1
|
Wallner PE, Yoo DC, Calais J, Escorcia FE, Mari Aparici C, Michalski J, Morris M, Morris ZS, Pryma D, Rabatic BM, Sharma N, Vapiwala N, Ghesani MV, Subramaniam RM, Small W, Schechter NR. ACR-ACNM-ARS-ASTRO-SNMMI Practice Parameter for the Performance of Therapy With Radiopharmaceuticals. Am J Clin Oncol 2024; 47:169-176. [PMID: 38131352 DOI: 10.1097/coc.0000000000001072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVES This practice parameter was revised collaboratively by the American College of Radiology (ACR), the American College of Nuclear Medicine, the American Radium Society, the American Society for Radiation Oncology, and the Society of Nuclear Medicine and Molecular Imaging. The document is intended to serve as a resource for appropriately trained and licensed physicians who perform therapeutic procedures with unsealed sources, referred to in the document using the more inclusive terminology of radiopharmaceuticals, for which a written directive is required for authorized users under NRC 10 CFR 35.300. METHODS This practice parameter was developed according to the process described under the heading The Process for Developing ACR Practice Parameters and Technical Standards on the ACR website ( https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards ) by the Committee on Practice Parameters-Radiation Oncology of the ACR Commission on Radiation Oncology in collaboration with the American Radium Society. RESULTS This practice parameter addresses the overall role of the applicable physician-authorized user, Qualified Medical Physicist, and other specialized personnel involved in the delivery of radiopharmaceutical therapy. Therapeutic radiopharmaceuticals include those administered as elemental radioactive isotopes (radionuclides) or the radioactive element incorporated into a targeting molecule (ligand) by one or more chemical bonds. This document provides guidance regarding general principles of radionuclide therapies and indications of various alpha, beta, gamma, and mixed emission agents with references to several recent practice parameters on new and commonly performed radiopharmaceutical therapies. CONCLUSION This document addresses clinical circumstances, elements of available agents, and the qualifications and responsibilities of various members of the radiation care team, specifications of consultation and other clinical documentation, post-therapy follow-up, radiation safety precautions, elements of quality control and improvement programs, infection control, and patient education to ensure optimal patient care and safety when utilizing radiopharmaceuticals.
Collapse
Affiliation(s)
| | - Don C Yoo
- The Warren Alpert Medical School of Brown University, Providence, RI
| | - Jeremie Calais
- University of California, Los Angeles (UCLA), Los Angeles
| | | | | | - Jeff Michalski
- Washington University School of Medicine, Saint Louis, MO
| | | | - Zachary S Morris
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Daniel Pryma
- Department of Radiology, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania
| | | | | | | | | | | | - William Small
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Chicago, IL
- Department of Radiation Oncology, Maguire Center, Maywood, IL
| | | |
Collapse
|
2
|
Benabdallah N, Lu P, Abou DS, Zhang H, Ulmert D, Hobbs RF, Gay HA, Simons BW, Saeed MA, Rogers BE, Jha AK, Tai YC, Malone CD, Ippolito JE, Michalski J, Jennings JW, Baumann BC, Pachynski RK, Thorek DLJ. Beyond Average: α-Particle Distribution and Dose Heterogeneity in Bone Metastatic Prostate Cancer. J Nucl Med 2024; 65:245-251. [PMID: 38124163 PMCID: PMC10858382 DOI: 10.2967/jnumed.123.266571] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/23/2023] [Indexed: 12/23/2023] Open
Abstract
α-particle emitters are emerging as a potent modality for disseminated cancer therapy because of their high linear energy transfer and localized absorbed dose profile. Despite great interest and pharmaceutical development, there is scant information on the distribution of these agents at the scale of the α-particle pathlength. We sought to determine the distribution of clinically approved [223Ra]RaCl2 in bone metastatic castration-resistant prostate cancer at this resolution, for the first time to our knowledge, to inform activity distribution and dose at the near-cell scale. Methods: Biopsy specimens and blood were collected from 7 patients 24 h after administration. 223Ra activity in each sample was recorded, and the microstructure of biopsy specimens was analyzed by micro-CT. Quantitative autoradiography and histopathology were segmented and registered with an automated procedure. Activity distributions by tissue compartment and dosimetry calculations based on the MIRD formalism were performed. Results: We revealed the activity distribution differences across and within patient samples at the macro- and microscopic scales. Microdistribution analysis confirmed localized high-activity regions in a background of low-activity tissue. We evaluated heterogeneous α-particle emission distribution concentrated at bone-tissue interfaces and calculated spatially nonuniform absorbed-dose profiles. Conclusion: Primary patient data of radiopharmaceutical therapy distribution at the small scale revealed that 223Ra uptake is nonuniform. Dose estimates present both opportunities and challenges to enhance patient outcomes and are a first step toward personalized treatment approaches and improved understanding of α-particle radiopharmaceutical therapies.
Collapse
Affiliation(s)
- Nadia Benabdallah
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Peng Lu
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri
| | - Diane S Abou
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Hanwen Zhang
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - David Ulmert
- Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Robert F Hobbs
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Hiram A Gay
- Department of Radiation Oncology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Brian W Simons
- Center for Comparative Medicine, Baylor University, Houston, Texas
| | - Muhammad A Saeed
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Buck E Rogers
- Department of Radiation Oncology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Abhinav K Jha
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri
| | - Yuan-Chuan Tai
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Christopher D Malone
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Joseph E Ippolito
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Jeff Michalski
- Department of Radiation Oncology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Jack W Jennings
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Brian C Baumann
- Department of Radiation Oncology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
- Department of Radiation Oncology, Springfield Clinic, Springfield, Illinois; and
| | - Russell K Pachynski
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Daniel L J Thorek
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri;
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri
- Oncologic Imaging Program, Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| |
Collapse
|
3
|
Waters M, Price A, Laugeman E, Henke L, Hugo G, Stowe H, Andruska N, Brenneman R, Hao Y, Green O, Robinson C, Gay H, Michalski J, Baumann BC. CT-based online adaptive radiotherapy improves target coverage and organ at risk (OAR) avoidance in stereotactic body radiation therapy (SBRT) for prostate cancer. Clin Transl Radiat Oncol 2024; 44:100693. [PMID: 38021093 PMCID: PMC10663731 DOI: 10.1016/j.ctro.2023.100693] [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: 01/04/2023] [Revised: 10/02/2023] [Accepted: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Stereotactic body radiation therapy (SBRT) is an emerging treatment modality for clinically localized prostate cancer (PCa). Online daily adaptive radiotherapy (ART) could potentially improve the therapeutic ratio of prostate SBRT by accounting for inter-fraction variation in target and OAR volumes. To our knowledge, no group has evaluated the clinical utility of a novel AI-augmented CT-based ART system for prostate SBRT. In this study we hypothesized that adaptive prostate SBRT plans would result in improved target coverage and lower dose to OARs in comparison to unadapted treatment plans. Methods Seven patients with favorable intermediate to oligometastatic PCa treated with 5-fx prostate adaptive SBRT were retrospectively reviewed. Patients were treated with 3625 cGy to the prostate and seminal vesicles. 6 patients additionally received 2500 cGy to the pelvic nodes, 5 patients underwent a boost to 4000 cGy to the prostate. For each fraction, a CBCT was acquired and OARs (rectum, bladder, bowel, sigmoid, femurs) were segmented/deformed using AI. CTVs were rigidly registered. Volumes were adjusted manually and PTV expansions added. Adaptive treatment plans were developed based on the contoured targets and OARs and dose to these volumes for the adapted vs. initial plans were compared for each fraction. V100 and the D0.03 cc between scheduled and adapted treatment plans were compared using a Student's t-test, with significance threshold of P < 0.05. Results Seven patients completed 35 Fx's of adaptive RT. Daily adaptation resulted in a statistically significant mean improvement in PTV V100 for all targets: [21.4 % ± 4.3 % for PTV 4000 (p < 0.0001); 8.7 % ± 1.1 % for PTV 3625 (p < 0.0001); and 11.5 % ± 3.1 % for PTV 2500 (p = 0.0013)]. Mean rectal D0.03 was significantly reduced by 38.8 cGy ± 5.95 cGy (p < 0.0001) per fraction (194 cGy/5 fractions) compared to the initial plans. There was a modest increase in bladder dose of 10.9 cGy ± 4.93 cGy per fraction (p = 0.0424) for the adaptive plans. The adaptive plans met bladder constraints for every fraction. There were no statistically significant differences between sigmoid or bowel dose for adapted vs. initial plans. No patients experienced acute CTCAE grade ≥ 3 GI/GU adverse events (median F/U 9.5 months). All statistically significant differences were maintained in the presence and absence of rectal hydrogel spacer (p < 0.05). Conclusions CT-based online adaptive SBRT resulted in statistically significant and clinically meaningful improvements in PTV coverage and D0.03 cc dose to the rectum. A trial evaluating CT adaptive whole-pelvis prostate SBRT is underway.
Collapse
Affiliation(s)
- Michael Waters
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Alex Price
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Eric Laugeman
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Lauren Henke
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Geoff Hugo
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Hayley Stowe
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Neal Andruska
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Randall Brenneman
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Yao Hao
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Olga Green
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Hiram Gay
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Jeff Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Brian C. Baumann
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| |
Collapse
|
4
|
FitzGerald TJ, Bishop-Jodoin M, Laurie F, Iandoli M, Smith K, Ulin K, Ding L, Moni J, Cicchetti MG, Knopp M, Kry S, Xiao Y, Rosen M, Prior F, Saltz J, Michalski J. The Importance of Quality Assurance in Radiation Oncology Clinical Trials. Semin Radiat Oncol 2023; 33:395-406. [PMID: 37684069 DOI: 10.1016/j.semradonc.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Clinical trials have been the center of progress in modern medicine. In oncology, we are fortunate to have a structure in place through the National Clinical Trials Network (NCTN). The NCTN provides the infrastructure and a forum for scientific discussion to develop clinical concepts for trial design. The NCTN also provides a network group structure to administer trials for successful trial management and outcome analyses. There are many important aspects to trial design and conduct. Modern trials need to ensure appropriate trial conduct and secure data management processes. Of equal importance is the quality assurance of a clinical trial. If progress is to be made in oncology clinical medicine, investigators and patient care providers of service need to feel secure that trial data is complete, accurate, and well-controlled in order to be confident in trial analysis and move trial outcome results into daily practice. As our technology has matured, so has our need to apply technology in a uniform manner for appropriate interpretation of trial outcomes. In this article, we review the importance of quality assurance in clinical trials involving radiation therapy. We will include important aspects of institution and investigator credentialing for participation as well as ongoing processes to ensure that each trial is being managed in a compliant manner. We will provide examples of the importance of complete datasets to ensure study interpretation. We will describe how successful strategies for quality assurance in the past will support new initiatives moving forward.
Collapse
Affiliation(s)
- Thomas J FitzGerald
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA..
| | | | - Fran Laurie
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA
| | - Matthew Iandoli
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA
| | - Koren Smith
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA
| | - Kenneth Ulin
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA
| | - Linda Ding
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA
| | - Janaki Moni
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA
| | - M Giulia Cicchetti
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA
| | - Michael Knopp
- Department of Radiology, University of Cincinnati, Cincinnati, OH
| | - Stephen Kry
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX
| | - Ying Xiao
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Mark Rosen
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Fred Prior
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Joel Saltz
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
| | - Jeff Michalski
- Department of Radiation Oncology, Washington University in St Louis, St Louis, MO
| |
Collapse
|
5
|
Spratt DE, Liu VYT, Michalski J, Davicioni E, Berlin A, Simko JP, Efstathiou JA, Tran PT, Sandler HM, Hall WA, Thompson DJS, Parliament MB, Dayes IS, Correa RJM, Robertson JM, Gore EM, Doncals DE, Vigneault E, Souhami L, Karrison TG, Feng FY. Genomic Classifier Performance in Intermediate-Risk Prostate Cancer: Results From NRG Oncology/RTOG 0126 Randomized Phase 3 Trial. Int J Radiat Oncol Biol Phys 2023; 117:370-377. [PMID: 37137444 PMCID: PMC10949135 DOI: 10.1016/j.ijrobp.2023.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/15/2023] [Accepted: 04/12/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE Intermediate-risk prostate cancer is a heterogeneous disease state with diverse treatment options. The 22-gene Decipher genomic classifier (GC) retrospectively has shown to improve risk stratification in these patients. We assessed the performance of the GC in men with intermediate-risk disease enrolled in NRG Oncology/RTOG 01-26 with updated follow-up. METHODS AND MATERIALS After National Cancer Institute approval, biopsy slides were collected from NRG Oncology/RTOG 01-26, a randomized phase 3 trial of men with intermediate-risk prostate cancer randomized to 70.2 Gy versus 79.2 Gy of radiation therapy without androgen deprivation therapy. RNA was extracted from the highest-grade tumor foci to generate the locked 22-gene GC model. The primary endpoint for this ancillary project was disease progression (composite of biochemical failure, local failure, distant metastasis, prostate cancer-specific mortality, and use of salvage therapy). Individual endpoints were also assessed. Fine-Gray or cause-specific Cox multivariable models were constructed adjusting for randomization arm and trial stratification factors. RESULTS Two-hundred fifteen patient samples passed quality control for analysis. The median follow-up was 12.8 years (range, 2.4-17.7). On multivariable analysis, the 22-gene GC (per 0.1 unit) was independently prognostic for disease progression (subdistribution hazard ratio [sHR], 1.12; 95% confidence interval [CI], 1.00-1.26; P = .04), biochemical failure (sHR, 1.22; 95% CI, 1.10-1.37; P < .001), distant metastasis (sHR, 1.28; 95% CI, 1.06-1.55; P = .01), and prostate cancer-specific mortality (sHR, 1.45; 95% CI, 1.20-1.76; P < .001). Ten-year distant metastasis in GC low-risk patients was 4% compared with 16% for GC high-risk patients. In patients with lower GC scores, the 10-year difference in metastasis-free survival rate between arms was -7%, compared with 21% for higher GC patients (P-interaction = .04). CONCLUSIONS This study represents the first validation of a biopsy-based gene expression classifier, assessing both its prognostic and predictive value, using data from a randomized phase 3 trial of intermediate-risk prostate cancer. Decipher improves risk stratification and can aid in treatment decision-making in men with intermediate-risk disease.
