James A Hayman

Concordia University–Ann Arbor, Ann Arbor, Michigan, United States

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Publications (197)881.71 Total impact

  • International journal of radiation oncology, biology, physics 11/2015; 93(3):S86. DOI:10.1016/j.ijrobp.2015.07.206 · 4.26 Impact Factor

  • International journal of radiation oncology, biology, physics 11/2015; 93(3):E606. DOI:10.1016/j.ijrobp.2015.07.2095 · 4.26 Impact Factor

  • International journal of radiation oncology, biology, physics 10/2015; DOI:10.1016/j.ijrobp.2015.10.030 · 4.26 Impact Factor
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    ABSTRACT: Randomized trials have established the long-term safety and efficacy of hypofractionated whole-breast radiotherapy, but little is known about the acute toxic effects experienced by patients treated with hypofractionation as compared with conventional fractionation, particularly in real-world settings and from the patient's own perspective. To evaluate prospectively collected data on acute toxic effects and patient-reported outcomes in a cohort treated with varying radiation fractionation schemes in practices collaborating in the Michigan Radiation Oncology Quality Consortium (MROQC). We compared toxic effects in patients receiving hypofractionation (HF) vs conventional fractionation (CF) during treatment (through 7 days after treatment) and in follow-up (posttreatment days 8-210), after adjustment for sociodemographic, clinical, and treatment characteristics. The MROQC includes academic and community radiation oncology practices across Michigan. All 2604 patients who received adjuvant whole-breast radiotherapy after lumpectomy for unilateral breast cancer at MROQC participating sites from October 2011 through June 2014 were registered; we analyzed 2309 for whom there was a comprehensive physician toxicity evaluation within 1 week of completion of radiotherapy and at least 1 weekly toxicity evaluation during treatment. Hypofractionation vs CF. Physicians reported dermatitis, pain, fatigue, and other common toxic effects associated with breast radiotherapy at baseline, weekly during radiotherapy, and in follow-up. Patients who consented also rated their own experiences, including breast pain, fatigue, and being bothered by symptoms. Of the 2309 evaluable patients, 578 received HF. During treatment, after adjustment for sociodemographic, clinical, and treatment factors, patients receiving CF had significantly higher maximum physician-assessed skin reaction (moist desquamation, 28.5% vs 6.6%, P < .001; grade ≥2 dermatitis, 62.6% vs 27.4%, P < .001), self-reported pain (moderate/severe pain, 41.1% vs 24.2%, P = .003), burning/stinging bother (often/always, 38.7% vs 15.7%, P = .002), hurting bother (33.5% vs 16.0%, P = .001), swelling bother (29.6% vs 15.7%, P = .03), and fatigue (29.7% vs 18.9%, P = .02) but slightly greater absence of skin induration in follow-up (84.5% vs 81.2%, P = .02). No significant differences were observed in any other measured outcomes during follow-up extending through 6 months. Hypofractionation not only improves convenience but also may reduce acute pain, fatigue, and the extent to which patients are bothered by dermatitis in patients with breast cancer undergoing whole-breast radiotherapy.
    08/2015; DOI:10.1001/jamaoncol.2015.2590
  • A Owrangi · D Roberts · E Covington · J Hayman · K Masi · C Lee · J Moran · J Prisciandaro ·
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    ABSTRACT: To evaluate the peripheral dose (PD) to a fetus during radiation therapy of pregnant patients when using a newly designed fetal lead shield (FLS). A custom FLS has been designed and fabricated for our department. The FLS (1.1 TVLs for 6 MV) is mounted on a mobile frame and can be adjusted vertically with a motor actuator. PD measurements were acquired for multiple simple square fields and for a variety of potential treatment sites a pregnant patient may be treated for including brain, head and neck (H&N) and thorax. For measurements of the brain, H&N, and thorax, an ionization chamber and OSLDs were positioned on average at a distance of 48, 29 and 26 cm, respectively, from the edge of treatment fields to mimic the approximate position of the fundus. Based on our measurements, applying a 90° collimator rotation and using tertiary MLCs to define the field aperture in combination with jaws resulted in an average dose reduction of 60%. When using these planning strategies in combination with the FLS, on average, the PD was reduced by additional 25% for simple square fields and 20% for clinical plans. The custom FLS is a safe, effective, and relatively easy system to position. Commissioning measurements have demonstrated that the PD to the fetus can be significantly reduced when using the FLS. The comprehensive dataset obviates the need for individual patient pre-treatment dose measurements as long as the geometry falls within the commissioning limits.
