Schiffler Cancer Center

Wheeling, WV, United States

Schiffler Cancer Center

Wheeling, WV, United States
SEARCH FILTERS
Time filter
Source Type

PHILADELPHIA, PA -- NRG-RTOG 0436 has determined that adding an epidermal growth factor receptor (EGFR) inhibitor to a chemo-radiation regimen does not improve overall survival for patients with locally advanced esophageal cancer treated in a non-operative manner. These results are reported in "Effect of the Addition of Cetuximab to Paclitaxel, Cisplatin, and Radiation Therapy for Patients with Esophageal Cancer - The NRG Oncology RTOG 0436 Phase 3 Randomized Clinical Trial," which was recently published in the Journal of the American Medical Association (JAMA) Oncology. NRG-RTOG 0436 is a phase III clinical trial which was open to patients with biopsy-proven carcinoma of the esophagus. During the time period of 2008-2013, 344 patients were accrued to this trial and randomized between two treatments arms: standard chemo-radiation alone versus standard chemo-radiation with the addition of the EGFR inhibitor cetuximab. "The addition of cetuximab to chemo-radiation yielded no significant benefit for the patients on the experimental treatment arm when compared to the standard treatment," stated the lead author, Mohan Suntharalingam, MD, MBA, the Marlene and Stewart Greenebaum Professor of Radiation Oncology at the University of Maryland School of Medicine and President and Chief Executive Officer of the University of Maryland Medical Center . "These results highlight the need for predictive biomarkers in order to improve and refine the treatment of esophageal cancer." All patients enrolled on NRG-RTOG 0436 received weekly cisplatin (50mg/m2) plus paclitaxel (25mg/m2), and daily radiation (50.4 Gy). Patients assigned to the experimental arm also received weekly cetuximab: day 1 (400mg/m2) and then weekly (250 mg/m2). Results indicated no significant improvement in overall survival between arms (24- and 36-month overall survival for experimental arm: 45% and 34% vs. standard arm: 44% and 28%). The incidence of grade 3/4/5 treatment-related adverse effects between experimental arm (46%/23%/4%) and the standard arm (50%/17%/1%), and the clinical complete response (cCR) rate between the experimental (56%) and the standard (58%) treatment arms also conveyed no substantial difference. "Carcinoma of the esophagus causes over400,000 fatalities worldwide every year, and most patients are at an advanced stage of the disease at presentation. The knowledge acquired from this study will ultimately impact how researchers approach treatment methods for this patient population in the future," says Walter J. Curran, Jr., MD, NRG Oncology Group Chair and Executive Director of the Winship Cancer Institute of Emory University. "Thank you to Dr. Suntharalingam, the NRG-RTOG 0436 study team, and all of the participating sites for their efforts." NRG-RTOG 0436 was funded by grants from the National Cancer Institute and Eli Lilly and Company. Effect of the Addition of Cetuximab to Paclitaxel, Cisplatin, and Radiation Therapy for Patients With Esophageal Cancer - The NRG Oncology RTOG 0436 Phase 3 Randomized Clinical Trial Mohan Suntharalingam, MD, MBA1; Kathryn Winter, MS2; David Ilson, MD, PhD3; Adam P. Dicker, MD, PhD4; Lisa Kachnic, MD5;André Konski, MD6; A. Bapsi Chakravarthy, MD5; Christopher J. Anker, MD7; Harish Thakrar, MD8; Naomi Horiba, MD1,9;Ajay Dubey, MD, MPH, MBA10; Joel S. Greenberger, MD11; Adam Raben, MD12; Jeffrey Giguere, MD13; Kevin Roof, MD14;Gregory Videtic, MD15; Jondavid Pollock, MD16; Howard Safran, MD17; Christopher H. Crane, MD3,18 1University of Maryland Medical System 2NRG Oncology Statistics and Data Management Center 3Memorial Sloan-Kettering Cancer Center 4Thomas Jefferson University Hospital 5Vanderbilt University Medical Center, Ingram Cancer Center 6The Chester County Hospital 7Huntsman Cancer Hospital, University of Utah 8John H. Stroger, Jr. Hospital of Cook County MBCCOP 9University of Maryland Medical System (during trial); Food and Drug Administration (current) 10USON- Texas Oncology 11UPMC-Shadyside Hospital 12Christiana Care Health Services, Inc. CCOP 13Greenville South Carolina CCOP 14Southeast Cancer Control Consortium, Inc. CCOP 15Cleveland Clinic 16The Schiffler Cancer Center 17Brown University Oncology Group 18University of Texas, MD Anderson Cancer Center (during trial); Memorial Sloan-Kettering Cancer Center (current) NRG Oncology conducts practice-changing, multi-institutional clinical and translational research to improve the lives of patients with cancer. Founded in 2012, NRG Oncology is a Pennsylvania-based nonprofit corporation that integrates the research of the National Adjuvant Breast and Bowel Project, the Radiation Therapy Oncology Group, and the Gynecologic Oncology Group. The research organization seeks to carry out clinical trials with emphases on gender-specific malignancies, including gynecologic, breast, and prostate cancers, and on localized or locally advanced cancers of all types. NRG Oncology's extensive research organization comprises multidisciplinary investigators, including medical oncologists, radiation oncologists, surgeons, physicists, pathologists, and statisticians, and encompasses more than 1300 research sites located world-wide with predominance in the United States and Canada. NRG Oncology is supported primarily through grants from the National Cancer Institute (NCI) and is one of five research groups in the NCI's National Clinical Trials Network.


