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van Sörnsen de Koste JR, van Vliet CC, Schneiders FL, Bruynzeel AME, Slotman BJ, Palacios MA, Senan S. Renal atrophy following gated delivery of stereotactic ablative radiotherapy to adrenal metastases. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2021; 20:1-4. [PMID: 34604552 PMCID: PMC8473532 DOI: 10.1016/j.phro.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 11/22/2022]
Abstract
Stereotactic ablative radiotherapy (SABR) planning for adrenal metastases aims to minimize doses to the adjacent kidney. Renal dose constraints for SABR delivery are not well defined. In 20 patients who underwent MR-guided breath-hold SABR in five daily fractions of 8–10 Gy, ipsilateral renal volumes receiving ≥20 Gy best correlated with loss of renal volumes, with median renal volume reduction being 6% (range: 3%-11%, 10th-90th percentiles). Organ function did not deteriorate in 18 patients, who had post treatment renal function tests available. This suggests that the ipsilateral renal volume receiving 20 Gy can be used as partial organ dose constraint for SABR to targets in the upper abdomen.
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Affiliation(s)
- John R van Sörnsen de Koste
- Department of Radiation Oncology, Amsterdam University Medical Centers, location VUmc, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Claire C van Vliet
- Department of Radiation Oncology, Amsterdam University Medical Centers, location VUmc, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Famke L Schneiders
- Department of Radiation Oncology, Amsterdam University Medical Centers, location VUmc, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Anna M E Bruynzeel
- Department of Radiation Oncology, Amsterdam University Medical Centers, location VUmc, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Berend J Slotman
- Department of Radiation Oncology, Amsterdam University Medical Centers, location VUmc, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Miguel A Palacios
- Department of Radiation Oncology, Amsterdam University Medical Centers, location VUmc, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Centers, location VUmc, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Amiri S, Akbarabadi M, Abdolali F, Nikoofar A, Esfahani AJ, Cheraghi S. Radiomics analysis on CT images for prediction of radiation-induced kidney damage by machine learning models. Comput Biol Med 2021; 133:104409. [PMID: 33940534 DOI: 10.1016/j.compbiomed.2021.104409] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 04/14/2021] [Accepted: 04/14/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION We aimed to assess the power of radiomic features based on computed tomography to predict risk of chronic kidney disease in patients undergoing radiation therapy of abdominal cancers. METHODS 50 patients were evaluated for chronic kidney disease 12 months after completion of abdominal radiation therapy. At the first step, the region of interest was automatically extracted using deep learning models in computed tomography images. Afterward, a combination of radiomic and clinical features was extracted from the region of interest to build a radiomic signature. Finally, six popular classifiers, including Bernoulli Naive Bayes, Decision Tree, Gradient Boosting Decision Trees, K-Nearest Neighbor, Random Forest, and Support Vector Machine, were used to predict chronic kidney disease. Evaluation criteria were as follows: accuracy, sensitivity, specificity, and area under the ROC curve. RESULTS Most of the patients (58%) experienced chronic kidney disease. A total of 140 radiomic features were extracted from the segmented area. Among the six classifiers, Random Forest performed best with the accuracy and AUC of 94% and 0.99, respectively. CONCLUSION Based on the quantitative results, we showed that a combination of radiomic and clinical features could predict chronic kidney radiation toxicities. The effect of factors such as renal radiation dose, irradiated renal volume, and urine volume 24-h on CKD was proved in this study.
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Affiliation(s)
- Sepideh Amiri
- Department of Information Technology, Faculty of Electrical and Computer Engineering, University of Tehran, Tehran, Iran.
| | - Mina Akbarabadi
- Department of Information Technology, Faculty of Industrial Engineering, K. N. Toosi University of Technology, Tehran, Iran.
| | - Fatemeh Abdolali
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, Alberta University, Edmonton, AB, Canada.
| | - Alireza Nikoofar
- Department of Radiation Oncology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Azam Janati Esfahani
- Department of Medical Biotechnology, School of Paramedical Sciences and Cellular and Molecular Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
| | - Susan Cheraghi
- Radiation Biology Research Center, Iran University of Medical Sciences, Tehran, Iran; Department of Radiation Sciences, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran.