    Medical Physics 06/2015; 42(6):3636. DOI:10.1118/1.4925788 · 2.64 Impact Factor
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    ABSTRACT: To characterize the adoption and variation of intensity-modulated radiation therapy (IMRT) use in the state of Michigan. As a certificate-of-need state, Michigan requires every radiation oncology facility to report the number of external-beam and IMRT treatments delivered annually. We examined the percentage of treatments delivered using IMRT across centers from 2005 to 2012. We constructed a repeated-measures longitudinal linear regression model to evaluate bivariable and multiple variable associations with IMRT use. The median proportion of treatments delivered with IMRT rose from 16% in 2005 to 42% in 2012. All treatment centers in the state of Michigan possessed the capacity to deliver IMRT as of 2009. The fraction of treatments delivered with IMRT varied between 23% and 96% (standard deviation, 19%) in the lowest- and highest-use centers in 2012. Higher IMRT use was significantly associated with freestanding facilities and year of treatment, with a trend toward higher IMRT use in academic centers and low-volume facilities. IMRT use grew significantly across the state of Michigan over time, with four-fold variability among centers, which was related to facility characteristics. These data provide no indication of an ideal or appropriate level of IMRT use. Rather, the wide variation in IMRT use among centers indicates a lack of consensus regarding the situations in which IMRT provides significant clinical benefit. This supports further research and interventions to ensure that patients receive appropriate care, regardless of where they are treated. Copyright © 2015 by American Society of Clinical Oncology.
    Journal of Oncology Practice 03/2015; 11(3). DOI:10.1200/JOP.2014.002568
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    ABSTRACT: A formal communication process was established and evaluated for the management of patients with cardiac implantable electronic devices (CIEDs) receiving radiation therapy (RT). Methods to estimate dose to the CIED were evaluated for their appropriateness in the management of these patients. A retrospective, institutional review board (IRB) approved study of 69 patients with CIEDs treated with RT between 2005 and 2011 was performed. The treatment sites, techniques, and the estimated doses to the CIEDs were analyzed and compared to estimates from published peripheral dose (PD) data and three treatment planning systems(TPSs) - UMPlan, Eclipse's AAA and Acuros algorithms. When measurements were indicated, radiation doses to the CIEDs ranged from 0.01-5.06 Gy. Total peripheral dose estimates based on publications differed from TLD measurements by an average of 0.94 Gy (0.05-4.49 Gy) and 0.51 Gy (0-2.74 Gy) for CIEDs within 2.5 cm and between 2.5 and 10 cm of the treatment field edge, respectively. Total peripheral dose estimates based on three TPSs differed from measurements by an average of 0.69 Gy (0.02-3.72 Gy) for CIEDs within 2.5 cm of the field edge. Of the 69 patients evaluated in this study, only two with defibrillators experienced a partial reset of their device during treatment. Based on this study, few CIED-related events were observed during RT. The only noted correlation with treatment parameters for these two events was beam energy, as both patients were treated with high-energy photon beams (16 MV). Differences in estimated and measured CIED doses were observed when using published PD data and TPS calculations. As such, we continue to follow conservative guidelines and measure CIED doses when the device is within 10 cm of the field or the estimated dose is greater than 2 Gy for pacemakers or 1 Gy for defibrillators.
    Journal of Applied Clinical Medical Physics 02/2015; 16(1):5189. · 1.17 Impact Factor
