Browsing by Author "Johnson, Ronald"

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Placement technique and the early complications of balloon breast brachytherapy - magee-womens hospital experience
(Lippincott Williams & Wilkins, 2007-04-01) Soran, Atilla; Beriwal, Sushil; Mogus, Robert; Keenan, Donald; Kelley, Joseph L.; Balkan, Mujdat; Harlak, Ali; Bonaventura, Marguerite A.; Johnson, Ronald; Falk, Jeffrey S.; Evrensel, Türkkan; EVRENSEL, TÜRKKAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Onkoloji Anabilim Dalı.; 0000-0002-3398-7230; 0000-0002-9015-5617; AAJ-1027-2021
Backgrounds and Objectives: Open (OT) and percutaneous closed (PCT) techniques have been described for placement of the MammoSite catheter to deliver accelerated partial breast brachytherapy. We report early complications of both techniques.Methods: A total of 125 patients underwent catheter placement for MammoSite high-dose rate brachytherapy, with 108 patients successfully completing treatment. The OT was used in 85 patients and PCT in 40 patients. The mean distance between the balloon surface and breast skin was 1.44 cm and 1.31 cm, respectively. Average skin dose was 278 cGy in the OT group and 295 cGy in the PCT group (P > 0.05). Average gross specimen size was 43.16 cm(3) in the OT group and 62.19 cm(3) in the PCT group. Median follow-up was I I months for the OT group and 5 months for the PCT group.Results: In 17 cases, the catheter was subsequently removed without the patient completing treatment. Two of the patients in the OT group (3%) developed a delayed abscess. The overall incidence of persistent seroma (>6 months) was 20% with all occurring in the OT group, 30% of those patients. There were no acute skin toxicities higher than grade 2. The overall cosmesis is excellent or good in 95% of patients.Conclusion: Despite short follow-up and a small sample size in this study, it seems that the MammoSite brachytherapy was well tolerated by patients with early stage breast cancer when using either the OT or PCT.
The predicted probability of having positive non-sentinel lymph nodes in patients who received neoadjuvant chemotherapy for large operable breast cancer
(Wiley, 2008-09) Johnson, Ronald; Ahrendt, Gretchen; Bonaventura, Marguerite; Falk, Jeffrey; Keenan, Donald; Soran, Atilla; Evrensel, Türkkan; Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Onkoloji Anabilim Dalı.; 0000-0002-9732-5340; AAJ-1027-2021; 6603942124
The accuracy of the nomogram in women with positive sentinel nodes following neoadjuvant chemotherapy (NCT) is unknown. The aim of this study was to evaluate the accuracy of the nomogram in patients receiving NCT. Between December 1999 and December 2005, we identified 233 patients who had a positive sentinel lymph node biopsy (SLNB) and complete axillary lymph node dissection at Magee-Womens Hospital of University of Pittsburgh Medical Center. Thirty-two patients (14%) had presented with clinically N0 breast cancer (BC) for which NCT was administered. The computerised BC nomogram was used to calculate the probability of non-sentinel node metastases utilising tumour size before NCT and after NCT for the same patient. The discrimination of the nomogram was assessed by calculating the area under (AUC) the receiver operating characteristic curve (ROC). The median patient age was 51.5 (range: 39-66) years in the NCT group of patients. Twelve patients (37%) had positive axillary non-sentinel lymph nodes (NSLNs). The nomogram was first validated in our institution for 201 patients without NCT and the predicted accuracy of the nomogram by the AUC was 0.73. The area under the ROC was identical regardless of whether pre- or posttreatment tumour size was used to determine predicted probability of NSLN metastases (0.66). The predictive accuracy of the nomogram was found to have less power for patients receiving NCT (0.66) than the non-NCT group of patients.
