Toxicities Following Stereotactic Ablative Radiotherapy Treatment of Locally-Recurrent and Previously Irradiated Head and Neck Squamous Cell Carcinoma
Stereotactic ablative radiotherapy (SABR) with concomitant cetuximab is an effective treatment option for previously irradiated, locally recurrent squamous cell carcinoma of the head and neck. Its local control and overall survival are similar to those of other available treatment options. Each retreatment depends heavily on the prior treatment and every patient is a special case. Based on the experience of our institution and previously published studies, for patients who receive concomitant cetuximab with a median prior radiation therapy dose of 70Gy, we recommend a total dose of 40-44Gy delivered in 5 fractions on alter...
Source: Seminars in Radiation Oncology - March 20, 2016 Category: Cancer & Oncology Authors: Kimmen Quan, Karen M. Xu, Yongqian Zhang, David A. Clump, John C. Flickinger, Ron Lalonde, Steven A. Burton, Dwight E. Heron Source Type: research
Dose-Response Modeling of the Visual Pathway Tolerance to Single-Fraction and Hypofractionated Stereotactic Radiosurgery
Patients with tumors adjacent to the optic nerves and chiasm are frequently not candidates for single-fraction stereotactic radiosurgery (SRS) due to concern for radiation-induced optic neuropathy. However, these patients have been successfully treated with hypofractionated SRS over 2-5 days, though dose constraints have not yet been well defined. We reviewed the literature on optic tolerance to radiation and constructed a dose-response model for visual pathway tolerance to SRS delivered in 1-5 fractions. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - March 20, 2016 Category: Cancer & Oncology Authors: Susan M. Hiniker, Leslie A. Modlin, Clara Y. Choi, Banu Atalar, Kira Seiger, Michael S. Binkley, Jeremy P. Harris, Yaping Joyce Liao, Nancy Fischbein, Lei Wang, Anthony Ho, Anthony Lo, Steven D. Chang, Griffith R. Harsh, Iris C. Gibbs, Steven L. Hancock, Source Type: research
Small Bowel Dose Tolerance for Stereotactic Body Radiation Therapy
Inconsistencies permeate the literature regarding small bowel dose tolerance limits for stereotactic body radiation therapy (SBRT) treatments. In this review, we organized these diverse published limits with MD Anderson at Cooper data into a unified framework, constructing the dose-volume histogram (DVH) Risk Map, demonstrating low-risk and high-risk SBRT dose tolerance limits for small bowel. Statistical models of clinical data from 2 institutions were used to assess the safety spectrum of doses used in the exposure of the gastrointestinal tract in SBRT; 30% of the analyzed cases had vascular endothelial growth factor inh...
Source: Seminars in Radiation Oncology - March 20, 2016 Category: Cancer & Oncology Authors: Tamara A. LaCouture, Jinyu Xue, Gopal Subedi, Qianyi Xu, Justin T. Lee, Gregory Kubicek, Sucha O. Asbell Source Type: research
Estimated Risk Level of Unified Stereotactic Body Radiation Therapy Dose Tolerance Limits for Spinal Cord
A literature review of more than 200 stereotactic body radiation therapy spine articles from the past 20 years found only a single article that provided dose-volume data and outcomes for each spinal cord of a clinical dataset: the Gibbs 2007 article (Gibbs et al, 20071), which essentially contains the first 100 stereotactic body radiation therapy (SBRT) spine treatments from Stanford University Medical Center. The dataset is modeled and compared in detail to the rest of the literature review, which found 59 dose tolerance limits for the spinal cord in 1-5 fractions. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - March 20, 2016 Category: Cancer & Oncology Authors: Jimm Grimm, Arjun Sahgal, Scott G. Soltys, Gary Luxton, Ashish Patel, Scott Herbert, Jinyu Xue, Lijun Ma, Ellen Yorke, John R. Adler, Iris C. Gibbs Source Type: research
Dose Tolerance for Stereotactic Body Radiation Therapy
Normal tissue complication probability (NTCP) results were detailed in the July 2001 issue of Seminars in Radiation Oncology1 for conventionally fractionated radiation therapy. After 7 years, an extensive collection of stereotactic ablative body radiotherapy (SABR) or stereotactic body radiation therapy (SBRT) dose-tolerance limits was presented in the October 2008 issue of Seminars in Radiation Oncology,2 but estimates of risk were not yet available. We now have sufficient data to combine the 2: NTCP for SBRT. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - March 20, 2016 Category: Cancer & Oncology Authors: Jimm Grimm Source Type: research
Dose-Volume Histogram Analysis of Stereotactic Body Radiotherapy Treatment of Pancreatic Cancer: A Focus on Duodenal Dose Constraints
Pancreatic carcinoma is an aggressive disease and radiotherapy treatment delivery to the primary tumor is constrained by the anatomical close location of the duodenum, stomach, and small bowel. Duodenal dose tolerance for radiosurgery in 2-5 fractions has been largely unknown. The literature was surveyed for quantitative models of risk in 1-5 fractions and we analyzed our own patient population of 44 patients with unresectable pancreatic tumors who received 3 or 5 fractions of stereotactic body radiotherapy (SBRT) between March 2009 and March 2013. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - March 20, 2016 Category: Cancer & Oncology Authors: Christy Goldsmith, Patricia Price, Timothy Cross, Sheila Loughlin, Ian Cowley, Nicholas Plowman Source Type: research
The Role of Postmastectomy Radiation Therapy in Patients With Breast Cancer Responding to Neoadjuvant Chemotherapy
When surgery is the first line of breast cancer treatment, numerous randomized clinical trials and meta-analyses have demonstrated that postmastectomy radiation therapy (PMRT) improves locoregional control and survival for many women with axillary lymph node–positive disease. In contrast, there are no randomized data regarding the use of PMRT in women who receive neoadjuvant chemotherapy (NAC) first followed by mastectomy. This has led to controversy regarding which patient with breast cancer will benefit from PMRT after NAC, particularly in women with clinically node-positive axillary disease that responds well and is d...
