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Article ; Online: Use of radiation therapy for patients with soft-tissue and bone sarcomas.

Sheplan, Lawrence J / Juliano, Justin J

2010 Volume 77 Suppl 1, Page(s) S27–9

Abstract: Radiation therapy is recommended as an adjuvant to resection for intermediate- and high-grade soft-tissue sarcomas; its role in bone sarcomas is largely limited to select patients with Ewing sarcoma. Despite the integral role of radiation therapy in soft- ...

Abstract	Radiation therapy is recommended as an adjuvant to resection for intermediate- and high-grade soft-tissue sarcomas; its role in bone sarcomas is largely limited to select patients with Ewing sarcoma. Despite the integral role of radiation therapy in soft-tissue sarcoma management, its optimal timing--preoperative versus postoperative--is uncertain, with each timing scenario having advantages and disadvantages. Preparation for radiation therapy involves a detailed planning session to optimize and standardize patient positioning and determine the target volume. Side effects of radiation therapy may include skin changes, delayed wound healing and other wound complications, fatigue, reduced range of motion of the affected limb, pain, and bone fractures.
MeSH term(s)	Bone Neoplasms/radiotherapy ; Humans ; Osteosarcoma/radiotherapy ; Radiotherapy, Adjuvant ; Sarcoma/radiotherapy ; Soft Tissue Neoplasms/radiotherapy
Language	English
Publishing date	2010-03
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	639116-3
ISSN	1939-2869 ; 0891-1150
ISSN (online)	1939-2869
ISSN	0891-1150
DOI	10.3949/ccjm.77.s1.06
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Article ; Online: Combining prior day contours to improve automated prostate segmentation.

Godley, Andrew / Sheplan Olsen, Lawrence J / Stephans, Kevin / Zhao, Anzi

Medical physics

2013 Volume 40, Issue 2, Page(s) 21722

Abstract: Purpose: To improve the accuracy of automatically segmented prostate, rectum, and bladder contours required for online adaptive therapy. The contouring accuracy on the current image guidance [image guided radiation therapy (IGRT)] scan is improved by ... ...

Abstract	Purpose: To improve the accuracy of automatically segmented prostate, rectum, and bladder contours required for online adaptive therapy. The contouring accuracy on the current image guidance [image guided radiation therapy (IGRT)] scan is improved by combining contours from earlier IGRT scans via the simultaneous truth and performance level estimation (STAPLE) algorithm. Methods: Six IGRT prostate patients treated with daily kilo-voltage (kV) cone-beam CT (CBCT) had their original plan CT and nine CBCTs contoured by the same physician. Three types of automated contours were produced for analysis. (1) Plan: By deformably registering the plan CT to each CBCT and then using the resulting deformation field to morph the plan contours to match the CBCT anatomy. (2) Previous: The contour set drawn by the physician on the previous day CBCT is similarly deformed to match the current CBCT anatomy. (3) STAPLE: The contours drawn by the physician, on each prior CBCT and the plan CT, are deformed to match the CBCT anatomy to produce multiple contour sets. These sets are combined using the STAPLE algorithm into one optimal set. Results: Compared to plan and previous, STAPLE improved the average Dice's coefficient (DC) with the original physician drawn CBCT contours to a DC as follows: Bladder: 0.81 ± 0.13, 0.91 ± 0.06, and 0.92 ± 0.06; Prostate: 0.75 ± 0.08, 0.82 ± 0.05, and 0.84 ± 0.05; and Rectum: 0.79 ± 0.06, 0.81 ± 0.06, and 0.85 ± 0.04, respectively. The STAPLE results are within intraobserver consistency, determined by the physician blindly recontouring a subset of CBCTs. Comparing plans recalculated using the physician and STAPLE contours showed an average disagreement less than 1% for prostate D98 and mean dose, and 5% and 3% for bladder and rectum mean dose, respectively. One scan takes an average of 19 s to contour. Using five scans plus STAPLE takes less than 110 s on a 288 core graphics processor unit. Conclusions: Combining the plan and all prior days via the STAPLE algorithm to produce treatment day contours is superior to the current standard of deforming only the plan contours to the daily CBCT. STAPLE also improves the precision, with a substantial decrease in standard deviation, a key for adaptive therapy. Geometrically and dosimetrically accurate contours can be automatically generated with STAPLE on prostate region kV CBCT in a time scale suitable for online adaptive therapy.
MeSH term(s)	Automation ; Cone-Beam Computed Tomography/methods ; Humans ; Image Processing, Computer-Assisted/methods ; Male ; Prostate/diagnostic imaging ; Prostatic Neoplasms/diagnostic imaging ; Prostatic Neoplasms/radiotherapy ; Radiotherapy, Intensity-Modulated ; Time Factors
Language	English
Publishing date	2013-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	188780-4
ISSN	2473-4209 ; 0094-2405
ISSN (online)	2473-4209
ISSN	0094-2405
DOI	10.1118/1.4789484
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Zs.A 1210: Show issues

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Article ; Online: Prostate rotation detected from implanted markers can affect dose coverage and cannot be simply dismissed.