Collapse
Affiliation(s)
- Daniel E Spratt
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio.
| | | | - Jeff Michalski
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | | | - Alejandro Berlin
- Princess Margaret Cancer Centre, Cancer Clinical Research Unit, Toronto, Ontario, Canada
| | - Jeffry P Simko
- Department of Pathology, UCSF Medical Center-Mount Zion, San Francisco, California
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Phuoc T Tran
- Department of Pathology, University of Maryland, Baltimore, Maryland
| | - Howard M Sandler
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - William A Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Matthew B Parliament
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Ian S Dayes
- Division of Radiation Oncology, Hamilton Regional Cancer Centre, Ontario, Canada
| | | | - John M Robertson
- Department of Radiation Oncology, Beaumont Health CCOP, Royal Oak, Michigan
| | - Elizabeth M Gore
- Department of Radiation Oncology, Milwaukee VA Medical Center, Milwaukee, Wisconsin
| | | | - Eric Vigneault
- Department of Radiation Oncology, CHU de Quebec Universite Laval, Quebec, Canada
| | - Luis Souhami
- Department of Radiation Oncology, Cedars Cancer Centre, McGill University, Quebec, Canada
| | - Theodore G Karrison
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | - Felix Y Feng
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| |
Collapse
|
6
|
Ganeshan D, Khatri G, Ali N, Avery R, Caserta MP, Chang SD, De Leon AD, Gupta RT, Lyshchik A, Michalski J, Nicola R, Pierorazio PM, Purysko AS, Smith AD, Taffel MT, Nikolaidis P. ACR Appropriateness Criteria® Staging of Renal Cell Carcinoma: 2022 Update. J Am Coll Radiol 2023; 20:S246-S264. [PMID: 37236747 DOI: 10.1016/j.jacr.2023.02.008] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Renal cell carcinoma is a complex group of highly heterogenous renal tumors demonstrating variable biological behavior. Pretreatment imaging of renal cell carcinoma involves accurate assessment of the primary tumor, presence of nodal, and distant metastases. CT and MRI are the key imaging modalities used in the staging of renal cell carcinoma. Important imaging features that impact treatment include tumor extension into renal sinus and perinephric fat, involvement of pelvicalyceal system, infiltration into adrenal gland, involvement of renal vein and inferior vena cava, as well as the presence of metastatic adenopathy and distant metastases. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
Collapse
Affiliation(s)
| | - Gaurav Khatri
- Panel Chair, UT Southwestern Medical Center, Dallas, Texas
| | - Norman Ali
- The University of Texas MD Anderson Cancer Center, Houston, Texas, Primary care physician
| | - Ryan Avery
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Commission on Nuclear Medicine and Molecular Imaging
| | | | - Silvia D Chang
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Rajan T Gupta
- Duke University Medical Center, Durham, North Carolina
| | - Andrej Lyshchik
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jeff Michalski
- Mallinckrodt Institute of Radiology Washington University School of Medicine, Saint Louis, Missouri; Commission on Radiation Oncology
| | - Refky Nicola
- SUNY Upstate Medical University, Syracuse, New York
| | - Phillip M Pierorazio
- Presbyterian Medical Center, University of Pennsylvania, Philadelphia, Pennsylvania; American Urological Association
| | | | - Andrew D Smith
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Myles T Taffel
- New York University Langone Medical Center, New York, New York
| | | |
Collapse
|
7
|
Solanki AA, Puckett LL, Kujundzic K, Katsoulakis E, Park J, Kapoor R, Hagan M, Kelly M, Palta J, Ballas LK, DeMarco J, Hoffman KE, Lawton CAF, Michalski J, Potters L, Zelefsky M, Kudner R, Dawes S, Wilson E, Sandler H. Consensus Quality Measures and Dose Constraints for Prostate Cancer From the Veterans Affairs Radiation Oncology Quality Surveillance Program and American Society for Radiation Oncology Expert Panel. Pract Radiat Oncol 2023; 13:e149-e165. [PMID: 36522277 DOI: 10.1016/j.prro.2022.08.018] [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] [Received: 04/26/2022] [Revised: 08/15/2022] [Accepted: 08/26/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE There are no agreed upon measures to comprehensively determine the quality of radiation oncology (RO) care delivered for prostate cancer. Consequently, it is difficult to assess the implementation of scientific advances and adherence to best practices in routine clinical practice. To address this need, the US Department of Veterans Affairs (VA) National Radiation Oncology Program established the VA Radiation Oncology Quality Surveillance (VA ROQS) Program to develop clinical quality measures to assess the quality of RO care delivered to Veterans with cancer. This article reports the prostate cancer consensus measures. METHODS AND MATERIALS The VA ROQS Program contracted with the American Society for Radiation Oncology to commission a Blue Ribbon Panel of prostate cancer experts to develop a set of evidence-based measures and performance expectations. From February to June 2021, the panel developed quality, aspirational, and surveillance measures for (1) initial consultation and workup, (2) simulation, treatment planning, and delivery, and (3) follow-up. Dose-volume histogram (DVH) constraints to be used as quality measures for definitive and post-prostatectomy radiation therapy were selected. The panel also identified the optimal Common Terminology Criteria for Adverse Events, version 5.0 (CTCAE V5.0), toxicity terms to assess in follow-up. RESULTS Eighteen prostate-specific measures were developed (13 quality, 2 aspirational, and 3 surveillance). DVH metrics tailored to conventional, moderately hypofractionated, and ultrahypofractionated regimens were identified. Decision trees to determine performance for each measure were developed. Eighteen CTCAE V5.0 terms were selected in the sexual, urinary, and gastrointestinal domains as highest priority for assessment during follow-up. CONCLUSIONS This set of measures and DVH constraints serves as a tool for assessing the comprehensive quality of RO care for prostate cancer. These measures will be used for ongoing quality surveillance and improvement among veterans receiving care across VA and community sites. These measures can also be applied to clinical settings outside of those serving veterans.
Collapse
Affiliation(s)
- Abhishek A Solanki
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, Illinois; Department of Radiation Oncology, Edward Hines Jr, VA Hospital, Hines, Illinois.
| | - Lindsay L Puckett
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin; Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin
| | | | - Evangelia Katsoulakis
- Department of Radiation Oncology, James A. Haley Veterans Affairs Healthcare System, Tampa, Florida
| | - John Park
- Department of Radiation Oncology, Kansas City VA Medical Center, Kansas City, Missouri; Department of Radiation Oncology, University of Missouri, Kansas City, Missouri
| | - Rishabh Kapoor
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia
| | - Michael Hagan
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia; National Radiation Oncology Program, Veteran's Healthcare Administration, Richmond, Virginia
| | - Maria Kelly
- National Radiation Oncology Program, Veteran's Healthcare Administration, Richmond, Virginia
| | - Jatinder Palta
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia; National Radiation Oncology Program, Veteran's Healthcare Administration, Richmond, Virginia
| | - Leslie K Ballas
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - John DeMarco
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Karen E Hoffman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer, Houston, Texas
| | - Colleen A F Lawton
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jeff Michalski
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri
| | - Louis Potters
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York; Department of Radiation Medicine, Zucker School of Medicine, Hempstead, New York
| | - Michael Zelefsky
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Randi Kudner
- American Society for Radiation Oncology, Arlington, Virginia
| | - Samantha Dawes
- American Society for Radiation Oncology, Arlington, Virginia
| | - Emily Wilson
- American Society for Radiation Oncology, Arlington, Virginia
| | - Howard Sandler
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| |
Collapse
|
8
|
Smith K, Ulin K, Knopp M, Kry S, Xiao Y, Rosen M, Michalski J, Iandoli M, Laurie F, Quigley J, Reifler H, Santiago J, Briggs K, Kirby S, Schmitter K, Prior F, Saltz J, Sharma A, Bishop-Jodoin M, Moni J, Cicchetti MG, FitzGerald TJ. Quality improvements in radiation oncology clinical trials. Front Oncol 2023; 13:1015596. [PMID: 36776318 PMCID: PMC9911211 DOI: 10.3389/fonc.2023.1015596] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 01/06/2023] [Indexed: 01/27/2023] Open
Abstract
Clinical trials have become the primary mechanism to validate process improvements in oncology clinical practice. Over the past two decades there have been considerable process improvements in the practice of radiation oncology within the structure of a modern department using advanced technology for patient care. Treatment planning is accomplished with volume definition including fusion of multiple series of diagnostic images into volumetric planning studies to optimize the definition of tumor and define the relationship of tumor to normal tissue. Daily treatment is validated by multiple tools of image guidance. Computer planning has been optimized and supported by the increasing use of artificial intelligence in treatment planning. Informatics technology has improved, and departments have become geographically transparent integrated through informatics bridges creating an economy of scale for the planning and execution of advanced technology radiation therapy. This serves to provide consistency in department habits and improve quality of patient care. Improvements in normal tissue sparing have further improved tolerance of treatment and allowed radiation oncologists to increase both daily and total dose to target. Radiation oncologists need to define a priori dose volume constraints to normal tissue as well as define how image guidance will be applied to each radiation treatment. These process improvements have enhanced the utility of radiation therapy in patient care and have made radiation therapy an attractive option for care in multiple primary disease settings. In this chapter we review how these changes have been applied to clinical practice and incorporated into clinical trials. We will discuss how the changes in clinical practice have improved the quality of clinical trials in radiation therapy. We will also identify what gaps remain and need to be addressed to offer further improvements in radiation oncology clinical trials and patient care.
Collapse
Affiliation(s)
- Koren Smith
- Imaging and Radiation Oncology Core-Rhode Island, Department of Radiation Oncology, UMass Chan Medical School, Lincoln, RI, United States
| | - Kenneth Ulin
- Imaging and Radiation Oncology Core-Rhode Island, Department of Radiation Oncology, UMass Chan Medical School, Lincoln, RI, United States
| | - Michael Knopp
- Imaging and Radiation Oncology Core-Ohio, Department of Radiology, The Ohio State University, Columbus, OH, United States
| | - Stephan Kry
- Imaging and Radiation Oncology Core-Houston, Division of Radiation Oncology, University of Texas, MD Anderson, Houston, TX, United States
| | - Ying Xiao
- Imaging and Radiation Oncology Core Philadelphia, Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States
| | - Mark Rosen
- Imaging and Radiation Oncology Core Philadelphia, Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Jeff Michalski
- Department of Radiation Oncology, Washington University, St Louis, MO, United States
| | - Matthew Iandoli
- Imaging and Radiation Oncology Core-Rhode Island, Department of Radiation Oncology, UMass Chan Medical School, Lincoln, RI, United States
| | - Fran Laurie
- Imaging and Radiation Oncology Core-Rhode Island, Department of Radiation Oncology, UMass Chan Medical School, Lincoln, RI, United States
| | - Jean Quigley
- Imaging and Radiation Oncology Core-Rhode Island, Department of Radiation Oncology, UMass Chan Medical School, Lincoln, RI, United States
| | - Heather Reifler
- Imaging and Radiation Oncology Core-Rhode Island, Department of Radiation Oncology, UMass Chan Medical School, Lincoln, RI, United States
| | - Juan Santiago
- Imaging and Radiation Oncology Core-Rhode Island, Department of Radiation Oncology, UMass Chan Medical School, Lincoln, RI, United States
| | - Kathleen Briggs
- Imaging and Radiation Oncology Core-Rhode Island, Department of Radiation Oncology, UMass Chan Medical School, Lincoln, RI, United States
| | - Shawn Kirby
- Imaging and Radiation Oncology Core-Rhode Island, Department of Radiation Oncology, UMass Chan Medical School, Lincoln, RI, United States
| | - Kate Schmitter
- Imaging and Radiation Oncology Core-Rhode Island, Department of Radiation Oncology, UMass Chan Medical School, Lincoln, RI, United States
| | - Fred Prior
- Department of Biomedical Informatics, University of Arkansas, Little Rock, AR, United States
| | - Joel Saltz
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, United States
| | - Ashish Sharma
- Department of Biomedical Informatics, Emory University, Atlanta, GA, United States
| | - Maryann Bishop-Jodoin
- Imaging and Radiation Oncology Core-Rhode Island, Department of Radiation Oncology, UMass Chan Medical School, Lincoln, RI, United States
| | - Janaki Moni
- Imaging and Radiation Oncology Core-Rhode Island, Department of Radiation Oncology, UMass Chan Medical School, Lincoln, RI, United States
| | - M. Giulia Cicchetti
- Imaging and Radiation Oncology Core-Rhode Island, Department of Radiation Oncology, UMass Chan Medical School, Lincoln, RI, United States
| | - Thomas J. FitzGerald
- Imaging and Radiation Oncology Core-Rhode Island, Department of Radiation Oncology, UMass Chan Medical School, Lincoln, RI, United States
| |
Collapse
|
9
|
Kavuma A, Kibudde S, Schmidt M, Zhao T, Gay H, Li B, Michalski J, Hugo G, Vanchinbazar E, Minjgee M, Nansalmaa E, Ssewamala F, Velarde A, De Fella V, Ixquiac M, Henke L, van Rheenen J, Sun B. Remote Global Radiation Oncology Education and Training: A Pathway to Increase Access to High-Quality Radiation Therapy Services in Low- and Middle-Income Countries. Adv Radiat Oncol 2023; 8:101180. [PMID: 36846439 PMCID: PMC9947225 DOI: 10.1016/j.adro.2023.101180] [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: 08/10/2022] [Accepted: 01/05/2023] [Indexed: 01/19/2023] Open
Abstract
Purpose There is a vital need to train radiation therapy professionals in low- and middle-income countries (LMICs) to develop sustainable cancer treatment capacity and infrastructure. LMICs have started to introduce intensity modulated radiation therapy (IMRT), which is the standard of care in high-income countries, because of improved outcomes and reduced toxicities. This work reports the efficacy of a complementary asynchronous plus synchronous virtual-training approach on improving radiation therapy professions' self-confidence levels and evaluating participants' attitudes toward asynchronous and synchronous didactic hands-on learning in 3 LMICs. Methods and Materials Training was provided to 37 participants from Uganda, Guatemala, and Mongolia, which included 4 theoretical lectures, 4 hands-on sessions, and 8 self-guided online videos. The 36-day training focused on IMRT contouring, site-specific target/organ definition, planning/optimization, and quality assurance. Participants completed pre- and postsession confidence surveys on a 0 to 10 scale, which was converted to a 5-point Likert rating scale to evaluate the training outcomes. The pros and cons of the 3 different training formats were compared. Results The participants included 15 (40.5%) radiation oncologists, 11 (29.7%) medical physicists, 6 (16.2%) radiation therapists, and 5 (13.5%) dosimetrists. Approximately 50% had more than 10 years of radiation therapy experience, 70.8% had no formal IMRT training, and only 25% had IMRT at their institutions. The average experience and confidence levels in using IMRT at baseline were 3.2 and 2.9, which increased to 5.2 and 4.9 (P < .001) after the theoretical training. After the hands-on training, the experience and confidence levels further improved to 5.4 and 5.5 (P < .001). After the self-guided training, the confidence levels increased further to 6.9 (P < .01). Among the 3 different training sessions, hands-on trainings (58.3%) were most helpful for the development of participants' IMRT skills, followed by theoretical sessions with 25%. Conclusions After completing the training sessions, Uganda and Mongolia started IMRT treatments. Remote training provides an excellent and feasible e-learning platform to train radiation therapy professionals in LMICs. The training program improved the IMRT confidence levels and treatment delivery. The hands-on trainings were most preferred.
