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Lawrence J Solin - One of the best experts on this subject based on the ideXlab platform.
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use of lymphoscintigraphy in Radiation Treatment of primary breast cancer in the context of lymphedema risk reduction
Radiotherapy and Oncology, 2011Co-Authors: Indra J Das, Andrea L Cheville, Joshua Scheuermann, Shyam Srinivas, Abass Alavi, Lawrence J SolinAbstract:Abstract Purpose The goal of this study was to determine the feasibility of SPECT/CT scintigraphic method for mapping lymphatic drainage for Radiation therapy of breast cancer. Materials and methods Thirty-six patients were enrolled in a SPECT/CT lymphoscintigraphy study. 99m Tc sulfur colloid (1 mCi) was injected intradermally in the ipsilateral arm. After 5–8 h post-injection, the SPECT/CT scans were taken and analyzed on a GE eNTRGRA system. The SPECT/CT images were co-registered in the Treatment planning system (TPS). The original Treatment plan was recreated for nodal dosimetry. Intensity modulated Radiation therapy (IMRT) planning was performed for reducing lymph node dose for reducing arm lymphedema. Results The number of lymph nodes varied from 0 to 10 with a mean value of 3.4 ± 5.4 nodes. The location of nodes varied in the axillary, supraclavicular, and breast regions depending upon the surgical procedure and the extent of the disease. The prescribed Radiation dose to the breast varied from 45 to 50.4 Gy depending on the disease pattern in 32 evaluated patients having CT data. The dose to lymph nodes varied from 0 to 61.8 Gy depending upon the location and the Radiation technique used. SPECT/CT study in conjunction with IMRT plan showed that it is possible to decrease nodal dose and thereby potentially reduce the risk of developing arm lymphedema. Conclusions The SPECT/CT device provides a novel method to map the lymph nodes in the Radiation Treatment fields that could be used to tailor the Radiation dose.
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the impact of adding Radiation Treatment after breast conservation surgery for ductal carcinoma in situ of the breast
Journal of The National Cancer Institute Monographs, 2010Co-Authors: Lawrence J SolinAbstract:Ductal carcinoma in situ (DCIS; intraductal carcinoma) is most commonly detected as suspicious microcalcifications on routine screening mammography in an asymptomatic woman. As most women with newly diagnosed DCIS are eligible for breast conservation Treatment, a major decision for most women is whether or not to add Radiation Treatment after surgical excision (lumpectomy). In four prospective randomized clinical trials, the addition of Radiation Treatment after lumpectomy reduced the risk of local recurrence by approximately 50%, both for overall local recurrence and for the subset of invasive local recurrence. Nonetheless, efforts have continued to attempt to identify a subset of patients with favorable DCIS who are at sufficiently low risk of local recurrence that omitting Radiation Treatment is reasonable. Prospective and retrospective studies have demonstrated excellent long-term outcomes at 10 and 15 years after breast conservation Treatment with Radiation. Careful follow-up, including yearly surveillance mammography, after initial breast conservation Treatment with Radiation is warranted for the early detection of potentially salvageable local and local-regional recurrences.
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the technical approach to Radiation Treatment as a component of breast conservation Treatment for early stage breast carcinoma
Seminars in Breast Disease, 2007Co-Authors: Lawrence J SolinAbstract:For the woman with newly diagnosed early stage breast carcinoma undergoing breast conservation Treatment, definitive Radiation Treatment is delivered after breast conservation surgery. While the importance of the technical approach to breast conservation surgery is widely appreciated, the technical skill for Radiation Treatment is also critical to maximize local-regional control and to minimize toxicity. Recent advances have dramatically improved technical Radiation Treatment planning and delivery. The Radiation Treatment technique must be integrated with the surgical procedure performed, the pathology findings, and the systemic Treatment delivered. The Radiation Treatment technique also must coordinate with newer Treatment approaches in surgery (e.g., sentinel lymph node biopsy) and systemic therapy (e.g., neoadjuvant systemic therapy, agents with potential cardiac toxicity). To maximize long-term outcome, a sound approach to the technical Radiation Treatment is an integral component of the combined modality Treatment for the patient with early stage breast carcinoma.
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coronary artery findings after left sided compared with right sided Radiation Treatment for early stage breast cancer
Journal of Clinical Oncology, 2007Co-Authors: Candace R Correa, Lawrence J Solin, Harold Litt, Weiting Hwang, Victor A Ferrari, Eleanor E R HarrisAbstract:Purpose To compare the incidence and distribution of coronary artery disease after left-sided versus right-sided irRadiation in patients treated with breast conservation for early-stage breast cancer who subsequently underwent cardiac stress testing and/or catheterization for cardiovascular symptoms. Patients and Methods The medical records of 961 stage I-II breast cancer patients treated from 1977 to 1995 at the University of Pennsylvania with conventional tangential beam Radiation Treatment (RT) were screened for cardiac stress tests and catheterizations performed after RT. The results of these tests were analyzed by laterality of RT and compared with baseline cardiovascular risk. Results At diagnosis, patients with left-sided and right-sided breast cancer had the same estimated 10-year risk (both 7%) of developing coronary artery disease. At a median time of 12 years post-RT (range, 2 to 24 years), 46 patients with left-sided and 36 patients with right-sided breast cancer (total, N = 82) had undergone ...
