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  1. Article ; Online: Acute Aortic Occlusion and Its Sequelae: Metabolic, Pathologic Etiology, and Management.

    Hines, George L / Liu, Helen H

    Cardiology in review

    2020  Volume 29, Issue 2, Page(s) 57–61

    Abstract: Acute occlusion of the abdominal aorta is a catastrophic occurrence that results in high risk of limb loss and death. The etiology has historically been either acute embolism obstructing the aortic bifurcation in 8% to 75% of patients, or thrombosis of ... ...

    Abstract Acute occlusion of the abdominal aorta is a catastrophic occurrence that results in high risk of limb loss and death. The etiology has historically been either acute embolism obstructing the aortic bifurcation in 8% to 75% of patients, or thrombosis of existing aorta-iliac occlusive disease in 35% to 84% of patients. Other etiologies include thrombosis of either a previously placed endograft or aortic graft or acute dissection. The most common symptoms are severe pain in almost 100% of patients or lower extremity paralysis/paresis in up to 80% of patients. Evaluation in the past was by angiography, but presently, computed tomography angiography is the preferred imaging study. Treatment is dependent on the etiology and includes embolectomy, aorta femoral bypass, axillary femoral bypass, and endovascular techniques. The aim of intervention is to restore flow in the shortest time period. Mortality rates vary widely from 17% to 52%, amputation occurs in up to 30% of patients. Paraplegia can occur in 40% of patients, renal insufficiency in 40% to 70%, and visceral ischemia in 6% to 14%. Both mortality and morbidity are affected by the duration of ischemia and the local and systemic complications of reperfusion injury. Complications of acute aortic occlusion can be reduced by a more prompt diagnosis, rapid intervention, and a more rapid and complete reestablishment of perfusion.
    MeSH term(s) Aorta, Abdominal/surgery ; Aortic Diseases/diagnosis ; Aortic Diseases/etiology ; Aortic Diseases/therapy ; Arterial Occlusive Diseases/etiology ; Arterial Occlusive Diseases/surgery ; Blood Vessel Prosthesis Implantation ; Humans ; Ischemia/etiology ; Ischemia/surgery ; Thrombosis ; Treatment Outcome
    Language English
    Publishing date 2020-04-29
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1294965-6
    ISSN 1538-4683 ; 1061-5377
    ISSN (online) 1538-4683
    ISSN 1061-5377
    DOI 10.1097/CRD.0000000000000313
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    Zs.A 4491: Show issues Location:
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  2. Article ; Online: Outcomes of Bariatric Surgery: Patients with Body Mass Index 60 or Greater.

    Howell, Raelina S / Liu, Helen H / Boinpally, Harika / Akerman, Meredith / Carruthers, Elizabeth / Brathwaite, Barbara M / Petrone, Patrizio / Brathwaite, Collin E M

    JSLS : Journal of the Society of Laparoendoscopic Surgeons

    2021  Volume 25, Issue 2

    Abstract: Introduction: Perioperative outcomes of bariatric surgery in patients with super super obesity (SSO) (BMI ≥ 60 kg/m: Methods: A retrospective review was conducted of patients with SSO who underwent surgery from Jun 2005 through Jun 2018 at a ... ...

    Abstract Introduction: Perioperative outcomes of bariatric surgery in patients with super super obesity (SSO) (BMI ≥ 60 kg/m
    Methods: A retrospective review was conducted of patients with SSO who underwent surgery from Jun 2005 through Jun 2018 at a Metabolic and Bariatric Surgery Center of Excellence. Quantitative demographic data was summarized using descriptive statistics; categorical variables were compared using Fisher's exact test.
    Results: Two hundred fourteen procedures were performed, of which 208 were eligible for inclusion. Majority were female (65.4%). The mean age and BMI was 43 (17-68 years) and 65.9 kg/m
    Conclusion: Bariatric surgery is feasible in patients with SSO. Revision procedures may increase risk of operative complications.
    MeSH term(s) Adolescent ; Adult ; Aged ; Bariatric Surgery/methods ; Bariatric Surgery/statistics & numerical data ; Body Mass Index ; Comorbidity ; Feasibility Studies ; Female ; Gastrectomy/methods ; Gastrectomy/statistics & numerical data ; Gastric Bypass/methods ; Gastric Bypass/statistics & numerical data ; Humans ; Laparoscopy/methods ; Laparoscopy/statistics & numerical data ; Male ; Middle Aged ; Obesity, Morbid/physiopathology ; Obesity, Morbid/surgery ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Reoperation/methods ; Reoperation/statistics & numerical data ; Retrospective Studies ; Treatment Outcome ; Young Adult
    Language English
    Publishing date 2021-05-10
    Publishing country United States
    Document type Evaluation Study ; Journal Article
    ZDB-ID 2011211-7
    ISSN 1938-3797 ; 1086-8089
    ISSN (online) 1938-3797
    ISSN 1086-8089
    DOI 10.4293/JSLS.2020.00089
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  3. Article ; Online: The First COVID-19 Pandemic Wave and the Effect on Health Care Trainees: A National Survey Study.

