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PURPOSE Application of linear-quadratic (LQ) model to large fractional dose treatments is inconsistent with observed cell survival curves having a straight portion at high doses. We have proposed a unified multi-activation (UMA) model to fit cell survival curves over the entire dose range that allows us to calculate EQD2 for hypofractionated SBRT, SRT, SRS, and HDRB. METHODS A unified formula of cell survival S=n/eDDo+n-1 using only the extrapolation number of n and the dose slope of Do was derived. Coefficient of determination, R2 , relative residuals, r, and relative experimental errors, e, normalized to survival fraction at each dose point, were calculated to quantify the goodness in modeling of a survival curve. Analytical solutions for α and β, the coefficients respectively describe the linear and quadratic parts of the survival curve, as well as the α/β ratio for the LQ model and EQD2 at any fractional doses were derived for tumor cells undertaking any fractionated radiation therapy. RESULTS Our proposed model fits survival curves of in-vivo and in-vitro tumor cells with R2 > 0.97 and r

This formative research study describes the development and preliminary evaluation of a theory-guided, online multimedia psycho-educational program (PROGRESS) designed to facilitate adaptive coping among prostate cancer patients transitioning from treatment into long-term survivorship. Guided by the Cognitive-Social Health Information Processing Model (C-SHIP) and using health communications best practices, we conducted a two-phase, qualitative formative research study with early stage prostate cancer patients (n = 29) to inform the Web program development. Phase 1 included individual (n = 5) and group (n = 12) interviews to help determine intervention content and interface. Phase 2 employed iterative user/usability testing (n = 12) to finalize the intervention. Interview data were independently coded and collectively analyzed to achieve consensus. Survivors expressed interest in action-oriented content on (1) managing treatment side effects, (2) handling body image and comorbidities related to overweight/obesity, (3) coping with emotional and communication issues, (4) tips to reduce disruptions of daily living activities, and (5) health skills training tools. Patients also desired the use of realistic and diverse survivor images. Incorporation of an established theoretical framework, application of multimedia intervention development best practices, and an evidence-based approach to content and format resulted in a psycho-educational tool that comprehensively addresses survivors’ needs in a tailored fashion. The results suggest that an interactive Web-based multimedia program is useful for survivors if it covers the key topics of symptom control, emotional well-being, and coping skills training; this tool has the potential to be disseminated and implemented as an adjunct to routine clinical care.

Purpose The purpose of this case series is to describe the treatment and outcomes of a cohort of patients with inoperable early-stage endometrioid endometrial cancer with 3D image-guided high-dose-rate (HDR) intracavitary brachytherapy. Materials and Methods A review was performed of patients with early-stage endometrial cancer who underwent primary radiation treatment between 2010 and 2016. Staging and treatment planning were performed CT, pelvic ultrasound, and pelvic MRI. Gross tumor volume (GTV) was defined as the MRI or ultrasound demonstrated endometrial stripe width, with the entire uterine corpus, cervix, and proximal vagina representing the clinical target volume (CTV). Dosimetry calculations were performed in each fraction of HDR brachytherapy. RESULTS Eight patients received external beam radiation therapy followed by intracavitary HDR brachytherapy. Seven patients underwent intracavitary HDR brachytherapy alone. In all patients, mean cumulative dose to 90% (D90) of GTV was 95.99 Gy in equivalent dose in 2 Gy fractions (EQD2, α/β = 10). Mean cumulative D90 EQD2 to CTV was 51.64 Gy. Average follow-up was 29 months. Four patients died from concurrent disease(s) at an average of 2.83 years after completion of treatment. Except for 1 (6.6%) patient who recurred at 9 months following completion of treatment, all patients remained disease-free for the remainder of follow-up. Conclusions In patients who are poor surgical candidates and have early-stage endometrioid type endometrial carcinoma, image-guided HDR intracavitary brachytherapy carries minimal side effects and a high response rate.

