Rahul D Tendulkar

Cleveland Clinic, Cleveland, Ohio, United States

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Publications (49)115.64 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Androgen deprivation therapy (ADT) is typically provided neoadjuvantly and concurrently with radiotherapy (RT) in the management of intermediate and high-risk prostate cancer. Our objective was to compare outcomes between patients who received adjuvant ADT (ADJ), ie, immediately after the completion of RT, to those who received a neoadjuvant and concurrent regimen (NEO). From 1995 to 2002, 515 patients with prostate cancer were definitively treated with RT and ADT. NEO was provided 2 to 3 months before the start of RT (n = 311). ADJ was initiated immediately after the completion of RT (n = 204). Kaplan-Meier analysis was used to calculate biochemical relapse-free survival (bRFS), distant metastasis-free survival (DMFS), and overall survival (OS). Cox proportional hazards regression was used to examine the impact of ADT timing on outcomes. Ten-year bRFS, DMFS, and OS rates were 61%, 80%, and 66%, respectively. Ten-year bRFS rates for ADJ versus NEO were 63% versus 60% (P = .98). Ten-year DMFS rates for ADJ versus NEO were both 80% (P = .60). Ten-year OS rates for ADJ versus NEO were 65% versus 67% (P = .98). There was no significant difference in bRFS, DMFS, or OS between neoadjuvant versus adjuvant ADT in the setting of dose-escalated RT for localized prostate cancer. This suggests that the synergy between RT and androgen deprivation is independent of the sequencing of both modalities and that the initiation of RT does not need to be delayed for a course of neoadjuvant ADT. Copyright © 2015 Elsevier Inc. All rights reserved.
    Clinical Genitourinary Cancer 12/2014; · 1.69 Impact Factor
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    ABSTRACT: Background Prostate cancer is the most common non-cutaneous malignancy diagnosed in men. From a large population-based database, we aim to report prostate cancer specific mortality (PCSM) rates of men diagnosed with various presentations of prostate cancer in order to examine the adequacy of the current American Joint Committee on Cancer (AJCC) staging system. Methods The Surveillance, Epidemiology, and End Results (SEER) database was queried for all patients diagnosed with prostate cancer from 1997 – 2005. PCSM was reported by extent of disease (EOD) classification provided by the SEER database, for clinically staged and pathologically staged cohorts. Results Using the cumulative incidence method, PCSM at 10 years for all patients (n=354,326) was 5% in clinically localized (CL) lesions, 7% in T3aN0M0, 14% T3bN0M0, 26% for T4N0M0, 27% for TanyN1M0 and 66% for TanyNanyM1 disease. Within the pathologically staged subgroup (n=108,135), PCSM at 10 years was 1% in clinically localized (CL) lesions, 4% in T3aN0M0, 9% T3bN0M0, 9% for T4N0M0 and 19% for TanyN1M0. Conclusion Staging of any disease site aims to accurately communicate, prognosticate and guide management for that particular level of disease. Stage IV prostate cancer is a diverse group with PCSM in the subgroups ranging from 9 to 68% in this study. Considering the favorable outcomes of those with T4 or N1 non-metastatic prostate cancer relative to those with M1 disease, we propose a new stage IIIB in which T4 or N1 M0 prostate cancer should be reclassified, and patients offered curative intent therapy whenever possible.
