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Full-Text Articles in Radiation Medicine

Impact Of Mr-Linac Technology On Prostate Cancer Treatment Outcomes, Anhdiep P. Tran Aug 2026

Impact Of Mr-Linac Technology On Prostate Cancer Treatment Outcomes, Anhdiep P. Tran

Radiologic Sciences

Purpose To evaluate the impact of magnetic resonance-guided linear accelerator (MR-Linac) technology on treatment precision, clinical outcomes, and operational challenges in prostate cancer radiotherapy.

Method A systematic literature review was conducted using PubMed, Scopus, and Google Scholar to identify peer-reviewed studies published between 2018 and 2026. Eligible studies evaluated MR-Linac technology for prostate cancer and reported outcomes related to treatment precision, toxicity, workflow, and clinical effectiveness.

Results Three primary themes emerged: (a) improved treatment precision through superior soft tissue visualization, real-time target tracking, and adaptive radiotherapy; (b) improved clinical outcomes characterized by reduced radiation exposure to organs at risk, decreased …


Aggressive Natural Killer Cell Leukemia: A Rare And Rapidly Progressive Hematologic Malignancy—Case Report And Literature Review, Jennifer Priessnitz, Ali Hariri, Yuliya Levkiavska, Kyle E. Bonner, Stephan I. Fisher, Joshua M. Sill Jan 2026

Aggressive Natural Killer Cell Leukemia: A Rare And Rapidly Progressive Hematologic Malignancy—Case Report And Literature Review, Jennifer Priessnitz, Ali Hariri, Yuliya Levkiavska, Kyle E. Bonner, Stephan I. Fisher, Joshua M. Sill

Department of Medicine Faculty Publications

Aggressive natural killer cell leukemia (ANKL) is a rare, fulminant hematologic malignancy characterized by neoplastic proliferation of mature NK cells. It is frequently associated with Epstein-Barr virus (EBV) infection, although EBV-negative cases have also been reported. While typically observed in young to middle-aged adults of East Asian descent, increasing recognition has led to identification of ANKL across diverse age groups and ethnicities. The disease is defined by a rapid clinical course and poor prognosis, underscoring the importance of early diagnosis and effective treatment. We present a case of a 71-year-old Caucasian male who developed fever, altered mental status, hepatosplenomegaly, pancytopenia, …


Improving Prostate Cancer Patients’ Experience And Understanding With A Pre-Ct Simulation Checklist In Genitourinary Radiation Oncology, Christopher Le Jan 2026

Improving Prostate Cancer Patients’ Experience And Understanding With A Pre-Ct Simulation Checklist In Genitourinary Radiation Oncology, Christopher Le

Doctor of Nursing Practice Final Project Abstract

Improving Prostate Cancer Patients’ Experience and Understanding With a Pre-CT Simulation Checklist in Genitourinary Radiation Oncology

Purpose

The purpose of this quality improvement (QI) project was to implement a Pre-CT Simulation checklist for Prostate cancer patients in the outpatient Radiation Oncology Genitourinary clinic to improve patients’ experience and comprehension on their Simulation Day.

Background

The CT simulation is a critical step in treatment planning. Lack of clear, concise, consistent instruction and education preparation prior to simulation day can delay planning and treatment. Currently, there is no standardized checklist to ensure patients are educated and prepared for their CT simulation day. …


Urgent Radiotherapy For Superior Vena Cava Syndrome In Metastatic Non-Small Cell Lung Cancer: A Case Report, Arpeet Patel, Nilanjan Haldar, Ida Micaily, Michael Greenberg, Evan Nardone, John A. Lippert, Christopher Fundakowski, Adam C. Mueller Dec 2025

Urgent Radiotherapy For Superior Vena Cava Syndrome In Metastatic Non-Small Cell Lung Cancer: A Case Report, Arpeet Patel, Nilanjan Haldar, Ida Micaily, Michael Greenberg, Evan Nardone, John A. Lippert, Christopher Fundakowski, Adam C. Mueller

Department of Radiation Oncology Faculty Papers

Superior vena cava (SVC) syndrome is a life-threatening complication of thoracic malignancies, requiring rapid management in the setting of airway compromise or hemodynamic instability. We present a 59-year-old male with metastatic non-small cell lung cancer (NSCLC) who developed superior vena cava syndrome (SVCS) due to compression from a large mediastinal mass identified as metastatic lung adenocarcinoma. His declining respiratory status progressed rapidly, necessitating intensive care. After extensive multidisciplinary collaboration, the patient was determined fit for inpatient radiation therapy and 10 fractions of 300 cGy external beam radiotherapy to the obstructing lesion was planned. However, the patient was unable to lay …


Evaluating Dosimetric Outcomes In A Prostate Rapid Plan Model: A Comparison Of Prostate Treatment Plans With And Without Standardized Planning Structures, Erica Wartman Aug 2025

Evaluating Dosimetric Outcomes In A Prostate Rapid Plan Model: A Comparison Of Prostate Treatment Plans With And Without Standardized Planning Structures, Erica Wartman

Masters Projects

Abstract

Knowledge-based planning (KBP) using RapidPlan (RP) has demonstrated the ability to produce high quality radiation therapy treatment plans while reducing time. This study evaluated whether the inclusion of department specific standardized planning structures, including rings and other optimization tools, improves plan quality when using a prostate and lymph node RP model, or if the model alone is sufficient to provide a quality plan without the use of these additional planning structures.

