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Rong Y, Chen Q, Fu Y, Yang X, Al-Hallaq HA, Wu QJ, Yuan L, Xiao Y, Cai B, Latifi K, Benedict SH, Buchsbaum JC, Qi XS. NRG Oncology Assessment of Artificial Intelligence Deep Learning-Based Auto-segmentation for Radiation Therapy: Current Developments, Clinical Considerations, and Future Directions. Int J Radiat Oncol Biol Phys 2024; 119:261-280. [PMID: 37972715 PMCID: PMC11023777 DOI: 10.1016/j.ijrobp.2023.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 09/16/2023] [Accepted: 10/14/2023] [Indexed: 11/19/2023]
Abstract
Deep learning neural networks (DLNN) in Artificial intelligence (AI) have been extensively explored for automatic segmentation in radiotherapy (RT). In contrast to traditional model-based methods, data-driven AI-based models for auto-segmentation have shown high accuracy in early studies in research settings and controlled environment (single institution). Vendor-provided commercial AI models are made available as part of the integrated treatment planning system (TPS) or as a stand-alone tool that provides streamlined workflow interacting with the main TPS. These commercial tools have drawn clinics' attention thanks to their significant benefit in reducing the workload from manual contouring and shortening the duration of treatment planning. However, challenges occur when applying these commercial AI-based segmentation models to diverse clinical scenarios, particularly in uncontrolled environments. Contouring nomenclature and guideline standardization has been the main task undertaken by the NRG Oncology. AI auto-segmentation holds the potential clinical trial participants to reduce interobserver variations, nomenclature non-compliance, and contouring guideline deviations. Meanwhile, trial reviewers could use AI tools to verify contour accuracy and compliance of those submitted datasets. In recognizing the growing clinical utilization and potential of these commercial AI auto-segmentation tools, NRG Oncology has formed a working group to evaluate the clinical utilization and potential of commercial AI auto-segmentation tools. The group will assess in-house and commercially available AI models, evaluation metrics, clinical challenges, and limitations, as well as future developments in addressing these challenges. General recommendations are made in terms of the implementation of these commercial AI models, as well as precautions in recognizing the challenges and limitations.
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Affiliation(s)
- Yi Rong
- Mayo Clinic Arizona, Phoenix, AZ
| | - Quan Chen
- City of Hope Comprehensive Cancer Center Duarte, CA
| | - Yabo Fu
- Memorial Sloan Kettering Cancer Center, Commack, NY
| | | | | | | | - Lulin Yuan
- Virginia Commonwealth University, Richmond, VA
| | - Ying Xiao
- University of Pennsylvania/Abramson Cancer Center, Philadelphia, PA
| | - Bin Cai
- The University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Stanley H Benedict
- University of California Davis Comprehensive Cancer Center, Sacramento, CA
| | | | - X Sharon Qi
- University of California Los Angeles, Los Angeles, CA
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Rios CI, DiCarlo AL, Harrison L, Prasanna PGS, Buchsbaum JC, Rudokas MW, Gomes L, Winters TA. Advanced Technologies in Radiation Research. Radiat Res 2024; 201:338-365. [PMID: 38453643 PMCID: PMC11046920 DOI: 10.1667/rade-24-00003.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 01/22/2024] [Indexed: 03/09/2024]
Abstract
The U.S. Government is committed to maintaining a robust research program that supports a portfolio of scientific experts who are investigating the biological effects of radiation exposure. On August 17 and 18, 2023, the Radiation and Nuclear Countermeasures Program, within the National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), partnered with the National Cancer Institute, NIH, the National Aeronautics and Space Administration, and the Radiation Injury Treatment Network to convene a workshop titled, Advanced Technologies in Radiation Research (ATRR), which focused on the use of advanced technologies under development or in current use to accelerate radiation research. This meeting report provides a comprehensive overview of the research presented at the workshop, which included an assembly of subject matter experts from government, industry, and academia. Topics discussed during the workshop included assessments of acute and delayed effects of radiation exposure using modalities such as clustered regularly interspaced short palindromic repeats (CRISPR) - based gene editing, tissue chips, advanced computing, artificial intelligence, and immersive imaging techniques. These approaches are being applied to develop products to diagnose and treat radiation injury to the bone marrow, skin, lung, and gastrointestinal tract, among other tissues. The overarching goal of the workshop was to provide an opportunity for the radiation research community to come together to assess the technological landscape through sharing of data, methodologies, and challenges, followed by a guided discussion with all participants. Ultimately, the organizers hope that the radiation research community will benefit from the workshop and seek solutions to scientific questions that remain unaddressed. Understanding existing research gaps and harnessing new or re-imagined tools and methods will allow for the design of studies to advance medical products along the critical path to U.S. Food and Drug Administration approval.
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Affiliation(s)
- Carmen I. Rios
- Radiation and Nuclear Countermeasures Program/Division of Allergy, Immunology, and Transplantation/National Institute of Allergy and Infectious Diseases/National Institutes of Health (NIH), Rockville, Maryland
| | - Andrea L. DiCarlo
- Radiation and Nuclear Countermeasures Program/Division of Allergy, Immunology, and Transplantation/National Institute of Allergy and Infectious Diseases/National Institutes of Health (NIH), Rockville, Maryland
| | - Lynn Harrison
- Division of Biological and Physical Sciences/National Aeronautics and Space Administration, Houston, Texas
| | - Pataje G. S. Prasanna
- Division of Cancer Treatment and Diagnosis/National Cancer Institute/NIH, Gaithersburg, Maryland
| | - Jeffrey C. Buchsbaum
- Division of Cancer Treatment and Diagnosis/National Cancer Institute/NIH, Gaithersburg, Maryland
| | - Michael W. Rudokas
- Radiation and Nuclear Countermeasures Program/Division of Allergy, Immunology, and Transplantation/National Institute of Allergy and Infectious Diseases/National Institutes of Health (NIH), Rockville, Maryland
| | - Lauren Gomes
- Radiation and Nuclear Countermeasures Program/Division of Allergy, Immunology, and Transplantation/National Institute of Allergy and Infectious Diseases/National Institutes of Health (NIH), Rockville, Maryland
| | - Thomas A. Winters
- Radiation and Nuclear Countermeasures Program/Division of Allergy, Immunology, and Transplantation/National Institute of Allergy and Infectious Diseases/National Institutes of Health (NIH), Rockville, Maryland
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Buchsbaum JC, Govern FS, Prasanna P. C. Norman Coleman, M.D.(1945-2024)1. Radiat Res 2024; 201:271-274. [PMID: 38588380 DOI: 10.1667/rade-24-00cnc.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Affiliation(s)
| | - Frank S Govern
- Radiation Research Program, National Cancer Institute, Bethesda, Maryland
| | - Pataje Prasanna
- Radiation Research Program, National Cancer Institute, Bethesda, Maryland
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Buchsbaum JC, Govern FS, Prasanna P. C. Norman Coleman, M.D. (1945-2024): mentorship, partnership, science, and kindness always. Int J Radiat Biol 2024; 100:817-819. [PMID: 38530806 DOI: 10.1080/09553002.2024.2331382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Affiliation(s)
| | - Frank S Govern
- Radiation Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Pataje Prasanna
- Radiation Research Program, National Cancer Institute, Bethesda, MD, USA
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Buchsbaum JC, Govern FS, Prasanna P. In Memoriam: C. Norman Coleman, M.D., (1945-2024). Radiother Oncol 2024; 194:110228. [PMID: 38513554 DOI: 10.1016/j.radonc.2024.110228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Affiliation(s)
- Jeffrey C Buchsbaum
- Radiation Research Program, National Cancer Institute, Bethesda, MD, United States.
