497 results on '"Moiseenko, Vitali"'
Search Results
2. Validation of Patient-Reported Outcomes in Patients With Nonmetastatic Breast Cancer Receiving Comprehensive Nodal Irradiation in the RadComp Trial
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Godette, Karen D., Patel, Sagar, Langen, Katja M., Zielan, Ryan R., DeBlois, David, Pang, Dalong, Rudra, Sonali, Benhabib, Sidi, Chawla, Ashish, Chen, Kuanling, Dadkhah, Hossein, Majithia, Lonika, Rao, Avani D., Stephenson, Lisa, Wang, Peng, Croog, Victoria J., Li, Heng, Smith, Karen, Stinson, Susan, Walker, Amanda J., Devisetty, Kiran, Hyde, Christian, Depauw, Nicholas, Godishala, Anuradha, Ho, Alice, Paganetti, Harald, Soto, Daniel, Suero-Abreu, Giselle, Taghian, Alphonse G., Corbin, Kimberly S., Halyard, Michele Y., Jackson, Amanda, Liang, Xiaoying, Manke, Heather, McGee, Lisa A., Pafundi, Deanna H., Remmes, Nicholas B., Shumway, Dean A., Yan, Elizabeth S., Bakhoum, Samuel F., Barron, David A., Bernstein, Michael, Cuaron, John J., Dover, Laura, Gelblum, Daphna Y., Gilbo, Philip, Gewanter, Richard M., Guttman, David M., Hong, Linda, Khan, Atif, LaPlant, Quincey, Mann, Justin, McCormick, Beryl, Mueller, Boris A., Mychalczak, Borys, Parikh, Dhwani, Powell, Simon N., Romesser, Paul B., Roth O'Brien, Diana, Schupak, Karen D., Shepherd, Annemarie F., Xu, Amy, Yu, Anthony, Zinovoy, Melissa, Bennouna, Jaafar, Fagundes, Marcio, Panoff, Joseph, Amelia Rodrigues, Maria, Yu, Jen, Lee, Choonsik, Chen, Chin-Cheng, Choi, J. Isabelle, Lin, Haibo, Akthar, Adil S., Akhter, Nausheen, Mihalcik, Stephen A., Pankuch, Mark, Parhar, Preeti K., Stutz, Michael D., Thukral, Arpi D., Mah, Dennis, Tsai, Henry K., Paulus, Rebecca, Haffty, Bruce G., Goyal, Sharad, Yue, Ning J., Sturgeon, Jared D., Wilkinson, J. Ben, Boggs, D. Hunter, Cardan, Rex A., Dalton, Allison, McDonald, Andrew, Prior, Fred, Mayadev, Jyoti S., Moiseenko, Vitali, Narezkina, Anya, Phreaner, Nicholas, Rash, Dominique, Seibert, Tyler, Yashar, Catheryn, Daugherty, Emily C., Mascia, Anthony, Medek, Sara A., Meier, Teresa, Bradley, Julie A., Lockney, Natalie, Mailhot, Raymond B., Mendenhall, Nancy, Rutenberg, Michael, Harris, Eleanor E., Lyons, Janice, Hong, Jack J., Kunaprayoon, Dan K., McAvoy, Sarah A., Manu Mysore, Nowak Choi, Kamila A., Patel, Akshar N., Vyfhuis, Melissa A.L., Wilson, Joelle, Algan, Ozer, Chen, Yong, Henson, Christina E., Dvorak, Tomas, Willoughby, Twyla, Zeidan, Omar, Berman, Abigail T., Chen, Et-tsu, Dong, Lei, Driscoll, Amanda, Feigenberg, Steven J., Feriozzi, Ashley, Hencek, Carolyn, Kolker, James D., Konski, Andre A., Ky, Bonnie, Lin, Lilie L., Novick, Kristina L., Reza, Nosheen, Siegal, Ann Marie, Tabakha, Sara, Taunk, Neil K., Wilcox, Nicholas, Zou, Wei, Bhooshan, Neha, Croley, Richard, Weksberg, David C., Ahmad, Neelour, Hoffman, Karen E., Joyner, Melissa M., Mitchell, Melissa P., Poenisch, Falk, Smith, Benjamin D., Strom, Eric A., Vallabhaneni, Srilakshmi, Cheng, Richard, Kang, Kylie H., Kim, H. Katherine, Kim, Janice N., Wang, Waylene A., Wong, Tony, Bosch, Walter, Mitchell, Joshua, Straube, William, Zoberi, Imran, Balanescu, Dinu, Chen, Peter Y., Dilworth, Joshua T., Ding, Xuanfeng, Donisan, Teodora, Hamstra, Daniel A., Daniella Dang, Phuong, Katz, Stanford, Wang, Chiachien J., Terry Wu, Hahn, Elizabeth A., Pugh, Stephanie L., Lu, Hien L., Vela, Alyssa M., Gillespie, Erin F., Nichols, Elizabeth M., Wright, Jean L., MacDonald, Shannon M., Cahlon, Oren, Baas, Carole, Braunstein, Lior Z., Fang, L. Christine, Freedman, Gary M., Jimenez, Rachel B., Kesslering, Christy M., Mishra, Mark V., Mutter, Robert W., Ohri, Nisha, Rosen, Lane R., Urbanic, James J., Jagsi, Reshma, Mitchell, Sandra A., Bekelman, Justin E., and Cella, David
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- 2024
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3. Chest wall pain after single-fraction thoracic stereotactic ablative Radiotherapy: Dosimetric analysis from the iSABR trial
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Lau, Brianna, Wu, Yufan F., Cui, Sunan, Fu, Jie, Jackson, Scott, Pham, Daniel, Dubrowski, Piotr, Eswarappa, Shaila, Skinner, Lawrie, Shirato, Hiroki, Taguchi, Hiroshi, Gensheimer, Michael F., Gee, Harriet, Chin, Alexander L., Diehn, Maximilian, Loo, Billy W., Jr., Moiseenko, Vitali, and Vitzthum, Lucas K.
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- 2024
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4. Cardiac Disease in Childhood Cancer Survivors Treated With Radiation Therapy: A PENTEC Comprehensive Review
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Bates, James E., Rancati, Tiziana, Keshavarz, Homa, Gagliardi, Giovanna, Aznar, Marianne C., Howell, Rebecca M., Shrestha, Suman, Moiseenko, Vitali, Yorke, Ellen, Armenian, Saro, Kremer, Leontien, Chen, Ming Hui, van der Pal, Helena J., Cutter, David J., Constine, Louis S., and Hodgson, David
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- 2024
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5. Risk of Cerebrovascular Events Among Childhood and Adolescent Patients Receiving Cranial Radiation Therapy: A PENTEC Normal Tissue Outcomes Comprehensive Review
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Waxer, Jonathan F., Wong, Kenneth, Modiri, Arezoo, Charpentier, Anne-Marie, Moiseenko, Vitali, Ronckers, Cécile M., Taddei, Phillip J., Constine, Louis S., Sprow, Grant, Tamrazi, Benita, MacDonald, Shannon, and Olch, Arthur J.
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- 2024
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6. Automated segmentation of multiparametric magnetic resonance images for cerebral AVM radiosurgery planning: a deep learning approach
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Simon, Aaron B, Hurt, Brian, Karunamuni, Roshan, Kim, Gwe-Ya, Moiseenko, Vitali, Olson, Scott, Farid, Nikdokht, Hsiao, Albert, and Hattangadi-Gluth, Jona A
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Biomedical and Clinical Sciences ,Clinical Sciences ,Biomedical Imaging ,Clinical Research ,Neurosciences ,Neurological ,Cerebral Angiography ,Cerebral Arteries ,Cerebral Veins ,Deep Learning ,Humans ,Intracranial Arteriovenous Malformations ,Magnetic Resonance Angiography ,Multiparametric Magnetic Resonance Imaging ,Radiosurgery - Abstract
Stereotactic radiosurgery planning for cerebral arteriovenous malformations (AVM) is complicated by the variability in appearance of an AVM nidus across different imaging modalities. We developed a deep learning approach to automatically segment cerebrovascular-anatomical maps from multiple high-resolution magnetic resonance imaging/angiography (MRI/MRA) sequences in AVM patients, with the goal of facilitating target delineation. Twenty-three AVM patients who were evaluated for radiosurgery and underwent multi-parametric MRI/MRA were included. A hybrid semi-automated and manual approach was used to label MRI/MRAs with arteries, veins, brain parenchyma, cerebral spinal fluid (CSF), and embolized vessels. Next, these labels were used to train a convolutional neural network to perform this task. Imaging from 17 patients (6362 image slices) was used for training, and 6 patients (1224 slices) for validation. Performance was evaluated by Dice Similarity Coefficient (DSC). Classification performance was good for arteries, veins, brain parenchyma, and CSF, with DSCs of 0.86, 0.91, 0.98, and 0.91, respectively in the validation image set. Performance was lower for embolized vessels, with a DSC of 0.75. This demonstrates the proof of principle that accurate, high-resolution cerebrovascular-anatomical maps can be generated from multiparametric MRI/MRA. Clinical validation of their utility in radiosurgery planning is warranted.
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- 2022
7. Germline genetic biomarkers to stratify patients for personalized radiation treatment
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Deichaite, Ida, Hopper, Austin, Krockenberger, Lena, Sears, Timothy J, Sutton, Leisa, Ray, Xenia, Sharabi, Andrew, Navon, Ami, Sanghvi, Parag, Carter, Hannah, and Moiseenko, Vitali
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Biomedical and Clinical Sciences ,Oncology and Carcinogenesis ,Cancer ,Orphan Drug ,Patient Safety ,Genetics ,Human Genome ,Rare Diseases ,Precision Medicine ,Clinical Research ,Radiation Oncology ,Genetic Testing ,Cancer Genomics ,Dental/Oral and Craniofacial Disease ,Good Health and Well Being ,Biomarkers ,Tumor ,Carcinoma ,Squamous Cell ,Germ Cells ,HLA-A Antigens ,Head and Neck Neoplasms ,Humans ,Neoplasm Recurrence ,Local ,Squamous Cell Carcinoma of Head and Neck ,Predictive biomarkers of radiation toxicity ,Head and neck squamous cell carcinoma ,Radiogenomics ,Germline variants ,TSC2 ,HLA-A ,TET2 ,GEN1 ,NCOR2 ,predictive biomarkers of radiation toxicity ,head and neck squamous cell carcinoma ,radiogenomics ,germline variants ,Medical and Health Sciences ,Immunology ,Biomedical and clinical sciences ,Health sciences - Abstract
BackgroundPrecision medicine incorporating genetic profiling is becoming a standard of care in medical oncology. However, in the field of radiation oncology there is limited use of genetic profiling and the impact of germline genetic biomarkers on radiosensitivity, radioresistance, or patient outcomes after radiation therapy is poorly understood. In HNSCC, the toxicity associated with treatment can cause delays or early cessation which has been associated with worse outcomes. Identifying potential biomarkers which can help predict toxicity, as well as response to treatment, is of significant interest.MethodsPatients with HNSCC who received RT and underwent next generation sequencing of somatic tumor samples, transcriptome RNA-seq with matched normal tissue samples were included. Patients were then grouped by propensity towards increased late vs. early toxicity (Group A) and those without (Group B), assessed by CTCAE v5.0. The groups were then analyzed for association of specific germline variants with toxicity and clinical outcomes.ResultsIn this study we analyzed 37 patients for correlation between germline variants and toxicity. We observed that TSC2, HLA-A, TET2, GEN1, NCOR2 and other germline variants were significantly associated with long term toxicities. 34 HNSCC patients treated with curative intent were evaluated for clinical outcomes. Group A had significantly improved overall survival as well as improved rates of locoregional recurrence and metastatic disease. Specific variants associated with improved clinical outcomes included TSC2, FANCD2, and PPP1R15A, while the HLA-A and GEN1 variants were not correlated with survival or recurrence. A group of five HLA-DMA/HLA-DMB variants was only found in Group B and was associated with a higher risk of locoregional recurrence.ConclusionsThis study indicates that germline genetic biomarkers may have utility in predicting toxicity and outcomes after radiation therapy and deserve further investigation in precision radiation medicine approaches.
