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Ramanathan S, Shen N, Kestin L, Balaraman S. The Treatment of a Novel Epidermal Growth Factor Receptor (EGFR)-GRB2 Genetic Mutation Using Osimertinib in Metastatic Non-Small Cell Lung Cancer. Cureus 2023; 15:e38059. [PMID: 37234142 PMCID: PMC10208280 DOI: 10.7759/cureus.38059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2023] [Indexed: 05/27/2023] Open
Abstract
Mutations in the epidermal growth factor receptor (EGFR) have been implicated in nearly one-third of non-small-cell lung cancers. For patients harboring non-traditional mutations, genomic and transcriptomic sequencing can help direct treatment. As cancer genomics evolves, novel driver mutations continue to be uncovered. We report on a unique EGFR-GRB2 fusion in a 48-year-old female never-smoker. This patient presented with stage IV lung adenocarcinoma (T2aN3M1) with metastatic disease in the iliac wing and liver. Despite systemic treatment, this patient continued to progress. On whole transcriptome sequencing, this patient was found to have a novel EGFR-GRB2 RNA fusion transcript similar to other EGFR fusions described in the literature. After treatment with osimertinib, this patient experienced remarkable clinical and radiological improvements. We believe that, especially for patients with metastatic lung cancer, the presence of novel driver mutations should be investigated. Potentially, patients harboring similar mutations may demonstrate analogous improvements with targeted treatment using the most recent generation of tyrosine kinase inhibitors.
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Affiliation(s)
- Siddharth Ramanathan
- College of Medicine, Oakland University William Beaumont School of Medicine, Rochester Hills, USA
| | - Nathan Shen
- Hematology and Oncology, Central Michigan University College of Medicine, Mount Pleasant, USA
| | | | - Savitha Balaraman
- Hematology and Oncology, Michigan Healthcare Professionals, Royal Oak, USA
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Moncion A, Wilson M, Ma R, Marsh R, Burmeister J, Dryden D, Lack D, Grubb M, Mayville A, Jursinic P, Dess K, Kamp J, Young K, Dilworth JT, Kestin L, Jagsi R, Mietzel M, Vicini F, Pierce LJ, Moran JM. Evaluation of Dose Accuracy in the Near-Surface Region for Whole Breast Irradiation Techniques in a Multi-Institutional Consortium. Pract Radiat Oncol 2022; 12:e317-e328. [DOI: 10.1016/j.prro.2022.01.013] [Citation(s) in RCA: 1] [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: 08/03/2021] [Revised: 11/02/2021] [Accepted: 01/10/2022] [Indexed: 11/29/2022]
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McFarlane MR, Hochstedler KA, Laucis AM, Sun Y, Chowdhury A, Matuszak MM, Hayman J, Bergsma D, Boike T, Kestin L, Movsas B, Grills I, Dominello M, Dess RT, Schonewolf C, Spratt DE, Pierce L, Paximadis P, Jolly S, Schipper M. Predictors of Pneumonitis After Conventionally Fractionated Radiotherapy for Locally Advanced Lung Cancer. Int J Radiat Oncol Biol Phys 2021; 111:1176-1185. [PMID: 34314815 DOI: 10.1016/j.ijrobp.2021.07.1691] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 07/14/2021] [Accepted: 07/19/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE Multiple factors influence the risk of developing pneumonitis after radiation therapy (RT) for lung cancer, but few resources exist to guide clinicians in predicting risk in an individual patient treated with modern techniques. We analyzed toxicity data from a state-wide consortium to develop an integrated pneumonitis risk model. METHODS AND MATERIALS All patients (N = 1302) received conventionally fractionated RT for stage II-III non-small cell lung cancer between April 2012 and July 2019. Pneumonitis occurring within 6 months of treatment was graded by local practitioners and collected prospectively from 27 academic and community clinics participating in a state-wide quality consortium. Pneumonitis was modeled as either grade ≥2 (G2+) or grade ≥3 (G3+). Logistic regression models were fit to quantify univariable associations with dose and clinical factors, and stepwise Akaike information criterion-based modeling was used to build multivariable prediction models. RESULTS The overall rate of pneumonitis of any grade in the 6 months following RT was 16% (208 cases). Seven percent of cases (n = 94) were G2+ and <1% (n = 11) were G3+. Adjusting for incomplete follow-up, estimated rates for G2+ and G3+ were 14% and 2%, respectively. In univariate analyses, gEUD, V5, V10, V20, V30, and mean lung dose (MLD) were positively associated with G2+ pneumonitis risk, whereas current smoking status was associated with lower odds of pneumonitis. G2+ pneumonitis risk of ≥22% was independently predicted by MLD of ≥20 Gy, V20 of ≥35%, and V5 of ≥75%. In multivariate analyses, the lung V5 metric remained a significant predictor of G2+ pneumonitis, even when controlling for MLD, despite their close correlation. For G3+ pneumonitis, MLD and V20 were statistically significant predictors. Number of patient comorbidities was an independent predictor of G3+, but not G2+ pneumonitis. CONCLUSIONS We present an analysis of pneumonitis risk after definitive RT for lung cancer using a large, prospective dataset. We incorporate comorbidity burden, smoking status, and dosimetric parameters in an integrated risk model. These data may guide clinicians in assessing pneumonitis risk in individual patients.
