Willis Knighton Cancer Center

Shreveport, United States

Willis Knighton Cancer Center

Shreveport, United States
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Yang Z.,Louisiana State University in Shreveport | Katz S.,Willis Knighton Cancer Center | Nathan C.-A.,Louisiana State University in Shreveport | Mehta V.,Louisiana State University in Shreveport
Thyroid | Year: 2017

Background: There is a lack of well-powered data regarding outcomes in stage IV differentiated thyroid carcinoma (DTC) treated with postsurgical radiation. The objective of this study was to examine survival in patients with stage IV papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC) who received radioactive iodine (RAI), external beam radiation therapy (EBRT), or neither following surgery. Methods: In this retrospective cohort study, data collected from the National Cancer Data Base (NCDB) yielded 11,832 patients with stage IV DTC who underwent primary surgical treatment between 2002 and 2012. Patients were stratified by histology and sub-stage. Fully parametric, multilevel survival-time models were used to evaluate survival outcomes in three adjuvant treatment groups: RAI, EBRT, or no adjuvant radiation. Hazard ratios (HR) and time ratios (TR) were calculated against patients who did not receive radiation. All models were adjusted for demographic and clinical factors. Results: The mean age of all patients was 61.6 years (SD = 11.6), and 57.5% were female. Patients who received EBRT had significantly higher 5- and 10-year hazards of death in several PTC sub-stages (10-year HRPTC Stage IV-A = 2.12 [confidence interval (CI) 1.79-2.52]; HRPTC Stage IV-B = 2.03 [CI 1.33-3.10]). For stage IV-B PTC requiring EBRT, lifespan after diagnosis was shortened by a factor of 3 when compared to patients who did not receive radiation (TRPTC Stage IV-B = 0.32 [CI 0.16-0.62]). In contrast, RAI was significantly associated with improved 5- and 10-year survival in both PTC and FTC patients regardless of pathological sub-stage. Large reductions in mortality were observed in patients with FTC who were treated with RAI (HRFTC Stage IV-C = 0.19 [CI 0.06-0.65]). When patients with stage IV-C FTC were treated with RAI, life-span after diagnosis doubled (TRFTC Stage IV-C = 1.98 [CI 1.31-3.00]). Conclusions: Through the NCDB, this study sought to describe prognosis and survival for adjuvant radiation in stage IV DTC. RAI was associated with improved survival for stage IV DTC. Despite treatment benefits conferred by adjuvant EBRT, indications to treat with EBRT were associated with poorer survival outcomes in patients with advanced-stage DTC, particularly PTC. © Copyright 2017, Mary Ann Liebert, Inc. 2017.

Greenberg P.L.,Stanford University | Garcia-Manero G.,University of Texas M. D. Anderson Cancer Center | Moore M.,Willis Knighton Cancer Center | Damon L.,University of California at San Francisco | And 4 more authors.
Leukemia and Lymphoma | Year: 2013

Patients with myelodysplastic syndrome (MDS) receiving hypomethylating agents commonly develop thrombocytopenia. This double-blind study evaluated the efficacy and safety of romiplostim, a peptibody protein that increases platelets, in patients with MDS receiving decitabine. Patients received romiplostim 750 μg (n = 15) or placebo (n = 14) and decitabine. Median platelet counts at the beginning of each decitabine cycle trended lower in placebo-treated than in romiplostim-treated patients. Bleeding events occurred in 43% of placebo-treated and 27% of romiplostim-treated patients, and platelet transfusions were administered to 57% of placebo-treated and 47% of romiplostim-treated patients. Overall clinical therapeutic response was achieved by 21% of placebo-treated and 33% of romiplostim-treated patients. Treatment was generally well tolerated. Progression to acute myeloid leukemia (AML) occurred in one patient per group. Adding romiplostim to decitabine treatment is well tolerated and may be beneficial, as indicated by trends toward higher platelet counts at the beginning of each treatment cycle and lower platelet transfusion rates and percentages of patients with bleeding events. © 2012 Informa UK, Ltd.

