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The Quality Assurance of a 1.5 T MR-Linac Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-12-15 Hans Lynggaard Riis, Joan Chick, Alex Dunlop, David Tilly
The recent introduction of a commercial 1.5 T MR-linac system has considerably improved the image quality of the patient acquired in the treatment unit as well as enabling online adaptive radiation therapy (oART) treatment strategies. Quality Assurance (QA) of this new technology requires new methodology that allows for the high field MR in a linac environment. The presence of the magnetic field requires
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The Future of MR-Guided Radiation Therapy Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-12-15 Matthias Guckenberger, Nicolaus Andratschke, Caroline Chung, Dave Fuller, Stephanie Tanadini-Lang, David A. Jaffray
Magnetic resonance image guided radiation therapy (MRIgRT) is a relatively new technology that has already shown outcomes benefits but that has not yet reached its clinical potential. The improved soft-tissue contrast provided with MR, coupled with the immediacy of image acquisition with respect to the treatment, enables expansion of on-table adaptive protocols, currently at a cost of increased treatment
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The Use of MR-Guided Radiation Therapy for Pancreatic Cancer Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-12-15 Lois A. Daamen, Parag J. Parikh, William A. Hall
The introduction of online adaptive magnetic resonance (MR)-guided radiation therapy (RT) has enabled safe treatment of pancreatic cancer with ablative doses. The aim of this review is to provide a comprehensive overview of the current literature on the use and clinical outcomes of MR-guided RT for treatment of pancreatic cancer. Relevant outcomes included toxicity, tumor response, survival and quality
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The Use of MR-Guided Radiation Therapy for Liver Cancer Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-12-15 Sabrina Prime, Joshua P. Schiff, Ali Hosni, Teodor Stanescu, Laura A. Dawson, Lauren E. Henke
The role of radiotherapy in the management of primary and metastatic liver malignancies has expanded in recent years due to advances such as IGRT and SBRT. MRI-guided radiotherapy (MRgRT) has arisen as an excellent option for the management of hepatocellular carcinoma, cholangiocarcinoma, and liver metastases due to the ability to combine improved hepatic imaging with conformal treatment planning paradigms
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Quantitative MRI on MR-Linacs: Towards Biological Image-Guided Adaptive Radiotherapy Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-12-15 Petra J. van Houdt, Shaolei Li, Yingli Yang, Uulke A. van der Heide
Recognizing the potential of quantitative imaging biomarkers (QIBs) in radiotherapy, many studies have investigated the prognostic value of quantitative MRI (qMRI). With the introduction of MRI-guided radiotherapy systems, the practical challenges of repeated imaging have been substantially reduced. Since patients are treated inside an MRI scanner, acquisition of qMRI can be done during each fraction
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MRgRT Quality Assurance for a Low-Field MR-Linac Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-12-15 Joshua P. Kim
The introduction of MR-guided treatment machines into the radiation oncology clinic has provided unique challenges for the radiotherapy QA program. These MR-linac systems require that existing QA procedures be adapted to verify linac performance within the magnetic field environment and that new procedures be added to ensure acceptable image quality for the MR system. While both high and low-field
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Magnetic Resonance Imaging Guided Radiation Therapy: Overview Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-12-15 Daniel Low, Daniel Zips
Abstract not available
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MRI-Guided Radiation Therapy—An Emerging and Disruptive Process of Care: Healthcare Economic and Policy Considerations Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-12-15 P. Travis Courtney, Luca F. Valle, Ann C. Raldow, Michael L. Steinberg
MRI-guided radiation therapy (MRgRT) is an emerging, innovative technology that provides opportunities to transform and improve the current clinical care process in radiation oncology. As with many new technologies in radiation oncology, careful evaluation from a healthcare economic and policy perspective is required for its successful implementation. In this review article, we describe the current
