Intensity modulated radiation therapy following lumpectomy in early-stage breast cancer: Patterns of use and cost consequences among Medicare beneficiaries.

Purpose: In 2013, the American Society for Radiation Oncology (ASTRO) issued a Choosing Wisely recommendation against the routine use of intensity modulated radiotherapy (IMRT) for whole breast irradiation. We evaluated IMRT use and subsequent impact on Medicare expenditure in the period immediately preceding this recommendation to provide a baseline measure of IMRT use and associated cost consequences.

Methods And Materials: SEER records for women ≥66 years with first primary diagnosis of Stage I/II breast cancer (2008-2011) were linked with Medicare claims (2007-2012).

Long term follow-up of neoadjuvant chemotherapy for non-small cell lung cancer (NSCLC) investigating early positron emission tomography (PET) scan as a predictor of outcome.

Background: Neoadjuvant chemotherapy is effective in improving survival of resectable NSCLC. Based on findings in the adjuvant and metastatic setting, FDG positron emission tomography (PET) scans may offer early prognostic or predictive value after one cycle of induction chemotherapy.

Methods: In this phase II non-randomized trial, patients with AJCC version 6 stage IB to IIIB operable NSCLC were treated with 3 cycles of cisplatin and pemetrexed neoadjuvant chemotherapy.

Correlation of Functional Lung Heterogeneity and Dosimetry to Radiation Pneumonitis using Perfusion SPECT/CT and FDG PET/CT Imaging.

Purpose: To apply a previously designed framework for predicting radiation pneumonitis by using pretreatment lung function heterogeneity metrics, anatomic dosimetry, and functional lung dosimetry derived from 2 imaging modalities within the same cohort.

Methods And Materials: Treatment planning computed tomography (CT) scans were co-registered with pretreatment [Tc] macro-aggregated albumin perfusion single-photon positron emission tomography (SPECT)/CT scans and [F]-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT scans of 28 patients who underwent definitive thoracic radiation. Clinical radiation pneumonitis was defined as grade ≥2 (Common Terminology Criteria for Adverse Events, v.

The relationship between cardiac radiation dose and mediastinal lymph node involvement in stage III non-small cell lung cancer patients.

Purpose: The results from Radiation Therapy Oncology Group (RTOG) 0617, a dose escalation trial that compared treatment with 60 Gy versus 74 Gy for patients with stage III non-small cell lung cancer (NSCLC), suggested that in these patients, the heart dose from radiation therapy correlates with survival. In particular, the study noted that patients with a high heart V5 and V30 had a poorer overall survival; however, the exact cause of this correlation is not known. We hypothesize that heart dose may be a surrogate for mediastinal nodal involvement, which has prognostic value in NSCLC.

Framework for radiation pneumonitis risk stratification based on anatomic and perfused lung dosimetry.

Purpose: To design and apply a framework for predicting symptomatic radiation pneumonitis in patients undergoing thoracic radiation, using both pretreatment anatomic and perfused lung dose-volume parameters.

Materials And Methods: Radiation treatment planning CT scans were coregistered with pretreatment [Tc]MAA perfusion SPECT/CT scans of 20 patients who underwent definitive thoracic radiation. Clinical radiation pneumonitis was defined as grade ≥ 2 (CTCAE v4 grading system).

Theoretical effectiveness of cell survival in fractionated radiotherapy with hypoxia-targeted dose escalation.

Purpose: The goal of this article is to compute the cell survival during fractionated radiotherapy with non-uniform hypoxia-targeted dose distribution relative to cell survival for a uniform dose distribution with equal integral tumor dose. The analysis is performed for different parameters of radiotherapy with conventional and hypofractionated dose regimens.

Methods: Our analysis is done using a parsimonious tumor response model that describes the major components of tumor response to radiotherapy such as radiosensitivity, cell proliferation, and hypoxia using as few variables as possible.

Trimodality Treatment of Malignant Pleural Mesothelioma: An Institutional Review.

Objective: Malignant pleural mesothelioma (MPM) is a deadly disease with varying treatment options. This study retrospectively describes treatment practices at the University of Washington Medical System from 1980 to 2011, and evaluates the impact of trimodality therapy and radiation (photon and neutron) on survival.

Methods: A retrospective study was conducted on patients treated for MPM.

Fast neutron radiotherapy in the treatment of malignant pleural mesothelioma.

Introduction: Malignant pleural mesothelioma (MPM) is a fatal disease lacking standardized treatment. We describe the use of fast neutron radiation therapy in MPM patients referred to the Department of Radiation Oncology at the University of Washington Medical Center.

Materials And Methods: Retrospective chart review of MPM patients receiving neutron radiotherapy treatment from 1980 to 2012.

Challenges and opportunities in patient-specific, motion-managed and PET/CT-guided radiation therapy of lung cancer: review and perspective.

The increasing interest in combined positron emission tomography (PET) and computed tomography (CT) to guide lung cancer radiation therapy planning has been well documented. Motion management strategies during treatment simulation PET/CT imaging and treatment delivery have been proposed to improve the precision and accuracy of radiotherapy. In light of these research advances, why has translation of motion-managed PET/CT to clinical radiotherapy been slow and infrequent? Solutions to this problem are as complex as they are numerous, driven by large inter-patient variability in tumor motion trajectories across a highly heterogeneous population.