Bio


Melody Chung, MD is currently a clinical research fellow in the Department of Rheumatology/Immunology at Stanford University under the mentorship of Dr. Lorinda Chung and a Masters student in the Epidemiology and Clinical Research program administered through Stanford's Department of Health Research and Policy.

All Publications


  • Increased Mortality in Black and Asian Patients with Systemic Sclerosis in Northern California Chung, M., Dontsi, M., Postlethwaite, D., Kesh, S., Zaba, L., Chung, L. WILEY. 2018
  • Exploring medical students' barriers to reporting mistreatment during clerkships: a qualitative study. Medical education online Chung, M. P., Thang, C. K., Vermillion, M., Fried, J. M., Uijtdehaage, S. 2018; 23 (1): 1478170

    Abstract

    Despite widespread implementation of policies to address mistreatment, the proportion of medical students who experience mistreatment during clinical training is significantly higher than the proportion of students who report mistreatment. Understanding barriers to reporting mistreatment from students' perspectives is needed before effective interventions can be implemented to improve the clinical learning environment.We explored medical students' reasons for not reporting perceived mistreatment or abuse experienced during clinical clerkships at the David Geffen School of Medicine at UCLA (DGSOM).This was a sequential two-phase qualitative study. In the first phase, we analyzed institutional survey responses to an open-ended questionnaire administered to the DGSOM graduating classes of 2013-2015 asking why students who experienced mistreatment did not seek help or report incidents. In the second phase, we conducted focus group interviews with third- and fourth-year medical students to explore their reasons for not reporting mistreatment. In total, 30 of 362 eligible students participated in five focus groups. On the whole, 63% of focus group participants felt they had experienced mistreatment, of which over half chose not to report to any member of the medical school administration. Transcripts were analyzed via inductive thematic analysis.The following major themes emerged: fear of reprisal even in the setting of anonymity; perception that medical culture includes mistreatment; difficulty reporting more subtle forms of mistreatment; incident is not important enough to report; reporting process damages the student-teacher relationship; reporting process is too troublesome; and empathy with the source of mistreatment. Differing perceptions arose as students debated whether or not reporting was beneficial to the clinical learning environment.Multiple complex factors deeply rooted in the culture of medicine, along with negative connotations associated with reporting, prevent students from reporting incidents of mistreatment. Further research is needed to establish interventions that will help identify mistreatment and change the underlying culture.

    View details for DOI 10.1080/10872981.2018.1478170

    View details for PubMedID 29848223

    View details for PubMedCentralID PMC5990956

  • Pulmonary Ventilation Imaging Based on 4-Dimensional Computed Tomography: Comparison With Pulmonary Function Tests and SPECT Ventilation Images INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS Yamamoto, T., Kabus, S., Lorenz, C., Mittra, E., Hong, J. C., Chung, M., Eclov, N., To, J., Diehn, M., Loo, B. W., Keall, P. J. 2014; 90 (2): 414-422

    Abstract

    4-dimensional computed tomography (4D-CT)-based pulmonary ventilation imaging is an emerging functional imaging modality. The purpose of this study was to investigate the physiological significance of 4D-CT ventilation imaging by comparison with pulmonary function test (PFT) measurements and single-photon emission CT (SPECT) ventilation images, which are the clinical references for global and regional lung function, respectively.In an institutional review board-approved prospective clinical trial, 4D-CT imaging and PFT and/or SPECT ventilation imaging were performed in thoracic cancer patients. Regional ventilation (V4DCT) was calculated by deformable image registration of 4D-CT images and quantitative analysis for regional volume change. V4DCT defect parameters were compared with the PFT measurements (forced expiratory volume in 1 second (FEV1; % predicted) and FEV1/forced vital capacity (FVC; %). V4DCT was also compared with SPECT ventilation (VSPECT) to (1) test whether V4DCT in VSPECT defect regions is significantly lower than in nondefect regions by using the 2-tailed t test; (2) to quantify the spatial overlap between V4DCT and VSPECT defect regions with Dice similarity coefficient (DSC); and (3) to test ventral-to-dorsal gradients by using the 2-tailed t test.Of 21 patients enrolled in the study, 18 patients for whom 4D-CT and either PFT or SPECT were acquired were included in the analysis. V4DCT defect parameters were found to have significant, moderate correlations with PFT measurements. For example, V4DCT(HU) defect volume increased significantly with decreasing FEV1/FVC (R=-0.65, P<.01). V4DCT in VSPECT defect regions was significantly lower than in nondefect regions (mean V4DCT(HU) 0.049 vs 0.076, P<.01). The average DSCs for the spatial overlap with SPECT ventilation defect regions were only moderate (V4DCT(HU)0.39 ± 0.11). Furthermore, ventral-to-dorsal gradients of V4DCT were strong (V4DCT(HU) R(2) = 0.69, P=.08), which was similar to VSPECT (R(2) = 0.96, P<.01).An 18-patient study demonstrated significant correlations between 4D-CT ventilation and PFT measurements as well as SPECT ventilation, providing evidence toward the validation of 4D-CT ventilation imaging.

