Browsing by Author "McClelland, Shearwood, III"
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Item A National Cancer Database analysis of the patterns of care for meningeal melanocytoma(Future Science Group, 2021) Tep, Amanda C.; Kelly, Patrick D.; Scarpelli, Daphne B.; Bergue, Bailey; McClelland, Shearwood, III; Jaboin, Jerry J.; Radiation Oncology, School of MedicineAim: To evaluate demographics, treatment patterns, radiotherapy utilization and patient outcomes in meningeal melanocytomas. Materials & methods: The National Cancer Database was queried for meningeal melanocytomas diagnosed in 2002-2016. The effects of demographic, clinical and treatment variables were determined via Kaplan-Meier log-rank and Cox regression analyses. Results: The median and 5-year overall survival were 57.46 months and 48%, respectively. Patients earning ≥$48K showed improved survival (p = 0.0319). Radiotherapy and chemotherapy were utilized in 37.7 and 9% of patients, respectively. Conclusion: Income significantly affected survival. Surgery remains the mainstay approach. Radiotherapy was delivered in more than one-third of patients but did not impact survival. However, further analyses were limited by poor treatment modality information in the database.Item Analysis of pre-residency research productivity, dual degree status, and gender distribution of underrepresented minorities among a current United States radiation oncology junior resident class(Elsevier, 2019-04-05) McClelland, Shearwood, III; Woodhouse, Kristina D.; Jaboin, Jerry J.; Zellars, Richard C.; Radiation Oncology, School of MedicineBackground: Among the most competitive medical subspecialties, representation of underrepresented minorities (African-American race and/or Hispanic ethnicity) among resident trainees has historically been low compared to their United States Census general population representation. Research productivity and dual degree status may impact residency applicant competitiveness. To date, such an analysis has yet to be performed in Radiation Oncology. Methods: A list of radiation oncology residents from the graduating class of 2022 was obtained through internet searches. Demographics included were gender and dual degree status. Research productivity was calculated using the number of pre-residency peer-reviewed publications (PRP). Fisher's exact test was used for statistical analysis. Results: Of the 179 residents evaluated from the 2022 class, eleven (6.1%) were underrepresented minorities. Compared to the remainder of the class, underrepresented minorities had a lower proportion of men (63.6% versus 69.3%), a higher proportion of dual degrees (45.5% versus 28.6%), and a lower proportion of MD-PhD degrees (9.1% versus 17.2%). Underrepresented minorities had a higher proportion of residents with at least two PRP (72.7% versus 57.1%) and a lower proportion of residents with no PRP (18.2% versus 24.4%). None of these differences reached statistical significance (p > 0.05). Conclusion: Underrepresented minorities were comparable to the remainder of their Radiation Oncology resident class regarding gender distribution, dual degrees status, and likelihood of having at least two peer-reviewed publications cited in PubMed during the calendar year of residency application. Further studies will be needed to determine how these findings translate into future scholarly activity and post-graduate career choice.Item Dramatic polarization in genitourinary expert opinions regarding the clinical utility of positron emission tomography (PET) imaging in prostate cance(SciELO, 2019-01) Sandler, Kiri A.; McClelland, Shearwood, III; Degnin, Catherine; Chen, Yiyi; Mitin, Timur; Radiation Oncology, School of MedicineOBJECTIVES: To ascertain the opinions of North American genitourinary (GU) experts regarding inclusion of technologies such as prostate - specific membrane antigen (PSMA) and C - 11 choline positron emission tomography (PET) into routine practice. MATERIALS AND METHODS: A survey was distributed to North American GU experts. Questions pertained to the role of PSMA and C - 11 PET in PCa management. Participants were categorized as "supporters" or "opponents" of incorporation of novel imaging techniques. Opinions were correlated with practice patterns. RESULTS: Response rate was 54% and we analyzed 42 radiation oncologist respondents. 17 participants (40%) have been in practice for > 20 years and 38 (90%) practice at an academic center. 