14 results on '"Harrison, Louis B."'
Search Results
2. Veterans Affairs Radiation Oncology Quality Surveillance Program and American Society for Radiation Oncology Quality Measures Initiative.
- Author
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Park J, Puckett LL, Katsoulakis E, Venkatesulu BP, Kujundzic K, Solanki AA, Movsas B, Simone CB 2nd, Sandler H, Lawton CA, Das P, Wo JY, Buchholz TA, Fisher CM, Harrison LB, Sher DJ, Kapoor R, Chapman CH, Dawes S, Kudner R, Wilson E, Hagan M, Palta J, and Kelly MD
- Subjects
- Male, United States, Humans, United States Department of Veterans Affairs, Quality Indicators, Health Care, Radiation Oncology, Veterans, Neoplasms radiotherapy
- Abstract
Purpose: Ensuring high quality, evidence-based radiation therapy for patients is of the upmost importance. As a part of the largest integrated health system in America, the Department of Veterans Affairs National Radiation Oncology Program (VA-NROP) established a quality surveillance initiative to address the challenge and necessity of providing the highest quality of care for veterans treated for cancer., Methods and Materials: As part of this initiative, the VA-NROP contracted with the American Society for Radiation Oncology to commission 5 Blue Ribbon Panels for lung, prostate, rectal, breast, and head and neck cancers experts. This group worked collaboratively with the VA-NROP to develop consensus quality measures. In addition to the site-specific measures, an additional Blue Ribbon Panel comprised of the chairs and other members of the disease sites was formed to create 18 harmonized quality measures for all 5 sites (13 quality, 4 surveillance, and 1 aspirational)., Conclusions: The VA-NROP and American Society for Radiation Oncology collaboration have created quality measures spanning 5 disease sites to help improve patient outcomes. These will be used for the ongoing quality surveillance of veterans receiving radiation therapy through the VA and its community partners., (Published by Elsevier Inc.)
- Published
- 2022
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3. The Radiosensitivity Index Gene Signature Identifies Distinct Tumor Immune Microenvironment Characteristics Associated With Susceptibility to Radiation Therapy.
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Grass GD, Alfonso JCL, Welsh E, Ahmed KA, Teer JK, Pilon-Thomas S, Harrison LB, Cleveland JL, Mulé JJ, Eschrich SA, Enderling H, and Torres-Roca JF
- Subjects
- Biomarkers, Tumor genetics, Gene Expression Regulation, Neoplastic, Humans, Male, Prognosis, Radiation Tolerance genetics, Transcriptome, Tumor Microenvironment genetics, CD8-Positive T-Lymphocytes, Neoplasms genetics, Neoplasms radiotherapy
- Abstract
Purpose: Radiation therapy (RT) is a mainstay of cancer care, and accumulating evidence suggests the potential for synergism with components of the immune response. However, few data describe the tumor immune contexture in relation to RT sensitivity. To address this challenge, we used the radiation sensitivity index (RSI) gene signature to estimate the RT sensitivity of >10,000 primary tumors and characterized their immune microenvironments in relation to the RSI., Methods and Materials: We analyzed gene expression profiles of 10,469 primary tumors (31 types) within a prospective tissue collection protocol. The RT sensitivity of each tumor was estimated by the RSI and respective distributions were characterized. The tumor biology measured by the RSI was evaluated by differentially expressed genes combined with single sample gene set enrichment analysis. Differences in the expression of immune regulatory molecules were assessed and deconvolution algorithms were used to estimate immune cell infiltrates in relation to the RSI. A subset (n = 2368) of tumors underwent DNA sequencing for mutational frequency characterization., Results: We identified a wide range of RSI values within and across various tumor types, with several demonstrating nonunimodal distributions (eg, colon, renal, lung, prostate, esophagus, pancreas, and PAM50 breast subtypes; P < .05). Across all tumor types, stratifying RSI at a tumor type-specific median identified 7148 differentially expressed genes, of which 146 were coordinate in direction. Network topology analysis demonstrates RSI measures a coordinated STAT1, IRF1, and CCL4/MIP-1β transcriptional network. Tumors with an estimated high sensitivity to RT demonstrated distinct enrichment of interferon-associated signaling pathways and immune cell infiltrates (eg, CD8
+ T cells, activated natural killer cells, M1-macrophages; q < 0.05), which was in the context of diverse expression patterns of various immunoregulatory molecules., Conclusions: This analysis describes the immune microenvironments of patient tumors in relation to the RSI gene expression signature., (Copyright © 2022 Elsevier Inc. All rights reserved.)- Published
- 2022
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4. Status of Cancer Care at Network Sites of the Nation's Academic Cancer Centers.
