Journal articles: 'Sloar radiation'

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SHEN Hong-jun, 沈宏君, 张瑞 ZHANG Rui, and 卢辉东 LU Hui-dong. "Design of An Amorphous Silicon Thin-film Sloar Cell with Absorption Enhancement." Chinese Journal of Luminescence 34, no. 6 (2013): 753–57. http://dx.doi.org/10.3788/fgxb20133406.0753.

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Leibel, Steven A., Gerald J. Kutcher, Radhe Mohan, Louis B. Harrison, John G. Armstrong, Michael J. Zelefsky, Thomas J. LoSasso, et al. "Three-dimensional conformal radiation therapy at the Memorial Sloan-Kettering Cancer Center." Seminars in Radiation Oncology 2, no. 4 (October 1992): 274–89. http://dx.doi.org/10.1016/1053-4296(92)90025-g.

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Roelofs, G. H. A., P. J. Groot, D. Steeghs, and G. Nelemans. "SDSS J1240-01: A New AM CVn Candidate from the Sloan Digital Sky Survey." International Astronomical Union Colloquium 194 (July 2004): 254. http://dx.doi.org/10.1017/s0252921100152996.

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A better understanding of the AM CVn population is crucial to constrain their candidacy as SN Ia progenitors, to test binary evolution (in particular the common-envelope phase), and to predict their observable gravitational radiation signature. An AM CVn dedicated search in the Sloan Digital Sky Survey-DRl resulted in the discovery of SDSS J124058.03-015919.2, a new AM CVn candidate previously identified as a DB white dwarf in the 2dF quasar survey.

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La, Trang H., Paul A. Meyers, Leonard H. Wexler, Kaled M. Alektiar, John H. Healey, Michael P. Laquaglia, Patrick J. Boland, and Suzanne L. Wolden. "Radiation therapy for Ewing’s sarcoma: Results from Memorial Sloan-Kettering in the modern era." International Journal of Radiation Oncology*Biology*Physics 64, no. 2 (February 2006): 544–50. http://dx.doi.org/10.1016/j.ijrobp.2005.07.299.

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Nicholls, Ralph. "A practical guide to intensity-modulated radiation therapy Authors: Memorial Sloan-Kettering Cancer Center." Australasian Physics & Engineering Sciences in Medicine 26, no. 4 (December 2003): 200. http://dx.doi.org/10.1007/bf03179182.

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Lebenthal, Justin, Junting Zheng, Paul A. Glare, Eileen Mary O'Reilly, and Andrew S. Epstein. "Prognostic value of the Memorial Sloan Kettering (MSK) prognostic score (MPS) in pancreatic ductal adenocarcinoma (PDAC)." Journal of Clinical Oncology 37, no. 31_suppl (November 1, 2019): 133. http://dx.doi.org/10.1200/jco.2019.37.31_suppl.133.

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133 Background: The MPS, a composite of the Neutrophil-Lymphocyte Ratio (NLR) and albumin, is an alternative prognostic tool to the Glasgow Prognostic Score (C-reactive protein and albumin). A retrospective analysis (jco.2016.34.26_suppl.36) of patients with PDAC suggested that the MPS predicts survival. This did not control for clinically relevant factors such as performance status (PS), metastatic sites, or cancer therapies. More discriminating prognostic tools are needed. Methods: A retrospective chart review identified patients at MSK with pathology-confirmed stage IV PDAC diagnosed from 2011 to 2014. An MPS scale of 0-2 was utilized: MPS = 0 for albumin ≥ 4 g/dl and NLR ≤ 4 g/dl, MPS = 1 for either albumin < 4 g/dl or NLR > 4 g/dl, and MPS = 2 for albumin < 4 g/dl and NLR > 4 g/dl. PS (ECOG or KPS) was abstracted from outpatient visit notes. Metastatic sites at initial MSK visit were assessed from cross-sectional imaging. Cancer therapies were characterized as 5FU-based, gemcitabine-based, experimental, and radiation to primary or metastatic sites. Thromboembolic (TE) diagnoses were also noted. Time-dependent Cox regression analyses identified clinical variables associated with overall survival (OS). Univariately significant variables were utilized in a multivariable regression model to interrogate their effect on the association of MPS and OS. Results: Univariate analyses in n = 833 stage IV PDAC patients identified higher MPS score, higher CA19-9 at diagnosis (n = 737), chemo, radiation, liver metastases, TE, hospital admission, and lower PS (n = 727) as associated with worse OS (p < 0.05). A multivariate model (n = 727) controlling for radiation, liver metastases, TE, admission, and PS demonstrated that higher MPS scores at diagnosis remained associated with worse OS (p < 0.001). Median OS in patients with MPS 0, 1, and 2 were 14.5 (95%CI: 12.9-17), 10.2 (9-11.6), and 6.2 (5.1-8.1) months, respectively. Conclusions: The MPS is an objective prognostic tool associated with OS in advanced PDAC independent of PS, disease characteristics, and types of cancer therapies. Future directions include prospective evaluation and application of the MPS to other PDAC disease settings and other malignancies.

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Chu, Florence C. H. "A Personal Reflection on the History of Radiation Oncology at Memorial Sloan-Kettering Cancer Center." International Journal of Radiation Oncology*Biology*Physics 80, no. 3 (July 2011): 845–50. http://dx.doi.org/10.1016/j.ijrobp.2010.02.027.

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Gapany, M. "Intensity-modulated radiation therapy (IMRT) for nasopharynx cancer: Update of the Memorial Sloan-Kettering experience." Yearbook of Otolaryngology-Head and Neck Surgery 2007 (January 2007): 276–77. http://dx.doi.org/10.1016/s1041-892x(07)70230-5.

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Chen, W. C. Y., M. J. Zelefsky, D. G. Pfister, S. L. Berry, D. H. Kraus, and S. L. Wolden. "Intensity modulated radiation therapy (IMRT) for nasopharynx cancer: Update of the Memorial Sloan-Kettering experience." Journal of Clinical Oncology 23, no. 16_suppl (June 2005): 5541. http://dx.doi.org/10.1200/jco.2005.23.16_suppl.5541.

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Wolden, Suzanne L., William C. Chen, David G. Pfister, Dennis H. Kraus, Sean L. Berry, and Michael J. Zelefsky. "Intensity-modulated radiation therapy (IMRT) for nasopharynx cancer: Update of the Memorial Sloan-Kettering experience." International Journal of Radiation Oncology*Biology*Physics 64, no. 1 (January 2006): 57–62. http://dx.doi.org/10.1016/j.ijrobp.2005.03.057.

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Bian, Fuyan, Lisa J. Kewley, Brent Groves, and Michael A. Dopita. "What drives the redshift evolution of strong emission line ratios?" Monthly Notices of the Royal Astronomical Society 493, no. 1 (January 29, 2020): 580–85. http://dx.doi.org/10.1093/mnras/staa259.

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ABSTRACT We study the physical mechanisms that cause the offset between low-redshift and high-redshift galaxies on the [O iii] λ5007/H β versus [N ii] λ6584/H α ‘Baldwin, Phillips & Terlevich’ (BPT) diagram using a sample of local analogues of high-redshift galaxies. These high-redshift analogue galaxies are selected from the Sloan Digital Sky Survey. Located in the same region on the BPT diagram as the ultraviolet selected galaxies at z ∼ 2, these high-redshift analogue galaxies provide an ideal local benchmark to study the offset between the local and high-redshift galaxies on the BPT diagram. We compare the nitrogen-to-oxygen ratio (N/O), the shape of the ionizing radiation field, and ionization parameters between the high-redshift analogues and a sample of local reference galaxies. The higher ionization parameter in the high-redshift analogues is the dominant physical mechanism driving the BPT offset from low- to high-redshift, particularly at high [N ii] λ6584/H α. Furthermore, the N/O ratio enhancement also plays a minor role to cause the BPT offset. However, the shape of the ionizing radiation field is unlikely to cause the BPT offset because the high-redshift analogues have a similar hard ionizing radiation field as local reference galaxies. This hard radiation field cannot be produced by the current standard stellar synthesis models. The stellar rotation and binarity may help solve the discrepancy.

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Liu, Jinzhong, and Yu Zhang. "The gravitational wave signal from close galaxy pairs." Proceedings of the International Astronomical Union 10, S312 (August 2014): 296–97. http://dx.doi.org/10.1017/s1743921315008054.

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AbstractThe early phase of coalescence of supermassive black hole binaries (SMBHBs) from their host galaxies provides a guaranteed source of low-frequency gravitational wave (GW) radiation by pulsar timing observations. Nowadays, SMBHBs are ubiquitous in the nuclei of galaxies. A latest sample of close galaxy pairs has been released from the Sloan Digital Sky Survey (SDSS) Data. A binary population synthesis (BPS) approach has been applied to study the characteristics of clusters and galaxies. Here we report how BPS, using SDSS results, can be used to determine the GW radiation from SMBHBs. In this study we show numerical results under the assumption that SMBHBs formed through the merger of two galaxies and give the waveform evolution using post-Newtonian approximation methods. Based on the sensitivity of the International Pulsar Timing Array (IPTA) and Square Kilometer Array (SKA) detectors, we show that the value of strain amplitude h can be changed from about 10−14 to 10−15 during the observation of 20 years, which can be considered as a precise evolution.

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Shah, Neil J., Nadia Bahadur, Lauren Esposito, Andrew Niederhausern, Chelsea Nichols, Anjali Pillai, Fenil Gandhi, et al. "A comprehensive Memorial Sloan Kettering Cancer Center real-world data model: Core clinical data elements." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e18755-e18755. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e18755.

