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Smith B.A.,University of Notre Dame | Xiao S.,University of Notre Dame | Wolter W.,University of Notre Dame | Wheeler J.,Center for Cancer Care | And 2 more authors.
Apoptosis | Year: 2011

A synthetic, near-infrared, fluorescent probe, named PSS-794 was assessed for its ability to detect cell death in two animal models. The molecular probe contains a zinc(II)-dipicolylamine (Zn2+-DPA) affinity ligand that selectively targets exposed phosphatidylserine on the surface of dead and dying cells. The first animal model used rats that were treated with dexamethasone to induce thymic atrophy. Ex vivo fluorescence imaging and histological analysis of excised organs showed thymus uptake of PSS-794 was four times higher than a control fluorophore that lacked the Zn2+-DPA affinity ligand. In addition, the presence of PSS-794 produced a delayed and higher build up of dead and dying cells in the rat thymus. The second animal model employed focal beam radiation to induce cell death in tumor-bearing rats. Whole-body and ex vivo imaging showed that the amount of PSS-794 in a radiationtreated tumor was almost twice that in a non-treated tumor. The results indicate that PSS-794 may be useful for preclinical optical detection of tumor cell death due to therapy. © Springer Science+Business Media, LLC 2011.


Gunn S.,CombiMatrix | Gunn S.,University of Texas Health Science Center at San Antonio | Gunn S.,Center for Cancer Care | Yeh I.-T.,University of Texas Health Science Center at San Antonio | And 9 more authors.
BMC Cancer | Year: 2010

Background: HER2 gene copy status, and concomitant administration of trastuzumab (Herceptin), remains one of the best examples of targeted cancer therapy based on understanding the genomic etiology of disease. However, newly diagnosed breast cancer cases with equivocal HER2 results present a challenge for the oncologist who must make treatment decisions despite the patient's unresolved HER2 status. In some cases both immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) are reported as equivocal, whereas in other cases IHC results and FISH are discordant for positive versus negative results. The recent validation of array-based, molecular karyotyping for clinical oncology testing provides an alternative method for determination of HER2 gene copy number status in cases remaining unresolved by traditional methods.Methods: In the current study, DNA extracted from 20 formalin fixed paraffin embedded (FFPE) tissue samples from newly diagnosed cases of invasive ductal carcinoma referred to our laboratory with unresolved HER2 status, were analyzed using a clinically validated genomic array containing 127 probes covering the HER2 amplicon, the pericentromeric regions, and both chromosome 17 arms.Results: Array-based comparative genomic hybridization (array CGH) analysis of chromosome 17 resolved HER2 gene status in [20/20] (100%) of cases and revealed additional chromosome 17 copy number changes in [18/20] (90%) of cases. Array CGH analysis also revealed two false positives and one false negative by FISH due to 'ratio skewing' caused by chromosomal gains and losses in the centromeric region. All cases with complex rearrangements of chromosome 17 showed genome-wide chromosomal instability.Conclusions: These results illustrate the analytical power of array-based genomic analysis as a clinical laboratory technique for resolution of HER2 status in breast cancer cases with equivocal results. The frequency of complex chromosome 17 abnormalities in these cases suggests that the two probe FISH interphase analysis is inadequate and results interpreted using the HER2/CEP17 ratio should be reported 'with caution' when the presence of centromeric amplification or monosomy is suspected by FISH signal gains or losses. The presence of these pericentromeric copy number changes may result in artificial skewing of the HER2/CEP17 ratio towards false negative or false positive results in breast cancer with chromosome 17 complexity. Full genomic analysis should be considered in all cases with complex chromosome 17 aneusomy as these cases are likely to have genome-wide instability, amplifications, and a poor prognosis. © 2010 Gunn et al; licensee BioMed Central Ltd.


