共查询到20条相似文献，搜索用时 15 毫秒
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Ahsan Farooqi Andrew J. Bishop Saphal Narang Pamela K. Allen Jing Li Mary Frances McAleer Claudio E. Tatsui Laurence D. Rhines Behrang Amini Xin A. Wang Amol J. Ghia 《Practical radiation oncology》2019,9(2):e142-e148
Purpose
Spine stereotactic radiosurgery delivers an ablative dose of radiation therapy (RT) with high conformity relative to standard fractionated RT. This technique is suboptimal for extended targets (>3 vertebral levels) owing to treatment alignment concerns or for patients with marked epidural extension. In these patients, we hypothesized that use of hypofractionated intensity modulated RT/volumetric modulated arc therapy to dose escalate the gross tumor volume (GTV) to 40 Gy as a spinal simultaneous integrated boost (SSIB) would allow for durable local control and palliation.Methods and Materials
We retrospectively analyzed 15 separate spinal sites (12 patients) that were treated with the SSIB technique between 2012 and 2016. The GTV and clinical target volume were prescribed at 40 Gy and 30 Gy, respectively, in 10 fractions. The spinal cord was allowed a maximum point dose of 34 Gy. The GTV was defined as gross tumor. The clinical target volume encompassed the GTV in addition to the involved vertebral bodies, at-risk paraspinal space, and spinal canal, followed by a planning target volume expansion of 3 to 5 mm.Results
The median follow-up for patients in our cohort was 17 months. At 1 year, local control was 93%, and overall survival was 58%, with a median time to death after treatment of 7 months. No grade ≥2 neurologic toxicities were reported for any of the patients. Nine of 12 patients had pain at presentation, of which 7 patients (78%) reported improvement and/or complete resolution of their pain after treatment.Conclusions
Our early experience using a dose of 40 Gy to the GTV delivered via an SSIB technique, in lieu of spine stereotactic radiation surgery but more aggressive than conventional palliative doses, provides durable local control and pain relief. This technique may allow for improved local control and palliation in patients with radioresistant disease compared with conventional 3-dimensional conformal fractionated RT. 相似文献5.
Chronic neutrophilic leukemia (CNL) is a BCR-ABL1–negative myeloproliferative neoplasm with notably dismal survival. The current 2016 World Health Organization classification of myeloid neoplasms enables clinicians to unequivocally differentiate CNL from its comparable myelodysplastic/myeloproliferative neoplasm overlap syndromes. Additionally, the gradual emergence of next-generation sequencing has progressively expanded our evolving understanding of the molecular pathogenesis of CNL and its therapeutic potential. Hematopoietic stem-cell transplantation remains the primary therapeutic option for the effective treatment of CNL. In this comprehensive review, we highlight the contemporaneous classification, diagnostic criteria, and molecular pathogenesis of CNL. We also discuss the therapeutic implications of the heterogeneous molecular fingerprint of CNL, focusing on emerging targeted therapies, specifically inhibitors of JAK and MAPK signaling pathways. 相似文献
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Sean M. Parker R. Alfredo Siochi Sijin Wen Malcolm D. Mattes 《Practical radiation oncology》2019,9(1):e90-e97
Purpose
Stereotactic body radiation therapy (SBRT) is commonly used to treat primary or oligometastatic malignancies in the lung, but most of the available data that describe the safety and efficacy of SBRT are for smaller tumors. The purpose of this study was to evaluate the impact of tumor size, among other factors, on local control (LC) and radiation pneumonitis (RP) in patients who received lung SBRT.Methods and materials
This retrospective study included 144 patients with 100 primary (57.1%) and 75 metastatic (42.9%) lung tumors treated with SBRT between 2012 and 2018. Measurements of tumor size, treatment volume, histology, and radiation dose were evaluated for association with LC. Additional factors evaluated for association with the development of symptomatic RP included volume of the lung, heart, and central airway exposed to relevant doses of radiation.Results
The median follow-up time was 15.0 months (interquartile range, 8.0-26.0 months). LC rates at 12 and 24 months posttreatment were 95.1% and 92.7%, respectively. LC at 1 year was higher for tumors <5 cm in diameter than for tumors >5 cm in diameter (98.2% vs 79.8%, respectively; P < .01). On univariate analysis, LC was associated with a smaller gross tumor volume (GTV) diameter (P < .01), GTV volume (P < .01), planning target volume (PTV) diameter (P < .01), PTV volume (P < .01), and larger PTV-to-GTV ratio (P = .04). Tumor histology and treatment intent were not correlated with LC. RP was associated with a higher ipsilateral lung mean lung dose (P = .02), V2.5 (P = .03), V5 (P = .02), V13 (P = .03), V20 (P = .05), V30 (P = .02), V40 (P = .02), and V50 (P = .03), and several similar total lung dose parameters and heart maximum point dose (P = .02). The optimal mean ipsilateral lung dose cutoff predictive of RP was 8.6 Gy.Conclusions
A larger tumor size and smaller PTV-to-GTV ratio was associated with local recurrence of lung tumors treated with SBRT, but ipsilateral lung doses were most associated with symptomatic RP. 相似文献7.
