“Wisest Is He Who Knows What He Does Not Know.”
This issue of the Red Journal contains reports espousing the potential of imaging to improve cancer treatment in general, and radiation therapy (RT) in particular. We share much of that enthusiasm. At the same time, it seems prudent to discuss some of the limits of imaging and the potential downside of overreliance on imaging to define RT targets (1). (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - October 18, 2018 Category: Radiology Authors: Lawrence B. Marks, Joel E. Tepper Tags: Editorial Source Type: research

Imaging (R)evolution: Questioning Our Motivations Behind Rapid Adoption of New Technologies in Radiation Oncology
Image-guided treatment has revolutionized the field of radiation oncology. Improved tumor visualization through CT and MRI in the 1970s prompted innovative methods of targeting: intensity modulated radiation therapy and multileaf collimators to deliver complex dose distributions (1). In head and neck cancer, for instance, these innovations are associated with improved survival and quality of life with reduced toxicities (2-4). Advances in functional and metabolic imaging create targets based on tumor biology (1). (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - October 18, 2018 Category: Radiology Authors: Kathryn R. Tringale, Jona A. Hattangadi-Gluth Tags: Editorial Source Type: research

Whither Thou Goest, I Will Go
The title of this editorial is from Ruth I:16 (King James version of the Bible), and as with Ruth and Naomi, the disciplines of diagnostic radiology (DR) and radiation oncology (RO) were inexorably linked from their inceptions through the post –World War II era. In the late 1940s, Juan del Regato, MD, one of the early proponents of RO in the United States, corresponded with the American Board of Radiology (ABR) to request a separation of the disciplines within radiology; however, it was not until more than 3 decades later, in 1982, that the ABR administered its last general radiology examination. (Source: Internation...
Source: International Journal of Radiation Oncology * Biology * Physics - October 18, 2018 Category: Radiology Authors: Paul E. Wallner, Stephen M. Hahn, Anthony L. Zietman Tags: Editorial Source Type: research

Artificial Intelligence in Radiation Oncology Imaging
Artificial intelligence (AI) is emerging as a technology with the power to transform the way we analyze, interpret, and leverage medical imaging data. This power is sure to extend to radiation oncology, which depends on multimodal imaging for most aspects of patient care, including but not limited to clinical decision-making, treatment planning, follow-up care, and quality assessment frameworks. In this editorial, we will comment on the current state and anticipated future impact of AI on radiation oncology, focusing on machine learning and deep learning approaches to medical imaging data analysis and their applications. (...
Source: International Journal of Radiation Oncology * Biology * Physics - October 18, 2018 Category: Radiology Authors: Reid F. Thompson, Gilmer Valdes, Clifton David Fuller, Colin M. Carpenter, Olivier Morin, Sanjay Aneja, William D. Lindsay, Hugo J.W.L. Aerts, Barbara Agrimson, Curtiland Deville, Seth A. Rosenthal, James B. Yu, Charles R. Thomas Tags: Radiomics and Machine Learning Source Type: research

Interim Analysis of a Two-Institution, Prospective Clinical Trial of 4DCT-Ventilation-based Functional Avoidance Radiation Therapy
Functional imaging has been proposed that uses 4DCT images to calculate 4DCT-based lung ventilation (4DCT-ventilation). We have started a 2-institution, phase 2 prospective trial evaluating the feasibility, safety, and preliminary efficacy of 4DCT-ventilation functional avoidance. The trial hypothesis is that the rate of grade ≥2 radiation pneumonitis could be reduced to 12% with functional avoidance, compared with a 25% rate of pneumonitis with a historical control. The trial employed a Simon 2-stage design with a planned futility analysis after 17 evaluable patients. (Source: International Journal of Radiation Oncolog...
Source: International Journal of Radiation Oncology * Biology * Physics - October 18, 2018 Category: Radiology Authors: Yevgeniy Vinogradskiy, Chad G. Rusthoven, Leah Schubert, Bernard Jones, Austin Faught, Richard Castillo, Edward Castillo, Laurie E. Gaspar, Jennifer Kwak, Timothy Waxweiler, Michele Dougherty, Dexiang Gao, Craig Stevens, Moyed Miften, Brian Kavanagh, Thom Tags: Imaging to Prevent Radiation Sequelae Source Type: research

Precision Medicine —Targeted Therapy
To the Editor: Central nervous system pathologic and normal anatomy have long been regarded as essentially static when planning treatment —motion management was thought to be unimportant because physiologic processes such as respiration or peristalsis do not affect intracranial anatomy. Indeed, 3-dimensional rigid registrations between magnetic resonance imaging (MRI) and computed tomography (CT) scans can be carried out with high d egrees of accuracy over months and years to permit the re-establishment of stereotactic coordinates for guidance and monitoring (1). (Source: International Journal of Radiation Oncol...
Source: International Journal of Radiation Oncology * Biology * Physics - October 18, 2018 Category: Radiology Authors: Jonathan P.S. Knisely Tags: Determining Disease Extent Source Type: research

