1
|
Schaeffer EM, Srinivas S, Adra N, An Y, Bitting R, Chapin B, Cheng HH, D'Amico AV, Desai N, Dorff T, Eastham JA, Farrington TA, Gao X, Gupta S, Guzzo T, Ippolito JE, Karnes RJ, Kuettel MR, Lang JM, Lotan T, McKay RR, Morgan T, Pow-Sang JM, Reiter R, Roach M, Robin T, Rosenfeld S, Shabsigh A, Spratt D, Szmulewitz R, Teply BA, Tward J, Valicenti R, Wong JK, Snedeker J, Freedman-Cass DA. Prostate Cancer, Version 3.2024. J Natl Compr Canc Netw 2024; 22:140-150. [PMID: 38626801 DOI: 10.6004/jnccn.2024.0019] [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: 04/19/2024]
Abstract
The NCCN Guidelines for Prostate Cancer include recommendations for staging and risk assessment after a prostate cancer diagnosis and for the care of patients with localized, regional, recurrent, and metastatic disease. These NCCN Guidelines Insights summarize the panel's discussions for the 2024 update to the guidelines with regard to initial risk stratification, initial management of very-low-risk disease, and the treatment of nonmetastatic recurrence.
Collapse
Affiliation(s)
| | | | - Nabil Adra
- 3Indiana University Melvin and Bren Simon Comprehensive Cancer Center
| | - Yi An
- 4Yale Cancer Center/Smilow Cancer Hospital
| | | | - Brian Chapin
- 6The University of Texas MD Anderson Cancer Center
| | | | | | - Neil Desai
- 9UT Southwestern Simmons Comprehensive Cancer Center
| | | | | | | | - Xin Gao
- 13Mass General Cancer Center
| | - Shilpa Gupta
- 14Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Thomas Guzzo
- 15Abramson Cancer Center at The University of Pennsylvania
| | - Joseph E Ippolito
- 16Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | - Tamara Lotan
- 20The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | - Todd Morgan
- 22University of Michigan Rogel Cancer Center
| | | | | | - Mack Roach
- 25UCSF Helen Diller Family Comprehensive Cancer Center
| | | | - Stan Rosenfeld
- 27University of California San Francisco Patient Services Committee
| | - Ahmad Shabsigh
- 28The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Daniel Spratt
- 14Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | | | | | | |
Collapse
|
2
|
Hall WA, Li J, You YN, Gollub MJ, Grajo JR, Rosen M, dePrisco G, Yothers G, Dorth JA, Rahma OE, Russell MM, Gross HM, Jacobs SA, Faller BA, George S, Al baghdadi T, Haddock MG, Valicenti R, Hong TS, George TJ. Prospective Correlation of Magnetic Resonance Tumor Regression Grade With Pathologic Outcomes in Total Neoadjuvant Therapy for Rectal Adenocarcinoma. J Clin Oncol 2023; 41:4643-4651. [PMID: 37478389 PMCID: PMC10564288 DOI: 10.1200/jco.22.02525] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/01/2023] [Accepted: 05/09/2023] [Indexed: 07/23/2023] Open
Abstract
PURPOSE Total neoadjuvant therapy (TNT) is a newly established standard treatment for rectal adenocarcinoma. Current methods to communicate magnitudes of regression during TNT are subjective and imprecise. Magnetic resonance tumor regression grade (MR-TRG) is an existing, but rarely used, regression grading system. Prospective validation of MR-TRG correlation with pathologic response in patients undergoing TNT is lacking. Utility of adding diffusion-weighted imaging to MR-TRG is also unknown. METHODS We conducted a multi-institutional prospective imaging substudy within NRG-GI002 (ClinicalTrials.gov identifier: NCT02921256) examining the ability of MR-based imaging to predict pathologic complete response (pCR) and correlate MR-TRG with the pathologic neoadjuvant response score (NAR). Serial MRIs were needed from 110 patients. Three radiologists independently, then collectively, reviewed each MRI for complete response (mriCR), which was tested for positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity with pCR. MR-TRG was examined for association with the pathologic NAR score. All team members were blinded to pathologic data. RESULTS A total of 121 patients from 71 institutions met criteria: 28% were female (n = 34), 84% White (n = 101), and median age was 55 (24-78 years). Kappa scores for T- and N-stage after TNT were 0.38 and 0.88, reflecting fair agreement and near-perfect agreement, respectively. Calling an mriCR resulted in a kappa score of 0.82 after chemotherapy and 0.56 after TNT reflected near-perfect agreement and moderate agreement, respectively. MR-TRG scores were associated with pCR (P < .01) and NAR (P < .0001), PPV for pCR was 40% (95% CI, 26 to 53), and NPV was 84% (95% CI, 75 to 94). CONCLUSION MRI alone is a poor tool to distinguish pCR in rectal adenocarcinoma undergoing TNT. However, the MR-TRG score presents a now validated method, correlated with pathologic NAR, which can objectively measure regression magnitude during TNT.
Collapse
Affiliation(s)
- William A. Hall
- Froedtert and the Medical College of Wisconsin, Milwaukee, WI
| | - Jiahe Li
- The University of Pittsburgh, Pittsburgh, PA
| | - Y. Nancy You
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Joseph R. Grajo
- University of Florida, Gainesville, FL
- University of Florida Health Cancer Center, Gainesville, FL
| | - Mark Rosen
- Imaging and Radiation Oncology Core (IROC) Group, and the University of Pennsylvania, Philadelphia, PA
| | - Greg dePrisco
- Baylor Scott and White Health Baylor University Medical Center at Dallas, Dallas, TX
| | | | - Jennifer A. Dorth
- University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, OH
| | | | - Marcia M. Russell
- Department of Surgery, David Geffen School of Medicine at UCLA, and VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | | | | | - Bryan A. Faller
- Missouri Baptist Medical Center/Heartland NCORP, St Louis, MO
| | - Sagila George
- Stephenson Cancer Center University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Tareq Al baghdadi
- Trinity Health Ann Arbor Hospital, Michigan Cancer Research Consortium (NCORP), Ann Arbor, MI
| | | | - Richard Valicenti
- University of California Davis Comprehensive Cancer Center/UC Davis School of Med/UC Davis Health, Sacramento, CA
| | - Theodore S. Hong
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Thomas J. George
- University of Florida, Gainesville, FL
- University of Florida Health Cancer Center, Gainesville, FL
| |
Collapse
|
3
|
Schaeffer EM, Srinivas S, Adra N, An Y, Barocas D, Bitting R, Bryce A, Chapin B, Cheng HH, D'Amico AV, Desai N, Dorff T, Eastham JA, Farrington TA, Gao X, Gupta S, Guzzo T, Ippolito JE, Kuettel MR, Lang JM, Lotan T, McKay RR, Morgan T, Netto G, Pow-Sang JM, Reiter R, Roach M, Robin T, Rosenfeld S, Shabsigh A, Spratt D, Teply BA, Tward J, Valicenti R, Wong JK, Shead DA, Snedeker J, Freedman-Cass DA. Prostate Cancer, Version 4.2023, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2023; 21:1067-1096. [PMID: 37856213 DOI: 10.6004/jnccn.2023.0050] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [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: 10/21/2023]
Abstract
The NCCN Guidelines for Prostate Cancer provide a framework on which to base decisions regarding the workup of patients with prostate cancer, risk stratification and management of localized disease, post-treatment monitoring, and treatment of recurrence and advanced disease. The Guidelines sections included in this article focus on the management of metastatic castration-sensitive disease, nonmetastatic castration-resistant prostate cancer (CRPC), and metastatic CRPC (mCRPC). Androgen deprivation therapy (ADT) with treatment intensification is strongly recommended for patients with metastatic castration-sensitive prostate cancer. For patients with nonmetastatic CRPC, ADT is continued with or without the addition of certain secondary hormone therapies depending on prostate-specific antigen doubling time. In the mCRPC setting, ADT is continued with the sequential addition of certain secondary hormone therapies, chemotherapies, immunotherapies, radiopharmaceuticals, and/or targeted therapies. The NCCN Prostate Cancer Panel emphasizes a shared decision-making approach in all disease settings based on patient preferences, prior treatment exposures, the presence or absence of visceral disease, symptoms, and potential side effects.
