Chi St Lukes Health

Houston, TX, United States

Chi St Lukes Health

Houston, TX, United States
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Haque W.,Chi St Lukes Health | Verma V.,University of Nebraska Medical Center | Butler E.B.,Methodist Hospital Research Institute | Teh B.S.,Methodist Hospital Research Institute
Journal of Neuro-Oncology | Year: 2017

For high-risk low-grade gliomas (LGGs), adjuvant radiotherapy (RT) with procarbazine/lomustine/vincristine (PCV) chemotherapy increases overall survival (OS) over RT alone. However, in practice, temozolomide (TMZ) is often used instead of PCV. Using the National Cancer Data Base (NCDB), we provide the first investigation of practice patterns and outcomes of chemoradiotherapy with single-agent chemotherapy (SAC, analogous to TMZ) or multi-agent chemotherapy (MAC, analogous to PCV) for LGG. Patients with high-risk Grade II LGGs were queried in the NCDB. Inclusion was limited to patients treated with definitive RT and chemotherapy. Patients were divided into cohorts receiving SAC or MAC. Kaplan–Meier analysis compared overall survival (OS), and Cox proportional hazards models determined variables independently associated with OS. Of 1029 patients, 989 (96.1%) received SAC, while 40 (3.9%) received MAC. Patients treated more recently (2010–2012) were less likely to receive MAC (p = 0.029). No differences in median OS were observed between patients treated with MAC and SAC (45.3 vs. 59.2 months, p = 0.861). Independent predictors of worse OS included age >40, high Charlson–Deyo index, other governmental/unrecorded insurance status, biopsy only, astrocytoma histology, Western geographical region, and higher income. Substuting MAC with SAC had no impact on OS (p = 0.804). There is a significantly greater utilization of SAC compared to MAC in the US. There were no differences in OS between patients receiving SAC and MAC, nor did this factor impact OS on multivariate analysis, suggesting that the practice of substituting MAC with SAC for management of LGG may not adversely affect outcome. © 2017 Springer Science+Business Media New York


Haque W.,Chi St Lukes Health | Verma V.,University of Nebraska Medical Center | Butler E.B.,Cornell College | Teh B.S.,Cornell College
Journal of Neuro-Oncology | Year: 2017

The standard of care for glioblastoma (GBM) is maximal safe resection followed by concurrent chemoradiation (CRT). For several neoplasms, receipt of radiation treatment at high-volume facilities has been associated with improved overall survival (OS). The purpose of the present investigation was to determine if there was an association between receipt of CRT for GBM at facilities with a higher case volume and improved OS. The National Cancer Data Base was queried for patients with GBM diagnosed between 2006 and 2012 that received full-course CRT. Statistics included Kaplan–Meier analysis to compare OS between patients treated facilities with the highest quartile volume (HVF) to those treated at lower case volume facilities, multivariate logistic regression to determine factors associated with treatment at a HVF, and Cox proportional hazards modeling to determine variables associated with OS. A total of 4892 patients met the specified criteria. Fourteen facilities (9.9%) treated the highest quartile volume of patients, while 69 (48.6%) treated the lowest quartile volume (LVF) of patients. Treatment at the HVF was associated with improved median OS (16.5 vs. 14.1 months, p < 0.001). Treatment at a LVF also independently predicted for worse OS on multivariate analysis, along with age >70 years, and a resection limited to a biopsy. This is the first study to demonstrate that treatment of GBM with CRT at a HVF is associated with improved survival. Major goals of future oncologic care should be to achieve greater standardization of quality of treatment across facilities with different case volumes. © 2017 Springer Science+Business Media, LLC


Haque W.,CHI St Lukes Health | Kee Yuan D.M.,University of Texas Medical Branch | Verma V.,University of Nebraska Medical Center | Butler E.B.,Houston Methodist Hospital | And 3 more authors.
Breast | Year: 2017

