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Advances in Radiation Oncology

Lauren E Henke, Jeffrey R Olsen, Jessika A Contreras, Austen Curcuru, Todd A DeWees, Olga L Green, Jeff Michalski, Sasa Mutic, Michael C Roach, Jeffrey D Bradley, Parag J Parikh, Rojano Kashani, Clifford G Robinson
Purpose: Stereotactic body radiation therapy (SBRT) is an effective treatment for oligometastatic or unresectable primary malignancies, although target proximity to organs at risk (OARs) within the ultracentral thorax (UCT) limits safe delivery of an ablative dose. Stereotactic magnetic resonance (MR)-guided online adaptive radiation therapy (SMART) may improve the therapeutic ratio using reoptimization to account for daily variation in target and OAR anatomy. This study assessed the feasibility of UCT SMART and characterized dosimetric and clinical outcomes in patients treated for UCT lesions on a prospective phase 1 trial...
January 2019: Advances in Radiation Oncology
Thilo Schuler, John Kipritidis, Thomas Eade, George Hruby, Andrew Kneebone, Mario Perez, Kylie Grimberg, Kylie Richardson, Sally Evill, Brooke Evans, Blanca Gallego
Purpose: To prepare for big data analyses on radiation therapy data, we developed Stature, a tool-supported approach for standardization of structure names in existing radiation therapy plans. We applied the widely endorsed nomenclature standard TG-263 as the mapping target and quantified the structure name inconsistency in 2 real-world data sets. Methods and Materials: The clinically relevant structures in the radiation therapy plans were identified by reference to randomized controlled trials...
January 2019: Advances in Radiation Oncology
Haijun Song, Joseph K Salama, William Robert Lee, Qiuwen Wu
Purpose: We hypothesized that the interfraction motions of the superior and inferior prostate beds differ and therefore require different margins. In this study, we used daily cone beam computed tomography (CBCT) to evaluate the motion of postprostatectomy surgical clips (separated to superior and inferior portions) within the planning target volume (PTV) to derive data-driven PTV margins. Methods and Materials: Our study cohort included consecutive patients with identifiable surgical clips undergoing prostate bed irradiation with daily CBCT image guidance...
January 2019: Advances in Radiation Oncology
Christopher L Guy, Elisabeth Weiss, Shaomin Che, Nuzhat Jan, Sherry Zhao, Mihaela Rosu-Bubulac
Purpose: To evaluate accuracy for 2 deformable image registration methods (in-house B-spline and MIM freeform) using image pairs exhibiting changes in patient orientation and lung volume and to assess the appropriateness of registration accuracy tolerances proposed by the American Association of Physicists in Medicine Task Group 132 under such challenging conditions via assessment by expert observers. Methods and Materials: Four-dimensional computed tomography scans for 12 patients with lung cancer were acquired with patients in prone and supine positions...
January 2019: Advances in Radiation Oncology
Joshua Kim, Brett Miller, M Salim Siddiqui, Benjamin Movsas, Carri Glide-Hurst
Purpose: To evaluate the implementation of a magnetic resonance (MR)-only workflow (ie, implementing MR simulation as the primary planning modality) using failure mode and effects analysis (FMEA) in comparison with a conventional multimodality (MR simulation in conjunction with computed tomography simulation) workflow for pelvis external beam planning. Methods and Materials: To perform the FMEA, a multidisciplinary 9-member team was assembled and developed process maps, identified potential failure modes (FMs), and assigned numerical values to the severity (S), frequency of occurrence (O), and detectability (D) of those FMs...
January 2019: Advances in Radiation Oncology
Pablo Yepes, Antony Adair, Steven J Frank, David R Grosshans, Zhongxing Liao, Amy Liu, Dragan Mirkovic, Falk Poenisch, Uwe Titt, Qianxia Wang, Radhe Mohan
Purpose: To evaluate how using models of proton therapy that incorporate variable relative biological effectiveness (RBE) versus the current practice of using a fixed RBE of 1.1 affects dosimetric indices on treatment plans for large cohorts of patients treated with intensity modulated proton therapy (IMPT). Methods and Materials: Treatment plans for 4 groups of patients who received IMPT for brain, head-and-neck, thoracic, or prostate cancer were selected. Dose distributions were recalculated in 4 ways: 1 with a fast-dose Monte Carlo calculator with fixed RBE and 3 with RBE calculated to 3 different models-McNamara, Wedenberg, and repair-misrepair-fixation...
January 2019: Advances in Radiation Oncology
Anna Ralston, Johnson Yuen
Purpose: Hospitals traditionally focus on reactive risk management such as incident reporting, but prospective risk management systems such as failure modes and effects analysis are also important tools to reduce risks and improve the safety culture. In 2015, the St George Cancer Care Centre (STGCCC) developed a multidisciplinary risk-based system for the safe and effective implementation of new technologies and techniques, using risk and benefit balance impact templates (RABBIT) developed in-house...