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Affiliation(s)
- Matthew R McFarlane
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | | | - Anna M Laucis
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Yilun Sun
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Aulina Chowdhury
- College of Osteopathic Medicine, Kansas City University of Medicine and Biosciences, Kansas City, Missouri
| | - Martha M Matuszak
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - James Hayman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Derek Bergsma
- Department of Radiation Oncology, Lacks Cancer Center, University of Michigan, Grand Rapids, Michigan
| | - Thomas Boike
- MHP Radiation Oncology/21st Century Oncology, Multiple Sites, Michigan
| | - Larry Kestin
- MHP Radiation Oncology/21st Century Oncology, Multiple Sites, Michigan
| | | | - Inga Grills
- Beaumont Radiation Oncology, Royal Oak, Michigan
| | - Michael Dominello
- Department of Radiation Oncology, Wayne State University, Detroit, Michigan
| | - Robert T Dess
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Caitlin Schonewolf
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Daniel E Spratt
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Lori Pierce
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | | | - Shruti Jolly
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
| | - Matthew Schipper
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
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Amini A, Verma V, Simone C, Chetty I, Choi JI, Chun S, Donington J, Edelman M, Higgins K, Kestin L, Mohindra P, Movsas B, Rodrigues G, Rosenzweig K, Rybkin I, Shepherd A, Slotman B, Wolf A, Chang J. American Radium Society® (ARS) Appropriate Use Criteria on Radiation Therapy in Oligometastatic or Oligoprogressive Non-Small Cell Lung Cancer (NSCLC). Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.02.582] [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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Matuszak MM, Paximadis P, Yudelev M, Grubb M, Wilson ML, Fraser C, Dalmia P, Alkhatib A, Sieffert DE, Haywood JR, Tatro D, Parker J, Ettaher O, Grills I, Kestin L, Walker EM, Friedle C, Kim H, Radawski JD, Boike T, Moran JM, Pierce LJ, Hayman JA. Managing motion in conventionally fractionated lung cancer radiation therapy: Collaborative quality improvement from a statewide consortium of academic and community practices. Pract Radiat Oncol 2018; 8:e208-e211. [DOI: 10.1016/j.prro.2017.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/27/2017] [Accepted: 11/30/2017] [Indexed: 12/25/2022]
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Paximadis P, Schipper M, Matuszak M, Feng M, Jolly S, Boike T, Grills I, Kestin L, Movsas B, Griffith K, Gustafson G, Moran J, Nurushev T, Radawski J, Pierce L, Hayman J. Dosimetric predictors for acute esophagitis during radiation therapy for lung cancer: Results of a large statewide observational study. Pract Radiat Oncol 2018; 8:167-173. [PMID: 28919249 PMCID: PMC6818411 DOI: 10.1016/j.prro.2017.07.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 06/07/2017] [Accepted: 07/16/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE The purpose of this study is to identify dosimetric variables that best predict for acute esophagitis in patients treated for locally advanced non-small cell lung cancer in a prospectively accrued statewide consortium. METHODS AND MATERIALS Patients receiving definitive radiation therapy for stage II-III non-small cell lung cancer within the Michigan Radiation Oncology Quality Consortium were included in the analysis. Dose-volume histogram data were analyzed to determine absolute volumes (cc) receiving doses from 10 to 60 Gy (V10, V20, V30, V40, V50, and V60), as well as maximum dose to 2 cc (D2cc), mean dose (MD), and generalized equivalent uniform dose (gEUD). Logistic regression models were used to characterize the risk of toxicity as a function of dose and other covariates. The ability of each variable to predict esophagitis, individually or in a multivariate model, was quantified by receiver operating characteristic analysis. RESULTS There were 533 patients who met study criteria and were included; 437 (81.9%) developed any grade of esophagitis. Significant variables on univariate analysis for grade ≥2 esophagitis were concurrent chemotherapy, V20, V30, V40, V50, V60, MD, D2cc, and gEUD. For grade ≥3 esophagitis, the predictive variables were: V30, V40, V50, V60, MD, D2cc, and gEUD. In multivariable modeling, gEUD was the most significant predictor of both grade ≥2 and grade ≥3 esophagitis. When gEUD was excluded from the model, D2cc was selected as the most predictive variable for grade ≥3 esophagitis. For an estimated risk of grade ≥3 esophagitis of 5%, the threshold values for gEUD and D2cc were 59.3 Gy and 68 Gy, respectively. CONCLUSIONS In this study, we report the novel finding that gEUD and D2cc, rather than MD, were the most predictive dose metrics for severe esophagitis. To limit the estimated risk of grade ≥3 esophagitis to <5%, thresholds of 59.3 Gy and 68 Gy were identified for gEUD and D2cc, respectively.
