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Portland, OR, United States

Tang K.Y.,Legacy Health System | Gardiner S.K.,Devers Eye Institute | Gould C.,Legacy Health System | Osmundsen B.,Legacy Health System | And 2 more authors.
American Journal of Obstetrics and Gynecology | Year: 2012

OBJECTIVE: To compare surgical outcomes for robotic vs laparotomy staging in obese endometrial cancer patients. STUDY DESIGN: This was a retrospective cohort study of patients with body mass index ≥30 kg/m 2 staged in a community gynecologic oncology practice. Patients undergoing robotic staging were compared with historic laparotomy controls. RESULTS: One hundred twenty-nine patients underwent robotic staging, compared with 110 laparotomy patients. The robotic cohort had fewer abdominal wound complications (13.9% vs 32.7%, P <.001), but more vaginal cuff complications (4.7% vs 0%, P =.032). Blood loss was lower in the robotic group (P <.001), as was length of stay (P <.001). Surgical times were longer in the robotic group (P <.001). There was no difference in terms of percentage of patients undergoing pelvic or paraaortic lymph node dissection. CONCLUSION: Robotic staging for endometrial cancer is feasible in obese women, with fewer abdominal wound complications, but more vaginal cuff complications. © 2012 Mosby, Inc. Source

Hoopes D.J.,University of California at San Diego | Dicker A.P.,Thomas Jefferson University | Eads N.L.,American Society for Radiation Oncology | Fraass B.A.,Cedars Sinai Medical Center | And 6 more authors.
Practical Radiation Oncology | Year: 2015

Purpose: Incident learning is a critical tool to improve patient safety. The Patient Safety and Quality Improvement Act of 2005 established essential legal protections to allow for the collection and analysis of medical incidents nationwide. Methods and materials: Working with a federally listed patient safety organization (PSO), the American Society for Radiation Oncology and the American Association of Physicists in Medicine established RO-ILS: Radiation Oncology Incident Learning System (RO-ILS). This paper provides an overview of the RO-ILS background, development, structure, and workflow, as well as examples of preliminary data and lessons learned. RO-ILS is actively collecting, analyzing, and reporting patient safety events. Results: As of February 24, 2015, 46 institutions have signed contracts with Clarity PSO, with 33 contracts pending. Of these, 27 sites have entered 739 patient safety events into local database space, with 358 events (48%) pushed to the national database. Conclusions: To establish an optimal safety culture, radiation oncology departments should establish formal systems for incident learning that include participation in a nationwide incident learning program such as RO-ILS. © 2015 American Society for Radiation Oncology. Source

Schnadig I.D.,Compass Oncology | Schnadig I.D.,McKesson | Hutson T.E.,Texas Oncology At Baylor Charles mmons Cancer Center | Chung H.,McKesson | And 4 more authors.
Clinical Genitourinary Cancer | Year: 2014

Dosing patterns of first-line sunitinib and association with toxicities and clinical outcomes were retrospectively evaluated across 17 community practices for 134 patients with advanced renal cell carcinoma. Dose reduction occurred more frequently and therapy was discontinued sooner than in clinical trials, with inferior clinical outcomes, potentially due to shorter therapy duration. Sunitinib therapy optimization in community practices remains a challenge. Background: This retrospective study by McKesson Specialty Health (MSH)/US Oncology Network (USON) evaluates dosing patterns of first-line sunitinib for patients with advanced renal cell carcinoma (aRCC) and its association with toxicities and clinical outcomes in community practices. Patients and Methods: Patients with aRCC who started firstline sunitinib between June 1, 2007, and May 31, 2011, were identified from 17 MSH/USON practices. Clinical data were extracted from iKnowMed electronic medical records linked to the MSH/USON pharmacy database. Results: In total, 134 patients were included; mean age was 63.9 years, 85% of the patients had an Eastern Cooperative Oncology Group performance score of 0 or 1, 82% had clear-cell renal cell carcinoma, and 65% had undergone nephrectomy. The median treatment duration was 4 cycles (range, 1-19). Overall, 113 patients discontinued sunitinib, mainly because of disease progression (45.1%) or toxicities (16.8%). Of all discontinuations, 77% occurred within the first 5 cycles. A total of 45 patients were dose-reduced, mostly because of toxicities (93%); 67% of all dose reductions occurred in the first 3 cycles. The objective response rate was 16.4%, median overall survival (OS) was 15.5 months,and progression-free survival (PFS) was 7.5 months. Multivariate analysis showed that OS and PFS were associated with sunitinib treatment duration. Conclusions: Patients with aRCC from community practices undergo sunitinib dose reductions more frequently because of toxicities and discontinue therapy sooner than in clinical trials. Clinical outcomes were inferior to those reported in clinical trials, potentially because of shorter duration of therapy. Sunitinib therapy optimization remains an important challenge in community practices. © 2014 Elsevier Inc. All rights reserved. Source