Shang, Qingyang / Sheplan Olsen, Lawrence J / Stephans, Kevin / Tendulkar, Rahul / Xia, Ping

Journal of applied clinical medical physics

2013 Volume 14, Issue 3, Page(s) 4262

Abstract: With implanted markers, daily prostate displacements can be automatically detected with six degrees of freedom. The reported magnitudes of the rotations, however, are often greater than the typical range of a six-degree treatment couch. The purpose of ... ...

Abstract	With implanted markers, daily prostate displacements can be automatically detected with six degrees of freedom. The reported magnitudes of the rotations, however, are often greater than the typical range of a six-degree treatment couch. The purpose of this study is to quantify geometric and dosimetric effects if the prostate rotations are not corrected (ROT_NC) and if they can be compensated with translational shifts (ROT_C). Forty-three kilovoltage cone-beam CTs (KV-CBCT) with implanted markers from five patients were available for this retrospective study. On each KV-CBCT, the prostate, bladder, and rectum were manually contoured by a physician. The prostate contours from the planning CT and CBCT were aligned manually to achieve the best overlaps. This contour registration served as the benchmark method for comparison with two marker registration methods: (a) using six degrees of freedom, but rotations were not corrected (ROT_NC); and (b) using three degrees of freedom while compensating rotations into the translational shifts (ROT_C). The center of mass distance (CMD) and overlap index (OI) were used to evaluate these two methods. The dosimetric effects were also analyzed by comparing the dose coverage of the prostate clinical target volume (CTV) in relation to the planning margins. According to our analysis, the detected rotations dominated in the left-right axis with systematic and random components of 4.6° and 4.1°, respectively. When the rotation angles were greater than 10°, the differences in CMD between the two registrations were greater than 5 mm in 85.7% of these fractions; when the rotation angles were greater than 6°, the differences of CMD were greater than 4 mm in 61.1% of these fractions. With 6 mm/4 mm posterior planning margins, the average difference between the dose to 99% (D99) of the prostate in CBCTs and the planning D99 of the prostate was -8.0 ± 12.3% for the ROT_NC registration, and -3.6 ± 9.0% for the ROT_C registration (p = 0.01). When the planning margin decreased to 4 mm/2 mm posterior, the average difference in D99 of the prostate was -22.0 ± 16.2% and -15.1 ± 15.2% for the ROT_NC and ROT_C methods, respectively (p < 0.05). In conclusion, prostate rotation cannot be simply dismissed, and the impact of the rotational errors depends on the distance between the isocenter and the centroid of implanted markers and the rotation angle.
MeSH term(s)	Cone-Beam Computed Tomography ; Fiducial Markers ; Humans ; Male ; Prostate/diagnostic imaging ; Prostatic Neoplasms/diagnostic imaging ; Prostatic Neoplasms/pathology ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; Rectum/diagnostic imaging ; Retrospective Studies ; Rotation ; Urinary Bladder/diagnostic imaging
Language	English
Publishing date	2013-05-06
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	2010347-5
ISSN	1526-9914 ; 1526-9914
ISSN (online)	1526-9914
ISSN	1526-9914
DOI	10.1120/jacmp.v14i3.4262
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Article ; Online: Brachytherapy in pelvic malignancies: a review for radiologists.

Vicens, Rafael A / Rodriguez, Joshua / Sheplan, Lawrence / Mayo, Cody / Mayo, Lauren / Jensen, Corey

Abdominal imaging

2015 Volume 40, Issue 7, Page(s) 2645–2659

Abstract: Brachytherapy, also known as sealed source or internal radiation therapy, involves placement of a radioactive source immediately adjacent to or within tumor, thus enabling delivery of a localized high dose of radiation. Compared with external beam ... ...