Ten previously treated Prostate+LN patients were replanned using the departmental RP model in Varian Eclipse treatment planning system.1 For each patient, two plans were created, one with standardized …


Investigating The Necessity Of Adaptive Radiotherapy In Tomotherapy Of Head And Neck Cancer Patients, Ali Chaparian, Mahsa Kianinia, Mahnaz Roayaei, Nadia Najafizade, Abolfazl Kanani, Leili Mahani, Hamidreza Nourzadeh Jul 2025

Investigating The Necessity Of Adaptive Radiotherapy In Tomotherapy Of Head And Neck Cancer Patients, Ali Chaparian, Mahsa Kianinia, Mahnaz Roayaei, Nadia Najafizade, Abolfazl Kanani, Leili Mahani, Hamidreza Nourzadeh

Department of Radiation Oncology Faculty Papers

BACKGROUND: Anatomical variations that occur during radiation therapy in head and neck cancer (HNC) patients can lead to significant dosimetric changes. The purpose of this study is to evaluate dosimetric and volume changes in key anatomical structures for different treatment sites in HNC patients, and to determine the percentage of patients who need adaptive radiotherapy (ART) per treatment site.

METHODS: A total of 1,740 megavoltage computed tomography (MVCT) images from 58 HNC patients treated with helical tomotherapy (HT) were exported to the PreciseART™ (Accuray) software. Volume changes in the planning target volume (PTV) and the organs at risk (OARs) in …


Desmoplastic Small Round Cell Tumor: An Update Of Current Management Practices, Ahmed Gawash, Alexa Simonetti, Brandon J Goodwin, Alissa Brotman O'Neill Apr 2025

Desmoplastic Small Round Cell Tumor: An Update Of Current Management Practices, Ahmed Gawash, Alexa Simonetti, Brandon J Goodwin, Alissa Brotman O'Neill

Rowan-Virtua School of Osteopathic Medicine Departmental Research

BACKGROUND: Desmoplastic small round cell tumor (DSRCT) poses a diagnostic challenge, initiating with imaging techniques like ultrasound, CT, MRI, and PET scans, with CT being the primary choice for abdominal tumor visualization. Despite advances, the absence of a standardized staging system complicates the diagnostic process.

METHODS: A comprehensive literature review and search strategy, encompassing databases like PubMed and Cochrane was performed.

RESULTS: Systemic chemotherapy, notably the P6 regimen, is the cornerstone of DSRCT treatment, while other options, including CDK4/6 inhibitors, antibody-drug conjugates, and anlotinib present varying efficacy. A novel chemotherapeutic agent, ONC-201, exhibits promise, inhibiting tumor growth in preclinical models. …


Chemoradiation Treatment With Or Without Concurrent Tumor-Treating Fields (Ttfields) Therapy In Newly Diagnosed Glioblastoma (Gbm) Patients In China, Liping Liang, Lingchao Chen, Chunxia Ni, Wenyin Shi, Zhirui Zhou, Shu Chen, Wenjia Zhu, Jiabing Liu, Xianxin Qiu, Wanzun Lin, Junyan Zhang, Zhiyong Qin, Yang Wang Mar 2025

Chemoradiation Treatment With Or Without Concurrent Tumor-Treating Fields (Ttfields) Therapy In Newly Diagnosed Glioblastoma (Gbm) Patients In China, Liping Liang, Lingchao Chen, Chunxia Ni, Wenyin Shi, Zhirui Zhou, Shu Chen, Wenjia Zhu, Jiabing Liu, Xianxin Qiu, Wanzun Lin, Junyan Zhang, Zhiyong Qin, Yang Wang

Department of Radiation Oncology Faculty Papers

BACKGROUND: Tumor-treating fields (TTFields) therapy and radiotherapy may have synergistic anti-glioma effect based on preclinical studies. The combination of chemoradiation therapy (CRT) with TTFields therapy has noticeably attracted clinicians' attention. This study aimed to provide insights into the clinical outcomes of patients with newly diagnosed glioblastoma who received either concurrent CRT and TTFields therapy or adjuvant TTFields therapy following CRT. The findings were based on a cohort of patients who were treated at Huashan Hospital (Shanghai, China).

