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154. Long-term Patient-Reported Outcomes in Older Breast Cancer Survivors: A Population-Based Survey Study

Author

Swanick, Cameron W., primary, Lei, Xiudong, additional, Xu, Ying, additional, Shen, Yu, additional, Goodwin, Nathan A., additional, Smith, Grace L., additional, Giordano, Sharon H., additional, Hunt, Kelly K., additional, Jagsi, Reshma, additional, Shaitelman, Simona F., additional, Peterson, Susan K., additional, and Smith, Benjamin D., additional

Published
2018
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155. Ultra-low-dose radiotherapy for definitive management of ocular adnexal B-cell lymphoma

Author

Pinnix, Chelsea C., primary, Dabaja, Bouthaina S., additional, Milgrom, Sarah A., additional, Smith, Grace L., additional, Abou, Zeinab, additional, Nastoupil, Loretta, additional, Romaguera, Jorge, additional, Turturro, Francesco, additional, Fowler, Nathan, additional, Fayad, Luis, additional, Westin, Jason, additional, Neelapu, Sattva, additional, Fanale, Michelle A., additional, Rodriguez, Maria A., additional, Hagemeister, Frederick, additional, Ju Lee, Hun, additional, Oki, Yasuhiro, additional, Wang, Michael, additional, Samaniego, Felipe, additional, Chi, Linda, additional, and Esmaeli, Bita, additional

Published
2018
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156. Pre-treatment neutrophil/lymphocyte ratio and platelet/lymphocyte ratio are prognostic of progression in early stage classical Hodgkin lymphoma

Author

Reddy, Jay P., primary, Hernandez, Mike, additional, Gunther, Jillian R., additional, Dabaja, Bouthaina S., additional, Martin, Geoffrey V., additional, Jiang, Wen, additional, Akhtari, Mani, additional, Allen, Pamela K., additional, Atkinson, Bradley J., additional, Smith, Grace L., additional, Pinnix, Chelsea C., additional, Milgrom, Sarah A., additional, Abou Yehia, Zeinab, additional, Osborne, Eleanor M., additional, Oki, Yasuhiro, additional, Lee, Hun, additional, Hagemeister, Fredrick, additional, and Fanale, Michelle A., additional

Published
2017
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160. (S003) Curative-Intent Treatment for Newly Diagnosed Breast Cancer With Limited Metastatic Disease to the Sternum or Mediastinum

Author

Christopherson, Kaitlin M., primary, Lei, Xiudong, additional, Barcenas, Carlos H., additional, Buchholz, Thomas A., additional, Hoffman, Karen, additional, Kuerer, Henry M., additional, Shaitelman, Simona F., additional, Perkins, George H., additional, Smith, Grace L., additional, Stauder, Michael C., additional, Strom, Eric A., additional, Tereffe, Welela, additional, Woodward, Wendy A., additional, and Smith, Benjamin D., additional

Published
2017
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161. Radiation therapy improves survival in patients with testicular diffuse large B-cell lymphoma

Author

Ho, Jennifer C., primary, Dabaja, Bouthaina S., additional, Milgrom, Sarah A., additional, Smith, Grace L., additional, Reddy, Jay P., additional, Mazloom, Ali, additional, Young, Ken H., additional, Deng, Lijuan, additional, Medeiros, L. Jeffrey, additional, Dong, Wenli, additional, Allen, Pamela K., additional, Andraos, Therese Y., additional, Fowler, Nathan H., additional, Nastoupil, Loretta J., additional, Oki, Yasuhiro, additional, Fayad, Luis E., additional, Turturro, Francesco, additional, Neelapu, Sattva S., additional, Westin, Jason, additional, Hagemeister, Fredrick B., additional, Rodriguez, Maria Alma, additional, and Pinnix, Chelsea C., additional

Published
2017
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162. Characteristics, management, and outcomes of patients with follicular dendritic cell sarcoma

