Predictors of Radiation-Induced Liver Disease in Eastern and Western Patients with Hepatocellular Carcinoma Undergoing Proton Beam Therapy
The optimal dose-volumetric indices to prevent radiation-induced liver disease (RILD) remain unclear in hepatoma patients undergoing proton beam therapy (PBT). This multi-institutional study demonstrated the unirradiated liver volume to standard liver volume ratio (ULV/SLV) as the most crucial RILD predictor. Distinct from photon radiotherapy, mean liver dose is not an independent RILD determinant. Our results indicate that doses ≥1 GyE could cause hepatic complications, and preserving sufficient ULV/SLV is imperative to prevent RILD in PBT. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 21, 2019 Category: Radiology Authors: Cheng-En Hsieh, Bhanu Prasad Venkatesulu, Ching-Hsin Lee, Sheng-Ping Hung, Pei-Fong Wong, Sathvik Panambur Aithala, Byung Kyu Kim, Arvind Rao, Joseph Tung-Chieh Chang, Ngan-Ming Tsang, Chun-Chieh Wang, Chung-Chi Lee, Chen-Chun Lin, Jeng-Hwei Tseng, Wen-Ch Tags: Clinical Investigation Source Type: research

Phenotype-Oriented Ablation of Oligometastatic Cancer With Single Dose Radiotherapy
Inherent biological drivers of the oligometastatic (OM) state determine conversion to polymetastatic (PM) dissemination over the impact of effective OM ablation by ultra-high dose radiotherapy. Baseline volumetric and metabolic OM metrics derived from PET/CT scanning before radioablation predict long-term PM conversion post-ablation, categorizing diverse OM phenotypes by susceptibility to PM conversion. The PET/CT platform provides guidelines for phenotype-driven OM therapy and promotes discovery of tractable PM conversion drivers as targets for new experimental treatments. (Source: International Journal of Radiation Oncol...
Source: International Journal of Radiation Oncology * Biology * Physics - February 21, 2019 Category: Radiology Authors: Carlo Greco, Oriol Pares, Nuno Pimentel, Vasco Louro, Javier Morales, Beatriz Nunes, Joana Castanhera, Carla Oliveira, Angelo Silva, Sofia Vaz, Durval Costa, Michael Zelefsky, Richard Kolesnick, Zvi Fuks Tags: Clinical Investigation Source Type: research

James Daniel Cox, MD, FASTRO, FACR
James D. Cox, MD, was born in Steubenville, Ohio, and died in Houston, Texas, on August 14, 2018, 1 month after celebrating his 80th birthday with his family. At the time of his death, Jim was professor emeritus in the Department of Radiation Oncology at the University of Texas MD Anderson Cancer Center, where he had served for the last 30 years. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 20, 2019 Category: Radiology Authors: J. Frank Wilson, Thomas A. Buchholz, Ritsuko Komaki Tags: Feature Source Type: research

Stereotactic Radiation for Ultra-Central Lung Tumors: Good Idea, or Ultra-Risky?
The dangers of treating patients with stereotactic ablative radiation therapy (SABR) for tumors in the “No Fly Zone” have been recognized for more than a decade.1 In 2006, a paradigm-changing phase 2 trial reported excessive toxicity with SABR doses of 60 to 66 Gy in 3 fractions for tumors within 2 cm of the proximal bronchial tree (PBT). The 2-year freedom from severe toxicity was only 54% for patients with central tumors, compared with 83% for those with peripheral tumors.1 (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 20, 2019 Category: Radiology Authors: David Palma, Megan Daly, James Urbanic, Meredith Giuliani Tags: Feature Source Type: research

The Headache of Hearing Loss
A 69-year-old woman presented to the emergency department with a worsening headache in the setting of a 5-year history of progressive right-sided hearing loss. Noncontrast magnetic resonance imaging (Fig.  1) revealed a 2.8 cm right cerebellopontine angle mass extending from the internal auditory canal with effacement of the fourth ventricle and associated normal pressure hydrocephalus. The patient underwent ventriculoperitoneal shunt placement by neurosurgery, which abated her headache. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 20, 2019 Category: Radiology Authors: Shearwood McClelland, Gordon A. Watson Tags: Gray Zone Source Type: research

