2,107 results on '"Rimner A"'
Search Results
602. 3. Grounds of Objection: India, America, Asia
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Steffen Rimner
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History ,Economic history ,World history - Published
- 2018
603. 1. Thunders before the Storm
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Steffen Rimner
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History ,Climatology ,Storm - Published
- 2018
604. 5. The Japanese Blueprint and Its American Discovery
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Steffen Rimner
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History ,Blueprint ,Library science ,World history - Published
- 2018
605. 2. The Porosity of International Law
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Steffen Rimner
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Geotechnical engineering ,World history ,International law ,Porosity ,Geology - Published
- 2018
606. 4. Britain’s Last Defense: The Anti-Opium Cause on Trial
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Steffen Rimner
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History ,medicine ,Opium ,World history ,Ancient history ,medicine.drug - Published
- 2018
607. 7. The Drugs of War: Germany, Japan, and the Morphine Threat
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Steffen Rimner
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Political science ,Economic history ,Morphine ,medicine ,World history ,medicine.drug - Published
- 2018
608. Radiation Therapy in Mesothelioma
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Andreas Rimner and Jonas Willmann
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Radiation therapy ,Oncology ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Internal medicine ,medicine ,Mesothelioma ,medicine.disease ,business - Published
- 2018
609. Opium’s Long Shadow
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Steffen Rimner
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- 2018
610. MA06.08 A Safety Study of Avelumab plus SBRT in Malignant Mesothelioma
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A. Rimner, E. Yorke, D. Gelblum, A. Shepherd, D. Guttmann, A. Iqbal, R. Daly, M. Offin, J. Fiore, A. Namakydoust, H. Li, M. Mccune, E. Gelb, N. Taunk, D. Von Reibnitz, P. Adusumilli, M.S.K. Center, and M. Zauderer
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Pulmonary and Respiratory Medicine ,Oncology ,Avelumab ,medicine.medical_specialty ,business.industry ,Internal medicine ,Medicine ,Mesothelioma ,business ,medicine.disease ,medicine.drug - Published
- 2021
611. P02.14 Radiotherapy-Associated CT Imaging as a Potential Screening Tool for COVID-19
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Andrew J. Plodkowski, Michelle S. Ginsberg, Daniel R. Gomez, Annemarie F. Shepherd, P. Gilbo, Narek Shaverdian, Y. Yue, Andreas Rimner, Quincey LaPlant, Abraham J. Wu, Lior Z. Braunstein, V. Ng, J.Y. Shin, and Daphna Y. Gelblum
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Lung ,business.industry ,Radiography ,Concordance ,medicine.medical_treatment ,Cancer ,medicine.disease ,Asymptomatic ,Article ,Radiation therapy ,Pneumonia ,medicine.anatomical_structure ,Oncology ,Medicine ,Radiology ,medicine.symptom ,business ,Radiation treatment planning - Abstract
Introduction: COVID-19 is associated with characteristic lung CT findings, such as rounded ground-glass opacities in certain distributions Diagnosing COVID-19 is a particular concern in oncology care, since cancer patients are a vulnerable population who receive treatment in close proximity to other patients and staff Radiotherapy patients routinely undergo CT simulation before starting therapy We hypothesized that simulation CT scans obtained on patients treated during the pandemic would reveal characteristic COVID-19 findings and represent a tool to identify patients with asymptomatic COVID-19 Methods: We reviewed patients undergoing CT simulation during a six-week period (March 1 to April 13, 2020) at a major tertiary cancer center located in an early epicenter of the COVID-19 pandemic in the United States Most scans were done under free-breathing conditions, with slice thickness ≤3mm and without IV contrast All scans were reviewed according to the RSNA classification of COVID-19 lung CT findings (“typical,” “indeterminate,” “atypical,” or “negative” for COVID-19 pneumonia) by radiation oncologists who had been trained by a diagnostic radiologist All “typical” or “indeterminate” scans were considered suspicious and re-reviewed by a board-certified diagnostic radiologist Radiographic classifications were then compared with available COVID-19 PCR test results A one-tailed T test was used to compare the rate of positive COVID-19 tests in the radiographically suspicious vs non-suspicious groups Results: 414 CT simulation scans that included the lungs were performed on 400 patients during the study period 119 patients (corresponding to 130 scans, or 31 4%) had COVID-19 PCR test results available The most common cancer types were breast (37%), lung/thoracic (23%), and spine (21%) On initial review by radiation oncologists, 17 scans (4 1%), were deemed “typical” for COVID-19 pneumonia, 54 (13%) were “indeterminate,” 85 (21%) were “atypical,” and 258 (62 3%) were “negative ” Of the 71 suspicious (typical or indeterminate) scans, 23 had corresponding COVID-19 test results, of which 3 (15 7%) were positive for infection 107 non-suspicious (atypical or negative) scans had corresponding COVID-19 test results, and 9 were positive (8 4%) This difference in COVID-19 positivity between radiographically suspicious and non-suspicious groups was not statistically significant (p=0 23) Upon re-review by a diagnostic radiologist, 25 (35%) of the suspicious scans were still deemed suspicious while the majority (n=46, or 65%) were deemed “atypical ” Conclusion: Simulation CT scans obtained for radiation treatment planning can be reviewed for signs of COVID-19 pneumonia About 17% of patients simulated in our metropolitan pandemic epicenter demonstrated findings suspicious for COVID-19 when reviewed by radiation oncologists according to consensus criteria However, few of these patients proved to have COVID-19 infections based on PCR testing, and there was no significant correlation between radiographically suspicious simulation CT scans and COVID-19 positivity in this study Analysis was limited by the lack of available COVID-19 test results in many patients The concordance between radiographic classification by radiation oncologists vs diagnostic radiologists was also low These results suggest that routine review of radiotherapy simulation CT scans is of limited value in identifying asymptomatic COVID-19 infection Keywords: COVID-19, radiotherapy, CT
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- 2021
612. P05.10 Risk Factors Associated with Pulmonary Toxicities from Multiple Courses of Lung Stereotactic Body Radiation Therapy (SBRT)
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Narek Shaverdian, A. Jackson, Daphna Y. Gelblum, Andreas Rimner, Xiaoyu Li, Charles B. Simone, Abraham J. Wu, Annemarie F. Shepherd, Y. Yue, Ellen Yorke, and Daniel R. Gomez
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Lung ,medicine.anatomical_structure ,Oncology ,Stereotactic body radiation therapy ,business.industry ,medicine ,Radiology ,business - Published
- 2021
613. Genomic Analyses for Predictors of Response to Chemoradiation in Stage III Non-Small Cell Lung Cancer
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Andreas Rimner, M. Sonnick, F. Oro, L. Luo, Jamie E. Chaft, Abraham J. Wu, R. Dick-Godfrey, Daniel R. Gomez, Robert M. Samstein, Narek Shaverdian, C. Wang, Paul K. Paik, and Baho Sidiqi
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lcsh:Medical physics. Medical radiology. Nuclear medicine ,Oncology ,medicine.medical_specialty ,DNA damage ,lcsh:R895-920 ,medicine.medical_treatment ,lcsh:RC254-282 ,DNA sequencing ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Scientific Article ,Radiology, Nuclear Medicine and imaging ,Stage (cooking) ,Gene ,Chemotherapy ,Proportional hazards model ,business.industry ,Hazard ratio ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,030220 oncology & carcinogenesis ,Cohort ,business - Abstract
Background: Radiation with platinum-based chemotherapy is the standard of care for unresectable stage III non-small cell lung cancer (NSCLC). Despite aggressive treatment, progression-free survival and overall survival remain poor. It is unclear whether any tumor genetic mutations are associated with response to chemoradiation therapy. Methods: We retrospectively reviewed clinical outcomes of patients with stage III NSCLC treated with definitive radiation who had undergone tumor molecular profiling through a next-generation DNA sequencing platform. Cox proportional hazards model was used to investigate associations between clinical outcomes and genetic mutations detected by next-generation sequencing. Results: 110 patients were identified with stage III NSCLC and underwent definitive radiation between 2013 and 2017 and tumor molecular profiling. Concurrent or sequential chemotherapy was given in 104 patients (95%). Unbiased genomic analyses revealed a significant association between AKT2 mutations and decreased local-regional tumor control and overall survival (hazard ratios [HR] 12.5 and 13.7, P = .003 and P = .003, respectively). Analyses restricted to loss-of-function mutations identified KMT2C and KMT2D deleterious mutations as negative prognostic factors for overall survival (HR 13.4 and 7.0, P < .001 and P < .001, respectively). Deleterious mutations in a panel of 38 DNA damage response and repair pathway genes were associated with improved local-regional control (HR 0.32, P = .049). Conclusions: This study coupled multiplexed targeted sequencing with clinical outcome and identified mutations in AKT2, KMT2C, and KMT2D as negative predictors of local-regional control and survival, and deleterious mutations in damage response and repair pathway genes were associated with improved local-regional disease control after chemoradiation therapy. These findings will require validation in a larger cohort of patients with prospectively collected and detailed clinical information.
