Jhingran A.,University of Houston |
Winter K.,Statistical Center |
Portelance L.,University of Miami |
Miller B.,Carolinas Medical Center North East |
And 6 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2012
Purpose: To determine the feasibility of pelvic intensity modulated radiation therapy (IMRT) for patients with endometrial cancer in a multi-institutional setting and to determine whether this treatment is associated with fewer short-term bowel adverse events than standard radiation therapy. Methods: Patients with adenocarcinoma of the endometrium treated with pelvic radiation therapy alone were eligible. Guidelines for target definition and delineation, dose prescription, and dose-volume constraints for the targets and critical normal structures were detailed in the study protocol and a web-based atlas. Results: Fifty-eight patients were accrued by 25 institutions; 43 were eligible for analysis. Forty-two patients (98%) had an acceptable IMRT plan; 1 had an unacceptable variation from the prescribed dose to the nodal planning target volume. The proportions of cases in which doses to critical normal structures exceeded protocol criteria were as follows: bladder, 67%; rectum, 76%; bowel, 17%; and femoral heads, 33%. Twelve patients (28%) developed grade ≥2 short-term bowel adverse events. Conclusions: Pelvic IMRT for endometrial cancer is feasible across multiple institutions with use of a detailed protocol and centralized quality assurance (QA). For future trials, contouring of vaginal and nodal tissue will need continued monitoring with good QA and better definitions will be needed for organs at risk. © 2012 Elsevier Inc. All rights reserved.
Seger H.M.M.,University of Utah |
Soisson A.P.,University of Utah |
Soisson A.P.,Huntsman Cancer Hospital |
Dodson M.K.,University of Utah |
And 4 more authors.
Gynecologic Oncology | Year: 2011
Objective: Using a genealogical database, we examined risk of endometrial cancer among family members of individuals with endometrial cancer. Methods: We identified endometrial cancer cases in the Utah Population Database (UPDB), a computerized archive of genealogy data linked to the Utah Cancer Registry. We tested for excess relatedness and estimated relative risks (RR) among first-, second-, and third-degree relatives of endometrial cancer cases and stratified analyses by tumor histology and body mass index (BMI). Results: We identified 3911 cases; 3546 were Type I cancers and 365 Type II cancers. The RR for all endometrial cancer cases and for cases with type I histology was significantly increased for first-, second-, and third-degree relatives. An almost three-fold risk was observed among first-degree relatives of individuals with Type I cancers and a 2.24-fold risk among second-degree relatives of Type I morbidly obese cases. The magnitude of endometrial cancer risk among relatives appeared to increase with case BMI. Conclusions: The elevated risks for endometrial cancer among first-, second-, and third-degree relatives support a genetic contribution to predisposition to endometrial cancer. The increased risk appears to be limited to Type I endometrial cancer. We observed increased risks for endometrial cancer among relatives of obese and morbidly obese Type I cases, which may be indicative of a synergistic relationship between underlying genetic propensity and shared environment. This study quantifies risk of developing cancer among relatives of patients with disease and provides the basis for further analysis of high risk pedigrees and gene identification for genetic etiologies of endometrial cancer. © 2011 Elsevier Inc. All rights reserved.
Compton J.J.,Indiana University |
Gaspar L.E.,University of Colorado at Denver |
Shrieve D.C.,Huntsman Cancer Hospital |
Wilson L.D.,Yale University |
And 3 more authors.
Brachytherapy | Year: 2013
Purpose: To describe resident-reported experience in brachytherapy in Accreditation Council of Graduate Medical Education-accredited radiation oncology training programs over the last 5 years. Methods and Materials: Archived reports of Accreditation Council of Graduate Medical Education final resident case logs from the last 5 years were reviewed and summarized. Brachytherapy was categorized according to the dose rate (low dose rate vs. high dose rate), technique (interstitial vs. intracavitary), and primary tumor site. Linear regression was used to test for trends. Results: The mean number of total brachytherapy procedures performed per resident in the last 5 years has decreased from 80.8 in 2006-2007 to 71.0 in 2010-2011, but the trend is not statistically significant. The average number of intracavitary procedures has remained steady. The average resident experience with interstitial brachytherapy has decreased in a statistically significant manner. The average number of interstitial procedures has decreased by 25%. Conclusions: The average number of interstitial procedures reported by residents has decreased by 25%. The community charged with training residents in interstitial brachytherapy should consider methods to ensure that residents obtain sufficient experience in the future. © 2013 American Brachytherapy Society.
