Public Health Commons^™

Management And Prognosis In Synchronous Solitary Resected Brain Metastasis From Non–Small-Cell Lung Cancer, Alexander Louie, George Rodrigues, Brian Yaremko, Edward Yu, A. Dar, Brian Dingle, Mark Vincent, Michael Sanatani, Richard Malthaner, Richard Inculet

Richard A. Malthaner

Background: Reports in the medical literature have described cases of extended survival of patients with non-small-cell lung cancer (NSCLC) with solitary metastatic disease who have received aggressive treatment both to the brain metastasis and to the local/regional disease. The objective of this research is to analyze prognostic factors that predict for outcome in this unique patient population.

Patients and methods: A single-institution, retrospective chart review was performed on 35 patients with NSCLC and a synchronous solitary brain metastasis (SSBM) treated with craniotomy and whole-brain radiation therapy. Eight patients (22.9%) had chest surgery, 24 (68.6%) had chemotherapy, and 14 (40%) had …

Neoadjuvant Or Adjuvant Therapy For Resectable Esophageal Cancer: A Systematic Review And Meta-Analysis, Richard Malthaner, Rebecca Wong, R. Rumble, Lisa Zuraw

Richard A. Malthaner

Background: Carcinoma of the esophagus is an aggressive malignancy with an increasing incidence. Its virulence, in terms of symptoms and mortality, justifies a continued search for optimal therapy. The large and growing number of patients affected, the high mortality rates, the worldwide geographic variation in practice, and the large body of good quality research warrants a systematic review with meta-analysis.

Methods: A systematic review and meta-analysis investigating the impact of neoadjuvant or adjuvant therapy on resectable thoracic esophageal cancer to inform evidence-based practice was produced.MEDLINE, CANCERLIT, Cochrane Library, EMBASE, and abstracts from the American Society of Clinical Oncology and the …

Definitive Radiation Therapy Management For Medically Non-Resectable Clinically Localised Non-Small Cell Lung Cancer: Results & Prognostic Factors, Edward Yu, Patricia Tai, Robert Ash, Michael Lee, Larry Stitt, George Rodrigues, Rashid Dar, Mark Vincent, Richard Inculet, Richard Malthaner

Richard A. Malthaner

The aim of this paper is to review the experience of radical radiation therapy and the prognostic factors of patient outcome for clinically localised, medically inoperable non-small cell lung cancer (NSCLC) patients. Clinically staged node-negative NSCLC patients who were not a surgical candidates due to co-morbid diseases but who were eligible for curative treatment, were reviewed in the London Regional Cancer Program (LRCP). This study population was treated between 1st Jan 1985 to 31st Jan 2004. Patients were excluded if they were previously treated with chest radiotherapy. Patients with localised disease, but who refused surgery, were also included in the …

Neoadjuvant Or Adjuvant Therapy For Resectable Esophageal Cancer: A Clinical Practice Guideline, Richard Malthaner, Rebecca Wong, R. Rumble, Lisa Zuraw

Richard A. Malthaner

Background: Carcinoma of the esophagus is an aggressive malignancy with an increasing incidence. Its virulence, in terms of symptoms and mortality, justifies a continued search for optimal therapy. A clinical practice guideline was developed based on a systematic review investigating neoadjuvant or adjuvant therapy on resectable thoracic esophageal cancer. Methods: A systematic review with meta-analysis was developed and clinical recommendations were drafted. External review of the practice guideline report by practitioners in Ontario, Canada was obtained through a mailed survey, and incorporated. Final approval of the practice guideline was obtained from the Practice Guidelines Coordinating Committee. Results: The systematic review …

What Factors Predict Outcome At Relapse After Previous Esophagectomy And Adjuvant Therapy In High-Risk Esophageal Cancer?, Edward Yu, Patricia Tai, Richard Malthaner, Larry Stitt, George Rodrigues, Rashid Dar, Brian Yaremko, Jawaid Younus, Michael Sanatani, Mark Vincent, Brian Dingle, Dalilah Fortin, Richard Inculet

