Bio

Clinical Focus


  • Radiation Oncology
  • Brachytherapy
  • Cancer > Gynecologic Cancer
  • Thyroid Cancer
  • Breast Cancer
  • Gynecologic Malignancies
  • Cancer > Radiation Oncology

Academic Appointments


Professional Education


  • Medical Education:Washington University School Of Medicine (2005) MO
  • Residency:Washington University Dept of Radiation Oncology (06/30/2010) MO
  • Board Certification: Radiation Oncology, American Board of Radiology (2011)
  • Internship:Washington University School Of Medicine (06/20/2006) MO

Research & Scholarship

Clinical Trials


  • Novel Serum Markers for Monitoring Response to Anti-Cancer Therapy Recruiting

    The purpose of this trial is to collect blood serum from cancer patients with tumors at different disease sites (such as pancreas, head and neck, and breast) prior to and at subsequent points following anti-cancer therapy to discover novel serum markers of response.

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  • Phase I Pilot Study to Evaluate the Prognostic Value of Perfusion CT for Primary Cervical Cancer Not Recruiting

    The investigators hope to learn whether perfusion CT is a useful way to assess primary cervical tumor microenvironment and whether there is a relationship between pretreatment perfusion CT measurements and primary cervical tumor size, lymph node involvement (as assessed by standard of care pretreatment fludeoxyglucose Positron emission tomography/CT (FDG-PET/CT)), and treatment response (as assessed by standard of care 3-month post-therapy FDG-PET/CT).

    Stanford is currently not accepting patients for this trial. For more information, please contact Jacob Wynne, 650-723-8843.

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  • Phase I Stereotactic Body Radiation for Metastatic or Recurrent Platinum-Resistant Ovarian Cancer Not Recruiting

    This phase I trial studies the side effects and the best dose of stereotactic body radiation therapy (SBRT) in treating patients with metastatic or recurrent ovarian cancer or primary peritoneal cancer. SBRT may be able to send x-rays directly to the tumor and cause less damage to normal tissue.

    Stanford is currently not accepting patients for this trial. For more information, please contact Elizabeth A. Kidd, 650-725-2174.

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  • Tissue and Plasma Biomarkers of Lymph Node Involvement in Cervical Cancer Recruiting

    SPECIFIC STUDY AIMS Specific Aim 1: To use gene expression analysis of primary cervical cancers to identify a gene expression signature that predicts for lymph node metastases in this disease. Specific Aim 2: To predict lymph node metastases by performing multiplex measurements of cancer-associated proteins and cytokines using proximity ligation assay (PLA) on plasma samples. Specific Aim 3: To measure circulating human papilloma virus (HPV) DNA in the plasma samples of cervical cancer patients using real-time quantitative polymerase chain reaction (qPCR) and determine its ability to predict for nodal metastases. Specific Aim 4: To use deep sequencing to evaluate gene and sequence differences between cervical cancer patients with and without lymph node metastasis.

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Teaching

2013-14 Courses


Publications

Journal Articles


  • Impact of chemotherapy on normal tissue complication probability models of acute hematologic toxicity in patients receiving pelvic intensity modulated radiation therapy. International journal of radiation oncology, biology, physics Bazan, J. G., Luxton, G., Kozak, M. M., Anderson, E. M., Hancock, S. L., Kapp, D. S., Kidd, E. A., Koong, A. C., Chang, D. T. 2013; 87 (5): 983-991

    Abstract

    To determine how chemotherapy agents affect radiation dose parameters that correlate with acute hematologic toxicity (HT) in patients treated with pelvic intensity modulated radiation therapy (P-IMRT) and concurrent chemotherapy.We assessed HT in 141 patients who received P-IMRT for anal, gynecologic, rectal, or prostate cancers, 95 of whom received concurrent chemotherapy. Patients were separated into 4 groups: mitomycin (MMC) + 5-fluorouracil (5FU, 37 of 141), platinum ± 5FU (Cis, 32 of 141), 5FU (26 of 141), and P-IMRT alone (46 of 141). The pelvic bone was contoured as a surrogate for pelvic bone marrow (PBM) and divided into subsites: ilium, lower pelvis, and lumbosacral spine (LSS). The volumes of each region receiving 5-40 Gy were calculated. The endpoint for HT was grade ≥3 (HT3+) leukopenia, neutropenia or thrombocytopenia. Normal tissue complication probability was calculated using the Lyman-Kutcher-Burman model. Logistic regression was used to analyze association between HT3+ and dosimetric parameters.Twenty-six patients experienced HT3+: 10 of 37 (27%) MMC, 14 of 32 (44%) Cis, 2 of 26 (8%) 5FU, and 0 of 46 P-IMRT. PBM dosimetric parameters were correlated with HT3+ in the MMC group but not in the Cis group. LSS dosimetric parameters were well correlated with HT3+ in both the MMC and Cis groups. Constrained optimization (0

