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Article ; Online: Incorporating detailed biology in hyperthermia treatment planning: a necessary condition for progress.

Myerson, Robert J

International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group

2016 Volume 33, Issue 3, Page(s) 364–365

Language	English
Publishing date	2016-12-07
Publishing country	England
Document type	Journal Article
ZDB-ID	632526-9
ISSN	1464-5157 ; 0265-6736
ISSN (online)	1464-5157
ISSN	0265-6736
DOI	10.1080/02656736.2016.1247467
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Article ; Online: Favorable anal cancer: does it include T2N0 disease? How might the electively irradiated nodal volume be reduced?

Myerson, Robert J

International journal of radiation oncology, biology, physics

2013 Volume 87, Issue 1, Page(s) 13–15

MeSH term(s)	Anus Neoplasms/radiotherapy ; Carcinoma, Squamous Cell/radiotherapy ; Carcinoma, Transitional Cell/radiotherapy ; Female ; Humans ; Lymphatic Irradiation/methods ; Male
Language	English
Publishing date	2013-09-01
Publishing country	United States
Document type	Comment ; Editorial
ZDB-ID	197614-x
ISSN	1879-355X ; 0360-3016
ISSN (online)	1879-355X
ISSN	0360-3016
DOI	10.1016/j.ijrobp.2013.06.001
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Article: Normal tissue dose conformality measures to guide radiotherapy fractionation decisions.

Myerson, Robert J

Medical physics

2011 Volume 38, Issue 4, Page(s) 1799–1805

Abstract: Purpose: To determine conditions under which hypofractionation could be favorable for a normal tissue--even if tumor [alpha/beta] exceeds the normal tissue's [alpha/beta].: Methods: The hypofractionation sufficiency condition (HSC) for an organ is ... ...

Abstract	Purpose: To determine conditions under which hypofractionation could be favorable for a normal tissue--even if tumor [alpha/beta] exceeds the normal tissue's [alpha/beta]. Methods: The hypofractionation sufficiency condition (HSC) for an organ is defined as a dose conformality constraint such that, if satisfied, a family of tumor control probability isoeffective fractionation schemes will show decreasing normal tissue complication probability with decreasing number of fractions. Results: In the extended equivalent uniform dose (EUD) model [obtained by replacing dose with linear quadratic (LQ) 2 Gy equivalent dose], the HSC for a normal organ is proven to be satisfied if a suitably weighted average of the relative dose [hypofractionation sufficiency index (HSI)] is less than the ratio of normal tissue to tumor [alpha/beta]. The HSI is determined solely by dose distribution and the normal tissue volume factor, "a." If the HSC is satisfied for every normal tissue of concern, then there is a therapeutic gain with hypofractionation. The corresponding multifractionation sufficiency condition (therapeutic gain with increasing number of fractions) and multifractionation sufficiency index (MSI) are also derived. A sample clinical case is presented. Conclusions: Within the context of the LQ/EUD models, conformality measures (HSI and MSI) can be used to inform fractionation decisions.
MeSH term(s)	Dose Fractionation ; Humans ; Liver Neoplasms/radiotherapy ; Liver Neoplasms/secondary ; Organs at Risk/radiation effects ; Radiotherapy Planning, Computer-Assisted/methods
Language	English
Publishing date	2011-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	188780-4
ISSN	0094-2405
ISSN	0094-2405
DOI	10.1118/1.3560417
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Article ; Online: Long-Term Outcomes of NRG Oncology/RTOG 0529: A Phase 2 Evaluation of Dose-Painted Intensity Modulated Radiation Therapy in Combination With 5-Fluorouracil and Mitomycin-C for the Reduction of Acute Morbidity in Anal Canal Cancer.

