The Experts below are selected from a list of 3084 Experts worldwide ranked by ideXlab platform
Alan Pollack - One of the best experts on this subject based on the ideXlab platform.
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Biopsy positivity in prostate cancer patients undergoing mpMRI-targeted Radiation Dose Escalation.
Journal of Clinical Oncology, 2020Co-Authors: Jessica Meshman, Eric M. Horwitz, Benjamin Farnia, Radka Stoyanova, Isildinha M. Reis, Matthew C. Abramowitz, Alan Dal Pra, Alan PollackAbstract:336Background: Radiation (RT) Dose Escalation improves prostate cancer outcomes, but when the whole gland is treated to high Doses complications can arise. We used prostate multiparametric MRI (mpM...
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Radiation Dose and late failures in prostate cancer.
International journal of radiation oncology biology physics, 2006Co-Authors: P.b. Morgan, Alexandra L. Hanlon, Eric M. Horwitz, Mark K. Buyyounouski, Robert G. Uzzo, Alan PollackAbstract:Purpose: To quantify the impact of Radiation Dose Escalation on the timing of biochemical failure (BF) and distant metastasis (DM) for prostate cancer treated with radiotherapy (RT) alone. Methods: The data from 667 men with clinically localized intermediate- and high-risk prostate cancer treated with three-dimensional conformal RT alone were retrospectively analyzed. The interval hazard rates of DM and BF, using the American Society for Therapeutic Radiology and Oncology (ASTRO) and Phoenix (nadir + 2) definitions, were determined. The median follow-up was 77 months. Results: Multivariate analysis showed that increasing Radiation Dose was independently associated with decreased ASTRO BF ( p p = 0.001), and DM ( p = 0.006). The preponderance (85%) of ASTRO BF occurred at ≤4 years after RT, and nadir + 2 BF was more evenly spread throughout Years 1–10, with 55% of BF in ≤4 years. Radiation Dose Escalation caused a shift in the BF from earlier to later years. The interval hazard function for DM appeared to be biphasic (early and late peaks) overall and for the Conclusion: The ASTRO definition of BF systematically underestimated late BF because of backdating. Radiation Dose Escalation diminished and delayed BF; the delay suggested that local persistence may still be present in some patients. For DM, a greater Radiation Dose reduced the early and late waves, suggesting that persistence of local disease contributed to both.
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The case for Dose Escalation versus adjuvant androgen deprivation therapy for intermediate risk prostate cancer.
The Canadian journal of urology, 2006Co-Authors: Tom Pickles, Alan PollackAbstract:Patients with intermediate-risk prostate cancer have a significant risk of biochemical failure after treatment with external beam Radiation therapy. Two strategies to improve outcomes are Radiation Dose Escalation and androgen deprivation therapy (ADT). This article discusses the evidence in favor of Dose Escalation. The case for Radiation Dose Escalation has been established by several randomized studies, which show improved biochemical control (bNED) rates. Although late toxicity was also increased, it remains at clinically acceptable levels. The use of more focal methods of Radiation, such as proton therapy and intensity modulated Radiation therapy (IMRT), allows safe Dose Escalation to 80 Gy. The role of adjuvant ADT is most clearly established in high-risk disease. Advantages in the intermediate-risk group are less pronounced. It is probable that therapeutic gain seen from Dose Escalation in intermediate-risk patients might allow them to be spared the toxicity of ADT and yet achieve good PSA and clinical control rates. Further randomized trials comparing and or combining the two treatment strategies are required.
William T Sause - One of the best experts on this subject based on the ideXlab platform.
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Radiation Dose Escalation in Stage III Non-Small-Cell Lung Cancer.
Frontiers in oncology, 2011Co-Authors: Breanne E. Terakedis, William T SauseAbstract:For patients with stage III non-small-cell lung cancer with unresectable or inoperable tumors, definitive chemoradiotherapy is often utilized. Historically, local control and overall survival rates have been poor. In an effort to improve local control, new chemotherapeutic agents in combination with higher Doses of radiotherapy have been investigated. Early Dose Escalation trials date back to the 1980s, and the feasibility and efficacy of Dose Escalation for patients with inoperable stage III lung cancer continue to be topics of investigation. Herein, we review the evolution of chemotherapy as it relates to treatment of unresectable stage III lung cancer, and we outline the early and the more recent Dose Escalation studies. While Dose Escalation appears to provide a modest benefit in terms of preventing local failure and improving overall survival, advances in diagnostic imaging and radiotherapy treatment have possibly resulted in selection of a more favorable patient population. These variables make statements regarding the benefit of Dose Escalation challenging.
