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1. Study of linear energy transfer effect on rib fracture in breast patients receiving pencil-beam-scanning proton therapy

Author

Yang, Yunze, Gergelis, Kimberly R., Shen, Jiajian, Afzal, Arslan, Mullikin, Trey C., Gao, Robert W., Aziz, Khaled, Shumway, Dean A., Corbin, Kimberly S., Liu, Wei, and Mutter, Robert W.

Subjects
Physics - Medical Physics
Abstract

Purpose: To study the effect of proton linear energy transfer (LET) on rib fracture in breast cancer patients treated with pencil-beam scanning proton therapy (PBS) using a novel tool of dose-LET volume histogram (DLVH). Methods: From a prospective registry of patients treated with post-mastectomy proton therapy to the chest wall and regional lymph nodes for breast cancer between 2015 and 2020, we retrospectively identified rib fracture cases detected after completing treatment. Contemporaneously treated control patients that did not develop rib fracture were matched to patients 2:1 considering prescription dose, boost location, reconstruction status, laterality, chest wall thickness, and treatment year. The DLVH index, V(d, l), defined as volume(V) of the structure with at least dose(d) and LET(l), was calculated. DLVH plots between the fracture and control group were compared. Conditional logistic regression (CLR) model was used to establish the relation of V(d, l) and the observed fracture at each combination of d and l. The p-value derived from CLR model shows the statistical difference between fracture patients and the matched control group. Using the 2D p-value map, the DLVH features associated with the patient outcomes were extracted. Results: Seven rib fracture patients were identified, and fourteen matched patients were selected for the control group. The median time from the completion of proton therapy to rib fracture diagnosis was 12 months (range 5 to 14 months). Two patients had grade 2 symptomatic rib fracture while the remaining 5 were grade 1 incidentally detected on imaging. The derived p-value map demonstrated larger V(0-36 Gy[RBE], 4.0-5.0 keV/um) in patients experiencing fracture (p<0.1). Conclusions: In breast cancer patients receiving PBS, a larger volume of chest wall receiving moderate dose and high LET may result in increased risk of rib fracture., Comment: 1 Table and 3 Figures

Published
2023

3. Assessment of minimum target dose as a predictor of local failure after spine SBRT

Author

Kowalchuk, Roman O., Mullikin, Trey C., Spears, Grant M., Johnson-Tesch, Benjamin A., Rose, Peter S., Siontis, Brittany L., Kun Kim, Dong, Costello, Brian A., Morris, Jonathan M., Gao, Robert W., Shiraishi, Satomi, Lucido, John J., Olivier, Kenneth R., Owen, Dawn, Stish, Bradley J., Waddle, Mark R., Laack, Nadia N., Park, Sean S., Brown, Paul D., and Merrell, Kenneth W.

Published
2024
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4. Postmastectomy Intensity Modulated Proton Therapy: 5-Year Oncologic and Patient-Reported Outcomes

Author

Gao, Robert W., Mullikin, Trey C., Aziz, Khaled A., Afzal, Arslan, Smith, Na L., Routman, David M., Gergelis, Kimberly R., Harmsen, William S., Remmes, Nicholas B., Tseung, Hok Seum Wan Chan, Shiraishi, Satomi S., Boughey, Judy C., Ruddy, Kathryn J., Harless, Christin A., Garda, Allison E., Waddle, Mark R., Park, Sean S., Shumway, Dean A., Corbin, Kimberly S., and Mutter, Robert W.

