15 results on '"Chmura, Steven J."'
Search Results
2. Flipping the Null: Lessons From Breast Cancer and Recalibrating Expectations in Oligometastases.
- Author
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Katipally RR, Olson AC, and Chmura SJ
- Subjects
- Humans, Female, Motivation, Breast Neoplasms, Radiosurgery, Lung Neoplasms secondary
- Published
- 2022
- Full Text
- View/download PDF
3. Highly aneuploid non-small cell lung cancer shows enhanced responsiveness to concurrent radiation and immune checkpoint blockade.
- Author
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Spurr LF, Martinez CA, Kang W, Chen M, Zha Y, Hseu R, Gutiontov SI, Turchan WT, Lynch CM, Pointer KB, Chang P, Murgu S, Husain AN, Cody B, Vokes EE, Bestvina CM, Patel JD, Diehn M, Gajewski TF, Weichselbaum RR, Chmura SJ, and Pitroda SP
- Subjects
- Humans, Immune Checkpoint Inhibitors, Biomarkers, Combined Modality Therapy, Carcinoma, Non-Small-Cell Lung therapy, Carcinoma, Non-Small-Cell Lung drug therapy, Lung Neoplasms therapy, Lung Neoplasms drug therapy
- Abstract
Over 500 clinical trials are investigating combination radiotherapy and immune checkpoint blockade (ICB) as cancer treatments; however, the majority of trials have found no positive interaction. Here we perform a comprehensive molecular analysis of a randomized phase I clinical trial of patients with non-small cell lung cancer (NSCLC) treated with concurrent or sequential ablative radiotherapy and ICB. We show that concurrent treatment is superior to sequential treatment in augmenting local and distant tumor responses and in improving overall survival in a subset of patients with immunologically cold, highly aneuploid tumors, but not in those with less aneuploid tumors. In addition, radiotherapy alone decreases intratumoral cytotoxic T cell and adaptive immune signatures, whereas radiotherapy and ICB upregulates key immune pathways. Our findings challenge the prevailing paradigm that local ablative radiotherapy beneficially stimulates the immune response. We propose the use of tumor aneuploidy as a biomarker and therapeutic target in personalizing treatment approaches for patients with NSCLC treated with radiotherapy and ICB., (© 2022. The Author(s), under exclusive licence to Springer Nature America, Inc.)
- Published
- 2022
- Full Text
- View/download PDF
4. Predictors of Pneumonitis in Combined Thoracic Stereotactic Body Radiation Therapy and Immunotherapy.
- Author
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Korpics MC, Katipally RR, Partouche J, Cutright D, Pointer KB, Bestvina CM, Luke JJ, Pitroda SP, Dignam JJ, Chmura SJ, and Juloori A
- Subjects
- Humans, Immune Checkpoint Inhibitors, Immunotherapy adverse effects, Prospective Studies, Carcinoma, Non-Small-Cell Lung radiotherapy, Lung Neoplasms radiotherapy, Pneumonia etiology, Radiation Pneumonitis epidemiology, Radiation Pneumonitis etiology, Radiosurgery methods
- Abstract
Purpose: Thoracic stereotactic body radiation therapy (SBRT) is associated with high rates of local control but carries a risk of pneumonitis. Immunotherapy is a standard treatment for patients with metastatic disease but can also cause pneumonitis. To evaluate the feasibility and safety of thoracic SBRT with systemic immunotherapy, clinical outcomes of patients treated with immune checkpoint blockade (ICB) and SBRT on prospective trials were reviewed., Methods and Materials: Three consecutive phase 1 trials of combination SBRT and ICB conducted between 2016 to 2020 for widely metastatic solid tumors were reviewed. The protocols mandated adherence to NRG BR001/BR002 organs at risk constraints, resulting in <100% coverage of some target volumes. ICB was administered either sequentially (within 7 days after completion of SBRT) or concurrently (before or at the start of SBRT), depending on protocol. End points included pneumonitis, dose-volume constraints, local failure, and overall survival. The cumulative incidence estimator and Kaplan-Meier method were used., Results: In the study, 123 patients met eligibility with 311 metastases irradiated. The most common histologies included non-small cell lung cancer (33%) and colorectal cancer (12%). Median follow-up was 12 months. The overall rate of grade 3+ pneumonitis was 8.1%; 1-year local failure was 3.6%. Established dosimetric parameters were significantly associated with the development of pneumonitis (P < .05). In most patients, the lungs were not challenged with high doses of radiation, defined as receiving ≥75% of the maximum for a given lung dose-volume constraint. Patients who were challenged were not found to have a significantly higher risk of pneumonitis., Conclusions: In the largest series of thoracic SBRT and immunotherapy, local control was excellent with acceptable toxicity and support the conclusion that established dose-volume constraints for the lung are safe. However, these results highlight the potential value in reporting of organs at risk being challenged with doses approaching protocol specified limits., (Copyright © 2022 Elsevier Inc. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF
5. Evaluation of Dose Distribution to Organs-at-Risk in a Prospective Phase 1 Trial of Pembrolizumab and Multisite Stereotactic Body Radiation Therapy (SBRT).