    View details for DOI 10.1016/j.ijrobp.2013.09.017

    View details for PubMedID 24161422

  • ACR APPROPRIATENESS CRITERIA (R) Management of Vaginal Cancer ONCOLOGY-NEW YORK Lee, L. J., Jhingran, A., Kidd, E., Cardenes, H. R., Elshaikh, M. A., Erickson, B., Mayr, N. A., Moore, D., Puthawala, A. A., Rao, G. G., Small, W., Varia, M. A., Wahl, A. O., Wolfson, A. H., Yashar, C. M., Yuh, W., Gaffney, D. K. 2013; 27 (11): 1166-1173
  • Primary squamous cell carcinoma of the vagina: Prognostic factors, treatment patterns, and outcomes. Gynecologic oncology Hiniker, S. M., Roux, A., Murphy, J. D., Harris, J. P., Tran, P. T., Kapp, D. S., Kidd, E. A. 2013; 131 (2): 380-385

    Abstract

    Primary squamous cell carcinoma (SCCA) of the vagina is a rare malignancy with limited data to guide treatment. We evaluated prognostic factors and outcomes for patients with primary vaginal SCCA treated with definitive radiation therapy at a single institution.A retrospective analysis was performed on patients treated for primary vaginal SCCA from 1959 to 2011.Ninety-one patients with primary vaginal SCCA were treated with definitive radiation therapy. Thirty-eight patients had FIGO stage I, 28 stage II, 13 stage III, and 12 stage IV disease. The mean total dose was 70.1Gy. Two-year overall survival (OS), locoregional control rate (LRC), and distant metastasis-free survival by stage were, respectively: stage I: 96.2%, 80.6%, 87.5%; stage II: 92.3%, 64.7%, 84.6%; stage III: 66.6%, 44.4%, 50.0%; and stage IV: 25.0%, 14.3%, 25.0%. Treatment with total dose over 70Gy was associated with improved OS (p=0.0956) and LRC (p=0.055). There was a significant difference in median dose received by patients who developed grade 3/4 toxicity compared to those who did not (82.9Gy versus 70.0Gy, p=0.0019). None of the 10 patients treated with IMRT experienced locoregional recurrence or grade 3/4 toxicity. Tumor size larger than 4cm was associated with worse OS (p=0.0034) and LRC (p=0.006).Our analysis suggests that the optimal dose for definitive treatment of SCCA of the vagina lies between 70 and 80Gy. Treatment with IMRT may allow for dose escalation with reduced toxicity and excellent LRC. Tumor size over 4cm is associated with inferior outcomes and may require additional treatment modalities.

    View details for DOI 10.1016/j.ygyno.2013.08.012

    View details for PubMedID 23954572

  • Treatment approach and outcomes of vaginal melanoma. International journal of gynecological cancer Kirschner, A. N., Kidd, E. A., Dewees, T., Perkins, S. M. 2013; 23 (8): 1484-1489

    Abstract

    To describe the characteristics of primary vaginal melanoma patients in the Surveillance, Epidemiology, and End Result database and to determine the outcome from the treatment approaches.From the Surveillance, Epidemiology, and End Result registry, 201 patients with vaginal melanoma were identified. Patients' characteristics and prognostic factors including age, race, extent of surgery, and use of radiation therapy were obtained.The median age was 68 years (range, 28-100 years). The population was 73% white, 11% black, and 16% Asian/American Indian. International Federation of Gynecology and Obstetrics staging results were stage I (46%), stage II (18%), stage III (3%), stage IVA (3%), stage IVB (12%), and unknown (18%). Treatment approach included surgical resection of the primary site in 70%, whereas 35% of the patients underwent lymph node resection. Approximately 40% of the patients received radiotherapy, which was primarily used in the adjuvant setting. Overall survival at 2 and 5 years was 24% and 15%, respectively. Presence of lymph nodes at diagnosis was associated with worse overall survival (hazard ratio, 1.98; P = 0.02). Adjuvant radiation did not offer a statistically significant overall survival advantage compared to surgery alone.Vaginal melanoma is a rare diagnosis primarily affecting the elderly. Overall survival is low even for patients presenting with disease limited to the vagina. Lymph node involvement at diagnosis is strongly predictive of worse overall survival. Most patients are treated with surgical resection with varying use of adjuvant radiotherapy. Further research is needed to identify the etiology and improve the outcome of this aggressive disease.

