Publications by authors named "Voong K"

Background: Radiation oncologists closely monitor patients during weekly on-treatment visits (OTVs). This study examines whether routine patient-reported outcome measures (PROMs) during OTVs change physicians' perceptions of treatment-toxicity and inform symptom-management.

Patient And Methods: IMPROVE is a single-arm prospective multicenter trial, conducted from 2020 to 2023.

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Adequate folate intake is required in preterm infants for rapid growth and development, but there is little evidence to back recommendations. We aimed to assess folate status in preterm infants at discharge and in early infancy, according to exposure to folate sources, particularly in those exclusively/predominantly breastfed. A prospective, multicenter, observational cohort study was conducted in the UK, involving 45 preterm infants <33 weeks' gestational age (GA) exclusively/predominantly fed human milk when approaching NICU (Neonatal Intensive Care Unit) discharge.

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: Preclinical and clinical data indicate that chemoradiotherapy (CRT) in combination with checkpoint inhibitors may prime an anti-tumor immunological response in esophageal cancer. However, responses to neoadjuvant therapy can vary widely and the key biomarkers to determine response remain poorly understood. The fecal microbiome is a novel and potentially modifiable biomarker of immunotherapy response, and both fecal and tumor microbes have been found to associate with outcomes in esophageal cancer.

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Background: Vitamin D deficiency in critically ill patients is associated with poor outcomes, and vitamin D supplementation is recommended for patients with chronic kidney disease. Whether acute kidney injury (AKI) is associated with altered Vitamin D metabolism is unknown. We aimed to compare the longitudinal profiles of serum 25(OH)D and 1,25(OH)D concentrations in critically ill patients with and without moderate to severe AKI and explore the impact of renal recovery and parathyroid hormone (PTH).

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Gastroesophageal cancer dynamics and drivers of clinical responses with immune checkpoint inhibitors (ICI) remain poorly understood. Potential synergistic activity of dual programmed cell death protein 1 (PD-1) and lymphocyte-activation gene 3 (LAG-3) inhibition may help improve immunotherapy responses for these tumors. We report a phase Ib trial that evaluated neoadjuvant nivolumab (Arm A, n = 16) or nivolumab-relatlimab (Arm B, n = 16) in combination with chemoradiotherapy in 32 patients with resectable stage II/stage III gastroesophageal cancer together with an in-depth evaluation of pathological, molecular and functional immune responses.

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Background: Brain metastasis (BRM) is uncommon in gastroesophageal cancer. As such, clinicopathologic and molecular determinants of BRM and impact on clinical outcome remain incompletely understood.

Methods: We retrospectively analyzed clinicopathologic data from advanced esophageal/gastroesophageal junction (E/GEJ) patients at Johns Hopkins from 2003 to 2021.

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Introduction:: The impact of neoadjuvant immune checkpoint inhibitor (ICI)-based therapies on mediastinal nodal recurrence patterns after resection for patients with locally advanced non-small cell lung cancer (NSCLC) is unknown. We reported cases of mediastinal nodal failure after receipt of neoadjuvant ICI and provided a descriptive analysis of patients who experienced mediastinal recurrences.

Methods:: We identified patients with stage I-IIIA NSCLC treated on a prospective trial with nivolumab-based therapies prior to resection between August 2015 and August 2021.

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Article Synopsis
  • - Stereotactic ablative body radiation (SABR) shows promise for treating early-stage non-small cell lung cancer (NSCLC), with 83% of patients remaining alive without tumor progression at a median follow-up of 40 months.
  • - The study examined the immune and pathological effects of SABR by analyzing blood and tumor biopsies from six patients before and after treatment, focusing on immune-cell populations and T-cell receptor changes.
  • - While early post-SABR biopsies revealed viable tumors and maintained immune-cell populations, a subset of patients exhibited a temporary increase in neoantigen-specific T-cells after treatment, suggesting that SABR can provoke a delayed immune response.
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Purpose: The study aimed to implement a novel, deeply accelerated adaptive radiation therapy (DAART) approach for lung cancer radiotherapy (RT). Lung cancer is the most common cause of cancer-related death, and RT is the preferred medically inoperable treatment for early stage non-small cell lung cancer (NSCLC). In the current lengthy workflow, it takes a median of four weeks from diagnosis to RT treatment, which can result in complete restaging and loss of local control with delay.

