Publications by authors named "Michael M Dominello"

29 Publications

  • Page 1 of 1

Toward Improving Patients' Experiences of Acute Toxicity From Breast Radiotherapy: Insights From the Analysis of Patient-Reported Outcomes in a Large Multicenter Cohort.

J Clin Oncol 2020 12 28;38(34):4019-4029. Epub 2020 Sep 28.

University of Michigan, Ann Arbor, MI.

Purpose: Understanding acute toxicities after whole-breast radiotherapy is important to inform patients, guide treatment decisions, and target supportive care. We evaluated patient-reported outcomes prospectively collected from a cohort of patients with breast cancer.

Methods: We describe the maximal toxicity reported by 8,711 patients treated between 2012 and 2019 at 27 practices. Multivariable models identified characteristics associated with (1) breast pain, (2) bother from itching, stinging/burning, swelling, or hurting of the treated breast, and (3) fatigue within 7 days of completing whole-breast radiotherapy.

Results: Moderate or severe breast pain was reported by 3,233 (37.1%): 1,282 (28.9%) of those receiving hypofractionation and 1,951 (45.7%) of those receiving conventional fractionation. Frequent bother from at least one breast symptom was reported by 4,424 (50.8%): 1,833 (41.3%) after hypofractionation and 2,591 (60.7%) after conventional fractionation. Severe fatigue was reported by 2,008 (23.1%): 843 (19.0%) after hypofractionation and 1,165 (27.3%) after conventional fractionation. Among patients receiving hypofractionated radiotherapy, younger age ( < .001), higher body mass index (BMI; < .001), Black ( < .001) or other race ( = .002), smoking status ( < .001), larger breast volume ( = .002), lack of chemotherapy receipt ( = .004), receipt of boost treatment ( < .001), and treatment at a nonteaching center predicted breast pain. Among patients receiving conventionally fractionated radiotherapy, younger age ( < .001), higher BMI ( = .003), Black ( < .001) or other race ( = .002), diabetes ( = .001), smoking status ( < .001), and larger breast volume ( < .001) predicted breast pain.

Conclusion: In this large observational data set, substantial differences existed according to radiotherapy dose fractionation. Race-related differences in pain existed despite controlling for multiple other factors; additional research is needed to understand what drives these differences to target potentially modifiable factors. Intensifying supportive care may be appropriate for subgroups identified as being vulnerable to greater toxicity.
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http://dx.doi.org/10.1200/JCO.20.01703DOI Listing
December 2020

Final Report from IBPRO: Impact of Multidisciplinary Collaboration on Research in Radiation Oncology.

Radiat Res 2020 08;194(2):188-190

Wayne State University School of Medicine, Detroit, Michigan.

An important hallmark of the field of radiation oncology has traditionally been multidisciplinary collaboration among its clinicians and scientists. Increased specialization, resulting from increased complexity, threatens to diminish this important characteristic. This article evaluates the success of a short-term educational environment developed specifically to enhance multidisciplinary collaboration. This NIH-funded educational course, named "Integration of Biology and Physics into Radiation Oncology (IBPRO)," was developed at Wayne State University, and designed to facilitate engagement among radiation oncologists, medical physicists and radiobiologists in activities that foster collaborative investigation. The question we address here is, "Did it work?" The 240 clinicians and researchers participating in IBPRO over the five years of the course were surveyed to quantify its effectiveness. In total, 95 respondents identified 45 institutional protocols, 52 research grant applications (19 of which have been funded thus far), 94 research manuscripts and 106 research presentations as being attributable to participation in IBPRO. The majority (66%) of respondents reported generating at least one of these research metrics attributable to participation in IBPRO, and these participants reported an average of nearly five such quantitative research metrics per respondent. This represents a remarkable contribution to radiation oncology research within a relatively short period through an intervention involving a relatively small number of radiation oncology professionals. Nearly two thirds of respondents reported ongoing collaborative working relationships generated by IBPRO. In addition, approximately 50% of respondents stated that specific information presented at IBPRO changed the way they practice, and 95% of respondents practicing in a clinical setting stated that, since participation in IBPRO, they have approached clinical dilemmas more collaboratively. Many collaborative working relationships generated by this course continue to actively drive research productivity. Additionally, one of the many enduring legacies of this course is the creation of a new debate series in a professional journal. IBPRO serves as a model for our ability to leverage collaborative learning in an educational intervention to foster multidisciplinary clinical and research collaboration. It has already had a profound impact on the profession of radiation oncology, and this impact can be anticipated to increase in the future.
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http://dx.doi.org/10.1667/RADE-20-00117.1DOI Listing
August 2020

ACR-ASTRO Practice Parameter for Communication: Radiation Oncology.

