Aaron Wolfson

University of Illinois at Chicago, Chicago, Illinois, United States

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Publications (19)43.38 Total impact

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    ABSTRACT: Purpose/Objective(s):The optimal choice of adjuvant therapy (AT) for patients (pts) with stages I, II, and III endometrial cancers (EC) at risk for death remains uncertain concerning the use of chemotherapy (CT), radiation therapy (RT) [external beam RT (EBRT) and/or vaginal brachytherapy (VBT)] or chemoradiotherapy (CRT). This study focused on the impact of these types of AT on overall survival (OS) of this patient population.Materials/Methods:This retrospective review of the tumor registry at a single medical center focused on pts with stages I, II, and III EC receiving AT from 1/1/2000 until 12/31/2010. Pts with stages I/II/III uterine papillary serous carcinoma (UPSC), clear cell carcinoma (CCC) or carcinosarcoma (CS) of the uterus, those with stages II/III adenocarcinoma (AC) cases [except T2a & T3a by peritoneal cytology] and pts in stage I AC with > 2 factors (age > 60, grade 3 tumor, or outer half myometrial invasion) were evaluated. Nodal sampling occurred in 165 (93.8%) pts. OS was estimated by Kaplan-Meier method from date of diagnosis until date of death or last contact. Median followup for all pts was 46 months (range: 7-127 months). Univariate analysis (UVA) and multivariate analysis (MVA) tested prognostic factors with p < 0.05 considered significant.Results: The table depicts the characteristics of 176 study pts: 26.7% received CT, 31.8% RT and 41.5% CRT. Of non-AC tumors, there were 35 UPSC, 8 CCC & 6 CS. EBRT was more commonly given in the RT than CRT group, while VBT was given more often in combination with CT than as sole AT (p<0.001). RT only was most commonly used for stages I/II tumors; while CRT was most often given in stage III [p<0.001]. RT alone was given most often for AC lesions, while CRT was used most often for non-AC tumors [p=0.019]. 5-year OS among various AT groups was: CT- 52.4% (95% confidence interval [CI]: 27.1%, 72.1%), RT- 81% (95% CI: 66.4%, 89.8%), CRT- 82.6% (95% CI: 70.6%, 90%), EBRT (+/- CT) - 75.6% (95% CI: 58.3%, 86.5%), and VBT (+/- CT) - 84.7% (95% CI: 73.6%, 91.5%). Following UVA and MVA, only age [p=0.017], EBRT (+/-CT) for stages I/II [p=0.015] and VBT (+/- CT) for stages I/II [p=0.001] maintained prognostic significance.Conclusions:This study found that survival is problematic for patients with stage I, II, and III EC selected to undergo AT. There is a suggestion that RT, including VBT, +/- CT in stages I/II disease may be beneficial. The results of ongoing cooperative group phase III trials are eagerly awaited to determine optimal AT for this patient population.All Patients N %CT N %RT N %CRT N %P-valueTotal176-4726.75631.87341.5RT type - VBT8950.6--2629.26370.8<.0001RT type - EBRT4022.7--3075.01025.0Age ≤ 60 years6738.11725.41725.43349.30.228Age >60 years10961.93027.53935.84036.7Stage I/II9755.11515.54546.43738.1<.0001Stage III7944.93240.51113.93645.6Histology - AC12772.23527.64737.04535.40.019Histology - Non-AC4927.81224.5918.42857.1
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting; 12/2013
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    ABSTRACT: Purpose: To assess the impact of prophylactic cranial irradiation (PCI) on self-reported cognitive functioning (SRCF), a functional scale on the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30). Methods and materials: Radiation Therapy Oncology Group (RTOG) protocol 0214 randomized patients with locally advanced non-small cell lung cancer to PCI or observation; RTOG 0212 randomized patients with limited-disease small cell lung cancer to high- or standard-dose PCI. In both trials, Hopkins Verbal Learning Test (HVLT)-Recall and -Delayed Recall and SRCF were assessed at baseline (after locoregional therapy but before PCI or observation) and at 6 and 12 months. Patients developing brain relapse before follow-up evaluation were excluded. Decline was defined using the reliable change index method and correlated with receipt of PCI versus observation using logistic regression modeling. Fisher's exact test correlated decline in SRCF with HVLT decline. Results: Of the eligible patients pooled from RTOG 0212 and RTOG 0214, 410 (93%) receiving PCI and 173 (96%) undergoing observation completed baseline HVLT or EORTC QLQ-C30 testing and were included in this analysis. Prophylactic cranial irradiation was associated with a higher risk of decline in SRCF at 6 months (odds ratio 3.60, 95% confidence interval 2.34-6.37, P<.0001) and 12 months (odds ratio 3.44, 95% confidence interval 1.84-6.44, P<.0001). Decline on HVLT-Recall at 6 and 12 months was also associated with PCI (P=.002 and P=.002, respectively) but was not closely correlated with decline in SRCF at the same time points (P=.05 and P=.86, respectively). Conclusions: In lung cancer patients who do not develop brain relapse, PCI is associated with decline in HVLT-tested and self-reported cognitive functioning. Decline in HVLT and decline in SRCF are not closely correlated, suggesting that they may represent distinct elements of the cognitive spectrum.
