Charles R Thomas

Publications of Charles R Thomas

• Success Breeds Success: Authorship Distribution in the Red Journal, 1975-2011.

  Authors: Emma Holliday, Clifton David Fuller, Lynn D Wilson, Charles R Thomas

  International journal of radiation oncology, biology, physics. 05/2012;

  PURPOSE: Publication analysis has value in evaluating the mechanics of academic efforts in specific scientific communities. The specific aim of this study was to evaluate whether establishedPURPOSE: Publication analysis has value in evaluating the mechanics of academic efforts in specific scientific communities. The specific aim of this study was to evaluate whether established bibliometric patterns seen in other academic fields were likewise observed in radiation oncology publication parameters. METHODS AND MATERIALS: We used a commercial bibliographic database to analyze all publications in Red Journal, or International Journal of Radiation Oncology Biology Physics (IJROBP), the New England Journal of Medicine (NEJM), the Journal of Clinical Oncology (JCO), and Radiology (Rad) between January 1, 1975 and May 18, 2011. Power-law (Lotka's law or 1/n(2)) conformance was assessed. Curve fit analysis was then performed. RESULTS: In all 4 journals, a total of 219,476 authors were responsible for 62,232 articles. Of those, 79,810 authors published 13,772 articles in IJROBP, with 79,446/16,707 authors/articles in NEJM, 106,984/11,920 authors/articles in JCO and 90,325/19,745 authors/articles in Rad. The mean ± standard deviation of authors per publication was 5.74 ± 4.61 overall. There were 5.8 ± 3.53, 4.8 ± 5.7, 8.9 ± 3.53, and 4.6 ± 2.8 authors per article in IJROBP, NEJM, JCO, and Rad, respectively (P<.001). The number of authors publishing n articles was 1/n(2.02) of those publishing 1 article in IJROBP, 1/n(2.52) in NEJM, 1/n(1.97) in JCO, and 1/n(2.16) in Rad. CONCLUSIONS: Bibliometric analysis shows that authorship distributions in IJROBP approximate those of the scientific literature in comparable scientific journals. Our results suggest that the majority of publications in the field of radiation oncology are produced by a small but highly productive group of authors.

• Distribution of the h-Index in Radiation Oncology Conforms to a Variation of Power Law: Implications for Assessing Academic Productivity.

  Authors: Matthew R Quigley, Emma B Holliday, Clifton D Fuller, Mehee Choi, Charles R Thomas

  Journal of cancer education : the official journal of the American Association for Cancer Education. 04/2012;

  Leaders of academic institutions evaluate academic productivity when deciding to hire, promote, or award resources. This study examined the distribution of the h-index, an assessment of academicLeaders of academic institutions evaluate academic productivity when deciding to hire, promote, or award resources. This study examined the distribution of the h-index, an assessment of academic standing, among radiation oncologists. The authors collected h-indices for 826 US academic radiation oncologists from a commercial bibliographic database (SCOPUS, Elsevier B.V., NL). Then, logarithmic transformation was performed on h-indices and ranked h-indices, and results were compared to estimates of a power law distribution. The h-index frequency distribution conformed to both the log-linear variation of a power law (r (2) = .99) and the beta distribution with the same fitting exponents as previously described in a power law analysis of the productivity of neurosurgeons. Within radiation oncology, as in neurosurgery, there are exceedingly more faculty with an h-index of 1-2. The distribution fitting the same variation of a power law within two fields suggests applicability to other areas of academia.

• Cetuximab Plus Cisplatin, Irinotecan, and Thoracic Radiotherapy as Definitive Treatment for Locally Advanced, Unresectable Esophageal Cancer: A Phase-II Study of The SWOG (S0414).

