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Mutsaers A, Li G, Fernandes J, Ali S, Barnes E, Chen H, Czarnota G, Karam I, Moore-Palhares D, Poon I, Soliman H, Vesprini D, Cheung P, Louie A. Uncovering the armpit of SBRT: An institutional experience with stereotactic radiation of axillary metastases. Clin Transl Radiat Oncol 2024; 45:100730. [PMID: 38317679 PMCID: PMC10839264 DOI: 10.1016/j.ctro.2024.100730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/07/2024] Open
Abstract
Purpose/objectives The growing use of stereotactic body radiotherapy (SBRT) in metastatic cancer has led to its use in varying anatomic locations. The objective of this study was to review our institutional SBRT experience for axillary metastases (AM), focusing on outcomes and process. Materials/methods Patients treated with SBRT to AM from 2014 to 2022 were reviewed. Cumulative incidence functions were used to estimate the incidence of local failure (LF), with death as competing risk. Kaplan-Meier method was used to estimate progression-free (PFS) and overall survival (OS). Univariate regression analysis examined predictors of LF. Results We analyzed 37 patients with 39 AM who received SBRT. Patients were predominantly female (60 %) and elderly (median age: 72). Median follow-up was 14.6 months. Common primary cancers included breast (43 %), skin (19 %), and lung (14 %). Treatment indication included oligoprogression (46 %), oligometastases (35 %) and symptomatic progression (19 %). A minority had prior overlapping radiation (18 %) or surgery (11 %). Most had prior systemic therapy (70 %).Significant heterogeneity in planning technique was identified; a minority of patient received 4-D CT scans (46 %), MR-simulation (21 %), or contrast (10 %). Median dose was 40 Gy (interquartile range (IQR): 35-40) in 5 fractions, (BED10 = 72 Gy). Seventeen cases (44 %) utilized a low-dose elective volume to cover remaining axilla.At first assessment, 87 % had partial or complete response, with a single progression. Of symptomatic patients (n = 14), 57 % had complete resolution and 21 % had improvement. One and 2-year LF rate were 16 % and 20 %, respectively. Univariable analysis showed increasing BED reduced risk of LF. Median OS was 21.0 months (95 % [Confidence Interval (CI)] 17.3-not reached) and median PFS was 7.0 months (95 % [CI] 4.3-11.3). Two grade 3 events were identified, and no grade 4/5. Conclusion Using SBRT for AM demonstrated low rates of toxicity and LF, and respectable symptom improvement. Variation in treatment delivery has prompted development of an institutional protocol to standardize technique and increase efficiency. Limited followup may limit detection of local failure and late toxicity.
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Affiliation(s)
- A. Mutsaers
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - G.J. Li
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - J.S. Fernandes
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - S. Ali
- Department of Radiation Therapy, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - E.A. Barnes
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - H. Chen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - G.J. Czarnota
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - I. Karam
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - D. Moore-Palhares
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - I. Poon
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - H. Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - D. Vesprini
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - P. Cheung
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
| | - A.V. Louie
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Hospital, University of Toronto, Canada
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Mutsaers A, Fernandes JS, Li GJ, Ali S, Palhares DM, Chen H, Cheung P, Czarnota GJ, Karam I, Poon I, Soliman H, Vesprini D, Sahgal A, Louie AV. Uncovering the Armpit of Axillary SBRT. Int J Radiat Oncol Biol Phys 2023; 117:e195. [PMID: 37784836 DOI: 10.1016/j.ijrobp.2023.06.1064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The growing use of stereotactic body radiotherapy (SBRT) in metastatic cancer has led to applications in new and unique anatomic locations, highlighting the importance of effective, safe, reproducible treatment delivery. The objective of this study was to review our institutional SBRT experience for axillary metastases (AM), focusing on outcomes, safety and process. MATERIALS/METHODS In this ethics approved single-institution retrospective review, patients treated with SBRT to AM from 2014-2022 had tumor, treatment planning, and dosimetric variables abstracted. Toxicity was assessed per Common Terminology for Adverse Events V5.0. Cumulative incidence functions were used to estimate the incidence of local failure (LF), with death as competing risk. Kaplan-Meier method was used to estimate progression-free (PFS) and overall survival (OS). RESULTS We analyzed 37 patients with 39 AM who received SBRT. Patients were predominantly female (60%), Eastern Cooperative Oncology Group performance status 0-1 (62%), and elderly (median age: 72), with a median follow-up of 14.6 months. Common primary sites included breast (n = 16, 43%), skin (n = 7, 19%), and lung (n = 5, 14%). Treatment indication included oligoprogression (n = 18, 46%), oligometastases (n = 14, 36%) and symptomatic progression (n = 7, 18%). A minority had prior overlapping radiation (n = 7, 18%) or regional surgery (n = 4, 11%), while most had prior systemic therapy (n = 26, 70%). Significant heterogeneity in simulation, planning and treatment was identified. Immobilization included 5-point thermoplastic mask (n = 12, 32%), Vacloc (n = 12, 32%) arms-up thorax bag (n = 11, 30%). 4-D CT scans were obtained in 46%, MR simulation in 21%, and intravenous contrast in 10%. Median dose was 40 Gy (interquartile range (IQR): 35-40) in 5 fractions, (BED10 = 72 Gy), over a median of 12 days (IQR: 9-14). Seventeen cases (44%) utilized a low-dose elective volume to cover remaining axilla; 14% used a high dose clinical target volume. Median planning target volume margin was 5mm (range: 3-10mm), and plans were generated with 5 different dose constraint protocols. At first radiographic assessment, 87% had partial or complete response, with a single progression. Of symptomatic patients (n = 14), 57% had complete symptom resolution and 21% had improvement. One and 2-year LF rate were 19% and 31%, respectively. Median OS was 21.0 months (95% [Confidence Interval (CI)] 17.3-not reached) and median PFS was 7.0 months (95% [CI] 4.3-11.3). Acute and late toxicities were uncommon, with two grade 3 events (1 plexopathy in a case with tumor involving brachial plexus, 1 skin ulceration) identified, and no grade 4/5. CONCLUSION In this series of AM SBRT, low rates of toxicity, and good rates of LF and symptom improvement were observed. As treatment was delivered with a variety of individual treatment differences, an institutional protocol is under development to standardize technique, optimize efficiency and improve evaluability.
