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Wee, Jon

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Wee

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Wee, Jon
Author's Publications: search.filters.isAuthorOfPublication.3601991d-a332-4a54-8650-a04a5f8115be

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    Low Incidence of Chest Wall Pain with a Risk-Adapted Lung Stereotactic Body Radiation Therapy Approach Using Three or Five Fractions Based on Chest Wall Dosimetry
    (Public Library of Science, 2014) Coroller, Thibaud; Mak, Raymond; Lewis, John H.; Baldini, Elizabeth; Chen, Aileen; Colson, Yolonda; Hacker, Fred; Hermann, Gretchen; Kozono, David; Mannarino, Edward; Molodowitch, Christina; Wee, Jon; Sher, David J.; Killoran, Joseph
    Purpose To examine the frequency and potential of dose-volume predictors for chest wall (CW) toxicity (pain and/or rib fracture) for patients receiving lung stereotactic body radiotherapy (SBRT) using treatment planning methods to minimize CW dose and a risk-adapted fractionation scheme. Methods: We reviewed data from 72 treatment plans, from 69 lung SBRT patients with at least one year of follow-up or CW toxicity, who were treated at our center between 2010 and 2013. Treatment plans were optimized to reduce CW dose and patients received a risk-adapted fractionation of 18 Gy×3 fractions (54 Gy total) if the CW V30 was less than 30 mL or 10–12 Gy×5 fractions (50–60 Gy total) otherwise. The association between CW toxicity and patient characteristics, treatment parameters and dose metrics, including biologically equivalent dose, were analyzed using logistic regression. Results: With a median follow-up of 20 months, 6 (8.3%) patients developed CW pain including three (4.2%) grade 1, two (2.8%) grade 2 and one (1.4%) grade 3. Five (6.9%) patients developed rib fractures, one of which was symptomatic. No significant associations between CW toxicity and patient and dosimetric variables were identified on univariate nor multivariate analysis. Conclusions: Optimization of treatment plans to reduce CW dose and a risk-adapted fractionation strategy of three or five fractions based on the CW V30 resulted in a low incidence of CW toxicity. Under these conditions, none of the patient characteristics or dose metrics we examined appeared to be predictive of CW pain.
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    Outcomes by Tumor Histology and KRAS Mutation Status After Lung Stereotactic Body Radiation Therapy for Early-Stage Non–Small-Cell Lung Cancer
    (Elsevier BV, 2015) Mak, Raymond; Hermann, Gretchen; Lewis, John H.; Aerts, Hugo J.W.L.; Baldini, Elizabeth; Chen, Aileen; Colson, Yolonda; Hacker, Fred; Kozono, David; Wee, Jon; Chen, Yu-Hui; Catalano, Paul; Wong, Kwok-Kin; Sher, David J.
    BACKGROUND: We analyzed outcomes after lung stereotactic body radiotherapy (SBRT) for early-stage non-small cell lung-carcinoma (NSCLC) by histology and KRAS genotype. PATIENTS AND METHODS: We included 75 patients with 79 peripheral tumors treated with SBRT (18 Gy × 3 or 10 to 12 Gy × 5) at our institution from 2009 to 2012. Genotyping for KRAS mutations was performed in 10 patients. Outcomes were analyzed by the Kaplan-Meier method/Cox regression, or cumulative incidence method/Fine-Gray analysis. RESULTS: The median patient age was 74 (range, 46 to 93) years, and Eastern Cooperative Oncology Group performance status was 0 to 1 in 63%. Tumor histology included adenocarcinoma (44%), squamous cell carcinoma (25%), and NSCLC (18%). Most tumors were T1a (54%). Seven patients had KRAS-mutant tumors (9%). With a median follow-up of 18.8 months among survivors, the 1-year estimate of overall survival was 88%, cancer-specific survival (CSS) 92%, primary tumor control 94%, and freedom from recurrence (FFR) 67%. In patients with KRAS-mutant tumors, there was a significantly lower tumor control (67% vs. 96%; P = .04), FFR (48% vs. 69%; P = .03), and CSS (75% vs. 93%; P = .05). On multivariable analysis, histology was not associated with outcomes, but KRAS mutation (hazard ratio, 10.3; 95% confidence interval, 2.3-45.6; P = .0022) was associated with decreased CSS after adjusting for age. CONCLUSION: In this SBRT series, histology was not associated with outcomes, but KRAS mutation was associated with lower FFR on univariable analysis and decreased CSS on multivariable analysis. Because of the small sample size, these hypothesis-generating results need to be studied in larger data sets.
