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  1. Article: Nasopharyngeal carcinoma presenting as an inconspicuous primary lesion with extensive cavernous sinus involvement and temporal lobe extension: a case report and review of literature.

    Pollard, Courtney / Mesko, Shane M / Ginsberg, Lawrence E / Kies, Merrill S / Raza, Shaan M / Su, Shirley Y / Tung, Sam / Phan, Jack

    Clinical case reports

    2017  Volume 5, Issue 10, Page(s) 1682–1688

    Abstract: Detection of nodal metastasis in the neck or adjacent structures is common in nasopharyngeal carcinoma (NPC) when there is frank primary disease. Intracranial extension without obvious nasopharyngeal disease is not common. Here, we discuss a patient with ...

    Abstract Detection of nodal metastasis in the neck or adjacent structures is common in nasopharyngeal carcinoma (NPC) when there is frank primary disease. Intracranial extension without obvious nasopharyngeal disease is not common. Here, we discuss a patient with NPC that presented with extensive intracranial disease with subtle findings in the nasopharynx.
    Language English
    Publishing date 2017-09-05
    Publishing country England
    Document type Case Reports
    ZDB-ID 2740234-4
    ISSN 2050-0904
    ISSN 2050-0904
    DOI 10.1002/ccr3.1166
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Deep-Inspiration Breath-Hold Intensity Modulated Radiation Therapy to the Mediastinum for Lymphoma Patients: Setup Uncertainties and Margins.

    Aristophanous, Michalis / Chi, Pai-Chun M / Kao, Jeremy / Williamson, Ryan / Tung, Sam / Andraos, Therese / Milgrom, Sarah A / Pinnix, Chelsea C / Dabaja, Bouthaina S

    International journal of radiation oncology, biology, physics

    2017  

    Abstract: Purpose: Patient setup for treating large target volumes can be challenging. In the present study, we measured the local uncertainties in the treatment of mediastinal lymphoma and investigated the need for region-specific planning target volume (PTV) ... ...

    Abstract Purpose: Patient setup for treating large target volumes can be challenging. In the present study, we measured the local uncertainties in the treatment of mediastinal lymphoma and investigated the need for region-specific planning target volume (PTV) margins.
    Methods and materials: The data from 30 patients who had undergone radiation therapy for mediastinal lymphoma were retrospectively analyzed. A computed tomography (CT)-on-rails (CTOR) system in the treatment room was used for daily image guidance. The total PTV was split into 6 regions: neck, supraclavicular fossa, axilla, mediastinum, upper heart, and lower heart. The total PTV and the 6 local regions were separately aligned to the planning CT scan using automatic rigid registration. The residual local errors using 3 setup strategies were investigated: no image guidance, CTOR setup to total PTV, and simulated cone beam CT setup to the mediastinum. Errors were recorded in the anteroposterior, superoinferior, and right-left directions separately. Using the residual error calculations, the margins required to cover 95% of the clinical target volume for 90% of the patients was estimated.
    Results: For each patient, 12 to 21 days of daily CTOR data were available for analysis. The residual errors for the total PTV and mediastinum setups were both smaller than those with no image guidance. The lower heart region had more uncertainty with all 3 setup strategies. Margin analysis revealed that the magnitude of the margin is dependent on the imaging strategy, direction, and local region inside the PTV. Margins >7 mm are necessary to account for uncertainty in the neck, lower heart, and axilla regions even under daily CT guidance.
    Conclusions: Setup uncertainties in the mediastinum are not uniform and are dependent on target location and imaging strategy. However, with the appropriate margin, we can target regions that might not be visualized with the available on-board imager system.
    Language English
    Publishing date 2017-09-25
    Publishing country United States
    Document type Journal Article
    ZDB-ID 197614-x
    ISSN 1879-355X ; 0360-3016
    ISSN (online) 1879-355X
    ISSN 0360-3016
    DOI 10.1016/j.ijrobp.2017.09.036
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Clinical outcomes after local field conformal reirradiation of patients with retropharyngeal nodal metastasis.

