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Gronberg MP, Jhingran A, Netherton TJ, Gay SS, Cardenas CE, Chung C, Fuentes D, Fuller CD, Howell RM, Khan M, Lim TY, Marquez B, Olanrewaju AM, Peterson CB, Vazquez I, Whitaker TJ, Wooten Z, Yang M, Court LE. Deep learning-based dose prediction to improve the plan quality of volumetric modulated arc therapy for gynecologic cancers. Med Phys 2023; 50:6639-6648. [PMID: 37706560 PMCID: PMC10947338 DOI: 10.1002/mp.16735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 08/22/2023] [Accepted: 08/26/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND In recent years, deep-learning models have been used to predict entire three-dimensional dose distributions. However, the usability of dose predictions to improve plan quality should be further investigated. PURPOSE To develop a deep-learning model to predict high-quality dose distributions for volumetric modulated arc therapy (VMAT) plans for patients with gynecologic cancer and to evaluate their usability in driving plan quality improvements. METHODS A total of 79 VMAT plans for the female pelvis were used to train (47 plans), validate (16 plans), and test (16 plans) 3D dense dilated U-Net models to predict 3D dose distributions. The models received the normalized CT scan, dose prescription, and target and normal tissue contours as inputs. Three models were used to predict the dose distributions for plans in the test set. A radiation oncologist specializing in the treatment of gynecologic cancers scored the test set predictions using a 5-point scale (5, acceptable as-is; 4, prefer minor edits; 3, minor edits needed; 2, major edits needed; and 1, unacceptable). The clinical plans for which the dose predictions indicated that improvements could be made were reoptimized with constraints extracted from the predictions. RESULTS The predicted dose distributions in the test set were of comparable quality to the clinical plans. The mean voxel-wise dose difference was -0.14 ± 0.46 Gy. The percentage dose differences in the predicted target metrics ofD 1 % ${D}_{1{\mathrm{\% }}}$ andD 98 % ${D}_{98{\mathrm{\% }}}$ were -1.05% ± 0.59% and 0.21% ± 0.28%, respectively. The dose differences in the predicted organ at risk mean and maximum doses were -0.30 ± 1.66 Gy and -0.42 ± 2.07 Gy, respectively. A radiation oncologist deemed all of the predicted dose distributions clinically acceptable; 12 received a score of 5, and four received a score of 4. Replanning of flagged plans (five plans) showed that the original plans could be further optimized to give dose distributions close to the predicted dose distributions. CONCLUSIONS Deep-learning dose prediction can be used to predict high-quality and clinically acceptable dose distributions for VMAT female pelvis plans, which can then be used to identify plans that can be improved with additional optimization.
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Affiliation(s)
- Mary P. Gronberg
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical SciencesHoustonTexasUSA
| | - Anuja Jhingran
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Tucker J. Netherton
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical SciencesHoustonTexasUSA
| | - Skylar S. Gay
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical SciencesHoustonTexasUSA
| | - Carlos E. Cardenas
- Department of Radiation OncologyThe University of Alabama at BirminghamBirminghamAlabamaUSA
| | - Christine Chung
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - David Fuentes
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical SciencesHoustonTexasUSA
- Department of Imaging PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Clifton D. Fuller
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical SciencesHoustonTexasUSA
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Rebecca M. Howell
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical SciencesHoustonTexasUSA
| | - Meena Khan
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Tze Yee Lim
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical SciencesHoustonTexasUSA
| | - Barbara Marquez
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical SciencesHoustonTexasUSA
| | - Adenike M. Olanrewaju
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Christine B. Peterson
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical SciencesHoustonTexasUSA
- Department of BiostatisticsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Ivan Vazquez
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Thomas J. Whitaker
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical SciencesHoustonTexasUSA
| | - Zachary Wooten
- Department of BiostatisticsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- Department of StatisticsRice UniversityHoustonTexasUSA
| | - Ming Yang
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical SciencesHoustonTexasUSA
| | - Laurence E. Court
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical SciencesHoustonTexasUSA
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Abbasi MA, Bruno G, Di Stefano C, Garcia Bello L, Laack NN, Corbin KS, Whitaker TJ, Pellikka PA, Mutter RW, Villarraga HR. Detection of Early Myocardial Dysfunction by Imaging Biomarkers in Cancer Patients Undergoing Photon Beam vs. Proton Beam Radiotherapy: A Prospective Study. J Cardiovasc Dev Dis 2023; 10:418. [PMID: 37887865 PMCID: PMC10607871 DOI: 10.3390/jcdd10100418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/30/2023] [Accepted: 10/02/2023] [Indexed: 10/28/2023] Open
Abstract
1. Background: We sought to determine acute and subacute changes in cardiac function after proton beam (PBT) and photon beam (PhT) radiotherapy (RT) using conventional and two-dimensional speckle tracking echocardiography (2D-STE) in patients with malignant breast and thoracic tumors. 2. Methods: Between March 2016 and March 2017, 70 patients with breast or thoracic cancer were prospectively enrolled and underwent transthoracic echocardiography with comprehensive strain analysis at pretreatment, mid-treatment, end of treatment, and 3 months after RT. 3. Results: PBT was used to treat 44 patients; PhT 26 patients. Mean ± SD age was 55 ± 12 years; most patients (93%) were women. The median (interquartile range) of the mean heart dose was lower in the PBT than the PhT group (47 [27-79] vs. 217 [120-596] cGy, respectively; p < 0.001). Ejection fraction did not change in either group. Only the PhT group had reduced systolic tissue Doppler velocities at 3 months. 2D-STE showed changes in endocardial and epicardial longitudinal, radial, and circumferential early diastolic strain rate (SRe) in patients undergoing PhT (global longitudinal SRe, pretreatment vs. end of treatment (p = 0.04); global circumferential SRe, pretreatment vs. at 3-month follow-up (p = 0.003); global radial SRe, pretreatment vs. at 3-month follow-up (p = 0.02) for endocardial values). Epicardial strain values decreased significantly only in patients treated with PhT. Patients in the PhT group had a significant decrease in epicardial global longitudinal systolic strain rate (GLSRs) (epicardial GLSRs, at baseline vs. at end of treatment [p = 0.009]) and in GCSRe and GRSRe (epicardial GCSRe, at baseline vs. at 3-month follow-up (p = 0.02); epicardial GRSRe, at baseline vs. at 3-month follow-up (p = 0.03)) during treatment and follow-up. No changes on 2D-STE were detected in the PBT group. 4. Conclusions: Patients who underwent PhT but not PBT had reduced tissue Doppler velocities and SRe values during follow-up, suggesting early myocardial relaxation abnormalities. PBT shows promise as a cardiac-sparing RT technology.
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Affiliation(s)
| | - Giulia Bruno
- Hypertension Unit, Department of Medical Sciences, Città della Salute e della Scienza, University of Torino, 3-10126 Torino, Italy
| | - Cristina Di Stefano
- Hypertension Unit, Department of Medical Sciences, Città della Salute e della Scienza, University of Torino, 3-10126 Torino, Italy
| | - Laura Garcia Bello
- Department of Cardiovascular Medicine Mayo Clinic, Rochester, MN 55905, USA
| | - Nadia N. Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | | | - Robert W. Mutter
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
- Department of Pharmacology, Mayo Clinic, Rochester, MN 55905, USA
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Baroudi H, Huy Minh Nguyen CI, Maroongroge S, Smith BD, Niedzielski JS, Shaitelman SF, Melancon A, Shete S, Whitaker TJ, Mitchell MP, Yvonne Arzu I, Duryea J, Hernandez S, El Basha D, Mumme R, Netherton T, Hoffman K, Court L. Automated contouring and statistical process control for plan quality in a breast clinical trial. Phys Imaging Radiat Oncol 2023; 28:100486. [PMID: 37712064 PMCID: PMC10498301 DOI: 10.1016/j.phro.2023.100486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 09/16/2023] Open
Abstract
Background and purpose Automatic review of breast plan quality for clinical trials is time-consuming and has some unique challenges due to the lack of target contours for some planning techniques. We propose using an auto-contouring model and statistical process control to independently assess planning consistency in retrospective data from a breast radiotherapy clinical trial. Materials and methods A deep learning auto-contouring model was created and tested quantitatively and qualitatively on 104 post-lumpectomy patients' computed tomography images (nnUNet; train/test: 80/20). The auto-contouring model was then applied to 127 patients enrolled in a clinical trial. Statistical process control was used to assess the consistency of the mean dose to auto-contours between plans and treatment modalities by setting control limits within three standard deviations of the data's mean. Two physicians reviewed plans outside the limits for possible planning inconsistencies. Results Mean Dice similarity coefficients comparing manual and auto-contours was above 0.7 for breast clinical target volume, supraclavicular and internal mammary nodes. Two radiation oncologists scored 95% of contours as clinically acceptable. The mean dose in the clinical trial plans was more variable for lymph node auto-contours than for breast, with a narrower distribution for volumetric modulated arc therapy than for 3D conformal treatment, requiring distinct control limits. Five plans (5%) were flagged and reviewed by physicians: one required editing, two had clinically acceptable variations in planning, and two had poor auto-contouring. Conclusions An automated contouring model in a statistical process control framework was appropriate for assessing planning consistency in a breast radiotherapy clinical trial.
