Monica Morrow

Memorial Sloan-Kettering Cancer Center, New York, New York, United States

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Publications (329)3083.17 Total impact

  • Monica Morrow · Steven J. Katz ·

    JNCI Journal of the National Cancer Institute 12/2015; 107(12):djv290. DOI:10.1093/jnci/djv290 · 12.58 Impact Factor
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    ABSTRACT: Background: American College of Surgeons Oncology Group (ACOSOG) Z0011 defined clinical node negativity by physical examination alone. Although axillary ultrasound with biopsy has a positive predictive value for lymph node (LN) metastases approaching 100 %, it may not appropriately identify clinically node-negative women with ≥3 positive LNs who require axillary lymph node dissection (ALND). We sought to identify the total number of positive LNs in women presenting with cT1-2N0 breast carcinoma with a positive preoperative LN biopsy to evaluate the potential for overtreatment when ALND is performed on the basis of a positive needle biopsy in patients who otherwise meet ACOSOG Z0011 eligibility criteria. Methods: Patients with cT1-2N0 breast cancer by physical examination with a positive preoperative LN biopsy were identified from a prospective institutional database. Clinicopathologic characteristics and axillary imaging results were compared between women with 1 to 2 total positive LNs and ≥3 total positive LNs. Results: Between May 2006 and December 2013, a total of 141 women with cT1-2N0 breast cancer had abnormal axillary imaging and a preoperative positive LN biopsy (median patient age 51 years, median tumor size 2.4 cm, 86 % ductal histology, 79 % estrogen receptor positive). Sixty-six women (47 %) had 1 to 2 total positive LNs, and 75 (53 %) had ≥3 total positive LNs. Women with ≥3 total positive LNs had larger tumors (2.4 vs. 2.2 cm, p = 0.03), fewer tumors with ductal histology (79 vs. 94 %, p = 0.01), more lymphovascular invasion (80 vs. 61 %, p = 0.01), and higher median body mass index (29.2 vs. 27.1 kg/m(2), p = 0.04). Having >1 abnormal LN on axillary imaging was significantly associated with having ≥3 total positive LNs at final pathology (68 vs. 43 %, p = 0.003). Conclusions: Axillary imaging with preoperative LN biopsy does not accurately discriminate low- versus high-volume nodal disease in clinically node-negative patients.
    Annals of Surgical Oncology 11/2015; DOI:10.1245/s10434-015-4944-y · 3.93 Impact Factor
  • A. Sabolch · K.A. Griffith · S. Katz · M. Morrow · R. Jagsi ·

    International journal of radiation oncology, biology, physics 11/2015; 93(3):E16. DOI:10.1016/j.ijrobp.2015.07.584 · 4.26 Impact Factor

  • International journal of radiation oncology, biology, physics 11/2015; 93(3):S224-S225. DOI:10.1016/j.ijrobp.2015.07.541 · 4.26 Impact Factor