  Authors: Michael B Tomblyn, Bryan H Goldman, Charles R Thomas, Jacqueline K Benedetti, Heinz-Josef Lenz, Vivek Mehta, Thaddeus Beeker, Philip J Gold, James L Abbruzzese, Charles D Blanke

  Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer. 04/2012;

  INTRODUCTION:: The specific aims of the study were to evaluate the 2-year overall survival (OS) and progression-free survival (PFS), toxicity profile, and best objective response rate in patientsINTRODUCTION:: The specific aims of the study were to evaluate the 2-year overall survival (OS) and progression-free survival (PFS), toxicity profile, and best objective response rate in patients with locally advanced, clinically unresectable esophageal cancer receiving cetuximab, cisplatin, irinotecan, and thoracic radiotherapy (TRT) within a multi-institutional cooperative-group setting. METHODS:: Eligible patients (cT4 M0 or medically unresectable, biopsy proven, and noncervical esophageal cancer) were to receive four 21-day cycles of cetuximab 400 mg/m (day 1, cycle 1), cetuximab 250 mg/m (day 8, 15, cycle 1; then days 1, 8, and 15 for subsequent cycles), cisplatin 30 mg/m (days 1 and 8, all cycles), and irinotecan 65 mg/m (days 1 and 8, all cycles). TRT was administered at 1.8 Gy in 28 daily fractions to a total dose of 50.4 Gy, to begin with on day 1 of cycle 3. The primary endpoint was 2-year OS, with an accrual goal of 75 patients with adenocarcinoma. RESULTS:: The study was closed because of slow accrual, with 21 eligible patients (11 squamous, 10 adenocarcinoma) enrolled from May 2005 to September 2007. Two-year OS and PFS (95% confidence interval [CI]) were 33.3% (14.6-57.0%) and 23.8% (8.2-47.2%), respectively. Kaplan-Meier estimates of median (95% CI) OS and PFS were 11.2 (6.4-43.6) and 6.4 (3.7-12.0) months, respectively. The overall response rate (95% CI) among 17 evaluable patients was 17.6% (3.8-43.4%), including 6% confirmed complete responders and 12% unconfirmed partial responders. Two deaths resulted from protocol treatment (sudden death and gastrointestinal necrosis). Ten (47.6%) and 6 (28.6%) patients had grade-3 or -4 toxicity, respectively: 52.4% were hematologic, 23.8% had fatigue, 19.0% had nausea, 19.0% had dehydration, and 19.0% had anorexia. CONCLUSIONS:: Concomitant cetuximab, cisplatin, irinotecan, and TRT were poorly tolerated in the first North American cooperative group trial testing this regimen for locally advanced esophageal cancer as treatment-related mortality approached 10%. Single-institution phase-II cetuximab-based combined modality trials have yielded encouraging results in preliminary analyses. The SWOG GI Committee endorses enrollment to open clinical trials to clarify the therapeutic ratio of cetuximab-based combined modality approaches for esophageal cancer.

• S0356: a phase II clinical and prospective molecular trial with oxaliplatin, fluorouracil, and external-beam radiation therapy before surgery for patients with esophageal adenocarcinoma.

  Authors: Lawrence P Leichman, Bryan H Goldman, Pierre O Bohanes, Heinz J Lenz, Charles R Thomas, Kevin G Billingsley, Christopher L Corless, Syma Iqbal, Philip J Gold, Jacqueline K Benedetti, Kathleen D Danenberg, Charles D Blanke

  Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 12/2011; 29(34):4555-60.

  Pathologic complete response (pCR) after neoadjuvant therapy for locally advanced esophageal adenocarcinoma is associated with improved survival. The Southwest Oncology Group designed a trimodality,Pathologic complete response (pCR) after neoadjuvant therapy for locally advanced esophageal adenocarcinoma is associated with improved survival. The Southwest Oncology Group designed a trimodality, phase II, single-arm trial with objectives of achieving a pCR rate of 40% with prospective exploratory analyses of intratumoral molecular markers postulated to affect response and survival. Patients with clinically staged II or III esophageal adenocarcinoma received oxaliplatin 85 mg/m(2) on days 1, 15, and 29; protracted-infusion fluorouracil (PI-FU) 180 mg/m(2)/d on days 8 through 43; and external-beam radiation therapy (EBRT) 5 days a week at 1.8 Gy/d for 25 fractions; surgery was performed 28 to 42 days after neoadjuvant therapy. Chemotherapy was planned after surgery. Tumors were analyzed for mRNA expression and polymorphisms in genes involved in drug metabolism and DNA repair. Ninety-three patients were evaluable. Two deaths (2.2%) were attributable to preoperative therapy, and two deaths (2.2%) were attributable to surgery. Grade 3 and 4 toxicities were recorded for 47.3% and 19.4% of patients, respectively. Seventy-nine patients (84.9%) underwent surgery; 67.7% of patients had R0 resections. Twenty-six patients (28.0%) had confirmed pCR (95% CI, 19.1% to 38.2%). At a median follow-up of 39.2 months, estimates of median and 3-year overall survival (OS) were 28.3 months and 45.1%, respectively. Intratumoral ERCC-1 gene expression was inversely related to progression-free survival and OS. Neoadjuvant oxaliplatin, PI-FU, and EBRT for esophageal adenocarcinoma is active and tolerable. Because the regimen failed to meet the primary end point, it does not define a new standard. However, future trials can be built on this platform to validate the role of ERCC-1 in determining the best systemic regimen for individual patients.

