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Lewis D, Wang X, Gao S, Nitsch P, Pollard J, Sadagopan R, Balter P. SU-E-T-26: A Dosimetric Comparison of Two Treatment Setups for Lung Stereotactic Body Radiation Therapy (SBRT) Patients. Med Phys 2015. [DOI: 10.1118/1.4924387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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77
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Zhou R, Yang J, Pan T, Milgrom S, Pinnix C, Shi A, Yang J, Liu Y, Nguyen Q, Gomez D, Dabaja B, Balter P, Court L, Liao Z. SU-E-J-129: Atlas Development for Cardiac Automatic Contouring Using Multi-Atlas Segmentation. Med Phys 2015. [DOI: 10.1118/1.4924215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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78
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Yang J, Zhang L, Zhang Y, Dong L, Balter P, Court L. SU-E-J-108: Solving the Chinese Postman Problem for Effective Contour Deformation. Med Phys 2015. [DOI: 10.1118/1.4924195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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79
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Fave X, Fried D, Zhang L, Yang J, Balter P, Followill D, Gomez D, Jones A, Stingo F, Court L. SU-D-BRA-07: A Phantom Study to Assess the Variability in Radiomics Features Extracted From Cone-Beam CT Images. Med Phys 2015. [DOI: 10.1118/1.4923887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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80
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Gao S, Balter P, Rose M, Simon W. SU-E-T-645: Qualification of a 2D Ionization Chamber Array for Beam Steering and Profile Measurement. Med Phys 2015. [DOI: 10.1118/1.4925008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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81
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Nitsch P, Robertson D, Balter P. SU-E-J-14: A Comparison of a 2.5MV Imaging Beam to KV and 6MV Imaging Beams. Med Phys 2015. [DOI: 10.1118/1.4924102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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82
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Fave X, Fried D, Zhang L, Yang J, Balter P, Followill D, Gomez D, Jones A, Stingo F, Court L. SU-E-J-242: Volume-Dependence of Quantitative Imaging Features From CT and CE-CT Images of NSCLC. Med Phys 2015. [DOI: 10.1118/1.4924328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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83
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Chang JY, Senan S, Paul MA, Mehran RJ, Louie AV, Balter P, Groen HJM, McRae SE, Widder J, Feng L, van den Borne BEEM, Munsell MF, Hurkmans C, Berry DA, van Werkhoven E, Kresl JJ, Dingemans AM, Dawood O, Haasbeek CJA, Carpenter LS, De Jaeger K, Komaki R, Slotman BJ, Smit EF, Roth JA. Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-cell lung cancer: a pooled analysis of two randomised trials. Lancet Oncol 2015; 16:630-7. [PMID: 25981812 PMCID: PMC4489408 DOI: 10.1016/s1470-2045(15)70168-3] [Citation(s) in RCA: 1022] [Impact Index Per Article: 113.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The standard of care for operable, stage I, non-small-cell lung cancer (NSCLC) is lobectomy with mediastinal lymph node dissection or sampling. Stereotactic ablative radiotherapy (SABR) for inoperable stage I NSCLC has shown promising results, but two independent, randomised, phase 3 trials of SABR in patients with operable stage I NSCLC (STARS and ROSEL) closed early due to slow accrual. We aimed to assess overall survival for SABR versus surgery by pooling data from these trials. METHODS Eligible patients in the STARS and ROSEL studies were those with clinical T1-2a (<4 cm), N0M0, operable NSCLC. Patients were randomly assigned in a 1:1 ratio to SABR or lobectomy with mediastinal lymph node dissection or sampling. We did a pooled analysis in the intention-to-treat population using overall survival as the primary endpoint. Both trials are registered with ClinicalTrials.gov (STARS: NCT00840749; ROSEL: NCT00687986). FINDINGS 58 patients were enrolled and randomly assigned (31 to SABR and 27 to surgery). Median follow-up was 40·2 months (IQR 23·0-47·3) for the SABR group and 35·4 months (18·9-40·7) for the surgery group. Six patients in the surgery group died compared with one patient in the SABR group. Estimated overall survival at 3 years was 95% (95% CI 85-100) in the SABR group compared with 79% (64-97) in the surgery group (hazard ratio [HR] 0·14 [95% CI 0·017-1·190], log-rank p=0·037). Recurrence-free survival at 3 years was 86% (95% CI 74-100) in the SABR group and 80% (65-97) in the surgery group (HR 0·69 [95% CI 0·21-2·29], log-rank p=0·54). In the surgery group, one patient had regional nodal recurrence and two had distant metastases; in the SABR group, one patient had local recurrence, four had regional nodal recurrence, and one had distant metastases. Three (10%) patients in the SABR group had grade 3 treatment-related adverse events (three [10%] chest wall pain, two [6%] dyspnoea or cough, and one [3%] fatigue and rib fracture). No patients given SABR had grade 4 events or treatment-related death. In the surgery group, one (4%) patient died of surgical complications and 12 (44%) patients had grade 3-4 treatment-related adverse events. Grade 3 events occurring in more than one patient in the surgery group were dyspnoea (four [15%] patients), chest pain (four [15%] patients), and lung infections (two [7%]). INTERPRETATION SABR could be an option for treating operable stage I NSCLC. Because of the small patient sample size and short follow-up, additional randomised studies comparing SABR with surgery in operable patients are warranted. FUNDING Accuray Inc, Netherlands Organisation for Health Research and Development, NCI Cancer Center Support, NCI Clinical and Translational Science Award.