  • Journal of the American College of Surgeons 11/2015; DOI:10.1016/j.jamcollsurg.2015.11.013 · 5.12 Impact Factor
  • Tari A. King · Melissa Pilewskie · Monica Morrow ·
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    ABSTRACT: The recognition that breast cancer is a group of genetically distinct diseases with differing responses to treatment and varying patterns of both local and systemic failure has led to many questions regarding optimal therapy for those considered to be high risk. Young patients, patients with triple-negative breast cancer (TNBC), and those who harbor a deleterious mutation in BRCA1 or BRCA2 are frequently considered to be at highest risk of local failure, leading to speculation that more-aggressive surgical treatment is warranted in these patients. For both age and the triple-negative subtype, it appears that the intrinsic biology which imparts inferior outcomes is not overcome with mastectomy; therefore, a recommendation for more extensive surgical therapy among these higher-risk groups is not warranted. For those at inherited risk, a more-aggressive surgical approach may be preferable, however; patient age, ER status, stage of the index lesion, and individual patient preferences should all be considered in the surgical decision-making process.
    Breast (Edinburgh, Scotland) 10/2015; DOI:10.1016/j.breast.2015.07.022 · 2.38 Impact Factor
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    ABSTRACT: Purpose: The increased breast cancer risk conferred by a diagnosis of lobular carcinoma in situ (LCIS) is poorly understood. Here, we review our 29-year longitudinal experience with LCIS to evaluate factors associated with breast cancer risk. Patients and methods: Patients participating in surveillance after an LCIS diagnosis are observed in a prospectively maintained database. Comparisons were made among women choosing surveillance, with or without chemoprevention, and those undergoing bilateral prophylactic mastectomies between 1980 and 2009. Results: One thousand sixty patients with LCIS without concurrent breast cancer were identified. Median age at LCIS diagnosis was 50 years (range, 27 to 83 years). Fifty-six patients (5%) underwent bilateral prophylactic mastectomy; 1,004 chose surveillance with (n = 173) or without (n = 831) chemoprevention. At a median follow-up of 81 months (range, 6 to 368 months), 150 patients developed 168 breast cancers (63% ipsilateral, 25% contralateral, 12% bilateral), with no dominant histology (ductal carcinoma in situ, 35%; infiltrating ductal carcinoma, 29%; infiltrating lobular carcinoma, 27%; other, 9%). Breast cancer incidence was significantly reduced in women taking chemoprevention (10-year cumulative risk: 7% with chemoprevention; 21% with no chemoprevention; P < .001). In multivariable analysis, chemoprevention was the only clinical factor associated with breast cancer risk (hazard ratio, 0.27; 95% CI, 0.15 to 0.50). In a subgroup nested case-control analysis, volume of disease, which was defined as the ratio of slides with LCIS to total number of slides reviewed, was also associated with breast cancer development (P = .008). Conclusion: We observed a 2% annual incidence of breast cancer among women with LCIS. Common clinical factors used for risk prediction, including age and family history, were not associated with breast cancer risk. The lower breast cancer incidence in women opting for chemoprevention highlights the potential for risk reduction in this population.
    Journal of Clinical Oncology 09/2015; DOI:10.1200/JCO.2015.61.4743 · 18.43 Impact Factor