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increasing tumor volume is predictive of poor overall and progression free survival secondary analysis of the Radiation therapy oncology group 93 11 phase i ii Radiation Dose Escalation study in patients with inoperable non small cell lung cancer
International Journal of Radiation Oncology Biology Physics, 2008Co-Authors: Maria Wernerwasik, Suzanne R Swann, Jeffrey D Bradley, Mary Beth Graham, Bahman Emami, James A Purdy, William T SauseAbstract:Purpose Patients with non–small-cell lung cancer (NSCLC) in the Radiation Therapy Oncology Group (RTOG) 93-11 trial received Radiation Doses of 70.9, 77.4, 83.8, or 90.3 Gy. The locoregional control and survival rates were similar among the various Dose levels. We investigated the effect of the gross tumor volume (GTV) on the outcome. Methods and Materials The GTV was defined as the sum of the volumes of the primary tumor and involved lymph nodes. The tumor response, median survival time (MST), and progression-free survival (PFS) were analyzed separately for smaller (≤45 cm 3 ) vs. larger (>45 cm 3 ) tumors. Results The distribution of the GTV was as follows: ≤45 cm 3 in 79 (49%) and >45 cm 3 in 82 (51%) of 161 patients. The median GTV was 47.3 cm 3 . N0 status and female gender were associated with better tumor responses. Patients with smaller (≤45 cm 3 ) tumors achieved a longer MST and better PFS than did patients with larger (>45 cm 3 ) tumors (29.7 vs. 13.3 months, p p p = 0.0002; and HR, 2.0, p = 0.0002, respectively). The GTV as a continuous variable was also significantly associated with the MST and PFS (HR, 1.59, p p Conclusions Radiation Dose Escalation up to 90.3 Gy did not result in improved MST or PFS. The tumor responses were greater in node-negative patients and women. An increasing GTV was strongly associated with decreased MST and PFS. Future radiotherapy trials patients might need to use stratification by tumor volume.
S. Isakovic - One of the best experts on this subject based on the ideXlab platform.
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Radiotherapy of inoperable recurrent rectal carcinoma
European Journal of Cancer, 2001Co-Authors: L. Radosevic-jelic, M. Durbaba, D. Scepanovic, S. Stojanovic, S. IsakovicAbstract:1. 1. Surgery for recurrent rectal carcinoma: The role of preoperative magnetic resonance imaging 2. 2006, Clinical Radiology 3. Show more information 2. 1. Palliative reirRadiation for recurrent rectal cancer 2. 1997, International Journal of Radiation Oncology*Biology*Physics 3. Show more information 3. 1. Rationale for a phase I/II Radiation Dose-Escalation study with concurrent amifostine (ethyol) and infusional 5-FU chemotherapy for preoperative treatment of unresectable or locally recurrent rectal carcinoma 2. 2002, Seminars in Radiation Oncology 3. Show more information 4. View more articles »
James W. Denham - One of the best experts on this subject based on the ideXlab platform.
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Radiation Dose Escalation or Longer Androgen Suppression to Prevent Distant Progression in Men With Locally Advanced Prostate Cancer: 10-Year Data From the TROG 03.04 RADAR Trial
International journal of radiation oncology biology physics, 2020Co-Authors: David Joseph, James W. Denham, Allison Steigler, David Lamb, Nigel Spry, Gillian M. Duchesne, Chris Atkinson, John Stanley, Tom Shannon, John H L MatthewsAbstract:Purpose To clarify the relative effects of duration of androgen suppression (AS) and Radiation Dose Escalation (RDE) on distant progression (DP) in men with locally advanced prostate cancer. Methods and Materials Participants with locally advanced prostate cancer in the TROG 03.04 RADAR trial were randomized to 6 or 18 months AS ± 18 months zoledronic acid (Z). The trial incorporated a RDE program by stratification at randomization and dosing options were 66, 70, or 74 Gy external beam Radiation therapy (EBRT), or 46 Gy EBRT plus high-Dose-rate brachytherapy boost (HDRB). The primary endpoint for this study was distant progression (DP). Secondary endpoints included local progression, bone progression, prostate cancer-specific mortality and all-cause mortality. Effect estimates for AS duration and RDE were derived using Fine and Gray competing risk models adjusting for use of Z, age, tumor stage, Gleason grade group, prostate-specific antigen, and treatment center. Cumulative incidence at 10 years was estimated for each RDE group. Results A total of 1051 out of 1071 randomized subjects were eligible for inclusion in this analysis. Compared with 6 months AS, 18 months AS significantly reduced DP independently of Radiation Dose (subhazard ratio 0.70; 95% confidence interval [CI], 0.56-0.87; P = .002). No statistically significant interaction between effect of AS duration and RT Dose was observed (Wald test P = .76). In subgroup analyses, DP was significantly reduced by the longer duration of AS in the 70 Gy and HDRB groups but not in the 66 Gy and 74 Gy. Compared with 70 Gy, HDRB significantly reduced DP (subhazard ratio 0.68 [95% CI, 0.57-0.80]; P Conclusions Compared with 6 months AS, 18 months AS reduced DP independently of Radiation Dose. Men treated with HDRB gained a significant benefit from a longer duration of AS. Evidence of improved oncologic outcomes for HDRB compared with Dose-escalated EBRT needs to be confirmed in a randomized trial.