Abstract	Brachytherapy, also known as sealed source or internal radiation therapy, involves placement of a radioactive source immediately adjacent to or within tumor, thus enabling delivery of a localized high dose of radiation. Compared with external beam radiation which must first pass through non-target tissues, brachytherapy results in less radiation dose to normal tissues. In the past decade, brachytherapy use has markedly increased, thus radiologists are encountering brachytherapy devices and their associated post-treatment changes to increasing degree. This review will present a variety of brachytherapy devices that radiologists may encounter during diagnostic pelvic imaging with a focus on prostate and gynecologic malignancies. The reader will become familiar with the function, correct position, and potential complications of brachytherapy devices in an effort to improve diagnostic reporting and communication with clinicians.
MeSH term(s)	Brachytherapy ; Humans ; Pelvic Neoplasms/radiotherapy
Language	English
Publishing date	2015-10
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1144553-1
ISSN	1432-0509 ; 0942-8925
ISSN (online)	1432-0509
ISSN	0942-8925
DOI	10.1007/s00261-015-0407-y
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Zs.A 1262: Show issues

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Article ; Online: Radiotherapy for prolactin-secreting pituitary tumors.

Sheplan Olsen, Lawrence J / Robles Irizarry, Lizbeth / Chao, Samuel T / Weil, Robert J / Hamrahian, Amir H / Hatipoglu, Betul / Suh, John H

Pituitary

2011 Volume 15, Issue 2, Page(s) 135–145

Abstract: Review the medical and surgical management of patients with prolactinomas and provide an in-depth appraisal of the role of radiotherapy in the treatment of prolactinomas. A thorough review of the pertinent literature was carried out and relevant topics ... ...

Abstract	Review the medical and surgical management of patients with prolactinomas and provide an in-depth appraisal of the role of radiotherapy in the treatment of prolactinomas. A thorough review of the pertinent literature was carried out and relevant topics were identified. Topics covered in this comprehensive review include: indications for the use of radiotherapy, choice between conventional radiotherapy and stereotactic radiosurgery, as well as the benefits and potential complications associated with each modality. Due to the excellent response rates with medical management, and rapid symptom relief afforded by resection or debulking surgery in patients who do not respond or tolerate medical therapy, radiotherapy is reserved for patients who do not respond to dopamine agonists and surgery. Both external beam radiotherapy and stereotactic radiosurgery retain important roles in the treatment of refractory or recurrent prolactinomas. Choosing the optimal approach is crucial in maximizing tumor control outcomes and minimizing the risks associated with treatment. The primary determinants of optimal radiation approach are proximity of the tumor to the optic apparatus and tumor size, with radiosurgery being our recommended treatment of choice unless the tumor is larger than 3-4 cm or within 3 mm of the optic nerves, chiasm or tracts. Optimal multidisciplinary management requires the identification of appropriate candidates for radiotherapy in order to take full advantage of treatment options available for each patient.
MeSH term(s)	Humans ; Pituitary Neoplasms/metabolism ; Pituitary Neoplasms/radiotherapy ; Prolactin/metabolism ; Prolactinoma/metabolism ; Prolactinoma/radiotherapy ; Radiosurgery/methods
Chemical Substances	Prolactin (9002-62-4)
Language	English
Publishing date	2011-09-21
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1385151-2
ISSN	1573-7403 ; 1386-341X
ISSN (online)	1573-7403
ISSN	1386-341X
DOI	10.1007/s11102-011-0348-6
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Zs.A 6139: Show issues

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Article ; Online: Late toxicity after intensity modulated and image guided radiation therapy for localized prostate cancer and post-prostatectomy patients.

Hunter, Grant K / Brockway, Kristin / Reddy, Chandana A / Rehman, Sana / Sheplan, Lawrence J / Stephans, Kevin L / Ciezki, Jay P / Xia, Ping / Tendulkar, Rahul D

Practical radiation oncology

2013 Volume 3, Issue 4, Page(s) 323–328

Abstract: Purpose: To examine late gastrointestinal (GI) and genitourinary (GU) toxicity profiles of patients treated for prostate cancer either definitively or post-prostatectomy with both intensity modulated radiation therapy (IMRT) and image guided radiation ... ...

