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1.  Impact of neck dissection on long-term feeding tube dependence in head and neck cancer patients treated with primary radiation or chemoradiation 
Head & neck  2010;32(3):341-347.
The impact of post-treatment neck dissection on prolonged feeding tube dependence in head and neck squamous cell cancer (HNSCC) patients treated with primary radiation or chemoradiation remains unknown.
Retrospective cohort study using propensity score adjustment to investigate the effect of neck dissection on prolonged feeding tube dependence.
A review of 67 patients with node positive HNSCC (T1-4N1-3), treated with primary radiation or chemoradiation, with no evidence of tumor recurrence and follow-up of at least 24 months was performed. Following adjustment for covariates, the relative risk of feeding tube dependence at 18 months was significantly increased in patients treated with post-treatment neck dissection (RR 4.74, 95% CI 2.07-10.89). At 24 months, the relative risk of feeding tube dependence in the patients having undergone neck dissection increased further (RR 7.66, 95% CI 2.07-10.89). Of patients with feeding tubes two years after completing treatment, 75% remained feeding tube dependent.
Neck dissection may contribute to chronic oropharyngeal dysphagia in HNSCC patients treated with primary radiation or chemoradiation.
PMCID: PMC3457780  PMID: 19693946
3.  Does Treatment Duration Affect Outcome after Radiotherapy for Prostate Cancer? 
The protraction of external beam radiotherapy (RT) time is detrimental in several disease sites. In prostate cancer, the overall treatment time can be considerable, as can the potential for treatment breaks. We evaluated the effect of elapsed treatment time on outcome after RT for prostate cancer.
Methods and Materials
Between April 1989 and November 2004, 1,796 men with prostate cancer were treated with RT alone. The nontreatment day ratio (NTDR) was defined as the number of nontreatment days divided by the total elapsed days of RT. This ratio was used to account for the relationship between treatment duration and total RT dose. Men were stratified into low risk (n = 789), intermediate risk (n = 798), and high risk (n = 209) using a single-factor model.
The 10-year freedom from biochemical failure (FFBF) rate was 68% for a NTDR <33% vs. 58% for NTDR ≥33% (p = 0.02; BF was defined as a prostate-specific antigen nadir + 2 ng/mL). In the low-risk group, the 10-year FFBF rate was 82% for NTDR <33% vs. 57% for NTDR ≥33% (p = 0.0019). The NTDR was independently predictive for FFBF (p = 0.03), in addition to T stage (p = 0.005) and initial prostate-specific antigen level (p < 0.0001) on multivariate analysis, including Gleason score and radiation dose. The NTDR was not a significant predictor of FFBF when examined in the intermediate-risk group, high-risk group, or all risk groups combined.
A proportionally longer treatment duration was identified as an adverse factor in low-risk patients. Treatment breaks resulting in a NTDR of ≥33% (e.g., four or more breaks during a 40-fraction treatment, 5 d/wk) should be avoided.
PMCID: PMC2763099  PMID: 18472368
Treatment break; Prostate; Biochemical failure; Radiotherapy; Prostate-specific antigen
To compare the toxicity and biochemical outcomes of intensity-modulated radiation therapy (IMRT) and 125I transperineal permanent prostate seed implant (125I) for patients with low-risk prostate cancer.
Methods and Materials
Between 1998 and 2004, a total of 374 low-risk patients (prostate-specific antigen < 10 ng/ml, T1c–T2b, Gleason score of 6 or less, and no neoadjuvant hormones) were treated at Fox Chase Cancer Center (216 IMRT and 158 125I patients). Median follow-up was 43 months for IMRT and 48 months for 125I. The IMRT prescription dose ranged from 74–78 Gy, and 125I prescription was 145 Gy. Acute and late gastrointestinal (GI) and genitourinary (GU) toxicity was recorded by using a modified Radiation Therapy Oncology Group scale. Freedom from biochemical failure was defined by using the Phoenix definition (prostate-specific antigen nadir + 2.0 ng/ml).
Patients treated by using IMRT were more likely to be older and have a higher baseline American Urological Association symptom index score, history of previous transurethral resection of the prostate, and larger prostate volumes. On multivariate analysis, IMRT was an independent predictor of lower acute and late Grade 2 or higher GU toxicity and late Grade 2 or higher GI toxicity. Three-year actuarial estimates of late Grade 2 or higher toxicity were 2.4% for GI and 3.5% for GU by using IMRT compared with 7.7% for GI and 19.2% for GU for 125I, respectively. Four-year actuarial estimates of freedom from biochemical failure were 99.5% for IMRT and 93.5% for 125I (p = 0.09).
The IMRT and 125I produce similar outcomes, although IMRT appears to have less acute and late toxicity.
PMCID: PMC2763097  PMID: 18207665
Prostate cancer; Radiation therapy; IMRT; Brachytherapy; Toxicity
5.  How Can Men Destined for Biochemical Failure After Androgen Deprivation and Radiotherapy be Identified Earlier? 
The significance of prostate-specific antigen (PSA) increases during the recovery of androgen after androgen deprivation therapy (ADT) and radiotherapy for prostate cancer is not well understood. This study sought to determine whether the initial PSA increase from undetectable after completion of all treatment predicts for eventual biochemical failure (BF).
Methods and Materials
Between July 1992 and March 2004, 163 men with a Gleason score of 8–10 or initial PSA level >20 ng/mL, or Stage T3 prostate cancer were treated with radiotherapy (median dose, 76 Gy) and ADT and achieved an undetectable PSA level. The first detectable PSA level after the cessation of ADT was defined as the PSA sentinel rise (SR). A PSA-SR of >0.25, >0.5, >0.75, and >1.0 ng/mL was studied as predictors of BF (nadir plus 2 ng/mL). Cox proportional hazards models were used for univariate and multivariate analyses for BF adjusting for pretreatment differences in Gleason score, stage, PSA level (continuous), dose (continuous), and ADT duration (<12 vs. ≥12 months).
Of the 163 men, 41 had BF after therapy. The median time to BF was 25 months (range, 4–96). The 5-year BF rate stratified by a PSA-SR of ≤0.25 vs. >0.25 ng/mL was 28% vs. 43% (p = 0.02), ≤0.5 vs. >0.5 ng/mL was 30% vs. 56% (p = 0.0003), ≤0.75 vs. >0.75 ng/mL was 29% vs. 66% (p < 0.0001), and ≤1.0 vs. >1.0 ng/mL was 29% vs. 75% (p < 0.0001). All four PSA-SRs were independently predictive of BF on multivariate analysis.
The PSA-SR predicts for BF. A PSA-SR of >0.5 ng/mL can be used for early identification of men at greater risk of BF.
PMCID: PMC2763093  PMID: 18164854
Prostate cancer; Radiotherapy; Androgen deprivation therapy; Prostate-specific antigen; Biochemical failure

Results 1-5 (5)