Northeast Radiation Oncology Center

Dunmore, PA, United States

Northeast Radiation Oncology Center

Dunmore, PA, United States
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Lawton C.A.F.,Medical College of Wisconsin | Lin X.,University of Chicago | Hanks G.E.,Fox Chase Cancer Center | Lepor H.,New York University | And 15 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2017

Purpose Trial RTOG 9202 was a phase 3 randomized trial designed to determine the optimal duration of androgen deprivation therapy (ADT) when combined with definitive radiation therapy (RT) in the treatment of locally advanced nonmetastatic adenocarcinoma of the prostate. Long-term follow-up results of this study now available are relevant to the management of this disease. Methods and Materials Men (N=1554) with adenocarcinoma of the prostate (cT2c-T4, N0-Nx) with a prostate-specific antigen (PSA) <150 ng/mL and no evidence of distant metastasis were randomized (June 1992 to April 1995) to short-term ADT (STAD: 4 months of flutamide 250 mg 3 times per day and goserelin 3.6 mg per month) and definitive RT versus long-term ADT (LTAD: STAD with definitive RT plus an additional 24 months of monthly goserelin). Results Among 1520 protocol-eligible and evaluable patients, the median follow-up time for this analysis was 19.6 years. In analysis adjusted for prognostic covariates, LTAD improved disease-free survival (29% relative reduction in failure rate, P<.0001), local progression (46% relative reduction, P=.02), distant metastases (36% relative reduction, P<.0001), disease-specific survival (30% relative reduction, P=.003), and overall survival (12% relative reduction, P=.03). Other-cause mortality (non–prostate cancer) did not differ (5% relative reduction, P=.48). Conclusions LTAD and RT is superior to STAD and RT for the treatment of locally advanced nonmetastatic adenocarcinoma of the prostate and should be considered the standard of care. © 2017


Yuan J.,ICT Radiotherapy | Yuan J.,Northeast Radiation Oncology Center | Chang S.,ICT Radiotherapy | Chang S.,Northeast Radiation Oncology Center | And 3 more authors.
Medical Physics | Year: 2010

Purpose: To evaluate the speed up and image quality for digitally reconstructed radiograph (DRR) calculations using a graphic processing unit (GPU) comparing with a central processing unit (CPU). Method and Materials: We developed an application for DRR image calculations using a faster incremental Siddon ray tracing algorithm. The implementation of the core integration loop was the same for the CPU and the GPU except that single‐precision operations were used on the GPU with CUDA 1.2. The GPU runs on NVIDIA GeForce GTX 280M with 1 GB video memory. To validate the correctness of the algorithm, we employed a clinical three‐field plan as an example. The CT volume image and the RT plan were exported from a commercial treatment planning system and read by our application to generate the DRR images. Results: By comparing visually with the bony structures from our DRR images and the commercial software generated DRR images, we have confidence in the correctness of our fast ray tracing implementation on both CPU and GPU. The accuracy of the GPU calculations comparing with the CPU calculation is well acceptable as only about 3% of the total pixels have less than 0.1% pixel values difference from the CPU calculations for the test fields. Conclusions: The DRR calculations using GPU is more than an order of magnitude faster than using a general purpose CPU. The image quality by the two methods is very similar where the difference comes from the float point operation type. This accelerated DRR computation has potential to reduce the patient‐positioning time during the 2D/3D registration where inline DRR calculations are required in the iteration. © 2010, American Association of Physicists in Medicine. All rights reserved.


he W.,Northeast Radiation Oncology Center | Chang S.,Northeast Radiation Oncology Center | Chen W.,Northeast Radiation Oncology Center | Baikadi M.,Northeast Radiation Oncology Center | And 3 more authors.
Medical Physics | Year: 2011

Purpose: To develop a two‐dimensional (2D) dose calculation software for helical tomotherapy with absolute dose validation capability. Methods: This in‐house software takes advantage of archived patient treatment planning documents, initial coordinates of red and green lasers, central coronal plane slice numbers of the Cheese phantom, and clinical dosimetric functions. A tomotherapy DQA plan has to be generated and archived first. The software performs an independent absolute dose check to the tomotherapy plan. The software calculates the 2D dose map of the central coronal plane of the Cheese phantom, and the 2D map is narrowed into a 3.2cm×3.1cm rectangular on the plane to save calculation duration. Doses of points on the plane are calculated with 1 mm resolution, so that a total of 992 points are calculated for each patient case. The center of the 2D square is the cross point of red lasers, which is the center of the Cheese phantom by default. The 2D dose map calculated is thereafter compared with the planned one, which is a 3D dose matrix from the DQA plan. Gamma index is then calculated with 3mm and 5% criteria. Results: The newly developed software has been tested on ten tomotherapy patients (cases of 1 pancreas, 2 brain, 1 stomach, 1 lung, 1 head & neck, 3 prostate, and 1 esophagus). The gamma distributions are all passed with a minimum ratio of 95%. Conclusions: An in‐house independent dose calculation software for helical tomotherapy has been developed to independently validates 2D doses with gamma index. Gamma in this software is calculated by comparing the 2D calculation to 3D doses, which makes the introduced method more superior than normal IMRT or tomotherapy QA. Validation of the software on more cases and more tomotherapy units is necessary. © 2011, American Association of Physicists in Medicine. All rights reserved.


