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Mendez LC, Crook J, Martell K, Schaly B, Hoover DA, Dhar A, Velker V, Ahmad B, Lock M, Halperin R, Warner A, Bauman GS, D'Souza DP. Is Ultrahypofractionated Whole Pelvis Radiation Therapy (WPRT) as Well Tolerated as Conventionally Fractionated WPRT in Patients With Prostate Cancer? Early Results From the HOPE Trial. Int J Radiat Oncol Biol Phys 2023:S0360-3016(23)08189-0. [PMID: 38072323 DOI: 10.1016/j.ijrobp.2023.11.058] [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: 09/08/2023] [Revised: 11/14/2023] [Accepted: 11/25/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVE The aim of this work was to evaluate the acute toxicity and quality-of-life (QOL) impact of ultrahypofractionated whole pelvis radiation therapy (WPRT) compared with conventional WPRT fractionation after high-dose-rate prostate brachytherapy (HDR-BT). METHODS AND MATERIALS The HOPE trial is a phase 2, multi-institutional randomized controlled trial of men with prostate-confined disease and National Comprehensive Cancer Network unfavorable intermediate-, high-, or very-high-risk prostate cancer. Patients were randomly assigned to receive conventionally fractionated WPRT (standard arm) or ultrahypofractionated WPRT (experimental arm) in a 1:1 ratio. All patients underwent radiation therapy with 15 Gy HDR-BT boost in a single fraction followed by WPRT delivered with conventional fractionation (45 Gy in 25 daily fractions or 46 Gy in 23 fractions) or ultrahypofractionation (25 Gy in 5 fractions delivered on alternate days). Acute toxicities measured during radiation therapy and at 6 weeks posttreatment were assessed using the clinician-reported Common Terminology Criteria for Adverse Events version 5.0, and QOL was measured using the Expanded Prostate Cancer Index Composite (EPIC-50) and International Prostate Symptom Score (IPSS). RESULTS A total of 80 patients were enrolled and treated across 3 Canadian institutions, of whom 39 and 41 patients received external radiation therapy with conventionally fractionated and ultrahypofractionated WPRT, respectively. All patients received androgen deprivation therapy except for 2 patients treated in the ultrahypofractionated arm. The baseline clinical characteristics of the 2 arms were similar, with 51 (63.8%) patients having high or very-high-risk prostate cancer disease. Treatment was well tolerated with no significant differences in the rate of acute adverse events between arms. No grade 4 adverse events or treatment-related deaths were reported. Ultrahypofractionated WPRT had a less detrimental impact on the EPIC-50 bowel total, function, and bother domain scores compared with conventional WPRT in the acute setting. By contrast, more patients treated with ultrahypofractionated WPRT reached the minimum clinical important difference on the EPIC-50 urinary domains. No significant QOL differences between arms were noted in the sexual and hormonal domains. CONCLUSIONS Ultrahypofractionated WPRT after HDR-BT is a well-tolerated treatment strategy in the acute setting that has less detrimental impact on bowel QOL domains compared with conventional WPRT.
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Affiliation(s)
- Lucas C Mendez
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.
| | - Juanita Crook
- Department of Radiation Oncology, BC Cancer Agency, Kelowna, British Columbia, Canada
| | - Kevin Martell
- Department of Radiation Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Bryan Schaly
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Douglas A Hoover
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Aneesh Dhar
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Vikram Velker
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Belal Ahmad
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Michael Lock
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Ross Halperin
- Department of Radiation Oncology, BC Cancer Agency, Kelowna, British Columbia, Canada
| | - Andrew Warner
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Glenn S Bauman
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - David P D'Souza
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
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Tang T, Rodrigues G, Bauman GS. Long-Term Outcomes Following Fairly Brief Androgen Suppression and Stereotactic Radiation Therapy in High-Risk Prostate Cancer: Update from the FASTR/FASTR-2 Trials. Int J Radiat Oncol Biol Phys 2023; 117:e445-e446. [PMID: 37785439 DOI: 10.1016/j.ijrobp.2023.06.1626] [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] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) There has been emerging interest in the role of ultra-hypofractionated radiotherapy for high-risk prostate cancer, especially given its low α/β ratio. However, there is limited data on the long-term outcomes of this treatment strategy. The FASTR and FASTR-2 clinical trials were designed to assess the tolerability of stereotactic ablative body radiotherapy (SABR) in high-risk prostate cancer. FASTR was discontinued early due to unacceptable acute toxicity, whereas the acute toxicities in FASTR-2 were minimal. Herein, the long-term results from these trials are reported. MATERIALS/METHODS Eligible patients had at least 1 high-risk feature as per the National Comprehensive Cancer Network criteria for high-risk prostate cancer, no evidence of metastatic disease, and either a score of 3+ on the Vulnerable Elderly Scale or declined standard therapy. A total of 19 patients from a single institution were enrolled on FASTR between 2011 and 2015. They received 40 Gy to the prostate and 25 Gy to the pelvic lymph nodes in 5 fractions delivered once weekly for 5 weeks, along with 1 year of androgen deprivation therapy (ADT). The excessive acute toxicity in FASTR prompted several modifications in FASTR-2, including the omission of nodal irradiation. A total of 30 patients from the same institution were enrolled on FASTR-2 between 2015 and 2017. They received 35 Gy to the prostate alone in 5 fractions delivered once weekly for 5 weeks, along with 18 months of ADT. RESULTS A total of 44 patients were eligible for analysis, 16 from FASTR and 28 from FASTR-2. Most patients were >70 years old (77%). High-risk features included Gleason score ≥8 (46%), T3-T4 disease (27%) and baseline PSA >20 (50%). With a median follow-up of 6.4 years, the cumulative incidence of grade ≥3 genitourinary/gastrointestinal toxicity was 50% among FASTR patients and 7% among FASTR-2 patients. At 5 years, the combined rates of biochemical failure-free survival, freedom from distant metastases, prostate cancer-specific survival and overall survival were 72%, 90%, 92% and 83%, respectively. A total of 12 patients (27%) required further treatment. No significant differences in clinical outcomes were noted between the FASTR and FASTR-2 cohorts. CONCLUSION SABR for high-risk prostate cancer is an attractive option for reducing treatment burden. Clinical outcomes and toxicity with the FASTR-2 protocol were comparable to conventionally-fractionated radiotherapy plus ADT. Larger prospective, randomized trials exploring the role of SABR with ADT in high-risk disease are necessary to better understand the efficacy and tolerability of this approach.
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Affiliation(s)
- T Tang
- London Regional Cancer Program, London, ON, Canada
| | - G Rodrigues
- London Regional Cancer Program, London, ON, Canada
| | - G S Bauman
- London Regional Cancer Program, London, ON, Canada
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Arifin AJ, Gulstene S, Warner A, Bauman GS, Mendez LC. 18F-DCFPyL PSMA-PET affects management of salvage radiotherapy for post-prostatectomy patients with biochemical failure: A matched cohort study. Can Urol Assoc J 2023; 17:247-253. [PMID: 37581539 PMCID: PMC10426430 DOI: 10.5489/cuaj.8165] [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] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Our objective was to assess the effect of 18F-DCFPyL prostate-specific membrane antigen (PSMA) positron emission tomography (PET) on the management and outcomes of patients receiving salvage radiotherapy following biochemical failure (BF) post-radical prostatectomy (RP) using a matched cohort analysis. METHODS A PSMA-PET cohort of patients with BF post-RP was identified through a prospective registry. Patients from this registry were included if they did not have disease outside of the pelvis and underwent salvage radiotherapy to the prostate and/or pelvis. Case-control matching was performed with a contemporary cohort of patients with BF post-RP without PSMA-PET information. RESULTS Forty-four patients were included in the PSMA-PET cohort and 80 were analyzed in the non-PSMA-PET cohort. The PSMA-PET cohort had a significantly higher pre-radiotherapy median prostate-specific antigen (PSA) of 0.48 ng/mL compared to 0.20 ng/mL in the non-PSMA-PET cohort (p<0.001), but these levels were similar after matching. The PSMA-PET cohort had a higher proportion of patients receiving radiotherapy to pelvic lymph nodes (n=27 [61.4%] vs. n=16 [20.0%], p<0.001). Median followup was 26 months (interquartile range 18.8-33) for both cohorts. BF-free survival and event-free survival were not significantly different between the two cohorts for all (p=0.662 and >0.99) and matched patients (p=0.808 and 0.808), respectively. Metastasis-free survival was significantly higher in the matched PSMA-PET cohort compared to the matched non-PSMA-PET cohort (p=0.046), although a higher proportion of patients in the non-PSMA-PET cohort underwent PSMA-PET restaging after BF (52% vs. 20%, p=0.08726). CONCLUSIONS Our study showed that patients undergoing PSMA-PET scans after BF post-RP had a higher likelihood of pelvic nodal treatment at the time of salvage RT. Despite higher PSA levels at salvage, we identified no recurrence or survival differences.
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Affiliation(s)
- Andrew J Arifin
- Division of Radiation Oncology, London Regional Cancer Program, London, ON, Canada
| | - Stephanie Gulstene
- Division of Radiation Oncology, London Regional Cancer Program, London, ON, Canada
| | - Andrew Warner
- Division of Radiation Oncology, London Regional Cancer Program, London, ON, Canada
| | - Glenn S Bauman
- Division of Radiation Oncology, London Regional Cancer Program, London, ON, Canada
| | - Lucas C Mendez
- Division of Radiation Oncology, London Regional Cancer Program, London, ON, Canada
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Arifin AJ, Young S, Bauman GS, Fakir H, Ahmad B, Laba JM, Rodrigues GB, Nguyen EK, Sahgal A, Nguyen TK. Planning for the impact of XX trial on spine stereotactic body radiotherapy (SBRT) utilization at a tertiary cancer centre. Adv Radiat Oncol 2023; 8:101220. [PMID: 37124027 PMCID: PMC10130065 DOI: 10.1016/j.adro.2023.101220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/06/2023] [Indexed: 03/19/2023] Open
Abstract
Purpose The goal of this study was to assess the potential real-world effect of the recently reported SC.24 trial on spine stereotactic body radiation therapy (SBRT) utilization. We estimated the proportion of patients treated with conventional radiation therapy (CRT) who would have been eligible for spine SBRT per trial inclusion criteria and analyzed the potential estimated increased costs to our institution. Methods and Materials This was a retrospective review of patients who received spine CRT at our institution between August and October 2020. Data abstracted included demographics, SC.24 eligibility criteria, provider-reported pain response, and survival. A cost analysis and time survey was performed using institutional and provincial data. Results Of 73 patients reviewed, 24 patients (33%) were eligible. The most common exclusion factors included irradiation of ≥3 consecutive spinal segments (n = 32, 44%), Eastern Cooperative Oncology Group performance status >2 (n = 17, 23%), and symptomatic spinal cord compression (n = 13, 18%). Of eligible patients, the mean age was 68.92 years, median spinal instability in neoplasia score was 8 (interquartile range, 7-9), and median Eastern Cooperative Oncology Group performance status was 2 (interquartile range, 1-2). The most common primary cancer types among eligible patients were lung (n = 10) and breast (n = 4). The median survival of eligible patients was 10 months (95% confidence interval, 4 months to not reached) with 58% surviving longer than 3 months. Of patients who had subjective pain documented after CRT, 54% had at least some response. The cost of spine SBRT was estimated at CA$4764.80 compared with $3589.10 for CRT, and tasks for spine SBRT took roughly 3 times as long as those for CRT. Conclusions One-third of patients who received palliative spine CRT met eligibility criteria for SC.24. This possible expanded indication for spine SBRT can have a substantial effect on resource utilization. These data may be useful in guiding resource planning at institutions looking to commence a spine SBRT program.
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Young S, Phaterpekar K, Tsang DS, Boldt G, Bauman GS. Clinical outcomes of medulloblastoma patients treated with proton radiotherapy: a systematic review. Adv Radiat Oncol 2023; 8:101189. [PMID: 37008255 PMCID: PMC10051027 DOI: 10.1016/j.adro.2023.101189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/27/2023] [Indexed: 02/10/2023] Open
Abstract
Purpose The aim of this study was to comprehensively review all studies examining clinical outcomes of craniospinal irradiation with proton radiotherapy for medulloblastoma (MB) to determine whether theoretical dosimetric advantages have translated into superior clinical outcomes (including survival and toxicities) compared with traditional photon-based techniques. Methods and Materials We performed a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles reporting on clinical outcomes of pediatric and/or adult patients with MB treated with proton radiotherapy were included. Evidence quality was assessed using a modified Newcastle Ottawa scale and GRADE score. Results Thirty-five studies were included, with a total of 2059 patients reported (representing an estimated 630-654 unique patients). None of the studies were randomized, 12 were comparative, 9 were prospective, 3 were mixed, and 22 were retrospective. Average mean/median follow-up was 5.0 years (range, 4 weeks to 12.6 years). The majority of studies (n = 19) reported on treatment with passive scatter proton beams exclusively. Average study quality was 6.0 out of 9 (median, 6; standard deviation, 1.6). Nine studies scored ≥8 out of 9 on the modified Newcastle Ottawa Scale; an overall "moderate" GRADE score was assigned. Well-designed comparative cohort studies with adequate follow-up demonstrate superior neurocognitive outcomes, lower incidence of hypothyroidism (23% vs 69%), sex hormone deficiency (3% vs 19%), greater heights, and reduced acute toxicities in patients treated with protons compared to photons. Overall survival (up to 10 years), progression-free survival (up to 10 years), brain stem injury, and other endocrine outcomes were similar to those reported for photon radiation. There was insufficient evidence to make conclusions on endpoints of quality of life, ototoxicity, secondary malignancy, alopecia, scoliosis, cavernomas, and cerebral vasculopathy. Conclusions Moderate-grade evidence supports proton radiotherapy as a preferred treatment for craniospinal irradiation of MB based on equivalent disease control and comparable-to-improved toxicity versus photon beam radiation therapy.
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Alfano R, Bauman GS, Gomez JA, Gaed M, Moussa M, Chin J, Pautler S, Ward AD. Prostate cancer classification using radiomics and machine learning on mp-MRI validated using co-registered histology. Eur J Radiol 2022; 156:110494. [PMID: 36095953 DOI: 10.1016/j.ejrad.2022.110494] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/04/2022] [Accepted: 08/16/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Multi-parametric magnetic resonance imaging (mp-MRI) is emerging as a useful tool for prostate cancer (PCa) detection but currently has unaddressed limitations. Computer aided diagnosis (CAD) systems have been developed to address these needs, but many approaches used to generate and validate the models have inherent biases. METHOD All clinically significant PCa on histology was mapped to mp-MRI using a previously validated registration algorithm. Shape and size matched non-PCa regions were selected using a proposed sampling algorithm to eliminate biases towards shape and size. Further analysis was performed to assess biases regarding inter-zonal variability. RESULTS A 5-feature Naïve-Bayes classifier produced an area under the receiver operating characteristic curve (AUC) of 0.80 validated using leave-one-patient-out cross-validation. As mean inter-class area mismatch increased, median AUC trended towards positively biasing classifiers to producing higher AUCs. Classifiers were invariant to differences in shape between PCa and non-PCa lesions (AUC: 0.82 vs 0.82). Performance for models trained and tested only in the peripheral zone was found to be lower than in the central gland (AUC: 0.75 vs 0.95). CONCLUSION We developed a radiomics based machine learning system to classify PCa vs non-PCa tissue on mp-MRI validated on accurately co-registered mid-gland histology with a measured target registration error. Potential biases involved in model development were interrogated to provide considerations for future work in this area.
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Affiliation(s)
- Ryan Alfano
- Baines Imaging Research Laboratory, 790 Commissioners Rd E, London, ON N6A 5W9, Canada; Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada; Western University, Department of Medical Biophysics, 1151 Richmond St., London, ON N6A 3K7, Canada.
| | - Glenn S Bauman
- Western University, Department of Medical Biophysics, 1151 Richmond St., London, ON N6A 3K7, Canada; Western University, Department of Oncology, 1151 Richmond St., London, ON N6A 3K7, Canada.
| | - Jose A Gomez
- Western University, Department of Pathology and Laboratory Medicine, 1151 Richmond St., London, ON N6A 3K7, Canada.
| | - Mena Gaed
- Western University, Department of Pathology and Laboratory Medicine, 1151 Richmond St., London, ON N6A 3K7, Canada.
| | - Madeleine Moussa
- Western University, Department of Pathology and Laboratory Medicine, 1151 Richmond St., London, ON N6A 3K7, Canada.
| | - Joseph Chin
- Western University, Department of Surgery, 1151 Richmond St., London, ON N6A 3K7, Canada; Western University, Department of Oncology, 1151 Richmond St., London, ON N6A 3K7, Canada.
| | - Stephen Pautler
- Western University, Department of Surgery, 1151 Richmond St., London, ON N6A 3K7, Canada; Western University, Department of Oncology, 1151 Richmond St., London, ON N6A 3K7, Canada.
| | - Aaron D Ward
- Baines Imaging Research Laboratory, 790 Commissioners Rd E, London, ON N6A 5W9, Canada; Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada; Western University, Department of Medical Biophysics, 1151 Richmond St., London, ON N6A 3K7, Canada; Western University, Department of Oncology, 1151 Richmond St., London, ON N6A 3K7, Canada.
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Eansor P, Norris ME, D'Souza LA, Bauman GS, Kassam Z, Leung E, Nichols AC, Sharma M, Tay KY, Velker V, Warner A, Willmore KE, Campbell N, Palma DA. Can We Identify Predictors of Success in Contouring Education for Radiation Oncology Trainees? An Analysis of the Anatomy and Radiology Contouring Bootcamp: Predictors of Success in Contouring Education. Pract Radiat Oncol 2022; 12:e486-e492. [PMID: 35690353 DOI: 10.1016/j.prro.2022.05.016] [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: 03/07/2022] [Revised: 05/12/2022] [Accepted: 05/27/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Although several different contouring instructional programs are available to radiation oncologists and trainees, very little is known about which methods and resources benefit learners most, and whether some learners may need alternate forms of instruction. This study aimed to determine the factors that were predictors of learners' success in anatomy, radiology, and contouring education. METHODS Participants in the online and face-to-face (F2F) Anatomy and Radiology Contouring (ARC) Bootcamp completed pre- and post-intervention evaluations that assessed anatomy/radiology knowledge, contouring skills, self-confidence, and spatial ability. Baseline factors were assessed as predictors of outcomes across multiple educational domains. RESULTS One hundred and eighty (F2F: n=40; online: n=140) participants enrolled in the ARC Bootcamp and fifty-seven (F2F: n=30; online: n=27) participants completed both evaluations. Of the participants enrolled, 37% were female, and most were radiation oncology (RO) residents (62%). In the anatomy/radiology knowledge testing, all quartiles (based on baseline performance) improved numerically, however, the largest improvements occurred in learners with the lowest baseline scores (p<0.001). At the end of the Bootcamp, learners with lower-performing scores did not reach the level of learners with the highest baseline scores (Bonferroni-corrected p<0.001). Regarding the contouring assessment, improvements were only evident for the participants with lower-performing baseline scores (p<0.05). Spatial anatomy skills, as measured by the spatial anatomy task, was correlated to contouring ability. Overall, the greatest improvements were seen for learners in postgraduate year 1-3, those with no previous rotation experience in a given discipline, and those who attended from 'other' programs (i.e. medical physics residents and medical students). CONCLUSIONS The ARC Bootcamp improved all levels of performers' anatomy and radiology knowledge but only lower-performers' contouring ability. The course alone does not help lower-performing learners reach the abilities of higher-performers. The ARC Bootcamp tends to be most beneficial for participants with less RO experience. Curriculum modifications can be made to help support ARC Bootcamp participants with lower performing scores.
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Affiliation(s)
- Paige Eansor
- Department of Anatomy and Cell Biology, Western University, London, Ontario, Canada.
| | - Madeleine E Norris
- Department of Anatomy, University of California San Francisco, San Francisco, California, United States
| | - Leah A D'Souza
- Department of Radiation Oncology, Rush University Medical Centre, Chicago, Illinois, United States
| | - Glenn S Bauman
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Zahra Kassam
- Department of Medical Imaging, St. Joseph's Health Care, London, Ontario, Canada
| | - Eric Leung
- Department of Radiation Oncology, Odette Cancer Centre, Toronto, Ontario, Canada
| | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Manas Sharma
- Department of Radiology, London Health Sciences Centre, London, Ontario, Canada
| | - Keng Yeow Tay
- Department of Radiology, London Health Sciences Centre, London, Ontario, Canada
| | - Vikram Velker
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Andrew Warner
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.
| | - Katherine E Willmore
- Department of Anatomy and Cell Biology, Western University, London, Ontario, Canada
| | - Nicole Campbell
- Department of Physiology and Pharmacology, Western University, London, Ontario, Canada
| | - David A Palma
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.
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D'Angelo K, Eansor P, D'Souza LA, Norris ME, Bauman GS, Kassam Z, Leung E, Nichols AC, Sharma M, Tay KY, Velker V, O'Neil M, Mitchell S, Feuz C, Warner A, Willmore KE, Campbell N, Probst H, Palma DA. Implementation and Evaluation of an Online Anatomy, Radiology and Contouring Bootcamp for Radiation Therapists. J Med Imaging Radiat Sci 2022. [DOI: 10.1016/j.jmir.2022.04.008] [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: 10/18/2022]
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Harrow S, Palma DA, Olson R, Gaede S, Louie AV, Haasbeek C, Mulroy L, Lock M, Rodrigues GB, Yaremko BP, Schellenberg D, Ahmad B, Senthi S, Swaminath A, Kopek N, Liu M, Schlijper R, Bauman GS, Laba J, Qu XM, Warner A, Senan S. Stereotactic Radiation for the Comprehensive Treatment of Oligometastases (SABR-COMET) – Extended Long-Term Outcomes. Int J Radiat Oncol Biol Phys 2022; 114:611-616. [DOI: 10.1016/j.ijrobp.2022.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 11/30/2022]
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Eansor P, Norris ME, D'Souza LA, Bauman GS, Kassam Z, Leung E, Nichols AC, Sharma M, Tay KY, Velker V, Warner A, Willmore KE, Campbell N, Palma DA. Is Remote Learning as Effective as In-Person Learning for Contouring Education? A Prospective Comparison of Face-to-Face vs. Online Delivery of the Anatomy and Radiology Contouring Bootcamp. Int J Radiat Oncol Biol Phys 2021; 112:590-599. [PMID: 34710522 DOI: 10.1016/j.ijrobp.2021.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/08/2021] [Accepted: 10/14/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE The Anatomy and Radiology Contouring (ARC) Bootcamp was a face-to-face (F2F) intervention providing integrated education for radiation oncology (RO) residents and medical physicists. To increase access, we launched an online offering in 2019. We evaluated the impact of the online course on participants' knowledge acquisition, contouring skills, and self-confidence by comparing it to the F2F course. METHODS AND MATERIALS: Using modules, the online course offers similar content to the F2F comparator. Participants from the 2019 F2F and the 2019-2020 online course completed pre- and post-evaluations, assessing anatomy/radiology knowledge, contouring skills, self-confidence, and course satisfaction. RESULTS There were 180 (F2F: n=40; online: n=140) enrolled and 57 (F2F: n=30; online: n=27) participants completed both evaluations. The online course had a wider geographic participation (19 countries) than F2F (4 countries). F2F had primarily RO resident participation (80%), compared to online (41%). Both cohorts demonstrated similar improvements in self-confidence pertaining to their anatomy/radiology knowledge, contouring skills, and in interpreting radiology images (all p < 0.001). Both the online (mean ± SD improvement: 6.6 ± 6.7 on a 40-point scale; p < 0.001) and F2F (3.7 ± 5.7; p=0.002) groups showed anatomy/radiology knowledge improvement. Only the F2F group demonstrated improvement with the contouring assessment (F2F: 0.10 ± 0.17 on a 1-point Dice scale; p=0.004; online: 0.07 ± 0.16; p=0.076). Both cohorts perceived the course as a positive experience (F2F: 4.8 ± 0.4 on a 5-point scale; online: 4.5 ± 0.6), stated it would improve their professional practice (F2F: 4.6 ± 0.5; online: 4.2 ± 0.8), and said they would recommend it to others (F2F: 4.8 ± 0.4; online: 4.4 ± 0.6). CONCLUSIONS The online ARC Bootcamp demonstrated improved self-confidence, knowledge scores, and high satisfaction levels among participants. The offering had lower completion rates but was more accessible to geographic regions, provided a flexible learning experience, and allowed for ongoing education during the COVID-19 pandemic.