January 2019: Advances in Radiation Oncology
Stephen A Rosenberg, Lauren E Henke, Narek Shaverdian, Kathryn Mittauer, Andrzej P Wojcieszynski, Craig R Hullett, Mitchell Kamrava, James Lamb, Minsong Cao, Olga L Green, Rojano Kashani, Bhudatt Paliwal, John Bayouth, Paul M Harari, Jeffrey R Olsen, Percy Lee, Parag J Parikh, Michael Bassetti
Purpose: Daily magnetic resonance (MR)-guided radiation has the potential to improve stereotactic body radiation therapy (SBRT) for tumors of the liver. Magnetic resonance imaging (MRI) introduces unique variables that are untested clinically: electron return effect, MRI geometric distortion, MRI to radiation therapy isocenter uncertainty, multileaf collimator position error, and uncertainties with voxel size and tracking. All could lead to increased toxicity and/or local recurrences with SBRT...
January 2019: Advances in Radiation Oncology
Anna Lee, Aleksandra Kuczmarska-Haas, Meghan W Macomber, Kaitlin Woo, Chris Freese, Zachary S Morris
Purpose: Complementary and alternative medicines (CAMs) are widely used by patients with cancer. However, little is known about the extent to which these potential remedies are used internationally to treat the most common toxicities of radiation therapy. We report on the results of an international survey that assessed the use of CAMs. Methods and Materials: Surveys were distributed to 1174 practicing radiation oncologists. Questions evaluated the perceptions of CAMs and specific practice patterns for the use of CAM remedies in the treatment of common radiation-induced toxicities (eg, skin, fatigue, nausea, diarrhea, and mucositis/xerostomia)...
January 2019: Advances in Radiation Oncology
Haley K Perlow, Vincent Cassidy, Benjamin Farnia, Deukwoo Kwon, Adam W Awerbuch, Stephanie Ciraula, Scott Alford, Jacob Griggs, Joseph A Quintana, Raphael Yechieli, Stuart E Samuels
Purpose: Previous studies have indicated a relationship between functional status and comorbidity on overall survival when treating patients with bone and brain metastases. However, the degree to which these findings have been integrated into modern-day practice remains unknown. This study examines the impact of performance measures, including Karnofsky Performance Status (KPS) and comorbidity, on palliative radiation therapy treatment tolerance and fractionation schedule. The relationship between a shorter fractionation schedule (SFx) and pending mortality is examined...
January 2019: Advances in Radiation Oncology
Tetsuo Saito, Ryo Toya, Etsushi Tomitaka, Tomohiko Matsuyama, Satoshi Ninomura, Takahiro Watakabe, Natsuo Oya
Purpose: Even when index pain (pain caused by the irradiated tumor) is palliated after radiation therapy (RT), patients may not derive the full benefits of RT in the presence of another, more intense pain. In this case-control study with prospectively collected data, we sought to identify predictors of the predominance of nonindex pain after palliative RT. Methods and Materials: Brief Pain Inventory data were collected from patients who received RT for painful tumors...
January 2019: Advances in Radiation Oncology
Lucas Resende Salgado, Shutao Wang, Ava Adler, Sanders Chang, Meng Ru, Erin Moshier, Kavita Dharmarajan, Hearn Jay Cho, Richard Bakst
Purpose: The management of multiple myeloma has evolved in the modern era, partially owing to the increasing number of biologic therapeutics. Nonetheless, radiation remains an important treatment in the management of painful lytic lesions from multiple myeloma. The goal of this study is to evaluate the side effect profile of radiation therapy (RT) while patients are concurrently treated with biologic agents. Methods and Materials: We conducted a retrospective study based on data collected from patients receiving RT at our institute from 2007 to 2017...
January 2019: Advances in Radiation Oncology
Abhishek A Solanki, Michael L Mysz, Rakesh Patel, Murat Surucu, Hyejoo Kang, Ahpa Plypoo, Amishi Bajaj, Mark Korpics, Brendan Martin, Courtney Hentz, Gopal Gupta, Ahmer Farooq, Kristin G Baldea, Julius Pawlowski, John Roeske, Robert Flanigan, William Small, Matthew M Harkenrider
Purpose: We transitioned from a low-dose-rate (LDR) to a high-dose-rate (HDR) prostate brachytherapy program. The objective of this study was to describe our experience developing a prostate HDR program, compare the LDR and HDR dosimetry, and identify the impact of several targeted interventions in the HDR workflow to improve efficiency. Methods and Materials: We performed a retrospective cohort study of patients treated with LDR or HDR prostate brachytherapy. We used iodine-125 seeds (145 Gy as monotherapy, and 110 Gy as a boost) and preoperative planning for LDR...
