Zhongxing X Liao

Zhongxing X Liao
University of Texas MD Anderson Cancer Center | MD Anderson · Division of Radiation Oncology

About

676
Publications
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Publications

Publications (676)
Article
Full-text available
Background Systemic corticosteroids are commonly prescribed for palliation of dyspnoea in patients with cancer, despite scarce evidence to support their use. We aimed to assess the effect of high-dose dexamethasone versus placebo on cancer-related dyspnoea. Methods The parallel-group, double-blind, randomised, controlled ABCD (Alleviating Breathle...
Article
Objective: Traditional radiotherapy (RT) treatment planning of non-small cell lung cancer (NSCLC) relies on population-wide estimates of organ tolerance to minimize excess toxicity. The goal of this study is to develop a personalized treatment planning based on patient-specific lung radiosensitivity, by combining machine learning and optimization....
Article
Full-text available
Introduction Durvalumab after concurrent chemoradiation (CCRT) for non-small cell lung cancer (NSCLC) improves survival, but only in a subset of patients. We investigated the effect of severe radiation-induced lymphopenia (sRIL) on survival in these patients. Methods Outcomes after CCRT (2010 - 2019) or CCRT followed by durvalumab (2018 - 2019) we...
Article
Background: Successful generation of biomechanical model-based deformable image registration (BM-DIR) relies on user-defined parameters that dictate surface mesh quality. The trial-and-error process to determine the optimal parameters can be labor intensive and hinder DIR efficiency and clinical workflow. Purpose: To identify optimal parameters...
Article
Full-text available
This study aimed to compare the predictive performance of different modeling methods in developing normal tissue complication probability (NTCP) models for predicting radiation-induced esophagitis (RE) in non–small cell lung cancer (NSCLC) patients receiving proton radiotherapy. The dataset was composed of 328 NSCLC patients receiving passive-scatt...
Article
Purpose In patients treated with chemoradiation for esophageal cancer (EC), randomized trial data demonstrate that proton beam therapy (PBT) reduces toxicities and postoperative complications (POCs) compared with intensity-modulated radiation therapy (IMRT). However, whether radiation therapy modality affects postoperative health care resource util...
Article
Full-text available
Purpose of Review Despite the advancements of modern radiotherapy, radiation-induced cardiovascular disease (RICVD) remains a common cause of morbidity and mortality among cancer survivors. Recent Findings Proposed pathogenetic mechanisms of RICVD include endothelial cell damage with accelerated atherosclerosis, pro-thrombotic alterations in the c...
Article
Full-text available
The aim of our study is to characterize the risk of radiation-induced esophagitis (RE) in a cohort of Non-Small-Cell Lung Cancer (NSCLC) patients treated with concurrent chemotherapy and photon/proton therapy. For each patient, the RE was graded according to the CTCAE v.3. The esophageal dose-volume histograms (DVHs) were extracted. Voxel-based ana...
Article
Purpose: In this multicenter, phase 3 trial, the efficacy and safety of 60 Gy and 50 Gy doses delivered with modern radiation technology for definitive concurrent chemoradiation (CCRT) in patients with inoperable esophageal squamous cell carcinoma (ESCC) were evaluated. Patients and methods: Patients with pathologically confirmed stage IIA‒IVA E...
Article
Purpose To investigate the interplay between spatial dose patterns and single nucleotide polymorphisms in the development of radiation-induced lymphopenia (RIL) in 186 non-small-cell lung cancer (NSCLC) patients undergoing chemo-radiotherapy (RT). Methods This study included NSCLC patients enrolled in a randomized trial of protons vs. photons with...
Article
Purpose/Objective(s) Cancer Associated Macrophage-Like cells (CAMLs) are a type of circulating stromal cell found in the blood of cancer patients (pts), described as of myeloid origin that represent the inflammatory state of the tumor microenvironment. We have previously reported that in non-small cell lung carcinoma (NSCLC), CAML PD-L1 expression...
Article
Full-text available
Radiotherapy is known to influence immune function, including T cell receptor (TCR) repertoire. We evaluated the TCR repertoire before and after stereotactic body radiotherapy (SBRT) for stage I non-small-cell lung cancer (NSCLC) and explored correlations between TCR indexes and distant failure after SBRT. TCR repertoires were analyzed in periphera...
