Author
Krystyna Kiel
Other affiliations: International Atomic Energy Agency, Memorial University of Newfoundland, Sage Group
Bio: Krystyna Kiel is an academic researcher from Northwestern University. The author has contributed to research in topics: Breast cancer & Cancer. The author has an hindex of 15, co-authored 24 publications receiving 1027 citations. Previous affiliations of Krystyna Kiel include International Atomic Energy Agency & Memorial University of Newfoundland.
Topics: Breast cancer, Cancer, Radiation therapy, Colorectal cancer, Mastectomy
Papers
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Stanford University1, Seattle Cancer Care Alliance2, Harvard University3, University of South Florida4, Roswell Park Cancer Institute5, Ohio State University6, Fox Chase Cancer Center7, Northwestern University8, University of Michigan9, Memorial Sloan Kettering Cancer Center10, University Of Tennessee System11, University of California, San Francisco12, Duke University13, University of Alabama at Birmingham14, University of Nebraska–Lincoln15, City of Hope National Medical Center16, University of Texas MD Anderson Cancer Center17, University of Utah18, Johns Hopkins University19
174 citations
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TL;DR: Among women presenting with de novo stage IV breast cancer, 35% to 60% undergo local therapy, presumably to avoid uncontrolled chest wall disease, and chest wall status, time to first progression (TTFP), and overall survival (OS) are reviewed.
Abstract: BACKGROUND
Among women presenting with de novo stage IV breast cancer, 35% to 60% undergo local therapy, presumably to avoid uncontrolled chest wall disease. Several studies suggest that resection of the primary tumor may prolong survival, but chest wall outcome data are notably lacking. The authors reviewed chest wall status, time to first progression (TTFP), and overall survival (OS) in this group of women.
METHODS
Women presenting at the Lynn Sage Breast Center (1995-2005) with an intact primary tumor and stage IV breast cancer or postoperative diagnosis of distant metastases were identified. Logistic regression and Cox proportional hazards models, adjusted for relevant covariates, were used to examine associations between surgical treatment and chest wall status, TTFP, and OS.
RESULTS
Of 111 eligible women, 47 (42%) underwent early resection of the primary tumor. Chest wall status was available for 103 women. Local control was maintained in 36 of 44 (82%) patients in the surgical group versus 20 of 59 (34%) patients without surgery (P = .001). TTFP was prolonged in the surgical group (adjusted hazards ratio [HR], 0.493; P = .015). The adjusted HR for OS in the surgical group was 0.798 (P = .520). Chest wall control was associated with improved OS regardless of whether surgical resection of the tumor was performed (HR, 0.415; P < .0002).
CONCLUSIONS
These data support the notion that improved local control may play a role in improving outcomes in women with stage IV breast cancer, and resection of in-breast tumors can help to achieve this. A randomized trial is needed to rule out selection bias as an explanation for these findings. Cancer 2008. © 2008 American Cancer Society.
120 citations
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TL;DR: This report summarizes the proceedings of this meeting, including discussions of the background of PET, possible future developments, and the role of PET in oncology.
Abstract: The use of positron emission tomography (PET) is increasing rapidly in the United States, with the most common use of PET scanning related to oncology. It is especially useful in the staging and management of lymphoma, lung cancer, and colorectal cancer, according to a panel of expert radiologists, surgeons, radiation oncologists, nuclear medicine physicians, medical oncologists, and general internists convened in November 2006 by the National Comprehensive Cancer Network. The Task Force was charged with reviewing existing data and developing clinical recommendations for the use of PET scans in the evaluation and management of breast cancer, colon cancer, non-small cell lung cancer, and lymphoma. This report summarizes the proceedings of this meeting, including discussions of the background of PET, possible future developments, and the role of PET in oncology.
103 citations
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Fox Chase Cancer Center1, Northwestern University2, City of Hope National Medical Center3, Johns Hopkins University4, University Of Tennessee System5, University of Nebraska–Lincoln6, Roswell Park Cancer Institute7, Dana Corporation8, University of Michigan9, Duke University10, Ohio State University11, Fred Hutchinson Cancer Research Center12, University of Alabama at Birmingham13, Memorial Sloan Kettering Cancer Center14, University of Texas MD Anderson Cancer Center15, University of California, San Francisco16, University of South Florida17
TL;DR: The NCCN Colon/Rectal/Anal Cancers Guidelines panel as discussed by the authors recommended an en bloc resection for colon cancer patients, followed by adjuvant chemotherapy and 5-FU/leucovorin/oxaliplatin therapy.