Background Radiation therapy (RT) utilization for elderly women with respect to human epidermal growth factor receptor 2 (HER2) receptor status has not been evaluated. Our purpose was to determine differences in RT utilization and breast cancer specific survival (BCSS) for elderly breast cancer patients with distinct molecular biomarkers. Methods The Surveillance, Epidemiology, and End Results database was queried for women ≥70 years of age diagnosed with T1N0M0 breast cancer between 2010 and 2013 receiving breast conservation. Chi-squared analysis was performed to determine the difference in RT utilization between groups. Multivariable logistic regression analysis was performed to determine predictors for RT use. Kaplan-Meier curves were created and the log-rank test done to compare differences in breast cancer specific survival (BCSS) between groups. Results A total of 12,312 patients met the inclusion criteria. Receipt of RT for patients with distinct tumor biomarkers was as follows: 55.7% for patients with Estrogen Receptor (ER) +/HER2+; 57.1% for patients with ER+/HER2-; 65.6% for patients with ER-/HER2+; and 69.2% for ER-/HER2- patients (p < 0.001). Factors associated with RT use included ER-/HER2- status, 70–74 years of age, and high grade disease, while adjuvant RT was associated with improve BCSS in ER+/HER2- and ER-/HER2- patients. Conclusions Patients 70–74 years old and those with ER-/HER2- are more likely to receive adjuvant RT. Moreover, adjuvant RT is associated with improvements in BCSS in ER+/HER2- and ER-/HER2- patients. Given possible poor compliance with hormonal therapy, the omission of RT in ER + patients, without consideration of HER2 status, should be undertaken with care. © 2017 Elsevier Ltd


Chang J.Y.,University of Houston | Senan S.,VU University Amsterdam | Paul M.A.,VU University Amsterdam | Mehran R.J.,University of Houston | And 21 more authors.
The Lancet Oncology | Year: 2015

Background: The standard of care for operable, stage I, non-small-cell lung cancer (NSCLC) is lobectomy with mediastinal lymph node dissection or sampling. Stereotactic ablative radiotherapy (SABR) for inoperable stage I NSCLC has shown promising results, but two independent, randomised, phase 3 trials of SABR in patients with operable stage I NSCLC (STARS and ROSEL) closed early due to slow accrual. We aimed to assess overall survival for SABR versus surgery by pooling data from these trials. Methods: Eligible patients in the STARS and ROSEL studies were those with clinical T1-2a (<4 cm), N0M0, operable NSCLC. Patients were randomly assigned in a 1:1 ratio to SABR or lobectomy with mediastinal lymph node dissection or sampling. We did a pooled analysis in the intention-to-treat population using overall survival as the primary endpoint. Both trials are registered with ClinicalTrials.gov (STARS: NCT00840749; ROSEL: NCT00687986). Findings: 58 patients were enrolled and randomly assigned (31 to SABR and 27 to surgery). Median follow-up was 40·2 months (IQR 23·0-47·3) for the SABR group and 35·4 months (18·9-40·7) for the surgery group. Six patients in the surgery group died compared with one patient in the SABR group. Estimated overall survival at 3 years was 95% (95% CI 85-100) in the SABR group compared with 79% (64-97) in the surgery group (hazard ratio [HR] 0·14 [95% CI 0·017-1·190], log-rank p=0·037). Recurrence-free survival at 3 years was 86% (95% CI 74-100) in the SABR group and 80% (65-97) in the surgery group (HR 0·69 [95% CI 0·21-2·29], log-rank p=0·54). In the surgery group, one patient had regional nodal recurrence and two had distant metastases; in the SABR group, one patient had local recurrence, four had regional nodal recurrence, and one had distant metastases. Three (10%) patients in the SABR group had grade 3 treatment-related adverse events (three [10%] chest wall pain, two [6%] dyspnoea or cough, and one [3%] fatigue and rib fracture). No patients given SABR had grade 4 events or treatment-related death. In the surgery group, one (4%) patient died of surgical complications and 12 (44%) patients had grade 3-4 treatment-related adverse events. Grade 3 events occurring in more than one patient in the surgery group were dyspnoea (four [15%] patients), chest pain (four [15%] patients), and lung infections (two [7%]). Interpretation: SABR could be an option for treating operable stage I NSCLC. Because of the small patient sample size and short follow-up, additional randomised studies comparing SABR with surgery in operable patients are warranted. Funding: Accuray Inc, Netherlands Organisation for Health Research and Development, NCI Cancer Center Support, NCI Clinical and Translational Science Award. © 2015 Elsevier Ltd.