| | - Frank S Govern
- Radiation Research Program, National Cancer Institute, Bethesda, MD, United States
| | - Pataje Prasanna
- Radiation Research Program, National Cancer Institute, Bethesda, MD, United States
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Mayo CS, Feng MU, Brock KK, Kudner R, Balter P, Buchsbaum JC, Caissie A, Covington E, Daugherty EC, Dekker AL, Fuller CD, Hallstrom AL, Hong DS, Hong JC, Kamran SC, Katsoulakis E, Kildea J, Krauze AV, Kruse JJ, McNutt T, Mierzwa M, Moreno A, Palta JR, Popple R, Purdie TG, Richardson S, Sharp GC, Satomi S, Tarbox LR, Venkatesan AM, Witztum A, Woods KE, Yao Y, Farahani K, Aneja S, Gabriel PE, Hadjiiski L, Ruan D, Siewerdsen JH, Bratt S, Casagni M, Chen S, Christodouleas JC, DiDonato A, Hayman J, Kapoor R, Kravitz S, Sebastian S, Von Siebenthal M, Bosch W, Hurkmans C, Yom SS, Xiao Y. Operational Ontology for Oncology (O3): A Professional Society-Based, Multistakeholder, Consensus-Driven Informatics Standard Supporting Clinical and Research Use of Real-World Data From Patients Treated for Cancer. Int J Radiat Oncol Biol Phys 2023; 117:533-550. [PMID: 37244628 PMCID: PMC10741247 DOI: 10.1016/j.ijrobp.2023.05.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 05/29/2023]
Abstract
PURPOSE The ongoing lack of data standardization severely undermines the potential for automated learning from the vast amount of information routinely archived in electronic health records (EHRs), radiation oncology information systems, treatment planning systems, and other cancer care and outcomes databases. We sought to create a standardized ontology for clinical data, social determinants of health, and other radiation oncology concepts and interrelationships. METHODS AND MATERIALS The American Association of Physicists in Medicine's Big Data Science Committee was initiated in July 2019 to explore common ground from the stakeholders' collective experience of issues that typically compromise the formation of large inter- and intra-institutional databases from EHRs. The Big Data Science Committee adopted an iterative, cyclical approach to engaging stakeholders beyond its membership to optimize the integration of diverse perspectives from the community. RESULTS We developed the Operational Ontology for Oncology (O3), which identified 42 key elements, 359 attributes, 144 value sets, and 155 relationships ranked in relative importance of clinical significance, likelihood of availability in EHRs, and the ability to modify routine clinical processes to permit aggregation. Recommendations are provided for best use and development of the O3 to 4 constituencies: device manufacturers, centers of clinical care, researchers, and professional societies. CONCLUSIONS O3 is designed to extend and interoperate with existing global infrastructure and data science standards. The implementation of these recommendations will lower the barriers for aggregation of information that could be used to create large, representative, findable, accessible, interoperable, and reusable data sets to support the scientific objectives of grant programs. The construction of comprehensive "real-world" data sets and application of advanced analytical techniques, including artificial intelligence, holds the potential to revolutionize patient management and improve outcomes by leveraging increased access to information derived from larger, more representative data sets.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Dan Ruan
- University of California, Los Angeles
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sue S Yom
- University of California, San Francisco
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7
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Shen CJ, Kry SF, Buchsbaum JC, Milano MT, Inskip PD, Ulin K, Francis JH, Wilson MW, Whelan KF, Mayo CS, Olch AJ, Constine LS, Terezakis SA, Vogelius IR. Retinopathy, Optic Neuropathy, and Cataract in Childhood Cancer Survivors Treated With Radiation Therapy: A PENTEC Comprehensive Review. Int J Radiat Oncol Biol Phys 2023:S0360-3016(23)00592-8. [PMID: 37565958 DOI: 10.1016/j.ijrobp.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/29/2023] [Accepted: 06/11/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE Few reports describe the risks of late ocular toxicities after radiation therapy (RT) for childhood cancers despite their effect on quality of life. The Pediatric Normal Tissue Effects in the Clinic (PENTEC) ocular task force aims to quantify the radiation dose dependence of select late ocular adverse effects. Here, we report results concerning retinopathy, optic neuropathy, and cataract in childhood cancer survivors who received cranial RT. METHODS AND MATERIALS A systematic literature search was performed using the PubMed, MEDLINE, and Cochrane Library databases for peer-reviewed studies published from 1980 to 2021 related to childhood cancer, RT, and ocular endpoints including dry eye, keratitis/corneal injury, conjunctival injury, cataract, retinopathy, and optic neuropathy. This initial search yielded abstracts for 2947 references, 269 of which were selected as potentially having useful outcomes and RT data. Data permitting, treatment and outcome data were used to generate normal tissue complication probability models. RESULTS We identified sufficient RT data to generate normal tissue complication probability models for 3 endpoints: retinopathy, optic neuropathy, and cataract formation. Based on limited data, the model for development of retinopathy suggests 5% and 50% risk of toxicity at 42 and 62 Gy, respectively. The model for development of optic neuropathy suggests 5% and 50% risk of toxicity at 57 and 64 Gy, respectively. More extensive data were available to evaluate the risk of cataract, separated into self-reported versus ophthalmologist-diagnosed cataract. The models suggest 5% and 50% risk of self-reported cataract at 12 and >40 Gy, respectively, and 50% risk of ophthalmologist-diagnosed cataract at 9 Gy (>5% long-term risk at 0 Gy in patients treated with chemotherapy only). CONCLUSIONS Radiation dose effects in the eye are inadequately studied in the pediatric population. Based on limited published data, this PENTEC comprehensive review establishes relationships between RT dose and subsequent risks of retinopathy, optic neuropathy, and cataract formation.
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Affiliation(s)
- Colette J Shen
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
| | - Stephen F Kry
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, Texas
| | | | - Michael T Milano
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Peter D Inskip
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, Maryland
| | - Kenneth Ulin
- Imaging and Radiation Oncology Rhode Island QA Center, Lincoln, Rhode Island
| | - Jasmine H Francis
- Ophthalmic Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Matthew W Wilson
- Division of Ophthalmology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kimberly F Whelan
- Pediatric Hematology/Oncology, University of Alabama School of Medicine, Birmingham, Alabama
| | - Charles S Mayo
- Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Arthur J Olch
- Department of Radiation Oncology, University of Southern California/Children's Hospital Los Angeles, Los Angeles, California
| | - Louis S Constine
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Stephanie A Terezakis
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Ivan R Vogelius
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Zou W, Zhang R, Schüler E, Taylor PA, Mascia AE, Diffenderfer ES, Zhao T, Ayan AS, Sharma M, Yu SJ, Lu W, Bosch WR, Tsien C, Surucu M, Pollard-Larkin JM, Schuemann J, Moros EG, Bazalova-Carter M, Gladstone DJ, Li H, Simone CB, Petersson K, Kry SF, Maity A, Loo BW, Dong L, Maxim PG, Xiao Y, Buchsbaum JC. Framework for Quality Assurance of Ultrahigh Dose Rate Clinical Trials Investigating FLASH Effects and Current Technology Gaps. Int J Radiat Oncol Biol Phys 2023; 116:1202-1217. [PMID: 37121362 PMCID: PMC10526970 DOI: 10.1016/j.ijrobp.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/28/2023] [Accepted: 04/17/2023] [Indexed: 05/02/2023]
Abstract
FLASH radiation therapy (FLASH-RT), delivered with ultrahigh dose rate (UHDR), may allow patients to be treated with less normal tissue toxicity for a given tumor dose compared with currently used conventional dose rate. Clinical trials are being carried out and are needed to test whether this improved therapeutic ratio can be achieved clinically. During the clinical trials, quality assurance and credentialing of equipment and participating sites, particularly pertaining to UHDR-specific aspects, will be crucial for the validity of the outcomes of such trials. This report represents an initial framework proposed by the NRG Oncology Center for Innovation in Radiation Oncology FLASH working group on quality assurance of potential UHDR clinical trials and reviews current technology gaps to overcome. An important but separate consideration is the appropriate design of trials to most effectively answer clinical and scientific questions about FLASH. This paper begins with an overview of UHDR RT delivery methods. UHDR beam delivery parameters are then covered, with a focus on electron and proton modalities. The definition and control of safe UHDR beam delivery and current and needed dosimetry technologies are reviewed and discussed. System and site credentialing for large, multi-institution trials are reviewed. Quality assurance is then discussed, and new requirements are presented for treatment system standard analysis, patient positioning, and treatment planning. The tables and figures in this paper are meant to serve as reference points as we move toward FLASH-RT clinical trial performance. Some major questions regarding FLASH-RT are discussed, and next steps in this field are proposed. FLASH-RT has potential but is associated with significant risks and complexities. We need to redefine optimization to focus not only on the dose but also on the dose rate in a manner that is robust and understandable and that can be prescribed, validated, and confirmed in real time. Robust patient safety systems and access to treatment data will be critical as FLASH-RT moves into the clinical trials.
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Affiliation(s)
- Wei Zou
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA.
| | - Rongxiao Zhang
- Department of Radiation Oncology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Emil Schüler
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paige A Taylor
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Eric S Diffenderfer
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Tianyu Zhao
- Department of Radiation Oncology, Washington University, St. Louis, MO, USA
| | - Ahmet S Ayan
- Department of Radiation Oncology, Ohio State University, Columbus, OH, USA
| | - Manju Sharma
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Shu-Jung Yu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Weiguo Lu
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA
| | - Walter R Bosch
- Department of Radiation Oncology, Washington University, St. Louis, MO, USA
| | - Christina Tsien
- Department of Radiation Oncology, McGill University Health Center, Montreal, QC, Canada
| | - Murat Surucu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Julianne M Pollard-Larkin
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jan Schuemann
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Eduardo G Moros
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | | | - David J Gladstone
- Department of Radiation Oncology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Heng Li
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, NY, USA
| | - Kristoffer Petersson
- Department of Radiation Oncology, MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - Stephen F Kry
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amit Maity
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Lei Dong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter G Maxim
- Department of Radiation Oncology, University of California Irvine, Irvine, CA, USA
| | - Ying Xiao
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeffrey C Buchsbaum
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institute of Health, Bethesda, MD, USA
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Dunkel IJ, Piao J, Chantada GL, Banerjee A, Abouelnaga S, Buchsbaum JC, Merchant TE, Granger MM, Jubran RF, Weinstein JL, Saguilig L, Abramson DH, Krailo MD, Rodriguez-Galindo C, Chintagumpala MM. Intensive Multimodality Therapy for Extraocular Retinoblastoma: A Children's Oncology Group Trial (ARET0321). J Clin Oncol 2022; 40:3839-3847. [PMID: 35820112 PMCID: PMC9671757 DOI: 10.1200/jco.21.02337] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 04/21/2022] [Accepted: 06/08/2022] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Metastatic retinoblastoma has a poor prognosis when treated with conventional chemotherapy and radiation therapy (RT). Intensified therapy may improve the outcome. METHODS A prospective, international trial enrolled patients with extraocular retinoblastoma. Patients with stage II or III (locoregional) retinoblastoma received four cycles of chemotherapy, followed by involved field RT (45 Gy). Patients with stage IVa or IVb (metastatic or trilateral) retinoblastoma also received four cycles of chemotherapy and those with ≥ partial response then received one cycle of high-dose carboplatin, thiotepa, and etoposide with autologous hematopoietic stem-cell support. Patients with stage IVa or IVb with residual tumor postchemotherapy received RT. The proportion of patients who achieved event-free survival would be reported and compared with historical controls separately for each of the three groups of patients. RESULTS Fifty-seven eligible patients were included in the analyses. Event-free survival at 1 year was 88.1% (90% CI, 66.6 to 96.2) for stage II-III, 82.6% (90% CI, 61.0 to 92.9) for stage IVa, and 28.3% (90% CI, 12.7 to 46.2) for stage IVb/trilateral. Toxicity was significant as expected and included two therapy-related deaths. CONCLUSION Intensive multimodality therapy is highly effective for patients with regional extraocular retinoblastoma and stage IVa metastatic retinoblastoma. Although the study met its aim for stage IVb, more effective therapy is still required for patients with CNS involvement (ClinicalTrials.gov identifier: NCT00554788).
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Affiliation(s)
- Ira J. Dunkel
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jin Piao
- University of Southern California, Los Angeles, CA
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10
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Taylor PA, Moran JM, Jaffray DA, Buchsbaum JC. A roadmap to clinical trials for FLASH. Med Phys 2022; 49:4099-4108. [PMID: 35366339 PMCID: PMC9321729 DOI: 10.1002/mp.15623] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 02/17/2022] [Accepted: 03/17/2022] [Indexed: 11/29/2022] Open
Abstract
While FLASH radiation therapy is inspiring enthusiasm to transform the field, it is neither new nor well understood with respect to the radiobiological mechanisms. As FLASH clinical trials are designed, it will be important to ensure we can deliver dose consistently and safely to every patient. Much like hyperthermia and proton therapy, FLASH is a promising new technology that will be complex to implement in the clinic and similarly will require customized credentialing for multi‐institutional clinical trials. There is no doubt that FLASH seems promising, but many technologies that we take for granted in conventional radiation oncology, such as rigorous dosimetry, 3D treatment planning, volumetric image guidance, or motion management, may play a major role in defining how to use, or whether to use, FLASH radiotherapy. Given the extended time frame for patients to experience late effects, we recommend moving deliberately but cautiously forward toward clinical trials. In this paper, we review the state of quality assurance and safety systems in FLASH, identify critical pre‐clinical data points that need to be defined, and suggest how lessons learned from previous technological advancements will help us close the gaps and build a successful path to evidence‐driven FLASH implementation.
