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Rinaa S. Punglia, MD, MPH


Radiation Oncology

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Physician

  • Senior Physician
  • Associate Professor of Radiation Oncology, Harvard Medical School

Clinical Interests

  • Breast cancer
  • Health services and outcomes research

Diseases Treated

Contact Information

  • Appointments617-632-4739
  • Office Phone Number617-632-3591
  • Fax617-632-4247

Board Certification:

  • Radiation Oncology

Residency:

  • Harvard Joint Center for Radiation Therapy, Radiation Oncology

Medical School:

  • Harvard Medical School

Research

Health services research, Radiation oncology, Breast oncology

My research focuses on the comparative effectiveness of breast cancer treatments and is conducted at the Center for Outcomes and Policy Research at DFCI. Comparative effectiveness research (CER) includes the generation and synthesis of evidence to compare alternative methods of treatment.  CER is especially useful in bridging the gap between what we know from randomized trials and what we need to know to optimize treatment.  My work in CER includes decision analyses to define outcomes after omission of radiation therapy in post-menopausal women with early-stage breast cancer, to compare endocrine therapy sequencing strategies for hormone receptor- positive breast cancer, and to separate outcomes on tamoxifen by CYP2D6 genotype.  We have also used Medicare claims data to reveal that delay initiating radiation after breast-conserving surgery leads to increased local recurrence.

My current focus of study has been the management of ductal carcinoma in situ (DCIS), one of the highest-priority topics for CER per the Institute of Medicine.  Despite a dramatic increase in the number of DCIS diagnoses, population-based analyses reveal vast discrepancies in its treatment.  We created a decision-analytic model to study the comparative effectiveness of lumpectomy alone versus lumpectomy and radiation for DCIS.  We found that radiation is associated with small improvements in survival outcomes, especially for younger women.  However, radiation paradoxically decreased the likelihood of lifetime breast preservation, since mastectomy is the standard surgical option for a recurrence or new diagnosis in a previously irradiated breast.  We recently completed multi-institutional contract from AHRQ to study the effectiveness of alternate treatment strategies for DCIS in a “real-world” setting, define treatment of recurrence, and translate information through construction of a web-based decision aid to improve and individualize decision-making. I have also recently received funding from PCORI to further characterize the impact of radiation therapy on DCIS outcomes.

