Improved plan quality with automated radiotherapy planning for whole brain with hippocampus sparing: a comparison to the RTOG 0933 trial

Abstract

Background

Whole-brain radiation therapy (WBRT) with hippocampus sparing (HS) has been investigated by the radiation oncology working group (RTOG) 0933 trial for patients with multiple brain metastases. They showed a decrease of adverse neurocognitive effects with HS WBRT compared to WBRT alone. With the development of automated treatment planning system (aTPS) in the last years, a standardization of the plan quality at a high level was achieved. The goal of this study was to evaluate the feasibility of using an aTPS for the treatment of HS WBRT and see if the RTOG 0933 dose constraints could be achieved and improved.

Methods

Ten consecutive patients treated with HS WBRT were enrolled in this study. 10 × 3 Gy was prescribed according to the RTOG 0933 protocol to 92% of the target volume (whole-brain excluding the hippocampus expanded by 5 mm in 3-dimensions). In contrast to RTOG 0933, the maximum allowed point dose to normal brain was significantly lowered and restricted to 36.5 Gy. All patients were planned with volumetric modulated arc therapy (VMAT) technique using four arcs. Plans were optimized using Auto-Planning (AP) (Philips Radiation Oncology Systems) with one single AP template and optimization.

Results

All the constraints from the RTOG 0933 trial were achieved. A significant improvement for the maximal dose to 2% of the brain with a reduction of 4 Gy was achieved (33.5 Gy vs. RTOG 37.5 Gy) and the minimum hippocampus dose was reduced by 10% (8.1 Gy vs. RTOG 9 Gy). A steep dose gradient around the hippocampus was achieved with a mean dose of 27.3 Gy at a distance between 0.5 cm and 1 cm from the hippocampus. The effective working time to optimize a plan was kept below 6′.

Conclusion

Automated treatment planning for HS WBRT was able to fulfil all the recommendations from the RTOG 0933 study while significantly improving dose homogeneity and decreasing unnecessary hot spot in the normal brain. With this approach, a standardization of plan quality was achieved and the effective time required for plan optimization was minimized.

from Cancer via ola Kala on Inoreader http://ift.tt/2yoVu6I
via IFTTT

Exclusion of emphysematous lung from dose-volume estimates of risk improves prediction of radiation pneumonitis

Abstract

Background

The risk factors for radiation pneumonitis (RP) in patients with chronic obstructive pulmonary disease (COPD) are unclear. Mean lung dose (MLD) and percentage of irradiated lung volume are common predictors of RP, but the most accurate dosimetric parameter has not been established. We hypothesized that the total lung volume irradiated without emphysema would influence the onset of RP.

Methods

We retrospectively evaluated 100 patients who received radiotherapy for lung cancer. RP was graded according to the Common Terminology Criteria for Adverse Events (version 4.03). We quantified low attenuation volume (LAV) using quantitative computed tomography analysis. The association between RP and traditional dosimetric parameters including MLD, volume of the lung receiving a dose of ≥2 Gy, ≥ 5 Gy, ≥ 10 Gy, ≥ 20 Gy, and ≥30 Gy, and counterpart measurements of the lung without LAV, were analyzed by logistic regression. We compared each dosimetric parameter for RP using multiple predictive performance measures including area under the receiver operating characteristic curve (AUC) and integrated discrimination improvement (IDI).

Results

Of 100 patients, RP of Grades 1, 2, 3, 4, and 5 was diagnosed in 24, 12, 13, 1, and 1 patients, respectively. Compared with traditional dosimetric parameters, counterpart measurements without LAV improved risk prediction of symptomatic RP. The ratio of the lung without LAV receiving ≥30 Gy to the total lung volume without LAV most accurately predicted symptomatic RP (AUC, 0.894; IDI, 0.064).

Conclusion

Irradiated lung volume without LAV predicted RP more accurately than traditional dosimetric parameters.

from Cancer via ola Kala on Inoreader http://ift.tt/2gm9V5b
via IFTTT

Comparative study of the effects of different radiation qualities on normal human breast cells

Abstract

Background

As there is a growing number of long-term cancer survivors, the incidence of carcinogenesis as a late effect of radiotherapy is getting more and more into the focus. The risk for the development of secondary malignant neoplasms might be significantly increased due to exposure of healthy tissue outside of the target field to secondary neutrons, in particular in proton therapy. Thus far, the radiobiological effects of these neutrons and a comparison with photons on normal breast cells have not been sufficiently characterised.

Methods

MCF10A cells were irradiated with doses of up to 2 Gy with neutrons of different energy spectra and X-rays for comparison. The biological effects of neutrons with a broad energy distribution (<E _n > = 5.8 MeV), monoenergetic neutrons (1.2 MeV, 0.56 MeV) and of the mixed field of gamma's and secondary neutrons (<E _n > = 70.5 MeV) produced by 190 MeV protons impinging on a water phantom, were analysed. The clonogenic survival and the DNA repair capacity were determined and values of relative biological effectiveness were compared. Furthermore, the influence of radiation on the sphere formation was observed to examine the radiation response of the potential fraction of stem like cells within the MCF10A cell population.

Results

X-rays and neutrons caused dose-dependent decreases of survival fractions after irradiations with up to 2 Gy. Monoenergetic neutrons with an energy of 0.56 MeV had a higher effectiveness on the survival fraction with respect to neutrons with higher energies and to the mixed gamma - secondary neutron field induced by proton interactions in water. Similar effects were observed for the DNA repair capacity after exposure to ionising radiation (IR). Both experimental endpoints provided comparable values of the relative biological effectiveness. Significant changes in the sphere formation were notable following the various radiation qualities.

Conclusion

The present study compared the radiation response of MCF10A cells after IR with neutrons and photons. For the first time it was shown that monoenergetic neutrons with energies around 1 MeV have stronger radiobiological effects on normal human breast cells with respect to X rays, to neutrons with a broad energy distribution (<E _n > = 5.8 MeV), and to the mixed gamma - secondary neutron field given by interactions of 190 MeV protons in water. The results of the present study are highly relevant for further investigations of radiation-induced carcinogenesis and are very important in perspective for a better risk assessment after secondary neutron exposure in the field of conventional and proton radiotherapy.

from Cancer via ola Kala on Inoreader http://ift.tt/2yoYq3g
via IFTTT

CT imaging features associated with recurrence in non-small cell lung cancer patients after stereotactic body radiotherapy

Abstract

Background

Predicting recurrence after stereotactic body radiotherapy (SBRT) in non-small cell lung cancer (NSCLC) patients is problematic, but critical for the decision of following treatment. This study aims to investigate the association of imaging features derived from the first follow-up computed tomography (CT) on lung cancer patient outcomes following SBRT, and identify patients at high risk of recurrence.

Methods

Fifty nine biopsy-proven non-small cell lung cancer patients were qualified for this study. The first follow-up CTs were performed about 3 months after SBRT (median time: 91 days). Imaging features included 34 manually scored radiological features (semantics) describing the lesion, lung and thorax and 219 quantitative imaging features (radiomics) extracted automatically after delineation of the lesion. Cox proportional hazard models and Harrel's C-index were used to explore predictors of overall survival (OS), recurrence-free survival (RFS), and loco-regional recurrence-free survival (LR-RFS). Five-fold cross validation was performed on the final prognostic model.

Results

The median follow-up time was 42 months. The model for OS contained Eastern Cooperative Oncology Group (ECOG) performance status (HR = 3.13, 95% CI: 1.17–8.41), vascular involvement (HR = 3.21, 95% CI: 1.29–8.03), lymphadenopathy (HR = 3.59, 95% CI: 1.58–8.16) and the 1st principle component of radiomic features (HR = 1.24, 95% CI: 1.02–1.51). The model for RFS contained vascular involvement (HR = 3.06, 95% CI: 1.40–6.70), vessel attachment (HR = 3.46, 95% CI: 1.65–7.25), pleural retraction (HR = 3.24, 95% CI: 1.41–7.42), lymphadenopathy (HR = 6.41, 95% CI: 2.58–15.90) and relative enhancement (HR = 1.40, 95% CI: 1.00–1.96). The model for LR-RFS contained vascular involvement (HR = 4.96, 95% CI: 2.23–11.03), lymphadenopathy (HR = 2.64, 95% CI: 1.19–5.82), circularity (F13, HR = 1.60, 95% CI: 1.10–2.32) and 3D Laws feature (F92, HR = 1.96, 95% CI: 1.35–2.83). Five-fold cross-validated the areas under the receiver operating characteristic curves (AUC) of these three models were all above 0.8.

Conclusions

Our analysis reveals disease progression could be prognosticated as early as 3 months after SBRT using CT imaging features, and these features would be helpful in clinical decision-making.

from Cancer via ola Kala on Inoreader http://ift.tt/2giy5xt
via IFTTT

Combined high dose radiation and pazopanib in metastatic renal cell carcinoma: a phase I dose escalation trial

Abstract

Background

The primary objective was to determine maximum tolerated radiation dose in patients with metastatic renal cell carcinoma on pazopanib treatment.

Methods

Treatment-naïve patients received pazopanib according to standard of care. Stereotactic body radiotherapy (SBRT) was delivered concurrently to the largest metastatic lesion at day 8, 10 and 12. SBRT doses were escalated in 3 dose levels (24 Gy/3, 30 Gy/3 and 36 Gy/3). Dose level was assigned using Time-to-Event Continual Reassessment Method with the target dose-limiting toxicity rate set to 0.25.

Results

Thirteen patients were included. One patient experienced dose limiting toxicity (DLT) at dose level 3 (grade 4 hypoglycemia). Maximum tolerated dose was not reached with a recommended dose of 36 Gy/3 having a probability of DLT of 11%. One-year local control was 83% (95% confidence interval 61–100) and 1-year progression-free survival was 28% (95% confidence interval 1–55).

Conclusions

SBRT in combination with pazopanib is well tolerated with good local control and response rates outside the radiation field.