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Affiliation(s)
- Paige A Taylor
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jean M Moran
- Memorial Sloan Kettering Cancer, New York, New York
| | - David A Jaffray
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey C Buchsbaum
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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11
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Buchsbaum JC, Espey MG, Obcemea C, Capala J, Ahmed M, Prasanna PG, Vikram B, Hong JA, Teicher B, Aryankalayil MJ, Bylicky MA, Coleman CN. Tumor Heterogeneity Research and Innovation in Biologically Based Radiation Therapy From the National Cancer Institute Radiation Research Program Portfolio. J Clin Oncol 2022; 40:1861-1869. [PMID: 35245101 DOI: 10.1200/jco.21.02579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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12
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Buchsbaum JC, Jaffray DA, Ba D, Borkon LL, Chalk C, Chung C, Coleman MA, Coleman CN, Diehn M, Droegemeier KK, Enderling H, Espey MG, Greenspan EJ, Hartshorn CM, Hoang T, Hsiao HT, Keppel C, Moore NW, Prior F, Stahlberg EA, Tourassi G, Willcox KE. Predictive Radiation Oncology - A New NCI-DOE Scientific Space and Community. Radiat Res 2022; 197:434-445. [PMID: 35090025 DOI: 10.1667/rade-22-00012.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 01/10/2022] [Indexed: 11/03/2022]
Abstract
With a widely attended virtual kickoff event on January 29, 2021, the National Cancer Institute (NCI) and the Department of Energy (DOE) launched a series of 4 interactive, interdisciplinary workshops-and a final concluding "World Café" on March 29, 2021-focused on advancing computational approaches for predictive oncology in the clinical and research domains of radiation oncology. These events reflect 3,870 human hours of virtual engagement with representation from 8 DOE national laboratories and the Frederick National Laboratory for Cancer Research (FNL), 4 research institutes, 5 cancer centers, 17 medical schools and teaching hospitals, 5 companies, 5 federal agencies, 3 research centers, and 27 universities. Here we summarize the workshops by first describing the background for the workshops. Participants identified twelve key questions-and collaborative parallel ideas-as the focus of work going forward to advance the field. These were then used to define short-term and longer-term "Blue Sky" goals. In addition, the group determined key success factors for predictive oncology in the context of radiation oncology, if not the future of all of medicine. These are: cross-discipline collaboration, targeted talent development, development of mechanistic mathematical and computational models and tools, and access to high-quality multiscale data that bridges mechanisms to phenotype. The workshop participants reported feeling energized and highly motivated to pursue next steps together to address the unmet needs in radiation oncology specifically and in cancer research generally and that NCI and DOE project goals align at the convergence of radiation therapy and advanced computing.
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Affiliation(s)
| | - David A Jaffray
- The University of Texas, MD Anderson Cancer Center, Houston, Texas 77030
| | - Demba Ba
- Harvard University, Cambridge, Massachusetts 02138
| | - Lynn L Borkon
- Frederick National Laboratory for Cancer Research, Frederick, Maryland, 21701
| | | | - Caroline Chung
- The University of Texas, MD Anderson Cancer Center, Houston, Texas 77030
| | | | | | | | | | - Heiko Enderling
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612
| | | | | | | | - Thuc Hoang
- U.S. Department of Energy, Washington, DC 20585
| | - H Timothy Hsiao
- American Society for Radiation Oncology (ASTRO), Arlington, Virginia 22202
| | | | - Nathan W Moore
- Sandia National Laboratories, Albuquerque, New Mexico 87123
| | - Fred Prior
- University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205
| | - Eric A Stahlberg
- Frederick National Laboratory for Cancer Research, Frederick, Maryland, 21701
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Prasanna PG, Rawojc K, Guha C, Buchsbaum JC, Miszczyk JU, Coleman CN. Normal Tissue Injury Induced by Photon and Proton Therapies: Gaps and Opportunities. Int J Radiat Oncol Biol Phys 2021; 110:1325-1340. [PMID: 33640423 PMCID: PMC8496269 DOI: 10.1016/j.ijrobp.2021.02.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/20/2021] [Accepted: 02/19/2021] [Indexed: 12/16/2022]
Abstract
Despite technological advances in radiation therapy (RT) and cancer treatment, patients still experience adverse effects. Proton therapy (PT) has emerged as a valuable RT modality that can improve treatment outcomes. Normal tissue injury is an important determinant of the outcome; therefore, for this review, we analyzed 2 databases: (1) clinical trials registered with ClinicalTrials.gov and (2) the literature on PT in PubMed, which shows a steady increase in the number of publications. Most studies in PT registered with ClinicalTrials.gov with results available are nonrandomized early phase studies with a relatively small number of patients enrolled. From the larger database of nonrandomized trials, we listed adverse events in specific organs/sites among patients with cancer who are treated with photons and protons to identify critical issues. The present data demonstrate dosimetric advantages of PT with favorable toxicity profiles and form the basis for comparative randomized prospective trials. A comparative analysis of 3 recently completed randomized trials for normal tissue toxicities suggests that for early stage non-small cell lung cancer, no meaningful comparison could be made between stereotactic body RT and stereotactic body PT due to low accrual (NCT01511081). In addition, for locally advanced non-small cell lung cancer, a comparison of intensity modulated RTwith passive scattering PT (now largely replaced by spot-scanned intensity modulated PT), PT did not provide any benefit in normal tissue toxicity or locoregional failure over photon therapy. Finally, for locally advanced esophageal cancer, proton beam therapy provided a lower total toxicity burden but did not improve progression-free survival and quality of life (NCT01512589). The purpose of this review is to inform the limitations of current trials looking at protons and photons, considering that advances in technology, physics, and biology are a continuum, and to advocate for future trials geared toward accurate precision RT that need to be viewed as an iterative process in a defined path toward delivering optimal radiation treatment. A foundational understanding of the radiobiologic differences between protons and photons in tumor and normal tissue responses is fundamental to, and necessary for, determining the suitability of a given type of biologically optimized RT to a patient or cohort.
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Affiliation(s)
- Pataje G Prasanna
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland.
| | - Kamila Rawojc
- The University Hospital in Krakow, Department of Endocrinology, Nuclear Medicine Unit, Krakow, Poland
| | - Chandan Guha
- Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Jeffrey C Buchsbaum
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - Justyna U Miszczyk
- Department of Experimental Physics of Complex Systems, Institute of Nuclear Physics, Polish Academy of Sciences, Krakow, Poland
| | - C Norman Coleman
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
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Buchsbaum JC, Coleman CN, Bernhard EJ, Espey MG, Vikram B. Overview and Lessons From the Preclinical Chemoradiotherapy Testing Consortium. Int J Radiat Oncol Biol Phys 2021; 111:1126-1130. [PMID: 34348172 DOI: 10.1016/j.ijrobp.2021.07.1709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/22/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE In the current molecular-targeted cancer treatment era, many new agents are being developed so that optimizing therapy with a combination of radiation and drugs is complex. The use of emerging laboratory technologies to further biological understanding of drug-radiation mechanisms of action will enhance the efficiency of the progression from preclinical studies to clinical trials. In 2017, the National Cancer Institute (NCI) solicited proposals through PAR 16-111 to conduct preclinical research combining targeted anticancer agents in the Cancer Therapy Evaluation Program's portfolio with chemoradiation. METHODS AND MATERIALS The Preclinical Chemo-Radiotherapy Testing Consortium (PCRTC) was formed with 4 U01 programs supported to generate validated high-quality preclinical data on the effects of molecular therapeutics when added to standard-of-care therapies with a concentration on cancers of the pancreas, lung, head and neck, gastrointestinal tract, and brain. RESULTS The PCRTC provides a rational basis for prioritizing NCI-supported investigational new drugs or agents most likely to have clinical activity with chemoradiotherapy and accelerate the pace at which combined modality treatments with greater efficacy are identified and incorporated into standard treatment practices. CONCLUSIONS Herein, we introduce and summarize the course of the PCRTC to date and report 3 preliminary observations from the consortium's work to date.
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Affiliation(s)
- Jeffrey C Buchsbaum
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
| | - C Norman Coleman
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Eric J Bernhard
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Michael G Espey
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Bhadrasain Vikram
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Coleman CN, Buchsbaum JC, Prasanna PGS, Capala J, Obcemea C, Espey MG, Ahmed MM, Hong JA, Vikram B. Moving Forward in the Next Decade: Radiation Oncology Sciences for Patient-Centered Cancer Care. JNCI Cancer Spectr 2021; 5:pkab046. [PMID: 34350377 PMCID: PMC8328099 DOI: 10.1093/jncics/pkab046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/15/2021] [Accepted: 04/23/2021] [Indexed: 11/24/2022] Open
Abstract
In a time of rapid advances in science and technology, the opportunities for radiation oncology are undergoing transformational change. The linkage between and understanding of the physical dose and induced biological perturbations are opening entirely new areas of application. The ability to define anatomic extent of disease and the elucidation of the biology of metastases has brought a key role for radiation oncology for treating metastatic disease. That radiation can stimulate and suppress subpopulations of the immune response makes radiation a key participant in cancer immunotherapy. Targeted radiopharmaceutical therapy delivers radiation systemically with radionuclides and carrier molecules selected for their physical, chemical, and biochemical properties. Radiation oncology usage of “big data” and machine learning and artificial intelligence adds the opportunity to markedly change the workflow for clinical practice while physically targeting and adapting radiation fields in real time. Future precision targeting requires multidimensional understanding of the imaging, underlying biology, and anatomical relationship among tissues for radiation as spatial and temporal “focused biology.” Other means of energy delivery are available as are agents that can be activated by radiation with increasing ability to target treatments. With broad applicability of radiation in cancer treatment, radiation therapy is a necessity for effective cancer care, opening a career path for global health serving the medically underserved in geographically isolated populations as a substantial societal contribution addressing health disparities. Understanding risk and mitigation of radiation injury make it an important discipline for and beyond cancer care including energy policy, space exploration, national security, and global partnerships.
