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Kotha NV, Guram K, Morgan K, Deshler L, Brown D, Rash D, Dyer B, McHale M, Yashar C, Scanderbeg D, Einck J, Mayadev J. A randomized patient education trial investigating treatment-related distress and satisfaction with the use of an at-home gynecologic brachytherapy educational video. Int J Gynecol Cancer 2023:ijgc-2023-004331. [PMID: 37247940 DOI: 10.1136/ijgc-2023-004331] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Physician explanation of gynecologic brachytherapy can be overwhelming or induce patient anxiety, and may be time-constrained given clinical limitations. We report the first randomized trial of an educational video intervention in gynecologic brachytherapy on patient-reported outcomes. METHODS Between February 2020 and January 2022, 80 gynecologic cancer patients prescribed brachytherapy were randomly assigned to either standard informed consent (Arm A) or a supplemental 16 min brachytherapy educational video (https://vimeo.com/403385455/d0716e3cc8) via the internet (Arm B). Primary outcome was treatment-related distress (National Comprehensive Cancer Network (NCCN) distress scale scored 0 (no distress) to 10 (maximum distress)). Secondary outcome was patient satisfaction (summated Likert-scale scored 11-55). Surveys were administered at baseline, after first treatment, and prior to brachytherapy completion. RESULTS All patients completed the prescribed brachytherapy. In Arm B, 19/40 (48%) patients and 10/40 (25%) patients' family/friends viewed the video. For patients that completed all surveys (Arm A n=29, Arm B n=28), there was no difference between arms in the sociodemographic, clinical, or treatment variables. Distress scores were low at baseline (Arm A median 4, Arm B median 4, p=0.65) and there was no detectable change in distress between arms on surveys 1 and 2 (β 0.36, p=0.67) or surveys 1 and 3 (β -1.02, p=0.29) in multivariable analysis. Satisfaction scores were high at baseline (Arm A median 54, Arm B median 54.5, p=0.64) and there was no detectable change in satisfaction between arms on surveys 1 and 2 (β 0.22, p=0.93) or surveys 1 and 3 (β 0.63, p=0.85) in multivariable analysis. CONCLUSIONS Among patients randomized to an educational video tool for gynecologic brachytherapy, approximately 50% of the cohort and 25% of the cohort's family/friends used the video. Overall, patients had low distress scores and high satisfaction scores with no significant differences between the standard and video intervention arms. Further work is needed to understand factors contributing to gynecologic brachytherapy anxiety. TRIAL REGISTRATION NUMBER NCT04363957.
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Affiliation(s)
- Nikhil V Kotha
- Radiation Oncology, Stanford University, Palo Alto, California, USA
| | - Kripa Guram
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
| | - Kylie Morgan
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
| | - Leah Deshler
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
| | - Derek Brown
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
| | - Dominique Rash
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
| | - Brandon Dyer
- Radiation Oncology, Legacy Health System, Portland, Oregon, USA
| | - Michael McHale
- Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, California, USA
| | - Catheryn Yashar
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
| | - Daniel Scanderbeg
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
| | - John Einck
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
| | - Jyoti Mayadev
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
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Yashar C, Khan AJ, Chen P, Einck J, Poppe M, Li L, Yehia ZA, Vicini FA, Moore D, Arthur D, Quinn TJ, Kowzun M, Simon L, Scanderbeg D, Shah C, Haffty BG, Kuske R. Three-Fraction Accelerated Partial Breast Irradiation (APBI) Delivered With Interstitial Brachytherapy Is Safe: First Results From the Tri-fraction Radiation Therapy Used to Minimize Patient Hospital Trips (TRIUMPH-T) Trial. Pract Radiat Oncol 2023:S1879-8500(23)00062-0. [PMID: 37140504 DOI: 10.1016/j.prro.2023.03.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/27/2023] [Accepted: 03/07/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE Shorter courses of breast radiotherapy are offered as an alternative to 4 weeks of whole-breast irradiation after lumpectomy, including brachytherapy. A prospective phase 2multi-institution clinical trial to study 3-fraction accelerated partial breast irradiation delivered by brachytherapy was conducted. METHODS AND MATERIALS The trial treated selected breast cancers after breast-conserving surgery with brachytherapy applicators that delivered 22.5 Gy in 3 fractions of 7.5 Gy. The planning treatment volume was 1 to 2 cm beyond the surgical cavity. Eligible women were age ≥45 years with unicentric invasive or in situ tumors ≤3 cm excised with negative margins and with positive estrogen or progesterone receptors and no metastases to axillary nodes. Strict dosimetric parameters were required to be met and follow up information was collected from the participating sites. RESULTS Two hundred patients were prospectively enrolled; however, a total of 185 patients who were enrolled were followed for a median of 3.63 years. Three-fraction brachytherapy was associated with low chronic toxicity. There was excellent or good cosmesis in 94% of patients. There were no grade 4 toxicities. Grade 3 fibrosis at the treatment site was present in 1.7% and 32% percent had grades 1 or 2 fibrosis at the treatment site. There was 1 rib fracture. Other late toxicities included 7.4% grade 1 hyperpigmentation, 2% grade 1 telangiectasias, 1.7% symptomatic seromas, 1.7% abscessed cavities, and 1.1% symptomatic fat necrosis. There were 2 (1.1%) ipsilateral local recurrences, 2 (1.1%) nodal recurrences and no distant recurrences. Other incidents included one contralateral breast cancer and 2 second malignancies (lung). CONCLUSIONS Ultra-short breast brachytherapy is feasible and has excellent toxicity and could be an alternative to standard 5-day, 10 fraction accelerated partial breast irradiation in eligible patients. Patients from this prospective trial will continue to be followed to evaluate long-term outcomes.
