Significant variability in clinical target volume localization of gastric marginal zone lymphoma occurs if daily RT is delivered based on alignment to bony anatomy. MRI-guided RT allows for significant reduction in planning target volumes expansions without compromising coverage.
SBRT appears to have a survival benefit in patients with locally advanced pancreatic cancer, especially after the delivery of maximal multiagent chemotherapy. SBRT may play a role in tumor downstaging and allow patients with locally advanced pancreatic cancer to undergo surgery.
In this national hospital-based study, the addition of postoperative radiation therapy with or without chemotherapy following esophagectomy was associated with improved survival for patients with node-positive disease or positive margins.
Intraductal papillary mucinous neoplasms with high malignant potential appear to have distinct imaging properties. Further validation of these findings may address a major clinical need in this population by identifying those most likely to benefit from surgical resection.
We conclude that every patient has the right to have continent diversion. An orthotopic bladder approach should be considered first, and if it is not feasible, then the Indiana pouch could be a suitable alternative with no additional complications, unless this procedure is contraindicated.
L5HU and psoas L4–L5, surrogates for bone mineral density and muscle mass, respectively, were independent predictors of overall survival in a multivariable model controlling for age, comorbidity, prostate cancer risk grouping, race, and ADT.
Rates of clinically significant GI and GU toxicities are modest following SBRT plus IMRT. Placement of rectal spacers may decrease rectal toxicity. Future studies should also identify dosimetric predictors of these toxicities.
Increasing time from diagnosis to simulation and from simulation until the start of therapy is associated with worse outcomes. Patients with HPV-associated oropharyngeal squamous cell carcinoma are at increased risk of nodal progression before treatment.
From our institutional experience, low-dose RT in addition to docetaxel and cetuximab is well tolerated. More durable treatment options may exist for definitive treatment; however, this protocol may offer low-morbidity palliation in select patients.
Differences in the legal needs of economically and geographically diverse patients with cancer suggest that those needs are not determined solely by disease state but that they also correspond with geographic and economic characteristics.
Assuming IMRT became more prevalent from 2000 to 2002, the annual incidence rate of second malignancy remains consistently below that of patients who receive no radiation. This pattern contradicts the argument that IMRT significantly increases the risk for second malignancy.
A hypofractionated course of 8 Gy/1 fx radiation therapy in the treatment of bony multiple myeloma metastases is an efficient and effective way to reduce pain and reduce the time from the completion of radiation therapy to the start of chemotherapy in patients with multiple myeloma.
For many individuals, keloids present a symptomatic and cosmetic issue after tissue injury. Surgical excision followed by immediate adjuvant RT provides excellent local control and cosmesis with minimal toxicity. Treatment with both prescribed regimens yielded equal results.
Systemic inflammatory markers are independent prognostic factors for survival in oropharyngeal cancer patients treated with radiation therapy. Future investigations to validate the identified cut points and to develop risk-adaptive treatment strategies are needed.
Prostate cancer patients with penile prostheses who had pre-existing urologic problems (incontinence, penile pain, pelvic pain) and/or prior insertion of artificial urinary sphincters were more likely to experience urologic issues during RT until the 1-month follow-up.
Despite better performance status noted for patients treated with stereotactic radiosurgery for first brain metastatic event compared with second brain metastatic event, no difference in survival was noted.
While IMRT is the standard technique for most head cancers and offers excellent sparing of normal tissues to avoid late effects, BolusECT is appropriate for superficial targets, with good sparing of mucosal tissue to reduce acute mucositis that impairs nutrition, quality of life, and treatment intensity.
In this cohort of older women with node-positive vulvar cancer, adjuvant RT is associated with improved OS, though overall outcomes are poor. More reliable delivery of quality RT may further improve survival in this population.
Para-aortic lymphatic failure occurred in 14.5% of patients in our study. Para-aortic failures occurred in 17.7% of patients with ≥ 3 lymph nodes and in 19.5% of patients with pelvic lymph nodes ≥ 1.5 cm. This may suggest the need for escalation of radiotherapy or chemotherapy in these patients.
Prostate brachytherapy is an effective treatment for men younger than 55 years with low-risk prostate cancer. Prostate brachytherapy should be considered for all men diagnosed with low-risk prostate cancer, regardless of age.
Overall, inversely optimized low-dose-rate prostate seed implantation, resulting in reduced needle and source exposure, demonstrates excellent, durable biochemical progression–free survival with modest grade 2 GU and very low GI toxicity in selected low-risk and favorable intermediate-risk patients.
Central nervous system PRT appears to be well tolerated. Radiographic findings suggest that periventricular white matter may be more sensitive to radiation injury. Strategies to further reduce dose are warranted, as is the development of imaging and molecular biomarkers to identify patients at higher risk.
Our findings suggest that differential treatment access alone does not explain racial disparities and that sociodemographic forces, such as referral patterns and provider biases, may heavily influence what should be a clinical decision regarding treatment provision and receipt.