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Affiliation(s)
- Paige Eansor
- Department of Anatomy and Cell Biology, Western University, London, Ontario, Canada
| | - Madeleine E Norris
- Department of Anatomy, University of California San Francisco, San Francisco, California
| | - Leah A D'Souza
- Department of Radiation Oncology, Rush University Medical Centre, Chicago, Illinois
| | - Glenn S Bauman
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Zahra Kassam
- Department of Medical Imaging, St. Joseph's Health Care, London, Ontario, Canada
| | - Eric Leung
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Manas Sharma
- Department of Radiology, London Health Sciences Centre, London, Ontario, Canada
| | - Keng Yeow Tay
- Department of Radiology, London Health Sciences Centre, London, Ontario, Canada
| | - Vikram Velker
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Andrew Warner
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Katherine E Willmore
- Department of Anatomy and Cell Biology, Western University, London, Ontario, Canada
| | - Nicole Campbell
- Department of Physiology and Pharmacology, Western University, London, Ontario, Canada
| | - David A Palma
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.
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D'Angelo K, Eansor P, D'Souza LA, Norris ME, Bauman GS, Kassam Z, Leung E, Nichols AC, Sharma M, Tay KY, Velker V, O'Neil M, Mitchell S, Feuz C, Warner A, Willmore KE, Campbell N, Probst H, Palma DA. Implementation and evaluation of an online anatomy, radiology and contouring bootcamp for radiation therapists. J Med Imaging Radiat Sci 2021; 52:567-575. [PMID: 34635471 DOI: 10.1016/j.jmir.2021.09.010] [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: 07/16/2021] [Revised: 09/10/2021] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND As new treatments and technologies have been introduced in radiation oncology, the clinical roles of radiation therapists (RTs) have expanded. However, there are few formal learning opportunities for RTs. An online, anatomy, radiology and contouring bootcamp (ARC Bootcamp) originally designed for medical residents was identified as a prospective educational tool for RTs. The purpose of this study was to evaluate an RT edition of the ARC Bootcamp on knowledge, contouring, and confidence, as well as to identify areas for future modification. METHODS Fifty licensed RTs were enrolled in an eight-week, multidisciplinary, online RT ARC Bootcamp. Contouring practice was available throughout the course using an online contouring platform. Outcomes were evaluated using a pre-course and post-course multiple-choice quiz (MCQ), contouring evaluation and qualitative self-efficacy and satisfaction survey. RESULTS Of the fifty enrolled RTs, 30 completed the course, and 26 completed at least one of the post-tests. Nineteen contouring dice similarity coefficient (DSC) scores were available for paired pre- and post-course analysis. RTs demonstrated a statistically significant increase in mean DSC scoring pooled across all contouring structures (mean ± SD improvement: 0.09 ± 0.18 on a scale from 0 to 1, p=0.020). For individual contouring structures, 3/15 reached significance in contouring improvement. MCQ scores were available for 26 participants and increased after RT ARC Bootcamp participation with a mean ± SD pre-test score of 18.6 ± 4.2 (46.5%); on a 40-point scale vs. post-test score of 24.5 ± 4.3 (61.4%) (p < 0.001). RT confidence in contouring, anatomy knowledge and radiographic identification improved after course completion (p < 0.001). Feedback from RTs recommended more contouring instruction, less in-depth anatomy review and more time to complete the course. CONCLUSIONS The RT ARC Bootcamp was an effective tool for improving anatomy and radiographic knowledge among RTs. The course demonstrated improvements in contouring and overall confidence. However, only approximately half of the enrolled RTs completed the course, limiting statistical power. Future modifications will aim to increase relevance to RTs and improve completion rates.
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Affiliation(s)
- Krista D'Angelo
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Paige Eansor
- Department of Anatomy and Cell Biology, Western University, London, Ontario, Canada
| | - Leah A D'Souza
- Department of Radiation Oncology, Rush University Medical Center, Chicago, IL, United States
| | - Madeleine E Norris
- Department of Anatomy, University of California San Francisco, San Francisco, CA, United States
| | - Glenn S Bauman
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Zahra Kassam
- Department of Medical Imaging, St. Joseph's Health Care, London, Ontario, Canada
| | - Eric Leung
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Anthony C Nichols
- Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Manas Sharma
- Department of Radiology, London Health Sciences Centre, London, Ontario, Canada
| | - Keng Yeow Tay
- Department of Radiology, London Health Sciences Centre, London, Ontario, Canada
| | - Vikram Velker
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Melissa O'Neil
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Sylvia Mitchell
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Carina Feuz
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Andrew Warner
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.
| | - Katherine E Willmore
- Department of Anatomy and Cell Biology, Western University, London, Ontario, Canada
| | - Nicole Campbell
- Department of Physiology and Pharmacology, Western University, London, Ontario, Canada
| | - Heidi Probst
- Department of Radiotherapy and Oncology, Sheffield Hallam University, Sheffield, United Kingdom
| | - David A Palma
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.
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12
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Smith CW, Alfano R, Hoover D, Surry K, D'Souza D, Thiessen J, Rachinsky I, Butler J, Gomez JA, Gaed M, Moussa M, Chin J, Pautler S, Bauman GS, Ward AD. Prostate specific membrane antigen positron emission tomography for lesion-directed high-dose-rate brachytherapy dose escalation. Phys Imaging Radiat Oncol 2021; 19:102-107. [PMID: 34589619 PMCID: PMC8459608 DOI: 10.1016/j.phro.2021.07.001] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 11/30/2022]
Abstract
This paper evaluated lesion-directed prostatic high dose rate brachytherapy. Lesions defined by prostate specific membrane antigen positron emission tomography. Dose escalation was confirmed using whole-mount digital histology. Targeting lesions led to significantly higher dose to high-grade histologic cancer.
Background and purpose Prostate specific membrane antigen positron emission tomography imaging (PSMA-PET) has demonstrated potential for intra-prostatic lesion localization. We leveraged our existing database of co-registered PSMA-PET imaging with cross sectional digitized pathology to model dose coverage of histologically-defined prostate cancer when tailoring brachytherapy dose escalation based on PSMA-PET imaging. Materials and methods Using a previously-developed automated approach, we created segmentation volumes delineating underlying dominant intraprostatic lesions for ten men with co-registered pathology-imaging datasets. To simulate realistic high-dose-rate brachytherapy (HDR-BT) treatments, we registered the PSMA-PET-defined segmentation volumes and underlying cancer to 3D trans-rectal ultrasound images of HDR-BT cases where 15 Gray (Gy) was delivered. We applied dose/volume optimization to focally target the dominant intraprostatic lesion identified on PSMA-PET. We then compared histopathology dose for all high-grade cancer within whole-gland treatment plans versus PSMA-PET-targeted plans. Histopathology dose was analyzed for all clinically significant cancer with a Gleason score of 7or greater. Results The standard whole-gland plans achieved a median [interquartile range] D98 of 15.2 [13.8–16.4] Gy to the histologically-defined cancer, while the targeted plans achieved a significantly higher D98 of 16.5 [15.0–19.0] Gy (p = 0.007). Conclusion This study is the first to use digital histology to confirm the effectiveness of PSMA-PET HDR-BT dose escalation using automatically generated contours. Based on the findings of this study, PSMA-PET lesion dose escalation can lead to increased dose to the ground truth histologically defined cancer.
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Affiliation(s)
- Christopher W Smith
- Baines Imaging Research Laboratory, 790 Commissioners Rd E, London, ON N6A 5W9, Canada.,Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada.,Western University Department of Medical Biophysics, 1151 Richmond St., London, ON N6A 3K7, Canada.,London Regional Cancer Program, 790 Commissioners Rd E, London, ON N6A 4L6, Canada
| | - Ryan Alfano
- Baines Imaging Research Laboratory, 790 Commissioners Rd E, London, ON N6A 5W9, Canada.,Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada.,Western University Department of Medical Biophysics, 1151 Richmond St., London, ON N6A 3K7, Canada.,London Regional Cancer Program, 790 Commissioners Rd E, London, ON N6A 4L6, Canada
| | - Douglas Hoover
- Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada.,Western University Department of Medical Biophysics, 1151 Richmond St., London, ON N6A 3K7, Canada.,London Regional Cancer Program, 790 Commissioners Rd E, London, ON N6A 4L6, Canada
| | - Kathleen Surry
- Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada.,Western University Department of Medical Biophysics, 1151 Richmond St., London, ON N6A 3K7, Canada.,London Regional Cancer Program, 790 Commissioners Rd E, London, ON N6A 4L6, Canada
| | - David D'Souza
- Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada.,Western University Department of Oncology, 1151 Richmond St., London, ON N6A 3K7, Canada.,London Regional Cancer Program, 790 Commissioners Rd E, London, ON N6A 4L6, Canada
| | - Jonathan Thiessen
- Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada.,Western University Department of Medical Biophysics, 1151 Richmond St., London, ON N6A 3K7, Canada
| | - Irina Rachinsky
- Western University Department of Medical Imaging, 1151 Richmond St., London, ON N6A 3K7, Canada
| | - John Butler
- Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada
| | - Jose A Gomez
- Western University Department of Pathology and Laboratory Medicine, 1151 Richmond St., London, ON N6A 3K7, Canada
| | - Mena Gaed
- Western University Department of Pathology and Laboratory Medicine, 1151 Richmond St., London, ON N6A 3K7, Canada
| | - Madeleine Moussa
- Western University Department of Pathology and Laboratory Medicine, 1151 Richmond St., London, ON N6A 3K7, Canada
| | - Joseph Chin
- Western University Department of Surgery, 1151 Richmond St., London, ON N6A 3K7, Canada.,Western University Department of Oncology, 1151 Richmond St., London, ON N6A 3K7, Canada
| | - Stephen Pautler
- Western University Department of Surgery, 1151 Richmond St., London, ON N6A 3K7, Canada.,Western University Department of Oncology, 1151 Richmond St., London, ON N6A 3K7, Canada
| | - Glenn S Bauman
- Western University Department of Medical Biophysics, 1151 Richmond St., London, ON N6A 3K7, Canada.,Western University Department of Oncology, 1151 Richmond St., London, ON N6A 3K7, Canada.,London Regional Cancer Program, 790 Commissioners Rd E, London, ON N6A 4L6, Canada
| | - Aaron D Ward
- Baines Imaging Research Laboratory, 790 Commissioners Rd E, London, ON N6A 5W9, Canada.,Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada.,Western University Department of Medical Biophysics, 1151 Richmond St., London, ON N6A 3K7, Canada.,Western University Department of Oncology, 1151 Richmond St., London, ON N6A 3K7, Canada.,London Regional Cancer Program, 790 Commissioners Rd E, London, ON N6A 4L6, Canada
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13
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Eansor P, D’Souza LA, Norris ME, Willmore KE, Kassam Z, Leung E, Nichols AC, Sharma M, Tay KY, Velker V, Bauman GS, Warner A, Campbell N, Palma DA. 12: Is Remote Learning as Effective as In-Person Learning for Contouring Education? a Comparison of Face-To-Face Versus Online Delivery of the Anatomy and Radiology Contouring Bootcamp. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08831-9] [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: 11/29/2022]
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14
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Corkum MT, Fakir H, Palma DA, Nguyen T, Bauman GS. Can Polymetastatic Disease Be ARRESTed Using SABR? A Dosimetric Feasibility Study to Inform Development of a Phase 1 Trial. Adv Radiat Oncol 2021; 6:100734. [PMID: 34278053 PMCID: PMC8267486 DOI: 10.1016/j.adro.2021.100734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/14/2020] [Accepted: 05/21/2021] [Indexed: 12/13/2022] Open
Abstract
Purpose Phase 2 randomized trials suggest that stereotactic ablative radiation therapy improves progression-free and overall survival in patients with oligometastatic cancer, with phase 3 trials currently testing stereotactic ablative radiation therapy in up to 10 metastases. Whether stereotactic radiation therapy could provide similar benefits in polymetastatic disease (>10 metastases) is unknown. We sought to evaluate the dosimetric feasibility of using stereotactic radiation therapy in polymetastatic disease in preparation for a phase 1 trial. Methods and Materials Five craniospinal computed tomography simulations were used to simulate 24 metastatic targets (n = 2 patients), 30 targets (n = 2 patients), and 50 targets (n = 1 patient) that were not present on the initial scan. Creation of radiation therapy plans was attempted for doses up to 30 Gy in 5 fractions, with de-escalation to 24 Gy/4, 18 Gy/3, 12 Gy/2, or 6 Gy/1 if not feasible based on standardized dose constraints. Plans were created using Raystation for delivery on linear accelerators using volumetric modulated arc therapy and validated using Mobius 3D. Results A stereotactic radiation therapy treatment plan was generated for each simulated patient. Dose constraints were met to a dose of 30 Gy in 5 fractions for the patients with 24 and 30 lesions. For the patient with 50 targets, dose de-escalation to 12 Gy in 2 fractions was required to meet lung constraints. Estimated beam-on time varied between 18 and 29 minutes per fraction of 6 Gy. Median D95 planning target volume dosimetry ranged from 96.6% to 97.7% of the prescription dose. The conformity index (R100) range was 0.89 to 0.95, and R50 range was 6.84 to 8.72. Conclusions Stereotactic radiation therapy treatment plans meeting standardized dose constraints could be created in the setting of 24 to 50 metastatic lesions using volumetric modulated arc therapy. This safety of this approach is being evaluated in a phase 1 trial (NCT04530513).
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Affiliation(s)
- Mark T Corkum
- Division of Radiation Oncology, Department of Oncology
| | - Hatim Fakir
- Department of Medical Biophysics, London Health Sciences Centre, London, Ontario, Canada
| | - David A Palma
- Division of Radiation Oncology, Department of Oncology
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15
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Bauman GS, Jani AB. American Society for Radiation Oncology Editorial: Rapidly Evolving Technologies Related to Imaging Strategies for Advanced Prostate Cancer. Pract Radiat Oncol 2021; 11:163-165. [PMID: 32891558 DOI: 10.1016/j.prro.2020.06.009] [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] [Received: 05/27/2020] [Accepted: 06/28/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Glenn S Bauman
- Department of Radiation Oncology, London Health Sciences Centre and Western University, London, Ontario, Canada.
| | - Ashesh B Jani
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
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16
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Bauman GS, Corkum MT, Fakir H, Nguyen TK, Palma DA. Ablative radiation therapy to restrain everything safely treatable (ARREST): study protocol for a phase I trial treating polymetastatic cancer with stereotactic radiotherapy. BMC Cancer 2021; 21:405. [PMID: 33853550 PMCID: PMC8048078 DOI: 10.1186/s12885-021-08020-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/10/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Patients with polymetastatic cancer are most often treated with systemic therapy to improve overall survival and/or delay progression, with palliative radiotherapy reserved for sites of symptomatic disease. Stereotactic ablative radiotherapy (SABR) has shown promise in the treatment of oligometastatic disease, but the utility of SABR in treating all sites of polymetastatic disease has yet to be evaluated. This study aims to evaluate the maximally tolerated dose (MTD) of SABR in patients with polymetastatic disease. METHODS Up to 48 patients with polymetastatic cancer (> 10 sites) will be enrolled on this phase I, modified 3 + 3 design trial. Eligible patients will have exhausted (or refused) standard systemic therapy options. SABR will be delivered as an escalating number of weekly fractions of 6 Gy, starting at 6 Gy × 2 weekly fractions (dose level 1). The highest dose level (dose level 4) will be 6 Gy × 5 weekly fractions. Feasibility and safety of SABR will be evaluated 6 weeks following treatment using a composite endpoint of successfully completing treatment as well as toxicity outcomes. DISCUSSION This study will be the first to explore delivering SABR in patients with polymetastatic disease. SABR will be planned using the guiding principles of: strict adherence to dose constraints, minimization of treatment burden, and minimization of toxicity. As this represents a novel use of radiotherapy, our phase I study will allow for careful selection of the MTD for exploration in future studies. TRIAL REGISTRATION This trial was prospectively registered in ClinicalTrials.gov as NCT04530513 on August 28, 2020.
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Affiliation(s)
- Glenn S Bauman
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6C 1K1, Canada.
| | - Mark T Corkum
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6C 1K1, Canada
| | - Hatim Fakir
- Department of Medical Biophysics, London Health Sciences Centre, London, Ontario, Canada
| | - Timothy K Nguyen
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6C 1K1, Canada
| | - David A Palma
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6C 1K1, Canada
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17
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Smith CW, Hoover D, Surry K, D'Souza D, Cool DW, Kassam Z, Bastian-Jordan M, Gomez JA, Moussa M, Chin J, Pautler S, Bauman GS, Ward AD. A multiobserver study investigating the effectiveness of prostatic multiparametric magnetic resonance imaging to dose escalate corresponding histologic lesions using high-dose-rate brachytherapy. Brachytherapy 2021; 20:601-610. [PMID: 33648893 DOI: 10.1016/j.brachy.2021.01.005] [Citation(s) in RCA: 3] [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: 10/20/2020] [Revised: 01/14/2021] [Accepted: 01/22/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE Using multiparametric MRI data and the pathologic data from radical prostatectomy specimens, we simulated the treatment planning of dose-escalated high-dose-rate brachytherapy (HDR-BT) to the Multiparametric MRI dominant intraprostatic lesion (mpMRI-DIL) to compare the dose potentially delivered to the pathologically confirmed locations of the high-grade component of the cancer. METHODS AND MATERIALS Pathologist-annotated prostatectomy midgland histology sections from 12 patients were registered to preprostatectomy mpMRI scans that were interpreted by four radiologists. To simulate realistic HDR-BT, we registered each observer's mpMRI-DILs and corresponding histology to two transrectal ultrasound images of other HDR-BT patients with a 15-Gy whole-gland prescription. We used clinical inverse planning to escalate the mpMRI-DILs to 20.25 Gy. We compared the dose that the histopathology would have received if treated with standard treatment plans to the dose mpMRI-targeting would have achieved. The histopathology was grouped as high-grade cancer (any Gleason Grade 4 or 5) and low-grade cancer (only Gleason Grade 3). RESULTS 212 mpMRI-targeted HDR-BT plans were analyzed. For high-grade histology, the mpMRI-targeted plans achieved significantly higher median [IQR] D98 and D90 values of 18.2 [16.7-19.5] Gy and 19.4 [17.8-20.9] Gy, respectively, in comparison with the standard plans (p = 0.01 and p = 0.003). For low-grade histology, the targeted treatment plans would have resulted in a significantly higher median D90 of 17.0 [16.1-18.4] Gy in comparison with standard plans (p = 0.015); the median D98 was not significantly higher (p = 0.2). CONCLUSIONS In this retrospective pilot study of 12 patients, mpMRI-based dose escalation led to increased dose to high-grade, but not low-grade, cancer. In our data set, different observers and mpMRI sequences had no substantial effect on dose to histologic cancer.
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Affiliation(s)
- Christopher W Smith
- Baines Imaging Research Laboratory, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada; Department of Medical Biophysics, Western University, London, Ontario, Canada; London Regional Cancer Program, London, Ontario, Canada
| | - Douglas Hoover
- Lawson Health Research Institute, London, Ontario, Canada; Department of Medical Biophysics, Western University, London, Ontario, Canada; London Regional Cancer Program, London, Ontario, Canada
| | - Kathleen Surry
- Lawson Health Research Institute, London, Ontario, Canada; Department of Medical Biophysics, Western University, London, Ontario, Canada; London Regional Cancer Program, London, Ontario, Canada
| | - David D'Souza
- Lawson Health Research Institute, London, Ontario, Canada; Department of Oncology, Western University, London, Ontario, Canada; London Regional Cancer Program, London, Ontario, Canada
| | - Derek W Cool
- Lawson Health Research Institute, London, Ontario, Canada; Department of Medical Imaging, Western University, London, Ontario, Canada
| | - Zahra Kassam
- Lawson Health Research Institute, London, Ontario, Canada; Department of Medical Imaging, Western University, London, Ontario, Canada
| | - Matthew Bastian-Jordan
- Department of Medical Imaging, University of Queensland, Brisbane, Queensland, Australia
| | - Jose A Gomez
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada
| | - Madeleine Moussa
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada
| | - Joseph Chin
- Department of Surgery, Western University, London, Ontario, Canada; Department of Oncology, Western University, London, Ontario, Canada
| | - Stephen Pautler
- Department of Surgery, Western University, London, Ontario, Canada; Department of Oncology, Western University, London, Ontario, Canada
| | - Glenn S Bauman
- Department of Medical Biophysics, Western University, London, Ontario, Canada; Department of Oncology, Western University, London, Ontario, Canada; London Regional Cancer Program, London, Ontario, Canada
| | - Aaron D Ward
- Baines Imaging Research Laboratory, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada; Department of Medical Biophysics, Western University, London, Ontario, Canada; Department of Oncology, Western University, London, Ontario, Canada; London Regional Cancer Program, London, Ontario, Canada.
