncologists. The primary outcome was delivery of standard treatment, assessed by responses to three specialty-specific management questions. We used the χ(2) test to evaluate associations between delivery of standard treatment, provider demographics, and perceptions of HIV-infected individuals. Multivariable logistic regression identified associations using factor analysis to combine several correlated survey questions.Our response rate was 60%; 69% of respondents felt that available cancer management guidelines were insufficient for the care of HIV-infected patients with cancer; 45% never or rarely discussed their cancer management plan with an HIV specialist; 20% and 15% of providers were not comfortable discussing cancer treatment adverse effects and prognosis with their HIV-infected patients with cancer, respectively; 79% indicated that they would provide standard cancer treatment to HIV-infected patients. In multivariable analysis, physicians comfortable discussing adverse effects and prognosis were more likely to provide standard cancer treatment (adjusted odds ratio, 1.52; 95% CI, 1.12 to 2.07). Physicians with concerns about toxicity and efficacy of treatment were significantly less likely to provide standard cancer treatment (adjusted odds ratio, 0.67; 95% CI, 0.53 to 0.85).Provider-level factors are associated with delivery of nonstandard cancer treatment to HIV-infected patients. Policy change, provider education, and multidisciplinary collaboration are needed to improve access to cancer treatment.

Authors
Suneja, G; Boyer, M; Yehia, BR; Shiels, MS; Engels, EA; Bekelman, JE; Long, JA
MLA Citation
Suneja, G, Boyer, M, Yehia, BR, Shiels, MS, Engels, EA, Bekelman, JE, and Long, JA. "Cancer Treatment in Patients With HIV Infection and Non-AIDS-Defining Cancers: A Survey of US Oncologists." Journal of oncology practice 11.3 (May 2015): e380-e387.
PMID
25873060
Source
epmc
Published In
Journal of Oncology Practice
Volume
11
Issue
3
Publish Date
2015
Start Page
e380
End Page
e387
DOI
10.1200/jop.2014.002709

Correction: Cancer Incidence following Expansion of HIV Treatment in Botswana.

Authors
Dryden-Peterson, S; Medhin, H; Kebabonye-Pusoentsi, M; Seage, GR; Suneja, G; Kayembe, MKA; Mmalane, M; Rebbeck, T; Rider, JR; Essex, M; Lockman, S
MLA Citation
Dryden-Peterson, S, Medhin, H, Kebabonye-Pusoentsi, M, Seage, GR, Suneja, G, Kayembe, MKA, Mmalane, M, Rebbeck, T, Rider, JR, Essex, M, and Lockman, S. "Correction: Cancer Incidence following Expansion of HIV Treatment in Botswana." PloS one 10.9 (January 2015): e0138742-.
PMID
26376079
Source
epmc
Published In
PloS one
Volume
10
Issue
9
Publish Date
2015
Start Page
e0138742
DOI
10.1371/journal.pone.0138742

Cancer Incidence following Expansion of HIV Treatment in Botswana.

The expansion of combination antiretroviral treatment (ART) in southern Africa has dramatically reduced mortality due to AIDS-related infections, but the impact of ART on cancer incidence in the region is unknown. We sought to describe trends in cancer incidence in Botswana during implementation of the first public ART program in Africa.We included 8479 incident cases from the Botswana National Cancer Registry during a period of significant ART expansion in Botswana, 2003-2008, when ART coverage increased from 7.3% to 82.3%. We fit Poisson models of age-adjusted cancer incidence and counts in the total population, and in an inverse probability weighted population with known HIV status, over time and estimated ART coverage.During this period 61.6% of cancers were diagnosed in HIV-infected individuals and 45.4% of all cancers in men and 36.4% of all cancers in women were attributable to HIV. Age-adjusted cancer incidence decreased in the HIV infected population by 8.3% per year (95% CI -14.1 to -2.1%). However, with a progressively larger and older HIV population the annual number of cancers diagnosed remained constant (0.0% annually, 95% CI -4.3 to +4.6%). In the overall population, incidence of Kaposi's sarcoma decreased (4.6% annually, 95% CI -6.9 to -2.2), but incidence of non-Hodgkin lymphoma (+11.5% annually, 95% CI +6.3 to +17.0%) and HPV-associated cancers increased (+3.9% annually, 95% CI +1.4 to +6.5%). Age-adjusted cancer incidence among individuals without HIV increased 7.5% per year (95% CI +1.4 to +15.2%).Expansion of ART in Botswana was associated with decreased age-specific cancer risk. However, an expanding and aging population contributed to continued high numbers of incident cancers in the HIV population. Increased capacity for early detection and treatment of HIV-associated cancer needs to be a new priority for programs in Africa.

Authors
Dryden-Peterson, S; Medhin, H; Kebabonye-Pusoentsi, M; Seage, GR; Suneja, G; Kayembe, MKA; Mmalane, M; Rebbeck, T; Rider, JR; Essex, M; Lockman, S
MLA Citation
Dryden-Peterson, S, Medhin, H, Kebabonye-Pusoentsi, M, Seage, GR, Suneja, G, Kayembe, MKA, Mmalane, M, Rebbeck, T, Rider, JR, Essex, M, and Lockman, S. "Cancer Incidence following Expansion of HIV Treatment in Botswana." PLoS ONE 10.8 (January 2015): e0135602-.
PMID
26267867
Source
epmc
Published In
PloS one
Volume
10
Issue
8
Publish Date
2015
Start Page
e0135602
DOI
10.1371/journal.pone.0135602

The cervix cancer research network: increasing access to cancer clinical trials in low- and middle-income countries.

