Carol Hahn

Overview:

Development of Evidence Based Clinical Practice Guidelines for Radiation Oncology.

Optimizing Quality of Care in Radiation Oncology and Development of Quality Measures.

Disparities in care for oncology patients between tertiary care and community hospitals.

Assessment of Neuropsychologic Function in Brain Tumor Patients and the metabolic and functional changes induced by Radiation Therapy.

Positions:

Professor Emeritus of Radiation Oncology

Radiation Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1990

Georgetown University

Publications:

A Multidisciplinary Consensus Recommendation on a Synoptic Radiation Treatment Summary: A Commission on Cancer Workgroup Report.

PURPOSE: The radiation treatment summary provides a clinical and technical overview of a patient's full course of radiation therapy. Despite its importance to multiple stakeholders, there is no widely followed radiation treatment summary template. METHODS AND MATERIALS: The Commission on Cancer convened a multistakeholder workgroup to develop a synoptic radiation treatment summary template. The workgroup included individuals with expertise in radiation, medical and surgical oncology, medical physics, oncology informatics, cancer registry, electronic medical record systems, treatment planning systems, and registry information systems. The workgroup iterated a template until consensus was achieved. RESULTS: The consensus radiation treatment summary template is divided into 3 sections that allows for a mix of structured and free text. The first section, "Radiation Course Summary," is meant to provide information that is of broad interest and in a manner that is potentially accessible to patients, their families, and nononcology-trained care team members. The second section, "Anatomic Target Summary," provides information that is potentially useful to oncology-trained care team members who will be primarily interested in which anatomies were irradiated, by what modality, and to what cumulative dose. The third section, "Delivered Prescriptions," summarizes technical information that is primarily of interest and accessible to radiation oncology-trained clinicians, registrars, and researchers. CONCLUSIONS: We have proposed a consensus template with 3 sections to meet the needs of a diverse set of consumers. We recommend that providers, professional societies, and accreditation bodies with interest in the radiation treatment summary continue collaborative efforts to test, iterate, and drive adoption of a synoptic template.
Authors
Christodouleas, JP; Anderson, N; Gabriel, P; Greene, R; Hahn, C; Kessler, S; Mayo, CS; McNutt, T; Shulman, LN; Smith, BD; West, J; Williamson, T
MLA Citation
Christodouleas, John P., et al. “A Multidisciplinary Consensus Recommendation on a Synoptic Radiation Treatment Summary: A Commission on Cancer Workgroup Report.Pract Radiat Oncol, vol. 10, no. 6, Nov. 2020, pp. 389–401. Pubmed, doi:10.1016/j.prro.2020.01.002.
URI
https://scholars.duke.edu/individual/pub1428963
PMID
31988040
Source
pubmed
Published In
Pract Radiat Oncol
Volume
10
Published Date
Start Page
389
End Page
401
DOI
10.1016/j.prro.2020.01.002

Consensus statement on palliative lung radiotherapy: third international consensus workshop on palliative radiotherapy and symptom control.