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- 2022
8. Evaluating predictive factors for toxicities experienced by head & neck cancer patients undergoing radiotherapy
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Ray, Xenia, Sumner, Whitney, Sutton, Leisa, Sanghvi, Parag, Deichaite, Ida, and Moiseenko, Vitali
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Biomedical and Clinical Sciences ,Clinical Sciences ,Oncology and Carcinogenesis ,Sexually Transmitted Infections ,Dental/Oral and Craniofacial Disease ,Digestive Diseases ,Prevention ,Cancer ,Infectious Diseases ,4.2 Evaluation of markers and technologies ,Detection ,screening and diagnosis ,Deglutition Disorders ,Head and Neck Neoplasms ,Humans ,Oropharyngeal Neoplasms ,Pharyngeal Muscles ,Retrospective Studies ,Predictive biomarkers of radiation toxicity ,Head and neck squamous cell carcinoma ,RT dosimetric data ,Human papilloma virus ,Medical and Health Sciences ,Immunology ,Biomedical and clinical sciences ,Health sciences - Abstract
PurposeThe purpose of this study was to evaluate if HPV status serves as an independent predictor of early and late dysphagia outcomes when considered alongside standard patient characteristics and dose metrics for head and neck cancer patients treated with radiotherapy.Methods and materialsThe age, sex, smoking history, cancer type (oropharyngeal vs non-oropharyngeal), HPV status, and early and late dysphagia outcomes were obtained for 99 retrospective head and neck cancer patients treated at our clinic with radiotherapy. Additionally for each patient, the mean radiation dose to the pharynx, superior/middle/inferior pharyngeal constrictor muscles, and cricopharyngeus was calculated. The predictive power of these clinical characteristics and radiation metrics was evaluated using chi-square tests for categorical variables and t-tests for continuous variables. Then multi-variate logistic models were built for each outcome using a single dose metric at a time, and either HPV status, cancer type, or both. Multi-variate models were built using both top-down and bottom-up technique to establish the most predictive independent covariates.ResultsIn the univariate analysis for early dysphagia, cancer type (p = 0.04) and four dose metrics (p ≤ 0.02) were significantly associated with outcome, while for late dysphagia, only cancer type (p = 0.04) was associated with outcome. In the multivariate analysis for early dysphagia, cancer type, smoking history, and mean dose to the five structures were consistently selected as covariates. For late dysphagia, either HPV status or cancer type was selected in each model and the mean dose to the cricopharyngeus was selected in one model.ConclusionWhile HPV is a known contributing factor for tumor prognosis in oropharyngeal cancers, its role in normal tissue toxicities for head and neck cancers has not previously been evaluated. Our results indicate having an oropharyngeal cancer may increase a patient's risk of high-grade early and late dysphagia while HPV status was seldom selected.
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- 2021
9. Gene alterations as predictors of radiation-induced toxicity in head and neck squamous cell carcinoma
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Sumner, Whitney, Ray, Xenia, Sutton, Leisa, Rebibo, Daniel, Marincola, Francesco, Sanghvi, Parag, Moiseenko, Vitali, and Deichaite, Ida
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Biomedical and Clinical Sciences ,Clinical Sciences ,Oncology and Carcinogenesis ,Rare Diseases ,Dental/Oral and Craniofacial Disease ,Patient Safety ,Biotechnology ,Cancer ,Clinical Research ,Genetics ,Good Health and Well Being ,Carcinoma ,Squamous Cell ,Head and Neck Neoplasms ,Humans ,Neoplasm Recurrence ,Local ,Quality of Life ,Squamous Cell Carcinoma of Head and Neck ,Predictive biomarkers of radiation toxicity ,Head and neck squamous cell carcinoma ,Radiogenomics ,BRCA2 ,ERBB3 ,RT dosimetric data ,TNFAIP3 ,HNF1A ,SPTA1 ,CASP8 ,predictive biomarkers of radiation toxicity ,head and neck squamous cell carcinoma ,radiogenomics ,Medical and Health Sciences ,Immunology ,Biomedical and clinical sciences ,Health sciences - Abstract
BackgroundOptimizing the therapeutic ratio for radiation therapy (RT) in head and neck squamous cell carcinoma (HNSCC) is uniquely challenging owing to high rates of early and late toxicity involving nearby organs at risk. These toxicities have a profound impact on treatment compliance and quality of life. Emerging evidence suggests that RT dose alone cannot fully account for the variable severity of RT-related adverse events (rtAEs) observed in HNSCC patients. Next-generation sequencing has become an increasingly valuable tool with widespread use in the oncology field and is being robustly explored for predicting rtAEs beyond dosimetric data.MethodsPatients who had Foundation Medicine sequencing data and received RT for primary or locally recurrent HNSCC were selected for this study. Early and late toxicity data were collected and reported based on Common Terminology Criteria for Adverse Events version 5.0. Dosimetric parameters were collected for pertinent structures.ResultsA total of HNSCC 37 patients were analyzed in this study. Genetic alterations in BRCA2, ERBB3, NOTCH1 and CCND1 were all associated with higher mean grade of toxicity with BRCA2 alteration implicated in all toxicity parameters evaluated including mucositis, early dysphagia, xerostomia and to a lesser extent, late dysphagia. Interestingly, patients who exhibited alterations in both BRCA2 and ERBB3 experienced a twofold or greater increase in early dysphagia, early xerostomia and late dysphagia compared to ERBB3 alteration alone. Furthermore, several gene alterations were associated with improved toxicity outcomes. Within an RT supersensitive patient subset, alterations were found in TNFAIP3, HNF1A, SPTA1 and CASP8. All of these alterations were not found in the RT insensitive patient subset. We found 17 gene alterations in the RT insensitive patient subset that were not found in the RT supersensitive patient subset.ConclusionDespite consistent RT dosimetric parameters, patients with HNSCC experience heterogeneous patterns of rtAEs. Identifying factors associated with toxicity outcomes offers a new avenue for personalized precision RT therapy and prophylactic management. Here, next-generation sequencing in a population of HNSCC patients correlates several genetic alterations with severity of rtAEs. Further analysis is urgently needed to identify genetic patterns associated with rtAEs in order to reduce harmful outcomes in this challenging population.
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- 2021
10. Single- and Multi-Fraction Stereotactic Radiosurgery Dose Tolerances of the Optic Pathways
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Milano, Michael T, Grimm, Jimm, Soltys, Scott G, Yorke, Ellen, Moiseenko, Vitali, Tomé, Wolfgang A, Sahgal, Arjun, Xue, Jinyu, Ma, Lijun, Solberg, Timothy D, Kirkpatrick, John P, Constine, Louis S, Flickinger, John C, Marks, Lawrence B, and El Naqa, Issam
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Cancer ,Rare Diseases ,Brain Cancer ,Neurosciences ,Eye Disease and Disorders of Vision ,Brain Disorders ,Patient Safety ,6.5 Radiotherapy and other non-invasive therapies ,Evaluation of treatments and therapeutic interventions ,Eye ,Adenoma ,Blindness ,Cavernous Sinus ,Craniopharyngioma ,Humans ,Maximum Tolerated Dose ,Meningeal Neoplasms ,Meningioma ,Models ,Biological ,Models ,Theoretical ,Optic Chiasm ,Optic Nerve ,Organs at Risk ,Pituitary Neoplasms ,Radiation Dose Hypofractionation ,Radiation Tolerance ,Radiosurgery ,Radiotherapy Dosage ,Re-Irradiation ,Skull Base Neoplasms ,Visual Acuity ,Visual Fields ,Other Physical Sciences ,Clinical Sciences ,Oncology and Carcinogenesis ,Oncology & Carcinogenesis - Abstract
PurposeDosimetric and clinical predictors of radiation-induced optic nerve/chiasm neuropathy (RION) after single-fraction stereotactic radiosurgery (SRS) or hypofractionated (2-5 fractions) radiosurgery (fSRS) were analyzed from pooled data that were extracted from published reports (PubMed indexed from 1990 to June 2015). This study was undertaken as part of the American Association of Physicists in Medicine Working Group on Stereotactic Body Radiotherapy, investigating normal tissue complication probability (NTCP) after hypofractionated radiation.Methods and materialsEligible studies described dose delivered to optic nerve/chiasm and provided crude or actuarial toxicity risks, with visual endpoints (ie, loss of visual acuity, alterations in visual fields, and/or blindness/complete vision loss). Studies of patients with optic nerve sheath tumors, optic nerve gliomas, or ocular/uveal melanoma were excluded to obviate direct tumor effects on visual outcomes, as were studies not specifying causes of vision loss (ie, tumor progression vs RION).ResultsThirty-four studies (1578 patients) were analyzed. Histologies included pituitary adenoma, cavernous sinus meningioma, craniopharyngioma, and malignant skull base tumors. Prior resection (76% of patients) did not correlate with RION risk (P = .66). Prior irradiation (6% of patients) was associated with a crude 10-fold increased RION risk versus no prior radiation therapy. In patients with no prior radiation therapy receiving SRS/fSRS in 1-5 fractions, optic apparatus maximum point doses resulting in
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- 2021
11. Organs at Risk Considerations for Thoracic Stereotactic Body Radiation Therapy: What Is Safe for Lung Parenchyma?
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Kong, Feng-Ming Spring, Moiseenko, Vitali, Zhao, Jing, Milano, Michael T, Li, Ling, Rimner, Andreas, Das, Shiva, Li, X Allen, Miften, Moyed, Liao, ZhongXing, Martel, Mary, Bentzen, Soren M, Jackson, Andrew, Grimm, Jimm, Marks, Lawrence B, and Yorke, Ellen
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Medical and Biological Physics ,Biomedical and Clinical Sciences ,Clinical Sciences ,Physical Sciences ,Oncology and Carcinogenesis ,Lung ,Rare Diseases ,Cancer ,Lung Cancer ,6.5 Radiotherapy and other non-invasive therapies ,Evaluation of treatments and therapeutic interventions ,Respiratory ,Carcinoma ,Non-Small-Cell Lung ,Humans ,Lung Neoplasms ,Models ,Biological ,Models ,Theoretical ,Organs at Risk ,Pulmonary Fibrosis ,Radiation Pneumonitis ,Radiation Tolerance ,Radiosurgery ,Radiotherapy Dosage ,Re-Irradiation ,Risk Factors ,Tumor Burden ,Other Physical Sciences ,Oncology & Carcinogenesis ,Oncology and carcinogenesis ,Theoretical and computational chemistry ,Medical and biological physics - Abstract
PurposeStereotactic body radiation therapy (SBRT) has become the standard of care for inoperable early-stage non-small cell lung cancer and is often used for recurrent lung cancer and pulmonary metastases. Radiation-induced lung toxicity (RILT), including radiation pneumonitis and pulmonary fibrosis, is a major concern for which it is important to understand dosimetric and clinical predictors.Methods and materialsThis study was undertaken through the American Association of Physicists in Medicine's Working Group on Biological Effects of Stereotactic Body Radiotherapy. Data from studies of lung SBRT published through the summer of 2016 that provided detailed information about RILT were analyzed.ResultsNinety-seven studies were ultimately considered. Definitions of the risk organ and complication endpoints as well as dose-volume information presented varied among studies. The risk of RILT, including radiation pneumonitis and pulmonary fibrosis, was reported to be associated with the size and location of the tumor. Patients with interstitial lung disease appear to be especially susceptible to severe RILT. A variety of dosimetric parameters were reported to be associated with RILT. There was no apparent threshold "tolerance dose-volume" level. However, most studies noted safe treatment with a rate of symptomatic RILT of
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- 2021
12. Fine Motor Skill Decline After Brain Radiation Therapy—A Multivariate Normal Tissue Complication Probability Study of a Prospective Trial
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Connor, Michael, Salans, Mia, Karunamuni, Roshan, Unnikrishnan, Soumya, Huynh-Le, Minh-Phuong, Tibbs, Michelle, Qian, Alexander, Reyes, Anny, Stasenko, Alena, McDonald, Carrie, Moiseenko, Vitali, El-Naqa, Issam, and Hattangadi-Gluth, Jona A.