    Pollard, Courtney / Nguyen, Theresa P / Ng, Sweet Ping / Frank, Steven J / Garden, Adam S / Gunn, Gary B / Fuller, Clifton D / Beadle, Beth M / Morrison, William H / Shah, Shah J / Wang, He / Tung, Sam / Wang, Conjun / Ginsberg, Lawrence D / Zafereo, Mark E / Sturgis, Erich M / Su, Shirley Y / Hanna, Ehab Y / Rosenthal, David I /
    Phan, Jack

    Head & neck

    2017  Volume 39, Issue 10, Page(s) 2079–2087

    Abstract: Background: The purpose of this study was to present our experience with retropharyngeal node reirradiation using highly conformal radiotherapy (RT).: Methods: A retrospective screen of 2504 consecutively irradiated patients with head and neck ... ...

    Abstract Background: The purpose of this study was to present our experience with retropharyngeal node reirradiation using highly conformal radiotherapy (RT).
    Methods: A retrospective screen of 2504 consecutively irradiated patients with head and neck malignancies between 2005 and 2015 identified 19 patients who underwent reirradiation for retropharyngeal node metastasis. Clinical and toxicity outcomes were assessed in these patients.
    Results: Thirteen patients (68%) had squamous cell carcinoma. Eleven patients (58%) received conventionally fractionated intensity-modulated radiotherapy (IMRT) or proton therapy, and 8 patients (42%) received single-fractionated or hypofractionated stereotactic RT. Fourteen patients (74%) received chemotherapy. Median follow-up was 14.7 months. The 1-year local control, locoregional control, overall survival, and progression-free survival rates were 100%, 94%, 92%, and 92%, respectively. Three patients (16%) experienced acute grade 3 toxicity and occurred in those treated with IMRT. There was no late grade ≥3 toxicity.
    Conclusion: Retropharyngeal node reirradiation with conformal therapy is well tolerated and associated with excellent short-term disease control.
    MeSH term(s) Combined Modality Therapy ; Female ; Head and Neck Neoplasms/pathology ; Head and Neck Neoplasms/radiotherapy ; Humans ; Lymph Nodes/pathology ; Lymphatic Metastasis ; Male ; Neoplasm Recurrence, Local ; Proton Therapy/adverse effects ; Proton Therapy/methods ; Radiosurgery/adverse effects ; Radiosurgery/methods ; Radiotherapy, Conformal/adverse effects ; Radiotherapy, Conformal/methods ; Re-Irradiation/adverse effects ; Re-Irradiation/methods ; Retrospective Studies ; Survival Rate ; Treatment Outcome
    Language English
    Publishing date 2017
    Publishing country United States
    Document type Journal Article
    ZDB-ID 645165-2
    ISSN 1097-0347 ; 0148-6403 ; 1043-3074
    ISSN (online) 1097-0347
    ISSN 0148-6403 ; 1043-3074
    DOI 10.1002/hed.24872
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 1493: Show issues Location:
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  4. Article: Intensity-modulated radiation therapy (IMRT) of cancers of the head and neck: comparison of split-field and whole-field techniques.

    Dabaja, Bouthaina / Salehpour, Mohammad R / Rosen, Isaac / Tung, Sam / Morrison, William H / Ang, K Kian / Garden, Adam S

    International journal of radiation oncology, biology, physics

    2005  Volume 63, Issue 4, Page(s) 1000–1005

    Abstract: Background: Oropharynx cancers treated with intensity-modulated radiation (IMRT) are often treated with a monoisocentric or half-beam technique (HB). IMRT is delivered to the primary tumor and upper neck alone, while the lower neck is treated with a ... ...

