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Papers by Daniel Shasha

Anticancer research, 2013

To investigate the impact of definitive radiation therapy (RT) in the management of early glottic... more To investigate the impact of definitive radiation therapy (RT) in the management of early glottic cancer on clinical RT-induced dysphagia (RID) and carotid vasculopathy (RICV). This is a single-institution retrospective study. From January 1997 to 2010, 253 patients, with early glottic cancer, underwent RT with (60)Co or LINAC-6 MV photons. RT fields with wedge pair and daily 5-mm bolus were applied in all patients treated with 6-MV photons to avoid under-dose of the anterior laryngeal structures. The whole larynx (LX), pharyngeal constrictors (PCs), and carotid arteries (CA) were contoured and dose-volume histograms (DVHs) were generated to assess the delivered dose. The median age of patients was 65 years (range; 28-93), Caucasians were 80%, males were 87%, and 23% had T2 lesions. After a median follow-up of seven years (range; 1.5-12), the median dose and fraction size delivered to the LX were 63 and 2.25 Gy, respectively. The mean doses to the LX, PC, and CA were 57 Gy delivered...

Oral Oncology, 2013

Locally Advanced Head-and-neck cancer (LAHNC) Lower cranial nerves IX-XII palsy Radiotherapy (RT)... more Locally Advanced Head-and-neck cancer (LAHNC) Lower cranial nerves IX-XII palsy Radiotherapy (RT) Intensity-modulated radiotherapy (IMRT) Contouring atlas Base of skull, nasopharyngeal and Paranasalsinus cancer s u m m a r y Objectives: Radiation induced cranial nerve palsy (RICNP) involving the lower cranial nerves (CNs) is a serious complication of head and neck radiotherapy (RT). Recommendations for delineating the lower CNs on RT planning studies do not exist. The aim of the current study is to develop a standardized methodology for contouring CNs IX-XII, which would help in establishing RT limiting doses for organs at risk (OAR). Methods: Using anatomic texts, radiologic data, and guidance from experts in head and neck anatomy, we developed step-by-step instructions for delineating CNs IX-XII on computed tomography (CT) imaging. These structures were then contoured on five consecutive patients who underwent definitive RT for locally-advanced head and neck cancer (LAHNC). RT doses delivered to the lower CNs were calculated. Results: We successfully developed a contouring atlas for CNs IX-XII. The median total dose to the planning target volume (PTV) was 70 Gy (range: 66-70 Gy). The median CN (IX-XI) and (XII) volumes were 10 c.c (range: 8-12 c.c) and 8 c.c (range: 7-10 c.c), respectively. The median V50, V60, V66, and V70 of the CN (IX-XI) and (XII) volumes were (85, 77, 71, 65) and (88, 80, 74, 64) respectively. The median maximal dose to the CN (IX-XI) and (XII) were 72 Gy (range: 66-77) and 71 Gy (range: 64-78), respectively. Conclusions: We have generated simple instructions for delineating the lower CNs on RT planning imaging. Further analyses to explore the relationship between lower CN dosing and the risk of RICNP are recommended in order to establish limiting doses for these OARs.

The Oncologist

Local recurrence remains a major obstacle to achieving cure of many locally advanced solid tumors... more Local recurrence remains a major obstacle to achieving cure of many locally advanced solid tumors treated with definitive radiation therapy. The microenvironment of solid tumors is hypoxic compared with normal tissue, and this hypoxia is associated with decreased radiosensitivity. Recent preclinical data also suggest that intratumoral hypoxia, particularly in conjunction with an acid microenvironment, may be directly or indirectly mutagenic. Investigations of the prognostic significance of the pretreatment oxygenation status of tumors in patients with head and neck or cervical cancer have demonstrated that increased hypoxia, typically designated in these studies as pO 2 levels below 2.5-10 mm Hg, is associated with decreased local tumor control and lower rates of disease-free and overall survival. Hypoxia-directed therapies in the radiation oncology setting include treatment using hyperbaric oxygen, fluosol infusion, carbogen breathing, and electron-affinic and hypoxic-cell sensitizers. These interventions have shown the potential to increase the effectiveness of curative-intent radiation therapy, demonstrating that the strategy of overcoming hypoxia may be a viable and important approach. Anemia is common in the cancer population and is suspected to contribute to intratumoral hypoxia. A review of the literature reveals that a low hemoglobin level before or during radiation therapy is an important risk factor for poor locoregional disease control and survival, implying that a strong correlation could exist between anemia and hypoxia (ultimately predicting for a poor outcome). While having a low hemoglobin level has been shown to be detrimental, it is unclear as to exactly what the threshold for "low" should be (studies in this area have used thresholds ranging from 9-14.5 g/dl). Optimal hemoglobin and pO 2 thresholds for improving outcomes may vary across and within tumor types, and this is an area that clearly The Oncologist 2002;7:492-508 www.TheOncologist.com The Oncologist ®