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When to choose radiotherapy for prostate cancer, and what technique?
2015Co-Authors: James W. DenhamAbstract:This review describes the present curative role of radiotherapy in men with localised prostate cancer, and the many technical innovations that have occurred over the last 20 years that have improved its accuracy and safety. These have resulted in today's state of the art irRadiation technique known as 'imaged guided intensity modulated radiotherapy'. Emerging changes in practice for men with good prognosis tumours, which include Radiation Dose Escalation, and major reductions in the duration of radiotherapy treatment courses are outlined. Finally, the role of adjuvant treatments for men with poor prognosis, high risk locally advanced tumours, and new approaches to these initiatives are summarised.
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Radiation Dose Escalation or longer androgen suppression for locally advanced prostate cancer? Data from the TROG 03.04 RADAR trial
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2015Co-Authors: James W. Denham, Allison Steigler, David Joseph, David Lamb, Nigel Spry, Gillian M. Duchesne, Chris Atkinson, John N. S. Matthews, Sandra Turner, Lizbeth KennyAbstract:Abstract Background The relative effects of Radiation Dose Escalation (RDE) and androgen suppression (AS) duration on local prostatic progression (LP) remain unclear. Methods We addressed this in the TROG 03.04 RADAR trial by incorporating a RDE programme by stratification at randomisation. Men were allocated 6 or 18months AS±18months zoledronate (Z). The main endpoint was a composite of clinically diagnosed LP or PSA progression with a PSA doubling time ⩾6months. Fine and Gray competing risk modelling with adjustment for site clustering produced cumulative incidence estimates at 6.5years for each RDE group. Results Composite LP declined coherently in the 66, 70 and 74Gy external beam dosing groups and was lowest in the high Dose rate brachytherapy boost (HDRB) group. At 6.5years, adjusted cumulative incidences were 22%, 15%, 13% and 7% respectively. Compared to 6months AS, 18months AS also significantly reduced LP ( p Conclusion RDE and increasing AS independently reduce LP and increase urethral strictures. The risks and benefits to the individual must be balanced when selecting Radiation Dose and AS duration.
James A Hayman - One of the best experts on this subject based on the ideXlab platform.
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final toxicity results of a Radiation Dose Escalation study in patients with non small cell lung cancer nsclc predictors for Radiation pneumonitis and fibrosis
International Journal of Radiation Oncology Biology Physics, 2006Co-Authors: Feng Ming Kong, James A Hayman, Kent A Griffith, Gregory P Kalemkerian, Douglas A Arenberg, Susan E Lyons, Andrew T Turrisi, Allen S Lichter, Benedick A FraassAbstract:Purpose: We aimed to report the final toxicity results on a Radiation-Dose Escalation trial designed to test a hypothesis that very high Doses of Radiation could be safely administered to patients with non–small-cell lung cancer (NSCLC) by quantifying the Dose–volume toxicity relationship of the lung. Methods and Materials: A total of 109 patients with unresectable or medically inoperable NSCLC were enrolled and treated with Radiation-Dose Escalation (on the basis of predicted normal-lung toxicity) either alone or with neoadjuvant chemotherapy by use of 3D conformal techniques. Eighty-four patients (77%) received more than 69 Gy, the trial was stopped after the Dose reached 103 Gy. Estimated median follow-up was 110 months. Results: There were 17 (14.6%) Grade 2 to 3 pneumonitis and 15 (13.8%) Grade 2 to 3 fibrosis and no Grade 4 to 5 lung toxicity. Multivariate analyses showed them to be (1) not associated with the Dose prescribed to the tumor, and (2) significantly ( p Conclusions: With long-term follow-up for toxicity, we have demonstrated that much higher Doses of Radiation than are traditionally administered can be safely delivered to a majority of patients with NSCLC. Quantitative lung Dose–volume toxicity–based Dose Escalation can form the basis for individualized high-Dose Radiation treatment to maximize the therapeutic ratio in these patients.
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The role of Radiation therapy in thoracic tumors.
Hematology oncology clinics of North America, 2006Co-Authors: Feng-ming Spring Kong, Lujun Zhao, James A HaymanAbstract:Radiation plays an important role in the treatment of thoracic tumors. During the last 10 years there have been several major advances in thoracic RT including the incorporation of concurrent chemotherapy and the application of con-formal Radiation-delivery techniques (eg, stereotactic RT, three-dimensional conformal RT, and intensity-modulated RT) that allow Radiation Dose Escalation. Radiation as a local measure remains the definitive treatment of medically inoperable or surgically unresectable disease in NSCLC and part of a multimodality regimen for locally advanced NSCLC, limited stage SCLC, esophageal cancer, thymoma, and mesothelioma.
