Publications by authors named "Eric D Miller"

44 Publications

The psychological effects of the COVID-19 pandemic: an introduction to the special issue.

Authors:
Eric D Miller

J Gen Psychol 2021 Apr 7:1-7. Epub 2021 Apr 7.

Kent State University.

This paper briefly introduces the Special Issue "The Psychological Effects of the COVID-19 Pandemic." In doing so, it first outlines the initial call for papers and some of the general contours of the issue before then offering a terse summary of the larger themes offered in each of the six papers included in this volume. Some final summary remarks and larger suggestions for additional work in this area are also noted.
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http://dx.doi.org/10.1080/00221309.2021.1902259DOI Listing
April 2021

Colon Cancer, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology.

J Natl Compr Canc Netw 2021 03 2;19(3):329-359. Epub 2021 Mar 2.

National Comprehensive Cancer Network.

This selection from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Colon Cancer focuses on systemic therapy options for the treatment of metastatic colorectal cancer (mCRC), because important updates have recently been made to this section. These updates include recommendations for first-line use of checkpoint inhibitors for mCRC, that is deficient mismatch repair/microsatellite instability-high, recommendations related to the use of biosimilars, and expanded recommendations for biomarker testing. The systemic therapy recommendations now include targeted therapy options for patients with mCRC that is HER2-amplified, or BRAF V600E mutation-positive. Treatment and management of nonmetastatic or resectable/ablatable metastatic disease are discussed in the complete version of the NCCN Guidelines for Colon Cancer available at NCCN.org. Additional topics covered in the complete version include risk assessment, staging, pathology, posttreatment surveillance, and survivorship.
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http://dx.doi.org/10.6004/jnccn.2021.0012DOI Listing
March 2021

Increasing neutrophil-to-lymphocyte ratio following radiation is a poor prognostic factor and directly correlates with splenic radiation dose in pancreatic cancer.

Radiother Oncol 2021 Mar 3;158:207-214. Epub 2021 Mar 3.

Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, United States. Electronic address:

Purpose: Neutrophil-to-lymphocyte ratio has been correlated with clinical outcomes in many cancers. We investigated whether the delta-NLR (ΔNLR) following radiation therapy (RT) could predict achieving surgical resection and the overall survival (OS) of patients with borderline resectable (BRPC) and locally advanced pancreatic cancer (LAPC), and whether the splenic radiation dose impacted ΔNLR.

Methods/materials: 101 patients with biopsy-proven BRPC or LAPC who received induction chemotherapy followed by RT were retrospectively enrolled. Following contouring of spleens, dose-volume histograms (DVHs) for splenic dosimetric parameters were calculated. Pre- and post-RT complete blood counts (CBC) within two weeks were recorded. Delta (Δ) values were calculated by subtracting the post-RT value from the pre-RT value. Cox regression survival analysis for pre and postradiation CBC values and OS was performed. Receiver operating curves (ROC) were generated and optimal cutoff points for highest sensitivity and specificity were identified. Kaplan-Meier curves for OS were generated.

Results: On univariate Cox regression analysis, the only significant CBC value associated with OS was ΔNLR (HR 1.06, CI 1.03-1.09, p < 0.001). On multivariate analysis, ΔNLR, age, and completed resection all significantly predicted for worse OS (p < 0.05). ΔNLR significantly predicted achieving surgical resection (p = 0.04) and the optimal cutoff point for ΔNLR was 2.5. Patients with ΔNLR < 2.5 had significantly longer OS (log rank p = 0.046). Spleen radiation dose parameters were all significantly higher in patients with a ΔNLR ≥ 2.5. Optimal radiation cutoff points to predict a ΔNLR ≥ 2.5 were splenic Dmean of 308 cGy and V5 of 10.3%.

Conclusions: Among patients with BRPC or LAPC who have received induction chemotherapy, elevated ΔNLR after RT significantly predicts worse OS and decreased odds of achieving resection. Furthermore, ΔNLR is correlated with higher splenic doses, suggesting the spleen may be an important organ at risk.
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http://dx.doi.org/10.1016/j.radonc.2021.02.035DOI Listing
March 2021

Neoadjuvant therapy versus surgery first for ampullary carcinoma: A propensity score-matched analysis of the NCDB.

J Surg Oncol 2021 Feb 17. Epub 2021 Feb 17.

Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.

Background: The role of neoadjuvant therapy (NT) for ampullary carcinoma (AC) has not been clearly established.

Methods: Patients who underwent pancreatoduodenectomy for AC between 2004 and 2016 were identified in the National Cancer Database. Overall survival (OS) was compared between those who received NT before resection and those who underwent surgery first (SF). Propensity score matching (PSM) was performed using age, pathologic T and N stage, and tumor differentiation.

Results: Among 8688 patients with AC, 175 (2.0%) received NT before surgery. While patients who received NT were younger (p = .022) and more likely to have nodal metastasis (43.3% vs. 35.1%, p < .001), there was no difference in OS on univariate (43 vs. 33 months; hazard ratio [HR]: 1.10, 95% confidence interval [CI]: 0.88-1.37, p = .401) or multivariate (HR: 1.09, 95% CI: 0.88-1.36, p = .416) analysis between groups. After PSM, there remained no difference in OS between NT or SF groups on univariate (37 vs. 32 months; HR: 1.20, 95% CI: 0.87-1.64, p = .350) or multivariate (HR: 0.99, 95% CI: 0.71-1.38, p = .943) analysis.

Conclusion: NT followed by surgery was not associated with improved survival outcomes compared with SF among patients with localized AC. While NT is an acceptable alternative for patients with advanced disease, SF should remain the standard of care.
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http://dx.doi.org/10.1002/jso.26435DOI Listing
February 2021

Potential Molecular Targets in the Setting of Chemoradiation for Esophageal Malignancies.

J Natl Cancer Inst 2020 Dec 22. Epub 2020 Dec 22.

Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, MD.

While the development of effective combined chemoradiation regimens for esophageal cancers has resulted in statistically significant survival benefits, the majority of patients treated with curative intent develop locoregional and/or distant relapse. Further improvements in disease control and survival will require the development of individualized therapy based on the knowledge of host and tumor genomics, and potentially harnessing the host immune system. Although there are a number of gene targets that are amplified and proteins that are overexpressed in esophageal cancers, attempts to target several of these have not proven successful in unselected patients. Herein, we review our current state of knowledge regarding the molecular pathways implicated in esophageal carcinoma, and the available agents for targeting these pathways that may rationally be combined with standard chemoradiation, with the hope that this commentary will guide future efforts of novel combinations of therapy.
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http://dx.doi.org/10.1093/jnci/djaa195DOI Listing
December 2020

Loneliness in the Era of COVID-19.