Abstract	Purpose: To examine late gastrointestinal (GI) and genitourinary (GU) toxicity profiles of patients treated for prostate cancer either definitively or post-prostatectomy with both intensity modulated radiation therapy (IMRT) and image guided radiation therapy (IGRT). Methods and materials: A total of 333 patients treated definitively and 104 patients treated postoperatively with IMRT and varying IGRT techniques were retrospectively examined to evaluate GI and GU toxicity profiles >1 year from treatment. Available dosimetric data were used for correlative analysis. Results: The median follow-up time for the definitive patients was 41 months and the median follow-up time for the post-prostatectomy patients was 33 months. No late grade 4 or 5 GI or GU toxicities were observed. For definitive patients, the rates of grade ≥2 GI and GU toxicity at 3 years were 4.9% and 4.5%, respectively. In the postoperative cohort the rate of grade >2 GU toxicity was 11.6%, with no grade ≥2 GI toxicity. In the definitive cohort's Cox proportional hazards regression univariate analysis, use of anticoagulation was significantly associated with GI toxicity and age, bladder V50 and IGRT modality were associated with GU toxicity, and only age remained significant in the multivariate model. In univariate analysis for the postoperative cohort, no dosimetric value correlated with GU toxicity, nor did age or time from radical prostatectomy to radiation. Conclusions: IMRT with IGRT achieved low rates of GI and GU toxicity in the definitive and postoperative setting.
Language	English
Publishing date	2013-10
Publishing country	United States
Document type	Journal Article
ISSN	1879-8519
ISSN (online)	1879-8519
DOI	10.1016/j.prro.2012.08.004
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Article ; Online: The efficacy of external beam radiotherapy and stereotactic body radiotherapy for painful spinal metastases from renal cell carcinoma.

Hunter, Grant K / Balagamwala, Ehsan H / Koyfman, Shlomo A / Bledsoe, Trevor / Sheplan, Lawrence J / Reddy, Chandana A / Chao, Samuel T / Djemil, Toufik / Angelov, Lilyana / Videtic, Gregory M M

Practical radiation oncology

2012 Volume 2, Issue 4, Page(s) e95–e100

Abstract: Purpose: Palliative radiotherapy is routinely used to treat painful spinal metastases from renal cell carcinoma (RCC). Conventionally planned external beam radiotherapy (CRT) has been standard, with high-dose stereotactic body radiotherapy (SBRT) ... ...

Abstract	Purpose: Palliative radiotherapy is routinely used to treat painful spinal metastases from renal cell carcinoma (RCC). Conventionally planned external beam radiotherapy (CRT) has been standard, with high-dose stereotactic body radiotherapy (SBRT) becoming increasingly common given the radioresistant nature of RCC. We compared the efficacy and durability of pain relief produced by these 2 modalities. Methods and materials: Patients with painful spinal metastases from RCC treated from 2002-2010 were included. Response was defined similar to the Radiation Therapy Oncology Group 0631 protocol: complete response (CR) being resolution of pain without increased narcotics; partial response (PR) included patients with an incomplete reduction in pain without increased narcotics. Patients who experienced a CR or PR were coded as having pain relief, while those with persistent pain or additional narcotics requirements were coded as failures. Achievement of pain relief was analyzed using competing risk analysis with death as the competing event. Time to pain relief was plotted using cumulative incidence analysis. Results: A total of 110 patients (34 CRT; 76 SBRT) were included. Median follow-up was 4.3 months (range, 0.2-38). Median Karnofsky performance score was higher for patients treated with SBRT compared with CRT (80 vs 70; P = .0004). Overall pain response rates were 68% for CRT and 62% for SBRT, with respective CR and PR rates of 12% and 56% for CRT, and 33% and 29% for SBRT (P = .01). Median time to pain relief was 0.6 weeks for CRT versus 1.2 weeks for SBRT (P = .29). For patients who achieved pain relief (n = 79), median duration was 1.7 months for CRT versus 4.8 months for SBRT (P = .095). On univariate analysis no factors were significantly related to pain relief. Conclusions: CRT was not statistically different than SBRT for pain relief in symptomatic spine metastases from RCC and should be used as first line treatment. The appropriate use of SBRT in this population merits prospective study.
Language	English
Publishing date	2012-10
Publishing country	United States
Document type	Journal Article
ISSN	1879-8519
ISSN (online)	1879-8519
DOI	10.1016/j.prro.2012.01.005
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Article ; Online: Use of radiation therapy for patients with soft-tissue and bone sarcomas.

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Article ; Online: Combining prior day contours to improve automated prostate segmentation.

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Article ; Online: Prostate rotation detected from implanted markers can affect dose coverage and cannot be simply dismissed.

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Article ; Online: Brachytherapy in pelvic malignancies: a review for radiologists.

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Article ; Online: Radiotherapy for prolactin-secreting pituitary tumors.

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Article ; Online: Late toxicity after intensity modulated and image guided radiation therapy for localized prostate cancer and post-prostatectomy patients.

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Article ; Online: The efficacy of external beam radiotherapy and stereotactic body radiotherapy for painful spinal metastases from renal cell carcinoma.

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