Collapse
Affiliation(s)
- Awusi Kavuma
- Department of Radiation Therapy, Uganda Cancer Institute, Kampala, Uganda
- Corresponding author: Awusi Kavuma, DPhil
| | - Solomon Kibudde
- Department of Radiation Therapy, Uganda Cancer Institute, Kampala, Uganda
| | - Matthew Schmidt
- Department of Radiation Oncology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Tianyu Zhao
- Department of Radiation Oncology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Hiram Gay
- Department of Radiation Oncology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | | | - Jeff Michalski
- Department of Radiation Oncology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Geoffrey Hugo
- Department of Radiation Oncology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | | | | | | | - Fred Ssewamala
- Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Angel Velarde
- Perelman School of Medicine, University of Pennsylvania & Center for Global Health, Philadelphia, Pennsylvania
| | - Vicky De Fella
- Liga Nacional Contra el Cancer/Instituto de Cancerologia, Guatemala City, Guatemala
| | - Milton Ixquiac
- Liga Nacional Contra el Cancer/Instituto de Cancerologia, Guatemala City, Guatemala
| | - Lauren Henke
- Liga Nacional Contra el Cancer/Instituto de Cancerologia, Guatemala City, Guatemala
| | - Jacaranda van Rheenen
- Global Health Center, Institute for Public Health, Washington University in St. Louis, St. Louis, Missouri
| | - Baozhou Sun
- Department of Radiation Oncology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| |
Collapse
|
10
|
Patel SA, Baumann B, Michalski J, Brenneman R, Zheng B, Gay H, Ferraro D, Brown SA, Chang AJ, Rossi PJ, Fischer-Valuck BW. Association of Brachytherapy Boost with Overall Survival for Gleason 9-10 Prostate Cancer: The Impact of Primary versus Secondary Pattern 5. Brachytherapy 2023; 22:310-316. [PMID: 36635202 DOI: 10.1016/j.brachy.2022.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 06/28/2022] [Revised: 10/18/2022] [Accepted: 12/07/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE The addition of a brachytherapy (BT) boost to external beam radiotherapy (EBRT) reduces recurrence risk in men with high-risk prostate cancer (PCa) and may reduce PCa-mortality for Gleason grade group 5 (GG5). Whether the extent of pattern five, a risk factor for distant metastases, impacts the benefit of a BT boost is unclear. METHODS Men with localized GG5 PCa treated with (1) EBRT or (2) EBRT+BT between 2010 and 2016 were identified in the National Cancer Database. EBRT monotherapy group received conventionally fractionated (1.8-2.0 Gy per fraction) ≥74 Gy or moderately hypofractionated (2.5-3.0 Gy per fraction) ≥60 Gy. EBRT + BT group received conventionally fractionated ≥45 Gy or moderately hypofractionated ≥37.5 Gy, and either LDR or HDR BT. All patients received concomitant ADT; none received chemotherapy, immunotherapy, or surgery. OS was compared using Kaplan-Meier, log-rank test, and multivariable Cox proportional hazards in the overall cohort, followed by subgroups based on primary versus secondary pattern 5. Propensity score- and exact-matching was used to corroborate results. RESULTS A total of 8260 men were eligible: EBRT alone (89%) versus EBRT + BT (11%). 5-year OS for EBRT versus EBRT + BT was 76.3% and 85.0%, respectively (p = 0.002; multivariable adjusted HR 0.84, 95% CI 0.65-0.98; p = 0.04). These results remained consistent after propensity score and exact matching. The OS advantage of a BT boost was more prominent in men with Gleason 4 + 5 PCa (p = 0.001) and not observed in men with Gleason 5 + 5 or 5 + 4 PCa. CONCLUSIONS Extent of pattern five may be useful in appropriately selecting men for EBRT+BT and should be considered as a pre-randomization stratification variable for future clinical trial design.
Collapse
Affiliation(s)
- Sagar A Patel
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA.
| | - Brian Baumann
- Department of Radiation Oncology, Washington University, St. Louis, MO
| | - Jeff Michalski
- Department of Radiation Oncology, Washington University, St. Louis, MO
| | - Randall Brenneman
- Department of Radiation Oncology, Washington University, St. Louis, MO
| | - Bill Zheng
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Hiram Gay
- Department of Radiation Oncology, Washington University, St. Louis, MO
| | | | | | - Albert J Chang
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - Peter J Rossi
- Calaway Young Cancer Center, Valley View Hospital, Glenwood Springs, CO
| | | |
Collapse
|
11
|
Naing A, Wang J, Sharma M, Sommerhalder D, Gandhi L, Oh DY, Jiang Y, Michalski J, Lee J, Zhou K, Taylor N, Yan L, Roda J, Blum L, Ling L, Mikaelian I, Depaoli A, Hanes V, Kaplan D, Lieu H. 174P First-in-human study of NGM707, an ILT2/ILT4 dual antagonist antibody in advanced or metastatic solid tumors: Preliminary monotherapy dose escalation data. Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
12
|
Flaig TW, Spiess PE, Abern M, Agarwal N, Bangs R, Boorjian SA, Buyyounouski MK, Chan K, Chang S, Friedlander T, Greenberg RE, Guru KA, Herr HW, Hoffman-Censits J, Kishan A, Kundu S, Lele SM, Mamtani R, Margulis V, Mian OY, Michalski J, Montgomery JS, Nandagopal L, Pagliaro LC, Parikh M, Patterson A, Plimack ER, Pohar KS, Preston MA, Richards K, Sexton WJ, Siefker-Radtke AO, Tollefson M, Tward J, Wright JL, Dwyer MA, Cassara CJ, Gurski LA. NCCN Guidelines® Insights: Bladder Cancer, Version 2.2022. J Natl Compr Canc Netw 2022; 20:866-878. [PMID: 35948037 DOI: 10.6004/jnccn.2022.0041] [Citation(s) in RCA: 82] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The NCCN Guidelines for Bladder Cancer provide recommendations for the diagnosis, evaluation, treatment, and follow-up of patients with bladder cancer and other urinary tract cancers (upper tract tumors, urothelial carcinoma of the prostate, primary carcinoma of the urethra). These NCCN Guidelines Insights summarize the panel discussion behind recent important updates to the guidelines regarding the treatment of non-muscle-invasive bladder cancer, including how to treat in the event of a bacillus Calmette-Guérin (BCG) shortage; new roles for immune checkpoint inhibitors in non-muscle invasive, muscle-invasive, and metastatic bladder cancer; and the addition of antibody-drug conjugates for metastatic bladder cancer.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Shilajit Kundu
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - Ronac Mamtani
- Abramson Cancer Center at the University of Pennsylvania
| | | | - Omar Y Mian
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Jeff Michalski
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | | | - Anthony Patterson
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | - Kamal S Pohar
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | | | | | | | - Jonathan L Wright
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; and
| | | | | | | |
Collapse
|
13
|
Jia AY, Kashani R, Zaorsky NG, Baumann BC, Michalski J, Zoberi JE, Kiess AP, Spratt DE. Lutetium-177 Prostate-Specific Membrane Antigen Therapy: A Practical Review. Pract Radiat Oncol 2022; 12:294-299. [PMID: 35717043 DOI: 10.1016/j.prro.2022.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 01/31/2022] [Indexed: 11/20/2022]
Abstract
Prostate-specific membrane antigen is a transmembrane protein found predominately on prostate epithelium and is expressed at high levels in prostate cancer. In this review, we discuss the background, clinical data, patient selection, side effects, and necessary resources to deliver lutetium-177 prostate-specific membrane antigen in the research setting, or as standard of care if approved by the United States Food and Drug Administration. Targeted radionuclide therapeutics require understanding of fundamental principles of radiobiology and physics, and radiation oncologists and medical physicists are well-suited to play an integral role in their delivery and treatment response monitoring as key components of a multidisciplinary care team.
Collapse
Affiliation(s)
- Angela Y Jia
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland.
| | - Rojano Kashani
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Brian C Baumann
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Jeff Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Jacqueline E Zoberi
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Ana P Kiess
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Daniel E Spratt
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio
| |
Collapse
|
14
|
Embry L, Hardy K, Orgel E, Wang Y, Michalski J, Li Y, Cullen P, Colte P, Bass J. QOL-13. Impact of hearing loss on neuropsychological functioning in children treated for medulloblastoma: A report from the Children’s Oncology Group (COG). Neuro Oncol 2022. [PMCID: PMC9164722 DOI: 10.1093/neuonc/noac079.496] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND/OBJECTIVE: We prospectively examined neuropsychological outcomes and ototoxicity in children with average-risk medulloblastoma. METHODS: Eligible patients included those treated on COG protocol ACNS0331 who completed audiograms at end of therapy or one-year off-therapy, and neuropsychological assessments between 2- and 5-years post-diagnosis. Conventional pure-tone audiometric evaluations (0.25-8kHz) were assigned an ototoxicity grade based on the International Society of Pediatric Oncology (SIOP) grading scale. Grade for the better hearing ear was used for analyses. Participants were divided into two groups: SIOP grade≥3 hearing loss (HL) versus SIOP grade<3. Cutoff score of 60 on BASC-2 was used to dichotomize parent-reported anxiety and depression scores as ‘low’ or ‘high’. RESULTS: Data were available for 113 children (66% male; 86% white), aged 3.0-18.5 at diagnosis (Mean=9.1). One-quarter (24.8%, n=28) had at least moderate HL (≥ SIOP grade 2), and 12.3% (n=14) had severe HL (≥ SIOP grade 3). After controlling for radiation exposure and age, children with severe HL showed significantly higher levels of anxiety (OR=5.9, 95%CI 1.3-26.0, p=0.0195) and borderline differences in depression (OR=4.0, 95%CI 1.0-16.5, p=0.0563), but no differences in cognitive functioning when compared to other participants. When moderate and severe HL were combined in exploratory analyses, significantly greater anxiety (OR=9.0, 95%CI 2.1-37.4, p=.0027) and depression (OR=4.6, 95%CI 1.3-15.7, p=.0165) were observed. CONCLUSIONS: Survivors of pediatric medulloblastoma with moderate to severe HL evidenced greater psychosocial, but not neurocognitive, difficulties compared to those with no or mild HL. It may be that modern treatment protocols generally preserve cognitive functioning such that associations between HL and cognitive impairment are no longer significant. It is also possible that neurocognitive risk associated with HL may not manifest until survivors are further from diagnosis. In contrast, survivors with HL may be at greater risk for negative psychosocial adjustment, suggesting that increased monitoring of mental health outcomes is warranted.
Collapse
Affiliation(s)
- Leanne Embry
- University of Texas Health Science Center, San Antonio , TX , USA
| | - Kristina Hardy
- Children's National Hospital , Washington, DC , USA
- George Washington University School of Medicine , Washington, DC , USA
| | - Etan Orgel
- Children's Hospital of Los Angeles, Los Angeles , CA , USA
- University of Southern California, Los Angeles , CA , USA
| | - Yu Wang
- St. Jude Children's Research Hospital , Memphis, TN , USA
| | - Jeff Michalski
- Washington University in St. Louis, St. Louis , MO , USA
| | - Yimei Li
- St. Jude Children's Research Hospital , Memphis, TN , USA
| | | | - Paul Colte
- Primary Children's Hospital, Salt Lake City , UT , USA
| | - Johnnie Bass
- St. Jude Children's Research Hospital , Memphis, TN , USA
| |
Collapse
|
15
|
He S, Wu J, Lian C, Gach H, Mutic S, Bosch W, Michalski J, Li H. An Adaptive Low-Rank Modeling-Based Active Learning Method for Medical Image Annotation. Ing Rech Biomed 2021; 42:334-344. [PMID: 34934476 PMCID: PMC8687126 DOI: 10.1016/j.irbm.2020.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Active learning is an effective solution to interactively select a limited number of informative examples and use them to train a learning algorithm that can achieve its optimal performance for specific tasks. It is suitable for medical image applications in which unlabeled data are abundant but manual annotation could be very time-consuming and expensive. However, designing an effective active learning strategy for informative example selection is a challenging task, due to the intrinsic presence of noise in medical images, the large number of images, and the variety of imaging modalities. In this study, a novel low-rank modeling-based multi-label active learning (LRMMAL) method is developed to address these challenges and select informative examples for training a classifier to achieve the optimal performance. The proposed method independently quantifies image noise and integrates it with other measures to guide a pool-based sampling process to determine the most informative examples for training a classifier. In addition, an automatic adaptive cross entropy-based parameter determination scheme is proposed for further optimizing the example sampling strategy. Experimental results on varied medical image datasets and comparisons with other state-of-the-art multi-label active learning methods illustrate the superior performance of the proposed method.
Collapse
Affiliation(s)
- S. He
- Department of Computer Science, Washington University, St. Louis, MO, USA
| | - J. Wu
- Department of Radiation Oncology, Washington University, St. Louis, MO, USA
| | - C. Lian
- Department of Radiology, The University of North Carolina at Chapel Hill, NC, USA
| | - H.M. Gach
- Department of Radiation Oncology, Washington University, St. Louis, MO, USA
| | - S. Mutic
- Department of Radiation Oncology, Washington University, St. Louis, MO, USA
| | - W. Bosch
- Department of Radiation Oncology, Washington University, St. Louis, MO, USA
| | - J. Michalski
- Department of Radiation Oncology, Washington University, St. Louis, MO, USA
| | - H. Li
- Department of BioEngineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Carle Cancer Center, Carle Foundation Hospital, Urbana, IL, USA
| |
Collapse
|
16
|
Kry S, Lye J, Clark C, Andratschke N, Dimitriadis A, Followill D, Howell R, Hussein M, Ishikawa M, Kito S, Kron T, Lee J, Michalski J, Monti A, Reynaert N, Taylor P, Venables K, Xiao Y, Lehmann J. PD-0899 Report dose-to-medium in clinical trials; a consensus from the Global Harmonisation Group. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07178-4] [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]
|
17
|
Leary SES, Packer RJ, Li Y, Billups CA, Smith KS, Jaju A, Heier L, Burger P, Walsh K, Han Y, Embry L, Hadley J, Kumar R, Michalski J, Hwang E, Gajjar A, Pollack IF, Fouladi M, Northcott PA, Olson JM. Efficacy of Carboplatin and Isotretinoin in Children With High-risk Medulloblastoma: A Randomized Clinical Trial From the Children's Oncology Group. JAMA Oncol 2021; 7:1313-1321. [PMID: 34292305 DOI: 10.1001/jamaoncol.2021.2224] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Brain tumors are the leading cause of disease-related death in children. Medulloblastoma is the most common malignant embryonal brain tumor, and strategies to increase survival are needed. Objective To evaluate therapy intensification with carboplatin as a radiosensitizer and isotretinoin as a proapoptotic agent in children with high-risk medulloblastoma in a randomized clinical trial and, with a correlative biology study, facilitate planned subgroup analysis according to World Health Organization consensus molecular subgroups of medulloblastoma. Design, Setting, and Participants A randomized clinical phase 3 trial was conducted from March 2007 to September 2018. Analysis was completed in September 2020. Patients aged 3 to 21 years with newly diagnosed high-risk medulloblastoma from Children's Oncology Group institutions within the US, Canada, Australia, and New Zealand were included. High-risk features included metastasis, residual disease, or diffuse anaplasia. Interventions Patients were randomized to receive 36-Gy craniospinal radiation therapy and weekly vincristine with or without daily carboplatin followed by 6 cycles of maintenance chemotherapy with cisplatin, cyclophosphamide, and vincristine with or without 12 cycles of isotretinoin during and following maintenance. Main Outcomes and Measures The primary clinical trial end point was event-free survival, using the log-rank test to compare arms. The primary biology study end point was molecular subgroup classification by DNA methylation array. Results Of 294 patients with medulloblastoma, 261 were evaluable after central radiologic and pathologic review; median age, 8.6 years (range, 3.3-21.2); 183 (70%) male; 189 (72%) with metastatic disease; 58 (22%) with diffuse anaplasia; and 14 (5%) with greater than 1.5-cm2 residual disease. For all participants, the 5-year event-free survival was 62.9% (95% CI, 55.6%-70.2%) and overall survival was 73.4% (95% CI, 66.7%-80.1%). Isotretinoin randomization was closed early owing to futility. Five-year event-free survival was 66.4% (95% CI, 56.4%-76.4%) with carboplatin vs 59.2% (95% CI, 48.8%-69.6%) without carboplatin (P = .11), with the effect exclusively observed in group 3 subgroup patients: 73.2% (95% CI, 56.9%-89.5%) with carboplatin vs 53.7% (95% CI, 35.3%-72.1%) without (P = .047). Five-year overall survival differed by molecular subgroup (P = .006): WNT pathway activated, 100% (95% CI, 100%-100%); SHH pathway activated, 53.6% (95% CI, 33.0%-74.2%); group 3, 73.7% (95% CI, 61.9%-85.5%); and group 4, 76.9% (95% CI, 67.3%-86.5%). Conclusions and Relevance In this randomized clinical trial, therapy intensification with carboplatin improved event-free survival by 19% at 5 years for children with high-risk group 3 medulloblastoma. These findings further support the value of an integrated clinical and molecular risk stratification for medulloblastoma. Trial Registration ClinicalTrials.gov Identifier: NCT00392327.