24 (57%) were supporters of PSMA and 29 (69%) were supporters of C - 11. Supporters were more likely to treat pelvic nodes (88% vs. 56%, p < 01) and trended to be more likely to treat patients with moderate or extreme hypofractionation (58% vs. 28%, p = 065). Supporters trended to be more likely to offer brachytherapy boost (55% vs. 23%, p = 09), favor initial observation and early salvage over adjuvant radiation (77% vs. 55%, p = 09), and to consider themselves expert brachytherapists (69% vs. 39%, p = 09). CONCLUSIONS: There is a polarization among GU radiation oncology experts regarding novel imaging techniques. A correlation emerged between support of novel imaging and adoption of treatment approaches that are clinically superior or less expensive. Pre - existing biases among GU experts on national treatment - decision panels and leaders of cooperative group studies may affect the design of future studies and influence the adoption of these technologies in clinical practice.Item Gender-based analysis of pre-residency research productivity among a current United States radiation oncology resident class(AME, 2021) McClelland, Shearwood, III; Murphy, Blair; Jaboin, Jerry J.; Zellars, Richard C.; Radiation Oncology, School of MedicineBackground: The increasing proportion of women in medicine has not been adequately reflected in the gender distribution of radiation oncology residents. The presence of at least one pre-residency peer-reviewed publication (PRP) has been associated with radiation oncology resident choice of academic over private practice career, with no significant gender difference in the likelihood of having a PRP (McClelland et al., 2017). We sought to pursue a gender-based analysis of PRP productivity in a current junior resident class. Methods: A list of radiation oncology residents from the graduating class of 2022 (PGY-2 academic year of 2018-2019) was obtained through internet investigation. Research productivity was calculated using PRP number, defined as the number of a resident's publications listed in PubMed (pubmed.gov) through the calendar year of residency application (2016 for this class). Results: Of 195 residents examined from the 2022 class, 61 (31%) were women, representing a nine percent increase from the resident class of 2016. Four-fifths of women had 1+ PRP, 31% had dual degrees, and 18% had a PhD. These percentages were comparable to their male counterparts, 73% with 1+ PRP, 28% with dual degrees, and 15% with a PhD. There were no statistically significant differences by gender in any of these benchmarks. Conclusions: While slower than the overall trend of increased female representation in medicine, the proportion of women in radiation oncology residency has increased by 0.9-1.5% annually over a recent six-year span. There remain no significant differences in PRP productivity, dual degree status, or PhD status by gender.Item Integrating Audiovisual Immersion Into Pediatric Radiation Therapy Across Multiple Centers: Methodology, Timeliness, and Cost of the Audiovisual-Assisted Therapeutic Ambience in Radiation Therapy Prospective Multi-Institutional Trial(Elsevier, 2024-08-10) Oh, Justin; Skinner, Lawrie; Gutkin, Paulina M.; Jiang, Alice; Donaldson, Sarah S.; Loo, Billy W., Jr.; Wang, Yi Peng; Ewongwo, Agnes; Bredfeldt, Jeremy S.; Breneman, John C.; Constine, Louis S.; Faught, Austin M.; Haas-Kogan, Daphne; Holmes, Jordan A.; Krasin, Matthew; Larkin, Charlene; Marcus, Karen J.; Maxim, Peter G.; McClelland, Shearwood, III; Murphy, Blair; Palmer, Joshua D.; Perkins, Stephanie M.; Shen, Colette J.; Terezakis, Stephanie; Bush, Karl; Hiniker, Susan M.; Radiation Oncology, School of MedicinePurpose: The Audiovisual-Assisted Therapeutic Ambience in Radiotherapy (AVATAR) trial was a prospective multicenter study (NCT03991156) examining the combination of video immersion with radiation therapy and was successfully conducted through the collaboration of pediatric radiation oncology teams at 10 institutions independent of any pre-existing consortium. We sought to analyze and report the methodology of trial conception and development, process map, and cost. Methods and materials: The study enrolled patients aged 3 to 10 years preparing to undergo radiation therapy, integrated the combination of AVATAR-based video immersion with radiation therapy at each institution, and offered AVATAR use as an alternative to anesthesia, with rates of anesthesia use and outcomes of serial standardized anxiety and quality-of-life assessments assessed among the 81 children enrolled. A process map was created based on the trial timeline with the following components: study development time (time from conception of the trial to the accrual of the first patient, including design phase, agreement and approval phase, and site preparation phase), and accrual duration time (time from the first to last accrual). Costs and institutional success rates were calculated. Results: Time from inception of study to last accrual was 3.6 years (1313 days). The study development time was 417 days (31.7%), and accrual duration time was 896 days (68.3%), with the final 50% of accrual occurring in <6 months. Equipment cost was approximately $550 per institution and was covered by funding from the lead study institution. All 10 centers were successful with AVATAR implementation, defined as ≥50% of patients able to avoid anesthesia with the use of