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Gerson SL, Shaw K, Harrison LB, Holcombe RF, Hutchins L, Lee CB, Loehrer PJ, Mulkerin D, Purcell WT, Teston L, Weiner LM, and Weiner GJ
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- Certification, Electronic Health Records, Humans, Surveys and Questionnaires, United States, Neoplasms epidemiology, Neoplasms therapy, Patient Navigation, Physicians
- Abstract
Background: Cancer care coordination across major academic medical centers and their networks is evolving rapidly, but the spectrum of organizational efforts has not been described. We conducted a mixed-methods survey of leading cancer centers and their networks to document care coordination and identify opportunities to improve geographically dispersed care., Methods: A mixed-methods survey was sent to 91 cancer centers in the United States and Canada. We analyzed the number and locations of network sites; access to electronic medical records (EMRs); clinical research support and participation at networks; use of patient navigators, care paths, and quality measures; and physician workforce. Responses were collected via Qualtrics software between September 2017 and December 2018., Results: Of the 69 responding cancer centers, 74% were NCI-designated. Eighty-seven percent of respondents were part of a matrix health system, and 13% were freestanding. Fifty-six reported having network sites. Forty-three respondents use navigators for disease-specific populations, and 24 use them for all patients. Thirty-five respondents use ≥1 types of care path. Fifty-seven percent of networks had complete, integrated access to their main center's EMRs. Thirty-nine respondents said the main center provides funding for clinical research at networks, with 22 reporting the main center provides all funding. Thirty-five said the main center provided pharmacy support at the networks, with 15 indicating the main center provides 100% pharmacy support. Certification program participation varied extensively across networks., Conclusions: The data show academic cancer centers have extensive involvement in network cancer care, often extending into rural communities. Coordinating care through improved clinical trial access and greater use of patient navigation, care paths, coordinated EMRs, and quality measures is likely to improve patient outcomes. Although it is premature to draw firm conclusions, the survey results are appropriate for mapping next steps and data queries.
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- 2021
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5. Harnessing COVID-Driven Technical Innovations for Improved Multi-Disciplinary Cancer Care in the Post-COVID Era: The Virtual Patient Room.
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Sim AJ, Redler G, Peacock J, Naso C, Wasserman S, McNitt KB, Hoffe SE, Johnstone PAS, Harrison LB, and Rosenberg SA
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- COVID-19, Comorbidity, Humans, Neoplasms epidemiology, Pandemics, Patient Satisfaction, SARS-CoV-2, Betacoronavirus, Coronavirus Infections epidemiology, Neoplasms diagnosis, Patient Acceptance of Health Care, Patients' Rooms organization & administration, Pneumonia, Viral epidemiology, Telemedicine methods, Virtual Reality
- Abstract
Emergence of the COVID-19 crisis has catalyzed rapid paradigm shifts throughout medicine. Even after the initial wave of the virus subsides, a wholesale return to the prior status quo is not prudent. As a specialty that values the proper application of new technology, radiation oncology should strive to be at the forefront of harnessing telehealth as an important tool to further optimize patient care. We remain cognizant that telehealth cannot and should not be a comprehensive replacement for in-person patient visits because it is not a one for one replacement, dependent on the intention of the visit and patient preference. However, we envision the opportunity for the virtual patient "room" where multidisciplinary care may take place from every specialty. How we adapt is not an inevitability, but instead, an opportunity to shape the ideal image of our new normal through the choices that we make. We have made great strides toward genuine multidisciplinary patient-centered care, but the continued use of telehealth and virtual visits can bring us closer to optimally arranging the spokes of the provider team members around the central hub of the patient as we progress down the road through treatment.
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- 2020
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6. Integrating Mathematical Modeling into the Roadmap for Personalized Adaptive Radiation Therapy.