Author

Jain, Preetesh, primary, Milgrom, Sarah A., additional, Patel, Keyur P., additional, Nastoupil, Loretta, additional, Fayad, Luis, additional, Wang, Michael, additional, Pinnix, Chelsea C., additional, Dabaja, Bouthaina S., additional, Smith, Grace L., additional, Yu, Jun, additional, Hu, Shimin, additional, Bueso Ramos, Carlos E., additional, Kanagal-Shamanna, Rashmi, additional, Medeiros, L. Jeffrey, additional, Oki, Yasuhiro, additional, and Fowler, Nathan, additional

Published
2017
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163. Ultra-low-dose radiotherapy for definitive management of ocular adnexal B-cell lymphoma

Author

Pinnix, Chelsea C., primary, Dabaja, Bouthaina S., additional, Milgrom, Sarah A., additional, Smith, Grace L., additional, Abou, Zeinab, additional, Nastoupil, Loretta, additional, Romaguera, Jorge, additional, Turturro, Francesco, additional, Fowler, Nathan, additional, Fayad, Luis, additional, Westin, Jason, additional, Neelapu, Sattva, additional, Fanale, Michelle A., additional, Rodriguez, Maria A., additional, Hagemeister, Frederick, additional, Lee, Hun Ju, additional, Oki, Yasuhiro, additional, Wang, Michael, additional, Samaniego, Felipe, additional, Chi, Linda, additional, and Esmaeli, Bita, additional

Published
2017
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165. Chemotherapy Response Assessment by FDG-PET-CT in Early-stage Classical Hodgkin Lymphoma: Moving Beyond the Five-Point Deauville Score

Author

Milgrom, Sarah A., primary, Dong, Wenli, additional, Akhtari, Mani, additional, Smith, Grace L., additional, Pinnix, Chelsea C., additional, Mawlawi, Osama, additional, Rohren, Eric, additional, Garg, Naveen, additional, Chuang, Hubert, additional, Yehia, Zeinab Abou, additional, Reddy, Jay P., additional, Gunther, Jillian R., additional, Khoury, Joseph D., additional, Suki, Tina, additional, Osborne, Eleanor M., additional, Oki, Yasuhiro, additional, Fanale, Michelle, additional, and Dabaja, Bouthaina S., additional

Published
2017
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166. Letter to the editor regarding "disparities in telemedicine during COVID‐19".

Author

De, Brian, Maroongroge, Sean, and Smith, Grace L.

Subjects
COVID-19 pandemic, TELEMEDICINE, SAFETY-net health care providers, MEDICAID, MEDICAL telematics
Abstract

Keywords: access; digital divide; pandemic; policy; telemedicine EN access digital divide pandemic policy telemedicine 1556 1557 2 01/31/23 20230115 NES 230115 We read with interest the study by Qian et al.[1] who reported on use of outpatient oncology telemedicine at their institution after the start of the COVID-19 pandemic. Letter to the editor regarding "disparities in telemedicine during COVID-19" However, the authors also found that resource barriers did not explain all disparities identified in the study, given that Asian patients also had lower telemedicine use but still had high rates of smartphone ownership and home broadband access. [Extracted from the article]

Published
2023
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167. A multi-institutional analysis of peritransplantation radiotherapy in patients with relapsed/refractory Hodgkin lymphoma undergoing autologous stem cell transplantation

Author

Milgrom, Sarah A., primary, Jauhari, Shekeab, additional, Plastaras, John P., additional, Nieto, Yago, additional, Dabaja, Bouthaina S., additional, Pinnix, Chelsea C., additional, Smith, Grace L., additional, Allen, Pamela K., additional, Lukens, J. Nicholas, additional, Maity, Amit, additional, Oki, Yasuhiro, additional, Fanale, Michelle A., additional, and Nasta, Sunita D., additional

Published
2016
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170. Treatment of Early-Stage Unfavorable Hodgkin Lymphoma: Efficacy and Toxicity of 4 Versus 6 Cycles of ABVD Chemotherapy With Radiation

