Shulian Wang

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

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Publications (11)47.34 Total impact

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    ABSTRACT: To compute the risk of radiation pneumonitis (RP) as a function of mean lung dose (MLD), with RP scored using three grading systems and analyzed at four threshold levels of toxicity in a large cohort of patients with non-small cell lung cancer (NSCLC) treated with definitive radiotherapy (RT). On the basis of medical records and radiographic images, RP was scored retrospectively in 442 patients with NSCLC who had >or=6 months of follow-up after the end of RT. The severity of RP was scored for each patient using the National Cancer Institute (NCI) Common Toxicity Criteria, version 2.0 (CTC2.0); the NCI Common Terminology Criteria for Adverse Events, version 3.0 (CTCAE3.0); and the grading system of the Radiation Therapy Oncology Group (RTOG). For each grading system and for each of four levels of toxicity (Grade >or=1, >or=2, >or=3, >or=4), the Lyman, logistic, and log-logistic normal tissue complication probability (NTCP) models were fitted to the data as functions of MLD. The parameter estimates from the model fits are listed in table form, and the RP risk estimates are presented graphically for the Lyman and log-logistic NTCP models. The results presented here illustrate the impact of scoring system and level of toxicity on the relationship between MLD and RP risk. These results facilitate quantitative comparisons between our data and studies of RP risk reported by others, and several examples of such comparisons are provided.
    International journal of radiation oncology, biology, physics 10/2009; 77(3):691-8. · 4.59 Impact Factor
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    ABSTRACT: To identify clinical risk factors and dose-volume thresholds for treatment-related pneumonitis (TRP) in patients with non-small cell lung cancer (NSCLC). Data were retrospectively collected from patients with inoperable NSCLC treated with radiotherapy with or without chemotherapy. TRP was graded according to Common Terminology Criteria for Adverse Events, version 3.0, with time to grade > or = 3 TRP calculated from start of radiotherapy. Clinical factors and dose-volume parameters were analyzed for their association with risk of TRP. Data from 576 patients (75% with stage III NSCLC) were included in this study. The Kaplan-Meier estimate of the incidence of grade > or = 3 TRP at 12 months was 22%. An analysis of dose-volume parameters identified a threshold dose-volume histogram (DVH) curve defined by V(20) < or = 25%, V(25) < or = 20%, V(35) < or = 15%, and V(50) < or = 10%. Patients with lung DVHs satisfying these constraints had only 2% incidence of grade > or = 3 TRP. Smoking status was the only clinical factor that affected the risk of TRP independent of dosimetric factors. The risk of TRP varied significantly, depending on radiation dose-volume parameters and patient smoking status. Further studies are needed to identify biological basis of smoking effect and methods to reduce the incidence of TRP.
    Radiotherapy and Oncology 11/2008; 91(3):427-32. · 4.52 Impact Factor
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    ABSTRACT: To introduce a version of the Lyman normal-tissue complication probability (NTCP) model adapted to incorporate censored time-to-toxicity data and clinical risk factors and to apply the generalized model to analysis of radiation pneumonitis (RP) risk. Medical records and radiation treatment plans were reviewed retrospectively for 576 patients with non-small cell lung cancer treated with radiotherapy. The time to severe (Grade >/=3) RP was computed, with event times censored at last follow-up for patients not experiencing this endpoint. The censored time-to-toxicity data were analyzed using the standard and generalized Lyman models with patient smoking status taken into account. The generalized Lyman model with patient smoking status taken into account produced NTCP estimates up to 27 percentage points different from the model based on dose-volume factors alone. The generalized model also predicted that 8% of the expected cases of severe RP were unobserved because of censoring. The estimated volume parameter for lung was not significantly different from n = 1, corresponding to mean lung dose. NTCP models historically have been based solely on dose-volume effects and binary (yes/no) toxicity data. Our results demonstrate that inclusion of nondosimetric risk factors and censored time-to-event data can markedly affect outcome predictions made using NTCP models.
    International Journal of Radiation OncologyBiologyPhysics 11/2008; 72(2):568-74. · 4.52 Impact Factor
