Jared Rex Robbins
- Professor, Radiation Oncology - (Clinical Scholar Track)
- (520) 626-6724
- AHSC, Rm. 914
- jrobbins@arizona.edu
Biography
Dr. Robbins grew up in a small, rural, farming community in Southeastern Idaho as the oldest son of a carpenter father and a high school teacher mother. He went on to receive his Bachelors of Science in Molecular Bioscience and Biotechnology at Arizona State University (summa cum laude) and his medical degree at the University of Arizona-College of Medicine, where he was elected to the medical honor society, Alpha Omega Alpha, and graduated with distinction in community service. He completed an oncology-focused internship at the Medical College of Wisconsin in Milwaukee, Wisconsin and his residency in Radiation Oncology at Henry Ford Hospital-Wayne State University in Detroit, Michigan, before returning to the Medical College of Wisconsin as faculty in the Radiation Oncology Department. During his 5 years as faculty at MCW, he focused on providing excellent patient care, helped facility multidisciplinary research, engaged in resident and medical student education, teaching, and mentoring, and served on an international consortium for the implementation and development of MRI-guided radiation therapy. Dr. Robbins has had multiple peer-reviewed publications in medical journals and presentations at national and international conferences. He also serves on several national committees. He is currently an Associate Professor in Radiation Oncology.
Degrees
- M.D. Medicine, distinction in Community Service
- University of Arizona College of Medicine, Tucson, Arizona, US
- B.S. Molecular Bioscience and Biotechnology, minor German
- Arizona State University, Tempe, Arizona, United States
Work Experience
- University of Arizona College of Medicine (2018 - Ongoing)
- Medical College of Wisconsin (2013 - 2018)
Licensure & Certification
- Diplomate, American Board of Radiology (2014)
Interests
Teaching
Dr. Robbins enjoys teaching and mentoring medical students and residents both in the in formal didactic settings and in the clinic.
Research
Dr. Robbins specializes in head and neck cancers, skin malignancies, palliative radiation therapy and stereotactic radiosurgery(SRS)/stereotactic body radiation therapy (SBRT). His research interests include methods to improve long-term toxicity for head and neck cancers, the application of new radiation techniques (Intensity-modulated radiation therapy, SBRT) to improve patient outcomes, using wearable technology to better assess symptoms and activity in patients receiving radiation therapy, and improving image-guided radiation therapy and using information acquired from these imaged to better tailor the treatment to patients’ individualized response.
Courses
2020-21 Courses
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Intro Radiation Oncology
RONC 850A (Spring 2021) -
Research
RONC 800A (Spring 2021)
Scholarly Contributions
Journals/Publications
- Ansinelli, H., Gay, C., Nguyen, S., Morrison, C., & Robbins, J. R. (2022). Personalized precision radiotherapy and its evolving role for human papillomavirus-positive oropharyngeal cancer. Journal of the National Cancer Center, available online, xxx.
- Awan, M., & Robbins, J. R. (2023). Post-treatment Imaging From the Perspective of the Head and Neck Radiation Oncologist. Seminars in roentgenology, 58(3), 355-362.
- Hanna, G. J., Chang, S. S., Siddiqui, F., Bain, P. A., Takiar, V., Ward, M. C., Shukla, M. E., Hu, K. S., Robbins, J., Witek, M. E., Bakst, R., Chandra, R. A., Galloway, T., & Margalit, D. N. (2023). Imaging and Biomarker Surveillance for Head and Neck Squamous cell carcinoma: A Systematic Review and Appropriate Use Criteria Document. International journal of radiation oncology, biology, physics.More infoSurveillance for survivors of head and neck cancer (HNC) is focused on early detection of recurrent or second primary malignancies. After initial restaging confirms disease-free status, there is controversy regarding the use of surveillance imaging for asymptomatic patients with HNC. Our objective was to comprehensively review literature pertaining to imaging and biomarker surveillance of asymptomatic patients treated for HNSCC, and to convene a multidisciplinary expert panel to provide appropriate use criteria for surveillance in representative clinical scenarios.
- Juloori, A., Katipally, R. R., Lemons, J. M., Singh, A. K., Iyer, R., Robbins, J. R., George, B., Hall, W. A., Pitroda, S. P., Arif, F., Fung, J., Pillai, A., Liao, C. Y., Sharma, M., & Liauw, S. L. (2023). Phase 1 Randomized Trial of Stereotactic Body Radiation Therapy Followed by Nivolumab plus Ipilimumab or Nivolumab Alone in Advanced/Unresectable Hepatocellular Carcinoma. International journal of radiation oncology, biology, physics, 115(1), 202-213.More infoImmunotherapy has emerged as a promising therapeutic option for advanced or unresectable hepatocellular carcinoma (HCC). However, survival remains poor with only a subset of patients deriving benefit. This trial investigated the safety and efficacy of stereotactic body radiation therapy (SBRT) with immunotherapy in HCC.
- Cardenas, C. E., Blinde, S. E., Mohamed, A. S., Ng, S. P., Raaijmakers, C., Philippens, M., Kotte, A., Al-Mamgani, A. A., Karam, I., Thomson, D. J., Robbins, J., Newbold, K., Fuller, C. D., & Terhaard, C. (2022). Comprehensive Quantitative Evaluation of Variability in Magnetic Resonance-Guided Delineation of Oropharyngeal Gross Tumor Volumes and High-Risk Clinical Target Volumes: An R-IDEAL Stage 0 Prospective Study. International journal of radiation oncology, biology, physics, 113(2), 426-436.More infoTumor and target volume manual delineation remains a challenging task in head and neck cancer radiation therapy. The purpose of this study was to conduct a multi-institutional evaluation of manual delineations of gross tumor volume (GTV), high-risk clinical target volume (CTV), parotids, and submandibular glands on treatment simulation magnetic resonance scans of patients with oropharyngeal cancer.
- Groysman, M., Yi, S. K., Robbins, J. R., Hsu, C. C., Julian, R., Bauman, J. E., Baker, A., Wang, S. J., & Bearelly, S. (2022). The impact of socioeconomic and geographic factors on access to transoral robotic/endoscopic surgery for early stage oropharyngeal malignancy. American journal of otolaryngology, 43(1), 103243.More infoTo evaluate the role of social and geographic factors on the likelihood of receiving transoral robotic surgery (TORS) or non-robotic transoral endoscopic surgery treatment in early stage oropharyngeal squamous cell carcinoma (OPSCC).
- Schmid, R. K., Robbins, J. R., & Johnstone, C. A. (2022). Palliative radiation for bone metastases from hepatocellular carcinoma: practice patterns and the amount of remaining life spent receiving treatment.. Annals of palliative medicine, 0(0), 0-0. doi:10.21037/apm-21-2657More infoPalliative radiation therapy (RT) for bone metastases (BMs) is a common practice. Wide variation exists in clinically used dose schema despite numerous studies demonstrating palliative equipoise between single and multifraction courses. We hypothesize that fraction scheme for palliating BMs for hepatocellular carcinoma (HCC) significantly affects how patients spend their remaining time..Patients with osseous HCC metastases who received RT were identified from the National Cancer Database (2004-2013). The percentage of remaining life spent receiving radiation therapy (PRLSRT) and the number of incomplete RT courses were calculated. Kaplan-Meier analysis and Cox proportional hazards models were used to evaluate trends and predictors..A total of 1,331 patients met the inclusion criteria. Median overall survival (OS) was 3.3 months. Just 49 (3.7%) of patients received single fraction RT and 34% received >10 fractions. The mean and median PRLSRT were as follows: 1 fraction (8.9% and 3.0%), 2-5 fractions (32.9% and 24.3%), 6-10 fractions (27.2% and 15.9%), and >10 fractions (24.1% and 14.4%). Of the patients with PRLSRT >50%, 99.6% received multifraction RT. The proportion of incomplete RT courses increased as fraction size decreased from 17.6% with 4 Gy to 34% with 2 Gy..: Single fraction palliative RT is vastly underutilized despite no additional palliative benefit with multifraction RT. PRLSRT significantly increased with multifraction RT. In the palliative treatment of painful BMs from HCC, single fraction treatment reduces time spent receiving radiation treatments and maximizes the number of patients who complete the prescribed treatment.
- Ward, M. C., Koyfman, S. A., Bakst, R. L., Margalit, D. N., Beadle, B. M., Beitler, J. J., Chang, S. S., Cooper, J. S., Galloway, T. J., Ridge, J. A., Robbins, J. R., Sacco, A. G., Tsai, C. J., Yom, S. S., & Siddiqui, F. (2022). Retreatment of Recurrent or Second Primary Head and Neck Cancer After Prior Radiation: Executive Summary of the American Radium Society Appropriate Use Criteria. International journal of radiation oncology, biology, physics, 113(4), 759-786.More infoRetreatment of recurrent or second primary head and neck cancers occurring in a previously irradiated field is complex. Few guidelines exist to support practice. We performed an updated literature search of peer-reviewed journals in a systematic fashion. Search terms, key questions, and associated clinical case variants were formed by panel consensus. The literature search informed the committee during a blinded vote on the appropriateness of treatment options via the modified Delphi method. The final number of citations retained for review was 274. These informed 5 key questions, which focused on patient selection, adjuvant reirradiation, definitive reirradiation, stereotactic body radiation, and reirradiation to treat nonsquamous cancer. Results of the consensus voting are presented along with discussion of the most current evidence. This provides updated evidence-based recommendations and guidelines for the retreatment of recurrent or second primary cancer of the head and neck.
- Yom, S. S., Ward, M. C., Tsai, C. J., Siddiqui, F., Sacco, A. G., Robbins, J. R., Ridge, J. A., Margalit, D. N., Koyfman, S. A., Galloway, T. J., Cooper, J. S., Chang, S. S., Beitler, J. J., Beadle, B. M., & Bakst, R. L. (2022). Retreatment of Recurrent or Second Primary Head and Neck Cancer After Prior Radiation: Executive Summary of the American Radium Society® (ARS) Appropriate Use Criteria (AUC): Expert Panel on Radiation Oncology - Head and Neck Cancer.. International journal of radiation oncology, biology, physics. doi:10.1016/j.ijrobp.2022.03.034More infoRe-treatment of recurrent or second primary head and neck cancers occurring in a previously irradiated field is complex. Few guidelines exist to support practice..We performed an updated literature search of peer-reviewed journals in a systematic fashion. Search terms, key questions, and associated clinical case variants were formed by panel consensus. The literature search informed the committee during a blinded vote on the appropriateness of treatment options via the modified Delphi method..The final number of citations retained for review was 274. These informed five key questions, which focused on patient selection, adjuvant re-irradiation, definitive re-irradiation, stereotactic body radiation (SBRT), and re-irradiation to treat non-squamous cancer. Results of the consensus voting are presented along with discussion of the most current evidence..This provides updated evidence-based recommendations and guidelines for the re-treatment of recurrent or second primary cancer of the head and neck.
- Margalit, D. N., Sacco, A. G., Cooper, J. S., Ridge, J. A., Bakst, R. L., Beadle, B. M., Beitler, J. J., Chang, S. S., Chen, A. M., Galloway, T. J., Koyfman, S. A., Mita, C., Robbins, J. R., Tsai, C. J., Truong, M. T., Yom, S. S., & Siddiqui, F. (2021). Systematic review of postoperative therapy for resected squamous cell carcinoma of the head and neck: Executive summary of the American Radium Society appropriate use criteria. Head & neck, 43(1), 367-391.More infoThe aims of this systematic review are to (a) evaluate the current literature on the impact of postoperative therapy for resected squamous cell carcinoma of the head and neck (SCCHN) on oncologic and non-oncologic outcomes and (b) identify the optimal evidence-based postoperative therapy recommendations for commonly encountered clinical scenarios.
- Robbins, J. (2021). Dosimetry Comparison of Palliative Radiation Plans Generated From Available Diagnostic CT Images Versus Dedicated CT Simulation for Inpatients.. Cureus.More infoIntroduction The morbidity sequelae of advanced cancer are often irreversible. Early palliative radiation can prevent, delay, and even improve these consequences. Treatment may be delayed due to a packed computed tomography (CT) simulation schedule or other logistics, including the cost and burden of arranging ambulance transportation when radiation centers are off-site. Objectives The primary objective was to determine the feasibility of using a recent diagnostic CT scan in lieu of a dedicated simulation CT to generate an adequate plan without sacrificing dosimetric goals and subsequent efficacy or tolerability. Secondary objectives included how much the lesion has grown, and how much earlier treatment could start if planned on a diagnostic CT scan. Materials/Methods For each inpatient treated with palliative radiation, a prior recent diagnostic CT scan was imported into the RayStation (RaySearch Laboratories, Stockholm, Sweden) planning system. From these diagnostic scans, planning treatment volumes (PTV) and organs at risk (OAR) were contoured using the same technique as the patient's actual treatment. The primary outcome was to compare both the PTV coverage and OAR dose between the plan generated from the diagnostic CT compared to that from the simulation CT. Our secondary outcomes include the mean time between CT simulation and first treatment, change in tumor volume between diagnostic scan and CT simulation, and the hottest 1% of each plan (D1). Results Between May and August 2019, a total of 22 inpatients were treated palliatively. Of those 22 patients, 10 patients (ages 32-92 years, median 64.5 years, 50% spine) met study criteria and had a diagnostic CT scan that was obtained within 14 days of simulation CT that was also compatible with our planning software. In the plans that were delivered, a mean of 98.8% (range 94.4-100%) of PTV was covered by at least 95% prescription dose. In the diagnostic CT plans, a mean of 95.4% (range 84.5-100%) of PTV was covered by at least 95% prescription dose. The difference between plans trended towards significance (p=0.061). When looking at patients receiving treatment to the spine or having a diagnostic CT within four days of the simulation CT, there was no statistically significant difference between the two plans (p=0.032 and 0.030, respectively). The OARs received, on average, 1.4% less mean radiation dose in the hypothetical plans (p=0.911). All OAR constraints were met in both groups. The mean time between diagnostic CT and CT simulation was 5.9 days and between CT simulation and first treatment was 1.9 days (range 0-5 days). The mean change in tumor volume was 22.64% smaller in the diagnostic CT scan plan. The D1 was an average 1% hotter in the hypothetical plans (p=0.16). Conclusion In hospitalized patients with an indication for palliative radiation, treatment planning on a pre-existing recent diagnostic CT scan produces comparable dose distributions without increases in dose to OARs when compared to the use of CT simulation scans, particularly for the treatment of the spine or when a very recent diagnostic CT is available. Bypassing CT simulation in select cases allows for earlier delivery of radiation with less patient and logistical burden. In combination with daily image guidance, this may translate to more timely delivery of radiation, less cost and burden to critically ill patients, and improved palliative benefit.
- Robbins, J. (2021). The impact of socioeconomic and geographic factors on access to transoral robotic/endoscopic surgery for early stage oropharyngeal malignancy.. American journal of otolaryngology.More infoObjectiveTo evaluate the role of social and geographic factors on the likelihood of receiving transoral robotic surgery (TORS) or non-robotic transoral endoscopic surgery treatment in early stage oropharyngeal squamous cell carcinoma (OPSCC).Materials and methodsThe National Cancer Database was queried to form a cohort of patients with T1-T2 N0-N1 M0 OPSCC (AJCC v.7) who underwent treatment from 2010 to 2016. Demographics, tumor characteristics, treatment type, social, and geographic factors were all collected. Univariate analysis and multivariate logistic regression were then performed.ResultsAmong 9267 identified patients, 1774 (19.1%) received transoral robotic surgery (TORS), 1191 (12.9%) received transoral endoscopic surgery, and 6302 (68%) received radiation therapy. We found that lower cancer stage, lower comorbidity burden and HPV- positive status predicted a statistically significant increased likelihood of receiving surgery. Patients who reside in suburban or small urban areas (>1 million population), were low-to- middle income, or rely on Medicaid were less likely to receive surgery. Patients that reside in Medicaid-expansion states were more likely to receive TORS (p > .0001). Patients that reside in states that expanded Medicaid January 2014 and after were more likely to receive non-robotic transoral endoscopic surgery (p > .0001).ConclusionsPoorer baseline health, lower socioeconomic status and residence in small urban areas may act as barriers to accessing minimally invasive transoral surgery while residence in a Medicaid-expansion state may improve access. Barriers to accessing robotic surgery may be greater than accessing non-robotic surgery.