Collapse
Affiliation(s)
- Sarah E S Leary
- Cancer and Blood Disorders Center, Seattle Children's, Seattle, Washington.,Department of Pediatrics, University of Washington School of Medicine, Seattle.,Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Roger J Packer
- Center for Neuroscience and Behavioral Health, Children's National Hospital, Washington, DC
| | - Yimei Li
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Catherine A Billups
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Kyle S Smith
- Department of Developmental Neurobiology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Alok Jaju
- Department of Radiology, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Linda Heier
- Department of Radiology, NYP/Weill Cornell Medical Center, New York, New York
| | - Peter Burger
- Sidney Kimmel Cancer Center, Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Karin Walsh
- Division of Neuropsychology, Children's National Hospital, Washington, DC
| | - Yuanyuan Han
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Leanne Embry
- Pediatric Hematology/Oncology, UT Health San Antonio, San Antonio, Texas
| | - Jennifer Hadley
- Department of Developmental Neurobiology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Rahul Kumar
- Department of Developmental Neurobiology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Jeff Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Eugene Hwang
- Center for Cancer and Blood Disorders, Children's National Hospital, Washington, DC
| | - Amar Gajjar
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Ian F Pollack
- Department of Neurosurgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Maryam Fouladi
- Pediatric Hematology & Oncology, Nationwide Children's Hospital, Columbus, Ohio
| | - Paul A Northcott
- Department of Developmental Neurobiology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - James M Olson
- Cancer and Blood Disorders Center, Seattle Children's, Seattle, Washington.,Department of Pediatrics, University of Washington School of Medicine, Seattle.,Fred Hutchinson Cancer Research Center, Seattle, Washington
| |
Collapse
|
18
|
Velarde A, Kihn-Alarcón A, Gay H, Michalski J, Ruiz E, Geoffrey H, de Falla V, Figueroa J, Najera KD, García C, Ma K, Salazar A, Zamorano A, Dávila S, van Rheenen J. Abstract 110: Colon Cancer in Patients under 50 in Guatemala: A Retrospective Comparative Cohort Study. Cancer Epidemiol Biomarkers Prev 2021. [DOI: 10.1158/1538-7755.asgcr21-110] [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: 11/16/2022] Open
Abstract
Abstract
Purpose: Describing and comparing clinico-pathological characteristics of younger (<50 years) versus older (≥50 years) colon cancer patients treated at the Guatemalan Liga Nacional Contra el Cáncer e Institute of Cancer (Liga-INCAN).
Methods: This IRB-approved single-institution retrospective cohort study reviewed the medical and pathological records of patients ≥18 years diagnosed with colon cancer at the Liga-INCAN, the largest specialized oncologic hospital in Guatemala, from 2013-2019. Continuous data are presented as mean and standard deviation, categorical data as frequency and percentage. Subjects were categorized into two groups, younger group (<50 years) and older group (≥50 years). Statistical analyses were performed with Chi-squared, Fisher's exact test, and Kruskal-Wallis test.
Results: Among 123 patients, 34.74% were <50 and 65.26% ≥50 years. Most of patients in the younger group were male 68.83% in comparison to the older group where most were female (p<0.01), patients resided in the rural area 60.47% vs 50.0% respectively (p=0.18). BMI index in younger patients was below 25 in 56.1% vs 50.64% (p=0.30). Patients <50 years old were diagnosed at earlier stages (I and II) 39.54% vs 22.5% when compared with ≥50 years old patients (p<0.05), tumors were more common in the left compared to the right colon in younger patients (58.14% vs 50.0%), the difference was not significant (p=0.15). Histopathological features did not show significant differences, most tumors were adenocarcinomas for both groups, but signet ring cell carcinomas were more frequent in the younger than in older patients (9.30% vs 1.25%).
Conclusion: Our findings indicate that Guatemalan patients diagnosed with colon cancer younger than fifty years old are more frequently male and are diagnosed at earlier stages compared to older patients. Although, histopathological characteristics did not show significant differences, further studies are needed to understand how these impact the prognosis of the patients in the different age groups.
Funding: None
Citation Format: Angel Velarde, Alba Kihn-Alarcón, Hiram Gay, Jeff Michalski, Edgar Ruiz, Hugo Geoffrey, Vicky de Falla, Javier Figueroa, Kirk Douglas Najera, Carlos García, Kevin Ma, Ana Salazar, Abigail Zamorano, Sonia Dávila, Jacaranda van Rheenen. Colon Cancer in Patients under 50 in Guatemala: A Retrospective Comparative Cohort Study [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 110.
Collapse
Affiliation(s)
- Angel Velarde
- 1Liga Nacional Contra El Cancer e Instituto de Cancerologia-INCAN, Guatemala City, Guatemala,
| | - Alba Kihn-Alarcón
- 1Liga Nacional Contra El Cancer e Instituto de Cancerologia-INCAN, Guatemala City, Guatemala,
| | - Hiram Gay
- 2Department of Radiation Oncology, Washington University in St Louis, St Louis, Missouri,
| | - Jeff Michalski
- 3Division of Infectious Diseases and Institute for Public Health, Washington University in St Louis, St Louis, Missouri,
| | - Edgar Ruiz
- 1Liga Nacional Contra El Cancer e Instituto de Cancerologia-INCAN, Guatemala City, Guatemala,
| | - Hugo Geoffrey
- 2Department of Radiation Oncology, Washington University in St Louis, St Louis, Missouri,
| | - Vicky de Falla
- 1Liga Nacional Contra El Cancer e Instituto de Cancerologia-INCAN, Guatemala City, Guatemala,
| | - Javier Figueroa
- 1Liga Nacional Contra El Cancer e Instituto de Cancerologia-INCAN, Guatemala City, Guatemala,
| | - Kirk Douglas Najera
- 1Liga Nacional Contra El Cancer e Instituto de Cancerologia-INCAN, Guatemala City, Guatemala,
| | - Carlos García
- 1Liga Nacional Contra El Cancer e Instituto de Cancerologia-INCAN, Guatemala City, Guatemala,
| | - Kevin Ma
- 4Department of Life Science, National Taiwan University, Taipei, Taiwan, ROC,
| | - Ana Salazar
- 5Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida,
| | - Abigail Zamorano
- 6Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis Missouri,
| | - Sonia Dávila
- 1Liga Nacional Contra El Cancer e Instituto de Cancerologia-INCAN, Guatemala City, Guatemala,
| | - Jacaranda van Rheenen
- 7Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis Missouri
| |
Collapse
|
19
|
Green OL, Henke LE, Price A, Marko A, Wittland EJ, Rudra S, Kim H, Mutic S, Michalski J, Robinson CG. The Role of MRI-Guided Radiation Therapy for Palliation of Mobile Abdominal Cancers: A Report of Two Cases. Adv Radiat Oncol 2021; 6:100662. [PMID: 33997480 PMCID: PMC8102139 DOI: 10.1016/j.adro.2021.100662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 12/29/2020] [Accepted: 01/12/2021] [Indexed: 12/02/2022] Open
Affiliation(s)
- Olga L Green
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Lauren E Henke
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Alex Price
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Areti Marko
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Erin J Wittland
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Soumon Rudra
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Hyun Kim
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Sasa Mutic
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Jeff Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Clifford G Robinson
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| |
Collapse
|
20
|
Roy A, Brenneman RJ, Hogan J, Barnes J, Huang Y, Morris R, Goddu SM, Michael A, Garcia-Ramirez J, Li H, Zoberi JE, Bullock A, Kim E, Smith Z, Figenshau R, Andriole G, Baumann B, Michalski J, Gay H. PRSOR07 Presentation Time: 12:30 PM. Brachytherapy 2021. [DOI: 10.1016/j.brachy.2021.06.071] [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: 10/21/2022]
|
21
|
Hijab A, Tocco B, Hanson I, Meijer H, Nyborg CJ, Bertelsen AS, Smeenk RJ, Smith G, Michalski J, Baumann BC, Hafeez S. MR-Guided Adaptive Radiotherapy for Bladder Cancer. Front Oncol 2021; 11:637591. [PMID: 33718230 PMCID: PMC7947660 DOI: 10.3389/fonc.2021.637591] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 12/03/2020] [Accepted: 01/11/2021] [Indexed: 12/14/2022] Open
Abstract
Radiotherapy has an important role in the curative and palliative treatment settings for bladder cancer. As a target for radiotherapy the bladder presents a number of technical challenges. These include poor tumor visualization and the variability in bladder size and position both between and during treatment delivery. Evidence favors the use of magnetic resonance imaging (MRI) as an important means of tumor visualization and local staging. The availability of hybrid systems incorporating both MRI scanning capabilities with the linear accelerator (MR-Linac) offers opportunity for in-room and real-time MRI scanning with ability of plan adaption at each fraction while the patient is on the treatment couch. This has a number of potential advantages for bladder cancer patients. In this article, we examine the technical challenges of bladder radiotherapy and explore how magnetic resonance (MR) guided radiotherapy (MRgRT) could be leveraged with the aim of improving bladder cancer patient outcomes. However, before routine clinical implementation robust evidence base to establish whether MRgRT translates into improved patient outcomes should be ascertained.
Collapse
Affiliation(s)
- Adham Hijab
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom.,Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Boris Tocco
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom.,Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Ian Hanson
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom.,Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Hanneke Meijer
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | | | | | - Robert Jan Smeenk
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Gillian Smith
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Jeff Michalski
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Brian C Baumann
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Shaista Hafeez
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom.,Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
22
|
Khairnar RR, Sandler HM, Lee WR, Villalonga Olives E, Mullins CD, Bruner D, Shah A, Malone S, Michalski J, Dayes IS, Seaward SA, Albert M, Currey AD, Pisansky TM, Chen Y, Horwitz EM, DeNittis AS, Demora L, Feng FY, Mishra MV. Longitudinal predictive ability of mapping algorithms: Secondary analysis of NRG Oncology/RTOG 0415. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.60] [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: 11/20/2022] Open
Abstract
60 Background: Mapping algorithms informing economic evaluations are often derived using baseline data from clinical trials. It is unclear if these algorithms can predict health utilities accurately in post-intervention data. Thus, this study examines the longitudinal predictive ability of mapping algorithms derived from baseline trial data and explores the factors associated with prediction errors. Methods: This methodological study utilized data from an international, multicenter, randomized controlled trial of patients with low-risk prostate cancer (PC), conducted by NRG Oncology (NCT00331773). In addition to patient demographic and clinical data, this study utilized PRO data collected at baseline and 6, 12 and 24 months post-intervention. The Expanded Prostate Cancer Index Composite (EPIC) questionnaire measures health-related quality-of-life (HRQoL) and has four domains (urinary, sexual, hormonal, and bowel) and two subdomains per domain (function and bother); EuroQOL-5D-3L (EQ5D) captures health utilities. Ordinary Least Squares (OLS) regression models were used to map EPIC scores to EQ5D utilities in the baseline data through 5-fold cross-validation. Predictive performance was tested in the post-intervention data; predicted and reported utilities were compared using t-tests, and the absolute prediction error was modeled using fixed effects, as a function of baseline demographic and clinical covariates, as well as observed and predicted EQ5D utilities. Results: A total of 267 (199) patients had complete EQ5D and EPIC domain (or subdomain) data at baseline and all subsequent assessments. In the EPIC domain sample, mean ± standard deviation observed EQ5D utility was 0.90±0.13 at baseline, 0.92±0.11 at 6 months, 0.90±0.13 at 12 months and 0.89±0.14 at 24 months. Mean absolute differences (MDs) between reported and predicted were lower for models using EPIC subdomain data compared to EPIC domain data, and generally decreased as the time of assessment increased. The mapping functions over-predicted utilities for patients in perfect health while the prediction errors were increasingly negative for lower reported EQ5D scores. According to the fixed effects model for EPIC domain data, lower observed and predicted baseline EQ5D scores, and time of assessment were significant predictors of the absolute prediction error; for EPIC subdomain data, lower observed and predicted baseline EQ5D scores, hormonal bother and function, and bowel function significantly predicted the absolute prediction error. Conclusions: This study is the first to demonstrate the longitudinal validity of EPIC questionnaire, and builds upon existing research on longitudinal validity of mapping functions. The low MDs in prediction errors in post-intervention data indicate that the mapping functions are sensitive to treatment effect, thereby increasing confidence in their use in economic evaluations in PC.