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Affiliation(s)
| | | | | | - Mary Feng
- University of Michigan, Ann Arbor, Michigan
| | | | | | - Inga Grills
- William Beaumont Hospital, Royal Oak, Michigan
| | - Larry Kestin
- 21st Century Oncology, Farmington Hills, Michigan
| | | | | | | | - Jean Moran
- University of Michigan, Ann Arbor, Michigan
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Paximadis P, Schipper M, Matuszak M, Feng M, Boike T, Grills I, Kestin L, Movsas B, Griffith K, Gustafson G, Moran J, Nurushev T, Radawski J, Pierce L, Hayman J. Dosimetric Variables Predicting for Acute Esophagitis During Definitive Radiation Therapy for Locally Advanced Non-Small Cell Lung Cancer—Results of a Large Prospective Observational Study. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abramowitz M, Williams S, Stephenson A, Kattan M, Pisansky T, Klein E, Anscher M, Michalski J, Sandler H, Forman J, Zelefsky M, Kestin L, DeWeese T, Liauw S, Valicenti R, Kuban D, Pollack A. Defining Long Term Failure Risk in Patients With an Undetectable PSA After Salvage Radiation. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.579] [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: 12/01/2022]
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Kestin L, Grills I, Guckenberger M, Belderbos J, Hope AJ, Werner-Wasik M, Sonke JJ, Bissonnette JP, Xiao Y, Yan D. Dose–response relationship with clinical outcome for lung stereotactic body radiotherapy (SBRT) delivered via online image guidance. Radiother Oncol 2014; 110:499-504. [DOI: 10.1016/j.radonc.2014.02.002] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 01/28/2014] [Accepted: 02/01/2014] [Indexed: 11/26/2022]
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Taylor JMG, Park Y, Ankerst DP, Proust-Lima C, Williams S, Kestin L, Bae K, Pickles T, Sandler H. Real-time individual predictions of prostate cancer recurrence using joint models. Biometrics 2013; 69:206-13. [PMID: 23379600 DOI: 10.1111/j.1541-0420.2012.01823.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Patients who were previously treated for prostate cancer with radiation therapy are monitored at regular intervals using a laboratory test called Prostate Specific Antigen (PSA). If the value of the PSA test starts to rise, this is an indication that the prostate cancer is more likely to recur, and the patient may wish to initiate new treatments. Such patients could be helped in making medical decisions by an accurate estimate of the probability of recurrence of the cancer in the next few years. In this article, we describe the methodology for giving the probability of recurrence for a new patient, as implemented on a web-based calculator. The methods use a joint longitudinal survival model. The model is developed on a training dataset of 2386 patients and tested on a dataset of 846 patients. Bayesian estimation methods are used with one Markov chain Monte Carlo (MCMC) algorithm developed for estimation of the parameters from the training dataset and a second quick MCMC developed for prediction of the risk of recurrence that uses the longitudinal PSA measures from a new patient.
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Affiliation(s)
- Jeremy M G Taylor
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan 48109, USA.
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Lanni T, Keisch M, Shah C, Wobb J, Kestin L, Vicini F. A Cost Comparison Analysis of Adjuvant Radiation Therapy Techniques after Breast-Conserving Surgery. Breast J 2013; 19:162-7. [DOI: 10.1111/tbj.12075] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Thomas Lanni
- Department of Radiation Oncology; William Beaumont Hospital; Royal Oak; Michigan
| | - Martin Keisch
- Cancer Healthcare Associates; University of Miami Hospital; Miami; Florida
| | - Chirag Shah
- Department of Radiation Oncology; Washington University School of Medicine; St. Louis; Missouri
| | - Jessica Wobb
- Department of Radiation Oncology; William Beaumont Hospital; Royal Oak; Michigan
| | - Larry Kestin
- Michigan Healthcare Professionals; Pontiac; Michigan
| | - Frank Vicini
- Michigan Healthcare Professionals; Pontiac; Michigan
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Yan D, Marples B, Grills I, McDermott S, Kestin L. Radio-inducible Adaptive Response Effect on Hypofractionation of Lung Cancer Radiation Therapy. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.313] [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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Vicini FA, Shah C, Kestin L, Ghilezan M, Krauss D, Ye H, Brabbins D, Martinez AA. Identifying Differences Between Biochemical Failure and Cure: Incidence Rates and Predictors. Int J Radiat Oncol Biol Phys 2011; 81:e369-75. [DOI: 10.1016/j.ijrobp.2011.05.017] [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: 02/21/2011] [Revised: 04/14/2011] [Accepted: 05/10/2011] [Indexed: 10/18/2022]
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Shah C, Tyagi N, Yan D, Grills I, Kestin L, Martinez A, Ghilezan M. Intrafraction Variation during Image Guided Hypofractionated Radiotherapy of the Prostate: Patient and Treatment Determinants. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.1200] [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]
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Grills I, Kestin L, Sonke J, Bissonnette J, Hope A, Belderbos J, Guckenberger M, Ionascu D, Yan D. Intrafraction Variation of Target Position During Cone-beam CT Image-guided Stereotactic Body Radiotherapy (SBRT) for Early-stage Non-small Cell Lung Cancer: A Collaborative Analysis. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.1091] [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: 10/16/2022]