Shaakir Hasan Paul Renz Matthew Packard Sean Horrigan Steven Gresswell Alexander V. Kirichenko 《Practical radiation oncology》2019,9(1):e38-e45
Purpose
We compared the rate and severity of fatigue in patients who completed stereotactic body radiation therapy (SBRT) to the liver daily (QD) compared with every other day (QOD).Methods and materials
From 2010 to 2017, 91 patients with Child Pugh (CP) A (n = 57) or CP-B (n = 34) cirrhosis who completed 100 SBRT sessions to 110 hepatocellular carcinoma (HCC) lesions were analyzed in this study. Confounding variables with fatigue such as CP-C cirrhosis, Eastern Cooperative Oncology Group score >2, or a history of ascites or encephalopathy were excluded. Fatigue was assessed against several treatment- and patient-related variables with univariate and propensity score-matched multivariate analysis. The median follow-up time was 18 months.Results
Patients with HCC and Barcelona-Clinic Liver Cancer stages 0 (n = 10), A (n = 32), and B (n = 58), and a median age of 62 years were analyzed. The median tumor diameter was 3 cm (1.1-11 cm). The Eastern Cooperative Oncology Group performance status score was 0 (n = 44), 1 (n = 43), or 2 (n = 13). The median dose was 45 Gy in 5 fractions, and 65 treatments were QD and 45 QOD. Grades 1 and 2 fatigue developed in 49% and 14% of treatments, respectively. Among the patients who were treated daily, 78% developed Grade 1 or 2 fatigue compared with 44% who were treated QOD (odds ratio: 4.52; P = .001). Grade 2 fatigue occurred in 22% of patients compared with 7.3% for QD and QOD treatment, respectively (odds ratio: 3.83; P = .048). There was no difference in fatigue rate for time of treatment (morning or afternoon), dose, treated volume, CP score, Barcelona-Clinic Liver Cancer stage, or performance status, which were not associated with any level of fatigue. There was no difference in local control between QD and QOD treatments.Conclusions
Compared with traditional daily treatment fractions, SBRT that is delivered QOD to cirrhotic patients with HCC may reduce the risk of fatigue. 相似文献8.