Collapse
Affiliation(s)
| | | | - Nabil Adra
- 3Indiana University Melvin and Bren Simon Comprehensive Cancer Center
| | - Yi An
- 4Yale Cancer Center/Smilow Cancer Hospital
| | | | | | - Alan Bryce
- 7Mayo Clinic Comprehensive Cancer Center
| | - Brian Chapin
- 8The University of Texas MD Anderson Cancer Center
| | | | | | - Neil Desai
- 11UT Southwestern Simmons Comprehensive Cancer Center
| | | | | | | | - Xin Gao
- 10Dana-Farber/Brigham and Women's Cancer Center | Mass General Cancer Center
| | - Shilpa Gupta
- 15Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Thomas Guzzo
- 16Abramson Cancer Center at The University of Pennsylvania
| | - Joseph E Ippolito
- 17Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | - Tamara Lotan
- 20The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | - Todd Morgan
- 22University of Michigan Rogel Cancer Center
| | | | | | | | - Mack Roach
- 26UCSF Helen Diller Family Comprehensive Cancer Center
| | | | - Stan Rosenfeld
- 28University of California San Francisco, Patient Services Committee Chair
| | - Ahmad Shabsigh
- 29The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Daniel Spratt
- 15Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | | | | | | |
Collapse
|
4
|
Schaeffer EM, Srinivas S, Adra N, An Y, Barocas D, Bitting R, Bryce A, Chapin B, Cheng HH, D'Amico AV, Desai N, Dorff T, Eastham JA, Farrington TA, Gao X, Gupta S, Guzzo T, Ippolito JE, Kuettel MR, Lang JM, Lotan T, McKay RR, Morgan T, Netto G, Pow-Sang JM, Reiter R, Roach M, Robin T, Rosenfeld S, Shabsigh A, Spratt D, Teply BA, Tward J, Valicenti R, Wong JK, Berardi RA, Shead DA, Freedman-Cass DA. NCCN Guidelines® Insights: Prostate Cancer, Version 1.2023. J Natl Compr Canc Netw 2022; 20:1288-1298. [PMID: 36509074 DOI: 10.6004/jnccn.2022.0063] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The NCCN Guidelines for Prostate Cancer address staging and risk assessment after a prostate cancer diagnosis and include management options for localized, regional, recurrent, and metastatic disease. The NCCN Prostate Cancer Panel meets annually to reevaluate and update their recommendations based on new clinical data and input from within NCCN Member Institutions and from external entities. These NCCN Guidelines Insights summarizes much of the panel's discussions for the 4.2022 and 1.2023 updates to the guidelines regarding systemic therapy for metastatic prostate cancer.
Collapse
Affiliation(s)
| | | | - Nabil Adra
- 3Indiana University Melvin and Bren Simon Comprehensive Cancer Center
| | - Yi An
- 4Yale Cancer Center/Smilow Cancer Hospital
| | | | | | | | - Brian Chapin
- 8The University of Texas MD Anderson Cancer Center
| | | | | | - Neil Desai
- 11UT Southwestern Simmons Comprehensive Cancer Center
| | | | | | | | - Xin Gao
- 15Massachusetts General Hospital Cancer Center
| | - Shilpa Gupta
- 16Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Thomas Guzzo
- 17Abramson Cancer Center at The University of Pennsylvania
| | - Joseph E Ippolito
- 18Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | - Tamara Lotan
- 21The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | - Todd Morgan
- 23University of Michigan Rogel Cancer Center
| | | | | | | | - Mack Roach
- 27UCSF Helen Diller Family Comprehensive Cancer Center
| | | | - Stan Rosenfeld
- 29University of California San Francisco Patient Services
| | - Ahmad Shabsigh
- 30The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Daniel Spratt
- 16Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Azghadi S, Moran A, Palo B, San D, Valicenti R, Zhao X. PO-0186 Analysis of Outcomes and Cost Effectiveness of Inpatient vs.Outpatient Based Interstitial Vaginal Brachytherapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06345-3] [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]
|
6
|
Chen H, Nguyen KNB, Huang H, Feng C, Zhao X, Daly ME, Rao S, Fragoso R, Valicenti R, Sekhon S, Navarro SM, Kim EJ, Cho M, Tam K, Farkas L, Halabi WJ, Monjazeb AM, Rong Y. Effect and Safety of Radiation Therapy Boost to Extramesorectal Lymph Nodes in Rectal Cancer. Pract Radiat Oncol 2020; 10:e372-e377. [DOI: 10.1016/j.prro.2019.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/28/2019] [Accepted: 12/04/2019] [Indexed: 12/20/2022]
|
7
|
Dyer BA, Yuan Z, Qiu J, Shi L, Wright C, Benedict SH, Valicenti R, Mayadev JS, Rong Y. Clinical feasibility of MR-assisted CT-based cervical brachytherapy using MR-to-CT deformable image registration. Brachytherapy 2020; 19:447-456. [DOI: 10.1016/j.brachy.2020.03.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/16/2020] [Accepted: 03/01/2020] [Indexed: 12/21/2022]
|
8
|
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
|
9
|
Mayadev J, Lim J, Durbin-Johnson B, Valicenti R, Alvarez E. Smoking Decreases Survival in Locally Advanced Cervical Cancer Treated With Radiation. Am J Clin Oncol 2019; 41:295-301. [PMID: 26808259 DOI: 10.1097/coc.0000000000000268] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To study the prevalence and effect of smoking on cervical cancer recurrence and mortality in patients undergoing definitive treatment with radiation. MATERIALS AND METHODS Between July 2007 and September 2013, 96 locally advanced cervical cancer patients received definitive radiation or chemoradiation followed by brachytherapy. Smoking status was obtained from prospective intake questionnaires and quantified by pack-years. Pelvic control (PC), disease-free survival (DFS), and overall survival (OS) were analyzed by multivariable Cox proportional hazards models. RESULTS Smoking history included 51 (53.1%) nonsmokers, 45 active smokers, and former smokers: 20 (20.8%) with 1 to 20 pack-years and 25 (26%) with 21+ pack-years. With a median follow-up of 2 years on univariate analysis, the impact of 1 to 20 pack-years on PC, DFS, and OS relative to nonsmokers was hazard ratio (HR) 4.29 (95% confidence interval [CI], 1.36-14.1; P=0.014), 4.99 (95% CI, 1.21-22.4; P=0.027), and 4.77 (95% CI, 1.34-17.8; P=0.017), respectively. For patients with 21+ pack-years, the impact on PC, DFS, and OS was HR=6.13 (95% CI, 2.29-18.6; P<0.001), 7.24 (95% CI, 2.28-29.1; P=0.001), and 4.21 (95% CI, 1.26-15.4; P=0.02). On multivariate analysis, there remained a significant difference of 1 to 20 pack-years smoking history on OS relative to nonsmokers, HR=4.68 (95% CI, 1.02-29; P=0.047). For patients with 21+ pack-years smoking history, there continued to be a negative impact on PC and DFS, HR=5.66 (95% CI, 1.7-22.18; P=0.004) and HR=6.89 (95% CI, 1.54-42; P=0.011), respectively. CONCLUSIONS Former and active tobacco smoking during radiation therapy for cervical cancer is associated with unfavorable PC, DFS, and OS outcomes. The increased number of smoking pack-years conferred a worse outcome effect in those treated with radiation.