SRS, in the setting of systemic immunotherapy, may provide improved intracranial control compared with WBRT in patients with ≥ 3 melanoma brain metastases. Future prospective studies may expand the utility of SRS and spare selective patients with large intracranial disease burdens from toxicities associated with WBRT.
GammaKnife radiosurgery appears to be safe regardless of whether it is delivered before or after checkpoint inhibitor immunotherapy. Conversely, WBRT delivered after immunotherapy was associated with heightened rates of grade ≥ 3 toxicity, including life-threatening cerebral edema, in approximately one-quarter of courses in this sample.
SRS is effective in treating BMs from breast cancer, and multiple courses of SRS are feasible and safe in select patients. Since this population can have a prolonged survival, aggressive local treatment with SRS can lead to improved survival and prevention of neurologic deficits.
Specialty-specific differences were identified for both upfront management and management after biochemical recurrences for high-risk prostate cancer, with specialists more likely to recommend the treatments they could deliver for nearly all clinical scenarios, whether these recommendations were based on high-level evidence or not.
On univariate and multivariate competing risks analysis, sarcoma histology and larger preoperative tumor volumes were significantly associated with worse local control. Radioresistant histology and Karnofsky performance status were significant predictors for OS on multivariate analysis.
While treatment at an academic center and increasing the time interval from chemoradiation to surgery were associated with a higher pCR rate, only treatment at an academic center improved survival. Overall, these data do not support routinely increasing the time interval between neoadjuvant chemoradiation and surgery.
We present demographics and factors associated with slow trial accrual at MDACC. We believe that this analysis serves as a baseline and highlights areas of weakness to aid in the development of evidence-based trial guidelines.
Outcomes for head and neck NHL were maintained using ISRT with IMRT, with no marginal failures. ISRT reduces dose to normal tissues, and our results suggest that further reductions can be achieved with IMRT. This approach may be most valuable for definitive treatment of early-stage NHL, as the excellent prognosis highlights the importance of minimizing RT sequelae.
Receipt of EBRT for CTCL varies by sociodemographic factors and the centers where patients receive their care. Among those receiving EBRT, there are variations in dose, and median survival may vary by race. Further research is needed to assess differences in receipt, outcomes, and dose.
This analysis demonstrates that significant interfractional target variation exists in the treatment of GMZL; this variation could lead to difficulties in target localization and/or reproducibility of treatment. MRIgRT is a promising method to evaluate and allow for adaptation to these variations.
The number of new trials examining treatment of oligometastatic disease has risen since 2011, signifying a paradigm shift in the local treatment of oligometastatic disease. RT continues to be the primary intervention in RCTs evaluating oligometastatic disease.
Such a platform technology will allow a point-of-care assay to be set up for the prediction of normal tissue toxicity after RT and ultimately for the monitoring of any intracellular protein assay diagnostic method.
Hyperbaric oxygen treatment is a well-tolerated treatment for delayed radiation injuries of breast cancer patients. Side effects are minimal and reversible. Patient-reported outcomes for patients receiving hyperbaric oxygen treatment are positive.
While our results do not demonstrate high neutrophil-to-lymphocyte ratio to be an independent risk factor for worsened clinical outcomes, they do show high neutrophil-to-lymphocyte ratio to have statistically and clinically significant predictive value for RFS and OS in patients with recently diagnosed soft tissue sarcoma.
SBRT is a very well-tolerated form of RT that appears to offer a statistically significant and high level of pain control for bone metastases from prostate cancer. In community practice, a highly variable fractionation scheme is also noted.
In this initial experience of melanoma brain metastases treated with BRAF and MEK inhibition with stereotactic radiosurgery, we find that the two modalities can be combined safely. These outcomes should be assessed further in prospective evaluations.
IMRT use in a community hospital is equally as efficacious and minimally toxic as it is in leading academic institutions. Age at diagnosis was the only significant predictor of survival, suggesting that cancer-specific mortality is minimal after IMRT in localized prostate cancer.
Although CA 19-9 does not appear to have large prognostic implications in patients with locally advanced pancreatic cancer who receive induction chemotherapy followed by SBRT, it is suggested to have predictive ability.
In addition to treating the tumors, radioembolization is a safe procedure with a predictable effect on contralateral liver hypertrophy. At 3 months post-radioembolization, degree of hypertrophy is significant, achieving the necessary threshold for safe liver resection.
Here, we report superior local control with treatment of tumors that have smaller planning target volumes. Five-fraction SBRT offers quick and effective treatment with acceptable toxicity and minimal delay in delivery of systemic therapy.
While respiratory-gated RT can reduce the dosimetric parameters for lungs and heart compared with non-gated ER, the results of this study demonstrated a marked further reduction in pulmonary doses for tangentially treated left-sided breast cancer patients, without compromising target coverage.
