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PURPOSE Brentuximab vedotin, an effective anti-CD30 antibody-drug conjugate approved for use in adults with classical Hodgkin lymphoma (HL), was introduced in this frontline trial to reduce prescribed radiation in children and adolescents with classical HL. METHODS Open-label, single-arm, multicenter trial for patients (age ≤ 18 years) with stage IIB, IIIB, or IV classical HL was conducted. Brentuximab vedotin replaced each vincristine in the OEPA/COPDac (vincristine, etoposide, prednisone, and doxorubicin/cyclophosphamide, vincristine, prednisone, and dacarbazine) regimen according to GPOH-HD2002 treatment group 3 (TG3); two cycles of AEPA and four cycles of CAPDac. Residual node radiotherapy (25.5 Gy) was given at the end of all chemotherapy only to nodal sites that did not achieve a complete response (CR) at the early response assessment (ERA) after two cycles of therapy. Primary objectives were to evaluate the safety and efficacy (complete remission at ERA) of this combination and the 3-year event-free (EFS) and overall survival (OS). The trials are registered at ClinicalTrials.gov (identifier: NCT01920932 ). RESULTS Of the 77 patients enrolled in the study, 27 (35%) achieved complete remission at ERA and were spared radiation. Patients who were irradiated received radiation to individual residual nodal tissue. At a median follow-up of 3.4 years, the 3-year EFS was 97.4% (SE 2.3%) and the OS was 98.7% (SE 1.6%). One irradiated patient experienced disease progression at the end of therapy and now remains disease free more than 6 years following salvage therapy, and one unexpected death occurred. Only 4% of patients experienced grade 3 neuropathy. CONCLUSION The integration of brentuximab vedotin in the frontline treatment of pediatric high-risk HL is highly tolerable, facilitated significant reduction in radiation exposure, and yielded excellent outcomes.
Monika L. Metzger; Michael P. Link; Amy L. Billett; Jamie Flerlage; John T. Lucas; Belinda N. Mandrell; Matthew J. Ehrhardt; Nickhill Bhakta; Torunn I. Yock; Alison M. Friedmann; Pedro de Alarcon; Sandra Luna-Fineman; Eric Larsen; Sue C. Kaste; Barry Shulkin; Zhaohua Lu; Chen Li; Susan M. Hiniker; Sarah S. Donaldson; Melissa M. Hudson; Matthew J. Krasin. Excellent Outcome for Pediatric Patients With High-Risk Hodgkin Lymphoma Treated With Brentuximab Vedotin and Risk-Adapted Residual Node Radiation. Journal of Clinical Oncology 2021, 39, 2276 -2283.
AMA StyleMonika L. Metzger, Michael P. Link, Amy L. Billett, Jamie Flerlage, John T. Lucas, Belinda N. Mandrell, Matthew J. Ehrhardt, Nickhill Bhakta, Torunn I. Yock, Alison M. Friedmann, Pedro de Alarcon, Sandra Luna-Fineman, Eric Larsen, Sue C. Kaste, Barry Shulkin, Zhaohua Lu, Chen Li, Susan M. Hiniker, Sarah S. Donaldson, Melissa M. Hudson, Matthew J. Krasin. Excellent Outcome for Pediatric Patients With High-Risk Hodgkin Lymphoma Treated With Brentuximab Vedotin and Risk-Adapted Residual Node Radiation. Journal of Clinical Oncology. 2021; 39 (20):2276-2283.
Chicago/Turabian StyleMonika L. Metzger; Michael P. Link; Amy L. Billett; Jamie Flerlage; John T. Lucas; Belinda N. Mandrell; Matthew J. Ehrhardt; Nickhill Bhakta; Torunn I. Yock; Alison M. Friedmann; Pedro de Alarcon; Sandra Luna-Fineman; Eric Larsen; Sue C. Kaste; Barry Shulkin; Zhaohua Lu; Chen Li; Susan M. Hiniker; Sarah S. Donaldson; Melissa M. Hudson; Matthew J. Krasin. 2021. "Excellent Outcome for Pediatric Patients With High-Risk Hodgkin Lymphoma Treated With Brentuximab Vedotin and Risk-Adapted Residual Node Radiation." Journal of Clinical Oncology 39, no. 20: 2276-2283.
The survival of patients with high‐risk neuroblastoma has improved significantly with the use of intensive multimodality treatment regimens, including chemotherapy, surgery, radiation therapy, myeloablative chemotherapy followed by stem cell rescue, and immunotherapy. This report summarizes the current treatment strategies used in the COG and SIOP for children with neuroblastoma. The improved global collaboration and the adoption of a uniform International Neuroblastoma Risk Group Staging System will help facilitate comparison of homogeneous pretreatment cohorts across clinical trials. Future research strategies regarding the indications for and dosages of radiation therapy to the primary and metastatic sites, and the integration of meta‐iodobenzyl guanidine therapy into the multimodal treatment program, are discussed.