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Affiliation(s)
- C Norman Coleman
- Correspondence to: C. Norman Coleman, MD, Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, MSC 9727, Bethesda, MD 20892-9727, USA (e-mail: )
| | - Jeffrey C Buchsbaum
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Pataje G S Prasanna
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jacek Capala
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ceferino Obcemea
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael G Espey
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mansoor M Ahmed
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Julie A Hong
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Bhadrasain Vikram
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Buchsbaum JC, Vikram B. NCI support for pediatric radiation therapy: Past, present, and future. Pediatr Blood Cancer 2021; 68 Suppl 2:e28689. [PMID: 32939959 DOI: 10.1002/pbc.28689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 08/23/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Jeffrey C Buchsbaum
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Bhadrasain Vikram
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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17
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Buchsbaum JC, Coleman CN, Capala J, Obcemea C. In Reply to Breneman et al. Int J Radiat Oncol Biol Phys 2021; 110:1545-1546. [PMID: 33781844 DOI: 10.1016/j.ijrobp.2021.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Jeffrey C Buchsbaum
- Radiation Research Program Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health Bethesda, Maryland
| | - C Norman Coleman
- Radiation Research Program Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health Bethesda, Maryland
| | - Jacek Capala
- Radiation Research Program Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health Bethesda, Maryland
| | - Ceferino Obcemea
- Radiation Research Program Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health Bethesda, Maryland
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18
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Buchsbaum JC. Comments on "Temporal lobe sparing radiotherapy with photons or protons for cognitive function preservation in paediatric craniopharyngioma" by Toussaint, et al.: Prior Similar Field Arrangement Work and a Need for Variable RBE Use. Radiother Oncol 2021; 158:327-329. [PMID: 33548283 DOI: 10.1016/j.radonc.2020.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/15/2020] [Accepted: 11/18/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Jeffrey C Buchsbaum
- Radiation Research Program, National Cancer Institute (NCI), National Institutes of Health, 9609 Medical Center, Bethesda, MD 20892, USA.
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Buchsbaum JC, Coleman CN, Espey MG, Prasanna PGS, Capala J, Ahmed MM, Hong JA, Obcemea C. FLASH Radiation Therapy: New Technology Plus Biology Required. Int J Radiat Oncol Biol Phys 2021; 110:1248-1249. [PMID: 33548337 DOI: 10.1016/j.ijrobp.2021.01.053] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/27/2021] [Accepted: 01/29/2021] [Indexed: 02/06/2023]
Affiliation(s)
- Jeffrey C Buchsbaum
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
| | - C Norman Coleman
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Michael G Espey
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Pataje G S Prasanna
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jacek Capala
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Mansoor M Ahmed
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Julie A Hong
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Ceferino Obcemea
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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20
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Roncali E, Capala J, Benedict SH, Akabani G, Bednarz B, Bhadrasain V, Bolch WE, Buchsbaum JC, Coleman NC, Dewaraja YK, Frey E, Ghaly M, Grudzinski J, Hobbs RF, Howell RW, Humm JL, Kunos CA, Larson S, Lin FI, Madsen M, Mirzadeh S, Morse D, Pryma D, Sgouros G, St. James S, Wahl RL, Xiao Y, Zanzonico P, Zukotynski K. Overview of the First NRG Oncology–National Cancer Institute Workshop on Dosimetry of Systemic Radiopharmaceutical Therapy. J Nucl Med 2020; 62:1133-1139. [DOI: 10.2967/jnumed.120.255547] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/20/2021] [Indexed: 11/16/2022] Open
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21
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Prasanna PG, Woloschak GE, DiCarlo AL, Buchsbaum JC, Schaue D, Chakravarti A, Cucinotta FA, Formenti SC, Guha C, Hu DJ, Khan MK, Kirsch DG, Krishnan S, Leitner WW, Marples B, McBride W, Mehta MP, Rafii S, Sharon E, Sullivan JM, Weichselbaum RR, Ahmed MM, Vikram B, Coleman CN, Held KD. Low-Dose Radiation Therapy (LDRT) for COVID-19: Benefits or Risks? Radiat Res 2020; 194:452-464. [PMID: 33045077 PMCID: PMC8009137 DOI: 10.1667/rade-20-00211.1] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/18/2020] [Indexed: 12/24/2022]
Abstract
The limited impact of treatments for COVID-19 has stimulated several phase 1 clinical trials of whole-lung low-dose radiation therapy (LDRT; 0.3-1.5 Gy) that are now progressing to phase 2 randomized trials worldwide. This novel but unconventional use of radiation to treat COVID-19 prompted the National Cancer Institute, National Council on Radiation Protection and Measurements and National Institute of Allergy and Infectious Diseases to convene a workshop involving a diverse group of experts in radiation oncology, radiobiology, virology, immunology, radiation protection and public health policy. The workshop was held to discuss the mechanistic underpinnings, rationale, and preclinical and emerging clinical studies, and to develop a general framework for use in clinical studies. Without refuting or endorsing LDRT as a treatment for COVID-19, the purpose of the workshop and this review is to provide guidance to clinicians and researchers who plan to conduct preclinical and clinical studies, given the limited available evidence on its safety and efficacy.
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Affiliation(s)
| | | | | | | | | | - Arnab Chakravarti
- Ohio State University, James Comprehensive Cancer Center, Columbus, Ohio
| | | | | | | | - Dale J. Hu
- National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | - Mohammad K. Khan
- Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA
| | | | | | | | - Brian Marples
- University of Rochester Medical Center, Rochester, NY
| | | | | | | | | | | | - Ralph R. Weichselbaum
- University of Chicago Medicine and Ludwig Center for Metastasis Research, Chicago, IL
| | | | | | | | - Kathryn D. Held
- National Council on Radiation Protection and Measurements, Bethesda, MD and Massachusetts General Hospital/Harvard Medical School, Boston, MA
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22
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Hua CH, Vern-Gross TZ, Hess CB, Olch AJ, Alaei P, Sathiaseelan V, Deng J, Ulin K, Laurie F, Gopalakrishnan M, Esiashvili N, Wolden SL, Krasin MJ, Merchant TE, Donaldson SS, FitzGerald TJ, Constine LS, Hodgson DC, Haas-Kogan DA, Mahajan A, Laack N, Marcus KJ, Taylor PA, Ahern VA, Followill DS, Buchsbaum JC, Breneman JC, Kalapurakal JA. Practice patterns and recommendations for pediatric image-guided radiotherapy: A Children's Oncology Group report. Pediatr Blood Cancer 2020; 67:e28629. [PMID: 32776500 PMCID: PMC7774502 DOI: 10.1002/pbc.28629] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 06/16/2020] [Accepted: 07/19/2020] [Indexed: 12/18/2022]
Abstract
This report by the Radiation Oncology Discipline of Children's Oncology Group (COG) describes the practice patterns of pediatric image-guided radiotherapy (IGRT) based on a member survey and provides practice recommendations accordingly. The survey comprised of 11 vignettes asking clinicians about their recommended treatment modalities, IGRT preferences, and frequency of in-room verification. Technical questions asked physicists about imaging protocols, dose reduction, setup correction, and adaptive therapy. In this report, the COG Radiation Oncology Discipline provides an IGRT modality/frequency decision tree and the expert guidelines for the practice of ionizing image guidance in pediatric radiotherapy patients.
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Affiliation(s)
- Chia-ho Hua
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | | | - Clayton B. Hess
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Arthur J. Olch
- Department of Radiation Oncology, University of Southern California and Children’s Hospital of Los Angeles, Los Angeles, California
| | - Parham Alaei
- Department of Radiation Oncology, University of Minnesota, Minneapolis, Minnesota
| | | | - Jun Deng
- Department of Therapeutic Radiology, Yale University, New Haven, Connecticut
| | - Kenneth Ulin
- Department of Radiation Oncology, University of Massachusetts, Worcester, Massachusetts
| | - Fran Laurie
- Department of Radiation Oncology, University of Massachusetts, Worcester, Massachusetts
| | | | - Natia Esiashvili
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Suzanne L. Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Matthew J. Krasin
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Sarah S. Donaldson
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Thomas J. FitzGerald
- Department of Radiation Oncology, University of Massachusetts, Worcester, Massachusetts
| | - Louis S. Constine
- Department of Radiation Oncology, University of Rochester, Rochester, New York
| | - David C. Hodgson
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Daphne A. Haas-Kogan
- Department of Radiation Oncology, Dana Farber Cancer Institute/Boston Children’s Hospital, Boston, Massachusetts
| | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Nadia Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Karen J. Marcus
- Department of Radiation Oncology, Dana Farber Cancer Institute/Boston Children’s Hospital, Boston, Massachusetts
| | - Paige A Taylor
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Verity A Ahern
- Department of Radiation Oncology, Children’s Hospital at Westmead, Sydney, Australia
| | - David S. Followill
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey C. Buchsbaum
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - John C. Breneman
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio
| | - John A. Kalapurakal
- Department of Radiation Oncology, Northwestern University, Chicago, Illinois
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23
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St James S, Bednarz B, Benedict S, Buchsbaum JC, Dewaraja Y, Frey E, Hobbs R, Grudzinski J, Roncali E, Sgouros G, Capala J, Xiao Y. Current Status of Radiopharmaceutical Therapy. Int J Radiat Oncol Biol Phys 2020; 109:891-901. [PMID: 32805300 DOI: 10.1016/j.ijrobp.2020.08.035] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 08/06/2020] [Indexed: 02/02/2023]
Abstract
In radiopharmaceutical therapy (RPT), a radionuclide is systemically or locally delivered with the goal of targeting and delivering radiation to cancer cells while minimizing radiation exposure to untargeted cells. Examples of current RPTs include thyroid ablation with the administration of 131I, treatment of liver cancer with 90Y microspheres, the treatment of bony metastases with 223Ra, and the treatment of neuroendocrine tumors with 177Lu-DOTATATE. New RPTs are being developed where radionuclides are incorporated into systemic targeted therapies. To assure that RPT is appropriately implemented, advances in targeting need to be matched with advances in quantitative imaging and dosimetry methods. Currently, radiopharmaceutical therapy is administered by intravenous or locoregional injection, and the treatment planning has typically been implemented like chemotherapy, where the activity administered is either fixed or based on a patient's body weight or body surface area. RPT pharmacokinetics are measurable by quantitative imaging and are known to vary across patients, both in tumors and normal tissues. Therefore, fixed or weight-based activity prescriptions are not currently optimized to deliver a cytotoxic dose to targets while remaining within the tolerance dose of organs at risk. Methods that provide dose estimates to individual patients rather than to reference geometries are needed to assess and adjust the injected RPT dose. Accurate doses to targets and organs at risk will benefit the individual patients and decrease uncertainties in clinical trials. Imaging can be used to measure activity distribution in vivo, and this information can be used to determine patient-specific treatment plans where the dose to the targets and organs at risk can be calculated. The development and adoption of imaging-based dosimetry methods is particularly beneficial in early clinical trials. In this work we discuss dosimetric accuracy needs in modern radiation oncology, uncertainties in the dosimetry in RPT, and best approaches for imaging and dosimetry of internal radionuclide therapy.