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Shi L, He Y, Yuan Z, Benedict S, Valicenti R, Qiu J, Rong Y. Radiomics for Response and Outcome Assessment for Non-Small Cell Lung Cancer. Technol Cancer Res Treat 2018; 17:1533033818782788. [PMID: 29940810 PMCID: PMC6048673 DOI: 10.1177/1533033818782788] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 03/09/2018] [Accepted: 05/16/2018] [Indexed: 12/24/2022] Open
Abstract
Routine follow-up visits and radiographic imaging are required for outcome evaluation and tumor recurrence monitoring. Yet more personalized surveillance is required in order to sufficiently address the nature of heterogeneity in nonsmall cell lung cancer and possible recurrences upon completion of treatment. Radiomics, an emerging noninvasive technology using medical imaging analysis and data mining methodology, has been adopted to the area of cancer diagnostics in recent years. Its potential application in response assessment for cancer treatment has also drawn considerable attention. Radiomics seeks to extract a large amount of valuable information from patients' medical images (both pretreatment and follow-up images) and quantitatively correlate image features with diagnostic and therapeutic outcomes. Radiomics relies on computers to identify and analyze vast amounts of quantitative image features that were previously overlooked, unmanageable, or failed to be identified (and recorded) by human eyes. The research area has been focusing on the predictive accuracy of pretreatment features for outcome and response and the early discovery of signs of tumor response, recurrence, distant metastasis, radiation-induced lung injury, death, and other outcomes, respectively. This review summarized the application of radiomics in response assessments in radiotherapy and chemotherapy for non-small cell lung cancer, including image acquisition/reconstruction, region of interest definition/segmentation, feature extraction, and feature selection and classification. The literature search for references of this article includes PubMed peer-reviewed publications over the last 10 years on the topics of radiomics, textural features, radiotherapy, chemotherapy, lung cancer, and response assessment. Summary tables of radiomics in response assessment and treatment outcome prediction in radiation oncology have been developed based on the comprehensive review of the literature.
Collapse
Affiliation(s)
- Liting Shi
- Department of Radiology, Taishan Medical University, Tai’an, China
| | - Yaoyao He
- Department of Radiology, Taishan Medical University, Tai’an, China
| | - Zilong Yuan
- Department of Radiology, Hubei Cancer Hospital, Wuhan, China
| | - Stanley Benedict
- Department of Radiation Oncology, University of California Davis
Comprehensive Cancer Center, Sacramento, CA, USA
| | - Richard Valicenti
- Department of Radiation Oncology, University of California Davis
Comprehensive Cancer Center, Sacramento, CA, USA
| | - Jianfeng Qiu
- Department of Radiology, Taishan Medical University, Tai’an, China
| | - Yi Rong
- Department of Radiation Oncology, University of California Davis
Comprehensive Cancer Center, Sacramento, CA, USA
| |
Collapse
|
12
|
Hoffman D, Nair CK, Wright C, Yamamoto T, Mayadev J, Valicenti R, Benedict S, Markham J, Rong Y. SU-F-T-433: Evaluation of a New Dose Mimicking Application for Clinical Flexibility and Reliability. Med Phys 2016. [DOI: 10.1118/1.4956618] [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
|
13
|
Tait LM, Hoffman D, Benedict S, Valicenti R, Mayadev JS. The use of MRI deformable image registration for CT-based brachytherapy in locally advanced cervical cancer. Brachytherapy 2016; 15:333-340. [DOI: 10.1016/j.brachy.2016.01.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 01/07/2016] [Accepted: 01/18/2016] [Indexed: 11/28/2022]
|
14
|
Mayadev J, Fish K, Valicenti R, West D, Chen A, Martinez S, Phillips T. Utilization and impact of a postmastectomy radiation boost for invasive breast cancer. Pract Radiat Oncol 2014; 4:e269-78. [DOI: 10.1016/j.prro.2014.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 05/14/2014] [Accepted: 05/15/2014] [Indexed: 10/25/2022]
|
15
|
Sperduto PW, Shanley R, Luo X, Andrews D, Werner-Wasik M, Valicenti R, Bahary JP, Souhami L, Won M, Mehta M. Secondary analysis of RTOG 9508, a phase 3 randomized trial of whole-brain radiation therapy versus WBRT plus stereotactic radiosurgery in patients with 1-3 brain metastases; poststratified by the graded prognostic assessment (GPA). Int J Radiat Oncol Biol Phys 2014; 90:526-31. [PMID: 25304947 DOI: 10.1016/j.ijrobp.2014.07.002] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [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: 04/22/2014] [Revised: 06/27/2014] [Accepted: 07/03/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE Radiation Therapy Oncology Group (RTOG) 9508 showed a survival advantage for patients with 1 but not 2 or 3 brain metastasis (BM) treated with whole-brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS) versus WBRT alone. An improved prognostic index, the graded prognostic assessment (GPA) has been developed. Our hypothesis was that if the data from RTOG 9508 were poststratified by the GPA, the conclusions may vary. METHODS AND MATERIALS In this analysis, 252 of the 331 patients were evaluable by GPA. Of those, 211 had lung cancer. Breast cancer patients were excluded because the components of the breast GPA are not in the RTOG database. Multiple Cox regression was used to compare survival between treatment groups, adjusting for GPA. Treatment comparisons within subgroups were performed with the log-rank test. A free online tool (brainmetgpa.com) simplified GPA use. RESULTS The fundamental conclusions of the primary analysis were confirmed in that there was no survival benefit overall for patients with 1 to 3 metastases; however, there was a benefit for the subset of patients with GPA 3.5 to 4.0 (median survival time [MST] for WBRT + SRS vs WBRT alone was 21.0 versus 10.3 months, P=.05) regardless of the number of metastases. Among patients with GPA 3.5 to 4.0 treated with WBRT and SRS, the MST for patients with 1 versus 2 to 3 metastases was 21 and 14.1 months, respectively. CONCLUSIONS This secondary analysis of predominantly lung cancer patients, consistent with the original analysis, shows no survival advantage for the group overall when treated with WBRT and SRS; however, in patients with high GPA (3.5-4), there is a survival advantage regardless of whether they have 1, 2, or 3 BM. This benefit did not extend to patients with lower GPA. Prospective validation of this survival benefit for patients with multiple BM and high GPA when treated with WBRT and SRS is warranted.