Practicing Pura Vida: Radiation Therapy in Costa Rica
Although perhaps better known for its beautiful beaches, temperate climate, volcanoes, tourist locations, and pura vida (translated as “pure” or “simple life”) lifestyle, Costa Rica continues its development of an internationally respected health care system. Radiation therapy is an integral and expanding part of oncologic services in Costa Rica. Similar to previous Around the Globe articles,1 this article will focus on the current state and future direction of radiation therapy services in Costa Rica, specifically addressing geographically unique features such as medical tourism and building a tech...
Source: International Journal of Radiation Oncology * Biology * Physics - February 20, 2019 Category: Radiology Authors: Alejandro Blanco Sabor ío, Rolando Loría Ruíz, Steven W. Davis Tags: Feature Source Type: research

With Regard to the Brainstem, Size Matters Most
The differential diagnosis for an enhancing lesion in the cerebellopontine angle includes vestibular schwannoma, metastasis, meningioma, lymphoma, or glioma. However, in an adult with a history of progressive hearing loss, the radiographic features of this lesion —a homogeneous enhancement pattern, classic “ice cream cone” appearance as the lesion grows medially with extracanalicular extension, and intracanalicular widening to create the so-called “trumpet sign”—are pathognomic for vestibular schwannoma. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 20, 2019 Category: Radiology Authors: Luke R.G. Pike, Michael J. McKenna, Helen A. Shih Tags: Gray Zone Source Type: research

Preserve the Facial Nerve
Magnetic resonance imaging shows typical radiographic features of a vestibular schwannoma (Koos grade 4, tumor deforming the pons, and shifting of the fourth ventricle), including the lack of surrounding edema in the compressed pons and the extension into the internal acoustic meatus.1 Typically, a neuroradiological diagnosis of vestibular schwannoma is sufficient and no biopsy is required. Beause lack of hearing is Gardner-Robertson grade 5 in the right ear, preservation of the right V and VII nerve functions are most important. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 20, 2019 Category: Radiology Authors: Simon S. Lo, Eric L. Chang Tags: Gray Zone Source Type: research

Resection First
The imaging findings are classic for a vestibular schwannoma: tumor arising from the internal acoustic canal that is hypointense on precontrast and hyperintense on postcontrast T1 magnetic resonance imaging scans.1 The presence of hypointense cysts in the periphery of the tumor is also consistent with a vestibular schwannoma.2 Given the classic imaging findings, tissue confirmation before making a treatment recommendation has little value. Because the local control with either radiation therapy or surgery is excellent,3,4 clinicians should prioritize risk for side effects and preservation of cranial nerve function when dec...
Source: International Journal of Radiation Oncology * Biology * Physics - February 20, 2019 Category: Radiology Authors: Ehsan H. Balagamwala, John H. Suh Tags: Gray Zone Source Type: research

Erratum to: Park I, Yang H, Park JS et  al. VEGF-Grab Enhances the Efficacy of Radiation Therapy by Blocking VEGF-A and Treatment-Induced PlGF. Int J Radiat Oncol Biol Phys 2018;102:609-618.
The affiliation of Eun Kyung Choi was listed incorrectly. It has been corrected to exclude one of the original affiliation (Institute for Innovative Cancer Research) and include ‘University of Ulsan, College of Medicine’ in the last affiliation. The correct list of authors and affiliations are listed below. The authors regret the error. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 20, 2019 Category: Radiology Tags: Erratum Source Type: research

Impact of MRI Timing on Accuracy of Stereotactic Radiosurgical Planning: Visualizing the Forest From the Trees
To the Editor: We read with interest the excellent prospective investigation by Salkeld et  al examining changes in brain metastases and resection cavity volumes between the initial planning magnetic resonance imaging (MRI) scans obtained before stereotactic radiosurgery (SRS) versus those obtained 24 hours before SRS.1 Their work revealed that for MRI scans obtained with ≤7 days bet ween scans, a change in management was required in 41% of patients; for MRI scans obtained>7  days apart, nearly 80% of patients required a change in management. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 20, 2019 Category: Radiology Authors: Shearwood McClelland, Gordon A. Watson Tags: Comment Source Type: research

In Regard to Renz et  al
To the Editor: We would like to comment on the recently published retrospective review by Renz et  al on adjuvant radiation therapy (RT) for excised keloids.1 Most patients in this series received 20 Gy in 5 fractions at 1 institution versus 12 Gy in 3 fractions or 16 Gy in 4 fractions at a second institution. Three other schedules were also used (18 Gy in 3 fractions, 15 Gy in 3 fractions , and 10 Gy in 2 fractions) for small numbers of patients. The authors concluded that there was a dose-response relationship for local control, with recurrence rates of 1.6% for the 20 Gy in 5 frac...
Source: International Journal of Radiation Oncology * Biology * Physics - February 20, 2019 Category: Radiology Authors: Daniel E. Roos, Jennifer G. Smith Tags: Comment Source Type: research

