Junzo Chino

Overview:

Clinical Research in Gynecologic Malignancies, Breast Malignancies, Radiation Oncology Resident Education, Stereotactic Radiation Therapy, and Brachytherapy

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. 2004

Indiana University at Indianapolis

Director of Brachytherapy, Radiation Oncology

Duke University School of Medicine

Intern

Indiana University, School of Medicine

Resident, Radiation Oncology

Duke University School of Medicine

Chief Resident, Radiation Oncology

Duke University School of Medicine

American Board of Radiology (ABR)

American Board of Radiology

Publications:

Long-term Consequences of Pelvic Irradiation: Toxicities, Challenges, and Therapeutic Opportunities with Pharmacologic Mitigators.

A percentage of long-term cancer survivors who receive pelvic irradiation will develop treatment-related late effects, collectively termed pelvic radiation disease. Thus, there is a need to prevent or ameliorate treatment-related late effects in these patients. Modern radiotherapy methods can preferentially protect normal tissues from radiation toxicities to permit higher doses to targets. However, concerns about chronic small bowel toxicity, for example, still constrain the prescription dose. This provides strong rationale for considering adding pharmacologic mitigators. Implementation of modern targeted radiotherapy methods enables delivery of focused radiation to target volumes, while minimizing dose to normal tissues. In prostate cancer, these technical advances enabled safe radiation dose escalation and better local tumor control without increasing normal tissue complications. In other pelvic diseases, these new radiotherapy methods have not resulted in the low probability of normal tissue damage achieved with prostate radiotherapy. The persistence of toxicity provides rationale for pharmacologic mitigators. Several new agents could be readily tested in clinical trials because they are being or have been studied in human patients already. Although there are promising preclinical data supporting mitigators, no clinically proven options to treat or prevent pelvic radiation disease currently exist. This review highlights therapeutic options for prevention and/or treatment of pelvic radiation disease, using pharmacologic mitigators. Successful development of mitigators would reduce the number of survivors who suffer from these devastating consequences of pelvic radiotherapy. It is important to note that pharmacologic mitigators to ameliorate pelvic radiation disease may be applicable to other irradiated sites in which chronic toxicity impairs quality of life.
Authors
Huh, JW; Tanksley, J; Chino, J; Willett, CG; Dewhirst, MW
MLA Citation
Huh, Jung Wook, et al. “Long-term Consequences of Pelvic Irradiation: Toxicities, Challenges, and Therapeutic Opportunities with Pharmacologic Mitigators.Clin Cancer Res, vol. 26, no. 13, July 2020, pp. 3079–90. Pubmed, doi:10.1158/1078-0432.CCR-19-2744.
URI
https://scholars.duke.edu/individual/pub1433146
PMID
32098770
Source
pubmed
Published In
Clinical Cancer Research : an Official Journal of the American Association for Cancer Research
Volume
26
Published Date
Start Page
3079
End Page
3090
DOI
10.1158/1078-0432.CCR-19-2744

COVID-19 impact on timing of brachytherapy treatment and strategies for risk mitigation.

PURPOSE: The purpose of this study was to highlight the importance of timely brachytherapy treatment for patients with gynecologic, breast, and prostate malignancies, and provide a framework for brachytherapy clinical practice and management in response to the COVID-19 pandemic. METHODS AND MATERIALS: We review amassing evidence to help guide the management and timing of brachytherapy for gynecologic, breast, and prostate cancers. Where concrete data could not be found, peer-reviewed expert opinion is provided. RESULTS: There may be a significant negative impact on oncologic outcomes for patients with gynecologic malignancies who have a delay in the timely completion of therapy. Delay of prostate or breast cancer treatment may also impact oncologic outcomes. If a treatment delay is expected, endocrine therapy may be an appropriate temporizing measure before delivery of radiation therapy. The use of shorter brachytherapy fractionation schedules will help minimize patient exposure and conserve resources. CONCLUSIONS: Brachytherapy remains a critical treatment for patients and may shorten treatment time and exposure for some. Reduced patient exposure and resource utilization is important during COVID-19. Every effort should be made to ensure timely brachytherapy delivery for patients with gynecologic malignancies, and endocrine therapy may help temporize treatment delays for breast and prostate cancer patients. Physicians should continue to follow developing institutional, state, and federal guidelines/recommendations as challenges in delivering care during COVID-19 will continue to evolve.
Authors
Williams, VM; Kahn, JM; Harkenrider, MM; Chino, J; Chen, J; Fang, LC; Dunn, EF; Fields, E; Mayadev, JS; Rengan, R; Petereit, D; Dyer, BA
MLA Citation
Williams, Vonetta M., et al. “COVID-19 impact on timing of brachytherapy treatment and strategies for risk mitigation.Brachytherapy, vol. 19, no. 4, July 2020, pp. 401–11. Pubmed, doi:10.1016/j.brachy.2020.04.005.
URI
https://scholars.duke.edu/individual/pub1439774
PMID
32359937
Source
pubmed
Published In
Brachytherapy
Volume
19
Published Date
Start Page
401
End Page
411
DOI
10.1016/j.brachy.2020.04.005