Collapse
Affiliation(s)
| | | | | | | | | | - Deborah Bruner
- Winship Cancer Institute at Emory University, Atlanta, GA
| | | | - Shawn Malone
- The Ottawa Hospital Cancer Center, Ottawa, ON, Canada
| | | | | | | | | | - Adam D. Currey
- Medical College of Wisconsin, Department of Radiation Oncology, Milwaukee, WI
| | | | - Yuhchyau Chen
- University of Rochester Medical Center, Rochester, NY
| | | | | | | | - Felix Y Feng
- University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Mark V. Mishra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| |
Collapse
|
23
|
Duriseti S, Kavanaugh J, Goddu S, Price A, Knutson N, Reynoso F, Michalski J, Mutic S, Robinson C, Spraker MB. Spatially fractionated stereotactic body radiation therapy (Lattice) for large tumors. Adv Radiat Oncol 2021; 6:100639. [PMID: 34195486 PMCID: PMC8233471 DOI: 10.1016/j.adro.2020.100639] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 06/26/2020] [Revised: 10/22/2020] [Accepted: 12/02/2020] [Indexed: 12/31/2022] Open
Abstract
Purpose Stereotactic body radiation therapy (SBRT) has demonstrated clinical benefits for patients with metastatic and/or unresectable cancer. Technical considerations of treatment delivery and nearby organs at risk can limit the use of SBRT in large tumors or those in unfavorable locations. Spatially fractionated radiation therapy (SFRT) may address this limitation because this technique can deliver high-dose radiation to discrete subvolume vertices inside a tumor target while restricting the remainder of the target to a safer lower dose. Indeed, SFRT, such as GRID, has been used to treat large tumors with reported dramatic tumor response and minimal side effects. Lattice is a modern approach to SFRT delivered with arc-based therapy, which may allow for safe, high-quality SBRT for large and/or deep tumors. Methods and Materials Herein, we report the results of a dosimetry and quality assurance feasibility study of Lattice SBRT in 11 patients with 12 tumor targets, each ≥10 cm in an axial dimension. Prior computed tomography simulation scans were used to generate volumetric modulated arc therapy Lattice SBRT plans that were then delivered on clinically available Linacs. Quality assurance testing included external portal imaging device and ion chamber analyses. Results All generated plans met the standard SBRT dose constraints, such as those from the American Association of Physicists in Medicine Task Group 101. Additionally, we provide a step-by-step approach to generate and deliver Lattice SBRT plans using commercially available treatment technology. Conclusions Lattice SBRT is currently being tested in a prospective trial for patients with metastatic cancer who need palliation of large tumors (NCT04553471, NCT04133415).
Collapse
Affiliation(s)
- Sai Duriseti
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - James Kavanaugh
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Sreekrishna Goddu
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Alex Price
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Nels Knutson
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Francisco Reynoso
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Jeff Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Sasa Mutic
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Matthew B Spraker
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| |
Collapse
|
24
|
Michalski J, Borsuk M, Nogalski Z, Baranowska M, Krawczyńska A, Purwin C. Ruminal degradability of Virginia fanpetals ( Sida hermaphrodita) herbage and silage depending on the harvest time. J Anim Feed Sci 2020. [DOI: 10.22358/jafs/131849/2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
25
|
Leary S, Packer R, Jaju A, Heier L, Burger P, Smith K, Michalski J, Li Y, Billups C, Hwang E, Gajjar A, Pollack I, Fouladi M, Northcott P, Olson J. MBCL-16. EFFICACY OF CARBOPLATIN GIVEN CONCOMITANTLY WITH RADIATION AND ISOTRETINOIN AS A PRO-APOPTOTIC AGENT IN MAINTENANCE THERAPY IN HIGH-RISK MEDULLOBLASTOMA: A REPORT FROM THE CHILDREN’S ONCOLOGY GROUP. Neuro Oncol 2020. [PMCID: PMC7715378 DOI: 10.1093/neuonc/noaa222.492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Metastasis, residual disease, and diffuse anaplasia are high-risk features in medulloblastoma.
METHODS
This was a randomized phase 3 study. Patients age 3–21 years with high-risk medulloblastoma received (+/-) daily carboplatin with 36Gy craniospinal radiation and weekly Vincristine followed by six cycles of maintenance chemotherapy with Cisplatin, Cyclophosphamide and Vincristine (+/) 12 cycles of isotretinoin during and following maintenance. The primary endpoint was event-free survival, with exact log-rank test to compare arms. Retrospective molecular analysis included DNA methylation and exome sequencing.
RESULTS
Of 294 medulloblastoma patients enrolled, 261 were eligible by central review of radiology and pathology, median age 8.6 years (range 3.3–21.2), 70% male, 189 (72%) with metastatic disease, 58 (22%) with diffuse anaplasia, 14 (5%) with >1.5cm2 residual disease. The 5-year EFS and OS for all subjects was 63%+4 and 73%+3, respectively. Isotretinoin randomization was closed due to futility. 5-year EFS was 66 + 5 with carboplatin versus 59 + 5 without (p=0.11), with effect exclusively observed in Group 3 subtype: 73%+8 with carboplatin versus 54%+9 without (p<0.05). Overall survival differed by molecular subgroup (p=0.006): WNT 100%, SHH 54%+11, Group 3 74%+6, Group 4 77%+5 at 5 years. MYC amplification or isochromosome 17 were unfavorable in Group 3 (p=0.029). Chromosome 11 loss or chromosome 17 gain were favorable in group 4 (p<0.001). No survival difference was observed with TP53 mutation in SHH subtype in this high-risk cohort.
CONCLUSIONS
Therapy intensification with carboplatin improved survival for high-risk group 3 medulloblastoma. These findings further support an integrated clinical and molecular risk stratification for medulloblastoma.
Collapse
Affiliation(s)
- Sarah Leary
- Seattle Children’s, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | - Roger Packer
- Children’s National Medical Center, Washington, DC, USA
| | - Alok Jaju
- Ann and Robert H Lurie Children’s Hospital, Chicago, IL, USA
| | - Linda Heier
- NYP/Weill Cornell Medical Center, New York, NY, USA
| | - Peter Burger
- Johns Hopkins University, Baltimore, MD, USA
- Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Kyle Smith
- St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Jeff Michalski
- Washington University School of Medicine, St. Louis, MO, USA
| | - Yimei Li
- St. Jude Children’s Research Hospital, Memphis, TN, USA
| | | | - Eugene Hwang
- Children’s National Medical Center, Washington, DC, USA
| | - Amar Gajjar
- St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Ian Pollack
- Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Maryam Fouladi
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | - James Olson
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Seattle Children’s, Seattle, WA, USA
| |
Collapse
|
26
|
Deek M, Ladra M, Lin L, Li Y, Han Y, Hardy K, Michalski J. RONC-27. PROTON THERAPY REDUCES DOSE TO CRITICAL CENTRAL NERVOUS SYSTEM STRUCTURES IN MEDULLOBLASTOMA: A DOSIMETRIC ANALYSIS OF CHILDREN’S ONCOLOGY GROUP (COG) ACNS0331. Neuro Oncol 2020. [PMCID: PMC7715304 DOI: 10.1093/neuonc/noaa222.796] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Recently published data demonstrated proton therapy (PRT) significantly reduced cognitive decline relative to photons for pediatric medulloblastoma. These findings imply that reductions in dose to critical CNS structures during the boost phase may account for better outcomes over time. Here, we examine differences in dosimetric data for medulloblastoma patients treated on ACNS0331 with photon (Intensity Modulated Radiation Therapy, 3D-Conformal Radiation Therapy) vs PRT to identify potential structures responsible for cognitive benefit. METHODS COG ACNS0331 was a randomized trial examining the impact of reduced craniospinal irradiation (CSI) dose (standard vs low dose, in patients aged 3–7) and volume (whole posterior fossa vs involved field) in pediatric medulloblastoma patients. We identified 136 patients (IMRT=95, 3DCRT=28, Proton=13) enrolled on ACNS0331 with complete radiation and imaging data and re-contoured 10 critical brain structures to calculate dose. RESULTS Proton therapy significantly reduced the dose to critical structures. For example, temporal lobe mean dose and V30 were 30Gy/38% (PRT), 40Gy/89% (IMRT), 41Gy/84% (3DCRT)), hippocampi mean dose were 51 Gy (IMRT), 52 Gy (3DCRT), and 44Gy (PRT) and cochlear mean dose were 43 Gy (IMRT), 49 Gy (3DCRT), and 31Gy (PRT). Dose to several other critical structures were also significantly reduced including the whole brain, supratentorium, cerebellum, and pituitary. CONCLUSIONS Proton therapy greatly reduces dose to critical CNS structures when compared to IMRT or 3DCRT. Further studies are needed to correlate dose reductions in these structures with improved cognitive outcomes.
Collapse
Affiliation(s)
| | | | - Lan Lin
- Johns Hopkins Hospital, Baltimore, MD, USA
| | - Yimei Li
- St. Jude Children Hospital, Memphis, TN, USA
| | | | | | | |
Collapse
|
27
|
Embry L, Colte P, Cullen P, Michalski J, Li Y, Han Y, Hardy K. QOL-20. IMPACT OF RADIATION DOSE AND VOLUME ON MEMORY FUNCTIONING IN CHILDREN WITH MEDULLOBLASTOMA: A REPORT FROM CHILDREN’S ONCOLOGY GROUP (COG) ACNS0331. Neuro Oncol 2020. [PMCID: PMC7715581 DOI: 10.1093/neuonc/noaa222.682] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND/OBJECTIVES We examined longitudinal verbal and visual memory functioning in children treated for medulloblastoma on COG protocol ACNS0331. METHODS Children with medulloblastoma participated in neuropsychological testing at three timepoints over a 6-year period. Children aged 3–7 years were randomized to receive craniospinal irradiation (CSI) of either 23.4Gy (standard dose; SDCSI) or 18Gy (lower dose; LDCSI). Children aged 8+ received SDCSI. All children were also randomized to receive either a reduced radiation boost to the involved field (IFRT) or a standard boost to the whole posterior fossa (PFRT). Memory functioning was evaluated an average of 0.67(T1), 2.95(T2), and 4.90(T3) years post-diagnosis. RESULTS Of 464 eligible patients enrolled on ACNS0331, 354 (76%; 65.3% male, 83.1% white) completed some neuropsychological testing. Mean age at diagnosis was 9.1 years (range=3–19). Verbal and visual short-term memory and learning were broadly within the average range for the overall sample at all three timepoints. However, a large percentage of children exhibited scores ≥1SD below the mean on tasks of verbal learning both immediately (43.4%) and after a delay (40.7%) at T3. In addition, 58.6% of children randomized to SDCSI exhibited impairment in verbal learning after a delay compared to 34.8% of children randomized to LDSCI, and 35.0% of those aged ≥8 at diagnosis receiving SDCSI. CONCLUSIONS Younger children receiving SDCSI have particularly high rates of memory impairment five years after diagnosis of medulloblastoma. Limiting CSI dose and/or volume in young children treated for this diagnosis may improve outcomes for memory functioning.
Collapse
Affiliation(s)
- Leanne Embry
- University of Texas Health Science Center, San Antonio, TX, USA
| | - Paul Colte
- Primary Children’s Hospital, Salt Lake City, UT, USA
| | | | - Jeff Michalski
- Washington University School of Medicine, St, Louis, MO, USA
| | - Yimei Li
- St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Yuanyuan Han
- St. Jude Children’s Research Hospital, Memphis, TN, USA
| | | |
Collapse
|
28
|
Michalski J, Northcott P, Li Y, Billups C, Smith K, Burger P, Merchant T, Gajjar A, Fitzgerald TJ, Vezina G, Fouladi M, Packer R, Tarbell N, Janss A. MBCL-15. IMPACT OF MOLECULAR SUBGROUPS ON OUTCOMES FOLLOWING RADIATION TREATMENT RANDOMIZATIONS FOR AVERAGE RISK MEDULLOBLASTOMA: A PLANNED ANALYSIS OF CHILDREN’S ONCOLOGY GROUP (COG) ACNS0331. Neuro Oncol 2020. [PMCID: PMC7715222 DOI: 10.1093/neuonc/noaa222.491] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
The COG conducted a randomized trial for average-risk medulloblastoma (AR-MB). Patients age 3–21 years were randomized to a radiation boost to the whole posterior fossa (PFRT) or an involved field volume (IFRT) after receiving CSI. Patients age 3–7 years were also randomized to standard dose CSI (23.4Gy, SDCSI) or low dose CSI (18Gy, LDCSI). 464 evaluable patients were available to compare PFRT vs. IFRT and 226 for SDCSI vs. LDCSI. 380 cases had sufficient tissue for DNA methylation-based molecular classification: 362 confirmed medulloblastoma; 6 non-medulloblastoma; 12 inconclusive. Molecular subgrouping confirmed the following representation amongst the evaluable cohort: 156 Group 4 (43.1%), 76 Group 3 (21.0%), 66 SHH (18.2%), 64 WNT (17.7%). Five-year event-free survival (EFS) estimates were 82.5±2.7% and 80.5±2.7% for IFRT and PFRT, respectively (p=0.44). Five-year EFS estimates were 71.4±4.4% and 82.9±3.7% for LDCSI and SDCSI, respectively (p=0.028). EFS distributions differed significantly by subgroup (p<0.0001). Group 3 had the worst outcome, while WNT had the best outcome. There was a significant difference in EFS by RT group among SHH patients; SHH patients receiving IFRT arm had better EFS compared to PFRT (p=0.018). There was a significant difference in EFS distributions by CSI group in Group 4 patients; young Group 4 patients treated with SDCSI had better EFS compared to LDCSI (p=0.047). As previously reported, IFRT is noninferior to PFRT in all patients with AR-MB but LDCSI is worse than SDCSI in younger children. Significant differences in outcome by study randomization and molecular subgroup are observed.