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MRI-Guided Radiation Therapy Systems Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-12-15 Daniel A. Low, B. Gino Fallone, Bas W. Raaymakers
MR-Guided Radiation Therapy (MRIgRT) has been made possible only due to the ingenuity and commitment of commercial radiation therapy system vendors. Unlike conventional linear accelerator systems, MRIgRT systems have had to overcome significant and previously untested techniques to integrate the MRI systems with the radiation therapy delivery systems. Each of these three commercial systems has developed
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MRI-Guided Radiotherapy for Prostate Cancer: Seeing is Believing Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-12-15 Rosalyne L Westley, Luca F Valle, Alison C Tree, Amar U. Kishan
The advent of MRI guided radiotherapy (MRIgRT) offers enormous promise in the treatment of prostate cancer. The MR-linac offers men the opportunity to receive daily MR imaging to guide and influence their radiotherapy treatment. This review focuses on the advantages that MRIgRT potentially offers as well as any potential disadvantages to MRIgRT that may have been recognized thus far. Ongoing clinical
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Exploring the Advantages and Challenges of MR-Guided Radiotherapy in Non–Small-Cell Lung Cancer: Who are the Optimal Candidates? Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-12-15 Trudy C. Wu, Lauren M. Smith, David Woolf, Corinne Faivre-Finn, Percy Lee
The landscape of lung radiotherapy (RT) has rapidly evolved over the past decade with modern RT and surgical techniques, systemic therapies, and expanding indications for RT. To date, 2 MRI-guided RT (MRgRT) units, 1 using a 0.35T magnet and 1 using a 1.5T magnet, are available for commercial use with more systems in the pipeline. MRgRT offers distinct advantages such as real-time target tracking,
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Rectal Cancer MRI Guided Radiotherapy: A Practical Review for the Physician Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-12-15 Giuditta Chiloiro, Cihan Gani, Luca Boldrini
MR-guided radiotherapy is a treatment approach that combines the advantages of magnetic resonance imaging (MRI) with the precision of radiation therapy. This practical review provides an overview of the current state-of-the-art of MR-guided radiotherapy for rectal cancer, including its technical aspects, clinical outcomes, and existing limitations. Even though some studies have demonstrated the feasibility
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The Use of MR-Guided Radiation Therapy for Head and Neck Cancer and Recommended Reporting Guidance Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-12-15 Brigid A. McDonald, Riccardo Dal Bello, Clifton D. Fuller, Panagiotis Balermpas
Although magnetic resonance imaging (MRI) has become standard diagnostic workup for head and neck malignancies and is currently recommended by most radiological societies for pharyngeal and oral carcinomas, its utilization in radiotherapy has been heterogeneous during the last decades. However, few would argue that implementing MRI for annotation of target volumes and organs at risk provides several
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MRI-Guided Adaptive Radiation Therapy Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-12-15 Cecil M. Benitez, Michael D. Chuong, Luise A. Künzel, Daniela Thorwarth
Magnetic resonance imaging-guided radiation therapy (MRIgRT) has improved soft tissue contrast over computed tomography (CT) based image-guided RT. Superior visualization of the target and surrounding radiosensitive structures has the potential to improve oncological outcomes partly due to safer dose-escalation and adaptive planning. In this review, we highlight the workflow of adaptive MRIgRT planning
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Intrafraction Motion Management With MR-Guided Radiation Therapy Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-12-15 Martin F. Fast, Minsong Cao, Parag Parikh, Jan-Jakob Sonke
High quality radiation therapy requires highly accurate and precise dose delivery. MR-guided radiotherapy (MRgRT), integrating an MRI scanner with a linear accelerator, offers excellent quality images in the treatment room without subjecting patient to ionizing radiation. MRgRT therefore provides a powerful tool for intrafraction motion management. This paper summarizes different sources of intrafraction
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Patient-Reported Outcomes in Clinical Trials: From an Endpoint to an Intervention in Cancer Care Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-09-06 Lakshmi Rekha Narra, Nicholas Verdini, Kaitlyn Lapen, Ryan Nipp, Erin F. Gillespie