    View details for DOI 10.1097/IGC.0b013e3182a1ced8

    View details for PubMedID 23945202

  • ACR Appropriateness Criteria® management of locoregionally advanced squamous cell carcinoma of the vulva. American journal of clinical oncology Kidd, E., Moore, D., Varia, M. A., Gaffney, D. K., Elshaikh, M. A., Erickson, B., Jhingran, A., Lee, L. J., Mayr, N. A., Puthawala, A. A., Rao, G. G., Small, W., Wahl, A. O., Wolfson, A. H., Yashar, C. M., Yuh, W., Cardenes, H. R. 2013; 36 (4): 415-422

    Abstract

    Locoregionally advanced vulvar cancer (LRAVC) is a rare disease that presents many challenging medical decisions. An expert panel was convened to reach consensus on the most appropriate pretreatment assessment and therapeutic interventions in LRAVC patients.The American College of Radiology Appropriateness Criteria are evidenced-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journal and the application of a well-established consensus methodology (modified Delphi) to rate appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to formulate recommendations.Three clinical variants were developed to address common scenarios in the management of LRAVC. Group members reached consensus on the appropriateness of specific evaluation and treatment approaches, with numerical ratings and descriptive commentary.In combining available medical literature and expert opinion, this manuscript may serve as an aid for other practitioners in the appropriate management of patients with LRAVC.

    View details for DOI 10.1097/COC.0b013e318295af1d

    View details for PubMedID 23872794

  • Changes in Cervical Cancer FDG Uptake During Chemoradiation and Association With Response INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS Kidd, E. A., Thomas, M., Siegel, B. A., Dehdashti, F., Grigsby, P. W. 2013; 85 (1): 116-122

    Abstract

    Previous research showed that pretreatment uptake of F-18 fluorodeoxyglucose (FDG), as assessed by the maximal standardized uptake value (SUVmax) and the variability of uptake (FDGhetero), predicted for posttreatment response in cervical cancer. In this pilot study, we evaluated the changes in SUVmax and FDGhetero during concurrent chemoradiation for cervical cancer and their association with post-treatment response.Twenty-five patients with stage Ib1-IVa cervical cancer were enrolled. SUVmax, FDGhetero, and metabolic tumor volume (MTV) were recorded from FDG-positron emission tomography (PET)/computed tomography (CT) scans performed pretreatment and during weeks 2 and 4 of treatment and were evaluated for changes and association with response assessed on 3-month post-treatment FDG-PET/CT.For all patients, the average pretreatment SUVmax was 17.8, MTV was 55.4 cm3, and FDGhetero was -1.33. A similar decline in SUVmax was seen at week 2 compared with baseline and week 4 compared with week 2 (34%). The areas of highest FDG uptake in the tumor remained relatively consistent on serial scans. Mean FDGhetero decreased during treatment. For all patients, MTV decreased more from week 2 to week 4 than from pretreatment to week 2. By week 4, the average SUVmax had decreased by 57% and the MTV had decreased by 30%. Five patients showed persistent or new disease on 3-month post-treatment PET. These poor responders showed a higher average SUVmax, larger MTV, and greater heterogeneity at all 3 times. Week 4 SUVmax (P=.037), week 4 FDGhetero (P=.005), pretreatment MTV (P=.008), and pretreatment FDGhetero (P=.008) were all significantly associated with post-treatment PET response.SUVmax shows a consistent rate of decline during treatment and declines at a faster rate than MTV regresses. Based on this pilot study, pretreatment and week 4 of treatment represent the best time points for prediction of response.

    View details for DOI 10.1016/j.ijrobp.2012.02.056

    View details for Web of Science ID 000312204700047

    View details for PubMedID 22520475

  • FDG-PET-based prognostic nomograms for locally advanced cervical cancer GYNECOLOGIC ONCOLOGY Kidd, E. A., El Naqa, I., Siegel, B. A., Dehdashti, F., Grigsby, P. W. 2012; 127 (1): 136-140

    Abstract

    We previously found several individual FDG/PET-based prognostic factors for cervical cancer, specifically cervical tumor SUVmax, tumor volume, and highest level of lymph node (LN) involvement. For this study, we evaluate the combined use of these three prognostic factors assessed on pretreatment FDG-PET for predicting recurrence-free survival (RFS), disease-specific survival (DSS), and overall survival (OS).The study included 234 cervical cancer patients, FIGO stage Ib1-IVa, treated with definitive radiation or chemoradiation therapy. All patients underwent FDG-PET or FDG-PET/CT at diagnosis, from which cervical tumor volume, SUVmax, and LN status were recorded. Using these PET-based factors, prognostic nomograms were created for RFS, DSS, and OS, and their prediction accuracies were measured using the concordance index (c-statistic).Fifty-three percent of patients had FDG-avid LN on PET; the highest level of nodal involvement was pelvic in 84, para-aortic in 41, and supraclavicular in 10. The average cervix tumor SUVmax was 12.4 (range, 2.1-50.4) and PET tumor volume average was 66.4 cm3 (range, 3.0-535.7 cm3). The median follow-up was 40.7 months for patients alive at last follow-up. PET LN status had the greatest influence on outcome. The c-statistics for the 3 nomograms were 0.741 for RFS, 0.739 for DSS, and 0.658 for OS. The PET-based nomograms performed better than FIGO stage with c-statistics of 0.605, 0.600 and 0.559 for RFS, DSS and OS, respectively.Pretreatment FDG-PET LN status, cervical tumor SUVmax, and tumor volume combined in a nomogram create good models for predicting cervical cancer RFS, DSS, and OS.