AVATAR, including centers with both photon and proton therapy. Conclusions: This report elaborates on the methodology and timeline of trial conception and development using data from a previously published supportive care study combining video immersion with radiation therapy among 10 cooperating pediatric oncology institutions. It highlights the potential for multicenter collaborations on prospective trials integrating supportive care therapies with radiation therapy.Item An Intracranial Hemorrhage Wrapped in an Enigma(Elsevier, 2019-10) McClelland, Shearwood, III; Saito, Naoyuki G.; Radiation Oncology, School of MedicineAn 88-year-old man with Alzheimer's dementia who previously received a diagnosis of solitary Fuhrman grade 2 renal cell carcinoma1 managed with active surveillance presented to the emergency department for progressive left-sided headache and difficulty recognizing numbers and letters. He and his family denied history of trauma, fall, or anticoagulant use. This occurred 1 week after presenting to the same emergency department with a headache and being discharged home after negative head computed tomography, 2 months after spontaneous subarachnoid hemorrhage involving the right central sulcus, and 11 months after transient ischemic attack symptoms with negative workup.Item Long-term stroke risk in meningioma patients treated with conventionally fractionated photon-based radiation therapy(Old City Publishing Group, 2019) McClelland, Shearwood, III; Mitin, Timur; Kubicky, Charlotte D.; Jaboin, Jerry J.; Radiation Oncology, School of MedicineItem Measure Twice: Promise of Liquid Biopsy in Pediatric High-Grade Gliomas(Elsevier, 2020-01-28) Dietz, Matthew S.; Beach, Catherine Z.; Barajas, Ramon; Parappilly, Michael S.; Sengupta, Sidharth K.; Baird, Lissa C.; Ciporen, Jeremy N.; Han, Seunggu J.; Loret de Mola, Rebecca; Cho, Yoon Jae; Nazemi, Kellie J.; McClelland, Shearwood, III; Wong, Melissa H.; Jaboin, Jerry J.; Radiation Oncology, School of MedicinePurpose To review and critique the current state of liquid biopsy in pHGG. Materials and Methods Published literature was reviewed for articles related to liquid biopsy in pediatric glioma and adult glioma with a focus on high-grade gliomas. Results This review discusses the current state of liquid biomarkers of pHGG and their potential applications for liquid biopsy development. Conclusions While nascent, the progress toward identifying circulating analytes of pHGG primes the field of neuro-oncoogy for liquid biopsy development.Item Nearly Half of Metastatic Brain Disease Patients Prescribed 10 Fractions of Whole-Brain Radiation Therapy Die Without Completing Treatment(Elsevier, 2019) McClelland, Shearwood, III; Agrawal, Namita; Shiue, Kevin; Bartlett, Gregory K.; Zellars, Richard C.; Watson, Gordon A.; Ellsworth, Susannah G.; Radiation Oncology, School of MedicineItem Pediatric Pleomorphic Xanthoastrocytoma: A National Database Inquiry on Current Treatment Approaches in the United States(Wiley, 2021) Scarpelli, Daphne B.; Yu, Yun; Tep, Amanda C.; Bergue, Bailey; Degnin, Catherine; Chen, Yiyi; McClelland, Shearwood, III; Jaboin, Jerry J.; Radiation Oncology, School of MedicineBackground: Pleomorphic xanthoastrocytomas (PXAs) account for <1% of primary brain tumors, occurring predominantly in children and young adults. Surgical resection serves as the primary treatment for PXAs, while radiotherapy (RT) and chemotherapy protocols remain poorly defined. Aim: This study aims to determine current care patterns utilized for pediatric patients (≤ 18 years) diagnosed with PXAs and their effect on overall survival. Methods: The United States National Cancer Database (NCDB) was queried between 2004 and 2015 for pediatric patients (≤18 years) diagnosed with PXAs. Results: From the 224 qualifying patients, most patients proceeded with surgery only (78.1%), while 11.6% of patients received both adjuvant RT and chemotherapy. In the 2010-2015 cohort, patients with subtotal resection were associated with poorer prognosis than those with gross-total resection (hazard ratio = 17.44, 95% confidence interval = 2.10-144.90, p < .001). RT and chemotherapy recipients were similarly associated with poorer survival than those treated with surgery only, with p-values of <.001 and respective hazard ratios of 3.82 (95% confidence interval = 1.85-7.90) and 6.68 (95% confidence interval = 3.21-13.89). The key factors impacting the probability of RT delivery involved WHO grade (p < .001) and chemotherapy administration (p < .001). However, WHO grade alone did not significantly impact survival (p-value = .088). Conclusion: Maximally safe resection is the current treatment goal for patients with PXAs. RT and chemotherapy are poorly utilized but had a greater role in managing more aggressive cases of PXAs. Additional research focusing on the impact of adjuvant therapies on tumor progression is needed to better guide treatment decisions.