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- 2021
614. EP16.01-04 Standardized Screening of Thoracic Oncology Patients for Clinical Trial Eligibility Increases Enrollment.
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Cislo, M.A., Mcmillan, M., Shaverdian, N., Simone, C., Gelblum, D., Khan, A., Rimner, A., Burleigh, A., Navarro, K., Spielsinger, D., and Gomez, D.
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- 2023
- Full Text
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615. Phase II Study of Hemithoracic Intensity-Modulated Pleural Radiation Therapy (IMPRINT) for Patients with Pleural Metastases from Thymic Malignancies.
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Rimner, A., Huang, J., Pagano, A., Ginsberg, M., Chang, J., Riely, G., Simone II, C.B., Gomez, D.R., and Shepherd, A.F.
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RADIOTHERAPY , *RADIATION pneumonitis , *METASTASIS , *THYMUS tumors , *PLEURA diseases , *PERICARDIUM diseases - Abstract
Pleural metastases are common sites for recurrence and progression in patients with thymic malignancies. The management of pleural metastases typically involves surgical resection with or without neoadjuvant or adjuvant systemic therapy. After surgical resection of pleural metastases, the 5-year progression-free survival (PFS) rate is about 29-45%. While radiation therapy (RT) is standardly used in the management of locally-advanced thymic malignancies, the role of RT in patients with pleural metastases in unclear. Intensity-modulated pleural radiation therapy (IMPRINT) is a RT technique currently being used to treat malignant pleural mesothelioma (MPM) patients with 2 intact lungs at centers that specialize in MPM treatment. This IMPRINT technique can potentially be extrapolated to thymic patients with pleural metastases. Because the risk of toxicity is of greater concern for thymic patients given their overall relatively favorable prognosis, the rate of toxicity, particularly radiation pneumonitis, needs to be established in the thymic patient population. This is a single-arm, single institution Phase II study of hemithoracic IMPRINT for patients with pleural metastases from thymic malignancies. The primary endpoint of this study is grade 3 or higher radiation pneumonitis within 4 months of completing RT. Secondary endpoints include any toxicity, progression-free survival, patterns of failure and overall survival. Patients must have a pathologically confirmed diagnosis of a thymic malignancy with radiologic or pathologic evidence of pleural metastases. Thymoma or thymic carcinoma are allowed. Patients may have de novo stage IVA disease or recurrent disease in the pleura. There must be no evidence of extrathoracic metastatic disease or contralateral pleural/pericardial disease. Surgical resection of the pleural nodules (ex: pleurectomy/decortication, debulking/metastasectomy) are allowed. Extrapleural pneumonectomy is not allowed. Patients are excluded if they have undergone prior thoracic radiation therapy preventing hemithoracic pleural IMRT, whereas prior thymic bed radiation and/or prior pleural SBRT are allowed. RT will be administered to the ipsilateral pleura to 50.4 Gy in 28 fractions. An optional dose-painting boost to gross disease up to 60 Gy while respecting normal tissue constraints is allowed. Patients can be treated with photon or proton therapy. Simulation, contouring and RT planning guidelines have been developed. Patients will be followed per protocol at regular intervals for at least 12 months following RT. The expected accrual is 36 patients over 4 years. Further information can be found on clinicaltrials.gov (NCT05354570). To be determined. To be determined. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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616. Concomitant hairy cell and acute myeloid leukemia
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Rimner, T., Went, P., Tichelli, A., and Gratwohl, A.
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- 2006
617. Relevance and mechanism of oxysterol stereospecifity in coronary artery disease
- Author
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Rimner, Andreas, Al Makdessi, Samar, Sweidan, Hicham, Wischhusen, Jörg, Rabenstein, Björn, Shatat, Khaula, Mayer, Petra, and Spyridopoulos, Ioakim
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- 2005
- Full Text
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618. The Impact of Durvalumab on Local-Regional Control in Stage III NSCLCs Treated With Chemoradiation and on KEAP1-NFE2L2-Mutant Tumors.
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Shaverdian, Narek, Offin, Michael, Shepherd, Annemarie F., Simone II, Charles B., Gelblum, Daphna Y., Wu, Abraham J., Hellmann, Matthew D., Rimner, Andreas, Paik, Paul K., Chaft, Jamie E., Gomez, Daniel R., and Simone, Charles B 2nd
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- 2021
- Full Text
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619. Deep cross‐modality (MR‐CT) educed distillation learning for cone beam CT lung tumor segmentation.