    Liu, Helen H / Petrone, Patrizio / Akerman, Meredith / Howell, Raelina S / Morel, Andrew H / Sohail, Amir H / Alsamarraie, Cindy / Brathwaite, Barbara / Kinzler, Wendy / Maurer, James / Brathwaite, Collin E M

    The American surgeon

    2022  Volume 89, Issue 11, Page(s) 4654–4661

    Abstract: Background: This study observes the trends and patterns among trainees during the coronavirus disease 2019 (COVID-19) pandemic and their response to resident education and hospital/program support.: Methods: An anonymous online 31-question survey was ...

    Abstract Background: This study observes the trends and patterns among trainees during the coronavirus disease 2019 (COVID-19) pandemic and their response to resident education and hospital/program support.
    Methods: An anonymous online 31-question survey was distributed to medical students and postgraduate year residents. Topics included were demographics, clinical responsibilities, educational/curricula changes, and trainee wellness. Descriptive analysis was performed for each set of demographic groupings as well as 2 and 3 group comparisons.
    Results: Total 1051 surveys collected, 930 used for analysis: 373 (40.1%) male, 434 (46.6%) aged 30-34 years, 588 (63.2%) white, 417 (44.8%) married, 168 (18%) with children, and 323 (34.7%) from the Northeast region. The Northeast experienced difficulty sleeping, feelings of guilt, hopelessness, and changes in appetite (
    Conclusion: We aim to provide continued educational support for our trainees' clinical development and well-being during the COVID-19 pandemic.
    MeSH term(s) Child ; Humans ; Male ; Female ; COVID-19/epidemiology ; Pandemics ; Internship and Residency ; Surveys and Questionnaires ; Attitude of Health Personnel
    Language English
    Publishing date 2022-09-18
    Publishing country United States
    Document type Journal Article
    ZDB-ID 202465-2
    ISSN 1555-9823 ; 0003-1348
    ISSN (online) 1555-9823
    ISSN 0003-1348
    DOI 10.1177/00031348221117028
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  4. Article ; Online: Neural Monitoring for Robotic Abdominal Wall Reconstruction.

    Halpern, David K / Liu, Helen H / Howell, Raelina S / Halpern, Robert M / Akerman, Meredith / Conlon, Joseph / Weidler, Christopher

    JSLS : Journal of the Society of Laparoendoscopic Surgeons

    2020  Volume 24, Issue 2

    Abstract: Introduction: Positioning-related neural injuries are an inherent risk in surgery, particularly in robotic-assisted abdominal wall reconstruction because of unique patient positioning and increased operative times. The implementation of intraoperative ... ...