Lawton C.A.,Medical College of Wisconsin | Yan Y.,Radiation Therapy Oncology Group Statistical Center | Lee W.R.,Duke University | Gillin M.,University of Houston | And 6 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2012

Purpose: External-beam radiation therapy combined with low - doserate permanent brachytherapy are commonly used to treat men with localized prostate cancer. This Phase II trial was performed to document late gastrointestinal or genitourinary toxicity as well as biochemical control for this treatment in a multi-institutional cooperative group setting. This report defines the long-term results of this trial. Methods and Materials: All eligible patients received external-beam radiation (45 Gy in 25 fractions) followed 2-6 weeks later by a permanent iodine 125 implant of 108 Gy. Late toxicity was defined by the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer late radiation morbidity scoring scheme. Biochemical control was defined by the American Society for Therapeutic Radiology and Oncology (ASTRO) Consensus definition and the ASTRO Phoenix definition. Results: One hundred thirty-eight patients were enrolled from 20 institutions, and 131 were eligible. Median follow-up (living patients) was 8.2 years (range, 2.7-9.3 years). The 8-year estimate of late grade >3 genitourinary and/or gastrointestinal toxicity was 15%. The most common grade >3 toxicities were urinary frequency, dysuria, and proctitis. There were two grade 4 toxicities, both bladder necrosis, and no grade 5 toxicities. In addition, 42% of patients complained of grade 3 impotence (no erections) at 8 years. The 8-year estimate of biochemical failure was 18% and 21% by the Phoenix and ASTRO consensus definitions, respectively. Conclusion: Biochemical control for this treatment seems durable with 8 years of follow-up and is similar to high - dose external beam radiation alone or brachytherapy alone. Late toxicity in this multi-institutional trial is higher than reports from similar cohorts of patients treated with high - dose external-beam radiation alone or permanent low - doserate brachytherapy alone, perhaps suggesting further attention to strategies that limit doses to normal structures or to unimodal radiotherapy techniques. © 2012 Elsevier Inc.


Churilla T.M.,Commonwealth Medical College | Lesko S.L.,Commonwealth Medical College | Lesko S.L.,Northeast Regional Cancer Institute | Brereton H.D.,Commonwealth Medical College | And 5 more authors.
BMJ Open | Year: 2011

Objectives: Low serum vitamin D levels have been associated with risk for certain malignancies, but studies have not directly analysed levels between community oncology and primary care practices. The purpose of this study was to compare serum vitamin D levels in patients at a community oncology practice with non-cancer patients at a primary care practice. Design: Retrospective case-control study. 25-Hydroxyvitamin D levels were ordered for screening in both cancer and non-cancer patients. Levels were compared in univariate and multivariate analyses adjusted for age, body mass index and season of blood draw. Setting: A community-based radiation oncology centre and a community-based primary care practice: both located in Northeastern Pennsylvania, USA. Participants: 170 newly diagnosed cancer patients referred for initial consultation at the community oncology centre from 21 November 2008 to 18 May 2010, and 170 non-cancer patients of the primary care practice who underwent screening for hypovitaminosis D for the first time from 1 January 2009 to 31 December 2009. Primary and secondary outcome measures: The primary outcome measure was mean serum vitamin D level, and the secondary outcome measures were frequencies of patients with vitamin D levels <20 ng/ml and levels <30 ng/ml. Results: The oncology patients had a significantly lower mean serum vitamin D level (24.9 ng/ml) relative to a cohort of non-cancer primary care patients (30.6 ng/ml, p<0.001) from the same geographical region. The relationship retained significance after adjustment for age, body mass index and season of blood draw in multivariate analysis (p=0.001). Levels <20 and <30 ng/ml were more frequent in the oncology patients (OR (95% CI)=2.59 (1.44 to 4.67) and 2.04 (1.20 to 3.46), respectively) in multivariate analysis. Conclusions: Cancer patients were found to have low vitamin D levels relative to a similar cohort of noncancer primary care patients from the same geographical region.


