C.A. Perez
New York University
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Featured researches published by C.A. Perez.
International Journal of Radiation Oncology Biology Physics | 2016
Raymond Mailhot Vega; O. Ishaq; Ann C. Raldow; C.A. Perez; R.B. Jimenez; Marielle Scherrer-Crosbie; Marc R. Bussière; Alphonse G. Taghian; David J. Sher; Shannon M. MacDonald
PURPOSE Cardiac toxicity due to conventional breast radiation therapy (RT) has been extensively reported, and it affects both the life expectancy and quality of life of affected women. Given the favorable oncologic outcomes in most women irradiated for breast cancer, it is increasingly paramount to minimize treatment side effects and improve survivorship for these patients. Proton RT offers promise in limiting heart dose, but the modality is costly and access is limited. Using cost-effectiveness analysis, we provide a decision-making tool to help determine which breast cancer patients may benefit from proton RT referral. METHODS AND MATERIALS A Markov cohort model was constructed to compare the cost-effectiveness of proton versus photon RT for breast cancer management. The model was analyzed for different strata of women based on age (40 years, 50 years, and 60 years) and the presence or lack of cardiac risk factors (CRFs). Model entrants could have 1 of 3 health states: healthy, alive with coronary heart disease (CHD), or dead. Base-case analysis assumed CHD was managed medically. No difference in tumor control was assumed between arms. Probabilistic sensitivity analysis was performed to test model robustness and the influence of including catheterization as a downstream possibility within the health state of CHD. RESULTS Proton RT was not cost-effective in women without CRFs or a mean heart dose (MHD) <5 Gy. Base-case analysis noted cost-effectiveness for proton RT in women with ≥1 CRF at an approximate minimum MHD of 6 Gy with a willingness-to-pay threshold of
Advances in radiation oncology | 2015
Benjamin H. Lok; Jennifer Ma; A. Foster; C.A. Perez; Weiji Shi; Zhigang Zhang; Bob T. Li; Charles M. Rudin; Andreas Rimner; Abraham J. Wu
100,000/quality-adjusted life-year. For women with ≥1 CRF, probabilistic sensitivity analysis noted the preference of proton RT for an MHD ≥5 Gy with a similar willingness-to-pay threshold. CONCLUSIONS Despite the cost of treatment, scenarios do exist whereby proton therapy is cost-effective. Referral for proton therapy may be cost-effective for patients with ≥1 CRF in cases for which photon plans are unable to achieve an MHD <5 Gy.
Radiotherapy and Oncology | 2017
M. Tam; S. Peter Wu; C.A. Perez; N.K. Gerber
Purpose Brain metastases are common in patients with limited-stage small cell lung cancer (LS-SCLC) due to the inability of most chemotherapeutics to penetrate the blood–brain barrier. Prophylactic cranial irradiation (PCI) is therefore recommended for use in patients with a good response to concurrent chemoradiotherapy. However, PCI is not always delivered; therefore, we investigated the reasons for PCI omission in patients who underwent therapy with curative intent. Methods and materials We retrospectively reviewed all patients with LS-SCLC who were treated with curative intent at our institution. Overall survival and cumulative incidence of brain metastasis were estimated by the Kaplan-Meier method. The Pearson χ2 test and Mann-Whitney U test were used to examine factors associated with PCI use, and prognostic factors were analyzed with Cox proportional hazards modeling. Results We examined 208 patients who were treated for LS-SCLC at our institution. A total of 115 patients (55%) received PCI. The most common documented reason for PCI omission was patient refusal due to neurotoxicity concerns (38%). Physician assessment of being medically unfit (33%) and of advanced age (8%) were the second and third most common reasons, respectively. Karnofsky performance status and clinical American Joint Committee on Cancer stage but not PCI were significantly associated with overall survival. Only clinical stage remained an independent factor on multivariate analysis. Conclusions Approximately half of patients with LS-SCLC ultimately receive PCI, generally for guideline-recommended reasons. The most common reason for PCI omission was patient concerns regarding neurotoxicity. Efforts to decrease PCI neurotoxicity, including hippocampal-sparing radiation and memantine use, may increase the use of this survival-improving intervention in eligible patients with LS-SCLC.
International Journal of Radiation Oncology Biology Physics | 2017
F. Shaikh; J. Chew; C.A. Perez; M. Tam; Benjamin T. Cooper; O.G. Maisonet; E. Peat; N.E. Huppert; S.C. Formenti; Naamit K. Gerber
BACKGROUND AND PURPOSE We evaluated the effect of post-mastectomy radiation (PMRT) in 1-3 positive lymph nodes (LN) in patients who received uniform modern systemic therapy. MATERIALS AND METHODS Cohort study using individual data collected for 1,649 node-positive women who received doxorubicin/cyclophosphamide with sequential docetaxel in 2000-2003 on the control arm of BCIRG-005. All women underwent mastectomy or lumpectomy and axillary LN dissection. PMRT was given at investigators discretion. RESULTS A total of 523 women with 1-3 positive LN underwent mastectomy and 39% (206/523) received PMRT. With a median follow-up of 10years, PMRT improved loco-regional control (LRC) from 91% to 98% (p=0.001) but had no effect on overall survival (OS) (84% vs. 86%, p=0.9). On multivariate analysis, PMRT improved local control (LC) (hazard ratio, 0.14; 95% CI, 0.03-0.62; p=0.01) and LRC (hazard ratio, 0.15; 95% CI, 0.04-0.50; p=0.002). PMRT did not significantly impact OS on multivariate analysis (hazard ratio, 0.91; 95% CI, 0.55-1.51; p=0.7). Results remained consistent with the use of propensity score analysis. CONCLUSIONS In this cohort of patients with N1 disease treated with modern systemic therapy, PMRT improves LRC but has no effect on OS. The rates of OS were excellent, irrespective of adjuvant radiation.
International Journal of Radiation Oncology Biology Physics | 2018
Juhi Purswani; F. Shaikh; P. Wu; J. Chun; F.R. Schnabel; N.E. Huppert; C.A. Perez; N.K. Gerber
International Journal of Radiation Oncology Biology Physics | 2018
S.X. Yan; C.A. Perez; N.E. Huppert; C. Hitchen; I.J. Das; O.G. Maisonet; N.K. Gerber
International Journal of Radiation Oncology Biology Physics | 2018
N.K. Gerber; B. Levinson; S.X. Yan; C.A. Perez; I.J. Das; O.G. Maisonet; N.E. Huppert; D. No; C. Hitchen; N. Mistry; J. Kelley; Judith D. Goldberg
Brachytherapy | 2018
Raymond Mailhot Vega; David Barbee; Bhartesh A. Shah; T. Duckworth; Christina Small; C.A. Perez; Peter B. Schiff; William Small; Matthew M. Harkenrider
International Journal of Radiation Oncology Biology Physics | 2017
F. Shaikh; M. Tam; C.A. Perez; N.E. Huppert; C. Hitchen; A. McCarthy; O.G. Maisonet; S.C. Formenti; Naamit K. Gerber
International Journal of Radiation Oncology Biology Physics | 2017
S.P.P. Wu; M. Tam; F.R. Schnabel; J. Chun; C.A. Perez; David Schreiber; N.K. Gerber