    International journal of radiation oncology, biology, physics 04/2013; 86(4). DOI:10.1016/j.ijrobp.2013.02.033 · 4.26 Impact Factor
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    ABSTRACT: Purpose: Peritumoral edema may harbor sarcoma cells. The extent of suspicious edema (SE) included in the treatment volume is subject to clinical judgment, balancing the risk of missing tumor cells with excess toxicity. Our goal was to determine variability in SE delineation by sarcoma radiation oncologists (RO). Methods and materials: Twelve expert ROs were provided with T1 gadolinium and T2-weighted MR images of 10 patients with high-grade extremity soft-tissue sarcoma. Gross tumor volume, clinical target volume (CTV)3cm (3 cm longitudinal and 1.5 cm radial margin), and CTV2cm (2 cm longitudinal and 1 cm radial margin) were contoured by a single observer. Suspicious peritumoral edema, defined as abnormal signal on T2 images, was independently delineated by all 12 ROs. Contouring agreement was analyzed using the simultaneous truth and performance level estimation (STAPLE) algorithm and kappa statistics. Results: The mean volumes of GTV, CTV2cm, and CTV3cm were, respectively, 130 cm(3) (7-413 cm(3)), 280 cm(3) and 360 cm(3). The mean consensus volume computed using the STAPLE algorithm at 95% confidence interval was 188 cm(3) (24-565 cm(3)) with a substantial overall agreement corrected for chance (mean kappa = 0.71; range: 0.32-0.87). The minimum, maximum, and mean volume of SE (excluding the GTV) were 4, 182, and 58 cm(3) (representing a median of 29% of the GTV volume). The median volume of SE not included in the CTV2cm and in the CTV3cm was 5 and 0.3 cm(3), respectively. There were 3 large tumors with >30 cm(3) of SE not included in the CTV3cm volume. Conclusion: Despite the fact that SE would empirically seem to be a more subjective volume, a substantial or near-perfect interobserver agreement was observed in SE delineation in most cases with high-grade soft-tissue sarcomas of the extremity. A median of 97% of the consensus SE is within the CTV2cm (99.8% within the CTV3cm). In a minority of cases, however, significant expansion of the CTVs is required to cover SE.
    International journal of radiation oncology, biology, physics 03/2013; 86(2). DOI:10.1016/j.ijrobp.2013.01.032 · 4.26 Impact Factor
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    ABSTRACT: Background: The objective of this study was to identify predictors of locoregional recurrence (LRR) after neoadjuvant therapy (NAT) and postmastectomy radiation (PMRT) in a cohort of patients with stage II through III breast cancer and to determine whether omission of the supraclavicular field had an impact on the risk of LRR. Methods: The authors reviewed records from 464 patients who received NAT and PMRT from January 1999 to December 2009. Results: The median patient age was 50 years (range, 25-81 years). Clinical disease stage was stage II in 29% of patients, stage III in 71%, and inflammatory in 14%. Receptor status was estrogen receptor (ER)-positive in 54% of patients, progesterone receptor (PR)-positive in 39%, human epidermal growth factor receptor 2 (HER2)-positive in 24%, and negative for all 3 receptors (triple negative) in 32%. All patients received NAT and underwent mastectomy, and 19.6% had a complete pathologic response in the breast and axilla, 17.5% received radiation to the chest wall only, and 82.5% received radiation to the chest wall and the supraclavicular field; omission of the supraclavicular field was more common in patients with lower clinical and pathologic lymph node status. The median follow-up was 50.5 months, and the 5-year cumulative incidence of LRR was 6% (95% confidence interval, 3.9%-8.6%). Predictors of LRR were clinical stage III (P = .038), higher clinical lymph node status (P = .025), higher pathologic lymph node status (P = .003), the combination of clinically and pathologically positive lymph nodes (P < .001), inflammatory presentation (P = .037), negative ER status (P = .006), negative PR status (P = .015), triple-negative status (P < .001), and pathologic tumor size >2 cm (P = .045). On univariate analysis, omission of the supraclavicular field was not associated significantly with LRR (hazard ratio, 0.89; P = .833); however, on multivariate analyses, omission of the supraclavicular field was associated significantly with LRR (hazard ratio, 3.39; P = .024). Conclusions: Presenting stage, receptor status, pathologic response to neoadjuvant therapy, and omission the supraclavicular field were identified as risk factors for LRR after neoadjuvant therapy and PMRT.
