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Início Publicações / RSS - International Journal of Radiation Oncology, Biology, Physics

- International Journal of Radiation Oncology, Biology, Physics

International Journal of Radiation Oncology • Biology • Physics
International Journal of Radiation Oncology • Biology • Physics RSS feed.

  • In Reply to Long and Ellsworth
    To the Editor: We appreciate Ellsworth and Long's comment on “Functional Liver Imaging and Dosimetry to Predict Hepatotoxicity Risk in Cirrhotic Patients with Primary Liver Cancer.”1,2 The authors compared our work using sulfur colloid (SC) single-photon emission tomography (SPECT) and their Practical Radiation Oncology article, “Functional Liver Image Guided Hepatic Therapy (FLIGHT) With Hepatobiliary Iminodiacetic Acid (HIDA) Scans.”3

  • In Regard to Schaub et al
    To the Editor: We read the article “Functional Liver Imaging and Dosimetry to Predict Hepatotoxicity Risk in Cirrhotic Patients with Primary Liver Cancer” by Schaub et al with interest.1 Our group has previously described functional dosimetric parameters that predict for hepatotoxicity after liver stereotactic body radiation therapy (SBRT).2 Instead of sulfur colloid scans, we used hepatobiliary iminodiacetic acid (HIDA) scans with Tc-99m mebrofenin for functional image guided liver SBRT planning.

  • In Regard to Britton et al
    To the Editor: We read the article by Britton et al1 with interest. In their report of the Eating as Treatment trial, they randomized patients with head and neck cancer undergoing radiation therapy to motivational interviewing and cognitive behavioral therapy to improve nutritional status.1 Patients randomized to this arm experienced less weight loss and fewer treatment interruptions. However, no report was given on local control and survival outcomes in the groups. Furthermore, it is unclear what nutritional recommendations were made to these patients.

  • In Regard to Stecklein et al
    To the Editor: Stecklein et al recently published a commendable analysis regarding outcomes in women with lymph node–positive breast cancer who received neoadjuvant chemotherapy.1 They evaluated the need for regional nodal irradiation (RNI) and developed a nomogram. The analysis is strengthened by the inclusion of >1000 women, novel evaluation of molecular subtype, lymphovascular invasion, patient age, grade, margin status, and pathologic complete response (pCR) and stratification of pCR into breast pCR and axillary pCR.

  • Advanced Treatment Technique for Locally Advanced Cervical Cancer: Time for a Standard of Care Shift?
    Radiation therapy for cervical cancer has undergone a significant shift in the past 15 years. Positron emission tomography (PET)/computed tomography (CT) is now routinely used for nodal staging for cervical cancer, and studies have shown significantly higher sensitivity and specificity in comparison to CT scans.1 Those with PET-positive lymph nodes have significantly worse disease-specific survival than those with PET-negative lymph nodes, and the extent of the PET-positive disease further worsens prognosis.

  • Selection Bias in Population Registry–Based Comparative Effectiveness Research
    Population registries have been increasingly used in the last decade to perform comparative effectiveness research (CER). Population-based CER can be leveraged to answer questions that either practically or ethically cannot be answered through randomization. Furthermore, it can be performed at a low cost and can be generalizable to real-world practice. However, because of a lack of randomization, population-based CER is subject to selection bias and cannot control for unknown confounding; thus, significant concerns remain as to whether treatment effects can be reliably inferred from these studies.

  • Challenging Current Conventions: Up-Front Stereotactic Radiosurgery Alone for Limited Brain Metastases in Small Cell Lung Cancer
    A 79-year-old woman with a history of anxiety, depression, and chronic obstructive pulmonary disease, as well as a remote history of breast cancer treated with lumpectomy and radiation, presented to her primary care physician with new right upper quadrant abdominal pain. Abdominal ultrasound identified 3 liver lesions, with MRI confirmation. Computed tomography–guided liver biopsy identified a diagnosis of small cell carcinoma, positive for synaptophysin and chromogranin. Positron emission tomography/computed tomography identified a 3.3-cm left hilar mass with mediastinal lymphadenopathy and concern for lymphangitic spread of tumor, in addition to multiple liver metastases.