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    ABSTRACT: To identify clinical and dosimetric factors influencing the risk of pericardial effusion (PCE) in patients with inoperable esophageal cancer treated with definitive concurrent chemotherapy and radiation therapy (RT). Data for 101 patients with inoperable esophageal cancer treated with concurrent chemotherapy and RT from 2000 to 2003 at our institution were analyzed. The PCE was confirmed from follow-up chest computed tomography scans and radiologic reports, with freedom from PCE computed from the end of RT. Log-rank tests were used to identify clinical and dosimetric factors influencing freedom from PCE. Dosimetric factors were calculated from the dose-volume histogram for the whole heart and pericardium. The crude rate of PCE was 27.7% (28 of 101). Median time to onset of PCE was 5.3 months (range, 1.0-16.7 months) after RT. None of the clinical factors investigated was found to significantly influence the risk of PCE. In univariate analysis, a wide range of dose-volume histogram parameters of the pericardium and heart were associated with risk of PCE, including mean dose to the pericardium, volume of pericardium receiving a dose greater than 3 Gy (V3) to greater than 50 Gy (V50), and heart volume treated to greater than 32-38 Gy. Multivariate analysis selected V30 as the only parameter significantly associated with risk of PCE. High-dose radiation to the pericardium may strongly increase the risk of PCE. Such a risk may be reduced by minimizing the dose-volume of the irradiated pericardium and heart.
    International Journal of Radiation OncologyBiologyPhysics 04/2008; 70(3):707-14. · 4.52 Impact Factor
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    ABSTRACT: There is limited information on risk factors for treatment-related pneumonitis in esophageal cancer patients. To determine factors associated with treatment-related pneumonitis in esophageal cancer patients treated with definitive chemoradiotherapy. We retrospectively reviewed clinical data from esophageal cancer patients treated with definitive chemoradiotherapy from 2000 to 2003. Demographic, clinical, and treatment-related data were collected for all patients. The time to occurrence of grade > or =2 pneumonitis was calculated from the end of radiotherapy. Univariate analyses were performed to determine the existence of any association between patient demographic, clinical, or treatment characteristics and pneumonitis. In total, 96 patients were included in the study with a median follow-up of 8 months (range, <1-48 months). Among them, 23 patients also received an average of two cycles of systemic chemotherapy before the initiation of concurrent chemoradiation. The incidence of grade > or =2 pneumonitis was 22% at 1 year. Systemic chemotherapy before concurrent chemoradiation was significantly associated with an increased risk of grade > or =2 pneumonitis (p = 0.003), with the 1-year incidence of grade > or =2 pneumonitis for patients with and without systemic chemotherapy being 49 and 14%, respectively. No other clinical or dosimetric factors investigated were associated with the risk of grade > or =2 pneumonitis. Systemic chemotherapy before concurrent chemoradiation was significantly associated with an increased risk of grade > or =2 pneumonitis, suggesting that induction chemotherapy may have sensitized the lung tissue to radiation damage in esophageal cancer patients.
    Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer 04/2008; 3(3):277-82. · 4.55 Impact Factor
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    ABSTRACT: To investigate the rate of high-grade treatment-related pneumonitis (TRP) in patients with advanced non-small-cell lung cancer (NSCLC) treated with concurrent chemotherapy and intensity-modulated radiotherapy (IMRT). From August 2002 to August 2005, 151 NSCLC patients were treated with IMRT. We excluded patients who did not receive concurrent chemotherapy or who had early-stage cancers, a history of major lung surgery, prior chest RT, a dose <50 Gy, or IMRT combined with three-dimensional conformal RT (3D-CRT). Toxicities were graded by Common Terminology Criteria for Adverse Events version 3.0. Grade > or = 3 TRP for 68 eligible IMRT patients was compared with TRP among 222 similar patients treated with 3D-CRT. The median follow-up durations for the IMRT and 3D-CRT patients were 8 months (range, 0-27 months) and 9 months (range, 0-56 months), respectively. The median IMRT and 3D-CRT doses were 63 Gy. The median gross tumor volume was 194 mL (range, 21-911 mL) for IMRT, compared with 142 mL (range, 1.5-1,186 mL) for 3D-CRT (p = 0.002). Despite the IMRT group's larger gross tumor volume, the rate of Grade > or = 3 TRP at 12 months was 8% (95% confidence interval 4%-19%), compared with 32% (95% confidence interval 26%-40%) for 3D-CRT (p = 0.002). In advanced NSCLC patients treated with chemoradiation, IMRT resulted in significantly lower levels of Grade > or = 3 TRP compared with 3D-CRT. Clinical, dosimetric, and patient selection factors that may have influenced rates of TRP require continuing investigation. A randomized trial comparing IMRT with 3D-CRT has been initiated.
