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Article ; Online: Are 5-Year Randomized Clinical Trial Results Sufficient for Implementation of Short-Course Whole Breast Radiation Therapy?

Gillespie, Erin F / Khan, Atif J / Cahlon, Oren / Braunstein, Lior Z

2021 Volume 11, Issue 5, Page(s) 301–304

MeSH term(s)	Female ; Humans ; Breast/radiation effects ; Breast/surgery ; Breast Neoplasms/therapy ; Mastectomy, Segmental ; Randomized Controlled Trials as Topic
Language	English
Publishing date	2021-09-03
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2655748-4
ISSN	1879-8519 ; 1879-8500
ISSN (online)	1879-8519
ISSN	1879-8500
DOI	10.1016/j.prro.2021.03.011
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Article ; Online: Cardiac Toxicity: The More We Learn, the Less We Know.

Cahlon, Oren / Khan, Atif J

International journal of radiation oncology, biology, physics

2017 Volume 99, Issue 5, Page(s) 1162–1165

MeSH term(s)	Cardiotoxicity ; Humans ; Learning
Language	English
Publishing date	2017-06-20
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	197614-x
ISSN	1879-355X ; 0360-3016
ISSN (online)	1879-355X
ISSN	0360-3016
DOI	10.1016/j.ijrobp.2017.08.048
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Zs.A 1218: Show issues

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Article ; Online: Potential Morbidity Reduction With Proton Radiation Therapy for Breast Cancer.

Braunstein, Lior Z / Cahlon, Oren

Seminars in radiation oncology

2018 Volume 28, Issue 2, Page(s) 138–149

Abstract: Proton radiotherapy confers significant dosimetric advantages in the treatment of malignancies that arise adjacent to critical radiosensitive structures. To date, these advantages have been most prominent in the treatment of pediatric and central nervous ...

Abstract	Proton radiotherapy confers significant dosimetric advantages in the treatment of malignancies that arise adjacent to critical radiosensitive structures. To date, these advantages have been most prominent in the treatment of pediatric and central nervous system malignancies, although emerging data support the use of protons among other anatomical sites in which radiotherapy plays an important role. With advances in the overall treatment paradigm for breast cancer, most patients with localized disease now exhibit long-term disease control and, consequently, may manifest the late toxicities of aggressive treatment. As a result, there is increasing emphasis on the mitigation of iatrogenic morbidity, with particular attention to heart and lung exposure in those receiving adjuvant radiotherapy. Indeed, recent landmark analyses have demonstrated an increase in significant cardiac events that is linked directly to low-dose radiation to the heart. Coupled with practice-changing trials that have expanded the indications for comprehensive regional nodal irradiation, there exists significant interest in employing novel technologies to mitigate cardiac dose while improving target volume coverage. Proton radiotherapy enjoys distinct physical advantages over photon-based approaches and, in appropriately selected patients, markedly improves both target coverage and normal tissue sparing. Here, we review the dosimetric evidence that underlies the putative benefits of proton radiotherapy, and further synthesize early clinical evidence that supports the efficacy and feasibility of proton radiation in breast cancer. Landmark, prospective randomized trials are underway and will ultimately define the role for protons in the treatment of this disease.
MeSH term(s)	Breast Neoplasms/radiotherapy ; Female ; Heart/radiation effects ; Humans ; Lung/radiation effects ; Organs at Risk/radiation effects ; Proton Therapy/adverse effects ; Proton Therapy/methods ; Radiation Injuries/etiology ; Radiation Injuries/prevention & control ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; Radiotherapy, Adjuvant
Language	English
Publishing date	2018-05-06
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1146999-7
ISSN	1532-9461 ; 1053-4296
ISSN (online)	1532-9461
ISSN	1053-4296
DOI	10.1016/j.semradonc.2017.11.009
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Zs.A 3654: Show issues

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Article: Proton Reirradiation for High-Risk Recurrent or New Primary Breast Cancer.

Chakraborty, Molly A / Khan, Atif J / Cahlon, Oren / Xu, Amy J / Braunstein, Lior Z / Powell, Simon N / Choi, J Isabelle

Cancers

2023 Volume 15, Issue 24

Abstract: Radiotherapy is an integral component of multidisciplinary breast cancer care. Given how commonly radiotherapy is used in the treatment of breast cancer, many patients with recurrences have received previous radiotherapy. Patients with new primary breast ...

