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Genome-Wide Linkage Analysis Reveals Evidence of Multiple Regions That Influence Variation in Plasma Lipid and Apolipoprotein Levels Associated With Risk of Coronary Heart Disease
Klos, Kathy L.E., Kardia, Sharon L.R., Ferrell, Robert E., Boerwinkle, Eric , Turner, Stephen T. , Sing, Charles F.

Arteriosclerosis, Thrombosis, and Vascular Biology | June 17, 2011 | Volume: 21 | Issue: 6 | Pages: 971-978

10.1161/01.atv.21.6.971 | PMID 11397706 Get It

Abstract —Results of genome-wide linkage analyses to identify chromosomal regions that influence interindividual variation in plasma lipid and apolipoprotein levels in the Rochester, Minn, population are reported. Analyses were conducted for total cholesterol (total-C), triglycerides (TGs), high density lipoprotein cholesterol (HDL-C), apolipoprotein A-I, apolipoprotein A-II, apolipoprotein B, apolipoprotein C-II, apolipoprotein C-III, apolipoprotein E, the total-C/HDL-C ratio, and the TG/HDL-C ratio. Genotypes were measured for 373 genome-wide marker loci on 1484 individuals distributed among 232 multigeneration pedigrees sampled without regard to health status. LOD scores and estimates of additive genetic variance associated with map locations were obtained by using the variance-component method of linkage analysis. No evidence of linkage with genes influencing variation in age served as a negative control. Plasma apolipoprotein E levels and the apolipoprotein E gene served as a positive control (LOD score 4.20). Evidence (LOD score >2.00) was provided that was suggestive of a gene or genes on chromosomes 4 and 5 influencing variation in the apolipoprotein A-II level, on chromosome 12 influencing variation in the apolipoprotein A-I level, and on chromosome 17 influencing variation of total-C/HDL-C. These analyses provide new information about genomic regions in humans that influence interindividual variation in plasma lipid and apolipoprotein levels and serve as a basis for further fine-mapping studies to identify new genes involved in lipid metabolism.
A Bivariate Genome-Wide Approach to Metabolic Syndrome
Kraja, Aldi T., Vaidya, Dhananjay , Pankow, James S. , Goodarzi, Mark O., Assimes, Themistocles L. , Sovio, Ulla , Mathias, Rasika A. , Sun, Yan V. , Franceschini, Nora , Absher, Devin , Zhang, Qunyuan, Feitosa, Mary F. , Glazer, Nicole L. , Hartikainen, Anna-Liisa, Knowles, Joshua W. , Iribarren, Carlos , Kral, Brian G. , Yanek, Lisa R. , O’Reilly, Paul F. , McCarthy, Mark I. , Jaquish, Cashell E. , Couper, David , Chakravarti, Aravinda , Becker, Lewis C. , Province, Michael A. , Boerwinkle, Eric , Quertermous, Thomas , Palotie, L, Järvelin, Marjo‐Riitta , Becker, Diane M. , Kardia, Sharon L. R., Rotter, Jerome I. , Chen, Yii-Der Ida , Borecki, Ingrid B. , Goodarzi, Mark O. , Kullo, Iftikhar J. , Guo, Li , Haritunians, Talin , Hartikainen, Anna‐Liisa, North, Kari E. , Psaty, Bruce M. , McCarthy, Mark I , Assimes, Themistocles L , Rotter, Jerome I , Mathias, Rasika A , Pankow, James S , Couper, David , Province, Mike