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e18755 Background: The 2016 21st Century Cures Act supports the use of Real-World Data (RWD) for regulatory decision/approval. Due to technological advances, a vast amount of health-related data are now available, but most are not standardized nor readily useable for research. Also, currently available standardized RWD models are not applicable across cancer types or oncology specialties (surgery, medical oncology, radiation oncology, pathology, radiology, etc.). To address these deficiencies Memorial Sloan Kettering Cancer Center (MSKCC) built a comprehensive, pan-cancer, pan-specialty RWD model. Methods: The Core Clinical Data Element (CCDE) data model incorporates aspects of existing academic and biopharma data models, including PRISSMM framework, ASCO’s mCODE, and NAACCR tumor registry model. The data model encompasses 11 domains that are critical to the understanding of the patient’s cancer journey, including: demographic, comorbidities, diagnosis, pathology, imaging, genomics, cancer surgeries, radiation oncology treatments, medical oncology treatments, cancer status/progression, and additional health information. To align with current standards, we are using ICD-10, ICDO3, CTACE V5.0, HL7, SNOMED and LOINC code sets. Further, this adaptable model allows for 5-10 disease specific elements to accommodate for disease heterogenicity and capture the differences among cancer types. Results: The CCDE database includes 1,126 of total data elements. MSKCC has 52,704 patients with MSK-IMPACT (Next-Generation sequencing platform with 505 genes panel) testing of which, we have identified 1,132 bladder cancer patients with at-least one year of cancer care follow-up for the initial curation cohort. Patients were identified as having an OncoTree bladder tumor type code that is assigned by a pathologist who attests the diagnosis by reviewing results from clinical tests on tumor specimens. To the date, 641 patients including 46,415 curated forms have been curated (Table). Conclusions: The comprehensive MSKCC’s CCDE data model standardizes the common and critical pan-cancer and pan-specialty elements for RWD. The dataset resulting from this curation efforts will provide robust structured and unified genomic and phenomic data across tumor types for future research enabling greater collaboration across various cancer types as well as oncology specialties.[Table: see text]

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Katsoulakis, Evangelia, Nadeem Riaz, Brett Cox, James Mechalakos, Joan Zatcky, Mark Bilsky, and Yoshiya Yamada. "Delivering a third course of radiation to spine metastases using image-guided, intensity-modulated radiation therapy." Journal of Neurosurgery: Spine 18, no. 1 (January 2013): 63–68. http://dx.doi.org/10.3171/2012.9.spine12433.

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Object The objective of this study was to investigate the feasibility and safety of delivering a third course of radiation to patients with multiply recurrent metastatic disease to the spine. Methods Between 2009 and 2011, 10 patients received a third course of radiation to spinal metastases at Memorial Sloan–Kettering Cancer Center using image-guided intensity-modulated radiation therapy (IMRT). Patient and tumor characteristics, dosimetry details, and outcomes were obtained using retrospective chart review. Spinal imaging was performed prior to treatment and at regular follow-up intervals. The cumulative biologically effective dose (BED) to the spinal cord and cauda equina was calculated and was normalized to 2 Gy equivalents (Gy2/2). Toxicity and local control were assessed. Results The median time between the first and second courses of radiation was 18.5 months and the median time between the second and third courses was 11.5 months. The median follow-up from the third course of radiation was 12 months and the median overall survival was 13 months. Pain or neurological symptoms were improved in 80% of patients. The median spinal cord maximum dose normalized BED (nBED) for the whole cohort was 70.73 Gy2/2 (range 51.9–101.7 Gy2/2). The median dose to 5% of the spinal cord D05 nBED for the entire cohort was 59.4 Gy2/2. Acute toxicity was most commonly fatigue and dermatitis, with 1 patient experiencing Grade 3 fatigue and 1 patient Grade 3 dermatitis. Late toxicity was limited to 2 cases of Grade 1 dysphagia. There was 1 case of Grade 1 neuropathy and 1 case of Grade 2 neuropathy. The crude rate of local control was 80% with 1 in-field failure and 1 marginal failure. Conclusions In this cohort of patients, a third course of IMRT to the spine was well tolerated with no significant late toxicities. Used as salvage therapy for select patients, a third course of radiation is a safe and effective treatment strategy.

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Kollmeier, Marisa, Chu-Cheng Kan, Bernard Bochner, Guido Dalbagni, Dean F. Bajorin, and Michael J. Zelefsky. "External beam radiotherapy for small cell carcinoma of the urinary bladder: The Memorial Sloan-Kettering experience." Journal of Clinical Oncology 30, no. 5_suppl (February 10, 2012): 290. http://dx.doi.org/10.1200/jco.2012.30.5_suppl.290.

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290 Background: To report our experience using definitive external beam radiotherapy for small cell carcinoma of the urinary bladder. Methods: We reviewed records of 17 patients (14 male, 3 female) with small cell carcinoma of the urinary bladder treated at our institution with external beam radiation therapy (median dose 64.8Gy) for small cell carcinoma of the bladder between January 1994 and June 2011. Median age was 69 years. Sixteen (94.1%) patients received neoadjuvant and/or concurrent platinum-based chemotherapy. All patients underwent pretreatment maximal transurethral resection (visibly complete (n=7); incomplete (n=10). Seven patients had radiographic or pathologic evidence of nodal spread. Patients were followed with cystoscopy and radiographic imaging post-RT. Median followup was 7 months (range, 2-161 mos). Acute (<90days) and late (≥90days) toxicity was recorded using CTCAE v 3.0. Kaplan Meier method was used for survival analysis. Results: The 2-year overall survival was 62%. Of 17 patients, 3 patients developed local recurrence (LR) with a median time to local recurrence of 19 months. Two of three patients had noninvasive LR managed with transurethral resection and had no evidence of disease at last followup. One patient with invasive LR had both LR and distant metastasis identified <3 months after RT. Four patients developed distant metastases at a median time to progression of 2.5mos in bone (n=2), lung (n=1), and retroperitoneal lymph nodes (n=1). All but one patient with distant metastases had node-positive disease at diagnosis. The 2y distant metastasis-free survival for node (-) and node (+)patients was 90% and 30% (p=0.03). Of 12 patients currently without evidence of disease, 5 have followup ≥30mos. The incidence of grade ≥2 acute and late GU/GI toxicity was 53% and 6% respectively. Conclusions: Bladder preservation therapy for small cell carcinoma is feasible with encouraging early results. Nodal disease portends a poor prognosis. Brain metastases are uncommon suggesting a limited role for prophylactic cranial irradiation. Radiation therapy with concurrent platinum-based chemotherapy was associated with a low risk of late GU/GI toxicity in our cohort.

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de Arruda, Fernando F., Dev R. Puri, Joanne Zhung, Ashwatha Narayana, Suzanne Wolden, Margie Hunt, Hilda Stambuk, et al. "Intensity-modulated radiation therapy for the treatment of oropharyngeal carcinoma: The Memorial Sloan-Kettering Cancer Center experience." International Journal of Radiation Oncology*Biology*Physics 64, no. 2 (February 2006): 363–73. http://dx.doi.org/10.1016/j.ijrobp.2005.03.006.

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Abrey, Lauren E., Leah Ben-Porat, Katherine S. Panageas, Joachim Yahalom, Brian Berkey, Walter Curran, Christopher Schultz, et al. "Primary Central Nervous System Lymphoma: The Memorial Sloan-Kettering Cancer Center Prognostic Model." Journal of Clinical Oncology 24, no. 36 (December 20, 2006): 5711–15. http://dx.doi.org/10.1200/jco.2006.08.2941.

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Purpose The purpose of this study was to analyze prognostic factors for patients with newly diagnosed primary CNS lymphoma (PCNSL) in order to establish a predictive model that could be applied to the care of patients and the design of prospective clinical trials. Patients and Methods Three hundred thirty-eight consecutive patients with newly diagnosed PCNSL seen at Memorial Sloan-Kettering Cancer Center (MSKCC; New York, NY) between 1983 and 2003 were analyzed. Standard univariate and multivariate analyses were performed. In addition, a formal cut point analysis was used to determine the most statistically significant cut point for age. Recursive partitioning analysis (RPA) was used to create independent prognostic classes. An external validation set obtained from three prospective Radiation Therapy Oncology Group (RTOG) PCNSL clinical trials was used to test the RPA classification. Results Age and performance status were the only variables identified on standard multivariate analysis. Cut point analysis of age determined that patients age ≤ 50 years had significantly improved outcome compared with older patients. RPA of 282 patients identified three distinct prognostic classes: class 1 (patients < 50 years), class 2 (patients ≥50; Karnofsky performance score [KPS] ≥ 70) and class 3 (patients ≥ 50; KPS < 70). These three classes significantly distinguished outcome with regard to both overall and failure-free survival. Analysis of the RTOG data set confirmed the validity of this classification. Conclusion The MSKCC prognostic score is a simple, statistically powerful model with universal applicability to patients with newly diagnosed PCNSL. We recommend that it be adopted for the management of newly diagnosed patients and incorporated into the design of prospective clinical trials.

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Noch, Evan K., Sameer F. Sait, Shama Farooq, Tanya M. Trippett, and Alexandra M. Miller. "A case series of extraneural metastatic glioblastoma at Memorial Sloan Kettering Cancer Center." Neuro-Oncology Practice 8, no. 3 (February 3, 2021): 325–36. http://dx.doi.org/10.1093/nop/npaa083.

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Abstract Background Extraneural metastasis of glioma is a rare event, often occurring in patients with advanced disease. Genomic alterations associated with extraneural glioma metastasis remain incompletely understood. Methods Ten patients at Memorial Sloan Kettering Cancer Center diagnosed with extraneural metastases of glioblastoma (9 patients) and gliosarcoma (1 patient) from 2003 to 2018 were included in our analysis. Patient characteristics, clinical course, and genomic alterations were evaluated. Results Patient age at diagnosis ranged from 14 to 73, with 7 men and 3 women in this group. The median overall survival from initial diagnosis and from diagnosis of extraneural metastasis was 19.6 months (range 11.2 to 57.5 months) and 5 months (range 1 to 16.1 months), respectively. The most common site of extraneural metastasis was bone, with other sites being lymph nodes, dura, liver, lung, and soft tissues. All patients received surgical resection and radiation, and 9 patients received temozolomide, with subsequent chemotherapy appropriate for individual cases. 1 patient had an Ommaya and then ventriculoperitoneal shunt placed, and 1 patient underwent craniectomy for cerebral edema associated with a brain abscess at the initial site of resection. Genomic analysis of primary tumors and metastatic sites revealed shared and private mutations with a preponderance of tumor suppressor gene alterations, illustrating clonal evolution in extraneural metastases. Conclusions Several risk factors emerged for extraneural metastasis of glioblastoma and gliosarcoma, including sarcomatous dedifferentiation, disruption of normal anatomic barriers during surgical resection, and tumor suppressor gene alterations. Next steps with this work include validation of these genomic markers of glioblastoma metastases in larger patient populations and the development of preclinical models. This work will lead to a better understanding of the molecular mechanisms of metastasis to develop targeted treatments for these patients.