Christine Chung; Tom Boterberg; John Lucas; Joseph Panoff; Dominique Valteau‐Couanet; Barbara Hero; Rochelle Bagatell; Christine E. Hill‐Kayser. Neuroblastoma. Pediatric Blood & Cancer 2021, 68, e28473 .
AMA StyleChristine Chung, Tom Boterberg, John Lucas, Joseph Panoff, Dominique Valteau‐Couanet, Barbara Hero, Rochelle Bagatell, Christine E. Hill‐Kayser. Neuroblastoma. Pediatric Blood & Cancer. 2021; 68 (S2):e28473.
Chicago/Turabian StyleChristine Chung; Tom Boterberg; John Lucas; Joseph Panoff; Dominique Valteau‐Couanet; Barbara Hero; Rochelle Bagatell; Christine E. Hill‐Kayser. 2021. "Neuroblastoma." Pediatric Blood & Cancer 68, no. S2: e28473.
PURPOSE Early identification of childhood cancer survivors at high risk for treatment-related cardiomyopathy may improve outcomes by enabling intervention before development of heart failure. We implemented artificial intelligence (AI) methods using the Children's Oncology Group guideline–recommended baseline ECG to predict cardiomyopathy. MATERIAL AND METHODS Seven AI and signal processing methods were applied to 10-second 12-lead ECGs obtained on 1,217 adult survivors of childhood cancer prospectively followed in the St Jude Lifetime Cohort (SJLIFE) study. Clinical and echocardiographic assessment of cardiac function was performed at initial and follow-up SJLIFE visits. Cardiomyopathy was defined as an ejection fraction < 50% or an absolute drop from baseline ≥ 10%. Genetic algorithm was used for feature selection, and extreme gradient boosting was applied to predict cardiomyopathy during the follow-up period. Model performance was evaluated by five-fold stratified cross-validation. RESULTS The median age at baseline SJLIFE evaluation was 31.7 years (range 18.4-66.4), and the time between baseline and follow-up evaluations was 5.2 years (0.5-9.5). Two thirds (67.1%) of patients were exposed to chest radiation, and 76.6% to anthracycline chemotherapy. One hundred seventeen (9.6%) patients developed cardiomyopathy during follow-up. In the model based solely on ECG features, the cross-validation area under the curve (AUC) was 0.87 (95% CI, 0.83 to 0.90), whereas the model based on clinical features had an AUC of 0.69 (95% CI, 0.64 to 0.74). In the model based on ECG and clinical features, the cross-validation AUC was 0.89 (95% CI, 0.86 to 0.91), with a sensitivity of 78% and a specificity of 81%. CONCLUSION AI using ECG data may assist in the identification of childhood cancer survivors at increased risk for developing future cardiomyopathy.
Fatma Güntürkün; Oguz Akbilgic; Robert L. Davis; Gregory T. Armstrong; Rebecca M. Howell; John L. Jefferies; Kirsten K. Ness; Ibrahim Karabayir; John T. Lucas; Deo Kumar Srivastava; Melissa M. Hudson; Leslie L. Robison; Elsayed Z. Soliman; Daniel A. Mulrooney. Artificial Intelligence–Assisted Prediction of Late-Onset Cardiomyopathy Among Childhood Cancer Survivors. JCO Clinical Cancer Informatics 2021, 5, 459 -468.
AMA StyleFatma Güntürkün, Oguz Akbilgic, Robert L. Davis, Gregory T. Armstrong, Rebecca M. Howell, John L. Jefferies, Kirsten K. Ness, Ibrahim Karabayir, John T. Lucas, Deo Kumar Srivastava, Melissa M. Hudson, Leslie L. Robison, Elsayed Z. Soliman, Daniel A. Mulrooney. Artificial Intelligence–Assisted Prediction of Late-Onset Cardiomyopathy Among Childhood Cancer Survivors. JCO Clinical Cancer Informatics. 2021; 5 (5):459-468.
Chicago/Turabian StyleFatma Güntürkün; Oguz Akbilgic; Robert L. Davis; Gregory T. Armstrong; Rebecca M. Howell; John L. Jefferies; Kirsten K. Ness; Ibrahim Karabayir; John T. Lucas; Deo Kumar Srivastava; Melissa M. Hudson; Leslie L. Robison; Elsayed Z. Soliman; Daniel A. Mulrooney. 2021. "Artificial Intelligence–Assisted Prediction of Late-Onset Cardiomyopathy Among Childhood Cancer Survivors." JCO Clinical Cancer Informatics 5, no. 5: 459-468.