Underreporting of patient symptoms by clinicians is a common and well-documented phenomenon that has led to integrating patient-reported outcomes (PROs) as endpoints into clinical trials. While PROs are often used to measure disease symptoms, cancer therapy toxicities, and quality of life, they can also assess patients’ general experiences and preferences. With the increasing use of electronic medical
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Integrating Artificial Intelligence and Machine Learning Into Cancer Clinical Trials Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-09-06 John Kang, Amit K. Chowdhry, Stephanie L. Pugh, John H. Park
The practice of oncology requires analyzing and synthesizing abundant data. From the patient's workup to determine eligibility to the therapies received to the post-treatment surveillance, practitioners must constantly juggle, evaluate, and weigh decision-making based on their best understanding of information at hand. These complex, multifactorial decisions have a tremendous opportunity to benefit
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Challenges, Complexities, and Considerations in the Design and Interpretation of Late-Phase Oncology Trials Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-09-06 Timothy A. Lin, Alexander D. Sherry, Ethan B. Ludmir
Optimal management of cancer patients relies heavily on late-phase oncology randomized controlled trials. A comprehensive understanding of the key considerations in designing and interpreting late-phase trials is crucial for improving subsequent trial design, execution, and clinical decision-making. In this review, we explore important aspects of late-phase oncology trial design. We begin by examining
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Optimizing Informed Consent in Cancer Clinical Trials Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-09-06 Subha Perni, Rachel Jimenez, Reshma Jagsi
The concept of informed consent has evolved considerably over the course of the 20th century, leading to its establishment as a foundational ethical principle for the conduct of biomedical research in the United States. Even though it is now a highly regulated part of cancer research, the process of obtaining informed consent is often impeded by systemic, clinician, and patient factors that require
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Selection and Prejudice: Addressing Clinical Trial Disparities With a Review of Current Shortcomings and Future Directions Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-09-06 Kelsey L. Corrigan, Michael K. Rooney, Ramez Kouzy, Gohar Manzar, Charles R. Thomas, Ethan B. Ludmir
Growing evidence has demonstrated significant, persistent, and widespread disparities in cancer clinical trial enrollment across myriad disease sites and target populations. Although mechanisms underlying such disparities are complex and multifactorial, clinical trial eligibility criteria may serve as a key structural barrier to equitable and diverse trial enrollment. In this review, we provide an
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Real-World Data: Applications and Relevance to Cancer Clinical Trials Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-09-06 Andrew J. Gross, Courtney E. Pisano, Chachrit Khunsriraksakul, Daniel E. Spratt, Henry S. Park, Yilun Sun, Ming Wang, Nicholas G. Zaorsky
Randomized controlled trials (RCTs) are the gold standard for comparative-effectiveness research (CER). Since the 1980s, there has been a rise in the creation and utilization of large national cancer databases to provide readily accessible “real-world data” (RWD). This review article discusses the role of RCTs in oncology, and the role of RWD from the national cancer database in CER. RCTs remain the
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The Importance of Quality Assurance in Radiation Oncology Clinical Trials Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-09-06 Thomas J. FitzGerald, Maryann Bishop-Jodoin, Fran Laurie, Matthew Iandoli, Koren Smith, Kenneth Ulin, Linda Ding, Janaki Moni, M. Giulia Cicchetti, Michael Knopp, Stephen Kry, Ying Xiao, Mark Rosen, Fred Prior, Joel Saltz, Jeff Michalski
Clinical trials have been the center of progress in modern medicine. In oncology, we are fortunate to have a structure in place through the National Clinical Trials Network (NCTN). The NCTN provides the infrastructure and a forum for scientific discussion to develop clinical concepts for trial design. The NCTN also provides a network group structure to administer trials for successful trial management
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Advances and Challenges in Conducting Clinical Trials With Proton Beam Therapy Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-09-06 J. Isabelle Choi, Charles B. Simone, Alicia Lozano, Steven J. Frank
