9 results on '"Xue, Jinyu"'
Search Results
2. Clinical evidence for dose tolerance of the central nervous system in hypofractionated radiotherapy.
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Xue, Jinyu, Emami, Bahman, Grimm, Jimm, Kubicek, Gregory J., Asbell, Sucha O., Lanciano, Rachelle, Welsh, James S., Peng, Luke, Quon, Harry, Laub, Wolfram, Gui, Chengcheng, Spoleti, Nicholas, Das, Indra J., Goldman, Howard Warren, Redmond, Kristin J., Kleinberg, Lawrence R., and Brady, Luther W.
- Published
- 2018
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3. Volume effects in radiosurgical spinal cord dose tolerance: how small is too small?
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Ma, Ting, Emami, Bahman, Grimm, Jimm, Xue, Jinyu, Asbell, Sucha, Kubicek, Gregory, Lanciano, Rachelle, Welsh, James, Peng, Luke, Gui, Chengcheng, Das, Indra, Goldman, Howard, Brady, Luther, Redmond, Kristin, and Kleinberg, Lawrence
- Abstract
Spinal cord dose constraints are a critical feature for stereotactic body radiation therapy (SBRT). Spinal cord maximum point dose (Dmax) by Monte Carlo (MC) calculations is used as a critical cord tolerance limit for SBRT, but information is lacking about its reproducibility. This study examines uncertainty of MC dose calculations for small volumes in spine SBRT. Seven consecutive spine radiosurgery cases were randomly selected to measure precision of the Dmax calculation in comparison to other volumes. Each plan was calculated five times using MC with a 2% uncertainty objective, and variabilities in dose-volume histogram (DVH) parameters across recalculations were evaluated with coefficient of variation (standard deviation divided by mean). The average ratio of D0.03 cc/Dmax was calculated across a larger series of 130 cases. The variability of Dmax was twice as high for D0.03 cc and five times as high for D1 cc across recalculations for the seven cases. For larger volumes, the variability was lower. The standard deviation of Dmax was 0.1959 Gy, compared to 0.0931 Gy, 0.0569 Gy, and 0.0364 Gy for D0.03 cc, D0.1 cc, and D1 cc, respectively. The average D0.03 cc/Dmax among 130 cases was 0.93. Dmax has greater variability compared to D0.03 cc, D0.1 cc, and D1 cc, potentially creating risks when used for guidance for spinal cord. D0.03 cc may be an attractive alternative with higher reliability while its limits could be obtained by scaling the reported Dmax limit by a factor of 0.93. This may help guide treatment planning and aid in discovering true dose constraints for spine SBRT.
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- 2019
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4. Clinical evidence for dose tolerance of the central nervous system in hypofractionated radiotherapy
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Xue, Jinyu, Emami, Bahman, Grimm, Jimm, Kubicek, Gregory, Asbell, Sucha, Lanciano, Rachelle, Welsh, James, Peng, Luke, Quon, Harry, Laub, Wolfram, Gui, Chengcheng, Spoleti, Nicholas, Das, Indra, Goldman, Howard, Redmond, Kristin, Kleinberg, Lawrence, and Brady, Luther
- Abstract
Stereotactic radiosurgery (SRS), stereotactic body radiotherapy (SBRT), and stereotactic ablative body radiotherapy (SABR) are commonly used in the treatment of central nervous system (CNS) disease. This study has refined the radiation toxicity estimates for some normal tissues of the CNS based on review and analysis of the clinical evidence for single fraction radiosurgery, hypofractionated SBRT, and conventionally fractionated radiation therapy. Published guidelines and protocols are reviewed. In the past, many normal tissue tolerances were compiled based on the experience of the investigators and publications in the literature. Some tolerances were determined by modeling or calculation using the existing biological formulas, in particular the linear quadratic (LQ) model. In the present study, the estimate of risk for each dose tolerance limit in some CNS tissues is provided exclusively with normal tissue complication probability (NTCP). The clinical outcomes are compared to understand the difference in biological effect between radiosurgery and radiotherapy. Normal tissue dose tolerances and the corresponding complication rates are provided for brainstem, optic nerves, cochlea, and spinal cord, including single fraction SRS, five-fraction SBRT, and conventional radiation therapy. Calculation of biologically effective dose (BED) or single fraction equivalent dose (SFED) alone using the LQ model conveys no consensus on the biological effect across different fractionations. Comparison of conventional radiation therapy to brain and spinal cord with single fraction equivalent dose leads to even conflicting clinical outcomes. Effective differences between single fraction SRS and conventional radiotherapy need to be better understood. The existing biological model might not be valid to predict the radiosurgical outcomes based on conventionally fractionated radiotherapy. However, application of the statistical dose response models of clinical SRS and SBRT outcomes data to selected current dose tolerance guidelines into simple tables can be a clinically useful resource.