News Article | December 27, 2016
Site: co.newswire.com

One of Two Radiation Oncology Centers in Pennsylvania to Achieve this Honor ​​Northeast Pennsylvanians often think that excellent cancer care is found strictly in larger cities. However, that perception was recently disproved by Scranton’s own Northeast Radiation Oncology Center (NROC). The experienced team of physicians at NROC were one of only two centers in the Commonwealth of Pennsylvania awarded a four-year accreditation for radiation oncology services from the American Society for Radiation Oncology (ASTRO) after successfully demonstrating compliance with the Accreditation Program for Excellence (APEx®). In order to gain the APEx accreditation, NROC had to meet a comprehensive set of sixteen evidence-based standards of radiation oncology practice. The sixteen standards are focused on five pillars of patient care: 1) the process of care; 2) the radiation oncology team; 3) safety; 4) quality management; and 5) patient-centered care. “The NROC team is very pleased to receive the APEx accreditation from the premier radiation oncology society in the world,” said Christopher A. Peters, MD, medical director. “We are particularly honored to be one of only two centers in the state to receive this accreditation. Evaluating our processes in relation to ASTRO’s high standards, including standards for safety and quality, validates our practices and recognizes the efforts of our radiation oncology team to deliver patient-centered, highest quality radiation oncology care.” Accreditation through APEx is a rigorous, multi-step process that can take up to one year to complete. In becoming accredited, NROC had to have its policies and procedures evaluated using objective, verifiable expectations for performance in radiation oncology. NROC also had to demonstrate its commitment to high standards of safety and quality in the practice of radiation oncology and that it practices patient-centered care by promoting effective communication, coordinating treatment, and engaging patients and their families as partners in care. “At NROC, patients always come first,” added Dr. Peters. “As your partners in cancer care, we’ll answer all your questions precisely and promptly. We’ll guide you in the right direction, doing everything humanly and scientifically possible to get you on the road to recovering. You do not need a referral to get our help.  Even if our groundbreaking radiation treatment is not right for you, we’ll connect you to the best doctors and the proper treatment – wherever that might be.” NROC patients are also given the opportunity to participate in cancer clinical research trials. NROC physicians have served as Principal Investigators for National Cancer Institute research trials for almost 30 years. The APEx program involves both a self-assessment process and a facility visit by a medical physicist, radiation oncologist, radiation therapist, nurse, dosimetrist, nurse practitioner, physician assistant or practice administrator. “ASTRO is proud to recognize Northeast Radiation Oncology Center for achieving APEx accreditation,” said ASTRO chair Bruce D. Minsky, MD, FASTRO. “NROC has demonstrated a commitment to providing their patients with safe, high quality radiation therapy services.” ASTRO is the premier radiation oncology society in the world, with more than 10,000 members who are physicians, nurses, biologists, physicists, radiation therapists, dosimetrists and other health care professionals who specialize in treating patients with radiation therapies. As the leading organization in radiation oncology, the Society is dedicated to improving patient care through professional education and training, support for clinical practice and health policy standards, advancement of science and research, and advocacy. ASTRO publishes three medical journals, International Journal of Radiation Oncology • Biology • Physics (www.redjournal.org), Practical Radiation Oncology (www.practicalradonc.org) and Advances in Radiation Oncology (www.advancesradonc.org); developed and maintains an extensive patient website, RT Answers (http://www.rtanswers.org); and created the Radiation Oncology Institute (www.roinstitute.org), a nonprofit foundation to support research and education efforts around the world that enhance and confirm the critical role of radiation therapy in improving cancer treatment. To learn more about ASTRO, visit www.astro.org. For more information, to interview Dr. Peters, or for photographs of the NROC team or facilities, please call Elaine Ferri at Lavelle Strategy Group at 570-969-6000 or eferri@lavellestrategy.com


Churilla T.M.,Commonwealth Medical College | Donnelly P.E.,Hospital for Special Surgery | Leatherman E.R.,West Virginia University | Adonizio C.S.,Commonwealth Medical College | And 2 more authors.
Breast Journal | Year: 2015