Radiation Therapy for Cervical Cancer: Executive Summary of an ASTRO Clinical Practice Guideline.

PURPOSE: This guideline reviews the evidence and provides recommendations for the indications and appropriate techniques of radiation therapy (RT) in the treatment of nonmetastatic cervical cancer. METHODS: The American Society for Radiation Oncology convened a task force to address 5 key questions focused on the use of RT in definitive and postoperative management of cervical cancer. These questions included the indications for postoperative and definitive RT, the use of chemotherapy in sequence or concurrent with RT, the use of intensity modulated radiation therapy (IMRT), and the indications and techniques of brachytherapy. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and system for grading evidence quality and recommendation strength. RESULTS: The guideline recommends postoperative RT for those with intermediate risk factors, and chemoradiation for those with high-risk factors. In the definitive setting, chemoradiation is recommended for stages IB3-IVA, and RT or chemoradiation is conditionally recommended for stages IA1-IB2 if medically inoperable. IMRT is recommended for postoperative RT and conditionally recommended for definitive RT, for the purposes of reducing acute and late toxicity. Brachytherapy is strongly recommended for all women receiving definitive RT, and several recommendations are made for target dose and fractionation, the use of intraoperative imaging, volume-based planning, and recommendations for doses limits for organs at risk. CONCLUSIONS: There is strong evidence supporting the use of RT with or without chemotherapy in both definitive and postoperative settings. Brachytherapy is an essential part of definitive management and volumetric planning is recommended. IMRT may be used for the reduction of acute and late toxicity. The use of radiation remains an essential component for women with cervical cancer to achieve cure.
Authors
Chino, J; Annunziata, CM; Beriwal, S; Bradfield, L; Erickson, BA; Fields, EC; Fitch, K; Harkenrider, MM; Holschneider, CH; Kamrava, M; Leung, E; Lin, LL; Mayadev, JS; Morcos, M; Nwachukwu, C; Petereit, D; Viswanathan, AN
MLA Citation
Chino, Junzo, et al. “Radiation Therapy for Cervical Cancer: Executive Summary of an ASTRO Clinical Practice Guideline.Pract Radiat Oncol, vol. 10, no. 4, July 2020, pp. 220–34. Pubmed, doi:10.1016/j.prro.2020.04.002.
URI
https://scholars.duke.edu/individual/pub1452590
PMID
32473857
Source
pubmed
Published In
Pract Radiat Oncol
Volume
10
Published Date
Start Page
220
End Page
234
DOI
10.1016/j.prro.2020.04.002

Incidence of Opioid-Associated Deaths in Cancer Survivors in the United States, 2006-2016: A Population Study of the Opioid Epidemic.

MLA Citation
Chino, Fumiko, et al. “Incidence of Opioid-Associated Deaths in Cancer Survivors in the United States, 2006-2016: A Population Study of the Opioid Epidemic.Jama Oncol, May 2020. Pubmed, doi:10.1001/jamaoncol.2020.0799.
URI
https://scholars.duke.edu/individual/pub1442278
PMID
32379275
Source
pubmed
Published In
Jama Oncol
Published Date
DOI
10.1001/jamaoncol.2020.0799

SAbR as an Alternative Boost Modality for Cervical Cancer: A Cautionary Exercise.

Authors
Kamrava, M; Chino, JP; Beriwal, S
MLA Citation
Kamrava, Mitchell, et al. “SAbR as an Alternative Boost Modality for Cervical Cancer: A Cautionary Exercise.Int J Radiat Oncol Biol Phys, vol. 106, no. 3, Mar. 2020, pp. 472–74. Pubmed, doi:10.1016/j.ijrobp.2019.11.026.
URI
https://scholars.duke.edu/individual/pub1431695
PMID
32014146
Source
pubmed
Published In
Int J Radiat Oncol Biol Phys
Volume
106
Published Date
Start Page
472
End Page
474
DOI
10.1016/j.ijrobp.2019.11.026