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    ABSTRACT: To characterize the regression rate of posterior uveal melanoma following radioactive iodine-125 (I-125) plaque. We retrospectively analyzed 95 patients with posterior uveal melanoma who were treated with only radioactive I-125 plaque and had more than 3 years follow-up. All patients were treated with plaque radiotherapy using tumor dose of 85 Gy at the tumor apex, following COMS protocol. Regression rate was assessed with standardized A-scan ultrasonography. Associations with tumor regression were evaluated by means of mixed linear regression modeling. Mean decrease in the tumor thickness (% original thickness) at 12, 24, and 36 months after radiotherapy for melanomas <3 mm in thickness was 29%, 38%, and 45%, for melanoma 3-8 mm in thickness was 32%, 44%, and 59%, and for melanoma more than 8 mm in thickness was 52%, 62%, and 68%, respectively. With a doubling of follow-up time (0.5-1 year, or 1-2 years of follow-up from treatment), tumors <3 mm in thickness at treatment showed a 0.5 mm decrease in tumor thickness, whereas melanomas 3-8 mm showed a 1 mm decrease, and melanomas >8 mm showed a 1.7 mm decrease. Uveal melanomas that developed systemic metastasis showed an additional 0.4 mm decrease with a doubling of follow-up time from treatment, compared with those that did not develop metastasis (P = 0.050). Posterior uveal melanomas with higher initial thickness show steeper and more reduction in tumor thickness following radioactive I-125 plaque. After the initial phases, the regression curve became similar for tumors with different thicknesses.
    Middle East African journal of ophthalmology 01/2015; 22(1):103-7. DOI:10.4103/0974-9233.148358
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    ABSTRACT: Purpose: Given evidence from randomized trials that have established the non-inferiority of more convenient and less costly courses of hypofractionated radiotherapy to the whole breast in selected breast cancer patients who receive lumpectomy, we sought to investigate the use of hypofractionated radiation therapy and factors associated with its use in a consortium of radiation oncology practices in Michigan. We sought to determine the extent to which variation in use occurs at the physician or practice level versus the extent to which use reflects individualization based on potentially relevant patient characteristics (such as habitus, age, chemotherapy receipt, or laterality). Methods and materials: We evaluated associations between receipt of hypofractionated radiation therapy and various patient, provider, and practice characteristics in a multilevel model. Results: Of 1477 patients who received lumpectomy and whole-breast radiation therapy and were registered by the Michigan Radiation Oncology Quality Consortium (MROQC) from October 2011 to December 2013, 913 had T1-2, N0 breast cancer. Of these 913, 283 (31%) received hypofractionated radiation therapy. Among the 13 practices, hypofractionated radiation therapy use ranged from 2% to 80%. On multilevel analysis, 51% of the variation in the rate of hypofractionation was attributable to the practice level, 21% to the provider level, and 28% to the patient level. On multivariable analysis, hypofractionation was more likely in patients who were older (odds ratio [OR] 2.16 for age ≥50 years, P=.007), less likely in those with larger body habitus (OR 0.52 if separation between tangent entry and exit ≥25 cm, P=.002), and more likely without chemotherapy receipt (OR 3.82, P<.001). Hypofractionation use was not higher in the last 6 months analyzed: 79 of 252 (31%) from June 2013 to December 2013 and 204 of 661 (31%) from October 2011 to May 2013 (P=.9). Conclusions: Hypofractionated regimens of whole-breast radiation therapy have been variably administered in the adjuvant setting in Michigan after the publication of long-term trial results and consensus guidelines. Most of this variability is explained at the practice and provider level rather than by patient-level features, although care is being individualized to some degree.
    International journal of radiation oncology, biology, physics 12/2014; 90(5):1010-6. DOI:10.1016/j.ijrobp.2014.09.027 · 4.26 Impact Factor
  • S. Samuels · M.H. Stenmark · J.A. Hayman · M.B. Orringer · S.G. Urba · L. Sun · C. Xie · F. Kong · K. Cuneo ·