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18
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Affiliation(s)
- David A Palma
- Division of Radiation Oncology, Western University, London, Canada.
| | - Glenn S Bauman
- Division of Radiation Oncology, Western University, London, Canada
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19
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Eansor P, Norris ME, D’Souza LA, Bauman GS, Kassam Z, Leung E, Nichols AC, Sharma M, Tay KY, Velker V, Warner A, Willmore KE, Palma DA, Campbell N. Development, Implementation, and Initial Participant Feedback of an Online Anatomy and Radiology Contouring Bootcamp in Radiation Oncology. J Med Educ Curric Dev 2021; 8:23821205211037756. [PMID: 34568575 PMCID: PMC8461572 DOI: 10.1177/23821205211037756] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/16/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The Anatomy and Radiology Contouring (ARC) Bootcamp was a face-to-face (F2F) course designed to ensure radiation oncology residents were equipped with the knowledge and skillset to use radiation therapy techniques properly. The ARC Bootcamp was proven to be a useful educational intervention for improving learners' knowledge of anatomy and radiology and contouring ability. An online version of the course was created to increase accessibility to the ARC Bootcamp and provide a flexible, self-paced learning environment. This study aimed to describe the instructional design model used to create the online offering and report participants' motivation to enroll in the course and the online ARC Bootcamp's strengths and improvement areas. METHODS The creation of the online course followed the analysis, design, development, implementation, and evaluation (ADDIE) framework. The course was structured in a linear progression of locked modules consisting of radiology and contouring lectures, anatomy labs, and integrated evaluations. RESULTS The online course launched on the platform Teachable in November 2019, and by January 2021, 140 participants had enrolled in the course, with 27 participants completing all course components. The course had broad geographic participation with learners from 19 different countries. Of the participants enrolled, 34% were female, and most were radiation oncology residents (56%), followed by other programs (24%), such as medical physics residents or medical students. The primary motivator for participants to enroll was to improve their subject knowledge/skill (44%). The most common strength identified by participants was the course's quality (41%), and the most common improvement area was to incorporate more course content (41%). CONCLUSIONS The creation of the online ARC Bootcamp using the ADDIE framework was feasible. The course is accessible to diverse geographic regions and programs and provides a flexible learning environment; however, the course completion rate was low. Participants' feedback regarding their experiences will inform future offerings of the online course.
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Affiliation(s)
| | | | | | | | | | - Eric Leung
- Odette Cancer Centre, Toronto, ON, Canada
| | | | - Manas Sharma
- London Health Sciences
Centre, London, ON, Canada
| | - Keng Y. Tay
- London Health Sciences
Centre, London, ON, Canada
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Sistani G, Metser U, Bauman GS, Laidley DT, Pautler SE, Zukotynski KA. Case series - 18F-DCFPyL-positron emission tomography/computed tomography (PET/CT) time of imaging. Can Urol Assoc J 2020; 15:E376-E379. [PMID: 33382375 DOI: 10.5489/cuaj.6984] [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] [Indexed: 11/19/2022]
Affiliation(s)
- Golmehr Sistani
- Department of Medical Imaging, Western University, London, ON, Canada
| | - Ur Metser
- Department of Radiology, University of Toronto, Toronto, ON, Canada
| | - Glenn S Bauman
- Department of Radiation Oncology, Western University, London, ON, Canada
| | - David T Laidley
- Department of Nuclear Medicine, Western University, London, ON, Canada
| | - Stephen E Pautler
- Department of Surgery, Division of Urology, Western University, London, ON, Canada
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21
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Mendez LC, Arifin AJ, Bauman GS, Velker VM, Ahmad B, Lock M, Venkatesan VM, Sexton TL, Rodrigues GB, Chen J, Schaly B, Warner A, D'Souza DP. Is hypofractionated whole pelvis radiotherapy (WPRT) as well tolerated as conventionally fractionated WPRT in prostate cancer patients? The HOPE trial. BMC Cancer 2020; 20:978. [PMID: 33036579 PMCID: PMC7547418 DOI: 10.1186/s12885-020-07490-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 08/16/2020] [Accepted: 10/04/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Patients with high-risk prostate cancer are at increased risk of lymph node metastasis and are thought to benefit from whole pelvis radiotherapy (WPRT). There has been recent interest in the use of hypofractionated radiotherapy in treating prostate cancer. However, toxicity and cancer outcomes associated with hypofractionated WPRT are unclear at this time. This phase II study aims to investigate the impact in quality of life associated with hypofractionated WPRT compared to conventionally fractionated WPRT. METHODS Fifty-eight patients with unfavourable intermediate-, high- or very high-risk prostate cancer will be randomized in a 1:1 ratio between high-dose-rate brachytherapy (HDR-BT) + conventionally fractionated (45 Gy in 25 fractions) WPRT vs. HDR-BT + hypofractionated (25 Gy in 5 fractions) WPRT. Randomization will be performed with a permuted block design without stratification. The primary endpoint is late bowel toxicity and the secondary endpoints include acute and late urinary and sexual toxicity, acute bowel toxicity, biochemical failure-, androgen deprivation therapy-, metastasis- and prostate cancer-free survival of the hypofractionated arm compared to the conventionally fractionated arm. DISCUSSION To our knowledge, this is the first study to compare hypofractionated WPRT to conventionally fractionated WPRT with HDR-BT boost. Hypofractionated WPRT is a more attractive and convenient treatment approach, and may become the new standard of care if demonstrated to be well-tolerated and effective. TRIAL REGISTRATION This trial was prospectively registered in ClinicalTrials.gov as NCT04197141 on December 12, 2019.
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Affiliation(s)
- Lucas C Mendez
- Division of Radiation Oncology, London Regional Cancer Program, 800 Commissioners Road East, London, Ontario, N6A 5W9, Canada.
| | - Andrew J Arifin
- Division of Radiation Oncology, London Regional Cancer Program, 800 Commissioners Road East, London, Ontario, N6A 5W9, Canada
| | - Glenn S Bauman
- Division of Radiation Oncology, London Regional Cancer Program, 800 Commissioners Road East, London, Ontario, N6A 5W9, Canada
| | - Vikram M Velker
- Division of Radiation Oncology, London Regional Cancer Program, 800 Commissioners Road East, London, Ontario, N6A 5W9, Canada
| | - Belal Ahmad
- Division of Radiation Oncology, London Regional Cancer Program, 800 Commissioners Road East, London, Ontario, N6A 5W9, Canada
| | - Michael Lock
- Division of Radiation Oncology, London Regional Cancer Program, 800 Commissioners Road East, London, Ontario, N6A 5W9, Canada
| | - Varagur M Venkatesan
- Division of Radiation Oncology, London Regional Cancer Program, 800 Commissioners Road East, London, Ontario, N6A 5W9, Canada
| | - Tracy L Sexton
- Division of Radiation Oncology, London Regional Cancer Program, 800 Commissioners Road East, London, Ontario, N6A 5W9, Canada
| | - George B Rodrigues
- Division of Radiation Oncology, London Regional Cancer Program, 800 Commissioners Road East, London, Ontario, N6A 5W9, Canada
| | - Jeff Chen
- Department of Physics and Engineering, London Regional Cancer Program, 800 Commissioners Road East, London, Ontario, N6A 5W9, Canada
| | - Bryan Schaly
- Department of Physics and Engineering, London Regional Cancer Program, 800 Commissioners Road East, London, Ontario, N6A 5W9, Canada
| | - Andrew Warner
- Division of Radiation Oncology, London Regional Cancer Program, 800 Commissioners Road East, London, Ontario, N6A 5W9, Canada
| | - David P D'Souza
- Division of Radiation Oncology, London Regional Cancer Program, 800 Commissioners Road East, London, Ontario, N6A 5W9, Canada
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Corkum MT, Fakir H, Palma DA, Nguyen TK, Bauman GS. 195: Can Polymetastatic Disease Be Arrested Using SABR? A Dosimetric Analysis to Inform Development of a Phase 1 Trial. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(20)31087-2] [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: 10/23/2022]
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23
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Alfano R, Bauman GS, Liu W, Thiessen JD, Rachinsky I, Pavlosky W, Butler J, Gaed M, Moussa M, Gomez JA, Chin JL, Pautler S, Ward AD. Histologic validation of auto-contoured dominant intraprostatic lesions on [ 18F] DCFPyL PSMA-PET imaging. Radiother Oncol 2020; 152:34-41. [PMID: 32827589 DOI: 10.1016/j.radonc.2020.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 05/26/2020] [Revised: 07/22/2020] [Accepted: 08/14/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND PSMA-PET1 has shown good concordance with histology, but there is a need to investigate the ability of PSMA-PET to delineate DIL2 boundaries for guided biopsy and focal therapy planning. OBJECTIVE To determine threshold and margin combinations that satisfy the following criteria: ≥95% sensitivity with max specificity and ≥95% specificity with max sensitivity. DESIGN, SETTING AND PARTICIPANTS We registered pathologist-annotated whole-mount mid-gland prostatectomy histology sections cut in 4.4 mm intervals from 12 patients to pre-surgical PSMA-PET/MRI by mapping histology to ex-vivo imaging to in-vivo imaging. We generated PET-derived tumor volumes using boundaries defined by thresholded PET volumes from 1-100% of SUV3max in 1% intervals. At each interval, we applied margins of 0-30 voxels in one voxel increments, giving 3000 volumes/patient. OUTCOME MEASUREMENTS Mean and standard deviation of sensitivity and specificity for cancer detection within the 2D oblique histologic planes that intersected with the 3D PET volume for each patient. RESULTS AND LIMITATIONS A threshold of 67% SUV max with an 8.4 mm margin achieved a (mean ± std.) sensitivity of 95.0 ± 7.8% and specificity of 76.4 ± 14.7%. A threshold of 81% SUV max with a 5.1 mm margin achieved sensitivity of 65.1 ± 28.4% and specificity of 95.1 ± 5.2%. CONCLUSIONS Preliminary evidence of thresholding and margin expansion of PSMA-PET images targeted at DILs validated with histopathology demonstrated excellent mean sensitivity and specificity in the setting of focal therapy/boosting and guided biopsy. These parameters can be used in a larger validation study supporting clinical translation.
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Affiliation(s)
- Ryan Alfano
- Baines Imaging Research Laboratory, London, Canada; London Health Sciences Centre, London, Canada; Western University Department of Medical Biophysics, London, Canada.
| | - Glenn S Bauman
- London Health Sciences Centre, London, Canada; Western University Department of Medical Biophysics, London, Canada; Western University Department of Oncology, London, Canada.
| | - Wei Liu
- London Health Sciences Centre, London, Canada; Western University Department of Oncology, London, Canada.
| | - Jonathan D Thiessen
- Western University Department of Medical Biophysics, London, Canada; St. Joseph's Health Centre, London, Canada; Western University Department of Medical Imaging, London, Canada.
| | - Irina Rachinsky
- London Health Sciences Centre, London, Canada; Western University Department of Medical Imaging, London, Canada.
| | - William Pavlosky
- Western University Department of Medical Imaging, London, Canada.
| | | | - Mena Gaed
- Western University Department of Pathology and Laboratory Medicine, London, Canada.
| | - Madeleine Moussa
- London Health Sciences Centre, London, Canada; Western University Department of Pathology and Laboratory Medicine, London, Canada.
| | - Jose A Gomez
- London Health Sciences Centre, London, Canada; Western University Department of Pathology and Laboratory Medicine, London, Canada.
| | - Joseph L Chin
- London Health Sciences Centre, London, Canada; Western University Department of Surgery, London, Canada; Western University Department of Oncology, London, Canada.
| | - Stephen Pautler
- St. Joseph's Health Centre, London, Canada; Western University Department of Oncology, London, Canada.
| | - Aaron D Ward
- Baines Imaging Research Laboratory, London, Canada; London Health Sciences Centre, London, Canada; Western University Department of Medical Biophysics, London, Canada; Western University Department of Oncology, London, Canada.
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24
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Chin JL, Bauman GS. Re: Benefits and Risks of Primary Treatments for High-risk Localized and Locally Advanced Prostate Cancer: An International Multidisciplinary Systematic Review. Eur Urol 2020; 78:765-766. [PMID: 32605858 DOI: 10.1016/j.eururo.2020.06.016] [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: 05/17/2020] [Accepted: 06/09/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Joseph L Chin
- Department of Surgery (Urology), Western University, London, ON, Canada.
| | - Glenn S Bauman
- Department of Oncology, Western University, London, ON, Canada
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25
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Han W, Johnson C, Gaed M, Gómez JA, Moussa M, Chin JL, Pautler S, Bauman GS, Ward AD. Histologic tissue components provide major cues for machine learning-based prostate cancer detection and grading on prostatectomy specimens. Sci Rep 2020; 10:9911. [PMID: 32555410 PMCID: PMC7303108 DOI: 10.1038/s41598-020-66849-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 10/07/2019] [Accepted: 05/19/2020] [Indexed: 11/10/2022] Open
Abstract
Automatically detecting and grading cancerous regions on radical prostatectomy (RP) sections facilitates graphical and quantitative pathology reporting, potentially benefitting post-surgery prognosis, recurrence prediction, and treatment planning after RP. Promising results for detecting and grading prostate cancer on digital histopathology images have been reported using machine learning techniques. However, the importance and applicability of those methods have not been fully investigated. We computed three-class tissue component maps (TCMs) from the images, where each pixel was labeled as nuclei, lumina, or other. We applied seven different machine learning approaches: three non-deep learning classifiers with features extracted from TCMs, and four deep learning, using transfer learning with the 1) TCMs, 2) nuclei maps, 3) lumina maps, and 4) raw images for cancer detection and grading on whole-mount RP tissue sections. We performed leave-one-patient-out cross-validation against expert annotations using 286 whole-slide images from 68 patients. For both cancer detection and grading, transfer learning using TCMs performed best. Transfer learning using nuclei maps yielded slightly inferior overall performance, but the best performance for classifying higher-grade cancer. This suggests that 3-class TCMs provide the major cues for cancer detection and grading primarily using nucleus features, which are the most important information for identifying higher-grade cancer.
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Affiliation(s)
- Wenchao Han
- Baines Imaging Research Laboratory, London Regional Cancer Program, London, Ontario, Canada. .,Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada. .,Lawson Health Research Institute, London, Ontario, Canada.
| | - Carol Johnson
- Baines Imaging Research Laboratory, London Regional Cancer Program, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Mena Gaed
- Department of Pathology and Laboratory Medicine, University of Western Ontario, London, Ontario, Canada
| | - José A Gómez
- Department of Pathology and Laboratory Medicine, University of Western Ontario, London, Ontario, Canada
| | - Madeleine Moussa
- Department of Pathology and Laboratory Medicine, University of Western Ontario, London, Ontario, Canada
| | - Joseph L Chin
- Department of Surgery, University of Western Ontario, London, Ontario, Canada.,Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - Stephen Pautler
- Department of Surgery, University of Western Ontario, London, Ontario, Canada.,Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - Glenn S Bauman
- Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada.,Department of Oncology, University of Western Ontario, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Aaron D Ward
- Baines Imaging Research Laboratory, London Regional Cancer Program, London, Ontario, Canada. .,Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada. .,Department of Oncology, University of Western Ontario, London, Ontario, Canada. .,Lawson Health Research Institute, London, Ontario, Canada.
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26
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Palma DA, Olson R, Harrow S, Gaede S, Louie AV, Haasbeek C, Mulroy L, Lock M, Rodrigues GB, Yaremko BP, Schellenberg D, Ahmad B, Senthi S, Swaminath A, Kopek N, Liu M, Moore K, Currie S, Schlijper R, Bauman GS, Laba J, Qu XM, Warner A, Senan S. Stereotactic Ablative Radiotherapy for the Comprehensive Treatment of Oligometastatic Cancers: Long-Term Results of the SABR-COMET Phase II Randomized Trial. J Clin Oncol 2020; 38:2830-2838. [PMID: 32484754 PMCID: PMC7460150 DOI: 10.1200/jco.20.00818] [Citation(s) in RCA: 611] [Impact Index Per Article: 152.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The oligometastatic paradigm hypothesizes that patients with a limited number of metastases may achieve long-term disease control, or even cure, if all sites of disease can be ablated. However, long-term randomized data that test this paradigm are lacking. METHODS < .20 indicates a positive trial). Secondary end points included progression-free survival (PFS), toxicity, and quality of life (QOL). Herein, we present long-term outcomes from the trial. RESULTS = .001). There were no new grade 2-5 adverse events and no differences in QOL between arms. CONCLUSION With extended follow-up, the impact of SABR on OS was larger in magnitude than in the initial analysis and durable over time. There were no new safety signals, and SABR had no detrimental impact on QOL.
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Affiliation(s)
- David A Palma
- London Health Sciences Centre, London, Ontario, Canada
| | - Robert Olson
- BC Cancer, Centre for the North, Prince George, British Columbia, Canada
| | - Stephen Harrow
- Beatson West of Scotland Cancer Centre, Glasgow, Scotland
| | - Stewart Gaede
- London Health Sciences Centre, London, Ontario, Canada
| | | | - Cornelis Haasbeek
- Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Liam Mulroy
- Nova Scotia Cancer Centre, Halifax, Nova Scotia, Canada
| | - Michael Lock
- London Health Sciences Centre, London, Ontario, Canada
| | | | | | | | - Belal Ahmad
- London Health Sciences Centre, London, Ontario, Canada
| | - Sashendra Senthi
- Alfred Health Radiation Oncology, Melbourne, Victoria, Australia
| | | | - Neil Kopek
- McGill University Health Centre, Montreal, Quebec, Canada
| | - Mitchell Liu
- BC Cancer, Vancouver Centre, Vancouver, British Columbia, Canada
| | - Karen Moore
- Beatson West of Scotland Cancer Centre, Glasgow, Scotland
| | - Suzanne Currie
- Beatson West of Scotland Cancer Centre, Glasgow, Scotland
| | - Roel Schlijper
- BC Cancer, Centre for the North, Prince George, British Columbia, Canada
| | | | - Joanna Laba
- London Health Sciences Centre, London, Ontario, Canada
| | - X Melody Qu
- London Health Sciences Centre, London, Ontario, Canada
| | - Andrew Warner
- London Health Sciences Centre, London, Ontario, Canada
| | - Suresh Senan
- Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Corkum MT, Mendez LC, Chin J, D’Souza D, Boldt RG, Bauman GS. A Novel Salvage Option for Local Failure in Prostate Cancer, Reirradiation Using External Beam or Stereotactic Radiation Therapy: Systematic Review and Meta-Analysis. Adv Radiat Oncol 2020; 5:965-977. [PMID: 33083660 PMCID: PMC7557139 DOI: 10.1016/j.adro.2020.04.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 11/10/2019] [Revised: 03/11/2020] [Accepted: 04/25/2020] [Indexed: 02/07/2023] Open
Abstract
Purpose Reirradiation (re-RT) using external beam radiation therapy (EBRT) is a novel salvage strategy for local failure in prostate cancer. We performed a systematic review describing oncologic and toxicity outcomes for salvage EBRT/stereotactic radiation therapy (SBRT) re-RT. Methods and Materials A International Prospective Register of Systematic Reviews registered (#141466) systematic review, meta-analysis, and meta-regression was conducted using preferred reporting items for systematic reviews and meta-analyses guidelines. PubMed and EMBASE were searched from inception through September 2019. Outcome measures included local control (LC), biochemical relapse free survival (BRFS), and ≥grade 3 genitourinary (GU)/gastrointestinal (GI) toxicity. EBRT and SBRT data were collected separately. Meta-regression explored disease and toxicity outcomes as a function of equivalent dose in 2 Gy fractions (EQD2), length of follow-up, and partial versus whole prostate reirradiation. Results Nineteen studies representing 13 cohorts were included (428 patients). Weighted mean follow-up was 26.1 months. Median re-RT EQD2 was 77.1 Gy (α/β = 1.5), with 92% of patients receiving SBRT, 52.1% of patients receiving partial prostate re-RT, and 30.1% of patients receiving androgen deprivation therapy with re-RT. LC was 83.2% (95% confidence interval [CI], 75.5%-90.9%) and BRFS was 59.3% (47.9%-70.7%). Reported late toxicity ≥grade 3 was 3.4% (95% CI, 1.0%-5.8%) for GU and 2.0% (95% CI, 0.1%-4.0%) for GI. Meta-regression found higher LC, BRFS, and reported GU/GI toxicity with increasing EQD2, with partial prostate re-RT associated with less reported GU/GI toxicity and no detriment to LC and BRFS. Conclusions Salvage re-RT using EBRT, particularly with SBRT, is an emerging technique to treat isolated local failure of prostate cancer. With short-term follow-up, LC, BRFS, and reported toxicities appear reasonable, although further follow-up is required before definitive statements on late toxicities can be made. Our review is limited by incomplete reporting of androgen deprivation therapy use in the primary literature. Further prospective studies and longer follow-up are needed before considering re-RT as standard practice.
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Affiliation(s)
- Mark T. Corkum
- Department of Radiation Oncology, London Health Sciences Centre, London, Canada
| | - Lucas C. Mendez
- Department of Radiation Oncology, London Health Sciences Centre, London, Canada
| | - Joseph Chin
- Department of Urology, London Health Sciences Centre, London, Canada
| | - David D’Souza
- Department of Radiation Oncology, London Health Sciences Centre, London, Canada
| | - R. Gabriel Boldt
- Department of Radiation Oncology, London Health Sciences Centre, London, Canada
| | - Glenn S. Bauman
- Department of Radiation Oncology, London Health Sciences Centre, London, Canada
- Corresponding author: Glenn S. Bauman, MD
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28
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Goodman CD, Fakir H, Pautler S, Chin J, Bauman GS. Dosimetric Evaluation of PSMA PET-Delineated Dominant Intraprostatic Lesion Simultaneous Infield Boosts. Adv Radiat Oncol 2020; 5:212-220. [PMID: 32280821 PMCID: PMC7136625 DOI: 10.1016/j.adro.2019.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 04/11/2019] [Revised: 08/30/2019] [Accepted: 09/18/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Prostate cancer is multifocal. However, there often exists a single dominant focus in the gland responsible for driving the biology of the disease. Dose escalation to the dominant lesion is a proposed strategy to increase tumor control. We applied radiobiological modeling to evaluate the dosimetric feasibility and benefit of dominant intraprostatic lesion simultaneous in-field boosts (DIL-SIB) to the gross tumor volume (GTV), defined using a novel molecular positron emission tomography (PET) probe (18F-DCFPyL) directed against prostate specific membrane antigen (PSMA). METHODS AND MATERIALS Patients with clinically localized, biopsy-proven prostate cancer underwent preoperative [18F]-DCFPyL PET/computed tomography (CT). DIL-SIB plans were generated by importing the PET/CT into the RayStation treatment planning system. GTV-PET for the DIL-SIB was defined by the highest %SUVmax (percentage of maximum standardized uptake value) that generated a biologically plausible volume. Volumetric arc-based plans incorporating prostate plus DIL-SIB treatment were generated. Tumor control probability (TCP) and normal tissue complication probability (NTCP) with fractionation schemes and boost doses specified in the FLAME (Investigate the Benefit of a Focal Lesion Ablative Microboost in Prostate Cancer; NCT01168479), PROFIT (Prostate Fractionated Irradiation Trial; NCT00304759), PACE (Prostate Advances in Comparative Evidence; NCT01584258), and hypoFLAME (Hypofractionated Focal Lesion Ablative Microboost in prostatE Cancer 2.0; NCT02853110) protocols were compared. RESULTS Comparative DIL-SIB plans for 6 men were generated from preoperative [18F]-DCFPyL PET/CT. Median boost GTV volume was 1.015 cm3 (0.42-1.83 cm3). Median minimum (D99%) DIL-SIB dose for F35BS, F20BS, F5BS, and F5BSH were 97.3 Gy, 80.8 Gy, 46.5 Gy, and 51.5Gy. TCP within the GTV ranged from 84% to 88% for the standard plan and 95% to 96% for the DIL-SIB plans. Within the rest of the prostate, TCP ranged from 89% to 91% for the standard plans and 90% to 92% for the DIL-SIB plans. NTCP for the rectum NTCP was similar for the DIL-SIB plans (0.3%-2.7%) compared with standard plans (0.7%-2.6%). Overall, DIL-SIB plans yielded higher uncomplicated TCP (NTCP, 90%-94%) versus standard plans (NTCP, 83%-85%). CONCLUSIONS PSMA PET provides a novel approach to define GTV for SIB-DIL dose escalation. Work is ongoing to validate PSMA PET-delineated GTV through correlation to coregistered postprostatectomy digitized histopathology.