Abstract: The NCCN Colon/Rectal/Anal Cancers Guidelines panel believes that a multidisciplinary approach is necessary for managing colorectal cancer. The panel endorses the concept that treating patients in a clinical trial has priority over standard or accepted therapy. The recommended surgical procedure for resectable colon cancer is an en bloc resection. For patients with stage III disease, 5-FU-based adjuvant therapy is recommended. A patient who has metastatic disease in the liver or lung should be considered for surgical resection if he or she is a candidate for surgery and if surgery can extend survival. Surgery should be followed by adjuvant chemotherapy. The panel advocates a conservative post-treatment surveillance program for colon carcinoma patients. Serial CEA determinations are appropriate if the patient is a candidate for aggressive surgical resection should recurrence be detected. Abdominal and pelvic CT scans should be used only when there are clinical indications of possible recurrence. Patients whose disease progresses during 5-FU-based therapy should be treated with bolus irinotecan. Patients who progress on irinotecan are candidates for 5-FU/leucovorin/oxaliplatin therapy or should be encouraged to participate in a phase I or phase II clinical trial.
94 citations
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TL;DR: The results of this study have shown that repeat RT of the chest wall for patients with locally recurrent breast cancer is feasible, because it is associated with acceptable acute and late morbidity and encouraging local response rates.
Abstract: Purpose To review the toxicity and clinical outcomes for patients who underwent repeat chest wall or breast irradiation (RT) after local recurrence Methods and Materials Between 1993 and 2005, 81 patients underwent repeat RT of the breast or chest wall for locally recurrent breast cancer at eight institutions The median dose of the first course of RT was 60 Gy and was 48 Gy for the second course The median total radiation dose was 106 Gy (range, 744–1375 Gy) At the second RT course, 20% received twice-daily RT, 54% were treated with concurrent hyperthermia, and 54% received concurrent chemotherapy Results The median follow-up from the second RT course was 12 months (range, 1–144 months) Four patients developed late Grade 3 or 4 toxicity However, 25 patients had follow-up >20 months, and no late Grade 3 or 4 toxicities were noted No treatment-related deaths occurred The development of Grade 3 or 4 late toxicity was not associated with any repeat RT variables The overall complete response rate was 57% No repeat RT parameters were associated with an improved complete response rate, although a trend was noted for an improved complete response with the addition of hyperthermia that was close to reaching statistical significance (67% vs 39%, p = 008) The 1-year local disease-free survival rate for patients with gross disease was 53% compared with 100% for those without gross disease ( p Conclusions The results of our study have shown that repeat RT of the chest wall for patients with locally recurrent breast cancer is feasible, because it is associated with acceptable acute and late morbidity and encouraging local response rates
91 citations
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01 Jan 2014
TL;DR: Lymphedema is a common complication after treatment for breast cancer and factors associated with increased risk of lymphedEMA include extent of axillary surgery, axillary radiation, infection, and patient obesity.
1,988 citations
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University of Alabama at Birmingham1, University of South Florida2, Vanderbilt University3, City of Hope National Medical Center4, Fox Chase Cancer Center5, University Of Tennessee System6, Brigham and Women's Hospital7, Seattle Cancer Care Alliance8, Case Western Reserve University9, Roswell Park Cancer Institute10, Northwestern University11, Harvard University12, University of Nebraska Medical Center13, University of Utah14, Memorial Sloan Kettering Cancer Center15
TL;DR: This manuscript focuses on the NCCN Guidelines Panel recommendations for the workup, primary treatment, risk reduction strategies, and surveillance specific to DCIS.
Abstract: Ductal carcinoma in situ (DCIS) of the breast represents a heterogeneous group of neoplastic lesions in the breast ducts. The goal for management of DCIS is to prevent the development of invasive breast cancer. This manuscript focuses on the NCCN Guidelines Panel recommendations for the workup, primary treatment, risk reduction strategies, and surveillance specific to DCIS.
1,545 citations
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Maastricht University Medical Centre1, Catholic University of the Sacred Heart2, University of Texas MD Anderson Cancer Center3, Taipei Medical University Hospital4, Hospital General Universitario Gregorio Marañón5, City of Hope National Medical Center6, Mount Vernon Hospital7, Katholieke Universiteit Leuven8, University of Padua9, Northwestern University10, University of Barcelona11, Bellvitge University Hospital12
TL;DR: Patients with pCR after chemoradiation have better long-term outcome than do those without pCR, and pCR might be indicative of a prognostically favourable biological tumour profile with less propensity for local or distant recurrence and improved survival.
