Kevin P. Redmond
University of Cincinnati
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The New England Journal of Medicine | 2010
K. Kian Ang; Jonathan Harris; Richard Wheeler; Randal S. Weber; David I. Rosenthal; Phuc Felix Nguyen-Tân; William H. Westra; Christine H. Chung; Richard Jordan; Charles Lu; Harold Kim; Rita Axelrod; C Craig Silverman; Kevin P. Redmond; Maura L. Gillison
BACKGROUND Oropharyngeal squamous-cell carcinomas caused by human papillomavirus (HPV) are associated with favorable survival, but the independent prognostic significance of tumor HPV status remains unknown. METHODS We performed a retrospective analysis of the association between tumor HPV status and survival among patients with stage III or IV oropharyngeal squamous-cell carcinoma who were enrolled in a randomized trial comparing accelerated-fractionation radiotherapy (with acceleration by means of concomitant boost radiotherapy) with standard-fractionation radiotherapy, each combined with cisplatin therapy, in patients with squamous-cell carcinoma of the head and neck. Proportional-hazards models were used to compare the risk of death among patients with HPV-positive cancer and those with HPV-negative cancer. RESULTS The median follow-up period was 4.8 years. The 3-year rate of overall survival was similar in the group receiving accelerated-fractionation radiotherapy and the group receiving standard-fractionation radiotherapy (70.3% vs. 64.3%; P=0.18; hazard ratio for death with accelerated-fractionation radiotherapy, 0.90; 95% confidence interval [CI], 0.72 to 1.13), as were the rates of high-grade acute and late toxic events. A total of 63.8% of patients with oropharyngeal cancer (206 of 323) had HPV-positive tumors; these patients had better 3-year rates of overall survival (82.4%, vs. 57.1% among patients with HPV-negative tumors; P<0.001 by the log-rank test) and, after adjustment for age, race, tumor and nodal stage, tobacco exposure, and treatment assignment, had a 58% reduction in the risk of death (hazard ratio, 0.42; 95% CI, 0.27 to 0.66). The risk of death significantly increased with each additional pack-year of tobacco smoking. Using recursive-partitioning analysis, we classified our patients as having a low, intermediate, or high risk of death on the basis of four factors: HPV status, pack-years of tobacco smoking, tumor stage, and nodal stage. CONCLUSIONS Tumor HPV status is a strong and independent prognostic factor for survival among patients with oropharyngeal cancer. (ClinicalTrials.gov number, NCT00047008.)
Journal of Clinical Oncology | 2014
Christine H. Chung; Qiang Zhang; Christina S. Kong; Jonathan Harris; Elana J. Fertig; Paul M. Harari; Dian Wang; Kevin P. Redmond; G. Shenouda; Andy Trotti; David Raben; Maura L. Gillison; Richard Jordan; Quynh-Thu Le
PURPOSE Although p16 protein expression, a surrogate marker of oncogenic human papillomavirus (HPV) infection, is recognized as a prognostic marker in oropharyngeal squamous cell carcinoma (OPSCC), its prevalence and significance have not been well established in cancer of the oral cavity, hypopharynx, or larynx, collectively referred as non-OPSCC, where HPV infection is less common than in the oropharynx. PATIENTS AND METHODS p16 expression and high-risk HPV status in non-OPSCCs from RTOG 0129, 0234, and 0522 studies were determined by immunohistochemistry (IHC) and in situ hybridization (ISH). Hazard ratios from Cox models were expressed as positive or negative, stratified by trial, and adjusted for clinical characteristics. RESULTS p16 expression was positive in 14.1% (12 of 85), 24.2% (23 of 95), and 19.0% (27 of 142) and HPV ISH was positive in 6.5% (six of 93), 14.6% (15 of 103), and 6.9% (seven of 101) of non-OPSCCs from RTOG 0129, 0234, and 0522 studies, respectively. Hazard ratios for p16 expression were 0.63 (95% CI, 0.42 to 0.95; P = .03) and 0.56 (95% CI, 0.35 to 0.89; P = .01) for progression-free (PFS) and overall survival (OS), respectively. Comparing OPSCC and non-OPSCC, patients with p16-positive OPSCC have better PFS and OS than patients with p16-positive non-OPSCC, but patients with p16-negative OPSCC and non-OPSCC have similar outcomes. CONCLUSION Similar to results in patients with OPSCC, patients with p16-negative non-OPSCC have worse outcomes than patients with p16-positive non-OPSCC, and HPV may also have a role in outcome in a subset of non-OPSCC. However, further development of a p16 IHC scoring system in non-OPSCC and improvement of HPV detection methods are warranted before broad application in the clinical setting.
