The Experts below are selected from a list of 11808 Experts worldwide ranked by ideXlab platform
Henry N. Wagner - One of the best experts on this subject based on the ideXlab platform.
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Enhancing the role of radioTherapy in non-small cell lung cancer
Current opinion in oncology, 1998Co-Authors: Henry N. WagnerAbstract:Radiation Therapy plays an important role in the treatment of patients with unresectable non-small cell lung cancer. Local control rates with past Radiation Therapy Techniques have been poor, in the range of 10% to 15%. Recent advances in dose planning and delivery, as well as Radiation biology, offer the promise of improved control and better protection of dose limiting normal tissues.
James Welsh - One of the best experts on this subject based on the ideXlab platform.
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Commercial Insurance Coverage of Advanced Radiation Therapy Techniques Compared With American Society for Radiation Oncology Model Policies
Practical radiation oncology, 2019Co-Authors: Vivek Verma, Ethan B. Ludmir, Shane Mesko, Eric D. Brooks, Alexander Augustyn, Michael T. Milano, Steven H. Lin, Joe Y. Chang, James WelshAbstract:Abstract Purpose This study aimed to compare and contrast the American Society for Radiation Oncology (ASTRO) model policies (MPs) for intensity modulated Radiation Therapy (IMRT), stereotactic radiosurgery (SRS), stereotactic ablative Radiation Therapy (SABR), and proton beam Therapy (PBT) with the coverage policies constructed by 5 of the largest publicly available commercial insurers throughout the United States (ie, Aetna, Anthem, Cigna, Humana, and United Healthcare). Methods and Materials Appropriate indications for IMRT, SRS, SABR, and PBT by disease site (and particular clinical setting thereof) were extracted from the most recently published ASTRO MPs and published coverage policies (2019 editions) of the 5 carriers. After tabulation, concordance between ASTRO MPs and insurance policies were calculated for each modality. Results All 5 insurer policies supported IMRT for neoplasms of the central nervous system, head/neck, hepatopancreaticobiliary, anal, and prostate cancers. The least covered diseases were retroperitoneal tumors (n = 0 carriers) and bladder cancer (n = 1). For SRS, all carriers covered benign brain tumors, brain metastases, arteriovenous malformations, and trigeminal neuralgia. None of the insurance carriers covered SRS for medically refractory epilepsy. For SABR, primary liver, lung, and low- or intermediate-risk prostate cancer were covered by all insurers, and none allowed SABR for primary biliary neoplasms. Only one insurance carrier each covered SABR for primary/metastatic adrenal disease and primary renal cancer. All carriers approved PBT for ocular melanoma, skull base tumors, and pediatric malignancies. The ASTRO MPs listed 4 PBT scenarios (ie, spinal disease, retroperitoneal sarcoma, head/neck neoplasms, and patients with genetic radiosensitivity syndromes) not covered by any insurer. Concordance between insurance carriers and ASTRO MPs was 67.8% for IMRT, 72.0% for SRS, 58.4% for SABR, and 41.8% for PBT (P = .005). Conclusions Coverage guidelines for IMRT, SRS, SABR, and PBT vary across 5 major insurance providers and may be substantially discordant compared with ASTRO coverage guidelines. There remain several specific areas where ongoing and future dialogues between ASTRO members, payers, and policymakers remain essential.
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Comparison of 2 Common Radiation Therapy Techniques for Definitive Treatment of Small Cell Lung Cancer
International journal of radiation oncology biology physics, 2013Co-Authors: Shervin M. Shirvani, Aditya Juloori, Pamela K. Allen, Ritsuko Komaki, Zhongxing Liao, Daniel R. Gomez, Michael S. O'reilly, James Welsh, Vassiliki A. Papadimitrakopoulou, James D. CoxAbstract:Purpose: Two choices are widely used for Radiation delivery, 3-dimensional conformal Radiation Therapy (3DCRT) and intensity modulated Radiation Therapy (IMRT). No randomized comparisons have been conducted in the setting of lung cancer, but theoretical concerns suggest that IMRT may negatively impact disease control. We analyzed a large cohort of limited-stage small-cell lung cancer (LS-SCLC) patients treated before and after institutional conversion from 3DCRT to IMRT to compare outcomes. Methods and Materials: Patients with LS-SCLC treated with definitive Radiation at our institution between 2000 and 2009 were retrospectively reviewed. Both multivariable Cox regression and propensity score matching were used to compare oncologic outcomes of 3DCRT and IMRT in the context of other clinically relevant covariables. Acute and chronic toxicities associated with the 2 Techniques were compared using Fisher exact and log–rank tests, respectively. Results: A total of 223 patients were treated during the study period, with 119 receiving 3DCRT and 104 receiving IMRT. Their median age was 64 years (range, 39-90 years). Median follow-up times for 3DCRT and IMRT were 27 months (range, 2-147 months) and 22 months (range, 4-83 months), respectively. Radiation modality was not associated with differences in overall survival or disease-free survival in either multivariable or propensity score-matchedmore » analyses. IMRT patients required significantly fewer percutaneous feeding tube placements (5% vs 17%, respectively, P=.005). Conclusions: IMRT was not associated with worse oncologic outcomes than those of 3DCRT. IMRT was associated with a lower rate of esophagitis-related percutaneous feeding tube placements.« less
Yuwei Lin - One of the best experts on this subject based on the ideXlab platform.