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Affiliation(s)
- Hana Baroudi
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX, USA
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Callistus I. Huy Minh Nguyen
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sean Maroongroge
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Benjamin D. Smith
- Department of Breast Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joshua S. Niedzielski
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Simona F. Shaitelman
- Department of Breast Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Adam Melancon
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sanjay Shete
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Thomas J. Whitaker
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Melissa P. Mitchell
- Department of Breast Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Isidora Yvonne Arzu
- Department of Breast Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jack Duryea
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Soleil Hernandez
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX, USA
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Daniel El Basha
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX, USA
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Raymond Mumme
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tucker Netherton
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Karen Hoffman
- Department of Breast Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Laurence Court
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX, USA
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Gronberg MP, Beadle BM, Garden AS, Skinner H, Gay S, Netherton T, Cao W, Cardenas CE, Chung C, Fuentes DT, Fuller CD, Howell RM, Jhingran A, Lim TY, Marquez B, Mumme R, Olanrewaju AM, Peterson CB, Vazquez I, Whitaker TJ, Wooten Z, Yang M, Court LE. Deep Learning-Based Dose Prediction for Automated, Individualized Quality Assurance of Head and Neck Radiation Therapy Plans. Pract Radiat Oncol 2023; 13:e282-e291. [PMID: 36697347 DOI: 10.1016/j.prro.2022.12.003] [Citation(s) in RCA: 8] [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: 09/29/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE This study aimed to use deep learning-based dose prediction to assess head and neck (HN) plan quality and identify suboptimal plans. METHODS AND MATERIALS A total of 245 volumetric modulated arc therapy HN plans were created using RapidPlan knowledge-based planning (KBP). A subset of 112 high-quality plans was selected under the supervision of an HN radiation oncologist. We trained a 3D Dense Dilated U-Net architecture to predict 3-dimensional dose distributions using 3-fold cross-validation on 90 plans. Model inputs included computed tomography images, target prescriptions, and contours for targets and organs at risk (OARs). The model's performance was assessed on the remaining 22 test plans. We then tested the application of the dose prediction model for automated review of plan quality. Dose distributions were predicted on 14 clinical plans. The predicted versus clinical OAR dose metrics were compared to flag OARs with suboptimal normal tissue sparing using a 2 Gy dose difference or 3% dose-volume threshold. OAR flags were compared with manual flags by 3 HN radiation oncologists. RESULTS The predicted dose distributions were of comparable quality to the KBP plans. The differences between the predicted and KBP-planned D1%,D95%, and D99% across the targets were within -2.53% ± 1.34%, -0.42% ± 1.27%, and -0.12% ± 1.97%, respectively, and the OAR mean and maximum doses were within -0.33 ± 1.40 Gy and -0.96 ± 2.08 Gy, respectively. For the plan quality assessment study, radiation oncologists flagged 47 OARs for possible plan improvement. There was high interphysician variability; 83% of physician-flagged OARs were flagged by only one of 3 physicians. The comparative dose prediction model flagged 63 OARs, including 30 of 47 physician-flagged OARs. CONCLUSIONS Deep learning can predict high-quality dose distributions, which can be used as comparative dose distributions for automated, individualized assessment of HN plan quality.
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Affiliation(s)
- Mary P Gronberg
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas.
| | - Beth M Beadle
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Heath Skinner
- Department of Radiation Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Skylar Gay
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas
| | - Tucker Netherton
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas
| | - Wenhua Cao
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Carlos E Cardenas
- Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Christine Chung
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David T Fuentes
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas; Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Clifton D Fuller
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rebecca M Howell
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas
| | - Anuja Jhingran
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tze Yee Lim
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas
| | - Barbara Marquez
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas
| | - Raymond Mumme
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Adenike M Olanrewaju
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Christine B Peterson
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas; Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ivan Vazquez
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Thomas J Whitaker
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas
| | - Zachary Wooten
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Statistics, Rice University, Houston, Texas
| | - Ming Yang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas
| | - Laurence E Court
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas
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Zhu XR, Li Y, Yang M, Whitaker TJ, Taylor PA, Zhang X, Poenisch F, Sahoo N, Liao Z, Chang JY. Stereotactic body proton therapy for early stage non-small cell lung cancer - Technical challenges and solutions: The MD Anderson experience. J Radiosurg SBRT 2023; 9:75-82. [PMID: 38029015 PMCID: PMC10681148] [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] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 08/10/2023] [Indexed: 12/01/2023]
Abstract
Our randomized clinical study comparing stereotactic body radiotherapy (SBRT) and stereotactic body proton therapy (SBPT) for early stage non-small cell lung cancer (NSCLC) was closed prematurely owing to poor enrollment, largely because of lack of volumetric imaging and difficulty in obtaining insurance coverage for the SBPT group. In this article, we describe technology improvements in our new proton therapy center, particularly in image guidance with cone beam CT (CBCT) and CT on rail (CTOR), as well as motion management with real-time gated proton therapy (RGPT) and optical surface imaging. In addition, we have a treatment planning system that provides better treatment plan optimization and more accurate dose calculation. We expect to re-start the SBPT program, including for early stage NSCLC as well as for other disease sites soon after starting patient treatment at our new proton therapy center.
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Affiliation(s)
- X Ronald Zhu
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yuting Li
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ming Yang
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thomas J Whitaker
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paige A Taylor
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xiaodong Zhang
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Falk Poenisch
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Narayan Sahoo
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zhongxing Liao
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joe Y Chang
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Ebner DW, Eckmann JD, Burger KN, Mahoney DW, Whitaker TJ, Petersen IA, Kisiel JB. High Positive Predictive Value of Multitarget Stool DNA After Aerodigestive Tract Radiotherapy. Gastro Hep Advances 2022; 1:746-754. [PMID: 36117548 PMCID: PMC9481191 DOI: 10.1016/j.gastha.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND AIMS: Multitarget stool DNA (mt-sDNA) is approved for average-risk colorectal cancer screening; test performance in persons with prior radiation therapy (RT) has not been studied. RT can induce gastrointestinal bleeding and alter DNA methylation, which may affect mt-sDNA accuracy. Among patients previously treated with RT, we aimed to measure the positive predictive value (PPV) of mt-sDNA and compare these results to historical estimates of mt-sDNA PPV among average-risk patients. METHODS: After institutional review board approval, we conducted a retrospective cohort study of a multisite academic and community-based practice. Patients with RT and subsequent mt-sDNA use during the study period (2014–2016) were identified. The findings at diagnostic colonoscopy were compared with published reports among average-risk patients. Nominal P values were generated by 2-tailed Fisher’s exact testing in comparisons of colorectal neoplasia (CRN) rates between groups. RESULTS: There were 220 patients who had RT before mt-sDNA testing. RT was delivered along the aerodigestive tract in 108 patients. Mt-sDNA tests were positive in 45 of 220 patients (20%), and colonoscopy findings were available for 42; 31 of 42 patients (74%) had CRN. PPV by mt-sDNA was similar when stratified by site of prior RT (along vs outside the aerodigestive tract; P = 1.00). Detection of advanced CRN (36%) was nominally higher than previously published retrospective (27%) and prospective (20%) studies. The median time from the start of RT to mt-sDNA use was 7 (interquartile range, 3–14) years. CONCLUSION: With a test positivity rate and PPV for CRN similar to reports among average-risk patients, prior RT does not appear to adversely affect mt-sDNA performance.
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Dougherty JM, Whitaker TJ, Mundy DW, Tryggestad EJ, Beltran CJ. Design of a 3D patient-specific collision avoidance virtual framework for half-gantry proton therapy system. J Appl Clin Med Phys 2021; 23:e13496. [PMID: 34890094 PMCID: PMC8833276 DOI: 10.1002/acm2.13496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/20/2021] [Accepted: 11/14/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction This study presents a comprehensive collision avoidance framework based on three‐dimension (3D) computer‐aided design (CAD) modeling, a graphical user interface (GUI) as peripheral to the radiation treatment planning (RTP) environment, and patient‐specific plan parameters for intensity‐modulated proton therapy (IMPT). Methods A stand‐alone software application was developed leveraging the Varian scripting application programming interface (API) for RTP database object accessibility. The Collision Avoider software models the Hitachi ProBeat‐V half gantry design and the Kuka robotic couch with triangle mesh structures. Patient‐specific plan parameters are displayed in the collision avoidance software for potential proximity evaluation. The external surfaces of the patients and the immobilization devices are contoured based on computed tomography (CT) images. A “table junction‐to‐CT‐origin” (JCT) measurement is made for every patient at the time of CT simulation to accurately provide reference location of the patient contours to the treatment couch. Collision evaluations were performed virtually with the program during treatment planning to prevent four major types of collisional events: collisions between the gantry head and the treatment couch, gantry head and the patient's body, gantry head and the robotic arm, and collisions between the gantry head and the immobilization devices. Results The Collision Avoider software was able to accurately model the proton treatment delivery system and the robotic couch position. Commonly employed clinical beam configuration and JCT values were investigated. Brain and head and neck patients require more complex gantry and patient positioning system configurations. Physical measurements were performed to validate 3D CAD model geometry. Twelve clinical proton treatment plans were used to validate the accuracy of the software. The software can predict all four types of collisional events in our clinic since its full implementation in 2020. Conclusion A highly efficient patient‐specific collision prevention program for scanning proton therapy has been successfully implemented. The graphical program has provided accurate collision detection since its inception at our institution.