Author

Gunther, Jillian R., primary, Fanale, Michelle A., additional, Reddy, Jay P., additional, Akhtari, Mani, additional, Smith, Grace L., additional, Pinnix, Chelsea C., additional, Milgrom, Sarah A., additional, Yehia, Zeinab Abou, additional, Allen, Pamela K., additional, Osborne, Eleanor M., additional, Mawlawi, Osama, additional, and Dabaja, Bouthaina S., additional

Published
2016
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171. Maternal and Fetal Outcomes After Therapy for Hodgkin or Non-Hodgkin Lymphoma Diagnosed During Pregnancy

Author

Pinnix, Chelsea C., primary, Osborne, Eleanor M., additional, Chihara, Dai, additional, Lai, Peter, additional, Zhou, Shouhao, additional, Ramirez, Mildred M., additional, Oki, Yasuhiro, additional, Hagemeister, Frederick B., additional, Rodriguez, Alma M., additional, Samaniego, Felipe, additional, Fowler, Nathan, additional, Romaguera, Jorge E., additional, Turturro, Francesco, additional, Fayad, Luis, additional, Westin, Jason R., additional, Nastoupil, Loretta, additional, Neelapu, Sattva S., additional, Cheah, Chan Y., additional, Dabaja, Bouthaina S., additional, Milgrom, Sarah A., additional, Smith, Grace L., additional, Horace, Patricia, additional, Milbourne, Andrea, additional, Wogan, Christine F., additional, Ballas, Leslie, additional, and Fanale, Michelle A., additional

Published
2016
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177. Sex-Based Disparities Among Cancer Clinical Trial Participants.

Author

Ludmir, Ethan B, Fuller, C David, Moningi, Shalini, Mainwaring, Walker, Lin, Timothy A, Miller, Austin B, Jethanandani, Amit, Espinoza, Andres F, Verma, Vivek, Smith, Benjamin D, Smith, Grace L, VanderWalde, Noam A, Holliday, Emma B, Guadagnolo, B Ashleigh, Stinchcombe, Thomas E, Jagsi, Reshma, Gomez, Daniel R, Minsky, Bruce D, Rödel, Claus, and Fokas, Emmanouil

Subjects
CLINICAL trials, RANDOMIZED controlled trials, LUNG cancer, COLON cancer, WOMEN patients, EXPERIMENTAL design, PATIENT selection, SEX distribution, RESEARCH funding, TUMORS
Abstract

Landmark investigation two decades ago demonstrated sex-based disparities among participants in cancer cooperative group trials. Although federal efforts have aimed to improve representation of female patients in government-sponsored research, less is known about sex disparities in the broader landscape of modern oncologic randomized controlled trials. Using ClinicalTrials.gov, we identified randomized controlled trials related to colorectal or lung cancer (the two most common non-sex-specific disease sites). Among the 147 included trials, the proportion of female patients enrolled on trial was on average 6.8% (95% confidence interval = -8.8% to -4.9%) less than the proportion of female patients in the population by disease site (P < .001). Whereas no statistically significant underrepresentation of women was noted within the 26 cooperative group trials, sex disparities were markedly heightened for the 121 noncooperative-group-sponsored trials. Furthermore, underrepresentation of women did not improve with time. Future efforts should therefore focus on addressing these pervasive sex-based enrollment disparities beyond cooperative group trials alone. [ABSTRACT FROM AUTHOR]

Published
2020
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178. Pre‐treatment neutrophil/lymphocyte ratio and platelet/lymphocyte ratio are prognostic of progression in early stage classical Hodgkin lymphoma.

Author

Reddy, Jay P., Hernandez, Mike, Gunther, Jillian R., Dabaja, Bouthaina S., Martin, Geoffrey V., Jiang, Wen, Akhtari, Mani, Allen, Pamela K., Atkinson, Bradley J., Smith, Grace L., Pinnix, Chelsea C., Milgrom, Sarah A., Abou Yehia, Zeinab, Osborne, Eleanor M., Oki, Yasuhiro, Lee, Hun, Hagemeister, Fredrick, and Fanale, Michelle A.