Source: Seminars in Radiation Oncology - November 28, 2015 Category: Cancer & Oncology Authors: Jose G. Bazan, Julia R. White Source Type: research
Molecular Phenotype, Multigene Assays, and the Locoregional Management of Breast Cancer
Molecular profiling has revealed that breast cancer is not a single disease entity, but rather a class of heterogeneous subtypes, each with its own inherent biology and natural history. As a result, different treatment approaches have been optimized for the various subtypes and, in turn, the ability to identify subtypes has become a critical element in the management of breast cancer. Comprehensive transcriptional profiling studies have revealed at least 4 principal subtypes that, in practice, are often distinguished by immunohistochemical staining of the estrogen receptor (ER), progesterone receptor (PR), and HER2, along ...
Source: Seminars in Radiation Oncology - November 28, 2015 Category: Cancer & Oncology Authors: Lior Z. Braunstein, Alphonse G. Taghian Source Type: research
Management of the Regional Lymph Nodes in Early-Stage Breast Cancer
The management of regional nodes in early-stage invasive breast cancer continues to evolve. Improved systemic therapy has contributed to better local regional control, and at the same time it has drawn more attention to its importance. Axillary dissections have decreased, in part because of the increased efficacy of systemic therapy, and also because adjuvant therapy decisions are increasingly driven by biologic characterization of the tumor rather than pathologic nodal information. The trend toward less axillary surgery and a shift toward increased reliance on systemic and radiation therapy to address nodal disease has cr...
Source: Seminars in Radiation Oncology - November 28, 2015 Category: Cancer & Oncology Authors: Julia S. Wong, Laura E.G. Warren, Jennifer R. Bellon Source Type: research
Surgical Management of de novo Stage IV Breast Cancer
The natural history of stage IV breast cancer is changing, with diagnosis when the disease burden is lower and better drugs translating into longer survival. Nevertheless, a small but constant fraction of women present with de novo stage IV disease and an intact primary tumor. The management of the primary site in this setting has classically been determined by the presence of symptoms, but this approach has been questioned based on multiple retrospective reviews reported over the past decade that suggested a survival advantage for women whose intact primary tumor is resected. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - November 28, 2015 Category: Cancer & Oncology Authors: Seema Ahsan Khan Source Type: research
Novel and Highly Compressed Schedules for the Treatment of Breast Cancer
Our thinking about radiotherapy (RT) for early-stage breast cancer has evolved considerably over the last several years. Increasingly patients and physicians together are making the decision to use altered fractionation rather than standard 6-7 weeks of conventional whole breast treatment plus lumpectomy bed boost. Adjuvant hypofractionated whole breast irradiation is now viewed as a preferred strategy for many eligible women, and can be completed in 3-4 weeks. Adjuvant accelerated partial breast irradiation is another alternative that is typically delivered in 8-10 fractions over 4-5 days. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - November 28, 2015 Category: Cancer & Oncology Authors: Atif J. Khan, Stuti Ahlawat, Sharad Goyal Source Type: research
Introduction: The Changing Spectrum of Breast Cancer
Change is the process by which the future invades our lives. (Alvin Toffler) (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - November 28, 2015 Category: Cancer & Oncology Authors: David E. Wazer Source Type: research
Contemporary Breast Radiotherapy and Cardiac Toxicity
Long-term cardiac effects are an important component of survivorship after breast radiotherapy. The pathophysiology of cardiotoxicity, history of breast radiotherapy, current methods of cardiac avoidance, modern outcomes, context of historical outcomes, quantifying cardiac effects, and future directions are reviewed in this article. Radiation-induced oxidative stress induces proinflammatory cytokines and is a process that potentiates late effects of fibrosis and intimal proliferation in endothelial vasculature. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - November 28, 2015 Category: Cancer & Oncology Authors: Debra Nana Yeboa, Suzanne Buckley Evans Source Type: research
Breast Cancer Risk Assessment: Moving Beyond BRCA 1 and 2
The National Cancer Institute estimates that 12.3% of all women (about 1 in 8) would be diagnosed with breast cancer throughout their lifetime. In 2015, a projected 231,840 new cases are expected in the United States, accompanied by 40,290 deaths. Presently, breast cancer is responsible for 6.8% of all cancer deaths, and roughly 30% of all cancers in women. Since the discovery of the BRCA gene in 1994, efforts have been made to develop effective screening methods for breast cancer detection. Although the BRCA gene certainly opened the door to breast cancer genetics, a wide variety of new genes have recently been linked to ...
Source: Seminars in Radiation Oncology - November 28, 2015 Category: Cancer & Oncology Authors: Jennifer Scalia-Wilbur, Bradley L. Colins, Richard T. Penson, Don S. Dizon Source Type: research
Advances in Medical Management of Early Stage and Advanced Breast Cancer: 2015
Standard management of early stage and advanced breast cancer has been improved over the past few years by knowledge gained about the biology of the disease, results from a number of eagerly anticipated clinical trials and the development of novel agents that offer our patients options for improved outcomes or reduced toxicity or both. This review highlights recent major developments affecting the systemic therapy of breast cancer, broken down by clinically relevant patient subgroups and disease stage, and briefly discusses some of the ongoing controversies in the treatment of breast cancer and promising therapies on the h...
Source: Seminars in Radiation Oncology - November 28, 2015 Category: Cancer & Oncology Authors: Sabrina Witherby, Tina Rizack, Bachir J. Sakr, Robert D. Legare, William M. Sikov Source Type: research