The burden of cervical cancer is large and growing in developing countries, due in large part to limited access to screening services and lack of human papillomavirus (HPV) vaccination. In spite of modern advances in diagnostic and therapeutic modalities, outcomes from cervical cancer have not markedly improved in recent years. Novel clinical trials are urgently needed to improve outcomes from cervical cancer worldwide.The Cervix Cancer Research Network (CCRN), a subsidiary of the Gynecologic Cancer InterGroup, is a multi-national, multi-institutional consortium of physicians and scientists focused on improving cervical cancer outcomes worldwide by making cancer clinical trials available in low-, middle-, and high-income countries. Standard operating procedures for participation in CCRN include a pre-qualifying questionnaire to evaluate clinical activities and research infrastructure, followed by a site visit. Once a site is approved, they may choose to participate in one of four currently accruing clinical trials.To date, 13 different CCRN site visits have been performed. Of these 13 sites visited, 10 have been approved as CCRN sites including Tata Memorial Hospital, India; Bangalore, India; Trivandrum, India; Ramathibodi, Thailand; Siriaj, Thailand; Pramongkutklao, Thailand; Ho Chi Minh, Vietnam; Blokhin Russian Cancer Research Center; the Hertzen Moscow Cancer Research Institute; and the Russian Scientific Center of Roentgenoradiology. The four currently accruing clinical trials are TACO, OUTBACK, INTERLACE, and SHAPE.The CCRN has successfully enrolled eight sites in developing countries to participate in four randomized clinical trials. The primary objectives are to provide novel therapeutics to regions with the greatest need and to improve the validity and generalizability of clinical trial results by enrolling a diverse sample of patients.

Authors
Suneja, G; Bacon, M; Small, W; Ryu, SY; Kitchener, HC; Gaffney, DK
MLA Citation
Suneja, G, Bacon, M, Small, W, Ryu, SY, Kitchener, HC, and Gaffney, DK. "The cervix cancer research network: increasing access to cancer clinical trials in low- and middle-income countries." Frontiers in oncology 5 (January 2015): 14-.
PMID
25745604
Source
epmc
Published In
Frontiers in Oncology
Volume
5
Publish Date
2015
Start Page
14
DOI
10.3389/fonc.2015.00014

Cancer Treatment in Patients with HIV and Cancer: A Survey of United States Oncologists

Authors
Suneja, G; Boyer, M; Yehia, BR; Shiels, MS; Engels, EA; Bekelman, JE; Long, JA
MLA Citation
Suneja, G, Boyer, M, Yehia, BR, Shiels, MS, Engels, EA, Bekelman, JE, and Long, JA. "Cancer Treatment in Patients with HIV and Cancer: A Survey of United States Oncologists." September 1, 2014.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
90
Publish Date
2014
Start Page
S139
End Page
S140

Cancer treatment disparities in HIV-infected individuals in the United States.

HIV-infected individuals with cancer have worse survival rates compared with their HIV-uninfected counterparts. One explanation may be differing cancer treatment; however, few studies have examined this.We used HIV and cancer registry data from Connecticut, Michigan, and Texas to study adults diagnosed with non-Hodgkin's lymphoma, Hodgkin's lymphoma, or cervical, lung, anal, prostate, colorectal, or breast cancers from 1996 to 2010. We used logistic regression to examine associations between HIV status and cancer treatment, adjusted for cancer stage and demographic covariates. For a subset of local-stage cancers, we used logistic regression to assess the relationship between HIV status and standard treatment modality. We identified predictors of cancer treatment among individuals with both HIV and cancer.We evaluated 3,045 HIV-infected patients with cancer and 1,087,648 patients with cancer without HIV infection. A significantly higher proportion of HIV-infected individuals did not receive cancer treatment for diffuse large B-cell lymphoma (DLBCL; adjusted odds ratio [aOR], 1.67; 95% CI, 1.41 to 1.99), lung cancer (aOR, 2.18; 95% CI, 1.80 to 2.64), Hodgkin's lymphoma (aOR, 1.77; 95% CI, 1.33 to 2.37), prostate cancer (aOR, 1.79; 95% CI, 1.31 to 2.46), and colorectal cancer (aOR, 2.27; 95% CI, 1.38 to 3.72). HIV infection was associated with a lack of standard treatment modality for local-stage DLBCL (aOR, 2.02; 95% CI, 1.50 to 2.72), non-small-cell lung cancer (aOR, 2.43; 95% CI, 1.46 to 4.03), and colon cancer (aOR, 4.77; 95% CI, 1.76 to 12.96). Among HIV-infected individuals, factors independently associated with lack of cancer treatment included low CD4 count, male sex with injection drug use as mode of HIV exposure, age 45 to 64 years, black race, and distant or unknown cancer stage.HIV-infected individuals are less likely to receive treatment for some cancers than uninfected people, which may affect survival rates.