- Tsai, C. J., Galloway, T. J., Margalit, D. N., Bakst, R. L., Beadle, B. M., Beitler, J. J., Chang, S., Chen, A., Cooper, J., Koyfman, S. A., Ridge, J. A., Robbins, J., Truong, M. T., Yom, S. S., & Siddiqui, F. (2021). Ipsilateral radiation for squamous cell carcinoma of the tonsil: American Radium Society appropriate use criteria executive summary. Head & neck, 43(1), 392-406.More infoWe conducted the current systemic review to provide up-to-date literature summary and optimal evidence-based recommendations for ipsilateral radiation for squamous cell carcinoma of the tonsil.
- Yom, S. S., Tsai, C. J., Truong, M. T., Siddiqui, F., Robbins, J. R., Ridge, J. A., Margalit, D. N., Koyfman, S. A., Galloway, T. J., Cooper, J. S., Chen, A. M., Chang, S. S., Beitler, J. J., Beadle, B. M., & Bakst, R. L. (2021). Ipsilateral radiation for squamous cell carcinoma of the tonsil: American Radium Society appropriate use criteria executive summary.. Head & neck, 43(1), 392-406. doi:10.1002/hed.26492More infoWe conducted the current systemic review to provide up-to-date literature summary and optimal evidence-based recommendations for ipsilateral radiation for squamous cell carcinoma of the tonsil..We performed literature search of peer-reviewed journals through PubMed. The search strategy and subject-specific keywords were developed based on the expert panel's consensus. Articles published from January 2000 to May 2020 with full text available on PubMed and restricted to the English language and human subjects were included. Several prespecified search terms were used to identify relevant publications and additional evidence published since the initial American College of Radiology Appropriateness Criteria Ipsilateral Tonsil Radiation recommendation was finalized in 2012. The full bibliographies of identified articles were reviewed and irrelevant studies were removed..The initial search and review returned 46 citations. The authors added three citations from bibliographies, websites, or books not found in the literature search. Of the 49 citations, 30 citations were retained for further detailed review, and 14 of them were added to the evidence table. Articles were removed from the bibliography if they were not relevant or generalizable to the topic, or focused on unknown primary disease. Several commonly encountered clinical case variants were created and panelists anonymously rated each treatment recommendation. The results were reviewed and disagreements discussed..The panel provided updated evidence and recommendations for ipsilateral radiation for squamous cell carcinoma of the tonsil in the setting of primary radiation-based therapy and postoperative adjuvant radiotherapy. This committee did not reach agreements for some case variants due to a lack of strong evidence supporting specific treatment decisions, indicating a further need for research in these topics.
- Yom, S. S., Tsai, C. J., Truong, M. T., Siddiqui, F., Sacco, A. G., Robbins, J. R., Ridge, J. A., Mita, C., Margalit, D. N., Koyfman, S. A., Galloway, T. J., Cooper, J. S., Chen, A. M., Chang, S. S., Beitler, J. J., Beadle, B. M., & Bakst, R. L. (2021). Systematic review of postoperative therapy for resected squamous cell carcinoma of the head and neck: Executive summary of the American Radium Society appropriate use criteria.. Head & neck, 43(1), 367-391. doi:10.1002/hed.26490More infoThe aims of this systematic review are to (a) evaluate the current literature on the impact of postoperative therapy for resected squamous cell carcinoma of the head and neck (SCCHN) on oncologic and non-oncologic outcomes and (b) identify the optimal evidence-based postoperative therapy recommendations for commonly encountered clinical scenarios..An analysis of the medical literature from peer-reviewed journals was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline. Prospective studies and methodology-based systematic reviews and meta-analyses of postoperative therapy for SCCHN were identified by searching Medline (OVID) and EMBASE (Elsevier) using controlled vocabulary terms (ie, National Library of Medicine Medical Subject Headings [MeSH], EMTREE). Study screening and selection was performed with Covidence software and full-text review. The RAND/UCLA appropriateness method was used by the expert panel to rate the appropriate use of postoperative therapy, and the modified Delphi method was used to come to consensus..A total of 5660 studies were identified and screened using the title and abstract, leading to 201 studies assessed for relevance using full-text review. After limitation to the eligibility criteria, 101 studies from 1977 to 2020 were identified, including 77 with oncologic endpoints and 24 with function and quality of life endpoints. All studies reported staging prior to the implementation of American Joint Committee on Cancer (AJCC-8)..Prospective clinical studies and systematic reviews identified through the PRISMA systematic review provided good evidence for consensus statements regarding the appropriate use of postoperative therapy for resected SCCHN. Further research is needed in domains where consensus by the expert panel could not be achieved for the appropriateness of specific postoperative therapeutic interventions.
- Abdelhakiem, M. K., Johnstone, C., Bergom, C., Currey, A., & Robbins, J. R. (2020). The influence of breast cancer subtype on survival after palliative radiation for osseous metastases. Cancer medicine, 9(23), 8979-8988.More infoAmong patients with osseous metastases, breast cancer (BC) patients typically have the best prognosis. In the palliative setting, BC is often considered a single disease, but based on receptor status there are four distinct subtypes: luminal A (LA), luminal B (LB), triple negative (TN), and HER2-enriched (HER2). We hypothesize that survival and palliative outcomes following palliative RT for osseous metastases correlate with breast cancer subtype (BCS).
- Gonzalez, V. J., Yi, S. K., Robbins, J. R., Robbins, C., Hsu, C. C., Heal, C., & Gonzalez, V. J. (2020). An Assessment of Technology Usage and Barriers to Adoption Among Patients in a Radiation Oncology Clinic. International Journal of Radiation Oncology Biology Physics, 108(2), E65. doi:10.1016/j.ijrobp.2020.02.627
- Robbins, J. (2020). Systematic review of postoperative therapy for resected squamous cell carcinoma of the head and neck: Executive summary of the American Radium Society appropriate use criteria.. Head & neck.More infoBackgroundThe aims of this systematic review are to (a) evaluate the current literature on the impact of postoperative therapy for resected squamous cell carcinoma of the head and neck (SCCHN) on oncologic and non-oncologic outcomes and (b) identify the optimal evidence-based postoperative therapy recommendations for commonly encountered clinical scenarios.MethodsAn analysis of the medical literature from peer-reviewed journals was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline. Prospective studies and methodology-based systematic reviews and meta-analyses of postoperative therapy for SCCHN were identified by searching Medline (OVID) and EMBASE (Elsevier) using controlled vocabulary terms (ie, National Library of Medicine Medical Subject Headings [MeSH], EMTREE). Study screening and selection was performed with Covidence software and full-text review. The RAND/UCLA appropriateness method was used by the expert panel to rate the appropriate use of postoperative therapy, and the modified Delphi method was used to come to consensus.ResultsA total of 5660 studies were identified and screened using the title and abstract, leading to 201 studies assessed for relevance using full-text review. After limitation to the eligibility criteria, 101 studies from 1977 to 2020 were identified, including 77 with oncologic endpoints and 24 with function and quality of life endpoints. All studies reported staging prior to the implementation of American Joint Committee on Cancer (AJCC-8).ConclusionsProspective clinical studies and systematic reviews identified through the PRISMA systematic review provided good evidence for consensus statements regarding the appropriate use of postoperative therapy for resected SCCHN. Further research is needed in domains where consensus by the expert panel could not be achieved for the appropriateness of specific postoperative therapeutic interventions.
- Robbins, J. (2020). The influence of breast cancer subtype on survival after palliative radiation for osseous metastases. Cancer Medicine.
- Robbins, J. R., Hsu, C. C., & Hirshberg, J. (2020). Abstract C001: Palliative radiation to bony metastases from GI tumors: Disparities, outcomes, and practice patterns. Cancer Epidemiology, Biomarkers & Prevention. doi:10.1158/1538-7755.disp19-c001
- Robbins, J. R., Johnstone, C., Currey, A., Bergom, C., & Abdelhakiem, M. K. (2020). The influence of breast cancer subtype on survival after palliative radiation for osseous metastases.. Cancer medicine, 9(23), 8979-8988. doi:10.1002/cam4.3597More infoAmong patients with osseous metastases, breast cancer (BC) patients typically have the best prognosis. In the palliative setting, BC is often considered a single disease, but based on receptor status there are four distinct subtypes: luminal A (LA), luminal B (LB), triple negative (TN), and HER2-enriched (HER2). We hypothesize that survival and palliative outcomes following palliative RT for osseous metastases correlate with breast cancer subtype (BCS)..We identified 3,895 BC patients with known receptor status who received palliative RT for osseous metastases from 2004-2013 in the National Cancer Database. Kaplan-Meier method with log-rank testing and univariate/multivariate Cox-regression was used to identify survival factors. Incomplete radiation courses, 30-day mortality rate, and percentage remaining life spent receiving RT (PRLSRT) were calculated..Subtypes were 54% LA, 33% LB, 8% TN, and 5% HER2 with median survival of 34.1, 28.2, 5.3, and 15.7 months, respectively (p < 0.001). Overall 82% of patients received ≥10 fractions. Although BCS had limited effect on radiation regimens, TN received nearly twice as many single or hypofractionated (≤5 fractions) treatments, but the overall rate of these fraction schemes was low at 3.7 and 13.7%, respectively. Compared to LA and LB, TN and HER2 patients had worse palliative outcomes; higher rates of incomplete courses at 18.8% and 18.3% versus 12.7%-14.4%; higher 30-day mortality post-radiotherapy at 21.5% and 16.0% versus 6.3%-7.9%, and higher median PRLSRT of 7.7% and 3.7% versus 2.2%-2.4% for LA and LB. On multivariate analysis, BCS was associated with overall survival with TN (HR 3.7), HER2 (HR 1.75), and LB (HR 1.28) fairing worse than LA (p < 0.001)..BCS correlated with survival and palliative outcome following radiation to osseous metastases. BCS should be considered by physicians when planning palliative RT to maximize quality-of-life, avoid unnecessary treatment, and ensure palliative benefits.
- Smith-raymond, L., Robbins, J. R., Locke, A., & Ho, Q. (2020). Comparison of Radiation Dosimetry Plans of Inpatients Using CT Simulation Versus Previous Diagnostic Scan. International Journal of Radiation Oncology Biology Physics, 108(2), E18. doi:10.1016/j.ijrobp.2020.02.506
- Wei, R., Tseng, Y. D., Schuster, J., Robbins, J. R., Marshall, D. C., Lo, S. S., Jones, J., Johnstone, C., Dharmarajan, K. V., & Balboni, T. A. (2020). Key Factors for Establishing and Maintaining A Successful Palliative Radiation Oncology Program: A Survey of the Society for Palliative Radiation Oncology. International Journal of Radiation Oncology Biology Physics, 108(2), E20-E21. doi:10.1016/j.ijrobp.2020.02.513
- Yi, S. K., Robbins, J. R., Robbins, C., & Hsu, C. C. (2020). Practice Patterns of Head and Neck Radiation for Patients Presenting with De Novo Metastatic Disease: Implication of Radiation Regimen on Survival and Time Spent Receiving Radiation Therapy. International Journal of Radiation Oncology Biology Physics, 108(2), E41. doi:10.1016/j.ijrobp.2020.02.564
- Yom, S. S., Tsai, C. J., Truong, M. T., Siddiqui, F., Sacco, A. G., Robbins, J. R., Ridge, J. A., Koyfman, S. A., Galloway, T. J., Cooper, J. S., Chen, A. M., Chang, S. S., Beitler, J. J., Beadle, B. M., & Bakst, R. L. (2020). Ipsilateral Radiation for Squamous Cell Carcinoma of the Tonsil: Summary of Findings and Controversies from the ARS Appropriate Use Criteria Expert Panel on Tonsil Cancer. International Journal of Radiation Oncology Biology Physics, 108(2), E41-E42. doi:10.1016/j.ijrobp.2020.02.565
- Yom, S. S., Tsai, C. J., Truong, M. T., Siddiqui, F., Sacco, A. G., Robbins, J. R., Ridge, J. A., Margalit, D. N., Koyfman, S. A., Galloway, T. J., Cooper, J. S., Chen, A. M., Chang, S. S., Beitler, J. J., Beadle, B. M., & Bakst, R. L. (2020). Postoperative Therapy for Resected Squamous Cell Carcinoma of the Head and Neck (SCCHN): Initial Findings of an American Radium Society (TM) (ARS) Appropriate Use Criteria Systematic Review (SR). International Journal of Radiation Oncology Biology Physics, 108(2), E44. doi:10.1016/j.ijrobp.2020.02.570
- Rahman, O., Johnstone, C., Robbins, J. R., Rich, S. E., & Dharmarajan, K. V. (2019). Patterns of Whole Brain Radiation Therapy for Nonsmall Cell Lung Cancer Patients with Brain Metastases (SA528D). Journal of Pain and Symptom Management, 57(2), 455. doi:10.1016/j.jpainsymman.2018.12.207
- Robbins, J. (2019). Downstaging Locally Advanced Cholangiocarcinoma Pre-Liver Transplantation: A Prospective Pilot Study.. The Journal of surgical research.More infoBACKGROUND:Orthotopic liver transplantation (OLT) after neoadjuvant therapy (NT) in well-selected patients with unresectable hilar cholangiocarcinoma (CCA) achieves excellent recurrence-free survival. Current criteria for NT-OLT exclude patients with locally advanced hilar and intrahepatic CCA from potential cure. We sought to evaluate the efficacy of NT in downstaging locally advanced CCA, and examine outcomes after OLT. METHODS:Among 24 patients referred for unresectable hilar and intrahepatic CCA from January 2013 through August 2017, 18 met center-specific inclusion criteria for the NT-OLT treatment protocol: hilar tumor size ≤3.5 cm or intrahepatic ≤8 cm, and regional lymphadenopathy but without distant metastasis. Median follow-up was 22.1 mo from diagnosis. RESULTS:Of 18 patients who initiated NT, 11 were removed from the protocol due to tumor progression (n = 6) or uncontrolled infection and failure-to-thrive (n = 5). Median NT duration tended to be shorter for patients progressing to dropout than for those surviving to OLT (5.5 versus 13.5 mo, P = 0.109). Among five patients who received OLT, 1-y post-OLT patient survival was 80%: three survive recurrence-free (14.5-29.2 mo post-OLT); one developed an isolated tumor recurrence in a single portacaval lymph node at 12 mo post-OLT; and one experienced non-tumor-related death. All dropout patients died at a median of 14.4 mo after diagnosis. CONCLUSIONS:This is the first prospective study to show successful NT downstaging of unresectable locally advanced hilar and intrahepatic CCA before OLT. NT-OLT for select patients with locally advanced hilar and intrahepatic CCA achieved acceptable short-term recurrence-free survival.
- Robbins, J. (2019). Neoadjuvant chemotherapy improves survival compared with concurrent chemoradiation alone in nasopharyngeal carcinoma patients with N3 disease.. Head & neck.More infoBACKGROUND:Neoadjuvant chemotherapy (NAC) trials in endemic regions of nasopharyngeal carcinoma (NPC) found improved survival, but studies are lacking in nonendemic regions. We assessed whether adding NAC to concurrent chemoradiation (CRT) improves overall survival (OS), especially in high-risk nonendemic patients. METHODS:Definitively treated NPC patients (n = 5424) from the National Cancer Database were analyzed for predictors of NAC and NAC effects on OS with multivariate Cox proportional hazards analysis (multivariate analysis [MVA]). Propensity score matched (1:2) survival analysis of NAC (n = 968) and CRT alone (n = 1914) was also performed. Effects on OS were stratified by risk group. RESULTS:On MVA, NAC-improved OS among the total cohort (hazard ratio [HR] 0.89, P = .049), particularly among stratified keratinizing histology (HR 0.82, P = .015) and N3 disease (HR 0.73, P = .046). Among propensity matched patients, NAC improved OS in patients with N3 disease (n = 336; HR 0.71, P = .046). CONCLUSIONS:NAC may improve OS among nonendemic NPC patients at higher risk of distant micrometastases, particularly N3 disease and those with unfavorable histology.
