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Papers by parvesh kumar
Journal of Urology, 2016
We will provide journalists and editors with full-text copies of the articles in question prior t... more We will provide journalists and editors with full-text copies of the articles in question prior to the embargo date so that stories can be adequately researched and written. The standard embargo time is 12:01 AM ET on that date. Questions regarding embargo should be directed to
Clinical Lung Cancer, 2002
Preoperative chemotherapy in patients with stage III non-small-cell lung cancer (NSCLC) remains c... more Preoperative chemotherapy in patients with stage III non-small-cell lung cancer (NSCLC) remains controversial. Phase II trials utilizing preoperative chemotherapy in selected patients have achieved complete resection rates of 50%-70% with 3-5 year failure-free survival rates of 15%-33%. Between October 1992 and November 1994, 57 adults (50 of whom were evaluable) with surgically staged IIIA NSCLC and pathologically documented ipsilateral mediastinal nodal involvement (N2) were enrolled in a Cancer and Leukemia Group B randomized trial. Preoperative therapy was thought to be critical to facilitating surgical resectability. For patients randomized to the radiotherapy/surgery/radiotherapy (RSR) arm (n = 24), treatment consisted of preoperative radiation therapy (RT) at 40 Gy, surgery, and then additional RT at 14-20 Gy. For patients randomized to the chemotherapy/surgery/chemotherapy/radiotherapy (CSCR) arm (n = 26), treatment consisted of 2 cycles of cisplatin/etoposide with filgrastim support (PE) followed by surgery, 2 more cycles of PE, then RT 54-60 Gy. The total dose of RT on either arm was 54 Gy if completely resected or 60 Gy if incompletely resected or unresected. Clinical characteristics were well balanced between the two arms. Thoracotomy was performed in 42 patients (84%), 28 (67%) of whom had complete resection. The median failure-free and overall survival rates were 12 months (95% confidence interval [CI], 9-23 months) and 23 months (95% CI, 19 months-∞) for the RSR arm and 11 months (95% CI, 5-20 months) and 18 months (95% CI, 12-32 months) for the CSCR arm. The rates of overall and complete surgical resection, downstaging of nodal involvement, and failure-free (P = 0.92) and overall survival (P = 0.41) did not differ between the two treatment arms. Moreover, in this trial, the chemotherapy regimen was sufficiently toxic to have had a lower completion rate of prescribed therapy in the CSCR arm than in the RSR arm.
Seminars in Interventional Radiology, 1998
The Indian Journal of Pediatrics, 2001
Neurocysticercosis is a common neuroparasitosis. Presentation with psychiatric symptoms is uncomm... more Neurocysticercosis is a common neuroparasitosis. Presentation with psychiatric symptoms is uncommon in neurocysticercosis. The present paper describes a patient who presented with mutism, neglect of personal care and incontinence in a psychiatric setting and investigations revealed diagnosis of neurocysticercosis. The case report highlights the possible misdiagnoses of a case of neurocysticercosis as psychiatric illness and mutism as an uncommon presentation of neurocysticercosis.
The Laryngoscope, 2004
To determine the relative risk of prognostic factors for local disease control following RADPLAT.... more To determine the relative risk of prognostic factors for local disease control following RADPLAT. Prospective study, academic medical center. Analyses of nine categories of risk factors among 240 patients with Stage II-IV carcinoma consecutively treated with RADPLAT (cisplatin 150 mg/m IA and sodium thiosulfate 9 g/m IV, weekly x4; radiotherapy 2 Gy/fraction/d, 5x weekly, 68-74 Gy over 6 to 7 weeks). Median follow-up: 58 months (range, 12-96 mo). The percentage of patients who had local disease control was 87.5%. Univariant analysis showed T classification (P =.01), laterality of neck disease (P =.026), number of neck levels involved (P =.008), total dose of radiation greater versus less than 60 Gy (P =.027), and presence of pathologically positive lymph nodes following chemoradiation (P =.01) to be significant. Logistic regression analysis showed total dose of radiation (P =.03) and the presence of pathologically positive lymph nodes following chemoradiation (P =.05) to be significant. For Kaplan-Meier estimates of local disease control at 5 years, T classification (P =.038), number of levels with nodal disease (P =.006), and total dose of radiation therapy (P =.0001) were significant. The log-rank test identified as significant the total dose of radiation therapy (P <.0001), the presence of pathologically positive lymph nodes following chemoradiation (P =.005), and the number of neck levels with positive nodes (P =.006). The Cox regression model showed significance for the total dose of radiation (P =.001), the presence of pathologically positive lymph nodes following chemoradiation (P =.007), and the T classification (P =.029). Risk factors significantly associated with local disease control after RADPLAT appears to differ from more traditional therapy and is suggestive of a paradigm shift.