Authors
Suneja, G; Shiels, MS; Angulo, R; Copeland, GE; Gonsalves, L; Hakenewerth, AM; Macomber, KE; Melville, SK; Engels, EA
MLA Citation
Suneja, G, Shiels, MS, Angulo, R, Copeland, GE, Gonsalves, L, Hakenewerth, AM, Macomber, KE, Melville, SK, and Engels, EA. "Cancer treatment disparities in HIV-infected individuals in the United States." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 32.22 (August 2014): 2344-2350.
PMID
24982448
Source
epmc
Published In
Journal of Clinical Oncology
Volume
32
Issue
22
Publish Date
2014
Start Page
2344
End Page
2350
DOI
10.1200/jco.2013.54.8644

Addressing the growing cancer burden in the wake of the AIDS epidemic in Botswana: The BOTSOGO collaborative partnership.

Botswana has experienced a dramatic increase in HIV-related malignancies over the past decade. The BOTSOGO collaboration sought to establish a sustainable partnership with the Botswana oncology community to improve cancer care. This collaboration is anchored by regular tumor boards and on-site visits that have resulted in the introduction of new approaches to treatment and perceived improvements in care, providing a model for partnership between academic oncology centers and high-burden countries with limited resources.

Authors
Efstathiou, JA; Bvochora-Nsingo, M; Gierga, DP; Alphonse Kayembe, MK; Mmalane, M; Russell, AH; Paly, JJ; Brown, C; Musimar, Z; Abramson, JS; Bruce, KA; Karumekayi, T; Clayman, R; Hodgeman, R; Kasese, J; Makufa, R; Bigger, E; Suneja, G; Busse, PM; Randall, TC; Chabner, BA; Dryden-Peterson, S
MLA Citation
Efstathiou, JA, Bvochora-Nsingo, M, Gierga, DP, Alphonse Kayembe, MK, Mmalane, M, Russell, AH, Paly, JJ, Brown, C, Musimar, Z, Abramson, JS, Bruce, KA, Karumekayi, T, Clayman, R, Hodgeman, R, Kasese, J, Makufa, R, Bigger, E, Suneja, G, Busse, PM, Randall, TC, Chabner, BA, and Dryden-Peterson, S. "Addressing the growing cancer burden in the wake of the AIDS epidemic in Botswana: The BOTSOGO collaborative partnership." International journal of radiation oncology, biology, physics 89.3 (July 2014): 468-475.
PMID
24929156
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
89
Issue
3
Publish Date
2014
Start Page
468
End Page
475
DOI
10.1016/j.ijrobp.2014.03.033

Radiation oncology in Africa: improving access to cancer care on the African continent.

Authors
Fisher, BJ; Daugherty, LC; Einck, JP; Suneja, G; Shah, MM; Dad, LK; Mutter, RW; Wilkinson, JB; Mundt, AJ
MLA Citation
Fisher, BJ, Daugherty, LC, Einck, JP, Suneja, G, Shah, MM, Dad, LK, Mutter, RW, Wilkinson, JB, and Mundt, AJ. "Radiation oncology in Africa: improving access to cancer care on the African continent." International journal of radiation oncology, biology, physics 89.3 (July 2014): 458-461.
PMID
24929154
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
89
Issue
3
Publish Date
2014
Start Page
458
End Page
461
DOI
10.1016/j.ijrobp.2013.12.032

Assessing interpersonal and communication skills in radiation oncology residents: a pilot standardized patient program.

PURPOSE: There is a lack of data for the structured development and evaluation of communication skills in radiation oncology residency training programs. Effective communication skills are increasingly emphasized by the Accreditation Council for Graduate Medical Education and are critical for a successful clinical practice. We present the design of a novel, pilot standardized patient (SP) program and the evaluation of communication skills among radiation oncology residents. METHODS AND MATERIALS: Two case scenarios were developed to challenge residents in the delivery of "bad news" to patients: one scenario regarding treatment failure and the other regarding change in treatment plan. Eleven radiation oncology residents paired with 6 faculty participated in this pilot program. Each encounter was scored by the SPs, observing faculty, and residents themselves based on the Kalamazoo guidelines. RESULTS: Overall resident performance ratings were "good" to "excellent," with faculty assigning statistically significant higher scores and residents assigning lower scores. We found inconsistent inter rater agreement among faculty, residents, and SPs. SP feedback was also valuable in identifying areas of improvement, including more collaborative decision making and less use of medical jargon. CONCLUSIONS: The program was well received by residents and faculty and regarded as a valuable educational experience that could be used as an annual feedback tool. Poor inter rater agreement suggests a need for residents and faculty physicians to better calibrate their evaluations to true patient perceptions. High scores from faculty members substantiate the concern that resident evaluations are generally positive and nondiscriminating. Faculty should be encouraged to provide honest and critical feedback to hone residents' interpersonal skills.

Authors
Ju, M; Berman, AT; Hwang, W-T; Lamarra, D; Baffic, C; Suneja, G; Vapiwala, N
MLA Citation
Ju, M, Berman, AT, Hwang, W-T, Lamarra, D, Baffic, C, Suneja, G, and Vapiwala, N. "Assessing interpersonal and communication skills in radiation oncology residents: a pilot standardized patient program." International journal of radiation oncology, biology, physics 88.5 (April 2014): 1129-1135.
PMID
24661666
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
88
Issue
5
Publish Date
2014
Start Page
1129
End Page
1135
DOI
10.1016/j.ijrobp.2014.01.007

Prevalence of HIV Infection among U.S. Hodgkin lymphoma cases.