Diabetes | March 9, 2011 | Volume: 60 | Issue: 4 | Pages: 1329-1339

10.2337/db10-1011 | PMID 21386085 Get It

OBJECTIVE The metabolic syndrome (MetS) is defined as concomitant disorders of lipid and glucose metabolism, central obesity, and high blood pressure, with an increased risk of type 2 diabetes and cardiovascular disease. This study tests whether common genetic variants with pleiotropic effects account for some of the correlated architecture among five metabolic phenotypes that define MetS. RESEARCH DESIGN AND METHODS Seven studies of the STAMPEED consortium, comprising 22,161 participants of European ancestry, underwent genome-wide association analyses of metabolic traits using a panel of ∼2.5 million imputed single nucleotide polymorphisms (SNPs). Phenotypes were defined by the National Cholesterol Education Program (NCEP) criteria for MetS in pairwise combinations. Individuals exceeding the NCEP thresholds for both traits of a pair were considered affected. RESULTS Twenty-nine common variants were associated with MetS or a pair of traits. Variants in the genes LPL, CETP, APOA5 (and its cluster), GCKR (and its cluster), LIPC, TRIB1, LOC100128354/MTNR1B, ABCB11, and LOC100129150 were further tested for their association with individual qualitative and quantitative traits. None of the 16 top SNPs (one per gene) associated simultaneously with more than two individual traits. Of them 11 variants showed nominal associations with MetS per se. The effects of 16 top SNPs on the quantitative traits were relatively small, together explaining from ∼9% of the variance in triglycerides, 5.8% of high-density lipoprotein cholesterol, 3.6% of fasting glucose, and 1.4% of systolic blood pressure. CONCLUSIONS Qualitative and quantitative pleiotropic tests on pairs of traits indicate that a small portion of the covariation in these traits can be explained by the reported common genetic variants.
Abstract 2854: Genetic variation in stromal genes decorin and lumican and susceptibility to serous ovarian cancer
Amankwah, Ernest K. , Wang, Qinggang , Beesley, Jonathan, Johnatty, Sharon E. , Phelan, Catherine M., Cunningham, Julie M. , Vachon, Celine M. , Iversen, Edwin S., Schildkraut, Joellen M. , Goode, Ellen L. , Sellers, Thomas A. , Kelemen, Linda E. , Tsai, Ya-Yu , Fridley, Brooke L. , Webb, Penelope M. , Chenevix‐Trench, Georgia , Vachon, Celine M. , Vierkant, Robert A. , Berchuck, Andrew

Cancer Research | February 25, 2011 | Volume: 70 | Issue: 8_Supplement | Pages: 2854-2854

10.1158/1538-7445.am10-2854 Get It

Abstract Introduction: Alterations in components of the stromal tissue that underlie the epithelium can initiate, promote or inhibit epithelial tumorigenesis. Decorin (DCN) and lumican (LUM) are stromal genes with reduced expression in serous ovarian cancer. We hypothesized that single nucleotide polymorphisms (SNPs) in these genes may influence susceptibility to serous ovarian cancer. Methods: To test this hypothesis, we compared genotype frequencies of 11 tagSNPs in DCN and LUM between 397 Caucasian cases with primary serous ovarian cancer and 920 Caucasian controls in two studies conducted at Mayo Clinic and Duke University (discovery set). Associations were evaluated further in a third Caucasian population of 436 cases and 1,098 controls in Australia (replication set). TagSNPs were selected from unrelated Caucasian samples within HapMap based on the following criteria: (i) minor allele frequency ≥ 0.05, (ii) pairwise linkage disequilibrium (LD) of r2 ≥ 0.8, and (iii) location within, and 5kb upstream and downstream of, each gene region. Genotyping was performed using the Illumina GoldenGate™ assay and associations between SNPs and serous cancer were evaluated using unconditional logistic regression to estimate per allele odds ratios (OR) and 95% confidence intervals (95%CI). Untyped genotypes for DCN rs13312816 in the discovery set, and for DCN rs3138165 and LUM rs17018765 in the replication set, were imputed using the MACH software. Results: In the discovery set, we observed inverse associations between DCN rs3138165 (OR=0.7; 95%CI=0.5-1.0), DCN rs13312816 (OR=0.7; 95%CI=0.5-1.0), DCN rs516115 (OR=0.8; 95%CI=0.7-1.0) and LUM rs17018765 (OR=0.7; 95%CI=0.5-1.0) and risk of serous ovarian cancers (all Ptrend=0.06). Associations were confirmed in the replication set for DCN rs3138165 (OR=0.6; 95%CI=0.4-0.9; Ptrend=0.009), DCN rs13312816 (OR=0.7; 95%CI=0.5-0.9; Ptrend=0.01) and LUM rs17018765 (OR=0.6; 95%CI=0.4-0.9; Ptrend=0.008), but not for DCN rs516115 (Ptrend=0.20). To increase statistical power, data from the discovery and replication sets were combined (833 cases and 2,013 controls) following confirmation of no statistical heterogeneity in the ORs between study sites. In the combined sample, associations were strengthened for DCN rs3138165 (OR=0.7; 95%CI=0.5-0.9; Ptrend=0.002), DCN rs13312816 (OR=0.7; 95%CI=0.5-0.9; Ptrend=0.002), DCN rs516115 (OR=0.9; 95%CI=0.8-1.0; Ptrend=0.03) and LUM rs17018765 (OR=0.6; 95%CI=0.5-0.8; Ptrend=0.001). All four SNPs were in the same LD block on chromosome 12, suggesting that serous ovarian cancer susceptibility may be driven by a single, correlated variant in the region. Conclusion: The findings of this study suggest that genetic variation in DCN and LUM may influence susceptibility to serous ovarian cancer and contribute to the mounting evidence that supports the role of the stroma in epithelial ovarian cancer. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 2854.
Abstract 4727: TERT SNPs and ovarian cancer risk
Johnatty, Sharon E. , Chen, Xiaoqing, Gava, Natalie, Group, Australian Ovarian Cancer Study, Rider, David N., Goode, Ellen L. , Chenevix‐Trench, Georgia , Beesley, Jonathan , Chen, Xiaoqing, DeFazio, Anna , Webb, Penelope M. , Group, Australian Ovarian Cancer Study, Berchuck, Andrew

