Minneapolis Radiation Oncology

Maple Plain, MN, United States

Minneapolis Radiation Oncology

Maple Plain, MN, United States

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Sperduto P.W.,Minneapolis Radiation Oncology | Shanley R.,University of Minnesota | Luo X.,University of Minnesota | Andrews D.,Thomas Jefferson University | And 6 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2014

Purpose: Radiation Therapy Oncology Group (RTOG) 9508 showed a survival advantage for patients with 1 but not 2 or 3 brain metastasis (BM) treated with whole-brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS) versus WBRT alone. An improved prognostic index, the graded prognostic assessment (GPA) has been developed. Our hypothesis was that if the data from RTOG 9508 were poststratified by the GPA, the conclusions may vary.Methods and Materials: In this analysis, 252 of the 331 patients were evaluable by GPA. Of those, 211 had lung cancer. Breast cancer patients were excluded because the components of the breast GPA are not in the RTOG database. Multiple Cox regression was used to compare survival between treatment groups, adjusting for GPA. Treatment comparisons within subgroups were performed with the log-rank test. A free online tool (brainmetgpa.com) simplified GPA use.Results: The fundamental conclusions of the primary analysis were confirmed in that there was no survival benefit overall for patients with 1 to 3 metastases; however, there was a benefit for the subset of patients with GPA 3.5 to 4.0 (median survival time [MST] for WBRT + SRS vs WBRT alone was 21.0 versus 10.3 months, P=.05) regardless of the number of metastases. Among patients with GPA 3.5 to 4.0 treated with WBRT and SRS, the MST for patients with 1 versus 2 to 3 metastases was 21 and 14.1 months, respectively.Conclusions: This secondary analysis of predominantly lung cancer patients, consistent with the original analysis, shows no survival advantage for the group overall when treated with WBRT and SRS; however, in patients with high GPA (3.5-4), there is a survival advantage regardless of whether they have 1, 2, or 3 BM. This benefit did not extend to patients with lower GPA. Prospective validation of this survival benefit for patients with multiple BM and high GPA when treated with WBRT and SRS is warranted. © 2014 Elsevier Inc.


Sperduto P.W.,University of Minnesota | Chao S.T.,Cleveland Clinic | Sneed P.K.,University of California at San Francisco | Luo X.,University of Minnesota | And 14 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2010

Purpose: Controversy endures regarding the optimal treatment of patients with brain metastases (BMs). Debate persists, despite many randomized trials, perhaps because BM patients are a heterogeneous population. The purpose of the present study was to identify significant diagnosis-specific prognostic factors and indexes (Diagnosis-Specific Graded Prognostic Assessment [DS-GPA]). Methods and Materials: A retrospective database of 5,067 patients treated for BMs between 1985 and 2007 was generated from 11 institutions. After exclusion of the patients with recurrent BMs or incomplete data, 4,259 patients with newly diagnosed BMs remained eligible for analysis. Univariate and multivariate analyses of the prognostic factors and outcomes by primary site and treatment were performed. The significant prognostic factors were determined and used to define the DS-GPA prognostic indexes. The DS-GPA scores were calculated and correlated with the outcomes, stratified by diagnosis and treatment. Results: The significant prognostic factors varied by diagnosis. For non-small-cell lung cancer and small-cell lung cancer, the significant prognostic factors were Karnofsky performance status, age, presence of extracranial metastases, and number of BMs, confirming the original GPA for these diagnoses. For melanoma and renal cell cancer, the significant prognostic factors were Karnofsky performance status and the number of BMs. For breast and gastrointestinal cancer, the only significant prognostic factor was the Karnofsky performance status. Two new DS-GPA indexes were thus designed for breast/gastrointestinal cancer and melanoma/renal cell carcinoma. The median survival by GPA score, diagnosis, and treatment were determined. Conclusion: The prognostic factors for BM patients varied by diagnosis. The original GPA was confirmed for non-small-cell lung cancer and small-cell lung cancer. New DS-GPA indexes were determined for other histologic types and correlated with the outcome, and statistical separation between the groups was confirmed. These data should be considered in the design of future randomized trials and in clinical decision-making. © 2010 Elsevier Inc. All rights reserved.