PubMed | University of Kentucky, PharPoint Research, Veterans Affairs Long Beach Hospital, Dana-Farber Cancer Institute and 6 more.
Type: | Journal: Journal of biotechnology | Year: 2016

Dusquetide, a novel Innate Defense Regulator, modulates the innate immune system at a key convergence point in intracellular signaling pathways and has demonstrated activity in both reducing inflammation and increasing clearance of bacterial infection. Innate immunity has also been implicated in the pathogenesis of oral mucositis (OM), a universal toxicity of chemoradiation therapy (CRT). Testing the hypothesis that dusquetide can mitigate the development and duration of OM, preclinical studies have been completed and correlated with interim results from a Phase 2 clinical study in patients undergoing CRT for head and neck cancer. Dusquetide reduced the duration of OM in mouse and hamster models by approximately 50%, which was recapitulated by the 50% reduction of severe OM (SOM) in the Phase 2 trial. A reduction in the clinical rate of infection was also observed, consistent with previously reported preclinical studies. In aggregate, these results not only demonstrate the safety and efficacy of dusquetide in addressing this unmet medical need, but also provide proof of concept for the translation of dusquetide action between animal models and the human clinical setting, and further support the contention that innate immunity is an important driver for the initiation and continued impact of OM.

Freund D.,Mary Bird Perkins Cancer Center | Freund D.,Louisiana State University | Freund D.,Willis Knighton Cancer Center | Zhang R.,Mary Bird Perkins Cancer Center | And 4 more authors.
Cancers | Year: 2015

Cancer of the brain and central nervous system (CNS) is the second most common of all pediatric cancers. Treatment of many of these cancers includes radiation therapy of which radiation induced cerebral necrosis (RICN) can be a severe and potentially devastating side effect. Risk factors for RICN include brain volume irradiated, the dose given per fraction and total dose. Thirteen pediatric patients were selected for this study to determine the difference in predicted risk of RICN when treating with volumetric modulated arc therapy (VMAT) compared to passively scattered proton therapy (PSPT) and intensity modulated proton therapy (IMPT). Plans were compared on the basis of dosimetric endpoints in the planned treatment volume (PTV) and brain and a radiobiological endpoint of RICN calculated using the Lyman-Kutcher-Burman probit model. Uncertainty tests were performed to determine if the predicted risk of necrosis was sensitive to positional errors, proton range errors and selection of risk models. Both PSPT and IMPT plans resulted in a significant increase in the maximum dose to the brain, a significant reduction in the total brain volume irradiated to low doses, and a significant lower predicted risk of necrosis compared with the VMAT plans. The findings of this study were upheld by the uncertainty analysis. © 2015 by the authors; licensee MDPI, Basel, Switzerland.

PubMed | Beaumont Health System, Willis Knighton Cancer Center and University of California at Los Angeles
Type: Journal Article | Journal: Radiation oncology (London, England) | Year: 2017

Intensity-modulated proton therapy (IMPT), non-coplanar 4 intensity-modulated radiation therapy (IMRT), and volumetric-modulated arc therapy (VMAT) represent the most advanced treatment methods based on heavy ion and X-rays, respectively. Here we compare their performance for prostate cancer treatment.Ten prostate patients were planned using IMPT with robustness optimization, VMAT, and 4 to an initial dose of 54Gy to a clinical target volume (CTV) that encompassed the prostate and seminal vesicles, then a boost prescription dose of 25.2Gy to the prostate for a total dose of 79.2Gy. The IMPT plans utilized two coplanar, oblique scanning beams 10 posterior of the lateral beam positions. Range uncertainties were taken into consideration in the IMPT plans. VMAT plans used two full, coplanar arcs to ensure sufficient PTV coverage. 4 plans were created by inversely selecting and optimizing 30 beams from 1162 candidate non-coplanar beams using a greedy column generation algorithm. CTV doses, bladder and rectum dose volumes (V40, V45, V60, V65, V70, V75, and V80), R100, R50, R10, and CTV homogeneity index (D95/D5) were evaluated.Compared to IMPT, 4 resulted in lower anterior rectal wall mean dose as well as lower rectum V40, V45, V60, V65, V70, and V75. Due to the opposing beam arrangement, IMPT resulted in significantly (p<0.05) greater femoral head doses. However, IMPT plans had significantly lower bladder, rectum, and anterior rectal wall max dose. IMPT doses were also significantly more homogeneous than 4 and VMAT doses.Compared to the VMAT and 4 plans, IMPT treatment plans are superior in CTV homogeneity and maximum point organ-at-risk (OAR) doses with the exception of femur heads. IMPT is inferior in rectum and bladder volumes receiving intermediate to high doses, particularly to the 4 plans, but significantly reduced low dose spillage and integral dose, which are correlated to secondary cancer for patients with expected long survival. The dosimetric benefits of 4 plans over VMAT are consistent with the previous publication.