Radiation-induced phantosmia has been reported both in children and adults. A fraction of these patients have nausea and vomiting triggered by phantosmia. Radiation-induced phantosmia, although transient, can be distressing enough to prevent a patient from staying still during radiation therapy. To date, specific interventions for radiation-induced phantosmia, including anesthesia, have not been reported. We report for the first time anesthesia as an intervention for transient severe radiation-induced phantosmia, in a 16-year-old girl with ependymoma undergoing proton therapy, and we discuss the pros and cons of techniques for anesthesia and airway management.
Kavitha C. Raghavan; Angela S. Camfield; John Lucas; Yousef Ismael; Michael G. Rossi; Doralina L. Anghelescu. Propofol Total Intravenous Anesthesia as an Intervention for Severe Radiation-Induced Phantosmia in an Adolescent with Ependymoma. Journal of Adolescent and Young Adult Oncology 2019, 1 .
AMA StyleKavitha C. Raghavan, Angela S. Camfield, John Lucas, Yousef Ismael, Michael G. Rossi, Doralina L. Anghelescu. Propofol Total Intravenous Anesthesia as an Intervention for Severe Radiation-Induced Phantosmia in an Adolescent with Ependymoma. Journal of Adolescent and Young Adult Oncology. 2019; ():1.
Chicago/Turabian StyleKavitha C. Raghavan; Angela S. Camfield; John Lucas; Yousef Ismael; Michael G. Rossi; Doralina L. Anghelescu. 2019. "Propofol Total Intravenous Anesthesia as an Intervention for Severe Radiation-Induced Phantosmia in an Adolescent with Ependymoma." Journal of Adolescent and Young Adult Oncology , no. : 1.
Limited data exist detailing the role of salvage reirradiation following local-regional recurrence (LR) in previously irradiated pediatric patients with rhabdomyosarcoma (RMS). We evaluated outcomes and prognostic factors in a multi-institutional cohort of 23 patients with LR-only (N = 19) or LR with distant failure (N = 4) RMS managed with (N = 12) or without (N = 11) re-irradiation who were treated from 1996 to 2012. At a median follow-up of 4.6 years from LR, 7 (30%) patients were alive and 5 (22%) had no evidence of disease. Median OS and PFS from LR were 19.3 and 16.9 months, respectively. LFFS and DFFS at 3 years from relapse were 54% and 56%, respectively. Salvage re-irradiation occurred in 12 (52%) patients, with 9 (75%) receiving resection before re-irradiation. Patients classified as low-risk at diagnosis with favorable primary tumor location had improved 3-year PFS 80% (95% CI 51.6–100%) vs. 47.1% (95% CI 27.3–81.2%), p = 0.066], and OS 80% [(95% CI 22.4–100%) vs. 47.1% (95% CI 27.3–81.3%), p = 0.051] following LR. Median LFFS and OS in unirradiated vs. re-irradiated patients was 12.4 vs. 19.6 (p = 0.1) and 18.8 vs. 26.1 months (p = 0.46). No patients experienced ≥grade 4 acute toxicity from re-irradiation. LR failure was a component of cancer-related death in 60% vs. 40% of the unirradiated and re-irradiated group (p = 0.02). Salvage re-irradiation appears tolerable with acceptable morbidity and may reduce the risk of subsequent LR as a component of death in patients with LR RMS.
Daniel V. Wakefield; Bree R. Eaton; Austin P.H. Dove; Chih-Yang Hsu; Thomas E. Merchant; Alberto Pappo; Andrew M. Davidoff; Natia Esiashvili; Matthew J. Krasin; John T. Lucas. Is there a role for salvage re-irradiation in pediatric patients with locoregional recurrent rhabdomyosarcoma? Clinical outcomes from a multi-institutional cohort. Radiotherapy and Oncology 2018, 129, 513 -519.
AMA StyleDaniel V. Wakefield, Bree R. Eaton, Austin P.H. Dove, Chih-Yang Hsu, Thomas E. Merchant, Alberto Pappo, Andrew M. Davidoff, Natia Esiashvili, Matthew J. Krasin, John T. Lucas. Is there a role for salvage re-irradiation in pediatric patients with locoregional recurrent rhabdomyosarcoma? Clinical outcomes from a multi-institutional cohort. Radiotherapy and Oncology. 2018; 129 (3):513-519.
Chicago/Turabian StyleDaniel V. Wakefield; Bree R. Eaton; Austin P.H. Dove; Chih-Yang Hsu; Thomas E. Merchant; Alberto Pappo; Andrew M. Davidoff; Natia Esiashvili; Matthew J. Krasin; John T. Lucas. 2018. "Is there a role for salvage re-irradiation in pediatric patients with locoregional recurrent rhabdomyosarcoma? Clinical outcomes from a multi-institutional cohort." Radiotherapy and Oncology 129, no. 3: 513-519.
