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  • 1
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    Online Resource
    Low grade, indolent lymphomas of the head and neck: Comparative toxicity of standard versus very low dose radiation therapy
    Wiley ; 2021
    In:  Hematological Oncology Vol. 39, No. 3 ( 2021-08), p. 304-312
    Details
    In: Hematological Oncology, Wiley, Vol. 39, No. 3 ( 2021-08), p. 304-312
    Abstract: National Comprehensive Cancer Network guidelines recommend radiation therapy (RT) for localized indolent non‐Hodgkin lymphomas (iNHL). Many referring physicians avoid RT to the head and neck (HN) due to fears of toxicity. Very low‐dose radiation (4 Gy) for select patients produces sustained local control and recently gained popularity. We compared early and late toxicities of standard 24–30 Gy to 4 Gy in patients with HN iNHL. We retrospectively analyzed 266 consecutive patients with HN iNHL receiving RT from 1994 to 2017. Patient characteristics, outcomes, and toxicities were collected from medical records. Early (≤2 months post‐RT) and late ( 〉 2 months post‐RT) toxicities were graded per Common Terminology Criteria for Adverse Events version 4. Grades 1–2 were defined as “low‐grade” and 3–4 “high‐grade.” Toxicity incidence was compared between 4 and  〉 4 Gy, grouped by treated site (orbit, nonorbital head, neck, skin) and early versus late. Median follow‐up was 23 months (2–145) and 68 months (2–256) for 4Gy and 〉 4 Gy cohorts, respectively. Median dose for the 〉 4 Gy cohort was 30 Gy (10.5–54 Gy). Early and late toxicity incidences were lower in the 4 Gy cohort compared to 〉 4 Gy across all RT‐sites: early toxicity, orbit, 42% versus 96%; nonorbital head, 24% versus 96%; neck, 22% versus 94%; skin, 31% versus 87%; late toxicity, orbit, 20% versus 71%; nonorbital head, 6% versus 66%; neck, 6% versus 57%; skin, 0% versus 46% (4 Gy vs. 〉 4 Gy, respectively). Toxicities among both cohorts were largely low‐grade. High‐grade early and late toxicities did not occur in the 4 Gy cohort. There was 1 high‐grade early toxicity (Grade 3 dry mouth) and 17 high‐grade late toxicities (Grade 3 cataracts) in the 〉 4 Gy cohort. RT to HN for iNHL is associated with minimal short‐ and long‐term toxicity and excellent local control among 4 Gy and 〉 4 Gy treatments. In this setting, “toxicity” concerns should not deter oncologists from potentially curative RT. In select patients where toxicity remains a concern, very low dose 4 Gy could be considered.
    Type of Medium: Online Resource
    ISSN: 0278-0232 , 1099-1069
    URL: Issue
    URL: Article
    DOI: 10.1002/hon.v39.3
    DOI: 10.1002/hon.2865
    Language: English
    Publisher: Wiley
    Publication Date: 2021
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  • 2
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    Online Resource
    To Keep His Arm “Flying” High, Omit Consolidation Radiation Therapy
    Elsevier BV ; 2024
    In:  International Journal of Radiation Oncology*Biology*Physics Vol. 119, No. 3 ( 2024-07), p. 718-719
    Details
    In: International Journal of Radiation Oncology*Biology*Physics, Elsevier BV, Vol. 119, No. 3 ( 2024-07), p. 718-719
    Type of Medium: Online Resource
    ISSN: 0360-3016
    URL: Article
    DOI: 10.1016/j.ijrobp.2024.02.060
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2024
    detail.hit.zdb_id: 197614-X
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  • 3
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    Online Resource
    P1220: EXPLORING TP53 BIOLOGY IN DIFFUSE LARGE B-CELL LYMPHOMA: A GENOMIC AND TRANSCRIPTOMIC META-ANALYSIS
    Wiley ; 2023
    In:  HemaSphere Vol. 7, No. S3 ( 2023-08), p. e465205e-
    Details
    In: HemaSphere, Wiley, Vol. 7, No. S3 ( 2023-08), p. e465205e-
    Type of Medium: Online Resource
    ISSN: 2572-9241
    URL: Article
    DOI: 10.1097/01.HS9.0000971776.46520.5e
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2922183-3
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  • 4
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    TRLS-07. Intracavitary carrier-embedded Cs131 brachytherapy for recurrent brain metastases: A randomized phase II study
    Oxford University Press (OUP) ; 2021
    In:  Neuro-Oncology Advances Vol. 3, No. Supplement_3 ( 2021-08-09), p. iii7-iii7
    Details
    In: Neuro-Oncology Advances, Oxford University Press (OUP), Vol. 3, No. Supplement_3 ( 2021-08-09), p. iii7-iii7
