Yvonne Mowery

• MD, PhD
• Professor (Assistant) at Duke University Medical Center

Objectives Head and neck cancer (HNC) often requires complex management and care. While the primary goal of treatment is curative, some advanced cases require consideration of non-curative pathways to optimize patients’ quality of life (QOL) and survival. This narrative review describes important aspects of palliative care and highlights strategies...

CD8 ⁺ tumor-infiltrating lymphocytes (TILs) are increasingly used in oncology as a prognostic and predictive tool to guide patient management. This review summarizes current literature on CD8 ⁺ TILs in head and neck squamous cell carcinoma (SCC). Published meta-analyses and clinical trials evaluating CD8 ⁺ TILs were analyzed. Consistent positive as...

Background and purpose To describe the clinical commissioning of an in‐house artificial intelligence (AI) treatment planning platform for head‐and‐neck (HN) Intensity Modulated Radiation Therapy (IMRT). Materials and methods The AI planning platform has three components: (1) a graphical user interface (GUI) is built within the framework of a comme...

Introduction Immune dysregulation plays a major role in cancer progression. The quantification of lymphocytic spatial inflammation may enable spatial system biology, improve understanding of therapeutic resistance, and contribute to prognostic imaging biomarkers. Methods In this paper, we propose a knowledge-guided deep learning framework to measu...

Background-Human papilloma virus (HPV-positive (+)) oropharynx cancer (OPC) are a distinct neoplastic entity associated with a significant survival advantage compared to HPV- OPCs. The survival advantage is so great that the presence of regional cervical lymph node metastasis is no longer considered an advanced stage III/IV cancer. The survival adv...

This abstract is being presented as a short talk in the scientific program. A full abstract is printed in the Proffered Abstracts section (PR004) of the Conference Program/Proceedings. Cell, Molecular, and Tumor Biology: Cell Growth Signaling Pathways Citation Format: Tammara L. Watts, Katerine Gonzalez, Xiangfeng Shen, Layne Rogers, Nosa Osazuwa-P...

Radiation therapy (RT) is frequently used to treat cancers, including soft-tissue sarcomas. Prior studies established that the toll-like receptor 9 (TLR9) agonist cytosine-phosphate-guanine oligodeoxynucleotide (CpG) enhances the response to RT in transplanted tumors, but the mechanisms of this enhancement remain unclear. Here, we used CRISPR/Cas9...

Purpose To identify significant relationships between quantitative cytometric tissue features and quantitative MR (qMRI) intratumorally in preclinical undifferentiated pleomorphic sarcomas (UPS). Materials and methods In a prospective study of genetically engineered mouse models of UPS, we registered imaging libraries consisting of matched multi-c...

Purpose: We aim to interrogate the role of positron emission tomography (PET) image discretization parameters on the prognostic value of radiomic features in patients with oropharyngeal cancer. Approach: A prospective clinical trial (NCT01908504) enrolled patients with oropharyngeal squamous cell carcinoma (N=69; mixed HPV status) undergoing def...

Radiation therapy is frequently used to treat cancers including soft tissue sarcomas. Prior studies established that the toll-like receptor 9 (TLR9) agonist cytosine-phosphate-guanine oligodeoxynucleotide (CpG) enhances the response to radiation therapy (RT) in transplanted tumors, but the mechanism(s) remain unclear. Here, we used CRISPR/Cas9 and...

Approximately half of patients with cancer receive radiotherapy and, as cancer survivorship increases, the low rate of radiation-associated sarcomas is rising. Pharmacologic inhibition of p53 has been proposed as an approach to ameliorate acute injury of normal tissues from genotoxic therapies, but how this might impact the risk of therapy-induced...

Background Recipients of radiation therapy (RT) for head and neck cancer (HNC) are at significantly increased risk for carotid artery stenosis (CAS) and cerebrovascular disease (CVD). We sought to determine (1) cumulative incidences of CAS and CVD among HNC survivors after RT and (2) whether CAS is associated with a RT dose response effect. Method...

Tumor hypoxia contributes to aggressive phenotypes and diminished therapeutic responses to radiation therapy (RT) with hypoxic tissue being 3-fold less radiosensitive than normoxic tissue. A major challenge in implementing hypoxic radiosensitizers is the lack of a high-resolution imaging modality that directly quantifies tissue-oxygen. The electron...