ACM SIGKDD Explorations Newsletter

PURPOSE/AIM To review the imaging appearance of newly diagnosed prostate cancer on multiparametri... more PURPOSE/AIM To review the imaging appearance of newly diagnosed prostate cancer on multiparametric endorectal magnetic resonance imaging (MRI). To review the various treatment options for prostate cancer. To compare the MR imaging appearance of the prostate gland or residual prostate bed after hormone ablation, radiation therapy, and post prostatectomy CONTENT ORGANIZATION Multiparametric MRI appearance of newly diagnosed prostate cancer: Anatomic (T1, T2) and Functional (DWI, DCE) imaging. Individualized treatment approach to prostate cancer: Watchful waiting, Chemical therapy (hormones), Radiation therapy (brachytherapy, EBRT), Surgery (RRP, thermal ablation). Multiparametric MRI appearance after hormone ablation and radiation therapy: Anatomic (T1, T2) and Functional (DWI, DCE) imaging; Imaging the prostate bed after prostatectomy (local recurrence) SUMMARY Imaging the treated prostate gland can pose significant challenges due to the varied effects on the gland. Understanding the...

The objective of this report is to develop and disseminate the American Brachytherapy Society (AB... more The objective of this report is to develop and disseminate the American Brachytherapy Society (ABS) recommendations for high dose rate (HDR) prostate brachytherapy. The ABS formed a committee of experts in HDR prostate brachytherapy to assess current clinical practice and develop recommendations through a critical analysis of published data supplemented by their clinical experience. Active US practices were surveyed to determine current practice patterns. The recommendations of the panel were reviewed by outside experts and approved by the Board of Directors of the ABS. The areas addressed by the panel included basic pretreatment evaluation, patient selection, external beam radiation therapy (EBRT) parameters, implant techniques, dosimetric parameters (including dose fractionation, prescription, optimization, imaging techniques, and methods for implant evaluation), morbidity, outcome analysis, and areas of future research. Recommendations were made whenever sufficient data were avai...

The journal of supportive oncology, 2006

Epoetin alfa is an established treatment of anemia in patients with cancer who are receiving chem... more Epoetin alfa is an established treatment of anemia in patients with cancer who are receiving chemotherapy with or without radiation therapy. However, fewer data support its use in patients with cancer not currently receiving either therapy. This 16-week, open-label, nonrandomized, multicenter pilot study evaluated the clinical profile of epoetin alfa (40,000 U) administered weekly via subcutaneous injection in anemic patients with cancer not receiving chemotherapy or radiation therapy. The primary endpoint was the proportion of patients who achieved a minor (hemoglobin [Hgb] increase > or = 1-1.9 g/dL) or major (Hgb increase > or = 2 g/dL) hematologic response. The trial was temporarily suspended to amend the protocol to reflect updated package insert recommendations for target Hgb and dose adjustments. Of the 98 patients enrolled, 91 (mean age, 69.5 +/- 9.5 years; baseline Hgb level, 10.4 +/- 0.7 g/dL) were evaluated for efficacy in a modified intent-to-treat analysis. Nearly...

Anticancer research, 2013

Journal of the National Comprehensive Cancer Network : JNCCN, 2004

This study in patients with cancer and anemia, who were receiving chemoradiation and were treated... more This study in patients with cancer and anemia, who were receiving chemoradiation and were treated with epoetin alfa, examined the relationship between hemoglobin level and quality of life (QOL), change in hemoglobin and change in QOL, and incremental (1 g/dL) increase in hemoglobin and related incremental improvement in QOL. Data from a multicenter, open-label, prospective study of once-weekly epoetin alfa therapy in anemic cancer patients receiving chemoradiation were used to retrospectively evaluate the relationship between hemoglobin changes and QOL changes via correlation and longitudinal analyses. A sample selection correction method was used to ensure unbiased results. QOL (energy, activity, overall QOL) was measured using the Linear Analog Scale Assessment. An incremental analysis determined the greatest incremental increase in QOL associated with a 1 g/dL increase in hemoglobin level. Of the 777 patients enrolled, 464 met chemotherapy and radiotherapy eligibility criteria. O...