    View details for DOI 10.1016/j.ijrobp.2014.06.006

    View details for Web of Science ID 000341994400026

  • Correlation of quantitative diffusion-weighted and dynamic contrast-enhanced MRI parameters with prognostic factors in prostate cancer JOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY Chung, M. P., Margolis, D., Mesko, S., Wang, J., Kupelian, P., Kamrava, M. 2014; 58 (5): 588-594

    Abstract

    The aim of this study was to determine if correlations exist between quantitative parameters from dynamic contrast-enhanced (DCE) and diffusion-weighted (DW) MRI with National Comprehensive Cancer Network (NCCN) risk group, Gleason score (GS), maximum tumour diameter (MTD), pre-treatment prostate-specific antigen (PSA), clinical T stage and MRI prostate volume in prostate cancer.We retrospectively reviewed 3T multiparametric MRI reports on biopsy-proven prostate cancer patients performed during radiation treatment evaluation or an active surveillance protocol. DCE-MRI parameters included K(trans) (influx volume transfer coefficient), Kep (efflux reflux rate constant) and iAUC (initial area under the curve). Average DCE and apparent diffusion coefficient (ADC) values were recorded for regions of interest on DW-MRI. Relationships between MRI metrics and risk group, GS, MTD, PSA, clinical T stage and MRI prostate volume were examined using analysis of variance. Central and peripheral tumours were also analysed separately in a sub-analysis. Statistical significance was defined as P < 0.0125.Of 58 patients, 29%, 52% and 19% had low (L), intermediate (I), or high (H) NCCN risk disease, respectively. K(trans) significantly correlated with PSA. For central tumours, K(trans) significantly correlated with MTD and PSA, and Kep significantly correlated with PSA. For peripheral tumours, iAUC was significantly different when stratified by L/I/H risk and GS, and ADC score with L/I/H risk, GS, and clinical T stage.DCE- and DW-MRI metrics correlate with some risk stratification factors in prostate cancer. Further work is required to determine if MRI metrics are complementary or independent prognostic factors.

    View details for DOI 10.1111/1754-9485.12230

    View details for Web of Science ID 000345630000011

    View details for PubMedID 25196228

  • Feasibility and Potential Utility of Multicomponent Exhaled Breath Analysis for Predicting Development of Radiation Pneumonitis After Stereotactic Ablative Radiotherapy JOURNAL OF THORACIC ONCOLOGY More, J. M., Eclov, N. C., Chung, M. P., Wynne, J. F., Shorter, J. H., Nelson, D. D., Hanlon, A. L., Burmeister, R., Banos, P., Maxim, P. G., Loo, B. W., Diehn, M. 2014; 9 (7): 957-964

