Radiation Medicine Commons^™

Development And Long-Term Stability Of A Comprehensive Daily Qa Program For A Modern Pencil Beam Scanning (Pbs) Proton Therapy Delivery System, Suresh Rana, Jaafar Bennouna, Alonso Gutierrez

All Publications

No abstract provided.

Combining Radiation And Immune Checkpoint Blockade In The Treatment Of Head And Neck Squamous Cell Carcinoma., Gregor Manukian, Voichita Bar-Ad, Bo Lu, Athanassios Argiris, Jennifer M. Johnson

Department of Radiation Oncology Faculty Papers

Head and neck squamous cell carcinoma (HNSCC) is a significant cause of morbidity and mortality worldwide. Current treatment options, even though potentially curative, have many limitations including a high rate of complications. Over the past few years immune checkpoint inhibitors (ICI) targeting cytotoxic lymphocyte antigen-4 (CTLA-4), programmed cell death protein 1 (PD-1), and programmed cell death ligand 1 (PD-L1) have changed treatment paradigms in many malignancies and are currently under investigation in HNSCC as well. Despite improvements in treatment outcomes and the implementation of combined modality approaches long-term survival rates in patients with locally advanced HNSCC remain suboptimal. Accumulating evidence …

Management Of Patients With Brain Metastases From Non-Small Cell Lung Cancer And Adverse Prognostic Features: Multi-National Radiation Treatment Recommendations Are Heterogeneous, Minesh Mehta

All Publications

No abstract provided.

A Nomogram To Determine Required Seed Air Kerma Strength In Planar 131 Cesium Permanent Seed Implant Brachytherapy, Emily Hubley, Michael Trager, Voichita Bar-Ad, Adam J. Luginbuhl, Laura Doyle

Department of Radiation Oncology Faculty Papers

Purpose: Intraoperatively implanted Cesium-131 ( ¹³¹ Cs) permanent seed brachytherapy is used to deliver highly localized re-irradiation in recurrent head and neck cancers. A single planar implant of uniform air kerma strength (AKS) seeds and 10 mm seed-to-seed spacing is used to deliver the prescribed dose to a point 5 mm or 10 mm perpendicular to the center of the implant plane. Nomogram tables to quickly determine the required AKS for rectangular and irregularly shaped implants were created and dosimetrically verified. By eliminating the need for a full treatment planning system plan, nomogram tables allow for fast dose calculation for …

Radiomics - Using Artificial Intelligence In The Quest Towards Personalised Radiation Treatment, Ahmed Nadeem Abbasi, Agha Muhammad Hammad Khan, Bilal Mazhar Qureshi

Department of Radiation Oncology

No abstract provided.

Quality Assurance Guidelines For Interstitial Hyperthermia., H. Dobšíček Trefná, M. Schmidt, G. C. Van Rhoon, H. P. Kok, S. S. Gordeyev, U. Lamprecht, D. Marder, J. Nadobny, P. Ghadjar, S Abdel-Rahman, A. M. Kukiełka, V. Strnad, M. D. Hurwitz, Z. Vujaskovic, C. J. Diederich, P. R. Stauffer, J. Crezee

Department of Radiation Oncology Faculty Papers

Quality assurance (QA) guidelines are essential to provide uniform execution of clinical hyperthermia treatments and trials. This document outlines the clinical and technical consequences of the specific properties of interstitial heat delivery and specifies recommendations for hyperthermia administration with interstitial techniques. Interstitial hyperthermia aims at tumor temperatures in the 40-44 °C range as an adjunct to radiation or chemotherapy. The clinical part of this document imparts specific clinical experience of interstitial heat delivery to various tumor sites as well as recommended interstitial hyperthermia workflow and procedures. The second part describes technical requirements for quality assurance of current interstitial heating equipment …

The Oncology Care Model: Oncology's First Foray Away From Volume And Toward Value-Based Care., Andrew Song, Valerie P. Csik, Amy Leader, Vittorio Maio

Department of Radiation Oncology Faculty Papers

No abstract provided.

