Brian Czito

Overview:

Listed in Best Doctors in America. Listed in Top Doctors in North Carolina. His research interests include gastrointestinal malignancies, including treatment and integration of novel systemic agents with radiation therapy in the treatment of esophageal, gastric, hepatobiliary, pancreatic, colorectal and anal malignancies; phase I/II clinical trials evaluating novel systemic/targeted agents in conjunction with radiation therapy; investigation and optimization of the treatment of gastrointestinal malignancies, with focus on the above tumor sites.

Positions:

Professor of Radiation Oncology

Radiation Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1996

Medical College of Georgia School of Medicine

Intern

St. Joseph Mercy Health Systems

Resident

Massachusetts General Hospital

Chief Resident

Massachusetts General Hospital

American Board of Radiology (ABR)

American Board of Radiology

Grants:

Phase II Randomized Trial comparing Percutaneous Ablation to Hypofractionaed Image Guided Radiation Therapy in Veteran and Non-Veteran, Non-surgical Hepatocelluar Carcinoma Patients (PROVE-HCC)

Administered By
Radiation Oncology
Role
Principal Investigator
Start Date
End Date

AN ADAPTIVE PHASE I/II DOSE ESCALATION TRIAL OF STEREOTACTIC BODY RADIATION THERAPY IN COMBINATION WITH RADIOMODULATING AGENT GC4419 IN LOCALLY ADVANCED PANCREATIC ADENOCARCINOMA

Administered By
Radiation Oncology
Role
Principal Investigator
Start Date
End Date

Publications:

Evaluating treatment protocols for rectal squamous cell carcinomas: the Duke experience and literature.

Background: Colorectal cancer is the third most common cancer in the United States and associated with significant morbidity and mortality. Within colorectal cancer histologies, squamous cell carcinomas (SCC) are rare compared to adenocarcinomas, with only about 200 cases reported to date. Because rectal SCC is rarely encountered, there is a lack of literature and clinical consensus surrounding its optimal treatment approach. Staging and management of SCC can be partly analogous to both rectal adenocarcinoma and anal canal SCC, which leads to a dilemma in how to best approach these patients. As large randomized prospective trials are unrealistic in the setting of this rare malignancy, this study evaluates an institutional experience and reviews the existing literature to help guide future management approaches. Methods: This retrospective study compared various treatment regimens for rectal SCC patients treated at Duke University Medical Center from January 1, 1980 through December 31, 2016. Patients ≥18 years old with histologically confirmed, nonmetastatic rectal SCC were included. Due to small sample size, all statistical analyses were descriptive. For our systematic review, a comprehensive search of PubMed from 1933 to March 2018 was performed, with selected articles referenced to ensure all relevant publications were included. A qualitative analysis was performed to examine patient diagnoses, treatments, and disease- and treatment-related outcomes. Results: Eight patients were included. Three patients underwent initial, curative attempt surgery and two of these patients required colostomy. With follow-up ranging from 7.1 to 31.5 months, one patient was alive with no evidence of disease while two developed local/regional recurrences. Five patients received definitive chemoradiation. Of these, three patients developed local/regional and/or metastatic recurrence. Two patients achieved complete response on imaging and currently remain disease-free (follow-up of 31.5 and 33.6 months). Conclusions: Although the review of our institutional experience is limited by small numbers, our analysis suggests that definitive chemoradiation therapy is the preferred treatment approach to rectal SCC based on improved disease-related outcomes, sphincter preservation and morbidity profiles. This conclusion is supported by a systematic literature review.
Authors
MLA Citation
Song, Erin J., et al. “Evaluating treatment protocols for rectal squamous cell carcinomas: the Duke experience and literature.J Gastrointest Oncol, vol. 11, no. 2, Apr. 2020, pp. 242–49. Pubmed, doi:10.21037/jgo.2018.11.02.
URI
https://scholars.duke.edu/individual/pub1441155
PMID
32399265
Source
pubmed
Published In
Journal of Gastrointestinal Oncology
Volume
11
Published Date
Start Page
242
End Page
249
DOI
10.21037/jgo.2018.11.02

Multi-Institutional Analysis of Synchronous Prostate and Rectosigmoid Cancers.

Purpose: To perform a multi-institutional analysis of patients with synchronous prostate and rectosigmoid cancers. Materials and Methods: A retrospective review of Duke University and Durham Veterans Affairs Medical Center records was performed for men with both prostate and rectosigmoid adenocarcinomas from 1988 to 2017. Synchronous presentation was defined as symptoms, diagnosis, or treatment of both cancers within 12 months of each other. The primary study endpoint was overall survival. Univariate and multivariable Cox regression was performed. Results: Among 31,883 men with prostate cancer, 330 (1%) also had rectosigmoid cancer and 54 (16%) of these were synchronous. Prostate cancer was more commonly the initial diagnosis (59%). Fifteen (28%) underwent prostatectomy or radiotherapy before an established diagnosis of rectosigmoid cancer. Stage I, II-III, or IV rectosigmoid cancer was present in 26, 57, and 17% of men, respectively. At a median follow-up of 43 months, there were 18 deaths due rectosigmoid cancer and two deaths due to prostate cancer. Crude late grade ≥3 toxicities include nine (17%) gastrointestinal and six (11%) genitourinary. Two anastomotic leaks following low anterior resection occurred in men who received a neoadjuvant radiotherapy prostate dose of 70.6-76.4 Gy. Rectosigmoid cancer stages II-III (HR 4.3, p = 0.02) and IV (HR 16, p < 0.01) as well as stage IV prostate cancer (HR 31, p < 0.01) were associated with overall survival on multivariable analysis. Conclusions: Synchronous rectosigmoid cancer is a greater contributor to mortality than prostate cancer. Men aged ≥45 with localized prostate cancer should undergo colorectal cancer screening prior to treatment to evaluate for synchronous rectosigmoid cancer.
Authors
Jacobs, CD; Trotter, J; Palta, M; Moravan, MJ; Wu, Y; Willett, CG; Lee, WR; Czito, BG
MLA Citation
Jacobs, Corbin D., et al. “Multi-Institutional Analysis of Synchronous Prostate and Rectosigmoid Cancers.Front Oncol, vol. 10, 2020, p. 345. Pubmed, doi:10.3389/fonc.2020.00345.
URI
https://scholars.duke.edu/individual/pub1436853
PMID
32266135
Source
pubmed
Published In
Frontiers in Oncology
Volume
10
Published Date
Start Page
345
DOI
10.3389/fonc.2020.00345