    Clinical Genitourinary Cancer 07/2014; 13(1). · 1.69 Impact Factor
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    ABSTRACT: Removing a flattening filter or replacing it with a thinner filter alters the characteristics of a photon beam, creating a forward peaked intensity profile to make the photon beam nonflat. This study is to investigate the feasibility of applying nonflat photon beams to the whole-breast irradiation with breath holds for a potential of delivery time reduction during the gated treatment. Photon beams of 6 MV with flat and nonflat intensity profiles were commissioned. Fifteen patients with early-stage breast cancer, who received whole-breast radiation without breathing control, were retrospectively selected for this study. For each patient, three plans were created using a commercial treatment planning system: (a) the clinically approved plan using forward planning method (FP); (b) a hybrid intensity-modulated radiation therapy (IMRT) plan where the flat beam open fields were combined with the nonflat beam IMRT fields using direct aperture optimization method (mixed DAO); (c) a hybrid IMRT plan where both open and IMRT fields were from nonflat beams using direct aperture optimization (nonflat DAO). All plans were prescribed for ≥ 95% of the breast volume receiving the prescription dose of 50 Gy (2.0 Gy per fraction). In comparison, all plans achieved a similar dosimetric coverage to the targeted volume. The average homogeneity index of the FP, mixed DAO, and nonflat DAO plans were 0.882 ± 0.024, 0.879 ± 0.023, and 0.867 ± 0.027, respectively. The average percentage volume of V105 was 57.66% ± 5.21%, 34.67% ± 4.91%, 41.64% ± 5.32% for the FP, mixed, and nonflat DAO plans, respectively. There was no significant difference (p > 0.05) observed for the defined endpoint doses in organs at risk (OARs). In conclusion, both mixed DAO and nonflat DAO plans can achieve similar plan quality as the clinically approved FP plan, measured by plan homogeneity and endpoint doses to the ORAs. Nonflat beam plans may reduce treatment time in breath-hold treatment, especially for hypofractionated treatment.
    Journal of Applied Clinical Medical Physics 01/2014; 15(1):4397. · 1.11 Impact Factor
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    ABSTRACT: Prostate cancer is the most commonly diagnosed noncutaneous malignancy in men, yet 100 years ago it was considered a rare disease. Over the past century, radiation therapy has evolved from a radium source placed in the urethra to today's advanced proton therapy delivered by only a few specialized centers. As techniques in radiation have evolved, the treatment of localized prostate cancer has become one of the most debated topics in oncology. Today, patients with prostate cancer must often make a difficult decision between multiple treatment modalities, each with the risk of permanent sequelae, without robust randomized data to compare every treatment option. Meanwhile, opinions of urologists and radiation oncologists about the risks and benefits involved with each modality vary widely. Further complicating the issue is rapidly advancing technology which often outpaces clinical data. This article represents a complete description of the evolution of prostate cancer radiation therapy with the goal of illuminating the historical basis for current challenges facing oncologists and their patients.
    Clinical Genitourinary Cancer 10/2013; · 1.69 Impact Factor
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    ABSTRACT: To examine late gastrointestinal (GI) and genitourinary (GU) toxicity profiles of patients treated for prostate cancer either definitively or post-prostatectomy with both intensity modulated radiation therapy (IMRT) and image guided radiation therapy (IGRT). A total of 333 patients treated definitively and 104 patients treated postoperatively with IMRT and varying IGRT techniques were retrospectively examined to evaluate GI and GU toxicity profiles >1 year from treatment. Available dosimetric data were used for correlative analysis. The median follow-up time for the definitive patients was 41 months and the median follow-up time for the post-prostatectomy patients was 33 months. No late grade 4 or 5 GI or GU toxicities were observed. For definitive patients, the rates of grade ≥2 GI and GU toxicity at 3 years were 4.9% and 4.5%, respectively. In the postoperative cohort the rate of grade >2 GU toxicity was 11.6%, with no grade ≥2 GI toxicity. In the definitive cohort's Cox proportional hazards regression univariate analysis, use of anticoagulation was significantly associated with GI toxicity and age, bladder V50 and IGRT modality were associated with GU toxicity, and only age remained significant in the multivariate model. In univariate analysis for the postoperative cohort, no dosimetric value correlated with GU toxicity, nor did age or time from radical prostatectomy to radiation. IMRT with IGRT achieved low rates of GI and GU toxicity in the definitive and postoperative setting.
    Practical radiation oncology. 10/2013; 3(4):323-8.