PubMed | Macquarie University, Baylor College of Medicine, Chi St Lukes Health, Texas A&M University and 2 more.
Type: Journal Article | Journal: Patient education and counseling | Year: 2015

To determine physician perspectives about direct notification of normal and abnormal test results.We conducted a cross-sectional survey at five clinical sites in the US and Australia. The US-based study was conducted via web-based survey of primary care physicians and specialists between July and October 2012. An identical paper-based survey was self-administered between June and September 2012 with specialists in Australia.Of 1417 physicians invited, 315 (22.2%) completed the survey. Two-thirds (65.3%) believed that patients should be directly notified of normal results, but only 21.3% were comfortable with direct notification of clinically significant abnormal results. Physicians were more likely to endorse direct notification of abnormal results if they believed it would reduce the number of patients lost to follow-up (OR=4.98, 95%CI=2.21-1.21) or if they had personally missed an abnormal test result (OR=2.95, 95%CI=1.44-6.02). Conversely, physicians were less likely to endorse if they believed that direct notification interfered with the practice of medicine (OR=0.39, 95%CI=0.20-0.74).Physicians we surveyed generally favor direct notification of normal results but appear to have substantial concerns about direct notification of abnormal results.Widespread use of direct notification should be accompanied by strategies to help patients manage test result abnormalities they receive.


PubMed | University of Houston, University of Nebraska Medical Center, CHI St Lukes Health and Houston Methodist Hospital
Type: | Journal: Breast cancer research and treatment | Year: 2016

In certain ductal carcinoma in situ (DCIS) subpopulations, there is no consensus regarding whether to postoperatively irradiate; decisions are often made based on potential risk of cardiac toxicities. Given the utility of Surveillance, Epidemiology, and End Results (SEER) data for studying cardiac mortality in invasive disease, this is the first such study specific for DCIS patients, evaluating trends in cardiac mortality after left-sided radiotherapy (RT).The SEER database was queried for patients with DCIS that received RT and had known unilaterality. The central design of this study was to compare cardiac-specific mortality (CSM) between left- and right-sided DCIS patients as stratifying for older RT (1973-1982) versus more modern RT (1983-1992 or 1993-2002). Survival analysis was performed using Kaplan-Meier methodology and multivariate Cox regression modeling for factors associated with overall survival (OS) and CSS.Left- and right-sided patients were demographically balanced. CSM was worse for left-sided patients with DCIS diagnosed in 1973-1982 [hazard ratio (HR)1.295; 95% confidence interval (CI) 1.182-1.420], but not in 1983-1992 (HR1.022; 95% CI 0.949-1.100) or in 1993-2002 (HR0.989; 95% CI 0.935-1.046)]. On multivariate analysis, laterality was not associated with OS in either decade. However, left-sided laterality was independently associated with CSM during the 1973-1982 time period, but not the more recent time periods. Examining temporal patterns in the 1973-1982 cohort, cardiac mortality was significantly increased during 10-19 and20years after diagnosis, but there was no significant increase in cardiac mortality for patients diagnosed up to 10years after diagnosis.In the largest such DCIS series to date, left-sided RT was an independent risk factor for increased cardiac mortality from 1973 to 1982, but not after 1983. Using modern RT techniques and maintaining low heart doses, RT may not induce excess CSM in the DCIS population.


Zhang J.,Chi St Lukes Health | Zhang J.,University of Houston | Fischer J.,Chi St Lukes Health | Warner L.,Philips | And 3 more authors.
Journal of Magnetic Resonance Imaging | Year: 2015

Purpose: To estimate the local thermal conductivity of uterine fibroid in vivo at a high temperature range (60-80°C) typically encountered in magnetic resonance imaging-guided high-intensity focused ultrasound (MRgHIFU) surgery. The thermal conductivity of uterine fibroids in vivo is unknown and knowledge about tissue thermal conductivity may aid in effective delivery of thermal energy for ablation. Materials and Methods: All subjects (nine women) provided written informed consent to participate in this Institutional Review Board-approved study. A total of 10 fibroids were treated using MRgHIFU surgery with real-time temperature monitoring during both heating and cooling periods. The local thermal conductivity was determined by analyzing the spatiotemporal spread of temperature during the cooling period. Results: The thermal conductivity of MRgHIFU-treated uterine fibroids was 0.47 ± 0.07 W·m-1·K-1 (range: 0.25∼0.67 W·m-1·K-1) which is slightly lower than the reported value for skeletal muscle at temperatures of <40°C (0.52 to 0.62 W·m-1·K-1). Conclusion: It is possible to estimate the thermal conductivity of uterine fibroids in vivo from the spatiotemporal spread of temperature around the HIFU focus during the cooling period. © 2014 Wiley Periodicals, Inc.