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Affiliation(s)
- Catheryn Yashar
- UC San Diego/Moores Cancer Center, La Jolla, California; Bryn Mawr Hospital, Bryn Mawr, Pennsylvania.
| | - Atif J Khan
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Peter Chen
- William Beaumont Hospital/Rose Cancer Treatment Center, Royal Oak, Michigan
| | - John Einck
- Kansas University Medical Center, Kansas City, Kansas
| | - Matthew Poppe
- Hunstman Cancer Center, University of Utah, Salt Lake City, Utah
| | - Linna Li
- William Beaumont Hospital/Rose Cancer Treatment Center, Royal Oak, Michigan
| | | | - Frank A Vicini
- Michigan Health care Professional, 21st Century Oncology, Farmington Hills, Michigan
| | - Dirk Moore
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Doug Arthur
- Virginia Commonwealth University, Massey Cancer Center, Richmond, Virginia
| | - T J Quinn
- William Beaumont Hospital/Rose Cancer Treatment Center, Royal Oak, Michigan
| | - Maria Kowzun
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Laurie Simon
- UC San Diego/Moores Cancer Center, La Jolla, California
| | | | - Chirag Shah
- Cleveland Clinic Cancer Center, Cleveland, Ohio
| | - Bruce G Haffty
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Robert Kuske
- Arizona Breast Cancer Specialists, Scottsdale, Arizona
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3
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Williamson CW, Kotha NV, Zou J, Brown D, Scanderbeg D, Rash D, Einck J, Yashar C, Mell LK, Mayadev J. Outcomes from a 3-fraction high-dose-rate brachytherapy regimen for patients with cervical cancer. Brachytherapy 2023; 22:317-324. [PMID: 36631374 DOI: 10.1016/j.brachy.2022.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE To estimate local control, survival, and toxicity associated with a 3-fraction (3F) image-guided brachytherapy (IGBT) regimen compared to longer fraction (LF) for cervical cancer. METHODS 150 patients treated between 2015-2020 with 3F (24Gy in 3 fractions) or LF (28...30 Gy in 4-5 fractions) were reviewed. The primary outcome was 2-year local failure. We compared overall survival (OS), disease-free survival (DFS), hospitalizations, and toxicity. RESULTS There were 32 patients in the 3F group and 118 in the LF group, with a median follow up of 22 months. The 3F had worse performance status (p = 0.01) but otherwise similar characteristics. The 2-year local failure rate was 3.6% (95% CI 0%, 10.6%) for 3F, and 7.5% (95% CI 2.4%, 12.6%) for LF. The univariable hazard ratio (HR) for local failure for 3F was 0.43 (0.05, 3.43; p = 0.43). Moreover, 2 of 32 (6.3%) 3F patients experienced Grade ...3 toxicity compared to 7 of 118 (5.9%) LF patients (p = 1.0), with no difference in hospitalization within 2 years (p = 0.66) and no treatment-related deaths. CONCLUSIONS Local control was excellent, with long term survival and toxicity similar between the groups. These findings support consideration of 3F.
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Affiliation(s)
- Casey W Williamson
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR
| | - Nikhil V Kotha
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Jingjing Zou
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California at San Diego, La Jolla, CA
| | - Derek Brown
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Daniel Scanderbeg
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Dominique Rash
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - John Einck
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Catheryn Yashar
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Loren K Mell
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Jyoti Mayadev
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA.
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Williamson CW, Sirák I, Xu R, Portelance L, Wei L, Tarnawski R, Mahantshetty U, Heide ES, Yashar CM, McHale MT, Bosch W, Lowenstein J, Saenz CC, Plaxe S, Eskander R, Einck J, Mundt AJ, Mayadev J, Mell LK. Positron Emission Tomography-Guided Bone Marrow-Sparing Radiation Therapy for Locoregionally Advanced Cervix Cancer: Final Results From the INTERTECC Phase II/III Trial. Int J Radiat Oncol Biol Phys 2022; 112:169-178. [PMID: 34419564 PMCID: PMC8688221 DOI: 10.1016/j.ijrobp.2021.08.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 06/10/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE To test effects of positron emission tomography (PET)-based bone marrow-sparing (BMS) image-guided intensity modulated radiation therapy (IG-IMRT) on efficacy and toxicity for patients with locoregionally advanced cervical cancer. METHODS AND MATERIALS In an international phase II/III trial, patients with stage IB-IVA cervical carcinoma were treated with either PET-based BMS-IG-IMRT (PET-BMS-IMRT group) or standard image-guided IMRT (IMRT group), with concurrent cisplatin (40 mg/m2 weekly), followed by brachytherapy. The phase II component nonrandomly assigned patients to PET-BMS-IMRT or standard IMRT. The phase III trial randomized patients to PET-BMS-IMRT versus IMRT, with a primary endpoint of progression-free survival (PFS) but was closed early for futility. Phase III patients were analyzed separately and in combination with phase II patients, comparing acute hematologic toxicity, cisplatin delivery, PFS, overall survival (OS), and patterns of failure. In a post-hoc exploratory analysis, we investigated the association between pretreatment absolute lymphocyte count (ALC) and OS. RESULTS In total, 101 patients were enrolled on the phase II/III trial, including 29 enrolled in phase III (PET-BMS-IMRT group: 16; IMRT group: 13) before early closure. Median follow-up was 33 months for phase III patients and 39 months for all patients. PFS and OS at 5 years for all patients were 73.6% (95% confidence interval [CI], 64.9%-84.3%) and 84% (95% CI, 76%-92.9%]), respectively. There were no differences in number of cisplatin cycles, OS, PFS, or patterns of failure between groups for the combined cohort. The incidence of acute grade ≥ 3 neutropenia was significantly lower in the PET-BMS-IMRT group compared with IMRT for randomized patients (19% vs 54%, χ2P = .048) and in the combined cohort (13% vs 35%, χ2P = .01). Patients with pretreatment ALC ≤ 1.5 k/µL had nonsignificantly worse OS on multivariable analysis (HR 2.85; 95% CI, 0.94-8.62; adjusted P = .216), compared with patients with ALC > 1.5 k/µL. There was no difference in posttreatment ALC by treatment group. CONCLUSIONS PET-BMS-IMRT significantly reduced acute grade ≥3 neutropenia, but not treatment-related lymphopenia, compared with standard IMRT. We found no evidence that PET-BMS-IMRT affected chemotherapy delivery or long-term outcomes, and weak evidence of an association between pretreatment ALC and OS.
