May Abdel-Wahab - Academia.edu (original) (raw)

Papers by May Abdel-Wahab

Prostate Cancer and Prostatic Diseases, Dec 1, 2003

Journal of Clinical Oncology, Feb 10, 2012

118 Background: The use of intensity modulated radiotherapy (IMRT) for the treatment of prostate ... more 118 Background: The use of intensity modulated radiotherapy (IMRT) for the treatment of prostate cancer (CaP) has been widely promoted due to the hypothesized benefit of low late toxicity. Methods: The SEER-Medicare database was queried for CaP patients treated with external beam radiotherapy (EBRT), 1991-2007. CPT billing codes were used to identify patients treated with IMRT or standard EBRT (sEBRT), which was comprised of conformal radiotherapy or a four-field technique. Patients without a treatment billing code were excluded from the analysis. Information on dose is unavailable. CPT codes were also used to identify procedures associated with gastrointestinal (GI) or genitourinary (GU) toxicity related treatments. Cumulative incidence rates for GI and GU toxicity were calculated with death treated as a competing event. Results: A total of 137,427 patients who were 65 years or older at the time of CaP diagnosis and who had CaP as their only cancer diagnosis were retrieved from the SEER-Medicare database: 60,806 were treated with EBRT and a treatment billing code was identified for 35,388 patients. No patient received combined therapy. Seventeen percent of patients received IMRT. The median follow-up for patients receiving IMRT is 40 months (mo) (range 2-157) vs 77 mo (range 0-203) for patients receiving sEBRT. Overall, 3,699 (10%) patients experienced a toxicity requiring an intervention. The five year rate of GI The gastrointestinal (GI) and genitourinary (GU) toxicity comparisons are listed in the table. For both endpoints, rate of toxicity at five years was higher for the IMRT group. The most common GU toxicity for both groups was dilation of a urethral stricture (3.8% of all sEBRT patients vs 3.4 of all IMRT patients). Cauterization of rectal bleeding was the most common GI toxicity (2.4% of all sEBRT patients vs 1.6 of all IMRT patients). Conclusions: While the rates of GI toxicity between IMRT and sEBRT are comparable, of concern is the higher rate of GU toxicity for the IMRT patients despite this group having a shorter follow up than the sEBRT group. [Table: see text]

International Journal of Radiation Oncology Biology Physics, Sep 1, 2004

Medical Dosimetry, Jun 1, 1997

Journal of Applied Clinical Medical Physics, Nov 20, 2017

International Journal of Radiation Oncology Biology Physics, Mar 1, 1998

International Journal of Radiation Oncology Biology Physics, Jul 1, 2014

The international growth of cancer and lack of available treatment is en route to become a global... more The international growth of cancer and lack of available treatment is en route to become a global crisis. With >60% of cancer patients needing radiation therapy at some point during their treatment course, the lack of available facilities and treatment programs worldwide is extremely problematic. The number of deaths from treatable cancers is projected to increase to 11.5 million deaths in 2030 because the international population is aging and growing. In this review, we present how best to answer the need for radiation therapy facilities from a technical standpoint. Specifically, we examine whether cobalt teletherapy machines or megavoltage linear accelerator machines are best equipped to handle the multitudes in need of radiation therapy treatment in the developing world.

Urology, Oct 1, 2009

To determine the incidence of second primary cancer (SPC) and primary pelvic late SPC/radiation-i... more To determine the incidence of second primary cancer (SPC) and primary pelvic late SPC/radiation-induced SPC after radical prostatectomy and radiation. A total of 228 235 prostate cancer patients in the 1973-2002 Surveillance, Epidemiology, and End Results database were studied. The age-adjusted estimates of SPCs was calculated. Competing risk multivariable Cox proportional hazards regression analysis was adjusted for age at diagnosis, race or ethnicity, and radiation and was used to evaluate the effect of treatment on SPC. The overall incidence of SPC was 8.4%. The most frequent pelvic SPCs were bladder (2303 cases), rectum or rectosigmoid junction (1006 cases). The most frequent nonpelvic SPCs were bronchus and lung (4131 cases), colon (2665 cases), and skin (1769 cases). The absolute risk of developing a second malignancy was 1747 cases per 100 000 in the "Radical surgery and x-ray treatment" group and 1581 in the "radical surgery" group. With regard to late primary pelvic SPC, a higher age-adjusted rate of 374 cases per 100 000 was seen in the radiated group. Radiation after radical surgery increased late primary pelvic SPC. No increases were seen in secondary pelvic or extrapelvic SPCs.