Hodgkin lymphoma is uncommon in the U.S. general population; however, Hodgkin lymphoma risk is elevated in people with human immunodeficiency virus (HIV) infection. Thus, despite the low HIV prevalence in the United States, the HIV epidemic may have contributed substantially to the general population burden of Hodgkin lymphoma.We used data from 14 U.S. cancer registries in the Surveillance, Epidemiology, and End Results Program that recorded HIV status of Hodgkin lymphoma cases at diagnosis during 2000 to 2010. We computed the HIV prevalence in Hodgkin lymphoma cases by demographic and tumor characteristics, the proportion of deaths among Hodgkin lymphoma cases because of HIV, and 5-year mortality by HIV status.Of 22,355 Hodgkin lymphoma cases, 848 (3.79%) were HIV infected at diagnosis. HIV prevalence in Hodgkin lymphoma cases was greater among males than females (6.0% vs. 1.2%). Among males, HIV prevalence was greatest among 40- to 59-year-olds (14.2%), non-Hispanic blacks (16.9%), Hispanics (9.9%), and among cases of lymphocyte-depleted (15.1%), and mixed cellularity Hodgkin lymphoma (10.5%). Eight percent of male and 1.5% of female Hodgkin lymphoma cases died from HIV. Five-year mortality was two-fold higher in HIV-infected Hodgkin lymphoma cases (36.9% vs. 17.5%).In the United States, a substantial proportion of lymphocyte-depleted and mixed cellularity Hodgkin lymphoma cases and Hodgkin lymphoma cases among non-Hispanic black, Hispanic, and middle-aged men are HIV infected. In addition, HIV is an important cause of death among Hodgkin lymphoma cases.Clinicians should be aware of the high prevalence of HIV in certain subgroups of patients with Hodgkin lymphoma and routine HIV testing should be recommended for all patients presenting with Hodgkin lymphoma.

Authors
Shiels, MS; Koritzinsky, EH; Clarke, CA; Suneja, G; Morton, LM; Engels, EA
MLA Citation
Shiels, MS, Koritzinsky, EH, Clarke, CA, Suneja, G, Morton, LM, and Engels, EA. "Prevalence of HIV Infection among U.S. Hodgkin lymphoma cases." Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 23.2 (February 2014): 274-281.
PMID
24326629
Source
epmc
Published In
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume
23
Issue
2
Publish Date
2014
Start Page
274
End Page
281
DOI
10.1158/1055-9965.epi-13-0865

Cancer in Botswana: A Prospective Cohort Study of Cancer Type, Treatment, and Outcomes

Authors
Suneja, G; Dryden-Peterson, S; Boyer, M; Musimar, Z; Nsingo-Bvochora, M; Ramogola-Masire, D; Medhin, H; Bekelman, J; Lockman, S; Rebbeck, T
MLA Citation
Suneja, G, Dryden-Peterson, S, Boyer, M, Musimar, Z, Nsingo-Bvochora, M, Ramogola-Masire, D, Medhin, H, Bekelman, J, Lockman, S, and Rebbeck, T. "Cancer in Botswana: A Prospective Cohort Study of Cancer Type, Treatment, and Outcomes." October 1, 2013.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
87
Issue
2
Publish Date
2013
Start Page
S492
End Page
S493

Acute toxicity of proton beam radiation for pediatric central nervous system malignancies.

BACKGROUND: Proton beam therapy (PBT) for pediatric CNS malignancies may reduce late toxicity, but acute toxicity is not well defined. We examined acute toxicity for children with CNS malignancies treated with PBT. PROCEDURE: We conducted a retrospective review of 48 children with malignant brain tumors treated with PBT at our facility from 2010 to 2012. For each patient, we recorded age at diagnosis, tumor location, histologic subtype, radiation dose, extent of radiation, and use of concurrent chemotherapy. Acute toxicity scores were recorded per the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0 at weekly on treatment visits. Maximum grade of fatigue, headache, insomnia, anorexia, nausea, vomiting, alopecia, and dermatitis over the radiation therapy treatment course were recorded, and rates of acute toxicity were calculated. RESULTS: The cohort consisted of 16 glial tumors, 9 medulloblastomas, 6 germinomas, 5 ependymomas, 4 craniopharyngiomas, 3 atypical teratoid rhabdoid tumors, and 5 other CNS tumors. The mean age was 10.8 years, and median dose was 5,400 cGy (RBE). Acute toxicities were generally low-grade and manageable. The most commonly observed acute toxicities were fatigue, alopecia, and dermatitis. The least common were insomnia and vomiting. Higher maximum grades for headache, nausea, and vomiting over the treatment course were associated with infratentorial location, while higher maximum grades for anorexia, nausea, and alopecia were associated with craniospinal radiation. CONCLUSIONS: PBT appears to be well tolerated in pediatric patients with CNS malignancies. Acute toxicity can be managed with supportive care.

Authors
Suneja, G; Poorvu, PD; Hill-Kayser, C; Lustig, RA
MLA Citation
Suneja, G, Poorvu, PD, Hill-Kayser, C, and Lustig, RA. "Acute toxicity of proton beam radiation for pediatric central nervous system malignancies." Pediatric blood & cancer 60.9 (September 2013): 1431-1436.
PMID
23610011
Source
epmc
Published In
Pediatric Blood & Cancer
Volume
60
Issue
9
Publish Date
2013
Start Page
1431
End Page
1436
DOI
10.1002/pbc.24554

Cancer in Botswana: resources and opportunities.