Abstract	Radiotherapy is an integral component of multidisciplinary breast cancer care. Given how commonly radiotherapy is used in the treatment of breast cancer, many patients with recurrences have received previous radiotherapy. Patients with new primary breast cancer may also have received previous radiotherapy to the thoracic region. Curative doses and comprehensive field photon reirradiation (reRT) have often been avoided in these patients due to concerns for severe toxicities to organs-at-risk (OARs), such as the heart, lungs, brachial plexus, and soft tissue. However, many patients may benefit from definitive-intent reRT, such as patients with high-risk disease features such as lymph node involvement and dermal/epidermal invasion. Proton therapy is a potentially advantageous treatment option for delivery of reRT due to its lack of exit dose and greater conformality that allow for enhanced non-target tissue sparing of previously irradiated tissues. In this review, we discuss the clinical applications of proton therapy for patients with breast cancer requiring reRT, the currently available literature and how it compares to historical photon reRT outcomes, treatment planning considerations, and questions in this area warranting further study. Given the dosimetric advantages of protons and the data reported to date, proton therapy is a promising option for patients who would benefit from the added locoregional disease control provided by reRT for recurrent or new primary breast cancer.
Language	English
Publishing date	2023-12-06
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers15245722
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Article ; Online: Vital organ sparing with proton therapy for pediatric Hodgkin lymphoma: Toxicity and outcomes in 50 patients.

Tringale, Kathryn R / Modlin, Leslie A / Sine, Kevin / Forlenza, Christopher J / Cahlon, Oren / Wolden, Suzanne L

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology

2022 Volume 168, Page(s) 46–52

Abstract: Background and purpose: With high survival rates for pediatric Hodgkin lymphoma (HL), attention has turned to minimizing treatment-related morbidity and mortality. Chemotherapy and dose of radiation to organs at risk (OARs) contribute to elevated risks ... ...

Abstract	Background and purpose: With high survival rates for pediatric Hodgkin lymphoma (HL), attention has turned to minimizing treatment-related morbidity and mortality. Chemotherapy and dose of radiation to organs at risk (OARs) contribute to elevated risks of secondary malignancy and cardiopulmonary disease. We sought to characterize the radiation dose to OARs, toxicities, and outcomes for pediatric HL patients treated with proton therapy (PT). Materials and methods: Fifty patients aged 11-21 with HL consecutively treated with PT were evaluated 1-2 months following completion of PT and every 6 months thereafter. Acute and late toxicities were captured retrospectively using CTCAE v5. Patterns of relapse were characterized, and survival was assessed using Kaplan-Meier method. Results: Most (47, 94%) patients received PT to the mediastinum. Median mean heart dose was 4.3 Gy (RBE) and median bilateral lung V20Gy was 5.8%. Median integral dose was 1.7 Gy. For the 27 female patients, a median mean dose of 0.4 and 0.3 Gy (RBE) was delivered to ipsilateral and contralateral breast tissue, respectively. No on-treatment grade 3-5 toxicities were seen. At a median follow-up of 5.3 years, no PT-related grade 3-5 toxicities or secondary malignancies developed. Five patients relapsed at a median time of 9.2 months after PT (range 2.5-24.9 months; 5-year recurrence free survival 90%). Recurrences were both in- and out-of-field in all 5 cases with no marginal failures. All relapsed patients were successfully salvaged (5-year overall survival 100%). Conclusion: For pediatric HL patients, proton treatment resulted in marked dose sparing of OARs with low rates of toxicity, no marginal failures, and excellent 5-year survival.
MeSH term(s)	Adolescent ; Adult ; Child ; Female ; Hodgkin Disease/radiotherapy ; Humans ; Neoplasm Recurrence, Local/etiology ; Organs at Risk/pathology ; Proton Therapy/adverse effects ; Proton Therapy/methods ; Radiotherapy Dosage ; Retrospective Studies ; Young Adult
Language	English
Publishing date	2022-01-29
Publishing country	Ireland
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	605646-5
ISSN	1879-0887 ; 0167-8140
ISSN (online)	1879-0887
ISSN	0167-8140
DOI	10.1016/j.radonc.2022.01.016
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Zs.A 1926: Show issues

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Article ; Online: Effectiveness and toxicity of five-fraction prone accelerated partial breast irradiation.

