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Narang AK, Trieu J, Radwan N, Ram A, Robertson SP, He P, Gergis C, Griffith E, Singh H, DeWeese TA, Honig S, Annadanam A, Greco S, DeVille C, McNutt T, DeWeese TL, Song DY, Tran PT. End-of-radiation PSA as a novel prognostic factor in patients undergoing definitive radiation and androgen deprivation therapy for prostate cancer. Prostate Cancer Prostatic Dis 2017; 20:203-209. [PMID: 28094250 PMCID: PMC5429233 DOI: 10.1038/pcan.2016.67] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 10/09/2016] [Accepted: 10/07/2016] [Indexed: 12/19/2022]
Abstract
Background In men undergoing definitive radiation for prostate cancer, it is unclear whether early biochemical response can provide additional prognostic value beyond pre-treatment risk stratification. Methods Prostate cancer patients consecutively treated with definitive radiation at our institution by a single provider from 1993–2006 and who had an EOR PSA (n=688, median follow-up 11.2 years). We analyzed the association of an end-of-radiation (EOR) prostate-specific antigen (PSA) level, obtained during the last week of radiation, with survival outcomes. Multivariable-adjusted cox proportional hazards models were constructed to assess associations between a detectable EOR PSA (defined as ≥0.1 ng ml−1) and biochemical failure-free survival (BFFS), metastasis-free survival (MFS), prostate cancer-specific survival (PCSS), and overall survival (OS). Kaplan-Meier survival curves were constructed, with stratification by EOR PSA. Results At the end of radiation, the PSA level was undetectable in 30% of patients. Men with a detectable EOR PSA experienced inferior 10-year BFFS (49.7% vs. 64.4%, p<0.001), 10-year MFS (84.8% vs. 92.0%, p=0.003), 10-year PCSS (94.3% vs. 98.2%, p=0.007), and 10-year OS (75.8% vs. 82.5%, p=0.01), as compared to men with an undetectable EOR PSA. Among NCCN intermediate- and high-risk men who were treated with definitive radiation and androgen deprivation therapy (ADT), a detectable EOR PSA was more strongly associated with PCSS than initial NCCN risk level (EOR PSA: HR 5.89, 95% CI 2.37–14.65, p<0.001; NCCN risk level: HR 2.01, 95% CI 0.74–5.42, p=0.168). Main study limitations are retrospective study design and associated biases. Conclusions EOR PSA was significantly associated with survival endpoints in men who received treated with definitive radiation and ADT. Whether the EOR PSA can be used to modulate treatment intensity merits further investigation.
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Affiliation(s)
- A K Narang
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J Trieu
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - N Radwan
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A Ram
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S P Robertson
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - P He
- Department of Biostatistics, Stanford University School of Medicine, Stanford, CA, USA
| | - C Gergis
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - E Griffith
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - H Singh
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - T A DeWeese
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S Honig
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A Annadanam
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S Greco
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C DeVille
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - T McNutt
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - T L DeWeese
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Departments of Oncology and Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - D Y Song
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Departments of Oncology and Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - P T Tran
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Departments of Oncology and Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Tosoian JJ, Alam R, Gergis C, Narang A, Radwan N, Robertson S, McNutt T, Ross AE, Song DY, DeWeese TL, Tran PT, Walsh PC. Unscreened older men diagnosed with prostate cancer are at increased risk of aggressive disease. Prostate Cancer Prostatic Dis 2017; 20:193-196. [PMID: 28045113 DOI: 10.1038/pcan.2016.64] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/17/2016] [Accepted: 11/10/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND To evaluate the relationship between PSA testing history and high-risk disease among older men diagnosed with prostate cancer. METHODS Records from 1993 to 2014 were reviewed for men who underwent radiotherapy for prostate cancer at age 75 years or older. Patients were classified into one of four groups based on PSA-testing history: (1) no PSA testing; (2) incomplete/ineffective PSA testing; (3) PSA testing; or (4) cannot be determined. Outcomes of interest were National Comprehensive Cancer Network (NCCN) risk group (that is, low, intermediate or high risk) and biopsy grade at diagnosis. Multivariable logistic regression was used to determine the association between PSA testing history and high-risk cancer. RESULTS PSA-testing history was available in 274 (94.5%) of 290 subjects meeting study criteria. In total, 148 men (54.0%) underwent PSA testing with follow-up biopsy, 72 (26.3%) underwent PSA testing without appropriate follow-up, and 54 men (19.7%) did not undergo PSA testing. Patients who underwent PSA testing were significantly less likely to be diagnosed with NCCN high-risk cancer (23.0% vs 51.6%, P<0.001). On multivariable analysis, men with no/incomplete PSA testing had more than three-fold increased odds of high-risk disease at diagnosis (odds ratio 3.39, 95% confidence interval 1.96-5.87, P<0.001) as compared to the tested population. CONCLUSIONS Older men who underwent no PSA testing or incomplete testing were significantly more likely to be diagnosed with high-risk prostate cancer than those who were previously screened. It is reasonable to consider screening in healthy older men likely to benefit from early detection and treatment.
