You are here

Hahn, Carol Anne

Overview:

Development of Evidence Based Clinical Practice Guidelines for Radiation Oncology.

Optimizing Quality of Care in Radiation Oncology and Development of Quality Measures.

Disparities in care for oncology patients between tertiary care and community hospitals.

Assessment of Neuropsychologic Function in Brain Tumor Patients and the metabolic and functional changes induced by Radiation Therapy.

Positions:

Professor of Radiation Oncology

Radiation Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1990

M.D. — Georgetown University

Awards:

Fellow of the American Society for Radiation Oncology. American Society for Radiation Oncology.

Type
National
Awarded By
American Society for Radiation Oncology
Date
October 01, 2015

Publications:

Palliative radiation therapy for bone metastases: Update of an ASTRO Evidence-Based Guideline.

The purpose is to provide an update the Bone Metastases Guideline published in 2011 based on evidence complemented by expert opinion. The update will discuss new high-quality literature for the 8 key questions from the original guideline and implications for practice.A systematic PubMed search from the last date included in the original Guideline yielded 414 relevant articles. Ultimately, 20 randomized controlled trials, 32 prospective nonrandomized studies, and 4 meta-analyses/pooled analyses were selected and abstracted into evidence tables. The authors synthesized the evidence and reached consensus on the included recommendations.Available literature continues to support pain relief equivalency between single and multiple fraction regimens for bone metastases. High-quality data confirm single fraction radiation therapy may be delivered to spine lesions with acceptable late toxicity. One prospective, randomized trial confirms both peripheral and spine-based painful metastases can be successfully and safely palliated with retreatment for recurrence pain with adherence to published dosing constraints. Advanced radiation therapy techniques such as stereotactic body radiation therapy lack high-quality data, leading the panel to favor its use on a clinical trial or when results will be collected in a registry. The panel's conclusion remains that surgery, radionuclides, bisphosphonates, and kyphoplasty/vertebroplasty do not obviate the need for external beam radiation therapy.Updated data analysis confirms that radiation therapy provides excellent palliation for painful bone metastases and that retreatment is safe and effective. Although adherence to evidence-based medicine is critical, thorough expert radiation oncology physician judgment and discretion regarding number of fractions and advanced techniques are also essential to optimize outcomes when considering the patient's overall health, life expectancy, comorbidities, tumor biology, anatomy, previous treatment including prior radiation at or near current site of treatment, tumor and normal tissue response history to local and systemic therapies, and other factors related to the patient, tumor characteristics, or treatment.

Authors
Lutz, S; Balboni, T; Jones, J; Lo, S; Petit, J; Rich, SE; Wong, R; Hahn, C
MLA Citation
Lutz, S, Balboni, T, Jones, J, Lo, S, Petit, J, Rich, SE, Wong, R, and Hahn, C. "Palliative radiation therapy for bone metastases: Update of an ASTRO Evidence-Based Guideline." Practical radiation oncology 7.1 (January 2017): 4-12.
PMID
27663933
Source
epmc
Published In
Practical Radiation Oncology
Volume
7
Issue
1
Publish Date
2017
Start Page
4
End Page
12
DOI
10.1016/j.prro.2016.08.001

Development of an Ultra-Fast, High-Quality Whole-Breast Radiation Therapy Treatment Planning System

Authors
Sheng, Y; Li, T; Yoo, S; Yin, FF; Blitzblau, RC; Sr, HJK; Palta, M; Hahn, CA; Ge, Y; Wu, QRJ
MLA Citation
Sheng, Y, Li, T, Yoo, S, Yin, FF, Blitzblau, RC, Sr, HJK, Palta, M, Hahn, CA, Ge, Y, and Wu, QRJ. "Development of an Ultra-Fast, High-Quality Whole-Breast Radiation Therapy Treatment Planning System." October 1, 2016.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2
Publish Date
2016
Start Page
S228
End Page
S228

Development of an Ultra-Fast, High-Quality Whole-Breast Radiation Therapy Treatment Planning System.

Authors
Sheng, Y; Li, T; Yoo, S; Yin, FF; Blitzblau, RC; Horton, JK; Palta, M; Hahn, CA; Ge, Y; Wu, QR
MLA Citation
Sheng, Y, Li, T, Yoo, S, Yin, FF, Blitzblau, RC, Horton, JK, Palta, M, Hahn, CA, Ge, Y, and Wu, QR. "Development of an Ultra-Fast, High-Quality Whole-Breast Radiation Therapy Treatment Planning System." International journal of radiation oncology, biology, physics 96.2S (October 2016): S228-.
PMID
27675847
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
96
Issue
2S
Publish Date
2016
Start Page
S228
DOI
10.1016/j.ijrobp.2016.06.566

Choosing wisely: the American Society for Radiation Oncology's top 5 list.

To highlight 5 interventions that patients should question, as part of the Choosing Wisely campaign. This initiative, led by the American Board of Internal Medicine Foundation, fosters conversations between physicians and patients about treatments and tests that may be overused, unnecessary, or potentially harmful.Potential items were initially compiled using an online survey. They were then evaluated and refined by a work group representing the American Society for Radiation Oncology (ASTRO) Clinical Affairs and Quality, Health Policy, and Government Relations Councils. Literature reviews were carried out to support the recommendation and narrative, as well as to provide references for each item. A final list of 5 items was then selected by the ASTRO Board of Directors.ASTRO's 5 recommendations for the Choosing Wisely campaign are the following: (1) Don't initiate whole-breast radiation therapy as a part of breast conservation therapy in women age ≥50 with early-stage invasive breast cancer without considering shorter treatment schedules; (2) don't initiate management of low-risk prostate cancer without discussing active surveillance; (3) don't routinely use extended fractionation schemes (>10 fractions) for palliation of bone metastases; (4) don't routinely recommend proton beam therapy for prostate cancer outside of a prospective clinical trial or registry; and (5) don't routinely use intensity modulated radiation therapy to deliver whole-breast radiation therapy as part of breast conservation therapy.The ASTRO list for the Choosing Wisely campaign highlights radiation oncology interventions that should be discussed between physicians and patients before treatment is initiated. These 5 items provide opportunities to offer higher quality and less costly care.

Authors
Hahn, C; Kavanagh, B; Bhatnagar, A; Jacobson, G; Lutz, S; Patton, C; Potters, L; Steinberg, M
MLA Citation
Hahn, C, Kavanagh, B, Bhatnagar, A, Jacobson, G, Lutz, S, Patton, C, Potters, L, and Steinberg, M. "Choosing wisely: the American Society for Radiation Oncology's top 5 list." Practical radiation oncology 4.6 (November 2014): 349-355.
PMID
25407853
Source
epmc
Published In
Practical Radiation Oncology
Volume
4
Issue
6
Publish Date
2014
Start Page
349
End Page
355
DOI
10.1016/j.prro.2014.06.003

"Choosing Wisely": The American Society for Radiation Oncology's Top 5 List

Authors
Hahn, CA; Kavanagh, B; Bhatnagar, A; Jacobson, GM; Lutz, S; Patton, C; Potters, L; Steinberg, ML
MLA Citation
Hahn, CA, Kavanagh, B, Bhatnagar, A, Jacobson, GM, Lutz, S, Patton, C, Potters, L, and Steinberg, ML. ""Choosing Wisely": The American Society for Radiation Oncology's Top 5 List." September 1, 2014.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
90
Publish Date
2014
Start Page
S591
End Page
S591

Adjuvant and salvage radiotherapy after prostatectomy: AUA/ASTRO Guideline.

PURPOSE: The purpose of this guideline is to provide a clinical framework for the use of radiotherapy after radical prostatectomy as adjuvant or salvage therapy. MATERIALS AND METHODS: A systematic literature review using the PubMed®, Embase, and Cochrane databases was conducted to identify peer-reviewed publications relevant to the use of radiotherapy after prostatectomy. The review yielded 294 articles; these publications were used to create the evidence-based guideline statements. Additional guidance is provided as Clinical Principles when insufficient evidence existed. RESULTS: Guideline statements are provided for patient counseling, the use of radiotherapy in the adjuvant and salvage contexts, defining biochemical recurrence, and conducting a re-staging evaluation. CONCLUSIONS: Physicians should offer adjuvant radiotherapy to patients with adverse pathologic findings at prostatectomy (i.e., seminal vesicle invasion, positive surgical margins, extraprostatic extension) and should offer salvage radiotherapy to patients with prostatic specific antigen or local recurrence after prostatectomy in whom there is no evidence of distant metastatic disease. The offer of radiotherapy should be made in the context of a thoughtful discussion of possible short- and long-term side effects of radiotherapy as well as the potential benefits of preventing recurrence. The decision to administer radiotherapy should be made by the patient and the multi-disciplinary treatment team with full consideration of the patient's history, values, preferences, quality of life, and functional status. Please visit the ASTRO and AUA websites (http://www.redjournal.org/webfiles/images/journals/rob/RAP%20Guideline.pdf and http://www.auanet.org/education/guidelines/radiation-after-prostatectomy.cfm) to view this guideline in its entirety, including the full literature review.