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Rosenzweig, Kenneth E., Sonal Sura, Andrew Jackson, and Ellen Yorke. "Involved-Field Radiation Therapy for Inoperable Non–Small-Cell Lung Cancer." Journal of Clinical Oncology 25, no. 35 (December 10, 2007): 5557–61. http://dx.doi.org/10.1200/jco.2007.13.2191.

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PurposeDose escalation has been shown to improve local control in non–small-cell lung cancer (NSCLC) treated with definitive radiation therapy, but with increased complications. We implemented the use of involved-field radiotherapy (IFRT) in an effort to reduce toxicity while treating the gross tumor to higher doses. This analysis reports failure rates in uninvolved nodal regions with the use of IFRT.Patients and MethodsA total of 524 patients with NSCLC treated with three-dimensional conformal radiotherapy at Memorial Sloan-Kettering Cancer Center between 1991 and 2005 were reviewed. Only lymph node regions initially involved with tumor by either biopsy or radiographic criteria were included in the clinical target volume. Elective nodal failure (ENF) was defined as a recurrence in an initially uninvolved lymph node in the absence of local failure.ResultsOnly 32 patients (6.1%) with ENF were identified. The 2-year actuarial rates of elective nodal control and primary tumor control were 92.4% and 51%, respectively, with a median follow-up of 41 months in survivors. In patients who achieved local disease control, the 2-year elective nodal control rate was 91%. The median time to ENF was 6 months (range, 0 to 56 months). Many patients experienced treatment failure in multiple lymph node regions simultaneously.ConclusionThe use of IFRT did not cause a significant amount of failure in lymph node regions not included in the tumor volume. Therefore, IFRT remains an acceptable method of treatment that allows for dose escalation while minimizing toxicity.

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Masoudi, Mozhgan, and Reza Saffari. "Study of a quadratic redshift-based correction in f(R) gravity with Baryonic matter." International Journal of Modern Physics D 24, no. 11 (September 6, 2015): 1550091. http://dx.doi.org/10.1142/s0218271815500911.

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This paper is considered as a second-order redshift-based corrections in derivative of modified gravitational action, f(R), to explain the late time acceleration which is appeared by Supernova Type Ia (SNeIa) without considering the dark components. Here, we obtained the cosmological dynamic parameters of universe for this redshift depended corrections. Next, we used the recent data of SNeIa Union2, shift parameter of the cosmic background radiation, Baryon acoustic oscillation from sloan digital sky survey (SDSS), and combined analysis of these observations to put constraints on the parameters of the selected F(z) model. It is very interesting that the well-known age problem of the three old objects for combined observations can be alleviated in this model. Finally, the reference action will be constructed in terms of its Taylor expansion. Also, we show that the reconstructed action definitely pass the solar system and stability of the cosmological solution tests.

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Rengan, Ramesh, Philip Paty, W. Douglas Wong, Jose Guillem, Martin Weiser, Larissa Temple, Leonard Saltz, and Bruce D. Minsky. "Distal cT2N0 Rectal Cancer: Is There an Alternative to Abdominoperineal Resection?" Journal of Clinical Oncology 23, no. 22 (August 1, 2005): 4905–12. http://dx.doi.org/10.1200/jco.2005.10.041.

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Purpose Patients with cT2N0 distal rectal cancer do not require adjuvant therapy. However, when a patient refuses an abdominoperineal resection (APR), is there an alternative? The purpose of this trial is to determine whether preoperative external-beam radiation therapy can increase the rate of sphincter preservation for patients with distal cT2N0 adenocarcinoma of the rectum. Patients and Methods Between April 1988 and October 2003, 27 patients with distal rectal adenocarcinoma staged T2 by clinical and/or endorectal ultrasound who were judged by the operating surgeon to require an APR were treated with preoperative pelvic radiation alone (50.4 Gy). Surgery was performed 4 to 7 weeks later. If pathologic positive pelvic nodes were identified, postoperative adjuvant chemotherapy was recommended. The median follow-up was 55 months (range, 9 to 140 months). Results The pathologic complete response rate was 15% and 78% of patients underwent a sphincter-sparing procedure. The crude incidence of local failure for patients undergoing a sphincter sparing procedure was 10% and the 5-year actuarial incidence was 13%. The actuarial 5-year survival for patients undergoing sphincter preservation was as follows: disease-free, 77%; colostomy-free, 100%; and overall, 85%. Using the Memorial Sloan-Kettering Cancer Center sphincter function score, 54% of those undergoing a sphincter-sparing procedure had good/excellent bowel function at 12 to 24 months after surgery, and 77% had good/excellent function at 24 to 36 months after surgery. Conclusion Our data suggest that for patients with cT2N0 distal rectal cancer who require an APR, preoperative pelvic radiation improves sphincter preservation without an apparent compromise in local control or survival.

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Wolden, Suzanne L., Ira J. Dunkel, Mark M. Souweidane, Laura Happersett, Yasmin Khakoo, Karen Schupak, David Lyden, and Steven A. Leibel. "Patterns of Failure Using a Conformal Radiation Therapy Tumor Bed Boost for Medulloblastoma." Journal of Clinical Oncology 21, no. 16 (August 15, 2003): 3079–83. http://dx.doi.org/10.1200/jco.2003.11.140.

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Purpose: To assess the patterns of failure for patients with medulloblastoma receiving a conformal tumor bed boost rather than a boost to the entire posterior fossa. Patients and Methods: From 1994 to 2002, 32 consecutive patients with newly diagnosed medulloblastoma treated at Memorial Sloan-Kettering Cancer Center (New York, NY) received a conformal boost to the tumor bed in conjunction with craniospinal radiation therapy. Twenty-eight patients also received chemotherapy. The median age was 9 years (range, 3 to 34 years), and the male to female ratio was 3:1. Twenty-seven patients had standard-risk disease, and five patients had high-risk disease. Craniospinal doses ranged from 23.4 to 39.6 Gy, and total tumor bed doses ranged from 54 to 59.4 Gy. Results: With a median follow-up of 56 months, six patients have relapsed; five relapsed outside of the posterior fossa, and one failed within the posterior fossa, outside of the high-dose boost volume. Five-year actuarial disease-free and overall survival rates were 84% and 85%, respectively. Freedom from posterior fossa failure was 100% and 86% at 5 and 10 years, respectively. Freedom from distant failure was 84% at 5 years, with a trend for improvement when full-dose craniospinal radiation (36 to 39.6 Gy) was used compared with a reduced dose (23.4 Gy) of radiation (100% v 63%, respectively; P = .06). No other predictive variables were identified. Conclusion: Conformal treatment to the tumor bed allows for significant sparing of critical structures. The posterior fossa failure rate in this series is similar to that reported when the entire posterior fossa is treated. This approach should be investigated further in a phase III trial.

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Serenelli, Aldo, René D. Rohrmann, and Masataka Fukugita. "Nature of blackbody stars." Astronomy & Astrophysics 623 (March 2019): A177. http://dx.doi.org/10.1051/0004-6361/201834032.

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A selection of 17 stars in the Sloan Digital Sky Survey, previously identified as DC-class white dwarfs (WDs), has been reported to show spectra very close to blackbody radiation in the wavelength range from ultraviolet to infrared. Because of the absence of lines and other details in their spectra, the surface gravity of these objects has previously been poorly constrained, and their effective temperatures have been determined by fits to the continuum spectrum using pure helium atmosphere models. We computed model atmospheres with pure helium and H/He mixtures and used Gaia DR2 parallaxes that are available for 16 of the 17 selected stars to analyze their physical properties. We find that the atmospheres of the selected stars are very probably contaminated with a trace amount of hydrogen of −6 ≤ log(NH/NHe) ≤ −5.4. For the 16 stars with Gaia parallaxes, we calculate a mean stellar mass 0.606 ± 0.076 M⊙, which represents typical mass values and surface gravities (7.8 < logg < 8.3) for WDs.

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Yi, Min, Funda Meric-Bernstam, Henry M. Kuerer, Elizabeth A. Mittendorf, Isabelle Bedrosian, Anthony Lucci, Rosa F. Hwang, Jaime R. Crow, Sheng Luo, and Kelly K. Hunt. "Evaluation of a Breast Cancer Nomogram for Predicting Risk of Ipsilateral Breast Tumor Recurrences in Patients With Ductal Carcinoma in Situ After Local Excision." Journal of Clinical Oncology 30, no. 6 (February 20, 2012): 600–607. http://dx.doi.org/10.1200/jco.2011.36.4976.