Terakedis B.,Huntsman Cancer Hospital |
Sause W.,Intermountain Medical Center
Frontiers in Oncology | Year: 2011
For patients with stage III non-small-cell lung cancer with unresectable or inoperable tumors, definitive chemoradiotherapy is often utilized. Historically, local control and overall survival rates have been poor. In an effort to improve local control, new chemotherapeutic agents in combination with higher doses of radiotherapy have been investigated. Early dose escalation trials date back to the 1980s, and the feasibility and efficacy of dose escalation for patients with inoperable stage III lung cancer continue to be topics of investigation. Herein, we review the evolution of chemotherapy as it relates to treatment of unresectable stage III lung cancer, and we outline the early and the more recent dose escalation studies. While dose escalation appears to provide a modest benefit in terms of preventing local failure and improving overall survival, advances in diagnostic imaging and radiotherapy treatment have possibly resulted in selection of a more favorable patient population. These variables make statements regarding the benefit of dose escalation challenging. © 2011 Terakedis and Sause.
Ly D.,University of Utah |
Soisson P.A.,Huntsman Cancer Hospital |
Dodson M.K.,Huntsman Cancer Hospital |
Sause W.T.,Intermountain Medical Center |
Gaffney D.K.,University of Utah
Gynecologic Oncology | Year: 2015
Objective High grade histologies of endometrial carcinomas portend a worse prognosis. Previous randomized, prospective studies examining the role of radiation have excluded endometrial cancer patients with FIGO IB with high risk histologies (clear cell, papillary serous, and Grade 3 endometrioid adenocarcinoma). Methods We retrospectively identified 51 patients who underwent a hysterectomy for a FIGO IB endometrial carcinoma with clear cell, papillary serous or Grade 3 endometrioid adenocarcinoma histology. Adjuvant radiation therapy was delivered in 44 of 51 patients (86%). We assessed pelvic control, vaginal control, and overall survival using Kaplan Meier estimate and the log rank test. We completed univariate analysis. Results The 5-year vaginal control rate in patients without and with adjuvant radiation therapy was 67% and 93.3%, respectively (p = 0.0066). At 5-years, the pelvic control rate in patients without and with adjuvant radiation therapy was 0% and 81.5%, respectively (p = 0.0003). At 5-years, the overall survival was 80% in patients who had adjuvant radiation compared to 21.4% in patients who did not have adjuvant radiation (p = 0.0026). Radiation therapy was the only studied variable that was associated with pelvic control. Radiation therapy, advanced age and pelvic lymphadenectomy were associated with overall survival. Conclusions Adjuvant radiation therapy in patients with FIGO IB endometrial carcinoma with high risk histologies was associated with improved vaginal control, pelvic control, and overall survival. © 2015 Published by Elsevier Inc.
Austria M.J.,Huntsman Cancer Hospital |
Baraki K.,University of Utah |
Doig A.K.,University of Utah
International Journal of Nursing Education Scholarship | Year: 2013
Formal pairing of student nurses to work collaboratively on one patient assignment is a strategy for improving the quality and efficiency of clinical instruction while better utilizing the limited resources at clinical agencies. The aim of this qualitative study was to explore the student nurse and patient experiences of collaborative learning when peer dyads are used in clinical nursing education. Interviews were conducted with 11 students and 9 patients. Students described the process of collaborative learning as information sharing, cross-checking when making clinical decisions, and group processing when assessing the outcomes of nursing interventions. Positive outcomes reported by students and patients included reduced student anxiety, increased confidence and task efficiency. Students' primary concern was reduced opportunity to perform hands-on skills which had to be negotiated within each dyad. Meeting the present and future challenges of educating nurses will require innovative models of clinical instruction such as collaborative learning using student peer dyads.