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    ABSTRACT: Men with high-risk prostate cancer have other competing causes of mortality; however, current risk stratification schema do not account for comorbidities. We aim to identify the causes of death and factors predictive for mortality in this population. A total of 660 patients with high-risk prostate cancer were treated with definitive high-dose external beam radiation therapy (≥74 Gy) and androgen deprivation (AD) between 1996 and 2009 at a single institution. Cox proportional hazards regression analysis was conducted to determine factors predictive of survival. The median radiation dose was 78 Gy, median duration of AD was 6 months, and median follow-up was 74 months. The 10-year overall survival (OS) was 60.6%. Prostate cancer was the leading single cause of death, with 10-year mortality of 14.1% (95% CI 10.7-17.6), compared with other cancers (8.4%, 95% CI 5.7-11.1), cardiovascular disease (7.3%, 95% CI 4.7-9.9), and all other causes (10.4%, 95% CI 7.2-13.6). On multivariate analysis, older age (HR 1.55, P=.002) and Charlson comorbidity index score (CS) ≥1 (HR 2.20, P<.0001) were significant factors predictive of OS, whereas Gleason score, T stage, prostate-specific antigen, duration of AD, radiation dose, smoking history, and body mass index were not. Men younger than 70 years of age with CS = 0 were more likely to die of prostate cancer than any other cause, whereas older men or those with CS ≥1 more commonly suffered non-prostate cancer death. The cumulative incidences of prostate cancer-specific mortality were similar regardless of age or comorbidities (P=.60). Men with high-risk prostate cancer are more likely to die of causes other than prostate cancer, except for the subgroup of men younger than 70 years of age without comorbidities. Only older age and presence of comorbidities significantly predicted for OS, whereas prostate cancer- and treatment-related factors did not.
    International journal of radiation oncology, biology, physics 09/2013; 87(1):94-9. · 4.59 Impact Factor
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    ABSTRACT: To determine the dosimetric impact of daily imaging alignment focus on the prostate soft tissue versus the pelvic bones for the concurrent treatment of the prostate and pelvic lymph nodes (PLN) and to assess whether multileaf collimator (MLC) tracking or adaptive planning (ART) is necessary with the current clinical planning margins of 8 mm/6 mm posterior to the prostate and 5 mm to the PLN. A total of 124 kilovoltage cone-beam computed tomography (kV-CBCT) images from 6 patients were studied. For each KV-CBCT, 4 plans were retrospectively created using an isocenter shifting method with 2 different alignment focuses (prostate, PLN), an MLC shifting method, and the ART method. The selected dosimetric endpoints were compared among these plans. For the isoshift contour, isoshift bone, MLC shift, and ART plans, D99 of the prostate was ≥97% of the prescription dose in 97.6%, 73.4%, 98.4%, and 96.8% of 124 fractions, respectively. Accordingly, D99 of the PLN was ≥97% of the prescription dose in 98.4%, 98.4%, 98.4%, and 100% of 124 fractions, respectively. For the rectum, D5 exceeded 105% of the planned D5 (and D5 of ART plans) in 11% (4%), 10% (2%), and 13% (5%) of 124 fractions, respectively. For the bladder, D5 exceeded 105% of the planned D5 (and D5 of ART) plans in 0% (2%), 0% (2%), and 0% (1%) of 124 fractions, respectively. For concurrent treatment of the prostate and PLN, with a planning margin to the prostate of 8 mm/6 mm posterior and a planning margin of 5 mm to the PLN, aligning to the prostate soft tissue can achieve adequate dose coverage to the both target volumes; aligning to the pelvic bone would result in underdosing to the prostate in one-third of fractions. With these planning margins, MLC tracking and ART methods have no dosimetric advantages.
    International journal of radiation oncology, biology, physics 07/2013; · 4.59 Impact Factor
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    ABSTRACT: Multidisciplinary approach to muscle-invasive bladder cancer is imperative to achieve optimal long-term cancer control. Radical cystectomy, pelvic lymph node dissection, and urinary diversion have been the mainstay of therapy for decades. Laparoscopic and robotic-assisted surgical techniques are becoming increasingly prevalent, and have shown short-term benefits in terms of blood loss, less pain, and smaller incisions. Neoadjuvant chemotherapy plus surgery results in absolute survival advantage and this approach is encouraged in appropriate patients. A similar survival advantage with the use of adjuvant chemotherapy has yet to be convincingly demonstrated. Bladder-preservation protocols involving a visibly complete transurethral resection followed by chemoradiation may be a feasible option for select patients.