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Affiliation(s)
- Christopher D. Goodman
- Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Hatim Fakir
- Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Stephen Pautler
- Division of Urology, Department of Surgery and Division of Surgical Oncology, Department of Oncology, Western University, London, Ontario, Canada
| | - Joseph Chin
- Division of Urology, Department of Surgery and Division of Surgical Oncology, Department of Oncology, Western University, London, Ontario, Canada
| | - Glenn S. Bauman
- Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
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29
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Trabulsi EJ, Rumble RB, Jadvar H, Hope T, Pomper M, Turkbey B, Rosenkrantz AB, Verma S, Margolis DJ, Froemming A, Oto A, Purysko A, Milowsky MI, Schlemmer HP, Eiber M, Morris MJ, Choyke PL, Padhani A, Oldan J, Fanti S, Jain S, Pinto PA, Keegan KA, Porter CR, Coleman JA, Bauman GS, Jani AB, Kamradt JM, Sholes W, Vargas HA. Optimum Imaging Strategies for Advanced Prostate Cancer: ASCO Guideline. J Clin Oncol 2020; 38:1963-1996. [PMID: 31940221 DOI: 10.1200/jco.19.02757] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Provide evidence- and expert-based recommendations for optimal use of imaging in advanced prostate cancer. Due to increases in research and utilization of novel imaging for advanced prostate cancer, this guideline is intended to outline techniques available and provide recommendations on appropriate use of imaging for specified patient subgroups. METHODS An Expert Panel was convened with members from ASCO and the Society of Abdominal Radiology, American College of Radiology, Society of Nuclear Medicine and Molecular Imaging, American Urological Association, American Society for Radiation Oncology, and Society of Urologic Oncology to conduct a systematic review of the literature and develop an evidence-based guideline on the optimal use of imaging for advanced prostate cancer. Representative index cases of various prostate cancer disease states are presented, including suspected high-risk disease, newly diagnosed treatment-naïve metastatic disease, suspected recurrent disease after local treatment, and progressive disease while undergoing systemic treatment. A systematic review of the literature from 2013 to August 2018 identified fully published English-language systematic reviews with or without meta-analyses, reports of rigorously conducted phase III randomized controlled trials that compared ≥ 2 imaging modalities, and noncomparative studies that reported on the efficacy of a single imaging modality. RESULTS A total of 35 studies met inclusion criteria and form the evidence base, including 17 systematic reviews with or without meta-analysis and 18 primary research articles. RECOMMENDATIONS One or more of these imaging modalities should be used for patients with advanced prostate cancer: conventional imaging (defined as computed tomography [CT], bone scan, and/or prostate magnetic resonance imaging [MRI]) and/or next-generation imaging (NGI), positron emission tomography [PET], PET/CT, PET/MRI, or whole-body MRI) according to the clinical scenario.
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Affiliation(s)
- Edouard J Trabulsi
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | | | | | - Thomas Hope
- University of California, San Francisco, San Francisco, CA
| | | | | | | | - Sadhna Verma
- University of Cincinnati Medical Center, Cincinnati, OH
| | | | | | | | | | | | | | | | | | | | - Anwar Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - Jorge Oldan
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | - Suneil Jain
- Queen's University Belfast, Belfast, Northern Ireland
| | | | | | | | | | | | | | | | - Westley Sholes
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
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30
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Palma DA, Olson R, Harrow S, Correa RJM, Schneiders F, Haasbeek CJA, Rodrigues GB, Lock M, Yaremko BP, Bauman GS, Ahmad B, Schellenberg D, Liu M, Gaede S, Laba J, Mulroy L, Senthi S, Louie AV, Swaminath A, Chalmers A, Warner A, Slotman BJ, de Gruijl TD, Allan A, Senan S. Stereotactic ablative radiotherapy for the comprehensive treatment of 4-10 oligometastatic tumors (SABR-COMET-10): study protocol for a randomized phase III trial. BMC Cancer 2019; 19:816. [PMID: 31426760 PMCID: PMC6699121 DOI: 10.1186/s12885-019-5977-6] [Citation(s) in RCA: 148] [Impact Index Per Article: 29.6] [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: 02/02/2019] [Accepted: 07/24/2019] [Indexed: 12/19/2022] Open
Abstract
Background Stereotactic ablative radiotherapy (SABR) has emerged as a new treatment option for patients with oligometastatic disease. SABR delivers precise, high-dose, hypofractionated radiotherapy, and achieves excellent rates of local control for primary tumors or metastases. A recent randomized phase II trial evaluated SABR in a group of patients with a small burden of oligometastatic disease (mostly with 1–3 metastatic lesions), and found that SABR was associated with benefits in progression-free survival and overall survival. The goal of this phase III trial is to assess the impact of SABR in patients with 4–10 metastatic cancer lesions. Methods One hundred and fifty-nine patients will be randomized in a 1:2 ratio between the control arm (consisting of standard of care palliative-intent treatments), and the SABR arm (consisting of standard of care treatment + SABR to all sites of known disease). Randomization will be stratified by two factors: histology (Group 1: prostate, breast, or renal; Group 2: all others), and type of pre-specified systemic therapy (Group 1: immunotherapy/targeted; Group 2: cytotoxic; Group 3: observation). SABR is to be completed within 2 weeks, allowing for rapid initiation of systemic therapy. Recommended SABR doses are 20 Gy in 1 fraction, 30 Gy in 3 fractions, or 35 Gy in 5 fractions, chosen to minimize risks of toxicity. The primary endpoint is overall survival, and secondary endpoints include progression-free survival, time to development of new metastatic lesions, quality of life, and toxicity. Translational endpoints include assessment of circulating tumor cells, cell-free DNA, and tumor tissue as prognostic and predictive markers, including assessment of immunological predictors of response and long-term survival. Discussion This study will provide an assessment of the impact of SABR on clinical outcomes and quality of life, to determine if long-term survival can be achieved for selected patients with 4–10 oligometastatic lesions. Trial registration Clinicaltrials.gov identifier: NCT03721341. Date of registration: October 26, 2018. Electronic supplementary material The online version of this article (10.1186/s12885-019-5977-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David A Palma
- Department of Oncology Western University, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6A4L6, Canada.
| | - Robert Olson
- Department of Radiation Oncology, British Columbia Cancer, Centre for the North, Prince George, BC, Canada
| | | | - Rohann J M Correa
- Department of Oncology Western University, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6A4L6, Canada
| | - Famke Schneiders
- Department of Radiation Oncology, Amsterdam UMC Vrije Universiteit Amsterdam Radiation Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Cornelis J A Haasbeek
- Department of Radiation Oncology, Amsterdam UMC Vrije Universiteit Amsterdam Radiation Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - George B Rodrigues
- Department of Oncology Western University, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6A4L6, Canada
| | - Michael Lock
- Department of Oncology Western University, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6A4L6, Canada
| | - Brian P Yaremko
- Department of Oncology Western University, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6A4L6, Canada
| | - Glenn S Bauman
- Department of Oncology Western University, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6A4L6, Canada
| | - Belal Ahmad
- Department of Oncology Western University, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6A4L6, Canada
| | - Devin Schellenberg
- Department of Radiation Oncology, British Columbia Cancer, Centre for the North, Prince George, BC, Canada
| | - Mitchell Liu
- Department of Radiation Oncology, British Columbia Cancer, Centre for the North, Prince George, BC, Canada
| | - Stewart Gaede
- Department of Oncology Western University, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6A4L6, Canada
| | - Joanna Laba
- Department of Oncology Western University, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6A4L6, Canada
| | - Liam Mulroy
- Nova Scotia Cancer Centre, Halifax, NS, Canada
| | | | - Alexander V Louie
- Department of Radiation Oncology, Sunnybrook Cancer Centre, Toronto, Canada
| | | | - Anthony Chalmers
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Andrew Warner
- Department of Oncology Western University, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6A4L6, Canada
| | - Ben J Slotman
- Department of Radiation Oncology, Amsterdam UMC Vrije Universiteit Amsterdam Radiation Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Tanja D de Gruijl
- Department of Radiation Oncology, Amsterdam UMC Vrije Universiteit Amsterdam Radiation Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Alison Allan
- Department of Oncology Western University, London Health Sciences Centre, 790 Commissioners Rd. E, London, Ontario, N6A4L6, Canada
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam UMC Vrije Universiteit Amsterdam Radiation Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
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Palma DA, Olson R, Harrow S, Gaede S, Louie AV, Haasbeek C, Mulroy L, Lock M, Rodrigues GB, Yaremko BP, Schellenberg D, Ahmad B, Griffioen G, Senthi S, Swaminath A, Kopek N, Liu M, Moore K, Currie S, Bauman GS, Warner A, Senan S. Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): a randomised, phase 2, open-label trial. Lancet 2019; 393:2051-2058. [PMID: 30982687 DOI: 10.1016/s0140-6736(18)32487-5] [Citation(s) in RCA: 1132] [Impact Index Per Article: 226.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/21/2018] [Accepted: 10/02/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The oligometastatic paradigm suggests that some patients with a limited number of metastases might be cured if all lesions are eradicated. Evidence from randomised controlled trials to support this paradigm is scarce. We aimed to assess the effect of stereotactic ablative radiotherapy (SABR) on survival, oncological outcomes, toxicity, and quality of life in patients with a controlled primary tumour and one to five oligometastatic lesions. METHODS This randomised, open-label phase 2 study was done at 10 hospitals in Canada, the Netherlands, Scotland, and Australia. Patients aged 18 or older with a controlled primary tumour and one to five metastatic lesions, Eastern Cooperative Oncology Group score of 0-1, and a life expectancy of at least 6 months were eligible. After stratifying by the number of metastases (1-3 vs 4-5), we randomly assigned patients (1:2) to receive either palliative standard of care treatments alone (control group), or standard of care plus SABR to all metastatic lesions (SABR group), using a computer-generated randomisation list with permuted blocks of nine. Neither patients nor physicians were masked to treatment allocation. The primary endpoint was overall survival. We used a randomised phase 2 screening design with a two-sided α of 0·20 (wherein p<0·20 designates a positive trial). All analyses were intention to treat. This study is registered with ClinicalTrials.gov, number NCT01446744. FINDINGS 99 patients were randomised between Feb 10, 2012, and Aug 30, 2016. Of 99 patients, 33 (33%) were assigned to the control group and 66 (67%) to the SABR group. Two (3%) patients in the SABR group did not receive allocated treatment and withdrew from the trial; two (6%) patients in the control group also withdrew from the trial. Median follow-up was 25 months (IQR 19-54) in the control group versus 26 months (23-37) in the SABR group. Median overall survival was 28 months (95% CI 19-33) in the control group versus 41 months (26-not reached) in the SABR group (hazard ratio 0·57, 95% CI 0·30-1·10; p=0·090). Adverse events of grade 2 or worse occurred in three (9%) of 33 controls and 19 (29%) of 66 patients in the SABR group (p=0·026), an absolute increase of 20% (95% CI 5-34). Treatment-related deaths occurred in three (4·5%) of 66 patients after SABR, compared with none in the control group. INTERPRETATION SABR was associated with an improvement in overall survival, meeting the primary endpoint of this trial, but three (4·5%) of 66 patients in the SABR group had treatment-related death. Phase 3 trials are needed to conclusively show an overall survival benefit, and to determine the maximum number of metastatic lesions wherein SABR provides a benefit. FUNDING Ontario Institute for Cancer Research and London Regional Cancer Program Catalyst Grant.
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Affiliation(s)
| | - Robert Olson
- British Columbia Cancer, Centre for the North, Prince George, BC, Canada
| | | | | | | | | | - Liam Mulroy
- Nova Scotia Cancer Centre, Halifax, NS, Canada
| | - Michael Lock
- London Health Sciences Centre, London, ON, Canada
| | | | | | | | - Belal Ahmad
- London Health Sciences Centre, London, ON, Canada
| | | | | | | | - Neil Kopek
- McGill University Health Centre, Montreal, QC, Canada
| | - Mitchell Liu
- British Columbia Cancer, Vancouver Centre, Vancouver, BC, Canada
| | - Karen Moore
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | | | | | - Suresh Senan
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Nguyen EK, Nguyen TK, Boldt G, Louie AV, Bauman GS. Hypofractionated stereotactic radiotherapy for intracranial meningioma: a systematic review. Neurooncol Pract 2018; 6:346-353. [PMID: 31555449 DOI: 10.1093/nop/npy053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Background The availability of image guidance and intensity modulation has led to the increasing use of hypofractionated stereotactic radiotherapy (hSRT) as an alternative to conventionally fractionated radiotherapy or radiosurgery for intracranial meningiomas (ICMs). As the safety and efficacy of this approach is not well characterized, we conducted a systematic review of the literature to assess the clinical outcomes of hSRT in the setting of ICMs. Methods A systematic review of Medline and EMBASE databases was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies were retrospective or prospective series that examined an ICM population of ≥10 patients, delivered >1 fraction of photon hSRT (≥2.5 Gy per fraction), and had a median follow-up of ≥2 years. Descriptive statistics were generated for included studies. Results Of 1480 initial studies, 14 met eligibility criteria for inclusion, reporting on 630 patients (age range, 18-90) treated for 638 tumors. Primary radiotherapy was delivered in 37% of patients, 36% had radiation following surgery, and surgical details were unavailable for 27%. In 474 tumors assessed for radiologic response, 78% remained stable, 18% decreased in size, and 4% increased in size. Crude local control was 90%-100% as reported in 10 studies. The median late toxicity rate was 10%. The most common significant late toxicities were decreased visual acuity and new cranial neuropathy. Conclusions With limited follow-up, the available literature suggests hSRT for ICMs has local control and toxicity profiles comparable to other radiotherapy approaches. Confirmation in larger patient cohorts with a longer duration of follow-up is required.
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Affiliation(s)
- Eric K Nguyen
- Department of Oncology, Division of Radiation Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | - Timothy K Nguyen
- Department of Radiation Oncology, London Regional Cancer Program, Ontario, Canada
| | - Gabe Boldt
- Department of Radiation Oncology, London Regional Cancer Program, Ontario, Canada
| | - Alexander V Louie
- Department of Radiation Oncology, London Regional Cancer Program, Ontario, Canada
| | - Glenn S Bauman
- Department of Radiation Oncology, London Regional Cancer Program, Ontario, Canada
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Shahedi M, Cool DW, Bauman GS, Bastian-Jordan M, Fenster A, Ward AD. Accuracy Validation of an Automated Method for Prostate Segmentation in Magnetic Resonance Imaging. J Digit Imaging 2018; 30:782-795. [PMID: 28342043 DOI: 10.1007/s10278-017-9964-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Three dimensional (3D) manual segmentation of the prostate on magnetic resonance imaging (MRI) is a laborious and time-consuming task that is subject to inter-observer variability. In this study, we developed a fully automatic segmentation algorithm for T2-weighted endorectal prostate MRI and evaluated its accuracy within different regions of interest using a set of complementary error metrics. Our dataset contained 42 T2-weighted endorectal MRI from prostate cancer patients. The prostate was manually segmented by one observer on all of the images and by two other observers on a subset of 10 images. The algorithm first coarsely localizes the prostate in the image using a template matching technique. Then, it defines the prostate surface using learned shape and appearance information from a set of training images. To evaluate the algorithm, we assessed the error metric values in the context of measured inter-observer variability and compared performance to that of our previously published semi-automatic approach. The automatic algorithm needed an average execution time of ∼60 s to segment the prostate in 3D. When compared to a single-observer reference standard, the automatic algorithm has an average mean absolute distance of 2.8 mm, Dice similarity coefficient of 82%, recall of 82%, precision of 84%, and volume difference of 0.5 cm3 in the mid-gland. Concordant with other studies, accuracy was highest in the mid-gland and lower in the apex and base. Loss of accuracy with respect to the semi-automatic algorithm was less than the measured inter-observer variability in manual segmentation for the same task.
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Affiliation(s)
- Maysam Shahedi
- Baines Imaging Research Laboratory, London Regional Cancer Program, A3-123A, 790 Commissioners Rd E, London, ON, N6A 4L6, Canada. .,Robarts Research Institute, The University of Western Ontario, London, ON, Canada. .,Graduate Program in Biomedical Engineering, The University of Western Ontario, London, ON, Canada.
| | - Derek W Cool
- Robarts Research Institute, The University of Western Ontario, London, ON, Canada.,The Department of Medical Imaging, The University of Western Ontario, London, ON, Canada
| | - Glenn S Bauman
- Baines Imaging Research Laboratory, London Regional Cancer Program, A3-123A, 790 Commissioners Rd E, London, ON, N6A 4L6, Canada.,The Department of Medical Biophysics, The University of Western Ontario, London, ON, Canada.,The Department of Oncology, The University of Western Ontario, London, ON, Canada
| | - Matthew Bastian-Jordan
- The Department of Medical Imaging, The University of Western Ontario, London, ON, Canada
| | - Aaron Fenster
- Robarts Research Institute, The University of Western Ontario, London, ON, Canada.,Graduate Program in Biomedical Engineering, The University of Western Ontario, London, ON, Canada.,The Department of Medical Imaging, The University of Western Ontario, London, ON, Canada.,The Department of Medical Biophysics, The University of Western Ontario, London, ON, Canada
| | - Aaron D Ward
- Baines Imaging Research Laboratory, London Regional Cancer Program, A3-123A, 790 Commissioners Rd E, London, ON, N6A 4L6, Canada.,Graduate Program in Biomedical Engineering, The University of Western Ontario, London, ON, Canada.,The Department of Medical Biophysics, The University of Western Ontario, London, ON, Canada.,The Department of Oncology, The University of Western Ontario, London, ON, Canada
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Correa RJM, Ahmad B, Warner A, Johnson C, MacKenzie MJ, Pautler SE, Bauman GS, Rodrigues GB, Louie AV. A prospective phase I dose-escalation trial of stereotactic ablative radiotherapy (SABR) as an alternative to cytoreductive nephrectomy for inoperable patients with metastatic renal cell carcinoma. Radiat Oncol 2018; 13:47. [PMID: 29558966 PMCID: PMC5859400 DOI: 10.1186/s13014-018-0992-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 01/06/2018] [Accepted: 03/06/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Cytoreductive nephrectomy is thought to improve survival in metastatic renal cell carcinoma (mRCC). As many patients are ineligible for major surgery, we hypothesized that SABR could be a safe alternative. METHODS In this dose-escalation trial, inoperable mRCC patients underwent SABR targeting the entire affected kidney. Toxicity (CTCAE v3.0), quality of life (QoL), renal function, and tumour response (RECIST v1.0) were assessed. RESULTS Twelve patients of mostly intermediate (67%) or poor (25%) International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) prognostic class, median KPS of 70%, and median tumour size of 8.7 cm (range: 4.8-13.8) were enrolled in successive dose cohorts of 25 (n = 3), 30 (n = 6), and 35 Gy (n = 3) in 5 fractions. SABR was well tolerated with 3 grade 3 events: fatigue (2) and bone pain (1). QoL decreased for physical well-being (p = 0.016), but remained unchanged in other domains. SABR achieved a median tumour size reduction of - 17.3% (range: + 5.3 to - 54.4) at 5.3 months. All patients progressed systemically and median OS was 6.7 months. Crude median follow-up was 5.8 months. CONCLUSIONS In non-operable mRCC patients, renal-ablative SABR to 35 Gy in 5 fractions yielded acceptable toxicity, renal function preservation, and stable QoL. SABR merits further prospective investigation as an alternative to cytoreductive nephrectomy. TRIAL REGISTRATION ClinicalTrials.gov NCT02264548. Registered July 22 2014 - Retrospectively registered: https://clinicaltrials.gov/ct2/show/NCT02264548.
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Affiliation(s)
- Rohann J M Correa
- Department of Radiation Oncology, London Regional Cancer Program, London, Canada
| | - Belal Ahmad
- Department of Radiation Oncology, London Regional Cancer Program, London, Canada
| | - Andrew Warner
- Department of Radiation Oncology, London Regional Cancer Program, London, Canada
| | - Craig Johnson
- Department of Radiation Oncology, London Regional Cancer Program, London, Canada
| | - Mary J MacKenzie
- Department of Medical Oncology, London Regional Cancer Program, London, Canada
| | - Stephen E Pautler
- Division of Urology, Western University, London, Canada.,Division of Surgical Oncology, Western University, London, Canada
| | - Glenn S Bauman
- Department of Radiation Oncology, London Regional Cancer Program, London, Canada
| | - George B Rodrigues
- Department of Radiation Oncology, London Regional Cancer Program, London, Canada.,Department of Epidemiology and Biostatistics, Western University, London, Canada
| | - Alexander V Louie
- Department of Radiation Oncology, London Regional Cancer Program, London, Canada. .,Department of Epidemiology and Biostatistics, Western University, London, Canada.
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Corkum MT, Liu W, Palma DA, Bauman GS, Dinniwell RE, Warner A, Mishra MV, Louie AV. Online advertising and marketing claims by providers of proton beam therapy: are they guideline-based? Radiat Oncol 2018; 13:43. [PMID: 29544511 PMCID: PMC5856220 DOI: 10.1186/s13014-018-0988-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 03/01/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cancer patients frequently search the Internet for treatment options, and hospital websites are seen as reliable sources of knowledge. Guidelines support the use of proton radiotherapy in specific disease sites or on clinical trials. This study aims to evaluate direct-to-consumer advertising content and claims made by proton therapy centre (PTC) websites worldwide. METHODS Operational PTC websites in English were identified through the Particle Therapy Co-Operative Group website. Data abstraction of website content was performed independently by two investigators. Eight international guidelines were consulted to determine guideline-based indications for proton radiotherapy. Univariate and multivariate logistic regression models were used to determine the characteristics of PTC websites that indicated proton radiotherapy offered greater disease control or cure rates. RESULTS Forty-eight PTCs with 46 English websites were identified. 60·9% of PTC websites claimed proton therapy provided improved disease control or cure. U.S. websites listed more indications than international websites (15·5 ± 5·4 vs. 10·4 ± 5·8, p = 0·004). The most common disease sites advertised were prostate (87·0%), head and neck (87·0%) and pediatrics (82·6%), all of which were indicated in least one international guideline. Several disease sites advertised were not present in any consensus guidelines, including pancreatobiliary (52·2%), breast (50·0%), and esophageal (43·5%) cancers. Multivariate analysis found increasing number of disease sites and claiming their centre was a local or regional leader in proton radiotherapy was associated with indicating proton radiotherapy offers greater disease control or cure. CONCLUSIONS Information from PTC websites often differs from recommendations found in international consensus guidelines. As online marketing information may have significant influence on patient decision-making, alignment of such information with accepted guidelines and consensus opinion should be adopted by PTC providers.