Background/aims Non-irradiative local therapies have shown promise in delaying or supplanting external beam radiotherapy (EBRT) and enucleation in patients with retinoblastoma. We hypothesised that prior focal therapy does not compromise the efficacy of delayed episcleral plaque brachytherapy (epBRT).Methods We performed an institutional review board-approved medical record review of patients with retinoblastoma who were treated with I-125 epBRT prior to (primary) or following chemoreduction (delayed), alone and in combination with non-irradiative focal therapy. Clinical and treatment characteristics were retrieved. Treatment failure was defined as the need for subsequent EBRT and/or enucleation. Event-free and ocular survival rates were calculated from the date of plaque placement. The cumulative incidences (CIs) of treatment failure and enucleation were compared across strata using Gray’s test.Results We identified 50 patients with retinoblastoma (54 eyes), who received a total of 56 plaques between January 1986 and December 2010, with a median follow-up of 8.3 years (range, 0.8–21.2 years). The median time from diagnosis to plaque placement was 12.7 months (range, 0.1–128 months). The CI and 95% CI of treatment failure and enucleation following epBRT at 5 years was 37%±7.2% and42.2%±7.3%, respectively. The lack of prior diode or green laser therapy was predictive of increased risk for treatment failure (p=0.02 and 0.03). International Classification group C or D was predictive of decreased time to enucleation (p=0.004). The use of any focal therapy was not predictive of time to treatment failure (p=0.33).Conclusions The use of non-irradiative focal therapies prior to or following epBRT does not decrease the time to enucleation or treatment failure.
John T Lucas; Rose McGee; Catherine A Billups; Ibrahim Qaddoumi; Thomas E Merchant; Rachel C Brennan; Jiangrong Wu; Matthew W Wilson. Prior non-irradiative focal therapies do not compromise the efficacy of delayed episcleral plaque brachytherapy in retinoblastoma. British Journal of Ophthalmology 2018, 103, 699 -703.
AMA StyleJohn T Lucas, Rose McGee, Catherine A Billups, Ibrahim Qaddoumi, Thomas E Merchant, Rachel C Brennan, Jiangrong Wu, Matthew W Wilson. Prior non-irradiative focal therapies do not compromise the efficacy of delayed episcleral plaque brachytherapy in retinoblastoma. British Journal of Ophthalmology. 2018; 103 (5):699-703.
Chicago/Turabian StyleJohn T Lucas; Rose McGee; Catherine A Billups; Ibrahim Qaddoumi; Thomas E Merchant; Rachel C Brennan; Jiangrong Wu; Matthew W Wilson. 2018. "Prior non-irradiative focal therapies do not compromise the efficacy of delayed episcleral plaque brachytherapy in retinoblastoma." British Journal of Ophthalmology 103, no. 5: 699-703.
Approximately 650 cases of neuroblastoma are diagnosed in the United States each year. With an incidence of 10.2 cases per million, it is the most common cancer that arises during the first year of life and the most common extracranial solid malignancy, representing 8–10% of all pediatric malignancies. Neuroblastoma is also responsible for 15% of childhood cancer mortality (Attiyeh et al. 2005; Brodeur 1997; Maris 2010). The median age at diagnosis is 17 months, and the incidence of the disease quickly dissipates with increasing age (Fig. 5.1).
Joseph Panoff; John Lucas; Luke Pater; Shefali Gajjar. Neuroblastoma. Pediatric Oncology 2018, 87 -110.
AMA StyleJoseph Panoff, John Lucas, Luke Pater, Shefali Gajjar. Neuroblastoma. Pediatric Oncology. 2018; ():87-110.
Chicago/Turabian StyleJoseph Panoff; John Lucas; Luke Pater; Shefali Gajjar. 2018. "Neuroblastoma." Pediatric Oncology , no. : 87-110.
The role of perfusion imaging in the management of pediatric high grade glioma is unclear. We evaluated the ability of dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) to determine grade, evaluate post-treatment response and predict treatment failure.
John T. Lucas; Brendan J. Knapp; Jinsoo Uh; Chia-Ho Hua; Thomas E. Merchant; Scott N. Hwang; Zoltan Patay; Alberto Broniscer; John T. Lucas Jr.. Posttreatment DSC-MRI is Predictive of Early Treatment Failure in Children with Supratentorial High-Grade Glioma Treated with Erlotinib. Clinical Neuroradiology 2017, 28, 393 -400.