    Abstract

    In this prospective pilot study, we evaluated the feasibility and potential utility of measuring multiple exhaled gases as biomarkers of radiation pneumonitis (RP) in patients receiving stereotactic ablative radiotherapy (SABR) for lung tumors.Breath analysis was performed for 26 patients receiving SABR for lung tumors. Concentrations of exhaled nitric oxide (eNO), carbon monoxide (eCO), nitrous oxide (eN2O), and carbon dioxide (eCO2) were measured before and immediately after each fraction using real-time, infrared laser spectroscopy. RP development (CTCAE grade ≥2) was correlated with baseline gas concentrations, acute changes in gas concentrations after each SABR fraction, and dosimetric parameters.Exhaled breath analysis was successfully completed in 77% of patients. Five of 20 evaluable patients developed RP at a mean of 5.4 months after SABR. Acute changes in eNO and eCO concentrations, defined as percent changes between each pre-fraction and post-fraction measurement, were significantly smaller in RP versus non-RP cases (p = 0.022 and 0.015, respectively). In an exploratory analysis, a combined predictor of baseline eNO greater than 24 parts per billion and acute decrease in eCO less than 5.5% strongly correlated with RP incidence (p =0.0099). Neither eN2O nor eCO2 concentrations were significantly associated with RP development. Although generally higher in patients destined to develop RP, dosimetric parameters were not significantly associated with RP development.The majority of SABR patients in this pilot study were able to complete exhaled breath analysis. Baseline concentrations and acute changes in concentrations of exhaled breath components were associated with RP development after SABR. If our findings are validated, exhaled breath analysis may become a useful approach for noninvasive identification of patients at highest risk for developing RP after SABR.

    View details for DOI 10.1097/JTO.0000000000000182

    View details for Web of Science ID 000338025600015

  • Dosimetric Comparison of 3-Dimensional Planning Techniques Using an Intravaginal Multichannel Balloon Applicator for High-Dose-Rate Gynecologic Brachytherapy INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS Park, S., Chung, M., Demanes, D. J., Banerjee, R., Steinberg, M., Kamrava, M. 2013; 87 (4): 840-846

    Abstract

    To study the dosimetric differences of various channel combinations of the Capri vaginal applicator.The Capri consists of a single central channel (R1), an inner array of 6 channels (R2), and an outer array of 6 channels (R3). Three-dimensional plans were simulated for 6 channel arrangements (R1, R2, R12, R13, R23, and R123). Treatment plans were optimized to the applicator surface or 5-mm depth while minimizing dose to organs at risk (OARs: bladder, rectum, sigmoid, and urethra). The clinical target volume (CTV) was defined as a 5-mm circumferential shell extending 4 cm in length around the applicator. Clinical target volume coverage (Dmean, D90, V100, and V150) and OAR doses (D0.1 cm3, D1 cm3, D2 cm3, and Dmean) were compared. A comparison between the Capri (R123) and a conventional single-channel applicator was also done. Statistical significance (P value<.05) was evaluated with a 2-tailed t test.When prescribing to 5-mm depth, CTV coverage using all 13 channels (R123) versus a single channel (R1) was similar; however, when prescribing to the surface there were differences (P<.0001) in all CTV metrics except for the V150. The R1 plans had higher doses to all OARs compared with R123 plans (P<.007). Doses to OARs were not significantly different between R23 and R123 plans (P=.05-.95), and CTV coverage differences were on the order of 1%. Capri R123 plans provided slightly lower CTV D90 and Dmean but equivalent OAR doses with smaller standard deviations compared with conventional cylinder plans for both prescriptions.The Capri multichannel applicator provides equivalent target coverage at 5-mm depth, with significantly reduced dose to OARs relative to using a single channel. Optimal plans can be achieved using R12 (lowest V150) or R123 or R23 (lowest OAR doses).

    View details for DOI 10.1016/j.ijrobp.2013.08.008

    View details for Web of Science ID 000325763300039

    View details for PubMedID 24138921

  • Safety of (90)y radioembolization in patients who have undergone previous external beam radiation therapy. International journal of radiation oncology, biology, physics Lam, M. G., Abdelmaksoud, M. H., Chang, D. T., Eclov, N. C., Chung, M. P., Koong, A. C., Louie, J. D., Sze, D. Y. 2013; 87 (2): 323-329