  • Journal of Clinical Oncology 09/2015; DOI:10.1200/JCO.2015.63.5524 · 18.43 Impact Factor
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    ABSTRACT: Objective: Our goal was to investigate, in a large population of women with ductal carcinoma in situ (DCIS) and long follow-up, the relationship between margin width and recurrence, controlling for other characteristics. Background: Although DCIS has minimal mortality, recurrence rates after breast-conserving surgery are significant, and half are invasive. Positive margins are associated with increased risk of local recurrence, but there is no consensus regarding optimal negative margin width. Methods: We retrospectively reviewed a prospective database of DCIS patients undergoing breast-conserving surgery from 1978 to 2010. Univariate and Cox proportional hazard models were used to investigate the association between margin width and recurrence. Results: In this review, 2996 cases were identified, of which 363 recurred. Median follow-up for women without recurrence was 75 months (range 0-30 years); 732 were studied for ≥10 years. Controlling for age, family history, presentation, nuclear grade, number of excisions, radiotherapy (RT), endocrine therapy, and year of surgery, margin width was significantly associated with recurrence in the entire population. Larger negative margins were associated with a lower hazard ratio compared with positive margins. An interaction between RT and margin width was significant (P < 0.03); the association of recurrence with margin width was significant in those without RT (P < 0.0001), but not in those with RT (P = 0.95). Conclusions: In women not receiving RT, wider margins are significantly associated with a lower rate of recurrence. Obtaining wider negative margins may be important in reducing the risk of recurrence in women who choose not to undergo RT and may not be necessary in those who receive RT.
    Annals of surgery 09/2015; 262(4):623-631. DOI:10.1097/SLA.0000000000001454 · 8.33 Impact Factor
  • A T Manning · C Wood · A Eaton · M Stempel · D Capko · A Pusic · M Morrow · V Sacchini ·
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    ABSTRACT: Nipple-sparing mastectomy (NSM) is associated with improved cosmesis and is being performed increasingly. Its role in BRCA mutation carriers has not been well described. This was a study of the indications for, and outcomes of, NSM in BRCA mutation carriers. BRCA mutation carriers who underwent NSM were identified. Details of patient demographics, surgical procedures, complications, and relevant disease stage and follow-up were recorded. A total of 177 NSMs were performed in 89 BRCA mutation carriers between September 2005 and December 2013. Twenty-six patients of median age 41 years had NSM for early-stage breast cancer and a contralateral prophylactic mastectomy. Mean tumour size was 1·4 (range 0·1-3·5) cm. Sixty-three patients of median age 39 years had prophylactic NSM, eight of whom had an incidental diagnosis of ductal carcinoma in situ. There were no local or regional recurrences in the 26 patients with breast cancer at a median follow-up of 28 (i.q.r. 15-43) months. There were no newly diagnosed breast cancers in the 63 patients undergoing prophylactic NSM at a median follow-up of 26 (11-42) months. All patients had immediate breast reconstruction. Five patients (6 per cent) required subsequent excision of the nipple-areola complex for oncological or other reasons. Skin desquamation occurred in 68 (38·4 per cent) of the 177 breasts, and most resolved without intervention. Debridement was required in 13 (7·3 per cent) of the 177 breasts, and tissue-expander or implant removal was necessary in six instances (3·4 per cent). NSM is an acceptable choice for patients with BRCA mutations, with no evidence of compromise to oncological safety at short-term follow-up. Complication rates were acceptable, and subsequent excision of the nipple-areola complex was rarely required. © 2015 BJS Society Ltd. Published by John Wiley & Sons Ltd.
    British Journal of Surgery 08/2015; 102(11). DOI:10.1002/bjs.9884 · 5.54 Impact Factor
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    ABSTRACT: Methods: In this Institutional Review Board approved retrospective study, our Hospital Information System was screened for ILC patients who underwent PET/CT in 2006-2013 prior to systemic or radiation therapy. Initial stage was determined from exam, mammography, ultrasound, magnetic resonance and/or surgery. PET/CT was performed to identify unsuspected distant metastases. A sequential cohort of stage III IDC patients was evaluated for comparison. Upstaging rates were compared using Pearson chi square test. Results: 146 ILC patients fulfilled criteria. PET/CT revealed unsuspected distant metastases in 12 (8%): 0/8 initial stage I, 2/50 (4%) stage II, and 10/88 (11%) stage III. All patients upstaged to IV by PET/CT were confirmed by biopsy. 3/12 upstaged patients were upstaged only by the CT component of the PET/CT, as metastases were non-(18)F-FDG -avid. In the comparison stage III IDC cohort, 22% (20/89) of patients were upstaged to IV by PET/CT. All 20 demonstrated (18)F-FDG -avid metastases. The relative risk of PET/CT revealing unsuspected distant metastases in stage III IDC patients was 1.98 times (95% CI 0.98-3.98) that of stage III ILC patients (P = .049). For (18)F-FDG -avid metastases, the relative risk of PET/CT revealing unsuspected (18)F-FDG -avid distant metastases in stage III IDC patients was 2.82 times (95% CI 1.26-6.34) that of stage III ILC patients (P = .007) CONCLUSION: (18)F-FDG PET/CT was more likely to reveal unsuspected distant metastases in stage III IDC patients than in stage III ILC patients. In addition, some ILC patients were upstaged by non-(18)F-FDG -avid lesions visible only by the CT component. Overall, PET/CT may have lower impact on systemic staging of ILC patients than IDC patients.
    Journal of Nuclear Medicine 08/2015; DOI:10.2967/jnumed.115.161455 · 6.16 Impact Factor
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    ABSTRACT: Bilateral breast cancer (BBC) may present as synchronous (SBC) or metachronous breast cancer (MBC). Optimal surgical management of BBC patients is not well-defined. In this study, we report on histopathology, treatment, and outcomes in BBC patients. Upon Institutional Review Board approval, we identified BBC patients diagnosed and treated for invasive breast cancer between 1999 and 2007. Retrospective chart review for demographics, histopathology, treatment, and outcomes was performed, and factors associated with BCS choice were collected. Contraindication to BCS was defined as any of the following one-breast findings: multicentric disease, tumor considered too large for BCS, and a patient without a nominal breast size for acceptable cosmetic results. McNemar's test for matched pairs (binary variables) or the paired t test (continuous variables) were used to examine if a pathologic characteristic differed within a cancer pair. Kaplan-Meier methods estimated overall survival (OS). A total of 203 BBC patients (119 SBC, 84 MBC) comprised our study group. Histopathologic characteristics of the first and second cancers diagnosed in both the SBC and MBC patients were very similar in histologic type and molecular profiles. Overall, 57 % of MBC patients underwent breast-conserving surgery (BCS) at initial diagnosis versus 34 % of patients with SBC. BCS contraindications were similar in both groups: 16 (34 %) MBC patients and 28 (36 %) SBC patients. Kaplan-Meier OS estimates at 5 and 10 years were 86 and 78 % for MBC, and 87 and 77 % for SBC patients, respectively. OS was excellent for both the MBC and SBC groups. Contraindications to BCS did not differ between groups. However, patients with SBC were less likely to undergo BCS compared with patients with MBC at the time of initial diagnosis.