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Purpose Prediction of patients at highest risk for ipsilateral breast tumor recurrence (IBTR) after local excision of ductal carcinoma in situ (DCIS) remains a clinical concern. The aim of our study was to evaluate a published nomogram from Memorial Sloan-Kettering Cancer Center to predict for risk of IBTR in patients with DCIS from our institution. Patients and Methods We retrospectively identified 794 patients with a diagnosis of DCIS who had undergone local excision from 1990 through 2007 at the MD Anderson Cancer Center (MDACC). Clinicopathologic factors and the performance of the Memorial Sloan-Kettering Cancer Center nomogram for prediction of IBTR were assessed for 734 patients who had complete data. Results There was a marked difference with respect to tumor grade, prevalence of necrosis, initial presentation, final margins, and receipt of endocrine therapy between the two cohorts. The biggest difference was that more patients received radiation in the MDACC cohort (75% at MDACC v 49% at MSKCC; P < .001). Follow-up time in the MDACC cohort was longer than in the MSKCC cohort (median 7.1 years v 5.6 years), and the recurrence rate was lower in the MDACC cohort (7.9% v 11%). The median 5-year probability of recurrence was 5%, and the median 10-year probability of recurrence was 7%. The nomogram for prediction of 5- and 10-year IBTR probabilities demonstrated imperfect calibration and discrimination, with a concordance index of 0.63. Conclusion Predictive models for IBTR in patients with DCIS who were treated with local excision are imperfect. Our current ability to accurately predict recurrence on the basis of clinical parameters alone is limited.

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Lim, S., N. Y. Lee, M. G. Fury, R. A. Ghossein, A. R. Shaha, S. L. Wolden, and D. G. Pfister. "Doxorubicin and concurrent radiotherapy for anaplastic thyroid cancer: We need to do better." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 16506. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.16506.

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16506 Background: Anaplastic thyroid cancer (ATC) is a rare, aggressive malignancy. The potential for pathologic misclassification complicates the interpretation of published data. One treatment option for locoregionally (LR) advanced disease is weekly low-dose doxorubicin (D) with concurrent radiation therapy (RT), based on reported 2-year local control rates of 68% (ATC)/77% (other TC histologic subtypes) (Cancer 1987;60:2372). We looked to evaluate our experience with this general approach, but in a larger series which included pathologic confirmation of all ATC cases. Methods: Patients (pts) were identified through the Memorial Sloan-Kettering Cancer Center (MSKCC) Radiation Oncology and Pathology Databases. Inclusion criteria: diagnosis of ATC between 1984–2006, with pathology review at MSKCC; LR disease only, able to be encompassed within a RT portal; treatment at MSKCC with planned weekly D (10 mg/m2) and concurrent radiation. Prior surgery was allowed. Documentation of failure was based on clinical/radiographic assessment. Principal outcomes assessed: LR control (LRC: no failure at the primary site, in the neck, or the mediastinum), progression-free survival (PFS), and overall survival (OS). The Kaplan-Meier method was applied. Results: Thirty-seven patients were included in our analysis (median age 64; 54% female, 46% male). Median RT dose 5760 cGy, >4500 cGy in 32 (87%), administered through hyperfractionated or once-daily schedules. Median number of D treatments received 5.5, >4 in 24 (65%). 2-year outcomes: LRC 25%; PFS 8%; OS 18%. 6 patients remain alive at the time of last follow-up with survival durations of 4.1, 11.4, 11.7, 57.3, 58.5, and 140.7 months, respectively. A subset analysis was performed limited to the 24 patients (65%) who completed >4,500 cGy of radiation and >4 doses of D. 2-year outcomes were improved in this latter group, but remained disappointing, even among these more highly selected pts (LRC 30%; PFS 11%; OS 27%). Conclusions: Better therapy is needed for this poor prognostic disease. Future analyses will evaluate the impact of histologic subtype of ATC, radiation technique/dose, and surgical resection on outcome. No significant financial relationships to disclose.

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Wilcox, Jessica, William Newman, Anne Reiner, Samantha Brown, Robert Young, Justin Chen, Kathryn Beal, et al. "SURG-04. SALVAGE RESECTION OF RECURRENT PREVIOUSLY-IRRADIATED BRAIN METASTASES: CLINICAL AND RADIOGRAPHIC OUTCOMES." Neuro-Oncology 22, Supplement_2 (November 2020): ii203—ii204. http://dx.doi.org/10.1093/neuonc/noaa215.851.

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Abstract BACKGROUND The management of brain metastasis (BrM) recurrence after stereotactic body radiotherapy (SBRT) poses a clinical challenge. The efficacy of salvage resection is undefined, and the role of adjuvant resection cavity reirradiation is unclear given the compounded risk of radiation injury. METHODS Retrospective analysis of previously-irradiated BrM that underwent resection between March 2003 and February 2020 at Memorial Sloan Kettering Cancer Center was performed. Only cases with histopathologic evidence of viable malignancy were included, and specimens were classified by the gross proportion of viable tumor versus treatment effect. Clinical and radiographic parameters were collected. Post-operative recurrence and radiation necrosis were based on RANO-BM criteria and distinguished by histopathologic, radiographic and clinical characteristics. Equivocal cases were adjudicated by a blinded neuroradiologist. RESULTS One-hundred fifty-five resected recurrent BrM following SBRT in 135 patients were evaluated. Seventeen received additional prior whole-brain radiation. Metastases derived from non-small-cell lung (36.8%), melanoma (27.1%), breast (21.3%), renal (3.9%), colorectal (1.9%) and other (9.0%) primary malignancies. Forty-eight (31.0%) had only microscopic malignant disease with extensive necrosis, 44 (28.4%) had mixed or unspecified tumor with treatment effect, and 63 (40.6%) were reported as purely viable tumor by histopathologic report. Thirty-nine (25.2%) post-operative cavities underwent adjuvant reirradiation within 60 days. At 6 and 12 months, local tumor recurrence occurred in 31.6% (95% CI: 24.4%-39.1%) and 40.4% (95% CI: 32.5%-48.2%), respectively, with a proportion of these lesions displaying mixed tumor plus treatment effect. Median overall survival was 13.4 months (95% CI: 10.5-17.7) from salvage resection. CONCLUSIONS Salvage of previously-irradiated BrM remains challenging. This represents the largest known series correlating salvage resection and histopathologically-confirmed viable recurrent BrM with long-term outcomes. Tumor recurrence risk remains high at one year. Further exploration will stratify local progression and radiation necrosis rates by features including extent of resection, degree of viable tumor and adjuvant reirradiation use.

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Wisłocka, A. M., A. B. Kovačević, and A. Balbi. "Comparative analysis of the influence of Sgr A* and nearby active galactic nuclei on the mass loss of known exoplanets." Astronomy & Astrophysics 624 (April 2019): A71. http://dx.doi.org/10.1051/0004-6361/201834655.

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Context. The detailed evolution of exoplanetary atmospheres has been the subject of decade-long studies. Only recently, investigations began on the possible atmospheric mass loss caused by the activity of galactic central engines. This question has so far been explored without using available exoplanet data. Aims. The goal of this paper is to improve our knowledge of the erosion of exoplanetary atmospheres through radiation from supermassive black holes (SMBHs) undergoing an active galactic nucleus (AGN) phase. Methods. To this end, we extended the well-known energy-limited mass-loss model to include the case of radiation from AGNs. We set the fraction of incident power ɛ available to heat the atmosphere as either constant (ɛ = 0.1) or flux dependent (ɛ = ɛ(FXUV)). We calculated the possible atmospheric mass loss for 54 known exoplanets (of which 16 are hot Jupiters residing in the Galactic bulge and 38 are Earth-like planets, EPs) due to radiation from the Milky Way’s (MW) central SMBH, Sagittarius A* (Sgr A*), and from a set of 107 220 AGNs generated using the 33 350 AGNs at z < 0.5 of the Sloan Digital Sky Survey database. Results. We found that planets in the Galactic bulge might have lost up to several Earth atmospheres in mass during the AGN phase of Sgr A*, while the EPs are at a safe distance from Sgr A* (>7 kpc) and have not undergone any atmospheric erosion in their lifetimes. We also found that the MW EPs might experience a mass loss up to ~15 times the Mars atmosphere over a period of 50 Myr as the result of exposure to the cumulative extreme-UV flux FXUV from the AGNs up to z = 0.5. In both cases we found that an incorrect choice of ɛ can lead to significant mass loss overestimates.

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Rothrock, Robert J., Yi Li, Eric Lis, Stephanie Lobaugh, Zhigang Zhang, Patrick McCann, Patricia Mae G. Santos, et al. "Hypofractionated spinal stereotactic body radiation therapy for high-grade epidural disease." Journal of Neurosurgery: Spine 33, no. 5 (November 2020): 680–87. http://dx.doi.org/10.3171/2020.4.spine20118.

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OBJECTIVETo characterize the clinical outcomes when stereotactic body radiation therapy (SBRT) alone is used to treat high-grade epidural disease without prior surgical decompression, the authors conducted a retrospective cohort study of patients treated at the Memorial Sloan Kettering Cancer Center between 2014 and 2018. The authors report locoregional failure (LRF) for a cohort of 31 cases treated with hypofractionated SBRT alone for grade 2 epidural spinal cord compression (ESCC) with radioresistant primary cancer histology.METHODSHigh-grade epidural disease was defined as grade 2 ESCC, which is notable for radiographic deformation of the spinal cord by metastatic disease. Kaplan-Meier survival curves and cumulative incidence functions were generated to examine the survival and incidence experiences of the sample level with respect to overall survival, LRF, and subsequent requirement of vertebral same-level surgery (SLS) due to tumor progression or fracture. Associations with dosimetric analysis were also examined.RESULTSTwenty-nine patients undergoing 31 episodes of hypofractionated SBRT alone for grade 2 ESCC between 2014 and 2018 were identified. The 1-year and 2-year cumulative incidences of LRF were 10.4% (95% CI 0–21.9) and 22.0% (95% CI 5.5–38.4), respectively. The median survival was 9.81 months (95% CI 8.12–18.54). The 1-year cumulative incidence of SLS was 6.8% (95% CI 0–16.0) and the 2-year incidence of SLS was 14.5% (95% CI 0.6–28.4). All patients who progressed to requiring surgery had index lesions at the thoracic apex (T5–7).CONCLUSIONSIn carefully selected patients, treatment of grade 2 ESCC disease with hypofractionated SBRT alone offers a 1-year cumulative incidence of LRF similar to that in low-grade ESCC and postseparation surgery adjuvant hypofractionated SBRT. Use of SBRT alone has a favorable safety profile and a low cumulative incidence of progressive disease requiring open surgical intervention (14.5%).