Authors
Suneja, G; Ramogola-Masire, D; Medhin, HG; Dryden-Peterson, S; Bekelman, JE
MLA Citation
Suneja, G, Ramogola-Masire, D, Medhin, HG, Dryden-Peterson, S, and Bekelman, JE. "Cancer in Botswana: resources and opportunities." The Lancet. Oncology 14.8 (July 2013): e290-e291. (Letter)
PMID
23816293
Source
epmc
Published In
The Lancet Oncology
Volume
14
Issue
8
Publish Date
2013
Start Page
e290
End Page
e291
DOI
10.1016/s1470-2045(13)70283-3

Effect of practice integration between urologists and radiation oncologists on prostate cancer treatment patterns.

National attention has focused on whether urology-radiation oncology practice integration, known as integrated prostate cancer centers, contributes to the use of intensity modulated radiation therapy, a common and expensive prostate cancer treatment.We examined prostate cancer treatment patterns before and after conversion of a urology practice to an integrated prostate cancer center in July 2006. Using the SEER (Statistics, Epidemiology and End Results)-Medicare database, we identified patients 65 years old or older in 1 statewide registry diagnosed with nonmetastatic prostate cancer between 2004 and 2007. We classified patients into 3 groups, including 1--those seen by integrated prostate cancer center physicians (exposure group), 2--those living in the same hospital referral region who were not seen by integrated prostate cancer center physicians (hospital referral region control group) and 3--those living elsewhere in the state (state control group). We compared changes in treatment among the 3 groups, adjusting for patient, clinical and socioeconomic factors.Compared with the 8.1 ppt increase in adjusted intensity modulated radiation therapy use in the state control group, the use of this therapy increased 20.3 ppts (95% CI 13.4, 27.1) in the integrated prostate cancer center group and 19.2 ppts (95% CI 9.6, 28.9) in the hospital referral region control group. Androgen deprivation therapy, for which Medicare reimbursement decreased sharply, similarly decreased in integrated prostate cancer center and hospital referral region controls. Prostatectomy decreased significantly in the integrated prostate cancer center group.Coincident with the conversion of a urology group practice to an integrated prostate cancer center, we observed an increase in intensity modulated radiation therapy and a decrease in androgen deprivation therapy in patients seen by integrated prostate cancer center physicians and those seen in the surrounding health care market that were not observed in the remainder of the state.

Authors
Bekelman, JE; Suneja, G; Guzzo, T; Pollack, CE; Armstrong, K; Epstein, AJ
MLA Citation
Bekelman, JE, Suneja, G, Guzzo, T, Pollack, CE, Armstrong, K, and Epstein, AJ. "Effect of practice integration between urologists and radiation oncologists on prostate cancer treatment patterns." The Journal of urology 190.1 (July 2013): 97-101.
PMID
23399652
Source
epmc
Published In
The Journal of Urology
Volume
190
Issue
1
Publish Date
2013
Start Page
97
End Page
101
DOI
10.1016/j.juro.2013.01.103

Reversal of associations between Spanish language use and mammography and pap smear testing.

Latina women are less likely to utilize cancer screening services than are non-Latina White women. The purpose of this study is to examine the relationship between preferred language (English vs. Spanish) and receipt of mammography and Pap-smear testing among US Latinas and non-Latinas. Cross-sectional analysis of the 2008 and 2010 Behavioral Risk Factor Surveillance System (BRFSS) surveys. While Latinas responding to the BRFSS in English or in Spanish had unadjusted lower odds of receiving mammography testing, in multivariable analysis Latinas responding-in-Spanish had 2.20 times the odds (OR = 2.20, 95 % CI, 1.90-2.55) of reporting mammography compared to non-Latinas. Similarly, Latinas responding-in- Spanish had lower unadjusted odds of receiving Pap-smear testing. However, Latinas responding-in-Spanish had 2.37 times the odds (OR = 2.37 CI, 2.04-2.75) of reporting having received Pap smear testing compared to non-Latinas in multivariate analysis. The results of this paper further confirm the "reversed associations" among Latinas and mammography and Pap smear testing described in previous studies and suggest that in addition to insurance status, preferred language may be a key variable contributing to the reversal phenomenon observed among Latinas.

Authors
Suneja, G; Diaz, JA; Roberts, M; Rakowski, W
MLA Citation
Suneja, G, Diaz, JA, Roberts, M, and Rakowski, W. "Reversal of associations between Spanish language use and mammography and pap smear testing." Journal of immigrant and minority health 15.2 (April 2013): 255-261.
PMID
22886745
Source
epmc
Published In
Journal of Immigrant and Minority Health
Volume
15
Issue
2
Publish Date
2013
Start Page
255
End Page
261
DOI
10.1007/s10903-012-9694-3

The impact of race and partner status on patterns of care and survival in young women with early-stage cervical cancer.