Kachnic, Lisa A / Winter, Kathryn A / Myerson, Robert J / Goodyear, Michael D / Abitbol, Andre A / Streeter, Oscar E / Augspurger, Mark E / Schefter, Tracey E / Katz, Alan W / Fisher, Barbara J / Henke, Lauren E / Narayan, Samir / Crane, Christopher H

International journal of radiation oncology, biology, physics

2021 Volume 112, Issue 1, Page(s) 146–157

Abstract: Purpose: A multi-institutional phase 2 trial assessed long-term outcomes of dose-painted intensity modulated radiation therapy (IMRT) with 5-fluorouracil (5FU) and mitomycin-C (MMC) for anal canal cancer.: Methods and materials: T2-4N0-3M0 anal ... ...

Abstract	Purpose: A multi-institutional phase 2 trial assessed long-term outcomes of dose-painted intensity modulated radiation therapy (IMRT) with 5-fluorouracil (5FU) and mitomycin-C (MMC) for anal canal cancer. Methods and materials: T2-4N0-3M0 anal cancers received 5FU (1000 mg/m Results: Of 52 patients, 54% were stage II, 25% were stage IIIA, and 21% were stage IIIB. Median follow-up was 7.9 years (min-max, 0.02-9.2 years). Local-regional failure, colostomy failures, distant metastases, overall survival, disease-free survival, and colostomy-free survival at 5 years are 16% (95% confidence interval [CI], 7%-27%), 10% (95% CI, 4%-20%), 16% (95% CI, 7%-27%), 76% (95% CI, 61%-86%), 70% (95% CI, 56%-81%), and 74% (95% CI, 59%-84%); and at 8 years they are 16% (95% CI, 7%-27%), 12% (95% CI, 5%-23%), 22% (95% CI, 12%-34%), 68% (95% CI, 53%-79%), 62% (95% CI, 47%-74%) and 66% (95% CI, 51%-77%), respectively. Eight patients experienced local-regional failure, with 5 patients having persistent disease at 12 weeks. No isolated nodal failures occurred in the microscopic elective nodal volumes. Six patients required colostomy-5 for local-regional salvage and 1 for a temporary ostomy for anorectal dysfunction. Rates of late adverse events included: 28 patients (55%) with grade 2, 8 patients (16%) with grade 3, 0 patients with grade 4, and 2 patients (4%) with grade 5 events (sinus bradycardia and myelodysplasia, possibly owing to chemotherapy). Only 11 patients reported grade 1 to 3 sexual dysfunction. Conclusions: Dose-painted IMRT with 5FU/MMC for the treatment of anal canal cancer yields comparable long-term efficacy as conventional radiation cohorts. Enhanced normal tissue protection lowered rates of grade 3 and higher late effects without compromising pelvic tumor control.
MeSH term(s)	Anal Canal ; Antineoplastic Combined Chemotherapy Protocols/adverse effects ; Anus Neoplasms/pathology ; Carcinoma, Squamous Cell/pathology ; Chemoradiotherapy/adverse effects ; Chemoradiotherapy/methods ; Fluorouracil/adverse effects ; Humans ; Mitomycin/adverse effects ; Morbidity ; Radiotherapy, Intensity-Modulated/adverse effects ; Radiotherapy, Intensity-Modulated/methods
Chemical Substances	Mitomycin (50SG953SK6) ; Fluorouracil (U3P01618RT)
Language	English
Publishing date	2021-08-14
Publishing country	United States
Document type	Clinical Trial, Phase II ; Journal Article ; Multicenter Study ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	197614-x
ISSN	1879-355X ; 0360-3016
ISSN (online)	1879-355X
ISSN	0360-3016
DOI	10.1016/j.ijrobp.2021.08.008
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Article ; Online: Is it time for tailored treatment of rectal cancer? From prescribing by consensus to prescribing by numbers.