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Habib, Larissa A., Jasmine H. Francis, Armida WM Fabius, Pierre Y. Gobin, Ira J. Dunkel, and David H. Abramson. "Second primary malignancies in retinoblastoma patients treated with intra-arterial chemotherapy: the first 10 years." British Journal of Ophthalmology 102, no. 2 (June 9, 2017): 272–75. http://dx.doi.org/10.1136/bjophthalmol-2017-310328.

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Background/AimsSurvivors of retinoblastoma carry a lifetime risk of secondary malignancies. It is well established that external beam radiation increases this risk; however, the risk with ophthalmic artery chemosurgery (OAC) remains unknown. We report on 10 years of experience with OAC and the rate of second primary malignancy (SPM) development.MethodsThis is a single-centre retrospective review approved by the Memorial Sloan Kettering Cancer Center Institutional Review Board of all patients who received OAC over a 10-year period, from May 2006 to November 2016. The second tumour incidence and survival in patients with germline disease (bilateral and unilateral with family history or confirmed germline mutation) was estimated using the Kaplan-Meier method. Patients who received external beam radiotherapy were excluded from analyses.ResultsTwo hundred and thirty-three patients with heritable retinoblastoma who received OAC were analysed. Nineteen patients were excluded for having received external beam radiation. The Kaplan-Meier estimate of the likelihood for SPM development was 2.7% at 5 years (95% CI 0 to 25). All of the SPMs were pineoblastomas and all patients had bilateral disease in this cohort.ConclusionsIn our 10-year experience, we have found that SPM development in patients with germline retinoblastoma treated with OAC alone is comparable to previously published rates. In the first 10 years, OAC did not increase the known incidence of SPMs. This cohort will continue to be followed to establish the rate of development with extended follow-up.

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Sura, Sonal, Vishal Gupta, Ellen Yorke, Andrew Jackson, Howard Amols, and Kenneth E. Rosenzweig. "Intensity-modulated radiation therapy (IMRT) for inoperable non-small cell lung cancer: The Memorial Sloan-Kettering Cancer Center (MSKCC) experience." Radiotherapy and Oncology 87, no. 1 (April 2008): 17–23. http://dx.doi.org/10.1016/j.radonc.2008.02.005.

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Kishtagari, Ashwin, Isaac Alexander Bowman, Martin S. Tallman, Dan Douer, Ellin Berman, Peter G. Maslak, Renier J. Brentjens, and Eytan M. Stein. "Chronic Myeloid Leukemia After Adjuvant Treatment For Breast Cancer: Is It Therapy Related?" Blood 122, no. 21 (November 15, 2013): 2740. http://dx.doi.org/10.1182/blood.v122.21.2740.2740.

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Abstract Chronic Myeloid Leukemia (CML) is a rare myeloid neoplasm with an age-adjusted incidence of 1.6 per 100,000 people in the United States (http://seer.cancer.gov/statfacts/html/cmyl.html). Despite the understanding of the pathogenesis of CML – the fusion of BCR-ABL leading to a constitutively activated tyrosine kinase – underlying events that lead to a 9;22 translocation are incompletely elucidated. Although CML was the most common leukemia seen among survivors of Hiroshima and Nagasaki, other causative factors are not well defined. There is a known association between exposure to radiation and/or cytotoxic chemotherapy and therapy-related acute myeloid leukemia (t-AML). This relationship is best described after adjuvant treatment for breast cancer (BC), but has also been reported in patients treated for lymphoma, testicular cancer and colorectal cancer. Based on a number of patients we have seen at Memorial Sloan-Kettering Cancer Center with CML who had prior adjuvant treatment for BC, we hypothesized that a subset of patients with CML have therapy-related disease and the acquisition of a 9;22 translocation may be related to prior exposure to cytotoxic chemotherapy and/or radiation. Using ICD-9 codes for BC, we queried the Memorial Sloan-Kettering institutional database from 1983-2012 to search for patients who had a co-occurring diagnosis of CML, as defined by a bone marrow aspirate or biopsy that was morphologically consistent with CML and either a cytogenetic report that confirmed a 9;22 translocation and/or a BCR-ABL p210 fusion transcript. Charts of patients identified in the institutional database were individually reviewed to confirm their eligibility for this retrospective study. In total, 15 patients who developed a diagnosis of CML after adjuvant treatment of BC were identified (table 1). Of those identified, all had received prior adjuvant chemotherapy (n=11), prior adjuvant radiation (n=12) or both (n=15). The cumulative doses of anthracycline and alkylating agents are detailed in table 1. The interval between the adjuvant treatment of breast cancer and CML was 4.7 years. Patients diagnosed with CML after treatment of BC tended to be younger than those with CML diagnosed in the general population (50.47 years vs. 64 years) and were overwhelmingly Caucasian. All patients were diagnosed in chronic phase and none of the patients had an additional cytogenetic abnormality. The cumulative incidence of CML was markedly higher than in the general population; while 78,000 unique patients with BC were seen at MSKCC between 1985 and 2012, 15 patients subsequently received a diagnosis of CML. This incidence is considerably greater than the age-adjusted incidence of 1.6 per 100,000 in the United States population.Table 1Patient CharacteristicsTotal15At time of Breast Cancer DiagnosisMedian Age (years)*46.59 (38-73)Race Caucasian13Asian2 African-American0Adjuvant Chemotherapy11 Anthracycline (n)5 Cumulative dose*240 mg/m2 Alkylator (n)10 Cumulative Dose*4800mg/m2Adjuvant Radiation12At time of CML DiagnosisMedian Age (years)*50.42Interval - Breast Ca and CML (years)*4.7 (1.2-18.8)White count at presentation*31 (24-188)Hgb at presentation*12.5 (7.9 – 14.1)Platelets at presentation*397 (185-1082)Initial Treatment Imatinib13 Dasatinib or Nilotinib0 Other2#*Median (range)#One patient received hydrea and one received an allogeneic stem cell transplant To our knowledge, our data represent the first comprehensive description of CML after adjuvant treatment of BC. The markedly elevated incidence of CML after receipt of adjuvant chemotherapy and/or radiation for BC as compared to the general US population suggests that this entity might be classified as a therapy-related leukemia. The exact pathogenesis of CML after adjuvant treatment for BC and reason patients more commonly develop t-AML requires further investigation. Given the remarkable efficacy of tyrosine kinase inhibitors in preventing progression to accelerated or blastic phase disease, the practicing oncologist focused in breast cancer should consider a diagnosis of t-CML in any BC patient, previously treated with adjuvant chemotherapy or radiation, who presents with an elevated white blood count.

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Tiersten, A., and L. B. Saltz. "Influence of inflammatory bowel disease on the ability of patients to tolerate systemic fluorouracil-based chemotherapy." Journal of Clinical Oncology 14, no. 7 (July 1996): 2043–46. http://dx.doi.org/10.1200/jco.1996.14.7.2043.

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PURPOSE To evaluate the safety of administering fluorouracil (5FU)-based chemotherapy to cancer patients with inflammatory bowel disease (IBD). PATIENTS AND METHODS We retrospectively reviewed all patients entered into the Memorial Sloan-Kettering Cancer Center clinical data base from 1985 through 1995 who had a diagnosis of IBD, had a gastrointestinal malignancy, and were treated with systemic 5FU-based chemotherapy. A total of 19 patient charts were identified and reviewed. RESULTS Fifty-three percent of patients reviewed experienced severe (grade III/IV) diarrhea on treatment. Sixty percent of patients with a history of active IBD and 40% of patients with a history of inactive IBD experienced severe diarrhea on treatment. The incidence of severe diarrhea did not appear to be substantially influenced by age, schedule of 5FU administration, concurrent radiation, or type of IBD. CONCLUSION While there does appear to be an increased risk of diarrhea exacerbation in IBD patients treated with 5FU, a substantial number of patients tolerate chemotherapy without increased difficulty. The degree of IBD activity or other clinical parameters can not be used to predict accurately the likelihood of toxicity.

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Adel, N. G., A. Khan, and C. Lucarelli. "Use of palonosetron 0.25 mg IV daily and incidence of nausea and vomiting in patients undergoing bone marrow transplantation (BMT)." Journal of Clinical Oncology 24, no. 18_suppl (June 20, 2006): 16510. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.16510.

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16510 Background: Preparative regimens for BMT are associated with a high incidence of nausea and vomiting, which can negatively affect quality of life. It is important to evaluate the incidence of nausea and vomiting and understand which antiemetic regimens are most effective in these patients in order to improve outcomes. Methods: A retrospective review of patients admitted to the adult BMT Unit at Memorial Sloan-Kettering Cancer Center (MSKCC) between 1/1/05 and 12/31/05 was performed. Currently at MSKCC, palonosetron (0.25 mg IV daily) is used as the main antiemetic agent during the preparative regimen; dexamethasone 20 mg IV is occasionally combined with palonosetron when there is no other contraindication to its use with some preparative regimens. The electronic medical records, as well as the pharmacy computer system, were used to collect demographics, primary diagnosis, BMT type, preparative BMT regimen, days of regimen, whether radiation was included, antiemetic used, and incidence of nausea and vomiting, which were assessed 3 times daily during the administration of the preparative regimen. Results: 176 pts (75 women, 101 men) received BMT; mean age was 50 yrs (18–73). All patients received a highly emetogenic preparative regimen for which the mean duration was 5 days (1–9 days). Over a 1–12 day period the incidence of nausea and vomiting were 78% and 39% in those undergoing an allogeneic transplant compared with 51% and 18% in those undergoing an autologous transplant. Patients with leukemia had the highest incidence of nausea (85%) and vomiting (45%). The rates of nausea and vomiting in those receiving radiation were 81% and 33%, while in those not receiving radiation, the rates of nausea and vomiting were 51% and 20%, respectively. Of patients receiving palonosetron alone, 87% experienced nausea and 41% had vomiting, compared to 48% and 15% for those receiving both palonosetron and dexamethasone. Conclusions: Radiation therapy and allogeneic transplant had higher incidences of nausea and vomiting when compared to autologous transplant. Nausea and vomiting were better controlled in patients receiving palonosetron and dexamethasone compared with those receiving palonosetron alone. No significant financial relationships to disclose.

