Chandana A Reddy

Peninsula Cancer Institute, Williamsburg, Virginia, United States

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Publications (188)376.38 Total impact

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    ABSTRACT: To examine regional nodal failure patterns with respect to lesion size in medically inoperable early-stage non-small cell lung cancer (NSCLC) patients treated with definitive lung stereotactic body radiation therapy (SBRT).
    Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer 09/2014; · 4.55 Impact Factor
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    ABSTRACT: To identify factors associated with grade ≥3 treatment related late esophageal toxicity after lung or liver stereotactic body radiation therapy (SBRT).
    International journal of radiation oncology, biology, physics 07/2014; · 4.59 Impact Factor
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    ABSTRACT: To review outcomes of 2 single-fraction lung stereotactic body radiation therapy (SBRT) schedules used for medically inoperable early stage lung cancer.
    International journal of radiation oncology, biology, physics 07/2014; · 4.59 Impact Factor
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    ABSTRACT: Repeating whole-brain radiation therapy (WBRT) in patients with progressive/recurrent brain metastases is controversial. We retrospectively reviewed our experience of repeat WBRT in an era where stereotactic radiosurgery was also available. In our IRB-approved database, 49 patients received repeat WBRT from 1996 to 2011. Median initial dose of WBRT was 30 Gy in 10 fractions (range, 27 to 37.5 Gy); median reirradiation dose was 20 Gy in 10 fractions (range, 14 to 30 Gy). Median Karnofsky performance status (KPS) at reirradiation was 70 (range, 40 to 90). Median number of discrete lesions at reirradiation was 6 (range, 1 to 30). Median interval between initial diagnosis of brain metastases and relapse requiring repeat WBRT was 11.5 months (range, 1.5 to 49.2 mo). Overall survival and relapse-free survival were summarized using the Kaplan-Meier method. The log-rank test was used to compare outcomes between groups. Ninety percent of patients completed repeat WBRT. Median survival after repeat WBRT was 3 months (95% CI, 1.9-4.0). Thirteen patients had improved neurological symptoms (27%), 12 were stable (24%), and 14 had worsening symptoms (29%). On radiographic follow-up of 22 patients, 10 (46%) were improved, 4 (18%) were stable, and 8 (36%) progressed. Improved neurological symptoms after repeat WBRT and higher KPS at first follow-up were associated with improved survival (P=0.05 and 0.02). Repeat WBRT was well tolerated. Modest survival times are seen. Prognostic factors for survival include improved neurological symptoms after repeat WBRT and higher KPS at first follow-up. Repeat WBRT may be useful to improve neurological symptoms in patients with limited treatment options, especially those who are not appropriate stereotactic radiosurgery candidates.
    American journal of clinical oncology 03/2014; · 2.21 Impact Factor
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    ABSTRACT: Exposure to ionizing radiation has been linked to myelodysplastic syndromes (MDS); it is not clear whether therapeutic radiation doses used for prostate cancer pose an increased MDS risk. We performed a retrospective cohort study of prostate cancer patients diagnosed between 1986 and 2011 at Cleveland Clinic, comparing those who underwent definitive treatment with radical prostatectomy (RP) to radiotherapy either external beam radiotherapy (EBRT) or prostate interstitial brachytherapy (PI) and to population-based registries. Competing risk regression analyses were used to determine the cumulative risk of developing MDS. All statistical tests were two-sided. Of 10924 patients, 5119 (47%) received radiation (n = 2183 [43%] in EBRT group and n = 2936 [57%] in PI group) and 5805 (53%) were treated with RP. Overall, 31 cases of MDS were observed, with age-adjusted incidence rates no higher than in population-based registries. In univariate analyses, advancing age (hazard ratio [HR] = 1.14; 95% confidence interval [CI] = 1.09 to 1.20; P < .001) and radiotherapy exposure (HR = 3.44; 95% CI = 1.41 to 8.37; P = .007) were statistically significantly associated with development of MDS. In multivariable analyses, although advanced age (HR = 1.13; 95% CI = 1.06 to 1.19; P < .001) remained statistically associated with MDS, radiation did not, although a small non-statistically significant trend existed for PI-treated patients. MDS rates were no higher than in population-based registries. With relatively short follow-up, prostate cancer patients definitively treated with radiation did not appear to have a statistically increased risk of subsequent MDS.
