Christopher Kelsey

Overview:

Clinical trials that are currently enrolling patients include a study investigating lower doses of radiation therapy for patients with diffuse large B-cell lymphoma, with the goal of maintaining excellent tumor control but decreasing the risk of long-term side effects of treatment.

I also have an interest in genetic determinants of radiation sensitivity, predictors of local recurrence after surgery for lung cancer, radiation-induced lung injury, and the role of radiation therapy in advanced (stage III-IV) diffuse large B-cell lymphoma and Hodgkin lymphoma.

Positions:

Professor of Radiation Oncology

Radiation Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

B.S. 1998

Brigham Young University

M.D. 2002

University of Colorado, Colorado Springs

Grants:

Early Detection of Changes in Pulmonary Gas Exchange by Hyperpolarized Xe MRI

Administered By
Radiology
Awarded By
National Institutes of Health
Role
Co Investigator
Start Date
End Date

Early Detection of Changes in Pulmonary Gas Exchange by Hyperpolarized Xe MRI

Awarded By
National Institutes of Health
Role
Co Investigator
Start Date
End Date

Phase 1/2 Study of Stereotactic Body Radiation Therapy (SBRT) with or without GC4711 for Early Stage, Centrally Located or Large Non-Small Cell Lung Cancer (NSCLC)

Administered By
Radiation Oncology
Awarded By
Galera Therapeutics, Inc.
Role
Principal Investigator
Start Date
End Date

Publications:

Analysis of Dosimetric and Clinical Risk Factors Predicting Chest Wall Toxicity after SBRT for NSCLC

Authors
Eclov, N; Wang, Z; Kelsey, CR; Yin, FF
MLA Citation
Eclov, N., et al. “Analysis of Dosimetric and Clinical Risk Factors Predicting Chest Wall Toxicity after SBRT for NSCLC.” International Journal of Radiation Oncology*Biology*Physics, vol. 105, no. 1, Elsevier BV, 2019, pp. E505–E505. Crossref, doi:10.1016/j.ijrobp.2019.06.1326.
URI
https://scholars.duke.edu/individual/pub1415737
Source
crossref
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
105
Published Date
Start Page
E505
End Page
E505
DOI
10.1016/j.ijrobp.2019.06.1326

Hyperpolarized 129Xe Magnetic Resonance Imaging for Functional Avoidance Treatment Planning in Thoracic Radiation Therapy: A Comparison of Ventilation- and Gas Exchange-Guided Treatment Plans.

