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The objective of this study is to review a long-term single-institutional experience with helical tomotherapy (HT) for the radiotherapeutic management of head and neck cancer. From February 2006 to January 2013, a total of 301 consecutive patients with squamous cell carcinoma of the head and neck were treated with HT to a median dose of 66 Gy (range, 60 to 72 Gy). One hundred and seventy patients (56 %) underwent definitive HT and 131 patients (44 %) were treated post-operatively after surgery. There was no significant imbalance in patient or disease characteristics among patients treated with or without surgery (p> 0.05). Megavoltage computed tomography (MVCT) scans were obtained for patient alignment prior to each delivered fraction. Concurrent chemotherapy was administered to 133 patients (43 %). The 3-year estimates of overall survival, local-regional control, and disease-free survival were 76, 82, and 69 %, respectively. No difference existed with any of these endpoints among patients treated by definitive surgery versus radiation (p> 0.05). The incidence of grade 3+ acute toxicity was 30 %, with the most common related to skin erythema/desquamation, oral mucositis, esophagitis, dysguesia, and xerostomia. Post-HT esophageal stricture requiring dilatation was diagnosed in 12 %. Thirty (10 %) and 16 patients (5 %) were gastrostomy tube-dependent at 6 months and 1 year after HT, respectively. HT achieves clinical outcomes consistent with other IMRT methods and is an effective means of treatment for head neck cancer either as primary or post-operative therapy.

IMPORTANCE Radiation therapy to the head and neck has traditionally been associated with adverse effects that can affect oral health and physical functioning. Although intensity-modulated radiotherapy (IMRT) has been widely adopted as a means of decreasing toxic effects, limited clinical data exist on its potential effect on long-term quality of life. OBJECTIVE To analyze quality of life among long-term survivors of head and neck cancer treated with IMRT. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional analysis studied 50 consecutive long-term survivors of head and neck cancer from a comprehensive cancer center who had previously undergone IMRT that required bilateral neck irradiation for locally advanced disease. All patients were clinically without evidence of recurrent disease and had at least 5 years of follow-up. MAIN OUTCOMES AND MEASURES The University of Washington Quality of Life (UW-QOL) scores were reviewed for all study participants. The UW-QOL questionnaire consists of 12 domains that pertain to the degree of quality of life in the categories of pain, appearance, activity, recreation, swallowing, chewing, speech, shoulder function, taste, saliva, mood, and anxiety. RESULTS Five years after completion of IMRT, 42 patients (84%) reported that their health-related quality of life was “much better” or “somewhat better” than at the time of cancer diagnosis. With respect to recent health-related quality of life during the preceding 7 days at the time of completing the UW-QOL questionnaire, 40 patients (80%) treated with IMRT reported “outstanding” or “very good” levels of functioning. Five years after completion of treatment, 41 (82%) rated their overall quality of life as “outstanding” or “very good.” The lowest domain score on the UW-QOL questionnaire at 5 years pertained to salivary dysfunction. However, 42 patients (84%) reported saliva “of normal consistency” or “less saliva than normal but enough” compared with 8 (16%) reporting “too little saliva.” No patient reported having “no saliva.” CONCLUSIONS AND RELEVANCE Our findings add to the body of literature that supports the acceptance of IMRT as standard treatment for head and neck cancer. The fact that most 5-year survivors were satisfied with their quality of lives points to the ability of IMRT to preserve long-term functioning.

Intensity-modulated radiotherapy (IMRT) treatment plans generated by segmental multileaf collimator (SMLC) and helical tomotherapy (HT) techniques for patients with nasopharyngeal carcinoma were compared using standardized criteria proposed by Radiation Therapy Oncology Group (RTOG) protocol 0225. The goal was to deliver a prescribed dose of 70 Gy to at least 95% of the planning target volume (PTV) encompassing gross tumor, and 59.4 Gy and 50.4 Gy, respectively, to areas at high and low risk for microscopic disease, over 33 treatments while respecting constraints to organs at risk (OAR). HT-IMRT significantly reduced dose to the contralateral parotid gland and improved dose homogeneity to the PTVs. Mean doses to the inner and middle ears were also reduced by 18% and 24%, respectively, on the ipsilateral side, and 24%, and 35%, respectively, on the contralateral side using HT-IMRT compared to SMLC-IMRT. Additionally, HT-IMRT reduced mean doses to brainstem (p = 0.02), larynx (p = 0.03), and oral cavity (p = 0.03). These findings suggest that HT-IMRT may be of improve the therapeutic ratio in the radiotherapeutic treatment of nasopharyngeal carcinoma.