Valentini, Vincenzo / Lambin, Philippe / Myerson, Robert J

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

2012 Volume 102, Issue 1, Page(s) 1–3

MeSH term(s)	Adenocarcinoma/therapy ; Combined Modality Therapy ; Decision Making ; Humans ; Models, Statistical ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Physician-Patient Relations ; Practice Guidelines as Topic ; Precision Medicine ; Randomized Controlled Trials as Topic ; Rectal Neoplasms/pathology ; Rectal Neoplasms/therapy
Language	English
Publishing date	2012-01
Publishing country	Ireland
Document type	Editorial
ZDB-ID	605646-5
ISSN	1879-0887 ; 0167-8140
ISSN (online)	1879-0887
ISSN	0167-8140
DOI	10.1016/j.radonc.2011.12.001
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Article ; Online: Stereotactic body radiotherapy for primary hepatic malignancies - Report of a phase I/II institutional study.

Weiner, Ashley A / Olsen, Jeffrey / Ma, Daniel / Dyk, Pawel / DeWees, Todd / Myerson, Robert J / Parikh, Parag

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

2016 Volume 121, Issue 1, Page(s) 79–85

Abstract: Background and purpose: To report outcomes and toxicities of a single-institution phase I/II study of stereotactic body radiotherapy (SBRT) in the treatment of unresectable hepatocellular cancer (HCC) and intrahepatic cholangiocarcinoma (IHC).: ... ...

Abstract	Background and purpose: To report outcomes and toxicities of a single-institution phase I/II study of stereotactic body radiotherapy (SBRT) in the treatment of unresectable hepatocellular cancer (HCC) and intrahepatic cholangiocarcinoma (IHC). Materials and methods: Patients with Child-Pugh score less than 8 were eligible. A total of 32 lesions in 26 patients were treated with SBRT. Kaplan-Meier survival analysis was performed. Toxicities were graded by CTCAEv4 criteria and response was scored by EASL guidelines. Results: Median prescribed dose was 55Gy (range 40-55Gy) delivered in 5 fractions. Mean tumor diameter was 5.0cm and mean GTV was 107cc. Median follow-up was 8.8months with a median survival of 11.1months, and one-year overall survival was 45%. Overall response rate was 42% and one-year local control was 91%. Nine patients experienced a decline in Child-Pugh class following treatment, and two grade 5 hepatic failure toxicities occurred during study follow-up. Conclusions: Primary hepatic malignancies not amenable to surgical resection portend a poor prognosis, despite available treatment options. Though radiation-induced liver disease (RILD) is rare following SBRT, this study demonstrates a risk of hepatic failure despite adherence to protocol constraints.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Dose-Response Relationship, Radiation ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Liver Neoplasms/radiotherapy ; Male ; Middle Aged ; Prospective Studies ; Radiosurgery/adverse effects ; Radiosurgery/methods ; Treatment Outcome
Keywords	covid19
Language	English
Publishing date	2016-10
Publishing country	Ireland
Document type	Clinical Trial, Phase I ; Clinical Trial, Phase II ; Journal Article
ZDB-ID	605646-5
ISSN	1879-0887 ; 0167-8140
ISSN (online)	1879-0887
ISSN	0167-8140
DOI	10.1016/j.radonc.2016.07.020
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Article ; Online: Positron emission tomography with [(18)F]-3'-deoxy-3'fluorothymidine (FLT) as a predictor of outcome in patients with locally advanced resectable rectal cancer: a pilot study.

Dehdashti, Farrokh / Grigsby, Perry W / Myerson, Robert J / Nalbantoglu, Ilke / Ma, Changqing / Siegel, Barry A

Molecular imaging and biology

2012 Volume 15, Issue 1, Page(s) 106–113

Abstract: Purpose: This pilot study was performed to evaluate whether tumor uptake of (18)F-labeled 3'-deoxy-3'fluorothymidine (FLT), a proliferative radiotracer, at baseline and early during therapy, is predictive of outcome in locally advanced rectal cancer.: ...

