MATTHIAS MANUEL - Academia.edu (original) (raw)
Papers by MATTHIAS MANUEL
Journal of scientific innovation in medicine, 2022
The Journal of Pediatrics, 2022
OBJECTIVE To examine the association between uropathogens and pyuria in children less than 24 mon... more OBJECTIVE To examine the association between uropathogens and pyuria in children less than 24 months of age. STUDY DESIGN: A retrospective study of children <24 months of age evaluated in the emergency department for suspected UTI with paired urinalysis (UA) and urine culture during a 6-year period. Bagged urine specimens or urine culture growing mixed/multiple urogenital organisms were excluded. Analysis was limited to children with positive urine culture as defined by the American Academy of Pediatrics clinical practice guideline culture thresholds. RESULTS Of 30,462 children, 1,916 had microscopic UA and positive urine culture. Urine was obtained by transurethral in-and-out catheterization in 98.3% of cases. Pyuria (≥5 WBCs per high-powered field) and positive leukocyte esterase (small or more) on the urine dipstick were present in 1,690 (88.2%) and 1,692 (88.3%) of the children respectively. Children with non-E. coli species were less likely to exhibit microscopic pyuria than children with E. coli (OR 0.24, 95% CI 0.17-0.34) with more pronounced effect on Enterococcus and Klebsiella (OR 0.08, 95% CI 0.03-0.18, and OR 0.18, 95% CI 0.11-0.27 respectively). Similarly, positive leukocyte esterase was less frequently seen in non-E. coli uropathogens compared with E. coli. CONCLUSION Pyuria and leukocyte esterase are not sensitive markers to identify non-E. coli UTI in young children. More sensitive screening biomarkers are needed to identify UTI with these uropathogens. .
Child and Adolescent Mental Health
BackgroundThe shortage of mental health services across the United States has turned pediatric em... more BackgroundThe shortage of mental health services across the United States has turned pediatric emergency departments (PEDs) into safety‐nets for the increasing population of children with mental and behavioral health (MBH) needs. This study provides a descriptive characterization of MBH‐related PED visits, the trends in visit, ED length of stay (EDLOS), and admission rate.MethodsWe reviewed electronic health records of children ≤18 years with MBH needs, who visited the PED of a large tertiary hospital from January 2017 to December 2019. We performed descriptive statistics, chi‐square (χ2), and logistic regression analyses to evaluate trend in visit, EDLOS, admission rate, and predictors of prolonged EDLOS and inpatient admission.ResultsOf 10,167 patients, 58.4% were females, median age was 13.8 years, and 86.1% were adolescents. On average, visits increased by 19.7% annually, with a 43.3% increase over 3 years. Common ED diagnoses include, suicidality (56.2%), depression (33.5%), ov...
Pediatric Emergency Care
Objectives: This study aimed to describe changes in pediatric emergency department (ED) mental an... more Objectives: This study aimed to describe changes in pediatric emergency department (ED) mental and behavioral health (MBH) visits before and during the early COVID-19 pandemic. Methods: We retrospectively reviewed medical records of patients aged from 5 to 17 years presenting to the pediatric ED of a major tertiary care hospital with MBH-related concerns from March 2017 to September 2020. We evaluated trends in MBH ED visits over the study period, specifically comparing patient demographics, diagnosis categories, and ED disposition between the pre-COVID (2019) and COVID (2020) periods using pairwise Pearson χ 2 analyses with reported odds ratios (ORs) in SAS statistical software version 9.4 (SAS Institute Inc, Cary, NC). Results: Of 8093 MBH-related visits, 58.5% were females, 85.4% were adolescents, and 62.7% self-identified as non-Hispanic. The proportion of MBH-related ED visits increased from 3.8% to 7.5% over the study period (P < 0.0001). Although total MBH visits decreased by 17.3% from 2019 to 2020, there was a proportionate increase in MBH-to-total-ED visits, representing a 42.8% increase through 2019. Compared with 2019, there was a proportionate increase in MBH-related ED visits by females (10.6%,
Gynecologic Oncology, Dec 1, 2016
Large tumor size was associated with an increased risk of any recurrence • Overall, there was an ... more Large tumor size was associated with an increased risk of any recurrence • Overall, there was an overall decrease in point A dose over 5 fractions • Point A dose was lower for those without relapse than those with relapse • CT-based rather than point A based BT results in outstanding local control
International Journal of Radiation Oncology Biology Physics, Nov 1, 2015