Trial registration

This trial was retrospectively registered on clinicaltrials.gov(NCT02334709) on January 6th, 2015.

from Cancer via ola Kala on Inoreader http://ift.tt/2yoTUBJ
via IFTTT

Comparison of volumetric-modulated arc therapy using simultaneous integrated boosts (SIB-VMAT) of 45 Gy/55 Gy in 25 fractions with conventional radiotherapy in preoperative chemoradiation for rectal cancers: a propensity score case-matched analysis

Abstract

Background and purpose

The aim of this retrospective study was to compare volumetric-modulated arc therapy using simultaneous integrated boosts (SIB-VMAT) of 45 Gy/55 Gy in 25 fractions with three-dimensional conformal radiotherapy (3D–CRT) in preoperative chemoradiation for rectal cancers.

Methods and materials

In the propensity score-matching analysis of 1:2, we selected 60 patients from the SIB-VMAT group and 120patients from the 3D–CRT group matched pairings out of 145 patients between 2005 and 2015. The regimen of concurrent combined chemotherapy was oral uracil/tegafur plus leucovorin with/without irinotecan.

Results

There were no significant differences between the two groups, in pathological complete response rates (pCR) (11% in the 3D–CRT group vs. 17% in the SIB-VMAT group, P = 0.39), pathological response rates (44% vs. 60%, P = 0.77), disease-free survival (P = 0.32), or local control (P = 0.52). The SIB-VMAT method marginally improved the rate of pathological grade 2–3 effects and the OS was significantly better in patients with grade 2–3 effects. Recurrence was seen in 36 patients (30%) in the 3D–CRT group and 19 patients (32%) in the SIB-VMAT group. The first distant recurrence site in the SIB-VMAT group was liver in 6 patients and lung in 8 patients. The obvious radiation-induced late toxicity in the SIB-VMAT group was recto-vesical fistula in two patients.

Conclusions

The SIB-VMAT may be a promising method for preoperative CRT of rectal cancer.

from Cancer via ola Kala on Inoreader http://ift.tt/2yodwG2
via IFTTT

Improved plan quality with automated radiotherapy planning for whole brain with hippocampus sparing: a comparison to the RTOG 0933 trial

Abstract

Background

Whole-brain radiation therapy (WBRT) with hippocampus sparing (HS) has been investigated by the radiation oncology working group (RTOG) 0933 trial for patients with multiple brain metastases. They showed a decrease of adverse neurocognitive effects with HS WBRT compared to WBRT alone. With the development of automated treatment planning system (aTPS) in the last years, a standardization of the plan quality at a high level was achieved. The goal of this study was to evaluate the feasibility of using an aTPS for the treatment of HS WBRT and see if the RTOG 0933 dose constraints could be achieved and improved.

Methods

Ten consecutive patients treated with HS WBRT were enrolled in this study. 10 × 3 Gy was prescribed according to the RTOG 0933 protocol to 92% of the target volume (whole-brain excluding the hippocampus expanded by 5 mm in 3-dimensions). In contrast to RTOG 0933, the maximum allowed point dose to normal brain was significantly lowered and restricted to 36.5 Gy. All patients were planned with volumetric modulated arc therapy (VMAT) technique using four arcs. Plans were optimized using Auto-Planning (AP) (Philips Radiation Oncology Systems) with one single AP template and optimization.

Results

All the constraints from the RTOG 0933 trial were achieved. A significant improvement for the maximal dose to 2% of the brain with a reduction of 4 Gy was achieved (33.5 Gy vs. RTOG 37.5 Gy) and the minimum hippocampus dose was reduced by 10% (8.1 Gy vs. RTOG 9 Gy). A steep dose gradient around the hippocampus was achieved with a mean dose of 27.3 Gy at a distance between 0.5 cm and 1 cm from the hippocampus. The effective working time to optimize a plan was kept below 6′.

Conclusion

Automated treatment planning for HS WBRT was able to fulfil all the recommendations from the RTOG 0933 study while significantly improving dose homogeneity and decreasing unnecessary hot spot in the normal brain. With this approach, a standardization of plan quality was achieved and the effective time required for plan optimization was minimized.

http://ift.tt/2yoVu6I

Exclusion of emphysematous lung from dose-volume estimates of risk improves prediction of radiation pneumonitis

Abstract

Background

The risk factors for radiation pneumonitis (RP) in patients with chronic obstructive pulmonary disease (COPD) are unclear. Mean lung dose (MLD) and percentage of irradiated lung volume are common predictors of RP, but the most accurate dosimetric parameter has not been established. We hypothesized that the total lung volume irradiated without emphysema would influence the onset of RP.

Methods

We retrospectively evaluated 100 patients who received radiotherapy for lung cancer. RP was graded according to the Common Terminology Criteria for Adverse Events (version 4.03). We quantified low attenuation volume (LAV) using quantitative computed tomography analysis. The association between RP and traditional dosimetric parameters including MLD, volume of the lung receiving a dose of ≥2 Gy, ≥ 5 Gy, ≥ 10 Gy, ≥ 20 Gy, and ≥30 Gy, and counterpart measurements of the lung without LAV, were analyzed by logistic regression. We compared each dosimetric parameter for RP using multiple predictive performance measures including area under the receiver operating characteristic curve (AUC) and integrated discrimination improvement (IDI).

Results

Of 100 patients, RP of Grades 1, 2, 3, 4, and 5 was diagnosed in 24, 12, 13, 1, and 1 patients, respectively. Compared with traditional dosimetric parameters, counterpart measurements without LAV improved risk prediction of symptomatic RP. The ratio of the lung without LAV receiving ≥30 Gy to the total lung volume without LAV most accurately predicted symptomatic RP (AUC, 0.894; IDI, 0.064).

Conclusion

Irradiated lung volume without LAV predicted RP more accurately than traditional dosimetric parameters.

http://ift.tt/2gm9V5b

Comparative study of the effects of different radiation qualities on normal human breast cells

Abstract

Background

As there is a growing number of long-term cancer survivors, the incidence of carcinogenesis as a late effect of radiotherapy is getting more and more into the focus. The risk for the development of secondary malignant neoplasms might be significantly increased due to exposure of healthy tissue outside of the target field to secondary neutrons, in particular in proton therapy. Thus far, the radiobiological effects of these neutrons and a comparison with photons on normal breast cells have not been sufficiently characterised.

Methods

MCF10A cells were irradiated with doses of up to 2 Gy with neutrons of different energy spectra and X-rays for comparison. The biological effects of neutrons with a broad energy distribution (<E _n > = 5.8 MeV), monoenergetic neutrons (1.2 MeV, 0.56 MeV) and of the mixed field of gamma's and secondary neutrons (<E _n > = 70.5 MeV) produced by 190 MeV protons impinging on a water phantom, were analysed. The clonogenic survival and the DNA repair capacity were determined and values of relative biological effectiveness were compared. Furthermore, the influence of radiation on the sphere formation was observed to examine the radiation response of the potential fraction of stem like cells within the MCF10A cell population.

Results

X-rays and neutrons caused dose-dependent decreases of survival fractions after irradiations with up to 2 Gy. Monoenergetic neutrons with an energy of 0.56 MeV had a higher effectiveness on the survival fraction with respect to neutrons with higher energies and to the mixed gamma - secondary neutron field induced by proton interactions in water. Similar effects were observed for the DNA repair capacity after exposure to ionising radiation (IR). Both experimental endpoints provided comparable values of the relative biological effectiveness. Significant changes in the sphere formation were notable following the various radiation qualities.

Conclusion

The present study compared the radiation response of MCF10A cells after IR with neutrons and photons. For the first time it was shown that monoenergetic neutrons with energies around 1 MeV have stronger radiobiological effects on normal human breast cells with respect to X rays, to neutrons with a broad energy distribution (<E _n > = 5.8 MeV), and to the mixed gamma - secondary neutron field given by interactions of 190 MeV protons in water. The results of the present study are highly relevant for further investigations of radiation-induced carcinogenesis and are very important in perspective for a better risk assessment after secondary neutron exposure in the field of conventional and proton radiotherapy.

http://ift.tt/2yoYq3g

CT imaging features associated with recurrence in non-small cell lung cancer patients after stereotactic body radiotherapy

Abstract

Background

Predicting recurrence after stereotactic body radiotherapy (SBRT) in non-small cell lung cancer (NSCLC) patients is problematic, but critical for the decision of following treatment. This study aims to investigate the association of imaging features derived from the first follow-up computed tomography (CT) on lung cancer patient outcomes following SBRT, and identify patients at high risk of recurrence.

Methods

Fifty nine biopsy-proven non-small cell lung cancer patients were qualified for this study. The first follow-up CTs were performed about 3 months after SBRT (median time: 91 days). Imaging features included 34 manually scored radiological features (semantics) describing the lesion, lung and thorax and 219 quantitative imaging features (radiomics) extracted automatically after delineation of the lesion. Cox proportional hazard models and Harrel's C-index were used to explore predictors of overall survival (OS), recurrence-free survival (RFS), and loco-regional recurrence-free survival (LR-RFS). Five-fold cross validation was performed on the final prognostic model.

Results

The median follow-up time was 42 months. The model for OS contained Eastern Cooperative Oncology Group (ECOG) performance status (HR = 3.13, 95% CI: 1.17–8.41), vascular involvement (HR = 3.21, 95% CI: 1.29–8.03), lymphadenopathy (HR = 3.59, 95% CI: 1.58–8.16) and the 1st principle component of radiomic features (HR = 1.24, 95% CI: 1.02–1.51). The model for RFS contained vascular involvement (HR = 3.06, 95% CI: 1.40–6.70), vessel attachment (HR = 3.46, 95% CI: 1.65–7.25), pleural retraction (HR = 3.24, 95% CI: 1.41–7.42), lymphadenopathy (HR = 6.41, 95% CI: 2.58–15.90) and relative enhancement (HR = 1.40, 95% CI: 1.00–1.96). The model for LR-RFS contained vascular involvement (HR = 4.96, 95% CI: 2.23–11.03), lymphadenopathy (HR = 2.64, 95% CI: 1.19–5.82), circularity (F13, HR = 1.60, 95% CI: 1.10–2.32) and 3D Laws feature (F92, HR = 1.96, 95% CI: 1.35–2.83). Five-fold cross-validated the areas under the receiver operating characteristic curves (AUC) of these three models were all above 0.8.

