Ingrid Meszoely - Academia.edu (original) (raw)

Papers by Ingrid Meszoely

International Journal of Cancer

Journal of Radiation Oncology

Objective Two prospective randomized trials, TARGIT-A and ELIOT, have shown intraoperative radiat... more Objective Two prospective randomized trials, TARGIT-A and ELIOT, have shown intraoperative radiation (IORT) to be safe and well-tolerated in low-risk patients. Electronic IORT with the Xoft Axxent system has few long-term reported results. Materials/methods A total of 100 patients (101 tumors) were treated with partial mastectomy and intraoperative brachytherapy. Electronic brachytherapy via IORT was utilized to deliver 20 Gy to the balloon surface in a single fraction prior to completion of surgery. Necessity of additional intervention with surgery or radiation was noted, as was the presence of clinical seroma and tumor recurrence. Patients were followed at regular intervals for at least 5 years. Results Patients ranged in age from 41 to 83, with a median age of 66. Out of the 101 tumors treated, T-staging consisted of 28.7% Tis, 2.0% T1mi, 11.9% T1a, 23.8% T1b, 30.7% T1c, and 3.0% T2. At a median follow up of 3.8 years, there have been two recurrences. Eighteen patients required additional surgery or radiation. Patients classified as "suitable" by the accelerated partial breast irradiation suitability criteria were less likely to require re-excision (suitable: 1.6%, cautionary: 22.6%, unsuitable: 87.5%, P < 0.001), but no less likely to require additional whole breast irradiation. Symptomatic seromas were noted in 15% of patients. Conclusion IORT is a convenient and well-tolerated treatment option for the appropriately selected woman undergoing partial breast irradiation. Rates of seroma formation are similar to rates reported for multiple fraction catheter-based systems.

JAMA Oncology

IMPORTANCE Survival differences between male and female patients with breast cancer have been rep... more IMPORTANCE Survival differences between male and female patients with breast cancer have been reported, but the underlying factors associated with the disparity have not been fully studied. This understanding is fundamental to developing strategies for cancer treatment and survivorship care. OBJECTIVE To compare mortality between male and female patients with breast cancer and quantitatively evaluate the factors associated with sex-based disparity in mortality. DESIGN, SETTING, AND PARTICIPANTS This large, nationwide, registry-based cohort study used the National Cancer Database to identify and obtain data on patients who

Journal of Clinical Oncology

Lymphatic research and biology, Mar 1, 2017

Breast cancer treatment-related lymphedema (BCRL) arises from a mechanical insufficiency followin... more Breast cancer treatment-related lymphedema (BCRL) arises from a mechanical insufficiency following cancer therapies. Early BCRL detection and personalized intervention require an improved understanding of the physiological processes that initiate lymphatic impairment. Here, internal magnetic resonance imaging (MRI) measures of the tissue microenvironment were paired with clinical measures of tissue structure to test fundamental hypotheses regarding structural tissue and muscle changes after the commonly used therapeutic intervention of manual lymphatic drainage (MLD). Measurements to identify lymphatic dysfunction in healthy volunteers (n = 29) and patients with BCRL (n = 16) consisted of (1) limb volume, tissue dielectric constant, and bioelectrical impedance (i.e., non-MRI measures); (2) qualitative 3 Tesla diffusion-weighted, T1-weighted and T2-weighted MRI; and (3) quantitative multi-echo T2 MRI of the axilla. Measurements were repeated in patients immediately following MLD. Nor...

Physics in medicine and biology, Jan 21, 2017

Tissue stiffness interrogation is fundamental in breast cancer diagnosis and treatment. Furthermo... more Tissue stiffness interrogation is fundamental in breast cancer diagnosis and treatment. Furthermore, biomechanical models for predicting breast deformations have been created for several breast cancer applications. Within these applications, constitutive mechanical properties must be defined and the accuracy of this estimation directly impacts the overall performance of the model. In this study, we present an image-derived computational framework to obtain quantitative, patient specific stiffness properties for application in image-guided breast cancer surgery and interventions. The method uses two MR acquisitions of the breast in different supine gravity-loaded configurations to fit mechanical properties to a biomechanical breast model. A reproducibility assessment of the method was performed in a test-retest study using healthy volunteers and was further characterized in simulation. In five human data sets, the within subject coefficient of variation ranged from 10.7% to 27% and t...

Science translational medicine, Jan 9, 2017

Inhibition of proliferation in estrogen receptor-positive (ER(+)) breast cancers after short-term... more Inhibition of proliferation in estrogen receptor-positive (ER(+)) breast cancers after short-term antiestrogen therapy correlates with long-term patient outcome. We profiled 155 ER(+)/human epidermal growth factor receptor 2-negative (HER2(-)) early breast cancers from 143 patients treated with the aromatase inhibitor letrozole for 10 to 21 days before surgery. Twenty-one percent of tumors remained highly proliferative, suggesting that these tumors harbor alterations associated with intrinsic endocrine therapy resistance. Whole-exome sequencing revealed a correlation between 8p11-12 and 11q13 gene amplifications, including FGFR1 and CCND1, respectively, and high Ki67. We corroborated these findings in a separate cohort of serial pretreatment, postneoadjuvant chemotherapy, and recurrent ER(+) tumors. Combined inhibition of FGFR1 and CDK4/6 reversed antiestrogen resistance in ER(+)FGFR1/CCND1 coamplified CAMA1 breast cancer cells. RNA sequencing of letrozole-treated tumors revealed th...