AMA StyleJohn T. Lucas, Brendan J. Knapp, Jinsoo Uh, Chia-Ho Hua, Thomas E. Merchant, Scott N. Hwang, Zoltan Patay, Alberto Broniscer, John T. Lucas Jr.. Posttreatment DSC-MRI is Predictive of Early Treatment Failure in Children with Supratentorial High-Grade Glioma Treated with Erlotinib. Clinical Neuroradiology. 2017; 28 (3):393-400.
Chicago/Turabian StyleJohn T. Lucas; Brendan J. Knapp; Jinsoo Uh; Chia-Ho Hua; Thomas E. Merchant; Scott N. Hwang; Zoltan Patay; Alberto Broniscer; John T. Lucas Jr.. 2017. "Posttreatment DSC-MRI is Predictive of Early Treatment Failure in Children with Supratentorial High-Grade Glioma Treated with Erlotinib." Clinical Neuroradiology 28, no. 3: 393-400.
Purpose: To develop a 4D MRI method for assessing respiration-induced abdominal organ motion in children receiving radiation therapy. Methods: A 4D MRI using internal image-based respiratory surrogate has been developed and implemented on a clinical scanner (1.5T Siemens Avanto). Ten patients (younger group: N=6, 2–5 years, anesthetized; older group: N=4, 11–15 years) with neuroblastoma, Wilm’s tumor rhabdomyosarcoma, or desmoplastic small round cell tumor received free breathing 4D MRI scans for treatment planning. Coronal image slices of the entire abdomen were retrospectively constructed in 10 respiratory phases. A B-spline deformable registration (Metz et al. 2011) was performed on 4D datasets to automatically derive motion trajectories of selected anatomical landmarks, including the dome and the center of the liver, and the superior edges of kidneys and spleen. The extents of the motion in three dimensions (anteroposterior, AP; mediolateral, ML; superoinferior, SI) and the correlations between organ motion trajectories were quantified. Results: The 4D MRI scans were successfully performed in <20 minutes for all patients without the use of any external device. Organ motion extents were larger in adolescents (kidneys: 3–13 mm SI, liver and spleen: 6–18 mm SI) than in younger children (kidneys:<3mm in all directions; liver and spleen: 1–8 mm SI, 1–5 mm ML and AP). The magnitude of respiratory motion in some adolescents may warrant special motion management. Motion trajectories were not synchronized across selected anatomical landmarks, particularly in the ML and AP directions, indicating inter- and intra-organ variations of the respiratory-induced motion. Conclusion: The developed 4D MRI acquisition and motion analysis methods provide a non-ionizing, non-invasive approach to automatically measure the organ motion trajectory in the pediatric abdomen. It is useful for defining ITV and PRV, monitoring changes in target motion patterns during the treatment course, and studying interplay effects in proton scanning.
J Uh; Mj Krasin; JT Lucas; C Tinkle; Te Merchant; C Hua; Jt Lucas Jr.. SU-D-207A-06: Pediatric Abdominal Organ Motion Quantified Via a Novel 4D MRI Method. Medical Physics 2016, 43, 3344 -3344.
AMA StyleJ Uh, Mj Krasin, JT Lucas, C Tinkle, Te Merchant, C Hua, Jt Lucas Jr.. SU-D-207A-06: Pediatric Abdominal Organ Motion Quantified Via a Novel 4D MRI Method. Medical Physics. 2016; 43 (6):3344-3344.
Chicago/Turabian StyleJ Uh; Mj Krasin; JT Lucas; C Tinkle; Te Merchant; C Hua; Jt Lucas Jr.. 2016. "SU-D-207A-06: Pediatric Abdominal Organ Motion Quantified Via a Novel 4D MRI Method." Medical Physics 43, no. 6: 3344-3344.
Our group created and routinely reviewed a dedicated prostate intensity-modulated radiation therapy (IMRT) delivery program. Previously, a retrospective review of our experience demonstrated that a larger bladder volume reduced radiation dose to the rectum. We conducted an observational study to confirm this relationship.
Bart Frizzel; James Lovato; Jennifer Foster; Ashley Towers; John Lucas; Charles Able. Impact of bladder volume on radiation dose to the rectum in the definitive treatment of prostate cancer. The Journal of Community and Supportive Oncology 2015, 13, 288 -291.
AMA StyleBart Frizzel, James Lovato, Jennifer Foster, Ashley Towers, John Lucas, Charles Able. Impact of bladder volume on radiation dose to the rectum in the definitive treatment of prostate cancer. The Journal of Community and Supportive Oncology. 2015; 13 (8):288-291.
Chicago/Turabian StyleBart Frizzel; James Lovato; Jennifer Foster; Ashley Towers; John Lucas; Charles Able. 2015. "Impact of bladder volume on radiation dose to the rectum in the definitive treatment of prostate cancer." The Journal of Community and Supportive Oncology 13, no. 8: 288-291.
