Bio

Clinical Focus


  • Radiation Oncology
  • Cancer > Sarcoma
  • cutaneous lymphoma, non hodgkin lymphoma, Hodgkin lymphoma
  • Pediatric cancers with a research focus on pediatric soft tissue and bone sarcoma's, adult sarcoma, transplant related disease, skin cancer
  • Cancer > Radiation Oncology

Academic Appointments


Professional Education


  • Fellowship:Stanford University - Radiation Oncology (06/30/1991) CA
  • Board Certification: Radiation Oncology, American Board of Radiology (1991)
  • Medical Education:University of Florida (1986) FL
  • Residency:Stanford University - Radiation Oncology (06/30/1990) CA
  • Internship:Georgia Baptist Medical Center (06/30/1987) GA

Teaching

2013-14 Courses


Publications

Journal Articles


  • Outcome of patients with localized orbital sarcoma who relapsed following treatment on Intergroup Rhabdomyosarcoma Study Group (IRSG) Protocols-III and -IV, 1984-1997: A report from the Children's Oncology Group PEDIATRIC BLOOD & CANCER Raney, B., Huh, W., Hawkins, D., Hayes-Jordan, A., Million, L., Rodeberg, D., Teot, L., Anderson, J. 2013; 60 (3): 371-376

    Abstract

    We wanted to ascertain patterns of recurrence, re-treatment, and outcome among 188 eligible patients treated for localized orbital sarcoma on IRSG Protocols III/IV, 1984-1997.Retrospective chart review.Twenty-four of 188 patients (12.8%) developed local (n?=?22) or distant relapse (n?=?2) at 0.057-7.05 years (median, 1.58) after enrollment. Ages at study entry were 0.14-17 years (median, 5 years). Initial tumor operations included biopsy (n?=?20) or gross resection with microscopic residual (n?=?4). Initial tumor diameters were 0.5-7?cm (median, 3). Pathologic subtypes were embryonal rhabdomyosarcoma (ERMS, n?=?19), sarcoma not otherwise specified (n?=?2), and alveolar RMS, botryoid ERMS, or undifferentiated sarcoma (n?=?1 each). Initial treatment included vincristine/dactinomycin (n?=?24) including an alkylator (n?=?4) and radiotherapy (RT, n?=?21). Twenty patients responded, 14 completely, 6 partially. After recurrence, patients underwent orbital exenteration (n?=?10), enucleation (2), tumor excision (3), or biopsy (1); 7 had no operation, and 1 had no data. Post-relapse chemotherapy included combinations of etoposide (n?=?14 patients), doxorubicin (14), ifosfamide (12), cyclophosphamide (7), and dacarbazine (n?=?1). Six patients received RT, including four previously treated and two not irradiated initially. Two patients died; one at 1.79 years after contralateral brain metastasis followed by local recurrence, and another at 2.49 years after multiple local recurrences. Twenty-two patients (91.7%) survived sarcoma-free for 0.04-17 years (median, 6.9) after relapse, and 18 of 22 (82%) were alive ?5 years after relapse.Survival following recurrent localized orbital sarcoma appears likely after vigorous re-treatment given with curative intent.

    View details for DOI 10.1002/pbc.24289

    View details for Web of Science ID 000313727000005

    View details for PubMedID 22961750

  • Is Tanning Bed Exposure Associated With Aggressive Basal Cell Carcinoma? JOURNAL OF CLINICAL ONCOLOGY Gamba, C. A., Wysong, A., Million, L., Aasi, S., Kim, J., Tang, J. Y. 2012; 30 (32): E333-E336

    View details for DOI 10.1200/JCO.2012.42.1008

    View details for Web of Science ID 000310914800006

    View details for PubMedID 23008324

  • Chest Wall Leiomyosarcoma After Breast-Conservative Therapy for Early-Stage Breast Cancer in a Young Woman With Li-Fraumeni Syndrome JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK Henry, E., Villalobos, V., Million, L., Jensen, K. C., West, R., Ganjoo, K., Lebensohn, A., Ford, J. M., Telli, M. L. 2012; 10 (8): 939-942

    Abstract

    Li-Fraumeni syndrome (LFS) is one of the most penetrant forms of familial cancer susceptibility syndromes, characterized by early age at tumor onset and a wide spectrum of malignant tumors. Identifying LFS in patients with cancer is clinically imperative because they have an increased sensitivity to ionizing radiation and are more likely to develop radiation-induced secondary malignancies. This case report describes a young woman whose initial presentation of LFS was early-onset breast cancer and whose treatment of this primary malignancy with breast conservation likely resulted in a secondary malignancy arising in her radiation field. As seen in this case, most breast cancers in patients with LFS exhibit a triple-positive phenotype (estrogen receptor-positive/progesterone receptor-positive/HER2-positive). Although this patient met classic LFS criteria based on age and personal and family history of cancer, the NCCN Clinical Practice Guidelines in Oncology for Genetic/Familial High-Risk Assessment: Breast and Ovarian Cancer endorse genetic screening for TP53 mutations in a subset of patients with early-onset breast cancer, even in the absence of a suggestive family history, because of the potential for de novo TP53 mutations.