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Mehran Yusuf Jeremy Gaskins Paul Tennant Jeffrey Bumpous Neal Dunlap 《Practical radiation oncology》2019,9(4):e372-e385
PurposeThis study aimed to determine the impact of time to initiation (TTI) of adjuvant radiation therapy (RT) on overall survival (OS) for patients with stage I or II Merkel cell carcinoma (MCC).Methods and materialsThe National Cancer Database was queried for patients with MCC of the head and neck, trunk, or extremities diagnosed between 2006 and 2014. Patients who did not undergo resection or receive adjuvant RT within 180 days of surgery were excluded. TTI was defined as the time from resection to first RT fraction. Linear regression was used to define factors associated with TTI. Recursive partitioning analysis modeling was performed to determine an optimal threshold for TTI. Cox proportional hazards modeling was performed to define covariates associated with OS.ResultsA total of 2293 patients were included in this study. The median TTI for the cohort was 62 days (interquartile range, 43-86 days). TTI was not associated with OS for the overall cohort by multivariable Cox modeling (P = .19). Age, treatment facility type, lymph node examination, anatomic subsite, and surgical margin were associated with TTI (P < .05). Age, sex, insurance status, Charlson-Deyo comorbidity score, lymph node examination status, tumor size, and surgical margin were associated with OS (all P < .05).ConclusionsIncreased TTI of adjuvant RT was not associated with OS for patients with early stage MCC in this analysis of the National Cancer Database. The median TTI of 62 days from resection to adjuvant RT initiation for our study cohort contextualizes TTI on a national level and may offer reassurance for patients with prolonged postoperative wound healing or intercurrent illness delaying immediate RT initiation. Despite the lack of a clear detriment to survival with increased TTI up to 180 days from surgery, unnecessary delays in initiating adjuvant therapy should continue to be minimized while ensuring optimal recovery from resection. 相似文献
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Narek Shaverdian Eric M. Chang Fang-I Chu Elizabeth Grace Morasso Michael A. Pfeffer Eric M. Cheng Allan Wu Susan A. McCloskey Ann C. Raldow Michael L. Steinberg 《Practical radiation oncology》2019,9(2):102-107
Purpose
There is an increasing effort to allow patients open access to their physician notes through electronic medical record portals. However, limited data exist on the impact of such access on oncology patients, and concerns remain regarding potential harms. Therefore, we determined the baseline perceptions and impact of open access to oncology notes on radiation oncology patients.Methods and materials
Patients receiving radiation therapy were provided instructional materials on accessing oncology notes at the time of their initial evaluation. Patients were prospectively surveyed to evaluate baseline interest and expectations before access and to determine the actual usage and impact at the end of their radiation treatment course.Results
A total of 220 patients were surveyed; 136 (62%) completed the baseline survey, of which 88 (40%) completed the final survey. The majority of participants were age >60 years (n = 83; 61%), and 70 were male (51%). Before accessing the notes, the majority of patients agreed that open access to oncology notes would improve understanding of diagnosis (99%), understanding of treatment side effects (98%), reassurance about treatment goals (96%), and communication with family (99%). All patients who accessed the notes found them to be useful. After accessing the notes, approximately 96%, 94%, and 96% of patients reported an improved understanding of their diagnosis, an improved understanding of treatment side effects, and feeling more reassured about their treatment, respectively. Approximately 11%, 6%, and 4% of patients noted increased worry, increased confusion, and finding information they now regret reading, respectively. Patient age, sex, and specific cancer diagnoses were not predictive of experiencing negative effects from accessing the notes.Conclusions
Radiation oncology patients have a strong interest in open access to their physician notes, and the majority of patients expect and actually report meaningful benefits. These data support strategies to allow more patients with cancer access to their physicians’ notes. 相似文献11.
Baoshe Zhang Sung-Woo Lee Shifeng Chen Jinghao Zhou Karl Prado Warren D&#x;Souza Byongyong Yi 《Practical radiation oncology》2019,9(1):49-54
Purpose
This study aimed to develop action levels for replanning to accommodate dosimetric variations resulting from anatomic changes during the course of treatments, using daily cone beam computed tomography (CBCT).Methods and materials
Daily or weekly CBCT images of 20 patients (10 head and neck, 5 lung, and 5 prostate cancers) who underwent resimulation per physicians' clinical decisions, mainly from the comparison of CBCT scans, were used to determine action levels. The first CBCT image acquired before the first treatment was used as the reference image to rule out effects of dose inaccuracy from the CBCT. The Pearson correlation of clinical target volume (CTV) was used as a parameter of anatomic variation. Parameters for action levels on dose and anatomic variation were deduced by comparing the parameters and clinical decisions made for replanning. A software tool was developed to automatically perform all procedures, including dose calculations, using the CBCT and plan evaluations.Results
Replans were clinically decided based on either significant dose or anatomic changes in 13 cases. The 7 cases that did not require replanning showed dose differences <5%, and the Pearson correlation of the CTV was >75% for all fractions. A difference in planning target volume dose >5% or a difference in the image correlation coefficient of the CTV <0.75 proved to be indicators for replanning. Once the results of the CBCT plan met the replanning criteria, the software tool automatically alerted the attending physician and physicist by both e-mail and pager so that the case could be examined closely.Conclusions
Our study shows that a dose difference of 5% and/or anatomy variation at 0.75 Pearson correlations are practical action levels on dose and anatomic variation for replanning for the given data sets. 相似文献12.