Materials/Methods: This study was performed on 6 cervical-cancer BT cases with different applicat... more Materials/Methods: This study was performed on 6 cervical-cancer BT cases with different applicators including tandem and ovoid, ovoid with needles and ring applicators. Computed tomography was used as an imagining modality for the first 3 cases and MRI for the other 3. For each case and imaging modality, participants from 6 different institutions each created 2 BT plans: the first was a plan normalized to point A, and the second was an optimized plan. The high-dose-rate (HDR) BT plans were created as boost plans under the assumption that the patients had previously received 45 Gy, during the initial course. The prescription dose for the HDR treatment was 27.5 Gy in 5 fractions. Plan construction required that the tumor D90 receive the highest possible total dose while respecting maximum dose constraints to the rectum, bladder and sigmoid (75, 90 and 75 Gy). The EQD2 calculation was performed so total dose from treatments could be evaluated. Data collected for statistical analysis included: CTV and high-risk CTV (D90, D100, V100, V150 and V200); D0.1cm 3 , D2cm 3 and D5cm 3 for the bladder, rectum and sigmoid. Results: On an institutional level, differences were most noted in the ovoid and needles plans, irrespective of the imaging modality. The average coverage (D90) of CTV for MR-based optimized and non-optimized plans were 4.92 (SD Z 0.74) Gy and 4.88 (SD Z 0.89) Gy, respectively, indicating the increase of variations with increase of the plan complexity. The table shows the average values of the optimized plans across 6 institutions; D90 for the optimized plans was 5.25 (SD Z 0.61) Gy per fraction resulting in a total equivalent dose of 77.6AE5.2 Gy. The average D2 doses for bladder, rectum and sigmoid for the optimized plans were 77.6 (SD Z 5.2) Gy, 68.2 (SD Z 5.8) Gy and 63.8 (SD Z 3.3) Gy, respectively. A high level of consistency between the dosimetric parameters for all plans was noted (all P>.05). Conclusion: No significant differences in target coverage were recorded in any plans. This conclusion is valid for both optimized plans and point A normalized plans, indicating the consistency of the treatment plans among the institutions. The differences in the doses to the OARs should not translate into meaningful clinical outcomes.
Brachytherapy, May 1, 2016
Gynecologic Oncology, Dec 1, 2015
International Journal of Radiation Oncology Biology Physics, Nov 1, 2015
International Journal of Radiation Oncology*Biology*Physics, 2015
International Journal of Radiation Oncology*Biology*Physics, 2015
Materials/Methods: This study was performed on 6 cervical-cancer BT cases with different applicat... more Materials/Methods: This study was performed on 6 cervical-cancer BT cases with different applicators including tandem and ovoid, ovoid with needles and ring applicators. Computed tomography was used as an imagining modality for the first 3 cases and MRI for the other 3. For each case and imaging modality, participants from 6 different institutions each created 2 BT plans: the first was a plan normalized to point A, and the second was an optimized plan. The high-dose-rate (HDR) BT plans were created as boost plans under the assumption that the patients had previously received 45 Gy, during the initial course. The prescription dose for the HDR treatment was 27.5 Gy in 5 fractions. Plan construction required that the tumor D90 receive the highest possible total dose while respecting maximum dose constraints to the rectum, bladder and sigmoid (75, 90 and 75 Gy). The EQD2 calculation was performed so total dose from treatments could be evaluated. Data collected for statistical analysis included: CTV and high-risk CTV (D90, D100, V100, V150 and V200); D0.1cm 3 , D2cm 3 and D5cm 3 for the bladder, rectum and sigmoid. Results: On an institutional level, differences were most noted in the ovoid and needles plans, irrespective of the imaging modality. The average coverage (D90) of CTV for MR-based optimized and non-optimized plans were 4.92 (SD Z 0.74) Gy and 4.88 (SD Z 0.89) Gy, respectively, indicating the increase of variations with increase of the plan complexity. The table shows the average values of the optimized plans across 6 institutions; D90 for the optimized plans was 5.25 (SD Z 0.61) Gy per fraction resulting in a total equivalent dose of 77.6AE5.2 Gy. The average D2 doses for bladder, rectum and sigmoid for the optimized plans were 77.6 (SD Z 5.2) Gy, 68.2 (SD Z 5.8) Gy and 63.8 (SD Z 3.3) Gy, respectively. A high level of consistency between the dosimetric parameters for all plans was noted (all P>.05). Conclusion: No significant differences in target coverage were recorded in any plans. This conclusion is valid for both optimized plans and point A normalized plans, indicating the consistency of the treatment plans among the institutions. The differences in the doses to the OARs should not translate into meaningful clinical outcomes.