Authors
Thompson, IM; Valicenti, RK; Albertsen, P; Davis, BJ; Goldenberg, SL; Hahn, C; Klein, E; Michalski, J; Roach, M; Sartor, O; Wolf, JS; Faraday, MM
MLA Citation
Thompson, IM, Valicenti, RK, Albertsen, P, Davis, BJ, Goldenberg, SL, Hahn, C, Klein, E, Michalski, J, Roach, M, Sartor, O, Wolf, JS, and Faraday, MM. "Adjuvant and salvage radiotherapy after prostatectomy: AUA/ASTRO Guideline." The Journal of urology 190.2 (August 2013): 441-449.
PMID
23707439
Source
epmc
Published In
The Journal of Urology
Volume
190
Issue
2
Publish Date
2013
Start Page
441
End Page
449
DOI
10.1016/j.juro.2013.05.032

Adjuvant and salvage radiation therapy after prostatectomy: American society for radiation oncology/american urological association guidelines

Purpose The purpose of this guideline was to provide a clinical framework for the use of radiation therapy after radical prostatectomy as adjuvant or salvage therapy. Methods and Materials A systematic literature review using PubMed, Embase, and Cochrane database was conducted to identify peer-reviewed publications relevant to the use of radiation therapy after prostatectomy. The review yielded 294 articles; these publications were used to create the evidence-based guideline statements. Additional guidance is provided as Clinical Principles when insufficient evidence existed. Results Guideline statements are provided for patient counseling, use of radiation therapy in the adjuvant and salvage contexts, defining biochemical recurrence, and conducting a restaging evaluation. Conclusions Physicians should offer adjuvant radiation therapy to patients with adverse pathologic findings at prostatectomy (ie, seminal vesicle invastion, positive surgical margins, extraprostatic extension) and salvage radiation therapy to patients with prostate-specific antigen (PSA) or local recurrence after prostatectomy in whom there is no evidence of distant metastatic disease. The offer of radiation therapy should be made in the context of a thoughtful discussion of possible short- and long-term side effects of radiation therapy as well as the potential benefits of preventing recurrence. The decision to administer radiation therapy should be made by the patient and the multidisciplinary treatment team with full consideration of the patient's history, values, preferences, quality of life, and functional status. The American Society for Radiation Oncology and American Urological Association websites show this guideline in its entirety, including the full literature review. © 2013 Elsevier Inc.

Authors
Valicenti, RK; Jr, IT; Albertsen, P; Davis, BJ; Goldenberg, SL; Wolf, JS; Sartor, O; Klein, E; Hahn, C; Michalski, J; III, MR; Faraday, MM
MLA Citation
Valicenti, RK, Jr, IT, Albertsen, P, Davis, BJ, Goldenberg, SL, Wolf, JS, Sartor, O, Klein, E, Hahn, C, Michalski, J, III, MR, and Faraday, MM. "Adjuvant and salvage radiation therapy after prostatectomy: American society for radiation oncology/american urological association guidelines." International Journal of Radiation Oncology Biology Physics 86.5 (2013): 822-828.
PMID
23845839
Source
scival
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
86
Issue
5
Publish Date
2013
Start Page
822
End Page
828
DOI
10.1016/j.ijrobp.2013.05.029

International practice survey on the management of brain metastases: Third International Consensus Workshop on Palliative Radiotherapy and Symptom Control.

AIM: To evaluate international patterns of practice for the management of metastatic disease to the brain. MATERIALS AND METHODS: An online international practice survey was conducted from April to June 2010. Most of the survey questions were based on common management issues for which optimal management using level 1 evidence was lacking. The survey consisted of three sections: respondent demographics, 13 general questions regarding surgery, whole brain radiotherapy (WBRT) and radiosurgery and 13 questions related to specific scenarios. RESULTS: In total, 445 individuals responded to the survey over a 3 month period. Ninety per cent of respondents worked in a hospital-based setting. Ninety-three per cent of respondents were radiation oncologists. Thirty-seven per cent worked in an academic setting. Only three of 26 survey questions generated at least 70% agreement for a favoured response. Eighty-eight per cent of respondents chose comfort measures only for patients with multiple brain metastases who have been previously treated with WBRT and who now present 6 months later with two to four brain metastases (all less than 4 cm in size) with uncontrolled extracranial disease and bedridden state. Seventy-eight per cent of respondents would use WBRT alone for initial treatment in patients with two to four brain metastases (all less than 4 cm in size), with active, uncontrolled extracranial disease and a Karnofsky performance status of 70. Seventy-eight per cent of respondents chose surgical resection for an enlarging single brain metastasis that has been previously treated with radiosurgery. The enlarging single brain metastasis is in a surgically accessible site and is now symptomatic. The patient has controlled extracranial disease, good performance status and magnetic resonance spectroscopy was not diagnostic. CONCLUSIONS: There is a lack of uniform agreement for many common management issues (not well answered by level 1 evidence) in patients with metastatic disease to the brain.

Authors
Tsao, MN; Rades, D; Wirth, A; Lo, SS; Danielson, BL; Vichare, A; Hahn, C; Chang, EL
MLA Citation
Tsao, MN, Rades, D, Wirth, A, Lo, SS, Danielson, BL, Vichare, A, Hahn, C, and Chang, EL. "International practice survey on the management of brain metastases: Third International Consensus Workshop on Palliative Radiotherapy and Symptom Control." Clin Oncol (R Coll Radiol) 24.6 (August 2012): e81-e92.
PMID
22794327
Source
pubmed
Published In
Comparative Haematology International
Volume
24
Issue
6
Publish Date
2012
Start Page
e81
End Page
e92
DOI
10.1016/j.clon.2012.03.008

Global reluctance to practice evidence-based medicine continues in the treatment of uncomplicated painful bone metastases despite level 1 evidence and practice guidelines.

Authors
Chow, E; Hahn, CA; Lutz, ST
MLA Citation
Chow, E, Hahn, CA, and Lutz, ST. "Global reluctance to practice evidence-based medicine continues in the treatment of uncomplicated painful bone metastases despite level 1 evidence and practice guidelines." Int J Radiat Oncol Biol Phys 83.1 (May 1, 2012): 1-2.
PMID
22516380
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
83
Issue
1
Publish Date
2012
Start Page
1
End Page
2
DOI
10.1016/j.ijrobp.2011.12.095

An international survey on liver metastases radiotherapy.

BACKGROUND: An international survey of radiation therapy (RT) of liver metastases was undertaken by the Liver Cancer Workgroup of the Third International Consensus on Metastases Workshop at the 2010 American Society for Radiation Oncology (ASTRO) meeting. MATERIAL AND METHODS: Canadian, European, Australian, New Zealand and American centers participated in this online survey. The survey had four objectives: 1) to describe the practice patterns for RT of liver metastases; 2) to report on the use of low-dose RT for symptomatic liver metastases; 3) to report on the use of technology; and 4) to describe the regional differences in the management of liver metastases. RESULTS: A total of 69 individuals treating liver metastases with radiotherapy responded to the survey. Regional response rates ranged from 39% to 50%. The primary professional affiliation of all respondents was evenly distributed amongst ASTRO, CARO, ESTRO and TROG/RANZCR. A 36% increase in the average annual number of referrals over the past five years is reported. The majority of referrals were for radical RT. The most common technologies used were 4D-CT (61%), SBRT (55%), IGRT (50%), and/or IMRT (28%). A uniform treatment approach was not found. The most commonly employed radical regimens were 45 Gy in 3 fractions, 40-50 Gy in 5 fractions, and 45 Gy in 15 fractions. Palliative regimens included 20 Gy in 5 fractions, 30 Gy in 10 fractions, 8 Gy in 1 fraction, and 10 Gy in 2 fractions. CONCLUSIONS: This survey suggests radiation oncologists will be seeing more referrals for liver RT. The majority of experience in liver metastases RT is with radical SBRT for focal metastases rather than low-dose palliative RT for symptom control. There is significant variation in technology utilization and dose regimens. Prospective studies or registries may allow for comparison of regimens and identification of parameters to optimize patient selection.

Authors
Lock, MI; Hoyer, M; Bydder, SA; Okunieff, P; Hahn, CA; Vichare, A; Dawson, LA
MLA Citation
Lock, MI, Hoyer, M, Bydder, SA, Okunieff, P, Hahn, CA, Vichare, A, and Dawson, LA. "An international survey on liver metastases radiotherapy." Acta Oncol 51.5 (May 2012): 568-574.
PMID
22559157
Source
pubmed
Published In
Acta Oncologica (Informa)
Volume
51
Issue
5
Publish Date
2012
Start Page
568
End Page
574
DOI
10.3109/0284186X.2012.681700

International practice survey on palliative lung radiotherapy: third international consensus workshop on palliative radiotherapy and symptom control.

BACKGROUND: The purpose of this work was to disseminate international practice survey results created in conjunction with the Third International Lung Cancer Consensus Workshop. PATIENTS AND METHODS: In conjunction with the American Society for Radiation Oncology (ASTRO) Guideline for Palliative Lung Cancer Care and International Workshop Consensus statements, an online international practice survey was conducted during the summer of 2010. The survey included demographic, educational, and clinical questions as well as 5 cases exploring the role of external beam radiotherapy, endobronchial brachytherapy, and concurrent chemoradiation. RESULTS: A total of 279 individuals responded to the survey over a 3-month period. Most respondents were hospital-based, academic, or government-funded radiation oncologists. Factors that consistently related to use and choice of external beam dose fractionation included estimated treatment benefit to patient, performance status (PS), symptom severity, patient choice, estimated prognosis, and previous radiation to the same site. Factors consistently not related to use and dose fractionation included requirement for future radiation therapy, department policy, and waiting lists. A significant range of dose fractionation schedules existed for external beam (n = 35) and endobronchial brachytherapy treatment (n = 10). The integration of concurrent chemotherapy was recorded by a significant minority of respondents despite lack of level I evidence to support its use. Geographic differences in the use of external beam dose fractionation and of concurrent chemotherapy were seen. CONCLUSIONS: Various patient, tumor, treatment, and logistic factors are associated with the variable use and external beam dose fractionation of palliative lung treatments. The copublication of the ASTRO Guideline for Palliative Lung Cancer Care and International Workshop Consensus statements should assist clinicians by providing evidence-based care.