    View details for Web of Science ID 000307494000004

    View details for PubMedID 22878818

  • Resectable pediatric nonrhabdomyosarcoma soft tissue sarcoma: which patients benefit from adjuvant radiation therapy and how much? ISRN oncology Million, L., Donaldson, S. S. 2012; 2012: 341408-?

    Abstract

    It remains unclear which children and adolescents with resected nonrhabdomyosarcoma soft tissue sarcoma (NRSTS) benefit from radiation therapy, as well as the optimal dose, volume, and timing of radiotherapy when used with primary surgical resection. This paper reviews the sparse literature from clinical trials and retrospective studies of resected pediatric NRSTS to discern local recurrence rates in relationship to the use of radiation therapy.

    View details for DOI 10.5402/2012/341408

    View details for PubMedID 22523704

  • INFLUENCE OF NONCOMPLIANCE WITH RADIATION THERAPY PROTOCOL GUIDELINES AND OPERATIVE BED RECURRENCES FOR CHILDREN WITH RHABDOMYOSARCOMA AND MICROSCOPIC RESIDUAL DISEASE: A REPORT FROM THE CHILDREN'S ONCOLOGY GROUP INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS Million, L., Anderson, J., Breneman, J., Hawkins, D. S., Laurie, F., Michalski, J., Rodeberg, D., Wharam, M., Wolden, S., Donaldson, S. S. 2011; 80 (2): 333-338

    Abstract

    Postoperative radiation therapy (RT) is recommended for patients with rhabdomyosarcoma having microscopic disease. Sometimes RT dose/volume is reduced or omitted in an attempt to avoid late effects, particularly in young children. We reviewed operative bed recurrences to determine if noncompliance with RT protocol guidelines influenced local-regional control.All operative bed recurrences among 695 Group II rhabdomyosarcoma patients in Intergroup Rhabdomyosarcoma Study Group (IRS) I through IV were reviewed for deviation from RT protocol. Major/minor dose deviation was defined as >10% or 6-10% of the prescribed dose (40-60 Gy), respectively. Major/minor volume deviation was defined as tumor excluded from the RT field or treatment volume not covered by the specified margin (preoperative tumor volume and 2- to 5-cm margin), respectively. No RT was a major deviation.Forty-six of 83 (55%) patients with operative bed recurrences did not receive the intended RT (39 major and 7 minor deviations). RT omission was the most frequent RT protocol deviation (19/46, 41%), followed by dose (17/46, 37%), volume (9/46, 20%), and dose and volume deviation (1/46, 2%). Only 7 operative bed recurrences occurred in IRS IV (5% local-regional failure) with only 3 RT protocol deviations. Sixty-three (76%) patients with recurrence died of disease despite retrieval therapy, including 13 of 19 nonirradiated children.Over half of the operative bed recurrences were associated with noncompliance; omission of RT was the most common protocol deviation. Three fourths of children die when local-regional disease is not controlled, emphasizing the importance of RT in Group II rhabdomyosarcoma.

    View details for DOI 10.1016/j.ijrobp.2010.01.058

    View details for Web of Science ID 000290837100003

    View details for PubMedID 20646841

  • Early Treatment Failure in Intermediate-Risk Rhabdomyosarcoma: Results From IRS-IV and D9803-A Report From the Children's Oncology Group JOURNAL OF CLINICAL ONCOLOGY Minn, A. Y., Lyden, E. R., Anderson, J. R., Million, L., Arndt, C. A., Brown, K., Hawkins, D. S., Donaldson, S. S. 2010; 28 (27): 4228-4232

    Abstract

    The goal of this study was to determine the frequency and clinical features of early treatment failure during induction chemotherapy before protocol radiation therapy for children with intermediate-risk rhabdomyosarcoma (RMS).Patients with intermediate-risk RMS enrolled onto the Intergroup Rhabdomyosarcoma Study-IV and the Children's Oncology Group D9803 study were reviewed for an early treatment failure. Early failure was defined as failure caused by progressive disease, death as a result of progressive disease, or death as a result of other causes occurring fewer than 120 days from study entry. Patients with parameningeal site RMS with high-risk features who received radiation therapy at week 1 were excluded from analysis. Overall survival (OS) was estimated using the Kaplan-Meier method. Fisher's exact test was used to compare differences between groups. Cumulative incidence of progression was estimated.Of 916 patients, 20 (2.2%) were found to have an early disease progression and did not receive planned protocol radiotherapy. Three additional early failures resulted from treatment-related death without progression. Median time to failure was 48 days (range, 7 to 106 days). Nineteen (95%) of the 20 patients experienced progression at their primary site. Five-year OS was 32% (95% CI, 12% to 54%) for patients experiencing an early progression.A small proportion of patients with intermediate-risk RMS suffer an early failure as a result of early progression (2.2%) or treatment-related mortality (0.3%). The majority of patients with early progression had a local failure. Earlier radiotherapy could potentially improve outcome by preventing early local progression.