    International Journal of Radiation OncologyBiologyPhysics 06/2007; 68(1):94-102. · 4.52 Impact Factor
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    ABSTRACT: To investigate factors associated with treatment-related pneumonitis in non-small-cell lung cancer patients treated with concurrent chemoradiotherapy. We retrospectively analyzed data from 223 patients treated with definitive concurrent chemoradiotherapy. Treatment-related pneumonitis was graded according to Common Terminology Criteria for Adverse Events version 3.0. Univariate and multivariate analyses were performed to identify predictive factors. Median follow-up was 10.5 months (range, 1.4-58 months). The actuarial incidence of Grade > or =3 pneumonitis was 22% at 6 months and 32% at 1 year. By univariate analyses, lung volume, gross tumor volume, mean lung dose, and relative V5 through V65, in increments of 5 Gy, were all found to be significantly associated with treatment-related pneumonitis. The mean lung dose and rV5-rV65 were highly correlated (p < 0.0001). By multivariate analysis, relative V5 was the most significant factor associated with treatment-related pneumonitis; the 1-year actuarial incidences of Grade > or =3 pneumonitis in the group with V5 < or =42% and V5 >42% were 3% and 38%, respectively (p = 0.001). In this study, a number of clinical and dosimetric factors were found to be significantly associated with treatment-related pneumonitis. However, rV5 was the only significant factor associated with this toxicity. Until it is better understood which dose range is most relevant, multiple clinical and dosimetric factors should be considered in treatment planning for non-small-cell lung cancer patients receiving concurrent chemoradiotherapy.
    International Journal of Radiation OncologyBiologyPhysics 01/2007; 66(5):1399-407. · 4.52 Impact Factor
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    ABSTRACT: The aim of this study was to investigate the effect of radiation dose distribution in the lung on the risk of postoperative pulmonary complications among esophageal cancer patients. We analyzed data from 110 patients with esophageal cancer treated with concurrent chemoradiotherapy followed by surgery at our institution from 1998 to 2003. The endpoint for analysis was postsurgical pneumonia or acute respiratory distress syndrome. Dose-volume histograms (DVHs) and dose-mass histograms (DMHs) for the whole lung were used to fit normal-tissue complication probability (NTCP) models, and the quality of fits were compared using bootstrap analysis. Normal-tissue complication probability modeling identified that the risk of postoperative pulmonary complications was most significantly associated with small absolute volumes of lung spared from doses > or = 5 Gy (VS5), that is, exposed to doses < 5 Gy. However, bootstrap analysis found no significant difference between the quality of this model and fits based on other dosimetric parameters, including mean lung dose, effective dose, and relative volume of lung receiving > or = 5 Gy, probably because of correlations among these factors. The choice of DVH vs. DMH or the use of fractionation correction did not significantly affect the results of the NTCP modeling. The parameter values estimated for the Lyman NTCP model were as follows (with 95% confidence intervals in parentheses): n = 1.85 (0.04, infinity), m = 0.55 (0.22, 1.02), and D50 = 17.5 Gy (9.4 Gy, 102 Gy). In this cohort of esophageal cancer patients, several dosimetric parameters including mean lung dose, effective dose, and absolute volume of lung receiving < 5 Gy provided similar descriptions of the risk of postoperative pulmonary complications as a function of the radiation dose distribution in the lung.
    International Journal of Radiation OncologyBiologyPhysics 11/2006; 66(3):754-61. · 4.52 Impact Factor