Collapse
Affiliation(s)
- Paul W Sperduto
- Metro-Minnesota CCOP and Minneapolis Radiation Oncology, Minneapolis, Minnesota.
| | - Ryan Shanley
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Xianghua Luo
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota; Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - David Andrews
- Thomas Jefferson University, Department of NeuroOncology, Philadelphia, Pennsylvania
| | - Maria Werner-Wasik
- Thomas Jefferson University, Department of Radiation Oncology, Philadelphia, Pennsylvania
| | - Richard Valicenti
- UC Davis Medical Center, Department of Radiation Oncology, Sacramento, California
| | | | | | - Minhee Won
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | - Minesh Mehta
- University of Maryland Medical System, Baltimore, Maryland
| |
Collapse
|
16
|
Mayadev J, Qi L, Lentz S, Benedict S, Courquin J, Dieterich S, Mathai M, Stern R, Valicenti R. Implant time and process efficiency for CT-guided high-dose-rate brachytherapy for cervical cancer. Brachytherapy 2014; 13:233-9. [DOI: 10.1016/j.brachy.2014.01.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 01/07/2014] [Accepted: 01/15/2014] [Indexed: 11/17/2022]
|
17
|
Rash DL, Lee YC, Kashefi A, Durbin-Johnson B, Mathai M, Valicenti R, Mayadev JS. Clinical response of pelvic and para-aortic lymphadenopathy to a radiation boost in the definitive management of locally advanced cervical cancer. Int J Radiat Oncol Biol Phys 2013; 87:317-22. [PMID: 23906933 DOI: 10.1016/j.ijrobp.2013.06.2031] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 05/24/2013] [Accepted: 06/11/2013] [Indexed: 11/15/2022]
Abstract
PURPOSE Optimal treatment with radiation for metastatic lymphadenopathy in locally advanced cervical cancer remains controversial. We investigated the clinical dose response threshold for pelvic and para-aortic lymph node boost using radiographic imaging and clinical outcomes. METHODS AND MATERIALS Between 2007 and 2011, 68 patients were treated for locally advanced cervical cancer; 40 patients had clinically involved pelvic and/or para-aortic lymph nodes. Computed tomography (CT) or 18F-labeled fluorodeoxyglucose-positron emission tomography scans obtained pre- and postchemoradiation for 18 patients were reviewed to assess therapeutic radiographic response of individual lymph nodes. External beam boost doses to involved nodes were compared to treatment response, assessed by change in size of lymph nodes by short axis and change in standard uptake value (SUV). Patterns of failure, time to recurrence, overall survival (OS), and disease-free survival (DFS) were determined. RESULTS Sixty-four lymph nodes suspicious for metastatic involvement were identified. Radiation boost doses ranged from 0 to 15 Gy, with a mean total dose of 52.3 Gy. Pelvic lymph nodes were treated with a slightly higher dose than para-aortic lymph nodes: mean 55.3 Gy versus 51.7 Gy, respectively. There was no correlation between dose delivered and change in size of lymph nodes along the short axis. All lymph nodes underwent a decrease in SUV with a complete resolution of abnormal uptake observed in 68%. Decrease in SUV was significantly greater for lymph nodes treated with ≥54 Gy compared to those treated with <54 Gy (P=.006). Median follow-up was 18.7 months. At 2 years, OS and DFS for the entire cohort were 78% and 50%, respectively. Locoregional control at 2 years was 84%. CONCLUSIONS A biologic response, as measured by the change in SUV for metastatic lymph nodes, was observed at a dose threshold of 54 Gy. We recommend that involved lymph nodes be treated to this minimum dose.
Collapse
Affiliation(s)
- Dominique L Rash
- Department of Radiation Oncology, University of California Davis Medical Center, Sacramento, California, USA
| | | | | | | | | | | | | |
Collapse
|
18
|
Lim J, Durbin-Johnson B, Valicenti R, Mathai M, Stern RL, Mayadev J. The impact of body mass index on rectal dose in locally advanced cervical cancer treated with high-dose-rate brachytherapy. Brachytherapy 2013; 12:550-4. [PMID: 23706512 DOI: 10.1016/j.brachy.2013.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 01/07/2013] [Revised: 03/13/2013] [Accepted: 04/08/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The impact of body mass index (BMI) on rectal dose in brachytherapy for cervical cancer is unknown. We assessed the association of BMI on rectal dose and lower gastrointestinal (GI) toxicity. METHODS AND MATERIALS Between 2007 and 2010, 51 patients with 97 brachytherapy planning images were reviewed. Volumetric measurements of the maximum percentage, mean percentage, dose to 2cc (D2cc), and dose to 1cc (D1cc) of the rectum, and the Internal Commission on Radiation Units and Measurement (ICRU) rectal point were recorded. Linear mixed effect models, analysis of variance, and regression analyses were used to determine the correlation between multiple observations or to detect a difference in the mean. The GI acute and late toxicity were prospectively recorded and retrospectively analyzed. RESULTS The average BMI (kg/m(2)) was 27.7 with a range of 17.4-46.6. Among the patients, 8% were morbidly obese, 25% obese, 25% overweight, 40% normal weight, and 2% underweight. The mean D1cc, D2cc, mean rectal dose (%), maximum rectal dose (%), and ICRU rectum was 3.03 Gy, 2.78 Gy, 20%, 60%, and 2.99 Gy, respectively. On multivariate analysis, there was a significant decrease in the D1cc and D2cc rectal dose (p=0.016), ICRU rectal point dose (p=0.022), and mean rectal dose percentage (p=0.021) with an increase in BMI. There was, however, no statistically significant relationship between BMI and GI toxicity. CONCLUSIONS Obesity decreases the rectal dose given in high-dose-rate brachytherapy for locally advanced cervical cancer because of an increase in fatty tissue in the recto-uterine space. There is no significant correlation between BMI and acute or late GI toxicity.