    CancerSpectrum Knowledge Environment 02/2014; · 14.07 Impact Factor
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    ABSTRACT: Higher isodose lines (IDL) in Gamma Knife (GK) Perfexion treatment of brain metastases (BMet) could result in lower local control (LC) or higher radiation necrosis (RN) rates, but reduce treatment time. To assess impact of heterogeneity (HI) and conformality (CI) indices on local failure (LF) for patients treated with GK for 1-3 BMet. From an IRB-approved database, 320 patients with 496 BMet were identified, treated for 1-3 BMet from July 2007 to April 2011 on GK Perfexion. Cox proportional hazards regression was used to analyze significance of HI, CI, IDL, dose, tumor diameter, RPA class, tumor radioresistance, primary, smoking history, metastasis location, and WBRT history with LF and RN. Median follow-up by lesion was 6.8 months (range: 0-49.6). Series median survival was 14.2 months. Per RECIST, 9.5% of lesions failed, 33.9% were stable, 38.3% partially responded, 17.1% responded completely, and 1.2% could not be assessed. The 12-month LC rate was 87.3%. On univariate analysis, dose <20 Gy (HR=2.940, p<.001); tumor size (HR=1.674, p<.001); and cerebellum/brainstem location vs. other (HR=1.891, p=.043) were significant for LF. NSCLC (HR=.333, p=.0097) was associated with better LC. On multivariate analysis, tumor size (HR=1.696, p<.001) and cerebellum/brainstem location vs. other (HR=1.959, p=.033) remained significant for LF. Variables not significant for LF included CI, IDL, and HI. Our study of patients with 1-3 BMet treated with GK demonstrated no difference in LC or RN with varying HI, indicating that physicians can treat to IDL at ≥70% IDL to reduce treatment time without increased LF or RN.
    Neurosurgery 01/2014; · 2.53 Impact Factor
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    ABSTRACT: Purpose To review the impact of a workflow enhancement (WE) team in reducing treatment errors that reach patients within radiation oncology. Methods and Materials It was determined that flaws in our workflow and processes resulted in errors reaching the patient. The process improvement team (PIT) was developed in 2010 to reduce errors and was later modified in 2012 into the current WE team. Workflow issues and solutions were discussed in PIT and WE team meetings. Due to tensions within PIT that resulted in employee dissatisfaction, there was a 6-month hiatus between the end of PIT and initiation of the renamed/redesigned WE team. In addition to the PIT/WE team forms, the department had separate incident forms to document treatment errors reaching the patient. These incident forms are rapidly reviewed and monitored by our departmental and institutional quality and safety groups, reflecting how seriously these forms are treated. The number of these incident forms was compared before and after instituting the WE team. Results When PIT was disbanded, a number of errors seemed to occur in succession, requiring reinstitution and redesign of this team, rebranded the WE team. Interestingly, the number of incident forms per patient visits did not change when comparing 6 months during the PIT, 6 months during the hiatus, and the first 6 months after instituting the WE team (P=.85). However, 6 to 12 months after instituting the WE team, the number of incident forms per patient visits decreased (P=.028). After the WE team, employee satisfaction and commitment to quality increased as demonstrated by Gallup surveys, suggesting a correlation to the WE team. Conclusions A team focused on addressing workflow and improving processes can reduce the number of errors reaching the patient. Time is necessary before a reduction in errors reaching patients will be seen.
