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Jonathan J Beitler

Publications and source records attributed to Jonathan J Beitler.

18 recordsLinked to original sources
PubMed2007

Phase II clinical trial of parenteral hydroxyurea and hyper-fractionated, accelerated external beam radiation therapy in patients with advanced squamous cell carcinoma of the head and neck: toxicity and efficacy with continuous ribonucleoside reductase inhibition.

BACKGROUND: Almost all concurrent chemoradiation regimens for head and neck are platinum based; however, cisplatin is associated with severe renal, oto-, and neurotoxicity. Hydroxyurea (HU) has been associated with fewer irreversible toxicities. We obtained HU in parenteral form to be administered continually during the radiation treatment. Intravenous HU promised better pharmacokinetics and cell cycle blockade. METHODS: Participants had biopsy-proven, untreated squamous cell carcinoma of the oral cavity, oropharynx (stage IV) and hypopharynx (stages II-IV). Radiation therapy consisted initially of 74.4 Gy administered in twice daily 1.2-Gy fractions. After 20 patients, the radiation dose was reduced to 60.0 Gy, and another 16 patients were enrolled. RESULTS: Patients received HU by Continuous Ambulatory Drug Delivery (CADD) pump on a daily x5 schedule during radiation therapy. Because of persistent long-term dysphagia, after 20 patients, the dose of external beam radiation therapy was reduced from 74 to 60 Gy, and the duration of concurrent HU was correspondingly reduced. The new regimen was much better tolerated. The median survival for the group as a whole was 30 months. Within this small study, there were no significant differences in survival, regional control, or local control between the 2 groups. CONCLUSIONS: Lower doses of concurrent parenteral HU and hyper-fractionated radiation therapy are tolerable and promising.

Aged↗
PubMed2006

Stereotactic body radiation therapy for nonmetastatic lung cancer: an analysis of 75 patients treated over 5 years.

PURPOSE: Non-small-cell lung cancer (NSCLC) may not be medically operable even in patients with surgically resectable disease. For patients who either refuse surgery or are medically inoperable, radiation therapy may be the best therapeutic choice. Stereotactic body radiation therapy (SBRT) employs external fixation and hypofractionation to deliver a high dose per fraction of radiation to a small target volume. METHODS AND MATERIALS: Retrospective review of 75 patients treated over 5 years at Staten Island University Hospital as definitive treatment for NSCLC or presumed NSCLC. Patients received a median of 5 fractions of 8 Gy per fraction over 27 days. RESULTS: Overall 1-, 2-, and 5-year actuarial survivals were 63%, 45%, and 17%. Patients with a gross tumor volume (GTV) less than 65 cm3 enjoyed a longer median survival (25.7 vs. 9.9 months, p < 0.003), and at 5 years, the actuarial survival for the patients with GTVs less than 65 cm3 was 24% vs. 0% for those with GTVs larger than 65 cm3. CONCLUSIONS: Stereotactic body radiation therapy as delivered was ineffective for curing the patients whose GTVs were larger than 65 cm3. SBRT was promising for those with GTVs less than 65 cm3.

Aged↗
PubMed2004

Loss of cervical spinal curvature during radiotherapy for head-and-neck cancers: the neck moves, too.

PURPOSE: We became concerned about our observation of the loss of the normal lordotic cervical spinal curvature during the course of radiotherapy (RT) for head-and-neck tumors. Our goal was to evaluate formally the cervical lordotic curve in 50 random patients by comparing the cervical spinal angles (CSAs) measured at the initiation of RT with the CSAs measured during the last week of RT. METHODS AND MATERIALS: Fifty patients treated mono-isocentrically for head-and-neck cancer were selected randomly for review. All patients had custom-made masks, shoulder pulls, and multiple tattoos to ensure reproducibility. The CSA was defined as the angle formed by the line projected parallel to the posterior surface of C2 and the line projected parallel to C6. The measurements were done on the simulation film and the first and last port films. RESULTS: The average decrease in the CSA was 2.26 degrees (SD +/-2.19 degrees ). In patients with the isocenter placed as low as possible, the change was significantly more compared with the remaining population. (3.8 degrees vs. 1.7 degrees, p = 0.004). CONCLUSION: Despite customized immobilization, the neck position changes during the course of RT for head-and-neck tumors. Patients with the isocenter placed very low have the least long-term reproducibility and a comfortable position may be best suited to intensity-modulated RT for such head-and-neck cancer patients.