    View details for DOI 10.1016/j.ygyno.2012.06.027

    View details for Web of Science ID 000308783800026

    View details for PubMedID 22735785

  • ACR Appropriateness Criteria (R) Definitive Therapy for Early-Stage Cervical Cancer AMERICAN JOURNAL OF CLINICAL ONCOLOGY-CANCER CLINICAL TRIALS Small, W., Strauss, J. B., Jhingran, A., Yashar, C. M., Cardenes, H. R., Erickson-Wittmann, B. A., Gullett, N., Kidd, E., Lee, L. J., Mayr, N. A., Moore, D., Puthawala, A. A., Rao, G. G., Varia, M. A., Wahl, A. O., Wolfson, A. H., Yuh, W., Gaffney, D. K. 2012; 35 (4): 399-405

    Abstract

    The definitive treatment of early-stage cervical cancer involves multidisciplinary decision making. This expert panel was convened to reach consensus on the selection of appropriate therapies based on patient and disease characteristics at presentation.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or the treatment.Three clinical variants were developed to represent common scenarios in the treatment of early-stage cervical cancer. Group members reached consensus on the appropriateness of therapeutic options. This process yielded numerical ratings and descriptive commentary.This manuscript represents the consensus opinion of an expert panel based on a survey of all available medical literature. This manuscript may be used to inform the clinical decision making of physicians involved in the treatment of early-stage cervical cancer.

    View details for DOI 10.1097/COC.0b013e3182610537

    View details for Web of Science ID 000306599200017

    View details for PubMedID 22810416

  • RADIATION THERAPY FOR PILOCYTIC ASTROCYTOMAS OF CHILDHOOD INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS Mansur, D. B., Rubin, J. B., Kidd, E. A., King, A. A., Hollander, A. S., Smyth, M. D., Limbrick, D. D., Park, T. S., Leonard, J. R. 2011; 79 (3): 829-834

    Abstract

    Though radiation therapy is generally considered the most effective treatment for unresectable pilocytic astrocytomas in children, there are few data to support this claim. To examine the efficacy of radiation therapy for pediatric pilocytic astrocytomas, we retrospectively reviewed the experience at our institution.Thirty-five patients 18 years old or younger with unresectable tumors and without evidence of neurofibromatosis have been treated since 1982. Patients were treated with local radiation fields to a median dose of 54 Gy. Six patients were treated with radiosurgery to a median dose of 15.5 Gy. Five patients were treated with initial chemotherapy and irradiated after progression.All patients were alive after a median follow-up of 5.0 years. However, progression-free survival was 68.7%. None of 11 infratentorial tumors progressed compared with 6 of 20 supratentorial tumors. A trend toward improved progression-free survival was seen with radiosurgery (80%) compared with external beam alone (66%), but this difference did not reach statistical significance. Eight of the 9 patients progressing after therapy did so within the irradiated volume.Although the survival of these children is excellent, almost one third of patients have progressive disease after definitive radiotherapy. Improvements in tumor control are needed in this patient population, and the optimal therapy has not been fully defined. Prospective trials comparing initial chemotherapy to radiation therapy are warranted.

    View details for DOI 10.1016/j.ijrobp.2009.11.015

    View details for Web of Science ID 000287382400027

    View details for PubMedID 20421157

  • CLINICAL OUTCOMES OF DEFINITIVE INTENSITY-MODULATED RADIATION THERAPY WITH FLUORODEOXYGLUCOSE-POSITRON EMISSION TOMOGRAPHY SIMULATION IN PATIENTS WITH LOCALLY ADVANCED CERVICAL CANCER INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS Kidd, E. A., Siegel, B. A., Dehdashti, F., Rader, J. S., Mutic, S., Mutch, D. G., Powell, M. A., Grigsby, P. W. 2010; 77 (4): 1085-1091