Anticancer research, 2014

To evaluate the locoregional control and treatment toxicity of patients with pleomorphic adenoma ... more To evaluate the locoregional control and treatment toxicity of patients with pleomorphic adenoma after resection with close or positive margins followed by postoperative radiation therapy (PORT). Between 2002 and 2011, twenty-one patients underwent PORT at the Mount Sinai Beth Israel Medical Center for pleomorphic adenoma of the parotid with close or positive margins. Four out of the 21 patients (19%) had recurrent lesions. The median dose was 57.6 Gy (range 55.8-69.96) delivered at 1.8-2.12 Gy/fraction. Treatment and follow-up data were retrospectively analyzed for locoregional control as well as acute- and late-treatment toxicities. Actuarial survival analysis was also performed. Twelve women and 9 men with a median age of 46 (26-65) at PORT were included in this study. Eighty-one percent of the cohort had positive resection margins while 19% had close margins. At a median follow-up of 92 months, 19/21 patients (90%) had locoregional control. Two patients who failed had primary le...

The Canadian journal of urology, 2003

To determine if there is correlation between the size of radical prostatectomy specimens and peri... more To determine if there is correlation between the size of radical prostatectomy specimens and perioperative complications including intraoperative blood loss. One hundred twenty consecutive retropubic radical prostatectomy cases were retrospectively reviewed. Perioperative complications, intraoperative blood loss, pathologic stage, and size of the prostatectomy specimen were recorded. Logistic regression was used to determine whether variables such as age, PSA, and prostate weight are significant predictors of perioperative complications and intraoperative blood loss. The final analysis included a total of 117 cases. Significant complications were seen in 10 patients (8.5%). The median weight of the prostatectomy specimen in the group with major complications was 44.5 g (range 24-219) which was significantly higher than the median weight of 39.9 g (range 13-124) for the group without any complications (p = 0.034). The size of the prostate gland predicted the likelihood of a periopera...

International Journal of Radiation Oncology*Biology*Physics, 2014

Supportive Care in Cancer, 2004

Oral transmucosal fentanyl citrate (OTFC; ACTIQ) incorporates fentanyl into a lozenge allowing dr... more Oral transmucosal fentanyl citrate (OTFC; ACTIQ) incorporates fentanyl into a lozenge allowing drug delivery through the oral mucosa resulting in rapid pain relief. OTFC is effective for breakthrough pain and could be particularly useful in patients with mucositis. This randomized, double-blind, crossover study assessed two formulations of OTFC for tolerability in 14 patients with radiation-induced mucositis. On four separate days, patients with grade 3 or 4 mucositis received an OTFC unit 45 min before radiation treatment. Two units had a sweetened matrix formulation and two had a compressed powder formulation. One unit of each formulation contained 200 microg fentanyl and one was placebo. Tolerability, mucositis pain, and formulation preference were evaluated. Changes in oral mucosa were recorded. Both formulations of OTFC were well tolerated. There were no significant differences between formulations in tolerability, patient preference, or VAS pain scores. No changes in oral mucosa were noted. Common treatment-related adverse events included a burning sensation in the mouth, nausea, and vomiting. Both formulations of OTFC are well tolerated. The presence of fentanyl in either the sweetened matrix or the compressed powder did not alter tolerability or safety. The dose of fentanyl tested did not yield analgesia greater than placebo; future studies of OTFC efficacy in mucositis should evaluate higher doses than 200 microg.

Seminars in Radiation Oncology, 1998

By precision dose delivery to a well-defined target, brachytherapy fulfills the complementary goa... more By precision dose delivery to a well-defined target, brachytherapy fulfills the complementary goals of delivering sufficient dose for tumor cell kill while sparing normal adjacent structures. The unique properties of this modality, either used alone or implemented in a combined modality setting with surgery or external-beam irradiation, offer an ideal means of enhancing the therapeutic ratio by exploiting the effect of local therapies while respecting normal tissue tolerance. Brachytherapy also provides an effective technique for the retreatment of patients with recurrent, persistent, or second primary head and neck malignant tumors in a previously irradiated region. The benefits of this treatment modality are reflected in excellent reported local control rates, shortened overall treatment times, reduced functional deficits, improved quality of life, and decreased costs. Successful brachytherapy relies, however, on close collaborative efforts between radiation oncologists and surgeons, careful assessment of the patient, precise planning, and technique that adheres to the rules of a system. Brachytherapy has been clearly identified as an effective, safe, and appealing modality in the treatment of head and neck malignancies.

