ScienceDirect Publication: Seminars in Radiation Oncology
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Introduction: Non?Small-Cell Lung Cancer and Pleural Malignancies: The End of...
3 Jun 2010 at 1:13pm
Publication year: 2010
Source: Seminars in Radiation Oncology, Volume 20, Issue 3, July 2010, Pages 147-148
Ramesh, Rengan , Stephen M., Hahn
Radiogenomics Predicting Tumor Responses to Radiotherapy in Lung Cancer
3 Jun 2010 at 1:13pm
Publication year: 2010
Source: Seminars in Radiation Oncology, Volume 20, Issue 3, July 2010, Pages 149-155
Amit K., Das , Marcus H., Bell , Chaitanya S., Nirodi , Michael D., Story , John D., Minna
The recently developed ability to interrogate genome-wide data arrays has provided invaluable insights into the molecular pathogenesis of lung cancer. These data have also provided information for developing targeted therapy in lung cancer patients based on the identification of cancer-specific vulnerabilities and set the stage for molecular biomarkers that provide information on clinical outcome and response to treatment. In addition, there are now large panels of lung cancer cell lines, both non?small-cell lung cancer and small-cell lung cancer, that have distinct chemotherapy and radiation response phenotypes. We anticipate that the integration of molecular data with therapy response data will allow...
The Tumor Microenvironment in Non?Small-Cell Lung Cancer
3 Jun 2010 at 1:13pm
Publication year: 2010
Source: Seminars in Radiation Oncology, Volume 20, Issue 3, July 2010, Pages 156-163
Edward E., Graves , Amit, Maity , Quynh-Thu, Le
The tumor microenvironment (TME) of NSCLC is heterogeneous with variable blood flow through leaky immature vessels resulting in regions of acidosis and hypoxia. Hypoxia has been documented in NSCLC directly by polarographic needle electrodes and indirectly by assessing tissue and plasma hypoxia markers. In general, elevated expression of these markers portends poorer outcomes in NSCLC. Impaired vascularity and hypoxia can lead to increased metastasis and treatment resistance. Compounds that directly target hypoxic cells such as tirapazamine have been tested in clinical trials for NSCLC with mixed results. Preclinical data, however, suggest other ways of exploiting the abnormal TME in NSCLC...
Image Guidance in Non?Small Cell Lung Cancer
3 Jun 2010 at 1:13pm
Publication year: 2010
Source: Seminars in Radiation Oncology, Volume 20, Issue 3, July 2010, Pages 164-170
B.C. John, Cho , Andrea, Bezjak , Laura A., Dawson
New imaging technologies have advanced our ability to treat lung cancers through enhanced and extended visualization of the tumor as well as patient and treatment response. Image guidance can reduce uncertainty by increasing precision and accuracy through improved patient selection, target delineation, and improved knowledge of nodal involvement. Conformal imaging-based radiotherapy (RT) can allow dose escalation. In the future, imaging may allow adaptive RT to be exploited in selected patients, especially those with large geometric changes occurring during RT. Furthermore, functional imaging, although in its infancy, has the potential to significantly improve RT, from RT planning and delivery to outcome...
Improving Radiation Conformality in the Treatment of Non?Small-Cell Lung Cancer
3 Jun 2010 at 1:13pm
Publication year: 2010
Source: Seminars in Radiation Oncology, Volume 20, Issue 3, July 2010, Pages 171-177
Joe Y., Chang , James D., Cox
One of the many challenges of lung cancer radiotherapy is conforming the radiation dose to the target because of tumor/organ motion and the need to spare surrounding critical structures. Evolving radiotherapy technologies, such as 4-dimensional image-based motion management, daily on-board imaging, and adaptive radiotherapy, have enabled us to improve the therapeutic index of radiation therapy for lung cancer by permitting the design of personalized treatments that deliver adequate doses conforming to the target while sparing the surrounding critical normal tissues. Four-dimensional computed tomography image-based motion management provides an opportunity to individualize target motion margins and reduce the risk of a...