    View details for DOI 10.1200/JCO.2010.29.0247

    View details for Web of Science ID 000281909700020

    View details for PubMedID 20713850

  • Undifferentiated High-Grade Pleomorphic Sarcomas in Children: A Clinicopathologic Study of 10 Cases and Review of Literature PEDIATRIC AND DEVELOPMENTAL PATHOLOGY Alaggio, R., Collini, P., Randall, R. L., Barnette, P., Million, L., Coffin, C. M. 2010; 13 (3): 209-217

    Abstract

    Undifferentiated high-grade pleomorphic sarcoma (UHGPS) is a sarcoma of debated nosology affecting adults, with rare cases reported in children. In order to investigate the clinicopathologic and prognostic features of pediatric UHGPS, 10 cases of UHGPS occurring before 18 years (mean age, 8.9 years) were analyzed. All were localized at diagnosis (head, 4; lower extremities, 4; trunk, 2), with a mean diameter of 4.5 cm. Mean follow-up was 6 years. Six patients were in complete remission, 1 after a relapse; 2 died of metastatic disease; 1 was alive with metastasis. Histologically, 8 tumors showed spindle cells with a focal or diffuse storiform pattern; 2 tumors had scattered aggregates of epithelioid cells. Two tumors displayed a prominent epithelioid component. Cellular pleomorphism, high mitotic rate with atypical mitoses, were found in all tumors; necrosis in 6 and vascular invasion in 2. CD68 and desmin were positive in 2 cases each, smooth muscle actin in 4, and S100 in 1. Five tumors in 1st and 1 in 2nd complete remission were superficial; 1 showed a spindle cell morphology with epithelioid foci, 3 had necrosis; 5 were grade 3; and 1 was grade 2. Three metastatic tumors (2 in the dura, 1 in the leg) displayed either a prominent epithelioid morphology (2) or scattered aggregates of epithelioid cells (1), with a myxoid background in 1. All were grade 3 and showed foci of necrosis. In summary, UHGPS is rare in children and frequently located in the head. A more favorable outcome is associated with superficial location. Foci of epithelioid cell may portend an aggressive behavior.

    View details for DOI 10.2350/09-07-0673-OA.1

    View details for Web of Science ID 000280500400006

    View details for PubMedID 20055602

  • Tumor volume and patient weight as predictors of outcome in children with intermediate risk rhabdomyosarcoma: a report from the children's oncology group. Cancer Rodeberg, D. A., Stoner, J. A., Garcia-Henriquez, N., Randall, R. L., Spunt, S. L., Arndt, C. A., Kao, S., Paidas, C. N., Million, L., Hawkins, D. S. 2010

    Abstract

    BACKGROUND:: The objectives of this study were to compare tumor volume and patient weight versus traditional factors of tumor size (greatest dimension) and patient age and to determine which parameters best discriminated outcome among pediatric patients with intermediate-risk rhabdomyosarcoma (RMS). METHODS:: Complete information was available for 370 patients with nonmetastatic RMS who were enrolled in the Children's Oncology Group (COG) intermediate-risk study D9803 (1999-2005). The Kaplan-Meier method was used to estimate survival distributions. A recursive partitioning model was used to identify prognostic factors that were associated with event-free survival (EFS). Cox proportional hazards regression models were used to estimate the association between patient characteristics and the risk of failure or death. RESULTS:: For all patients with intermediate-risk RMS, a recursive partitioning algorithm for EFS suggested that prognostic groups should be defined optimally by tumor volume (with a transition point at 20 cm(3)), patient weight (with a transition point at 50 kg), and embryonal histology. Tumor volume and patient weight added significant outcome information to the standard prognostic factors, including greatest tumor dimension and patient age (P = .02). The ability to resect the tumor completely was not associated significantly with the size of the patient, and patient weight did not significantly modify the association between tumor volume and EFS after adjustment for standard risk factors (P = .2). CONCLUSIONS:: The factors that had the strongest association with EFS were tumor volume, patient weight, and histology. On the basis of regression modeling, tumor volume and patient weight were superior predictors of outcome compared with greatest tumor dimension and patient age in children with intermediate-risk RMS. The current results indicated that the prognostic performance of tumor volume and patient weight should be assessed in an independent prospective study. Cancer 2011. © 2010 American Cancer Society.

    View details for PubMedID 21157950

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