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Article ; Online: Prognostic Understanding and Goals of Palliative Radiotherapy: A Qualitative Study.

Chen, Jie Jane / Roldan, Claudia S / Nichipor, Alexandra N / Balboni, Tracy A / Krishnan, Monica S / Revette, Anna C / Chen, Aileen B / Hertan, Lauren M

Journal of pain and symptom management

2022 Volume 64, Issue 6, Page(s) 567–576

Abstract: Context: There is a paucity of data describing patients' expectations of goals of palliative radiotherapy (RT) and overall prognosis.: Objectives: To explore patients' perceptions of and preferences for communication surrounding goals of palliative ... ...

Abstract	Context: There is a paucity of data describing patients' expectations of goals of palliative radiotherapy (RT) and overall prognosis. Objectives: To explore patients' perceptions of and preferences for communication surrounding goals of palliative RT and cancer prognosis. Methods: We conducted a qualitative study utilizing semi-structured interviews with seventeen patients with either bone or lung metastases receiving their first course of palliative RT at a comprehensive cancer center. All patient interviews were recorded, transcribed verbatim, and thematically analyzed. Results: Themes of goals of palliative RT centered on either restoration, such as through improving quality of life or minimizing pain, or on a desire to combat cancer by eliminating tumor. While most patients perceived that palliative RT would palliate symptoms but not cure their cancer, some patients believed that the goal of palliative RT was to cure. Themes that emerged surrounding patients' understanding of prognosis and what lies ahead included uncertainty and apprehension about the future, a focus on additional treatment, and confronting mortality. Most patients preferred to receive information about goals of treatment and prognosis from their doctors, including radiation oncologists, rather than other members of the medical team. Patients also expressed a desire for written patient education materials on palliative RT. Conclusion: Unclear perceptions of goals of treatment and prognosis may motivate some patients to pursue unnecessarily aggressive cancer treatments. Patients desire prognostic information from their doctors, including radiation oncologists, who are important contributors to goals of care discussions and may improve patient understanding and well-being by using restorative rather than combat-oriented language.
MeSH term(s)	Humans ; Prognosis ; Goals ; Quality of Life ; Palliative Care ; Qualitative Research ; Lung Neoplasms/therapy
Language	English
Publishing date	2022-08-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	639142-4
ISSN	1873-6513 ; 0885-3924
ISSN (online)	1873-6513
ISSN	0885-3924
DOI	10.1016/j.jpainsymman.2022.08.011
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Article ; Online: Lewy body disease as a potential negative outcome modifier of glioblastoma treatment: a case report.

Wong, Eric T / Rosenberg, Harry / Dawood, Olivia / Hertan, Lauren / Vega, Rafael A / Anderson, Matthew / Uhlmann, Erik J

BMC neurology

2023 Volume 23, Issue 1, Page(s) 257

Abstract: Background: Elderly patients with glioblastoma are particularly susceptible to the adverse effects of ionizing radiation to the brain. This population also has an increasing prevalence of dementia in the successive seventh, eighth and nineth decade of ... ...

Abstract	Background: Elderly patients with glioblastoma are particularly susceptible to the adverse effects of ionizing radiation to the brain. This population also has an increasing prevalence of dementia in the successive seventh, eighth and nineth decade of life, and dementia with Lewy bodies is characterized by pathologic α-synucleins, proteins that take part in neuronal DNA damage repair. Case presentation: We report a 77-year-old man, with a history of coronary artery disease and mild cognitive impairment, who experienced subacute behavioral changes over 3 months with wording-finding difficulty, memory loss, confusion, perseveration, and irritable mood. Neuroimaging studies disclosed a 2.5 × 2.4 × 2.7 cm cystic enhancing mass with central necrosis in the left temporal lobe of the brain. Gross total resection of the tumor revealed IDH-1 wild-type glioblastoma. After treatment with radiation and temozolomide chemotherapy, his cognitive status deteriorated rapidly, and he died from unexpected sudden death 2 months after radiation. Autopsy of his brain revealed (i) tumor cells with atypical nuclei and small lymphocytes, (ii) neuronal cytoplasmic inclusions and Lewy bodies that were positive for α-synuclein in the midbrain, pons, amygdala, putamen and globus pallidus, and (iii) no amyloid plaques and only rare neurofibrillary tangles near the hippocampi. Conclusions: This patient most likely had pre-clinical limbic subtype of dementia with Lewy bodies prior to his diagnosis of glioblastoma. The radiation and temozolomide that was used to treat his tumor may have accelerated neuronal damage due to induction of DNA breakage when his brain was already compromised by pathologic α-synucleins. α-Synucleinopathy could be a negative outcome modifier in glioblastoma patients.
MeSH term(s)	Male ; Humans ; Aged ; Lewy Body Disease/pathology ; Glioblastoma/pathology ; Temozolomide ; Lewy Bodies/metabolism ; Lewy Bodies/pathology ; Brain/pathology
Chemical Substances	Temozolomide (YF1K15M17Y)
Language	English
Publishing date	2023-07-04
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	2041347-6
ISSN	1471-2377 ; 1471-2377
ISSN (online)	1471-2377
ISSN	1471-2377
DOI	10.1186/s12883-023-03313-4
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Article: A Prospective Study Assessing the Efficacy and Toxicity of Stereotactic Body Radiation Therapy for Oligometastatic Bone Metastases.