    Abstract: The salvage treatment of recurrent brain metastases after failed irradiation is a clinical challenge. Adjuvant SRS is standard of care for resected brain metastases in the upfront post-resection setting given a significant local control advantage over surgery alone. However, the role of reirradiation following salvage resection of recurrent post-irradiation metastases is unclear owing to both reduced efficacy of subsequent courses of external beam radiation, and likely increased risk of radiation injury. Intracavitary cesium 131 (Cs131) brachytherapy offers a highly conformal adjunct radiation option that we hypothesize may allow for improved local control while also theoretically conveying a low risk of radiation necrosis. In this randomized controlled study, we aim to define the potential benefits and risks of resection plus permanently implanted, carrier-embedded intracavitary Cs131 brachytherapy versus conventional care (surgery alone). Methods This is a single-center randomized controlled study of patients undergoing resection of recurrent, previously-irradiated brain metastases. Exclusion criteria include prior in-field infection, prior radiation & gt;100Gy (in 2Gy fraction equivalents), & gt;5 additional active or untreated CNS lesions, or leptomeningeal carcinomatosis. Subjects are randomized 1:1 to undergo either surgery with placement of Cs131 brachytherapy or surgery alone. The primary endpoint is freedom from treated-site progression at 9 months. Secondary endpoints include wound complications at 3 months and time to local retreatment at the index site, and exploratory objectives include neurocognitive function prior to surgery and at 3 and 12 months postoperatively, with correlative analyses of the previously irradiated brain metastasis tissue. Accrual began on December 24, 2020 and 5 of a planned 76 patients have enrolled. This is the first randomized controlled trial of surgery plus permanently implanted intracavitary Cs131 brachytherapy versus surgery alone for recurrent brain metastases. ClinicalTrials.gov Identifier: NCT04690348
    Type of Medium: Online Resource
    ISSN: 2632-2498
    URL: Article
    DOI: 10.1093/noajnl/vdab071.025
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
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  • 5
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    Online Resource
    Increasing Heart Dose Reduces Overall Survival in Patients Undergoing Postoperative Radiation Therapy for NSCLC
    Elsevier BV ; 2021
    In:  JTO Clinical and Research Reports Vol. 2, No. 8 ( 2021-08), p. 100209-
    Details
    In: JTO Clinical and Research Reports, Elsevier BV, Vol. 2, No. 8 ( 2021-08), p. 100209-
    Type of Medium: Online Resource
    ISSN: 2666-3643
    URL: Article
    DOI: 10.1016/j.jtocrr.2021.100209
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
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  • 6
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    Online Resource
    Salvage resection plus cesium-131 brachytherapy durably controls post-SRS recurrent brain metastases
    Springer Science and Business Media LLC ; 2022
    In:  Journal of Neuro-Oncology Vol. 159, No. 3 ( 2022-09), p. 609-618
    Details
    In: Journal of Neuro-Oncology, Springer Science and Business Media LLC, Vol. 159, No. 3 ( 2022-09), p. 609-618
    Type of Medium: Online Resource
    ISSN: 0167-594X , 1573-7373
    URL: Article
    DOI: 10.1007/s11060-022-04101-9
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
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    detail.hit.zdb_id: 2007293-4
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  • 7
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    Long‐term outcomes of patients with limited‐stage ocular adnexal DLBCL treated with combined modality therapy in the rituximab era
    Wiley ; 2023
    In:  British Journal of Haematology Vol. 200, No. 4 ( 2023-02), p. 524-527
    Details
    In: British Journal of Haematology, Wiley, Vol. 200, No. 4 ( 2023-02), p. 524-527
    Type of Medium: Online Resource
    ISSN: 0007-1048 , 1365-2141
    URL: Issue
    URL: Article
    DOI: 10.1111/bjh.v200.4
    DOI: 10.1111/bjh.18590
    RVK:
    XA 34100
    Language: English
    Publisher: Wiley
    Publication Date: 2023
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  • 8
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    Genomic biomarkers of CNS-specific outcomes in patients with breast cancer brain metastases.