    Abstract

    Previous external beam radiation therapy (EBRT) is theoretically contraindicated for yttrium-90 ((90)Y) radioembolization (RE) because the liver has a lifetime tolerance to radiation before becoming vulnerable to radiation-induced liver disease. We analyzed the safety of RE as salvage treatment in patients who had previously undergone EBRT.Between June 2004 and December 2010, a total of 31 patients who had previously undergone EBRT were treated with RE. Three-dimensional treatment planning with dose-volume histogram (DVH) analysis of the liver was used to calculate the EBRT liver dose. Liver-related toxicities including RE-induced liver disease (REILD) were reviewed and classified according to Common Terminology Criteria for Adverse Events version 4.02.The mean EBRT and RE liver doses were 4.40 Gy (range, 0-23.13 Gy) and 57.9 Gy (range, 27.0-125.9 Gy), respectively. Patients who experienced hepatotoxicity (≥grade2; n=12) had higher EBRT mean liver doses (7.96 ± 8.55 Gy vs 1.62 ± 3.39 Gy; P=.037), the only independent predictor in multivariate analysis. DVH analysis showed that the fraction of liver exposed to ≥30 Gy (V30) was the strongest predictor of hepatotoxicity (10.14% ± 12.75% vs 0.84% ± 3.24%; P=.006). All patients with V30 >13% experienced hepatotoxicity. Fatal REILD (n=2) occurred at the 2 highest EBRT mean liver doses (20.9 Gy and 23.1 Gy) but also at the highest cumulative liver doses (91.8 Gy and 149 Gy).Prior exposure of the liver to EBRT may lead to increased liver toxicity after RE treatment, depending on fractional liver exposure and dose level. The V30 was the strongest predictor of toxicity. RE appears to be safe for the treatment of hepatic malignancies only in patients who have had limited hepatic exposure to prior EBRT.

    View details for DOI 10.1016/j.ijrobp.2013.05.041

    View details for PubMedID 23849697

  • Radiotherapy for nonadenoid cystic carcinomas of major salivary glands. American journal of otolaryngology Chung, M. P., Tang, C., Chan, C., Hara, W. Y., Loo, B. W., Kaplan, M. J., Fischbein, N., Le, Q., Chang, D. T. 2013; 34 (5): 425-430

    Abstract

    To report outcomes in patients treated with postoperative radiotherapy for nonadenoid cystic carcinomas of the major salivary glands.From 1998-2011, 37 patients with nonadenoid cystic carcinomas of the major salivary gland underwent postoperative radiotherapy. The median radiation dose was 60 Gy (range, 45-70 Gy). TNM distribution included T1-2 (n=16, 44%), T3-T4 (n=21, 56%), N0 (n=19, 51%), and N+ (n=18, 49%). Histologies included adenocarcinoma (n=13, 35%), squamous cell carcinoma (n=8, 22%), mucoepidermoid carcinoma (n=8, 22%), and other (n=8, 21%). Median follow-up was 4.7 years for all patients (range, 0.3-14.1 years) and 5.0 years for living patients (range, 1.2-12.2 years).Five-year local-regional control, overall survival (OS), and cancer-specific survival (CSS) were 97%, 76%, and 84%. On univariate analysis, OS was significantly worse for patients ≥65 years old (p=0.04). CSS was significantly worse for positive perineural invasion (p=0.02), extraparenchymal extension (p=0.04), and in patients who received no chemotherapy (p=0.02). Doses >60 Gy was significantly worse for OS (p=0.003) and CSS (p=0.003), although these patients had higher TNM (>T2, p=0.01) and trended towards a higher rate of extraparenchymal extension (p=0.08). Four patients (11%) developed ≥grade 2 toxicities; 3 patients developed early toxicities and one patient developed late toxicities.Radiotherapy for salivary gland tumors provides excellent local-regional control when combined with surgery. Distant metastasis is the predominant pattern of failure, although chemotherapy seemed to improve cancer-specific survival.

    View details for DOI 10.1016/j.amjoto.2013.03.007

    View details for PubMedID 23583094

  • Focal high-dose-rate brachytherapy: A dosimetric comparison of hemigland vs. conventional whole-gland treatment BRACHYTHERAPY Kamrava, M., Chung, M. P., Kayode, O., Wang, J., Marks, L., Kupelian, P., Steinberg, M., Park, S., Demanes, D. J. 2013; 12 (5): 434-441