Authors
Rodrigues, G; Macbeth, F; Burmeister, B; Kelly, K-L; Bezjak, A; Langer, C; Hahn, C; Vichare, A; Movsas, B
MLA Citation
Rodrigues, G, Macbeth, F, Burmeister, B, Kelly, K-L, Bezjak, A, Langer, C, Hahn, C, Vichare, A, and Movsas, B. "International practice survey on palliative lung radiotherapy: third international consensus workshop on palliative radiotherapy and symptom control." Clin Lung Cancer 13.3 (May 2012): 225-235.
PMID
22169482
Source
pubmed
Published In
Clinical lung cancer
Volume
13
Issue
3
Publish Date
2012
Start Page
225
End Page
235
DOI
10.1016/j.cllc.2011.11.002

Update of the international consensus on palliative radiotherapy endpoints for future clinical trials in bone metastases.

PURPOSE: To update the international consensus on palliative radiotherapy endpoints for future clinical trials in bone metastases by surveying international experts regarding previous uncertainties within the 2002 consensus, changes that may be necessary based on practice pattern changes and research findings since that time. METHODS AND MATERIALS: A two-phase survey was used to determine revisions and new additions to the 2002 consensus. A total of 49 experts from the American Society for Radiation Oncology, the European Society for Therapeutic Radiology and Oncology, the Faculty of Radiation Oncology of the Royal Australian and New Zealand College of Radiologists, and the Canadian Association of Radiation Oncology who are directly involved in the care of patients with bone metastases participated in this survey. RESULTS: Consensus was established in areas involving response definitions, eligibility criteria for future trials, reirradiation, changes in systemic therapy, radiation techniques, parameters at follow-up, and timing of assessments. CONCLUSION: An outline for trials in bone metastases was updated based on survey and consensus. Investigators leading trials in bone metastases are encouraged to adopt the revised guideline to promote consistent reporting. Areas for future research were identified. It is intended for the consensus to be re-examined in the future on a regular basis.

Authors
Chow, E; Hoskin, P; Mitera, G; Zeng, L; Lutz, S; Roos, D; Hahn, C; van der Linden, Y; Hartsell, W; Kumar, E; International Bone Metastases Consensus Working Party,
MLA Citation
Chow, E, Hoskin, P, Mitera, G, Zeng, L, Lutz, S, Roos, D, Hahn, C, van der Linden, Y, Hartsell, W, Kumar, E, and International Bone Metastases Consensus Working Party, . "Update of the international consensus on palliative radiotherapy endpoints for future clinical trials in bone metastases." Int J Radiat Oncol Biol Phys 82.5 (April 1, 2012): 1730-1737.
PMID
21489705
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
82
Issue
5
Publish Date
2012
Start Page
1730
End Page
1737
DOI
10.1016/j.ijrobp.2011.02.008

Consensus statement on palliative lung radiotherapy: third international consensus workshop on palliative radiotherapy and symptom control.

The purpose of this work is to disseminate a consensus statement on palliative radiotherapy (RT) of lung cancer created in conjunction with the Third International Lung Cancer Consensus Workshop. The palliative lung RT workshop committee agreed on 5 questions relating to (1) patient selection, (2) thoracic external-beam radiation therapy (XRT) fractionation, (3) endobronchial brachytherapy (EBB), (4) concurrent chemotherapy (CC), and (5) palliative endpoint definitions. A PubMed search for primary/cross-referenced practice guidelines, consensus statements, meta-analyses, and/or systematic reviews was conducted. Final consensus statements were created after review and discussion of the available evidence. The following summary statements reflect the consensus of the international working group. 1. Key factors involved in the decision to deliver palliative RT include performance status, tumor stage, pulmonary function, XRT volume, symptomatology, weight loss, and patient preference. 2. Palliative thoracic XRT is generally indicated for patients with stage IV disease with current/impending symptoms and for patients with stage III disease treated for palliative intent. 3. There is no evidence to routinely recommend EBB alone or in conjunction with other palliative maneuvers in the initial palliative management of endobronchial obstruction resulting from lung cancer. 4. There is currently no evidence to routinely recommend CC with palliative-intent RT. 5. Standard assessment of symptoms and health-related quality of life (QOL) using validated questionnaires should be carried out in palliative RT lung cancer trials. Despite an expanding literature, continued prospective randomized investigations to better define the role of XRT, EBB, and CC in the context of thoracic palliation of patients with lung cancer is needed.

Authors
Rodrigues, G; Macbeth, F; Burmeister, B; Kelly, K-L; Bezjak, A; Langer, C; Hahn, C; Movsas, B
MLA Citation
Rodrigues, G, Macbeth, F, Burmeister, B, Kelly, K-L, Bezjak, A, Langer, C, Hahn, C, and Movsas, B. "Consensus statement on palliative lung radiotherapy: third international consensus workshop on palliative radiotherapy and symptom control." Clin Lung Cancer 13.1 (January 2012): 1-5. (Review)
PMID
21729656
Source
pubmed
Published In
Clinical lung cancer
Volume
13
Issue
1
Publish Date
2012
Start Page
1
End Page
5
DOI
10.1016/j.cllc.2011.04.004

Radiotherapeutic and surgical management for newly diagnosed brain metastasis(es): An American Society for Radiation Oncology evidence-based guideline

Purpose: To systematically review the evidence for the radiotherapeutic and surgical management of patients newly diagnosed with intraparenchymal brain metastases. Methods and Materials: Key clinical questions to be addressed in this evidence-based Guideline were identified. Fully published randomized controlled trials dealing with the management of newly diagnosed intraparenchymal brain metastases were searched systematically and reviewed. The U.S. Preventative Services Task Force levels of evidence were used to classify various options of management. Results: The choice of management in patients with newly diagnosed single or multiple brain metastases depends on estimated prognosis and the aims of treatment (survival, local treated lesion control, distant brain control, neurocognitive preservation).Single brain metastasis and good prognosis (expected survival 3 months or more): For a single brain metastasis larger than 3 to 4 cm and amenable to safe complete resection, whole brain radiotherapy (WBRT) and surgery (level 1) should be considered. Another alternative is surgery and radiosurgery/radiation boost to the resection cavity (level 3). For single metastasis less than 3 to 4 cm, radiosurgery alone or WBRT and radiosurgery or WBRT and surgery (all based on level 1 evidence) should be considered. Another alternative is surgery and radiosurgery or radiation boost to the resection cavity (level 3). For single brain metastasis (less than 3 to 4 cm) that is not resectable or incompletely resected, WBRT and radiosurgery, or radiosurgery alone should be considered (level 1). For nonresectable single brain metastasis (larger than 3 to 4 cm), WBRT should be considered (level 3).Multiple brain metastases and good prognosis (expected survival 3 months or more): For selected patients with multiple brain metastases (all less than 3 to 4 cm), radiosurgery alone, WBRT and radiosurgery, or WBRT alone should be considered, based on level 1 evidence. Safe resection of a brain metastasis or metastases causing significant mass effect and postoperative WBRT may also be considered (level 3).Patients with poor prognosis (expected survival less than 3 months): Patients with either single or multiple brain metastases with poor prognosis should be considered for palliative care with or without WBRT (level 3).It should be recognized, however, that there are limitations in the ability of physicians to accurately predict patient survival. Prognostic systems such as recursive partitioning analysis, and diagnosis-specific graded prognostic assessment may be helpful. Conclusions: Radiotherapeutic intervention (WBRT or radiosurgery) is associated with improved brain control. In selected patients with single brain metastasis, radiosurgery or surgery has been found to improve survival and locally treated metastasis control (compared with WBRT alone). © 2012 American Society for Radiation Oncology.

Authors
Tsao, MN; Rades, D; Wirth, A; Lo, SS; Danielson, BL; Gaspar, LE; Sperduto, PW; Vogelbaum, MA; Radawski, JD; Wang, JZ; Gillin, MT; Mohideen, N; Hahn, CA; Chang, EL
MLA Citation
Tsao, MN, Rades, D, Wirth, A, Lo, SS, Danielson, BL, Gaspar, LE, Sperduto, PW, Vogelbaum, MA, Radawski, JD, Wang, JZ, Gillin, MT, Mohideen, N, Hahn, CA, and Chang, EL. "Radiotherapeutic and surgical management for newly diagnosed brain metastasis(es): An American Society for Radiation Oncology evidence-based guideline." Practical Radiation Oncology 2.3 (2012): 210-225.
PMID
25925626
Source
scival
Published In
Practical Radiation Oncology
Volume
2
Issue
3
Publish Date
2012
Start Page
210
End Page
225
DOI
10.1016/j.prro.2011.12.004

Fractionation for whole breast irradiation: an American Society for Radiation Oncology (ASTRO) evidence-based guideline.

