12 results on '"Julian, Thomas B"'
Search Results
2. Long-term Peripheral Neuropathy in Breast Cancer Patients Treated With Adjuvant Chemotherapy: NRG Oncology/NSABP B-30
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Bandos, Hanna, primary, Melnikow, Joy, additional, Rivera, Donna R., additional, Swain, Sandra M., additional, Sturtz, Keren, additional, Fehrenbacher, Louis, additional, Wade, James L., additional, Brufsky, Adam M., additional, Julian, Thomas B., additional, Margolese, Richard G., additional, McCarron, Edward C., additional, and Ganz, Patricia A., additional
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- 2017
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3. Simulation Modeling of Cancer Clinical Trials: Application to Omitting Radiotherapy in Low-risk Breast Cancer.
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Jayasekera, Jinani, Li, Yisheng, Schechter, Clyde B, Jagsi, Reshma, Song, Juhee, White, Julia, Luta, George, Chapman, Judith-Anne W, Feuer, Eric J, Zellars, Richard C, Stout, Natasha, Julian, Thomas B, Whelan, Timothy, Huang, Xuelin, Hwang, E Shelley, Hopkins, Judith O, Sparano, Joseph A, Anderson, Stewart J, Fyles, Anthony W, and Gray, Robert
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CLINICAL trials ,BREAST cancer treatment ,RADIOTHERAPY ,HORMONE therapy ,EPIDERMAL growth factor receptors - Abstract
Background: We used two models to simulate a proposed noninferiority trial of radiotherapy (RT) omission in low-risk invasive breast cancer to illustrate how modeling could be used to predict the trial's outcomes, inform trial design, and contribute to practice debates.Methods: The proposed trial was a prospective randomized trial of no-RT vs RT in women age 40 to 74 years undergoing lumpectomy and endocrine therapy for hormone receptor-positive, human epidermal growth factor receptor 2-negative, stage I breast cancer with an Oncotype DX score of 18 or lower. The primary endpoint was recurrence-free interval (RFI), including locoregional recurrence, distant recurrence, and breast cancer death. Noninferiority required the two-sided 90% confidence interval of the RFI hazard ratio (HR) for no-RT vs RT to be entirely below 1.7. Model inputs included published data. The trial was simulated 1000 times, and results were summarized as percent concluding noninferiority and mean (standard deviation) of hazard ratios for Model GE and Model M, respectively.Results: Noninferiority was demonstrated in 18.0% and 3.7% for the two models. The respective means (SD) of the RFI hazard ratios were 1.8 (0.7) and 2.4 (0.9); most were locoregional recurrences. The mean five-year RFI rates for no-RT vs RT (SD) were 92.7% (2.9%) vs 95.5% (2.2%) and 88.4% (2.0%) vs 94.5% (1.6%). Both models showed little or no difference in breast cancer-specific or overall survival. Alternative definitions of low risk based on combinations of age and grade produced similar results.Conclusions: The proposed trial was unlikely to show noninferiority of omitting radiotherapy even using alternative definitions of low-risk, as the endpoint included local recurrence. Future trials regarding radiotherapy should address absolute reduction in recurrence and impact of type of recurrence on the patient. [ABSTRACT FROM AUTHOR]- Published
- 2018
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4. Effects of Radiotherapy in Early-Stage, Low-Recurrence Risk, Hormone-Sensitive Breast Cancer.