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Affiliation(s)
- A Mutsaers
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - J S Fernandes
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - G J Li
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - S Ali
- Department of Radiation Therapy, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - D M Palhares
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Chen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - P Cheung
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - G J Czarnota
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - I Karam
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - I Poon
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - D Vesprini
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - A Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - A V Louie
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Weiss Y, Mutsaers A, Chin L, Pang G, Bayley A, Poon I, Lau A, Karam I. Heatmaps to Assess Tumor Motion Probability with MRcine in Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2023; 117:S48. [PMID: 37784510 DOI: 10.1016/j.ijrobp.2023.06.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Intrafraction motion affects tumor position during radiation for head and neck cancers (HNC) and can be assessed using magnetic resonance cine (MR-cine). Heatmaps - visual representation of patient specific temporal tumor location akin to internal target volume (ITV) - were analyzed to demonstrate the variation of population-based motion margins in primary oropharyngeal (OP) and laryngeal/hypopharyngeal (LH) sites with the goal to provide insights towards personalized margins. MATERIALS/METHODS MR-cine were performed for LH and OP HNC patients as part of simulation protocol. Images (900-1500 slices) were acquired across 3-5 minutes per patient. Gross target volumes were propagated on T1 contrast sagittal sequence using deformable image registration then adjusted manually. Tumor locations were integrated across all frames and displayed as heatmaps representing location probability. To determine individualized motion, a baseline contour representing average tumor rest position was expanded both isotropically and directionally in 1 mm increments in a novel analysis to define the contribution of each increment on target coverage. To assess directional dependence, displacements from rest position were evaluated in 4 planes from centroid: (A) 12 o'clock (OC) to 6OC (capturing volumetric shift in a portion of superior, posterior and inferior directions), B) 3OC-9OC, C) 6OC-12OC, D) 9OC-3OC. Histograms demonstrating the proportion of scan time the tumor was within expansions were generated, with expansion margins for 25%-95% coverage analyzed by patient. Wilcoxon-rank-sum test was performed to compare motion by site. RESULTS Motion was evaluated in 66 patients (LH n = 27, OP n = 39). In LH, a median (med) isometric expansion of 8.5mm to achieve 95% target was required, with large variations observed for minimum (min): 2.8mm and maximum (max):23.5mm. Smaller differences were observed for OP with med of 5.3mm, (min:1.9mm, max:14.6mm). At 75%, 50% and 25% coverage, expansions for LH (med: 4.8 min: 1.9 max: 17.3; med: 3.8 min: 1.2 max: 12.9; med: 3.3, min: 0.6, max: 9.3) were not significantly different than OP (med: 3.8, min: 1.7, max: 10.9; med: 3.1 min: 1.3, max: 9.4; med: 2.1, min: 0.7, max: 8.4), suggesting larger but infrequent shifts in LH. Directional tumor displacement varied widely (Table 1), and by site and points describing the need for personalized margins. CONCLUSION Current literature as well as the analysis in this study indicate a wide range of motion - both in magnitude and duty cycle - between and within HN sub-sites not captured on CT simulation. Moving forward, motion based heatmaps based on MR-cine may serve as visualization tool for ITV contouring or to generate personalized motion margins.