Background: Present line indications for pembrolizumab are for patients with metastatic or unresectable recurrent (i.e. incurable) head and neck squamous cell carcinoma (HNSCC). However, only a minority of patients on immunotherapy will realize a durable survival benefit because >80% of patients with metastatic HNSCC do not respond to PD-1 blockade...

Despite aggressive multimodal treatment with chemoradiation or surgery and adjuvant radiation therapy (RT) +/- chemotherapy, recurrence rates approach 50% for locally advanced human papillomavirus (HPV)-negative HNSCC. Thus, more effective therapeutics are needed in both the upfront and recurrent settings to improve outcomes for HNSCC patients. Ata...

The adaptive immune system plays an essential anti-tumor role through immunosurveillance and response to immunotherapies. Characterizing phenotypic features and mechanisms of dysfunction of tumor-specific T cell populations may uncover novel immunotherapeutic targets and biomarkers of response. To study tumor-specific T cell responses in vivo, a tu...

The availability of high-fidelity animal models for oncology research has grown enormously in recent years, enabling preclinical studies relevant to prevention, diagnosis, and treatment of cancer to be undertaken. This has led to increased opportunities to conduct co-clinical trials, which are studies on patients that are carried out parallel to or...

Objectives: To characterize factors including nodal burden, pre-treatment imaging, and other patient factors which may influence the role of ipsilateral neck radiotherapy (IRT) in tonsillar squamous cell carcinoma (SCC) with multiple involved ipsilateral nodes. Methods: Patients with cT1-2N0-2bM0 (AJCC 7th edition) tonsillar SCC treated with def...

Objectives: Clinical artificial intelligence and machine learning (ML) face barriers related to implementation and trust. There have been few prospective opportunities to evaluate these concerns. System for High Intensity EvaLuation During Radiotherapy (NCT03775265) was a randomised controlled study demonstrating that ML accurately directed clinic...

Purpose: The uninsured rate began rising after 2016, which some have attributed to health policies undermining aspects of the Affordable Care Act. Our primary objectives were to assess the changes in insurance coverage and forgoing medical care because of cost in cancer survivors from pre-enactment (2016) through postenactment of those policies (2...

Increasing rates of human papillomavirus (HPV)–driven oropharyngeal cancer (OPC) have largely offset declines in tobacco-associated head and neck squamous cell carcinoma (HNSCC) at non-OPC sites. Host immunity is an important modulator of HPV infection, persistence, and clearance, and also of immune evasion in both virally- and nonvirally-driven ca...

Purpose/Objective(s) Patients undergoing definitive head and neck cancer (HNC) treatment are at risk for high out-of-pocket (OOP) costs given complex treatment and high symptom burden. The PaRTNer pilot study was designed to assess costs, financial toxicity, and the benefit of education for patients undergoing definitive radiation (RT) for HNC. Ma...

Purpose/Objective(s) The incidence of asymptomatic carotid artery stenosis (CAS) in the general population is ∼5%. CAS is a known toxicity of radiation therapy (RT) for head and neck cancer (HNC). CAS screening is not routinely performed after RT despite the increased risk of cerebrovascular disease (CVD) in this population. Here we report long-ter...

Purpose/Objective(s) Radiation treatment planning for head and neck (HN) cancers is challenging due to complex anatomy and labor-intensive inverse optimization. Recently we developed an Artificial Intelligence (AI) tool to generate IMRT plans for bilateral planning target volumes (PTVs) with promising results in both plan quality and efficiency. In...

Head and neck squamous cell carcinoma (HNSCC) is a heterogenous disease where, in advanced stages, clinical and pathological stages do not correlate with outcome. Molecular and genomic biomarkers for HNSCC classification have shown promise for prognostic and therapeutic applications. In this study, we utilize automated image analysis techniques in...

Background Approximately half of all cancer patients receive radiotherapy and, as cancer survivorship rates increase with more effective therapies, the very low rate of radiation-associated sarcomas is rising. Radiation-associated sarcomas are life-threatening cancers, and radiation exposure is a primary risk factor for sarcoma development. During...

Background Artificial intelligence (AI) and machine learning (ML) have resulted in significant enthusiasm for their promise in healthcare. Despite this, prospective randomized controlled trials and successful clinical implementation remain limited. One clinical application of ML is mitigation of the increased risk for acute care during outpatient c...