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Krauss D, Kestin L, Ye H, Brabbins D, Ghilezan M, Gustafson G, Vicini F, Martinez A. Lack of Benefit for the Addition of Androgen Deprivation Therapy to Dose-Escalated Radiotherapy in the Treatment of Intermediate- and High-Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2011; 80:1064-71. [DOI: 10.1016/j.ijrobp.2010.04.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 03/24/2010] [Accepted: 04/02/2010] [Indexed: 10/19/2022]
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Mohammed N, Kestin L, Grills I, Shah C, Glide-Hurst C, Yan D, Ionascu D. Comparison of IGRT registration strategies for optimal coverage of primary lung tumors and involved nodes based on multiple four-dimensional CT scans obtained throughout the radiotherapy course. Int J Radiat Oncol Biol Phys 2011; 82:1541-8. [PMID: 21664070 DOI: 10.1016/j.ijrobp.2011.04.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 03/16/2011] [Accepted: 04/11/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the impact of primary tumor and involved lymph node (LN) geometry (centroid, shape, volume) on internal target volume (ITV) throughout treatment for locally advanced non-small cell lung cancer using weekly four-dimensional computed tomography (4DCT). METHODS AND MATERIALS Eleven patients with advanced non-small cell lung cancer were treated using image-guided radiotherapy with acquisition of weekly 10-Phase 4DCTs (n = 51). Initial ITV was based on planning 4DCT. Master-ITV incorporated target geometry across the entire treatment (all 4DCTs). Geographic miss was defined as the % Master-ITV positioned outside of the initial planning ITV after registration is complete. Registration strategies considered were bony (B), primary tumor soft tissue alone (T), and registration based on primary tumor and involved LNs (T_LN). RESULTS The % geographic miss for the primary tumor, mediastinal, and hilar lymph nodes based on each registration strategy were (1) B: 30%, 30%, 30%; (2) T: 21%, 40%, 36%; and (3) T_LN: 26%, 26%, 27%. Mean geographic expansions to encompass 100% of the primary tumor and involved LNs were 1.2 ± 0.7 cm and 0.8 ± 0.3 cm, respectively, for B and T_LN. Primary and involved LN expansions were 0.7 ± 0.5 cm and 1.1 ± 0.5 cm for T. CONCLUSION T is best for solitary targets. When treatments include primary tumor and LNs, B and T_LN provide more comprehensive geographic coverage. We have identified high % geographic miss when considering multiple registration strategies. The dosimetric implications are the subject of future study.
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Affiliation(s)
- Nasiruddin Mohammed
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI 48073, USA
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Ye H, Martinez A, Krauss D, Kestin L, Ghilezan M, Gustafson G. 1020 poster HOW BIOLOGICALLY EFFECTIVE DOSE (BED) LEVEL IMPACT LONG-TERM OUTCOMES IN INTERMEDIATE-RISK PROSTATE CANCER PATIENTS TREATED WITH HIGH-DOSE-RATE BRACHYTHERAPY. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)71142-2] [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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Ye H, Martinez AA, Wallace M, Marvin K, Kestin L, Ghilezan M, Gustafson G. Long-Term Outcome and Late Toxicity Analysis for Clinically Localized Prostate Cancer Treated With Permanent Interstitial Brachytherapy. Brachytherapy 2011. [DOI: 10.1016/j.brachy.2011.02.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Martinez AA, Gonzalez J, Ye H, Ghilezan M, Shetty S, Kernen K, Gustafson G, Krauss D, Vicini F, Kestin L. Dose escalation improves cancer-related events at 10 years for intermediate- and high-risk prostate cancer patients treated with hypofractionated high-dose-rate boost and external beam radiotherapy. Int J Radiat Oncol Biol Phys 2011; 79:363-70. [PMID: 21195875 DOI: 10.1016/j.ijrobp.2009.10.035] [Citation(s) in RCA: 132] [Impact Index Per Article: 10.2] [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: 08/26/2009] [Revised: 10/29/2009] [Accepted: 10/30/2009] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the 10-year outcomes of intermediate- and high-risk prostate cancer patients treated with a prospective dose escalation hypofractionated trial of pelvic external beam radiation therapy (P-EBRT) with a high-dose-rate (HDR) brachytherapy boost. METHODS AND MATERIALS From 1992 to 2007, 472 patients were treated with a HDR boost at William Beaumont Hospital. They had at least one of the following: a prostate-specific antigen (PSA) level of >10 ng/ml, a Gleason score of ≥7, or clinical stage ≥T2b. Patients received 46-Gy P-EBRT and an HDR boost. The HDR dose fractionation was divided into two dose levels. The prostate biologically equivalent dose (BED) low-dose-level group received <268 Gy, and the high-dose group received >268 Gy . Phoenix biochemical failure (BF) definition was used. RESULTS Median follow-up was 8.2 years (range, 0.4-17 years). The 10-year biochemical failure rate of 43.1% vs. 18.9%, (p < 0.001), the clinical failure rate of 23.4% vs. 7.7%, (p < 0.001), and the distant metastasis of 12.4% vs. 5.7%, (p = 0.028) were all significantly better for the high-dose level group. On Cox multivariate analysis, higher BED levels (p = 0.017; hazard ratio [HR] = 0.586), pretreatment PSA assays (p < 0.001, HR = 1.022), and Gleason scores (p = 0.004) were significant variables for reduced biochemical failure. Higher dose levels (p, 0.002; HR, 0.397) and Gleason scores (p < 0.001) were significant for clinical failure. Grade 3 genitourinary complications were 2% and 3%, respectively, and grade 3 gastrointestinal complication was <0.5%. CONCLUSIONS This prospective trial using P-EBRT with HDR boost and hypofractionated dose escalation demonstrates a strong dose-response relationship for intermediate- and high-risk prostate cancer patients. The improvement at 10 years for locoregional control with higher radiation doses (BED, > 268 Gy) has significantly decreased biochemical and clinical failures as well as distant metastasis.