    Abstract

    This study aimed to evaluate the toxicity and clinical outcomes for cervical cancer patients treated definitively with intensity-modulated radiation therapy (IMRT) compared with non-IMRT treatment.This prospective cohort study included 452 patients with newly diagnosed cervical cancer treated with curative intent (135 IMRT and 317 non-IMRT). Treatment involved external irradiation and brachytherapy, and 85% of patients received concurrent chemotherapy. All IMRT patients underwent an F-18 fluorodeoxyglucose positron emission tomography (FDG-PET/CT) simulation. A 3-month post-therapy PET was obtained to evaluate treatment response. Toxicity was scored by the Common Terminology Criteria for Adverse Events Version 3.0.The IMRT and non-IMRT groups had similar stage distribution and histology. For all patients, the post-therapy FDG-PET response correlated with overall recurrence risk (p < 0.0001) and cause-specific survival (p < 0.0001). Post-treatment FDG-PET findings were not significantly different between the IMRT and non-IMRT patients (p = 0.9774). The mean follow-up for all patients alive at the time of last follow-up was 52 months (72 months non-IMRT, 22 months IMRT). At last follow-up, 178 patients (39 IMRT, 139 non-IMRT) had developed a recurrence. The difference in recurrence-free survival between the two groups did not reach statistical significance (p = 0.0738), although the IMRT group showed better overall and cause-specific survivals (p < 0.0001). Of the patients, 62 patients (8 IMRT and 54 non-IMRT) developed Grade 3 or greater bowel or bladder complications, and by cumulative hazard function analysis the risk was significantly less for patients treated with IMRT (p = 0.0351).Cervical cancer patients treated with FDG-PET/CT-guided IMRT have improved survival and less treatment-related toxicity compared with patients treated with non-IMRT radiotherapy.

    View details for DOI 10.1016/j.ijrobp.2009.06.041

    View details for Web of Science ID 000279489500018

    View details for PubMedID 19880262

  • Anal cancer maximum F-18 fluorodeoxyglucose uptake on positron emission tomography is correlated with prognosis RADIOTHERAPY AND ONCOLOGY Kidd, E. A., Dehdashti, F., Siegel, B. A., Grigsby, P. W. 2010; 95 (3): 288-291

    Abstract

    To evaluate anal cancer uptake of F-18 fluorodeoxyglucose (FDG) measured as the maximum standardized uptake value (SUV(max)) by positron emission tomography (PET) and its correlation with prognostic factors.The study population consisted of 77 patients with stages 0-IIIB anal cancer who underwent pre-treatment FDG-PET. Tumor histology included 65 squamous cell, 11 basaloid, and 1 small cell cancers. SUV(max) and sites of lymph node metastasis were recorded. We analyzed the association between SUV(max) and prognostic factors.The mean SUV(max) was 10.0 (range 1.0-43.1). The stage distribution included: 2 stage 0, 7 stage I, 49 stage II, 10 stage IIIA, 9 stage IIIB. SUV(max) and clinical tumor size were not associated (R(2)=0.338). Histology did not significantly influence SUV(max) (mean SUV(max) 10.0 for squamous versus 9.90 for basaloid). Higher SUV(max) was associated with an increased risk of nodal metastasis at diagnosis (p<0.0001). Higher SUV(max) was associated with worse disease-free survival (p=0.05). Patients with high anal tumor SUV(max) at diagnosis were at an increased risk of persistent or recurrent disease on post-therapy FDG-PET performed less than 4months after completing therapy (p=0.0402).SUV(max) is a valuable biomarker of anal cancer prognosis, predicting increased risk of lymph node metastasis and worse disease-free survival.

    View details for DOI 10.1016/j.radonc.2010.02.019

    View details for Web of Science ID 000279038400005

    View details for PubMedID 20231040

  • Lymph Node Staging by Positron Emission Tomography in Cervical Cancer: Relationship to Prognosis JOURNAL OF CLINICAL ONCOLOGY Kidd, E. A., Siegel, B. A., Dehdashti, F., Rader, J. S., Mutch, D. G., Powell, M. A., Grigsby, P. W. 2010; 28 (12): 2108-2113

    Abstract

    PURPOSE A previous retrospective study demonstrated that positron emission tomography with [(18)F]fluorodeoxyglucose (FDG-PET) was more sensitive than computed tomography for lymph node staging in patients with cervical cancer; the findings on FDG-PET were strongly associated with progression-free survival. Therefore, a prospective cohort study was initiated to evaluate FDG-PET lymph node staging in a larger patient population. PATIENTS AND METHODS The study was conducted between July 2000 and March 2009. All 560 patients with cervical cancer underwent pretreatment FDG-PET lymph node staging. Treatment included surgery alone, surgery and postoperative radiation therapy, and definitive radiation or combination radiation and chemotherapy. PET findings were correlated with the risk of disease progression and with survival. Results Overall, 47% of patients had lymph node involvement by FDG-PET at diagnosis. The frequency of lymph node metastasis increased with clinical stage and was similar to that in historical surgical series. Within a stage, patients with PET-positive lymph nodes had significantly worse disease-specific survival than those with PET-negative lymph nodes (P < .001). Disease-specific survival was stratified into distinct groups based on the most distant level of PET-detected nodal disease (none, pelvic, para-aortic, or supraclavicular; P < .001). The hazard ratios for disease recurrence increased incrementally based on the most distant level of nodal disease: pelvic 2.40 (95% CI, 1.63 to 3.52), para-aortic 5.88 (95% CI, 3.80 to 9.09), and supraclavicular 30.27 (95% CI 16.56 to 55.34). CONCLUSION Nodal involvement detected by FDG-PET in cervical cancer relates to clinical stage, is comparable to historical data, and stratifies patient recurrence and survival outcomes.

