Thomas A Aloia

University of Texas MD Anderson Cancer Center, Houston, Texas, United States

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Publications (124)536.99 Total impact

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    ABSTRACT: Background Little is known about changes in body composition that may occur during neoadjuvant therapy for pancreatic cancer. This study was designed to characterize these changes and their potential relationships with therapeutic outcomes. Methods The study population consisted of patients with potentially resectable pancreatic cancer treated on a phase II trial of neoadjuvant chemotherapy and chemoradiation. Skeletal muscle and adipose tissue compartments were measured before and after administration of neoadjuvant therapy using SliceOMatic software (TomoVision, 2012) and protocol-mandated CT scans. Sarcopenia was defined using gender-adjusted norms. Results Among 89 eligible patients, 46 (52 %) patients met anthropometric criteria for sarcopenia prior to the initiation of neoadjuvant therapy. Further depletion of skeletal muscle, visceral adipose tissue, and subcutaneous adipose tissue occurred during neoadjuvant therapy, but these losses did not preclude the performance of potentially curative surgery. Degree of skeletal muscle loss correlated with disease-free survival while visceral adipose loss was associated with overall and progression-free survival. However, completion of all therapy, including pancreatectomy, was the only independently significant predictor of outcome in a multivariate analysis of overall survival. Discussion These data suggest that body composition analysis of standard CT images may provide clinically relevant information for patients with potentially resectable pancreatic cancer who receive neoadjuvant therapy. Anthropometric changes must be considered in the design of preoperative therapy regimens, and further efforts should focus on maintenance of muscle and visceral adipose tissue in the preoperative setting.
    Annals of Surgical Oncology 12/2014; · 3.94 Impact Factor
  • Journal of the American College of Surgeons 11/2014; · 4.45 Impact Factor
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    ABSTRACT: Advances in multidisciplinary care are changing the prognostic impact of colorectal lung metastases. Resection of colorectal liver metastases (CLM) may benefit patients with synchronous lung metastases even when lung metastases are not resected. The aim of this study was to investigate the survival of patients undergoing complete resection of CLM in the setting of unresected lung metastases.
    Annals of Surgical Oncology 11/2014; · 3.94 Impact Factor
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    ABSTRACT: RAS mutations have been reported to be a potential prognostic factor in patients with colorectal liver metastases (CLM). However, the impact of RAS mutations on response to chemotherapy remains unclear. The purpose of this study was to investigate the correlation between RAS mutations and response to preoperative chemotherapy and their impact on survival in patients undergoing curative resection of CLM.
    Annals of Surgical Oncology 09/2014; · 3.94 Impact Factor
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    ABSTRACT: Purpose To retrospectively analyze factors influencing survival in patients with non-small cell lung cancer presenting with ≤3 synchronous metastatic lesions. Methods and Materials We identified 90 patients presenting between 1998 and 2012 with non-small cell lung cancer and ≤3 metastatic lesions who had received at least 2 cycles of chemotherapy followed by surgery or radiation therapy before disease progression. The median number of chemotherapy cycles before comprehensive local therapy (CLT) (including concurrent chemoradiation as first-line therapy) was 6. Factors potentially affecting overall (OS) or progression-free survival (PFS) were evaluated with Cox proportional hazards regression. Propensity score matching was used to assess the efficacy of CLT. Results Median follow-up time was 46.6 months. Benefits in OS (27.1 vs 13.1 months) and PFS (11.3 months vs 8.0 months) were found with CLT, and the differences were statistically significant when propensity score matching was used (P ≤ .01). On adjusted analysis, CLT had a statistically significant benefit in terms of OS (hazard ratio, 0.37; 95% confidence interval, 0.20-0.70; P ≤ .01) but not PFS (P=.10). In an adjusted subgroup analysis of patients receiving CLT, favorable performance status (hazard ratio, 0.43; 95% confidence interval, 0.22-0.84; P=.01) was found to predict improved OS. Conclusions Comprehensive local therapy was associated with improved OS in an adjusted analysis and seemed to favorably influence OS and PFS when factors such as N status, number of metastatic lesions, and disease sites were controlled for with propensity score–matched analysis. Patients with favorable performance status had improved outcomes with CLT. Ultimately, prospective, randomized trials are needed to provide definitive evidence as to the optimal treatment approach for this patient population.