    International journal of radiation oncology, biology, physics 09/2014; 90(1):S11. DOI:10.1016/j.ijrobp.2014.05.090 · 4.26 Impact Factor
  • M.M. Matuszak · S. Hadley · M. Feng · J. Hayman · D. Owen · T. Lawrence · J. Moran ·

    International journal of radiation oncology, biology, physics 09/2014; 90(1):S128. DOI:10.1016/j.ijrobp.2014.05.572 · 4.26 Impact Factor
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    ABSTRACT: Purpose To report the final cosmetic results from a single-arm prospective clinical trial evaluating accelerated partial breast irradiation (APBI) using intensity modulated radiation therapy (IMRT) with active-breathing control (ABC). Methods and Materials Women older than 40 with breast cancer stages 0-I who received breast-conserving surgery were enrolled in an institutional review board-approved prospective study evaluating APBI using IMRT administered with deep inspiration breath-hold. Patients received 38.5 Gy in 3.85-Gy fractions given twice daily over 5 consecutive days. The planning target volume was defined as the lumpectomy cavity with a 1.5-cm margin. Cosmesis was scored on a 4-category scale by the treating physician. Toxicity was scored according to National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE version 3.0). We report the cosmetic and toxicity results at a median follow-up of 5 years. Results A total of 34 patients were enrolled. Two patients were excluded because of fair baseline cosmesis. The trial was terminated early because fair/poor cosmesis developed in 7 of 32 women at a median follow-up of 2.5 years. At a median follow-up of 5 years, further decline in the cosmetic outcome was observed in 5 women. Cosmesis at the time of last assessment was 43.3% excellent, 30% good, 20% fair, and 6.7% poor. Fibrosis according to CTCAE at last assessment was 3.3% grade 2 toxicity and 0% grade 3 toxicity. There was no correlation of CTCAE grade 2 or greater fibrosis with cosmesis. The 5-year rate of local control was 97% for all 34 patients initially enrolled. Conclusions In this prospective trial with 5-year median follow-up, we observed an excellent rate of tumor control using IMRT-planned APBI. Cosmetic outcomes, however, continued to decline, with 26.7% of women having a fair to poor cosmetic result. These results underscore the need for continued cosmetic assessment for patients treated with APBI by technique.
    International journal of radiation oncology, biology, physics 05/2014; 89(1). DOI:10.1016/j.ijrobp.2014.01.005 · 4.26 Impact Factor
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    ABSTRACT: To provide evidence-based recommendations to practicing oncologists, surgeons, and radiation therapy clinicians to update the 2005 clinical practice guideline on the use of sentinel node biopsy (SNB) for patients with early-stage breast cancer. The American Society of Clinical Oncology convened an Update Committee of experts in medical oncology, pathology, radiation oncology, surgical oncology, guideline implementation, and advocacy. A systematic review of the literature was conducted from February 2004 to January 2013 in Medline. Guideline recommendations were based on the review of the evidence by Update Committee. This guideline update reflects changes in practice since the 2005 guideline. Nine randomized clinical trials (RCTs) met systematic review criteria for clinical questions 1 and 2; 13 cohort studies informed clinical question 3. Women without sentinel lymph node (SLN) metastases should not receive axillary lymph node dissection (ALND). Women with one to two metastatic SLNs planning to undergo breast-conserving surgery with whole-breast radiotherapy should not undergo ALND (in most cases). Women with SLN metastases who will undergo mastectomy should be offered ALND. These three recommendation are based on RCTs. Women with operable breast cancer and multicentric tumors, with ductal carcinoma in situ (DCIS) who will undergo mastectomy, who previously underwent breast and/or axillary surgery, or who received preoperative/neoadjuvant systemic therapy may be offered SNB. Women who have large or locally advanced invasive breast cancer (tumor size T3/T4), inflammatory breast cancer, or DCIS (when breast-conserving surgery is planned) or are pregnant should not undergo SNB. These recommendations are based on cohort studies and/or informal consensus. In some cases, updated evidence was insufficient to update previous recommendations.
    Journal of Clinical Oncology 03/2014; 32(13). DOI:10.1200/JCO.2013.54.1177 · 18.43 Impact Factor
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    ABSTRACT: Merkel cell carcinoma (MCC) is a rare malignancy of the skin, and prospective randomized clinical studies on management and treatment are very limited. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for MCC provide up-to-date, best evidence-based, and consensus-driven management pathways with the purpose of providing best care and outcomes. Multidisciplinary management with consensus treatment recommendations to individualize patient care within the framework of these guidelines is optimal. The University of Michigan multidisciplinary MCC program uses NCCN Guidelines in the management and treatment of its patients. This article discusses 4 patient presentations to highlight the implementation of the NCCN Guidelines for MCC at the University of Michigan.
    Journal of the National Comprehensive Cancer Network: JNCCN 03/2014; 12(3):434-41. · 4.18 Impact Factor