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Affiliation(s)
- Jingjing M Dougherty
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, USA.,Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas J Whitaker
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, Texas, USA
| | - Daniel W Mundy
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Erik J Tryggestad
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Chris J Beltran
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, USA
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Bai M, Gergelis KR, Sir M, Whitaker TJ, Routman DM, Stish BJ, Davis BJ, Pisansky TM, Choo R. Comparing bowel and urinary domains of patient-reported quality of life at the end of and 3 months post radiotherapy between intensity-modulated radiotherapy and proton beam therapy for clinically localized prostate cancer. Cancer Med 2020; 9:7925-7934. [PMID: 32931662 PMCID: PMC7643652 DOI: 10.1002/cam4.3414] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/04/2020] [Accepted: 08/06/2020] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To prospectively assess acute differences in patient-reported outcomes in bowel and urinary domains between intensity-modulated radiotherapy (IMRT) and proton beam therapy (PBT) for prostate cancer. METHODS AND MATERIALS Bowel function (BF), urinary irritative/obstructive symptoms (UO), and urinary incontinence (UI) domains of EPIC-26 were collected in patients with T1-T2 prostate cancer receiving IMRT or PBT at a tertiary cancer center (2015-2018). Mean changes in domain scores were analyzed from pretreatment to the end of and 3 months post-radiotherapy for each modality. A clinically meaningful change was defined as a score change >50% of the baseline standard deviation. RESULTS A total of 157 patients receiving IMRT and 105 receiving PBT were included. There were no baseline differences in domain scores between cohorts. At the end of radiotherapy, there was significant and clinically meaningful worsening of BF and UO scores for patients receiving either modality. In the BF domain, the IMRT cohort experienced greater decrement (-13.0 vs -6.7, P < .01), and had a higher proportion of patients with clinically meaningful reduction (58.4% vs 39.5%, P = .01), compared to PBT. At 3 months post-radiotherapy, the IMRT group had significant and clinically meaningful worsening of BF (-9.3, P < .001), whereas the change in BF score of the PBT cohort was no longer significant or clinically meaningful (-1.2, P = .25). There were no significant or clinically meaningful changes in UO or UI 3 months post-radiotherapy. CONCLUSIONS PBT had less acute decrement in BF than IMRT following radiotherapy. There was no difference between the two modalities in UO and UI.
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Affiliation(s)
- Miao Bai
- Department of Operations and Information Management, University of Connecticut, Storrs, CT, USA
| | | | - Mustafa Sir
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Thomas J Whitaker
- Department of Radiation Oncology, Baylor College of Medicine, Houston, TX, USA
| | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Bradley J Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Brian J Davis
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - Richard Choo
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
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9
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Taparra K, Lester SC, Harmsen WS, Petersen M, Funk RK, Blanchard MJ, Young P, Herrmann J, Hunzeker A, Schultz H, McCollough C, Tasson A, Leng S, Martenson JA, Whitaker TJ, Williamson E, Laack NN. Reducing Heart Dose with Protons and Cardiac Substructure Sparing for Mediastinal Lymphoma Treatment. Int J Part Ther 2020; 7:1-12. [PMID: 33094130 PMCID: PMC7574827 DOI: 10.14338/ijpt-20-00010.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 06/15/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose Electrocardiogram-gated computed tomography with coronary angiography can be used for cardiac substructure sparing (CSS) optimization, which identifies and improves avoidance of cardiac substructures when treating with intensity modulated radiotherapy (IMRT). We investigated whether intensity modulated proton therapy (IMPT) would further reduce dose to cardiac substructures for patients with mediastinal lymphoma. Patients and Methods Twenty-one patients with mediastinal lymphoma were enrolled and underwent electrocardiogram-gated computed tomography angiography during or shortly after simulation for radiotherapy planning. Thirteen patients with delineated cardiac substructures underwent comparative planning with both IMPT and IMRT. Plans were normalized for equivalent (95%) target volume coverage for treatment comparison. Results Thirteen patients met criteria for this study. The median size of the mediastinal lymphadenopathy was 7.9 cm at the greatest diameter. Compared with IMRT-CSS, IMPT-CSS significantly reduced mean dose to all cardiac substructures, including 3 coronary arteries and 4 cardiac valves. Use of IMPT significantly reduced average whole-heart dose from 9.6 to 4.9 Gy (P < .0001), and average mean lung dose was 9.7 vs 5.8 Gy (P < .0001). Prospectively defined clinically meaningful improvement was observed in at least 1 coronary artery in 9 patients (69%), at least 1 cardiac valve in 10 patients (77%), and whole heart in all 13 patients. Conclusions For patients with mediastinal lymphoma, IMPT-CSS treatment planning significantly reduced radiation dose to cardiac substructures. The significant improvements outlined in this study for proton therapy suggest possible clinical improvement in alignment with previous analyses of CSS optimization.
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Affiliation(s)
- Kekoa Taparra
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA.,Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, USA.,This author contributed to and was responsible for statistical analyses
| | - Scott C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - W Scott Harmsen
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.,This author contributed to and was responsible for statistical analyses
| | - Molly Petersen
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.,This author contributed to and was responsible for statistical analyses
| | - Ryan K Funk
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - Phillip Young
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN, USA
| | - Joerg Herrmann
- Department of Cardiology, Mayo Clinic, Rochester, MN, USA
| | - Ashley Hunzeker
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Heather Schultz
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Shuai Leng
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Eric Williamson
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN, USA
| | - Nadia N Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
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10
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Deisher AJ, Whitaker TJ, Beltran CJ, Foote RL, Haddock MG, Mahajan A. Technical Delivery Parameters of 2000 Proton Treatment Courses. Int J Part Ther 2020; 6:27-34. [PMID: 32582812 DOI: 10.14338/ijpt-19-00066.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 01/07/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose To summarize the technical delivery parameters of proton plans delivered at the Mayo Clinic in Rochester, Minnesota. Materials and Methods The database of treated patient proton plans was queried to extract field parameters such as gantry angle, patient support angle, minimum and maximum water-equivalent depth (WED) treated, number of layers, field size, patient orientation, and monitor units. The plans were analyzed in aggregate, by disease site, and by fractionation. Results There were 2963 proton plans for 2023 distinct treatment sites delivered between June 2015 and September 2018. The mean number of fields per plan was 2.8. The mean number of energy layers per field was 51.9. The mean monitor unit per field was 117.4. The median maximum field dimension was 12.4 cm; 95% of the fields had a maximum dimension < 28.7 cm, and the maximum field dimension was 39.8 cm. The median maximum field WED was 16.4 cm; 95% of the fields reached a maximum WED of ≤ 26.4 cm, and the maximum field WED was 32.4 cm. Conclusion A large variety of disease sites were treated using the maximum field size (40 cm) and WED (32.4 cm) capabilities of our half-gantry system.
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Affiliation(s)
- Amanda J Deisher
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - Chris J Beltran
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
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11
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Manzar GS, Lester SC, Routman DM, Harmsen WS, Petersen MM, Sloan JA, Mundy DW, Hunzeker AE, Amundson AC, Anderson JL, Patel SH, Garces YI, Halyard MY, McGee LA, Neben-Wittich MA, Ma DJ, Frank SJ, Whitaker TJ, Foote RL. Comparative analysis of acute toxicities and patient reported outcomes between intensity-modulated proton therapy (IMPT) and volumetric modulated arc therapy (VMAT) for the treatment of oropharyngeal cancer. Radiother Oncol 2020; 147:64-74. [PMID: 32234612 DOI: 10.1016/j.radonc.2020.03.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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: 10/18/2019] [Revised: 02/12/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND PURPOSE IMPT improves normal tissue sparing compared to VMAT in treating oropharyngeal cancer (OPC). Our aim was to assess if this translates into clinical benefits. MATERIALS AND METHODS OPC patients treated with definitive or adjuvant IMPT or VMAT from 2013 to 2018 were included. All underwent prospective assessment using patient-reported-outcomes (PROs) (EORTC-QLQ-H&N35) and provider-assessed toxicities (CTCAEv4.03). End-of-treatment and pretreatment scores were compared. PEG-tube use, hospitalization, and narcotic use were retrospectively collected. Statistical analysis used the Wilcoxon Rank-Sum Test with propensity matching for PROs/provider-assessed toxicities, and t-tests for other clinical outcomes. RESULTS 46 IMPT and 259 VMAT patients were included; median follow-up was 12 months (IMPT) and 30 months (VMAT). Baseline characteristics were balanced except for age (p = 0.04, IMPT were older) and smoking (p < 0.01, 10.9% IMPT >20PYs, 29.3% VMAT). IMPT was associated with lower PEG placement (OR = 0.27; 95% CI: 0.12-0.59; p = 0.001) and less hospitalization ≤60 days post-RT (OR = 0.21; 95% CI:0.07-0.6, p < 0.001), with subgroup analysis revealing strongest benefits in patients treated definitively or with concomitant chemoradiotherapy (CRT). IMPT was associated with a relative risk reduction of 22.3% for end-of-treatment narcotic use. Patients reported reduced cough and dysgeusia with IMPT (p < 0.05); patients treated definitively or with CRT also reported feeling less ill, reduced feeding tube use, and better swallow. Provider-assessed toxicities demonstrated less pain and mucositis with IMPT, but more mucosal infection. CONCLUSION IMPT is associated with improved PROs, reduced PEG-tube placement, hospitalization, and narcotic requirements. Mucositis, dysphagia, and pain were decreased with IMPT. Benefits were predominantly seen in patients treated definitively or with CRT.
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Affiliation(s)
- Gohar S Manzar
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, USA
| | - Scott C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, USA
| | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, USA
| | - William S Harmsen
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, USA
| | - Molly M Petersen
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, USA
| | - Jeff A Sloan
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, USA
| | - Daniel W Mundy
- Department of Radiation Oncology, Mayo Clinic, Rochester, USA
| | | | - Adam C Amundson
- Department of Radiation Oncology, Mayo Clinic, Rochester, USA
| | | | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, Phoenix, USA
| | | | | | - Lisa A McGee
- Department of Radiation Oncology, Mayo Clinic, Phoenix, USA
| | | | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, USA
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | | | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, USA.