- Robbins, J. (2019). Palliative care education for oncologists: how are we doing?. Annals of palliative medicine.
- Robbins, J. (2019). Stereotactic body radiation therapy for hepatocellular carcinoma: Practice patterns, dose selection and factors impacting survival.. Cancer medicine.More infoBACKGROUND:Stereotactic body radiation therapy (SBRT) is an emerging option for unresectable hepatocellular carcinoma (HCC) without consensus regarding optimal dose schemas. This analysis identifies practice patterns and factors that influence dose selection and overall survival, with particular emphasis on dose and tumor size. MATERIALS/METHODS:Query of the National Cancer Database (NCDB) identified patients with unresectable, nonmetastatic HCC who received SBRT from 2004 to 2013. Biological Effective Dose (BED) was calculated for each patient in order to uniformly analyze different fractionation regimens. RESULTS:A total of 456 patients met the inclusion criteria. The median BED was 100 Gy (22.5-208.0), which corresponded to the most common dose fractionation (50 Gy in five fractions). Various factors influenced dose selection including tumor size (P
- Robbins, J. (2019). The Dosimetric Impact of Inter-fractional Organ-at-Risk Movement During Liver Stereotactic Body Radiation Therapy.. Practical radiation oncology.More infoPURPOSE:Stereotactic body radiation therapy (SBRT) is an effective therapy for treating liver malignancies. However, little is known about interfractional dose variations to adjacent organs-at-risk (OARs). We examine the effects of interfractional organ movement and setup variation on dose delivered to OARs in patients receiving liver SBRT. METHODS AND MATERIALS:Thirty subjects treated with liver SBRT were analyzed. Daily image-guidance with diagnostic quality CT-on-rails imaging was performed prior to each fraction. In Phase I, these daily images were used to delineate all OARs including the liver, heart, right kidney, esophagus, stomach, duodenum, and large bowel in 10 patients. In Phase II, only OARS in close proximity to the target were contoured in 20 additional patients. Dose distribution on each daily CT was generated and daily doses to each OAR were recorded and compared to clinical thresholds to determine whether a daily dose excess (DDE) occurred. RESULTS:Phase 1: Significant interfractional dose differences between planned and delivered dose to OARs were observed, but differences were rarely clinically significant with just one DDE. Phase 2: multiple DDEs were recorded for OARs close to the target mainly involving the stomach, heart, and esophagus. Tumors in the hilum, liver segments I, IV, and VIII were the most common locations for DDEs. On root cause analysis, three etiologies of DDE emerged, Cranial-Caudal shift (69.2%), anatomic changes (28.2%), and Anterior-Posterior shifts (2.6%). CONCLUSIONS:OARs close to liver lesions may receive higher doses than expected during SBRT due to interfractional variations in OARs relative to the target. These differences in planned versus expected dose can lead to toxicity. Efforts to better evaluate OARs with daily image guidance may help reduce risks. Application of adaptive replanning and improved and real time image guidance could mitigate risks of toxicity and further study into their applications is warranted.
- Robbins, J. R., Kilari, D., & Johnston, F. M. (2019). Palliative care education for oncologists: how are we doing?. Annals of palliative medicine, 8(4), 364-371. doi:10.21037/apm.2019.03.05More infoWith the aging U.S. population, the cancer burden is increasing exponentially (1,2). Most cancer deaths occur after a period of prolonged chronic disease accompanied by progressive symptomatic burden, and psychological and spiritual distress (3). Efforts to improve cancer care, reduce cancer-related suffering, and help patients understand their prognosis and treatment options are urgently needed and are an essential part of engaging patients in their own care (4). Palliative care (PC) is patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering throughout the continuum of illness and involves addressing physical, intellectual, emotional, social, and spiritual needs (5,6). PC is consistent with quality value based care recommendations (4-7). Timely PC intervention can sustain quality of life, reduced healthcare costs, and possibly lengthened overall survival (8-10). As the demand for PC services grow, leading to a shortage of specialty-trained/certified PC providers (specialty PC), other members of the interdisciplinary team will need to step-up to help manage PC needs. As such oncologists [medical oncologists (MO), radiation oncologists (RO), surgical oncologists (SO)] need to take a more active role as primary PC providers (generalist PC) to address basic PC issues and to provide better care for their patients (11-13). Therefore it is imperative that these oncology specialists are adequately trained and educated in PC principles and delivery.
- Robbins, J. R., Schmid, R. K., Hammad, A. Y., Gamblin, T. C., & Erickson, B. A. (2019). Stereotactic body radiation therapy for hepatocellular carcinoma: Practice patterns, dose selection and factors impacting survival.. Cancer medicine, 8(3), 928-938. doi:10.1002/cam4.1948More infoStereotactic body radiation therapy (SBRT) is an emerging option for unresectable hepatocellular carcinoma (HCC) without consensus regarding optimal dose schemas. This analysis identifies practice patterns and factors that influence dose selection and overall survival, with particular emphasis on dose and tumor size..Query of the National Cancer Database (NCDB) identified patients with unresectable, nonmetastatic HCC who received SBRT from 2004 to 2013. Biological Effective Dose (BED) was calculated for each patient in order to uniformly analyze different fractionation regimens..A total of 456 patients met the inclusion criteria. The median BED was 100 Gy (22.5-208.0), which corresponded to the most common dose fractionation (50 Gy in five fractions). Various factors influenced dose selection including tumor size (P < 0.001), tumor stage (P = 0.002), and facility case volume (4 months, HR 2.192, P < 0.001) were associated with worse survival..SBRT use is increasing for HCC, and multiple regimens are clinically employed. Although high BED was associated with improved outcomes, multiple factors contributed to the dose selection with favorable patients receiving higher doses. Continued efforts to enhance radiation planning and delivery may help improve utilization, safety, and efficacy.
- Robbins, J. R., Wang, S. J., Sindhu, S. K., Yi, S. K., Wang, S. J., Sindhu, S. K., Robbins, J. R., Hsu, C. C., Han, J. E., Erman, A. B., Bearelly, S., & Bauman, J. E. (2019). Neoadjuvant chemotherapy improves survival compared with concurrent chemoradiation alone in nasopharyngeal carcinoma patients with N3 disease.. Head & neck, 41(12), 4076-4087. doi:10.1002/hed.25955More infoNeoadjuvant chemotherapy (NAC) trials in endemic regions of nasopharyngeal carcinoma (NPC) found improved survival, but studies are lacking in nonendemic regions. We assessed whether adding NAC to concurrent chemoradiation (CRT) improves overall survival (OS), especially in high-risk nonendemic patients..Definitively treated NPC patients (n = 5424) from the National Cancer Database were analyzed for predictors of NAC and NAC effects on OS with multivariate Cox proportional hazards analysis (multivariate analysis [MVA]). Propensity score matched (1:2) survival analysis of NAC (n = 968) and CRT alone (n = 1914) was also performed. Effects on OS were stratified by risk group..On MVA, NAC-improved OS among the total cohort (hazard ratio [HR] 0.89, P = .049), particularly among stratified keratinizing histology (HR 0.82, P = .015) and N3 disease (HR 0.73, P = .046). Among propensity matched patients, NAC improved OS in patients with N3 disease (n = 336; HR 0.71, P = .046)..NAC may improve OS among nonendemic NPC patients at higher risk of distant micrometastases, particularly N3 disease and those with unfavorable histology.
- Schmid, R. K., Tai, A., Klawikowski, S., Ramahi, K., Li, X. A., Robbins, J. R., & Straza, M. W. (2019). The Dosimetric Impact of Interfractional Organ-at-Risk Movement During Liver Stereotactic Body Radiation Therapy.. Practical radiation oncology, 9(6), e549-e558. doi:10.1016/j.prro.2019.05.014More infoStereotactic body radiation therapy (SBRT) is an effective therapy for treating liver malignancies. However, little is known about interfractional dose variations to adjacent organs at risk (OARs). We examine the effects of interfractional organ movement and setup variation on dose delivered to OARs in patients receiving liver SBRT..Thirty patients treated with liver SBRT were analyzed. Daily image guidance with diagnostic quality computed tomography-on-rails imaging was performed before each fraction. In phase 1, these daily images were used to delineate all OARs including the liver, heart, right kidney, esophagus, stomach, duodenum, and large bowel in 10 patients. In phase 2, only OARS in close proximity to the target were contoured in 20 additional patients. Dose distribution on each daily computed tomography was generated, and daily doses to each OAR were recorded and compared with clinical thresholds to determine whether a daily dose excess (DDE) occurred..In phase 1, significant interfractional dose differences between planned and delivered dose to OARs were observed, but differences were rarely clinically significant, with just 1 DDE. In phase 2, multiple DDEs were recorded for OARs close to the target, mainly involving the stomach, heart, and esophagus. Tumors in the hilum and liver segments I, IV, and VIII were the most common locations for DDEs. On root cause analysis, 3 etiologies of DDE emerged: craniocaudal shift (69.2%), anatomic changes (28.2%), and anteroposterior shifts (2.6%)..OARs close to liver lesions may receive higher doses than expected during SBRT owing to interfractional variations in OARs relative to the target. These differences in planned versus expected dose can lead to toxicity. Efforts to better evaluate OARs with daily image guidance may help reduce risks. Application of adaptive replanning and improved and real-time image guidance could mitigate risks of toxicity, and further study into their applications is warranted.
- Wong, M., George, B., Pearson, T., Zimmerman, M. A., Hong, J. C., Robbins, J. R., Kim, J. H., & Eriksen, C. M. (2019). Downstaging Locally Advanced Cholangiocarcinoma Pre-Liver Transplantation: A Prospective Pilot Study.. The Journal of surgical research, 242, 23-30. doi:10.1016/j.jss.2019.04.023More infoOrthotopic liver transplantation (OLT) after neoadjuvant therapy (NT) in well-selected patients with unresectable hilar cholangiocarcinoma (CCA) achieves excellent recurrence-free survival. Current criteria for NT-OLT exclude patients with locally advanced hilar and intrahepatic CCA from potential cure. We sought to evaluate the efficacy of NT in downstaging locally advanced CCA, and examine outcomes after OLT..Among 24 patients referred for unresectable hilar and intrahepatic CCA from January 2013 through August 2017, 18 met center-specific inclusion criteria for the NT-OLT treatment protocol: hilar tumor size ≤3.5 cm or intrahepatic ≤8 cm, and regional lymphadenopathy but without distant metastasis. Median follow-up was 22.1 mo from diagnosis..Of 18 patients who initiated NT, 11 were removed from the protocol due to tumor progression (n = 6) or uncontrolled infection and failure-to-thrive (n = 5). Median NT duration tended to be shorter for patients progressing to dropout than for those surviving to OLT (5.5 versus 13.5 mo, P = 0.109). Among five patients who received OLT, 1-y post-OLT patient survival was 80%: three survive recurrence-free (14.5-29.2 mo post-OLT); one developed an isolated tumor recurrence in a single portacaval lymph node at 12 mo post-OLT; and one experienced non-tumor-related death. All dropout patients died at a median of 14.4 mo after diagnosis..This is the first prospective study to show successful NT downstaging of unresectable locally advanced hilar and intrahepatic CCA before OLT. NT-OLT for select patients with locally advanced hilar and intrahepatic CCA achieved acceptable short-term recurrence-free survival.
- Abdelhakiem, M. K., Currey, A. D., & Robbins, J. R. (2018). Outcomes of Tomotherapy for Advanced Cutaneous Scalp Squamous Cell Carcinoma. International Journal of Radiation Oncology Biology Physics, 100(5), 1344. doi:10.1016/j.ijrobp.2017.12.100
- Abdelhakiem, M. K., Johnstone, C., Bergom, C., Currey, A. D., & Robbins, J. R. (2018). The Influence of Breast Cancer Subtype on Survival after Palliative Radiation for Osseous Metastases. International Journal of Radiation Oncology Biology Physics, 102(3), e436. doi:10.1016/j.ijrobp.2018.07.1268More infoBACKGROUND: Among patients with osseous metastases, breast cancer (BC) patients typically have the best prognosis. In the palliative setting, BC is often considered a single disease, but based on receptor status there are four distinct subtypes: luminal A (LA), luminal B (LB), triple negative (TN), and HER2-enriched (HER2). We hypothesize that survival and palliative outcomes following palliative RT for osseous metastases correlate with breast cancer subtype (BCS). METHODS: We identified 3,895 BC patients with known receptor status who received palliative RT for osseous metastases from 2004-2013 in the National Cancer Database. Kaplan-Meier method with log-rank testing and univariate/multivariate Cox-regression was used to identify survival factors. Incomplete radiation courses, 30-day mortality rate, and percentage remaining life spent receiving RT (PRLSRT) were calculated. RESULTS: Subtypes were 54% LA, 33% LB, 8% TN, and 5% HER2 with median survival of 34.1, 28.2, 5.3, and 15.7 months, respectively (p < 0.001). Overall 82% of patients received ≥10 fractions. Although BCS had limited effect on radiation regimens, TN received nearly twice as many single or hypofractionated (≤5 fractions) treatments, but the overall rate of these fraction schemes was low at 3.7 and 13.7%, respectively. Compared to LA and LB, TN and HER2 patients had worse palliative outcomes; higher rates of incomplete courses at 18.8% and 18.3% versus 12.7%-14.4%; higher 30-day mortality post-radiotherapy at 21.5% and 16.0% versus 6.3%-7.9%, and higher median PRLSRT of 7.7% and 3.7% versus 2.2%-2.4% for LA and LB. On multivariate analysis, BCS was associated with overall survival with TN (HR 3.7), HER2 (HR 1.75), and LB (HR 1.28) fairing worse than LA (p < 0.001). CONCLUSIONS: BCS correlated with survival and palliative outcome following radiation to osseous metastases. BCS should be considered by physicians when planning palliative RT to maximize quality-of-life, avoid unnecessary treatment, and ensure palliative benefits.
- Bahig, H., Yuan, Y., Mohamed, A. S., Brock, K. K., Ng, S. P., Wang, J., Ding, Y., Balter, P. A., Lai, S. Y., Al-mamgani, A., Sonke, J., Heide, U. A., Li, X. A., Karam, I., Newbold, K., Oelfke, U., Bhide, S., Philippens, M. E., Terhaard, C. H., , Mcpartlin, A. J., et al. (2018). Magnetic Resonance-based Response Assessment and Dose Adaptation in Human Papilloma Virus Positive Tumors of the Oropharynx treated with Radiotherapy (MR-ADAPTOR): An R-IDEAL stage 2a-2b/Bayesian phase II trial.. Clinical and translational radiation oncology, 13, 19-23. doi:10.1016/j.ctro.2018.08.003More infoCurrent standard radiotherapy for oropharynx cancer (OPC) is associated with high rates of severe toxicities, shown to adversely impact patients' quality of life. Given excellent outcomes of human papilloma virus (HPV)-associated OPC and long-term survival of these typically young patients, treatment de-intensification aimed at improving survivorship while maintaining excellent disease control is now a central concern. The recent implementation of magnetic resonance image - guided radiotherapy (MRgRT) systems allows for individual tumor response assessment during treatment and offers possibility of personalized dose-reduction. In this 2-stage Bayesian phase II study, we propose to examine weekly radiotherapy dose-adaptation based on magnetic resonance imaging (MRI) evaluated tumor response. Individual patient's plan will be designed to optimize dose reduction to organs at risk and minimize locoregional failure probability based on serial MRI during RT. Our primary aim is to assess the non-inferiority of MRgRT dose adaptation for patients with low risk HPV-associated OPC compared to historical control, as measured by Bayesian posterior probability of locoregional control (LRC)..Patients with T1-2 N0-2b (as per AJCC 7th Edition) HPV-positive OPC, with lymph node
- Blinde, S., Mohamed, A. S., Al-mamgani, A., Newbold, K., Karam, I., Robbins, J. R., Thomson, D., Raaijmakers, N., Fuller, C. D., & Terhaard, C. H. (2018). Interobserver Variation in the International MRI Linear Accelerator Oropharyngeal Carcinoma Delineation Study. International Journal of Radiation Oncology Biology Physics, 100(5), 1362. doi:10.1016/j.ijrobp.2017.12.143
- Hirsch, T., Firat, S., Schultz, C. J., Wong, S. J., Robbins, J. R., Stadler, M. E., Shukla, M. E., Massey, B. L., & Campbell, B. H. (2018). Post-treatment evaluation of head and neck cancer patients in the era of advanced imaging and value-based care.. Journal of Clinical Oncology, 36(15_suppl), 6079-6079. doi:10.1200/jco.2018.36.15_suppl.6079More info6079Background: Current guidelines recommend imaging (CT and/or PET) to evaluate treatment response and detect residual disease after nonsurgical management of head and neck cancers squamous cell c...