Lee, Joyce H / Shi, Diana D / Shin, Kee-Young / Buckley, Elizabeth / Gunasti, Lauren / Hall, Emily / Mann, Eileen / Spicer, Beverly / Chen, Yu-Hui / Hammoudeh, Lubna / Brennan, Victoria / Huynh, Mai Anh / Spektor, Alexander / Krishnan, Monica S / Balboni, Tracy A / Hertan, Lauren M

Advances in radiation oncology

2023 Volume 9, Issue 4, Page(s) 101411

Abstract: Purpose: Stereotactic body radiation therapy (SBRT) is a promising treatment for oligometastatic disease in bone because of its delivery of high dose to target tissue and minimal dose to surrounding tissue. The purpose of this study is to assess the ... ...

Abstract	Purpose: Stereotactic body radiation therapy (SBRT) is a promising treatment for oligometastatic disease in bone because of its delivery of high dose to target tissue and minimal dose to surrounding tissue. The purpose of this study is to assess the efficacy and toxicity of this treatment in patients with previously unirradiated oligometastatic bony disease. Methods and materials: In this prospective phase II trial, patients with oligometastatic bone disease, defined as ≤3 active sites of disease, were treated with SBRT at Brigham and Women's Hospital/Dana Farber Cancer Center and Beth Israel Deaconess Medical Center between December 2016 and May 2019. SBRT dose and fractionation regimen were not protocol mandated. Local progression-free survival, progression-free survival, prostatic specific antigen progression, and overall survival were reported. Treatment-related toxicity was also reported. Results: A total of 98 patients and 126 lesions arising from various tumor histologies were included in this study. The median age of patients enrolled was 72.8 years (80.6% male, 19.4% female). Median follow-up was 26.7 months. The most common histology was prostate cancer (68.4%, 67/98). The most common dose prescriptions were 27/30 Gy in 3 fractions (27.0%, 34/126), 30 Gy in 5 fractions (16.7%, 21/126), or 30/35 Gy in 5 fractions (16.7%, 21/126). Multiple doses per treatment regimen reflect dose painting employing the lower dose to the clinical target volume and higher dose to the gross tumor volume. Four patients (4.1%, 4/98) experienced local progression at 1 site for each patient (3.2%, 4/126). Among the entire cohort, 2-year local progression-free survival (including death without local progression) was 84.8%, 2-year progression-free survival (including deaths as well as local, distant, and prostatic specific antigen progression) was 47.5%, and 2-year overall survival was 87.3%. Twenty-six patients (26.5%, 26/98) developed treatment-related toxicities. Conclusions: Our study supports existing literature in showing that SBRT is effective and tolerable in patients with oligometastatic bone disease. Larger phase III trials are necessary and reasonable to determine long-term efficacy and toxicities.
Language	English
Publishing date	2023-12-06
Publishing country	United States
Document type	Journal Article
ISSN	2452-1094
ISSN	2452-1094
DOI	10.1016/j.adro.2023.101411
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Article ; Online: Durable Response to PD-1 Blockade in a Patient With Metastatic Pancreatic Undifferentiated Carcinoma With Osteoclast-Like Giant Cells.