Clinical cancer research : an official journal of the American Association for Cancer Research, Jan 7, 2017

Due to inherent disease heterogeneity, targeted therapies have eluded TNBC, and biomarkers predic... more Due to inherent disease heterogeneity, targeted therapies have eluded TNBC, and biomarkers predictive of treatment response have not yet been identified. This study was designed to determine if the mTOR inhibitor everolimus with cisplatin and paclitaxel would provide synergistic anti-tumor effects in TNBC. Stage II/III patients with TNBC were enrolled in a randomized phase II trial of preoperative weekly cisplatin, paclitaxel and daily everolimus or placebo for 12 weeks, until definitive surgery. Tumor specimens were obtained at baseline, cycle 1 and surgery. Primary endpoint was pathological complete response (pCR); secondary endpoints included clinical responses, breast conservation rate, safety, and discovery of molecular features associated with outcome. Between 2009 and 2013, 145 patients were accrued; 36% patients in the everolimus arm and 49% patients in the placebo arm achieved pCR; in each arm, 50% of patients achieved complete responses by imaging. Higher rates of neutrope...

Medical Imaging 2016: Image-Guided Procedures, Robotic Interventions, and Modeling, 2016

Proceedings of Spie the International Society For Optical Engineering, Jun 16, 2007

... 17. AS Haka, Z. Volynskaya, JA Gardecki, J. Nazemi, J. Lyons, D. Hicks, M. Fitzmaurice, RR Da... more ... 17. AS Haka, Z. Volynskaya, JA Gardecki, J. Nazemi, J. Lyons, D. Hicks, M. Fitzmaurice, RR Dasari, JP Crowe and MS Feld, "In ... SK Majumder, MD Keller and A. Mahadevan-Jansen, "Optical detection of breast tumors - a comparison of diagnostic performance of autofluorescence ...

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, Jan 21, 2016

The objective of this study was to determine whether the 21-gene Recurrence Score (RS) provides c... more The objective of this study was to determine whether the 21-gene Recurrence Score (RS) provides clinically meaningful information in patients with de novo stage IV breast cancer enrolled in the Translational Breast Cancer Research Consortium (TBCRC) 013. TBCRC 013 was a multicenter prospective registry that evaluated the role of surgery of the primary tumor in patients with de novo stage IV breast cancer. From July 2009 to April 2012, 127 patients from 14 sites were enrolled; 109 (86%) patients had pretreatment primary tumor samples suitable for 21-gene RS analysis. Clinical variables, time to first progression (TTP), and 2-year overall survival (OS) were correlated with the 21-gene RS by using log-rank, Kaplan-Meier, and Cox regression. Median patient age was 52 years (21 to 79 years); the majority had hormone receptor-positive/human epidermal growth factor receptor 2 (HER2)-negative (72 [66%]) or hormone receptor-positive/HER2-positive (20 [18%]) breast cancer. At a median follow-...

The American surgeon

The prognostic significance of malignant cells in the peritoneal washings of patients with pancre... more The prognostic significance of malignant cells in the peritoneal washings of patients with pancreatic adenocarcinoma remains poorly defined. Prior reports suggest that positive peritoneal cytology (PPC) is associated with advanced disease and reduced survival. To determine the prognostic value of PPC in patients with pancreatic cancer, we retrospectively reviewed our database between July 1987 and September 2002 and identified 168 patients who had undergone exploration for potentially resectable pancreatic cancer with peritoneal washings performed at the time of exploration. One hundred thirty-five patients underwent resection; 33 were considered unresectable. PPC was reported for 27 patients (16.1%): 13 (9.6%) in the resected and 14 (42.4%) in the unresected group. Median time to macroscopically detected recurrence in the resected group was not significantly different in the PPC versus negative peritoneal cytology (NPC) patients (10 vs 12 months, P = 0.46). Median overall survival of patients with PPC versus NPC approached, but did not reach, significance (15 vs 19 months, P = 0.055). Peritoneal cytology status was not associated with administration of chemoradiation, margin status, antecedent fine-needle aspiration, stage, or site of recurrence. These data suggest that malignant cells in peritoneal washings of patients with potentially resectable pancreatic adenocarcinoma should not preclude resection. Long-term survival may be achieved, therefore aggressive treatment should strongly be considered.

International Journal of Computer Assisted Radiology and Surgery, 2015

Purpose-Unfortunately, the current re-excision rates for breast conserving surgeries due to posit... more Purpose-Unfortunately, the current re-excision rates for breast conserving surgeries due to positive margins average 20-40%. The high re-excision rates arise from difficulty in localizing tumor boundaries intraoperatively and lack of real-time information on the presence of residual disease. The work presented here introduces the use of supine magnetic resonance (MR) images, digitization technology, and bio-mechanical models to investigate the capability of using an image guidance system to localize tumors intraoperatively. Methods-Preoperative supine MR images were used to create patient-specific biomechanical models of the breast tissue, chest wall, and tumor. In a mock intraoperative setup, a laser range scanner was used to digitize the breast surface and tracked ultrasound was used to digitize the chest wall and tumor. Rigid registration combined with a novel non-rigid registration routine was used to align the preoperative and intraoperative patient breast and tumor. The registra tion framework is driven by breast surface data (laser range scan of visible surface), ultrasound chest wall surface, and MR-visible fiducials. Tumor localizations by tracked ultra-sound were only used to evaluate the fidelity of aligning preoperative MR tumor contours to physical patient space. The use of tracked ultrasound to digitize subsurface features to constrain our nonrigid registration approach and to assess the fidelity of our framework makes this work unique. Two patient subjects were analyzed as a preliminary investigation toward the realization of this supine image-guided approach. Results-An initial rigid registration was performed using adhesive MR-visible fiducial markers for two patients scheduled for a lumpectomy. For patient 1, the rigid registration resulted in a rootmean-square fiducial registration error (FRE) of 7.5 mm and the difference between the intraoperative tumor centroid as visualized with tracked ultrasound imaging and the registered Rebekah H. Conley