Michael T Milano

University of Rochester, Rochester, New York, United States

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Publications (99)387.47 Total impact

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    ABSTRACT: Radiotherapy remains the standard approach for brain metastases from renal cell carcinoma (RCC). Kinase inhibitors (KI) have become standard of care for metastatic RCC. They also increase the radiosensitivity of various tumor types in preclinical models. Data are lacking regarding the effect of KIs among RCC patients undergoing radiotherapy for brain metastases. We report our experience of radiotherapy for brain metastatic RCC in the era of targeted therapy and analyzed effects of concurrent KI therapy. We retrospectively analyzed 25 consecutive patients who received radiotherapy for brain metastases from RCC with whole-brain radiotherapy (WBRT), stereotactic radiosurgery (SRS), or both. Kaplan-Meier rates of overall survival (OS) and brain progression-free survival (BPFS) were calculated and univariate analyses performed. Lower diagnosis-specific graded prognostic assessment (DS-GPA) score and multiple intracranial metastases were associated with decreased OS and BPFS on univariate analysis; DS-GPA is also a prognostic factor on multivariate analysis. There was no significant difference in OS or BPFS for SRS compared with WBRT or WBRT and SRS combined. The concurrent use of KI was not associated with any change in OS or BPFS. This hypothesis-generating analysis suggests among patients with brain metastatic RCC treated with the most current therapies, those selected to undergo SRS did not experience significantly different survival or control outcomes than those selected to undergo WBRT. From our experience to date, limited in patient numbers, there seems to be neither harm nor benefit in using concurrent KI therapy during radiotherapy. Given that most patients progress systemically, we would recommend considering KI use during brain radiotherapy in these patients.
    American Journal of Clinical Oncology 02/2015; DOI:10.1097/COC.0000000000000186 · 2.61 Impact Factor
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    ABSTRACT: BACKGROUND Survivors of Hodgkin lymphoma (HL) are at an increased risk of developing second malignancies. To the authors' knowledge, the risks of head and neck cancer (HNC) after HL and subsequent survival have not been thoroughly investigated.METHODS From the US population-based Surveillance, Epidemiology, and End Results (SEER) database for 1973 through 2011, survivors of HL who developed HNC as a second cancer were analyzed. Patients with a first primary HNC were used as a comparison group. Observed-to-expected ratios and summary statistics were performed on patients with HL with squamous cell carcinoma (HL-SCC) and salivary gland cancer (HL-SGC). The impact of HL history on overall survival was assessed using a multivariate Cox proportional hazards model.RESULTSThe observed-to-expected ratio for SCC among patients with HL was 1.73 (95% confidence interval [95% CI], 1.36-2.16; P<.05), whereas it was 8.56 for SGC (95% CI, 5.82-12.15; P<.05). Using Cox proportional hazards modeling, a history of HL was found to be an adverse prognostic factor for overall survival for SCC (hazard ratio, 1.37; 95% CI, 1.08-1.73 [P = .009]) but not SGC (hazard ratio, 1.21; 95% CI, 0.82-1.79 [P = .34]). The inferior survival of the patients in the HL-SCC cohort appears to be attributable to more deaths from HL and other malignancies diagnosed after SCC.CONCLUSIONS There is a significantly increased risk of salivary and nonsalivary HNC after HL, and worse survival for patients with HL-SCC versus those with a first primary SCC. Clinicians should be aware of the risks of HNC after HL. In the absence of evidence-based criteria, the authors recommend that survivors of HL undergo periodic head and neck examination. Cancer 2015. © 2015 American Cancer Society.
    Cancer 01/2015; 121(9). DOI:10.1002/cncr.29231 · 4.90 Impact Factor
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    ABSTRACT: The management of patients with oligometastatic NSCLC is controversial. The findings of this meta-analysis of 757 oligometastatic NSCLC patients treated with ablative treatments to all sites of disease suggest that the timing of metastatic disease (synchronous vs. metachronous) and intra-thoracic nodal status are key determinants of long term survival. A risk classification scheme is proposed to guide clinical decision-making.
    Clinical Lung Cancer 11/2014; DOI:10.1016/j.ijrobp.2014.08.028 · 3.22 Impact Factor
  • Joseph K Salama, Michael T Milano
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    ABSTRACT: Advances in radiotherapy planning and delivery have been used to treat patients with limited metastatic disease. With these techniques, high rates of treated metastasis control and low toxicity have been reported. Some patients have long disease-free intervals after radiotherapy similar to those seen after surgical resection. Ongoing studies will determine the benefit of these irradiation techniques to treat limited metastases, identify appropriate candidates, and assist in integrating these treatments into management strategies for specific diseases.