The Treatment of Early-Stage Disease
3 Jun 2010 at 1:13pm
Publication year: 2010
Source: Seminars in Radiation Oncology, Volume 20, Issue 3, July 2010, Pages 178-185
Clifford G., Robinson , Jeffrey D., Bradley
For medically operable patients with stage I non?small-cell lung cancer (NSCLC), lobectomy or pneumonectomy remains the standard of care. The utility of radiotherapy or chemotherapy after major pulmonary resection remains unproven, though clinical and biological models may identify subgroups most likely to benefit. Limited resection results in higher rates of local failure for all but the most highly selected patients, though brachytherapy may reduce this risk. In medically inoperable patients, conventional radiotherapy results in control rates less than half of that achieved by surgery. Dose escalation and hypofractionation are technically feasible with modern planning and delivery, and appear to improve...
Combined Modality Therapy for Stage III Non?Small-Cell Lung Cancer
3 Jun 2010 at 1:13pm
Publication year: 2010
Source: Seminars in Radiation Oncology, Volume 20, Issue 3, July 2010, Pages 186-191
Cynthia S., Anderson , Walter J., Curran
With 40,000 to 50,000 patients diagnosed annually, stage III lung cancer represents approximately one third of all non?small-cell lung cancer cases. It is a heterogeneous disease stage encompassing stage IIIa, for which surgery in combination with chemotherapy and/or radiation therapy represents a treatment strategy for select patients, and stage IIIb, for which chemoradiation represents the prevailing standard of care. Overcoming unacceptably high rates of intrathoracic tumor failures remains a central obstacle. Current clinical trial efforts focus on targeted therapies, new chemotherapy regimens, dose-escalated radiation therapy, and improvements in radiation therapy treatment delivery.
Current Status of Postoperative Radiation for Non?Small-Cell Lung Cancer
3 Jun 2010 at 1:13pm
Publication year: 2010
Source: Seminars in Radiation Oncology, Volume 20, Issue 3, July 2010, Pages 192-200
Mert, Saynak , Daniel S., Higginson , David E., Morris , Lawrence B., Marks
Radiation therapy can increase local control and potentially improve survival in patients who have had resection for lung cancer. However, radiation therapy also has the potential to cause serious toxicity and should not be indiscriminately delivered. The PORT meta-analysis clearly illustrated the potential toxic effects of postoperative radiotherapy (PORT). Modern three-dimensional radiation treatment planning facilitates the design of treatment fields that more conformally treat the site(s) at risk, and this appears, based on limited data, to improve the therapeutic ratio of PORT. Moreover, systemic and local therapies are likely synergistic, and thus improvements in systemic staging and treatment may increase...
Radiation Pulmonary Toxicity: From Mechanisms to Management
3 Jun 2010 at 1:13pm
Publication year: 2010
Source: Seminars in Radiation Oncology, Volume 20, Issue 3, July 2010, Pages 201-207
Paul R., Graves , Farzan, Siddiqui , Mitchell S., Anscher , Benjamin, Movsas
The goal of radiation therapy is to reduce or eliminate tumor burden while sparing normal tissues from long-term injury. Thoracic radiation presents a unique challenge because of the inherent sensitivity of normal lung tissue to radiation. Damage to normal lung tissue presents a major obstacle in the treatment of individuals. To overcome this problem, a number of strategies are being used, including the modulation of dose volume, the use of image-guided radiotherapy, and the use of agents designed to reduce lung injury from radiation. Herein we discuss our current knowledge of the molecular and cellular events that occur after radiation...
Pleural Malignancies
3 Jun 2010 at 1:13pm
Publication year: 2010
Source: Seminars in Radiation Oncology, Volume 20, Issue 3, July 2010, Pages 208-214
Joseph S., Friedberg , Keith A., Cengel
Pleural malignancies, primary or metastatic, portend a grim prognosis. In addition to the serious oncologic implications of a pleural malignancy, these tumors can be highly symptomatic. A malignant pleural effusion can cause dyspnea, secondary to lung compression, or even tension physiology from a hydrothorax under pressure. The need to palliate these effusions is a seemingly straightforward clinical scenario, but with nuances that can result in disastrous complications for the patient if not attended to appropriately. Solid pleural malignancies can cause great pain from chest wall invasion or can cause a myriad of morbid symptoms because of the invasion of thoracic...
