Sue C Kaste

St. Jude Children's Research Hospital, Memphis, Tennessee, United States

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Publications (266)1062.54 Total impact

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    Full-text · Dataset · Dec 2015
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    Full-text · Dataset · Dec 2015
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    Full-text · Dataset · Dec 2015

  • No preview · Article · Nov 2015 · Pediatric Blood & Cancer
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    ABSTRACT: Introduction Great strides in pediatric cancer treatment are allowing hundreds of thousands of children to survive into adulthood. However, these treatments can be responsible for long-term medical and dental complications. The treatments may alter the patients' dental health and require modifications to standard orthodontic care. The aim of this study was to examine knowledge and clinical experience regarding orthodontic management of childhood cancer survivors. Methods A 12-question online survey consisting of 3 sections was sent to 2500 randomly selected members of the American Association of Orthodontists and all 2300 members of the Southern Association of Orthodontists. The first section consisted of questions about the respondents' practice characteristics, the second questioned how many survivor patients the respondent had treated, and the third included questions about specific (anonymous) patient experiences and treatment modifications. Results and Conclusions There were 381 responses. The data from this study suggest a tendency for more experienced practitioners to have treated survivors of childhood cancer. Orthodontic education regarding the treatment of these patients is limited. Although most orthodontists reported having treated such patients, few had treated more than 10. There is a need for more information regarding dental complications of pediatric cancer treatment and for guidelines for the orthodontic treatment of these patients.
    No preview · Article · Nov 2015 · American Journal of Orthodontics and Dentofacial Orthopedics
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    ABSTRACT: Effective cancer therapies have resulted in significant improvement in survival. However, treatment-related acute and subacute complications are a cause of significant morbidity and mortality. Effects of cancer therapy in children can be seen early in the survival period or later in life in almost all organ systems of the body. Many of these conditions are evaluated by imaging and some are diagnosed based on characteristic imaging features. This article aims to discuss acute and subacute toxicities of cancer therapy in children involving multiple organ systems, pulmonary, gastrointestinal, hepatobiliary, genitourinary and musculoskeletal systems with emphasis on those in which imaging plays a role in diagnosis or management. We also discuss the role of imaging and choice of imaging modalities in these conditions.
    No preview · Article · Oct 2015 · Pediatric Radiology
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    ABSTRACT: Objective To examine whether panoramic radiograph-determined mandibular cortical thickness correlated with quantitative computed tomography-derived bone mineral density (BMD) in survivors of childhood acute lymphoblastic leukemia (ALL).Methods We identified patients treated for ALL at St. Jude Children's Research Hospital, seen in the After Completion of Therapy (ACT) Clinic between January of 2006 and January of 2014 who had QCT-derived BMD and panoramic radiographs obtained within 1 month of each other. Panoramic radiographs were independently scored by a pediatric radiologist, two pediatric dentists, and a general dentist using the Klemetti technique. We used the Spearman's rank correlation test and the multivariate regression model to investigate the effect of evaluator experience on results.ResultsThe study cohort comprised 181 patients with 320 paired studies: 112 (62%) male, 112 (71%) were white. Median age at ALL diagnosis was 6.4 (range, 0–18.8) years. Median age at study was 11.9 (range, 3.3 to 29.4) years. The median average BMD was 154.6 (range, 0.73–256) mg/cc; median QCT Z-score (age and gender adjusted) was −0.875 (range, −5.04 to 3.2). We found very weak association between panoramic radiograph score and both QCT-BMD average (P = 0.53) and QCT Z-score (P = 0.39). Results were not influenced by level of reader experience.Conclusions The Klemetti technique of estimating BMD does not predict BMD deficits in children and young adult survivors of ALL, regardless of reviewer expertise. Alternative methods are needed whereby dental healthcare providers can identify and refer patients at risk for BMD deficits for detailed assessment and intervention.
    No preview · Article · Sep 2015 · International Journal of Paediatric Dentistry