The Future of Virtual Reality in Radiation Oncology
Advances in high-performance computing technology continue to deeply affect the practice of medicine. In radiation oncology we have seen this evolution firsthand as contouring has become completely digital, dose calculation has evolved from approximated 2-dimensional (2D) calculations to 3-dimensional (3D) physics-based simulation, and techniques such as inverse-planned intensity modulated radiation therapy have been introduced to the clinic. The current revolution in machine learning and artificial intelligence has the promise to make even deeper changes to how we work with computers to perform our daily clinical tasks. (...
Source: International Journal of Radiation Oncology * Biology * Physics - October 18, 2018 Category: Radiology Authors: Christopher L. Williams, Konstantin A. Kovtun Tags: Radiomics and Machine Learning Source Type: research

Radiation Therapy Outcomes Models in the Era of  Radiomics and Radiogenomics: Uncertainties and Validation
Models by their nature are mathematical approximations of reality, as conveyed by the statement that “all models are wrong but some are useful (1).” Their usefulness in radiation therapy (RT) is highlighted by the roles that outcome models play in improving the quality and efficacy of radiation treatment of tumors by predicting response, individualizing prescriptions, and optimizing and ranking planning options. These models are generally categorized into those for tumor response prediction by tumor control probability (TCP) and those for predicting radiation-induced toxicities by normal-tissue complication pro...
Source: International Journal of Radiation Oncology * Biology * Physics - October 18, 2018 Category: Radiology Authors: Issam El Naqa, Gaurav Pandey, Hugo Aerts, Jen-Tzung Chien, Christian Nicolaj Andreassen, Andrzej Niemierko, Randall K. Ten Haken Tags: Radiomics and Machine Learning Source Type: research

The Influence of Imaging in the Modern Practice of Radiation Oncology
The current practice of radiation oncology now requires a strong relationship with all radiology subspecialists and is embedded with a variety of imaging modalities and formats for both treatment planning and treatment execution. Unlike technology in the past, modern treatment technology delivery systems include kilovoltage imaging and cone beam computed tomography –guided treatment systems for daily patient treatment reproducibility. Today's radiation planning tools include 4-dimensional motion management and fusion software that can routinely blend anatomic and metabolic imaging for target volume definition. (Sourc...
Source: International Journal of Radiation Oncology * Biology * Physics - October 18, 2018 Category: Radiology Authors: Thomas J. FitzGerald, Mark A. Rosen, Maryann Bishop-Jodoin Tags: Editorial Source Type: research

Seeing What's Before Us: Imaging in the Electronic Age
If you break your foot and need an x-ray, you are much more likely to be directed to the Department of Diagnostic Imaging than to the Radiology Department. Forward-thinking radiology departments now like to include “imaging” in their titles. It captures the trajectory of growth away from the classic Roentgen ray of 1895 into a boundless visual universe comprised of bits and bytes. Workhorse computed tomography (CT) scans are yielding ground to a complex stew of ultrasound, magnetic resonance, and molecular and nuclear imaging-based technologies, all readily accessible on-screen in just a few clicks. (Source: In...
Source: International Journal of Radiation Oncology * Biology * Physics - October 18, 2018 Category: Radiology Authors: Kristy K. Brock, Sue S. Yom Tags: Introduction Source Type: research

The Importance of Imaging in Radiation Oncology for National Clinical Trials Network Protocols
Imaging is essential in successfully executing radiation therapy (RT) in oncology clinical trials. As technically sophisticated diagnostic imaging and RT were incorporated into trials, quality assurance in the National Clinical Trials Network groups entered a new era promoting image acquisition and review. Most trials involving RT require pre- and post-therapy imaging for target validation and outcome assessment. The increasing real-time (before and during therapy) imaging and RT object reviews are to ensure compliance with trial objectives. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - October 18, 2018 Category: Radiology Authors: Thomas J. FitzGerald, Maryann Bishop-Jodoin, Fran Laurie, Elizabeth O'Meara, Christine Davis, Jeffrey Bogart, John Kalapurakal, Marilyn J. Siegel, Bapsi Chakravarthy, Paul Okunieff, Bruce Haffty, Jeff Michalski, Kenneth Ulin, David S. Followill, Stephen K Tags: Novel Imaging for Treatment Planning Source Type: research

Meetings
November 16-17, 2018 (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - October 18, 2018 Category: Radiology Source Type: research

Influence of linear energy transfer on the nucleo-shuttling of the ATM protein: a novel biological interpretation relevant for particles and radiation
The nucleoshuttling of the ATM protein has recently been shown to influence the individual response to radiation. However, the previous observations were performed with low-linear energy transfer (LET) radiation. Here, the model of the nucleoshuttling of the ATM protein is also relevant for high-LET particles such as protons and carbon ions. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - October 18, 2018 Category: Radiology Authors: Mira Maalouf, Adeline Granzotto, Cl ément Devic, Larry Bodgi, Mélanie Ferlazzo, Christophe Peaucelle, Marcel Bajard, Jean-Yves Giraud, Jacques Balosso, Joël Hérault, Marie-Claude Biston, Claude Malet, Nicolas Foray Tags: Biology Contribution Source Type: research

