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Purpose Questions remain about whether moderately hypofractionated whole-breast irradiation is appropriate for patients with triple-negative breast cancer. Methods and Materials Using the prospective database of a multicenter, collaborative quality improvement consortium, we identified patients with node-negative, triple-negative breast cancer who received whole-breast irradiation with either moderate hypofractionation or conventional fractionation. Using inverse probability of treatment weighting (IPTW), we compared outcomes using the Kaplan-Meier product-limit estimation method with Cox regression models estimating the hazard ratio for time-to-event endpoints between groups. Results The sample included 538 patients treated at 18 centers in 1 state in the United States, of whom 307 received conventionally fractionated whole-breast irradiation and 231 received moderately hypofractionated whole-breast irradiation. The median follow-up time was 5.0 years (95% confidence interval [CI], 4.77-5.15 years). The 5-year IPTW estimates for freedom from local recurrence were 93.6% (95% CI, 87.8%-96.7%) in the moderate hypofractionation group and 94.4% (95% CI, 90.3%-96.8%) in the conventional fractionation group. The hazard ratio was 1.05 (95% CI, 0.51-2.17; P = .89). The 5-year IPTW estimates for recurrence-free survival were 87.8% (95% CI, 81.0%-92.4%) in the moderate hypofractionation group and 88.4% (95% CI 83.2%-92.1%) in the conventional fractionation group. The hazard ratio was 1.02 (95% CI, 0.62-1.67; P = .95). The 5-year IPTW estimates for overall survival were 96.6% (95% CI, 92.0%-98.5%) in the moderate hypofractionation group and 93.4% (95% CI, 88.7%-96.1%) in the conventional fractionation group. The hazard ratio was 0.65 (95% CI, 0.30-1.42; P = .28). Conclusions Analysis of outcomes in this large observational cohort of patients with triple-negative, node-negative breast cancer treated with whole-breast irradiation revealed no differences by dose fractionation. This adds evidence to support the use of moderate hypofractionation in patients with triple-negative disease.

Multiple factors influence the risk of developing pneumonitis after radiation therapy (RT) for lung cancer, but few resources exist to guide clinicians in predicting risk in an individual patient treated with modern techniques. We analyzed toxicity data from a state-wide consortium to develop an integrated pneumonitis risk model.All patients (N = 1302) received conventionally fractionated RT for stage II-III non-small cell lung cancer between April 2012 and July 2019. Pneumonitis occurring within 6 months of treatment was graded by local practitioners and collected prospectively from 27 academic and community clinics participating in a state-wide quality consortium. Pneumonitis was modeled as either grade ≥2 (G2+) or grade ≥3 (G3+). Logistic regression models were fit to quantify univariable associations with dose and clinical factors, and stepwise Akaike information criterion-based modeling was used to build multivariable prediction models.The overall rate of pneumonitis of any grade in the 6 months following RT was 16% (208 cases). Seven percent of cases (n = 94) were G2+ and1% (n = 11) were G3+. Adjusting for incomplete follow-up, estimated rates for G2+ and G3+ were 14% and 2%, respectively. In univariate analyses, gEUD, V5, V10, V20, V30, and mean lung dose (MLD) were positively associated with G2+ pneumonitis risk, whereas current smoking status was associated with lower odds of pneumonitis. G2+ pneumonitis risk of ≥22% was independently predicted by MLD of ≥20 Gy, V20 of ≥35%, and V5 of ≥75%. In multivariate analyses, the lung V5 metric remained a significant predictor of G2+ pneumonitis, even when controlling for MLD, despite their close correlation. For G3+ pneumonitis, MLD and V20 were statistically significant predictors. Number of patient comorbidities was an independent predictor of G3+, but not G2+ pneumonitis.We present an analysis of pneumonitis risk after definitive RT for lung cancer using a large, prospective dataset. We incorporate comorbidity burden, smoking status, and dosimetric parameters in an integrated risk model. These data may guide clinicians in assessing pneumonitis risk in individual patients.