    Cancer 01/2013; 119(1). DOI:10.1002/cncr.27717 · 4.89 Impact Factor
  • Jean Wright · Aaron Wolfson
    Current problems in cancer 04/2012; 36(3):106-16. DOI:10.1016/j.currproblcancer.2012.03.002 · 0.53 Impact Factor
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    ABSTRACT: To develop a guideline for quality practice of low-dose-rate (LDR) and pulsed-dose-rate (PDR) brachytherapy for locally advanced cervical cancer. Members of the American Brachytherapy Society (ABS) with expertise in cervical cancer brachytherapy formulated updated guidelines for LDR and PDR brachytherapy for locally advanced (International Federation of Gynecology and Obstetrics [FIGO] Stages IB2-IVA) cervical cancer based on literature review and clinical experience. The ABS strongly recommends the use of brachytherapy as a component of the definitive treatment of locally advanced cervical carcinoma. Precise applicator placement is necessary to maximize the probability of achieving local control without major side effects. The ABS recommends a cumulative delivered dose of approximately 80-90Gy for definitive treatment. Dosimetry must be performed after each insertion before treatment delivery. The dose delivered to point A should be reported for all intracavitary brachytherapy applications regardless of treatment planning technique. The ABS also recommends adoption of the Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology guidelines for contouring, image-based treatment planning and dose reporting. Interstitial brachytherapy may be considered for a small proportion of patients whose disease cannot be adequately encompassed by intracavitary application and should be performed by practitioners with special expertise in these procedures. Quality management measures must be performed, and follow-up information should also be obtained. Updated ABS guidelines are provided for LDR and PDR brachytherapy for locally advanced cervical cancer. Practitioners and cooperative groups are encouraged to use these guidelines to formulate their clinical practices and to adopt dose-reporting policies that are critical for outcome analysis.
    Brachytherapy 01/2012; 11(1):53-7. DOI:10.1016/j.brachy.2011.07.001 · 2.76 Impact Factor
  • Fuel and Energy Abstracts 10/2011; 81(2). DOI:10.1016/j.ijrobp.2011.06.921
  • International Journal of Radiation OncologyBiologyPhysics 10/2011; 81(2):S50. DOI:10.1016/j.ijrobp.2011.06.100 · 4.26 Impact Factor
  • Omar Mahmoud · Aaron Wolfson
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    ABSTRACT: Adjuvant radiotherapy constitutes an important component of the treatment of soft tissue sarcomas. Extremity soft tissue sarcomas constitute a large proportion of this rare mesenchymal tumor. Questions regarding timing, techniques and toxicity come into play about optimizing adjuvant radiotherapy. This article will discuss recent trends and outcomes of perioperative, that is, preoperative and postoperative, irradiation.
    Expert Review of Anti-infective Therapy 08/2011; 11(8):1233-41. DOI:10.1586/era.11.95 · 2.25 Impact Factor
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    ABSTRACT: Accurate target definition is vitally important for definitive treatment of cervix cancer with intensity-modulated radiotherapy (IMRT), yet a definition of clinical target volume (CTV) remains variable within the literature. The aim of this study was to develop a consensus CTV definition in preparation for a Phase 2 clinical trial being planned by the Radiation Therapy Oncology Group. A guidelines consensus working group meeting was convened in June 2008 for the purposes of developing target definition guidelines for IMRT for the intact cervix. A draft document of recommendations for CTV definition was created and used to aid in contouring a clinical case. The clinical case was then analyzed for consistency and clarity of target delineation using an expectation maximization algorithm for simultaneous truth and performance level estimation (STAPLE), with kappa statistics as a measure of agreement between participants. Nineteen experts in gynecological radiation oncology generated contours on axial magnetic resonance images of the pelvis. Substantial STAPLE agreement sensitivity and specificity values were seen for gross tumor volume (GTV) delineation (0.84 and 0.96, respectively) with a kappa statistic of 0.68 (p < 0.0001). Agreement for delineation of cervix, uterus, vagina, and parametria was moderate. This report provides guidelines for CTV definition in the definitive cervix cancer setting for the purposes of IMRT, building on previously published guidelines for IMRT in the postoperative setting.