- Author
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Xiao A, Luke JJ, Partouche J, Karrison T, Chmura SJ, and Al-Hallaq HA
- Subjects
- Antibodies, Monoclonal, Humanized, Humans, Organs at Risk, Prospective Studies, Radiotherapy Dosage, Radiotherapy Planning, Computer-Assisted, Lung Neoplasms surgery, Radiosurgery adverse effects
- Abstract
Purpose: Our purpose was to characterize the radiation doses to organs-at-risk (OAR) in the phase I trial (NCT02608385) that established safety/efficacy of stereotactic body radiation therapy (SBRT) using NRG-BR001 dose constraints combined with programmed cell death protein 1 blockade for metastatic disease., Methods and Materials: Between January 2016 and May 2018, 73 patients with advanced solid tumors were treated with SBRT followed by pembrolizumab. Tumor volumes (gross tumor volume/internal tumor volume) were delineated for each metastasis, with planning target volume contraction to limit OAR dose per protocol (n = 54) or when gross tumor volume/internal tumor volume > 65 cm
3 (n = 19). For 20 OAR, doses were compared with NRG-BR001 constraints. Protocol constraints were considered challenged when the minimum of the highest dose received by ≥6 patients without dose-limiting toxicities (DLTs) (Dmax 6th ) was ≥70% of the protocol constraint., Results: A total of 151 metastases were irradiated including 32 peripheral lung, 23 central lung, 13 mediastinal/cervical, 24 liver, 28 abdominal-pelvic, 16 osseous, and 15 spinal metastases. A median of 2 metastases (range, 2-4) with mean volumes of 33.5 cm3 (range, 0.4-391 cm3 ) were treated using average planning target volumes of 50.7 cm3 (range, 3.2-161 cm3 ). At least 1 dose constraint from NRG-BR001 was exceeded in 38 of 73 (52%) patients. OAR constraints were challenged in 10 serial organs (gastrointestinal, cardio-pulmonary, musculoskeletal, and nervous systems) and 1 parallel OAR (lung). Grade 3 DLTs occurred in 6 patients, including pneumonitis (n = 3), colitis (n = 2), and hepatic failure (n = 1). In 4 patients, the toxicity could be directly attributed to the planned dose to OAR (ie, pneumonitis due to high lung dose or colitis due to high bowel dose)., Conclusions: Multisite SBRT in combination with programmed cell death protein 1 blockade was safely tolerated when treating critical central, abdominal-pelvic, and peripheral OAR nearing NRG-BR001 constraints with clinically acceptable toxicity in the corresponding organ systems. The observed relationship between dose and DLTs in 4 of 6 patients indicates that NRG-BR001 dose constraints should be respected in subsequent trials to maintain clinical safety., (Copyright © 2021 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.)- Published
- 2022
- Full Text
- View/download PDF
6. A Phase 1 Trial of Concurrent or Sequential Ipilimumab, Nivolumab, and Stereotactic Body Radiotherapy in Patients With Stage IV NSCLC Study.