Conclusions

Our analysis reveals disease progression could be prognosticated as early as 3 months after SBRT using CT imaging features, and these features would be helpful in clinical decision-making.

http://ift.tt/2giy5xt

Combined high dose radiation and pazopanib in metastatic renal cell carcinoma: a phase I dose escalation trial

Abstract

Background

The primary objective was to determine maximum tolerated radiation dose in patients with metastatic renal cell carcinoma on pazopanib treatment.

Methods

Treatment-naïve patients received pazopanib according to standard of care. Stereotactic body radiotherapy (SBRT) was delivered concurrently to the largest metastatic lesion at day 8, 10 and 12. SBRT doses were escalated in 3 dose levels (24 Gy/3, 30 Gy/3 and 36 Gy/3). Dose level was assigned using Time-to-Event Continual Reassessment Method with the target dose-limiting toxicity rate set to 0.25.

Results

Thirteen patients were included. One patient experienced dose limiting toxicity (DLT) at dose level 3 (grade 4 hypoglycemia). Maximum tolerated dose was not reached with a recommended dose of 36 Gy/3 having a probability of DLT of 11%. One-year local control was 83% (95% confidence interval 61–100) and 1-year progression-free survival was 28% (95% confidence interval 1–55).

Conclusions

SBRT in combination with pazopanib is well tolerated with good local control and response rates outside the radiation field.

Trial registration

This trial was retrospectively registered on clinicaltrials.gov(NCT02334709) on January 6th, 2015.

http://ift.tt/2yoTUBJ

Comparison of volumetric-modulated arc therapy using simultaneous integrated boosts (SIB-VMAT) of 45 Gy/55 Gy in 25 fractions with conventional radiotherapy in preoperative chemoradiation for rectal cancers: a propensity score case-matched analysis

Abstract

Background and purpose

The aim of this retrospective study was to compare volumetric-modulated arc therapy using simultaneous integrated boosts (SIB-VMAT) of 45 Gy/55 Gy in 25 fractions with three-dimensional conformal radiotherapy (3D–CRT) in preoperative chemoradiation for rectal cancers.

Methods and materials

In the propensity score-matching analysis of 1:2, we selected 60 patients from the SIB-VMAT group and 120patients from the 3D–CRT group matched pairings out of 145 patients between 2005 and 2015. The regimen of concurrent combined chemotherapy was oral uracil/tegafur plus leucovorin with/without irinotecan.

Results

There were no significant differences between the two groups, in pathological complete response rates (pCR) (11% in the 3D–CRT group vs. 17% in the SIB-VMAT group, P = 0.39), pathological response rates (44% vs. 60%, P = 0.77), disease-free survival (P = 0.32), or local control (P = 0.52). The SIB-VMAT method marginally improved the rate of pathological grade 2–3 effects and the OS was significantly better in patients with grade 2–3 effects. Recurrence was seen in 36 patients (30%) in the 3D–CRT group and 19 patients (32%) in the SIB-VMAT group. The first distant recurrence site in the SIB-VMAT group was liver in 6 patients and lung in 8 patients. The obvious radiation-induced late toxicity in the SIB-VMAT group was recto-vesical fistula in two patients.

Conclusions

The SIB-VMAT may be a promising method for preoperative CRT of rectal cancer.

http://ift.tt/2yodwG2

Evaluation of aprepitant for acute chemotherapy-induced nausea and vomiting in children and adolescents with acute lymphoblastic leukemia receiving high-dose methotrexate

Abstract

Background

Chemotherapy-induced nausea and vomiting (CINV) negatively impacts patients' quality of life. The emetogenicity of high-dose methotrexate in children and adolescents with cancer is incompletely characterized. At our institution, a number of patients with acute lymphoblastic leukemia (ALL) have received aprepitant with courses of high-dose methotrexate after poor CINV control with prior courses.

Procedure

We conducted a retrospective cohort analysis on patients with ALL who received methotrexate 5 g/m²/dose with and without concomitant aprepitant at Texas. Children's Hospital between October 1, 2010 and January 31, 2016.

Results

We identified 16 patients who received a total of 69 courses of methotrexate. An enhanced antiemetic regimen containing aprepitant was administered with 42 methotrexate courses and resulted in a 54% reduction in the use of as-needed antiemetics (P = 0.002, 95% CI: 21–89%). There were no statistically significant differences in methotrexate area under the curve values (2,209 μM⋅hr/l ± 151 vs. 2,051 μM⋅hr/l ± 94, P = 0.355) or end-infusion methotrexate concentrations (80.5 μM ± 5.6 vs. 74.7 μM ± 3.2, P = 0.335) in patients receiving a standard versus an enhanced antiemetic regimen.

Conclusions

The addition of aprepitant reduces both CINV and the use of rescue antiemetics. Aprepitant does not appear to affect the pharmacokinetics of methotrexate. Granisetron was prescribed more frequently than ondansetron, but selection of secondary and tertiary agents, if any, was highly variable.

http://ift.tt/2yieWCQ

Medication contaminants as a potential cause of anaphylaxis to vincristine: What about drug-specific antigens?

http://ift.tt/2g8OGjI

Evaluation of aprepitant for acute chemotherapy-induced nausea and vomiting in children and adolescents with acute lymphoblastic leukemia receiving high-dose methotrexate

Abstract

Background

Chemotherapy-induced nausea and vomiting (CINV) negatively impacts patients' quality of life. The emetogenicity of high-dose methotrexate in children and adolescents with cancer is incompletely characterized. At our institution, a number of patients with acute lymphoblastic leukemia (ALL) have received aprepitant with courses of high-dose methotrexate after poor CINV control with prior courses.

Procedure

We conducted a retrospective cohort analysis on patients with ALL who received methotrexate 5 g/m²/dose with and without concomitant aprepitant at Texas. Children's Hospital between October 1, 2010 and January 31, 2016.

Results

We identified 16 patients who received a total of 69 courses of methotrexate. An enhanced antiemetic regimen containing aprepitant was administered with 42 methotrexate courses and resulted in a 54% reduction in the use of as-needed antiemetics (P = 0.002, 95% CI: 21–89%). There were no statistically significant differences in methotrexate area under the curve values (2,209 μM⋅hr/l ± 151 vs. 2,051 μM⋅hr/l ± 94, P = 0.355) or end-infusion methotrexate concentrations (80.5 μM ± 5.6 vs. 74.7 μM ± 3.2, P = 0.335) in patients receiving a standard versus an enhanced antiemetic regimen.

Conclusions

The addition of aprepitant reduces both CINV and the use of rescue antiemetics. Aprepitant does not appear to affect the pharmacokinetics of methotrexate. Granisetron was prescribed more frequently than ondansetron, but selection of secondary and tertiary agents, if any, was highly variable.

from Cancer via ola Kala on Inoreader http://ift.tt/2yieWCQ
via IFTTT

Medication contaminants as a potential cause of anaphylaxis to vincristine: What about drug-specific antigens?

from Cancer via ola Kala on Inoreader http://ift.tt/2g8OGjI
via IFTTT

Cancers, Vol. 9, Pages 137: STAT3 but Not HIF-1α Is Important in Mediating Hypoxia-Induced Chemoresistance in MDA-MB-231, a Triple Negative Breast Cancer Cell Line

Cancers, Vol. 9, Pages 137: STAT3 but Not HIF-1α Is Important in Mediating Hypoxia-Induced Chemoresistance in MDA-MB-231, a Triple Negative Breast Cancer Cell Line

Cancers doi: 10.3390/cancers9100137

Authors: Hoda Soleymani Abyaneh Nidhi Gupta Aneta Radziwon-Balicka Paul Jurasz John Seubert Raymond Lai Afsaneh Lavasanifar

Hypoxia-induced chemoresistance (HICR) is a well-recognized phenomenon, and in many experimental models, hypoxia inducible factor-1α (HIF-1α) is believed to be a key player. We aimed to better understand the mechanism underlying HICR in a triple negative breast cancer cell line, MDA-MB-231, with a focus on the role of HIF-1α. In this context, the effect of hypoxia on the sensitivity of MDA-MB-231 cells to cisplatin and their stem-like features was evaluated and the role of HIF-1α in both phenomena was assessed. Our results showed that hypoxia significantly increased MDA-MB-231 resistance to cisplatin. Correlating with this, intracellular uptake of cisplatin was significantly reduced under hypoxia. Furthermore, the stem-like features of MDA-MB-231 cells increased as evidenced by the significant increases in the expression of ATP-binding cassette (ABC) drug transporters, the proportion of CD44+/CD24− cells, clonogenic survival and cisplatin chemoresistance. Under hypoxia, both the protein level and DNA binding of HIF-1α was dramatically increased. Surprisingly, siRNA knockdown of HIF-1α did not result in an appreciable change to HICR. Instead, signal transducer and activator of transcription 3 (STAT3) activation was found to be important. STAT3 activation may confer HICR by upregulating ABC transporters, particularly ABCC2 and ABCC6. This study has demonstrated that, in MDA-MB-231 cells, STAT3 rather than HIF-1α is important in mediating HICR to cisplatin.

http://ift.tt/2xEGApm

Cancers, Vol. 9, Pages 137: STAT3 but Not HIF-1α Is Important in Mediating Hypoxia-Induced Chemoresistance in MDA-MB-231, a Triple Negative Breast Cancer Cell Line

Cancers, Vol. 9, Pages 137: STAT3 but Not HIF-1α Is Important in Mediating Hypoxia-Induced Chemoresistance in MDA-MB-231, a Triple Negative Breast Cancer Cell Line