Authors:
Eric D Miller

Front Psychol 2020 18;11:2219. Epub 2020 Sep 18.

Department of Psychology, Kent State University, East Liverpool, OH, United States.

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http://dx.doi.org/10.3389/fpsyg.2020.02219DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7530332PMC
September 2020

Contemporary Understandings of Cardiovascular Disease After Cancer Radiotherapy: a Focus on Ischemic Heart Disease.

Curr Cardiol Rep 2020 Sep 23;22(11):151. Epub 2020 Sep 23.

Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH, USA.

Purpose Of Review: Radiation-induced cardiovascular disease, including coronary artery disease, is a well-known sequela of radiation therapy and represents a significant source of morbidity and mortality for cancer survivors. This review examines current literature and guidelines to care for this growing population of cancer survivors.

Recent Findings: The development of radiation-induced ischemic heart disease following radiation can lead even to early cardiotoxicities, inclusive of coronary artery disease, which limit cancer treatment outcomes. These coronary lesions tend to be diffuse, complex, and proximal. Early detection with multimodality imaging and targeted intervention is required to minimize these risks. Early awareness, detection, and management of radiation-induced cardiovascular disease are paramount as cancer survivorship continues to grow.
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http://dx.doi.org/10.1007/s11886-020-01380-4DOI Listing
September 2020

A Pilot Trial Evaluating Stereotactic Body Radiation Therapy to Induce Hyperemia in Combination With Transarterial Chemoembolization for Hepatocellular Carcinoma.

Int J Radiat Oncol Biol Phys 2020 12 23;108(5):1276-1283. Epub 2020 Jul 23.

Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio. Electronic address:

Purpose: Despite the survival benefit of transarterial chemoembolization (TACE) for unresectable hepatocellular carcinoma (HCC), a majority of tumors recur, attributed to hypovascularity and treatment resistance. Preclinical studies show that moderate radiation doses induce changes in tumor permeability and perfusion, suggesting an opportunity for TACE sensitization by radiation. In this prospective phase 1 trial, we evaluated the feasibility, safety, tolerability, response, and functional magnetic resonance imaging (MRI) changes associated with single-fraction stereotactic body radiation therapy (SBRT) followed by TACE within 24 hours.

Methods And Materials: Patients with HCC, 1 to 3 lesions, Childs-Pugh A/B liver function, and no major vascular invasion were enrolled. The primary objective was to establish the feasibility of single-dose SBRT (7.5 or 10 Gy) followed by TACE within 24 hours. Secondary endpoints included safety, tolerability, perfusional changes via functional MRI, overall response rate (ORR), clinical benefit rate (CBR), freedom from local progression, progression-free survival, and overall survival.

Results: Sixteen patients were enrolled, and 13 received SBRT and TACE. Median follow-up was 15.3 months. Best overall ORR and CBR were 76.9% and 92.3%, respectively. The 1- and 3-month ORR was 76.9% and 69.2%, respectively, and 1- and 3-month CBR was 92.3% and 69.2%, respectively. Median overall survival, progression-free survival, and freedom from local progression were 14.0, 5.2, and 5.9 months, respectively. Crude rates of grade 1+ and grade 2+ toxicity were 85% and 38%, respectively. No grade 3 to 4 toxicities were recorded. One grade 5 toxicity occurred due to hemorrhage 4 days after TACE. On dynamic contrast-enhanced MRI, the transfer rate constant from blood plasma to extracellular extravascular space (k) increased within 6 hours post-SBRT but decreased by 24 hours.

Conclusions: We hypothesized a strategy of SBRT preceding TACE for the purpose of enhancing TACE delivery and efficacy and tested this strategy in a small pilot study. We found that single-dose SBRT followed by TACE within 24 hours is feasible and tolerable. Dynamic contrast-enhanced MRI revealed acute changes in tumor permeability/perfusion after SBRT. Additional studies are needed to establish the safety and efficacy of this combination and the effects of SBRT on the HCC microenvironment.
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http://dx.doi.org/10.1016/j.ijrobp.2020.07.033DOI Listing
December 2020

NCCN Guidelines Insights: Rectal Cancer, Version 6.2020.

J Natl Compr Canc Netw 2020 07;18(7):806-815

29National Comprehensive Cancer Network.

The NCCN Guidelines for Rectal Cancer provide recommendations for the diagnosis, evaluation, treatment, and follow-up of patients with rectal cancer. These NCCN Guidelines Insights summarize the panel discussion behind recent important updates to the guidelines. These updates include clarifying the definition of rectum and differentiating the rectum from the sigmoid colon; the total neoadjuvant therapy approach for localized rectal cancer; and biomarker-targeted therapy for metastatic colorectal cancer, with a focus on new treatment options for patients with BRAF V600E- or HER2 amplification-positive disease.
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http://dx.doi.org/10.6004/jnccn.2020.0032DOI Listing
July 2020

Neoadjuvant-modified FOLFIRINOX vs nab-paclitaxel plus gemcitabine for borderline resectable or locally advanced pancreatic cancer patients who achieved surgical resection.

Cancer Med 2020 07 16;9(13):4711-4723. Epub 2020 May 16.

Department of Radiation Oncology, Ohio State University James Comprehensive Cancer Center, Columbus, OH, USA.