Fieke M. Prins Bjorn Stemkens Linda G.W. Kerkmeijer Maurits M. Barendrecht Hans J. de Boer Evert-Jan P.A. Vonken Jan J.W. Lagendijk Rob H.N. Tijssen 《Practical radiation oncology》2019,9(1):e55-e61
Purpose
One of the major challenges in stereotactic body radiation therapy (SBRT) of renal cell carcinoma is internal motion during treatment. Previous literature has aimed to mitigate the effects of motion by expanding the treatment margins or respiratory tracking. Online magnetic resonance imaging (MRI)-guided radiation therapy has the potential to further improve the treatment of renal cell carcinoma by direct visualization of the tumor during treatment. The efficacy of 2 motion management techniques were assessed: tumor trailing and respiratory tracking. The simulation of a single-fraction, MRI-based SBRT was performed to quantify intrafraction motion and assess the efficacy of the different motion management strategies.Methods and materials
Fifteen patients were included in the study. At the beginning and end of the scanning protocol, 2 cine-MRI scans were acquired to assess cyclic respiratory motion. In addition, 3-dimensional spoiled gradient echo scans were acquired at 4 different time points to assess the slow drifts over 25 minutes. The systematic and random errors owing to intrafraction drift were calculated, as well as the random error induced by respiratory motion. The motion margins were calculated for tumor trailing and respiratory tracking and compared with the margin when no motion compensation would be performed to assess the relative efficacy of each technique.Results
The largest respiratory tumor motion was observed along the caudo-cranial direction with a median 95% maximum amplitude of approximately 12 mm. ΣDRIFT, σDRIFT, and σRESP were determined to be 1.0 mm 1.8 mm, and 3.8 mm, respectively. Without mechanical immobilization, intrafraction drift accounted for 75% of the total intrafraction motion margin for online midposition-based SBRT treatments.Conclusions
The contribution of intrafraction drift to the total internal motion margin is much larger than periodic respiratory motion. This makes tumor trailing a viable option to consider on the MRI linac because it allows for 3-dimensional MRI acquisitions during beam delivery, which simplifies the introduction of new techniques, such as dose accumulation and online intrafraction replanning. 相似文献13.
Nitin Ohri Wolfgang Tomé Shalom Kalnicki Madhur Garg 《Practical radiation oncology》2018,8(2):e33-e39
Background
Stereotactic body radiation therapy (SBRT) is increasingly used to treat early-stage non-small cell lung cancer (NSCLC). A previous report introduced the term size-adjusted biologically effective dose (sBED), which accounts for tumor diameter and biologically effective dose (BED) and may be used to predict the likelihood of local control following SBRT. Here we seek to replicate those findings using a separate dataset.Methods and materials
We queried the RSSearch Patient Registry for patients treated with SBRT for stage I NSCLC. Kaplan-Meier survival curves, log-rank testing, and Cox proportional hazards modeling were used to evaluate tumor diameter, BED, and treatment planning algorithm as predictors of local control. sBED was defined as BED minus 10 times the tumor diameter (in centimeters). Tumor control probability (TCP) modeling was performed to characterize the relationship between sBED and the likelihood of local control 2 years after SBRT.Results
A total of 928 patients met inclusion criteria. Median BED was 115.5 Gy, and 59% of patients had T1 tumors. Local control rates following treatments planned using a pencil beam algorithm were inferior to those observed following treatments planned using a Monte Carlo algorithm (89% vs 96% at 2 years, log-rank P = .022). In a multivariable Cox model adjusted for tumor diameter and BED, the use of a pencil beam planning algorithm was associated with increased risk of local failure (hazard ratio, 2.39; 95% confidence interval, 1.08-5.29; P = .032). TCP modeling, restricted to patients treated using a Monte Carlo algorithm, demonstrated that sBED values of 60, 80, and 100 Gy yield predicted TCP rates of 91%, 95%, and 97%, respectively.Conclusions
Using a large, multi-institutional database, we found a strong association between treatment planning algorithm and local control rates following SBRT for early-stage NSCLC. sBED is a useful tool for predicting the likelihood of local control following SBRT in this setting. 相似文献14.
