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Vaginal cancer treated with curative radiotherapy with or without concomitant chemotherapy: oncologic outcomes and prognostic factors

Meixner, Eva; Arians, Nathalie; Bougatf, Nina; Hoeltgen, Line; König, Laila; Lang, Kristin; Domschke, Christoph; Wallwiener, Markus; Lischalk, Jonathan W; Kommoss, Felix K F; Debus, Jürgen; Hörner-Rieber, Juliane
BACKGROUND/UNASSIGNED:Vaginal cancer is a rare disease for which prospective randomized trials do not exist. We aimed to assess survival outcomes, patterns of recurrence, prognostic factors, and toxicity in the curative treatment using image-guided radiotherapy (RT). METHODS/UNASSIGNED:In this retrospective review, we identified 53 patients who were treated at a single center with external beam radiotherapy and brachytherapy with or without concomitant chemotherapy from 2000 to 2021. RESULTS/UNASSIGNED:= 0.027). Minimal toxicity was observed with no patients having documentation of high-grade toxicity (CTCAE grade 3+). CONCLUSION/UNASSIGNED:In treatment of vaginal cancer, high-dose RT in combination with brachytherapy is well tolerated and results in effective local control rates, which significantly improve with an EQD2(α/β=10) ⩾65 Gy. Multivariate analyses revealed concomitant chemotherapy was a positive prognostic factor for overall and progression-free survival.
PMID: 34724840
ISSN: 2038-2529
CID: 5037892

Radiolucent Carbon Fiber-Reinforced Implants for Treatment of Spinal Tumors-Clinical, Radiographic, and Dosimetric Considerations

Takayanagi, Ariel; Siddiqi, Imran; Ghanchi, Hammad; Lischalk, Jonathan; Vrionis, Frank; Ratliff, John; Bilsky, Mark; Hariri, Omid R
The management of spine tumors is multimodal and personalized to each individual patient. Patients often require radiation therapy after surgical fixation. Although titanium implants are used most commonly, they produce significant artifact, leading to decreased confidence in target-volume coverage and normal tissue sparing. Carbon-based materials have been found to have minimal effects on dose perturbation in postoperative radiation therapy and have shown biostability and biocompatibility that are comparable to titanium implants. Using the PubMed and Web of Sciences databases, we conducted a systematic review of carbon-based screw and rod fixation systems in the treatment of spinal tumors. We reviewed clinical studies regarding safety of spine fixation with carbon fiber-reinforced (CFR) implants and biomechanical studies, as well as radiation and dosimetric studies. The radiolucency of CFR-polyether ether ketone implants has the potential to benefit patients with spine tumor. Clinical studies have shown no increase in complications with implementation of CFR-polyether ether ketone implants, and these devices seem to have sufficient stiffness and pullout strength. However, further trials are necessary to determine if there is a clinically significant impact on local tumor control.
PMID: 34062294
ISSN: 1878-8769
CID: 5013492

Stereotactic body radiation therapy for the treatment of localized prostate cancer in men with underlying inflammatory bowel disease

Lischalk, Jonathan W; Blacksburg, Seth; Mendez, Christopher; Repka, Michael; Sanchez, Astrid; Carpenter, Todd; Witten, Matthew; Garbus, Jules E; Evans, Andrew; Collins, Sean P; Katz, Aaron; Haas, Jonathan
BACKGROUND:Historically, IBD has been thought to increase the underlying risk of radiation related toxicity in the treatment of prostate cancer. In the modern era, contemporary radiation planning and delivery may mitigate radiation-related toxicity in this theoretically high-risk cohort. This is the first manuscript to report clinical outcomes for men diagnosed with prostate cancer and underlying IBD curatively treated with stereotactic body radiation therapy (SBRT). METHODS:A large institutional database of patients (n = 4245) treated with SBRT for adenocarcinoma of the prostate was interrogated to identify patients who were diagnosed with underlying IBD prior to treatment. All patients were treated with SBRT over five treatment fractions using a robotic radiosurgical platform and fiducial tracking. Baseline IBD characteristics including IBD subtype, pre-SBRT IBD medications, and EPIC bowel questionnaires were reviewed for the IBD cohort. Acute and late toxicity was evaluated using the CTCAE version 5.0. RESULTS:A total of 31 patients were identified who had underlying IBD prior to SBRT for the curative treatment of prostate cancer. The majority (n = 18) were diagnosed with ulcerative colitis and were being treated with local steroid suppositories for IBD. No biochemical relapses were observed in the IBD cohort with early follow up. High-grade acute and late toxicities were rare (n = 1, grade 3 proctitis) with a median time to any GI toxicity of 22 months. Hemorrhoidal flare was the most common low-grade toxicity observed (n = 3). CONCLUSION/CONCLUSIONS:To date, this is one of the largest groups of patients with IBD treated safely and effectively with radiation for prostate cancer and the only review of patients treated with SBRT. Caution is warranted when delivering therapeutic radiation to patients with IBD, however modern radiation techniques appear to have mitigated the risk of GI side effects.
PMID: 34243797
ISSN: 1748-717x
CID: 4965222