- Author
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Jiang, Jue, Riyahi Alam, Sadegh, Chen, Ishita, Zhang, Perry, Rimner, Andreas, Deasy, Joseph O., and Veeraraghavan, Harini
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CONE beam computed tomography ,MAGNETIC resonance imaging ,NOMOGRAPHY (Mathematics) ,LUNG tumors ,DEEP learning ,DISTILLATION - Abstract
Purpose: Despite the widespread availability of in‐treatment room cone beam computed tomography (CBCT) imaging, due to the lack of reliable segmentation methods, CBCT is only used for gross set up corrections in lung radiotherapies. Accurate and reliable auto‐segmentation tools could potentiate volumetric response assessment and geometry‐guided adaptive radiation therapies. Therefore, we developed a new deep learning CBCT lung tumor segmentation method. Methods: The key idea of our approach called cross‐modality educed distillation (CMEDL) is to use magnetic resonance imaging (MRI) to guide a CBCT segmentation network training to extract more informative features during training. We accomplish this by training an end‐to‐end network comprised of unpaired domain adaptation (UDA) and cross‐domain segmentation distillation networks (SDNs) using unpaired CBCT and MRI datasets. UDA approach uses CBCT and MRI that are not aligned and may arise from different sets of patients. The UDA network synthesizes pseudo MRI from CBCT images. The SDN consists of teacher MRI and student CBCT segmentation networks. Feature distillation regularizes the student network to extract CBCT features that match the statistical distribution of MRI features extracted by the teacher network and obtain better differentiation of tumor from background. The UDA network was implemented with a cycleGAN improved with contextual losses separately on Unet and dense fully convolutional segmentation networks (DenseFCN). Performance comparisons were done against CBCT only using 2D and 3D networks. We also compared against an alternative framework that used UDA with MR segmentation network, whereby segmentation was done on the synthesized pseudo MRI representation. All networks were trained with 216 weekly CBCTs and 82 T2‐weighted turbo spin echo MRI acquired from different patient cohorts. Validation was done on 20 weekly CBCTs from patients not used in training. Independent testing was done on 38 weekly CBCTs from patients not used in training or validation. Segmentation accuracy was measured using surface Dice similarity coefficient (SDSC) and Hausdroff distance at 95th percentile (HD95) metrics. Results: The CMEDL approach significantly improved (p < 0.001) the accuracy of both Unet (SDSC of 0.83 ± 0.08; HD95 of 7.69 ± 7.86 mm) and DenseFCN (SDSC of 0.75 ± 0.13; HD95 of 11.42 ± 9.87 mm) over CBCT only 2DUnet (SDSC of 0.69 ± 0.11; HD95 of 21.70 ± 16.34 mm), 3D Unet (SDSC of 0.72 ± 0.20; HD95 15.01 ± 12.98 mm), and DenseFCN (SDSC of 0.66 ± 0.15; HD95 of 22.15 ± 17.19 mm) networks. The alternate framework using UDA with the MRI network was also more accurate than the CBCT only methods but less accurate the CMEDL approach. Conclusions: Our results demonstrate feasibility of the introduced CMEDL approach to produce reasonably accurate lung cancer segmentation from CBCT images. Further validation on larger datasets is necessary for clinical translation. [ABSTRACT FROM AUTHOR]
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- 2021
- Full Text
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620. Optimizing adjuvant therapy in EGFR-mutated non-small cell lung cancer
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Andreas Rimner, Abraham J. Wu, Daniel R. Gomez, Daphna Y. Gelblum, Annemarie F. Shepherd, Charles B. Simone, Isabel Ruth Preeshagul, and Narek Shaverdian
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Editorial Commentary ,business.industry ,Adjuvant therapy ,Cancer research ,Medicine ,General Medicine ,Non small cell ,business ,Lung cancer ,medicine.disease - Published
- 2020
621. Predicting spatial esophageal changes in a multimodal longitudinal imaging study via a convolutional recurrent neural network
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Chuang Wang, Yu-Chi Hu, Si-Yuan Zhang, Pengpeng Zhang, Saad Nadeem, Sadegh R Alam, Neelam Tyagi, Maria Thor, Andreas Rimner, and Wei Lu
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Multimodal Imaging ,Convolutional neural network ,Article ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Esophagus ,0302 clinical medicine ,Sørensen–Dice coefficient ,Image Processing, Computer-Assisted ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Longitudinal Studies ,Radiological and Ultrasound Technology ,Artificial neural network ,medicine.diagnostic_test ,business.industry ,Deep learning ,Magnetic resonance imaging ,Cone-Beam Computed Tomography ,Magnetic Resonance Imaging ,Radiation therapy ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Female ,Neural Networks, Computer ,Artificial intelligence ,Radiology ,Tomography ,business - Abstract
Acute esophagitis (AE) occurs among a significant number of patients with locally advanced lung cancer treated with radiotherapy. Early prediction of AE, indicated by esophageal wall expansion, is critical, as it can facilitate the redesign of treatment plans to reduce radiation-induced esophageal toxicity in an adaptive radiotherapy (ART) workflow. We have developed a novel machine learning framework to predict the patient-specific spatial presentation of the esophagus in the weeks following treatment, using magnetic resonance imaging (MRI)/ cone-beam CT (CBCT) scans acquired earlier in the 6 week radiotherapy course. Our algorithm captures the response patterns of the esophagus to radiation on a patch level, using a convolutional neural network. A recurrence neural network then parses the evolutionary patterns of the selected features in the time series, and produces a predicted esophagus-or-not label for each individual patch over future weeks. Finally, the esophagus is reconstructed, using all the predicted labels. The algorithm is trained and validated by means of ∼ 250 000 patches taken from MRI scans acquired weekly from a variety of patients, and tested using both weekly MRI and CBCT scans under a leave-one-patient-out scheme. In addition, our approach is externally validated using a publicly available dataset (Hugo 2017). Using the first three weekly scans, the algorithm can predict the condition of the esophagus over the succeeding 3 weeks with a Dice coefficient of 0.83 ± 0.04, estimate esophagus volume highly (0.98), correlated with the actual volume, using our institutional MRI/CBCT data. When evaluated using the external weekly CBCT data, the averaged Dice coefficient is 0.89 ± 0.03. Our novel algorithm may prove useful in enabling radiation oncologists to monitor and detect AE in its early stages, and could potentially play an important role in the ART decision-making process.
- Published
- 2020
622. Exploring Associations between Immune Parameters and Radiation Pneumonitis in Locally Advanced Non-Small Cell Lung Cancer after Chemoradiation and Durvalumab
- Author
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Joseph O. Deasy, Narek Shaverdian, Daniel R. Gomez, Charles B. Simone, A. Jackson, Andreas Rimner, Michael Offin, Abraham J. Wu, Maria Thor, Daphna Y. Gelblum, Ellen Yorke, and Annemarie F. Shepherd
- Subjects
Oncology ,Cancer Research ,medicine.medical_specialty ,Radiation ,Durvalumab ,business.industry ,Locally advanced ,medicine.disease ,Immune system ,Internal medicine ,medicine ,Radiology, Nuclear Medicine and imaging ,Non small cell ,Lung cancer ,business ,Radiation Pneumonitis - Published
- 2020
623. A Pre-Treatment PET And CT-Derived Model for Progression-Free Survival in Early Stage Non-Small Cell Lung Cancer
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Joseph O. Deasy, Abraham J. Wu, Saad Nadeem, Daphna Y. Gelblum, K.J. Fitzgerald, Andreas Rimner, Ellen Yorke, Aditi Iyer, A. Apte, Wookjin Choi, Maria Thor, Michael Offin, J.H. Oh, and Jamie E. Chaft
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Oncology ,Pre treatment ,Cancer Research ,medicine.medical_specialty ,Radiation ,business.industry ,medicine.disease ,Internal medicine ,medicine ,Radiology, Nuclear Medicine and imaging ,Progression-free survival ,Non small cell ,Stage (cooking) ,Lung cancer ,business - Published
- 2020
624. Circulating Tumor DNA as a Biomarker in Oligometastatic Non-small Cell Lung Cancer
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Pedram Razavi, Daniel R. Gomez, Charles M. Rudin, Lee P. Lim, Andreas Rimner, Maria E. Arcila, Zhigang Zhang, T.J. Yang, E.S. Lebow, Y. Murciano-Goroff, A. Drilon, James M. Isbell, B.T. Li, Jessica Flynn, C. Bertucci, Jorge S. Reis-Filho, David R. Jones, Mark Li, Hai-Yan Tu, and G. J. Riely
- Subjects
Cancer Research ,Radiation ,Oncology ,Circulating tumor DNA ,business.industry ,medicine ,Cancer research ,Biomarker (medicine) ,Radiology, Nuclear Medicine and imaging ,Non small cell ,Lung cancer ,medicine.disease ,business - Published
- 2020
625. Early Prediction of Acute Esophagitis Using Accumulated Dose and Local Volume Change of Esophagus
- Author
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Y Hu, Wei Lu, Neelam Tyagi, Sadegh R Alam, Saad Nadeem, Si-Yuan Zhang, P Zhang, L Kuo, Ellen Yorke, Maria Thor, Joseph O. Deasy, and Andreas Rimner