    Journal of Clinical Oncology 08/2014; 32(26). DOI:10.1200/JCO.2014.55.9567 · 17.88 Impact Factor
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    ABSTRACT: Annually, 1.4 million women worldwide are diagnosed with breast cancer (BC) and are at risk for another common malignancy: non-small-cell lung cancer (NSCLC). No large population-based study has examined subsequent survival.
    Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer 08/2014; 9(8):1081-1090. DOI:10.1097/JTO.0000000000000213 · 5.80 Impact Factor
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    ABSTRACT: An individual patient data metaanalysis was performed to determine clinical outcomes, and to propose a risk stratification system, related to the comprehensive treatment of patients with oligometastatic NSCLC.
    Clinical Lung Cancer 05/2014; DOI:10.1016/j.cllc.2014.04.003 · 3.22 Impact Factor
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    ABSTRACT: Myxopapillary ependymoma (MPE) is a World Health Organization grade I ependymoma that is quite rare and generally thought to be benign. Possible drop metastasis from MPE has been reported three times in the literature; in each case there were cotemporaneous additional MPE lesions. We report the case of a man who had a piecemeal gross total resection of a MPE at L1-L3 followed by adjuvant external beam radiotherapy (EBRT) who presented sixteen months later with a lesion in the thecal sac consistent with drop metastasis. A subtotal resection and adjuvant EBRT were performed. The patient has been disease-free in follow-up 27 months from the second surgery. A review of the literature regarding the treatment for MPE showed that gross total resection is optimal initial management. Several retrospective studies supported the role of adjuvant radiotherapy in enhancing local control and progression-free survival. Chemotherapy has a minimal role in the management of MPE.
    Rare tumors 05/2014; 6(2):5404. DOI:10.4081/rt.2014.5404
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    ABSTRACT: To report our institutional experience with five fractions of daily 8-12 Gy stereotactic body radiotherapy (SBRT) for the treatment of oligometastatic cancer to the lung. Thirty-four consecutive patients with oligometastatic cancers to the lung were treated with image-guided SBRT between 2008 and 2011. Patient age ranged from 38 to 81 years. There were 17 males and 17 females. Lung metastases were from the following primary cancer types: colon cancer (n=13 patients), head and neck cancer (n=6), breast cancer (n=4), melanoma (n=4), sarcoma (n=4) and renal cell carcinoma (n=3). The median prescription dose was 50 Gy in five fractions (range, 40-60 Gy) to the isocenter, with the 80% isodose line encompassing the planning target volume (PTV) [defined as gross tumor volume (GTV) + 7-11 mm volumetric expansion]. The follow-up interval ranged from 2.4-54 months, with a median of 16.7 months. The 1-, 2-, and 3-year patient local control (LC) rates for all patients were 93%, 88%, and 80% respectively. The 1-, 2-, and 3-year overall survival (OS) rates were 62%, 44%, and 23% respectively. The 1- and 2-year patient LC rates were 95% and 88% for tumor size 1-2 cm (n=25), and 86% for tumor size 2-3 cm (n=7). The majority (n=4) of local failures occurred within 12 months. No patient experienced local failure after 12 months except for one patient with colon cancer whose tumors progressed locally at 26 months. All five patients with local recurrences had colorectal cancer. Statistical analyses showed that age, gender, previous chemotherapy, previous surgery or radiation had no significant effect on LC rates. No patient was reported to have any symptomatic pneumonitis at any time point. SBRT for oligometastatic disease to the lung using 8-12 Gy daily fractions over five treatments resulted in excellent 1- and 2-year LC rates. Most local failures occurred within the first 12 months, with five local failures associated with colorectal cancer. The treatment is safe using this radiation fractionation schedule with no therapy-related pneumonitis.