Cancers doi: 10.3390/cancers9100137

Authors: Hoda Soleymani Abyaneh Nidhi Gupta Aneta Radziwon-Balicka Paul Jurasz John Seubert Raymond Lai Afsaneh Lavasanifar

Hypoxia-induced chemoresistance (HICR) is a well-recognized phenomenon, and in many experimental models, hypoxia inducible factor-1α (HIF-1α) is believed to be a key player. We aimed to better understand the mechanism underlying HICR in a triple negative breast cancer cell line, MDA-MB-231, with a focus on the role of HIF-1α. In this context, the effect of hypoxia on the sensitivity of MDA-MB-231 cells to cisplatin and their stem-like features was evaluated and the role of HIF-1α in both phenomena was assessed. Our results showed that hypoxia significantly increased MDA-MB-231 resistance to cisplatin. Correlating with this, intracellular uptake of cisplatin was significantly reduced under hypoxia. Furthermore, the stem-like features of MDA-MB-231 cells increased as evidenced by the significant increases in the expression of ATP-binding cassette (ABC) drug transporters, the proportion of CD44+/CD24− cells, clonogenic survival and cisplatin chemoresistance. Under hypoxia, both the protein level and DNA binding of HIF-1α was dramatically increased. Surprisingly, siRNA knockdown of HIF-1α did not result in an appreciable change to HICR. Instead, signal transducer and activator of transcription 3 (STAT3) activation was found to be important. STAT3 activation may confer HICR by upregulating ABC transporters, particularly ABCC2 and ABCC6. This study has demonstrated that, in MDA-MB-231 cells, STAT3 rather than HIF-1α is important in mediating HICR to cisplatin.

from Cancer via ola Kala on Inoreader http://ift.tt/2xEGApm
via IFTTT

Identification of coronary artery anatomy on dual-source cardiac computed tomography before arterial switch operation in newborns and young infants: comparison with transthoracic echocardiography

Abstract

Background

Considering inherent limitations of transthoracic echocardiography, the diagnostic accuracy of cardiac CT in identifying coronary artery anatomy before arterial switch operation needs to be investigated with recently improved coronary artery visibility using electrocardiogram (ECG)-synchronized dual-source CT.

Objective

To compare diagnostic accuracy between cardiac CT using a dual-source scanner and transthoracic echocardiography in identifying coronary artery anatomy before arterial switch operation in newborns and young infants.

Materials and methods

The study included 101 infants (median age 4 days, range 0 days to 10 months; M:F=78:23) who underwent ECG-synchronized cardiac dual-source CT and transthoracic echocardiography before arterial switch operation between July 2011 and December 2016. We evaluated and classified coronary artery anatomy on cardiac CT and transthoracic echocardiography. With the surgical findings as the reference standard, we compared the diagnostic accuracy for identifying coronary artery anatomy between cardiac CT and transthoracic echocardiography.

Results

The most common coronary artery pattern was the usual pattern (left coronary artery from sinus 1 and right coronary artery from sinus 2; 64.4%, 65/101), followed by a single coronary artery from sinus 2 and a conal branch from sinus 1 (7.9%, 8/101), the inverted pattern (5.9%, 6/101), the right coronary artery and left anterior descending artery from sinus 1 and the left circumflex artery from sinus 2 (5.9%, 6/101), and others. In 96 infants with surgically proven coronary artery anatomy, the diagnostic accuracy of cardiac CT was significantly higher than that of transthoracic echocardiography (91.7%, 88/96 vs. 54.2%, 52/96; P<0.0001).

Conclusion

Diagnostic accuracy of cardiac CT is significantly higher than that of echocardiography in identifying coronary artery anatomy before arterial switch operation in newborns and young infants.

from Cancer via ola Kala on Inoreader http://ift.tt/2gj6In2
via IFTTT

Identification of coronary artery anatomy on dual-source cardiac computed tomography before arterial switch operation in newborns and young infants: comparison with transthoracic echocardiography

Abstract

Background

Considering inherent limitations of transthoracic echocardiography, the diagnostic accuracy of cardiac CT in identifying coronary artery anatomy before arterial switch operation needs to be investigated with recently improved coronary artery visibility using electrocardiogram (ECG)-synchronized dual-source CT.

Objective

To compare diagnostic accuracy between cardiac CT using a dual-source scanner and transthoracic echocardiography in identifying coronary artery anatomy before arterial switch operation in newborns and young infants.

Materials and methods

The study included 101 infants (median age 4 days, range 0 days to 10 months; M:F=78:23) who underwent ECG-synchronized cardiac dual-source CT and transthoracic echocardiography before arterial switch operation between July 2011 and December 2016. We evaluated and classified coronary artery anatomy on cardiac CT and transthoracic echocardiography. With the surgical findings as the reference standard, we compared the diagnostic accuracy for identifying coronary artery anatomy between cardiac CT and transthoracic echocardiography.

Results

The most common coronary artery pattern was the usual pattern (left coronary artery from sinus 1 and right coronary artery from sinus 2; 64.4%, 65/101), followed by a single coronary artery from sinus 2 and a conal branch from sinus 1 (7.9%, 8/101), the inverted pattern (5.9%, 6/101), the right coronary artery and left anterior descending artery from sinus 1 and the left circumflex artery from sinus 2 (5.9%, 6/101), and others. In 96 infants with surgically proven coronary artery anatomy, the diagnostic accuracy of cardiac CT was significantly higher than that of transthoracic echocardiography (91.7%, 88/96 vs. 54.2%, 52/96; P<0.0001).

Conclusion

Diagnostic accuracy of cardiac CT is significantly higher than that of echocardiography in identifying coronary artery anatomy before arterial switch operation in newborns and young infants.

http://ift.tt/2gj6In2

Microvesicles releasing by oral cancer cells enhance endothelial cell angiogenesis via Shh/RhoA signaling pathway

.


http://ift.tt/2ynODu7

Expression of SESN1, UHRF1BP1, and miR-377-3p as prognostic markers in mutated TP53 squamous cell carcinoma of the head and neck

.


http://ift.tt/2xEQyqv

Leptomeningeal carcinomatosis from gastric cancer successfully treated by the intrathecal methotrexate plus temozolomide and simultaneous radiotherapy: Case report and literatures review

.


http://ift.tt/2ynxb96

MALAT1/miR-124/Capn4 axis regulates proliferation, invasion and EMT in nasopharyngeal carcinoma cells

.


http://ift.tt/2xF8OA2

Microvesicles releasing by oral cancer cells enhance endothelial cell angiogenesis via Shh/RhoA signaling pathway

.


from Cancer via ola Kala on Inoreader http://ift.tt/2ynODu7
via IFTTT

Expression of SESN1, UHRF1BP1, and miR-377-3p as prognostic markers in mutated TP53 squamous cell carcinoma of the head and neck

.


from Cancer via ola Kala on Inoreader http://ift.tt/2xEQyqv
via IFTTT

Leptomeningeal carcinomatosis from gastric cancer successfully treated by the intrathecal methotrexate plus temozolomide and simultaneous radiotherapy: Case report and literatures review

.


from Cancer via ola Kala on Inoreader http://ift.tt/2ynxb96
via IFTTT

MALAT1/miR-124/Capn4 axis regulates proliferation, invasion and EMT in nasopharyngeal carcinoma cells

.


from Cancer via ola Kala on Inoreader http://ift.tt/2xF8OA2
via IFTTT

Molecular alterations and clinical prognostic factors for cholangiocarcinoma in Thai population

http://ift.tt/2yowqNk

Mutation analysis and copy number alterations of KIF23 in non-small-cell lung cancer exhibiting KIF23 over-expression

http://ift.tt/2giDfJN

Prognostication and Initiation of Therapy in Polycythemia Vera: Do We Have it Right?

Abstract

ᅟ

from Cancer via ola Kala on Inoreader http://ift.tt/2hGD1cb
via IFTTT

Prognostication and Initiation of Therapy in Polycythemia Vera: Do We Have it Right?

Abstract

ᅟ

http://ift.tt/2hGD1cb

Clinical Characteristics of Patients Experiencing Pathologic Complete Response Following Neoadjuvant Therapy for Borderline Resectable/Locally Advanced Pancreatic Adenocarcinoma.

Objectives: The purpose of this study is to describe clinical characteristics and outcomes of patients with borderline resectable pancreatic cancer (BRPC) or locally advanced pancreatic cancer (LAPC) who achieved pathologic complete response (pCR) following neoadjuvant therapy. Materials and Methods: A single institution clinical database for patients with pancreatic ductal adenocarcinoma was queried. Between 2008 and 2014 patients were identified with BRPC and LAPC, who underwent surgical resection after receiving neoadjuvant treatment. Clinical and pathologic features of the patients who achieved pCR were acquired retrospectively. Results: Six patients were identified to have pCR on pathology of the postoperative specimen. On the basis of pretreatment clinical staging, 2 patients were considered to have BRPC and 4 LAPC. Four patients received gemcitabine-based chemotherapy and 2 patients received FOLFIRINOX (5-fluorouracil, oxaliplatin, irinotecan, and leucovorin). Five of 6 patients received radiation therapy before operative resection. Operative procedures included distal pancreatectomy (n=3) and pancreatoduodenectomy (n=3). Pancreatic intraepithelial neoplasia 1 to 2 was present in 3 cases, and pancreatic intraepithelial neoplasia 3 in 1 case. During a median follow-up of 21.3 months, 2 patients died, with a median survival of 11.0 months (range, 10.4 to 11.6 mo). Four patients are alive and continue to follow-up with median survival of 28.7 months (range, 20.1 to 42.4 mo). Conclusions: Multimodality neoadjuvant therapy may lead to complete pathologic response in a small number of patients with borderline resectable/locally advanced pancreatic adenocarcinoma. pCR to neoadjuvant therapy does not lead to cure in most cases, and the majority of patients appear to relapse locally or systemically. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

from Cancer via ola Kala on Inoreader http://ift.tt/2gFgkFD
via IFTTT

"Lost to Follow-up" Among Adult Cancer Survivors.