PURPOSE: In patients with early-stage breast cancer treated with breast-conserving surgery, randomized trials have found little difference in local control and survival outcomes between patients treated with conventionally fractionated (CF-) whole breast irradiation (WBI) and those receiving hypofractionated (HF)-WBI. However, it remains controversial whether these results apply to all subgroups of patients. We therefore developed an evidence-based guideline to provide direction for clinical practice. METHODS AND MATERIALS: A task force authorized by the American Society for Radiation Oncology weighed evidence from a systematic literature review and produced the recommendations contained herein. RESULTS: The majority of patients in randomized trials were aged 50 years or older, had disease Stage pT1-2 pN0, did not receive chemotherapy, and were treated with a radiation dose homogeneity within ±7% in the central axis plane. Such patients experienced equivalent outcomes with either HF-WBI or CF-WBI. Patients not meeting these criteria were relatively underrepresented, and few of the trials reported subgroup analyses. For patients not receiving a radiation boost, the task force favored a dose schedule of 42.5 Gy in 16 fractions when HF-WBI is planned. The task force also recommended that the heart should be excluded from the primary treatment fields (when HF-WBI is used) due to lingering uncertainty regarding late effects of HF-WBI on cardiac function. The task force could not agree on the appropriateness of a tumor bed boost in patients treated with HF-WBI. CONCLUSION: Data were sufficient to support the use of HF-WBI for patients with early-stage breast cancer who met all the aforementioned criteria. For other patients, the task force could not reach agreement either for or against the use of HF-WBI, which nevertheless should not be interpreted as a contraindication to its use.

Authors
Smith, BD; Bentzen, SM; Correa, CR; Hahn, CA; Hardenbergh, PH; Ibbott, GS; McCormick, B; McQueen, JR; Pierce, LJ; Powell, SN; Recht, A; Taghian, AG; Vicini, FA; White, JR; Haffty, BG
MLA Citation
Smith, BD, Bentzen, SM, Correa, CR, Hahn, CA, Hardenbergh, PH, Ibbott, GS, McCormick, B, McQueen, JR, Pierce, LJ, Powell, SN, Recht, A, Taghian, AG, Vicini, FA, White, JR, and Haffty, BG. "Fractionation for whole breast irradiation: an American Society for Radiation Oncology (ASTRO) evidence-based guideline." Int J Radiat Oncol Biol Phys 81.1 (September 1, 2011): 59-68. (Review)
PMID
20638191
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
81
Issue
1
Publish Date
2011
Start Page
59
End Page
68
DOI
10.1016/j.ijrobp.2010.04.042

Palliative radiotherapy for bone metastases: an ASTRO evidence-based guideline.

PURPOSE: To present guidance for patients and physicians regarding the use of radiotherapy in the treatment of bone metastases according to current published evidence and complemented by expert opinion. METHODS AND MATERIALS: A systematic search of the National Library of Medicine's PubMed database between 1998 and 2009 yielded 4,287 candidate original research articles potentially applicable to radiotherapy for bone metastases. A Task Force composed of all authors synthesized the published evidence and reached a consensus regarding the recommendations contained herein. RESULTS: The Task Force concluded that external beam radiotherapy continues to be the mainstay for the treatment of pain and/or prevention of the morbidity caused by bone metastases. Various fractionation schedules can provide significant palliation of symptoms and/or prevent the morbidity of bone metastases. The evidence for the safety and efficacy of repeat treatment to previously irradiated areas of peripheral bone metastases for pain was derived from both prospective studies and retrospective data, and it can be safe and effective. The use of stereotactic body radiotherapy holds theoretical promise in the treatment of new or recurrent spine lesions, although the Task Force recommended that its use be limited to highly selected patients and preferably within a prospective trial. Surgical decompression and postoperative radiotherapy is recommended for spinal cord compression or spinal instability in highly selected patients with sufficient performance status and life expectancy. The use of bisphosphonates, radionuclides, vertebroplasty, and kyphoplasty for the treatment or prevention of cancer-related symptoms does not obviate the need for external beam radiotherapy in appropriate patients. CONCLUSIONS: Radiotherapy is a successful and time efficient method by which to palliate pain and/or prevent the morbidity of bone metastases. This Guideline reviews the available data to define its proper use and provide consensus views concerning contemporary controversies or unanswered questions that warrant prospective trial evaluation.

Authors
Lutz, S; Berk, L; Chang, E; Chow, E; Hahn, C; Hoskin, P; Howell, D; Konski, A; Kachnic, L; Lo, S; Sahgal, A; Silverman, L; von Gunten, C; Mendel, E; Vassil, A; Bruner, DW; Hartsell, W; American Society for Radiation Oncology (ASTRO),
MLA Citation
Lutz, S, Berk, L, Chang, E, Chow, E, Hahn, C, Hoskin, P, Howell, D, Konski, A, Kachnic, L, Lo, S, Sahgal, A, Silverman, L, von Gunten, C, Mendel, E, Vassil, A, Bruner, DW, Hartsell, W, and American Society for Radiation Oncology (ASTRO), . "Palliative radiotherapy for bone metastases: an ASTRO evidence-based guideline." Int J Radiat Oncol Biol Phys 79.4 (March 15, 2011): 965-976. (Review)
PMID
21277118
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
79
Issue
4
Publish Date
2011
Start Page
965
End Page
976
DOI
10.1016/j.ijrobp.2010.11.026

Palliative thoracic radiotherapy in lung cancer: An American Society for Radiation Oncology evidence-based clinical practice guideline

Purpose: To provide guidance to physicians and patients with regard to the use of external beam radiotherapy, endobronchial brachytherapy, and concurrent chemotherapy in the setting of palliative thoracic treatment for lung cancer, based on available evidence complemented by expert opinion. Methods and Materials: A Task Force authorized by the American Society for Radiation Oncology (ASTRO) Board of Directors synthesized and assessed evidence from 3 systematic reviews on the following topics: (1) dose fractionation in thoracic external beam radiotherapy (EBRT); (2) clinical utility of initial and salvage endobronchial brachytherapy (EBB); and (3)use of concurrent chemotherapy (CC) with palliative thoracic radiotherapy. Practice guideline recommendations were produced and are contained herein. Results: Studies suggest that higher dose/fractionation palliative EBRT regimens (eg, 30 Gy/10 fraction equivalent or greater) are associated with modest improvements in survival and total symptom score, particularly in patients with good performance status. As these improvements are associated with an increase in esophageal toxicity, various shorter EBRT dose/fractionation schedules (eg, 20 Gy in 5 fractions, 17 Gy in 2 weekly fractions, 10 Gy in 1 fraction), which provide good symptomatic relief with fewer side effects, can be used for patients requesting a shorter treatment course and/or in those with a poor performance status. No defined role for EBB in the routine initial palliative treatment of chest disease has been demonstrated; however, EBB can be a reasonable option for the palliation of endobronchial lesions causing obstructive symptomatology including lung collapse, or for hemoptysis after EBRT failure. The integration of concurrent chemotherapy with palliative intent/fractionated radiotherapy is not currently supported by the medical literature. Conclusion: This Guideline is intended to serve as a guide for the use of EBRT, EBB, and CC in thoracic palliation of lung cancer outside the clinical trial setting. Further prospective clinical investigations with relevant palliative endpoints into the respective roles of EBB and CC/targeted therapy in the thoracic palliation of lung cancer are warranted, given the current state of the medical literature in these areas. © 2011 American Society for Radiation Oncology.

Authors
Rodrigues, G; Videtic, GMM; Sur, R; Bezjak, A; Bradley, J; Hahn, CA; Langer, C; Miller, KL; Moeller, BJ; Rosenzweig, K; Movsas, B
MLA Citation
Rodrigues, G, Videtic, GMM, Sur, R, Bezjak, A, Bradley, J, Hahn, CA, Langer, C, Miller, KL, Moeller, BJ, Rosenzweig, K, and Movsas, B. "Palliative thoracic radiotherapy in lung cancer: An American Society for Radiation Oncology evidence-based clinical practice guideline." Practical Radiation Oncology 1.2 (2011): 60-71.
PMID
25740118
Source
scival
Published In
Practical Radiation Oncology
Volume
1
Issue
2
Publish Date
2011
Start Page
60
End Page
71
DOI
10.1016/j.prro.2011.01.005

Radiation dose-volume effects in the brain.

We have reviewed the published data regarding radiotherapy (RT)-induced brain injury. Radiation necrosis appears a median of 1-2 years after RT; however, cognitive decline develops over many years. The incidence and severity is dose and volume dependent and can also be increased by chemotherapy, age, diabetes, and spatial factors. For fractionated RT with a fraction size of <2.5 Gy, an incidence of radiation necrosis of 5% and 10% is predicted to occur at a biologically effective dose of 120 Gy (range, 100-140) and 150 Gy (range, 140-170), respectively. For twice-daily fractionation, a steep increase in toxicity appears to occur when the biologically effective dose is >80 Gy. For large fraction sizes (>or=2.5 Gy), the incidence and severity of toxicity is unpredictable. For single fraction radiosurgery, a clear correlation has been demonstrated between the target size and the risk of adverse events. Substantial variation among different centers' reported outcomes have prevented us from making toxicity-risk predictions. Cognitive dysfunction in children is largely seen for whole brain doses of >or=18 Gy. No substantial evidence has shown that RT induces irreversible cognitive decline in adults within 4 years of RT.

Authors
Lawrence, YR; Li, XA; el Naqa, I; Hahn, CA; Marks, LB; Merchant, TE; Dicker, AP
MLA Citation
Lawrence, YR, Li, XA, el Naqa, I, Hahn, CA, Marks, LB, Merchant, TE, and Dicker, AP. "Radiation dose-volume effects in the brain." Int J Radiat Oncol Biol Phys 76.3 Suppl (March 1, 2010): S20-S27. (Review)
PMID
20171513
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
76
Issue
3 Suppl
Publish Date
2010
Start Page
S20
End Page
S27
DOI
10.1016/j.ijrobp.2009.02.091

Imaging for assessment of radiation-induced normal tissue effects.