In Reply to Roos and Smith
To the Editor: We appreciate the commentary by the doctors, and in response we wish to fully comment and clarify our methodology and rationale for our conclusions.1 (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 20, 2019 Category: Radiology Authors: Mark Trombetta, Shaakir Hasan, Paul Renz Tags: Comment Source Type: research

Jim Cox: A Tribute
Jim Cox was the perfect editor-in-chief. He was fair, objective, decisive, firm, and determined. He did not regard The International Journal of Radiation Oncology, Biology, Physics as an extension of himself, though he did have a clear vision for the journal. In his role as editor, he well understood the obligation he had to the international radiation oncology community to ensure that, by means of the peer-review process, all research reported in the journal was of the highest caliber possible. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 20, 2019 Category: Radiology Authors: Beth Notzon Tags: Feature Source Type: research

Hematologic Malignancies Abstracts Table of Contents
(Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 20, 2019 Category: Radiology Source Type: research

Long-Term Outcomes in 10-Year Survivors of Early-Stage Hodgkin Lymphoma
The progression-free survival benefit of radiotherapy (RT) in patients with early-stage Hodgkin lymphoma (HL) has been affirmed by numerous prospective trials. However, concerns regarding late RT effects have resulted in a decline in the use of RT in recent years. We aimed to investigate differences in overall survival (OS) among 10-year survivors of early-stage HL to further elucidate long-term treatment risks. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 20, 2019 Category: Radiology Authors: J.E. Bates, N.P. Mendenhall, R.T. Hoppe, L.S. Constine, B.S. Hoppe Tags: Oral Abstracts Source Type: research

The Management of Primary Mediastinal B Cell Lymphoma Refractory to Dose-Adjusted R-EPOCH alone
Primary mediastinal B-cell lymphoma (PMBCL) is a subtype of diffuse large B-cell lymphoma that generally affects young adults. Patients often present with bulky, symptomatic mediastinal masses. Until recently the standard of care therapy was doxorubicin based immune-chemotherapy followed by consolidative radiation therapy. In the United States many practitioners now elect for dose adjusted R-EPOCH immune-chemotherapy without planned RT based on encouraging phase 2 trial data with event free survival rates over 90%. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 20, 2019 Category: Radiology Authors: C.C. Pinnix, S.A. Milgrom, J.R. Gunther, L. Nastoupil, B. Dabaja Source Type: research

Radiotherapy is an Effective Definitive Treatment for Limited Stage Grade 3A Follicular Lymphoma
While radiotherapy (RT) is established as a highly effective strategy for limited stage, grade 1-2 follicular lymphoma (FL), the treatment of grade 3A disease remains controversial. We sought to review outcomes of grade 3A patients treated definitively with RT. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 20, 2019 Category: Radiology Authors: E. Goldberg, B.S. Imber, K. Chau, E. Joffe, J. Yahalom Source Type: research

Successful treatment of debilitating back pain, in patient with polycythemia vera, with fractionated low-dose external-beam-radiation-therapy
Bone pain as the presenting symptom in polycythemia vera (PV) is rare, especially without the diagnosis of myelofibrosis (MF). Pain, however, can manifest as a late symptom in approximately 50% of patients with the diagnosis. The cause of pain has been attributed to hematopoiesis, periostitis, and osteosclerosis. Pain is usually progressive and eventually refractory to pain regimens, and durable treatments are limited. Radiation therapy has been used in the management of different conditions associated with PV, including splenomegaly, extramedullary hematopoiesis, etc. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 20, 2019 Category: Radiology Authors: A.O. Wright, W.J. Kil, M. Khan Source Type: research

Robust Planning Reduces Toxicity in the Treatment of Head and Neck (HN) Pediatric Hodgkin ’s Lymphoma (PHL)
PHL radiotherapy can cause delayed toxicity due to a large irradiated volume. Decreasing toxicity by reducing the volume of irradiated normal tissue is of interest (i.e., PTV elimination). (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 20, 2019 Category: Radiology Authors: J.A. Penagaricano, X. Zhang, G. Narayanasamy Source Type: research