Subjects
NEUTROPHILS, LYMPHOCYTES, BLOOD platelets, HODGKIN'S disease, DISEASE relapse
Abstract

Summary: To determine whether pre‐treatment neutrophil/lymphocyte (NLR) or platelet/lymphocyte ratios (PLR) are predictive for progression in early‐stage classical Hodgkin lymphoma (cHL), we derived NLR and PLR values for 338 stage I/II cHL patients and appropriate cut‐off point values to define progression. Two‐year freedom from progression (FFP) for patients with NLR ≥6·4 was 82·2% vs. 95·7% with NLR <6·4 (P < 0·001). Similarly, 2‐year FFP was 84·3% for patients with PLR ≥266·2 vs. 96·1% with PLR <266·2 (P = 0·003). On univariate analysis, both NLR and PLR were significantly associated with worse FFP (P = 0·001). On multivariate analysis, PLR remained a significant, independent prognostic factor (P < 0·001). [ABSTRACT FROM AUTHOR]

Published
2018
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179. Outcomes After Chemotherapy Followed by Radiation for Stage IIB Hodgkin Lymphoma With Bulky Disease

Author

Reddy, Jay P., primary, Akhtari, Mani, additional, Smith, Grace L., additional, Pinnix, Chelsea, additional, Osborne, Eleanor M., additional, Gunther, Jillian R., additional, Allen, Pamela K., additional, Yehia, Zeinab Abou, additional, Fanale, Michelle, additional, Rodriguez, M. Alma, additional, Fowler, Nathan, additional, Milgrom, Sarah A., additional, Wogan, Christine F., additional, and Dabaja, Bouthaina S., additional

Published
2015
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182. Primary cutaneous B-cell lymphoma (non-leg type) has excellent outcomes even after very low dose radiation as single-modality therapy

Author

Akhtari, Mani, primary, Reddy, Jay Paul, additional, Pinnix, Chelsea C., additional, Allen, Pamela K., additional, Osborne, Eleanor M., additional, Gunther, Jillian R., additional, Milgrom, Sarah A., additional, Smith, Grace L., additional, Wogan, Christine F., additional, Fowler, Nathan, additional, Rodriguez, Maria Alma, additional, and Dabaja, Bouthaina, additional

Published
2015
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183. Predictors of Radiation Pneumonitis in Patients Receiving Intensity Modulated Radiation Therapy for Hodgkin and Non-Hodgkin Lymphoma

Author

Pinnix, Chelsea C., primary, Smith, Grace L., additional, Milgrom, Sarah, additional, Osborne, Eleanor M., additional, Reddy, Jay P., additional, Akhtari, Mani, additional, Reed, Valerie, additional, Arzu, Isidora, additional, Allen, Pamela K., additional, Wogan, Christine F., additional, Fanale, Michele A., additional, Oki, Yasuhiro, additional, Turturro, Francesco, additional, Romaguera, Jorge, additional, Fayad, Luis, additional, Fowler, Nathan, additional, Westin, Jason, additional, Nastoupil, Loretta, additional, Hagemeister, Fredrick B., additional, Rodriguez, M. Alma, additional, Ahmed, Sairah, additional, Nieto, Yago, additional, and Dabaja, Bouthaina, additional

Published
2015
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184. Procedural outcomes of fluoroless catheter ablation outside the traditional catheterization lab.

Author

Bigelow, Amee M., Smith, Philip C., Timberlake, Dylan T., McNinch, Neil L., Smith, Grace L., Lane, John R., and Clark, John M.

