Radiation Medicine Commons^™

High-Dose-Rate Brachytherapy For The Treatment Of Basal And Squamous Cell Carcinomas On Sensitive Areas Of The Face: A Report Of Clinical Outcomes And Acute And Subacute Toxicities, James M. Taylor, Bahar Dasgeb, Spencer Liem, Ayesha Ali, Amy Harrison, Mitchell Finkelstein, Jisun Cha, Rani Anne, Steven Greenbaum, William Sherwin, Wenyin Shi

Department of Radiation Oncology Faculty Papers

Purpose Basal cell and cutaneous squamous cell carcinoma are common malignancies (keratinocyte carcinomas [KCs]). Surgical resection is the standard of care. Radiation using high-dose rate brachytherapy (HDR-BT) may serve as a superior alternative where surgical scars may be of cosmetic concern or in elderly patients with significant comorbidity. We aim to describe the clinical and cosmetic outcomes as well as posttreatment radiation toxicities associated with HDR-BT in patients who were treated for KCs of the face.

Methods and Materials Patients with KCs treated with HDR-BT from 2015 to 2018 were included in the study. Patient medical records and clinical photos …

Mir-21 Plays A Dual Role In Tumor Formation And Cytotoxic Response In Breast Tumors, Tu Dan, Anuradha A. Shastri, Ajay Palagani, Simone Buraschi, Thomas Neill, Jason E Savage, Aastha Kapoor, Tiziana Deangelis, Sankar Addya, Kevin Camphausen, Renato V. Iozzo, Nicole L Simone

Department of Radiation Oncology Faculty Papers

Breast cancer (BrCa) relies on specific microRNAs to drive disease progression. Oncogenic miR-21 is upregulated in many cancers, including BrCa, and is associated with poor survival and treatment resistance. We sought to determine the role of miR-21 in BrCa tumor initiation, progression and treatment response. In a triple-negative BrCa model, radiation exposure increased miR-21 in both primary tumor and metastases. In vitro, miR-21 knockdown decreased survival in all BrCa subtypes in the presence of radiation. The role of miR-21 in BrCa initiation was evaluated by implanting wild-type miR-21 BrCa cells into genetically engineered mouse models where miR-21 was intact, heterozygous …

Combined High-Dose Lattice Radiation Therapy And Immune Checkpoint Blockade For Advanced Bulky Tumors: The Concept And A Case Report, Liuqing Jiang, Xiaobo Li, Jianping Zhang, Wenyao Li, Fangfen Dong, Cheng Chen, Qingliang Lin, Chonglin Zhang, Fen Zheng, Weisi Yan, Yi Zheng, Xiaodong Wu, Benhua Xu

Department of Radiation Oncology Faculty Papers

Although the combination of immune checkpoint blockades with high dose of radiation has indicated the potential of co-stimulatory effects, consistent clinical outcome has been yet to be demonstrated. Bulky tumors present challenges for radiation treatment to achieve high rate of tumor control due to large tumor sizes and normal tissue toxicities. As an alternative, spatially fractionated radiotherapy (SFRT) technique has been applied, in the forms of GRID or LATTICE radiation therapy (LRT), to safely treat bulky tumors. When used alone in a single or a few fractions, GRID or LRT can be best classified as palliative or tumor de-bulking treatments. …

Safety And Efficacy Of Hypofractionated Stereotactic Radiosurgery For High-Grade Gliomas At First Recurrence: A Single-Center Experience., Yun Guan, Ji Xiong, Mingyuan Pan, Wenyin Shi, Jing Li, Huaguang Zhu, Xiu Gong, Chao Li, Guanghai Mei, Xiaoxia Liu, Li Pan, Jiazhong Dai, Yang Wang, Enmin Wang, Xin Wang

Department of Radiation Oncology Faculty Papers

BACKGROUND: The optimal treatment for recurrent high-grade gliomas (rHGGs) remains uncertain. This study aimed to investigate the efficacy and safety of hypofractionated stereotactic radiosurgery (HSRS) as a first-line salvage treatment for in-field recurrence of high-grade gliomas.