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Unlabelled: This study assessed whether vitamin K, given with oral bisphosphonate, calcium and/or vitamin D has an additive effect on fracture risk in post-menopausal women with osteoporosis. No difference in bone density or bone turnover was observed although vitamin K supplementation led to a modest effect on parameters of hip geometry.

Purpose: Some clinical studies have suggested that vitamin K prevents bone loss and may improve fracture risk.

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Biotin interference in immunoassays using biotin-streptavidin binding technology is well recognised by clinical laboratories, though the prevalence of elevated biotin in patient populations is largely unknown. We determined serum biotin concentrations in 4385 patient samples received sequentially by 6 laboratories for routine immunoassay analysis in England, and Korea, Singapore and Thailand (3 countries within the Asia Pacific region, APAC). Samples were initially analysed using a research use-only immunoassay, with those identified as having potentially elevated biotin concentrations referred for definitive analysis by LC-MS/MS.

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Objective: Immunotherapy, particularly immune checkpoint inhibitors (ICIs), has revolutionized the treatment of patients with many tumor histologies. Simultaneously, stereotactic body radiotherapy (SBRT) provides excellent local control (LC) and plays an important role in the management of spine metastasis. Promising preclinical work suggests the potential therapeutic benefit of combining SBRT with ICI therapy, but the safety profile of combined therapy is unclear.

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Article Synopsis
  • - The study assessed pre-treatment peer review for stereotactic body radiation therapy (SBRT) cases, aimed at improving patient outcomes while balancing physician workload and avoiding treatment delays.
  • - Between March 2020 and August 2021, a quality checklist was used for 252 SBRT patients, leading to an increase in pre-treatment review completion rates from 19% to 79%, significantly enhancing compliance.
  • - The implementation of a structured workflow resulted in higher early review rates, demonstrating a successful model for thorough pre-treatment assessment in thoracic SBRT, ensuring better treatment planning without compromising efficiency.
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Purpose: The Bone Metastases Ensemble Trees for Survival Decision Support Platform (BMETS-DSP) provides patient-specific survival predictions and evidence-based recommendations to guide multidisciplinary management for symptomatic bone metastases. We assessed the clinical utility of the BMETS-DSP through a pilot prepost design in a simulated clinical environment.

Methods: Ten Radiation Oncology physicians reviewed 55 patient cases at two time points: without and then with the use of BMETS-DSP.

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Background: There is near-global consensus that all newborns be given parenteral vitamin K (VK ) at birth as prophylaxis against VK deficiency bleeding (VKDB). Breastmilk has a low VK content and cases of late VKDB are reported in exclusively breastmilk-fed preterm infants despite VK prophylaxis at birth.

Objectives: To assess the prevalence of functional VK insufficiency in preterm infants based on elevated under-γ-carboxylated (Glu) species of Gla proteins, factor II (PIVKA-II), and osteocalcin (GluOC), synthesized by liver and bone, respectively.

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Background: Consolidation durvalumab immunotherapy following definitive chemoradiation (CRT) for unresectable stage III non-small cell lung cancer (NSCLC) improves overall survival. As therapeutic options for patients with KRAS-driven disease evolve, more understanding regarding genomic determinants of response and patterns of progression for durvalumab consolidation is needed to optimize outcomes.

Methods: We conducted a single-institutional retrospective analysis of real-world patients with locally advanced, unresectable NSCLC who completed CRT and received durvalumab consolidation.

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Introduction: With the increasing use of immune checkpoint inhibitors (ICI) for cancer, there is a growing burden on the healthcare system to provide care for the toxicities associated with these agents. Herein, we aim to identify and describe the distribution of encounters seen in an urgent care setting for immune-related adverse events (irAEs) and the clinical outcomes from irAE management. Methods: Patient demographics, disease characteristics, and treatment data were collected retrospectively from encounters at an oncology Urgent Care Clinic (UCC) from a single tertiary center for upper aerodigestive malignancies from 1 July 2018 to 30 June 2019.