Cancer | 1991
David A. Holladay; Joseph F. Montebello; Aileen Holladay; Kevin P. Redmond
In this report, three new cases of trilateral retinoblastoma are presented. The clinical presentation, treatment, and outcome of the patients are described and compared with those of 32 cases that have been previously reported in the literature. A positive family history was obtained in 68% of the patients. The mean age at diagnosis of bilateral retinoblastoma was 7.2 months. The mean age at diagnosis of trilateral disease was 39.7 months, resulting in a mean latent interval of 32.6 months. The mean time from diagnosis of trilateral retinoblastoma to death was 6.6 months, and all patients died with spinal metastases. The patients who received no therapy survived an average of 1.3 months after the diagnosis of trilateral disease. The patients who received any form of definitive therapy survived 9.7 months. Five patients who had complete or dramatic response to therapy by computed tomography scans had local intracranial tumor present at autopsy. Therefore, more aggressive local therapy may be warranted.
International Journal of Radiation Oncology Biology Physics | 1988
David L. Denman; Alvis E. Foster; G. Cooper Lewis; Kevin P. Redmond; Howard R. Elson; John C. Breneman; James G. Kereiakes; Bernard S. Aron
The distribution of power and temperature generated by 915 MHz interstitial microwave antenna arrays was studied in static muscle-equivalent phantoms and both perfused and non-perfused canine thigh muscle. These arrays, which would form the geometric basis of larger volume implants, consisted of four parallel antennas oriented such that transverse to their long axes they formed the corners of a square. Arrays with 2 and 3 cm sides were compared at various depths of insertion where the nodes for all four antennas were coincident at the same depth. The position relative to the antenna nodes of the maximum power and highest temperature within the array volume varied with the depth of insertion of the antennas. Though power dropped rapidly distal to the nodes at all depths, a shift in the location of the maximum power proximal to the nodes resulted in an increase in the effective heating volume at certain insertion depths. For 2 cm array spacing the highest power and temperature were measured along the central axis of the array at all insertion depths. However, arrays using 3 cm spacing generated their maximum power adjacent to the antennas with only 50% of this level occurring along the central axis. When the temperature produced by 3 cm arrays was measured in phantoms midway through simulated 30-minute hyperthermia treatments, the effect of thermal conduction on the temperature distribution was evident. Though power was only 50% centrally, the highest temperatures occurred there. This same pattern of central heating occurred in perfused canine muscle demonstrating the importance of conductive and convective heat redistribution in reducing thermal gradients within the array volume.
Cancer Investigation | 2007
Abdul Rahman Jazieh; Ahmer Younas; Malek Safa; Kevin P. Redmond; Ralph Buncher; John A. Howington
Esophagitis is a dose-limiting toxicity of combined chemoradiation therapy in patients with locally advanced lung cancer. Our study aimed at minimizing this complication by using glutamine in an attempt to escalate the dose of chemotherapy. This was a Phase I trial of escalating the dose of weekly paclitaxel and carboplatin with concurrent radiation therapy. Fifteen patients were enrolled, with median age 62 years (58–78), 13 males and 12 Caucasians. Due to multiple severe toxicities including hematological toxicities and esophagitis, the combination was deemed not feasible. In conclusion, the addition of glutamine does not prevent serious toxities of this concurrent chemoradiotherapy regimen.