Besaw, Robert J / Terra, Adrienne R / Malvar, Grace L / Chapman, Tobias R / Hertan, Lauren M / Schlechter, Benjamin L

Journal of the National Comprehensive Cancer Network : JNCCN

2021 Volume 19, Issue 3, Page(s) 247–252

Abstract: Undifferentiated carcinoma with osteoclast-like giant cells (UCOGC) of the pancreas is a rare and potentially aggressive variant of pancreatic ductal adenocarcinoma. Data on this disease are sparse, and despite genetic similarities to pancreatic ductal ... ...

Abstract	Undifferentiated carcinoma with osteoclast-like giant cells (UCOGC) of the pancreas is a rare and potentially aggressive variant of pancreatic ductal adenocarcinoma. Data on this disease are sparse, and despite genetic similarities to pancreatic ductal adenocarcinoma, UCOGC clinical outcomes can be markedly different. We report on a female patient aged 62 years who presented with UCOGC with pulmonary metastases initially treated with 2 lines of cytotoxic chemotherapy. After rapid disease progression with both cytotoxic treatments, the patient's tissue was sent for next-generation sequencing, which revealed a high tumor mutation burden (32 mutations per megabase), as well as somatic mutations in BRAF, NF1, PIK3CA, CDKN2A, TERT, and TP53. Pancreatic cancers have previously demonstrated suboptimal responses to immunotherapeutic approaches. However, given the high tumor mutation burden and distinctiveness of the tumor class, the patient began third-line pembrolizumab monotherapy after palliative radiation to the rapidly progressing and painful abdominal mass from her primary tumor. She had a marked response in her primary UCOGC tumor and metastatic sites, and she remains on pembrolizumab monotherapy with ongoing response after 32 months of therapy. Recent evidence showing significant PD-L1 enrichment on neoplastic cells of undifferentiated carcinomas (including UCOGC) may indicate a role for immunotherapeutic approaches in these patients. Rare cancers such as UCOGC and other undifferentiated carcinomas may benefit from next-generation sequencing to inform treatment decisions when standards of care are absent, as in this report.
MeSH term(s)	Carcinoma, Pancreatic Ductal/drug therapy ; Carcinoma, Pancreatic Ductal/pathology ; Female ; Giant Cells ; Humans ; Middle Aged ; Neoplasm Metastasis ; Osteoclasts ; Pancreatic Neoplasms/drug therapy ; Pancreatic Neoplasms/pathology ; Programmed Cell Death 1 Receptor/antagonists & inhibitors
Chemical Substances	Programmed Cell Death 1 Receptor
Language	English
Publishing date	2021-03-02
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2250759-0
ISSN	1540-1413 ; 1540-1405
ISSN (online)	1540-1413
ISSN	1540-1405
DOI	10.6004/jnccn.2021.7001
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Article ; Online: Patient-Provider Communication, Decision-Making, and Psychosocial Burdens in Palliative Radiotherapy: A Qualitative Study on Patients' Perspectives.

Chen, Jie Jane / Roldan, Claudia S / Nichipor, Alexandra N / Balboni, Tracy A / Krishnan, Monica S / Revette, Anna C / Hertan, Lauren M / Chen, Aileen B

Journal of pain and symptom management

2021 Volume 62, Issue 3, Page(s) 512–522

Abstract: Context: Patient-provider communication impacts how patients with cancer make decisions about treatment.: Objectives: To examine patient perceptions of discussions, decision-making, and psychosocial burdens related to receiving palliative ... ...

