Publications by authors named "Jason Molitoris"

This study addresses the limited noninvasive tools for Head and Neck Squamous Cell Carcinoma (HNSCC) progression-free survival (PFS) prediction by identifying Computed Tomography (CT)-based biomarkers for predicting prognosis. A retrospective analysis was conducted on data from 203 HNSCC patients. An ensemble feature selection involving correlation analysis, univariate survival analysis, best-subset selection, and the LASSO-Cox algorithm was used to select functional features, which were then used to build final Cox Proportional Hazards models (CPH).

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Objectives: Radiotherapy manages pancreatic cancer in various settings; however, the proximity of gastrointestinal (GI) luminal organs-at-risk (OAR) poses challenges to conventional radiotherapy. Proton beam therapy (PBT) may reduce toxicities compared to photon therapy. This consensus statement summarizes PBT's safe and optimal delivery for pancreatic tumors.

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Purpose: Since the inaugural workshop "Understanding High-Dose, Ultra-High Dose Rate and Spatially Fractionated Radiotherapy." hosted by the NCI and sponsored by the Radiosurgery Society (RSS), growing collaborations and investigations have ensued among experts, practitioners, and researchers. The RSS GRID, Lattice, Microbeam & FLASH (GLMF) Working Groups were formed as a framework for these efforts and have focused on advancing the understanding of the biology, technical/physical parameters, trial design, and clinical practice of these new radiation therapy modalities.

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Purpose: Single vocal cord irradiation (SVCI) is a promising technique to maintain excellent oncologic control and potentially improve upon toxicities for treatment of early-stage glottic squamous cell carcinomas. We sought to investigate whether pencil beam scanning (PBS) proton therapy could improve upon the already favorable dose gradients demonstrated with volumetric modulated arc therapy (VMAT) SVCI.

Patients And Methods: A 64-year-old gentleman was treated in our department with 6X-flattening filter-free VMAT SVCI to 58.

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Article Synopsis
  • A new proton lattice (RPL) planning method has been proposed, which uses multifield delivery to potentially improve upon traditional photon lattice therapy.
  • In a comparison with photon plans, RPL achieved a 30% increase in the number of treatment vertices and a significantly higher peak-to-valley dose ratio (PVDR), indicating enhanced dosimetric characteristics.
  • The RPL method was clinically validated through treatment of two patients, demonstrating improved dose conformity and reduced low-dose exposure to the gross target volume (GTV).
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  • Oligometastatic castration-sensitive prostate cancer (omCSPC) is an early stage of metastatic disease with varying outcomes among patients, leading to a study on the impact of tumor genomics on disease progression and failure patterns after treatment.
  • A multi-institutional analysis of 267 men who underwent tumor sequencing highlighted that the presence of specific genomic mutations, like TP53, could influence modes of progression and overall survival rates.
  • The findings suggested that patients with oligoprogression had significantly better three-year overall survival rates (91%) compared to those with polyprogression (71%), indicating the importance of genomic profiling in predicting clinical outcomes.
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Purpose: The objective of this study was to characterize the conditional risk of developing grade 2+ urinary or gastrointestinal (GI) toxicity for patients treated with external beam radiation therapy in Radiation Therapy Oncology Group 0126. A secondary objective was to analyze baseline patient and treatment characteristics and determine their relevance in predicting toxicity both at the time of trial enrollment and at later points of follow-up.

Methods And Materials: One thousand five hundred thirty-two patients with localized prostate cancer were enrolled between March 2002 and August 2008, of whom 1499 were eligible and included in data analysis with a median follow-up of 8.

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Introduction: Re-irradiation (re-RT) for recurrent head and neck cancer (rHNC) is challenging. We describe clinical outcomes and toxicity of proton therapy (PT) for recurrent HNC, and report genomic alterations associated with patterns of failure.

Materials & Methods: We performed a retrospective analysis of rHNC patients treated with PT.