    View details for DOI 10.1200/JCO.2009.25.4151

    View details for Web of Science ID 000276764000023

    View details for PubMedID 20308664

  • Pelvic Lymph Node F-18 Fluorodeoxyglucose Uptake as a Prognostic Biomarker in Newly Diagnosed Patients With Locally Advanced Cervical Cancer CANCER Kidd, E. A., Siegel, B. A., Dehdashti, F., Grigsby, P. W. 2010; 116 (6): 1469-1475

    Abstract

    The objective of the current study was to evaluate the prognostic significance of the maximum standardized uptake value (SUV(max)) of F-18 fluorodeoxyglucose (FDG) as measured by positron emission tomography (PET) in pelvic lymph nodes in patients with cervical cancer.The authors studied cervical cancer patients with pelvic lymph node metastasis, as evidenced on FDG-PET, who were treated between November 2003 and October 2008. The maximum dimension and SUV(max) for the most FDG-avid pelvic lymph node (SUV(PLN)) and the SUV(max) of the primary cervical tumor (SUV(cervix)) were recorded from the FDG-PET/computed tomography (CT) scan. The SUV(PLN) was analyzed for its association with treatment response, pelvic disease recurrence, disease-specific survival, and overall survival.The population was comprised of 83 women with International Federation of Gynecology and Obstetrics (FIGO) stages IB1 to IIIB cervical cancer. The average SUV(PLN) was 6.9 (range, 2.1-33.0), whereas the average SUV(cervix) was 14.0 (range, 3.2-38.4). The SUV(cervix) and SUV(PLN) were found to be weakly correlated (correlation coefficient [R(2)] = 0.301). The average size of the pelvic lymph nodes was 2.1 cm (range, 0.6-7.9 cm), and was also found to be only weakly associated with the SUV(PLN) (R(2) = 0.225). The SUV(PLN) was found to be correlated with an increased risk of persistent disease after treatment (P = .0025), specifically within the pelvic lymph node region (P = .0003). The SUV(PLN) was found to be predictive of an increased risk of ever developing pelvic disease recurrence (P = .0035). Patients with a higher SUV(PLN) were found to have significantly worse disease-specific (P = .0230) and overall survival (P = .0378) using Kaplan-Meier evaluation. A Cox proportional hazards model for the risk of pelvic disease recurrence was performed including SUV(PLN,) patient age, and tumor stage, and found only an increased SUV(PLN) to be an independent predictor.SUV(PLN) is a prognostic biomarker, predicting treatment response, pelvic recurrence risk, and disease-specific survival in patients with cervical cancer.

    View details for DOI 10.1002/cncr.24972

    View details for Web of Science ID 000275238800014

    View details for PubMedID 20108309

  • Cervical Cancer Histology and Tumor Differentiation Affect F-18-Fluorodeoxyglucose Uptake CANCER Kidd, E. A., Spencer, C. R., Huettner, P. C., Siegel, B. A., Dehdashti, F., Rader, J. S., Grigsby, P. W. 2009; 115 (15): 3548-3554

    Abstract

    This study aimed to evaluate the variation in cervical cancer glucose metabolism for different tumor histologies and levels of differentiation, as measured by the uptake of 18F-fluorodeoxyglucose (FDG) by positron emission tomography (PET).The study population consisted of 240 patients with International Federation of Gynecology and Obstetrics stages Ib1 through IVb cervical cancer, who underwent a pretreatment FDG-PET. Tumor histology included 221 squamous cell (SC), 4 adenosquamous (AS), and 15 adenocarcinoma (AC) tumors. There were 14 well, 145 moderately, and 81 poorly differentiated tumors. The stage distribution was as follows: 70 stage I tumors (9 AC, 2 AS, and 59 SC), 102 stage II tumors (3 AC, 1 AS, and 98 SC), 64 stage III tumors (3 AC, 1 AS, and 60 SC), and 4 stage IV tumors (4 SC). From the FDG-PET, maximal standardized uptake value (SUVmax) was determined. The variation in SUVmax was analyzed for differences based on tumor histology and differentiation.For all patients, the mean SUVmax was 11.62 (range, 2.50-50.39). The mean SUVmax by histology was as follows: SC, 11.91 (range, 2.50-50.39); AS, 8.85 (range, 6.53-11.26); and AC, 8.05 (range, 2.83-13.92). Squamous versus nonsquamous tumors demonstrated a significant difference in SUVmax (P=.0153). SUVmax and tumor volume were not found to be correlated (R2=0.013). The mean SUVmax was 8.58 for well-differentiated, 11.56 for moderately differentiated, and 12.23 for poorly differentiated tumors. The mean SUVmax was significantly different for well-differentiated versus poorly differentiated cervical tumors (P=.0474).Cervical tumor FDG uptake varied by histology and differentiation. SC tumors demonstrated a significantly higher SUVmax compared with nonsquamous cell tumors, and poorly differentiated tumors also had a higher SUVmax.