The purpose of this work is to disseminate a consensus statement on palliative radiotherapy (RT) of lung cancer created in conjunction with the Third International Lung Cancer Consensus Workshop. The palliative lung RT workshop committee agreed on 5 questions relating to (1) patient selection, (2) thoracic external-beam radiation therapy (XRT) fractionation, (3) endobronchial brachytherapy (EBB), (4) concurrent chemotherapy (CC), and (5) palliative endpoint definitions. A PubMed search for primary/cross-referenced practice guidelines, consensus statements, meta-analyses, and/or systematic reviews was conducted. Final consensus statements were created after review and discussion of the available evidence. The following summary statements reflect the consensus of the international working group. 1. Key factors involved in the decision to deliver palliative RT include performance status, tumor stage, pulmonary function, XRT volume, symptomatology, weight loss, and patient preference. 2. Palliative thoracic XRT is generally indicated for patients with stage IV disease with current/impending symptoms and for patients with stage III disease treated for palliative intent. 3. There is no evidence to routinely recommend EBB alone or in conjunction with other palliative maneuvers in the initial palliative management of endobronchial obstruction resulting from lung cancer. 4. There is currently no evidence to routinely recommend CC with palliative-intent RT. 5. Standard assessment of symptoms and health-related quality of life (QOL) using validated questionnaires should be carried out in palliative RT lung cancer trials. Despite an expanding literature, continued prospective randomized investigations to better define the role of XRT, EBB, and CC in the context of thoracic palliation of patients with lung cancer is needed.
Authors
Rodrigues, G; Macbeth, F; Burmeister, B; Kelly, K-L; Bezjak, A; Langer, C; Hahn, C; Movsas, B
MLA Citation
Rodrigues, George, et al. “Consensus statement on palliative lung radiotherapy: third international consensus workshop on palliative radiotherapy and symptom control.Clin Lung Cancer, vol. 13, no. 1, Jan. 2012, pp. 1–5. Pubmed, doi:10.1016/j.cllc.2011.04.004.
URI
https://scholars.duke.edu/individual/pub744197
PMID
21729656
Source
pubmed
Published In
Clin Lung Cancer
Volume
13
Published Date
Start Page
1
End Page
5
DOI
10.1016/j.cllc.2011.04.004

Dose-Dependent Effects of Radiation Therapy on Cerebral Blood Flow, Metabolism and Neurocognitive Dysfunction

Authors
Hahn, CA; Zhou, S; Renee, DH; Shafman, T; Wong, T; Kirkpatrick, J; Turkington, T; Tisch, A; Coleman, R; Light, K; Hollis, D; Marks, L
MLA Citation
Hahn, C. A., et al. “Dose-Dependent Effects of Radiation Therapy on Cerebral Blood Flow, Metabolism and Neurocognitive Dysfunction.” International Journal of Radiation Oncology*Biology*Physics, vol. 63, Elsevier BV, 2005, pp. S67–S67. Crossref, doi:10.1016/j.ijrobp.2005.07.116.
URI
https://scholars.duke.edu/individual/pub882491
Source
crossref
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
63
Published Date
Start Page
S67
End Page
S67
DOI
10.1016/j.ijrobp.2005.07.116

Fractionation for whole breast irradiation: an American Society for Radiation Oncology (ASTRO) evidence-based guideline.

PURPOSE: In patients with early-stage breast cancer treated with breast-conserving surgery, randomized trials have found little difference in local control and survival outcomes between patients treated with conventionally fractionated (CF-) whole breast irradiation (WBI) and those receiving hypofractionated (HF)-WBI. However, it remains controversial whether these results apply to all subgroups of patients. We therefore developed an evidence-based guideline to provide direction for clinical practice. METHODS AND MATERIALS: A task force authorized by the American Society for Radiation Oncology weighed evidence from a systematic literature review and produced the recommendations contained herein. RESULTS: The majority of patients in randomized trials were aged 50 years or older, had disease Stage pT1-2 pN0, did not receive chemotherapy, and were treated with a radiation dose homogeneity within ±7% in the central axis plane. Such patients experienced equivalent outcomes with either HF-WBI or CF-WBI. Patients not meeting these criteria were relatively underrepresented, and few of the trials reported subgroup analyses. For patients not receiving a radiation boost, the task force favored a dose schedule of 42.5 Gy in 16 fractions when HF-WBI is planned. The task force also recommended that the heart should be excluded from the primary treatment fields (when HF-WBI is used) due to lingering uncertainty regarding late effects of HF-WBI on cardiac function. The task force could not agree on the appropriateness of a tumor bed boost in patients treated with HF-WBI. CONCLUSION: Data were sufficient to support the use of HF-WBI for patients with early-stage breast cancer who met all the aforementioned criteria. For other patients, the task force could not reach agreement either for or against the use of HF-WBI, which nevertheless should not be interpreted as a contraindication to its use.
Authors
Smith, BD; Bentzen, SM; Correa, CR; Hahn, CA; Hardenbergh, PH; Ibbott, GS; McCormick, B; McQueen, JR; Pierce, LJ; Powell, SN; Recht, A; Taghian, AG; Vicini, FA; White, JR; Haffty, BG
MLA Citation
Smith, Benjamin D., et al. “Fractionation for whole breast irradiation: an American Society for Radiation Oncology (ASTRO) evidence-based guideline.Int J Radiat Oncol Biol Phys, vol. 81, no. 1, Sept. 2011, pp. 59–68. Pubmed, doi:10.1016/j.ijrobp.2010.04.042.
URI
https://scholars.duke.edu/individual/pub733144
PMID
20638191
Source
pubmed
Published In
Int J Radiat Oncol Biol Phys
Volume
81
Published Date
Start Page
59
End Page
68
DOI
10.1016/j.ijrobp.2010.04.042