    Abstract Background: Oropharynx cancers treated with intensity-modulated radiation (IMRT) are often treated with a monoisocentric or half-beam technique (HB). IMRT is delivered to the primary tumor and upper neck alone, while the lower neck is treated with a matching anterior beam. Because IMRT can treat the entire volume or whole field (WF), the primary aim of the study was to test the ability to plan cases using WF-IMRT while obtaining an optimal plan and acceptable dose distribution and also respecting normal critical structures.
    Methods and materials: Thirteen patients with early-stage oropharynx cancers had treatment plans created with HB-IMRT and WF-IMRT techniques. Plans were deemed acceptable if they met the planning guidelines (as defined or with minor violations) of the Radiation Therapy Oncology Group protocol H0022. Comparisons included coverage to the planning target volume (PTV) of the primary (PTV66) and subclinical disease (PTV54). We also compared the ability of both techniques to respect the tolerance of critical structures.
    Results: The volume of PTV66 treated to >110% was less in 9 of the 13 patients in the WF-IMRT plan as compared to the HB-IMRT plan. The calculated mean volume receiving >110% for all patients planned with WF-IMRT was 9.3% (0.8%-25%) compared to 13.7% (2.7%-23.7%) with HB-IMRT (p = 0.09). The PTV54 volume receiving >110% of dose was less in 10 of the 13 patients planned with WF-IMRT compared to HB-IMRT. The mean doses to all critical structures except the larynx were comparable with each plan. The mean dose to the larynx was significantly less (p = 0.001), 18.7 Gy, with HB-IMRT compared to 47 Gy with WF-IMRT.
    Conclusions: Regarding target volumes, acceptable plans can be generated with either WF-IMRT or HB-IMRT. WF-IMRT has an advantage if uncertainty at the match line is a concern, whereas HB-IMRT, particularly in cases not involving the base of tongue, can achieve much lower doses to the larynx.
    MeSH term(s) Clinical Trials, Phase I as Topic/standards ; Clinical Trials, Phase II as Topic/standards ; Guidelines as Topic ; Head and Neck Neoplasms/diagnostic imaging ; Head and Neck Neoplasms/radiotherapy ; Humans ; Radiography ; Radiotherapy Planning, Computer-Assisted/methods ; Radiotherapy, Intensity-Modulated/methods ; Radiotherapy, Intensity-Modulated/standards
    Language English
    Publishing date 2005-11-15
    Publishing country United States
    Document type Comparative Study ; Journal Article
    ZDB-ID 197614-x
    ISSN 1879-355X ; 0360-3016
    ISSN (online) 1879-355X
    ISSN 0360-3016
    DOI 10.1016/j.ijrobp.2005.03.069
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Comparison of 2D radiographic images and 3D cone beam computed tomography for positioning head-and-neck radiotherapy patients.

    Li, Heng / Zhu, X Ronald / Zhang, Lifei / Dong, Lei / Tung, Sam / Ahamad, Anesa / Chao, K S Clifford / Morrison, William H / Rosenthal, David I / Schwartz, David L / Mohan, Radhe / Garden, Adam S

    International journal of radiation oncology, biology, physics

    2008  Volume 71, Issue 3, Page(s) 916–925

    Abstract: Purpose: To assess the positioning accuracy using two-dimensional kilovoltage (2DkV) imaging and three-dimensional cone beam CT (CBCT) in patients with head and neck (H&N) cancer receiving radiation therapy. To assess the benefit of patient-specific ... ...

    Abstract Purpose: To assess the positioning accuracy using two-dimensional kilovoltage (2DkV) imaging and three-dimensional cone beam CT (CBCT) in patients with head and neck (H&N) cancer receiving radiation therapy. To assess the benefit of patient-specific headrest.
    Materials and methods: All 21 patients studied were immobilized using thermoplastic masks with either a patient-specific vacuum bag (11 of 21, IMA) or standard clear plastic (10 of 21, IMB) headrests. Each patient was imaged with a pair of orthogonal 2DkV images in treatment position using onboard imaging before the CBCT procedure. The 2DkV and CBCT images were acquired weekly during the same session. The 2DkV images were reviewed by oncologists and also analyzed by a software tool based on mutual information (MI).
    Results: Ninety-eight pairs of assessable 2DkV-CBCT alignment sets were obtained. Systematic and random errors were <1.6 mm for both 2DkV and CBCT alignments. When we compared shifts determined by CBCT and 2DkV for the same patient setup, statistically significant correlations were observed in all three major directions. Among all CBCT couch shifts, 4.1% > or = 0.5 cm and 18.7% > or = 0.3 cm, whereas among all 2DkV (MI) shifts, 1.7% > or = 0.5 cm and 11.2% > or = 0.3 cm. Statistically significant difference was found on anteroposterior direction between IMA and IMB with the CBCT alignment only.
    Conclusions: The differences between 2D and 3D alignments were mainly caused by the relative flexibility of certain H&N structures and possibly by rotation. Better immobilization of the flexible neck is required to further reduce the setup errors for H&N patients receiving radiotherapy.
    MeSH term(s) Head and Neck Neoplasms/diagnostic imaging ; Head and Neck Neoplasms/radiotherapy ; Humans ; Imaging, Three-Dimensional/methods ; Radiographic Image Interpretation, Computer-Assisted/methods ; Reproducibility of Results ; Sensitivity and Specificity ; Tomography, Spiral Computed/methods
    Language English
    Publishing date 2008-07-01
    Publishing country United States
    Document type Comparative Study ; Evaluation Studies ; Journal Article ; 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.2008.01.008
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  6. Article: Disease-control rates following intensity-modulated radiation therapy for small primary oropharyngeal carcinoma.

