Browsing by UMass Chan Affiliation "Imaging and Radiation Oncology Core (IROC)"

Now showing items 1-3 of 3

    • Local Control For High-Grade Nonrhabdomyosarcoma Soft Tissue Sarcoma Assigned to Radiation Therapy on ARST0332: A Report From the Childrens Oncology Group
      Million, Lynn; Laurie, Frances; Morano, Karen; FitzGerald, Thomas J. (2021-02-03)
      PURPOSE: The ARST0332 trial for pediatric and young adults with nonrhabdomyosarcoma soft tissue sarcoma (NRSTS) used risk-based treatment including primary resection with lower-than-standard radiation doses to optimize local control (LC) while minimizing long-term toxicity in those requiring radiation therapy (RT). RT for high-grade NRSTS was based on extent of resection (R0: negative margins, R1: microscopic margins, R2/U: gross disease/unresectable); those with > 5 cm tumors received chemotherapy (CT; ifosfamide/doxorubicin). This analysis evaluates LC for patients assigned to RT and prognostic factors associated with local recurrence (LR). METHODS AND MATERIALS: Patients aged < 30 years with high-grade NRSTS received RT (55.8 Gy) for R1 < /=5 cm tumor (arm B); RT (55.8 Gy)/CT for R0/R1 > 5 cm tumor (arm C); or neoadjuvant RT (45 Gy)/CT plus delayed surgery, CT, and postoperative boost to 10.8 Gy R0 < 5 mm margins/R1 or 19.8 Gy for R2/unresected tumors (arm D). RESULTS: One hundred ninety-three eligible patients had 24 LRs (arm B 1/15 [6.7%], arm C 7/65 [10.8%], arm D 16/113 [14.2%]) at median time to LR of 1.1 years (range, 0.11-5.27). Of 95 eligible for delayed surgery after neoadjuvant therapy, 89 (93.7%) achieved R0/R1 margins. Overall LC after RT were as follows: R0, 106 of 109 (97%); R1, 51 of 60 (85%); and R2/unresectable, 2 of 6 (33%). LR predictors include extent of delayed resection (P < .001), imaging response before delayed surgery (P < .001), histologic subtype (P < .001), and no RT (P = .046). The 5-year event-free survival was significantly lower (P = .0003) for patients unable to undergo R0/R1 resection. CONCLUSIONS: Risk-based treatment for young patients with high-grade NRSTS treated on ARST0332 produced very high LC, particularly after R0 resection (97%), despite lower-than-standard RT doses. Neoadjuvant CT/RT enabled delayed R0/R1 resection in most patients and is preferred over adjuvant therapy due to the lower RT dose delivered.

    • The Children's Oncology Group Radiation Oncology Discipline: 15 Years of Contributions to the Treatment of Childhood Cancer
      Breneman, John C.; Ulin, Kenneth (2018-07-15)
      PURPOSE: Our aim was to review the advances in radiation therapy for the management of pediatric cancers made by the Children's Oncology Group (COG) radiation oncology discipline since its inception in 2000. METHODS AND MATERIALS: The various radiation oncology disease site leaders reviewed the contributions and advances in pediatric oncology made through the work of the COG. They have presented outcomes of relevant studies and summarized current treatment policies developed by consensus from experts in the field. RESULTS: The indications and techniques for pediatric radiation therapy have evolved considerably over the years for virtually all pediatric tumor types, resulting in improved cure rates together with the potential for decreased treatment-related morbidity and mortality. CONCLUSIONS: The COG radiation oncology discipline has made significant contributions toward the treatment of childhood cancer. Our discipline is committed to continuing research to refine and modernize the use of radiation therapy in current and future protocols with the goal of further improving the cure rates and quality of life of children with cancer.

    • The Influence of Imaging in the Modern Practice of Radiation Oncology
      Fitzgerald, Thomas J.; Rosen, Mark A.; Bishop-Jodoin, Maryann (2018-11-15)
      The current practice of radiation oncology now requires a strong relationship with all radiology subspecialists and is embedded with a variety of imaging modalities and formats for both treatment planning and treatment execution. Unlike technology in the past, modern treatment technology delivery systems include kilovoltage imaging and cone beam computed tomography–guided treatment systems for daily patient treatment reproducibility. Today's radiation planning tools include 4-dimensional motion management and fusion software that can routinely blend anatomic and metabolic imaging for target volume definition. Imaging tools are used daily for each patient by all members of a modern radiation oncology department. As imaging tools improve and can be successfully registered with radiation planning imaging, targets will be further refined and patient-specific treatment planning optimized with confidence that the target is reproduced correctly every treatment day. Imaging has become symbiotic with all elements of daily practice, and application of emerging imaging tools will be an essential component of modern radiation oncology clinical translational research for the next generation of clinical trial investigators.