Subjects
ACTION potentials, CARDIAC catheterization, CATHETER ablation, COMPARATIVE studies, FLUOROSCOPY, HEART beat, HEART function tests, LONGITUDINAL method, RESEARCH methodology, MEDICAL cooperation, OPERATING rooms, INTERVENTIONAL radiology, RESEARCH, TIME, TRANSESOPHAGEAL echocardiography, EVALUATION research, TREATMENT effectiveness, PREDICTIVE tests, RETROSPECTIVE studies, SUPRAVENTRICULAR tachycardia, DIAGNOSIS
Abstract

Aims: Non-fluoroscopic catheter ablation is becoming routine. In experienced centres, fluoroscopy is rarely required. The use of a traditional catheterization lab (cath lab) may no longer be necessary. We began performing catheter ablations at a paediatric centre outside the traditional cardiac cath lab in 2013. The purpose of this study was to compare procedural features of paediatric catheter ablation performed outside the cath lab to those performed within a cath lab.Methods and Results: We prospectively looked at patients presenting to the paediatric centre with supraventricular tachycardia (SVT) undergoing catheter ablation outside the cath lab in a standard operating room (OR group). We compared retrospectively to a control group matched for age, type, and location of arrhythmia who had ablations in a traditional cath lab (CL group). Catheter visualization was exclusively by electro-anatomic mapping. Fifty-nine patients with SVT underwent catheter ablation in the OR from October 2013 to December 2015. Thirty-three patients had accessory pathways, 29 were manifest, and 13 of those were left sided. Twenty-six had atrioventricular nodal re-entrant tachycardia. Transseptal puncture with transoesophageal echocardiography guidance was used for 10 left-sided pathways, whereas the other 3 had patent foramen ovales. Procedure time did not differ significantly between groups (OR group mean 131 min, range 57-408; CL group mean 152 min, range 68-376; P = 0.12). Acute success was similar in both groups [OR group: 58/59 (98.3%) and CL group: 57/59 (96.6%)]. There were no major complications in either group. There was no fluoroscopy used in either group.Conclusion: Although performing paediatric catheter ablations outside the traditional cath lab is early in our experience, we produced similar outcomes and results without encountering procedural difficulties of performing ablations in a non-conventional setting. Larger multi-centred trials will be essential to determine the feasibility of this practice. [ABSTRACT FROM AUTHOR]

Published
2017
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185. A multi-institutional analysis of peritransplantation radiotherapy in patients with relapsed/refractory Hodgkin lymphoma undergoing autologous stem cell transplantation.

Author

Milgrom, Sarah A., Jauhari, Shekeab, Plastaras, John P., Nieto, Yago, Dabaja, Bouthaina S., Pinnix, Chelsea C., Smith, Grace L., Allen, Pamela K., Lukens, J. Nicholas, Maity, Amit, Oki, Yasuhiro, Fanale, Michelle A., and Nasta, Sunita D.

Subjects
HODGKIN'S disease, LYMPHOMA treatment, RADIOTHERAPY, STEM cell transplantation, PHYSIOLOGICAL effects of chemotherapy, PATIENTS, HODGKIN'S disease treatment, ANTINEOPLASTIC agents, AUTOGRAFTS, COMBINED modality therapy, COMPARATIVE studies, DRUG resistance in cancer cells, HEMATOPOIETIC stem cell transplantation, RESEARCH methodology, MEDICAL cooperation, RESEARCH, POSITRON emission tomography, TUMOR classification, DISEASE relapse, EVALUATION research, TREATMENT effectiveness, DIAGNOSIS
Abstract