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Affiliation(s)
- Mark T. Corkum
- Department of Radiation Oncology, London Health Sciences Centre, 790 Commissioners Road East, London, ON N6A 4L6 Canada
| | - Wei Liu
- Department of Radiation Oncology, London Health Sciences Centre, 790 Commissioners Road East, London, ON N6A 4L6 Canada
| | - David A. Palma
- Department of Radiation Oncology, London Health Sciences Centre, 790 Commissioners Road East, London, ON N6A 4L6 Canada
| | - Glenn S. Bauman
- Department of Radiation Oncology, London Health Sciences Centre, 790 Commissioners Road East, London, ON N6A 4L6 Canada
| | - Robert E. Dinniwell
- Department of Radiation Oncology, London Health Sciences Centre, 790 Commissioners Road East, London, ON N6A 4L6 Canada
| | - Andrew Warner
- Department of Radiation Oncology, London Health Sciences Centre, 790 Commissioners Road East, London, ON N6A 4L6 Canada
| | - Mark V. Mishra
- Departments of Radiation Oncology, University of Maryland School of Medicine, Baltimore, USA
| | - Alexander V. Louie
- Department of Radiation Oncology, London Health Sciences Centre, 790 Commissioners Road East, London, ON N6A 4L6 Canada
- Department of Epidemiology and Biostatistics, Western University, London, Canada
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Belliveau JG, Jensen MD, Stewart JMP, Solovey I, Klassen LM, Bauman GS, Menon RS. Prediction of radiation necrosis in a rodent model using magnetic resonance imaging apparent transverse relaxation ([Formula: see text]). Phys Med Biol 2018; 63:035010. [PMID: 29372691 DOI: 10.1088/1361-6560/aaa034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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
BACKGROUND AND PURPOSE Radiation necrosis remains an irreversible long-term side-effect following radiotherapy to the brain. The ability to predict areas that could ultimately develop into necrosis could lead to prevention and management of radiation necrosis. MATERIALS AND METHODS Fischer 344 rats were irradiated using two platforms (micro-CT irradiator and x-Rad 225 IGRT) with radiation up to 30 Gy for the micro-CT and 40 Gy for the xRAD-224 to half the brain. Animals were subsequently imaged using a 9.4 T MRI scanner every 2-4 weeks for up to 28 weeks using a 7-echo gradient echo sequence. The apparent transverse relaxation constant ([Formula: see text]) was calculated and retrospectively analyzed. RESULTS Animals irradiated with the low-dose rate micro-CT did not exhibit any symptoms or imaging changes associated with RN. Animals irradiated with the xRAD-225 exhibited imaging changes consistent with RN at week 24. Analysis of the [Formula: see text] coefficient within the lesion and hippocampus shows the potential for detection of RN up to 10 weeks prior to morphological changes. CONCLUSIONS The ability to predict areas of RN and increases of [Formula: see text] within the hippocampus provides a method for long-term monitoring and prediction of RN.
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Affiliation(s)
- Jean-Guy Belliveau
- Department of Medical Biophysics, University of Western Ontario, London, ON, Canada. Centre for Functional and Metabolic Mapping, University of Western Ontario, London, ON, Canada
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Belliveau JG, Bauman GS, Macdonald D, Macdonald M, Klassen LM, Menon RS. Apparent transverse relaxation (R2∗) on MRI as a method to differentiate treatment effect (pseudoprogression) versus progressive disease in chemoradiation for malignant glioma. J Med Imaging Radiat Oncol 2017; 62:224-231. [PMID: 29193849 DOI: 10.1111/1754-9485.12694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 05/16/2017] [Accepted: 10/23/2017] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Pseudoprogression (psPD) is a transient post-treatment imaging change that is commonly seen when treating glioma with chemotherapy and radiation. The use of apparent transverse relaxation rate (R2∗), which is calculated from a contrast-free multi-echo gradient echo Magnetic Resonance Imaging (MRI) sequence, may allow for quantitative identification of patients with suspected psPD. METHODS We acquired a multi-echo gradient echo sequence using a 3T-Siemens Prisma MRI. The signal decay through the echoes was fitted to provide the R2∗ coefficient. We segmented the T1 -gadolinium enhancing the image to provide a contrast enhancing lesion (CEL) and the FLAIR hyperintensity to provide a non-enhancing lesion (NEL). These regions of interest were applied to the multi-echo gradient echo to acquire a mean R2∗ within the CEL and NEL. We additionally acquired ADC data to attempt to corroborate our findings. RESULTS We found that patients who later exhibited PD exhibited a higher R2∗ within the CEL as well as a higher ratio of CEL to NEL. Our data correctly distinguished pseudoprogression from treatment effect in 9/9 patients, while ADC corrected identified 7/9 patients using an absolute ADC of 1200 × 10-6 mm2 /s. CONCLUSIONS Our method seems promising for the accurate identification of psPD, and the technique is amenable to evaluation in larger, multi-centre patient cohorts.
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Affiliation(s)
- Jean-Guy Belliveau
- Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada.,Center for Functional and Metabolic Mapping, Robarts Research Institute, University of Western Ontario, London, Ontario, Canada
| | - Glenn S Bauman
- Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada.,Department of Oncology, University of Western Ontario, London, Ontario, Canada.,London Regional Cancer Program, London, Ontario, Canada
| | - David Macdonald
- Department of Oncology, University of Western Ontario, London, Ontario, Canada.,London Regional Cancer Program, London, Ontario, Canada
| | - Maria Macdonald
- Department of Oncology, University of Western Ontario, London, Ontario, Canada.,London Regional Cancer Program, London, Ontario, Canada
| | - L Martyn Klassen
- Center for Functional and Metabolic Mapping, Robarts Research Institute, University of Western Ontario, London, Ontario, Canada
| | - Ravi S Menon
- Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada.,Center for Functional and Metabolic Mapping, Robarts Research Institute, University of Western Ontario, London, Ontario, Canada
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Belliveau JG, Bauman GS, Tay KY, Ho D, Menon RS. Initial Investigation into Microbleeds and White Matter Signal Changes following Radiotherapy for Low-Grade and Benign Brain Tumors Using Ultra-High-Field MRI Techniques. AJNR Am J Neuroradiol 2017; 38:2251-2256. [PMID: 28970242 DOI: 10.3174/ajnr.a5395] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 07/24/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE External beam radiation therapy is a common treatment for many brain neoplasms. While external beam radiation therapy adheres to dose limits to protect the uninvolved brain, areas of high dose to normal tissue still occur. Patients treated with chemoradiotherapy can have adverse effects such as microbleeds and radiation necrosis, but few studies exist of patients treated without chemotherapy. MATERIALS AND METHODS Ten patients were treated for low-grade or benign neoplasms with external beam radiation therapy only and scanned within 12-36 months following treatment with a 7T MR imaging scanner. A multiecho gradient-echo sequence was acquired and postprocessed into SWI, quantitative susceptibility mapping, and apparent transverse relaxation maps. Six patients returned for follow-up imaging approximately 18 months following their first research scan and were imaged with the same techniques. RESULTS At the first visit, 7/10 patients had microbleeds evident on SWI, quantitative susceptibility mapping, and apparent transverse relaxation. All microbleeds were within a dose region of >45 Gy. Additionally, 4/10 patients had asymptomatic WM signal changes evident on standard imaging. Further analysis with our technique revealed that these lesions were venocentric, suggestive of a neuroinflammatory process. CONCLUSIONS There exists a potential for microbleeds in patients treated with external beam radiation therapy without chemotherapy. This finding is of clinical relevance because it could be a precursor of future neurovascular disease and indicates that additional care should be taken when using therapies such as anticoagulants. Additionally, the appearance of venocentric WM lesions could be suggestive of a neuroinflammatory mechanism that has been suggested in diseases such as MS. Both findings merit further investigation in a larger population set.
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Affiliation(s)
- J-G Belliveau
- From the Departments of Medical Biophysics (J.-G.B., G.S.B., R.S.M.).,Centre for Functional and Metabolic Mapping (J.-G.B., R.S.M.), Robarts Research Institute, London, Ontario, Canada
| | - G S Bauman
- From the Departments of Medical Biophysics (J.-G.B., G.S.B., R.S.M.).,Oncology (G.S.B.).,London Regional Cancer Program (G.S.B.), London, Ontario, Canada
| | - K Y Tay
- Medical Imaging (K.Y.T.), University of Western Ontario, London, Ontario, Canada
| | - D Ho
- Department of Radiology (D.H.), Woodstock General Hospital, Woodstock, Ontario, Canada
| | - R S Menon
- From the Departments of Medical Biophysics (J.-G.B., G.S.B., R.S.M.) .,Centre for Functional and Metabolic Mapping (J.-G.B., R.S.M.), Robarts Research Institute, London, Ontario, Canada
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Catton CN, Lukka H, Gu CS, Martin JM, Supiot S, Chung PWM, Bauman GS, Bahary JP, Ahmed S, Cheung P, Tai KH, Wu JS, Parliament MB, Tsakiridis T, Corbett TB, Tang C, Dayes IS, Warde P, Craig TK, Julian JA, Levine MN. Randomized Trial of a Hypofractionated Radiation Regimen for the Treatment of Localized Prostate Cancer. J Clin Oncol 2017; 35:1884-1890. [PMID: 28296582 DOI: 10.1200/jco.2016.71.7397] [Citation(s) in RCA: 455] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Men with localized prostate cancer often are treated with external radiotherapy (RT) over 8 to 9 weeks. Hypofractionated RT is given over a shorter time with larger doses per treatment than standard RT. We hypothesized that hypofractionation versus conventional fractionation is similar in efficacy without increased toxicity. Patients and Methods We conducted a multicenter randomized noninferiority trial in intermediate-risk prostate cancer (T1 to 2a, Gleason score ≤ 6, and prostate-specific antigen [PSA] 10.1 to 20 ng/mL; T2b to 2c, Gleason ≤ 6, and PSA ≤ 20 ng/mL; or T1 to 2, Gleason = 7, and PSA ≤ 20 ng/mL). Patients were allocated to conventional RT of 78 Gy in 39 fractions over 8 weeks or to hypofractionated RT of 60 Gy in 20 fractions over 4 weeks. Androgen deprivation was not permitted with therapy. The primary outcome was biochemical-clinical failure (BCF) defined by any of the following: PSA failure (nadir + 2), hormonal intervention, clinical local or distant failure, or death as a result of prostate cancer. The noninferiority margin was 7.5% (hazard ratio, < 1.32). Results Median follow-up was 6.0 years. One hundred nine of 608 patients in the hypofractionated arm versus 117 of 598 in the standard arm experienced BCF. Most of the events were PSA failures. The 5-year BCF disease-free survival was 85% in both arms (hazard ratio [short v standard], 0.96; 90% CI, 0.77 to 1.2). Ten deaths as a result of prostate cancer occurred in the short arm and 12 in the standard arm. No significant differences were detected between arms for grade ≥ 3 late genitourinary and GI toxicity. Conclusion The hypofractionated RT regimen used in this trial was not inferior to conventional RT and was not associated with increased late toxicity. Hypofractionated RT is more convenient for patients and should be considered for intermediate-risk prostate cancer.
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Affiliation(s)
- Charles N Catton
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Himu Lukka
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Chu-Shu Gu
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Jarad M Martin
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Stéphane Supiot
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Peter W M Chung
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Glenn S Bauman
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Jean-Paul Bahary
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Shahida Ahmed
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Patrick Cheung
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Keen Hun Tai
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Jackson S Wu
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Matthew B Parliament
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Theodoros Tsakiridis
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Tom B Corbett
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Colin Tang
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Ian S Dayes
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Padraig Warde
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Tim K Craig
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Jim A Julian
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
| | - Mark N Levine
- Charles N. Catton, Peter W.M. Chung, Patrick Cheung, Padraig Warde, and Tim K. Craig, University of Toronto, Toronto; Himu Lukka, Chu-Shu Gu, Theodoros Tsakiridis, Tom B. Corbett, Ian S. Dayes, Jim A. Julian, and Mark N. Levine, McMaster University, Hamilton; Glenn S. Bauman, University of Western Ontario, London, Ontario; Jean-Paul Bahary, University of Montreal, Montreal, Quebec; Shahida Ahmed, University of Manitoba, Winnipeg, Manitoba; Jackson S. Wu, University of Calgary, Calgary; Matthew B. Parliament, University of Alberta, Edmonton, Alberta, Canada; Jarad M. Martin, University of Newcastle, Newcastle, New South Wales; Keen Hun Tai, University of Melbourne, Melbourne, Victoria; Colin Tang, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and Stéphane Supiot, University of Nantes, Nantes, France
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Qu XM, Mishra MV, Bauman GS, Slotman B, Mehta M, Gondi V, Louie AV. Cost-effectiveness of prophylactic cranial irradiation with hippocampal avoidance in limited stage small cell lung cancer. Radiother Oncol 2017; 122:411-415. [PMID: 28109544 DOI: 10.1016/j.radonc.2017.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 09/20/2016] [Revised: 11/28/2016] [Accepted: 01/03/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Prophylactic cranial irradiation (PCI) in limited stage small cell lung cancer (LS-SCLC) prevents brain metastases and improves survival, with the potential for neurocognitive toxicity. RTOG0933 demonstrated that hippocampal avoidance (HA) during whole brain radiotherapy preserves neurocognition. This study's objective was to evaluate the cost-effectiveness of HA-PCI in LS-SCLC through decision analysis. MATERIALS AND METHODS A Markov model was developed to simulate the clinical course of LS-SCLC who received HA-PCI or conventional PCI (C-PCI). A willingness-to-pay threshold of $100,000/QALY was used. Incremental cost effectiveness ratio was calculated (ICER). Sensitivity analyses were performed to determine the parameter thresholds and to assess the robustness of the model. RESULTS In the base case scenario, HA-PCI is more cost-effective than C-PCI, with an ICER of $47,107/QALY. HA-PCI was preferred over C-PCI provided that the risk of developing brain metastases was not increased by at least 14%, or if neurocognitive dysfunction rates were reduced by at least 40%. HA-PCI was the cost-effective strategy in 68% of tested iterations in probabilistic sensitivity analysis. CONCLUSION This study demonstrates that HA-PCI is more cost-effective than C-PCI in LS-SCLC. Our results support the use of HA-PCI in this patient population, should results from RTOG0933 be confirmed by the ongoing NRGCC003 trial.
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Affiliation(s)
| | | | | | - Ben Slotman
- VU University Medical Center, Amsterdam, Netherlands
| | | | - Vinai Gondi
- Northwestern Medicine Cancer Chicago Center Warrenville and Northwestern Medicine Chicago Proton Center, Northwestern University, IL, USA
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Shahedi M, Cool DW, Romagnoli C, Bauman GS, Bastian-Jordan M, Rodrigues G, Ahmad B, Lock M, Fenster A, Ward AD. Postediting prostate magnetic resonance imaging segmentation consistency and operator time using manual and computer-assisted segmentation: multiobserver study. J Med Imaging (Bellingham) 2016; 3:046002. [PMID: 27872873 DOI: 10.1117/1.jmi.3.4.046002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 07/12/2016] [Accepted: 09/19/2016] [Indexed: 11/14/2022] Open
Abstract
Prostate segmentation on T2w MRI is important for several diagnostic and therapeutic procedures for prostate cancer. Manual segmentation is time-consuming, labor-intensive, and subject to high interobserver variability. This study investigated the suitability of computer-assisted segmentation algorithms for clinical translation, based on measurements of interoperator variability and measurements of the editing time required to yield clinically acceptable segmentations. A multioperator pilot study was performed under three pre- and postediting conditions: manual, semiautomatic, and automatic segmentation. We recorded the required editing time for each segmentation and measured the editing magnitude based on five different spatial metrics. We recorded average editing times of 213, 328, and 393 s for manual, semiautomatic, and automatic segmentation respectively, while an average fully manual segmentation time of 564 s was recorded. The reduced measured postediting interoperator variability of semiautomatic and automatic segmentations compared to the manual approach indicates the potential of computer-assisted segmentation for generating a clinically acceptable segmentation faster with higher consistency. The lack of strong correlation between editing time and the values of typically used error metrics ([Formula: see text]) implies that the necessary postsegmentation editing time needs to be measured directly in order to evaluate an algorithm's suitability for clinical translation.
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Affiliation(s)
- Maysam Shahedi
- London Regional Cancer Program, 790 Commissioners Road, London, Ontario N6A 4L6, Canada; University of Western Ontario, Robarts Research Institute, 1151 Richmond Street, London, Ontario N6A 5B7, Canada; University of Western Ontario, Graduate Program in Biomedical Engineering, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Derek W Cool
- University of Western Ontario, Robarts Research Institute, 1151 Richmond Street, London, Ontario N6A 5B7, Canada; University of Western Ontario, Department of Medical Imaging, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Cesare Romagnoli
- University of Western Ontario , Department of Medical Imaging, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Glenn S Bauman
- London Regional Cancer Program, 790 Commissioners Road, London, Ontario N6A 4L6, Canada; University of Western Ontario, Department of Medical Biophysics, 1151 Richmond Street, London, Ontario N6A 3K7, Canada; University of Western Ontario, Department of Oncology, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Matthew Bastian-Jordan
- University of Western Ontario , Department of Medical Imaging, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - George Rodrigues
- London Regional Cancer Program, 790 Commissioners Road, London, Ontario N6A 4L6, Canada; University of Western Ontario, Department of Oncology, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Belal Ahmad
- London Regional Cancer Program, 790 Commissioners Road, London, Ontario N6A 4L6, Canada; University of Western Ontario, Department of Oncology, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Michael Lock
- London Regional Cancer Program, 790 Commissioners Road, London, Ontario N6A 4L6, Canada; University of Western Ontario, Department of Oncology, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Aaron Fenster
- University of Western Ontario, Robarts Research Institute, 1151 Richmond Street, London, Ontario N6A 5B7, Canada; University of Western Ontario, Graduate Program in Biomedical Engineering, 1151 Richmond Street, London, Ontario N6A 3K7, Canada; University of Western Ontario, Department of Medical Imaging, 1151 Richmond Street, London, Ontario N6A 3K7, Canada; University of Western Ontario, Department of Medical Biophysics, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Aaron D Ward
- London Regional Cancer Program, 790 Commissioners Road, London, Ontario N6A 4L6, Canada; University of Western Ontario, Graduate Program in Biomedical Engineering, 1151 Richmond Street, London, Ontario N6A 3K7, Canada; University of Western Ontario, Department of Medical Biophysics, 1151 Richmond Street, London, Ontario N6A 3K7, Canada; University of Western Ontario, Department of Oncology, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
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Nguyen TK, Bauman GS, Watling CJ, Hahn K. Patient- and family-centered care: a qualitative exploration of oncologist perspectives. Support Care Cancer 2016; 25:213-219. [PMID: 27614869 DOI: 10.1007/s00520-016-3414-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 09/05/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE Increasingly, patient- and family-centered care (PFCC) is recognized as a valuable component of healthcare reform with rich opportunities for improvement within oncology. Shifting toward PFCC requires physician buy-in; however, research examining their perspectives on PFCC is lacking. We sought to explore oncologists' perspectives on PFCC to identify factors that influence their ability to practice PFCC. METHODS We conducted semi-structured interviews with 18 oncologists (8 radiation, 4 medical, 4 surgical, 2 hematologist-oncologists) at a single Canadian academic cancer institution. Interview data were analyzed using thematic analysis and principles drawn from grounded theory. Subsequently, focus groups consisting of the interviewed participants were facilitated to confirm and elaborate on our findings. Constant comparisons were used to identify recurring themes. RESULTS Three dominant themes emerged. First, physicians displayed cautious engagement in their approach to PFCC. Collectively, participants understood the general principles of PFCC. However, there was a limited understanding of the value, implications, and motivation for improving PFCC which may create reluctance with physician buy-in. Second, both individual and system barriers to practicing PFCC were identified. A lack of physician acknowledgement and engagement and competing responsibilities emerged as provider-level challenges. System barriers included impaired clinic workflow, physical infrastructure constraints, and delays in access to care. Third, physicians were able to identify existing and potential PFCC behaviors that were feasible within existing system constraints. CONCLUSIONS Advancing PFCC will require continued physician education regarding the value of PFCC, acknowledgement and preservation of effective patient- and family-centered strategies, and creative solutions to address the system constraints to delivering PFCC.
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Affiliation(s)
- Timothy K Nguyen
- Division of Radiation Oncology, Department of Oncology, Western University and London Health Sciences Centre, London, ON, Canada
| | - Glenn S Bauman
- Division of Radiation Oncology, Department of Oncology, Western University and London Health Sciences Centre, London, ON, Canada.
| | - Christopher J Watling
- Department of Clinical Neurological Sciences and Oncology, Western University, London, ON, Canada
| | - Karin Hahn
- Division of Medical Oncology, Department of Oncology, Western University and London Health Sciences Centre, London, ON, Canada
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Gibson E, Bauman GS, Romagnoli C, Cool DW, Bastian-Jordan M, Kassam Z, Gaed M, Moussa M, Gómez JA, Pautler SE, Chin JL, Crukley C, Haider MA, Fenster A, Ward AD. Toward Prostate Cancer Contouring Guidelines on Magnetic Resonance Imaging: Dominant Lesion Gross and Clinical Target Volume Coverage Via Accurate Histology Fusion. Int J Radiat Oncol Biol Phys 2016; 96:188-96. [PMID: 27375167 DOI: 10.1016/j.ijrobp.2016.04.018] [Citation(s) in RCA: 24] [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: 12/11/2015] [Revised: 03/16/2016] [Accepted: 04/13/2016] [Indexed: 12/30/2022]
Abstract
PURPOSE Defining prostate cancer (PCa) lesion clinical target volumes (CTVs) for multiparametric magnetic resonance imaging (mpMRI) could support focal boosting or treatment to improve outcomes or lower morbidity, necessitating appropriate CTV margins for mpMRI-defined gross tumor volumes (GTVs). This study aimed to identify CTV margins yielding 95% coverage of PCa tumors for prospective cases with high likelihood. METHODS AND MATERIALS Twenty-five men with biopsy-confirmed clinical stage T1 or T2 PCa underwent pre-prostatectomy mpMRI, yielding T2-weighted, dynamic contrast-enhanced, and apparent diffusion coefficient images. Digitized whole-mount histology was contoured and registered to mpMRI scans (error ≤2 mm). Four observers contoured lesion GTVs on each mpMRI scan. CTVs were defined by isotropic and anisotropic expansion from these GTVs and from multiparametric (unioned) GTVs from 2 to 3 scans. Histologic coverage (proportions of tumor area on co-registered histology inside the CTV, measured for Gleason scores [GSs] ≥6 and ≥7) and prostate sparing (proportions of prostate volume outside the CTV) were measured. Nonparametric histologic-coverage prediction intervals defined minimal margins yielding 95% coverage for prospective cases with 78% to 92% likelihood. RESULTS On analysis of 72 true-positive tumor detections, 95% coverage margins were 9 to 11 mm (GS ≥ 6) and 8 to 10 mm (GS ≥ 7) for single-sequence GTVs and were 8 mm (GS ≥ 6) and 6 mm (GS ≥ 7) for 3-sequence GTVs, yielding CTVs that spared 47% to 81% of prostate tissue for the majority of tumors. Inclusion of T2-weighted contours increased sparing for multiparametric CTVs with 95% coverage margins for GS ≥6, and inclusion of dynamic contrast-enhanced contours increased sparing for GS ≥7. Anisotropic 95% coverage margins increased the sparing proportions to 71% to 86%. CONCLUSIONS Multiparametric magnetic resonance imaging-defined GTVs expanded by appropriate margins may support focal boosting or treatment of PCa; however, these margins, accounting for interobserver and intertumoral variability, may preclude highly conformal CTVs. Multiparametric GTVs and anisotropic margins may reduce the required margins and improve prostate sparing.