An Anti-Tumor Immune Response is Evoked By Partial-Volume Single Dose Radiation in Two Murine Models
The response of tumors subjected to partial irradiation was studied in two different immunocompetent models. A single dose of 10-20Gy of radiation delivered to half the tumor, reproducibly activates an anti-tumor immune response that eliminates the entire tumor. This response is dependent on vascular adhesion molecules that mediate infiltration of cytotoxic T cells. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - October 17, 2018 Category: Radiology Authors: Ela Markovsky, Sadna Budhu, Robert M. Samstein, Hongyan Li, James Russell, Zhigang Zhang, Esther Drill, Chloe Bodden, Qing Chen, Simon N. Powell, Taha Merghoub, Jedd D. Wolchok, John Humm, Joseph O. Deasy, Adriana Haimovitz-Friedman Tags: Biology Contribution Source Type: research

Pseudo-CT generation for MRI-only radiotherapy treatment planning: comparison between patch-based, atlas-based, and bulk density methods
Methods have been recently developed to generate pseudo-CT (pCT) images from MRI for radiotherapy dose calculation. We propose an original non-local mean patch-based method to generate pseudo-CT for prostate cancer radiotherapy. Our method provides low dose uncertainties from clinical perspective. These uncertainties are lower compared to those of an atlas-based and bulk density methods. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - October 15, 2018 Category: Radiology Authors: Axel Largent, Ana ïs Barateau, Jean-Claude Nunes, Caroline Lafond, Peter B. Greer, Jason A. Dowling, Hervé Saint-Jalmes, Oscar Acosta, Renaud de Crevoisier Tags: Clinical Investigation Source Type: research

Interleukin-6 signaling blockade exacerbates acute and late injury from focal intestinal irradiation
The time-dependent immune response to focal intestinal irradiation has not been investigated. Therefore, we used immunofluorescence to quantify changes in leukocyte populations after focal irradiation. Subsequently, we investigated the role of interleukin-6 signaling using knockout mice and antibody mediated signaling blockade. We identified time-dependent fluctuations in leukocyte populations in the irradiated intestine and further noted interleukin-6 signaling blockade exacerbates intestinal radiation injury. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - October 15, 2018 Category: Radiology Authors: Brett I. Bell, Sravya Koduri, Carlo Salas Salinas, James Monslow, Ellen Pur é, Edgar Ben-Josef, Constantinos Koumenis, Ioannis I. Verginadis Tags: Biology Contribution Source Type: research

A Spatiotemporal-Constrained Sorting Method for Motion-robust 4D-MRI: A Feasibility Study
In this work, a spatiotemporal-constrained sorting technique was developed to improve 4D-MRI motion-robustness. This sorting technique adapted to optimized sparse k-space acquisition trajectory to reduce motion artifacts due to irregular breathing. Self-gating technique and compressed-sensing based image reconstruction methods were incorporated to improve image resolution with reduced imaging time. Both computer simulation study and phantom imaging study proved that the proposed method outperformed the conventional phase-sorting method in motion range assessment with superior image quality (Source: International Journal of...
Source: International Journal of Radiation Oncology * Biology * Physics - October 12, 2018 Category: Radiology Authors: Chunhao Wang, Ergys Subashi, Fang-Fang Yin, Zheng Chang, Jing Cai Tags: Physics Contribution Source Type: research

Phase II randomized study of radiotherapy and three-year androgen deprivation with or without concurrent weekly docetaxel in high-risk localized prostate cancer patients
This trial aimed to assess the activity of weekly docetaxel concurrent with radiotherapy plus three year androgen deprivation in patients with high-risk localized prostate cancer. No statistically significant differences for 5-year biochemical RFS, PFS and OS has been observed when 9 weekly docetaxel cycles were added to conventional treatment. Concurrent weekly docetaxel can be administered safely with standard doses of radiotherapy without a significant increase in the toxicity profile. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - October 12, 2018 Category: Radiology Authors: Joan Carles, Enrique Gallardo, Montserrat Dom énech, Albert Font, Joaquim Bellmunt, Mariona Figols, Begoña Mellado, Ma Isabel Sáez, Cristina Suárez, Ma José Méndez, Pablo Maroto, Raquel Luque, Teresa de Portugal, Ramón Aldabo, Teresa Bonfill, Rafae Tags: Clinical Investigation Source Type: research