The American Journal of Surgery, 1997
The value of tumor regression rates in predicting survival outcome during chemoradiation therapy ... more The value of tumor regression rates in predicting survival outcome during chemoradiation therapy was prospectively evaluated. Sixty-two patients diagnosed with locally advanced stage III/IV unresectable head and neck squamous cell carcinoma underwent weekly clinical and endoscopic serial assessment of primary and nodal tumor sizes during chemoradiation therapy between July 1993 and September 1995. Chemoradiation therapy consisted of protocol treatment using supradose intra-arterial targeted cisplatin (SIT-P) at 150 mg/m2 four times at weekly intervals along with intravenous sodium thiosulfate at 9 g/m2 and concurrent conventionally fractionated radiotherapy at 1.8 to 2.0 Gy/fraction (fx) to a total dose of 68 to 74 Gy. Tumor reduction was serially measured as a percentage of the original pretreatment size at weekly intervals by the same team of surgical and radiation oncologists. Correlations were then made between tumor regression rates and survival. Complete or near complete regression of disease during chemoradiation therapy as compared with nonresponsive/partially responsive disease was associated with better survival outcome (P = 0.001 and P = 0.013, respectively). Among patients exhibiting complete or near complete regression of disease, rapid tumor reduction (median = 4.2 weeks) was associated with inferior survival outcome when compared with slower disease regression (median = 6.4 weeks, P = 0.007). Our findings fail to support the "traditional" hypothesis that rapid tumor regression during treatment is predictive of an improved survival outcome. Treatment strategies that alter ongoing therapy based upon initial tumor regression rates should be avoided.
Radiotherapy and Oncology, 1996
Radiotherapy and Oncology, 1996
Radiotherapy and Oncology, 1997
Background: We conducted a multicentre phase II trial to investigate feasibility and antitumor ac... more Background: We conducted a multicentre phase II trial to investigate feasibility and antitumor activity of sequential FOLFIRINOX and Stereotactic Body Radiotherapy (SBRT) in patients with locally advanced pancreatic cancer (LAPC), (LAPC-1 trial). Methods: Patients with biopsy-proven LAPC treated in four hospitals in the Netherlands between December 2014 and June 2017. Patients received 8 cycles of FOLFIRINOX followed by SBRT (5 fractions/8 Gy) if no tumour progression after the FOLFIRINOX treatment was observed. Primary outcome was 1-year overall survival (OS). Secondary outcomes were median OS, 1-year progression-free survival (PFS), treatmentrelated toxicity, and resection rate. The study is registered with ClinicalTrials.gov, NCT02292745, and is completed. Findings: Fifty patients were included. Nineteen (38%) patients did not receive all 8 cycles of FOLFIRINOX, due to toxicity (n = 12), disease progression (n = 6), or patients' preference (n = 1). Thirty-nine (78%) patients received the SBRT treatment. The 1-year OS and PFS were 64% (95% CI: 50%-76%) and 34% (95% CI: 22%-48%), respectively. Thirty grade 3 or 4 adverse events were observed during FOLFIRINOX. Two (5%) grade 3 or 4 adverse events after SBRT were observed. Two (5%) patients died due to a gastro-intestinal bleeding within three months after SBRT were observed. Six (12%) patients underwent a resection, all resulting in a complete (R0) resection. Two patients had a complete pathological response. Interpretation: FOLFIRINOX followed by SBRT in patients with LAPC is feasible and shows relevant antitumor activity. In 6 (12%) patients a potentially curative resection could be pursued following this combined treatment, with a complete histological response being observed in two patients.