Abstract	Context: Patient-provider communication impacts how patients with cancer make decisions about treatment. Objectives: To examine patient perceptions of discussions, decision-making, and psychosocial burdens related to receiving palliative radiotherapy (RT), in order to inform best practices for communication about palliative RT. Methods: We conducted an exploratory qualitative study using oral questionnaires and semi-structured interviews. Seventeen patients receiving their first course of palliative RT for lung or bone metastases at a comprehensive cancer center were interviewed. Patient interviews were transcribed verbatim and thematically analyzed using NVivo software. Results: Themes that impacted patients' decisions to initiate RT included a desire to minimize pain, optimism about what RT could provide for the future, perception of having "no other choice," disappointment about cancer progression, and unfamiliarity with RT. Most patients preferred shared decision-making regarding RT initiation and reported patient empowerment, effective communication, and team collaboration as contributing to shared decision-making. Most patients preferred their physicians to make decisions about RT treatment intensity and described trust in their physicians, institutional reputation, and RT expertise as motivators for this preference. Patients who possessed a proactive decisional mindset about initiating RT as opposed to having "no other choice" were less likely to report experiencing psychosocial burdens. Conclusion: Most patients prefer shared decision-making regarding RT initiation but prefer their radiation oncologists to make decisions regarding treatment intensity. Communication that empowers patients in their desired level of engagement for RT decision-making may help patients make informed decisions, contribute toward a proactive decisional mindset, and reduce their perception of psychosocial burdens.
MeSH term(s)	Communication ; Decision Making ; Humans ; Palliative Care ; Patient Participation ; Physician-Patient Relations ; Qualitative Research
Language	English
Publishing date	2021-02-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	639142-4
ISSN	1873-6513 ; 0885-3924
ISSN (online)	1873-6513
ISSN	0885-3924
DOI	10.1016/j.jpainsymman.2021.01.129
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Article ; Online: Palliative Radiation Oncology: Moving Beyond the Single Fraction.

Hertan, Lauren M / Jones, Joshua A / Balboni, Tracy A

International journal of radiation oncology, biology, physics

2016 Volume 94, Issue 1, Page(s) 48–50

MeSH term(s)	Bone Neoplasms/radiotherapy ; Bone Neoplasms/secondary ; Cancer Care Facilities/standards ; Dose Fractionation ; Female ; Humans ; Male ; Palliative Care/methods ; Palliative Care/standards ; Practice Guidelines as Topic ; Radiation Oncology/standards
Language	English
Publishing date	2016-01-01
Publishing country	United States
Document type	Comment ; Journal Article
ZDB-ID	197614-x
ISSN	1879-355X ; 0360-3016
ISSN (online)	1879-355X
ISSN	0360-3016
DOI	10.1016/j.ijrobp.2015.09.041
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Article ; Online: Longitudinal symptoms and temporal trends in palliative care, palliative radiotherapy, and anti-cancer treatment near end of life among patients with metastatic cancer.

Chen, Jie Jane / Shin, Kee-Young / Hong, Peter J / Hertan, Lauren M / Krishnan, Monica S / Roldan, Claudia S / Huynh, Mai Anh / Spektor, Alexander / Balboni, Tracy A

Annals of palliative medicine

2022 Volume 11, Issue 8, Page(s) 2646–2657

Abstract: Background: Early specialty palliative care (PC) integration improves oncologic outcomes. We aimed to examine longitudinal relationships between specialty PC and palliative radiotherapy (RT), temporal distribution of symptoms, and predictors of earlier ... ...

Abstract	Background: Early specialty palliative care (PC) integration improves oncologic outcomes. We aimed to examine longitudinal relationships between specialty PC and palliative radiotherapy (RT), temporal distribution of symptoms, and predictors of earlier specialty PC. Methods: We retrospectively reviewed 135 patients with metastatic cancer who received palliative RT at our institution (7/2017-2/2018) and who had died by final study follow-up (6/2021). Descriptive statistics summarized frequencies of clinical visits and symptoms over relative survival time (quartiles 1-3: first 75% of life remaining from metastatic diagnosis to death versus quartile 4: last 25% of life remaining from metastatic diagnosis to death). Logistic regression analyses revealed predictors of receiving earlier (quartiles 1-3) versus later (quartile 4) specialty PC. Results: There were 16.3%, 10.4%, 26.7%, and 46.7% of palliative RT consultations, compared to 4.7%, 7.6%, 14.0%, and 73.7% of specialty PC visits, that occurred in quartiles 1, 2, 3, and 4, respectively. On multivariable analysis, pain significantly predicted for receiving earlier specialty PC [odds ratios (OR) =15.34; 95% confidence interval (CI): 2.16-324.23; P=0.020], while patients with ≥2 prior chemotherapy regimens were less likely to have received earlier specialty PC (OR =0.16; 95% CI: 0.04-0.58; P=0.009). The most common reasons for first specialty PC visit were addressing pain (61.0%) and goals of care (19.5%). Overall, 73.3% (99/135) of patients were referred to hospice and 9.6% (13/135) received either palliative RT, chemotherapy, or surgery within 30 days of death. Conclusions: Nearly 47% of palliative RT visits compared with 74% of specialty PC visits occurred in the last quarter of life from metastatic diagnosis to death. Multidisciplinary efforts are needed to manage longitudinal symptoms and offer goal-concordant care.
MeSH term(s)	Death ; Hospice and Palliative Care Nursing ; Humans ; Neoplasms/radiotherapy ; Pain ; Palliative Care ; Retrospective Studies
Language	English
Publishing date	2022-07-06
Publishing country	China
Document type	Journal Article
ZDB-ID	2828544-X
ISSN	2224-5839 ; 2224-5839
ISSN (online)	2224-5839
ISSN	2224-5839
DOI	10.21037/apm-22-301
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Article: Parkinsonism reversed from treatment of pineal non-germinomatous germ cell tumor.