Hardy-Abeloos, Camille / Xiao, Julie / Oh, Cheongeun / Barbee, David / Shah, Bhartesh / Maisonet, Olivier / Perez, Carmen / Adams, Sylvia / Schnabel, Freya / Axelrod, Deborah / Guth, Amber / Karp, Nolan / Cahlon, Oren / Gerber, Naamit

Breast cancer research and treatment

2024 Volume 204, Issue 3, Page(s) 485–495

Abstract: Purpose: Our institution was an early adopter of 5-fraction accelerated partial breast irradiation (ABPI) to treat women with early-stage breast cancer. This study reports long-term oncologic and cosmetic outcomes.: Methods: We included patients ... ...

Abstract	Purpose: Our institution was an early adopter of 5-fraction accelerated partial breast irradiation (ABPI) to treat women with early-stage breast cancer. This study reports long-term oncologic and cosmetic outcomes. Methods: We included patients receiving APBI 600 cGy × 5 fx delivered every other day or every day between 2010 and 2022. Logistic regression models were used to identify factors associated with development of late toxicities, clinician, and patient-rated cosmesis. Kaplan-Meier methodology was used to calculate overall survival (OS), disease-free survival (DFS), and locoregional recurrence-free survival (LR-RFS). Results: 442 patients received APBI either daily (56%) or every other day (44%) in the prone position (92%). At a median follow-up of 48 months (range: 5.96-155 months), 12 (2.7%) patients developed a local recurrence (LR). Out of 258 patients with > 3-month toxicity data available, the most common late grade ≥ 2 adverse event was breast fibrosis (6.2%). On multivariate analysis, daily APBI treatment (vs every other day) did not correlate with an increased risk of any late grade ≥ 2 toxicity though it did correlate with a lower risk of any late grade ≥ 2 fibrosis. Overall, at a median follow-up of 80 months, the rates of good-excellent physician and patient-rated cosmesis were 95% and 85%, respectively, with no difference between patients treated on consecutive vs. every other day. On multivariate analysis, patients who did not receive any adjuvant therapy were at increased risk of developing a LR. Five-year OS, LRFS, and DFS were 97.2%, 97.7%, and 89.5%, respectively. Conclusions: Five-fraction APBI delivered primarily in the prone position either daily or every other day was effective with low rates of local recurrence, minimal toxicity, and excellent cosmesis at long-term follow-up.
MeSH term(s)	Female ; Humans ; Breast Neoplasms/radiotherapy ; Breast Neoplasms/surgery ; Breast Neoplasms/etiology ; Brachytherapy/adverse effects ; Mastectomy, Segmental ; Breast/surgery ; Fibrosis ; Treatment Outcome
Language	English
Publishing date	2024-01-06
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	604563-7
ISSN	1573-7217 ; 0167-6806
ISSN (online)	1573-7217
ISSN	0167-6806
DOI	10.1007/s10549-023-07190-w
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Zs.A 1655: Show issues

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Article ; Online: Radiotherapy in the setting of hypersensitivity syndromes.

Billena, Cole / Khan, Atif J / Cahlon, Oren / Braunstein, Lior Z

The breast journal

2019 Volume 26, Issue 3, Page(s) 588–589

MeSH term(s)	Breast Neoplasms/radiotherapy ; Female ; Humans ; Hypersensitivity ; Radiotherapy/adverse effects ; Syndrome
Language	English
Publishing date	2019-09-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	1289960-4
ISSN	1524-4741 ; 1075-122X
ISSN (online)	1524-4741
ISSN	1075-122X
DOI	10.1111/tbj.13621
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Zs.A 4483: Show issues

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Article ; Online: Radiation Therapy for Hodgkin Lymphoma--Can It Be Administered More Safely if Necessary?