This paper reports a step-by-step shielding calculation recipe for a helical tomotherapy unit (TomoTherapy Inc., Madison, WI, USA), recently installed in an existing Varian 600C treatment room. Both primary and secondary radiations (leakage and scatter) are explicitly considered. A typical patient load is assumed. Use factor is calculated based on an analytical formula derived from the tomotherapy rotational beam delivery geometry. Leakage and scatter are included in the calculation based on corresponding measurement data as documented by TomoTherapy Inc. Our calculation result shows that, except for a small area by the therapists' console, most of the existing Varian 600C shielding is sufficient for the new tomotherapy unit. This work cautions other institutions facing the similar situation, where an HT unit is considered for an existing LINAC treatment room, more secondary shielding might be considered at some locations, due to the significantly increased secondary shielding requirement by HT.

The purpose of the study was to investigate the feasibility and the optimization of tomotherapy-based intensity-modulated radiation therapy (IMRT) in patients with head and neck cancer. From February 1997 to November 1997, 17 patients with squamous cell carcinoma of the head and neck were treated with IMRT. Patients were immobilized with a noninvasive mask and treated using a serial tomotherapy device on a 6 MV linear accelerator. Treatment planning was performed on a Peacock inverse planning system and prescription optimization was used to achieve the best plan for target coverage and parotid sparing. The treatment planning system process has a dosimetric characteristic of delivering different doses to different target structures simultaneously in each daily treatment; therefore, the biological equivalent dose was implemented using the linear-quadratic model to adjust the total dose to the target volume receiving a daily dose of less than 1.9 Gy. All eight patients with gross disease (six in the nasopharynx, two in the tonsil) and one patient with recurrent nasopharyngeal carcinoma received concurrent cisplatin chemotherapy. Six postoperative patients were treated with irradiation alone. Median follow-up was 2.2 years (range 2.6–1.8 years). All patients completed the prescribed treatment without unexpected interruption. Acute side effects were comparable to those of patients treated with conventional beam arrangements during the same period. No patient required gastrostomy during irradiation. The preliminary experience showed that the noninvasive immobilization mask yielded high positioning reproducibility for our patients. To spare the parotid gland, which is in the proximity of the target, a fraction of the target volume may not receive the prescribed dose. In the best-achievable plan of our studied cohort, only 27% ± 8% of parotid gland volumes were treated to more than 30 Gy, while an average of 3.3% ± 0.6% of the target volume received less than 95% of the prescribed dose. This is mainly related to the steep dose gradient in the region where the target abuts the parotid gland. The inverse planning system allowed us the freedom of weighting normal tissue-sparing and target coverage to select the best-achievable plan. Local control was achieved in eight patients with gross tumor; six were treated postoperatively. Of three reirradiated patients, two had symptomatic improvement but persistent disease, and one is without evidence of disease. In summary, a system for patient immobilization, setup verification, and dose optimization for head and neck cancer with parotid sparing without significantly compromising target coverage is being implemented for a tomotherapy-based IMRT plan at the Mallinckrodt Institute of Radiology. The initial clinical experience in tumor control is promising, and no severe adverse acute side effects have been observed. Further refining of delivery technology and the inverse planning system, gaining clinical experience to address target definition and dose inhomogeneity within the targets, and understanding the partial volume effect on normal tissue tolerance are needed for IMRT to excel in the treatment of head and neck cancer. Int. J. Cancer (Radiat. Oncol. Invest.) 90, 92–103, (2000). © 2000 Wiley-Liss, Inc.

Radiation therapy treatment planning and treatment delivery are in the process of changing dramatically over the next several years. This change has been driven in large part by continued advances in computer hardware and software and in medical imaging. Three-dimensional radiation treatment planning systems are rapidly being implemented in clinics around the world. These developments in turn have prompted manufacturers to employ advanced microcircuitry and computer technology to produce treatment delivery systems capable of precise shaping of dose distributions via computer-controlled multileaf collimators which cause the beam intensity to be varied across the beam. Image-based 3D planning and beam intensity modulated delivery systems show significant potential for improving the quality of radiotherapy and improving the efficiency with which radiation therapy can be planned and delivered. However, significant research and development work on these systems and their clinical use remains to be performed. The techniques used for the treatment planning and the methods used for quality assurance procedures and testing must all be revised and/or redesigned to allow efficient clinical use of these technological advances. Although much of the current 3D radiation therapy process requires interactive tasks (and some still very laborious) the path is clear toward solving the technological obstacles so that a nearly automated planning, delivery, and verification system will become a reality over the next decade. Such systems will allow radiation oncologists to significantly increase dose to many tumor sites while concomitantly lowering doses to critical organs-at-risk. Most of the tasks will be automated, thus lowering the overall costs currently needed to provide high-quality external beam radiation therapy.