    International journal of radiation oncology, biology, physics 01/2014; · 4.59 Impact Factor
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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: To compare the need for repeat treatment or urinary diversion in patients undergoing transurethral resection of the prostate (TURP) compared with photoselective vaporization of the prostate (PVP) after brachytherapy or external beam radiation therapy (EBRT). The prostate cancer database of Cleveland Clinic includes 3600 patients who have undergone prostate brachytherapy and 2500 patients who have undergone EBRT. We cross-referenced these patients with the electronic medical record to identify patients who required PVP or TURP after radiation. The primary outcome was the need for any further intervention after PVP or TURP, including bladder neck incision, repeat TURP, or permanent supravesicular diversion. Sixty of the 3600 patients (1.7%) required prostate reduction surgery after brachytherapy. Of these 60 patients, 19 of 40 (47.5%) who underwent TURP required further intervention, and 10 of 20 patients (50%) who underwent PVP required subsequent intervention. Twenty-eight of the 2500 patients (1.1%) required prostate reduction surgery after EBRT. Of these 28 patients, 5 of 18 patients (27.8%) who underwent TURP required further intervention, and 5 of 10 patients (50%) who underwent PVP required subsequent intervention. Following either type of radiation there was not a significant difference in the need for further treatment based on the type of surgery (P >.999 for brachytherapy; P = .412 for EBRT). The median time between radiation and prostate reduction surgery is 20.2 months (range, 14.6-27.6) after brachytherapy and 53.3 months (range, 27.5-53.3) after EBRT (P = .0005). This study suggests that PVP and TURP are comparable in treating prostatic obstruction after brachytherapy or EBRT. However, obstruction after brachytherapy occurs earlier compared with after EBRT.
    Urology 12/2013; · 2.42 Impact Factor
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    ABSTRACT: Although stereotactic radiosurgery (SRS) is an effective treatment option for patients with brain tumors, its increased use has raised concern for increased incidence of radiation necrosis (RN). No established standard or guidelines exists regarding non-invasive techniques to diagnose or treat RN. This study was conducted to assess current patterns of evaluation and treatment of RN among physicians who treat intracranial malignancies. A questionnaire consisting of 20 questions was sent to 3,041 members of the American Society for Radiation Oncology (ASTRO) and the Society for Neurologic Oncology (SNO). Questions addressed demographics, utilization of SRS, perceptions regarding RN diagnosis treatment, approach to steroid-refractory RN, and management of two clinical scenarios using Kwiksurvey© software. The survey response rate was 8.74 % (266/3,041). Most respondents practice in an academic and/or university setting (62 %) at a facility that performs SRS (94 %) with a variety of systems. The number of annual cases performed at the participant's institution varied from <50 to >400, with a wide degree of variability. Most respondents practice at an institution that performs 50-100 cases/year (28 %). The most common range of symptomatic RN seen in clinical practice was 1-5 % (61 %). Most respondents reported that asymptomatic RN occurs in 6-10 % (33 %). Favored non-invasive diagnostic mechanisms were clinical evaluation (37 %) and MRI (19 %). In response to a clinical scenario depicting an asymptomatic patient post-SRS for brain metastasis with an enlarging lesion and edema at the treatment site, most respondents felt the image represented RN or a combination of RN and tumor progression. Most (58 %) favored short-term follow-up with repeat MRI. Ninety-three percent of the respondents initiated steroids as a first-line approach if patient was to develop symptoms. Steroids were the preferred first therapy in symptomatic patients on initial follow-up (81 %). In steroid-refractory patients, most recommend surgical intervention (63 %). Most physicians who responded to this questionnaire believe that post-SRS RN is uncommon (≤10 % of cases). The approach to establish the diagnosis of RN is variable. Steroids are the most commonly utilized first-line treatment for suspected RN. Considerable variation exists in the management of steroid-refractory RN. Additional studies are required to establish guidelines for evaluation and treatment of RN.