![Research paper thumbnail of Corrigendum to "comparison of outcomes for MR-guided versus CT-guided high-dose-rate interstitial brachytherapy in women with locally advanced carcinoma of the cervix" [Gynecol. Oncol. 145 (2017) 284-290]](https://attachments.academia-assets.com/109533366/thumbnails/1.jpg)
](Gynecologic oncology, Aug 1, 2017
Gynecologic Oncology, 2015
Brachytherapy, Jan 27, 2017
To investigate the dose-volume histogram metrics and optimization results of the contoured bowel ... more To investigate the dose-volume histogram metrics and optimization results of the contoured bowel in cervical cancer brachytherapy. Treatment plans of cervical cancer patients treated with image-guided high dose rate were retrospectively analyzed with institutional review board approval. In addition to the clinical target volume, rectum, bladder, and sigmoid, the bowel was contoured at the time of planning (Group 1) or at the time of this analysis (Group 2). Thirty-two patients treated with 145 insertions were included. Before optimization, mean ± 1 standard deviation overall bowel minimum dose to the most irradiated 2 cm(3) volume of an organ (D2cc) was 67.8 Gyα/β3 ± 13.7 Gyα/β3 (Group 1: 72.6 ± 13.2 Gyα/β3; Group 2: 57.3 ± 8.0 Gyα/β3). Before optimization, one patient in Group 1 presented a bowel D2cc metric exceeding 100 Gyα/β3. After optimization, bowel D2cc mean ± 1 standard deviation was 59.4 ± 6.7 Gyα/β3 (Group 1: 61.4 ± 6.0 Gyα/β3, p < 0.001; Group 2: 55.2 ± 6.5 Gyα/β3, p ...
Gynecologic oncology, May 17, 2017
The purpose was to compare local control (LC), overall survival (OS) and dose to the organs at ri... more The purpose was to compare local control (LC), overall survival (OS) and dose to the organs at risk (OAR) in women with locally advanced cervical cancer treated with MR-guided versus CT-guided interstitial brachytherapy (BT). 56 patients (29 MR, 27 CT) were treated with high-dose-rate (HDR) interstitial BT between 2005-2015. The MR patients had been prospectively enrolled on a Phase II clinical trial. Data were analyzed using Kaplan-Meier (K-M) and Cox proportional hazards statistical modeling in JMP® & R®. Median follow-up time was 19.7months (MR group) and 18.4months (CT group). There were no statistically significant differences in patient age at diagnosis, histology, percent with tumor size >4cm, grade, FIGO stage or lymph node involvement between the groups. Patients in the MR group had more lymphovascular involvement compared to patients in the CT group (p<0.01). When evaluating plans generated, there were no statistically significant differences in median cumulative dos...
Gynecologic oncology, Jan 6, 2016
To determine prognostic factors for progression-free survival (PFS) and overall survival (OS) for... more To determine prognostic factors for progression-free survival (PFS) and overall survival (OS) for stage I-II cervical-cancer patients treated using computed-tomography (CT)-planned high-dose-rate (HDR) intracavitary brachytherapy (BT). A total of 150 patients were treated for Stage I-II cervical cancer using CT-planned BT between 4/2004 and 10/2014. Of these, 128 were eligible for inclusion. Kaplan-Meier local control (LC), pelvic control (PC), overall survival (OS), and PFS estimates were calculated. After a median follow-up of 30months, the 2-year LC rate was 96%, PFS was 88%, and OS was 88%. Overall, 18 patients (14%) experienced any recurrence (AR), 8 had distant recurrence only and 10 had a combination of local, pelvic, regional, and distant recurrence. No patients had LR only. A prognostic factor for AR was tumor size >4cm (p=0.01). Patients with tumors >4cm were 3.3 times more likely to have AR than those with tumors ≤4cm (hazard ratio [HR]=3.3; 95% confidence interval ...