- Noid, G., Tai, A., Schott, D., Mistry, N., Liu, Y., Gilat-schmidt, T., Robbins, J. R., & Li, X. A. (2018). Technical Note: Enhancing soft tissue contrast and radiation-induced image changes with dual-energy CT for radiation therapy.. Medical physics, 45(9), 4238-4245. doi:10.1002/mp.13083More infoThe purpose of this work is to investigate the use of low-energy monoenergetic decompositions obtained from dual-energy CT (DECT) to enhance image contrast and the detection of radiation-induced changes of CT textures in pancreatic cancer..The DECT data acquired for 10 consecutive pancreatic cancer patients during routine nongated CT-guided radiation therapy (RT) using an in-room CT (Definition AS Open, Siemens Healthcare, Malvern, PA) were analyzed. With a sequential DE protocol, the scanner rapidly performs two helical acquisitions, the first at a tube voltage of 80 kVp and the second at a tube voltage of 140 kVp. Virtual monoenergetic images across a range of energies from 40 to 140 keV were reconstructed using an image-based material decomposition. Intravenous (IV) bolus-free contrast enhancement in pancreas patient tumors was measured across a spectrum of monoenergies. For treatment response assessment, the changes in CT histogram features (including mean CT number (MCTN), entropy, kurtosis) in pancreas tumors were measured during treatment. The results from the monoenergetic decompositions were compared to those obtained from the standard 120 kVp CT protocol for the same subjects..Data of monoenergetic decompositions of the 10 patients confirmed the expected enhancement of soft tissue contrast as the energy is decreased. The changes in the selected CT histogram features in the pancreas during RT delivery were amplified with the low-energy monoenergetic decompositions, as compared to the changes measured from the 120 kVp CTs. For the patients studied, the average reduction in the MCTN in pancreas from the first to the last (the 28th) treatment fraction was 4.09 HU for the standard 120 kVp and 11.15 HU for the 40 keV monoenergetic decomposition..Low-energy monoenergetic decompositions from DECT substantially increase soft tissue contrast and increase the magnitude of radiation-induced changes in CT histogram textures during RT delivery for pancreatic cancer. Therefore, quantitative DECT may assist the detection of early RT response.
- Quinn, C., Robbins, J. R., Shukla, M. E., Firat, S., Schultz, C. J., Wong, S. J., Stadler, M. E., Massey, B. L., & Campbell, B. H. (2018). Acinic Cell Carcinoma of the Major Salivary Glands: Analysis of Prognostic Factors in 2,950 patients. International Journal of Radiation Oncology Biology Physics, 100(5), 1379. doi:10.1016/j.ijrobp.2017.12.185
- Rich, S. E., Robbins, J. R., Dharmarajan, K. V., Rahman, O. K., & Johnstone, C. (2018). Whole Brain Radiation Therapy Use Among Metastatic Non-Small Cell Lung Cancer Patients. International Journal of Radiation Oncology Biology Physics, 102(3), S166. doi:10.1016/j.ijrobp.2018.07.025
- Robbins, J. (2018). Diffuse recurrent cutaneous melanoma of the scalp and neck successfully treated with volumetric modulated arc therapy and concurrent ipilimumab. Practical radiation oncology.
- Robbins, J. (2018). Early Prediction of Acute Xerostomia During Radiation Therapy for Head and Neck Cancer Based on Texture Analysis of Daily CT. International Journal of Radiation Oncology*Biology*Physics.
- Robbins, J. (2018). Magnetic Resonance-based Response Assessment and Dose Adaptation in Human Papilloma Virus Positive Tumors of the Oropharynx treated with Radiotherapy (MR-ADAPTOR): An R-IDEAL stage 2a-2b/Bayesian phase II trial. Clinical and Translational Radiation Oncology.
- Robbins, J. (2018). Technical Note: Enhancing soft tissue contrast and radiation-induced image changes with dual-energy CT for radiation therapy. Medical physics.
- Robbins, J. R., Firat, S., Schultz, C. J., Wong, S. J., Stadler, M. E., Shukla, M. E., Massey, B. L., & Campbell, B. H. (2018). CAPTN: A nomogram for predicting survival and guiding therapy for patients with de novo metastatic head and neck squamous cell carcinoma.. Journal of Clinical Oncology, 36(15_suppl), 6041-6041. doi:10.1200/jco.2018.36.15_suppl.6041More info6041Background: Determining prognosis for de novo metastatic head and neck squamous cell carcinoma (mHNSCC) is difficult with limited data to direct clinical management. Recommendations for aggress...
- Schmid, R. K., Harker-murray, A., Niemczyk, K., & Robbins, J. R. (2018). Diffuse recurrent cutaneous melanoma of the scalp and neck successfully treated with volumetric modulated arc therapy and concurrent ipilimumab.. Practical radiation oncology, 8(3), 174-178. doi:10.1016/j.prro.2017.09.006
- Wu, H., Chen, X., Yang, X., Tao, Y., Xia, Y., Deng, X., Zheng, C., Li, X. A., Schultz, C. J., & Robbins, J. R. (2018). Early Prediction of Acute Xerostomia During Radiation Therapy for Head and Neck Cancer Based on Texture Analysis of Daily CT.. International journal of radiation oncology, biology, physics, 102(4), 1308-1318. doi:10.1016/j.ijrobp.2018.04.059More infoTo investigate radiation-induced changes of computed tomography (CT) textures in parotid glands (PG) to predict acute xerostomia during radiotherapy (RT) for head and neck cancer (HNC)..Daily or fraction kilovoltage CTs acquired using diagnostic CT scanners (eg, in-room CTs) during intensity-modulated RT for 59 HNC patients at 3 institutions were analyzed. The PG contours were generated on selected daily/fraction CTs. A series of histogram-based texture features, including the mean CT number (MCTN) in Hounsfield units, volume, standard deviation, skewness, kurtosis, and entropy for PGs were calculated for each fraction. Correlations between the changes of the texture features, radiation dose, and observed acute xerostomia were analyzed. A classifier model and the incurred CT-based xerostomia score (CTXS) were introduced to predict xerostomia based on combined changes of MCTN and volume of PGs. The t test and Spearman and Pearson correlation tests were used in the analyses..Substantial changes in various CT texture features of PGs were observed during RT delivery. The changes of PG MCTN or volume are not strongly correlated with the observed xerostomia grades if they are considered separately. The CTXS showed a significant correlation to the observed xerostomia grades (r = 0.71, P < .00001). The CTXS-based classifier can predict the xerostomia severity with a success rate ranging from 79% to 98%. The xerostomia severity at the end of treatment can be predicted based on the CTXS determined at the fifth week with a precision and sensitivity of 100%..Significant changes in the CT histogram features of the parotid glands were observed during RT of HNC. A practical method of using the changes of MCTN and volume of PGs is proposed to predict radiation-induced acute xerostomia, which may be used to help design adaptive treatment.
- Abdelhakiem, M. K., Wilson, F. J., & Robbins, J. R. (2017). P073) Management of Squamous Cell Carcinoma of the Scalp With Bone Involvement. International Journal of Radiation Oncology Biology Physics, 98(2), E34-E35. doi:10.1016/j.ijrobp.2017.02.169
- Blinde, S., Mohamed, A. S., Al-mamgani, A., Newbold, K., Karam, I., Robbins, J. R., Thomson, D., Fuller, C. D., Raaijmakers, C. P., & Terhaard, C. H. (2017). Large Interobserver Variation in the International MR-LINAC Oropharyngeal Carcinoma Delineation Study. International Journal of Radiation Oncology Biology Physics, 99(2), E639-E640. doi:10.1016/j.ijrobp.2017.06.2145
- Hammad, A. Y., Robbins, J. R., Turaga, K. K., Christians, K. K., Gamblin, T. C., & Johnston, F. M. (2017). Palliative interventions for hepatocellular carcinoma patients: analysis of the National Cancer Database.. Annals of palliative medicine, 6(1), 26-35. doi:10.21037/apm.2016.11.02More infoPalliative therapies are provided to a subset of hepatocellular carcinoma (HCC) patients with the aim of providing symptomatic relief, better quality of life and improved survival. The present study sought to assess and compare the efficacy of different palliative therapies for HCC..The National Cancer Database (NCDB), a retrospective national database that captures approximately 70% of all patients treated for cancer in the US, was queried for patients with HCC who were deemed unresectable from 1998-2011. Patients were stratified by receipt of palliative therapy. Survival analysis was examined by log-rank test and Kaplan Meier curves, and a multivariate proportional hazards model was utilized to identify the predictors of survival..A total of 3,267 patients were identified; 287 (8.7%) received surgical palliation, 827 (25.3%) received radiotherapy (RT), 877 (26.8%) received chemotherapy, 1,067 (32.6%) received pain management therapy, while 209 (6.4%) received a combination of the previous three modalities. On multivariate analysis palliative RT was identified as a positive predictor of survival [hazards ratio (HR) 0.65; 95% CI, 0.50-0.83]. Stratifying by disease stage, palliative RT provided a significant survival benefit for patients with stage IV disease..Palliative RT appears to extend survival and should be considered for patients presenting with late stage HCC.
- Kainz, K., Lim, S. N., Chen, G. P., Lawton, C. A., Siker, M. L., Firat, S., Robbins, J. R., Erickson, B., Li, A., & Erickson, E. (2017). Initial Clinical Experience with Using an Automated Dose Tracking Tool to Verify Dose Delivery and Trigger Adaptive Replanning. International Journal of Radiation Oncology Biology Physics, 99(2), S222-S223. doi:10.1016/j.ijrobp.2017.06.547
- Kinchen, C. L., Taylor, T. N., Johnstone, C. A., & Robbins, J. R. (2017). Stereotactic body radiation therapy for palliative treatment of bone metastases: Practice patterns and survival outcomes.. Journal of Clinical Oncology, 35(31_suppl), 242-242. doi:10.1200/jco.2017.35.31_suppl.242More info242Background: Stereotactic body radiation therapy (SBRT) is an emerging modality of treatment designed to deliver high radiation doses in few fractions. We examine practice trends in the use of SBRT for managing bone metastases in patients with breast, kidney, non-small-cell lung, melanoma, or prostate cancer. Methods: We selected patients from the National Cancer Database (2004-2013) diagnosed with bone metastases from breast, kidney, non-small-cell lung, melanoma, or prostate cancer. SBRT fractionation regimens were defined as 12-45 Gy in 1 fraction, 14-50 Gy in 2 fractions, 21-50 Gy in 3 fractions, 28-50 Gy in 4 fractions, and 30-60 Gy in 5 fractions. Standard palliative radiation fractionation regimens were defined as all other cases with 2-40 Gy in 20 fractions or fewer. Results: Patients receiving SBRT regimens made up 1454 of 57,556 total palliative cases. Bone metastases treated with SBRT primarily at the spine (65.5%), hip/pelvis (12.3%), and shoulder/extremity (11.4%). SBRT palliation regimens ...
- Noid, G., Tai, A., Li, X. A., Robbins, J. R., & Chen, G. P. (2017). Reducing radiation dose and enhancing imaging quality of 4DCT for radiation therapy using iterative reconstruction algorithms.. Advances in radiation oncology, 2(3), 515-521. doi:10.1016/j.adro.2017.04.003More infoFour-dimensional computed tomography (CT) images are typically used to quantify the necessary internal target volumes for thoracic and abdominal tumors. However, 4-dimensional CT is typically associated with excessive imaging dose to patients and the situation is exacerbated when using repeat 4-dimensional CT imaging on a weekly or daily basis throughout fractionated therapy. The aim of this work is to evaluate an iterative reconstruction (IR) algorithm that helps reduce the imaging dose to the patient while maintaining imaging quality as quantified by point spread function and contrast-to-noise ratios (CNRs)..An IR algorithm, SAFIRE, was applied to CT data of a phantom and patients with varying CT doses and reconstruction kernels. Phantom data enable measurements of spatial resolution, contrast, and noise. The impact of SAFIRE on 4-dimensional CT was assessed with patient data acquired at 2 different dose levels during image guided radiation therapy with an in-room CT..Phantom data demonstrate that IR reduces noise approximately in proportion to the number of iterations indicated by the strength (SAFIRE 1 to SAFIRE 5). Spatial resolution and contrast are conserved independent of dose and reconstruction parameters. The CNR increases with an increase of imaging dose or an increase in the number of iterations. The use of IR on CT sets confirms the results that were derived from phantom scans. The IR significantly enhances single breathing phase CTs in 4-dimensional CT sets as assessed by CT number discrimination. Furthermore, the IR of the low dose 4-dimensional CT features a 45% increase in the CNR in comparison with the standard dose 4-dimensional CT..The use of IR algorithms reduces noise while preserving spatial resolution and contrast, as evaluated from both phantom and patient CT data sets. For 4-dimensional CT, the IR can significantly improve image quality and reduce imaging dose without compromising image quality.
- Onyeama, S. N., Hammad, A. Y., Johnston, F. M., Gamblin, T. C., & Robbins, J. R. (2017). The utilization of palliative radiation therapy to the liver for hepatocellular carcinoma.. Journal of Clinical Oncology, 35(4_suppl), 474-474. doi:10.1200/jco.2017.35.4_suppl.474More info474Background: Despite retrospective and prospective clinical trials conveying the efficacy of palliative radiation therapy (RT) to the liver, this modality is not commonly used. The purpose of this project is to evaluate trends, dose schemas, and techniques of palliative RT to the liver in current practice. We aim to identify factors associated with overall survival using patient data from the National Cancer Database (NCDB). Methods: Using the NCDB, we analyzed patients with hepatocellular carcinoma (HCC) diagnosed from 2004-2012 treated with palliative RT. Various patient factors were reviewed and survival analyses were performed. Doses were converted to biological effective dose (BED) to compare the different fractionation schemas. Univariate and multivariate analyses were performed with Kaplan Meier and Cox regression tests. Results: A total of 3,267 HCC patients were identified who were treated with palliative intent. Of these 877 (27%) received radiation therapy and only 138 (4% of total, 16% of RT...
- Robbins, J. (2017). Early Prediction of Xerostomia During Radiation Therapy for Head and Neck Cancer Based on Radiomic Analysis of Daily CT. International Journal of Radiation Oncology*Biology*Physics.
- Robbins, J. (2017). Palliative interventions for hepatocellular carcinoma patients: analysis of the National Cancer Database. Annals of palliative medicine.
- Robbins, J. (2017). Reducing radiation dose and enhancing imaging quality of 4DCT for radiation therapy using iterative reconstruction algorithms. Advances in Radiation Oncology.
- Robbins, J. (2017). Stereotactic body radiotherapy for elderly patients with medically inoperable pancreatic cancer. American Journal of Clinical Oncology: Cancer Clinical Trials.