Collapse
Affiliation(s)
- Jihoon Lim
- University of California Davis School of Medicine, University of California Davis, Sacramento, CA
| | | | | | | | | | | |
Collapse
|
19
|
Mayadev JS, Qi L, Lentz S, Dieterich S, Courquin J, Mathai M, Benedict S, Stern RL, Valicenti R. Tandem and Ring Brachytherapy for Cervical Cancer: How Long Does the Process Take? Brachytherapy 2013. [DOI: 10.1016/j.brachy.2013.01.116] [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]
|
20
|
Rash D, Lee Y, Mathai M, Stern R, Valicenti R, Mayadev J. Pelvic and Paraortic Lymph Node Response to Chemoradiation Therapy in Patients With Locally Advanced Cervical Cancer: Does a Higher Boost Dose Impact Nodal Control? Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1152] [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]
|
21
|
Mayadev J, Qi L, Lentz S, Stuart K, Mathai M, Stern R, Valicenti R, Kern M, Courquin J. CT-based Image Guided Brachytherapy for Locally Advanced Cervical Cancer: The Time Required for Optimal Implantation to Delivery. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1162] [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]
|
22
|
Mayadev J, Qi L, Lentz S, Stuart K, Mathai M, Stern R, Valicenti R, Kern M, Ourquin J. A time and efficiency study of optimal implantation to treatment delivery in CT based image guided brachytherapy for locally advanced cervical cancer. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2012.07.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
23
|
Rash D, Lee Y, Valicenti R, Mathai M, Mayadev J. Radiographic response of pelvic and para-aortic lymphadenopathy to a radiation boost in the definitive management of locally advanced cervical cancer. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2012.07.008] [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]
|
24
|
Kunos C, Winter K, Dicker A, Small W, Abdul-Karim F, Dawson D, Jhingran A, Valicenti R, Weidhaas J, Gaffney D. RTOG 0116 and 0128: Secondary analysis of ribonucleotide reductase in cervix cancer. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
25
|
Rash D, Wooten H, Hunt J, Valicenti R, Mayadev J. Interfraction Motion of the Vaginal Apex in Patients With Gynecologic Malignancies Treated with Postoperative Intensity Modulated Radiation Therapy (IMRT): Are We Missing the Target? Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.335] [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: 10/15/2022]
|
26
|
Mayadev J, Lim J, Durbin-Johnson B, Mathai M, Stern R, Valicenti R. The Impact Of Rectal Distention On The Maximum Rectal Dose Delivered In 3-D Planned High Dose Rate Brachytherapy For Cervical Cancer. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.978] [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: 10/15/2022]
|
27
|
Lee Y, Perks J, Yi S, Purdy J, Valicenti R. TU-C-214-10: Analysis of Difference of Daily Setup Variations for Intensity- Modulated Radiation Therapy (IMRT) Prostate Patients between KV Cone Beam Computed Tomography (CBCT) and Electromagnetic Tracking System (Calypso). Med Phys 2011. [DOI: 10.1118/1.3613142] [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
|
28
|
Li B, Shi XB, Nori D, Chao CKS, Chen AM, Valicenti R, White RDV. Down-regulation of microRNA 106b is involved in p21-mediated cell cycle arrest in response to radiation in prostate cancer cells. Prostate 2011; 71:567-74. [PMID: 20878953 DOI: 10.1002/pros.21272] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 08/16/2010] [Indexed: 12/19/2022]
Abstract
BACKGROUND microRNAs (miRNAs) are endogenous short non-coding RNAs, and play a pivotal role in regulating of a variety of cellular processes, including proliferation and apoptosis, both of which are cellular responses to radiation treatment. The purpose of this study is to identify candidate miRNAs whose levels are altered in response to radiation in prostate cancer cells and to investigate the molecular pathway of such miRNAs in the regulation of radiation-induced cellular response. METHODS Using a miRNA microarray assay, we screened 132 cancerous miRNAs in LNCaP cells in response to radiation treatment. The function of one candidate miRNA was investigated for checkpoint protein expression, cell cycle arrest, cell proliferation, and cell survival in cells transfected with precursor or antisense miRNA. RESULTS In response to radiation, multiple miRNAs, including mi-106b, showed altered expression. Cells transfected with precursor miR-106b were able to suppress radiation-induced p21 activation. Functionally, exogenous addition of precursor miR-106b overrode the G2/M arrest in response to radiation and resulted in a transient diminishment of radiation-induced growth inhibition. CONCLUSION We have shown a novel role of miR-106b, in the setting of radiation treatment, in regulating the p21-activated cell cycle arrest. Our finding that miR-106b is able to override radiation-induced cell cycle arrest and cell growth inhibition points to a potential therapeutic target in certain prostate cancer cells whose radiation resistance is likely due to consistently elevated level of miR-106b.
Collapse
Affiliation(s)
- Baoqing Li
- Department of Radiation Oncology, Weill Medical College of Cornell University, New York, New York 10065, USA.
| | | | | | | | | | | | | |
Collapse
|
29
|
Perks J, Turnbull H, Liu T, Purdy J, Valicenti R. Vector Analysis of Prostate Patient Setup With Image-Guided Radiation Therapy via kV Cone Beam Computed Tomography. Int J Radiat Oncol Biol Phys 2011; 79:915-9. [DOI: 10.1016/j.ijrobp.2010.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2009] [Revised: 02/23/2010] [Accepted: 04/06/2010] [Indexed: 10/24/2022]
|
30
|
Mayadev J, Greasby T, Durbin-Johnson B, McCloskey S, Valicenti R, Vaughan A. Biologically Equivalent Dose Heterogeneity in Adjuvant Vaginal Brachytherapy Alone or in Combination with External Beam Radiation for Early Stage Endometrial Cancer. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
31
|
Yang J, Liu T, Yang C, Jennelle R, Chen A, Do L, Valicenti R, Purdy J. SU-FF-T-176: Rectal and Bladder Dose in Relationship to PTV Percentage Coverage in Prostate IMRT. Med Phys 2009. [DOI: 10.1118/1.3181651] [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
|
32
|
Fogh SE, Yu A, Li J, Weiner P, Suh D, Dicker AP, Valicenti R, Xiao Y, Yu Y, Harrison AS. Comparison of CT vs. ultrasound to determine prostate volume prior to real-time ultrasound based intraoperative planning for 125 I seed implantation. Brachytherapy 2009. [DOI: 10.1016/j.brachy.2009.03.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
33
|
Lawton CAF, Michalski J, El-Naqa I, Kuban D, Lee WR, Rosenthal SA, Zietman A, Sandler H, Shipley W, Ritter M, Valicenti R, Catton C, Roach M, Pisansky TM, Seider M. Variation in the definition of clinical target volumes for pelvic nodal conformal radiation therapy for prostate cancer. Int J Radiat Oncol Biol Phys 2008; 74:377-82. [PMID: 18947941 DOI: 10.1016/j.ijrobp.2008.08.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Revised: 07/30/2008] [Accepted: 08/02/2008] [Indexed: 12/29/2022]
Abstract
PURPOSE We conducted a comparative study of clinical target volume (CTV) definition of pelvic lymph nodes by multiple genitourinary (GU) radiation oncologists looking at the levels of discrepancies amongst this group. METHODS AND MATERIALS Pelvic computed tomography (CT) scans from 2 men were distributed to 14 Radiation Therapy Oncology Group GU radiation oncologists with instructions to define CTVs for the iliac and presacral lymph nodes. The CT data with contours were then returned for analysis. In addition, a questionnaire was completed that described the physicians' method for target volume definition. RESULTS Significant variation in the definition of the iliac and presacral CTVs was seen among the physicians. The minimum, maximum, mean (SD) iliac volumes (mL) were 81.8, 876.6, 337.6 +/- 203 for case 1 and 60.3, 627.7, 251.8 +/- 159.3 for case 2. The volume of 100% agreement was 30.6 and 17.4 for case 1 and 2 and the volume of the union of all contours was 1,012.0 and 807.4 for case 1 and 2, respectively. The overall agreement was judged to be moderate in both cases (kappa = 0.53 (p < 0.0001) and kappa = 0.48 (p < 0.0001). There was no volume of 100% agreement for either of the two presacral volumes. These variations were confirmed in the responses to the associated questionnaire. CONCLUSIONS Significant disagreement exists in the definition of the CTV for pelvic nodal radiation therapy among GU radiation oncology specialists. A consensus needs to be developed so as to accurately assess the merit and safety of such treatment.