Background: Follow-up cancer care is important for patients who have received IV chemotherapy but some patients discontinue their care and are lost to follow-up (LFU) at the cancer center where they were treated. The purpose of this study was to determine what proportion of cancer survivors are LFU at 5 years after treatment, the timing of LFU, and the characteristics of those who do not continue survivorship care. Methods: Adult patients with cancer who were treated with chemotherapy at a large community teaching hospital in 2006 and 2007 were identified and linked with State tumor registry data. Hospital medical records were reviewed to obtain information on demographics, diagnosis, treatment, and date of last follow-up visit. Characteristics of patients with >=5 years of follow-up care were compared with those who were LFU. Results: In total, 487 patients received chemotherapy and 304 died (62%) during the 5-year follow-up period. Among the 183 cancer patients who were known to be alive at 5 years, 92 (50%) were LFU and 50% (46/92) of this LFU group were LFU within 1 year of diagnosis. At 5 years, follow-up care was continuing for 55% of women, compared with 39% of men. The highest proportion of follow-up was observed among lung cancer patients (84%), followed by patients with breast cancers (63%) and gastrointestinal cancers (40%). Patients with hematological cancers had the lowest follow-up proportion at 5 years (29%) (P=5 years beyond their diagnosis but there is little data on oncology follow-up rates. In our retrospective study of 183 patients who were treated with chemotherapy only 49.7% continue to follow-up at their treatment center. LFU has important implications in planning long-term care strategies for cancer survivors and in survivorship research. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

from Cancer via ola Kala on Inoreader http://ift.tt/2z7Vky4
via IFTTT

Clinical Characteristics of Patients Experiencing Pathologic Complete Response Following Neoadjuvant Therapy for Borderline Resectable/Locally Advanced Pancreatic Adenocarcinoma.

Objectives: The purpose of this study is to describe clinical characteristics and outcomes of patients with borderline resectable pancreatic cancer (BRPC) or locally advanced pancreatic cancer (LAPC) who achieved pathologic complete response (pCR) following neoadjuvant therapy. Materials and Methods: A single institution clinical database for patients with pancreatic ductal adenocarcinoma was queried. Between 2008 and 2014 patients were identified with BRPC and LAPC, who underwent surgical resection after receiving neoadjuvant treatment. Clinical and pathologic features of the patients who achieved pCR were acquired retrospectively. Results: Six patients were identified to have pCR on pathology of the postoperative specimen. On the basis of pretreatment clinical staging, 2 patients were considered to have BRPC and 4 LAPC. Four patients received gemcitabine-based chemotherapy and 2 patients received FOLFIRINOX (5-fluorouracil, oxaliplatin, irinotecan, and leucovorin). Five of 6 patients received radiation therapy before operative resection. Operative procedures included distal pancreatectomy (n=3) and pancreatoduodenectomy (n=3). Pancreatic intraepithelial neoplasia 1 to 2 was present in 3 cases, and pancreatic intraepithelial neoplasia 3 in 1 case. During a median follow-up of 21.3 months, 2 patients died, with a median survival of 11.0 months (range, 10.4 to 11.6 mo). Four patients are alive and continue to follow-up with median survival of 28.7 months (range, 20.1 to 42.4 mo). Conclusions: Multimodality neoadjuvant therapy may lead to complete pathologic response in a small number of patients with borderline resectable/locally advanced pancreatic adenocarcinoma. pCR to neoadjuvant therapy does not lead to cure in most cases, and the majority of patients appear to relapse locally or systemically. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2gFgkFD

"Lost to Follow-up" Among Adult Cancer Survivors.

Background: Follow-up cancer care is important for patients who have received IV chemotherapy but some patients discontinue their care and are lost to follow-up (LFU) at the cancer center where they were treated. The purpose of this study was to determine what proportion of cancer survivors are LFU at 5 years after treatment, the timing of LFU, and the characteristics of those who do not continue survivorship care. Methods: Adult patients with cancer who were treated with chemotherapy at a large community teaching hospital in 2006 and 2007 were identified and linked with State tumor registry data. Hospital medical records were reviewed to obtain information on demographics, diagnosis, treatment, and date of last follow-up visit. Characteristics of patients with >=5 years of follow-up care were compared with those who were LFU. Results: In total, 487 patients received chemotherapy and 304 died (62%) during the 5-year follow-up period. Among the 183 cancer patients who were known to be alive at 5 years, 92 (50%) were LFU and 50% (46/92) of this LFU group were LFU within 1 year of diagnosis. At 5 years, follow-up care was continuing for 55% of women, compared with 39% of men. The highest proportion of follow-up was observed among lung cancer patients (84%), followed by patients with breast cancers (63%) and gastrointestinal cancers (40%). Patients with hematological cancers had the lowest follow-up proportion at 5 years (29%) (P=5 years beyond their diagnosis but there is little data on oncology follow-up rates. In our retrospective study of 183 patients who were treated with chemotherapy only 49.7% continue to follow-up at their treatment center. LFU has important implications in planning long-term care strategies for cancer survivors and in survivorship research. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2z7Vky4

Letter from Puerto Rico: The State of Radiation Oncology 1 Week After Maria’s Landfall

Publication date: Available online 12 October 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Javier Lopez-Araujo, O. Lee Burnett




from Cancer via ola Kala on Inoreader http://ift.tt/2z8yuX3
via IFTTT

Outcomes after re-irradiation for recurrent pediatric intracranial ependymoma

Publication date: Available online 13 October 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Derek S. Tsang, Elizabeth Burghen, Paul Klimo, Frederick A. Boop, David W. Ellison, Thomas E. Merchant
PurposeRe-irradiation for recurrent pediatric ependymoma is feasible and safe, but the long-term outcomes and the optimal dose and volume for re-treatment are unknown.Methods and MaterialsPatients with recurrent ependymoma treated with a second course of fractionated radiotherapy (RT2) were reviewed retrospectively. Eligible patients had localized, intracranial ependymoma at initial diagnosis that was treated with focal radiation (RT1) without craniospinal irradiation (CSI-RT1), and were aged ≤21 years at the time of RT2. The median doses of RT1, focal RT2, and CSI-RT2 were 59.4, 54, and 39.6 Gy, respectively. The primary endpoint, overall survival (OS), was measured from the first day of RT2.ResultsWe included 101 patients in the study. The median interval between RT1 and RT2 was 26.8 months (interquartile range [IQR] 18.0–43.1). The median durations of OS and freedom from progression (FFP) were 75.1 and 27.3 months, respectively. Male sex and anaplastic histology at recurrence were associated with decreased OS and FFP on multivariate analysis. Distant-only failure treated with CSI-RT2 was independently associated with improved OS compared to individuals with local failure treated with focal RT2 (HR 0.37, 95% CI 0.16–0.87). Among individuals experiencing any distant failure after RT1, gain of chromosome 1q was adversely associated with poorer OS (HR 3.5, 95% CI 1.1–10.6). No distant-only failures were observed in individuals with RT1 local failure who received CSI-RT2 (n = 10). The 10-year cumulative incidence of grade ≥3 radiation necrosis after RT2 was 7.9%.ConclusionsRe-irradiation for relapsed pediatric ependymoma was well tolerated by most patients and resulted in long-term survival in a subset of patients. The best results were observed in patients who experienced distant-only failure after RT1 and were treated with CSI as part of RT2, without anaplasia at recurrence. The option of re-irradiation should be discussed with patients who develop recurrent ependymoma.

Teaser

Repeat radiation therapy (RT) for recurrent pediatric ependymoma results in long-term disease control in some patients. Five-year survival was 57% for all patients. Patients with distant-only failure treated with craniospinal irradiation had the best outcomes (5-year survival of 76%). The 10-year incidence of grade 3 or higher radiation necrosis was low at 7.9%. Repeat RT is a feasible, safe, and effective treatment for children with recurrent ependymoma.


from Cancer via ola Kala on Inoreader http://ift.tt/2znIFrw
via IFTTT

Randomized, Double-blind, Placebo-Controlled Trial of Shuanghuabaihe Tablets to Prevent Oral Mucositis in Patients with Nasopharyngeal Cancer Undergoing Chemoradiotherapy

Publication date: Available online 13 October 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Baomin Zheng, Xiaodong Zhu, Mengzhong Liu, Zhenzhou Yang, Ling Yang, Jinyi Lang, Mei Shi, Gang Wu, Xia He, Xiaozhong Chen, Xuping Xi, Dan zhao, Guangying Zhu
PurposeOral mucositis is a common, unpreventable complication associated with chemoradiotherapy. Shuanghuabaihe tablets have been approved by Chinese Food and Drug Administration for treating recurrent oral mucosa ulceration. This study is to assess whether Shuanghuabaihe tablets could prevent oral mucositis during chemoradiotherapy for locally advanced nasopharyngeal carcinoma.Patients and MethodsThis multi-centre, randomized, double-blind, placebo-controlled trial was conducted at 11 hospitals in China between January 22nd, 2014 and September 21st, 2015. Eligible patients (n = 240, 18 - 70 years old) with pathologically diagnosed locally advanced nasopharyngeal carcinoma were randomly assigned (computer-block randomization; 1:1) to receive Shuanghuabaihe tablets or placebo (four tablets, three times a day, for seven weeks) at the time from initiation of chemoradiotherapy. Administration of Shuanghuabaihe tablets could be ended if patients developed ≥ grade 3 oral mucositis and were unwilling to continue taking the drug. Primary end points were oral mucositis incidence and latency.ResultsThe incidence of oral mucositis during this study was significantly lower in the Shuanghuabaihe group (85.0%, 95% CI 78.6∼91.4) compared with that in the placebo group (96.6%, 95% CI 93.4∼99.9; P=0.0028). Median latency was 28 days in the Shuanghuabaihe group and 14 days in the placebo group (HR 0.17, 95% CI 0.12∼0.23; P<0.0001). Compared with the placebo, Shuanghuabaihe tablets significantly reduced oral mucositis severity scores recorded by investigators (24.0 [0.0∼67.8] vs.57.5 [0.0∼98.0], P<0.0001), full-time nurses (OAG: 462.0 [392.0∼664.7] vs.520.4 [392.0∼714.0], P<0.0001) and patients (soreness of the mouth and throat: 4.0 [0∼10] vs.6.0 [0∼10], P<0.0001). No serious adverse events were observed and the incidence of mild/moderate gastrointestinal adverse events associated with Shuanghuabaihe tablets was 3.3%.The short-term response rate is similar in patients with Shuanghuabaihe tablets and with placebo during chemoradiotherapy during this study.ConclusionShuanghuabaihe tablets reduced the occurrence, latency and severity of oral mucositis in patients with nasopharyngeal cancer during chemoradiotherapy treatment.