Charles L. Dunn; John T. Lucas; Hollins Clark; Thomas W. McLean; John Lucas Jr.. Successful Radiofrequency Ablation for Recurrent Pulmonary Hepatoblastoma. Pediatric Blood & Cancer 2015, 62, 2242 -2242.
AMA StyleCharles L. Dunn, John T. Lucas, Hollins Clark, Thomas W. McLean, John Lucas Jr.. Successful Radiofrequency Ablation for Recurrent Pulmonary Hepatoblastoma. Pediatric Blood & Cancer. 2015; 62 (12):2242-2242.
Chicago/Turabian StyleCharles L. Dunn; John T. Lucas; Hollins Clark; Thomas W. McLean; John Lucas Jr.. 2015. "Successful Radiofrequency Ablation for Recurrent Pulmonary Hepatoblastoma." Pediatric Blood & Cancer 62, no. 12: 2242-2242.
Our objective was to explore the hypothesis that the risk of leptomeningeal dissemination (LMD) in patients who underwent stereotactic radiosurgery (SRS) for brain metastases is influenced by the site of the primary cancer, the addition of whole brain radiation therapy (WBRT), surgical resection, and control over their systemic disease. We conducted a retrospective cohort analysis of 805 patients who were treated with SRS for brain metastases between 1999 and 2012 at the Wake Forest Baptist Medical Center, and excluded all patients with evidence of LMD before SRS. The primary outcome was LMD. Forty-nine of 795 patients developed LMD with a cumulative incidence of 6.2 % (95 % Confidence Interval (CI), 4.7–8.0). Median time from SRS to LMD was 7.4 months (Interquartile Range (IQR), 3.3–15.4). A colorectal primary site (Hazard Ratio (HR), 4.5; 95 % CI 2.5–8.0; p < 0.0001), distant brain failure (HR, 2.0; 95 % CI 1.2–3.2; p = 0.007), breast primary site (HR, 1.6; 95 % CI 1.0–2.7; p = 0.05), the number of intracranial metastases at time of initial SRS (HR, 1.1; 95 % CI 1.0–1.2; p = 0.02), and age (by 5-year interval) (HR, 0.9; 95 % CI 0.8, 0.9; p = 0.0006) were independent factors associated with LMD. There was no evidence that surgical resection before SRS altered the risk of LMD (HR, 1.1; 95 % CI 0.6–2.0, p = 0.78). In patients who underwent SRS for brain metastases, a colorectal or breast primary site, distant brain failure, younger age, and an increased number of intracranial metastases were independently associated with LMD. Given its relative rarity as an outcome, multi-institutional prospective studies will likely be necessary to validate and quantify these relationships.
Andrew J. Huang; Karen E. Huang; Brandi R. Page; Diandra N. Ayala-Peacock; John T. Lucas; Glenn J. Lesser; Adrian W. Laxton; Stephen B. Tatter; Michael D. Chan; John T. Lucas Jr.. Risk factors for leptomeningeal carcinomatosis in patients with brain metastases who have previously undergone stereotactic radiosurgery. Journal of Neuro-Oncology 2014, 120, 163 -169.
AMA StyleAndrew J. Huang, Karen E. Huang, Brandi R. Page, Diandra N. Ayala-Peacock, John T. Lucas, Glenn J. Lesser, Adrian W. Laxton, Stephen B. Tatter, Michael D. Chan, John T. Lucas Jr.. Risk factors for leptomeningeal carcinomatosis in patients with brain metastases who have previously undergone stereotactic radiosurgery. Journal of Neuro-Oncology. 2014; 120 (1):163-169.
Chicago/Turabian StyleAndrew J. Huang; Karen E. Huang; Brandi R. Page; Diandra N. Ayala-Peacock; John T. Lucas; Glenn J. Lesser; Adrian W. Laxton; Stephen B. Tatter; Michael D. Chan; John T. Lucas Jr.. 2014. "Risk factors for leptomeningeal carcinomatosis in patients with brain metastases who have previously undergone stereotactic radiosurgery." Journal of Neuro-Oncology 120, no. 1: 163-169.
John T. Lucas; Jeffrey G. Kuremsky; Mike Soike; William W. Hinson; William T. Kearns; Carnell J. Hampton; A. William Blackstock; James Urbanic; John Lucas Jr.. Comparison of accelerated hypofractionation and stereotactic body radiotherapy for Stage 1 and node negative Stage 2 non-small cell lung cancer (NSCLC). Lung Cancer 2014, 85, 59 -65.
AMA StyleJohn T. Lucas, Jeffrey G. Kuremsky, Mike Soike, William W. Hinson, William T. Kearns, Carnell J. Hampton, A. William Blackstock, James Urbanic, John Lucas Jr.. Comparison of accelerated hypofractionation and stereotactic body radiotherapy for Stage 1 and node negative Stage 2 non-small cell lung cancer (NSCLC). Lung Cancer. 2014; 85 (1):59-65.