Multi-institutional analysis of synchronous prostate and rectosigmoid cancers.

<jats:p> 33 </jats:p><jats:p> Background: Synchronous prostate cancer (PC) and rectosigmoid (RS) cancer (RSC) is a challenging clinical situation. Methods: A retrospective review of Duke University and Durham VA charts was performed for men with adenocarcinomas of the prostate and RS colon from 1988-2017. Synchronous presentation was defined as symptoms, diagnosis (dx), or treatment (tx) of PC/RSC within 12 months. The primary endpoint was overall survival (OS), calculated from latest dx date. Univariate and multivariate (MVA) Cox regression was performed using STATA 15.1. Results: Among 31,883 men with PC identified, 330 (1%) also had RSC. 54 (16%) were considered synchronous (median age 67, IQR 62-72). PC was more commonly the first dx (59%), and 15 (28%) underwent prostatectomy (n=13) or radiotherapy (RT, n=2) before a dx of synchronous RSC. 26%, 57%, and 17% had stage I, II-III, and IV RSC, respectively. Prostatectomy, LAR, APR, and combined surgery for both PC/RSC was performed in 17 (31%), 24 (44%), 10 (19%), and 2 (4%) men, respectively. 35 (65%) received RT with median RS dose of 50.4 Gy (IQR 50.4-54 Gy) and prostate boost to 66 Gy (IQR 61-72 Gy). 34 (63%) received 5-FU based chemotherapy, 23 (43%) received ADT, and 9 (17%) received no PC-specific tx. After a median follow up of 43 (IQR 21-93) months, there were 34 deaths: 18 (53%) due to RSC, 2 (6%) due to PC, 3 (9%) due to grade 5 toxicity, 7 (21%) due to another malignancy, and 4 (12%) due to unknown cause without recurrence. Grade 5 toxicities resulted from sequential hepatectomy/LAR, combined prostatectomy/APR, and myocardial infarction while on ADT. Crude late grade ≥3 toxicities include 9 (17%) GI and 6 (11%) GU. Two anastomotic leaks &lt;2.3 years after LAR occurred in men who received neoadjuvant prostate RT boost of 70.6-76.4 Gy. Stages II-III (HR 4.3, p=0.02) and IV (HR 16, p&lt;0.01) for RSC but only stage IV (HR 31, p&lt;0.01) for PC were significantly associated with OS on MVA. Among 30 men with stage II-III RSC and non-metastatic PC, 5-FU based chemotherapy (HR 0.34, p=0.04) but no PC-specific tx was significantly associated with OS on MVA. Conclusions: Synchronous RSC is a greater contributor to mortality than PC. Men aged ≥50 with localized PC should undergo colorectal cancer screening prior to tx to evaluate for synchronous RSC. </jats:p>
Authors
Jacobs, C; Trotter, J; Palta, M; Wu, Y; Willett, C; Lee, WR; Czito, BG
MLA Citation
Jacobs, Corbin, et al. “Multi-institutional analysis of synchronous prostate and rectosigmoid cancers.Journal of Clinical Oncology, vol. 37, no. 7_suppl, American Society of Clinical Oncology (ASCO), 2019, pp. 33–33. Crossref, doi:10.1200/jco.2019.37.7_suppl.33.
URI
https://scholars.duke.edu/individual/pub1416745
Source
crossref
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
37
Published Date
Start Page
33
End Page
33
DOI
10.1200/jco.2019.37.7_suppl.33

Colon Cancer

MLA Citation
Czito, B. G., et al. “Colon Cancer.” Clinical Radiation Oncology, 2015, pp. 977-991.e2. Scopus, doi:10.1016/B978-0-323-24098-7.00050-2.
URI
https://scholars.duke.edu/individual/pub1411897
Source
scopus
Published Date
Start Page
977
End Page
991.e2
DOI
10.1016/B978-0-323-24098-7.00050-2

Intraoperative Irradiation

Authors
Czito, BG; Calvo, FA; Haddock, MG; Palta, M; Willett, CG
MLA Citation
Czito, B. G., et al. “Intraoperative Irradiation.” Clinical Radiation Oncology, 2015, pp. 325-340.e3. Scopus, doi:10.1016/B978-0-323-24098-7.00017-4.
URI
https://scholars.duke.edu/individual/pub1411898
Source
scopus
Published Date
Start Page
325
End Page
340.e3
DOI
10.1016/B978-0-323-24098-7.00017-4