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  1. Article: Adaptive hypofractionted and stereotactic body radiotherapy for lung tumors with real-time MRI guidance.

    Bryant, John M / Sim, Austin J / Feygelman, Vladimir / Latifi, Kujtim / Rosenberg, Stephen A

    Frontiers in oncology

    2023  Volume 13, Page(s) 1061854

    Abstract: The treatment of central and ultracentral lung tumors with radiotherapy remains an ongoing clinical challenge. The risk of Grade 5 toxicity with ablative radiotherapy doses to these high-risk regions is significant as shown in recent prospective studies. ...

    Abstract The treatment of central and ultracentral lung tumors with radiotherapy remains an ongoing clinical challenge. The risk of Grade 5 toxicity with ablative radiotherapy doses to these high-risk regions is significant as shown in recent prospective studies. Magnetic resonance (MR) image-guided adaptive radiotherapy (MRgART) is a new technology and may allow the delivery of ablative radiotherapy to these high-risk regions safely. MRgART is able to achieve this by utilizing small treatment margins, real-time gating/tracking and on-table plan adaptation to maintain dose to the tumor but limit dose to critical structures. The process of MRgART is complex and has nuances and challenges for the treatment of lung tumors. We outline the critical steps needed for appropriate delivery of MRgART for lung tumors safely and effectively.
    Language English
    Publishing date 2023-01-27
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2649216-7
    ISSN 2234-943X
    ISSN 2234-943X
    DOI 10.3389/fonc.2023.1061854
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  2. Article ; Online: Radiation therapy prior to CAR T-cell therapy in lymphoma: impact on patient outcomes.

    Figura, Nicholas B / Sim, Austin J / Jain, Michael D / Chavez, Julio C / Robinson, Timothy J

    Expert review of hematology

    2022  Volume 15, Issue 12, Page(s) 1023–1030

    Abstract: Introduction: Anti-CD19 chimeric antigen receptor (CAR) T-cell therapy has revolutionized the treatment paradigm for patients with refractory or recurrent (R/R) diffuse large B-cell lymphomas (DLBCL). Nonetheless, most patients ultimately progress. The ... ...

    Abstract Introduction: Anti-CD19 chimeric antigen receptor (CAR) T-cell therapy has revolutionized the treatment paradigm for patients with refractory or recurrent (R/R) diffuse large B-cell lymphomas (DLBCL). Nonetheless, most patients ultimately progress. The use of bridging or salvage radiotherapy (RT) in combination with CAR T-cell therapy has been proposed as potential strategies to improve patient outcomes, but consensus is currently lacking as to which, if either, approach is effective.
    Areas covered: We reviewed the immunologic and molecular mechanisms of resistance and the current retrospective data on patterns-of-failure, clinical risk factors, and treatment outcomes in patients undergoing CAR T-cell therapy, with and without bridging or salvage RT.
    Expert opinion: We believe that current basic and clinical evidence supports the use of comprehensive, ablative bridging irradiation (CABI), as opposed to low-dose bridging or salvage radiotherapy, as a promising strategy to improve CAR T-cell therapy outcomes in patients with R/R DLBCL. This potential benefit is likely greatest in patients with high tumor burden and/or localized disease, who are both at elevated risk of local recurrence and can often be safely and comprehensively treated with ablative radiation doses (EQD2 > 39 Gy). Hypothesis-driven clinical trials are needed prospectively assess the impact of radiation on outcomes in patients undergoing CAR T-cell therapy.
    Language English
    Publishing date 2022-11-17
    Publishing country England
    Document type Journal Article
    ZDB-ID 2516804-6
    ISSN 1747-4094 ; 1747-4086
    ISSN (online) 1747-4094
    ISSN 1747-4086
    DOI 10.1080/17474086.2022.2147919
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    Zs.A 6943: Show issues Location:
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  3. Article: Diagnostic Delay in HPV-Related Oropharyngeal Squamous Cell Carcinoma.

    McGarey, Patrick O / Hamdi, Osama / Donaldson, Lane / Zhan, Kevin / Crandley, Edwin F / Wilson, David D / Sim, Austin J / Read, Paul W / Garneau, Jonathan C / Fedder, Katherine L / Shonka, David C / Jameson, Mark J

    International archives of otorhinolaryngology

    2024  Volume 28, Issue 1, Page(s) e42–e49

    Abstract: ... ...

