Publications (72) View all
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Article: Hematologic Toxicity in RTOG 0418: A Phase 2 Study of Postoperative IMRT for Gynecologic Cancer.
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ABSTRACT: Intensity modulated radiation therapy (IMRT), compared with conventional 4-field treatment, can reduce the volume of bone marrow irradiated. Pelvic bone marrow sparing has produced a clinically significant reduction in hematologic toxicity (HT). This analysis investigated HT in Radiation Therapy Oncology Group (RTOG) 0418, a prospective study to test the feasibility of delivering postoperative IMRT for cervical and endometrial cancer in a multiinstitutional setting. Patients in the RTOG 0418 study were treated with postoperative IMRT to 50.4 Gy to the pelvic lymphatics and vagina. Endometrial cancer patients received IMRT alone, whereas patients with cervical cancer received IMRT and weekly cisplatin (40 mg/m(2)). Pelvic bone marrow was defined within the treatment field by using a computed tomography density-based autocontouring algorithm. The volume of bone marrow receiving 10, 20, 30, and 40 Gy and the median dose to bone marrow were correlated with HT, graded by Common Terminology Criteria for Adverse Events, version 3.0, criteria. Eighty-three patients were eligible for analysis (43 with endometrial cancer and 40 with cervical cancer). Patients with cervical cancer treated with weekly cisplatin and pelvic IMRT had grades 1-5 HT (23%, 33%, 25%, 0%, and 0% of patients, respectively). Among patients with cervical cancer, 83% received 5 or more cycles of cisplatin, and 90% received at least 4 cycles of cisplatin. The median percentage volume of bone marrow receiving 10, 20, 30, and 40 Gy in all 83 patients, respectively, was 96%, 84%, 61%, and 37%. Among cervical cancer patients with a V40 >37%, 75% had grade 2 or higher HT compared with 40% of patients with a V40 less than or equal to 37% (P =.025). Cervical cancer patients with a median bone marrow dose of >34.2 Gy also had higher rates of grade ≥2 HT than did those with a dose of ≤34.2 Gy (74% vs 43%, P=.049). Pelvic IMRT with weekly cisplatin is associated with low rates of HT and high rates of weekly cisplatin use. The volume of bone marrow receiving 40 Gy and the median dose to bone marrow correlated with higher rates of grade ≥2 toxicity among patients receiving weekly cisplatin (cervical cancer patients). Evaluation and limitation of the volume of bone marrow treated with pelvic IMRT is warranted in patients receiving concurrent chemotherapy.International journal of radiation oncology, biology, physics 05/2013; 86(1):83-90. · 4.59 Impact Factor -
Article: Localized Colon Cancer, Version 3.2013.
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ABSTRACT: The NCCN Clinical Practice Guidelines in Oncology for Colon Cancer begin with the clinical presentation of the patient to the primary care physician or gastroenterologist and address diagnosis, pathologic staging, surgical management, perioperative treatment, patient surveillance, management of recurrent and metastatic disease, and survivorship. The NCCN Colon Cancer Panel meets annually to review comments from reviewers within their institutions and to reevaluate and update their recommendations. In addition, the panel has interim conferences as new data necessitate. These NCCN Guidelines Insights summarize the NCCN Colon Cancer Panel's discussions regarding the treatment of localized disease for the 2013 update of the guidelines.Journal of the National Comprehensive Cancer Network: JNCCN 05/2013; 11(5):519-528. · 4.41 Impact Factor -
Article: Ribonucleotide Reductase Expression in Cervical Cancer: A Radiation Therapy Oncology Group Translational Science Analysis.