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Affiliation(s)
- J J Tosoian
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - R Alam
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C Gergis
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A Narang
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - N Radwan
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S Robertson
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - T McNutt
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A E Ross
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - D Y Song
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - T L DeWeese
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - P T Tran
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - P C Walsh
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Cheng Z, Rosati L, Chen L, Robertson S, Moore J, Peng L, Mian O, Narang A, Hacker-Prietz A, Herman J, McNutt T. SU-F-R-47: Quantitative Shape Relationship Analysis of PTV Modification for Critical Anatomy Sparing and Its Impact On Pathologic Response for Neoadjuvant Stereotactic Radiotherapy for Pancreatic Cancer. Med Phys 2016. [DOI: 10.1118/1.4955818] [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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McNutt T. WE-H-BRB-03: Learning Health Systems for Radiation Oncology: Needs and Challenges for Future Success. Med Phys 2016. [DOI: 10.1118/1.4957991] [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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McNutt T. MO-F-201-04: Panel Member. Med Phys 2016. [DOI: 10.1118/1.4957273] [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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Bowers M, Robertson S, Moore J, Wong J, Phillips M, Hendrickson K, Evans K, McNutt T. SU-F-P-35: A Multi-Institutional Plan Quality Checking Tool Built On Oncospace: A Shared Radiation Oncology Database System. Med Phys 2016. [DOI: 10.1118/1.4955742] [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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Park S, Quon H, McNutt T, Plishker W, Shekhar R, Lee J. SU-F-J-218: Predicting Radiation-Induced Xerostomia by Dosimetrically Accounting for Daily Setup Uncertainty During Head and Neck IMRT. Med Phys 2016. [DOI: 10.1118/1.4956126] [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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Wu B, Kusters M, Kunze-busch M, Dijkema T, McNutt T, Sanguineti G, Pang D. MO-G-201-01: A Multi-Institutional Study Investigating the Performance of a Knowledge-Based Planning System Against Pinnacle Auto-Planning Engine in SIB-IMRT for the Head-And-Neck Cancer. Med Phys 2016. [DOI: 10.1118/1.4957367] [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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Bowers M, Robertson S, Moore J, Wong J, Phillips M, Hendrickson K, Song W, Kwok P, DeWeese T, McNutt T. SU-E-P-26: Oncospace: A Shared Radiation Oncology Database System Designed for Personalized Medicine, Decision Support, and Research. Med Phys 2015. [DOI: 10.1118/1.4923960] [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] [Indexed: 11/07/2022] Open
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Matuszak M, Moran J, Xiao Y, Mayo C, Bosch W, Popple R, Marks L, Wu Q, Molineu A, Miller R, Yock T, McNutt T, Brown N, Purdie T, Yorke E, Santanam L, Gabriel P, Michalski J, Moore J, Richardson S, Siochi R, Napalitano M, Ulin K, Fitzgerald T, Feng M, Verbakel W, Siddiqui S, Morgas T, Martel M, Archambault Y, Ladra M, Lansing B, Ruo R, Fogliata-Cozzi A, Hurkmans C. SU-E-P-22: AAPM Task Group 263 Tackling Standardization of Nomenclature for Radiation Therapy. Med Phys 2015. [DOI: 10.1118/1.4923956] [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] [Indexed: 11/07/2022] Open
