Germ Cell Tumor of the Testis: Lethal Subtypes of a Curable Cancer.

Germ cell tumor of the testis (GCT) is a curable cancer even when it is widely metastatic; however, outcomes can differ based on tumor histology. Chemo-resistance in certain phenotypes, such as teratoma and yolk sac tumor, contributes to poor clinical outcomes in some patients with GCT. Despite this resistance to S-YSTemic therapy, many of these tumor subtypes remain amenable to surgical resection and possible cure.

Stem Cell Theory of Cancer: Clinical Implications for Cellular Metabolism and Anti-Cancer Metabolomics.

Although Otto Warburg may be right about the role of glycolysis versus OXPHOS in cancer metabolism, it remains unclear whether an altered metabolism is causative or correlative and is the main driver or a mere passenger in the pathogenesis of cancer. Currently, most of our successful treatments are designed to eliminate non-cancer stem cells (non-CSCs) such as differentiated cancer cells. When the treatments also happen to control CSCs or the stem-ness niche, it is often unintended, unexpected, or undetected for lack of a pertinent theory about the origin of cancer that clarifies whether cancer is a metabolic, genetic, or stem cell disease.

Stem Cell Origin of Cancer: Clinical Implications for Cancer Immunity and Immunotherapy.

A simple way to understand the immune system is to separate the self from non-self. If it is self, the immune system tolerates and spares. If it is non-self, the immune system attacks and destroys.

A Prospective Study Measuring Resident and Faculty Contour Concordance: A Potential Tool for Quantitative Assessment of Residents' Performance in Contouring and Target Delineation in Radiation Oncology Residency.

Purpose/objective(s): Accurate target delineation (ie, contouring) is essential for radiation treatment planning and radiotherapy efficacy. As a result, improving the quality of target delineation is an important goal in the education of radiation oncology residents. The purpose of this study was to track the concordance of radiation oncology residents' contours with those of faculty physicians over the course of 1 year to assess for patterns.

Stem Cell Origin of Cancer: Implications of Oncogenesis Recapitulating Embryogenesis in Cancer Care.

From this perspective, we wonder about the clinical implications of oncology recapturing ontogeny in the contexts of neoantigens, tumor biomarkers, and cancer targets. We ponder about the biological ramifications of finding remnants of mini-organs and residuals of tiny embryos in some tumors. We reminisce about classical experiments showing that the embryonic microenvironment possesses antitumorigenic properties.

Cleaning the dose falloff with low modulation in SBRT lung plans.

This dosimetric study is intended to lower the modulation factor in lung SBRT plans generated in the Eclipse TPS that could replace highly modulated plans that are prone to the interplay effect.Twenty clinical lung SBRT plans with high modulation factors (≥4) were replanned in Varian Eclipse TPS version 15.5 utilizing 2 mm craniocaudal and 1 mm axial block margins followed by light optimization in order to reduce modulation.

Facilitators and barriers to employment for rural women cancer survivors.

Purpose: Limited research exists on the employment experiences of rural women cancer survivors, yet this population may face unique barriers to employment following a cancer diagnosis. This study aims to identify facilitators and barriers to employment for rural women cancer survivors.

Methods: We used a qualitative descriptive design to examine facilitators and barriers to employment for rural women cancer survivors.

The Role of Radiotherapy Among Patients With Prostate Ductal Adenocarcinoma.

Introduction: The aim of this study was to perform a Surveillance, Epidemiology, and End Results (SEER) analysis on the effect of radiotherapy (RT) on survival among patients with prostate ductal adenocarcinoma (DA), a rare variant of prostate cancer.

Patients And Methods: Cases of T1 to 4 N0 M0 prostate DA diagnosed between 2004 and 2013 were extracted from SEER. The association between categorical variables and radiation therapy was assessed for statistical significance using the χ test or Fisher exact test.

Brachytherapy vs external beam therapy among NSCLC patients undergoing limited surgical resection.

Purpose: To compare brachytherapy to external beam radiation therapy (EBRT) with respect to overall survival (OS) and disease-specific survival (DSS) among NSCLC patients undergoing limited surgical resection.

Methods: All cases of T1-4 N0 M0 NSCLC undergoing limited resection and either brachytherapy or EBRT diagnosed between 2004 and 2014 were extracted from the Surveillance, Epidemiology, and End Results database. Chi-square test and Fisher's exact analysis were used to analyze categorical variables while Student's t-test was used to analyze continuous variables.

The effect of post mastectomy radiation therapy on survival in breast cancer patients with N1mic disease.

Background: The role of post mastectomy radiation therapy (PMRT) in patients with N1mic breast cancer has not been well defined. A retrospective analysis was performed using the SEER database to evaluate the impact of PMRT on survival in patients with N1mic breast cancer.