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Affiliation(s)
- Y Weiss
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - A Mutsaers
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - L Chin
- Department of Medical Physics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - G Pang
- Department of Medical Physics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - A Bayley
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - I Poon
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - A Lau
- Department of Physical Sciences, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - I Karam
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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AlDohan M, Zhang E, Karam I, Bayley A, Galapin M, Eskander A, Higgins K, Zhang L, Chin L, Poon I. An Update of Stereotactic Body Radiotherapy (SBRT) for the Palliation of Unirradiated Mucosal Head and Neck Squamous Cell Carcinoma (SCC). Int J Radiat Oncol Biol Phys 2023; 117:e560-e561. [PMID: 37785720 DOI: 10.1016/j.ijrobp.2023.06.1879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) We report the treatment outcomes of palliative Stereotactic Body Radiation Therapy (SBRT) in patients with primary mucosal head and neck cancer (HNC) who were not eligible to receive conventional radiation therapy (RT). MATERIALS/METHODS This is a retrospective study that reviewed the medical records of patients with primary SCC mucosal HNC who were treated with SBRT between 2011 and 2022. Patients with other histologies, skin cancer, parotid tumors, or recurrent previously irradiated tumors were excluded from the study. RESULTS A total of 74 patients and 77 tumors were treated with SBRT in this cohort. The median age in the study was 81 (52-97) years and the median follow-up was 7.2 months. The most common site of HNC was the oral cavity (62%), followed by the oropharynx (18%), hypopharynx (8%), larynx (5%), nasal cavity/sinonasal cancer (3%), and unknown primary (1%). T3-4 lesions were found in most patients (76%). SBRT doses ranged from 35-50 Gy in 5 fractions, and the most common prescription dose was ≥45 Gy in 5 fractions (60%) for the GTV prescription. An elective nodal volume of 25 Gy in 5 fractions was infrequently (17%) used. Most patients (81%) who were treated twice a week completed in ≤14 days. The predominant symptoms at presentation were: pain (41%), mass effect (39%), dysphagia/odynophagia (14%), headache/nasal obstruction (1.4%), bleeding (1.4%), stridor (1.4%), asymptomatic (1.4%), and unknown (1.4%). 84% of patients had symptomatic response to treatment with 24% of them having complete symptom response. Cumulative incidence of local failure (LF) was 6.7% and at 6 months and 17.9% at 12 months, respectively. Cumulative incidence of distant metastasis was 7.3% and 10.5% at 6 and 12 months. Cancer was the most common cause of death in 29 patients (51%). The median overall survival (OS) was 8 months with 6 and 12-month OS rates of 67% and 36%, respectively. 39% of patients developed acute G3 toxicity, including 30% with G3 mucositis, 5% with G3 dysphagia, and 4% with G3 dermatitis. A crude rate of late G ≥3 toxicity was observed in 11% of patients including (5%, n = 4) with osteoradionecrosis, and a single case of dysphagia, soft tissue necrosis, supraglottic ulceration, and mucosal necrosis. CONCLUSION This study highlights the feasibility of SBRT as a treatment option for primary mucosal head and neck cancer patients who are not eligible for conventional radiation therapy. The results indicate that SBRT was effective in achieving local control and symptom relief, but larger prospective studies are needed to confirm the findings. The Canadian Cancer Trials Group has endorsed HN-13, a randomized control trial comparing HN SBRT to palliative RT.
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Affiliation(s)
- M AlDohan
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - E Zhang
- Sunnybrook Research Institute, Toronto, ON, Canada
| | - I Karam
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - A Bayley
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - M Galapin
- Department of Radiation Therapy, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - A Eskander
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - K Higgins
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - L Zhang
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - L Chin
- Department of Medical Physics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - I Poon
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Li GJ, Tan H, Nusrat H, Chen H, Chang JH, Shahi J, Poon I, Tsao M, Ung YC, Cheung P, Louie AV. Safety and Efficacy of Stereotactic Body Radiotherapy for Ultra-Central Thoracic Tumors. Int J Radiat Oncol Biol Phys 2023; 117:e35-e36. [PMID: 37785212 DOI: 10.1016/j.ijrobp.2023.06.725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Stereotactic body radiotherapy (SBRT) is increasingly utilized in the management of ultra-central thoracic tumors, although concerns regarding significant toxicity remain. We sought to evaluate the toxicity and efficacy of SBRT to these tumors at our institution. MATERIALS/METHODS Patients with ultra-central lung tumors or nodes treated at our institution with SBRT between 2009 and 2019 were retrospectively reviewed. Ultra-central was defined as having the planning target volume (PTV) overlapping or abutting the central bronchial tree and/or esophagus. All SBRT plans were generated with homogenous dose distributions using target coverage objectives of ITV V100% >99%, PTV V95% >99%, and an ideal PTV Dmax <105% (strict <120%). All plans were reviewed in quality assurance rounds by a team of dosimetrists, physicists, and radiation oncologists. The primary endpoint was incidence of severe toxicity (ST), defined as SBRT-related grade ≥3 toxicities, graded using the Common Terminology Criteria for Adverse Events V5.0. Secondary endpoints included local failure (LF), progression-free survival (PFS) and overall survival (OS). Competing risk analysis was used to estimate incidence and predictors of ST and LF, with death as a competing risk. Kaplan-Meier method was used to estimate PFS and OS. RESULTS A total of 154 patients who received 162 ultra-central courses of SBRT were included, with a median follow-up of 21.5 months. Treatment intent was most commonly for oligoprogression (46%), oligometastasis (30%), followed by curative (20%). The most frequent tumor histologies were NSCLC (41%) and RCC (26%). SBRT prescription doses ranged from 30-55 Gy in 5 fractions (BED10 range 48-115 Gy). The most common prescription was 50 Gy in 5 fractions (42%). The cumulative incidence of ST was 8.9% at 3-years. The most common ST was pneumonitis (n = 4). Notable toxicities included bronchopleural fistula (n = 2, grade 3 and 4), bronchial stricture (n = 1, grade 3), and esophagitis leading to bleeding (n = 1, grade 4). There were no esophageal strictures or perforations, and no bronchial bleeds. There was 1 possible treatment related death from pneumonitis/pneumonia. Predictors of any ST included increased lung V5 Gy, decreased PTV V95%, and not having prior radiation therapy to the chest. The cumulative incidence of LF was 4.8%, 11% and 14% at 1-, 2-, and 3-years respectively. Predictors of LF included younger age, and greater volume of overlap between the PTV and esophagus. Median PFS was 8.4 months, while median OS was 3.7 years. CONCLUSION In one of the largest case series of ultra-central thoracic SBRT reported to date, homogenously prescribed SBRT plans were associated with relatively low rates of ST and LF across a variety of treatment indications. Predictors of ST should be interpreted recognizing the heterogeneity in toxicities observed. Identified predictors of both ST and LF can contribute to future work to optimize the therapeutic ratio in treatment of ultra-central thoracic tumors.
