Charles R Thomas

Oregon Health and Science University, Portland, Oregon, United States

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Publications (154)1048.29 Total impact

  • Ravi Shridhar, David Shibata, Emily Chan, Charles R. Thomas
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    ABSTRACT: Answer questions and earn CME/CNEThe management of squamous cell carcinomas of the anal canal has evolved from surgery as first-line treatment to curative chemoradiation, with surgery reserved for salvage. Significant progress has been made in understanding how to most effectively deliver chemotherapy and reduce toxicity through advancements in radiation delivery. The purpose of this article is to review the multimodality approach to the diagnosis and management of anal cancer based on a review of the published data and in light of available guidelines. CA Cancer J Clin 2015. © 2015 American Cancer Society.
    CA A Cancer Journal for Clinicians 01/2015; · 153.46 Impact Factor
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    ABSTRACT: The management of rectal cancer in patients with metastatic disease at presentation is highly variable. There are no phase III trials addressing therapeutic approaches, and the optimal sequencing of chemotherapy, radiation therapy, and surgery remains unresolved. Although chemoradiation is standard for patients with stage II/III rectal cancer, its role in the metastatic setting is controversial. Omitting chemoradiation may not be appropriate in all stage IV patients, particularly those with symptomatic primary tumors. Moreover, outcomes in this setting are vastly different, as some treatments carry the potential for cure in selected patients, while others are purely palliative. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application, by the panel, of a well-established consensus methodology (Modified Delphi) to rate the appropriateness of imaging and treatment procedures. In instances in which evidence is lacking or not definitive, expert opinion may be used as the basis for recommending imaging or treatment.
    Oncology (Williston Park, N.Y.) 10/2014; 28(10). · 2.98 Impact Factor
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    ABSTRACT: Exaggerating the current benefit of screening mammography and minimizing its harms are readily accomplished by the application of assumptions based on data one‐quarter to half of a century old, and they are neither reliable for predicting what is happening today nor appropriate for the treatment advances that have happened since. Helvie and colleagues are culpable of this conduct.
    Cancer 09/2014; · 5.20 Impact Factor
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    ABSTRACT: To assess the medical oncology (MO) physician workforce diversity by race, Hispanic ethnicity, and sex, with attention to trainees.
    Journal of Oncology Practice 07/2014;
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    ABSTRACT: Chemoradiotherapy (CRT), the primary treatment for anal cancer, achieves complete tumor regression in most patients. Abdominoperineal resection (APR) is reserved for persistent or recurrent disease. An additional boost dose of radiation after CRT often is used to improve the response rate for advanced local disease (T3, 4, and N+). This study examines the need for salvage APR after radiation boost.
    Annals of Surgical Oncology 06/2014; · 3.94 Impact Factor
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    ABSTRACT: Volumetric-modulated arc radiotherapy (VMAT) is an iteration of intensity-modulated radiotherapy (IMRT), both of which deliver highly conformal dose distributions. Studies have shown the superiority of VMAT and IMRT in comparison with 3-dimensional conformal radiotherapy (3D-CRT) in planning target volume (PTV) coverage and organs-at-risk (OARs) sparing. This is the first study examining the benefits of VMAT in pancreatic cancer for doses more than 55.8Gy. A planning study comparing 3D-CRT, IMRT, and VMAT was performed in 20 patients with pancreatic cancer. Treatments were planned for a 25-fraction delivery of 45Gy to a large field followed by a reduced-volume 8-fraction external beam boost to 59.4Gy in total. OARs and PTV doses, conformality index (CI) deviations from 1.0, monitor units (MUs) delivered, and isodose volumes were compared. IMRT and VMAT CI deviations from 1.0 for the large-field and the boost plans were equivalent (large field: 0.032 and 0.046, respectively; boost: 0.042 and 0.037, respectively; p > 0.05 for all comparisons). Both IMRT and VMAT CI deviations from 1.0 were statistically superior to 3D-CRT (large field: 0.217, boost: 0.177; p < 0.05 for all comparisons). VMAT showed reduction of the mean dose to the boost PTV (VMAT: 61.4Gy, IMRT: 62.4Gy, and 3D-CRT: 62.3Gy; p < 0.05). The mean number of MUs per fraction was significantly lower for VMAT for both the large-field and the boost plans. VMAT delivery time was less than 3 minutes compared with 8 minutes for IMRT. Although no statistically significant dose reduction to the OARs was identified when comparing VMAT with IMRT, VMAT showed a reduction in the volumes of the 100% isodose line for the large-field plans. Dose escalation to 59.4Gy in pancreatic cancer is dosimetrically feasible with shorter treatment times, fewer MUs delivered, and comparable CIs for VMAT when compared with IMRT.