Imaging can provide quantitative assessment of radiation-induced normal tissue effects. Identifying an early sign of normal tissue damage with imaging would have the potential to predict organ dysfunction, thereby allowing reoptimization of treatment strategies based on individual patients' risks and benefits. Early detection with noninvasive imaging may enable interventions to mitigate therapy-associated injury before its clinical manifestation. Furthermore, successive imaging may provide an objective assessment of the impact of such mitigation therapies. However, many problems make application of imaging to normal tissue assessment challenging, and further work is required to establish imaging biomarkers as surrogate endpoints of clinical outcome. The performance of clinical trials in which normal tissue injury is a clearly defined endpoint would greatly aid in realization of these goals.

Authors
Jeraj, R; Cao, Y; Ten Haken, RK; Hahn, C; Marks, L
MLA Citation
Jeraj, R, Cao, Y, Ten Haken, RK, Hahn, C, and Marks, L. "Imaging for assessment of radiation-induced normal tissue effects." Int J Radiat Oncol Biol Phys 76.3 Suppl (March 1, 2010): S140-S144. (Review)
PMID
20171509
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
76
Issue
3 Suppl
Publish Date
2010
Start Page
S140
End Page
S144
DOI
10.1016/j.ijrobp.2009.08.077

Assessing neurotoxicity from the low-dose radiation component of radiosurgery using magnetic resonance spectroscopy.

The aim of the study was to determine if biochemical changes indicative of injury, assessed using magnetic resonance spectroscopic imaging (SI), are observed after stereotactic radiosurgery (SRS). The study included patients who underwent SI immediately before and 1, 30, and 90 days following SRS. Short TE spectra (TR/TE 1000/35 ms) were acquired at the SRS isocenter with a 2D PRESS-CSI sequence on a single 1.5 T scanner. The SRS isodose lines were overlaid on the magnetic resonance imaging slice utilized for SI data acquisition. N-Acetyl aspartate (NAA)/creatine (Cr) and choline (Cho)/Cr ratios were computed for multiple voxels located between the 25 and 50 cGy isodose lines (low dose) and the 200 and 350 cGy isodose lines (medium dose). An analysis of variance and paired t-tests compared metabolite levels at different time points. Twelve patients were enrolled, although 3 were excluded secondary to poor spectral data quality or deviations from the prescribed SI protocol. The median number of voxels analyzed from the low- and medium-dose region was 7 and 4, respectively. No significant changes in metabolite peak height ratios over time were seen in the low-dose region, for either NAA/Cr (P = .89) or Cho/Cr (P = .85). There was no difference in Cho/Cr peak height ratios in the medium-dose region (P = .62). There was an increase in the NAA/Cr peak height ratio in the medium-dose region between day -1 and day +30 (P = .003), followed by a decline to baseline between days +30 and +90 (P = .03). We did not observe a significant decline in NAA/Cr or change in Cho/Cr peak heights in uninvolved brain parenchyma after SRS.

Authors
Kelsey, CR; Mukundan, S; Wang, Z; Hahn, CA; Soher, BJ; Kirkpatrick, JP
MLA Citation
Kelsey, CR, Mukundan, S, Wang, Z, Hahn, CA, Soher, BJ, and Kirkpatrick, JP. "Assessing neurotoxicity from the low-dose radiation component of radiosurgery using magnetic resonance spectroscopy." Neuro Oncol 12.2 (February 2010): 145-152.
PMID
20150381
Source
pubmed
Published In
Neuro-Oncology
Volume
12
Issue
2
Publish Date
2010
Start Page
145
End Page
152
DOI
10.1093/neuonc/nop040

In Reply to Dr. Beal et al

Authors
Smith, BD; Arthur, DW; Todor, DA; Buchholz, TA; Haffty, BG; Hahn, CA; Hardenbergh, PH; Julian, TB; Marks, LB; Vicini, FA; Whelan, TJ; White, J; Wo, JY; Harris, JR
MLA Citation
Smith, BD, Arthur, DW, Todor, DA, Buchholz, TA, Haffty, BG, Hahn, CA, Hardenbergh, PH, Julian, TB, Marks, LB, Vicini, FA, Whelan, TJ, White, J, Wo, JY, and Harris, JR. "In Reply to Dr. Beal et al." International Journal of Radiation Oncology Biology Physics 76.2 (2010): 638-639.
Source
scival
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
76
Issue
2
Publish Date
2010
Start Page
638
End Page
639
DOI
10.1016/j.ijrobp.2009.09.013

Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO).

Authors
Smith, BD; Arthur, DW; Buchholz, TA; Haffty, BG; Hahn, CA; Hardenbergh, PH; Julian, TB; Marks, LB; Todor, DA; Vicini, FA; Whelan, TJ; White, J; Wo, JY; Harris, JR
MLA Citation
Smith, BD, Arthur, DW, Buchholz, TA, Haffty, BG, Hahn, CA, Hardenbergh, PH, Julian, TB, Marks, LB, Todor, DA, Vicini, FA, Whelan, TJ, White, J, Wo, JY, and Harris, JR. "Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO)." J Am Coll Surg 209.2 (August 2009): 269-277.
PMID
19632605
Source
pubmed
Published In
Journal of the American College of Surgeons
Volume
209
Issue
2
Publish Date
2009
Start Page
269
End Page
277
DOI
10.1016/j.jamcollsurg.2009.02.066

Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO).

PURPOSE: To present guidance for patients and physicians regarding the use of accelerated partial-breast irradiation (APBI), based on current published evidence complemented by expert opinion. METHODS AND MATERIALS: A systematic search of the National Library of Medicine's PubMed database yielded 645 candidate original research articles potentially applicable to APBI. Of these, 4 randomized trials and 38 prospective single-arm studies were identified. A Task Force composed of all authors synthesized the published evidence and, through a series of meetings, reached consensus regarding the recommendations contained herein. RESULTS: The Task Force proposed three patient groups: (1) a "suitable" group, for whom APBI outside of a clinical trial is acceptable, (2) a "cautionary" group, for whom caution and concern should be applied when considering APBI outside of a clinical trial, and (3) an "unsuitable" group, for whom APBI outside of a clinical trial is not generally considered warranted. Patients who choose treatment with APBI should be informed that whole-breast irradiation (WBI) is an established treatment with a much longer track record that has documented long-term effectiveness and safety. CONCLUSION: Accelerated partial-breast irradiation is a new technology that may ultimately demonstrate long-term effectiveness and safety comparable to that of WBI for selected patients with early breast cancer. This consensus statement is intended to provide guidance regarding the use of APBI outside of a clinical trial and to serve as a framework to promote additional clinical investigations into the optimal role of APBI in the treatment of breast cancer.

Authors
Smith, BD; Arthur, DW; Buchholz, TA; Haffty, BG; Hahn, CA; Hardenbergh, PH; Julian, TB; Marks, LB; Todor, DA; Vicini, FA; Whelan, TJ; White, J; Wo, JY; Harris, JR
MLA Citation
Smith, BD, Arthur, DW, Buchholz, TA, Haffty, BG, Hahn, CA, Hardenbergh, PH, Julian, TB, Marks, LB, Todor, DA, Vicini, FA, Whelan, TJ, White, J, Wo, JY, and Harris, JR. "Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO)." Int J Radiat Oncol Biol Phys 74.4 (July 15, 2009): 987-1001.
PMID
19545784
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
74
Issue
4
Publish Date
2009
Start Page
987
End Page
1001
DOI
10.1016/j.ijrobp.2009.02.031

Morbidity and prostate-specific antigen control of external beam radiation therapy plus low-dose-rate brachytherapy boost for low, intermediate, and high-risk prostate cancer.

PURPOSE: Dose escalation has been shown beneficial in prostate cancer. Brachytherapy (BT) provides an opportunity for dose escalation beyond what can be safely delivered using only teletherapy methods. The purpose of this study was to determine cancer control and morbidity of external beam radiation therapy (EBRT) plus low-dose-rate (LDR) BT boost in patients with prostate cancer treated at Duke University Health System. METHODS: Between June 1997 and August 2007, 199 patients were consecutively treated at our facility with 46Gy EBRT followed by 100Gy palladium-103 ((103)Pd) or 120Gy iodine-125 ((125)I) LDR prostate implant. Treatment characteristics and followup data were retrospectively analyzed. Intermediate risk was defined as T2b-c, Gleason score 7 (GS 7), or prostate-specific antigen (PSA) of 10.1-19.9ng/mL. High risk was defined as GS 8-10, PSA>20, T3+, or two intermediate risk factors. The Radiation Therapy Oncology Group toxicity scale was used to report morbidity for gastrointestinal (GI) and genitourinary (GU) effects. PSA recurrence was defined as nadir+2ng/mL. RESULTS: Median followup was 4.2 years for all patients, 4.8 years for high-risk patients. Risk categories were as follows: 20% low risk, 47% intermediate risk, and 33% high risk. Forty five percent of patients received adjuvant androgen deprivation therapy (ADT). The median length of time since end of ADT to last followup was 2.7 years in all patients, 2.0 years for high-risk patients. Five-year biochemical relapse-free survival was 87% for all, 81% for high-risk patients. PSA control was similar at 92% for all and 86% for high-risk patients. Five-year actuarial risk of any and Grade 3 late GI morbidity was 38% and 7% respectively, and any and Grade 3 late GU morbidity was 21% and 3%, respectively. There were no significant differences in risk of Grade 2+GI or GU morbidity with choice of isotope. CONCLUSIONS: EBRT plus LDR BT has acceptable morbidity and, with 5-year followup, provides excellent cancer control even in high-risk patients.