This study aims to investigate whether adding neoadjuvant radiotherapy (RT), anti-programmed cell death protein-1 (PD-1) antibody (anti–PD-1), or RT + anti-PD-1 to surgical resection improves disease-free survival for mice with soft tissue sarcomas (STS). We generated a high mutational load primary mouse model of STS by intramuscular injection of a...

Despite aggressive conventional therapy, many patients with high-risk soft-tissue sarcoma develop metastatic disease. To investigate mechanism(s) of sarcoma metastasis, our lab has utilized genetically engineered mouse models. For example, we injected an adenovirus expressing Cre recombinase (adeno-Cre) into the gastrocnemius muscle of LSL-KrasG12D...

Background Persons living with HIV/AIDS have a higher incidence of virus‐related and tobacco/alcohol‐related cancers. This study is the first to estimate the effect of HIV versus HIV‐negative veterans on the risk of head and neck squamous cell carcinoma incidence in a large retrospective cohort study. Methods The authors constructed a retrospectiv...

Objectives: To develop and validate a prediction model to estimate overall survival (OS) with and without postoperative radiotherapy (PORT) for resected major salivary gland (SG) cancers. Materials and methods: Adults in the National Cancer Database diagnosed with invasive non-metastatic major SG cancer between 2004 and 2015 were identified. Exc...

Head and neck squamous cell carcinoma (HNSCC) is a heterogenous disease where, in advanced stages, clinical and pathological stages do not correlate with outcome. Molecular and genomic biomarkers for HNSCC classification have shown promise for prognostic and therapeutic applications. In this study, we utilize automated image analysis techniques in...

The tumor microenvironment (TME) plays an important role in the progression of head and neck squamous cell carcinoma (HNSCC). Currently, pathologic assessment of TME is nonstandardized and subject to observer bias. Genome-wide transcriptomic approaches to understanding the TME, while less subject to bias, are expensive and not currently a part of t...

TPS6108 Background: Despite aggressive multimodal treatment that typically includes radiation therapy (RT), recurrence rates approach 50% for patients with non-HPV-related locally advanced HNSCC. Treatment options for unresectable recurrent or metastatic HNSCC are limited, though PD-1 inhibitors improve survival for a subset of patients. Radiation...

Purpose To develop a method of biologically guided deep learning for post-radiation ¹⁸FDG-PET image outcome prediction based on pre-radiation images and radiotherapy dose information. Methods Based on the classic reaction–diffusion mechanism, a novel biological model was proposed using a partial differential equation that incorporates spatial radi...

Purpose: We previously reported on the clinical outcomes of treating oligometastases with radiation using an elective simultaneous integrated boost technique (SIB), delivering higher doses to known metastases and reduced doses to adjacent bone or nodal basins. Here we compare outcomes of oligometastases receiving radiation targeting metastases alo...

Background Patients with cancer are at an increased suicide risk, and socioeconomic deprivation may further exacerbate that risk. The Affordable Care Act (ACA) expanded insurance coverage options for low-income individuals and mandated coverage of mental health care. Our objective was to quantify associations of the ACA with suicide incidence among...

Purpose/Objective(s) Radiotherapy (RT) plays a major role in HNSCC treatment. Unfortunately, recurrence rates approach 50% for locally advanced, HPV-negative HNSCC, and treatment options for recurrent HNSCC are limited. New therapies are needed to enhance RT response and improve local tumor control. Ataxia telangiectasia and Rad 3-related (ATR) is...

The purpose of this study was to investigate if radiomic analysis based on spectral micro-CT with nanoparticle contrast-enhancement can differentiate tumors based on lymphocyte burden. High mutational load transplant soft tissue sarcomas were initiated in Rag2+/− and Rag2−/− mice to model varying lymphocyte burden. Mice received radiation therapy (...

Objective: To develop and characterize novel methods of extreme spatially fractionated kV radiation therapy (including mini-GRID therapy) and to evaluate efficacy in the context of a pre-clinical mouse study. Approach: Spatially fractionated GRIDs were precision-milled from 3 mm thick lead sheets compatible with mounting on a 225 kVp small anima...

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Purpose To review the preliminary outcomes of patients with uveal melanoma treated with Iodine-125 plaques using a novel treatment planning approach. Methods This was a single institution, retrospective review of patients treated with ¹²⁵I brachytherapy for uveal melanoma from November 2016 to February 2019. We used 3-dimensional treatment plannin...

