Long-Term Update of NRG/RTOG 0522: A Randomized Phase 3 Trial of Concurrent Radiation and Cisplatin With or Without Cetuximab in Locoregionally Advanced Head and Neck Cancer.

Purpose: The combination of cisplatin and radiation or cetuximab and radiation improves overall survival of patients with locoregionally advanced head and neck carcinoma. NRG Oncology conducted a phase 3 trial to test the hypothesis that adding cetuximab to radiation and cisplatin would improve progression-free survival (PFS).

Methods And Materials: Eligible patients with American Joint Committee on Cancer sixth edition stage T2 N2a-3 M0 or T3-4 N0-3 M0 were accrued from November 2005 to March 2009 and randomized to receive radiation and cisplatin without (arm A) or with (arm B) cetuximab.

NRG Oncology/RTOG1205: A Randomized Phase II Trial of Concurrent Bevacizumab and Reirradiation Versus Bevacizumab Alone as Treatment for Recurrent Glioblastoma.

Purpose: To assess whether reirradiation (re-RT) and concurrent bevacizumab (BEV) improve overall survival (OS) and/or progression-free survival (PFS), compared with BEV alone in recurrent glioblastoma (GBM). The primary objective was OS, and secondary objectives included PFS, response rate, and treatment adverse events (AEs) including delayed CNS toxicities.

Methods: NRG Oncology/RTOG1205 is a prospective, phase II, randomized trial of re-RT and BEV versus BEV alone.

Resection and radiotherapy for intracranial ependymoma: a multiinstitutional 50-year experience.

Objective: Maximal safe resection is the standard-of-care treatment for adults with intracranial ependymoma. The value of adjuvant radiotherapy remains unclear as these tumors are rare and current data are limited to a few retrospective cohort studies. In this study, the authors assembled a cohort of patients across multiple international institutions to assess the utility of adjuvant radiotherapy in this patient population.

Treatment of Recurrent Optic Nerve Sheath Meningioma With a Secondary Course of Radiotherapy.

Optic nerve sheath meningiomas (ONSM) are benign neoplasms found surrounding the optic nerve that can affect vision, and potentially lead to blindness. The use of radiotherapy has been advocated to improve visual outcomes and minimize the risk of complications. We present a case of a 58-year-old woman who was treated with a second course of radiotherapy 27-years after initial radiotherapy for recurrent ONSM.

A prospective single-institution study of intraoperative radiotherapy (IORT) for early-stage breast cancer.

Intraoperative radiation therapy (IORT) is an option for breast-conserving therapy in early-stage breast cancer. IORT is given in one fraction at the time of surgery and eliminates the need for adjuvant external beam radiation therapy. However, previous trials indicate increased local failure rates compared with whole-breast irradiation, which engenders controversy around the appropriate use of IORT.

Laser Interstitial Thermal Therapy for Metastatic Melanoma After Failed Radiation Therapy: A Case Series.

Background: Laser interstitial thermal therapy (LITT) is a growing technology to treat a variety of brain lesions. It offers an alternative to treatment options, such as open craniotomy and stereotactic radiosurgery.

Objective: To analyze our experience using LITT for metastatic melanoma.

Bilateral Carotid-cavernous Fistulas Treated with Partial Embolization and Radiosurgery.

Bilateral carotid-cavernous fistulas (CCFs) are rare. In this paper, we report the case of an 88-year-old woman who presented with a two-month history of worsening visual symptoms and was subsequently found to have bilateral Barrow grade D CCFs. Cannulation and complete embolization of the offending vessels during angiography proved unsuccessful, and so the patient underwent adjuvant radiosurgery as salvage therapy with a good clinical outcome.

Factors Associated with Treatment Failure and Radiosurgery-Related Edema in WHO Grade 1 and 2 Meningioma Patients Receiving Gamma Knife Radiosurgery.

Background: Before the advent of radiosurgery, neurosurgical treatment of meningiomas typically involved gross total resection of the mass whenever surgery was deemed possible. Over the past 4 decades, though, Gamma Knife radiosurgery (GKRS) has proved to be an effective, minimally invasive means to control the growth of these tumors. However, the variables associated with treatment failure (regrowth or clinical progression) after GKRS and GKRS-related complications, such as cerebral edema, are less well understood.

Clinicopathologic Features and Radiation Therapy Utilization in Patients with Male Breast Cancer: A National Cancer Database Study.