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Affiliation(s)
- Casey W. Williamson
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Igor Sirák
- Department of Oncology and Radiotherapy, University Hospital, Hradec Kralove, Czech Republic
| | - Ronghui Xu
- University of California San Diego, La Jolla, California
| | | | | | - Rafal Tarnawski
- Marie Sklodowska Cancer Center and Institute of Oncology, Gliwice, Poland
| | | | | | - Catheryn M. Yashar
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | | | - Walter Bosch
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO
| | | | | | - Steve Plaxe
- University of California San Diego, La Jolla, California
| | - Ramez Eskander
- University of California San Diego, La Jolla, California
| | - John Einck
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Arno J. Mundt
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Jyoti Mayadev
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California,La Jolla Center for Precision Radiation Medicine, La Jolla, California
| | - Loren K. Mell
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California,La Jolla Center for Precision Radiation Medicine, La Jolla, California
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5
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Klebaner D, Travis Courtney P, Garraway IP, Einck J, Kumar A, Elena Martinez M, McKay R, Murphy JD, Parada H, Sandhu A, Stewart T, Yamoah K, Rose BS. Association of Health-Care System with Prostate Cancer-Specific Mortality in African American and Non-Hispanic White Men. J Natl Cancer Inst 2021; 113:1343-1351. [PMID: 33892497 DOI: 10.1093/jnci/djab062] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/19/2021] [Accepted: 03/30/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Disparities in prostate cancer-specific mortality (PCSM) between African American and non-Hispanic White (White) patients have been attributed to biological and systemic factors. We evaluated drivers of these disparities in the Surveillance, Epidemiology and End Results (SEER) national registry and an equal-access system, the Veterans Health Administration (VHA). METHODS We identified African American and White patients diagnosed with prostate cancer between 2004-2015 in SEER (N = 311,691) and the VHA (N = 90,749). We analyzed the association between race and metastatic disease at presentation using multivariable logistic regression adjusting for sociodemographic factors, and PCSM using sequential competing-risks regression adjusting for disease and sociodemographic factors. RESULTS The median follow-up was 5.3 years in SEER and 4.7 years in the VHA. African American men were more likely than White men to present with metastatic disease in SEER (adjusted odds ratio = 1.23, 95% confidence interval [CI] = 1.17-1.30), but not in the VHA (adjusted odds ratio = 1.07, 95% CI = 0.98-1.17). African American versus White race was associated with an increased risk of PCSM in SEER (subdistribution hazard ratio [SHR] = 1.32, 95% CI = 1.10-1.60), but not in the VHA (SHR = 1.00, 95% CI: 0.93-1.08). Adjusting for disease extent, PSA, and Gleason score eliminated the association between race and PCSM in SEER (aSHR 1.04, 95% CI 0.93-1.16). CONCLUSIONS Racial disparities in PCSM were present in a nationally representative registry, but not in an equal-access healthcare system, due to differences in advanced disease at presentation. Strategies to increase healthcare access may bridge the racial disparity in outcomes. Longer follow-up is needed to fully assess mortality outcomes.Disparities between African American and non-Hispanic White (White) patients in cancer-specific mortality have been described across numerous cancer types and healthcare systems[1-5]. The survival gap between African American and White patients with prostate cancer has been well-characterized, with two-fold higher prostate cancer-specific mortality (PCSM) rates among African American patients depending on the setting[1, 6-10]. This disparity has been attributed to differences in prostate cancer biology in African American men, in addition to systemic factors in mediating this disparity, such as differential access to healthcare, Prostate-Specific Antigen (PSA) screening, and distrust in the healthcare system[1, 11-16].The Veterans Health Administration (VHA) is a relatively equal-access healthcare system that treats a large, ethnically diverse population of veterans. The Surveillance, Epidemiology and End Results (SEER) program is a national cancer registry program that collects data from the general United States (US) population. The goals of the present investigation were to 1) Compare PCSM between African American and White men within SEER and the VHA and 2) Identify modifiable system-level contributors to these disparities. We hypothesized that PCSM would be comparable among African American and White men in an equal-access setting, the VHA, but not in a national registry, SEER, and that this disparity in SEER would be in part driven by more advanced disease at presentation.
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Affiliation(s)
- Daniella Klebaner
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California
| | - P Travis Courtney
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California.,Veterans Health Administration San Diego Health Care System, La Jolla, California, USA
| | - Isla P Garraway
- Department of Urology, University of California Los Angeles School of Medicine, Los Angeles, California
| | - John Einck
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California
| | - Abhishek Kumar
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California
| | - Maria Elena Martinez
- Department of Population Sciences, University of California San Diego Moores Cancer Center, La Jolla, California.,Wertheim School of Public Health, University of California San Diego, La Jolla, California
| | - Rana McKay
- Department of Medicine, University of California San Diego School of Medicine, La Jolla, California
| | - James D Murphy
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California.,Veterans Health Administration San Diego Health Care System, La Jolla, California, USA
| | - Humberto Parada
- Department of Epidemiology and Biostatistics, San Diego State University Graduate School of Public Health,San Diego, California
| | - Ajay Sandhu
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California
| | - Tyler Stewart
- Department of Medicine, University of California San Diego School of Medicine, La Jolla, California
| | - Kosj Yamoah
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa Bay, Florida
| | - Brent S Rose
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California.,Veterans Health Administration San Diego Health Care System, La Jolla, California, USA
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Scanderbeg DJ, Yashar C, Ouhib Z, Jhingran A, Einck J. Development, implementation, and associated challenges of a new HDR brachytherapy program. Brachytherapy 2020; 19:874-880. [PMID: 32950407 PMCID: PMC7495265 DOI: 10.1016/j.brachy.2020.08.018] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/20/2020] [Accepted: 08/27/2020] [Indexed: 12/24/2022]
Abstract
Developing any new radiation oncology program requires planning and analysis of the current state of the facility and its capacity to take on another program. Staff must consider a large number of factors to establish a feasible, safe, and sustainable program. We present a simple and generic outline that lays out the process for developing and implementing a new HDR brachytherapy program in any setting, but with particular emphasis on challenges associated with starting the program in a limited resource setting. The sections include feasibility of a program, starting cases, machine and equipment selection, and quality and safety.