• Nomogram for predicting the benefit of adjuvant chemoradiotherapy for resected gallbladder cancer.

  Authors: Samuel J Wang, Andrew Lemieux, Jayashree Kalpathy-Cramer, Celine B Ord, Gary V Walker, C David Fuller, Jong-Sung Kim, Charles R Thomas

  Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 11/2011; 29(35):4627-32.

  Although adjuvant chemoradiotherapy for resected gallbladder cancer may improve survival for some patients, identifying which patients will benefit remains challenging because of the rarity of thisAlthough adjuvant chemoradiotherapy for resected gallbladder cancer may improve survival for some patients, identifying which patients will benefit remains challenging because of the rarity of this disease. The specific aim of this study was to create a decision aid to help make individualized estimates of the potential survival benefit of adjuvant chemoradiotherapy for patients with resected gallbladder cancer. Patients with resected gallbladder cancer were selected from the Surveillance, Epidemiology, and End Results (SEER) -Medicare database who were diagnosed between 1995 and 2005. Covariates included age, race, sex, stage, and receipt of adjuvant chemotherapy or chemoradiotherapy (CRT). Propensity score weighting was used to balance covariates between treated and untreated groups. Several types of multivariate survival regression models were constructed and compared, including Cox proportional hazards, Weibull, exponential, log-logistic, and lognormal models. Model performance was compared using the Akaike information criterion. The primary end point was overall survival with or without adjuvant chemotherapy or CRT. A total of 1,137 patients met the inclusion criteria for the study. The lognormal survival model showed the best performance. A Web browser-based nomogram was built from this model to make individualized estimates of survival. The model predicts that certain subsets of patients with at least T2 or N1 disease will gain a survival benefit from adjuvant CRT, and the magnitude of benefit for an individual patient can vary. A nomogram built from a parametric survival model from the SEER-Medicare database can be used as a decision aid to predict which gallbladder patients may benefit from adjuvant CRT.

• The taccalonolides, novel microtubule stabilizers, and γ-radiation have additive effects on cellular viability.

  Authors: April L Risinger, Mohan Natarajan, Charles R Thomas, Susan L Mooberry

  Cancer letters. 08/2011; 307(1):104-11.

  The taccalonolides are novel antimitotic microtubule stabilizers that have a unique mechanism of action independent of a direct interaction with tubulin. Cytotoxicity and clonogenic assays show thatThe taccalonolides are novel antimitotic microtubule stabilizers that have a unique mechanism of action independent of a direct interaction with tubulin. Cytotoxicity and clonogenic assays show that taccalonolide A and radiation act in an additive manner to cause cell death. The taxanes and epothilones have utility when combined with radiotherapy and these findings further suggest the additive effects of microtubule targeting agents with radiation on cellular proliferation are independent of direct tubulin binding and are instead a result of the downstream effects of these agents. These studies suggest that diverse antimitotic agents, including the taccalonolides, may have utility in chemoradiotherapy.

• Prospective randomized double-blind pilot study of site-specific consensus atlas implementation for rectal cancer target volume delineation in the cooperative group setting.