    Abstract Introduction: Positioning-related neural injuries are an inherent risk in surgery, particularly in robotic-assisted abdominal wall reconstruction because of unique patient positioning and increased operative times. The implementation of intraoperative neurophysiological monitoring should be considered in such cases.
    Methods: This was a two-armed study with one prospective intervention group and one retrospective control group. All patients underwent robotic abdominal wall reconstruction at an academic center. The prospective arm underwent robotic reconstruction from January through July 2019. The retrospective database reviewed patients who underwent the same procedure from August 2015 through July 2018. Factors assessed included: demographics (age, gender, body mass index, comorbidities), surgical details (American Society of Anesthesiologists class, procedure, operative time, positioning), outcomes (length of stay, 30-d readmission, reoperation), and any new-onset intraoperative or postoperative neuropathy. Patients were seen in the clinic postoperatively at weeks 1 and 6.
    Results: Ten patients were included in the prospective arm. All received intraoperative neurophysiological monitoring using somatosensory evoked potentials. They were compared with 47 patients in the retrospective arm who underwent surgery without intraoperative neurophysiological monitoring. One position-related neural response from baseline was detected intraoperatively in the prospective arm; however, there were no peripheral neurological symptoms present postoperatively. Two patients in the control group developed transient peripheral neuropathies that resolved within 6 weeks. Demographics, surgical procedures, and length of surgery were similar in both groups. The prospective group had a higher rate of preoperative neuropathy and intraoperative use of vasopressors.
    Conclusion: Incorporation of neurophysiological monitoring in robotic surgery is feasible and may lead to the prevention and reduction in positioning-related injuries.
    MeSH term(s) Abdominal Wall/surgery ; Adult ; Feasibility Studies ; Female ; Humans ; Male ; Middle Aged ; Neurophysiological Monitoring ; Operative Time ; Patient Positioning ; Peripheral Nervous System Diseases/epidemiology ; Pilot Projects ; Postoperative Complications/epidemiology ; Prospective Studies ; Reoperation ; Retrospective Studies ; Robotic Surgical Procedures/methods ; Young Adult
    Language English
    Publishing date 2020-04-19
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2011211-7
    ISSN 1938-3797 ; 1086-8089
    ISSN (online) 1938-3797
    ISSN 1086-8089
    DOI 10.4293/JSLS.2020.00009
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  5. Article ; Online: Development of a Method for Clinical Evaluation of Artificial Intelligence-Based Digital Wound Assessment Tools.

    Howell, Raelina S / Liu, Helen H / Khan, Aziz A / Woods, Jon S / Lin, Lawrence J / Saxena, Mayur / Saxena, Harshit / Castellano, Michael / Petrone, Patrizio / Slone, Eric / Chiu, Ernest S / Gillette, Brian M / Gorenstein, Scott A

    JAMA network open

    2021  Volume 4, Issue 5, Page(s) e217234

    Abstract: Importance: Accurate assessment of wound area and percentage of granulation tissue (PGT) are important for optimizing wound care and healing outcomes. Artificial intelligence (AI)-based wound assessment tools have the potential to improve the accuracy ... ...