    Medical dosimetry: official journal of the American Association of Medical Dosimetrists 05/2014; · 1.26 Impact Factor
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    ABSTRACT: Embolization coils as fiducial markers for pulmonary stereotactic body radiation therapy (SBRT) are perceived to be the optimal marker type, given their ability to conform and anchor within the small airways. The aim of our study was to assess retention, placement, migration, feasibility, and safety of electromagnetic navigational bronchoscopy (ENB)-guided embolization coil markers throughout courses of SBRT. Thirty-one patients with 34 nodules underwent ENB-guided fiducial placement of several 4 mm fibered platinum embolization coils before SBRT. Patient and nodule positioning was confirmed with daily pretreatment cone-beam computed tomography (CBCT). Fiducial positional characteristics were analyzed utilizing radiation treatment-planning software comparing the simulation CT with daily CBCTs. Of 105 fiducials placed, 103 were identifiable on simulation CT (retention rate: 98.1%). Incidence of asymptomatic pneumothoraces was 6%. One patient experienced hemoptysis requiring hospitalization. Eighty-six percent of fiducials were placed within 1 cm of the nodule, with 52% of fiducials placed directly on the nodule surface. Throughout a 5-fraction SBRT course, fiducial displacement was <7, 5, and 2 mm in 98%, 96%, and 67% of pretreatment CBCTs. ENB placement of embolization coils as fiducials for lung SBRT image guidance is associated with a low rate of iatrogenic pneumothoraces, and resulted in reliable placement of the fiducials in close proximity to the lung nodule. Embolization coils retained their relative position to the nodule throughout the course of SBRT, and provide an excellent alternative to linear gold seeds.
    Journal of bronchology & interventional pulmonology. 04/2014; 21(2):123-30.
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    ABSTRACT: Patients treated with neoadjuvant chemoradiotherapy (NAC) followed by esophagectomy are more likely to have negative margins at resection, be downstaged, and have improved overall survival (OS). The specific aim of this study was to analyze OS outcomes using NAC followed by esophagectomy at a single, tertiary care academic medical center. We retrospectively analyzed 106 patients that underwent NAC with platinum-based chemotherapy plus 5-fluorouracil (5-FU) or capecitabine followed by esophagectomy from September 1996 to May 2011. OS was analyzed by the Kaplan Meier method. Initial staging determined that of 106 patients, 62% had stage III (n=66), 31% stage II (n=33), and 7% had stage I disease (n=7). Following NAC, 92.5% (n=98) were resected with negative (R0) margins and pathologic staging revealed 59% (n=62) were downstaged, 9% (n=10) were upstaged, and 32% (n=34) remained at the same stage. A pathologic complete response (pCR) was achieved in 29% (n=31) of the cohort. Median OS was 35.2 months for all patients, 42 months for downstaged patients, 13 months when upstaged, and 17 months for those who remained at the same stage (P=0.08). OS by histological type was 30 months for adenocarcinoma and 71 months for squamous cell carcinoma (P=0.06). NAC was effective in downstaging 59% of patients and effectively increased the chance for an R0 resection. These patients, in turn, had improved OS compared to the median OS. Patients with squamous cell carcinoma showed a trend towards more favorable OS.
    Journal of gastrointestinal oncology 04/2014; 5(2):86-91.