    Annals of Surgical Oncology 08/2015; 22(10). DOI:10.1245/s10434-015-4746-2 · 3.93 Impact Factor
  • Monica Morrow ·
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    ABSTRACT: Recognition of differing risks of locoregional recurrence (LRR) in breast cancer patients based on estrogen receptor, progesterone receptor, and HER2 status, coupled with a reduction in LRR in patients receiving adjuvant systemic therapy, offers the opportunity to tailor surgical treatment and reduce the morbidity of therapy. New guidelines for margins in breast-conserving therapy of tumor not touching ink and avoidance of axillary dissection in sentinel node positive patients undergoing breast-conserving therapy are examples of this approach which have entered practice. Increased use of neoadjuvant therapy offers the opportunity to identify which patients are responsive to chemotherapy prior to surgery, potentially allowing further tailoring of treatment, and ongoing clinical trials will address the question of the extent of axillary surgery and radiotherapy after neoadjuvant therapy in patients with and without pathologic complete response. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Breast (Edinburgh, Scotland) 08/2015; DOI:10.1016/j.breast.2015.07.003 · 2.38 Impact Factor
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    ABSTRACT: The relative contribution of biologic subtype to locoregional recurrence (LRR) in patients treated with neoadjuvant chemotherapy (NAC), mastectomy, and postmastectomy radiotherapy (PMRT) is not clearly defined. 233 patients with stages 2 and 3 breast cancer who received NAC, mastectomy, and PMRT between 2000 and 2009 were included: 53 % (n = 123) had HR+ (ER or PR+/HER2-), 23 % (n = 53) had HER2+ (HER2+/HR+ or HR-), and 24 % (n = 57) had triple-negative (TN) disease (HR-/HER2-). The 5-year LRR rates were estimated by Kaplan-Meier methods. Cox regression analysis was performed to evaluate covariates associated with LRR. The median follow-up period was 62 months. A pathologic complete response (pCR) was seen in 14 % of the patients. The 5-year LRR rate was 8 % for the entire cohort. The LRR rate was 0 % for the patients with a pCR versus 9 % for the patients without a pCR (p = 0.05). TN disease [Hazard ratio (HR) 4.4; p = 0.003] and pathologic node positivity (HR 9.8; p = 0.03) were associated with LRR. Patients with TN disease had a higher LRR rate than patients with HER2+ or HR+ disease (20 vs. 6 and 4 %; p = 0.005). Among patients without a pCR, TN subtype was associated with increased LRR risk (26 versus 7 % HER+ and 4 % HR+; p < 0.001). Patients with TN breast cancer had the highest LRR rate after NAC, mastectomy and PMRT. Whereas no LRR was observed among TN patients with a pCR, TN patients with residual disease had a significantly higher LRR risk. Patients with HR+ and HER2+ breast cancer had favorable LRR rates regardless of NAC response, likely due to receipt of adjuvant systemic targeted therapies.
    Annals of Surgical Oncology 08/2015; DOI:10.1245/s10434-015-4697-7 · 3.93 Impact Factor
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    ABSTRACT: Randomized trials of radiation after breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS) found substantial rates of recurrence, with half of the recurrences being invasive. Decreasing local recurrence rates for invasive breast carcinoma have been observed and are largely attributed to improvements in systemic therapy. In this study, we examine recurrence rates after BCS for DCIS over 3 decades at one institution. We retrospectively reviewed a prospectively maintained database of DCIS patients undergoing BCS from 1978 to 2010. Cox proportional hazard models were used to investigate the association between the treatment period and recurrence, controlling for other variables. Overall, 363 (12 %) recurrences among 2996 cases were observed. Median follow-up for patients without recurrence was 75 months (range 0-30 years); 732 patients were followed for ≥10 years. The 5-year recurrence rate for the period 1978-1998 was 13.6 versus 6.6 % for the period 1999-2010 [hazard ratio (HR) 0.62, p < 0.0001]. Controlling for age, family history, presentation, nuclear grade, necrosis, number of excisions, margin status, radiation, and endocrine therapy, treatment period remained significantly associated with recurrence, with later years associated with a lower HR (0.74, p = 0.02) compared to earlier. After stratification by radiation use, association of recurrence with treatment period persisted in those treated without radiation (HR 0.62, p = 0.003). Recurrence rates for DCIS have fallen over time, with increases in screen detection, negative margins, and use of adjuvant therapies only partially explaining this decrease. The unexplained decline persists in women not receiving radiation, suggesting it is not due to changes in radiation efficacy but may be due to improvements in radiologic detection and pathologic assessment.
    Annals of Surgical Oncology 07/2015; 22(10). DOI:10.1245/s10434-015-4740-8 · 3.93 Impact Factor
  • Monica Morrow ·
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    ABSTRACT: Local control has traditionally been considered a function of disease burden. Local control is now known to differ among biologic subtypes of breast cancer and is greatly improved with the use of systemic therapy. This offers opportunities for decreasing the morbidity of treatment and individualizing local therapy. The use of smaller margins in breast-conserving surgery and elimination of axillary dissection for some node-positive breast cancer patients are current examples of leveraging the benefits of systemic therapy to reduce surgery. Emerging evidence indicates that molecular profiling can identify patients at high and low risk for locoregional recurrence after surgery in a more accurate way than tumor burden, potentially allowing individualization of the use of postmastectomy and comprehensive node field irradiation. Future clinical trials should incorporate both disease burden and molecular profiling when examining treatment strategies.
    Annals of Surgical Oncology 07/2015; 22(10). DOI:10.1245/s10434-015-4750-6 · 3.93 Impact Factor
  • Steven J Katz · Allison W Kurian · Monica Morrow ·