METHODS: Between January 2016 and October 2019, 70 patients with rHGG who underwent HSRS were retrospectively analysed. The primary endpoint was overall survival (OS), and secondary endpoints included both progression-free survival (PFS) and adverse events, which were assessed according to Common Toxicity Criteria Adverse Events (CTCAE) version 5. The prognostic value of key clinical features (age, performance status, planning target volume, dose, use of …

Use Of A Cancer Registry To Evaluate Patient-Reported Outcomes Of Immune Checkpoint Inhibitors., Heather S L Jim, Sarah L Eisel, Aasha I Hoogland, Sandra Shaw, Jennifer C King, Adam P Dicker

Department of Radiation Oncology Faculty Papers

Immune checkpoint inhibitors (ICIs) are increasingly used for advanced lung cancer, butfew studies have reported on patient-reported outcomes (PROs) outside the context of a clinicaltrial. The goal of the current study was to assess PROs in participants of a lung cancer registry whohad been treated with an ICI. Patients participating in the GO2Foundation’s Lung Cancer Registrywho reported receiving atezolizumab, durvalumab, nivolumab, or pembrolizumab were invited toparticipate in a survey about their experiences during treatment. Quality of life was evaluated usingthe Functional Assessment of Cancer Therapy–General (FACT-G). Common symptomatic adverseevents were evaluated using an item bank generated for ICIs. Internationally, 226 …

A Systematic Review Of Home-Based Dietary Interventions During Radiation Therapy For Cancer., Taylor H Allenby, Megan L Crenshaw, Katlynn Mathis, Colin E Champ, Nicole L Simone, Kathryn H Schmitz, Leila T Tchelebi, Nicholas G Zaorsky

Department of Radiation Oncology Faculty Papers

Purpose: Our objectives are to assess (1) the acceptability and feasibility of dietary interventions for patients undergoing radiation therapy (RT), and (2) the impact of dietary interventions on patient reported outcomes, toxicities, and survival.

Methods: A PICOS/PRISMA/MOOSE selection protocol was used to include articles that evaluate adding dietary interventions to patients receiving RT. Acceptability was defined as (# accepting/# approached); feasibility was (# completing/# approached). Patient-reported outcomes were reported based on questionnaires used in each study and survival was measured from the date of diagnosis until death in each study. Level of evidence was assessed with Center for Evidence-Based Medicine …

Target Treatment With Stereotactic Radiation For Recurrent Gliomas, Ayesha Ali, Victor E. Chen, Claire Zurlo, James M Taylor, Christian Fernandez, Wenyin Shi

Department of Radiation Oncology Faculty Papers

High grade gliomas (HGG) have a propensity to recur locally and have poor outcomes. As such, safe and effective treatment is paramount. Target treatment with stereotactic radiation allows safe re-irradiation through minimizing normal brain tissue radiation due to its high precision. In this review, we evaluated the clinical experiences using SRS and FSRT for re-irradiation in HGG. We report the radiobiological advantages and disadvantages of both modalities as well as the safety and efficacy published in current literature.

The Impact Of Prostate Cancer Treatment On Quality Of Life: A Narrative Review With A Focus On Randomized Data., James M Taylor, Victor E. Chen, Ryan C. Miller, Benjamin A. Greenberger

Department of Radiation Oncology Faculty Papers

Despite excellent oncologic outcomes, the management of localized prostate cancer remains complex and is dependent on multiple factors, including patient life expectancy, medical comorbidities, tumor characteristics, and genetic risk factors. Decades of iterative clinical trials have improved the optimization and utilization of surgical and radiation-based modalities, as well as their combinatorial use with anti-androgen and systemic therapies. While cure rates are high and converging on equivalent disease control should an upfront surgical or radiotherapeutic approach be optimized, the long-term side effects of surgical and radiation-based treatments can differ significantly in nature. Decisions regarding the selection of therapy are therefore best …

Feasibility Of Removable Balloon Implant For Simultaneous Magnetic Nanoparticle Heating And Hdr Brachytherapy Of Brain Tumor Resection Cavities., Paul R. Stauffer, Dario B. Rodrigues, Robert Goldstein, Thinh Nguyen, Yan Yu, Shuying Wan, Richard Woodward, Michael Gibbs, Ilya L. Vasilchenko, Alexey M. Osintsev, Voichita Bar-Ad, Dennis B. Leeper, Wenyin Shi, Kevin D. Judy, Mark D. Hurwitz

Department of Radiation Oncology Faculty Papers

AIM: Hyperthermia (HT) has been shown to improve clinical response to radiation therapy (RT) for cancer. Synergism is dramatically enhanced if HT and RT are combined simultaneously, but appropriate technology to apply treatments together does not exist. This study investigates the feasibility of delivering HT with RT to a 5-10mm annular rim of at-risk tissue around a tumor resection cavity using a temporary thermobrachytherapy (TBT) balloon implant.