Miller R.C.,Mayo Medical School | Schwartz D.J.,Minneapolis Radiation Oncology | Sloan J.A.,Mayo Medical School | Griffin P.C.,Upstate Carolina Community Clinic Oncology Program | And 9 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2011

Purpose: A two-arm, double-blind, randomized trial was performed to evaluate the effect of 0.1% mometasone furoate (MMF) on acute skin-related toxicity in patients undergoing breast or chest wall radiotherapy. Methods and Materials: Patients with ductal carcinoma in situ or invasive breast carcinoma who were undergoing external beam radiotherapy to the breast or chest wall were randomly assigned to apply 0.1% MMF or placebo cream daily. The primary study endpoint was the provider-assessed maximal grade of Common Terminology Criteria for Adverse Events, version 3.0, radiation dermatitis. The secondary endpoints included provider-assessed Common Terminology Criteria for Adverse Events Grade 3 or greater radiation dermatitis and adverse event monitoring. The patient-reported outcome measures included the Skindex-16, the Skin Toxicity Assessment Tool, a Symptom Experience Diary, and a quality-of-life self-assessment. An assessment was performed at baseline, weekly during radiotherapy, and for 2 weeks after radiotherapy. Results: A total of 176 patients were enrolled between September 21, 2007, and December 7, 2007. The provider-assessed primary endpoint showed no difference in the mean maximum grade of radiation dermatitis by treatment arm (1.2 for MMF vs. 1.3 for placebo; p = .18). Common Terminology Criteria for Adverse Events toxicity was greater in the placebo group (p = .04), primarily from pruritus. For the patient-reported outcome measures, the maximum Skindex-16 score for the MMF group showed less itching (p = .008), less irritation (p = .01), less symptom persistence or recurrence (p = .02), and less annoyance with skin problems (p = .04). The group's maximal Skin Toxicity Assessment Tool score showed less burning sensation (p = .02) and less itching (p = .002). Conclusion: Patients receiving daily MMF during radiotherapy might experience reduced acute skin toxicity compared with patients receiving placebo. © 2011 Elsevier Inc.


Varadhan R.,Minneapolis Radiation Oncology | Karangelis G.,Oncology Systems Ltd | Krishnan K.,Kitware | Hui S.,University of Minnesota
Journal of Applied Clinical Medical Physics | Year: 2013

Quantitative validation of deformable image registration (DIR) algorithms is extremely difficult because of the complexity involved in constructing a deformable phantom that can duplicate various clinical scenarios. The purpose of this study is to describe a framework to test the accuracy of DIR based on computational modeling and evaluating using inverse consistency and other methods. Three clinically relevant organ deformations were created in prostate (distended rectum and rectal gas), head and neck (large neck flexion), and lung (inhale and exhale lung volumes with variable contrast enhancement) study sets. DIR was performed using both B-spline and diffeomorphic demons algorithms in the forward and inverse direction. A compositive accumulation of forward and inverse deformation vector fields was done to quantify the inverse consistency error (ICE). The anatomical correspondence of tumor and organs at risk was quantified by comparing the original RT structures with those obtained after DIR. Further, the physical characteristics of the deformation field, namely the Jacobian and harmonic energy, were computed to quantify the preservation of image topology and regularity of spatial transformation obtained in DIR. The ICE was comparable in prostate case but the B-spline algorithm had significantly better anatomical correspondence for rectum and prostate than diffeomorphic demons algorithm. The ICE was 6.5 mm for demons algorithm for head and neck case when compared to 0.7 mm for B-spline. Since the induced neck flexion was large, the average Dice similarity coefficient between both algorithms was only 0.87, 0.52, 0.81, and 0.67 for tumor, cord, parotids, and mandible, respectively. The B-spline algorithm accurately estimated deformations between images with variable contrast in our lung study, while diffeomorphic demons algorithm led to gross errors on structures affected by contrast variation. The proposed framework offers the application of known deformations on any image datasets, to evaluate the overall accuracy and limitations of a DIR algorithm used in radiation oncology. The evaluation based on anatomical correspondence, physical characteristics of deformation field, and image characteristics can facilitate DIR verification with the ultimate goal of implementing adaptive radiotherapy. The suitability of application of a particular evaluation metric in validating DIR is dependent on the clinical deformation observed.