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Cancer Research ,medicine.medical_specialty ,Radiation ,business.industry ,Volume change ,Gastroenterology ,medicine.anatomical_structure ,Oncology ,Internal medicine ,Early prediction ,medicine ,Radiology, Nuclear Medicine and imaging ,Esophagus ,business ,Acute Esophagitis - Published
- 2020
626. Risk Factors Associated with Pulmonary Toxicities from Multiple Courses of Stereotactic Body Radiation Therapy (SBRT) for Synchronous or Metachronous Primary Lung Tumors or Lung Metastases
- Author
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Daphna Y. Gelblum, Charles B. Simone, Andreas Rimner, Xiang Li, A. Jackson, Abraham J. Wu, Narek Shaverdian, Ellen Yorke, Daniel R. Gomez, Y. Yue, and Annemarie F. Shepherd
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Cancer Research ,medicine.medical_specialty ,Radiation ,Lung ,medicine.anatomical_structure ,Oncology ,Stereotactic body radiation therapy ,business.industry ,medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,business - Published
- 2020
627. Durvalumab with Concurrent Definitive Radiation Therapy (DART) for Locally-Advanced Non-Small Cell Lung Cancer - A Phase II Study
- Author
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D. McKnight, M. Mccune, Andreas Rimner, Rupesh Kotecha, B. Patson, H. Li, Jamie E. Chaft, Narek Shaverdian, Daniel R. Gomez, and Michael Offin
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Oncology ,Cancer Research ,medicine.medical_specialty ,Radiation ,Durvalumab ,business.industry ,Locally advanced ,Phases of clinical research ,medicine.disease ,Definitive Radiation Therapy ,Internal medicine ,medicine ,Radiology, Nuclear Medicine and imaging ,Non small cell ,Lung cancer ,business - Published
- 2020
628. One-Year Disease Outcomes in Stage III Non-Small Cell Lung Cancers Treated with Trimodality Therapy vs Concurrent Chemoradiation and Durvalumab
- Author
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Abraham J. Wu, Charles B. Simone, Daphna Y. Gelblum, David R. Jones, Andreas Rimner, Annemarie F. Shepherd, Zhigang Zhang, Stephanie Lobaugh, Daniel R. Gomez, Charles M. Rudin, Michael Offin, James M. Isbell, Narek Shaverdian, Mark G. Kris, Jamie E. Chaft, and Matthew D. Hellmann
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Oncology ,Cancer Research ,medicine.medical_specialty ,Radiation ,Durvalumab ,Lung ,business.industry ,Disease outcome ,Concurrent chemoradiation ,medicine.anatomical_structure ,Internal medicine ,medicine ,Radiology, Nuclear Medicine and imaging ,Non small cell ,Stage (cooking) ,business - Published
- 2020
629. PO-1545: Dose-volume factors predicting esophageal after SBRT for ultra-central lung tumors
- Author
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Daphna Y. Gelblum, Andreas Rimner, Abraham J. Wu, A. Apte, Ellen Yorke, A. Jackson, J Yang, and Chuang Wang
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Lung ,medicine.anatomical_structure ,Oncology ,Volume (thermodynamics) ,business.industry ,Medicine ,Radiology, Nuclear Medicine and imaging ,Hematology ,business ,Nuclear medicine - Published
- 2020
630. Final Results of a Phase I Trial of Stereotactic Body Radiotherapy for Larger (>3cm) Inoperable Non-Small Cell Lung Cancer
- Author
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Abraham J. Wu, Si-Yuan Zhang, John J. Cuaron, D. von Reibnitz, Andreas Rimner, E. Gelb, Ellen Yorke, Jamie E. Chaft, Daphna Y. Gelblum, and Kenneth K.-S. Ng
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Cancer Research ,medicine.medical_specialty ,Radiation ,business.industry ,Phase (waves) ,medicine.disease ,Oncology ,Medicine ,Radiology, Nuclear Medicine and imaging ,Non small cell ,Radiology ,business ,Lung cancer ,Stereotactic body radiotherapy - Published
- 2020
631. The value of collaboration between thoracic surgeons and radiation oncologists while awaiting evidence in operable stage i non–small cell lung cancer
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Moghanaki, Drew, Simone, Charles B., II, Rimner, Andreas, Karas, Tomer Z., Donington, Jessica, Shirvani, Shervin M., Daly, Megan, Videtic, Gregory M., and Movsas, Benjamin
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- 2018
- Full Text
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632. Geometric dose prediction model for hemithoracic intensity-modulated radiation therapy in mesothelioma patients with two intact lungs
- Author
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James Mechalakos, A. Foster, L Kuo, Ellen Yorke, Vishruta A. Dumane, Zhigang Zhang, Abraham J. Wu, Kenneth E. Rosenzweig, and Andreas Rimner
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Mesothelioma ,medicine.medical_specialty ,Pleural Neoplasms ,medicine.medical_treatment ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,intensity‐modulated radiation therapy (IMRT) ,0302 clinical medicine ,Dose prediction ,medicine ,Radiation Oncology Physics ,Humans ,Radiology, Nuclear Medicine and imaging ,Lung volumes ,Pleural Neoplasm ,Lung ,Instrumentation ,malignant pleural mesothelioma (MPM) ,Rank correlation ,Radiation ,business.industry ,Radiotherapy Planning, Computer-Assisted ,Radiotherapy Dosage ,respiratory system ,medicine.disease ,respiratory tract diseases ,Surgery ,Radiation therapy ,Exact test ,dose prediction model ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Radiotherapy, Intensity-Modulated ,business ,Nuclear medicine - Abstract
The presence of two intact lungs makes it challenging to reach a tumoricidal dose with hemithoracic pleural intensity-modulated radiation therapy (IMRT) in patients with malignant pleural mesothelioma (MPM) who underwent pleurectomy/decortications or have unresectable disease. We developed an anatomy-based model to predict attainable prescription dose before starting optimization. Fifty-six clinically delivered IMRT plans were analyzed regarding correlation of prescription dose and individual and total lung volumes, planning target volume (PTV), ipsilateral normal lung volume and ratios: contralateral/ipsilateral lung (CIVR); contralateral lung/PTV (CPVR); ipsilateral lung /PTV (IPVR); ipsilateral normal lung /total lung (INTLVR); ipsilateral normal lung/PTV (INLPVR). Spearman's rank correlation and Fisher's exact test were used. Correlation between mean ipsilateral lung dose (MILD) and these volume ratios and between prescription dose and single lung mean doses were studied. The prediction models were validated in 23 subsequent MPM patients. CIVR showed the strongest correlation with dose (R=0.603,p
- Published
- 2016
633. High- and low-dose-rate intraoperative radiotherapy for thoracic malignancies resected with close or positive margins
- Author
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Michael J. Zelefsky, Andreas Rimner, Zhigang Zhang, Manjit S. Bains, Kenneth E. Rosenzweig, Abraham J. Wu, Gil'ad N. Cohen, Kaitlin M. Woo, Christopher Fleming, and Kaled M. Alektiar
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Adult ,Thorax ,medicine.medical_specialty ,Lung Neoplasms ,Neoplasm, Residual ,medicine.medical_treatment ,Brachytherapy ,Article ,030218 nuclear medicine & medical imaging ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Cumulative incidence ,External beam radiotherapy ,Survival rate ,Aged ,Retrospective Studies ,Intraoperative Care ,business.industry ,Incidence (epidemiology) ,Radiotherapy Dosage ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Primary tumor ,Surgery ,Survival Rate ,Oncology ,030220 oncology & carcinogenesis ,Neoplasm Recurrence, Local ,business - Abstract
Purpose Local recurrence is a significant problem after surgical resection of thoracic tumors. As intraoperative radiotherapy (IORT) can deliver radiation directly to the threatened margin, we have used this therapy in an attempt to reduce local recurrence, using high-dose-rate (HDR) as well as low-dose-rate (LDR) techniques. Methods and Materials We performed a retrospective review of patients undergoing LDR ( 125 I) mesh placement or HDR ( 192 Ir) afterloading therapy during lung tumor resection between 2001 and 2013 at our institution. Competing risks methods were used to estimate the cumulative incidence of local failure. We also assessed possible predictive factors of local failure. Results Fifty-nine procedures (41 LDR and 18 HDR) were performed on 58 patients. Median follow-up was 55.1 months. Cumulative incidence of local failure at 1, 2, and 3 years was 28.5%, 34.2%, and 34.2%, respectively. Median overall survival was 39.9 months. There was no significant difference in local failure according to margin status, HDR vs. LDR, use of adjuvant external beam radiotherapy, or metastatic vs. primary tumor. Two patients (3.4%) experienced Grade 3+ toxicities likely related to brachytherapy. Additionally, 7 patients experienced Grade 3+ postsurgical complications unlikely related to brachytherapy. Conclusions IORT is associated with good local control after resection of thoracic tumors otherwise at very high risk for local recurrence. There is a low incidence of severe toxicity attributable to brachytherapy. HDR-IORT appears to have equivalent outcomes to LDR-IORT. HDR or LDR-IORT can, therefore, be considered in situations where the oncologic completeness of thoracic tumor resection is in doubt.