    Abstract Importance: Accurate assessment of wound area and percentage of granulation tissue (PGT) are important for optimizing wound care and healing outcomes. Artificial intelligence (AI)-based wound assessment tools have the potential to improve the accuracy and consistency of wound area and PGT measurement, while improving efficiency of wound care workflows.
    Objective: To develop a quantitative and qualitative method to evaluate AI-based wound assessment tools compared with expert human assessments.
    Design, setting, and participants: This diagnostic study was performed across 2 independent wound centers using deidentified wound photographs collected for routine care (site 1, 110 photographs taken between May 1 and 31, 2018; site 2, 89 photographs taken between January 1 and December 31, 2019). Digital wound photographs of patients were selected chronologically from the electronic medical records from the general population of patients visiting the wound centers. For inclusion in the study, the complete wound edge and a ruler were required to be visible; circumferential ulcers were specifically excluded. Four wound specialists (2 per site) and an AI-based wound assessment service independently traced wound area and granulation tissue.
    Main outcomes and measures: The quantitative performance of AI tracings was evaluated by statistically comparing error measure distributions between test AI traces and reference human traces (AI vs human) with error distributions between independent traces by 2 humans (human vs human). Quantitative outcomes included statistically significant differences in error measures of false-negative area (FNA), false-positive area (FPA), and absolute relative error (ARE) between AI vs human and human vs human comparisons of wound area and granulation tissue tracings. Six masked attending physician reviewers (3 per site) viewed randomized area tracings for AI and human annotators and qualitatively assessed them. Qualitative outcomes included statistically significant difference in the absolute difference between AI-based PGT measurements and mean reviewer visual PGT estimates compared with PGT estimate variability measures (ie, range, standard deviation) across reviewers.
    Results: A total of 199 photographs were selected for the study across both sites; mean (SD) patient age was 64 (18) years (range, 17-95 years) and 127 (63.8%) were women. The comparisons of AI vs human with human vs human for FPA and ARE were not statistically significant. AI vs human FNA was slightly elevated compared with human vs human FNA (median [IQR], 7.7% [2.7%-21.2%] vs 5.7% [1.6%-14.9%]; P < .001), indicating that AI traces tended to slightly underestimate the human reference wound boundaries compared with human test traces. Two of 6 reviewers had a statistically higher frequency in agreement that human tracings met the standard area definition, but overall agreement was moderate (352 yes responses of 583 total responses [60.4%] for AI and 793 yes responses of 1166 total responses [68.0%] for human tracings). AI PGT measurements fell in the typical range of variation in interreviewer visual PGT estimates; however, visual PGT estimates varied considerably (mean range, 34.8%; mean SD, 19.6%).
    Conclusions and relevance: This study provides a framework for evaluating AI-based digital wound assessment tools that can be extended to automated measurements of other wound features or adapted to evaluate other AI-based digital image diagnostic tools. As AI-based wound assessment tools become more common across wound care settings, it will be important to rigorously validate their performance in helping clinicians obtain accurate wound assessments to guide clinical care.
    MeSH term(s) Adolescent ; Adult ; Aged ; Aged, 80 and over ; Artificial Intelligence ; Clinical Competence ; Female ; Granulation Tissue/physiology ; Humans ; Male ; Middle Aged ; Observer Variation ; Photography ; Software Design ; Wound Healing/physiology ; Young Adult
    Language English
    Publishing date 2021-05-03
    Publishing country United States
    Document type Journal Article ; Multicenter Study
    ISSN 2574-3805
    ISSN (online) 2574-3805
    DOI 10.1001/jamanetworkopen.2021.7234
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  6. Article ; Online: Short-Term Outcomes in Patients Undergoing Paraesophageal Hiatal Hernia Repair.

    Howell, Raelina S / Liu, Helen H / Petrone, Patrizio / Anduaga, María Fernanda / Servide, María José / Hall, Keneth / Barkan, Alexander / Islam, Shahidul / Brathwaite, Collin E M

    Scientific reports

    2020  Volume 10, Issue 1, Page(s) 7366

    Abstract: Many patients with hiatal hernias (HH) are asymptomatic; however, symptoms may include heartburn, regurgitation, dysphagia, nausea, or vague epigastric pain depending on the hernia type and severity. The ideal technique and timing of repair remains ... ...

    Abstract Many patients with hiatal hernias (HH) are asymptomatic; however, symptoms may include heartburn, regurgitation, dysphagia, nausea, or vague epigastric pain depending on the hernia type and severity. The ideal technique and timing of repair remains controversial. This report describes short-term outcomes and readmissions of patients undergoing HH repair at our institution. All patients who underwent HH repair from January 2012 through April 2017 were reviewed. Patients undergoing concomitant bariatric surgery were excluded. 239 patients were identified and 128 were included. Eighty-eight were female (69%) and 40 were male (31%) with a mean age of 59 years (range 20-91 years) and a mean BMI of 29.2 kg/m
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Female ; Fundoplication/methods ; Gastroesophageal Reflux/surgery ; Hernia, Hiatal/surgery ; Herniorrhaphy ; Humans ; Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult
    Language English
    Publishing date 2020-04-30
    Publishing country England
    Document type Journal Article
    ZDB-ID 2615211-3
    ISSN 2045-2322 ; 2045-2322
    ISSN (online) 2045-2322
    ISSN 2045-2322
    DOI 10.1038/s41598-020-61566-2
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  7. Article: Dose sculpting with generalized equivalent uniform dose.

    Wu, Qiuwen / Djajaputra, David / Liu, Helen H / Dong, Lei / Mohan, Radhe / Wu, Yan

    Medical physics

    2005  Volume 32, Issue 5, Page(s) 1387–1396

    Abstract: With intensity-modulated radiotherapy (IMRT), a variety of user-defined dose distribution can be produced using inverse planning. The generalized equivalent uniform dose (gEUD) has been used in IMRT optimization as an alternative objective function to ... ...