  Authors: Clifton D Fuller, Jasper Nijkamp, Joop C Duppen, Coen R N Rasch, Charles R Thomas, Samuel J Wang, Paul Okunieff, William E Jones, Daniel Baseman, Shilpen Patel [......] Benjamin D Smith, Alan W Katz, Camille McGann, Jennifer L Harper, Daniel T Chang, Stephen Smalley, David T Marshall, Karyn A Goodman, Niko Papanikolaou, Lisa A Kachnic

  International journal of radiation oncology, biology, physics. 02/2011; 79(2):481-9.

  Variations in target volume delineation represent a significant hurdle in clinical trials involving conformal radiotherapy. We sought to determine the effect of a consensus guideline-based visualVariations in target volume delineation represent a significant hurdle in clinical trials involving conformal radiotherapy. We sought to determine the effect of a consensus guideline-based visual atlas on contouring the target volumes. A representative case was contoured (Scan 1) by 14 physician observers and a reference expert with and without target volume delineation instructions derived from a proposed rectal cancer clinical trial involving conformal radiotherapy. The gross tumor volume (GTV), and two clinical target volumes (CTVA, including the internal iliac, presacral, and perirectal nodes, and CTVB, which included the external iliac nodes) were contoured. The observers were randomly assigned to receipt (Group A) or nonreceipt (Group B) of a consensus guideline and atlas for anorectal cancers and then instructed to recontour the same case/images (Scan 2). Observer variation was analyzed volumetrically using the conformation number (CN, where CN = 1 equals total agreement). Of 14 evaluable contour sets (1 expert and 7 Group A and 6 Group B observers), greater agreement was found for the GTV (mean CN, 0.75) than for the CTVs (mean CN, 0.46-0.65). Atlas exposure for Group A led to significantly increased interobserver agreement for CTVA (mean initial CN, 0.68, after atlas use, 0.76; p = .03) and increased agreement with the expert reference (initial mean CN, 0.58; after atlas use, 0.69; p = .02). For the GTV and CTVB, neither the interobserver nor the expert agreement was altered after atlas exposure. Consensus guideline atlas implementation resulted in a detectable difference in interobserver agreement and a greater approximation of expert volumes for the CTVA but not for the GTV or CTVB in the specified case. Visual atlas inclusion should be considered as a feature in future clinical trials incorporating conformal RT.

• An interactive tool for individualized estimation of conditional survival in rectal cancer.

  Authors: Samuel J Wang, Amanda R Wissel, Join Y Luh, C David Fuller, Jayashree Kalpathy-Cramer, Charles R Thomas

  Annals of surgical oncology. 01/2011; 18(6):1547-52.

  For rectal cancer patients who have already survived a period of time after diagnosis, survival probability changes and is more accurately depicted by conditional survival. The specific aim of thisFor rectal cancer patients who have already survived a period of time after diagnosis, survival probability changes and is more accurately depicted by conditional survival. The specific aim of this study was to develop an interactive tool for individualized estimation of changing prognosis for rectal cancer patients. A multivariate Cox proportional hazards (CPH) survival model was constructed using data from rectal cancer patients diagnosed from 1994 to 2003 from the Surveillance, Epidemiology, and End Results (SEER) database. Age, race, sex, and stage were used as covariates in the survival prediction model. The primary outcome variable was overall survival conditional on having survived up to 5 years from diagnosis. Data from 42,830 rectal cancer patients met the inclusion criteria. The multivariate CPH model showed age, race, sex, and stage as significant independent predictors of survival. The survival prediction model demonstrated good calibration and discrimination, with a bootstrap-corrected concordance index of 0.75. A web-based prediction tool was built from this regression model that can compute individualized estimates of changing prognosis over time. An interactive prediction modeling tool can estimate prognosis for rectal cancer patients who have already survived a period of time after diagnosis and treatment. Having more accurate prognostic information can empower both patients and clinicians to be able to make more appropriate decisions regarding follow-up, surveillance testing, and future treatment.

• Renal atrophy secondary to chemoradiotherapy of abdominal malignancies.