Head and neck squamous cell carcinoma (HNSCC) poses significant treatment challenges, with high recurrence rates for locally advanced disease despite aggressive therapy typically involving a combination of surgery, radiation therapy, and/or chemotherapy. HNSCCs commonly exhibit reduced or absent TP53 function due to genomic alterations or human pap...

Purpose Atypical (WHO grade II) and malignant (WHO grade III) meningiomas have high rates of local recurrence, and questions remain about the role of adjuvant radiotherapy (RT) for patients with WHO grade II disease. These patients frequently require salvage therapy, and optimal management is uncertain given limited prospective data. We report long...

Purpose/Objective(s) Prevention/mitigation of oral mucositis (OM) and xerostomia are challenges to the use of chemoradiation (CRT) for advanced head and neck squamous ca (HNSCC). MnTnBuOE-2-PyP5⁺(BMX-001) is a lipophilic manganese metalloporphyrin superoxide dismutase mimic that protects against radiation and chemotherapy induced OM in orthotopic a...

Purpose/Objective(s) Preclinical studies using transplant tumor models have shown promising results for immunotherapy combined with radiotherapy (RT). However, research using primary tumor models is limited, and results from tumors using transplanted cell lines that do not develop in a native microenvironment under immunosurveillance often do not t...

Purpose/Objective(s) Mortality prediction is critical to appropriate cancer care planning. This has become a topic of interest, with machine learning (ML) tools demonstrating accurate binary predictions for mortality at specific time points. There are limited prospective data validating the clinical utility of health care ML tools. We previously de...

Purpose/Objective(s) Radiation is increasingly used to treat oligometastatic patients (OM). Following metastasis directed radiation therapy, progression in nearby nodal basins or bones is common. We previously reported clinical outcomes of OM treated with an elective simultaneous integrated boost (SIB) technique delivering higher doses to known met...

56 Background: Cancer patients face considerable financial burden, but few studies have explored associations between radiation therapy (RT) and financial toxicity. This study assessed financial toxicity, patient-reported outcomes, and attitudes/perspectives on the role of cost in treatment decisions. Methods: In a prospective, survey-based, longit...

The purpose of this study was to assess baseline variability in histogram and texture features derived from apparent diffusion coefficient (ADC) maps from diffusion-weighted MRI (DW-MRI) examinations and to identify early treatment-induced changes to these features in patients with head and neck squamous cell carcinoma (HNSCC) undergoing definitive...

We are developing imaging methods for a co-clinical trial investigating synergy between immunotherapy and radiotherapy. We perform longitudinal micro-computed tomography (micro-CT) of mice to detect lung metastasis after treatment. This work explores deep learning (DL) as a fast approach for automated lung nodule detection. We used data from contro...

Purpose This study investigated the prognostic potential of intra‐treatment PET radiomics data in patients undergoing definitive (chemo) radiation therapy for oropharyngeal cancer (OPC) on a prospective clinical trial. We hypothesized that the radiomic expression of OPC tumors after 20 Gy is associated with recurrence‐free survival (RFS). Material...

This paper develops a method of biologically guided deep learning for post-radiation FDG-PET image outcome prediction based on pre-radiation images and radiotherapy dose information. Based on the classic reaction-diffusion mechanism, a novel biological model was proposed using a partial differential equation that incorporates spatial radiation dose...

1509 Background: SHIELD-RT was a randomized controlled quality improvement study (NCT03775265) that implemented electronic health record-based machine learning (ML) to direct supplemental visits for high risk (HR) patients undergoing radiotherapy (RT). Acute care visits (ER visits or hospitalizations) were reduced from 22% to 12%. We evaluated the...

Purpose: To establish a platform for quantitative tissue-based interpretation of cytoarchitecture features from tumor MRI measurements. Materials and Methods: In a pilot preclinical study, multicontrast in vivo MRI of murine soft-tissue sarcomas in 10 mice, followed by ex vivo MRI of fixed tissues (termed MR histology), was performed. Paraffin-embe...

Purpose Due to the low incidence of intracranial disease among patients with esophageal cancer (EC), optimal management for these patients has not been established. The aim of this real-world study is to describe the clinical characteristics, treatment approaches, and outcomes for esophageal squamous cell carcinoma (ESCC) patients with brain metast...