Stout NK, Cronin AM, Uno H, Ozanne EM, Hassett MJ, Frank ES, Greenberg CC, Punglia RS. Estrogen-receptor status and risk of contralateral breast cancer following DCIS. Breast Cancer Res Treat. 2018 Jun 26.
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Grossmith S, Nguyen A, Hu J, Plichta JK, Nakhlis F, Cutone L, Dominici L, Golshan M, Duggan M, Carter K, Rhei E, Barbie T, Calvillo K, Nimbkar S, Bellon J, Wong J, Punglia R, Barry W, King TA. Multidisciplinary Management of the Axilla in Patients with cT1-T2 N0 Breast Cancer Undergoing Primary Mastectomy: Results from a Prospective Single-Institution Series. Ann Surg Oncol. 2018 Jun 04.
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Sher DJ, Tishler RB, Pham NL, Punglia RS. Cost-Effectiveness Analysis of Intensity Modulated Radiation Therapy Versus Proton Therapy for Oropharyngeal Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys. 2018 Jul 15; 101(4):875-882.
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Hassett MJ, Jiang W, Hughes ME, Edge S, Javid SH, Niland JC, Theriault R, Wong YN, Schrag D, Punglia RS. Treating Second Breast Events After Breast-Conserving Surgery for Ductal Carcinoma in Situ. J Natl Compr Canc Netw. 2018 Apr; 16(4):387-394.
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van Ravesteyn NT, van den Broek JJ, Li X, Weedon-Fekjær H, Schechter CB, Alagoz O, Huang X, Weaver DL, Burnside ES, Punglia RS, de Koning HJ, Lee SJ. Modeling Ductal Carcinoma In Situ (DCIS): An Overview of CISNET Model Approaches. Med Decis Making. 2018 Apr; 38(1_suppl):126S-139S.
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Punglia RS, Jiang W, Lipsitz SR, Hughes ME, Schnitt SJ, Hassett MJ, Nekhlyudov L, Achacoso N, Edge S, Javid SH, Niland JC, Theriault RL, Wong YN, Habel LA. Clinical risk score to predict likelihood of recurrence after ductal carcinoma in situ treated with breast-conserving surgery. Breast Cancer Res Treat. 2018 Feb; 167(3):751-759.
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Martin AM, Cagney DN, Catalano PJ, Warren LE, Bellon JR, Punglia RS, Claus EB, Lee EQ, Wen PY, Haas-Kogan DA, Alexander BM, Lin NU, Aizer AA. Brain Metastases in Newly Diagnosed Breast Cancer: A Population-Based Study. JAMA Oncol. 2017 Aug 01; 3(8):1069-1077.
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Royce TJ, Punglia RS, Chen AB, Patel SA, Thornton KA, Raut CP, Baldini EH. Cost-Effectiveness of Surveillance for Distant Recurrence in Extremity Soft Tissue Sarcoma. Ann Surg Oncol. 2017 Oct; 24(11):3264-3270.
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Wong SM, Stout NK, Punglia RS, Prakash I, Sagara Y, Golshan M. Breast cancer prevention strategies in lobular carcinoma in situ: A decision analysis. Cancer. 2017 Jul 15; 123(14):2609-2617.
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Mihalcik SA, Rawal B, Braunstein LZ, Capuco A, Wong JS, Punglia RS, Bellon JR, Harris JR. The Impact of Reexcision and Residual Disease on Local Recurrence Following Breast-Conserving Therapy. Ann Surg Oncol. 2017 Jul; 24(7):1868-1873.
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Marshall D, Tringale K, Connor M, Punglia R, Recht A, Hattangadi-Gluth J. Nature of Medical Malpractice Claims Against Radiation Oncologists. Int J Radiat Oncol Biol Phys. 2017 05 01; 98(1):21-30.
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Punglia RS, Cronin AM, Uno H, Stout NK, Ozanne EM, Greenberg CC, Frank ES, Schrag D. Association of Regional Intensity of Ductal Carcinoma In Situ Treatment With Likelihood of Breast Preservation. JAMA Oncol. 2017 Jan 01; 3(1):101-104.
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Braunstein LZ, Taghian AG, Niemierko A, Salama L, Capuco A, Bellon JR, Wong JS, Punglia RS, MacDonald SM, Harris JR. Breast-cancer subtype, age, and lymph node status as predictors of local recurrence following breast-conserving therapy. Breast Cancer Res Treat. 2017 01; 161(1):173-179.
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Raldow AC, Sher D, Chen AB, Recht A, Punglia RS. Cost Effectiveness of the Oncotype DX DCIS Score for Guiding Treatment of Patients With Ductal Carcinoma In Situ. J Clin Oncol. 2016 Nov 20; 34(33):3963-3968.
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Halasz LM, Uno H, Punglia RS. Reply to comparative effectiveness of stereotactic radiosurgery versus whole-brain radiation therapy for patients with brain metastases from breast or non-small cell lung cancer. Cancer. 2016 10 15; 122(20):3244-3245.