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Park S, Plishker W, Robinson A, Zaki G, Shekhar R, McNutt T, Wong J, Lee J. TU-AB-303-08: GPU-Based Software Platform for Efficient Image-Guided Adaptive Radiation Therapy. Med Phys 2015. [DOI: 10.1118/1.4925525] [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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Cheng Z, Moore J, Rosati L, Mian O, Narang A, Herman J, McNutt T. SU-E-T-170: Characterization of the Location, Extent, and Proximity to Critical Structures of Target Volumes Provides Detail for Improved Outcome Predictions Among Pancreatic Cancer Patients. Med Phys 2015. [DOI: 10.1118/1.4924532] [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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McNutt T. WE-F-BRB-03: Inclusion of Data-Driven Risk Predictions in Radiation Treatment Planning in the Context of a Local Level Learning Health System. Med Phys 2015. [DOI: 10.1118/1.4926045] [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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Sanguineti G, Farneti A, Binbin W, McNutt T, Fiorino C. PO-0633: Parotid shrinkage during IMRT for oropharyngeal cancer as a signal of gland reactivity: a longitudinal study. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40625-5] [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: 10/23/2022]
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Redmond K, Mahone M, Sair H, Vannorsdall T, Terezakis S, Kleinberg L, McNutt T, Wharam M, Horska A. NC-13 * CRANIAL RADIATION ENCOMPASSING THE GENU IS ASSOCIATED WITH NEURO-PSYCHOLOGICAL SEQUELAE IN CHILDREN: A PROSPECTIVE STUDY OF DIFFUSION TENSOR IMAGING (DTI) AND PROTON MR SPECTROSCOPY (MRS). Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou263.13] [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: 11/14/2022] Open
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Plishker W, Zaki G, Lee J, Wong J, McNutt T, Shekhar R. Retrospective Assessment of Image Mask Box Sizing for Automatic Patient Positioning. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.2389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Quon H, Cheng Z, Starmer H, Robertson S, Yang W, Richardson M, Allen M, Afonso S, Stoltzfus M, Sanguineti G, Kiess A, Gourin C, McNutt T. Effective Pain Management of Mucositis With Prophylactic Gabapentin in the Irradiated Head and Neck Cancer Patient Is Associated With Functional Benefits. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ricchetti F, McNutt T, Wu B, Fiorino C, Sanguineti G. Parotid Gland Shrinkage During IMRT for Oropharyngeal Cancer and Xerostomia. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Moore J, Zhang Y, Duhon M, Smith K, McNutt T, Wong J. SU-E-T-61: Capabilities and Considerations for the Clinical Use of Flattening Filter Free (FFF) Beams for Volumetric Modulated Arc Therapy (VMAT). Med Phys 2014. [DOI: 10.1118/1.4888391] [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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Phillips M, Kalet I, McNutt T, Smith W. TU-F-BRD-01: Biomedical Informatics for Medical Physicists. Med Phys 2014. [DOI: 10.1118/1.4889318] [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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Moore K, Kagadis G, Xing L, McNutt T. WE-B-BRD-01: Innovation in Radiation Therapy Planning II: Cloud Computing in RT. Med Phys 2014. [DOI: 10.1118/1.4889387] [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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Zhang Y, Ding K, Hobbs R, Liang X, Zhu T, McNutt T, Wang K. SU-E-T-74: Commissioning of the Elekta VersaHD Linear