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Article ; Online: Discovery of increased number or interval growth of brain metastases on same-day GammaKnife™ planning MRI: Predicting factors and patient outcomes.

Mereniuk, Todd R / Burney, Heather N / Lautenschlaeger, Tim / Watson, Gordon A / Rhome, Ryan M

Journal of radiosurgery and SBRT

2023 Volume 8, Issue 3, Page(s) 189–199

Abstract: Purpose: To determine factors associated with increased risk of finding new and/or enlarged brain metastases (BM) on GammaKnife™ (GK) MRI and their impact on patient outcomes.: Results: 43.9% of patients showed BM growth, 32.9% had additional brain ... ...

Abstract	Purpose: To determine factors associated with increased risk of finding new and/or enlarged brain metastases (BM) on GammaKnife™ (GK) MRI and their impact on patient outcomes. Results: 43.9% of patients showed BM growth, 32.9% had additional brain metastases (aBM), and 18.1 % had both. Initial brain metastasis velocity (iBMV) was associated with finding aBM. Time between diagnostic MRI (dMRI) and GK MRI was associated with interval growth and each day increased this risk by 2%. Prior brain metastasectomy and greater time between either dMRI or latest extracranial RT and GK MRI predicted both aBM and BM growth. aBM and/or BM growth led to management change in 1.8% of cases and were not associated with OS or incidence of distant intracranial failure. Conclusions: Number of metastases seen on dMRI and iBMV predicted both aBM and/or BM growth, however, these factors did not significantly affect survival or incidence of distant intracranial failure.
Language	English
Publishing date	2023-02-13
Publishing country	United States
Document type	Journal Article
ISSN	2156-4647
ISSN (online)	2156-4647
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Article: Patient characteristics and clinical factors affecting lumpectomy cavity volume: implications for partial breast irradiation.

Le, Amy / Achiko, Flora Amy / Boyd, LaKeisha / Shan, Mu / Zellars, Richard C / Rhome, Ryan M

Frontiers in oncology

2023 Volume 13, Page(s) 1118713

Abstract: Introduction: Partial breast irradiation (PBI) has increased in utilization, with the postoperative lumpectomy cavity and clips used to guide target volumes. The ideal timing to perform computed tomography (CT)-based treatment planning for this ... ...

Abstract	Introduction: Partial breast irradiation (PBI) has increased in utilization, with the postoperative lumpectomy cavity and clips used to guide target volumes. The ideal timing to perform computed tomography (CT)-based treatment planning for this technique is unclear. Prior studies have examined change in volume over time from surgery but not the effect of patient characteristics on lumpectomy cavity volume. We sought to investigate patient and clinical factors that may contribute to larger postsurgical lumpectomy cavities and therefore predict for larger PBI volumes. Methods: A total of 351 consecutive women with invasive or Results: Median age was 61.0 years (range, 30-91), 23.9% of patients were Black people, 52.1% had hypertension, the median body mass index (BMI) was 30.4 kg/m², 11.4% received neoadjuvant chemotherapy, 32.5% were treated prone, mean interval from surgery to CT simulation was 54.1 days ± 45.9, and mean lumpectomy cavity volume was 42.2 cm Discussion: These data may be used to select patients for which longer time to simulation may result in smaller lumpectomy cavity volumes and therefore smaller PBI target volumes. Racial disparity in cavity size is not explained by known confounders and may reflect unmeasured systemic determinants of health. Larger datasets and prospective evaluation would be ideal to confirm these hypotheses.
Language	English
Publishing date	2023-05-23
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2649216-7
ISSN	2234-943X
ISSN	2234-943X
DOI	10.3389/fonc.2023.1118713
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Article: Concurrent chemotherapy with partial breast irradiation in triple negative breast cancer patients may improve disease control compared with sequential therapy.

Rhome, Ryan / Wright, Jean / De Souza Lawrence, Lana / Stearns, Vered / Wolff, Antonio / Zellars, Richard

Frontiers in oncology

2023 Volume 13, Page(s) 1146754

Abstract: Purpose: To report outcomes on a subset of patients with triple negative breast cancer (TNBC) treated on prospective trials with post-lumpectomy partial breast irradiation and concurrent chemotherapy (PBICC) and compare them to a retrospectively ... ...

