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Publications (2)6.02 Total impact

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    ABSTRACT: Background Prostate cancer is the most common non-cutaneous malignancy diagnosed in men. From a large population-based database, we aim to report prostate cancer specific mortality (PCSM) rates of men diagnosed with various presentations of prostate cancer in order to examine the adequacy of the current American Joint Committee on Cancer (AJCC) staging system. Methods The Surveillance, Epidemiology, and End Results (SEER) database was queried for all patients diagnosed with prostate cancer from 1997 – 2005. PCSM was reported by extent of disease (EOD) classification provided by the SEER database, for clinically staged and pathologically staged cohorts. Results Using the cumulative incidence method, PCSM at 10 years for all patients (n=354,326) was 5% in clinically localized (CL) lesions, 7% in T3aN0M0, 14% T3bN0M0, 26% for T4N0M0, 27% for TanyN1M0 and 66% for TanyNanyM1 disease. Within the pathologically staged subgroup (n=108,135), PCSM at 10 years was 1% in clinically localized (CL) lesions, 4% in T3aN0M0, 9% T3bN0M0, 9% for T4N0M0 and 19% for TanyN1M0. Conclusion Staging of any disease site aims to accurately communicate, prognosticate and guide management for that particular level of disease. Stage IV prostate cancer is a diverse group with PCSM in the subgroups ranging from 9 to 68% in this study. Considering the favorable outcomes of those with T4 or N1 non-metastatic prostate cancer relative to those with M1 disease, we propose a new stage IIIB in which T4 or N1 M0 prostate cancer should be reclassified, and patients offered curative intent therapy whenever possible.
    Clinical Genitourinary Cancer 01/2014; · 1.43 Impact Factor
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    ABSTRACT: Postmastectomy radiation therapy (PMRT) remains controversial for patients with 1-3 positive lymph nodes (LN+). We conducted a retrospective review of all 369 breast cancer patients with 1-3 LN+ who underwent mastectomy without neoadjuvant systemic therapy between 2000 and 2007 at Cleveland Clinic. We identified 271 patients with 1-3 LN+ who did not receive PMRT and 98 who did receive PMRT. The median follow-up time was 5.2 years, and the median number of LN dissected was 11. Of those not treated with PMRT, 79% received adjuvant chemotherapy (of whom 70% received a taxane), 79% received hormonal therapy, and 5% had no systemic therapy. Of the Her2/neu amplified tumors, 42% received trastuzumab. The 5-year rate of locoregional recurrence (LRR) was 8.9% without PMRT vs 0% with PMRT (P=.004). For patients who did not receive PMRT, univariate analysis showed 6 risk factors significantly (P<.05) correlated with LRR: estrogen receptor/progesterone receptor negative (hazard ratio [HR] 2.6), lymphovascular invasion (HR 2.4), 2-3 LN+ (HR 2.6), nodal ratio >25% (HR 2.7), extracapsular extension (ECE) (HR 3.7), and Bloom-Richardson grade III (HR 3.1). The 5-year LRR rate was 3.4% (95% confidence interval [CI], 0.1%-6.8%] for patients with 0-1 risk factor vs 14.6% [95% CI, 8.4%-20.9%] for patients with ≥2 risk factors (P=.0006), respectively. On multivariate analysis, ECE (HR 4.3, P=.0006) and grade III (HR 3.6, P=.004) remained significant risk factors for LRR. The 5-year LRR was 4.1% in patients with neither grade III nor ECE, 8.1% with either grade III or ECE, and 50.4% in patients with both grade III and ECE (P<.0001); the corresponding 5-year distant metastasis-free survival rates were 91.8%, 85.4%, and 59.1% (P=.0004), respectively. PMRT offers excellent control for patients with 1-3 LN+, with no locoregional failures to date. Patients with 1-3 LN+ who have grade III disease and/or ECE should be strongly considered for PMRT.
    International journal of radiation oncology, biology, physics 05/2012; 83(5):e577-81. · 4.59 Impact Factor