Innovations In Radiation Therapy Research Articles

The Radiation Therapy Technology Evidence Matrix: a framework to visualize evidence development for innovations in radiation therapy.

Clinical evidence is crucial in enabling the judicious adoption of technological innovations in radiation therapy (RT). Pharmaceutical evidence development frameworks are not useful for understanding how technical advances are maturing. In this paper, we introduce a new framework, the Radiation Therapy Technology Evidence Matrix (rtTEM), that helps visualize how the clinical evidence supporting new technologies is developing. The matrix is a unique 2D model based on the R-IDEAL clinical evaluation framework. It can be applied to clinical hypothesis testing trials, as well as publications reporting clinical treatment. We present the rtTEM and illustrate its application, using emerging and mature RT technologies as examples. The model breaks down the type of claim along the vertical axis and the strength of the evidence for that claim on the horizontal axis, both of which are inherent in clinical hypothesis testing. This simplified view allows for stakeholders to understand where the evidence is and where it is heading. Ultimately, the value of an innovation is typically demonstrated through superiority studies, which we have divided into three key categories - administrative, toxicity and control, to enable more detailed visibility of evidence development in that claim area. We propose the rtTEM can be used to track evidence development for new interventions in RT. We believe it will enable researchers and sponsors to identify gaps in evidence and to further direct evidence development. Thus, by highlighting evidence looked for by key policy decision makers, the rtTEM will support wider, timely patient access to high value technological advances.

RETRACTED: Laryngeal Function After Radiation Therapy

Laryngeal function after oncologic treatment is a key aspect and focus of interest in the contemporary management of head and neck cancers. Although historically the treatment of most locally advanced laryngeal cancers has been total laryngectomy, recent innovations in radiation therapy and combined chemotherapy and radiation therapy have shown that organ and function preservation can be achieved with good oncologic outcomes. Technical improvements, along with better understanding of tumor biology and dose tolerance of critical organs involved in speech and swallowing function, have paved the way for better outcomes. This article reviews in comprehensive detail the recent data of laryngeal function after radiotherapy.

WE‐G‐BRB‐01: The Importance of NIH Funding in Innovation in Radiation Therapy

Over the past 20 years the NIH has funded individual grants, program projects grants, and clinical trials which have been instrumental in advancing patient care. The ways that each grant mechanism lends itself to the different phases of translating research into clinical practice will be described. Major technological innovations, such as IMRT and proton therapy, have been advanced with R01‐type and P01‐type funding and will be discussed. Similarly, the role of program project grants in identifying and addressing key hypotheses on the potential of 3D conformal therapy, normal tissue‐guided dose escalation and motion management will be described. An overview will be provided regarding how these technological innovations have been applied to multi‐institutional NIH‐sponsored trials. Finally, the panel will discuss regarding which research questions should be funded by the NIH to inspire the next advances in radiation therapy.Learning Objectives: Understand the different funding mechanisms of the NIH Learn about research advances that have led to innovation in delivery Review achievements due to NIH‐funded program project grants in radiotherapy over the past 20 years Understand example advances achieved with multi‐institutional clinical trials NIH

WE-B-BRD-01: Innovation in Radiation Therapy Planning II: Cloud Computing in RT

As defined by the National Institute of Standards and Technology, cloud computing is “a model for enabling ubiquitous, convenient, on-demand network access to a shared pool of configurable computing resources (e.g., networks, servers, storage, applications, and services) that can be rapidly provisioned and released with minimal management effort or service provider interaction.” Despite the omnipresent role of computers in radiotherapy, cloud computing has yet to achieve widespread adoption in clinical or research applications, though the transition to such “on-demand” access is underway. As this transition proceeds, new opportunities for aggregate studies and efficient use of computational resources are set against new challenges in patient privacy protection, data integrity, and management of clinical informatics systems. In this Session, current and future applications of cloud computing and distributed computational resources will be discussed in the context of medical imaging, radiotherapy research, and clinical radiation oncology applications. Learning Objectives: 1. Understand basic concepts of cloud computing. 2. Understand how cloud computing could be used for medical imaging applications. 3. Understand how cloud computing could be employed for radiotherapy research.4. Understand how clinical radiotherapy software applications would function in the cloud.