News Article | November 7, 2016
Site: www.prweb.com

HMO’s, PPO’s, co-pays, co-insurance… Yes, open enrollment time is here, a time when millions of consumers will be overwhelmed with complex information on policies, premiums, and coverage that can have dramatic financial implications down the road. To clear confusion and help with decision-making, White Plains Hospital is offering a free, downloadable guide for consumers to help them make informed decisions. The guide is available through the Hospital’s website at http://www.wphospital.org/insuranceguide. “Choosing A Health Plan: It Pays to Know Your Options” offers the following information: The guide was written to help consumers make more informed health plan choices, whether they purchase coverage through their employer or on the New York State of Health marketplace. “Our goal is to help people in the community avoid unexpected healthcare costs,” says Joseph J. Guarracino, CFO of White Plains Hospital. “Whether you are using an employer-provided plan, or evaluating coverage on the health insurance exchange, it’s important to consider how much coverage you might need, how much your monthly premium will cover, and what you may be responsible for if you have a significant health event.” Since the Affordable Care Act created state health insurance exchanges, the number of people with health insurance has grown. In 2015, the percentage of people without health insurance coverage for the entire calendar year was 9.1%, or 29 million, lower than the rate and number of uninsured in 2014 (10.4% or 33 million), according to the US Census Bureau. The US Census also notes that the percentage of people with health insurance coverage for all or part of 2015 was 90.9%, higher than the rate in 2014 (89.6%). But, as more and more consumers are getting the health coverage they need, the decision-making process is difficult and available information is hard to comprehend. A 2016 Harris Poll reported on PlanSponsor.com found that nearly half (49%) of employees eligible for employer-sponsored benefits said making health insurance decisions is “always stressful,” and 41% of employees found their companies’ open enrollment process “very confusing.” The health insurance guide can be downloaded through the White Plains Hospital website, and will be available in waiting rooms at the Hospital, and through its outpatient medical facilities in New Rochelle and Armonk through the end of January 2017. White Plains Hospital (WPH) is a proud member of the Montefiore Health System, serving as its tertiary hub of advanced care in the Hudson Valley. WPH is a 292-bed not-for-profit health care organization with the primary mission of providing exceptional acute and preventive medical care to all people who live in, work in or visit Westchester County and its surrounding areas. Centers of Excellence include the Center for Cancer Care, The William & Sylvia Silberstein Neonatal & Maternity Center and The Ruth and Jerome A. Siegel Stroke Center. The Hospital’s Flanzer Emergency Department is the busiest in Westchester County, seeing nearly 57,000 visits a year. White Plains Hospital performs lifesaving emergency and elective angioplasty in its Joan and Alan Herfort, M.D. Cardiac Catheterization Laboratory and Marie Promuto Cardiac Catheterization Laboratory. White Plains Hospital also has outpatient medical facilities in Armonk and New Rochelle. The Hospital is fully accredited by the Joint Commission and earned its recognition as a Top Performer for Key Quality Measures® in 2015 and 2013. The Hospital is also an eleven-time winner of the Consumer Choice Award, an honor given to the nation’s top hospitals by the National Research Corporation, and received Magnet® designation in 2012 from the American Nurses Credentialing Center (ANCC). In 2014 and 2016, White Plains Hospital received the Outstanding Patient Experience Award from Healthgrades®, given to only 10% of hospitals nationwide. For additional information, visit http://www.wphospital.org.


Bowers L.W.,University of Texas at Austin | Maximo I.X.F.,University of Texas at Austin | Brenner A.J.,University of Texas Health Science Center at San Antonio | Beeram M.,Center for Cancer Care | And 5 more authors.
Cancer Research | Year: 2014

Obesity is associated with a worse breast cancer prognosis and elevated levels of inflammation, including greater cyclooxygenase-2 (COX-2) expression and activity in adipose-infiltrating macrophages. The product of this enzyme, the proinflammatory eicosanoid prostaglandin E2 (PGE2), stimulates adipose tissue aromatase expression and subsequent estrogen production, which could promote breast cancer progression. This study demonstrates that daily use of a nonsteroidal anti-inflammatory drug (NSAID), which inhibits COX-2 activity, is associated with reduced estrogen receptor a (ERa)-positive breast cancer recurrence in obese and overweight women. Retrospective review of data from ERa-positive patients with an average body mass index of >30 revealed that NSAID users had a 52% lower recurrence rate and a 28-month delay in time to recurrence. To examine the mechanisms that may be mediating this effect, we conducted in vitro studies that utilized sera from obese and normal-weight patients with breast cancer. Exposure to sera from obese patients stimulated greater macrophage COX-2 expression and PGE2 production. This was correlated with enhanced preadipocyte aromatase expression following incubation in conditioned media (CM) collected from the obese-patient, sera-exposed macrophages, an effect neutralized by COX-2 inhibition with celecoxib. In addition, CM from macrophage/preadipocyte cocultures exposed to sera from obese patients stimulated greater breast cancer cell ERa activity, proliferation, and migration compared with sera from normal-weight patients, and these differences were eliminated or reduced by the addition of an aromatase inhibitor during CM generation. Prospective studies designed to examine the clinical benefit of NSAID use in obese patients with breast cancer are warranted. ©2014 AACR.