METHODS: A balloon catheter was designed to deliver radiation from High Dose Rate (HDR) brachytherapy concurrent with HT delivered by filling the balloon with magnetic nanoparticles (MNP) and immersing it in a radiofrequency …

Breast Carcinoma Metastasis In A Resected Meningioma With Early Diagnosis Of Oligometastatic Disease: A Case Report., Christian Fernandez, Louis Cappelli, Sara Chapin,, Lawrence Kenyon, Christopher J Farrell, Wenyin Shi

Department of Radiation Oncology Faculty Papers

Tumor-to-tumor metastasis describes the ability of primary tumors to metastasize to other primary tumors. These events generally occur in aggressive and widely-metastatic disease, with the appropriate management and significance of these events unknown. A 56-year-old woman with a history of bilateral, localized, invasive lobular breast carcinoma treated with surgery, systemic therapy, and adjuvant radiation presented five and two years post-treatment with progressive neurological symptoms. Imaging revealed an intracranial meningioma, and the patient underwent resection. Pathology revealed metastatic invasive lobular carcinoma cells within the resected meningioma, and the patient was treated with postoperative radiation without sequelae. Subsequent staging scans revealed a …

Dosimetric Differences Between Cesium-131 And Iodine-125 Brachytherapy For The Treatment Of Resected Brain Metastases, Menachem Yondorf, Shahdabul Faraz, Andrew Smith, Albert Sabbas, Bhupesh Parashar, Theodore Schwartz, Gabriella Wernicke

Department of Radiation Oncology Faculty Papers

Purpose: To compare treatment plans and evaluate dosimetric characteristics of permanent cesium-131 (131Cs) vs. iodine-125 (125I) implants used in brain brachytherapy. Material and methods: Twenty-four patients with 131Cs implants from a prospective phase I/II trial were re-planned with 125I implants. In order to evaluate the volume of brain tissue exposed to radiation therapy (RT), the dose volume histogram was generated for both radioisotopes. To evaluate the dosimetric differences of the two radioisotopes we compared homogeneity (HI) and conformity indices (CI), and dose covering 100% (D100), 90% (D90), 80% (D80), and 50% (D50) of the clinical target volume (CTV). Results: At …

Brain Extraction On Mri Scans In Presence Of Diffuse Glioma: Multi-Institutional Performance Evaluation Of Deep Learning Methods And Robust Modality-Agnostic Training, Siddhesh Thakur, Jimit Doshi, Sarthak Pati, Saima Rathore, Chiharu Sako, Michel Bilello, Sung Min Ha, Gaurav Shukla, Adam Flanders, Aikaterini Kotrotsou, Mikhail Milchenko, Spencer Liem, Bs, Gregory S Alexander, Joseph Lombardo, Joshua D Palmer, Pamela Lamontagne, Arash Nazeri, Sanjay Talbar, Uday Kulkarni, Daniel Marcus, Rivka Colen, Christos Davatzikos, Guray Erus, Spyridon Bakas

Department of Radiation Oncology Faculty Papers

Brain extraction, or skull-stripping, is an essential pre-processing step in neuro-imaging that has a direct impact on the quality of all subsequent processing and analyses steps. It is also a key requirement in multi-institutional collaborations to comply with privacy-preserving regulations. Existing automated methods, including Deep Learning (DL) based methods that have obtained state-of-the-art results in recent years, have primarily targeted brain extraction without considering pathologically-affected brains. Accordingly, they perform sub-optimally when applied on magnetic resonance imaging (MRI) brain scans with apparent pathologies such as brain tumors. Furthermore, existing methods focus on using only T1-weighted MRI scans, even though multi-parametric MRI …

Covid-19 Medical Papers Have Fewer Women First Authors Than Expected., Jens Peter Andersen, Mathias Wullum Nielsen, Nicole L Simone, Resa E Lewiss, Reshma Jagsi

Department of Radiation Oncology Faculty Papers

The COVID-19 pandemic has resulted in school closures and distancing requirements that have disrupted both work and family life for many. Concerns exist that these disruptions caused by the pandemic may not have influenced men and women researchers equally. Many medical journals have published papers on the pandemic, which were generated by researchers facing the challenges of these disruptions. Here we report the results of an analysis that compared the gender distribution of authors on 1893 medical papers related to the pandemic with that on papers published in the same journals in 2019, for papers with first authors and last …