METHODS: This retrospective study analyzed ndGBM patients' clinical outcomes who were treated at Huashan Hospital and received TTFields therapy. Patients were categorized into …


Patient-Reported Outcomes: Comparing Functional Avoidance And Standard Thoracic Radiation Therapy In Lung Cancer, Spencer Poiset, Joseph Lombardo, Edward Castillo, Richard Castillo, Bernard Jones, Moyed Miften, Brian Kavanagh, Adam Dicker, Cullen Boyle, Nicole Simone, Benjamin Movsas, Inga Grills, Chad Rusthoven, Yevgeniy Vinogradskiy, Lydia Wilson Feb 2025

Patient-Reported Outcomes: Comparing Functional Avoidance And Standard Thoracic Radiation Therapy In Lung Cancer, Spencer Poiset, Joseph Lombardo, Edward Castillo, Richard Castillo, Bernard Jones, Moyed Miften, Brian Kavanagh, Adam Dicker, Cullen Boyle, Nicole Simone, Benjamin Movsas, Inga Grills, Chad Rusthoven, Yevgeniy Vinogradskiy, Lydia Wilson

Department of Radiation Oncology Faculty Papers

PURPOSE: Novel methods generate functional images using image processing techniques combined with four-dimensional computed tomography (4DCT) data (4DCT-ventilation). 4DCT-ventilation was implemented in a phase II, multicenter functional avoidance clinical trial. The work compares functional avoidance patient-reported outcomes (PROs) against historical standards.

METHODS: Patients with locally advanced lung cancer undergoing curative-intent chemoradiation were accrued. 4DCT-ventilation imaging was generated and functional avoidance treatment plans created reduced dose to functional lung. PRO instruments included Functional Assessment of Cancer Therapy Lung questionnaire and accompanying subscales (including the Trial Outcome Index [TOI]), EuroQol-5 Dimension (EQ-5D), and EQ-Visual Analog Scale (EQ-VAS). The average change from baseline …


Atypical Presentation Of Non-Small Cell Lung Carcinoma With Metastasis To Breast Tissue, Tylar P. Seckman, Diane Krutzler-Berry, Mohamed Ashal, Waqas Mahmud, Krista L. Denning, Logan M. Lawrence Jan 2025

Atypical Presentation Of Non-Small Cell Lung Carcinoma With Metastasis To Breast Tissue, Tylar P. Seckman, Diane Krutzler-Berry, Mohamed Ashal, Waqas Mahmud, Krista L. Denning, Logan M. Lawrence

Marshall Journal of Medicine

Malignant neoplasms of the lung commonly metastasize to lymph nodes, bone, brain, and liver via hematogenous and lymphatic routes. Much less commonly, metastasis occurs in the breast. Secondary metastatic disease of the breast is very rare, with a reported incidence ranging from 0.4-1.3%­­—with primary lung cancer being one of the most anomalous sources. This case details non-small cell lung cancer metastasis to the breast with proven primary contralateral lung origination. This atypical finding prompts medical professionals to consider these malignant cells' immunologic, histologic, and pathologic makeup to understand further and treat the neoplasm.


Durable Local Control With Hypofractionated Radiation Therapy For Unresectable Or Metastatic Melanoma, Sydney A Keatts, Aya F Salem, David M Swanson, Ahsan S Farooqi, Andrew J Bishop, Rodabe N Amaria, Jennifer L Mcquade, Isabella C Glitza Oliva, Adi Diab, Roi Weiser, Sarah B Fisher, Ryan P Goepfert, Merrick I Ross, B Ashleigh Guadagnolo, Devarati Mitra Nov 2024

Durable Local Control With Hypofractionated Radiation Therapy For Unresectable Or Metastatic Melanoma, Sydney A Keatts, Aya F Salem, David M Swanson, Ahsan S Farooqi, Andrew J Bishop, Rodabe N Amaria, Jennifer L Mcquade, Isabella C Glitza Oliva, Adi Diab, Roi Weiser, Sarah B Fisher, Ryan P Goepfert, Merrick I Ross, B Ashleigh Guadagnolo, Devarati Mitra

Faculty, Staff and Student Publications

BACKGROUND AND PURPOSE: As patients with advanced melanoma live longer in the context of systemic therapy advancements, better strategies for durable control of bulky tumors are needed. In this study, we evaluated if dose-escalated hypofractionated radiation therapy (HFRT) can provide durable local control and improve tumor-associated symptoms in patients with unresectable or bulky metastatic melanoma for whom stereotactic ablative radiotherapy (RT) approaches are not feasible due to tumor size or location.

MATERIALS AND METHODS: We retrospectively reviewed 49 patients with unresectable or bulky metastatic melanoma who were treated to a total of 53 tumor targets with 12-17 fractions HFRT at …


Comparative Plan Analysis: Helical Tomotherapy Vs. Linac Vmat For Lower Extremity Sarcomas, Marie E. Dibona Aug 2024

Comparative Plan Analysis: Helical Tomotherapy Vs. Linac Vmat For Lower Extremity Sarcomas, Marie E. Dibona

