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Parashar B.,Stich Radiation Center | Patro K.C.,Mahatma Gandhi Cancer Hospital | Smith M.,Stich Radiation Center | Arora S.,Stich Radiation Center | And 2 more authors.
Seminars in Interventional Radiology | Year: 2014

Renal cell carcinoma (RCC) is an aggressive malignancy that carries a poor prognosis, especially in patients presenting with advanced stage. Primary treatment for localized RCC is surgical resection however, a significant number of patients still develop locoregional and distant metastasis after curative resection. In metastatic disease, radiation therapy (RT) has been used for palliation routinely for brain and other extracranial lesions with respectable response rates. However, RT for primary RCC has questionable benefit. In this article, the authors discuss the evidence with regards to the role of RT in primary RCC either as a primary treatment, adjuvant treatment, or preoperatively to improve resection outcomes. In addition, novel RT techniques such as stereotactic body radiation therapy and its use in RCC management are also addressed. Finally, the authors discuss the techniques and doses of RT for primary RCC.©2014 by Thieme Medical Publishers, Inc.


Patel S.H.,Stich Radiation Center | Ma Y.,New York Medical College | Wernicke A.G.,Stich Radiation Center | Nori D.,Stich Radiation Center | And 2 more authors.
Lung Cancer | Year: 2014

Purpose: Post-operative radiotherapy (PORT) treatment for lung cancer declined since a meta-analysis failed to show benefit in patients with N2 disease. Because several included studies employed outmoded radiation planning and delivery techniques, we sought to determine whether PORT with modern technology benefits patients with N2 disease. Methods: We conducted searches of the published literature. For inclusion, studies must have included patients with stage III-N2 lung cancer treated with PORT using only linear accelerators, used a control group that did not receive PORT, and reported outcome data for overall survival (OS). Prospective and retrospective analyses were included. Exclusion criteria were the use of cobalt devices or orthovoltage radiation. Results: Data were evaluated with random-effects models. Three prospective and eight retrospective studies were included. The PORT and no-PORT groups included 1368 and 1360 patients, respectively. The PORT group had significantly improved OS over the no-PORT group (hazard ratio [HR]. = 0.77, 95% confidence interval [CI] 0.62-0.96, P= 0.020). Locoregional recurrence-free survival (LRFS) in 10 studies for which data was available was also improved in the PORT group (HR. = 0.51, CI 0.41-0.65, P<. 0.001). Conclusions: PORT was associated with significantly lower risk of death and locoregional recurrence in patients with N2 lung cancer. Our study was limited by lack of access to individual patient data, which would have enabled more detailed analyses. Regardless, data thus far suggest PORT may be associated with a survival benefit. Given a lack of large-scale prospective data, clinical trials evaluating PORT with modern technology are warranted. © 2014 Elsevier Ireland Ltd.


Chen J.J.,Weill Cornell Sloan Kettering Rockefeller Tri Institutional MD PhD Program | Stessin A.,Stich Radiation Center | Christos P.,New York Medical College | Wernicke A.G.,Stich Radiation Center | And 2 more authors.
Laryngoscope | Year: 2015

Objective The purpose of this study was to investigate and compare the cause-specific survival (CSS) of stage I (tumor [T]1 node [N]0 metastasis [M]0) versus stage II (T2N0M0) glottic cancer in a large population cohort. Study Design We analyzed data from the Surveillance, Epidemiology, and End Results 18 database from 1973 to 2009, comprising patients diagnosed with T1N0M0 or T2N0M0 squamous cell glottic cancer. Kaplan-Meier survival analysis, multivariable Cox proportional hazards regression analysis, and competing-risks survival regression were used for statistical analysis. Results There were 4,422 patients who met all inclusion criteria. The 36-month CSS was 93.9% for stage I verus 86.5% for stage II, with P<0.0001. Stage II status conferred a 2.494 hazard ratio for increased risk of cause-specific death compared to stage I. Conclusions Stage II glottic cancers have a significantly worse prognosis and may need a different approach to management than stage I tumors. Level of Evidence 4. Laryngoscope, 125:2093-2098, 2015. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.


Parashar B.,Stich Radiation Center | Hirsh A.Z.,Stich Radiation Center | Yan W.,Stich Radiation Center | Wei L.,New York Hospital Queens | Wernicke A.G.,Stich Radiation Center
Sarcoma | Year: 2010

Retiform hemangioendothelioma (RH) is an infrequently encountered vascular neoplasm of intermediate or borderline malignancy. Treatment of RH is controversial. We present a case of a 44-year-old Asian male presenting with an unresectable RH of the pelvis. The patient was treated with concurrent low-dose Cisplatin and External beam Radiation (4140cGy in 180cGy per fraction). This is the first report of a clinical complete response and a long-term local control of this rare tumor. This has significant clinical implication, since it gives the first evidence of treatment of this rare tumor using concurrent low-dose chemotherapy and radiation. © 2010 Alina Z. Hirsh et al.


Parashar B.,Stich Radiation Center | Edwards A.,Weill Cornell Medical Center | Mehta R.,Northwestern University | Pasmantier M.,Cornell University | And 5 more authors.
American Journal of Clinical Oncology: Cancer Clinical Trials | Year: 2011

Introduction: The reported rate of developing radiation pneumonitis (RP) in patients receiving deflnitive radiation therapy (RT) for lung cancer is 5% to 36%. However, this incidence is probably underreported because of the nonspeciflc symptoms of RP that may be erroneously attributed to another cardiovascular or respiratory disorder. The objective of this study was to evaluate the incidence of RP in lung cancer patients receiving RT or chemoradiation therapy. Methods: Of the 110 patients that were reviewed, 86 were chosen for a retrospective analysis. A diagnosis of RP was made based on clinical assessment in the flrst 6 to 12 months after RT. Radiation pneumonitis was graded as per Radiation Therapy Oncology Group grading criteria. Results: The incidence of developing grade 2 or higher RP was signiflcantly associated with addition of chemotherapy. The incidence of RP in patients receiving chemotherapy was 62.7% (42/67) versus 15.8% (3/19) in patients receiving no chemotherapy (P < 0.001). However, there was no signiflcant effect of the type or sequence of chemotherapy on the incidence of RP. The risk of developing RP is 5 times greater in patients receiving chemotherapy when compared with those not receiving this treatment (hazard ratio: 5.0; 95% confldence interval 1.5, 16.1). In addition, patients in age group 61 to 70 years had a signiflcantly increased risk of developing RP compared with patients of age 60 or younger (hazard ratio: 3.0; 95% confldence interval: 1.4, 6.5). Histology and radiation dose were not signiflcant factors in development of RP. Conclusion: The incidence of RP in patients receiving external-beam RT is signiflcantly increased with addition of chemotherapy and 61 to 70 year age group. Copyright © 2011 by Lippincott Williams & Wilkins.

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