Article
Background A previous pooled analysis of the STARS and ROSEL trials showed higher survival after stereotactic ablative radiotherapy (SABR) than with surgery for operable early-stage non-small-cell lung cancer (NSCLC), but that analysis had notable limitations. This study reports long-term results of the revised STARS trial, in which the SABR group...
Article
Full-text available
Background and purpose: The efficacy of clinical trials and the outcome of patient treatment are dependent on the quality assurance (QA) of radiation therapy (RT) plans. There are two widely utilized approaches that include plan optimization guidance created based on patient-specific anatomy. This study examined these two techniques for dose-volum...
Article
Full-text available
Purpose: Re-planning for four-dimensional computed tomography (4DCT)-based lung adaptive radiotherapy commonly requires deformable dose mapping between the planning average-intensity image (AVG) and the newly acquired AVG. However, such AVG-AVG deformable image registration (DIR) lacks accuracy assessment. The current work quantified and compared...
Article
Full-text available
This study investigates the dose–response patterns associated with radiation pneumonitis (RP) in patients treated for thoracic malignancies with different radiation modalities. To this end, voxel-based analysis (VBA) empowered by a novel strategy for the characterization of spatial properties of dose maps was applied. Data from 382 lung cancer and...
Article
Full-text available
Introduction Cardiotoxicities induced by cancer therapy can negatively affect quality of life and survival. We investigated whether high-sensitivity cardiac troponin T (hs-cTnT) levels could serve as biomarker for early detection of cardiac adverse events (CAEs) after chemoradiation therapy (CRT) for non-small cell lung cancer (NSCLC). Methods Thi...
Article
Purpose To investigate thoracic dose-response patterns for pericardial effusion (PCE) and mortality in patients treated for locally advanced Non-Small-Cell Lung Cancer (NSCLC) by Intensity Modulated RT (IMRT) or Passive-Scattering Proton Therapy (PSPT). Methods Among 178 patients, 43.5% developed grade≥2 PCE. Clinical and dosimetric factors associ...
Article
Background: Palliative radiotherapy (RT) is effective, but some patients die during treatment or too soon afterward to experience benefit. This study investigates end-of-life RT patterns to inform shared decision-making and facilitate treatment consistent with palliative goals. Materials and methods: All patients who died ≤6 months after initiat...
Conference Paper
Introduction: Despite evidence that a subset of patients with locoregionally advanced non-small cell lung cancer (NSCLC) can be cured with radiation doses less than 60 Gy, there are currently no validated approaches to identify patients that could benefit from radiation dose de-escalation. Normal tissue changes including inflammation and fibrosis c...
Article
Full-text available
Introduction Clinical trial enrollment has declined globally due to the COVID-19 pandemic. This underscores the importance of structured methods to continue critical medical research safely and efficiently. Methods We report the impact of a phased trial reopening strategy, remote research staffing, and telemedicine on cancer trial enrollment at on...
Article
Full-text available
Purpose To investigate the incidence and prognosis of severe radiation-induced lymphopenia (sRIL) after postoperative radiotherapy (PORT) for resected NSCLC. Patients and Methods Between 1998 and 2017, 170 patients treated with PORT for NSCLC were retrospectively reviewed. Lymphopenia was divided into tertiles with severe lymphopenia defined as ab...
Article
Full-text available
Introduction: Postoperative radiation therapy (PORT) for non-small-cell lung cancer remains controversial with studies showing no overall survival (OS) benefit in the setting of excessive cardiopulmonary toxicity. Proton beam therapy (PBT) can potentially reduce toxicity with improved organ-at-risk sparing. We evaluated outcomes of PORT patients t...
Article
PURPOSE AND OBJECTIVES: This multi-institutional review explores associations between radiation dose-volume histogram (DVH) parameters and cardiopulmonary toxicities with trimodality therapy for esophageal cancer. MATERIALS AND METHODS We reviewed 465 consecutive esophageal cancer patients treated with chemoradiotherapy (CRT) followed by surgery a...