PubMed | Philips, University of Houston, Chi St Lukes Health and University of Chicago
Type: Journal Article | Journal: Journal of magnetic resonance imaging : JMRI | Year: 2015

To estimate the local thermal conductivity of uterine fibroid in vivo at a high temperature range (60-80C) typically encountered in magnetic resonance imaging-guided high-intensity focused ultrasound (MRgHIFU) surgery. The thermal conductivity of uterine fibroids in vivo is unknown and knowledge about tissue thermal conductivity may aid in effective delivery of thermal energy for ablation.All subjects (nine women) provided written informed consent to participate in this Institutional Review Board-approved study. A total of 10 fibroids were treated using MRgHIFU surgery with real-time temperature monitoring during both heating and cooling periods. The local thermal conductivity was determined by analyzing the spatiotemporal spread of temperature during the cooling period.The thermal conductivity of MRgHIFU-treated uterine fibroids was 0.47 0.07 Wm(-1) K(-1) (range: 0.250.67 Wm(-1) K(-1) ) which is slightly lower than the reported value for skeletal muscle at temperatures of <40C (0.52 to 0.62 Wm(-1) K(-1) ).It is possible to estimate the thermal conductivity of uterine fibroids in vivo from the spatiotemporal spread of temperature around the HIFU focus during the cooling period.


PubMed | Texas Heart Institute and Chi St Lukes Health
Type: Journal Article | Journal: Journal of magnetic resonance imaging : JMRI | Year: 2016

Magnetic resonance elastography (MRE) can estimate liver stiffness (LS) noninvasively. We prospectively assessed whether motion-encoding gradient (MEG) direction, slice position, or high-caloric food intake affects the repeatability of MRE measurements of LS.Twenty healthy volunteers (8 women, 12 men; age, 4812 years) were imaged in a 3.0T scanner at four timepoints: twice after overnight fasting (B1 , B2 ) and twice after consuming a 1050-calorie standardized meal (A1 , A2 ; after 30 and 60min, respectively). Each session comprised sequential MRE acquisitions in which MEG was applied in three orthogonal directions with three slices positioned over the liver for each. Between sessions, the participants were repositioned to assess test-retest reproducibility.The LS measurements before/after food intake were 3.361.31 kPa/3.221.03 kPa, 2.040.33 kPa/2.270.38 kPa, and 2.470.50 kPa/2.640.76 kPa for MEG superimposed along the anterior-posterior (AP), foot-head (FH), and right-left (RL) directions, respectively. Before and after food intake, LS estimates were lower and more reproducible (<10% coefficient of variation) when the MEG was in the FH direction, not the AP or RL direction. Liver stiffness estimates were significantly elevated after meal consumption when the MEG was in the FH direction (P < 0.05 for B1 vs. A1 , B1 vs. A2 , B2 vs. A1 , and B2 vs. A2 ).MRE estimates of LS were highly reproducible, particularly when MEG was applied in the FH direction, suggesting that this method could be used for long-term monitoring of antifibrotic therapy without repeated biopsies. High-caloric food intake resulted in slightly elevated LS on MRE.


Unlike echocardiography which can quantify both LV filling and ejection, cine steady state free precession sequence (SSFP)-despite its high intrinsic signal and contrast to noise ratio, accuracy and precision of volume measurements-, is mostly relegated to quantifying LV ejection. The steady-state requirement typically constrains SSFP sequence to a breathhold (and limited temporal resolution). We describe: (a) free breathing cine SSFP approach that meets the SS requirement allowing high frame rate acquisition, (b) two MRI indices based on time-LV volume (TV) change during filling and compare against echocardiagraphic diastolic index (E/A ratio), and (c) evaluate the effect of temporal resolution on: LV volumes; ejection and filling rates; and normalized indices of systolic and diastolic function.A stack of contiguous LV short axis slices at high temporal resolution (=15 ms) was acquired using an in-house respiratory-triggered (RT), SS prepared, cardiac gated, free-breathing cine SSFP sequence (TR/TE/flip: 3.2 ms/1.5 ms/55). All 24 study subjects provided written informed consent per IRB requirements. Subjects underwent both echo and MRI in one imaging session. From the expert-drawn contours, TV curve, and its derivative (dV/dt) were generated and these curves were downsampled to rates at 2,3,and 4. From TV and dV/dt curves during the early filling period (EFP) and late filling periods (LFP), volume based (VVBy incorporating SS prep, RT can be used to obtain high frame rate cine SSFP sequence that can evaluate both LV systolic and diastolic function. Temporal resolution of cine SSFP is a key determinant of error in rate based diastolic indices. Research was partly supported by funding from Philips Healthcare.

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