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ABSTRACT: OBJECTIVE: To evaluate pretherapy ribonucleotide reductase (RNR) expression and its effect on radiochemotherapeutic outcome in women with cervical cancer. METHODS/MATERIALS: Pretherapy RNR M1, M2, and M2b immunohistochemistry was done on cervical cancer specimens retrieved from women treated on Radiation Therapy Oncology Group (RTOG) 0116 and 0128 clinical trials. Enrollees of RTOG 0116 (node-positive stages IA-IVA) received weekly cisplatin (40 mg/m) with amifostine (500 mg) and extended-field radiation then brachytherapy (85 Gy). Enrollees of RTOG 0128 (node-positive or bulky ≥5 cm, stages IB-IIA or stages IIB-IVA) received cisplatin (75 mg/m) on days 1, 23, and 43 and 5-FU (1 g/m for 4 days) during pelvic radiation then brachytherapy (85 Gy), plus celecoxib (400 mg twice daily, day 1 through 1 year). Disease-free survival (DFS) was estimated univariately by the Kaplan-Meier method. Cox proportional hazards models evaluated the impact of RNR immunoreactivity on DFS. RESULTS: Fifty-one tissue samples were analyzed: 13 from RTOG 0116 and 38 from RTOG 0128. M1, M2, and M2b overexpression (3+) frequencies were 2%, 80%, and 47%, respectively. Low-level (0-1+, n = 44/51) expression of the regulatory subunit M1 did not associate with DFS (P = 0.38). High (3+) M2 expression occurred in most (n = 41/51) but without impact alone on DFS (hazard ratio, 0.54; 95% confidence interval, 0.2-1.4; P = 0.20). After adjusting for M2b status, pelvic node-positive women had increased hazard for relapse or death (hazard ratio, 5.5; 95% confidence interval, 2.2-13.8; P = 0.0003). CONCLUSIONS: These results suggest that RNR subunit expression may discriminate cervical cancer phenotype and radiochemotherapy outcome. Future RNR biomarker studies are warranted.International Journal of Gynecological Cancer 04/2013; · 1.65 Impact Factor -
Article: Metastatic Colon Cancer, Version 3.2013: Featured Updates to the NCCN Guidelines.
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ABSTRACT: The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Colon Cancer begin with the clinical presentation of the patient to the primary care physician or gastroenterologist and address diagnosis, pathologic staging, surgical management, perioperative treatment, patient surveillance, management of recurrent and metastatic disease, and survivorship. The NCCN Colon Cancer Panel meets annually to review comments from reviewers within their institutions and to reevaluate and update their recommendations. In addition, the panel has interim conferences as new data necessitate. These NCCN Guidelines Insights summarize the NCCN Colon Cancer Panel's discussions surrounding metastatic colorectal cancer for the 2013 update of the guidelines. Importantly, changes were made to the continuum of care for patients with advanced or metastatic disease, including new drugs and an additional line of therapy.Journal of the National Comprehensive Cancer Network: JNCCN 02/2013; 11(2):141-152. · 4.41 Impact Factor -
Article: Radical Hysterectomy Compared With Primary Radiation for Treatment of Stage IB1 Cervix Cancer.
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ABSTRACT: OBJECTIVE:: We reviewed data on treatment of stage IB1 cervical cancer at our institution to compare recurrence, complications, and survival of women treated primarily by radical hysterectomy versus radiation. METHODS:: Records for women treated for stage IB1 cervical cancer between January 1, 1990 and June 1, 2010 were retrospectively reviewed. Recurrence, survival outcomes, and complications were examined and compared. Demographic, clinical, and histopathologic factors were also analyzed. RESULTS:: Of 198 patients with stage IB1 cervix cancer, 169 (85%) underwent radical hysterectomy, including 37 (20%) who received postoperative radiation, and 29 (15%) were treated primarily with radiotherapy±chemotherapy. Progression-free survival, overall survival, and disease-specific survival were all longer in the surgery group (89%, 95%, and 96%) versus the radiation group (70%, 70%, and 78%), respectively (P<0.001). Patients in the radiation group were older, had larger tumors, and were more likely to have medical comorbidities than patients in the surgery group. Within the surgical cohort, lymphvascular space invasion, outer third cervical stromal invasion, positive surgical margins, and lymph node metastasis were all predictive of recurrence (P<0.002), whereas histopathology, smoking, diabetes, and immunosuppression were not. Grade 3 or 4 complication rates were higher among the 29 patients who had primary radiotherapy (20.7%) and the 37 patients who had surgery followed by radiotherapy (21.6%) compared with the 132 patients who had surgery only (9.1%) (P=0.047). CONCLUSIONS:: Primary treatment of stage IB1 cervix cancer with radical hysterectomy±adjuvant radiation resulted in a significantly lower rate of recurrence and an improved survival with fewer complications compared with radiotherapy with or without chemotherapy.American journal of clinical oncology 09/2012; · 2.21 Impact Factor