Collapse
Affiliation(s)
- Jeff Michalski
- Washington University School of Medicine, St. Louis, MO, USA
| | | | - Yimei Li
- St. Jude’s Research Hospital, Memphis, TN, USA
| | | | - Kyle Smith
- St. Jude’s Research Hospital, Memphis, TN, USA
| | | | | | - Amar Gajjar
- St. Jude’s Research Hospital, Memphis, TN, USA
| | | | | | - Maryam Fouladi
- Cincinnati Children’s Medical Center, Cincinnati, OH, USA
| | - Roger Packer
- Children’s National Medical Center, Washington, DC, USA
| | | | - Anna Janss
- Children’s Healthcare of Atlanta, Atlanta, GA, USA
| |
Collapse
|
29
|
Spratt DE, Malone S, Roy S, Grimes S, Eapen L, Morgan SC, Malone J, Craig J, Dess RT, Jackson WC, Hartman HE, Kishan AU, Mehra R, Kaffenberger S, Morgan TM, Reichert ZR, Alumkal JJ, Michalski J, Lee WR, Pisansky TM, Feng FY, Shipley W, Sandler HM, Schipper MJ, Roach M, Sun Y, Lawton CAF. Prostate Radiotherapy With Adjuvant Androgen Deprivation Therapy (ADT) Improves Metastasis-Free Survival Compared to Neoadjuvant ADT: An Individual Patient Meta-Analysis. J Clin Oncol 2020; 39:136-144. [PMID: 33275486 DOI: 10.1200/jco.20.02438] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE There remains a lack of clarity regarding the influence of sequencing of androgen deprivation therapy (ADT) and radiotherapy (RT) on outcomes in prostate cancer (PCa). Herein, we evaluate the optimal sequencing of ADT with prostate-directed RT in localized PCa. METHODS MEDLINE (1966-2018), Embase (1982-2018), ClinicalTrials.gov, and conference proceedings (1990-2018) were searched to identify randomized trials evaluating the sequencing, but not duration, of ADT with RT. Two randomized phase III trials were identified, and individual patient data were obtained: Ottawa 0101 and NRG Oncology's Radiation Therapy Oncology Group 9413. Ottawa 0101 randomly assigned patients to neoadjuvant or concurrent versus concurrent or adjuvant short-term ADT. Radiation Therapy Oncology Group 9413, a 2 × 2 factorial trial, included a random assignment of neoadjuvant or concurrent versus adjuvant short-term ADT. The neoadjuvant or concurrent ADT arms of both trials were combined into the neoadjuvant group, and the arms receiving adjuvant ADT were combined into the adjuvant group. The primary end point of this meta-analysis was progression-free survival (PFS). RESULTS The median follow-up was 14.9 years. Overall, 1,065 patients were included (531 neoadjuvant and 534 adjuvant). PFS was significantly improved in the adjuvant group (15-year PFS, 29% v 36%, hazard ratio [HR], 1.25 [95% CI, 1.07 to 1.47], P = .01). Biochemical failure (subdistribution HR [sHR], 1.37 [95% CI, 1.12 to 1.68], P = .002), distant metastasis (sHR, 1.40 [95% CI, 1.00 to 1.95], P = .04), and metastasis-free survival (HR, 1.17 [95% CI, 1.00 to 1.37], P = .050) were all significantly improved in the adjuvant group. There were no differences in late grade ≥ 3 gastrointestinal (2% v 3%, P = .33) or genitourinary toxicity (5% v 5%, P = .76) between groups. CONCLUSION The sequencing of ADT with prostate-directed RT has significant association with long-term PFS and MFS in localized PCa. Our findings favor use of an adjuvant over a neoadjuvant approach, without any increase in long-term toxicity.
Collapse
Affiliation(s)
- Daniel E Spratt
- Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, MI
| | - Shawn Malone
- The Ottawa Hospital Cancer Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Soumyajit Roy
- The Ottawa Hospital Cancer Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,New York Medical College, New York, NY
| | - Scott Grimes
- The Ottawa Hospital Cancer Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Libni Eapen
- The Ottawa Hospital Cancer Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Mayo Clinic, Rochester, MN
| | - Scott C Morgan
- The Ottawa Hospital Cancer Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Julia Malone
- The Ottawa Hospital Cancer Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Julia Craig
- The Ottawa Hospital Cancer Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Robert T Dess
- Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, MI
| | - William C Jackson
- Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, MI
| | - Holly E Hartman
- Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, MI.,Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - Amar U Kishan
- University of California Los Angeles, Los Angeles, CA
| | - Rohit Mehra
- Department of Pathology, University of Michigan, Ann Arbor, MI
| | | | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, MI
| | | | - Joshi J Alumkal
- Department of Medicine, University of Michigan, Ann Arbor, MI
| | | | | | | | | | | | | | - Mathew J Schipper
- Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, MI
| | | | - Yilun Sun
- Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, MI
| | | |
Collapse
|
30
|
Hsu IC, Rodgers JP, Shinohara K, Purdy J, Michalski J, Roach M, Vigneault E, Ivker RA, Pryzant RM, Kuettel M, Taussky D, Gustafson GS, Raben A, Sandler HM. Long-Term Results of NRG Oncology/RTOG 0321: A Phase II Trial of Combined High Dose Rate Brachytherapy and External Beam Radiation Therapy for Adenocarcinoma of the Prostate. Int J Radiat Oncol Biol Phys 2020; 110:700-707. [PMID: 33186617 DOI: 10.1016/j.ijrobp.2020.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 10/19/2020] [Accepted: 11/19/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To report the long-term outcome of patients with prostate cancer treated with external beam radiation therapy and high dose rate (HDR) brachytherapy from a prospective multi-institutional trial conducted by NRG Oncology/RTOG. METHODS AND MATERIALS Patients with clinically localized (T1c-T3b) prostate cancer without prior history of transurethral resection of prostate or hip prosthesis were eligible for this study. All patients were treated with a combination of 45 Gy in 25 fractions from external beam radiation therapy and one HDR implant delivering 19 Gy in 2 fractions. Adverse events (AE) were collected using Common Toxicity Criteria for Adverse Events, version 3. Cumulative incidence was used to estimate time to severe late gastrointestinal (GI)/genitourinary (GU) toxicity, biochemical failure, disease-specific mortality, local failure, and distant failure. Overall survival was estimated using the Kaplan-Meier method. RESULTS One hundred and twenty-nine patients were enrolled from July 2004 to May 2006. AE data was available for 115 patients. Patients were National Comprehensive Cancer Network (NCCN) intermediate to very high risk. The median age was 68, T1c-T2c 91%, T3a-T3b 9%, PSA ≤10 70%, PSA >10 to ≤20 30%, GS 6 10%, GS 7 72%, and GS 8 to 10 18%. Forty-three percent of patients received hormonal therapy. At a median follow-up time of 10 years, there were 6 (5%) patients with grade 3 GI and GU treatment-related AEs, and no late grade 4 to 5 GI and GU AEs. At 5 and 10 years, the rate of late grade 3 gastrointestinal and genitourinary AEs was 4% and 5%, respectively. Five- and 10-year overall survival rates were 95% and 76%. Biochemical failure rates per Phoenix definition at 5 and 10 years were 14% and 23%. The 10-year rate of disease-specific mortality was 6%. At 5 and 10 years, the rates of distant failure were 4% and 8%, respectively. The rates of local failure at 5 and 10 years were 2% at both time points. CONCLUSIONS Combined modality treatment using HDR prostate brachytherapy leads to excellent long-term clinical outcomes in this prospective multi-institutional trial.
Collapse
Affiliation(s)
- I-Chow Hsu
- University of California, San Francisco, California.
| | | | | | - James Purdy
- University of California Davis, Davis, California
| | | | - Mack Roach
- University of California, San Francisco, California
| | | | | | | | | | - Daniel Taussky
- Center Hospitalier de l'Université de Montréal-Notre Dame
| | | | | | | |
Collapse
|
31
|
Bridgelall S, Michalski J, Zhang X, Sokol L, Dong N, Zhang L. Single Institutional Experience on Cutaneous Manifestation of Adult T-cell Leukemia/Lymphoma - Potential Diagnostic Pitfall. Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.211] [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: 11/12/2022] Open
Abstract
Abstract
Introduction/Objective
Adult T-cell Leukemia/Lymphoma (ATLL) is an aggressive peripheral T-cell neoplasm caused by the human T-cell lymphotropic virus-1 (HTLV1). Approximately half of the patients diagnosed with ATLL have heterogeneous cutaneous manifestations and 1/3 of those patients have skin changes e.g. rashes, papules, and nodules at initial presentation. There is clinical and morphologic overlap between ATLL and other cutaneous T-cell neoplasms such as Cutaneous T-Cell Lymphoma/mycosis fungoides (CTCL/MF) which could pose a potential diagnostic challenge.
Methods
A retrospective study was conducted using PathNet system to search for HTLV1 positive ATLL patients. Clinicopathologic features of the patients with cutaneous involvement were analyzed.
Results
Total 31 patients with ATLL were identified. Nine patients (29%, median 54.5 years, range 47-67 years, male: female ratio 2:7) showed skin manifestations, and the cutaneous involvement with ATLL was confirmed by skin biopsy. Five (55.5%, 5/9) cases were initially misdiagnosed as CTCL/MF. Among the 5 patients, 2 presented with skin rash or diffuse erythematous patch/plaque before developing generalized lymphadenopathy or overt circulating atypical lymphocytosis; 2 developed severe pruritic rash with erythematous skin changes resembling Sezary syndrome; and 1 patient had folliculotrophic MF diagnosed 12 years before. Notably, atypical lymphocytosis (0.46- 41.19/µL) occurred in 3 of the 4 remaining cases. In addition, eight of the 9 patients displayed a variable level of CD3+/CD4+/ CD25strong+ abnormal T-cells on flow cytometry. A low-level bone marrow involvement (2-10%) was found in 8 of 9 cases. Elevated calcium levels were identified in 3 of 9 cases (33%). There were 7 of 8 patients (87.5%) who developed generalized lymphadenopathy when diagnosis of ATLL was rendered.
Conclusion
In patients with cutaneous manifestations, features including hypercalcemia, atypical lymphocytosis, lymphadenopathy, CD3/CD4/strong CD25 coexpression, and bone marrow involvement should prompt a test for HTLV1. Early diagnosis of ATLL can initiate proper treatment and improve patient clinical outcomes.
Collapse
Affiliation(s)
- S Bridgelall
- Pathology and Cell Biology, University of South Florida, Tampa, Florida, UNITED STATES
| | - J Michalski
- Pathology and Cell Biology, University of South Florida, Tampa, Florida, UNITED STATES
| | - X Zhang
- Moffitt Cancer Center, Tampa, Florida, UNITED STATES
| | - L Sokol
- Moffitt Cancer Center, Tampa, Florida, UNITED STATES
| | - N Dong
- Moffitt Cancer Center, Tampa, Florida, UNITED STATES
| | - L Zhang
- Moffitt Cancer Center, Tampa, Florida, UNITED STATES
| |
Collapse
|
32
|
Rodgers J, Crook J, Pisansky T, Trabulsi E, Amin M, Bice W, Morton G, Pervez N, Vigneault E, Catton C, Michalski J, Roach M, Beyer D, Rossi P, Horwitz E, Donavanik V, Sandler H. 10: NCI Salvage Low Dose Rate Prostate Brachytherapy: Clinical Outcomes of a Phase II Trial for Local Recurrence after External Beam Radiotherapy (NRG/RTOG 0526). Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(20)30902-6] [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]
|
33
|
Solanki AA, Savir-Baruch B, Liauw SL, Michalski J, Tward JD, Vapiwala N, Teoh EJ, Adler LP, Andriole GL, Belkoff LH, Burzon D, Chau A, Dato P, Duan F, Farwell M, Fogelson S, Gardiner P, Hanna L, Hoffman JM, Intenzo C, Josephson D, Kaminetsky J, Kipper M, Kostakoglu L, Krynyckyi B, Linder KE, Mahmood U, Marques H, Mankoff D, McConathy J, Melnick J, Miller MP, Oh W, Philips S, Rose J, Savir-Baruch B, Schuster DM, Siegel BA, Stevens DJ, Tewari A, Twardowski P, Ward P, Wasserman M, Weick S, (Michael) Yu JQ. 18F-Fluciclovine Positron Emission Tomography in Men With Biochemical Recurrence of Prostate Cancer After Radical Prostatectomy and Planning to Undergo Salvage Radiation Therapy: Results from LOCATE. Pract Radiat Oncol 2020; 10:354-362. [DOI: 10.1016/j.prro.2020.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
|
34
|
Price A, Kim H, Henke LE, Knutson NC, Spraker MB, Michalski J, Hugo GD, Robinson CG, Green O. Implementing a Novel Remote Physician Treatment Coverage Practice for Adaptive Radiation Therapy During the Coronavirus Pandemic. Adv Radiat Oncol 2020; 5:737-742. [PMID: 32775784 PMCID: PMC7246005 DOI: 10.1016/j.adro.2020.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/22/2020] [Revised: 05/06/2020] [Accepted: 05/14/2020] [Indexed: 12/31/2022] Open
Abstract
PURPOSE The 2019 coronavirus disease pandemic has placed an increased importance on physical distancing to minimize the risk of transmission in radiation oncology departments. The pandemic has also increased the use of hypofractionated treatment schedules where magnetic resonance-guided online adaptive radiation therapy (ART) can aid in dose escalation. This specialized technique requires increased staffing in close proximity, and thus the need for novel coverage practices to increase physical distancing while still providing specialty care. METHODS AND MATERIALS A remote-physician ART coverage practice was developed and described using commercially available software products. Our remote-physician coverage practice provided control to the physician to contour and review of the images and plans. The time from completion of image registration to the beginning of treatment was recorded for 20 fractions before remote-physician ART coverage and 14 fractions after implementation of remote-physician ART coverage. Visual quality was calculated using cross-correlation between the treatment delivery and remote-physician computer screens. RESULTS For the 14 fractions after implementation, the average time from image registration to the beginning of treatment was 24.9 ± 6.1 minutes. In comparison, the 20 fractions analyzed without remote coverage had an average time of 29.2 ± 9.8 minutes. The correlation between the console and remote-physician screens was R = .95. CONCLUSIONS Our novel remote-physician ART coverage practice is secure, interactive, timely, and of high visual quality. When using remote physicians for ART, our department was able to increase physical distancing to lower the risk of virus transmission while providing specialty care to patients in need.