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- 2023
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13. VAPOR: Visual Analytics for the Exploration of Pelvic Organ Variability in Radiotherapy
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Furmanová, Katarína, Grossmann, Nicolas, Muren, Ludvig P, Casares-Magaz, Oscar, Moiseenko, Vitali, Einck, John P, Gröller, M Eduard, and Raidou, Renata G
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Patient Safety ,Urologic Diseases ,Prostate Cancer ,Cancer ,Medical visualization ,Visual analytics ,Comparative visualization ,Ensemble visualization ,Radiotherapy planning ,Cohort study ,Artificial Intelligence and Image Processing ,Computer Software ,Software Engineering - Published
- 2020
14. WITHDRAWN: VAPOR: Visual Analytics for the Exploration of Pelvic Organ Variability in Radiotherapy
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Furmanová, Katarína, Grossmann, Nicolas, Muren, Ludvig P, Casares-Magaz, Oscar, Moiseenko, Vitali, Einck, John P, Gröller, M Eduard, and Raidou, Renata G
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- 2020
15. Quantitative Imaging Biomarkers of Damage to Critical Memory Regions Are Associated With Post–Radiation Therapy Memory Performance in Brain Tumor Patients
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Tringale, Kathryn R, Nguyen, Tanya T, Karunamuni, Roshan, Seibert, Tyler, Huynh-Le, Minh-Phuong, Connor, Michael, Moiseenko, Vitali, Gorman, Mary Kay, Marshall, Anisa, Tibbs, Michelle Devereux, Farid, Nikdokht, Simpson, Daniel, Sanghvi, Parag, McDonald, Carrie R, and Hattangadi-Gluth, Jona A
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Biomedical and Clinical Sciences ,Oncology and Carcinogenesis ,Cancer ,Acquired Cognitive Impairment ,Neurosciences ,Biomedical Imaging ,Clinical Research ,Brain Disorders ,Mental health ,Adult ,Aged ,Agnosia ,Anisotropy ,Antineoplastic Agents ,Brain Neoplasms ,Cranial Irradiation ,Diffusion Magnetic Resonance Imaging ,Dose Fractionation ,Radiation ,Entorhinal Cortex ,Female ,Functional Neuroimaging ,Hippocampus ,Humans ,Male ,Memory ,Memory Disorders ,Mental Recall ,Middle Aged ,Neuropsychological Tests ,Prospective Studies ,Radiation Injuries ,Seizures ,Temporal Lobe ,White Matter ,Young Adult ,Other Physical Sciences ,Clinical Sciences ,Oncology & Carcinogenesis ,Oncology and carcinogenesis ,Theoretical and computational chemistry ,Medical and biological physics - Abstract
PurposeWe used quantitative magnetic resonance imaging to prospectively analyze the association between microstructural damage to memory-associated structures within the medial temporal lobe and longitudinal memory performance after brain radiation therapy (RT).Methods and materialsPatients with a primary brain tumor receiving fractionated brain RT were enrolled on a prospective trial (n = 27). Patients underwent high-resolution volumetric brain magnetic resonance imaging, diffusion-weighted imaging, and neurocognitive testing before and 3, 6, and 12 months post-RT. Medial temporal lobe regions (hippocampus; entorhinal, parahippocampal, and temporal pole white matter [WM]) were autosegmented, quantifying volume and diffusion biomarkers of WM integrity (mean diffusivity [MD]; fractional anisotropy [FA]). Reliable change indices measured changes in verbal (Hopkins Verbal Learning Test-Revised) and visuospatial (Brief Visuospatial Memory Test-Revised [BVMT-R]) memory. Linear mixed-effects models assessed longitudinal associations between imaging parameters and memory.ResultsVisuospatial memory significantly declined at 6 months post-RT (mean reliable change indices, -1.3; P = .012). Concurrent chemotherapy and seizures trended toward a significant association with greater decline in visuospatial memory (P = .053 and P = .054, respectively). Higher mean dose to the left temporal pole WM was significantly associated with decreased FA (r = -0.667; P = .002). Over all time points, smaller right hippocampal volume (P = .021), lower right entorhinal FA (P = .023), greater right entorhinal MD (P = .047), and greater temporal pole MD (BVMT-R total recall, P = .003; BVMT-R delayed recall, P = .042) were associated with worse visuospatial memory. The interaction between right entorhinal MD (BVMT-R total recall, P = .021; BVMT-R delayed recall, P = .004) and temporal pole FA (BVMT-R delayed recall, P = .024) significantly predicted visuospatial memory performance.ConclusionsBrain tumor patients exhibited visuospatial memory decline post-RT. Microstructural damage to critical memory regions, including the hippocampus and medial temporal lobe WM, were associated with post-RT memory decline. The integrity of medial temporal lobe structures is critical to memory performance post-RT, representing possible avoidance targets for memory preservation.
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- 2019
16. Dose-painted volumetric modulated arc therapy of high-grade glioma using 3,4-dihydroxy-6-[18F]fluoro-L-phenylalanine positron emission tomography
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Kosztyla, Robert, Raman, Srinivas, Moiseenko, Vitali, Reinsberg, Stefan A, Toyota, Brian, and Nichol, Alan
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Biomedical and Clinical Sciences ,Clinical Sciences ,Oncology and Carcinogenesis ,Bioengineering ,Biomedical Imaging ,Rare Diseases ,Cancer ,Adult ,Aged ,Aged ,80 and over ,Brain ,Brain Neoplasms ,Dihydroxyphenylalanine ,Female ,Glioma ,Humans ,Male ,Middle Aged ,Organs at Risk ,Positron-Emission Tomography ,Radiotherapy Dosage ,Radiotherapy Planning ,Computer-Assisted ,Radiotherapy ,Intensity-Modulated ,Retrospective Studies ,Tumor Burden ,Young Adult ,Nuclear Medicine & Medical Imaging ,Clinical sciences ,Oncology and carcinogenesis - Abstract
ObjectiveTo determine whether dose painting with volumetric modulated arc therapy for high-grade gliomas using 3,4-dihydroxy-6-[18F]fluoro-l-phenylalanine (18F-FDOPA) positron emission tomography (PET) could achieve dose-escalated coverage of biological target volumes (BTVs) without increasing the dose to cranial organs at risk (OARs).Methods10 patients with high-grade gliomas underwent CT, MRI, and 18F-FDOPA PET/CT images for post-operative radiation therapy planning. Two volumetric modulated arc therapy plans were retrospectively generated for each patient: a conventional plan with 60 Gy in 30 fractions to the planning target volume delineated on MRI and a dose-escalated plan with a maximum dose of 80 Gy in 30 fractions to BTVs. BTVs were created by thresholding 18F-FDOPA PET/CT uptake using a linear quadratic model that assumed tracer uptake was linearly related to tumour cell density. The maximum doses and equivalent uniform doses of OARs were compared.ResultsThe median volume of the planning target volume receiving at least 95% of the prescribed dose (V 95%) was 99.6% with and 99.5% without dose painting. The median V 95% was >99.2% for BTVs. The maximum doses and equivalent uniform doses to the OARs did not differ significantly between the conventional and dose-painted plans.ConclusionUsing commercially available treatment planning software, dose painting for high-grade gliomas was feasible with good BTV coverage and no significant change in the dose to OARs.Advances in knowledgeA novel treatment planning strategy was used to achieve dose painting for gliomas with BTVs obtained from 18F-FDOPA PET/CT using a radiobiological model.
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- 2019
17. Dose-dependent atrophy of the amygdala after radiotherapy
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Huynh-Le, Minh-Phuong, Karunamuni, Roshan, Moiseenko, Vitali, Farid, Nikdokht, McDonald, Carrie R, Hattangadi-Gluth, Jona A, and Seibert, Tyler M
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Biomedical and Clinical Sciences ,Clinical Sciences ,Oncology and Carcinogenesis ,Brain Disorders ,Brain Cancer ,Rare Diseases ,Biomedical Imaging ,Cancer ,Neurosciences ,Radiation Oncology ,6.5 Radiotherapy and other non-invasive therapies ,Neurological ,Adult ,Aged ,Amygdala ,Atrophy ,Brain Neoplasms ,Cranial Irradiation ,Female ,Humans ,Magnetic Resonance Imaging ,Male ,Memory ,Middle Aged ,Radiation Injuries ,Retrospective Studies ,Young Adult ,Brain radiotherapy ,Quantitative MRI ,Other Physical Sciences ,Oncology & Carcinogenesis ,Clinical sciences ,Oncology and carcinogenesis ,Medical and biological physics - Abstract
Background and purposeThe amygdalae are deep brain nuclei critical to emotional processing and the creation and storage of memory. It is not known whether the amygdalae are affected by brain radiotherapy (RT). We sought to quantify dose-dependent amygdala change one year after brain RT.Materials and methods52 patients with primary brain tumors were retrospectively identified. Study patients underwent high-resolution, volumetric magnetic resonance imaging before RT and 1 year afterward. Images were processed using FDA-cleared software for automated segmentation of amygdala volume. Tumor, surgical changes, and segmentation errors were manually censored. Mean amygdala RT dose was tested for correlation with amygdala volume change 1 year after RT via the Pearson correlation coefficient. A linear mixed-effects model was constructed to evaluate potential predictors of amygdala volume change, including age, tumor hemisphere, sex, seizure history, and bevacizumab treatment during the study period. As 51 of 52 patients received chemotherapy, possible chemotherapy effects could not be studied. A two-tailed p-value
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- 2019
18. Report of the AAPM TG‐256 on the relative biological effectiveness of proton beams in radiation therapy
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Paganetti, Harald, Blakely, Eleanor, Carabe‐Fernandez, Alejandro, Carlson, David J, Das, Indra J, Dong, Lei, Grosshans, David, Held, Kathryn D, Mohan, Radhe, Moiseenko, Vitali, Niemierko, Andrzej, Stewart, Robert D, and Willers, Henning
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Medical and Biological Physics ,Physical Sciences ,Cancer ,Humans ,Neoplasms ,Practice Guidelines as Topic ,Proton Therapy ,Radiotherapy Dosage ,Radiotherapy Planning ,Computer-Assisted ,Relative Biological Effectiveness ,Research Report ,proton therapy ,RBE ,relative biological effectiveness ,Other Physical Sciences ,Biomedical Engineering ,Oncology and Carcinogenesis ,Nuclear Medicine & Medical Imaging ,Biomedical engineering ,Medical and biological physics - Abstract
The biological effectiveness of proton beams relative to photon beams in radiation therapy has been taken to be 1.1 throughout the history of proton therapy. While potentially appropriate as an average value, actual relative biological effectiveness (RBE) values may differ. This Task Group report outlines the basic concepts of RBE as well as the biophysical interpretation and mathematical concepts. The current knowledge on RBE variations is reviewed and discussed in the context of the current clinical use of RBE and the clinical relevance of RBE variations (with respect to physical as well as biological parameters). The following task group aims were designed to guide the current clinical practice: Assess whether the current clinical practice of using a constant RBE for protons should be revised or maintained. Identifying sites and treatment strategies where variable RBE might be utilized for a clinical benefit. Assess the potential clinical consequences of delivering biologically weighted proton doses based on variable RBE and/or LET models implemented in treatment planning systems. Recommend experiments needed to improve our current understanding of the relationships among in vitro, in vivo, and clinical RBE, and the research required to develop models. Develop recommendations to minimize the effects of uncertainties associated with proton RBE for well-defined tumor types and critical structures.