OBJECTIVES: Although outcomes for surgery versus radiotherapy (RT) for stage IB patients are similar, young women are often preferentially treated with surgery rather than RT. Adjuvant RT is indicated for high-risk patients after surgery. Our goal was to study the impact of race and partner status on patterns of care of young women with stage I cervical cancer. METHODS: We identified a cohort of 6586 women, aged 15 to 39 years, in the Surveillance, Epidemiology and End Results database diagnosed with stage I cervical cancer between 1988 and 2007. RESULTS: In our cohort, 93% (n = 5080) of white women had surgery, and 86.5% (n = 985) of nonwhite women had surgery as primary treatment. On multivariate analysis, higher FIGO (International Federation of Gynecology and Obstetrics) stage (IA2 odds ratio [OR] 3.09 [P = 0.01]; IB OR, 21.41 [P < 0.001]), widowed/single (OR, 1.39; P = 0.02), squamous histology (OR, 1.69; P < 0.001), diagnosis during 1993-1997 time period (OR, 1.69; P < 0.001), and nonwhite race (OR, 1.95; P ≤ 0.001) were more likely to receive RT as primary treatment. Of the surgical patients, 15.45% of white women versus 20.4% in the nonwhite women (P < 0.001) had high-risk disease, and 66% of the white women versus 71% of the nonwhite women received adjuvant RT (P = 0.136). Race and marital status were not significant predictors of receiving adjuvant RT on multivariate analysis. Predictors of worse overall survival included RT as primary treatment (hazard ratio [HR], 1.89; P < 0.001) and nonwhite race (HR, 1.6; P = 0.001). Marital status was not a significant predictor of overall survival. Race was a significant predictor of survival for women who received surgery as primary treatment (nonwhite HR, 1.93; P < 0.001). CONCLUSIONS: Nonwhites are more likely than whites to have RT as primary treatment. This suggests that nonwhite women may have social/cultural barriers impacting their treatment decision making or may have a higher likelihood of other comorbidities that limit their surgical options.

Authors
Grover, S; Showalter, S; Kraft, KH; Suneja, G; Lin, L
MLA Citation
Grover, S, Showalter, S, Kraft, KH, Suneja, G, and Lin, L. "The impact of race and partner status on patterns of care and survival in young women with early-stage cervical cancer." International journal of gynecological cancer : official journal of the International Gynecological Cancer Society 23.3 (March 2013): 494-499.
PMID
23388613
Source
epmc
Published In
International Journal of Gynecological Cancer
Volume
23
Issue
3
Publish Date
2013
Start Page
494
End Page
499
DOI
10.1097/igc.0b013e318280824d

Disparities in the treatment and outcomes of lung cancer among HIV-infected individuals.

HIV-infected people have elevated risk for lung cancer and higher mortality following cancer diagnosis than HIV-uninfected individuals. It is unclear whether HIV-infected individuals with lung cancer receive similar cancer treatment as HIV-uninfected individuals.We studied adults more than 18 years of age with lung cancer reported to the Texas Cancer Registry (N = 156 930) from 1995 to 2009. HIV status was determined by linkage with the Texas enhanced HIV/AIDS Reporting System. For nonsmall cell lung cancer (NSCLC) cases, we identified predictors of cancer treatment using logistic regression. We used Cox regression to evaluate effects of HIV and cancer treatment on mortality.Compared with HIV-uninfected lung cancer patients (N = 156 593), HIV-infected lung cancer patients (N = 337) were more frequently young, non-Hispanic black, men, and with distant stage disease. HIV-infected NSCLC patients less frequently received cancer treatment than HIV-uninfected patients [60.3 vs. 77.5%; odds ratio 0.39, 95% confidence interval (CI) 0.30-0.52, after adjustment for diagnosis year, age, sex, race, stage, and histologic subtype]. HIV infection was associated with higher lung cancer-specific mortality (hazard ratio 1.34, 95% CI 1.15-1.56, adjusted for demographics and tumor characteristics). Inclusion of cancer treatment in adjusted models slightly attenuated the effect of HIV on lung cancer-specific mortality (hazard ratio 1.25; 95% CI 1.06-1.47). Also, there was a suggestion that HIV was more strongly associated with mortality among untreated than among treated patients (adjusted hazard ratio 1.32 vs. 1.16, P-interaction = 0.34).HIV-infected NSCLC patients were less frequently treated for lung cancer than HIV-uninfected patients, which may have affected survival.

Authors
Suneja, G; Shiels, MS; Melville, SK; Williams, MA; Rengan, R; Engels, EA
MLA Citation
Suneja, G, Shiels, MS, Melville, SK, Williams, MA, Rengan, R, and Engels, EA. "Disparities in the treatment and outcomes of lung cancer among HIV-infected individuals." AIDS (London, England) 27.3 (January 2013): 459-468.
PMID
23079809
Source
epmc
Published In
AIDS
Volume
27
Issue
3
Publish Date
2013
Start Page
459
End Page
468
DOI
10.1097/qad.0b013e32835ad56e

Postoperative radiation therapy for low-grade glioma: patterns of care between 1998 and 2006.

BACKGROUND: The role of postoperative radiotherapy (PORT) in the management of low-grade glioma remains controversial. An analysis using data from the European Organization for Research and Treatment of Cancer 22844/22845 studies concluded that several factors portend a poor prognosis: age ≥40 years, astrocytoma histology, tumor size ≥6 cm, tumor crossing midline, and preoperative neurologic deficits. PORT may benefit patients with high-risk features. The aim of this study was to assess temporal trends and determinants of the use of PORT. METHODS: By using data from the Surveillance, Epidemiology, and End Results program, the authors identified 1127 adult patients diagnosed with low-grade glioma (World Health Organization grade I and II) who underwent surgical resection between January 1, 1998 and December 31, 2006. The primary outcome was receipt of PORT. The authors performed multivariate logistic regression to examine the association between clinical, patient, and demographic characteristics and receipt of PORT. RESULTS: Receipt of PORT declined during the study period, from 64% of patients in 1998 to 36% of patients in 2006. On multivariate analysis, significant predictors of receipt of PORT were age ≥40 years, tumor crossing midline, and partial surgical resection. CONCLUSIONS: The use of PORT for patients with low-grade glioma has declined in the period from 1998 to 2006 for both low-risk and high-risk patients.