    Journal of Neuro-Oncology 09/2013; · 3.12 Impact Factor
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    ABSTRACT: Men with high-risk prostate cancer have other competing causes of mortality; however, current risk stratification schema do not account for comorbidities. We aim to identify the causes of death and factors predictive for mortality in this population. A total of 660 patients with high-risk prostate cancer were treated with definitive high-dose external beam radiation therapy (≥74 Gy) and androgen deprivation (AD) between 1996 and 2009 at a single institution. Cox proportional hazards regression analysis was conducted to determine factors predictive of survival. The median radiation dose was 78 Gy, median duration of AD was 6 months, and median follow-up was 74 months. The 10-year overall survival (OS) was 60.6%. Prostate cancer was the leading single cause of death, with 10-year mortality of 14.1% (95% CI 10.7-17.6), compared with other cancers (8.4%, 95% CI 5.7-11.1), cardiovascular disease (7.3%, 95% CI 4.7-9.9), and all other causes (10.4%, 95% CI 7.2-13.6). On multivariate analysis, older age (HR 1.55, P=.002) and Charlson comorbidity index score (CS) ≥1 (HR 2.20, P<.0001) were significant factors predictive of OS, whereas Gleason score, T stage, prostate-specific antigen, duration of AD, radiation dose, smoking history, and body mass index were not. Men younger than 70 years of age with CS = 0 were more likely to die of prostate cancer than any other cause, whereas older men or those with CS ≥1 more commonly suffered non-prostate cancer death. The cumulative incidences of prostate cancer-specific mortality were similar regardless of age or comorbidities (P=.60). Men with high-risk prostate cancer are more likely to die of causes other than prostate cancer, except for the subgroup of men younger than 70 years of age without comorbidities. Only older age and presence of comorbidities significantly predicted for OS, whereas prostate cancer- and treatment-related factors did not.
    International journal of radiation oncology, biology, physics 09/2013; 87(1):94-9. · 4.59 Impact Factor
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    ABSTRACT: BACKGROUND: Medical comorbidity is a confounding factor in prostate cancer (PCa) treatment selection and mortality. Large-scale comparative evaluation of PCa mortality (PCM) and overall mortality (OM) restricted to men without comorbidity at the time of treatment has not been performed. OBJECTIVE: To evaluate PCM and OM in men with no recorded comorbidity treated with radical prostatectomy (RP), external-beam radiation therapy (EBRT), or brachytherapy (BT). DESIGN, SETTING, AND PARTICIPANTS: Data from 10 361 men with localized PCa treated from 1995 to 2007 at two academic centers in the United States were prospectively obtained at diagnosis and retrospectively reviewed. We identified 6692 men with no recorded comorbidity on a validated comorbidity index. Median follow-up after treatment was 7.2 yr. INTERVENTION: Treatment with RP in 4459 men, EBRT in 1261 men, or BT in 972 men. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Univariate and multivariate Cox proportional hazards regression analysis, including propensity score adjustment, compared PCM and OM for EBRT and BT relative to RP as reference treatment category. PCM was also evaluated by competing risks analysis. RESULTS AND LIMITATIONS: Using Cox analysis, EBRT was associated with an increase in PCM compared with RP (hazard ratio [HR]: 1.66; 95% confidence interval [CI], 1.05-2.63), while there was no statistically significant increase with BT (HR: 1.83; 95% CI, 0.88-3.82). Using competing risks analysis, the benefit of RP remained but was no longer statistically significant for EBRT (HR: 1.55; 95% CI, 0.92-2.60) or BT (HR: 1.66; 95% CI, 0.79-3.46). In comparison with RP, both EBRT (HR: 1.71; 95% CI, 1.40-2.08) and BT (HR: 1.78; 95% CI, 1.37-2.31) were associated with increased OM. CONCLUSIONS: In a large multicenter series of men without recorded comorbidity, both forms of radiation therapy were associated with an increase in OM compared with surgery, but there were no differences in PCM when evaluated by competing risks analysis. These findings may result from an imbalance of confounders or differences in mortality related to primary or salvage therapy.