Collapse
Affiliation(s)
- Alex Price
- Department of Radiation Oncology, Washington University in St Louis School of Medicine, St. Louis, Missouri
- Department of Engineering Management and Systems Engineering, Missouri University of Science and Technology, St. Louis, Missouri
| | - Hyun Kim
- Department of Radiation Oncology, Washington University in St Louis School of Medicine, St. Louis, Missouri
| | - Lauren E. Henke
- Department of Radiation Oncology, Washington University in St Louis School of Medicine, St. Louis, Missouri
| | - Nels C. Knutson
- Department of Radiation Oncology, Washington University in St Louis School of Medicine, St. Louis, Missouri
| | - Matthew B. Spraker
- Department of Radiation Oncology, Washington University in St Louis School of Medicine, St. Louis, Missouri
| | - Jeff Michalski
- Department of Radiation Oncology, Washington University in St Louis School of Medicine, St. Louis, Missouri
| | - Geoffrey D. Hugo
- Department of Radiation Oncology, Washington University in St Louis School of Medicine, St. Louis, Missouri
| | - Clifford G. Robinson
- Department of Radiation Oncology, Washington University in St Louis School of Medicine, St. Louis, Missouri
| | - Olga Green
- Department of Radiation Oncology, Washington University in St Louis School of Medicine, St. Louis, Missouri
| |
Collapse
|
35
|
Maher C, Dang HX, Chauhan PS, Ellis H, Feng W, Harris P, Smith G, Qiao M, Dienstbach K, Beck R, Atkocius A, Qaium F, Luo J, Michalski J, Picus J, Pachynski RK, Chaudhuri A. AR enhancer and locus genomic alterations as cell-free DNA biomarkers of primary resistance to AR-directed treatment of metastatic prostate cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.5529] [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: 11/20/2022] Open
Abstract
5529 Background: Predicting primary resistance to androgen receptor (AR)-directed therapies is critical for personalizing treatment of metastatic prostate cancer (mPCa). Analyses of liquid biopsies are potential tools but remained underutilized due to limited sensitivity. We developed a cell-free DNA (cfDNA) assay (EnhanceAR-Seq) to monitor genomic alterations in mPCa including AR enhancer duplication, a resistance marker recently discovered in ~81% of mPCa patients. Here we show that applying EnhanceAR-Seq to plasma cfDNA to monitor alterations of AR gene and enhancer ( AR/enhancer) predicted primary resistance with high sensitivity and outperformed the clinically validated CTC AR-V7 assay. Methods: Forty mPCa patients were prospectively enrolled at the Washington University School of Medicine Siteman Cancer Center with plasma cfDNA analyzed by EnhanceAR-Seq. Twenty-five of them also had the Oncotype DX AR-V7 Nucleus Detect CTC assay performed at a similar timepoint at the discretion of the treating oncologist. All patients received AR-directed therapy (eg. abiraterone, enzalutamide) and underwent standard-of-care clinical and laboratory follow-up. Primary resistance was defined as PSA progression, change of treatment or death within 4 months of treatment initiation, or radiographic progression within 6 months. Results: Median clinical follow up after diagnosis was 50 months. EnhanceAR-Seq detected alterations targeting AR/enhancer in 18 patients (45%), TP53 in 8 patients (20%), and PTEN in 6 patients (15%). We found that AR/enhancer alterations (copy gain, tandem duplication, and point mutation) in cfDNA were strongly predictive of primary resistance to AR-directed therapy (PPV = 100%, Sens. = 89%). Our assay outperformed the CTC AR-V7 assay, which was positive in only two patients (PPV = 50%, Sens. = 6%). Furthermore, patients with AR/enhancer alterations had significantly worse progression-free survival (P = 0.0015; HR = 11.5) and overall survival (P = 0.0002; HR = 6.8). Finally, serial cell-free DNA analysis of 10 patients showed that AR/enhancer copy number gain was maintained or acquired in 5 of 6 AR-resistant cases, and neutrality maintained in 4 of 4 AR-sensitive cases. Conclusions: cfDNA-based AR/enhancer locus genomic alterations could potentially be used to predict primary resistance to AR-directed therapy with higher sensitivity than the clinically validated CTC AR-V7 assay, be used for serial timepoint monitoring and guiding personalized clinical decision-making.
Collapse
Affiliation(s)
- Chris Maher
- Washington University in St. Louis, St. Louis, MO
| | - Ha X. Dang
- Washington University in St. Louis, St. Louis, MO
| | | | - Haley Ellis
- Washington University in St. Louis, St. Louis, MO
| | - Wenjia Feng
- Washington University School of Medicine, Department of Radiation Oncology, St. Louis, MO
| | - Peter Harris
- Washington University School of Medicine, Department of Radiation Oncology, St. Louis, MO
| | - Grace Smith
- Washington University in St. Louis, St. Louis, MO
| | - Mark Qiao
- Washington University in St. Louis, St. Louis, MO
| | | | - Rachel Beck
- Washington University in St. Louis, St. Louis, MO
| | | | - Faridi Qaium
- Washington University School of Medicine, Department of Radiation Oncology, St. Louis, MO
| | - Jingqin Luo
- Washington University in St. Louis, St. Louis, MO
| | | | - Joel Picus
- Washington University in St. Louis School of Medicine, St. Louis, MO
| | | | - Aadel Chaudhuri
- Washington University School of Medicine, Department of Radiation Oncology, St. Louis, MO
| |
Collapse
|
36
|
Quinn TJ, Daignault-Newton S, Bosch W, Mariados N, Sylvester J, Shah D, Gross E, Hudes R, Beyer D, Kurtzman S, Bogart J, Hsi RA, Kos M, Ellis R, Logsdon M, Zimberg S, Forsythe K, Zhang H, Soffen E, Francke P, Mantz C, DeWeese T, Gay HA, Michalski J, Hamstra DA. Who Benefits From a Prostate Rectal Spacer? Secondary Analysis of a Phase III Trial. Pract Radiat Oncol 2020; 10:186-194. [DOI: 10.1016/j.prro.2019.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 11/07/2019] [Accepted: 12/12/2019] [Indexed: 10/25/2022]
|
37
|
Flaig TW, Spiess PE, Agarwal N, Bangs R, Boorjian SA, Buyyounouski MK, Chang S, Downs TM, Efstathiou JA, Friedlander T, Greenberg RE, Guru KA, Guzzo T, Herr HW, Hoffman-Censits J, Hoimes C, Inman BA, Jimbo M, Kader AK, Lele SM, Michalski J, Montgomery JS, Nandagopal L, Pagliaro LC, Pal SK, Patterson A, Plimack ER, Pohar KS, Preston MA, Sexton WJ, Siefker-Radtke AO, Tward J, Wright JL, Gurski LA, Johnson-Chilla A. Bladder Cancer, Version 3.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020; 18:329-354. [PMID: 32135513 DOI: 10.6004/jnccn.2020.0011] [Citation(s) in RCA: 337] [Impact Index Per Article: 84.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This selection from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Bladder Cancer focuses on the clinical presentation and workup of suspected bladder cancer, treatment of non-muscle-invasive urothelial bladder cancer, and treatment of metastatic urothelial bladder cancer because important updates have recently been made to these sections. Some important updates include recommendations for optimal treatment of non-muscle-invasive bladder cancer in the event of a bacillus Calmette-Guérin (BCG) shortage and details about biomarker testing for advanced or metastatic disease. The systemic therapy recommendations for second-line or subsequent therapies have also been revised. Treatment and management of muscle-invasive, nonmetastatic disease is covered in the complete version of the NCCN Guidelines for Bladder Cancer available at NCCN.org. Additional topics covered in the complete version include treatment of nonurothelial histologies and recommendations for nonbladder urinary tract cancers such as upper tract urothelial carcinoma, urothelial carcinoma of the prostate, and primary carcinoma of the urethra.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Thomas Guzzo
- Abramson Cancer Center at the University of Pennsylvania
| | | | | | - Christopher Hoimes
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | - Jeff Michalski
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | | | - Anthony Patterson
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | - Kamal S Pohar
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | | | - Jonathan L Wright
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; and
| | | | | |
Collapse
|
38
|
Khairnar RR, DeMora L, Sandler HM, Lee WR, Villalonga Olives E, Mullins CD, Bruner D, Shah A, Malone S, Michalski J, Dayes I, Seaward SA, Albert M, Currey AD, Pisansky TM, Chen Y, Horwitz EM, DeNittis AS, Feng FY, Mishra MV. A methodological comparison of mapping algorithms to obtain health utilities derived using cross-sectional and longitudinal data: Secondary analysis of NRG/RTOG 0415. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.55] [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: 11/20/2022] Open
Abstract
55 Background: To compare the predictive ability of health utility mapping algorithms derived using cross-sectional and longitudinal data specific to the Expanded Prostate Cancer Index Composite (EPIC). Methods: This mapping study utilized data from an international, multicenter, randomized controlled trial of patients with low-risk prostate cancer conducted by NRG Oncology (NCT00331773). Health-related quality-of-life (HRQoL) data were collected using EPIC, and health utilities were obtained using EuroQOL-5D (EQ5D) at baseline and 6, 12 and 24 months post-intervention. Data were split into an estimation sample (70%) and a validation sample (30%). Ordinary Least Squares (OLS) regression models were estimated using baseline cross-sectional data as well as pooled data from all assessment periods. Random effects (RE) specifications that explicitly model the longitudinal nature of the data were also estimated. Candidate models were selected based on root mean square error (RMSE). Results: A total of 196 (147) patients in the estimation sample had complete EQ5D and EPIC domain (subdomain) data at all time points. OLS models using combined data outperformed the counter-part RE models as well as OLS models using baseline data in the five-fold cross-validation. Addition of covariates to the models resulted in improved predictive ability. In the external validation, when only EPIC domain/ subdomain data are available, the OLS model using combined data predicted EQ5D utilities better than the counterpart RE model and OLS model using baseline data (RMSE=0.121108 & 0.111345). OLS model using baseline data outperformed other model types for algorithms with EPIC domains and demographics (RMSE=0.121757), while RE models outperformed the other two model types for algorithms with EPIC subdomains and demographic data, (0.112782) and for algorithms with EPIC domains/ subdomains, demographics, and clinical covariates (RMSE=0.123589 & 0.163093). Conclusions: While algorithms using pooled data outperformed other model types in internal validation, RE models showed better predictive ability in external validation for algorithms with covariates. Clinical trial information: NCT00331773.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Deborah Bruner
- Winship Cancer Institute at Emory University, Atlanta, GA
| | | | - Shawn Malone
- The Ottawa Hospital Cancer Center, Ottawa, ON, Canada
| | | | - Ian Dayes
- McMaster University, Hamilton, ON, Canada
| | | | | | - Adam D. Currey
- Medical College of Wisconsin, Department of Radiation Oncology, Milwaukee, WI
| | | | - Yuhchyau Chen
- University of Rochester Medical Center, Rochester, NY
| | | | | | - Felix Y Feng
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | | |
Collapse
|
39
|
Hagan M, Kapoor R, Michalski J, Sandler H, Movsas B, Chetty I, Lally B, Rengan R, Robinson C, Rimner A, Simone C, Timmerman R, Zelefsky M, DeMarco J, Hamstra D, Lawton C, Potters L, Valicenti R, Mutic S, Bosch W, Abraham C, Caruthers D, Brame R, Palta JR, Sleeman W, Nalluri J. VA-Radiation Oncology Quality Surveillance Program. Int J Radiat Oncol Biol Phys 2020; 106:639-647. [PMID: 31983560 DOI: 10.1016/j.ijrobp.2019.08.064] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/08/2019] [Accepted: 08/21/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE We sought to develop a quality surveillance program for approximately 15,000 US veterans treated at the 40 radiation oncology facilities at the Veterans Affairs (VA) hospitals each year. METHODS AND MATERIALS State-of-the-art technologies were used with the goal to improve clinical outcomes while providing the best possible care to veterans. To measure quality of care and service rendered to veterans, the Veterans Health Administration established the VA Radiation Oncology Quality Surveillance program. The program carries forward the American College of Radiology Quality Research in Radiation Oncology project methodology of assessing the wide variation in practice pattern and quality of care in radiation therapy by developing clinical quality measures (QM) used as quality indices. These QM data provide feedback to physicians by identifying areas for improvement in the process of care and identifying the adoption of evidence-based recommendations for radiation therapy. RESULTS Disease-site expert panels organized by the American Society for Radiation Oncology (ASTRO) defined quality measures and established scoring criteria for prostate cancer (intermediate and high risk), non-small cell lung cancer (IIIA/B stage), and small cell lung cancer (limited stage) case presentations. Data elements for 1567 patients from the 40 VA radiation oncology practices were abstracted from the electronic medical records and treatment management and planning systems. Overall, the 1567 assessed cases passed 82.4% of all QM. Pass rates for QM for the 773 lung and 794 prostate cases were 78.0% and 87.2%, respectively. Marked variations, however, were noted in the pass rates for QM when tumor site, clinical pathway, or performing centers were separately examined. CONCLUSIONS The peer-review protected VA-Radiation Oncology Surveillance program based on clinical quality measures allows providers to compare their clinical practice to peers and to make meaningful adjustments in their personal patterns of care unobtrusively.
Collapse
Affiliation(s)
- Michael Hagan
- VHA National Radiation Oncology Program Office, Richmond, Virginia.
| | - Rishabh Kapoor
- VHA National Radiation Oncology Program Office, Richmond, Virginia
| | - Jeff Michalski
- Washington University in Saint Louis, Saint Louis, Missouri
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sasa Mutic
- Washington University in Saint Louis, Saint Louis, Missouri
| | - Walter Bosch
- Washington University in Saint Louis, Saint Louis, Missouri
| | | | | | - Ryan Brame
- Washington University in Saint Louis, Saint Louis, Missouri
| | - Jatinder R Palta
- VHA National Radiation Oncology Program Office, Richmond, Virginia
| | - William Sleeman
- Department of Radiation Oncology, Virginia Commonwealth University, Rcihmond, Virginia
| | - Joseph Nalluri
- Department of Radiation Oncology, Virginia Commonwealth University, Rcihmond, Virginia
| |
Collapse
|
40
|
Bryndal I, Lorenc J, Macalik L, Michalski J, Sąsiadek W, Lis T, Hanuza J. Crystal structure, vibrational and optic properties of 2-N-methylamino-3-methylpyridine N-oxide - Its X-ray and spectroscopic studies as well as DFT quantum chemical calculations. J Mol Struct 2019; 1195:208-219. [PMID: 32336784 PMCID: PMC7173143 DOI: 10.1016/j.molstruc.2019.05.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 02/05/2019] [Revised: 04/27/2019] [Accepted: 05/17/2019] [Indexed: 01/10/2023]
Abstract
The crystal and molecular structure and physicochemical properties of 2-N-methylamino-3-methylpyridine N-oxide (MA3MPO) have been studied. MA3MPO was synthesized from 2-amino-3-methylpyridine by several steps to form colorless crystals suitable for crystallographic analysis. The data reveal that MA3MPO crystallizes in the monoclinic space group P21/n. The studied compound contains a nearly flat triply substituted pyridine skeleton whose structure is stabilized by an intramolecular N–H⋅⋅⋅O hydrogen bond. The N-oxide molecules are connected together by weak C–H⋯O hydrogen bonds, an acceptor of which is the oxygen atom from the N-oxide group. This leads to creation of two-dimensional network of hydrogen bonds. Its IR, Raman, UV–Vis and luminescence spectra have been measured and analyzed on the basis of DFT and NBO quantum chemical calculations in which the B3LYP/6-311++G(d,p) approach was applied. The distribution of the electron levels in the studied compound has been analyzed in terms of the possibility of its participation in the ligand-to-lanthanide ion energy transfer. The 2-N-methylamino-3-methylpyridine N-oxide (MA3MPO) was synthesized and characterized. The studied compound structure is stabilized by an intramolecular N–H⋯O hydrogen bond. The molecules are connected together by weak C–H⋯O hydrogen bonds. The amino group plays the role of effective hydrogen-bond donor but the N-oxide group is a hydrogen-bond acceptor. X-ray, IR, Raman and DFT methods recognized the existence of the intramolecular N–H⋯O hydrogen bond in the studied compound.