Advances in proton therapy have garnered much attention and speculation in recent years as the indications for proton therapy have grown beyond pediatric, prostate, spine, and ocular tumors. To achieve and maintain consistent access to this cancer treatment and to ensure the future viability and availability of proton centers in the United States, a call for evidence has been heard and answered by
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Advances and Challenges in Trials of Local Therapy for Patients With Oligometastatic or Oligoprogressive Disease Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-09-06 Michael Yan, Fadwa Abdel-Rahman, Laura Dawson, Philip Wong, Rebecca K.S. Wong, C. Jillian Tsai
The paradigm of oligometastatic disease (OMD), characterized by a limited number of metastases potentially amenable to local therapies, presents unique opportunities and challenges in clinical trial design and implementation. Although local ablative therapies, such as stereotactic body radiation therapy, have shown promise in improving outcomes for patients with OMD, there is a lack of large-scale
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Advancing Towards Personalized Prescription of Radiotherapy Dose Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-06-16 Deborah Citrin, Zachary S. Morris
Abstract not available
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[18F]FDG-PET-Based Personalized Radiotherapy Dose Prescription Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-06-16 Johannes H.A.M. Kaanders, Johan Bussink, Erik H.J.G. Aarntzen, Pètra Braam, Heidi Rütten, Richard W.M. van der Maazen, Marcel Verheij, Sven van den Bosch
PET imaging with 2’-deoxy-2’-[18F]fluoro-D-glucose ([18F]FDG) has become one of the pillars in the management of malignant diseases. It has proven value in diagnostic workup, treatment policy, follow-up, and as prognosticator for outcome. [18F]FDG is widely available and standards have been developed for PET acquisition protocols and quantitative analyses. More recently, [18F]FDG-PET is also starting
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Hypoxia-Targeted Dose Painting in Radiotherapy Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-06-16 Ahmed Salem
Hypoxia (oxygen deprivation) occurs in most solid malignancies, albeit with considerable heterogeneity. Hypoxia is associated with an aggressive cancer phenotype by promotion of genomic instability, evasion of anti-cancer therapies including radiotherapy and enhancement of metastatic risk. Therefore, hypoxia results in poor cancer outcomes. Targeting hypoxia to improve cancer outcomes is an attractive
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Theranostics and Patient-Specific Dosimetry Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-06-16 Bryan Bednarz
Radiopharmaceutical therapy (RPT) is an invigorated form of cancer therapy that systemically delivers targeted radioactive drugs to cancer cells. Theranostics is a type of RPT that utilizes imaging, either of the RPT drug directly or a companion diagnostic, to inform whether a patient will benefit from the treatment. Given the ability to image the drug onboard theranostic treatments also lends itself
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Towards Data Driven RT Prescription: Integrating Genomics into RT Clinical Practice Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-06-16 Javier F. Torres-Roca, G. Daniel Grass, Jacob G. Scott, Steven A. Eschrich
The genomic era has significantly changed the practice of clinical oncology. The use of genomic-based molecular diagnostics including prognostic genomic signatures and new-generation sequencing has become routine for clinical decisions regarding cytotoxic chemotherapy, targeted agents and immunotherapy. In contrast, clinical decisions regarding radiation therapy (RT) remain uninformed about the genomic
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Histology Specific Molecular Biomarkers: Ushering in a New Era of Precision Radiation Oncology Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-06-16 Philip Sutera, Heath Skinner, Matthew Witek, Mark Mishra, Young Kwok, Elai Davicioni, Felix Feng, Daniel Song, Elizabeth Nichols, Phuoc T. Tran, Carmen Bergom
Histopathology and clinical staging have historically formed the backbone for allocation of treatment decisions in oncology. Although this has provided an extremely practical and fruitful approach for decades, it has long been evident that these data alone do not adequately capture the heterogeneity and breadth of disease trajectories experienced by patients. As efficient and affordable DNA and RNA