Teaser

Shuanghuabaihe tablets have been used for treating recurrent oral mucosa ulceration.Eligible patients (n=240, 18-70 years old) with pathologically diagnosed locally advanced nasopharyngeal carcinoma were randomly assigned (computer-block randomization; 1:1) to receive Shuanghuabaihe tablets or placebo (four tablets, three times a day, for seven weeks) at the initiation of chemoradiotherapy.Shuanghuabaihe tablets reduce the occurrence, latency and severity of oral mucositis in patients with nasopharyngeal cancer during chemoradiotherapy treatment.


from Cancer via ola Kala on Inoreader http://ift.tt/2z6ik0q
via IFTTT

Multiplex proximity ligation assay to identify potential prognostic biomarkers for improved survival in locally advanced pancreatic cancer patients treated with stereotactic body radiation therapy

Publication date: Available online 12 October 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Avani D. Rao, Yufei Liu, Rie von Eyben, Charles C. Hsu, Chen Hu, Lauren M. Rosati, Arti Parekh, Kendall Ng, Amy Hacker-Prietz, Lei Zheng, Timothy M. Pawlik, Daniel A. Laheru, Elizabeth M. Jaffee, Matthew J. Weiss, Dung T. Le, Ralph H. Hruban, Ana De Jesus-Acosta, Christopher L. Wolfgang, Amol K. Narang, Daniel T. Chang, Albert C. Koong, Joseph M. Herman
Purpose/ObjectivesIn locally advanced pancreatic cancer (LAPC), the role of stereotactic body radiotherapy (SBRT) is evolving. Non-invasive seromarkers are needed to define prognosis. A proximity ligation assay (PLA) can evaluate expression levels of proteins that may correlate with outcomes. Herein, seromarker levels were explored for associations with outcomes in LAPC patients who received chemotherapy and SBRT.Materials/MethodsSerum from LAPC patients in two prospective trials of hypofractionated SBRT (5-6.6 Gyx5) was collected pre-SBRT. PLA quantified the expression levels of 36 pancreatic cancer-specific candidate seromarkers: Axl, BMP2, Ca 125, CA19-9, CEA, CXCL-1/6/9/10, EGFR, Gas6, Her2, IGF2, IGFBP-2/3/7, IL-6/6Ra/7/8/12, mesothelin, MMP-1/2/3/7, osteopontin, PDGFRa, PDK1, PF4, RegIV, SPARC, TGFβ, VEGF-A/D, and YKL40. Seromarker values were log transformed due to log-normal distribution of the values and Cox regression analysis was performed to assess for any association with overall survival. The Benjamini-Hochberg method was used to control for a false discovery rate (FDR) of only 10%.ResultsSixty-four patients with LAPC were included. No clinical factors (including surgical resection, receipt of pre-SBRT chemotherapy, receipt of post-SBRT chemotherapy, performance status, and age) or potential biomarkers in the panel were associated with improved survival in this cohort after application of the FDR correction. Potential prognostic factors for improved survival for future investigation included surgical resection (p=0.007, adjusted p=0.153) and the serum expression of IL-8 (p=0.006, adjusted p=0.153), CA19-9 (p=0.031, adjusted p=0.377), and MMP1 (p=0.036, adjusted p=0.377).ConclusionThese data explore the expression of a panel of proteins in pre-SBRT serum of LAPC patients in the context of a conservative false discovery rate correction. None of the clinical factors or expression levels of the serum proteins were found to be associated with survival; however, IL8, CA19-9, and MMP1 were highlighted as possible candidates warranting inclusion in future seromarker studies in the ongoing efforts to identify tools for risk stratification and treatment allocation in LAPC.



from Cancer via ola Kala on Inoreader http://ift.tt/2zmApIm
via IFTTT

PSA Bounce After Dose-Escalated External Beam Radiation Therapy Is an Independent Predictor of PSA Recurrence, Metastasis, and Survival in Prostate Adenocarcinoma Patients

Publication date: Available online 13 October 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Paul B. Romesser, Xin Pei, Weiji Shi, Zhigang Zhang, Marisa Kollmeier, Sean M. McBride, Michael J. Zelefsky
PurposePost-treatment PSA bounce (PSA-B) is well recognized and reported in 15%-30% of prostate adenocarcinoma patients treated with radiotherapy. We evaluated the difference in PSA recurrence-free (PSA-RFS), distant metastasis–free (DMFS), overall (OS), and cancer-specific (CSS) survival between PSA bounce (PSA-B) and non-bounce patients treated with dose-escalated external beam radiotherapy (DE-EBRT).Materials/MethodsDuring 1990-2010, 1898 prostate adenocarcinoma patients were treated with DE-EBRT to ≥75 Gy with ≥5 years follow-up. Patients receiving neoadjuvant/concurrent androgen-deprivation therapy (n=1035) or with less than four PSA values obtained 6 months or more after post-EBRT completion (n=87) were excluded. The evaluable 776 patients were treated (median, 81.0 Gy). PSA-B was defined as a ≥0.2 ng/mL increase above the interval PSA nadir followed by a decrease to nadir or below. PSA relapse (PSA-R) was defined as post-RT PSA nadir + 2 ng/mL. Median follow-up was 9.2 years (IQR, 5.3-10.6 years).ResultsOne hundred twenty-three patients (15.9%) experienced PSA-B after DE-EBRT at a median of 24.6 months (IQR, 16.1-38.5 months). On multivariate analysis, younger age (P=0.001), lower Gleason score (P=0.0003), and higher RT dose (P=0.0002) independently predicted PSA-B. PSA-B was independently associated with decreased risk for PSA relapse (HR, 0.53; 95% CI, 0.33-0.85; P=0.008), distant metastatic disease (HR, 0.34; 95% CI, 0.12-0.94; P=0.04), and all-cause mortality (HR, 0.53; 95% CI, 0.29-0.96; P=0.04) on multivariate Cox analysis. As all 50 prostate cancer–specific deaths in patients without PSA-B were in the non-bounce cohort, competing-risks analysis was not applicable. Nonparametric competing-risks test demonstrated that patients with PSA-B had superior cancer specific survival compared to patients without PSA-B (P=0.004)ConclusionsPatients treated with dose-escalated radiotherapy for prostate adenocarcinoma who experience post-treatment PSA-B have improved PSA-RFS, DMFS, OS, and CSS outcomes.

Teaser

In a cohort of 1898 patients treated with a uniform external-beam radiation therapy treatment approach for prostate cancer, prostate-specific antigen (PSA) fluctuations were carefully evaluated to determine their impact on long-term survival outcomes. Multivariate analysis demonstrated that the occurrence of a PSA bounce in the follow-up period predicted for reduced PSA recurrences, decreased incidence of distant metastases, and improved cause-specific and overall survival outcomes.


from Cancer via ola Kala on Inoreader http://ift.tt/2z7Q0L6
via IFTTT

A Review of the First 12 Years of the ASTRO Political Action Committee

Publication date: Available online 13 October 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Nishant K. Shah, Brad Zehr, Ankit Agarwal, Apar Gupta, Ariel E. Hirsch




from Cancer via ola Kala on Inoreader http://ift.tt/2zmAo7g
via IFTTT

A particle filter-based target tracking algorithm for MR-guided respiratory compensation: robustness and accuracy assessment

Publication date: Available online 12 October 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Alexandra E. Bourque, Stéphane Bedwani, Jean-François Carrier, Cynthia Ménard, Pim Borman, Clemens Bos, Bas Raaymakers, Nikolai Mickevicius, Eric Paulson, Rob. H.N. Tijssen
PurposeTo assess overall robustness and accuracy of a modified particle filter based tracking algorithm for MR-guided radiation therapy treatments.MethodsAn improved particle filter based tracking algorithm is implemented, which employs a normalized cross-correlation function as the likelihood calculation. With a total of 5 healthy volunteers and 8 patients, the robustness of the algorithm is tested on 24 dynamic MRI time-series with varying resolution, contrast, and signal-to-noise ratio. The complete data set includes data acquired with different scan parameters on a number of MRI scanners with varying field strengths including the 1.5T MR-linac. Tracking errors are computed by comparing the results obtained by the particle filter algorithm to experts' delineations.ResultsThe ameliorated tracking algorithm is able to accurately track abdominal as well as thoracic tumors, whereas the previous Bhattacharyya distance based implementation fails in over 50% of the cases. The tracking error, combined over all MRI acquisitions, is (1.1 ± 0.4) mm, which demonstrates high robustness against variations in contrast, noise and image resolution. Finally, the effect of the input/control parameters of the model is very similar across all cases suggesting a class-based optimization is possible.ConclusionThe modified particle filter tracking algorithm is highly accurate and robust against varying image quality. This makes the algorithm a promising candidate for automated tracking on the MR-linac.

