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Article ; Online: Small Changes, Big Impact: Excitement and Caution in Dose and Volume Reduction for Nasopharyngeal Carcinoma Radiation Therapy After Induction Chemotherapy.

Hahn, Ezra / Ng, Wai Tong

International journal of radiation oncology, biology, physics

2023 Volume 117, Issue 4, Page(s) 925–927

MeSH term(s)	Humans ; Nasopharyngeal Carcinoma/pathology ; Induction Chemotherapy ; Nasopharyngeal Neoplasms/drug therapy ; Nasopharyngeal Neoplasms/radiotherapy ; Carcinoma/pathology ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Cisplatin ; Neoplasm Staging ; Chemoradiotherapy/adverse effects
Chemical Substances	Cisplatin (Q20Q21Q62J)
Language	English
Publishing date	2023-07-28
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	197614-x
ISSN	1879-355X ; 0360-3016
ISSN (online)	1879-355X
ISSN	0360-3016
DOI	10.1016/j.ijrobp.2023.06.276
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Article ; Online: Leveraging the Potential of Induction Therapy in Human Papillomavirus-Mediated Oropharyngeal Carcinoma.

Hahn, Ezra / Huang, Shao Hui

International journal of radiation oncology, biology, physics

2023 Volume 118, Issue 1, Page(s) 179–181

MeSH term(s)	Humans ; Human Papillomavirus Viruses ; Induction Chemotherapy ; Oropharyngeal Neoplasms/radiotherapy ; Oropharyngeal Neoplasms/pathology ; Carcinoma, Squamous Cell/pathology ; Papillomavirus Infections/complications ; Papillomaviridae
Language	English
Publishing date	2023-11-11
Publishing country	United States
Document type	Editorial
ZDB-ID	197614-x
ISSN	1879-355X ; 0360-3016
ISSN (online)	1879-355X
ISSN	0360-3016
DOI	10.1016/j.ijrobp.2023.09.035
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Article ; Online: Hyperbaric Oxygen Therapy for Management of Late Radiation Toxicity-A Honey of a Trial?

Hahn, Ezra / Popovtzer, Aron / Corn, Benjamin W

JAMA oncology

2024 Volume 10, Issue 4, Page(s) 437–438

MeSH term(s)	Humans ; Hyperbaric Oxygenation ; Honey ; Radiation Injuries
Language	English
Publishing date	2024-02-06
Publishing country	United States
Document type	Journal Article
ISSN	2374-2445
ISSN (online)	2374-2445
DOI	10.1001/jamaoncol.2023.6698
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Article ; Online: Are we ready for deintensification in human papillomavirus-positive oropharyngeal carcinomas?

Huang, Shao Hui / Hahn, Ezra / Salunkhe, Rohan / Barcelona, Marc Vincent N / O'Sullivan, Brian

Current opinion in otolaryngology & head and neck surgery

2023 Volume 31, Issue 2, Page(s) 118–128

Abstract: Purpose of review: Excellent outcomes following contemporary treatment of human papillomavirus (HPV)-positive oropharyngeal carcinoma (HPV+ OPC) have prompted the exploration of deintensification approaches to minimize treatment-related toxicities. This ...

Abstract	Purpose of review: Excellent outcomes following contemporary treatment of human papillomavirus (HPV)-positive oropharyngeal carcinoma (HPV+ OPC) have prompted the exploration of deintensification approaches to minimize treatment-related toxicities. This review describes the landscape of deintensification to date (up to November 2022). Recent findings: Although several deintensification trials have been published, none are practice changing. Three phase III randomized-controlled trials studying cetuximab and radiation therapy vs. standard chemoradiotherapy all showed inferior outcomes. Although some phase II trials reported favourable outcomes, they are often single-arm trials without an adequate control arm, thereby limiting the ability to modify practice. Summary: Substantial effort has been expended to explore deintensification options for selected HPV+ OPC patients aiming to avoid unnecessary toxicity. Strategies have included replacing cisplatin with cetuximab, reduced chemotherapy or radiotherapy intensity, reduction of radiotherapy volumes and risk stratification after trans-oral surgery or following induction chemotherapy. Challenges remain in the current deintensification landscape, including identifying the most suitable candidates along with a choice of most appropriate deintensification strategies. Promising selection criteria included either static baseline features or kinetic characteristics of clinical-biological parameters. Practice-changing trials remain elusive, and the search continues to attempt optimization of the therapeutic ratio for these patients.
MeSH term(s)	Humans ; Human Papillomavirus Viruses ; Cetuximab ; Papillomavirus Infections ; Oropharyngeal Neoplasms/pathology ; Chemoradiotherapy ; Carcinoma
Chemical Substances	Cetuximab (PQX0D8J21J)
Language	English
Publishing date	2023-01-31
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	1232518-1
ISSN	1531-6998 ; 1068-9508
ISSN (online)	1531-6998
ISSN	1068-9508
DOI	10.1097/MOO.0000000000000871
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Zs.A 4814: Show issues