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- 2019
19. Prefer Nested Segmentation to Compound Segmentation
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Clark, Haley D., Reinsberg, Stefan A., Moiseenko, Vitali, Wu, Jonn, and Thomas, Steven D.
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Quantitative Biology - Quantitative Methods ,Physics - Medical Physics ,Quantitative Biology - Tissues and Organs - Abstract
Introduction: Intra-organ radiation dose sensitivity is becoming increasingly relevant in clinical radiotherapy. One method for assessment involves partitioning delineated regions of interest and comparing the relative contributions or importance to clinical outcomes. We show that an intuitive method for dividing organ contours, compound (sub-)segmentation, can unintentionally lead to sub-segments with inconsistent volumes, which will bias relative importance assessment. An improved technique, nested segmentation, is introduced and compared. Methods: Clinical radiotherapy planning parotid contours from 510 patients were segmented. Counts of radiotherapy dose matrix voxels interior to sub-segments were used to determine the equivalency of sub-segment volumes. The distribution of voxel counts within sub-segments were compared using Kolmogorov-Smirnov tests and characterized by their dispersion. Analytical solutions for 2D/3D analogues were derived and sub-segment area/volume were compared directly. Results: Both parotid and 2D/3D region of interest analogue segmentation confirmed compound segmentation intrinsically produces sub-segments with volumes that depend on the region of interest shape and selection location. Significant volume differences were observed when sub-segmenting parotid contours into 18ths, and vanishingly small sub-segments were observed when sub-segmenting into 96ths. Central sub-segments were considerably smaller than sub-segments on the periphery. Nested segmentation did not exhibit these shortcomings and produced sub-segments with equivalent volumes when dose grid and contour collinearity was addressed, even when dividing the parotid into 96ths. Nested segmentation was always faster or equivalent in runtime to compound segmentation. Conclusions: Nested segmentation is more suited than compound segmentation for analyses requiring equal weighting of sub-segments., Comment: 7 figures
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- 2017
20. A case-control study using motion-inclusive spatial dose-volume metrics to account for genito-urinary toxicity following high-precision radiotherapy for prostate cancer
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Casares-Magaz, Oscar, Muren, Ludvig P, Pettersson, Niclas, Thor, Maria, Hopper, Austin, Knopp, Rick, Deasy, Joseph O, Væth, Michael, Einck, John, and Moiseenko, Vitali
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Medical and Biological Physics ,Biomedical and Clinical Sciences ,Clinical Sciences ,Physical Sciences ,Oncology and Carcinogenesis ,Urologic Diseases ,Patient Safety ,Aging ,Prostate Cancer ,Cancer ,Clinical Research ,6.5 Radiotherapy and other non-invasive therapies ,Evaluation of treatments and therapeutic interventions ,Prostate cancer ,Bladder ,Genitourinary toxicity ,CBCT ,DVH ,Spatial ,Clinical sciences ,Oncology and carcinogenesis ,Medical and biological physics - Abstract
Background and purposeThe risk of genitourinary (GU) toxicity is dose-limiting in radiotherapy (RT) for prostate cancer. This study investigated whether motion-inclusive spatial dose/volume metrics explain the GU toxicity manifesting after high-precision RT for prostate cancer.Material and methodsA matched case-control was performed within a cohort of 258 prostate cancer patients treated with daily cone-beam CT (CBCT)-guided RT (prescription doses of 77.4-81.0 Gy). Twenty-seven patients (10.5%) presented late RTOG GU ≥ Grade 2 toxicity and those without symptoms of toxicity prior treatment (N = 7) were selected as cases. Each case was matched with three controls based on pre-treatment GU symptoms, age, Gleason score, follow-up time, and hormone therapy. Thirteen CBCTs per patient were rigidly registered to the planning CT using the recorded treatment shifts, and the bladder was manually contoured on each CBCT. Planned and actually delivered dose/volume metrics (the latter averaged across the CBCTs) were extracted from the bladder and its subsectors, and compared between cases and controls (two-way ANOVA test).ResultsThere were no significant differences between planned and delivered dose/volume metrics; also, there were no significant differences between cases and controls at any dose level, neither for planned nor delivered doses. The cases tended to have larger bladder volumes during treatment than controls (221 ± 71 cm3 vs 166 ± 73 cm3; p = 0.09).ConclusionsHigh-precision RT for prostate cancer eliminates differences between planned and delivered dose distributions. Neither planned nor delivered bladder dose/volume metrics were associated to the remaining low risk of developing GU toxicity after high-precision radiotherapy for prostate cancer.
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- 2018
21. Heterogeneous radiotherapy dose-outcomes response in parotid glands
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Clark, Haley D, Thomas, Steven D, Reinsberg, Stefan A, Moiseenko, Vitali V, Hovan, Allan J, and Wu, Jonn S
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- 2018
22. 4 π plan optimization for cortical-sparing brain radiotherapy
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Murzin, Vyacheslav L, Woods, Kaley, Moiseenko, Vitali, Karunamuni, Roshan, Tringale, Kathryn R, Seibert, Tyler M, Connor, Michael J, Simpson, Daniel R, Sheng, Ke, and Hattangadi-Gluth, Jona A
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Medical and Biological Physics ,Biomedical and Clinical Sciences ,Clinical Sciences ,Physical Sciences ,Oncology and Carcinogenesis ,Neurosciences ,Cancer ,Clinical Research ,Brain Disorders ,Evaluation of treatments and therapeutic interventions ,6.5 Radiotherapy and other non-invasive therapies ,Adult ,Aged ,Brain Neoplasms ,Cerebral Cortex ,Female ,Hippocampus ,Humans ,Magnetic Resonance Imaging ,Male ,Middle Aged ,Organs at Risk ,Probability ,Radiation Injuries ,Radiotherapy Dosage ,Radiotherapy Planning ,Computer-Assisted ,Radiotherapy ,Intensity-Modulated ,Retrospective Studies ,Intracranial radiotherapy ,Non-coplanar IMRT ,Brain sparing ,NTCP ,Cortical atrophy ,Other Physical Sciences ,Oncology & Carcinogenesis ,Clinical sciences ,Oncology and carcinogenesis ,Medical and biological physics - Abstract
Background and purposeIncidental irradiation of normal brain tissue during radiotherapy is linked to cognitive decline, and may be mediated by damage to healthy cortex. Non-coplanar techniques may be used for cortical sparing. We compared normal brain sparing and probability of cortical atrophy using 4π radiation therapy planning vs. standard fixed gantry intensity-modulated radiotherapy (IMRT).Material and methodsPlans from previously irradiated brain tumor patients ("original IMRT", n = 13) were re-planned to spare cortex using both 4π optimization ("4π") and IMRT optimization ("optimized IMRT"). Homogeneity index (HI), gradient measure, doses to cortex and white matter (excluding tumor), brainstem, optics, and hippocampus were compared with matching PTV coverage. Probability of three grades of post-treatment cortical atrophy was modeled based on previously established dose response curves.ResultsWith matching PTV coverage, 4π significantly improved HI by 27% (p = 0.005) and gradient measure by 8% (p = 0.001) compared with optimized IMRT. 4π optimization reduced mean and equivalent uniform doses (EUD) to all standard OARs, with 14-15% reduction in hippocampal EUD (p ≤ 0.003) compared with the other two plans. 4π significantly reduced dose to fractional cortical volumes (V50, V40 and V30) compared with the original IMRT plans, and reduced cortical V30 by 7% (p = 0.008) compared with optimized IMRT. White matter EUD, mean dose, and fractional volumes V50, V40 and V30 were also significantly lower with 4π (p ≤ 0.001). With 4π, probability of grade 1, 2 and 3 cortical atrophy decreased by 12%, 21% and 26% compared with original IMRT and by 8%, 14% and 3% compared with optimized IMRT, respectively (p ≤ 0.001).Conclusions4π radiotherapy significantly improved cortical sparing and reduced doses to standard brain OARs, white matter, and the hippocampus. This was achieved with superior PTV dose homogeneity. Such sparing could reduce the probability of cortical atrophy that may lead to cognitive decline.
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- 2018
23. 4π plan optimization for cortical-sparing brain radiotherapy.
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Murzin, Vyacheslav L, Woods, Kaley, Moiseenko, Vitali, Karunamuni, Roshan, Tringale, Kathryn R, Seibert, Tyler M, Connor, Michael J, Simpson, Daniel R, Sheng, Ke, and Hattangadi-Gluth, Jona A
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Hippocampus ,Cerebral Cortex ,Humans ,Brain Neoplasms ,Radiation Injuries ,Magnetic Resonance Imaging ,Radiotherapy Dosage ,Radiotherapy Planning ,Computer-Assisted ,Probability ,Retrospective Studies ,Adult ,Aged ,Middle Aged ,Female ,Male ,Radiotherapy ,Intensity-Modulated ,Organs at Risk ,Brain sparing ,Cortical atrophy ,Intracranial radiotherapy ,NTCP ,Non-coplanar IMRT ,Brain Disorders ,Clinical Research ,Cancer ,Neurosciences ,Evaluation of treatments and therapeutic interventions ,6.5 Radiotherapy and other non-invasive therapies ,Other Physical Sciences ,Oncology and Carcinogenesis ,Oncology & Carcinogenesis - Abstract
BACKGROUND AND PURPOSE:Incidental irradiation of normal brain tissue during radiotherapy is linked to cognitive decline, and may be mediated by damage to healthy cortex. Non-coplanar techniques may be used for cortical sparing. We compared normal brain sparing and probability of cortical atrophy using 4π radiation therapy planning vs. standard fixed gantry intensity-modulated radiotherapy (IMRT). MATERIAL AND METHODS:Plans from previously irradiated brain tumor patients ("original IMRT", n = 13) were re-planned to spare cortex using both 4π optimization ("4π") and IMRT optimization ("optimized IMRT"). Homogeneity index (HI), gradient measure, doses to cortex and white matter (excluding tumor), brainstem, optics, and hippocampus were compared with matching PTV coverage. Probability of three grades of post-treatment cortical atrophy was modeled based on previously established dose response curves. RESULTS:With matching PTV coverage, 4π significantly improved HI by 27% (p = 0.005) and gradient measure by 8% (p = 0.001) compared with optimized IMRT. 4π optimization reduced mean and equivalent uniform doses (EUD) to all standard OARs, with 14-15% reduction in hippocampal EUD (p ≤ 0.003) compared with the other two plans. 4π significantly reduced dose to fractional cortical volumes (V50, V40 and V30) compared with the original IMRT plans, and reduced cortical V30 by 7% (p = 0.008) compared with optimized IMRT. White matter EUD, mean dose, and fractional volumes V50, V40 and V30 were also significantly lower with 4π (p ≤ 0.001). With 4π, probability of grade 1, 2 and 3 cortical atrophy decreased by 12%, 21% and 26% compared with original IMRT and by 8%, 14% and 3% compared with optimized IMRT, respectively (p ≤ 0.001). CONCLUSIONS:4π radiotherapy significantly improved cortical sparing and reduced doses to standard brain OARs, white matter, and the hippocampus. This was achieved with superior PTV dose homogeneity. Such sparing could reduce the probability of cortical atrophy that may lead to cognitive decline.