PubMed | Translational Research Center, The Christ Hospital Cancer Center, Translational Research Consortium TRC, Kerri Perry and 9 more.
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2017

92 Background: Limited data are available on the treatment of ductal carcinoma in situ (DCIS) with accelerated partial breast irradiation (APBI). The American Society for Radiation Oncology (ASTRO) consensus guidelines on APBI classify patients with DCIS as cautionary. We present the largest series of DCIS patients reported to date treated with APBI using strut-based brachytherapy.The SAVI Collaborative Research Group (SCRG) database was used to identify APBI patients with DCIS at 15 institutions treated with strut-based brachytherapy. All patients had a histologic diagnosis of DCIS and received monotherapy APBI (34 Gy in 10 fractions). Data on patient age and margin status, implant dosimetry, device size, disease status and toxicity in this population were analyzed.From 2007-2011, 321 patients (322 breasts) with DCIS received APBI using strut-based brachytherapy. Patient ages ranged from 40-88 with a median age of 62. 51 patients were under 50 years of age. Detailed dosimetry data were reported on 245 patients. Long-term follow up was available on 221 breasts (median F/U = 25 months). Sixty patients have been followed for >3 years. Skin spacing was a challenge in a significant number of patients including 52 with skin spacing 5mm and 20 with skin spacing 3mm. Median maximum skin dose in those patient groups were 87% and 84% of prescription dose (PD), respectively. Overall reported dosimetry (n=245) was excellent: median percent of target volume receiving 90% PD was 96.9%, median maximum skin dose was 83.2%, V150% and V200% (volume at 150% and 200% PD) were 25.2 cc and 12.7 cc respectively. The ipsilateral recurrence rate was 2.2% (1.1% TR/MM). Late toxicity (grade 2) was low: hyperpigmentation = 0.0%, telangiectasias =1.4%, seroma = 3.2%, and fat necrosis in 1.8%.APBI using strut-based brachytherapy appears to be an effective treatment for patients with DCIS with acceptably low ipsilateral breast recurrence rates and low rates of late toxicity. 52 patients in our series had skin spacing 5 mm or less. APBI using brachytherapy may not have been possible for these women with other single-entry devices.