    Surgical Oncology Clinics of North America 04/2013; 22(2):357-73. · 1.67 Impact Factor
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    ABSTRACT: With implanted markers, daily prostate displacements can be automatically detected with six degrees of freedom. The reported magnitudes of the rotations, however, are often greater than the typical range of a six-degree treatment couch. The purpose of this study is to quantify geometric and dosimetric effects if the prostate rotations are not corrected (ROT_NC) and if they can be compensated with translational shifts (ROT_C). Forty-three kilovoltage cone-beam CTs (KV-CBCT) with implanted markers from five patients were available for this retrospective study. On each KV-CBCT, the prostate, bladder, and rectum were manually contoured by a physician. The prostate contours from the planning CT and CBCT were aligned manually to achieve the best overlaps. This contour registration served as the benchmark method for comparison with two marker registration methods: (a) using six degrees of freedom, but rotations were not corrected (ROT_NC); and (b) using three degrees of freedom while compensating rotations into the translational shifts (ROT_C). The center of mass distance (CMD) and overlap index (OI) were used to evaluate these two methods. The dosimetric effects were also analyzed by comparing the dose coverage of the prostate clinical target volume (CTV) in relation to the planning margins. According to our analysis, the detected rotations dominated in the left-right axis with systematic and random components of 4.6° and 4.1°, respectively. When the rotation angles were greater than 10°, the differences in CMD between the two registrations were greater than 5 mm in 85.7% of these fractions; when the rotation angles were greater than 6°, the differences of CMD were greater than 4 mm in 61.1% of these fractions. With 6 mm/4 mm posterior planning margins, the average difference between the dose to 99% (D99) of the prostate in CBCTs and the planning D99 of the prostate was -8.0 ± 12.3% for the ROT_NC registration, and -3.6 ± 9.0% for the ROT_C registration (p = 0.01). When the planning margin decreased to 4 mm/2 mm posterior, the average difference in D99 of the prostate was -22.0 ± 16.2% and -15.1 ± 15.2% for the ROT_NC and ROT_C methods, respectively (p < 0.05). In conclusion, prostate rotation cannot be simply dismissed, and the impact of the rotational errors depends on the distance between the isocenter and the centroid of implanted markers and the rotation angle.
    Journal of Applied Clinical Medical Physics 01/2013; 14(3):4262. · 1.11 Impact Factor
  • S Ferjani, K Stephans, R Tendulkar, P Xia
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    ABSTRACT: Purpose: To validate prostate planning margins for concurrent treatment of the prostate and pelvic lymph nodes (PLN) under daily kilo‐voltage cone beam (KV‐CBCT) imaging guidance while applying MLC and iso‐center shifting methods to compensate for inter‐fractional prostate motion. Methods and Materials: Ninety‐four daily KV‐CBCTs from five patients, who received IMRT treatment with a clinical planning margin to the prostate of 8mm/6mm posterior (M(8,6)) and 5mm to the PLN, were selected. Three additional IMRT plans were created for each patient with the prostate planning margins of 6mm/4mm posterior (M(6,4)), 4mm/2mm posterior (M(4,2)) and 2mm uniform margin (M(2,2)). The PLN planning margin remained 5mm. Subsequently, each plan was applied to the daily KV‐CBCT using MLC and iso‐center shifting methods. Daily D95 of the prostate and D95 of the PLN, and D5 of the rectum and D5 of the bladder were evaluated for adequate planning margins. Results: For both the MLC and iso‐center shifting methods, D95 of the prostate was greater than or equal 97% of the prescription dose in 97.8% (100%), 98.9% (97.9%), 95.8% (97.9%), and 93.7%(96.8%) of 94 fractions, for M(8,6), M(6,4), M(4,2), and M(2,2) respectively. Accordingly, D95 of the PLN was greater than or equal 97% of the prescription dose in 98.9%(100%), 100%(98.9%), 98.9%(98.9%), and 100%(98.9%), for M(8,6), M(6,4), M(4,2), and M(2,2) respectively. For the rectum, D5 exceeded 105% of the original IMRT D5 for the MLC‐shift (and iso‐center shift) plans in 16%(14.9%), 14.9%(16.4%), 5.4%(12.2%) and 4.3%(12.2%) for these four planning margins respectively. For the bladder, D5 exceeded 105% of the original IMRT D5 for the MLC‐shift (and iso‐center shift) plans in 0%(1.1%), 6.4% 3.2%), 13.9%(4.3%), and 8.6%(4.3%), respectively. Conclusion: With 5 mm planning margin to the PLN, both MLC and iso‐center shifting methods can reduce the prostate planning margin to 4mm/2mm posterior while achieving adequate targets coverage. This research was supported by the United States Army Medical Research and Materiel Command (USAMRMC) (Grant No. W81XWH‐080‐0358)