Collapse
|
34
|
Misic V, Houser C, Den R, Valicenti R. Dosimetry Optimization for Miami Vaginal Applicator. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.190] [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]
|
35
|
Buzurovic I, Podder T, Yan K, Hu Y, Valicenti R, Dicker A, Yu Y. MO-D-AUD B-04: Parameter Optimization for Brachytherapy Robotic Needle Insertion and Seed Deposition. Med Phys 2008. [DOI: 10.1118/1.2962345] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
36
|
Buzurovic I, Podder T, Hu Y, Yan K, Valicenti R, Dicker A, Yu Y. TH-C-AUD A-04: Calibration of Image-Guided Robotic System for Prostate Brachytherapy. Med Phys 2008. [DOI: 10.1118/1.2962839] [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
|
37
|
Podder T, Buzurovic I, Yan K, Hu Y, Valicenti R, Dicker A, Rubens D, Messing E, Ng WS, Yu Y. Robotic system for image-guided prostate seed implant. Brachytherapy 2008. [DOI: 10.1016/j.brachy.2008.02.361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
38
|
Roach M, Bae K, Speight J, Wolkov HB, Rubin P, Lee RJ, Lawton C, Valicenti R, Grignon D, Pilepich MV. Short-Term Neoadjuvant Androgen Deprivation Therapy and External-Beam Radiotherapy for Locally Advanced Prostate Cancer: Long-Term Results of RTOG 8610. J Clin Oncol 2008; 26:585-91. [DOI: 10.1200/jco.2007.13.9881] [Citation(s) in RCA: 512] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose Radiation Therapy Oncology Group (RTOG) 8610 was the first phase III randomized trial to evaluate neoadjuvant androgen deprivation therapy (ADT) in combination with external-beam radiotherapy (EBRT) in men with locally advanced prostate cancer. This report summarizes long-term follow-up results. Materials and Methods Between 1987 and 1991, 456 assessable patients (median age, 70 years) were enrolled. Eligible patients had bulky (5 × 5 cm) tumors (T2-4) with or without pelvic lymph node involvement according to the 1988 American Joint Committee on Cancer TNM staging system. Patients received combined ADT that consisted of goserelin 3.6 mg every 4 weeks and flutamide 250 mg tid for 2 months before and concurrent with EBRT, or they received EBRT alone. Study end points included overall survival (OS), disease-specific mortality (DSM), distant metastasis (DM), disease-free survival (DFS), and biochemical failure (BF). Results Ten-year OS estimates (43% v 34%) and median survival times (8.7 v 7.3 years) favored ADT and EBRT, respectively; however, these differences did not reach statistical significance (P = .12). There was a statistically significant improvement in 10-year DSM (23% v 36%; P = .01), DM (35% v 47%; P = .006), DFS (11% v 3%; P < .0001), and BF (65% v 80%; P < .0001) with the addition of ADT, but no differences were observed in the risk of fatal cardiac events. Conclusion The addition of 4 months of ADT to EBRT appears to have a dramatic impact on clinically meaningful end points in men with locally advanced disease with no statistically significant impact on the risk of fatal cardiac events.
Collapse
Affiliation(s)
- Mack Roach
- From the Departments of Radiation Oncology and Urology, University of California San Francisco, San Francisco; Radiation Oncology Center, Sutter Cancer Center, Sacramento; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA; University of Rochester, Medical Center, Rochester, NY; Latter-Day Saints Hospital Radiation Center, Salt Lake City, UT; Medical College of Wisconsin Department of Radiation Oncology, Milwaukee, WI; Radiation Therapy Oncology Group Department of
| | - Kyounghwa Bae
- From the Departments of Radiation Oncology and Urology, University of California San Francisco, San Francisco; Radiation Oncology Center, Sutter Cancer Center, Sacramento; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA; University of Rochester, Medical Center, Rochester, NY; Latter-Day Saints Hospital Radiation Center, Salt Lake City, UT; Medical College of Wisconsin Department of Radiation Oncology, Milwaukee, WI; Radiation Therapy Oncology Group Department of
| | - Joycelyn Speight
- From the Departments of Radiation Oncology and Urology, University of California San Francisco, San Francisco; Radiation Oncology Center, Sutter Cancer Center, Sacramento; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA; University of Rochester, Medical Center, Rochester, NY; Latter-Day Saints Hospital Radiation Center, Salt Lake City, UT; Medical College of Wisconsin Department of Radiation Oncology, Milwaukee, WI; Radiation Therapy Oncology Group Department of
| | - Harvey B. Wolkov
- From the Departments of Radiation Oncology and Urology, University of California San Francisco, San Francisco; Radiation Oncology Center, Sutter Cancer Center, Sacramento; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA; University of Rochester, Medical Center, Rochester, NY; Latter-Day Saints Hospital Radiation Center, Salt Lake City, UT; Medical College of Wisconsin Department of Radiation Oncology, Milwaukee, WI; Radiation Therapy Oncology Group Department of
| | - Phillip Rubin
- From the Departments of Radiation Oncology and Urology, University of California San Francisco, San Francisco; Radiation Oncology Center, Sutter Cancer Center, Sacramento; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA; University of Rochester, Medical Center, Rochester, NY; Latter-Day Saints Hospital Radiation Center, Salt Lake City, UT; Medical College of Wisconsin Department of Radiation Oncology, Milwaukee, WI; Radiation Therapy Oncology Group Department of
| | - R. Jeffrey Lee
- From the Departments of Radiation Oncology and Urology, University of California San Francisco, San Francisco; Radiation Oncology Center, Sutter Cancer Center, Sacramento; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA; University of Rochester, Medical Center, Rochester, NY; Latter-Day Saints Hospital Radiation Center, Salt Lake City, UT; Medical College of Wisconsin Department of Radiation Oncology, Milwaukee, WI; Radiation Therapy Oncology Group Department of
| | - Colleen Lawton
- From the Departments of Radiation Oncology and Urology, University of California San Francisco, San Francisco; Radiation Oncology Center, Sutter Cancer Center, Sacramento; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA; University of Rochester, Medical Center, Rochester, NY; Latter-Day Saints Hospital Radiation Center, Salt Lake City, UT; Medical College of Wisconsin Department of Radiation Oncology, Milwaukee, WI; Radiation Therapy Oncology Group Department of
| | - Richard Valicenti
- From the Departments of Radiation Oncology and Urology, University of California San Francisco, San Francisco; Radiation Oncology Center, Sutter Cancer Center, Sacramento; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA; University of Rochester, Medical Center, Rochester, NY; Latter-Day Saints Hospital Radiation Center, Salt Lake City, UT; Medical College of Wisconsin Department of Radiation Oncology, Milwaukee, WI; Radiation Therapy Oncology Group Department of
| | - David Grignon
- From the Departments of Radiation Oncology and Urology, University of California San Francisco, San Francisco; Radiation Oncology Center, Sutter Cancer Center, Sacramento; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA; University of Rochester, Medical Center, Rochester, NY; Latter-Day Saints Hospital Radiation Center, Salt Lake City, UT; Medical College of Wisconsin Department of Radiation Oncology, Milwaukee, WI; Radiation Therapy Oncology Group Department of
| | - Miljenko V. Pilepich
- From the Departments of Radiation Oncology and Urology, University of California San Francisco, San Francisco; Radiation Oncology Center, Sutter Cancer Center, Sacramento; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA; University of Rochester, Medical Center, Rochester, NY; Latter-Day Saints Hospital Radiation Center, Salt Lake City, UT; Medical College of Wisconsin Department of Radiation Oncology, Milwaukee, WI; Radiation Therapy Oncology Group Department of
| |
Collapse
|
39
|
Lawton CA, DeSilvio M, Roach M, Uhl V, Kirsch R, Seider M, Rotman M, Jones C, Asbell S, Valicenti R, Hahn S, Thomas CR. An update of the phase III trial comparing whole pelvic to prostate only radiotherapy and neoadjuvant to adjuvant total androgen suppression: updated analysis of RTOG 94-13, with emphasis on unexpected hormone/radiation interactions. Int J Radiat Oncol Biol Phys 2007; 69:646-55. [PMID: 17531401 PMCID: PMC2917177 DOI: 10.1016/j.ijrobp.2007.04.003] [Citation(s) in RCA: 345] [Impact Index Per Article: 20.3] [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: 09/19/2006] [Revised: 04/03/2007] [Accepted: 04/03/2007] [Indexed: 12/30/2022]
Abstract
PURPOSE This trial was designed to test the hypothesis that total androgen suppression and whole pelvic radiotherapy (WPRT) followed by a prostate boost improves progression-free survival (PFS) by > or =10% compared with total androgen suppression and prostate only RT (PORT). This trial was also designed to test the hypothesis that neoadjuvant hormonal therapy (NHT) followed by concurrent total androgen suppression and RT improves PFS compared with RT followed by adjuvant hormonal therapy (AHT) by > or =10%. METHODS AND MATERIALS Patients eligible for the study included those with clinically localized adenocarcinoma of the prostate and an elevated prostate-specific antigen level of <100 ng/mL. Patients were stratified by T stage, prostate-specific antigen level, and Gleason score and were required to have an estimated risk of lymph node involvement of >15%. RESULTS The difference in overall survival for the four arms was statistically significant (p = 0.027). However, no statistically significant differences were found in PFS or overall survival between NHT vs. AHT and WPRT compared with PORT. A trend towards a difference was found in PFS (p = 0.065) in favor of the WPRT + NHT arm compared with the PORT + NHT and WPRT + AHT arms. CONCLUSIONS Unexpected interactions appear to exist between the timing of hormonal therapy and radiation field size for this patient population. Four Phase III trials have demonstrated better outcomes when NHT was combined with RT compared with RT alone. The Radiation Therapy Oncology Group 9413 trial results have demonstrated that when NHT is used in conjunction with RT, WPRT yields a better PFS than does PORT. It also showed that when NHT + WPRT results in better overall survival than does WPRT + short-term AHT. Additional studies are warranted to determine whether the failure to demonstrate an advantage for NHT + WPRT compared with PORT + AHT is chance or, more likely, reflects a previously unrecognized biologic phenomenon.