Prevalence of depression and anxiety among cancer patients in small town in India: Single Centre study
Depression and anxiety in cancer patients is a common comorbidity, therefore can deteriorate ones ’ Quality of Life. HADS (Hospital Anxiety and Depression Scale) is a reliable instrument used to asses these psychological issues. To assess the predominance of depression and anxiety, this review was conducted. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 20, 2019 Category: Radiology Authors: A. Tiwari Tags: Publish Only Source Type: research

Jim Cox —The Passing of an Era
The Red Journal was created more than 4 decades ago to capture and disseminate the science of the new specialty of radiation oncology. Since its birth, the journal has had only 3 editors in chief, their lengthy tenures testifying to their devout belief in the power of a good scientific journal to steward the advancement of a specialty. Editorship is, by its nature, an unselfish labor —selecting, improving, and promoting others' work because you deeply believe that the circulation of new findings, or new perspectives, will improve medicine as a whole. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 20, 2019 Category: Radiology Authors: Sue S. Yom, Anthony L. Zietman Tags: Feature Source Type: research

Issue Highlights
Yom and Zietman (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 20, 2019 Category: Radiology Source Type: research

Meetings
March 14-16, 2019 (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 20, 2019 Category: Radiology Source Type: research

Pravastatin Reverses Established Radiation-Induced Cutaneous and Subcutaneous Fibrosis in Patients with Head and Neck Cancer: Results of the Biology-Driven Phase Ii Clinical Trial Pravacur
Previous preclinical investigations based on the inhibition of the Rho/ROCK/CTGF pathway brought the biological rationale for this bicentric phase II clinical trial on the use of statins for the treatment of established radio-induced fibrosis. This trial showed that pravastatin (40mg/day for 12 months) is a safe and efficient anti-fibrotic agent in patients with established grade ≥2 cutaneous and subcutaneous fibrosis after head and neck cancer radiotherapy. These results support the concept of fibrosis reversibility. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 15, 2019 Category: Radiology Authors: Celine Bourgier, Anne Auperin, Sofia Rivera, Pierre Boisselier, Benoit Petit, Philippe Lang, Nathalie Lassau, Patrice Taourel, Raphael Tetreau, David Azria, Jean Bourhis, Eric Deutsch, Marie-Catherine Vozenin Tags: Clinical Investigation Source Type: research

Optimized Hypofractionation can Markedly Improve Tumor Control and Decrease Late Effects for Head and Neck Cancer
Radiotherapy of rapidly-growing HPV-negative head and neck cancers (HNC) remains challenging. We use systematic radiobiological optimization, focusing on improved models of accelerated repopulation, to identify optimized fractionation schemes that markedly improve tumor control probability (TCP) as well as sharply decreasing the late normal tissue complication probability (LNTCP), compared with standard 35 × 2 Gy fractionation. An optimized hypofractionated HNC schedule of 18×3.0 Gy is predicted to substantially increase TCP and decrease LNTCP. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 15, 2019 Category: Radiology Authors: Igor Shuryak, Eric J. Hall, David J. Brenner Tags: Physics Contribution Source Type: research

5-Year Outcomes of a Single Institution Prospective Trial of 19 Gy Single-Fraction HDR Brachytherapy for Low- and Intermediate-Risk Prostate Cancer
We previously reported preliminary results of our 19 Gy single-fraction HDR brachytherapy protocol for low/intermediate-risk prostate cancer showing favorable efficacy and toxicity. Here we report that the long-term results have demonstrated a highly favorable toxicity profile, but with a higher than expected rate of local failure. We therefore recommend against treatment with this dose fractionation and hope to see further study of dose escalation with single-fraction regimens. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 13, 2019 Category: Radiology Authors: Zaid A. Siddiqui, Gary S. Gustafson, Hong Ye, Alvaro A. Martinez, Beth Mitchell, Evelyn Sebastian, Amy Limbacher, Daniel J. Krauss Tags: Clinical Investigation Source Type: research

Outcomes After Reduced-Dose Intensity Modulated Radiation Therapy for Gastric Mucosa- Associated Lymphoid Tissue (MALT) Lymphoma
We evaluated the outcome of patients with gastric mucosa-associated lymphoid tissue (gMALT) lymphoma treated with intensity modulated radiation therapy and involved site targeting. The 2-year freedom from local treatment failure rate was 100% and 2-year overall survival was 97%. There was no difference in outcome among patients treated with standard RT doses of 30-36 Gy compared to those who received reduced RT doses of 24 Gy. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 12, 2019 Category: Radiology Authors: Chelsea C. Pinnix, Jillian R. Gunther, Sarah A. Milgrom, Ruben J. Cruz Chamorro, L.Jeffrey Medeiros, Joseph D. Khoury, Behrang Amini, Sattva Neelapu, Hun Lee, Jason Westin, Nathan Fowler, Loretta Nastoupil, Bouthaina Dabaja Tags: Clinical Investigation Source Type: research