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- 2018
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5. Estimated Risk Level of Unified Stereotactic Body Radiation Therapy Dose Tolerance Limits for Spinal Cord.
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Grimm, Jimm, Sahgal, Arjun, Soltys, Scott G., Luxton, Gary, Patel, Ashish, Herbert, Scott, Xue, Jinyu, Ma, Lijun, Yorke, Ellen, Adler, John R., and Gibbs, Iris C.
- Abstract
A literature review of more than 200 stereotactic body radiation therapy spine articles from the past 20 years found only a single article that provided dose-volume data and outcomes for each spinal cord of a clinical dataset: the Gibbs 2007 article (Gibbs et al, 2007 1 ), which essentially contains the first 100 stereotactic body radiation therapy (SBRT) spine treatments from Stanford University Medical Center. The dataset is modeled and compared in detail to the rest of the literature review, which found 59 dose tolerance limits for the spinal cord in 1-5 fractions. We partitioned these limits into a unified format of high-risk and low-risk dose tolerance limits. To estimate the corresponding risk level of each limit we used the Gibbs 2007 clinical spinal cord dose-volume data for 102 spinal metastases in 74 patients treated by spinal radiosurgery. In all, 50 of the patients were previously irradiated to a median dose of 40 Gy in 2-3 Gy fractions and 3 patients developed treatment-related myelopathy. These dose-volume data were digitized into the dose-volume histogram (DVH) Evaluator software tool where parameters of the probit dose-response model were fitted using the maximum likelihood approach (Jackson et al, 1995 3 ). Based on this limited dataset, for de novo cases the unified low-risk dose tolerance limits yielded an estimated risk of spinal cord injury of ≤1% in 1-5 fractions, and the high-risk limits yielded an estimated risk of ≤3%. The QUANTEC D max limits of 13 Gy in a single fraction and 20 Gy in 3 fractions had less than 1% risk estimated from this dataset, so we consider these among the low-risk limits. In the previously irradiated cohort, the estimated risk levels for 10 and 14 Gy maximum cord dose limits in 5 fractions are 0.4% and 0.6%, respectively. Longer follow-up and more patients are required to improve the risk estimates and provide more complete validation. [ABSTRACT FROM AUTHOR]
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- 2016
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6. Introduction and Clinical Overview of the DVH Risk Map.
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Asbell, Sucha O., Grimm, Jimm, Xue, Jinyu, Chew, Meng-Sang, and LaCouture, Tamara A.
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Radiation oncologists need reliable estimates of risk for various fractionation schemes for all critical anatomical structures throughout the body, in a clinically convenient format. Reliable estimation theory can become fairly complex, however, and estimates of risk continue to evolve as the literature matures. To navigate through this efficiently, a dose-volume histogram (DVH) Risk Map was created, which provides a comparison of radiation tolerance limits as a function of dose, fractionation, volume, and risk level. The graphical portion of the DVH Risk Map helps clinicians to easily visualize the trends, whereas the tabular portion provides quantitative precision for clinical implementation. The DVH Risk Map for rib tolerance from stereotactic ablative body radiotherapy (SABR) and stereotactic body radiation therapy (SBRT) is used as an example in this overview; the 5% and 50% risk levels for 1-5 fractions for 5 different volumes are given. Other articles throughout this issue of Seminars in Radiation Oncology present analysis of new clinical datasets including the DVH Risk Maps for other anatomical structures throughout the body. [ABSTRACT FROM AUTHOR]
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- 2016
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7. Validity of Current Stereotactic Body Radiation Therapy Dose Constraints for Aorta and Major Vessels.
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Xue, Jinyu, Kubicek, Gregory, Patel, Ashish, Goldsmith, Benjamin, Asbell, Sucha O., and LaCouture, Tamara A.
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Understanding dose constraints for critical structures in stereotactic body radiation therapy (SBRT) is essential to generate a plan for optimal efficacy and safety. Published dose constraints are derived by a variety of methods, including crude statistics, actuarial analysis, modeling, and simple biologically effective dose (BED) conversion. Many dose constraints reported in the literature are not consistent with each other, secondary to differences in clinical and dosimetric parameters. Application of a dose constraint without discriminating the variation of all the factors involved may result in suboptimal treatment. This issue of Seminars in Radiation Oncology validates dose tolerance limits for 10 critical anatomic structures based on dose response modeling of clinical outcomes data to include detailed dose-volume metrics. This article presents a logistic dose-response model for aorta and major vessels based on 238 cases from the literature in addition to 387 cases from MD Anderson Cancer Center at Cooper University Hospital, for a total of 625 cases. The Radiation Therapy Oncology Group (RTOG) 0813 dose-tolerance limit of D max = 52.5 Gy in 5 fractions was found to have a 1.2% risk of grade 3-5 toxicity, and the Timmerman 2008 limit of D max = 45 Gy in 3 fractions had 2.3% risk. From the model, the 1% and 2% risk levels for D 4 cc , D 1 cc , and D 0.5 cc are also provided in 1-5 fractions, in the form of a dose-volume histogram (DVH) Risk Map. [ABSTRACT FROM AUTHOR]
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- 2016
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8. Small Bowel Dose Tolerance for Stereotactic Body Radiation Therapy.