    Abstract

    To determine the utility of focal high-dose-rate brachytherapy for localized prostate cancer, we investigated the impact on target coverage and dose to organs at risk (OARs) with hemigland (HG) compared with whole-gland (WG) treatment.A total of 10 WG implants were used to generate 10 WG and 20 HG (left and right) treatment plans optimized with the inverse planning simulation annealing algorithm using Oncentra MasterPlan (Nucletron B.V., Veenendaal, The Netherlands). The standard distribution of 17-18 catheters designed for WG was used to generate HG plans. The same OARs namely bladder, rectum, and urethra contours and dose constraints were applied for HG and WG plans. The HG contour was a modification of the WG contour whereby the urethra divided the prostate into HGs. The prescription dose was 7.25 Gy×6. Evaluated dose parameters were target dose D90, V100, and V150 and D0.1 cc, D1 cc, and D2 cc to OARs.The HG plans had a D90, V100, and V150 to the HG target of 112%, 97.6%, and 33.8%, respectively. The WG plans had a D90, V100, and V150 to the WG target of 108%, 98.8%, and 26.5%, respectively. The OAR D2 cc doses were significantly lower in HG vs. WG plans: rectum (53.1% vs. 64.1%, p<0.0001), bladder (55.9% vs. 67.5%, p<0.0001), and urethra (69.3% vs. 95.2%, p<0.0001).In the present model, HG plans yielded a statistically significant decreased radiation dose to OARs and provided complete target coverage with a catheter array designed for WG coverage. The good dosimetry results obtained in this study support the feasibility of HG brachytherapy by using a subset of the WG catheter array. Catheter distribution and dosimetry refinements tailored to subtotal prostate brachytherapy should be explored to see if further improvements in dosimetry can be achieved.

    View details for DOI 10.1016/j.brachy.2012.09.002

    View details for Web of Science ID 000324657400010

    View details for PubMedID 23406987

  • Electronic brachytherapy for postsurgical adjuvant vaginal cuff irradiation therapy in endometrial and cervical cancer: A retrospective study BRACHYTHERAPY Kamrava, M., Chung, M. P., DeMarco, J., Kayode, O., Park, S., Borja, L., Chow, L., Lee, S. P., Steinberg, M. L., Demanes, D. J. 2013; 12 (2): 141-147

    Abstract

    A new platform for brachytherapy called electronic brachytherapy (EBT) has been developed, which uses a miniature X-ray source to generate low-energy radiation. A retrospective study of adverse events and clinical outcomes in patients treated with EBT to the vaginal cuff, either as monotherapy or in combination with external beam radiation therapy (EBRT), was conducted.Medical records were reviewed from 16 patients treated with postoperative EBT for endometrial (n=13) or cervical cancer (n=3) between February 2009 and November 2010. Patients received either intracavitary vaginal EBT alone or EBT in combination with EBRT. The radiobiologic effectiveness of EBT was assumed to be one.Median follow-up was 20.5 months (range, 7-36 months). When EBT was used alone (n=5), the median dose per fraction, number of fractions, and total dose delivered were: 6Gy (range, 5.5-6.2Gy), 5 fractions (range, 5-6), and 30Gy (range, 30-34Gy), respectively. When EBT was combined with EBRT, the EBT component median dose per fraction, number of fractions, and total dose delivered were: 5Gy (range, 4.5-7Gy), 2 fractions (range, 2-4), and 14Gy (range, 9-20Gy), respectively. The median EBRT dose was 45Gy (range, 45-49.2Gy). Our local control rate, locoregional (pelvic) control rate, and overall survival rate were 94%, 94%, and 88%, respectively. Of the 16 patients, 4 patients reported Grade 2 or greater toxicity (25%); however, there were no Grade 4-5 adverse events. Gynecologic, genitourinary, and gastrointestinal adverse events accounted for 57% (n=4), 43% (n=3), and 0% (n=0) of all Grade 2 or greater side effects. No Grade 2 or higher toxicities were noted in patients treated with EBT alone.EBT is an acceptable means of delivering postoperative vaginal brachytherapy and appears comparable with other methods; as the sole method of treatment, the toxicity rates of EBT are low.