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Affiliation(s)
- G J Li
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Tan
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Nusrat
- Department of Medical Physics, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Chen
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - J H Chang
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - J Shahi
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - I Poon
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - M Tsao
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Y C Ung
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - P Cheung
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - A V Louie
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Zeng KL, Poon I, Ung Y, Tsao M, Zhang L, Cumal A, Louie AV, Cheung P. Accelerated Hypofractionated Radiotherapy for Centrally Located Lung Tumours Not Suitable for Stereotactic Body Radiotherapy or Chemoradiotherapy. Clin Oncol (R Coll Radiol) 2023; 35:e173-e181. [PMID: 36470682 DOI: 10.1016/j.clon.2022.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 06/01/2022] [Accepted: 11/18/2022] [Indexed: 12/04/2022]
Abstract
AIMS Accelerated hypofractionated radiotherapy is used at our institution for non-small cell lung cancer (NSCLC) patients not eligible for stereotactic body radiotherapy or chemoradiotherapy. The purpose of this study was to report clinical outcomes of delivering 60 Gy in 15 fractions for these patients. MATERIALS AND METHODS All NSCLC patients who received 60 Gy in 15 fractions were reviewed. Outcomes of interest were local failure, regional failure, distant progression, overall survival and treatment-associated toxicities. RESULTS In total, 111 patients were included. The median age was 78.8 years and most tumours were adenocarcinoma (n = 55, 49.6%). Sixty-five patients (58.6%) were N0. The cumulative incidence of local failure at 12 and 24 months in the N0 cohort was 5.2% and 14.2%, respectively, compared with 11.5% and 14.8% for N+ patients. Tumour size >35 mm predicted for local failure (hazard ratio 2.706, 95% confidence interval 1.002-7.307, P = 0.0494). Distant progression at 12 and 24 months in N0 patients was 13.7% and 24.3% compared with 24.6% and 33.5% in N+ patients. In N0 patients, larger tumour size was associated with increased risk of distant progression. The median overall survival was 38.1 months in N0 patients versus 31.7 months in N+ patients. The most common toxicity was radiation pneumonitis (n = 6, 6.4%). The incidence of any grade 3 toxicity was 10.3% at ≥1 year. There were no deaths or hospitalisations attributed to treatment. CONCLUSIONS Accelerated hypofractionated radiotherapy is well tolerated and resulted in favourable clinical outcomes in various stages of NSCLC patients.
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Affiliation(s)
- K L Zeng
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada
| | - I Poon
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada
| | - Y Ung
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada
| | - M Tsao
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada
| | - L Zhang
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada
| | - A Cumal
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada
| | - A V Louie
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada
| | - P Cheung
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada.
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Peng J, Erler D, Chen H, Dagan R, Redmond K, Foote M, Badellino S, Biswas T, Louie A, Ricardi U, Sahgal A, Poon I. Outcomes of Extracranial Oligorecurrence after Prior Metastases Directed Stereotactic Body Radiotherapy for Oligometastatic Disease. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Nguyen E, Poon I, Ung Y, Tsao M, Korol R, Elzibak A, Erler D, Zhang L, Louie A, Cheung P. Multi-Target Thoracic Stereotactic Body Radiotherapy – Toxicity and Efficacy Analysis. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mak D, Yan M, Cheung P, Parmar A, Poon I, Ung Y, Tsao M, Warner A, Louie A. Evaluation of Pneumonitis in EGFR-Mutated Non-Small Cell Lung Cancer Patients Receiving Osimertinib and Thoracic Radiotherapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Karam I, Abugharib A, Loblaw J, Husain Z, Bayley A, Zhang L, Chin L, Erler D, Higgins K, Enepekides D, Eskander A, Poon I. Stereotactic Body Radiotherapy for Metastases to the Head and Neck. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Mak D, Yan M, Cheung P, Parmar A, Poon I, Ung Y, Tsao M, Warner A, Louie A. EP08.05-001 Evaluation of Pneumonitis in EGFR-Mutated Non-Small Cell Lung Cancer Patients Receiving Osimertinib and Thoracic Radiation. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Baydoun A, Chen H, Poon I, Badellino S, Dagan R, Erler D, Foote M, Louie A, Redmond K, Ricardi U, Sahgal A, Biswas T. Outcomes and toxicities in oligometastatic patients treated with stereotactic body radiotherapy for adrenal gland metastases: A multi-institutional retrospective study. Clin Transl Radiat Oncol 2022; 33:159-164. [PMID: 35243027 PMCID: PMC8885400 DOI: 10.1016/j.ctro.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/22/2021] [Accepted: 09/06/2021] [Indexed: 11/29/2022] Open
Abstract
SBRT to adrenal gland oligometastases achieves a satisfactory local control and OS. A minimum PTV dose BED10 > 46 Gy was associated with an improved OS and LRFS. A prescribed BED10 > 70 Gy was correlated with improved local control. High adrenal metastases volume should not preclude the delivery of SBRT.