Richard A. Malthaner

Management of patients who have disease relapse after completion of surgery and adjuvant chemo-radiation (CRT) is controversial. Some oncologists would advocate intensive therapeutic intervention due to promising experience on treatment for recurrence disease while others would recommend palliative support due to the concerns for poor patient outcome post disease recurrence. In Addition, it is not clear if patient outcome is improved post adjuvant CRT when patients at risk have resection margin involvement and if time interval to recurrence can affect patient survival post relapse. The present study was conducted to determine what factors will affect patient outcome at relapse after …

Post-Operative Extended Volume External Beam Radiation Therapy Is Safe For High Risk Esophageal Cancer Patients, Edward Yu, Patricia Tai, Jawaid Younus, Richard Malthaner, Larry Stitt, Pauline Truong, George Rodrigues, Robert Ash, Rashid Dar, Anna Tomiak, Mark Vincent, Walter Kocha, Brian Dingle, Richard Inculet

Richard A. Malthaner

Post-operative radiation therapy (RT) (1) and post-operative chemoradiation (2) have been used for esophageal cancer patients deemed high risk for recurrence after esophagectomy. Defining opitmal RT target volume after esophagectomy is difficult due to significant changes in patient anatomy and function. Some radiationon cologists advocated the inclusion of the anastomotic site within the irradiation volume due to concerns for potential increased relapse risk, while others did not subscribe to this practice due to concerns for increased treatment related toxicity. We have previously reported patient outcome benefit using extended volume RT In management with high risk esophageal cancer patients underwent esopagectomy(3). …

Extended Vs. Small Field Irradiation In High Risk Post Esophagectomy Patients Receiving Combined Chemoradiation Therapy: A Decade Experience In Treatment Of Esophageal Cancer, Edward Yu, Patricia Tai, George Rodrigues, Robert Ash, Larry Stitt, Rashid A. Dar, Pauline Truong, Gregory M. Videtic, Richard Malthaner, Richard Inculet, Anna Tomiak, Jawaid Younus, Brian Dingle, Walter Kocha, Mark Vincent

Richard A. Malthaner

OBJECTIVE: To assess the impact of extended field irradiation with anastomotic coverage on local recurrence in high risk resected esophageal cancerpatients. METHODS: From 1989-1999, high risk resected esophageal cancer cases receiving post-resection chemoradiation were reviewed. Adjuvant chemotherapy consisted of four cycles of fluorouracil-based regimens. Loco-regional irradiation with or without coverage of anastomotic site had radiation a dose range from 45-60 Gyat 1.8-2.0 Gy/fraction given with initial anterior-posterior/posterior-anterior arrangement with either extended (with anastomotic coverage), or small (without anastomotic coverage) field followed by oblique fields for boost. RESULTS: One hundred eighty-eight charts were reviewed. Seventy-two patients were eligible for post-resection chemoradiation. …

Cyclosporin Versus Tacrolimus For Liver Transplanted Patients, Elizabeth Haddad, Vivian Mcalister, Elizabeth Renouf, Richard Malthaner, Mette Kjaer, Lise Gluud

Richard A. Malthaner

A systematic review of randomized clinical trials (RCT) was undertaken to evaluate the beneficial and harmful effects of immunosuppression with cyclosporin versus tacrolimus for liver transplanted patients. MEDLINE, EMBASE, Cochrane Central and Hepato-Biliary Group Controlled Trials Registers were searched. Using fixed and random effects model, relative risk (RR), values <1 favoring>tacrolimus, with 95% confidence intervals (CI) were calculated. Of 717 potentially relevant references, 16 RCTs were eligible for inclusion. Mortality and graft loss at 1 year were significantly reduced in tacrolimus-treated recipients (Death: RR 0.85, 95% CI 0.73-0.99; graft loss: RR 0.73, 95% CI 0.61-0.86). Tacrolimus reduced the number of recipients …