Cole, Sydni M / Sarangi, Sasmit / Einstein, David / McMasters, Malgorzata / Alterman, Ron / Bruce, Jeffrey / Hertan, Lauren / Shih, Helen A / Wong, Eric T

Surgical neurology international

2021 Volume 12, Page(s) 237

Abstract: Background: Parkinsonism is a rare complication of non-germinomatous germ cell tumors (NGGCTs) arising from the pineal region.: Case description: We describe a 23-year-old man who presented with Parinaud syndrome, fatigue, and hypersomnia that were ... ...

Abstract	Background: Parkinsonism is a rare complication of non-germinomatous germ cell tumors (NGGCTs) arising from the pineal region. Case description: We describe a 23-year-old man who presented with Parinaud syndrome, fatigue, and hypersomnia that were caused by a pineal region NGGCT with yolk sac component and an initial α-fetoprotein (AFP) of 1011.0 ng/ml. MRI revealed that the tumor was causing 10 mm of midline shift and compressing the cerebral aqueduct, the left thalamus, and the midbrain. Obstructive hydrocephalus was relieved by ventriculoperitoneal shunting. Six cycles of induction chemotherapy with ifosfamide, carboplatin, and etoposide reduced tumor size and decreased AFP levels in both serum and cerebrospinal fluid. Following the first cycle, the patient developed asymmetric, bilateral Parkinsonism consisting of bradykinesia, bradyphrenia, facial hypomimia, drooling, and dysphagia. Levodopa, amantadine, and methylphenidate were administered and resulted in symptom improvement. Second look neurosurgery revealed residual yolk sac tumor and a second induction regimen of gemcitabine, paclitaxel, and oxaliplatin was administered for rising AFP. The patient eventually received an autologous bone marrow transplant using a regimen of high-dose carboplatin, thiotepa, and etoposide with concomitant colony-stimulating factor and romiplostim support followed by consolidative proton craniospinal radiotherapy. Posttreatment head MRI showed that no evidence of tumor growth and serum AFP was within normal limits. His Parkinsonism eventually resolved and he was weaned off all dopaminergic drugs. Conclusion: Bilateral Parkinsonism from NGGCT in this patient is probably caused by pressure on nigrostriatal tracts, substantia nigra, or both. The Parkinsonian symptoms can be reversed by aggressive treatment of the tumor and administration of dopaminergic drugs.
Language	English
Publishing date	2021-05-25
Publishing country	United States
Document type	Case Reports
ISSN	2229-5097
ISSN	2229-5097
DOI	10.25259/SNI_595_2020
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Article: Characteristics and Predictors of Radiographic Local Failure in Patients With Spinal Metastases Treated With Palliative Conventional Radiation Therapy.

Chen, Jie Jane / Sullivan, Adam J / Shi, Diana D / Krishnan, Monica S / Hertan, Lauren M / Roldan, Claudia S / Huynh, Mai Anh / Spektor, Alexander / Fareed, M Mohsin / Lam, Tai Chung / Balboni, Tracy A

Advances in radiation oncology

2021 Volume 6, Issue 3, Page(s) 100665

Abstract: Purpose: Although local control is an important issue for longer-term survivors of spinal metastases treated with conventional external beam radiation therapy (EBRT), the literature on radiographic local failure (LF) in these patients is sparse. To ... ...