Masters Projects

Abstract

Introduction

Soft tissue sarcomas (STS) affect about 13,500 people annually in the United States, and those in the lower extremities present unique challenges in radiation therapy due to the wide variability in tumor sizes, sometimes exceeding 30cm. Traditional treatment involves C-Arm linear accelerators using Volumetric Modulated Radiation Therapy (VMAT), which provides precise targeting while sparing nearby organs. Helical Tomotherapy (HT) is another option, delivering radiation in a helical pattern with a binary MLC for a uniform dose distribution. However, no studies have compared VMAT and HT for lower extremity sarcomas of different sizes. This study aims to compare these …


Analyzing The Relationship Between Dose And Geometric Agreement Metrics For Auto-Contouring In Head And Neck Normal Tissues, Barbara Marquez, Zachary T Wooten, Ramon M Salazar, Christine B Peterson, David T Fuentes, T J Whitaker, Anuja Jhingran, Julianne Pollard-Larkin, Surendra Prajapati, Beth Beadle, Carlos E Cardenas, Tucker J Netherton, Laurence E Court Jul 2024

Analyzing The Relationship Between Dose And Geometric Agreement Metrics For Auto-Contouring In Head And Neck Normal Tissues, Barbara Marquez, Zachary T Wooten, Ramon M Salazar, Christine B Peterson, David T Fuentes, T J Whitaker, Anuja Jhingran, Julianne Pollard-Larkin, Surendra Prajapati, Beth Beadle, Carlos E Cardenas, Tucker J Netherton, Laurence E Court

Faculty, Staff and Student Publications

This study aimed to determine the relationship between geometric and dosimetric agreement metrics in head and neck (H&N) cancer radiotherapy plans. A total 287 plans were retrospectively analyzed, comparing auto-contoured and clinically used contours using a Dice similarity coefficient (DSC), surface DSC (sDSC), and Hausdorff distance (HD). Organs-at-risk (OARs) with ≥200 cGy dose differences from the clinical contour in terms of Dmax (D0.01cc) and Dmean were further examined against proximity to the planning target volume (PTV). A secondary set of 91 plans from multiple institutions validated these findings. For 4995 contour pairs across 19 OARs, 90% had a DSC, sDSC, …


Assessing Breast Disease With Deep Learning Model Using Bimodal Bi-View Ultrasound Images And Clinical Information, Fengping Liang, Yihua Song, Xiaoping Huang, Tong Ren, Qiao Ji, Yanan Guo, Xiang Li, Yajuan Sui, Xiaohui Xie, Lanqing Han, Yuanqing Li, Yong Ren, Zuofeng Xu Jul 2024

Assessing Breast Disease With Deep Learning Model Using Bimodal Bi-View Ultrasound Images And Clinical Information, Fengping Liang, Yihua Song, Xiaoping Huang, Tong Ren, Qiao Ji, Yanan Guo, Xiang Li, Yajuan Sui, Xiaohui Xie, Lanqing Han, Yuanqing Li, Yong Ren, Zuofeng Xu

Faculty, Staff and Students Publications

Breast cancer is the second leading cause of carcinoma-linked death in women. We developed a multi-modal deep-learning model (BreNet) to differentiate breast cancer from benign lesions. BreNet was constructed and trained on 10,108 images from one center and tested on 3,762 images from two centers in three steps. The diagnostic ability of BreNet was first compared with that of six radiologists; a BreNet-aided scheme was constructed to improve the diagnostic ability of the radiologists; and the diagnosis of real-world radiologists' scheme was then compared with the BreNet-aided scheme. The diagnostic performance of BreNet was superior to that of the radiologists …


Early Outcomes Of Mr-Guided Sbrt For Patients With Recurrent Pancreatic Adenocarcinoma, Spencer Poiset, Sophia Shah, Louis Cappelli, Rani Anné, Karen Mooney, Maria Werner-Wasik, Talya Laufer, James Posey, Daniel Lin, Atrayee Mallick, Harish Lavu, Babar Bashir, Charles Yeo, Adam Mueller May 2024

Early Outcomes Of Mr-Guided Sbrt For Patients With Recurrent Pancreatic Adenocarcinoma, Spencer Poiset, Sophia Shah, Louis Cappelli, Rani Anné, Karen Mooney, Maria Werner-Wasik, Talya Laufer, James Posey, Daniel Lin, Atrayee Mallick, Harish Lavu, Babar Bashir, Charles Yeo, Adam Mueller

Kimmel Cancer Center Faculty Papers

BACKGROUND: Local treatment options for locally recurrent pancreatic adenocarcinoma (LR-PAC) are limited, with median survival time (MST) of 9-13 months (mos) following recurrence. MRI-guided stereotactic body radiation therapy (MRgSBRT) provides the ability to dose escalate while sparing normal tissue. Here we report on the early outcomes of MRgSBRT for LR-PAC.

