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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 Yilmaz et al
    To the Editor: Thank you for the favorable letter about the recent publication of the long-term follow-up results from Radiation Therapy Oncology Group study 0915, the randomized phase 2 study of lung stereotactic body radiation therapy that compared 34 Gy in 1 fraction to 48 Gy in 4 fractions.1,2 With respect to your questions, the first asked whether it was necessary to specifically account for a peripheral tumor's location in the lung because there could be differential motion of lesions in the lung (eg, apex vs base).

  • In Regard to Videtic et al
    To the Editor: We read the article titled “Long-term follow-up on NRG Oncology RTOG 0915 (NCCTG N0927): A randomized phase II study comparing 2 stereotactic body radiation therapy schedules for medically inoperable patients with stage I peripheral non-small cell lung cancer,” with great interest.1

  • In Reply to Ryu
    To the Editor: We read with interest the letter in response to our case “A Kidney Conundrum: More or Less?”1,2 The authors highlight the alternative paradigm of stereotactic radiosurgery (SRS) alone, in lieu of surgery, to effectively decompress the spinal cord and treat disease in patients with metastatic epidural spinal cord compression. However, optimal dosimetry can still be restricted by the risk of radiation-induced myelopathy and the much more common late effect of radiation-induced vertebral compression fracture.

  • In Regard to Amsbaugh et al
    To the Editor: Reirradiation (reRT) in recurrent diffuse intrinsic pontine glioma (DIPG) is by far the most effective modality for palliation.1-6 However, the optimal dose for reRT is an issue yet to be settled. Doses ranging from 20 to 30 Gy (conventional fractionation) have been commonly used by various centers.7 We read with great interest the paper by Amsbaugh et al, a study conducted to identify an optimal dose of reRT for DIPG using an adaptive utility dose-finding method.8 Authors are commended for the first prospective study evaluating this challenging and rare clinical problem.

  • In Regard to Dunne and Liu
    To the Editor: The Gray Zone case of “A Kidney Conundrum: More or Less?”1 is a case of metastatic renal cell carcinoma with multiple bone metastases that received palliative treatment with 8 Gy radiation therapy and with poor tolerance of several systemic treatments. The patient has spinal cord compression (Bilsky grade 2 based on magnetic resonance imaging) after treatment with 8 Gy radiation. The patient is neurologically intact (Ryu grade 4a based on dual components of magnetic resonance imaging and neurological status).

  • Circulating Tumor DNA to Personalize Treatment in Nasopharynx Cancer – Time to Look “Ahead”?
    In the management of human cancers, liquid biopsies represent a promising new paradigm for the detection of occult tumor clones. Conceptually, it is a simple and appealing idea that a blood test will inform on the presence of tumor cells circulating in the peripheral vascular system that are not detected by even the most sensitive imaging modality. Such a test, if validated, offers a broad spectrum of clinical utility ranging from prognostication, disease surveillance, and monitoring of treatment response.

  • In Reply to Ryu
    To the Editor: We respectfully disagree with the authors of the comment stating that stereotactic body radiation therapy (SBRT) represents an alternative to surgery in previously irradiated patients with high-grade spinal cord compression.1 The primary study cited to support this claim was small and retrospective with limited, short-term radiographic follow-up.2 Thus, although thought-provoking, it should not change the standard of care. Furthermore, a response within 2 to 3 months of SBRT may not correspond with durable local control.

  • Stampede to Cure
    Advanced imaging modalities such as prostate-specific membrane antigen/positron emission tomography have dramatically affected the clinical approach to patients with a rising prostate-specific antigen after salvage radiation therapy and prostatectomy. In this case,1 the patient appears to have a solitary paraortic lymph node (cM+, node-only disease). Earlier detection of oligometastastic disease has created a window of opportunity in the management of patients with prostate cancer who were previously only candidates for androgen deprivation therapy (ADT).

  • Prostate-Specific Membrane Antigen Positron Emission Tomography–Identified Para-aortic Prostate Cancer Recurrence After Surgery and Salvage Radiation Therapy
    A 56-year-old man with medically controlled human immunodeficiency virus, hypertension, and hyperlipidemia was diagnosed with low-risk (Gleason score [GS] 3+3, cT1c, prostate-specific antigen [PSA] 3.3 μg/L) prostate adenocarcinoma (PAC) and underwent active surveillance. Repeat biopsy 1 year later (PSA 4.4 μg/L) found GS 4+3 PAC. Radical prostatectomy and lymph node (LN) dissection revealed GS 4+3 (tertiary pattern 5), pT3aN0 (extensive extracapsular extension; 0/11 LN) PAC with negative margins.

  • Cured in a FLASH: Reducing Normal Tissue Toxicities Using Ultra-High-Dose Rates
    In this Physics Oncology Scan, we address the latest hot topic, flash radiation therapy. Although no human has been treated to date, investigators are strongly engaged. The available techniques range from x-rays to protons, with dose rates exceeding 10,000 Gy/s. An abundance of investigators and commercial entities are simultaneously studying the technical capabilities and biological impact. Thus far, the normal tissue sparing that has been evidenced in animal studies generates hope that this will translate into humans.

  • Responding to Information From Novel Positron Emission Tomography Imaging in Prostate Cancer
    This patient is a young male who underwent radical prostatectomy for pT3apN0 Gleason 4 + 3 = 7 adenocarcinoma and has received salvage radiation therapy (RT) to the prostate bed without androgen deprivation therapy (ADT).1 The patient completed salvage RT a few years ago and now has a prostate-specific antigen (PSA) level of 0.35 ng/mL. Unsurprisingly, conventional bone scan with Tc99m shows no skeletal lesions; however, also unsurprisingly, prostate-specific membrane antigen positron emission tomography (PET) scan identified a small PET-avid paraortic lymph node just anterior to the L4 vertebral body.