We conducted an institutional study to compare the clinical and pathological efficacy between the neoadjuvant therapy (NAT)-modified FOLFIRINOX (mFOLF) vs nanoparticle albumin-bound paclitaxel plus gemcitabine (nab-P/G) for borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC) patients who completed resection. The study retrospectively enrolled patients with pathologically confirmed BRPC or LAPC from 2010 to 2018 at our institution. The survival rates were determined by the Kaplan-Meier method and log-rank test was used to test differences. Cox's proportional hazard model was used to assess survival with respect to covariates. Seventy-two patients who completed at least two cycles of neoadjuvant chemotherapy and surgical resection were included, with 52 (72.2%) patients receiving mFOLF and 20 (27.8%) receiving nab-P/G. Patients treated with mFOLF had statistically higher rates of RECIST 1.1 partial or complete response (16/52 vs 1/20, P = .028). Additionally, mFOLF patients had greater pathological tumor size reduction, fewer positive lymph nodes, and higher treatment response grade compared to the nab-P/G patients (all P < .05). The median overall survival was 33.3 months vs 27.1 months (P = .105), and distant metastasis-free survival (DMFS) was 21.3 months vs 14.6 months (P = .042) in the mFOLF vs nab-P/G groups, respectively. On multivariate analysis, mFOLF (hazard ratio, 0.428; 95% confidence interval [CI], 0.186-0.987) and abnormal postoperative CA 19-9 (hazard ratio, 2.47; 95% CI, 1.06-5.76) were associated with DMFS. Among patients with BRPC and LAPC who complete surgical resection, neoadjuvant mFOLF was associated with improved pathological and clinical outcomes compared with nab-P/G.
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http://dx.doi.org/10.1002/cam4.3075DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7333854PMC
July 2020

2020 Reflections from a Mid-Career Academic Psychologist: Select Tips for Prospective Graduate Psychology Students.

Authors:
Eric D Miller

J Psychol 2020 15;154(8):535-544. Epub 2020 May 15.

Kent State University.

This paper provides some personal and academic reflections from a mid-career academic psychologist. In doing so, several select tips and suggestions are offered to prospective graduate psychology students, in particular. This paper strikes to encourage such students to seriously and thoughtfully consider why they wish to attend graduate school and some of the realistic possible negative consequences of doing so. Several select additional suggestions are noted for those students who ultimately decide to attend graduate school with a particular emphasis on the value and importance of forging a productive and collegial relationship with one's graduate mentor. graduate school; mid-career; academia; psychology; mentorship.
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http://dx.doi.org/10.1080/00223980.2020.1758607DOI Listing
February 2021

Wee1 Kinase Inhibitor AZD1775 Effectively Sensitizes Esophageal Cancer to Radiotherapy.

Clin Cancer Res 2020 07 27;26(14):3740-3750. Epub 2020 Mar 27.

The Ohio State University Medical Center, Arthur G. James Comprehensive Cancer Center and Richard J. Solove Research Institute, Columbus, Ohio.

Purpose: Esophageal cancer is a deadly malignancy with a 5-year survival rate of only 5% to 20%, which has remained unchanged for decades. Esophageal cancer possesses a high frequency of mutations leading to dysfunctional G cell-cycle checkpoint, which likely makes esophageal cancer cells highly reliant upon G-M checkpoint for adaptation to DNA replication stress and DNA damage after radiation. We aim to explore whether targeting Wee1 kinase to abolish G-M checkpoint sensitizes esophageal cancer cells to radiotherapy.

Experimental Design: Cell viability was assessed by cytotoxicity and colony-forming assays, cell-cycle distribution was analyzed by flow cytometry, and mitotic catastrophe was assessed by immunofluorescence staining. Human esophageal cancer xenografts were generated to explore the radiosensitizing effect of AZD1775 .

Results: The IC concentrations of AZD1775 on esophageal cancer cell lines were between 300 and 600 nmol/L. AZD1775 (100 nmol/L) as monotherapy did not alter the viability of esophageal cancer cells, but significantly radiosensitized esophageal cancer cells. AZD1775 significantly abrogated radiation-induced G-M phase arrest and attenuation of p-CDK1-Y15. Moreover, AZD1775 increased radiation-induced mitotic catastrophe, which was accompanied by increased γH2AX levels, and subsequently reduced survival after radiation. Importantly, AZD1775 in combination with radiotherapy resulted in marked tumor regression of esophageal cancer tumor xenografts.

Conclusions: Abrogation of G-M checkpoint by targeting Wee1 kinase with AZD1775 sensitizes esophageal cancer cells to radiotherapy and in mouse xenografts. Our findings suggest that inhibition of Wee1 by AZD1775 is an effective strategy for radiosensitization in esophageal cancer and warrants clinical testing.
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http://dx.doi.org/10.1158/1078-0432.CCR-19-3373DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7367716PMC
July 2020

Reporting of Cardiovascular Events in Clinical Trials Supporting FDA Approval of Contemporary Cancer Therapies.

J Am Coll Cardiol 2020 02;75(6):620-628

Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, Ohio; Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio. Electronic address:

Background: Cardiovascular disease (CVD) has become an increasingly common limitation to effective anticancer therapy. Yet, whether CVD events were consistently reported in pivotal trials supporting contemporary anticancer drugs is unknown.

Objectives: The authors sought to evaluate the incidence, consistency, and nature of CVD event reporting in cancer drug trials.

Methods: From the Drugs@FDA, clinicaltrials.gov, MEDLINE, and publicly available U.S. Food and Drug Administration (FDA) drug reviews, all reported CVD events across latter-phase (II and III) trials supporting FDA approval of anticancer drugs from 1998 to 2018 were evaluated. The primary outcome was the report of major adverse cardiovascular events (MACE), defined as incident myocardial infarction, stroke, heart failure, coronary revascularization, atrial fibrillation, or CVD death, irrespective of treatment arm. The secondary outcome was report of any CVD event. Pooled reported annualized incidence rates of MACE in those without baseline CVD were compared with reported large contemporary population rates using relative risks. Population risk differences for MACE were estimated. Differences in drug efficacy using pooled binary endpoint hazard ratios on the basis of the presence or absence of reported CVD were also assessed.

Results: Overall, there were 189 trials, evaluating 123 drugs, enrolling 97,365 participants (58.5 ± 5 years, 46.0% female, 72.5% on biologic, targeted, or immune-based therapies) with 148,138 person-years of follow-up. Over a median follow-up of 30 months, 1,148 incidents of MACE (375 heart failure, 253 myocardial infarction, 180 strokes, 65 atrial fibrillation, 29 revascularizations, and 246 CVD deaths; 792 in the intervention vs. 356 in the control arm; p < 0.01) were reported from the 62.4% of trials noting any CVD. The overall weighted-average incidence was 542 events per 100,000 person-years (716 per 100,000 in the intervention arm), compared with 1,408 among similar-aged non-cancer trial subjects (relative risk: 0.38; p < 0.01), translating into a risk difference of 866. There was no association between reporting CVD events and drug efficacy (hazard ratio: 0.68 vs. 0.67; p = 0.22).