Am J Clin Oncol 2020 08;43(8):553-558

Geisel School of Medicine at Dartmouth, Hanover, NH.

Aim/objectives/background: Timely, accurate, and effective communications are critical to quality in contemporary medical practices. Radiation oncology incorporates the science and technology of complex integrated radiation treatment delivery and the art of managing individual patients. Through written physical and/or electronic reports and direct communication, radiation oncologists convey critical information regarding patient care, services provided, and quality of care. Applicable practice parameters need to be revised periodically regarding medical record documentation for professional and technical components of services delivered.

Methods: The ACR-ASTRO Practice Parameter for Communication: Radiation Oncology was revised according to the process described on the American College of Radiology (ACR) Web site ("The Process for Developing ACR Practice Parameters and Technical Standards," www.acr.org/ClinicalResources/Practice-Parametersand-Technical-Standards) by the Committee on Practice Parameters of the ACR Commission on Radiation Oncology in collaboration with the American Society for Radiation Oncology (ASTRO). Both societies then reviewed and approved the document.

Results: This practice parameter addresses radiation oncology communications in general, including (a) medical record, (b) electronic, and (c) doctor-patient communications, as well as specific documentation for radiation oncology reports such as (a) consultation, (b) clinical treatment management notes (including inpatient communication), (c) treatment (completion) summary, and (d) follow-up visits.

Conclusions: The radiation oncologist's participation in the multidisciplinary management of patients is reflected in timely, medically appropriate, and informative communication with the referring physician and other members of the health care team. The ACR-ASTRO Practice Parameter for Communication: Radiation Oncology is an educational tool designed to assist practitioners in providing appropriate communication regarding radiation oncology care for patients.
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http://dx.doi.org/10.1097/COC.0000000000000707DOI Listing
August 2020

The Role of Facility Variation on Racial Disparities in Use of Hypofractionated Whole Breast Radiation Therapy.

Int J Radiat Oncol Biol Phys 2020 08 4;107(5):949-958. Epub 2020 May 4.

Rogel Comprehensive Cancer Center at the University of Michigan, Ann Arbor, Michigan. Electronic address:

Purpose: Hypofractionated radiation therapy is a less burdensome and less costly approach that is efficacious for most patients with early-stage breast cancer. Concerns about racial disparities in adoption of medical advances motivate investigation of the use of hypofractionated radiation in diverse populations. The goal of our study was to determine whether hypofractionated whole breast radiation therapy after breast-conserving surgery was being similarly used across racial groups in the state of Michigan.

Methods And Materials: A prospectively collected statewide quality consortium database from 25 institutions was queried for patients with breast cancer who completed hypofractionated (HF) or conventionally fractionated whole breast radiation therapy from January 2012 to December 2018. We used patient-level multivariable modeling to evaluate associations between HF use and race, controlling for patient and facility factors, and multilevel modeling to account for patient clustering within facilities.

Results: Of 9634 patients analyzed, 81% self-reported race as white, 17% as black, and 2% as Asian, similar to statewide and national distributions. In addition, 31.7% of whites were treated at teaching centers compared with 66.7% of blacks and 64.8% of Asians. In 2018, HF was used in 72.7% of whites versus 56.7% of blacks and 67.6% of Asians (P = .0411). On patient-level multivariable analysis, black and Asian races were significantly associated with a lower likelihood of HF receipt (P < .001), despite accounting for treatment year, age, laterality, body mass index, breast volume, comorbidities, stage, triple-negative status, intensity modulated radiation therapy use, teaching center treatment, and 2011 American Society for Radiation Oncology Hypofractionation Guideline eligibility. On multilevel analysis, race was no longer significantly associated with HF receipt.

Conclusions: We observed that black and Asian patients receive hypofractionated whole breast radiation therapy less often than whites, despite more frequent treatment at teaching centers. Multilevel modeling eliminated this disparity, suggesting that differences in facility-specific HF use appear to have contributed. Further inquiry is needed to determine whether reduction of facility-level variation may reduce disparities in accessing HF treatment.
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http://dx.doi.org/10.1016/j.ijrobp.2020.04.035DOI Listing
August 2020

Targeted Needs Assessment of Treatment Planning Education for United States Radiation Oncology Residents.