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Keam, Jennifer, Mark H. Bilsky, Ilya Laufer, Weiji Shi, Zhigang Zhang, Moses Tam, Joan Zatcky, Dale M. Lovelock, and Yoshiya Yamada. "No association between excessive wound complications and preoperative high-dose, hypofractionated, image-guided radiation therapy for spine metastasis." Journal of Neurosurgery: Spine 20, no. 4 (April 2014): 411–20. http://dx.doi.org/10.3171/2013.12.spine12811.

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Object Radiation therapy is known to impair wound healing. Higher dose per fraction is believed to increase this risk. This study sought to quantify rates of wound complication in patients receiving preoperative conventionally fractionated radiotherapy (XRT) or high-dose hypofractionated image-guided radiation therapy (IGRT) for spinal metastasis, and to identify predictors of wound complication. Methods The records of 165 consecutive patients who underwent spine surgery for metastasis at Memorial Sloan–Kettering Cancer Center between 1999 and 2010, with a history of prior radiation therapy, were reviewed. Patients with primary spine tumors, 2 courses of prior radiation therapy to the surgical site, total dose < 9 Gy, or radiation therapy adjacent to or partially overlapping the surgical site, were excluded. One hundred thirty patients received XRT (≤ 3 Gy/fraction) and 35 received IGRT (> 3 Gy/fraction). The total dose prescribed to the 100% isodose line to treat the planning target volume was 18–30 Gy in 1–5 fractions. Clinical factors evaluated included age, Karnofsky Performance Scale score, body mass index, presence of diabetes, smoking, ambulatory status, prior surgery at same spinal site, preoperative laboratory results (hemoglobin, lymphocyte count, and albumin), perioperative chemotherapy or steroids, estimated blood loss, extent of stabilization hardware, time between radiation therapy and surgery, number of vertebral bodies irradiated, total radiation dose, and dose per fraction of radiation therapy. Wound complication was defined as poor healing, dehiscence, or infection. Potential predictors of wound complication were assessed by univariate analyses using competing-risk methods to adjust for risk of death. Results For XRT patients, median dose was 30 Gy (range 11.5–70 Gy) with 72% of them receiving 3 Gy × 10 fractions. For IGRT patients, 66% received 18–24 Gy × 1 fraction and 23% received 6 Gy × 5 fractions. Groups differed only by the mean number of vertebral bodies treated (4.6 XRT and 1.8 IGRT, p < 0.0001). Wound complications occurred at a median of 0.95 months (range 0.4–3.9 months). A total of 22 wound events occurred in the XRT group and 2 in the IGRT group. The 6-month cumulative incidence of wound complications for XRT was 17% and for IGRT was 6%. There was no significant difference in wound complications between groups (IGRT vs XRT: hazard ratio 0.31, 95% CI 0.08–1.3; p = 0.11). Higher dose per fraction appeared to be associated with a lower risk of wound complication (hazard ratio 0.27, 95% CI 0.06–1.15; p = 0.08), which trended toward significance. Univariate analyses did not reveal any significant predictors of wound complications. Conclusions Patients who underwent XRT or IGRT did not have significantly different rates of postoperative wound complications. This finding may be explained by the treatment of fewer vertebral bodies in IGRT patients, or by the low overall number of total events. With a wound complication rate of 6%, preoperative IGRT, a highly conformal treatment, resulted in a very low rate of surgical wound complication.

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Kattan, Michael W., Michael J. Zelefsky, Patrick A. Kupelian, Peter T. Scardino, Zvi Fuks, and Steven A. Leibel. "Pretreatment Nomogram for Predicting the Outcome of Three-Dimensional Conformal Radiotherapy in Prostate Cancer." Journal of Clinical Oncology 18, no. 19 (October 19, 2000): 3352–59. http://dx.doi.org/10.1200/jco.2000.18.19.3352.

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PURPOSE: Several studies have defined risk groups for predicting the outcome after external-beam radiotherapy of localized prostate cancer. However, most models formed patient risk groups, and none of these models considers radiation dose as a predictor variable. The purpose of this study was to develop a nomogram to improve the accuracy of predicting outcome after three-dimensional conformal radiotherapy. MATERIALS AND METHODS: This study was a retrospective, nonrandomized analysis of patients treated at the Memorial Sloan-Kettering Cancer Center between 1988 and 1998. Clinical parameters of the 1,042 patients included stage, biopsy Gleason score, pretreatment serum prostate-specific antigen (PSA) level, whether neoadjuvant androgen deprivation therapy was administered, and the radiation dose delivered. Biochemical (PSA) treatment failure was scored when three consecutive rises of serum PSA occurred. A nomogram, which predicts the probability of remaining free from biochemical recurrence for 5 years, was validated internally on this data set using a bootstrapping method and externally using a cohort of patients treated at the Cleveland Clinic, Cleveland, OH. RESULTS: When predicting outcomes for patients in the validation data set from the Cleveland Clinic, the nomogram had a Somers’ D rank correlation between predicted and observed failure times of 0.52. Predictions from this nomogram were more accurate (P < .0001) than the best of seven published risk stratification systems, which achieved a Somers’ D coefficient of 0.47. CONCLUSION: The development process illustrated here produced a nomogram that seems to predict more accurately than other available systems and may be useful for treatment selection by both physicians and patients.

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Kattan, Michael W., Michael J. Zelefsky, Patrick A. Kupelian, Daniel Cho, Peter T. Scardino, Zvi Fuks, and Steven A. Leibel. "Pretreatment Nomogram That Predicts 5-Year Probability of Metastasis Following Three-Dimensional Conformal Radiation Therapy for Localized Prostate Cancer." Journal of Clinical Oncology 21, no. 24 (December 15, 2003): 4568–71. http://dx.doi.org/10.1200/jco.2003.05.046.

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Purpose: There are several nomograms for the patient considering radiation therapy for clinically localized prostate cancer. Because of the questionable clinical implications of prostate-specific antigen (PSA) recurrence, its use as an end point has been criticized in several of these nomograms. The goal of this study was to create and to externally validate a nomogram for predicting the probability that a patient will develop metastasis within 5 years after three-dimensional conformal radiation therapy (CRT). Patients and Methods: We conducted a retrospective, nonrandomized analysis of 1,677 patients treated with three-dimensional CRT at Memorial Sloan-Kettering Cancer Center (MSKCC) from 1988 to 2000. Clinical parameters examined were pretreatment PSA level, clinical stage, and biopsy Gleason sum. Patients were followed until their deaths, and the time at which they developed metastasis was noted. A nomogram for predicting the 5-year probability of developing metastasis was constructed from the MSKCC cohort and validated using the Cleveland Clinic series of 1,626 patients. Results: After three-dimensional CRT, 159 patients developed metastasis. At 5 years, 11% of patients experienced metastasis by cumulative incidence analysis (95% CI, 9% to 13%). A nomogram constructed from the data gathered from these men showed an excellent ability to discriminate among patients in an external validation data set, as shown by a concordance index of 0.81. Conclusion: A nomogram with reasonable accuracy and discrimination has been constructed and validated using an external data set to predict the probability that a patient will experience metastasis within 5 years after three-dimensional CRT.

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Wilcox, Jessica, Samantha Brown, Anne Reiner, Robert Young, Justin Chen, Tejus Bale, Marc Rosenblum, et al. "MLTI-05. Adjuvant re-irradiation improves local control of surgically resected recurrent brain metastases." Neuro-Oncology Advances 3, Supplement_3 (August 1, 2021): iii13—iii14. http://dx.doi.org/10.1093/noajnl/vdab071.054.

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Abstract Background The efficacy of salvage resection (SR) of recurrent brain metastases (BrM) post-stereotactic radiosurgery (SRS) is not well described. We sought to characterize the impact of adjuvant post-salvage radiation therapy (PSRT) in this setting and identify tumor-specific variables that influence local control. Methods Retrospective analysis of post-SRS recurrent BrM that underwent SR between 2003–2020 at Memorial Sloan Kettering Cancer Center was performed. Cases with histologically-viable malignancy were included and stratified by receipt of adjuvant PSRT within 60 days of SR (PSRT cohort) vs. observation (observation cohort). Resection-site outcomes were described using cumulative incidences and univariate and multivariate competing risks regression accounting for clustering. Results One-hundred fifty-five recurrent BrM in 135 patients were included. Thirty-nine (25.2%) of the post-operative cavities were treated with adjuvant PSRT, and the remaining 116 (74.8%) cavities were initially observed. Gross- or near-total resection was associated with significantly improved local control compared to subtotal resection (p=0.007). Adjuvant PSRT was associated with a reduced rate of LR at 6 months [18.0% (95%CI: 9.8–33.1%) vs. 35.9% (95%CI: 27.9–46.2%) with initial observation] and 12 months [28.8% (95%CI: 17.0–48.8%) vs. 43.9% (95%CI: 36.2–53.4%)]. On multivariate analysis, adjuvant PSRT (p=0.095), low tumor-viability within the resected BrM (p=0.17), and first-time resection (p=0.035) all independently trended towards improved local control. BrM size at SR (≥3cm vs. <3cm, p=0.48), primary malignancy (p=0.35), and specific PSRT modality (whole or partial brain radiation vs. SRS, p=0.43) were not associated with differences in LR rate. Radiation necrosis (RN) was significantly increased in the PSRT cohort (HR 4.55, 95%CI: 1.26–16.39, p=0.02), though the total percentage with symptomatic RN remained low (PSRT cohort 5.1% vs observation cohort 0.9%). Conclusions Local control after SR of a recurrent BrM may be optimized with gross- or near-total resection and adjuvant post-operative re-irradiation, with low symptomatic RN.