Background: No consensus exists regarding the use of radiotherapy (RT) in conjunction with high-dose chemotherapy and autologous stem cell transplantation (HDC/ASCT) for patients with relapsed/refractory classical Hodgkin lymphoma (HL). The objectives of the current study were to characterize practice patterns and assess the efficacy and toxicity of RT at 2 major transplantation centers.Methods: Eligible patients underwent HDC/ASCT from 2006 through 2015 using the combination of either carmustine (BCNU), etoposide, cytarabine, and melphalan (BEAM) or cyclophosphamide, BCNU, and etoposide (CBV).Results: For the cohort of 189 patients, the 4-year overall survival rate was 80%, the progression-free survival rate was 67%, and the local control (LC) rate was 68%. RT was used within 4 months of ASCT for 22 patients (12%) and was given more often for disease that was early stage, primary refractory, or [18 F]fluorodeoxyglucose (FDG)-avid at the time of HDC/ASCT. Disease recurrence occurring after HDC/ASCT was associated with primary refractory disease and FDG-avidity at the time of HDC/ASCT. RT was not found to be associated with LC, progression-free survival, or overall survival on univariate analysis. In a model incorporating primary refractory HL and FDG-avid disease at the time of HDC/ASCT, RT was found to be associated with a decreased risk of local disease recurrence (hazard ratio, 0.3; P = .02). In patients with primary refractory HL and/or FDG-avid disease at the time of HDC/ASCT, the 4-year LC rate was 81% with RT versus 49% without RT (P = .03). There was one case of Common Terminology Criteria for Adverse Events grade ≥ 3 RT-related toxicity (acute grade 3 pancytopenia).Conclusions: In patients undergoing ASCT for relapsed/refractory HL, peritransplantation RT was used more often for disease that was early stage, primary refractory, or FDG-avid after salvage conventional-dose chemotherapy. RT was associated with improved LC of high-risk localized disease and was well tolerated with modern techniques. Cancer 2017;123:1363-1371. © 2016 American Cancer Society. [ABSTRACT FROM AUTHOR]

Published
2017
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186. Promoting the Appropriate Use of Advanced Radiation Technologies in Oncology: Summary of a National Cancer Policy Forum Workshop.

Author

Smith, Grace L., Ganz, Patricia A., Bekelman, Justin E., Chmura, Steven J., Dignam, James J., Efstathiou, Jason A., Jagsi, Reshma, Johnstone, Peter A., Steinberg, Michael L., Williams, Stephen B., Yu, James B., Zietman, Anthony L., Weichselbaum, Ralph R., and Tina Shih, Ya-Chen

Subjects
*RADIOTHERAPY, *ONCOLOGY, *CANCER treatment, *STAKEHOLDERS, *ONCOLOGISTS, *RADIATION therapy equipment, *DECISION making, *DIFFUSION of innovations, *RESEARCH funding, *TUMORS, *COST analysis, *RESEARCH personnel, *EVALUATION of human services programs, *PROTON therapy, *RADIOLOGIC technology, *EQUIPMENT & supplies
Abstract

Purpose: Leaders in the oncology community are sounding a clarion call to promote "value" in cancer care decisions. Value in cancer care considers the clinical effectiveness, along with the costs, when selecting a treatment. To discuss possible solutions to the current obstacles to achieving value in the use of advanced technologies in oncology, the National Cancer Policy Forum of the National Academies of Sciences, Engineering, and Medicine held a workshop, "Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology" in July 2015. The present report summarizes the discussions related to radiation oncology.Methods and Materials: The workshop convened stakeholders, including oncologists, researchers, payers, policymakers, and patients. Speakers presented on key themes, including the rationale for a value discussion on advanced technology use in radiation oncology, the generation of scientific evidence for value of advanced radiation technologies, the effect of both scientific evidence and "marketplace" (or economic) factors on the adoption of technologies, and newer approaches to improving value in the practice of radiation oncology. The presentations were followed by a panel discussion with dialogue among the stakeholders.Results: Challenges to generating evidence for the value of advanced technologies include obtaining contemporary, prospective, randomized, and representative comparative effectiveness data. Proposed solutions include the use of prospective registry data; integrating radiation oncology treatment, outcomes, and quality benchmark data; and encouraging insurance coverage with evidence development. Challenges to improving value in practice include the slow adoption of higher value and the de-adoption of lower value treatments. The proposed solutions focused on engaging stakeholders in iterative, collaborative, and evidence-based efforts to define value and promote change in radiation oncology practice. Recent examples of ongoing or successful responses to the discussed challenges were provided.Conclusions: Discussions of "value" have increased as a priority in the radiation oncology community. Practitioners in the radiation oncology community can play a critical role in promoting a value-oriented framework to approach radiation oncology treatment. [ABSTRACT FROM AUTHOR]

Published
2017
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188. A prospective evaluation of pelvic radiation vs. no radiation among patients with young-onset rectal cancer: Impact on patient-reported outcomes.