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LaCouture, Tamara A., Xue, Jinyu, Subedi, Gopal, Xu, Qianyi, Lee, Justin T., Kubicek, Gregory, and Asbell, Sucha O.
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Inconsistencies permeate the literature regarding small bowel dose tolerance limits for stereotactic body radiation therapy (SBRT) treatments. In this review, we organized these diverse published limits with MD Anderson at Cooper data into a unified framework, constructing the dose-volume histogram (DVH) Risk Map, demonstrating low-risk and high-risk SBRT dose tolerance limits for small bowel. Statistical models of clinical data from 2 institutions were used to assess the safety spectrum of doses used in the exposure of the gastrointestinal tract in SBRT; 30% of the analyzed cases had vascular endothelial growth factor inhibitors (VEGFI) or other biological agents within 2 years before or after SBRT. For every dose tolerance limit in the DVH Risk Map, the probit dose-response model was used to estimate the risk level from our clinical data. Using the current literature, 21 Gy to 5 cc of small bowel in 3 fractions has low toxicity and is reasonably safe, with 6.5% estimated risk of grade 3 or higher complications, per Common Terminology Criteria for Adverse Events version 4.0. In the same fractionation for the same volume, if lower risk is required, 16.2 Gy has an estimated risk of only 2.5%. Other volumes and fractionations are also reviewed; for all analyzed high-risk small bowel limits, the risk is 8.2% or less, and the low-risk limits have 4% or lower estimated risk. The results support current clinical practice, with some possibility for dose escalation. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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9. Low toxicity for lung tumors near the mediastinum treated with stereotactic body radiation therapy.
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Srivastava, Roma, Asbell, Sucha O., LaCouture, Tamara, Kramer, Noel, Pahlajani, Niraj, Xue, Jinyu, Ahmad, Nazish, Chen, Yan, Croce, Raymond, and Grimm, Jimm
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STEREOTACTIC radiotherapy ,MEDIASTINUM diseases ,LUNG cancer patients ,DRUG tolerance ,DOSE-effect relationship in pharmacology ,FOLLOW-up studies (Medicine) ,THERAPEUTICS - Abstract
Abstract: Purpose: To report the local control, survival, and low toxicity observed at the Cooper University Hospital CyberKnife Center post stereotactic body radiation therapy (SBRT) in the treatment of lung tumors near the mediastinum. Methods and Materials: Twenty-four medically inoperable lung cancer patients with tumors near the mediastinum were treated using the Accuray CyberKnife system (Accuray, Sunnyvale, CA) with Monte Carlo dose calculations and heterogeneity corrections from July 2008 to May 2010. The prescription dose ranged from 28.5 Gy to 60 Gy in 3-5 fractions. For conventional fractionation schemes, Emami et al
1 organized the dose tolerance limits into a unified format for clinical utility and partitioned them into 2 risk levels (5% and 50%) with preset volumes for most critical structures throughout the body. In contrast, statistical SBRT dose tolerance limits for mediastinal structures have not been established yet. We have sufficient experience at least to begin organizing a unified format with low-risk and high-risk partitions and preset volumes for 1-5 fractions exposing mediastinal structures. With the help of the (dose-volume histogram) DVH Evaluator, a software tool developed by our senior author, each treatment plan was assessed for safety and feasibility prior to treatment. The DVH Evaluator was also used to analyze the follow-up data and to create graphs of risk, called DVH Risk Maps, superimposing clinical data onto the unified SBRT dose tolerance limits. Results: It was not feasible to prescribe the doses of peripheral lung lesions for all tumors near the mediastinum because of known toxicity. The crude local tumor control rate achieved in our series was 92%. Median survival was 26.8 months for the primary lung cases and 9.6 months for the metastatic cases. No patients experienced grade 3 or higher toxicities. Conclusions: We affirm that SBRT is feasible in the treatment of centrally located lung cancers when the dose tolerance limits of critical structures are diligently respected. The low adverse event rates that we have experienced, combined with a good local tumor control rate, are encouraging. [Copyright &y& Elsevier]- Published
- 2013
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