Tumour hypoxia negatively impacts therapy outcomes and continues to be a major unsolved clinical problem. Nitroimidazoles are hypoxia selective compounds that become entrapped in hypoxic cells by forming drug-protein adducts. They are widely used as hypoxia diagnostics and have also shown promise as hypoxia-directed therapeutics. However, little is...

Background Bloodstream infections (BSIs) occur in 20-45% of inpatient autologous and allogeneic hematopoietic cell transplant (HCT) patients. Daily bathing with the antiseptic chlorhexidine gluconate (CHG) has been shown to reduce the incidence of BSIs in critically ill patients although very few studies include HCT patients or have evaluated the i...

Immunotherapy fails to cure most cancer patients. Preclinical studies indicate that radiotherapy synergizes with immunotherapy, promoting radiation-induced antitumor immunity. Most preclinical immunotherapy studies utilize transplant tumor models, which overestimate patient responses. Here, we show that transplant sarcomas are cured by PD-1 blockad...

Background: Alveolar ridge squamous cell carcinoma (ARSCC) is poorly represented in randomized trials. Methods: Adults in the National Cancer Database diagnosed with ARSCC between 2010 and 2014 who should be considered for postoperative radiotherapy (PORT) based on National Comprehensive Cancer Network (NCCN)-defined risk factors were identified...

Purpose: Patients undergoing outpatient radiotherapy (RT) or chemoradiation (CRT) frequently require acute care (emergency department evaluation or hospitalization). Machine learning (ML) may guide interventions to reduce this risk. There are limited prospective studies investigating the clinical impact of ML in health care. The objective of this...

The National Institutes of Health's (National Cancer Institute) precision medicine initiative emphasizes the biological and molecular bases for cancer prevention and treatment. Importantly, it addresses the need for consistency in preclinical and clinical research. To overcome the translational gap in cancer treatment and prevention, the cancer res...

PurposeTo develop a deep learning-based AI agent, DDD-PIOP (Dose-Distribution-Driven PET Image Outcome Prediction), for predicting 18FDG-PET image outcomes of oropharyngeal cancer (OPC) in response to intensity-modulated radiation therapy (IMRT).MethodsDDD-PIOP uses pre-radiotherapy 18FDG-PET/CT images and the planned spatial dose distribution as t...

Purpose Early indication of treatment outcome may guide therapeutic de-escalation strategies in patients with human papillomavirus (HPV)-related oropharyngeal cancer (OPC). This study investigated the relationships between tumor volume and ¹⁸F-FDG-PET parameters before and during definitive radiotherapy with treatment outcomes. Methods and Materia...

e16525 Background: Esophageal squamous cell carcinoma (ESCC) is one of the most common malignant tumors in China, but brain metastasis is rare and less reported. The aim of this study is to investigate the clinical characteristics and outcomes of ESCC patients with brain metastasis, so as to provide some references for them. Methods: Between Januar...

Purpose/Objectives Fiberoptic laryngoscopy (FOL) is a critical tool for the diagnosis, staging, assessment of treatment response, and detection of recurrence for head and neck (H&N) malignancies. No standardized recommendations exist for procedural FOL education in radiation oncology. We therefore implemented a pilot simulation workshop to train ra...

Despite impressive responses in some patients, immunotherapy fails to cure most cancer patients. Preclinical studies indicate that radiotherapy synergizes with immunotherapy, promoting radiation-induced antitumor immunity. Nearly all preclinical immunotherapy studies utilize transplant tumor models, but cure rates of transplant tumor models treated...

Small-animal imaging is an essential tool that provides noninvasive, longitudinal insight into novel cancer therapies. However, considerable variability in image analysis techniques can lead to inconsistent results. We have developed quantitative imaging for application in the preclinical arm of a coclinical trial by using a genetically engineered...

Small animal imaging has become essential in evaluating new cancer therapies as they are translated from the preclinical to clinical domain. However, preclinical imaging faces unique challenges that emphasize the gap between mouse and man. One example is the difference in breathing patterns and breath-holding ability, which can dramatically affect...

Objective: Evaluate trends in place of death for patients with head and neck cancers (HNC) in the U.S. from 1999 to 2017 based on the CDC WONDER (Wide-ranging Online Data for Epidemiologic Research) database. Materials/methods: Using patient-level data from 2015 and aggregate data from 1999 to 2017, multivariable logistic regression analyses (ML...