John M Buatti - One of the best experts on this subject based on the ideXlab platform.
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value of fdg pet in assessment of Treatment response and surveillance in head and neck cancer patients after intensity modulated Radiation Treatment a preliminary report
International Journal of Radiation Oncology Biology Physics, 2004Co-Authors: Min Yao, Michael M Graham, Russell B Smith, Kenneth J Dornfeld, Mark Skwarchuk, Henry T Hoffman, Gerry F Funk, Scott M Graham, Yusuf Menda, John M BuattiAbstract:Purpose [ 18 F] fluorodeoxyglucose positron emission tomography (FDG PET) imaging has been shown to be valuable in early detection of persistent and recurrent head-and-neck cancer after Treatment. Previous studies have reported its use in patients treated with conventional Radiation. Many patients are now treated with intensity-modulated Radiation Treatment (IMRT). We evaluated the value of FDG PET in the assessment of Treatment response and surveillance in head-and-neck cancer patients treated with IMRT. Methods and materials We performed a retrospective review of 85 head-and-neck cancer patients treated with IMRT at our institution between December 2000 and September 2003 who had FDG PET in their follow-up. Of these, 58 were treated with primary IMRT with or without chemotherapy, and 27 were treated with postoperative IMRT. Results Sixty-four patients had negative initial FDG PET after Treatment. Forty of them, who had 6 to 24 months of follow-up after the imaging study, had no evidence of local or regional recurrence, although three of them developed distant disease. Twenty-one patients had a positive initial FDG PET after Treatment, with 11 positive at the primary site, 9 positive in the neck, and 3 positive distantly. Six of 11 patients with a positive FDG PET at the primary site were true positive, and 3 had salvage surgery. Eight of 9 patients positive in the neck had a salvage neck dissection. One had fine needle aspiration of the lymph node with positive cytology but refused surgery later. For patients with follow-up of 6 months and longer, only 1 of 45 patients with a negative initial FDG PET at the primary site developed a local recurrence. None of 49 patients with a negative initial FDG PET in the neck developed a regional recurrence. Two cases are presented in which abnormal FDG PET preceded laryngoscopy or computed tomography in detection of tumor recurrences. Conclusions FDG PET is useful in the postTreatment management of head-and-neck cancer patients treated with IMRT. It is highly accurate in the detection of persistent and recurrent disease after Treatment and allows salvage Treatment to be initiated in a timely manner. It also provides prognostic information concerning the risk of recurrence after curative therapy.
Gerald J Kutcher - One of the best experts on this subject based on the ideXlab platform.
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the impact of 18f fluoro 2 deoxy d glucose positron emission tomography fdg pet lymph node staging on the Radiation Treatment volumes in patients with non small cell lung cancer
Radiotherapy and Oncology, 2000Co-Authors: L Vanuytsel, Johan Vansteenkiste, Sigrid Stroobants, Paul De Leyn, Walter De Wever, Eric Verbeken, Giovanna Gatti, D Huyskens, Gerald J KutcherAbstract:Abstract Purpose : 18 F-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) combined with computer tomography (PET-CT) is superior to CT alone in mediastinal lymph node (LN) staging in non-small cell lung cancer (NSCLC). We studied the potential impact of this non-invasive LN staging procedure on the Radiation Treatment plan of patients with NSCLC. Patients and methods : The imaging and surgical pathology data from 105 patients included in two previously published prospective LN staging protocols form the basis for the present analysis. For 73 of these patients, with positive LN's on CT and/or on PET, a theoretical study was performed in which for each patient the gross tumour volume (GTV) was defined based on CT and on PET-CT data. For each GTV, the completeness of tumour coverage was assessed, using the available surgical pathology data as gold standard. A more detailed analysis was done for the first ten consecutive patients in whom the PET-CT-GTV was smaller than the CT-GTV. Theoretical Radiation Treatment plans were constructed based on both CT-GTV and PET-CT-GTV. Dose-volume histograms for the planning target volume (PTV), for the total lung volume and the lung volume receiving more than 20 Gy ( V lung(20) ), were calculated. Results : Data from 988 assessed LN stations were available. In the subgroup of 73 patients with CT or PET positive LN's, tumour coverage improved from 75% when the CT-GTV was used to 89% with the PET-CT-GTV ( P =0.005). In 45 patients (62%) the information obtained from PET would have led to a change of the Treatment volumes. For the ten patients in the dosimetry study, the use of PET-CT to define the GTV, resulted in an average reduction of the PTV by 29±18% (±1 SD) ( P =0.002) and of the V lung(20) of 27±18% (±1 SD) ( P =0.001). Conclusion : In patients with NSCLC considered for curative Radiation Treatment, assessment of locoregional LN tumour extension by PET will improve tumour coverage, and in selected patients, will reduce the volume of normal tissues irradiated, and thus toxicity. This subgroup of patients could then become candidates for Treatment intensification.