Wildes K.A.,University of Texas at San Antonio | Miller A.R.,Center for Cancer Care | De Majors S.S.M.,University of Texas at San Antonio | Otto P.M.,University of Texas Health Science Center at San Antonio | Ramirez A.G.,University of Texas at San Antonio
Journal of Women's Health | Year: 2011

Objective: The aim of this study was to evaluate the relationship of satisfaction with the cancer care doctor and health-related quality of life (HRQOL) among Latina breast cancer survivors (BCS) by (1) assessing whether satisfaction would be positively correlated with HRQOL and (2) assessing whether satisfaction would significantly influence HRQOL while controlling for covariates. Methods: The cross-sectional study used self-report data from 117 Latina BCS. Satisfaction was measured with the Hall Satisfaction Index, and HRQOL was measured with the Functional Assessment of Cancer Therapy-General (FACT-G). Analyses included calculation of descriptive statistics, t tests, bivariate correlations, analyses of variance (ANOVAs), and multivariate analyses. Results: Latina BCS had high satisfaction and generally good HRQOL. The Hall Satisfaction Index total score was positively associated with FACT-G functional well-being (r=0.265, p=0.004). Multivariate analyses showed that the Hall Satisfaction Index total score was a significant predictor of FACT-G functional well-being (p=0.012). Employment status was also a significant predictor, where being employed or retired resulted in better functional well-being than being unemployed. Conclusions: Latina BCS were quite satisfied with their cancer care doctors, and high levels of satisfaction with the cancer care doctor influenced functional well-being when confounding variables were controlled. Despite reportedly high satisfaction, Latina BCS did report barriers to satisfaction that could be considered cultural. Implications are discussed. Copyright © 2011, Mary Ann Liebert, Inc.


Sarkar V.,University of Utah | Wang B.,University of Louisville | Zhao H.,University of Utah | Lynch B.,Center for Cancer Care | And 3 more authors.
Journal of Applied Clinical Medical Physics | Year: 2015

As very small ion chambers become commercially available, medical physicists may be inclined to use them during the linear accelerator commissioning process to better characterize the beam in steep dose gradient areas. For this work, a total of eight different ion chambers (volumes from 0.007 cc to 0.6 cc) and four different scanning systems were used to scan PDDs at both +300V and -300V biases. We observed a reproducible, significant difference (overresponse with depth) in PDDs acquired when using very small ion chambers, with specific bias/water tank combinations - up to 5% at a depth of 25 cm in water. This difference was not observed when the PDDs were sampled using the ion chamber in static positions in conjunction with an external electrometer. This suggests noise/signal interference produced by the controller box and cable system assemblies, which can become relatively significant for the very small current signals collected by very small ion chambers, especially at depth as the signal level is even further reduced. Based on the results observed here, the use of very small active volume chambers under specific scanning conditions may lead to collection of erroneous data, introducing systematic errors into the treatment planning system. In case the use of such a chamber is required, we recommend determining whether such erroneous effect exists by comparing the scans with those obtained with a larger chamber.


PubMed | University of Louisville, University of Utah and Center for Cancer Care
Type: Journal Article | Journal: Medical physics | Year: 2016

As more so-called micro ion chambers become commercially available, medical physicists may be inclined to use them during the linear accelerator commissioning process, in an attempt to better characterize the beam in steep dose gradient areas. The purpose of this work is to inform the medical physics community of a non-trivial, anomalous behavior observed when very small chambers are used in certain beam scanning configurations.A total of six ion chambers (0.007cc to 0.6cc) were used to scan PDDs from a 1010cm2 field at both +300V and -300V biases. PDDs were scanned using three different water tank scanning systems to determine whether different scanners exhibit the same abnormality. Finally, PDDs were sampled using an external electrometer to bypass the internal electrometer of the scanner to determine the potential contributions of the scanner electronics to the abnormality observed.We observed a reproducible, significant difference (over-response with depth) in PDDs acquired when using very small ion chambers with certain bias and watertank combinations, on the order of 3-5% at a depth of 25 cm in water. This difference was not observed when the PDDs were sampled using the ion chambers in conjunction with an external electrometer. This suggests a contribution of interference produced by the controller box and scanning system, which becomes significant for the very small signals collected by very small ion chambers, especially at depth, as the signal level is reduced even further.Based on the results observed here, if currently available very small ion chambers are used with specific bias and scanning water-tank combinations, erroneous PDD data may be collected. If this data is used as input to the Treatment Planning System, systematic errors on the order of 3%-5% may be introduced into the treatment planning process.


Gulec S.A.,Florida International University | Pennington K.,Center for Cancer Care | Wheeler J.,Center for Cancer Care | Barot T.C.,Florida International University | And 3 more authors.
American Journal of Clinical Oncology: Cancer Clinical Trials | Year: 2013