Seminars in Radiation Oncology, 2000

The goal of palliative radiation is to alleviate symptoms in a short amount of time and maintain ... more The goal of palliative radiation is to alleviate symptoms in a short amount of time and maintain an optimal functional and quality-of-life level while minimizing toxicity and patient inconvenience. Despite advances in multimodality antineoplastic therapies, failure to control the tumor at its primary site frustratingly remains the predominant source of morbidity and mortality in many patients with cancer. Escalation of doses of radiation using external beam irradiation has been shown to improve local tumor control, but limits are imposed by the tolerance of normal surrounding structures. The highly conformal nature of brachytherapy enables the radiation oncologist to accomplish safe escalation of radiation doses to the tumor while minimizing doses to normal surrounding structures. Thus, by enhancing the potential for local control, brachytherapy used alone or as a supplement to external beam radiation therapy retains a significant and important role in achieving the goals of palliation. Proper patient selection, excellent technique, and adherence to implant rules will minimize the risk of complications. The advantages realized with the use of brachytherapy include good patient tolerance, short treatment time, and high rates of sustained palliation. This article reviews various aspects of palliative brachytherapy, including patient selection criteria, implant techniques, treatment planning, dose and fractionation schedules, results, and complications of treatment. Tumors of the head and neck, trachea and bronchi, esophagus, biliary tract, and brain, all in which local failure represents the predominant cause of morbidity and mortality, are highlighted.

Seminars in Oncology, 2001

Anemia is associated with reduced local tumor control and impaired quality of life in patients wi... more Anemia is associated with reduced local tumor control and impaired quality of life in patients with several types of solid tumors. The prevalence of anemia in patients who present at radiation oncology departments has not been well documented, and the impact of anemia on the outcome of radiation therapy is not widely appreciated in the radiation oncology setting. In an ongoing study, we are retrospectively reviewing the medical charts of patients before and after radiation therapy at our institutions to determine the magnitude of the anemia problem in this population. Preliminary data are available for 574 randomly selected patients (52% female) seen between December 1996 and June 1999. At presentation, 41% of all patients were anemic (hemoglobin < 12 g/dL); by the end of radiation therapy, this percentage increased to 54%. The most common tumor types were prostate (16%), breast (14%), head and neck (12%), colorectal (11%), lung/bronchus (11%), and uterine-cervix (9%). Anemia was most prevalent in patients with uterine-cervical tumors (75%), increasing to 79% by the end of radiation therapy. The prevalence of lung/bronchus and colorectal cancer was 55% and 44%, respectively, at baseline and increased to 77% and 63%, respectively, after radiation therapy. For nearly all tumor types, the majority of patients had or developed mild to moderate anemia (hemoglobin 10.0 to 11.9 g/dL). These data show that anemia is widespread among patients seen in radiation oncology practices. However, the anemia is usually mild and readily correctable. Because anemia and hypoxia possibly associated with anemia are obstacles to local tumor control and maintenance of quality of life, strategies to reverse anemia should receive greater attention.

Radiotherapy and Oncology, 2001

ABSTRACT This report presents the American Brachytherapy Society (ABS) guidelines for the use of ... more ABSTRACT This report presents the American Brachytherapy Society (ABS) guidelines for the use of brachytherapy for patients with soft tissue sarcoma. Members of the ABS with expertise in soft tissue sarcoma formulated brachytherapy guidelines based upon their clinical experience and a review of the literature. The Board of Directors of the ABS approved the final report. Brachytherapy used alone or in combination with external beam irradiation is an established means of safely providing adjuvant local treatment after resection for soft tissue sarcomas in adults and in children. Brachytherapy options include low dose rate techniques with iridium 192 or iodine 125, fractionated high dose rate brachytherapy, or intraoperative high dose rate therapy. Recommendations are made for patient selection, techniques, dose rates, and dosages. Complications and possible interventions to minimize their occurrence and severity are reviewed. Brachytherapy represents an effective means of enhancing the therapeutic ratio, offering both biologic and dosimetric advantage in the treatment of patients with soft tissue sarcoma. The treatment approach used depends upon the institution, physician expertise, and the clinical situation. Guidelines are established for the use of brachytherapy in the treatment of soft tissue sarcomas in adults and in children. Practitioners and cooperative groups are encouraged to use these guidelines to formulate their treatment and dose-reporting policies. These guidelines will be modified, as further clinical results become available.

Anticancer research, 2013

Oral Oncology, 2013

The Oncologist

ACM SIGKDD Explorations Newsletter

The journal of supportive oncology, 2006

Anticancer research, 2013

Journal of the National Comprehensive Cancer Network : JNCCN, 2004

Anticancer research, 2014

The Canadian journal of urology, 2003

International Journal of Radiation Oncology*Biology*Physics, 2014

Supportive Care in Cancer, 2004

Seminars in Radiation Oncology, 1998

Seminars in Radiation Oncology, 2000

Seminars in Oncology, 2001

Radiotherapy and Oncology, 2001