DVH-based Inverse Planning using Monte Carlo Dosimetry for LDR Prostate Brachytherapy
We proposed an inverse planning method based on dose volume histogram optimization and Monte Carlo dosimetry. We compared plans calculated using our proposed method with clinical plans calculated using the TG-43 dosimetry formalism. We demonstrated that our method can provide plans with higher prostate dose homogeneity (up to 6.1%) and lower urethral dose (up to 4.0%) compared to the clinical plans. The computational time (37.5 ± 3.2s) complies with intraoperative time restrictions. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - October 10, 2018 Category: Radiology Authors: Konstantinos A. Mountris, Dimitris Visvikis, Julien Bert Tags: Physics Contribution Source Type: research

Radiotherapy Modulates DNA Repair Efficiency in Peripheral Blood Mononuclear Cells Of Patients With Non-Small Cell Lung Cancer
DNA repair analysis using the γ-H2AX assay in peripheral blood lymphocytes previously demonstrated the capability to predict individual radiosensitivity in a retrospective patient cohort. Now, in lung cancer patients undergoing radiotherapy, we report modulation of DNA repair in response to fractionated radiotherapy. This pheno menon is intriguing, and has implications for predicting severe radiotherapy-related adverse effects. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - October 10, 2018 Category: Radiology Authors: Xiaoyu Yin, Joel Mason, Pavel N. Lobachevsky, Laura Munforte, Lisa Selbie, David L. Ball, Roger F. Martin, Trevor Leong, Shankar Siva, Olga A. Martin Tags: Biology Contribution Source Type: research

Differences in Physician Compensation between Men and Women at United States Public Academic Radiation Oncology Departments
Compensation differences between men and women have been demonstrated in many medical fields. Using public compensation databases and internet sites, we performed univariate and multivariable analyses to determine whether physicians at United States public academic radiation oncology departments were compensated equally between genders. Mean salary was $26,458 (6.4%) less for women than it was for men after accounting for other factors associated with higher compensation. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - October 10, 2018 Category: Radiology Authors: Zachary D. Guss, Qinyu Chen, Chen Hu, Lark G. Guss, Theodore L. DeWeese, Stephanie A. Terezakis Tags: Clinical Investigation Source Type: research

A Prospective Phase II Trial of Trans-perineal Ultrasound-Guided Brachytherapy for Locally Recurrent Prostate Cancer after External Beam Radiotherapy (NRG Oncology/RTOG -0526)
We report the primary endpoint of the phase 2 NRG/RTOG 0526 trial of salvage low dose rate prostate brachytherapy for locally recurrent prostate cancer following prior external beam radiotherapy (EBRT). Eligible patients initially presented with favorable or intermediate risk prostate cancer. At a median follow up of 54 months, 12 of 92 analyzable patients (14%) had late grade 3 gastrointestinal or genitourinary adverse events, which did not exceed the previously set threshold for unacceptable toxicity. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - October 9, 2018 Category: Radiology Authors: Juanita M. Crook, Peixin Zhang, Thomas M. Pisansky, Edouard J. Trabulsi, Mahul B. Amin, William Bice, Gerard Morton, Nadeem Pervez, Eric Vigneault, Charles Catton, Jeff Michalski, Mack Roach, David Beyer, Ashesh Jani, Eric Horwitz, Viroon Donavanik, Howar Tags: Clinical Investigation Source Type: research

The Needs and Benefits of Continuous Model Updates on the Accuracy of RT-induced Toxicity Prediction Models within a Learning Health System
Development of outcome prediction models from clinical data can form the foundation for a learning health system offering precision radiotherapy. We hypothesize that regular prediction model updates along with prospective data collection is important to maintain the prediction accuracy. Prediction models for grade ≥2 xerostomia were developed by bivariate logistic regression. Four methods of model updating (sliding training period/increasing training period/conditionally increasing training period/no updates) were compared. Updating prediction models was effective for maintaining the prediction performance. (Source: Int...
Source: International Journal of Radiation Oncology * Biology * Physics - October 6, 2018 Category: Radiology Authors: Minoru Nakatsugawa, Zhi Cheng, Ana Kiess, Amanda Choflet, Michael Bowers, Kazuki Utsunomiya, Shinya Sugiyama, John Wong, Harry Quon, Todd McNutt Tags: Clinical Investigation Source Type: research

Eating As Treatment (EAT): a stepped-wedge, randomised controlled trial of a health behaviour change intervention provided by dietitians to improve nutrition in patients with head and neck cancer undergoing radiotherapy (TROG 12.03)
Malnutrition during head and neck cancer is associated with poorer morbidity and mortality outcomes. This trial assessed the effectiveness of a psychological intervention delivered by dietitians to prevent malnutrition in head and neck cancer patients while having radiotherapy. Those patients that received the intervention had significantly better nutritional scores; lost less weight; had fewer radiotherapy interruptions; had lower depression scores; and reported a higher quality of life. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - October 5, 2018 Category: Radiology Authors: Ben Britton, Amanda L. Baker, Luke Wolfenden, Chris Wratten, Judith Bauer, Alison K. Beck, Kristen McCarter, Jane Harrowfield, Elizabeth Isenring, Colin Tang, Chris Oldmeadow, Gregory Carter Source Type: research