Published
2023
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5. Conventional versus hypofractionated postmastectomy proton radiotherapy in the USA (MC1631): a randomised phase 2 trial

Author

Mutter, Robert W, Giri, Sharmila, Fruth, Briant F, Remmes, Nicholas B, Boughey, Judy C, Harless, Christin A, Ruddy, Kathryn J, McGee, Lisa A, Afzal, Arslan, Gao, Robert W, Shumway, Dean A, Vern-Gross, Tamara Z, Villarraga, Hector R, Kenison, Stephanie L, Kang, Yixiu, Wong, William W, Stish, Bradley J, Merrell, Kenneth W, Yan, Elizabeth S, Park, Sean S, Corbin, Kimberly S, and Vargas, Carlos E

Published
2023
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6. Dosimetric predictors of pneumonitis in locally advanced non-small cell lung cancer patients treated with chemoradiation followed by durvalumab

Author

Gao, Robert W., Day, Courtney N., Yu, Nathan Y., Bush, Aaron, Amundson, Adam C., Prodduturvar, Pranitha, Majeed, Umair, Butts, Emily, Oliver, Thomas, Schwecke, Anna J., Moffett, Jenesse N., Routman, David M., Breen, William G., Potter, Ashley L., Rivera-Concepcion, Joel, Hoppe, Bradford S., Schild, Steven E., Sio, Terence T., Lou, Yanyan, Ernani, Vinicius, Ko, Stephen, Olivier, Kenneth R., Merrell, Kenneth W., Garces, Yolanda I., Manochakian, Rami, Harmsen, William S., Leventakos, Konstantinos, and Owen, Dawn

Published
2022
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7. Development and Internal Validation of a Recursive Partitioning Analysis–Based Model Predictive of Pain Flare Incidence After Spine Stereotactic Body Radiation Therapy

Author

Kowalchuk, Roman O., Mullikin, Trey C., Harmsen, William S., Rose, Peter S., Siontis, Brittany L., Kim, Dong Kun, Costello, Brian A., Morris, Jonathan M., Marion, Joseph T., Johnson-Tesch, Benjamin A., Gao, Robert W., Shiraishi, Satomi, Lucido, John J., Olivier, Kenneth R., Owen, Dawn, Stish, Bradley J., Laack, Nadia N., Park, Sean S., Brown, Paul D., and Merrell, Kenneth W.

Published
2022
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10. Metastasis-directed Therapy Prolongs Efficacy of Systemic Therapy and Improves Clinical Outcomes in Oligoprogressive Castration-resistant Prostate Cancer

Author

Deek, Matthew P., Taparra, Kekoa, Phillips, Ryan, Velho, Pedro Isaacsson, Gao, Robert W., Deville, Curtiland, Song, Daniel Y., Greco, Stephen, Carducci, Michael, Eisenberger, Mario, DeWeese, Theodore L., Denmeade, Samuel, Pienta, Kenneth, Paller, Channing J., Antonarakis, Emmanuel S., Olivier, Kenneth R., Park, Sean S., Tran, Phuoc T., and Stish, Bradley J.

Published
2021
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11. Patterns of Recurrence and Modes of Progression After Metastasis-Directed Therapy in Oligometastatic Castration-Sensitive Prostate Cancer

Author

Deek, Matthew P., Taparra, Kekoa, Dao, Dyda, Chan, Luanna, Phillips, Ryan, Gao, Robert W., Kwon, Eugene D., Deville, Curtiland, Song, Daniel Y., Greco, Stephen, Carducci, Michael A., Eisenberger, Mario, DeWeese, Theodore L., Denmeade, Samuel, Pienta, Kenneth, Paller, Channing J., Antonarakis, Emmanuel S., Olivier, Kenneth R., Park, Sean S., Stish, Bradley J., and Tran, Phuoc T.