Randomized trial comparing resection of primary tumor with no surgery in stage IV breast cancer at presentation: Protocol MF07-01
(Springer, 2018-10-24) Soran, Atilla; Ozmen, Vahit; Ozbas, Serdar; Karanlık, Hasan; Muslumanoglu, Mahmut; Igci, Abdullah; Canturk, Zafer; Utkan, Zafer; Ozaslan, Cihangir; Uras, Cihan; Aksaz, Erol; Soyder, Aykut; Ugurlu, Umit; Col, Cavit; Cabioglu, Neslihan; Bozkurt, Betül; Uzunkoy, Ali; Koksal, Neset; Gulluoglu, Bahadir M.; Ünal, Bülent; Atalay, Can; Yildirim, Emin; Erdem, Ergun; Salimoglu, Semra; Sezer, Atakan; Koyuncu, Ayhan; Gurleyik, Gunay; Alagol, Haluk; Ulufi, Nalan; Berberoglu, Ugur; Dulger, Mustafa; Cengiz, Omer; Sezgin, Efe; Johnson, Ronald; Evrensel, Türkkan; Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; 0000-0002-9732-5340; AAJ-1027-2021; 6603942124
The MF07-01 trial is a multicenter, phase III, randomized, controlled study comparing locoregional treatment (LRT) followed by systemic therapy (ST) with ST alone for treatment-na < ve stage IV breast cancer (BC) patients. At initial diagnosis, patients were randomized 1:1 to either the LRT or ST group. All the patients were given ST either immediately after randomization or after surgical resection of the intact primary tumor. The trial enrolled 274 patients: 138 in the LRT group and 136 in the ST group. Hazard of death was 34% lower in the LRT group than in the ST group (hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.49-0.88; p = 0.005). Unplanned subgroup analyses showed that the risk of death was statistically lower in the LRT group than in the ST group with respect to estrogen receptor (ER)/progesterone receptor (PR)(+) (HR 0.64; 95% CI 0.46-0.91; p = 0.01), human epidermal growth factor 2 (HER2)/neu(-) (HR 0.64; 95% CI 0.45-0.91; p = 0.01), patients younger than 55 years (HR 0.57; 95% CI 0.38-0.86; p = 0.007), and patients with solitary bone-only metastases (HR 0.47; 95% CI 0.23-0.98; p = 0.04). In the current trial, improvement in 36-month survival was not observed with upfront surgery for stage IV breast cancer patients. However, a longer follow-up study (median, 40 months) showed statistically significant improvement in median survival. When locoregional treatment in de novo stage IV BC is discussed with the patient as an option, practitioners must consider age, performance status, comorbidities, tumor type, and metastatic disease burden.
The predictive probability of two different breast cancer nomograms for non sentinel axillary lymph node metastasis in positive sentinel lymph node biopsy
(Aves, 2008-07-01) Gür, Akif Serhat; Ünal, Bülent; Johnson, Ronald; Ahrendt, Gretchen; Bonaventura, Marguerite; Evrensel, Türkkan; Soran, Atilla; EVRENSEL, TÜRKKAN; Uludağ Üniversitesi/Tıp Fakültesi/Medikal Onkoloji Anabilim Dalı.; 0000-0002-9732-5340; AAJ-1027-2021
INTRODUCTION: Non sentinel axillary lymph node metastasis (NSLNM) occurs in 35-50% of breast cancer (BC) patients having positive sentinel lymph nodes (SLN). A nomogram which includes 8 variables was developed at Memorial Sloan Kettering Cancer Center (MSKCC) in 2003 and it has been validated at sources outside that institution. The Stanford University group recently reported their nomogram which evaluated 3 variables. AIM: The aim of this study is to evaluate the predictability of two different scoring systems wherein 3 or 8 variables are used in the same patient groups.MATERIALS and METHODS: We identified 201 patients who had a positive SLN biopsy and completion axillary lymph node dissection at Magee-Womens Hospital of UPMC over a 5 year period. The computerized BC nomograms developed by MSKCC and Stanford University were used to calculate the probability of non-sentinel lymph node metastases. Area Under (AUC) Receiver Operating Characteristics Curve (ROC) was calculated for each nomogram and the values more than 0.70 have been accepted that presents considerable discrimination.RESULTS: Sixty-six of 201 patients (32.8%) had positive axillary NSLNM. The mean predicted probability of positive NSLNM was 25.4% (3-93), and 66.3% (7-100) for the MSKCC and Stanford nomograms, respectively. The AUC values were 0.73 and 0.67 for MSKCC and Stanford nomograms, respectively.DISCUSSION and CONCLUSION: Nomograms for predicting the probability of NSLNM in BC patients have been in use for 5 years. It is clear there are discrepancies in the results of nomograms among the studies using the same scoring system. Notwithstanding the Stanford nomogram is easier to implement as it considers only 3 variables in our study, we found the MSKCC nomogram to be more predictive than the Stanford nomogram Nomograms developed at outside institutions should be used with caution when counseling patients regarding the risk of additional nodal disease.
What is the predicted probability of having positive non-sentinel lymph nodes in patients who received neoadjuvant chemotherapy (NCT) for locally advanced breast cancer?
(Elsevier, 2006) Soran, Atilla; Ahrendt, Gretchen; Koçer, Belma; Bonaventura, Marguerite; Falk, Jeffrey; Keenan, Donald; Johnson, Ronald; Evrensel, Türkkan; Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Onkoloji Anabilim Dalı.; 0000-0002-9732-5340; AAJ-1027-2021