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Affiliation(s)
- Daniel J Scanderbeg
- Radiation Medicine and Applied Sciences, University of California, San Diego, CA.
| | - Catheryn Yashar
- Radiation Medicine and Applied Sciences, University of California, San Diego, CA
| | - Zoubir Ouhib
- Radiation Oncology, Lynn Regional Cancer Center, Delray Beach, FL
| | - Anuja Jhingran
- Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - John Einck
- Radiation Medicine and Applied Sciences, University of California, San Diego, CA
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Casares-Magaz O, Bülow S, Pettersson NJ, Moiseenko V, Pedersen J, Thor M, Einck J, Hopper A, Knopp R, Muren LP. High accumulated doses to the inferior rectum are associated with late gastro-intestinal toxicity in a case-control study of prostate cancer patients treated with radiotherapy. Acta Oncol 2019; 58:1543-1546. [PMID: 31364905 DOI: 10.1080/0284186x.2019.1632476] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
| | - Steffen Bülow
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - Niclas J. Pettersson
- Department of Medical Physics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Vitali Moiseenko
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - Jesper Pedersen
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - Maria Thor
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - John Einck
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - Austin Hopper
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - Rick Knopp
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - Ludvig Paul Muren
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
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Guram K, Nunez M, Einck J, Mell LK, Cohen E, Sanders PD, Miyauchi S, Weihe E, Kurzrock R, Boles S, Sharabi AB. Radiation Therapy Combined With Checkpoint Blockade Immunotherapy for Metastatic Undifferentiated Pleomorphic Sarcoma of the Maxillary Sinus With a Complete Response. Front Oncol 2018; 8:435. [PMID: 30386736 PMCID: PMC6199376 DOI: 10.3389/fonc.2018.00435] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/19/2018] [Indexed: 01/22/2023] Open
Abstract
Background: Undifferentiated pleomorphic sarcoma (UPS) of the maxillary sinus is an extremely rare malignancy of the head and neck. Surgery is the mainstay of treatment for UPS; however, proximity to vital structures makes it challenging to achieve negative surgical margins. Adjuvant therapy including radiation therapy with or without chemotherapy is generally indicated. Despite advances in multimodality treatment, objective response rates to available therapies and prognosis of metastatic UPS remain dismal. Immunotherapy has become a fourth cornerstone of cancer therapy and checkpoint blockade immunotherapy is a standard of care for recurrent or metastatic cisplatin-refractory head and neck squamous cell carcinoma. Checkpoint blockade immunotherapy is being studied in metastatic sarcoma, including UPS, and while initial results are promising, objective response rates remain below 20%. However, adding radiation therapy to checkpoint blockade immunotherapy has been shown, in both preclinical and retrospective clinical studies, to have combinatorial effects on both local and metastatic disease. Thus, further investigation into the effects of radiation therapy combined with immunotherapy in head and neck sarcomas is warranted. Case Presentation: We present a case of metastatic, chemotherapy-refractory, UPS of the maxillary sinus in a 55-year-old male treated with checkpoint blockade immunotherapy combined with radiation, which resulted in a complete response. Conclusions: This is the first report to our knowledge of metastatic UPS treated with a combination of radiation and dual agent checkpoint blockade immunotherapy. Further investigation is warranted to study the effects of this combination in patients with metastatic UPS that fail to respond to currently available therapies.
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Affiliation(s)
- Kripa Guram
- Department of Radiation Medicine and Applied Science, UC San Diego Moores Cancer Center, San Diego, CA, United States
| | - Maria Nunez
- Division of Experimental Therapeutics, UC San Diego Moores Cancer Center, San Diego, CA, United States
| | - John Einck
- Department of Radiation Medicine and Applied Science, UC San Diego Moores Cancer Center, San Diego, CA, United States
| | - Loren K Mell
- Department of Radiation Medicine and Applied Science, UC San Diego Moores Cancer Center, San Diego, CA, United States
| | - Ezra Cohen
- Division of Hematology and Oncology, Center for Personalized Cancer Therapy, UC San Diego Moores Cancer Center, San Diego, CA, United States
| | - P Dominick Sanders
- Department of Radiation Medicine and Applied Science, UC San Diego Moores Cancer Center, San Diego, CA, United States
| | - Sayuri Miyauchi
- Department of Radiation Medicine and Applied Science, UC San Diego Moores Cancer Center, San Diego, CA, United States
| | - Elizabeth Weihe
- Department of Radiology, University of California, San Diego, San Diego, CA, United States
| | - Razelle Kurzrock
- Division of Experimental Therapeutics, UC San Diego Moores Cancer Center, San Diego, CA, United States.,Division of Hematology and Oncology, Center for Personalized Cancer Therapy, UC San Diego Moores Cancer Center, San Diego, CA, United States
| | - Sarah Boles
- Division of Hematology and Oncology, Center for Personalized Cancer Therapy, UC San Diego Moores Cancer Center, San Diego, CA, United States
| | - Andrew B Sharabi
- Department of Radiation Medicine and Applied Science, UC San Diego Moores Cancer Center, San Diego, CA, United States
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Clark H, Casares-Magaz O, Pettersson N, Muren L, Hopper A, Knopp R, Einck J, Moiseenko V. [OA009] Motion inclusive variations in bladder dose surface maps during the course of high-precision radiotherapy for prostate cancer. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.06.081] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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10
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Mayadev J, Klapheke A, Yashar C, Hsu IC, Kamrava M, Mundt AJ, Mell LK, Einck J, Benedict S, Valicenti R, Cress R. Underutilization of brachytherapy and disparities in survival for patients with cervical cancer in California. Gynecol Oncol 2018; 150:73-78. [PMID: 29709291 DOI: 10.1016/j.ygyno.2018.04.563] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE The treatment for locally advanced cervical cancer is external beam radiation (EBRT), concurrent chemotherapy, and brachytherapy (BT). We investigated demographic and socioeconomic factors that influence trends in BT utilization and disparities in survival. METHODS Using the California Cancer Registry, cervical cancer patients FIGO IB2-IVA from 2004 to 2014 were identified. We collected tumor, demographic and socioeconomic (SES) factors. We used multivariable logistic regression analysis to determine predictors of use of BT. Using Cox proportional hazards, we examined the impact of BT vs EBRT boost on cause specific (CSS) and overall survival (OS). RESULTS We identified 4783 patients with FIGO stage 11% IB2; 32% II, 54% III, 3% IVA. Nearly half (45%) of patients were treated with BT, 18% were treated with a EBRT boost, and 37% had no boost. Stage II and III were more likely to be treated with BT (p = 0.002 and p = 0.0168) vs Stage IB2. As patients aged, the use of BT decreased. Using multivariate analysis, BT impacted CCS (HR 1.16, p = 0.0330) and OS (HR 1.14, p = 0.0333). Worse CSS was observed for black patients (p = 0.0002), low SES (p = 0.0263), stage III and IVA (p < 0.0001. Black patients, low and middle SES had worse OS, (p = 0.0003). CONCLUSIONS The utilization of BT in locally advanced cervical cancer was low at 45%, with a decrease in CSS and OS. Black patients and those in low SES had worse CSS. As we strive for outcome improvement in cervical cancer, we need to target increasing access and disparities for quality and value.
