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Pediatrician, Oncology Specialist (cancer), Pediatric Specialist, Radiologist
36 years of experience
Video profile
Accepting new patients

Education ?

Medical School Score Rankings
University of Nebraska (1974)
  • Currently 4 of 4 apples
Top 25%

Awards & Distinctions ?

Awards  
Castle Connolly's Top Doctors™ (2012 - 2013)
Castle Connolly Top Doctors: Texas™ (2009)
Associations
American Board of Pediatrics
American Board of Radiology
American Society for Therapeutic Radiology and Oncology

Affiliations ?

Dr. Munoz is affiliated with 7 hospitals.

Hospital Affilations

Score

Rankings

  • Texas Health Presbyterian Hospital Allen
    1105 Central Expy N, Allen, TX 75013
    • Currently 3 of 4 crosses
    Top 50%
  • Medical Center Of Lewisville
    500 W Main St, Lewisville, TX 75057
    • Currently 3 of 4 crosses
    Top 50%
  • North Central Medical Center
    Medical Oncology
    4500 Medical Center Dr, McKinney, TX 75069
    • Currently 2 of 4 crosses
  • Medical City Dallas Hospital
    Medical Oncology
    7777 Forest Ln, Dallas, TX 75230
    • Currently 2 of 4 crosses
  • UT Southwestern St Paul Hospital
  • Children's Medical Center of Dallas
  • St Paul Med Ctr
  • Publications & Research

    Dr. Munoz has contributed to 6 publications.
    Title Safety and Cost-effectiveness of Outpatient Total Body Irradiation in Pediatric Patients Undergoing Stem Cell Transplantation.
    Date August 1998
    Journal Journal of Pediatric Hematology/oncology : Official Journal of the American Society of Pediatric Hematology/oncology
    Excerpt

    PURPOSE: To determine the feasibility, safety, and cost of delivering total body irradiation (TBI) in an outpatient setting. PATIENTS AND METHODS: The records of 33 pediatric patients with hematopoietic malignancies undergoing TBI in preparation for bone marrow transplantation (BMT) at the Children's Medical Center of Dallas between February 1992 and June 1997 were retrospectively reviewed. Seventeen children received TBI in an outpatient setting, including 7 patients younger than 8 years of age. All patients had a good performance status (Karnofsky index > 90%) and lived or were housed within a 50-mile radius of the hospital. Patients received 1200 cGy or 1350 cGy in 8 or 9 fractions twice daily over 4 to 5 days and were admitted for high-dose chemotherapy after the last TBI fraction. Mean age was 9 years (range 13 months to 16 years). Close contact was maintained with the BMT staff during outpatient TBI. RESULTS: Eleven patients (65%) received oral ondansetron for nausea and vomiting, 6 received promethazine and ondansetron, and 3 required dexamethasone. Only 2 of the 17 children (12%) required admission during TBI for persistent vomiting and poor oral intake. Two other children (12%) required outpatient administration of intravenous fluids. The other 13 patients (76%) tolerated the outpatient TBI regimen well. Taking into account hospitalization and ambulance transport charges, outpatient TBI represented a savings of approximately $3250 per patient compared with inpatient TBI. CONCLUSIONS: Fractionated TBI delivered in an outpatient setting to selected children of all ages is a safe and cost-effective practice.

    Title Autologous Bone Marrow Transplantation in the Treatment of Selected Human Malignancies: The Johns Hopkins Oncology Center Program.
    Date April 1983
    Journal Experimental Hematology
    Excerpt

    Preliminary clinical trials using cryopreserved autologous bone marrow reinfusion have now been carried out at our institution in 5 children and 2 adults with advanced stages of neuroblastoma, rhabdomyosarcoma, non-Hodgkin's lymphoma and small cell carcinoma of the lung. Normal numbers of in vitro colony forming cells (CFU-C) were obtained from these patients despite prior courses of combination chemotherapy. The dose of marrow cells cryopreserved ranged from 1-6 X 10(8) cells/kg and recovery of CFU-C after thawing averaged 50%. Partial or complete hematologic reconstitution was achieved in all patients. The time for recovery ranged from 10-43 days for leukocytes (greater than 1000 cells/mm3) and 23-45 days for platelets (greater than 50,000/mm3). Two patients have died of interstitial pneumonitis due to cytomegalovirus. Three patients have died of recurrent tumor at 40, 48 and 156 days post-transplant. Two patients have had significant therapeutic benefit. One of these had a stable partial response permitting the use of further post-transplant therapy and is alive and well 16+ months post-transplant. The other patient had a complete response and remains tumor-free 25+ months following therapy. We conclude: 1) Autologous bone marrow reinfusion permits hematologic reconstitution following marrow-ablative therapy. 2) A quantity of marrow sufficient for this purpose remains viable following cryopreservation even when obtained from patients previously exposed to chemotherapy. 3) Autologous bone marrow reinfusion now allows the exploration of more intensive cytoreductive therapy in selected malignancies.

