Papers by Jacqueline Kelly
International Journal of Radiation Oncology*Biology*Physics, 2019
Background: Pathologic nodal staging in the AJCC 8th edition for HPVmediated oropharyngeal squamo... more Background: Pathologic nodal staging in the AJCC 8th edition for HPVmediated oropharyngeal squamous cell carcinoma (HPV-OPSCC) focuses exclusively on number of positive lymph nodes (LN) rather than LN laterality, which is the historic standard. Objectives: Our goal was to explore whether the presence of contralaterally involved LN adds additional prognostic information to the AJCC 8th edition pathologic nodal staging. Methods: We identifi ed 4617 patients in the National Cancer Database (NCDB) diagnosed with HPV-OPSCC from 2004-2015 who were treated with curative intent surgery, had 10 LN removed, and had 1 positive LN. We excluded patients with in situ disease, missing T and N stage, or no follow-up. Our fi nal cohort consisted of 2947 patients, 138 of whom had contralateral LN involvement. Univariable and multivariable survival analyses were conducted with Cox proportional hazards regression. Independent variables included age, race, comorbidities, pathologic T-stage, number of LN involved , lymphovascular invasion (LVI), extranodal extension (ENE), LN laterality, and AJCC 8th edition pathologic N-stage (pN2 vs. pN1). A propensity score-matched analysis was conducted based on variables that were statistically diff erent between the ipsilateral vs. contralateral LN cohorts. Results: On univariate analysis, variables signifi cantly associated with worse survival were AJCC 8th edition pathologic nodal stage, pathologic T-stage, age, comorbidities, ENE, LVI, and the presence of contralateral LN. On multivariable analysis, all variables that were signifi cant on univariate analysis remained signifi cant, with the exception of nodal laterality: pN2 vs.
Oral Oncology, 2019
Objectives: Contralateral lymph node (LN) involvement is a prognostic factor in clinical staging ... more Objectives: Contralateral lymph node (LN) involvement is a prognostic factor in clinical staging of oropharyngeal squamous cell carcinoma (OPSCC), while pathologic nodal staging in the AJCC 8th edition for human papillomavirus-mediated OPSCC (HPV + OPSCC) focuses exclusively on the number of involved LNs (pLN+). This study assessed if the presence of contralateral pLN+ adds prognostic importance to the number of pLN+. Materials and methods: The National Cancer Database was queried for pLN+ HPV + OPSCC treated with surgery with 10 or more LN dissected. Data were evaluated with Cox regression, propensity score matching (PSM), and Kaplan-Meier overall survival (OS) analysis. Results: Of 3407 patients, 152 (4.5%) patients had contralateral pLN+. Subjects with contralateral pLN+ had higher pT/pN stage, more positive margins, extranodal extension (ENE), and lymphovascular invasion (LVI) (all p < 0.05). On univariate analysis, contralateral pLN+ trended toward worse OS (HR 1.58, 95% CI 0.98-2.55, p = 0.061). In the multivariable model (controlling for age, comorbidities, T-stage, N-stage, LN size, ENE, LVI, margin status and adjuvant therapy), LN laterality had no impact on OS (HR 0.87, 95% CI 0.52-1.45, p = 0.520). Further PSM analysis confirmed that contralateral pLN+ is not associated with OS in this population (HR 0.79, 95% CI 0.41-1.53, p = 0.494). Conclusion: This study supports the AJCC 8th edition pathologic staging for HPV + OPSCC by observing that LN laterality is not associated with OS. ENE was associated with inferior OS and should be considered for future staging systems. Further study should be directed at the importance of nodal size in this population.
Practical radiation oncology, Jan 27, 2018
Initial deescalation studies for human papilloma virus (HPV)-positive driven oropharyngeal squamo... more Initial deescalation studies for human papilloma virus (HPV)-positive driven oropharyngeal squamous cell carcinomas (HPV+ OPSCC) altered radiation therapy dose or the systemic agent used. Newer trials examine the disease control achieved with a reduced elective nodal field. We examined patterns of nodal involvement in patients with HPV+ OPSCC with a focus on implications for radiation field design for treatment deescalation. Records of patients with HPV+ OPSCC with preoperative imaging (computed tomography or fludeoxyglucose positron emission tomography/computed tomography) who underwent neck dissection without neoadjuvant therapy from 2010 to 2017 were retrospectively reviewed. The number and location of clinically positive lymph nodes on preoperative imaging were compared with those documented on pathology. These data were then used to establish the probability of missing nodal disease in 3 modified radiation field designs. One hundred patients were included. The median time betwe...
Emergency radiology, Jan 23, 2014
The purpose of this study is to evaluate the performance of a sequential multi-modality imaging a... more The purpose of this study is to evaluate the performance of a sequential multi-modality imaging algorithm for diagnosing acute appendicitis in pregnancy. This IRB-approved, HIPAA compliant study included 127 consecutive pregnant patients imaged for suspected appendicitis between October 2007 and May 2012; all patients initially underwent ultrasound (US) examination, followed by magnetic resonance imaging (MRI) if results of US were negative or equivocal. Computerized tomography (CT) was reserved for cases with inconclusive US and MRI results. The EMR was reviewed, recording results of imaging examinations and clinical outcomes. The diagnostic performance of this sequential multi-modality imaging algorithm was calculated with pathology correlation. Two (1.9 %) of the 127 US examinations reported suspected appendicitis; 125 (98.4 %) were inconclusive. Of the 125 patients with inconclusive US examinations, 103 underwent MRI, of which eight (6.2 %) demonstrated findings of acute appendi...
Emergency radiology, Jan 23, 2014
The purpose of this study is to evaluate the performance of a sequential multi-modality imaging a... more The purpose of this study is to evaluate the performance of a sequential multi-modality imaging algorithm for diagnosing acute appendicitis in pregnancy. This IRB-approved, HIPAA compliant study included 127 consecutive pregnant patients imaged for suspected appendicitis between October 2007 and May 2012; all patients initially underwent ultrasound (US) examination, followed by magnetic resonance imaging (MRI) if results of US were negative or equivocal. Computerized tomography (CT) was reserved for cases with inconclusive US and MRI results. The EMR was reviewed, recording results of imaging examinations and clinical outcomes. The diagnostic performance of this sequential multi-modality imaging algorithm was calculated with pathology correlation. Two (1.9 %) of the 127 US examinations reported suspected appendicitis; 125 (98.4 %) were inconclusive. Of the 125 patients with inconclusive US examinations, 103 underwent MRI, of which eight (6.2 %) demonstrated findings of acute appendi...
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Papers by Jacqueline Kelly