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Affiliation(s)
| | - Amy Klapheke
- California Cancer Registry, Sacramento, CA, United States
| | | | - I-Chow Hsu
- UCSF Medical Center, San Francisco, CA, United States
| | | | | | | | - John Einck
- UC San Diego, San Diego, CA, United States
| | | | | | - Rosemary Cress
- California Cancer Registry, Sacramento, CA, United States
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11
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Casares-Magaz O, Moiseenko V, Hopper A, Pettersson NJ, Thor M, Knopp R, Deasy JO, Muren LP, Einck J. Associations between volume changes and spatial dose metrics for the urinary bladder during local versus pelvic irradiation for prostate cancer. Acta Oncol 2017; 56:884-890. [PMID: 28401808 DOI: 10.1080/0284186x.2017.1312014] [Citation(s) in RCA: 14] [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] [Indexed: 10/19/2022]
Abstract
BACKGROUND Inter-fractional variation in urinary bladder volumes during the course of radiotherapy (RT) for prostate cancer causes deviations between planned and delivered doses. This study compared planned versus daily cone-beam CT (CBCT)-based spatial bladder dose distributions, for prostate cancer patients receiving local prostate treatment (local treatment) versus prostate including pelvic lymph node irradiation (pelvic treatment). MATERIAL AND METHODS Twenty-seven patients (N = 15 local treatment; N = 12 pelvic treatment) were treated using daily image-guided RT (1.8 Gy@43-45 fx), adhering to a full bladder/empty rectum protocol. For each patient, 9-10 CBCTs were registered to the planning CT, using the clinically applied translations. The urinary bladder was manually segmented on each CBCT, 3 mm inner shells were generated, and semi and quadrant sectors were created using axial/coronal cuts. Planned and delivered DVH metrics were compared across patients and between the two groups of treatment (t-test, p < .05; Holm-Bonferroni correction). Associations between bladder volume variations and the dose-volume histograms (DVH) of the bladder and its sectors were evaluated (Spearman's rank correlation coefficient, rs). RESULTS Bladder volumes varied considerably during RT (coefficient of variation: 16-58%). The population-averaged planned and delivered DVH metrics were not significantly different at any dose level. Larger treatment bladder volumes resulted in increased absolute volume of the posterior/inferior bladder sector receiving intermediate-high doses, in both groups. The superior bladder sector received less dose with larger bladder volumes for local treatments (rs ± SD: -0.47 ± 0.32), but larger doses for pelvic treatments (rs ± SD: 0.74 ± 0.24). CONCLUSIONS Substantial bladder volume changes during the treatment course occurred even though patients were treated under a full bladder/daily image-guided protocol. Larger bladder volumes resulted in less bladder wall spared at the posterior-inferior sector, regardless the treatment received. Contrary, larger bladder volumes meant larger delivered doses to the superior bladder sector for pelvic RT but smaller doses for local treatments.
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Affiliation(s)
| | - Vitali Moiseenko
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - Austin Hopper
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - Niclas Johan Pettersson
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - Maria Thor
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Rick Knopp
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - Joseph O. Deasy
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Ludvig Paul Muren
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - John Einck
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
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12
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Moiseenko V, Einck J, Murphy J, Ödén J, Bjöhle J, Uzan J, Gagliardi G. Clinical evaluation of QUANTEC guidelines to predict the risk of cardiac mortality in breast cancer patients. Acta Oncol 2016; 55:1506-1510. [PMID: 27732122 DOI: 10.1080/0284186x.2016.1234067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Vitali Moiseenko
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - John Einck
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - James Murphy
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - Jakob Ödén
- Department of Medical Physics, Karolinska University Hospital, Stockholm, Sweden
| | - Judith Bjöhle
- Department of Oncology-Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Julien Uzan
- Department of Medical Physics, Karolinska University Hospital, Stockholm, Sweden
- RaySearch Laboratories AB, Stockholm, Sweden
| | - Giovanna Gagliardi
- Department of Medical Physics, Karolinska University Hospital, Stockholm, Sweden
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13
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Grover S, Longo J, Einck J, Puri P, Brown D, Chino J, Mahantshetty U, Yashar C, Erickson B. The Unique Issues With Brachytherapy in Low- and Middle-Income Countries. Semin Radiat Oncol 2016; 27:136-142. [PMID: 28325239 DOI: 10.1016/j.semradonc.2016.11.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Gynecologic carcinomas, including cervical cancer, present a significant burden on low- and middle-income countries (LMICs). Brachytherapy plays an integral role in the treatment of gynecologic carcinomas, as it is essential for both curative and palliative treatment. However, there are numerous geographic and economic barriers to providing brachytherapy to cancer patients in LMICs. This article examines the role and delivery of brachytherapy in gynecological cancer treatment; brachytherapy capacity in LMICs, including infrastructure, equipment, and human resources considerations; commissioning, training, and clinical implementation of brachytherapy in LMICs; other challenges, and strategies for improvement in brachytherapy delivery in LMICs, including innovation and current and upcoming international initiatives.