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    ABSTRACT: Glucocorticoids are important therapy for acute lymphoblastic leukemia (ALL) and their major adverse effect is osteonecrosis. Our goal was to identify genetic and nongenetic risk factors for osteonecrosis. We performed a genome-wide association study of single nucleotide polymorphisms (SNPs) in a discovery cohort comprising 2285 children with ALL treated on the Children's Oncology Group AALL0232 protocol (NCT00075725 https://clinicaltrials.gov/ct2/show/NCT00075725), adjusting for covariates. The minor allele at SNP rs10989692 (near the glutamate receptor GRIN3A locus) was associated with osteonecrosis (hazard ratio = 2.03, P=3.59x10(-7)). The association was supported by two replication cohorts, including 361 children with ALL on St. Jude's Total XV protocol (NCT00137111 https://clinicaltrials.gov/ct2/show/NCT00137111) and 309 non-ALL patients from Vanderbilt University's BioVU repository treated with glucocorticoids (odds ratio = 1.87 and 2.26, P = 0.063 and 0.0074 respectively). In a meta-analysis, rs10989692 was also highest ranked (P = 2.68x10(-8)), and the glutamate pathway was the top ranked pathway (P = 9.8x10(-4)). Osteonecrosis-associated glutamate receptor variants were also associated with other vascular phenotypes including cerebral ischemia (OR = 1.64, P = 2.5x10(-3)) and arterial embolism and thrombosis (OR = 1.88, P = 4.2x10(-3)). In conclusion, osteonecrosis was associated with inherited variations near glutamate receptor genes. Further understanding this association may allow interventions to decrease osteonecrosis. Copyright © 2015 American Society of Hematology.
    No preview · Article · Aug 2015 · Blood
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    ABSTRACT: Two phase II studies assessed the efficacy of vismodegib, a sonic hedgehog (SHH) pathway inhibitor that binds smoothened (SMO), in pediatric and adult recurrent medulloblastoma (MB). Adult patients enrolled onto PBTC-025B and pediatric patients enrolled onto PBTC-032 were treated with vismodegib (150 to 300 mg/d). Protocol-defined response, which had to be sustained for 8 weeks, was confirmed by central neuroimaging review. Molecular tests to identify patterns of response and insensitivity were performed when tissue was available. A total of 31 patients were enrolled onto PBTC-025B, and 12 were enrolled onto PBTC-032. Three patients in PBTC-025B and one in PBTC-032, all with SHH-subgroup MB (SHH-MB), exhibited protocol-defined responses. Progression-free survival (PFS) was longer in those with SHH-MB than in those with non-SHH-MB, and prolonged disease stabilization occurred in 41% of patient cases of SHH-MB. Among those with SHH-MB, loss of heterozygosity of PTCH1 was associated with prolonged PFS, and diffuse staining of P53 was associated with reduced PFS. Whole-exome sequencing identified mutations in SHH genes downstream from SMO in four of four tissue samples from nonresponders and upstream of SMO in two of four patients with favorable responses. Vismodegib exhibits activity against adult recurrent SHH-MB but not against recurrent non-SHH-MB. Inadequate accrual of pediatric patients precluded conclusions in this population. Molecular analyses support the hypothesis that SMO inhibitor activity depends on the genomic aberrations within the tumor. Such inhibitors should be advanced in SHH-MB studies; however, molecular and genomic work remains imperative to identify target populations that will truly benefit. © 2015 by American Society of Clinical Oncology.
    No preview · Article · Jul 2015 · Journal of Clinical Oncology
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    ABSTRACT: Background. Mesenchymal chondrosarcoma is an aggressive, uncommon histologic entity arising in bone and soft tissues. We reviewed our institutional experience with this rare diagnosis. Methods. We conducted a retrospective chart review on patients with mesenchymal chondrosarcoma over a 24-year period. Clinicopathologic and radiographic features were reviewed. Results. Twelve patients were identified. Nine were females; median age was 14.5 years (1.2-19.7 years). The most common site was the head/neck (7/12). Disease was localized in 11/12 patients (one with lung nodules). Six with available tissue demonstrated NCOA2 rearrangement by FISH. Six underwent upfront surgical resection, and six received neoadjuvant therapy (2 chemotherapy alone and 4 chemotherapy and radiation). All patients received adjuvant chemotherapy (most commonly ifosfamide/doxorubicin) and/or radiation (median dose 59.4 Gy). At a median follow-up of 4.8 years, 5-year disease-free survival and overall survival were 68.2% (95% CI 39.8%, 96.6%) and 88.9% (95% CI 66.9%, 100%). Two patients had distant recurrences at 15 and 42 months, respectively. Conclusion. Aggressive surgical resection of mesenchymal chondrosarcoma with chemoradiotherapy yields excellent local control and may reduce likelihood of late recurrence. Characterization of downstream targets of the HEY1-NCOA2 fusion protein, xenograft models, and drug screening are needed to identify novel therapeutic strategies.
    Full-text · Article · Jul 2015 · Sarcoma