The Role Of Radiation Therapy On Medically Inoperable Clinically Localized Non-Small Cell Lung Patients: London Regional Cancer Program (Lrcp) Clinical Experience, Michael Lee, Edward Yu, Robert Ash, Patricia Tai, Larry Stitt, George Rodrigues, Rashid Dar, Mark Vincent, Richard Inculet, Richard Malthaner

Richard A. Malthaner

Lung cancer is the most frequent cause of cancer death in both men and women in North America. In 2006, an estimated 22,700 Canadians will be diagnosed with lung cancer and 19,300 will die of it (Canadian Cancer Statistics 2006). Approximately 15-20% of NSCLC patients present with early or localized disease. Surgical resection of T1-2N0 NSCLC remains the treatment of choice for this population, and results in a 5-year survival rate of 50-70%. Patients deemed medically inoperable have been treated with non-surgical therapies, such as radiation therapy(RT), while some patients have simply been observed without any tumor therapy because of …

Subsets More Likely To Benefit From Surgery Or Prophylactic Cranial Irradiation After Chemoradiation For Localized Non-Small-Cell Lung Cancer, Bruce Keith, Mark Vincent, Larry Stitt, Anna Tomiak, Richard Malthaner, Edward Yu, Pauline Truong, Richard Inculet, Michael Lefcoe, A. Dar, Walter Kocha, Ian Craig

Richard A. Malthaner

After chemoradiation for localized non-small-cell lung cancer, surgery and prophylactic cranial irradiation (PCI) have been used as additional therapies. Less than a third of patients develop brain recurrences, or have local recurrence as their sole initial site of recurrence; these are groups that would benefit from PCI or surgery, respectively. Pretreatment identification of patients more likely to benefit from surgery or PCI would be useful. A retrospective analysis of 80 patients was performed to determine prognostic factors for such patterns of failure. Twenty-nine patients were subsequently selected for surgery in a nonrandomized manner. Seventeen patients had isolated local initial recurrence …

Management And Prognosis In Synchronous Solitary Resected Brain Metastasis From Non–Small-Cell Lung Cancer, Alexander Louie, George Rodrigues, Brian Yaremko, Edward Yu, A. Dar, Brian Dingle, Mark Vincent, Michael Sanatani, Richard Malthaner, Richard Inculet

Richard A. Malthaner

Background: Reports in the medical literature have described cases of extended survival of patients with non-small-cell lung cancer (NSCLC) with solitary metastatic disease who have received aggressive treatment both to the brain metastasis and to the local/regional disease. The objective of this research is to analyze prognostic factors that predict for outcome in this unique patient population.

Patients and methods: A single-institution, retrospective chart review was performed on 35 patients with NSCLC and a synchronous solitary brain metastasis (SSBM) treated with craniotomy and whole-brain radiation therapy. Eight patients (22.9%) had chest surgery, 24 (68.6%) had chemotherapy, and 14 (40%) had …

Neoadjuvant Or Adjuvant Therapy For Resectable Esophageal Cancer: A Systematic Review And Meta-Analysis, Richard Malthaner, Rebecca Wong, R. Rumble, Lisa Zuraw

Richard A. Malthaner

Background: Carcinoma of the esophagus is an aggressive malignancy with an increasing incidence. Its virulence, in terms of symptoms and mortality, justifies a continued search for optimal therapy. The large and growing number of patients affected, the high mortality rates, the worldwide geographic variation in practice, and the large body of good quality research warrants a systematic review with meta-analysis.