    Medical Physics 01/2013; 40(6):355. · 3.01 Impact Factor
  • International journal of radiation oncology, biology, physics 11/2012; 84(3):S16–S17. · 4.59 Impact Factor
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    ABSTRACT: What's known on the subject? and What does the study add? Little has been published related to transponders per se, but a number of studies relating to prostate biopsy-related infections and the increased incidence of quinolone-resistant Escherichia coli have been published. The study alerts the practising urologist to the risk of quinolone-resistant E. coli in the setting of transrectally placed transponders. Furthermore, it proposes an antibiotic regimen that should reduce this risk. To report our series of early infectious complications after placement of Calypso(®) transponders (Calypso Medical, Seattle, WA, USA) into the prostate. Between February 2008 and October 2010, 50 consecutive patients underwent placement of Calypso(®) transponders into the prostate. Patients were administered ciprofloxacin 500 mg every 12 h, starting the night before the procedure and for 2 days after the procedure. Data were collected via chart review, and complications were classified according to the Clavien classification system. Of the 50 patients undergoing the procedure, five (10%) developed infectious complications, and three (6%) developed a grade II complication with a UTI requiring antibiotic therapy. One patient (2%) developed a grade IIIb complication with an epidural abscess and osteomyelitis of the lumbar vertebrae requiring open debridement and a lumbar fusion. One patient (2%) developed a prostatic abscess with methicillin-resistant Staphylococcus aureus and subsequently died of an unrelated lower GI bleed. In 4/50 patients (8%), a culture confirmed the responsible bacteria, of which three cases were quinolone-resistant Escherichia coli. As with prostate biopsy, the emergence of quinolone-resistant E. coli remains a challenging infectious complication with transrectal prostate procedures. We propose an alternative strategy of double antibiotic coverage with one dose of oral ciprofloxacin 500 mg and gentamicin 80 mg i.m. before this procedure.
    BJU International 09/2012; 110(6):834-9. · 3.13 Impact Factor
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    ABSTRACT: PURPOSE: Correction for intrafraction prostate motion becomes important for hypofraction treatment of prostate cancer. The purpose of this study was to estimate an ideal planning margin to account for intrafraction prostate motion as a function of imaging and repositioning frequency in the absence of continuous prostate motion monitoring. METHODS AND MATERIALS: For 31 patients receiving intensity modulated radiation therapy treatment, prostate positions sampled at 10 Hz during treatment using the Calypso system were analyzed. Using these data, we simulated multiple, less frequent imaging protocols, including intervals of every 10, 15, 20, 30, 45, 60, 90, 120, 180, and 240 seconds. For each imaging protocol, the prostate displacement at the imaging time was corrected by subtracting prostate shifts from the subsequent displacements in that fraction. Furthermore, we conducted a principal component analysis to quantify the direction of prostate motion. RESULTS: Averaging histograms of every 240 and 60 seconds for all patients, vector displacements of the prostate were, respectively, within 3 and 2 mm for 95% of the treatment time. A vector margin of 1 mm achieved 91.2% coverage of the prostate with 30 second imaging. The principal component analysis for all fractions showed the largest variance in prostate position in the midsagittal plane at 54° from the anterior direction, indicating that anterosuperior to inferoposterior is the direction of greatest motion. The smallest prostate motion is in the left-right direction. CONCLUSIONS: The magnitudes of intrafraction prostate motion along the superior-inferior and anterior-posterior directions are comparable, and the smallest motion is in the left-right direction. In the absence of continuous prostate motion monitoring, and under ideal circumstances, 1-, 2-, and 3-mm vector planning margins require a respective imaging frequency of every 15, 60, and 240 to account for intrafraction prostate motion while achieving adequate geometric target coverage for 95% of the time.