Accelerator. Med Phys 2014. [DOI: 10.1118/1.4888404] [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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Hendrickson K, Phillips M, Fishburn M, Evans K, Banerian S, Mayr N, Wong J, McNutt T, Moore J, Robertson S. SU-E-T-544: A Radiation Oncology-Specific Multi-Institutional Federated Database: Initial Implementation. Med Phys 2014. [DOI: 10.1118/1.4888878] [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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Yang WY, Moore J, Quon H, Evans K, Sharabi A, Herman J, Hacker-Prietz A, McNutt T. Browser Based Platform in Maintaining Clinical Activities – Use of The iPads in Head and Neck Clinics. ACTA ACUST UNITED AC 2014. [DOI: 10.1088/1742-6596/489/1/012095] [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: 11/11/2022]
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Moore JA, Evans K, Yang W, Herman J, McNutt T. Automatic treatment planning implementation using a database of previously treated patients. ACTA ACUST UNITED AC 2014. [DOI: 10.1088/1742-6596/489/1/012054] [Citation(s) in RCA: 5] [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: 11/12/2022]
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Wong J, Kazanzides P, Iordachita I, Jacques R, Cho N, Eslami S, Velarde E, Wang K, McNutt T. 220: Advancing the small animal radiation research platform for pre-clinical radiation research. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)34241-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Anwar M, Lupo J, Molinaro A, Clarke J, Butowski N, Prados M, Chang S, HaasKogan D, Nelson S, Ashman J, Drazkowski J, Zimmerman R, Lidner T, Giannini C, Porter A, Patel N, Atean I, Shin N, Toltz A, Laude C, Freeman C, Seuntjens J, Roberge D, Back M, Kastelan M, Guo L, Wheeler H, Beauchesne P, Faure G, Noel G, Schmitt T, Martin L, Jadaud E, Carnin C, Bowers J, Bennion N, Lomas H, Spencer K, Richardson M, McAllister W, Sheehan J, Schlesinger D, Kersh R, Brower J, Gans S, Hartsell W, Goldman S, Chang JHC, Mohammed N, Siddiqui M, Gondi V, Christensen E, Klawikowski S, Garg A, McAleer M, Rhines L, Yang J, Brown P, Chang E, Settle S, Ghia A, Edson M, Fuller GN, Allen P, Li J, Garsa A, Badiyan S, Simpson J, Dowling J, Rich K, Chicoine M, Leuthardt E, Kim A, Robinson C, Gill B, Peskorski D, Lalonde R, Huq MS, Flickinger J, Graff A, Clerkin P, Smith H, Isaak R, Dinh J, Grosshans D, Allen P, de Groot J, McGovern S, McAleer M, Gilbert M, Brown P, Mahajan A, Gupta T, Mohanty S, Kannan S, Jalali R, Hardie J, Laack N, Kizilbash S, Buckner J, Giannini C, Uhm J, Parney I, Jenkins R, Decker P, Voss J, Hiramatsu R, Kawabata S, Furuse M, Niyatake SI, Kuroiwa T, Suzuki M, Ono K, Hobbs C, Vallow L, Peterson J, Jaeckle K, Heckman M, Bhupendra R, Horowitz D, Wuu CS, Feng W, Drassinower D, Lasala A, Lassman A, Wang T, Indelicato D, Rotondo R, Bradley J, Sandler E, Aldana P, Mendenhall N, Marcus R, Kabarriti R, Mourad WF, Mejia DM, Glanzman J, Patel S, Young R, Bernstein M, Hong L, Fox J, LaSala P, Kalnicki S, Garg M, Khatua S, Hou P, Wolff J, Hamilton J, Zaky W, Mahajan A, Ketonen L, Kim SH, Lee SR, Ji, Oh Y, Krishna U, Shah N, Pathak R, Gupta T, Lila A, Menon P, Goel A, Jalali R, Lall R, Lall R, Smith T, Schumacher A, McCaslin A, Kalapurakal J, Chandler J, Magnuson W, Robins HI, Mohindra P, Howard S, Mahajan A, Manfredi D, Rogers CL, Palmer M, Hillebrandt E, Bilton S, Robinson G, Velasco K, Mehta M, McGregor J, Grecula J, Ammirati M, Pelloski C, Lu L, Gupta N, Bell S, Moller S, Law I, Rosenschold PMA, Costa J, Poulsen HS, Engelholm SA, Morrison A, Cuglievan B, Khatib Z, Mourad WF, Kabarriti R, Young R, Santiago T, Blakaj DM, Welch M, Graber J, Patel S, Hong LX, Patel A, Tandon A, Bernstein MB, Shourbaji RA, Glanzman