Dosimetric Performance And Planning/Delivery Efficiency Of A Dual-Layer Stacked And Staggered Mlc On Treating Multiple Small Targets: A Planning Study Based On Single-Isocenter Multi-Target Stereotactic Radiosurgery (Srs) To Brain Metastases., Taoran Li, Peyton Irmen, Haisong Lui, Wenyin Shi, Michelle Alonso-Basanta, Wei Zou, Boon-Keng Kevin Teo, James M. Metz, Lei Dong

Department of Radiation Oncology Faculty Papers

Purpose: To evaluate the dosimetric performance and planning/delivery efficiency of a dual-layer MLC system for treating multiple brain metastases with a single isocenter.

Materials and Methods: 10 patients each with 6-10 targets with volumes from 0.11 to 8.57 cc, and prescription doses from 15 to 24 Gy, were retrospectively studied. Halcyon has only coplanar delivery mode. Halcyon V1 MLC modulates only with the lower layer at 1 cm resolution, whereas V2 MLC modulates with both layers at an effective resolution of 0.5 cm. For each patient five plans were compared varying MLC and beam arrangements: the clinical plan using multi-aperture …

A Custom Radiopaque Thermoresponsive Chemotherapy-Loaded Hydrogel For Intratumoural Injection: An In Vitro And Ex Vivo Assessment Of Imaging Characteristics And Material Properties, Seóna M. Rossi, Timothy E. Murray, John Cassidy, Michael J. Lee, Helena M. Kelly

Articles

Purpose Thermoresponsive hydrogels are gels which have different properties at varying temperatures. The objective of this study was to assess the material characteristics, imaging properties and chemotherapeutic drug release profile of a novel radiopaque thermoresponsive hydrogel in vitro, which is liquid at room temperature but solidifies at body temperature, to determine potential suitability for intratumoural delivery. Materials and Methods An iodinated radiopaque thermoresponsive hydrogel was formulated using iodixanol at a range of concentrations and assessed for sol–gel transition, radiopacity and imaging using CT and US. A lead formulation containing iodixanol at a concentration of 9.22% weight by weight (w/w, g …

Recent Advances In The Vibrational Spectroscopic Diagnosis Of Non-Small Cell Lung Cancer, Declan O'Dea, Fiona Lyng, Siobhan Nicholson, Finbar O'Connell, Aoife Maguire, Alison Malkin

Articles

Lung cancer is the leading cause of cancer deaths worldwide accounting for 1.69 million deaths in 2015. Studies have indicated a 5 year survival rate of 8%–15% in western countries, although a survival rate as low as 1% has been demonstrated for late stage diagnosis. With the advent of targeted therapies, it is imperative to accurately differentiate non-small cell lung cancer (NSCLC) subtypes in order to ensure efficacy of treatment for patients. Immunohistochemistry and molecular techniques for the diagnosis of NSCLC are increasingly part of the diagnostic algorithm and clinical work-up of lung cancer patients, however due to the limitation …

Effect Of Neoadjuvant Chemoradiation On Preoperative Pulmonary Physiology, Postoperative Respiratory Complications And Quality Of Life In Patients With Oesophageal Cancer, J. A. Elliott, L. O'Byrne, G. Foley, C. F. Murphy, Suzanne Doyle, S. King, E. M. Guinan, N. Ravi, V. Reynolds

Articles

Background: It remains controversial whether neoadjuvant chemoradiation (nCRT) for oesophageal cancer influences operative morbidity, in particular pulmonary, and quality of life. This study combined clinical outcome data with systematic evaluation of pulmonary physiology to determine the impact of nCRT on pulmonary physiology and clinical outcomes in locally advanced oesophageal cancer.

Methods: Consecutive patients treated between 2010 and 2016 were included. Three-dimensional conformal radiation was standard, with a lung dose–volume histogram of V20 less than 25 per cent, and total radiation between 40 and 41⋅4Gy. Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and diffusion capacity …

Spaceoar To Improve Dosimetric Outcomes For Monotherapy High-Dose-Rate Prostate Implantation In A Patient With Ulcerative Colitis., Michael Trager, Benjamin Greenberger, Amy S. Harrison, James Keller, Robert B. Den