    View details for DOI 10.1016/j.brachy.2012.04.003

    View details for Web of Science ID 000316371900008

    View details for PubMedID 22748291

  • Predictors of distant metastasis after combined HDR brachytherapy and external beam radiation for prostate cancer JOURNAL OF CONTEMPORARY BRACHYTHERAPY Kamrava, M., Rwigema, J., Chung, M., Banerjee, R., Wang, J., Steinberg, M., Demanes, D. J. 2013; 5 (3): 127-133

    Abstract

    To determine predictors of distant metastases (DM) in prostate cancer patients treated with high dose rate brachytherapy boost (HDR-B) and external beam radiation therapy (EBRT).From 1991 to 2002, 768 men with localized prostate cancer were treated with HDR-B and EBRT. The mean EBRT dose was 37.5 Gy (range: 30.6-45 Gy), and the HDR-B was 22 or 24 Gy delivered in 4 fractions. Univariate and multivariate analyses using a Cox proportional hazards model including age at diagnosis, T stage, Gleason score (GS), pretreatment PSA, biologically equivalent dose (BED), and use of androgen deprivation therapy (ADT) was used to determine predictors of developing distant metastases.The median follow-up time for the entire patient population was 4.2 years (range: 1-11.2 years). Distant metastases were identified in 22/768 (3%) of patients at a median of 4.1 years. PSA failure according to the Phoenix definition developed in 3%, 5%, and 14% of men with low, intermediate, and high risk disease with a median time to failure of 3.8 years. Prostate cancer specific mortality was observed in 2% of cases. T stage, GS, and use of ADT were significantly associated with developing DM on univariate analysis. GS, and use of ADT were the only factors significantly associated with developing DM on multivariate analysis (p < 0.01). Patients who received ADT had significantly higher risk features suggesting patient selection bias for higher DM in this group of patients rather than a negative interaction between HDR-B and EBRT.In men treated with HDR-B and EBRT, GS is a significant factor on multivariate analysis for developing distant metastasis.

    View details for DOI 10.5114/jcb.2013.37942

    View details for Web of Science ID 000338353100003

    View details for PubMedID 24143146

    View details for PubMedCentralID PMC3797412

  • Reproducibility of Four-dimensional Computed Tomography-based Lung Ventilation Imaging ACADEMIC RADIOLOGY Yamamoto, T., Kabus, S., von Berg, J., Lorenz, C., Chung, M. P., Hong, J. C., Loo, B. W., Keall, P. J. 2012; 19 (12): 1554-1565

    Abstract

    A novel ventilation imaging method based on four-dimensional (4D) computed tomography (CT) has been applied to the field of radiation oncology. Understanding its reproducibility is a prerequisite for clinical applications. The purpose of this study was to quantify the reproducibility of 4D CT ventilation imaging over different days and the same session.Two ventilation images were created from repeat 4D CT scans acquired over the average time frames of 15 days for 6 lung cancer patients and 5 minutes for another 6 patients. The reproducibility was quantified using the voxel-based Spearman rank correlation coefficients for all lung voxels and Dice similarity coefficients (DSC) for the spatial overlap of segmented high-, moderate-, and low-functional lung volumes. Furthermore, the relationship between the variation in abdominal motion range as a measure of the depth of breathing and variation in ventilation was evaluated using linear regression.The voxel-based correlation between the two ventilation images was moderate on average (0.50 ± 0.15). The DSCs were also moderate for the high- (0.60 ± 0.08), moderate- (0.46 ± 0.06), and low-functional lung (0.58 ± 0.09). No patients demonstrated strong correlations. The relationship between the motion range variation and ventilation variation was found to be moderate and significant.We investigated the reproducibility of 4D CT ventilation imaging over the time frames of 15 days and 5 minutes and found that it was only moderately reproducible. Respiratory variation during 4D CT scans was found to deteriorate the reproducibility. Improvement of 4D CT imaging is necessary to increase the reproducibility of 4D CT ventilation imaging.