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Affiliation(s)
- Alvaro A Martinez
- Radiation Oncology Department, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
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Mohammed N, Kestin L, Ghilezan M, Krauss D, Vicini F, Brabbins D, Gustafson G, Ye H, Martinez A. Comparison of acute and late toxicities for three modern high-dose radiation treatment techniques for localized prostate cancer. Int J Radiat Oncol Biol Phys 2010; 82:204-12. [PMID: 21167653 DOI: 10.1016/j.ijrobp.2010.10.009] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 09/01/2010] [Accepted: 10/04/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE We compared acute and late genitourinary (GU) and gastrointestinal (GI) toxicities in prostate cancer patients treated with three different high-dose radiation techniques. METHODS AND MATERIALS A total of 1,903 patients with localized prostate cancer were treated with definitive RT at William Beaumont Hospital from 1992 to 2006: 22% with brachytherapy alone (BT), 55% with image-guided external beam (EB-IGRT), and 23% external beam with high-dose-rate brachytherapy boost (EBRT+HDR). Median dose with BT was 120 Gy for LDR and 38 Gy for HDR (9.5 Gy × 4). Median dose with EB-IGRT was 75.6 Gy (PTV) to prostate with or without seminal vesicles. For EBRT+HDR, the pelvis was treated to 46 Gy with an additional 19 Gy (9.5 Gy × 2) delivered via HDR. GI and GU toxicity was evaluated utilizing the NCI-CTC criteria (v.3.0). Median follow-up was 4.8 years. RESULTS The incidences of any acute ≥ Grade 2 GI or GU toxicities were 35%, 49%, and 55% for BT, EB-IGRT, and EBRT+HDR (p < 0.001). Any late GU toxicities ≥ Grade 2 were present in 22%, 21%, and 28% for BT, EB-IGRT, and EBRT+HDR (p = 0.01), respectively. Patients receiving EBRT+HDR had a higher incidence of urethral stricture and retention, whereas dysuria was most common in patients receiving BT. Any Grade ≥ 2 late GI toxicities were 2%, 20%, and 9% for BT, EB-IGRT, and EBRT+HDR (p < 0.001). Differences were most pronounced for rectal bleeding, with 3-year rates of 0.9%, 20%, and 6% (p < 0.001) for BT, EB-IGRT, and EBRT+HDR respectively. CONCLUSIONS Each of the three modern high-dose radiation techniques for localized prostate cancer offers a different toxicity profile. These data can help patients and physicians to make informed decisions regarding radiotherapy for prostate andenocarcinoma.
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Affiliation(s)
- Nasiruddin Mohammed
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI 48073, USA
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Galerani AP, Grills I, Hugo G, Kestin L, Mohammed N, Chao KK, Suen A, Martinez A, Yan D. Dosimetric Impact of Online Correction via Cone-Beam CT-Based Image Guidance for Stereotactic Lung Radiotherapy. Int J Radiat Oncol Biol Phys 2010; 78:1571-8. [DOI: 10.1016/j.ijrobp.2010.02.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Revised: 01/13/2010] [Accepted: 02/15/2010] [Indexed: 11/25/2022]
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Vicini F, Arthur D, Wazer D, Chen P, Mitchell C, Wallace M, Kestin L, Martinez A, Ye H. Limitations of the American Society of Therapeutic Radiology and Oncology (ASTRO) Consensus Panel Guidelines on the Use of Accelerated Partial Breast Irradiation. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.386] [Citation(s) in RCA: 2] [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: 10/19/2022]
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Ghilezan M, Yan D, Kestin L, Brabbins D, Wallace M, Mitchell C, Casey A, Krauss D, Vicini F, Martinez A. Hypofractionated Online Cone-beam CT-guided Intensity Modulated Radiation Therapy (hypoCBCT-IMRT) for Localized Prostate Cancer: Acute Toxicity Profile Compared to Adaptive Offline Image-guided IMRT (ART-IMRT). Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Belderbos J, Hope A, Kestin L, Guckenberger M, Werner-Wasik M, Sonke J, Bissonnette J, Xiao Y, Yan D, Grills I. Time Interval between Staging FDG Positron Emission Tomography (PET) and Initiation of Stereotactic Lung Radiotherapy (SBRT) Impacts the Risk of Recurrence and Metastasis in Non-small Cell Lung Cancer (NSCLC). Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wallace M, Ghilezan M, Mitchell C, Kestin L, Shah C, Marvin K, Brabbins D, Gustafson G, Ye H, Martinez A. Five-year Clinical Outcome in Intermediate Risk Gleason 7 Cancer Patients Treated with Image-guided Adaptive Radiation Therapy vs. Image-guided Brachytherapy as Monotherapy. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.865] [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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Mohammed N, Kestin L, Grills I, Shah C, Glide-Hurst C, Yan D, Ionascu D. Comparison of IGRT Registration Strategies for Optimal Coverage of Primary Lung Tumors and Involved Nodes Based on Multiple 4D-CT Scans Obtained Throughout the RT Course. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1690] [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: 10/19/2022]