Equal heart sparing can be achieved in left WBRT in either the prone or supine position with deep inspiration breath hold or free breathing when planning is individualized and driven by appropriate dose constraints.
With aggressive trimodality therapy, excellent locoregional control was achieved in patients with newly diagnosed inflammatory breast cancer. However, DFS and OS are suboptimal, despite modern trimodality treatment.
Protons for postmastectomy radiation therapy, particularly in cases of challenging anatomy, result in decreased dose to normal structures compared with photon plans, with acceptable acute toxicity. Dose escalation after double-scattered proton should be used with caution to avoid skin toxicity.
We document survival and prognostic factors of SBRT for breast cancer oligometastases in a single institution. Information about the survival benefit of SBRT following chemotherapy awaits the results of the phase II/III NRG BR002 trial.
Using these criteria, about 6% of patients preoperatively meeting no ASTRO APBI consensus cautionary or unsuitable risk factors are recommended for WBRT after IORT. This rate is much higher for patients meeting cautionary criteria before resection.
From logistic modeling of 625 major vessels, the Radiation Therapy Oncology Group 0813 trial limit of Dmax = 52.5 Gy in five fractions was found to have a 1.2% risk of grade 3–5 toxicity, and the 2008 Timmerman limit of Dmax = 45 Gy in three fractions had a 2.3% risk. Further investigation is warranted, especially for the pulmonary artery, which might not have a dose tolerance as high as other major vessels.
For patients with low-risk disease, LRFS and LRRFS were not significantly different for mastectomy techniques. For this patient population, SSM and NSM appear to be safe and equivalent to TM at 8 years of follow-up.
Our observations show a low incidence of BI-RADS 4 recommendations and a very low yield (0.8%) of cancer noted on pathology using a frequent follow-up mammogram schedule. We noted a trend of BI-RADS 4 returning positive for cancer in younger patients. This suggests that 6-month follow-up schedules are not necessary and that there may be value in defining risk-adaptive follow-up schedules after BCT.
The data suggest that different cellular pathways may be activated, depending on RT regimen, leading to differential biological effects. A better understanding of these mechanisms might assist in building novel combination-treatment regimens.
The results suggest that G3 EAC has a slightly more favorable survival than UPSC and CC but predictably does poorer than G1–2 EAC. Further research is warranted to determine if G3 EAC should be reclassified as a type 2 cancer.
There is no significant difference between D2cc%, D1cc%, and D0.1cc% to the rectum and sigmoid colon for VBs and RRs. There was a significant difference in ICRU% rectal point dose between VBs and RRs, but differences in clinical outcome, if present, will require additional investigation.
Academic radiation oncology chairs have high emotional Intelligence, and increased emotional Intelligence correlates significantly with decreased rates of self-reported burnout. In the future, emotional Intelligence scores may be of increasing importance when it comes to recruitment and retention of academic medical leadership.
To promote legal decisions in favor of the radiation oncologist, we recommend: accreditation by the American Society for Radiation Oncology (ASTRO) Accreditation Program for Excellence (APEx); use of the ASTRO Radiation Oncology Incident Learning System (RO-ILS); and physician-patient discussion about treatment toxicity (eg, timing, etiologies, and risk of morbidity and mortality), with diligent documentation.
QOL preservation in patients with terminal illnesses, such as brain metastasis, must remain paramount as healthcare technology continues to progress. In the present investigation, 72% of patients maintained their QOL following GKRS, with 24% of patients experiencing clinically significant improvement.
Less than 50% of the level I LN volume was covered by 90% PD; less than 30% was covered by 95% PD. Mean (29 Gy) and median (30 Gy) doses to the level I LN were subtherapeutic. There was a moderate correlation between V20 ipsilateral lung and coverage of level I LNs.
Although the female RO full professors in our cohort were similar overall in terms of productivity and NIH funding to their male colleagues, they tended to have longer times to promotion earlier in their careers at lower academic ranks. Women may experience barriers to productivity early in their careers that may delay promotion.
Single-fraction RT to the femur was effective in the prevention of femoral fractures. The pain score was also decreased in our patient population. Further studies are needed to explore 8 Gy/1 fx against standard radiation as a more effective means of delivering therapeutic and convenient treatment in metastatic patients.
In this large population dataset, adjuvant radiation was associated with an improvement in OS in a modern cohort of patients. Patients with distal tumors, higher-grade disease, negative lymph nodes, and larger tumors may derive a greater benefit with radiation.
In this first-of-its-kind analysis, assessing the radiosensitivity of multiple metastases from the same patient, we note a similar radiosensitivity fingerprint for lesions from the liver and lung from the same primary lesion.
Esophageal melanoma is an aggressive disease with very poor outcomes. Esophagectomy may result in reasonable survival for localized disease. Treatment with RT did not result in any surviving patients at 3 years.