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Machine Learning & Molecular Radiation Tumor Biomarkers Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-06-16 Nicholas R. Rydzewski, Kyle T. Helzer, Matthew Bootsma, Yue Shi, Hamza Bakhtiar, Martin Sjöström, Shuang G. Zhao
Developing radiation tumor biomarkers that can guide personalized radiotherapy clinical decision making is a critical goal in the effort towards precision cancer medicine. High-throughput molecular assays paired with modern computational techniques have the potential to identify individual tumor-specific signatures and create tools that can help understand heterogenous patient outcomes in response
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The Promise and Future of Radiomics for Personalized Radiotherapy Dosing and Adaptation Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-06-16 Rachel B. Ger, Lise Wei, Issam El Naqa, Jing Wang
Quantitative image analysis, also known as radiomics, aims to analyze large-scale quantitative features extracted from acquired medical images using hand-crafted or machine-engineered feature extraction approaches. Radiomics has great potential for a variety of clinical applications in radiation oncology, an image-rich treatment modality that utilizes computed tomography (CT), magnetic resonance imaging
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Emerging Roles of Circulating Tumor DNA for Increased Precision and Personalization in Radiation Oncology Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-06-16 Noah Earland, Kevin Chen, Nicholas P. Semenkovich, Pradeep S. Chauhan, Jose P. Zevallos, Aadel A. Chaudhuri
Recent breakthroughs in circulating tumor DNA (ctDNA) technologies present a compelling opportunity to combine this emerging liquid biopsy approach with the field of radiogenomics, the study of how tumor genomics correlate with radiotherapy response and radiotoxicity. Canonically, ctDNA levels reflect metastatic tumor burden, although newer ultrasensitive technologies can be used after curative-intent
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Radiation Sensitivity: The Rise of Predictive Patient-Derived Cancer Models Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-06-16 Liliana L Berube, Kwang-ok P Nickel, Mari Iida, Sravani Ramisetty, Prakash Kulkarni, Ravi Salgia, Deric L Wheeler, Randall J Kimple
Patient-derived cancer models have been used for decades to improve our understanding of cancer and test anticancer treatments. Advances in radiation delivery have made these models more attractive for studying radiation sensitizers and understanding an individual patient's radiation sensitivity. Advances in the use of patient-derived cancer models lead to a more clinically relevant outcome, although
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Normal Tissue Toxicity Prediction: Clinical Translation on the Horizon Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-06-16 Sarah L. Kerns, William A. Hall, Brian Marples, Catharine M.L. West
Improvements in radiotherapy delivery have enabled higher therapeutic doses and improved efficacy, contributing to the growing number of long-term cancer survivors. These survivors are at risk of developing late toxicity from radiotherapy, and the inability to predict who is most susceptible results in substantial impact on quality of life and limits further curative dose escalation. A predictive assay
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Radiotherapy Dose in Patients Receiving Immunotherapy Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-06-16 Kelly J. Fitzgerald, Jonathan D. Schoenfeld
There is significant rationale for combining radiation therapy (RT) and immuno-oncology (IO) agents, but the optimal radiation parameters are unknown. This review summarizes key trials in the RT and IO space with a focus on RT dose. Very low RT doses solely modulate the tumor immune microenvironment, intermediate doses both modulate the tumor immune microenvironment and kill some fraction of tumor
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Lessons and Opportunities for Biomarker-Driven Radiation Personalization in Head and Neck Cancer Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-06-16 Elham Rahimy, Michael F. Gensheimer, Beth Beadle, Quynh-Thu Le
Head and neck cancer is notoriously challenging to treat in part because it constitutes an anatomically and biologically diverse group of cancers with heterogeneous prognoses. While treatment can be associated with significant late toxicities, recurrence is often difficult to salvage with poor survival rates and functional morbidity.1,2 Thus, achieving tumor control and cure at the initial diagnosis
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Radiotherapy for Lung Metastases: Conventional to Stereotactic Body Radiation Therapy Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-03-27 Avipsa Das, Meredith Giuliani, Andrea Bezjak