Reports of Practical Oncology & Radiotherapy | 2013
Joshua T. McKenzie; Emory McTyre; Dan Kunaprayoon; Kevin P. Redmond
Superior vena cava syndrome (SVCS) is characterized by a spectrum of clinical findings that result from the occlusion of the superior vena cava (SVC), usually caused by extracaval compression of the SVC by either a bronchogenic tumor or an enlarged mediastinal lymph node. Most efforts at treatment for SVCS are palliative, and long-term survival for malignancy-related SVCS is very low. Therefore, radiotherapy treatment is usually delivered with palliative intent utilizing hypofractionated regimens. The use of high dose per fraction may result in more rapid and more durable responses to treatment. Similarly, the high dose per fraction utilized in stereotactic body radiotherapy (SBRT) has been proven highly efficacious in treating early stage non-small cell lung cancer (NSCLC). Here we report the first reported case of a patient with SVCS from NSCLC successfully treated with SBRT to alleviate SVCS.
Journal of Cancer Education | 2009
W. L. Barrett; Bernard S. Aron; John C. Breneman; Ashwatha Narayana; Kevin P. Redmond
BACKGROUND A two-week elective clerkship in clinical oncology is offered to third-year medical students. METHODS Two students at a time participated in the rotation and spent time with attendings in a one-to-one setting in outpatient clinics in the cancer specialties. The students also attended multidisciplinary tumor boards. Grand rounds, peer review conferences, and problem-case conferences were attended by the students as well. The students met with an attending for one-hour, twice-per-week to discuss pertinent oncologic cases and problems. The exposure to clinical oncology for two weeks is intended to educate the students relative to the presentation, evaluation, treatment, prognosis, and follow-up for a variety of cancers. RESULTS The rotation has been highly successful as measured by its popularity and by consistently high course evaluations from the medical students. CONCLUSION The overall quality of the learning experience for the rotation has been rated by the students as the highest among all courses in their four-year curriculum.
American Journal of Clinical Oncology | 2006
Andrew M. Lowy; Irfan Firdaus; Debasish Roychowdhury; Kevin P. Redmond; John A. Howington; Jeffrey J. Sussman; Malek Safa; Syed A. Ahmad; Michael F. Reed; Patricia Rose; Laura E. James; Abdul Rahman Jazieh
Objective:To evaluate the feasibility and efficacy of sequential neoadjuvant chemotherapy, chemoradiation, and surgery in patients with locally advanced esophageal cancer. Patients and Methods:There were 29 patients who received paclitaxel 150 mg/m2 and gemcitabine 3000 mg/m2 2 weeks apart. Two weeks later, patients received cisplatin 75 mg/m2 and 5-fluorouracil (5-FU) 1000 mg/m2/d continuous infusion for 4 days with concurrent radiotherapy in 15 fractions to a total dose of 4000 cGy. After 6 weeks, cisplatin and 5-FU were repeated at the above doses. After 4 to 6 weeks, patients were restaged and underwent surgical resection. Results:All 29 patients completed the prescribed gemcitabine, paclitaxel, and radiation therapy. Febrile neutropenia occurred in 1 patient and 4 patients received growth factor support. After neoadjuvant treatment, 1 patient refused surgery, 23 underwent R0 resection (82%), while 5 developed progressive disease. Four patients developed anastomotic leaks (17%). Four patients had complete pathologic responses (14%) and 4 (14%) had only residual microscopic disease. Nine patients remain alive at a median follow-up of 48 months. Three-year survival for the entire cohort was 36%. Conclusion:This regimen was associated with a high rate of compliance and induction therapy had an acceptable toxicity profile. The R0 resection rate and 3-year survival data are similar to recently reported studies. While active, gemcitabine and paclitaxel induction therapy was associated with an increased rate of postoperative complications, but no increase in survival. Patterns of failure continue to demonstrate the need for regimens incorporating greater emphasis on systemic therapy for locally advanced esophageal cancer.