Purpose/objective(s) Cardiac radiation exposure is associated with an increased rate of adverse cardiac events in patients receiving radiation therapy for locally advanced non-small cell lung carcinoma (NSCLC). Previous analysis of practice patterns within the statewide Michigan Radiation Oncology Quality Consortium (MROQC) revealed 1 in 4 patients received a mean heart dose > 20 Gy and significant heterogeneity existed among treatment centers in using cardiac dose constraints. The purpose of this study is to analyze the effect of education and initiation of standardized cardiac dose constraints on heart dose across a statewide consortium. Materials/methods From 2012 to 2020, 1604 patients from 27 academic and community centers who received radiation therapy for locally advanced NSCLC were included in this analysis. Dosimetric endpoints including mean heart dose (MHD), mean lung dose, and mean esophagus dose were calculated using data from dose-volume histograms. These dose metrics were grouped by year of treatment initiation for all patients. Education regarding data for cardiac dose constraints was discussed in small lung cancer working group meetings and consortium-wide starting in 2016. This was followed in 2018 by implementation of a quality metric requiring mean heart dose Results Following education and implementation of the heart dose performance metric, mean MHD declined from an average of 12.2 Gy pre-intervention to 10.4 Gy post-intervention, and the percentage of patients receiving MHD > 20 Gy reduced by half. (Table). Mean lung dose and mean esophagus dose did not increase, and tumor coverage remained unchanged. Conclusion Education and implementation of a standardized cardiac dose quality measure across a statewide consortium was associated with a reduction of mean heart dose in patients receiving radiation therapy for locally advanced NSCLC. These dose reductions were achieved without sacrificing tumor coverage, increasing mean lung dose or mean esophagus dose. Analysis of the clinical ramifications of the reduction in cardiac doses is ongoing.

Cerebral blindness is a loss of vision as a result of postchiasmatic damage to the visual pathways. Parts of the lost visual field can be restored through training. However, the neuronal mechanisms through which training effects occur are still unclear. We therefore assessed training-induced changes in brain function in eight patients with cerebral blindness. Visual fields were measured with perimetry and retinotopic maps were acquired with functional magnetic resonance imaging (fMRI) before and after vision restoration training. We assessed differences in hemodynamic responses between sessions that represented changes in amplitudes of neural responses and changes in receptive field locations and sizes. Perimetry results showed highly varied visual field recovery with shifts of the central visual field border ranging between 1 and 7°. fMRI results showed that, although retinotopic maps were mostly stable over sessions, there was a small shift of receptive field locations toward a higher eccentricity after training in addition to increases in receptive field sizes. In patients with bilateral brain activation, these effects were stronger in the affected than in the intact hemisphere. Changes in receptive field size and location could account for limited visual field recovery (±1°), although it could not account for the large increases in visual field size that were observed in some patients. Furthermore, the retinotopic maps strongly matched perimetry measurements before training. These results are taken to indicate that local visual field enlargements are caused by receptive field changes in early visual cortex, whereas large-scale improvement cannot be explained by this mechanism.

Cerebrale blindheid verwijst naar het blind zijn in delen van het gezichtsveld als gevolg van niet-aangeboren hersenschade, waarvan een cva (herseninfarct of hersenbloeding) de voornaamste oorzaak vormt. Bijna de helft van de cortex is verbonden met het visuele systeem waardoor een cva al snel tot een visueel defect leidt. Visuele-velddefecten kunnen enorm beperkend zijn en daarom wordt er reeds sinds de jaren 80gezocht naar methoden om deze beperkingen tegen te gaan. Een van die methoden betreft het (zoveel mogelijk) herstellen van het gezichtsvelddefect zelf, ofwel Visuele Veld Vergroting (vvv). In dit artikel beschrijven we de studie die we de afgelopen jaren hebben uitgevoerd in het kader van het falsifieren of verifieren van die methode.

Onze maatschappij doet een steeds hoger beroep op het menselijke visuele systeem. Informatie wordt meer en meer visueel overgedragen. Het is van groot belang om teksten goed te kunnen lezen, verkeersborden te kunnen zien, en tv- en niet te vergeten computerschermen te kunnen bekijken. Visuele stoornissen, zoals het verlies van delen van het gezichtsveld, kunnen het opnemen van deze informatie heel moeilijk maken. Dit artikel bespreekt training die gezichtsvelduitval door een niet-aangeboren hersenletsel mogelijk kan verminderen.