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- 2018
24. Microstructural Injury to Corpus Callosum and Intrahemispheric White Matter Tracts Correlate With Attention and Processing Speed Decline After Brain Radiation
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Huynh-Le, Minh-Phuong, Tibbs, Michelle D., Karunamuni, Roshan, Salans, Mia, Tringale, Kathryn R., Yip, Anthony, Connor, Michael, Simon, Aaron B., Vitzthum, Lucas K., Reyes, Anny, Macari, Anna Christina, Moiseenko, Vitali, McDonald, Carrie R., and Hattangadi-Gluth, Jona A.
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- 2021
- Full Text
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25. PREVIS: Predictive visual analytics of anatomical variability for radiotherapy decision support
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Furmanová, Katarína, Muren, Ludvig P., Casares-Magaz, Oscar, Moiseenko, Vitali, Einck, John P., Pilskog, Sara, and Raidou, Renata G.
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- 2021
- Full Text
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26. Initial Data Pooling for Radiation Dose-Volume Tolerance for Carotid Artery Blowout and Other Bleeding Events in Hypofractionated Head and Neck Retreatments
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Grimm, Jimm, Vargo, John A., Mavroidis, Panayiotis, Moiseenko, Vitali, Emami, Bahman, Jain, Sheena, Caudell, Jimmy J., Clump, David A., Ling, Diane C., Das, Shiva, Moros, Eduardo G., Vinogradskiy, Yevgeniy, Xue, Jinyu, and Heron, Dwight E.
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- 2021
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27. A Primer on Dose-Response Data Modeling in Radiation Therapy
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Moiseenko, Vitali, Marks, Lawrence B., Grimm, Jimm, Jackson, Andrew, Milano, Michael T., Hattangadi-Gluth, Jona A., Huynh-Le, Minh-Phuong, Pettersson, Niclas, Yorke, Ellen, and El Naqa, Issam
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- 2021
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28. Single- and Multifraction Stereotactic Radiosurgery Dose/Volume Tolerances of the Brain
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Milano, Michael T., Grimm, Jimm, Niemierko, Andrzej, Soltys, Scott G., Moiseenko, Vitali, Redmond, Kristin J., Yorke, Ellen, Sahgal, Arjun, Xue, Jinyu, Mahadevan, Anand, Muacevic, Alexander, Marks, Lawrence B., and Kleinberg, Lawrence R.
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- 2021
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29. Radiation Dose‐Volume Effects for Liver SBRT
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Miften, Moyed, Vinogradskiy, Yevgeniy, Moiseenko, Vitali, Grimm, Jimm, Yorke, Ellen, Jackson, Andrew, Tomé, Wolfgang A., Ten Haken, Randall K., Ohri, Nitin, Méndez Romero, Alejandra, Goodman, Karyn A., Marks, Lawrence B., Kavanagh, Brian, and Dawson, Laura A.
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- 2021
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30. Head and Neck Tumor Control Probability: Radiation Dose–Volume Effects in Stereotactic Body Radiation Therapy for Locally Recurrent Previously-Irradiated Head and Neck Cancer: Report of the AAPM Working Group
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Vargo, John A., Moiseenko, Vitali, Grimm, Jimm, Caudell, Jimmy, Clump, David A., Yorke, Ellen, Xue, Jinyu, Vinogradskiy, Yevgeniy, Moros, Eduardo G., Mavroidis, Panayiotis, Jain, Sheena, El Naqa, Issam, Marks, Lawrence B., and Heron, Dwight E.
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- 2021
- Full Text
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31. Medical Device Recalls in Radiation Oncology: Analysis of US Food and Drug Administration Data, 2002-2015
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Connor, Michael J, Tringale, Kathryn, Moiseenko, Vitali, Marshall, Deborah C, Moore, Kevin, Cervino, Laura, Atwood, Todd, Brown, Derek, Mundt, Arno J, Pawlicki, Todd, Recht, Abram, and Hattangadi-Gluth, Jona A
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Biomedical and Clinical Sciences ,Clinical Sciences ,Oncology and Carcinogenesis ,Brachytherapy ,Chi-Square Distribution ,Databases ,Factual ,Equipment and Supplies ,Linear Models ,Medical Device Recalls ,Product Surveillance ,Postmarketing ,Radiation Oncology ,Radiotherapy Planning ,Computer-Assisted ,Software ,Statistics ,Nonparametric ,Time Factors ,United States ,United States Food and Drug Administration ,Other Physical Sciences ,Oncology & Carcinogenesis ,Oncology and carcinogenesis ,Theoretical and computational chemistry ,Medical and biological physics - Abstract
PurposeTo analyze all recalls involving radiation oncology devices (RODs) from the US Food and Drug Administration (FDA)'s recall database, comparing these with non-radiation oncology device recalls to identify discipline-specific trends that may inform improvements in device safety.Methods and materialsRecall data on RODs from 2002 to 2015 were sorted into 4 product categories (external beam, brachytherapy, planning systems, and simulation systems). Outcomes included determined cause of recall, recall class (severity), quantity in commerce, time until recall termination (date FDA determines recall is complete), and time since 510(k) approval. Descriptive statistics were performed with linear regression of time-series data. Results for RODs were compared with those for other devices by Pearson χ2 test for categorical data and 2-sample Kolmogorov-Smirnov test for distributions.ResultsThere were 502 ROD recalls and 9534 other class II device recalls during 2002 to 2015. Most recalls were for external beam devices (66.7%) and planning systems (22.9%), and recall events peaked in 2011. Radiation oncology devices differed significantly from other devices in all recall outcomes (P≤.04). Recall cause was commonly software related (49% vs 10% for other devices). Recall severity was more often moderate among RODs (97.6% vs 87.2%) instead of severe (0.2% vs 4.4%; P
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- 2017
32. Multi‐component diffusion characterization of radiation‐induced white matter damage
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Karunamuni, Roshan A, White, Nathan S, McDonald, Carrie R, Connor, Michael, Pettersson, Niclas, Seibert, Tyler M, Kuperman, Joshua, Farid, Nikdokht, Moiseenko, Vitali, Dale, Anders M, and Hattangadi‐Gluth, Jona A
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Medical and Biological Physics ,Physical Sciences ,Biomedical Imaging ,Neurosciences ,Cancer ,Brain ,Brain Neoplasms ,Diffusion ,Diffusion Magnetic Resonance Imaging ,Humans ,Retrospective Studies ,White Matter ,biexponential ,diffusion MRI ,radiation ,white matter ,Other Physical Sciences ,Biomedical Engineering ,Oncology and Carcinogenesis ,Nuclear Medicine & Medical Imaging ,Biomedical engineering ,Medical and biological physics - Abstract
PurposeWe used multi-b-value diffusion models to characterize microstructural white matter changes after brain radiation into fast and slow components, in order to better understand the pathophysiology of radiation-induced tissue damage.MethodsFourteen patients were included in this retrospective analysis with imaging prior to, and at 1, 4-5, and 9-10 months after radiotherapy (RT). Diffusion signal decay within brain white matter was fit to a biexponential model to separate changes within the slow and fast components. Linear mixed-effects models were used to obtain estimates of the effect of radiation dose and time on the model parameters.ResultsWe found an increase of 0.11 × 10-4 and 0.14 × 10-4 mm2 /s in the fast diffusion coefficient per unit dose-time (Gy-month) in the longitudinal and transverse directions, respectively. By contrast, the longitudinal slow diffusion coefficient decreased independently of dose, by 0.18 × 10-4 , 0.16 × 10-4 , and 0.098 × 10-4 mm2 /s at 1, 4, and 9 months post-RT, respectively.ConclusionsRadiation-induced white matter changes in the first year following RT are driven by dose-dependent increases in the fast component and dose-independent decreases in the slow component.
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- 2017
33. Regional susceptibility to dose-dependent white matter damage after brain radiotherapy
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Connor, Michael, Karunamuni, Roshan, McDonald, Carrie, Seibert, Tyler, White, Nathan, Moiseenko, Vitali, Bartsch, Hauke, Farid, Nikdokht, Kuperman, Joshua, Krishnan, Anitha, Dale, Anders, and Hattangadi-Gluth, Jona A
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Physical Sciences ,Biomedical and Clinical Sciences ,Oncology and Carcinogenesis ,Clinical Research ,Biomedical Imaging ,Neurosciences ,Adult ,Brain Neoplasms ,Diffusion Tensor Imaging ,Dose-Response Relationship ,Radiation ,Female ,Humans ,Magnetic Resonance Imaging ,Male ,Middle Aged ,White Matter ,Diffusion tensor imaging ,White matter ,Radiotherapy ,Dose-dependent ,Radiation ,Other Physical Sciences ,Oncology & Carcinogenesis ,Clinical sciences ,Oncology and carcinogenesis ,Medical and biological physics - Abstract
Background and purposeRegional differences in sensitivity to white matter damage after brain radiotherapy (RT) are not well-described. We characterized the spatial heterogeneity of dose-response across white matter tracts using diffusion tensor imaging (DTI).Materials and methodsForty-nine patients with primary brain tumors underwent MRI with DTI before and 9-12months after partial-brain RT. Maps of fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were generated. Atlas-based white matter tracts were identified. A secondary analysis using skeletonized tracts was also performed. Linear mixed-model analysis of the relationship between mean and max dose and percent change in DTI metrics was performed.ResultsTracts with the strongest correlation of FA change with mean dose were the fornix (-0.46 percent/Gy), cingulum bundle (-0.44 percent/Gy), and body of corpus callosum (-0.23 percent/Gy), p
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- 2017
34. Cerebral Cortex Regions Selectively Vulnerable to Radiation Dose-Dependent Atrophy
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Seibert, Tyler M, Karunamuni, Roshan, Kaifi, Samar, Burkeen, Jeffrey, Connor, Michael, Krishnan, Anitha Priya, White, Nathan S, Farid, Nikdokht, Bartsch, Hauke, Murzin, Vyacheslav, Nguyen, Tanya T, Moiseenko, Vitali, Brewer, James B, McDonald, Carrie R, Dale, Anders M, and Hattangadi-Gluth, Jona A
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Medical and Biological Physics ,Physical Sciences ,Biomedical and Clinical Sciences ,Oncology and Carcinogenesis ,Behavioral and Social Science ,Neurosciences ,Clinical Research ,Brain Disorders ,Cancer ,Acquired Cognitive Impairment ,Mental health ,Neurological ,Adult ,Aged ,Atrophy ,Brain Neoplasms ,Cerebral Cortex ,Cranial Irradiation ,Dose-Response Relationship ,Radiation ,Humans ,Magnetic Resonance Imaging ,Middle Aged ,Radiation Injuries ,Radiotherapy Dosage ,Reproducibility of Results ,Retrospective Studies ,Sensitivity and Specificity ,Young Adult ,Other Physical Sciences ,Clinical Sciences ,Oncology & Carcinogenesis ,Oncology and carcinogenesis ,Theoretical and computational chemistry ,Medical and biological physics - Abstract
Purpose and objectivesNeurologic deficits after brain radiation therapy (RT) typically involve decline in higher-order cognitive functions such as attention and memory rather than sensory defects or paralysis. We sought to determine whether areas of the cortex critical to cognition are selectively vulnerable to radiation dose-dependent atrophy.Methods and materialsWe measured change in cortical thickness in 54 primary brain tumor patients who underwent fractionated, partial brain RT. The study patients underwent high-resolution, volumetric magnetic resonance imaging (T1-weighted; T2 fluid-attenuated inversion recovery, FLAIR) before RT and 1 year afterward. Semiautomated software was used to segment anatomic regions of the cerebral cortex for each patient. Cortical thickness was measured for each region before RT and 1 year afterward. Two higher-order cortical regions of interest (ROIs) were tested for association between radiation dose and cortical thinning: entorhinal (memory) and inferior parietal (attention/memory). For comparison, 2 primary cortex ROIs were also tested: pericalcarine (vision) and paracentral lobule (somatosensory/motor). Linear mixed-effects analyses were used to test all other cortical regions for significant radiation dose-dependent thickness change. Statistical significance was set at α = 0.05 using 2-tailed tests.ResultsCortical atrophy was significantly associated with radiation dose in the entorhinal (P=.01) and inferior parietal ROIs (P=.02). By contrast, no significant radiation dose-dependent effect was found in the primary cortex ROIs (pericalcarine and paracentral lobule). In the whole-cortex analysis, 9 regions showed significant radiation dose-dependent atrophy, including areas responsible for memory, attention, and executive function (P≤.002).ConclusionsAreas of cerebral cortex important for higher-order cognition may be most vulnerable to radiation-related atrophy. This is consistent with clinical observations that brain radiation patients experience deficits in domains of memory, executive function, and attention. Correlations of regional cortical atrophy with domain-specific cognitive functioning in prospective trials are warranted.