    European Urology 03/2013; · 10.48 Impact Factor
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    ABSTRACT: To report on medically inoperable stage I small cell lung cancer (SCLC) patients for whom stereotactic body radiation therapy (SBRT) was employed to manage the primary tumor. Review of our institutional review board approved SBRT registry revealed 6 cases of stage I SCLC out of 430 patients over a 6-year interval (2004-2010). All patients had biopsy proven disease and deemed medically inoperable by a thoracic surgeon. Our institutional approach was to treat with a combination of SBRT, platinum-etoposide chemotherapy (CHT) and prophylactic cranial irradiation (PCI). SBRT was delivered using a Novalis/BrainLAB platform and ExacTrac (BrainLab, Westchester, IL) for image guidance. Patient characteristics included a median Karnofsky performance scale of 80, a median age of 68 years, 4 females, and 1 patient still smoking at presentation. Impaired pulmonary function caused inoperability in 50% of cases. Tumor characteristics included median tumor size of 2.6 cm and median positron emission tomography-standard uptake valuemax of 9. The SBRT was 60 Gy/3 fractions (3 patients), 50 Gy/5 fractions (2 patients), 30 Gy/1 fraction (1 patient). Median follow-up was 11.9 months. There was no grade 3 or higher, and 1 grade 2, toxicity. Three patients were alive at analysis and 3 patients had died of non-cancer causes. At 1 year, local control was 100%, there was no regional nodal failure, and 1 patient had distant failure (liver). Overall and disease-free survivals at 1 year were 63% and 75%, respectively. Employing SBRT for stage I medically inoperable SCLC is rational, with excellent local control and encouraging disease-specific survival. The absence of regional nodal failure supports positron emission tomography for mediastinal staging. Platinum-based CHT may be feasible in vulnerable populations.
    Practical radiation oncology. 01/2013; 3(4):301-6.
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    ABSTRACT: To examine late gastrointestinal (GI) and genitourinary (GU) toxicity profiles of patients treated for prostate cancer either definitively or post-prostatectomy with both intensity modulated radiation therapy (IMRT) and image guided radiation therapy (IGRT). A total of 333 patients treated definitively and 104 patients treated postoperatively with IMRT and varying IGRT techniques were retrospectively examined to evaluate GI and GU toxicity profiles >1 year from treatment. Available dosimetric data were used for correlative analysis. The median follow-up time for the definitive patients was 41 months and the median follow-up time for the post-prostatectomy patients was 33 months. No late grade 4 or 5 GI or GU toxicities were observed. For definitive patients, the rates of grade ≥2 GI and GU toxicity at 3 years were 4.9% and 4.5%, respectively. In the postoperative cohort the rate of grade >2 GU toxicity was 11.6%, with no grade ≥2 GI toxicity. In the definitive cohort's Cox proportional hazards regression univariate analysis, use of anticoagulation was significantly associated with GI toxicity and age, bladder V50 and IGRT modality were associated with GU toxicity, and only age remained significant in the multivariate model. In univariate analysis for the postoperative cohort, no dosimetric value correlated with GU toxicity, nor did age or time from radical prostatectomy to radiation. IMRT with IGRT achieved low rates of GI and GU toxicity in the definitive and postoperative setting.
    Practical radiation oncology. 01/2013; 3(4):323-8.
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    ABSTRACT: PurposeTo report our 20 yr experience of definitive radiotherapy for early glottic squamous cell carcinoma (SCC).Methods and materialsRadiation records of 141 patients were retrospectively evaluated for patient, tumor, and treatment characteristics. Cox proportional hazard models were used to perform univariate (UVA) and multivariate analyses (MVA). Cause specific survival (CSS) and overall survival (OS) were plotted using cumulative incidence and Kaplan-Meir curves, respectively. RESULTS: Of the 91% patients that presented with impaired voice, 73% noted significant improvement. Chronic laryngeal edema and dysphagia were noted in 18% and 7%, respectively. The five year LC was 94% (T1a), 83% (T1b), 87% (T2a), 65% (T2b); the ten year LC was 89% (T1a), 83% (T1b), 87% (T2a), and 53% (T2b). The cumulative incidence of death due to larynx cancer at 10 yrs was 5.5%, respectively. On MVA, T-stage, heavy alcohol consumption during treatment, and used of weighted fields were predictive for poor outcome (p < 0.05). The five year CSS and OS was 95.9% and 76.8%, respectively. CONCLUSIONS: Definitive radiotherapy provides excellent LC and CSS for early glottis carcinoma, with excellent voice preservation and minimal long term toxicity. Alternative management strategies should be pursued for T2b glottis carcinomas.