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84
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Balter P. TH-CD-201-01: Radiation Therapy Databases. Med Phys 2015. [DOI: 10.1118/1.4926272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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85
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Faught JT, Johnson J, Stingo F, Kry S, Court L, Balter P, Followill D. SU-E-T-105: An FMEA Survey of Intensity Modulated Radiation Therapy (IMRT) Step and Shoot Dose Delivery Failure Modes. Med Phys 2015. [DOI: 10.1118/1.4924466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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86
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Castillo SJ, Castillo R, Castillo E, Pan T, Ibbott G, Balter P, Hobbs B, Guerrero T. Evaluation of 4D CT acquisition methods designed to reduce artifacts. J Appl Clin Med Phys 2015; 16:4949. [PMID: 26103169 PMCID: PMC4504190 DOI: 10.1120/jacmp.v16i2.4949] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 11/21/2014] [Accepted: 11/09/2014] [Indexed: 12/25/2022] Open
Abstract
Four-dimensional computed tomography (4D CT) is used to account for respiratory motion in radiation treatment planning, but artifacts resulting from the acquisition and postprocessing limit its accuracy. We investigated the efficacy of three experimental 4D CT acquisition methods to reduce artifacts in a prospective institutional review board approved study. Eighteen thoracic patients scheduled to undergo radiation therapy received standard clinical 4D CT scans followed by each of the alternative 4D CT acquisitions: 1) data oversampling, 2) beam gating with breathing irregularities, and 3) rescanning the clinical acquisition acquired during irregular breathing. Relative values of a validated correlation-based artifact metric (CM) determined the best acquisition method per patient. Each 4D CT was processed by an extended phase sorting approach that optimizes the quantitative artifact metric (CM sorting). The clinical acquisitions were also postprocessed by phase sorting for artifact comparison of our current clinical implementation with the experimental methods. The oversampling acquisition achieved the lowest artifact presence among all acquisitions, achieving a 27% reduction from the current clinical 4D CT implementation (95% confidence interval = 34-20). The rescan method presented a significantly higher artifact presence from the clinical acquisition (37%; p < 0.002), the gating acquisition (26%; p < 0.005), and the oversampling acquisition (31%; p < 0.001), while the data lacked evidence of a significant difference between the clinical, gating, and oversampling methods. The oversampling acquisition reduced artifact presence from the current clinical 4D CT implementation to the largest degree and provided the simplest and most reproducible implementation. The rescan acquisition increased artifact presence significantly, compared to all acquisitions, and suffered from combination of data from independent scans over which large internal anatomic shifts occurred.