Conclusions: Among pivotal clinical trials linked to contemporary FDA-approved cancer drugs, reported CVD event rates trail expected population rates.
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http://dx.doi.org/10.1016/j.jacc.2019.11.059DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7860639PMC
February 2020

Platinum-based regimens versus cetuximab in definitive chemoradiation for human papillomavirus-unrelated head and neck cancer.

Int J Cancer 2020 07 11;147(1):107-115. Epub 2019 Nov 11.

Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH.

For patients ineligible for cisplatin with definitive radiotherapy (CP-CRT) for locally advanced head and neck squamous cell carcinoma (LA-HNSCC), concurrent cetuximab (C225-RT) is a popular substitute. Carboplatin-based chemoradiation (CB-CRT) is another option; however, relative efficacies of CP-CRT, CB-CRT and C225-RT are unclear, particularly in the human papillomavirus (HPV)-unrelated population. We identified 316 patients with stage III-IVB cancers of the oropharynx (24.7%), larynx (58.2%) and hypopharynx (17.1%) undergoing definitive C225-RT (N = 61), CB-CRT (N = 74) or CP-CRT (N = 181). Kaplan-Meier and cumulative incidence functions were generated to estimate overall survival (OS), locoregional failure (LRF) and distant metastasis (DM). Cox proportional hazards were used to determine the association of survival endpoints with clinical characteristics. Respectively, 3-year cumulative incidences for CP-CRT, CB-CRT and C225-RT were: LRF (0.19, 0.18 and 0.48, p ≤ 0.001), DM (0.17, 0.12 and 0.25, p = 0.32). Kaplan-Meier estimates for 3 year OS were: CP-CRT: 71%; CB-CRT: 59% and C225-RT: 54%; p = 0.0094. CP-CRT (hazard ratio [HR] 0.336; 95% confidence interval [CI] 0.203-0.557, p < 0.01) and CB-CRT (HR 0.279; 95% CI 0.141-0.551, p < 0.01) were associated with reduced hazard for LRF on multivariable analysis. CP-CRT (HR 0.548; 95% CI 0.355-0.845, p < 0.01) and CB-CRT (HR 0.549; 95% CI 0.334-0.904, p = 0.02) were associated with a reduced hazard for death on multivariable analysis. Propensity matching confirmed reduced hazards with a combined CP/CB-CRT group compared to C225-RT for LRF: HR 0.384 (p = 0.018) and OS: HR 0.557 (p = 0.045) and CB-CRT group compared to C225-RT for LRF: HR 0.427 (p = 0.023). In conclusion, CB-CRT is an effective alternative to CP-CRT in HPV-unrelated LA-HNSCC with superior locoregional control and OS compared to C225-RT.
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http://dx.doi.org/10.1002/ijc.32736DOI Listing
July 2020

Association of Liver-Directed Local Therapy With Overall Survival in Adults With Metastatic Intrahepatic Cholangiocarcinoma.

JAMA Netw Open 2019 09 4;2(9):e1911154. Epub 2019 Sep 4.

Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus.

Importance: Intrahepatic cholangiocarcinoma is an aggressive hepatobiliary malignant neoplasm characterized by local progression and frequent metastasis. Definitive local therapy to the liver in the setting of metastatic intrahepatic cholangiocarcinoma may improve overall survival.

Objective: To compare the overall survival of patients with metastatic intrahepatic cholangiocarcinoma treated with chemotherapy alone vs chemotherapy with definitive liver-directed local therapy.

Design, Setting, And Participants: This cohort study used the National Cancer Database to identify 2201 patients with metastatic intrahepatic cholangiocarcinoma diagnosed between January 2004 and December 2014 who received chemotherapy with or without hepatic surgery or external beam radiation to a dose 45 Gy or higher. Multiple imputation, Cox proportional hazards, propensity score matching, and landmark analysis were used to adjust for confounding variables. Analyses were performed between September 2018 and February 2019.

Exposures: Chemotherapy alone and chemotherapy with liver-directed surgery or radiation.

Main Outcomes And Measures: Overall survival.

Results: A total of 2201 patients (1131 [51.4%] male; median [interquartile range] age, 63 [55-71] years) who received chemotherapy alone (2097 [95.3%]) or chemotherapy with liver-directed local therapy (total, 104 [4.7%]; surgery, 76 [73.1%]; radiation, 28 [26.9%]) were identified. Patients treated with chemotherapy alone had larger median (interquartile range) primary tumor size (7.0 [4.4-10.0] cm vs 5.6 [4.0-8.3] cm; P = .048) and higher frequency of lung metastases (383 [25.9%] vs 7 [6.7%]; P = .004). Patients treated with liver-directed local therapy had higher frequency of distant lymph node metastases (34 [32.7%] vs 528 [25.2%]; P = .045). Liver-directed local therapy was associated with higher overall survival compared with chemotherapy alone on multivariable analysis (hazard ratio [HR], 0.60; 95% CI, 0.48-0.74; P < .001). A total of 208 patients treated with chemotherapy alone were propensity score matched with 104 patients treated with chemotherapy plus liver-directed local therapy. Liver-directed local therapy continued to be associated with higher overall survival (HR, 0.57; 95% CI, 0.44-0.74; P < .001), which persisted on landmark analysis at 3 months (HR, 0.61; 95% CI, 0.47-0.79; log-rank P < .001), 6 months (HR, 0.68; 95% CI, 0.50-0.92; log-rank P = .01), and 12 months (HR, 0.68; 95% CI, 0.47-0.98; log-rank P = .04).

Conclusions And Relevance: In this study, the addition of hepatic surgery or irradiation to chemotherapy was associated with higher overall survival when compared with chemotherapy alone in patients with metastatic intrahepatic cholangiocarcinoma. These findings may be valuable given the paucity of available data for this disease and should be validated in an independent cohort or prospective study.
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http://dx.doi.org/10.1001/jamanetworkopen.2019.11154DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6745054PMC
September 2019

Stereotactic body radiation therapy is associated with improved overall survival compared to chemoradiation or radioembolization in the treatment of unresectable intrahepatic cholangiocarcinoma.

Clin Transl Radiat Oncol 2019 Nov 26;19:66-71. Epub 2019 Jul 26.

Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, 460 W. 10 Ave, Columbus, OH 43210, USA.