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Purpose: Radiotherapy delivery in the definitive management of lower gastrointestinal (LGI) tract malignancies is associated with substantial risk of acute and late gastrointestinal (GI), genitourinary, dermatologic, and hematologic toxicities. Advanced radiation therapy techniques such as proton beam therapy (PBT) offer optimal dosimetric sparing of critical organs at risk, achieving a more favorable therapeutic ratio compared with photon therapy.

Materials And Methods: The international Particle Therapy Cooperative Group GI Subcommittee conducted a systematic literature review, from which consensus recommendations were developed on the application of PBT for LGI malignancies.

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Introduction: This study aimed to identify CT-based imaging biomarkers for locoregional recurrence (LR) in Oral Cavity Squamous Cell Carcinoma (OSCC) patients.

Methods: Computed tomography scans were collected from 78 patients with OSCC who underwent surgical treatment at a single medical center. We extracted 1,092 radiomic features from gross tumor volume in each patient's pre-treatment CT.

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Article Synopsis
  • Pancreatic cancer has a very low five-year survival rate (10%) primarily due to late diagnoses and restricted treatment options, with current frontline therapies showing limited effectiveness against cancer stem cells (CSCs).
  • The study investigated the effects of various treatments (radiation, 5-FU, and 3-Bromopyruvate) on pancreatic tumor organoids, revealing that while radiation increased CSC markers (OCT4 and SOX2), 5-FU decreased them, and that a combination of 5-FU and radiation inhibited CSC self-renewal.
  • Findings suggest that the expression levels of CSC markers and the β-catenin pathway could be potential targets for improving treatment efficacy against pancreatic cancer.
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This study aimed to identify CT-based imaging biomarkers for locoregional recurrence (LR) in Oral Cavity Squamous Cell Carcinoma (OSCC) patients. Our study involved a retrospective review of 78 patients with OSCC who underwent surgical treatment at a single medical center. An approach involving feature selection and statistical model diagnostics was utilized to identify biomarkers.

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Objectives: We sought to describe outcomes for locally advanced cutaneous squamous cell carcinoma (SCC) involving the parotid treated with volumetric modulated arc therapy (VMAT) versus pencil beam scanning proton beam therapy (PBT).

Materials And Methods: Patients were gathered from 2016 to 2022 from 5 sites of a large academic RT department; included patients were treated with RT and had parotid involvement by: direct extension of a cutaneous primary, parotid regional spread from a previously or contemporaneously resected but geographically separate cutaneous primary, or else primary parotid SCC (with a cutaneous primary ostensibly occult). Acute toxicities were provider-reported (CTCAE v5.

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Purpose: Breath-hold (BH) technique can mitigate target motion, minimize target margins, reduce normal tissue doses, and lower the effect of interplay effects with intensity-modulated proton therapy (IMPT). This study presents dosimetric comparisons between BH and nonbreath-hold (non-BH) IMPT plans and investigates the reproducibility of BH plans using frequent quality assurance (QA) computed tomography scans (CT).

Methods And Materials: Data from 77 consecutive patients with liver (n = 32), mediastinal/lung (n = 21), nonliver upper abdomen (n = 20), and malignancies in the gastroesophageal junction (n = 4), that were treated with a BH spirometry system (SDX) were evaluated.

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Article Synopsis
  • The study highlights that proton radiation therapy may positively affect the oral microbiome and patient outcomes in head and neck cancer, while photon radiation appears to have detrimental effects.
  • A pilot study was conducted with patients undergoing both proton and photon radiation, analyzing oral microbiome shifts at three different stages: before, during, and after treatment.
  • Results showed that patients receiving photon therapy had reduced microbial diversity and more oral health issues (like mucositis), while proton therapy patients maintained a healthier oral microbiome and did not experience mucositis.
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This study addresses the limited non-invasive tools for Oral Cavity Squamous Cell Carcinoma (OSCC) survival prediction by identifying Computed Tomography (CT)-based biomarkers to improve prognosis prediction. A retrospective analysis was conducted on data from 149 OSCC patients, including CT radiomics and clinical information. An ensemble approach involving correlation analysis, score screening, and the Sparse-L1 algorithm was used to select functional features, which were then used to build Cox Proportional Hazards models (CPH).