  • Educational Opportunities in Radiation Oncology for the Non-Radiation Oncologist
    To the Editor: Radiation oncology (RO) enjoys a unique place in the field of medicine. Although our field is poorly understood by non–radiation oncologists, we work closely with many clinical specialties and strive to understand their intricacies. RO residency has long incorporated formal training requirements outside of our department: the Accreditation Council for Graduate Medical Education (ACGME) specifically requires interns to spend ≥9 months in medical or surgical rotations outside of RO.

  • In Reply to Mailhot et al
    To the Editor: We appreciate the thoughtful letter1 to the editor regarding our recent analysis,2 and we welcome the opportunity to respond.

  • Whole Brain Irradiation at Lower Doses
    To the Editor: I read with interest the pair of articles Point/Counterpoint “The Demise of Whole-Brain Radiation Therapy”1 and “Reports on the Death of Whole Brain Radiation Therapy Are Greatly Exaggerated”2 in the Journal at the end of 2017. I was involved at the turn of the century in a prospective study of treatment of brain metastases with stereotactic radiosurgery (SRS) without whole brain radiation therapy (WBRT). The unpublished findings (that patients with 1-2 metastases may be safely treated by SRS alone with 3 monthly magnetic resonance imaging follow-ups, with some long-term WBRT-free survivors, private communication 8/25/2005) are now demonstrated by larger studies, including a meta-analysis of phase 3 trials.

  • Genomic Assays to Assess Local Recurrence Risk and Predict Radiation Therapy Benefit in Patients With Ductal Carcinoma In Situ
    Approximately 60,000 women in the United States are diagnosed with ductal carcinoma in situ (DCIS) annually.1 Although DCIS is both a precursor and risk factor for development of invasive breast cancer (IBC), survival after treatment of DCIS is very high regardless of treatment approach.2 After lumpectomy, radiation therapy (RT) decreases local recurrence rates by 50% relatively but has no apparent impact on distant metastases or survival.2 Breast preservation and prevention of local recurrence, either in the form of DCIS or invasive cancer, is thus the primary oncologic benefit of RT in patients who received a diagnosis of DCIS.

  • Moody D. Wharam Jr, MD, FACR, FASTRO, July 22, 1941–August 10, 2018
    “Determine that the thing can and shall be done, and then we will find the way.”—Abraham Lincoln

  • Single Fraction SBRT for Early Stage Lung Cancer—Less is More?
    It is incontestable that stereotactic body radiation therapy (SBRT) is a breakthrough advance in the treatment of peripheral stage I non-small cell lung cancer (NSCLC). Effective, noninvasive, inexpensive, and with the convenience of a few outpatient attendances for a painless procedure, it could be the ideal cancer treatment. Yet after 2 decades of increasingly widespread use, there is still no consensus in the radiation oncology community as to what should be the recommended standard prescription.

  • Meetings
    April 5-7, 2019

  • Small Cell Lung Cancer: PCI Uncertainty and Emerging Radiosurgery Interest
    For extensive-stage small cell lung cancer (ES-SCLC), shared decision-making discussions regarding the risks and benefits of prophylactic cranial irradiation (PCI) are appropriate.1 PCI reduces brain metastases at the notable costs of neurocognitive and quality of life decline, with toxicities that increase with age and warrant greater caution in older patients.2 The impact of PCI on overall survival (OS) in the magnetic resonance imaging (MRI) era, however, is uncertain. The European Organisation for Research and Treatment of Cancer ES-SCLC trial3 demonstrated improved OS with PCI versus observation without MRI staging or surveillance, whereas the Japanese trial4 reported no OS benefit with the addition of PCI to MRI staging and surveillance (Fig. 1).