Patterns of care and outcome Radiation-Induced Soft Tissue Sarcomas
We report the largest series of radiation-induced sarcomas (RIS). We demonstrate that a majority of RIS can be cured, provided they underwent well-planned surgery. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - October 5, 2018 Category: Radiology Authors: A. Italiano, Sol ène Bringer, J.Y. Blay, S. Bonvalot, A. Le Cesne, F. Le Loarer, P. Maingon Source Type: research

Validation of Effective Dose as a Better Predictor of Radiation Pneumonitis Risk than Mean Lung Dose: Secondary Analysis of a Randomized Trial
We found that a normal tissue complications model based on effective dose (Deff) (with volume parameter n=0.5, corresponding to root mean squared dose) predicts risk of radiation pneumonitis after either intensity-modulated radiation therapy or passively scattering proton therapy more accurately than a model based on mean lung dose and suggests that delivering higher doses to smaller lung volumes (vs. lower doses to larger volumes) may increase RP risk more than previously recognized. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - October 3, 2018 Category: Radiology Authors: Susan L. Tucker, Ting Xu, Harald Paganetti, Timo Deist, Vivek Verma, Noah Choi, Radhe Mohan, Zhongxing Liao Source Type: research

Disseminated tumor cells predict efficacy of regional nodal irradiation in early stage breast cancer
This study also confirms that DTC is an independent prognostic factor for locoregional relapse. These data can be used to conduct a prospective comparative study based on DTC or CTC detection to determine whether it could constitute a predictive marker allowing better selection of patients for regional irradiation. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - October 3, 2018 Category: Radiology Authors: Fabien Mignot, Delphine Loirat, Sylvain Dureau, Guillaume Bataillon, Martial Caly, Anne Vincent-Salomon, Fr édérique Berger, Alain Fourquet, Jean-Yves Pierga, Youlia M. Kirova, Francois-Clement Bidard Source Type: research

50 Gy Stereotactic Body Radiation Therapy to the Dominant Intra-Prostatic Nodule: Results from a Phase Ia/b Trial
After prostate radiation therapy (RT) local recurrences are observed in the dominant intraprostatic nodule (DIN). This phase Ia/b study safely escalated the RT dose to the DIN up to 50 Gy by using stereotactic body radiation therapy (SBRT) without grade 3 acute toxicity. SBRT increased antigen specific immune responses in a subset of patients (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - September 26, 2018 Category: Radiology Authors: Fernanda G. Herrera, Massimo Valerio, Dominik Berthold, Thomas Tawadros, Jean-Yves Meuwly, Veronique Vallet, Petra Baumgaertner, Anne-Christine Thierry, Berardino De Bari, Patrice Jichlinski, Lana Kandalaft, George Coukos, Alexandre Harari, J. Bourhis Tags: Clinical Investigation Source Type: research

Pathologic predictors of local recurrence in atypical meningiomas following gross total resection
Local recurrence following gross total resection of atypical meningiomas is difficult to prognosticate. Pathologic predictors could help risk stratify patients. This retrospective analysis assesses various pathologic variables, including the 2016 World Health Organization grade II criteria, through central review by a neuro-pathologist. Ki67 proliferative index and mitotic number strongly predict for local recurrence following gross total resection and 30.3% of patients locally recur by 3 years. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - September 22, 2018 Category: Radiology Authors: Olivia Claire Barrett, James R. Hackney, Andrew M. McDonald, Christopher D. Willey, Markus Bredel, John B. Fiveash Tags: Clinical Investigation Source Type: research

Cost and Cost-Effectiveness of Image Guided Partial Breast Irradiation in Comparison to Hypofractionated Whole Breast Irradiation
Based on micro-costing analysis, accelerated partial breast irradiation (APBI) delivered with IMRT in 5 fractions was less costly to deliver than hypofractionated whole breast irradiation (HWBI) with or without boost and additionally had higher utility outcomes. When utilizing reimbursement, IMRT APBI was less costly than HWBI with or without boost, dominating the technique; however, when billed as SBRT it was not cost-effective. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - September 22, 2018 Category: Radiology Authors: Chirag Shah, Matthew C. Ward, Rahul D. Tendulkar, Sheen Cherian, Frank Vicini, Mendel E. Singer Tags: Clinical Investigation Source Type: research

Local Relapse after Breast Conserving Therapy vs. Mastectomy for Extensive Pure Ductal Carcinoma In-Situ ≥4 cm
This study evaluates population-based outcomes for patients with extensive ( ≥4 centimeters) pure ductal carcinoma in-situ (DCIS). Local recurrence was 2% with mastectomy, 8% with breast conserving surgery (BCS) and radiotherapy and 16% with BCS alone. Mastectomy remains a standard local treatment for extensive DCIS, while BCS and radiotherapy may be reasonably considered in selected patients with a careful discussion of the benefits and side effects. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - September 22, 2018 Category: Radiology Authors: Sarah Nicole Hamilton, Alan Nichol, Elaine Wai, Lovedeep Gondara, H éctor A. Velásquez García, Caroline Speers, Rekha Diocee, Pauline Truong Tags: Clinical Investigation Source Type: research