    04/2014; 6(4):369-74. DOI:10.3978/j.issn.2072-1439.2013.12.03
  • Journal of Clinical Oncology 03/2014; DOI:10.1200/JCO.2013.54.6168 · 17.88 Impact Factor
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    ABSTRACT: Cancer specialists require an understanding of survivors' needs to insure optimal delivery of care. Training programs currently focus on treatment, while survivorship care focuses on time after treatment. Cancer survivorship training represents an education paradigm shift. The Cancer Survivorship Workshop was held at the James P. Wilmot Cancer Center of the University of Rochester in academic year 2011-2012, with six sessions held. Objectives included the following: learning about survivorship from patient, primary care physician, and oncologist perspectives using a curriculum based on survivorship literature; designing treatment summaries (TSs) and survivorship care plans (SCPs) for five malignancies (lung, breast, prostate, colon, and lymphoma); and establishing collaboration between hematology/oncology (HO) and radiation oncology (RO) trainees by working together in teams. Course impact was assessed pre- and post-training using a 13-question survey. Questions were answered using a 10-point scale, with predefined rating for each question. Statistically significant differences in responses to several survey questions were observed comparing pre- and post-course experience. Improvement was noted in comfort discussing survivorship issues with patients (p = 0.001), reported knowledge of survivorship care for five types of cancer (p = 0.002), confidence in ability to explain a SCP (p = 0.001), and comfort discussing late effects of cancer treatment (p = 0.001). Five unique sets of TS and SCPs were completed. This study demonstrates the feasibility of implementing cancer survivorship education into the curriculum of HO and RO training. The project was designed with intension to optimize survivor care through enhanced provider training.
    Journal of Cancer Survivorship 12/2013; 8(2). DOI:10.1007/s11764-013-0328-0 · 3.29 Impact Factor
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    ABSTRACT: The purpose of this study was to determine whether dynamic susceptibility contrast MR perfusion relative cerebral blood volume (rCBV) correlates with prognosis of World Health Organization (WHO) grade III glial tumors and their different subtypes. Retrospective evaluation of pre-treatment tumor rCBV derived from dynamic susceptibility contrast MR perfusion was performed in 34 patients with histopathologically diagnosed WHO grade III glial tumors (anaplastic astrocytomas (n = 20), oligodendrogliomas (n = 4), and oligoastrocytomas (n = 10)). Progression free survival was correlated with rCBV using Spearman rank analysis. ROC curve analysis was performed to determine the operating point for rCBV in patients with anaplastic astrocytomas dichotomized at the median progression free survival time. For all grade III tumors (n = 34) the mean rCBV was 2.51 with a progression free survival of 705.5 days. The mean rCBV of anaplastic astrocytomas was 2.47 with progression free survival 495.2 days. In contrast, the mean rCBV for oligodendroglial tumors was 2.56 with a progression free survival of 1005.6 days. Although there was no significant correlation between rCBV and progression free survival among all types of grade III gliomas (P = 0.12), among anaplastic astrocytomas there was a significant correlation between pretreatment rCBV and progression free survival with correlation coefficient of -0.51 (P = 0.02). The operating point for rCBV in patients with anaplastic astrocytomas dichotomized at the median progression free survival time (446.5 days) was 2.86 with 78 % accuracy and there was a significant difference between the survival of patients with anaplastic astrocytomas in the dichotomized groups (P = 0.0009). Pre-treatment rCBV may serve as a prognostic imaging biomarker for anaplastic astrocytomas, but not grade III oligodendroglioma tumors.
    Journal of Neuro-Oncology 11/2013; 116(2). DOI:10.1007/s11060-013-1298-9 · 2.79 Impact Factor
  • International Journal of Radiation OncologyBiologyPhysics 10/2013; 87(2):S512. DOI:10.1016/j.ijrobp.2013.06.1354 · 4.18 Impact Factor
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    ABSTRACT: Increased risks of solid tumors after older radiotherapy strategies for testicular cancer (TC) are well established. Few population-based studies, however, focus on solid cancer risk among survivors of TC managed with nonradiotherapy approaches. We quantified the site-specific risk of solid cancers among testicular nonseminoma patients treated in the modern era of cisplatin-based chemotherapy, without radiotherapy. Standardized incidence ratios (SIRs) for solid tumors were calculated for 12,691 patients with testicular nonseminoma reported to the population-based Surveillance, Epidemiology, and End Results program (1980 to 2008) and treated initially with either chemotherapy (n = 6,013) or surgery (n = 6,678) without radiotherapy. Patients accrued 116,073 person-years of follow-up. Two hundred ten second solid cancers were observed. No increased risk followed surgery alone (SIR, 0.93; 95% CI, 0.76 to 1.14; n = 99 solid cancers), whereas significantly increased 40% excesses (SIR, 1.43; 95% CI, 1.18 to 1.73; n = 111 solid cancers) occurred after chemotherapy. Increased risks of solid cancers after chemotherapy were observed in most follow-up periods (median latency, 12.5 years), including more than 20 years after treatment (SIR, 1.54; 95% CI, 0.96 to 2.33); significantly increased three- to seven-fold risks occurred for cancers of the kidney (SIR, 3.37; 95% CI, 1.79 to 5.77), thyroid (SIR, 4.40; 95% CI, 2.19 to 7.88), and soft tissue (SIR, 7.49; 95% CI, 3.59 to 13.78). To our knowledge, this is the first large population-based series reporting significantly increased risks of solid cancers among patients with testicular nonseminoma treated in the modern era of cisplatin-based chemotherapy. Subsequent analytic studies should focus on the evaluation of dose-response relationships, types of solid cancers, latency patterns, and interactions with other possible factors, including genetic susceptibility.