Cervical Vertebrae↗
PubMed2004

Decreased short- and long-term swallowing problems with altered radiotherapy dosing used in an organ-sparing protocol for advanced pharyngeal carcinoma.

OBJECTIVE: To determine the effect of a reduced radiotherapy dose on short- and long-term swallowing problems after organ-sparing treatment. DESIGN: Prospective case series. SETTING: Tertiary care referral center. PATIENTS: A consecutive sample of 29 patients with advanced oropharyngeal or hypopharyngeal cancer who were treated with intravenous hydroxyurea and concomitant hyperfractionated, accelerated radiotherapy. INTERVENTIONS: Initial experience with 74.4 Gy of radiation demonstrated severe long-term swallowing problems, prompting a dose reduction to 60.0 Gy. Eighteen patients were followed up for this study in the 74.4-Gy group, while 11 were in the 60.0-Gy group. MAIN OUTCOME MEASURES: Swallowing variables were assessed in both patient groups at 4 months and at 12 months following completion of therapy. RESULTS: Patient demographics and tumor characteristics were similar in each group, while significant differences were noted in the posttreatment clinical swallowing variables. Persistent severe odynophagia at 4 months (89% [16/18] vs 30% [3/10]) and at 12 months (64% [7/11] vs 11% [1/9]) was greater in the 74.4-Gy group (P =.002). Clinical signs of aspiration were also increased in the 74.4-Gy group, with 81% (13/16) vs 11% (1/9) at 4 months and 60% (6/10) vs 11% (1/9) at 12 months (P<.05). Most striking, however, was the incidence of long-term gastrostomy, with 78% (14/18) of patients receiving 74.4 Gy requiring gastrostomy feedings at 12 months compared with 18% (2/11) in the 60.0-Gy group (P =.002). Local control was unchanged by the altered dosing, with median follow-ups of 43.5 and 24.0 months in the 74.4-Gy and 60.0-Gy groups, respectively. CONCLUSION: Decreased radiation doses can maintain disease control and reduce treatment-related long-term swallowing complications.

Adult↗
PubMed2004

Controversies in management of the neck in head and neck cancer.

As definitive external radiation and multimodality organ preservation strategies (eg, combined chemotherapy and radiation therapy ) improve, the role of surgery is being re-examined in the management of locally advanced head and neck cancer. Consensus regarding the use of neck dissections for complete responders and incomplete responders has yet to be achieved and the data are surprisingly controversial. A possible benefit from neck dissection after a complete response of the primary tumor after CCRT or definitive external radiation for advanced squamous cell carcinoma of the head and neck may only be anticipated in patients with persisting subclinical neck disease who have no other sites of disease. Some clinicians have even argued that the salvage rate for clinically detectable residual neck disease does not justify neck dissection. Randomized data addressing these questions and a trial addressing the accuracy of new imaging modalities, such as postchemotherapy and postradiation positron emission tomography scanning, across multiple institutions would be appropriate. As a department, we are aggressive in our treatment of isolated residual neck disease after CCRT or definitive external radiation and for patients initially diagnosed with N3 nodal disease. We are investigating the use of adjuvant neck brachytherapy at the time of neck dissection and we are pleased with our early results.

Antineoplastic Agents↗
PubMed2004

Adjuvant high dose rate brachytherapy (Ir-192) in the management of keloids which have recurred after surgical excision and external radiation.

We describe our experience with adjuvant high dose rate brachytherapy (Ir-192) (HDRB) in patients, who failed surgery and post-operative external radiation therapy. The salvage treatment consisted of excision of the keloid and wound closure followed by HDRB (15 Gy in three fractions given on three consecutive business days beginning the day of surgery). At the time of last follow up, 88% (15/17) of the keloids were without any evidence of recurrence.

Adolescent↗
PubMed2004

Definitive, high-dose-per-fraction, conformal, stereotactic external radiation for renal cell carcinoma.