Dosimetric benefits of mid-position compared with internal target volume strategy for esophageal cancer radiation therapy
Two strategies to account for respiration-induced target motion using 4D-CT in treatment planning of esophageal cancer patients (i.e., mid-position and internal target volume) were compared in 15 patients. Deformable image registration-based 4D-dose accumulation indicated adequate target coverage and a reduction of approximately 10% in the dose to the lungs, heart, and liver for the mid-position strategy. Our results suggest clinically relevant dosimetric benefits for the mid-position strategy and its feasibility of clinical implementation. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - September 22, 2018 Category: Radiology Authors: Peng Jin, M élanie Machiels, Koen F. Crama, Jorrit Visser, Niek van Wieringen, Arjan Bel, Maarten C.C.M. Hulshof, Tanja Alderliesten Tags: Physics Contribution Source Type: research

Predictors of early recurrence prior to planned post-operative radiation therapy for oral cavity squamous cell carcinoma and outcomes following salvage intensified radiation therapy
Identification of recurrence before planned PORT in OSCC is critical to allow treatment intensification. Retrospective review was performed for 601 OSCC patients treated with PORT following curative-intent surgery. We have identified rates and risk factors of early recurrence, and predictors of outcomes following salvage therapy with higher dose PORT+/-concurrent chemotherapy. Understanding the characteristics and outcomes of this very high-risk group may allow alternate treatment strategies to be explored in the future. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - September 20, 2018 Category: Radiology Authors: Ali Hosni, Shao Hui Huang, Kevin Chiu, Wei Xu, Jie Su, Andrew Bayley, Scott V. Bratman, John Cho, Meredith Giuliani, John Kim, Brian O ’Sullivan, Jolie Ringash, John Waldron, Anna Spreafico, Eugene Yu, John R. de Almeida, Eric Monteiro, Douglas B. Chepe Tags: Clinical Investigation Source Type: research

Late Sequelae of Childhood and Adolescent Nasopharyngeal Carcinoma Survivors after Radiotherapy
This study examined the long-term sequelae of children and adolescent nasopharyngeal carcinoma (NPC) survivors after radiotherapy. Comparing with convention radiotherapy treatment (CRT), intensity-modulated radiotherapy treatment (IMRT) can potentially ameliorate xerostomia, dysphagia and otitis media in survivors. Besides, patients younger than 10 years old had a higher cumulative incidence (CI) of blurred vision. Moreover, a dose of more than 72 Gray (Gy) to primary tumor increased the CI of hearing loss, lalopathy and cranial nerve injury. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - September 20, 2018 Category: Radiology Authors: Suying Lu, Jiawang Wei, Feifei Sun, Weiwei Xiao, Ruiqing Cai, Zijun Zhen, Jia Zhu, Juan Wang, Junting Huang, Lixia Lu, Xiaofei Sun, Yuanhong Gao Tags: Clinical Investigation Source Type: research

Adjuvant Chemotherapy in Rectal Cancer Patients Treated with Preoperative Chemoradiation and Total Mesorectal Excision: A Multicenter and Retrospective Propensity-Score Matching Study
In this multi-institutional and retrospective analysis, we evaluated 1,442 patients with rectal cancer who received preoperative chemoradiotherapy (CRT) and curative surgery. After propensity-score matching, 1,225 patients who received adjuvant chemotherapy were matched with the 217 observed patients after curative surgery in a 1:4 ratio. After matching analysis, 5-FU based adjuvant chemotherapy after preoperative CRT followed by total mesorectal excision was not significantly associated with improved relapse-free survival for patients with locally advanced rectal cancer. (Source: International Journal of Radiation Oncolog...
Source: International Journal of Radiation Oncology * Biology * Physics - September 20, 2018 Category: Radiology Authors: Mi Joo Chung, Joo Hwan Lee, Jong Hoon Lee, Sung Hwan Kim, Jin Ho Song, Songmi Jeong, Mina Yu, Taek Keun Nam, Jae Uk Jeong, Hong Seok Jang Tags: Clinical Investigation Source Type: research

Tumor trailing for liver SBRT on the MR-Linac
This study investigates whether tumor trailing on the MR-Linac can improve target coverage in liver SBRT in the case of baseline motion. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - September 19, 2018 Category: Radiology Authors: Martin Fast, Agustinus van de Schoot, Tessa van de Lindt, Casper Carbaat, Uulke van der Heide, Jan-Jakob Sonke Tags: Physics Contribution Source Type: research

p53-loss mitigates early volume deficits in the brains of irradiated young mice
In the brain, radiation-induced apoptosis is largely mediated by p53. We used longitudinal magnetic resonance imaging in a mouse model to map radiation-induced changes in neuroanatomy and quantified the impact of knocking out p53. We observed mitigation of radiation-induced volume loss by p53-knockout one week after treatment, but this was not maintained to adulthood due to decreased growth. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - September 19, 2018 Category: Radiology Authors: A. Elizabeth de Guzman, Mashal Ahmed, Yu-Qing Li, C. Shun Wong, Brian J. Nieman Tags: Biology Contribution Source Type: research