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Phase I/II Trial of Neoadjuvant Oregovomab-based Chemoimmunotherapy Followed by Stereotactic Body Radiotherapy and Nelfinavir For Locally Advanced Pancreatic Adenocarcinoma. Am J Clin Oncol 2020; 42:755-760. [PMID: 31513018 DOI: 10.1097/coc.0000000000000599] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Cancer antigen (CA)-125 influences progression, metastasis, and outcomes in pancreatic cancer. This phase I/II trial (NCT01959672) evaluated the safety, efficacy, and immunologic correlates of chemoimmunotherapy (CIT) with oregovomab (anti-CA-125), followed by stereotactic body radiotherapy (SBRT) with the radiosensitizer nelfinavir. MATERIALS AND METHODS Following imaging, pathologic confirmation, and staging laparoscopy, subjects received three 3-week cycles of CIT (gemcitabine/leucovorin/fluorouracil/oregovomab). Thereafter, nelfinavir was delivered (1250 mg bid) for 5 weeks, with SBRT (40 Gy/5 fractions) occurring during the third week of nelfinavir. Following another cycle of CIT, pancreaticoduodenectomy was performed if resectable. Three more cycles of CIT were then delivered (total 7 cycles). In subjects with high (≥10 U/mL) CA-125, oregovomab (2 mg) was administered for 7 total doses (3 pre-SBRT, 1 between SBRT and resection, and 3 postoperatively). The enzyme-linked immunospot assay evaluated the development of CA-125-specific CD8 T-lymphocytes. RESULTS The trial was prematurely closed because gemcitabine/leucovorin/fluorouracil was replaced by FOLFIRINOX and gemcitabine/nab-paclitaxel as the standard of care. Median follow-up was 13 months. Of 11 enrolled patients, 10 had high CA-125; 1 patient suffered an unexpected cardiac-related death, so 9 subjects received oregovomab. Ten received SBRT and 4 underwent resection. Overall, 6/11 patients experienced any grade ≥3 event. The median survival and time to progression were 13 and 8.6 months, respectively. Five patients had samples available for immunospot testing, of whom 2 (40%) developed CA-125-specific CD8 T-lymphocytes. CONCLUSION A combined pancreatic cancer multimodality approach using CIT and radiosensitized radiotherapy is feasible and safe; delivery of immunotherapy can lead to T-cell immunity. Re-evaluation with modern systemic paradigms is recommended.
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Neilsen BK, Lin C. Changing paradigm of radiation therapy for the treatment of pancreatic cancer. PRECISION RADIATION ONCOLOGY 2019. [DOI: 10.1002/pro6.1080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Beth K Neilsen
- Department of Radiation OncologyUniversity of Nebraska Medical Center Omaha Nebraska USA
| | - Chi Lin
- Department of Radiation OncologyUniversity of Nebraska Medical Center Omaha Nebraska USA
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Lin C, Verma V, Ly QP, Lazenby A, Sasson A, Schwarz JK, Meza JL, Are C, Li S, Wang S, Hahn SM, Grem JL. Phase I trial of concurrent stereotactic body radiotherapy and nelfinavir for locally advanced borderline or unresectable pancreatic adenocarcinoma. Radiother Oncol 2018; 132:55-62. [PMID: 30825970 DOI: 10.1016/j.radonc.2018.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 10/26/2018] [Accepted: 11/05/2018] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The HIV protease inhibitor nelfinavir (NFV) displays notable radiosensitizing effects. There have been no studies evaluating combined stereotactic body radiotherapy (SBRT) and NFV for borderline/unresectable pancreatic cancer. The primary objective of this phase I trial (NCT01068327) was to determine the maximum tolerated SBRT/NFV dose, and secondarily evaluate outcomes. METHODS Following initial imaging, pathologic confirmation, and staging laparoscopy, subjects initially received three 3-week cycles of gemcitabine/leucovorin/fluorouracil; patients without radiologic progression received 5-fraction SBRT/NFV. Dose escalation was as follows: (1) 25 Gy/625 mg BID ×3wks; (2) 25 Gy/1250 mg BID ×3wks; (3) 30 Gy/1250 mg BID ×3wks; (4) 35 Gy/1250 mg BID ×3wks; (5) 35 Gy/1250 mg BID ×5wks; and (6) 40 Gy/1250 mg BID ×5wks. Pancreaticoduodenectomy was performed thereafter if resectable; if not, gemcitabine/leucovorin/fluorouracil was administered. RESULTS Forty-six patients enrolled (10/2008-5/2013); 39 received protocol-directed therapy. Sixteen (41%) experienced any grade ≥2 event during and 1 month after SBRT. Four grade 3 and both grade 4 events occurred in a single patient at the initial dose level. 