    International journal of radiation oncology, biology, physics 02/2011; 79(2):348-55. DOI:10.1016/j.ijrobp.2009.10.075 · 4.26 Impact Factor
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    ABSTRACT: We recently published the results of the PCI99 randomised trial comparing the effect of a prophylactic cranial irradiation (PCI) at 25 or 36 Gy on the incidence of brain metastases (BM) in 720 patients with limited small-cell lung cancer (SCLC). As concerns about neurotoxicity were a major issue surrounding PCI, we report here midterm and long-term repeated evaluation of neurocognitive functions and quality of life (QoL). At predetermined intervals, the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and brain module were used for self-reported patient data, whereas the EORTC-Radiation Therapy Oncology Group Late Effects Normal Tissue-Subjective, Objective, Management, Analytic scale was used for clinicians' assessment. For each scale, the unfavourable status was analysed with a logistic model including age, grade at baseline, time and PCI dose. Over the 3 years studied, there was no significant difference between the two groups in any of the 17 selected items assessing QoL and neurological and cognitive functions. We observed in both groups a mild deterioration across time of communication deficit, weakness of legs, intellectual deficit and memory (all P < 0.005). Patients should be informed of these potential adverse effects, as well as the benefit of PCI on survival and BM. PCI with a total dose of 25 Gy remains the standard of care in limited-stage SCLC.
    Annals of Oncology 12/2010; 22(5):1154-63. DOI:10.1093/annonc/mdq576 · 7.04 Impact Factor
  • 04/2010; 9. DOI:10.7759/cureus.10
  • Fuel and Energy Abstracts 11/2009; 75(3). DOI:10.1016/j.ijrobp.2009.07.984
  • Fuel and Energy Abstracts 11/2009; 75(3). DOI:10.1016/j.ijrobp.2009.07.942
  • Fuel and Energy Abstracts 11/2009; 75(3). DOI:10.1016/j.ijrobp.2009.07.099
  • Brachytherapy 04/2006; 5(2):99. DOI:10.1016/j.brachy.2006.03.071 · 2.76 Impact Factor
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    ABSTRACT: Purpose/Objective: Conjunctival lymphoma is commonly treated with external beam radiation therapy. Treatment could cause corneal toxicity, ranging from superficial erosions (grade 1) to opacification or perforation (grade 4). In 1994, our practice began using a corneal shield to decrease the dose to the cornea and decrease toxicity. This review reports our experience. Materials/Methods: A retrospective study was performed of eighteen (18) orbits from fifteen (15) patients treated with radiation therapy and a corneal shield at Sylvester Comprehensive Cancer Center and Bascom Palmer Eye Institute at University of Miami Hospital and Clinics between 1994-2003. All of the patients had biopsy proven conjuctival lymphoma. All patients were treated with a custom made corneal shield placed daily. The shield was constructed with a plastic eye conformer with a custom measured corneal shield (1.4-1.7 cm) centered on the pupil. The lead shield was 0.0625 in (1.6 mm) in thickness and coated with wax. The eye was anesthetized daily with topical eye drops, and the corneal shield was placed under the eyelid prior to the electron beam delivery. The treatment was megavoltage beam, and varied from 6-12 MeV electron beam alone to 6 MeV photon beam mixed with 9-18 MeV electrons. Doses were 30 Gy-45 Gy at 1.8-2.0 Gy/fx. All patients completed therapy without any extended break. Results: The stages of lymphoma were IAE (12/15), IIAE (1/15), and IV (2/15). Only two (2/15) patients presented with extra-orbital disease. The histologic subtypes included B cell lymphomas: extranodal marginal zone of mucous associated lymphoid tissue (11), follicular small cleaved B cell (4), mantle cell (1), and non-hodgkins lymphoma otherwise unspecified (3). The patients were followed in regular intervals by an ophthalmologist and a radiation oncologist for 3-101 months (median 60 months, mean 53 months). The 5-year Kaplan Meier estimates for overall survival (OS) is 100% and disease-free survival (DFS) is 80%. Local control is 100%. Acute corneal toxicity is 0% (grade 1-4). Late corneal toxicity is 0% (grade 1-4). Other late side effects include dry eye (5), cataractogenesis (3), and radiation vasculopathy (2), all responding to therapy, as needed. Two (2) patients recurred in the other eye, which were subsequently radiated with the same regimen. They both remain controlled in both orbits. One patient who presented with stage IV disease recurred in the axilla, with control in the orbit. After salvage chemotherapy, the patient remains NED. No patient presenting with disease localized to the orbit (IAE, IIAE) progressed to systemic disease. Conclusions: Radiation dose has been described as the most important factor in the development of both acute and late radiation keratopathy. Complications have been described at doses as low as 12 Gy, with a proven dose-response relationship. Due to the morbidity of corneal damage, any toxicity could be devastating to patients. Since there are no lymphomatous components in the cornea, this region can be excluded from the clinical target volume (CTV). Our custom made internal corneal shield decreases the dose to the cornea, thereby reducing toxicity, while still providing excellent tumor control. Prospective study is indicated.