    Journal of Clinical Oncology 09/2013; 31(30). DOI:10.1200/JCO.2013.50.3409 · 17.88 Impact Factor
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    ABSTRACT: Background Surgical resection is the standard treatment for liver metastases, although for the majority of patients this is not possible. Stereotactic body radiotherapy (SBRT) is an alternative local-regional therapy. The purpose of this study was to evaluate the results of SBRT for secondary liver tumours from a combined multicentre database. Methods Variables from patients treated with SBRT from four Academic Medical Centres were entered into a common database. Local tumour control and 1-year survival rates were calculated. ResultsIn total, 153 patients (91 women) 598.4 years old with 363 metastatic liver lesions were treated with SBRT. The underlying primary tumour arose from gastrointestinal (GI), retroperitoneal and from extra-abdominal primaries in 56%, 8% and 36% of patients, respectively. Metastases, with a gross tumour volume (GTV) of 138.5 +/- 126.8cm(3), were treated with a total radiation dose of 37.5 +/- 8.2 Gy in 5 +/- 3 fractions. The 1-year overall survival was 51% with an overall local control rate of 62% at a mean follow-up of 25.2 +/- 5.9 months. A complete tumour response was observed in 32% of patients. Grade 3-5 adverse events were noted in 3% of patients. Conclusion Secondary liver tumours treated with SBRT had a high rate of local control with a low incidence of adverse events.
    HPB 01/2013; 15(11). DOI:10.1111/hpb.12044 · 2.05 Impact Factor
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    ABSTRACT: Purpose: Few studies have evaluated the risk profile of prostate-specific antigen (PSA)-detected T1cN0M0 prostate cancer, defined as tumors diagnosed by needle biopsy because of elevated PSA levels without other clinical signs of disease. However, some men with stage T1cN0M0 prostate cancer may have high-risk disease (HRD), thus experiencing inferior outcomes as predicted by a risk group stratification model. Methods: We identified men diagnosed with stage T1cN0M0 prostate cancer from 2004 to 2008 reported to the surveillance, epidemiology, and end results (SEER) program. Multivariate logistic regression was used to model the probability of intermediate-risk-disease (IRD) (PSA ≥ 10 ng/ml but <20 ng/ml and/or GS 7), and high-risk-disease (HDR) (PSA ≥ 20 ng/ml, and/or GS ≥ 8), relative to low-risk disease (LRD) (PSA < 10 ng/ml and GS ≤ 6), adjusting for age, race, marital status, median household income, and area of residence. Results: A total of 70,345 men with PSA-detected T1cN0M0 prostate cancer were identified. Of these, 47.6, 35.9, and 16.5% presented with low-, intermediate-, and high-risk disease, respectively. At baseline (50 years of age), risk was higher for black men than for whites for HRD (OR 3.31, 95% CI 2.85-3.84). The ORs for age (per year) for HRD relative to LRD were 1.09 (95% CI 1.09-1.10) for white men, and as 1.06 (95% CI 1.05-1.07) for black men. Further, among a subgroup of men with low PSA (<10 ng/ml) T1cN0M0 prostate cancer, risk was also higher for black man than for white men at baseline (50 years of age) (OR 2.70, 95% CI 2.09-3.48). The ORs for age (per year) for HRD relative to LRD were 1.09 (95% CI 1.09-1.10) for white men, and as 1.06 (95% CI 1.05-1.07) for black men. Conclusion: A substantial proportion of men with PSA-detected prostate cancer as reported to the SEER program had HRD. Black race and older age were associated with a greater likelihood of HRD.