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, Sep 16, 2016
To compare clinical outcomes of image-based versus non-image-based interstitial brachytherapy (IB... more To compare clinical outcomes of image-based versus non-image-based interstitial brachytherapy (IBBT) for vaginal cancer. Of 72 patients with vaginal cancer treated with brachytherapy (BT), 47 had image guidance (CT=31, MRI=16) and 25 did not. Kaplan-Meier (KM) estimates were generated for any recurrence, local control (LC), disease-free interval (DFI), and overall survival (OS) and Cox models were used to assess prognostic factors. Median age was 66 and median follow-up time was 24months. Median cumulative EQD2 dose was 80.8Gy in the non-IBBT group and 77Gy in the IBBT group. For non-IBBT versus IBBT, the 2-year KM LC was 71% vs. 93% (p=0.03); DFI was 54% vs. 86% (p=0.04); and OS 52% vs. 82% (p=0.35). On multivariate analysis, IBBT was associated with better DFI (HR 0.24, 95% CI 0.07-0.73). Having any 2 or more of chemotherapy, high-dose-rate (HDR) BT or IBBT (temporally correlated variables) significantly reduced risk of relapse (HR=0.33, 95% CI=0.13-0.83), compared to having none ...
Brachytherapy, Jan 16, 2017
To compare clinical outcomes of MR-based versus CT-based high-dose-rate interstitial brachytherap... more To compare clinical outcomes of MR-based versus CT-based high-dose-rate interstitial brachytherapy (ISBT) for vaginal recurrence of endometrioid endometrial cancer (EC). We reviewed 66 patients with vaginal recurrent EC; 18 had MR-based ISBT on a prospective clinical trial and 48 had CT-based treatment. Kaplan-Meier survival modeling was used to generate estimates for local control (LC), disease-free interval (DFI), and overall survival (OS), and multivariate Cox modeling was used to assess prognostic factors. Toxicities were evaluated and compared. Median followup was 33 months (CT 30 months, MR 35 months). Median cumulative equivalent dose in 2-Gy fractions was 75.5 Gy for MR-ISBT and 73.8 Gy for CT-ISBT (p = 0.58). MR patients were older (p = 0.03) and had larger tumor size (>4 cm vs. ≤ 4 cm) compared to CT patients (p = 0.04). For MR-based versus CT-based ISBT, 3-year KM rate for local control was 100% versus 78% (p = 0.04), DFI was 69% versus 55% (p = 0.1), and OS was 63% ve...
Journal of scientific innovation in medicine, 2022
The Journal of Pediatrics, 2022
OBJECTIVE To examine the association between uropathogens and pyuria in children less than 24 mon... more OBJECTIVE To examine the association between uropathogens and pyuria in children less than 24 months of age. STUDY DESIGN: A retrospective study of children <24 months of age evaluated in the emergency department for suspected UTI with paired urinalysis (UA) and urine culture during a 6-year period. Bagged urine specimens or urine culture growing mixed/multiple urogenital organisms were excluded. Analysis was limited to children with positive urine culture as defined by the American Academy of Pediatrics clinical practice guideline culture thresholds. RESULTS Of 30,462 children, 1,916 had microscopic UA and positive urine culture. Urine was obtained by transurethral in-and-out catheterization in 98.3% of cases. Pyuria (≥5 WBCs per high-powered field) and positive leukocyte esterase (small or more) on the urine dipstick were present in 1,690 (88.2%) and 1,692 (88.3%) of the children respectively. Children with non-E. coli species were less likely to exhibit microscopic pyuria than children with E. coli (OR 0.24, 95% CI 0.17-0.34) with more pronounced effect on Enterococcus and Klebsiella (OR 0.08, 95% CI 0.03-0.18, and OR 0.18, 95% CI 0.11-0.27 respectively). Similarly, positive leukocyte esterase was less frequently seen in non-E. coli uropathogens compared with E. coli. CONCLUSION Pyuria and leukocyte esterase are not sensitive markers to identify non-E. coli UTI in young children. More sensitive screening biomarkers are needed to identify UTI with these uropathogens. .