Background: Intrahepatic cholangiocarcinoma (ICC) is a highly lethal malignancy. For patients with locally advanced, unresectable disease, numerous liver-directed therapy options exist, including chemoradiation (CRT), stereotactic body radiation therapy (SBRT), and transarterial radioembolization (TARE). There is no randomized data to inform clinicians regarding the optimal treatment modality.

Method: We used the National Cancer Database (NCDB) to study the overall survival (OS) of patients with ICC treated with CRT, SBRT, and TARE. We used Cox proportional hazards modeling and inverse probability of treatment weighting (IPTW) to account for confounding variables.

Results: We identified 170 patients with unresected ICC treated with SBRT (n = 37), CRT (n = 61), or TARE (n = 72). SBRT was associated with higher OS compared to CRT (hazard ratio [HR] = 0.37; 95% confidence interval [CI] 0.20-0.68; p = 0.001) and TARE (HR = 0.40; 95% CI 0.22-0.74; p = 0.003). On multivariable analysis, SBRT remained associated with higher OS compared to CRT (HR = 0.44; 95% CI 0.21-0.91; p = 0.028) and TARE (HR = 0.42; 95% CI 0.21-0.84; p = 0.014). After IPTW (Bonferroni-adjusted significance threshold, α = 0.017), SBRT again had a statistically significant association with higher OS compared to CRT (HR = 0.22; 95% CI 0.11-0.44; p < 0.0001) and was nominally associated TARE (HR = 0.58; 95% CI 0.37-0.91; p = 0.019).

Conclusions: We found SBRT is associated with higher OS when compared to CRT or TARE for the treatment of unresectable ICC. Due to the retrospective nature of the study and potential selection bias, these findings should be evaluated prospectively.
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http://dx.doi.org/10.1016/j.ctro.2019.07.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6734105PMC
November 2019

Small Bowel Adenocarcinoma, Version 1.2020, NCCN Clinical Practice Guidelines in Oncology.

J Natl Compr Canc Netw 2019 09;17(9):1109-1133

National Comprehensive Cancer Network.

Small bowel adenocarcinoma (SBA) is a rare malignancy of the gastrointestinal tract that has increased in incidence across recent years. Often diagnosed at an advanced stage, outcomes for SBA are worse on average than for other related malignancies, including colorectal cancer. Due to the rarity of this disease, few studies have been done to direct optimal treatment, although recent data have shown that SBA responds to treatment differently than colorectal cancer, necessitating a separate approach to treatment. The NCCN Guidelines for Small Bowel Adenocarcinoma were created to establish an evidence-based standard of care for patients with SBA. These guidelines provide recommendations on the workup of suspected SBA, primary treatment options, adjuvant treatment, surveillance, and systemic therapy for metastatic disease. Additionally, principles of imaging and endoscopy, pathologic review, surgery, radiation therapy, and survivorship are described.
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http://dx.doi.org/10.6004/jnccn.2019.0043DOI Listing
September 2019

Neoadjuvant and adjuvant treatment strategies for hepatocellular carcinoma.

World J Gastroenterol 2019 Jul;25(28):3704-3721

Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States.

Hepatocellular carcinoma (HCC) is the most common liver malignancy worldwide and a major cause of cancer-related mortality for which liver resection is an important curative-intent treatment option. However, many patients present with advanced disease and with underlying chronic liver disease and/or cirrhosis, limiting the proportion of patients who are surgical candidates. In addition, the development of recurrent or cancers following surgical resection is common. These issues have led investigators to evaluate the benefit of neoadjuvant and adjuvant treatment strategies aimed at improving resectability rates and decreasing recurrence rates. While high-level evidence to guide treatment decision making is lacking, recent advances in locoregional and systemic therapies, including antiviral treatment and immunotherapy, raise the prospect of novel approaches that may improve the outcomes of patients with HCC. In this review, we evaluate the evidence for various neoadjuvant and adjuvant therapies and discuss opportunities for future clinical and translational research.
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http://dx.doi.org/10.3748/wjg.v25.i28.3704DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676544PMC
July 2019

Increasing Radiation Dose to the Thoracic Marrow Is Associated With Acute Hematologic Toxicities in Patients Receiving Chemoradiation for Esophageal Cancer.

Front Oncol 2019 15;9:147. Epub 2019 Mar 15.

Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH, United States.

To test the hypothesis that increasing radiation dose to the thoracic marrow (TM) contributes to the development of hematologic toxicities (HT) in esophageal cancer (EC) patients receiving chemoradiation therapy (CRT). We identified EC cases treated with curative intent CRT at our institution from 2007 to 2016. The TM was contoured as the union of the vertebral bodies (VB) from T1-L1, the ribs from T1-L1, and the sternum. The TM-mean dose and the TM volume receiving at least 5-50 Gy (V5-V50) were collected. Grade ≥ 3 HT (HT3+) was the primary endpoint. Normal tissue complication probability (NTCP) was evaluated using the Lyman-Kutcher-Burman (LKB) model. Logistic regression was used to test associations between HT3+ and dosimetric parameters. Odds ratios (OR) and 95% confidence intervals (CI) are reported with < 0.05 considered significant. Receiver operating characteristics analysis was used to determine optimal cut points. We identified 137 EC cases, and most received concurrent carboplatin/paclitaxel ( = 83). Median radiation dose was 50.4 Gy (IQR = 50.4-50.4 Gy). The rate of HT3+ was 39.4%. Optimization of the LKB model yielded the results = 0.70, = 0.67, and TD = 20.1 Gy. The TM-V30 was most strongly associated with HT3+ and on multivariate analysis, patients with TM-V30 ≥ 14% had a 5.7-fold (95% CI 2.42-14.54, < 0.001) increased odds of HT3+ in the entire cohort and a 4-fold (95% CI 1.54-11.11, = 0.006) increased odds of HT3+ in the carboplatin/paclitaxel cohort compared to patients with TM-V30 < 14%. Radiation dose to the VB and rib sub-sites of the TM were also associated with HT3+, particularly VB-V40. We found that increasing TM radiation dose was associated with HT3+ in EC patients treated with CRT. Radiation dose to the VB and rib sub-sites were also associated with HT3+. These findings suggest that limiting radiation dose to the TM (or its sub-sites) may be sufficient to decrease HT3+, but further prospective evaluation of these results is needed.
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http://dx.doi.org/10.3389/fonc.2019.00147DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6429979PMC
March 2019

Plasma-based biomaterials for the treatment of cutaneous radiation injury.