Journal of Surgical Oncology, 2006
CALGB 8935 was a phase II protocol for mediastinoscopically staged IIIA (N2) non-small cell lung ... more CALGB 8935 was a phase II protocol for mediastinoscopically staged IIIA (N2) non-small cell lung cancer. Induction cisplatin/vinblastine chemotherapy was followed by surgical resection, adjuvant cisplatin/vinblastine, and radiotherapy. We now evaluate the prognosis of pathologic nodes. Failure-free survival was calculated from a landmark 3 months after resection to account for heterogeneity in adjuvant therapy. Nine of 42 (21%) resected patients had no residual N2 disease. This subset of 9 had a median failure-free interval of 47.8 months from landmark, whereas the 33 patients (79%) with persistent N2 disease had a median failure-free survival of 8.2 months from landmark (P=0.01). Although 21/42 (50%) had an incomplete resection (positive highest resected node and/or margin), completeness of resection did not influence failure-free survival. There were 3 distant and no local recurrences among the N2 negative group, and 12 local recurrences among patients with residual N2 disease (P=0.041). These data suggest: (1) persistent N2 disease following induction chemotherapy is unfavorable; (2) patients downstaged to N2 negative may benefit from surgical resection; however, (3) 33% of N2 negative patients suffered disease relapse.
The Journal of Clinical Psychiatry, 2001
Journal of Clinical Oncology, 2005
Purpose To determine the feasibility of high-dose intra-arterial (IA) cisplatin and concurrent ra... more Purpose To determine the feasibility of high-dose intra-arterial (IA) cisplatin and concurrent radiation therapy (RT) for head and neck squamous cell carcinoma in the multi-institutional setting (Multi-RADPLAT). Patients and Methods Eligibility included T4 squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx. Patients received cisplatin (150 mg/m2 IA with sodium thiosulfate 9 g/m2 intravenous [IV], followed by 12 g/m2 IV over 6 hours, weekly for 4 weeks) and concurrent RT (70 Gy, 2.0 Gy/fraction, daily for 5 days over 7 weeks). Between May 1997 and December 1999, 67 patients from three experienced and eight inexperienced centers were enrolled, of whom 61 were eligible for analysis. Results Multi-RADPLAT was feasible (ie, three or four infusions of IA cisplatin and full dose of RT) in 53 patients (87%). The complete response (CR) rate was 85% at the primary site and 88% at nodal regions, and the overall CR rate was 80%. At a median follow-up of 3.9 years for...
International Journal of Radiation Oncology*Biology*Physics, 1996
Objective: To assess the patterns of failure in locally advanced (Stage III) non-small celI lung ... more Objective: To assess the patterns of failure in locally advanced (Stage III) non-small celI lung cancer (NSCLC) treated with concurrent chemotherapy and irradiation with or without surgery, according to stage of disease, treatment group, pathologic response, and histology. Material and Methods: In an effort to improve the cure rate for locally advanced NSCLC, 211 patients with clinical stage III NSCLC, from November 1982 through Au ust 1991 were entered on three consecutive phase II studies at Rush-Presbyterian-St Luke's Medical Center, designed to address both local and distant f. adure. Treatment in the fvs study consisted of cisplatin and 5-fluorou~cil infusion with concomitant split course radiation, while in the second and third etoposide was added. Radiation and chemotherapy were given simultaneously on days one through five of esch cycle in a preoperative fashion in patients considered eligible for surgery (ES) and as defmitive treatment for patients considered ineligible for s WglY py. Radiation was given as 200 cGy fractions on days l-5 of each cycle which was repeated every 14 days in study 1 and every 21 days in study , whtle m study III two fractions of 150 cGy were delivered on days 1-5 of each 21 day cycle with 46 hours between fractions. preoperative dose of 39-40 Gy and a definitive dose of 60 Gy. Radiation was given to a planned Surgical resection was attempted four to five weeks later in patients treated preoperatively.
