International journal of radiation oncology, biology, physics
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Int. J. Radiat. Oncol. Biol. Phys. · Aug 2005
Multicenter Study Comparative StudyLack of benefit from a short course of androgen deprivation for unfavorable prostate cancer patients treated with an accelerated hypofractionated regime.
High-dose radiotherapy, delivered in an accelerated hypofractionated course, was utilized to treat prostate cancer. Therapy consisted of external beam radiotherapy (EBRT) and transrectal ultrasound (TRUS)-guided conformally modulated high-dose rate (HDR) brachytherapy. The purpose of this report is (1) to assess long-term comparative outcomes from three trials using similar accelerated hypofractionated regimes; and (2) to examine the long-term survival impact of a short course of < or =6 months adjuvant/concurrent androgen deprivation when a very high radiation dose was delivered. ⋯ Accelerated hypofractionated pelvic EBRT integrated with TRUS-guided conformally modulated HDR administered to 1,260 patients in three institutions was an excellent method of delivering very high radiation dose to the prostate in 5 weeks. Similar high overall, cause-specific, and biochemical no evidence of disease survival rates achieved show that prostate HDR can be successfully delivered in academic and community settings. At 8 years, the addition of a course of < or =6 months of neoadjuvant/concurrent androgen deprivation therapy to a very high radiation dose did not confer a therapeutic advantage but added side effects and cost. Furthermore, for the most unfavorable group, there was a higher rate of distant metastasis and more prostate cancer-related deaths. We question the value of a short course of androgen deprivation therapy when used with high-dose radiation.
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Int. J. Radiat. Oncol. Biol. Phys. · Aug 2005
Comparative StudyInitial experience with megavoltage (MV) CT guidance for daily prostate alignments.
The on-board megavoltage (MV) computed tomography (CT) capabilities of a TomoTherapy Hi*ART unit were used to obtain daily MVCT images of prostate cancer patients. For patient alignment the daily MVCT image needs to be registered with the planning CT image to calculate couch shifts. Three manual techniques of registering the MVCT images with the planning kilovoltage (kV) CT images were evaluated. The techniques are based on visual alignment of (1) fiducial prostate markers, (2) CT anatomy, and (3) kVCT contours. ⋯ The use of fiducial markers for MVCT image guidance is advantageous to reduce the inter-user variability of the image registration. If fiducial markers are not used, anatomy-based registrations outperform contour-based registrations in terms of (1) agreement with a reference alignment and (2) inter-user variability.
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Int. J. Radiat. Oncol. Biol. Phys. · Aug 2005
Results of stereotactic radiosurgery for patients with imaging defined cavernous sinus meningiomas.
The purpose of this study was to evaluate the efficacy and safety of stereotactic radiosurgery as primary management for patients with imaging defined cavernous sinus meningiomas. ⋯ Radiosurgery was an effective primary management strategy for patients with an imaging defined cavernous sinus meningioma. Except in situations of symptomatic mass effect, unusual clinical presentation, or atypical imaging features, surgery to confirm the histologic diagnosis is unlikely to provide clinical benefit.
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Int. J. Radiat. Oncol. Biol. Phys. · Aug 2005
Review Clinical TrialDose-volume analysis of predictors for chronic rectal toxicity after treatment of prostate cancer with adaptive image-guided radiotherapy.
We analyzed our experience treating localized prostate cancer with image-guided off-line correction with adaptive high-dose radiotherapy (ART) in our Phase II dose escalation study to identify factors predictive of chronic rectal toxicity. ⋯ In our ART dose escalation study, rectal wall or rectum relative > or =V50 are closely predictive for chronic rectal toxicity. If rectal dose-volume histogram constraints are used to select the dose level, the risk of chronic rectal toxicity will reflect the risk of toxicity of the selected constraint rather than the dose selected as found in our study using an adaptive process. To select the prescribed dose, different dose-volume histogram constraints may be used including the rectal wall V70. Patients experiencing acute rectal toxicity are more likely to experience chronic toxicity.
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Int. J. Radiat. Oncol. Biol. Phys. · Aug 2005
ReviewVaginal brachytherapy alone is sufficient adjuvant treatment of surgical stage I endometrial cancer.
To determine the efficacy and complications of adjuvant vaginal high-dose-rate brachytherapy alone for patients with Stage I endometrial cancer in whom complete surgical staging had been performed. ⋯ Adjuvant vaginal high-dose-rate brachytherapy alone may be a safe and effective alternative to pelvic external beam radiotherapy for surgical Stage I endometrial cancer.