PubMed | University of Minnesota and Minneapolis Radiation Oncology
Type: Journal Article | Journal: Medical physics | Year: 2017

To verify experimentally the accuracy of Monaco (Elekta) electron Monte Carlo (eMC) algorithm to calculate small field size depth doses, monitor units and isodose distributions.Beam modeling of eMC algorithm was performed for electron energies of 6, 9, 12 15 and 18 Mev for a Elekta Infinity Linac and all available (6, 10, 14 20 and 25 cone) applicator sizes. Electron cutouts of incrementally smaller field sizes (20, 40, 60 and 80% blocked from open cone) were fabricated. Dose calculation was performed using a grid size smaller than one-tenth of the RThe measured dose and output factors of incrementally reduced cutout sizes (to 3cm diameter) agreed with eMC calculated doses within 2.5%. The profile comparisons at dmax, dOur results indicate that the Monaco eMC algorithm can accurately predict depth doses, isodose distributions, and monitor units in homogeneous water phantom for field sizes as small as 3.0 cm diameter for energies in the 6 to 18 MeV range at 100 cm SSD. Consequently, the old rule of thumb to approximate limiting cutout size for an electron field determined by the lateral scatter equilibrium (E (MeV)/2.5 in centimeters of water) does not apply to Monaco eMC algorithm.


PubMed | University of Minnesota and Minneapolis Radiation Oncology
Type: Journal Article | Journal: Medical physics | Year: 2017

To compare the plan quality between Eclipse (Varian) and Monaco (Elekta) TPS. To ascertain, if SBRT lung treatment could be delivered in a single coplanar arc (360 degrees) with both Elekta and Varian platforms. To assess if the smaller leaf width in Varian Millennium and Elekta Agility MLC heads have a dosimetric advantage over Elekta MLCi2 head METHODS: Ten SBRT lung patients (PTV volumes ranging from 11 cc to 103cc) who were previously treated on Varian Linac with non-coplanar arcs and received 50Gy in 5 fractions were chosen for this study. The patients were replanned in Eclipse TPS (AAA algorithm) using a 360 degree coplanar single arc (SA) delivery technique and 2 partial complimentary 180 degree arcs (PA). Treatment planning using single coplanar arc (360 degree arc) was also done on Monaco TPS (Montecarlo) for both Agility (160 leaf) and MLCi2 (80 leaf) Elekta MLC heads RESULTS: The average monitor units to deliver 10 Gy across all delivery methods were 3000 474 MU and did not vary with PTV size. Coplanar single arc and partial arc techniques did not compromise either the RTOG 0813 or 0915 low dose spillage criteria for R50% or the maximum dose to any point 2cm away from the PTV. OAR doses to spinal cord, heart, great vessels, esophagus, rib and lung were comparable on both Eclipse (Varian) and Monaco (Elekta) platforms regardless of the delivery method.SBRT lung tumors can be treated with a single coplanar 360 degree arc in both Varian and Elekta platforms. Non coplanar arcs and increasing arc degrees more than 360 degrees had no benefit in this study regardless of the volume of PTV. 0.5 cm leaf width used in Millennium and Agility MLC heads had no significant dosimetric improvement over 1 cm leaves in the MLCi2 head.


News Article | November 17, 2016
Site: www.eurekalert.org

A new article published online by JAMA Oncology updates a tool to estimate survival in patients with lung cancer and brain metastases. Lung cancer is a leading cause of death in the United States and around the world. A frequent and serious consequence of the disease is metastasis to the brain. New therapies mean survival from lung cancer continues to improve and patients are at increased risk of developing later complications of the disease, such as brain metastases. Understanding prognosis for lung cancer is important, both for designing individualized care and future clinical trials. In their article, Paul W. Sperduto, M.D., M.P.P., of Minneapolis Radiation Oncology and the University of Minnesota, Minneapolis, and coauthors update the original Diagnosis-Specific Graded Prognostic Assessment(DS-GPA) with new genetic and molecular data to create a new index called the Lung-moIGPA, which can be accessed electronically. The updated Lung-moIGPA was designed by analyzing data from 2,186 patients in a multi-institution database from 2006 through 2014 with non-small cell lung cancer and newly diagnosed brain metastases. Two new prognostic factors were used in the new Lung-moIGPA: EGFR and ALK gene mutations. The authors reported overall median survival in the patient group was 12 months. Study limitations include its design, which cannot establish causality. "The updated Lung-moIGPA incorporating gene alteration data into the DS-GPA is a user-friendly tool that may facilitate clinical decision-making and appropriate stratification of future clinical trials," the study concludes. Editor's Note: The article contains conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.