Wound Repair Regen 2019 03 21;27(2):139-149. Epub 2018 Dec 21.

Department of Radiation Oncology, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.

Cutaneous wounds caused by an exposure to high doses of ionizing radiation remain a therapeutic challenge. While new experimental strategies for treatment are being developed, there are currently no off-the-shelf therapies for the treatment of cutaneous radiation injury that have been proven to promote repair of the damaged tissues. Plasma-based biomaterials are biologically active biomaterials made from platelet enriched plasma, which can be made into both solid and semi-solid forms, are inexpensive, and are available as off-the-shelf, nonrefrigerated products. In this study, the use of plasma-based biomaterials for the mitigation of acute and late toxicity for cutaneous radiation injury was investigated using a mouse model. A 2-cm diameter circle of the dorsal skin was irradiated with a single dose of 35 Gy followed by topical treatment with plasma-based biomaterial or vehicle once daily for 5 weeks postirradiation. Weekly imaging demonstrated more complete wound resolution in the plasma-based biomaterial vs. vehicle group which became statistically significant (p < 0.05) at weeks 12, 13, and 14 postmaximum wound area. Despite more complete wound healing, at 9 and 17 weeks postirradiation, there was no statistically significant difference in collagen deposition or skin thickness between the plasma-based biomaterial and vehicle groups based on Masson trichrome staining nor was there a statistically significant difference in inflammatory or fibrosis-related gene expression between the groups. Although significant improvement was not observed for late toxicity, plasma-based biomaterials were effective at promoting wound closure, thus helping to mitigate acute toxicity.
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http://dx.doi.org/10.1111/wrr.12691DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7261420PMC
March 2019

Identifying patterns of care for elderly patients with non-surgically treated stage III non-small cell lung cancer: an analysis of the national cancer database.

Radiat Oncol 2018 Oct 5;13(1):196. Epub 2018 Oct 5.

Department of Radiation Oncology, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, 460 W. 10th Avenue, Columbus, OH, 43210, USA.

Background: To compare patterns of care for elderly patients versus non-elderly patients with non-surgically treated stage III non-small cell lung cancer (NSCLC) using the National Cancer Database (NCDB). We hypothesize that elderly patients are less likely to receive curative treatments, including concurrent chemoradiation (CCRT), compared to non-elderly patients.

Methods: We identified patients from the NCDB between 2003 and 2014 with non-surgically treated stage III NSCLC. We defined elderly as ≥70 years old and non-elderly <70 years old. Treatment categories included: no treatment, palliative treatment (chemotherapy alone, radiation (RT) alone <59.4 Gy or chemoradiation (CRT) <59.4 Gy), or definitive treatment (RT alone ≥59.4 Gy or CRT ≥59.4 Gy). Differences in treatment between elderly and non-elderly were tested using the χ test.

Results: We identified 57,602 elderly and 55,928 non-elderly patients. More elderly patients received no treatment (24.5% vs. 13.2%, P < 0.0001) and the elderly were less likely to receive definitive treatment (48.5% vs. 56.3%, P < 0.0001). CCRT was delivered in a significantly smaller proportion of elderly vs. non-elderly patients (66.0% vs. 78.9%, P < 0.0001 in patients treated with definitive intent; 32.0% vs. 44.5%, P < 0.0001 in patients receiving any treatment; and 24.2% vs. 38.6%, P < 0.0001 amongst all patients).

Conclusions: In this large study of patients with non-surgically treated stage III NSCLC, elderly patients were less likely to receive any treatment or treatment with definitive intent compared to the non-elderly. The lack of use of concurrent or sequential chemotherapy in the elderly with stage III NSCLC suggests that the optimal treatment approach for this vulnerable population remains undefined.
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http://dx.doi.org/10.1186/s13014-018-1142-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6173899PMC
October 2018

NCCN Guidelines Insights: Colon Cancer, Version 2.2018.

J Natl Compr Canc Netw 2018 Apr;16(4):359-369

The NCCN Guidelines for Colon Cancer provide recommendations regarding diagnosis, pathologic staging, surgical management, perioperative treatment, surveillance, management of recurrent and metastatic disease, and survivorship. These NCCN Guidelines Insights summarize the NCCN Colon Cancer Panel discussions for the 2018 update of the guidelines regarding risk stratification and adjuvant treatment for patients with stage III colon cancer, and treatment of V600E mutation-positive metastatic colorectal cancer with regimens containing vemurafenib.
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http://dx.doi.org/10.6004/jnccn.2018.0021DOI Listing
April 2018

Hitomi X-ray studies of Giant Radio Pulses from the Crab pulsar.