Frank S.J.,University of Texas M. D. Anderson Cancer Center | Arterbery V.E.,Crittenton DMC Health Service | Hsu I.C.J.,University of California at San Francisco | Abdel-Wahab M.,University of Miami | And 8 more authors.
Brachytherapy | Year: 2011

Purpose: Permanent prostate brachytherapy has emerged as a standard of care treatment for approximately 50,000 men annually who present with clinically localized prostate cancer. The purpose of this review was to provide clarification on the appropriateness criteria and management considerations for the treatment of prostate cancer with permanent prostate brachytherapy. Methods: Panel members with expertise on prostate cancer were assembled and provided several clinical scenarios for consensus treatment and management guidelines. Prostate cancer patient vignettes were presented along with specific management recommendations based on an extensive review of the modern brachytherapy literature. The brachytherapy topic development and review consists of two parts which require extensive participation by the expert panel. The American College of Radiology (ACR) Appropriateness Criteria (AC) are derived from a multidisciplinary panel of experts from both the academic and private practice settings. The first activity is a review of the current literature with development of an evidence table, referenced narrative, and ratings table of treatments. The second activity is the consensus-building process using a modified Delphi technique via an anonymous voting process. Results: Most brachytherapy series have demonstrated favorable morbidity profiles and durable biochemical control rates for patients with low-, intermediate-, and high-risk features. However, as brachytherapy followups have matured, it has become increasingly apparent that efficacy and morbidity are highly dependent on implant quality. Conclusion: Continued attempts to refine patient selection, brachytherapy treatment planning philosophy, technique, and postimplant management should result in further improvements in biochemical outcome and decreased brachytherapy-related morbidity. © 2011 American Brachytherapy Society.


Wong S.J.,Medical College of Wisconsin | Moughan J.,Radiation Therapy Oncology Group Statistical Center | Meropol N.J.,Case Western Reserve University | Anne P.R.,Thomas Jefferson University | And 9 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2015

Purpose: To report secondary efficacy endpoints of Radiation Therapy Oncology Group protocol 0247, primary endpoint analysis of which demonstrated that preoperative radiation therapy (RT) with capecitabine plus oxaliplatin achieved a pathologic complete remission prespecified threshold (21%) to merit further study, whereas RT with capecitabine plus irinotecan did not (10%). Methods and Materials: A randomized, phase 2 trial evaluated preoperative RT (50.4 Gy in 1.8-Gy fractions) with 2 concurrent chemotherapy regimens: (1) capecitabine (1200 mg/m2/d Monday-Friday) plus irinotecan (50 mg/m2/wk × 4); and (2) capecitabine (1650 mg/m2/d Monday-Friday) plus oxaliplatin (50 mg/m2/wk × 5) for clinical T3 or T4 rectal cancer. Surgery was performed 4 to 8 weeks after chemoradiation, then 4 to 6 weeks later, adjuvant chemotherapy (oxaliplatin 85 mg/m2; leucovorin 400 mg/m2; 5-fluorouracil 400 mg/m2; 5-fluorouracil 2400 mg/m2) every 2 weeks × 9. Disease-free survival (DFS) and overall survival (OS) were estimated univariately by the Kaplan-Meier method. Local - regional failure (LRF), distant failure (DF), and second primary failure (SP) were estimated by the cumulative incidence method. No statistical comparisons were made between arms because each was evaluated individually. Results: A total of 104 patients (median age, 57 years) were treated; characteristics were similar for both arms. Median follow-up for RT with capecitabine/irinotecan arm was 3.77 years and for RT with capecitabine/oxaliplatin arm was 3.97 years. Four-year DFS, OS, LRF, DF, and SP estimates for capecitabine/irinotecan arm were 68%, 85%, 16%, 24%, and 2%, respectively. The 4-year DFS, OS, LRF, DF, and SP failure estimates for capecitabine/oxaliplatin arm were 62%, 75%, 18%, 30%, and 6%, respectively. Conclusions: Efficacy results for both arms are similar to other reported studies but suggest that pathologic complete remission is an unsuitable surrogate for traditional survival metrics of clinical outcome. Although it remains uncertain whether the addition of a second cytotoxic agent enhances the effectiveness of fluorouracil plus RT, these results suggest that further study of irinotecan may be warranted. © 2015 Elsevier Inc.