  Authors: Gary Y Yang, Kilian Salerno May, Renuka V Iyer, Rameela Chandrasekhar, Gregory E Wilding, Susan A McCloskey, Nikhil I Khushalani, Saikrishna S Yendamuri, John F Gibbs, Marwan Fakih, Charles R Thomas

  International journal of radiation oncology, biology, physics. 10/2010; 78(2):539-46.

  To identify factors predictive of renal atrophy after chemoradiotherapy of gastrointestinal malignancies. Patients who received chemotherapy and abdominal radiotherapy (RT) between 2002 and 2008 wereTo identify factors predictive of renal atrophy after chemoradiotherapy of gastrointestinal malignancies. Patients who received chemotherapy and abdominal radiotherapy (RT) between 2002 and 2008 were identified for this study evaluating change in kidney size and function after RT. Imaging and biochemical data were obtained before and after RT in 6-month intervals. Kidney size was defined by craniocaudal measurement on CT images. The primarily irradiated kidney (PK) was defined as the kidney that received the greater mean kidney dose. Receiver operating characteristic (ROC) curves were generated to predict risk for renal atrophy. Of 130 patients, median age was 64 years, and 51.5% were male. Most primary disease sites were pancreas and periampullary tumors (77.7%). Median follow-up was 9.4 months. Creatinine clearance declined 20.89%, and size of the PK decreased 4.67% 1 year after completion of chemoradiation. Compensatory hypertrophy of the non-PK was not seen. Percentage volumes of the PK receiving ≥10 Gy (V(10)), 15 Gy (V(15)), and 20 Gy (V(20)) were significantly associated with renal atrophy 1 year after RT (p = 0.0030, 0.0029, and 0.0028, respectively). Areas under the ROC curves for V(10), V(15), and V(20) to predict >5% decrease in PK size were 0.760, 0.760, and 0.762, respectively. Significant detriments in PK size and renal function were seen after abdominal RT. The V(10), V(15), and V(20) were predictive of risk for PK atrophy 1 year after RT. Analyses suggest the association of lower-dose renal irradiation with subsequent development of renal atrophy.

• Radiotherapy for thymic neoplasms.

  Authors: Clifton D Fuller, Emma H Ramahi, Noel Aherne, Tony Y Eng, Charles R Thomas

  Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer. 10/2010; 5(10 Suppl 4):S327-35.

  The role of radiotherapy in the treatment of thymoma and thymic carcinoma has been evaluated by many investigators over the past two decades. The low incidence of these neoplasms has limited mostThe role of radiotherapy in the treatment of thymoma and thymic carcinoma has been evaluated by many investigators over the past two decades. The low incidence of these neoplasms has limited most published studies to small series spanning long time intervals or population-based studies. The exact indications and protocols for the use of radiotherapy as a part of the multidisciplinary approach to thymoma and thymic carcinoma are still unclear. However, a review of recent literature shows potential benefits for certain patients based on stage and grade of disease as well as the extent of surgical resection.

• Prognostic factors derived from a prospective database dictate clinical biology of anal cancer: the intergroup trial (RTOG 98-11).

  Authors: Jaffer A Ajani, Kathryn A Winter, Leonard L Gunderson, John Pedersen, Al B Benson, Charles R Thomas, Robert J Mayer, Michael G Haddock, Tyvin A Rich, Christopher G Willett

  Cancer. 09/2010; 116(17):4007-13.

  Only 4 prospective randomized phase 3 trials have been reported for anal cancer. A prognostic factor analysis for anal cancer from a prospective database has been published from only 1 study (N =Only 4 prospective randomized phase 3 trials have been reported for anal cancer. A prognostic factor analysis for anal cancer from a prospective database has been published from only 1 study (N = 110). To confirm and uncover new prognostic factors, we analyzed the prospective database of intergroup RTOG 98-11. Univariate and multivariate analyses of the baseline characteristics for 5-year overall survival (OS) and disease-free survival (DFS) were carried out. Various combinations of tumor diameter and clinically positive nodes (N(+)) were analyzed to identify subgroups. A total of 644 were assessable and analyzed. Tumor diameter >5 cm was associated with poorer 5-year DFS (P = .0003) and poorer 5-year OS (P = .0031), and N(+) was associated with poorer 5-year DFS (P </= .0001) and poorer 5-year OS (P = </= .0001) in the multivariate analysis. In stratified analyses, N(+) had more adverse influence on DFS and OS than did tumor diameter. Patients with >5-cm tumor and N(+) had the worst DFS (only 30% at 3 years compared with 74% for the best group; <5 cm primary and N0) and OS (only 48% at 4 years compared with 81% for the best group; <5 cm primary and N0). Men had worse DFS (P = .02) and OS (P = .016). These factors maintained their influence in each treatment arm. This prospective prognostic factor analysis establishes tumor diameter as an independent prognosticator of poorer 5-year DFS and OS and confirms N(+) and male sex as poor prognostic factors. This analysis also uncovers novel subgroups (derived from combining prognostic factors) with incremental worsening of DFS and OS.