Department of Radiation Oncology Faculty Papers

High-dose-rate (HDR) brachytherapy is an attractive option for patients receiving definitive radiation therapy for prostate cancer with decreased overall dose to the pelvis. However, ulcerative colitis increases rectal toxicity risk and may be a contraindication. A synthetic hydrogel, SpaceOAR (Augmentix Inc., Waltham, MA, USA), can facilitate the use of HDR brachytherapy for patients where rectal toxicity is a limiting factor. SpaceOAR gel (13.19 cc) was utilized in a monotherapy HDR prostate treatment with Ir-192 under transrectal ultrasound guidance, with the intention of decreasing rectal dose. SpaceOAR gel was inserted transperineally into the patient 18 days prior to the procedure. The …

Challenges Faced By Pakistani Healthcare System: Clinician's Perspective, Faran Khalid, Ahmed Nadeem Abbasi

Department of Radiation Oncology

Abstract are not provided by the author/publisher

Clinical Audit To Assess Delays In Chemotherapy Administration At Daycare Oncology Center At A Tertiary Care Hospital In Karachi, Pakistan, Arifa Arifa Aziz, Zarka Samoon, Afsheen Feroz, Nadia Ayoub, Safia Awan, Madhia Beg

Department of Radiation Oncology

Aim: There were delays reported by patients in chemotherapy administration in daycare oncology. Therefore, we decided to audit all processes which are involved in chemotherapy administration. The objective was to improve our service by decreasing the time between admission and initiation of chemotherapy and identify the reasons for delays. Materials and Methods: The audit was conducted in three parts. In Review I, audit tool was developed and information documented of 109 patients receiving chemotherapy at daycare center from April 14 to May 13, 2015. Five processes were assessed out of which delay in initial assessment by the nurse was the …

Development And Validation Of A Prostate Cancer Genomic Signature That Predicts Early Adt Treatment Response Following Radical Prostatectomy., R. Jeffrey Karnes, Vidit Sharma, Voleak Choeurng, Hussam Al-Deen Ashab, Nicholas Erho, Mohammed Alshalalfa, Bruce Trock, Ashley Ross, Kasra Yousefi, Harrison Tsai, Shuang G. Zhao, Jeffrey J. Tosoian, Zaid Haddad, Mandeep Takhar, S. Laura Chang, Daniel E. Spratt, Firas Abdollah, Robert B. Jenkins, Eric A. Klein, Paul L. Nguyen, Adam P. Dicker, Robert B. Den, Elai Davicioni, Felix Y. Feng, Tamara L. Lotan, Edward M. Schaeffer

Department of Radiation Oncology Faculty Papers

Purpose: Currently, no genomic signature exists to distinguish men most likely to progress on adjuvant androgen deprivation therapy (ADT) after radical prostatectomy for high-risk prostate cancer. Here we develop and validate a gene expression signature to predict response to postoperative ADT.

Experimental Design: A training set consisting of 284 radical prostatectomy patients was established after 1:1 propensity score matching metastasis between adjuvant-ADT (a-ADT)-treated and no ADT–treated groups. An ADT Response Signature (ADT-RS) was identified from neuroendocrine and AR signaling–related genes. Two independent cohorts were used to form three separate data sets for validation (set I, n = 232; set II, …

Prognostic Factors For Elderly Patients Treated With Stereotactic Body Radiation Therapy For Pancreatic Adenocarcinoma, Philip A. Sutera, Mark E. Bernard, Hong Wang, Dwight E. Heron

Radiation Medicine Faculty Publications

Introduction: Pancreatic ductal adenocarcinoma (PDAC) commonly presents later in life with a median age at diagnosis of 70 years. Unfortunately, elderly patients are significantly underrepresented in clinical trials. Stereotactic body radiation therapy (SBRT) is a promising treatment modality in this population as it has demonstrated excellent local control with minimal toxicity. We aimed to determine prognostic factors associated with outcomes in elderly patients treated with SBRT.