- Author
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Bestvina CM, Pointer KB, Karrison T, Al-Hallaq H, Hoffman PC, Jelinek MJ, Juloori A, Melotek JM, Murgu S, Partouche J, Vokes EE, Weichselbaum RR, Pitroda SP, Patel JD, and Chmura SJ
- Subjects
- Antineoplastic Combined Chemotherapy Protocols, Humans, Ipilimumab therapeutic use, Nivolumab therapeutic use, Carcinoma, Non-Small-Cell Lung drug therapy, Lung Neoplasms drug therapy, Radiosurgery
- Abstract
Introduction: Previous studies have evaluated stereotactic body radiotherapy (SBRT) in oligometastatic patients with NSCLC, including multimodality treatment with anti-programmed cell death protein-1 monotherapy. Questions remain regarding the timing of SBRT and immunotherapy, safety with dual checkpoint blockade, and the utility in widely metastatic patients. This randomized phase 1 trial combined nivolumab and ipilimumab with sequential or concurrent multisite SBRT in patients with stage IV NSCLC to evaluate safety and obtain preliminary activity data., Methods: Treatment-naive patients with metastatic NSCLC were randomized to concurrent (SBRT with immunotherapy) or sequential (SBRT followed by immunotherapy) treatment. A maximum of four treatment fields received SBRT. Nivolumab and ipilimumab were continued until clinical progression, development of toxicity, or after 2 years. Dose-limiting toxicity was defined as greater than or equal to grade 3 toxicity to the relevant organ system attributed to SBRT and immunotherapy occuring within 3 months., Results: A total of 37 patients were assessable. No dose-limiting toxicity occurred in the concurrent cohort (n = 18). The sequential cohort required a dose reduction in the central lung group owing to two grade 4 pneumonitis events (2 of 19). Overall best response was as follows: 5.4% (2 of 37) complete response, 40.5% (15 of 37) partial response, 16.2% (6 of 37) stable disease, and 37.8% (14 of 37) progressive disease. Median progression-free survival was 5.8 months (95% confidence interval: 3.6-11.4 mo), with median follow-up of 17.0 months. Median overall survival was not reached., Conclusions: Concurrent nivolumab, ipilimumab, and SBRT were not more toxic than sequential therapy, and multisite SBRT was well tolerated in widely metastatic patients. Multimodality therapy resulted in durable metastasis control and encouraging early overall survival., (Copyright © 2021 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF
7. CDKN2A loss-of-function predicts immunotherapy resistance in non-small cell lung cancer.
- Author
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Gutiontov SI, Turchan WT, Spurr LF, Rouhani SJ, Chervin CS, Steinhardt G, Lager AM, Wanjari P, Malik R, Connell PP, Chmura SJ, Juloori A, Hoffman PC, Ferguson MK, Donington JS, Patel JD, Vokes EE, Weichselbaum RR, Bestvina CM, Segal JP, and Pitroda SP
- Subjects
- Adult, Aged, Aged, 80 and over, Carcinoma, Non-Small-Cell Lung drug therapy, Carcinoma, Non-Small-Cell Lung genetics, Female, Follow-Up Studies, Humans, Lung Neoplasms drug therapy, Lung Neoplasms genetics, Male, Middle Aged, Prognosis, Retrospective Studies, Survival Rate, Biomarkers, Tumor genetics, Carcinoma, Non-Small-Cell Lung pathology, Cyclin-Dependent Kinase Inhibitor p16 genetics, Drug Resistance, Neoplasm genetics, Immunotherapy methods, Loss of Function Mutation, Lung Neoplasms pathology
- Abstract
Immune checkpoint blockade (ICB) improves outcomes in non-small cell lung cancer (NSCLC) though most patients progress. There are limited data regarding molecular predictors of progression. In particular, there is controversy regarding the role of CDKN2A loss-of-function (LOF) in ICB resistance. We analyzed 139 consecutive patients with advanced NSCLC who underwent NGS prior to ICB initiation to explore the association of CDKN2A LOF with clinical outcomes. 73% were PD-L1 positive (≥ 1%). 48% exhibited high TMB (≥ 10 mutations/megabase). CDKN2A LOF was present in 26% of patients and was associated with inferior PFS (multivariate hazard ratio [MVA-HR] 1.66, 95% CI 1.02-2.63, p = 0.041) and OS (MVA-HR 2.08, 95% CI 1.21-3.49, p = 0.0087) when compared to wild-type (WT) patients. These findings held in patients with high TMB (median OS, LOF vs. WT 10.5 vs. 22.3 months; p = 0.069) and PD-L1 ≥ 50% (median OS, LOF vs. WT 11.1 vs. 24.2 months; p = 0.020), as well as in an independent dataset. CDKN2A LOF vs. WT tumors were twice as likely to experience disease progression following ICB (46% vs. 21%; p = 0.021). CDKN2A LOF negatively impacts clinical outcomes in advanced NSCLC treated with ICB, even in high PD-L1 and high TMB tumors. This novel finding should be prospectively validated and presents a potential therapeutic target., (© 2021. The Author(s).)