Abstract	Purpose: To report outcomes on a subset of patients with triple negative breast cancer (TNBC) treated on prospective trials with post-lumpectomy partial breast irradiation and concurrent chemotherapy (PBICC) and compare them to a retrospectively assessed similar cohort treated with whole breast irradiation after adjuvant chemotherapy (WBIaC). Methods and materials: Women with T1-2, N0-1 invasive breast cancer with ≥ 2mm lumpectomy margins were offered therapy on one of two PBICC trials. PBI consisted of 40.5 Gy in 15 daily 2.7 Gy fractions delivered concurrently with the first 2 cycles of adjuvant chemotherapy. The comparison cohort received WBI to a median dose of 60.7 Gy, (including boost, range 42.5 - 66 Gy), after completion of non-concurrent, adjuvant chemotherapy. We evaluated disease-free survival (DFS), and local/loco-regional/distant recurrence-free survival (RFS). We compared survival rates using Kaplan-Meier curves and log-rank test of statistical significance. Results: Nineteen patients with TNBC were treated with PBICC on prospective protocol, and 49 received WBIaC. At a median follow-up of 35.5 months (range 4.8-71.9), we observed no deaths in the PBICC cohort and 2 deaths in the WBIaC cohort (one from disease recurrence). With a median time of 23.4 (range 4.8 to 47) months, there were 7 recurrences (1 nodal, 4 local, 4 distant), all in the WBIaC group. At 5 years, there was a trend towards increased local RFS (100% vs. 85.4%, Conclusion: This study suggests that PBICC may offer similar and possibly better outcomes in patients with TNBC compared to a retrospective cohort treated with WBIaC. This observation is hypothesis-generating for prospective trials.
Language	English
Publishing date	2023-07-12
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2649216-7
ISSN	2234-943X
ISSN	2234-943X
DOI	10.3389/fonc.2023.1146754
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Article: Clinical and Preclinical Outcomes of Combining Targeted Therapy With Radiotherapy.

Elbanna, May / Chowdhury, Nayela N / Rhome, Ryan / Fishel, Melissa L

Frontiers in oncology

2021 Volume 11, Page(s) 749496

Abstract: In the era of precision medicine, radiation medicine is currently focused on the precise delivery of highly conformal radiation treatments. However, the tremendous developments in targeted therapy are yet to fulfill their full promise and arguably have ... ...

Abstract	In the era of precision medicine, radiation medicine is currently focused on the precise delivery of highly conformal radiation treatments. However, the tremendous developments in targeted therapy are yet to fulfill their full promise and arguably have the potential to dramatically enhance the radiation therapeutic ratio. The increased ability to molecularly profile tumors both at diagnosis and at relapse and the co-incident progress in the field of radiogenomics could potentially pave the way for a more personalized approach to radiation treatment in contrast to the current ''one size fits all'' paradigm. Few clinical trials to date have shown an improved clinical outcome when combining targeted agents with radiation therapy, however, most have failed to show benefit, which is arguably due to limited preclinical data. Several key molecular pathways could theoretically enhance therapeutic effect of radiation when rationally targeted either by directly enhancing tumor cell kill or indirectly through the abscopal effect of radiation when combined with novel immunotherapies. The timing of combining molecular targeted therapy with radiation is also important to determine and could greatly affect the outcome depending on which pathway is being inhibited.
Language	English
Publishing date	2021-10-18
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2649216-7
ISSN	2234-943X
ISSN	2234-943X
DOI	10.3389/fonc.2021.749496
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Article ; Online: Radiation oncology crossword: breast cancer.

McClelland, Shearwood / Rhome, Ryan M / Zellars, Richard C

Breast cancer research and treatment

2019 Volume 177, Issue 1, Page(s) 225–230

Language	English
Publishing date	2019-06-01
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/s10549-019-05304-x
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Article: Analysis of Retrospective Versus Prospective Peer Review in a Multisite Academic Radiation Department.

Shiue, Kevin R / Agrawal, Namita / Rhome, Ryan M / DesRosiers, Colleen M / Hutchins, Karen M / Zellars, Richard C / Watson, Gordon A / Holmes, Jordan A

Advances in radiation oncology

2023 Volume 9, Issue 2, Page(s) 101333

Abstract: Purpose: Our multisite academic radiation department reviewed our experience with transitioning from weekly primarily retrospective to daily primarily prospective peer review to improve plan quality and decrease the rate of plan revisions after ... ...

