Stephen Seagren

University of California, San Diego, San Diego, California, United States

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Publications (7)38.86 Total impact

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    ABSTRACT: PURPOSE/OBJECTIVE(S): We report our experience using hypofractionated radiotherapy in older patients. This analysis includes patients aged 60 years and older at our institution with inoperable Stage I (T1/T2 N0 M0) non--small-cell lung cancer that completed a curative course of radiotherapy alone using a hypofractionated schedule. Between 1991 and 2006, 75 such patients were identified with median age of 74 years (range, 60-86). Patient characteristics were as follows: male, 65/75 (86.7%); stage IA (T1N0), 47/75 (62.7%); stage IB (T2N0), 28/75 (37.3%). Patients received a median total dose of 6500 cGy using median daily dose fractions of 250 cGy. The following outcomes were analyzed: local failure free survival (time to local failure or death from any cause), time to distal failure as first event, and overall survival. Toxicities were evaluated using Common Terminology Criteria for Adverse Events v 3.0. The median follow-up was 19.6 months (range: 4.0-128.8 months). Median local failure free survival was 19.6 months (95% confidence interval [CI]: 14.4-28.8 months); and median overall survival was 21.2 months (95% CI: 14.9-29.3 months). Analysis of competing risks showed that at 5 years, the probability of local failure as the first detected event was 22.1% (95% CI: 12.8%-32.9%); the probability of distal failure as the first detected event was 14.5% (95% CI: 7.3%-24.0%); and the probability of death without recording a failure was 48.6% (95% CI: 36.1%-60.1%). Radiation-related toxicity of grade 3 or greater was seen in 3 patients and there were no treatment-related deaths. Hypofractionated radiotherapy is an effective, safe treatment for older patients with stage I non--small-cell lung cancer.
    American journal of clinical oncology 06/2011; 34(3):254-8. DOI:10.1097/COC.0b013e3181dea7a3 · 2.61 Impact Factor
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    ABSTRACT: Purpose: We report our single-institution experience using hypofractionated radiotherapy in a patient population 75 years and older diagnosed with stage IA or IB (T1/T2 N0) Non-Small Cell Lung Carcinoma. Materials and methods: This is a single-institution, retrospective analysis examining disease free and overall survival and toxicity after hy-pofractionated radiation therapy in a patient population 75 years and older diagnosed with stage IA or IB (T1/T2 N0) NSCLC. Between 1991 and 2005, a total of 33 such patients were identified with a median age of 79 years. Patients were treated with a median total dose of 7000 cGy using median daily dose fractions of 250 cGy. Analysis of competing risks (local failure, distal failure or death as the first event) was performed and cumulative incidence functions (CIF) were estimated. Results: The median length of follow-up was 19.8 months (range: 4.3 -103.8 months). Of the 33 pa-tients treated, 21 (63.6% of total) had no evidence of disease recurrence on follow-up imaging over the course of the study. Of the 12 patients with disease recurrence, 6 (18.2% of total) had local failure as the first event and 6 (18.2% of total) had distant metastasis as the first event. Analysis of competing risks showed that at 5 years, the probability of local failure as the first detected event was 19.5% (95%CI: 7.6%, 35.6%); the probability of distal failure as the first detected event was 21.5% (95%CI: 7.9%,39.4%); and the probability of death without recording a failure was 44.1% (95%CI: 26.1%, 60.7%). There were no treatment related deaths reported. Conclusions: Elderly patients diagnosed with stage I non-small cell lung cancer may safely be offered hypofractionated radiotherapy as an effective option with curative intent.