International Journal of Radiation Oncology Biology Physics, Jun 1, 2009

American Journal of Clinical Oncology, Apr 1, 1997

Progression of brain metastases after brain irradiation has prompted several studies on retreatme... more Progression of brain metastases after brain irradiation has prompted several studies on retreatment of the brain. Increased durations of survival and improved quality of life have been reported. Fifteen patients with previously treated brain metastases were entered into this pilot study between May 1990 and January 1994. All patients had neurologic and/or radiologic evidence of progression of brain metastases. The lung was the primary site in 60% of cases. The remaining 40% had breast, ovarian, and skin primaries. The median interval between the first treatment and retreatment was 10 months. All patients received whole-brain irradiation with or without a boost for their initial treatment course. Doses ranged from 3,000 to 5,500 cGy for initial treatments (median, 3,000). Retreatment consisted of limited fields with a median side equivalent square of 8.8 cm. Patients were retreated with a median dose of 3,000 cGy (range, 600-3,000 cGy). A median cumulative dose of 6,000 cGy was achieved. Retreatment consisted of twice-daily fractions (150 cGy/fraction). Retreatment was tolerated without serious complications. Of the 15 patients treated, nine (60%) experienced improvement, and five (27%) had stabilization of neurologic function and/or radiographic parameters. Median survival was 3.2 months; two of the reirradiated patients survived > or = 9 months. In conclusion, reirradiation is a viable option in patients with recurrent metastatic lesions of the brain, and the use of a limited retreatment volume makes this a well-tolerated, low-morbidity treatment that leads to clinical benefits and, in some instances, enhanced survival. The influence of hyperfractionation on the outcome needs to be investigated further in large series.

International Journal of Radiation Oncology Biology Physics, Apr 1, 2015

JCO Global Oncology

PURPOSE Key to achieving better population-based outcomes for patients with lung cancer is the im... more PURPOSE Key to achieving better population-based outcomes for patients with lung cancer is the improvement of medical imaging and nuclear medicine infrastructure globally. This paper aims to outline why and spark relevant health systems strengthening. METHODS The paper synthesizes the global lung cancer landscape, imaging referral guidelines (including resource-stratified ones), the reliance of TNM staging upon imaging, relevant multinational health technology assessments, and precisely how treatment selection and in turn patient outcomes hinge upon imaging findings. The final discussion presents data on current global gaps in both diagnostics (including imaging) and therapies and how, informed by such data, improved population-based outcomes are tangible through strategic planning. RESULTS Imaging findings are central to appropriate lung cancer patient management and can variably lead to life-prolonging interventions and/or to life-enhancing palliative measures. Early-stage lung ca...

European Journal of Nuclear Medicine and Molecular Imaging, 2020

European Journal of Nuclear Medicine and Molecular Imaging, 2020

International Journal of Radiation Oncology*Biology*Physics, 2020

Stereotactic and Functional Neurosurgery, 2004

Stereotactic radiosurgery has become a more widely employed modality of treatment for acoustic ne... more Stereotactic radiosurgery has become a more widely employed modality of treatment for acoustic neuromas, but controversy still arises regarding the safety and efficacy of the technique. In general, radiation doses have been reduced over time. Since beginning treatments of acoustic neuromas with the Gamma Knife at the University of Miami/Jackson Memorial Medical Center in 1994, a dose regimen was adopted by the first author employing limited doses selected on the basis of tumor size with the anterior and medial regions of the prescription isodose surface kept just inside the gadolinium-enhanced limit of the tumor, in order to protect the facial nerve and brainstem. The records of patients treated for unilateral tumors were retrospectively reviewed. Fifty-two patients, aged 23-83 years, were treated with peripheral tumor doses of 10-14 Gy at the 45-70% isodoses. No patient developed new facial weakness or sensory loss; 3 patients had minor transient facial twitching within a few months of treatment. Of 34 patients followed more than 1 year (range 14-100 months, mean 43.4 months, median 37 months), 17 tumors reduced in size, 16 remained unchanged, and 1 increased in size. One patient, who had radiosurgery as planned postoperative adjuvant treatment after partial resection of a large tumor, developed an enlarging peritumoral arachnoid cyst that required surgical resection 79 months after radiosurgery. Patients with good pretreatment hearing retained approximately the same subjective level of hearing. Very good control of unilateral acoustic neuroma has been achieved by a limited-dose scheme that produces minimal complications, but due to the frequently indolent course of these tumors, continued long-term monitoring will be necessary.

Brachytherapy, Sep 1, 2011

PurposePermanent prostate brachytherapy has emerged as a standard of care treatment for approxima... more PurposePermanent prostate brachytherapy has emerged as a standard of care treatment for approximately 50,000 men annually who present with clinically localized prostate cancer. The purpose of this review was to provide clarification on the appropriateness criteria and management considerations for the treatment of prostate cancer with permanent prostate brachytherapy.