Materials and Methods: Elderly patients older than 70 treated with SBRT for PDAC at our institution, from 2004 to 2014 were included. Our primary endpoints included overall survival (OS) and local-progression-free survival (LPFS). Secondary …

Impact Of The Spop Mutant Subtype On The Interpretation Of Clinical Parameters In Prostate Cancer., Deli Liu, Mandeep Takhar, Mohammed Alshalalfa, Nicholas Erho, Jonathan Shoag, Robert B. Jenkins, R. Jeffrey Karnes, Ashley E. Ross, Edward M. Schaeffer, Mark A. Rubin, Bruce Trock, Eric A. Klein, Robert B. Den, Scott A. Tomlins, Daniel E. Spratt, Elai Davicioni, Andrea Sboner, Christopher E. Barbieri

Department of Radiation Oncology Faculty Papers

Purpose: Molecular characterization of prostate cancer, including The Cancer Genome Atlas, has revealed distinct subtypes with underlying genomic alterations. One of these core subtypes, SPOP (speckle-type POZ protein) mutant prostate cancer, has previously only been identifiable via DNA sequencing, which has made the impact on prognosis and routinely used risk stratification parameters unclear.

Methods: We have developed a novel gene expression signature, classifier (Subclass Predictor Based on Transcriptional Data), and decision tree to predict the SPOP mutant subclass from RNA gene expression data and classify common prostate cancer molecular subtypes. We then validated and further interrogated the association of prostate …

Analysis Of Clinical Data To Determine The Minimum Number Of Sensors Required For Adequate Skin Temperature Monitoring Of Superficial Hyperthermia Treatments., Akke Bakker, Rebecca Holman, Dario B. Rodrigues, Hana Dobšíček Trefná, Paul R. Stauffer, Geertjan Van Tienhoven, Coen R.N. Rasch, Hans Crezee

Department of Radiation Oncology Faculty Papers

PURPOSE: Tumor response and treatment toxicity are related to minimum and maximum tissue temperatures during hyperthermia, respectively. Using a large set of clinical data, we analyzed the number of sensors required to adequately monitor skin temperature during superficial hyperthermia treatment of breast cancer patients.

METHODS: Hyperthermia treatments monitored with >60 stationary temperature sensors were selected from a database of patients with recurrent breast cancer treated with re-irradiation (23 × 2 Gy) and hyperthermia using single 434 MHz applicators (effective field size 351-396 cm²). Reduced temperature monitoring schemes involved randomly selected subsets of stationary skin sensors, and another subset …

Therapeutic Challenge With A Cdk 4/6 Inhibitor Induces An Rb-Dependent Smac-Mediated Apoptotic Response In Non-Small Cell Lung Cancer., Thangavel Chellappagounder, Boopathi Ettickan, Yi Liu, Christopher Mcnair, Alex Haber, Maryna Perepelyuk, Anshul Bhardwaj, Sankar Addya, Adam Ertel, Sunday Shoyele, Ruth Birbe, Joseph M. Salvino, Adam P. Dicker, Karen E. Knudsen, Robert B. Den

Department of Radiation Oncology Faculty Papers

Purpose: The retinoblastoma tumor suppressor (RB), a key regulator of cell-cycle progression and proliferation, is functionally suppressed in up to 50% of non-small cell lung cancer (NSCLC). RB function is exquisitely controlled by a series of proteins, including the CyclinD-CDK4/6 complex. In this study, we interrogated the capacity of a CDK4/6 inhibitor, palbociclib, to activate RB function.

Experimental Design and Results: We employed multiple isogenic RB-proficient and -deficient NSCLC lines to interrogate the cytostatic and cytotoxic capacity of CDK 4/6 inhibition in vitro and in vivo We demonstrate that while short-term exposure to palbociclib induces cellular senescence, prolonged exposure results …

Outlier Identification In Radiation Therapy Knowledge-Based Planning: A Study Of Pelvic Cases., Yang Sheng, Yaorong Ge, Lulin Yuan, Taoran Li, Fang-Fang Yin, Qingrong Jackie Wu

Department of Radiation Oncology Faculty Papers

PURPOSE: The purpose of this study was to apply statistical metrics to identify outliers and to investigate the impact of outliers on knowledge-based planning in radiation therapy of pelvic cases. We also aimed to develop a systematic workflow for identifying and analyzing geometric and dosimetric outliers.