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- 2017
35. Radiation Dose–Dependent Hippocampal Atrophy Detected With Longitudinal Volumetric Magnetic Resonance Imaging
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Seibert, Tyler M, Karunamuni, Roshan, Bartsch, Hauke, Kaifi, Samar, Krishnan, Anitha Priya, Dalia, Yoseph, Burkeen, Jeffrey, Murzin, Vyacheslav, Moiseenko, Vitali, Kuperman, Joshua, White, Nathan S, Brewer, James B, Farid, Nikdokht, McDonald, Carrie R, and Hattangadi-Gluth, Jona A
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Medical and Biological Physics ,Biomedical and Clinical Sciences ,Clinical Sciences ,Physical Sciences ,Oncology and Carcinogenesis ,Neurosciences ,Clinical Research ,Brain Disorders ,Cancer ,Bioengineering ,Biomedical Imaging ,Neurological ,Adult ,Age Factors ,Aged ,Atrophy ,Brain Neoplasms ,Dose Fractionation ,Radiation ,Dose-Response Relationship ,Radiation ,Female ,Hippocampus ,Humans ,Magnetic Resonance Imaging ,Male ,Memory Disorders ,Middle Aged ,Multivariate Analysis ,Organ Size ,Retrospective Studies ,Time Factors ,Other Physical Sciences ,Oncology & Carcinogenesis ,Oncology and carcinogenesis ,Theoretical and computational chemistry ,Medical and biological physics - Abstract
PurposeAfter radiation therapy (RT) to the brain, patients often experience memory impairment, which may be partially mediated by damage to the hippocampus. Hippocampal sparing in RT planning is the subject of recent and ongoing clinical trials. Calculating appropriate hippocampal dose constraints would be improved by efficient in vivo measurements of hippocampal damage. In this study we sought to determine whether brain RT was associated with dose-dependent hippocampal atrophy.Methods and materialsHippocampal volume was measured with magnetic resonance imaging (MRI) in 52 patients who underwent fractionated, partial brain RT for primary brain tumors. Study patients had high-resolution, 3-dimensional volumetric MRI before and 1 year after RT. Images were processed using software with clearance from the US Food and Drug Administration and Conformité Européene marking for automated measurement of hippocampal volume. Automated results were inspected visually for accuracy. Tumor and surgical changes were censored. Mean hippocampal dose was tested for correlation with hippocampal atrophy 1 year after RT. Average hippocampal volume change was also calculated for hippocampi receiving high (>40 Gy) or low (
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- 2017
36. Internal and external generalizability of temporal dose-response relationships for xerostomia following IMRT for head and neck cancer.
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Thor, Maria, Owosho, Adepitan A, Clark, Haley D, Oh, Jung Hun, Riaz, Nadeem, Hovan, Allan, Tsai, Jillian, Thomas, Steven D, Yom, Sae Hee K, Wu, Jonn S, Huryn, Joseph M, Moiseenko, Vitali, Lee, Nancy Y, Estilo, Cherry L, and Deasy, Joseph O
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Parotid Gland ,Humans ,Head and Neck Neoplasms ,Xerostomia ,Retrospective Studies ,Dose-Response Relationship ,Radiation ,Adult ,Aged ,Middle Aged ,Female ,Male ,Radiotherapy ,Intensity-Modulated ,Dose response ,Head and neck ,IMRT ,QUANTEC ,Radiotherapy ,Dental/Oral and Craniofacial Disease ,Cancer ,Other Physical Sciences ,Oncology and Carcinogenesis ,Oncology & Carcinogenesis - Abstract
Background and purposeTo study internal and external generalizability of temporal dose-response relationships for xerostomia after intensity-modulated radiotherapy (IMRT) for head and neck cancer, and to investigate potential amendments of the QUANTEC guidelines.Material and methodsObjective xerostomia was assessed in 121 patients (nCohort1=55; nCohort2=66) treated to 70Gy@2Gy in 2006-2015. Univariate and multivariate analyses (UVA, MVA with 1000 bootstrap populations) were conducted in Cohort1, and generalizability of the best-performing MVA model was investigated in Cohort2 (performance: AUC, p-values, and Hosmer-Lemeshow p-values (pHL)). Ultimately and for clinical guidance, minimum mean dose thresholds to the contralateral and the ipsilateral parotid glands (Dmeancontra, Dmeanipsi) were estimated from the generated dose-response curves.ResultsThe observed xerostomia rate was 38%/47% (3months) and 19%/23% (11-12months) in Cohort1/Cohort2. Risk of xerostomia at 3months increased for higher Dmeancontra and Dmeanipsi (Cohort1: 0.17·Dmeancontra+0.11·Dmeanipsi-8.13; AUC=0.90±0.05; p=0.0002±0.002; pHL=0.22±0.23; Cohort2: AUC=0.81; p
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- 2017
37. Adverse Events Involving Radiation Oncology Medical Devices: Comprehensive Analysis of US Food and Drug Administration Data, 1991 to 2015
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Connor, Michael J, Marshall, Deborah C, Moiseenko, Vitali, Moore, Kevin, Cervino, Laura, Atwood, Todd, Sanghvi, Parag, Mundt, Arno J, Pawlicki, Todd, Recht, Abram, and Hattangadi-Gluth, Jona A
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Medical and Biological Physics ,Biomedical and Clinical Sciences ,Clinical Sciences ,Physical Sciences ,Oncology and Carcinogenesis ,Patient Safety ,Brachytherapy ,Chi-Square Distribution ,Databases ,Factual ,Device Approval ,Equipment Failure Analysis ,Equipment Safety ,Humans ,Interrupted Time Series Analysis ,Linear Models ,Medical Errors ,Product Recalls and Withdrawals ,Product Surveillance ,Postmarketing ,Radiation Oncology ,Radiotherapy ,Radiotherapy Dosage ,Radiotherapy Planning ,Computer-Assisted ,Simulation Training ,Software ,Statistics ,Nonparametric ,Technology ,Radiologic ,Time Factors ,United States ,United States Food and Drug Administration ,Other Physical Sciences ,Oncology & Carcinogenesis ,Oncology and carcinogenesis ,Theoretical and computational chemistry ,Medical and biological physics - Abstract
PurposeRadiation oncology relies on rapidly evolving technology and highly complex processes. The US Food and Drug Administration collects reports of adverse events related to medical devices. We sought to characterize all events involving radiation oncology devices (RODs) from the US Food and Drug Administration's postmarket surveillance Manufacturer and User Facility Device Experience (MAUDE) database, comparing these with non-radiation oncology devices.Methods and materialsMAUDE data on RODs from 1991 to 2015 were sorted into 4 product categories (external beam, brachytherapy, planning systems, and simulation systems) and 5 device problem categories (software, mechanical, electrical, user error, and dose delivery impact). Outcomes included whether the device was evaluated by the manufacturer, adverse event type, remedial action, problem code, device age, and time since 510(k) approval. Descriptive statistics were performed with linear regression of time-series data. Results for RODs were compared with those for other devices by the Pearson χ2 test for categorical data and 2-sample Kolmogorov-Smirnov test for distributions.ResultsThere were 4234 ROD and 4,985,698 other device adverse event reports. Adverse event reports increased over time, and events involving RODs peaked in 2011. Most ROD reports involved external beam therapy (50.8%), followed by brachytherapy (24.9%) and treatment planning systems (21.6%). The top problem types were software (30.4%), mechanical (20.9%), and user error (20.4%). RODs differed significantly from other devices in each outcome (P
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- 2017
38. Dose-dependent white matter damage after brain radiotherapy
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Connor, Michael, Karunamuni, Roshan, McDonald, Carrie, White, Nathan, Pettersson, Niclas, Moiseenko, Vitali, Seibert, Tyler, Marshall, Deborah, Cervino, Laura, Bartsch, Hauke, Kuperman, Joshua, Murzin, Vyacheslav, Krishnan, Anitha, Farid, Nikdokht, Dale, Anders, and Hattangadi-Gluth, Jona
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Physical Sciences ,Biomedical and Clinical Sciences ,Clinical Sciences ,Oncology and Carcinogenesis ,Cancer ,Neurosciences ,Biomedical Imaging ,Clinical Research ,Adult ,Aged ,Aged ,80 and over ,Brain Neoplasms ,Cranial Irradiation ,Diffusion Tensor Imaging ,Dose-Response Relationship ,Radiation ,Female ,Glioma ,Humans ,Magnetic Resonance Imaging ,Male ,Middle Aged ,White Matter ,Diffusion tensor imaging ,MRI ,White matter ,Radiotherapy ,b-Value ,Radiation ,Other Physical Sciences ,Oncology & Carcinogenesis ,Clinical sciences ,Oncology and carcinogenesis ,Medical and biological physics - Abstract
Background and purposeBrain radiotherapy is limited in part by damage to white matter, contributing to neurocognitive decline. We utilized diffusion tensor imaging (DTI) with multiple b-values (diffusion weightings) to model the dose-dependency and time course of radiation effects on white matter.Materials and methodsFifteen patients with high-grade gliomas treated with radiotherapy and chemotherapy underwent MRI with DTI prior to radiotherapy, and after months 1, 4-6, and 9-11. Diffusion tensors were calculated using three weightings (high, standard, and low b-values) and maps of fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (λ∥), and radial diffusivity (λ⊥) were generated. The region of interest was all white matter.ResultsMD, λ∥, and λ⊥ increased significantly with time and dose, with corresponding decrease in FA. Greater changes were seen at lower b-values, except for FA. Time-dose interactions were highly significant at 4-6months and beyond (p
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- 2016
39. Interhemispheric Difference Images from Postoperative Diffusion Tensor Imaging of Gliomas
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Kosztyla, Robert, Reinsberg, Stefan A, Moiseenko, Vitali, Toyota, Brian, and Nichol, Alan
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Clinical Research ,Neurosciences ,Brain Cancer ,Cancer ,Biomedical Imaging ,Brain Disorders ,Rare Diseases ,glioma ,diffusion tensor imaging ,magnetic resonance imaging ,image analysis ,target volumes ,Medical and Health Sciences - Abstract
Introduction Determining the full extent of gliomas during radiotherapy planning can be challenging with conventional T1 and T2 magnetic resonance imaging (MRI). The purpose of this study was to develop a method to automatically calculate differences in the fractional anisotropy (FA) and mean diffusivity (MD) values in target volumes obtained with diffusion tensor imaging (DTI) by comparing with values from anatomically homologous voxels on the contralateral side of the brain. Methods Seven patients with a histologically confirmed glioma underwent postoperative radiotherapy planning with 1.5 T MRI and computed tomography. DTI was acquired using echo planar imaging for 20 noncolinear directions with b = 1000 s/mm2 and one additional image with b = 0, repeated four times for signal averaging. The distribution of FA and MD was calculated in the gross tumor volume (GTV), shells 0-5 mm, 5-10 mm, 10-15 mm, 15-20 mm, and 20-25 mm outside the GTV, and the GTV mirrored in the left-right direction (mirGTV). All images were aligned to a template image, and FA and MD interhemispheric difference images were calculated. The difference in mean FA and MD between the regions of interest was statistically tested using two-sided paired t-tests with α = 0.05. Results The mean FA in mirGTV was 0.20 ± 0.04, which was larger than the FA in the GTV (0.12 ± 0.03) and shells 0-5 mm (0.15 ± 0.03) and 5-10 mm (0.17 ± 0.03) outside the GTV. The mean MD (×10-3 mm2/s) in mirGTV was 0.93 ± 0.09, which was smaller than the MD in the GTV (1.48 ± 0.19) and the peritumoral shells. The distribution of FA and MD interhemispheric differences followed the same trends as FA and MD values. Conclusions This study successfully implemented a method for calculation of FA and MD differences by comparison of voxel values with anatomically homologous voxels on the contralateral side of the brain. Further research is warranted to determine if radiotherapy planning using these images can be used to improve target delineation.