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Affiliation(s)
- Sara St James
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California.
| | - Bryan Bednarz
- Department of Medical Physics and Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Stanley Benedict
- Department of Radiation Oncology, University of California Davis, Sacramento, California
| | - Jeffrey C Buchsbaum
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, NCI, NIH, Bethesda, Maryland
| | - Yuni Dewaraja
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Eric Frey
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland
| | - Robert Hobbs
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland
| | | | - Emilie Roncali
- Department of Radiation Oncology, University of California Davis, Sacramento, California
| | - George Sgouros
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland
| | - Jacek Capala
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, NCI, NIH, Bethesda, Maryland
| | - Ying Xiao
- Hospital of the University of Pennsylvania
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Zakeri K, Narayanan D, Prasanna PGS, Vikram B, Buchsbaum JC. Development of Novel Radiosensitizers through the National Cancer Institute's Small Business Innovation Research Program. Radiat Res 2020; 193:425-434. [PMID: 32216707 DOI: 10.1667/rr15545.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
While radiosensitizing chemotherapy has improved survival for several types of cancer, current chemoradiation regimens remain ineffective for many patients and have substantial toxicities. Given the strong need for the development of novel radiosensitizers to further improve patient outcomes, the Radiation Research Program (RRP) and the Small Business Innovation Research (SBIR) in the National Cancer Institute (NCI) issued a Request for Proposals (RFP) through the NCI SBIR Development Center's contracts pathway. We sought to determine the research outcomes for the NCI SBIR Development Center's funded proposals for the development of radiosensitizers. We identified SBIR-funded contracts and grants for the development of radiosensitizers from 2009 to 2018 using the National Institutes of Health (NIH) Reporter database. Research outcomes of the NCI SBIR Development Center-funded proposals were determined using a comprehensive internet search. We searched PubMed, clinicaltrials.gov, company websites and google.com for research articles, abstracts and posters, clinical trials, press releases and other news, related to progress in the development of funded radiosensitizers. To protect the intellectual property of the investigators and small businesses, all information obtained and reported is publicly available. The SBIR Program has funded four contracts and 11 grants for the development of novel radiosensitizers. Two companies have received phase IIb bridge awards. Overall, 50% of companies (6/12) have successfully advanced their investigational drugs into prospective clinical trials in cancer patients, and all but one company are investigating their drug in combination with radiation therapy as described in the NCI SBIR Development Center proposal. To date, only one company has initiated a randomized trial of standard of care with or without their radiosensitizer. In conclusion, the NCI SBIR Development Center has funded the development of novel radiosensitizers leading to clinical trials of novel drugs in combination with radiation therapy. Continued follow-up is needed to determine if any of these novel radiosensitizers produce improved tumor control and/or overall survival.
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Affiliation(s)
- Kaveh Zakeri
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, Maryland.,Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Deepa Narayanan
- Department of Small Business Innovation Research (SBIR) Development Center, National Cancer Institute, Bethesda, Maryland
| | - Pataje G S Prasanna
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, Maryland
| | - Bhadrasain Vikram
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, Maryland
| | - Jeffrey C Buchsbaum
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, Maryland
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Vapiwala N, Thomas CR, Grover S, Yap ML, Mitin T, Shulman LN, Gospodarowicz MK, Longo J, Petereit DG, Ennis RD, Hayman JA, Rodin D, Buchsbaum JC, Vikram B, Abdel-Wahab M, Epstein AH, Okunieff P, Goldwein J, Kupelian P, Weidhaas JB, Tucker MA, Boice JD, Fuller CD, Thompson RF, Trister AD, Formenti SC, Barcellos-Hoff MH, Jones J, Dharmarajan KV, Zietman AL, Coleman CN. Enhancing Career Paths for Tomorrow's Radiation Oncologists. Int J Radiat Oncol Biol Phys 2019; 105:52-63. [PMID: 31128144 PMCID: PMC7084166 DOI: 10.1016/j.ijrobp.2019.05.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 05/03/2019] [Accepted: 05/08/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Neha Vapiwala
- Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon
| | - Surbhi Grover
- Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania; University of Botswana, Gaborone, Botswana
| | - Mei Ling Yap
- Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute, University of New South Wales, Sydney, Australia; Liverpool and Macarthur Cancer Therapy Centre, Western Sydney University, Campbelltown, Australia; School of Public Health, University of Sydney, Camperdown, Australia
| | - Timur Mitin
- Department of Radiation Medicine Director, Program in Global Radiation Medicine, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | - Lawrence N Shulman
- Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mary K Gospodarowicz
- Department of Radiation Oncology, University of Toronto, Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - John Longo
- Department of Radiation Oncology Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Daniel G Petereit
- Department of Radiation Oncology, Rapid City Regional Cancer Care Institute, Rapid City, South Dakota
| | - Ronald D Ennis
- Clinical Network for Radiation Oncology, Rutgers and Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - James A Hayman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Danielle Rodin
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Jeffrey C Buchsbaum
- Radiation Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Bhadrasain Vikram
- Clinical Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - May Abdel-Wahab
- Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Alan H Epstein
- Uniformed Service University of the Health Sciences, Bethesda, Maryland
| | - Paul Okunieff
- Department of Radiation Oncology, University of Florida Health Cancer Center, Gainesville, Florida
| | - Joel Goldwein
- Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania; Elekta AB, Stockholm, Sweden
| | - Patrick Kupelian
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California; Varian Medical Systems, Palo Alto, California
| | - Joanne B Weidhaas
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California; MiraDx, Los Angeles, California
| | - Margaret A Tucker
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - John D Boice
- National Council on Radiation Protection and Measurements, Bethesda, Maryland; Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Clifton David Fuller
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Reid F Thompson
- Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon; VA Portland Health Care System, Portland, Oregon
| | - Andrew D Trister
- Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon
| | - Silvia C Formenti
- Department of Radiation Oncology, Weill Cornell Medicine, New York City, New York
| | | | - Joshua Jones
- Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kavita V Dharmarajan
- Department of Radiation Oncology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Anthony L Zietman
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - C Norman Coleman
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Coleman CN, Prasanna PGS, Bernhard EJ, Buchsbaum JC, Ahmed MM, Capala J, Obcemea C, Deye JA, Pistenmma DA, Vikram B, Bernier J, Dosanjh M. Accurate, Precision Radiation Medicine: A Meta-Strategy for Impacting Cancer Care, Global Health, and Nuclear Policy and Mitigating Radiation Injury From Necessary Medical Use, Space Exploration, and Potential Terrorism. Int J Radiat Oncol Biol Phys 2019; 101:250-253. [PMID: 29726348 DOI: 10.1016/j.ijrobp.2018.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 01/26/2018] [Accepted: 02/01/2018] [Indexed: 11/16/2022]
Affiliation(s)
- C Norman Coleman
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
| | - Pataje G S Prasanna
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Eric J Bernhard
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jeffrey C Buchsbaum
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Mansoor M Ahmed
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jacek Capala
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Ceferino Obcemea
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jim A Deye
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - David A Pistenmma
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Bhadrasain Vikram
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jacques Bernier
- Department of Radio-Oncology, Genolier Clinic, Genolier, Switzerland; Centre d'Oncologie des Eaux-Vives, Geneva, Switzerland; International Conference on Translational Research in Radio-Oncology-Physics for Health in Europe, Genolier, Switzerland
| | - Manjit Dosanjh
- International Conference on Translational Research in Radio-Oncology-Physics for Health in Europe, Genolier, Switzerland; Conseil Européen pour la Recherche Nucléaire (European Council for Nuclear Research), Geneva, Switzerland
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Zakeri K, Narayanan D, Evans G, Prasanna P, Buchsbaum JC, Vikram B, Capala J. Advancing Targeted Radionuclide Therapy Through the National Cancer Institute's Small Business Innovation Research Pathway. J Nucl Med 2018; 60:41-49. [PMID: 30030338 DOI: 10.2967/jnumed.118.214684] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 06/18/2018] [Indexed: 12/13/2022] Open
Abstract
The Small Business Innovation Research (SBIR) and Small Business Technology Transfer (STTR) programs of the National Cancer Institute (NCI) are congressionally mandated set-aside programs that provide research funding to for-profit small businesses for the development of innovative technologies and treatments that serve the public good. These two programs have an annual budget of $159 million (in 2017) and serve as the NCI's main engine of innovation for developing and commercializing cancer technologies. In collaboration with the NCI's Radiation Research Program, the NCI SBIR Development Center published in 2015-2017 three separate requests for proposals from small businesses for the development of systemic targeted radionuclide therapy (TRT) technologies to treat cancer. TRT combines a cytotoxic radioactive isotope with a molecularly targeted agent to produce an anticancer therapy capable of treating local or systemic disease. This article summarizes the NCI SBIR funding solicitations for the development of TRTs and the research proposals funded through them.