    International journal of radiation oncology, biology, physics 09/2014; · 4.59 Impact Factor
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    ABSTRACT: Benign or pre-cancerous lesions and foreign bodies of the stomach not amendable to endoscopic removal often require extensive surgery to address a process that does not necessitate lymph node sampling or formal gastrectomy. These lesions are particularly difficult to address endoscopically when located at the esophagogastric junction as a retroflexed view is needed. From its first description in 1995, intragastric laparoscopic surgery has evolved with respect to both technological advancements and tactical innovations. Here we report the development of four distinct techniques of laparoscopic intragastric surgery which we have developed over time and applied in 11 patients. These techniques consist of a (1) combined gastroscopic/laparoscopic approach when minimal manipulation of the lesion is needed, (2) multiport resection which provides optimal triangulation and allows for resection of more complex lesions, (3) stapled removal of broad-based lesions, and (4) single access technique with the device placed directly through the abdominal wall into the stomach. The techniques expand the surgeon's armamentarium to address more complex intragastric processes safely, while the typical postoperative benefits of minimal access surgery such as fast recovery time and less pain are preserved. As we gain greater experience with intragastric laparoscopic surgery, this technique holds the promise of becoming a standard surgical technique for benign lesions for which it is oncologically safe to perform a limited resection.
    Surgical Endoscopy 08/2014; · 3.31 Impact Factor
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    ABSTRACT: The impact of first-stage resection on volume regeneration of segments 2 and 3 (2 + 3) after right portal vein embolization (RPVE) in patients undergoing two-stage right hepatectomy has not been investigated.
    Gastroenterology 08/2014; · 13.93 Impact Factor
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    ABSTRACT: The impact of neoadjuvant therapy on postpancreatectomy complications is inadequately described.
    Gastroenterology 08/2014; · 13.93 Impact Factor
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    ABSTRACT: Background Reoperative surgery is suspected, but not proven, to increase postoperative complication rates. In the absence of a specific definition for reoperative surgery, the American College of Surgeons NSQIP has proposed using procedural coding for lysis of adhesions (LOA) as a surrogate for reoperative surgery to risk adjust hospitals. We hypothesized that coding of reoperative surgery will be associated with worse 30-day outcomes and, for abdominal procedures, will be more accurate than operative dictation and coding of “lysis of adhesions.” Study Design Reoperative surgery was categorized at the time of data abstraction from February 2012 to December 2012 for all NSQIP cases collected at a single institution by independent surgical clinical reviewers. Reoperative surgery classification and coding of LOA were compared with each other and with 30-day outcomes. The setting was a tertiary cancer center, multispecialty NSQIP model. During the study period, 1,289 operations were classified as nonreoperative (n = 793), regionally reoperative (n = 39; prior surgery in an adjacent area of current operation), or locally reoperative (n = 457; prior surgery at same site or organ). Results In the multispecialty cohort, the non−risk-adjusted rates of overall 30-day morbidity, serious morbidity, and mortality were 21.5%, 17.7%, and 0.5%. Compared with nonreoperative surgery (overall 30-day morbidity 16.8%, serious morbidity 13.9%, and mortality .38%), both regionally reoperative surgery (overall 30-day morbidity 30.8%, serious morbidity 28.2%, and mortality 2.5%) and locally reoperative surgery (overall 30-day morbidity 28.9%, serious morbidity 23.4%, and mortality .66%) were associated with worse outcomes (p < 0.001). One hundred ninety-nine of the 327 gastrointestinal/laparotomy cases were recorded as reoperative, but only of 20 of these were CPT coded as LOA (sensitivity = 10%). Conclusions Reoperative surgery is frequent, increases the risk of complications, and can be captured. Operative LOA coding vastly under reports reoperative surgery and, therefore, is not an adequate surrogate for this important risk factor.