Successful Stereotactic Radiotherapy Of Meningiomas In A Patient With Cowden Syndrome: A Case Report, Christian Fernandez, Md, Corey Savard, Christopher J Farrell, Md, Wenyin Shi

Department of Radiation Oncology Faculty Papers

Cowden's Syndrome (CS) is a rare disease with increased risk for several carcinomas. Experimental studies and limited case reports have described the negative effects of radiotherapy. A 35-yearold woman presented with newly diagnosed CS and multiple meningiomas. She underwent subtotal resection of a right petroclival meningioma to relieve brainstem compression and received adjuvant fractionated stereotactic radiotherapy 50 Gy in 25 fractions with minimal side effects. Twenty months post-operatively the patient presented with neurological deficits from progression of additional meningiomas. Craniotomy was performed and gross total resection was achieved for all sites of disease. Imaging five months after surgery demonstrated progressive …

Dietary Alterations Modulate The Microrna 29/30 And Igf-1/Akt Signaling Axis In Breast Cancer Liver Metastasis., Anuradha A. Shastri, Anthony Saleh, Jason E. Savage, Tiziana Deangelis, Kevin Camphausen, Nicole L. Simone

Department of Radiation Oncology Faculty Papers

Background: Metastatic cancer is incurable and understanding the molecular underpinnings is crucial to improving survival for our patients. The IGF-1/Akt signaling pathway is often impaired in cancer leading to its progression and metastases. Diet modification is known to alter the IGF-1/Akt pathway and affect the expression of microRNA involved in tumor initiation, growth and metastases. Liver metastases are one of the most common type of metastases in breast and colon cancer. In the present study, we looked at the effect of diet modification on the expression of microRNA in normal liver and liver with breast cancer metastases using in vivo …

Design And Analysis Of A Novel Long-Distance Double Tendon-Sheath Transmission Device For Breast Intervention Robots Under Mri Field, Xiaohong Jia, Yongde Zhang, Jingang Jiang, Haiyan Du, Yan Yu

Department of Radiation Oncology Faculty Papers

Cancer represents a major threat to human health. Magnetic resonance imaging (MRI) provides superior performance to other imaging-based examination methods in the detection of tumors and offers distinct advantages in biopsy and seed implantation. However, because of the MRI environment, the material requirements for actuating devices for the medical robots used in MRI are incredibly demanding. This paper describes a novel double tendon-sheath transmission device for use in MRI applications. LeBus grooves are used in the original transmission wheels, thus enabling the system to realize long-distance and large-stroke transmission with improved accuracy. The friction model of the transmission system and …

Spatially Fractionated Radiation Therapy: History, Present And The Future, Weisi Yan, Mohammad K. Khan, Xiaodong Wu, Charles B. Simone Ii, Jiajin Fan, Eric Gressen, Xin Zhang, Charles L. Limoli, Houda Bahig, Slavisa Tubin, Waleed F. Mourad

Department of Radiation Oncology Faculty Papers

No abstract provided.

Phase Iib, Randomized, Double-Blind Trial Of Gc4419 Versus Placebo To Reduce Severe Oral Mucositis Due To Concurrent Radiotherapy And Cisplatin For Head And Neck Cancer., Carryn M. Anderson, Christopher M Lee, Deborah P. Saunders, Amarinthia Curtis, Neal Dunlap, Chaitali Nangia, Arielle S. Lee, Sharon M. Gordon, Philip Kovoor, Roberto Arevalo-Araujo, Voichita Bar-Ad, Abhinand Peddada, Kyle Colvett, Douglas Miller, Anshu K. Jain, James Wheeler, Dukagjin Blakaj, Marcelo Bonomi, Sanjiv S. Agarwala, Madhur Garg, Francis Worden, Jon Holmlund, Jeffrey M. Brill, Matt Downs, Stephen T. Sonis, Sanford Katz, John M. Buatti

Department of Radiation Oncology Faculty Papers

PURPOSE: Oral mucositis (OM) remains a common, debilitating toxicity of radiation therapy (RT) for head and neck cancer. The goal of this phase IIb, multi-institutional, randomized, double-blind trial was to compare the efficacy and safety of GC4419, a superoxide dismutase mimetic, with placebo to reduce the duration, incidence, and severity of severe OM (SOM).