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- 2016
40. Recent Developments in the Prediction of Clinical Outcomes Data in Radiation Oncology
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Toma-Dasu, Iuliana, Moiseenko, Vitali, Purdie, Thomas G., and Carlson, David J.
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- 2020
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41. Modern Radiation Therapy and Cardiac Outcomes in Breast Cancer
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Boero, Isabel J, Paravati, Anthony J, Triplett, Daniel P, Hwang, Lindsay, Matsuno, Rayna K, Gillespie, Erin F, Yashar, Catheryn M, Moiseenko, Vitali, Einck, John P, Mell, Loren K, Parikh, Sahil A, and Murphy, James D
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Biomedical and Clinical Sciences ,Oncology and Carcinogenesis ,Clinical Research ,Heart Disease - Coronary Heart Disease ,Heart Disease ,Prevention ,Aging ,Breast Cancer ,Cardiovascular ,Cancer ,2.4 Surveillance and distribution ,Aetiology ,Good Health and Well Being ,Aged ,Aged ,80 and over ,Arrhythmias ,Cardiac ,Confidence Intervals ,Female ,Heart ,Heart Diseases ,Humans ,Medicare ,Myocardial Ischemia ,Percutaneous Coronary Intervention ,SEER Program ,Unilateral Breast Neoplasms ,United States ,Other Physical Sciences ,Clinical Sciences ,Oncology & Carcinogenesis ,Oncology and carcinogenesis ,Theoretical and computational chemistry ,Medical and biological physics - Abstract
PurposeAdjuvant radiation therapy, which has proven benefit against breast cancer, has historically been associated with an increased incidence of ischemic heart disease. Modern techniques have reduced this risk, but a detailed evaluation has not recently been conducted. The present study evaluated the effect of current radiation practices on ischemia-related cardiac events and procedures in a population-based study of older women with nonmetastatic breast cancer.Methods and materialsA total of 29,102 patients diagnosed from 2000 to 2009 were identified from the Surveillance, Epidemiology, and End Results-Medicare database. Medicare claims were used to identify the radiation therapy and cardiac outcomes. Competing risk models were used to assess the effect of radiation on these outcomes.ResultsPatients with left-sided breast cancer had a small increase in their risk of percutaneous coronary intervention (PCI) after radiation therapy-the 10-year cumulative incidence for these patients was 5.5% (95% confidence interval [CI] 4.9%-6.2%) and 4.5% (95% CI 4.0%-5.0%) for right-sided patients. This risk was limited to women with previous cardiac disease. For patients who underwent PCI, those with left-sided breast cancer had a significantly increased risk of cardiac mortality with a subdistribution hazard ratio of 2.02 (95% CI 1.23-3.34). No other outcome, including cardiac mortality for the entire cohort, showed a significant relationship with tumor laterality.ConclusionsFor women with a history of cardiac disease, those with left-sided breast cancer who underwent radiation therapy had increased rates of PCI and a survival decrement if treated with PCI. The results of the present study could help cardiologists and radiation oncologists better stratify patients who need more aggressive cardioprotective techniques.
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- 2016
42. Dose-Dependent Cortical Thinning After Partial Brain Irradiation in High-Grade Glioma
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Karunamuni, Roshan, Bartsch, Hauke, White, Nathan S, Moiseenko, Vitali, Carmona, Ruben, Marshall, Deborah C, Seibert, Tyler M, McDonald, Carrie R, Farid, Nikdokht, Krishnan, Anithapriya, Kuperman, Joshua, Mell, Loren, Brewer, James B, Dale, Anders M, and Hattangadi-Gluth, Jona A
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Physical Sciences ,Biomedical and Clinical Sciences ,Clinical Sciences ,Oncology and Carcinogenesis ,Cancer ,Biomedical Imaging ,Clinical Research ,Rare Diseases ,Brain Cancer ,Brain Disorders ,Neurosciences ,Neurological ,Adult ,Aged ,Atrophy ,Brain ,Brain Neoplasms ,Cerebral Cortex ,Cranial Irradiation ,Dose Fractionation ,Radiation ,Dose-Response Relationship ,Radiation ,Female ,Glioma ,Humans ,Magnetic Resonance Imaging ,Male ,Middle Aged ,Retrospective Studies ,Time Factors ,Other Physical Sciences ,Oncology & Carcinogenesis ,Oncology and carcinogenesis ,Theoretical and computational chemistry ,Medical and biological physics - Abstract
PurposeRadiation-induced cognitive deficits may be mediated by tissue damage to cortical regions. Volumetric changes in cortex can be reliably measured using high-resolution magnetic resonance imaging (MRI). We used these methods to study the association between radiation therapy (RT) dose and change in cortical thickness in high-grade glioma (HGG) patients.Methods and materialsWe performed a voxel-wise analysis of MRI from 15 HGG patients who underwent fractionated partial brain RT. Three-dimensional MRI was acquired pre- and 1 year post RT. Cortex was parceled with well-validated segmentation software. Surgical cavities were censored. Each cortical voxel was assigned a change in cortical thickness between time points, RT dose value, and neuroanatomic label by lobe. Effects of dose, neuroanatomic location, age, and chemotherapy on cortical thickness were tested using linear mixed effects (LME) modeling.ResultsCortical atrophy was seen after 1 year post RT with greater effects at higher doses. Estimates from LME modeling showed that cortical thickness decreased by -0.0033 mm (P
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- 2016
43. Radiation sparing of cerebral cortex in brain tumor patients using quantitative neuroimaging.
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Karunamuni, Roshan A, Moore, Kevin L, Seibert, Tyler M, Li, Nan, White, Nathan S, Bartsch, Hauke, Carmona, Ruben, Marshall, Deborah, McDonald, Carrie R, Farid, Nikdokht, Krishnan, Anithapriya, Kuperman, Joshua, Mell, Loren K, Brewer, James, Dale, Anders M, Moiseenko, Vitali, and Hattangadi-Gluth, Jona A
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Cerebral Cortex ,Humans ,Glioma ,Brain Neoplasms ,Radiation Injuries ,Atrophy ,Magnetic Resonance Imaging ,Radiotherapy Dosage ,Radiotherapy Planning ,Computer-Assisted ,Cohort Studies ,Feasibility Studies ,Adult ,Female ,Male ,Neuroimaging ,Cortex ,OAR ,Radiation sparing ,Brain Disorders ,Neurosciences ,Cancer ,Brain Cancer ,Rare Diseases ,Clinical Research ,6.5 Radiotherapy and other non-invasive therapies ,Neurological ,Oncology & Carcinogenesis ,Other Physical Sciences ,Oncology and Carcinogenesis - Abstract
Background and purposeNeurocognitive decline in brain tumor patients treated with radiotherapy (RT) may be linked to cortical atrophy. We developed models to determine radiation treatment-planning objectives for cortex, which were tested on a sample population to identify the dosimetric cost of cortical sparing.Material and methodsThe relationship between the probability of cortical atrophy in fifteen high-grade glioma patients at 1-year post-RT and radiation dose was fit using logistic mixed effects modeling. Cortical sparing was implemented using two strategies: region-specific sparing using model parameters, and non-specific sparing of all normal brain tissue.ResultsA dose threshold of 28.6 Gy was found to result in a 20% probability of severe atrophy. Average cortical sparing at 30 Gy was greater for region-specific dose avoidance (4.6%) compared to non-specific (3.6%). Cortical sparing resulted in an increase in heterogeneity index of the planning target volume (PTV) with an average increase of 1.9% (region-specific) and 0.9% (non-specific).ConclusionsWe found RT doses above 28.6 Gy resulted in a greater than 20% probability of cortical atrophy. Cortical sparing can be achieved using region-specific or non-specific dose avoidance strategies at the cost of an increase in the dose heterogeneity of the PTV.
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- 2016
44. RADT-50. EVIDENCE-BASED MULTIVARIATE NORMAL TISSUE COMPLICATION PROBABILITY (NTCP) STUDY OF DOMAIN-SPECIFIC COGNITIVE DECLINE AFTER PARTIAL BRAIN RADIATION (RT)
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Hopper, Austin, primary, Connor, Michael, additional, Salans, Mia, additional, Karunamuni, Roshan, additional, Unnikrishnan, Soumya, additional, Huynh-Le, Minh, additional, Tibbs, Michelle, additional, Reyes, Anny, additional, Stasenko, Alena, additional, McDonald, Carrie, additional, Moiseenko, Vitali, additional, El-Naqa, Issam, additional, and Hattangandi-Gluth, Jona, additional
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- 2023
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45. An image-based method to quantify biomechanical properties of the rectum in radiotherapy of prostate cancer
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Casares-Magaz, Oscar, Thor, Maria, Liao, Donghua, Frøkjær, Jens B, Kræmer, Pia, Krogh, Klaus, Drewes, Asbjørn M, Gregersen, Hans, Moiseenko, Vitali, Høyer, Morten, and Muren, Ludvig P
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Biomedical and Clinical Sciences ,Clinical Sciences ,Oncology and Carcinogenesis ,Rare Diseases ,Bioengineering ,Prostate Cancer ,Clinical Research ,Urologic Diseases ,Biomedical Imaging ,Cancer ,Biomechanical Phenomena ,Humans ,Magnetic Resonance Imaging ,Male ,Prostatic Neoplasms ,Radiation Injuries ,Rectum ,Oncology & Carcinogenesis ,Oncology and carcinogenesis - Abstract
BackgroundGastrointestinal morbidity after radiotherapy (RT) for prostate cancer may be related to the biomechanical properties of the rectum. In this study we present a magnetic resonance imaging (MRI)-based method to quantitate the thickness and elasticity of the rectal wall in prostate cancer patients treated with RT.Material and methodsFour patients previously treated with RT for prostate cancer underwent an MRI session with stepwise rectal bag deflation (from a maximum tolerable volume to 0 ml, in 50 ml steps), with a probe inserted inside the bag to monitor the internal rectal pressure. MRIs were acquired using Dixon sequences (4 mm axial slice thickness) at each deflation step. Rectal walls were defined from the recto-sigmoid junction to 3 cm above the anal canal as the space between the inner and outer wall surfaces. The wall thickness was determined and biomechanical properties (strain and stress) were calculated from the pressure measurements and the MRI-segmented rectal walls.ResultsThe integral rectal pressure varied for the maximum tolerable volume (range 150-250 ml) across patients and ranged from 1.3 to 4.0 kPa (SD = 1.2 kPa). Wall thickness was found to vary between patients and also across different rectum segments, with a mean (SD) thickness for the different segments at the 50 ml distension volume of 1.8-4.0 (0.6) mm. Stress showed larger variation than strain, with mean (SD) values for the different segments ranging between 1.5 and 7.0 (1.5) kPa.ConclusionWe have developed a method to quantify biomechanical properties of the rectal wall. The resulting rectal wall thickness, strain and stress differed between patients, as well as across different rectal wall sections. These findings could provide guidance in future predictive outcome modelling in order to better understand the rectal dose-volume response relationship.