    Abstract With intensity-modulated radiotherapy (IMRT), a variety of user-defined dose distribution can be produced using inverse planning. The generalized equivalent uniform dose (gEUD) has been used in IMRT optimization as an alternative objective function to the conventional dose-volume-based criteria. The purpose of this study was to investigate the effectiveness of gEUD optimization to fine tune the dose distributions of IMRT plans. We analyzed the effect of gEUD-based optimization parameters on plan quality. The objective was to determine whether dose distribution to selected structures could be improved using gEUD optimization without adversely altering the doses delivered to other structures, as in sculpting. We hypothesized that by carefully defining gEUD parameters (EUD0 and n) based on the current dose distributions, the optimization system could be instructed to search for alternative solutions in the neighborhood, and we could maintain the dose distributions for structures already satisfactory and improve dose for structures that need enhancement. We started with an already acceptable IMRT plan optimized with any objective function. The dose distribution was analyzed first. For structures that dose should not be changed, a higher value of n was used and EUD0 was set slightly higher/lower than the EUD value at the current dose distribution for critical structures/targets. For structures that needed improvement in dose, a higher to medium value of n was used, and EUD0 was set to the EUD value or slightly lower/higher for the critical structure/target at the current dose distribution. We evaluated this method in one clinical case each of head and neck, lung and prostate cancer. Dose volume histograms, isodose distributions, and relevant tolerance doses for critical structures were used for the assessment. We found that by adjusting gEUD optimization parameters, the dose distribution could be improved with only a few iterations. A larger value of n could lead to faster convergence and a medium value of n could result in a search in a broader area. Such improvement could also be achieved by optimization based on other criteria, but the gEUD-based method has the advantage of efficiency and flexibility. Therefore, gEUD-based optimization can be used as a tool to improve IMRT plans by adjusting the planning parameters, thereby making dose sculpting feasible.
    MeSH term(s) Algorithms ; Body Burden ; Computer Simulation ; Humans ; Models, Biological ; Neoplasms/radiotherapy ; Radiation Protection/methods ; Radiometry/methods ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted/methods ; Radiotherapy, Conformal/methods ; Relative Biological Effectiveness
    Language English
    Publishing date 2005-05
    Publishing country United States
    Document type Comparative Study ; Evaluation Studies ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S. ; Validation Studies
    ZDB-ID 188780-4
    ISSN 0094-2405
    ISSN 0094-2405
    DOI 10.1118/1.1897464
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  8. Article: Intensity-modulated radiotherapy optimization with gEUD-guided dose-volume objectives.

    Wu, Qiuwen / Djajaputra, David / Wu, Yan / Zhou, Jining / Liu, Helen H / Mohan, Radhe

    Physics in medicine and biology

    2003  Volume 48, Issue 3, Page(s) 279–291

    Abstract: Currently, most intensity-modulated radiation therapy systems use dose-volume (DV)-based objectives. Although acceptable plans can be generated using these objectives, much trial and error is necessary to plan complex cases with many structures because ... ...