Abstract	Purpose: Our multisite academic radiation department reviewed our experience with transitioning from weekly primarily retrospective to daily primarily prospective peer review to improve plan quality and decrease the rate of plan revisions after treatment start. Methods and materials: This study was an institutional review board-approved prospective comparison of radiation treatment plan review outcomes of plans reviewed weekly (majority within 1 week after treatment start) versus plans reviewed daily (majority before treatment start, except brachytherapy, frame-based radiosurgery, and some emergent plans). Deviations were based on peer comments and considered major if plan revisions were recommended before the next fraction and minor if modifications were suggested but not required. Categorical variables were compared using χ Results: In all, 798 patients with 1124 plans were reviewed: 611 plans weekly and 513 plans daily. Overall, 76 deviations (6.8%) were noted. Rates of any deviation were increased in the daily era (8.6% vs 5.2%; Conclusions: Daily prospective peer review is feasible in a multisite academic setting. Daily peer review with emphasis on prospective plan evaluation increased constructive plan feedback, plan revisions, and plan revisions being implemented before treatment start.
Language	English
Publishing date	2023-08-09
Publishing country	United States
Document type	Journal Article
ISSN	2452-1094
ISSN	2452-1094
DOI	10.1016/j.adro.2023.101333
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Article ; Online: Predictors of Whole Breast Radiation Therapy Completion in Early Stage Breast Cancer Following Lumpectomy.

McClelland, Shearwood / Burney, Heather N / Zellars, Richard C / Ohri, Nisha / Rhome, Ryan M

Clinical breast cancer

2020 Volume 20, Issue 6, Page(s) 469–479

Abstract: Background: Whole breast radiation therapy (RT) has become standard of care in early stage breast cancer treatment following lumpectomy. Predictors of RT completion have been sparsely studied, with no previous nationwide examination of the impact of ... ...

Abstract	Background: Whole breast radiation therapy (RT) has become standard of care in early stage breast cancer treatment following lumpectomy. Predictors of RT completion have been sparsely studied, with no previous nationwide examination of the impact of fractionation regimen on completion rate. Patients and methods: The National Cancer Database identified patients with early stage breast cancer having undergone lumpectomy and RT from 2004 through 2015. Fraction size of 1.8-2.0 Gray (Gy) was defined as standard fractionation (SFRT); 2.66-2.70 Gy/fraction as hypofractionation (HFRT). RT completion was defined as receipt of at least 46 Gy for SFRT and 40 Gy for HFRT. A multivariable logistic regression model characterized RT completion predictors. Results: A total of 100,734 patients were identified where fraction size could be reliably characterized as above; more than 87% completed RT. Of these, 66.8% received SFRT, yet HFRT use significantly increased over time (5.2% increase/year; P < .0001). RT completion rates were significantly greater following HFRT (99.3%) versus SFRT (79.7%); patients receiving SFRT had higher odds of not completing RT (odds ratio, 41.5; 95% confidence interval, 36.6-47.1; P < .0001). Multivariable analysis revealed that African-American and Caucasian patients treated with SFRT versus HFRT had 22 and 43 times the odds of not completing RT, respectively (P < .0001). Conclusions: SFRT remained the majority of RT fractionation in the studied time period, although HFRT use has increased over time. Patients residing > 10 miles from a treatment facility or of African-American race had lower odds of completing RT, as were patients treated with SFRT versus HFRT. These findings suggest compliance advantages of HFRT for patients with early stage breast cancer having undergone lumpectomy.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Breast/pathology ; Breast/radiation effects ; Breast/surgery ; Breast Neoplasms/diagnosis ; Breast Neoplasms/pathology ; Breast Neoplasms/therapy ; Female ; Humans ; Mastectomy, Segmental ; Middle Aged ; Neoplasm Staging ; Patient Compliance/statistics & numerical data ; Radiation Dose Hypofractionation/standards ; Radiotherapy, Adjuvant/standards ; Radiotherapy, Adjuvant/statistics & numerical data ; Registries/statistics & numerical data ; Retrospective Studies ; United States ; Young Adult
Language	English
Publishing date	2020-06-27
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2106734-X
ISSN	1938-0666 ; 1526-8209
ISSN (online)	1938-0666
ISSN	1526-8209
DOI	10.1016/j.clbc.2020.06.006
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Article ; Online: Stage-matched survival differences by ethnicity among gastric cancer patients of Asian ancestry treated in the United States.