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Affiliation(s)
- Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA.
| | - John Longo
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - John Einck
- Department of Radiation Oncology, University of California San Diego, San Diego, CA
| | - Priya Puri
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Derek Brown
- Department of Radiation Oncology, University of California San Diego, San Diego, CA
| | - Junzo Chino
- Department of Radiation Oncology, Duke Cancer Institute, Durham, NC
| | - Umesh Mahantshetty
- Department of Radiation Oncology, Tata Memorial Cancer Hospital, Mumbai, Maharashtra, India
| | - Catheryn Yashar
- Department of Radiation Oncology, University of California San Diego, San Diego, CA
| | - Beth Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
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14
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Brown D, Mundt A, Einck J, Pawlicki T. SU-F-E-12: Elective International Rotations in Medical Physics Residency Programs. Med Phys 2016. [DOI: 10.1118/1.4955698] [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: 11/07/2022] Open
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15
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Boero I, Paravati A, Matsuno R, Gillespie E, Einck J, Mell L, Murphy J. EP-1452: The impact of individual surgeons on the likelihood of mastectomy in breast cancer. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32702-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Harry T, Rahn D, Semenov D, Gu X, Yashar C, Einck J, Jiang S, Cerviño L. Cardiac dosimetric evaluation of deep inspiration breath-hold level variances using computed tomography scans generated from deformable image registration displacement vectors. Med Dosim 2015. [PMID: 26206154 DOI: 10.1016/j.meddos.2015.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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] [Indexed: 11/17/2022]
Abstract
There is a reduction in cardiac dose for left-sided breast radiotherapy during treatment with deep inspiration breath-hold (DIBH) when compared with treatment with free breathing (FB). Various levels of DIBH may occur for different treatment fractions. Dosimetric effects due to this and other motions are a major component of uncertainty in radiotherapy in this setting. Recent developments in deformable registration techniques allow displacement vectors between various temporal and spatial patient representations to be digitally quantified. We propose a method to evaluate the dosimetric effect to the heart from variable reproducibility of DIBH by using deformable registration to create new anatomical computed tomography (CT) scans. From deformable registration, 3-dimensional deformation vectors are generated with FB and DIBH. The obtained deformation vectors are scaled to 75%, 90%, and 110% and are applied to the reference image to create new CT scans at these inspirational levels. The scans are then imported into the treatment planning system and dose calculations are performed. The average mean dose to the heart was 2.5Gy (0.7 to 9.6Gy) at FB, 1.2Gy (0.6 to 3.8Gy, p < 0.001) at 75% inspiration, 1.1Gy (0.6 to 3.1Gy, p = 0.004) at 90% inspiration, 1.0Gy (0.6 to 3.0Gy) at 100% inspiration or DIBH, and 1.0Gy (0.6 to 2.8Gy, p = 0.019) at 110% inspiration. The average mean dose to the left anterior descending artery (LAD) was 19.9Gy (2.4 to 46.4Gy), 8.6Gy (2.0 to 43.8Gy, p < 0.001), 7.2Gy (1.9 to 40.1Gy, p = 0.035), 6.5Gy (1.8 to 34.7Gy), and 5.3Gy (1.5 to 31.5Gy, p < 0.001), correspondingly. This novel method enables numerous anatomical situations to be mimicked and quantifies the dosimetric effect they have on a treatment plan.
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Affiliation(s)
- Taylor Harry
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA; Department of Radiation Medicine, Oregon Health and Science University, Portland, OR; Department of Nuclear Engineering and Radiation Health Physics, Oregon State University, Corvallis, OR
| | - Doug Rahn
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Denis Semenov
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Xuejun Gu
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Catheryn Yashar
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - John Einck
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Steve Jiang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Laura Cerviño
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA.
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17
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Yock A, Manger R, Einck J, Yashar C, Sanghvi P, Hattangadi-Gluth J, Cervino L. SU-E-T-176: Clinical Experience of Brass Mesh Bolus: Patient-Specific Parameters as Predictors of Measured Dosimetric Effect. Med Phys 2015. [DOI: 10.1118/1.4924537] [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: 11/07/2022] Open
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18
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Simpson DR, Scanderbeg D, Carmona R, McMurtrie R, Einck J, Mell LK, McHale M, Saenz C, Plaxe S, Mundt AJ, Yashar CM. Clinical Outcomes of Computed Tomography-Based Volumetric Brachytherapy Planning for Cervical Cancer. Brachytherapy 2015. [DOI: 10.1016/j.brachy.2015.02.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Casares-Magaz O, Thor M, Muren L, Hopper A, Einck J, Cornell M, Knopp R, Deasy J, Moiseenko V. The need for dose re-calculation on cone-beam CTs in dose-response studies of pelvic normal tissues. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40953-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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20
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Mayadev J, Einck J, Elson S, Rugo H, Hwang S, Bold R, Daroui P, McCloskey S, Yashar C, Kim D, Fowble B. Practice Patterns in the Delivery of Radiation Therapy After Mastectomy Among the University of California Athena Breast Health Network. Clin Breast Cancer 2015; 15:43-7. [DOI: 10.1016/j.clbc.2014.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 07/09/2014] [Accepted: 07/11/2014] [Indexed: 11/24/2022]
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21
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Brown DW, Shulman A, Hudson A, Smith W, Fisher B, Hollon J, Pipman Y, Van Dyk J, Einck J. A framework for the implementation of new radiation therapy technologies and treatment techniques in low-income countries. Phys Med 2014; 30:791-8. [PMID: 25096162 DOI: 10.1016/j.ejmp.2014.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 06/26/2014] [Accepted: 07/13/2014] [Indexed: 11/18/2022] Open
Abstract
We present a practical, generic, easy-to-use framework for the implementation of new radiation therapy technologies and treatment techniques in low-income countries. The framework is intended to standardize the implementation process, reduce the effort involved in generating an implementation strategy, and provide improved patient safety by reducing the likelihood that steps are missed during the implementation process. The 10 steps in the framework provide a practical approach to implementation. The steps are, 1) Site and resource assessment, 2) Evaluation of equipment and funding, 3) Establishing timelines, 4) Defining the treatment process, 5) Equipment commissioning, 6) Training and competency assessment, 7) Prospective risk analysis, 8) System testing, 9) External dosimetric audit and incident learning, and 10) Support and follow-up. For each step, practical advice for completing the step is provided, as well as links to helpful supplementary material. An associated checklist is provided that can be used to track progress through the steps in the framework. While the emphasis of this paper is on addressing the needs of low-income countries, the concepts also apply in high-income countries.