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Affiliation(s)
- Eli Gibson
- Robarts Research Institute, University of Western Ontario, London, Ontario, Canada; Biomedical Engineering, University of Western Ontario, London, Ontario, Canada; Centre for Medical Image Computing, University College London, London, UK; Department of Radiology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Glenn S Bauman
- Lawson Health Research Institute, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada.
| | - Cesare Romagnoli
- Department of Medical Imaging, University of Western Ontario, London, Ontario, Canada
| | - Derek W Cool
- Department of Medical Imaging, University of Western Ontario, London, Ontario, Canada
| | - Matthew Bastian-Jordan
- Department of Medical Imaging, University of Western Ontario, London, Ontario, Canada; Queensland Health, Brisbane, Queensland, Australia
| | - Zahra Kassam
- Department of Medical Imaging, University of Western Ontario, London, Ontario, Canada
| | - Mena Gaed
- Robarts Research Institute, University of Western Ontario, London, Ontario, Canada; Department of Pathology, University of Western Ontario, London, Ontario, Canada
| | - Madeleine Moussa
- Department of Pathology, University of Western Ontario, London, Ontario, Canada
| | - José A Gómez
- Department of Pathology, University of Western Ontario, London, Ontario, Canada
| | - Stephen E Pautler
- Lawson Health Research Institute, London, Ontario, Canada; Department of Urology, University of Western Ontario, London, Ontario, Canada
| | - Joseph L Chin
- Lawson Health Research Institute, London, Ontario, Canada; Department of Urology, University of Western Ontario, London, Ontario, Canada
| | - Cathie Crukley
- Robarts Research Institute, University of Western Ontario, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada
| | - Masoom A Haider
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Aaron Fenster
- Robarts Research Institute, University of Western Ontario, London, Ontario, Canada; Biomedical Engineering, University of Western Ontario, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada; Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada
| | - Aaron D Ward
- Biomedical Engineering, University of Western Ontario, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada; Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada; Baines Imaging Research Laboratory, London Regional Cancer Centre, London, Ontario, Canada
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Caine C, Deshmukh S, Gondi V, Mehta M, Tomé W, Corn BW, Kanner A, Rowley H, Kundapur V, DeNittis A, Greenspoon JN, Konski AA, Bauman GS, Raben A, Shi W, Wendland M, Kachnic L. CogState computerized memory tests in patients with brain metastases: secondary endpoint results of NRG Oncology RTOG 0933. J Neurooncol 2015; 126:327-36. [PMID: 26511494 DOI: 10.1007/s11060-015-1971-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [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: 05/01/2015] [Accepted: 10/25/2015] [Indexed: 11/29/2022]
Abstract
Whole brain radiotherapy (WBRT) is associated with memory dysfunction. As part of NRG Oncology RTOG 0933, a phase II study of WBRT for brain metastases that conformally avoided the hippocampal stem cell compartment (HA-WBRT), memory was assessed pre- and post-HA-WBRT using both traditional and computerized memory tests. We examined whether the computerized tests yielded similar findings and might serve as possible alternatives for assessment of memory in multi-institution clinical trials. Adult patients with brain metastases received HA-WBRT to 30 Gy in ten fractions and completed Hopkins Verbal Learning Test-Revised (HVLT-R), CogState International Shopping List Test (ISLT) and One Card Learning Test (OCLT), at baseline, 2 and 4 months. Tests' completion rates were 52-53 % at 2 months and 34-42 % at 4 months. All baseline correlations between HVLT-R and CogState tests were significant (p ≤ 0.003). At baseline, both CogState tests and one component of HVLT-R differentiated those who were alive at 6 months and those who had died (p ≤ 0.01). At 4 months, mean relative decline was 7.0 % for HVLT-R Delayed Recall and 18.0 % for ISLT Delayed Recall. OCLT showed an 8.0 % increase. A reliable change index found no significant changes from baseline to 2 and 4 months for ISLT Delayed Recall (z = -0.40, p = 0.34; z = -0.68, p = 0.25) or OCLT (z = 0.15, p = 0.56; z = 0.41, p = 0.66). Study findings support the possibility that hippocampal avoidance may be associated with preservation of memory test performance, and that these computerized tests also may be useful and valid memory assessments in multi-institution adult brain tumor trials.
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Affiliation(s)
- Chip Caine
- Neurosciences Institute, Intermountain Medical Center, 5171 Cottonwood Street, 8th Floor, Murray, UT, 84107, USA.
- University of Phoenix, Utah Campus, 5373 S 360 W, Salt Lake City, UT, 84123, USA.
| | - Snehal Deshmukh
- NRG Oncology Statistics and Data Management Center, 1818 Market Street, Suite 1600, Philadelphia, PA, 19103, USA
| | - Vinai Gondi
- Northwestern Medicine Cancer Center, Warrenville and Northwestern Chicago Proton Center, 4455 Weaver Parkway, Warrenville, IL, 60555, USA
- Department of Human Oncology, UW-Madison School of Medicine and Public Health, 600 Highland Avenue, K4/334-3684, Madison, WI, 53792, USA
| | - Minesh Mehta
- Department of Radiation Oncology, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, 21201, USA
| | - Wolfgang Tomé
- Montefiore Medical Center and Albert Einstein College of Medicine of Yeshiva University, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Benjamin W Corn
- Institute of Radiotherapy, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel
| | - Andrew Kanner
- Institute of Radiotherapy, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel
| | - Howard Rowley
- Department of Radiation Oncology, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, 21201, USA
| | | | - Albert DeNittis
- Main Line CCOP, Lankenau Medical Center, 100 Lancaster Ave: 4 MSB, Suite 4430, Wynnewood, PA, 19096, USA
| | - Jeffrey Noah Greenspoon
- Juravinski Cancer Centre, McMaster University-Hamilton, 699 Concession St., Hamilton, ON, L8V 5C2, Canada
| | - Andre A Konski
- The Chester County Hospital, 440 East Marshall Street, Suite 201, West Chester, PA, 19380, USA
| | - Glenn S Bauman
- Department of Oncology, London Regional Cancer Program, 790 Commissioners Road East, London, ON, N6A 4L6, Canada
| | - Adam Raben
- Christiana Care Health Services, CCOP, Helen F. Graham Cancer Center & Research Institute, 4701 Ogletown-Stanton Rd., S-1110, Newark, DE, 19713, USA
| | - Wenyin Shi
- Bodine Center, Thomas Jefferson University Hospital, 111 South 11th Street, Philadelphia, PA, 19107, USA
| | - Merideth Wendland
- Willamette Valley Cancer Institute, 520 Country Club Road, Eugene, OR, 97401, USA
| | - Lisa Kachnic
- Department of Radiation Oncology, Boston Medical Center MBCCOP, 830 Harrison Avenue, Boston, MA, 02118, USA
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Shahedi M, Cool DW, Romagnoli C, Bauman GS, Bastian-Jordan M, Gibson E, Rodrigues G, Ahmad B, Lock M, Fenster A, Ward AD. Spatially varying accuracy and reproducibility of prostate segmentation in magnetic resonance images using manual and semiautomated methods. Med Phys 2015; 41:113503. [PMID: 25370674 DOI: 10.1118/1.4899182] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Three-dimensional (3D) prostate image segmentation is useful for cancer diagnosis and therapy guidance, but can be time-consuming to perform manually and involves varying levels of difficulty and interoperator variability within the prostatic base, midgland (MG), and apex. In this study, the authors measured accuracy and interobserver variability in the segmentation of the prostate on T2-weighted endorectal magnetic resonance (MR) imaging within the whole gland (WG), and separately within the apex, midgland, and base regions. METHODS The authors collected MR images from 42 prostate cancer patients. Prostate border delineation was performed manually by one observer on all images and by two other observers on a subset of ten images. The authors used complementary boundary-, region-, and volume-based metrics [mean absolute distance (MAD), Dice similarity coefficient (DSC), recall rate, precision rate, and volume difference (ΔV)] to elucidate the different types of segmentation errors that they observed. Evaluation for expert manual and semiautomatic segmentation approaches was carried out. Compared to manual segmentation, the authors' semiautomatic approach reduces the necessary user interaction by only requiring an indication of the anteroposterior orientation of the prostate and the selection of prostate center points on the apex, base, and midgland slices. Based on these inputs, the algorithm identifies candidate prostate boundary points using learned boundary appearance characteristics and performs regularization based on learned prostate shape information. RESULTS The semiautomated algorithm required an average of 30 s of user interaction time (measured for nine operators) for each 3D prostate segmentation. The authors compared the segmentations from this method to manual segmentations in a single-operator (mean whole gland MAD = 2.0 mm, DSC = 82%, recall = 77%, precision = 88%, and ΔV = - 4.6 cm(3)) and multioperator study (mean whole gland MAD = 2.2 mm, DSC = 77%, recall = 72%, precision = 86%, and ΔV = - 4.0 cm(3)). These results compared favorably with observed differences between manual segmentations and a simultaneous truth and performance level estimation reference for this data set (whole gland differences as high as MAD = 3.1 mm, DSC = 78%, recall = 66%, precision = 77%, and ΔV = 15.5 cm(3)). The authors found that overall, midgland segmentation was more accurate and repeatable than the segmentation of the apex and base, with the base posing the greatest challenge. CONCLUSIONS The main conclusions of this study were that (1) the semiautomated approach reduced interobserver segmentation variability; (2) the segmentation accuracy of the semiautomated approach, as well as the accuracies of recently published methods from other groups, were within the range of observed expert variability in manual prostate segmentation; and (3) further efforts in the development of computer-assisted segmentation would be most productive if focused on improvement of segmentation accuracy and reduction of variability within the prostatic apex and base.
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Affiliation(s)
- Maysam Shahedi
- London Regional Cancer Program, London, Ontario N6A 5W9, Canada; Robarts Research Institute, The University of Western Ontario, London, Ontario N6A 3K7, Canada; and Graduate Program in Biomedical Engineering, The University of Western Ontario, London, Ontario N6A 3K7, Canada
| | - Derek W Cool
- Robarts Research Institute, The University of Western Ontario, London, Ontario N6A 3K7, Canadaand The Department of Medical Imaging, The University of Western Ontario, London, Ontario N6A 3K7, Canada
| | - Cesare Romagnoli
- The Department of Medical Imaging, The University of Western Ontario, London, Ontario N6A 3K7, Canada
| | - Glenn S Bauman
- London Regional Cancer Program, London, Ontario N6A 5W9, Canada; The Department of Medical Biophysics, The University of Western Ontario, London, Ontario N6A 3K7, Canada; and The Department of Oncology, The University of Western Ontario, London, Ontario N6A 3K7, Canada
| | - Matthew Bastian-Jordan
- The Department of Medical Imaging, The University of Western Ontario, London, Ontario N6A 3K7, Canada
| | - Eli Gibson
- Robarts Research Institute, The University of Western Ontario, London, Ontario N6A 3K7, Canada and Graduate Program in Biomedical Engineering, The University of Western Ontario, London, Ontario N6A 3K7, Canada
| | - George Rodrigues
- London Regional Cancer Program, London, Ontario N6A 5W9, Canada and The Department of Oncology, The University of Western Ontario, London, Ontario N6A 3K7, Canada
| | - Belal Ahmad
- London Regional Cancer Program, London, Ontario N6A 5W9, Canada and The Department of Oncology, The University of Western Ontario, London, Ontario N6A 3K7, Canada
| | - Michael Lock
- London Regional Cancer Program, London, Ontario N6A 5W9, Canada and The Department of Oncology, The University of Western Ontario, London, Ontario N6A 3K7, Canada
| | - Aaron Fenster
- Robarts Research Institute, The University of Western Ontario, London, Ontario N6A 3K7, Canada; Graduate Program in Biomedical Engineering, The University of Western Ontario, London, Ontario N6A 3K7, Canada; The Department of Medical Biophysics, The University of Western Ontario, London, Ontario N6A 3K7, Canada; and The Department of Medical Imaging, The University of Western Ontario, London, Ontario N6A 3K7, Canada
| | - Aaron D Ward
- London Regional Cancer Program, London, Ontario N6A 5W9, Canada; Graduate Program in Biomedical Engineering, The University of Western Ontario, London, Ontario N6A 3K7, Canada; The Department of Medical Biophysics, The University of Western Ontario, London, Ontario N6A 3K7, Canada; and The Department of Oncology, The University of Western Ontario, London, Ontario N6A 3K7, Canada
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Pisansky TM, Hunt D, Gomella LG, Amin MB, Balogh AG, Chinn DM, Seider MJ, Duclos M, Rosenthal SA, Bauman GS, Gore EM, Rotman MZ, Lukka HR, Shipley WU, Dignam JJ, Sandler HM. Duration of androgen suppression before radiotherapy for localized prostate cancer: radiation therapy oncology group randomized clinical trial 9910. J Clin Oncol 2014; 33:332-9. [PMID: 25534388 DOI: 10.1200/jco.2014.58.0662] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine whether prolonged androgen suppression (AS) duration before radiotherapy improves survival and disease control in prostate cancer. PATIENTS AND METHODS One thousand five hundred seventy-nine men with intermediate-risk prostate cancer were randomly assigned to 8 weeks of AS followed by radiotherapy with an additional 8 weeks of concurrent AS (16 weeks total) or to 28 weeks of AS followed by radiotherapy with an additional 8 weeks of AS (36 weeks total). The trial sought primarily to detect a 33% reduction in the hazard of prostate cancer death in the 28-week assignment. Time-to-event end points are reported for up to 10 years of follow-up. RESULTS There were no between-group differences in baseline characteristics of 1,489 eligible patients with follow-up. For the 8- and 28-week assignments, 10-year disease-specific survival rates were 95% (95% CI, 93.3% to 97.0%) and 96% (95% CI, 94.6% to 98.0%; hazard ratio [HR], 0.81; P = .45), respectively, and 10-year overall survival rates were 66% (95% CI, 62.0% to 69.9%) and 67% (95% CI, 63.0% to 70.8%; HR, 0.95; P = .62), respectively. For the 8- and 28-week assignments, 10-year cumulative incidences of locoregional progression were 6% (95% CI, 4.3% to 8.0%) and 4% (95% CI, 2.5% to 5.7%; HR, 0.65; P = .07), respectively; 10-year distant metastasis cumulative incidences were 6% (95% CI, 4.0% to 7.7%) and 6% (95% CI, 4.0% to 7.6%; HR, 1.07; P = .80), respectively; and 10-year prostate-specific antigen-based recurrence cumulative incidences were 27% (95% CI, 23.1% to 29.8%) and 27% (95% CI, 23.4% to 30.3%; HR, 0.97; P = .77), respectively. CONCLUSION Extending AS duration from 8 weeks to 28 weeks before radiotherapy did not improve outcomes. A lower than expected prostate cancer death rate reduced ability to detect a between-group difference in disease-specific survival. The schedule of 8 weeks of AS before radiotherapy plus 8 weeks of AS during radiotherapy remains a standard of care in intermediate-risk prostate cancer.
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Affiliation(s)
- Thomas M Pisansky
- Thomas M. Pisansky, Mayo Clinic, Rochester, MN; Daniel Hunt and James J. Dignam, Radiation Therapy Oncology Group Statistical Center; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Mahul B. Amin and Howard M. Sandler, Cedars-Sinai Medical Center, Los Angeles; Daniel M. Chinn, John Muir Medical Center-Concord Campus, Concord; Seth A. Rosenthal, Sutter Medical Group, Sacramento, CA; Michael J. Seider, Akron City Hospital, Akron, OH; Elizabeth M. Gore, Zablocki Veterans Administration Medical Center-Wood, Milwaukee, WI; Marvin Z. Rotman, Brooklyn Minority-Based Community Clinical Oncology Program, State University of New York Downstate, Brooklyn, NY; William U. Shipley, Massachusetts General Hospital, Boston, MA; James J. Dignam, University of Chicago, Chicago, IL; Alexander G. Balogh, Tom Baker Cancer Centre, Calgary, Alberta; Marie Duclos, McGill University, Montreal, Quebec; Glenn S. Bauman, London Regional Cancer Program, London; and Himanshu R. Lukka, McMaster University, Hamilton, Ontario, Canada.