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  • No preview · Article · May 2015 · Pediatric Blood & Cancer
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    ABSTRACT: There is limited information on body composition, energy balance and fitness among childhood ALL survivors, especially those treated without cranial radiation (CRT). This analysis compares these metrics among 365 ALL survivors with a mean age of 28.6±5.9 years (149 treated with and 216 without CRT) and 365 age-, sex-, and race-matched peers. We also report risk factors for outcomes among survivors treated without CRT. Male survivors not exposed to CRT had abnormal body composition when compared to peers (%body fat 26.2±8.2 vs. 22.7±7.1). Survivors without CRT had similar energy balance, but had significantly impaired quadriceps strength (-21.9±6.0 Nm/kg, 60°/s) and endurance (-11.4±4.6 Nm/kg, 300°/s), exercise capacity (-2.0±2.1 ml/kg/min), low-back and hamstring flexibility (-4.7±1.6 cm), and dorsiflexion range of motion (-3.1±0.9°), and higher modified total neuropathy scores (+1.6±1.1) than peers. Cumulative asparaginase dose ≥120,000 IU/m(2) was associated with impaired flexibility, vincristine dose ≥39 mg/m(2) with peripheral neuropathy, glucocorticoid (prednisone equivalent) dose ≥8000 mg/m(2) with hand weakness, and intrathecal methotrexate dose ≥225 mg with dorsiflexion weakness. Physical inactivity was associated with hand weakness and decreased exercise capacity. Smoking was associated with peripheral neuropathy. Elimination of CRT from ALL therapy has improved, but not eliminated, body composition outcomes. Survivors remain at risk for impaired fitness. Copyright © 2015 American Society of Hematology.
    No preview · Article · Mar 2015 · Blood
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    ABSTRACT: The diagnostic utility of obtaining chest and abdomen CT evaluating for invasive fungal infection (IFI) pre-and post-HSCT remains unclear. The study was conducted as a Quality Improvement project. Chest and abdomen CT of patients who underwent an allogeneic HSCT over a 13 month period were reviewed. Scans included those done pre-transplant in all patients, and day 0-100 post-transplant in selected patients. There were 66 patients with chest and abdomen CT scans pre-transplant. Chest CT was suggestive of IFI in 9 (13.6%) patients including 3 patients with prior history of IFI. After transplant, 37 patients had initial chest CT, and 14 patients had initial abdominal CT. The first chest CT post-transplant was suggestive of IFI in 3 patients; all had an abnormal CT pre-transplant. Following the initial post-transplant evaluation 15 patients had 28 additional CT scans of the chest, and 12 patients had 19 additional CT scans of the abdomen. An abnormal chest CT with proven evidence of IFI was seen in only one patient. None of the 99 abdominal CT scans performed pre-or post-transplant had evidence of IFI. There is little benefit in obtaining abdominal CT scans in HSCT patients for detecting IFI either pre-or post-transplant. Copyright © 2015 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Mar 2015 · Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation
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    ABSTRACT: Childhood cancer survivors (CCSs) are at risk for obesity. The purpose of this project was to determine which clinical measures of body composition are most accurate among CCSs in comparison with dual-energy x-ray absorptiometry (DXA). The agreement between the body mass index (BMI), skinfold percent body fat, and waist-to-height ratio (WHtR) and DXA was evaluated among 1361 CCSs (mean age, 32.4 ± 7.7 years) 10 or more years after the diagnosis. The sensitivity and specificity of BMI, skinfold, and WHtR obesity classifications were calculated with respect to DXA. Log-binomial regression, stratified by sex, was used to evaluate treatment-related factors for misclassification as nonobese by BMI, skinfolds, and WHtR. The mean body fat values were 23.3% ± 7.7% (males) and 32.3% ± 8.1% (females) for skinfolds and 26.9% ± 7.4% (males) and 38.4% ± 7.7% (females) for DXA. Pearson correlations between skinfolds and DXA were high (R = 0.83 for males, R = 0.84 for females). Skinfolds incorrectly classified 34.5% of obese males and 27.3% of obese females. BMI measures were the least sensitive with false-negative rates of 46.4% (males) and 53.1% (females). Males exposed to abdominal/pelvic radiation were at increased risk for misclassification as nonobese by BMI (relative risk, 1.57; 95% confidence interval, 1.25-1.95). The percentages classified as obese were highest with DXA (males, 63.1%; females, 84.8%) and lowest with BMI (males, 35.7%; females, 39.7%). Although skinfolds and WHtR underestimated the percentage classified as obese in comparison with DXA, the differences were not as large. Findings suggest that skinfolds and WHtR are better than BMI for obesity classification in CCSs. Clinicians should be aware of the high risk of misclassifying obese CCSs as nonobese. Cancer 2015. © 2015 American Cancer Society. © 2015 American Cancer Society.