Phase I/II trial of intravenous Doxil and whole abdomen hyperthermia in patients with refractory ovarian cancer.

OBJECTIVE: A phase I/II study of Doxil combined with whole abdomen hyperthermia was conducted in patients with refractory ovarian cancer. Liposomal doxorubicin combined with hyperthermia has been shown to increase both liposomal delivery and drug extravasation into tumour xenografts resulting in enhanced cytotoxic effects. PATIENTS AND METHODS: Thirty patients with either recurrent or persistent epithelial ovarian cancer were enrolled. All patients had either measurable or assessable disease. Patients received intravenous (IV) Doxil at a dose of 40 mg m-2 as a 1-h infusion followed by whole abdomen hyperthermia. The phase I portion of the study was performed to determine the maximal tolerated dose (MTD) of hyperthermia. Quality of life (QoL) was performed at baseline, prior to each cycle and every 3 months. Plasma pharmacokinetic studies were performed with the first cycle. RESULTS: Ten patients participated in the phase I portion of the study which demonstrated that the MTD of hyperthermia was 60 min after either average vaginal and rectal temperatures of 40 degrees C had been achieved or after 30 min of power application, whichever was shorter. All 30 patients were either paclitaxel and/or platinum resistant initially or developed resistant disease. The median number of prior chemotherapeutic regimens was three (range 2-8) and six patients had been previously treated with Doxil. There were three partial responses for a response rate of 10% (95% CI: [2%, 27%]) and eight patients (27%; 95% CI: [12%, 46%]) had disease stabilization. The median time to progression or death was 3.4 months (95% CI: [2.6, 5.2]) and the median survival was 10.8 months (95% CI: [8.8, 17.4]). Twelve patients (40%) experienced palmar-plantar erythrodysesthesia (PPE), but only four (13%) experienced grade 3-4 PPE toxicity. Doxil systemic exposure was higher in those with grade 3-4 PPE compared to those with no PPE. None of the patients had grade 3-4 thermal toxicity due to hyperthermia. QoL was not decreased in patients responding to therapy. CONCLUSIONS: Therapy with intravenous Doxil and whole abdomen hyperthermia for patients with platinum/paclitaxel resistant ovarian cancer is feasible and does not negatively impact quality of life.
Authors
Alvarez Secord, A; Jones, EL; Hahn, CA; Petros, WP; Yu, D; Havrilesky, LJ; Soper, JT; Berchuck, A; Spasojevic, I; Clarke-Pearson, DL; Prosnitz, LR; Dewhirst, MW
MLA Citation
Alvarez Secord, A., et al. “Phase I/II trial of intravenous Doxil and whole abdomen hyperthermia in patients with refractory ovarian cancer.Int J Hyperthermia, vol. 21, no. 4, June 2005, pp. 333–47. Pubmed, doi:10.1080/02656730500110155.
URI
https://scholars.duke.edu/individual/pub714709
PMID
16019859
Source
pubmed
Published In
International Journal of Hyperthermia : the Official Journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group
Volume
21
Published Date
Start Page
333
End Page
347
DOI
10.1080/02656730500110155