Adaptive Radiotherapy: Merging Principle Into Clinical Practice
27 Feb 2010 at 1:03pm
Publication year: 2010
Source: Seminars in Radiation Oncology, Volume 20, Issue 2, April 2010, Pages 79-83
Di, Yan
Adaptive Radiotherapy of Head and Neck Cancer
27 Feb 2010 at 1:03pm
Publication year: 2010
Source: Seminars in Radiation Oncology, Volume 20, Issue 2, April 2010, Pages 84-93
Pierre, Castadot , John A., Lee , Xavier, Geets , Vincent, Grégoire
Intensity-modulated radiation therapy (IMRT) in head and neck (H&N) cancer has the capability to generate steep dose gradients, leading to an improved therapeutic index. IMRT plans are typically based on a pretreatment computed tomography scan that provides a snapshot of the patient's anatomy. Nevertheless, interfractional patient variations may occur because of setup error and anatomical modifications. Therefore, the accuracy of IMRT delivery for H&N cancer may be compromised during the treatment course, potentially affecting the therapeutic index. In this framework, adaptive radiotherapy is a potential solution, which consists of ?the explicit inclusion of the temporal changes in anatomy during the...
Adaptive Radiotherapy for Lung Cancer
27 Feb 2010 at 1:03pm
Publication year: 2010
Source: Seminars in Radiation Oncology, Volume 20, Issue 2, April 2010, Pages 94-106
Jan-Jakob, Sonke , José, Belderbos
Lung cancer radiation therapy (RT) is associated with complex geometrical uncertainties, such as respiratory motion, differential baseline shifts between primary tumor and involved lymph nodes, and anatomical changes due to treatment response. Generous safety margins required to account for these uncertainties limit the potential of dose escalation to improve treatment outcome. Four dimensional inverse planning incorporating pretreatment patient-specific respiratory motion information into the treatment plan already improves treatment plan quality. More importantly, repetitive imaging during treatment quantifies patient-specific intrafraction, interfraction, and progressive geometrical variations. These patient-specific parameters subsequently can drive adaptive plan modification correcting for systematic errors while incorporating random...
Adaptive Management of Liver Cancer Radiotherapy
27 Feb 2010 at 1:03pm
Publication year: 2010
Source: Seminars in Radiation Oncology, Volume 20, Issue 2, April 2010, Pages 107-115
Kristy K., Brock , Laura A., Dawson
Adaptive radiation therapy for liver cancer has the potential to reduce normal tissue complications and enable dose escalation, allowing the potential for tumor control in this challenging site. Using adaptive techniques to tailor treatment margins to reflect patient-specific breathing motions and image-guidance techniques can reduce the high dose delivered to surrounding normal tissues while ensuring that the prescription dose is delivered to the tumor. Several treatment planning and delivery techniques have been developed for use in the liver, including a margin to encompass the full breathing motion, mean position techniques, which evaluate the probability of tumor location during breathing, breath...
Adaptive Management of Bladder Cancer Radiotherapy
27 Feb 2010 at 1:03pm
Publication year: 2010
Source: Seminars in Radiation Oncology, Volume 20, Issue 2, April 2010, Pages 116-120
Floris, Pos , Peter, Remeijer
Recently, the bladder preserving potential of radiotherapy for invasive bladder cancer (bladder RT) has been recognized, and there is a renewed interest to improve bladder RT. The pivotal problem in bladder RT is caused by organ motion: without image-guided radiotherapy (IGRT), generous margins in the range of 2-3 cm have to be applied to account for organ motion, implying large treatment volumes and dose-limiting toxicity. IGRT has the potential to substantially reduce those margins, and thereby reduce treatment volumes. This review summarizes the literature on organ motion and IGRT for bladder cancer, and several bladder-specific problems and IGRT strategies are...

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