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Article ; Online: Can Molecular Biomarkers Help Reduce the Overtreatment of DCIS?

Hahn, Ezra / Rodin, Danielle / Sutradhar, Rinku / Nofech-Mozes, Sharon / Trebinjac, Sabina / Paszat, Lawrence Frank / Rakovitch, Eileen

Current oncology (Toronto, Ont.)

2023 Volume 30, Issue 6, Page(s) 5795–5806

Abstract: Ductal carcinoma in situ (DCIS), especially in the era of mammographic screening, is a commonly diagnosed breast tumor. Despite the low breast cancer mortality risk, management with breast conserving surgery (BCS) and radiotherapy (RT) is the prevailing ... ...

Abstract	Ductal carcinoma in situ (DCIS), especially in the era of mammographic screening, is a commonly diagnosed breast tumor. Despite the low breast cancer mortality risk, management with breast conserving surgery (BCS) and radiotherapy (RT) is the prevailing treatment approach in order to reduce the risk of local recurrence (LR), including invasive LR, which carries a subsequent risk of breast cancer mortality. However, reliable and accurate individual risk prediction remains elusive and RT continues to be standardly recommended for most women with DCIS. Three molecular biomarkers have been studied to better estimate LR risk after BCS-Oncotype DX DCIS score, DCISionRT Decision Score and its associated Residual Risk subtypes, and Oncotype 21-gene Recurrence Score. All these molecular biomarkers represent important efforts towards improving predicted risk of LR after BCS. To prove clinical utility, these biomarkers require careful predictive modeling with calibration and external validation, and evidence of benefit to patients; on this front, further research is needed. Most trials do not incorporate molecular biomarkers in evaluating de-escalation of therapy for DCIS; however, one-the Prospective Evaluation of Breast-Conserving Surgery Alone in Low-Risk DCIS (ELISA) trial-incorporates the Oncotype DX DCIS score in defining a low-risk population and is an important next step in this line of research.
MeSH term(s)	Female ; Humans ; Carcinoma, Intraductal, Noninfiltrating/diagnosis ; Carcinoma, Intraductal, Noninfiltrating/genetics ; Carcinoma, Intraductal, Noninfiltrating/therapy ; Breast Neoplasms/genetics ; Breast Neoplasms/therapy ; Breast Neoplasms/diagnosis ; Risk ; Biomarkers, Tumor/genetics ; Overtreatment
Chemical Substances	Biomarkers, Tumor
Language	English
Publishing date	2023-06-13
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	1236972-x
ISSN	1718-7729 ; 1198-0052
ISSN (online)	1718-7729
ISSN	1198-0052
DOI	10.3390/curroncol30060433
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Zs.A 4305: Show issues

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Article: Levamisole-induced Vasculitis in a Cocaine User.