    Frontiers in Oncology 01/2013; 3:312. DOI:10.3389/fonc.2013.00312
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    ABSTRACT: BACKGROUND: Patients with head and neck squamous cell cancer (HNSCC) are at risk of developing second primary lung cancer (SPLC). METHODS: Among 61,883 patients with HNSCC from the Surveillance, Epidemiology and End Results (SEER) database, 4522 developed SPLC (any histology) ≥2 months after HNSCC. We correlated risk with demographic and tumor-related parameters. RESULTS: The risk of SPLC after HNSCC was 5.8%, 11.4%, and 16.4% at 5, 10, and 15 years, respectively. From Cox regression, significantly adverse (p < .0001) risk factors for SPLC included: regional versus localized HNSCC stage (hazard ratio [HR] = 1.16), hypopharyngeal or supraglottic laryngeal site (HR = 1.57), increased age (HR = 1.26/decade), black race (HR = 1.27), and male sex (HR = 1.26). Glottic (HR = 0.75) and tonsillar or oral cavity sites (HR = 0.80) were associated with significantly (p < .0001) lower risks of SPLC. CONCLUSION: From population-based actuarial analyses, HNSCCs with more aggressive clinicopathologic features were more apt to develop SPLC, suggestive of similar environmental and/or host factors for these cancers. © 2012 Wiley Periodicals, Inc. Head Neck, 2012.
    Head & Neck 12/2012; 34(12). DOI:10.1002/hed.22006 · 3.01 Impact Factor
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    ABSTRACT: PURPOSE Purpose: To report our institutional experience with 5 fractions of SBRT for the treatment of chemotherapy refractory oligometastatic cancer to lung . METHOD AND MATERIALS Methods: Thirty four consecutive patients with oligo-metastatic cancer to lung who were noted to be refractory to chemotherapy, were treated with image guided SBRT between 2008 and 2011. The median prescription dose was 50 Gy in 5 fractions (range 45-60 Gy) to the isocenter, with the 80% isodose line covering the PTV (defined as GTV + 7-10 mm volumetric expansion). The follow-up ranged from 2.4-39.8 months with a median of 15 months. RESULTS Results: The age ranged from 38 to 81 years among the 34 patients comprising of 17 males and 17 females each. There were 13 patients with metastases from colon cancer, followed by head and neck metastases 6 patients, breast, melanoma and sarcoma with 4 patients each, and renal cell cancer with 3 patients. The 1- and 2-year local control (LC) rates for all patients were 93% and 87% respectively. The majority of the patients (n=4) who failed locally occurred within 12 months. N0 patient failed locally after 13 months except for one patient with colon cancer who was noted to have progression of local disease at 26 months. Majority of the local failures were noted among the patients with adenocarcinoma histology followed by melanoma, sarcoma and squamous cell carcinoma. However with multivariate analysis, age, gender, previous chemotherapy or previous surgery or radiation had no significant effect on local control rates. No patient was reported to have any symptomatic pneumonitis at any point of time. CONCLUSION Conclusions: SBRT is very safe and plays important role offering excellent one and two year LC in patients with oligo-metastatic disease to lungs who are deemed refractory to chemotherapy. Majority of the local failures were noted within first 12 months but there after the LC were maintained well at 24 months to as far as over 36 months. CLINICAL RELEVANCE/APPLICATION Role of SBRT in improving local control rates for oligo-metastatic cancer to lungs in chemotherapy refractory patients.
    Radiological Society of North America 2012 Scientific Assembly and Annual Meeting; 11/2012
  • C.R. Peterson, P. Youn, P. Sood, M.T. Milano
    International Journal of Radiation OncologyBiologyPhysics 11/2012; 84(3):S599. DOI:10.1016/j.ijrobp.2012.07.1597 · 4.18 Impact Factor
  • International Journal of Radiation OncologyBiologyPhysics 11/2012; 84(3):S174. DOI:10.1016/j.ijrobp.2012.07.451 · 4.18 Impact Factor
  • International Journal of Radiation OncologyBiologyPhysics 11/2012; 84(3):S494. DOI:10.1016/j.ijrobp.2012.07.1313 · 4.18 Impact Factor

Publication Stats

2k Citations
387.47 Total Impact Points

Institutions

  • 2006–2015
    • University of Rochester
      • Department of Radiation Oncology
      Rochester, New York, United States
    • University of Maryland, Baltimore
      • Department of Radiation Oncology
      Baltimore, Maryland, United States
  • 2014
    • Duke University
      Durham, North Carolina, United States
  • 2006–2014
    • University Center Rochester
      • Department of Radiation Oncology
      Rochester, Minnesota, United States
  • 2003–2005
    • University of Chicago
      • Department of Radiation & Cellular Oncology
      Chicago, Illinois, United States
  • 2004
    • Northwestern University
      Evanston, Illinois, United States