Wong S.J.,Medical College of Wisconsin | Winter K.,Radiation Therapy Oncology Group Statistical Center | Meropol N.J.,Case Western Reserve University | Anne P.R.,Thomas Jefferson University | And 9 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2012

Purpose: To evaluate the rate of pathologic complete response (pCR) and the toxicity of two neoadjuvant chemoradiotherapy (chemoRT) regimens for Stage T3-T4 rectal cancer in a randomized Phase II study. Methods and Materials: Patients with Stage T3 or T4 rectal cancer of <12 cm from the anal verge were randomized to preoperative RT (50.4 Gy in 1.8-Gy fractions) with concurrent capecitabine (1,200 mg/m 2/d Mondays through Friday) and irinotecan (50 mg/m 2 weekly in four doses) (Arm 1) or concurrent capecitabine (1,650 mg/m 2/d Monday through Friday) and oxaliplatin (50 mg/m 2 weekly in five doses) (Arm 2). Surgery was performed 4-8 weeks after chemoRT, and adjuvant chemotherapy 4-6 weeks after surgery. The primary endpoint was the pCR rate, requiring 48 evaluable patients per arm. Results: A total of 146 patients were enrolled. The protocol chemotherapy was modified because of excessive gastrointestinal toxicity after treatment of 35 patients; 96 were assessed for the primary endpoint - the final regimen described above. The patient characteristics were similar for both arms. After chemoRT, the rate of tumor downstaging was 52% and 60% and the rate of nodal downstaging (excluding N0 patients) was 46% and 40%, for Arms 1 and 2, respectively. The pCR rate for Arm 1 was 10% and for Arm 2 was 21%. For Arm 1 and 2, the preoperative chemoRT rate of Grade 3-4 hematologic toxicity was 9% and 4% and the rate of Grade 3-4 nonhematologic toxicity was 26% and 27%, respectively. Conclusions: Preoperative chemoRT with capecitabine plus oxaliplatin for distal rectal cancer has significant clinical activity (10 of 48 pCRs) and acceptable toxicity. This regimen is currently being evaluated in a Phase III randomized trial (National Surgical Adjuvant Breast and Bowel Project R04). Copyright © 2012 Elsevier Inc. Printed in the USA. All rights reserved.


Pollock J.,Schiffler Cancer Center | Welsh J.S.,Louisiana State University Health Sciences Center | Welsh J.S.,Willis Knighton Hospital
American Journal of Clinical Oncology: Cancer Clinical Trials | Year: 2014

Since the discovery of proven genetic mutations which predispose people to breast cancer along with the routine availability of genetic testing for such mutations, a number of issues have surfaced regarding potential methods of breast cancer diagnosis, surveillance, treatment, and risk reduction. Many of these issues pertain to the practice of radiation oncology and can affect decisions on management. This article aims to describe some of the more salient features of individuals at high genetic risk for breast developing cancer along with aspects of their tumor biology, clinical natural history, and how the radiation oncologist may address these challenges. Copyright © 2012 by Lippincott Williams & Wilkins.


Butler W.M.,Schiffler Cancer Center | Merrick G.S.,Schiffler Cancer Center | Reed J.L.,Schiffler Cancer Center | Murray B.C.,Schiffler Cancer Center | Kurko B.S.,Schiffler Cancer Center
Journal of Applied Clinical Medical Physics | Year: 2013