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Li H, Park P, Liu W, Matney J, Liao Z, Balter P, Li Y, Zhang X, Li X, Zhu XR. Patient-specific quantification of respiratory motion-induced dose uncertainty for step-and-shoot IMRT of lung cancer. Med Phys 2014; 40:121712. [PMID: 24320498 DOI: 10.1118/1.4829522] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The objective of this study was to quantify respiratory motion-induced dose uncertainty at the planning stage for step-and-shoot intensity-modulated radiation therapy (IMRT) using an analytical technique. METHODS Ten patients with stage II∕III lung cancer who had undergone a planning four-dimensional (4D) computed tomographic scan and step-and-shoot IMRT planning were selected with a mix of motion and tumor size for this retrospective study. A step-and-shoot IMRT plan was generated for each patient. The maximum and minimum doses with respiratory motion were calculated for each plan, and the mean deviation from the 4D dose was calculated, taking delivery time, fractionation, and patient breathing cycle into consideration. RESULTS For all patients evaluated in this study, the mean deviation from the 4D dose in the planning target volume (PTV) was <2.5%, with a standard deviation <1.2%, and maximum point dose variation from the 4D dose was <6.2% in the PTV assuming delivery dose rate of 200 MU∕min and patient breathing cycle of 8 s. The motion-induced dose uncertainty is a function of motion, fractionation, MU (plan modulation), dose rate, and patient breathing cycle. CONCLUSIONS Respiratory motion-induced dose uncertainty varies from patient to patient. Therefore, it is important to evaluate the dose uncertainty on a patient-specific basis, which could be useful for plan evaluation and treatment strategy determination for selected patients.
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Court L, Fullen D, Tharp K, Palmer J, Ungchusri G, Reyes L, Tong T, Nguyen S, Phillips T, Balter P. SU-C-19A-05: Treatment Chairs for Modern Radiation Therapy Treatments. Med Phys 2014. [DOI: 10.1118/1.4889704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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89
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Kantor M, Balter P, Ohrt J. SU-E-T-95: Delivery Time Estimator. Med Phys 2014. [DOI: 10.1118/1.4888425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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90
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Tonigan J, Johnson J, Kry S, Balter P, Court L, Stingo F, Followill D. SU-E-T-192: FMEA Severity Scores - Do We Really Know? Med Phys 2014. [DOI: 10.1118/1.4888522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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91
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Fave X, Zhang L, Yang J, Fried D, Balter P, Court L. TU-A-12A-03: Monitoring Changes in Tumor Texture Features On Weekly CT and CBCT Scans of NSCLC Patients. Med Phys 2014. [DOI: 10.1118/1.4889249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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92
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Shepard D, Popple R, Balter P. MO-G-BRD-01: Point/Counterpoint Debate: Arc Based Techniques Will Make Conventional IMRT Obsolete. Med Phys 2014. [DOI: 10.1118/1.4889193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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93
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Court L, Aristophanous M, Bellezza D, Followill D, Kirsner S, Kisling K, Massingill B, Papanikolaou N, Parker B, Pidikiti R, Wong P, Zhen H, Balter P. SU-E-J-189: Credentialing of IGRT Equipment and Processes for Clinical Trials. Med Phys 2014. [DOI: 10.1118/1.4888242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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94
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Castillo S, Castillo R, Castillo E, Pan T, Ibbott G, Balter P, Hobbs B, Dai J, Guerrero T. TH-E-17A-07: Improved Cine Four-Dimensional Computed Tomography (4D CT) Acquisition and Processing Method. Med Phys 2014. [DOI: 10.1118/1.4889682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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95
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Fave X, Yang J, Balter P, Court L. SU-E-J-186: Acquiring and Assessing Upright CBCT Images for Future Treatment Planning. Med Phys 2014. [DOI: 10.1118/1.4888239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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96
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Zhang Y, Yang J, Zhang L, Balter P, Dong L, Court L. MO-C-17A-09: Deformation Image Registration Using a Spatial-Context Regularization Filter. Med Phys 2014. [DOI: 10.1118/1.4889132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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97
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McKenzie E, Balter P, Stingo F, Followill D, Jones J, Kry S. TU-C-BRE-09: Performance Comparisons of Patient Specific IMRT QA Methodologies Using ROC Analysis. Med Phys 2014. [DOI: 10.1118/1.4889272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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98
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Hsieh M, Balter P, Beadle B, Chi P, Stingo F, Court L. SU-E-T-273: Radiation Shielding for a Fixed Horizontal-Beam Linac in a Shipping Container and a Conventional Treatment Vault. Med Phys 2014. [DOI: 10.1118/1.4888604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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99
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Gao S, Balter P, Rose M, Simon W. SU-E-T-359: Measurement of Various Metrics to Determine Changes in Megavoltage Photon Beam Energy. Med Phys 2014. [DOI: 10.1118/1.4888692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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100
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Yang J, Zhang Y, Zhang L, Balter P, Court L. SU-F-BRF-06: Density Correction for Deformable Image Registration to Improve CT Number Mapping. Med Phys 2014. [DOI: 10.1118/1.4889075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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