Authors:
Felix Aharonian Hiroki Akamatsu Fumie Akimoto Steven W Allen Lorella Angelini Marc Audard Hisamitsu Awaki Magnus Axelsson Aya Bamba Marshall W Bautz Roger Blandford Laura W Brenneman Gregory V Brown Esra Bulbul Edward M Cackett Maria Chernyakova Meng P Chiao Paolo S Coppi Elisa Costantini Jelle De Plaa Cor P De Vries Jan-Willem Den Herder Chris Done Tadayasu Dotani Ken Ebisawa Megan E Eckart Teruaki Enoto Yuichiro Ezoe Andrew C Fabian Carlo Ferrigno Adam R Foster Ryuichi Fujimoto Yasushi Fukazawa Akihiro Furuzawa Massimiliano Galeazzi Luigi C Gallo Poshak Gandhi Margherita Giustini Andrea Goldwurm Liyi Gu Matteo Guainazzi Yoshito Haba Kouichi Hagino Kenji Hamaguchi Ilana M Harrus Isamu Hatsukade Katsuhiro Hayashi Takayuki Hayashi Kiyoshi Hayashida Junko S Hiraga Ann Hornschemeier Akio Hoshino John P Hughes Yuto Ichinohe Ryo Iizuka Hajime Inoue Yoshiyuki Inoue Manabu Ishida Kumi Ishikawa Yoshitaka Ishisaki Masachika Iwai Jelle Kaastra Tim Kallman Tsuneyoshi Kamae Jun Kataoka Satoru Katsuda Nobuyuki Kawai Richard L Kelley Caroline A Kilbourne Takao Kitaguchi Shunji Kitamoto Tetsu Kitayama Takayoshi Kohmura Motohide Kokubun Katsuji Koyama Shu Koyama Peter Kretschmar Hans A Krimm Aya Kubota Hideyo Kunieda Philippe Laurent Shiu-Hang Lee Maurice A Leutenegger Olivier O Limousin Michael Loewenstein Knox S Long David Lumb Greg Madejski Yoshitomo Maeda Daniel Maier Kazuo Makishima Maxim Markevitch Hironori Matsumoto Kyoko Matsushita Dan Mccammon Brian R Mcnamara Missagh Mehdipour Eric D Miller Jon M Miller Shin Mineshige Kazuhisa Mitsuda Ikuyuki Mitsuishi Takuya Miyazawa Tsunefumi Mizuno Hideyuki Mori Koji Mori Koji Mukai Hiroshi Murakami Richard F Mushotzky Takao Nakagawa Hiroshi Nakajima Takeshi Nakamori Shinya Nakashima Kazuhiro Nakazawa Kumiko K Nobukawa Masayoshi Nobukawa Hirofumi Noda Hirokazu Odaka Takaya Ohashi Masanori Ohno Takashi Okajima Kenya Oshimizu Naomi Ota Masanobu Ozaki Frits Paerels Stéphane Paltani Robert Petre Ciro Pinto Frederick S Porter Katja Pottschmidt Christopher S Reynolds Samar Safi-Harb Shinya Saito Kazuhiro Sakai Toru Sasaki Goro Sato Kosuke Sato Rie Sato Makoto Sawada Norbert Schartel Peter J Serlemtsos Hiromi Seta Megumi Shidatsu Aurora Simionescu Randall K Smith Yang Soong Łukasz Stawarz Yasuharu Sugawara Satoshi Sugita Andrew Szymkowiak Hiroyasu Tajima Hiromitsu Takahashi Tadayuki Takahashi Shiníchiro Takeda Yoh Takei Toru Tamagawa Takayuki Tamura Takaaki Tanaka Yasuo Tanaka Yasuyuki T Tanaka Makoto S Tashiro Yuzuru Tawara Yukikatsu Terada Yuichi Terashima Francesco Tombesi Hiroshi Tomida Yohko Tsuboi Masahiro Tsujimoto Hiroshi Tsunemi Takeshi Go Tsuru Hiroyuki Uchida Hideki Uchiyama Yasunobu Uchiyama Shutaro Ueda Yoshihiro Ueda Shiníchiro Uno C Megan Urry Eugenio Ursino Shin Watanabe Norbert Werner Dan R Wilkins Brian J Williams Shinya Yamada Hiroya Yamaguchi Kazutaka Yamaoka Noriko Y Yamasaki Makoto Yamauchi Shigeo Yamauchi Tahir Yaqoob Yoichi Yatsu Daisuke Yonetoku Irina Zhuravleva Abderahmen Zoghbi Toshio Terasawa Mamoru Sekido Kazuhiro Takefuji Eiji Kawai Hiroaki Misawa Fuminori Tsuchiya Ryo Yamazaki Eiji Kobayashi Shota Kisaka Takahiro Aoki

Publ Astron Soc Jpn Nihon Tenmon Gakkai 2018 Apr;70(2)

The Research Institute for Time Studies, Yamaguchi University, 1677-1 Yoshida, Yamaguchi 753-8511.

To search for giant X-ray pulses correlated with the giant radio pulses (GRPs) from the Crab pulsar, we performed a simultaneous observation of the Crab pulsar with the X-ray satellite Hitomi in the 2 - 300 keV band and the Kashima NICT radio observatory in the 1.4 - 1.7 GHz band with a net exposure of about 2 ks on 25 March 2016, just before the loss of the Hitomi mission. The timing performance of the Hitomi instruments was confirmed to meet the timing requirement and about 1,000 and 100 GRPs were simultaneously observed at the main and inter-pulse phases, respectively, and we found no apparent correlation between the giant radio pulses and the X-ray emission in either the main or inter-pulse phases. All variations are within the 2 sigma fluctuations of the X-ray fluxes at the pulse peaks, and the 3 sigma upper limits of variations of main- or inter-pulse GRPs are 22% or 80% of the peak flux in a 0.20 phase width, respectively, in the 2 - 300 keV band. The values become 25% or 110% for main or inter-pulse GRPs, respectively, when the phase width is restricted into the 0.03 phase. Among the upper limits from the Hitomi satellite, those in the 4.5-10 keV and the 70-300 keV are obtained for the first time, and those in other bands are consistent with previous reports. Numerically, the upper limits of main- and inter-pulse GRPs in the 0.20 phase width are about (2.4 and 9.3) ×10 erg cm, respectively. No significant variability in pulse profiles implies that the GRPs originated from a local place within the magnetosphere and the number of photon-emitting particles temporally increases. However, the results do not statistically rule out variations correlated with the GRPs, because the possible X-ray enhancement may appear due to a > 0.02% brightening of the pulse-peak flux under such conditions.
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http://dx.doi.org/10.1093/pasj/psx083DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6999749PMC
April 2018

The Addition of Chemotherapy to Radiation Therapy Improves Survival in Elderly Patients with Stage III Non-Small Cell Lung Cancer.

J Thorac Oncol 2018 03 8;13(3):426-435. Epub 2018 Jan 8.

Department of Radiation Oncology, The Ohio State University, Columbus, Ohio. Electronic address:

Introduction: Elderly patients account for the majority of lung cancer diagnoses but are poorly represented in clinical trials. We evaluated the overall survival (OS) of elderly patients with stage III NSCLC treated with definitive radiation compared with that of patients treated with definitive chemoradiation.

Methods: We conducted a comparative effectiveness study of radiation therapy versus chemoradiation in elderly (≥70 years old) patients with stage III NSCLC not treated surgically diagnosed from 2003 to 2014; the patients were identified by using the National Cancer Database. Two cohorts were evaluated: patients (n = 5023) treated with definitive radiation (≥59.4 Gy) and patients (n = 18,206) treated with definitive chemoradiation. Chemoradiation was further defined as concurrent (radiation and chemotherapy started within 30 days of each other) or sequential (radiation started >30 days after chemotherapy). We compared OS between the treatment groups by using the Kaplan-Meier method and Cox proportional hazards regression before and after propensity score matching (PSM).