    Journal of the American College of Surgeons 07/2014; 219(1):143–150. · 4.45 Impact Factor
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    ABSTRACT: Background A well-defined treatment strategy for elderly patients with resectable pancreatic cancer is lacking. Multiple reports have described highly selected older cancer patients who have successfully undergone pancreatectomy. However, multimodality therapy is essential for long-term survival, and elderly patients are at high risk for not receiving adjuvant therapy postoperatively. We sought to describe the treatment patterns and outcomes of a series of elderly patients with pancreatic cancer who were treated with a multimodality strategy which liberally employed neoadjuvant therapy. Study Design The treatment plan, short-term outcomes and overall survival of all patients 70+ years old presenting to our institution over a 9-year period who were treated for anatomically resectable pancreatic cancer were retrospectively reviewed. Results 179 (76%) of 236 patients with resectable pancreatic cancer were treated with curative intent. 153 (85%) of these patients initiated neoadjuvant therapy: 74 (48%) subsequently underwent pancreatectomy and 79 did not due to disease progression (n=46), insufficient performance status (n=23), or other reasons (n=10). Eleven (42%) of 26 patients who underwent surgery first received postoperative therapy. Among patients treated with curative intent, the median overall survival of all patients initiating neoadjuvant therapy (16.6 [range, 2.1–142.7] months) was similar to that of patients undergoing resection primarily (15.1 [range, 5.4–100.8] months), p = 0.53. Following pancreatectomy, patients had a 2% in-hospital mortality rate and 91% were discharged home. Conclusion 85% of all patients 70+ years old who underwent pancreatectomy for anatomically resectable pancreatic cancer received multimodality therapy. Over 90% were discharged home. These data demonstrate a potential role for neoadjuvant therapy in selecting elderly patients for surgery, and support further studies to refine individualized treatment protocols for this high-risk population.
    Journal of the American College of Surgeons 07/2014; · 4.45 Impact Factor
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    ABSTRACT: For patients with synchronous liver and lung metastases from colorectal cancer, the invasiveness of adding thoracic to abdominal surgery is an obstacle to concurrent liver and lung metastasectomy. We developed a simple technique to resect lung lesions via a transdiaphragmatic approach without thoracic incision in patients undergoing liver metastasectomy.
    Surgery 06/2014; · 3.37 Impact Factor
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    ABSTRACT: To determine the prognostic impact of tumor location in gallbladder cancer.
    Annals of Surgery 05/2014; · 7.19 Impact Factor
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    ABSTRACT: Child-Turcotte-Pugh (CTP) score is the standard tool to assess hepatic reserve in hepatocellular carcinoma (HCC), and CTP-A is the classic group for active therapy. However, CTP stratification accuracy has been questioned. We hypothesized that plasma insulin-like growth factor 1 (IGF-1) is a valid surrogate for hepatic reserve to replace the subjective parameters in CTP score to improve its prognostic accuracy. We retrospectively tested plasma IGF-1 levels in the training set (n = 310) from MD Anderson Cancer Center. Recursive partitioning identified three optimal IGF-1 ranges that correlated with overall survival (OS): greater than 50ng/mL = 1 point; 26 to 50ng/mL = 2 points; and less than 26ng/mL = 3 points. We modified the CTP score by replacing ascites and encephalopathy grading with plasma IGF-1 value (IGF-CTP) and subjected both scores to log-rank analysis. Harrell's C-index and U-statistics were used to compare the prognostic performance of both scores in both the training and validation cohorts (n = 155). All statistical tests were two-sided. Patients' stratification was statistically significantly stronger for IGF-CTP than CTP score for the training (P = .003) and the validation cohort (P = .005). Patients reclassified by IGF-CTP relative to their original CTP score were better stratified by their new risk groups. Most important, patients classified as A by CTP but B by IGF-CTP had statistically significantly worse OS than those who remained under class A by IGF-CTP in both cohorts (P = .03 and P < .001, respectively, from Cox regression models). AB patients had a worse OS than AA patients in both the training and validation set (hazard ratio [HR] = 1.45, 95% confidence interval [CI] = 1.03 to 2.04, P = .03; HR = 2.83, 95% CI = 1.65 to 4.85, P < .001, respectively). The IGF-CTP score is simple, blood-based, and cost-effective, stratified HCC better than CTP score, and validated well on two independent cohorts. International validation studies are warranted.