Authors
Koontz, BF; Chino, J; Lee, WR; Hahn, CA; Buckley, N; Huang, S; Kim, J; Reagan, R; Joyner, R; Anscher, MS
MLA Citation
Koontz, BF, Chino, J, Lee, WR, Hahn, CA, Buckley, N, Huang, S, Kim, J, Reagan, R, Joyner, R, and Anscher, MS. "Morbidity and prostate-specific antigen control of external beam radiation therapy plus low-dose-rate brachytherapy boost for low, intermediate, and high-risk prostate cancer." Brachytherapy 8.2 (April 2009): 191-196.
PMID
19433320
Source
pubmed
Published In
Brachytherapy
Volume
8
Issue
2
Publish Date
2009
Start Page
191
End Page
196
DOI
10.1016/j.brachy.2009.01.002

Dose-dependent effects of radiation therapy on cerebral blood flow, metabolism, and neurocognitive dysfunction.

PURPOSE: A prospective study was performed to formally relate dose-dependent radiologically defined changes in normal brain induced by radiotherapy (RT) to neurocognitive dysfunction in subjects with primary brain tumors. METHODS AND MATERIALS: Adult patients receiving three-dimensional RT for central nervous system (CNS) tumors were enrolled. Positron emission tomography (PET) scanning and neuropsychological testing were performed before RT and 3 weeks and 6 months after treatment. Analyses were performed for correlations between changes in 2-deoxy-2-[(18)F]-fluoro-d-glucose (FDG)-PET (metabolism), (15)O-PET (relative blood flow), regional radiation dose, follow-up time, and neuropsychological test scores. RESULTS: Eleven subjects were enrolled and 6 completed follow-up studies. The PET data showed reduced FDG uptake, with average decreases of 2-6% in regions of the brain receiving greater than 40 Gy at 3 weeks' and 6 months' follow-up. The (15)O-H(2)O PET showed increases (<10%) at 3 weeks in relative regional blood flow in brain receiving greater than 30 Gy, but less at the 6-month follow-up studies. There were significant correlations between decreases in FDG uptake and increased scores from the Symptom Checklist-90-R, with an average increase in T score of 2 (p < 0.0001). The Wisconsin Card Sorting Test showed a significant correlation of decreased FDG uptake with increased errors and perseveration in test performance, with an average decrease in T score of 11 (p = 0.037). CONCLUSIONS: A dose-dependent response of CNS tissue was detected using FDG PET in this small number of patients. Decreases in CNS metabolism correlated with decreased performance on neuropsychological tests for problem solving, cognitive flexibility, and global measures of psychopathology. Additional research is needed to verify and define these findings.

Authors
Hahn, CA; Zhou, S-M; Raynor, R; Tisch, A; Light, K; Shafman, T; Wong, T; Kirkpatrick, J; Turkington, T; Hollis, D; Marks, LB
MLA Citation
Hahn, CA, Zhou, S-M, Raynor, R, Tisch, A, Light, K, Shafman, T, Wong, T, Kirkpatrick, J, Turkington, T, Hollis, D, and Marks, LB. "Dose-dependent effects of radiation therapy on cerebral blood flow, metabolism, and neurocognitive dysfunction." Int J Radiat Oncol Biol Phys 73.4 (March 15, 2009): 1082-1087.
PMID
18755558
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
73
Issue
4
Publish Date
2009
Start Page
1082
End Page
1087
DOI
10.1016/j.ijrobp.2008.05.061

Bioimaging In Vivo to Discern the Evolution of Late Effects Temporally and Spatially

Authors
Hubbs, JL; Nam, J; Zhou, S; Hahn, CA; Marks, LB
MLA Citation
Hubbs, JL, Nam, J, Zhou, S, Hahn, CA, and Marks, LB. "Bioimaging In Vivo to Discern the Evolution of Late Effects Temporally and Spatially." 2008.
Source
wos-lite
Publish Date
2008
Start Page
7
End Page
+

The role of functional imaging in the diagnosis and management of late normal tissue injury.

Normal tissue injury after radiation therapy (RT) can be defined based on either clinical symptoms or laboratory/radiologic tests. In the research setting, functional imaging (eg, single-photon emission computed tomography [SPECT], positron-emission tomography [PET], and magnetic resonance imaging [MRI]) is useful because it provides objective quantitative data such as metabolic activity, perfusion, and soft-tissue contrast within tissues and organs. For RT-induced lung, heart, and parotid gland injury, pre- and post-RT SPECT images can be compared with the dose- and volume-dependent nature of regional injury. In the brain, SPECT can detect changes in perfusion and blood flow post-RT, and PET can detect metabolic changes, particularly to regions of the brain that have received doses above 40 to 50 Gy. On MRI, changes in contrast-enhanced images, T(1) and T(2) relaxation times, and pulmonary vascular resistance at different intervals pre- and post-RT show its ability to detect and distinguish different phases of radiation pneumonitis. Similarly, conventional and diffusion-weighted MRI can be used to differentiate between normal tissue edema, necrosis, and tumor in the irradiated brain, and magnetic resonance spectroscopy can measure changes in compounds, indicative of membrane and neuron disruption. The use of functional imaging is a powerful tool for early detection of RT-induced normal tissue injury, which may be related to long-term clinically significant injury.

Authors
Evans, ES; Hahn, CA; Kocak, Z; Zhou, S-M; Marks, LB
MLA Citation
Evans, ES, Hahn, CA, Kocak, Z, Zhou, S-M, and Marks, LB. "The role of functional imaging in the diagnosis and management of late normal tissue injury." Semin Radiat Oncol 17.2 (April 2007): 72-80. (Review)
PMID
17395037
Source
pubmed
Published In
Seminars in Radiation Oncology
Volume
17
Issue
2
Publish Date
2007
Start Page
72
End Page
80
DOI
10.1016/j.semradonc.2006.11.003

A randomized prospective trial of the effect of video Radiation Oncology education on patient anxiety

Authors
Hahn, CA; Raynor, R; Fish, L; Day, J; Brigidil, B; Hollis, D; Halperin, EC
MLA Citation
Hahn, CA, Raynor, R, Fish, L, Day, J, Brigidil, B, Hollis, D, and Halperin, EC. "A randomized prospective trial of the effect of video Radiation Oncology education on patient anxiety." 2007.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
69
Issue
3
Publish Date
2007
Start Page
S581
End Page
S582
DOI
10.1016/j.ijrobp.2007.07.1866

Prospective trial of a video educational tool for radiation oncology patients.

OBJECTIVES: Prospective assessment of the informational needs of radiation oncology patients and efficacy of an educational video in meeting them. METHODS: Subjects completed baseline self-administered questionnaires and subsequently viewed the patient education video. Post-testing was performed after initiation of therapy and subjects rated their satisfaction with the video, its relevance, and their emotional response. Analyses were performed with respect to patient and disease characteristics. RESULTS: Fifty-three subjects were enrolled and completed both before and after video measures. The mean age of participants was 58 years (range, 33 to 83). Pretreatment, >90% of patients reported specific information needs. One hundred percent of patients watched the video and 77% rated it as highly relevant. High levels of satisfaction (>90%) were reported with video information describing radiation and simulation. Older subjects (58 years and older) found video information significantly more relevant than those younger (55% versus 27%, P = 0.04) and rated greater satisfaction with side effect information (78% versus 41%, P = 0.006). Subjects with breast cancer exhibited a trend towards feeling better informed by the video. CONCLUSIONS: Radiation oncology patients reported informational needs unmet by standard educational measures. High levels of satisfaction were reported with video education. It promoted better understanding of radiotherapy. Older patients found the video to be significantly more relevant and informative.

Authors
Hahn, CA; Fish, LJ; Dunn, RH; Halperin, EC
MLA Citation
Hahn, CA, Fish, LJ, Dunn, RH, and Halperin, EC. "Prospective trial of a video educational tool for radiation oncology patients." American journal of clinical oncology 28.6 (December 2005): 609-612. (Academic Article)
PMID
16317273
Source
manual
Published In
American Journal of Clinical Oncology: Cancer Clinical Trials
Volume
28
Issue
6
Publish Date
2005
Start Page
609
End Page
612

Phase I/II trial of intravenous Doxil and whole abdomen hyperthermia in patients with refractory ovarian cancer.

OBJECTIVE: A phase I/II study of Doxil combined with whole abdomen hyperthermia was conducted in patients with refractory ovarian cancer. Liposomal doxorubicin combined with hyperthermia has been shown to increase both liposomal delivery and drug extravasation into tumour xenografts resulting in enhanced cytotoxic effects. PATIENTS AND METHODS: Thirty patients with either recurrent or persistent epithelial ovarian cancer were enrolled. All patients had either measurable or assessable disease. Patients received intravenous (IV) Doxil at a dose of 40 mg m-2 as a 1-h infusion followed by whole abdomen hyperthermia. The phase I portion of the study was performed to determine the maximal tolerated dose (MTD) of hyperthermia. Quality of life (QoL) was performed at baseline, prior to each cycle and every 3 months. Plasma pharmacokinetic studies were performed with the first cycle. RESULTS: Ten patients participated in the phase I portion of the study which demonstrated that the MTD of hyperthermia was 60 min after either average vaginal and rectal temperatures of 40 degrees C had been achieved or after 30 min of power application, whichever was shorter. All 30 patients were either paclitaxel and/or platinum resistant initially or developed resistant disease. The median number of prior chemotherapeutic regimens was three (range 2-8) and six patients had been previously treated with Doxil. There were three partial responses for a response rate of 10% (95% CI: [2%, 27%]) and eight patients (27%; 95% CI: [12%, 46%]) had disease stabilization. The median time to progression or death was 3.4 months (95% CI: [2.6, 5.2]) and the median survival was 10.8 months (95% CI: [8.8, 17.4]). Twelve patients (40%) experienced palmar-plantar erythrodysesthesia (PPE), but only four (13%) experienced grade 3-4 PPE toxicity. Doxil systemic exposure was higher in those with grade 3-4 PPE compared to those with no PPE. None of the patients had grade 3-4 thermal toxicity due to hyperthermia. QoL was not decreased in patients responding to therapy. CONCLUSIONS: Therapy with intravenous Doxil and whole abdomen hyperthermia for patients with platinum/paclitaxel resistant ovarian cancer is feasible and does not negatively impact quality of life.