Hyperthyroidism Following Radiation Therapy for Childhood Cancer: A Report from the Childhood Cancer Survivor Study
The association of hyperthyroidism with exposure to ionizing radiation is poorly understood. We evaluated the occurrence of hyperthyroidism in relation to incidental therapeutic radiation dose to the thyroid and pituitary glands among 12,183 childhood cancer survivors based on individualized radiation dosimetry and serial questionnaires to ascertain hyperthyroidism. Risk of hyperthyroidism was positively associated with radiation dose to the thyroid gland, but not the pituitary gland, with radiation-related excess risk persisting for> 25 years. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 12, 2019 Category: Radiology Authors: Peter D. Inskip, Lene H.S. Veiga, Alina V. Brenner, Alice J. Sigurdson, Evgenia Ostroumova, Eric J. Chow, Marilyn Stovall, Susan A. Smith, Wendy Leisenring, Leslie L. Robison, Gregory T. Armstrong, Charles A. Sklar, Jay H. Lubin Source Type: research

The optimal use of imaging in Radiation Therapy for lymphoma – Guidelines from the International Lymphoma Radiation Oncology Group (ILROG)
The objective of this manuscript is to provide guidelines for best practice of use of imaging in pre-treatment evaluation, treatment choice, RT target volume definition, and RT treatment verification and delivery. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 11, 2019 Category: Radiology Authors: N.George Mikhaeel, Sarah A. Milgrom, Stephanie Terezakis, Anne Kiil Berthelsen, David Hodgson, Hans Theodor Eich, Karin Dieckmann, Shu-nan Qi, Joachim Yahalom, Lena Specht Tags: Critical Review Source Type: research

Cardiac Function After Radiotherapy for Breast Cancer
The relationship between individual cardiac dose distributions and systolic and diastolic dysfunction is unclear. We conducted a cross-sectional study consisting of 109 breast cancer survivors treated with post-operative radiotherapy (RT). The endpoint was systolic and diastolic cardiac function, assessed by echocardiography. Although no relation between RT dose parameters and left ventricle ejection fraction was found, an association between individual RT dose and global longitudinal systolic strain of the left ventricle was determined. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 11, 2019 Category: Radiology Authors: Veerle A.B. van den Bogaard, Peter van Luijk, Yoran M. Hummel, Peter van der Meer, E. Schuit, Liselotte M. Boerman, Saskia W.M.C. Maass, Jan.F. Nauta, Lars C. Steggink, Jourik A. Gietema, Geertruida H. de Bock, Annette J. Berendsen, Wilma G.J.M. Smit, Nan Tags: Clinical Investigation Source Type: research

Reduced-dose Radiation Therapy to the Primary Site is Effective for High-risk Neuroblastoma: Results from a Prospective Trial
We developed a prospective radiation dose-reduction protocol for patients with high-risk neuroblastoma, with the goal of maintaining disease control while reducing late morbidity. We found that dose reduction from 21 Gy to 18 Gy after gross total resection did not compromise local control or survival outcomes in our cohort of 25 patients with high-risk neuroblastoma. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 11, 2019 Category: Radiology Authors: Dana L. Casey, Brian H. Kushner, Nai-Kong V. Cheung, Shakeel Modak, Ellen M. Basu, Stephen S. Roberts, Michael P. LaQuaglia, Suzanne L. Wolden Tags: Clinical Investigation Source Type: research

Corneal Substructure Dosimetry Predicts Corneal Toxicity in Patients with Uveal Melanoma Treated with Proton Beam Therapy
In patients with uveal melanoma treated with proton beam therapy, we examine the relationships of tumor-related factors and corneal dose-volume parameters with incidence of grade 2+ intervention-requiring corneal toxicity. Patients with anterior uveal melanomas experience a high rate of GR2+ corneal toxicity due to increased corneal dose. Anterior location and corneal DVH parameters independently predict toxicity risk. We propose dosimetric constraints to facilitate treatment planning and toxicity mitigation. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 11, 2019 Category: Radiology Authors: Howard J. Lee, Andrew Stacey, Todd R. Klesert, Craig Wells, Alison Skalet, Charles Bloch, Angela Fung, Stephen R. Bowen, Tony P. Wong, Dean Shibata, Lia M. Halasz, Ramesh Rengan Tags: Clinical Investigation Source Type: research