J, Kinon MD, Fox JL, Lasala P, Kalnicki S, Garg MK, Nicholas S, Salvatori R, Lim M, Redmond K, Quinones A, Gallia G, Rigamonti D, Kleinberg L, Patel S, Mourad W, Young R, Kabarriti R, Santiago T, Glanzman J, Bernstein M, Patel A, Yaparpalvi R, Hong L, Fox J, LaSala P, Kalnicki S, Garg M, Redmond K, Mian O, Degaonkar M, Sair H, Terezakis S, Kleinberg L, McNutt T, Wharam M, Mahone M, Horska A, Rezvi U, Melian E, Surucu M, Mescioglu I, Prabhu V, Clark J, Anderson D, Robbins J, Yechieli R, Ryu S, Ruge MI, Suchorska B, Hamisch C, Mahnkopf K, Lehrke R, Treuer H, Sturm V, Voges J, Sahgal A, Al-Omair A, Masucci L, Masson-Cote L, Atenafu E, Letourneau D, Yu E, Rampersaud R, Lewis S, Yee A, Thibault I, Fehlings M, Shi W, Palmer J, Li J, Kenyon L, Glass J, Kim L, Werner-wasik M, Andrews D, Susheela S, Revannasiddaiah S, Muzumder S, Mallarajapatna G, Basavalingaiah A, Gupta M, Kallur K, Hassan M, Bilimagga R, Tamura K, Aoyagi M, Ando N, Ogishima T, Yamamoto M, Ohno K, Maehara T, Xu Z, Vance ML, Schlesinger D, Sheehan J, Young R, Blakaj D, Kinon MD, Mourad W, LaSala PA, Hong L, Kalnicki S, Garg M, Young R, Mourad W, Patel S, Fox J, LaSala PA, Hong L, Graber JJ, Santiago T, Kalnicki S, Garg M, Zimmerman AL, Vogelbaum MA, Barnett GH, Murphy ES, Suh JH, Angelov L, Reddy CA, Chao ST. RADIATION THERAPY. Neuro Oncol 2013; 15:iii178-iii188. [PMCID: PMC3823902 DOI: 10.1093/neuonc/not187] [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: 09/23/2023] Open
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Quon H, Yang W, Kumar R, McNutt T, Richmon J, Szajna K, Gourin C, Koch W, Forastiere A, Starmer H. Swallow Function in Patients With Oropharyngeal Squamous Cell Carcinomas Treated With Radiation Therapy Dose De-escalation. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sanguineti G, Ricchetti F, Thomas O, Wu B, McNutt T. Pattern and predictors of volumetric change of parotid glands during intensity modulated radiotherapy. Br J Radiol 2013; 86:20130363. [PMID: 24029628 DOI: 10.1259/bjr.20130363] [Citation(s) in RCA: 25] [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: 11/05/2022] Open
Abstract
OBJECTIVE To describe the pattern and predictors of volumetric change of parotid glands during intensity modulated radiotherapy (IMRT) for oropharyngeal cancer. METHODS A cohort of patients undergoing weekly CT scans during dose-painted IMRT was considered. The parotid glands were contoured at the time of treatment planning (baseline) and on all subsequent scans. For a given patient, the parotid glands were labelled as higher (H) and lower (L), based on the mean dose at planning. The volume of each gland was determined for each scan and the percent change from baseline computed. Data were fit to both linear and quadratic functions. The role of selected covariates was assessed with both logistic regression and pair-wise comparison between the sides. The analyses were performed considering the whole treatment duration or each separate half. RESULTS 85 patients, 170 glands and 565 scans were analysed. For all parotids except one, the quadratic function provided a better fit than the linear one. Moreover, according to both the logistic regression and pair-wise comparison, the cumulative mean dose of radiation is independently correlated with the parotid shrinkage during the first but not the second half of the treatment. Conversely, age and weight loss are predictors of relative parotid shrinkage during the entire course of the treatment. CONCLUSION Parotid gland shrinkage during IMRT is not linear. Age, weight loss and radiation dose independently predict parotid shrinkage during a course of IMRT. ADVANCES IN KNOWLEDGE The present study adds to the pathophysiology of parotid shrinkage during radiotherapy.