    JAMA The Journal of the American Medical Association 07/2015; 314(10). DOI:10.1001/jama.2015.8088 · 35.29 Impact Factor
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    ABSTRACT: Rates of mastectomy with immediate reconstruction are rising. Skin flap necrosis after this procedure is a recognized complication that can have an impact on cosmetic outcomes and patient satisfaction, and in worst cases can potentially delay adjuvant therapies. Many retrospective studies of this complication have identified variable event rates and inconsistent associated factors. A prospective study was designed to capture the rate of skin flap necrosis as well as pre-, intra-, and postoperative variables, with follow-up assessment to 8 weeks postoperatively. Uni- and multivariate analyses were performed for factors associated with skin flap necrosis. Of 606 consecutive procedures, 85 (14 %) had some level of skin flap necrosis: 46 mild (8 %), 6 moderate (1 %), 31 severe (5 %), and 2 uncategorized (0.3 %). Univariate analysis for any necrosis showed smoking, history of breast augmentation, nipple-sparing mastectomy, and time from incision to specimen removal to be significant. In multivariate models, nipple-sparing, time from incision to specimen removal, sharp dissection, and previous breast reduction were significant for any necrosis. Univariate analysis of only moderate or severe necrosis showed body mass index, diabetes, nipple-sparing mastectomy, specimen size, and expander size to be significant. Multivariate analysis showed nipple-sparing mastectomy and specimen size to be significant. Nipple-sparing mastectomy was associated with higher rates of necrosis at every level of severity. Rates of skin flap necrosis are likely higher than reported in retrospective series. Modifiable technical variables have limited the impact on rates of necrosis. Patients with multiple risk factors should be counseled about the risks, especially if they are contemplating nipple-sparing mastectomy.
    Annals of Surgical Oncology 07/2015; DOI:10.1245/s10434-015-4709-7 · 3.93 Impact Factor
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    ABSTRACT: We sought to determine if adoption of the Z0011 criteria was associated with removal of more sentinel lymph nodes (SLNs). In a retrospective review of a prospective database of breast cancer patients treated at our institution from 2006 to 2013, we identified 5213 eligible patients who elected to undergo breast-conserving surgery; 2372 were treated pre-Z0011 and 2841 post-Z0011. Clinicopathologic factors were collected, and univariate and multivariate models were fit to identify variables associated with number of SLNs removed. Median patient age, 60 years, did not differ between groups. Median tumor size was similar in both groups: 1.1 (0.05-5.0) cm in the pre-Z0011 group and 1.2 (0.1-5.2) cm in the post-Z0011 group. The mean number of SLNs excised in the pre-Z0011 patients was 2.8 compared with 2.9 in post-Z0011 patients (p = 0.01). Three or fewer lymph nodes were removed in 1771 (75 %) pre-Z0011 patients compared with 2006 (71 %) post-Z0011 patients (p = 0.01). Factors associated with the removal of more SLNs on multivariate analysis included adoption of ACOSOG Z0011 criteria (p = 0.03), young age (p ≤ 0.0001), and large tumor size (p = 0.0005). Axillary lymph node dissection (ALND) was performed in 379 (16 %) patients pre-Z0011 compared with 68 (2 %) node-positive post-Z0011 patients (p < 0.0001). Since the adoption of Z0011 criteria, we found significantly fewer patients undergoing ALND for positive SLNs. We noted a significant, slight shift in the removal of ≥4 SLNs. The Z0011 criteria were not associated with a clinically significant increase in the number of SLNs removed.
    Annals of Surgical Oncology 07/2015; DOI:10.1245/s10434-015-4698-6 · 3.93 Impact Factor
  • Andrea V. Barrio · Monica Morrow ·
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    ABSTRACT: Axillary lymph node dissection (ALND), once considered standard of care for all patients with invasive breast cancer, is now obsolete in patients with histologically negative sentinel lymph nodes (SLNs). Alternatives to ALND in patients with histologically positive SLNs are available after the ACOSOG Z0011 and AMAROS trials demonstrated no difference in locoregional recurrence, disease-free survival, or overall survival between SLN biopsy alone (ACOSOG Z0011) or with axillary radiotherapy (AMAROS) and ALND in women with clinical T1-2 invasive breast cancer and 1–2 positive SLNs treated with multimodality therapy, offering the opportunity to reduce the morbidity of treatment. In contrast, the MA.20 and EORTC 22922-10925 studies suggest that similar patient populations benefit from ALND and comprehensive nodal irradiation. Here, we will discuss the contemporary surgical management of clinically node-negative breast cancer patients with metastases in the SLNs.
    07/2015; 3(7). DOI:10.1007/s40137-015-0095-0