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Halasz LM, Uno H, Hughes M, D'Amico T, Dexter EU, Edge SB, Hayman JA, Niland JC, Otterson GA, Pisters KM, Theriault R, Weeks JC, Punglia RS. Comparative effectiveness of stereotactic radiosurgery versus whole-brain radiation therapy for patients with brain metastases from breast or non-small cell lung cancer. Cancer. 2016 Jul 01; 122(13):2091-100.
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Decker MR, Trentham-Dietz A, Loconte NK, Neuman HB, Smith MA, Punglia RS, Greenberg CC, Wilke LG. The Role of Intraoperative Pathologic Assessment in the Surgical Management of Ductal Carcinoma In Situ. Ann Surg Oncol. 2016 Sep; 23(9):2788-94.
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Hassett MJ, Jiang W, Habel LA, Nekhlyudov L, Achacoso N, Acton L, Schnitt SJ, Schrag D, Punglia RS. Characteristics of second breast events among women treated with breast-conserving surgery for DCIS in the community. Breast Cancer Res Treat. 2016 Feb; 155(3):541-9.
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Freedman RA, Fedewa SA, Punglia RS, Lin CC, Ward EM, Jemal A, Sineshaw HM. Factors associated with radiation therapy incompletion for patients with early-stage breast cancer. Breast Cancer Res Treat. 2016 Jan; 155(1):187-99.
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Ozanne EM, Schneider KH, Soeteman D, Stout N, Schrag D, Fordis M, Punglia RS. onlineDeCISion.org: a web-based decision aid for DCIS treatment. Breast Cancer Res Treat. 2015 Nov; 154(1):181-90.
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Tanguturi SK, Lyatskaya Y, Chen Y, Catalano PJ, Chen MH, Yeo WP, Marques A, Truong L, Yeh M, Orlina L, Wong JS, Punglia RS, Bellon JR. Prospective assessment of deep inspiration breath-hold using 3-dimensional surface tracking for irradiation of left-sided breast cancer. Pract Radiat Oncol. 2015 Nov-Dec; 5(6):358-65.
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Tseng YD, Uno H, Hughes ME, Niland JC, Wong YN, Theriault R, Blitzblau RC, Moy B, Breslin T, Edge SB, Hassett MJ, Punglia RS. Biological Subtype Predicts Risk of Locoregional Recurrence After Mastectomy and Impact of Postmastectomy Radiation in a Large National Database. Int J Radiat Oncol Biol Phys. 2015 Nov 01; 93(3):622-30.
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Rose BS, Jiang W, Punglia RS. Effect of lymph node metastasis size on breast cancer-specific and overall survival in women with node-positive breast cancer. Breast Cancer Res Treat. 2015 Jul; 152(1):209-216.
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Marshall DC, Punglia RS, Fox D, Recht A, Hattangadi-Gluth JA. Medical Malpractice Claims in Radiation Oncology: A Population-Based Study 1985-2012. Int J Radiat Oncol Biol Phys. 2015 Oct 01; 93(2):241-50.
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Braunstein LZ, Niemierko A, Shenouda MN, Truong L, Sadek BT, Abi Raad R, Wong JS, Punglia RS, Taghian AG, Bellon JR. Outcome following local-regional recurrence in women with early-stage breast cancer: impact of biologic subtype. Breast J. 2015 Mar-Apr; 21(2):161-7.
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Punglia RS, Hughes KS, Muss HB. Management of older women with early-stage breast cancer. Am Soc Clin Oncol Educ Book. 2015; 48-55.
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Warren LE, Punglia RS, Wong JS, Bellon JR. Management of the regional lymph nodes following breast-conservation therapy for early-stage breast cancer: an evolving paradigm. Int J Radiat Oncol Biol Phys. 2014 Nov 15; 90(4):772-7.
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Mak KS, Chen YH, Catalano PJ, Punglia RS, Wong JS, Truong L, Bellon JR. Dosimetric Inhomogeneity Predicts for Long-Term Breast Pain After Breast-Conserving Therapy. Int J Radiat Oncol Biol Phys. 2015 Dec 01; 93(5):1087-95.
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Sher DJ, Parikh RB, Mays-Jackson S, Punglia RS. Cost-effectiveness analysis of SBRT versus IMRT for low-risk prostate cancer. Am J Clin Oncol. 2014 Jun; 37(3):215-21.
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Greenberg CC, Habel LA, Hughes ME, Nekhlyudov L, Achacoso N, Acton L, Schrag D, Jiang W, Edge S, Weeks JC, Punglia RS. Characterization and treatment of local recurrence following breast conservation for ductal carcinoma in situ. Ann Surg Oncol. 2014 Nov; 21(12):3766-73.
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Sher DJ, Punglia RS. Decision analysis and cost-effectiveness analysis for comparative effectiveness research--a primer. Semin Radiat Oncol. 2014 Jan; 24(1):14-24.
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Punglia RS, Schnitt SJ, Weeks JC. Treatment of ductal carcinoma in situ after excision: would a prophylactic paradigm be more appropriate? J Natl Cancer Inst. 2013 Oct 16; 105(20):1527-33.