January 2019: Advances in Radiation Oncology
Ryan Douglas Kraus, Andrew Barsky, Lingyun Ji, Patricia Mae Garcia Santos, Nathan Cheng, Susan Groshen, Neha Vapiwala, Leslie K Ballas
Purpose: Perineural invasion (PNI) is a histologic feature that is present in as many as 84% of patients with prostate cancer. The prognostic significance of PNI is controversial, with recent studies yielding contradictory results. This study aims to assess whether PNI, on the surgical pathology of patients with pT2N0M0 disease and with negative surgical margins, is an independent prognostic indicator of the risk of biochemical recurrence. Methods and materials: We identified 1549 patients who received a diagnosis of margin-negative pT2N0M0 prostate cancer at 3 separate institutions between January 1, 2008 and December 31, 2014...
January 2019: Advances in Radiation Oncology
Andrew M McDonald, Michael C Dobelbower, Eddy S Yang, Grant M Clark, Rojymon Jacob, Robert Y Kim, Rex A Cardan, Richard Popple, Jeffrey W Nix, Soroush Rais-Bahrami, John B Fiveash
Purpose: This study aimed to report the early toxicity results of a prospective clinical trial of prostate stereotactic body radiation therapy (SBRT) to the entire prostate with a simultaneous integrated boost (SIB) to magnetic resonance imaging (MRI)-defined focal lesions. Methods and materials: Eligible patients included men with biopsy-proven prostate stage T1c to T2c adenocarcinoma, a Gleason score ≤7, and prostate-specific antigen values of ≤20 ng/mL, who had at least 1 focal lesion visible on MRI and a total prostate volume no greater than 120 cm3 ...
January 2019: Advances in Radiation Oncology
Brian T Welch, Ann T Packard, Thomas D Atwell, Geoffrey B Johnson, Val J Lowe, Robert Jeffrey Karnes, Lance A Mynderse, Tina M Gunderson, Sean S Park, Bradley J Stish, Jaden D Evans, Eugene D Kwon, Brian J Davis, Mark A Nathan
Purpose: Management of recurrent prostate cancer necessitates timely diagnosis and accurate localization of the sites of recurrent disease. The purpose of this study was to assess predictors of histologic outcomes after 11C-choline positron emission tomography/computed tomography (CholPET) to increase the positive predictive value and specificity of CholPET in identifying imaging predictors of malignant and benign nodal disease to better inform clinical decision making regarding local therapy planning...
January 2019: Advances in Radiation Oncology
Howard J Lee, Meghan W Macomber, Matthew B Spraker, Stephen R Bowen, Daniel Hippe, Angela Fung, Kenneth J Russell, George E Laramore, Ramesh Rengan, Jay Liao, Smith Apisarnthanarax, Jing Zeng
Purpose: We characterized both physician- and patient-reported rates of gastrointestinal (GI) toxicity in patients treated with proton beam therapy (PBT) at our institution for prostate adenocarcinoma and identified factors associated with toxicity. Methods and materials: We treated 192 patients with PBT between July 2013 and July 2016. Included patients had ≥1 year of follow-up. Potential preexisting clinical and treatment-related risk factors for GI toxicity were recorded...
January 2019: Advances in Radiation Oncology
David M Routman, Aurelie Garant, Scott C Lester, Courtney N Day, William S Harmsen, Cristobal T Sanheuza, Harry H Yoon, Michelle A Neben-Wittich, James A Martenson, Michael G Haddock, Christopher L Hallemeier, Kenneth W Merrell
Purpose: Grade 4 lymphopenia (G4L) during radiation therapy (RT) is associated with higher rates of distant metastasis and decreased overall survival in a number of malignancies, including esophageal cancer (EC). Through a reduction in integral radiation dose, proton RT (PRT) may reduce G4L relative to photon RT (XRT). The purpose of this study was to compare G4L in patients with EC undergoing PRT versus XRT. Methods and materials: Patients receiving curative-intent RT and concurrent chemotherapy for EC were identified...
January 2019: Advances in Radiation Oncology
Philip Sutera, Ronny Kalash, David A Clump, David D'Ambrosio, Alina Mihai, Steven A Burton, Dwight E Heron
Purpose: Patients with oligometastatic colorectal cancer have demonstrated excellent clinical outcomes with surgical resection of hepatic and pulmonary metastases. Stereotactic ablative radiation therapy (SABR) has emerged as an alternative local therapy for nonsurgical candidates. Herein, we report the oncologic and patient-reported quality-of-life (PR-QoL) outcomes for a subset of patients with oligometastatic colorectal cancer who were treated in a prospective phase 2 multicenter clinical trial...
January 2019: Advances in Radiation Oncology
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