Int J Radiat Oncol Biol Phys 2020 03 28;106(4):677-682. Epub 2019 Nov 28.

Department of Radiation Oncology, University of California, San Francisco, California. Electronic address:

Purpose: Prior surveys suggest almost one-third of chief residents report insufficient exposure to treatment planning. We evaluated the state of treatment planning education among United States residents.

Methods And Materials: A web-based survey was sent to current residents identified using the Association of Residents in Radiation Oncology directory.

Results: The response rate was 33%. Twenty-six percent of residents reported a mandatory treatment planning rotation. Seventy-one percent of residents reported reviewing ≤50% of plans with an attending. Twenty-three percent of respondents were not at all or only slightly comfortable (1 or 2 on a 1-5 scale) evaluating treatment plans. Residents with mandatory treatment planning rotations were more comfortable evaluating plans compared with those without mandatory rotations (P = .045). Overall, 60% reported insufficient exposure to treatment planning. Among postgraduate year 5 residents, this rate was 52%. Ninety-two percent of residents expressed interest in free supplemental treatment planning resources.

Conclusions: A significant proportion of residents surveyed report insufficient exposure to treatment planning. Development of a practical treatment planning curriculum would offer the opportunity to improve resident education, and ultimately quality of care, at the national level.
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http://dx.doi.org/10.1016/j.ijrobp.2019.11.023DOI Listing
March 2020

Pretreatment Volume of MRI-Determined White Matter Injury Predicts Neurocognitive Decline After Hippocampal Avoidant Whole-Brain Radiation Therapy for Brain Metastases: Secondary Analysis of NRG Oncology Radiation Therapy Oncology Group 0933.

Adv Radiat Oncol 2019 Oct-Dec;4(4):579-586. Epub 2019 Jul 16.

Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee.

Purpose: NRG Oncology's RTOG 0933 demonstrated benefits to memory preservation after hippocampal avoidant whole-brain radiation therapy (HA-WBRT), the avoidance of radiation dose to the hippocampus (using intensity modulated radiation planning and delivery techniques) during WBRT, supporting the hypothesis of hippocampal radiosensitivity and associated memory specificity. However, some patients demonstrated cognitive decline, suggesting mechanisms outside hippocampal radiosensitivity play a role. White matter injury (WMI) has been implicated in radiation therapy-induced neurocognitive decline. This secondary analysis explored the relationship between pretreatment WMI and memory after HA-WBRT.

Methods And Materials: Volumetric analysis of metastatic disease burden and disease-unrelated WMI was conducted on the pretreatment magnetic resonance image. Correlational analyses were performed examining the relationship between pretreatment WMI and Hopkins Verbal Learning Test-Revised (HVLT-R) outcomes at baseline and 4 months after HA-WBRT.

Results: In the study, 113 patients received HA-WBRT. Of 113 patients, 33 underwent pretreatment and 4-month posttreatment HVLT testing and pretreatment postcontrast volumetric T1 and axial T2/fluid-attenuated inversion recovery magnetic resonance imaging. Correlation was found between larger volumes of pretreatment WMI and decline in HVLT-R recognition (r = 0.54, 05), and a correlational trend was observed between larger volume of pretreatment WMI and decline in HVLT-R delayed recall (r = 0.31, 08). Patients with higher pretreatment disease burden experienced a greater magnitude of stability or positive shift in HVLT-R recall and delayed recall after HA-WBRT (r = -0.36 and r = -0.36,  < .05), compared to the magnitude of stability or positive shift in those with lesser disease burden.

Conclusions: In patients receiving HA-WBRT for brain metastases, extent of pretreatment WMI predicts posttreatment memory decline, suggesting a mechanism for radiation therapy-induced neurocognitive toxicity independent of hippocampal stem cell radiosensitivity. Stability or improvement in HVLT after HA-WBRT for patients with higher pretreatment intracranial metastatic burden supports the importance of WBRT-induced intracranial control on neurocognition.
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http://dx.doi.org/10.1016/j.adro.2019.07.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6817553PMC
July 2019

Radiation Oncology Resident Didactic Education in Medical Physics: Evaluating Residents, Educators, and the Process.