WE-A-BRD-01: Innovation in Radiation Therapy Planning I: Knowledge Guided Treatment Planning

Intensity modulated radiation therapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) offer the capability of normal tissues and organs sparing. However, the exact amount of sparing is often unknown until the plan is complete. This lack of prior guidance has led to the iterative, trialand-error approach in current planning practice. Even with this effort the search for patient-specific optimal organ sparing is still strongly influenced by planner's experience. While experience generally helps in maximizing the dosimetric advantages of IMRT/VMAT, there have been several reports showing unnecessarily high degree of plan quality variability at individual institutions and amongst different institutions, even with a large amount of experience and the best available tools. Further, when physician and physicist evaluate a plan, the dosimetric quality of the plan is often compared with a standard protocol that ignores individual patient anatomy and tumor characteristic variations. In recent years, developments of knowledge models for clinical IMRT/VMAT planning guidance have shown promising clinical potentials. These knowledge models extract past expert clinical experience into mathematical models that predict dose sparing references at patient-specific level. For physicians and planners, these references provide objective values that reflect best achievable dosimetric constraints. For quality assurance, applying patient-specific dosimetry requirements will enable more quantitative and objective assessment of protocol compliance for complex IMRT planning. Learning Objectives: 1. Modeling and representation of knowledge for knowledge-guided treatment planning. 2. Demonstrations of knowledge-guided treatment planning with a few clinical caanatomical sites. 3. Validation and evaluation of knowledge models for cost and quality effective standardization of plan optimization.

When Hope Hinders Science and Patient-Centered Care

When Hope Hinders Science and Patient-Centered Care

Comparative Effectiveness Research for Prostate Cancer Radiation Therapy: Current Status and Future Directions

Comparative effectiveness research aims to help clinicians, patients and policymakers make informed treatment decisions under real-world conditions. Prostate cancer patients have multiple treatment options, including active surveillance, androgen deprivation therapy, surgery and multiple modalities of radiation therapy. Technological innovations in radiation therapy for prostate cancer have been rapidly adopted into clinical practice despite relatively limited evidence for effectiveness showing the benefit for one modality over another. Comparative effectiveness research has become an essential component of prostate cancer research to help define the benefits, risks and effectiveness of the different radiation therapy modalities currently in use for prostate cancer treatment.

Radiation therapy: state of the art and the future

Technical innovation in radiation therapy (RT) such as stereotactic irradiation, intensity modulated RT, image-guided RT, and brachytherapy using remote controlled after-loading system have made it possible to deliver ideally distributed radiation dose to the target with great accuracy, while sparing the adjacent organs at risk. As a result, tumor control rate by RT improved markedly and became excellent alternative to surgery for asymptomatic or mildly symptomatic brain tumors, early stage lung cancer, and low-risk prostate cancer. In locally advanced stage of cancer, randomized controlled trials established the chemoradiation therapy as a standard treatment option for patients with head and neck cancer, lung cancer, esophageal cancer, and cervical cancer. RT is also a valuable treatment for palliation of local symptoms caused by cancer with consistently high response rates. Minimally invasive therapy has come to be emphasized its needs in the background of increased tendency of elderly patients with cancer, and advances in conformal dose delivery technique raise the RT at a more important position in cancer therapy. However, adequate number of RT profession is indispensable to utilize highly-sophisticated RT technology. Substantiality of an education system for radiation oncologist, RT technologist, and medical physicists is our current most important issue.