INTRODUCTION: Localized renal cell carcinoma is conventionally treated surgically. Preoperative and adjuvant external radiation have not improved survival. However, renal cell cancer brain metastases, although radioresistant to conventional external radiation, have been responsive to radiosurgery. The following report was compiled with information from our experience using high-dose-per-fraction, conformal radiation delivered to patients who refused definitive surgery. MATERIALS AND METHODS: Nine patients with nonmetastatic renal cell carcinomas were identified, 2 of which had bilateral renal cell cancers. Patients were treated definitively with 40 Gy in 5 fractions using conformal external radiation. RESULTS: With a median follow up of 26.7 months, 4 of the 9 patients are alive. The survivors have a minimum follow up of 48 months. At presentation, all 4 of the survivors had tumors < or =3.4 cm in largest dimension, had clinically negative nodes, and presented no clinical evidence of penetration of Gerota fascia or renal vein extension. CONCLUSION: High-dose-per-fraction, conformal external radiation may have a curative role for small, node-negative, organ-confined renal cell carcinomas.

Aged↗
PubMed2003

Inhibitory effect of brachytherapy on intimal hyperplasia in arteriovenous fistula.

PURPOSE: To determine whether endovascular radiation can inhibit intimal hyperplasia in a swine model of hemodialysis access. MATERIALS AND METHODS: Polytetrafluoroethylene arteriovenous grafts (6 mm in diameter) were placed between the common carotid artery and the external jugular vein bilaterally in 8 pigs. Two days after the surgery, fistulography was performed. Gamma radiation (12 Gy) was delivered endovascularly to one of the grafts at the venous anastomosis by using an iridium(192) source. Thus, the other graft in each pig served as an untreated control. Fistulas were evaluated with fistulography or venography 6 week after radiation. All grafts were then harvested for histological and immunohistochemical examination. RESULTS: Seven grafts on the treated side and 5 grafts on the control side remained patent for at least 6 weeks. Angiography demonstrated that the percentage stenosis at the venous anastomosis was significantly lower for the treated group (15.9 +/- 14.1 versus 32.6 +/- 16.7%, P = 0.045). Histopathologic analyses revealed that the mean intimal area and maximal intimal thickness were significantly lower with reduced smooth muscle cell proliferation at the venous anastomosis on the treated side compared to the control side (0.68 +/- 0.30 versus 1.06 +/- 0.29 mm(2), P = 0.017, and 0.18 +/- 0.08 versus 0.26 +/- 0.07 mm, P = 0.004, respectively). The residual lumen was significantly greater for the treated group (1.59 +/- 0.42 versus 1.06 +/- 0.37 mm(2), P = 0.031). No significant differences were found in the area, nor maximal thickness in the vein either proximal or distal to the anastomosis between the two groups. CONCLUSIONS: In an animal model of hemodialysis access, brachytherapy with iridium(192) delivered 2 days after graft implantation reduces intimal hyperplasia and stenosis at the venous anastomosis. The reduced smooth-muscle cells found in the radiated veins suggests that brachytherapy may exert its effect on neointimal formation by inhibition of smooth muscle cell proliferation.

Angiography↗
PubMed2003

Radiation therapy for the salvage of unresectable subungual squamous cell carcinoma.

BACKGROUND: A case of subungual squamous cell carcinoma, which is a rare malignancy and has an elusive etiology, is reported. OBJECTIVE: To present radiation therapy as a viable treatment option to amputation for surgically unresectable subungual squamous cell cancer. METHODS: A 69-year-old man with a 16-year-old history of subungual squamous cell carcinoma of the left thumb was treated by external beam radiation therapy. In this case, bone invasion precluded the patient from successfully completing Moh's micrographic surgery. RESULTS: The treated thumb at 17 months after radiation therapy remained tumor free. CONCLUSION: Radiation therapy should be considered a treatment option for nail bed squamous cell carcinoma before considering amputation and perhaps as salvage for all unresectable lesions.

Aged↗
PubMed2002

Phase I clinical trial of parenteral hydroxyurea in combination with pelvic and para-aortic external radiation and brachytherapy for patients with advanced squamous cell cancer of the uterine cervix.