    View details for DOI 10.1002/cncr.24400

    View details for Web of Science ID 000268060500023

    View details for PubMedID 19472399

  • Exploring feature-based approaches in PET images for predicting cancer treatment outcomes. Pattern recognition El Naqa, I., Grigsby, P., Apte, A., Kidd, E., Donnelly, E., Khullar, D., Chaudhari, S., Yang, D., Schmitt, M., Laforest, R., Thorstad, W., Deasy, J. O. 2009; 42 (6): 1162-1171

    Abstract

    Accumulating evidence suggests that characteristics of pre-treatment FDG-PET could be used as prognostic factors to predict outcomes in different cancer sites. Current risk analyses are limited to visual assessment or direct uptake value measurements. We are investigating intensity-volume histogram metrics and shape and texture features extracted from PET images to predict patient's response to treatment. These approaches were demonstrated using datasets from cervix and head and neck cancers, where AUC of 0.76 and 1.0 were achieved, respectively. The preliminary results suggest that the proposed approaches could potentially provide better tools and discriminant power for utilizing functional imaging in clinical prognosis.

    View details for PubMedID 20161266

  • Intratumoral metabolic heterogeneity of cervical cancer CLINICAL CANCER RESEARCH Kidd, E. A., Grigsby, P. W. 2008; 14 (16): 5236-5241

    Abstract

    Previous research has shown that the intertumoral maximum standardized uptake value (SUVMax) of F-18 fluorodeoxyglucose (FDG)-positron emission tomography (PET) for cervical cancer predicts disease outcome. The purpose of this study was to evaluate the pretreatment intratumoral metabolic heterogeneity of FDG.This is a prospective cohort study of 72 patients with International Federation of Gynecology and Obstetrics stages Ib1 to IVa cervical cancer treated with chemoradiation. Three-dimensional FDG-PET threshold tumor volumes were calculated using image segmentation and an adaptive thresholding method for the primary cervix tumor from the pretreatment FDG-PET/computerized tomography. Intratumor heterogeneity was obtained for each patient's cervical tumor by taking the derivative (dV/dT) of the volume-threshold function from 40% to 80%. The association between intratumoral heterogeneity and tumor-specific factors and patient outcomes were determined.The mean cervix tumor SUV(Max) was 12.4 (range, 3.0-38.4). The mean differential tumor heterogeneity was -1.074 (range, -0.107 to -5.623). There was no association between dV/dT and SUVMax (R2 = 0.069), but there was a relationship with dV/dT and tumor volume (R2 = 0.881). There was no correlation of dV/dT with tumor histology (P = 0.4905). Heterogeneity was significantly associated with the risk of lymph node metastasis at diagnosis (P = 0.0009), tumor response to radiation as evaluated by FDG-PET obtained 3 months after completing treatment (P = 0.0207), risk of pelvic recurrence (P = 0.0017), and progression-free survival (P = 0.03).Cervical intratumoral FDG metabolic heterogeneity on the pretreatment FDG-PET predicts risk of lymph node involvement at diagnosis, response to therapy, and risk of pelvic recurrence.

    View details for DOI 10.1158/1078-0432.CCR-07-5252

    View details for Web of Science ID 000258523800029

    View details for PubMedID 18698042

  • The standardized uptake value for F-18 fluorodeoxyglucose is a sensitive predictive biomarker for cervical cancer treatment response and survival CANCER Kidd, E. A., Siegel, B. A., Dehdashti, F., Grigsby, P. W. 2007; 110 (8): 1738-1744