    Radiological Society of North America 2005 Scientific Assembly and Annual Meeting; 11/2005
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    ABSTRACT: This retrospective study was done to determine whether the number of brachytherapy implants significantly influenced outcome in 86 patients with carcinoma of the cervix treated with radiation alone at the University of Miami/Jackson Memorial Hospital from August 1981 to May 1995. One brachytherapy application was performed in 36 (42%) of the study cohort, whereas 50 (58%) had two implants. Cumulative doses to points A and B ranged from 60.74 Gy to 97.58 Gy (median: 82.46 Gy) and 46.57 Gy to 73.99 Gy (median: 58.51 Gy), respectively. Five-year overall survival (OS) and disease-free survival (DFS) for study patients were 49.4% and 38.7%, respectively. Patients receiving two implants had a higher total dose to point A (p = 0.02), were less likely to complete the radiation in less than 8 weeks (p = 0.01), and showed a trend of having more advanced disease (p = 0.1) and a greater rate of chronic complications (p = 0.09). Univariate analysis failed to demonstrate a statistically significant difference in either OS or DFS concerning one versus two brachytherapy procedures in this series. However, because of the confounding interactions of cumulative dose to point A and overall treatment time in the present series, a prospectively randomized phase III trial is needed to more adequately evaluate this question.
    American Journal of Clinical Oncology 07/2002; 25(3):313-7. DOI:10.1097/00000421-200206000-00023 · 3.06 Impact Factor
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    ABSTRACT: The purpose of this study was to determine the impact of various prognostic factors on survival in spinal cord gliomas treated with radiation. Fifty-three patients with spinal cord gliomas irradiated at three major institutions were studied. Fifty-one patients were classified as having ependymoma, astrocytoma, or both. Two patients were classified as having gliomas (otherwise unspecified). Eleven patients had complete resection of their tumor. Biopsy or partial resection was done in the remaining patients. All patients received external beam radiation. Information on these patients was placed in a central database file and analyzed for the effect of several prognostic factors on survival. Overall survival of the entire group was 76.9% and 61.5% at 5 and 10 years, respectively. Pathologic status significantly affected survival (p = 0.03). Patients with ependymomas had a 5-year survival of 93.8% and a 10-year survival of 67.5%. Patients with astrocytoma had a 5-year survival of 64.2% and a 10-year survival of 54%. Univariate analysis showed pathology and the presence of cysts (p = 0.038) to significantly affect survival. Age, sex, location of the primary, extent of surgery radiation dose, and number of involved segments did not affect survival. On multivariate analysis, astrocytic pathology, involvement of more than five segments, male sex, and the absence of cysts (in or adjacent to the tumor) were associated with a significantly inferior survival. This study confirms the importance of pathology and number of segments involved in determining outcome or survival. The presence of cysts adjacent to or within the tumor was found to be associated with an improvement in survival.
    American Journal of Clinical Oncology 07/1999; 22(4):344-351. DOI:10.1016/S0360-3016(98)80396-9 · 3.06 Impact Factor

Publication Stats

179 Citations
43.38 Total Impact Points


  • 2013
    • University of Illinois at Chicago
      Chicago, Illinois, United States
  • 2002–2013
    • University of Miami Miller School of Medicine
      • Department of Radiation Oncology
      Miami, Florida, United States
  • 2009–2010
    • University of Miami
      كورال غيبلز، فلوريدا, Florida, United States
  • 1999
    • Jackson Memorial Hospital
      Miami, Florida, United States