Chicago/Turabian StyleJohn T. Lucas; Jeffrey G. Kuremsky; Mike Soike; William W. Hinson; William T. Kearns; Carnell J. Hampton; A. William Blackstock; James Urbanic; John Lucas Jr.. 2014. "Comparison of accelerated hypofractionation and stereotactic body radiotherapy for Stage 1 and node negative Stage 2 non-small cell lung cancer (NSCLC)." Lung Cancer 85, no. 1: 59-65.
The contents of working memory (WM) steer visual attention, but the extent of this guidance can be strategically enhanced or inhibited when WM content is reliably helpful or harmful to a visual task. Current understanding of the neural substrates mediating the cognitive control over WM biases is limited, however, by the correlational nature of functional MRI approaches. A recent fMRI study provided suggestive evidence for a functional lateralization of these control processes in posterior parietal cortex (PPC): activity in left PPC correlated with the presentation of WM cues that ought to be strategically enhanced to optimize performance, while activity in the right PPC correlated with the presentation of cues that ought to be inhibited to prevent detrimental attentional biases in a visual search. Here, we aimed to directly assess whether the left and right PPC are causally involved in the cognitive control of WM biases, and to clarify their precise functional contributions. We therefore applied 1 Hz repetitive transcranial magnetic stimulation (rTMS) to left and right PPC (and a vertex control site) prior to administering a behavioral task assessing WM biasing control functions. We observed that the perturbation of left PPC eliminated the strategic benefit of predictably helpful WM cueing, while the perturbation of right PPC amplified the cost of unpredictable detrimental WM cueing. The left and right PPC thus play distinct causal roles in WM–attention interactions: the left PPC to maximize benefits, and the right PPC to minimize costs, of internally maintained content on visual attention.
Anastasia Kiyonaga; Franziska M. Korb; John Lucas; David Soto; Tobias Egner. Dissociable causal roles for left and right parietal cortex in controlling attentional biases from the contents of working memory. NeuroImage 2014, 100, 200 -205.
AMA StyleAnastasia Kiyonaga, Franziska M. Korb, John Lucas, David Soto, Tobias Egner. Dissociable causal roles for left and right parietal cortex in controlling attentional biases from the contents of working memory. NeuroImage. 2014; 100 ():200-205.
Chicago/Turabian StyleAnastasia Kiyonaga; Franziska M. Korb; John Lucas; David Soto; Tobias Egner. 2014. "Dissociable causal roles for left and right parietal cortex in controlling attentional biases from the contents of working memory." NeuroImage 100, no. : 200-205.
There is significant variation in recommendation for percutaneous endoscopic gastrostomy (PEG) tube placement in patients undergoing definitive chemoradiation therapy (CRT) for locally advanced squamous cell carcinoma of the head and neck (LAHNC), with some clinicians globally recommending prophylactic PEG and others waiting until toxicity has occurred. The present study was conceived to identify specific factors associated with PEG requirement, in a population of LAHNC patients who did not have up-front PEG placement. Using a quality assurance database, we identified patients with oropharyngeal (ORP) or laryngeal-hypopharyngeal (LHP) LAHNC who were treated with CRT for inclusion in a cohort study of factors impacting PEG placement. Eligibility included stage III/IV squamous cell carcinoma of ORP and LHP. Patients were excluded if they had a PEG placement prior to commencement of CRT. The primary endpoint compared across groups was PEG placement, and multivariate analysis of factors was performed. We identified 107 patients with LAHNC who did not receive PEG tubes prior to treatment. After treatment initiation, 41% of patients with ORP tumors required PEG placement during treatment compared with 16% of LHP patients (P = .03). After adjusting for covariates, multivariate analysis revealed that the only predictor for PEG placement was ORP primary (odds ratio 4.77; 95% confidence interval 1.6-13.8, P = .009) using LHP as reference. Our findings suggest that the patients with ORP cancers are more likely to require PEG placement during treatment and should be considered for prophylactic PEG placement, while LHP sites were associated with lower likelihood of PEG requirement. The primary reason for this difference appears to be severity of pharyngitis; proactive nutritional monitoring and supplementation should be implemented early. Patients with pretreatment risk stratification for PEG placement in LAHNC may improve quality of care and avoid unnecessary treatment breaks.
A. Jason Zauls; John Watkins; John Lucas; Keisuke Shirai; Anand K. Sharma. Requirement of percutaneous endoscopic gastrostomy tube placement in head-and-neck cancer treated with definitive concurrent chemoradiation therapy: An analysis of clinical and anatomic factors. Practical Radiation Oncology 2013, 3, e61 -e69.