    CancerSpectrum Knowledge Environment 05/2014; · 14.07 Impact Factor
  • Thomas A. Aloia, Jean-Nicolas Vauthey
    Journal of the American College of Surgeons 05/2014; 218(5):1078–1079. · 4.45 Impact Factor
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    ABSTRACT: Delivery of radiation therapy (RT) to unresectable liver tumors is sometimes limited by proximity of radiosensitive bowel. We sought to determine if biologic mesh spacers (BMS) could be used in this situation. BMS composed of acellular human dermis were placed via a laparoscopic or open approach to displace bowel away from unresectable liver tumors in patients previously unable to receive radiation therapy (RT) due to risk of bowel toxicity. In 1 year, 14 patients were treated. Median age was 64 years. Diagnoses included intrahepatic cholangiocarcinoma (n = 6), hepatocellular carcinoma (n = 3), and metastases (n = 5). A solitary lesion was present in 8 patients, while 4 patients had 2 lesions and 2 patients had 3 lesions. Median largest tumor size was 6.3 cm (range, 1.6-17.5 cm). Limited extrahepatic disease was present in 5 patients. The surgical approach was laparoscopic in 10 patients and open in 4 patients. Median length of stay was 2.5 days (1-8), and 3 patients developed low-grade complications. Folded, extra thick (2.3-3.3 mm) BMS, with a median area of 384 cm(2) (256-640 cm(2)), were used to displace stomach (n = 9), duodenum (7), colon (6), and small bowel (2). The mean displacement of these organs on postprocedure imaging was 23 mm, 23 mm, 24 mm, and 20 mm, respectively. Two patients did not receive RT due to extrahepatic disease progression. The remaining patients had 3-dimensional conformal proton RT (n = 5), stereotactic body RT (4), or intensity modulated RT (3). Median dose delivered was 54 Gy (40-58.5) in 5-15 fractions with only 1 patient with grade 3-4 toxicity. At short-term follow-up of at least 10 months, local disease control was obtained in 11 of 12 patients. Initial dual institution experience with this novel strategy demonstrates feasibility, allowing previously untreatable liver tumor patients to receive high-dose RT.
    Practical radiation oncology. 05/2014; 4(3):167-73.
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    ABSTRACT: Background After cancer surgery, complications, and disability prevent some patients from receiving subsequent treatments. Given that an inability to complete all intended cancer therapies might negate the oncologic benefits of surgical therapy, strategies to improve return to intended oncologic treatment (RIOT), including minimally invasive surgery (MIS), are being investigated.Methods This project was designed to evaluate liver tumor patients to determine the RIOT rate, risk factors for inability to RIOT, and its impact on survivals. Outcomes for a homogenous cohort of 223 patients who underwent open-approach surgery for metachronous colorectal liver metastases and a group of 27 liver tumor patients treated with MIS hepatectomy were examined.ResultsOf the 223 open-approach patients, 167 were offered postoperative therapy, yielding a RIOT rate of 75%. The remaining 56 (25%) patients were unable to receive further treatment due to surgical complications (n = 29 pts) or poor performance status (n = 27 pts). Risk factors associated with inability to RIOT were hypertension (OR 2.2, P = 0.025), multiple preoperative chemotherapy regimens (OR 5.9, P = 0.039), and postoperative complications (OR 2.0, P = 0.039). Inability to RIOT correlated with shorter disease-free and overall survivals (P < 0.001, HR = 2.16; and P = 0.005, HR = 2.07, respectively). In contrast to the open surgery group, 100% of MIS patients who were intended to initiate postoperative therapy did so (P = 0.038) within a shorter median time interval (MIS: 15 days vs. open: 42 days; P < 0.001).Conclusions The relationship between RIOT and long-term oncologic outcomes suggests that RIOT rates for both open- and MIS-approach cancer surgery should routinely be reported as a quality indicator. J. Surg. Oncol. © 2014 Wiley Periodicals, Inc.