Prostate Cancer and Prostatic Diseases, Dec 1, 2003

Journal of Clinical Oncology, Feb 10, 2012

118 Background: The use of intensity modulated radiotherapy (IMRT) for the treatment of prostate ... more 118 Background: The use of intensity modulated radiotherapy (IMRT) for the treatment of prostate cancer (CaP) has been widely promoted due to the hypothesized benefit of low late toxicity. Methods: The SEER-Medicare database was queried for CaP patients treated with external beam radiotherapy (EBRT), 1991-2007. CPT billing codes were used to identify patients treated with IMRT or standard EBRT (sEBRT), which was comprised of conformal radiotherapy or a four-field technique. Patients without a treatment billing code were excluded from the analysis. Information on dose is unavailable. CPT codes were also used to identify procedures associated with gastrointestinal (GI) or genitourinary (GU) toxicity related treatments. Cumulative incidence rates for GI and GU toxicity were calculated with death treated as a competing event. Results: A total of 137,427 patients who were 65 years or older at the time of CaP diagnosis and who had CaP as their only cancer diagnosis were retrieved from the SEER-Medicare database: 60,806 were treated with EBRT and a treatment billing code was identified for 35,388 patients. No patient received combined therapy. Seventeen percent of patients received IMRT. The median follow-up for patients receiving IMRT is 40 months (mo) (range 2-157) vs 77 mo (range 0-203) for patients receiving sEBRT. Overall, 3,699 (10%) patients experienced a toxicity requiring an intervention. The five year rate of GI The gastrointestinal (GI) and genitourinary (GU) toxicity comparisons are listed in the table. For both endpoints, rate of toxicity at five years was higher for the IMRT group. The most common GU toxicity for both groups was dilation of a urethral stricture (3.8% of all sEBRT patients vs 3.4 of all IMRT patients). Cauterization of rectal bleeding was the most common GI toxicity (2.4% of all sEBRT patients vs 1.6 of all IMRT patients). Conclusions: While the rates of GI toxicity between IMRT and sEBRT are comparable, of concern is the higher rate of GU toxicity for the IMRT patients despite this group having a shorter follow up than the sEBRT group. [Table: see text]

International Journal of Radiation Oncology Biology Physics, Sep 1, 2004

Medical Dosimetry, Jun 1, 1997

Journal of Applied Clinical Medical Physics, Nov 20, 2017

International Journal of Radiation Oncology Biology Physics, Mar 1, 1998

International Journal of Radiation Oncology Biology Physics, Jul 1, 2014

The international growth of cancer and lack of available treatment is en route to become a global... more The international growth of cancer and lack of available treatment is en route to become a global crisis. With >60% of cancer patients needing radiation therapy at some point during their treatment course, the lack of available facilities and treatment programs worldwide is extremely problematic. The number of deaths from treatable cancers is projected to increase to 11.5 million deaths in 2030 because the international population is aging and growing. In this review, we present how best to answer the need for radiation therapy facilities from a technical standpoint. Specifically, we examine whether cobalt teletherapy machines or megavoltage linear accelerator machines are best equipped to handle the multitudes in need of radiation therapy treatment in the developing world.

Urology, Oct 1, 2009

To determine the incidence of second primary cancer (SPC) and primary pelvic late SPC/radiation-i... more To determine the incidence of second primary cancer (SPC) and primary pelvic late SPC/radiation-induced SPC after radical prostatectomy and radiation. A total of 228 235 prostate cancer patients in the 1973-2002 Surveillance, Epidemiology, and End Results database were studied. The age-adjusted estimates of SPCs was calculated. Competing risk multivariable Cox proportional hazards regression analysis was adjusted for age at diagnosis, race or ethnicity, and radiation and was used to evaluate the effect of treatment on SPC. The overall incidence of SPC was 8.4%. The most frequent pelvic SPCs were bladder (2303 cases), rectum or rectosigmoid junction (1006 cases). The most frequent nonpelvic SPCs were bronchus and lung (4131 cases), colon (2665 cases), and skin (1769 cases). The absolute risk of developing a second malignancy was 1747 cases per 100 000 in the "Radical surgery and x-ray treatment" group and 1581 in the "radical surgery" group. With regard to late primary pelvic SPC, a higher age-adjusted rate of 374 cases per 100 000 was seen in the radiated group. Radiation after radical surgery increased late primary pelvic SPC. No increases were seen in secondary pelvic or extrapelvic SPCs.