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    ABSTRACT: To determine the frequency and appearance of radiation-induced liver disease on PET/CT in patients undergoing serial imaging during neoadjuvant chemoradiation of distal esophageal cancer. In this IRB-approved, HIPAA-compliant retrospective analysis, we identified 112 patients with distal esophageal cancer treated by neoadjuvant chemoradiation who had serial PET/CT imaging available for review. Two readers reviewed all studies in consensus and recorded those cases where new foci of visually detectable increased FDG avidity appeared in the liver during therapy. The etiology of such foci was determined from corresponding findings at CT or MRI, by hepatic biopsy during surgery, by characteristic evolution on post-operative imaging, or by a combination of these methods. New foci of FDG avidity developed in the liver during neoadjuvant therapy in 10 of 112 (9%) patients, of whom nine (8%) were determined to have radiation-induced liver disease based on further imaging and/or biopsy and one of whom had developed interval metastatic disease based on biopsy. In the cases of radiation-induced liver disease, the abnormal foci were found only in the caudate and left hepatic lobes, near the primary tumor, while the patient who developed interval metastatic disease had involvement of the inferior right hepatic lobe, remote from the radiation therapy field. New foci of increased FDG avidity are commonly seen in the caudate and left hepatic lobes of the liver during neoadjuvant chemoradiation of distal esophageal cancer, and these findings generally reflect radiation-induced liver disease rather than metastatic disease.
    Abdominal Imaging 03/2014; · 1.91 Impact Factor
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    ABSTRACT: This study aimed to analyze gender differences in rank, career duration, publication productivity, and research funding among radiation oncologists at U.S. academic institutions. For 82 domestic academic radiation oncology departments, the authors identified current faculty and recorded their academic rank, degree, and gender. The authors recorded bibliographic metrics for physician faculty from a commercially available database (Scopus, Elsevier BV), including numbers of publications from 1996 to 2012 and h-indices. The authors then concatenated these data with National Institutes of Health (NIH) funding per Research Portfolio Online Reporting Tools. The authors performed descriptive and correlative analyses, stratifying by gender and rank. Of 1,031 faculty, 293 (28%) women and 738 (72%) men, men had a higher median m-index, 0.58 (range 0-3.23) versus 0.47 (0-2.5) (P < .05); h-index, 8 (0-59) versus 5 (0-39) (P < .05); and publication number, 26 (0-591) versus 13 (0-306) (P < .05). Men were more likely to be senior faculty and receive NIH funding. After stratifying for rank, these differences were largely nonsignificant. On multivariate analysis, there were correlations between gender, career duration and academic position, and h-index (P < .01). Determinants of a successful career in academic medicine are multifactorial. Data from radiation oncologists show a systematic gender association, with fewer women achieving senior faculty rank. However, women achieving seniority have productivity metrics comparable to those of male counterparts. This suggests that early career development and mentorship of female faculty may narrow productivity disparities.
    Academic medicine: journal of the Association of American Medical Colleges 03/2014; · 2.34 Impact Factor
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    ABSTRACT: To assess toxicity and efficacy of intensity-modulated radiation therapy (IMRT) for anal cancer. Records of 152 patients were reviewed retrospectively from multiple institutions. Data on disease control and toxicity were collected as well as patient and treatment characteristics. Acute (<6 mo) and late (≥6 mo) severe toxicity (grade ≥3) were graded. Four patients were excluded due to the presence of metastatic disease or stage TX. Late toxicity data were available for 120 patients. Median cumulative IMRT dose was 51.25 Gy (median, 28 fractions). All but 2 patients received chemotherapy. With median follow-up of 26.8 months, local control at 3 years was 87%, worse for patients with T3-T4 than T1-T2 disease on univariate analysis (79% vs. 90%; P=0.04). Regional control, distant control, and overall survival were 97%, 91%, and 87%, respectively, at 3 years. Nodal status was associated with regional control, distant control, and overall survival (P<0.01 for each). Most common severe acute toxicity was hematologic (41%), skin (20%), and gastrointestinal tract (11%). Two grade 5 toxicities occurred (hematologic and gastrointestinal tract). Severe late toxicity affected skin (1%) and gastrointestinal tract (3%). IMRT with chemotherapy resulted in excellent local control. Although T stage predicted worse local control, most T3-T4 disease was controlled with IMRT. Nodal status predicted regional and distant control and overall survival. Severe toxicity was acceptable.