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Setton, Jeremy, Nicola Caria, Jonathan Romanyshyn, Lawrence Koutcher, Suzanne L. Wolden, Michael J. Zelefsky, Nicholas Rowan, et al. "Intensity-Modulated Radiotherapy in the Treatment of Oropharyngeal Cancer: An Update of the Memorial Sloan-Kettering Cancer Center Experience." International Journal of Radiation Oncology*Biology*Physics 82, no. 1 (January 2012): 291–98. http://dx.doi.org/10.1016/j.ijrobp.2010.10.041.

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Gilbride, Lucas, Malika Siker, Joseph Bovi, Elizabeth Gore, Christopher Schultz, and William A. Hall. "Current Predictive Indices and Nomograms To Enable Personalization of Radiation Therapy for Patients With Secondary Malignant Neoplasms of the Central Nervous System: A Review." Neurosurgery 82, no. 5 (April 6, 2018): 595–603. http://dx.doi.org/10.1093/neuros/nyx631.

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Abstract The proper treatment of brain metastases continues to be a challenge for oncologists given the variability of individual patients’ prognoses and the variety of treatment options available to address brain metasteses. There have been efforts since the 1990s to develop prognostic indices and nomograms to help clinicians determine the best approach for individuals with secondary malignant neoplasms of the central nervous system. A literature search was performed to identify the existing prognostic tools published between January 1995 and January 2017. While there have been several reported indices, many are limited by the number of patients analyzed or lack of generalizability. The most robust prognostic tools available are the Disease Specific Graded Prognostic Assessment and the Barnholtz-Sloan nomogram, both of which have online tools available to help clinicians. While these tools are helpful in stratifying different patients’ outcomes, they are limited by their retrospective nature and likely underestimate survival in the modern era, where there is a rapidly growing arsenal of systemic agents available to patients with metastatic disease.

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Kumar, Anita, Carla Casulo, Ranjana H. Advani, Elizabeth Budde, Paul M. Barr, Connie L. Batlevi, Philip Caron, et al. "Brentuximab Vedotin Combined With Chemotherapy in Patients With Newly Diagnosed Early-Stage, Unfavorable-Risk Hodgkin Lymphoma." Journal of Clinical Oncology 39, no. 20 (July 10, 2021): 2257–65. http://dx.doi.org/10.1200/jco.21.00108.

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PURPOSE To improve curability and limit long-term adverse effects for newly diagnosed early-stage (ES), unfavorable-risk Hodgkin lymphoma. METHODS In this multicenter study with four sequential cohorts, patients received four cycles of brentuximab vedotin (BV) and doxorubicin, vinblastine, and dacarbazine (AVD). If positron emission tomography (PET)-4–negative, patients received 30-Gy involved-site radiotherapy in cohort 1, 20-Gy involved-site radiotherapy in cohort 2, 30-Gy consolidation-volume radiotherapy in cohort 3, and no radiotherapy in cohort 4. Eligible patients had ES, unfavorable-risk disease. Bulk disease defined by Memorial Sloan Kettering criteria (> 7 cm in maximal transverse or coronal diameter on computed tomography) was not required for cohorts 1 and 2 but was for cohorts 3 and 4. The primary end point was to evaluate safety for cohort 1 and to evaluate complete response rate by PET for cohorts 2-4. RESULTS Of the 117 patients enrolled, 116 completed chemotherapy, with the median age of 32 years: 50% men, 98% stage II, 86% Memorial Sloan Kettering–defined disease bulk, 27% traditional bulk (> 10 cm), 52% elevated erythrocyte sedimentation rate, 21% extranodal involvement, and 56% > 2 involved lymph node sites. The complete response rate in cohorts 1-4 was 93%, 100%, 93%, and 97%, respectively. With median follow-up of 3.8 years (5.9, 4.5, 2.5, and 2.2 years for cohorts 1-4), the overall 2-year progression-free and overall survival were 94% and 99%, respectively. In cohorts 1-4, the 2-year progression-free survival was 93%, 97%, 90%, and 97%, respectively. Adverse events included neutropenia (44%), febrile neutropenia (8%), and peripheral neuropathy (54%), which was largely reversible. CONCLUSION BV + AVD × four cycles is a highly active and well-tolerated treatment program for ES, unfavorable-risk Hodgkin lymphoma, including bulky disease. The efficacy of BV + AVD supports the safe reduction or elimination of consolidative radiation among PET-4–negative patients.

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Mandell, L., F. Ghavimi, T. Peretz, M. LaQuaglia, and P. Exelby. "Radiocurability of microscopic disease in childhood rhabdomyosarcoma with radiation doses less than 4,000 cGy." Journal of Clinical Oncology 8, no. 9 (September 1990): 1536–42. http://dx.doi.org/10.1200/jco.1990.8.9.1536.

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In an attempt to evaluate the radiocurability of microscopic disease in childhood rhabdomyosarcoma (RMS) with total tumor doses of less than 4,000 cGy, we performed a retrospective analysis of all patients with microscopic residual RMS who were treated at the Memorial Sloan-Kettering Cancer Center (MSKCC) during the years 1970 to 1987. There were 32 patients ranging in age from 3 months to 22 years (median, 6 years) with microscopic residual of either (1) a localized primary tumor (MSKCC, stage IB; Intergroup Rhabdomyosarcoma Study [IRS] group IIA), 19 patients; or (2) an involved lymph node region with the primary tumor completely resected (MSKCC stage III; IRS group IIC), 13 patients. Twenty-nine of the 32 patients presented with embryonal histology. All patients were treated with combination chemotherapy (CT) and megavoltage external beam radiotherapy (RT). The RT was delivered in either conventional fractionation of 180 to 200 cGy daily (30 patients) or hyperfractionation of 150 cGy twice daily (two patients). Fifteen patients received RT doses of less than 4,000 cGy with a range of 3,000 to 3,600 cGy and a median value of 3,100 cGy; 17 patients received 4,000 cGy or more with a range of 4,000 to 6,000 cGy and a median value of 4,600 cGy. With a median follow-up of 11 years, the relapse-free survival was 25 of 32 patients (less than 4,000 cGy, 12 of 15; greater than or equal to 4,000 cGy, 13 of 17). The RT local control rate was 30 of 32 (less than 4,000 cGy, 14 of 15; greater than or equal to 4,000 cGy, 16 of 17 [P = .94]). Our results suggest that radiation doses of below 4,000 cGy, when combined with effective multiagent CT, may be sufficient for local control of microscopic disease in childhood embryonal RMS.

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Zhan, Frank Qian, Vathani Sharon Packianathan, and Nathalie Charlotte Zeitouni. "Merkel Cell Carcinoma: A Review of Current Advances." Journal of the National Comprehensive Cancer Network 7, no. 3 (March 2009): 333–39. http://dx.doi.org/10.6004/jnccn.2009.0025.

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Merkel cell carcinoma (MCC) is a rare but aggressive cutaneous malignancy of neuroendocrine origin. Its incidence has tripled over the past 15 years. This article reviews the recent advancement in diagnosis, discoveries in pathogenesis, and updates in management. The acronym, AEIOU, has been proposed to aid in clinical identification. In addition to cytokeratin 20, newer immunohistochemical stains (in particular thyroid transcription factor-1 and neurofilament protein) have proven to be essential in pathologic diagnosis. Although immune suppression and ultraviolet radiation have long been associated with the MCC oncogenesis, recent studies also show involvement of a new polyomavirus and bcl-2. Several tumor classifications have been published in the literature, with the 4-tiered system from Memorial Sloan-Kettering Cancer Center the most widely used. A similar classification with additional distinctions among nodal disease is being constructed. A multidisciplinary treatment algorithm is recommended for MCC. Surgical excision with adjuvant radiotherapy (RT) is indicated for localized tumors. RT is favored over complete lymph node dissection and chemotherapy for regional lymph node involvement. For distant metastasis, management should be individualized with a combination of palliative surgery, RT, and chemotherapy.

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Zinchenko, I. A., L. S. Pilyugin, F. Sakhibov, E. K. Grebel, A. Just, P. Berczik, Y. A. Nefedyev, J. M. Vílchez, and V. M. Shulga. "Peculiar motions of the gas at the centre of the barred galaxy UGC 4056." Astronomy & Astrophysics 628 (August 2019): A55. http://dx.doi.org/10.1051/0004-6361/201935897.

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We derive the circular velocity curves of the gaseous and stellar discs of UGC 4056, a giant barred galaxy with an active galactic nucleus (AGN). We analyse UGC 4056 using the 2D spectroscopy obtained within the framework of the Mapping Nearby Galaxies at APO (MaNGA) survey. Using images and the colour index g − r from the Sloan Digital Sky Survey (SDSS), we determined the tilt of the galaxy, which allows us to conclude that the galaxy rotates clockwise with trailing spiral arms. We found that the gas motion at the central part of the UGC 4056 shows peculiar features. The rotation velocity of the gaseous disc shows a bump within around three kiloparsecs while the rotation velocity of the stellar disc falls smoothly to zero with decreasing galactocentric distance. We demonstrate that the peculiar radial velocities in the central part of the galaxy may be caused by the inflow of the gas towards the nucleus of the galaxy. The unusual motion of the gas takes place at the region with the AGN-like radiation and can be explained by the gas response to the bar potential.

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Noy, Ariela, Joachim Yahalom, Leah Zaretsky, Ian Brett, and Andrew D. Zelenetz. "Gastric Mucosa-Associated Lymphoid Tissue Lymphoma Detected by Clonotypic Polymerase Chain Reaction Despite Continuous Pathologic Remission Induced by Involved-Field Radiotherapy." Journal of Clinical Oncology 23, no. 16 (June 1, 2005): 3768–72. http://dx.doi.org/10.1200/jco.2005.10.018.

