Manisha Palta

Overview:

Clinical research in gastrointestinal malignancies, lymphomas and breast malignancies.

Positions:

Associate Professor of Radiation Oncology

Radiation Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 2007

University of Florida, College of Medicine

Intern, Internal Medicine

University of North Carolina - Chapel Hill

Resident, Radiation Oncology

Duke University School of Medicine

Grants:

PROCEED

Administered By
Radiation Oncology
Awarded By
Merck Sharp & Dohme
Role
Principal Investigator
Start Date
End Date

Publications:

The multidisciplinary management of early-stage cervical esophageal cancer

© Springer Nature Switzerland AG 2020. All rights reserved. Cervical esophageal cancer (CEC) was historically treated with primary surgery, typically a pharyngo-laryngo-esophagectomy (PLE), a morbid procedure with substantial impact on a patient’s long-term quality of life. More recently, a paradigm shift has occurred such that now the preferred initial approach is treatment with definitive, concurrent chemotherapy and radiation (CRT), with a goal of preserving a functional larynx while not compromising survival. There is ongoing debate as to whether CEC should be treated with CRT schedules used in locally advanced head and neck squamous cell cancers (HNSCC) as opposed to the CRT schedules used in more distal esophageal cancers. The anatomy, risk factors, clinical presentation, diagnostic work-up, and a discussion of the data that have informed the current, however variable, approach to the treatment of CEC will be reviewed in this chapter.
Authors
Tanksley, JP; Torok, JA; Salama, JK; Palta, M
MLA Citation
Tanksley, J. P., et al. “The multidisciplinary management of early-stage cervical esophageal cancer.” Esophageal Cancer: Prevention, Diagnosis and Therapy, 2019, pp. 221–36. Scopus, doi:10.1007/978-3-030-29832-6_11.
URI
https://scholars.duke.edu/individual/pub1447287
Source
scopus
Published Date
Start Page
221
End Page
236
DOI
10.1007/978-3-030-29832-6_11

Interrater Reliability in Toxicity Identification: Limitations of Current Standards.

PURPOSE: The National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) v5.0 is the standard for oncology toxicity encoding and grading, despite limited validation. We assessed interrater reliability (IRR) in multireviewer toxicity identification. METHODS AND MATERIALS: Two reviewers independently reviewed 100 randomly selected notes for weekly on-treatment visits during radiation therapy from the electronic health record. Discrepancies were adjudicated by a third reviewer for consensus. Term harmonization was performed to account for overlapping symptoms in CTCAE. IRR was assessed based on unweighted and weighted Cohen's kappa coefficients. RESULTS: Between reviewers, the unweighted kappa was 0.68 (95% confidence interval, 0.65-0.71) and the weighted kappa was 0.59 (0.22-1.00). IRR was consistent between symptoms noted as present or absent with a kappa of 0.6 (0.66-0.71) and 0.6 (0.65-0.69), respectively. CONCLUSIONS: Significant discordance suggests toxicity identification, particularly retrospectively, is a complex and error-prone task. Strategies to minimize IRR, including training and simplification of the CTCAE criteria, should be considered in trial design and future terminologies.
Authors
Fairchild, AT; Tanksley, JP; Tenenbaum, JD; Palta, M; Hong, JC
MLA Citation
Fairchild, Andrew T., et al. “Interrater Reliability in Toxicity Identification: Limitations of Current Standards.Int J Radiat Oncol Biol Phys, vol. 107, no. 5, Aug. 2020, pp. 996–1000. Pubmed, doi:10.1016/j.ijrobp.2020.04.040.
URI
https://scholars.duke.edu/individual/pub1440587
PMID
32371073
Source
pubmed
Published In
Int J Radiat Oncol Biol Phys
Volume
107
Published Date
Start Page
996
End Page
1000
DOI
10.1016/j.ijrobp.2020.04.040

Survival Advantage With Adjuvant Chemotherapy for Locoregionally Advanced Rectal Cancer: A Veterans Health Administration Analysis.