Mind the gap: an analysis of ‘gap year’ prevalence, productivity, and perspectives among radiation oncology residency applicants
We analyzed ERAS and survey data regarding the use of a “gap year” among applicants to radiation oncology. One-third of non-PhD applicants take gap years primarily for research productivity. Most gap year students report external funding as difficult to obtain and over half rely on personal funding. With perceived belief that gap years are important for matching, this data raises questions about whether potential applicants are being deterred, affecting the demographics of radiation oncology overall. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 11, 2019 Category: Radiology Authors: Baho Sidiqi, Erin Gillespie, Chunyu Wang, Melissa Dawson, Abraham J. Wu Tags: Clinical Investigation Source Type: research

Patterns of Failure and Survival Outcomes After Total Lymphoid Irradiation and High-Dose Chemotherapy With Autologous Stem Cell Transplantation for Relapsed or Refractory Classical Hodgkin Lymphoma
The strategy of combined sequential salvage chemotherapy, total lymphoid irradiation, high-dose chemotherapy and transplant has been shown to result in good long-term outcomes in patients with refractory or recurrent Hodgkin lymphoma. We used the posttreatment scans to precisely study the patterns of failure and found that most patients failed less than a year after the transplant within the irradiated volume, reflecting treatment-resistant biology. Efforts should continue to identify more effective systemic treatments. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 11, 2019 Category: Radiology Authors: Nitika Paudel, Derek Schulze, Ryan D. Gentzler, Andrew M. Evens, Irene Helenowski, Gary Dillehay, Olga Frankfurt, Jayesh Mehta, Eric D. Donnelly, Leo I. Gordon, Jane N. Winter, Bharat B. Mittal Tags: Clinical Investigation Source Type: research

Endothelial Cell-Derived Extracellular Vesicles Mitigate Radiation- Induced Hematopoietic Injury
Ionizing radiation causes morbidity and mortality in part due to injury to the hematopoietic system. We demonstrate that either syngeneic or allogeneic extracellular vesicles, which are generated from cultured primary marrow endothelial cells, can accelerate hematopoietic regeneration and prolong survival following radiation. These data indicate that endothelial cell-derived extracellular vesicles may be utilized clinically following either therapeutic or accidental radiation exposures. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 11, 2019 Category: Radiology Authors: Sadhna O. Piryani, Yiqun Jiao, Angel Y.F. Kam, Yang Liu, Tuan Vo-Dinh, Benny J. Chen, Nelson J. Chao, Phuong L. Doan Tags: Biology Contribution Source Type: research

Outcomes after Proton Therapy for Treatment of Pediatric High-Risk Neuroblastoma
We present the largest ever population of patients with neuroblastoma treated with proton therapy, demonstrating minimal toxicity and 97% local disease free survival. This treatment is safe and allows minimization of dose to normal tissues in young patients with neuroblastoma, who require intensive multimodality therapy. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 7, 2019 Category: Radiology Authors: Christine E. Hill-Kayser, Zelig Tochner, Yimei Li, Goldie Kurtz, Robert A. Lustig, Paul James, Naomi Balamuth, Richard Womer, Peter Mattei, Stephen Grupp, Yael P. Mosse, John M. Maris, Rochelle Bagatell Tags: Clinical Investigation Source Type: research

Using the Proton Energy Spectrum and Microdosimetry To Model Proton Relative Biological Effectiveness
Using Monte Carlo simulations, the microdosimetric kinetic model (MKM) was applied to three previously published proton relative biological effectiveness (RBE) studies. The MKM fitting was compared to a generic RBE model as a function of dose averaged linear energy transfer (LETD). Analysis of the fittings reveal no clear advantage to using one model over the other and we conclude that both the MKM and LETD based proton RBE models are appropriate. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 4, 2019 Category: Radiology Authors: Mark Newpower, Darshana Patel, Lawrence Bronk, Fada Guan, Pankaj Chaudhary, Stephen J. McMahon, Kevin M. Prise, Giuseppe Schettino, David R. Grosshans, Radhe Mohan Tags: Physics Contribution Source Type: research