40 Gy/1250 mg BID ×5wks was the maximum tolerated dose. Five patients had late gastrointestinal bleeding (n = 2 superior mesenteric artery pseudo-aneurysm, n = 1 disease progression, n = 1 lower GI tract, n = 1 unknown location). The median overall survival was 14.4 months. Six (15%) patients recurred locally; median local failure-free survival was not reached. The median distant failure-free survival was 11 months, and median all failure-free survival was 10 months. CONCLUSIONS Concurrent SBRT (40 Gy)/NFV (1250 mg BID) for locally advanced pancreatic cancer is feasible and safe, although careful attention to treatment planning parameters is recommended to reduce the incidence of late gastrointestinal bleeding.
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Affiliation(s)
- Chi Lin
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, USA.
| | - Vivek Verma
- Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, USA
| | - Quan P Ly
- Department of Surgery, University of Nebraska Medical Center, Omaha, USA
| | - Audrey Lazenby
- Department of Pathology, University of Nebraska Medical Center, Omaha, USA
| | - Aaron Sasson
- Department of Surgery, Stony Brook School of Medicine, Stony Brook, USA
| | - James K Schwarz
- Department of Internal Medicine, Division of Hematology Oncology, University of Nebraska Medical Center, Omaha, USA
| | - Jane L Meza
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, USA
| | - Chandrakanth Are
- Department of Surgery, University of Nebraska Medical Center, Omaha, USA
| | - Sicong Li
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, USA
| | - Shuo Wang
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, USA
| | - Stephen M Hahn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Jean L Grem
- Department of Internal Medicine, Division of Hematology Oncology, University of Nebraska Medical Center, Omaha, USA
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Toesca DAS, Koong AJ, von Eyben R, Koong AC, Chang DT. Stereotactic body radiation therapy for adrenal gland metastases: Outcomes and toxicity. Adv Radiat Oncol 2018; 3:621-629. [PMID: 30370363 PMCID: PMC6200881 DOI: 10.1016/j.adro.2018.05.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/07/2018] [Accepted: 05/14/2018] [Indexed: 12/15/2022] Open
Abstract
Purpose This study aimed to report on our institutional experience in the use of stereotactic body radiation therapy (SBRT) for the treatment of adrenal gland metastases. Specifically, we examined the outcomes and toxicity from this treatment modality on adjacent organs at risk. Methods and Materials Data were retrieved from patients with adrenal metastases who were treated with SBRT between 2008 and 2017. Patients with primary adrenal malignancies were excluded. Toxicities were graded in accordance with the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.03. Time-to-event rates were calculated from the date of SBRT delivery. Results In total, 35 patients with adrenal metastases were identified. Four patients were treated for bilateral disease. The median dose was 40 Gy (range, 20-54 Gy) in 5 fractions (range, 1-6 fractions). The median follow-up time was 37 months (range, 14-451 months) from disease diagnosis and 7 months (range, 1-54 months) from the SBRT start date. With death treated as a competing risk event, the cumulative incidence of local failure was 7.6% at 1 year after SBRT and 19.2% at 3 years. The median overall survival (OS) time was 19 months (95% confidence interval, 8-54 months) and tumor size correlated with survival (P = .0006). Patients with metastases <2.9 cm had a median OS of 54 months compared with 11 months for those with adrenal metastases ≥2.9 cm (P = .01). Incidence of grade 2 toxicity was 17% with no case of grade ≥3 toxicity. SBRT did not impact renal function with a mean estimated decline in glomerular filtration rate of only 2.6 ± 8 mL/min/1.73 m2 compared with baseline. Combined kidneys V5 and combined renal cortex V17.5 did not correlate with a change in estimated glomerular filtration rate (P = .7 and P = .9, respectively). Conclusions SBRT offers excellent local control for the treatment of adrenal gland metastases with very low toxicity rates and no significant short-term impact on renal function.