    Abstract Currently, most intensity-modulated radiation therapy systems use dose-volume (DV)-based objectives. Although acceptable plans can be generated using these objectives, much trial and error is necessary to plan complex cases with many structures because numerous parameters need to be adjusted. An objective function that makes use of a generalized equivalent uniform dose (gEUD) was developed recently that has the advantage of involving simple formulae and fewer parameters. In addition, not only does the gEUD-based optimization provide the same coverage of the target, it provides significantly better protection of critical structures. However, gEUD-based optimization may not be superior once dose distributions and dose-volume histograms (DVHs) are used to evaluate the plan. Moreover, it is difficult to fine-tune the DVH with gEUD-based optimization. In this paper, we propose a method for combining the gEUD-based and DV-based optimization approaches to overcome these limitations. In this method, the gEUD optimization is performed initially to search for a solution that meets or exceeds most of the treatment objectives. Depending on the requirements, DV-based optimization with a gradient technique is then used to fine-tune the DVHs. The DV constraints are specified according to the gEUD plan, and the initial intensities are obtained from the gEUD plan as well. We demonstrated this technique in two clinical cases: aprostate cancer and ahead and neck cancer case. Compared with the DV-optimized plan, the gEUD plan provided better protection of critical structures and the target coverage was similar. However, homogeneities were slightly poorer. The gEUD plan was then fine-tuned with DV constraints, and the resulting plan was superior to the other plans in terms of the dose distributions. The planning time was significantly reduced as well. This technique is an effective means of optimizing individualized treatment plans.
    MeSH term(s) Adenocarcinoma/radiotherapy ; Aged ; Aged, 80 and over ; Algorithms ; Dose-Response Relationship, Radiation ; Head and Neck Neoplasms/radiotherapy ; Humans ; Male ; Middle Aged ; Models, Biological ; Neoplasms, Squamous Cell/radiotherapy ; Organ Specificity ; Prostatic Neoplasms/radiotherapy ; Quality Control ; Radiation Injuries/prevention & control ; Radiation Protection/methods ; Radiometry/methods ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted/methods ; Radiotherapy, Conformal/adverse effects ; Radiotherapy, Conformal/methods
    Language English
    Publishing date 2003-02-07
    Publishing country England
    Document type Evaluation Studies ; Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, P.H.S. ; Validation Studies
    ZDB-ID 208857-5
    ISSN 1361-6560 ; 0031-9155
    ISSN (online) 1361-6560
    ISSN 0031-9155
    DOI 10.1088/0031-9155/48/3/301
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  9. Article: Analysis of clinical and dosimetric factors associated with treatment-related pneumonitis (TRP) in patients with non-small-cell lung cancer (NSCLC) treated with concurrent chemotherapy and three-dimensional conformal radiotherapy (3D-CRT).

    Wang, Shulian / Liao, Zhongxing / Wei, Xiong / Liu, Helen H / Tucker, Susan L / Hu, Chao-Su / Mohan, Rodhe / Cox, James D / Komaki, Ritsuko

    International journal of radiation oncology, biology, physics

    2006  Volume 66, Issue 5, Page(s) 1399–1407

    Abstract: Purpose: To investigate factors associated with treatment-related pneumonitis in non-small-cell lung cancer patients treated with concurrent chemoradiotherapy.: Patients and methods: We retrospectively analyzed data from 223 patients treated with ... ...

    Abstract Purpose: To investigate factors associated with treatment-related pneumonitis in non-small-cell lung cancer patients treated with concurrent chemoradiotherapy.
    Patients and methods: We retrospectively analyzed data from 223 patients treated with definitive concurrent chemoradiotherapy. Treatment-related pneumonitis was graded according to Common Terminology Criteria for Adverse Events version 3.0. Univariate and multivariate analyses were performed to identify predictive factors.
    Results: Median follow-up was 10.5 months (range, 1.4-58 months). The actuarial incidence of Grade > or =3 pneumonitis was 22% at 6 months and 32% at 1 year. By univariate analyses, lung volume, gross tumor volume, mean lung dose, and relative V5 through V65, in increments of 5 Gy, were all found to be significantly associated with treatment-related pneumonitis. The mean lung dose and rV5-rV65 were highly correlated (p < 0.0001). By multivariate analysis, relative V5 was the most significant factor associated with treatment-related pneumonitis; the 1-year actuarial incidences of Grade > or =3 pneumonitis in the group with V5 < or =42% and V5 >42% were 3% and 38%, respectively (p = 0.001).
    Conclusions: In this study, a number of clinical and dosimetric factors were found to be significantly associated with treatment-related pneumonitis. However, rV5 was the only significant factor associated with this toxicity. Until it is better understood which dose range is most relevant, multiple clinical and dosimetric factors should be considered in treatment planning for non-small-cell lung cancer patients receiving concurrent chemoradiotherapy.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Analysis of Variance ; Antineoplastic Agents/therapeutic use ; Carcinoma, Non-Small-Cell Lung/drug therapy ; Carcinoma, Non-Small-Cell Lung/radiotherapy ; Combined Modality Therapy/methods ; Female ; Humans ; Lung Neoplasms/drug therapy ; Lung Neoplasms/radiotherapy ; Male ; Middle Aged ; Radiation Pneumonitis/etiology ; Radiotherapy Dosage ; Radiotherapy, Conformal ; Retrospective Studies
    Chemical Substances Antineoplastic Agents
    Language English
    Publishing date 2006-12-01
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 197614-x
    ISSN 1879-355X ; 0360-3016
    ISSN (online) 1879-355X
    ISSN 0360-3016
    DOI 10.1016/j.ijrobp.2006.07.1337
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  10. Article ; Online: Influence of technologic advances on outcomes in patients with unresectable, locally advanced non-small-cell lung cancer receiving concomitant chemoradiotherapy.

