Amber Orman

The Modern Role of Radiation Therapy in Treating Advanced-Stage Retinoblastoma: Long-Term Outcomes and Racial Differences

PURPOSE/OBJECTIVE(S) To evaluate the effects of various patient characteristics and radiation therapy treatment variables on outcomes in advanced-stage retinoblastoma. METHODS AND MATERIALS This was a retrospective review of 41 eyes of 30 patients treated with external beam radiation therapy between June 1, 1992, and March 31, 2012, with a median follow-up time of 133 months (11 years). Outcome measures included overall survival, progression-free survival, local control, eye preservation rate, and toxicity. RESULTS Over 90% of the eyes were stage V. Definitive external beam radiation therapy (EBRT) was delivered in 43.9% of eyes, adjuvant EBRT in 22% of eyes, and second-line/salvage EBRT in 34.1% of eyes. A relative lens sparing (RLS) technique was used in 68.3% of eyes and modified lens sparing (MLS) in 24.4% of eyes. Three eyes were treated with other techniques. Doses ≥45 Gy were used in 68.3% of eyes. Chemotherapy was a component of treatment in 53.7% of eyes. The 10-year overall survival was 87.7%, progression-free survival was 80.5%, and local control was 87.8%. White patients had significantly better overall survival than did African-American patients in univariate analysis (hazard ratio 0.09; 95% confidence interval 0.01-0.84; P=.035). Toxicity was seen in 68.3% of eyes, including 24.3% with isolated acute dermatitis. CONCLUSIONS External beam radiation therapy continues to be an effective treatment modality for advanced retinoblastoma, achieving excellent long-term local control and survival with low rates of treatment-related toxicity and secondary malignancy.

Leptomeningeal failure of retinoblastoma

Leptomeningeal (LM) failure of retinoblastoma (Rb) has not previously been reported. Upon review of our institutional experience of external beam radiotherapy (EBRT) for Rb, we found three LM failures. We sought to better define the clinical parameters of this type of recurrence. All children with LM failure had Reese‐Ellsworth stage Vb eyes. Otherwise, no variables were significantly associated with LM failure. We theorize that this phenomenon is a function of the late‐stage eyes for which EBRT is being reserved in the modern era. Pediatr Blood Cancer 2015;62:533–535.

Early prostate cancer (T1–2N0M0)

The definitive treatment of early stage prostate cancer with radiation therapy has progressed dramatically over the past two decades primarily due to the development and implementation of intensity-modulated radiation therapy (IMRT) techniques and better definition of the role of androgen deprivation therapy (ADT). IMRT has permitted the escalation of radiotherapy dose to the target tissues, namely, the prostate and proximal seminal vesicles, in an effort to improve tumor cell killing and local tumor control, while also reducing dose to nearby organs at risk (OARs) including the bladder, rectum, bowel, femoral heads, and penile bulb. Advances in image-guided radiotherapy (IGRT) have improved the accuracy of the delivery of IMRT, reduced PTV margins, and consequently decreased acute and long-term side effects. This chapter will review the clinical evidence for the use of IMRT for early stage, clinically localized (T1–2N0M0) prostate cancer and will outline the processes involved in designing and implementing a safe and effective IMRT treatment plan.

A meta-analysis of health-related quality of life after primary treatment for prostate cancer as measured by the Expanded Prostate Cancer Index Composite.

39 Background: Health-related quality of life (HRQoL) outcomes are important in treatment selection for prostate cancer. The Expanded Prostate Cancer Index Composite (EPIC) is a validated and widely-utilized HRQoL survey which accounts for newer radiotherapeutic, surgical, and hormonal treatment methods. We present a meta-analysis of patient reported HRQoL outcomes collected with EPIC and compare HRQoL trends with radiation therapy, surgery, or active surveillance as primary treatment. Methods: The PubMed database was systematically searched for all studies which presented data directly derived from the use of EPIC on patients with prostate cancer prior to 07/09/2014. All eligible studies were selected for either inclusion and analysis or exclusion based on pre-determined criteria. The data from included studies was compiled and a simulation-based estimation method using Approximate Bayesian Computation was performed to obtain missing standard deviation estimate. A longitudinal meta-analysis was conducted...

A Phase 3 Randomized Trial of MRI-Mapped Dose-Escalated Salvage Radiation Therapy Postprostatectomy: The MAPS Trial, An Initial Dosimetric Assessment

DMFS, CSS and OS are summarized in the table below for all three groups when compared to aRT. None of the men in the HR group experienced BC at 5 years. Pairwise comparisons of outcomes between the aRT and FR groups demonstrated no significant differences. Conclusions: Our analysis identified a group of FR men treated with sRT who had outcomes comparable to men treated with aRT. Our risk grouping identified IR and HR groups who may be good candidates for clinical trials that incorporate systemic therapies aimed at improving DMFS, CSS and the efficacy of sRT.