Authors
Suneja, G; Alonso-Basanta, M; Lustig, R; Lee, JYK; Bekelman, JE
MLA Citation
Suneja, G, Alonso-Basanta, M, Lustig, R, Lee, JYK, and Bekelman, JE. "Postoperative radiation therapy for low-grade glioma: patterns of care between 1998 and 2006." Cancer 118.15 (August 2012): 3735-3742.
PMID
22180333
Source
epmc
Published In
Cancer
Volume
118
Issue
15
Publish Date
2012
Start Page
3735
End Page
3742
DOI
10.1002/cncr.26693

Disparities in the treatment and outcomes of lung cancer among HIV-infected people in Texas

Authors
Suneja, G; Shiels, MS; Melville, SK; Williams, MA; Rengan, R; Engels, EA
MLA Citation
Suneja, G, Shiels, MS, Melville, SK, Williams, MA, Rengan, R, and Engels, EA. "Disparities in the treatment and outcomes of lung cancer among HIV-infected people in Texas." May 20, 2012.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
30
Issue
15
Publish Date
2012

Patterns of treatment in young women with early-stage cervical cancer

Authors
Grover, S; Lin, LL; Suneja, G
MLA Citation
Grover, S, Lin, LL, and Suneja, G. "Patterns of treatment in young women with early-stage cervical cancer." JOURNAL OF CLINICAL ONCOLOGY 29.15 (May 20, 2011).
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
29
Issue
15
Publish Date
2011

Patterns of treatment in young women with early-stage cervical cancer.

1601 Background: Radical surgery and radiation offer similar survival outcomes for treatment of early stage cervical cancer. Younger women tend to have surgery more than radiation to preserve ovarian function. The goal of this study was to understand the factors that may impact the type of treatment delivered to young women with early stage cervical cancer.We identified 1368 women with early stage cervical cancer aged 15-39, treated between 1988 and 2007 from the Surveillance, Epidemiology, and End Results [SEER] database.Of the 1368 women with early stage cervical cancer, 1199 (80%) were white, 152 (11%) black and 117 (8%) other. 894 (65%) had surgery only 154 (11%) had radiation (RT) only, 302 (22%) had a combination of RT+surgery and 18 (1%) had no treatment. Of the 1199 white women, 738 (67%) had surgery, 109 (10%) had RT, 244 (22%) had both and 8 (0.7%) had no treatment. Of the 152 black women, 80 (53%) had surgery, 38 (25%) had RT, 27 (18%) had both and 7 (5%) had no treatment. On univariate and multivariate analysis, black race (p=0.0009), squamous histology (p=0.0006) and being single (p< 0.0001) were significantly related to receiving RT (OR MV 2.32, 2.09 and 2.18 respectively.) On univariate analysis, percent of population less than high school educated was related to receiving RT (p=0.0006 OR 0.31).Higher percentage of young black women received RT as opposed to surgery for treatment of early stage cervical cancer compared to young white women. Significant predictors of RT being the primary modality for treatment of early stage cervical cancer were black race, being single, squamous histology and living in a county with higher percentage of population with less than high school education.

Authors
Grover, S; Lin, LL; Suneja, G
MLA Citation
Grover, S, Lin, LL, and Suneja, G. "Patterns of treatment in young women with early-stage cervical cancer." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 29.15_suppl (May 2011): 1601-.
PMID
28019754
Source
epmc
Published In
Journal of Clinical Oncology
Volume
29
Issue
15_suppl
Publish Date
2011
Start Page
1601

Association between an Integrated Prostate Cancer Center and Prostate Cancer Treatment Trends in Louisiana: A Study from 2004-2007

Authors
Suneja, G; Epstein, A; Pollack, C; Guzzo, T; Lipschultz, A; Armstrong, K; Bekelman, J
MLA Citation
Suneja, G, Epstein, A, Pollack, C, Guzzo, T, Lipschultz, A, Armstrong, K, and Bekelman, J. "Association between an Integrated Prostate Cancer Center and Prostate Cancer Treatment Trends in Louisiana: A Study from 2004-2007." INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 81.2 (2011): S436-S436.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
81
Issue
2
Publish Date
2011
Start Page
S436
End Page
S436

Abstract P5-14-03: The Impact of Routine Cavity Margins on Reducing the Need for Re-Excision in Women Undergoing Breast-Conserving Surgery for Invasive or Non-Invasive Breast Cancer

Authors
Suneja, G; Goyal, A; Mies, C; Morrissey, S; Hwang, W-T; Czerniecki, B; Prosnitz, R
MLA Citation
Suneja, G, Goyal, A, Mies, C, Morrissey, S, Hwang, W-T, Czerniecki, B, and Prosnitz, R. "Abstract P5-14-03: The Impact of Routine Cavity Margins on Reducing the Need for Re-Excision in Women Undergoing Breast-Conserving Surgery for Invasive or Non-Invasive Breast Cancer." Cancer Research 70.24 Supplement (December 15, 2010): P5-14-03-P5-14-03.
Source
crossref
Published In
Cancer Research
Volume
70
Issue
24 Supplement
Publish Date
2010
Start Page
P5-14-03
End Page
P5-14-03
DOI
10.1158/0008-5472.SABCS10-P5-14-03