- Published
- 2021
- Full Text
- View/download PDF
8. Radiation treatment planning study to investigate feasibility of delivering Immunotherapy in Combination with Ablative Radiosurgery to Ultra-High DoSes (ICARUS).
- Author
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Rokni MB, Pointer KB, George J, Luke JJ, Chmura SJ, and Redler G
- Subjects
- Feasibility Studies, Humans, Immunotherapy, Organs at Risk, Radiotherapy Dosage, Radiotherapy Planning, Computer-Assisted, Lung Neoplasms surgery, Radiosurgery, Radiotherapy, Intensity-Modulated
- Abstract
Purpose: Immune checkpoint inhibitors improve survival in metastatic diseases for some cancers. Multisite SBRT with pembrolizumab (SBRT + Pembro) was shown to be safe with promising local control using biologically effective doses (BEDs) = 95-120 Gy. Increased BED may improve response rate; however, SBRT doses are limited by surrounding organs at risk (OARs). The purpose of this work was to develop and validate methods for safe delivery of ultra-high doses of radiation (BED
10 > 300) to be used in future clinical trials., Methods and Materials: The radiation plans from 15 patients enrolled on a phase I trial of SBRT + pembro were reanalyzed. Metastatic disease sites included liver (8/15), inguinal region (1/15), pelvis (2/15), lung (1/15), abdomen (1/15), spleen (1/15), and groin (1/15). Gross tumor volumes (GTVs) ranged from 80 to 708 cc. Following the same methodology used in the Phase I trial on which these patients were treated, GTVs > 65 cc were contracted to a 65 cc subvolume (SubGTV) resulting in only a portion of the GTV receiving prescription dose. Volumetric modulated arc therapy (VMAT) was used to plan treatments BED10 = 360 Gy. Plans utilizing both 6FFF and 10FFF beams were compared to clinical plans delivering BED10 = 112.50 Gy. The target primary goal was V100% > 95% with a secondary goal of V70% > 99% and OAR objectives per the trial. To demonstrate feasibility, plans were delivered to a diode array phantom and evaluated for fidelity using gamma analysis., Results: All 30 plans met the secondary coverage goal and satisfied all OAR constraints. The primary goal was achieved in 12/15 of the 6FFF plans and 13/15 of the 10FFF plans. Average gamma analysis passing rate using criteria of 3% dose difference and 3, 2, and 1 mm were 99.1 ± 1.0%, 98.5 ± 1.6%, and 95.1 ± 3.8%, respectively., Conclusion: Novel VMAT planning approaches with clinical treatment planning software and linear accelerators prove capable of delivering radiation doses in excess of 360 Gy BED10 to tumor subvolumes, while maintaining safe OAR doses., (© 2021 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.)- Published
- 2021
- Full Text
- View/download PDF
9. Putting the "BR" in SBRT.
- Author
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Foster CC and Chmura SJ
- Subjects
- Animals, Mediastinum, Carcinoma, Non-Small-Cell Lung surgery, Lung Neoplasms surgery, Mammary Neoplasms, Animal, Radiosurgery
- Published
- 2018
- Full Text
- View/download PDF
10. Is immune checkpoint inhibition part of standard therapy for stage III non-small cell lung cancer?
- Author
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Patel JD and Chmura SJ
- Subjects
- Antibodies, Monoclonal adverse effects, Antineoplastic Agents, Immunological adverse effects, B7-H1 Antigen antagonists & inhibitors, B7-H1 Antigen immunology, Carcinoma, Non-Small-Cell Lung immunology, Carcinoma, Non-Small-Cell Lung mortality, Clinical Trials, Phase III as Topic, Humans, Lung Neoplasms immunology, Lung Neoplasms mortality, Pneumonia chemically induced, Pneumonia epidemiology, Pneumonia immunology, Programmed Cell Death 1 Receptor antagonists & inhibitors, Programmed Cell Death 1 Receptor immunology, Progression-Free Survival, Antibodies, Monoclonal administration & dosage, Antineoplastic Agents, Immunological administration & dosage, Carcinoma, Non-Small-Cell Lung therapy, Chemoradiotherapy methods, Lung Neoplasms therapy