    Radiation Oncology 11/2012; 7(1):193. · 2.11 Impact Factor
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    ABSTRACT: Object Stereotactic body radiotherapy (SBRT) has emerged as an important treatment option for spinal metastases from renal cell carcinoma (RCC) as a means to overcome RCC's inherent radioresistance. The authors reviewed the outcomes of SBRT for the treatment of RCC metastases to the spine at their institution, and they identified factors associated with treatment failure. Methods Fifty-seven patients (88 treatment sites) with RCC metastases to the spine received single-fraction SBRT. Pain relief was based on the Brief Pain Inventory and was adjusted for narcotic use according to the Radiation Therapy Oncology Group protocol 0631. Toxicity was scored according to Common Toxicity Criteria for Adverse Events version 4.0. Radiographic failure was defined as infield or adjacent (within 1 vertebral body [VB]) failure on follow-up MRI. Multivariate analyses were performed to correlate outcomes with the following variables: epidural, paraspinal, single-level, or multilevel disease (2-5 sites); neural foramen involvement; and VB fracture prior to SBRT. Kaplan-Meier analysis and Cox proportional hazards modeling were used for statistical analysis. Results The median follow-up and survival periods were 5.4 months (range 0.3-38 months) and 8.3 months (range 1.5-38 months), respectively. The median time to radiographic failure and unadjusted pain progression were 26.5 and 26.0 months, respectively. The median time to pain relief (from date of simulation) and duration of pain relief (from date of treatment) were 0.9 months (range 0.1-4.4 months) and 5.4 months (range 0.1-37.4 months), respectively. Multivariate analyses demonstrated that multilevel disease (hazard ratio [HR] 3.5, p = 0.02) and neural foramen involvement (HR 3.4, p = 0.02) were correlated with radiographic failure; multilevel disease (HR 2.3, p = 0.056) and VB fracture (HR 2.4, p = 0.046) were correlated with unadjusted pain progression. One patient experienced Grade 3 nausea and vomiting; no other Grade 3 or 4 toxicities were observed. Twelve treatment sites (14%) were complicated by subsequent vertebral fractures. Conclusions Stereotactic body radiotherapy for RCC metastases to the spine offers fast and durable pain relief with minimal toxicity. Stereotactic body radiotherapy seems optimal for patients who have solitary or few spinal metastases. Patients with neural foramen involvement are at an increased risk for failure.
    Journal of neurosurgery. Spine 09/2012; · 1.61 Impact Factor
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    ABSTRACT: To examine the effect of prostate-specific antigen screening on the development of metastatic disease after treatment relative to 1992, the year that prostate-specific antigen screening was recommended by the American Urological Association. Screening for cancer of the prostate (CaP) with prostate-specific antigen has been questioned because of its modest impact on survival in two randomized trials. Its impact on the metastatic disease burden in a population was not assessed. To account for lead-time bias, we compared the 10-year metastasis-free survival rate for the prescreening era group (PRE) to the 15-year metastases-free survival rate of the postscreening era group (POST). From 1986 to 1996, a total of 1721 CaP patients were definitively treated at our institution. The cohort was divided into PRE (1986-1992; n = 575) and POST (1993-1996; n = 1146). PRE patients were censored at 10 years, and POST patients were censored at 15 years. The 10- and 15-year metastasis-free survival rate and the characteristics associated with the risk of developing metastatic disease were assessed. Median follow up for all patients was 10 years (range 0.1-15 years), 9.6 years (range 0.1-10 years) for PRE, and 10.25 years (range 0.1-15 years) for POST. The 10-year PRE versus 15-year POST metastasis-free survival rate was 58% versus 65% for high-risk (P < .0001), 79% versus 86% for intermediate-risk (P < .0001), and 90% versus 96% (P = .0001) for low-risk patients. On multivariable analysis, screening era (P < .0001, hazard ratio = 4.2, 95% confidence interval = 3.1-5.7), T-stage, biopsy Gleason score, and post-treatment prostate-specific antigen testing frequency were significant for the development of metastatic disease. The implementation of prostate-specific antigen screening in this population is associated with a decrease in metastatic disease.