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Olamide O. Omidele Mark Finkelstein Aisosa Omorogbe Michael Palese 《Clinical genitourinary cancer》2019,17(5):e1011-e1019
IntroductionThe objective of this study was to assess the impact of volume status on socio-demographic disparities for radical prostatectomy (RP) in New York State.Patients and MethodsAll patients undergoing RP from 2006 to 2014 with an admitting or principal diagnosis of prostate cancer were identified. All 40,533 cases were separated into volume groups stratified by hospital and physician quartiles with a goal of maintaining consistent numbers between the 4 volume groups. Patient-level data included race, ethnicity, Charlson Comorbidity Index (CCI), median income by zip code, and source of payment. Hospital-level data included hospital location, teaching status, health service area, and facility number. Continuous and categorical variables were compared between cohorts using the Mann-Whitney-Wilcoxon test and Pearson χ2 tests, respectively. Multivariate regression analysis was conducted to assess predictors of access to very high-volume facilities and physician groups as well as predictors of receiving a minimally invasive RP.ResultsOf 40,533 total cases, 9602 (24%) were conducted at low-volume hospitals, 9208 (22%) were conducted at medium-volume hospitals, 8478 (21%) were conducted at high-volume hospitals, and 13,245 (33%) were conducted at very high-volume hospitals. Negative predictors of receiving care from a very high-volume physician include increased CCI, Asian race, black race, unknown race, Medicaid status, age 65 to 79 years, and age 80 to 130 years (P < .001). Negative predictors of receiving care from a very high-volume facility include Asian race, black race, unknown race, Medicaid status, and self-payment status (P < .001).ConclusionSocioeconomic disparities exist in New York State for RP and are associated with disadvantaged groups being overrepresented in low-volume hospital and physician groups. 相似文献
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Hiram A. Gay Roberto Santiago Betty Gil Carlos Remedios Pedro J. Montes Javier López-Araujo Carlos M. Chévere Winston S. Imbert Julia White Douglas W. Arthur Janet K. Horton Reshma Jagsi Rachel Rabinovich Sushil Beriwal Akila Viswanathan Beth A. Erickson Ramesh Rengan David Palma Omer Lee Burnett 《Practical radiation oncology》2019,9(5):305-321
PurposeAlthough the wind, rain, and flooding of Hurricane Maria in Puerto Rico abated shortly after its landfall on September 20, 2017, the disruption of the electrical, communications, transportation, and medical infrastructure of the island was unprecedented in scope and caused lasting harm for many months afterward. A compilation of recommendations from radiation oncologists who were in Puerto Rico during the disaster, and from a panel of American Society for Radiation Oncology (ASTRO) cancer experts was created.Methods and materialsRadiation oncologists throughout Puerto Rico collaborated and improvised to continue treating patients in the immediate aftermath of the storm and as routine clinical operations were restored gradually. Empirical lessons from the experience of radiation therapy administration in this profoundly altered context of limited resources, impaired communication, and inadequate transportation were organized into a recommended template, applicable to any radiation oncology practice. ASTRO disease-site experts provided evidence-guidelines for mitigating the impact of a 2- to 3-week interruption in radiation therapy.ResultsPractical measures to mitigate the medical impact of a disaster are summarized within the framework of “Prepare, Communicate, Operate, Compensate.” Specific measures include the development of an emergency operations plan tailored to specific circumstances, prospective coordination with other radiation oncology clinics before a disaster, ongoing communications with emergency management organizations, and routine practice of alternate methods to disseminate information among providers and patients.ConclusionsThese recommendations serve as a starting point to assist any radiation oncology practice in becoming more resiliently prepared for a local or regional disruption from any cause. Disease-site experts provide evidence-based guidelines on how to mitigate the impact of a 2- to 3-week interruption in radiation therapy for lung, head and neck, uterine cervix, breast, and prostate cancers through altered fractionation or dose escalation. 相似文献