    American journal of clinical oncology 01/2014; · 2.21 Impact Factor
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    ABSTRACT: Biliary tract cancers are a rare subgroup of malignancies that include gallbladder carcinoma and cholangiocarcinoma. They generally carry a poor prognosis based on the advanced nature of disease at presentation and overall treatment refractoriness. Surgical resection remains the optimal treatment for long-term survival, with consideration of neo-adjuvant or adjuvant therapies. In this review, we summarize the role of adjuvant treatments including radiation therapy, chemotherapy, and concurrent chemoradiation with the existing clinical evidence for each treatment decision. Given the rarity of these tumors, the evidence provided is based largely on retrospective studies, SEER database inquiries, single- or multi-institutional prospective studies, and a meta-analysis of adjuvant therapy studies. Currently, there is no adjuvant therapy that has been agreed upon as standard of care. Results from prospective, multi-institutional phase II and III trials are awaited, along with advances in molecularly-targeted therapies and radiation techniques, which will better define treatment standards and improve outcomes in this group of diseases.
    Seminars in Arthroplasty 01/2014;
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    ABSTRACT: The management of anal cancer is driven by randomized and nonrandomized clinical trials. However, trials may present conflicting conclusions. Furthermore, different clinical situations may not be addressed in certain trials because of eligibility inclusion criteria. Although prospective studies point to the use of definitive 5-fluorouracil and mitomycin C-based chemoradiation as a standard, some areas remain that are not well defined. In particular, management of very early stage disease, radiation dose, and the use of intensity-modulated radiation therapy remain unaddressed by phase III studies. The American College of Radiology (ACR) Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
    Gastrointestinal cancer research: GCR 01/2014; 7(1):4-14.
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    ABSTRACT: To analyze survey information regarding mentorship practices and cross-correlate the results with objective metrics of academic productivity among academic radiation oncologists at US Accreditation Council for Graduate Medical Education (ACGME)-accredited residency training programs. An institutional review board-approved survey for the Radiation Oncology Academic Development and Mentorship Assessment Project (ROADMAP) was sent to 1031 radiation oncologists employed at an ACGME-accredited residency training program and administered using an international secure web application designed exclusively to support data capture for research studies. Data collected included demographics, presence of mentorship, and the nature of specific mentoring activities. Productivity metrics, including number of publications, number of citations, h-index, and date of first publication, were collected for each survey respondent from a commercially available online database, and m-index was calculated. A total of 158 academic radiation oncologists completed the survey, 96 of whom reported having an academic/scientific mentor. Faculty with a mentor had higher numbers of publications, citations, and h- and m-indices. Differences in gender and race/ethnicity were not associated with significant differences in mentorship rates, but those with a mentor were more likely to have a PhD degree and were more likely to have more time protected for research. Bivariate fit regression modeling showed a positive correlation between a mentor's h-index and their mentee's h-index (R(2) = 0.16; P<.001). Linear regression also showed significant correlates of higher h-index, in addition to having a mentor (P=.001), included a longer career duration (P<.001) and fewer patients in treatment (P=.02). Mentorship is widely believed to be important to career development and academic productivity. These results emphasize the importance of identifying and striving to overcome potential barriers to effective mentorship.
    International journal of radiation oncology, biology, physics 11/2013; · 4.59 Impact Factor
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    ABSTRACT: The survival impact of neoadjuvant chemoradiotherapy (CRT) on esophageal cancer remains difficult to establish for specific patients. The aim of the current study was to create a Web-based prediction tool providing individualized survival projections based on tumor and treatment data. Patients diagnosed with esophageal cancer between 1997 and 2005 were selected from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. The covariates analyzed were sex, T and N classification, histology, total number of lymph nodes examined, and treatment with esophagectomy or CRT followed by esophagectomy. After propensity score weighting, a log-logistic regression model for overall survival was selected based on the Akaike information criterion. A total of 824 patients with esophageal cancer who were treated with esophagectomy or trimodal therapy met the selection criteria. On multivariate analysis, age, sex, T and N classification, number of lymph nodes examined, treatment, and histology were found to be significantly associated with overall survival and were included in the regression analysis. Preoperative staging data and final surgical margin status were not available within the SEER-Medicare data set and therefore were not included. The model predicted that patients with T4 or lymph node disease benefitted from CRT. The internally validated concordance index was 0.72. The SEER-Medicare database of patients with esophageal cancer can be used to produce a survival prediction tool that: 1) serves as a counseling and decision aid to patients and 2) assists in risk modeling. Patients with T4 or lymph node disease appeared to benefit from CRT. This nomogram may underestimate the benefit of CRT due to its variable downstaging effect on pathologic stage. It is available at Cancer 2013;. © 2013 American Cancer Society.