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treatment plan comparison between stereotactic body Radiation Therapy Techniques for prostate cancer non isocentric cyberknife versus isocentric rapidarc
Physica Medica, 2014Co-Authors: Yuwei Lin, Kueihua Lin, Hsiuman Lin, Liching Lin, Steve P Lee, Chenshou ChuiAbstract:Abstract Purpose The aim of this study was to evaluate the feasibility and dose distribution of two different stereotactic body Radiation Therapy (SBRT) Techniques, isocentric RapidArc (RA) and non-isocentric CyberKnife (CK), for the treatment of localized prostate cancer. Methods Two groups of patients (Groups 1 and 2 with ten patients per group) treated with CK were re-planned with RA. The patients were grouped according to the rectum constraint used (Group1, maximum dose for rectum; Group 2, dose–volume histogram for rectum). The prescription dose was 37.5 Gy in five fractions. The two SBRT Techniques were compared by target coverage, normal tissue sparing, and dose distribution parameters. Monitor units (MUs) and the delivery time were likewise compared to assess delivery efficiency. Results The RA plans consistently exhibited superior PTV coverage and better rectum sparing at low doses in the both groups. The conformity and heterogeneity indices of the RA plans were better than the CK plans. Additionally, the RA plans resulted in fewer low-dose regions, lower MUs, and faster delivery times than the CK plans. Conclusions The good dosimetric distribution and shorter delivery time make RA an attractive SBRT technique for the treatment of localized prostate cancer.
Shervin M. Shirvani - One of the best experts on this subject based on the ideXlab platform.
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incidence and predictors of severe acute esophagitis and subsequent esophageal stricture in patients treated with accelerated hyperfractionated chemoRadiation for limited stage small cell lung cancer
Practical radiation oncology, 2015Co-Authors: Jonathan D Grant, Shervin M. Shirvani, Pamela K. Allen, Chad Tang, A Juloori, Neal Rebueno, Joe Y. ChangAbstract:Abstract Purpose Clinical and dosimetric predictors of severe (grade 3 or greater) acute esophageal toxicity and subsequent esophageal dilation were explored in patients with limited-stage small cell lung cancer treated with accelerated hyperfractionated chemoRadiation. Methods and materials A total of 130 patients were identified who were treated to 45 Gy in 1.5-Gy twice-daily fractions with concurrent platinum-based chemoTherapy between 2000 and 2009. Data on clinical, disease-related, and treatment-related variables were collected. Patients with percutaneous endoscopic gastrostomy tube insertion or intravenous hydration because of poor oral intake were designated as having acute grade 3 esophagitis. Univariate and multivariate analyses that associated treatment characteristics with esophagitis were assessed via logistic regression, and optimal cut points were identified with recursive partitioning analysis. Results Twenty-five patients developed severe acute esophagitis, at a rate of 26% (18/69) in patients treated with earlier 3-dimensional conformal Radiation Therapy Techniques and 11.5% (7/61) in patients treated with intensity modulated Radiation Therapy Techniques and omission of elective nodal irRadiation. The incidence of esophageal stricture was 6% overall (8 of 128 eligible) but 26% (6/23) among those who experienced prior grade 3 acute esophagitis and 2% (2/105) among those with acute esophagitis less than or equal to grade 2. Significant multivariate predictors of acute esophagitis were mean dose and volume of esophagus receiving at least 5% to 35% of the prescribed dose (V 5 to V 40 ). Patients with V 5 ≥ 74% had a 44.4% risk of severe acute esophagitis (12/27) versus 12.6% (13/103) among those with V 5 45 was the only dosimetric predictor for esophageal stricture, with 13.7% of patients in whom V 45 was ≥37.5% requiring subsequent dilation. Conclusions Modern Radiation Techniques are associated with a lower frequency of severe acute esophagitis than previous paradigms. The proportion of esophagus receiving low- to moderate-range doses (mean, V 5 through V 40 ) predicts acute esophagitis, whereas the proportion of esophagus that receives high doses (V 45 ) predicts the development of esophageal stricture that requires dilation. Patients who develop grade 3 acute esophagitis are at significant risk for subsequent esophageal stricture, whereas those with acute esophagitis of grade 2 or less display minimal risk.