- Published
- 2018
- Full Text
- View/download PDF
11. Oligometastasis-Directed Ablative Therapy: A Clinical Trial Question.
- Author
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Melotek JM and Chmura SJ
- Subjects
- Humans, Lung Neoplasms surgery, Radiosurgery
- Published
- 2017
- Full Text
- View/download PDF
12. The evolving role of radiotherapy in treatment of oligometastatic NSCLC.
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Bergsma DP, Salama JK, Singh DP, Chmura SJ, and Milano MT
- Subjects
- Carcinoma, Non-Small-Cell Lung pathology, Combined Modality Therapy, Humans, Lung Neoplasms pathology, Neoplasm Metastasis, Patient Selection, Prognosis, Survival Rate, Carcinoma, Non-Small-Cell Lung therapy, Lung Neoplasms therapy, Radiosurgery methods
- Abstract
Non-small cell lung cancer (NSCLC) patients with metastases limited in site and number, termed oligometastases, may represent a unique subpopulation of advanced NSCLC with improved prognosis. The optimal management of these patients remains unclear with the treatment approach currently undergoing a paradigm shift. The potential benefit of aggressive metastasis directed local treatment with surgery and/or radiotherapy (RT) in combination with systemic therapy is bolstered predominantly by retrospective analyses but also by a growing number of non-randomized prospective studies regarding the use of ablative RT techniques including stereotactic body radiotherapy (SBRT), alternatively termed stereotactic ablative radiotherapy (SABR), directed at the primary tumor (if present) and all metastatic sites. Long-term survival is possible in a subset of patients treated aggressively in this manner. The challenge for the clinical oncology community moving forward is appropriately selecting patients for this treatment approach based on clinical, imaging, and molecular features and increasing enrollment of patients to prospective clinical trials to more definitively determine the added benefit and appropriate timing of aggressive metastasis directed therapy in the oligometastatic setting.
- Published
- 2015
- Full Text
- View/download PDF
13. Stereotactic radiotherapy for pulmonary metastases.
- Author
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Chmura SJ, Salama JK, and Weichselbaum RR
- Subjects
- Dose Fractionation, Radiation, Humans, Lung Neoplasms mortality, Patient Selection, Risk Factors, Treatment Outcome, Lung Neoplasms secondary, Lung Neoplasms surgery, Radiosurgery adverse effects
- Abstract
The most common treatment of pulmonary metastasis for solid tumors employs systemic chemotherapy, hormonal therapy, or biologic agents. Some series have suggested that aggressive surgical resection of pulmonary metastasis may improve patient outcomes in terms of quality of life and overall survival. Recently, data from clinical trials and retrospective series support the use of aggressive local control with high conformal dose radiotherapy (stereotactic body radiation therapy) in patients with limited metastases or oligometastases. Further evidence suggests that these patients represent a distinct clinical and biological class of patients. This review focuses on the role of ablative doses of radiotherapy in the treatment of pulmonary metastases. Specifically we discuss the rationale, treatment delivery, and local control that have led to the ongoing randomized clinical trials attempting to demonstrate a benefit over the current palliative standard of care., (Copyright © 2014 Elsevier Inc. All rights reserved.)
- Published
- 2013
- Full Text
- View/download PDF
14. Hypofractionated image-guided radiation therapy for patients with limited volume metastatic non-small cell lung cancer.