Chapter
Proton therapy for lung cancer has been demonstrated to have dosimetric advantages over photon therapies in treatment plan comparisons, but the clinical evidence is still relatively limited, as are potential criteria to identify which patients would benefit (or not benefit) from proton therapy. This chapter reviews known indications for passive sca...
Article
Full-text available
Purpose: This study hypothesized that insurance denial would lead to bias and loss of statistical power when evaluating the results from an intent-to-treat (ITT), per-protocol, and as-treated analyses using a simulated randomized clinical trial comparing proton therapy to intensity modulated radiation therapy where patients incurred increasing rat...
Article
Full-text available
Background Cancer Associated Macrophage-Like cells (CAMLs) are polynucleated circulating stromal cells found in the bloodstream of numerous solid-tumor malignancies. Variations within CAML size have been associated with poorer progression free survival (PFS) and overall survival (OS) in a variety of cancers; however, no study has evaluated their cl...
Article
Despite the advancements of modern radiotherapy, radiation-induced heart disease remains a common cause of morbidity and mortality amongst cancer survivors. This review outlines the basic mechanism, clinical presentation, risk stratification, early detection, possible mitigation, and treatment of this condition.
Article
Context: Metastatic lung cancer (LC) patients and their spousal caregivers are at high risk of psychological symptoms. Mindfulness may improve psychological symptoms via spiritual well-being (SW); yet, this mediation model has not been examined in a dyadic context. Objectives: We examined the mediating role of two dimensions of SW (meaning/peace...
Article
Objective Although intensity-modulated radiation therapy (IMPT) is dosimetrically superior to passive scattering proton therapy (PSPT) for locally advanced NSCLC (LA-NSCLC), direct comparisons of clinical outcomes are lacking. Here, we compare toxicity profiles and clinical outcomes after IMPT versus PSPT for LA-NSCLC. Methods This is a nonrandomi...
Article
Background & purpose: We investigated clinical and genetic factors associated with severe radiation-induced lymphopenia (RIL) in a randomized clinical trial of photon vs. proton radiation, with chemotherapy, for non-small cell lung cancer. Methods: XRCC1 rs25487 was genotyped in lymphocytes from serial peripheral blood samples. Severe RIL was de...
Article
Background Typically, cardiac substructures are neither delineated nor analyzed during radiation treatment planning. Therefore, we developed a novel machine learning model to evaluate the impact of cardiac substructure dose for predicting radiation-induced pericardial effusion (PCE). Materials and methods One-hundred and forty-one stage III NSCLC...
Article
Background: Although mindfulness-based interventions have been widely examined in patients with non-metastatic cancer, the feasibility and efficacy of these types of programs are largely unknown for those with advanced disease. We pilot-tested a couple-based mediation (CBM) relative to a supportive-expressive (SE) and a usual care (UC) arm targeti...
Preprint
Full-text available
Background: Cancer Associated Macrophage-Like cells (CAMLs) are polynucleated circulating stromal cells found in the bloodstream of numerous solid-tumor malignancies. Variations within CAML size have been associated with poorer progression free survival (PFS) and overall survival (OS) in a variety of cancers; however, no study has evaluated their c...
Preprint
Full-text available
Background: Cancer Associated Macrophage-Like cells (CAMLs) are polynucleated circulating stromal cells found in the bloodstream of numerous solid-tumor malignancies. Variations within CAML size have been associated with poorer progression free survival (PFS) and overall survival (OS) in a variety of cancers; however, no study has evaluated their c...
Preprint
Full-text available
Background: Cancer Associated Macrophage-Like cells (CAMLs) are polynucleated circulating stromal cells found in the bloodstream of numerous solid-tumor malignancies. Variations within CAML size have been associated with poorer progression free survival (PFS) and overall survival (OS) in a variety of cancers; however, no study has evaluated their c...
Article
Purpose The goal of this study was to assess whether a model-based approach applied retrospectively to a completed randomized controlled trial (RCT) would have significantly altered the selection of patients of the original trial, using the same selection criteria and endpoint for testing the potential clinical benefit of protons compared to photon...