Male breast cancer (MBC) accounts for approximately 1% of all breast cancers, limiting the data characterizing clinicopathologic features and treatment outcomes in patients with MBC. This paucity of data has led to most of our treatment guidance being extrapolated from patients with female breast cancer (FBC). From 1998 to 2012, data were captured using the National Cancer Database to identify patients with nonmetastatic MBC (n = 23 305) and FBC (n = 2 678 061).

Comparison of Volumetric Modulated Arc Therapy and Intensity Modulated Radiation Therapy for Whole Brain Hippocampal Sparing Treatment Plans Based on Radiobiological Modeling.

Introduction: In this article, we report the results of our investigation on comparison of radiobiological aspects of treatment plans with linear accelerator-based intensity-modulated radiation therapy and volumetric-modulated arc therapy for patients having hippocampal avoidance whole-brain radiation therapy.

Materials And Methods: In this retrospective study using the dose-volume histogram, we calculated and compared biophysical indices of equivalent uniform dose, tumor control probability, and normal tissue complication probability (NTCP) for 15 whole-brain radiotherapy patients.

Results And Discussions: Dose-response models for tumors and critical structures were separated into two groups: mechanistic and empirical.

Dosimetric comparison of sector-blocked and non-sector-blocked Gamma Knife Perfexion treatment plans for trigeminal neuralgia.

The purpose of this study is to compare the quality of trigeminal neuralgia (TN) treatment plans with and without utilizing sector blocking. Twelve patients with 13 cases of TN were evaluated in this retrospective study. Identical magnetic resonance imaging (MRI) contour sets and prescription doses used in treatments were reused for all plans.

Simultaneous Resection of Multiple Metastatic Brain Tumors with Multiple Keyhole Craniotomies.

Background: The proper management of symptomatic patients with 2 or more brain metastases is not entirely clear, and the surgical outcomes of these patients undergoing multiple simultaneous craniotomies have not been well described. In this article, we describe patient outcomes after simultaneously resecting metastatic lesions through multiple keyhole craniotomies.

Methods: We conducted a retrospective review of data obtained for all patients undergoing resection of multiple brain metastases in one operation between 2014 and 2016.

When Evaluating a New Thyroid Mass and a Ring-Enhancing Brain Lesion (When Two Presentations Collide).

We aimed to evaluate the clinical and pathologic features of two common medical illnesses and their appropriate workup and pathognomonic findings. A 57-year-old white male presented with a new onset expressive aphasia while traveling abroad. He was evaluated at an outside facility and underwent workup for a stroke.

Radiotherapy in Patients 70 Years and Older With Triple-Negative Breast Cancer.

Purpose: To evaluate the use of radiotherapy (RT) in older patients with triple-negative breast cancer (TNBC).

Patients And Methods: The National Cancer Data Base (NCDB) is a comprehensive national database that captures approximately 70% of newly diagnosed cancer patients in the United States. Data for patients meeting the criteria of nonmetastatic TNBC were extracted and analyzed.

Evaluation of localization uncertainty of fiducial markers due to length and position variations induced by motion in CT imaging by measurement and modeling.

Purpose: To quantify the variations in the length and position of fiducial markers induced by motion in axial (ACT), helical (HCT) and cone-beam CT (CBCT) imaging and associated uncertainty in image-guided radiotherapy (IGRT) by measurement and modeling.

Methods: A mobile thorax phantom containing markers of various lengths was imaged using ACT, HCT and CBCT imaging. The phantom was imaged while stationary and moving where it was moved sinusoidally with different motion amplitudes and frequency.

Quantitative evaluation of patient setup uncertainty of stereotactic radiotherapy with the frameless 6D ExacTrac system using statistical modeling.

The purpose of this study is to evaluate patient setup accuracy and quantify indi-vidual and cumulative positioning uncertainties associated with different hardware and software components of the stereotactic radiotherapy (SRS/SRT) with the frameless 6D ExacTrac system. A statistical model is used to evaluate positioning uncertainties of the different components of SRS/SRT treatment with the Brainlab 6D ExacTrac system using the positioning shifts of 35 patients having cranial lesions. All these patients are immobilized with rigid head-and-neck masks, simu-lated with Brainlab localizer and planned with iPlan treatment planning system.

Quantitative evaluation of correlation of dose and FDG-PET uptake value with clinical chest wall complications in patients with lung cancer treated with stereotactic body radiation therapy.