- Author
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Enderling H, Alfonso JCL, Moros E, Caudell JJ, and Harrison LB
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- Biomarkers, Tumor genetics, Dose Fractionation, Radiation, Dose-Response Relationship, Radiation, Humans, Magnetic Resonance Imaging, Neoplasms diagnostic imaging, Neoplasms genetics, Radiation Tolerance genetics, Tomography, X-Ray Computed, Treatment Outcome, Tumor Microenvironment genetics, Tumor Microenvironment radiation effects, Models, Theoretical, Neoplasms radiotherapy, Precision Medicine methods, Radiation Oncology methods, Radiotherapy Planning, Computer-Assisted methods
- Abstract
In current radiation oncology practice, treatment protocols are prescribed based on the average outcomes of large clinical trials, with limited personalization and without adaptations of dose or dose fractionation to individual patients based on their individual clinical responses. Predicting tumor responses to radiation and comparing predictions against observed responses offers an opportunity for novel treatment evaluation. These analyses can lead to protocol adaptation aimed at the improvement of patient outcomes with better therapeutic ratios. We foresee the integration of mathematical models into radiation oncology to simulate individual patient tumor growth and predict treatment response as dynamic biomarkers for personalized adaptive radiation therapy (RT)., (Copyright © 2019 Elsevier Inc. All rights reserved.)
- Published
- 2019
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7. Immunologic Consequences of Sequencing Cancer Radiotherapy and Surgery.
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López Alfonso JC, Poleszczuk J, Walker R, Kim S, Pilon-Thomas S, Conejo-Garcia JJ, Soliman H, Czerniecki B, Harrison LB, and Enderling H
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- Algorithms, Dose-Response Relationship, Radiation, Humans, Models, Theoretical, Neoplasm Staging, Neoplasms mortality, Neoplasms therapy, Prognosis, Public Health Surveillance, Radiotherapy, Adjuvant adverse effects, Radiotherapy, Adjuvant methods, SEER Program, Surgical Procedures, Operative adverse effects, Surgical Procedures, Operative methods, Treatment Outcome, Immunity radiation effects, Neoplasms epidemiology, Neoplasms immunology
- Abstract
Purpose: Early-stage cancers are routinely treated with surgery followed by radiotherapy (SR). Radiotherapy before surgery (RS) has been widely ignored for some cancers. We evaluate overall survival (OS) and disease-free survival (DFS) with SR and RS for different cancer types and simulate the plausibility of RS- and SR-induced antitumor immunity contributing to outcomes., Materials and Methods: We analyzed a SEER data set of early-stage cancers treated with SR or RS. OS and DFS were calculated for cancers with sufficient numbers for statistical power (cancers of lung and bronchus, esophagus, rectum, cervix uteri, corpus uteri, and breast). We simulated the immunologic consequences of SR, RS, and radiotherapy alone in a mathematical model of tumor-immune interactions., Results: RS improved OS for cancers with low 20-year survival rates (lung: hazard ratio [HR], 0.88; P = .046) and improved DFS for cancers with higher survival (breast: HR = 0.64; P < .001). For rectal cancer, with intermediate 20-year survival, RS improved both OS (HR = 0.89; P = .006) and DFS (HR = 0.86; P = .04). Model simulations suggested that RS could increase OS by eliminating cancer for a broader range of model parameters and radiotherapy-induced antitumor immunity compared with SR for selected parameter combinations. This could create an immune memory that may explain increased DFS after RS for certain cancers., Conclusion: Study results suggest plausibility that radiation to the bulk of the tumor could induce a more robust immune response and better harness the synergy of radiotherapy and antitumor immunity than postsurgical radiation to the tumor bed. This exploratory study provides motivation for prospective evaluation of immune activation of RS versus SR in controlled clinical studies.
- Published
- 2019
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8. Immune interconnectivity of anatomically distant tumors as a potential mediator of systemic responses to local therapy.
- Author
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Walker R, Poleszczuk J, Pilon-Thomas S, Kim S, Anderson AARA, Czerniecki BJ, Harrison LB, Moros EG, and Enderling H
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- Humans, Neoplasms pathology, Neoplasms therapy, T-Lymphocytes immunology, Treatment Outcome, Models, Theoretical, Neoplasms immunology
- Abstract
Complex interactions occur between tumor and host immune system at each site in the metastatic setting, the outcome of which can determine behavior ranging from dormancy to rapid growth. An additional layer of complexity arises from the understanding that cytotoxic T cells can traffic through the host circulatory system. Coupling mathematical models of local tumor-immune dynamics and systemic T cell trafficking allows us to simulate the evolution of tumor and immune cell populations in anatomically distant sites following local therapy and thus computationally evaluate immune interconnectivity. Results suggest that the presence of a secondary site may either inhibit or promote growth of the primary, depending on the capacity for immune recruitment of each tumor and the resulting systemic redistribution of T cells. Treatment such as surgical resection and radiotherapy can be simulated to estimate both the decrease in tumor volume at the local treatment-targeted site, and the change in overall tumor burden and tumor growth trajectories across all sites. Qualitatively similar responses of distant tumors to local therapy (positive and negative abscopal effects) to those reported in the clinical setting were observed. Such findings may facilitate an improved understanding of general disease kinetics in the metastatic setting: if metastatic sites are interconnected through the immune system, truly local therapy does not exist.