International Journal of Radiation Oncology*Biology*Physics, 1996
International Journal of Radiation Oncology*Biology*Physics, 1994
weight loss of 5 5% @=O.OOOW2). Howtvcr, survival analysis within each of subgroups of patients w... more weight loss of 5 5% @=O.OOOW2). Howtvcr, survival analysis within each of subgroups of patients within the same imbalanced prognostic factor (Age : < 60 yr vs~ 60 yr; Stage : A vs B; weight loss : 5 5% vs > 5%) showed that patients treated with shorter intervals did better than those treated with longer intervals. Multivaria~ analysis confirmed that interfraction interval is independent prognostic factor (p=O.OOOOO), together with sex, age, KF'S and Stage. Concurrent CT did not have influence on the observed effect of interfraction intervals. Patients treated with shorter intervals had increased incidence of acute high grade toxicity and this difference almost reached statistical significance (p = 0.0576, chi-square). No increase in late toxicity was seen with shorter intervals. Conclusion : Results of this study show that patients treated with shorter (4.5-5.0 hr) interfraction intervals have better survival than those treated with longer (5.5-6.0 hr) intervals. They warrant further studies exploring influence of interfraction interval in patients treated with multiple fractions per day in a prospective randomized fashion.
International Journal of Radiation OncologyBiologyPhysics, 2004
Purpose/Objective: The use of planned neck dissection (ND) in patients with advanced nodal diseas... more Purpose/Objective: The use of planned neck dissection (ND) in patients with advanced nodal disease in head and neck squamous cell carcinoma (HNSCC) after treatment with chemoradiotherapy is controversial. The purpose of this study is to clarify the role for neck dissection in patients treated with combined chemoradiotherapy (CRT) on 2 similar organ preservation protocols at our institution. Materials/Methods: The records of 90 patients with N2-N3 neck nodes who were treated between 1991 and 2001 at Stanford University on two organ preservation CRT protocols (OSP2 and OSP3) were reviewed. All patients received 2 cycles of cisplatin and 5-Fluorouracil (5-FU) induction chemotherapy, followed by concurrent CRT with similar chemotherapeutic agents. Patients on OSP3 were randomized to receive either CRT alone versus CRT and Tirapazamine for 8 doses. Radiotherapy was delivered at conventional fractionation at 2 Gy/fraction to a total dose of 66-70 Gy to the gross target volume. Patients with persistent neck nodes either clinically or radiographically at a planned evaluation at 50 Gy proceeded to a neck dissection following completion of CRT. Patients treated on the OSP3 protocol (n ϭ 54) also received a single dose of 5 Gy delivered via 9-16 MeV electrons to the largest nodal mass prior to treatment for the comet study. The median follow up was 3.6 years. Results: Overall, 63% (n ϭ 57) of the patients attained a clinical complete response (cCR) in the neck; of these, 8 patients had a ND and all 8 had a pathologic complete response (pCR). Of the remaining 49 cCR patients whose necks were observed, 13 relapsed and 2 had a neck relapse without a recurrence at the primary site (1 with an isolated neck recurrence, 1 with a neck and distant failure). Of the 33 patients (37%) with Ͻ cCR in the neck, 2 had progressive disease and died. The remaining 31 patients had NDs with a pCR rate of 52% (n ϭ 16). Outcomes of the 3 groups: (1) cCR, (2) Ͻ cCR/pCR and (3) Ͻ cCR/Ͻ pCR are summarized in table 1. The cCR rates were similar for the 2 OSP protocols (61% and 65%). There was a trend for higher pCR rate patients who underwent ND in OSP3 group (58% vs. 42%, p ϭ 0.3, 2 Test) Conclusions: Based on our experience, in patients with N2-N3 neck nodes who have achieved a clinical and radiographic cCR in the neck following CRT, planned ND benefited only 4% (2/49) and is therefore not routinely recommended. Patients with a ϽcCR should proceed to ND. Patients with pathologically persistent tumors in the neck on ND specimens have poor prognosis and will need more aggressive therapy.