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Affiliation(s)
- G Sanguineti
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Medicine, Johns Hopkins University, Baltimore, MD
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Sanguineti G, Ricchetti F, McNutt T, Wu B, Fiorino C. Dosimetric predictors of dysphonia after intensity-modulated radiotherapy for oropharyngeal carcinoma. Clin Oncol (R Coll Radiol) 2013; 26:32-8. [PMID: 23992739 DOI: 10.1016/j.clon.2013.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [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: 10/11/2012] [Revised: 05/13/2013] [Accepted: 06/20/2013] [Indexed: 11/30/2022]
Abstract
AIMS To investigate dosimetric predictors of voice changes after whole-field intensity-modulated radiotherapy (IMRT). MATERIALS AND METHODS Patients treated with whole-field IMRT for oropharyngeal/unknown primary tumours were selected for the present retrospective study having grossly uninvolved larynx at the time of radiotherapy and at least one follow-up visit. Voice changes were prospectively scored at each follow-up examination according to the Common Terminology Criteria for Adverse Events (CTCAE) v3.0 scale and self-reported by two items (HN4 and HN10) of the Functional Assessment of Cancer Therapy-Head and Neck Scale (FACT-HN) questionnaire. Predictors of toxicity were investigated at logistic regression, including various patient and tumour characteristics, as well as individual dosimetric data. RESULTS With a median follow-up of 18 months (range 3-46 months), peak CTCAE dysphonia was graded as 2 in 13 patients (10.5%), whereas 45 patients (36.3%) reported peak grade 0-1 voice changes according to FACT-HN4. Communication (FACT-HN10) was barely affected. At multivariate analysis, the mean laryngeal dose was an independent predictor of both grade 2 CTCAE dysphonia (odds ratio = 1.10, 95% confidence interval 1.01-1.20, P = 0.025) and grade 0-1 FACT-HN4 voice changes (odds ratio = 1.11, 95% confidence interval 1.04-1.18, P = 0.001). Further stratification optimised by a receiver operating characteristic (ROC) analysis showed that, to minimise the risk of grade 0-1 FACT-HN4 voice changes, the mean dose to the larynx has to be kept ≤ 49.4 Gy. CONCLUSION Voice changes after whole-field IMRT are common, but mild, and are strictly correlated to the dose received by the uninvolved larynx; in order to minimise the risk of side-effects, the mean dose to the larynx should be kept ≤ 50 Gy.
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Affiliation(s)
- G Sanguineti
- Radiation Oncology, Johns Hopkins University, Baltimore, MD, USA.
| | - F Ricchetti
- Radiation Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - T McNutt
- Radiation Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - B Wu
- Radiation Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - C Fiorino
- Physics, Ospedale San Raffaele, Milano, Italy
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Lee J, Jacques R, Li W, Plishker W, Moore J, Shekhar R, McNutt T, Wong J. SU-E-J-205: Fast Computation of Actual Dose Delivered to the Patient for IMRT Treatment Quality Assessment and Adaptive Radiotherapy. Med Phys 2013. [DOI: 10.1118/1.4814417] [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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Moore J, Yang W, Evans K, Herman J, McNutt T. SU-E-T-687: Reverse Auto-Planning: Assessing Dose Escalation in Pancreatic Stereotactic Radiotherapy From a Shape Database of Prior Patients. Med Phys 2013. [DOI: 10.1118/1.4815114] [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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Moore J, Smith K, Duhon M, Qian J, Gonzales R, McNutt T, Wong J. SU-E-T-394: Evaluation of Volumetric Modulated Arc Therapy (VMAT) Efficiency Using the Elekta Agility. Med Phys 2013. [DOI: 10.1118/1.4814828] [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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McNutt T, Evans K, Moore J, Yang W, Herman J, Quon H, Sharabi A, Wong J, DeWeese T. WE-G-108-02: Oncospace: A Database Designed for Personalized Medicine in Radiation Oncology. Med Phys 2013. [DOI: 10.1118/1.4815626] [Citation(s) in RCA: 3] [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
