Browsing by Author "Ellsworth, Susannah"

Now showing 1 - 4 of 4
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    Circulating Lymphocyte Counts Early During Radiotherapy are Associated with Recurrence in Pediatric Medulloblastoma
    (Elsevier, 2021) Grassberger, Clemens; Shinnick, Daniel; Yeap, Beow Y.; Tracy, Mark; Ellsworth, Susannah; Hess, Clayton B.; Weyman, Elizabeth A.; Gallotto, Sara L.; Lawell, Miranda P.; Bajaj, Benjamin; Ebb, David H.; Ioakeim-Ioannidou, Myrsini; Loeffler, Jay; MacDonald, Shannon; Tarbell, Nancy J.; Yock, Torunn I.; Radiation Oncology, School of Medicine
    Background Decreased peripheral lymphocyte counts are associated with outcome after RT in several solid tumors, though appear late during or after the radiation course and often correlate with other clinical factors. Here we investigate if absolute lymphocyte counts (ALC) are independently associated with recurrence in pediatric medulloblastoma early during RT. Methods We assessed 202 medulloblastoma patients treated between 2000 and 2016 and analyzed ALC throughout therapy, focusing on both early markers (ALC during week 1 – ALC wk1; grade 3+ Lymphopenia during week 2 – Lymphopenia wk2) and late markers (ALC nadir). Uni- and multivariable regressions were used to assess association of clinical and treatment variables with ALC and of ALC with recurrence. Results Thirty-six recurrences were observed, with a median time to recurrence of 1.6 years (Range 0.2-10.3) and 7.1 years median follow-up. ALC during RT was associated with induction chemotherapy (p<0.001), concurrent carboplatin (p=0.009), age (p=0.01) and high-risk status (p=0.05). On univariable analysis, high-risk disease (HR 2.0[1.06–3.9],p=0.03) and M stage≥1 (HR 2.2[1.1–4.4]) were associated with recurrence risk, as was lower ALC early during RT (ALC wk1 HR 0.28[0.12–0.65],p=0.003; Lymphopenia wk2 HR 2.27[1.1-4.6],p=0.02). Neither baseline ALC nor nadir correlated with outcome. These associations persisted when excluding carboplatin and pre-RT chemotherapy patients, and in the multivariable analysis accounting for confounders lymphocyte counts remain significant (ALC wk1 HR 0.23[0.09–0.57],p=0.002; Lymphopenia wk2 HR 2.3[1.1–4.8],p=0.03). Conclusion ALC during weeks 1 and 2 of RT was associated with recurrence and low ALC is an independent prognostic factor in medulloblastoma. Strategies to mitigate the risk of radiation-induced lymphopenia should be considered.
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    Comment on 'Dexamethasone exerts profound immunologic interference on treatment efficacy for recurrent glioblastoma'
    (British Journal of Cancer, 2015-12-01) Ellsworth, Susannah; Grossman, Stuart A.; Department of Radiation Oncology, IU School of Medicine
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    A Multidisciplinary Approach to Pancreas Cancer in 2016: A Review
    (Nature, 2017) Fogel, Evan L.; Shahda, Safi; Sandrasegaran, Kumar; DeWitt, John; Easler, Jeffrey J.; Agarwal, David M.; Eagleson, Mackenzie; Zyromski, Nicholas J.; House, Michael G.; Ellsworth, Susannah; El Hajj, Ihab I.; O'Neil, Bert H.; Nakeeb, Attila; Sherman, Stuart; Medicine, School of Medicine
    In this article, we review our multidisciplinary approach for patients with pancreatic cancer. Specifically, we review the epidemiology, diagnosis and staging, biliary drainage techniques, selection of patients for surgery, chemotherapy, radiation therapy, and discuss other palliative interventions. The areas of active research investigation and where our knowledge is limited are emphasized.
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    Proton therapy reduces the likelihood of high-grade radiation-induced lymphopenia in glioblastoma patients: phase II randomized study of protons vs photons
    (Oxford University Press, 2021-02-25) Mohan, Radhe; Liu, Amy Y.; Brown, Paul D.; Mahajan, Anita; Dinh, Jeffrey; Chung, Caroline; McAvoy, Sarah; McAleer, Mary Frances; Lin, Steven H.; Li, Jing; Ghia, Amol J.; Zhu, Cong; Sulman, Erik P.; de Groot, John F.; Heimberger, Amy B.; McGovern, Susan L.; Grassberger, Clemens; Shih, Helen; Ellsworth, Susannah; Grosshans, David R.; Radiation Oncology, School of Medicine
    Background: We investigated differences in radiation-induced grade 3+ lymphopenia (G3+L), defined as an absolute lymphocyte count (ALC) nadir of <500 cells/µL, after proton therapy (PT) or X-ray (photon) therapy (XRT) for patients with glioblastoma (GBM). Methods: Patients enrolled in a randomized phase II trial received PT (n = 28) or XRT (n = 56) concomitantly with temozolomide. ALC was measured before, weekly during, and within 1 month after radiotherapy. Whole-brain mean dose (WBMD) and brain dose-volume indices were extracted from planned dose distributions. Univariate and multivariate logistic regression analyses were used to identify independent predictive variables. The resulting model was evaluated using receiver operating characteristic (ROC) curve analysis. Results: Rates of G3+L were lower in men (7/47 [15%]) versus women (19/37 [51%]) (P < 0.001), and for PT (4/28 [14%]) versus XRT (22/56 [39%]) (P = 0.024). G3+L was significantly associated with baseline ALC, WBMD, and brain volumes receiving 5‒40 Gy(relative biological effectiveness [RBE]) or higher (ie, V5 through V40). Stepwise multivariate logistic regression analysis identified being female (odds ratio [OR] 6.2, 95% confidence interval [CI]: 1.95‒22.4, P = 0.003), baseline ALC (OR 0.18, 95% CI: 0.05‒0.51, P = 0.003), and whole-brain V20 (OR 1.07, 95% CI: 1.03‒1.13, P = 0.002) as the strongest predictors. ROC analysis yielded an area under the curve of 0.86 (95% CI: 0.79-0.94) for the final G3+L prediction model. Conclusions: Sex, baseline ALC, and whole-brain V20 were the strongest predictors of G3+L for patients with GBM treated with radiation and temozolomide. PT reduced brain volumes receiving low and intermediate doses and, consequently, reduced G3+L.