PATIENTS AND METHODS: A total of 223 patients (from 44 institutions) with locally advanced oral cavity or oropharynx cancer planned to be treated with definitive or postoperative intensity-modulated RT (IMRT; 60 to 72 Gy [≥ 50 Gy to two or more oral sites]) plus cisplatin (weekly …

Combined Modality Therapies For High-Risk Prostate Cancer: Narrative Review Of Current Understanding And New Directions., Benjamin A. Greenberger, Victor E. Chen, Robert B. Den

Department of Radiation Oncology Faculty Papers

Despite the many prospective randomized trials that have been available in the past decade regarding the optimization of radiation, hormonal, and surgical therapies for high-risk prostate cancer (PCa), many questions remain. There is currently a lack of level I evidence regarding the relative efficacy of radical prostatectomy (RP) followed by adjuvant radiation compared to radiation therapy (RT) combined with androgen deprivation therapy (ADT) for high-risk PCa. Current retrospective series have also described an improvement in biochemical outcomes and PCa-specific mortality through the use of augmented radiation strategies incorporating brachytherapy. The relative efficacy of modern augmented RT compared to RP is …

Report Of The First Patient Treated For Pelvic Sarcoma With A Directional 103pd Brachytherapy Device., Serguei A. Castaneda, Marian Khalili, Jacqueline Emrich, Veronica M Zoghbi, Michael S Weingarten, Mark J Rivard, Wilbur B Bowne, Jaganmohan Poli

Department of Radiation Oncology Faculty Papers

No abstract provided.

Multi-Institutional Dosimetric Evaluation Of Modern Day Stereotactic Radiosurgery (Srs) Treatment Options For Multiple Brain Metastases., Irina Vergalasova, Haisong Lui, Michelle Alonso-Basanta, Lei Dong, Jun Li, Ke Nie, Wenyin Shi, Boon-Keng Kevin Teo, Yan Yu, Ning Jeff Yue, Wei Zou, Taoran Li

Department of Radiation Oncology Faculty Papers

Purpose/Objectives: There are several popular treatment options currently available for stereotactic radiosurgery (SRS) of multiple brain metastases: 60Co sources and cone collimators around a spherical geometry (GammaKnife), multi-aperture dynamic conformal arcs on a linac (BrainLab Elements™ v1.5), and volumetric arc therapy on a linac (VMAT) calculated with either the conventional optimizer or with the Varian HyperArc™ solution. This study aimed to dosimetrically compare and evaluate the differences among these treatment options in terms of dose conformity to the tumor as well as dose sparing to the surrounding normal tissues.

Methods and Materials: Sixteen patients and a total of 112 metastases …

Single Institution Implementation Of Permanent 131cs Interstitial Brachytherapy For Previously Irradiated Patients With Resectable Recurrent Head And Neck Carcinoma, Voichita Bar-Ad, Emily Hubley, Adam Luginbuhl, David Cognetti, Joseph Curry, Amy Harrison, Jennifer Johnson, James Keller, Cheng Peng, David To, Laura Doyle

Department of Radiation Oncology Faculty Papers

Purpose: Permanent interstitial brachytherapy is an appealing treatment modality for patients with locoregional recurrent, resectable head and neck carcinoma (HNC), having previously received radiation. Cesium-131 (131Cs) is a permanent implant brachytherapy isotope, with a low average photon energy of 30 keV and a short half-life of 9.7 days. Exposure to medical staff and family members is low; patient isolation and patient room shielding are not required. This work presents a single institution’s implementation process of utilizing an intraoperative, permanent 131Cs implant for patients with completely resected recurrent HNC.

Materials & Methods: Fifteen patients receiving 131Cs permanent seed brachytherapy were included …

Rethinking Pulmonary Toxicity In Advanced Non-Small Cell Lung Cancer In The Era Of Combining Anti-Pd-1/Pd-L1 Therapy With Thoracic Radiotherapy., Mengqian Li, Lu Gan, Andrew Song, Jianxin Xue, You Lu

Department of Radiation Oncology Faculty Papers

The combination of programmed cell death 1/programmed cell death ligand 1 blockade and thoracic radiotherapy has become the new standard of care in the treatment of locally advanced non-small-cell lung cancer. The information regarding the pulmonary safety of such therapy remains limited to mostly retrospective studies and case reports with a small portion of data from prospective clinical trials. By analyzing the underlying mechanisms of interactions between radiation and immunotherapy from preclinical data and summarizing safety data from relevant clinical studies with pulmonary toxicity, we believe that longer and rigorous follow-up is warranted, to determine if the combination of such …

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 …

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 …

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 …

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 …

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, …