    Liao, Zhongxing X / Komaki, Ritsuko R / Thames, Howard D / Liu, Helen H / Tucker, Susan L / Mohan, Radhe / Martel, Mary K / Wei, Xiong / Yang, Kunyu / Kim, Edward S / Blumenschein, George / Hong, Waun Ki / Cox, James D

    International journal of radiation oncology, biology, physics

    2010  Volume 76, Issue 3, Page(s) 775–781

    Abstract: Purpose: In 2004, our institution began using four-dimensional computed tomography (4DCT) simulation and then intensity-modulated radiotherapy (IMRT) (4DCT/IMRT) instead of three-dimensional conformal radiotherapy (3DCRT) for the standard treatment of ... ...

    Abstract Purpose: In 2004, our institution began using four-dimensional computed tomography (4DCT) simulation and then intensity-modulated radiotherapy (IMRT) (4DCT/IMRT) instead of three-dimensional conformal radiotherapy (3DCRT) for the standard treatment of non-small-cell lung cancer (NSCLC). This retrospective study compares disease outcomes and toxicity in patients treated with concomitant chemotherapy and either 4DCT/IMRT or 3DCRT.
    Methods and materials: A total of 496 NSCLC patients have been treated at M. D. Anderson Cancer Center between 1999 and 2006 with concomitant chemoradiotherapy. Among these, 318 were treated with CT/3DCRT and 91 with 4DCT/IMRT. Both groups received a median dose of 63 Gy. Disease end points were locoregional progression (LRP), distant metastasis (DM), and overall survival (OS). Disease covariates were gross tumor volume (GTV), nodal status, and histology. The toxicity end point was Grade >or=3 radiation pneumonitis; toxicity covariates were GTV, smoking status, and dosimetric factors. Data were analyzed using Cox proportional hazards models.
    Results: Mean follow-up times in the 4DCT/IMRT and CT/3DCRT groups were 1.3 (range, 0.1-3.2) and 2.1 (range, 0.1-7.9) years, respectively. The hazard ratios for 4DCT/IMRT were <1 for all disease end points; the difference was significant only for OS. The toxicity rate was significantly lower in the IMRT/4DCT group than in the CT/3DCRT group. V20 was significantly higher in the 3DCRT group and was a significant factor in determining toxicity. Freedom from DM was nearly identical in both groups.
    Conclusions: Treatment with 4DCT/IMRT was at least as good as that with 3DCRT in terms of the rates of freedom from LRP and DM. There was a significant reduction in toxicity and a significant improvement in OS.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Carcinoma, Non-Small-Cell Lung/diagnostic imaging ; Carcinoma, Non-Small-Cell Lung/drug therapy ; Carcinoma, Non-Small-Cell Lung/pathology ; Carcinoma, Non-Small-Cell Lung/radiotherapy ; Combined Modality Therapy/methods ; Disease-Free Survival ; Female ; Four-Dimensional Computed Tomography/methods ; Humans ; Lung Neoplasms/diagnostic imaging ; Lung Neoplasms/drug therapy ; Lung Neoplasms/pathology ; Lung Neoplasms/radiotherapy ; Male ; Middle Aged ; Radiation Pneumonitis/pathology ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted/methods ; Radiotherapy, Intensity-Modulated/methods ; Retrospective Studies ; Treatment Outcome ; Tumor Burden
    Language English
    Publishing date 2010-03-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 197614-x
    ISSN 1879-355X ; 0360-3016
    ISSN (online) 1879-355X
    ISSN 0360-3016
    DOI 10.1016/j.ijrobp.2009.02.032
    Database MEDical Literature Analysis and Retrieval System OnLINE

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