Methods: A systematic review and meta-analysis investigating the impact of neoadjuvant or adjuvant therapy on resectable thoracic esophageal cancer to inform evidence-based practice was produced.MEDLINE, CANCERLIT, Cochrane Library, EMBASE, and abstracts from the American Society of Clinical Oncology and the …

Definitive Radiation Therapy Management For Medically Non-Resectable Clinically Localised Non-Small Cell Lung Cancer: Results & Prognostic Factors, Edward Yu, Patricia Tai, Robert Ash, Michael Lee, Larry Stitt, George Rodrigues, Rashid Dar, Mark Vincent, Richard Inculet, Richard Malthaner

Richard A. Malthaner

The aim of this paper is to review the experience of radical radiation therapy and the prognostic factors of patient outcome for clinically localised, medically inoperable non-small cell lung cancer (NSCLC) patients. Clinically staged node-negative NSCLC patients who were not a surgical candidates due to co-morbid diseases but who were eligible for curative treatment, were reviewed in the London Regional Cancer Program (LRCP). This study population was treated between 1st Jan 1985 to 31st Jan 2004. Patients were excluded if they were previously treated with chest radiotherapy. Patients with localised disease, but who refused surgery, were also included in the …

Neoadjuvant Or Adjuvant Therapy For Resectable Esophageal Cancer: A Clinical Practice Guideline, Richard Malthaner, Rebecca Wong, R. Rumble, Lisa Zuraw

Richard A. Malthaner

Background: Carcinoma of the esophagus is an aggressive malignancy with an increasing incidence. Its virulence, in terms of symptoms and mortality, justifies a continued search for optimal therapy. A clinical practice guideline was developed based on a systematic review investigating neoadjuvant or adjuvant therapy on resectable thoracic esophageal cancer.

Methods: A systematic review with meta-analysis was developed and clinical recommendations were drafted. External review of the practice guideline report by practitioners in Ontario, Canada was obtained through a mailed survey, and incorporated. Final approval of the practice guideline was obtained from the Practice Guidelines Coordinating Committee.

Results: The systematic review …

What Factors Predict Outcome At Relapse After Previous Esophagectomy And Adjuvant Therapy In High-Risk Esophageal Cancer?, Edward Yu, Patricia Tai, Richard Malthaner, Larry Stitt, George Rodrigues, Rashid Dar, Brian Yaremko, Jawaid Younus, Michael Sanatani, Mark Vincent, Brian Dingle, Dalilah Fortin, Richard Inculet

Richard A. Malthaner

Management of patients who have disease relapse after completion of surgery and adjuvant chemo-radiation (CRT) is controversial. Some oncologists would advocate intensive therapeutic intervention due to promising experience on treatment for recurrence disease while others would recommend palliative support due to the concerns for poor patient outcome post disease recurrence. In Addition, it is not clear if patient outcome is improved post adjuvant CRT when patients at risk have resection margin involvement and if time interval to recurrence can affect patient survival post relapse. The present study was conducted to determine what factors will affect patient outcome at relapse after …

Post-Operative Extended Volume External Beam Radiation Therapy Is Safe For High Risk Esophageal Cancer Patients, Edward Yu, Patricia Tai, Jawaid Younus, Richard Malthaner, Larry Stitt, Pauline Truong, George Rodrigues, Robert Ash, Rashid Dar, Anna Tomiak, Mark Vincent, Walter Kocha, Brian Dingle, Richard Inculet

Richard A. Malthaner

Post-operative radiation therapy (RT) (1) and post-operative chemoradiation (2) have been used for esophageal cancer patients deemed high risk for recurrence after esophagectomy. Defining opitmal RT target volume after esophagectomy is difficult due to significant changes in patient anatomy and function. Some radiationon cologists advocated the inclusion of the anastomotic site within the irradiation volume due to concerns for potential increased relapse risk, while others did not subscribe to this practice due to concerns for increased treatment related toxicity. We have previously reported patient outcome benefit using extended volume RT In management with high risk esophageal cancer patients underwent esopagectomy(3). …

Extended Vs. Small Field Irradiation In High Risk Post Esophagectomy Patients Receiving Combined Chemoradiation Therapy: A Decade Experience In Treatment Of Esophageal Cancer, Edward Yu, Patricia Tai, George Rodrigues, Robert Ash, Larry Stitt, Rashid A. Dar, Pauline Truong, Gregory M. Videtic, Richard Malthaner, Richard Inculet, Anna Tomiak, Jawaid Younus, Brian Dingle, Walter Kocha, Mark Vincent