• Cancer emergencies. Preface.

  Authors: Mohamud Daya, David M Spiro, Charles R Thomas

  Hematology/oncology clinics of North America. 06/2010; 24(3):xi-xii.

• Conditional survival and the choice of conditioning set for patients with colon cancer: an analysis of NSABP trials C-03 through C-07.

  Authors: Beth A Zamboni, Greg Yothers, Mehee Choi, Clifton D Fuller, James J Dignam, Peter C Raich, Charles R Thomas, Michael J O'Connell, Norman Wolmark, Samuel J Wang

  Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 05/2010; 28(15):2544-8.

  Colon cancer overall survival (OS) is usually computed from the time of diagnosis. Survival gives the initial prognosis but does not reflect how prognosis changes with changing hazard rates overColon cancer overall survival (OS) is usually computed from the time of diagnosis. Survival gives the initial prognosis but does not reflect how prognosis changes with changing hazard rates over time. Conditional survival (probability of surviving y additional years given they have survived x years [CS or OS|OS]) is an alternative measure that accounts for elapsed time since diagnosis, providing more relevant prognostic information. We extend the concept of CS to condition on the set of patients alive, recurrence-free, and second primary cancer-free (disease-free survival [OS|DFS]). Using data from National Surgical Adjuvant Breast and Bowel Project trials C-03 through C-07, 5-year OS|DFS was calculated on patients who were disease free up to 5 years after diagnosis, stratified by age, stage, nodal status, and performance status (PS). For stage II, OS|DFS improved from 87% to 92% at 5 years. For stage III, OS|DFS improved from 69% to 88%. Patients younger than 50 years showed OS|DFS improvement from 79% to 95%; those older than 70 years showed no sustained increase in OS|DFS. Node-negative patients with > or = 12 nodes resected showed little change (89% to 94%); those with more than four positive nodes showed an improvement (57% to 86%). Patients with a PS of 0 or 1 demonstrated a small improvement; those with a PS of 2 did not (64% to 58%). Prognosis improves over time for almost all groups of patients with colon cancer, especially those with positive nodes. OS|DFS is a more relevant measure of prognosis for those who have already survived disease free a period of time after diagnosis.

• Chemoradiation for anal cancer: the more things change, the more they stay the same.

  Authors: Clifton D Fuller, Charles R Thomas

  Oncology (Williston Park, N.Y.). 04/2010; 24(5):427-30.

• Parametric survival models for predicting the benefit of adjuvant chemoradiotherapy in gallbladder cancer.

  Authors: Samuel J Wang, Jayashree Kalpathy-Cramer, Jong Sung Kim, C David Fuller, Charles R Thomas

  AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 01/2010; 2010:847-51.

  The Cox proportional hazards model is the most commonly used survival model in oncology; however, this semi-parametric model may not be the most appropriate survival model when the proportionalityThe Cox proportional hazards model is the most commonly used survival model in oncology; however, this semi-parametric model may not be the most appropriate survival model when the proportionality assumption does not hold. In this study, we consider the use of several types of accelerated failure time parametric survival techniques for modeling the benefit of adjuvant chemoradiotherapy for gallbladder cancer. In comparing the Weibull, exponential, log-logistic, and log-normal models, we found that the log-normal had the most favorable Akaike Information Criterion, and additional analyses of this model indicated that our gallbladder cancer dataset exhibited a good fit with the log-normal cumulative hazard function. This log-normal survival model can be used to help predict which patients will benefit from adjuvant chemoradiotherapy.