International Journal of Radiation Oncology*Biology*Physics, 1992
International Journal of Radiation Oncology*Biology*Physics, 1999
Journal of Urology, 2016
We will provide journalists and editors with full-text copies of the articles in question prior t... more We will provide journalists and editors with full-text copies of the articles in question prior to the embargo date so that stories can be adequately researched and written. The standard embargo time is 12:01 AM ET on that date. Questions regarding embargo should be directed to
Clinical Lung Cancer, 2002
Preoperative chemotherapy in patients with stage III non-small-cell lung cancer (NSCLC) remains c... more Preoperative chemotherapy in patients with stage III non-small-cell lung cancer (NSCLC) remains controversial. Phase II trials utilizing preoperative chemotherapy in selected patients have achieved complete resection rates of 50%-70% with 3-5 year failure-free survival rates of 15%-33%. Between October 1992 and November 1994, 57 adults (50 of whom were evaluable) with surgically staged IIIA NSCLC and pathologically documented ipsilateral mediastinal nodal involvement (N2) were enrolled in a Cancer and Leukemia Group B randomized trial. Preoperative therapy was thought to be critical to facilitating surgical resectability. For patients randomized to the radiotherapy/surgery/radiotherapy (RSR) arm (n = 24), treatment consisted of preoperative radiation therapy (RT) at 40 Gy, surgery, and then additional RT at 14-20 Gy. For patients randomized to the chemotherapy/surgery/chemotherapy/radiotherapy (CSCR) arm (n = 26), treatment consisted of 2 cycles of cisplatin/etoposide with filgrastim support (PE) followed by surgery, 2 more cycles of PE, then RT 54-60 Gy. The total dose of RT on either arm was 54 Gy if completely resected or 60 Gy if incompletely resected or unresected. Clinical characteristics were well balanced between the two arms. Thoracotomy was performed in 42 patients (84%), 28 (67%) of whom had complete resection. The median failure-free and overall survival rates were 12 months (95% confidence interval [CI], 9-23 months) and 23 months (95% CI, 19 months-∞) for the RSR arm and 11 months (95% CI, 5-20 months) and 18 months (95% CI, 12-32 months) for the CSCR arm. The rates of overall and complete surgical resection, downstaging of nodal involvement, and failure-free (P = 0.92) and overall survival (P = 0.41) did not differ between the two treatment arms. Moreover, in this trial, the chemotherapy regimen was sufficiently toxic to have had a lower completion rate of prescribed therapy in the CSCR arm than in the RSR arm.
Seminars in Interventional Radiology, 1998
The Indian Journal of Pediatrics, 2001
Neurocysticercosis is a common neuroparasitosis. Presentation with psychiatric symptoms is uncomm... more Neurocysticercosis is a common neuroparasitosis. Presentation with psychiatric symptoms is uncommon in neurocysticercosis. The present paper describes a patient who presented with mutism, neglect of personal care and incontinence in a psychiatric setting and investigations revealed diagnosis of neurocysticercosis. The case report highlights the possible misdiagnoses of a case of neurocysticercosis as psychiatric illness and mutism as an uncommon presentation of neurocysticercosis.
The Laryngoscope, 2004
To determine the relative risk of prognostic factors for local disease control following RADPLAT.... more To determine the relative risk of prognostic factors for local disease control following RADPLAT. Prospective study, academic medical center. Analyses of nine categories of risk factors among 240 patients with Stage II-IV carcinoma consecutively treated with RADPLAT (cisplatin 150 mg/m IA and sodium thiosulfate 9 g/m IV, weekly x4; radiotherapy 2 Gy/fraction/d, 5x weekly, 68-74 Gy over 6 to 7 weeks). Median follow-up: 58 months (range, 12-96 mo). The percentage of patients who had local disease control was 87.5%. Univariant analysis showed T classification (P =.01), laterality of neck disease (P =.026), number of neck levels involved (P =.008), total dose of radiation greater versus less than 60 Gy (P =.027), and presence of pathologically positive lymph nodes following chemoradiation (P =.01) to be significant. Logistic regression analysis showed total dose of radiation (P =.03) and the presence of pathologically positive lymph nodes following chemoradiation (P =.05) to be significant. For Kaplan-Meier estimates of local disease control at 5 years, T classification (P =.038), number of levels with nodal disease (P =.006), and total dose of radiation therapy (P =.0001) were significant. The log-rank test identified as significant the total dose of radiation therapy (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.0001), the presence of pathologically positive lymph nodes following chemoradiation (P =.005), and the number of neck levels with positive nodes (P =.006). The Cox regression model showed significance for the total dose of radiation (P =.001), the presence of pathologically positive lymph nodes following chemoradiation (P =.007), and the T classification (P =.029). Risk factors significantly associated with local disease control after RADPLAT appears to differ from more traditional therapy and is suggestive of a paradigm shift.