Cancer Research | February 25, 2011 | Volume: 70 | Issue: 8_Supplement | Pages: 4727-4727

10.1158/1538-7445.am10-4727 Get It

Abstract There is increasing evidence that neighboring stromal cells are not uninvolved bystanders in the pathway to cancer. We hypothesized that SNPs in genes expressed as a consequence of interactions between ovarian cancer cells and the host micro-environment could contribute to ovarian cancer susceptibility. We therefore used a two-stage approach to comprehensively evaluate common single nucleotide polymorphisms (SNPs) in the Ovarian Cancer Association Consortium (OCAC) for 173 genes involved in stromal-epithelial interactions. Cases with epithelial ovarian cancer (n=675) and controls (n=1,162) were genotyped at 1536 SNPs using an Illumina GoldenGate™ BeadArray array. Logistic regression was used to estimate odds ratios (ORs) and adjust for potential confounders. Based on Positive Predictive Value estimates, three SNPs - PODXL rs1013368, ITGA6 rs13027811 and MMP3 rs522616 - were selected for replication using TaqMan genotyping in 3,734 serous invasive cases and 10,067 controls from 16 OCAC case-control studies. An additional 18 SNPs with Pper-allele <0.05 in the test set, and which fitted into an iPLEX design, were selected for replication by a subset of five OCAC studies (n=1771 serous invasive cases; n=4022 controls). The associations observed in the test set for the PODXL, ITGA6 and MMP3 SNPs were completely attenuated in the replication set (adj. Pper-allele ≥0.5). However, TERT rs7726159 showed evidence of a log additive association with ovarian cancer risk in the replication study (Pper-allele =0.03). Combined analysis of the test and replication sets for this SNP showed a significant association with risk of serous ovarian cancer among non-Hispanic whites [adj. ORper-allele 1.14 (1.04 - 1.24) p = 0.003]. A stronger association was observed for serous invasive cases when data for all ethnicities were included [adj. ORper-allele 1.18 (1.09 - 1.28) p = 2.46 × 10−5]. Stratification by histological subtype and malignant potential showed that TERT rs7726159 was also associated with risk of serous borderline tumors, but not with any other subtypes. Although TERT variants have not been previously reported to be associated with ovarian cancer, multiple genome-wide association studies have reported associations with this locus and risk of glioma, basal cell carcinoma, and several cancer types that are known to originate in the epithelium, including lung, bladder, prostate and cervical cancer. Further analysis of this locus is necessary to definitively identify the causal SNP(s). Our study adds to the growing evidence that, as well as 8q24, the TERT locus at 5p15.33, is a general cancer susceptibility locus. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 4727.
Safety and Immunogenicity of Influenza A H5 Subunit Vaccines: Effect of Vaccine Schedule and Antigenic Variant
Belshe, Robert B. , Frey, Sharon E. , Graham, Irene, Mulligan, Mark J. , Edupuganti, Srilatha , Jackson, Lisa A. , Wald, Anna , Jacobson, Robert M. , Keyserling, Harry, Hill, Heather , Wolff, Mark, Poland, Gregory A. , Spearman, Paul W. , Jacobson, Robert M