The aim of this study was to investigate quantitatively the dosimetric factors that increase the risk of clinical complications of rib fractures or chest wall pain after stereotactic body radiation therapy (SBRT) to the lung. The correlations of clinical complications with standard-uptake values (SUV) and FDG-PET activity distributions from post-treatment PET-imaging were studied. Mean and maximum doses from treatment plans, FDG-PET activity values on post-SBRT PET scans and the presence of clinical complications were determined in fifteen patients undergoing 16 SBRT treatments for lung cancer.

Dosimetric comparison of intracranial metastasis treatment using two radiosurgery systems: TrueBeam STx with VMAT and Gamma Knife Model 4C.

We compared treatment plan quality based on target coverage and normal brain tissue sparing for two intracranial stereotactic radiosurgery systems: TrueBeam STx using VMAT and Gamma Knife (GK). Ten patients with 24 tumors (seven with 1-2 and three with 4-6 ranging from 0.1 to 20.

Quantitative evaluation of the dosimetric effects of balloon deformation and source position in high-dose rate mammosite breast brachytherapy.

Purpose: To investigate quantitatively the deformation of the mammosite balloon, eccentricity of the source position and their effects on the dose delivered to the tumor lumpectomy site and critical structures.

Materials And Methods: The distances of the brachytherapy source to the surface of the mammosite balloon were measured in using radiographic images for fractions 1 to 10 for twelve patients. The dose at the balloon surface (nearly 680cGy) and prescription dose of 340cGy at 1cm from the balloon surface were calculated for the different fractions and their dependence on the balloon volume and source position were investigated.

Comparison of doses received by the hippocampus in patients treated with single isocenter- vs multiple isocenter-based stereotactic radiation therapy to the brain for multiple brain metastases.

To investigate the doses received by the hippocampus and normal brain tissue during a course of stereotactic radiation therapy using a single isocenter (SI)-based or multiple isocenter (MI)-based treatment planning in patients with less than 4 brain metastases. In total, 10 patients with magnetic resonance imaging (MRI) demonstrating 2-3 brain metastases were included in this retrospective study, and 2 sets of stereotactic intensity-modulated radiation therapy (IMRT) treatment plans (SI vs MI) were generated. The hippocampus was contoured on SPGR sequences, and doses received by the hippocampus and the brain were calculated and compared between the 2 treatment techniques.

Central nervous system metastasis in gynecologic cancer: symptom management, prognosis and palliative management strategies.

Introduction: CNS metastasis (CNSmet) with gynecologic malignancy (GM) is associated with poor prognosis and symptom burden. Two prognostic indices, the recursive partitioning analysis (RPA) and graded prognostic assessment (GPA), used in other solid tumors to guide intervention options were evaluated among GM patients.

Methods: Retrospective chart review was performed to identify patients with primary GM diagnosed with CNSmet from 2005-2014.

Quantitative assessment by measurement and modeling of mobile target elongation in cone-beam computed tomographic imaging.

The purpose of this study was to assess quantitatively elongation of mobile targets in cone-beam CT (CBCT) imaging by measurement and modeling. A mathematical model was derived that predicts the measured lengths of mobile targets and its dependence on target size and motion patterns in CBCT imaging. Three tissue-equivalent targets of differing sizes were inserted in an artificial thorax phantom to simulate lung lesions.

Dosimetric comparison between IMRT delivery modes: Step-and-shoot, sliding window, and volumetric modulated arc therapy - for whole pelvis radiation therapy of intermediate-to-high risk prostate adenocarcinoma.

THIS STUDY WAS PERFORMED TO EVALUATE DOSIMETRIC DIFFERENCES BETWEEN CURRENT INTENSITY MODULATED RADIATION THERAPY (IMRT) DELIVERY MODES: Step-and-shoot (SS), sliding window (SW), and volumetric modulated arc therapy (VMAT). Plans for 15 prostate cancer patients with 10 MV photon beams using each IMRT mode were generated. Patients had three planning target volumes (PTVs) including prostate, prostate plus seminal vesicles, and pelvic lymphatics.

Gross tumour volume variations in primary non-small-cell lung cancer during the course of treatment with stereotactic body radiation therapy.

Introduction: We aim to quantify the variations in the gross tumour volume (GTV) during a course of stereotactic body radiotherapy (SBRT) and determine its impact on dosimetric coverage of the GTV.

Methods: The GTVs and dose coverage for 14 patients with 16 primary non-small-cell lung tumours treated with SBRT were investigated. Initial GTVs were calculated from treatment planning CT scans.