The American Journal of Surgery, 1997
The value of tumor regression rates in predicting survival outcome during chemoradiation therapy ... more The value of tumor regression rates in predicting survival outcome during chemoradiation therapy was prospectively evaluated. Sixty-two patients diagnosed with locally advanced stage III/IV unresectable head and neck squamous cell carcinoma underwent weekly clinical and endoscopic serial assessment of primary and nodal tumor sizes during chemoradiation therapy between July 1993 and September 1995. Chemoradiation therapy consisted of protocol treatment using supradose intra-arterial targeted cisplatin (SIT-P) at 150 mg/m2 four times at weekly intervals along with intravenous sodium thiosulfate at 9 g/m2 and concurrent conventionally fractionated radiotherapy at 1.8 to 2.0 Gy/fraction (fx) to a total dose of 68 to 74 Gy. Tumor reduction was serially measured as a percentage of the original pretreatment size at weekly intervals by the same team of surgical and radiation oncologists. Correlations were then made between tumor regression rates and survival. Complete or near complete regression of disease during chemoradiation therapy as compared with nonresponsive/partially responsive disease was associated with better survival outcome (P = 0.001 and P = 0.013, respectively). Among patients exhibiting complete or near complete regression of disease, rapid tumor reduction (median = 4.2 weeks) was associated with inferior survival outcome when compared with slower disease regression (median = 6.4 weeks, P = 0.007). Our findings fail to support the "traditional" hypothesis that rapid tumor regression during treatment is predictive of an improved survival outcome. Treatment strategies that alter ongoing therapy based upon initial tumor regression rates should be avoided.
Radiotherapy and Oncology, 1996
Radiotherapy and Oncology, 1996
Radiotherapy and Oncology, 1997
Background: We conducted a multicentre phase II trial to investigate feasibility and antitumor ac... more Background: We conducted a multicentre phase II trial to investigate feasibility and antitumor activity of sequential FOLFIRINOX and Stereotactic Body Radiotherapy (SBRT) in patients with locally advanced pancreatic cancer (LAPC), (LAPC-1 trial). Methods: Patients with biopsy-proven LAPC treated in four hospitals in the Netherlands between December 2014 and June 2017. Patients received 8 cycles of FOLFIRINOX followed by SBRT (5 fractions/8 Gy) if no tumour progression after the FOLFIRINOX treatment was observed. Primary outcome was 1-year overall survival (OS). Secondary outcomes were median OS, 1-year progression-free survival (PFS), treatmentrelated toxicity, and resection rate. The study is registered with ClinicalTrials.gov, NCT02292745, and is completed. Findings: Fifty patients were included. Nineteen (38%) patients did not receive all 8 cycles of FOLFIRINOX, due to toxicity (n = 12), disease progression (n = 6), or patients' preference (n = 1). Thirty-nine (78%) patients received the SBRT treatment. The 1-year OS and PFS were 64% (95% CI: 50%-76%) and 34% (95% CI: 22%-48%), respectively. Thirty grade 3 or 4 adverse events were observed during FOLFIRINOX. Two (5%) grade 3 or 4 adverse events after SBRT were observed. Two (5%) patients died due to a gastro-intestinal bleeding within three months after SBRT were observed. Six (12%) patients underwent a resection, all resulting in a complete (R0) resection. Two patients had a complete pathological response. Interpretation: FOLFIRINOX followed by SBRT in patients with LAPC is feasible and shows relevant antitumor activity. In 6 (12%) patients a potentially curative resection could be pursued following this combined treatment, with a complete histological response being observed in two patients.