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Williams S, Buyyounouski M, Kestin L, Duchesne G, Pickles T. Predictors of androgen deprivation therapy efficacy combined with prostatic irradiation: the central role of tumor stage and radiation dose. Int J Radiat Oncol Biol Phys 2010; 79:724-31. [PMID: 20472361 DOI: 10.1016/j.ijrobp.2009.11.044] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2009] [Revised: 11/14/2009] [Accepted: 11/16/2009] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the response of clinically localized prostate cancer to various durations of planned androgen deprivation therapy (ADT) and to investigate subgroups predicting response. METHODS AND MATERIALS Data of 3,666 prostate cancer patients treated with either combined ADT and external beam radiotherapy (EBRT) or EBRT alone at four institutions were examined. ADT consisted of neoadjuvant, concurrent, or adjuvant ADT or combinations of these regimens. The primary endpoint was time to biochemical failure (nadir plus 2 ng/ml), assessed from the end of therapy. Factors predictive for the need for ADT were examined with interaction analyses. RESULTS The impact of increasing ADT duration was nonlinear with, on average, 6 months of adjuvant ADT resulting in a reduction of the risk of biochemical failure by 38% (95% confidence interval [CI], 29%-46%), while 12, 24, and 36 months of ADT resulted in a 58% (95% CI, 47%-67%), 66% (95% CI, 55%-75%), and 66% (95% CI, 51%-77%) relative failure reduction, respectively. Patients with higher T stage cancers and those treated with lower radiation doses had a significantly greater benefit for increasing ADT duration (interaction, p=0.016 and p=0.007, respectively). Pretreatment prostate-specific antigen values, Gleason score, age, and risk group did not modify the response to ADT. CONCLUSIONS The known ADT efficacy derived from randomized studies can be generalized to patients with different features, and individual predictions of potential benefit from ADT use and duration may be calculated to aid patient and physician decision making. Tumor stage and radiation dose variations were related to significantly different ADT duration effects. The validity of these predictive factors requires prospective evaluation.
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Affiliation(s)
- Scott Williams
- Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Australia.
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Vicini F, Jones P, Rivers A, Wallace M, Mitchell C, Kestin L, Jaiyesimi I, Dekhne N, Martinez A. Differences in disease presentation, management techniques, treatment outcome, and toxicities in African-American women with early stage breast cancer treated with breast-conserving therapy. Cancer 2010; 116:3485-92. [DOI: 10.1002/cncr.25088] [Citation(s) in RCA: 18] [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] [Indexed: 12/22/2022]
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Proust-Lima C, Taylor JMG, Sécher S, Sandler H, Kestin L, Pickles T, Bae K, Allison R, Williams S. Confirmation of a low α/β ratio for prostate cancer treated by external beam radiation therapy alone using a post-treatment repeated-measures model for PSA dynamics. Int J Radiat Oncol Biol Phys 2010; 79:195-201. [PMID: 20381268 DOI: 10.1016/j.ijrobp.2009.10.008] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [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: 07/21/2009] [Revised: 09/24/2009] [Accepted: 10/19/2009] [Indexed: 11/18/2022]
Abstract
PURPOSE To estimate the α/β ratio of prostate cancer treated with external beam radiation only by use of a model of long-term prostate-specific antigen (PSA) dynamics. METHODS AND MATERIALS Repeated measures of PSA from 5,093 patients from 6 institutions treated for localized prostate cancer by external beam radiation therapy (EBRT) without planned androgen deprivation were analyzed. A biphasic linear mixed model described the post-treatment evolution of PSA, rather than a conventional model of time to biochemical recurrence. The model was adjusted for standard prognostic factors (T stage, initial PSA level, and Gleason score) and cohort-specific effects. The radiation dose fractionation effect was estimated from the long-term rate of rise of PSA level. RESULTS Adjusted for other factors, total dose of EBRT and sum of squared doses per fraction were associated with long-term rate of change of PSA level (p = 0.0017 and p = 0.0003, respectively), an increase of each being associated with a lower rate of rise. The α/β ratio was estimated at 1.55 Gy (95% confidence band, 0.46-4.52 Gy). This estimate was robust to adjustment of the linear mixed model. CONCLUSIONS By analysis of a large EBRT-only cohort along with a method that uses all the repeated measures of PSA after the end of treatment, a low and precise α/β was estimated. These data support the use of hypofractionation at fractional doses up to 2.8 Gy but cannot presently be assumed to accurately represent higher doses per fraction.
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Affiliation(s)
- Cécile Proust-Lima
- INSERM, U897, Epidemiology and Biostatistics Research Center, Bordeaux, France.