Abstract	Purpose: Although local control is an important issue for longer-term survivors of spinal metastases treated with conventional external beam radiation therapy (EBRT), the literature on radiographic local failure (LF) in these patients is sparse. To inform clinical decision-making, we evaluated rates, consequences, and predictors of radiographic LF in patients with spinal metastases managed with palliative conventional EBRT alone. Methods and materials: We retrospectively reviewed 296 patients with spinal metastases who received palliative EBRT at a single institution (2006-2013). Radiographic LF was defined as radiologic progression within the treatment field, with death considered a competing risk. Kaplan-Meier, cumulative incidence, and Cox regression analyses determined overall survival estimates, LF rates, and predictors of LF, respectively. Results: There were 182 patients with follow-up computed tomography or magnetic resonance imaging; median overall survival for these patients was 7.7 months. Patients received a median of 30 Gy in 10 fractions to a median of 4 vertebral bodies. Overall, 74 of 182 patients (40.7%) experienced LF. The 6-, 12-, and 18-month LF rates were 26.5%, 33.1%, and 36.5%, respectively, while corresponding rates of death were 24.3%, 38.1%, and 45.9%. Median time to LF was 3.8 months. Of those with LF, 51.4% had new compression fractures, 39.2% were admitted for pain control, and 35.1% received reirradiation; median time from radiation therapy (RT) to each of these events was 3.0, 5.7, and 9.2 months, respectively. Independent predictors of LF included single-fraction RT (8 Gy) (hazard ratio [HR], 2.592; 95% confidence interval [CI], 1.437-4.675; Conclusions: Patients experienced a >30% rate of radiographic LF by 1 year after EBRT. Single-fraction RT and lung or kidney histology predicted LF. Given the high rates of LF for patients with favorable prognosis, assessing the risk of death versus LF is important for clinical decision-making.
Language	English
Publishing date	2021-02-07
Publishing country	United States
Document type	Journal Article
ISSN	2452-1094
ISSN	2452-1094
DOI	10.1016/j.adro.2021.100665
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Article ; Online: Piling up the JNK: drug synergy through ER stress.

Hertan, Lauren M / Koumenis, Constantinos

Cancer biology & therapy

2009 Volume 8, Issue 9, Page(s) 820–822

MeSH term(s)	Antineoplastic Combined Chemotherapy Protocols/pharmacology ; Benzopyrans/administration & dosage ; Benzopyrans/pharmacology ; Boronic Acids/administration & dosage ; Boronic Acids/pharmacology ; Bortezomib ; Drug Synergism ; Endoplasmic Reticulum/drug effects ; Endoplasmic Reticulum/enzymology ; Enzyme Inhibitors/administration & dosage ; Enzyme Inhibitors/pharmacology ; Humans ; JNK Mitogen-Activated Protein Kinases/metabolism ; Lymphoma, Large B-Cell, Diffuse/drug therapy ; Lymphoma, Large B-Cell, Diffuse/genetics ; Lymphoma, Large B-Cell, Diffuse/metabolism ; Nitriles/administration & dosage ; Nitriles/pharmacology ; Protease Inhibitors/administration & dosage ; Protease Inhibitors/pharmacology ; Pyrazines/administration & dosage ; Pyrazines/pharmacology ; Signal Transduction
Chemical Substances	Benzopyrans ; Boronic Acids ; Enzyme Inhibitors ; Nitriles ; Protease Inhibitors ; Pyrazines ; ethyl 2-amino-6-bromo-4-(1-cyano-2-ethoxy-2-oxoethyl)-4H-chromene-3-carboxylate ; Bortezomib (69G8BD63PP) ; JNK Mitogen-Activated Protein Kinases (EC 2.7.11.24)
Language	English
Publishing date	2009-07-30
Publishing country	United States
Document type	Comment ; Journal Article
ZDB-ID	2146305-0
ISSN	1555-8576 ; 1538-4047
ISSN (online)	1555-8576
ISSN	1538-4047
DOI	10.4161/cbt.8.9.8403
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