Journal of Surgical Oncology, 2006
CALGB 8935 was a phase II protocol for mediastinoscopically staged IIIA (N2) non-small cell lung ... more CALGB 8935 was a phase II protocol for mediastinoscopically staged IIIA (N2) non-small cell lung cancer. Induction cisplatin/vinblastine chemotherapy was followed by surgical resection, adjuvant cisplatin/vinblastine, and radiotherapy. We now evaluate the prognosis of pathologic nodes. Failure-free survival was calculated from a landmark 3 months after resection to account for heterogeneity in adjuvant therapy. Nine of 42 (21%) resected patients had no residual N2 disease. This subset of 9 had a median failure-free interval of 47.8 months from landmark, whereas the 33 patients (79%) with persistent N2 disease had a median failure-free survival of 8.2 months from landmark (P=0.01). Although 21/42 (50%) had an incomplete resection (positive highest resected node and/or margin), completeness of resection did not influence failure-free survival. There were 3 distant and no local recurrences among the N2 negative group, and 12 local recurrences among patients with residual N2 disease (P=0.041). These data suggest: (1) persistent N2 disease following induction chemotherapy is unfavorable; (2) patients downstaged to N2 negative may benefit from surgical resection; however, (3) 33% of N2 negative patients suffered disease relapse.
The Journal of Clinical Psychiatry, 2001
Journal of Clinical Oncology, 2005
Purpose To determine the feasibility of high-dose intra-arterial (IA) cisplatin and concurrent ra... more Purpose To determine the feasibility of high-dose intra-arterial (IA) cisplatin and concurrent radiation therapy (RT) for head and neck squamous cell carcinoma in the multi-institutional setting (Multi-RADPLAT). Patients and Methods Eligibility included T4 squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx. Patients received cisplatin (150 mg/m2 IA with sodium thiosulfate 9 g/m2 intravenous [IV], followed by 12 g/m2 IV over 6 hours, weekly for 4 weeks) and concurrent RT (70 Gy, 2.0 Gy/fraction, daily for 5 days over 7 weeks). Between May 1997 and December 1999, 67 patients from three experienced and eight inexperienced centers were enrolled, of whom 61 were eligible for analysis. Results Multi-RADPLAT was feasible (ie, three or four infusions of IA cisplatin and full dose of RT) in 53 patients (87%). The complete response (CR) rate was 85% at the primary site and 88% at nodal regions, and the overall CR rate was 80%. At a median follow-up of 3.9 years for...
International Journal of Radiation Oncology*Biology*Physics, 1996
Objective: To assess the patterns of failure in locally advanced (Stage III) non-small celI lung ... more Objective: To assess the patterns of failure in locally advanced (Stage III) non-small celI lung cancer (NSCLC) treated with concurrent chemotherapy and irradiation with or without surgery, according to stage of disease, treatment group, pathologic response, and histology. Material and Methods: In an effort to improve the cure rate for locally advanced NSCLC, 211 patients with clinical stage III NSCLC, from November 1982 through Au ust 1991 were entered on three consecutive phase II studies at Rush-Presbyterian-St Luke's Medical Center, designed to address both local and distant f. adure. Treatment in the fvs study consisted of cisplatin and 5-fluorou~cil infusion with concomitant split course radiation, while in the second and third etoposide was added. Radiation and chemotherapy were given simultaneously on days one through five of esch cycle in a preoperative fashion in patients considered eligible for surgery (ES) and as defmitive treatment for patients considered ineligible for s WglY py. Radiation was given as 200 cGy fractions on days l-5 of each cycle which was repeated every 14 days in study 1 and every 21 days in study , whtle m study III two fractions of 150 cGy were delivered on days 1-5 of each 21 day cycle with 46 hours between fractions. preoperative dose of 39-40 Gy and a definitive dose of 60 Gy. Radiation was given to a planned Surgical resection was attempted four to five weeks later in patients treated preoperatively.