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Jayasekera, Jinani, Schechter, Clyde B, Sparano, Joseph A, Jagsi, Reshma, White, Julia, Chapman, Judith-Anne W, Whelan, Timothy, Anderson, Stewart J, Fyles, Anthony W, Sauerbrei, Willi, Zellars, Richard C, Li, Yisheng, Song, Juhee, Huang, Xuelin, Julian, Thomas B, Luta, George, Berry, Donald A, Feuer, Eric J, Mandelblatt, Jeanne, and Group, CISNET-BOLD Collaborative
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RADIOTHERAPY ,BREAST cancer treatment ,HORMONES ,GENE expression ,MEDICAL care - Abstract
Background: Radiotherapy after breast conservation has become the standard of care. Prior meta-analyses on effects of radiotherapy predated availability of gene expression profiling (GEP) to assess recurrence risk and/or did not include all relevant outcomes. This analysis used GEP information with pooled individual-level data to evaluate the impact of omitting radiotherapy on recurrence and mortality.Methods: We considered trials that evaluated or administered radiotherapy after lumpectomy in women with low-risk breast cancer. Women included had undergone lumpectomy and were treated with hormonal therapy for stage I, ER+ and/or PR+, HER2- breast cancer with Oncotype scores no greater than 18. Recurrence-free interval (RFI), type of RFI (locoregional or distant), and breast cancer-specific and overall survival were compared between no radiotherapy and radiotherapy using adjusted Cox models. All statistical tests were two-sided.Results: The final sample included 1778 women from seven trials. Omission of radiotherapy was associated with an overall adjusted hazard ratio of 2.59 (95% confidence interval [CI] = 1.38 to 4.89, P = .003) for RFI. There was a statistically significant increase in any first locoregional recurrence (P = .001), but not distant recurrence events (P = .90), or breast cancer-specific (P = .85) or overall survival (P = .61). Five-year RFI rate was high (93.5% for no radiotherapy vs 97.9% for radiotherapy; absolute reduction = 4.4%, 95% CI = 0.7% to 8.1%, P = .03). The effects of radiotherapy varied across subgroups, with lower RFI rates for those with Oncotype scores of less than 11 (vs 11-18), older (vs younger), and ER+/PR+ status (vs other).Conclusions: Omission of radiotherapy in hormone-sensitive patients with low recurrence risk may lead to a modest increase in locoregional recurrence event rates, but does not appear to increase the rate of distant recurrence or death. [ABSTRACT FROM AUTHOR]- Published
- 2018
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5. 21-Gene Recurrence Score and Locoregional Recurrence in Node-Positive/ER-Positive Breast Cancer Treated With Chemo-Endocrine Therapy.
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Mamounas, Eleftherios P., Qing Liu, Soonmyung Paik, Baehner, Frederick L., Gong Tang, Jong-Hyeon Jeong, Kim, S. Rim, Butler, Steven M., Jamshidian, Farid, Cherbavaz, Diana B., Sing, Amy P., Shak, Steven, Julian, Thomas B., Lembersky, Barry C., Wickerham, D. Lawrence, Costantino, Joseph P., Wolmark, Norman, Liu, Qing, Paik, Soonmyung, and Tang, Gong
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BREAST cancer chemotherapy ,CANCER relapse ,TAMOXIFEN ,ADJUVANT treatment of cancer ,CANCER radiotherapy ,BREAST tumor treatment ,PROTEIN analysis ,ANTHROPOMETRY ,ANTINEOPLASTIC agents ,BREAST tumors ,CELL receptors ,COMBINED modality therapy ,COMPARATIVE studies ,DOXORUBICIN ,LONGITUDINAL method ,RESEARCH methodology ,MEDICAL cooperation ,METASTASIS ,PACLITAXEL ,RADIOTHERAPY ,RESEARCH ,RESEARCH funding ,LUMPECTOMY ,EVALUATION research ,RANDOMIZED controlled trials ,PREDICTIVE tests ,RETROSPECTIVE studies ,CYCLOPHOSPHAMIDE - Abstract
Background: The 21-gene recurrence score (RS) predicts risk of locoregional recurrence (LRR) in node-negative, estrogen receptor (ER)-positive breast cancer. We evaluated the association between RS and LRR in node-positive, ER-positive patients treated with adjuvant chemotherapy plus tamoxifen in National Surgical Adjuvant Breast and Bowel Project B-28.Methods: B-28 compared doxorubicin/cyclophosphamide (AC X 4) with AC X 4 followed by paclitaxel X 4. Tamoxifen was given to patients age 50 years or older and those younger than age 50 years with ER-positive and/or progesterone receptor-positive tumors. Lumpectomy patients received breast radiotherapy. Mastectomy patients received no radiotherapy. The present study includes 1065 ER-positive, tamoxifen-treated patients with RS assessment. Cumulative incidence functions and subdistribution hazard regression models were used for LRR to account for competing risks including distant recurrence, second primary cancers, and death from other causes. Median follow-up was 11.2 years. All statistical tests were one-sided.Results: There were 80 LRRs (7.5%) as first events (68% local/32% regional). RS was low: 36.2%; intermediate: 34.2%; and high: 29.6%. RS was a statistically significant predictor of LRR in univariate analyses (10-year cumulative incidence of LRR = 3.3%, 7.2%, and 12.2% for low, intermediate, and high RS, respectively, P < .001). In multivariable regression analysis, RS remained an independent predictor of LRR (hazard ratio [HR] = 2.59, 95% confidence interval [CI] = 1.28 to 5.26, for a 50-point difference, P = .008) along with pathologic nodal status (HR = 1.91, 95% CI = 1.20 to 3.03, for four or more vs one to three positive nodes, P = .006) and tumor size (HR = 1.28, 95% CI = 1.05 to 1.55, for a 1 cm difference, P = .02).Conclusions: RS statistically significantly predicts risk of LRR in node-positive, ER-positive breast cancer patients after adjuvant chemotherapy plus tamoxifen. These findings can help in the selection of appropriate candidates for comprehensive radiotherapy. [ABSTRACT FROM AUTHOR]- Published
- 2017
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6. Long-Term Outcomes of Invasive Ipsilateral Breast Tumor Recurrences After Lumpectomy in NSABP B-17 and B-24 Randomized Clinical Trials for DCIS.