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    ABSTRACT: To characterize the treatment and outcome of patients with cervical and upper thoracic esophageal cancer, the authors retrospectively reviewed the 11-year experience from The University of Texas M. D. Anderson Cancer Center. Thirty-five patients with M0 cervical or upper thoracic esophageal cancer and treated with concurrent chemoradiotherapy were analyzed. Median radiation dose was 50.4 Gy (range, 24.5-64.8) Gy delivered with 1.8-Gy daily fractions over 5.5 weeks. Chemotherapy was 5-fluorouracil based. Response after treatment was evaluated on the basis of radiography, biopsy, or both. The survival rates were calculated by means of the Kaplan-Meier method. The median follow-up for the surviving patients was 39 months. The actuarial 5-year overall survival (OS), cause-specific survival, disease-free survival, local relapse-free survival, and distant metastasis-free survival rates were 18.6%, 27.6%, 22.4%, 47.7%, and 57.0%, respectively. Patients who received a radiation dose of greater than or equal to 50 Gy had a higher complete response rate than those who received less than 50 Gy (79.2% versus 27.3%; p = 0.003). On multivariate analysis, radiation dose was the only protective factor associated with the rates of OS (p = 0.006), cause-specific survival (p = 0.003), and local relapse-free survival (p = 0.001); tumor stage was the only factor associated with rate of disease-free survival (p = 0.007). Concurrent chemoradiotherapy is an effective treatment modality for patients with cervical and upper thoracic esophageal cancer. The authors' results suggest that a total radiation dose of 50 to 65 Gy with a concurrent chemotherapy regimen may improve local control and the OS rate in this rare type of esophageal cancer.
    Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer 04/2006; 1(3):252-9. · 4.55 Impact Factor
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    ABSTRACT: Background: To characterize the treatment and outcome of patients with cervical and upper thoracic esophageal cancer, the authors retrospectively reviewed the 11-year experience from The University of Texas M. D. Anderson Cancer Center. Methods: Thirty-five patients with M0 cervical or upper thoracic esophageal cancer and treated with concurrent chemoradiotherapy were analyzed. Median radiation dose was 50.4 Gy (range, 24.5-64.8) Gy delivered with 1.8-Gy daily fractions over 5.5 weeks. Chemotherapy was 5-fluorouracil based. Response after treatment was evaluated on the basis of radiography, biopsy, or both. The survival rates were calculated by means of the Kaplan-Meier method. Results: The median follow-up for the surviving patients was 39 months. The actuarial 5-year overall survival (OS), cause-specific survival, disease-free survival, local relapse-free survival, and distant metastasis-free survival rates were 18.6%, 27.6%, 22.4%, 47.7%, and 57.0%, respectively. Patients who received a radiation dose of greater than or equal to 50 Gy had a higher complete response rate than those who received less than 50 Gy (79.2% versus 27.3%; p = 0.003). On multivariate analysis, radiation dose was the only protective factor associated with the rates of OS (p = 0.006), cause-specific survival (p = 0.003), and local relapse-free survival (p = 0.001); tumor stage was the only factor associated with rate of disease-free survival (p = 0.007). Conclusion: Concurrent chemoradiotherapy is an effective treatment modality for patients with cervical and upper thoracic esophageal cancer. The authors' results suggest that a total radiation dose of 50 to 65 Gy with a concurrent chemotherapy regimen may improve local control and the OS rate in this rare type of esophageal cancer.
    Journal of Thoracic Oncology 02/2006; 1(3):252-259. · 4.47 Impact Factor
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    ABSTRACT: Lambert-Eaton myasthenic syndrome (LEMS), an autoimmune neuromuscular disorder, often has underlying small-cell lung cancer (SCLC). Thorough search for SCLC in patients with LEMS can result in early detection of limited-stage SCLC, one quarter of which can be successfully treated with chemotherapy and radiation therapy. To elucidate the pathogenesis, diagnosis, treatment, and prognosis of patients with SCLC and LEMS, we present a 51-year-old man who was diagnosed with LEMS and limited-stage SCLC after an 18-month history of weakness in the lower extremities. The patient exhibited a complete response in lung tumors and a resolution in LEMS symptoms after chemotherapy and radiation therapy.
    Clinical Lung Cancer 02/2006; 7(4):282-4. · 2.04 Impact Factor

Publication Stats

324 Citations
47.34 Total Impact Points

Institutions

  • 2007–2009
    • University of Texas MD Anderson Cancer Center
      • • Department of Bioinformatics and Computational Biology
      • • Department of Radiation Physics
      • • Division of Radiation Oncology
      Houston, TX, United States
  • 2006–2009
    • Peking Union Medical College Hospital
      Peping, Beijing, China
  • 2008
    • Chinese Academy of Medical Sciences
      Peping, Beijing, China