Article
PURPOSE Cancer-associated macrophage-like cells (CAMLs) are a potential peripheral blood biomarker for disease progression. This study used data from a phase 2 clinical trial to evaluate prognostic utility of CAMLs for locally advanced non-small cell lung cancer (NSCLC) treated with definitive chemoradiotherapy (CRT) and atezolizumab (DETERRED; NCT...
Article
Full-text available
Purpose Late cardiotoxicity related to radiotherapy (RT) in breast cancer and Hodgkin lymphoma has been well reported. However, the relatively higher cardiac dose exposure for esophageal cancer (EC) may result in earlier onset of cardiac diseases. In this report, we examined the incidence, onset, and long-term survival outcomes of high-grade cardia...
Article
Background To examine the effect of radiotherapy field size on survival outcomes and patterns of recurrence in patients treated with postoperative radiotherapy (PORT) for non-small cell lung cancer (NSCLC). Methods We retrospectively reviewed the records of 216 patients with T1-4 N1-2 NSCLC following surgery and PORT using whole mediastinum (WM) o...
Article
Background Poorer work productivity due to pain and functional impairment is commonly seen in ankylosing spondylitis (AS) patients, which may contribute to huge social economic burden. However, data about work outcomes and associated factors in Chinese AS patients were barely reported. Objectives To assess work outcomes and identify factors associ...
Article
Full-text available
During the corona virus disease 2019 pandemic, minimizing exposure risk for patients with cancer and health care personnel was of utmost importance. Here, we present steps taken to date to flatten the curve at the radiation oncology division of a tertiary cancer center with the goal of mitigating risk of exposure among patients and staff, and optim...
Article
COVID-19 has spread around the planet, sending billions of people into lockdown as health services struggle to cope. By April 2020, there are over a million two hundred thousand confirmed cases and more than sixty-five thousand deaths worldwide Meanwhile in Asia, where the disease began, the spread continues, in China it seems for now to have passe...
Article
Background and purpose The COVID-19 pandemic warrants operational initiatives to minimize transmission, particularly among cancer patients who are thought to be at high-risk. Within our department, a multidisciplinary tracer team prospectively monitored all patients under investigation, tracking their test status, treatment delays, clinical outcome...
Article
Importance Small cell lung cancer (SCLC) is an aggressive neoplasm requiring rapid access to subspecialized multidisciplinary care. For this reason, insurance coverage such as Medicaid may be associated with oncologic outcomes in this disproportionately economically vulnerable population. With Medicaid expansion under the Affordable Care Act, it is...
Article
Full-text available
Purpose To evaluate the safety and efficacy of definitive chemoradiotherapy (CRT) for patients with clinical T1N0M0 esophageal adenocarcinoma. Materials and methods This was a retrospective study of patients with clinical T1N0 adenocarcinoma of the esophagus treated with curative-intent CRT between 2004 and 2017 at two tertiary care centers. Patie...
Article
Background Clinical trials are considered the “gold-standard” in evidence-based medicine, yet few cancer patients ultimately enroll. Here we examine patients screened for thoracic radiation oncology (TRO) clinical trials to better understand enrollment trends. Methods A prospective database tracking screening and enrollment for patients referred f...
Article
Purpose: To develop and test an Lyman-Kutcher-Burman (LKB) normal tissue complication probability (NTCP) model to predict radiation-induced esophagitis (RE) in non-small cell lung cancer (NSCLC) patients receiving passive-scattering proton therapy (PSPT). Material and methods: We retrospectively reviewed 328 NSCLC patients receiving PSPT at our...
Article
Full-text available
Radiation therapy (RT) of thoracic cancers may cause severe radiation dermatitis (RD), which impacts on the quality of a patient's life. Aim of this study was to analyze the incidence of acute RD and develop normal tissue complication probability (NTCP) models for severe RD in thoracic cancer patients treated with Intensity-Modulated RT (IMRT) or P...
Article
PURPOSE Whether dosimetric advantages of proton beam therapy (PBT) translate to improved clinical outcomes compared with intensity-modulated radiation therapy (IMRT) remains unclear. This randomized trial compared total toxicity burden (TTB) and progression-free survival (PFS) between these modalities for esophageal cancer. METHODS This phase IIB...