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Wapnir, Irene L., Dignam, James J., Fisher, Bernard, Mamounas, Eleftherios P., Anderson, Stewart J., Julian, Thomas B., Land, Stephanie R., Margolese, Richard G., Swain, Sandra M., Costantino, Joseph P., and Wolmark, Norman
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BREAST tumors ,LUMPECTOMY ,CLINICAL trials ,CANCER relapse ,DUCTAL carcinoma - Abstract
Background Ipsilateral breast tumor recurrence (IBTR) is the most common failure event after lumpectomy for ductal carcinoma in situ (DCIS). We evaluated invasive IBTR (I-IBTR) and its influence on survival among participants in two National Surgical Adjuvant Breast and Bowel Project (NSABP) randomized trials for DCIS. Methods In the NSABP B-17 trial (accrual period: October 1, 1985, to December 31, 1990), patients with localized DCIS were randomly assigned to the lumpectomy only (LO, n = 403) group or to the lumpectomy followed by radiotherapy (LRT, n = 410) group. In the NSABP B-24 double-blinded, placebo-controlled trial (accrual period: May 9, 1991, to April 13, 1994), all accrued patients were randomly assigned to LRT+ placebo, (n=900) or LRT + tamoxifen (LRT + TAM, n = 899). Endpoints included I-IBTR, DCIS-IBTR, contralateral breast cancers (CBC), overall and breast cancer–specific survival, and survival after I-IBTR. Median follow-up was 207 months for the B-17 trial (N = 813 patients) and 163 months for the B-24 trial (N = 1799 patients). Results Of 490 IBTR events, 263 (53.7%) were invasive. Radiation reduced I-IBTR by 52% in the LRT group compared with LO (B-17, hazard ratio [HR] of risk of I-IBTR = 0.48, 95% confidence interval [CI] = 0.33 to 0.69, P < .001). LRT + TAM reduced I-IBTR by 32% compared with LRT + placebo (B-24, HR of risk of I-IBTR = 0.68, 95% CI = 0.49 to 0.95, P = .025). The 15-year cumulative incidence of I-IBTR was 19.4% for LO, 8.9% for LRT (B-17), 10.0% for LRT + placebo (B-24), and 8.5% for LRT + TAM. The 15-year cumulative incidence of all contralateral breast cancers was 10.3% for LO, 10.2% for LRT (B-17), 10.8% for LRT + placebo (B-24), and 7.3% for LRT + TAM. I-IBTR was associated with increased mortality risk (HR of death = 1.75, 95% CI = 1.45 to 2.96, P < .001), whereas recurrence of DCIS was not. Twenty-two of 39 deaths after I-IBTR were attributed to breast cancer. Among all patients (with or without I-IBTR), the 15-year cumulative incidence of breast cancer death was 3.1% for LO, 4.7% for LRT (B-17), 2.7% for LRT + placebo (B-24), and 2.3% for LRT + TAM. Conclusions Although I-IBTR increased the risk for breast cancer–related death, radiation therapy and tamoxifen reduced I-IBTR, and long-term prognosis remained excellent after breast-conserving surgery for DCIS. [ABSTRACT FROM PUBLISHER]
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- 2011
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7. Surgeon Training, Protocol Compliance, and Technical Outcomes From Breast Cancer Sentinel Lymph Node Randomized Trial.
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Krag, David N., Ashikaga, Takamaru, Harlow, Seth P., Skelly, Joan M., Julian, Thomas B., Brown, Ann M., Weaver, Donald L., and Wolmark, Norman
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LYMPH node surgery ,SURGICAL excision ,SURGEONS ,MEDICAL protocols ,LEGAL compliance ,HEALTH outcome assessment - Abstract
Background: The National Surgical Adjuvant Breast and Bowel Project B-32 trial was designed to determine whether sentinel lymph node resection can achieve the same therapeutic outcomes as axillary lymph node resection but with fewer side effects and is one of the most carefully controlled and monitored randomized trials in the field of surgical oncology. We evaluated the relationship of surgeon trial preparation, protocol compliance audit, and technical outcomes. [ABSTRACT FROM PUBLISHER]
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- 2009
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8. Mammographic density and breast cancer after ductal carcinoma in situ.