Hahn, Ezra / Bogoch, Isaac I

The Journal of rheumatology

2015 Volume 42, Issue 10, Page(s) 1924–1925

MeSH term(s)	Cocaine-Related Disorders/complications ; Debridement/methods ; Dexamethasone/administration & dosage ; Drug Contamination ; Female ; Humans ; Infusions, Intravenous ; Levamisole/adverse effects ; Middle Aged ; Necrosis/pathology ; Necrosis/therapy ; Rare Diseases ; Risk Assessment ; Treatment Outcome ; Vasculitis, Leukocytoclastic, Cutaneous/chemically induced ; Vasculitis, Leukocytoclastic, Cutaneous/pathology ; Vasculitis, Leukocytoclastic, Cutaneous/therapy
Chemical Substances	Levamisole (2880D3468G) ; Dexamethasone (7S5I7G3JQL)
Language	English
Publishing date	2015-10
Publishing country	Canada
Document type	Case Reports ; Journal Article
ZDB-ID	194928-7
ISSN	1499-2752 ; 0315-162X
ISSN (online)	1499-2752
ISSN	0315-162X
DOI	10.3899/jrheum.150027
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Zs.A 1168: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Locoregional Ablative Radiation Therapy for Patients With Breast Cancer Unsuitable for Surgical Resection.

Moore-Palhares, Daniel / Chen, Hanbo / Khan, Benazir Mir / McCann, Claire / Bosnic, Sandi / Hahn, Ezra / Soliman, Hany / Czarnota, Gregory / Karam, Irene / Rakovitch, Eileen / Lee, Justin / Vesprini, Danny

Practical radiation oncology

2023

Abstract: Purpose: Patients with breast cancer who are unsuitable for surgical resection are typically managed with palliative systemic therapy alone. We report outcomes of 5-fraction ablative radiation therapy for nonresected breast cancers.: Methods and ... ...

Abstract	Purpose: Patients with breast cancer who are unsuitable for surgical resection are typically managed with palliative systemic therapy alone. We report outcomes of 5-fraction ablative radiation therapy for nonresected breast cancers. Methods and materials: This is a retrospective analysis of an institutional registry of patients with breast cancer who were unsuitable for resection and underwent 35 to 40 Gy/5 fractions to the primary breast tumor or regional lymph nodes from 2014 to 2021. Primary outcomes were cumulative incidence of local failure and grade ≥3 toxicity (Common Terminology Criteria for Adverse Events, version 5.0). Results: We reviewed 57 patients who received 61 treatment courses (median age of 81 years; range, 38-99). Unresectable tumor (10%), patient refusal (18%), medical inoperability (35%), and metastatic disease (37%) were the causes of not having surgery. Five patients (8%) had previously undergone adjuvant locoregional radiation therapy. Fifty-four percent (n = 33/61) of treatment courses targeted the breast only, 31% (n = 19/61) both the breast and lymph nodes, and 15% (n = 9/61) the lymph nodes only. Sixty-seven percent (n = 35/52) of the courses that targeted the breast were delivered with partial breast irradiation and 33% (n = 17/52) with whole breast radiation therapy (median dose of 25 Gy in 5 fractions) ± simultaneous integrated boost to the primary tumor. Most primary tumors (65%, n = 34/52) and target lymph nodes (61%, n = 17/28) were treated with a dose of 35 Gy in 5 fractions. Most treatments (52%) were delivered with intensity modulated radiation therapy (IMRT). Radiation therapy was delivered daily (20%), every other day (18%), twice weekly (36%), or weekly (26%). The 2-year cumulative incidence of local failure was 11.4% and grade≥3 toxicity was 15.1%. The grade ≥3 toxicity was 6.5% for IMRT treatments, versus 7.7% for non-IMRT treatments targeting partial breast or lymph nodes (hazard ratio, 1.13, P = .92), versus 38.9% for non-IMRT treatments targeting the entire breast (hazard ratio, 6.91, P = .023). All grade ≥3 toxicity cases were radiation dermatitis. No cases of brachial plexopathy were observed. Conclusions: Thirty-five to 40 Gy in 5 fractions is a safe and effective breast stereotactic body radiation therapy (SBRT) regimen and may be an attractive option for patients who are not surgical candidates. Highly conformal techniques (ie, IMRT or partial breast irradiation) were associated with a reduced risk of toxicity and should be the preferred treatment approaches.
Language	English
Publishing date	2023-12-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	2655748-4
ISSN	1879-8519 ; 1879-8500
ISSN (online)	1879-8519
ISSN	1879-8500
DOI	10.1016/j.prro.2023.12.003
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Article ; Online: The Association Between Surgical Axillary Staging, Adjuvant Treatment Use and Survival in Older Women with Early Stage Breast Cancer: A Population-Based Study.