PURPOSE: To present a methodology to use pulmonary gas exchange maps to guide functional avoidance treatment planning in radiation therapy (RT) and evaluate its efficacy compared with ventilation-guided treatment planning. METHODS AND MATERIALS: Before receiving conventional RT for non-small cell lung cancer, 11 patients underwent hyperpolarized 129Xe gas exchange magnetic resonance imaging to map the distribution of xenon in its gas phase (ventilation) and transiently bound to red blood cells in the alveolar capillaries (gas exchange). Both ventilation and gas exchange maps were independently used to guide development of new functional avoidance treatment plans for every patient, while adhering to institutional dose-volume constraints for normal tissues and target coverage. Furthermore, dose-volume histogram (DVH)-based reoptimizations of the clinical plan, with reductions in mean lung dose (MLD) equal to the functional avoidance plans, were created to serve as the control group. To evaluate each plan (regardless of type), gas exchange maps, representing end-to-end lung function, were used to calculate gas exchange-weighted MLD (fMLD), gas exchange-weighted volume receiving ≥20 Gy (fV20), and mean dose in the highest gas exchanging 33% and 50% volumes of lung (MLD-f33% and MLD-f50%). Using each clinically approved plan as a baseline, the reductions in functional metrics were compared for ventilation-optimization, gas exchange optimization, and DVH-based reoptimization. Statistical significance was determined using the Freidman test, with subsequent subdivision when indicated by P values less than .10 and post hoc testing with Wilcoxon signed rank tests to determine significant differences (P < .05). Toxicity modeling was performed using an established function-based model to estimate clinical significance of the results. RESULTS: Compared with DVH-based reoptimization of the clinically approved plans, gas exchange-guided functional avoidance planning more effectively reduced the gas exchange-weighted metrics fMLD (average ± SD, -78 ± 79 cGy, compared with -45 ± 34 cGy; P = .03), MLD-f33% (-135 ± 136 cGy, compared with -52 ± 47 cGy; P = .004), and MLD-f50% (-96 ± 95 cGy, compared with -47 ± 40 cGy; P = .01). Comparing the 2 functional planning types, Gas Exchange-Guided planning more effectively reduced MLD-f33% compared with ventilation-guided planning (-64 ± 95; P = .009). For some patients, Gas Exchange-Guided functional avoidance plans demonstrated clinically significant reductions in model-predicted toxicity, more so than the accompanying ventilation-guided plans and DVH-based reoptimizations. CONCLUSION: Gas Exchange-Guided planning effectively reduced dose to high gas exchanging regions of lung while maintaining clinically acceptable plan quality. In many patients, ventilation-guided planning incidentally reduced dose to higher gas exchange regions, to a lesser extent. This methodology enables future prospective trials to examine patient outcomes.
Authors
Rankine, LJ; Wang, Z; Kelsey, CR; Bier, E; Driehuys, B; Marks, LB; Das, SK
MLA Citation
Rankine, Leith J., et al. “Hyperpolarized 129Xe Magnetic Resonance Imaging for Functional Avoidance Treatment Planning in Thoracic Radiation Therapy: A Comparison of Ventilation- and Gas Exchange-Guided Treatment Plans.Int J Radiat Oncol Biol Phys, vol. 111, no. 4, Nov. 2021, pp. 1044–57. Pubmed, doi:10.1016/j.ijrobp.2021.07.002.
URI
https://scholars.duke.edu/individual/pub1488545
PMID
34265395
Source
pubmed
Published In
Int J Radiat Oncol Biol Phys
Volume
111
Published Date
Start Page
1044
End Page
1057
DOI
10.1016/j.ijrobp.2021.07.002

Recumbent Total Skin Electron Beam Therapy.

Purpose: Our purpose was to describe preliminary dosimetric and clinical results of a recumbent total skin electron beam therapy (TSEBT) technique and compare this to a conventional standing TSEBT technique. Methods and Materials: A customized treatment platform with recessed side wheels was constructed and commissioned for patients to be treated in a recumbent position. Dosimetric and clinical information was collected for patients treated with this new recumbent technique in addition to that of a cohort of patients treated contemporaneously using the conventional standing method. Dose delivery and clinical outcomes were compared for patients treated with the recumbent and standing techniques. Results: Between 2017 and 2019, 27 patients were treated with TSEBT with the recumbent (n = 13) or conventional standing technique (n = 14) at our institution. Measured dose at 15 body sites could be directly compared. Of these, 10 showed no significant difference between the two techniques while five sites showed significant differences in median measured dose, including the top of left shoulder, right biceps, bend of left elbow, upper back, and medial right thigh (P < .003). Measured dose was significantly higher with the standing technique at these sites with the exception of the upper back. Rates of complete response (25% vs 23%), partial response (50% vs 69%), and stable disease (17% vs 8%) were similar between the standing and recumbent cohorts, respectively (P = .78). Conclusions: We have developed, commissioned, and implemented a floor-based, recumbent technique that allows for treatment of patients who would otherwise not be eligible for TSEBT. Dosimetric and clinical measurements suggest that this technique is a viable alternative to the standing method.
Authors
Ackerson, BG; Wu, Q; Craciunescu, O; Oyekunle, T; Niedzwiecki, D; Gupton, J; Laug, P; Brumfield, K; Crain, E; Champ, CE; Kelsey, CR
MLA Citation
Ackerson, Bradley G., et al. “Recumbent Total Skin Electron Beam Therapy.Adv Radiat Oncol, vol. 6, no. 4, July 2021, p. 100698. Pubmed, doi:10.1016/j.adro.2021.100698.
URI
https://scholars.duke.edu/individual/pub1484270
PMID
34409205
Source
pubmed
Published In
Advances in Radiation Oncology
Volume
6
Published Date
Start Page
100698
DOI
10.1016/j.adro.2021.100698

Durable Control of Mycosis Fungoides after Sepsis: "Coley's Toxin?" Case Report and Review of the Literature.