    View details for DOI 10.1016/j.acra.2012.07.006

    View details for PubMedID 22975070

  • Intensity-Modulated Radiotherapy for Tumors of the Nasal Cavity and Paranasal Sinuses: Clinical Outcomes and Patterns of Failure 52nd Annual Meeting of the American-Society-for-Therapeutic-Radiation-Oncology (ASTRO) Wiegner, E. A., Daly, M. E., Murphy, J. D., Abelson, J., Chapman, C. H., Chung, M., Yu, Y., Colevas, A. D., Kaplan, M. J., Fischbein, N., Quynh-Thu Le, Q. T., Chang, D. T. ELSEVIER SCIENCE INC. 2012: 243–51

    Abstract

    To report outcomes in patients treated with intensity-modulated radiotherapy (IMRT) for tumors of the paranasal sinuses and nasal cavity (PNS/NC).Between June 2000 and December 2009, 52 patients with tumors of the PNS/NC underwent postoperative or definitive radiation with IMRT. Twenty-eight (54%) patients had squamous cell carcinoma (SCC). Twenty-nine patients (56%) received chemotherapy. The median follow-up was 26.6 months (range, 2.9-118.4) for all patients and 30.9 months for living patients.Eighteen patients (35%) developed local-regional failure (LRF) at median time of 7.2 months. Thirteen local failures (25%) were observed, 12 in-field and 1 marginal. Six regional failures were observed, two in-field and four out-of-field. No patients treated with elective nodal radiation had nodal regional failure. Two-year local-regional control (LRC), in-field LRC, freedom from distant metastasis (FFDM), and overall survival (OS) were 64%, 74%, 71%, and 66% among all patients, respectively, and 43%, 61%, 61%, and 53% among patients with SCC, respectively. On multivariate analysis, SCC and >1 subsite involved had worse LRC (p = 0.0004 and p = 0.046, respectively) and OS (p = 0.003 and p = 0.046, respectively). Cribriform plate invasion (p = 0.005) and residual disease (p = 0.047) also had worse LRC. Acute toxicities included Grade ≥3 mucositis in 19 patients (37%), and Grade 3 dermatitis in 8 patients (15%). Six patients had Grade ≥3 late toxicity including one optic toxicity.IMRT for patients with PNS/NC tumors has good outcomes compared with historical series and is well tolerated. Patients with SCC have worse LRC and OS. LRF is the predominant pattern of failure.

    View details for DOI 10.1016/j.ijrobp.2011.05.044

    View details for PubMedID 22019239

  • Intensity-Modulated Radiotherapy for Pancreatic Adenocarcinoma 51st Annual Meeting of the American-Society-for-Radiation-Oncology (ASTRO) Abelson, J. A., Murphy, J. D., Minn, A. Y., Chung, M., Fisher, G. A., Ford, J. M., Kunz, P., Norton, J. A., Visser, B. C., Poultsides, G. A., Koong, A. C., Chang, D. T. ELSEVIER SCIENCE INC. 2012: E595–E601

    Abstract

    To report the outcomes and toxicities in patients treated with intensity-modulated radiotherapy (IMRT) for pancreatic adenocarcinoma.Forty-seven patients with pancreatic adenocarcinoma were treated with IMRT between 2003 and 2008. Of these 47 patients, 29 were treated adjuvantly and 18 definitively. All received concurrent 5-fluorouracil chemotherapy. The treatment plans were optimized such that 95% of the planning target volume received the prescription dose. The median delivered dose for the adjuvant and definitive patients was 50.4 and 54.0 Gy, respectively.The median age at diagnosis was 63.9 years. For adjuvant patients, the 1- and 2-year overall survival rate was 79% and 40%, respectively. The 1- and 2-year recurrence-free survival rate was 58% and 17%, respectively. The local-regional control rate at 1 and 2 years was 92% and 80%, respectively. For definitive patients, the 1-year overall survival, recurrence-free survival, and local-regional control rate was 24%, 16%, and 64%, respectively. Four patients developed Grade 3 or greater acute toxicity (9%) and four developed Grade 3 late toxicity (9%).Survival for patients with pancreatic cancer remains poor. A small percentage of adjuvant patients have durable disease control, and with improved therapies, this proportion will increase. Systemic therapy offers the greatest opportunity. The present results have demonstrated that IMRT is well tolerated. Compared with those who received three-dimensional conformal radiotherapy in previously reported prospective clinical trials, patients with pancreatic adenocarcinoma treated with IMRT in our series had improved acute toxicity.

    View details for DOI 10.1016/j.ijrobp.2011.09.035

    View details for PubMedID 22197234