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Affiliation(s)
- Derek W Brown
- University of Calgary, Depts of Oncology and Physics and Astronomy, Tom Baker Cancer Centre, Calgary, AB, Canada.
| | | | | | - Wendy Smith
- University of Calgary, Depts of Oncology and Physics and Astronomy, Tom Baker Cancer Centre, Calgary, AB, Canada.
| | | | - Jon Hollon
- Varian Medical Systems, Palo Alto, CA, USA.
| | - Yakov Pipman
- International Educational Activities Committee, American Association of Physicists in Medicine, USA.
| | - Jacob Van Dyk
- Dept of Medical Biophysics, Western University, London, ON, Canada.
| | - John Einck
- Dept of Oncology, Moores Cancer Center, San Diego, CA, USA.
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22
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Weiss A, Lee KC, Romero Y, Ward E, Kim Y, Ojeda-Fournier H, Einck J, Blair SL. Calcifications on Mammogram Do Not Correlate with Tumor Size After Neoadjuvant Chemotherapy. Ann Surg Oncol 2014; 21:3310-6. [DOI: 10.1245/s10434-014-3914-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Indexed: 01/15/2023]
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23
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Pritz J, Gulaya S, Bydder M, Liang Y, Zhu H, Hoh C, Yashar CM, McHale M, Einck J, Fanta P, Vaida F, Bydder G. WE-C-WAB-06: Effects of Radiation On Functional Bone Marrow in Patients with Pelvic Malignancies. Med Phys 2013. [DOI: 10.1118/1.4815542] [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: 11/07/2022] Open
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24
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Liang Y, Bydder M, Yashar CM, Rose BS, Cornell M, Hoh CK, Lawson JD, Einck J, Saenz C, Fanta P, Mundt AJ, Bydder GM, Mell LK. Prospective Study of Functional Bone Marrow-Sparing Intensity Modulated Radiation Therapy With Concurrent Chemotherapy for Pelvic Malignancies. Int J Radiat Oncol Biol Phys 2013; 85:406-14. [DOI: 10.1016/j.ijrobp.2012.04.044] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 03/23/2012] [Accepted: 04/27/2012] [Indexed: 10/27/2022]
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25
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Simpson D, Yashar C, Kannan N, Zakeri K, McMurtrie R, Einck J, Mell L, Kim H, Scanderbeg D, Beriwal S. CT and MRI-based Image Guided Brachytherapy for Cervical Cancer: A Multi-institutional Report. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Harry T, Rahn D, Yashar C, Einck J, Pawlicki T, Jiang S, Cervino L. WE-G-213CD-08: Initial Experience with the Clinical Implementation of a Deep Inspiration Breath Hold for Left Breast Radiotherapy Using Surface Imaging and Visual Aid. Med Phys 2012; 39:3972. [DOI: 10.1118/1.4736209] [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: 11/07/2022] Open
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27
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Schwartz DL, Einck J, Hunt K, Bruckner J, Conrad E, Koh WJ, Laramore GE. The effect of delayed postoperative irradiation on local control of soft tissue sarcomas of the extremity and torso. Int J Radiat Oncol Biol Phys 2002; 52:1352-9. [PMID: 11955749 DOI: 10.1016/s0360-3016(01)02807-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE The impact of delayed adjuvant radiotherapy in patients treated by surgical resection for peripheral or torso soft tissue sarcoma has not been well characterized. We retrospectively examined this issue in an institutional patient cohort. METHODS AND MATERIALS One hundred two adult patients were treated at the University of Washington Medical Center between 1981 and 1998 with postoperative radiotherapy for cure of a newly diagnosed soft tissue sarcoma. Of this group, 58 patients had primary intermediate- or high-grade disease of the extremity or torso (50 extremity/8 torso). Tumor histology was predominantly malignant fibrohistiocytoma, synovial cell sarcoma, and leiomyosarcoma. The group was dichotomized according to time interval from definitive resection to the start of adjuvant radiation. Twenty-six patients had a short delay, defined as <4 months, and 32 patients had a long delay of >or=4 months. Both groups were balanced with regard to site, size, margin status, and tumor depth; however, the long-delay group had a larger proportion of high histologic grade lesions and was treated more frequently with chemotherapy (31/32 [97%] for long-delay patients vs. 14/26 [54%] for short-delay patients). Median follow-up was 49.5 months (range: 7-113 months). Median follow-up for patients still alive was 54 months (range: 9-113 months). Survival outcomes were estimated by the Kaplan-Meier method. RESULTS Overall local relapse-free survival at 5 years from the time of definitive resection was 74%. On univariate analysis, estimated 5-year local relapse-free survival was significantly improved in the short-delay group (88% vs. 62% for the long-delay group, p = 0.048 by log rank). Overall distant relapse-free survival, disease-free survival, and overall survival at 5 years were 77%, 68%, and 86%, respectively. These survival outcomes were statistically equivalent in both radiation delay groups. There was no evidence to suggest that delaying adjuvant systemic therapy for postoperative radiation negatively impacted distant relapse-free survival, disease-free survival, or overall survival. Patterns of failure analysis revealed that 11/12 disease failures in the long-delay group had a local component, with five patients presenting with solitary local recurrences. Severe chronic radiation-related soft tissue or peripheral nerve morbidity was infrequent (5/58 or 8.6%) and similar in both groups. CONCLUSIONS Postoperative radiation delays of 4 months or greater were associated with inferior local disease control for intermediate- and high-grade soft tissue sarcomas of the extremity and torso. Our results suggest that timing postoperative radiation before postoperative chemotherapy may optimize local therapy for such patients without adversely affecting distant disease control, long-term morbidity, or overall survival. Prospective testing of this hypothesis is warranted.
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Affiliation(s)
- David L Schwartz
- Department of Radiation Oncology, Seattle VA Medical Center/Puget Sound Health Care System, Seattle, WA 98108, USA.