Many cancer patients continue to smoke postdiagnosis, which is associated with poorer clinical outcomes. Identifying prospective predictors of smoking cessation among patients currently receiving smoking cessation treatment can help guide the development and implementation of smoking cessation programs with this population.Data from 246 cancer patients participating in a randomized placebo-controlled smoking cessation clinical trial were used to examine baseline predictors of end-of-treatment and six-month postbaseline smoking cessation outcomes. Baseline demographic, smoking-related, disease-related, and psychological variables were examined as predictors of biochemically-confirmed point-prevalence abstinence.Multivariate analysis indicated that, for end-of-treatment abstinence, patients were significantly more likely to have quit smoking if they were older (OR = 1.06, 95% CI: 1.03-1.10, p0.05) and were diagnosed with a non-tobacco related cancer (OR = 2.54, 95% CI: 1.24-5.20, p0.05). Likewise, for six-month abstinence, patients were significantly more likely to have quit smoking if they were older (OR = 1.04, 95% CI: 1.01-1.08, p0.05) and were significantly less likely to have quit smoking if they were female (OR = 0.47, 95% CI: 0.22-0.97, p0.05). Patients with tobacco-related cancers and female patients reported significantly higher levels of depression symptoms (p0.05), which proved predictive of smoking relapse.Patient age, gender, and cancer-type may be important factors to consider when developing and implementing smoking cessation interventions for cancer patients.

Background. The monoclonal antibody anti-epidermal growth factor receptor (EGFr)antibody-425, against the epidermal growth factor receptor, has the potential to bind specifically to gliomas and not normal brain tissue. 1-3 A prospective study was conducted (1986-1988) to evaluate the use of Indium-111 ( 111 In)-labeled anti-EGFr-425 in the localization of gliomas before radioimmunotherapy with Iodine-125 ( 125 I)-labeled anti-EGFr-425. Methods. Twenty-eight patients with intracranial neoplasms were injected intravenously with an average dose of 2.2 mCi 111 In-labeled anti-EGFr-425

In 1993, roughly 1,170,000 new cases of invasive cancer will be diagnosed in the United States. A considerable portion of these patients who die will do so because of uncontrolled local and/or regional disease. Numerous advances in the radiologic treatment of cancer have led to improved local and regional control, as well as survival. These advances include improved radiologic imaging techniques, improved techniques of radiation therapy, innovative brachytherapeutic techniques, intraoperative electron beam therapy techniques, and stereotaxic radiosurgical techniques. In this paper, the authors discuss these techniques with specific attention to how they have lead to improved local and regional control, as well as cancer cure with organ preservation.

We report a case of low-grade follicular lymphoma presenting as a primary lesion in the intracranial dura. Based on the preoperative MRI, our patient was presumed to have meningioma. A surgical excision was performed and the histology showed features of a grade 1 follicular lymphoma predominately small-cleaved cell type. Postoperative investigations confirmed that it was the only site of involvement. The patient then received cranial radiotherapy and she is doing well with a follow up period of 18 months. To the best of our knowledge, it is the first case of a primary dural grade 1 follicular lymphoma, small-cleaved cell type.