Materials And Methods: Women with T1-T2, N1mic, M0 breast cancer who had undergone mastectomy were analyzed.

The role of poly(ADP-ribose) polymerase inhibitors in the treatment of cancer and methods to overcome resistance: a review.

Poly(ADP-ribose) polymerase (PARP) inhibitors represent one of the successful novel approaches to targeted cancer treatment. Indeed, the US Food and Drug Administration (FDA) has recently approved PARP inhibitors for the treatment of breast and ovarian cancers. Despite the proven efficacy of these agents, certain challenges remain with their use.

The epidemiology and role of surgery in the treatment of urethral clear cell carcinoma.

Purpose: To perform a retrospective analysis of the epidemiology and role of surgery on survival in patients with urethral clear cell carcinoma (UCCC) using the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database.

Methods: UCCC cases diagnosed from January 1, 1973, to December 31, 2014, were extracted from SEER. Descriptive statistics were calculated for all variables.

The Role of Immunotherapy and Radiation Therapy in Tumor Chemosensitivity in Advanced Head and Neck Cancer.

BACKGROUND Cancer is the second leading cause of death internationally, resulting in millions of deaths each year. While treatment in the past has heavily relied on surgery and radiotherapy, chemotherapy and immunotherapy are being increasingly utilized depending on disease presentation. CASE REPORT A 56-year-old male presented to the Emergency Department with a 3-week history of a rapidly enlarging left supraclavicular neck mass.

A Dose Falloff Gradient Study in RapidArc Planning of Lung Stereotactic Body Radiation Therapy.

Introduction: Radiation Therapy Oncology Group (RTOG) report #0813 and 0915 recommends using D and R as plan quality metrics for evaluation of normal tissue sparing in stereotactic body radiation therapy (SBRT) of lung lesion. This study introduces dose falloff gradient (DFG) as a tool for analyzing the dose beyond the planning target volume (PTV) extending into normal tissue structures. In ascertaining the impact of PTV size and SBRT planning techniques in DFG, this study questions the independence of the RTOG recommended metrics.

Robust optimization in lung treatment plans accounting for geometric uncertainty.

Robust optimization generates scenario-based plans by a minimax optimization method to find optimal scenario for the trade-off between target coverage robustness and organ-at-risk (OAR) sparing. In this study, 20 lung cancer patients with tumors located at various anatomical regions within the lungs were selected and robust optimization photon treatment plans including intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) plans were generated. The plan robustness was analyzed using perturbed doses with setup error boundary of ±3 mm in anterior/posterior (AP), ±3 mm in left/right (LR), and ±5 mm in inferior/superior (IS) directions from isocenter.

Technical Note: A planning technique to lower normal tissue toxicity in lung SBRT plans based on two likely dependent RTOG metrics.

Purpose: Intermediate- and low-dose falloff in stereotactic body radiotherapy (SBRT) of lung tumor is known to relate to normal tissue toxicity. The purpose is twofold to analyze the relation between RTOG parameters (namely, R50%, D2cm) in lung SBRT plans and to explore planning methods that correlate with higher than acceptable dose to normal tissue.

Methods: RTOG recommended target dose coverage, conformity index, homogeneity index, R50%, and D2cm were evaluated retrospectively in 105 lung tumor SBRT plans.

Helical tomotherapy to LINAC plan conversion utilizing RayStation Fallback planning.

RaySearch RayStation Fallback (FB) planning module can generate an equivalent backup radiotherapy treatment plan facilitating treatment on other linear accelerators. FB plans were generated from the RayStation FB module by simulating the original plan target and organ at risk (OAR) dose distribution and delivered in various backup linear accelerators. In this study, helical tomotherapy (HT) backup plans used in Varian TrueBeam linear accelerator were generated with the RayStation FB module.

Therapeutic benefits in grid irradiation on Tomotherapy for bulky, radiation-resistant tumors.

Introduction: Spatially fractionated radiation therapy (SFRT or grid therapy) has proven to be effective in management of bulky tumors. The aim of this project is to study the therapeutic ratio (TR) of helical Tomotherapy (HT)-based grid therapy using linear-quadratic cell survival model.

Material And Methods: HT-based grid (or HT-GRID) plan was generated using a patient-specific virtual grid pattern of high-dose cylindrical regions using MLCs.

A comparative study to evaluate the efficacy of on board imaging with cone beam CT using target registration in patients with lung tumors undergoing stereotactic body radiation therapy and comparison with ExacTrac using skeletal registration on Novalis Tx.

Background: Stereotactic body radiation therapy is an advanced technique, which delivers ablative doses to lung lesions. Target verification is done either by orthogonal x-rays or cone beam CT. This study was undertaken to compare these two verification methods.