Author

Corrigan, Kelsey L, Holliday, Emma, Guraieb-Trueba, Montserrat, Peacock, Oliver, Skibber, John Michael, Bednarski, Brian K., Messick, Craig, Tillman, Matthew Murray, Johnson, Benny, Smith, Grace L., Nguyen, Sa Thi, Kundu, Suprateek, Reinhardt, Alec, Chang, George J., Das, Prajnan, and You, Y. Nancy

Published
2023
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189. Molecular landscape and survival outcomes on early phase clinical trials in sporadic young onset colorectal cancer.

Author

Johnson, Benny, Willis, Jason, Williams, Christopher, Wang, Xuemei, Smith, Grace L., You, Y. Nancy, Dumbrava, Ecaterina Elena, Fu, Siqing, Karp, Daniel D., Naing, Aung, Piha-Paul, Sarina A., Rodon Ahnert, Jordi, Tsimberidou, Apostolia Maria, Yap, Timothy A., Overman, Michael J., Pant, Shubham, Hong, David S., Kopetz, Scott, Meric-Bernstam, Funda, and Subbiah, Vivek

Published
2023
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190. Quality of Breast Cancer Care in the U.S.: A National Analysis of Medicare Beneficiaries, 2003-2007

Author

Eberth, Jan Marie, primary, Xu, Ying, additional, Smith, Grace L., additional, Shen, Yu, additional, Jiang, Jing, additional, Buchholz, Thomas A., additional, Hunt, Kelly K., additional, Black, Dalliah M., additional, Giordano, Sharon H., additional, Whitman, Gary J., additional, Yang, Wei, additional, Shen, Chan, additional, Elting, Linda, additional, and Smith, Benjamin D., additional

Published
2014
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192. Surgeon Influence on Use of Needle Biopsy in Patients With Breast Cancer: A National Medicare Study

Author

Eberth, Jan M., primary, Xu, Ying, additional, Smith, Grace L., additional, Shen, Yu, additional, Jiang, Jing, additional, Buchholz, Thomas A., additional, Hunt, Kelly K., additional, Black, Dalliah M., additional, Giordano, Sharon H., additional, Whitman, Gary J., additional, Yang, Wei, additional, Shen, Chan, additional, Elting, Linda, additional, and Smith, Benjamin D., additional

Published
2014
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196. Positron emission tomography–computed tomography predictors of progression after DA-R-EPOCH for PMBCL

Author

Pinnix, Chelsea C., Ng, Andrea K., Dabaja, Bouthaina S., Milgrom, Sarah A., Gunther, Jillian R., Fuller, C. David, Smith, Grace L., Abou Yehia, Zeinab, Qiao, Wei, Wogan, Christine F., Akhtari, Mani, Mawlawi, Osama, Medeiros, L. Jeffrey, Chuang, Hubert H., Martin-Doyle, William, Armand, Philippe, LaCasce, Ann S., Oki, Yasuhiro, Fanale, Michelle, Westin, Jason, Neelapu, Sattva, and Nastoupil, Loretta

Abstract

Dose-adjusted rituximab plus etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (DA-R-EPOCH) has produced good outcomes in primary mediastinal B-cell lymphoma (PMBCL), but predictors of resistance to this treatment are unclear. We investigated whether [18F]fluorodeoxyglucose positron emission tomography–computed tomography (PET-CT) findings could identify patients with PMBCL who would not respond completely to DA-R-EPOCH. We performed a retrospective analysis of 65 patients with newly diagnosed stage I to IV PMBCL treated at 2 tertiary cancer centers who had PET-CT scans available before and after frontline therapy with DA-R-EPOCH. Pretreatment variables assessed included metabolic tumor volume (MTV) and total lesion glycolysis (TLG). Optimal cutoff points for progression-free survival (PFS) were determined by a machine learning approach. Univariate and multivariable models were constructed to assess associations between radiographic variables and PFS. At a median follow-up of 36.6 months (95% confidence interval, 28.1-45.1), 2-year PFS and overall survival rates for the 65 patients were 81.4% and 98.4%, respectively. Machine learning–derived thresholds for baseline MTV and TLG were associated with inferior PFS (elevated MTV: hazard ratio [HR], 11.5; P = .019; elevated TLG: HR, 8.99; P = .005); other pretreatment clinical factors, including International Prognostic Index and bulky (>10 cm) disease, were not. On multivariable analysis, only TLG retained statistical significance (P = .049). Univariate analysis of posttreatment variables revealed that residual CT tumor volume, maximum standardized uptake value, and Deauville score were associated with PFS; a Deauville score of 5 remained significant on multivariable analysis (P = .006). A model combining baseline TLG and end-of-therapy Deauville score identified patients at increased risk of progression.