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Affiliation(s)
- Kaveh Zakeri
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, Maryland.,Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California; and
| | - Deepa Narayanan
- Small Business Innovation Research Development Center, National Cancer Institute, Bethesda, Maryland
| | - Greg Evans
- Small Business Innovation Research Development Center, National Cancer Institute, Bethesda, Maryland
| | - Pataje Prasanna
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, Maryland
| | - Jeffrey C Buchsbaum
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, Maryland
| | - Bhadrasain Vikram
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, Maryland
| | - Jacek Capala
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, Maryland
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Ahmed MM, Coleman CN, Mendonca M, Bentzen S, Vikram B, Seltzer SM, Goodhead D, Obcemea C, Mohan R, Prise KM, Capala J, Citrin D, Kao G, Aryankalayil M, Eke I, Buchsbaum JC, Prasanna PGS, Liu FF, Le QT, Teicher B, Kirsch DG, Smart D, Tepper J, Formenti S, Haas-Kogan D, Raben D, Mitchell J. Workshop Report for Cancer Research: Defining the Shades of Gy: Utilizing the Biological Consequences of Radiotherapy in the Development of New Treatment Approaches-Meeting Viewpoint. Cancer Res 2018; 78:2166-2170. [PMID: 29686020 DOI: 10.1158/0008-5472.can-17-3760] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/13/2018] [Accepted: 02/19/2018] [Indexed: 01/03/2023]
Affiliation(s)
- Mansoor M Ahmed
- Radiation Research Program, National Cancer Institute, Bethesda, Maryland.
| | - C Norman Coleman
- Radiation Research Program, National Cancer Institute, Bethesda, Maryland. .,Radiation Oncology Branch, Centre for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Marc Mendonca
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Soren Bentzen
- Department of Epidemiology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Bhadrasain Vikram
- Radiation Research Program, National Cancer Institute, Bethesda, Maryland
| | | | | | - Ceferino Obcemea
- Radiation Research Program, National Cancer Institute, Bethesda, Maryland
| | - Radhe Mohan
- Division of Radiation Oncology, Department of Radiation Physics, The University of Texas, MD Anderson Cancer Centre, Houston, Texas
| | - Kevin M Prise
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, United Kingdom
| | - Jacek Capala
- Radiation Research Program, National Cancer Institute, Bethesda, Maryland
| | - Deborah Citrin
- Radiation Oncology Branch, Centre for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Gary Kao
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Molykutty Aryankalayil
- Radiation Oncology Branch, Centre for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Iris Eke
- Radiation Oncology Branch, Centre for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | | | | | - Fei-Fei Liu
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Canada
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Beverly Teicher
- Development Therapeutics Program, National Cancer Institute, Bethesda, Maryland
| | - David G Kirsch
- Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina
| | - DeeDee Smart
- Radiation Oncology Branch, Centre for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Joel Tepper
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Silvia Formenti
- Department of Radiation Oncology, Weill Cornell Medical College, New York City, New York
| | - Daphne Haas-Kogan
- Department of Radiation Oncology, Harvard Medical School, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - David Raben
- Department of Radiation Oncology; University of Colorado Cancer Center, Aurora, Colorado
| | - James Mitchell
- Radiation Biology Branch, National Cancer Institute, Bethesda, Maryland
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Citrin DE, Prasanna PGS, Walker AJ, Freeman ML, Eke I, Barcellos-Hoff MH, Arankalayil MJ, Cohen EP, Wilkins RC, Ahmed MM, Anscher MS, Movsas B, Buchsbaum JC, Mendonca MS, Wynn TA, Coleman CN. Radiation-Induced Fibrosis: Mechanisms and Opportunities to Mitigate. Report of an NCI Workshop, September 19, 2016. Radiat Res 2017; 188:1-20. [PMID: 28489488 DOI: 10.1667/rr14784.1] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
A workshop entitled "Radiation-Induced Fibrosis: Mechanisms and Opportunities to Mitigate" (held in Rockville, MD, September 19, 2016) was organized by the Radiation Research Program and Radiation Oncology Branch of the Center for Cancer Research (CCR) of the National Cancer Institute (NCI), to identify critical research areas and directions that will advance the understanding of radiation-induced fibrosis (RIF) and accelerate the development of strategies to mitigate or treat it. Experts in radiation biology, radiation oncology and related fields met to identify and prioritize the key areas for future research and clinical translation. The consensus was that several known and newly identified targets can prevent or mitigate RIF in pre-clinical models. Further, basic and translational research and focused clinical trials are needed to identify optimal agents and strategies for therapeutic use. It was felt that optimally designed preclinical models are needed to better study biomarkers that predict for development of RIF, as well as to understand when effective therapies need to be initiated in relationship to manifestation of injury. Integrating appropriate endpoints and defining efficacy in clinical trials testing treatment of RIF were felt to be critical to demonstrating efficacy. The objective of this meeting report is to (a) highlight the significance of RIF in a global context, (b) summarize recent advances in our understanding of mechanisms of RIF,
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Affiliation(s)
- Deborah E Citrin
- a Radiation Oncology Branch, Center for Cancer Research, Bethesda, Maryland
| | - Pataje G S Prasanna
- b Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, Maryland
| | - Amanda J Walker
- c Office of Hematology and Oncology Products, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Michael L Freeman
- d Department of Radiation Oncology, Vanderbilt School of Medicine, Nashville, Tennessee
| | - Iris Eke
- a Radiation Oncology Branch, Center for Cancer Research, Bethesda, Maryland
| | - Mary Helen Barcellos-Hoff
- e Department of Radiation Oncology, University of California, San Francisco, San Francisco, California
| | | | - Eric P Cohen
- f Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Ruth C Wilkins
- g Radiobiology Division, Consumer and Clinical Radiation Protection Bureau, Health Canada, Ottawa, Ontario
| | - Mansoor M Ahmed
- b Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, Maryland
| | - Mitchell S Anscher
- h Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia
| | - Benjamin Movsas
- i Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan
| | - Jeffrey C Buchsbaum
- b Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, Maryland
| | - Marc S Mendonca
- h Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia
| | - Thomas A Wynn
- k National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - C Norman Coleman
- b Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, Maryland.,j Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana
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Bosarge CL, Ewing MM, DesRosiers CM, Buchsbaum JC. A dosimetric comparison of whole-lung treatment techniques in the pediatric population. Med Dosim 2016; 41:126-30. [DOI: 10.1016/j.meddos.2015.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 10/02/2015] [Accepted: 10/16/2015] [Indexed: 11/16/2022]
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Qutub MAZ, Klein SB, Buchsbaum JC. Rapid RBE-Weighted Proton Radiation Dosimetry Risk Assessment. Technol Cancer Res Treat 2015; 15:NP1-7. [PMID: 26283051 DOI: 10.1177/1533034615599313] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 07/01/2015] [Indexed: 11/17/2022] Open
Abstract
Proton therapy dose is affected by relative biological effectiveness differently than X-ray therapies. The current clinically accepted weighting factor is 1.1 at all positions along the depth-dose profile. However, the relative biological effectiveness correlates with the linear energy transfer, cell or tissue type, and the dose per fraction causing variation of relative biological effectiveness along the depth-dose profile. In this article, we present a simple relative biological effectiveness-weighted treatment planning risk assessment algorithm in 2-dimensions and compare the results with those derived using the standard relative biological effectiveness of 1.1. The isodose distribution profiles for beams were accomplished using matrices that represent coplanar intersecting beams. These matrices were combined and contoured using MATLAB to achieve the distribution of dose. There are some important differences in dose distribution between the dose profiles resulting from the use of relative biological effectiveness = 1.1 and the empirically derived depth-dependent values of relative biological effectiveness. Significant hot spots of up to twice the intended dose are indicated in some beam configurations. This simple and rapid risk analysis could quickly evaluate the safety of various dose delivery schema.
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Affiliation(s)
- Mohammad A Z Qutub
- Department of Physics, Indiana University School of Arts and Sciences, Indianapolis, IN, USA
| | - Susan B Klein
- Department of Physics, Indiana University School of Arts and Sciences, Indianapolis, IN, USA
| | - Jeffrey C Buchsbaum
- Department of Physics, Indiana University School of Arts and Sciences, Indianapolis, IN, USA Departments of Radiation Oncology, Pediatrics, and Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
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Kralik SF, Ho CY, Finke W, Buchsbaum JC, Haskins CP, Shih CS. Radiation Necrosis in Pediatric Patients with Brain Tumors Treated with Proton Radiotherapy. AJNR Am J Neuroradiol 2015; 36:1572-8. [PMID: 26138138 DOI: 10.3174/ajnr.a4333] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 01/15/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Proton radiotherapy has been increasingly utilized to treat pediatric brain tumors, however, limited information exists regarding radiation necrosis among these patients. Our aim was to evaluate the incidence, timing, clinical significance, risk factors, and imaging patterns of radiation necrosis in pediatric patients with brain tumors treated with proton radiation therapy. MATERIALS AND METHODS A retrospective study was performed on 60 consecutive pediatric patients with primary brain tumors treated with proton radiation therapy. Radiation necrosis was assessed by examining serial MRIs and clinical records to determine the incidence, timing, risk factors, imaging patterns, and clinical significance associated with the development of radiation necrosis in these patients. Radiation necrosis was defined as areas of new enhancement within an anatomic region with previous exposure to proton beam therapy with subsequent decrease on follow-up imaging without changes in chemotherapy. RESULTS Thirty-one percent of patients developed radiation necrosis with a median time to development of 5.0 months (range, 3-11 months). Risk factors included multiple chemotherapy agents (>3 cytotoxic agents) and atypical teratoid rhabdoid tumor pathology (P = .03 and P = .03, respectively). The most common imaging patterns were small (median, 0.9 cm) and multifocal (63% of patients) areas of parenchymal enhancement remote from the surgical site. The median time to complete resolution on imaging was 5.3 months (range, 3-12 months). Among patients with imaging findings of radiation necrosis, 25% demonstrated severe symptoms with medical intervention indicated. CONCLUSIONS Pediatric patients with brain tumors treated with proton radiation therapy demonstrate a high incidence of radiation necrosis and a short time to development of necrosis. Multiple small areas of necrosis are frequently identified on imaging. Exposure to multiple chemotherapy agents was a significant risk factor associated with radiation necrosis in these patients.
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Affiliation(s)
- S F Kralik
- From the Departments of Radiology and Imaging Sciences (S.F.K., C.Y.H., W.F.)
| | - C Y Ho
- From the Departments of Radiology and Imaging Sciences (S.F.K., C.Y.H., W.F.)
| | - W Finke
- From the Departments of Radiology and Imaging Sciences (S.F.K., C.Y.H., W.F.)
| | | | - C P Haskins
- Indiana University School of Medicine (C.P.H.), Indianapolis, Indiana
| | - C-S Shih
- Pediatrics, Hematology/Oncology Section (C.-S.S.)