International Journal of Radiation Oncology*Biology*Physics, 1996
International Journal of Radiation Oncology*Biology*Physics, 1994
weight loss of 5 5% @=O.OOOW2). Howtvcr, survival analysis within each of subgroups of patients w... more weight loss of 5 5% @=O.OOOW2). Howtvcr, survival analysis within each of subgroups of patients within the same imbalanced prognostic factor (Age : < 60 yr vs~ 60 yr; Stage : A vs B; weight loss : 5 5% vs > 5%) showed that patients treated with shorter intervals did better than those treated with longer intervals. Multivaria~ analysis confirmed that interfraction interval is independent prognostic factor (p=O.OOOOO), together with sex, age, KF'S and Stage. Concurrent CT did not have influence on the observed effect of interfraction intervals. Patients treated with shorter intervals had increased incidence of acute high grade toxicity and this difference almost reached statistical significance (p = 0.0576, chi-square). No increase in late toxicity was seen with shorter intervals. Conclusion : Results of this study show that patients treated with shorter (4.5-5.0 hr) interfraction intervals have better survival than those treated with longer (5.5-6.0 hr) intervals. They warrant further studies exploring influence of interfraction interval in patients treated with multiple fractions per day in a prospective randomized fashion.
International Journal of Radiation OncologyBiologyPhysics, 2004
Purpose/Objective: The use of planned neck dissection (ND) in patients with advanced nodal diseas... more Purpose/Objective: The use of planned neck dissection (ND) in patients with advanced nodal disease in head and neck squamous cell carcinoma (HNSCC) after treatment with chemoradiotherapy is controversial. The purpose of this study is to clarify the role for neck dissection in patients treated with combined chemoradiotherapy (CRT) on 2 similar organ preservation protocols at our institution. Materials/Methods: The records of 90 patients with N2-N3 neck nodes who were treated between 1991 and 2001 at Stanford University on two organ preservation CRT protocols (OSP2 and OSP3) were reviewed. All patients received 2 cycles of cisplatin and 5-Fluorouracil (5-FU) induction chemotherapy, followed by concurrent CRT with similar chemotherapeutic agents. Patients on OSP3 were randomized to receive either CRT alone versus CRT and Tirapazamine for 8 doses. Radiotherapy was delivered at conventional fractionation at 2 Gy/fraction to a total dose of 66-70 Gy to the gross target volume. Patients with persistent neck nodes either clinically or radiographically at a planned evaluation at 50 Gy proceeded to a neck dissection following completion of CRT. Patients treated on the OSP3 protocol (n ϭ 54) also received a single dose of 5 Gy delivered via 9-16 MeV electrons to the largest nodal mass prior to treatment for the comet study. The median follow up was 3.6 years. Results: Overall, 63% (n ϭ 57) of the patients attained a clinical complete response (cCR) in the neck; of these, 8 patients had a ND and all 8 had a pathologic complete response (pCR). Of the remaining 49 cCR patients whose necks were observed, 13 relapsed and 2 had a neck relapse without a recurrence at the primary site (1 with an isolated neck recurrence, 1 with a neck and distant failure). Of the 33 patients (37%) with Ͻ cCR in the neck, 2 had progressive disease and died. The remaining 31 patients had NDs with a pCR rate of 52% (n ϭ 16). Outcomes of the 3 groups: (1) cCR, (2) Ͻ cCR/pCR and (3) Ͻ cCR/Ͻ pCR are summarized in table 1. The cCR rates were similar for the 2 OSP protocols (61% and 65%). There was a trend for higher pCR rate patients who underwent ND in OSP3 group (58% vs. 42%, p ϭ 0.3, 2 Test) Conclusions: Based on our experience, in patients with N2-N3 neck nodes who have achieved a clinical and radiographic cCR in the neck following CRT, planned ND benefited only 4% (2/49) and is therefore not routinely recommended. Patients with a ϽcCR should proceed to ND. Patients with pathologically persistent tumors in the neck on ND specimens have poor prognosis and will need more aggressive therapy.
International Journal of Radiation Oncology*Biology*Physics, 1992
International Journal of Radiation Oncology*Biology*Physics, 1999