Mycosis fungoides, along with Sezary syndrome, is the most common subtype of cutaneous T-cell lymphoma. In this report, we present a patient with advanced-stage mycosis fungoides, who after successful treatment of methicillin-resistant Staphylococcus aureus bacteremia had prolonged disease control off systemic therapy. While this may have been due to single-agent gemcitabine, which can result in long remission, we hypothesize that our patient's durable response was in part due to the immune response elicited after treatment of her severe infection.
Authors
Heyman, B; Kelsey, CR; Beaven, A
MLA Citation
Heyman, Benjamin, et al. “Durable Control of Mycosis Fungoides after Sepsis: "Coley's Toxin?" Case Report and Review of the Literature.Case Rep Hematol, vol. 2019, 2019, p. 1507014. Pubmed, doi:10.1155/2019/1507014.
URI
https://scholars.duke.edu/individual/pub1406377
PMID
31467737
Source
pubmed
Published In
Case Reports in Hematology
Volume
2019
Published Date
Start Page
1507014
DOI
10.1155/2019/1507014

Effective Pain Control With Very Low Dose Palliative Radiation Therapy for Patients With Multiple Myeloma With Uncomplicated Osseous Lesions.

BACKGROUND: Osteolytic lesions are present in 75% of patients with multiple myeloma (MM) and frequently require palliation with radiation therapy (RT). Prior case series of patients with MM with bone pain undergoing palliative RT suggests doses ≥12 Gy (equivalent dose in 2Gy fractions, EQD2) provide excellent bone pain relief. However, recent advances in care and novel biologic agents have significantly improved overall survival and quality of life for patients with MM. We hypothesized that lower-dose RT (LDRT, EQD2 <12 Gy) offers an effective alternative to higher-dose RT (HDRT, EQD2 ≥12 Gy) for palliation of painful, uncomplicated MM bone lesions. METHODS: We retrospectively identified patients with MM treated with RT for uncomplicated, painful bone lesions and stratified by EQD2 ≥/< 12 Gy. Clinical pain response (CPR) rates, acute and late toxicity, pain response duration, and retreatment rates between LDRT and HDRT groups were analyzed. RESULTS: Thirty-five patients with 70 treated lesions were included: 24 patients (48 lesions) treated with HDRT and 11 patients (22 lesions) with LDRT. Median follow-up was 14 and 16.89 months for HDRT and LDRT, respectively. The median dose of HDRT treatment was 20 Gy versus 4 Gy in the LDRT group. The CPR rate was 98% for HDRT and 95% for LDRT. There was no significant difference in any-grade acute toxicity between the HDRT and LDRT cohorts (24.5% vs 9.1%, Χ2 P = .20). Pain recurred in 10% of lesions (12% HDRT vs 9.5% LDRT). Median duration of pain response did not significantly differ between cohorts (P = .91). Five lesions were retreated, 2 (9.5%) in the LDRT cohort, and 3 (6.3%) in the HDRT cohort. CONCLUSION: In this study, LDRT effectively palliated painful, uncomplicated MM bony lesions with acceptable CPR and duration of palliation. These data support prospective comparisons of LDRT versus HDRT for palliation of painful, uncomplicated MM bony lesions.
Authors
Price, JG; Niedzwiecki, D; Oyekunle, T; Arcasoy, MO; Champ, CE; Kelsey, CR; Salama, JK; Moravan, MJ
MLA Citation
Price, Jeremy G., et al. “Effective Pain Control With Very Low Dose Palliative Radiation Therapy for Patients With Multiple Myeloma With Uncomplicated Osseous Lesions.Adv Radiat Oncol, vol. 6, no. 4, July 2021, p. 100729. Pubmed, doi:10.1016/j.adro.2021.100729.
URI
https://scholars.duke.edu/individual/pub1488947
PMID
34258474
Source
pubmed
Published In
Advances in Radiation Oncology
Volume
6
Published Date
Start Page
100729
DOI
10.1016/j.adro.2021.100729