Child and Adolescent Mental Health
BackgroundThe shortage of mental health services across the United States has turned pediatric em... more BackgroundThe shortage of mental health services across the United States has turned pediatric emergency departments (PEDs) into safety‐nets for the increasing population of children with mental and behavioral health (MBH) needs. This study provides a descriptive characterization of MBH‐related PED visits, the trends in visit, ED length of stay (EDLOS), and admission rate.MethodsWe reviewed electronic health records of children ≤18 years with MBH needs, who visited the PED of a large tertiary hospital from January 2017 to December 2019. We performed descriptive statistics, chi‐square (χ2), and logistic regression analyses to evaluate trend in visit, EDLOS, admission rate, and predictors of prolonged EDLOS and inpatient admission.ResultsOf 10,167 patients, 58.4% were females, median age was 13.8 years, and 86.1% were adolescents. On average, visits increased by 19.7% annually, with a 43.3% increase over 3 years. Common ED diagnoses include, suicidality (56.2%), depression (33.5%), ov...
Pediatric Emergency Care
Objectives: This study aimed to describe changes in pediatric emergency department (ED) mental an... more Objectives: This study aimed to describe changes in pediatric emergency department (ED) mental and behavioral health (MBH) visits before and during the early COVID-19 pandemic. Methods: We retrospectively reviewed medical records of patients aged from 5 to 17 years presenting to the pediatric ED of a major tertiary care hospital with MBH-related concerns from March 2017 to September 2020. We evaluated trends in MBH ED visits over the study period, specifically comparing patient demographics, diagnosis categories, and ED disposition between the pre-COVID (2019) and COVID (2020) periods using pairwise Pearson χ 2 analyses with reported odds ratios (ORs) in SAS statistical software version 9.4 (SAS Institute Inc, Cary, NC). Results: Of 8093 MBH-related visits, 58.5% were females, 85.4% were adolescents, and 62.7% self-identified as non-Hispanic. The proportion of MBH-related ED visits increased from 3.8% to 7.5% over the study period (P < 0.0001). Although total MBH visits decreased by 17.3% from 2019 to 2020, there was a proportionate increase in MBH-to-total-ED visits, representing a 42.8% increase through 2019. Compared with 2019, there was a proportionate increase in MBH-related ED visits by females (10.6%,
Gynecologic Oncology, Dec 1, 2016
Large tumor size was associated with an increased risk of any recurrence • Overall, there was an ... more Large tumor size was associated with an increased risk of any recurrence • Overall, there was an overall decrease in point A dose over 5 fractions • Point A dose was lower for those without relapse than those with relapse • CT-based rather than point A based BT results in outstanding local control
International Journal of Radiation Oncology Biology Physics, Nov 1, 2015
Materials/Methods: This study was performed on 6 cervical-cancer BT cases with different applicat... more Materials/Methods: This study was performed on 6 cervical-cancer BT cases with different applicators including tandem and ovoid, ovoid with needles and ring applicators. Computed tomography was used as an imagining modality for the first 3 cases and MRI for the other 3. For each case and imaging modality, participants from 6 different institutions each created 2 BT plans: the first was a plan normalized to point A, and the second was an optimized plan. The high-dose-rate (HDR) BT plans were created as boost plans under the assumption that the patients had previously received 45 Gy, during the initial course. The prescription dose for the HDR treatment was 27.5 Gy in 5 fractions. Plan construction required that the tumor D90 receive the highest possible total dose while respecting maximum dose constraints to the rectum, bladder and sigmoid (75, 90 and 75 Gy). The EQD2 calculation was performed so total dose from treatments could be evaluated. Data collected for statistical analysis included: CTV and high-risk CTV (D90, D100, V100, V150 and V200); D0.1cm 3 , D2cm 3 and D5cm 3 for the bladder, rectum and sigmoid. Results: On an institutional level, differences were most noted in the ovoid and needles plans, irrespective of the imaging modality. The average coverage (D90) of CTV for MR-based optimized and non-optimized plans were 4.92 (SD Z 0.74) Gy and 4.88 (SD Z 0.89) Gy, respectively, indicating the increase of variations with increase of the plan complexity. The table shows the average values of the optimized plans across 6 institutions; D90 for the optimized plans was 5.25 (SD Z 0.61) Gy per fraction resulting in a total equivalent dose of 77.6AE5.2 Gy. The average D2 doses for bladder, rectum and sigmoid for the optimized plans were 77.6 (SD Z 5.2) Gy, 68.2 (SD Z 5.8) Gy and 63.8 (SD Z 3.3) Gy, respectively. A high level of consistency between the dosimetric parameters for all plans was noted (all P>.05). Conclusion: No significant differences in target coverage were recorded in any plans. This conclusion is valid for both optimized plans and point A normalized plans, indicating the consistency of the treatment plans among the institutions. The differences in the doses to the OARs should not translate into meaningful clinical outcomes.