OBJECTIVES:: Selective internal radiation therapy (SIRT) with yttrium-90 (Y) microspheres has emerged as an effective liver-directed therapy with a favorable therapeutic ratio for treatment of colorectal cancer liver metastases. The aim of this study was to investigate the objective responses obtained by Y microsphere treatment when combined with contemporary chemotherapy in the front-line (first or second line) setting in patients with CRCLM. METHODS:: This study used an in vivo comparison between the right and left liver lobes; systemic chemotherapy was supplied to both liver lobes by virtue of systemic administration, whereas SIRT was administered selectively to the target liver lobe only. Response to treatment was evaluated by serial fludeoxyglucose positron emission tomography computed tomography performed at 4 weeks, 2 to 4 months, and 6 to 8 months. Standard uptake value, anatomic volume, functional tumor volume, and total lesion glycolysis (TLG) calculations were obtained at each time point. RESULTS:: A decrease in TLG on fludeoxyglucose positron emission tomography computed tomography imaging was seen in 19 of the 20 patients. The mean decrease in TLG values in the tumors receiving chemo-SIRT and chemo-only treatment were 86.26%±18.57% and 31.74%±80.99% (P<0.01), 93.13%±11.81% and 40.80%±73.32% (P=0.01), and 90.55%±19.75% and 54.91%±38.55% (P<0.01) at 4 weeks, 2 to 4 months, 6 to 8 months posttreatment, respectively. Functional and anatomic tumor volume changes were in concordance with the TLG changes. CONCLUSIONS:: The study demonstrated that, under near identical conditions in terms of patient and tumor characteristics, the chemo-SIRT combination produced superior objective responses compared with chemo-only treatment in a front-line treatment setting in patients with colorectal cancer liver metastases. Copyright © 2012 by Lippincott Williams & Wilkins.


Gulec S.A.,Florida International University | Suthar R.R.,Florida International University | Barot T.C.,Florida International University | Pennington K.,Center for Cancer Care
European Journal of Nuclear Medicine and Molecular Imaging | Year: 2011

Purpose: Functional tumor volume (FTV) and total lesion glycolysis (TLG) are measures of metabolic activity of tumors determined by fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT images. These parameters could potentially have clinical value in response to treatment evaluation and disease prognostication. The objectives of this study were to investigate the relationship between functional tumor parameters (FTV and TLG) and clinical outcomes in patients with colorectal cancer liver metastases (CRCLM) undergoing 90Y-resin microsphere selective internal radiation therapy (SIRT) (SIR-Spheres®, Sirtex Medical Limited, Lane Cove, NSW, Australia). Methods: FDG PET/CT studies of 20 patients with unresectable CRCLM who underwent 90Y SIRT under a phase II clinical trial were analyzed. FTV and TLG were calculated using PET VCAR (GE Healthcare, Milwaukee, WI, USA) on pretreatment and 4-week posttreatment scans. The effects of pretreatment and posttreatment functional tumor activity on patient survival were evaluated using Kaplan-Meier survival curves. Results: The median survival in the study group was 14.8 months (range 2.0-27.7 months). The median survival for patients with pretreatment FTV values of above and below 200 cc were 11.2 and 26.9 months, respectively (p<0.05). The median survival for patients with 4-week posttreatment FTV values of above and below 30 cc were 10.9 and 26.9 months, respectively (p<0.05). The median survival for patients with pretreatment TLG values of above and below 600 g were 11.2 and 26.9 months, respectively (p<0.05). The median survival for patients with 4-week posttreatment TLG values of above and below 100 g were 10.9 and 26.9 months, respectively (p<0.05). Conclusion: Pretreatment and posttreatment FTV and TLG showed very strong association with survival. These values can be useful quantitative criteria for patient selection and disease prognostication when 90Y SIRT is contemplated in patients with CRCLM. © 2011 Springer-Verlag.


PubMed | Center for Cancer Care
Type: Journal Article | Journal: Medical physics | Year: 2017

Spine metastases have traditionally been treated using a parallel opposed 3-D technique: an anterior field and a posterior field (AP/PA). This has proven to give the lesions adequate coverage. The downside to this type of treatment is that the full prescription dose covers a large area of the patient and can go through critical organs such as the heart, spine, lungs, bowel, and others depending on the vertebrae being treated. Conformal arc therapy can also be used for this type of treatment. These two techniques will be compared for target coverage and doses to organs at risk (OARs).20 multi-vertebra metastases patients were chosen for this study, with a range of vertebrae being treated amongst each case. The original AP/PA treatments were re-planned with 1-3 conformal arcs placed depending on the location of nearby OARs. The GTV coverage was normalized so that both techniques had equal coverage. The OAR doses and the volume of the 50% prescription dose value were then compared between the two planning techniques.Initial results on average show lower doses for the heart maximum, heart mean, lung V20, spinal cord maximum, and bowel maximum for the conformal arc plans. The AP/PA plans however on average showed lower kidney mean dose, liver mean dose, and parotid mean dose. The 50% prescription dose volume was smaller in all the conformal arc plans except for one.From the preliminary results the conformal arc plans spare critical OARs better than the two field technique, except when treating the vertebrae near the kidneys, liver, and parotids. The conformal arc plans also have a lower volume of the 50% prescription dose value. The data suggests that conformal arcs can be used for certain palliative spine treatments and that this technique should be considered when beginning planning.

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