- Robbins, J. R., Bedi, M., Johnstone, C. A., & Shukla, M. E. (2017). Development of a Prompt Radiation Oncology Mediated Palliative Treatment (PROMPT) program for handling urgent cases at an academic hospital.. Journal of Clinical Oncology, 35(31_suppl), 173-173. doi:10.1200/jco.2017.35.31_suppl.173More info173Background: Oncology inpatients frequently need urgent palliative radiation therapy (RT). Evaluating and treating these unscheduled patients adds challenge and stress to all members of the radiation oncology team. To efficiently and compassionately address these situations, and ensure prompt, evidence-based, quality treatment, we developed the PROMPT program. This included scheduling designated consult slots for emergencies, adding flexible CT simulation times, assigning palliative-specific dosimetrists, and engaging support staff to improve workflow. The purpose of this project was to evaluate the PROMPT program with various quality metrics and identify areas for further improvement. Methods: Patient data from inpatient encounters for academic year 2016-2017 (July 1, 2016 to June 30, 2017) were reviewed. The day of the consultation, reason for consult, date of simulations, and dose fractionation were recorded. Time from consult to simulation, and treatment initiation were calculated. Results: A total ...
- Schmid, R. K., Hammad, A. Y., Johnstone, C., Gamblin, T. C., & Robbins, J. R. (2017). (P093) Palliative Radiation for Bone Metastases From Hepatocellular Carcinoma: Practice Patterns and the Implications of Fraction Scheme on the Amount of Remaining Life Spent Receiving Treatment. International Journal of Radiation Oncology Biology Physics, 98(2), E40. doi:10.1016/j.ijrobp.2017.02.189
- Straza, M. W., Gamblin, T. C., & Robbins, J. R. (2017). (P025) Predictors of Survival in Intrahepatic Cholangiocarcinoma Treated With Stereotactic Body Radiation Therapy: A National Cancer Database Study. International Journal of Radiation Oncology Biology Physics, 98(2), E21-E22. doi:10.1016/j.ijrobp.2017.02.120
- Tai, A., Ramahi, K., Klawikowski, S., Li, A., Robbins, J. R., & Schmid, R. K. (2017). A Dosimetric Investigation of Interfractional Organ-at-Risk Movements during Stereotactic Body Radiation Therapy for Liver Malignancies. International Journal of Radiation Oncology Biology Physics, 99(2), E719-E720. doi:10.1016/j.ijrobp.2017.06.2334
- Taylor, T. N., Kinchen, C. L., Johnstone, C. A., & Robbins, J. R. (2017). Practice patterns in radiation therapy for bone metastases in multiple histologies.. Journal of Clinical Oncology, 35(31_suppl), 151-151. doi:10.1200/jco.2017.35.31_suppl.151More info151Background: Radiation therapy (RT) is a common palliative treatment for bone metastasis. Despite copious evidence of palliative equipoise between single and multiple fractions, practice patterns vary widely amongst physicians. We evaluate practice patterns and the impact of treatment regimens on percentage of remaining life spent receiving RT (PRLSRT) and overall survival. Methods: Patients with metastases from Prostate, Lung, Breast, and Kidney to the bone who received RT were identified from the National Cancer Database. The percentage of remaining life spent receiving RT (PRLSRT) was calculated by dividing the elapse days of RT by the number of days they survive from starting RT to death. Results: 43516 patients met the inclusion criteria. The majority were non-small cell lung (64.7%), while breast (13.5%), prostate (11.0%), and kidney (10.8%) had almost equal amounts. Median patient age was 67 years old (18-90). Treated metastatic sites included the spine (61.9%), hip/pelvis (11.2%), and extremity ...
- Wu, H., Chen, X., Robbins, J. R., Schultz, C. J., & Li, A. (2017). Early Prediction of Xerostomia During Radiation Therapy for Head and Neck Cancer Based on Radiomic Analysis of Daily CT. International Journal of Radiation Oncology Biology Physics, 99(2), E382. doi:10.1016/j.ijrobp.2017.06.1516
- Yechieli, R. L., Robbins, J. R., Mahan, M., Siddiqui, F., & Ajlouni, M. (2017). Stereotactic Body Radiotherapy for Elderly Patients With Medically Inoperable Pancreatic Cancer.. American journal of clinical oncology, 40(1), 22-26. doi:10.1097/coc.0000000000000090More infoPeople over the age of 75 years account for approximately 40% of patients diagnosed with pancreatic cancer, many with comorbidities that may limit their treatment options. This study reports on the use of stereotactic body radiation therapy (SBRT) in this population..Twenty consecutively treated patients over the age of 75 with pathologically proven localized pancreatic cancer were included in this retrospective review. All had been evaluated by a multidisciplinary team as unable to tolerate surgery or combined chemoradiation therapy. Patient outcomes were analyzed to determine the safety and efficacy of SBRT in this elderly cohort..The median age was 83.2 years (minimum 77 y, maximum 90 y). Eighteen patients were treated at time of initial diagnosis, and 2 for recurrence after surgery. Eleven (55%) of the patients had an Adult Comorbidity Evaluation-27 comorbidity index score of 3 (severe) and 6 (30%) had a score of 2 (moderate). Fourteen patients were treated with 35 Gy in 5 fractions, 5 with 30 Gy in 5 fractions, and 1 patient with 36 Gy in 3 fractions. Seven (35%) patients had common terminology criteria for adverse events (CTCAE) V4.0 toxicity grade of 1-2, and 3 patients had a CTCAE V4.0 toxicity grade of 3-4, 2 with dehydration, and 1 had episodes of gastrointestinal bleeding. Three patients recurred locally, 10 had distant metastases, 4 of whom were found on the first posttreatment scan. Median overall survival was 6.4 months (95% confidence interval, 3.5-10.8 mo). Median recurrence-free survival was 6.8 months (95% confidence interval, 1.3-23.5 mo). Two patients survived >23 months..SBRT for pancreatic cancer appears to be a safe and effective method for treatment of elderly patients, even in the setting of severe comorbidities.
- Feghali, K. A., Robbins, J. R., Mahan, M., Burmeister, C., Khan, N. T., Rasool, N., Elshaikh, M. A., & Munkarah, A. R. (2016). Predictive Capacity of 3 Comorbidity Indices in Estimating Survival Endpoints in Women With Early-Stage Endometrial Carcinoma.. International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 26(8), 1455-60. doi:10.1097/igc.0000000000000802More infoThe negative impact of comorbidity on survival in women with endometrial carcinoma (EC) is well-known. Few validated comorbidity indices are available for clinical use, such as the Charlson Comorbidity Index (CCI), the Age-Adjusted CCI (AACCI), and the Adult Comorbidity Evaluation-27 (ACE-27). The aim of the study is to determine which index best correlates with survival endpoints in women with EC..We identified 1132 women with early-stage EC treated at an academic center. Three scores were calculated for each patient using CCI, AACCI, and ACE-27 at the time of hysterectomy. Univariate and multivariable modeling was used to determine predictors of survival..For each of the studied comorbidity indices, the highest scores were significantly correlated with poorer overall survival. The hazard ratio of death from any cause was 3.92 for AACCI, 2.25 for CCI, and 1.57 for ACE-27. All 3 indices were independent predictors of overall survival with a P value of less than 0.001 on multivariate analysis. In addition, lymphovascular space invasion, lower uterine segment involvement, and tumor grade were predictors of overall survival. Lymphovascular space invasion, grade (P < 0.001), and high AACCI score were the only significant predictors of recurrence-free survival (RFS). Lymphovascular space invasion and tumor grade were the only 2 predictors of disease-specific survival..Although all 3 studied comorbidity indices were significant predictors of overall survival in women with early-stage EC, AACCI showed a stronger association. It should be considered for evaluating comorbidity in women with early-stage EC.
- Hammad, A. Y., Christians, K. K., Gamblin, T. C., Johnston, F. M., Turaga, K. K., & Robbins, J. R. (2016). Palliative care for hepatocellular carcinoma: Analysis of the National Cancer Data Base.. Journal of Clinical Oncology, 34(4_suppl), 390-390. doi:10.1200/jco.2016.34.4_suppl.390More info390 Background: Palliative care is provided to a subset of hepatocellular carcinoma (HCC) patients with the aim of symptomatic relief and improving quality of life. The present study sought to assess and compare the prevalence and efficacy of different palliative therapies for HCC from the National Cancer Database (NCDB). Methods: The NCDB, a retrospective national database that captures approximately 70% of all patients treated for cancer, was queried for patients with HCC who were deemed non-resectable from 1998-2011. Patients were stratified by receipt of palliative care. Descriptive analyses were performed. Survival analysis was examined by log-rank test and Kaplan Meier curves, and a multivariate proportional hazards model was utilized to identify the predictors of survival. Results: A total of 3,267 patients were identified; 287 (8.7%) received surgical palliation, 827 (25.3%) received radiotherapy, 877 (26.8%) received chemotherapy, 1,067 (32.6%) received pain therapy, while 209 (6.4%) received a c...
- Hammad, A. Y., Schmid, R. K., Erickson, B., Gamblin, T. C., Robbins, J. R., & Erickson, E. (2016). The Impact of Dose on Overall Survival in Unresectable Hepatocellular Carcinoma Treated With Stereotactic Body Radiation Therapy. International Journal of Radiation Oncology Biology Physics, 96(2), E152. doi:10.1016/j.ijrobp.2016.06.972
- Robbins, J. (2016). Predictive Capacity of 3 Comorbidity Indices in Estimating Survival Endpoints in Women with Early-Stage Endometrial Carcinoma. International Journal of Gynecological Cancer.
- Suppiah, S., Michel, M. A., Stadler, M. E., Massey, B. L., Campbell, B. H., Wang, D., Schultz, C. J., Robbins, J. R., & Wong, S. J. (2016). The Long-Term Predictive Value of Posttreatment Positron Emission Tomography–Computed Tomography Imaging in Head and Neck Squamous Cell Carcinoma. International Journal of Radiation Oncology Biology Physics, 94(4), 918. doi:10.1016/j.ijrobp.2015.12.160
- Kainz, K., Robbins, J. R., Erickson, B., Li, A., Erickson, E., & Dalah, E. Z. (2015). Utility of Dynamic Contrast Enhanced and Apparent Diffusion Coefficient MR Imaging in Target Definition for Liver Cancer Radiation Therapy. International Journal of Radiation Oncology Biology Physics, 93(3), S193-S194. doi:10.1016/j.ijrobp.2015.07.463
- Paulson, E. S., Hall, W. A., & Robbins, J. R. (2015). Feasibility of Diffusion Weighted MR Lymphography for Cervical Lymph Node Delineation in Head and Neck Cancer. International Journal of Radiation Oncology Biology Physics, 93(3), E604. doi:10.1016/j.ijrobp.2015.07.2090
- Straza, M. W., Prah, D. E., Paulson, E. S., Knechtges, P. M., Erickson, B., Robbins, J. R., & Erickson, E. (2015). Pretransplant Stereotactic Body Radiation Therapy for Inoperable Cholangiocarcinoma: MR Versus CT Based Tumor Volume Delineation. International Journal of Radiation Oncology Biology Physics, 93(3), E159. doi:10.1016/j.ijrobp.2015.07.955
- Gore, E. M., Bradley, J. D., Buatti, J. M., Ghafoori, A. P., Henderson, M. A., Murad, G. J., Patchell, R. A., Patel, S. H., Robbins, J. R., Robins, H. I., Vassil, A. D., Wippold, F. J., Yunes, M. J., Videtic, G. M., Lo, S. S., & Germano, I. M. (2014). ACR Appropriateness Criteria® pre-irradiation evaluation and management of brain metastases.. Journal of palliative medicine, 17(8), 880-6. doi:10.1089/jpm.2014.9417More infoPretreatment evaluation is performed to determine the number, location, and size of the brain metastases and magnetic resonance imaging (MRI) is the recommended imaging technique, particularly in patients being considered for surgery or stereotactic radiosurgery. A contiguous thin-cut volumetric MRI with gadolinium with newer gadolinium-based agents can improve detection of small brain metastases. A systemic workup and medical evaluation are important, given that subsequent treatment for the brain metastases will also depend on the extent of the extracranial disease and on the age and performance status of the patient. Patients with hydrocephalus or impending brain herniation should be started on high doses of corticosteroids and evaluated for possible neurosurgical intervention. Patients with moderate symptoms should receive approximately 4-8 mg/d of dexamethasone in divided doses. The routine use of corticosteroids in patients without neurologic symptoms is not necessary. There is no proven benefit of anticonvulsants in patient without seizures. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
- Huang, Y., Chin, K., Robbins, J. R., Kim, J., Li, H., Amro, H., Chetty, I. J., Gordon, J., & Ryu, S. (2014). Radiosurgery of multiple brain metastases with single-isocenter dynamic conformal arcs (SIDCA).. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 112(1), 128-32. doi:10.1016/j.radonc.2014.05.009More infoTo propose single-isocenter dynamic conformal arcs (SIDCA), a novel technique for radiosurgery of multiple brain metastases, and to compare SIDCA with volumetric modulated arc therapy (VMAT) and multiple-isocenter dynamic conformal arcs (MIDCA) for plan quality..SIDCA, MIDCA, and VMAT plans were created on 6 patients with 3-5 metastases. Plans were evaluated using Radiation Therapy Oncology Group conformity index (RCI), Paddick conformity index (PCI), gradient index (GI), volumes that received more than 100% (V(100%)), 50% (V(50%)), 25% (V(25%)) and 10% (V(10%)) of prescription dose, total monitor units (MUs), and delivery time (DT)..SIDCA achieved conformal plans (RCI = 1.38 ± 0.12, PCI = 0.72 ± 0.06) with steep dose fall-off (GI = 3.97 ± 0.51). MIDCA plans had comparable plan quality and MUs as SIDCA, but 52% longer DT. The VMAT plans had better conformity (RCI = 1.15 ± 0.09, p < 0.01 and PCI = 0.86 ± 0.06, p < 0.01) than SIDCA, worse GI (4.34 ± 0.46, p < 0.01), higher V(25%) (p = 0.05) and V(10%) (p = 0.02), 49% less MUs and 46% shorter DT..All three techniques achieved conformal plans with steep dose fall-off from targets. SIDCA plans had similar plan quality as MIDCA but more efficient to delivery. SIDCA plans had lower peripheral dose spread than VMAT; VMAT plans had better conformity and faster delivery time than SIDCA.
- Robbins, J. (2014). ACR Appropriateness Criteria® pre-irradiation evaluation and management of brain metastases. Journal of palliative medicine.
- Robbins, J. (2014). Patient with multiple metachronous primary cancers. Indian Journal of Cancer.
- Robbins, J. (2014). Radiosurgery of multiple brain metastases with single-isocenter dynamic conformal arcs (SIDCA). Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.
- Robbins, J. R., X, W., Tousignant, R., I, A., Siddiqui, F., Wang, X., Robbins, R., R, T., & Aref, I. (2014). Patient with multiple metachronous primary cancers.. Indian journal of cancer, 51(4), 480. doi:10.4103/0019-509x.175346
- Elshaikh, M. A., Munkarah, A. R., Robbins, J. R., Laser, B. S., Bhatt, N., Siddiqui, F., & Cogan, C. M. (2013). The impact of race on outcomes of patients with early stage uterine endometrioid carcinoma.. Gynecologic oncology, 128(2), 171-4. doi:10.1016/j.ygyno.2012.10.016More infoThe purpose of the present study was to determine whether racial disparity exists between African American (AA) and non-African American (NAA) patients with uterine endometrioid carcinoma who received similar multidisciplinary management..We identified 766 patients with endometrioid adenocarcinoma 2009 FIGO stages I-II who underwent hysterectomy. Patients were divided into two groups; AA and NAA. Recurrence-free survival (RFS), disease specific survival (DSS) and overall survival (OS) for two groups were calculated..Median follow-up was 5.1 years. 27% were AA and 73% were NAA. All patients underwent hysterectomy and oophorectomy. 80% had peritoneal cytology examination and 69% underwent lymphadenectomy. AA patients were more likely to have higher grade tumors, and higher incidence of lymphovascular space involvement (LVSI). Although the two groups were balanced with regards to surgical staging and adjuvant treatment received, the 5-year RFS and DSS were significantly lower in AA compared to NAA patients (91% vs 84%, p=0.030; 95% vs 88%, p=0.011, respectively). Overall survival was not significantly different between the two groups. On multivariate analysis, after adjusting for other prognostic factors, race (AA vs NAA) was not a significant predictor of outcome. Grade 3 tumors and the presence of LVSI were the only two independent predictors of RFS and DSS with p ≤ 0.001 and p ≤ 0.001, respectively..In this large hospital-based study, AA race was associated with a higher incidence of adverse pathological features and worse recurrence-free and disease-specific survival. However, on multivariate analysis race was not an independent prognostic factor. Further studies are needed to elucidate possible underlying molecular mechanisms for these poorer outcomes.