• A population-based analysis of surgical and adjuvant therapy for resected gastric cancer: are patients receiving appropriate treatment following publication of the intergroup 0116 results?

  Authors: C Kristian Enestvedt, Brian S Diggs, Donald K Shipley, Charles R Thomas, Kevin G Billingsley

  Gastrointestinal cancer research : GCR. 11/2009; 3(6):233-8.

  The use of adjuvant therapy for resectable gastric adenocarcinoma has become standard of care since the publication of the Intergroup 0116 data. The aims of this study were to (1) assess currentThe use of adjuvant therapy for resectable gastric adenocarcinoma has become standard of care since the publication of the Intergroup 0116 data. The aims of this study were to (1) assess current practice patterns in gastric cancer treatment, and (2) determine the effect of increasing use of adjuvant chemoradiotherapy on survival in patients with gastric cancer. Data from the Oregon State Cancer Registry were abstracted for demographics, disease stage, resection type, number of lymph nodes resected, adjuvant chemoradiotherapy (CRT), and survival for 1996-2006. Patients with stages IB-III disease were divided into cohorts treated through year 2001 (Group 1) or after 2001 (Group 2). Chemoradiotherapy use between groups was compared with the chi-square test. Univariate and multivariate analyses of survival were performed. Binary logistic regression determined predictors for the receipt of CRT. A total of 308 patients met study criteria. Adjuvant therapy was employed in 17.0% of cases in Group 1 vs. 36.8% in Group 2 (P < .001). Tumor stage, tumor location, and American Joint Committee on Cancer (AJCC) stage were independent predictors of survival in both univariate and multivariate analyses. In this retrospective analysis, a modest survival benefit was associated with CRT, but this benefit did not reach statistical significance. Independent predictors for the receipt of CRT included age, AJCC stage, N2 disease, and treatment era. While the use of adjuvant CRT increased after publication of Intergroup 0116 data, 63.2% of potentially eligible patients did not receive CRT. Future efforts should focus on identifying and removing barriers to the receipt of adjuvant therapy following resection of gastric adenocarcinoma.

• Report from the Radiation Therapy Committee of the Southwest Oncology Group (SWOG): Research Objectives Workshop 2008.

  Authors: Paul Okunieff, Lisa A Kachnic, Louis S Constine, Clifton D Fuller, Laurie E Gaspar, Daniel F Hayes, Jean Hooks, Clifton Ling, Frank L Meyskens, Philip A Philip, David Raben, Stephen R Smalley, Gregory P Swanson, Beverly A Teicher, Charles R Thomas, Bhadrasain Vikram, Michael J Zelefsky, Laurence H Baker

  Clinical cancer research : an official journal of the American Association for Cancer Research. 10/2009;

  Strategic planning for the Radiation Therapy Committee of the Southwest Oncology Group (SWOG) is comprehensively evaluated every six years in an effort to maintain a current and relevant scientificStrategic planning for the Radiation Therapy Committee of the Southwest Oncology Group (SWOG) is comprehensively evaluated every six years in an effort to maintain a current and relevant scientific focus, and to provide a standard platform for future development of protocol concepts. Participants in the 2008 Strategic Planning Workshop included clinical trial experts from multiple specialties, industry representatives from both pharmaceuticals and equipment manufacturers, and basic scientists. High-priority research areas such as image-guided radiation therapy for control of limited metastatic disease, analysis of biomarkers for treatment response and late toxicity, assessment of novel agents in combination with radiation, standardization of radiation target delineation, and the assessment of new imaging techniques to individualize cancer therapy, were discussed. Research priorities included clinical study designs featuring translational end points that identify patients most likely to benefit from combined modality therapy; intervention including combination radiation with standard chemotherapy; radiation with radiosensitizing molecular-targeted therapies; and stereotactic radiation for treatment of patients with regard to asymptomatic metastasis and radiation-induced tumor autoimmunity. The Committee concluded that the future research opportunities are among the most exciting to have developed in the last decade, and work is in progress to embark on these plans. (Clin Cancer Res 2009;15(18):OF1-8).