    Cancer 11/2013; · 5.20 Impact Factor
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    ABSTRACT: The aims of this study were to determine the self-reported prevalence of burnout in chairs of academic radiation oncology departments, to identify factors contributing to burnout, and to compare the prevalence of burnout with that seen in other academic chair groups. An anonymous online survey was administered to the membership of the Society of Chairs of Academic Radiation Oncology Programs (SCAROP). Burnout was measured with the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). Questionnaires were returned from 66 of 87 chairs (76% response rate). Seventy-nine percent of respondents reported satisfaction with their current positions. Common major stressors were budget deficits and human resource issues. One-quarter of chairs reported that it was at least moderately likely that they would step down in the next 1 to 2 years; these individuals demonstrated significantly higher emotional exhaustion. Twenty-five percent of respondents met the MBI-HSS criteria for low burnout, 75% for moderate burnout, and none for high burnout. Group MBI-HSS subscale scores demonstrated a pattern of moderate emotional exhaustion, low depersonalization, and moderate personal accomplishment, comparing favorably with other specialties. This is the first study of burnout in radiation oncology chairs with a high response rate and using a validated psychometric tool. Radiation oncology chairs share similar major stressors to other chair groups, but they demonstrate relatively high job satisfaction and lower burnout. Emotional exhaustion may contribute to the anticipated turnover in coming years. Further efforts addressing individual and institutional factors associated with burnout may improve the relationship with work of chairs and other department members.
    International journal of radiation oncology, biology, physics 11/2013; · 4.59 Impact Factor
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    ABSTRACT: The long-term update of US GI Intergroup RTOG 98-11 anal cancer trial found that concurrent chemoradiation (CCRT) with fluorouracil (5-FU) plus mitomycin had a significant impact on disease-free survival (DFS) and overall survival (OS) compared with induction plus concurrent 5-FU plus cisplatin. The intent of the current analysis was to determine the impact of tumor node (TN) category of disease on survival (DFS and OS), colostomy failure (CF), and relapse (local-regional failure [LRF] and distant metastases [DM]) in this patient group. DFS and OS were estimated univariately by using the Kaplan-Meier method, and 6 TN categories were compared by the log-rank test (T2N0, T3N0, T4N0, T2N1-3, T3N1-3, and T4N1-3). Time to relapse and colostomy were estimated by the cumulative incidence method, and TN categories were compared using Gray's test. Of 682 patients, 620 were analyzable for outcomes by TN category. All endpoints showed statistically significant differences among the TN categories of disease (OS, P<.0001; DFS, P<.0001; LRF, P<.0001; DM, P=.0011; CF, P=.01). Patients with the poorest OS, DFS, and LRF outcomes were those with T3-4N-positive (+) disease. CF was lowest for T2N0 and T2N+ (11%, 11%, respectively) and worst for the T4N0, T3N+, and T4N+ categories (26%, 27%, 24%, respectively). TN category of disease has a statistically significant impact on OS, DFS, LRF, DM, and CF in patients treated with CCRT and provides excellent prognostic information for outcomes in patients with anal carcinoma. Significant challenges remain for patients with T4N0 and T3-4N+ categories of disease with regard to survival, relapse, and CF and lesser challenges for T2-3N0/T2N+ categories.