- Kim, J., Kumar, S., Liu, C., Zhong, H., Pradhan, D., Cattaneo, R., Yechieli, R., Robbins, J. R., Elshaikh, M. A., Chetty, I. J., & Shah, M. M. (2013). A novel approach for establishing benchmark CBCT/CT deformable image registrations in prostate cancer radiotherapy.. Physics in medicine and biology, 58(22), 8077-97. doi:10.1088/0031-9155/58/22/8077More infoDeformable image registration (DIR) is an integral component for adaptive radiation therapy. However, accurate registration between daily cone-beam computed tomography (CBCT) and treatment planning CT is challenging, due to significant daily variations in rectal and bladder fillings as well as the increased noise levels in CBCT images. Another significant challenge is the lack of 'ground-truth' registrations in the clinical setting, which is necessary for quantitative evaluation of various registration algorithms. The aim of this study is to establish benchmark registrations of clinical patient data. Three pairs of CT/CBCT datasets were chosen for this institutional review board approved retrospective study. On each image, in order to reduce the contouring uncertainty, ten independent sets of organs were manually delineated by five physicians. The mean contour set for each image was derived from the ten contours. A set of distinctive points (round natural calcifications and three implanted prostate fiducial markers) were also manually identified. The mean contours and point features were then incorporated as constraints into a B-spline based DIR algorithm. Further, a rigidity penalty was imposed on the femurs and pelvic bones to preserve their rigidity. A piecewise-rigid registration approach was adapted to account for the differences in femur pose and the sliding motion between bones. For each registration, the magnitude of the spatial Jacobian (|JAC|) was calculated to quantify the tissue compression and expansion. Deformation grids and finite-element-model-based unbalanced energy maps were also reviewed visually to evaluate the physical soundness of the resultant deformations. Organ DICE indices (indicating the degree of overlap between registered organs) and residual misalignments of the fiducial landmarks were quantified. Manual organ delineation on CBCT images varied significantly among physicians with overall mean DICE index of only 0.7 among redundant contours. Seminal vesicle contours were found to have the lowest correlation amongst physicians (DICE = 0.5). After DIR, the organ surfaces between CBCT and planning CT were in good alignment with mean DICE indices of 0.9 for prostate, rectum, and bladder, and 0.8 for seminal vesicles. The Jacobian magnitudes |JAC| in the prostate, rectum, and seminal vesicles were in the range of 0.4-1.5, indicating mild compression/expansion. The bladder volume differences were larger between CBCT and CT images with mean |JAC| values of 2.2, 0.7, and 1.0 for three respective patients. Bone deformation was negligible (|JAC| = ∼ 1.0). The difference between corresponding landmark points between CBCT and CT was less than 1.0 mm after DIR. We have presented a novel method of establishing benchmark DIR accuracy between CT and CBCT images in the pelvic region. The method incorporates manually delineated organ surfaces and landmark points as well as pixel similarity in the optimization, while ensuring bone rigidity and avoiding excessive deformation in soft tissue organs. Redundant contouring is necessary to reduce the overall registration uncertainty.
- Kumar, S., Liu, C., Zhong, H., Pradhan, D., Chetty, I. J., Robbins, J. R., Kim, J. H., & Elshaikh, M. A. (2013). A Novel Approach for Establishing Benchmark CBCT/CT Deformable Image Registrations in Prostate Cancer Radiation Therapy. International Journal of Radiation Oncology Biology Physics, 87(2), S713. doi:10.1016/j.ijrobp.2013.06.1889
- Patel, S. H., Robbins, J. R., & Hamzavi, I. (2013). Radiation Therapy for Chronic Hidradenitis Suppurativa. Journal of Nuclear Medicine and Radiation Therapy, 4(1), 1-3. doi:10.4172/2155-9619.1000146More infoBackground: Hidradenitis suppurativa is a chronic follicular occlusive disease in apocrine gland-bearing regions. Frequently refractory to conventional oral and topical treatments, it may require surgical intervention. Objective: To investigate the effectiveness of radiation therapy for refractory hidradenitis suppurativa. Methods and materials: Five patients with refractory Hurley stage II/III hidradenitis suppurativa were treated with radiation therapy to 13 affected sites. Electron beam radiation to a total dose of 7.5 gray was applied over 3 consecutive days. Results: The mean age of patients was 45 years; 80% had hidradenitis suppurativa for ≥ 6 years. Three patients had Hurley stage III; 2 had Hurley stage II. All had been treated previously with topical and oral antibiotics and other therapies, including surgery, radiation therapy, Nd:YAG laser therapy, and infliximab. No complete responses were observed, but 53% of the lesions had a partial response. Lesions in the axilla, gluteal, and inguinal areas had response rates of 100%, 67%, and 50%, respectively, compared to 0% for perineal lesions. Conclusions: Radiation therapy may be a promising treatment for refractory hidradenitis suppurativa. A prospective study is warranted to further evaluate response rates, define optimal dose fractionation schedules, and better understand the risk of long-term toxicity.
- Robbins, J. (2013). A novel approach for establishing benchmark CBCT/CT deformable image registrations in prostate cancer radiotherapy. Physics in medicine and biology.
- Robbins, J. (2013). Adjuvant radiation therapy for patients with type II endometrial carcinoma: impact on tumor recurrence and survival. International journal of gynecological cancer : official journal of the International Gynecological Cancer Society.
- Robbins, J. (2013). Impact of age-adjusted Charlson comorbidity score on outcomes for patients with early-stage endometrial cancer. Gynecologic oncology.
- Robbins, J. (2013). The impact of income on clinical outcomes in FIGO stages i to II endometrioid adenocarcinoma of the uterus. American Journal of Clinical Oncology: Cancer Clinical Trials.
- Robbins, J. (2013). The impact of race on outcomes of patients with early stage uterine endometrioid carcinoma. Gynecologic oncology.
- Robbins, J. R., Gayar, O. H., Mahan, M., Elshaikh, M. A., Zaki, M. A., & Buekers, T. E. (2013). Impact of age-adjusted Charlson comorbidity score on outcomes for patients with early-stage endometrial cancer.. Gynecologic oncology, 131(3), 593-7. doi:10.1016/j.ygyno.2013.10.007More infoTo determine the impact of Age-Adjusted Charlson Comorbidity (AAC) index score on survival outcomes for patients with early stage endometrial cancer..After IRB-approval, AAC score at time of hysterectomy was retrospectively tabulated by physician chart review for 671 patients with 2009 FIGO stage I-II endometrioid adenocarcinoma. Patients were grouped based on their AAC scores as follows: 0-1 (n=204), 2-3 (n=293) and >3 (n=174). Kaplan-Meier and log-rank test methods and univariate and multivariate modeling with Cox regression analysis was used to determine significant predictors of each survival endpoint..After a median follow-up of 85 months, 225 deaths were recorded (34 from EC and 191 from other causes) with a 7-year Overall (OS) and Disease-specific survival (DSS) of 77.6% and 94.0%, respectively. Based on AAC grouping, the 7-year OS, DSS, and Recurrence-free survival (RFS) were: 92.9%, 96.8%, and 94.9% for AAC 0-1; 81.7%, 95.3%, and 89.8% for AAC 2-3: and 56%, 88.2%, and 84.9% for AAC>3 (p
- Robbins, J. R., Mahan, M. G., Krajenta, R. J., Munkarah, A. R., & Elshaikh, M. A. (2013). The impact of income on clinical outcomes in FIGO stages I to II endometrioid adenocarcinoma of the uterus.. American journal of clinical oncology, 36(6), 625-9. doi:10.1097/coc.0b013e31825eb386More infoTo determine the influence of income on clinical outcomes in patients with surgical stages I to II endometrioid adenocarcinoma of the uterus..We retrospectively analyzed the records of 660 women initially treated from 1985 to 2009. On the basis of income data obtained from the 2000 US census, patients were separated into various income groups (halves, tertiles, and quartiles) based on median household income, with most focus on the half income groups..Income groups were similar regarding treatments received and characteristics, with the exception of more African American (AA), unmarried patients, and a predilection for higher grade in the lower half income group (LHIG). Compared with the upper half income group (UHIG), the LHIG had lower disease-specific survival (DSS) (5 y: 93.9% vs. 97.0% and 10 y: 90.1% vs. 95.9%; P=0.023) and a trend toward lower overall survival (OS) (5 y: 83.4% vs. 86.5% and 10 y: 62.6% vs. 68.5%; P=0.067). In patients with higher-risk features, differences in outcomes between LHIG and UHIG were more pronounced; 10-year OS of 43.4% versus 60.2% (P=0.004) and 10-year DSS of 75.0% versus 93.0% (P=0.007), respectively. Regarding race, AA patients in the LHIG had lower OS than AA in the UHIG. On univariate analysis, income group and race were significant predictors for DSS, but on multivariate analysis, they were not statistically significant..Despite similar treatments and characteristics, a small decrease in DSS and a trend toward reduced OS was observed in LHIG patients, but income group was not statistically significant on multivariate analysis of outcome. These differences were more significant in patients with high-risk features.
- Yechieli, R., Rasool, N., Robbins, J. R., Cogan, C. M., & Elshaikh, M. A. (2013). Adjuvant radiation therapy for patients with type II endometrial carcinoma: impact on tumor recurrence and survival.. International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 23(4), 763-8. doi:10.1097/igc.0b013e31828b15cbMore infoThe optimal adjuvant treatment of type II endometrial carcinoma after hysterectomy remains controversial. The objective of this study was to determine the effect of adjuvant radiation therapy (RT) on recurrence-free survival (RFS), disease-specific survival (DSS), and overall survival in patients with early-stage type II endometrial carcinoma..In this institutional review board-approved study, our database of 1450 patients with endometrial cancer was reviewed. Seventy-nine surgically staged patients with 2009 International Federation of Gynecology and Obstetrics (FIGO) stages I and II serous and clear cell carcinoma were treated from 1991 to 2010. These patients were then divided into 2 groups; one group received adjuvant RT, and the other group included patients who did not receive adjuvant RT..The median age of the study cohort is 65 years, and the median follow-up is 47 months. Thirty-nine patients (49%) received adjuvant RT, and 40 patients did not. The 5-year RFS was significantly improved in patients who received RT (84% vs 58%; P = 0.002). Similarly, 5-year DSS was significantly improved in patients who received RT (87% vs 58%; P = 0.023) with a trend toward improved 5-year overall survival (74% vs 58%; P = 0.088). On multivariate analysis, lack of angiolymphatic invasion (P < 0.001 and P < 0.001), adjuvant RT (P < 0.001 and P = 0.004), and lack of lower uterine segment involvement (P = 0.007 and P = 0.009) were independent predictors of improved RFS and DSS, respectively..In the current study of surgically staged patients with type II endometrial carcinoma International Federation of Gynecology and Obstetrics stages I and II, adjuvant radiation therapy with or without chemotherapy resulted in a significant improvement in recurrence-free and disease-specific survival.
- Yechieli, R., Robbins, J. R., Mahan, M., Siddiqui, F., & Ajlouni, M. (2013). Stereotactic Body Radiation Therapy for the Treatment of Elderly Patients With Medically Inoperable Pancreatic Cancer. International Journal of Radiation Oncology Biology Physics, 87(2), S305. doi:10.1016/j.ijrobp.2013.06.802
- Ahunbay, E. E., Christian, R., Godley, A., White, J., Li, X. A., & Robbins, J. R. (2012). Interfractional target variations for partial breast irradiation.. International journal of radiation oncology, biology, physics, 82(5), 1594-604. doi:10.1016/j.ijrobp.2011.01.041More infoIn this work, we quantify the interfractional variations in the shape of the clinical target volume (CTV) by analyzing the daily CT data acquired during CT-guided partial breast irradiation (PBI) and compare the effectiveness of various repositioning alignment strategies considered to account for the variations..The daily CT data for 13 breast cancer patients treated with PBI in either prone (10 patients) or supine (3 patients) with daily kV CT guidance using CT on Rails (CTVision, Siemens, Malvern, PA) were analyzed. For approximately 25 points on the surface of the CTV, deformation vectors were calculated by means of deformable image registration and verified by visual inspection. These were used to calculate the distances along surface normals (DSN), which directly related to the required margin expansions for each point. The DSN values were determined for seven alignment methods based on volumetric imaging and also two-dimensional projections (portal imaging)..The margin expansion necessary to cover 99% of all points for all days was 2.7 mm when utilizing the alignment method based on deformation field data (the best alignment method). The center-of-mass based alignment yielded slightly worse results (a margin of 4.0 mm), and shifts obtained by operator placement (7.9 mm), two-dimensional-based methods (7.0-10.1 mm), and skin marks (13.9 mm) required even larger margin expansions. Target shrinkage was evident for most days by the negative values of DSN. Even with the best alignment, the range of DSN values could be as high as 7 mm, resulting in a large amount of normal tissue irradiation, unless adaptive replanning is employed..The appropriate alignment method is important to minimize the margin requirement to cover the significant interfractional target deformations observed during PBI. The amount of normal tissue unnecessarily irradiated is still not insignificant, and can be minimized if adaptive radiotherapy is applied.
- Kumar, S., Siddiqui, S. U., Yechieli, R., Pradhan, D., Kim, J., Shah, M. M., Saka, R. E., Robbins, J. R., & Elshaikh, M. A. (2012). Establishment of Benchmark CBCT/CT Deformable Image Registration in Radiation Therapy of Prostate Cancer. International Journal of Radiation Oncology Biology Physics, 84(3), S814. doi:10.1016/j.ijrobp.2012.07.2177
- Patel, S. H., Robbins, J. R., Gore, E. M., Bradley, J. D., Gaspar, L. E., Ghafoori, P., Henderson, M. A., Lutz, S. T., Mcdermott, M. W., Patchell, R. A., Robins, H. I., Vassil, A. D., Wippold, F. J., Videtic, G. M., & Germano, I. M. (2012). ACR Appropriateness Criteria® follow-up and retreatment of brain metastases.. American journal of clinical oncology, 35(3), 302-6. doi:10.1097/coc.0b013e31824be246More infoMultiple options for retreatment are available, which include whole-brain radiation therapy, stereotactic radiosurgery, surgery, chemotherapy, and supportive care. Size, number, timing, location, histology, performance status, and extracranial disease status all need to be carefully considered when choosing a treatment modality. There are no randomized trials examining the retreatment of brain metastases. Repeat whole-brain radiation has been examined in a single-institution experience, showing the potential for clinical responses in selected patients. Local control rates as high as 91% using stereotactic radiosurgery for relapses after whole-brain radiation are reported. Surgery can be indicated in progressive and/or hemorrhagic lesions causing mass effect. The role of chemotherapy in the recurrent setting is limited but some agents may have activity on the basis of experiences on a smaller scale. Supportive care continues to be an important option, especially in those with a poor prognosis. Follow-up for brain metastases patients is discussed, examining the modality, frequency of imaging, and imaging options in differentiating treatment effect from recurrence. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of the current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
- Rasool, N., Yechieli, R., Elshaikh, E., Robbins, J. R., Elshaikh, M., & Cogan, C. M. (2012). The impact of adjuvant therapy on tumor recurrence and survival of surgically staged patients with type II endometrial carcinoma: A single institution experience. Gynecologic Oncology, 125, S148. doi:10.1016/j.ygyno.2011.12.363
- Robbins, J. (2012). ACR appropriateness criteria® follow-up and retreatment of brain metastases. American Journal of Clinical Oncology: Cancer Clinical Trials.