The Journal of Infectious Diseases | February 1, 2011 | Volume: 203 | Issue: 5 | Pages: 666-673

10.1093/infdis/jiq093 | PMID 21282194 Get It

Corin Is Present in the Normal Human Heart, Kidney, and Blood, with Pro–B-Type Natriuretic Peptide Processing in the Circulation
Ichiki, Tomoko , Huntley, Brenda K., Heublein, Denise M., Sandberg, Sharon M., Martín, Fernando L., Jougasaki, Michihisa , Burnett, John C. , McKie, Paul M.

Clinical Chemistry | November 13, 2010 | Volume: 57 | Issue: 1 | Pages: 40-47

10.1373/clinchem.2010.153908 | PMID 21075870 Get It

BACKGROUNDB-type natriuretic peptide (BNP), which is activated in heart failure (HF), is processed to an active form by corin. The corin gene is expressed in the human heart and kidney, but corin protein expression in the heart, kidney, and circulation, along with whether proBNP is processed by circulating corin, remains unknown.METHODSWe examined corin protein expression by immunostaining and Western blot in human heart and kidney, and we assessed the circulating corin concentration by ELISA. We examined histidine-tagged (His-tag) proBNP1–108 processing in serum and plasma by immunoprecipitation and Western blot and sequenced the processed form.RESULTSNormal human heart and kidney displayed the presence of corin, especially in cells around the vasculature. Both corin and proBNP1–108 were present in the plasma of healthy human subjects, with circulating corin significantly higher in men than women (P < 0.0001) and a positive correlation of corin to age (P = 0.0497, r = 0.27). In fresh normal plasma and serum, His-tag proBNP1–108 was processed to a lower molecular weight form confirmed to be BNP. Processed BNP was higher in men than women (P = 0.041) and was positively correlated to plasma corin concentrations (P = 0.041, r = 0.65).CONCLUSIONSOur results support the concept that proBNP1–108 may be processed outside of the heart in the circulation where the proprotein convertase is present. Moreover, sex may impact this process, since corin concentrations are higher in men. These findings may have important physiologic and pathophysiologic implications for the proBNP/corin system in the human.
International Society for Sexual Medicine’s Guidelines for the Diagnosis and Treatment of Premature Ejaculation
Althof, Stanley E., Abdo, Carmita Helena Najjar , Dean, John, Hackett, Geoff , McCabe, Marita P. , McMahon, Chris G., Rosen, Raymond C., Sadovsky, Richard, Waldinger, Marcel D., Becher, Edgardo, Broderick, Gregory A. , Buvat, Jacques, El-Meliegy, Amr, Hellstrom, Wayne J.G. , Incrocci, Luca , Jannini, Emmanuele A. , Park, Kwangsung , Parish, Sharon J. , Porst, Hartmut, Segraves, Robert, Sharlip, Ira D., Simonelli, Chiara , Tan, Hui Meng, Buvat, Jacques, Goldstein, Irwin , Giuliano, François , Rowland, David L.

The Journal of Sexual Medicine | September 13, 2010 | Volume: 7 | Issue: 9 | Pages: 2947-2969