Published
2018
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197. Reclassifying patients with early-stage Hodgkin lymphoma based on functional radiographic markers at presentation

Author

Akhtari, Mani, Milgrom, Sarah A., Pinnix, Chelsea C., Reddy, Jay P., Dong, Wenli, Smith, Grace L., Mawlawi, Osama, Abou Yehia, Zeinab, Gunther, Jillian, Osborne, Eleanor M., Andraos, Therese Y., Wogan, Christine F., Rohren, Eric, Garg, Naveen, Chuang, Hubert, Khoury, Joseph D., Oki, Yasuhiro, Fanale, Michelle, and Dabaja, Bouthaina S.

Abstract

The presence of bulky disease in Hodgkin lymphoma (HL), traditionally defined with a 1-dimensional measurement, can change a patient’s risk grouping and thus the treatment approach. We hypothesized that 3-dimensional measurements of disease burden obtained from baseline 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) scans, such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG), would more accurately risk-stratify patients. To test this hypothesis, we reviewed pretreatment PET-CT scans of patients with stage I-II HL treated at our institution between 2003 and 2013. Disease was delineated on prechemotherapy PET-CT scans by 2 methods: (1) manual contouring and (2) subthresholding of these contours to give the tumor volume with standardized uptake value ≥2.5. MTV and TLG were extracted from the threshold volumes (MTVt, TLGt) and from the manually contoured soft-tissue volumes. At a median follow-up of 4.96 years for the 267 patients evaluated, 27 patients were diagnosed with relapsed or refractory disease and 12 died. Both MTVt and TLGt were highly correlated with freedom from progression and were dichotomized with 80th percentile cutoff values of 268 and 1703, respectively. Consideration of MTV and TLG enabled restratification of early unfavorable HL patients as having low- and high-risk disease. We conclude that MTV and TLG provide a potential measure of tumor burden to aid in risk stratification of early unfavorable HL patients.

Published
2018
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198. Patterns of Care and Disparities in the Treatment of Early Breast Cancer

Author

M D ANDERSON CANCER CENTER HOUSTON TX, Smith, Grace L, M D ANDERSON CANCER CENTER HOUSTON TX, and Smith, Grace L

Abstract

Prior research evidence that has suggested that regional variation and socioeconomic barriers in breast cancer treatment remain substantial problems for patients across the nation. The purpose of our project was to characterize national patterns in the treatment of early invasive breast cancer in older women with incident disease. We specifically sought to characterize variation in cost of cancer care across the nation. Methods. We sought to apply a novel resource, comprehensive national Medicare claims data, to study cost variations in women treated for breast cancer. We first identified patients with invasive breast cancer treated with mastectomy or breast conserving surgery (BCS) and evaluated variations in breast cancer treatment utilization and resulting costs of treatment. Multivariate logistic and liniear regression was used to model these outcomes. Findings. Significant regional variation in utilization of breast cancer treatment existed in our cohort of older women diagnosed with invasive disease, even after standardization for patient and disease characteristics. In addition, significant disparities in costs or spending for breast cancer existed, with not only patient and clinical factors playing a significant role in costs, but also socioeconomic factors. Conclusions. Our research adds to the existing literature by providing the first comprehensive national sample to address these study questions. Our future research will extend on our current findings by determining whether these variations in breast cancer treatment also affect outcomes, such as cancer recurrence, mortality and costs of cancer care.

Published
2009

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