METHODS: Patients with prior resection of pancreatic adenocarcinoma with local recurrence treated with MRgSBRT at a single tertiary referral center from 5-2021 to 2-2023 were identified from our prospective database. MRgSBRT was delivered to 40-50 Gy in 4-5 fractions with target and OAR delineation per institutional standards. Endpoints included local …


Resection And Reconstruction Of Ewing Sarcoma Of The Cuboid Utilizing Vascularized Fibular Autograft: A Case Report, Brandon Cunha, Alexandre Arkader May 2024

Resection And Reconstruction Of Ewing Sarcoma Of The Cuboid Utilizing Vascularized Fibular Autograft: A Case Report, Brandon Cunha, Alexandre Arkader

Rowan-Virtua Research Day

Ewing Sarcoma (EWS) rarely presents in the bones of the foot, and particularly in the cuboid, making it an exceedingly rare occurrence. We present the case of a 7-year-old female diagnosed with EWS of the right cuboid, detailing the management and outcomes of this rare presentation. The patient, now almost 5 years post-initial local control, exhibits restored foot function, a normalized gait, and no evidence of disease recurrence. This case underscores the potential for preserving lower extremity function and improving postoperative quality of life in rare presentations of EWS through innovative reconstruction strategies.


Mr-Guided Stereotactic Radiation Therapy For Head And Neck Cancers, He Wang, Jinzhong Yang, Anna Lee, Jack Phan, Tze Yee Lim, Clifton D Fuller, Eun Young Han, Dong Joo Rhee, Travis Salzillo, Yao Zhao, Nitish Chopra, Mary Pham, Pam Castillo, Angela Sobremonte, Amy C Moreno, Jay P Reddy, David Rosenthal, Adam S Garden, Xin Wang May 2024

Mr-Guided Stereotactic Radiation Therapy For Head And Neck Cancers, He Wang, Jinzhong Yang, Anna Lee, Jack Phan, Tze Yee Lim, Clifton D Fuller, Eun Young Han, Dong Joo Rhee, Travis Salzillo, Yao Zhao, Nitish Chopra, Mary Pham, Pam Castillo, Angela Sobremonte, Amy C Moreno, Jay P Reddy, David Rosenthal, Adam S Garden, Xin Wang

Faculty, Staff and Student Publications

PURPOSE: MR-guided radiotherapy (MRgRT) has the advantage of utilizing high soft tissue contrast imaging to track daily changes in target and critical organs throughout the entire radiation treatment course. Head and neck (HN) stereotactic body radiation therapy (SBRT) has been increasingly used to treat localized lesions within a shorter timeframe. The purpose of this study is to examine the dosimetric difference between the step-and-shot intensity modulated radiation therapy (IMRT) plans on Elekta Unity and our clinical volumetric modulated arc therapy (VMAT) plans on Varian TrueBeam for HN SBRT.

METHOD: Fourteen patients treated on TrueBeam sTx with VMAT treatment plans were …


Acute Pain Prediction In Oral Cavity And Oropharyngeal Cancer Patients Receiving Radiation Therapy, Vivian Salama May 2024

Acute Pain Prediction In Oral Cavity And Oropharyngeal Cancer Patients Receiving Radiation Therapy, Vivian Salama

Dissertations and Theses (Open Access)

Oral-Cavity and oropharyngeal cancers (OC/OPC) are types of head and neck cancers that are increasing in incidence domestically. Radiation therapy (RT) is crucial in OC/OPC management. Pain is a common and challenging symptom for most patients during therapy, as nearly all patients undergoing locoregional RT in OC/OPC require analgesia for acute iatrogenic pain. Moreover, about 45% of long-term survivors report chronic pain, with more than 10% exhibiting severe chronic pain. Pain control is challenging due to the multifactorial clinical, molecular, and cellular etiology of cancer/therapy pain, as well as variation in pain assessment and the non-uniform management of pain between …


Real World Clinical Experience Using Daily Intelligence-Assisted Online Adaptive Radiotherapy For Head And Neck Cancer, Philip Blumenfeld, Eduard Arbit, Robert Den, Ayman Salhab, Tal Falick Michaeli, Marc Wygoda, Yair Hillman, Raphael Pfeffer, Marcel Fang, Yael Misrati, Noam Weizman, Jon Feldman, Aron Popovtzer Mar 2024

Real World Clinical Experience Using Daily Intelligence-Assisted Online Adaptive Radiotherapy For Head And Neck Cancer, Philip Blumenfeld, Eduard Arbit, Robert Den, Ayman Salhab, Tal Falick Michaeli, Marc Wygoda, Yair Hillman, Raphael Pfeffer, Marcel Fang, Yael Misrati, Noam Weizman, Jon Feldman, Aron Popovtzer

Department of Radiation Oncology Faculty Papers

Background

Adaptive radiation therapy (ART) offers a dynamic approach to address structural and spatial changes that occur during radiotherapy (RT) for locally advanced head and neck cancers. The integration of daily ART with Cone-Beam CT (CBCT) imaging presents a solution to enhance the therapeutic ratio by addressing inter-fractional changes.