Int J Radiat Oncol Biol Phys 2020 01 21;106(1):45-46. Epub 2019 Oct 21.

Wayne State University School of Medicine, Detroit, Michigan.

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http://dx.doi.org/10.1016/j.ijrobp.2019.05.035DOI Listing
January 2020

Miniaturized phased-array ultrasound and photoacoustic endoscopic imaging system.

Photoacoustics 2019 Sep 25;15:100139. Epub 2019 Jul 25.

Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA.

Visualization and detection of early-stage gynecological malignancies represents a challenge for imaging due to limiting factors including tissue accessibility, device ease of use, and accuracy of imaging modalities. In this work, we introduce a miniaturized phased-array ultrasound and photoacoustic endoscopic probe which is capable of providing structural, functional, and molecular data for the characterization of gynecologic disease. The proposed probe consists of a 64-element ultrasound phased-array transducer coupled to a fiber-optic light delivery system for co-registered ultrasound and photoacoustic imaging. The fabricated US and PA imaging endoscope's diameter is 7.5 mm, allowing for potential passage through the cervical canal and thus an intimate contact with gynecological tissues such as the cervical canal and uterus. The developed endoscopic probe was tested and characterized in a set of tissue-mimicking phantoms. US and PA resolutions were measured experimentally using 200 μm diameter wires, resulting in apparent axial and lateral diameters of 289 μm and 299 μm for US, and 308 μm and 378 μm for PA, respectively. The probe's abilities to operate in both discrete and integrated illumination/acquisition were tested in gelatin phantoms with embedded optical absorbers with the results demonstrating the ability to acquire volumetric dual-modal US and PA images.
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http://dx.doi.org/10.1016/j.pacs.2019.100139DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677929PMC
September 2019

Cardiac Dose in Locally Advanced Lung Cancer: Results From a Statewide Consortium.

Pract Radiat Oncol 2020 Jan - Feb;10(1):e27-e36. Epub 2019 Aug 2.

Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.

Purpose: The heart has been identified as a potential significant organ at risk in patients with locally advanced non-small cell lung cancer treated with radiation. Practice patterns and radiation dose delivered to the heart in routine practice in academic and community settings are unknown.

Methods And Materials: Between 2012 and 2017, 746 patients with stage III non-small cell lung cancer were treated with radiation within the statewide Michigan Radiation Oncology Quality Consortium (MROQC). Cardiac radiation dose was characterized, including mean and those exceeding historical or recently proposed Radiation Therapy Oncology Group and NRG Oncology constraints. Sites were surveyed to determine dose constraints used in practice. Patient-, anatomic-, and treatment-related associations with cardiac dose were analyzed using multivariable regression analysis and inverse probability weighting.

Results: Thirty-eight percent of patients had a left-sided primary, and 80% had N2 or N3 disease. Median prescription was 60 Gy (interquartile range, 60-66 Gy). Twenty-two percent of patients were prescribed 60 Gy in 2012, which increased to 62% by 2017 (P < .001). Median mean heart dose was 12 Gy (interquartile range, 5-19 Gy). The volume receiving 30 Gy (V30 Gy) exceeded 50% in 5% of patients, and V40 Gy was >35% in 3% of cases. No heart dose constraint was uniformly applied. Intensity modulated radiation therapy (IMRT) usage increased from 33% in 2012 to 86% in 2017 (P < .001) and was significantly associated with more complex cases (larger planning target volume, higher stage, and preexisting cardiac disease). In multivariable regression analysis, IMRT was associated with a lower percent of the heart receiving V30 Gy (absolute reduction = 3.0%; 95% confidence interval, 0.5%-5.4%) and V50 Gy (absolute reduction = 3.6%; 95% confidence interval, 2.4%-4.8%) but not mean dose. In inverse probability weighting analysis, IMRT was associated with 29% to 48% relative reduction in percent of the heart receiving V40-V60 Gy without increasing lung or esophageal dose or compromising planning target volume coverage.

Conclusions: Within MROQC, historical cardiac constraints were met in most cases, yet 1 in 4 patients received a mean heart dose exceeding 20 Gy. Future work is required to standardize heart dose constraints and to develop treatment approaches that allow for constraints to be met without compromising other planning goals.
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http://dx.doi.org/10.1016/j.prro.2019.07.013DOI Listing
June 2020

Recommendations for Single-Fraction Radiation Therapy and Stereotactic Body Radiation Therapy in Palliative Treatment of Bone Metastases: A Statewide Practice Patterns Survey.