Implanted radiofrequency transponders were used for real-time monitoring of the intrafraction prostate displacement between patients in the prone position and the same patients in the supine position. Thirteen patients had three transponders implanted transperineally and were treated prone with a custom-fitted thermoplastic immobilization device. After collecting data from the last fraction, patients were realigned in the supine position and the displacements of the transponders were monitored for 5-7 minutes. Fourier transforms were applied to the data from each patient to determine periodicity and its amplitude. To remove auto correlation from the stream of displacement data, the distribution of short-term and long-term velocity components were calculated from Poincaré plots of paired sequential vector displacements. The mean absolute displacement was significantly greater prone than supine in the superior-inferior (SI) plane (1.2 ± 0.6 mm vs. 0.6 ± 0.4 mm, p= 0.015), but not for the lateral or anterior-posterior (AP) planes. Displacements were least in the lateral direction. Fourier analyses showed the amplitude of respiratory oscillations was much greater for the SI and AP planes in the prone versus the supine position. Analysis of Poincaré plots confirmed greater short-term variance in the prone position, but no difference in the long-term variance. The centroid of the implanted transponders was offset from the treatment isocenter by > 5 mm for 1.9% of the time versus 0.8% of the time for supine. These results confirmed significantly greater net intrafraction prostate displacement of patients in the prone position than in the supine position, but most of the difference was due to respiration-induced motion that was most pronounced in the SI and AP directions. Because the respiratory motion remained within the action threshold and also within our 5 mm treatment planning margins, there is no compelling reason to choose one treatment position over the other.


Pollock J.,Schiffler Cancer Center | Welsh J.S.,University of Wisconsin - Madison | Welsh J.S.,Cancer Center
American Journal of Clinical Oncology: Cancer Clinical Trials | Year: 2011

There is an increasing recognition of the importance of genetic and familial cancer syndromes in routine clinical practice. Although most of gastrointestinal cancers are sporadic, a number of important cancer predisposition syndromes are now recognized and well characterized. In this review, we discuss some of the basic principles of clinical cancer genetics and clinically relevant aspects of the more common gastrointestinal cancer syndromes from the perspective of practicing radiation oncologists. Copyright © 2011 by Lippincott Williams & Wilkins.


Butler W.M.,Schiffler Cancer Center
Journal of applied clinical medical physics / American College of Medical Physics | Year: 2013

Implanted radiofrequency transponders were used for real-time monitoring of the intrafraction prostate displacement between patients in the prone position and the same patients in the supine position. Thirteen patients had three transponders implanted transperineally and were treated prone with a custom-fitted thermoplastic immobilization device. After collecting data from the last fraction, patients were realigned in the supine position and the displacements of the transponders were monitored for 5-7 minutes. Fourier transforms were applied to the data from each patient to determine periodicity and its amplitude. To remove auto correlation from the stream of displacement data, the distribution of short-term and long-term velocity components were calculated from Poincaré plots of paired sequential vector displacements. The mean absolute displacement was significantly greater prone than supine in the superior-inferior (SI) plane (1.2 ± 0.6 mm vs. 0.6 ± 0.4 mm, p= 0.015), but not for the lateral or anterior-posterior (AP) planes. Displacements were least in the lateral direction. Fourier analyses showed the amplitude of respiratory oscillations was much greater for the SI and AP planes in the prone versus the supine position. Analysis of Poincaré plots confirmed greater short-term variance in the prone position, but no difference in the long-term variance. The centroid of the implanted transponders was offset from the treatment isocenter by > 5 mm for 1.9% of the time versus 0.8% of the time for supine. These results confirmed significantly greater net intrafraction prostate displacement of patients in the prone position than in the supine position, but most of the difference was due to respiration-induced motion that was most pronounced in the SI and AP directions. Because the respiratory motion remained within the action threshold and also within our 5 mm treatment planning margins, there is no compelling reason to choose one treatment position over the other.


PubMed | Schiffler Cancer Center
Type: Journal Article | Journal: American journal of clinical oncology | Year: 2011

There is an increasing recognition of the importance of genetic and familial cancer syndromes in routine clinical practice. Although most of gastrointestinal cancers are sporadic, a number of important cancer predisposition syndromes are now recognized and well characterized. In this review, we discuss some of the basic principles of clinical cancer genetics and clinically relevant aspects of the more common gastrointestinal cancer syndromes from the perspective of practicing radiation oncologists.

Loading Schiffler Cancer Center collaborators
Loading Schiffler Cancer Center collaborators