Methods

We evaluated the initial clinical experience of daily ART for patients with head and neck cancer using an online adaptive platform with intelligence-assisted workflows on daily CBCT. Treatment included auto-contour and structure deformation of Organs at Risk (OARs) and target structures, with adjustments by the treating physician. Two plans were …


Quality Assurance For Stereotactic Body Radiation Therapy For Gynecologic Malignancies, Samuel N Andersen, Mark D Bonnen, Michelle S Ludwig, Shraddha M Dalwadi Feb 2024

Quality Assurance For Stereotactic Body Radiation Therapy For Gynecologic Malignancies, Samuel N Andersen, Mark D Bonnen, Michelle S Ludwig, Shraddha M Dalwadi

Faculty, Staff and Students Publications

The use of stereotactic body radiation therapy (SBRT) is not well studied or reported in the treatment of gynecologic malignancies, despite its success in the definitive management of other cancer sites. This report describes a rigorous quality assurance process for patients to undergo dose escalation to the pelvis via stereotactic photon beam irradiation. Patients who receive SBRT must be ineligible for conventional brachytherapy boost and undergo comprehensive informed consent. Fiducial placement, bowel prep, Foley catheter placement with standardized bladder filling, computerized tomography (CT) simulation with whole-body immobilization, magnetic resonance imaging (MRI)-assisted target delineation, planning aims based on the established brachytherapy …


Developing Radiosensitizers To Enhance Radiotherapy In Treating Gastroenteropancreatic Neuroendocrine Tumor, Zeta Chow Jan 2024

Developing Radiosensitizers To Enhance Radiotherapy In Treating Gastroenteropancreatic Neuroendocrine Tumor, Zeta Chow

Theses and Dissertations--Clinical and Translational Science

Gastroenteropancreatic Neuroendocrine Tumor (GEP-NET) is a heterogeneous group of malignancies arising from multipotent neuroendocrine stem cells in the gastrointestinal tract. The incidence of GEP-NET continues to rise, possibly due to the advancement of imaging and biomarkers available for diagnosis. However, even though the majority of patients are diagnosed with low-grade and localized disease, a significant percentage of patients present with advanced-stage metastatic disease with poor prognosis in months to a few years. These advanced-stage GEP-NET patients can also present with a variety of debilitating symptoms that significantly impact their quality of life. The role of palliative-intent surgery is limited, and …


Comprehensive Evaluation And New Recommendations In The Use Of Gafchromic Ebt3 Film, Kevin Liu, Patrik Gonçalves Jorge, Ramesh Tailor, Raphaël Moeckli, Emil Schüler Nov 2023

Comprehensive Evaluation And New Recommendations In The Use Of Gafchromic Ebt3 Film, Kevin Liu, Patrik Gonçalves Jorge, Ramesh Tailor, Raphaël Moeckli, Emil Schüler

Faculty, Staff and Student Publications

BACKGROUND: Gafchromic film's unique properties of tissue-equivalence, dose-rate independence, and high spatial resolution make it an attractive choice for many dosimetric applications. However, complicated calibration processes and film handling limits its routine use.

PURPOSE: We evaluated the performance of Gafchromic EBT3 film after irradiation under a variety of measurement conditions to identify aspects of film handling and analysis for simplified but robust film dosimetry.

METHODS: The short- (from 5 min to 100 h) and long-term (months) film response was evaluated for clinically relevant doses of up to 50 Gy for accuracy in dose determination and relative dose distributions. The dependence …


The Inherited Kras-Variant As A Biomarker Of Cetuximab Response In Nsclc, Joanne Weidhaas, Chen Hu, Ritsuko Komaki, Gregory Masters, George Blumenschein, Joe Chang, Bo Lu, Adam Dicker, Jeffrey Bogart, Yolanda Garces, Samir Narayan, Clifford Robinson, Vivek Kavadi, Joel S Greenberger, Christopher Koprowski, James Welsh, Elizabeth Gore, Robert Macrae, Rebecca Paulus, Jeffrey Bradley Oct 2023

The Inherited Kras-Variant As A Biomarker Of Cetuximab Response In Nsclc, Joanne Weidhaas, Chen Hu, Ritsuko Komaki, Gregory Masters, George Blumenschein, Joe Chang, Bo Lu, Adam Dicker, Jeffrey Bogart, Yolanda Garces, Samir Narayan, Clifford Robinson, Vivek Kavadi, Joel S Greenberger, Christopher Koprowski, James Welsh, Elizabeth Gore, Robert Macrae, Rebecca Paulus, Jeffrey Bradley

Department of Radiation Oncology Faculty Papers

PURPOSE: RTOG 0617 was a phase III randomized trial for patients with unresectable stage IIIA/IIIB non-small cell lung cancer comparing standard-dose (60 Gy) versus high-dose (74 Gy) radiotherapy and chemotherapy, plus or minus cetuximab. Although the study was negative, based on prior evidence that patients with the KRAS-variant, an inherited germline mutation, benefit from cetuximab, we evaluated KRAS-variant patients in RTOG 0617.