    Abstract

    The objective of this study was to evaluate cervical tumor uptake of F-18 fluorodeoxyglucose (FDG) measured as the maximal standardized uptake value (SUV(max)) by positron emission tomography (PET) and its association with treatment response and prognosis in patients with cervical cancer.The study population consisted of 287 patients with stage IA2 through IVB cervical cancer who underwent pretreatment FDG-PET studies. SUV(max), tumor volume, and sites of lymph node metastasis were recorded. Therapy included surgery, chemoradiation, or palliation.The mean SUV(max) was 11.4 (range, 1-50.4). The mean tumor volume by stage was 42.1 cm(3) for stage I tumors (using International Federation of Gynecology and Obstetrics [FIGO] staging criteria), 63.7 cm(3) for stage II tumors, 129.2 cm(3) for stage III tumors, and 166.2 cm(3) for stage IV tumors. There was no correlation between tumor volume and SUV(max) (correlation coefficient [R(2)] = 0.01). No significant difference in SUV(max) was observed between squamous histology (n = 247 patients) and nonsquamous histology (n = 40 patients; P = .089). Higher SUV(max) was associated with an increased risk of lymph node metastasis at diagnosis (P = .0009). A Cox proportional-hazards model for death from cervical cancer was used to evaluate tumor histology, lymph node metastasis, tumor volume, and SUV(max). The results indicated that SUV(max) was the only significant independent factor (P = .0027). Three prognostic groups were established using SUV(max). The overall survival rates at 5 years were 95% for an SUV(max) 5.2 and 13.3 (P < .0001). Increasing SUV(max) was associated with persistent abnormal FDG uptake in the cervix on 3-month FDG-PET studies in 238 patients who received curative chemoradiation (P = .04).The SUV(max) of the cervical tumor at diagnosis was a sensitive biomarker of treatment response and prognosis for patients with cervical cancer.

    View details for DOI 10.1002/cncr.22974

    View details for Web of Science ID 000250033300014

    View details for PubMedID 17786947

  • The efficacy of radiation therapy in the management of grade I astrocytomas JOURNAL OF NEURO-ONCOLOGY Kidd, E. A., Mansur, D. B., Leonard, J. R., Michalski, J. M., Simpson, J. R., Perry, A. 2006; 76 (1): 55-58

    Abstract

    The purpose of this study was to analyze the outcome of patients with grade I astrocytomas treated with radiation therapy, specifically looking at the prognostic significance of age, timing of radiation therapy (immediately after surgery or delayed until progression) and tumor location.The records of patients with grade I astrocytomas treated at Washington University Medical Center between 1982 and 2002 were reviewed. Twenty patients with grade I pilocytic astrocytoma (n=19) or subependymal giant cell astrocytoma (n=1) were treated with radiation therapy with curative intent.The median follow-up was 6.4 years. The 5-year overall survival for all patients was 100%. The 5-year progression-free survival (PFS) following radiation therapy for all patients was 68%. Patients who received radiation therapy immediately after biopsy or surgery had a 5-year PFS of 77% versus 50% for patients who received radiation therapy after initial disease progression (P=0.013). Patients with infratentorial tumors had an improved outcome with a 5-year PFS of 80% versus 59% for those with supratentorial tumors (P=0.0076). Patient age did not significantly influence outcome. All tumor recurrences were local.While this study reports an excellent overall survival, approximately one third of patients with grade I astrocytomas had progressive disease following radiation therapy. In particular, patients with supratentorial tumors and delayed radiation therapy had a worse PFS. Additional investigation is needed to improve the outcome in these patients.

    View details for DOI 10.1007/s11060-005-2913-1

    View details for Web of Science ID 000234553400008

    View details for PubMedID 16132503

  • Variance in the expression of 5-fluorouracil pathway genes in colorectal cancer CLINICAL CANCER RESEARCH Kidd, E. A., Yu, J. S., Li, X., Shannon, W. D., Watson, M. A., McLeod, H. L. 2005; 11 (7): 2612-2619

    Abstract

    Although colorectal cancer has the third highest cancer mortality rate, the treatment remains far from optimized with patients showing variable responses to standard treatment. Molecular differences in pharmacologically relevant genes may contribute to the variability in response. This study used Taqman PCR to investigate the expression of 24 5-fluorouracil (5-FU) pathway genes in colorectal cancer using paired nontumor and tumor sample from 52 patients with Dukes' C colon cancer. In comparing tumor versus nonmalignant tissue, 14 of the 24 genes showed significant variation in gene expression. For 11 of these same genes (FPGS, DHFR, GGH, NME1, NME2, RRM2, UMPH2, UNG, UMPS, TP53, and TK1), a significant proportion of the patients showed an over expression of the particular gene in tumor tissue with a tumor-to-nonmalignant (T/N) ratio >1.2, whereas one gene (DPYD) showed the converse with a large number of patients showing a lower expression in the tumor tissue (T/N < 0.8). Multiple gene correlations for the genes of the 5-FU pathway were found with the Spearman rank correlation of >0.6 (all P > 0.001), suggesting possible coregulation mechanisms. Hierarchical clustering analysis created at least three groups of genes, which were consistent with groupings by the other statistical methods. Additionally, the hierarchical clustering showed two distinct groups of patients based on their gene expression. These variations in gene expression could provide valuable insights for optimizing treatment selection for patients with colorectal cancer.

    View details for Web of Science ID 000228320100023

    View details for PubMedID 15814641

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