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Purpose Gastric mucosa-associated lymphoid tissue (MALT) lymphoma is indolent and often associated with Helicobacter pylori bacterial infection. H pylori–independent MALT develops either in the absence of the bacteria or persists after bacterial eradication. We have previously demonstrated long-term pathologic remission after involved-field radiotherapy therapy (IFRT). We determined molecular remission status by clonotypic polymerase chain reaction (PCR). Patients and Methods Twenty-four consecutive patients with stage I to IIE gastric MALT lymphoma who obtained a pathologic remission after IFRT alone were evaluated. All had at least two follow-up endoscopic gastroduodenal biopsies at Memorial Sloan-Kettering Cancer Center. IFRT median dose was 30 Gy (range, 28.5 to 43.5 Gy). Post-treatment biopsies were subjected to semi-nested clonotypic PCR. Results All patients obtained a complete response based on routine immunohistochemical pathologic analysis of random post-treatment gastric biopsies. Median follow-up from completion of IFRT was 63 months (range, 19 to 117 months). Event-free survival was 96%; 23 of 34 patients remained in clinical and pathologic complete remission. Baseline DNA extraction yielded 17 clone-specific primer pairs. At the first follow-up test, 14 of 17 pairs were PCR positive. Eight remained persistently positive; and one was persistently negative. Others were intermittently positive. Conclusion Despite sustained biopsy-proven remissions for as long as 117 months after radiation, the vast majority of patients remain positive by clonotypic PCR. This suggests that the malignant clone is present but missing either an internal or external signal essential to the cancer phenotype. One possibility is that radiation eradicates the polyclonal H pylori–specific T cells eliminating critical local factors necessary for proliferation of the monoclonal B cells.

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Morikawa, Aki, Adi Diab, Sujata Patil, Victoria Forte, Brian Blum, Robert J. Young, Kathryn Beal, Clifford Hudis, Andrew David Seidman, and Heather L. McArthur. "Radiation therapy for breast cancer (BC) with central nervous system (CNS) metastases: A contemporary experience at Memorial Sloan-Kettering Cancer Center (MSKCC)." Journal of Clinical Oncology 31, no. 26_suppl (September 10, 2013): 144. http://dx.doi.org/10.1200/jco.2013.31.26_suppl.144.

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144 Background: Many of the well-studied prognostic factors for patients with breast cancer (BC) brain metastases (BM) are based on data from an era when stereotactic radiosurgery (SRS) was not commonly used. In this study, we examined patient characteristics and outcomes for patients with CNS metastases who recently underwent cranial radiation at MSKCC. Methods: 173 consecutive BC patients with CNS metastases receiving SRS or WBRT from January 2009 to December 2011 were identified. Clinico-pathologic and treatment information was obtained by retrospective review. Patient characteristics and associations were evaluated. Time from BM to death was evaluated by Kaplan-Meier and log-rank tests. Results: Of 173 patients (2 missing HER2 status), the subgroups were: HR+HER2-: 77 (45%), HR+HER2+: 28 (16%), HR-HER2+: 17(10%), and HR-HER2-(TNBC): 49 (29%). 121 had whole brain radiotherapy (4 with prior SRS), and 50 had SRS only. The use of SRS differed by subtype (overall Fisher’s exact p=0.02): 59% (HR-HER2+), 33% (TNBC), 29% (HR+HER2+), 21% (HR+HER2-). There were a total of 110 deaths. The median follow-up for survivors was 19mo (range: 6-67mo). The median time from BM to death for all patients was 17.5mo (95% confidence interval: 14-20mo): 41mo (HR-HER2+), 63mo (HR+HER2+), 14.5mo (HR+HER2-), 14mo (TNBC; log-rank test p=0.0001). Conclusions: Although HER2+ and TNBC subtypes are associated with a higher risk of BM, we noted a higher prevalence of HR+HER2- disease in BC patients with CNS metastasis, a group currently understudied. The prognostic information for time from BM to death differs according to subtype and may be important for future planning of clinical trials. Further evaluation of factors related to these outcomes is ongoing.

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Lee, K. S., R. M. Tuttle, R. A. Ghossein, S. G. Patel, A. R. Shaha, and N. Y. Lee. "Role of External Radiation Therapy in Patients With Advanced or Recurrent Non-Anaplastic Thyroid Cancer: The Memorial Sloan-Kettering Cancer Center Experience." International Journal of Radiation Oncology*Biology*Physics 69, no. 3 (November 2007): S454. http://dx.doi.org/10.1016/j.ijrobp.2007.07.1630.

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Edwards-Bennett, S. M., B. A. McCormick, L. M. Jacks, M. C. Azu, A. Y. Ho, S. N. Powell, and C. L. Brown. "Patterns of Utilization of Adjuvant Radiation Therapy and Outcomes in Black Women after Breast Conservation - The Memorial Sloan Kettering Cancer Center Experience." International Journal of Radiation Oncology*Biology*Physics 75, no. 3 (November 2009): S214. http://dx.doi.org/10.1016/j.ijrobp.2009.07.495.

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Terezakis, Stephanie A., Kyungmouk S. Lee, Ronald A. Ghossein, Michael Rivera, Robert M. Tuttle, Suzanne L. Wolden, Michael J. Zelefsky, et al. "Role of External Beam Radiotherapy in Patients With Advanced or Recurrent Nonanaplastic Thyroid Cancer: Memorial Sloan-Kettering Cancer Center Experience." International Journal of Radiation Oncology*Biology*Physics 73, no. 3 (March 2009): 795–801. http://dx.doi.org/10.1016/j.ijrobp.2008.05.012.

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Moskowitz, Craig H., Stephen D. Nimer, Andrew D. Zelenetz, Paul A. Hamlin, Steven M. Horwitz, Ariela Noy, Carol S. Portlock, et al. "Normalization of FDG-PET Pre-ASCT with Additional Non-Cross Resistant Chemotherapy Improves EFS in Patients with Relapsed and Primary Refractory Hodgkin Lymphoma-Memorial Sloan Kettering Protocol 04-047." Blood 112, no. 11 (November 16, 2008): 775. http://dx.doi.org/10.1182/blood.v112.11.775.775.

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Abstract We have reported that outcome of transplant-eligible patients (pts) with relapsed and primary refractory HL is determined by three pre-second-line chemotherapy (ST) risk factors (RF): remission duration of <1 yr., extranodal disease and B symptoms. In addition, normalization of FDG-PET prior to ASCT is the most important factor predicting favorable EFS. We now report the preliminary results of an ongoing phase II risk-adapted study where HL pts receive the following: Favorable risk (0–1 RF) - one cycle of standard dose ifosfamide, carboplatin and etoposide (ICE) ST followed by one cycle of augmented ICE; unfavorable risk (2-RF)- 2 cycles of augmented ICE. All pts then underwent a restaging FDG-PET and the results determined the next treatment. Pts with a negative FDG-PET went directly to HDT/ASCT; however if the FDG-PET was still positive, pts received an additional four biweekly cycles of gemcitabine (1000 mg/m2), vinorelbine (20 mg/m2) and liposomal doxorubicin (15 mg/m2) (GVD) followed by repeat FDG-PET scan; pts without evidence of progression then received HDT/ASCT. Preceding high-dose chemotherapy and ASCT, patients that were radiation therapy-naive received involved field radiotherapy (IFRT) followed by total lymphoid irradiation. Selected previously irradiated patients received only IFRT. Sixty-two pts are evaluable; median follow-up of surviving pts is 30 months; median age was 35. Forty-eight pts had a remission duration of < 1 yr. of those, 28 had primary refractory disease; 28 had extranodal disease and 11 had B symptoms. All patients had previously failed doxorubicin-based chemotherapy; 18 had received prior radiation; of those, 13 failed in the radiation field. Following first ST chemotherapy with ICE, 3 pts progressed, while 37 pts normalized their FDG-PET scan and currently 31 of these pts are event-free. Twenty-five pts with an improving CT scan after ICE still had a persistently positive FDG-PET; they received the second ST with GVD. Of these, 13 pts normalized their FDG-PET scan and 11 are eventfree; the remaining 12 pts had persistently abnormal FDG-PET scan or progressed; only 4 of them are event-free. There was no difference in outcome between the pts who had normal FDG-PET after ICE (pre-ASCT) and those who achieved a negative FDG-PET scan because of the additional ST with GVD. Both of these cohorts had a statistically significant improvement in EFS compared to pts with a persistently positive FDG-PET. In total 46/62 (65%) pts on this program are currently event-free. One pt died from sepsis. Conclusion: For pts with relapsed and primary refractory HL our evolving strategy is to administer ST until normalization of FDG-PET is achieved prior to HDT/ASCT. Figure Figure

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Kelly, Brandon C., Marianne Vestergaard, Xiaohui Fan, Lars Hernquist, Philip Hopkins, and Aneta Siemiginowska. "The Distribution and Evolution of Black Hole Mass in Broad Line Quasars." Proceedings of the International Astronomical Union 5, S267 (August 2009): 263. http://dx.doi.org/10.1017/s174392131000640x.

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We present the first estimate of the black hole mass function (BHMF) of broad-line quasars (BLQSOs) that self-consistently corrects for incompleteness and the statistical uncertainty in the mass estimates, based on a sample of 9886 quasars at 1 < z < 4.5 drawn from the Sloan Digital Sky Survey. We find evidence for “cosmic downsizing” of black holes in BLQSOs, where the peak in their number density shifts to higher redshift with increasing black hole mass. We estimate the lifetime of the BLQSO phase to be 70 ± 5 Myr for supermassive black holes (SMBHs) at z = 1 with a mass of MBH = 109M⊙, and we constrain the maximum mass of a black hole in a BLQSO to be ~ 1010M⊙. We find that most BLQSOs are not radiating at or near the Eddington limit. Our results are consistent with models for self-regulated black hole growth, where the BLQSO phase occurs at the end of a fueling event when black hole feedback unbinds the accreting gas.

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Journal articles on the topic 'Sloar radiation'

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