    No preview · Article · Feb 2015 · Cancer
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    ABSTRACT: Hip osteonecrosis frequently complicates treatment with glucocorticoids. When extensive (affecting ≥ 30% of the epiphyseal surface), 80% of joints collapse within 2 years, so interventions are needed to prevent this outcome. This prospective cohort magnetic resonance imaging (MRI) screening study included all consecutive children treated for acute lymphoblastic leukemia on a single protocol. Hip MRI was performed at 6.5 and 9 months from diagnosis (early screening) and at completion of chemotherapy (final evaluation) to determine whether screening could identify extensive hip osteonecrosis before symptom development. Of 498 patients, 462 underwent screening MRI. Extensive asymptomatic osteonecrosis was identified by early screening in 26 patients (41 hips); another four patients (seven hips) were detected after the screening period, such that screening sensitivity was 84.1% and specificity was 99.4%. The number of joints screened to detect one lesion was 20.1 joints for all patients, 4.4 joints for patients older than 10 years, and 198 joints for patients ≤ 10 years old (P < .001). Of the 40 extensive lesions in patients older than 10 years, 19 required total hip arthroplasty and none improved. Of eight extensive lesions in younger patients, none required arthroplasty and four improved. In patients age 10 years old or younger who require prolonged glucocorticoid therapy, screening for extensive hip osteonecrosis is unnecessary because their risk is low and lesions tend to heal. In children older than 10 years, early screening successfully identifies extensive asymptomatic lesions in patients who would be eligible for studies of interventions to prevent or delay joint collapse. © 2015 by American Society of Clinical Oncology.
    Full-text · Article · Jan 2015 · Journal of Clinical Oncology
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    ABSTRACT: Background Standardization of imaging obtained in children with neuroblastoma is not well established. This study examines chest CT in pediatric patients with high-risk neuroblastoma.ProcedureMedical records and imaging from 88 patients with high-risk neuroblastoma, diagnosed at St. Jude Children's Research Hospital between January, 2002 and December, 2009, were reviewed. Surveillance imaging was conducted through 2013. Ten patients with thoracic disease at diagnosis were excluded. Event free survival (EFS) and overall survival (OS) were estimated. Size specific dose estimates for CT scans of the chest, abdomen, and pelvis were used to estimate absolute organ doses to 23 organs. Organ dosimetry was used to calculate cohort effective dose.ResultsThe 5 year OS and EFS were 51.9% ± 6.5% and 42.6% ± 6.5%, respectively. Forty-six (58.9%) patients progressed/recurred and 41 (52.6%) died of disease. Eleven patients (14%) developed thoracic disease progression/recurrence identified by chest CT (1 paraspinal mass, 1 pulmonary nodules, and 9 nodal). MIBG (metaiodobenzylguanidine) scans identified thoracic disease in six patients. Five of the 11 had normal chest MIBG scans; three were symptomatic and two were asymptomatic with normal chest MIBG scans but avid bone disease. The estimated radiation dose savings from surveillance without CT chest imaging was 42%, 34% when accounting for modern CT acquisition (2011–2013).Conclusions Neuroblastoma progression/recurrence in the chest is rare and often presents with symptoms or is identified using standard non-CT imaging modalities. For patients with non-thoracic high-risk neuroblastoma at diagnosis, omission of surveillance chest CT imaging can save 35–42% of the radiation burden without compromising disease detection. Pediatr Blood Cancer © 2015 Wiley Periodicals, Inc.
    No preview · Article · Jan 2015 · Pediatric Blood & Cancer
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    ABSTRACT: Malignancies arising in connective tissue comprise a clinically important and histologically diverse category of pediatric cancers. These have traditionally been classified by presumed cell of origin or type of differentiation, with the caveat that some diagnoses originate from undefined cell types. Newer genetic data indicates that molecular perturbations, particularly translocations and their derivative chimeric fusions, correlate with histological types and better predict clinical behavior and outcome. Many diagnostic imaging techniques can be profitably applied to these tumors for the purposes of diagnosis, staging, and disease monitoring. These range from ultrasonography to newer positron emission tomography (PET) scans. Rhabdomyosarcomas constitute a large proportion of sarcomas in children, but in older children and adolescents, non-rhabdomyosarcomatous soft tissue sarcomas (NRSTS) predominate as a group. This review will cover classification, grading, morphological and genetic diagnosis, and diagnostic imaging features of these diverse lesions, Rarely adult types of sarcomas occur in children, but they will be included in this relatively brief chapter.