Salary and Resources Provided to Junior Faculty in Radiation Oncology
Adequate resource allocation is essential for junior radiation oncology faculty to navigate the road to academic advancement. We surveyed junior academic radiation oncologists in the US and Canada using a pre-tested questionnaire evaluating: time, space, staff, start-up resources, and compensation. Our findings suggest perceived needs for protected time and personnel support. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - September 18, 2018 Category: Radiology Authors: Nafisha Lalani, Kent A. Griffith, Rochelle D. Jones, Kyle Cuneo, Reshma Jagsi Source Type: research

The impact of radiation therapy on lymphocyte count and survival in metastatic cancer patients receiving PD-1 immune checkpoint inhibitors
The impact of radiation therapy on circulating lymphocyte count and survival in metastatic cancer patients receiving immune checkpoint inhibitors (ICI) is unknown. In this retrospective review of 110 patients with metastatic NSCLC, melanoma, or RCC who received RT and PD-1 inhibitors, patients treated with>5 fractions of extracranial RT were more likely to experience severe lymphopenia ( (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - September 15, 2018 Category: Radiology Authors: Luke R.G. Pike, Andrew Bang, Brandon A. Mahal, Allison Taylor, Monica Krishnan, Alexander Spektor, Daniel N. Cagney, Ayal A. Aizer, Brian M. Alexander, Osama Rahma, Tracy Balboni, Patrick A. Ott, F. Stephen Hodi, Jonathan D. Schoenfeld Tags: Clinical Investigation Source Type: research

A 63-Year-Old Woman With a Pineal Mass
A 63-year-old woman (Karnofsky performance status 80) presented with a several-month history of shuffling gait, frontal headache, and urinary urgency. Magnetic resonance imaging of the brain demonstrated hydrocephalus secondary to a 2.7-cm, fairly well demarcated, enhancing mass in the pineal gland (Fig.  1). The patient underwent suboccipital craniotomy and gross total resection, with pathology demonstrating a pineal parenchymal tumor of intermediate differentiation (World Health Organization II vs III, favoring grade III) with MIB-1 index of 10% (1). (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - September 14, 2018 Category: Radiology Authors: Paul Renz, Shaakir Hasan Tags: Gray Zone Source Type: research

Not to Treat
Pineal tumors of intermediate differentiation are pineal parenchymal tumors that appear histologically more aggressive than World Health Organization grade I pineocytomas. The prognosis of pineal tumors of intermediate differentiation is actually similar to that of pineocytomas in the setting of gross total resection (GTR), though they do have a higher rate of both local recurrence and leptomeningeal dissemination than lower-grade tumors. Given their rarity and the retrospective nature of the reports, the literature is limited to inform clinical management. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - September 14, 2018 Category: Radiology Authors: Michael Chan Tags: Gray Zone Source Type: research

Resection Bed Only
Data guiding management of pineal parenchymal tumors of intermediate differentiation (PPTID) are limited because they are rare and difficult to interpret owing to reclassification in 2007. Adjuvant radiation therapy (RT) appears beneficial. In the largest analysis of PPTID, adjuvant RT was associated with improved overall survival, whereas chemotherapy had no impact (1). The leptomeningeal recurrence rate was 11.8%, suggesting that not all patients require craniospinal irradiation (CSI). In a series of histopathologically reviewed pineal parenchymal tumors, none recurred in patients who underwent gross total resection (2)....
Source: International Journal of Radiation Oncology * Biology * Physics - September 14, 2018 Category: Radiology Authors: Martin Tom, Erin S. Murphy Tags: Gray Zone Source Type: research

Defining the Place of Adjuvant Chemotherapy and Radiation for High-Risk Endometrial Cancer From Recent Randomized Clinical Trials: Some Answers, More Questions
Endometrial carcinoma is the most common gynecologic malignancy. Most patients present with early stage disease,  but in about 10% to 15% of all new cases of endometrial cancer, disease is found outside the uterus at diagnosis. These patients account for more than 50% of all uterine cancer–related deaths. They are treated with adjuvant chemotherapy (CT) and/or radiation therapy (RT), although we do not kno w the true impact of adjuvant treatment on survival (1). This issue's Oncology Scan covers 3 recently presented or published prospective trials—Gynecology Oncology Group (GOG)-258 (2), GOG-249 ...
Source: International Journal of Radiation Oncology * Biology * Physics - September 14, 2018 Category: Radiology Authors: Kevin Albuquerque, Junzo Chino, Ann Klopp, Mitchell Kamrava, Sushil Beriwal Tags: Feature Source Type: research