EXPERIMENTAL DESIGN: From RTOG 0617, 328 of 496 (66%) of patients were included in this analysis. For time-to-event outcomes, stratified log-rank tests and multivariable Cox regression models were used. For binary outcomes, Cochran-Mantel-Haenzel tests and multivariable logistic regression …


Conditional Risks Of Biochemical Failure And Prostate Cancer-Specific Death In Patients Undergoing External Beam Radiotherapy: A Secondary Analysis Of 2 Randomized Clinical Trials, Gregory S. Alexander, Rebecca F Krc, James W Assif, Kai Sun, Jason K Molitoris, Phuoc Tran, Zaker Rana, Søren M Bentzen, Mark V Mishra Sep 2023

Conditional Risks Of Biochemical Failure And Prostate Cancer-Specific Death In Patients Undergoing External Beam Radiotherapy: A Secondary Analysis Of 2 Randomized Clinical Trials, Gregory S. Alexander, Rebecca F Krc, James W Assif, Kai Sun, Jason K Molitoris, Phuoc Tran, Zaker Rana, Søren M Bentzen, Mark V Mishra

Department of Radiation Oncology Faculty Papers

IMPORTANCE: As patients achieve years of survival after treatment for prostate cancer, the risk of biochemical failure (BF) or prostate cancer-specific death (PCSD) may evolve over time, with clinical relevance to both patients and clinicians.

OBJECTIVE: To determine conditional BF-free survival, PSCD, and overall survival estimates for patients with low- or intermediate-risk prostate cancer enrolled in the Radiation Therapy Oncology Group (RTOG) 0126 and RTOG 0415 clinical trials. A secondary objective was to determine whether prognostic factors at diagnosis remain relevant at later points in follow-up.

DESIGN, SETTING, AND PARTICIPANTS: A pooled secondary analysis of patients treated with external-beam radiotherapy …


Longitudinal Diffusion And Volumetric Kinetics Of Head And Neck Cancer Magnetic Resonance On A 15 T Mr-Linear Accelerator Hybrid System: A Prospective R-Ideal Stage 2a Imaging Biomarker Characterization/Pre-Qualification Study, Joint Head And Neck Radiation Therapy-Mri Development Cooperative, Mr-Linac Consortium Head And Neck Tumor Site Group Jul 2023

Longitudinal Diffusion And Volumetric Kinetics Of Head And Neck Cancer Magnetic Resonance On A 15 T Mr-Linear Accelerator Hybrid System: A Prospective R-Ideal Stage 2a Imaging Biomarker Characterization/Pre-Qualification Study, Joint Head And Neck Radiation Therapy-Mri Development Cooperative, Mr-Linac Consortium Head And Neck Tumor Site Group

Faculty, Staff and Student Publications

Objectives: We aim to characterize the serial quantitative apparent diffusion coefficient (ADC) changes of the target disease volume using diffusion-weighted imaging (DWI) acquired weekly during radiation therapy (RT) on a 1.5 T MR-Linac and correlate these changes with tumor response and oncologic outcomes for head and neck squamous cell carcinoma (HNSCC) patients as part of a programmatic R-IDEAL biomarker characterization effort.

Methods:Thirty patients with HNSCC who received curative-intent RT at MD Anderson Cancer Center, were included. Baseline and weekly MRI were obtained, and various ADC parameters were extracted from the regions of interest (ROIs). Baseline and weekly ADC parameters were …


Multiple Primary Lung Cancers: Treatment Outcomes After Stereotactic Body Radiotherapy (Sbrt), Gyujae Choi, George Chen, Weiyuan Mai, Albert Chen, Angela Zhu Jul 2023

Multiple Primary Lung Cancers: Treatment Outcomes After Stereotactic Body Radiotherapy (Sbrt), Gyujae Choi, George Chen, Weiyuan Mai, Albert Chen, Angela Zhu

Faculty, Staff and Students Publications

PURPOSE/OBJECTIVES: Patients with lung cancer sometimes present with multiple primary lung cancers (MPLCs), either simultaneously (synchronous) or after treatment of an initial lesion (metachronous). Although open surgery remains a treatment mainstay for patients with stage I-II non-small-cell lung cancer (NSCLC), stereotactic body radiation therapy (SBRT) is an acceptable alternative for patients who are medically unfit for or who refuse surgery. In this study, we retrospectively examine the outcome among patients with early-stage MPLCs treated at our institution with SBRT.

MATERIALS/METHODS: Patients at our institution receiving SBRT for MPLC between June 2011 and March 2020 were reviewed retrospectively. Prior to undergoing …


Comparison Of Clinical And Radiographic Efficacy Of Particles Versus Nbca/Onyx In Middle Meningeal Artery Embolization For Chronic Subdural Hematoma, Jane Khalife, Mohamed Salem, Victoria Wong Murray, Allen Karimov, Brian Jankowitz, Jan Karl Burkhardt, Hamza Shaikh, Daniel Tonetti, Pratit Patel, Tudor Jovin, Ajith Thomas May 2023

Comparison Of Clinical And Radiographic Efficacy Of Particles Versus Nbca/Onyx In Middle Meningeal Artery Embolization For Chronic Subdural Hematoma, Jane Khalife, Mohamed Salem, Victoria Wong Murray, Allen Karimov, Brian Jankowitz, Jan Karl Burkhardt, Hamza Shaikh, Daniel Tonetti, Pratit Patel, Tudor Jovin, Ajith Thomas

Rowan-Virtua Research Day

Different embolic materials are utilized in MMA embolization of chronic subdural hematoma per operators’ discretion. We aim to compare the clinical and radiographic efficacy of different embolic materials in a pooled retrospective cohort of two US centers.


