Understanding and modeling human-AI interaction of artificial intelligence tool in radiation oncology clinic using deep neural network: a feasibility study using three year prospective data.

Artificial intelligence (AI) based treatment planning tools are being implemented in clinic. However, human interactions with such AI tools are rarely analyzed. This study aims to comprehend human planner's interaction with the AI planning tool and incorporate the analysis to improve the existing AI tool.

Survival among patients with untreated metastatic breast cancer: "What if I do nothing?".

Purpose: We sought to assess survival outcomes of patients with de novo metastatic breast cancer (dnMBC) who did not receive treatment irrespective of the reason.

Methods: Adults with dnMBC were selected from the NCDB (2010-2016) and stratified based on receipt of treatment (treated = received at least one treatment and untreated = received no treatments). Overall survival (OS) was estimated using the Kaplan-Meier method, and groups were compared.

Optimizing Adjuvant Treatment Recommendations for Older Women with Biologically Favorable Breast Cancer: Short-Course Radiation or Long-Course Endocrine Therapy?

Omission of radiotherapy among older women taking 5 years of adjuvant endocrine therapy following breast conserving surgery for early-stage, hormone sensitive breast cancers is well-studied. However, endocrine therapy toxicities are significant, and many women have difficulty tolerating endocrine therapy, particularly elderly patients with comorbidities. Omission of endocrine therapy among women receiving adjuvant radiation is less well-studied, but available randomized and non-randomized data suggest that this approach may confer equivalent local control and survival for select patients.

Dosimetric variation in preoperative partial breast radiosurgery assessed by deformable image registrations.

Objective: To assess dosimetric variation caused by breast deformation in breast radiosurgery based on deformable image registration.

Methods: This study included 30 patients who were treated in the prone position for preoperative partial breast radiosurgery. The biopsy clip in CBCT was aligned to the one from the planning CT.

Prospective Longitudinal Assessment of Health-related Quality of Life in Patients With Brain Metastases Undergoing Radiation Therapy.

Objective: We conducted a prospective clinical trial of patients receiving radiation (RT) for brain metastases to identify clinical predictors of pre-RT and post-RT health-related quality of life (hrQoL).

Materials And Methods: Patients with brain metastases completed overall (European Organisation for Research and Treatment of Cancer QLQ C15-PAL) and brain tumor-specific (QLQ-BN20) hrQoL assessments pre-RT (n=127) and 1 (n=56) and 3 (n=45) months post-RT. Linear and proportional-odds models analyzed patient, disease, and treatment predictors of baseline, 1-, and 3-month hrQoL scores.

Circulating Tumor DNA Predicts Pathologic and Clinical Outcomes Following Neoadjuvant Chemoradiation and Surgery for Patients With Locally Advanced Rectal Cancer.

Purpose: This study was designed to assess the ability of perioperative circulating tumor DNA (ctDNA) to predict surgical outcome and recurrence following neoadjuvant chemoradiation for locally advanced rectal cancer (LARC).

Materials And Methods: Twenty-nine patients with newly diagnosed LARC treated between January 2014 and February 2018 were enrolled. Patients received long-course neoadjuvant chemoradiation prior to surgery.

Clinical Experience With Machine Learning-Based Automated Treatment Planning for Whole Breast Radiation Therapy.

Purpose: The machine learning-based automated treatment planning (MLAP) tool has been developed and evaluated for breast radiation therapy planning at our institution. We implemented MLAP for patient treatment and assessed our clinical experience for its performance.

Methods And Materials: A total of 102 patients of breast or chest wall treatment plans were prospectively evaluated with institutional review board approval.

ATM Variants in Breast Cancer: Implications for Breast Radiation Therapy Treatment Recommendations.

Purpose: Advances in germline genetic testing have led to a surge in identification of ataxia-telangiectasia mutated (ATM) variant carriers among breast cancer patients, raising numerous questions regarding use of breast radiation therapy (RT) in this population.

Methods: A literature search using PubMed identified articles assessing association(s) between the germline ATM variant status and the risk of toxicity after breast RT. An expert panel of breast radiation oncologists, genetic counselors, and basic scientists convened to review the association between ATM variants and radiation-induced toxicity or secondary malignancy risk and to determine any impact on breast RT recommendations.

Oligometastatic breast cancer: where are we now and where are we headed?-a narrative review.

Metastatic breast cancer has traditionally been considered incurable, with treatments focused on systemic therapies and palliative local treatment. However, evidence is emerging that in some patients with limited metastatic disease, or "oligometastatic disease," often defined as five or fewer metastases diagnosed on imaging, aggressive metastasis-directed therapy (MDT) with surgery and/or hypofractionated image-guided radiation therapy (HIGRT) improves outcomes and may even be curative. This practice is becoming more common as evidence has grown to support the approach and as technology has made it more feasible.

Surgery for Men with Breast Cancer: Do the Same Data Still Apply?

Background: Men represent a small proportion of breast cancer diagnoses, and they are often excluded from clinical trials. Current treatments are largely extrapolated from evidence in women. We compare practice patterns between men and women with breast cancer following the publication of several landmark clinical trials in surgery.

Surgical Management of the Axilla in Elderly Women With Node-Positive Breast Cancer.

Background: Elderly women with clinically node-positive (cN+) breast cancer (BC) often have comorbidities that limit life expectancy and complicate treatment. We sought to determine whether the number of lymph nodes (LNs) retrieved among older women with node-positive BC was associated with overall survival (OS).