- Robbins, J. (2012). Clinical outcomes of adjuvant chemotherapy and vaginal brachytherapy with or without pelvic radiation for surgical Stage I-II uterine serous carcinoma. European Journal of Gynaecological Oncology.
- Robbins, J. (2012). Histological grade predicts for recurrence in patients with uterine endometrioid carcinoma without myometrial involvement. Anticancer Research.
- Robbins, J. (2012). Interfractional Target Variations for Partial Breast Irradiation. International Journal of Radiation Oncology*Biology*Physics.
- Robbins, J. (2012). Is time to recurrence after hysterectomy predictive of survival in patients with early stage endometrial carcinoma?. Gynecologic oncology.
- Robbins, J. (2012). Radiosurgery to the Surgical Cavity as Adjuvant Therapy for Resected Brain Metastasis. Neurosurgery.
- Robbins, J. (2012). Radiosurgery to the surgical cavity as adjuvant therapy for resected brain metastasis. Neurosurgery.
- Robbins, J. R., Gayar, O. H., Zaki, Z., Mahan, M. G., Elshaikh, E., Elshaikh, M. A., & Buekers, T. E. (2012). The Impact of Age-adjusted Charlson Comorbidity Index on Survival in Patients With Early-stage Uterine Carcinoma -- A Single Institution Study. International Journal of Radiation Oncology Biology Physics, 84(3), S98. doi:10.1016/j.ijrobp.2012.07.256
- Robbins, J. R., Jacobson, G., Movsas, B., Elshaikh, E., Saka, R. E., & Elshaikh, M. A. (2012). Outcomes for Hormone-naïve Patients Who Achieved Undetectable PSA After Salvage Prostate Bed Radiation Treatment Postprostatectomy. International Journal of Radiation Oncology Biology Physics, 84(3), S393. doi:10.1016/j.ijrobp.2012.07.1037
- Robbins, J. R., Laser, B. S., Bhat, N., Elshaikh, M. A., Munkarah, A. R., & Cogan, C. M. (2012). The impact of racial disparity on outcomes of patients with early-stage uterine endometrioid carcinoma in an equal-access environment.. Journal of Clinical Oncology, 30(15_suppl), 5088-5088. doi:10.1200/jco.2012.30.15_suppl.5088More info5088 Background: To determine if racial disparity exists between African American (AA) and non-African American (NAA) patients with early stage uterine endometrioid carcinoma who had similar multidisciplinary management. Methods: Our prospectively-maintained database of 1,450 uterine cancer patients was reviewed for this IRB-approved study. We identified 766 consecutive patients with endometrioid carcinoma 1988 FIGO stages I-II who underwent hysterectomy between 1987-2009. Patients with non-endometrioid carcinoma, mixed histologies and those who received preoperative treatments were excluded. For the purpose of data analysis, patients were divided into two groups; AA and NAA. Recurrence-free survival (RFS), disease specific (DSS) and overall survival (OS) was calculated from the date of hysterectomy using the Kaplan-Meier method. Cox regression modeling was used to explore the risks of various factors on recurrence. Results: Median follow-up was 5.1 years. 27% were AA and 73% were NAA. All patients underw...
- Robbins, J. R., Ryu, S., Rock, J., Movsas, B., Kim, J. H., Rosenblum, M. L., Kalkanis, S. N., & Cogan, C. M. (2012). Radiosurgery to the surgical cavity as adjuvant therapy for resected brain metastasis.. Neurosurgery, 71(5), 937-43. doi:10.1227/neu.0b013e31826909f2More infoThe standard treatment of resected brain metastasis is whole-brain radiotherapy (WBRT). To avoid the potential toxicity of WBRT and to improve local control, we have used radiosurgery alone to the surgical cavity..To demonstrate the rates of local control, new intracranial metastasis, and overall survival using this treatment scheme without WBRT..Eighty-five consecutive patients with brain metastasis were treated with surgical resection of at least 1 lesion followed by radiosurgery alone to the surgical cavity and any unresected lesions from August 2000 to March 2011. Sixty-eight percent had gross total resections. After surgery, radiosurgery was delivered to the surgical cavity with a 2- to 3-mm margin. The median marginal radiosurgery dose was 16 Gy, and median target volume was 13.96 cm. Follow-up imaging and clinical examination were obtained every 2 to 3 months..Median follow-up time was 11.2 months. Overall local control was 81.2%. The 6-month, 1-year, and 2-year rates of local control were 88.7%, 81.4%, and 75.7%, respectively. Forty-seven patients (55%) developed new intracranial metastases at a median time of 5.6 months. For the entire population, the rate of new metastases was 32.1%, 58.1%, and 62.9% at 6 months, 1 year, and 2 years, respectively. Median overall survival time was 12.1 months. From initial treatment until death or last follow-up, only 30 patients (35%) received WBRT as salvage treatment..Radiosurgery to the surgical cavity without WBRT achieved excellent local control of resected brain metastasis. Close imaging follow-up allows early intervention for any new metastasis.
- Robbins, J. R., Siddiqui, M. S., Al-wahab, Z., Laser, B., Lu, M., Ali-fehmi, R., Elshaikh, M. A., & Munkarah, A. R. (2012). Clinical outcomes of adjuvant chemotherapy and vaginal brachytherapy with or without pelvic radiation for surgical stage I-II uterine serous carcinoma.. European journal of gynaecological oncology, 33(5), 449-54.More infoTo evaluate the benefit of adding pelvic radiation treatment (EBRT) to vaginal cuff brachytherapy (VB) for women with early stage uterine serous carcinoma (USC) treated with adjuvant chemotherapy..After institutional review board (IRB) approval, the authors retrospectively identified 56 patients with 2009 International Federation of Gynecology and Obstetrics (FIGO) Stage I-II USC treated with hysterectomy, bilateral oophorectomy +/- lymphadenectomy, adjuvant chemotherapy, and radiation therapy with either VB alone (n = 33) or VB + EBRT (n = 23) between July 1998 and August 2009..Median age and follow-up were 68.5 years and 54 months respectively. Median VB alone surface dose was 37.5 Gy and median pelvic EBRT dose was 45 Gy. The prevalence of lower uterine segment involvement, > 50% myometrial invasion, and Stage II disease were higher for patients receiving VB + EBRT. Overall, only one vaginal recurrence was observed. Pelvic recurrence rate was 26% for VB + EBRT compared to 12% for VB alone (p = 0.179). The five-year recurrence-free survival (RFS) was 80.5% for VB vs 67.3% for VB + EBRT (p = 0.3847), and the five-year overall survival (OS) was 65.9% for VB vs 66.7% for VB + EBRT (p = 0.7159). On univariate and multivariate analysis, radiation treatment modality was not a predictor for local control or survival..In this cohort, there was no significant clinical benefit of adding pelvic EBRT to the adjuvant management of early stage uterine serous carcinoma. The higher prevalence of high-risk features in the VB + EBRT group may underestimate the value of this treatment. Further investigation is warranted to identify the optimal radiation treatment regiment for early stage USC treated with surgery and adjuvant chemotherapy.
- Robbins, J. R., Yechieli, R., Laser, B., Mahan, M., Rasool, N., & Elshaikh, M. A. (2012). Is time to recurrence after hysterectomy predictive of survival in patients with early stage endometrial carcinoma?. Gynecologic oncology, 127(1), 38-42. doi:10.1016/j.ygyno.2012.06.042More infoTo determine the prognostic significance of time to recurrence (TTR) on overall survival (OS) and disease-specific survival (DSS) following recurrence in patients with stage I-II uterine endometrioid carcinoma..After IRB approval, we retrospectively identified 57 patients with recurrent endometrioid carcinoma who were initially treated for FIGO 1988 stages I-II between 1987 and 2009. The Kaplan-Meier approach and Cox regression analysis were used to estimate OS and DSS following recurrence and identify factors impacting outcomes..Median follow-up times were 54.8 months from hysterectomy and 19.8 months after recurrence. Median time to recurrence was 20.2 months. Twenty-eight (47%) patients had a recurrence
- Zaki, M. A., Robbins, J. R., Fatteh, S., Mahan, M. G., Hanna, R. K., & Elshaikh, M. A. (2012). Histological grade predicts for recurrence in patients with uterine endometrioid carcinoma without myometrial involvement.. Anticancer research, 32(9), 4061-5.More infoTo evaluate clinical outcomes and identify factors predictive for recurrence in patients with 1988 (FIGO) stage IA uterine endometrioid carcinoma..Patients who underwent hysterectomy for stage IA carcinoma were identified in our database. Fisher's exact and χ(2) tests were used to identify factors that influenced outcome. Survival plots were generated according to Kaplan-Meier product-limit method and the log-rank test was used to determine significance..A total of 121 patients were identified. Eighty-seven percent (n=105) had tumor FIGO grade 1, 9% (n=11) grade 2, and 4% (n=5) grade 3 tumors. Six patients (5%) experienced recurrence. The 5-year recurrence-free survival (RFS), disease-specific survival (DSS) and overall survival (OS) were 93%, 95%, and 85%, respectively. On univariate analysis, tumor FIGO grade 2/3 was strongly associated with tumor recurrence (p=0.003), DSS (p=0.016), and OS (p=0.023). The 5-year RFS, DSS, and OS were 65.1%, 73.9%, and 63.9% respectively for patients with grade 2 and 3 tumors, which were significantly less than the corresponding rates of 97.5% (p ≤ 0.0001), 98.6% (p=0.001), and 87.7% (p=0.024) for patients with grade 1 tumors..In this large cohort of patients, RFS, DSS and OS were excellent. Patients with FIGO grade 2/3 tumors had worse outcomes compared to those with grade 1 tumors. Therefore, while most patients with stage IA disease do not need adjuvant treatment after hysterectomy, our results suggest that patients with higher-grade tumors have an increased likelihood for recurrence and they may benefit from counseling regarding adjuvant therapies.
- Gayar, O. H., Robbins, J. R., Parikh, K., Lu, M., Elshaikh, M. A., Munkarah, A. R., & Buekers, T. E. (2011). Hysterectomy for uterine adenocarcinoma in the elderly: tumor characteristics, and long-term outcome.. Gynecologic oncology, 123(1), 71-5. doi:10.1016/j.ygyno.2011.06.036More infoTo evaluate the tumor recurrences and survival in elderly patients ≥75 years of age with uterine endometrioid carcinoma treated with surgical staging with/without adjuvant radiation therapy (RT)..We identified 675 surgically staged patients with FIGO stage I-II uterine endometrioid carcinoma who were treated between 1985 and 2009. Their medical records were retrospectively reviewed in this IRB-approved study. Patients were classified as ≥75 years vs.
- Laser, B., Robbins, J. R., Yechieli, R., Fatteh, S., Rasool, N., Mahan, M., Munkarah, A. R., & Elshaikh, M. A. (2011). Time to Recurrence After Primary Treatment Predicts Survival of Patients with Stage I-II Endometrial Cancer. International Journal of Radiation Oncology Biology Physics, 81(2), S472. doi:10.1016/j.ijrobp.2011.06.1013
- Robbins, J. (2011). Hysterectomy for uterine adenocarcinoma in the elderly: tumor characteristics, and long-term outcome. Gynecologic oncology.
- Robbins, J. (2011). Sorafenib induced radiation recall dermatitis after spine radiosurgery. Journal of Radiosurgery and SBRT.
- Robbins, J. (2011). Vaginal recurrence more than 17 years after hysterectomy and adjuvant treatment for uterine carcinoma with successful salvage brachytherapy: a case report. Case reports in oncology.
- Robbins, J. R., Alawieh, Z., Siddiqui, M., Aldridge, K., Dragovic, J., Pradhan, D., Levin, K., Walker, E. M., Siddiqui, U., & Glide-hurst, C. K. (2011). Dosimetric Indications for Intensity Modulated Radiation Therapy (IMRT) for the Treatment of Large Right Breast Volumes. International Journal of Radiation Oncology Biology Physics, 81(2), S267. doi:10.1016/j.ijrobp.2011.06.458
- Robbins, J. R., Siddiqui, M. S., Laser, B. S., Mahan, M. G., & Elshaikh, M. A. (2011). The Impact of Income on the Utilization of Adjuvant Radiation Therapy and Clinical Outcomes in Patients With FIGO Stage I-II Endometrial Adenocarcinoma. Brachytherapy, 10, S99. doi:10.1016/j.brachy.2011.02.209More infoGy e 60.3% vs 29.4%; 26e40 Gy e 28.2% vs 58.8%. In whole, preeplanned course of chemoradiation was completed successfully in 104 (92.8%) [Ie74 (94.9%), II e 30 (88.2%)] with HReCTV doses lower in group I vs group II: 62e66 Gy e 42.3% vs 17.6%, 67e70 Gy e 39.7% vs 52.9%, 71e75 Gy e 12.8% vs 23.5%, 76e81 Gy e 5.1% vs 5.8%. Treatment was safe in both groups, more tolerable in group I vs group II (no breaks: 25.6% vs 5.8%; break duration 7 3.4 vs 12.5 5.4 days, toxicity 3 II grade RTOG in bladder 15.4% vs 23.5%, intestinum 17.1% vs 41.1%, hematologic e 32.1% vs 73.5%. 5-year OS 88 (75.9%) [I- 62 (79.8%), II e 23 (67.6%)], DFS 81 (72.3%) [Ie 60 (76.9%), II e 21 (62.4%)], no late complications Grade III-IV EORTC. Conclusions: In locally advanced cervical cancer patients neoadjuvant chemotherapy allows to reduce significantly GTV, HR-CTV and OAR irradiated volumes before brachytherapy to ensure adequate tandem positioning and dose minimization in OAR; concomitant chemoradiation with full-dose chemotherapy doesn’t increase significantly speed and volume of tumor regression before brachytherapy. Image-guided brachytherapy with 3D DVH-based dose optimization allows to concentrate doses in target with maximal sparing of bladder, rectum and sigmoid, so optimal HR-CTV and IR-CTV doses for full-dose chemotherapy chemoradiation programs should be specify in additional trials. 10e15% increase of target dose and new cytotoxic drugs synthesis with moderate haematological, gastro-intestinal and urological toxicity are the most real ways to improve the results of locally advanced cervical cancer treatment.
- Yechieli, R., Robbins, J. R., Rock, J., Mikkelsen, T., Patel, S., Wen, N., & Ryu, S. (2011). Fractionated Stereotactic Radiosurgery in Recurrent Glioblastoma Multiforme: An Effective Method for Salvage Therapy. International Journal of Radiation Oncology Biology Physics, 81(2), S279. doi:10.1016/j.ijrobp.2011.06.483
- Yechieli, R., Robbins, J. R., Schultz, D., Elshaikh, M. A., & Munkarah, A. R. (2011). Vaginal recurrence more than 17 years after hysterectomy and adjuvant treatment for uterine carcinoma with successful salvage brachytherapy: a case report.. Case reports in oncology, 4(1), 242-5. doi:10.1159/000328076More infoAlthough the majority of recurrences occur within the first 3 years of hysterectomy for endometrioid carcinoma, we report herein a successful salvage vaginal brachytherapy in a patient with endometrioid uterine carcinoma which recurred more than 17 years after initial treatment..A 61-year-old female was diagnosed with endometrioid adenocarcinoma of the uterus and treated with TAH-BSO, followed by adjuvant external beam radiation therapy (EBRT) to the whole pelvis. After remaining free of any recurrent or metastatic disease for more than 17 years, she was diagnosed with isolated vaginal cuff recurrence and successfully treated with a salvage high-dose-rate intracavitary vaginal brachytherapy..The patient remained disease free until her death from unrelated causes 7 years later..To the best of our knowledge, this case represents the longest time to recurrence of endometrial cancer in someone who had been treated with TAH-BSO and adjuvant pelvic EBRT. This case highlights that even with adjuvant therapy, late recurrences may occur, and successful salvage brachytherapy is very effective.