  • Making Sure Retractions Matter
    If a tree falls in the forest, but no one hears it, did the tree fall? If a retraction is issued, but everyone ignores it, did the retraction matter? This is the problem posed in the survey we have published in this issue. Retracted manuscripts continue to be cited, even years after their formal retractions.1 Manuscripts may be retracted because of concerns regarding data integrity, author misconduct, or a variety of other reasons. A prior investigation indicated that 43% of radiation oncology articles were retracted because of scientific misconduct and 21% for methodological error.

  • A Gray Zone Regarding Gray Matter
    I would favor observation over prophylactic cranial irradiation (PCI), but I prefer to use the term “active surveillance” with brain magnetic resonance imaging scans. I would provide the patient with both options but hopefully make the following points clear.1

  • Observe the Brain and Preserve the Mind
    In light of the phase 3 study by Takahashi et al that demonstrated no survival benefit to prophylactic cranial irradiation in extensive-stage small cell lung cancer (SCLC), we would recommend observation,1 particularly for an elderly patient who is at greater risk for neurocognitive decline and thereby worse quality of life.2

  • Issue Highlights

  • In Regard to Britton et al
    To the Editor: We would like to applaud the ambitious dietary intervention of Britton et al.1 Many patients with cancer have questions about the effect of diet on their disease and treatment, and randomized controlled trials addressing this topic are lacking. However, we have some concerns with their “eating as treatment” report.

  • In Reply to Lee and Douthit, and Champ and Klement
    We thank the authors for their interest in our trial.1,2 Eating As Treatment (EAT) was a multidisciplinary, multilevel, and multicomponent trial of a behavioral intervention. It aimed to change not just patient self-care behaviors but also the clinical interaction style of the dietitians. It was not a trial of a nutritional intervention.

  • Erratum to: Kong X-T, Nguyen NT, Choi YJ, et al. Phase 2 Study of Bortezomib Combined With Temozolomide and Regional Radiation Therapy for Upfront Treatment of Patients With Newly Diagnosed Glioblastoma Multiforme: Safety and Efficacy Assessment. Int J Radiat Oncol Biol Phys 2018;100:1195-1203.
    In the above referenced article, the middle initial of author, Andrew B. Lassman, was erroneously omitted in the final published version. In addition, his affiliation is: Department of Neurology and Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY.

  • Dynamic Modulated Brachytherapy (DMBT) Balloon Applicator for Accelerated Partial Breast Irradiation
    Current intra-cavitary brachytherapy applicators used for accelerated partial breast irradiation (APBI) have varying limits in their ability to shape dose distributions due to the static nature of the applicator channels. In this work, we propose a novel design for a balloon-based applicator with dynamic channels that enables superior dose modulation capable of generating highly conformal plans tailored specific to each patient anatomy/geometry for HDR-based APBI. Dosimetric benefits are demonstrated through a treatment planning study.

  • IDO1 Inhibition Overcomes Radiation-Induced “Rebound Immune Suppression” by Reducing Numbers of IDO1-Expressing Myeloid-Derived Suppressor Cells in the Tumor Microenvironment
    In seeking to clarify the mechanisms underlying radiation resistance in a mouse model of non-small cell lung cancer (NSCLC), we found that hypofractionated radiation induced “rebound immune suppression” via the dose-dependent activation and recruitment of IDO1-expressing myeloid-derived suppressor cells to the tumor microenvironment. Inhibition of IDO1, in combination with radiation, reduced the percentages of these cells, overcame immune suppression, and sensitized these NSCLC tumors to radiation.

  • Importance of technique, target selection, contouring, dose prescription and dose-planning in external beam radiotherapy for cervix cancer: evolution of practice from EMBRACE-I to II
    The evolution of EBRT practice in cervix cancer was evaluated by comparing PTVs, treated volumes (V43Gy) and conformity index (V43Gy/PTV) between two studies: EMBRACE-I with general guidelines for EBRT and the initial phase of EMBRACE-II where adherence to a detailed EBRT protocol was required and monitored. In conclusion, application of IMRT/VMAT, IGRT, 45Gy dose prescription and treatment planning constraints on conformity is related with significant conformality improvement inducing a reduction of treated volume by 40%.

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