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Ruddy KJ, Desantis SD, Gelman RS, Wu AH, Punglia RS, Mayer EL, Tolaney SM, Winer EP, Partridge AH, Burstein HJ. Personalized medicine in breast cancer: tamoxifen, endoxifen, and CYP2D6 in clinical practice. Breast Cancer Res Treat. 2013 Oct; 141(3):421-7.
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Russo AL, Arvold ND, Niemierko A, Wong N, Wong JS, Bellon JR, Punglia RS, Golshan M, Troyan SL, Brock JE, Harris JR. Margin status and the risk of local recurrence in patients with early-stage breast cancer treated with breast-conserving therapy. Breast Cancer Res Treat. 2013 Jul; 140(2):353-61.
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Soeteman DI, Stout NK, Ozanne EM, Greenberg C, Hassett MJ, Schrag D, Punglia RS. Modeling the effectiveness of initial management strategies for ductal carcinoma in situ. J Natl Cancer Inst. 2013 Jun 05; 105(11):774-81.
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Krishnan MS, Recht A, Bellon JR, Punglia RS. Trade-offs associated with axillary lymph node dissection with breast irradiation versus breast irradiation alone in patients with a positive sentinel node in relation to the risk of non-sentinel node involvement: implications of ACOSOG Z0011. Breast Cancer Res Treat. 2013 Feb; 138(1):205-13.
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Vichare A, Eads N, Punglia R, Potters L. American Society for Radiation Oncology's Performance Assessment for the Advancement of Radiation Oncology Treatment: A practical approach for informing practice improvement. Pract Radiat Oncol. 2013 Apr-Jun; 3(2):e37-43.
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Halasz LM, Weeks JC, Neville BA, Taback N, Punglia RS. Use of stereotactic radiosurgery for brain metastases from non-small cell lung cancer in the United States. Int J Radiat Oncol Biol Phys. 2013 Feb 01; 85(2):e109-16.
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Recht A, Bellon JR, Punglia RS. Trade-offs associated with axillary lymph node dissection: Implications of the eligibility versus enrollment in ACOSOG Z0011. J Clin Oncol. 2012 Sep 20; 30(27_suppl):151.
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Childs SK, Chen YH, Duggan MM, Golshan M, Pochebit S, Punglia RS, Wong JS, Bellon JR. Impact of margin status on local recurrence after mastectomy for ductal carcinoma in situ. Int J Radiat Oncol Biol Phys. 2013 Mar 15; 85(4):948-52.
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Arvold ND, Punglia RS, Hughes ME, Jiang W, Edge SB, Javid SH, Laronga C, Niland JC, Theriault RL, Weeks JC, Wong YN, Lee SJ, Hassett MJ. Pathologic characteristics of second breast cancers after breast conservation for ductal carcinoma in situ. Cancer. 2012 Dec 15; 118(24):6022-30.
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Halasz LM, Sreedhara M, Chen YH, Bellon JR, Punglia RS, Wong JS, Harris JR, Brock JE. Improved outcomes of breast-conserving therapy for patients with ductal carcinoma in situ. Int J Radiat Oncol Biol Phys. 2012 Mar 15; 82(4):e581-6.
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Hattangadi JA, Taback N, Neville BA, Harris JR, Punglia RS. Accelerated partial breast irradiation using brachytherapy for breast cancer: patterns in utilization and guideline concordance. J Natl Cancer Inst. 2012 Jan 04; 104(1):29-41.
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Hattangadi JA, Taback N, Neville BA, Harris JR, Punglia RS. Accelerated partial breast irradiation using brachytherapy (APBIb) for breast cancer (bca): Predictors of use and guideline concordance. J Clin Oncol. 2011 Sep 20; 29(27_suppl):84.
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Westover KD, Westover MB, Winer EP, Richardson AL, Iglehart JD, Punglia RS. Should a sentinel node biopsy be performed in patients with high-risk breast cancer? Int J Breast Cancer. 2011; 2011:973245.
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Punglia RS, Burstein HJ, Weeks JC. Radiation therapy for ductal carcinoma in situ: a decision analysis. Cancer. 2012 Feb 01; 118(3):603-11.
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Hoffman KE, Neville BA, Mamon HJ, Kachnic LA, Katz MS, Earle CC, Punglia RS. Adjuvant therapy for elderly patients with resected gastric adenocarcinoma: population-based practices and treatment effectiveness. Cancer. 2012 Jan 01; 118(1):248-57.
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Wo JY, Chen K, Neville BA, Lin NU, Punglia RS. Effect of very small tumor size on cancer-specific mortality in node-positive breast cancer. J Clin Oncol. 2011 Jul 01; 29(19):2619-27.