Background Studies reporting SBRT outcomes in oligometastatic patients with adrenal gland metastases (AGM) are limited. Herein, we present a multi-institutional analysis of oligometastatic patients treated with SBRT for AGM. Material/methods The Consortium for Oligometastases Research (CORE) is among the largest retrospective series of patients with oligometastases. Among CORE patients, those treated with SBRT for AGM were included. Clinical and dosimetric data were collected. Adrenal metastatic burden (AMB) was defined as the sum of all adrenal GTV if more than one oligometastases is present. Competing risk analysis was used to estimate actuarial cumulative local recurrence (LR) and widespread progression (WP). Kaplan-Meier method was used to report overall survival (OS), local recurrence-free survival (LRFS), and progression-free survival (PFS). Treatment related toxicities were also reported. Results The analysis included 47 patients with 57 adrenal lesions. Median follow-up was 18.2 months. Median LRFS, PFS, and OS were 15.3, 5.3, and 19.1 months, respectively. A minimum PTV dose BED10 > 46 Gy was associated with an improved OS and LRFS. A prescribed BED10 > 70 Gy was an independent predictor of a lower LR probability. AMB>10 cc was an independent predictor of a lower risk for WP. Only one patient developed an acute Grade 3 toxicity consisting of abdominal pain. Conclusion SBRT to AGM achieved a satisfactory local control and OS in oligometastatic patients. High minimum PTV dose and BED10 prescription doses were predictive of improved LR and OS, respectively. Prospective studies are needed to determine comprehensive criteria for patients SBRT eligibility and dosimetric planning.
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Affiliation(s)
- A. Baydoun
- Department of Radiation Oncology, University Hospitals of Cleveland, Cleveland, OH 44106, USA
| | - H. Chen
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario M4N 3M5, Canada
| | - I. Poon
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario M4N 3M5, Canada
| | - S. Badellino
- Radiation Oncology Unit, Department of Oncology, University of Turin and Città della Salute e della Scienza Hospital, Via Genova 3, Turin 10126, Italy
| | - R. Dagan
- Department of Radiation Oncology, University of Florida Health Proton Therapy Institute, Jacksonville, FL 32206, United States
| | - D. Erler
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario M4N 3M5, Canada
| | - M.C. Foote
- Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, QLD 4120, Australia
| | - A.V. Louie
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario M4N 3M5, Canada
| | - K.J. Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University, Baltimore, MD 21218, United States
| | - U. Ricardi
- Radiation Oncology Unit, Department of Oncology, University of Turin and Città della Salute e della Scienza Hospital, Via Genova 3, Turin 10126, Italy
| | - A. Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario M4N 3M5, Canada
| | - T. Biswas
- Department of Radiation Oncology, University Hospitals of Cleveland, Cleveland, OH 44106, USA
- Corresponding author at: Department of Radiation Oncology, University Hospitals, Cleveland Medical Center, 11100 Euclid Avenue, Cleveland OH 44106, United States.
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Palma D, Prisman E, Berthelet E, Tran E, Hamilton S, Wu J, Eskander A, Higgins K, Karam I, Poon I, Husain Z, Enepekides D, Hier M, Sultanem K, Richardson K, Mlynarek A, Johnson-Obaseki S, Eapen L, Odell M, Bayley A, Dowthwaite S, Jackson J, Dzienis M, O'Neil J, Chandarana S, Banerjee R, Hart R, Chung J, Tenenholz T, Krishnan S, Le H, Yoo J, Mendez A, Winquist E, Kuruvilla S, Stewart P, Warner A, Mitchell S, Chen J, Parker C, Wehrli B, Kwan K, Theurer J, Sathya J, Hammond J, Read N, Venkatesan V, MacNeil D, Fung K, Nichols A. A Randomized Trial of Radiotherapy vs. Trans-Oral Surgery for Treatment De-Escalation in HPV-Associated Oropharyngeal Squamous Cell Carcinoma (ORATOR2). Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Baydoun A, Chen H, Poon I, Badellino S, Dagan R, Erler D, Foote M, Louie A, Redmond K, Ricardi U, Sahgal A, Biswas T. Outcomes and Toxicities in Oligometastatic Patients Treated With Stereotactic Body Radiotherapy for Adrenal Gland Metastases: A Multi-Institutional Study. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cao Y, Chen H, Sahgal A, Erler D, Badellino S, Biswas T, Dagan R, Foote M, Louie A, Poon I, Ricardi U, Redmond K. Impact of Volumetric Burden of Metastatic Lesions on Outcomes in Extracranial Oligometastatic Patients: A Multi-Institutional Study. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Tan H, Nusrat H, Li G, Poon I, Tsao M, Ung Y, Chen H, Tjong M, Cheung P, Louie A. Safety and Efficacy of Stereotactic Body Radiotherapy for Ultra-Central Thoracic Tumors. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Chen H, Atenafu E, Erler D, Poon I, Dagan R, Redmond K, Foote M, Badellino S, Biswas T, Ricardi U, Sahgal A, Louie A. A Prognostic Model for Patients With Oligometastatic Disease Treated With Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sheikh S, Chen H, Sahgal A, Poon I, Erler D, Badellino S, Dagan R, Foote M, Louie A, Redmond K, Ricardi U, Biswas T. Role of Stereotactic Body Radiotherapy (SBRT) in the Treatment of Oligo Metastatic Colorectal Cancer: Analysis of a Large Multi-Institutional Database. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Voruganti I, Poon I, Husain Z, Zhang L, Chin L, Erler D, Barnes E, Higgins K, Enepekides D, Eskander A, Karam I. SBRT For Head and Neck Skin Cancer: An Initial Experience in 106 Medically Unfit Patients. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Donovan E, Cheung P, Erler D, Davidson M, Sahgal A, Chung H, Poon I, Taggar A, Barnes E, Jerzak K, Gien L, Leung E. Stereotactic Ablative Radiotherapy (SABR) in Oligometastatic and Oligoprogressive Gynecologic Cancers: Clinical Outcomes of a Single Institution Analysis. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Chen H, Sahgal A, Erler D, Badellino S, Biswas T, Dagan R, Foote M, Poon I, Redmond K, Ricardi U, Louie A. Conditional Survival of Extracranial Oligometastatic Patients Treated with Stereotactic Body Radiation Therapy (SBRT): An International Consortium Study. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Malik N, Kim M, Chen H, Poon I, Husain Z, Eskander A, Boldt G, Louie A, Karam I. SBRT for Primary Head and Neck Cancers: A Systematic Review and Meta-Analysis. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Cao Y, Chen H, Sahgal A, Erler D, Badellino S, Biswas T, Dagan R, Foote M, Louie A, Poon I, Ricardi U, Redmond K. SBRT for Oligometastatic Non-Spine Bone Metastases: A Multi-Institutional Study. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dasgupta A, Osapoetra L, DiCenzo D, Sannachi L, Saifuddin M, Fatima K, Quiaoit K, Karam I, Poon I, Husain Z, Tran W, Czarnota G. Assessment of Clinical Radiosensitivity in Patients with Head-Neck Squamous Cell Carcinoma using Pre-treatment Quantitative Ultrasound Texture-Derivatives and Machine Learning Classifiers. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tjong M, Ragulojan M, Poon I, Cheng S, Doherty M, Ung Y, Cheung P, Cheema P. P2.01-72 Safety of Palliative Radiotherapy and Immune Checkpoint Inhibitors in Patients with Metastatic Non-Small Cell Lung Cancer. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Erler D, Poon I, Cheung P, Sahgal A, Soliman H, Korol R. Evaluating Respiratory Motion of the Bony Thorax in the Context of Stereotactic Body Radiation Therapy (SBRT). Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Poon I, Erler D, Dagan R, Janson K, Foote M, Badellino S, Louie A, Baswas T, Ricardo U, Lo S, Lee Y, Sahgal A. A Multi-Institutional Retrospective Clinical and Dosimetric Analyses of 1033 Oligometastatic Patients Treated with SBRT from the Consortium for Oligometastases Research - CORE. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Tjong M, Malik N, Boldt G, Li G, Cheung P, Poon I, Ung Y, Louie A. Stereotactic Ablative Radiotherapy for Mediastinal and Hilar Lymphadenopathy: A Systematic Review. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Weiss Y, Chin L, Lau A, Husain Z, Higgins K, Enepekides D, Eskander A, Ho L, Poon I, Karam I. Cine MRI-based Analysis of Intrafractional Motion in Radiation Treatment Planning of Head and Neck Cancer Patients. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Fatima K, Sannachi L, Quiaiot K, Suraweera H, Saifuddin M, Dasgupta A, Cardenas D, Leong K, DiCenzo D, Karam I, Poon I, Rahman S, Jang D, Gangeh M, Garcia E, Tabbarah S, Sadeghi-Naini A, Tran W, Czarnota G. Predicting Recurrence for Patients with Head-Neck Squamous Cell Carcinoma Using Quantitative Ultrasound Based Radiomic Signatures Integrated with Machine Learning. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Saifuddin M, Dasgupta A, Fatima K, Sannachi L, Suraweera H, Quiaiot K, Cardenas D, Leong K, DiCenzo D, Rahman S, Karam I, Poon I, Jang D, Gangeh M, Garcia E, Tabbarah S, Sadeghi-Naini A, Tran W, Czarnota G. Radiomic Signature Using Quantitative Ultrasound Integrated with Machine Learning for Predicting Clinical Radiosensitivity in Patients with Head-Neck Squamous Cell Carcinoma Treated with Radical Radiotherapy. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zeng K, Poon I, Ung Y, Zhang L, Cheung P. Accelerated Hypofractionated Radiation Therapy for Centrally Located Lung Tumors Not Suitable for Stereotactic Body Radiation Therapy (SBRT) or Concurrent Chemoradiotherapy (CRT). Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Cheung P, Thompson R, Chu W, Myrehaug S, Poon I, Sahgal A, Soliman H, Tseng C, Wong S, Ung Y, Abrahao A, Berry S, Chan K, Cheng S, Earle C, Erler D, Zhang L, Ko Y, Chung H. Stereotactic Body Radiation Therapy for Metastatic Colorectal Cancer: Comprehensive Review from a Large Academic Institution. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Al Hanaqta M, Niglas M, Jiang C, Erler D, Cheung P, Chu W, Chung H, Myrehaug S, Poon I, Sahgal A, Soliman H. Outcomes and Toxicity of Stereotactic Radiation Therapy for Metastatic Breast Cancer – A Retrospective Cohort Study. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Zeng K, Poon I, Ung Y, Zhang L, Cheung P. P1.16-29 Accelerated Hypofractionated Radiotherapy for Central Lung Tumors Unsuitable for Stereotactic Body Radiotherapy Or Concurrent CRT. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Raman S, Erler D, Chin L, Cheung P, Chu W, Chung H, Loblaw D, Poon I, Rubenstein J, Soliman H, Sahgal A, Tseng C. Value of MRI in Contouring Non-spine Bone Metastases for Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.2319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Erler D, Brotherston D, Sahgal A, Cheung P, Chu W, Soliman H, Loblaw D, Chung H, Chow E, Poon I. Stereotactic Body Radiation Therapy for Non-Spine Bone Metastases: A Single Institution's Experience. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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McEwen S, Dunphy C, Norman Rios J, Davis A, Jones J, Lam A, Poon I, Martino R, Ringash J. Development and pre-testing of a rehabilitation planning consultation for head-and-neck cancer. ACTA ACUST UNITED AC 2017; 24:153-160. [PMID: 28680274 DOI: 10.3747/co.24.3529] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In contrast with other major chronic conditions such as heart disease and stroke, cancer care does not routinely integrate evidence-based rehabilitation services within the standard continuum. The objectives of the present project were to develop a rehabilitation planning consultation (rpc) for survivors of head-and-neck (hn) cancer, to test its feasibility, and to make refinements. METHODS Using intervention mapping, the rpc-alpha was developed by examining potential theoretical methods and practical applications relative to the program objectives. During feasibility testing, a single case series was conducted with survivors of hn cancer who had completed their cancer treatment within the preceding 11 months; iterative refinements were made after each case. RESULTS The rpc-alpha was led by a rehabilitation professional and was based on self-management principles. The initial consultation included instruction in a global cognitive strategy, goal-setting, introduction to available resources, action planning, and coping planning. A follow-up consultation was conducted a few weeks later. Of 9 participants recruited, 5 completed post-intervention assessments. Participants reported that the rpc helped them to make rehabilitation plans. CONCLUSIONS The rpc was feasible to use and satisfactory to a small group of hn cancer survivors. A pilot test of the refined version is in process.