Castelo, Matthew / Sutradhar, Rinku / Faught, Neil / Mata, Danilo Giffoni M M / Hahn, Ezra / Nguyen, Lena / Paszat, Lawrence / Rodin, Danielle / Trebinjac, Sabina / Fong, Cindy / Rakovitch, Eileen

Annals of surgical oncology

2023 Volume 30, Issue 7, Page(s) 3901–3912

Abstract: Background: Choosing Wisely guidelines recommend against surgical axillary staging (AS) in women ≥70 years with ER+/HER2- early stage breast cancer (BC). This study examined the impact of AS omission on survival in older patients with BC.: Methods: ... ...

Abstract	Background: Choosing Wisely guidelines recommend against surgical axillary staging (AS) in women ≥70 years with ER+/HER2- early stage breast cancer (BC). This study examined the impact of AS omission on survival in older patients with BC. Methods: This was a population-based cohort study using health administrative data in Ontario, Canada. We identified women aged 65-95 years who underwent surgery for Stage I/II BC between 2010 and 2016. Patients were weighted by propensity scores for receipt of AS that included patient and disease characteristics using overlap weights. Association with overall survival (OS) was calculated using weighted Cox models, and breast cancer-specific survival (BCSS) was calculated using weighted Fine and Gray models, adjusting for biomarkers and adjuvant treatments. Adjuvant treatment receipt was modelled with weighted log-binomial models. Results: Among 17,370 older women, the 1771 (10.2%) who did not undergo AS were older, more comorbid, and less likely to undergo mastectomy. Women who did not undergo AS were less likely to receive adjuvant chemotherapy (RR 0.68, 95% CI 0.57-0.82), endocrine therapy (RR 0.85, 95% CI 0.81-0.89) or radiotherapy (RR 0.69, 95% CI 0.65-0.74). After weighting and adjustment, there was no significant difference in BCSS (sdHR 0.98, 95% CI 0.77-1.25), but women who did not undergo AS had worse OS (HR 1.14, 95% CI 1.04-1.25). The results among 6215 ER+/HER2- women ≥70 years undergoing SLNB vs no AS were similar. Conclusions: The omission of AS in older women with early stage BC was not associated with adverse BCSS, although OS was worse.
MeSH term(s)	Female ; Humans ; Aged ; Breast Neoplasms/surgery ; Breast Neoplasms/drug therapy ; Mastectomy ; Cohort Studies ; Breast/pathology ; Adjuvants, Immunologic/therapeutic use ; Ontario/epidemiology ; Neoplasm Staging
Chemical Substances	Adjuvants, Immunologic
Language	English
Publishing date	2023-03-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-023-13274-0
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Article ; Online: Impact of non-adherence to endocrine therapy on recurrence risk in older women with stage I breast cancer after breast-conserving surgery.

Rodin, Danielle / Sutradhar, Rinku / Jerzak, Katarzyna J / Hahn, Ezra / Nguyen, Lena / Castelo, Matthew / Fatiregun, Omolara / Fong, Cindy / Mata, Danilo Giffoni M M / Trebinjac, Sabina / Paszat, Lawrence / Rakovitch, Eileen

Breast cancer research and treatment

2023 Volume 201, Issue 1, Page(s) 77–87

Abstract: Purpose: We examined the impact of non-adherence to adjuvant endocrine therapy (ET) on the risk and site of recurrence among older women with early stage, hormone receptor positive (HR+) breast cancer (EBC).: Methods: A population-based cohort of ... ...