BACKGROUND: Adjuvant chemotherapy (AC) after chemoradiation (CRT) and surgery for locoregionally advanced rectal cancer (LARC) is a standard of care in the United States. This study examined the role, optimal regimen, and duration of AC using data from the largest integrated health system in the United States. PATIENTS AND METHODS: Using the Veterans Affairs Central Cancer Registry, patients with stage II-III rectal cancer diagnosed in 2001 through 2011 who received neoadjuvant CRT and surgery with or without AC were identified. Kaplan-Meier analysis, log-rank tests, and propensity score (PS) adjustment analysis were used to assess survival. RESULTS: A total of 866 patients were identified; 417 received AC and 449 did not (observation [OBS] group). Median follow-up was 109 months. Median disease-specific survival (DSS) was not reached. Six-year DSS was 73.7%; 79.5% for the AC group versus 68.0% for the OBS group. PS-matched analysis for DSS favored AC (P=.0002). Median overall survival (OS) was 90.8 months. Six-year OS was 56.7%; 64.3% for AC versus 49.6% for OBS. In PS-matched analysis, median OS was 117.4 months for AC and 74.3 months for OBS (P<.0001). A DSS advantage was seen when comparing ≥4 months with <4 months of AC (P=.023). No difference in DSS or OS was seen with single-agent versus multiagent AC. CONCLUSIONS: In this population of patients with LARC treated with neoadjuvant CRT and surgery, OS and DSS were improved among those treated with AC versus OBS. DSS benefits were seen with ≥4 months of AC. No additional benefit was observed with multiagent therapy. In the absence of phase III data, these findings support the use of AC for LARC.
Authors
Spiegel, DY; Boyer, MJ; Hong, JC; Williams, CD; Kelley, MJ; Salama, JK; Palta, M
MLA Citation
Spiegel, Daphna Y., et al. “Survival Advantage With Adjuvant Chemotherapy for Locoregionally Advanced Rectal Cancer: A Veterans Health Administration Analysis.J Natl Compr Canc Netw, vol. 18, no. 1, Jan. 2020, pp. 52–58. Pubmed, doi:10.6004/jnccn.2019.7329.
URI
https://scholars.duke.edu/individual/pub1427151
PMID
31910388
Source
pubmed
Published In
J Natl Compr Canc Netw
Volume
18
Published Date
Start Page
52
End Page
58
DOI
10.6004/jnccn.2019.7329

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

Mind the gap: Gendered publication trends in oncology.

BACKGROUND:Investigating scientific publication trends in the field of oncology may highlight opportunities for improved representation, mentorship, collaboration, and advancement for women. METHODS:We conducted a bibliometric analysis of Annals of Surgical Oncology; Cancer; International Journal of Radiation Oncology, Biology, Physics (IJROBP); JAMA Oncology; and Journal of Clinical Oncology in 1990, 2000, 2010, and 2017. Full name and degree credentials per author role (ie, first or senior author), article type, publication year, and citation metrics were collected. First names were used to identify author gender. RESULTS:Across 9189 articles, female representation rose between 1990 and 2017 (first authors: 17.7% in 1990, 36.6% in 2017; senior authors: 11.7% in 1990, 28.5% in 2017). For the 50 most cited articles per year, women comprised a smaller percent of first (26.5%) and senior (19.9%) authors. The average citation count was higher for male first (44.8 per article) and senior (47.1) authors compared to female first (39.7) and senior (44.1) authors. With male senior authors, the first author was more likely male (71.4% male; 25.0% female); with female senior authors, first authors were 50.2% male and 47.6% female. IJROBP had the lowest total female representation among first (25.1%) and senior (16.7%) authors. Women had more MDs with Masters degrees, whereas men held more MDs only and more MDs with PhDs. CONCLUSION:Despite positive trends, substantial gendered differences in oncology publications persist. Fostering more women in oncology research will benefit female representation at many levels of academia and improve productivity, collaboration, and recruitment, especially in technical fields such as radiation and surgical oncology.
Authors
Dalal, NH; Chino, F; Williamson, H; Beasley, GM; Salama, AKS; Palta, M
MLA Citation
Dalal, Nicole H., et al. “Mind the gap: Gendered publication trends in oncology.Cancer, vol. 126, no. 12, June 2020, pp. 2859–65. Epmc, doi:10.1002/cncr.32818.
URI
https://scholars.duke.edu/individual/pub1435855
PMID
32212334
Source
epmc
Published In
Cancer
Volume
126
Published Date
Start Page
2859
End Page
2865
DOI
10.1002/cncr.32818