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12
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Lester SC, Taparra K, Petersen MM, Funk RK, Blanchard MJ, Young PM, Herrmann J, Hunzeker AE, Schultz HL, McCollough C, Tasson AM, Leng S, Martenson JA, Deisher AJ, Whitaker TJ, Williamson EE, Laack NN. Electrocardiogram-Gated Computed Tomography with Coronary Angiography for Cardiac Substructure Delineation and Sparing in Patients with Mediastinal Lymphomas Treated with Radiation Therapy. Pract Radiat Oncol 2020; 10:104-111. [DOI: 10.1016/j.prro.2019.10.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 09/19/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022]
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13
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Jethwa KR, Jang S, Mullikin TC, Harmsen WS, Petersen MM, Olivier KR, Park SS, Neben-Wittich MA, Hubbard JM, Sandhyavenu H, Whitaker TJ, Waltman LA, Kipp BR, Merrell KW, Haddock MG, Hallemeier CL. Association of tumor genomic factors and efficacy for metastasis-directed stereotactic body radiotherapy for oligometastatic colorectal cancer. Radiother Oncol 2020; 146:29-36. [PMID: 32114263 DOI: 10.1016/j.radonc.2020.02.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 02/07/2020] [Accepted: 02/09/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE/OBJECTIVE(S) To report tumor genomic factors associated with overall survival (OS) and local failure (LF) for patients with colorectal cancer (CRC) who received metastasis-directed stereotactic body radiation therapy (SBRT). MATERIALS/METHODS This was a retrospective review of patients with CRC who received metastasis-directed SBRT. Tumor genomic alterations were identified through KRAS, BRAF, or a 50-gene next generation sequencing panel. OS and LF were estimated using Kaplan-Meier and competing-risk methods. RESULTS Eighty-five patients and 109 lesions were treated between 2008 and 2018. The median patient follow-up was 50 months (IQR: 28-107). The median and 5-year OS was 34 months and 26% (95% CI: 16-41%), respectively. The 2-year cumulative incidence of LF was 30% (95% CI: 23-41%). Univariate associates with OS included patient age ≥60 years, bone metastasis, increasing tumor size, KRAS mutation, and combined KRAS and TP53 mutation, while increasing tumor size, bone metastasis, biologically effective dose <100 Gy, and combined KRAS and TP53 mutation were associated with LF. Multivariate associates with OS included patient age ≥60 years (HR: 2.4, 95% CI: 1.2-4.8, p = 0.01), lesion size per 1 cm (HR: 1.3, 95% CI: 1.1-1.5, p < 0.01), and KRAS mutation (HR: 2.2, 95% CI: 1.2-4.3, p < 0.01), while no multivariable model for LF retained more than a single variable. CONCLUSION Genomic factors, in particular KRAS and TP53 mutation, may assist in patient selection and radiotherapeutic decision-making for patients with oligometastatic CRC. Prospective validation, ideally with genomic correlation of all irradiated metastases, is warranted.
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Affiliation(s)
- Krishan R Jethwa
- Department of Radiation Oncology, Mayo Clinic, Rochester, United States; Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, United States
| | - Samuel Jang
- Department of Radiation Oncology, Mayo Clinic, Rochester, United States
| | - Trey C Mullikin
- Department of Radiation Oncology, Mayo Clinic, Rochester, United States
| | - William S Harmsen
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, United States
| | - Molly M Petersen
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, United States
| | - Kenneth R Olivier
- Department of Radiation Oncology, Mayo Clinic, Rochester, United States
| | - Sean S Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, United States
| | | | - Joleen M Hubbard
- Division of Medical Oncology, Mayo Clinic, Rochester, United States
| | | | - Thomas J Whitaker
- Department of Radiation Oncology, Mayo Clinic, Rochester, United States
| | - Lindsey A Waltman
- Department of Laboratory Medicine and pathology, Mayo Clinic, Rochester, United States
| | - Benjamin R Kipp
- Department of Laboratory Medicine and pathology, Mayo Clinic, Rochester, United States
| | - Kenneth W Merrell
- Department of Radiation Oncology, Mayo Clinic, Rochester, United States
| | - Michael G Haddock
- Department of Radiation Oncology, Mayo Clinic, Rochester, United States
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14
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Mutter RW, Jethwa KR, Gonuguntla K, Remmes NB, Whitaker TJ, Hieken TJ, Ruddy KJ, McGee LA, Corbin KS, Park SS. 3 fraction pencil-beam scanning proton accelerated partial breast irradiation: early provider and patient reported outcomes of a novel regimen. Radiat Oncol 2019; 14:211. [PMID: 31752934 PMCID: PMC6873533 DOI: 10.1186/s13014-019-1417-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 03/08/2019] [Accepted: 11/07/2019] [Indexed: 12/19/2022] Open
Abstract
Background and purpose To report dosimetry and early adverse effects, aesthetic, and patient-reported outcomes of a prospective study of 3-fraction pencil-beam scanning (PBS) proton accelerated partial irradiation (APBI). Materials and methods Eligibility included women age ≥ 50 years with estrogen receptor positive (ER+), sentinel lymph node negative invasive or in-situ breast cancer measuring ≤2.5 cm. The prescription was 21.9 Gy (RBE 1.1) in 3 daily fractions to the post-operative tumor bed with a 1 cm expansion. Toxicities were collected using Common Terminology Criteria for Adverse Events (CTCAE) version 4.0, 10-point Linear Analog Scale Assessment, Patient-Reported Outcomes Version of the CTCAE, and the Harvard Breast Cosmesis Scale. Results Seventy-six women were treated between 2015 and 2017. The median breast volume receiving 50% of prescription or more was 28%. Median mean heart, mean ipsilateral lung, and maximum skin dose were 0 Gy, 0.1 Gy, and 20.6 Gy, respectively. With a median follow-up of 12 months, no treatment-related toxicity grade ≥ 2 has been observed. Most common grade 1 adverse events were dermatitis (68%) and skin hyperpigmentation (18%). At 12 months, the only persistent toxicities were one patient with grade 1 breast edema and one patient with a grade 1 seroma. 90% of patients reported quality of life as ≥7 out of 10 (0 indicating “as bad as it can be” and 10 indicating “as good as it can be”) and 98% of patients reported excellent or good cosmesis. Conclusion 3-fraction PBS proton APBI is well tolerated with low rates of physician and patient reported early adverse effects. Follow-up is ongoing to assess late toxicities and disease control outcomes. Further investigation of this novel adjuvant treatment strategy is warranted.
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Affiliation(s)
- Robert W Mutter
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
| | - Krishan R Jethwa
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Karthik Gonuguntla
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Nicholas B Remmes
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Thomas J Whitaker
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Tina J Hieken
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Kathryn J Ruddy
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Lisa A McGee
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Kimberly S Corbin
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Sean S Park
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
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15
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Garant A, Whitaker TJ, Spears GM, Routman DM, Harmsen WS, Wilhite TJ, Ashman JB, Sio TT, Rule WG, Neben Wittich MA, Martenson JA, Tryggestad EJ, Yoon HH, Blackmon S, Merrell KW, Haddock MG, Hallemeier CL. A Comparison of Patient-Reported Health-Related Quality of Life During Proton Versus Photon Chemoradiation Therapy for Esophageal Cancer. Pract Radiat Oncol 2019; 9:410-417. [DOI: 10.1016/j.prro.2019.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 12/17/2022]
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16
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Mutter RW, Jethwa KR, Wan Chan Tseung HS, Wick SM, Kahila MMH, Viehman JK, Shumway DA, Corbin KS, Park SS, Remmes NB, Whitaker TJ, Beltran CJ. Incorporation of Biologic Response Variance Modeling Into the Clinic: Limiting Risk of Brachial Plexopathy and Other Late Effects of Breast Cancer Proton Beam Therapy. Pract Radiat Oncol 2019; 10:e71-e81. [PMID: 31494289 PMCID: PMC7734652 DOI: 10.1016/j.prro.2019.08.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/30/2019] [Accepted: 08/29/2019] [Indexed: 12/25/2022]
Abstract
Purpose: The relative biologic effectiveness (RBE) rises with increasing linear energy transfer toward the end of proton tracks. Presently, there is no consensus on how RBE heterogeneity should be accounted for in breast cancer proton therapy treatment planning. Our purpose was to determine the dosimetric consequences of incorporating a brachial plexus (BP) biologic dose constraint and to describe other clinical implications of biologic planning. Methods and Materials: We instituted a biologic dose constraint for the BP in the context of MC1631, a randomized trial of conventional versus hypofractionated postmastectomy intensity modulated proton therapy (IMPT). IMPT plans of 13 patients treated before the implementation of the biologic dose constraint (cohort A) were compared with IMPT plans of 38 patients treated on MC1631 after its implementation (cohort B) using (1) a commercially available Eclipse treatment planning system (RBE = 1.1); (2) an in-house graphic processor unit-based Monte Carlo physical dose simulation (RBE = 1.1); and (3) an in-house Monte Carlo biologic dose (MCBD) simulation that assumes a linear relationship between RBE and dose-averaged linear energy transfer (product of RBE and physical dose = biologic dose). Results: Before implementation of a BP biologic dose constraint, the Eclipse mean BP D0.01 cm3 was 107%, and the MCBD estimate was 128% (ie, 64 Gy [RBE = biologic dose] in 25 fractions for a 50-Gy [RBE = 1.1] prescription), compared with 100.0% and 116.0%, respectively, after the implementation of the constraint. Implementation of the BP biologic dose constraint did not significantly affect clinical target volume coverage. MCBD plans predicted greater internal mammary node coverage and higher heart dose than Eclipse plans. Conclusions: Institution of a BP biologic dose constraint may reduce brachial plexopathy risk without compromising target coverage. MCBD plan evaluation provides valuable information to physicians that may assist in making clinical judgments regarding relative priority of target coverage versus normal tissue sparing.