Straus, David J / Cahlon, Oren

JAMA oncology

2016 Volume 2, Issue 2, Page(s) 169–170

MeSH term(s)	Hodgkin Disease/diagnosis ; Hodgkin Disease/radiotherapy ; Humans ; Patient Safety ; Radiation Dosage ; Radiation Injuries/diagnosis ; Radiation Injuries/etiology ; Radiation Injuries/prevention & control ; Radiotherapy, Adjuvant/adverse effects ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome
Language	English
Publishing date	2016-02
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ISSN	2374-2445
ISSN (online)	2374-2445
DOI	10.1001/jamaoncol.2015.4794
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Article ; Online: Novel Inpatient Radiation Oncology Consult Service Model Reduces Hospital Length of Stay.

Xu, Amy J / Yerramilli, Divya / Cahlon, Oren / Powell, Simon N / Yang, Jonathan T / Gomez, Daniel R

JCO oncology practice

2021 Volume 17, Issue 12, Page(s) e1930–e1934

Abstract: Palliative care and radiation therapy have played an expanding role in the management of patients with advanced cancers. Recent advances in our understanding of oligometastatic disease have led to increasing demand for familiarity with ablative ... ...

Abstract	Palliative care and radiation therapy have played an expanding role in the management of patients with advanced cancers. Recent advances in our understanding of oligometastatic disease have led to increasing demand for familiarity with ablative techniques. Recognizing the demands of hospitalized patients for rapid access to care, we created an inpatient radiation oncology consult service (IROC) with consolidated expertise in palliative radiation and ablative techniques. In this quality improvement cohort study, we analyzed inpatient radiation oncology consults placed before and after IROC implementation and found that IROC led to increased delivery of specialty care and decreased hospital length of stay (median 8 days
MeSH term(s)	Cohort Studies ; Hospitals ; Humans ; Inpatients ; Length of Stay ; Radiation Oncology
Language	English
Publishing date	2021-03-31
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	3028198-2
ISSN	2688-1535 ; 2688-1527
ISSN (online)	2688-1535
ISSN	2688-1527
DOI	10.1200/OP.20.00923
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Article ; Online: Bias in Patient Experience Scores in Radiation Oncology: A Multicenter Retrospective Analysis.

Cha, Elaine / Mathis, Noah J / Joshi, Himanshu / Sharma, Sonam / Zinovoy, Melissa / Ru, Meng / Cahlon, Oren / Gillespie, Erin F / Marshall, Deborah C

Journal of the American College of Radiology : JACR

2022 Volume 19, Issue 4, Page(s) 542–551

Abstract: Purpose: Patient experience scores are increasingly important in measuring quality of care and determining reimbursement from payers, including the Hospital Value-Based Purchasing Program and the Radiation Oncology Model. However, the role of bias in ... ...

Abstract	Purpose: Patient experience scores are increasingly important in measuring quality of care and determining reimbursement from payers, including the Hospital Value-Based Purchasing Program and the Radiation Oncology Model. However, the role of bias in patient experience scores in oncology is unknown, raising the possibility that such payment structures may inadvertently perpetuate bias in reimbursement. Therefore, the authors characterized patient-, physician-, and practice-level predictors of patient experience scores in patients undergoing radiation therapy. Methods: The authors retrospectively reviewed patient experience surveys for radiation oncology patients treated at two large multisite academic cancer centers. The outcome was responses on four survey questions. Covariates included self-reported patient demographics, physician characteristics, practice setting characteristics, and wait-time rating linked to each survey. Multivariable ordinal regression models were fitted to identify predictors of receiving a higher score on each of the survey questions. Results: In total, 2,868 patients completed surveys and were included in the analysis. Patient experience scores were generally high, with >90% of respondents answering 5 of 5 on the four survey items. Physician gender was not associated with any measured patient experience outcomes (P > 0.40 for all). Independent predictors of higher score included a wait-time experience classified as "good" compared with "not good" (q < .001 for all). Conclusions: Oncology practices aiming to improve patient experience scores may wish to focus their attention on improving wait times for patients. Although a difference in patient experience scores on the basis of physician gender was not observed, such bias is likely to be complex, and further research is needed to characterize its effects.
MeSH term(s)	Humans ; Patient Outcome Assessment ; Patient Satisfaction ; Radiation Oncology ; Retrospective Studies ; Surveys and Questionnaires
Language	English
Publishing date	2022-03-02
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2274861-1
ISSN	1558-349X ; 1546-1440
ISSN (online)	1558-349X
ISSN	1546-1440
DOI	10.1016/j.jacr.2022.01.013
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