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    ABSTRACT: In 1999, the Institute of Medicine (IOM) published Ensuring Quality Cancer Care, an influential report that described an ideal cancer care system and issued ten recommendations to address pervasive gaps in the understanding and delivery of quality cancer care. Despite generating much fervor, the report's recommendations-including two recommendations related to quality measurement-remain largely unfulfilled. Amidst continuing concerns regarding increasing costs and questionable quality of care, the IOM charged a new committee with revisiting the 1999 report and with reassessing national cancer care, with a focus on the aging US population. The committee identified high-quality patient-clinician relationships and interactions as central drivers of quality and attributed existing quality gaps, in part, to the nation's inability to measure and improve cancer care delivery in a systematic way. In 2013, the committee published its findings in Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis, which included two recommendations that emphasize coordinated, patient-centered quality measurement and information technology enhancements: Develop a national quality reporting program for cancer care as part of a learning health care system; and,Develop an ethically sound learning health care information technology system for cancer that enables real-time analysis of data from cancer patients in a variety of care settings. These recommendations underscore the need for independent national oversight, public-private collaboration, and substantial funding to create robust, patient-centered quality measurement and learning enterprises to improve the quality, accessibility, and affordability of cancer care in America.
    Healthcare 03/2014; 2(1):53-62. DOI:10.1016/j.hjdsi.2013.11.003
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    ABSTRACT: Background Diffusion MRI, although having the potential to be a biomarker for early assessment of tumor response to therapy, could be confounded by edema and necrosis in or near the brain tumors. This study aimed to develop and investigate the ability of the diffusion abnormality index (DAI) to be a new imaging biomarker for early assessment of brain metastasis response to radiation therapy (RT).Methods Patients with either radiosensitive or radioresistant brain metastases that were treated by whole brain RT alone or combined with bortezomib as a radiation sensitizer had diffusion-weighted (DW) MRI pre-RT and 2 weeks (2W) after starting RT. A patient-specific diffusion abnormality probability function (DAProF) was created to account for abnormal low and high apparent diffusion coefficients differently, reflecting respective high cellularity and edema/necrosis. The DAI of a lesion was then calculated by the integral of DAProF-weighted tumor apparent diffusion coefficient histogram. The changes in DAI from pre-RT to 2W were evaluated for differentiating the responsive, stable, and progressive tumors and compared with the changes in gross tumor volume and conventional diffusion metrics during the same time interval.ResultsIn lesions treated with whole brain RT, the DAI performed the best among all metrics in predicting the posttreatment response of brain metastases to RT. In lesions treated with whole brain RT + bortezomib, although DAI was the best predictor, the performance of all metrics worsened compared with the first group.Conclusions The ability of DAI for early assessment of brain metastasis response to RT depends upon treatment regimes.
    Neuro-Oncology 12/2013; 16(1). DOI:10.1093/neuonc/not153 · 5.56 Impact Factor
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    ABSTRACT: Multidisciplinary tumor board conferences foster collaboration among health care providers from a variety of specialties and help to facilitate optimal patient care. Typical cases from thoracic tumor board conferences include patients with known or suspected bronchogenic and esophageal carcinomas, as well as less common diseases such as thymomas and mesotheliomas. In most instances, the clinical questions revolve around the best options for establishing a diagnosis, staging the disease and directing treatment. This article describes and illustrates the clinical scenarios of three patients who were presented at our tumor board, focusing on management issues and the role of imaging. These patients had non-small cell lung cancer and mediastinal lymph node metastases; a small, growing ground glass nodule; and oligometastatic non-small cell lung cancer, respectively.
    Cancer Imaging 12/2013; 13(3):1-11. DOI:10.1102/1470-7330.2013.0037 · 2.07 Impact Factor
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    ABSTRACT: Multidisciplinary tumor board conferences foster collaboration among health care providers from a variety of specialties and help to facilitate optimal patient care. Generally, the clinical questions revolve around the best options for establishing a diagnosis, staging the disease and directing treatment. This article describes and illustrates the clinical scenarios of three patients who were presented at our thoracic Tumor Board, focusing on management issues and the role of imaging. These patients had invasive thymoma; concurrent small cell lung cancer and non-small cell lung cancer; and esophageal cancer with celiac lymph node metastases, respectively.
    Cancer Imaging 12/2013; 13(3):298-305. DOI:10.1102/1470-7330.2013.0030 · 2.07 Impact Factor