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conformal Radiation Treatment of prostate cancer using inversely planned intensity modulated photon beams produced with dynamic multileaf collimation
International Journal of Radiation Oncology Biology Physics, 1996Co-Authors: Clifton C Ling, Radhe Mohan, Thomas Bortfeld, C Burman, Chen S Chui, Gerald J Kutcher, Stephen A Leibel, Thomas Losasso, Larry Reinstein, Spiridon V SpirouAbstract:Purpose : To implement radiotherapy with intensity-modulated beams, based on the inverse method of Treatment design and using a multileaf collimation system operating in the dynamic mode. Methods and Materials : An algorithm, based on the inverse technique, has been integrated into the radiotherapy Treatment-planning computer system in our Center. This method of computer-assisted Treatment design was used to derive intensity-modulated beams to optimize the boost portion of the Treatment plan for a patient with a T1c cancer of the prostate. A dose of 72 Gy (in 40 fractions) was given with a six-field plan, and an additional 9 Gy (in five fractions) with six intensity-modulated beams. The intensity-modulated fields were delivered using dynamic multileaf collimation 1 , that is, individual leaves were in motion during Radiation delivery, with the Treatment machine operating in the clinical mode. Exhaustive quality assurance measurement and monitoring were carried out to ensure safe and accurate implementation. Results : Dose distribution and dose-volume histogram of the inverse method boost plan and of the composite (72 Gy primary + 9 Gy boost) plan were judged clinically acceptable. Compared to a manually designed boost plan, the inverse Treatment design gave improved conformality and increased dose homogeneity in the planning target volume. Film and ion chamber dosimetry, performed prior to the first Treatment, indicated that each of the six intensity-modulated fields was accurately produced. Thermoluminescent dosimeter (TLD) measurements performed on the patient confirmed that the intended dose was delivered in the Treatment. In addition, computer-aided Treatment-monitoring programs assured that the multileaf collimator (MLC) position file was executed to the specified precision. In terms of the overall Radiation Treatment process, there will likely be labor savings in the planning and the Treatment phases. Conclusions : We have placed into clinical use an integrated system of conformal Radiation Treatment that incorporated the inverse method of Treatment design and the use of dynamic multileaf collimation to deliver intensity-modulated beams. The system can provide better Treatment design, which can be implemented reliably and safely. We are hopeful that improved Treatment efficacy will result.
Myung Hoon Han - One of the best experts on this subject based on the ideXlab platform.
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Effect of osteoporotic conditions on the development of peritumoral brain edema after LINAC-based Radiation Treatment in patients with intracranial meningioma
'Springer Science and Business Media LLC', 2021Co-Authors: Sang Mook Kang, Jae Min Kim, Jin Hwan Cheong, Je Il Ryu, Young Soo Kim, Yu Deok Won, Myung Hoon HanAbstract:Abstract Purpose Disruption of the tumor-brain barrier in meningioma is a crucial factor in peritumoral brain edema (PTBE). We previously reported the possible effect of osteoporosis on the integrity of the arachnoid trabeculae because both the bone and the arachnoid trabeculae are composed of type 1 collagen. We hypothesized that osteoporotic conditions may be associated with PTBE occurrence after Radiation Treatment in patients with meningioma. Methods A receiver operating characteristic curve analysis was used to identify the optimal cut-off values of mean skull Hounsfield unit for predicting osteopenia and osteoporosis in patients from our registry. Multivariate Cox regression analysis was used to determine whether possible osteoporosis independently predicted PTBE development in patients with meningioma after Radiation. Results A total of 106 intracranial meningiomas were included for the study. All patients received linear accelerator-based Radiation therapy in our hospital over an approximate 6-year period. Multivariate Cox regression analysis identified that hypothetical osteoporosis was an independent predictive factor for the development of PTBE in patients with meningioma after linear accelerator-based Radiation Treatment (hazard ratio 5.20; 95% confidence interval 1.11–24.46; p = 0.037). Conclusions Our study suggests that possible osteoporotic conditions may affect PTBE development after linear accelerator-based Radiation Treatment for intracranial meningioma. However, due to the study’s small number of patients, these findings need to be validated in future studies with larger cohorts, before firm recommendations can be made. Graphic abstrac
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significance of skull osteoporosis to the development of peritumoral brain edema after linac based Radiation Treatment in patients with intracranial meningioma