Post-operative Radiation Therapy for Low Grade Glioma: Patterns of Care between 1998 and 2006

Authors
Suneja, G; Alonso-Basanta, M; Lustig, R; Bekelman, JE
MLA Citation
Suneja, G, Alonso-Basanta, M, Lustig, R, and Bekelman, JE. "Post-operative Radiation Therapy for Low Grade Glioma: Patterns of Care between 1998 and 2006." 2010.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
78
Issue
3
Publish Date
2010
Start Page
S276
End Page
S277

Language and utilization of women's cancer screening: The association of Spanish language with receipt of mammography and Pap smear testing

Authors
Suneja, G; Diaz, J; Roberts, M; Rakowski, W
MLA Citation
Suneja, G, Diaz, J, Roberts, M, and Rakowski, W. "Language and utilization of women's cancer screening: The association of Spanish language with receipt of mammography and Pap smear testing." JOURNAL OF CLINICAL ONCOLOGY 26.15 (May 20, 2008).
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
26
Issue
15
Publish Date
2008

Primary CNS lymphoma in the immunocompetent

Authors
Suneja, G; Jegapragasan, V; Gupta, R; Paggioli, D; Birnbaum, A
MLA Citation
Suneja, G, Jegapragasan, V, Gupta, R, Paggioli, D, and Birnbaum, A. "Primary CNS lymphoma in the immunocompetent." April 2007.
Source
wos-lite
Published In
Journal of General Internal Medicine
Volume
22
Publish Date
2007
Start Page
226
End Page
226

Dose response explorer: an integrated open-source tool for exploring and modelling radiotherapy dose-volume outcome relationships.

Radiotherapy treatment outcome models are a complicated function of treatment, clinical and biological factors. Our objective is to provide clinicians and scientists with an accurate, flexible and user-friendly software tool to explore radiotherapy outcomes data and build statistical tumour control or normal tissue complications models. The software tool, called the dose response explorer system (DREES), is based on Matlab, and uses a named-field structure array data type. DREES/Matlab in combination with another open-source tool (CERR) provides an environment for analysing treatment outcomes. DREES provides many radiotherapy outcome modelling features, including (1) fitting of analytical normal tissue complication probability (NTCP) and tumour control probability (TCP) models, (2) combined modelling of multiple dose-volume variables (e.g., mean dose, max dose, etc) and clinical factors (age, gender, stage, etc) using multi-term regression modelling, (3) manual or automated selection of logistic or actuarial model variables using bootstrap statistical resampling, (4) estimation of uncertainty in model parameters, (5) performance assessment of univariate and multivariate analyses using Spearman's rank correlation and chi-square statistics, boxplots, nomograms, Kaplan-Meier survival plots, and receiver operating characteristics curves, and (6) graphical capabilities to visualize NTCP or TCP prediction versus selected variable models using various plots. DREES provides clinical researchers with a tool customized for radiotherapy outcome modelling. DREES is freely distributed. We expect to continue developing DREES based on user feedback.

Authors
El Naqa, I; Suneja, G; Lindsay, PE; Hope, AJ; Alaly, JR; Vicic, M; Bradley, JD; Apte, A; Deasy, JO
MLA Citation
El Naqa, I, Suneja, G, Lindsay, PE, Hope, AJ, Alaly, JR, Vicic, M, Bradley, JD, Apte, A, and Deasy, JO. "Dose response explorer: an integrated open-source tool for exploring and modelling radiotherapy dose-volume outcome relationships." Physics in medicine and biology 51.22 (November 2006): 5719-5735.
PMID
17068361
Source
epmc
Published In
Physics in Medicine and Biology
Volume
51
Issue
22
Publish Date
2006
Start Page
5719
End Page
5735
DOI
10.1088/0031-9155/51/22/001

TH-E-230A-01: Can Dose-Volume Parameters Be Replaced with GEUD in the Treatment Planning Process?

Authors
Clark, V; El Naqa, I; Hope, A; Suneja, G; Bradley, J; Deasy, J
MLA Citation
Clark, V, El Naqa, I, Hope, A, Suneja, G, Bradley, J, and Deasy, J. "TH-E-230A-01: Can Dose-Volume Parameters Be Replaced with GEUD in the Treatment Planning Process?." June 2006.
Source
crossref
Published In
Medical physics
Volume
33
Issue
6Part23
Publish Date
2006
Start Page
2294
End Page
2294
DOI
10.1118/1.2241963

MO-D-T-6E-02: Dose-Response Explorer: An Open-Source-Code Matlab-Based Tool for Modeling Treatment Outcome as a Function of Predictive Factors

Authors
Suneja, G; El Naqa, I; Alaly, J; Lindsay, P; Hope, A; Deasy, J
MLA Citation
Suneja, G, El Naqa, I, Alaly, J, Lindsay, P, Hope, A, and Deasy, J. "MO-D-T-6E-02: Dose-Response Explorer: An Open-Source-Code Matlab-Based Tool for Modeling Treatment Outcome as a Function of Predictive Factors." June 2005.
Source
crossref
Published In
Medical physics
Volume
32
Issue
6Part14
Publish Date
2005
Start Page
2061
End Page
2062
DOI
10.1118/1.1998272
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