    Abstract Introduction
    Language English
    Publishing date 2024-02-05
    Publishing country Brazil
    Document type Journal Article
    ZDB-ID 2578584-9
    ISSN 1809-4864 ; 1809-9777
    ISSN (online) 1809-4864
    ISSN 1809-9777
    DOI 10.1055/s-0043-1767795
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  4. Article ; Online: A review of the role of MRI in diagnosis and treatment of early stage lung cancer.

    Sim, Austin J / Kaza, Evangelia / Singer, Lisa / Rosenberg, Stephen A

    Clinical and translational radiation oncology

    2020  Volume 24, Page(s) 16–22

    Abstract: Despite magnetic resonance imaging (MRI) being a mainstay in the oncologic care for many disease sites, it has not routinely been used in early lung cancer diagnosis, staging, and treatment. While MRI provides improved soft tissue contrast compared to ... ...

    Abstract Despite magnetic resonance imaging (MRI) being a mainstay in the oncologic care for many disease sites, it has not routinely been used in early lung cancer diagnosis, staging, and treatment. While MRI provides improved soft tissue contrast compared to computed tomography (CT), an advantage in multiple organs, the physical properties of the lungs and mediastinum create unique challenges for lung MRI. Although multi-detector CT remains the gold standard for lung imaging, advances in MRI technology have led to its increased clinical relevance in evaluating early stage lung cancer. Even though positron emission tomography is used more frequently in this context, functional MR imaging, including diffusion-weighted MRI and dynamic contrast-enhanced MRI, are emerging as useful modalities for both diagnosis and evaluation of treatment response for lung cancer. In parallel with these advances, the development of combined MRI and linear accelerator devices (MR-linacs), has spurred the integration of MRI into radiation treatment delivery in the form of MR-guided radiotherapy (MRgRT). Despite challenges for MRgRT in early stage lung cancer radiotherapy, early data utilizing MR-linacs shows potential for the treatment of early lung cancer. In both diagnosis and treatment, MRI is a promising modality for imaging early lung cancer.
    Language English
    Publishing date 2020-06-06
    Publishing country Ireland
    Document type Journal Article ; Review
    ISSN 2405-6308
    ISSN (online) 2405-6308
    DOI 10.1016/j.ctro.2020.06.002
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  5. Article: Delivery of Online Adaptive MRI-Guided Radiation Therapy for a Deaf Patient.

    Linkowski, Lauren C / Sim, Austin J / Redler, Gage / Brohl, Andrew S / Rosenberg, Stephen A / Wuthrick, Evan J

    Cureus

    2022  Volume 14, Issue 8, Page(s) e27558

    Abstract: MRI-guided radiation therapy (MRgRT) enables real-time imaging during treatment and daily online adaptive planning. It is particularly useful for areas of treatment that have been previously excluded or restricted from ablative doses due to potential ... ...

    Abstract MRI-guided radiation therapy (MRgRT) enables real-time imaging during treatment and daily online adaptive planning. It is particularly useful for areas of treatment that have been previously excluded or restricted from ablative doses due to potential damage to adjacent normal tissue. In certain cases, ablative doses to metastatic lesions may be justified and treated with MRgRT using video-assisted gated breath-hold adjustments throughout delivery. The workflow relies on patient biofeedback and auditory cues. A 74-year-old deaf male with a history of prostate cancer status post prostatectomy was found to have an enlarged cervical lymph node, which was excised with histopathology demonstrating Merkel cell carcinoma. Approximately one year after treatment with two cycles of pembrolizumab, which was subsequently discontinued due to toxicity, surveillance imaging demonstrated an enlarging left adrenal nodule. It was initially stable for an additional seven months with pembrolizumab rechallenge but was again found enlarged on subsequent imaging. The patient underwent MRg stereotactic body radiation therapy (MRgSBRT) to a total dose of 60 Gy in five fractions to this isolated site of progression. The patient was equipped with mirrored glasses to view the tracking structure with respect to gating the boundary structure, and the traditional reliance on verbal cues for coaching was reimagined to rely on visual cues instead. Follow-up positron emission tomography/CT (PET/CT) two weeks after treatment demonstrated interval resolution of the left adrenal metastatic nodule and a return to symmetric bilateral adrenal gland metabolic activity. The necessary MRgSBRT treatment for single metastatic lesions near normal tissue structures relies on verbal cues and coaching. However, deaf patients are unable to receive this treatment according to the traditional workflow model. Unique opportunities exist for the implementation of culturally competent care for the Deaf community, relying more heavily on visual cues, in radiation oncology practice.
    Language English
    Publishing date 2022-08-01
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.27558
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article: Novel MR-Guided Radiotherapy Elective Rotation for Radiation Oncology Trainees.