PLOS ONE, 2020Co-Authors: Ryang Hun Lee, Jae Min Kim, Jin Hwan Cheong, Je Il Ryu, Young Soo Kim, Myung Hoon HanAbstract:Background and purpose Disruption of the tumor-brain barrier in meningioma plays a critical role in the development of peritumoral brain edema (PTBE). We hypothesized that osteoporotic conditions may be associated with PTBE occurrence after Radiation in patients with intracranial meningioma. Methods We measured Hounsfield units (HU) of the frontal skull on simulation brain CT in patients who underwent linear accelerator (LINAC)-based Radiation Treatment for intracranial meningioma. Receiver operating characteristic curve analysis was performed to determine the optimal cut-off values for several predictive factors. The cumulative hazard for PTBE was estimated and classified according to these factors. Hazard ratios were then estimated to identify independent predictive factors associated with the development of PTBE after Radiation in intracranial meningioma patients. Results A total of 83 intracranial meningiomas in 76 patients who received LINAC-based Radiation Treatment in our hospital over an approximate 5-year period were included for the study. We found mean frontal skull HU ≤630.625 and gross tumor volume >7.194 cc to be independent predictors of PTBE after Radiation Treatment in patients with meningioma (hazard ratio, 8.41; P = 0.019; hazard ratio, 5.92; P = 0.032, respectively). In addition, patients who were ≥65 years showed a marginally significant association with PTBE. Conclusions Our study suggests that possible osteoporotic conditions, large tumor volume, and older age may be associated with PTBE occurrence after LINAC-based Radiation Treatment for intracranial meningioma. In the future we anticipate that these findings may enhance the understanding of the underlying mechanisms of PTBE after Radiation in meningioma patients.
Michael Molls - One of the best experts on this subject based on the ideXlab platform.
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positron emission tomography for Radiation Treatment planning
Strahlentherapie Und Onkologie, 2005Co-Authors: Anca L Grosu, Wolfgang A. Weber, Morand Piert, Branislav Jeremic, Maria Picchio, Ulrich Schratzenstaller, Frank B Zimmermann, Markus Schwaiger, Michael MollsAbstract:Purpose: To evaluate the impact of positron emission tomography (PET) on target volume delineation for Radiation Treatment planning. Material and Methods: The data of the literature concerning the use of PET in target volume delineation are summarized. The following points are discussed for each tumor entity: biological background for the PET investigation, sensitivity and specificity of PET (with different tracers) in comparison to computed tomography (CT) and magnetic resonance imaging (MRI) and impact of PET on target volume definition. New PET tracers, which could visualize biological pathways, such as hypoxia, proliferation, angiogenesis, apoptosis and gene expression patterns, will also be discussed. Results: The results of clinical studies on the integration of PET in target volume definition for lung, head-and-neck, genitourinary and brain tumors were analyzed. Fluorodeoxyglucose-(FDG-)PET has a significant impact on GTV (gross tumor volume) and PTV (planning target volume) delineation in lung cancer and can detect lymph node involvement and differentiate malignant tissue from atelectasis. In head-and-neck cancer, the value of FDG-PET for Radiation Treatment planning is still under investigation. For example, FDG-PET could be superior to CT and MRI in the detection of lymph node metastases and unknown primary cancer and in the differentiation of viable tumor tissue after Treatment. Therefore, it might play an important role in GTV definition and sparing of normal tissue. Choline PET and acetate PET are promising tracers in the diagnosis of prostate cancer, but their validity in local tumor demarcation, lymph node diagnosis and detection of recurrence has to be defined in future clinical trials. FDG-PET seems to be particularly valuable in lymph node status definition in cervical cancer. In high-grade gliomas and meningiomas, methionine PET helps to define the GTV and differentiate tumor from normal tissue. For other entities like gastrointestinal cancer, lymphomas, sarcomas, etc., the data of the literature are yet insufficient. The imaging of hypoxia, cell proliferation, angiogenesis, apoptosis and gene expression leads to the identification of different areas of a biologically heterogeneous tumor mass that can individually be targeted using intensity modulated radiotherapy (IMRT). In addition, a biological dose distribution can be generated, the socalled dose painting. However, systematic experimental and clinical trials are necessary to validate this hypothesis. Conclusion: Regarding Treatment planning in radiotherapy, PET offers advantages in terms of tumor delineation and the description of biological processes. To define the real impact of this investigation in Radiation Treatment planning, subsequent experimental, clinical and cost-benefit analyses are required.