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Jia X, Gu X, McNutt T, Hissoiny S. TH-A-108-01: Radiation Dose Calculations On Graphics Processing Units (GPUs): Advances and Challenges. Med Phys 2013. [DOI: 10.1118/1.4815694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Wu B, Pang D, Gatti J, Lei S, Colin S, McNutt T, Kole T, Collins S, Dritschilo A. SU-E-T-670: Using Overlap Volume Histogram Analysis of a Prior Plan Dataset to Generate Clinically Acceptable Plans for CyberKnife Robotic Radiosurgery Treatment of Localized Prostate Cancer. Med Phys 2013. [DOI: 10.1118/1.4815097] [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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Alcorn S, Tryggestad E, Roland T, Han-Oh S, Tran P, McNutt T, Song D, Hales R. Utility of Daily Cone Beam CT in Predicting Setup Within Clinical CTV-PTV Margins in Lung Radiation Therapy. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Agbahiwe H, Horska A, Mahone M, Lin D, McNutt T, Cohen K, Redmond K, Wharam M, Terezakis S. A Prospective Study of Cerebral, Frontal Lobe, and Temporal Lobe Volume and Neuropsychologic Performance in Children With Primary Brain Tumors Treated With Cranial Radiation. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Alcorn S, Katzman J, Tryggestad E, Roland T, Han-Oh S, Tran P, McNutt T, Hales R. Multisite Assessment of the Utility of Daily Cone Beam CT in Achieving Clinical CTV-PTV Setup Margin. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1956] [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]
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Redmond K, Mahone E, Terezakis S, Kleinberg L, McNutt T, Agbahiwe H, Cohen K, Lim M, Wharam M, Horska A. Motor Dysfunction Following Cranial Irradiation for Pediatric Brain Tumors: A Prospective Study. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.279] [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]
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Sharabi A, McNutt T, DeWeese T. Automated Cross-Referencing of Radiation Prescriptions to Diagnosis: A Proposed Mechanism to Improve Patient Safety. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1774] [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: 11/30/2022]
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Alcorn S, Kumar R, Tryggestad E, Roland T, Han-Oh S, McNutt T, Hales R, Quon H. Assessing Utility of Daily Cone Beam CT in Head-and-Neck Cancers: The Effect of Disease Site. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sharabi A, Alcorn S, Tryggestad E, Ahuja N, Frassica D, McNutt T, Hales R, Terezakis S. Analysis of Cone BeamCT Shifts in Image Guided Radiation Therapy for Abdominopelvic Soft-tissue Sarcomas. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Yoon WS, Kim JT, Han YM, Chung DS, Park YS, Lizarraga KJ, Allen-Auerbach M, De Salles AA, Yong WH, Chen W, Ruge MI, Kickingereder P, Simon T, Treuer H, Sturm V, D'Alessandro PR, Jarrett J, Walling SA, Fleetwood IG, Kim TG, Lim DH, McGovern SL, Grosshans D, McAleer MF, Chintagumpala M, Khatua S, Vats T, Mahajan A, Beauchesne PD, Faure G, Noel G, Schmitt T, Martin L, Jadaud E, Carnin C, Astradsson A, Rosenschold PMA, Lund AKW, Feldt-Rasmussen U, Roed H, Juhler M, Kumar N, Kumar R, Sharma SC, Mukherjee KK, Khandelwal N, Kumar R, Gupta PK, Bansal A, Kapoor R, Ghosal S, Barney CL, Brown AP, Lowe MC, McAleer MF, Grosshans DR, de Groot JF, Puduvalli V, Gilbert MR, Vats TS, Brown PD, Mahajan A, Pollock BE, Stafford SL, Link MJ, Brown PD, Garces YI, Foote RL, Ryu S, Kim EY, Yechieli R, Kim JK, Mikkelsen T, Kalkanis S, Rock J, Prithviraj GK, Oppelt P, Arfons L, Cuneo KC, Vredenburgh J, Desjardins A, Peters K, Sampson J, Chang Z, Kirkpatrick J, Nath SK, Sheridan AD, Rauch PJ, Contessa JN, Yu JB, Knisely JP, Minja FJ, Vortmeyer AO, Chiang VL, Koto M, Hasegawa A, Takagi R, Sasahara G, Ikawa H, Kamada T, Iwadate Y, Matsutani M, Kanner AA, Sela G, Gez E, Matceyevsky D, Strauss N, Corn BW, Brachman DG, Smith KA, Nakaji P, Sorensen S, Redmond KJ, Mahone EM, Kleinberg L, Terezakis S, McNutt T, Agbahiwe H, Cohen K, Lim M, Wharam M, Horska A, Amendola B, Wolf A, Coy S, Blach L, Mesfin F, Suki D, Mahajan A, Rao G, Palkonda VAR, More N, Ganesan P, Kesavan R, Shunmugavel M, Kasirajan T, Maram VR, Kakkar S, Upadhyay P, Das S, Nigudgi S, Katz JS, Knisely JP, Ghaly M, Schulder M, Palkonda VAR, More N, Shunmugavel M, Kasirajan T, Ganesan P, Kakkar S, Maram VR, Nigudgi S, Upadhyay P, Das S, Kesavan R, Taylor RB, Schaner PE, Dragovic AF, Markert JM, Guthrie BL, Dobelbower MC, Spencer SA, Fiveash JB, Katz JS, Knisely JP, Ghaly M, Schulder M, Chen L, Guerrero-Cazares H, Ford E, McNutt T, Kleinberg L, Lim M, Quinones-Hinojosa A, Redmond K, Wernicke