Authors
Alvarez Secord, A; Jones, EL; Hahn, CA; Petros, WP; Yu, D; Havrilesky, LJ; Soper, JT; Berchuck, A; Spasojevic, I; Clarke-Pearson, DL; Prosnitz, LR; Dewhirst, MW
MLA Citation
Alvarez Secord, A, Jones, EL, Hahn, CA, Petros, WP, Yu, D, Havrilesky, LJ, Soper, JT, Berchuck, A, Spasojevic, I, Clarke-Pearson, DL, Prosnitz, LR, and Dewhirst, MW. "Phase I/II trial of intravenous Doxil and whole abdomen hyperthermia in patients with refractory ovarian cancer." Int J Hyperthermia 21.4 (June 2005): 333-347.
PMID
16019859
Source
pubmed
Published In
International Journal of Hyperthermia (Informa)
Volume
21
Issue
4
Publish Date
2005
Start Page
333
End Page
347
DOI
10.1080/02656730500110155

Prospective assessment of quality of life in ovarian cancer patients receiving whole abdomen hyperthermia and liposomal doxorubicin.

PURPOSE: Prospective assessment of quality of life (QoL) in patients with refractory, residual or recurrent ovarian cancer receiving whole abdomen hyperthermia and intravenous liposomal doxorubicin chemotherapy. METHODS: Treatment consisted of six cycles of intravenous liposomal doxorubicin at 40 mg m2 followed by whole abdomen hyperthermia with each cycle delivered every 4 weeks. QoL assessment was performed at baseline, prior to each cycle of chemotherapy and every 3 months during follow-up using self-administered questionnaires. Global QoL was rated on a seven-point scale and specific domains of QoL, disease related symptoms and treatment related toxicity were rated on a four-point scale. RESULTS: Thirty-two patients were enrolled on the study and 129 QoL questionnaires were completed. Average age was 57.9 (range 45-76); nine patients had persistent and 23 recurrent disease. Ten patients completed six cycles of therapy. Three patients returned follow-up surveys. Subjects rated their overall QoL and health at baseline as above average with mean scores 5.10 (95% CI=4.62-5.58) and 4.66 (95% CI=4.23-5.08), respectively. No significant change in overall QoL was found between baseline and cycles 4-6 of therapy. Mean ratings of overall health and subject reported differences in QoL between cycles were not significantly changed during therapy. Limited follow-up data were available, but scores suggest possible improvement in QoL for patients completing all therapy. Subjects rated the greatest negative impact on QoL in areas of role functioning and social functioning, where the mean (SD) over all cycles was 2.00 (0.67) and 1.98 (0.70), respectively. For physical symptoms, fatigue and sleep disturbance had the most negative impact on QoL with means (SD) of 2.26 (0.62) and 1.91 (0.70). The moderate treatment related toxicity seen in this study did not significantly impact patients reported QoL. CONCLUSIONS: Patients with unfavourable ovarian cancer responding to intravenous liposomal doxorubicin and whole abdomen hyperthermia maintained above average QoL during therapy. Limited data on patients completing protocol therapy demonstrated possible improvement in QoL.

Authors
Hahn, CA; Jones, EL; Blivin, JL; Sanders, LL; Yu, D; Dewhirst, MW; Secord, AA; Prosnitz, LR
MLA Citation
Hahn, CA, Jones, EL, Blivin, JL, Sanders, LL, Yu, D, Dewhirst, MW, Secord, AA, and Prosnitz, LR. "Prospective assessment of quality of life in ovarian cancer patients receiving whole abdomen hyperthermia and liposomal doxorubicin." Int J Hyperthermia 21.4 (June 2005): 349-357.
PMID
16019860
Source
pubmed
Published In
International Journal of Hyperthermia (Informa)
Volume
21
Issue
4
Publish Date
2005
Start Page
349
End Page
357
DOI
10.1080/02656730400022260

Dose-dependent effects of radiation therapy on cerebral blood flow, metabolism and neurocognitive dysfunction

Authors
Hahn, CA; Zhou, S; Renee, DH; Shafman, T; Wong, T; Kirkpatrick, J; Turkington, T; Tisch, A; Coleman, R; Light, K; Hollis, D; Marks, L
MLA Citation
Hahn, CA, Zhou, S, Renee, DH, Shafman, T, Wong, T, Kirkpatrick, J, Turkington, T, Tisch, A, Coleman, R, Light, K, Hollis, D, and Marks, L. "Dose-dependent effects of radiation therapy on cerebral blood flow, metabolism and neurocognitive dysfunction." 2005.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
63
Issue
2
Publish Date
2005
Start Page
S67
End Page
S67
DOI
10.1016/j.ijrobp.2005.07.116

Routine screening for depression in radiation oncology patients.

PURPOSE: Depression is a debilitating illness with symptoms that overlap those of cancer and radiotherapy. We sought to measure the frequency of depression in adult radiation oncology patients. METHODS AND MATERIALS: The Beck Depression Inventory-II (BDI-II) was incorporated into routine clinical evaluation of patients. Results were analyzed by univariate analysis and multivariate analysis of variance (MANOVA). RESULTS: One hundred twenty-four patients were screened and 19 (15%) endorsed significant depressive symptoms. Of these, levels of depression were: 58% mild, 32% moderate, and 10% severe. Twenty-six percent of the depressed group had a history of previous psychiatric diagnoses and 32% previously had been placed on psychotropic medications. The most frequent somatic symptoms for the entire group were loss of energy (73%) and tiredness or fatigue (69%). All depressed patients endorsed some somatic symptoms, but these alone were insufficient to score in the range of depression. CONCLUSIONS: A simple tool can be administered in the clinic by radiation oncologists to screen for depression. The frequency of depression in our patients was 15%. Somatic symptoms alone were insufficient to score as depressed.

Authors
Hahn, CA; Dunn, R; Halperin, EC
MLA Citation
Hahn, CA, Dunn, R, and Halperin, EC. "Routine screening for depression in radiation oncology patients." American journal of clinical oncology 27.5 (October 2004): 497-499. (Academic Article)
PMID
15596919
Source
manual
Published In
American Journal of Clinical Oncology: Cancer Clinical Trials
Volume
27
Issue
5
Publish Date
2004
Start Page
497
End Page
499

Phase I/II trial of intravenous liposomal doxorubicin and whole abdomen hyperthermia in patients with refractory ovarian cancer.

Authors
Secord, AA; Jones, E; Hahn, CA; Havrilesky, LJ; Soper, JT; Berchuck, A; Clarke-Pearson, DL; Prosnitz, LR
MLA Citation
Secord, AA, Jones, E, Hahn, CA, Havrilesky, LJ, Soper, JT, Berchuck, A, Clarke-Pearson, DL, and Prosnitz, LR. "Phase I/II trial of intravenous liposomal doxorubicin and whole abdomen hyperthermia in patients with refractory ovarian cancer." July 15, 2004.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
22
Issue
14
Publish Date
2004
Start Page
471S
End Page
471S

Phase I/II trial of intravenous liposomal doxorubicin and whole abdomen hyperthermia in patients with refractory ovarian cancer.

5089 Background: A phase I/II study of liposomal doxorubicin combined with whole abdominal hyperthermia was conducted in patients with refractory ovarian cancer. Liposomal doxorubicin combined with hyperthermia has been shown to increase liposomal extravasation into tumor xenografts resulting in enhanced cytotoxic effects.Thirty patients with either recurrent or persistent epithelial ovarian cancer were enrolled. All patients had either measurable or assessable disease. Patients received intravenous (IV) liposomal doxorubicin 40 mg/m2 as a 1-hour infusion followed by whole abdominal hyperthermia. Quality of life (QOL) was performed at baseline, prior to each cycle, and every 3 months following treatment.All 30 patients were either paclitaxel and/or platinum resistant initially or developed resistant disease. The median number of prior chemotherapeutic regimens was three (range 2-8) and 6 patients had been previously treated with liposomal doxorubicin. There were 3 partial responses for a response rate of 10% and 8 patients (27%) had disease stabilization. The median time to progression was 3.4 months (range, 1.3 to 20.7) and the median survival was 10.8 months (range, 2.7 to 27.2). Twelve patients (40%) experienced palmar-plantar erythrodysesthesia (PPE), but only 4 (13%) experienced grade 3/4 PPE toxicity. None of the patients had grade 3/4 thermal toxicity due to hyperthermia. QOL was stable in patients responding to therapy.Therapy with intravenous doxorubicin and whole abdominal hyperthermia for patients with platinum/paclitaxel resistant ovarian cancer has modest activity and stabilized quality of life. Whole abdomen hyperthermia was well tolerated in this population. Work supported by a grant from the NIH CA42745. [Table: see text].