- Published
- 2016
634. Fatal complications after stereotactic body radiation therapy for central lung tumors abutting the proximal bronchial tree
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Abraham J. Wu, Andreas Rimner, Ankit Modh, Kenneth E. Rosenzweig, Justin Haseltine, Andrew Jackson, Daphna Y. Gelblum, and Ellen Yorke
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Male ,medicine.medical_specialty ,Lung Neoplasms ,medicine.medical_treatment ,Bronchi ,Context (language use) ,Radiosurgery ,Article ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,medicine ,Clinical endpoint ,Humans ,Radiology, Nuclear Medicine and imaging ,Adverse effect ,Aged ,Retrospective Studies ,Lung ,business.industry ,Retrospective cohort study ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Toxicity ,Adenocarcinoma ,Female ,Radiology ,business ,Follow-Up Studies - Abstract
Stereotactic body radiation therapy (SBRT) is associated with excess toxicity following treatment of central lung tumors. Risk-adapted fractionation appears to have mitigated this risk, but it remains unclear whether SBRT is safe for all tumors within the central lung zone, especially those abutting the proximal bronchial tree (PBT). We investigated the dependence of toxicity on tumor proximity to PBT and whether tumors abutting the PBT had greater toxicity than other central lung tumors after SBRT.A total of 108 patients receiving SBRT for central lung tumors were reviewed. Patients were classified based on closest distance from tumor to PBT. Primary endpoint was SBRT-related death. Secondary endpoints were overall survival, local control, and grade 3+ pulmonary adverse events. We compared tumors abutting the PBT to nonabutting and those ≤1 cm and1 cm from PBT.Median follow-up was 22.7 months. Median distance from tumor to PBT was 1.78 cm. Eighty-eight tumors were primary lung and 20 were recurrent or metastatic; 23% of tumors were adenocarcinoma and 71% squamous cell. Median age was 77.5 years. Median dose was 4500 cGy in 5 fractions prescribed to the 100% isodose line. Eighteen patients had tumors abutting the PBT, 4 of whom experienced SBRT-related death. No other patients experienced death attributed to SBRT. Risk of SBRT-related death was significantly higher for tumors abutting the PBT compared with nonabutting tumors (P.001). Two patients with SBRT-related death received anti-vascular endothelial growth factor therapy and experienced pulmonary hemorrhage. Patients with tumors ≤1 cm from PBT had significantly more grade 3+ events than those with tumors1cm from PBT (P = .014).Even with risk-adapted fractionation, tumors abutting PBT are associated with a significant and differential risk of SBRT-related toxicity and death. SBRT should be used with particular caution in central-abutting tumors, especially in the context of anti-vascular endothelial growth factor therapy.
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- 2016
635. Four-Year Survival With Durvalumab After Chemoradiotherapy in Stage III NSCLC-an Update From the PACIFIC Trial.
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Faivre-Finn, Corinne, Vicente, David, Kurata, Takayasu, Planchard, David, Paz-Ares, Luis, Vansteenkiste, Johan F., Spigel, David R., Garassino, Marina C., Reck, Martin, Senan, Suresh, Naidoo, Jarushka, Rimner, Andreas, Wu, Yi-Long, Gray, Jhanelle E., Özgüroğlu, Mustafa, Lee, Ki H., Cho, Byoung C., Kato, Terufumi, de Wit, Maike, and Newton, Michael
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- 2021
- Full Text
- View/download PDF
636. Delivering safe and effective stereotactic body radiation therapy for patients with centrally located early stage non-small cell lung cancer
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Andreas Rimner, Abraham J. Wu, Charles B. Simone, Daphna Y. Gelblum, Narek Shaverdian, Annemarie F. Shepherd, Daniel R. Gomez, and Justin Haseltine
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medicine.medical_specialty ,Stereotactic body radiation therapy ,business.industry ,medicine.medical_treatment ,General Medicine ,medicine.disease ,Radiosurgery ,Oncology ,medicine ,Carcinoma ,Neoplasm staging ,Radiology ,Small Cell Lung Carcinoma ,Non small cell ,Stage (cooking) ,Lung cancer ,business - Published
- 2020
637. Locoregional control, failure patterns and clinical outcomes in patients with stage III non-small cell lung cancers treated with chemoradiation and durvalumab
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Jamie E. Chaft, Narek Shaverdian, Daphna Y. Gelblum, Charles B. Simone, Nancy Y. Lee, Stephanie Lobaugh, Annemarie F. Shepherd, Michael Offin, Charles M. Rudin, Matthew D. Hellmann, Mark G. Kris, Andreas Rimner, Zhigang Zhang, Daniel R. Gomez, and Abraham J. Wu
- Subjects
Oncology ,Cancer Research ,medicine.medical_specialty ,Durvalumab ,Lung ,business.industry ,Concurrent chemoradiation ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Internal medicine ,Medicine ,In patient ,Non small cell ,Stage (cooking) ,business ,Standard therapy ,030215 immunology - Abstract
e21058 Background: Definitive concurrent chemoradiation (cCRT) and durvalumab is a standard therapy for patients with unresectable stage III non-small cell lung cancers (NSCLC). Data is limited on outcomes with this regimen outside of clinical trials. Local-regional control rates to date remain undefined. Methods: We reviewed patients with stage III unresectable NSCLC treated between November 2017 and February 2019 with cCRT. Patients that received at least one cycle of durvalumab were further assessed for 12-month progression free survival (PFS), overall survival (OS), and the incidence and pattern of local-regional and metastatic failures. Disease-relapse was characterized to determine patients potentially eligible for metastasis-directed ablative therapies. Toxicities leading to durvalumab discontinuation were evaluated using CTCAE v.5.0. Results: Of the 83 patients with stage III NSCLC treated with cCRT (median 60Gy), 62 received durvalumab and were evaluable (median follow-up: 12 months). Patients (n = 21, 25%) did not receive durvalumab largely related to metastatic progression (n = 9) or persistent cCRT toxicity (n = 10). In the 62 durvalumab treated patients the median age was 66 (range: 49 - 86), 73% had stage IIIB (n = 33) or IIIC (n = 12) disease, and 58% (n = 36) had adenocarcinoma. The median time from cCRT end to durvalumab start was 1.5 months. Patients received a median of 8 months of durvalumab; 35% (n = 22) of patients completed 12 months of therapy. Common reasons for discontinuing durvalumab included disease progression (32%, 20/62) and toxicity (24%, 15/62). The estimated 12-month PFS and OS were 65% (95% CI: 51 - 79%) and 85% (95% CI: 75 - 95%), respectively. High TMB (≥ 8.8 mt/Mb) or PD-L1 (≥ 1% or PD-L1 ≥ 50%) did not predict improved PFS. Patients who discontinued durvalumab due to toxicity did not have inferior PFS. The cumulative 12-month incidence of local-regional and distant metastatic failures were 18% (95% CI: 5.9 - 30%) and 30% (95% CI: 16.3 - 44.5%), respectively. Of the 17 patients with distant metastases, 9 had oligometastases and would have been potential candidates for comprehensive ablative therapies. Conclusions: Outcomes and toxicities outcomes with cCRT and durvalumab in clinical practice align with the PACIFIC trial. Analysis of disease-relapse suggests a substantial minority of patients with disease progression may be potential candidates for metastasis-directed therapies. Local regional outcomes appear improved to historical data of cCRT alone.