Teaser

A modified particle filter based algorithm allows tracking of abdominal and thoracic anatomies of interest. A total of 5 healthy volunteers and 8 patients were scanned with various image contrasts and resolutions. The results demonstrate an accurate and robust technique with promising clinical potential.


from Cancer via ola Kala on Inoreader http://ift.tt/2z7FXpd
via IFTTT

Prospective phase II trial of permanent seed implantation prostate brachytherapy for intermediate-risk localized prostate cancer: efficacy, toxicity, and quality of life outcomes

Publication date: Available online 12 October 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Steven J. Frank, Thomas J. Pugh, Pierre Blanchard, Usama Mahmood, William J. Graber, Rajat J. Kudchadker, John W. Davis, Jeri Kim, Haesun Choi, Patricia Troncoso, Deborah A. Kuban, Seungtaek Choi, Sean McGuire, Karen E. Hoffman, Hsiang-Chun Chen, Xuemei Wang, David A. Swanson
BackgroundBrachytherapy monotherapy is a treatment option for intermediate-risk localized prostate cancer but published prospective data are scarce.MethodsProspective phase II trial of 300 patients with previously untreated prostate cancer treated between 2006–2013. Eligible patients had ≤cT2b (T3 excluded based on magnetic resonance imaging), Gleason score [GS]=6 and prostate-specific antigen [PSA] level 10-15 ng/mL, or GS=7 and PSA<10 ng/mL, and were treated with prostate brachytherapy (without hormonal therapy).ResultsMedian patient age was 64.9 years; 3.7% had GS 6, 78.7% had GS 7(3+4), and 17.7% had GS 7(4+3). Median follow-up time was 5.1 years. Median PSA at 5 years was 0.01 ng/mL (range 0–6.0). Ten biochemical failures occurred, for a 5-year freedom from biochemical failure rate of 97.3% (95% confidence interval [CI] 95.1%, 99.5%), and 16 patients died, only one from prostate cancer, for 5-year rates of overall and biochemical progression-free survival of 94.9% (95% CI 92.1%, 97.9%) and 92.7% (95% CI 89.3%, 96.2%). Four patients had late grade 3 genitourinary toxicity and two late grade 3 rectal toxicity; no grade 4 or 5 toxicity was observed. Rates of "moderate or big problems" at 4 years were 7.4% for urinary (vs. 0.4% baseline), 2.9% bowel (vs. 0.4%), and 29.7% sexual function (vs. 19.7%). Most men were "satisfied or extremely satisfied" (91% at 2 years after treatment and 93% at 4 years).ConclusionsBrachytherapy monotherapy is safe, effective, and leads to good quality of life for select men with localized intermediate-risk prostate cancer.

Teaser

We report efficacy, toxicity and quality of life after prostate brachytherapy monotherapy for favorable intermediate risk cancer.Out of 300 patients, after a median follow-up of 5.1 years, only 10 recurrences were reported, yielding a 5-year freedom from biochemical failure rate of 97.3% and a 5-year biochemical progression-free survival rate of 94.9%.Four patients had late grade 3 genitourinary toxicity and two late grade 3 rectal toxicity; no grade 4 or 5 toxicity was observed.


from Cancer via ola Kala on Inoreader http://ift.tt/2zmRB0t
via IFTTT

Letter from Puerto Rico: The State of Radiation Oncology 1 Week After Maria’s Landfall

Publication date: Available online 12 October 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Javier Lopez-Araujo, O. Lee Burnett




http://ift.tt/2z8yuX3

Outcomes after re-irradiation for recurrent pediatric intracranial ependymoma

Publication date: Available online 13 October 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Derek S. Tsang, Elizabeth Burghen, Paul Klimo, Frederick A. Boop, David W. Ellison, Thomas E. Merchant
PurposeRe-irradiation for recurrent pediatric ependymoma is feasible and safe, but the long-term outcomes and the optimal dose and volume for re-treatment are unknown.Methods and MaterialsPatients with recurrent ependymoma treated with a second course of fractionated radiotherapy (RT2) were reviewed retrospectively. Eligible patients had localized, intracranial ependymoma at initial diagnosis that was treated with focal radiation (RT1) without craniospinal irradiation (CSI-RT1), and were aged ≤21 years at the time of RT2. The median doses of RT1, focal RT2, and CSI-RT2 were 59.4, 54, and 39.6 Gy, respectively. The primary endpoint, overall survival (OS), was measured from the first day of RT2.ResultsWe included 101 patients in the study. The median interval between RT1 and RT2 was 26.8 months (interquartile range [IQR] 18.0–43.1). The median durations of OS and freedom from progression (FFP) were 75.1 and 27.3 months, respectively. Male sex and anaplastic histology at recurrence were associated with decreased OS and FFP on multivariate analysis. Distant-only failure treated with CSI-RT2 was independently associated with improved OS compared to individuals with local failure treated with focal RT2 (HR 0.37, 95% CI 0.16–0.87). Among individuals experiencing any distant failure after RT1, gain of chromosome 1q was adversely associated with poorer OS (HR 3.5, 95% CI 1.1–10.6). No distant-only failures were observed in individuals with RT1 local failure who received CSI-RT2 (n = 10). The 10-year cumulative incidence of grade ≥3 radiation necrosis after RT2 was 7.9%.ConclusionsRe-irradiation for relapsed pediatric ependymoma was well tolerated by most patients and resulted in long-term survival in a subset of patients. The best results were observed in patients who experienced distant-only failure after RT1 and were treated with CSI as part of RT2, without anaplasia at recurrence. The option of re-irradiation should be discussed with patients who develop recurrent ependymoma.

Teaser

Repeat radiation therapy (RT) for recurrent pediatric ependymoma results in long-term disease control in some patients. Five-year survival was 57% for all patients. Patients with distant-only failure treated with craniospinal irradiation had the best outcomes (5-year survival of 76%). The 10-year incidence of grade 3 or higher radiation necrosis was low at 7.9%. Repeat RT is a feasible, safe, and effective treatment for children with recurrent ependymoma.


http://ift.tt/2znIFrw

Randomized, Double-blind, Placebo-Controlled Trial of Shuanghuabaihe Tablets to Prevent Oral Mucositis in Patients with Nasopharyngeal Cancer Undergoing Chemoradiotherapy

Publication date: Available online 13 October 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Baomin Zheng, Xiaodong Zhu, Mengzhong Liu, Zhenzhou Yang, Ling Yang, Jinyi Lang, Mei Shi, Gang Wu, Xia He, Xiaozhong Chen, Xuping Xi, Dan zhao, Guangying Zhu
PurposeOral mucositis is a common, unpreventable complication associated with chemoradiotherapy. Shuanghuabaihe tablets have been approved by Chinese Food and Drug Administration for treating recurrent oral mucosa ulceration. This study is to assess whether Shuanghuabaihe tablets could prevent oral mucositis during chemoradiotherapy for locally advanced nasopharyngeal carcinoma.Patients and MethodsThis multi-centre, randomized, double-blind, placebo-controlled trial was conducted at 11 hospitals in China between January 22nd, 2014 and September 21st, 2015. Eligible patients (n = 240, 18 - 70 years old) with pathologically diagnosed locally advanced nasopharyngeal carcinoma were randomly assigned (computer-block randomization; 1:1) to receive Shuanghuabaihe tablets or placebo (four tablets, three times a day, for seven weeks) at the time from initiation of chemoradiotherapy. Administration of Shuanghuabaihe tablets could be ended if patients developed ≥ grade 3 oral mucositis and were unwilling to continue taking the drug. Primary end points were oral mucositis incidence and latency.ResultsThe incidence of oral mucositis during this study was significantly lower in the Shuanghuabaihe group (85.0%, 95% CI 78.6∼91.4) compared with that in the placebo group (96.6%, 95% CI 93.4∼99.9; P=0.0028). Median latency was 28 days in the Shuanghuabaihe group and 14 days in the placebo group (HR 0.17, 95% CI 0.12∼0.23; P<0.0001). Compared with the placebo, Shuanghuabaihe tablets significantly reduced oral mucositis severity scores recorded by investigators (24.0 [0.0∼67.8] vs.57.5 [0.0∼98.0], P<0.0001), full-time nurses (OAG: 462.0 [392.0∼664.7] vs.520.4 [392.0∼714.0], P<0.0001) and patients (soreness of the mouth and throat: 4.0 [0∼10] vs.6.0 [0∼10], P<0.0001). No serious adverse events were observed and the incidence of mild/moderate gastrointestinal adverse events associated with Shuanghuabaihe tablets was 3.3%.The short-term response rate is similar in patients with Shuanghuabaihe tablets and with placebo during chemoradiotherapy during this study.ConclusionShuanghuabaihe tablets reduced the occurrence, latency and severity of oral mucositis in patients with nasopharyngeal cancer during chemoradiotherapy treatment.

Teaser

Shuanghuabaihe tablets have been used for treating recurrent oral mucosa ulceration.Eligible patients (n=240, 18-70 years old) with pathologically diagnosed locally advanced nasopharyngeal carcinoma were randomly assigned (computer-block randomization; 1:1) to receive Shuanghuabaihe tablets or placebo (four tablets, three times a day, for seven weeks) at the initiation of chemoradiotherapy.Shuanghuabaihe tablets reduce the occurrence, latency and severity of oral mucositis in patients with nasopharyngeal cancer during chemoradiotherapy treatment.


http://ift.tt/2z6ik0q

Multiplex proximity ligation assay to identify potential prognostic biomarkers for improved survival in locally advanced pancreatic cancer patients treated with stereotactic body radiation therapy