Ly D.,University of Utah |
Bagshaw H.P.,University of Utah |
Anker C.J.,University of Vermont |
Tward J.D.,University of Utah |
And 4 more authors.
Journal of Neurosurgery | Year: 2015
Object BRAF inhibitors improve progression-free and overall survival in patients with metastatic melanoma. Brain metastases are common, and stereotactic radiosurgery (SRS) has been used, resulting in excellent local control. Because BRAF inhibitors are associated with intracranial responses, the authors hypothesized that BRAF inhibitors would improve local control in patients with melanoma who are receiving SRS for brain metastases. Methods The authors retrospectively identified patients with metastatic melanoma who had been tested for BRAF mutation and treated with SRS for brain metastases. Patients with previous resection, multiple brain metastases, or multiple courses of SRS were eligible. SRS was delivered in a single fraction to a median dose of 2000 cGy. Patients with a BRAF mutation were treated with a BRAF inhibitor on the basis of physician preference. Results The authors identified 52 patients who were treated in 82 treatment sessions for 185 brain metastases and 13 tumor beds. At a median follow-up of 10.5 months, the 1-year local control rate was 69.2%. At 1 year, the local control rate for brain metastases in patients with BRAF mutation with BRAF treatment was 85.0%, and the local control rate for brain metastases in those without BRAF treatment was 51.5% (p = 0.0077). The rates of distant brain failure, freedom from whole-brain radiation, and overall survival were not different on the basis of BRAF mutation status or inhibitor therapy. The number of new intratumoral hemorrhages after SRS was increased significantly in patients with BRAF treatment. Conclusions Treatment with BRAF inhibitors was associated with improved local control after SRS in patients with melanoma and brain metastases. An increased number of intratumoral hemorrhages was associated with BRAF inhibitor therapy. © AANS, 2015.
Jensen R.L.,University of Utah |
Jensen P.R.,University of Utah |
Shrieve A.F.,Huntsman Cancer Hospital |
Hazard L.,University of Utah |
Shrieve D.C.,University of Utah
Journal of Neuro-Oncology | Year: 2010
Linear accelerator single-fraction radiosurgery (SRS) for skull base lesions is usually delivered with dynamic conformal arcs (DCAs), but intensity-modulated radiosurgery (IMRS) is another option when SRS dose is limited by proximity of the optic nerve and chiasm. We review the long-term outcome of patients treated with IMRS for parasellar lesions. Fourteen patients with parasellar lesions were treated with IMRS when standard DCA radiosurgery was limited by optic nerve tolerance. Prospective patient data included endocrine function, visual acuity and field testing, nonoptic nerve cranial neuropathy, and overall survival. In addition, tumor control on serial magnetic resonance imaging is reported as progression-free survival (PFS). Six patients with cavernous sinus meningiomas and eight with recurrent pituitary adenomas were treated. Three of the pituitary tumors were hormonally active (two with Cushing disease, one with acromegaly). The median patient age was 50 years (range 24-70 years). Median follow-up was 54 months. Average tumor treatment volume was 4.99 ml (average dose 16 Gy, average of 10 IMRS fields). Tumor control was achieved in 11 of 14 (79%) patients. Median PFS has not been reached in our patient population. Thirteen patients are alive (one died of an unrelated cancer). No patients developed new endocrinological, ophthalmological, or cranial nerve deficits. IMRS allows for treatment of parasellar lesions when standard DCA SRS is limited by optic nerve tolerance. Although our follow-up period was relatively short and the number of patients was small, it appears that this can be accomplished with a high tumor control rate and survival without new endocrinopathies, optic neuropathies, or other complications in patients who have failed other therapies. © 2010 Springer Science+Business Media, LLC.