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Affiliation(s)
- Robert W Mutter
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
| | - Krishan R Jethwa
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Stephanie M Wick
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Jason K Viehman
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Dean A Shumway
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Sean S Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Chris J Beltran
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
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17
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Jethwa KR, Park SS, Gonuguntla K, Wick SM, Vallow LA, Deufel CL, Whitaker TJ, Furutani KM, Ruddy KJ, Corbin KS, Hieken TJ, Mutter RW. In Reply to Hannoun-Levi and Hannoun. Int J Radiat Oncol Biol Phys 2019; 104:1177-1179. [PMID: 31039420 DOI: 10.1016/j.ijrobp.2019.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 04/11/2019] [Accepted: 04/13/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Krishan R Jethwa
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Sean S Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Stephanie M Wick
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Laura A Vallow
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | | | | | - Keith M Furutani
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Kathryn J Ruddy
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Tina J Hieken
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Robert W Mutter
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
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18
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Jethwa KR, Hellekson CD, Evans JD, Harmsen WS, Wilhite TJ, Whitaker TJ, Park SS, Choo CR, Stish BJ, Olivier KR, Haloi R, Lowe VJ, Welch BT, Quevedo JF, Mynderse LA, Karnes RJ, Kwon ED, Davis BJ. 11C-Choline PET Guided Salvage Radiation Therapy for Isolated Pelvic and Paraortic Nodal Recurrence of Prostate Cancer After Radical Prostatectomy: Rationale and Early Genitourinary or Gastrointestinal Toxicities. Adv Radiat Oncol 2019; 4:659-667. [PMID: 31673659 PMCID: PMC6817538 DOI: 10.1016/j.adro.2019.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 02/04/2019] [Revised: 06/03/2019] [Accepted: 06/21/2019] [Indexed: 11/01/2022] Open
Abstract
Purpose To assess gastrointestinal (GI) and genitourinary (GU) adverse events (AEs) of 11C-choline-positron emission tomography (CholPET) guided lymph node (LN) radiation therapy (RT) in patients who experience biochemical failure after radical prostatectomy. Methods and Materials From 2013 to 2016, 107 patients experienced biochemical failure of prostate cancer, had CholPET-detected pelvic and/or paraortic LN recurrence, and were referred for RT. Patients received androgen suppression and CholPET guided LN RT (median dose, 45 Gy) with a simultaneous integrated boost to CholPET-avid sites (median dose, 56.25 Gy), all in 25 fractions. RT-naïve patients had the prostatic fossa included in the initial treatment volumes followed by a sequential boost (median dose, 68 Gy). GI and GU AEs were reported per Common Terminology Criteria for Adverse Events (version 4.0) with data gathered retrospectively. Differences in maximum GI and GU AEs at baseline, immediately post-RT, and at early (median, 4 months) and late (median, 14 months) follow-up were assessed. Results Median follow-up was 16 months (interquartile range [IQR], 11-25). Median prostate-specific antigen at time of positive CholPET was 2.3 ng/mL (IQR, 1.3-4.8), with a median of 2 (IQR, 1-4) choline-avid LNs per patient. Most recurrences were within the pelvis (53%) or pelvis + paraortic (40%). Baseline rates of grade 1 to 2 GI AEs were 8.4% compared with 51.9% (4.7% grade 2) of patients post-RT (P < .01). These differences resolved by 4-month (12.2%, P = .65) and 14-month AE assessments (9.1%, P = .87). There was no significant change in grade 1 to 2 GU AEs post-RT (64.1%) relative to baseline (56.0%, P = .21), although differences did arise at 4-month (72.2%, P = .01) and 14-month (74.3%, P = .01) AE assessments. Conclusions Salvage CholPET guided nodal RT has acceptably low rates of acute GI and GU AEs and no significant detriment in 14-month GI AEs. These data are of value in counseling patients and designing prospective trials evaluating the oncologic efficacy of this treatment strategy.
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Affiliation(s)
| | | | - Jaden D Evans
- Department of Radiation Oncology, Rochester, Minnesota
| | | | | | | | - Sean S Park
- Department of Radiation Oncology, Rochester, Minnesota
| | | | | | | | - Rimki Haloi
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - Val J Lowe
- Department of Radiology, Rochester, Minnesota
| | | | - J Fernando Quevedo
- Department of Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Eugene D Kwon
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - Brian J Davis
- Department of Radiation Oncology, Rochester, Minnesota
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Smith NL, Jethwa KR, Viehman JK, Harmsen WS, Gonuguntla K, Elswick SM, Grauberger JN, Amundson AC, Whitaker TJ, Remmes NB, Harless CA, Boughey JC, Nguyen MDT, Park SS, Corbin KS, Mutter RW. Post-mastectomy intensity modulated proton therapy after immediate breast reconstruction: Initial report of reconstruction outcomes and predictors of complications. Radiother Oncol 2019; 140:76-83. [PMID: 31185327 DOI: 10.1016/j.radonc.2019.05.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 03/21/2019] [Revised: 05/16/2019] [Accepted: 05/20/2019] [Indexed: 01/02/2023]
Abstract
PURPOSE To report reconstructive outcomes of patients treated with post-mastectomy intensity modulated proton therapy (IMPT) following immediate breast reconstruction (IBR). MATERIALS AND METHODS Consecutive women with breast cancer who underwent implant-based IBR and post-mastectomy IMPT were included. Clinical characteristics, dosimetry, and acute toxicity were collected prospectively and reconstruction complications retrospectively. RESULTS Fifty-one women were treated between 2015 and 2017. Forty-two had bilateral reconstruction with unilateral IMPT. The non-irradiated contralateral breasts served as controls. Conventional fractionation (median 50 Gy/25 fractions) was administered in 37 (73%) and hypofractionation (median 40.5 Gy/15 fractions) in 14 (27%) patients. Median mean heart, ipsilateral lung V20Gy, and CTV-IMN V95% were 0.6 Gy, 13.9%, and 97.4%. Maximal acute dermatitis grade was 1 in 32 (63%), 2 in 17 (33%), and 3 in 2 (4%) patients. Surgical site infection (hazard ratio [HR] 13.19, 95% confidence interval [CI] 1.67-104.03, p = 0.0012), and unplanned surgical intervention (HR 9.86, 95% CI 1.24-78.67, p = 0.0068) were more common in irradiated breasts. Eight of 51 irradiated breasts and 2 of 42 non-irradiated breasts had reconstruction failure (HR 3.59, 95% CI 0.78-16.41, p = 0.084). Among irradiated breasts, hypofractionation was significantly associated with reconstruction failure (HR 4.99, 95% CI 1.24-20.05, p = 0.024), as was older patient age (HR 1.14, 95% CI 1.05-1.24, p = 0.002). CONCLUSIONS IMPT following IBR spared underlying organs and had low rates of acute toxicity. Reconstruction complications are more common in irradiated breasts, and reconstructive outcomes appear comparable with photon literature. Hypofractionation was associated with higher reconstruction failure rates. Further investigation of optimal dose-fractionation after IBR is needed.
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Affiliation(s)
- Na L Smith
- Department of Radiation Oncology, Mayo Clinic, Rochester, USA
| | | | - Jason K Viehman
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, USA
| | - William S Harmsen
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, USA
| | | | | | | | - Adam C Amundson
- Department of Radiation Oncology, Mayo Clinic, Rochester, USA
| | | | | | | | | | | | - Sean S Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, USA
| | | | - Robert W Mutter
- Department of Radiation Oncology, Mayo Clinic, Rochester, USA.
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20
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Whitaker TJ, Routman DM, Schultz H, Harmsen WS, Corbin KS, Wong WW, Choo R. IMPT versus VMAT for Pelvic Nodal Irradiation in Prostate Cancer: A Dosimetric Comparison. Int J Part Ther 2019; 5:11-23. [PMID: 31788504 PMCID: PMC6874187 DOI: 10.14338/ijpt-18-00048.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 01/22/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose: To compare dosimetric data of the organs at risk (OARs) and clinical target volumes (CTVs) between intensity-modulated proton therapy (IMPT) and volumetric-modulated arc therapy (VMAT) for patients undergoing prostate and elective, pelvic lymph node radiotherapy in the setting of unfavorable, intermediate and high-risk prostate carcinoma. Methods and Materials: A study of moderately hypofractionated proton therapy (6750 centigray [cGy] in 25 fractions) is in progress for unfavorable, intermediate and high-risk prostate cancer where treatment includes an elective pelvic nodal CTV (4500 cGy in 25 fractions). Ten consecutively accrued patients were the subjects for dose-volume histogram comparison between IMPT and VMAT. Two treatment plans (IMPT and VMAT) were prepared for each patient with predefined planning objectives for target volumes and OARs. The IMPT plans were prepared with 2 lateral beams and VMAT plans with 2 arcs. Results: The CTV coverage was adequate for both plans with 99% of CTVs receiving ≥ 100% of the prescription doses. Mean doses to the bladder, rectum, large bowel, and small bowel were lower with IMPT versus VMAT. Mean femoral head dose was greater with IMPT. The percentage of volumes of rectum receiving ≤ 47.5 Gy, large bowel receiving ≤ 27.5 Gy, small bowel receiving ≤ 30 Gy, and bladder receiving ≤ 37.5 Gy was less with IMPT versus VMAT, largely because of reduction in the low-dose “bath” associated with VMAT. Conclusions: In the setting of prostate and elective, pelvic nodal radiotherapy for prostate cancer, IMPT can significantly reduce the dose to OARs, in comparison to VMAT, and provide adequate target coverage.