- Published
- 2018
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9. Modern brachytherapy.
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Lukens JN, Gamez M, Hu K, and Harrison LB
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- Animals, Humans, Brachytherapy methods, Neoplasms radiotherapy
- Abstract
Brachytherapy consists of placing radioactive sources within, or directly adjacent to a tumor, and is a means of delivering highly targeted and conformal radiation. While its history dates back to the origins of the field, in recent years brachytherapy treatment paradigms have been evolving considerably. This has been driven primarily by advancements in imaging, which allow for precise placement of sources and applicators under image guidance, and volume-based optimization to ensure adequate tumor coverage while sparing adjacent normal tissue. There has been a shift towards high-dose-rate (HDR) brachytherapy for many of the disease sites treated with brachytherapy. Simultaneously, with increasingly conformal treatment, there has been a shift towards utilization of higher doses per fraction, over fewer fractions, for specific disease sites where hypofractionation is believed to confer a radiobiological benefit. Here we review recent data and trends for those disease sites and conditions that are commonly treated with brachytherapy, including prostate, gynecologic, breast, head and neck, and skin cancers and salvage of recurrent disease., (Copyright © 2014 Elsevier Inc. All rights reserved.)
- Published
- 2014
- Full Text
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10. Present status and future directions of intraoperative radiotherapy.
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Debenham BJ, Hu KS, and Harrison LB
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- Combined Modality Therapy, Humans, Neoplasms pathology, Neoplasms surgery, Intraoperative Care, Neoplasms radiotherapy
- Abstract
In this Review, we summarise recent published work on the use of intraoperative radiotherapy to treat common tumour sites in the primary or recurrent setting. Techniques, radiobiology, and the physics of intraoperative radiotherapy are also explored. Disease sites discussed in this Review include head and neck cancer, breast cancer, sarcoma, gastrointestinal cancer, genitourinary cancer, gynaecological cancer, thoracic cancer, and palliative applications., (Copyright © 2013 Elsevier Ltd. All rights reserved.)
- Published
- 2013
- Full Text
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11. Cost savings in inpatient oncology through an integrative medicine approach.
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Kligler B, Homel P, Harrison LB, Levenson HD, Kenney JB, and Merrell W
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- Anxiety prevention & control, Anxiety psychology, Aromatherapy, Depression prevention & control, Depression psychology, Female, Health Care Costs, Holistic Nursing, Humans, Integrative Medicine statistics & numerical data, Length of Stay, Male, Medical Oncology statistics & numerical data, Neoplasms nursing, Neoplasms therapy, Pain prevention & control, Pain psychology, Pilot Projects, Quality of Life psychology, Statistics as Topic, United States, Yoga, Cost Savings statistics & numerical data, Inpatients statistics & numerical data, Integrative Medicine economics, Medical Oncology economics, Neoplasms economics, Philosophy, Medical
- Abstract
Objectives: To evaluate the cost impact of an integrative medicine intervention on an inpatient oncology service., Study Design: This study used nonrandomized, nonequivalent groups. A baseline sample of inpatient oncology patients at Beth Israel Medical Center admitted to the medical oncology unit before implementation of the Urban Zen Initiative were compared with patients admitted after the Urban Zen Initiative was in place., Methods: The Urban Zen Initiative incorporated yoga therapy, holistic nursing techniques, and a "healing environment" into routine inpatient oncology care. Length of stay and medication use data were extracted from Beth Israel's decision support electronic database. We compared length of stay, total medication costs, and costs of as-needed medications for both groups: the baseline sample of inpatient oncology patients and patients exposed to the Urban Zen healing environment initiative., Results: We had complete cost data on 85 patients in our baseline group and 72 in our intervention group. We found no difference in length of stay between the 2 groups. We found a significant decrease in use of antiemetic, anxiolytic, and hypnotic medication costs as well as a decrease in total medication costs in the Urban Zen sample compared with the baseline group., Conclusions: An integrative medicine approach including yoga therapy, holistic nursing, and a healing environment in the inpatient setting can decrease use of medications, resulting in substantial cost savings for hospitals in the care of oncology patients.
- Published
- 2011
12. Impact of the Urban Zen Initiative on patients' experience of admission to an inpatient oncology floor: a mixed-methods analysis.