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Purpose: This study aimed to quantitatively evaluate the range uncertainties that arise from daily cone-beam CT (CBCT) images for proton dose calculation compared to CT using a measurement-based technique.

Methods: For head and thorax phantoms, wedge-shaped intensity-modulated proton therapy (IMPT) treatment plans were created such that the gradient of the wedge intersected and was measured with a 2D ion chamber array. The measured 2D dose distributions were compared with 2D dose planes extracted from the dose distributions using the IMPT plan calculated on CT and CBCT.

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Herein, we report the first case presentation of paraneoplastic myelofibrosis associated with cancer. Paraneoplastic syndromes occur in some patients with thoracic malignancies; however, myelofibrosis is not commonly seen in non-small cell lung cancer (NSCLC). We report a case of myelofibrosis in a patient with a new diagnosis of NSCLC that resolved after stereotactic ablative radiotherapy (SABR).

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Introduction: Checkpoint inhibitor pneumonitis (CIP) is a serious toxicity of anti-programmed death-(ligand) 1 immunotherapy. Whether pretreatment differences in pulmonary function exist in patients who develop CIP is unknown. We analyzed the pulmonary function tests (PFTs) of patients with NSCLC treated with immune checkpoint inhibitors (ICIs) to evaluate whether pretreatment lung function was associated with CIP development.

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In patients with known or suspected lung cancer, pathologic reports of cytologic "atypia" in the mediastinal nodal fine-needle aspirate samples pose a diagnostic and therapeutic dilemma. For the patents with non-operable disease, should the radiation oncologist empirically include lymph nodes with atypical findings in the radiation field, or should they exclude these mediastinal lymph nodes from the treatment field? Inclusion of an atypical finding in the management decision or radiation target would mean that the treating physicians are interpreting a pathologic report of "atypia" as probably "positive" rather than probably "negative" disease. Empirically treating lymph nodes without cancer involvement in thoracic radiotherapy for non-small cell lung cancer, also known as elective nodal irradiation, is generally avoided given increased treatment-related toxicities including esophagitis, pneumonitis, and cardiotoxicity without a demonstrated survival benefit.

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Background: Here, we investigated the relationship between clinical parameters, including the site of surgical anastomosis and radiation dose to the anastomotic region, and anastomotic complications in esophageal cancer patients treated with trimodality therapy.

Methods: Between 2007 and 2016, esophageal cancer patients treated with trimodality therapy at a tertiary academic cancer center were identified. Patient, treatment, and outcome parameters were collected.

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Purpose: Early identification of patients who may be at high risk of significant weight loss (SWL) is important for timely clinical intervention in lung cancer radiotherapy (RT). A clinical decision support system (CDSS) for SWL prediction was implemented within the routine clinical workflow and assessed on a prospective cohort of patients.

Materials And Methods: CDSS incorporated a machine learning prediction model on the basis of radiomics and dosiomics image features and was connected to a web-based dashboard for streamlined patient enrollment, feature extraction, SWL prediction, and physicians' evaluation processes.

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Article Synopsis
  • Patients with non-small cell lung cancer can develop pneumonitis from thoracic radiotherapy (RT) and immune checkpoint inhibitors (ICIs), and this study aimed to identify different CT imaging features associated with each cause of pneumonitis.
  • The research compared CT features of pneumonitis in 82 patients, revealing that ICI-pneumonitis generally affected more lung lobes, was more often bilateral, and lacked sharp borders compared to RT-pneumonitis.
  • The findings suggest that recognizing these distinct imaging features can help in better managing treatment decisions for patients experiencing pneumonitis after RT and ICIs.
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Purpose/methods: This retrospective study evaluated local recurrence (LR) and fracture risk in non-spine bone metastases treated with SBRT.

Results: 181 lesions in 116 patients are reported. The median dose was 27 Gy (range 15-40) in 3 fractions (range 1-6).

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