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    ABSTRACT: Surgical resection for stage I non-small-cell lung cancer (NSCLC) is not always feasible because of the high likelihood of medical comorbidity in this patient population. We report our experience using conventional and hypofractionated radiation therapy schedules with a conformal approach. Between 1991 and 2006, 102 patients with medically or otherwise inoperable stage T1/T2 N0 NSCLC were treated with curative radiation therapy alone at our institution. Patients received a median total dose of 6600 cGy, with median daily dose fractions of 250 cGy. The following outcomes were analyzed: local failure-free survival (LFFS; time to local failure or death from any cause), time to local or distal failure or death as first event, and overall survival (OS). Local failure was defined as an increase in size on imaging studies. Toxicities were evaluated using Common Terminology Criteria for Adverse Events, version 3.0. Median follow-up was 20.9 months (range, 4.0-138.9 months). Median LFFS was 21.2 months (95% CI, 17.3-27.2 months), and median OS was 21.3 months (95% CI, 17.9-28.8 months). Analysis of competing risks showed that at 5 years, the probability of local failure as the first detected event was 15.1% (95% CI, 8.5%-23.4%), the probability of distal failure as the first detected event was 18% (95% CI, 10.9%-26.5%), and the probability of death without recording a failure was 51.6% (95% CI, 40.6%-61.5%). No patients experienced grade >or= 4 toxicity, and only 4 patients experienced grade 3 toxicity. Conformal radiation therapy is an effective and safe alternative to surgery for selected patients with stage I NSCLC.
    Clinical Lung Cancer 11/2009; 10(6):433-7. DOI:10.3816/CLC.2009.n.081 · 3.22 Impact Factor
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    ABSTRACT: The optimal treatment for medically inoperable stage I non-small-cell lung cancer (NSCLC) has not been defined. Cancer and Leukemia Group B trial 39904 prospectively assessed accelerated, once-daily, three-dimensional radiotherapy for early-stage NSCLC. The primary objectives were to define the maximally accelerated course of conformal radiotherapy and to describe the short-term and long-term toxicity of therapy. Entry was limited to patients with clinical stage T1N0 or T2N0 NSCLC (< 4 cm) and pulmonary dysfunction. The nominal total radiotherapy dose remained at 70 Gy, while the number of daily fractions in each successive cohort was reduced. Thirty-nine eligible patients were accrued (eight patients each on cohorts 1 to 4 and seven patients on cohort 5) between January 2001 and July 2005. One grade 3 nonhematologic toxicity was observed in both cohort 3 (dyspnea) and cohort 4 (pain). The major response rate was 77%. After a median follow-up time of 53 months, the actuarial median survival time of all eligible patients was 38.5 months. Local relapse was observed in three patients. Accelerated conformal radiotherapy was well tolerated in a high-risk population with clinical stage I NSCLC. Outcomes are comparable to prospective reports of alternative therapies, including stereotactic body radiation therapy and limited resection, with less apparent severe toxicity. Further investigation of this approach is warranted.
    Journal of Clinical Oncology 11/2009; 28(2):202-6. DOI:10.1200/JCO.2009.25.0753 · 17.88 Impact Factor
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    ABSTRACT: PurposeSurgical resection remains the treatment of choice for patients with stage I non—small-cell lung cancer (NSCLC). However, there is high likelihood of medical comorbidity in this patient population, requiring management by nonsurgical approaches. We report our experience using conventional and hypofractionated radiation therapy schedules with conformal approach.Patients and Methods Between 1991 and 2006, 108 patients with medically or otherwise inoperable stage T1/T2 N0 NSCLC were treated with curative radiation therapy alone at our institution. Patient characteristics were as follows: median age, 73 years (range, 37–86 years); male, 88/108 (81.5%); stage T2, 46/108 (42.6%), and histology/cytology, 91/108 (84.3%). Patients received a median total dose of 6500 cGy using median daily dose fractions of 250 cGy. The majority of patients were treated using hypofractionated schedules: daily dose fractions > 200 cGy, 79/108 (73.1%). The following outcomes were analyzed: local failure-free survival (LFFS; time to local failure or death from any cause), time to local or distal failure as first event, and overall survival (OS). Local failure was defined as an increase in size on imaging studies. Toxicities were evaluated using Common Terminology Criteria for Adverse Events v3.0.ResultsMedian follow-up was 19.9 months (range, 4–138.9 months). Median LFFS was 20.8 months (95% CI, 15.1–24.3 months), and median OS was 20.9 months (95% CI, 17.1–27.2 months). Analysis of competing risks showed that, at 5 years, the probability of local failure as the first detected event was 17.1% (95% CI, 10.3–25.3%), the probability of distal failure as the first detected event was 17.9% (95% CI, 11–26.1%), and the probability of death without recording a failure was 50.7% (95% CI, 40.1–60.3%). Patients aged ≥ 70 years had higher probability of death without recording a failure within 5 years (55.5%; 95% CI, 41.7% −67.3%) than patients aged < 70 years (42.6%; 95% CI, 36.4%–58%) but similar probability of local failure as first detected event (age ≥ 70 years, 14.9%; 95% CI, 7.1%–25.1%; age < 70 years, 19.9%, 95% CI 8.9% −33.9%). There was no significant difference in LFFS when comparing tertiles of dose per fractionation or presence or absence of histology/cytology at diagnosis. No patients experienced grade ≥ 4 toxicity, and only 4 patients had grade 3 toxicity.Conclusion Conformal radiation therapy is an effective and safe alternative to surgery for patients with stage I NSCLC. The results are limited because this is a single-institution observational study. Nevertheless, a large majority of patients remained free of local recurrence and without significant clinical toxicity.
