Publications by authors named "C D Fuller"

1,427 Publications

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Dynamics-Adapted Radiotherapy Dose (DARD) for Head and Neck Cancer Radiotherapy Dose Personalization.

J Pers Med 2021 Nov 1;11(11). Epub 2021 Nov 1.

Department of Integrated Mathematical Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA.

Standard of care radiotherapy (RT) doses have been developed as a one-size-fits all approach designed to maximize tumor control rates across a population. Although this has led to high control rates for head and neck cancer with 66-70 Gy, this is done without considering patient heterogeneity. We present a framework to estimate a personalized RT dose for individual patients, based on pre- and early on-treatment tumor volume dynamics-a dynamics-adapted radiotherapy dose (). We also present the results of an in silico trial of this dose personalization using retrospective data from a combined cohort of = 39 head and neck cancer patients from the Moffitt and MD Anderson Cancer Centers that received 66-70 Gy RT in 2-2.12 Gy weekday fractions. This trial was repeated constraining between (54, 82) Gy to test more moderate dose adjustment. was estimated to range from 8 to 186 Gy, and our in silico trial estimated that 77% of patients treated with standard of care were overdosed by an average dose of 39 Gy, and 23% underdosed by an average dose of 32 Gy. The in silico trial with constrained dose adjustment estimated that locoregional control could be improved by >10%. We demonstrated the feasibility of using early treatment tumor volume dynamics to inform dose personalization and stratification for dose escalation and de-escalation. These results demonstrate the potential to both de-escalate most patients, while still improving population-level control rates.
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http://dx.doi.org/10.3390/jpm11111124DOI Listing
November 2021

Self-controlled assessment of thromboembolic event (TEE) risk following intravenous immune globulin (IGIV) in the U.S. (2006-2012).

J Thromb Thrombolysis 2021 Nov 24. Epub 2021 Nov 24.

Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA.

Since 2013, the U.S. Food and Drug administration (FDA) has required that intravenous immune globulin (IGIV) products carry a boxed warning concerning the risk of thromboembolic events (TEEs). This study assessed the incidence of TEEs attributable to IGIV in a large population-based cohort. A self-controlled risk interval design was used to quantify the transient increase in TEE risk during the risk interval (days 0-2 and 0-13 following IGIV for arterial and venous TEEs, respectively) relative to a later control interval (days 14-27 following IGIV). Potential IGIV-exposed TEE cases from 2006 to 2012 were identified from the FDA-sponsored Sentinel Distributed Database and confirmed through medical record review. Inpatient IGIV exposures were not included in the venous TEE analysis due to concerns about time-varying confounding. 19,069 new users of IGIV who received 93,555 treatment episodes were included. Charts were retrieved for 62% and 70% of potential venous and arterial cases, respectively. There was a transient increase in the risk of arterial TEEs during days 0-2 following IGIV treatment (RR = 4.69; 95% CI 1.87, 11.90; absolute increase in risk = 8.86 events per 10,000 patients, 95% CI 3.25, 14.6), but no significant increase in venous TEE risk during days 0-13 following outpatient IGIV treatments (RR = 1.07, 95% CI 0.34, 3.48). Our results suggest there is a small increase in the absolute risk of arterial TEEs following IGIV. However, lower-than-expected chart retrieval rates and the possibility of time-varying confounding mean that our results should be interpreted cautiously. Continued pharmacovigilance efforts are warranted.
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http://dx.doi.org/10.1007/s11239-021-02610-4DOI Listing
November 2021

Storytelling as a Research Tool Used to Explore Insights and as an Intervention in Public Health: A Systematic Narrative Review.

Int J Public Health 2021 2;66:1604262. Epub 2021 Nov 2.

Institute of Health, University College London, London, United Kingdom.

Studies of storytelling (ST) used as a research tool to extract information and/or as an intervention to effect change in the public knowledge, attitudes, and behavior/practice (KAB/P) were sought and analyzed. Medline, EMBASE, PsycINFO, ERIC, Web of Science, Art and Humanities database, Scopus, and Google Scholar were searched, and a basic and broad quantitative analysis was performed, followed by an in-depth narrative synthesis of studies on carefully selected topics. From this search, 3,077 studies were identified. 145 studies entered quantitative analysis [cancer and cancer screening (32/145), HIV (32/145), mental health (10/145), vaccination (8/145), and climate change (3/145)]. Ten studies entered final analysis [HIV/AIDs (5), climate change (1), sexual health (3), and croup (1)]. ST techniques included digital ST (DST), written ST, verbal ST, and use of professional writers. Of the ten studies, seven used ST to change KAB/P; the remainder used ST to extract insights. Follow-up and evaluation were very limited. ST reveals insights and serves as an intervention in public health. Benefits of ST largely outweigh the limitations, but more follow-up/evaluation is needed. ST should play a more significant role in tackling public health issues. CRD42019124704.
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http://dx.doi.org/10.3389/ijph.2021.1604262DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8592844PMC
November 2021

Changes in COVID-19 outbreak severity and duration in long-term care facilities following vaccine introduction, England, November 2020 to June 2021.

Euro Surveill 2021 11;26(46)

UCL Institute of Health Informatics, London, United Kingdom.

We describe the impact of changing epidemiology and vaccine introduction on characteristics of COVID-19 outbreaks in 330 long-term care facilities (LTCF) in England between November 2020 and June 2021. As vaccine coverage in LTCF increased and national incidence declined, the total number of outbreaks and outbreak severity decreased across the LTCF. The number of infected cases per outbreak decreased by 80.6%, while the proportion of outbreaks affecting staff only increased. Our study supports findings of vaccine effectiveness in LTCF.
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http://dx.doi.org/10.2807/1560-7917.ES.2021.26.46.2100995DOI Listing
November 2021

Magnetic resonance linear accelerator technology and adaptive radiation therapy: An overview for clinicians.

CA Cancer J Clin 2021 Nov 18. Epub 2021 Nov 18.

Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas.

Radiation therapy (RT) continues to play an important role in the treatment of cancer. Adaptive RT (ART) is a novel method through which RT treatments are evolving. With the ART approach, computed tomography or magnetic resonance (MR) images are obtained as part of the treatment delivery process. This enables the adaptation of the irradiated volume to account for changes in organ and/or tumor position, movement, size, or shape that may occur over the course of treatment. The advantages and challenges of ART maybe somewhat abstract to oncologists and clinicians outside of the specialty of radiation oncology. ART is positioned to affect many different types of cancer. There is a wide spectrum of hypothesized benefits, from small toxicity improvements to meaningful gains in overall survival. The use and application of this novel technology should be understood by the oncologic community at large, such that it can be appropriately contextualized within the landscape of cancer therapies. Likewise, the need to test these advances is pressing. MR-guided ART (MRgART) is an emerging, extended modality of ART that expands upon and further advances the capabilities of ART. MRgART presents unique opportunities to iteratively improve adaptive image guidance. However, although the MRgART adaptive process advances ART to previously unattained levels, it can be more expensive, time-consuming, and complex. In this review, the authors present an overview for clinicians describing the process of ART and specifically MRgART.
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http://dx.doi.org/10.3322/caac.21707DOI Listing
November 2021
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