METHODS: Four groups (G1-G4) of pelvic plans were sampled in this study. These include the following three groups of clinical IMRT cases: G1 (37 prostate cases), G2 (37 prostate plus lymph node cases) and G3 (37 prostate bed cases). Cases in G4 were planned in accordance with dynamic-arc radiation therapy procedure and include 10 …

Knowledge, Attitude And Perceptions Of Muslim Cancer Patients Regarding Cancer Treatment During Ramadan: Results From A Tertiary Care Hospital Karachi, Afshan Asghar Rasheed, Yasmin Abdul Rashid, Farah Tahir Pirzada, Fawad Haroon, Adnan Jabbar, Ahmed Raheem Buksh

Department of Radiation Oncology

Objective: To assess the knowledge and attitude of Muslim cancer patients regarding cancer treatment during Ramadan.
Methods: This cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, from July to August 2015, and comprised cancer patients. .Adult Muslim cancer patients receiving active oncological treatment or on surveillance were included. Patients on only supportive treatment were excluded. SPSS 19 was used for data analysis.
Results: Of the 265 patients, 87(32.8%) were males and 178(67.2%) were females. The overall mean age was 49±13.87 years. Besides, 184(70.9%) patients belonged to the middle class. Breast cancer was the most common cancer 106(40.6%). …

Establishment Of Site Specific Multi-Disciplinary Tumour Boards In Pakistan: Sharing Experience Of Neuro Oncology Team Based At A Tertiary Care University Hospital, Muhammad Waqas, Ahmed Nadeem Abbasi

Section of Neurosurgery

No abstract provided.

Repurposing Mebendazole As A Replacement For Vincristine For The Treatment Of Brain Tumors, M. De Witt, A. Gamble, D. Hanson, D. Markowitz, C. Powell, S. Al Dimassi, M. Atlas, J. Boockvar, R. Ruggieri, M. Symons

Journal Articles

No abstract provided.

Effect Of Variable Dose Rate On Biologically Effective Dose, Vadim Y. Kuperman, Gregory S. Spradlin

Publications

Purpose: to investigate the effect of variable dose rate on biologically effective dose ( BED ).

Materials and methods: by using the linear-quadratic (LQ) model with bi-exponential repair, we analytically determine the time-dependent dose rate R ~ which minimizes the effective protraction factor ( eff G ) and BEDunder the condition of fixed fraction time and dose per fraction.  Because normal tissue complication probability ( NTCP) monotonically decreases with decreasingBED , the dose rate R ~ also minimizes NTCP.

Results: the dependences of Geff, BED, and NTCP on fraction time were determined for different radiobiological parameters and two different …

Cisplatin-Induced Posterior Reversible Encephalopathy Syndrome And Successful Re-Treatment In A Patient With Non-Seminomatous Germ Cell Tumor: A Case Report, Muhammad Nauman Zahir, Nehal Masood, Munira Shabbir-Moosajee

Department of Radiation Oncology

UNLABELLED: Introduction: Cisplatin is a platinum compound that has revolutionized the treatment of various solid organ tumors. Cisplatin is associated with a variety of side effects and has recently been indicted in the development of posterior reversible encephalopathy syndrome. Posterior reversible encephalopathy syndrome is a potentially reversible condition, with the mainstay of therapy being correction of the underlying cause and withdrawal of the offending drug. However, there are no clear guidelines regarding the possibility of subsequent re-treatment with the causative agent.CASE PRESENTATION: A 23-year-old Asian man presented to our Emergency Department with a four-month history of concomitant abdominal pain and …

A Model Using Radiation And Pws4-Htnf-Α Gene Therapy For Treatment Of Glioblastomas, Angelo G. Baher

Loma Linda University Electronic Theses, Dissertations & Projects

The efficacy of radiotherapy for cancer is limited by the dose that can be safely delivered to the tumor without causing debilitating side effects. In addition, successful treatment of highly malignant tumors such as glioblastomas is likely to require adjunctive therapies to enhance tumor response to radiation. Previous studies have shown immunomodulation and a synergestic reduction in tumor volume of malignant tumors when tumor necrosis factor-α (TNF-α) protein is administered prior to radiation. The major goal of the present investigation was to evaluate the efficacy of pWS4-human TNF-α (pWS4-hTNF-α), a new plasmid construct that expresses human TNF-α protein, together with …