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- 2020
638. A phase III randomized trial of pleurectomy/decortication plus chemotherapy with or without adjuvant hemithoracic intensity-modulated pleural radiation therapy (IMPRINT) for malignant pleural mesothelioma (MPM) (NRG LU-006)
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Andreas Rimner, K. Ranh Voong, Jeffrey D. Bradley, Valerie W. Rusch, Ellen Yorke, Charles B. Simone, Ritu R. Gill, Tobias Peikert, Zuofeng Li, Marjorie G. Zauderer, and Ming-Sound Tsao
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Cancer Research ,medicine.medical_specialty ,Chemotherapy ,business.industry ,Pleural mesothelioma ,medicine.medical_treatment ,Decortication ,law.invention ,Pleurectomy decortication ,Radiation therapy ,Oncology ,Randomized controlled trial ,law ,medicine ,Radiology ,business ,Pleurectomy ,Adjuvant - Abstract
TPS9079 Background: Pleurectomy/Decortication (P/D) with neoadjuvant or adjuvant chemotherapy has become a common lung-sparing surgical approach for MPM. Adjuvant hemithoracic IMPRINT was developed at Memorial Sloan Kettering Cancer Center and safe in a multi-institutional phase II study, with promising survival outcomes. The National Cancer Institute (NCI) sponsored this phase III randomized cooperative group trial to test the efficacy of this lung-sparing trimodality approach for resectable MPM. Methods: Patients with newly diagnosed MPM amenable to P/D are enrolled and undergo P/D followed by adjuvant platinum/pemetrexed (preferred) or neoadjuvant chemotherapy followed by P/D. Patients are stratified by histologic subtype, resection status (R0/1 vs. R2), and center patient volume (≤10 vs. > 10 P/Ds per year). Within 8 weeks after completion of the second modality patients are randomized 1:1 to undergo hemithoracic IMPRINT vs. no further therapy. All IMPRINT contours and treatment plans will be centrally reviewed. A contouring atlas and treatment planning constraints for target structures and organs at risk including acceptable and unacceptable variations and deviations were developed. Photon and proton therapy are permitted. The primary endpoint of the study is overall survival. Secondary endpoints include local failure-free, distant-metastases-free and progression-free survival, treatment-related toxicities (CTCAE v5.0) and change in quality-of-life (EORTC QLQ-C30 mean score changes at 9 months post randomization). The target accrual is 150 patients. This study was activated on January 29, 2020. Over 20 institutions have already committed to opening the study which is open to all National Clinical Trials Network (NCTN) sites. Treatment planning guidelines and helpful hints for photon and proton therapy will be presented. Conclusions: NRG LU-006 (clinicaltrials.gov: NCT04158141 ) is open to accrual. This is the first NRG Oncology randomized phase III trial on MPM and evaluates the use of IMPRINT following lung-sparing P/D and chemotherapy. This project was supported by grants U10CA180868 (NRG Oncology Operations), U10CA180822 (NRG Oncology SDMC), U24CA180803 (IROC) from the National Cancer Institute (NCI). Clinical trial information: NCT04158141.
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- 2020
639. Long-term, disease-specific outcomes of thymic malignancies presenting with de novo pleural metastasis
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Manjit S. Bains, Robert J. Downey, Valerie W. Rusch, Amanda Ghanie, Gregory J. Riely, David R. Jones, Giye Choe, Prasad S. Adusumilli, Bernard J. Park, Andreas Rimner, and James Huang
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Pulmonary and Respiratory Medicine ,Extrapleural Pneumonectomy ,medicine.medical_specialty ,Chemotherapy ,education.field_of_study ,Thymoma ,business.industry ,medicine.medical_treatment ,Population ,Perioperative ,030204 cardiovascular system & hematology ,medicine.disease ,Surgery ,Thymectomy ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,030228 respiratory system ,medicine ,Pericardium ,Cardiology and Cardiovascular Medicine ,education ,business ,Thymic carcinoma - Abstract
Objective Treatment of patients with thymic malignancies metastatic to the pleura or pericardium is challenging, and benefits of aggressive treatment are unclear. We sought to characterize the long-term outcomes in this population. Methods We retrospectively identified patients who underwent resection for de novo thymic malignancies metastatic to the pleura between May 1997 and December 2017. Patients with pleural recurrence after prior thymectomy were excluded. Patient demographics, perioperative treatments, pathologic findings, and postoperative outcomes were collected. Descriptive statistics and Kaplan–Meier analyses were performed. Results Seventy-two patients were included (median age, 51 years [range 25-80]; 36/72 women [50%]). Pathologic diagnosis was thymoma in 57 patients (79%) and thymic carcinoma in 15 patients (21%). Most patients (67/72; 93%) received chemotherapy, radiation, or both. Forty-eight patients underwent thymectomy with pleurectomy, 7 patients underwent extrapleural pneumonectomy, 10 patients underwent thymectomy alone, and 7 patients were unresectable. Macroscopic complete resection was achieved in 52 patients (73%). Five-, 10-, and 15-year overall survivals were 73%, 51%, and 18%, respectively, and median overall survival was 11 years (median follow-up, 5.9 years). Forty-six patients (64%) had disease progression (median time to progression, 2.2 years). Repeat episodes of progression and treatment were common (median, 3 episodes/patient). The longest disease-free interval was 12.4 years. Thirteen patients (18%) remain disease-free; 7 patients (10%) were disease-free for more than 5 years. The longest ongoing survival without progression or reintervention is 9.9 years. Conclusions Prolonged survival and, in some cases, cure can be achieved in patients with thymic malignancies metastatic to the pleura or pericardium. Aggressive multimodality therapy may be appropriate for select patients.
- Published
- 2020
640. PIK3CA mutation is associated with increased local failure in lung stereotactic body radiation therapy (SBRT)
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Lockney, Natalie A., Yang, T. Jonathan, Barron, David, Gelb, Emily, Gelblum, Daphna Y., Yorke, Ellen, Shi, Weiji, Zhang, Zhigang, Rimner, Andreas, and Wu, Abraham J.
- Published
- 2017
- Full Text
- View/download PDF
641. Tumor-aware, Adversarial Domain Adaptation from CT to MRI for Lung Cancer Segmentation
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Andreas Rimner, Yu-Chi Hu, Gig S. Mageras, Joseph O. Deasy, Pengpeng Zhang, Harini Veeraraghavan, Jue Jiang, and Neelam Tyagi
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Domain adaptation ,business.industry ,Computer science ,Deep learning ,Pattern recognition ,medicine.disease ,Article ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Text mining ,medicine ,Segmentation ,Artificial intelligence ,Lung cancer ,business ,030217 neurology & neurosurgery - Abstract
We present an adversarial domain adaptation based deep learning approach for automatic tumor segmentation from T2-weighted MRI. Our approach is composed of two steps: (i) a tumor-aware unsupervised cross-domain adaptation (CT to MRI), followed by (ii) semi-supervised tumor segmentation using Unet trained with synthesized and limited number of original MRIs. We introduced a novel target specific loss, called tumor-aware loss, for unsupervised cross-domain adaptation that helps to preserve tumors on synthesized MRIs produced from CT images. In comparison, state-of-the art adversarial networks trained without our tumor-aware loss produced MRIs with ill-preserved or missing tumors. All networks were trained using labeled CT images from 377 patients with non-small cell lung cancer obtained from the Cancer Imaging Archive and unlabeled T2w MRIs from a completely unrelated cohort of 6 patients with pre-treatment and 36 on-treatment scans. Next, we combined 6 labeled pre-treatment MRI scans with the synthesized MRIs to boost tumor segmentation accuracy through semi-supervised learning. Semi-supervised training of cycle-GAN produced a segmentation accuracy of 0.66 computed using Dice Score Coefficient (DSC). Our method trained with only synthesized MRIs produced an accuracy of 0.74 while the same method trained in semi-supervised setting produced the best accuracy of 0.80 on test. Our results show that tumor-aware adversarial domain adaptation helps to achieve reasonably accurate cancer segmentation from limited MRI data by leveraging large CT datasets.