- Laser, B., Robbins, J. R., Munkarah, A. R., Haley, M. M., & Elshaikh, M. A. (2010). Long-term Clinical Outcomes and Patterns of Recurrence of 750 Surgically Staged Patients with Stages I-II Endometrial Carcinoma: A Single Institution Experience. International Journal of Radiation Oncology Biology Physics, 78(3), S396-S397. doi:10.1016/j.ijrobp.2010.07.935
- Robbins, J. (2010). Radiation therapy as part of local control of metastatic neuroblastoma: the St Jude Children's Research Hospital experience. Journal of pediatric surgery.
- Robbins, J. R., Krasin, M. J., Panandiker, A. S., Watkins, A., Wu, J., Santana, V. M., Furman, W. L., Davidoff, A. M., & Mcgregor, L. M. (2010). Radiation therapy as part of local control of metastatic neuroblastoma: the St Jude Children's Research Hospital experience.. Journal of pediatric surgery, 45(4), 678-86. doi:10.1016/j.jpedsurg.2009.11.003More infoThe purpose of the study was to compare outcomes of pediatric patients with high-risk metastatic neuroblastoma who received radiotherapy (RT) with those of patients who did not..We reviewed the records of 63 patients with newly diagnosed metastatic neuroblastoma treated at our institution (1989-2001) to investigate their characteristics at presentation, dose and field of RT, treatment response, and failure patterns..Seventeen patients received RT, and 46 did not. In the RT group, a greater percentage of patients had residual disease before consolidation than did those in the no-RT group (88.2% vs 69.6%, P = .008). Gross total resection was achieved less often in the RT group (65% vs 89%, P = .055), but the 5-year cumulative incidences of local failure were similar (35.3% +/- 12.4% vs 32.6% +/- 7.1%). Although there was no difference in 5-year event-free survival, overall survival was better in the no-RT group (47.8% +/- 7.2% vs 23.5% +/- 9.2%, P = .026)..The addition of RT to the therapy of a group of patients with more residual locoregional disease appeared to improve the local failure rate to approximately that of patients with less residual disease. Radiotherapy may provide even greater benefit to those with less residual disease before consolidation.
- Robbins, J. R., Laser, B., Siddiqui, M. U., Bhatt, N., Al-wahab, Z., Elshaikh, E., Munkarah, A. R., Laser, L., & Elshaikh, M. A. (2010). Outcomes of Adjuvant Chemotherapy and Vaginal Brachytherapy with or without Pelvic External Beam Radiation for Surgical Stage I-II Uterine Serous Carcinoma. International Journal of Radiation Oncology Biology Physics, 78(3), S410. doi:10.1016/j.ijrobp.2010.07.965
- Ahunbay, E. E., Godley, A., White, J., Li, X. A., & Robbins, J. R. (2009). Interfractional Change of Lumpectomy Cavity during Partial Breast Irradiation. International Journal of Radiation Oncology Biology Physics, 75(3), S142-S143. doi:10.1016/j.ijrobp.2009.07.338
- Morrow, N., Ahunbay, E., White, J., Robbins, J. R., & Li, X. A. (2009). SU‐FF‐J‐83: Interfractional Geometric and Dosimetric Variations in Prone Breast Irradiation. Medical Physics, 36(6), 2495-2495. doi:10.1118/1.3181375More infoPurpose: To quantitatively evaluate interfractional variations in treatment setup and their dosimetric effects, in prone breast irradiation based on daily kVCT acquired during IGRT.Materials/Methods: In‐house study enrolling patients with prone breast irradiation to be treated on linac and CT‐on‐Rails combination (CTVision, Siemens) is on going. Patients with surgical clips placed in the lumpectomy cavity who fit through standard bore CT with field of view sufficient to image the whole treated breast are selected. Patients were setup prone with shifts made from a PA set up point to the isocenter. Registration was adjusted manually to achieve visual agreement between the daily and planning CTs using the cavity in conjunction with surgical clips. Daily CT data and repositioning shifts acquired for 15 patients were analyzed. Dose plan delivered with CT guidance (IGRT plan) for each treatment was reconstructed in the planning system (Xio, CMS) by placing the original beams on CT of the day with the corresponding shifts. In addition, the dosimetric plan with the patient shifts based on 2D portal images (non‐IGRT plan), as conventionally practiced, was reconstructed. Dose‐Volume‐Histograms (DVH) for PTV and organs‐at‐risk (OAR) for the IGRT, non‐IGRT and original plans were compared. Results: The daily shifts are patient dependent. Comparison of variations of D95 and D50 values shows higher interfractional variability for non‐IGRT plan. Average D95 was 1–2% lower for non‐IGRT plans than IGRT plans, with some fractions receiving as low as 91% of planned dose. IGRT plans showed improvement with minimum D95 of 95% of planned D95. Effect of the repositioning on the OAR DVH is patient specific and depends on the location of the cavity.Conclusion: The interfractional variations in patient setup and anatomic changes, and their dosimetric impact, in prone breast irradiation are significant, and can be reduced with IGRT based on kV fan‐beam CT.
- Robbins, J. (2009). SU-FF-J-83: Interfractional Geometric and Dosimetric Variations in Prone Breast Irradiation. Medical Physics.
- Robbins, J. R., Ehunbay, E. E., White, J., & Li, X. A. (2009). Dosimetric Advantages of Lumpectomy Cavity Guided Patient Positioning in Partial Breast Irradiation. International Journal of Radiation Oncology Biology Physics, 75(3), S650. doi:10.1016/j.ijrobp.2009.07.1482More infoposition were used in this study to compare dosimetric effects of commonly-used four image registration methods for patient repositioning: registration of the CT of the day with the planning CT based on the center of mass (COM) of lumpectomy cavity, and registration of the daily DRR (portal image for the day) with the planning DRR based on chest wall, surgical clips, or breast contours. AnIMRTplan with 5-9 beams wasgenerated for each patientsbasedon the planningCT. Thisplan was applied toeach daily CT to reconstruct the four plans for the four repositioning methods. Various dose-volume parameters including D95-PTV (dose covering 95% of PTV), D95-CTV and mean dose of the whole breast were compared. Results: The repositioning shifts consist systematic and random components (S, s) and were (4.5, 4.0), (3.2, 3.9), and (3.2, 4.5 mm), respectively, for clip, breast contour, and chest wall based alignments relative to those for the COM alignment. The average daily D95-PTVreductionfrom its planningvalue was1.0, 4.4, 4.0and 6.2%for COM, surgicalclips, breastcontour and chest-wall alignments respectively. The daily variation in the D95-PTV reduction was large for the DRR based methods, especially for the chest wall alignment, as compared to the COM method. Similar findings were obtained for D95-CTV. Conclusions: Comparing the various clinically-used image guidance methods in partial breast irradiation, the high-quality CT guided repositioning based on lumpectomy cavity is preferred for correcting interfractional setup errors and anatomic changes. The repositioning based on chest wall using 2D images should be avoided.
- Robbins, J. (2006). Cellular and molecular bases of the initiation of fever. PLoS biology.
- Steiner, A. A., Ivanov, A. I., Serrats, J., Hosokawa, H., Phayre, A. N., Robbins, J. R., Roberts, J. L., Kobayashi, S., Matsumura, K., Sawchenko, P. E., & Romanovsky, A. A. (2006). Cellular and molecular bases of the initiation of fever.. PLoS biology, 4(9), e284. doi:10.1371/journal.pbio.0040284More infoAll phases of lipopolysaccharide (LPS)-induced fever are mediated by prostaglandin (PG) E2. It is known that the second febrile phase (which starts at approximately 1.5 h post-LPS) and subsequent phases are mediated by PGE2 that originated in endotheliocytes and perivascular cells of the brain. However, the location and phenotypes of the cells that produce PGE2 triggering the first febrile phase (which starts at approximately 0.5 h) remain unknown. By studying PGE2 synthesis at the enzymatic level, we found that it was activated in the lung and liver, but not in the brain, at the onset of the first phase of LPS fever in rats. This activation involved phosphorylation of cytosolic phospholipase A2 (cPLA2) and transcriptional up-regulation of cyclooxygenase (COX)-2. The number of cells displaying COX-2 immunoreactivity surged in the lung and liver (but not in the brain) at the onset of fever, and the majority of these cells were identified as macrophages. When PGE2 synthesis in the periphery was activated, the concentration of PGE2 increased both in the venous blood (which collects PGE2 from tissues) and arterial blood (which delivers PGE2 to the brain). Most importantly, neutralization of circulating PGE2 with an anti-PGE2 antibody both delayed and attenuated LPS fever. It is concluded that fever is initiated by circulating PGE2 synthesized by macrophages of the LPS-processing organs (lung and liver) via phosphorylation of cPLA2 and transcriptional up-regulation of COX-2. Whether PGE2 produced at the level of the blood-brain barrier also contributes to the development of the first phase remains to be clarified.
- Robbins, J. (2005). Expanding the febrigenic role of cyclooxygenase-2 to the previously overlooked responses. American Journal of Physiology - Regulatory, Integrative and Comparative Physiology.
- Robbins, J. (2005). Thermoregulatory responses of rats to conventional preparations of lipopolysaccharide are caused by lipopolysaccharide per se-- not by lipoprotein contaminants. American Journal of Physiology - Regulatory, Integrative and Comparative Physiology.
- Robbins, J. (2005). Thermoregulatory responses to lipopolysaccharide in the mouse: dependence on the dose and ambient temperature. American Journal of Physiology - Regulatory, Integrative and Comparative Physiology.
- Rudaya, A. Y., Steiner, A. A., Robbins, J. R., Dragic, A. S., & Romanovsky, A. A. (2005). Thermoregulatory responses to lipopolysaccharide in the mouse: dependence on the dose and ambient temperature.. American journal of physiology. Regulatory, integrative and comparative physiology, 289(5), R1244-52. doi:10.1152/ajpregu.00370.2005More infoMost published studies of thermoregulatory responses of mice to LPS involved a stressful injection of LPS, were run at a poorly controlled and often subneutral ambient temperature (T(a)), and paid little attention to the dependence of the response on the LPS dose. These pitfalls have been overcome in the present study. Male C57BL/6 mice implanted with jugular vein catheters were kept in an environmental chamber at a tightly controlled T(a). The relationship between the T(a)s used and the thermoneutral zone of the mice was verified by measuring tail skin temperature, either by infrared thermography or thermocouple thermometry. Escherichia coli LPS in a wide dose range (10(0)-10(4) microg/kg) was administered through an extension of the jugular catheter from outside the chamber. The responses observed were dose dependent. At a neutral T(a), low (just suprathreshold) doses of LPS (10(0)-10(1) microg/kg) caused a monophasic fever. To a slightly higher dose (10(1.5) microg/kg), the mice responded with a biphasic fever. To even higher doses (10(1.75)-10(4) microg/kg), they responded with a polyphasic fever, of which three distinct phases were identified. The dose dependence and dynamics of LPS fever in the mouse appeared to be remarkably similar to those seen in the rat. However, the thermoregulatory response of mice to LPS in a subthermoneutral environment is remarkably different from that of rats. Although very high doses of LPS (10(4) microg/kg) did cause a late (latency, approximately 3 h) hypothermic response in mice, the typical early (latency, 10-30 min) hypothermic response seen in rats did not occur. The present investigation identifies experimental conditions to study LPS-induced mono-, bi-, and polyphasic fevers and late hypothermia in mice and provides detailed characteristics of these responses.
- Steiner, A. A., Chakravarty, S., Robbins, J. R., Dragic, A. S., Pan, J., Herkenham, M., & Romanovsky, A. A. (2005). Thermoregulatory responses of rats to conventional preparations of lipopolysaccharide are caused by lipopolysaccharide per se-- not by lipoprotein contaminants.. American journal of physiology. Regulatory, integrative and comparative physiology, 289(2), R348-R352. doi:10.1152/ajpregu.00223.2005More infoLPS preparations cause a variety of body temperature (T(b)) responses: monophasic fever, different phases of polyphasic fever, and hypothermia. Conventional (c) LPS preparations contain highly active lipoprotein contaminants (endotoxin proteins). Whereas LPS signals predominantly via the Toll-like receptor (TLR) 4, endotoxin proteins signal via TLR2. Several TLR2-dependent responses of immunocytes to cLPS in vitro are triggered by endotoxin proteins and not by LPS itself. We tested whether any T(b) response to cLPS from Escherichia coli 055:B5 is triggered by non-TLR4-signaling contaminants. A decontaminated (d) LPS preparation (free of endotoxin proteins) was produced by subjecting cLPS to phenol-water reextraction. The presence of non-TLR4-signaling contaminants in cLPS (and their absence in dLPS) was confirmed by showing that cLPS (but not dLPS) induced IL-1beta expression in the spleen and increased serum levels of TNF-alpha and IL-1beta of C3H/HeJ mice; these mice bear a nonfunctional TLR4. Yet, both cLPS and dLPS caused cytokine responses in C3H/HeOuJ mice; these mice bear a fully functional TLR4. We then studied the T(b) responses to cLPS and dLPS in Wistar rats preimplanted with jugular catheters. At a neutral ambient temperature (30 degrees C), a low (0.1 microg/kg iv) dose of cLPS caused a monophasic fever, whereas a moderate (10 microg/kg iv) dose produced a polyphasic fever. In the cold (20 degrees C), a high (500 microg/kg iv) dose of cLPS caused hypothermia. All T(b) responses to dLPS were identical to those of cLPS. We conclude that all known T(b) responses to LPS preparations are triggered by LPS per se and not by non-TLR4-signaling contaminants of such preparations.
- Steiner, A. A., Rudaya, A. Y., Robbins, J. R., Dragic, A. S., Langenbach, R., & Romanovsky, A. A. (2005). Expanding the febrigenic role of cyclooxygenase-2 to the previously overlooked responses.. American journal of physiology. Regulatory, integrative and comparative physiology, 289(5), R1253-7. doi:10.1152/ajpregu.00371.2005More infoPrevious studies on the role of cyclooxygenase (COX)-1 and -2 in fever induced by intravenous LPS have failed to investigate the role of these isoenzymes in the earliest responses: monophasic fever (response to a low, near-threshold dose of LPS) and the first phase of polyphasic fever (response to higher doses). We studied these responses in 96 mice that were COX-1 or COX-2 deficient (-/-) or sufficient (+/+). Each mouse was implanted with a temperature telemetry probe into the peritoneal cavity and a jugular catheter. The study was conducted at a tightly controlled, neutral ambient temperature (31 degrees C). To avoid stress hyperthermia (which masks the onset of fever), all injections were performed through a catheter extension. The +/+ mice responded to intravenous saline with no change in deep body temperature. To a low dose of LPS (1 microg/kg iv), they responded with a monophasic fever. To a higher dose (56 microg/kg), they responded with a polyphasic fever. Neither monophasic fever nor the first phase of polyphasic fever was attenuated in the COX-1 -/- mice, but both responses were absent in the COX-2 -/- mice. The second and third phases of polyphasic fever were also missing in the COX-2 -/- mice. The present study identifies a new, critical role for COX-2 in the mediation of the earliest responses to intravenous LPS: monophasic fever and the first phase of polyphasic fever. It also suggests that no product of the COX-1 gene, including the splice variant COX-1b (COX-3), is essential for these responses.
Others
- Robbins, J. (2019). Radiation Therapy. Cancer Regional Therapy.
- Robbins, J. (2017). Liver Malignancies. Handbook of Palliative Radiation Therapy.