    Urology 08/2012; 80(2):367-72. · 2.42 Impact Factor
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    Urology 08/2012; 80(2):373. · 2.42 Impact Factor
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    ABSTRACT: Patients with locally advanced or recurrent rectal cancer often require multimodality treatment. Intraoperative radiation therapy (IORT) is a focal approach which aims to improve local control. We retrospectively reviewed 42 patients treated with IORT following definitive resection of a locally advanced or recurrent rectal cancer from 2000-2009. All patients were treated with the Intrabeam® Photon Radiosurgery System (PRS). A dose of 5 Gy was prescribed to a depth of 1 cm (surface dose range: 13.4-23.1, median: 14.4 Gy). Median survival times were calculated using Kaplan-Meier analysis. Of 42 patients, 32 had recurrent disease (76%) while 10 had locally advanced disease (24%). Eighteen patients (43%) had tumors fixed to the sidewall. Margins were positive in 19 patients (45%). Median follow-up after IORT was 22  months (range 0.2-101). Median survival time after IORT was 34 months. The 3-year overall survival rate was 49% (43% for recurrent and 65% for locally advanced patients). Local recurrence was evaluable in 34 patients, of whom 32% failed. The 1-year local recurrence rate was 16%. Distant metastasis was evaluable in 30 patients, of whom 60% failed. The 1-year distant metastasis rate was 32%. No intraoperative complications were attributed to IORT. Median duration of IORT was 35 minutes (range: 14-39). Median discharge time after surgery was 7 days (range: 2-59). Hydronephrosis after IORT occurred in 10 patients (24%), 7 of whom had documented concomitant disease recurrence. The Intrabeam® PRS appears to be a safe technique for delivering IORT in rectal cancer patients. IORT with PRS marginally increased operative time, and did not appear to prolong hospitalization. Our rates of long-term toxicity, local recurrence, and survival rates compare favorably with published reports of IORT delivery with other methods.
    Radiation Oncology 07/2012; 7:110. · 2.11 Impact Factor
  • Jay P Ciezki, Chandana A Reddy
    Urology 06/2012; 80(3):654; author reply 654-5. · 2.42 Impact Factor

Publication Stats

2k Citations
376.38 Total Impact Points


  • 2009–2014
    • Peninsula Cancer Institute
      Williamsburg, Virginia, United States
    • Penn State Hershey Medical Center and Penn State College of Medicine
      Hershey, Pennsylvania, United States
  • 2012
    • Northeast Ohio Medical University
      Ravenna, Ohio, United States
  • 2010–2012
    • Case Western Reserve University
      Cleveland, Ohio, United States
  • 2002–2012
    • Cleveland Clinic
      • Department of Radiation Oncology
      Cleveland, OH, United States
    • Lerner Research Institute
      Cleveland, Ohio, United States
  • 2011
    • William Beaumont Army Medical Center
      El Paso, Texas, United States
    • Trakya University
      • Department of Radiation Oncology
      Adrianoupolis, Edirne, Turkey
  • 2006–2008
    • University of Texas MD Anderson Cancer Center
      • Division of Radiation Oncology
      Houston, TX, United States
  • 2007
    • University of Pennsylvania
      • Department of Radiation Oncology
      Philadelphia, PA, United States
  • 2005
    • University of Texas Health Science Center at San Antonio
      San Antonio, Texas, United States
  • 2004
    • Memorial Sloan-Kettering Cancer Center
      • Department of Radiation Oncology
      New York City, NY, United States