Purpose/Objective(s): Radiation therapy (RT) for prevention of heterotopic ossification (HO) around the joints has been used for decades. While there is ample evidence to support its use at the hip, data on non-hip joints such as the elbow are scant, with recent studies raising concern over toxicities. We conducted an IRB-approved single-institution retrospective review of our experience delivering radiation to the elbow to evaluate outcomes and complications related to RT. Materials/Methods: From 2003 to 2012, 31 patients received perioperative RT for HO prophylaxis at the elbow. Patients with postoperative films (n Z 20) were included in our study. Data on patient characteristics, treatment details, and clinical status at each encounter were reviewed. Radiological studies were reviewed using 5 classification schemes. Patients were contacted for interview on current status using the Mayo Elbow Performance Score (MEPS). Results: Median patient age was 42.5 years, median body mass index (BMI) was 29, and 85% were male. Mean follow-up was 9.2 months. All patients received a single fraction of 600-700 cGy, preoperatively within 24 hours (n Z 8), postoperatively within 24 hours (n Z 11), or postoperatively in 3 days (n Z 1). Five patients underwent primary prophylaxis while 15 patients received RT for secondary prophylaxis. Two patients developed new HO and 1 patient had progression of disease at the time of follow-up, but all 3 reported a fair MEPS and denied severe functional limitations. Three patients required surgical re-excision of HO. Conclusions: NSAID treatment, whether newly prescribed or prior use, variations in field size, differences in technique, whether open-field AP/PA or 3D conformal with multi-leaf collimation, did not appear to make a difference in risk of recurrence, mal-union, non-union, or functional outcome. Furthermore, all of the subjects available for phone interview, including those with evidence of severe HO, reported fair or better functionality. Timing of RT seems optimal within 24 hours preoperatively or postoperatively. Patients with high-risk indications should undergo primary prophylaxis against HO. Author Disclosure: S.K. Yoo: None. C. Miyamoto: None.

Objectives: Retrospective analysis of patients with recurrences at or closely adjacent to the site of prior lung stereotactic body radiation therapy (SBRT) who received repeat SBRT. Materials and Methods: Nine patients with non-small cell lung cancer (n = 8) or oligometastatic colonic adenocarcinoma (n = 1) were treated with image-guided lung SBRT to a median of 60 Gy (range, 30-60) in a median of 3 fractions (3-5). Patients developed in-field relapse (n = 3) or recurrence adjacent (≤3.5 cm away) to the previous tumor location (n = 6) and received 2 nd lung SBRT to a median of 60 Gy. Results: Median follow-up after 2 nd SBRT was 22 months (4-40). All completed prescribed course of repeat SBRT and acute toxicity was limited. There was no grade >3 late toxicity. 3 (33.3%) patients developed Grade 3 late reactions: 2 pulmonary and 1 chest wall pain. Late pulmonary toxicity included 2 (22.2%) patients with Grade 3 and 3 (33.3%) with Grade 2. One patient (11.1%) had late Grade 3 and 1 (11.1%) Grade 2 chest wall pain. 1 (11.1%) developed Grade 2 late brachial plexopathy. No myelopathy was observed. Two patients developed progression of tumors treated by 2 nd SBRT. Local recurrence free survival and overall survival was 75% and 68.6%, respectively at 2 years. Relative volume of ipsilateral lung receiving 5 Gy (V5) and V10 were lower for 2 nd SBRT. Conclusion: Repeat image-guided SBRT for patients with small peripheral recurrences was feasible and severe toxicity was not observed. Additional studies are needed to evaluate the safety and efficacy of lung reirradiation using 2 nd SBRT.

In summary, SRS and SBRT require a team-based approach, staffed by appropriately trained and credentialed specialists. SRS and SBRT training should become a required part of radiation oncology residency training and of Accreditation of Medical Physics Educational Programs accredited clinical medical physics training. SRS and SBRT require significant resources in personnel, specialized technology, and implementation time. A thorough feasibility analysis of resources required to achieve the clinical and technical goals must be performed and discussed with all personnel, including medical center administration. Because various disease sites may have different clinical and technical requirements, feasibility and planning discussions are needed prior to undertaking new disease sites. Treatment of SRS/SBRT patients should adhere to established national guidelines. Acceptance and commissioning protocols and tests must be developed to explore in detail every aspect of the individual and integrated systems with the goal of ensuring safe and effective operation. A comprehensive quality assurance program, encompassing all clinical, technical, and patient-specific treatment aspects, must be developed to ensure SRS and SBRT are performed in a safe and effective manner. Patient safety in radiation therapy is everyone's responsibility. Professional organizations, regulators, vendors, and end-users must demonstrate a clear commitment to working closely together to ensure the highest levels of safety and efficacy in stereotactic radiosurgery and stereotactic body radiation therapy.