Rosen L.R.,Willis Knighton Cancer Center | Fischer-Valuck B.W.,Willis Knighton Cancer Center | Katz S.R.,Willis Knighton Cancer Center | Durci M.,Willis Knighton Cancer Center | And 3 more authors.
Tumori | Year: 2014

Aims and background. Our aim is to report on the clinical methods and outcomes of helical intensity-modulated stereotactic body radiotherapy (SBRT) for the treatment of early-stage non-small cell lung cancer (NSCLC). Methods and study design. Seventy-nine patients with stage I NSCLC underwent helical SBRT with 48 Gy in 4 fractions or 60 Gy in 5 fractions. All patients underwent 18Ffluorodeoxyglucose (FDG) positron emission tomography (PET) or FDG-PET/computed tomography (CT) scanning in the immobilized treatment position for planned fusion with a separate kilovoltage (KV) CT simulation prior to treatment. Megavoltage CT images were obtained on the treatment unit prior to therapy and repeated at midfraction with comparison and fusion to the KV CT simulation planning images to assure setup accuracy. Serial follow-up with FDG-PET or FDG-PET/CT was performed at 3-4 months and every 6 months thereafter. Results. Median follow-up was 27 months (range, 4-82 months). Overall local control rate (LCR) was 93.6% (95% confidence interval [CI], 86.0-97.3%) and 3-year overall survival (OS) was 58.4% (95% CI, 47.2-69.5%). For patients with T1N0M0 disease (n = 59) the LCR was 94.9% (95% CI, 86.1-98.3%) and the 3-year OS was 62.8% (95% CI, 49.9-73.9%). Patients treated with 60 Gy had longer 3-year OS than patients treated with 48 Gy (65.2% vs 37.5%; P = 0.044). SBRT-related toxicity was modest, with 10 patients developing grade 1/2 chest wall toxicity based on the Common Terminology Criteria for Adverse Events (CTCAE). Conclusion. Image-guided SBRT with helical IMRT delivered in 4 or 5 fractions of 12 Gy with rigid immobilization, FDG-PET-assisted targeting, and repeat mid-fraction CT scan is an effective treatment for early NSCLC.

Rosen L.R.,Willis Knighton Cancer Center | Powell K.,Willis Knighton Cancer Center | Katz S.R.,Willis Knighton Cancer Center | Wu H.T.,Willis Knighton Cancer Center | Durci M.,Willis Knighton Cancer Center
American Journal of Clinical Dermatology | Year: 2010

We report the outcomes of three patients who were treated with external beam radiotherapy as an alternative to distal phalanx amputation for subungual squamous cell carcinomas between December 2004 and September 2006. The patients ages ranged from 46 to 83 years and the median follow-up time was 48 months (range: 3652 months). As of the current date, the three patients show no signs of recurrence following a course of external beam radiotherapy. Complete function of the treated digit was obtained in all three patients.Irradiation should be considered as an alternative modality choice in the treatment of subungual squamous cell carcinoma in lieu of distal phalanx amputation. © 2010 Adis Data Information.