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Habel, Laurel A., Dignam, James J., Land, Stephanie R., Salane, Martine, Capra, Angela M., and Julian, Thomas B.
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MAMMOGRAMS ,BREAST cancer ,CANCER treatment ,CANCER in women ,CANCER patients ,IMMUNOLOGICAL adjuvants ,PHOTOTHERAPY - Abstract
Women with ductal carcinoma in situ (DCIS) are at substantially increased risk for a second breast cancer, but few strong predictors for these subsequent tumors have been identified. We used Cox regression modeling to examine the association between mammographic density at diagnosis of DCIS of 504 women from the National Surgical Adjuvant Breast and Bowel Project B-17 trial and risk of subsequent breast cancer events. In this group of patients, mostly 50 years old or older, approximately 6.6% had breasts categorized as highly dense (i.e., > or =75% of the breast occupied by dense tissue). After adjusting for treatment with radiotherapy, age, and body mass index, women with highly dense breasts had 2.8 (95% confidence interval [CI] = 1.3 to 6.1) times the risk of subsequent breast cancer (DCIS or invasive), 3.2 (95% CI = 1.2 to 8.5) times the risk of invasive breast cancer, and 3.0 (95% CI = 1.2 to 7.5) times the risk of any ipsilateral breast cancer, compared with women with less than 25% of the breast occupied by dense tissue. Our results provide initial evidence that the risk of second breast cancers may be increased among DCIS patients with highly dense breasts. [ABSTRACT FROM AUTHOR]
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- 2004
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9. A Multigene Expression Assay to Predict Local Recurrence Risk for Ductal Carcinoma In Situ.
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Duggal, Shivani and Julian, Thomas B.
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DUCTAL carcinoma , *CLINICAL trials , *BIOLOGICAL assay research , *LUMPECTOMY , *BREAST cancer treatment , *BREAST cancer surgery , *MASTECTOMY , *CANCER risk factors - Abstract
The article discusses the effectiveness of a multigene expression assay in predicting the local recurrence risk for ductal carcinoma in situ (DCIS). Based on the results of four randomized clinical studies, breast-conserving surgery (BCS) emerged as the accepted alternative approach to mastectomy for the treatment of DCIS. Some studies identified the genetic similarities of DCIS with an ipsilateral breast event (IBE).
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- 2013
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10. Ductal Carcinoma In Situ: A Rose by Any Other Name.
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Wickerham, D. Lawrence and Julian, Thomas B.
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DUCTAL carcinoma , *ADENOCARCINOMA , *SURGICAL excision , *BREAST cancer research , *CANCER genetics - Abstract
The article discusses research being done on ductal carcinoma in situ (DCIS). It references the study "Treatment of Ductal Carcinoma in Situ After Exciation: Would a Prophylactic Paradigm Be More Appropriate?," by R. Punglia, S. Schnittand J. Weeks published in a 2013 issue of the "Journal of National Cancer Institute." It is recommended that further studies into the molecular biology and genetics of breast cancer should be undertaken given the controversy of classifying DCIS.
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- 2013
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11. Does Predicting Positive Nonsentinel Nodes Answer the Question of Axillary Dissection and Provide a Benefit?
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Slomski, Carol and Julian, Thomas B.
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SENTINEL lymph nodes , *LYMPH node surgery , *DISSECTION , *BREAST cancer , *CANCER invasiveness , *METASTASIS , *SURGERY - Abstract
The authors explore the questions about the role of axillary node dissection in the setting of a positive sentinel node biopsy in line with the paper "International Multicenter Tool to Predict the Risk of Nonsentinel Node Metastases in Breast Cancer," published in a previous issue of the "Journal of the National Cancer Institute." An overview of the outcomes of the primary endpoint analysis of the B-32 trial and the Oxford overview analysis.
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- 2012
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12. Practice patterns of sentinel node biopsy at five comprehensive cancer centers.
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Krag, David N. and Julian, Thomas B.
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PHYSICIAN practice patterns , *BREAST cancer - Abstract
Editorial. Comments on an article analyzing trends of modern practice patterns for the surgical management of breast cancer patients, published in the October 15, 2003 issue of the 'Journal of the National Cancer Institute.' Data indicating that sentinel node biopsy alone and omission of axillary node dissection was more frequently performed in patients with earlier stage breast cancer.
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- 2003
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