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Abstract: Purpose: To report our institutional experience using image-guided stereotactic body radiation therapy (SBRT) for early stage lung cancer, including an analysis into factors associated with nodal and distant failures (NF, DF). Methods: Forty-eight patients with early-stage primary lung cancer were treated with image-guided SBRT between 2007 and 2009. Median prescription dose was 48Gy in 4 fractions. Toxicity was graded according to the NCI CTCAE v3.0 scale. Results: Local failure was detected in two lesions and actuarial 24-month local control was 95%. At 24months, the cumulative incidence of NF was 6%, and DF was 29%. Larger lesions (>3cm) and younger age (<70years) were the only factors found to be significantly correlated with increased DF (p =0.005 and p =0.015, respectively). A single grade⩾3 toxicity was observed. After adjusting for age and lesion size, distant failure was significantly associated with a poorer OS (Cox regression, p =0.0059). Conclusion: Image-guided SBRT can produce excellent LC rates with minimal toxicity. Distant failure was a major determinant of OS and the most common pattern of failure, indicating a potential role for systemic therapy in younger patients with large lesions. [Copyright &y& Elsevier]

Purpose: To report on the acute and late gastrointestinal (GI) and genitourinary (GU) toxicity associated with a unique technique of image-guided radiotherapy (IGRT) in patients undergoing postprostatectomy irradiation. Methods and Materials: Fifty patients were treated with intensity-modulated radiation therapy (IMRT) after radical prostatectomy. Daily image guidance was performed to localize the prostate bed using kilovoltage imaging or cone-beam computed tomography. The median prescription dose was 68 Gy (range, 62–68 Gy). Toxicity was graded every 3 to 6 months according to the Common Terminology Criteria for Adverse Events version 3.0. Results: The median follow-up was 24 months (range, 13–38 months). Grade 2 acute GI and GU events occurred in 4 patients (8%) and 7 patients (14%), respectively. No Grade 3 or higher acute GI or GU toxicities were observed. Late Grade 2 GI and GU events occurred in 1 patient (2%) and 8 patients (16%), respectively. Only a single (2%) Grade 3 or higher late toxicity was observed. Conclusions: Image-guided IMRT in the postprostatectomy setting is associated with a low frequency of acute and late GI/GU toxicity. These results compare more favorably to radiotherapy techniques that do not use in-room image-guidance, suggesting that daily prostate bed localization may reduce the incidence of adverse events in patients undergoing postprostatectomy irradiation. [Copyright &y& Elsevier]

Our purpose was to investigate the effect of physicist-patient consults on patient anxiety and patient satisfaction with a randomized prospective phase III clinical trial. Sixty-six patients were randomly assigned to the physics direct patient care (PDPC) arm or the control arm of the trial. Patients assigned to the PDPC arm received 2 physicist-patient consults to educate them on the technical aspects of their radiation therapy, while patients assigned to the control arm received the standard of care (ie, standard radiation therapy workflow without any additional physicist-patient consults). Questionnaires were administered to all patients at 4 time points (after enrollment, after the simulation, after the first treatment, and after the last treatment) to assess anxiety and satisfaction. The decrease in anxiety for the PDPC arm, compared with the control arm, was statistically significant at the first treatment (P =.027) time point. The increase in technical satisfaction for the PDPC arm, compared with the control arm, was statistically significant at the simulation (P =.005), first treatment (P <.001), and last treatment (P =.002) time points. The increase in overall satisfaction for the PDPC arm, compared with the control arm, was statistically significant at the first treatment (P =.014) and last treatment (P =.001) time points. Physicist-patient consults improved the patient experience by decreasing anxiety and increasing satisfaction. Future work is needed to modify current radiation oncology workflows and medical physics responsibilities to allow all patients to benefit from this advancement in patient care. [ABSTRACT FROM AUTHOR]

Background: The lung is a common site of extracranial metastases. Frameless Stereotactic Body Radiation Therapy (SBRT) is a promising new therapy for non surgically resectable neoplastic lung lesions used at our institution. Methods: A retrospective study of 21 patients and 33 lesions treated with SBRT was done. Local control (LC), distant control (DC), progression-free survival (PFS) and overall survival (OS) were analyzed using the Kaplan-Meier method. Potential prognostic factors were analyzed using the log-rank test and Cox regression. Toxicities were also reported. Results: Actuarial local control rates by lesions were 88% (95% confidence interval [CI], 77-99%) and 76% (95% CI, 59-92%) at 12-and 24-months, respectively. Actuarial local control rates by patients was 80% (95% CI, 62-98%) and 71% (95% CI, 43-100%) for 12- and 24-months, respectively. DC rates were 52% (95% CI 31-74%) and 38% (95% CI, 15-61%), at 12- and 24-months respectively. PFS rates were 52% (95% CI 31-74%) and 32% (95% CI 9-55%) at 12- and 24-months, respectively. Overall survival rates were 90% (95% CI 77-100%) and 78% (95% CI 59-97%) at 12- and 24-months, respectively. Single metastasis was associated with better PFS (p=0.023). No toxicities greater than CTCAE grade 3 were observed. Conclusions: Frameless SBRT achieves acceptable control in pulmonary metastatic lesions with an excellent toxicity profile. [ABSTRACT FROM AUTHOR]

Background. Lung is a common site of extracranial metastases. Frameless Stereotactic Body Radiation Therapy (SBRT) is a promising new therapy for unresectable neoplastic lung lesions used at our institution. Methods. A retrospective study of 21 patients and 33 lesions treated with SBRT was done. Local control (LC), distant control (DC), progression-free survival (PFS) and overall survival (OS) were analyzed using the Kaplan-Meier method. Potential prognostic factors were analyzed using the log-rank test and Cox regression. Toxicities were also reported. Results. Actuarial local control rates by lesions were 88% (95% confidence interval [CI], 77-99%) and 76% (95% CI, 59-92%) at 12-and 24-months, respectively. Actuarial local control rates by patients was 80% (95% CI, 62-98%) and 71% (95% CI, 43-100%) for 12- and 24-months, respectively. DC rates were 52% (95% CI 31-74%) and 38% (95% CI, 15-61%), at 12- and 24-months respectively. PFS rates were 52% (95% CI 31-74%) and 32% (95% CI 9-55%) at 12- and 24-months, respectively. Overall survival rates were 90% (95% CI 77-100%) and 78% (95% CI 59-97%) at 12- and 24-months, respectively. Single metastasis was associated with better PFS (p=0.023). No toxicities greater than CTCAE grade 3 were observed. Conclusions. Frameless SBRT achieves acceptable control in pulmonary metastatic lesions with an excellent toxicity profile. [ABSTRACT FROM AUTHOR]

Radiotherapy has a well-established role in the management of head and neck cancers. Over the past decade, a variety of new imaging modalities have been incorporated into the radiotherapy planning and delivery process. These technologies are collectively referred to as image-guided radiotherapy and may lead to significant gains in tumor control and radiation side effect profiles. In the following review, these techniques as they are applied to head and neck cancer patients are described, and clinical studies analyzing their use in target delineation, patient positioning, and adaptive radiotherapy are highlighted. Finally, we conclude with a brief discussion of potential areas of further radiotherapy advancement. [ABSTRACT FROM AUTHOR]