| | - Daniel Hunt
- Thomas M. Pisansky, Mayo Clinic, Rochester, MN; Daniel Hunt and James J. Dignam, Radiation Therapy Oncology Group Statistical Center; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Mahul B. Amin and Howard M. Sandler, Cedars-Sinai Medical Center, Los Angeles; Daniel M. Chinn, John Muir Medical Center-Concord Campus, Concord; Seth A. Rosenthal, Sutter Medical Group, Sacramento, CA; Michael J. Seider, Akron City Hospital, Akron, OH; Elizabeth M. Gore, Zablocki Veterans Administration Medical Center-Wood, Milwaukee, WI; Marvin Z. Rotman, Brooklyn Minority-Based Community Clinical Oncology Program, State University of New York Downstate, Brooklyn, NY; William U. Shipley, Massachusetts General Hospital, Boston, MA; James J. Dignam, University of Chicago, Chicago, IL; Alexander G. Balogh, Tom Baker Cancer Centre, Calgary, Alberta; Marie Duclos, McGill University, Montreal, Quebec; Glenn S. Bauman, London Regional Cancer Program, London; and Himanshu R. Lukka, McMaster University, Hamilton, Ontario, Canada
| | - Leonard G Gomella
- Thomas M. Pisansky, Mayo Clinic, Rochester, MN; Daniel Hunt and James J. Dignam, Radiation Therapy Oncology Group Statistical Center; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Mahul B. Amin and Howard M. Sandler, Cedars-Sinai Medical Center, Los Angeles; Daniel M. Chinn, John Muir Medical Center-Concord Campus, Concord; Seth A. Rosenthal, Sutter Medical Group, Sacramento, CA; Michael J. Seider, Akron City Hospital, Akron, OH; Elizabeth M. Gore, Zablocki Veterans Administration Medical Center-Wood, Milwaukee, WI; Marvin Z. Rotman, Brooklyn Minority-Based Community Clinical Oncology Program, State University of New York Downstate, Brooklyn, NY; William U. Shipley, Massachusetts General Hospital, Boston, MA; James J. Dignam, University of Chicago, Chicago, IL; Alexander G. Balogh, Tom Baker Cancer Centre, Calgary, Alberta; Marie Duclos, McGill University, Montreal, Quebec; Glenn S. Bauman, London Regional Cancer Program, London; and Himanshu R. Lukka, McMaster University, Hamilton, Ontario, Canada
| | - Mahul B Amin
- Thomas M. Pisansky, Mayo Clinic, Rochester, MN; Daniel Hunt and James J. Dignam, Radiation Therapy Oncology Group Statistical Center; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Mahul B. Amin and Howard M. Sandler, Cedars-Sinai Medical Center, Los Angeles; Daniel M. Chinn, John Muir Medical Center-Concord Campus, Concord; Seth A. Rosenthal, Sutter Medical Group, Sacramento, CA; Michael J. Seider, Akron City Hospital, Akron, OH; Elizabeth M. Gore, Zablocki Veterans Administration Medical Center-Wood, Milwaukee, WI; Marvin Z. Rotman, Brooklyn Minority-Based Community Clinical Oncology Program, State University of New York Downstate, Brooklyn, NY; William U. Shipley, Massachusetts General Hospital, Boston, MA; James J. Dignam, University of Chicago, Chicago, IL; Alexander G. Balogh, Tom Baker Cancer Centre, Calgary, Alberta; Marie Duclos, McGill University, Montreal, Quebec; Glenn S. Bauman, London Regional Cancer Program, London; and Himanshu R. Lukka, McMaster University, Hamilton, Ontario, Canada
| | - Alexander G Balogh
- Thomas M. Pisansky, Mayo Clinic, Rochester, MN; Daniel Hunt and James J. Dignam, Radiation Therapy Oncology Group Statistical Center; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Mahul B. Amin and Howard M. Sandler, Cedars-Sinai Medical Center, Los Angeles; Daniel M. Chinn, John Muir Medical Center-Concord Campus, Concord; Seth A. Rosenthal, Sutter Medical Group, Sacramento, CA; Michael J. Seider, Akron City Hospital, Akron, OH; Elizabeth M. Gore, Zablocki Veterans Administration Medical Center-Wood, Milwaukee, WI; Marvin Z. Rotman, Brooklyn Minority-Based Community Clinical Oncology Program, State University of New York Downstate, Brooklyn, NY; William U. Shipley, Massachusetts General Hospital, Boston, MA; James J. Dignam, University of Chicago, Chicago, IL; Alexander G. Balogh, Tom Baker Cancer Centre, Calgary, Alberta; Marie Duclos, McGill University, Montreal, Quebec; Glenn S. Bauman, London Regional Cancer Program, London; and Himanshu R. Lukka, McMaster University, Hamilton, Ontario, Canada
| | - Daniel M Chinn
- Thomas M. Pisansky, Mayo Clinic, Rochester, MN; Daniel Hunt and James J. Dignam, Radiation Therapy Oncology Group Statistical Center; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Mahul B. Amin and Howard M. Sandler, Cedars-Sinai Medical Center, Los Angeles; Daniel M. Chinn, John Muir Medical Center-Concord Campus, Concord; Seth A. Rosenthal, Sutter Medical Group, Sacramento, CA; Michael J. Seider, Akron City Hospital, Akron, OH; Elizabeth M. Gore, Zablocki Veterans Administration Medical Center-Wood, Milwaukee, WI; Marvin Z. Rotman, Brooklyn Minority-Based Community Clinical Oncology Program, State University of New York Downstate, Brooklyn, NY; William U. Shipley, Massachusetts General Hospital, Boston, MA; James J. Dignam, University of Chicago, Chicago, IL; Alexander G. Balogh, Tom Baker Cancer Centre, Calgary, Alberta; Marie Duclos, McGill University, Montreal, Quebec; Glenn S. Bauman, London Regional Cancer Program, London; and Himanshu R. Lukka, McMaster University, Hamilton, Ontario, Canada
| | - Michael J Seider
- Thomas M. Pisansky, Mayo Clinic, Rochester, MN; Daniel Hunt and James J. Dignam, Radiation Therapy Oncology Group Statistical Center; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Mahul B. Amin and Howard M. Sandler, Cedars-Sinai Medical Center, Los Angeles; Daniel M. Chinn, John Muir Medical Center-Concord Campus, Concord; Seth A. Rosenthal, Sutter Medical Group, Sacramento, CA; Michael J. Seider, Akron City Hospital, Akron, OH; Elizabeth M. Gore, Zablocki Veterans Administration Medical Center-Wood, Milwaukee, WI; Marvin Z. Rotman, Brooklyn Minority-Based Community Clinical Oncology Program, State University of New York Downstate, Brooklyn, NY; William U. Shipley, Massachusetts General Hospital, Boston, MA; James J. Dignam, University of Chicago, Chicago, IL; Alexander G. Balogh, Tom Baker Cancer Centre, Calgary, Alberta; Marie Duclos, McGill University, Montreal, Quebec; Glenn S. Bauman, London Regional Cancer Program, London; and Himanshu R. Lukka, McMaster University, Hamilton, Ontario, Canada
| | - Marie Duclos
- Thomas M. Pisansky, Mayo Clinic, Rochester, MN; Daniel Hunt and James J. Dignam, Radiation Therapy Oncology Group Statistical Center; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Mahul B. Amin and Howard M. Sandler, Cedars-Sinai Medical Center, Los Angeles; Daniel M. Chinn, John Muir Medical Center-Concord Campus, Concord; Seth A. Rosenthal, Sutter Medical Group, Sacramento, CA; Michael J. Seider, Akron City Hospital, Akron, OH; Elizabeth M. Gore, Zablocki Veterans Administration Medical Center-Wood, Milwaukee, WI; Marvin Z. Rotman, Brooklyn Minority-Based Community Clinical Oncology Program, State University of New York Downstate, Brooklyn, NY; William U. Shipley, Massachusetts General Hospital, Boston, MA; James J. Dignam, University of Chicago, Chicago, IL; Alexander G. Balogh, Tom Baker Cancer Centre, Calgary, Alberta; Marie Duclos, McGill University, Montreal, Quebec; Glenn S. Bauman, London Regional Cancer Program, London; and Himanshu R. Lukka, McMaster University, Hamilton, Ontario, Canada
| | - Seth A Rosenthal
- Thomas M. Pisansky, Mayo Clinic, Rochester, MN; Daniel Hunt and James J. Dignam, Radiation Therapy Oncology Group Statistical Center; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Mahul B. Amin and Howard M. Sandler, Cedars-Sinai Medical Center, Los Angeles; Daniel M. Chinn, John Muir Medical Center-Concord Campus, Concord; Seth A. Rosenthal, Sutter Medical Group, Sacramento, CA; Michael J. Seider, Akron City Hospital, Akron, OH; Elizabeth M. Gore, Zablocki Veterans Administration Medical Center-Wood, Milwaukee, WI; Marvin Z. Rotman, Brooklyn Minority-Based Community Clinical Oncology Program, State University of New York Downstate, Brooklyn, NY; William U. Shipley, Massachusetts General Hospital, Boston, MA; James J. Dignam, University of Chicago, Chicago, IL; Alexander G. Balogh, Tom Baker Cancer Centre, Calgary, Alberta; Marie Duclos, McGill University, Montreal, Quebec; Glenn S. Bauman, London Regional Cancer Program, London; and Himanshu R. Lukka, McMaster University, Hamilton, Ontario, Canada
| | - Glenn S Bauman
- Thomas M. Pisansky, Mayo Clinic, Rochester, MN; Daniel Hunt and James J. Dignam, Radiation Therapy Oncology Group Statistical Center; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Mahul B. Amin and Howard M. Sandler, Cedars-Sinai Medical Center, Los Angeles; Daniel M. Chinn, John Muir Medical Center-Concord Campus, Concord; Seth A. Rosenthal, Sutter Medical Group, Sacramento, CA; Michael J. Seider, Akron City Hospital, Akron, OH; Elizabeth M. Gore, Zablocki Veterans Administration Medical Center-Wood, Milwaukee, WI; Marvin Z. Rotman, Brooklyn Minority-Based Community Clinical Oncology Program, State University of New York Downstate, Brooklyn, NY; William U. Shipley, Massachusetts General Hospital, Boston, MA; James J. Dignam, University of Chicago, Chicago, IL; Alexander G. Balogh, Tom Baker Cancer Centre, Calgary, Alberta; Marie Duclos, McGill University, Montreal, Quebec; Glenn S. Bauman, London Regional Cancer Program, London; and Himanshu R. Lukka, McMaster University, Hamilton, Ontario, Canada
| | - Elizabeth M Gore
- Thomas M. Pisansky, Mayo Clinic, Rochester, MN; Daniel Hunt and James J. Dignam, Radiation Therapy Oncology Group Statistical Center; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Mahul B. Amin and Howard M. Sandler, Cedars-Sinai Medical Center, Los Angeles; Daniel M. Chinn, John Muir Medical Center-Concord Campus, Concord; Seth A. Rosenthal, Sutter Medical Group, Sacramento, CA; Michael J. Seider, Akron City Hospital, Akron, OH; Elizabeth M. Gore, Zablocki Veterans Administration Medical Center-Wood, Milwaukee, WI; Marvin Z. Rotman, Brooklyn Minority-Based Community Clinical Oncology Program, State University of New York Downstate, Brooklyn, NY; William U. Shipley, Massachusetts General Hospital, Boston, MA; James J. Dignam, University of Chicago, Chicago, IL; Alexander G. Balogh, Tom Baker Cancer Centre, Calgary, Alberta; Marie Duclos, McGill University, Montreal, Quebec; Glenn S. Bauman, London Regional Cancer Program, London; and Himanshu R. Lukka, McMaster University, Hamilton, Ontario, Canada
| | - Marvin Z Rotman
- Thomas M. Pisansky, Mayo Clinic, Rochester, MN; Daniel Hunt and James J. Dignam, Radiation Therapy Oncology Group Statistical Center; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Mahul B. Amin and Howard M. Sandler, Cedars-Sinai Medical Center, Los Angeles; Daniel M. Chinn, John Muir Medical Center-Concord Campus, Concord; Seth A. Rosenthal, Sutter Medical Group, Sacramento, CA; Michael J. Seider, Akron City Hospital, Akron, OH; Elizabeth M. Gore, Zablocki Veterans Administration Medical Center-Wood, Milwaukee, WI; Marvin Z. Rotman, Brooklyn Minority-Based Community Clinical Oncology Program, State University of New York Downstate, Brooklyn, NY; William U. Shipley, Massachusetts General Hospital, Boston, MA; James J. Dignam, University of Chicago, Chicago, IL; Alexander G. Balogh, Tom Baker Cancer Centre, Calgary, Alberta; Marie Duclos, McGill University, Montreal, Quebec; Glenn S. Bauman, London Regional Cancer Program, London; and Himanshu R. Lukka, McMaster University, Hamilton, Ontario, Canada
| | - Himanshu R Lukka
- Thomas M. Pisansky, Mayo Clinic, Rochester, MN; Daniel Hunt and James J. Dignam, Radiation Therapy Oncology Group Statistical Center; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Mahul B. Amin and Howard M. Sandler, Cedars-Sinai Medical Center, Los Angeles; Daniel M. Chinn, John Muir Medical Center-Concord Campus, Concord; Seth A. Rosenthal, Sutter Medical Group, Sacramento, CA; Michael J. Seider, Akron City Hospital, Akron, OH; Elizabeth M. Gore, Zablocki Veterans Administration Medical Center-Wood, Milwaukee, WI; Marvin Z. Rotman, Brooklyn Minority-Based Community Clinical Oncology Program, State University of New York Downstate, Brooklyn, NY; William U. Shipley, Massachusetts General Hospital, Boston, MA; James J. Dignam, University of Chicago, Chicago, IL; Alexander G. Balogh, Tom Baker Cancer Centre, Calgary, Alberta; Marie Duclos, McGill University, Montreal, Quebec; Glenn S. Bauman, London Regional Cancer Program, London; and Himanshu R. Lukka, McMaster University, Hamilton, Ontario, Canada
| | - William U Shipley
- Thomas M. Pisansky, Mayo Clinic, Rochester, MN; Daniel Hunt and James J. Dignam, Radiation Therapy Oncology Group Statistical Center; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Mahul B. Amin and Howard M. Sandler, Cedars-Sinai Medical Center, Los Angeles; Daniel M. Chinn, John Muir Medical Center-Concord Campus, Concord; Seth A. Rosenthal, Sutter Medical Group, Sacramento, CA; Michael J. Seider, Akron City Hospital, Akron, OH; Elizabeth M. Gore, Zablocki Veterans Administration Medical Center-Wood, Milwaukee, WI; Marvin Z. Rotman, Brooklyn Minority-Based Community Clinical Oncology Program, State University of New York Downstate, Brooklyn, NY; William U. Shipley, Massachusetts General Hospital, Boston, MA; James J. Dignam, University of Chicago, Chicago, IL; Alexander G. Balogh, Tom Baker Cancer Centre, Calgary, Alberta; Marie Duclos, McGill University, Montreal, Quebec; Glenn S. Bauman, London Regional Cancer Program, London; and Himanshu R. Lukka, McMaster University, Hamilton, Ontario, Canada
| | - James J Dignam
- Thomas M. Pisansky, Mayo Clinic, Rochester, MN; Daniel Hunt and James J. Dignam, Radiation Therapy Oncology Group Statistical Center; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Mahul B. Amin and Howard M. Sandler, Cedars-Sinai Medical Center, Los Angeles; Daniel M. Chinn, John Muir Medical Center-Concord Campus, Concord; Seth A. Rosenthal, Sutter Medical Group, Sacramento, CA; Michael J. Seider, Akron City Hospital, Akron, OH; Elizabeth M. Gore, Zablocki Veterans Administration Medical Center-Wood, Milwaukee, WI; Marvin Z. Rotman, Brooklyn Minority-Based Community Clinical Oncology Program, State University of New York Downstate, Brooklyn, NY; William U. Shipley, Massachusetts General Hospital, Boston, MA; James J. Dignam, University of Chicago, Chicago, IL; Alexander G. Balogh, Tom Baker Cancer Centre, Calgary, Alberta; Marie Duclos, McGill University, Montreal, Quebec; Glenn S. Bauman, London Regional Cancer Program, London; and Himanshu R. Lukka, McMaster University, Hamilton, Ontario, Canada
| | - Howard M Sandler
- Thomas M. Pisansky, Mayo Clinic, Rochester, MN; Daniel Hunt and James J. Dignam, Radiation Therapy Oncology Group Statistical Center; Leonard G. Gomella, Thomas Jefferson University, Philadelphia, PA; Mahul B. Amin and Howard M. Sandler, Cedars-Sinai Medical Center, Los Angeles; Daniel M. Chinn, John Muir Medical Center-Concord Campus, Concord; Seth A. Rosenthal, Sutter Medical Group, Sacramento, CA; Michael J. Seider, Akron City Hospital, Akron, OH; Elizabeth M. Gore, Zablocki Veterans Administration Medical Center-Wood, Milwaukee, WI; Marvin Z. Rotman, Brooklyn Minority-Based Community Clinical Oncology Program, State University of New York Downstate, Brooklyn, NY; William U. Shipley, Massachusetts General Hospital, Boston, MA; James J. Dignam, University of Chicago, Chicago, IL; Alexander G. Balogh, Tom Baker Cancer Centre, Calgary, Alberta; Marie Duclos, McGill University, Montreal, Quebec; Glenn S. Bauman, London Regional Cancer Program, London; and Himanshu R. Lukka, McMaster University, Hamilton, Ontario, Canada
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Gondi V, Pugh SL, Tome WA, Caine C, Corn B, Kanner A, Rowley H, Kundapur V, DeNittis A, Greenspoon JN, Konski AA, Bauman GS, Shah S, Shi W, Wendland M, Kachnic L, Mehta MP. Preservation of memory with conformal avoidance of the hippocampal neural stem-cell compartment during whole-brain radiotherapy for brain metastases (RTOG 0933): a phase II multi-institutional trial. J Clin Oncol 2014; 32:3810-6. [PMID: 25349290 DOI: 10.1200/jco.2014.57.2909] [Citation(s) in RCA: 714] [Impact Index Per Article: 71.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Hippocampal neural stem-cell injury during whole-brain radiotherapy (WBRT) may play a role in memory decline. Intensity-modulated radiotherapy can be used to avoid conformally the hippocampal neural stem-cell compartment during WBRT (HA-WBRT). RTOG 0933 was a single-arm phase II study of HA-WBRT for brain metastases with prespecified comparison with a historical control of patients treated with WBRT without hippocampal avoidance. PATIENTS AND METHODS Eligible adult patients with brain metastases received HA-WBRT to 30 Gy in 10 fractions. Standardized cognitive function and quality-of-life (QOL) assessments were performed at baseline and 2, 4, and 6 months. The primary end point was the Hopkins Verbal Learning Test-Revised Delayed Recall (HVLT-R DR) at 4 months. The historical control demonstrated a 30% mean relative decline in HVLT-R DR from baseline to 4 months. To detect a mean relative decline ≤ 15% in HVLT-R DR after HA-WBRT, 51 analyzable patients were required to ensure 80% statistical power with α = 0.05. RESULTS Of 113 patients accrued from March 2011 through November 2012, 42 patients were analyzable at 4 months. Mean relative decline in HVLT-R DR from baseline to 4 months was 7.0% (95% CI, -4.7% to 18.7%), significantly lower in comparison with the historical control (P < .001). No decline in QOL scores was observed. Two grade 3 toxicities and no grade 4 to 5 toxicities were reported. Median survival was 6.8 months. CONCLUSION Conformal avoidance of the hippocampus during WBRT is associated with preservation of memory and QOL as compared with historical series.
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Affiliation(s)
- Vinai Gondi
- Vinai Gondi, Cadence Brain Tumor Center and CDH Proton Center, Warrenville, IL; Vinai Gondi and Howard Rowley, University of Wisconsin School of Medicine and Public Health, Madison, WI; Stephanie L. Pugh, Radiation Therapy Oncology Group Statistical Center; Wenyin Shi, Thomas Jefferson University Hospital, Philadelphia; Albert DeNittis, Lankenau Medical Center, Main Line Community Clinical Oncology Program (CCOP), Wynnewood; Andre A. Konski, Chester County Hospital, West Chester; Wolfgang A. Tome, Montefiore Medical Center and Albert Einstein College of Medicine, Yeshiva University, Bronx, NY; Chip Caine, Intermountain Medical Center and University of Phoenix, Salt Lake City, UT; Ben Corn and Andrew Kanner, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Vijayananda Kundapur, Saskatoon Cancer Centre, Saskatoon, Saskatchewan; Jeffrey N. Greenspoon, McMaster University-Hamilton, Hamilton; Glenn S. Bauman, London Regional Cancer Program, London, Ontario, Canada; Sunjay Shah, Christiana Care Health Services CCOP, Newark, DE; Merideth Wendland, US Oncology-Willamette Valley Cancer Institute, Eugene, OR; Lisa Kachnic, Boston Medical Center Minority-Based CCOP, Boston, MA; and Minesh P. Mehta, University of Maryland School of Medicine, Baltimore, MD.
| | - Stephanie L Pugh
- Vinai Gondi, Cadence Brain Tumor Center and CDH Proton Center, Warrenville, IL; Vinai Gondi and Howard Rowley, University of Wisconsin School of Medicine and Public Health, Madison, WI; Stephanie L. Pugh, Radiation Therapy Oncology Group Statistical Center; Wenyin Shi, Thomas Jefferson University Hospital, Philadelphia; Albert DeNittis, Lankenau Medical Center, Main Line Community Clinical Oncology Program (CCOP), Wynnewood; Andre A. Konski, Chester County Hospital, West Chester; Wolfgang A. Tome, Montefiore Medical Center and Albert Einstein College of Medicine, Yeshiva University, Bronx, NY; Chip Caine, Intermountain Medical Center and University of Phoenix, Salt Lake City, UT; Ben Corn and Andrew Kanner, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Vijayananda Kundapur, Saskatoon Cancer Centre, Saskatoon, Saskatchewan; Jeffrey N. Greenspoon, McMaster University-Hamilton, Hamilton; Glenn S. Bauman, London Regional Cancer Program, London, Ontario, Canada; Sunjay Shah, Christiana Care Health Services CCOP, Newark, DE; Merideth Wendland, US Oncology-Willamette Valley Cancer Institute, Eugene, OR; Lisa Kachnic, Boston Medical Center Minority-Based CCOP, Boston, MA; and Minesh P. Mehta, University of Maryland School of Medicine, Baltimore, MD
| | - Wolfgang A Tome
- Vinai Gondi, Cadence Brain Tumor Center and CDH Proton Center, Warrenville, IL; Vinai Gondi and Howard Rowley, University of Wisconsin School of Medicine and Public Health, Madison, WI; Stephanie L. Pugh, Radiation Therapy Oncology Group Statistical Center; Wenyin Shi, Thomas Jefferson University Hospital, Philadelphia; Albert DeNittis, Lankenau Medical Center, Main Line Community Clinical Oncology Program (CCOP), Wynnewood; Andre A. Konski, Chester County Hospital, West Chester; Wolfgang A. Tome, Montefiore Medical Center and Albert Einstein College of Medicine, Yeshiva University, Bronx, NY; Chip Caine, Intermountain Medical Center and University of Phoenix, Salt Lake City, UT; Ben Corn and Andrew Kanner, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Vijayananda Kundapur, Saskatoon Cancer Centre, Saskatoon, Saskatchewan; Jeffrey N. Greenspoon, McMaster University-Hamilton, Hamilton; Glenn S. Bauman, London Regional Cancer Program, London, Ontario, Canada; Sunjay Shah, Christiana Care Health Services CCOP, Newark, DE; Merideth Wendland, US Oncology-Willamette Valley Cancer Institute, Eugene, OR; Lisa Kachnic, Boston Medical Center Minority-Based CCOP, Boston, MA; and Minesh P. Mehta, University of Maryland School of Medicine, Baltimore, MD
| | - Chip Caine
- Vinai Gondi, Cadence Brain Tumor Center and CDH Proton Center, Warrenville, IL; Vinai Gondi and Howard Rowley, University of Wisconsin School of Medicine and Public Health, Madison, WI; Stephanie L. Pugh, Radiation Therapy Oncology Group Statistical Center; Wenyin Shi, Thomas Jefferson University Hospital, Philadelphia; Albert DeNittis, Lankenau Medical Center, Main Line Community Clinical Oncology Program (CCOP), Wynnewood; Andre A. Konski, Chester County Hospital, West Chester; Wolfgang A. Tome, Montefiore Medical Center and Albert Einstein College of Medicine, Yeshiva University, Bronx, NY; Chip Caine, Intermountain Medical Center and University of Phoenix, Salt Lake City, UT; Ben Corn and Andrew Kanner, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Vijayananda Kundapur, Saskatoon Cancer Centre, Saskatoon, Saskatchewan; Jeffrey N. Greenspoon, McMaster University-Hamilton, Hamilton; Glenn S. Bauman, London Regional Cancer Program, London, Ontario, Canada; Sunjay Shah, Christiana Care Health Services CCOP, Newark, DE; Merideth Wendland, US Oncology-Willamette Valley Cancer Institute, Eugene, OR; Lisa Kachnic, Boston Medical Center Minority-Based CCOP, Boston, MA; and Minesh P. Mehta, University of Maryland School of Medicine, Baltimore, MD
| | - Ben Corn
- Vinai Gondi, Cadence Brain Tumor Center and CDH Proton Center, Warrenville, IL; Vinai Gondi and Howard Rowley, University of Wisconsin School of Medicine and Public Health, Madison, WI; Stephanie L. Pugh, Radiation Therapy Oncology Group Statistical Center; Wenyin Shi, Thomas Jefferson University Hospital, Philadelphia; Albert DeNittis, Lankenau Medical Center, Main Line Community Clinical Oncology Program (CCOP), Wynnewood; Andre A. Konski, Chester County Hospital, West Chester; Wolfgang A. Tome, Montefiore Medical Center and Albert Einstein College of Medicine, Yeshiva University, Bronx, NY; Chip Caine, Intermountain Medical Center and University of Phoenix, Salt Lake City, UT; Ben Corn and Andrew Kanner, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Vijayananda Kundapur, Saskatoon Cancer Centre, Saskatoon, Saskatchewan; Jeffrey N. Greenspoon, McMaster University-Hamilton, Hamilton; Glenn S. Bauman, London Regional Cancer Program, London, Ontario, Canada; Sunjay Shah, Christiana Care Health Services CCOP, Newark, DE; Merideth Wendland, US Oncology-Willamette Valley Cancer Institute, Eugene, OR; Lisa Kachnic, Boston Medical Center Minority-Based CCOP, Boston, MA; and Minesh P. Mehta, University of Maryland School of Medicine, Baltimore, MD
| | - Andrew Kanner