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Lauren E. Henke Jessika A. Contreras Thomas Mazur Olga Green Nalini Daniel Hilary Lashmett Tammy Senter H. Michael Gach Laura Ochoa Sasa Mutic Imran Zoberi Jeffrey Bradley Clifford Robinson Maria A. Thomas 《Practical radiation oncology》2019,9(3):e298-e306
PurposeCardiac radiation is associated with cardiotoxicity in patients with thoracic and breast malignancies. We conducted a prospective study using cine magnetic resonance imaging (MRI) scans to evaluate heart motion. We hypothesized that cine MRI could be used to define population-based cardiac planning organ-at-risk volumes (PRV).Methods and MaterialsA total of 16 real-time acquisitions were obtained per subject on a 1.5 Tesla MRI (Philips Ingenia). Planar cine MRI was performed in 4 sequential sagittal and coronal planes at free-breathing (FB) and deep-inspiratory breath hold (DIBH). In-plane cardiac motion was assessed using a scale-invariant feature transformation–based algorithm. Subject-specific pixel motion ranges were defined in anteroposterior (AP), left-right (LR), and superoinferior (SI) planes. Averages of the 98% and 67% of the maximum ranges of pixel displacement were defined by subject, then averaged across the cohort to calculate PRV expansions at FB and DIBH.ResultsData from 20 subjects with a total of 3120 image frames collected per subject in coronal and sagittal planes at DIBH and FB, and 62,400 total frames were analyzed. Cohort averages of 98% of the maximum cardiac motion ranges comprised margin expansions of 12.5 ± 1.1 mm SI, 5.8 ± 1.2 mm AP, and 6.6 ± 1.0 mm LR at FB and 6.7 ± 1.5 mm SI, 4.7 ± 1.3 mm AP, and 5.3 ± 1.3 mm LR at DIBH. Margins for 67% of the maximum range comprised 7.7 ± 0.7 mm SI, 3.2 ± 0.6 mm AP, and 3.7 ± 0.6 mm LR at FB and 4.1 ± 0.9 mm SI, 2.7 ± 0.8 mm AP, and 3.2 ± 0.8 mm LR at DIBH. Subsequently, these margins were simplified to form PRVs for treatment planning.ConclusionsWe implemented scale-invariant feature transformation-based motion tracking for analysis of the cardiac cine MRI scans to quantify motion and create cohort-based cardiac PRVs to improve cardioprotection in breast and thoracic radiation. 相似文献
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Purpose
Stereotactic body radiation therapy (SBRT) is increasingly utilized in the neoadjuvant and definitive settings for pancreatic adenocarcinoma. The risk of local and regional recurrence after this treatment remains largely unknown. Because of the lack of elective nodal treatment and high fractional dose, we hypothesized that the incidence of regional out-of-field recurrence would predominate after SBRT.Methods and materials
Electronic medical records of all patients treated in our department with SBRT for pancreatic adenocarcinoma were retrospectively reviewed. Patients were separated into those who converted or did not convert to surgical resectability. Demographic, treatment, and outcome data were collected and analyzed. Recurrence was assessed based on the Response Evaluation Criteria In Solid Tumors version 1.1. Treatment plans were reviewed to determine the locations of failure with respect to treatment volume. Statistical comparisons were made using Mann-Whitney U testing for continuous variables and χ2 testing for dichotomous variables.Results
Data on 69 patients was available for analysis. After treatment, 18 patients (26.1%) suffered in-field recurrence and 11 patients (15.9%) recurred regionally out of field. The median time to in-field and out-of-field failures were similar at 120.5 and 108.0 days, respectively (P = .65). Of those who failed out-of-field, 4 of 11 patients (36.4%) were without in-field failure prior to death. In-field failure rates were less in patients who subsequently underwent surgical resection compared with those who did not (2 of 22 patients [9.1%] vs 16 of 47 patients [34.0%]; P = .028), but out-of-field recurrence was unaffected by subsequent surgical resection (3 of 22 patients [13.6%] vs 8 of 47 patients [17.0%]; P = .720). All out-of-field failures occurred in areas that received <2600 cGy.Conclusions
The incidence of out-of-field failure remains acceptable after SBRT for pancreatic adenocarcinoma. Despite the high biological equivalent dose allowed by SBRT, in-field control remains problematic and continues to signal relative radiation resistance that is associated with bulky disease. 相似文献20.
Bindu V. Manyam Gregory M.M. Videtic Kyle Verdecchia Chandana A. Reddy Neil M. Woody Kevin L. Stephans 《Practical radiation oncology》2019,9(2):e187-e195