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Haskins CP, Jyoti B, Hines M, Simoneaux V, Buchsbaum JC. Single Center Results following Proton Beam Therapy in Children with Atypical Teratoid Rhabdoid Tumors of the Central Nervous System. Int J Part Ther 2015. [DOI: 10.14338/ijpt-14-00028.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Estabrook NC, McDonald MW, Hoene TA, Bartlett GK, Johnstone PA, McMullen KP, Buchsbaum JC. Proton Radiotherapy for Midline Central Nervous System Lesions: A Class Solution. Oncology 2015; 89:111-7. [DOI: 10.1159/000377727] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 02/05/2015] [Indexed: 11/19/2022]
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Abstract
OBJECTIVE Few data exist on evaluating utilization patterns of radiotherapy (RT) at the end of life (EOL) in children. Metastatic disease in pediatric patients is not pathognomonic for palliative treatment intent; further complicating the issue are complexities surrounding the very select population of children receiving proton therapy (PrT). We compared data for RT and PrT in terms of death rate within 30 days. METHODS We performed chart reviews for patients receiving radiation therapy at age ≤21 years treated at Indiana University Health Proton Therapy Center (IUHPTC) between June 2008 and June 2013 and University of Miami Radiation Oncology Department (UM) between June 2000 and June 2013. Included were patients not completing prescribed courses of RT, and those dying within 30 days of therapy. Comparison was made of differences between practice data for PrT and conventional RT. RESULTS At IUHPTC, 2 children of 272 did not complete their courses and died within 30 days (0.7%). At UM, data are available for 425 children; 9 did not complete their courses and 7 died within 30 days (1.6%). Neither the number of patients who did not complete treatment nor the 30-day death rates (P=.21) for PrT and RT were significantly different. CONCLUSIONS Delivery of RT for children at EOL is complex. Frequency of RT at EOL in children occurs in is <2% of cases, and is not significantly less frequent in the proton milieu. This appears to be about an order of magnitude less than in adults.
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Affiliation(s)
- Joseph Panoff
- 1 Department of Radiation Oncology, University of Miami School of Medicine , Miami, Florida
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Kasper HB, Raeke L, Indelicato DJ, Symecko H, Hartsell W, Mahajan A, Hill-Kayser C, Perkins SM, Chang AL, Childs S, Buchsbaum JC, Laurie F, Khan AJ, Giraud C, Yeap BY, Yock TI. The Pediatric Proton Consortium Registry: A Multi-institutional Collaboration in U.S. Proton Centers. Int J Part Ther 2014. [DOI: 10.14338/ijpt.13-00006.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Vincent AJ, Singhal M, Johnstone PAS, Buchsbaum JC. Age-Related Changes in Frontal Lobe Anatomy Require Alternatives to Opposed Lateral Fields. Int J Part Ther 2014. [DOI: 10.14338/ijpt.13.00004.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Buchsbaum JC, McDonald MW, Johnstone PAS, Hoene T, Mendonca M, Cheng CW, Das IJ, McMullen KP, Wolanski MR. Range modulation in proton therapy planning: a simple method for mitigating effects of increased relative biological effectiveness at the end-of-range of clinical proton beams. Radiat Oncol 2014; 9:2. [PMID: 24383792 PMCID: PMC3904459 DOI: 10.1186/1748-717x-9-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 12/23/2013] [Indexed: 01/28/2023] Open
Abstract
Background The increase in relative biological effectiveness (RBE) of proton beams at the distal edge of the spread out Bragg peak (SOBP) is a well-known phenomenon that is difficult to quantify accurately in vivo. For purposes of treatment planning, disallowing the distal SOBP to fall within vulnerable tissues hampers sparing to the extent possible with proton beam therapy (PBT). We propose the distal RBE uncertainty may be straightforwardly mitigated with a technique we call “range modulation”. With range modulation, the distal falloff is smeared, reducing both the dose and average RBE over the terminal few millimeters of the SOBP. Methods One patient plan was selected to serve as an example for direct comparison of image-guided radiotherapy plans using non-range modulation PBT (NRMPBT), and range-modulation PBT (RMPBT). An additional plan using RMPBT was created to represent a re-treatment scenario (RMPBTrt) using a vertex beam. Planning statistics regarding dose, volume of the planning targets, and color images of the plans are shown. Results The three plans generated for this patient reveal that in all cases dosimetric and device manufacturing advantages are able to be achieved using RMPBT. Organ at risk (OAR) doses to critical structures such as the cochleae, optic apparatus, hypothalamus, and temporal lobes can be selectively spared using this method. Concerns about the location of the RBE that did significantly impact beam selection and treatment planning no longer have the same impact on the process, allowing these structures to be spared dose and subsequent associated issues. Conclusions This present study has illustrated that RMPBT can improve OAR sparing while giving equivalent coverage to target volumes relative to traditional PBT methods while avoiding the increased RBE at the end of the beam. It has proven easy to design and implement and robust in our planning process. The method underscores the need to optimize treatment plans in PBT for both traditional energy dose in gray (Gy) and biologic dose (RBE).
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Affiliation(s)
- Jeffrey C Buchsbaum
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, USA.
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Ray GL, Buchsbaum JC, McMullen KP, Simoneaux RV, Hines M, Douglas JG, Johnstone PAS. Definitive treatment of leptomeningeal spinal metastases in children. Pediatr Blood Cancer 2013; 60:1839-41. [PMID: 23788317 DOI: 10.1002/pbc.24659] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 05/22/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Uniquely in children, the existence of leptomeningeal spinal metastases does not confer a uniformly grave prognosis. Although the radiation tolerance of the spinal cord is of significant concern in these cases, the chemo- and radiosensitivity of these lesions argues for an aggressive approach where possible. METHODS The records of the Indiana University Health Proton Therapy Center were reviewed for patients undergoing proton beam therapy with curative intent for LSM between January 1, 2004 and July 7, 2012. Patients with microscopic disease only on LP were not included. Particulars of therapy, including dose, field sizes, toxicities, and outcomes were collated. RESULTS Twenty-two children received therapy as described, of median age 5 years (range 1.1-17.1). Patients had medulloblastoma (n = 9), ATRT (n = 4), ependymoma, and PNET (n = 3 each). Five lesions (23%) were chemo-recurrent, though no patient had prior radiation to the spine. Median follow-up was 14 months (range 4-33) for all living patients. Fifteen (68%) children continued to have local control at last follow-up visit. Median dose was 37.8 Gy (range 21.6-54 Gy). Eight patients with chemo-recurrent disease or diffuse cord seeding did poorly, with local control and overall survival achieved in four. The 12-month overall survival was 68% with grade 1 skin erythema as the most frequent toxicity. CONCLUSIONS We describe a cohort of LSM patients treated with RT with definitive intent, and the only available data from the proton environment. Durable response is possible for these children in over two-thirds of cases. Significant toxicity was infrequent using proton radiotherapy and these fractionation schemes.
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Affiliation(s)
- Geoffrey L Ray
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana; IU Health Proton Therapy Center, Bloomington, Indiana
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Moskvin V, Lasley FD, Ray GL, Gautam AS, Cheng CW, Das IJ, Buchsbaum JC. Acute skin toxicity associated with proton beam therapy in spine and brain patients. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s13566-013-0128-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Cheng CW, Das IJ, Srivastava SP, Zhao L, Wolanski M, Simmons J, Johnstone PA, Buchsbaum JC. Dosimetric comparison between proton and photon beams in the moving gap region in cranio-spinal irradiation (CSI). Acta Oncol 2013; 52:553-60. [PMID: 22554342 DOI: 10.3109/0284186x.2012.681065] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate the moving gap region dosimetry in proton beam cranio-spinal irradiation (CSI) to provide optimal dose uniformity across the treatment volume. MATERIAL AND METHODS Proton beams of ranges 11.6 cm and 16 cm are used for the spine and the brain fields, respectively. Beam profiles for a 30 cm snout are first matched at the 50% level (hot match) on the computer. Feathering is simulated by shifting the dose profiles by a known distance two successive times to simulate a 2 × feathering scheme. The process is repeated for 2 mm and 4 mm gaps. Similar procedures are used to determine the dose profiles in the moving gap for a series of gap widths, 0-10 mm, and feathering step sizes, 4-10 mm, for a Varian iX 6MV beam. The proton and photon dose profiles in the moving gap region are compared. RESULTS The dose profiles in the moving gap exhibit valleys and peaks in both proton and photon beam CSI. The dose in the moving gap for protons is around 100% or higher for 0 mm gap, for both 5 and 10 mm feathering step sizes. When the field gap is comparable or larger than the penumbra, dose minima as low as 66% is obtained. The dosimetric characteristics for 6 MV photon beams can be made similar to those of the protons by appropriately combining gap width and feathering step size. CONCLUSION The dose in the moving gap region is determined by the lateral penumbras, the width of the gap and the feathering step size. The dose decreases with increasing gap width or decreasing feathering step size. The dosimetric characteristics are similar for photon and proton beams. However, proton CSI has virtually no exit dose and is beneficial for pediatric patients, whereas with photon beams the whole lung and abdomen receive non-negligible exit dose.