    Garden, Adam S / Morrison, William H / Wong, Pei-Fong / Tung, Sam S / Rosenthal, David I / Dong, Lei / Mason, Brian / Perkins, George H / Ang, K Kian

    International journal of radiation oncology, biology, physics

    2007  Volume 67, Issue 2, Page(s) 438–444

    Abstract: Background: The purpose of this study was to assess the ability of intensity-modulated radiation therapy (IMRT) to achieve favorable disease-control rates while minimizing parotid gland doses in patients treated for small primary tumors of the ... ...

    Abstract Background: The purpose of this study was to assess the ability of intensity-modulated radiation therapy (IMRT) to achieve favorable disease-control rates while minimizing parotid gland doses in patients treated for small primary tumors of the oropharynx.
    Methods and materials: We retrospectively identified all patients who received IMRT as treatment for a small (<4 cm) primary tumor of the oropharynx between October 2000 and June 2002. Tumor characteristics, IMRT parameters, and patient outcomes were assessed.
    Results: Fifty-one patients met the criteria for our study. All patients had treatment to gross disease with margin (CTV1), and all but 1 had treatment to the bilateral necks. The most common treatment schedule (39 patients) was a once-daily fractionation of prescribed doses of 63-66 Gy to the CTV1 and 54 Gy to subclinical sites, delivered in 30 fractions. Twenty-one patients (40%) had gastrostomy tubes placed during therapy; in 4 patients, the tube remained in place for more than 6 months after completion of IMRT. The median follow-up was 45 months. The 2-year actuarial locoregional control, recurrence-free, and overall survival rates were 94%, 88%, and 94%, respectively.
    Conclusions: These preliminary data suggest that treatment with IMRT results in favorable locoregional control of small primary oropharynx tumors. IMRT did not appear to have a more favorable acute toxicity profile in this group with respect to the use of a feeding tube; however, the mean dose of radiation delivered to the parotid gland by IMRT was decreased, because 95% of patients had a mean dose of <30 Gy to at least one gland.
    MeSH term(s) Adult ; Aged ; Carcinoma/drug therapy ; Carcinoma/mortality ; Carcinoma/pathology ; Carcinoma/radiotherapy ; Combined Modality Therapy/methods ; Disease-Free Survival ; Dose Fractionation ; Female ; Humans ; Male ; Middle Aged ; Oropharyngeal Neoplasms/drug therapy ; Oropharyngeal Neoplasms/mortality ; Oropharyngeal Neoplasms/pathology ; Oropharyngeal Neoplasms/radiotherapy ; Parotid Gland/radiation effects ; Radiation Injuries/prevention & control ; Radiotherapy, Intensity-Modulated/methods ; Retrospective Studies ; Treatment Outcome
    Language English
    Publishing date 2007-02-01
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 197614-x
    ISSN 1879-355X ; 0360-3016
    ISSN (online) 1879-355X
    ISSN 0360-3016
    DOI 10.1016/j.ijrobp.2006.08.078
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