Brachytherapy, May 1, 2016
Gynecologic Oncology, Dec 1, 2015
International Journal of Radiation Oncology Biology Physics, Nov 1, 2015
International Journal of Radiation Oncology*Biology*Physics, 2015
International Journal of Radiation Oncology*Biology*Physics, 2015
Materials/Methods: This study was performed on 6 cervical-cancer BT cases with different applicat... more Materials/Methods: This study was performed on 6 cervical-cancer BT cases with different applicators including tandem and ovoid, ovoid with needles and ring applicators. Computed tomography was used as an imagining modality for the first 3 cases and MRI for the other 3. For each case and imaging modality, participants from 6 different institutions each created 2 BT plans: the first was a plan normalized to point A, and the second was an optimized plan. The high-dose-rate (HDR) BT plans were created as boost plans under the assumption that the patients had previously received 45 Gy, during the initial course. The prescription dose for the HDR treatment was 27.5 Gy in 5 fractions. Plan construction required that the tumor D90 receive the highest possible total dose while respecting maximum dose constraints to the rectum, bladder and sigmoid (75, 90 and 75 Gy). The EQD2 calculation was performed so total dose from treatments could be evaluated. Data collected for statistical analysis included: CTV and high-risk CTV (D90, D100, V100, V150 and V200); D0.1cm 3 , D2cm 3 and D5cm 3 for the bladder, rectum and sigmoid. Results: On an institutional level, differences were most noted in the ovoid and needles plans, irrespective of the imaging modality. The average coverage (D90) of CTV for MR-based optimized and non-optimized plans were 4.92 (SD Z 0.74) Gy and 4.88 (SD Z 0.89) Gy, respectively, indicating the increase of variations with increase of the plan complexity. The table shows the average values of the optimized plans across 6 institutions; D90 for the optimized plans was 5.25 (SD Z 0.61) Gy per fraction resulting in a total equivalent dose of 77.6AE5.2 Gy. The average D2 doses for bladder, rectum and sigmoid for the optimized plans were 77.6 (SD Z 5.2) Gy, 68.2 (SD Z 5.8) Gy and 63.8 (SD Z 3.3) Gy, respectively. A high level of consistency between the dosimetric parameters for all plans was noted (all P>.05). Conclusion: No significant differences in target coverage were recorded in any plans. This conclusion is valid for both optimized plans and point A normalized plans, indicating the consistency of the treatment plans among the institutions. The differences in the doses to the OARs should not translate into meaningful clinical outcomes.
Gynecologic oncology, Aug 1, 2017
Gynecologic Oncology, 2015
Brachytherapy, Jan 27, 2017
To investigate the dose-volume histogram metrics and optimization results of the contoured bowel ... more To investigate the dose-volume histogram metrics and optimization results of the contoured bowel in cervical cancer brachytherapy. Treatment plans of cervical cancer patients treated with image-guided high dose rate were retrospectively analyzed with institutional review board approval. In addition to the clinical target volume, rectum, bladder, and sigmoid, the bowel was contoured at the time of planning (Group 1) or at the time of this analysis (Group 2). Thirty-two patients treated with 145 insertions were included. Before optimization, mean ± 1 standard deviation overall bowel minimum dose to the most irradiated 2 cm(3) volume of an organ (D2cc) was 67.8 Gyα/β3 ± 13.7 Gyα/β3 (Group 1: 72.6 ± 13.2 Gyα/β3; Group 2: 57.3 ± 8.0 Gyα/β3). Before optimization, one patient in Group 1 presented a bowel D2cc metric exceeding 100 Gyα/β3. After optimization, bowel D2cc mean ± 1 standard deviation was 59.4 ± 6.7 Gyα/β3 (Group 1: 61.4 ± 6.0 Gyα/β3, p < 0.001; Group 2: 55.2 ± 6.5 Gyα/β3, p ...