    American Society of Clinical Oncology (ASCO) ; 2024
    In:  Journal of Clinical Oncology Vol. 42, No. 16_suppl ( 2024-06-01), p. 2028-2028
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 42, No. 16_suppl ( 2024-06-01), p. 2028-2028
    Abstract: 2028 Background: The diagnosis of brain metastasis (BM) is a life- and prognosis-altering event for patients with breast cancer (BC). The standard of care for the management of limited BM remains ablation with stereotactic radiosurgery (SRS). There are no established genomic biomarkers to guide CNS-directed treatment among patients with breast cancer brain metastases (BCBM). Methods: We retrospectively reviewed clinical and genomic features of a cohort of patients who received SRS for newly diagnosed BCBM between 2010 and 2021 at Memorial Sloan Kettering Cancer Center (MSK). Next-generation genomic sequencing (NGS) was performed using the MSK-IMPACT assay, covering all exonic and selected intronic regions for up to 505 genes. Time-to-CNS progression (TTCP) and overall survival (OS) were analyzed using multivariable Fine-Gray and Cox proportional hazards models, respectively, adjusted for clinically relevant factors. Relevant clinical factors and genomic alterations present at an instance at 5% or greater were included in the univariate and multivariate analyses, completed for the overall cohort and BC receptor subtypes. Results: From 2010-2021, 260 patients were identified; 123 (47%), 74 (28%), and 63 (24%) patients had hormone receptor-positive (HR+), HER2+, and triple-negative (TN) disease, respectively. 116 (45%) patients had 1 BM and 184 (71%) patients had at least 1 BM greater than 1 cm in axial diameter. Median follow up for the overall cohort was 18 months (Interquartile range (IQR) 9, 36). Among patients who progressed, median TTCP was 6 (IQR 4, 13) and 6 (4, 13), 11 (5, 18), and 4(3, 8) months for the overall cohort, and HR+, HER2+, and TN subgroups, respectively. Median OS was 19 (95% CI 16, 23) and 15 (13, 21), 58 (39, --), and 13 (11, 20), for the overall cohort, and HR+, HER2+, and TN subgroups, respectively. In the overall cohort, shorter TTCP was associated with TN subtype, 〉 5 BMs, and pathogenic alterations in MYC, AGO2, PTEN, AURKA, and NF1 (p 〈 0.05); decreased OS was associated with non-HER2+ subtype, presence of extracranial metastatic disease, and oncogenic alterations in TP53, CDH1 and NF1 (p 〈 0.05). In stratified analyses by receptor subtype, shorter TTCP was associated with oncogenic alterations in GAB2 and PTEN in the HR+ subgroup, AURKA, DDR2, and NF1 in the HER2+ subgroup, and with MYC and RB1 in the TN subgroup (p 〈 0.05). Conclusions: In this large clinico-genomic analysis of CNS-specific outcomes in BC, we identified clinical and putative genomic biomarkers associated with BCBM receiving SRS that could be used to risk stratify patients and optimize treatment strategies.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/JCO.2024.42.16_suppl.2028
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2024
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  • 9
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    Tyrosine Kinase Inhibitors With and Without Up-Front Stereotactic Radiosurgery for Brain Metastases From EGFR and ALK Oncogene–Driven Non–Small Cell Lung Cancer (TURBO-NSCLC)
    American Society of Clinical Oncology (ASCO) ; 2024
    In:  Journal of Clinical Oncology
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO)