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Arvold ND, Punglia RS, Hughes ME, Jiang W, Edge SB, Javid SH, Laronga C, Niland JC, Theriault RL, Weeks JC, Wong Y, Lee SJ, Hassett MJ. Pathologic characteristics of second breast cancers (SBC) among women previously treated for ductal carcinoma in situ (DCIS) with breast conservation. J Clin Oncol. 2011 May 20; 29(15_suppl):1042.
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Hattangadi JA, Taback N, Neville BA, Harris JR, Punglia RS. Accelerated partial-breast irradiation using brachytherapy (APBIb) for breast cancer (BCA): Predictors of use and guideline concordance. J Clin Oncol. 2011 May 20; 29(15_suppl):6080.
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Smith BD, Pan IW, Shih YC, Smith GL, Harris JR, Punglia R, Pierce LJ, Jagsi R, Hayman JA, Giordano SH, Buchholz TA. Adoption of intensity-modulated radiation therapy for breast cancer in the United States. J Natl Cancer Inst. 2011 May 18; 103(10):798-809.
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Sher DJ, Wee JO, Punglia RS. Cost-effectiveness analysis of stereotactic body radiotherapy and radiofrequency ablation for medically inoperable, early-stage non-small cell lung cancer. Int J Radiat Oncol Biol Phys. 2011 Dec 01; 81(5):e767-74.
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Punglia RS, Hassett MJ. Using lifetime risk estimates to recommend magnetic resonance imaging screening for breast cancer survivors. J Clin Oncol. 2010 Sep 20; 28(27):4108-10.
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Punglia RS, Saito AM, Neville BA, Earle CC, Weeks JC. Impact of interval from breast conserving surgery to radiotherapy on local recurrence in older women with breast cancer: retrospective cohort analysis. BMJ. 2010 Mar 02; 340:c845.
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Sher DJ, Tishler RB, Annino D, Punglia RS. Cost-effectiveness of CT and PET-CT for determining the need for adjuvant neck dissection in locally advanced head and neck cancer. Ann Oncol. 2010 May; 21(5):1072-7.
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Chen AB, Punglia RS, Kuntz KM, Mauch PM, Ng AK. Cost effectiveness and screening interval of lipid screening in Hodgkin's lymphoma survivors. J Clin Oncol. 2009 Nov 10; 27(32):5383-9.
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Sher DJ, Wittenberg E, Suh WW, Taghian AG, Punglia RS. Partial-breast irradiation versus whole-breast irradiation for early-stage breast cancer: a cost-effectiveness analysis. Int J Radiat Oncol Biol Phys. 2009 Jun 01; 74(2):440-6.
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Hoffman KE, Chen MH, Punglia RS, Beard CJ, D'Amico AV. Influence of year of diagnosis, patient age, and sociodemographic status on recommending adjuvant radiation treatment for stage I testicular seminoma. J Clin Oncol. 2008 Aug 20; 26(24):3937-42.
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Punglia RS, Hughes ME, Edge SB, Theriault RL, Bookman MA, Wilson JL, Ottesen RA, Niland JC, Weeks JC. Factors associated with guideline-concordant use of radiotherapy after mastectomy in the national comprehensive cancer network. Int J Radiat Oncol Biol Phys. 2008 Dec 01; 72(5):1434-40.
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Sher DJ, Punglia RS. Cost-effectiveness of partial breast irradiation versus whole breast irradiation for early-stage breast cancer. J Clin Oncol. 2008 May 20; 26(15_suppl):6530.
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Punglia RS, Weeks JC, Neville BA, Earle CC. Predictors and effect of delay in initiation of radiation therapy (RT) after breast-conserving surgery (BCS) in elderly women. J Clin Oncol. 2008 May 20; 26(15_suppl):6515.
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Punglia RS, Burstein HJ, Winer EP, Weeks JC. Pharmacogenomic variation of CYP2D6 and the choice of optimal adjuvant endocrine therapy for postmenopausal breast cancer: a modeling analysis. J Natl Cancer Inst. 2008 May 07; 100(9):642-8.
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Punglia RS, Cullen J, McLeod DG, Chen Y, D'Amico AV. Prostate-specific antigen velocity and the detection of gleason score 7 to 10 prostate cancer. Cancer. 2007 Nov 01; 110(9):1973-8.
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Sher DJ, Wittenberg E, Taghian AG, Bellon JR, Punglia RS. Partial breast irradiation versus whole breast radiotherapy for early-stage breast cancer: a decision analysis. Int J Radiat Oncol Biol Phys. 2008 Feb 01; 70(2):469-76.
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Punglia RS, Morrow M, Winer EP, Harris JR. Local therapy and survival in breast cancer. N Engl J Med. 2007 Jun 07; 356(23):2399-405.