Collapse
Affiliation(s)
- Colleen A Lawton
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Roach M, DeSilvio M, Valicenti R, Grignon D, Asbell SO, Lawton C, Thomas CR, Shipley WU. Whole-pelvis, “mini-pelvis,” or prostate-only external beam radiotherapy after neoadjuvant and concurrent hormonal therapy in patients treated in the Radiation Therapy Oncology Group 9413 trial. Int J Radiat Oncol Biol Phys 2006; 66:647-53. [PMID: 17011443 DOI: 10.1016/j.ijrobp.2006.05.074] [Citation(s) in RCA: 155] [Impact Index Per Article: 8.6] [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: 04/27/2006] [Revised: 05/29/2006] [Accepted: 05/31/2006] [Indexed: 11/17/2022]
Abstract
PURPOSE The Radiation Therapy Oncology Group (RTOG) 9413 trial demonstrated a better progression-free survival (PFS) with whole-pelvis (WP) radiotherapy (RT) compared with prostate-only (PO) RT. This secondary analysis was undertaken to determine whether "mini-pelvis" (MP; defined as > or = 10 x 11 cm but < 11 x 11 cm) RT resulted in progression-free survival (PFS) comparable to that of WP RT. To avoid a timing bias, this analysis was limited to patients receiving neoadjuvant and concurrent hormonal therapy (N&CHT) in Arms 1 and 2 of the study. METHODS AND MATERIALS Eligible patients had a risk of lymph node (LN) involvement > 15%. Neoadjuvant and concurrent hormonal therapy (N&CHT) was administered 2 months before and during RT for 4 months. From April 1, 1995, to June 1, 1999, a group of 325 patients were randomized to WP RT + N&CHT and another group of 324 patients were randomized to receive PO RT + N&CHT. Patients randomized to PO RT were dichotomized by median field size (10 x 11 cm), with the larger field considered an "MP" field and the smaller a PO field. RESULTS The median PFS was 5.2, 3.7, and 2.9 years for WP, MP, and PO fields, respectively (p = 0.02). The 7-year PFS was 40%, 35%, and 27% for patients treated to WP, MP, and PO fields, respectively. There was no association between field size and late Grade 3+ genitourinary toxicity but late Grade 3+ gastrointestinal RT complications correlated with increasing field size. CONCLUSIONS This subset analysis demonstrates that RT field size has a major impact on PFS, and the findings support comprehensive nodal treatment in patients with a risk of LN involvement of > 15%.
Collapse
Affiliation(s)
- Mack Roach
- University of California San Francisco, San Francisco, CA 94143-1708, USA.
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Lawton C, DeSilvio M, Roach M, Uhl V, Krisch R, Seider M, Rotman M, Jones C, Asbell S, Valicenti R, Han S, Thomas C. An Update of the Phase III Trial Comparing Whole-Pelvic (WP) to Prostate Only (PO) Radiotherapy and Neoadjuvant to Adjuvant Total Androgen Suppression (TAS): Updated Analysis of RTOG 94-13. Int J Radiat Oncol Biol Phys 2005. [DOI: 10.1016/j.ijrobp.2005.07.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
42
|
Chen Y, Valicenti R, Suh D, Houser C, Galvin J. SU-FF-J-90: An Accurate Method for Determining Prostate Shift and Rotation Using Portal Images with Implanted Fiducial Seeds. Med Phys 2005. [DOI: 10.1118/1.1997636] [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
|
43
|
Valicenti R, Desilvio M, Hanks G, Porter A, Brereton H, Shipley W, Sandler H. Surrogate endpoint for prostate cancer-specific survival: Validation from an analysis of Radiation Therapy Oncology Group Protocol 92–02. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.4549] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- R. Valicenti
- Thomas Jefferson Univ, Philadelphia, PA; RTOG, Philadelphia, PA; Fox Chase Cancer Ctr, Philadelphia, PA; Detroit Medcl Ctr, Detroit, MI; Mercy Hosp, Scranton, PA; MA Gen Hosp, Boston, MA; Univ of Michigan, Ann Arbor, MI
| | - M. Desilvio
- Thomas Jefferson Univ, Philadelphia, PA; RTOG, Philadelphia, PA; Fox Chase Cancer Ctr, Philadelphia, PA; Detroit Medcl Ctr, Detroit, MI; Mercy Hosp, Scranton, PA; MA Gen Hosp, Boston, MA; Univ of Michigan, Ann Arbor, MI
| | - G. Hanks
- Thomas Jefferson Univ, Philadelphia, PA; RTOG, Philadelphia, PA; Fox Chase Cancer Ctr, Philadelphia, PA; Detroit Medcl Ctr, Detroit, MI; Mercy Hosp, Scranton, PA; MA Gen Hosp, Boston, MA; Univ of Michigan, Ann Arbor, MI
| | - A. Porter
- Thomas Jefferson Univ, Philadelphia, PA; RTOG, Philadelphia, PA; Fox Chase Cancer Ctr, Philadelphia, PA; Detroit Medcl Ctr, Detroit, MI; Mercy Hosp, Scranton, PA; MA Gen Hosp, Boston, MA; Univ of Michigan, Ann Arbor, MI
| | - H. Brereton
- Thomas Jefferson Univ, Philadelphia, PA; RTOG, Philadelphia, PA; Fox Chase Cancer Ctr, Philadelphia, PA; Detroit Medcl Ctr, Detroit, MI; Mercy Hosp, Scranton, PA; MA Gen Hosp, Boston, MA; Univ of Michigan, Ann Arbor, MI
| | - W. Shipley
- Thomas Jefferson Univ, Philadelphia, PA; RTOG, Philadelphia, PA; Fox Chase Cancer Ctr, Philadelphia, PA; Detroit Medcl Ctr, Detroit, MI; Mercy Hosp, Scranton, PA; MA Gen Hosp, Boston, MA; Univ of Michigan, Ann Arbor, MI
| | - H. Sandler
- Thomas Jefferson Univ, Philadelphia, PA; RTOG, Philadelphia, PA; Fox Chase Cancer Ctr, Philadelphia, PA; Detroit Medcl Ctr, Detroit, MI; Mercy Hosp, Scranton, PA; MA Gen Hosp, Boston, MA; Univ of Michigan, Ann Arbor, MI
| |
Collapse
|
44
|
Wernicke AG, Valicenti R, Dieva K, Houser C, Pequignot E. Radiation dose delivered to the proximal penis as a predictor of the risk of erectile dysfunction after three-dimensional conformal radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 2004; 60:1357-63. [PMID: 15590165 DOI: 10.1016/j.ijrobp.2004.05.030] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [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: 12/22/2003] [Revised: 04/09/2004] [Accepted: 05/11/2004] [Indexed: 11/22/2022]
Abstract