    Journal of Surgical Oncology 04/2014; · 2.84 Impact Factor
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    ABSTRACT: T1a gastric cancer and gastrointestinal stromal tumors (GIST) often require extensive resection despite their favorable tumor biology. This holds especially true for lesions located at the gastroesophageal junction. In this video we will demonstrate an oncologically sound technique of laparoscopic intragastric surgery that allows for safe and effective tumor resection. The first patient has a T1a gastric adenocarcinoma with no adverse features at the gastroesophageal junction. The tumor is resected with multiple cuffed ports placed directly into the stomach. The specimen is removed via the mouth. The next video shows the use of multi-port access to resect a 6 cm GIST at the cardia. An endoloop is used to provide safe manipulation with minimal handling of the GIST itself. The third patient has a small 1.5 cm GIST, and a single incision access device is used for stapled removal of this tumor located at the gastroesophageal junction. The video shows safe and feasible techniques for intragastric surgery to remove early gastric cancer and GIST. We demonstrate the use of multiple ports and single access, as well as stapling inside the stomach. The technique of intragastric laparoscopic surgery allows for safe removal of T1a gastric cancer too extensive for endoscopic resection. At this point, gastric adenocarcinomas of <4-5 cm, with no submucosal, lymphatic, or vascular invasion or ulceration and no suspicion for lymph node metastasis should undergo this treatment. Excellent visualization, the ability to perform full-thickness resection and manage perforations make this new technique an excellent treatment option for early gastric cancer and GIST.
    Annals of Surgical Oncology 03/2014; · 3.94 Impact Factor
  • Thomas A Aloia
    Annals of surgery 03/2014; · 7.19 Impact Factor
  • Molecular Cancer Therapeutics 01/2014; 12(11_Supplement):B132-B132. · 6.11 Impact Factor
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    ABSTRACT: Objective: Hepatocellular carcinoma (HCC) staging systems were developed using data predominantly from patients who had hepatitis and cirrhosis. Given the recent change in prevalence of viral hepatitis and cirrhosis at oncology centers, which has altered the natural history of HCC, we aimed at comparing the accuracy of HCC staging systems in patients with or without hepatitis and cirrhosis. Methods: A total of 438 patients were enrolled. Baseline clinicopathologic parameters, Barcelona Clinic Liver Cancer stage, Cancer of the Liver Italian Program score, TNM (6th edition) stage, Okuda stage, and Chinese University Prognostic Index score were prospectively obtained for all patients, and retrospectively analyzed. Kaplan-Meier analysis was used to determine overall survival (OS), Cox regression analyses were performed, and Harrell's Correspondence Index compared the staging systems' ability to predict OS duration. Subgroup analyses of patients with or without hepatitis or cirrhosis were performed. Results: Median patient OS was 13.9 months; 165 patients (37.7%) had no cirrhosis and 256 patients (58.4%) had no hepatitis. Overall, all staging systems were significantly less predictive of OS in patients who did not have cirrhosis or hepatitis. Conclusion: Our results advocate the need to further stratify HCC based on cirrhosis and hepatitis status, which may change patient risk-stratification and, ultimately, treatment decisions. © 2014 S. Karger AG, Basel.
    Oncology 01/2014; 86(2):63-71. · 2.17 Impact Factor

Publication Stats

2k Citations
536.99 Total Impact Points


  • 2005–2014
    • University of Texas MD Anderson Cancer Center
      • Department of Surgical Oncology
      Houston, Texas, United States
  • 2013
    • University of Texas Southwestern Medical Center
      • Division of Surgical Oncology
      Dallas, TX, United States
    • University of Kentucky
      • Department of Surgery
      Lexington, Kentucky, United States
  • 2009–2010
    • Weill Cornell Medical College
      • Department of Surgery
      New York City, NY, United States
    • Robert Wood Johnson University Hospital
      New Brunswick, New Jersey, United States
  • 2008–2010
    • Houston Methodist Hospital
      Houston, Texas, United States
    • Methodist Hospitals
      Gary, Indiana, United States
    • Rice University
      Houston, Texas, United States
  • 2007–2009
    • Baylor College of Medicine
      • Department of Surgery
      Houston, TX, United States
    • Université Paris-Sud 11
      • Faculty of Medicine
      Orsay, Île-de-France, France
    • Assistance Publique – Hôpitaux de Paris
      Lutetia Parisorum, Île-de-France, France
  • 2007–2008
    • Hôpital Paul-Brousse – Hôpitaux universitaires Paris-Sud
      Île-de-France, France