    Sim, Austin J / Frakes, Jessica M / Hoffe, Sarah E / Wuthrick, Evan / Dilling, Thomas J / Rosenberg, Stephen

    Cureus

    2020  Volume 12, Issue 9, Page(s) e10706

    Abstract: MR-guided adaptive radiation therapy (RT) is emerging as an integral treatment modality for certain applications and is poised to become an exciting opportunity for greater treatment precision and personalization. However, this is still a relatively ... ...

    Abstract MR-guided adaptive radiation therapy (RT) is emerging as an integral treatment modality for certain applications and is poised to become an exciting opportunity for greater treatment precision and personalization. However, this is still a relatively nascent technology and only a few institutions and programs have access to this technology for clinical use and trainee education. To increase the diversity of elective offerings and improve the understanding of an MR-guided radiotherapy program, we initiated a unique MR-guided radiotherapy elective rotation for radiation oncology residents. During a representative four-week rotation, 21 simulations were completed by the resident on service. A plurality of simulations were for pancreas stereotactic body radiation therapy (SBRT; 48%) and a majority (71%) of simulations were for adaptive treatments. Additionally, 74 adaptive fractions were completed during this month, of which a significant majority (74%) were for pancreas SBRT. Of the non-adaptive fractions, the majority were for prostate SBRT and intensity-modulated radiation therapy (IMRT). Although many programs may offer training in some aspects of MR-guided radiotherapy as trainees rotate through certain disease sites, we hope this may serve as a blueprint to encourage programs with this technology to fully embrace training in essential competencies related to MR-guided radiotherapy. MR-guided radiotherapy has unique challenges that trainees need to understand to deliver treatment safely: geometric uncertainty, MRI to RT isocenter, and uncertainties with voxel size/tracking.
    Language English
    Publishing date 2020-09-29
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.10706
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  7. Article ; Online: Magnetic Resonance-Guided Stereotactic Body Radiation Therapy/Hypofractionated Radiation therapy for Metastatic and Primary Central and Ultracentral Lung Lesions.

    Sandoval, Maria L / Sim, Austin J / Bryant, John M / Bhandari, Menal / Wuthrick, Evan J / Perez, Bradford A / Dilling, Thomas J / Redler, Gage / Andreozzi, Jacqueline / Nardella, Louis / Feygelman, Vladimir / Latifi, Kujtim / Rosenberg, Stephen A

    JTO clinical and research reports

    2023  Volume 4, Issue 5, Page(s) 100488

    Abstract: Introduction: The recent results from the Nordic-HILUS study indicate stereotactic body radiation therapy (SBRT) is associated with high-grade toxicity for ultracentral (UC) tumors. We hypothesized that magnetic resonance-guided SBRT (MRgSBRT) or ... ...

    Abstract Introduction: The recent results from the Nordic-HILUS study indicate stereotactic body radiation therapy (SBRT) is associated with high-grade toxicity for ultracentral (UC) tumors. We hypothesized that magnetic resonance-guided SBRT (MRgSBRT) or hypofractionated radiation therapy (MRgHRT) enables the safe delivery of high-dose radiation to central and UC lung lesions.
    Methods: Patients with UC or central lesions were treated with MRgSBRT/MRgHRT with real-time gating or adaptation. Central lesions were defined as per the Radiation Therapy Oncology Group and UC as per the HILUS study definitions: (1) group A or tumors less than 1 cm from the trachea and/or mainstem bronchi; or (2) group B or tumors less than 1 cm from the lobar bronchi. The Kaplan-Meier estimate and log-rank test were used to estimate survival. Associations between toxicities and other patient factors were tested using the Mann-Whitney
    Results: A total of 47 patients were included with a median follow-up of 22.9 months (95% confidence interval: 16.4-29.4). Most (53%) had metastatic disease. All patients had central lesions and 55.3% (n = 26) had UC group A. The median distance from the proximal bronchial tree was 6.0 mm (range: 0.0-19.0 mm). The median biologically equivalent dose (α/β = 10) was 105 Gy (range: 75-151.2). The most common radiation schedule was 60 Gy in eight fractions (40.4%). Most (55%) had previous systemic therapy, 32% had immunotherapy and 23.4% had previous thoracic radiation therapy. There were 16 patients who underwent daily adaptation. The 1-year overall survival was 82% (median = not reached), local control 87% (median = not reached), and progression-free survival 54% (median = 15.1 mo, 95% confidence interval: 5.1-25.1). Acute toxicity included grade 1 (26%) and grade 2 (21%) with only two patients experiencing grade 3 (4.3%) in the long term. No grade 4 or 5 toxicities were seen.
    Conclusions: Previous studies noted high rates of toxicity after SBRT to central and UC lung lesions, with reports of grade 5 toxicities. In our cohort, the use of MRgSBRT/MRgHRT with high biologically effective doses was well tolerated, with two grade 3 toxicities and no grade 4/5.
    Language English
    Publishing date 2023-02-25
    Publishing country United States
    Document type Journal Article
    ISSN 2666-3643
    ISSN (online) 2666-3643
    DOI 10.1016/j.jtocrr.2023.100488
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  8. Article ; Online: Representation Matters: Expanding the Leadership Table for All Radiation Oncology Trainees.