Thymic malignancies treated with active scanning proton beam radiation and Monte Carlo planning: early clinical experience [Letter]

McGunigal, Mary; Margolis, Marc; Forsthoefel, Matthew; Singh, Tanvee; Amarell, Katherine; Deblois, David; Campbell, Lloyd; Kim, Chul; Liu, Stephen; Bergquist, Peter J; Debrito, Pedro; Collins, Brian T; Giaccone, Giuseppe; Lischalk, Jonathan W
PMID: 33629926
ISSN: 1651-226x
CID: 5013462

Intensity Modulated Radiation Therapy (IMRT) With Simultaneously Integrated Boost Shortens Treatment Time and Is Noninferior to Conventional Radiation Therapy Followed by Sequential Boost in Adjuvant Breast Cancer Treatment: Results of a Large Randomized Phase III Trial (IMRT-MC2 Trial)

Hörner-Rieber, Juliane; Forster, Tobias; Hommertgen, Adriane; Haefner, Matthias F; Arians, Nathalie; König, Laila; Harrabi, Semi B; Schlampp, Ingmar; Weykamp, Fabian; Lischalk, Jonathan W; Heinrich, Vanessa; Weidner, Nicola; Hüsing, Johannes; Sohn, Christof; Heil, Jörrg; Hof, Holger; Krug, David; Debus, Jürgen
PURPOSE:In the modern era, improvements in radiation therapy techniques have paved the way for simultaneous integrated boost irradiation in adjuvant breast radiation therapy after breast conservation surgery. Nevertheless, randomized trials supporting the noninferiority of this treatment to historical standards of care approach are lacking. METHODS:A prospective, multicenter, randomized phase 3 trial (NCT01322854) was performed to analyze noninferiority of conventional fractionated intensity modulated radiation therapy with simultaneous integrated boost (IMRT-SIB) to 3-D conformal radiation therapy with sequential boost (3-D-CRT-seqB) for breast cancer patients. Primary outcomes were local control (LC) rates at 2 and 5 years (noninferiority margin at hazard ratio [HR] of 3.5) as well as cosmetic results 6 weeks and 2 years after radiation therapy (evaluated via photo documentation calculating the relative breast retraction assessment [pBRA] score [noninferiority margin of 1.25]). RESULTS:A total of 502 patients were randomly assigned from 2011 to 2015. After a median follow-up of 5.1 years, the 2-year LC for the IMRT-SIB arm was noninferior to the 3-D-CRT-seqB arm (99.6% vs 99.6%, respectively; HR, 0.602; 95% CI, 0.123-2.452; P = .487). In addition, noninferiority was also shown for cosmesis after IMRT-SIB and 3-D-CRT-seqB at both 6 weeks (median pBRA, 9.1% vs 9.1%) and 2 years (median pBRA, 10.4% vs 9.8%) after radiation therapy (95% CI, -0.317 to 0.107 %; P = .332). Cosmetic assessment according to the Harvard scale by both the patient and the treating physician as well as late-toxicity evaluation with the late effects normal tissues- subjective, objective, management, analytic criteria, a score for the evaluation of long-term adverse effects in normal tissue, revealed no significant differences between treatment arms. In addition, there was no difference in overall survival rates (99.6% vs 99.6%; HR, 3.281; 95% CI: -0.748 to 22.585; P = .148) for IMRT-SIB and 3-D-CRT-seqB, respectively. CONCLUSIONS:To our knowledge, this is the first prospective trial reporting the noninferiority of IMRT-SIB versus 3-D-CRT-seqB with respect to cosmesis and LC at 2 years of follow-up. This treatment regimen considerably shortens adjuvant radiation therapy times without compromising clinical outcomes.
PMID: 33321192
ISSN: 1879-355x
CID: 5013422