Gynecologic oncology, May 17, 2017
The purpose was to compare local control (LC), overall survival (OS) and dose to the organs at ri... more The purpose was to compare local control (LC), overall survival (OS) and dose to the organs at risk (OAR) in women with locally advanced cervical cancer treated with MR-guided versus CT-guided interstitial brachytherapy (BT). 56 patients (29 MR, 27 CT) were treated with high-dose-rate (HDR) interstitial BT between 2005-2015. The MR patients had been prospectively enrolled on a Phase II clinical trial. Data were analyzed using Kaplan-Meier (K-M) and Cox proportional hazards statistical modeling in JMP® & R®. Median follow-up time was 19.7months (MR group) and 18.4months (CT group). There were no statistically significant differences in patient age at diagnosis, histology, percent with tumor size >4cm, grade, FIGO stage or lymph node involvement between the groups. Patients in the MR group had more lymphovascular involvement compared to patients in the CT group (p<0.01). When evaluating plans generated, there were no statistically significant differences in median cumulative dos...
Gynecologic oncology, Jan 6, 2016
To determine prognostic factors for progression-free survival (PFS) and overall survival (OS) for... more To determine prognostic factors for progression-free survival (PFS) and overall survival (OS) for stage I-II cervical-cancer patients treated using computed-tomography (CT)-planned high-dose-rate (HDR) intracavitary brachytherapy (BT). A total of 150 patients were treated for Stage I-II cervical cancer using CT-planned BT between 4/2004 and 10/2014. Of these, 128 were eligible for inclusion. Kaplan-Meier local control (LC), pelvic control (PC), overall survival (OS), and PFS estimates were calculated. After a median follow-up of 30months, the 2-year LC rate was 96%, PFS was 88%, and OS was 88%. Overall, 18 patients (14%) experienced any recurrence (AR), 8 had distant recurrence only and 10 had a combination of local, pelvic, regional, and distant recurrence. No patients had LR only. A prognostic factor for AR was tumor size >4cm (p=0.01). Patients with tumors >4cm were 3.3 times more likely to have AR than those with tumors ≤4cm (hazard ratio [HR]=3.3; 95% confidence interval ...
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, Sep 16, 2016
To compare clinical outcomes of image-based versus non-image-based interstitial brachytherapy (IB... more To compare clinical outcomes of image-based versus non-image-based interstitial brachytherapy (IBBT) for vaginal cancer. Of 72 patients with vaginal cancer treated with brachytherapy (BT), 47 had image guidance (CT=31, MRI=16) and 25 did not. Kaplan-Meier (KM) estimates were generated for any recurrence, local control (LC), disease-free interval (DFI), and overall survival (OS) and Cox models were used to assess prognostic factors. Median age was 66 and median follow-up time was 24months. Median cumulative EQD2 dose was 80.8Gy in the non-IBBT group and 77Gy in the IBBT group. For non-IBBT versus IBBT, the 2-year KM LC was 71% vs. 93% (p=0.03); DFI was 54% vs. 86% (p=0.04); and OS 52% vs. 82% (p=0.35). On multivariate analysis, IBBT was associated with better DFI (HR 0.24, 95% CI 0.07-0.73). Having any 2 or more of chemotherapy, high-dose-rate (HDR) BT or IBBT (temporally correlated variables) significantly reduced risk of relapse (HR=0.33, 95% CI=0.13-0.83), compared to having none ...
Brachytherapy, Jan 16, 2017
To compare clinical outcomes of MR-based versus CT-based high-dose-rate interstitial brachytherap... more To compare clinical outcomes of MR-based versus CT-based high-dose-rate interstitial brachytherapy (ISBT) for vaginal recurrence of endometrioid endometrial cancer (EC). We reviewed 66 patients with vaginal recurrent EC; 18 had MR-based ISBT on a prospective clinical trial and 48 had CT-based treatment. Kaplan-Meier survival modeling was used to generate estimates for local control (LC), disease-free interval (DFI), and overall survival (OS), and multivariate Cox modeling was used to assess prognostic factors. Toxicities were evaluated and compared. Median followup was 33 months (CT 30 months, MR 35 months). Median cumulative equivalent dose in 2-Gy fractions was 75.5 Gy for MR-ISBT and 73.8 Gy for CT-ISBT (p = 0.58). MR patients were older (p = 0.03) and had larger tumor size (>4 cm vs. ≤ 4 cm) compared to CT patients (p = 0.04). For MR-based versus CT-based ISBT, 3-year KM rate for local control was 100% versus 78% (p = 0.04), DFI was 69% versus 55% (p = 0.1), and OS was 63% ve...