    International journal of radiation oncology, biology, physics 09/2013; · 4.59 Impact Factor
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    ABSTRACT: Purpose:To assess the diversity of the U.S. diagnostic radiology physician workforce by race, Hispanic ethnicity, and sex in the context of the available pipeline of medical students.Materials and Methods:Institutional review board evaluation and exemption were granted for the study, as primary data were obtained from publicly available registry sources, with no identifiable private or protected information. Publicly available American Medical Association, American Association of Medical Colleges, and U.S. census registries were used to assess differences for 2010 among diagnostic radiology practicing physicians, academic faculty, residents, subspecialty trainees, residency applicants, medical school graduates, and U.S. population by using binomial tests; with adjustment for multiple comparisons among different groups, differences with P < .001 were considered significant. Significant differences in diagnostic radiology resident representation were evaluated for academic years 2003-2004 to 2010-2011 and for 2010, compared among the 20 largest residency training programs.Results:Females and traditionally underrepresented minorities in medicine (URM)-blacks, Hispanics, American Indians, Alaskan Natives, Native Hawaiians, and Pacific Islanders (AI/AN/NH/PI)-are underrepresented as practicing physicians (23.5% and 6.5%, respectively), faculty (26.1%, 5.9%), and diagnostic radiology residents (27.8%, 8.3%), compared with the U.S. population (50.8%, 30.0%) (all P < .001). Although they are increased in percentage as residents compared with practicing physicians, females and URMs remain underrepresented at the resident trainee level, compared with their proportions as medical school graduates (48.3%, 15.3%, respectively). During the past 8 years, there was no significant increase in female or URM resident (all P > .01) representation, suggesting no dramatic change in future representation as practicing physicians. Moreover, diagnostic radiology ranks 17th in female and 20th in URM representation among the 20 largest residency training specialties.Conclusion:Females and URM remain underrepresented in the diagnostic radiology physician workforce despite an available medical student pipeline. Given prevalent health care disparities and an increasingly diverse society, future research and training efforts should address increasing resident diversity with program directors and department chairs.© RSNA, 2013.
    Radiology 07/2013; · 6.21 Impact Factor
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    ABSTRACT: Objective assessment of academic productivity is useful for residency programs. This study aims to analyze the number of publications and Hirsch index (h index) among radiation oncology residents. Names of residents during the 2010 academic year (n = 607) were collected from the Association of Residents in Radiation Oncology 2010 Directory. Number of publications and h index from Jan. 1996 to Feb. 2012 were collected from a bibliographic database (SCOPUS, Elsevier, BV, Amsterdam, NL). Analysis of h index included stratification by gender, residency size, and postresidency private practice or academic employment. Six hundred seven residents, 67 % men and 33 % women, had an overall mean h index of 2.5 ± 3.2. Graduates in academia exhibited a higher mean h index (3.9 ± 0.30) compared to private practice (2.0 ± 0.25; p < 0.01). Gender, residency size, and post-graduate position remained correlates of h index (all p ≤ 0.01). Women had lower mean h index and number of publications than men (2.1 ± 2.3 vs 2.7 ± 3.5, 4.5 ± 5.3 vs 6.2 ± 8.0, respectively; both p < 0.05). However, when stratified by current position (resident, private practice, or academic), there were no significant differences in h index by gender. The mean ± SD h indices for institutions comprising the top 10 % ranged 4.17 ± 3.2-5.25 ± 5.4 while the bottom 10 % ranged 0.0 ± 0.0-0.75 ± 1.4. The h index is a useful metric to assess residents' early dedication to scholarly endeavors. Female radiation oncology residents had fewer total publications and slightly lower h indices, warranting accessible research avenues and environments for future female physician-scientists. The application of the h index provides a reference for medical students, residents, residency program directors, and many others to gauge academic performance and establish appropriate benchmarks.