    No preview · Chapter · Jan 2015
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    ABSTRACT: Survivors of childhood cancer are at risk for treatment-related musculoskeletal late effects. Early detection and orthopedic intervention can help ameliorate musculoskeletal late effects and prevent subsequent complications. This systematic review summarizes the literature describing associations between cancer, its treatment, and musculoskeletal late effects. We searched PubMed and Web of Science for English language articles published between January 1970 and December 2012. The search was limited to investigations with at least 15 participants and conducted at least 2 years after completion of therapy for childhood, adolescent, or young adult cancer. Some late skeletal effects, including low bone mineral density, osteonecrosis, slipped capital femoral epiphyses, oncogenic rickets, and hormone-related growth disturbances have been previously reviewed and were excluded, as were outcomes following amputation and limb-salvage procedures. Of 2347 references identified, 30 met inclusion criteria and were retained. An additional 54 studies that met inclusion criteria were found in reference lists of retained studies. Of 84 studies, 60 focused on associations between radiotherapy, six between chemotherapy, and 18 between surgery and musculoskeletal late effects. We found that younger age, higher radiation dosage, and asymmetric or partial bone radiation volume influences the effects of radiation on the musculoskeletal system. Methotrexate and vincristine are associated with long-term muscular strength and flexibility deficits. Laminectomy and chest wall resection are associated with spinal malalignment, and enucleation is associated with orbital deformities among survivors. Radiotherapy, chemotherapy, and surgery are associated with musculoskeletal late effects independently and additively. Associations are additionally influenced by host and treatment characteristics - See more at: http://eurekaselect.com/126128#sthash.oR3WGlrK.dpuf
    Full-text · Article · Nov 2014 · Current Pediatric Reviews
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    ABSTRACT: Modular and non-invasive expandable prostheses have been developed to provide a functional knee joint that allows future expansion as growth occurs in the contralateral extremity in children with bone sarcomas that require removal of the growth plate. This study aimed to evaluate the functional outcomes of paediatric patients who received either a non-invasive expandable or modular prosthesis for bone sarcomas arising around the knee. We evaluated clinician-reported, patient-reported and measured function in 42 paediatric patients at least one year (median age at assessment 19.1years) after limb salvage surgery, and compared patients who received modular system prostheses (N=29, median age 15.5), who did not require lengthening procedures to those who received non-invasive expandable prostheses (N=13, median age 11.1) requiring lengthening procedures (median 5). The number of revisions and time to first revision did not differ between the two groups. There were no differences between the two groups in total scores on the Enneking Musculoskeletal Tumor Society Scale, the Toronto Extremity Salvage Scale, and the Functional Mobility Assessment. Children with non-invasive expandable prostheses climbed stairs (11.93±4.83 versus 16.73±7.24s, p=0.02) in less time than those with modular prostheses. Our results suggest that the non-invasive expandable prosthesis produces similar functional results to the more traditional modular prosthesis. Copyright © 2014 Elsevier Ltd. All rights reserved.
    Full-text · Article · Oct 2014 · European journal of cancer (Oxford, England: 1990)

Publication Stats

5k Citations
1,062.54 Total Impact Points

Institutions

  • 1992-2015
    • St. Jude Children's Research Hospital
      • • Department of Oncology
      • • Department of Radiological Sciences
      • • Division of Diagnostic Imaging
      • • Department of Surgery
      Memphis, Tennessee, United States
  • 2012
    • The University of Tennessee Health Science Center
      • Department of Pediatrics
      Memphis, Tennessee, United States
  • 1997-2012
    • University of Tennessee
      Knoxville, Tennessee, United States
  • 2008-2010
    • The University of Tennessee Medical Center at Knoxville
      Knoxville, Tennessee, United States
    • Harvard University
      Cambridge, Massachusetts, United States
  • 2004
    • University of Chicago
      Chicago, Illinois, United States
  • 1998-1999
    • The University of Memphis
      Memphis, Tennessee, United States
  • 1995
    • University of Texas MD Anderson Cancer Center
      • Department of Pediatrics
      Houston, Texas, United States