A 58-year old hemianopsia patient was submitted to a two-fold neuropsychological training in order to enhance visual functions in the affected part of his visual field. At first, the visual field was measured perimetrically, to serve as a starting measurement with which after-measurements could be compared. Then, the first training was started: the border area between the intact and the defect visual field was being stimulated by small light spots. The training consisted of repetitive detection threshold measurements. After 27 one-hour sessions, the visual field was being measured again. The visual field appeared to have been enlarged 5 to 12 degrees in the direction of the affected hemifield and contrast-sensitivity thresholds to have been decreased almost at every point in the stimulus-array. Then, a second training started; an eye-movement training. Again, the border area, now shifted outwards, was stimulated. This time, the stimulus concerned a short presentation of light (

Item does not contain fulltext OBJECTIVE: Visual training of light detection in the transition zone between blind and healthy hemianopic visual fields leads to improvement of color and simple pattern recognition. Recently, we demonstrated that visual field enlargement (VFE) also occurs when an area just beyond the transition zone is stimulated. In the current study, we attempted to determine whether this peripheral training also causes improvement in color and shape perception and reading speed. Further, we evaluated which measure of VFE relates best to improvements in performance: the average border shift (ABS) in degrees or the estimated amount of cortical surface gain (ECSG) in millimeters, using the cortical magnification factor (CMF). METHOD: Twelve patients received 40 sessions of 1-hour restorative function training (RFT). Before and after training, we measured visual fields and reading speed. Additionally, color and shape perception in the trained visual field area was measured in 7 patients. RESULTS: VFE was found for 9 of 12 patients. Significant improvements were observed in reading speed for 8 of 12 patients and in color and shape perception for 3 of 7 patients. ECSG correlates significantly with performance; ABS does not. Our data indicate that the threshold ECSG, needed for significant changes in color and shape perception and reading speed, is about 6 mm. CONCLUSIONS: White stimulus training-induced VFE can lead to improved color and shape perception and to increased reading speed in and beyond the pretraining transition zone if ECSG is sufficiently large. The latter depends on the eccentricity of the VFE.

Item does not contain fulltext BACKGROUND: Visual Restorative function training aims to decrease visual field defect size after acquired brain damage. Some chronic stroke patients regain permission to drive a car after training. This points to a concomitant change in oculomotor behavior, because visual field enlargement is hardly ever large enough for legal driving. This study investigated vRFT-induced changes in oculomotor behavior, using a driving simulator. METHODS: Driving performance and oculomotor behavior were measured before and after training in 6 hemianopia patients who had trained 65 hours with vRFT on a PC at home. RESULTS: Two patients showed negligible visual field enlargement (VFE) and four showed moderate to substantial VFE. Because less visual cortex is devoted to the processing of peripheral than central visual field the same VFE corresponds to less functional restoration of cortex when the defect is at high eccentricity. When this is taken into account, then precisely the two patients that showed the largest cortical gains made significantly more eye movements in the direction of their visual field defect after training. CONCLUSIONS: vRFT with mandatory eye fixation can result in increased eye movement behavior towards the defect. Our study suggests that a threshold amount of cortical functional restoration is required for this effect.

Background: Multiple studies on recovery of hemianopsia after cerebrovascular accident report visual-field enlargements after stimulation of the visual-field border area. These enlargements are made evident by the difference between pre- and post-training measurements of the visual field. Until now, it was not known how the visual-field enlargement develops. Aim: To study how the enlargement develops as a function of time. Methods: 11 subjects were trained by stimulating the border area of their visual-field defect using a Goldmann perimeter. The visual-field border location was assessed using dynamic Goldmann perimetry before, after and during training (after each 10th training session). To monitor eye fixation, a video-based eye-tracker was used during each complete perimetry session. Results: It was found that visual-field enlargement during training is actually a gradual shift of the visual-field border, which was independent of the type of stimulus-set used during training. The shift could be observed while eye fixation was accurate. Conclusion: Visual-detection training leads to a decrease in detection thresholds in the affected visual-field areas and to visual-field enlargement. Training effects can be generalised to important daily-life activities like reading.

To study the quality of the visual field areas that were regained after training. In those areas, we measured some of the elementary visual properties that make up the quality of visual functioning in daily-life. This was to provide information about whether the functional visual field had been enlarged.Patients with visual field defects after a CVA were trained to detect stimuli presented in the border area of the visual field defect. Then, in the regained areas, we measured visual acuity as a measure for spatial properties. Secondly, to assess for temporal properties we measured critical flicker frequency (CFF). Finally, we studied color vision as a third property of the regained areas.Since we could not predict where restoration of visual fields would occur, we did not present pre-post comparisons. However, despite the fact that training was carried out with simple white light stimuli, we could assess acuity, CFF and color vision in the regained areas. The performance of the patients during testing of the elementary properties appeared to be almost normal when compared to control subjects and comparable to the patient's own ipsilesional visual field.These results support the idea that the regained visual fields that emerged after training are actually used for processing additional visual stimuli other than those used during training.