Mastectomy and breast conservation therapy (BCT) are equivalent in survival for treatment of early stage breast cancer. This study evaluated the impact of radiation oncologist accessibility on choice of breast conserving surgery (BCS) versus mastectomy, and the appropriate receipt of radiotherapy after BCS. In the National Cancer Institute Survival, Epidemiology, and End Results data base, the authors selected breast cancer cases from 2004 to 2008 with the following criteria: T2N1M0 or less, lobular or ductal histology, and treatment with simple or partial mastectomy. We combined the Health Resources and Services Administration Area Resource File to define average radiation oncologist density (ROD) by county over the same time period. We evaluated tumor characteristics, demographic information, and ROD with respect to BCS rates and receipt of radiation therapy after BCS in univariable and multivariable analyses. In 118,773 cases analyzed, mastectomy was performed 33.2% of the time relative to BCS. After adjustment for demographic and tumor variables, the odds of having BCS versus mastectomy were directly associated with ROD (multiplicative change in odds for a single unit increase in ROD [95% CI] = 1.02 [1.01-1.03]; p < 0.001). Adjuvant radiation therapy was not administered in 28.2% of BCS cases. When adjusting for demographic and tumor variables, the odds of having BCS without adjuvant radiation were inversely associated with ROD (0.95 [0.94-0.97]; p < 0.001). We observed a direct relationship between ROD and BCS rates independent of demographic and tumor variables, and an inverse trend for omission of radiotherapy after BCS. Access to radiation oncologists may represent an important factor in surgical choice and receiving appropriate BCT in early stage breast cancer. © 2015 Wiley Periodicals, Inc.


Yuan J.,Northeast Radiation Oncology Center | Chen W.,Northeast Radiation Oncology Center
Medical Physics | Year: 2010

Purpose: The authors propose an algorithm based on the k-d tree for nearest neighbor searching to improve the γ calculation time for 2D and 3D dose distributions. Methods: The γ calculation method has been widely used for comparisons of dose distributions in clinical treatment plans and quality assurances. By specifying the acceptable dose and distance-to-agreement criteria, the method provides quantitative measurement of the agreement between the reference and evaluation dose distributions. The γ value indicates the acceptability. In regions where γ1, the predefined criterion is satisfied and thus the agreement is acceptable; otherwise, the agreement fails. Although the concept of the method is not complicated and a quick nave implementation is straightforward, an efficient and robust implementation is not trivial. Recent algorithms based on exhaustive searching within a maximum radius, the geometric Euclidean distance, and the table lookup method have been proposed to improve the computational time for multidimensional dose distributions. Motivated by the fact that the least searching time for finding a nearest neighbor can be an O (log N) operation with a k-d tree, where N is the total number of the dose points, the authors propose an algorithm based on the k-d tree for the γ evaluation in this work. Results: In the experiment, the authors found that the average k-d tree construction time per reference point is O (log N), while the nearest neighbor searching time per evaluation point is proportional to O (N1/k), where k is between 2 and 3 for two-dimensional and three-dimensional dose distributions, respectively. Conclusions: Comparing with other algorithms such as exhaustive search and sorted list O (N), the k-d tree algorithm for γ evaluation is much more efficient. © 2010 American Association of Physicists in Medicine.


Churilla T.M.,Commonwealth Medical College | Brereton H.D.,Commonwealth Medical College | Brereton H.D.,Northeast Radiation Oncology Center | Klem M.,Northeast Radiation Oncology Center | And 2 more authors.
Nutrition and Cancer | Year: 2012

The purpose of this study was to correlate serum vitamin D levels with potential clinical variables and to determine the extent of vitamin D deficiency in a large, outpatient oncology practice. One hundred ninety-five consecutive patients referred for consultation at a community radiation oncology center from October 8, 2008 to March 17, 2010 had vitamin D levels ordered. Patients who were deficient in vitamin D were treated with replacement therapy. Demographic and medical data were collected prospectively and subsequently analyzed. Pretreatment baseline patient and tumor characteristics were evaluated with respect to vitamin D concentrations. One hundred and sixty patients were analyzed. A total of 74% of patients had 25-hydroxyvitamin D concentrations considered either deficient (<20 ng/mL) or suboptimal (20-30 ng/mL). Replacement therapy raised serum vitamin D levels by an average of 15 ng/mL (95% CI = 11-18, P < 0.01). Lower than median serum vitamin D levels were associated with stage III disease in univariate analysis [OR = 2.6 (95% CI = 1.1-6.2), p = 0.04] as well as multivariate analysis adjusted for age, sex, body mass index, and season of draw [OR = 3.3 (95% CI = 1.1-9.7), P = 0.03]. Three-quarters of patients in our series had suboptimal or deficient circulating concentrations of 25-hydroxyvitamin D. Low serum vitamin D levels, independent of age, sex, and body mass index, predicted advanced stage disease. © 2012 Copyright Taylor and Francis Group, LLC.


News Article | December 27, 2016
Site: www.prnewswire.com

SCRANTON, Pa., Dec. 27, 2016 /PRNewswire/ -- Northeast Pennsylvanians often think that excellent cancer care is found strictly in larger cities. However, that perception was recently disproved by Scranton's own Northeast Radiation Oncology Center (NROC). The experienced team of...

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