Abstract	Purpose: This pilot study was performed to evaluate whether tumor uptake of (18)F-labeled 3'-deoxy-3'fluorothymidine (FLT), a proliferative radiotracer, at baseline and early during therapy, is predictive of outcome in locally advanced rectal cancer. Procedures: Fourteen patients underwent positron emission tomography (PET) with 2-deoxy-2-[(18)F]fluoro-D-glucose (FDG) and FLT before therapy and PET with FLT approximately 2 weeks after initiating neoadjuvant chemoradiotherapy. FLT and FDG uptake were evaluated qualitatively and by maximum standardized uptake value (SUV(max)). Tumor FLT and FDG uptake were correlated with disease-free survival (DFS). Results: Thirteen patients underwent surgery after therapy, one died before surgery with progressive disease. FDG-PET/computed tomography detected regional lymph node metastases in five and FLT-PET was positive in one. High pretherapy FDG uptake (SUV(max) ≥ 14.3), low during-therapy FLT uptake (SUV(max) < 2.2), and high percentage change in FLT uptake (≥60 %) were predictive of improved DFS (p < 0.05 for all three values). Conclusion: Pretherapy FDG uptake, during-therapy FLT uptake, and percentage change in FLT uptake were equally predictive of DFS.
MeSH term(s)	Adult ; Aged ; Chemoradiotherapy, Adjuvant ; Dideoxynucleosides/chemistry ; Dideoxynucleosides/pharmacokinetics ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Neoadjuvant Therapy ; Pilot Projects ; Positron-Emission Tomography/methods ; Predictive Value of Tests ; Prognosis ; Rectal Neoplasms/diagnosis ; Rectal Neoplasms/diagnostic imaging ; Rectal Neoplasms/metabolism ; Rectal Neoplasms/therapy ; Treatment Outcome
Chemical Substances	Dideoxynucleosides ; alovudine (PG53R0DWDQ)
Language	English
Publishing date	2012-06-09
Publishing country	United States
Document type	Clinical Trial ; Journal Article
ZDB-ID	2079160-4
ISSN	1860-2002 ; 1536-1632
ISSN (online)	1860-2002
ISSN	1536-1632
DOI	10.1007/s11307-012-0566-y
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Article: Design and dosimetric characteristics of a new endocavitary contact radiotherapy system using an electronic brachytherapy source.

Richardson, Susan / Garcia-Ramirez, Jose / Lu, Wei / Myerson, Robert J / Parikh, Parag

Medical physics

2012 Volume 39, Issue 11, Page(s) 6838–6846

Abstract: Purpose: To present design aspects and acceptance tests performed for clinical implementation of electronic brachytherapy treatment of early stage rectal adenocarcinoma. A dosimetric comparison is made between the historically used Philips RT-50 unit ... ...

Abstract	Purpose: To present design aspects and acceptance tests performed for clinical implementation of electronic brachytherapy treatment of early stage rectal adenocarcinoma. A dosimetric comparison is made between the historically used Philips RT-50 unit and the newly developed Axxent(®) Model S700 electronic brachytherapy source manufactured by Xoft (iCad, Inc.). Methods: Two proctoscope cones were manufactured by ElectroSurgical Instruments (ESI). Two custom surface applicators were manufactured by Xoft and were designed to fit and interlock with the proctoscope cones from ESI. Dose rates, half value layers (HVL), and percentage depth dose (PDD) measurements were made with the Xoft system and compared to historical RT-50 data. A description of the patient treatment approach and exposure rates during the procedure is also provided. Results: The electronic brachytherapy system has a lower surface dose rate than the RT-50. The dose rate to water on the surface from the Xoft system is approximately 2.1 Gy∕min while the RT-50 is 10-12 Gy∕min. However, treatment times with Xoft are still reasonable. The HVLs and PDDs between the two systems were comparable resulting in similar doses to the target and to regions beyond the target. The exposure rate levels around a patient treatment were acceptable. The standard uncertainty in the dose rate to water on the surface is approximately ±5.2%. Conclusions: The Philips RT-50 unit is an out-of-date radiotherapy machine that is no longer manufactured with limited replacement parts. The use of a custom-designed proctoscope and Xoft surface applicators allows delivery of a well-established treatment with the ease of a modern radiotherapy device. While the dose rate is lower with the use of Xoft, the treatment times are still reasonable. Additionally, personnel may stand farther away from the Xoft radiation source, thus potentially reducing radiation exposure to the operator and other personnel.
MeSH term(s)	Brachytherapy/instrumentation ; Equipment Design ; Humans ; Radiometry ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted
Language	English
Publishing date	2012-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	188780-4
ISSN	0094-2405
ISSN	0094-2405
DOI	10.1118/1.4757915
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Article ; Online: Preoperative short-course radiation therapy for rectal cancer provides excellent disease control and toxicity: Results from a single US institution.