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Kligler B, Homel P, Harrison LB, Sackett E, Levenson H, Kenney J, Fleishman SB, Serra D, and Merrell W
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- Adult, Aged, Female, Holistic Nursing, Humans, Inpatients, Male, Middle Aged, Neoplasms complications, Pain etiology, Pain psychology, Qualitative Research, Stress, Psychological etiology, Adaptation, Psychological, Interior Design and Furnishings, Neoplasms psychology, Pain prevention & control, Patient Satisfaction, Relaxation Therapy psychology, Stress, Psychological prevention & control
- Abstract
Purpose: The purpose of this study was to evaluate the impact of the Urban Zen Initiative, an "optimal healing environment" intervention, at Beth Israel Medical Center on both quantitative and qualitative measures of the experience of patients admitted for inpatient oncology care., Materials and Methods: A quasi-experimental design was used comparing a baseline sample of patients admitted to the oncology floor before the intervention to a similar group admitted during the intervention. Data collected included the Profile of Mood States, the EuroQol-5D (EQ-5D), and, on a subset of patients, a semistructured qualitative interview., Results: Patients in the intervention group experienced significantly less emotional distress during their stay when compared to patients in the baseline group. There were also significantly greater improvements in pain and discomfort during the stay in the treatment group as compared to controls. The qualitative analysis described a number of possible explanations for this change including increased sense of connection and control as well as specific techniques for symptom relief., Conclusions: It is possible to improve the experience of patients admitted for inpatient cancer care with a "healing environment" intervention. Further studies are needed that incorporate randomized design and the ability to examine specific components of the intervention independently as well as the impact of the intervention as a whole.
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- 2011
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13. Prevalence of anemia in cancer patients undergoing radiotherapy: prognostic significance and treatment.
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Harrison LB, Shasha D, and Homel P
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- Anemia epidemiology, Epoetin Alfa, Humans, Peripheral Nervous System Diseases drug therapy, Peripheral Nervous System Diseases etiology, Predictive Value of Tests, Prevalence, Prognosis, Quality of Life, Radiotherapy adverse effects, Recombinant Proteins, Survival Analysis, Treatment Outcome, Anemia drug therapy, Anemia etiology, Erythropoietin administration & dosage, Hematinics administration & dosage, Neoplasms radiotherapy
- Abstract
As the antitumor activity of radiation is mediated via its interaction with oxygen to form labile free radicals, the intratumoral oxygen level has an important influence on the ability of radiation therapy to kill malignant cells. By decreasing the oxygen-carrying capacity of the blood, anemia may result in tumor hypoxia and may have a negative influence on the outcome of radiotherapy for various malignancies, even for small tumors not normally assumed to be hypoxic. In addition, anemia also has a negative effect on the quality of life of cancer patients, as evidenced by worsening fatigue. As a high proportion (about 50%) of cancer patients undergoing radiotherapy are anemic prior to or during treatment, strategies to correct anemia and/or the resultant tumor hypoxia are increasingly being considered an important component of treatment. In particular, epoetin alfa (recombinant human erythropoietin), which has proved an effective and well-tolerated means of raising hemoglobin levels in anemic patients receiving radiotherapy, potentially could reverse the negative prognostic influence of a low hemoglobin in patients with certain malignancies. Radiation oncologists need to be aware of the possibility of anemia in cancer patients undergoing radiotherapy so that timely intervention can be instituted whenever anemia is diagnosed., (Copyright 2002 S. Karger AG, Basel)
- Published
- 2002
- Full Text
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14. High-dose-rate intraoperative irradiation: current status and future directions.
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Hu KS, Enker WE, and Harrison LB
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- Combined Modality Therapy, Forecasting, Humans, Intraoperative Period, Neoplasms surgery, Radiation Oncology trends, Neoplasms radiotherapy
- Abstract
Intraoperative irradiation (IORT) refers to the delivery of a single high dose of radiation therapy at the time of surgery when the tumor bed can be precisely defined and adjacent normal tissue maximally protected. It can be effectively delivered using either electrons (IOERT) or photons produced from a high-dose-rate gamma emitting radioisotope (HDR-IORT) and has been explored primarily for locally advanced or recurrent tumors at high risk for local failure despite extensive resection and full dose external beam radiation. With coordinated multidisciplinary interaction, IORT can be integrated in a combined-modality setting without undue additional toxicity. The purpose of this review will be to summarize the growing HDR-IORT experience in the treatment of various cancers, to compare its efficacy and toxicity vis a vis the IOERT data, and to discuss future trials as well as new areas of potential application., (Copyright 2002 by W.B. Saunders Company)
- Published
- 2002
- Full Text
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