    Title Administration of Iduronate Sulfatase by Plasma Exchange to Patients with the Hunter Syndrome: a Clinical Study.
    Date February 1983
    Journal American Journal of Medical Genetics
    Excerpt

    The Hunter syndrome (MPS II) is the only mucopolysaccharidosis in which there is appreciable activity of the deficient enzyme in normal plasma. We performed enzyme-replacement treatment by plasma exchange in five Hunter syndrome children. Carefully monitoring the cardiovascular status, we administered monthly single plasma volume exchanges for a 3 to 8 mo period. The results indicate a substantial gain of enzyme activity, persisting with a t50% = 19 +/- 5 hr. The maximal level and persistence of increased enzyme activity did not change after repeated exchanges, suggesting that immune responses were not elicited. Despite this, no demonstrable clinical benefit was apparent when the study group was compared with an age-matched control group of Hunter syndrome patients.

    Title Requirements for the Successful Application of Autologous Bone Marrow Transplantation in the Treatment of Selected Malignancies.
    Date October 1981
    Journal Haematology and Blood Transfusion
    Title Cryopreserved Autologous Bone Marrow Transplantation in the Treatment of Selected Pediatric Malignancies: a Preliminary Report.
    Date August 1979
    Journal Transplantation Proceedings
    Excerpt

    We have shown that it is possible to collect and viably store sufficient numbers of stem cells to hematologically reconstitute patients following marrow-lethal doses of chemoradiotherapy. While no current procedure can be guaranteed to eliminate clonogenic tumor from the bone marrow, the fact that hematopoietic stem cells capable of reconstituting the host can be obtained after intensive chemotherapy makes it possible to clear microscopic foci of tumor from the marrow prior to storage. Such patients are now included in our protocol. The initial treatment results indicate that, in selected circumstances, tumor in otherwise refractory patients can be eliminated or partially controlled by a single intensive pulse of chemoradiotherapy with severe but acceptable extramedullary toxicity. The fact that patients can be rescued from otherwise lethal myelotoxicity by the reinfusion of cryopreserved autologous bone marrow permits wider exploration of new, more intensive cytoreductive regimens in a variety of cancers.

    Title Survival Outcomes in Resected Extrahepatic Cholangiocarcinoma: Effect of Adjuvant Radiotherapy in a Surveillance, Epidemiology, and End Results Analysis.
    Date
    Journal International Journal of Radiation Oncology, Biology, Physics
    Excerpt

    PURPOSE: The benefit of adjuvant radiotherapy (RT) after surgical resection for extrahepatic cholangiocarcinoma has not been clearly established. We analyzed survival outcomes of patients with resected extrahepatic cholangiocarcinoma and examined the effect of adjuvant RT. METHODS AND MATERIALS: Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) program between 1973 and 2003. The primary endpoint was the overall survival time. Cox regression analysis was used to perform univariate and multivariate analyses of the following clinical variables: age, year of diagnosis, histologic grade, localized (Stage T1-T2) vs. regional (Stage T3 or greater and/or node positive) stage, gender, race, and the use of adjuvant RT after surgical resection. RESULTS: The records for 2,332 patients were obtained. Patients with previous malignancy, distant disease, incomplete or conflicting records, atypical histologic features, and those treated with preoperative/intraoperative RT were excluded. Of the remaining 1,491 patients eligible for analysis, 473 (32%) had undergone adjuvant RT. After a median follow-up of 27 months (among surviving patients), the median overall survival time for the entire cohort was 20 months. Patients with localized and regional disease had a median survival time of 33 and 18 months, respectively (p < .001). The addition of adjuvant RT was not associated with an improvement in overall or cause-specific survival for patients with local or regional disease. CONCLUSION: Patients with localized disease had significantly better overall survival than those with regional disease. Adjuvant RT was not associated with an improvement in long-term overall survival in patients with resected extrahepatic bile duct cancer. Key data, including margin status and the use of combined chemotherapy, was not available through the SEER database.

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