PURPOSE/OBJECTIVE In this study, we evaluated in a serial manner whether radiation dose to the bulb of the penis is predictive of erectile dysfunction, ejaculatory difficulty (EJ), and overall satisfaction with sex life (quality of life) by using serial validated self-administered questionnaires. METHODS AND MATERIALS Twenty-nine potent men with AJCC Stage II prostate cancer treated with three-dimensional conformal radiation therapy alone to a median dose 72.0 Gy (range: 66.6-79.2 Gy) were evaluated by determining the doses received by the penile bulb. The penile bulb was delineated volumetrically, and the dose-volume histogram was obtained on each patient. RESULTS The median follow-up time was 35 months (range, 16-43 months). We found that for D(30), D(45), D(60), and D(75) (doses to a percent volume of PB: 30%, 45%, 60%, and 75%), higher than the corresponding median dose (defined as high-dose group) correlated with an increased risk of impotence (erectile dysfunction firmness score = 0) (odds ratio [OR] = 7.5, p = 0.02; OR = 7.5, p = 0.02; OR = 8.6, p = 0.008; and OR = 6.9, p = 0.015, respectively). Similarly, for EJD D(30), D(45), D(60), and D(75), doses higher than the corresponding median ones correlated with worsening ejaculatory function score (EJ = 0 or 1) (OR = 8, p = 0.013; OR = 8, p = 0.013; OR = 9.2, p = 0.015; and OR = 8, p = 0.026, respectively). For quality of life, low (< or =median dose) dose groups of patients improve over time, whereas high-dose groups of patients worsen. CONCLUSIONS This study supports the existence of a penile bulb dose-volume relationship underlying the development of radiation-induced erectile dysfunction. Our data may guide the use of inverse treatment planning to maximize the probability of maintaining sexual potency after radiation therapy.
Collapse
Affiliation(s)
- A Gabriella Wernicke
- Department of Radiation Oncology, Jefferson Medical College and Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA
| | | | | | | | | |
Collapse
|
45
|
Roach M, DeSilvio M, Thomas C, Valicenti R, Asbell S, Lawton C, Shipley W. Progression free survival (PFS) after whole-pelvic (WP) vs. mini-pelvic (MP) or prostate only (PO) radiotherapy (RT): A subset analysis of RTOG 9413, a Phase III prospective randomized trial using neoadjuvant and concurrent (N&CHT). Int J Radiat Oncol Biol Phys 2004. [DOI: 10.1016/j.ijrobp.2004.07.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
46
|
Abstract
Intensity modulated radiation therapy (IMRT) has stirred considerable excitement in the radiation oncology community. Its objective is to make the dose conform to the tumor and spare other organs. Instead of resorting to the rather complex inverse-planning, the technique described here is an extension of the conventional treatment planning technique. The beam orientation and wedge angles are chosen in the conventional rule-based manner. However, within each conformal beam's eye view (BEV) field including margin, a number of sub-field openings are added. The smaller field openings are designed to irradiate the tumor, while sparing the normal tissue of the organs at risk (OARs) that intrude into the target region in the BEV. As the number of intrusions into the target BEV increases, the number of sub-fields for each beam increases. The Cimmino simultaneous projection method was employed to obtain the optimized weighting for each field of each beam. In cases where the dose constraints for the tumor and for the OARs are reasonable, it is possible to obtain a plan with a fairly small number of beams that satisfies the specified dose objectives. This is illustrated for the treatment of prostate cancer, where the rectum creates a concavity in the planning target volume. An advantage of this technique is that the quality assurance for the delivery of these plans does not require extensive special efforts.
Collapse
Affiliation(s)
- Y Xiao
- Kimmel Cancer Center of Jefferson Medical College, Philadelphia, Pennsylvania 19107, USA.
| | | | | | | |
Collapse
|
47
|
Valicenti R, Lu J, Pilepich M, Asbell S, Grignon D. Survival advantage from higher-dose radiation therapy for clinically localized prostate cancer treated on the Radiation Therapy Oncology Group trials. J Clin Oncol 2000; 18:2740-6. [PMID: 10894874 DOI: 10.1200/jco.2000.18.14.2740] [Citation(s) in RCA: 119] [Impact Index Per Article: 5.0] [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] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We evaluated the effect of external-beam radiation therapy on disease-specific survival (death from causes related to prostate cancer) and overall survival in men with clinically localized prostate cancer. METHODS From 1975 to 1992, 1,465 men with clinically localized prostate cancer received radiation therapy on four Radiation Therapy Oncology Group phase III randomized trials and were pooled for this analysis. No one received androgen-deprivation therapy with his initial treatment. All original histology had central pathologic review for grading using the Gleason classification system. Total delivered radiation dose ranged from 60 to 78 Gy (median, 68.4 Gy). The median follow-up time was 8 years. RESULTS A Cox regression model revealed that Gleason score was an independent predictor of disease-specific survival and overall survival. The 10-year disease-specific survival rates by Gleason score were as follows: score of 2 through 5, 85%; score of 6, 79%; score of 7, 62%; and score of 8 through 10, 43%. Stratifying outcome by this important prognostic factor revealed that higher radiation dose was a significant predictor for improved disease-specific survival and overall survival only for those patients whose cancers had Gleason scores of 8 through 10 (P <.05). After adjusting for clinical T stage, nodal status, and age, treating with a higher radiation dose was associated with a 29% lower relative risk of death from prostate cancer and 27% reduced mortality rate (P <.05). CONCLUSION These data demonstrate that higher-dose radiation therapy can significantly reduce the risk of dying from prostate cancer in men with clinically localized disease. This survival benefit is restricted to men with poorly differentiated cancers.
Collapse
Affiliation(s)
- R Valicenti
- Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA 19107-5097, USA.
| | | | | | | | | |
Collapse
|
48
|
Gomella L, Valicenti R, Hyslop T, Grant Mulholland S, Liberman S, Corn B. 2063 T3 Prostate cancer: Induction androgen suppression combined with prostatectomy does not surpass definitive irradiation. Int J Radiat Oncol Biol Phys 1996. [DOI: 10.1016/s0360-3016(97)85639-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
49
|
DiBiase S, Valicenti R, Schultz D, Corn BW. 2079 Metastatic renal cell carcinoma: Can it be palliated with radiotherapy? Do higher biologically effective doses help? Int J Radiat Oncol Biol Phys 1996. [DOI: 10.1016/s0360-3016(97)85655-6] [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: 11/15/2022]
|
50
|
Moreno JG, Corn BW, Valicenti R, Alexander A, Shupp-Byrne D, Gomella LG. 2067 RT-PCR evidence for the turp effect: Re-visiting an 80's concept with a 90's technology. Int J Radiat Oncol Biol Phys 1996. [DOI: 10.1016/s0360-3016(97)85643-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|