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Affiliation(s)
- S McEwen
- Sunnybrook Research Institute, St. John's Rehab Research Program, Toronto.,University of Toronto, Toronto
| | - C Dunphy
- University Health Network, Princess Margaret Cancer Centre, Toronto
| | - J Norman Rios
- Sunnybrook Research Institute, St. John's Rehab Research Program, Toronto
| | - A Davis
- University of Toronto, Toronto.,University Health Network, Toronto Western Research Institute, Toronto
| | - J Jones
- University of Toronto, Toronto.,University Health Network, Princess Margaret Cancer Centre, Toronto
| | - A Lam
- University Health Network, Princess Margaret Cancer Centre, Toronto.,The University of Western Ontario, London; and
| | - I Poon
- University of Toronto, Toronto.,Odette Cancer Centre, Sunnybrook Hospital, Toronto, ON
| | | | - J Ringash
- University of Toronto, Toronto.,University Health Network, Princess Margaret Cancer Centre, Toronto
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Karam I, Yao M, Heron D, Poon I, Koyfman S, Yom S, Siddiqui F, Lartigau E, Cengiz M, Yamazaki H, Hara W, Phan J, Vargo J, Lee V, Foote R, Harter K, Lee N, Sahgal A, Lo S. Consensus Statement From the International Stereotactic Body Radiotherapy Consortium for Head and Neck Carcinoma—Technical Factors. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Merino Lara T, Helou J, Poon I, Sahgal A, Chung H, Chu W, Soliman H, Verma S, Cheema P, Cheng S, Khanna S, Erler D, Zhang L, Cheung P. Stereotactic Body Radiation Therapy in Metastatic Non-Small Cell Lung Cancer: For Oligometastases, Oligoprogression, and Local Control. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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41
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Tjong M, Faruqi S, Helou J, Zhang L, Cheung P, Erler D, Poon I. Post-Stereotactic Body Radiation Therapy (SBRT) Tumor Response and Inflammatory Changes as Predictors of Nonlocal Failure and Survival Outcomes in Patients With Stage I Non-Small Cell Lung Cancer (NSCLC). Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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42
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Farha G, Chin L, Dhillon A, Lim-Reinders S, Gaitan JC, Conrad T, Brotherston D, Caldwell C, Lee J, Karam I, Poon I. Can Intratreatment Positron Emission Tomography/Computed Tomography–Based Adaptive Radiation Therapy Reduce Treatment Margins in Head and Neck Cancers? Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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43
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De Santis RJ, Poon I, Lee J, Karam I, Enepekides DJ, Higgins KM. Comparison of survival between radiation therapy and trans-oral laser microsurgery for early glottic cancer patients; a retrospective cohort study. J Otolaryngol Head Neck Surg 2016; 45:42. [PMID: 27485726 PMCID: PMC4969973 DOI: 10.1186/s40463-016-0155-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 07/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The literature reports various treatment methodologies, such as trans-oral laser microsurgery, radiation therapy, total/partial laryngectomies, and concurrent radiation chemotherapy for patients with early larynx cancer. However, at the forefront of early glottis treatment is trans-oral laser microsurgery and radiation therapy, likely due to better functional and survival outcomes. Here we conduct the largest Canadian head-to-head comparison of consecutive patients treated with either radiation therapy or trans-oral laser microsurgery. Additionally, we compare these two treatments and their 5-year survival rates post treatment to add to the existing literature. METHODS Charts of patients who were diagnosed with early glottic cancer between 2006 and 2013 were reviewed. Seventy-five patients were identified, and split into 2 groups based on their primary treatment, trans-oral laser microsurgery and radiation therapy. Kaplan-Meier survival curves, life-tables, and the log-rank statistic were reported to determine if there was a difference between the two treatment groups and their disease-specific survival, disease-free survival, and total laryngectomy-free survival. Additionally, each different survival analysis was stratified by potential confounding variables, to help conclude which treatment is more efficacious in this population. RESULTS The 5-year disease-specific survival rate is 93.3 % σ = 0.063 and 90.8 % σ = 0.056 for patients treated with trans-oral laser microsurgery and radiation therapy, respectively (χ (2) < 0.001, p = 0.983). The disease free survival rate is 60.0 % (σ =0.121) for patients treated with trans-oral laser microsurgery, and 67.2 % (σ = 0.074) for those who received RT (χ (2) = 0.19, p = 0.663). Additionally, the total laryngectomy-free survival rate is 84.1 % (σ = 0.1) and 79.1 % (σ = 0.072) for patients' early glottic cancer treated by trans-oral laser microsurgery and radiation therapy, respectively (χ (2) = 0.235, p = 0.628). Chi-square analysis of age-group versus treatment group (χ (2) = 6.455, p = 0.04) and T-stage versus treatment group (χ (2) = 11.3, p = 0.001) revealed a statistically significant relationship, suggesting survival analysis should be stratified by these variables. However, after stratification, there was no statistically significant difference between the trans-oral laser microsurgery and radiation therapy groups in any of the survival analyses. CONCLUSION No difference was demonstrated in the 5-year disease-specific survival, disease-free survival, and total laryngectomy-free survival, between the RT and TLM treatment groups. Additionally, both groups showed similar 5-year survival after stratifying by confounding variables.