Abstract: Summary Background Locally advanced rectal cancer is usually treated with preoperative chemoradiation. After chemoradiation and surgery, 15–27% of the patients have no residual viable tumour at pathological examination, a pathological complete response (pCR). This study established whether patients with pCR have better long-term outcome than do those without pCR. Methods In PubMed, Medline, and Embase we identified 27 articles, based on 17 different datasets, for long-term outcome of patients with and without pCR. 14 investigators agreed to provide individual patient data. All patients underwent chemoradiation and total mesorectal excision. Primary outcome was 5-year disease-free survival. Kaplan-Meier survival functions were computed and hazard ratios (HRs) calculated, with the Cox proportional hazards model. Subgroup analyses were done to test for effect modification by other predicting factors. Interstudy heterogeneity was assessed for disease-free survival and overall survival with forest plots and the Q test. Findings 484 of 3105 included patients had a pCR. Median follow-up for all patients was 48 months (range 0–277). 5-year crude disease-free survival was 83·3% (95% CI 78·8–87·0) for patients with pCR (61/419 patients had disease recurrence) and 65·6% (63·6–68·0) for those without pCR (747/2263; HR 0·44, 95% CI 0·34–0·57; p Q test and forest plots did not suggest significant interstudy variation. The adjusted HR for pCR for failure was 0·54 (95% CI 0·40–0·73), indicating that patients with pCR had a significantly increased probability of disease-free survival. The adjusted HR for disease-free survival for administration of adjuvant chemotherapy was 0·91 (95% CI 0·73–1·12). The effect of pCR on disease-free survival was not modified by other prognostic factors. Interpretation Patients with pCR after chemoradiation have better long-term outcome than do those without pCR. pCR might be indicative of a prognostically favourable biological tumour profile with less propensity for local or distant recurrence and improved survival. Funding None.
1,459 citations
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TL;DR: The number of lymph nodes evaluated after surgical resection was positively associated with survival of patients with stage II and stage III colon cancer, and support consideration of the number ofymph nodes evaluated as a measure of the quality of colon cancer care.
Abstract: Background Adequate lymph node evaluation for cancer involvement is important for prognosis and treatment of patients with colon cancer. The number of lymph nodes evaluated may be a measure of quality in colon cancer care and appears to be inadequate in most patients treated for colon cancer. We performed a systematic review of the evidence for the association between lymph node evaluation and oncologic outcomes in patients with colon cancer. Methods Medline, Scopus, Cochrane, and the National Guidelines Clearinghouse databases were searched from January 1, 1990, through June 30, 2006, for studies in which survival data as a function of number of lymph nodes evaluated were available. These studies were evaluated for methodologic quality, design, and data source. A total of 61,371 patients were included. Results Seventeen studies from nine countries were eligible for systematic review, including two secondary analyses of multicenter randomized trials of adjuvant chemotherapy for colon cancer, five population-based observational studies, and 10 single-institution retrospective cohort studies. Despite heterogeneity in methodology and differences in threshold numbers of lymph nodes evaluated (range = 6-40 lymph nodes), 16 of 17 studies reported that increased survival of patients with stage II colon cancer was associated with increased numbers of lymph nodes evaluated. Four of six studies with data from stage III patients also reported a positive association with survival among patients with stage III colon cancer. Conclusions The number of lymph nodes evaluated after surgical resection was positively associated with survival of patients with stage II and stage III colon cancer. These results support consideration of the number of lymph nodes evaluated as a measure of the quality of colon cancer care.
939 citations
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TL;DR: Radiotherapy is a successful and time efficient method by which to palliate pain and/or prevent the morbidity of bone metastases and is recommended for surgical decompression and postoperative radiotherapy in highly selected patients with sufficient performance status and life expectancy.
Abstract: Purpose To present guidance for patients and physicians regarding the use of radiotherapy in the treatment of bone metastases according to current published evidence and complemented by expert opinion. Methods and Materials A systematic search of the National Library of Medicine’s PubMed database between 1998 and 2009 yielded 4,287 candidate original research articles potentially applicable to radiotherapy for bone metastases. A Task Force composed of all authors synthesized the published evidence and reached a consensus regarding the recommendations contained herein. Results The Task Force concluded that external beam radiotherapy continues to be the mainstay for the treatment of pain and/or prevention of the morbidity caused by bone metastases. Various fractionation schedules can provide significant palliation of symptoms and/or prevent the morbidity of bone metastases. The evidence for the safety and efficacy of repeat treatment to previously irradiated areas of peripheral bone metastases for pain was derived from both prospective studies and retrospective data, and it can be safe and effective. The use of stereotactic body radiotherapy holds theoretical promise in the treatment of new or recurrent spine lesions, although the Task Force recommended that its use be limited to highly selected patients and preferably within a prospective trial. Surgical decompression and postoperative radiotherapy is recommended for spinal cord compression or spinal instability in highly selected patients with sufficient performance status and life expectancy. The use of bisphosphonates, radionuclides, vertebroplasty, and kyphoplasty for the treatment or prevention of cancer-related symptoms does not obviate the need for external beam radiotherapy in appropriate patients. Conclusions Radiotherapy is a successful and time efficient method by which to palliate pain and/or prevent the morbidity of bone metastases. This Guideline reviews the available data to define its proper use and provide consensus views concerning contemporary controversies or unanswered questions that warrant prospective trial evaluation.
747 citations