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Affiliation(s)
- Chee-Wai Cheng
- IU Health Proton Therapy Center,
Bloomington, Indiana, USA
- Department of Radiation Oncology, Indiana University School of Medicine,
Indianapolis, Indiana, USA
| | - Indra J. Das
- IU Health Proton Therapy Center,
Bloomington, Indiana, USA
- Department of Radiation Oncology, Indiana University School of Medicine,
Indianapolis, Indiana, USA
| | - Shiv P. Srivastava
- Department of Radiation Oncology, Indiana University School of Medicine,
Indianapolis, Indiana, USA
- Department of Radiation Oncology, Reid Hospital,
Richmond, IN
| | - Li Zhao
- IU Health Proton Therapy Center,
Bloomington, Indiana, USA
- Department of Radiation Oncology, Indiana University School of Medicine,
Indianapolis, Indiana, USA
| | - Mark Wolanski
- IU Health Proton Therapy Center,
Bloomington, Indiana, USA
- Department of Radiation Oncology, Indiana University School of Medicine,
Indianapolis, Indiana, USA
| | - Joseph Simmons
- IU Health Proton Therapy Center,
Bloomington, Indiana, USA
| | - Peter A.S. Johnstone
- IU Health Proton Therapy Center,
Bloomington, Indiana, USA
- Department of Radiation Oncology, Indiana University School of Medicine,
Indianapolis, Indiana, USA
| | - Jeffrey C. Buchsbaum
- IU Health Proton Therapy Center,
Bloomington, Indiana, USA
- Department of Radiation Oncology, Indiana University School of Medicine,
Indianapolis, Indiana, USA
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Buchsbaum JC, McMullen KP, Douglas JG, Jackson JL, Simoneaux RV, Hines M, Bratton J, Kerstiens J, Johnstone PA. Repetitive Pediatric Anesthesia in a Non-Hospital Setting. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2012.10.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Buchsbaum JC, Besemer A, Simmons J, Hoene T, Simoneaux V, Sandefur A, Wolanski M, Li Z, Cheng CW. Supine proton beam craniospinal radiotherapy using a novel tabletop adapter. Med Dosim 2013; 38:70-6. [DOI: 10.1016/j.meddos.2012.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Revised: 05/31/2012] [Accepted: 07/23/2012] [Indexed: 10/28/2022]
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McDonald MW, Wolanski MR, Simmons JW, Buchsbaum JC. Technique for sparing previously irradiated critical normal structures in salvage proton craniospinal irradiation. Radiat Oncol 2013; 8:14. [PMID: 23311343 PMCID: PMC3556160 DOI: 10.1186/1748-717x-8-14] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 12/27/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cranial reirradiation is clinically appropriate in some cases but cumulative radiation dose to critical normal structures remains a practical concern. The authors developed a simple technique in 3D conformal proton craniospinal irradiation (CSI) to block organs at risk (OAR) while minimizing underdosing of adjacent target brain tissue. METHODS Two clinical cases illustrate the use of proton therapy to provide salvage CSI when a previously irradiated OAR required sparing from additional radiation dose. The prior radiation plan was coregistered to the treatment planning CT to create a planning organ at risk volume (PRV) around the OAR. Right and left lateral cranial whole brain proton apertures were created with a small block over the PRV. Then right and left lateral "inverse apertures" were generated, creating an aperture opening in the shape of the area previously blocked and blocking the area previously open. The inverse aperture opening was made one millimeter smaller than the original block to minimize the risk of dose overlap. The inverse apertures were used to irradiate the target volume lateral to the PRV, selecting a proton beam range to abut the 50% isodose line against either lateral edge of the PRV. Together, the 4 cranial proton fields created a region of complete dose avoidance around the OAR. Comparative photon treatment plans were generated with opposed lateral X-ray fields with custom blocks and coplanar intensity modulated radiation therapy optimized to avoid the PRV. Cumulative dose volume histograms were evaluated. RESULTS Treatment plans were developed and successfully implemented to provide sparing of previously irradiated critical normal structures while treating target brain lateral to these structures. The absence of dose overlapping during irradiation through the inverse apertures was confirmed by film. Compared to the lateral X-ray and IMRT treatment plans, the proton CSI technique improved coverage of target brain tissue while providing the least additional radiation dose to the previously irradiated OAR. CONCLUSIONS Proton craniospinal irradiation can be adapted to provide complete sparing of previously irradiated OARs. This technique may extend the option of reirradiation to patients otherwise deemed ineligible for further radiotherapy due to prior dose to critical normal structures.
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Affiliation(s)
- Mark W McDonald
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, USA.
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Quigg TC, Haddad NG, Buchsbaum JC, Shih CS. Hypothalamic obesity syndrome: rare presentation of CNS+ B-cell lymphoblastic lymphoma. Pediatr Blood Cancer 2012; 59:930-3. [PMID: 22213612 PMCID: PMC4020003 DOI: 10.1002/pbc.24058] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 11/28/2011] [Indexed: 11/06/2022]
Abstract
Hypothalamic obesity syndrome can affect brain tumor patients following surgical intervention and irradiation. This syndrome is rare at diagnosis in childhood cancer, but has been reported with relapse of acute lymphoblastic leukemia. Here we present a case of hypothalamic obesity syndrome as the primary presentation of a toddler found to have CNS+ B-cell lymphoblastic lymphoma. Cytogenetic studies on diagnostic cerebrospinal fluid revealed MLL gene rearrangement (11q23). Hyperphagia and obesity dramatically improved following induction and consolidation chemotherapy. We describe a novel presentation of hypothalamic obesity syndrome in CNS B-cell lymphoblastic lymphoma, responsive to chemotherapy.
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Affiliation(s)
- Troy C. Quigg
- Section of Pediatric Hematology/Oncology, Riley Hospital for Children, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Nadine G. Haddad
- Section of Pediatric Endocrinology, Riley Hospital for Children, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Jeffrey C. Buchsbaum
- Department of Radiation Oncology, Indiana University Health Proton Therapy Center, Indiana University School of Medicine, Indianapolis, IN
| | - Chie-Schin Shih
- Section of Pediatric Hematology/Oncology, Riley Hospital for Children, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
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Singhal M, Vincent A, Simoneaux V, Johnstone PA, Buchsbaum JC. Overcoming the Learning Curve in Supine Pediatric Proton Craniospinal Irradiation. J Am Coll Radiol 2012; 9:285-7. [DOI: 10.1016/j.jacr.2011.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Accepted: 11/07/2011] [Indexed: 10/28/2022]
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Buchsbaum JC, Johnstone PAS. Proton therapy for lung cancer: new data to consider. Oncology (Williston Park) 2010; 24:1058-1059. [PMID: 21155460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Kerr ID, Sivakolundu S, Li Z, Buchsbaum JC, Knox LA, Kriwacki R, White SW. Crystallographic and NMR Analyses of UvsW and UvsW.1 from Bacteriophage T4. J Biol Chem 2007; 282:34392-400. [PMID: 17878153 DOI: 10.1074/jbc.m705900200] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The uvsWXY system is implicated in the replication and repair of the bacteriophage T4 genome. Whereas the roles of the recombinase (UvsX) and the recombination mediator protein (UvsY) are known, the precise role of UvsW is unclear. Sequence analysis identifies UvsW as a member of the monomeric SF2 helicase superfamily that translocates nucleic acid substrates via the action of two RecA-like motor domains. Functional homologies to Escherichia coli RecG and biochemical analyses have shown that UvsW interacts with branched nucleic acid substrates, suggesting roles in recombination and the rescue of stalled replication forks. A sequencing error at the 3'-end of the uvsW gene has revealed a second, short open reading frame that encodes a protein of unknown function called UvsW.1. We have determined the crystal structure of UvsW to 2.7A and the NMR solution structure of UvsW.1. UvsW has a four-domain architecture with structural homology to the eukaryotic SF2 helicase, Rad54. A model of the UvsW-ssDNA complex identifies structural elements and conserved residues that may interact with nucleic acid substrates. The NMR solution structure of UvsW.1 reveals a dynamic four-helix bundle with homology to the structure-specific nucleic acid binding module of RecQ helicases.
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Affiliation(s)
- Iain D Kerr
- Department of Structural Biology, St. Jude Children's Research Hospital, 332 N. Lauderdale Street, Memphis, TN 38105, USA
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Kupelian PA, Buchsbaum JC, Elshaikh MA, Reddy CA, Klein EA. Improvement in relapse-free survival throughout the PSA era in patients with localized prostate cancer treated with definitive radiotherapy: Year of treatment an independent predictor of outcome. Int J Radiat Oncol Biol Phys 2003; 57:629-34. [PMID: 14529766 DOI: 10.1016/s0360-3016(03)00630-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE In patients treated with radical prostatectomy in the prostate-specific antigen (PSA) era, it has been demonstrated that the year of treatment in the PSA era is associated with better pathologic parameters and outcomes, independently of other well-recognized parameters such as clinical stage, pretreatment PSA level, or Gleason score. The purpose of the present study was to study a similar phenomenon with definitive radiotherapy (RT). METHODS AND MATERIALS The inclusion criteria were as follows: clinical Stage T1-T2, available pretreatment PSA level and biopsy Gleason score, treatment delivered before January 2000 with standard fractionation external beam radiotherapy to at least 70 Gy, no adjuvant androgen deprivation (AD), all neoadjuvant AD limited to < or =6 months, and a minimum of 3 years of PSA follow-up. A total of 467 cases treated between January 1986 and December 1999 were included. Short-course AD in the adjuvant or neoadjuvant setting for < or =6 months was given in 124 cases (27%). The median radiation dose was 74 Gy (range 70.0-78.0). A conformal technique was used in 293 cases (63%). The median follow-up was 62 months (range 37-189). A total of 4931 follow-up PSA levels were available for analysis (average 11 per patient). A multivariate analysis for factors affecting biochemical relapse-free survival rates using the proportional hazards model was performed for all cases using the following variables: age (continuous variable), race (black vs. white), clinical T stage (T1-T2a vs. T2b-T2c), pretreatment PSA (continuous variable), biopsy Gleason score (continuous variable), use of AD (yes vs. no), radiation dose (continuous variable), and year of treatment (continuous variable: 1986-1999). RESULTS The projected 8-year biochemical relapse-free survival rate was 74%. The projected 5-year biochemical relapse-free survival rate for the 143 patients treated in the 1986-1995 period was 58% vs. 82% for the 324 patients treated in the 1996-1999 period (p <0.001). The difference was attributable to a multitude of factors (earlier stage cancer, higher radiation doses, shorter follow-up). To study the confounding effects of these factors on the year of therapy, a multivariate analysis was performed. The multivariate analysis revealed the initial PSA level (p <0.001), Gleason score (p <0.001), RT dose (p = 0.045), and year of treatment (p <0.001) to be independent predictors of outcome. Age (p = 0.41), race (p = 0.14), T stage (p = 0.10), and use of AD (p = 0.58) were not. CONCLUSION When controlling for tumor, treatment, and follow-up parameters, the year in which RT was performed was still an independent predictor of outcome, consistent with observations made for radical prostatectomy patients. This indicates a more favorable presentation of localized prostate in current years probably related to a combination of factors such as screening and increased patient awareness leading to earlier diagnosis. Outcome predictions should be based on contemporaneous series.
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Affiliation(s)
- Patrick A Kupelian
- Department of Radiation Oncology, M. D. Anderson Cancer Center Orlando, Orlando, FL 32806, USA.
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