Abstract	Purpose: We examined the impact of non-adherence to adjuvant endocrine therapy (ET) on the risk and site of recurrence among older women with early stage, hormone receptor positive (HR+) breast cancer (EBC). Methods: A population-based cohort of women age ≥ 65 years with T1N0 HR + EBC who were diagnosed between 2010 and 2016 and treated with breast-conserving surgery (BCS) + ET was identified. Treatment and outcomes were ascertained through linkage with administrative databases. ET non-adherence was examined as a time-dependent covariate in multivariable cause-specific Cox regression models to evaluate its effect on the risks of ipsilateral local recurrence (LR), contralateral breast cancer, and distant metastases. Results: The population cohort includes 2637 women; 73% (N = 1934) received radiation (RT) + ET and 27% (N = 703) received ET alone. At a median follow-up of 8.14 years, the first event was LR in 3.6% of women treated with ET alone and 1.4% for those treated with RT + ET (p < 0.001); the risk of distant metastases was < 1% in both groups. The proportion of time adherent to ET was 69.0% among those treated with RT + ET and 62.8% for those treated with ET alone. On multivariable analysis, increasing proportion of time non-adherent to ET was associated with increased risk of LR ((HR = 1.52 per 20% increase in time; 95%CI 1.25, 1.85; p < 0.001), contralateral BC (HR = 1.55; 95%CI 1.30, 1.84; p < 0.001), and distant metastases (HR = 1.44; 95%CI 1.08, 1.94; p = 0.01) but absolute risks were low. Conclusion: Non-adherence to adjuvant ET was associated with an increased risk of recurrence, but absolute recurrence rates were low.
MeSH term(s)	Female ; Humans ; Aged ; Breast Neoplasms/drug therapy ; Breast Neoplasms/surgery ; Mastectomy, Segmental ; Neoplasm Staging ; Risk ; Combined Modality Therapy ; Neoplasm Recurrence, Local/pathology
Language	English
Publishing date	2023-06-16
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	604563-7
ISSN	1573-7217 ; 0167-6806
ISSN (online)	1573-7217
ISSN	0167-6806
DOI	10.1007/s10549-023-06989-x
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Article ; Online: Development and Standardization of an Osteoradionecrosis Classification System in Head and Neck Cancer: Implementation of a Risk-Based Model.

Watson E, Erin E / Hueniken, Katrina / Lee, Junhyung / Huang, Shao Hui / El Maghrabi, Amr / Xu, Wei / Moreno, Amy C / Tsai, C Jillian / Hahn, Ezra / McPartlin, Andrew J / Yao, Christopher M K L / Goldstein, David P / De Almeida, John R / Waldon, John N / Fuller, Clifton D / Hope, Andrew J / Ruggiero, Salvatore L / Glogauer, Michael / Hosni, Ali A

Journal of clinical oncology : official journal of the American Society of Clinical Oncology

2024 , Page(s) JCO2301951

Abstract: Purpose: Osteoradionecrosis of the jaw (ORN) can manifest in varying severity. The aim of this study is to identify ORN risk factors and develop a novel classification to depict the severity of ORN.: Methods: Consecutive patients with head and neck ... ...

Abstract	Purpose: Osteoradionecrosis of the jaw (ORN) can manifest in varying severity. The aim of this study is to identify ORN risk factors and develop a novel classification to depict the severity of ORN. Methods: Consecutive patients with head and neck cancer (HNC) treated with curative-intent intensity-modulated radiation therapy (IMRT) (≥45 Gy) from 2011 to 2017 were included. Occurrence of ORN was identified from in-house prospective dental and clinical databases and charts. Multivariable logistic regression model was used to identify risk factors and stratify patients into high-risk and low-risk groups. A novel ORN classification system was developed to depict ORN severity by modifying existing systems and incorporating expert opinion. The performance of the novel system was compared with 15 existing systems for their ability to identify and predict serious ORN event (jaw fracture or requiring jaw resection). Results: ORN was identified in 219 of 2,732 (8%) consecutive patients with HNC. Factors associated with high risk of ORN were oral cavity or oropharyngeal primaries, received IMRT dose ≥60 Gy, current/ex-smokers, and/or stage III to IV periodontal condition. The ORN rate for high-risk versus low-risk patients was 12.7% versus 3.1% ( Conclusion: We identified risk factors for ORN and proposed a novel ORN classification system on the basis of vertical extent of bone necrosis and presence/absence of exposed bone/fistula. It outperformed existing systems in depicting the seriousness of ORN and may facilitate clinical care and clinical trials.
Language	English
Publishing date	2024-05-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	604914-x
ISSN	1527-7755 ; 0732-183X
ISSN (online)	1527-7755
ISSN	0732-183X
DOI	10.1200/JCO.23.01951
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