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Ghilezan MI, Park S, Gustafson G, Brabbins D, Chen P, Krauss D, Vicini FA, Martinez AA, Kestin L. Is the Phoenix Biochemical Failure Definition Accurate for Prostate Cancer Patients Treated with Brachytherapy Alone? Brachytherapy 2010. [DOI: 10.1016/j.brachy.2010.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wallace M, Vicini FA, Mitchell C, Kestin L, Ye H, Chen PY. Excellent Ten-Year Results following Accelerated Partial Breast Irradiation with Multicatheter Interstitial Brachytherapy in Unsuitable Patients as Categorized by the American Society of Therapeutic Radiology and Oncology Consensus Panel. Brachytherapy 2010. [DOI: 10.1016/j.brachy.2010.02.005] [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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McGrath S, Matuszak M, Yan D, Kestin L, Martinez A, Grills I. Volumetric Modulated Arc Therapy for Delivery of Stereotactic Lung Radiotherapy: A Dosimetric and Treatment Efficiency Analysis. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.1558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Belderbos J, Grills I, Sonke J, Hope A, Guckenberger M, Werner-Wasik M, Kestin L, Bissonnette J, Xiao Y, Yan D. A Multinational Report on Methods for Delivery of Lung Stereotactic Radiotherapy (SBRT) using Online Volumetric Image-guidance (VIGRT): Results from the Synergy Research Group. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.374] [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: 10/20/2022]
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Mohammed N, Glide-Hurst C, Kestin L, Grills I, Shah C, Ionascu D, Yan D. Assessment of Radiographic Regression, Intrafraction (Intrafx), and Interfraction (Interfx) Motion of Primary Lung Tumors and Regional Lymph Nodes during Treatment: Implications for Adaptive Image-guided Radiotherapy. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.1452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Buyyounouski M, Pickles T, Kestin L, Allison R, Williams S. Validating the Interval to Biochemical Failure for the Identification of Potentially Lethal Prostate Cancer. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.252] [Citation(s) in RCA: 3] [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: 11/27/2022]
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Huang J, Kestin L, Ye H, Martinez A, Wallace M, Gjeltema R, Robertson B, Vicini F. Rates of Secondary Primary Cancers after Definitive Treatment for Prostate Cancer using Modern Radiation Therapy Techniques. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chen PY, Wallace M, Mitchell C, Grills I, Kestin L, Fowler A, Martinez A, Vicini F. Four-year efficacy, cosmesis, and toxicity using three-dimensional conformal external beam radiation therapy to deliver accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys 2009; 76:991-7. [PMID: 19515514 DOI: 10.1016/j.ijrobp.2009.03.012] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 03/02/2009] [Accepted: 03/05/2009] [Indexed: 12/24/2022]
Abstract
PURPOSE This prospective study examines the use of three-dimensional conformal external beam radiation therapy (3D-CRT) to deliver accelerated partial breast irradiation (APBI). Four-year data on efficacy, cosmesis, and toxicity are presented. METHODS Patients with Stage O, I, or II breast cancer with lesions </=3 cm, negative margins, and negative nodes were eligible. The 3D-CRT delivered was 38.5 Gy in 3.85 Gy/fraction. Ipsilateral breast, ipsilateral nodal, contralateral breast, and distant failure (IBF, INF, CBF, DF) were estimated using the cumulative incidence method. Disease-free, overall, and cancer-specific survival (DFS, OS, CSS) were recorded. The National Cancer Institute Common Terminology Criteria for Adverse Events (version 3) toxicity scale was used to grade acute and late toxicities. RESULTS Ninety-four patients are evaluable for efficacy. Median patient age was 62 years with the following characteristics: 68% tumor size <1 cm, 72% invasive ductal histology, 77% estrogen receptor (ER) (+), 88% postmenopausal; 88% no chemotherapy and 44% with no hormone therapy. Median follow-up was 4.2 years (range, 1.3-8.3). Four-year estimates of efficacy were IBF: 1.1% (one local recurrence); INF: 0%; CBF: 1.1%; DF: 3.9%; DFS: 95%; OS: 97%; and CSS: 99%. Four (4%) Grade 3 toxicities (one transient breast pain and three fibrosis) were observed. Cosmesis was rated good/excellent in 89% of patients at 4 years. CONCLUSIONS Four-year efficacy, cosmesis, and toxicity using 3D-CRT to deliver APBI appear comparable to other experiences with similar follow-up. However, additional patients, further follow-up, and mature Phase III data are needed to evaluate thoroughly the extent of application, limitations, and complete value of this particular form of APBI.