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28
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Douglas JG, Einck J, Austin-Seymour M, Koh WJ, Laramore GE. Neutron radiotherapy for recurrent pleomorphic adenomas of major salivary glands. Head Neck 2001; 23:1037-42. [PMID: 11774388 DOI: 10.1002/hed.10027] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [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: 11/07/2022] Open
Abstract
INTRODUCTION Pleomorphic adenoma is the most common neoplasm arising in the salivary glands. Surgical management is the primary therapeutic modality. With the use of modern surgical techniques, recurrence is infrequent, and facial nerve sparing is the norm. However, for patients with recurrent disease, the risk of further relapses is increased with surgical resection alone, particularly for those patients in whom multiple recurrences have already occurred. The role of adjuvant radiotherapy in this setting remains uncertain. Although neutron radiotherapy is superior to conventional radiotherapy for malignant salivary gland tumors, its role in the treatment of pleomorphic adenomas is less well defined. We report our experience using this modality for high-risk, recurrent pleomorphic adenomas. METHODS Sixteen patients were treated with neutron radiotherapy for recurrent pleomorphic adenomas of major salivary glands from 1986 through 1993. The median age at diagnosis was 33 years (range, 11-77 years); median age at the time of neutron radiotherapy was 52 years (range, 22-77 years); median number of prior surgical procedures was 3 (range, 1-6); median duration from initial diagnosis to radiotherapy was 14.5 years (range, 3 months-30 years); median follow-up was 83 months (range, 9-144 months). The median period at risk for survivors was 96 months (defined as the interval from completion of neutron radiotherapy to last follow-up). Ten patients had evidence of gross residual disease at the time of treatment as determined by imaging studies, with nine patients having multinodular disease. RESULTS The 10-year actuarial survival was 79%. One patient died from lung metastases 9 months after treatment; one patient died from a liver tumor of uncertain origin, but the histology could not rule out a metastasis from the previous pleomorphic adenoma; and one patient died from recurrent disease at the base of skull. The 15-year actuarial locoregional control rate was 85%. One of the two patients with locoregional recurrence had a malignant transformation into an adenocarcinoma. No statistical difference in 15-year actuarial survival (75% vs 83%, p =.82) was found comparing patients with gross residual disease vs microscopic residual disease. The actuarial 15-year locoregional control was 76% for patients with gross residual disease vs 100% for those with microscopic disease. The 15-year actuarial risk of RTOG/ESTRO nonaudiologic grade III/IV complications was 21%. No facial nerve injuries were observed as a direct consequence of neutron radiotherapy. CONCLUSIONS Neutron radiotherapy offers both excellent local control rates and survival rates in patients with multiply recurrent pleomorphic adenomas that are not candidates for surgical resection, even in the presence of gross residual disease. The treatment-related morbidity is acceptable. Malignant transformations and metastases, although uncommon, may be observed in this tumor.
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Affiliation(s)
- J G Douglas
- Department of Radiation Oncology, University of Washington, 1959 NE Pacific St., Box 356043, Seattle, Washington 98195-6043, USA.
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29
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Schwartz D, Einck J, Hunt K, Bruckner J, Conrad C, Koh W, Laramore G. Effect of post-operative radiation delay in the combined modality treatment of soft tissue sarcoma of the extremity or torso. Int J Radiat Oncol Biol Phys 2001. [DOI: 10.1016/s0360-3016(01)02092-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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30
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Schwartz DL, Einck J, Bellon J, Laramore GE. Fast neutron radiotherapy for soft tissue and cartilaginous sarcomas at high risk for local recurrence. Int J Radiat Oncol Biol Phys 2001; 50:449-56. [PMID: 11380233 DOI: 10.1016/s0360-3016(00)01586-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [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: 10/27/2022]
Abstract
PURPOSE The practice policy at the University of Washington has been to employ fast neutron radiotherapy for soft tissue sarcoma lesions with prognostic features predictive for poor local control. These include gross residual disease/inoperable disease, recurrent disease, and contaminated surgical margins. Cartilaginous sarcomas have also been included in this high-risk group. This report updates and expands our previously described experience with this approach. METHODS AND MATERIALS Eighty-nine soft tissue sarcoma lesions in 72 patients were treated with neutron radiotherapy in our department between 1984 and 1996. Six patients, each with solitary lesions, were excluded from analysis due to lack of follow-up. Seventy-three percent were treated with fast neutron radiation alone, the rest with a combination of neutrons and photons. Median neutron dose was 18.3 nGy (range 4.8-22). Forty-two patients with solitary lesions were treated with curative intent. Thirty-one patients (including 7 previously treated with neutrons) with 41 lesions were treated with the goal of local palliation. Tumors were predominantly located in the extremity and torso. Thirty of 35 (85%) of curative group patients treated postoperatively had close or positive surgical margins. Thirty-four (82%) lesions treated for palliation were unresectable. Thirty-five patients (53%) were treated at the time of recurrence. Median tumor size at initial presentation was 8.0 cm (range 0.6-29), median treated gross disease size was 5.0 cm (range 1-22), and 46/69 evaluable lesions (67%) were judged to be of intermediate to high histologic grade. Fourteen patients (21%) had chondrosarcomas. RESULTS Median follow-up was 6 months (range 2-47) and 38 months (range 2-175) for the palliative and curative groups, respectively. Kaplan-Meier estimates were obtained for probability of local relapse-free survival (68%), distant disease-free survival (59%), cause-specific survival (68%), and overall survival (66%) at 4 years for the curatively treated group. For the palliatively treated group, estimated local relapse-free survival at 1 year was 62%. Log-rank analysis of the curative group revealed recurrent disease to be the only risk factor predictive for significantly worse local and distant disease-free survival. Intermediate-/high-grade histology was predictive for inferior overall survival. Effective clinical response was documented for 21/27 (78%) lesions treated palliatively. Ten patients (15%) experienced serious chronic radiation-related complications. All of these patients had clinical situations requiring delivery of high neutron doses and/or large radiotherapy fields. CONCLUSION Fast neutron radiotherapy is locally effective for soft tissue and cartilaginous sarcomas having well-recognized high-risk features. Results in the palliative setting appear to be particularly encouraging, with neutrons frequently providing significant symptomatic response for gross disease, with minimal serious chronic sequelae. Fast neutron radiotherapy should be considered in patients at high risk for local recurrence in both the curative and palliative settings.
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Affiliation(s)
- D L Schwartz
- Department of Radiation Oncology, Seattle VA Medical Center/Puget Sound Health Care System, WA 98108, USA.
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