The lung parenchyma and adjacent tissues are one of the most common sites of metastatic disease. Traditionally, the approach to treatment of a patient with lung metastases has been with systemic therapy, with radiotherapy being reserved for palliative management of symptomatic disease. The concept of oligo metastatic disease has paved the way for more radical treatment options, administered either
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The Role of Stereotactic Body Radiation Therapy in the Management of Liver Metastases Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-03-27 Sangjune Laurence Lee, Michael F. Bassetti, Chad G. Rusthoven
The liver is a common site for metastatic spread for various primary tumor histologies. Stereotactic body radiation therapy (SBRT) is a non-invasive treatment technique with broad patient candidacy for the ablation of tumors in the liver and other organs. SBRT involves focused, high-dose radiation therapy delivered in one to several treatments, resulting in high rates of local control. Use of SBRT
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Radiation Therapy in the Management of Adrenal Metastases Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-03-27 Ciro Franzese, Sara Stefanini, Marta Scorsetti
Adrenal glands represent a common site of metastases from several primary tumors, including lung cancer, breast cancer and melanoma. Surgical resection is considered the standard of care, but surgery is not always feasible given the challenges related to anatomical site and/or due to patient and/or disease characteristics. Stereotactic body radiation therapy (SBRT) represents a promising treatment
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Palliative Radiation Oncology: Personalized Approaches to Radiotherapeutic Technologies, Quality of Life, and End-of-life Cancer Care Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-03-27 Tracy A. Balboni, Dirk Rades
Abstract not available
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Pharmacologic Pain Management: What Radiation Oncologists Should Know Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-03-27 Lara Michal Skarf, Katie Fitzgerald Jones, Jordana L. Meyerson, Janet L. Abrahm
Individuals with cancer experience a host of symptoms, especially when the malignancy is advanced. Pain occurs from the cancer itself or related treatments. Undertreated pain contributes to patient suffering and lack of engagement in cancer-directed therapies. Adequate pain management includes thorough assessment; treatment by radiotherapists or anesthesia pain specialists; anti-inflammatory medications
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Prognostication for Patients Receiving Palliative Radiation Therapy Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-03-27 Susan Sun, Monica Krishnan, Sara Alcorn
Estimation of patient prognosis plays a central role in guiding decision making for the palliative management of metastatic disease, and a number of statistical models have been developed to provide survival estimates for patients in this context. In this review, we discuss several well-validated survival prediction models for patients receiving palliative radiotherapy to sites outside of the brain
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Precision Radiation for Brain Metastases With a Focus on Hypofractionated Stereotactic Radiosurgery Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-03-27 Kevin Shiue, Arjun Sahgal, Simon S. Lo
There are multiple published randomized controlled trials supporting single-fraction stereotactic radiosurgery (SF-SRS) for patients presenting with 1 to 4 brain metastases, with the benefit of minimizing radiation-induced neurocognitive sequelae as compared to whole brain radiotherapy . More recently, the dogma of SF-SRS as the only means of delivering an SRS treatment has been challenged by hypofractionated
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Brain Metastases: Is There Still a Role for Whole-Brain Radiation Therapy? Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-03-27 Carsten Nieder, Nicolaus H. Andratschke, Anca L. Grosu
Whole-brain radiation therapy (WBRT) has commonly been prescribed to palliate symptoms from brain metastases, to reduce the risk of local relapse after surgical resection, and to improve distant brain control after resection or radiosurgery. While targeting micrometastases throughout the brain can be considered advantageous, the simultaneous exposure of healthy brain tissue might cause adverse events
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Radiation Therapy for Painful Bone Metastases: Fractionation, Recalcification, and Symptom Control Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-03-27 Yolanda D. Tseng