    LeCompte, Michael C / Vidal, Gabriel S / Rivera, Amanda / Sim, Austin J / Chaurasia, Avinash / Pereira, Ian / Tye, Karen E / McVorran, Shauna / Franco, Idalid

    International journal of radiation oncology, biology, physics

    2023  Volume 116, Issue 2, Page(s) 328–333

    MeSH term(s) Humans ; Radiation Oncology ; Leadership
    Language English
    Publishing date 2023-04-22
    Publishing country United States
    Document type Editorial
    ZDB-ID 197614-x
    ISSN 1879-355X ; 0360-3016
    ISSN (online) 1879-355X
    ISSN 0360-3016
    DOI 10.1016/j.ijrobp.2023.01.051
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 1218: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
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    Jg. 1995 - 2021: Lesesall (1.OG)
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  9. Article ; Online: Malpractice Litigation in Vitreoretinal Surgery and Medical Retina.

    Engelhard, Stephanie B / Justin, Grant A / Zimmer-Galler, Ingrid E / Sim, Austin J / Reddy, Ashvini K

    Ophthalmic surgery, lasers & imaging retina

    2020  Volume 51, Issue 5, Page(s) 272–278

    Abstract: Background and objective: To report and analyze the causes and outcomes of vitreoretinal surgery and medical retina malpractice litigation.: Patients and methods: The WestLaw database was reviewed for all vitreoretinal malpractice litigation in the ... ...

    Abstract Background and objective: To report and analyze the causes and outcomes of vitreoretinal surgery and medical retina malpractice litigation.
    Patients and methods: The WestLaw database was reviewed for all vitreoretinal malpractice litigation in the United States between 1930 and 2014.
    Results: One hundred forty-two retina cases were included. Overall, 64.1% of cases were resolved in favor of defendants. Eighty-three (58.5%) cases were resolved via jury trial, 30.1% of which were associated with plaintiff verdicts with mean adjusted jury award of $5,222,894 (median, $691,974). Eight cases (5.6%) resulted in settlements with mean adjusted indemnity of $726,003 (median: $437,165). Jury awards were higher than settlement awards (P = .04). Commonly litigated scenarios included retinal detachment (46.5%) and retinopathy of prematurity (9.2%).
    Conclusions: The complexity of treating vitreoretinal problems and the high potential for vision loss inherent in many diagnoses make treating retinal problems high-risk. Many cases in this series resulted in multi-million-dollar plaintiff awards. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:272-278.].
    MeSH term(s) Databases, Factual ; Humans ; Malpractice/legislation & jurisprudence ; Ophthalmology/legislation & jurisprudence ; Retina ; Retinal Diseases/surgery ; Retrospective Studies ; United States ; Vitreoretinal Surgery/legislation & jurisprudence
    Language English
    Publishing date 2020-05-06
    Publishing country United States
    Document type Journal Article ; Multicenter Study
    ZDB-ID 2701167-7
    ISSN 2325-8179 ; 2325-8160
    ISSN (online) 2325-8179
    ISSN 2325-8160
    DOI 10.3928/23258160-20200501-04
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    Zs.A 756: Show issues Location:
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  10. Article ; Online: Taking a Step in the Right Direction for Radiation Oncology.

    Sim, Austin J / Laucis, Anna M / Chowdhary, Mudit / Chino, Fumiko / Golden, Daniel W / Tendulkar, Rahul D

    International journal of radiation oncology, biology, physics

    2020  Volume 107, Issue 5, Page(s) 1014–1015

    MeSH term(s) Humans ; Radiation Oncology
    Language English
    Publishing date 2020-07-22
    Publishing country United States
    Document type Letter
    ZDB-ID 197614-x
    ISSN 1879-355X ; 0360-3016
    ISSN (online) 1879-355X
    ISSN 0360-3016
    DOI 10.1016/j.ijrobp.2020.04.033
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