    Abstract: Newer-generation tyrosine kinase inhibitors (TKIs) for non–small cell lung cancer (NSCLC) with epidermal growth factor receptor ( EGFR) mutations and anaplastic lymphoma kinase ( ALK) rearrangements have demonstrated high CNS activity. The optimal use of up-front stereotactic radiosurgery (SRS) for brain metastases (BM) in patients eligible for CNS-penetrant TKIs is controversial, and data to guide patient management are limited. MATERIALS AND METHODS Data on TKI-naïve patients with EGFR- and ALK-driven NSCLC with BM treated with CNS-penetrant TKIs with and without up-front SRS were retrospectively collected from seven academic centers in the United States. Time-to-CNS progression and overall survival (OS) were analyzed, with multivariable adjustment in Fine & Gray and Cox proportional hazards models for clinically relevant factors. RESULTS From 2013 to 2022, 317 patients were identified (200 TKI-only and 117 TKI + SRS). Two hundred fifty (79%) and 61 (19%) patients received osimertinib and alectinib, respectively. Patients receiving TKI + SRS were more likely to have BM ≥1 cm ( P 〈 .001) and neurologic symptoms ( P 〈 .001) at presentation. Median OS was similar between the TKI and TKI + SRS groups (median 41 v 40 months, respectively; P = .5). On multivariable analysis, TKI + SRS was associated with a significant improvement in time-to-CNS progression (hazard ratio [HR], 0.63 [95% CI, 0.42 to 0.96] ; P = .033). Local CNS control was significantly improved with TKI + SRS (HR, 0.30 [95% CI, 0.16 to 0.55]; P 〈 .001), whereas no significant differences were observed in distant CNS control. Subgroup analyses demonstrated a greater benefit from TKI + SRS in patients with BM ≥1 cm in diameter for time-to-CNS progression and CNS progression-free survival. CONCLUSION The addition of up-front SRS to CNS-penetrant TKI improved time-to-CNS progression and local CNS control, but not OS, in patients with BM from EGFR - and ALK-driven NSCLC. Patients with larger BM (≥1 cm) may benefit the most from up-front SRS.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/JCO.23.02668
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2024
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    detail.hit.zdb_id: 604914-X
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  • 10
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    Online Resource
    Radiation Therapy for Patients with Diffuse Large B Cell Richter's Syndrome of CLL
    American Society of Hematology ; 2021
    In:  Blood Vol. 138, No. Supplement 1 ( 2021-11-05), p. 1565-1565
    Details
    In: Blood, American Society of Hematology, Vol. 138, No. Supplement 1 ( 2021-11-05), p. 1565-1565
    Abstract: Introduction: The transformation of chronic lymphocytic leukemia (CLL) into a highly aggressive B-cell lymphoma histology, known as Richter's syndrome (RS), is associated with rapid progression and remains a serious treatment challenge. Standard chemoimmunotherapy approaches often yield poor response rates, short remission durations, and limited overall survival. The role of radiation therapy (RT) in the management of RS has not been explored, and decision making regarding the use of RT in RS is extrapolated from the de novo diffuse large B cell lymphoma (DLBCL) literature. Herein, we report, to the best of our knowledge, the largest case series of patients with RS who received RT. Methods: We conducted a retrospective review of all patients Memorial Sloan Kettering Cancer Center diagnosed with DLBCL RS between April 2002 and August 2020 who received RT at any time following RS diagnosis. Baseline characteristics, information regarding CLL- and RS-directed therapy, RT characteristics including its therapeutic intent, and outcomes were collected. Progression free and overall survival (PFS, OS) were estimated using Kaplan Meier method. All other analyses were descriptive. Analyses were performed using STATA 17.0. Results: 34 RS patients who received RT were identified. Twenty-one received RT as part of a definitive therapeutic strategy while 13 received RT solely for palliation. Baseline characteristics for the entire cohort, as well as divided by RT therapeutic intent, are described in Table 1. Patients received a median of 1 (range 0-5) prior line of CLL-directed therapy prior to RS diagnosis; 24% had prior