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Affiliation(s)
| | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Heather Schultz
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | | | | - William W Wong
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | - Richard Choo
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
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21
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Routman DM, Whitaker TJ, Day CN, Harmsen WS, Neben-Wittich MA, Haddock MG, Hallemeier CL, Merrell K. Predictors of lymphopenia in esophageal cancer patients receiving photon or proton radiation therapy: A dosimetric analysis. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
147 Background: Lymphopenia during radiation therapy (RT) has been associated with worse oncologic outcomes in a number of malignancies, including esophageal cancer (EC). No studies to date have investigated specific dosimetric parameters associated with this lymphopenia in EC. We performed an analysis of RT dose to multiple organs at risk (OARs) to investigate associations with grade 4 lymphopenia (G4L). Methods: Consecutive EC patients receiving curative intent chemoradiotherapy +/- surgery between July of 2015 and December of 2017 were included. Lymphocyte nadir was defined as the lowest lymphocyte count during RT. G4L was defined as absolute lymphocyte count <200/mm3. Dose to OARs including aorta, body, bone marrow, heart, liver, lung, and spleen were calculated. Univariate logistic regression analyses were performed for each OAR at the 1, 5, 10, 15, 20, 30, 35, 40, and 50 Gy levels with volume receiving dose ‘x’(VxGy) analyzed as a continuous variable per 10% increase. Clinical tumor volume (CTV) and RT modality (photon vs. proton) as well clinical factors including sex, stage (I/II vs. III/IV), age (per 10 year increase), and BMI (per 5 unit increase) were also analyzed. Results: One hundred forty-four pts were identified for inclusion. Seventy-nine pts received photon RT and 65 proton RT. Chemotherapy was weekly carbotaxol (99%). G4L at nadir was 40% overall (56% photon, 22% proton). By organ, body V1-V30Gy (OR 1.45-8.18, p<0.01), heart V1-V30Gy (OR 1.24-1.49, p<0.01), liver V1-V35Gy (OR 1.23-2.75, p<0.01), lung V1-V30Gy (OR 1.26-5.73 p<0.01), and spleen V1-V40Gy (OR 1.26-1.49 p<0.01) were highly associated with G4L whereas dose to aorta and bone marrow were not. Advanced stage (OR, 3.92 p<0.01), photon vs. proton (OR 4.58 p<0.01), and CTV (per 100 cc’s (OR=1.21, p<0.01)) were also associated with G4L. Sex, age, and BMI were not associated with G4L. Conclusions: Low to intermediate dose volumes to OARs including body, spleen, liver, lungs, and heart were associated with G4L. These findings provide rational for the differences seen in rates of G4L for photon versus proton RT.
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Affiliation(s)
| | | | | | | | | | | | | | - Kenneth Merrell
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
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22
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Jethwa KR, Park SS, Gonuguntla K, Wick SM, Vallow LA, Deufel CL, Whitaker TJ, Furutani KM, Ruddy KJ, Corbin KS, Hieken TJ, Mutter RW. Three-Fraction Intracavitary Accelerated Partial Breast Brachytherapy: Early Provider and Patient-Reported Outcomes of a Novel Regimen. Int J Radiat Oncol Biol Phys 2018; 104:75-82. [PMID: 30583041 DOI: 10.1016/j.ijrobp.2018.12.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 12/10/2018] [Accepted: 12/13/2018] [Indexed: 01/26/2023]
Abstract
PURPOSE To report early adverse events and patient-reported outcomes (PROs) of 3-fraction intracavitary catheter-based partial breast brachytherapy (ICBB). MATERIALS AND METHODS Eligible women ≥50 years of age with ≤2.5-cm, lymph node-negative invasive or in situ breast cancer underwent breast-conserving surgery and placement of a brachytherapy applicator. ICBB was initiated on the second weekday after surgery and prescribed to 21 Gy in 3 once-daily fractions. Common Terminology Criteria for Adverse Events, version 4.0; 10-point linear analog scale assessment; the PRO version of the Common Terminology Criteria for Adverse Events; and the Harvard Breast Cosmesis Scale were used for provider and patient-reported assessments. RESULTS Seventy-three women were treated for invasive (79%) or in situ (21%) breast cancer. The median time to completion of surgery and radiation therapy was 6 days. After 14-months median follow-up, 2 patients (3%) had developed breast infections that resolved with oral antibiotics. There was no other treatment-associated adverse event grade ≥2. The grade 1 seroma rate at 3 months was 20%, which dropped to 8% at 12 months; no events required intervention. At 12 months, 91% of patients reported an overall quality of life score as ≥8 of 10, and patient-reported cosmesis was good or excellent in 95%. All patients are alive without relapse at the last follow-up. CONCLUSIONS Three-fraction ICBB is associated with low rates of early provider and patient- reported adverse events and compares favorably with early outcomes of more protracted ICBB regimens, including twice-daily (3.4 Gy × 10) fractionation studied in the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-39. Further investigation is warranted.
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Affiliation(s)
- Krishan R Jethwa
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Sean S Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Stephanie M Wick
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Laura A Vallow
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota; Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | | | | | - Keith M Furutani
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Kathryn J Ruddy
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Tina J Hieken
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Robert W Mutter
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
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23
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Jethwa KR, Tryggestad EJ, Whitaker TJ, Giffey BT, Kazemba BD, Neben-Wittich MA, Merrell KW, Haddock MG, Hallemeier CL. Initial experience with intensity modulated proton therapy for intact, clinically localized pancreas cancer: Clinical implementation, dosimetric analysis, acute treatment-related adverse events, and patient-reported outcomes. Adv Radiat Oncol 2018; 3:314-321. [PMID: 30202800 PMCID: PMC6128024 DOI: 10.1016/j.adro.2018.04.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 02/05/2018] [Revised: 03/25/2018] [Accepted: 04/04/2018] [Indexed: 12/22/2022] Open
Abstract
Purpose Pencil-beam scanning intensity modulated proton therapy (IMPT) may allow for an improvement in the therapeutic ratio compared with conventional techniques of radiation therapy delivery for pancreatic cancer. The purpose of this study was to describe the clinical implementation of IMPT for intact and clinically localized pancreatic cancer, perform a matched dosimetric comparison with volumetric modulated arc therapy (VMAT), and report acute adverse event (AE) rates and patient-reported outcomes (PROs) of health-related quality of life. Methods and materials Between July 2016 and March 2017, 13 patients with localized pancreatic cancer underwent concurrent capecitabine or 5-fluorouracil-based chemoradiation therapy (CRT) utilizing IMPT to a dose of 50 Gy (radiobiological effectiveness: 1.1). A VMAT plan was generated for each patient to use for dosimetric comparison. Patients were assessed prospectively for AEs and completed PRO questionnaires utilizing the Functional Assessment of Cancer Therapy-Hepatobiliary at baseline and upon completion of CRT. Results There was no difference in mean target coverage between IMPT and VMAT (P > .05). IMPT offered significant reductions in dose to organs at risk, including the small bowel, duodenum, stomach, large bowel, liver, and kidneys (P < .05). All patients completed treatment without radiation therapy breaks. The median weight loss during treatment was 1.6 kg (range, 0.1-5.7 kg). No patients experienced grade ≥3 treatment-related AEs. The median Functional Assessment of Cancer Therapy-Hepatobiliary scores prior to versus at the end of CRT were 142 (range, 113-163) versus 136 (range, 107-173; P = .18). Conclusions Pencil-beam scanning IMPT was feasible and offered significant reductions in radiation exposure to multiple gastrointestinal organs at risk. IMPT was associated with no grade ≥3 gastrointestinal AEs and no change in baseline PROs, but the conclusions are limited due to the patient sample size. Further clinical studies are warranted to evaluate whether these dosimetric advantages translate into clinically meaningful benefits.
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Affiliation(s)
- Krishan R Jethwa
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Broc T Giffey
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Bret D Kazemba
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
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Whitaker TJ, Mayo CS, Ma DJ, Haddock MG, Miller RC, Corbin KS, Neben-Wittich M, Leenstra JL, Laack NN, Fatyga M, Schild SE, Vargas CE, Tzou KS, Hadley AR, Buskirk SJ, Foote RL. Data collection of patient outcomes: one institution's experience. J Radiat Res 2018. [PMID: 29538757 PMCID: PMC5868196 DOI: 10.1093/jrr/rry013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Patient- and provider-reported outcomes are recognized as important in evaluating quality of care, guiding health care policy, comparative effectiveness research, and decision-making in radiation oncology. Combining patient and provider outcome data with a detailed description of disease and therapy is the basis for these analyses. We report on the combination of technical solutions and clinical process changes at our institution that were used in the collection and dissemination of this data. This initiative has resulted in the collection of treatment data for 23 541 patients, 20 465 patients with provider-based adverse event records, and patient-reported outcome surveys submitted by 5622 patients. All of the data is made accessible using a self-service web-based tool.