Multiparametric Magnetic Resonance Imaging Artificial Intelligence Pipeline For Oropharyngeal Cancer Radiotherapy Treatment Guidance, Kareem Wahid May 2023

Multiparametric Magnetic Resonance Imaging Artificial Intelligence Pipeline For Oropharyngeal Cancer Radiotherapy Treatment Guidance, Kareem Wahid

Dissertations and Theses (Open Access)

Oropharyngeal cancer (OPC) is a widespread disease and one of the few domestic cancers that is rising in incidence. Radiographic images are crucial for assessment of OPC and aid in radiotherapy (RT) treatment. However, RT planning with conventional imaging approaches requires operator-dependent tumor segmentation, which is the primary source of treatment error. Further, OPC expresses differential tumor/node mid-RT response (rapid response) rates, resulting in significant differences between planned and delivered RT dose. Finally, clinical outcomes for OPC patients can also be variable, which warrants the investigation of prognostic models. Multiparametric MRI (mpMRI) techniques that incorporate simultaneous anatomical and functional information …


Safety Of Nivolumab Added To Chemoradiation Therapy Platforms For Intermediate And High-Risk Locoregionally Advanced Head And Neck Squamous Cell Carcinoma: Rtog Foundation 3504, Maura L Gillison, Robert L Ferris, Jonathan Harris, A Dimitrios Colevas, Loren K Mell, Christina Kong, Richard C Jordan, Kevin L Moore, Minh-Tam Truong, Claudia Kirsch, Arnab Chakravarti, Dukagjin M Blakaj, David A Clump, James P Ohr, John F Deeken, Michael F Gensheimer, Nabil F Saba, Jennifer A Dorth, David I Rosenthal, Rom S Leidner, Randall J Kimple, Mitchell Machtay, Walter J Curran, Pedro Torres-Saavedra, Quynh Thu Le Mar 2023

Safety Of Nivolumab Added To Chemoradiation Therapy Platforms For Intermediate And High-Risk Locoregionally Advanced Head And Neck Squamous Cell Carcinoma: Rtog Foundation 3504, Maura L Gillison, Robert L Ferris, Jonathan Harris, A Dimitrios Colevas, Loren K Mell, Christina Kong, Richard C Jordan, Kevin L Moore, Minh-Tam Truong, Claudia Kirsch, Arnab Chakravarti, Dukagjin M Blakaj, David A Clump, James P Ohr, John F Deeken, Michael F Gensheimer, Nabil F Saba, Jennifer A Dorth, David I Rosenthal, Rom S Leidner, Randall J Kimple, Mitchell Machtay, Walter J Curran, Pedro Torres-Saavedra, Quynh Thu Le

Faculty, Staff and Student Publications

PURPOSE: Programmed death-1 immune checkpoint blockade improves survival of patients with recurrent/metastatic head and neck squamous cell carcinoma (HNSCC), but the benefits of addition to (chemo)radiation for newly diagnosed patients with HNSCC remain unknown.

METHODS AND MATERIALS: We evaluated the safety of nivolumab concomitant with 70 Gy intensity modulated radiation therapy and weekly cisplatin (arm 1), every 3-week cisplatin (arm 2), cetuximab (arm 3), or alone for platinum-ineligible patients (arm 4) in newly diagnosed intermediate- or high-risk locoregionally advanced HNSCC. Patients received nivolumab from 2 weeks prior to radiation therapy until 3 months post-radiation therapy. The primary endpoint was dose-limiting …


Radiation Therapy For Retroperitoneal Sarcomas: A Strass-Ful Situation, Ahsan S Farooqi, B Ashleigh Guadagnolo, Devarati Mitra, Andrew J Bishop Jan 2023

Radiation Therapy For Retroperitoneal Sarcomas: A Strass-Ful Situation, Ahsan S Farooqi, B Ashleigh Guadagnolo, Devarati Mitra, Andrew J Bishop

Faculty, Staff and Student Publications

Locoregional recurrence (LRR) is the predominant pattern of relapse and often the cause of death in patients with retroperitoneal sarcomas (RPS). As a result, reducing LRR is a critical objective for RPS patients. However, unlike soft tissue sarcomas (STS) of the superficial trunk and extremity where the benefits of radiation therapy (RT) are well-established, the role of RT in the retroperitoneum remains controversial. Historically, preoperative or postoperative RT, either alone or in combination with intraoperative radiation (IORT), was commonly justified for RPS based on extrapolation from the superficial trunk and extremity STS literature. However, long-awaited results were recently published from …