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    Lymph node volume predicts survival but not nodal clearance in Stage IIIA-IIIB NSCLC
    (Public Library of Science, 2017) Agrawal, Vishesh; Coroller, Thibaud; Hou, Ying; Lee, Stephanie W.; Romano, John L.; Baldini, Elizabeth; Chen, Aileen; Kozono, David; Swanson, Scott; Wee, Jon; Aerts, Hugo; Mak, Raymond
    Background: Locally advanced non-small cell lung cancer (LA-NSCLC) patients have poorer survival and local control with mediastinal node (N2) tumor involvement at resection. Earlier assessment of nodal burden could inform clinical decision-making prior to surgery. This study evaluated the association between clinical outcomes and lymph node volume before and after neoadjuvant therapy. Materials and methods CT imaging of patients with operable LA-NSCLC treated with chemoradiation and surgical resection was assessed. Clinically involved lymph node stations were identified by FDG-PET or mediastinoscopy. Locoregional recurrence (LRR), distant metastasis (DM), progression free survival (PFS) and overall survival (OS) were analyzed by the Kaplan Meier method, concordance index and Cox regression. Results: 73 patients with Stage IIIA-IIIB NSCLC treated with neoadjuvant chemoradiation and surgical resection were identified. The median RT dose was 54 Gy and all patients received concurrent chemotherapy. Involved lymph node volume was significantly associated with LRR and OS but not DM on univariate analysis. Additionally, lymph node volume greater than 10.6 cm3 after the completion of preoperative chemoradiation was associated with increased LRR (p<0.001) and decreased OS (p = 0.04). There was no association between nodal volumes and nodal clearance. Conclusion: For patients with LA-NSCLC, large volume nodal disease post-chemoradiation is associated with increased risk of locoregional recurrence and decreased survival. Nodal volume can thus be used to further stratify patients within the heterogeneous Stage IIIA-IIIB population and potentially guide clinical decision-making.
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    Case report of tracheobronchial squamous cell carcinoma treated with radiation therapy and concurrent chemotherapy
    (Elsevier BV, 2016) Agrawal, Vishesh; Marcoux, J.; Rabin, Michael; Vernovsky, Inna; Wee, Jon; Mak, Raymond
    Tracheobronchial tumors include primary malignant tumors, secondary malignant tumors, and benign tumors. Primary malignant tumors of the trachea are rare, representing only 0.1% to 0.4% of all malignant disease. Squamous cell carcinoma (SCC) and adenoid cystic carcinoma are the most common histological subtypes, making up approximately two-thirds of primary tracheal neoplasms.1 Such tumors have typically been treated with surgical resection and adjuvant radiation therapy (RT; Table 1). Medically inoperable tumors are usually treated with definitive RT, but because of the rarity of these tumors, there are no randomized trials to determine the optimal treatment regimen. A radiation dose of ∼60 Gy has been most commonly reported for external beam RT, with higher doses having significant toxicity of the tracheal and esophageal tissue using historical techniques. In contrast to definitive RT, the use of definitive RT with concurrent chemotherapy for tracheal SCC has been sparingly described in the literature. In this report, we describe our experience with 2 patients at our institution who received definitive RT using modern techniques with concurrent chemotherapy for tracheobronchial SCC.