PubMed | Cleveland Clinic, Huntsman Cancer Hospital and Cleveland State University
Type: Journal Article | Journal: Medical physics | Year: 2016
To study the dosimetric impact of MLC leaf width in patients treated with Volumetric Modulated Arc Therapy (VMAT) for spine Stereotactic Body radiation Therapy (SBRT).Twelve spine SBRT patients were retrospectively selected for this study. The patients were treated with IMRT following the RTOG-0631 of spine metastasis. The prescription dose was 16 Gy in one fraction to 90% of the target volume (V16 > 90%). The maximum spinal cord dose of 14 Gy and 10% of the cord receiving < 10 Gy (V10) were set as dose constraints. For purpose of this study, three dual arc VMAT plans were created for each patient using three different MLC leaf widths: 2.5 mm, 4mm, and 5mm. The compliance to RTOG 0631, conformal index (CI), dose gradient index (DGI), and number of monitor units (MUs) were compared.The average V16 of the target was 91.911.36%, 93.732.38%, and 92.252.49% for 2.5 mm, 4 mm, and 5 mm leaf widths, respectively (p=0.39). Accordingly, the average CI was 1.360.39, 1.360.34, and 1.410.3 (0.96), respectively. The average DGI was 0.24 0.05, 0.22 0.05, and 0.23 0.04, respectively (p=0.86). The average spinal cord maximum dose was 12.10 0.88 Gy, 12.52 1.15 Gy, and 12.05 1.12 (p=0.75) and V10 was 2.69 1.71 cc, 5.43 2.16 cc, and 3.71 2.34 cc (p=0.15) for 2.5 mm, 4 mm, and 5 mm leaf widths, respectively. According, the average number of MUs was 4255 431 MU, 5049 1036 MU, and 4231 580 MU respectively (p=0.17).The use of 2.5 mm, 4 mm, and 5 mm MLCs achieved similar VMAT plan quality as recommended by RTOG-0631. The dosimetric parameters were also comparable for the three MLCs.
PubMed | Bariatric Medicine Institute and Huntsman Cancer Hospital
Type: | Journal: Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery | Year: 2016
Portal vein thrombosis (PVT) is a serious problem with a high morbidity and mortality, often exceeding 40% of affected patients. Recently, PVT has been reported in patients after laparoscopic sleeve gastrectomy (LSG). The frequency is surprisingly high compared with other abdominal operations.We present a series of 5 patients with PVT after LSG. The treatment was not restricted simply to anticoagulation alone, but was determined by the extent of disease. A distinction is made among nonocclusive, high-grade nonocclusive, and occlusive PVT. We present evidence that systemic anticoagulation is insufficient in occlusive thrombosis and may also be insufficient in high-grade nonocclusive disease.Single private institution, United States.We present a retrospective analysis of 646 patients who underwent LSG between 2012 and 2015. In all patients, the diagnosis was established with an abdominal computed tomography (CT) scan as well as duplex ultrasound of the portal venous system. All patients received systemic anticoagulation. Depending on the extent of disease, thrombolytic therapy and portal vein thrombectomy were utilized. All patients received long-term anticoagulation.Four patients with PVT were identified. A fifth patient with PVT after LSG was referred from another center. The mean age of all patients was 49 years. One patient had a history of deep vein thrombosis (DVT). No complications were identified intraoperatively or during the hospital stay, and all patients were discharged by postoperative day 2. The patients presented with PVT at an average of 20 days (range: 10-35) post-LSG. The CT scan was positive for PVT in all patients. In stable noncirrhotic patients with nonocclusive disease, we administered therapeutic anticoagulation. One patient with high-grade, nonocclusive PVT received anticoagulation alone. Patients with occlusive disease were treated with operative thrombectomy including intraoperative and postoperative thrombolysis (tissue plasminogen activator) with subsequent therapeutic anticoagulation, followed by oral warfarin or a factor Xa inhibitor. There was 1 death from multisystem organ failure in the patient who was referred from another institution with occlusive disease, initially managed only with an anticoagulation infusion.We maintain that portal vein patency is essential to normal gastrointestinal physiology and should be the treatment goal in all patients with PVT. In these patients, the therapeutic option should be guided by the extent of the thrombosis. In view of currently available approaches, we propose that operative portal vein thrombectomy, in conjunction with fibrinolysis and anticoagulation, offers the best long-term success in patients with occlusive PVT.