Johnson P.B.,University of Miami | Padgett K.R.,University of Miami | Chen K.L.,Willis Knighton Cancer Center | Dogan N.,University of Miami
Journal of Applied Clinical Medical Physics | Year: 2016

"Reg Refine" is a tool available in the MIM Maestro v6.4.5 platform (www.mimsoftware.com) that allows the user to actively participate in the deformable image registration process. The purpose of this work was to evaluate the efficacy of this tool and investigate strategies for how to apply it effectively. This was done by performing DIR on two publicly available ground-truth models, the Pixel-based Breathing Thorax Model (POPI) for lung, and the Deformable Image Registration Evaluation Project (DIREP) for head and neck. Image noise matched in both magnitude and texture to clinical CBCT scans was also added to each model to simulate the use case of CBCT-CT alignment. For lung, the results showed Reg Refine effective at improving registration accuracy when controlled by an expert user within the context of large lung deformation. CBCT noise was also shown to have no effect on DIR performance while using the MIM algorithm for this site. For head and neck, the results showed CBCT noise to have a large effect on the accuracy of registration, specifically for low-contrast structures such as the brainstem and parotid glands. In these cases, the Reg Refine tool was able to improve the registration accuracy when controlled by an expert user. Several strategies for how to achieve these results have been outlined to assist other users and provide feedback for developers of similar tools. © Creative Commons Attribution 4.0 International License.

The multichannel cylindrical vaginal applicator is a variation of traditional single channel cylindrical vaginal applicator. The multichannel applicator has additional peripheral channels that provide more flexibility in the planning process. The dosimetric advantage is to reduce dose to adjacent organ at risk (OAR) such as bladder and rectum while maintaining target coverage with the dose optimization from additional channels.Vaginal HDR brachytherapy plans are all CT based. CT images were acquired in 2 mm thickness to keep integrity of cylinder contouring. The CTV of 5mm Rind with prescribed treatment length was reconstructed from 5mm expansion of inserted cylinder. The goal was 95% of CTV covered by 95% of prescribed dose in both single channel planning (SCP)and multichannel planning (MCP) before proceeding any further optimization for dose reduction to critical structures with emphasis on D2cc and V2Gy .This study demonstrated noticeable dose reduction to OAR was apparent in multichannel plans. The D2cc of the rectum and bladder were showing the reduced dose for multichannel versus single channel. The V2Gy of the rectum was 93.72% and 83.79% (p=0.007) for single channel and multichannel respectively (Figure 1 and Table 1). To assure adequate coverage to target while reducing the dose to the OAR without any compromise is the main goal in using multichannel vaginal applicator in HDR brachytherapy.Multichannel plans were optimized using anatomical based inverse optimization algorithm of inverse planning simulation annealing. The optimization solution of the algorithm was to improve the clinical target volume dose coverage while reducing the dose to critical organs such as bladder, rectum and bowels. The comparison between SCP and MCP demonstrated MCP is superior to SCP where the dwell positions were based on geometric array only. It concluded that MCP is preferable and is able to provide certain features superior to SCP.

PubMed | Willis Knighton Cancer Center
Type: Journal Article | Journal: Medical physics | Year: 2016

This study summarizes the results of an initial radiation survey of the Willis-Knighton Cancer Center in Shreveport, Louisiana. The facility houses an IBA ProteusOne compact single room proton therapy unit coupled with a C230 cyclotron that operates at a maximum energy of 230 MeV.A calibrated survey meter was used for the photon measurements to obtain reliable results. A neutron detector was used as the measuring instrument for neutrons. The locations of the survey and measurements were planned carefully in order to get a proper evaluation of the facility shielding configuration. The walls, ceiling, vault entrance, and the adjacent environment were each surveyed with suitable measurement instruments. A total of 22 locations were chosen for radiation survey. Dose equivalent values were calculated for both the photon and the neutron radiation using measured data.All measured dose values are presented in millisievert per year. The highest dose measured at the vault entrance is 0.34 mSv/year. A dedicated shielding door was not present at the time of the measurement. The vault entrance area is considered as a controlled area. The shielding design goals are not to exceed 5 mSv/year for the controlled area and 1 mSv/year the uncontrolled area. The total combined neutron and photon dose equivalent values were found to be compliant with the Louisiana Department of Environmental Quality radiation protection regulatory codes.In our efforts to evaluate the radiation levels at the Willis-Knighton Cancer Center proton treatment facility, we have found that all the measured values of the radiation shielding are below the critical radiation limits per year. Since the total dose measured at the vault entrance is below the shielding design goal, a shielding door is not required at this proton treatment vault.

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