Published
2021
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16. Development and validation of a recursive partitioning analysis–based pretreatment decision‐making tool identifying ideal candidates for spine stereotactic body radiation therapy

Author

Kowalchuk, Roman O., primary, Mullikin, Trey C., additional, Florez, Marcus, additional, De, Brian S., additional, Spears, Grant M., additional, Rose, Peter S., additional, Siontis, Brittany L., additional, Kim, Dong Kun, additional, Costello, Brian A., additional, Morris, Jonathan M., additional, Marion, Joseph T., additional, Johnson‐Tesch, Benjamin A., additional, Gao, Robert W., additional, Shiraishi, Satomi, additional, Lucido, John J., additional, Trifiletti, Daniel M., additional, Olivier, Kenneth R., additional, Owen, Dawn, additional, Stish, Bradley J., additional, Waddle, Mark R., additional, Laack, Nadia N., additional, Park, Sean S., additional, Brown, Paul D., additional, Ghia, Amol J., additional, and Merrell, Kenneth W., additional

Published
2022
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17. Adenoid cystic carcinoma of the head and neck: Patterns of recurrence and implications for intensity‐modulated radiotherapy

Author

Gao, Robert W., primary, Routman, David M., additional, Harmsen, William S., additional, Ebrahimi, Sasha, additional, Foote, Robert L., additional, Ma, Daniel J., additional, Neben‐Wittich, Michelle, additional, McGee, Lisa A., additional, Patel, Samir H., additional, Moore, Eric J., additional, Choby, Garret W., additional, Tasche, Kendall K., additional, Price, Katharine A., additional, Gamez, Mauricio E., additional, and Lester, Scott C., additional

Published
2022
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18. Development and validation of a recursive partitioning analysis–based pretreatment decision‐making tool identifying ideal candidates for spine stereotactic body radiation therapy.

Author

Kowalchuk, Roman O., Mullikin, Trey C., Florez, Marcus, De, Brian S., Spears, Grant M., Rose, Peter S., Siontis, Brittany L., Kim, Dong Kun, Costello, Brian A., Morris, Jonathan M., Marion, Joseph T., Johnson‐Tesch, Benjamin A., Gao, Robert W., Shiraishi, Satomi, Lucido, John J., Trifiletti, Daniel M., Olivier, Kenneth R., Owen, Dawn, Stish, Bradley J., and Waddle, Mark R.

Subjects
STEREOTACTIC radiotherapy, RECURSIVE partitioning, SPINE, SPINAL instability, DECISION making
Abstract

Background: This study was aimed at developing and validating a decision‐making tool predictive of overall survival (OS) for patients receiving stereotactic body radiation therapy (SBRT) for spinal metastases. Methods: Three hundred sixty‐one patients at one institution were used for the training set, and 182 at a second institution were used for external validation. Treatments most commonly involved one or three fractions of spine SBRT. Exclusion criteria included proton therapy and benign histologies. Results: The final model consisted of the following variables and scores: Spinal Instability Neoplastic Score (SINS) ≥ 6 (1), time from primary diagnosis < 21 months (1), Eastern Cooperative Oncology Group (ECOG) performance status = 1 (1) or ECOG performance status > 1 (2), and >1 organ system involved (1). Each variable was an independent predictor of OS (p <.001), and each 1‐point increase in the score was associated with a hazard ratio of 2.01 (95% confidence interval [CI], 1.79–2.25; p <.0001). The concordance value was 0.75 (95% CI, 0.71–0.78). The scores were discretized into three groups—favorable (score = 0–1), intermediate (score = 2), and poor survival (score = 3–5)—with 2‐year OS rates of 84% (95% CI, 79%–90%), 46% (95% CI, 36%–59%), and 21% (95% CI, 14%–32%), respectively (p <.0001 for each). In the external validation set (182 patients), the score was also predictive of OS (p <.0001). Increasing SINS was predictive of decreased OS as a continuous variable (p <.0001). Conclusions: This novel score is proposed as a decision‐making tool to help to optimize patient selection for spine SBRT. SINS may be an independent predictor of OS. A model predictive of overall survival after spine stereotactic body radiation therapy (SBRT) has been developed and externally validated, and it provides a decision‐making tool to help to optimize patient selection for spine SBRT. The model components are the Spinal Instability Neoplastic Score, the time from diagnosis, the performance status, and the organ systems involved. [ABSTRACT FROM AUTHOR]