Bone is a common site for metastases, which may cause pain and other skeletal-related events (SRE) in patients with advanced cancer. Since the 1980s, prospective clinical trials have demonstrated the high efficacy of external beam radiotherapy (EBRT) for pain relief from focal, symptomatic lesions. In uncomplicated bone metastases, which include those without pathologic fracture, evidence of cord compression
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Personalization of Radiation Therapy in the Primary Treatment of Malignant Epidural Spinal Cord Compression (MESCC) Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-03-27 Dirk Rades, Steven E. Schild
“True” malignant epidural spinal cord compression (MESCC) is used here to describe a lesion compressing of infiltrating the spinal cord associated with neurologic deficits. Radiotherapy alone is the most common treatment, for which several dose-fractionation regimens are available including single-fraction, short-course and longer-course regimens. Since these regimens are similarly effective regarding
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Stereotactic Body Radiation Therapy for Spinal Metastases: Benefits and Limitations Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-03-27 Matthias Guckenberger, Max Dahele, Wee Loon Ong, Arjun Sahgal
Progress in biological cancer characterization, targeted systemic therapies and multimodality treatment strategies have shifted the goals of radiotherapy for spinal metastases from short-term palliation to long-term symptom control and prevention of compilations. This article gives an overview of the spine stereotactic body radiotherapy (SBRT) methodology and clinical results of SBRT in cancer patients
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Radiation Therapy at the End of-Life: Quality of Life and Financial Toxicity Considerations Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-03-27 Divya Yerramilli, Candice A. Johnstone
In patients with advanced cancer, radiation therapy is considered at various time points in the patient's clinical course from diagnosis to death. As some patients are living longer with metastatic cancer on novel therapeutics, radiation oncologists are increasingly using radiation therapy as an ablative therapy in appropriately selected patients. However, most patients with metastatic cancer still
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Palliative Care Delivery Systems and Integration With Palliative Care Teams Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2023-03-27 Michelle Iocolano, Alyssa Langi, Kavita V. Dharmarajan, Joshua Jones
Radiotherapy (RT) plays a critical role in the palliation of symptoms in patients with advanced or metastatic cancer. To address the growing need for these services, multiple dedicated palliative RT programs have been established. This article serves to highlight the novel ways in which palliative RT delivery systems support patients with advanced cancer. Through early integration of multidisciplinary
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The Many Faces of Muscle-Invasive Bladder Cancer: Histopathological and Molecular Characterization Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2022-12-13 Brian Mau, Burles Johnson, Donna E. Hansel, David J. McConkey
Abstract not available
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Seeing is Believing: State of the Art Imaging of Bladder Cancer Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2022-12-13 Emanuele Messina, Martina Pecoraro, Martina Lucia Pisciotti, Francesco Del Giudice, Sara Lucciola, Marco Bicchetti, Ludovica Laschena, Michela Roberto, Ettore De Berardinis, Giorgio Franco, Valeria Panebianco
Imaging plays an important role in bladder cancer (BCa) diagnostic work-up. Ultrasound achieves an intermediate sensitivity in detecting urinary tract alterations and is considered a suboptimal imaging technique in diagnosis of BCa. CT urography accurately detects BCa in patients presenting with hematuria Multiparametric MRI achieves a very high rate of BCa detection and helps with accurate staging
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Myths About Bladder Preservation in Muscle-Invasive Bladder Cancer Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2022-12-13 Thiraviyam Elumalai, Nuradh Joseph, Ananya Choudhury
Radical cystectomy is long considered as the "gold standard" in the management of localized muscle-invasive bladder cancer (MIBC), and curative intent radiotherapy is relegated to those with either inoperable tumors or with multiple co-morbidities precluding surgery. This is despite a large volume of data showing equal survival between the two modalities of treatment in this setting. In this work we