    Clinical Lung Cancer 09/2008; 9(5):299. DOI:10.1016/S1525-7304(11)70865-8 · 3.22 Impact Factor
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    ABSTRACT: Retrospective data suggests prolonging the time to complete thoracic radiotherapy (TRT) may negatively impact tumor control and survival in limited stage small cell lung cancer (LSCLC). We examined the association between TRT duration and outcomes on a prospective phase III study. This review included 267 patients who received protocol TRT on a phase III CALGB LSCLC study assessing the addition of tamoxifen to standard chemo-radiotherapy. TRT, to a planned dose of 50Gy in 2Gy daily fractions, was initiated with the fourth chemotherapy cycle. TRT interruptions were mandated for hematologic toxicity (granulocytes<1000/mm3 or platelets<75,000/mm3) and esophageal toxicity (dysphagia necessitating intravenous hydration). TRT interruptions > or =3 days occurred in 115 patients (43%), most frequently during the 4th week of TRT, and did not differ between treatment arms. Hematologic toxicity and esophageal toxicity were the most frequent indications for interrupting TRT. Variables including advanced age (>70 years), gender, race, or radiotherapy treatment volume did not predict for TRT interruptions. Overall survival (OS) and local tumor control did not correlate with the administration of TRT interruptions or with TRT duration. Toxicity mandated interruptions of conventional dose, once-daily, TRT may not adversely affect outcomes for patients receiving TRT concurrent with chemotherapy (cycle 4) for LSCLC. The implications for accelerated or high dose TRT regimens are not clear.
    Lung Cancer 03/2008; 62(1):92-8. DOI:10.1016/j.lungcan.2008.02.006 · 3.74 Impact Factor
  • Jeffrey A Bogart, Stephen L Seagren, Arvin Glicksman
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    ABSTRACT: Radiation oncology initiatives have been an integral component in the evolution of multidisciplinary research in the Cancer and Leukemia Group B. Although early studies in the Group primarily focused on chemotherapy for hematologic and pediatric malignancies, the Radiation Oncology Committee was established in 1972, reflecting the broadening scope of clinical investigation with an increased emphasis on solid tumor research. A major early contribution of the Radiation Oncology Committee was the recognition of the importance of formalized radiation quality review, which led to the development of the Quality Assurance Review Center. The committee has been instrumental in designing trials, in conjunction with our medical oncology and surgical oncology colleagues, to assess multimodality therapy. The results of many of these studies have had important implications for clinical practice. Recent efforts have explored our major research theme of treatment intensification via radiotherapy dose modulation and novel combinations of radiotherapy with sensitizing agents, with an emphasis on safely implementing advanced technologies in the cooperative group setting.
    Clinical Cancer Research 07/2006; 12(11 Pt 2):3628s-34s. DOI:10.1158/1078-0432.CCR-06-9011 · 8.19 Impact Factor