  • In Reply to Ryu
    To the Editor: I read the comment on this case with interest.1 First, this is a reirradiation case, and as such the dose to the spinal cord is kept to a lower threshold than in the de novo setting.2,3 This likely limits the therapeutic efficacy of reirradiation stereotactic body radiation therapy (SBRT) in the setting of high-grade epidural disease (Bilsky 2 and 3). In the de novo setting, there is now some evidence to suggest dose escalation to 14 to 16 Gy in a single fraction to the spinal cord may be safe in the setting of epidural disease; however, the sample size in that phase 1 study was limited and consisted of low-grade epidural disease (Bilsky 1A-C) only.

  • Issue Highlights
    Al-Hallaq et al

  • In Reply to Krishnatry and Manjali
    To the Editor: In response to Krishnatry and Manjali regarding our phase 1/2 trial of reirradiation (reRT) for diffuse intrinsic pontine glioma,1,2 it must first be noted that the trial was closed earlier than planned owing to poor accrual. Only 12 of 30 planned patients were enrolled; all were followed to the first trial-specified follow-up at 6 weeks post-reRT.

  • Erratum to: Wilson JF, Buchholz TA, and Komaki R. James Daniel Cox, MD, FASTRO, FACR. Int J Radiat Oncol Biol Phys 2019;103:784-785.
    Dr Cox was preceded in death by his daughter, Valerie, and his first wife, Christa Begemann Cox, who passed in 2010 and was the mother of his three children.

  • What Are We Even Looking At?
    This young man has biochemically recurrent prostate cancer after salvage radiation therapy with no evidence of M1 disease by conventional imaging.1 What is the standard of care for such a patient? Observation. The prostate-specific antigen level is too low with too few data points to reliably calculate a doubling time; thus, systemic therapy should not be initiated. The patient had a prostate-specific membrane antigen (PSMA) positron emission tomography (PET) scan, which demonstrated a questionable oligometastatic focus in a single paraortic lymph node.

  • Meetings
    June 9-13, 2019

  • A Survey Study of Female Radiation Oncology Residents’ Experiences to Inform Change
    In a survey of all female U.S. radiation oncology residents in 2017-2018 with 125 respondents (74% response rate), half agreed that gender-specific bias existed in their programs and a quarter reported experiencing sexual harassment. Half reported that lack of mentorship affected career ambitions, and 90% expressed interest in joining a professional group for women in radiation oncology. These findings inform interventions to promote gender equity in a field where women remain under-represented.

  • Testosterone Levels and Sexual Quality of Life Following Stereotactic Body Radiotherapy for Prostate Cancer: A Multi-Institutional Analysis of Prospective Trials
    The impact of higher scatter doses per fraction on testicular function and quality of life following prostate SBRT is poorly studied.

  • DNA damage response after ionizing radiation exposure in skin keratinocytes derived from human induced pluripotent stem cells
    Epidermal cells are positioned on the most out layer of skin and thus have the potential risk of being exposed to environmental factors. The biological effect of ionizing radiation (IR) on the skin tissue is a significant problem for medical applications, such as radiotherapy for cancer treatment. In this study, we established human induced pluripotent stem cells (iPSCs) and skin keratinocytes from iPSCs and analyzed DNA damage response and cell senescence after IR exposure.

  • Development and validation of a nomogram to predict lymphedema following axillary surgery and radiotherapy in women with breast cancer from the NCIC CTG MA.20 randomized trial
    Regional nodal irradiation for women with breast cancer is known to be an important risk factor for the development of upper extremity lymphedema, but tools to accurately predict lymphedema risks for individual patients are lacking. This study sought to develop and validate a nomogram to predict lymphedema risk following axillary surgery and radiotherapy in women with breast cancer.

  • Quality at the American Society for Radiation Oncology (ASTRO) Annual Meeting: Gender Balance among Invited Speakers and Associations with Panel Success
  • Multi-parametric MRI tumor probability model for the detection of locally recurrent prostate cancer after radiotherapy: pathological validation and comparison with manual tumor delineations
    The success of focal salvage treatments for recurrent prostate cancer after radiotherapy relies on accurate detection and delineation of the treating target. A logistic regression model based on multi-parametric MRI was used to obtain voxel-wise tumor probability maps. This information was used to define areas of low, intermediate, and high risk of tumor presence, which can be utilized as input for treatment planning.

  • Effect of irradiation time on biological effectiveness and tumor control probability in proton therapy
    An effect of the irradiation time on the biological effectiveness was systematically evaluated in proton therapy for various target sizes, depths and prescribed doses per fraction. Spread-out Bragg peak plans were created using a constant relative biological effectiveness of 1.1 and the biological doses were then calculated based on the microdosimetric kinetic model. The biological dose large decreased with longer irradiation time or higher prescribed dose.

  • Impact of radiation on local regional control in women with node positive breast cancer treated with neoadjuvant chemotherapy and axillary lymph node dissection: Results from ACOSOG 1071 Clinical Trial
    In this prospective trial evaluating the false negative rate in sentinel nodes for patients undergoing neoadjuvant chemotherapy post surgical radiation therapy was employed at the discretion of the treating physicians. Herein we report outcome of patients in the trial as a function of clinical-pathologic features and radiation therapy administered.

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