International Journal of Radiation Oncology Biology Physics | 1990
Srinath Sundararaman; David L. Denman; R.A. Legorreta; Alvis E. Foster; Kevin P. Redmond; Howard R. Elson; Angela M. Born; Ranasinghage C. Samaratunga; G. Cooper Lewis; James G. Kereiakes; Bernard S. Aron
Patterns of specific absorption rates generated by interstitial, microwave antenna arrays must be experimentally ascertained and quantified to facilitate their clinical incorporation. Phantom studies involved the use of four single-gap, coaxial antennas oriented in a 2 cm square array. These dipoles were driven in phase by a microwave generator at a frequency of 915 MHz. The inherent limitations in modifying the specific absorption rate patterns were addressed with the addition of bolus to the phantom. These additions of Guys muscle tissue-equivalent material were made either proximal or distal to the phantom proper. Experiments conducted in the presence and absence of tissue-equivalent material bolus showed the ability to achieve broader bands of 50% power deposition in certain bolus conditions. These heating patterns were sufficiently reproducible and predictable to warrant clinical application of the bolus addition. A through-and-through method of catheter implantation allowed for bolus addition when deemed necessary. Treatments with veterinary and human patients using the bolus method to modify heating patterns yielded augmented patterns of power deposition. The effective length of the antennas that would radiate efficiently was essentially broadened via introduction of a microwave-interacting medium. As a result of the tissue equivalent materials ability to absorb microwave power, it was necessary to interpose minimally-interactive styrofoam spacers to limit heat transfer effects at the tissue-bolus interfaces.
Journal of Clinical Oncology | 2004
A. Younas; Kevin P. Redmond; J. Howington; B. Kleykamp; A. R. Jazieh
7296 Background: Esophagitis is a common and often the dose limiting toxicity of the combined chemo-radiation therapy in patients with locally advanced lung cancer. Our study aimed to minimize this complication by using G in an attempt to escalate the dose of chemotherapy. METHODS This is a phase I trial of escalating dose of weekly P, (Taxol, Bristol-Myers Squibb, New York, NY) by 10 mg/m2 increments starting at 50 mg/m2, and weekly C, (Paraplatin, Bristol-Myers Squibb, New York, NY) using auc of 2, 2.5, 3 mg/ml/min for seven weeks. G, (Sympt-X, Baxter, Deerfield, IL) was given at a dose of 10 gm. p.o tid for nine weeks. Radiation therapy dose was 6300 cGy in 34 daily fractions. Consolidation therapy consisted of C auc = 6 mg/ml/min, and P, 100 mg weekly times 3 every 28 days for 2 cycles. RESULTS 10 patients were enrolled, with median age 63 years (59-78), 9 males and 1 female, 7 patients were Caucasian and 3 African Americans. At the dose level of C auc = 2, and P 60 mg/m2, grade three esophagitis and one death due to sepsis were encountered. Therefore, the maximum tolerated dose (MTD) was determined to be C auc = 2 and P 50 mg/m2. Toxicities in the induction phase included grade three hypersensitivity reaction to P (1), grade one esophagitis (5), grade two constipation (2), grade one nausea (1), grade two emesis (2), grade one cough (3), grade two neutropenia (4), and grade two anemia (2). Consolidation treatment was given to four patients; toxicities encountered were grade one nausea (1), grade one emesis (2), grade two neutropenia (1) and grade two anemia (2). No significant thrombocytopenia or renal impairment resulted in induction or consolidation. CONCLUSION The MTD of the above regimen is C = auc 2, P 50 mg/m2, and G 10 gm. p.o tid. Addition of G did not facilitate the escalation of the concomitant chemotherapy. Phase II trial of this combination at the recommended doses is in progress. [Table: see text].