AG, Chao KC, Nori D, Parashar B, Yondorf M, Boockvar JA, Pannullo S, Stieg P, Schwartz TH, Leeman JE, Clump DA, Flickinger JC, Burton SA, Mintz AH, Heron DE, O'Neil SH, Wong K, Buranahirun C, Gonzalez-Morkos B, Brown RJ, Hamilton A, Malvar J, Sposto R, Dhall G, Finlay J, Olch A, Reddy K, Damek D, Gaspar L, Ney D, Kavanagh B, Waziri A, Lillehei K, Stuhr K, Chen C, Kalakota K, Offor O, Patel R, Dess R, Schumacher A, Helenowski I, Marymont M, Sperduto P, Chmura SJ, Mehta M, Zadeh G, Shi W, Liu H, Studenski M, Fu L, Peng C, Gunn V, Rudoler S, Farrell C, Andrews D, Chu J, Turian J, Rooney JW, Ramiscal JAB, Laack NN, Shah K, Surucu M, Melian E, Anderson D, Prabhu V, Origitano T, Sethi A, Emami B. CLIN-RADIATION THERAPY. Neuro Oncol 2012; 14:vi133-vi141. [PMCID: PMC3488792 DOI: 10.1093/neuonc/nos238] [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: 08/31/2023] Open
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Moore J, Herman J, Evans K, Yang W, McNutt T. SU-E-T-212: Clinical Deployment of an Automatic Planning Interface for Overlap Volume Histogram Based Treatment Planning. Med Phys 2012; 39:3752. [DOI: 10.1118/1.4735273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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McNutt T, Wu B, Moore J, Petit S, Kazhdan M, Taylor R. TH-E-BRCD-02: Automated Treatment Planning Using a Database of Prior Patient Treatment Plans. Med Phys 2012. [DOI: 10.1118/1.4736348] [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: 11/07/2022] Open
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Yang Y, Wong J, McNutt T, Tryggestad E, Le Y. SU-E-T-385: Accelerated Beam Delivery with MLC Gaps in IMRT Fields. Med Phys 2012; 39:3793. [DOI: 10.1118/1.4735474] [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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Abstract
PURPOSE We developed a better method of accounting for the effects of heterogeneity in convolution algorithms. We integrated this method into our GPU-accelerated, multi-energetic convolution/superposition (C/S) implementation. In doing so, we have created a new dose algorithm: heterogeneity compensated superposition (HCS). METHODS Convolution in the spherical density-scaled distance space, a.k.a. C/S, has proven to be a good estimator of the dose deposited in a homogeneous volume. However, near heterogeneities electron disequilibrium occurs, leading to faster fall-off and re-buildup than predicted by C/S. We propose to filter the actual patient density in a position and direction sensitive manner, allowing the dose deposited near interfaces to be increased or decreased relative to traditional C/S. We implemented the effective density function as a multivariate first-order recursive filter. We compared HCS against traditional C/S using the ICCR 2000 Monte-Carlo accuracy benchmark, 23 similar accuracy benchmarks and 5 patient cases. For the patient cases, we created custom routines capable of using the discrete material mappings used by Monte-Carlo. C/S normally considers each voxel to be a mixture of materials based on a piecewise-linear density look-up table. RESULTS Multi-energetic HCS increased the dosimetric accuracy for the vast majority of voxels; in many cases near Monte-Carlo results were achieved. HCS improved the mean Van Dyk error by 0.79 (% of Dmax or mm) on average for the patient volumes; reducing the mean error from 1.93%|mm to 1.14%|mm. We found a mean error difference of up to 0.30 %|mm between linear and discrete material mappings. Very low densities (i.e. <0.1 g / cm3 ) remained problematic, but may be solvable with a better filter function. CONCLUSIONS We have developed a novel dose calculation algorithm based on the principals of C/S that better accounts for the electron disequilibrium caused by patient heterogeneity. This work was funded in part by the National Science Foundation under Grant No. EEC9731748, in part by Johns Hopkins University internal funds and in part by Elekta.
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Affiliation(s)
- R Jacques
- Johns Hopkins University, Baltimore, MD
| | - T McNutt
- Johns Hopkins University, Baltimore, MD
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Wu B, Pang D, Sanguineti G, Taylor R, McNutt T. SU-C-211-03: Using OVH and IMRT Plan Data to Automate VMAT Planning: A Head-And-Neck Study. Med Phys 2012. [DOI: 10.1118/1.4734602] [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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