10.1111/j.1743-6109.2010.01975.x | PMID 21050394 Get It

ABSTRACTIntroductionOver the past 20 years our knowledge of premature ejaculation (PE) has significantly advanced. Specifically, we have witnessed substantial progress in understanding the physiology of ejaculation, clarifying the real prevalence of PE in population-based studies, reconceptualizing the definition and diagnostic criterion of the disorder, assessing the psychosocial impact on patients and partners, designing validated diagnostic and outcome measures, proposing new pharmacologic strategies and examining the efficacy, safety and satisfaction of these new and established therapies. Given the abundance of high level research it seemed like an opportune time for the International Society for Sexual Medicine (ISSM) to promulgate an evidenced-based, comprehensive and practical set of clinical guidelines for the diagnosis and treatment of PE.AimDevelop clearly worded, practical, evidenced-based recommendations for the diagnosis and treatment of PE for family practice clinicians as well as sexual medicine experts.MethodReview of the literature.ResultsThis article contains the report of the ISSM PE Guidelines Committee. It affirms the ISSM definition of PE and suggests that the prevalence is considerably lower than previously thought. Evidence-based data regarding biological and psychological etiology of PE are presented, as is population-based statistics on normal ejaculatory latency. Brief assessment procedures are delineated and validated diagnostic and treatment questionnaires are reviewed. Finally, the best practices treatment recommendations are presented to guide clinicians, both familiar and unfamiliar with PE, in facilitating treatment of their patients.ConclusionDevelopment of guidelines is an evolutionary process that continually reviews data and incorporates the best new research. We expect that ongoing research will lead to a more complete understanding of the pathophysiology as well as new efficacious and safe treatments for this sexual dysfunction. Therefore, it is strongly recommended that these guidelines be re-evaluated and updated by the ISSM every 4 years.
Strategic Plan for Lung Vascular Research: An NHLBI-ORDR Workshop Report
Erzurum, Serpil C. , Rounds, Sharon , Stevens, Troy , Aldred, Micheala A. , Aliotta, Jason M., Asosingh, Kewal, Balaban, Robert S. , Bauer, Natalie , Bhattacharya, Jahar , Bogaard, Harm Jan , Choudhary, Gaurav , Dorn, Gerald W., Dweik, Raed A. , Fagan, Karen, Fallon, Michael B. , Finkel, Toren , Geraci, Mark W. , Gladwin, Mark T. , Humbert, Marc , Kaminski, Naftali , McMurtry, Ivan F., Newman, John H. , Nicolls, Mark R. , Rabinovitch, Marlene , Shizuru, Judy, Oka, Masahiko, Polgàr, Péter , Rodman, David M., Schumacker, Paul T. , Stenmark, Kurt R. , Tuder, Rubin M. , Voelkel, Norbert F., Sullivan, Eugene J., Weinshilboum, Richard M. , Yöder, Mervin C. , Zhao, Yingming , Gail, Dorothy B., Moore, Timothy M. , Archer, Stephen L. , Hassoun, Paul M. , Kawut, Steven M. , Loscalzo, Joseph , McDonald, Donald M. , Weinshilboum, Richard M. , Kaminski, Naftali

American Journal of Respiratory and Critical Care Medicine | September 10, 2010 | Volume: 182 | Issue: 12 | Pages: 1554-1562

10.1164/rccm.201006-0869ws | PMID 20833821 Get It

Abstract The Division of Lung Diseases of the National Heart, Lung, and Blood Institute, with the Office of Rare Diseases Research, held a workshop to identify priority areas and strategic goals to enhance and accelerate research that will result in improved understanding of the lung vasculature, translational research needs, and ultimately the care of patients with pulmonary vascular diseases. Multidisciplinary experts with diverse experience in laboratory, translational, and clinical studies identified seven priority areas and discussed limitations in our current knowledge, technologies, and approaches. The focus for future research efforts include the following: (1) better characterizing vascular genotype–phenotype relationships and incorporating systems biology approaches when appropriate; (2) advancing our understanding of pulmonary vascular metabolic regulatory signaling in health and disease; (3) expanding our knowledge of the biologic relationships between the lung circulation and circulating elements, systemic vascular function, and right heart function and disease; (4) improving translational research for identifying disease-modifying therapies for the pulmonary hypertensive diseases; (5) establishing an appropriate and effective platform for advancing translational findings into clinical studies testing; and (6) developing the specific technologies and tools that will be enabling for these goals, such as question-guided imaging techniques and lung vascular investigator training programs. Recommendations from this workshop will be used within the Lung Vascular Biology and Disease Extramural Research Program for planning and strategic implementation purposes.
Moesin1 and Ve-cadherin are required in endothelial cells during in vivo tubulogenesis
Kaiser, Mark S., Nasevicius, Aidas, Clark, Karl J. , Wadman, Shannon A., Roberg-Perez, Sharon E., Ekker, Stephen C. , Hackett, Perry B., McGrail, Maura , Essner, Jeffrey J. , Wang, Ying , Larson, Jon D. , Ekker, Stephen C , Clark, Karl J , McGrail, Maura , Essner, Jeffrey