Roy, Amit / Mahasittiwat, Pawinee / Weiner, Ashley A / Hunt, Steven R / Mutch, Matthew G / Birnbaum, Elisa H / Kodner, Ira J / Read, Thomas E / Fleshman, James W / Olsen, Jeffrey R / Myerson, Robert J / Parikh, Parag J

Practical radiation oncology

2017 Volume 7, Issue 1, Page(s) e51–e58

Abstract: Purpose: Preoperative short-course radiation therapy (SCRT) has rarely been used for rectal cancer in the United States, although 2 randomized phase 3 trials demonstrate equivalence to conventional chemoradiation (CRT), and recent updates to national ... ...

Abstract	Purpose: Preoperative short-course radiation therapy (SCRT) has rarely been used for rectal cancer in the United States, although 2 randomized phase 3 trials demonstrate equivalence to conventional chemoradiation (CRT), and recent updates to national guidelines include this regimen as a treatment option. We sought to evaluate the efficacy and safety of preoperative SCRT followed by immediate surgery within 1 week to treat rectal cancer in the US setting. Methods and materials: All patients treated with preoperative SCRT (4 Gy × 5 fractions for total 20 Gy) followed by planned surgery within 1 week at our institution were retrospectively evaluated. Censored cases with ≥2 years of follow-up were included along with any disease failure or death. Patients with cM1 disease were excluded. Patients with yp stage II/III disease typically received adjuvant chemotherapy from the 1990s onwards. The primary outcomes were actuarial (Kaplan-Meier) 5-year locoregional control (LC), disease-free survival (DFS), and overall survival (OS) as well as late severe (greater than or equal to grade 3) toxicity. Results: Our analysis included 202 consecutive patients with clinical stage I-III disease treated from 1977 through 2011. Median follow-up was 6.5 years (range, 2-29.2). Five-year disease outcomes were 95.9% ± 1.5% for LC, 76.4% ± 3.1% for DFS, and 84.6% ± 2.6% for OS. For patients with locally advanced rectal cancer (cT3-4 and/or cN+), 5-year LC, DFS, and OS were 95.1% ± 2.1%, 73.3% ± 4.3%, and 80.6% ± 3.7%, respectively. The late severe toxicity rate was 11.4%. Conclusions: SCRT followed by immediate surgery is a safe and effective treatment for patients with rectal cancer in the United States. Though SCRT has not been widely adopted, recent updates to the national guidelines for rectal cancer as well as financial pressures to reduce healthcare costs may lead to increased utilization of this treatment regimen in the future.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Chemoradiotherapy ; Combined Modality Therapy ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Rectal Neoplasms/mortality ; Rectal Neoplasms/radiotherapy ; Rectal Neoplasms/surgery ; Retrospective Studies
Language	English
Publishing date	2017-01
Publishing country	United States
Document type	Journal Article
ISSN	1879-8519
ISSN (online)	1879-8519
DOI	10.1016/j.prro.2016.08.010
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Article ; Online: Improved Metastasis- and Disease-Free Survival With Preoperative Sequential Short-Course Radiation Therapy and FOLFOX Chemotherapy for Rectal Cancer Compared With Neoadjuvant Long-Course Chemoradiotherapy: Results of a Matched Pair Analysis.