Rhome, Ryan M / Ru, Meng / Moshier, Erin / Mazumdar, Madhu / Buckstein, Michael H

Journal of surgical oncology

2019 Volume 119, Issue 6, Page(s) 737–748

Abstract: Background: Differences have been noted in overall survival (OS) in gastric cancer (GC) between trials conducted in Western vs Asian countries. The National Cancer Database (NCDB) reports outcomes and patient/disease variables relevant to OS.: Methods! ...

Abstract	Background: Differences have been noted in overall survival (OS) in gastric cancer (GC) between trials conducted in Western vs Asian countries. The National Cancer Database (NCDB) reports outcomes and patient/disease variables relevant to OS. Methods: Using NCDB, we identified 89 558 adult patients with GC diagnosed (2004-2012), where self-reported race/ethnicity was available. Cox proportional hazard model was used to calculate multivariable hazard ratio (HR) of death, adjusting for race/ethnicity, age, gender, insurance, histology, grade, location, stage, and treatment type. Results: After adjustment, Asian patients had improved OS (HR = 0.74, 95% confidence intervals [CI] = 0.71-0.77). There were differences in OS between Asian ethnicities compared with white patients (n = 69 945), notably with Korean (n = 1249, HR = 0.70, 95% CI = 0.64-0.75), Chinese (n = 1271, HR = 0.69, 95% CI = 0.64-0.75), and Indian/Pakistani patients (n = 492, HR = 0.68, 95% CI = 0.61-0.76). Japanese (n = 829, HR = 0.84, 95% CI = 0.77-0.91) and Vietnamese (n = 560, HR = 0.79, 95% CI = 0.71-0.88) OS was also improved (P < 0.0001), while Filipino patients showed no difference (n = 415, HR = 1.00). Black patients had slightly improved OS (n = 13 500, HR = 0.98, 95% CI = 0.95-1.00, P = 0.035). Conclusions: This analysis supports improved OS in Asian patients independent of stage, treatment, and known patient or disease characteristics in this large US cohort, and is the largest to define OS differences between Asian ethnicities.
MeSH term(s)	Adenocarcinoma/mortality ; Adenocarcinoma/pathology ; African Continental Ancestry Group/statistics & numerical data ; Asian Americans/statistics & numerical data ; Carcinoma, Squamous Cell/mortality ; Carcinoma, Squamous Cell/pathology ; Databases, Factual ; European Continental Ancestry Group/statistics & numerical data ; Female ; Humans ; Male ; Middle Aged ; Proportional Hazards Models ; Stomach Neoplasms/mortality ; Stomach Neoplasms/pathology ; United States/epidemiology
Language	English
Publishing date	2019-01-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	82063-5
ISSN	1096-9098 ; 0022-4790
ISSN (online)	1096-9098
ISSN	0022-4790
DOI	10.1002/jso.25389
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Article: Long-term outcomes of acromegaly treated with fractionated stereotactic radiation: case series and literature review.

Rhome, Ryan / Germano, Isabelle M / Sheu, Ren-Dih / Green, Sheryl

Neuro-oncology practice

2017 Volume 4, Issue 4, Page(s) 255–262

Abstract: Background: Growth hormone (GH)-secreting pituitary adenomas represent an uncommon subset of pituitary neoplasms. Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) have been used as primary or adjuvant treatment. The ... ...