  • International Journal of Radiation OncologyBiologyPhysics 10/2013; 87(2):S495-S496. DOI:10.1016/j.ijrobp.2013.06.1310 · 4.26 Impact Factor
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    ABSTRACT: Purpose/Objective(s) Pulmonary toxicity and decreased pulmonary function are important side effects of thoracic radiation. The ability to predict which patients are at higher risk of having pulmonary dysfunction caused by radiation therapy (RT) would be of great benefit to clinicians. The purpose of this study is to determine whether pulmonary function changes that occur during RT (1) correlate with post-RT changes, and (2) are predictive of clinically significant lung toxicity. Materials/Methods The study population included patients enrolled onto prospective studies of NSCLC with complete pulmonary function tests (PFT) 2 weeks prior to (“pre”), during (“dur”), and 3 months after (“post”) a definitive course of either fractionated conformal radiation therapy (CRT) or stereotactic body radiation therapy (SBRT). Correlations between continuous variables such as mean lung dose (MLD) and changes in PFTs obtained pre, dur, and post RT were tested by linear regression. Logistic regression was used to estimate the significance of PFTs on pulmonary toxicity in the form of radiation pneumonitis (RP). Additionally, the differences in the changes in PFTs observed in patients receiving CRT and SBRT were compared. The data is presented as mean (±95% CI) unless otherwise specified. Results Data from 44 (CRT n = 34, SBRT n = 10) patients treated from 2007 to 2012 were analyzed. The mean changes in FEV1%, FEV1/FVC, and DLCO% were 4.2 ± 4.9, 0.78 ± 2.76, and -4.8 ±5.0 and 2.86 ± 6.6, 0.48 ± 2.9 and -11.7 ± 5.9 during RT and post RT, respectively. Only DLCO had a significant decrease after RT (p = 0.024). The reduction in DLCO measured during RT was correlated with post-RT changes (R = 0.46). DLCO reduction after RT had an inverse correlation with the MLD (R = -0.45). Patients with a greater reduction of DLCO (more than 10%) after RT had a higher incidence of RP compared to patients with less reduction (38% vs 23%). In this study of limited sample size, the SBRT patients did not have a statistically significant change in DLCO either during (p = 0.55) or post (p = 0.64) RT. SBRT patients had less of a decrement in DLCO compared to CRT patients (-2.9 ±12.8 vs -14.2 ± 6.5, p = .11 trend for pre to post, 3.85 ±14.6 vs -10.5 ±5.2, p = 0.027 dur to post) that may be related to a trend in the decrease in MLD in SBRT plans (14.5 Gy CRT vs 9.95 Gy SBRT p = 0.079). Conclusions We have confirmed the previous finding that DLCO may be the most sensitive PFT parameter to evaluate lung function after RT. Radiation induced reduction in DLCO measured during RT and high MLD in RT plans appears to be predictive of a reduction in lung function and RP after radiation. We also observed that during and post RT changes in DLCO for SBRT patients were substantially less than in CRT patients.
    International Journal of Radiation OncologyBiologyPhysics 10/2013; 87(2):S33-S34. DOI:10.1016/j.ijrobp.2013.06.090 · 4.26 Impact Factor

Publication Stats

5k Citations
881.71 Total Impact Points


  • 1999-2015
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, United States
  • 1997-2015
    • University of Michigan
      • Department of Radiation Oncology
      Ann Arbor, Michigan, United States
  • 2013
    • Dana-Farber Cancer Institute
      Boston, Massachusetts, United States
  • 1996-2013
    • Harvard Medical School
      Boston, Massachusetts, United States
  • 2011
    • Peter MacCallum Cancer Centre
      • Peter MacCallum Cancer Center
      Melbourne, Victoria, Australia
  • 2008-2009
    • Fudan University
      Shanghai, Shanghai Shi, China
  • 2006
    • University of Chicago
      Chicago, Illinois, United States
  • 2005
    • William Beaumont Army Medical Center
      El Paso, Texas, United States
  • 2004
    • Johns Hopkins University
      Baltimore, Maryland, United States
  • 2003
    • Netherlands Cancer Institute
      • Department of Radiotherapy
      Amsterdamo, North Holland, Netherlands
  • 2002
    • University of Alabama at Birmingham
      Birmingham, Alabama, United States