Published
2023
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19. Development and Assessment of a Predictive Score for Vertebral Compression Fracture After Stereotactic Body Radiation Therapy for Spinal Metastases

Author

Kowalchuk, Roman O., primary, Johnson-Tesch, Benjamin A., additional, Marion, Joseph T., additional, Mullikin, Trey C., additional, Harmsen, William S., additional, Rose, Peter S., additional, Siontis, Brittany L., additional, Kim, Dong Kun, additional, Costello, Brian A., additional, Morris, Jonathan M., additional, Gao, Robert W., additional, Shiraishi, Satomi, additional, Lucido, John J., additional, Sio, Terence T., additional, Trifiletti, Daniel M., additional, Olivier, Kenneth R., additional, Owen, Dawn, additional, Stish, Bradley J., additional, Waddle, Mark R., additional, Laack, Nadia N., additional, Park, Sean S., additional, Brown, Paul D., additional, and Merrell, Kenneth W., additional

Published
2022
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20. Adenoid cystic carcinoma of the head and neck: Patterns of recurrence and implications for intensity‐modulated radiotherapy.

Author

Gao, Robert W., Routman, David M., Harmsen, William S., Ebrahimi, Sasha, Foote, Robert L., Ma, Daniel J., Neben‐Wittich, Michelle, McGee, Lisa A., Patel, Samir H., Moore, Eric J., Choby, Garret W., Tasche, Kendall K., Price, Katharine A., Gamez, Mauricio E., and Lester, Scott C.

Subjects
ADENOID cystic carcinoma, INTENSITY modulated radiotherapy, RADIOTHERAPY, PATIENTS' attitudes, HEAD & neck cancer, NECK
Abstract

Background: We seek to inform radiotherapy (RT) delivery for adenoid cystic carcinoma of the head and neck (ACC) by evaluating RT techniques and recurrence patterns. Methods: We identified patients with ACC treated with curative‐intent RT from 2005 to 2021. Imaging was reviewed to determine local recurrence (LR). Results: Ninety‐one patients were included. The 5‐year LR risk was 12.2% (6.6–22.7). One patient each experienced a marginal and out‐of‐field recurrence. Patients receiving >60 Gy postoperatively had a 5‐year LR risk of 0% compared to 10.7% (4.2–27.2) with ≤60 Gy. Those receiving 70 and <70 Gy definitively had a 5‐year LR risk of 15.2% (2.5–91.6) and 33.3% (6.7–100.0), respectively. No patients had regional nodal failure. Conclusions: Modern, conformal RT for ACC results in low rates of LR. Doses >60 and 70 Gy may improve control in the postoperative and definitive settings, respectively. Elective nodal treatment can be omitted in well‐selected patients. [ABSTRACT FROM AUTHOR]

Published
2023
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21. Outcomes and Patterns of Recurrence for Anaplastic Thyroid Cancer Treated with Comprehensive Chemoradiotherapy

Author

Gao, Robert W., primary, Foote, Robert L., additional, Garces, Yolanda I., additional, Ma, Daniel J., additional, Neben-Wittich, Michelle, additional, Routman, David M., additional, Patel, Samir H., additional, Ko, Stephen J., additional, McGee, Lisa A., additional, Bible, Keith C., additional, Chintakuntlawar, Ashish V., additional, Ryder, Mabel, additional, Morris, John C., additional, Van Abel, Kathryn M., additional, Rivera, Michael, additional, Abraha, Feven, additional, and Lester, Scott C., additional

Published
2021
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22. Single institution toxicity of definitive chemoradiation and maintenance durvalumab in locally advanced non-small cell lung cancer.