- Vinai Gondi, Cadence Brain Tumor Center and CDH Proton Center, Warrenville, IL; Vinai Gondi and Howard Rowley, University of Wisconsin School of Medicine and Public Health, Madison, WI; Stephanie L. Pugh, Radiation Therapy Oncology Group Statistical Center; Wenyin Shi, Thomas Jefferson University Hospital, Philadelphia; Albert DeNittis, Lankenau Medical Center, Main Line Community Clinical Oncology Program (CCOP), Wynnewood; Andre A. Konski, Chester County Hospital, West Chester; Wolfgang A. Tome, Montefiore Medical Center and Albert Einstein College of Medicine, Yeshiva University, Bronx, NY; Chip Caine, Intermountain Medical Center and University of Phoenix, Salt Lake City, UT; Ben Corn and Andrew Kanner, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Vijayananda Kundapur, Saskatoon Cancer Centre, Saskatoon, Saskatchewan; Jeffrey N. Greenspoon, McMaster University-Hamilton, Hamilton; Glenn S. Bauman, London Regional Cancer Program, London, Ontario, Canada; Sunjay Shah, Christiana Care Health Services CCOP, Newark, DE; Merideth Wendland, US Oncology-Willamette Valley Cancer Institute, Eugene, OR; Lisa Kachnic, Boston Medical Center Minority-Based CCOP, Boston, MA; and Minesh P. Mehta, University of Maryland School of Medicine, Baltimore, MD
| | - Howard Rowley
- Vinai Gondi, Cadence Brain Tumor Center and CDH Proton Center, Warrenville, IL; Vinai Gondi and Howard Rowley, University of Wisconsin School of Medicine and Public Health, Madison, WI; Stephanie L. Pugh, Radiation Therapy Oncology Group Statistical Center; Wenyin Shi, Thomas Jefferson University Hospital, Philadelphia; Albert DeNittis, Lankenau Medical Center, Main Line Community Clinical Oncology Program (CCOP), Wynnewood; Andre A. Konski, Chester County Hospital, West Chester; Wolfgang A. Tome, Montefiore Medical Center and Albert Einstein College of Medicine, Yeshiva University, Bronx, NY; Chip Caine, Intermountain Medical Center and University of Phoenix, Salt Lake City, UT; Ben Corn and Andrew Kanner, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Vijayananda Kundapur, Saskatoon Cancer Centre, Saskatoon, Saskatchewan; Jeffrey N. Greenspoon, McMaster University-Hamilton, Hamilton; Glenn S. Bauman, London Regional Cancer Program, London, Ontario, Canada; Sunjay Shah, Christiana Care Health Services CCOP, Newark, DE; Merideth Wendland, US Oncology-Willamette Valley Cancer Institute, Eugene, OR; Lisa Kachnic, Boston Medical Center Minority-Based CCOP, Boston, MA; and Minesh P. Mehta, University of Maryland School of Medicine, Baltimore, MD
| | - Vijayananda Kundapur
- Vinai Gondi, Cadence Brain Tumor Center and CDH Proton Center, Warrenville, IL; Vinai Gondi and Howard Rowley, University of Wisconsin School of Medicine and Public Health, Madison, WI; Stephanie L. Pugh, Radiation Therapy Oncology Group Statistical Center; Wenyin Shi, Thomas Jefferson University Hospital, Philadelphia; Albert DeNittis, Lankenau Medical Center, Main Line Community Clinical Oncology Program (CCOP), Wynnewood; Andre A. Konski, Chester County Hospital, West Chester; Wolfgang A. Tome, Montefiore Medical Center and Albert Einstein College of Medicine, Yeshiva University, Bronx, NY; Chip Caine, Intermountain Medical Center and University of Phoenix, Salt Lake City, UT; Ben Corn and Andrew Kanner, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Vijayananda Kundapur, Saskatoon Cancer Centre, Saskatoon, Saskatchewan; Jeffrey N. Greenspoon, McMaster University-Hamilton, Hamilton; Glenn S. Bauman, London Regional Cancer Program, London, Ontario, Canada; Sunjay Shah, Christiana Care Health Services CCOP, Newark, DE; Merideth Wendland, US Oncology-Willamette Valley Cancer Institute, Eugene, OR; Lisa Kachnic, Boston Medical Center Minority-Based CCOP, Boston, MA; and Minesh P. Mehta, University of Maryland School of Medicine, Baltimore, MD
| | - Albert DeNittis
- Vinai Gondi, Cadence Brain Tumor Center and CDH Proton Center, Warrenville, IL; Vinai Gondi and Howard Rowley, University of Wisconsin School of Medicine and Public Health, Madison, WI; Stephanie L. Pugh, Radiation Therapy Oncology Group Statistical Center; Wenyin Shi, Thomas Jefferson University Hospital, Philadelphia; Albert DeNittis, Lankenau Medical Center, Main Line Community Clinical Oncology Program (CCOP), Wynnewood; Andre A. Konski, Chester County Hospital, West Chester; Wolfgang A. Tome, Montefiore Medical Center and Albert Einstein College of Medicine, Yeshiva University, Bronx, NY; Chip Caine, Intermountain Medical Center and University of Phoenix, Salt Lake City, UT; Ben Corn and Andrew Kanner, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Vijayananda Kundapur, Saskatoon Cancer Centre, Saskatoon, Saskatchewan; Jeffrey N. Greenspoon, McMaster University-Hamilton, Hamilton; Glenn S. Bauman, London Regional Cancer Program, London, Ontario, Canada; Sunjay Shah, Christiana Care Health Services CCOP, Newark, DE; Merideth Wendland, US Oncology-Willamette Valley Cancer Institute, Eugene, OR; Lisa Kachnic, Boston Medical Center Minority-Based CCOP, Boston, MA; and Minesh P. Mehta, University of Maryland School of Medicine, Baltimore, MD
| | - Jeffrey N Greenspoon
- Vinai Gondi, Cadence Brain Tumor Center and CDH Proton Center, Warrenville, IL; Vinai Gondi and Howard Rowley, University of Wisconsin School of Medicine and Public Health, Madison, WI; Stephanie L. Pugh, Radiation Therapy Oncology Group Statistical Center; Wenyin Shi, Thomas Jefferson University Hospital, Philadelphia; Albert DeNittis, Lankenau Medical Center, Main Line Community Clinical Oncology Program (CCOP), Wynnewood; Andre A. Konski, Chester County Hospital, West Chester; Wolfgang A. Tome, Montefiore Medical Center and Albert Einstein College of Medicine, Yeshiva University, Bronx, NY; Chip Caine, Intermountain Medical Center and University of Phoenix, Salt Lake City, UT; Ben Corn and Andrew Kanner, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Vijayananda Kundapur, Saskatoon Cancer Centre, Saskatoon, Saskatchewan; Jeffrey N. Greenspoon, McMaster University-Hamilton, Hamilton; Glenn S. Bauman, London Regional Cancer Program, London, Ontario, Canada; Sunjay Shah, Christiana Care Health Services CCOP, Newark, DE; Merideth Wendland, US Oncology-Willamette Valley Cancer Institute, Eugene, OR; Lisa Kachnic, Boston Medical Center Minority-Based CCOP, Boston, MA; and Minesh P. Mehta, University of Maryland School of Medicine, Baltimore, MD
| | - Andre A Konski
- Vinai Gondi, Cadence Brain Tumor Center and CDH Proton Center, Warrenville, IL; Vinai Gondi and Howard Rowley, University of Wisconsin School of Medicine and Public Health, Madison, WI; Stephanie L. Pugh, Radiation Therapy Oncology Group Statistical Center; Wenyin Shi, Thomas Jefferson University Hospital, Philadelphia; Albert DeNittis, Lankenau Medical Center, Main Line Community Clinical Oncology Program (CCOP), Wynnewood; Andre A. Konski, Chester County Hospital, West Chester; Wolfgang A. Tome, Montefiore Medical Center and Albert Einstein College of Medicine, Yeshiva University, Bronx, NY; Chip Caine, Intermountain Medical Center and University of Phoenix, Salt Lake City, UT; Ben Corn and Andrew Kanner, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Vijayananda Kundapur, Saskatoon Cancer Centre, Saskatoon, Saskatchewan; Jeffrey N. Greenspoon, McMaster University-Hamilton, Hamilton; Glenn S. Bauman, London Regional Cancer Program, London, Ontario, Canada; Sunjay Shah, Christiana Care Health Services CCOP, Newark, DE; Merideth Wendland, US Oncology-Willamette Valley Cancer Institute, Eugene, OR; Lisa Kachnic, Boston Medical Center Minority-Based CCOP, Boston, MA; and Minesh P. Mehta, University of Maryland School of Medicine, Baltimore, MD
| | - Glenn S Bauman
- Vinai Gondi, Cadence Brain Tumor Center and CDH Proton Center, Warrenville, IL; Vinai Gondi and Howard Rowley, University of Wisconsin School of Medicine and Public Health, Madison, WI; Stephanie L. Pugh, Radiation Therapy Oncology Group Statistical Center; Wenyin Shi, Thomas Jefferson University Hospital, Philadelphia; Albert DeNittis, Lankenau Medical Center, Main Line Community Clinical Oncology Program (CCOP), Wynnewood; Andre A. Konski, Chester County Hospital, West Chester; Wolfgang A. Tome, Montefiore Medical Center and Albert Einstein College of Medicine, Yeshiva University, Bronx, NY; Chip Caine, Intermountain Medical Center and University of Phoenix, Salt Lake City, UT; Ben Corn and Andrew Kanner, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Vijayananda Kundapur, Saskatoon Cancer Centre, Saskatoon, Saskatchewan; Jeffrey N. Greenspoon, McMaster University-Hamilton, Hamilton; Glenn S. Bauman, London Regional Cancer Program, London, Ontario, Canada; Sunjay Shah, Christiana Care Health Services CCOP, Newark, DE; Merideth Wendland, US Oncology-Willamette Valley Cancer Institute, Eugene, OR; Lisa Kachnic, Boston Medical Center Minority-Based CCOP, Boston, MA; and Minesh P. Mehta, University of Maryland School of Medicine, Baltimore, MD
| | - Sunjay Shah
- Vinai Gondi, Cadence Brain Tumor Center and CDH Proton Center, Warrenville, IL; Vinai Gondi and Howard Rowley, University of Wisconsin School of Medicine and Public Health, Madison, WI; Stephanie L. Pugh, Radiation Therapy Oncology Group Statistical Center; Wenyin Shi, Thomas Jefferson University Hospital, Philadelphia; Albert DeNittis, Lankenau Medical Center, Main Line Community Clinical Oncology Program (CCOP), Wynnewood; Andre A. Konski, Chester County Hospital, West Chester; Wolfgang A. Tome, Montefiore Medical Center and Albert Einstein College of Medicine, Yeshiva University, Bronx, NY; Chip Caine, Intermountain Medical Center and University of Phoenix, Salt Lake City, UT; Ben Corn and Andrew Kanner, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Vijayananda Kundapur, Saskatoon Cancer Centre, Saskatoon, Saskatchewan; Jeffrey N. Greenspoon, McMaster University-Hamilton, Hamilton; Glenn S. Bauman, London Regional Cancer Program, London, Ontario, Canada; Sunjay Shah, Christiana Care Health Services CCOP, Newark, DE; Merideth Wendland, US Oncology-Willamette Valley Cancer Institute, Eugene, OR; Lisa Kachnic, Boston Medical Center Minority-Based CCOP, Boston, MA; and Minesh P. Mehta, University of Maryland School of Medicine, Baltimore, MD
| | - Wenyin Shi
- Vinai Gondi, Cadence Brain Tumor Center and CDH Proton Center, Warrenville, IL; Vinai Gondi and Howard Rowley, University of Wisconsin School of Medicine and Public Health, Madison, WI; Stephanie L. Pugh, Radiation Therapy Oncology Group Statistical Center; Wenyin Shi, Thomas Jefferson University Hospital, Philadelphia; Albert DeNittis, Lankenau Medical Center, Main Line Community Clinical Oncology Program (CCOP), Wynnewood; Andre A. Konski, Chester County Hospital, West Chester; Wolfgang A. Tome, Montefiore Medical Center and Albert Einstein College of Medicine, Yeshiva University, Bronx, NY; Chip Caine, Intermountain Medical Center and University of Phoenix, Salt Lake City, UT; Ben Corn and Andrew Kanner, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Vijayananda Kundapur, Saskatoon Cancer Centre, Saskatoon, Saskatchewan; Jeffrey N. Greenspoon, McMaster University-Hamilton, Hamilton; Glenn S. Bauman, London Regional Cancer Program, London, Ontario, Canada; Sunjay Shah, Christiana Care Health Services CCOP, Newark, DE; Merideth Wendland, US Oncology-Willamette Valley Cancer Institute, Eugene, OR; Lisa Kachnic, Boston Medical Center Minority-Based CCOP, Boston, MA; and Minesh P. Mehta, University of Maryland School of Medicine, Baltimore, MD
| | - Merideth Wendland
- Vinai Gondi, Cadence Brain Tumor Center and CDH Proton Center, Warrenville, IL; Vinai Gondi and Howard Rowley, University of Wisconsin School of Medicine and Public Health, Madison, WI; Stephanie L. Pugh, Radiation Therapy Oncology Group Statistical Center; Wenyin Shi, Thomas Jefferson University Hospital, Philadelphia; Albert DeNittis, Lankenau Medical Center, Main Line Community Clinical Oncology Program (CCOP), Wynnewood; Andre A. Konski, Chester County Hospital, West Chester; Wolfgang A. Tome, Montefiore Medical Center and Albert Einstein College of Medicine, Yeshiva University, Bronx, NY; Chip Caine, Intermountain Medical Center and University of Phoenix, Salt Lake City, UT; Ben Corn and Andrew Kanner, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Vijayananda Kundapur, Saskatoon Cancer Centre, Saskatoon, Saskatchewan; Jeffrey N. Greenspoon, McMaster University-Hamilton, Hamilton; Glenn S. Bauman, London Regional Cancer Program, London, Ontario, Canada; Sunjay Shah, Christiana Care Health Services CCOP, Newark, DE; Merideth Wendland, US Oncology-Willamette Valley Cancer Institute, Eugene, OR; Lisa Kachnic, Boston Medical Center Minority-Based CCOP, Boston, MA; and Minesh P. Mehta, University of Maryland School of Medicine, Baltimore, MD
| | - Lisa Kachnic
- Vinai Gondi, Cadence Brain Tumor Center and CDH Proton Center, Warrenville, IL; Vinai Gondi and Howard Rowley, University of Wisconsin School of Medicine and Public Health, Madison, WI; Stephanie L. Pugh, Radiation Therapy Oncology Group Statistical Center; Wenyin Shi, Thomas Jefferson University Hospital, Philadelphia; Albert DeNittis, Lankenau Medical Center, Main Line Community Clinical Oncology Program (CCOP), Wynnewood; Andre A. Konski, Chester County Hospital, West Chester; Wolfgang A. Tome, Montefiore Medical Center and Albert Einstein College of Medicine, Yeshiva University, Bronx, NY; Chip Caine, Intermountain Medical Center and University of Phoenix, Salt Lake City, UT; Ben Corn and Andrew Kanner, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Vijayananda Kundapur, Saskatoon Cancer Centre, Saskatoon, Saskatchewan; Jeffrey N. Greenspoon, McMaster University-Hamilton, Hamilton; Glenn S. Bauman, London Regional Cancer Program, London, Ontario, Canada; Sunjay Shah, Christiana Care Health Services CCOP, Newark, DE; Merideth Wendland, US Oncology-Willamette Valley Cancer Institute, Eugene, OR; Lisa Kachnic, Boston Medical Center Minority-Based CCOP, Boston, MA; and Minesh P. Mehta, University of Maryland School of Medicine, Baltimore, MD
| | - Minesh P Mehta
- Vinai Gondi, Cadence Brain Tumor Center and CDH Proton Center, Warrenville, IL; Vinai Gondi and Howard Rowley, University of Wisconsin School of Medicine and Public Health, Madison, WI; Stephanie L. Pugh, Radiation Therapy Oncology Group Statistical Center; Wenyin Shi, Thomas Jefferson University Hospital, Philadelphia; Albert DeNittis, Lankenau Medical Center, Main Line Community Clinical Oncology Program (CCOP), Wynnewood; Andre A. Konski, Chester County Hospital, West Chester; Wolfgang A. Tome, Montefiore Medical Center and Albert Einstein College of Medicine, Yeshiva University, Bronx, NY; Chip Caine, Intermountain Medical Center and University of Phoenix, Salt Lake City, UT; Ben Corn and Andrew Kanner, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Vijayananda Kundapur, Saskatoon Cancer Centre, Saskatoon, Saskatchewan; Jeffrey N. Greenspoon, McMaster University-Hamilton, Hamilton; Glenn S. Bauman, London Regional Cancer Program, London, Ontario, Canada; Sunjay Shah, Christiana Care Health Services CCOP, Newark, DE; Merideth Wendland, US Oncology-Willamette Valley Cancer Institute, Eugene, OR; Lisa Kachnic, Boston Medical Center Minority-Based CCOP, Boston, MA; and Minesh P. Mehta, University of Maryland School of Medicine, Baltimore, MD
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Gibson E, Gaed M, Gómez JA, Moussa M, Romagnoli C, Pautler S, Chin JL, Crukley C, Bauman GS, Fenster A, Ward AD. 3D prostate histology reconstruction: an evaluation of image-based and fiducial-based algorithms. Med Phys 2014; 40:093501. [PMID: 24007184 DOI: 10.1118/1.4816946] [Citation(s) in RCA: 13] [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: 12/14/2022] Open
Abstract
PURPOSE Evaluation of in vivo prostate imaging modalities for determining the spatial distribution and aggressiveness of prostate cancer ideally requires accurate registration of images to an accepted reference standard, such as histopathological examination of radical prostatectomy specimens. Three-dimensional (3D) reconstruction of prostate histology facilitates these registration-based evaluations by reintroducing 3D spatial information lost during histology processing. Because the reconstruction accuracy may constrain the clinical questions that can be answered with these data, it is important to assess the tradeoffs between minimally disruptive methods based on intrinsic image information and potentially more robust methods based on extrinsic fiducial markers. METHODS Ex vivo magnetic resonance (MR) images and digitized whole-mount histology images from 12 radical prostatectomy specimens were used to evaluate four 3D histology reconstruction algorithms. 3D reconstructions were computed by registering each histology image to the corresponding ex vivo MR image using one of two similarity metrics (mutual information or fiducial registration error) and one of two search domains (affine transformations or a constrained subset thereof). The algorithms were evaluated for accuracy using the mean target registration error (TRE) computed from homologous intrinsic point landmarks (3-16 per histology section; 232 total) identified on histology and MR images, and for the sensitivity of TRE to rotational, translational, and scaling initialization errors. RESULTS The algorithms using fiducial registration error and mutual information had mean ± standard deviation TREs of 0.7 ± 0.4 and 1.2 ± 0.7 mm, respectively, and one algorithm using fiducial registration error and affine transforms had negligible sensitivities to initialization errors. The postoptimization values of the mutual information-based metric showed evidence of errors due to both the optimizer and the similarity metric, and variation of parameters of the mutual information-based metric did not improve its performance. CONCLUSIONS The extrinsic fiducial-based algorithm had lower mean TRE and lower sensitivity to initialization than the intrinsic intensity-based algorithm using mutual information. A model relating statistical power to registration error for certain imaging validation study designs estimated that a reconstruction algorithm with a mean TRE of 0.7 mm would require 27% fewer subjects than the method used to initialize the algorithms (mean TRE 1.3 ± 0.7 mm), suggesting the choice of reconstruction technique can have a substantial impact on the design of imaging validation studies, and on their overall cost.
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Affiliation(s)
- E Gibson
- Biomedical Engineering Graduate Program, The University of Western Ontario, London, Ontario N6A 5B9, Canada.
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Gibson E, Gaed M, Gómez JA, Moussa M, Pautler S, Chin JL, Crukley C, Bauman GS, Fenster A, Ward AD. 3D prostate histology image reconstruction: Quantifying the impact of tissue deformation and histology section location. J Pathol Inform 2013; 4:31. [PMID: 24392245 PMCID: PMC3869958 DOI: 10.4103/2153-3539.120874] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [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: 06/26/2013] [Accepted: 08/03/2013] [Indexed: 01/22/2023] Open
Abstract
Background: Guidelines for localizing prostate cancer on imaging are ideally informed by registered post-prostatectomy histology. 3D histology reconstruction methods can support this by reintroducing 3D spatial information lost during histology processing. The need to register small, high-grade foci drives a need for high accuracy. Accurate 3D reconstruction method design is impacted by the answers to the following central questions of this work. (1) How does prostate tissue deform during histology processing? (2) What spatial misalignment of the tissue sections is induced by microtome cutting? (3) How does the choice of reconstruction model affect histology reconstruction accuracy? Materials and Methods: Histology, paraffin block face and magnetic resonance images were acquired for 18 whole mid-gland tissue slices from six prostates. 7-15 homologous landmarks were identified on each image. Tissue deformation due to histology processing was characterized using the target registration error (TRE) after landmark-based registration under four deformation models (rigid, similarity, affine and thin-plate-spline [TPS]). The misalignment of histology sections from the front faces of tissue slices was quantified using manually identified landmarks. The impact of reconstruction models on the TRE after landmark-based reconstruction was measured under eight reconstruction models comprising one of four deformation models with and without constraining histology images to the tissue slice front faces. Results: Isotropic scaling improved the mean TRE by 0.8-1.0 mm (all results reported as 95% confidence intervals), while skew or TPS deformation improved the mean TRE by <0.1 mm. The mean misalignment was 1.1-1.9° (angle) and 0.9-1.3 mm (depth). Using isotropic scaling, the front face constraint raised the mean TRE by 0.6-0.8 mm. Conclusions: For sub-millimeter accuracy, 3D reconstruction models should not constrain histology images to the tissue slice front faces and should be flexible enough to model isotropic scaling.
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Affiliation(s)
- Eli Gibson
- Robarts Research Institute, London, Canada ; Graduate Program in Biomedical Engineering, London, Canada
| | - Mena Gaed
- Robarts Research Institute, London, Canada ; Lawson Health Research Institute, London, Canada ; Department of Pathology, The University of Western Ontario, London, Canada
| | - José A Gómez
- Department of Pathology, The University of Western Ontario, London, Canada
| | - Madeleine Moussa
- Department of Pathology, The University of Western Ontario, London, Canada
| | - Stephen Pautler
- Lawson Health Research Institute, London, Canada ; Department of Urology, The University of Western Ontario, London, Canada
| | - Joseph L Chin
- Department of Urology, The University of Western Ontario, London, Canada
| | - Cathie Crukley
- Robarts Research Institute, London, Canada ; Lawson Health Research Institute, London, Canada
| | - Glenn S Bauman
- Department of Oncology, The University of Western Ontario, London, Canada
| | - Aaron Fenster
- Robarts Research Institute, London, Canada ; Graduate Program in Biomedical Engineering, London, Canada ; Lawson Health Research Institute, London, Canada ; Department of Oncology, The University of Western Ontario, London, Canada ; Department of Medical Biophysics, The University of Western Ontario, London, Canada
| | - Aaron D Ward
- Graduate Program in Biomedical Engineering, London, Canada ; Lawson Health Research Institute, London, Canada ; Department of Oncology, The University of Western Ontario, London, Canada ; Department of Medical Biophysics, The University of Western Ontario, London, Canada
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Louie AV, Chan E, Hanna M, Bauman GS, Fisher BJ, Palma DA, Rodrigues GB, Warner A, D'Souza DP. Assessing fitness to drive in brain tumour patients: a grey matter of law, ethics, and medicine. ACTA ACUST UNITED AC 2013; 20:90-6. [PMID: 23559871 DOI: 10.3747/co.20.1260] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neurocognitive deficits from brain tumours may impair the ability to safely operate a motor vehicle. Although certain jurisdictions in Canada legally require that physicians report patients who are unfit to drive, criteria for determining fitness are not clearly defined for brain tumours. METHODS Patients receiving brain radiotherapy at our institution from January to June 2009 were identified using the Oncology Patient Information System. In addition to descriptive statistics, details of driving assessment were reviewed retrospectively. The Fisher exact test was used to determine factors predictive of reporting a patient to the Ontario Ministry of Transportation (mto) as unfit to drive. A logistic regression model was constructed to further determine factors predictive of reporting. RESULTS Of the 158 patients available for analysis, 48 (30%) were reported to the mto, and 64 (41%) were advised to stop driving. With respect to the 53 patients with seizures, a report was submitted to the mto for 30 (57%), and a documented discussion about the implications of driving was held with 35 (66%). On univariate analysis, younger age, a central nervous system primary, higher brain radiotherapy dose, unifocal disease, and the presence of seizures were predictive of physician reporting (p < 0.05). On logistic regression modelling, the presence of seizures (odds ratio: 3.9) and a higher radiotherapy dose (odds ratio: 1.3) remained predictive of reporting. INTERPRETATION Physicians frequently do not discuss the implications of driving with brain tumour patients or are not properly documenting such advice (or both). Clear and concise reporting guidelines need to be drafted given the legal, medical, and ethical concerns surrounding this public health issue.
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Affiliation(s)
- A V Louie
- Department of Radiation Oncology, London Regional Cancer Program, London, ON. ; Schulich School of Medicine and Dentistry, Western University, London, ON
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