PURPOSE: Oral hydroxyurea (HU) is a potent radiation sensitizer, but in vitro studies have suggested that prolonged exposure to HU by way of continuous parenteral infusion would enhance clinical efficacy. The objective of this study was to determine the maximal tolerated dose and identify the toxicities of continuous infusion HU in combination with pelvic and para-aortic external beam radiotherapy (RT) and intrauterine brachytherapy in patients with locally advanced carcinoma of the uterine cervix. METHODS: This Phase I study of concomitant RT was designed with an escalating dose schedule of HU administered by continuous infusion. HU was administered parenterally as a continuous infusion, 5 d/wk, during the first 21 days of external radiation, during the final 5 days of external beam RT, followed by another 5-day infusion schedule bracketing the single fraction of brachytherapy. The maximal tolerated dose was defined as the highest dose level at which 3 of 3 or 5 of 6 patients could be treated without dose-limiting toxicity. RESULTS: At dose level 1 (0.25 mg/m(2)/min), 0 of 4 patients experienced Grade 4 toxicities and 2 patients experienced Grade 3 hematologic toxicities that were not considered dose-limiting. One of the first 4 patients at level 2 (0.375 mg/m(2)/min) had Grade 3 diarrhea, but the 3 subsequent patients tolerated the dose. At level 3 (0.5 mg/m(2)/min), 4 of 5 patients failed to complete therapy without a >7-day interruption in HU. CONCLUSIONS: The maximal tolerated dose of parenteral HU was 0.375 mg/m(2)/min when administered with concomitant RT. The most common toxicities were hematologic. A new trial, incorporating concurrent cisplatin, HU, and RT is planned.

Aged↗
PubMed2002

Endobronchial brachytherapy and external-beam radiotherapy in patients with endobronchial obstruction and extrabronchial extension.

PURPOSE: To evaluate the efficacy of high-dose rate endobronchial brachytherapy (HDR-EB) with concomitant short-course external-beam radiotherapy (EBRT) in patients with both endobronchial and extrabronchial tumor. METHODS AND MATERIALS: Patients with endobronchial disease and extrabronchial lesions greater than 2.5cm were treated with three 5Gy HDR-EB and 37.5Gy EBRT delivered over 3.5 weeks. Flexible fiberoptic bronchoscopy was performed with the patient under conscious sedation, and tumor location, length of lesion, percentage of lumen occlusion, and presence of bleeding were recorded. Fluoroscopic visualization of the guide wire in the catheter tip assisted in demarcating the proximal and distal extent of the intraluminal tumor. 5Gy was prescribed to a distance of 1cm from the catheter and a computerized treatment planning system was used to optimize the dose distribution to the gross target volume with 1.5-2cm margins at the distal and proximal ends. Bronchoscopic and symptomatic response rates were assessed at the third HDR-EB and patients were seen in follow-up every 2 months. RESULTS: One hundred seventeen endobronchial treatments were delivered to 33 patients with primary carcinoma, and 8 patients with metastatic carcinoma. The median age was 69 (range = 36-94); 95% reported dyspnea; 71% cough and 22% hemoptysis. Seventy-two percent of patients reported resolution of their symptoms and 54% achieved a bronchoscopic response (at least 50% decrease in intraluminal obstruction). In a multivariate logistic model including stage, age, primary tumor type, and Karnofsky performance status (KPS) as predictors, only KPS was statistically associated with bronchoscopic response (OR = 1.1; 95%CI = 1.01-1.13) and palliation of symptoms (OR = 1.3; 95%CI = 1.05-1.59). The overall median survival was 5.2 months and was associated with bronchoscopic response (11 months in responders vs 4 in nonresponders) and symptom resolution (8 months in responders vs 1.5 in nonresponders). In a multivariate Cox survival model with stage, age, primary tumor type, and KPS as predictors, only KPS was significantly associated with survival (RR = 0.92;95%CI = 0.88-0.95). CONCLUSIONS: HDR-EB with concomitant EBRT is an effective treatment regimen for patients with both endobronchial and extrabronchial tumor. Patients with higher performance status are more likely to have resolution of disease and have longer median survival.

Adult↗
PubMed2002

Intensity-modulated radiation therapy for head and neck cancer: emphasis on the selection and delineation of the targets.

The head and neck contain many critical, noninvolved structures in close vicinity to the targets. The tightly conformal doses produced by intensity-modulated radiation therapy (IMRT), and the lack of internal organ motion in the head and neck, provide the potential for organ sparing and improved tumor irradiation. Many studies of treatment planning for head and neck cancer have demonstrated the dosimetric superiority of IMRT over conventional techniques in these respects. The initial results of clinical studies demonstrate reduced xerostomia. They suggest an improvement in tumor control, which needs to be verified in larger studies and longer follow-up. Critical issues for successful outcome of head and neck IMRT are accurate selection of the neck lymph nodes that require adjuvant treatment, and accurate delineation on the planning computed tomography (CT) of the lymph-node bearing areas and subclinical disease adjoining the gross tumor. This review emphasizes these topics and provides some guidelines.

Head and Neck Neoplasms↗