- Published
- 2018
642. P2.17-32 Using Next-Generation Sequencing to Identify Genetic Predictors of Local Failure After Lung Stereotactic Body Radiation Therapy
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B. Sidiqi, V. Ng, A. Rimner, and Abraham J. Wu
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Lung ,medicine.anatomical_structure ,Oncology ,Stereotactic body radiation therapy ,business.industry ,medicine ,Local failure ,Radiology ,business ,DNA sequencing - Published
- 2019
643. P1.01-122 A Clinical Utility Study of Plasma DNA Next Generation Sequencing Guided Treatment of Uncommon Drivers in Advanced Non-Small-Cell Lung Cancers
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M. Ladanyi, Z. Iqbal, Alex Makhnin, Mackenzie L. Myers, Adrian Lee, Azadeh Namakydoust, Maria E. Arcila, Michael Offin, H. Jain, Stephen Clarke, Connie I. Diakos, Andres Martinez, Jennifer Hernandez, E. Schapira, David Chan, Chongrui Xu, S. Watford, Pedram Razavi, David R. Jones, H. Li, Mark Li, A. Hosseini, Tristan Shaffer, James M. Isbell, Ariana Adamski, Charles M. Rudin, Hai-Yan Tu, Lee P. Lim, Andreas Rimner, C. Tong-Li, A. Drilon, Bob T. Li, V. Rusch, and Nick Pavlakis
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Pulmonary and Respiratory Medicine ,Lung ,medicine.anatomical_structure ,Oncology ,business.industry ,Plasma dna ,Cancer research ,Medicine ,Non small cell ,business ,DNA sequencing - Published
- 2019
644. IBS26.01 Treatment Planning for Pleural Imrt (Imprint)
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A. Rimner
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Oncology ,business.industry ,medicine ,Medical physics ,Radiation treatment planning ,business - Published
- 2019
645. Current and Future Management of Malignant Mesothelioma: A Consensus Report from the National Cancer Institute Thoracic Malignancy Steering Committee, International Association for the Study of Lung Cancer, and Mesothelioma Applied Research Foundation
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Edward L. Korn, Emanuela Taioli, O. Wolf Lindwasser, Anna K. Nowak, Fred R. Hirsch, Anne S. Tsao, Aaron S. Mansfield, Ravi Salgia, Suzanne E. Dahlberg, Harvey I. Pass, Bruce W. S. Robinson, Hedy L. Kindler, Shakun Malik, Marjorie G. Zauderer, Andreas Rimner, Valerie W. Rusch, Rajeshwari Sridhara, Ritu R. Gill, Matthew L. Beyers, Michele Carbone, Joseph S. Friedberg, Alex A. Adjei, Dean A. Fennell, Gideon M. Blumenthal, Boris Sepesi, Ming-Sound Tsao, Mary Hesdorffer, Kenneth E. Rosenzweig, Haining Yang, Raphael Bueno, Julija Hmeljak, Daniel R. Gomez, Marc de Perrot, Geoffrey Liu, Tobias Peikert, Charles B. Simone, David H. Harpole, Prasad S. Adusumilli, Bryan M. Burt, Peter W. Szlosarek, and Raffit Hassan
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0301 basic medicine ,Pulmonary and Respiratory Medicine ,Oncology ,Mesothelioma ,medicine.medical_specialty ,Consensus ,Lung Neoplasms ,medicine.medical_treatment ,Multimodality Therapy ,Malignancy ,Targeted therapy ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Applied research ,Lung cancer ,business.industry ,Mesothelioma, Malignant ,Cancer ,respiratory system ,medicine.disease ,National Cancer Institute (U.S.) ,United States ,respiratory tract diseases ,Clinical trial ,030104 developmental biology ,030220 oncology & carcinogenesis ,business - Abstract
On March 28- 29, 2017, the National Cancer Institute (NCI) Thoracic Malignacy Steering Committee, International Association for the Study of Lung Cancer, and Mesothelioma Applied Research Foundation convened the NCI-International Association for the Study of Lung Cancer- Mesothelioma Applied Research Foundation Mesothelioma Clinical Trials Planning Meeting in Bethesda, Maryland. The goal of the meeting was to bring together lead academicians, clinicians, scientists, and the U.S. Food and Drug Administration to focus on the development of clinical trials for patients in whom malignant pleural mesothelioma has been diagnosed. In light of the discovery of new cancer targets affecting the clinical development of novel agents and immunotherapies in malignant mesothelioma, the objective of this meeting was to assemble a consensus on at least two or three practice-changing multimodality clinical trials to be conducted through NCI's National Clinical Trials Network.
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- 2018
646. Stereotactic body radiation therapy (SBRT) improves local control and overall survival compared to conventionally fractionated radiation for stage I non-small cell lung cancer (NSCLC)
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Abraham J. Wu, Weiji Shi, Andreas Rimner, Kenneth E. Rosenzweig, Ellen Yorke, Daphna Y. Gelblum, Kaitlin M. Woo, A. Foster, Gregory C Treharne, Zhigang Zhang, R. Dick-Godfrey, S.U. Din, F. Shaikh, and Donata von Reibnitz
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Oncology ,medicine.medical_specialty ,Lung Neoplasms ,Stereotactic body radiation therapy ,Kaplan-Meier Estimate ,Radiosurgery ,Article ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Carcinoma, Non-Small-Cell Lung ,medicine ,Carcinoma ,Overall survival ,Humans ,Radiology, Nuclear Medicine and imaging ,Cumulative incidence ,Treatment Failure ,Aged ,Retrospective Studies ,Aged, 80 and over ,Proportional hazards model ,business.industry ,Dose fractionation ,Retrospective cohort study ,Hematology ,General Medicine ,Middle Aged ,medicine.disease ,Treatment Outcome ,030220 oncology & carcinogenesis ,Propensity score matching ,Dose Fractionation, Radiation ,Neoplasm Recurrence, Local ,business - Abstract
BACKGROUND: Stereotactic Body Radiotherapy (SBRT) has been adopted as the standard of care for inoperable early-stage non-small cell lung cancer (NSCLC), with local control rates consistently > 90%. However, data directly comparing the outcomes of SBRT with those of conventionally fractionated radiotherapy (CONV) is lacking. MATERIAL AND METHODS: Between 1990 and 2013, 497 patients (525 lesions) with early-stage NSCLC (T1-T2N0M0) were treated with CONV (n=127) or SBRT (n=398). In this retrospective analysis, five endpoints were compared, with and without adjusting for clinical and dosimetric factors. Competing risks analysis was performed to estimate and compare the cumulative incidence of local failure (LF), nodal failure (NF), distant failure (DF) and disease progression. Overall survival (OS) was estimated by the Kaplan-Meier method and compared by the Cox regression model. Propensity score (PS) matched analysis was performed based on seven patient and clinical variables: age, gender, Karnofsky performance status (KPS), histology, T-stage, biologically equivalent dose (BED), and history of smoking. RESULTS: The median dose delivered for CONV was 75.6 Gy in 1.8 to 2.0 Gy fractions (range 60 to 90 Gy; median BED = 89.20 Gy) and for SBRT 48 Gy in 4 fractions (45 to 60 Gy in 3 to 5 fractions; median BED = 105.60 Gy). Median follow up was 24.4 months, and 3-year LF rates were 34.1% with CONV and 13.6% with SBRT (p
- Published
- 2018
647. Validating a Predictive Atlas of Tumor Shrinkage for Adaptive Radiotherapy of Locally Advanced Lung Cancer
- Author
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Ellen Yorke, Gig S. Mageras, Andreas Rimner, Joseph O. Deasy, Pengpeng Zhang, and Jan-Jakob Sonke
- Subjects
Cancer Research ,medicine.medical_specialty ,Lung Neoplasms ,medicine.medical_treatment ,Residual ,Article ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Bayes' theorem ,0302 clinical medicine ,Text mining ,Atlas (anatomy) ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Stage (cooking) ,Radiation treatment planning ,Lung cancer ,Retrospective Studies ,Radiation ,business.industry ,Radiotherapy Planning, Computer-Assisted ,Bayes Theorem ,Radiotherapy Dosage ,medicine.disease ,Tumor Burden ,Radiation therapy ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Radiology ,business ,Tomography, X-Ray Computed - Abstract
Purpose To cross-validate and expand a predictive atlas that can estimate geometric patterns of lung tumor shrinkage during radiation therapy using data from 2 independent institutions and to model its integration into adaptive radiation therapy (ART) for enhanced dose escalation. Methods and Materials Data from 22 patients at a collaborating institution were obtained to cross-validate an atlas, originally created with 12 patients, for predicting patterns of tumor shrinkage during radiation therapy. Subsequently, the atlas was expanded by integrating all 34 patients. Each study patient was selected via a leave-one-out scheme and was matched with a subgroup of the remaining 33 patients based on similarity measures of tumor volume and surroundings. The spatial distribution of residual tumor was estimated by thresholding the superimposed shrinkage patterns in the subgroup. A Bayesian method was also developed to recalibrate the prediction using the tumor observed on the midcourse images. Finally, in a retrospective predictive treatment planning (PTP) study, at the initial planning stage, the predicted residual tumors were escalated to the highest achievable dose while maintaining the original prescription dose to the remainder of the tumor. The PTP approach was compared isotoxically to ART that replans with midcourse imaging and to PTP-ART with the recalibrated prediction. Results Predictive accuracy (true positive plus true negative ratios based on predicted and actual residual tumor) were comparable across institutions, 0.71 versus 0.73, and improved to 0.74 with an expanded atlas including 2 institutions. Recalibration further improved accuracy to 0.76. PTP increased the mean dose to the actual residual tumor by an averaged 6.3Gy compared to ART. Conclusion A predictive atlas found to perform well across institutions and benefit from more diversified shrinkage patterns and tumor locations. Elevating tumoricidal dose to the predicted residual tumor throughout the entire treatment course could improve the efficacy and efficiency of treatment compared to ART with midcourse replanning.