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The Emerging Evidence Supporting Integration of Deep Regional Hyperthermia With Chemoradiation in Bladder Cancer Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2022-12-13 Oliver J. Ott, Udo S. Gaipl, Allison Lamrani, Rainer Fietkau
For decades, the antineoplastic potential of hyperthermia alone or in combination with radiotherapy and/or chemotherapy has been subject of intensive preclinical and clinical research in various tumor entities. The clinical evidence on the beneficial effects of additional hyperthermia in combination with intravesical Mitomycin C for superficial non-muscle-invasive bladder cancer as well as for deep
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Pushing the Envelope: The Role of Radiation Therapy in Non-muscle-Invasive Bladder Cancer Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2022-12-13 Sri Harsha Kombathula, Peter Hoskin
The standard of care for non-muscle-invasive bladder cancer (NMIBC) is transurethral resection followed by risk stratified use of intravesical immune- or chemotherapy and for multifocal, recurrent and high grade disease, radical cystectomy with high rates of cure. Bladder preservation analogous to the trimodality therapy approach in muscle-invasive bladder cancer (MIBC) has not been adequately explored
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The Legacy of RTOG/NRG Protocols in Shaping Current Bladder Preservation Therapy in North America Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2022-12-13 Sophia C. Kamran, Jason A. Efstathiou
For muscle-invasive bladder cancer, the historical, gold standard treatment was radical cystectomy. However, the notion of organ preservation using trimodality therapy (TMT, consisting of maximal transurethral resection of bladder tumor followed by chemoradiation) has been established as a viable treatment alternative to complete removal of the bladder. Despite the lack of direct head-to-head randomized
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Multidisciplinary Management and Radiotherapy Recommendations for Clinically and Pathologically Node-positive Bladder Cancer Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2022-12-13 BhanuPrasad Venkatesulu, Stanley L. Liauw, Monika Joshi, Brian C. Baumann, Ryan Yoo, Morgan Roupret, Ananya Choudhury, Jason A. Efstathiou, Vedang Murthy, Paul Sargos, Abhishek A. Solanki
There are limited data regarding the optimal management of patients with pelvic node-positive, but non-metastatic, bladder cancer. Increasing data demonstrate that this is a distinct clinical entity with outcomes bridging between bladder-confined muscle-invasive bladder cancer and metastatic advanced bladder cancer. Guidelines and staging systems have formalized the need to incorporate the unique considerations
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The Role of Neoadjuvant Chemotherapy in Bladder Preservation Approaches in Muscle-Invasive Bladder Cancer Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2022-12-13 Carlos Stecca, Timur Mitin, Srikala S. Sridhar
Neoadjuvant chemotherapy (NAC), which aims to eliminate micrometastatic disease, has been established as the standard of care for patients with muscle-invasive bladder cancer (MIBC) undergoing radical cystectomy (RC). This is based on randomized controlled trials showing a survival benefit of NAC prior to RC compared to RC alone. It was anticipated that a similar survival benefit would also be seen
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Bladder Preservation for Muscle-Invasive Bladder Cancer With Variant Histology Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2022-12-13 Andrew Brocklehurst, Mohini Varughese, Alison Birtle
A growing body of evidence has shown bladder-preservation with chemo-radiotherapy achieves comparable survival to Radical Cystectomy (5-year OS 50%-70%) and superior quality of life outcomes for patients with muscle-invasive urothelial carcinoma of the bladder (UC). However, up to 55% of patients harbor variant histology and in this review we aim to clarify the role of bladder-preservation for this
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Bladder Cancer Radiation Oncology of the Future: Prognostic Modelling, Radiomics, and Treatment Planning With Artificial Intelligence Semin. Radiat. Oncol. (IF 3.5) Pub Date : 2022-12-13 Nicholas S. Moore, Alan McWilliam, Sanjay Aneja
Machine learning (ML) and artificial intelligence (AI) have demonstrated potential to improve the care of radiation oncology patients. Here we review recent advances applicable to the care of bladder cancer, with an eye towards studies that may suggest next steps in clinical implementation. Algorithms have been applied to clinical records, pathology, and radiology data to generate accurate predictive