In Reply to Fakhry et  al
To the Editor: We would like to thank Fakhry et  al for their comments and constructive observations with regard to the validation of their nomograms of oropharyngeal cancer that we performed in our retrospective series of consecutive patients who had complete clinical data (1-3). (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - September 14, 2018 Category: Radiology Authors: Paolo Bossi, Rosalba Miceli, Roberta Granata, Simona Naimo, Gabriele Infante, Laura Deborah Locati, Nicola Alessandro Iacovelli, Carlo Fallai, Ester Orlandi, Lisa Licitra Tags: Comment Source Type: research

In Regard to Bossi et  al
Bossi et  al undertook an independent evaluation of the NRG oropharynx squamous cell cancer nomograms (1, 2). To do so, they retrospectively extracted relevant data, some of which may be difficult to ascertain from the medical record (tobacco use, marital status, weight loss, performance status, education , and survival outcomes). Presumably, more than 184 patients with oropharynx cancer were treated at their high-volume center between 2004 and 2016. Perhaps it is not surprising that there appear to be distinct differences between the NRG clinical trial study populations and the Bossi et al cl...
Source: International Journal of Radiation Oncology * Biology * Physics - September 14, 2018 Category: Radiology Authors: Carole Fakhry, Phuc Felix Nguyen-T ân, Louise Lambert, David I. Rosenthal, Randal S. Weber, Maura L. Gillison, Andy M. Trotti, William L. Barrett, Wade L. Thorstad, Christopher U. Jones, Sue S. Yom, Stuart J. Wong, John A. Ridge, Shyam S.D. Rao, James A. Tags: Comment Source Type: research

Implementing Radiation Therapy in Haiti: Current Status and Future Directions
This report reviews the status of cancer care and implementation of radiation therapy in Haiti. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - September 14, 2018 Category: Radiology Authors: Shefali R. Gajjar, Joseph Bernard, Jean Cantave, Nalia Cruz Ventura, Jean Ronald Cornely, Ruth Damuse, Pascale Yola Gassant Heurtelou, Adam J. Luginbuhl, Maxi Raymondville, Vincent DeGennaro Tags: Feature Source Type: research

Evidence-based Risk Stratification to Guide Hormone Therapy Use With Salvage Radiation Therapy for Prostate Cancer
Analogous to the overtreatment of men with intact prostate cancer, there is an increase in the use of hormone therapy for men receiving salvage radiation therapy (SRT) for biochemical recurrence. We are fortunate to now have 2 published randomized trials, Radiation Therapy Oncology Group (RTOG) 9601 and GETUG-AFU-16, to help inform us of the potential benefits and harms of hormone therapy in this patient population (1, 2). However, an oversimplification of the results from these trials appears to have led to the notion that all men undergoing SRT should receive hormone therapy. (Source: International Journal of Radiation O...
Source: International Journal of Radiation Oncology * Biology * Physics - September 14, 2018 Category: Radiology Authors: Daniel E. Spratt Tags: Clinical Investigation Source Type: research

In Regard to Jang et  al
To the Editor: We read with great interest the recent article by Jang et  al reporting their findings that more than half of radiation oncology residency applicants completed an elective rotation at the institution at which they later matched (1). They report that applicants completed a median of 3 rotations, including 1 at their home institution. The authors state that the data suggest that performing multiple elective rotations helped some applicants secure their residency positions. They balance the benefit of allowing students to familiarize themselves with the program against the drawback of losing time for other...
Source: International Journal of Radiation Oncology * Biology * Physics - September 14, 2018 Category: Radiology Authors: Ye Lin, Daniel W. Golden Tags: Comment Source Type: research

In Reply to Lin and Golden
To the Editor: We would like to thank Dr. Golden and colleagues for their thoughtful input regarding our recent study (1, 2). They raise an important point regarding the use of elective rotations and the opportunity costs associated with  a prolonged focus on 1 specialty during medical school (3, 4). (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - September 14, 2018 Category: Radiology Authors: Samuel Jang, Stephen A. Rosenberg, Kristin A. Bradley, Randall J. Kimple Tags: Comment Source Type: research

Professor Gerrit Willem (Eddie) Barendsen, August 14, 1927 – June 20, 2018
Professor Eddie Barendsen, also known as “Mr. Linear Quadratic Model,” has peacefully passed away. In the early 1960s, the Holy Grail of radiobiology was to predict the biological and clinical response to radiation using biophysical principles and to describe this dose-response relationship in a mathematical equation. Many radiobiologi cal models came and went, and it took Barendsen more than 20 years to publish what became known as the linear quadratic (LQ) model. In its original version, Barendsen formulated the cellular survival S(D) curve after irradiation dose D as an inverse exponential function depe...
Source: International Journal of Radiation Oncology * Biology * Physics - September 14, 2018 Category: Radiology Authors: Nicolaas A.P. Franken, Lukas J.A. Stalpers, Johannes Crezee Tags: Feature Source Type: research