    Journal of Cancer Education 07/2013; · 0.88 Impact Factor
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    ABSTRACT: In 2013, roughly 18,000 cases of esophageal cancer will be diagnosed in the United States with more than 15,000 people dying from the disease. Worldwide, an estimated 482,300 new esophageal cancer cases were diagnosed with 406,800 deaths in 2008. Squamous cell carcinoma (SCC) and adenocarcinoma (AC) account for >90 % of all esophageal cancer cases. The authors will examine the role of radiation therapy, chemotherapy, and surgery in the curative management of esophageal cancer by examining randomized control data, single arm phase II trials, several recently published meta-analyses, as well as retrospective data where there is no clinical trial data available. The role of positron emission tomography (PET) will be reviewed as well. Current data support the role of neoadjuvant chemoradiotherapy followed by surgical resection for locally advanced esophageal cancer with 3-year overall survival ranging from 30 % to 60 %. The benefit of adjuvant chemoradiation therapy is limited to margin positive and/or node positive patients. There is emerging data questioning the survival benefit of surgical resection after chemoradiotherapy. External beam radiation therapy alone results in very few long-term survivors and is considered palliative at best. Radiation dose-escalation has failed to improve local control or survival. PET scanning is vital in staging and has become a strong predictor of response and survival. Preoperative or definitive concurrent chemoradiotherapy is the established standard of care for locally advanced cancers of the esophagus. While preoperative chemotherapy is supported by level 1 evidence, the true benefit of induction chemotherapy before chemoradiotherapy has not been established in a prospective randomized control trial. The role of surgery in the management of SCC is still a hotly debated subject, however, it is still recommended for AC. There is no data to support adjuvant chemotherapy after preoperative chemoradiotherapy. The benefit of neoadjuvant chemotherapy seems to be limited AC. Radiation without chemotherapy is palliative and never curative. PET continues to be integrated into treatment decisions and predicts for response and survival after therapy.
    Journal of Gastrointestinal Cancer 07/2013;

Publication Stats

2k Citations
1,048.29 Total Impact Points


  • 2004–2014
    • Oregon Health and Science University
      • • Department of Radiation Medicine
      • • Department of Emergency Medicine
      • • Division of Surgical Oncology
      Portland, Oregon, United States
  • 2013
    • Mayo Clinic - Scottsdale
      Scottsdale, Arizona, United States
    • Moffitt Cancer Center
      Tampa, Florida, United States
  • 2009–2013
    • University of Texas MD Anderson Cancer Center
      • Division of Radiation Oncology
      Houston, Texas, United States
    • Vanderbilt University
      • Division of Hematology and Oncology
      Nashville, MI, United States
  • 2001–2013
    • University of Texas Health Science Center at San Antonio
      • Department of Radiation Oncology
      San Antonio, Texas, United States
  • 2012
    • Memorial Sloan-Kettering Cancer Center
      • Department of Radiation Oncology
      New York City, NY, United States
    • Drexel University College of Medicine
      • Department of Neurosurgery
      Philadelphia, PA, United States
  • 2011
    • Portland VA Medical Center
      Portland, Oregon, United States
    • Portland State University
      Portland, Oregon, United States
  • 2010
    • Johns Hopkins University
      • Department of Radiation Oncology and Molecular Radiation Sciences
      Baltimore, MD, United States
    • Robert Wood Johnson University Hospital
      New Brunswick, New Jersey, United States
    • University of Pittsburgh
      • Department of Biostatistics
      Pittsburgh, PA, United States
  • 2004–2010
    • Roswell Park Cancer Institute
      • Department of Radiation Medicine
      Buffalo, New York, United States
  • 2008
    • Fred Hutchinson Cancer Research Center
      Seattle, Washington, United States
  • 2007
    • Medical College of Wisconsin
      • Department of Radiation Oncology
      Milwaukee, WI, United States
    • City of Hope National Medical Center
      • Department of Surgery
      Duarte, CA, United States
    • Indiana University-Purdue University Indianapolis
      • Department of Radiation Oncology
      Indianapolis, IN, United States
  • 2006
    • University of California, Los Angeles
      • Department of Radiation Oncology
      Los Angeles, CA, United States
  • 2005
    • Sleep Therapy and Research Center
      San Antonio, Texas, United States
  • 2003–2005
    • Emory University
      • Department of Radiation Oncology
      Atlanta, GA, United States
    • University of Texas Health Science Center at Tyler
      Tyler, Texas, United States
    • University of California, San Francisco
      • Department of Surgery
      San Francisco, CA, United States
  • 1999
    • Medical University of South Carolina
      • Department of Radiation Oncology
      Charleston, SC, United States