Radiation Modalities Used in Lung Cancer: An Overview for Thoracic Surgeons

McGunigal, Mary; Lischalk, Jonathan W; Randolph-Jackson, Pamela; Khaitan, Puja Gaur
Radiation is a constantly evolving technology which plays a role in the management of lung cancer in a variety of settings: as an adjunct to surgery, definitively, and palliatively. Key aspects of radiation oncology-including acute and chronic toxicities of thoracic radiation and rationale for choosing one modality of radiation over another-may be obscure to those outside the field. We aim to provide a useful overview relevant for the thoracic surgeon of radiation technology and delivery. A review was performed of salient articles identifying radiation technologies used in lung cancer which were summarized and expounded upon with focus on integrating their history, evolution, and landmark trials establishing basis of their use. This article reviews the four fundamental means of external beam radiation employed in managing lung cancer and provides visual examples of comparison plans. We also touch on potential practice-changing developments in regards to proton therapy and radiation in the era of immunotherapy. Radiation oncology has evolved considerably over time to become a critical part of lung cancer management, particularly in early-stage inoperable disease and locally advanced disease. Maximizing tumor control while minimizing toxicity drives treatment strategies. Knowledge of these fundamentals will help the thoracic surgeon answer many questions patients pose regarding radiation.
PMID: 33705939
ISSN: 1532-9488
CID: 5013472

Secondary Malignancy Risk after Proton- versus Photon-based Irradiation in the Treatment of epithelial Thymic Tumors: A comparative Modeling Study on Organ-specific Cancer Risk [Meeting Abstract]

Koenig, L.; Forsthoefel, M.; Haering, P.; Meixner, E.; Kraemer, A.; Eichkorn, T.; Regnery, S.; Mielke, T.; Tonndorf-Martini, E.; Haefner, M.; Herfarth, K.; Debus, J.; Lischalk, J.; Hoerner-Rieber, J.
ISSN: 0179-7158
CID: 5013672

Utilization of Iodinated SpaceOAR Vue (TM) During Robotic Prostate Stereotactic Body Radiation Therapy (SBRT) to Identify the Rectal-Prostate Interface and Spare the Rectum: A Case Report

Conroy, Dylan; Becht, Kelly; Forsthoefel, Matthew; Pepin, Abigail N.; Lei, Siyuan; Rashid, Abdul; Collins, Brian Timothy; Lischalk, Jonathan W.; Suy, Simeng; Aghdam, Nima; Hankins, Ryan Andrew; Collins, Sean P.
ISSN: 2234-943x
CID: 5013612

Central vs Peripheral Thoracic Malignancies Treated with SBRT: Early Outcomes of a Prospective Quality of Life Study [Meeting Abstract]

Carrasquilla, M.; Krochmal, R.; Anderson, E.; Bergquist, P.; Margolis, M.; Forsthoefel, M.; Collins, B.; Kim, C.; Liu, S.; Lischalk, J.
ISSN: 1556-0864
CID: 5013652

Abscopal effect in pulmonary carcinoid tumor following ablative stereotactic body radiation therapy: a case report [Case Report]

Kareff, Samuel A; Lischalk, Jonathan W; Krochmal, Rebecca; Kim, Chul
BACKGROUND:The abscopal effect was described as early as the 1950s, when untreated tumors demonstrated a response after radiation therapy was delivered to an untreated, distant site. The mechanisms underlying this global response to otherwise localized therapy remain unknown, though there is increasing evidence that increased antigen expression following ablative radiotherapy may play a role. CASE PRESENTATION/METHODS:We report a case of a 69-year-old African American woman with a history of metastatic typical pulmonary carcinoid with multiple lung nodules who had a significant decrease in size of an untreated left upper lobe nodule after stereotactic body radiation therapy to an oligoprogressive left lower lobe lesion. CONCLUSIONS:To our knowledge, this report describes the first case of an abscopal effect in a typical pulmonary carcinoid. Further research is needed regarding the mechanisms responsible for this finding and the role of combining radiation therapy and cancer immunotherapy in patients with pulmonary carcinoid tumors.
PMID: 33010806
ISSN: 1752-1947
CID: 5013402