Methods: Using the National Cancer Database (2010-2015), women 70-90 y with cN + BC and ≥1 LNs removed were categorized by treatment sequence: upfront surgery or neoadjuvant chemotherapy (NAC).

Radiation and chemotherapy for high-risk lower grade gliomas: Choosing between temozolomide and PCV.

Purpose: The majority of patients with high-risk lower grade gliomas (LGG) are treated with single-agent temozolomide (TMZ) and radiotherapy despite three randomized trials showing a striking overall survival benefit with adjuvant procarbazine, lomustine, and vincristine (PCV) chemotherapy and radiotherapy. This article aims to evaluate the evidence and rationale for the widespread use of TMZ instead of PCV for high-risk LGG.

Methods And Materials: We conducted a literature search utilizing PubMed for articles investigating the combination of radiotherapy and chemotherapy for high-risk LGG and analyzed the results of these studies.

Timing of Lymphedema After Treatment for Breast Cancer: When Are Patients Most At Risk?

Purpose: The purpose of the study was to determine when the risk of lymphedema is highest after treatment of breast cancer and which factors influence the time course of lymphedema development.

Methods And Materials: Between 2005 and 2017, 2171 women (with 2266 at-risk arms) who received surgery for unilateral or bilateral breast cancer at our institution were enrolled. Perometry was used to objectively assess limb volume preoperatively, and lymphedema was defined as a ≥10% relative arm-volume increase arising >3 months postoperatively.

Liver reirradiation for patients with hepatocellular carcinoma and liver metastasis.

Purpose: This study aimed to assess the safety and efficacy of administering liver reirradiation to patients with primary liver tumors or liver metastasis.

Methods And Materials: A total of 49 patients (with 64 individual tumors) who received liver reirradiation at our institution between June 2008 and December 2016 were identified for retrospective review. Patients were treated to the same, different, or a combination of previously treated liver tumors for recurrent primary (53%) or metastatic (47%) disease using photons or protons.

Impact of time to testosterone rebound and comorbidity on the risk of cause-specific mortality in men with unfavorable-risk prostate cancer.

Background: Herein, the authors evaluated how the time to testosterone rebound (TTR) after radiotherapy (RT) and 6 months of androgen deprivation therapy (ADT) impacted the risk of prostate cancer-specific mortality (PCSM) and cardiovascular-specific mortality (CVM) among men with varying comorbidity extent.

Methods: Between 1995 and 2001, a total of 206 men who were randomized to receive RT either alone or with 6 months of ADT for unfavorable-risk PC and who had a comorbidity score assigned using the Adult Comorbidity Evaluation 27 metric comprised the study cohort. Multivariable competing risk regression was used to evaluate the impact of and possible interaction between comorbidity and TTR on PCSM and CVM.

Evaluating a grading change at UCSD school of medicine: pass/fail grading is associated with decreased performance on preclinical exams but unchanged performance on USMLE step 1 scores.

Background: To assess the impact of a change in preclerkship grading system from Honors/Pass/Fail (H/P/F) to Pass/Fail (P/F) on University of California, San Diego (UCSD) medical students' academic performance.

Methods: Academic performance of students in the classes of 2011 and 2012 (constant-grading classes) were collected and compared with performance of students in the class of 2013 (grading-change class) because the grading policy at UCSD SOM was changed for the class of 2013, from H/P/F during the first year (MS1) to P/F during the second year (MS2). For all students, data consisted of test scores from required preclinical courses from MS1 and MS2 years, and USMLE Step 1 scores.

Neurocognitive assessment following whole brain radiation therapy and radiosurgery for patients with cerebral metastases.

The treatment of metastatic brain lesions remains a central challenge in oncology. Because most chemotherapeutic agents do not effectively cross the blood-brain barrier, it is widely accepted that radiation remains the primary modality of treatment. The mode by which radiation should be delivered has, however, become a source of intense controversy in recent years.

Role of the hippocampus in remembering the past and imagining the future.

It has been proposed that a core network of brain regions, including the hippocampus, supports both past remembering and future imagining. We investigated the importance of the hippocampus for these functions. Five patients with bilateral hippocampal damage and one patient with large medial temporal lobe lesions were tested for their ability to recount autobiographical episodes from the remote past, the recent past, and to imagine plausible episodes in the near future.

Recollection, familiarity, and cortical reinstatement: a multivoxel pattern analysis.

Episodic memory retrieval is thought to involve reinstatement of the neurocognitive processes engaged when an episode was encoded. Prior fMRI studies and computational models have suggested that reinstatement is limited to instances in which specific episodic details are recollected. We used multivoxel pattern-classification analyses of fMRI data to investigate how reinstatement is associated with different memory judgments, particularly those accompanied by recollection versus a feeling of familiarity (when recollection is absent).

Multivoxel pattern analysis reveals increased memory targeting and reduced use of retrieved details during single-agenda source monitoring.

We used multivoxel pattern analysis (MVPA) of functional MRI (fMRI) data to gain insight into how subjects' retrieval agendas influence source memory judgments (was item X studied using source Y?). In Experiment 1, we used a single-agenda test where subjects judged whether items were studied with the targeted source or not. In Experiment 2, we used a multiagenda test where subjects judged whether items were studied using the targeted source, studied using a different source, or nonstudied.