Publication Stats

11k Citations
3,083.17 Total Impact Points


  • 2008-2015
    • Memorial Sloan-Kettering Cancer Center
      • • Department of Surgery
      • • Breast Service
      New York, New York, United States
  • 2012-2014
    • Cornell University
      • Department of Surgery
      Итак, New York, United States
  • 2010
    • University of Michigan
      Ann Arbor, Michigan, United States
    • Treatment Research Institute, Philadelphia PA
      Philadelphia, Pennsylvania, United States
  • 2009
    • Harvard University
      Cambridge, Massachusetts, United States
  • 2004-2008
    • Fox Chase Cancer Center
      • • Department of Surgery
      • • Department of Radiation Oncology
      Filadelfia, Pennsylvania, United States
  • 2005
    • Duke University Medical Center
      • Department of Surgery
      Durham, NC, United States
  • 2000-2005
    • Northwestern Memorial Hospital
      • Department of Surgery
      Chicago, Illinois, United States
    • American College of Surgeons
      Chicago, Illinois, United States
  • 1995-2005
    • University of Illinois at Chicago
      • Department of Biopharmaceutical Sciences
      Chicago, Illinois, United States
  • 2000-2004
    • Northwestern University
      • • Department of Surgery
      • • Division of Gastroenterology and Hepatology
      Evanston, Illinois, United States
  • 1999
    • Beth Israel Deaconess Medical Center
      • Department of Pathology
      Boston, Massachusetts, United States
    • American College of Radiology
      Philadelphia, Pennsylvania, United States
  • 1997
    • Northwest Hospital & Medical Center
      Seattle, Washington, United States