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- 2015
46. Sparing the region of the salivary gland containing stem cells preserves saliva production after radiotherapy for head and neck cancer
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van Luijk, Peter, Pringle, Sarah, Deasy, Joseph O, Moiseenko, Vitali V, Faber, Hette, Hovan, Allan, Baanstra, Mirjam, van der Laan, Hans P, Kierkels, Roel GJ, van der Schaaf, Arjen, Witjes, Max J, Schippers, Jacobus M, Brandenburg, Sytze, Langendijk, Johannes A, Wu, Jonn, and Coppes, Robert P
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Stem Cell Research - Nonembryonic - Human ,Regenerative Medicine ,Transplantation ,Stem Cell Research - Nonembryonic - Non-Human ,Stem Cell Research ,Cancer ,Dental/Oral and Craniofacial Disease ,Digestive Diseases ,Evaluation of treatments and therapeutic interventions ,6.5 Radiotherapy and other non-invasive therapies ,Animals ,Head and Neck Neoplasms ,Humans ,Mice ,Parotid Gland ,Quality of Life ,Radiotherapy ,Rats ,Saliva ,Salivary Glands ,Stem Cells ,Xerostomia ,Biological Sciences ,Medical and Health Sciences - Abstract
Each year, 500,000 patients are treated with radiotherapy for head and neck cancer, resulting in relatively high survival rates. However, in 40% of patients, quality of life is severely compromised because of radiation-induced impairment of salivary gland function and consequent xerostomia (dry mouth). New radiation treatment technologies enable sparing of parts of the salivary glands. We have determined the parts of the major salivary gland, the parotid gland, that need to be spared to ensure that the gland continues to produce saliva after irradiation treatment. In mice, rats, and humans, we showed that stem and progenitor cells reside in the region of the parotid gland containing the major ducts. We demonstrated in rats that inclusion of the ducts in the radiation field led to loss of regenerative capacity, resulting in long-term gland dysfunction with reduced saliva production. Then we showed in a cohort of patients with head and neck cancer that the radiation dose to the region of the salivary gland containing the stem/progenitor cells predicted the function of the salivary glands one year after radiotherapy. Finally, we showed that this region of the salivary gland could be spared during radiotherapy, thus reducing the risk of post-radiotherapy xerostomia.
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- 2015
47. Quantifying Unnecessary Normal Tissue Complication Risks due to Suboptimal Planning: A Secondary Study of RTOG 0126
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Moore, Kevin L, Schmidt, Rachel, Moiseenko, Vitali, Olsen, Lindsey A, Tan, Jun, Xiao, Ying, Galvin, James, Pugh, Stephanie, Seider, Michael J, Dicker, Adam P, Bosch, Walter, Michalski, Jeff, and Mutic, Sasa
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Clinical Research ,Benchmarking ,Dose-Response Relationship ,Radiation ,Humans ,Male ,Models ,Statistical ,Organ Sparing Treatments ,Organs at Risk ,Prostatic Neoplasms ,Quality of Health Care ,Radiation Injuries ,Radiotherapy Planning ,Computer-Assisted ,Radiotherapy ,Intensity-Modulated ,Rectum ,Risk Assessment ,Other Physical Sciences ,Clinical Sciences ,Oncology and Carcinogenesis ,Oncology & Carcinogenesis - Abstract
PurposeThe purpose of this study was to quantify the frequency and clinical severity of quality deficiencies in intensity modulated radiation therapy (IMRT) planning in the Radiation Therapy Oncology Group 0126 protocol.Methods and materialsA total of 219 IMRT patients from the high-dose arm (79.2 Gy) of RTOG 0126 were analyzed. To quantify plan quality, we used established knowledge-based methods for patient-specific dose-volume histogram (DVH) prediction of organs at risk and a Lyman-Kutcher-Burman (LKB) model for grade ≥2 rectal complications to convert DVHs into normal tissue complication probabilities (NTCPs). The LKB model was validated by fitting dose-response parameters relative to observed toxicities. The 90th percentile (22 of 219) of plans with the lowest excess risk (difference between clinical and model-predicted NTCP) were used to create a model for the presumed best practices in the protocol (pDVH0126,top10%). Applying the resultant model to the entire sample enabled comparisons between DVHs that patients could have received to DVHs they actually received. Excess risk quantified the clinical impact of suboptimal planning. Accuracy of pDVH predictions was validated by replanning 30 of 219 patients (13.7%), including equal numbers of presumed "high-quality," "low-quality," and randomly sampled plans. NTCP-predicted toxicities were compared to adverse events on protocol.ResultsExisting models showed that bladder-sparing variations were less prevalent than rectum quality variations and that increased rectal sparing was not correlated with target metrics (dose received by 98% and 2% of the PTV, respectively). Observed toxicities were consistent with current LKB parameters. Converting DVH and pDVH0126,top10% to rectal NTCPs, we observed 94 of 219 patients (42.9%) with ≥5% excess risk, 20 of 219 patients (9.1%) with ≥10% excess risk, and 2 of 219 patients (0.9%) with ≥15% excess risk. Replanning demonstrated the predicted NTCP reductions while maintaining the volume of the PTV receiving prescription dose. An equivalent sample of high-quality plans showed fewer toxicities than low-quality plans, 6 of 73 versus 10 of 73 respectively, although these differences were not significant (P=.21) due to insufficient statistical power in this retrospective study.ConclusionsPlan quality deficiencies in RTOG 0126 exposed patients to substantial excess risk for rectal complications.
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- 2015
48. Aspiration pneumonia after concurrent chemoradiotherapy for head and neck cancer
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Xu, Beibei, Boero, Isabel J, Hwang, Lindsay, Le, Quynh‐Thu, Moiseenko, Vitali, Sanghvi, Parag R, Cohen, Ezra EW, Mell, Loren K, and Murphy, James D
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Biomedical and Clinical Sciences ,Health Services and Systems ,Health Sciences ,Clinical Sciences ,Oncology and Carcinogenesis ,Pneumonia & Influenza ,Cancer ,Aging ,Pneumonia ,Patient Safety ,Rare Diseases ,Dental/Oral and Craniofacial Disease ,Clinical Research ,Lung ,Good Health and Well Being ,Aged ,Aged ,80 and over ,Chemoradiotherapy ,Female ,Head and Neck Neoplasms ,Hospitalization ,Humans ,Male ,Medicare ,Pneumonia ,Aspiration ,Risk Factors ,SEER Program ,Sex Factors ,United States ,aspiration pneumonia ,chemoradiotherapy ,head and neck neoplasms ,Surveillance ,Epidemiology ,End Results Program ,Public Health and Health Services ,Oncology & Carcinogenesis ,Oncology and carcinogenesis ,Public health - Abstract
BackgroundAspiration pneumonia represents an under-reported complication of chemoradiotherapy in patient with head and neck cancer. The objective of the current study was to evaluate the incidence, risk factors, and mortality of aspiration pneumonia in a large cohort of patients with head and neck cancer who received concurrent chemoradiotherapy.MethodsPatients who had head and neck cancer diagnosed between 2000 and 2009 were identified from the Surveillance, Epidemiology, and End Results-Medicare database. Aspiration pneumonia was identified from Medicare billing claims. The cumulative incidence, risk factors, and survival after aspiration pneumonia were estimated and compared with a noncancer population.ResultsOf 3513 patients with head and neck cancer, 801 developed aspiration pneumonia at a median of 5 months after initiating treatment. The 1-year and 5-year cumulative incidence of aspiration pneumonia was 15.8% and 23.8%, respectively, for patients with head and neck cancer and 3.6% and 8.7%, respectively, for noncancer controls. Among the patients with cancer, multivariate analysis identified independent risk factors (P
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- 2015
49. Intensity-modulated stereotactic radiosurgery for arteriovenous malformations: guidance for treatment planning
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Sonier, Marcus, Gete, Ermias, Herbert, Chris, McKenzie, Michael, Murphy, James, and Moiseenko, Vitali
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Sciences ,Oncology and Carcinogenesis ,Patient Safety ,Neurosciences ,Clinical Research ,Cancer ,Evaluation of treatments and therapeutic interventions ,6.5 Radiotherapy and other non-invasive therapies ,Arteriovenous Malformations ,Brain ,Dose-Response Relationship ,Radiation ,Guidelines as Topic ,Humans ,Radiation Injuries ,Radiosurgery ,Radiotherapy Dosage ,Radiotherapy Planning ,Computer-Assisted ,Radiotherapy ,Intensity-Modulated ,Retrospective Studies ,Stereotactic radiosurgery ,Intensity modulated radiotherapy ,Arteriovenous malformation ,Treatment planning ,Patient stratification ,Oncology & Carcinogenesis ,Clinical sciences ,Oncology and carcinogenesis - Abstract
BackgroundStereotactic Radiosurgery (SRS) is a common tool used to treat Arteriovenous Malformations (AVMs) in anatomical locations associated with a risk of surgical complications. Despite high rates of clinical effectiveness, SRS carries a risk of toxicity as a result of radiation injury to brain tissue. The use of intensity-modulated radiotherapy (IMRT) has increased because it may lead to improved PTV conformity and better Normal Tissue (NT) sparing compared to 3D Conformal Radiotherapy (3DCRT). The aim of this study was twofold: 1) to develop simple patient stratification rules for the recommendation of IMRT planning strategies over 3DCRT in the treatment of AVMs with SRS; and 2) to estimate the impact of IMRT in terms of toxicity reduction using retrospectively reported data for symptomatic radiation injury following SRS.MethodsThirty-one AVM patients previously treated with 3DCRT were replanned in a commercial treatment planning system using 3DCRT and static gantry IMRT with identical beam arrangements. The radiotherapy planning metrics analyzed included AVM volume, diameter, and volume to surface area ratio. The dosimetric endpoints analyzed included conformity index improvements and NT sparing measured by the maximum NT dose, and the volume of surrounding tissue that received 7Gy and 12Gy.ResultsOur analysis revealed stratified subsets of patients for IMRT that were associated with improved conformity, and those that were associated with decreased doses to normal tissue. The stratified patients experienced an improvement in conformity index by -6-68%, a reduction in the maximum NT dose by -0.5-12.3%, a reduction in the volume of NT receiving 7Gy by 1-8 cc, and a reduction in the volume of NT receiving 12Gy by 0-3.7 cc. The reduction in NT receiving 12Gy translated to a theoretical decrease in the probability of symptomatic injury by 0-9.3%.ConclusionsThis work indicates the potential for significant patient improvements when treating AVMs and provides rules to predict which patients are likely to benefit from IMRT.
- Published
- 2014
50. Geometric and dosimetric evaluation of atlas based auto-segmentation of cardiac structures in breast cancer patients
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Kaderka, Robert, Gillespie, Erin F., Mundt, Robert C., Bryant, Alex K., Sanudo-Thomas, Camila B., Harrison, Anna L., Wouters, Emilie L., Moiseenko, Vitali, Moore, Kevin L., Atwood, Todd F., and Murphy, James D.
- Published
- 2019
- Full Text
- View/download PDF
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