Abstract	Background: Growth hormone (GH)-secreting pituitary adenomas represent an uncommon subset of pituitary neoplasms. Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) have been used as primary or adjuvant treatment. The purpose of this study is to report the long-term tumor control and toxicity from our institution and to perform a systematic literature review of acromegaly patients treated with FSRT. Methods: We retrospectively reviewed all patients treated with FSRT (median dose 50.4 Gray [Gy], range 50.4-54 Gy) between 2005 and 2012 who had: 1) GH-secreting adenoma with persistently elevated insulin growth factor-1 (IGF-1) despite medical therapy and 2) clinical follow up >3 years after FSRT. Patients were treated with modern FSRT planning techniques. Biochemical control was defined as IGF-1 normalization. Systematic review of the literature was performed for FSRT in acromegaly. Results: With a median follow-up of 80 months, radiographic control was achieved in all 11 patients and overall survival was 100%. Long-term biochemical control was achieved in 10 patients (90.9%) with either FSRT alone (36.4%) or FSRT with continued medical management (45.5%). No patient experienced new hypopituitarism, cranial nerve dysfunctions, or visual deficits. Our systematic review found published rates of biochemical control and hypopituitarism vary, with uniformly good radiographic control and low incidence of visual changes. Conclusions: Adjuvant FSRT offered effective long-term biochemical control and radiographic control, and there was a lower rate of complications in this current series. Review of the literature shows variations in published rates of biochemical control after FSRT for acromegaly, but low incidence of serious toxicities.
Language	English
Publishing date	2017-03-31
Publishing country	England
Document type	Journal Article
ZDB-ID	2768945-1
ISSN	2054-2585 ; 2054-2577
ISSN (online)	2054-2585
ISSN	2054-2577
DOI	10.1093/nop/npx002
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Article ; Online: Prostate-specific antigen doubling time is a significant predictor of overall and disease-free survival in patients with prostate adenocarcinoma treated with brachytherapy.

Resende Salgado, Lucas / Rhome, Ryan / Oh, William / Stone, Nelson / Stock, Richard

Brachytherapy

2018 Volume 17, Issue 6, Page(s) 874–881

Abstract: Purpose: Recently, new approaches have been implemented in treating patients with newly diagnosed metastatic prostate cancer (PCa). An interesting area of study is to determine which risk factors may be used as predictors of more aggressive PCa behavior ...

Abstract	Purpose: Recently, new approaches have been implemented in treating patients with newly diagnosed metastatic prostate cancer (PCa). An interesting area of study is to determine which risk factors may be used as predictors of more aggressive PCa behavior in patients with biochemical failure. The aim of this study was to determine prognostic factors in patients with prostate-specific antigen (PSA) failure after undergoing brachytherapy. Methods and materials: Between 1990 and 2015, 2771 patients with localized PCa underwent treatment at our institution treated by a single radiation oncologist with low-dose-rate brachytherapy as a component of definitive radiation therapy. Disease-specific survival (DSS), distant metastases (DM), and overall survival were calculated by the Kaplan-Meier method. Multivariable Cox regression analysis was also performed. Results: In this group, 2126 patients (89%) had no evidence of PSA failure. Of the 251 of patients that did have biochemical failure, 115 (45.8%), 58 (23.1%), 78 (31.1%) had a PSA doubling time (PSADT) of <6 months, 6-12 months, and >12 months, respectively. Doubling time was associated with a statistically significant impact on DSS and DM but not overall survival, which appears to be dominated by initial age at diagnosis as well as stage. Conclusions: We have shown here that PSADT predicts for DSS and freedom from DM in our large prospectively followed cohort. Given the variable trajectory of metastatic and recurrent PCa, strong prognostic factors such as PSADT may be able to select a group of patients who benefit from earlier or escalated systemic therapies such as androgen deprivation or cytotoxic chemotherapy.
MeSH term(s)	Adenocarcinoma/blood ; Adenocarcinoma/mortality ; Adenocarcinoma/radiotherapy ; Adult ; Aged ; Aged, 80 and over ; Biomarkers, Tumor/blood ; Brachytherapy/adverse effects ; Brachytherapy/methods ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local/epidemiology ; Prognosis ; Prospective Studies ; Prostate-Specific Antigen/analysis ; Prostatic Neoplasms/blood ; Prostatic Neoplasms/mortality ; Prostatic Neoplasms/radiotherapy ; Risk Factors ; Survival Analysis ; Treatment Failure
Chemical Substances	Biomarkers, Tumor ; Prostate-Specific Antigen (EC 3.4.21.77)
Language	English
Publishing date	2018-07-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	2098608-7
ISSN	1873-1449 ; 1538-4721
ISSN (online)	1873-1449
ISSN	1538-4721
DOI	10.1016/j.brachy.2018.07.008
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