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Affiliation(s)
- Peter Y Chen
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI 48073, USA
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McInerney E, Grills I, Galerani A, Martinez A, Wallace M, Robertson B, Welsh R, Seidman J, Kestin L. Changes in Pulmonary Function and Toxicity after Image Guided Lung Stereotactic Body Radiotherapy (SBRT). Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.1823] [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]
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Brabbins D, Kestin L, Yan D, McGrath S, Vicini F, Gustafson G, Chen P, Wong J, Edmundson G, Martinez A. Improvement in Clinical Outcomes with Prostate Radiotherapy at a Single Institution in the PSA Era. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.1097] [Citation(s) in RCA: 3] [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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Caldwell P, Rivers A, Mitchell C, Wallace M, Martinez A, Goldstein N, Kestin L, Vicini F. Ethnic Differences in Disease Presentation, Management Techniques and Treatment Outcome in Patients Treated with Breast Conserving Therapy for Early Stage Breast Cancer. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.755] [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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Martinez A, Brabbins D, Gustafson G, Demanes J, Galalae R, Mitchell C, Kestin L, Ghilezan M, Vicini F. 10 Year Radiotherapy Results for Prostate Cancer Patients Harboring Gleason 7-10, Stage ≥T2b, iPSA ≥20: More and Faster is Better. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.1047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kestin L, Antonucci J, Goldstein N, Grills I, Paximadis P, Welsh R, Chmielewski G. Complete Pathologic Review of Thymic Tumors: Clinical Outcome over Three Decades at a Single Institution. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.1359] [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]
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Williams S, Pickles T, Kestin L, Buyyounouski M, Martinez A, Demanes J, Taylor J, Duchesne G. Androgen Deprivation Therapy Plus Hypofractionated Prostate Radiotherapy—Are We Castrating the Radiobiological Advantage? Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.933] [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: 10/21/2022]
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Goldstein N, Martinez A, Swanson T, Kestin L, Vicini F. Clonality of Post-radiation and Post-prostatectomy Adenocarcinomas: Some Local Recurrences are Second Primary Neoplasms. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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McGrath S, Kestin L, Dilworth J, Liang J, Krauss D, Yan D, Vicini F, Martinez A. Adaptive Image Guided Radiotherapy (IGRT) Eliminates the Risk of Geometric Miss Due to Rectal Distention in Prostate Cancer Treatment Planning: Biochemical and Clinical Evidence of Efficacy. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.1109] [Citation(s) in RCA: 3] [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: 11/28/2022]
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Park S, Kestin L, McGrath S, Ghilezan M, Brabbins D, Gustafson G, Vicini F, Martinez A. Impact of Young Age on Clinical Outcome in Prostate Cancer Treated with High-dose RT in the Modern ERA. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.1057] [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: 12/01/2022]
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Vicini F, Goldstein NS, Wallace M, Kestin L, Schell S. Molecular evidence demonstrating that local treatment failure is the source of distant metastases in some patients treated for breast cancer. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.1098] [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: 11/20/2022] Open
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Williams SG, Buyyounouski MK, Pickles T, Kestin L, Martinez A, Hanlon AL, Duchesne GM. Percentage of Biopsy Cores Positive for Malignancy and Biochemical Failure Following Prostate Cancer Radiotherapy in 3,264 Men: Statistical Significance Without Predictive Performance. Int J Radiat Oncol Biol Phys 2008; 70:1169-75. [DOI: 10.1016/j.ijrobp.2007.08.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Revised: 08/04/2007] [Accepted: 08/09/2007] [Indexed: 11/29/2022]
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Vicini FA, Chen P, Wallace M, Mitchell C, Hasan Y, Grills I, Kestin L, Schell S, Goldstein NS, Kunzman J, Gilbert S, Martinez A. Interim cosmetic results and toxicity using 3D conformal external beam radiotherapy to deliver accelerated partial breast irradiation in patients with early-stage breast cancer treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys 2007; 69:1124-30. [PMID: 17967306 DOI: 10.1016/j.ijrobp.2007.04.033] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Revised: 04/18/2007] [Accepted: 04/20/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE We present our ongoing clinical experience utilizing three-dimensional (3D)-conformal radiation therapy (3D-CRT) to deliver accelerated partial breast irradiation (APBI) in patients with early-stage breast cancer treated with breast-conserving therapy. METHODS AND MATERIALS Ninety-one consecutive patients were treated with APBI using our previously reported 3D-CRT technique. The clinical target volume consisted of the lumpectomy cavity plus a 10- to 15 -mm margin. The prescribed dose was 34 or 38.5 Gy in 10 fractions given over 5 consecutive days. The median follow-up was 24 months. Twelve patients have been followed for > or =4 years, 20 for > or =3.5 years, 29 for >3.0 years, 33 for > or =2.5 years, and 46 for > or =2.0 years. RESULTS No local recurrences developed. Cosmetic results were rated as good/excellent in 100% of evaluable patients at > or = 6 months (n = 47), 93% at 1 year (n = 43), 91% at 2 years (n = 21), and in 90% at > or =3 years (n = 10). Erythema, hyperpigmentation, breast edema, breast pain, telangiectasias, fibrosis, and fat necrosis were evaluated at 6, 24, and 36 months after treatment. All factors stabilized by 3 years posttreatment with grade I or II rates of 0%, 0%, 0%, 0%, 9%, 18%, and 9%, respectively. Only 2 patients (3%) developed grade III toxicity (breast pain), which resolved with time. CONCLUSIONS Delivery of APBI with 3D-CRT resulted in minimal chronic (> or =6 months) toxicity to date with good/excellent cosmetic results. Additional follow-up is needed to assess the long-term efficacy of this form of APBI.
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Affiliation(s)
- Frank A Vicini
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI 48073, USA.
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