Rebekah Young

Clinical validation and applications for CT-based atlas for contouring the lower cranial nerves for head and neck cancer radiation therapy

OBJECTIVES Radiation induced cranial nerve palsy (RICNP) involving the lower cranial nerves (CNs) is a serious complication of head and neck radiotherapy (RT). Recommendations for delineating the lower CNs on RT planning studies do not exist. The aim of the current study is to develop a standardized methodology for contouring CNs IX-XII, which would help in establishing RT limiting doses for organs at risk (OAR). METHODS Using anatomic texts, radiologic data, and guidance from experts in head and neck anatomy, we developed step-by-step instructions for delineating CNs IX-XII on computed tomography (CT) imaging. These structures were then contoured on five consecutive patients who underwent definitive RT for locally-advanced head and neck cancer (LAHNC). RT doses delivered to the lower CNs were calculated. RESULTS We successfully developed a contouring atlas for CNs IX-XII. The median total dose to the planning target volume (PTV) was 70Gy (range: 66-70Gy). The median CN (IX-XI) and (XII) volumes were 10c.c (range: 8-12c.c) and 8c.c (range: 7-10c.c), respectively. The median V50, V60, V66, and V70 of the CN (IX-XI) and (XII) volumes were (85, 77, 71, 65) and (88, 80, 74, 64) respectively. The median maximal dose to the CN (IX-XI) and (XII) were 72Gy (range: 66-77) and 71Gy (range: 64-78), respectively. CONCLUSIONS We have generated simple instructions for delineating the lower CNs on RT planning imaging. Further analyses to explore the relationship between lower CN dosing and the risk of RICNP are recommended in order to establish limiting doses for these OARs.

The DCIS score: Potential for health care savings?

35 Background: The Oncotype Dx Recurrence Score for DCIS (DCIS Score) is a 12-gene assay derived from the original Oncotype DX test. The DCIS Score provides a local recurrence risk estimate at 10 years after lumpectomy for DCIS. Results can guide decisions regarding adjuvant radiation (RT). Foregoing RT can be a source of significant healthcare savings. We investigated the actual healthcare dollar savings to-date in our patients. METHODS We evaluated patients in whom the DCIS Score was ordered (x) and calculated total cost of testing. Potential cost of RT was that of IMRT as reimbursed by Medicare for a 16 fraction course, multiplied by x. Many of our patients with large breasts require IMRT for dose homogeneity and normal tissue parameters. We also calculated potential cost with 3D conformal (3D-CRT). Total potential cost was the sum of testing and treatment costs, determined for each modality. The number of patients ultimately treated (y) was also multiplied by these costs. Total actual cost was the sum of test expenses and actual treatment costs. Savings was the difference between total actual and total potential cost. RESULTS From 2/2012 to 5/ 2014 the DCIS Score was performed in 38 patients (x = 38). Median age was 66 (40 to 85). Grade was low in 39%, intermediate in 45%, and high in 16%. Fifty percent had necrosis and median size was 0.5 cm (0.1 to 3.1cm). The total cost of testing was

Lack of Adjuvant Radiotherapy May Increase Risk of Retropharyngeal Node Recurrence in Patients with Squamous Cell Carcinoma of the Head and Neck after Transoral Robotic Surgery

4125 * 38 =

Abstract P6-13-08: The DCIS Score - Potential for healthcare savings?

156,750. IMRT reimburses at

Recurrence patterns among T1-2N0 triple-negative breast cancer patients following mastectomy.

23, 000 and 3D-CRT at

25-Year Follow-up of HIV-positive Patients with Benign Lymphoepithelial Cysts of the Parotid Glands: A Retrospective Review

11,000. Potential total cost of RT ranged from

Comprehensive Head and Neck Radiotherapy Dose-Volume Constraints Do Not Apply to Smaller Volumes

418,000 to

Management algorithm for HIV-associated parotid lymphoepithelial cysts.

874, 000; testing brought total potential costs to

The role of post-SRS systemic therapy in synchronous lung cancer brain metastases.

574, 750 to

Comparison of predictive models for local recurrence of DCIS after breast conserving surgery.

1,030, 750. Upon receipt of test results, 12 (y) patients ultimately underwent therapy. IMRT was given in 11 patients and 3D-CRT in 1, for a total treatment cost of