AMA StyleA. Jason Zauls, John Watkins, John Lucas, Keisuke Shirai, Anand K. Sharma. Requirement of percutaneous endoscopic gastrostomy tube placement in head-and-neck cancer treated with definitive concurrent chemoradiation therapy: An analysis of clinical and anatomic factors. Practical Radiation Oncology. 2013; 3 (2):e61-e69.
Chicago/Turabian StyleA. Jason Zauls; John Watkins; John Lucas; Keisuke Shirai; Anand K. Sharma. 2013. "Requirement of percutaneous endoscopic gastrostomy tube placement in head-and-neck cancer treated with definitive concurrent chemoradiation therapy: An analysis of clinical and anatomic factors." Practical Radiation Oncology 3, no. 2: e61-e69.
Hemophagocytic lymphohistiocytosis (HLH) is rare in adults and is usually fatal without treatment. We present a consecutive series of 18 adults with HLH diagnosed at our institution between 2004 and 2009. All diagnoses were confirmed by pathology. The median age at diagnosis was 56 years (range: 18-73 years), with a male: female ratio of 2:1. Patients uniformly presented with fever. Fifty-five per cent of the patients presented with evidence of hepatomegaly or splenomegaly. All of the patients had at least a bi- or trilineage cytopenia. Elevated liver enzymes, hyperferritinemia, hypertriglyceridemia and hyperfibrinogenemia were seen in 50, 100, 40 and 50% of patients, respectively. The presumed causes were as follows; haematological malignancies (n = 4), post-autologous stem cell transplant (n = 2), infection (n = 2), rheumatologic illness (n = 2), sickle cell disease (n = 1), post-orthotopic liver transplant (n = 1) and idiopathic (n = 3). The median time from suspicion to diagnosis was 5 days (1-27 days). Corticosteroids and/or cyclosporine were the most frequently used treatment regimen. Other agents used were etoposide, IVIG, cyclophosphamide and chemotherapy. The mortality rate was 72%, with multi-system organ failure being the most common cause of death. Median survival time from diagnosis was 35 days. Six patients are alive to date. In a univariate analysis, the presence of fever was the only factor that was statistically significant for predicting a poor prognosis (early mortality) (p = 0.05). In conclusion, a high index of suspicion is the critical factor for early diagnosis. Early treatment with immunosuppressant is warranted, and a thorough diagnostic evaluation to identify the underlying cause should be undertaken.
Munira Shabbir; John Lucas; John Lazarchick; Keisuke Shirai. Secondary hemophagocytic syndrome in adults: a case series of 18 patients in a single institution and a review of literature. Hematological Oncology 2010, 29, 100 -106.
AMA StyleMunira Shabbir, John Lucas, John Lazarchick, Keisuke Shirai. Secondary hemophagocytic syndrome in adults: a case series of 18 patients in a single institution and a review of literature. Hematological Oncology. 2010; 29 (2):100-106.
Chicago/Turabian StyleMunira Shabbir; John Lucas; John Lazarchick; Keisuke Shirai. 2010. "Secondary hemophagocytic syndrome in adults: a case series of 18 patients in a single institution and a review of literature." Hematological Oncology 29, no. 2: 100-106.
Neurofibromatosis type 1 (NF1) is an autosomal dominant condition with a worldwide incidence of ∼1 per 2500 to 3000 individuals. Caused by a germ-line–inactivating mutation in the NF1 gene on chromosome 17, the disease is associated with increased morbidity and mortality. In the past several years, significant progress has been made in standardizing management of the major clinical features of neurofibromatosis type 1. Moreover, improved understanding of how the neurofibromatosis type 1 protein, neurofibromin, regulates cell growth recently provided insight into the pathogenesis of the disease and has led to the development of new therapies. In this review, we describe the clinical manifestations, recent molecular and genetic findings, and current and developing therapies for managing clinical problems associated with neurofibromatosis type 1.
Virginia C. Williams; John Lucas; Michael A. Babcock; David H. Gutmann; Bruce Korf; Bernard L. Maria. Neurofibromatosis Type 1 Revisited. PEDIATRICS 2009, 123, 124 -133.
AMA StyleVirginia C. Williams, John Lucas, Michael A. Babcock, David H. Gutmann, Bruce Korf, Bernard L. Maria. Neurofibromatosis Type 1 Revisited. PEDIATRICS. 2009; 123 (1):124-133.
Chicago/Turabian StyleVirginia C. Williams; John Lucas; Michael A. Babcock; David H. Gutmann; Bruce Korf; Bernard L. Maria. 2009. "Neurofibromatosis Type 1 Revisited." PEDIATRICS 123, no. 1: 124-133.