Development | August 24, 2010 | Volume: 137 | Issue: 18 | Pages: 3119-3128

10.1242/dev.048785 | PMID 20736288 Get It

Endothelial tubulogenesis is a crucial step in the formation of functional blood vessels during angiogenesis and vasculogenesis. Here, we use in vivo imaging of living zebrafish embryos expressing fluorescent fusion proteins of β-Actin, α-Catenin, and the ERM family member Moesin1 (Moesin a), to define a novel cord hollowing process that occurs during the initial stages of tubulogenesis in intersegmental vessels (ISVs) in the embryo. We show that the primary lumen elongates along cell junctions between at least two endothelial cells during embryonic angiogenesis. Moesin1-EGFP is enriched around structures that resemble intracellular vacuoles, which fuse with the luminal membrane during expansion of the primary lumen. Analysis of silent heart mutant embryos shows that initial lumen formation in the ISVs is not dependent on blood flow; however, stabilization of a newly formed lumen is dependent upon blood flow. Zebrafish moesin1 knockdown and cell transplantation experiments demonstrate that Moesin1 is required in the endothelial cells of the ISVs for in vivo lumen formation. Our analyses suggest that Moesin1 contributes to the maintenance of apical/basal cell polarity of the ISVs as defined by adherens junctions. Knockdown of the adherens junction protein Ve-cadherin disrupts formation of the apical membrane and lumen in a cell-autonomous manner. We suggest that Ve-cadherin and Moesin1 function to establish and maintain apical/basal polarity during multicellular lumen formation in the ISVs.
Inhaled Granulocyte-Macrophage Colony Stimulating Factor for First Pulmonary Recurrence of Osteosarcoma: Effects on Disease-Free Survival and Immunomodulation. A Report From the Children's Oncology Group
Arndt, Carola A.S., Koshkina, Nadya, Inwards, Carrie Y., Hawkins, Douglas S. , Krailo, Mark , Villaluna, Doojduen, Anderson, Peter M. , Goorin, Allen M., Blakely, Martin L. , Bernstein, Mark L. , Bell, Sharon A., Ray, Kaylee, Grendahl, Darryl C., Marina, Neyssa , Kleinerman, Eugenie S. , Hawkins, Douglas S , Marina, Neyssa

Clinical Cancer Research | June 25, 2010 | Volume: 16 | Issue: 15 | Pages: 4024-4030

10.1158/1078-0432.ccr-10-0662 | PMID 20576718 Get It

Abstract Purpose: Osteosarcoma most commonly recurs in the lung. Based on preliminary data on the antitumor effects of granulocyte-macrophage colony stimulating factor (GM-CSF) in animal models, and promising phase I trials, we embarked on a feasibility study of inhaled GM-CSF in patients with first isolated pulmonary recurrence of osteosarcoma. Experimental Design: Forty-three eligible patients received inhaled GM-CSF at doses from 250 to 1,750 μg twice daily on alternate weeks. Following two cycles, patients underwent thoracotomy to resect tumor and analyze pulmonary nodules for expression of Fas/Fas ligand (Fas/FasL), and the presence of dendritic cells by immunostaining for CD1a, clusterin, and S100. Following surgery, patients received 12 additional cycles of therapy on alternating weeks or until progression. Event-free survival and survival, and feasibility of therapy delivery were evaluated. Results: Dose escalation to 1,750 μg twice daily was feasible with no dose-limiting toxicity. Mean scores for Fas/FasL in nodules from patients with bilateral recurrence who underwent unilateral thoracotomy pretreatment (using a scoring system of 0-3) were 1.3 and 0.88, respectively, compared with 0.78 and 0.62 in nodules resected following two cycles of therapy. Only 11 of 30 nodules postinhalation were positive for CD1a, 4 of 30 for S100, and 6 of 30 for clusterin. Event-free and overall survival at 3 years were 7.8% and 35.4%, respectively. Conclusions: Inhalation of GM-CSF at doses from 250 to 1,750 μg twice daily on alternate weeks was feasible with low toxicity. However, no detectable immunostimulatory effect in pulmonary metastases or improved outcome postrelapse was seen. Clin Cancer Res; 16(15); 4024–30. ©2010 AACR.