Markovina, Stephanie / Youssef, Fady / Roy, Amit / Aggarwal, Sonya / Khwaja, Shariq / DeWees, Todd / Tan, Benjamin / Hunt, Steven / Myerson, Robert J / Chang, Daniel T / Parikh, Parag J / Olsen, Jeffrey R

International journal of radiation oncology, biology, physics

2017 Volume 99, Issue 2, Page(s) 417–426

Abstract: Purpose: To compare treatment and toxicity outcomes between a phase 2 institutional trial of near total neoadjuvant therapy (nTNT) for locally advanced rectal cancer and a similar historical control cohort treated at Washington University in St. Louis ... ...

Abstract	Purpose: To compare treatment and toxicity outcomes between a phase 2 institutional trial of near total neoadjuvant therapy (nTNT) for locally advanced rectal cancer and a similar historical control cohort treated at Washington University in St. Louis with the current US standard of care, defined as neoadjuvant chemoradiotherapy (NCRT), total mesorectal excision (TME), and adjuvant FOLFOX chemotherapy; to expand the comparison to an additional institution, patients treated with similar NCRT at Stanford University were included. Methods and materials: Sixty-nine patients with cT3-4N0-2M0 rectal adenocarcinoma enrolled on the Washington University in St. Louis phase 2 study of nTNT were included for analysis. Patients treated at the same institution with conventional NCRT and adjuvant FOLFOX were matched for exact cTNM stage. Forty-one patients treated with NCRT at Stanford University were included in a second analysis. Kaplan-Meier analysis with log-rank test was used to compare local control, distant metastasis-free survival, disease-free survival, and overall survival. Results: Median follow-up was 49 and 54 months for nTNT and NCRT, respectively. Pathologic complete response and T-downstaging rates were 28% versus 16% (P=.21) and 75% versus 41% (P<.001) in the nTNT and NCRT cohorts, respectively. Three-year disease-free survival (85% vs 68%, P=.032) was significantly better in the nTNT group. Actuarial 3-year local control (92% vs 96%, P=.36) and overall survival (96% vs 88%, P=.67) were similar. The Stanford cohort had significantly lower clinical stage. After controlling for clinical stage, age, tumor location, institution, and number of chemotherapy cycles, nTNT treatment remained significantly associated with lower risk of recurrence (P=.006). Conclusions: Patients treated with nTNT had higher T-downstaging and superior distant metastasis-free survival and disease-free survival compared with conventional NCRT when matched for tumor location and exact cTNM stage. Near total neoadjuvant therapy remained a significant multivariate predictor for improved outcome when including patients treated with NCRT at another institution.
MeSH term(s)	Adenocarcinoma/pathology ; Adenocarcinoma/therapy ; Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols/administration & dosage ; Antineoplastic Combined Chemotherapy Protocols/adverse effects ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Chemoradiotherapy/adverse effects ; Chemoradiotherapy/methods ; Disease-Free Survival ; Female ; Fluorouracil/administration & dosage ; Fluorouracil/adverse effects ; Humans ; Kaplan-Meier Estimate ; Leucovorin/administration & dosage ; Leucovorin/adverse effects ; Male ; Matched-Pair Analysis ; Middle Aged ; Neoadjuvant Therapy/adverse effects ; Neoadjuvant Therapy/methods ; Neoplasm Recurrence, Local/mortality ; Organoplatinum Compounds/administration & dosage ; Organoplatinum Compounds/adverse effects ; Preoperative Care ; Radiotherapy/methods ; Rectal Neoplasms/mortality ; Rectal Neoplasms/pathology ; Rectal Neoplasms/therapy
Chemical Substances	Organoplatinum Compounds ; Leucovorin (Q573I9DVLP) ; Fluorouracil (U3P01618RT)
Language	English
Publishing date	2017-10-01
Publishing country	United States
Document type	Clinical Trial, Phase II ; Comparative Study ; Journal Article ; Multicenter Study
ZDB-ID	197614-x
ISSN	1879-355X ; 0360-3016
ISSN (online)	1879-355X
ISSN	0360-3016
DOI	10.1016/j.ijrobp.2017.05.048
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