Authors
Secord, AA; Jones, E; Hahn, CA; Havrilesky, LJ; Soper, JT; Berchuck, A; Clarke-Pearson, DL; Prosnitz, LR; Dewhirst, MW
MLA Citation
Secord, AA, Jones, E, Hahn, CA, Havrilesky, LJ, Soper, JT, Berchuck, A, Clarke-Pearson, DL, Prosnitz, LR, and Dewhirst, MW. "Phase I/II trial of intravenous liposomal doxorubicin and whole abdomen hyperthermia in patients with refractory ovarian cancer." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 22.14_suppl (July 2004): 5089-.
PMID
28015342
Source
epmc
Published In
Journal of Clinical Oncology
Volume
22
Issue
14_suppl
Publish Date
2004
Start Page
5089

Adjuvant and salvage radiotherapy following radical prostatectomy

Authors
Kirkpatrick, JP; Calingaert, B; Clough, RW; Oleson, JR; Quaranta, BP; Hahn, CA; Montana, GS; Ingram, SS; Anscher, MS
MLA Citation
Kirkpatrick, JP, Calingaert, B, Clough, RW, Oleson, JR, Quaranta, BP, Hahn, CA, Montana, GS, Ingram, SS, and Anscher, MS. "Adjuvant and salvage radiotherapy following radical prostatectomy." 2004.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
60
Issue
1
Publish Date
2004
Start Page
S450
End Page
S451

Prospective trial of a video educational tool for radiation oncology patients

Authors
Hahn, CA; Fish, L; Dunn, R; Bushyhead, A; Halperin, EC
MLA Citation
Hahn, CA, Fish, L, Dunn, R, Bushyhead, A, and Halperin, EC. "Prospective trial of a video educational tool for radiation oncology patients." 2004.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
60
Issue
1
Publish Date
2004
Start Page
S554
End Page
S555

Breast conservation rates-barriers between tertiary care and community practice.

PURPOSE: Low rates of breast conservation therapy (BCT) are reported in the southern United States. We evaluated the influence on BCT rates of opening a radiotherapy (RT) clinic at a community hospital in North Carolina. Before opening, RT was available 5 miles away at a tertiary care center. METHODS AND MATERIALS: A review of the pathology database of the community hospital identified patients who underwent definitive surgery for invasive breast malignancy or ductal carcinoma in situ between 1994 and 1995, and 1997 and 1998, before and after the opening of the RT clinic in 1996. From these data, the mode of therapy, mastectomy or BCT, was determined. The results were compared using logistic regression analysis. Surgical and RT physician staffing were unchanged throughout the study period. RESULTS: A total of 586 patients was evaluated. The BCT rate at the community hospital for 1994-1995 and 1997-1998 was 29% and 44%, respectively. On both univariate and multivariate logistic regression analysis, the era of treatment was statistically significant in its impact on the procedure performed (p <0.001). CONCLUSION: The use of BCT increased at a community hospital after the opening of an on-site RT facility, even though RT was available 5 miles away previously.

Authors
Hahn, CA; Marks, LB; Chen, DY; Lind, PA; Lind, HM; Prosnitz, LR
MLA Citation
Hahn, CA, Marks, LB, Chen, DY, Lind, PA, Lind, HM, and Prosnitz, LR. "Breast conservation rates-barriers between tertiary care and community practice." Int J Radiat Oncol Biol Phys 55.5 (April 1, 2003): 1196-1199.
PMID
12654427
Source
pubmed
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
55
Issue
5
Publish Date
2003
Start Page
1196
End Page
1199

Prospective study of neuropsychologic testing and quality-of-life assessment of adults with primary malignant brain tumors.

PURPOSE: To identify the characteristics of adult patients with newly diagnosed primary brain tumors associated with identifiable deficits in neuropsychologic function to target interventions to improve function and quality of life (QOL). MATERIALS AND METHODS: Adult patients with newly diagnosed primary brain tumors and their caregivers were enrolled and underwent a battery of standardized neuropsychologic tests, allowing for qualitative and quantitative assessment and sensitive to the effects of the brain tumor, QOL, or caregiver stress. RESULTS: We enrolled 68 patients with no prior radiotherapy. Patients with left hemisphere tumors reported significantly more memory problems and depressive symptoms. They also exhibited poorer attention and were more distractible, with poorer verbal fluency and poorer verbal learning. Patients with glioblastoma multiforme demonstrated poorer psychomotor speed and visual tracking than patients with non-glioblastoma multiforme histologic features. Patients and caregivers perceived QOL in a similar fashion, with significant correlation between patient and caregiver on hope testing and general QOL on the Linear Analog Self-Assessment Scale. CONCLUSIONS: Patients with left hemisphere tumors and glioblastoma multiforme histologic features demonstrated testable differences in neuropsychologic function and QOL that may be amenable to improvement with medical therapy or tailored rehabilitation programs. Caregiver assessments can predict patient QOL, which may be useful in patients with declining status.

Authors
Hahn, CA; Dunn, RH; Logue, PE; King, JH; Edwards, CL; Halperin, EC
MLA Citation
Hahn, CA, Dunn, RH, Logue, PE, King, JH, Edwards, CL, and Halperin, EC. "Prospective study of neuropsychologic testing and quality-of-life assessment of adults with primary malignant brain tumors." Int J Radiat Oncol Biol Phys 55.4 (March 15, 2003): 992-999.
PMID
12605978
Source
pubmed
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
55
Issue
4
Publish Date
2003
Start Page
992
End Page
999

Gastrointestinal toxicity of transperineal interstitial prostate brachytherapy.

PURPOSE: To characterize the severity and time course of rectal toxicity following transperineal prostate brachytherapy using prospectively recorded data, and to determine factors associated with toxicity. METHODS AND MATERIALS: One hundred thirty-four patients with prostate cancer treated with transperineal brachytherapy from 1997 to 1999 had rectal toxicity data available for analysis. Patients with Gleason score (GS) > 6, prostate-specific antigen (PSA) > 6, or stage > T2a were treated initially with external beam radiation therapy followed by brachytherapy boost; patients with none of these features were treated with brachytherapy alone. Both iodine-125 and palladium-103 sources were used, and loaded according to a modified Quimby distribution. At each follow-up, toxicity was recorded according to a modified RTOG gastrointestinal scale. RESULTS: Thirty-nine percent of patients experienced gastrointestinal toxicity, mostly Grade 1. Median duration of symptoms was 6 months. Two patients experienced Grade 3 toxicity, both of whom had minimal symptoms until their 12-month follow-up. There was no Grade 4 or 5 toxicity. The addition of external beam radiation therapy (p = 0.003), higher clinical stage (p = 0.006), and Caucasian race (p = 0.01) were associated with increased incidence of toxicity. CONCLUSION: Most patients with rectal toxicity have very mild symptoms. There is a small risk of severe late toxicity. External beam radiation, higher stage, and race are associated with toxicity.

Authors
Kang, SK; Chou, RH; Dodge, RK; Clough, RW; Kang, H-SL; Hahn, CA; Whitehurst, AW; Buckley, NJ; Kim, JH; Joyner, RE; Montana, GS; Ingram, SS; Anscher, MS
MLA Citation
Kang, SK, Chou, RH, Dodge, RK, Clough, RW, Kang, H-SL, Hahn, CA, Whitehurst, AW, Buckley, NJ, Kim, JH, Joyner, RE, Montana, GS, Ingram, SS, and Anscher, MS. "Gastrointestinal toxicity of transperineal interstitial prostate brachytherapy." Int J Radiat Oncol Biol Phys 53.1 (May 1, 2002): 99-103.
PMID
12007947
Source
pubmed
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
53
Issue
1
Publish Date
2002
Start Page
99
End Page
103

Computed axial tomography tandem and ovoids (CATTO) dosimetry: three-dimensional assessment of bladder and rectal doses.

The purpose of this work is to compare bladder and rectal dose rates in brachytherapy for carcinoma of the cervix using two different dosimetry systems: traditional orthogonal radiograph-based dosimetry vs. computed axial tomography tandem and ovoids (CATTO) dosimetry. Twenty-two patients with carcinoma of the uterine cervix received the brachytherapy component of their radiotherapy with a computed-tomography compatible Fletcher-Suit-Delclos device. A total of 27 implants were performed. The average maximum bladder dose (Bmax) for the implants was 85.8 cGy/hr using the CATTO system as compared to 42.6 cGy/hr using traditional dosimetry, (P < 0.005). The average maximum rectal dose (R.) using the CATTO system was 59.2 cGy/hr as compared with 46.3 cGy/hr using the traditional system (P < 0.05). The traditional methods for choosing points to determine bladder and rectal dose rates underestimated the true Bmax in all cases and the R. in most. Based on the complication rates published in the literature, it is likely that the maximum tolerance dose of both the rectum and bladder, but especially the bladder, is higher than previously thought.

Authors
Gebara, WJ; Weeks, KJ; Hahn, CA; Montana, GS; Anscher, MS
MLA Citation
Gebara, WJ, Weeks, KJ, Hahn, CA, Montana, GS, and Anscher, MS. "Computed axial tomography tandem and ovoids (CATTO) dosimetry: three-dimensional assessment of bladder and rectal doses." Radiat Oncol Investig 6.6 (1998): 268-275.
PMID
9885943
Source
pubmed
Published In
Radiation Oncology Investigations
Volume
6
Issue
6
Publish Date
1998
Start Page
268
End Page
275
DOI
10.1002/(SICI)1520-6823(1998)6:6<268::AID-ROI4>3.0.CO;2-4
Show More