International Journal of Radiation Oncology Biology Physics, Jun 1, 2009

American Journal of Clinical Oncology, Apr 1, 1997

Progression of brain metastases after brain irradiation has prompted several studies on retreatme... more Progression of brain metastases after brain irradiation has prompted several studies on retreatment of the brain. Increased durations of survival and improved quality of life have been reported. Fifteen patients with previously treated brain metastases were entered into this pilot study between May 1990 and January 1994. All patients had neurologic and/or radiologic evidence of progression of brain metastases. The lung was the primary site in 60% of cases. The remaining 40% had breast, ovarian, and skin primaries. The median interval between the first treatment and retreatment was 10 months. All patients received whole-brain irradiation with or without a boost for their initial treatment course. Doses ranged from 3,000 to 5,500 cGy for initial treatments (median, 3,000). Retreatment consisted of limited fields with a median side equivalent square of 8.8 cm. Patients were retreated with a median dose of 3,000 cGy (range, 600-3,000 cGy). A median cumulative dose of 6,000 cGy was achieved. Retreatment consisted of twice-daily fractions (150 cGy/fraction). Retreatment was tolerated without serious complications. Of the 15 patients treated, nine (60%) experienced improvement, and five (27%) had stabilization of neurologic function and/or radiographic parameters. Median survival was 3.2 months; two of the reirradiated patients survived > or = 9 months. In conclusion, reirradiation is a viable option in patients with recurrent metastatic lesions of the brain, and the use of a limited retreatment volume makes this a well-tolerated, low-morbidity treatment that leads to clinical benefits and, in some instances, enhanced survival. The influence of hyperfractionation on the outcome needs to be investigated further in large series.

International Journal of Radiation Oncology Biology Physics, Apr 1, 2015

JCO Global Oncology

PURPOSE Key to achieving better population-based outcomes for patients with lung cancer is the im... more PURPOSE Key to achieving better population-based outcomes for patients with lung cancer is the improvement of medical imaging and nuclear medicine infrastructure globally. This paper aims to outline why and spark relevant health systems strengthening. METHODS The paper synthesizes the global lung cancer landscape, imaging referral guidelines (including resource-stratified ones), the reliance of TNM staging upon imaging, relevant multinational health technology assessments, and precisely how treatment selection and in turn patient outcomes hinge upon imaging findings. The final discussion presents data on current global gaps in both diagnostics (including imaging) and therapies and how, informed by such data, improved population-based outcomes are tangible through strategic planning. RESULTS Imaging findings are central to appropriate lung cancer patient management and can variably lead to life-prolonging interventions and/or to life-enhancing palliative measures. Early-stage lung ca...

European Journal of Nuclear Medicine and Molecular Imaging, 2020

European Journal of Nuclear Medicine and Molecular Imaging, 2020

International Journal of Radiation Oncology*Biology*Physics, 2020

Stereotactic and Functional Neurosurgery, 2004

Stereotactic radiosurgery has become a more widely employed modality of treatment for acoustic ne... more Stereotactic radiosurgery has become a more widely employed modality of treatment for acoustic neuromas, but controversy still arises regarding the safety and efficacy of the technique. In general, radiation doses have been reduced over time. Since beginning treatments of acoustic neuromas with the Gamma Knife at the University of Miami/Jackson Memorial Medical Center in 1994, a dose regimen was adopted by the first author employing limited doses selected on the basis of tumor size with the anterior and medial regions of the prescription isodose surface kept just inside the gadolinium-enhanced limit of the tumor, in order to protect the facial nerve and brainstem. The records of patients treated for unilateral tumors were retrospectively reviewed. Fifty-two patients, aged 23-83 years, were treated with peripheral tumor doses of 10-14 Gy at the 45-70% isodoses. No patient developed new facial weakness or sensory loss; 3 patients had minor transient facial twitching within a few months of treatment. Of 34 patients followed more than 1 year (range 14-100 months, mean 43.4 months, median 37 months), 17 tumors reduced in size, 16 remained unchanged, and 1 increased in size. One patient, who had radiosurgery as planned postoperative adjuvant treatment after partial resection of a large tumor, developed an enlarging peritumoral arachnoid cyst that required surgical resection 79 months after radiosurgery. Patients with good pretreatment hearing retained approximately the same subjective level of hearing. Very good control of unilateral acoustic neuroma has been achieved by a limited-dose scheme that produces minimal complications, but due to the frequently indolent course of these tumors, continued long-term monitoring will be necessary.

Brachytherapy, Sep 1, 2011

PurposePermanent prostate brachytherapy has emerged as a standard of care treatment for approxima... more PurposePermanent prostate brachytherapy has emerged as a standard of care treatment for approximately 50,000 men annually who present with clinically localized prostate cancer. The purpose of this review was to provide clarification on the appropriateness criteria and management considerations for the treatment of prostate cancer with permanent prostate brachytherapy.