Richard A. Malthaner

OBJECTIVE: To assess the impact of extended field irradiation with anastomotic coverage on local recurrence in high risk resected esophageal cancerpatients. METHODS: From 1989-1999, high risk resected esophageal cancer cases receiving post-resection chemoradiation were reviewed. Adjuvant chemotherapy consisted of four cycles of fluorouracil-based regimens. Loco-regional irradiation with or without coverage of anastomotic site had radiation a dose range from 45-60 Gyat 1.8-2.0 Gy/fraction given with initial anterior-posterior/posterior-anterior arrangement with either extended (with anastomotic coverage), or small (without anastomotic coverage) field followed by oblique fields for boost. RESULTS: One hundred eighty-eight charts were reviewed. Seventy-two patients were eligible for post-resection chemoradiation. …

Cyclosporin Versus Tacrolimus For Liver Transplanted Patients, Elizabeth Haddad, Vivian Mcalister, Elizabeth Renouf, Richard Malthaner, Mette Kjaer, Lise Gluud

Richard A. Malthaner

A systematic review of randomized clinical trials (RCT) was undertaken to evaluate the beneficial and harmful effects of immunosuppression with cyclosporin versus tacrolimus for liver transplanted patients. MEDLINE, EMBASE, Cochrane Central and Hepato-Biliary Group Controlled Trials Registers were searched. Using fixed and random effects model, relative risk (RR), values <1 favoring>tacrolimus, with 95% confidence intervals (CI) were calculated. Of 717 potentially relevant references, 16 RCTs were eligible for inclusion. Mortality and graft loss at 1 year were significantly reduced in tacrolimus-treated recipients (Death: RR 0.85, 95% CI 0.73-0.99; graft loss: RR 0.73, 95% CI 0.61-0.86). Tacrolimus reduced the number of recipients …

The Role Of Radiation Therapy On Medically Inoperable Clinically Localized Non-Small Cell Lung Patients: London Regional Cancer Program (Lrcp) Clinical Experience, Michael Lee, Edward Yu, Robert Ash, Patricia Tai, Larry Stitt, George Rodrigues, Rashid Dar, Mark Vincent, Richard Inculet, Richard Malthaner

Richard A. Malthaner

Lung cancer is the most frequent cause of cancer death in both men and women in North America. In 2006, an estimated 22,700 Canadians will be diagnosed with lung cancer and 19,300 will die of it (Canadian Cancer Statistics 2006). Approximately 15-20% of NSCLC patients present with early or localized disease. Surgical resection of T1-2N0 NSCLC remains the treatment of choice for this population, and results in a 5-year survival rate of 50-70%. Patients deemed medically inoperable have been treated with non-surgical therapies, such as radiation therapy(RT), while some patients have simply been observed without any tumor therapy because of …

Subsets More Likely To Benefit From Surgery Or Prophylactic Cranial Irradiation After Chemoradiation For Localized Non-Small-Cell Lung Cancer, Bruce Keith, Mark Vincent, Larry Stitt, Anna Tomiak, Richard Malthaner, Edward Yu, Pauline Truong, Richard Inculet, Michael Lefcoe, A. Dar, Walter Kocha, Ian Craig

Richard A. Malthaner

After chemoradiation for localized non-small-cell lung cancer, surgery and prophylactic cranial irradiation (PCI) have been used as additional therapies. Less than a third of patients develop brain recurrences, or have local recurrence as their sole initial site of recurrence; these are groups that would benefit from PCI or surgery, respectively. Pretreatment identification of patients more likely to benefit from surgery or PCI would be useful. A retrospective analysis of 80 patients was performed to determine prognostic factors for such patterns of failure. Twenty-nine patients were subsequently selected for surgery in a nonrandomized manner. Seventeen patients had isolated local initial recurrence …