News Article | November 19, 2016
Site: www.sciencedaily.com

A new article published online by JAMA Oncology updates a tool to estimate survival in patients with lung cancer and brain metastases. Lung cancer is a leading cause of death in the United States and around the world. A frequent and serious consequence of the disease is metastasis to the brain. New therapies mean survival from lung cancer continues to improve and patients are at increased risk of developing later complications of the disease, such as brain metastases. Understanding prognosis for lung cancer is important, both for designing individualized care and future clinical trials. In their article, Paul W. Sperduto, M.D., M.P.P., of Minneapolis Radiation Oncology and the University of Minnesota, Minneapolis, and coauthors update the original Diagnosis-Specific Graded Prognostic Assessment(DS-GPA) with new genetic and molecular data to create a new index called the Lung-moIGPA, which can be accessed electronically. The updated Lung-moIGPA was designed by analyzing data from 2,186 patients in a multi-institution database from 2006 through 2014 with non-small cell lung cancer and newly diagnosed brain metastases. Two new prognostic factors were used in the new Lung-moIGPA: EGFR and ALK gene mutations. The authors reported overall median survival in the patient group was 12 months. Study limitations include its design, which cannot establish causality. "The updated Lung-moIGPA incorporating gene alteration data into the DS-GPA is a user-friendly tool that may facilitate clinical decision-making and appropriate stratification of future clinical trials," the study concludes.


Varadhan R.,Minneapolis Radiation Oncology
Journal of applied clinical medical physics / American College of Medical Physics | Year: 2013

Quantitative validation of deformable image registration (DIR) algorithms is extremely difficult because of the complexity involved in constructing a deformable phantom that can duplicate various clinical scenarios. The purpose of this study is to describe a framework to test the accuracy of DIR based on computational modeling and evaluating using inverse consistency and other methods. Three clinically relevant organ deformations were created in prostate (distended rectum and rectal gas), head and neck (large neck flexion), and lung (inhale and exhale lung volumes with variable contrast enhancement) study sets. DIR was performed using both B-spline and diffeomorphic demons algorithms in the forward and inverse direction. A compositive accumulation of forward and inverse deformation vector fields was done to quantify the inverse consistency error (ICE). The anatomical correspondence of tumor and organs at risk was quantified by comparing the original RT structures with those obtained after DIR. Further, the physical characteristics of the deformation field, namely the Jacobian and harmonic energy, were computed to quantify the preservation of image topology and regularity of spatial transformation obtained in DIR. The ICE was comparable in prostate case but the B-spline algorithm had significantly better anatomical correspondence for rectum and prostate than diffeomorphic demons algorithm. The ICE was 6.5 mm for demons algorithm for head and neck case when compared to 0.7 mm for B-spline. Since the induced neck flexion was large, the average Dice similarity coefficient between both algorithms was only 0.87, 0.52, 0.81, and 0.67 for tumor, cord, parotids, and mandible, respectively. The B-spline algorithm accurately estimated deformations between images with variable contrast in our lung study, while diffeomorphic demons algorithm led to gross errors on structures affected by contrast variation. The proposed framework offers the application of known deformations on any image datasets, to evaluate the overall accuracy and limitations of a DIR algorithm used in radiation oncology. The evaluation based on anatomical correspondence, physical characteristics of deformation field, and image characteristics can facilitate DIR verification with the ultimate goal of implementing adaptive radiotherapy. The suitability of application of a particular evaluation metric in validating DIR is dependent on the clinical deformation observed.


PubMed | Minneapolis Radiation Oncology and UniversityMinnesota
Type: Journal Article | Journal: Medical physics | Year: 2016

To establish the fundamental relationship between deformation and its causative physical force using a deformable bladder phantom. To ascertain if a threshold limit exists for DIR accuracy, beyond which its applicability in deformed anatomy may be clinically inappropriate.A tissue equivalent deformable bladder phantom with 21 implanted aluminum markers was developed using a viscoelastic polymer with Youngs modulus and physical density properties comparable to human bladder. Applied force on the organ was incrementally varied from 10N to 70N which in turn deforms the organ. DIR accuracy was studied for commercially available algorithms (MIM and Velocity AI) by comparing the centroid (3D vector) of the 21 marker locations at the undeformed CT (ground truth) with synthetically derived marker positions from each target image from DIR.The relationship between applied force and both 1D deformation along the axis of applied force (Rhe accuracy of DIR was evaluated using a tissue equivalent mass and density conserving bladder phantom in the best case scenario using 21 implanted aluminum high contrast markers to improve the accuracy. The limits of applicability of DIR are strongly dependent on the magnitude of deformation. There is a threshold limit beyond which the accuracy of DIR fails for the range of mass and density conserving deformation studied.

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