• Relative lack of conditional survival improvement in young adults with cancer.

  Authors: Archie Bleyer, Mehee Choi, C David Fuller, Charles R Thomas, Samuel J Wang

  Seminars in oncology. 10/2009; 36(5):460-7.

  Cancer prognosis is usually reported in terms of survival from time of diagnosis. For patients surviving a period of time after diagnosis, conditional survival (CS) accounts for changing risk overCancer prognosis is usually reported in terms of survival from time of diagnosis. For patients surviving a period of time after diagnosis, conditional survival (CS) accounts for changing risk over time. This report provides information on how CS in cancer patients changes as a function of age at diagnosis. Using data from the US Surveillance, Epidemiology and End Results database, we examined survival for patients diagnosed between 1973 and 2002. The average annual percent change (AAPC) in CS during the first 5 years after diagnosis was evaluated for the 14 most common cancers occurring in young adults, defined as 15- to 39-year-olds, and how they compared with cancers that are more common in older and younger patients. For all cancers, young adult patients had less CS improvement over time than younger or older patients, and this difference was most pronounced in those aged 20 to 29 years (45% below the mean). Eleven of the 14 most common cancers in 15- to 39-year-olds either had a lower CS improvement after diagnosis than either younger or older patients, or than just the older patients. Young adults with leukemia had the greatest improvement in CS over time. In conclusion, young adults with cancer have not enjoyed the same improvement in CS over time compared with other age groups. Explanations for this deficit include the biologic nature of the type of cancers in young adults and less effective therapies for patients in the age group. Regardless of the reasons, the deficit is yet another challenge faced by young adult patients that merits further study.

• Multimodality therapy for locoregional extrahepatic cholangiocarcinoma : a population-based analysis.

  Authors: Clifton D Fuller, Samuel J Wang, Mehee Choi, Brian G Czito, John Cornell, Tania M Welzel, Katherine A McGlynn, Join Y Luh, Charles R Thomas

  Cancer. 08/2009;

  BACKGROUND:: Although surgical resection is the mainstay of treatment for extrahepatic cholangiocarcinoma, the majority of patients present with advanced disease. Due in part to numeric rarity, theBACKGROUND:: Although surgical resection is the mainstay of treatment for extrahepatic cholangiocarcinoma, the majority of patients present with advanced disease. Due in part to numeric rarity, the optimum role of radiotherapy (RT) for extrahepatic cholangiocarcinoma, as well as its relative benefit, is an area of debate. The specific aim of this series was to estimate survival for extrahepatic cholangiocarcinoma patients receiving surgery and adjuvant RT using a robust population-based data set. METHODS:: Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) limited-use data set for selected extrahepatic cholangiocarcinoma cases. Lognormal multivariate survival analysis was implemented to estimate survival for patients for treatment cohorts based on extent of surgical intervention and RT. RESULTS:: Parametric estimated median survival for patients receiving total/radical resection + RT was 26 months; it was 25 months for total/radical resection alone, 25 months for subtotal/debulking resection + RT, 21 months for subtotal/debulking resection, 12 months for RT alone, and 9 months for those not receiving surgery or RT. Parametric multivariate analysis revealed age, American Joint Committee on Cancer Stage, grade, and surgical/radiation regimen as statistically significant covariates with survival. Surgery alone and adjuvant RT cohorts demonstrated evidence of improved survival compared with no treatment; comparatively, RT alone was associated with survival decrement. Early improvement in survival in adjuvant cohorts was not observed at later time points. CONCLUSIONS:: Survival estimates using SEER data suggest an early survival advantage for adjuvant RT for patients with locoregional extrahepatic cholangiocarcinoma. Although future prospective series are needed to confirm these observations, SEER data represent the largest domestic population-based extrahepatic cholangiocarcinoma cohort, and may provide useful baseline survival estimates for future studies. Cancer 2009. Published 2009 by the American Cancer Society.

• Cancer emergencies, part I. Preface.

  Authors: Mohamud Daya, Charles R Thomas

  Emergency medicine clinics of North America. 06/2009; 27(2):xvii-xviii.