Radiosurgical management of brain metastases.

Stereotactic radiosurgery (SRS) should be considered in the comprehensive treatment paradigm for all patients with brain metastases. This technique has proven benefits for local tumor control in individuals with as many as 4 lesions, and when combined with structured radiographic follow-up, will likely preserve a better quality of life for appropriately selected patients. Institutions and physicians treating patients with brain metastases should have the capability of safely performing SRS and individual cases should be prospectively reviewed by multidisciplinary teams to provide the best comprehensive care.

Pneumonectomy for lung cancer after preoperative concurrent chemotherapy and high-dose radiation.

Background: We studied the clinical characteristics and outcomes of patients undergoing pneumonectomy after preoperative concurrent chemoradiation for non-small cell lung cancer.

Methods: Clinical records of patients with non-small cell lung cancer who underwent pneumonectomy at our institution between 1995 and 2005 after preoperative concurrent chemoradiation were reviewed retrospectively.

Results: Twenty-nine patients underwent pneumonectomy after preoperative concurrent chemoradiation.

The use of gated and 4D CT imaging in planning for stereotactic body radiation therapy.

The localization of treatment targets is of utmost importance for patients receiving stereotactic body radiation therapy (SBRT), where the dose per fraction is large. While both setup or respiration-induced motion components affect the localization of the treatment volume, the purpose of this work is to describe our management of the intrafraction localization uncertainty induced by normal respiration. At our institution, we have implemented gated computed tomography (CT) acquisition with an active breathing control system (ABC), and 4-dimensional (4D) CT using a skin-based marker and retrospective respiration phase-based image sorting.

Radiation oncology emergencies.

Radiation therapy is an important and effective treatment modality when used in the management of oncologic emergencies. For any patient who has MSCC, ISCM, SVC syndrome, or life-threatening hemoptysis/obstruction, optimal management hinges on efficient multidisciplinary evaluation and communication to arrive at a treatment plan tailored to the individual patient. Optimal management may include steroids, surgery, chemotherapy, or bronchoscopic intervention.

Gated CT imaging using a free-breathing respiration signal from flow-volume spirometry.

Respiration-induced tumor motion is known to cause artifacts on free-breathing spiral CT images used in treatment planning. This leads to inaccurate delineation of target volumes on planning CT images. Flow-volume spirometry has been used previously for breath-holds during CT scans and radiation treatments using the active breathing control (ABC) system.

Simultaneous integrated intensity-modulated radiotherapy boost for locally advanced gynecological cancer: radiobiological and dosimetric considerations.

Purpose: Whole-pelvis irradiation (WPI) followed by a boost to the tumor site is the standard of practice for the radiotherapeutic management of locally advanced gynecologic cancers. The boost is frequently administered by use of brachytherapy or, occasionally, external-beam radiotherapy (EBRT) when brachytherapy does not provide sufficient coverage because of the size of the tumor or the geometry of the patient. In this work, we propose using an intensity-modulated radiotherapy (IMRT) simultaneous integrated boost (SIB), which is a single-phase process, to replace the conventional two-phase process involving WPI plus a boost.