Publication date: Available online 12 October 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Avani D. Rao, Yufei Liu, Rie von Eyben, Charles C. Hsu, Chen Hu, Lauren M. Rosati, Arti Parekh, Kendall Ng, Amy Hacker-Prietz, Lei Zheng, Timothy M. Pawlik, Daniel A. Laheru, Elizabeth M. Jaffee, Matthew J. Weiss, Dung T. Le, Ralph H. Hruban, Ana De Jesus-Acosta, Christopher L. Wolfgang, Amol K. Narang, Daniel T. Chang, Albert C. Koong, Joseph M. Herman
Purpose/ObjectivesIn locally advanced pancreatic cancer (LAPC), the role of stereotactic body radiotherapy (SBRT) is evolving. Non-invasive seromarkers are needed to define prognosis. A proximity ligation assay (PLA) can evaluate expression levels of proteins that may correlate with outcomes. Herein, seromarker levels were explored for associations with outcomes in LAPC patients who received chemotherapy and SBRT.Materials/MethodsSerum from LAPC patients in two prospective trials of hypofractionated SBRT (5-6.6 Gyx5) was collected pre-SBRT. PLA quantified the expression levels of 36 pancreatic cancer-specific candidate seromarkers: Axl, BMP2, Ca 125, CA19-9, CEA, CXCL-1/6/9/10, EGFR, Gas6, Her2, IGF2, IGFBP-2/3/7, IL-6/6Ra/7/8/12, mesothelin, MMP-1/2/3/7, osteopontin, PDGFRa, PDK1, PF4, RegIV, SPARC, TGFβ, VEGF-A/D, and YKL40. Seromarker values were log transformed due to log-normal distribution of the values and Cox regression analysis was performed to assess for any association with overall survival. The Benjamini-Hochberg method was used to control for a false discovery rate (FDR) of only 10%.ResultsSixty-four patients with LAPC were included. No clinical factors (including surgical resection, receipt of pre-SBRT chemotherapy, receipt of post-SBRT chemotherapy, performance status, and age) or potential biomarkers in the panel were associated with improved survival in this cohort after application of the FDR correction. Potential prognostic factors for improved survival for future investigation included surgical resection (p=0.007, adjusted p=0.153) and the serum expression of IL-8 (p=0.006, adjusted p=0.153), CA19-9 (p=0.031, adjusted p=0.377), and MMP1 (p=0.036, adjusted p=0.377).ConclusionThese data explore the expression of a panel of proteins in pre-SBRT serum of LAPC patients in the context of a conservative false discovery rate correction. None of the clinical factors or expression levels of the serum proteins were found to be associated with survival; however, IL8, CA19-9, and MMP1 were highlighted as possible candidates warranting inclusion in future seromarker studies in the ongoing efforts to identify tools for risk stratification and treatment allocation in LAPC.



http://ift.tt/2zmApIm

PSA Bounce After Dose-Escalated External Beam Radiation Therapy Is an Independent Predictor of PSA Recurrence, Metastasis, and Survival in Prostate Adenocarcinoma Patients

Publication date: Available online 13 October 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Paul B. Romesser, Xin Pei, Weiji Shi, Zhigang Zhang, Marisa Kollmeier, Sean M. McBride, Michael J. Zelefsky
PurposePost-treatment PSA bounce (PSA-B) is well recognized and reported in 15%-30% of prostate adenocarcinoma patients treated with radiotherapy. We evaluated the difference in PSA recurrence-free (PSA-RFS), distant metastasis–free (DMFS), overall (OS), and cancer-specific (CSS) survival between PSA bounce (PSA-B) and non-bounce patients treated with dose-escalated external beam radiotherapy (DE-EBRT).Materials/MethodsDuring 1990-2010, 1898 prostate adenocarcinoma patients were treated with DE-EBRT to ≥75 Gy with ≥5 years follow-up. Patients receiving neoadjuvant/concurrent androgen-deprivation therapy (n=1035) or with less than four PSA values obtained 6 months or more after post-EBRT completion (n=87) were excluded. The evaluable 776 patients were treated (median, 81.0 Gy). PSA-B was defined as a ≥0.2 ng/mL increase above the interval PSA nadir followed by a decrease to nadir or below. PSA relapse (PSA-R) was defined as post-RT PSA nadir + 2 ng/mL. Median follow-up was 9.2 years (IQR, 5.3-10.6 years).ResultsOne hundred twenty-three patients (15.9%) experienced PSA-B after DE-EBRT at a median of 24.6 months (IQR, 16.1-38.5 months). On multivariate analysis, younger age (P=0.001), lower Gleason score (P=0.0003), and higher RT dose (P=0.0002) independently predicted PSA-B. PSA-B was independently associated with decreased risk for PSA relapse (HR, 0.53; 95% CI, 0.33-0.85; P=0.008), distant metastatic disease (HR, 0.34; 95% CI, 0.12-0.94; P=0.04), and all-cause mortality (HR, 0.53; 95% CI, 0.29-0.96; P=0.04) on multivariate Cox analysis. As all 50 prostate cancer–specific deaths in patients without PSA-B were in the non-bounce cohort, competing-risks analysis was not applicable. Nonparametric competing-risks test demonstrated that patients with PSA-B had superior cancer specific survival compared to patients without PSA-B (P=0.004)ConclusionsPatients treated with dose-escalated radiotherapy for prostate adenocarcinoma who experience post-treatment PSA-B have improved PSA-RFS, DMFS, OS, and CSS outcomes.

Teaser

In a cohort of 1898 patients treated with a uniform external-beam radiation therapy treatment approach for prostate cancer, prostate-specific antigen (PSA) fluctuations were carefully evaluated to determine their impact on long-term survival outcomes. Multivariate analysis demonstrated that the occurrence of a PSA bounce in the follow-up period predicted for reduced PSA recurrences, decreased incidence of distant metastases, and improved cause-specific and overall survival outcomes.


http://ift.tt/2z7Q0L6

A Review of the First 12 Years of the ASTRO Political Action Committee

Publication date: Available online 13 October 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Nishant K. Shah, Brad Zehr, Ankit Agarwal, Apar Gupta, Ariel E. Hirsch




http://ift.tt/2zmAo7g

A particle filter-based target tracking algorithm for MR-guided respiratory compensation: robustness and accuracy assessment

Publication date: Available online 12 October 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Alexandra E. Bourque, Stéphane Bedwani, Jean-François Carrier, Cynthia Ménard, Pim Borman, Clemens Bos, Bas Raaymakers, Nikolai Mickevicius, Eric Paulson, Rob. H.N. Tijssen
PurposeTo assess overall robustness and accuracy of a modified particle filter based tracking algorithm for MR-guided radiation therapy treatments.MethodsAn improved particle filter based tracking algorithm is implemented, which employs a normalized cross-correlation function as the likelihood calculation. With a total of 5 healthy volunteers and 8 patients, the robustness of the algorithm is tested on 24 dynamic MRI time-series with varying resolution, contrast, and signal-to-noise ratio. The complete data set includes data acquired with different scan parameters on a number of MRI scanners with varying field strengths including the 1.5T MR-linac. Tracking errors are computed by comparing the results obtained by the particle filter algorithm to experts' delineations.ResultsThe ameliorated tracking algorithm is able to accurately track abdominal as well as thoracic tumors, whereas the previous Bhattacharyya distance based implementation fails in over 50% of the cases. The tracking error, combined over all MRI acquisitions, is (1.1 ± 0.4) mm, which demonstrates high robustness against variations in contrast, noise and image resolution. Finally, the effect of the input/control parameters of the model is very similar across all cases suggesting a class-based optimization is possible.ConclusionThe modified particle filter tracking algorithm is highly accurate and robust against varying image quality. This makes the algorithm a promising candidate for automated tracking on the MR-linac.

Teaser

A modified particle filter based algorithm allows tracking of abdominal and thoracic anatomies of interest. A total of 5 healthy volunteers and 8 patients were scanned with various image contrasts and resolutions. The results demonstrate an accurate and robust technique with promising clinical potential.


http://ift.tt/2z7FXpd

Prospective phase II trial of permanent seed implantation prostate brachytherapy for intermediate-risk localized prostate cancer: efficacy, toxicity, and quality of life outcomes

Publication date: Available online 12 October 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Steven J. Frank, Thomas J. Pugh, Pierre Blanchard, Usama Mahmood, William J. Graber, Rajat J. Kudchadker, John W. Davis, Jeri Kim, Haesun Choi, Patricia Troncoso, Deborah A. Kuban, Seungtaek Choi, Sean McGuire, Karen E. Hoffman, Hsiang-Chun Chen, Xuemei Wang, David A. Swanson
BackgroundBrachytherapy monotherapy is a treatment option for intermediate-risk localized prostate cancer but published prospective data are scarce.MethodsProspective phase II trial of 300 patients with previously untreated prostate cancer treated between 2006–2013. Eligible patients had ≤cT2b (T3 excluded based on magnetic resonance imaging), Gleason score [GS]=6 and prostate-specific antigen [PSA] level 10-15 ng/mL, or GS=7 and PSA<10 ng/mL, and were treated with prostate brachytherapy (without hormonal therapy).ResultsMedian patient age was 64.9 years; 3.7% had GS 6, 78.7% had GS 7(3+4), and 17.7% had GS 7(4+3). Median follow-up time was 5.1 years. Median PSA at 5 years was 0.01 ng/mL (range 0–6.0). Ten biochemical failures occurred, for a 5-year freedom from biochemical failure rate of 97.3% (95% confidence interval [CI] 95.1%, 99.5%), and 16 patients died, only one from prostate cancer, for 5-year rates of overall and biochemical progression-free survival of 94.9% (95% CI 92.1%, 97.9%) and 92.7% (95% CI 89.3%, 96.2%). Four patients had late grade 3 genitourinary toxicity and two late grade 3 rectal toxicity; no grade 4 or 5 toxicity was observed. Rates of "moderate or big problems" at 4 years were 7.4% for urinary (vs. 0.4% baseline), 2.9% bowel (vs. 0.4%), and 29.7% sexual function (vs. 19.7%). Most men were "satisfied or extremely satisfied" (91% at 2 years after treatment and 93% at 4 years).ConclusionsBrachytherapy monotherapy is safe, effective, and leads to good quality of life for select men with localized intermediate-risk prostate cancer.

Teaser

We report efficacy, toxicity and quality of life after prostate brachytherapy monotherapy for favorable intermediate risk cancer.Out of 300 patients, after a median follow-up of 5.1 years, only 10 recurrences were reported, yielding a 5-year freedom from biochemical failure rate of 97.3% and a 5-year biochemical progression-free survival rate of 94.9%.Four patients had late grade 3 genitourinary toxicity and two late grade 3 rectal toxicity; no grade 4 or 5 toxicity was observed.


http://ift.tt/2zmRB0t