Innovations in radiation therapy (RT) for breast cancer

The EBCTCG has clearly demonstrated that the use of RT after either breast conserving surgery (BCS) or after mastectomy in node-positive patients not only reduces local recurrence (LR), but also improves long-term survival. The EBCTCG specifically found that the absolute reduction in the 5-year rate of LR was proportional to the absolute reduction in 15-year breast cancer mortality with a 4:1 ratio. Studies from the EBCTCG have also clearly shown that when RT for breast cancer inadvertently delivers 'excessive' dose to the heart, there is an increased rate of late cardiac deaths. Over time, LR rates with RT have decreased, particularly after BCS, and this is largely due to a favorable interaction of RT with adjuvant systemic therapy. There is new information emerging about the effectiveness of RT based on newer biologic classification of breast cancer and about how the 4:1 ratio might change in the face of increasingly effective systemic therapy and with a better understanding of the importance of biologic classification and of the competing risks of local and distant recurrence. Technical innovations in RT include the development of techniques that minimize cardiac irradiation. It is critical that CT simulation be done during which the heart should be contoured and the radiation dose-cardiac volume relationship be determined. In the EBCTCG's preliminary analysis, increased late cardiac deaths were most closely linked to mean cardiac doses >5 Gy. A number of techniques are available to minimize cardiac dose both after BCS and mastectomy and these will be described. There has also been development of fractionation and treatment techniques to complete RT faster for purposes of patient convenience and to assure its optimal level of use. There are now 10-year results from a Canadian trial showing equivalent LR and cosmetic outcome with RT using the conventional 25 treatments to the whole breast compared to 16 treatments using a higher dose per day. Few randomized patients, however, were treated with adjuvant chemotherapy and a boost was not used. The generalizability of the Canadian trial results to patients treated with adjuvant chemotherapy or requiring a boost is not known. For patients treated after BCS, there has been great interest in the use of accelerated partial breast irradiation (APBI), which can be accomplished using interstitial, intracavitary, external-beam or intraoperative techniques. Clinical trials are now underway to compare APBI to conventional techniques, but mature results from these trials will not be available for some time. In the U.S., ASTRO has developed a consensus statement based on an expert panel as to when APBI can be reasonably used outside of a clinical trial and this will be described.

S32 Innovations in radiation therapy (RT) for breast cancer

S32 Innovations in radiation therapy (RT) for breast cancer

Potential for Radiation Therapy Technology Innovations to Permit Dose Escalation for Non–Small-Cell Lung Cancer

BACKGROUND: Innovations in radiation therapy (RT) technology could have the potential to allow for radiation dose escalation by evaluating tumor motion, minimizing and compensating for motion, and evaluating delivery technologies such as 3-dimensonal (3D) conformal radiation therapy (CRT) and intensity-modulated RT (IMRT) using tomotherapy. MATERIALS AND METHODS: Ninety different RT plans were generated using 3 different treatment techniques for 10 patients. These were evaluated using dosimetric tools such as dose-volume histogram (DVH) analysis, tumor equivalent uniform dose (EUD), and dosimetric parameters predictive for lung toxicity, such as the volume of lung receiving > 20 Gy of radiation (V20) and the normalized mean total radiation dose to the lung (NTDmean). The 3 techniques studied included free breathing using 3D CRT, 3D CRT with maximum-inspiration breath-hold (MIBH) to minimize tumor motion, and IMRT delivery with MIBH; the combination of 3 separate planning treatment-volume sets resulted in the generation of 90 different treatment plans. To plan these, patients underwent treatment-planning computed tomography in MIBH and free breathing followed by simulation with measurement of tumor motion and generation/evaluation of DVHs, EUDs, V20, and NTDmean. RESULTS: Average tumor motion was 1.54 cm in the cephalocaudad directions, 1.26 cm in the anteroposterior directions, and 0.56 cm in the lateral directions between maximum inspiration and expiration. Maximum-inspiration breath-hold produced superior lung sparing evidenced by lower V20 and NTDmean values, and these parameters predicted lower modeled pneumonitis rates. Tomotherapy-based IMRT provided further lung sparing. CONCLUSION: Treatment in MIBH results in lower V20 and NTDmean values and lower modeled pneumonitis rates. This effect is enhanced by the use of IMRT. The use of MIBH with IMRT may therefore aid in escalating the dose in RT.

Innovations in Radiation Therapy

Pearson¹⁷has shown that radiation is the best method of treatment for esophageal cancer; even so, only 20% of his patients treated on a radical basis survived five years. His results are even more remarkable when one considers that these patients were surgical rejects; however, their disease was not so advanced as to be suitable for palliative treatment only. Few, if any, comparable results have been achieved by other radiotherapists, and no surgical series comes near to these results. It is important to ask why Pearson could achieve such outstanding results. A critical review of the experience at Toronto²⁰suggests the following conclusions: A Supervoltage is essential. While cobalt 60 is probably adequate, it is certainly the minimal energy level to give. X-rays of 20 to 25 mev are undoubtedly better for two reasons: they deliver better depth dose and consequently spare more lung tissue; they are affected

Cancer of the gastrointestinal tract. II. Esophagus: Treatment--localized and advanced. Innovations in radiation therapy

Cancer of the gastrointestinal tract. II. Esophagus: Treatment--localized and advanced. Innovations in radiation therapy