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Affiliation(s)
- Diego A S Toesca
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California
| | - Amanda J Koong
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California
| | - Rie von Eyben
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California
| | - Albert C Koong
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Daniel T Chang
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California
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Haque W, Verma V, Lewis GD, Lo SS, Butler EB, Teh BS. Utilization of radiotherapy and stereotactic body radiation therapy for renal cell cancer in the USA. Future Oncol 2018. [PMID: 29527938 DOI: 10.2217/fon-2017-0536] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
AIM This study evaluated national practice patterns of cT1N0M0 renal cell cancer, with a focus on stereotactic body radiation therapy (SBRT) utilization. METHODS The National Cancer Database was queried (2004-2013) for patients with newly-diagnosed cT1a/bN0M0 renal cell cancer that received definitive treatment. Temporal trends in utilization were tabulated. RESULTS Altogether, 138,495 patients met inclusion criteria; 13,725 (9.9%) patients received ablative therapy, 57,924 (41.8%) partial nephrectomy, 67,168 (48.5%) radical nephrectomy and 308 (0.2%) external beam radiation therapy (EBRT). The proportion of EBRT that was SBRT increased substantially from 25% in 2004 to 95.4% in 2013, with a sharp inflection point from 2005 to 2006. CONCLUSION SBRT utilization has sharply risen over time; in most recent years, the vast majority of EBRT is delivered in the form of SBRT.
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Affiliation(s)
- Waqar Haque
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Vivek Verma
- Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA 15212, USA
| | - Gary D Lewis
- Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Simon S Lo
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Edward Brian Butler
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Bin S Teh
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX 77030, USA
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Verma V, Simone CB. Approaches to stereotactic body radiation therapy for large (≥5 centimeter) non-small cell lung cancer. Transl Lung Cancer Res 2018; 8:70-77. [PMID: 30788236 DOI: 10.21037/tlcr.2018.06.10] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Although larger (≥5 cm) node-negative non-small cell lung cancer (NSCLC) lesions are altogether uncommon, their incidence may increase following the implementation of lung cancer screening. A rigorous assessment of stereotactic body radiation therapy (SBRT) for these challenging cases is imperative not only owing to concerns of increased risks when delivering ablative doses to large volumes, but also due to lack of prospective data, as these patients were excluded from seminal phase II SBRT trials. In addition to appraising the available institutional or multi-institutional experiences, multiple strategies to reduce toxicities are discussed. These include exploration of several different dose/fractionation schemes and regimens, as well as specialized techniques for SBRT treatment planning and delivery. Because these lesions have a higher rate of occult lymphatic or distant spread, the role of systemic therapies (including chemotherapy and immunotherapy) are also discussed. Altogether, the publication of several key reports, entirely over the last few years, has created a more solid foundation with which to utilize evidence-based management for this unique patient population.
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Affiliation(s)
- Vivek Verma
- Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Charles B Simone
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
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