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- 2018
648. Outcomes of Stage III NSCLC with occult primary vs. known primary lesions
- Author
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James Huang, David R. Jones, Yonatan Bardash, Darren J. Buonocore, Paul B. Romesser, Jamie E. Chaft, Abraham J. Wu, and Andreas Rimner
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0301 basic medicine ,Pulmonary and Respiratory Medicine ,Oncology ,Male ,Cancer Research ,medicine.medical_specialty ,Multivariate analysis ,Lung Neoplasms ,Stage III NSCLC ,Article ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Carcinoma, Non-Small-Cell Lung ,Positron Emission Tomography Computed Tomography ,medicine ,Humans ,Neoplasm Metastasis ,Lung cancer ,neoplasms ,Definitive radiotherapy ,Aged ,Neoplasm Staging ,Retrospective Studies ,business.industry ,Hazard ratio ,medicine.disease ,Occult ,Primary tumor ,Survival Analysis ,respiratory tract diseases ,030104 developmental biology ,Treatment Outcome ,030220 oncology & carcinogenesis ,Cohort ,Neoplasms, Unknown Primary ,Female ,Neoplasm Recurrence, Local ,business - Abstract
OBJECTIVES: Occult primary non-small cell lung cancer (OP-NSCLC) involving mediastinal lymph nodes without an identifiable primary tumor is a rare presentation, with little known about how outcomes compare to typical Stage III NSCLC. We reviewed our experience treating OP-SCLC with definitive radiotherapy and compared outcomes to a contemporary cohort of stage III NSCLC patients. MATERIALS AND METHODS: We reviewed 605 patients with stage III NSCLC staged with PET-CT and treated with definitive radiotherapy between 1998 and 2013. Overall survival, intrathoracic control, and freedom from distant metastasis were computed using Kaplan-Meier method and logrank comparison. Cox hazard ratios were used to perform univariate and multivariate analyses. RESULTS: Twenty-one patients were identified with OP-NSCLC (3.5%). Patients with OP-NSCLC, as compared to known primary NSCLC, had significantly better 5-year rates of intrathoracic control (83.5% vs. 24.2%, P
- Published
- 2018
649. Treatment of Thymic Neoplasms by Radiation Therapy
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Daniel R. Gomez and Andreas Rimner
- Subjects
Radiation therapy ,Thymic Neoplasms ,business.industry ,medicine.medical_treatment ,Cancer research ,Medicine ,business - Published
- 2018
650. Evaluation of automatic contour propagation in T2-weighted 4DMRI for normal-tissue motion assessment using internal organ-at-risk volume (IRV)
- Author
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Jingjing Zhang, Wookjin Choi, Andreas Rimner, Wei Lu, Xingyu Nie, Kirk Huang, Svetlana Markova, Alejandro Garcia, Guang Li, and Abraham J. Wu
- Subjects
87.19. Wx ,treatment planning ,Jaccard index ,Image quality ,four‐dimensional magnetic resonance imaging ,Image registration ,87.57.nm ,respiratory‐induced organ motion ,030218 nuclear medicine & medical imaging ,87.57.nj ,03 medical and health sciences ,Motion ,0302 clinical medicine ,Similarity (network science) ,Humans ,Radiation Oncology Physics ,Radiology, Nuclear Medicine and imaging ,Instrumentation ,87.55.d ,Mathematics ,Retrospective Studies ,Ground truth ,normal tissue and organ contouring ,Radiation ,business.industry ,Radiotherapy Planning, Computer-Assisted ,Respiration ,Magnetic Resonance Imaging ,Confidence interval ,030220 oncology & carcinogenesis ,Organ at risk ,87.61.Tg ,deformable image registration and automatic contour propagation ,Nuclear medicine ,business ,Algorithms ,Volume (compression) - Abstract
Purpose The purpose of this study was to evaluate the quality of automatically propagated contours of organs at risk (OARs) based on respiratory‐correlated navigator‐triggered four‐dimensional magnetic resonance imaging (RC‐4DMRI) for calculation of internal organ‐at‐risk volume (IRV) to account for intra‐fractional OAR motion. Methods and Materials T2‐weighted RC‐4DMRI images were of 10 volunteers acquired and reconstructed using an internal navigator‐echo surrogate and concurrent external bellows under an IRB‐approved protocol. Four major OARs (lungs, heart, liver, and stomach) were delineated in the 10‐phase 4DMRI. Two manual‐contour sets were delineated by two clinical personnel and two automatic‐contour sets were propagated using free‐form deformable image registration. The OAR volume variation within the 10‐phase cycle was assessed and the IRV was calculated as the union of all OAR contours. The OAR contour similarity between the navigator‐triggered and bellows‐rebinned 4DMRI was compared. A total of 2400 contours were compared to the most probable ground truth with a 95% confidence level (S95) in similarity, sensitivity, and specificity using the simultaneous truth and performance level estimation (STAPLE) algorithm. Results Visual inspection of automatically propagated contours finds that approximately 5–10% require manual correction. The similarity, sensitivity, and specificity between manual and automatic contours are indistinguishable (P > 0.05). The Jaccard similarity indexes are 0.92 ± 0.02 (lungs), 0.89 ± 0.03 (heart), 0.92 ± 0.02 (liver), and 0.83 ± 0.04 (stomach). Volume variations within the breathing cycle are small for the heart (2.6 ± 1.5%), liver (1.2 ± 0.6%), and stomach (2.6 ± 0.8%), whereas the IRV is much larger than the OAR volume by: 20.3 ± 8.6% (heart), 24.0 ± 8.6% (liver), and 47.6 ± 20.2% (stomach). The Jaccard index is higher in navigator‐triggered than bellows‐rebinned 4DMRI by 4% (P
- Published
- 2018
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