Presents the short story 'The Anonymous/Anomalous Letters of Passion--The Saga of S. Vireo.'

Presents the short story 'The Vorago.'

Presents the short story 'Rapture.'

Presents a short story about a gay man.

Presents the short story 'Some of These Days.'

Presents an excerpt of the book 'The Candles of Your Eyes.'

Presents several poems. 'The Balcony'; 'A Voice'; 'Lines for an Unknown Lover.'

Presents the first chapter of a novel in progress to be published by Arbor House in 1977.

IMPORTANCE: Optimizing radiation therapy techniques for localized prostate cancer can affect patient outcomes. Dose escalation improves biochemical control, but no prior trials were powered to detect overall survival (OS) differences. OBJECTIVE: To determine whether radiation dose escalation to 79.2 Gy compared with 70.2 Gy would improve OS and other outcomes in prostate cancer. DESIGN, SETTING, AND PARTICIPANTS: The NRG Oncology/RTOG 0126 randomized clinical trial randomized 1532 patients from 104 North American Radiation Therapy Oncology Group institutions March 2002 through August 2008. Men with stage cT1b to T2b, Gleason score 2 to 6, and prostate-specific antigen (PSA) level of 10 or greater and less than 20 or Gleason score of 7 and PSA less than 15 received 3-dimensional conformal radiation therapy or intensity-modulated radiation therapy to 79.2 Gy in 44 fractions or 70.2 Gy in 39 fractions. MAIN OUTCOMES AND MEASURES: Time to OS measured from randomization to death due to any cause. American Society for Therapeutic Radiology and Oncology (ASTRO)/Phoenix definitions were used for biochemical failure. Acute (≤90 days of treatment start) and late radiation therapy toxic effects (>90 days) were graded using the National Cancer Institute Common Toxicity Criteria, version 2.0, and the RTOG/European Organisation for the Research and Treatment of Cancer Late Radiation Morbidity Scoring Scheme, respectively. RESULTS: With a median follow-up of 8.4 (range, 0.02-13.0) years in 1499 patients (median [range] age, 71 [33-87] years; 70% had PSA <10 ng/mL, 84% Gleason score of 7, 57% T1 disease), there was no difference in OS between the 751 men in the 79.2-Gy arm and the 748 men in the 70.2-Gy arm. The 8-year rates of OS were 76% with 79.2 Gy and 75% with 70.2 Gy (hazard ratio [HR], 1.00; 95% CI, 0.83-1.20; P = .98). The 8-year cumulative rates of distant metastases were 4% for the 79.2-Gy arm and 6% for the 70.2-Gy arm (HR, 0.65; 95% CI, 0.42-1.01; P = .05). The ASTRO and Phoenix biochemical failure rates at 5 and 8 years were 31% and 20% with 79.2 Gy and 47% and 35% with 70.2 Gy, respectively (both P < .001; ASTRO: HR, 0.59; 95% CI, 0.50-0.70; Phoenix: HR, 0.54; 95% CI, 0.44-0.65). The high-dose arm had a lower rate of salvage therapy use. The 5-year rates of late grade 2 or greater gastrointestinal and/or genitourinary toxic effects were 21% and 12% with 79.2 Gy and 15% and 7% with 70.2 Gy (P = .006 [HR, 1.39; 95% CI, 1.10-1.77] and P = .003 [HR, 1.59; 95% CI, 1.17-2.16], respectively). CONCLUSIONS AND RELEVANCE: Despite improvements in biochemical failure and distant metastases, dose escalation did not improve OS. High doses caused more late toxic effects but lower rates of salvage therapy. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00033631

Presents the short story 'Dawn.'

Presents the poem 'In a Deep Slumber.'

Presents the poems 'Jonathan to David,' 'Jan Erick, Alone:,' and 'Faint Honey.'