Ten-year outcomes of moderately hypofractionated (70 Gy in 28 fractions) intensity modulated radiotherapy for localized prostate cancer
We present a large institutional series with over 11 years of follow up in 854 patients with localized prostate cancer treated with moderately hypofractionated (70 Gy in 28 fractions) intensity modulated radiation therapy (IMRT) with daily image guidance (IGRT). NCCN high risk patients composed 29% of the cohort. Outcomes beyond 10 years remained excellent, with low rates of late grade ≥ 3 GU and GI toxicities at 2 and 1%, respectively. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 2, 2019 Category: Radiology Authors: Ibrahim Abu-Gheida, Chandana A. Reddy, Rupesh Kotecha, Michael A. Weller, Chirag Shah, Patrick A. Kupelian, Omar Mian, Jay P. Ciezki, Kevin L. Stephans, Rahul D. Tendulkar Tags: Clinical Investigation Source Type: research

Outcomes of a Dose-Escalated Stereotactic Body Radiation Phase I/II trial for Patients with Low and Intermediate-Risk Prostate Cancer
This study presents a prospective phase I, IRB-approved dose-escalated stereotactic body radiotherapy (SBRT) trial for prostate cancer (CaP) to assess the impact of dose level on quality of life, toxicity, and clinical outcomes. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 2, 2019 Category: Radiology Authors: Louis Potters, Zaker Rana, Lucille Lee, Brett W. Cox Tags: Clinical Investigation Source Type: research

Treatment of WHO Grade 2 and 3 Gliomas With Potentially Favorable Survival: Is Monotherapy Obsolete?
Previous central nervous system oncology scans in this publication have discussed management and molecular characterization of low-grade gliomas, (1) treatment strategies for high-grade gliomas in the elderly, (2) emerging treatment options for glioblastoma (GBM), (3) and molecular characterization of gliomas (4). Similar to trends observed in other oncologic diseases, grading gliomas by their molecular characteristics is emerging as a useful tool for identifying patients with potentially long-term survival after treatment of this disease. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 1, 2019 Category: Radiology Authors: Scott G. Soltys, Nadia N. Laack, Lia M. Halasz, Giuseppe Minniti, Michael D. Chan, John P. Kirkpatrick Tags: Feature Source Type: research

To Treat, or Not to Treat, That is the Question for a 13-Month-Old Girl with Cranial Ependymoma and an Unknown Spinal Mass
The patient is a 13-month-old girl diagnosed with anaplastic ependymoma (World Health Organization grade 3). A presurgical magnetic resonance imaging (MRI) scan with and without contrast at an outside hospital revealed a 3.5  × 2.1 × 3.5 cm enhancing lesion located infratentorially with extension to the level of the C1 arch and through the right foramen of Luschka, moderate hydrocephalus, and no evidence of spinal involvement (eg, drop metastasis) (Fig. 1). A craniotomy was performed and revealed the mass to be attached to the floor of the fourth ventricle. (Source: Internatio...
Source: International Journal of Radiation Oncology * Biology * Physics - February 1, 2019 Category: Radiology Authors: Jason Domogauer, Shannon MacDonald Tags: Gray Zone Source Type: research

Individualization of Clinical Target Volume Delineation Based on Stepwise Spread of Nasopharyngeal Carcinoma: Outcome of More Than a Decade of Clinical Experience
Radiation-related toxicity in nasopharyngeal carcinoma (NPC) is common. There are no well-established guidelines for clinical target volume (CTV) delineation with long-term follow-up. Current consensus continues to rely heavily on bony landmarks and fixed margins around the gross tumor volume (GTV), an approach used to define fields in the conventional 2- and 3-dimensional radiation therapy era. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 1, 2019 Category: Radiology Authors: Nina N. Sanford, Jackson Lau, Miranda B. Lam, Amy F. Juliano, Judith A. Adams, Saveli I. Goldberg, Hsiao-Ming Lu, Yue C. Lu, Norbert J. Liebsch, Hugh D. Curtin, Annie W. Chan Tags: Clinical Investigation Source Type: research