Results: Treatment with chemoradiation was associated with improved OS versus that with radiation both before PSM (hazard ratio [HR] = 0.66, 95% confidence interval [CI]: 0.64-0.68, p < 0.001) and after PSM (HR = 0.67, 95% CI: 0.64-0.70, p < 0.001). Relative to concurrent chemoradiation, sequential chemoradiation was associated with a 9% reduction in the risk for death (HR = 0.91, 95% CI: 0.85-0.96, p = 0.002).

Conclusions: We found that definitive chemoradiation resulted in a survival advantage compared with definitive radiation in elderly patients. Sequential chemotherapy and radiation was superior to concurrent chemoradiation. Although prospective trials are needed, this analysis suggests that chemoradiation should be strongly considered for elderly patients and the optimal sequencing of chemotherapy and radiation remains an unanswered question for this patient population.
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http://dx.doi.org/10.1016/j.jtho.2017.11.135DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5910031PMC
March 2018

Sinonasal adenoid cystic carcinoma: Treatment outcomes and association with human papillomavirus.

Head Neck 2017 07 3;39(7):1405-1411. Epub 2017 Apr 3.

Department of Radiation Oncology, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.

Background: The purpose of this study was to review long-term outcomes of sinonasal adenoid cystic carcinoma (ACC) and to clarify its association with human papillomavirus (HPV).

Methods: The medical records of 23 patients with sinonasal ACC treated with primary surgical resection between 1998 and 2013 were reviewed. Tissue specimens were available for 17 patients. The p16 testing was performed using immunohistochemistry (IHC), and HPV infection was determined using quantitative polymerase chain reaction (PCR) with primers targeting the E6/E7 region.

Results: Two of the 17 samples showed strong and diffuse p16 staining, whereas the remaining 15 cases showed p16-positivity isolated to the luminal cells. Only one of the p16-positive cases was positive for HPV. The 5-year local failure, disease-free survival (DFS), and overall survival (OS) were 51%, 52%, and 62%, respectively.

Conclusion: Local failures are common with advanced sinonasal ACC, and the association of HPV with true sinonasal ACC is low.
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http://dx.doi.org/10.1002/hed.24778DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5469703PMC
July 2017

Making Sense of the Brutality of the Holocaust: Critical Themes and New Perspectives.

Authors:
Eric D Miller

J Psychol 2017 Jan 1;151(1):88-106. Epub 2016 Sep 1.

a Kent State University.

This article offers an analytic, integrative review of select themes associated with one of history's greatest atrocities: the Holocaust. Much of this review considers general and Holocaust-specific themes as they pertain to the nature of senseless violence and evil. The importance of having a greater understanding of the sheer brutality of violence perpetuated in the Holocaust is emphasized. As part of this discussion, considerable attention is given to how Internet-based photographs and videos from the Holocaust era can provide greater insight into understanding the evil associated with this genocide. Some consideration of the larger meaning of the Holocaust, particularly for Jews, is also examined.
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http://dx.doi.org/10.1080/00223980.2016.1217191DOI Listing
January 2017

Patterns of major wound complications following multidisciplinary therapy for lower extremity soft tissue sarcoma.

J Surg Oncol 2016 Sep 30;114(3):385-91. Epub 2016 May 30.

Department of Radiation Oncology, The Ohio State University, Columbus, Ohio.

Background And Objectives: The purpose of this study was to determine the pattern and timing of major wound complications (MWCs) in patients at our institution who received multimodality treatment for lower extremity soft tissue sarcoma (LE-STS) and to evaluate the impact of MWCs on tumor control and patient outcomes.

Methods: The medical records of 102 LE-STS patients treated with limb-sparing surgery and radiation therapy were reviewed. MWCs were defined as secondary operations with anesthesia, seroma/hematoma aspiration, admission for IV antibiotics, or persistent deep packing.

Results: MWCs occurred in 22% of patients, with 45% of events occurring >120 days after resection. On multivariate analysis, preoperative external beam radiation therapy (EBRT) (OR 4.29, 95% CI 1.06-17.40, P = 0.042) and skin graft placement (OR 6.39, 95% CI 1.37-29.84, P = 0.018) were found to be independent predictors of MWCs. MWC occurrence did not predict for chronic toxicity and did not impact tumor control or survival.

Conclusions: A considerable proportion of MWCs occur >120 days from surgical resection with preoperative EBRT and skin graft placement independent predictors for MWCs. While an additional source of morbidity, MWC occurrence did not impact tumor control, nor did it predict for chronic toxicity. J. Surg. Oncol. 2016;114:385-391. © 2016 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/jso.24313DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7664295PMC
September 2016

Content Analysis of Select YouTube Postings: Comparisons of Reactions to the Sandy Hook and Aurora Shootings and Hurricane Sandy.

Authors:
Eric D Miller

Cyberpsychol Behav Soc Netw 2015 Nov 17;18(11):635-40. Epub 2015 Sep 17.

Department of Psychology, Kent State University , East Liverpool, Ohio.

This study details an innovative and methodical content analysis of 2,207 YouTube comments from four different YouTube videos (e.g., breaking news or memorials) related to the 2012 Sandy Hook Elementary School and Aurora theater mass shootings and the catastrophic Hurricane Sandy. As expected, YouTube comments associated with the Sandy Hook shootings (particularly those from a memorial video) were especially likely to feature compassion and grief with lessened hostility. This study highlights differing online contexts by which individuals show grief and related emotions following man-made and natural calamities and how-even in an online environment-powerful situational contexts greatly guide behavior.
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http://dx.doi.org/10.1089/cyber.2015.0045DOI Listing
November 2015

The role of modern radiation therapy in the management of extremity sarcomas.

J Surg Oncol 2015 Apr 3;111(5):599-603. Epub 2014 Nov 3.

Department of Radiation Oncology, Arthur G. James Cancer Hospital & Richard J. Solove Research Institute, Ohio State University Wexner Medical Center, Columbus, Ohio.

For nearly half a decade, surgery and radiation therapy have been used in combination to achieve the goal of limb preservation in extremity soft tissue sarcoma, with success rates in excess of 90%. Common decision points in therapeutic radiation delivery for sarcoma are discussed, including preoperative versus postoperative irradiation, the postoperative boost, and when irradiation might be unnecessary. We describe specialized techniques, such as brachytherapy and intraoperative irradiation. The data driving current practice is summarized.
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http://dx.doi.org/10.1002/jso.23823DOI Listing
April 2015