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Affiliation(s)
- R J De Santis
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Suite M1 102, Toronto, ON, M4N 3 M5, Canada
| | - I Poon
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3 M5, Canada
| | - J Lee
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3 M5, Canada
| | - I Karam
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3 M5, Canada
| | - D J Enepekides
- Department of Otolaryngology - Head & Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Suite M1 102, Toronto, ON, M4N 3 M5, Canada
| | - K M Higgins
- Department of Otolaryngology - Head & Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Suite M1 102, Toronto, ON, M4N 3 M5, Canada.
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Erler D, Cheung P, Sahgal A, Chung H, Poon I, Chu W, Zhang L, Bedard G, Pulenzas N, Chow E. A Phase 1 Trial of Stereotactic Ablative Radiation Therapy (SABR) for Oligometastatic Cancer: Toxicity and Quality of Life. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Helou J, Thibault I, Yeung L, Poon I, Tjong M, Chiang A, Jain S, Soliman H, Cheung P. Stereotactic Ablative Radiation Therapy for Pulmonary Oligometastases and Oligoprogression. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lo S, Redmond K, Poon I, Foote M, Dagan R, Lohr F, Ricardi U, Sahgal A. A Multi-National Report on Technical Factors of Stereotactic Body Radiation Therapy for Oligometastases. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.2535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chiang A, Thibault I, Rodrigues G, Palma D, Warner A, Poon I, Soliman H, Jain S, Cheung P. Accelerated Hypofractionation Versus Stereotactic Ablative Radiation Therapy (SABR) for Early-Stage Non-Small Cell Lung Cancer: Results of a Propensity Score–Matched Analysis. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Thibault I, Poon I, Yeung L, Erler D, Kim A, Keller B, Lochray F, Jain S, Soliman H, Cheung P. Predictive factors for local control in primary and metastatic lung tumours after four to five fraction stereotactic ablative body radiotherapy: a single institution's comprehensive experience. Clin Oncol (R Coll Radiol) 2014; 26:713-9. [PMID: 25085765 DOI: 10.1016/j.clon.2014.06.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 06/09/2014] [Accepted: 06/16/2014] [Indexed: 10/25/2022]
Abstract
AIMS We report the outcomes of a large lung stereotactic ablative body radiotherapy (SABR) programme for primary non-small cell lung cancer (NSCLC) and pulmonary metastases. The primary study aim was to identify factors predictive for local control. MATERIALS AND METHODS In total, 311 pulmonary tumours in 254 patients were treated between 2008 and 2011 with SABR using 48-60 Gy in four to five fractions. Local, regional and distant failure data were collected prospectively, whereas other end points were collected retrospectively. Potential clinical and dosimetric predictors of local control were evaluated using univariate and multivariate analyses. RESULTS Of the 311 tumours, 240 were NSCLC and 71 were other histologies. The 2 year local control rate was 96% in stage I NSCLC, 76% in colorectal cancer (CRC) metastases and 91% in non-lung/non-CRC metastases. Predictors of better local control on multivariate analysis were non-CRC tumours and a larger proportion of the planning target volume (PTV) receiving ≥100% of the prescribed dose (higher PTV V100). Among the 45 CRC metastases, a higher PTV V100 and previous chemotherapy predicted for better local control. CONCLUSIONS Lung SABR of 48-60 Gy/four to five fractions resulted in high local control rates for all tumours except CRC metastases. Covering more of the PTV with the prescription dose (a higher PTV V100) also resulted in superior local control.
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Affiliation(s)
- I Thibault
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - I Poon
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - L Yeung
- Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - D Erler
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - A Kim
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - B Keller
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - F Lochray
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - S Jain
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
| | - H Soliman
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - P Cheung
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada.
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Thibault I, Poon I, Erler D, Kim A, Keller B, Yeung L, Jain S, Soliman H, Lochray F, Cheung P. Stereotactic Body Radiation Therapy (SBRT) for Primary Non-Small Cell Lung Cancer (NSCLC) and Pulmonary Metastases: Analysis of Outcomes and Predictive Factors for Local Control. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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50
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Jain S, Poon I, Keller B, Soliman H, Lochray F, Kim A, Cheung P. A Randomized Trial of Lung Stereotactic Body Radiation Therapy (SBRT) Delivered Over 4 or 11 Days - Acute Toxicity and Quality of Life. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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