Flatley E.M.,Oregon Health And Science University | Segal G.M.,Compass Oncology | Batiuk T.D.,Legacy Good Samaritan Medical Center Transplant Services | Bennett W.M.,Legacy Good Samaritan Medical Center Transplant Services | And 2 more authors.
American Journal of Surgical Pathology | Year: 2015

Paraproteins have varied effects on the kidney on the basis of molecular structure, concentration, and renal function. Prototypical patterns include myeloma cast nephropathy, monoclonal immunoglobulin deposition disease, and amyloid, among others. We report a 69-year-old man with end-stage diabetic nephropathy and biclonal gammopathy of unknown significance. Serum monoclonal immunoglobulin G (IgG)-κ and urine monoclonal free λ light chains were identified during workup for nephrotic syndrome. A native renal biopsy demonstrated diabetic nephropathy, without indication of paraprotein-related pathology. After transplantation, a surveillance biopsy showed endothelialitis (type 2 rejection) and abundant eosinophilic droplets, nearly occluding glomerular capillary loops. Electron microscopy localized tightly packed electron-dense vesicles in glomerular endothelial cells. Immunofluorescence studies revealed IgG-κ-dominant endothelial staining, along with λ monotypic protein resorption droplets in tubules. Two additional biopsies within the following year showed this same paraprotein distribution, with some increase in mesangial sclerosis. Two years after transplant the patient remains asymptomatic with normal creatinine levels. Literature review yields rare cases of immunoglobulin crystalline deposits in multiple glomerular cell types, rarely including endothelial cells; however, this appears to be the first report of monoclonal immunoglobulin vesicles localized solely to endothelial cells. As these vesicles were not seen in the native kidney biopsy, we hypothesize an interaction of alloimmune-mediated endothelial injury and the physiochemical properties of the IgG-κ paraprotein. In addition, this case illustrates simultaneous different patterns of accumulation of monoclonal immunoglobulin and light chain components in this unique patient with biclonal gammopathy of unknown significance. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. Source

Dao K.H.T.,Oregon Health And Science University | Solti M.B.,Compass Oncology | Maxson J.E.,Oregon Health And Science University | Winton E.F.,Emory University | And 4 more authors.
Leukemia Research Reports | Year: 2015

Mutations in CSF3R (colony-stimulating factor 3 receptor) are frequent oncogenic drivers in chronic neutrophilic leukemia (CNL) and atypical chronic myeloid leukemia (aCML). Here we describe a 75 year old man who was diagnosed with CSF3R-T618I-positive atypical CML. He presented with leukocytosis, anemia, and thrombocytopenia and developed massive splenomegaly and severe constitutional symptoms. Hydroxyurea was given over a 6 month period but failed to provide any measureable clinical benefit. Eventually, he was treated with ruxolitinib, an FDA-approved JAK1/2 inhibitor, which resulted in dramatic improvement of his blood counts. He also had significant reduction of spleen volume and constitutional symptoms. This case highlights the need for a clinical trial to interrogate JAK1/2 as a potential molecular target in CNL and aCML in patients with or without CSF3R mutation. A clinical trial evaluating the safety and efficacy of ruxolitinib for this patient population is registered at ClinicalTrials.gov (NCT02092324). © 2014 The Authors. Source

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