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Affiliation(s)
- Thomas J Whitaker
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
- Corresponding author. Department of Radiation Oncology, Mayo Clinic, 200 First St. S.W., Rochester, MN, USA. Tel: +01-507-255-2129; Fax: +01-507-284-0079;
| | - Charles S Mayo
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael G Haddock
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert C Miller
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - Kimberly S Corbin
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - James L Leenstra
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Nadia N Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mirek Fatyga
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Carlos E Vargas
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Katherine S Tzou
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - Austin R Hadley
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - Steven J Buskirk
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
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Fossum CC, Beltran CJ, Whitaker TJ, Ma DJ, Foote RL. Biological Model for Predicting Toxicity in Head and Neck Cancer Patients Receiving Proton Therapy. Int J Part Ther 2017; 4:18-25. [PMID: 31773005 PMCID: PMC6871554 DOI: 10.14338/ijpt-17-00015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 05/01/2017] [Accepted: 10/27/2017] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To use a linear energy transfer (LET) dependent formula for relative biological effectiveness (RBE) to generate a biological model that can be used to predict toxicity in patients treated with proton therapy for cancer of the head and neck. PATIENTS AND METHODS Patients treated with protons to a dose of 60 to 70 Gy (RBE = 1.1) for head and neck cancer were eligible to participate in this study. Treatment plans were developed using graphics processing unit Monte Carlo calculations. The equation, RBE = (1.1)[0.08(LETd)+0.88], was the biological model. The physical model assumes RBE = 1.1. Tumor volumes and organs at risk (OARs) were contoured, and isodose lines were created for 105%-120% of the prescribed dose. Dose to volume of OARs was calculated for both models for comparative purposes. Physician-reported toxicity was graded from 0 to 5 using the Common Terminology Criteria for Adverse Events, version 4.03. Patient-reported outcomes were obtained using the Promis10 and European Organisation for Research and Treatment of Cancer's QLQ-H&N35 instruments. RESULTS Eleven patients were included in this study. In each case the biological model revealed an increased dose to several OARs compared with the physical model. For selected OARs, the volume receiving >105% of the target dose was 2-fold to 15-fold greater in the biological model than the volume predicted by the physical model. Patients experienced toxicity that was consistent with the dose to OARs predicted by the biological model. Furthermore, 1 patient developed mucosal ulceration and another developed osteoradionecrosis at the location of a biological hot spot. In each case, the biological hot spot was located 2 mm inside the clinical target volume. CONCLUSION The results suggest that increases in dose predicted by the biological model are clinically relevant and that LET and RBE corrections and optimization should be a component of the treatment-planning process in proton therapy.
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Affiliation(s)
| | - Chris J. Beltran
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - Daniel J. Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Robert L. Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
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Reynolds MM, Whitaker TJ, Parney IF, Kozelsky TF, Garces YI, Foote RL, Tryggestad EJ, Pulido JS. Carbon fiducials for large choroidal melanoma treated with gamma knife radiosurgery. Acta Ophthalmol 2016; 94:e806-e807. [PMID: 26893172 DOI: 10.1111/aos.12982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Thomas J. Whitaker
- Department of Radiation Oncology/Radiation Physics; Mayo Clinic; Rochester MN USA
| | - Ian F. Parney
- Department of Neurosurgery; Mayo Clinic; Rochester MN USA
| | | | | | - Robert L. Foote
- Department of Radiation Oncology; Mayo Clinic; Rochester MN USA
| | - Erik J. Tryggestad
- Department of Radiation Oncology/Radiation Physics; Mayo Clinic; Rochester MN USA
| | - Jose S. Pulido
- Department of Ophthalmology; Mayo Clinic; Rochester MN USA
- Department of Molecular Medicine; Mayo Clinic; Rochester MN USA
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27
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Stish BJ, Pafundi DH, Hieken TJ, Whitaker TJ, Furutani KM, Jakub JW, Boughey JC, Degnim AC, McLemore LB, Mou B, Mutter RW, Park SS. Feasibility and full-course dosimetry of an intraoperatively placed multichannel brachytherapy catheter for accelerated partial breast irradiation. Brachytherapy 2016; 15:796-803. [PMID: 27614660 DOI: 10.1016/j.brachy.2016.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/03/2016] [Accepted: 08/04/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Determine feasibility and resultant dosimetry of an intraoperatively placed multichannel intracavitary brachytherapy catheter for accelerated partial breast irradiation (APBI). METHODS Patients with breast cancer underwent intraoperative brachytherapy catheter placement based on frozen section analysis with immediate postoperative APBI. The planning target volume evaluation (PTVEval) and organs at risk were contoured on daily pretreatment CT scans for each patient, and the original treatment plan was applied to assess full-course dosimetry. RESULTS Of the first 21 patients consented for intraoperative catheter placement, 20 (95%) were able to proceed with treatment as planned. The mean volume of PTVEval receiving 90% of prescription dose (V90%) and mean percentage of prescription dose to 90% of the PTVEval (D90%) on initial planning were 96.7 (±1.1%) and 100.2 (±2.1%), respectively. Full-course dose coverage remained excellent with a mean PTVEval V90% and D90% of 95.0 (±4.4%) and 100.2 (±9.6%), respectively. Mean full-course maximum dose constraints for chest wall and skin were met by 70% and 95% of patients, respectively. Air accumulation >1 cc during treatment increased the risk of a daily fraction with PTVEval coverage below goal (odds ratio, 9.8; p = 0.05), whereas those with applicators <0.5 cm from the chest wall at planning were at risk of exceeding that organ's maximum dose constraint on a daily fraction (odds ratio, 45; p = 0.02). CONCLUSIONS Intraoperative catheter placement and early initiation of APBI based on frozen section pathology is feasible, yields acceptable dosimetry, and is an option for completing breast conserving therapy in less than 10 days.
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Affiliation(s)
- Bradley J Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | | | - Amy C Degnim
- Department of Surgery, Mayo Clinic, Rochester, MN
| | - Luke B McLemore
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - Benjamin Mou
- Department of Radiation Oncology, British Columbia Cancer Agency, Centre for the Southern Interior, Kelowna, BC, Canada
| | - Robert W Mutter
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - Sean S Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN.
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28
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Hieken TJ, Mutter RW, Jakub JW, Boughey JC, Degnim AC, Sukov WR, Childs S, Corbin KS, Furutani KM, Whitaker TJ, Park SS. Erratum to: A Novel Treatment Schedule for Rapid Completion of Surgery and Radiation in Early-Stage Breast Cancer. Ann Surg Oncol 2016; 23:1059. [PMID: 27439416 DOI: 10.1245/s10434-016-5444-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Tina J Hieken
- Department of Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Robert W Mutter
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - James W Jakub
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Amy C Degnim
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - William R Sukov
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | - Stephanie Childs
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - Keith M Furutani
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - Sean S Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
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Hieken TJ, Mutter RW, Jakub JW, Boughey JC, Degnim AC, Sukov WR, Childs S, Corbin KS, Furutani KM, Whitaker TJ, Park SS. A Novel Treatment Schedule for Rapid Completion of Surgery and Radiation in Early-Stage Breast Cancer. Ann Surg Oncol 2016; 23:3297-303. [DOI: 10.1245/s10434-016-5321-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Indexed: 12/11/2022]
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Grams MP, Fong de los Santos LE, Antolak JA, Brinkmann DH, Clarke MJ, Park SS, Olivier KR, Whitaker TJ. Cadaveric verification of the Eclipse AAA algorithm for spine SBRT treatments with titanium hardware. Pract Radiat Oncol 2016; 6:131-41. [DOI: 10.1016/j.prro.2015.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 09/16/2015] [Accepted: 10/25/2015] [Indexed: 11/27/2022]
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Whitaker TJ, Beltran C, Tryggestad E, Bues M, Kruse JJ, Remmes NB, Tasson A, Herman MG. Comparison of two methods for minimizing the effect of delayed charge on the dose delivered with a synchrotron based discrete spot scanning proton beam. Med Phys 2014; 41:081703. [PMID: 25086513 DOI: 10.1118/1.4885961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Delayed charge is a small amount of charge that is delivered to the patient after the planned irradiation is halted, which may degrade the quality of the treatment by delivering unwarranted dose to the patient. This study compares two methods for minimizing the effect of delayed charge on the dose delivered with a synchrotron based discrete spot scanning proton beam. METHODS The delivery of several treatment plans was simulated by applying a normally distributed value of delayed charge, with a mean of 0.001(SD 0.00025) MU, to each spot. Two correction methods were used to account for the delayed charge. Method one (CM1), which is in active clinical use, accounts for the delayed charge by adjusting the MU of the current spot based on the cumulative MU. Method two (CM2) in addition reduces the planned MU by a predicted value. Every fraction of a treatment was simulated using each method and then recomputed in the treatment planning system. The dose difference between the original plan and the sum of the simulated fractions was evaluated. Both methods were tested in a water phantom with a single beam and simple target geometry. Two separate phantom tests were performed. In one test the dose per fraction was varied from 0.5 to 2 Gy using 25 fractions per plan. In the other test the number fractions were varied from 1 to 25, using 2 Gy per fraction. Three patient plans were used to determine the effect of delayed charge on the delivered dose under realistic clinical conditions. The order of spot delivery using CM1 was investigated by randomly selecting the starting spot for each layer, and by alternating per layer the starting spot from first to last. Only discrete spot scanning was considered in this study. RESULTS Using the phantom setup and varying the dose per fraction, the maximum dose difference for each plan of 25 fractions was 0.37-0.39 Gy and 0.03-0.05 Gy for CM1 and CM2, respectively. While varying the total number of fractions, the maximum dose difference increased at a rate of 0.015 Gy and 0.0018 Gy per fraction for CM1 and CM2, respectively. For CM1, the largest dose difference was found at the location of the first spot in each energy layer, whereas for CM2 the difference in dose was small and showed no dependence on location. For CM1, all of the fields in the patient plans had an area where their excess dose overlapped. No such correlation was found when using CM2. Randomly selecting the starting spot reduces the maximum dose difference from 0.708 to 0.15 Gy. Alternating between first and last spot reduces the maximum dose difference from 0.708 to 0.37 Gy. In the patient plans the excess dose scaled linearly at 0.014 Gy per field per fraction for CM1 and standard delivery order. CONCLUSIONS The predictive model CM2 is superior to a cumulative irradiation model CM1 for minimizing the effects of delayed charge, particularly when considering maximal dose discrepancies and the potential for unplanned hot-spots. This study shows that the dose discrepancy potentially scales at 0.014 Gy per field per fraction for CM1.