    International journal of radiation oncology, biology, physics 07/2012; · 4.59 Impact Factor
  • A Magnelli, R Tendulkar, R Macklis, P Xia
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    ABSTRACT: Purpose: The purpose of this work is to evaluate the accuracy of a three-dimensional surface based optical imaging device for treatment setup of breast patients. A commercial system has been used to acquire live surface contour data, which are registered with a reference surface contour for setup corrections. This work is to investigate the accuracy of this system when compared with conventional portal images. Methods: The system was clinically applied to twenty breast cancer patients receiving radiotherapy treatment. For each patient, conventional portal imaging before the first fraction was acquired and approved by clinicians. After approval of portal images, a reference surface contour was acquired. This reference contour was subsequently used to guide daily patient setup followed by weekly portal images. A total of 89 sets of portal images were acquired for these patients. On days when portal images were taken, optical images were used to guide for initial patient setup, then portal images were taken and evaluated in order to make direct comparison between the optical imaging system and the conventional portal images. Results: Among 89 sets of portal images taken after optical imaging guidance, 11 (12%) sets of portal images required further adjustments in order to achieve clinically acceptable criteria. The average vector adjustments for these 11 fractions were 0.65 cm ± 0.30 cm. Average vector shifts made according to the optical imaging for all fractions of 20 patients was 0.66 ± 0.33 cm. Conclusions: Our data show that the commercial optical system can improve the accuracy of treatment setup for breast patients without additional radiation exposure. The observed discrepancy between the portal images and optimal images requires further investigation. The optical imaging guidance can be routinely used between normally scheduled portal imaging.
    Medical Physics 06/2012; 39(6):3670. · 3.01 Impact Factor
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    ABSTRACT: Postmastectomy radiation therapy (PMRT) remains controversial for patients with 1-3 positive lymph nodes (LN+). We conducted a retrospective review of all 369 breast cancer patients with 1-3 LN+ who underwent mastectomy without neoadjuvant systemic therapy between 2000 and 2007 at Cleveland Clinic. We identified 271 patients with 1-3 LN+ who did not receive PMRT and 98 who did receive PMRT. The median follow-up time was 5.2 years, and the median number of LN dissected was 11. Of those not treated with PMRT, 79% received adjuvant chemotherapy (of whom 70% received a taxane), 79% received hormonal therapy, and 5% had no systemic therapy. Of the Her2/neu amplified tumors, 42% received trastuzumab. The 5-year rate of locoregional recurrence (LRR) was 8.9% without PMRT vs 0% with PMRT (P=.004). For patients who did not receive PMRT, univariate analysis showed 6 risk factors significantly (P<.05) correlated with LRR: estrogen receptor/progesterone receptor negative (hazard ratio [HR] 2.6), lymphovascular invasion (HR 2.4), 2-3 LN+ (HR 2.6), nodal ratio >25% (HR 2.7), extracapsular extension (ECE) (HR 3.7), and Bloom-Richardson grade III (HR 3.1). The 5-year LRR rate was 3.4% (95% confidence interval [CI], 0.1%-6.8%] for patients with 0-1 risk factor vs 14.6% [95% CI, 8.4%-20.9%] for patients with ≥2 risk factors (P=.0006), respectively. On multivariate analysis, ECE (HR 4.3, P=.0006) and grade III (HR 3.6, P=.004) remained significant risk factors for LRR. The 5-year LRR was 4.1% in patients with neither grade III nor ECE, 8.1% with either grade III or ECE, and 50.4% in patients with both grade III and ECE (P<.0001); the corresponding 5-year distant metastasis-free survival rates were 91.8%, 85.4%, and 59.1% (P=.0004), respectively. PMRT offers excellent control for patients with 1-3 LN+, with no locoregional failures to date. Patients with 1-3 LN+ who have grade III disease and/or ECE should be strongly considered for PMRT.