The Management of Colorectal Cancer Liver Metastases: The Interventional Radiology Viewpoint
“Comparison of Stereotactic Body Radiation Therapy and Radiofrequency Ablation in the Treatment of Intrahepatic Metastases” by Jackson et al is a thought-provoking addition to the literature concerning treatment of colorectal cancer metastasis (CLM). The benefits of hepatic CLM resection are we ll established; however, most patients are not candidates for resection. Local tumor ablation is a safe and effective alternative treatment for select patients. Considerable research has evaluated percutaneous ablation as treatment of CLM, including retrospective reviews with long-term follow-up and prospective rand...
Source: International Journal of Radiation Oncology * Biology * Physics - February 1, 2019 Category: Radiology Authors: Samuel L. Rice, Reto Bale, David J. Breen, Thierry de Baere, Alban Denys, Boris Guiu, Nahum Goldberg, Edward Kim, Robert J. Lewandowski, Thomas Helmberger, Martijn Mejerjink, Philippe L. Pereira, Luigi Solbiati, Stephen B. Solomon, Constantinos T. Sofocle Tags: Feature Source Type: research

The Management of Colorectal Cancer Liver Metastases: The Radiation Oncology Viewpoint
Advances in technical precision and shortened treatment time in radiation therapy have established stereotactic body radiation therapy (SBRT) as an effective treatment option for oligometastatic disease. Liver SBRT has been shown to have a positive effect on patients' quality of life,1 local control (LC),2,3 and potentially overall survival.4 (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 1, 2019 Category: Radiology Authors: Aisling Barry, Rebecca Wong, Laura A. Dawson Tags: Feature Source Type: research

In Regard to Borm et  al
To the Editor: We read with great interest the article by Borm et  al on the lymph node atlas in breast cancer based on fluorodeoxyglucose-positron emission tomography.1 The authors should be commended for their laborious task of contouring lymph nodes and their high-quality analysis. They analyzed lymph node metastasis patterns based on contouring guidelines of the Radiation Therapy Oncology Group and the European Society for Radiotherapy and Oncology (ESTRO)2,3 and concluded that neither adequately covers lymph node metastasis. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 1, 2019 Category: Radiology Authors: Hwa Kyung Byun, Jee Suk Chang, Yong Bae Kim Tags: Comment Source Type: research

The Value of Surgical Exposure in Radiation Oncology Training
To the Editor: Radiation oncology residents are in a unique position to experience 1  year in a specialty separate from their own before beginning an integrated program. A broad knowledge base encompassing medical oncology, surgery, and radiology is necessary for radiation oncology training; postgraduate year 2 residents often enter with the same clinical expectations as senior-lev el residents. However, presently, very little time is dedicated to meaningful surgical exposure in medical school and preliminary/transitional year programs. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 1, 2019 Category: Radiology Authors: Shraddha M. Dalwadi, Bin S. Teh, Joseph D. Love Tags: Comment Source Type: research

Biopsy First, CSI Much Much Later
This case of a 13-month-old girl with an anaplastic ependymoma illustrates the complexities involved in the management of pediatric brain tumors, specifically the interpretation of spinal imaging and decisions regarding optimal therapy in a young and developing 13-month-old child.1 (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 1, 2019 Category: Radiology Authors: Sujith Baliga, Torunn I. Yock Tags: Gray Zone Source Type: research

Image Guided Evolution of Nodal Contouring Guidelines in Breast Cancer
External beam radiation therapy for breast cancer is administered to reduce locoregional recurrences, but there is increasing evidence that radiation therapy can also improve survival. The MA.201 and the European Organisation for Research and Treatment of Cancer2 trials demonstrated improved disease-free survival in patients with breast cancer receiving regional nodal irradiation, even in early stage patients with higher risk disease. However, external beam radiation therapy for breast cancer can also cause toxicity. (Source: International Journal of Radiation Oncology * Biology * Physics)
Source: International Journal of Radiation Oncology * Biology * Physics - February 1, 2019 Category: Radiology Authors: Carmen Bergom, Wouter V. Vogel Tags: Clinical Investigation Source Type: research

Aggressive Focal Therapy
In this interesting case of a 13-month-old girl with anaplastic ependymoma, the potential complicating finding of a new spinal mass may affect prognosis and current treatment paradigm.1 It is important to note that the appropriate workup was performed at the time of diagnosis and reviewed by the treating team; workup did not reveal any distant disease. However, with its high proliferative rate and tendency to disseminate into the cerebrospinal fluid, suspicious findings in the surgically unexplored neuro-axis, most commonly in the lumbosacral spine, are not uncommon in anaplastic disease. (Source: International Journal of ...
Source: International Journal of Radiation Oncology * Biology * Physics - February 1, 2019 Category: Radiology Authors: Rahul R. Parikh Tags: Gray Zone Source Type: research