Collapse
Affiliation(s)
- I Bryndal
- Department of Drugs Technology, Faculty of Pharmacy with Division of Laboratory Diagnostics, Wroclaw Medical University, Borowska 211A, 50-556, Wrocław, Poland
| | - J Lorenc
- Department of Bioorganic Chemistry, Institute of Chemistry and Food Technology, Faculty of Engineering and Economics, Wrocław University of Economics, Komandorska 118/120, 53-345, Wrocław, Poland
| | - L Macalik
- Institute of Low Temperature and Structure Research, Polish Academy of Sciences, Okólna 2, 50-422, Wrocław, Poland
| | - J Michalski
- Department of Bioorganic Chemistry, Institute of Chemistry and Food Technology, Faculty of Engineering and Economics, Wrocław University of Economics, Komandorska 118/120, 53-345, Wrocław, Poland
| | - W Sąsiadek
- Department of Bioorganic Chemistry, Institute of Chemistry and Food Technology, Faculty of Engineering and Economics, Wrocław University of Economics, Komandorska 118/120, 53-345, Wrocław, Poland
| | - T Lis
- Faculty of Chemistry, University of Wroclaw, Joliot-Curie Street 14, 50-383, Wrocław, Poland
| | - J Hanuza
- Institute of Low Temperature and Structure Research, Polish Academy of Sciences, Okólna 2, 50-422, Wrocław, Poland
| |
Collapse
|
41
|
Lee WR, Amdur R, Daly ME, Das P, Evans S, Michalski J, Pawlicki T, Tegbaru D. Appreciation of 2018 Peer Reviewers for Practical Radiation Oncology. Pract Radiat Oncol 2019. [DOI: 10.1016/j.prro.2019.02.018] [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: 10/27/2022]
|
42
|
Jabbour SK, Timmerman RD, Raben D, DeWeese TL, Donaldson SS, Thomas P, Laurie F, Bishop-Jodoin M, Tarbell N, Wolden S, Halperin E, Constine LS, Haas-Kogan D, Marcus K, Freeman C, Terezakis S, Million L, Smith MA, Mendenhall NP, Marcus RB, Cherlow J, Kalapurakal J, Breneman J, Yock T, MacDonald S, Laack N, Donahue B, Indelicato D, Michalski J, Perkins S, Kachnic L, Esiashvilli N, Roberts KB, FitzGerald TJ. Moody D. Wharam Jr, MD, FACR, FASTRO, July 22, 1941–August 10, 2018. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.01.004] [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: 10/27/2022]
|
43
|
Hsu I, Rodgers J, Shinohara K, Purdy J, Michalski J, Ibbott G, Roach M, Vigneault E, Ivker R, Pryzant R, Kuettel M, Taussky D, Gustafson G, Raben A, Sandler H. OC-0159 Long-Term Results of RTOG 0321: HDR Brachytherapy and External Beam Radiotherapy for Prostate Cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30579-1] [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]
|
44
|
Haas-Kogan D, Indelicato D, Paganetti H, Esiashvili N, Mahajan A, Yock T, Flampouri S, MacDonald S, Fouladi M, Stephen K, Kalapurakal J, Terezakis S, Kooy H, Grosshans D, Makrigiorgos M, Mishra K, Poussaint TY, Cohen K, Fitzgerald T, Gondi V, Liu A, Michalski J, Mirkovic D, Mohan R, Perkins S, Wong K, Vikram B, Buchsbaum J, Kun L. National Cancer Institute Workshop on Proton Therapy for Children: Considerations Regarding Brainstem Injury. Int J Radiat Oncol Biol Phys 2019; 101:152-168. [PMID: 29619963 DOI: 10.1016/j.ijrobp.2018.01.013] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 12/21/2017] [Accepted: 01/01/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE Proton therapy can allow for superior avoidance of normal tissues. A widespread consensus has been reached that proton therapy should be used for patients with curable pediatric brain tumor to avoid critical central nervous system structures. Brainstem necrosis is a potentially devastating, but rare, complication of radiation. Recent reports of brainstem necrosis after proton therapy have raised concerns over the potential biological differences among radiation modalities. We have summarized findings from the National Cancer Institute Workshop on Proton Therapy for Children convened in May 2016 to examine brainstem injury. METHODS AND MATERIALS Twenty-seven physicians, physicists, and researchers from 17 institutions with expertise met to discuss this issue. The definition of brainstem injury, imaging of this entity, clinical experience with photons and photons, and potential biological differences among these radiation modalities were thoroughly discussed and reviewed. The 3 largest US pediatric proton therapy centers collectively summarized the incidence of symptomatic brainstem injury and physics details (planning, dosimetry, delivery) for 671 children with focal posterior fossa tumors treated with protons from 2006 to 2016. RESULTS The average rate of symptomatic brainstem toxicity from the 3 largest US pediatric proton centers was 2.38%. The actuarial rate of grade ≥2 brainstem toxicity was successfully reduced from 12.7% to 0% at 1 center after adopting modified radiation guidelines. Guidelines for treatment planning and current consensus brainstem constraints for proton therapy are presented. The current knowledge regarding linear energy transfer (LET) and its relationship to relative biological effectiveness (RBE) are defined. We review the current state of LET-based planning. CONCLUSIONS Brainstem injury is a rare complication of radiation therapy for both photons and protons. Substantial dosimetric data have been collected for brainstem injury after proton therapy, and established guidelines to allow for safe delivery of proton radiation have been defined. Increased capability exists to incorporate LET optimization; however, further research is needed to fully explore the capabilities of LET- and RBE-based planning.
Collapse
Affiliation(s)
- Daphne Haas-Kogan
- Department of Radiation Oncology, Harvard Medical School and Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston Children's Hospital, Boston, Massachusetts
| | - Daniel Indelicato
- Department of Radiation Oncology, University of Florida, Jacksonville, Florida
| | - Harald Paganetti
- Department of Radiation Oncology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - Natia Esiashvili
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Anita Mahajan
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Torunn Yock
- Department of Radiation Oncology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - Stella Flampouri
- Department of Radiation Oncology, University of Florida, Jacksonville, Florida
| | - Shannon MacDonald
- Department of Radiation Oncology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - Maryam Fouladi
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kry Stephen
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John Kalapurakal
- Department of Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Stephanie Terezakis
- Department of Radiation Oncology, Johns Hopkins Medical Institute, Baltimore, Maryland
| | - Hanne Kooy
- Department of Radiation Oncology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - David Grosshans
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mike Makrigiorgos
- Department of Radiation Oncology, Harvard Medical School and Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kavita Mishra
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California
| | - Tina Young Poussaint
- Department of Radiology, Harvard Medical School and Dana-Farber Cancer Institute, Boston Children's Hospital, Boston, Massachusetts
| | - Kenneth Cohen
- Department of Pediatrics, Johns Hopkins Medical Institute, Baltimore, Maryland
| | - Thomas Fitzgerald
- Department of Radiation Oncology, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Vinai Gondi
- Northwestern Medicine Chicago Proton Center, Chicago, Illinois
| | - Arthur Liu
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Jeff Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Dragan Mirkovic
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Radhe Mohan
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephanie Perkins
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Kenneth Wong
- Children's Hospital of Angeles and University of Southern California Keck School of Medicine, Los Angles, California
| | - Bhadrasain Vikram
- Radiation Research Program, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Jeff Buchsbaum
- Radiation Research Program, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Larry Kun
- Department of Radiation Oncology, University of Texas Southwestern Medical School, Dallas, Texas.
| |
Collapse
|
45
|
Henke LE, Green OL, Schiff J, Rodriguez VL, Mutic S, Michalski J, Perkins SM. First Reported Case of Pediatric Radiation Treatment With Magnetic Resonance Image Guided Radiation Therapy. Adv Radiat Oncol 2019; 4:233-236. [PMID: 31011667 PMCID: PMC6460231 DOI: 10.1016/j.adro.2019.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/23/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Stephanie M. Perkins
- Corresponding author. Department of Radiation Oncology, Washington University School of Medicine, Campus Box 8224, 4921 Parkview Place, Floor LL, St. Louis, MO 63110.
| |
Collapse
|
46
|
Dignam JJ, Winter KA, Michalski J. Detecting a Survival Benefit to Dose Escalation—Reply. JAMA Oncol 2019; 5:110. [DOI: 10.1001/jamaoncol.2018.5093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- James J. Dignam
- NRG Oncology Statistics and Data Management Center, University of Chicago, Chicago, Illinois
| | - Kathryn A. Winter
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | | |
Collapse
|
47
|
FitzGerald TJ, Donaldson SS, Wharam M, Laurie F, Bishop-Jodoin M, Moni J, Tarbell N, Shulkin B, McCarville E, Merchant T, Krasin M, Wolden S, Halperin E, Constine LS, Haas-Kogan D, Marcus K, Freeman C, Wilson JF, Hoppe R, Cox J, Terezakis S, Million L, Smith MA, Mendenhall NP, Marcus RB, Cherlow J, Kalapurakal J, Breneman J, Yock T, MacDonald S, Laack N, Donahue B, Indelicato D, Michalski J, Perkins S, Kachnic L, Choy H, Braunstein S, Esiashvilli N, Roberts KB. Larry Emanuel Kun, March 10, 1946-May 27, 2018. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2018.08.018] [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]
|
48
|
Stan-Głasek K, Kasperowicz A, Michalski J, Taciak M, Michałowski T. Ability of the rumen bacterium Pseudobutyrivibrio ruminis strain k3 to utilize fructose, sucrose and fructose polymers. J Anim Feed Sci 2018. [DOI: 10.22358/jafs/100548/2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
49
|
Henke LE, Contreras JA, Green OL, Cai B, Kim H, Roach MC, Olsen JR, Fischer-Valuck B, Mullen DF, Kashani R, Thomas MA, Huang J, Zoberi I, Yang D, Rodriguez V, Bradley JD, Robinson CG, Parikh P, Mutic S, Michalski J. Magnetic Resonance Image-Guided Radiotherapy (MRIgRT): A 4.5-Year Clinical Experience. Clin Oncol (R Coll Radiol) 2018; 30:720-727. [PMID: 30197095 PMCID: PMC6177300 DOI: 10.1016/j.clon.2018.08.010] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/19/2018] [Accepted: 08/21/2018] [Indexed: 10/28/2022]
Abstract
AIMS Magnetic resonance image-guided radiotherapy (MRIgRT) has been clinically implemented since 2014. This technology offers improved soft-tissue visualisation, daily imaging, and intra-fraction real-time imaging without added radiation exposure, and the opportunity for adaptive radiotherapy (ART) to adjust for anatomical changes. Here we share the longest single-institution experience with MRIgRT, focusing on trends and changes in use over the past 4.5 years. MATERIALS AND METHODS We analysed clinical information, including patient demographics, treatment dates, disease sites, dose/fractionation, and clinical trial enrolment for all patients treated at our institution using MRIgRT on a commercially available, integrated 0.35 T MRI, tri-cobalt-60 device from 2014 to 2018. For each patient, factors including disease site, clinical rationale for MRIgRT use, use of ART, and proportion of fractions adapted were summated and compared between individual years of use (2014-2018) to identify shifts in institutional practice patterns. RESULTS Six hundred and forty-two patients were treated with 666 unique treatment courses using MRIgRT at our institution between 2014 and 2018. Breast cancer was the most common disease, with use of cine MRI gating being a particularly important indication, followed by abdominal sites, where the need for cine gating and use of ART drove MRIgRT use. One hundred and ninety patients were treated using ART in 1550 fractions, 67.6% (1050) of which were adapted. ART was primarily used in cancers of the abdomen. Over time, breast and gastrointestinal cancers became increasingly dominant for MRIgRT use, hypofractionated treatment courses became more popular, and gastrointestinal cancers became the principal focus of ART. DISCUSSION MRIgRT is widely applicable within the field of radiation oncology and new clinical uses continue to emerge. At our institution to date, applications such as ART for gastrointestinal cancers and accelerated partial breast irradiation (APBI) for breast cancer have become dominant indications, although this is likely to continue to evolve.
Collapse
Affiliation(s)
- L E Henke
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - J A Contreras
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - O L Green
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - B Cai
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - H Kim
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - M C Roach
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - J R Olsen
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - B Fischer-Valuck
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - D F Mullen
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - R Kashani
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - M A Thomas
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - J Huang
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - I Zoberi
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - D Yang
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - V Rodriguez
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - J D Bradley
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - C G Robinson
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - P Parikh
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - S Mutic
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - J Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA.
| |
Collapse
|
50
|
Henke LE, Olsen JR, Contreras JA, Curcuru A, DeWees TA, Green OL, Michalski J, Mutic S, Roach MC, Bradley JD, Parikh PJ, Kashani R, Robinson CG. Stereotactic MR-Guided Online Adaptive Radiation Therapy (SMART) for Ultracentral Thorax Malignancies: Results of a Phase 1 Trial. Adv Radiat Oncol 2018; 4:201-209. [PMID: 30706029 PMCID: PMC6349650 DOI: 10.1016/j.adro.2018.10.003] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [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: 03/06/2018] [Accepted: 10/05/2018] [Indexed: 12/25/2022] Open
Abstract
Purpose Stereotactic body radiation therapy (SBRT) is an effective treatment for oligometastatic or unresectable primary malignancies, although target proximity to organs at risk (OARs) within the ultracentral thorax (UCT) limits safe delivery of an ablative dose. Stereotactic magnetic resonance (MR)–guided online adaptive radiation therapy (SMART) may improve the therapeutic ratio using reoptimization to account for daily variation in target and OAR anatomy. This study assessed the feasibility of UCT SMART and characterized dosimetric and clinical outcomes in patients treated for UCT lesions on a prospective phase 1 trial. Methods and Materials Five patients with oligometastatic (n = 4) or unresectable primary (n = 1) UCT malignancies underwent SMART. Initial plans prescribed 50 Gy in 5 fractions with goal 95% planning target volume (PTV) coverage by 95% of prescription, subject to strict OAR constraints. Daily real-time online adaptive plans were created as needed to preserve hard OAR constraints, escalate PTV dose, or both, based on daily setup MR image set anatomy. Treatment times, patient outcomes, and dosimetric comparisons were prospectively recorded. Results All initial and daily adaptive plans met strict OAR constraints based on simulation and daily setup MR imaging anatomy, respectively. Four of the 5 patients received ≥1 adapted fraction. Ten of the 25 total delivered fractions were adapted. A total of 30% of plan adaptations were performed to improve PTV coverage; 70% were for reversal of ≥1 OAR violation. Local control by Response Evaluation Criteria in Solid Tumors was 100% at 3 and 6 months. No grade ≥3 acute (within 6 months of radiation completion) treatment-related toxicities were identified. Conclusions SMART may allow PTV coverage improvement and/or OAR sparing compared with nonadaptive SBRT and may widen the therapeutic index of UCT SBRT. In this small prospective cohort, we found that SMART was clinically deliverable to 100% of patients, although treatment delivery times surpassed our predefined, timing-based feasibility endpoint. This technique is well tolerated, offering excellent local control with no identified acute grade ≥3 toxicity.
Collapse
Affiliation(s)
- Lauren E. Henke
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Jeffrey R. Olsen
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Jessika A. Contreras
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Austen Curcuru
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Todd A. DeWees
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Scottsdale, Arizona
| | - Olga L. Green
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Jeff Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Sasa Mutic
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Michael C. Roach
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Jeffrey D. Bradley
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Parag J. Parikh
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Rojano Kashani
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Clifford G. Robinson
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
- Corresponding author. Department of Radiation Oncology, Washington University School of Medicine, Campus Box 8224, 4921 Parkview Place, Floor LL, St Louis, MO 63110.
| |
Collapse
|