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Comparison of 2 Common Radiation Therapy Techniques for Definitive Treatment of Small Cell Lung Cancer
International journal of radiation oncology biology physics, 2013Co-Authors: Shervin M. Shirvani, Aditya Juloori, Pamela K. Allen, Ritsuko Komaki, Zhongxing Liao, Daniel R. Gomez, Michael S. O'reilly, James Welsh, Vassiliki A. Papadimitrakopoulou, James D. CoxAbstract:Purpose: Two choices are widely used for Radiation delivery, 3-dimensional conformal Radiation Therapy (3DCRT) and intensity modulated Radiation Therapy (IMRT). No randomized comparisons have been conducted in the setting of lung cancer, but theoretical concerns suggest that IMRT may negatively impact disease control. We analyzed a large cohort of limited-stage small-cell lung cancer (LS-SCLC) patients treated before and after institutional conversion from 3DCRT to IMRT to compare outcomes. Methods and Materials: Patients with LS-SCLC treated with definitive Radiation at our institution between 2000 and 2009 were retrospectively reviewed. Both multivariable Cox regression and propensity score matching were used to compare oncologic outcomes of 3DCRT and IMRT in the context of other clinically relevant covariables. Acute and chronic toxicities associated with the 2 Techniques were compared using Fisher exact and log–rank tests, respectively. Results: A total of 223 patients were treated during the study period, with 119 receiving 3DCRT and 104 receiving IMRT. Their median age was 64 years (range, 39-90 years). Median follow-up times for 3DCRT and IMRT were 27 months (range, 2-147 months) and 22 months (range, 4-83 months), respectively. Radiation modality was not associated with differences in overall survival or disease-free survival in either multivariable or propensity score-matchedmore » analyses. IMRT patients required significantly fewer percutaneous feeding tube placements (5% vs 17%, respectively, P=.005). Conclusions: IMRT was not associated with worse oncologic outcomes than those of 3DCRT. IMRT was associated with a lower rate of esophagitis-related percutaneous feeding tube placements.« less
Yong Chan Ahn - One of the best experts on this subject based on the ideXlab platform.
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effect of Radiation Therapy Techniques on outcome in n3 positive iiib non small cell lung cancer treated with concurrent chemoradioTherapy
Cancer Research and Treatment, 2015Co-Authors: Jae Myoung Noh, Yong Chan Ahn, Jin Man Kim, Hongryull Pyo, Bokyong Kim, Jinsung Kim, Jung Suk Shin, Chaeseon Hong, Hyo Jung Park, Eonju LeeAbstract:PURPOSE This study was conducted to evaluate clinical outcomes following definitive concurrent chemoradioTherapy (CCRT) for patients with N3-positive stage IIIB (N3-IIIB) non-small cell lung cancer (NSCLC), with a focus on Radiation Therapy (RT) Techniques. MATERIALS AND METHODS From May 2010 to November 2012, 77 patients with N3-IIIB NSCLC received definitive CCRT (median, 66 Gy). RT Techniques were selected individually based on estimated lung toxicity, with 3-dimensional conformal RT (3D-CRT) and intensity-modulated RT (IMRT) delivered to 48 (62.3%) and 29 (37.7%) patients, respectively. Weekly docetaxel/paclitaxel plus cisplatin (67, 87.0%) was the most common concurrent chemoTherapy regimen. RESULTS The median age and clinical target volume (CTV) were 60 years and 288.0 cm(3), respectively. Patients receiving IMRT had greater disease extent in terms of supraclavicular lymph node (SCN) involvement and CTV ≥ 300 cm(3). The median follow-up time was 21.7 months. Fortyfive patients (58.4%) experienced disease progression, most frequently distant metastasis (39, 50.6%). In-field locoregional control, progression-free survival (PFS), and overall survival (OS) rates at 2 years were 87.9%, 38.7%, and 75.2%, respectively. Although locoregional control was similar between RT Techniques, patients receiving IMRT had worse PFS and OS, and SCN metastases from the lower lobe primary tumor and CTV ≥ 300 cm(3)were associated with worse OS. The incidence and severity of toxicities did not differ significantly between RT Techniques. CONCLUSION IMRT could lead to similar locoregional control and toxicity, while encompassing a greater disease extent than 3D-CRT. The decision to apply IMRT should be made carefully after considering oncologic outcomes associated with greater disease extent and cost.
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Role of Radiation Therapy for Non-small Cell Lung Cancer: Focused on Stereotactic Ablative Radiation Therapy in Stage I
Hanyang Medical Reviews, 2014Co-Authors: Yong Chan AhnAbstract:Radiation Therapy has played a key role, together with surgery and systemic chemoTherapy, in treating in all stages of non-small cell lung cancer. We have witnessed remarkable improvements in Radiation Therapy Techniques, with the innovations in hardware and software. Stereotactic ablative Radiation Therapy, which can deliver high Radiation dose focused to small target volume, represents one of the state-of-the-art Radiation Therapy Techniques. The technical development of Radiation Therapy and the role of stereotactic ablative Radiation Therapy in treating inoperable stage I non-small cell lung cancer are briefly reviewed.