ibrutinib while 9% had prior venetoclax. Patients received a median of 2 (range 0-5) lines of RS-directed therapy prior to RT; chemoimmunotherapy was first-line RS-directed therapy for 82%. Figure 1 depicts a swimmer's plot for all patients from time of RS diagnosis and includes timing of RT and cellular therapy (CAR-T or allogeneic stem cell transplant, alloSCT). Heterogeneity in the parameters of radiation utilized reflected diverse clinical situations in this cohort. Across the cohort, most commonly irradiated areas included head and neck sites (n=11), abdomen (n=5), paraspinal (n=4) and pelvis/groin (n=4). Median delivered dose was 30.6 Gy (range: 18-54) and 25 Gy (range: 4.5-45) for the definitively and palliatively-treated patients, respectively. Four patients (3 palliative, 1 consolidative) did not complete prescribed course of RT. We subsequently focused on 21 patients treated with RT as part of a definitive therapeutic strategy. With a median follow-up time of 5.8 (range 0.2 - 18.5) years, median OS was estimated to be 6.8 years from RS diagnosis. Fourteen patients (67%) experienced DLBCL progression following RT. A subset of 12 patients received RT following chemoimmunotherapy without immediate cellular therapy in the front-line setting (58%; 7/12) or relapsed/refractory setting (42%; 5/12). Response at the time of RT was CR/clinical CR in 7 patients (58%), PR in 3 (25%), and PD in 1 (8%); response at the time of RT was unknown for 1 patient. In this subset, four (33%) experienced RS disease relapse with 2 occurring within the prior radiation field and 2 occurring distantly. Two patients received RT as an up-front therapy prior to any chemoimmunotherapy in the setting of localized disease. One of these two subsequently had a DLBCL relapse within the prior radiation field. RT was used as a bridging strategy to cellular therapy in 7 patients including alloSCT (n=4) and CAR-T (n=3). Four patients experienced RS relapse. Estimated median PFS was 1.1 years and median OS was 1.9 years from time of cellular therapy. Conclusion: In the largest single-institution series to describe the use of RT in RS, patients who received RT for the diagnosis of RS experienced favorable long-term survival when used as part of a definitive therapeutic strategy, including consolidation following chemoimmunotherapy and as bridging to cellular therapy. These data suggest a role for RT in the management of RS to be further explored through multicenter collaborations and prospective studies. Figure 1 Figure 1. Disclosures Thompson: VJHemOnc: Honoraria; Curio Science: Honoraria; MJH Life Sciences: Honoraria. Mato: Acerta/AstraZeneca: Consultancy, Research Funding; LOXO: Consultancy, Research Funding; Nurix: Research Funding; Sunesis: Consultancy, Research Funding; Adaptive Biotechnologies: Consultancy, Research Funding; AbbVie: Consultancy, Research Funding; BeiGene: Consultancy, Research Funding; Genentech: Consultancy, Research Funding; Pharmacyclics LLC, an AbbVie Company: Consultancy, Research Funding; Genmab: Research Funding; AstraZeneca: Consultancy; DTRM BioPharma: Consultancy, Research Funding; Janssen: Consultancy, Research Funding; Johnson and Johnson: Consultancy, Research Funding; TG Therapeutics: Consultancy, Other: DSMB, Research Funding; MSKCC: Current Employment. Roeker: AbbVie, AstraZeneca, Janssen, LOXO, Pharmacyclics, TG Therapeutics, Vaniam Group, Verastem: Consultancy; Pfizer: Consultancy, Research Funding; Pharmacyclics: Consultancy; TG Therapeutics: Consultancy; Loxo Oncology: Consultancy; Abbot Laboratories: Current equity holder in publicly-traded company.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    URL: Article
    DOI: 10.1182/blood-2021-153771
    RVK:
    XA 33000
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2021
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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