    International journal of radiation oncology, biology, physics 05/2012; 83(5):e577-81. · 4.59 Impact Factor
  • Sana Rehman, Chandana A Reddy, Rahul D Tendulkar
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    ABSTRACT: To report contemporary outcomes for inflammatory breast cancer (IBC) patients treated in the modern era of trastuzumab and taxane-based chemotherapy. We retrospectively reviewed the charts of 104 patients with nonmetastatic IBC treated between January 2000 and December 2009. Patients who received chemotherapy, surgery, and radiation therapy were considered to have completed the intended therapy. Kaplan-Meier curves estimated locoregional control (LRC), distant metastases-free survival (DMFS), and overall survival. The median follow-up time was 34 months; 57 (55%) patients were estrogen receptor progesterone receptor (ER/PR) negative, 34 (33%) patients were human epidermal growth factor receptor 2 (her2)/neu amplified, and 78 (75%) received definitive postoperative radiation. Seventy-five (72%) patients completed all of the intended therapy, of whom 67 (89%) received a taxane and 18/28 (64%) of her2/neu-amplified patients received trastuzumab. For the entire cohort, the 5-year rates of overall survival, LRC, and DMFS were 46%, 83%, and 44%, respectively. The ER/PR-negative patients had a 5-year DMFS of 39% vs. 52% for ER/PR-positive patients (p = 0.03). The 5-year DMFS for patients who achieved a pathologic complete response compared with those who did not was 83% vs. 44% (p < 0.01). Those patients who received >60.4 Gy (n = 15) to the chest wall had a 5-year LRC rate of 100% vs. 83% for those who received 45 to 60.4 Gy (n = 49; p = 0.048). On univariate analysis, significant predictors of DMFS included achieving a complete response to neoadjuvant chemotherapy (hazard ratio [HR] = 5.8; 95% confidence interval [CI] = 1.4-24.4; p = 0.02) and pathologically negative lymph nodes (HR = 4.1; 95% CI = 1.4-11.9; p < 0.01), but no factor was significant on multivariate analysis. For IBC patients, the rate of distant metastases is still high despite excellent local control, particularly for patients who received >60.4 Gy to the chest wall. Despite the use of taxanes and trastuzumab, outcomes remain modest, particularly for those with ER/PR-negative disease and those without a pathologic complete response.
    International journal of radiation oncology, biology, physics 03/2012; 84(3):619-24. · 4.59 Impact Factor
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    ABSTRACT: Radiation therapy has been shown to increase complication rates of tissue expander/implant breast reconstructions. The purpose of this study was to evaluate patient characteristics to assess their impact on complications. A retrospective review of patients who underwent mastectomy plus tissue expander/implant reconstruction from January 2000 to December 2006 was performed. The main outcome of interest was the development of postoperative complications. Analyses were performed to detect risk factors for complications. A total of 560 patients were included in the study. A total of 385 patients underwent unilateral and 174 underwent bilateral tissue expander/implant reconstructions, for a total of 733 reconstructions. A total complication rate of 31.8% and a major complication rate of 24.4% were calculated. The risk factors associated with a significantly increased incidence of complications were age greater than 50 years, body mass index (BMI) greater than 30, and radiation. Women younger than 50 years had a complication rate of 28.4%, whereas women older than 50 years had a complication rate of 37.0%. Women with a BMI less than 30 had a complication rate of 27.5%, whereas women with a BMI greater than 30 had a complication rate of 49%. The major complication rate in nonradiated and radiated patients was 21.2% and 45.4%, respectively. Despite higher complication rates, tissue expander/implant reconstructions were successful in 70.1% of radiated patients. Based on this study, the ideal radiated patient would have a BMI less than 30 and be younger than 50 years of age to maximize the likelihood of a successful tissue expander/implant reconstruction.
    The Breast Journal 11/2011; 18(1):28-34. · 1.43 Impact Factor
  • S. Rehman, C. A. Reddy, M. E. Shukla, R. D. Tendulkar
    Fuel and Energy Abstracts 10/2011; 81(2).
  • M. E. Shukla, C. A. Reddy, R. D. Tendulkar
    Fuel and Energy Abstracts 10/2011; 81(2).
  • Fuel and Energy Abstracts 10/2011; 81(2).

Publication Stats

183 Citations
115.64 Total Impact Points


  • 2008–2014
    • Cleveland Clinic
      • Department of Radiation Oncology
      Cleveland, Ohio, United States
  • 2007
    • University of Minnesota Twin Cities
      • Department of Neurosurgery
      Minneapolis, MN, United States