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Affiliation(s)
| | - Chris Beltran
- Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905
| | - Erik Tryggestad
- Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905
| | - Martin Bues
- Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, Arizona 85054
| | - Jon J Kruse
- Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905
| | | | | | - Michael G Herman
- Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905
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Stish BJ, Hieken TJ, Pafundi DH, Whitaker TJ, Furutani KM, Mou B, Mayo CS, Jakub JW, Boughey JC, McLemore LB, Hallemeier CL, Mutter RW, Park SS. Assessment of Dosimetric Changes and Adaptive Replanning for Intraoperatively Placed Brachytherapy Applicators during Accelerated Partial Breast Irradiation. Brachytherapy 2014. [DOI: 10.1016/j.brachy.2014.02.353] [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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Brown S, Vicini F, Vanapalli JR, Whitaker TJ, Pope DK, Lyden M, Bruggeman L, Haile KL, McLaughlin MP. Factors Associated With Chest Wall Toxicity After Accelerated Partial Breast Irradiation Using High-Dose-Rate Brachytherapy. Int J Radiat Oncol Biol Phys 2012; 83:801-5. [DOI: 10.1016/j.ijrobp.2011.08.033] [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: 04/18/2011] [Revised: 07/07/2011] [Accepted: 08/14/2011] [Indexed: 11/25/2022]
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Brown S, McLaughlin M, Pope K, Haile K, Whitaker TJ, Hughes L, Israel P. Initial radiation experience evaluating early tolerance and toxicities in patients undergoing accelerated partial breast irradiation using the Contura™ multi-lumen balloon (MLB) breast brachytherapy catheter. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-5138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Abstract #5138
Purpose: We reviewed our institution's experience treating patients with the Contura™ Multi-Lumen Balloon (MLB) breast brachytherapy catheter to deliver accelerated partial breast irradiation (APBI) to determine short-term treatment efficacy, cosmesis, toxicity and additional dosimetric capabilities of the new APBI device.
 Materials and Methods: From 05/07 to 05/08, 41 patients, from a single surgeon (PI), were treated with breast conserving therapy (BCT) received adjuvant radiation using the Contura™ catheter (34 Gy in 3.4 Gy fractions). 13/41 patients (31.7%) had stage 0 disease, 21 (51.2%) had stage I and 7 (17.1%) had stage II breast cancer.
 For each patient, the dosimetric plan was customized using the 5 high dose rate brachytherapy channels of the Contura™ catheter by selecting from 45 different dwell positions (9 per catheter).
 Results: Median, minimum skin spacing was 10 mm (range 2 to 17). The median maximum skin dose (% of prescribed dose [PD]) was 99.7 (57.1 to 124.1). Eight patients were able to be treated with a skin spacing of 5 mm or less, 2 had spacing of 2 mm. The median maximum rib dose was 102.6 % of PD (10.0 to 187.7), median percentage of the planning target volume (PTV) receiving 95% of the PD was 98.8 (79.4 to 107.4) and the median volume receiving 200% of the PD was 5.7 cc (range 1.3 to 9.9).
 The percentage of patients with excellent/good cosmetic results at 3 and 6 months was 94% (16 evaluable patients) and 89% (9 evaluable patients), respectively. One patient developed skin ulceration after receiving chemotherapy. Patient tolerance was assessed on a scale 0-10 (0=no pain, 10 = requiring narcotic analgesics). In 37/38 (97.3%) patients, pain was graded ≤ 3 at the time of catheter insertion. Four transient breast infections (11%) developed and one transient symptomatic seroma developed (3%).
 Conclusion: Adjuvant APBI using the Contura™ MLB catheter exhibited similar toxicities to standard single-lumen balloon brachytherapy with absolute improvements in dosimetric capabilities (i.e., reduced skin dose, improved PTV coverage and normal tissue avoidance). With multiple lumen planning, more conformal dosimtery was achieved as compared to single-lumen balloon treatment. This allowed the treatment of 8 patients with skin spacing of 5 mm or less, normally not achievable with single-lumen balloon treatment.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5138.
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Affiliation(s)
- S Brown
- 1 Dept. of Radiation Oncology, Wellstar Kennestone Hospital, Marietta, GA
| | - M McLaughlin
- 1 Dept. of Radiation Oncology, Wellstar Kennestone Hospital, Marietta, GA
| | - K Pope
- 2 Dept. of Radiation Physics, Wellstar Kennestone Hospital, Marietta, GA
| | - K Haile
- 1 Dept. of Radiation Oncology, Wellstar Kennestone Hospital, Marietta, GA
| | - TJ Whitaker
- 2 Dept. of Radiation Physics, Wellstar Kennestone Hospital, Marietta, GA
| | - L Hughes
- 1 Dept. of Radiation Oncology, Wellstar Kennestone Hospital, Marietta, GA
| | - P Israel
- 3 The Breast Center, Marietta, GA
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Meyer HO, Whitaker TJ, Pollock RE, Von Przewoski B, Rinckel T, Doskow J, Kuroś-Zołnierczuk J, Thörngren-Engblom P, Pancella PV, Wise T, Lorentz B, Rathmann F. Axial observables in d-->p--> breakup and the three-nucleon force. Phys Rev Lett 2004; 93:112502. [PMID: 15447333 DOI: 10.1103/physrevlett.93.112502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2004] [Indexed: 05/24/2023]
Abstract
We have measured three axial polarization observables in d-->p--> breakup with a polarized 270 MeV deuteron beam on a polarized proton target. Axial observables are zero by parity conservation in elastic scattering but can be easily observed in the breakup channel at the present energy. Based on a symmetry argument, the sensitivity of these observables to the three-nucleon force might be enhanced. Calculations without three-nucleon force are in fair agreement with our measurement, indicating that the expected sensitivity of axial observables to the three-nucleon force is not confirmed. Including a three-nucleon force in the calculation does not improve the agreement with the data.
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Affiliation(s)
- H O Meyer
- Indiana University Cyclotron Facility, Bloomington, Indiana 47405, USA
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Whitaker SB, Bouquot JE, Alimario AE, Whitaker TJ. Identification and semiquantification of estrogen and progesterone receptors in pyogenic granulomas of pregnancy. Oral Surg Oral Med Oral Pathol 1994; 78:755-60. [PMID: 7534897 DOI: 10.1016/0030-4220(94)90092-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Cases of pyogenic granuloma in pregnant women, nonpregnant women, and men were evaluated for the detection of estrogen and progesterone receptor proteins by immunoperoxidase staining. Immunostaining for estrogen receptors revealed a marked immunoreactivity of the endothelium within lesional tissue and in the overlying mucosal epithelium in many cases. Progesterone receptor immunoreactivity was only present within the epithelium, where it was much less than that of estrogen receptor immunoreactivity in both quantity (proportion of positive cells) and intensity. No characteristic staining pattern or significant quantitative difference among the three study groups could be discerned. These findings suggest that the quantity of estrogen or progesterone receptors in pyogenic granuloma is not the determining factor in the pathogenesis of this lesion. Rather, such a role may be attributed to the levels of circulating hormones. The levels of estrogen and progesterone are markedly increased in pregnancy and could therefore exert a greater effect on the endothelium of the pyogenic granuloma.
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Affiliation(s)
- S B Whitaker
- Department of Oral Diagnosis, School of Denistry, Medical College of Georgia, Augusta
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Whitaker TJ, Li A, Jones PL, Watts RO. Isotopic shift of the (5)F degrees (1) ? (3)F(2) transition in (91)Zr. Opt Lett 1992; 17:291-293. [PMID: 19784305 DOI: 10.1364/ol.17.000291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Laser-induced fluorescence spectra of Zr atoms sputtered by ion bombardment have been obtained for the (5)F degrees (1) ? (3)F(2) transition at 595.5 nm. The isotopic shift of (91)Zr is found to be -70 +/- 40 MHz relative to the (90)Zr peak. A discrepancy in literature values for the hyperfine constants of the (5)F degrees (1) state is also resolved.
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Abstract
Sequential photon-excitation, electron-impact ionization with subsequent mass analysis has been applied to a barium atomic beam. High-resolution, Doppler-free laser excitation produces the 6s6p(1)P(1) excited state, which is then ionized by electron bombardment. The excited state is selectively ionized when bombardment energies are between the excited- and ground-state ionization thresholds. Mass discrimination has permitted the recording of individual optical spectra for all the stable isotopes, including the 0.1% abundant (130)Ba and (132)Ba, in a sample with natural isotopic abundances.
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