Author

Prodduturvar, Pranitha, primary, Leventakos, Konstantinos, additional, Potter, Ashley, additional, Gao, Robert W., additional, Dimou, Anastasios, additional, Marks, Randolph, additional, Garces, Yolanda I., additional, Olivier, Kenneth R., additional, Molina, Julian R., additional, Merrell, Kenneth, additional, Mansfield, Aaron Scott, additional, Adjei, Alex A., additional, Schwecke, Anna, additional, Hocum, Craig, additional, Moffett, Jenesse Nicole, additional, Park, Sean Sunghun, additional, and Owen, Dawn, additional

Published
2021
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24. Single-fraction Stereotactic Body Radiation Therapy versus Conventionally Fractionated Radiation Therapy for the Treatment of Prostate Cancer Bone Metastases

Author

Gao, Robert W., primary, Olivier, Kenneth R., additional, Park, Sean S., additional, Davis, Brian J., additional, Pisansky, Thomas M., additional, Choo, Richard, additional, Kwon, Eugene D., additional, Karnes, R. Jeffrey, additional, Harmsen, William S., additional, and Stish, Bradley J., additional

Published
2019
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25. Dramatic Regression of a Fungating Breast Lesion Treated with Radiation Therapy

Author

Gao, Robert W, Edlund, Shane, and Yuan, Jianling

Subjects
locally advanced breast cancer, Oncology, Radiation Oncology, palliative radiotherapy, fungating breast lesions
Abstract

Although advances in screening mammography have dramatically improved the early detection of breast cancer, a subset of breast cancer cases still present as locally advanced disease. Some of these patients develop fungating lesions, which are difficult to manage and can have a severe impact on the quality of life. Palliative treatment options include surgery, intra-arterial chemotherapy, and radiation therapy. Herein, we describe the case of a patient who presented with a fungating breast mass and demonstrated an immediate and durable response to radiation therapy with a significantly improved quality of life.

Published
2017

26. Study of linear energy transfer effect on rib fracture in breast patients receiving pencil-beamscanning proton therapy.

Author

Yang Y, Gergelis KR, Shen J, Afzal A, Mullikin TC, Gao RW, Aziz K, Shumway DA, Corbin KS, Liu W, and Mutter RW

Abstract

Purpose: To study the effect of proton linear energy transfer (LET) on rib fracture in breast cancer patients treated with pencil-beam scanning proton therapy (PBS) using a novel tool of dose-LET volume histogram (DLVH)., Methods: From a prospective registry of patients treated with post-mastectomy proton therapy to the chest wall and regional lymph nodes for breast cancer between 2015 and 2020, we retrospectively identified rib fracture cases detected after completing treatment. Contemporaneously treated control patients that did not develop rib fracture were matched to patients 2:1 considering prescription dose, boost location, reconstruction status, laterality, chest wall thickness, and treatment year.The DLVH index, V ( d , l ), defined as volume( V ) of the structure with at least dose (d) and LET( l) , was calculated. DLVH plots between the fracture and control group were compared. Conditional logistic regression (CLR) model was used to establish the relation of V ( d , l ) and the observed fracture at each combination of d and l . The p -value derived from CLR model shows the statistical difference between fracture patients and the matched control group. Using the 2D p -value map derived from CLR model, the DLVH features associated with the patient outcomes were extracted., Results: Seven rib fracture patients were identified, and fourteen matched patients were selected for the control group. The median time from the completion of proton therapy to rib fracture diagnosis was 12 months (range 5 to 14 months). Two patients had grade 2 symptomatic rib fracture while the remaining 5 were grade 1 incidentally detected on imaging. The derived p -value map demonstrated larger V (0-36Gy[RBE], 4.0-5.0 keV/μm) in patients experiencing fracture ( p <0.1). For example, the p value for V(30 Gy[RBE], 4.0 keV/um) was 0.069., Conclusions: In breast cancer patients receiving PBS, a larger volume of chest wall receiving moderate dose and high LET may result in increased risk of rib fracture., Competing Interests: Conflict of Interest Statement for All Authors The authors declare no conflict of interest.

Published
2023

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