- Author
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Hasselle MD, Haraf DJ, Rusthoven KE, Golden DW, Salgia R, Villaflor VM, Shah N, Hoffman PC, Chmura SJ, Connell PP, Vokes EE, Weichselbaum RR, and Salama JK
- Subjects
- Adenocarcinoma mortality, Adenocarcinoma secondary, Adult, Aged, Carcinoma, Large Cell mortality, Carcinoma, Large Cell secondary, Carcinoma, Non-Small-Cell Lung mortality, Carcinoma, Non-Small-Cell Lung secondary, Carcinoma, Squamous Cell mortality, Carcinoma, Squamous Cell secondary, Female, Follow-Up Studies, Humans, Image Processing, Computer-Assisted, Lung Neoplasms mortality, Lung Neoplasms pathology, Lymphatic Metastasis, Male, Middle Aged, Neoplasm Recurrence, Local mortality, Neoplasm Recurrence, Local pathology, Neoplasm Staging, Prognosis, Prospective Studies, Retrospective Studies, Survival Rate, Adenocarcinoma radiotherapy, Carcinoma, Large Cell radiotherapy, Carcinoma, Non-Small-Cell Lung radiotherapy, Carcinoma, Squamous Cell radiotherapy, Dose Fractionation, Radiation, Lung Neoplasms radiotherapy, Neoplasm Recurrence, Local radiotherapy, Radiotherapy, Image-Guided
- Abstract
Introduction: Outcomes data treating patients with oligometastatic (≤ 5 metastases) non-small cell lung carcinoma (NSCLC) with hypofractionated image-guided radiotherapy (HIGRT) are limited., Methods: Consecutive oligometastatic NSCLC patients were reviewed from a prospective database. Patients were included if all active diseases were treated with HIGRT. Lesions that had received prior radiation or had radiographic/metabolic resolution after chemotherapy were not treated with HIGRT. Local control of all treated lesions, distant control, progression-free survival (PFS), overall survival (OS), and control of individual lesions (LeC) were calculated., Results: Twenty-five patients with median of 2 treated oligometastatic lesions were included. Median follow-up was 14 months. Median age was 66 years. Nineteen patients received systemic therapy before HIGRT and 11 had progressive disease after their most recent systemic therapy before HIGRT. Median OS and PFS were 22.7 and 7.6 months. The 18 months local control, distant control, OS, and PFS were 66.1%, 31.7%, 52.9%, and 28.0%. Greater than two sites treated with HIGRT, nonadenocarcinoma histology, prior systemic therapy, and progression after systemic therapy were associated with worse PFS. Sixty-two individual lesions of median size 2.7 cm were treated. For extracranial lesions, median total and fraction dose were 50 and 5 Gy. Median standard equivalent dose in 2 Gy fractions for extracranial lesions was 64.6 Gy yielding 18 months LeC of 70.7%. Standard equivalent dose ≥64.6 Gy increased LeC (p = 0.04). Two patients experienced grade 3 toxicity., Conclusions: HIGRT for oligometastatic NSCLC provides durable LeC and may provide long-term PFS in some patients. Future HIGRT studies should optimize patient selection and integration with systemic therapy.
- Published
- 2012
- Full Text
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15. Oligo- and polymetastatic progression in lung metastasis(es) patients is associated with specific microRNAs.
- Author
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Lussier YA, Khodarev NN, Regan K, Corbin K, Li H, Ganai S, Khan SA, Gnerlich JL, Darga TE, Fan H, Karpenko O, Paty PB, Posner MC, Chmura SJ, Hellman S, Ferguson MK, and Weichselbaum RR
- Subjects
- Adenocarcinoma mortality, Disease Progression, Humans, Lung metabolism, Lung Neoplasms mortality, MicroRNAs metabolism, Survival Rate, Adenocarcinoma genetics, Adenocarcinoma secondary, Lung pathology, Lung Neoplasms genetics, Lung Neoplasms secondary, MicroRNAs genetics
- Abstract
Rationale: Strategies to stage and treat cancer rely on a presumption of either localized or widespread metastatic disease. An intermediate state of metastasis termed oligometastasis(es) characterized by limited progression has been proposed. Oligometastases are amenable to treatment by surgical resection or radiotherapy., Methods: We analyzed microRNA expression patterns from lung metastasis samples of patients with ≤ 5 initial metastases resected with curative intent., Results: Patients were stratified into subgroups based on their rate of metastatic progression. We prioritized microRNAs between patients with the highest and lowest rates of recurrence. We designated these as high rate of progression (HRP) and low rate of progression (LRP); the latter group included patients with no recurrences. The prioritized microRNAs distinguished HRP from LRP and were associated with rate of metastatic progression and survival in an independent validation dataset., Conclusion: Oligo- and poly- metastasis are distinct entities at the clinical and molecular level.
- Published
- 2012
- Full Text
- View/download PDF
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