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Background: Proton beam therapy (PBT) is a non-surgical treatment that spares adjacent tissues compared to photon radiation and useful for Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA). We present a single center experience in HCC and iCCA treated with Pencil Beam Scanning (PBS) PBT.

Methods: Forty-four consecutive patients (22 patients in each group) receiving PBT were included and reviewed.

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Purpose: Noncoplanar plans (NCPs) are commonly used for proton treatment of bilateral head and neck (HN) malignancies. NCP requires additional verification setup imaging between beams to correct residual errors of robotic couch motion, which increases imaging dose and total treatment time. This study compared the quality and robustness of NCPs with those of coplanar plans (CPs).

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Introduction: Unilateral radiation therapy is appropriate for select patients with oropharyngeal squamous cell carcinoma (OPSCC). The use of proton beam therapy (PBT) in the unilateral setting decreases the dose to the contralateral neck and organs at risk. This study aims to evaluate contralateral recurrences in patients who received ipsilateral PBT.

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Purpose: Despite well-informed work in several malignancies, the phenotypic effects of TP53 mutations in metastatic castration-sensitive prostate cancer (mCSPC) progression and metastasis are not clear. We characterized the structure-function and clinical impact of TP53 mutations in mCSPC.

Patients And Methods: We performed an international retrospective review of men with mCSPC who underwent next-generation sequencing and were stratified according to TP53 mutational status and metastatic burden.

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Objectives: Given emerging data suggesting that uncertainty in the relative biologic effectiveness at the distal end of the Bragg peak results in increased mucosal injury in patients with oropharynx cancer receiving adjuvant proton therapy, we evaluated the results of post-treatment positron emission tomography-computed tomography (PET/CT) in patients with p16-positive oropharynx cancer (p16+OPC) treated with definitive intensity-modulated proton therapy (IMPT).

Material And Methods: A retrospective cohort study of patients with p16+OPC treated with definitive IMPT between 2016 and 2022 was performed at a single institution. Patients with PET/CT scans within 6 months following completion of IMPT were included in the study.

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Importance: As patients achieve years of survival after treatment for prostate cancer, the risk of biochemical failure (BF) or prostate cancer-specific death (PCSD) may evolve over time, with clinical relevance to both patients and clinicians.

Objective: To determine conditional BF-free survival, PSCD, and overall survival estimates for patients with low- or intermediate-risk prostate cancer enrolled in the Radiation Therapy Oncology Group (RTOG) 0126 and RTOG 0415 clinical trials. A secondary objective was to determine whether prognostic factors at diagnosis remain relevant at later points in follow-up.

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This study addresses the limited non-invasive tools for Oral Cavity Squamous Cell Carcinoma OSCC survival prediction by identifying Computed Tomography (CT)-based biomarkers for improved prognosis. A retrospective analysis was conducted on data from 149 OSCC patients, including radiomics and clinical. An ensemble approach involving correlation analysis, score screening, and the Sparse-L1 algorithm was used to select functional features, which were then used to build Cox Proportional Hazards models (CPH).

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Objectives: To survey academic and community physician preferences regarding the virtual multidisciplinary tumor board (MTB) for further improvement and expansion.

Study Design: This anonymous 14-question survey was sent to individuals that participated in the head and neck virtual MTBs. The survey was sent via email beginning August 3, 2021, through October 5, 2021.

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Background: To determine if the extent of high-dose gross tumor volume (GTV) to clinical target volume (CTV) expansion is associated with local control in patients with p16-positive oropharynx cancer (p16+ OPC) treated with definitive intensity modulated proton therapy (IMPT).

Methods: We performed a retrospective analysis of patients with p16+ OPC treated with IMPT at a single institution between 2016 and 2021. Patients with a pre-treatment PET-CT and restaging PET-CT within 4 months following completion of IMPT were analyzed.

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