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Landis DM, Luo W, Song J, Bellon JR, Punglia RS, Wong JS, Killoran JH, Gelman R, Harris JR. Variability among breast radiation oncologists in delineation of the postsurgical lumpectomy cavity. Int J Radiat Oncol Biol Phys. 2007 Apr 01; 67(5):1299-308.
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Guadagnolo BA, Punglia RS, Kuntz KM, Mauch PM, Ng AK. Cost-effectiveness analysis of computerized tomography in the routine follow-up of patients after primary treatment for Hodgkin's disease. J Clin Oncol. 2006 Sep 01; 24(25):4116-22.
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Punglia RS, Weeks JC, Neville BA, Earle CC. Radiation therapy after mastectomy between 1991 and 1999 in elderly women: response to clinical trial information. J Clin Oncol. 2006 Jul 20; 24(21):3474-82.
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Punglia RS, Weeks JC, Neville BA, Earle CC. Effect of distance to radiation treatment facility on use of radiation therapy after mastectomy in elderly women. Int J Radiat Oncol Biol Phys. 2006 Sep 01; 66(1):56-63.
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Punglia RS, Weeks JC, Neville BA, Earle CC. Effect of distance to radiation treatment facility on use of radiation therapy after mastectomy in elderly women. J Clin Oncol. 2006 Jun 20; 24(18_suppl):6030.
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Punglia RS, Kuntz KM, Winer EP, Weeks JC, Burstein HJ. The impact of tumor progesterone receptor status on optimal adjuvant endocrine therapy for postmenopausal patients with early-stage breast cancer: a decision analysis. Cancer. 2006 Jun 15; 106(12):2576-82.
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Punglia RS, D'Amico AV, Catalona WJ, Roehl KA, Kuntz KM. Impact of age, benign prostatic hyperplasia, and cancer on prostate-specific antigen level. Cancer. 2006 Apr 01; 106(7):1507-13.
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Punglia RS, Kuntz KM, Catalona WJ, D'Amico A. Operating characteristics of prostate-specific antigen and verification bias. JAMA. 2005 Dec 07; 294(21):2698; author reply 2698-9.
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Punglia RS, Kuntz KM, Winer EP, Weeks JC, Burstein HJ. Optimizing adjuvant endocrine therapy in postmenopausal women with early-stage breast cancer: a decision analysis. J Clin Oncol. 2005 Aug 01; 23(22):5178-87.
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Burstein HJ, Winer EP, Kuntz KM, Weeks JC, Punglia RS. Optimizing endocrine therapy in postmenopausal women with early stage breast cancer: A decision analysis for biological subsets of tumors. J Clin Oncol. 2005 Jun; 23(16_suppl):529.
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Punglia RS, D'Amico AV, Catalona WJ, Roehl KA, Kuntz KM. Determination of mean population values of the prostate-specific antigen test after correcting for verification bias. J Clin Oncol. 2005 Jun; 23(16_suppl):6031.
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Burstein HJ, Punglia RS. . Choosing the best adjuvant endocrine treatment strategy for patients with postmenopausal breast cancer: A decision analysis. In: Perry MC, ed. American Society of Clinical Oncology Educational Book. 2005; 40-44.
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Punglia RS, Hughes ME, Edge SB, Theriault RL, Bookman MA, Burak WE, Ottesen R, Niland JC, Weeks JC. Factors associated with appropriate use of radiation therapy after mastectomy in women with Stage I-II breast cancer treated within the National Comprehensive Cancer Network (NCCN). J Clin Oncol. 2004 Jul 15; 22(14_suppl):6032.
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Punglia RS, D'Amico AV, Catalona WJ, Roehl KA, Kuntz KM. Effect of verification bias on screening for prostate cancer by measurement of prostate-specific antigen. N Engl J Med. 2003 Jul 24; 349(4):335-42.
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Punglia RS, Kuntz KM, Lee JH, Recht A. Radiation therapy plus tamoxifen versus tamoxifen alone after breast-conserving surgery in postmenopausal women with stage I breast cancer: a decision analysis. J Clin Oncol. 2003 Jun 15; 21(12):2260-7.
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Punglia RS, Harris JR. Integrating surgery and radiotherapy to reduce toxicity while maintaining local control for breast cancer: a fine balance. Ann Surg Oncol. 2002 Jul; 9(6):526-8.
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Punglia RS, Lu M, Hsu J, Kuroki M, Tolentino MJ, Keough K, Levy AP, Levy NS, Goldberg MA, D'Amato RJ, Adamis AP. Regulation of vascular endothelial growth factor expression by insulin-like growth factor I. Diabetes. 1997 Oct; 46(10):1619-26.
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