International journal of radiation oncology, biology, physics
-
Int. J. Radiat. Oncol. Biol. Phys. · Nov 2012
ReviewThe clinical development of molecularly targeted agents in combination with radiation therapy: a pharmaceutical perspective.
This paper explores historical and current roles of pharmaceutical industry sponsorship of clinical trials testing radiation therapy combinations with molecularly targeted agents and attempts to identify potential solutions to expediting further combination studies. An analysis of clinical trials involving a combination of radiation therapy and novel cancer therapies was performed. Ongoing and completed trials were identified by searching the clinicaltrials.gov Web site, in the first instance, with published trials of drugs of interest identified through American Society of Clinical Oncology, European CanCer Organisation/European Society for Medical Oncology, American Society for Radiation Oncology/European Society for Therapeutic Radiology and Oncology, and PubMed databases and then cross-correlated with clinicaltrials.gov protocols. ⋯ In phase III studies, the most common (58%) primary endpoint was overall survival. Collectively, this analysis suggests that such trials are not given priority by pharmaceutical companies. The potential reasons for this and some challenges and possible solutions are discussed.
-
Int. J. Radiat. Oncol. Biol. Phys. · Nov 2012
Quality control quantification (QCQ): a tool to measure the value of quality control checks in radiation oncology.
To quantify the error-detection effectiveness of commonly used quality control (QC) measures. ⋯ The effectiveness of QC measures in radiation oncology depends sensitively on which checks are used and in which combinations. A small percentage of errors cannot be detected by any of the standard formal QC checks currently in broad use, suggesting that further improvements are needed. These data require confirmation with a broader incident-reporting database.
-
Int. J. Radiat. Oncol. Biol. Phys. · Nov 2012
A three-isocenter jagged-junction IMRT approach for craniospinal irradiation without beam edge matching for field junctions.
Traditionally craniospinal irradiation treats the central nervous system using two or three adjacent field sets. We propose a technique using a three-isocenter intensity-modulated radiotherapy (IMRT) plan (jagged-junction IMRT) which overcomes problems associated with field junctions and beam edge matching and improves planning and treatment setup efficiencies with homogenous target dose distribution. ⋯ Jagged-junction IMRT planning provided good dose homogeneity and conformity to the target while maintaining a low dose to organs at risk. Results from jagged-junction IMRT plans were better than or equivalent to those from the conventional technique. Jagged-junction IMRT optimization smoothly distributed dose in the junction between field sets. Because there was no beam matching, this treatment technique is less likely to produce hot or cold spots at the junction, in contrast to conventional techniques. The planning process is also simplified as only one IMRT plan is required for the entire target volume.
-
Int. J. Radiat. Oncol. Biol. Phys. · Nov 2012
A mathematical study to select fractionation regimen based on physical dose distribution and the linear-quadratic model.
Hypofractionated irradiation is often used in precise radiotherapy instead of conventional multifractionated irradiation. We propose a novel mathematical method for selecting a hypofractionated or multifractionated irradiation regimen based on physical dose distribution adding to biologic consideration. ⋯ Our mathematical method shows that multifractionated irradiation with a constant dose is better if the ratio of α/β for the OAR and tumor is less than the ratio of the dose for the OAR and tumor, whereas hypofractionated irradiation is better otherwise.
-
Int. J. Radiat. Oncol. Biol. Phys. · Nov 2012
What is the optimal treatment of large brain metastases? An argument for a multidisciplinary approach.
Single-modality treatment of large brain metastases (>2 cm) with whole-brain irradiation, stereotactic radiosurgery (SRS) alone, or surgery alone is not effective, with local failure (LF) rates of 50% to 90%. Our goal was to improve local control (LC) by using multimodality therapy of surgery and adjuvant SRS targeting the resection cavity. ⋯ Surgery and adjuvant resection cavity SRS yields excellent LC of large brain metastases. Compared with other multimodality treatment options, this approach allows patients to avoid or delay whole-brain irradiation without compromising LC.