Pract Radiat Oncol 2019 Nov 19;9(6):e541-e548. Epub 2019 Jul 19.

Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan. Electronic address:

Purpose: Single-fraction (SF) radiation therapy is effective and convenient for patients with painful noncomplex bone metastases. Prior survey results reported a low recommendation of SF radiation therapy in the US. We sought to assess contemporary treatment recommendations for the management of bone metastases among diverse physicians participating in a statewide quality consortium.

Methods And Materials: Members of the Michigan Radiation Oncology Quality Consortium were surveyed between April and May 2017. Physicians rated the importance of 31 variables on their choice of dose fractionation. The survey also covered 7 patient scenarios.

Results: Fifty-six physicians responded who were practicing at 18 of 20 centers surveyed. Respondents recommended 23 dose-fractionation schedules across the 7 scenarios. Highest-rated factors considered when choosing a dose fractionation regimen were performance status, prognosis, spinal cord compression, and prior radiation therapy. Recommendations for SF overall were uncommon (16.1%). On multivariable analysis, factors associated with SF use included academic employment (odds ratio [OR] 2.04; 95% CI, 1.02-4.08; P = .044) and higher palliative case volume (OR 2.59; 95% CI, 1.45-4.63; P = .001). Stereotactic body radiation therapy (SBRT) was recommended in 16.4% of scenarios overall, and on multivariable analysis, significant predictors for SBRT use were academic employment (OR 2.99; 95% CI, 1.39-6.44; P = .005), more recent residency completion (OR 4.37; 95% CI, 1.26-15.17; P = .02), spine location (OR 12.54; 95% CI, 3.96-39.68; P < .001), and prior radiation therapy (OR 26.67; 95% CI, 7.86-90.57; P < .001). SF rates were higher than in a survey reported in 2009 (16.1% vs 9.4%, P = .0004).

Conclusions: SF radiation therapy remains uncommonly recommended, although it may be recommended more now than it was 10 years ago despite the increased utilization of SBRT. We identify multiple key drivers in physician decision making affecting SF recommendations that have not been addressed by prior level one evidence. Further research with evidence-based recommendations to clarify the role of SF and SBRT in management of patients with bony metastases are needed.
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http://dx.doi.org/10.1016/j.prro.2019.07.005DOI Listing
November 2019

In Reply to Malicki.

Int J Radiat Oncol Biol Phys 2018 12;102(5):1592-1593

Karmanos Cancer Center, Wayne State University School of Medicine, Detroit, Michigan.

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http://dx.doi.org/10.1016/j.ijrobp.2018.07.2008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6482837PMC
December 2018

Analysis of the 2017 American Society for Radiation Oncology (ASTRO) Research Portfolio.

Int J Radiat Oncol Biol Phys 2019 02;103(2):297-304

American Society for Radiation Oncology, Arlington, Virginia.

Purpose: Research in radiation oncology (RO) is imperative to support the discovery of new uses of radiation and improvement of current approaches to radiation delivery and to foster the continued evolution of our field. Therefore, in 2016, the American Society of Radiation Oncology performed an evaluation of research grant funding for RO.

Methods And Materials: Members of the Society of Chairs of Academic Radiation Oncology Programs (SCAROP) were asked about funded and unfunded grants that were submitted by their departments between the fiscal years 2014 and 2016. Grants were grouped according to broad categories defined by the 2017 American Society of Radiation Oncology Research Agenda. Additionally, active grants in the National Institutes of Health (NIH) Research Portfolio Online Reporting Tools database were collated using RO faculty names.

Results: Overall, there were 816 funded (44%) and 1031 unfunded (56%) SCAROP-reported grants. Total grant funding was over $196 million. The US government funded the plurality (42.2%; 345 of 816) of grants compared with nonprofit and industry funders. Investigators from 10 institutions accounted for >75% of funded grants. Of the funded grants, 43.5% were categorized as "genomic influences and targeted therapies." The proportion of funded to unfunded grants was highest within the category of "tumor microenvironment, normal tissue effects, and reducing toxicity" (53.4% funded). "New clinical trial design and big data" had the smallest share of SCAROP grant applications and the lowest percent funded (38.3% of grants). NIH grants to RO researchers in 2014 to 2016 accounted for $85 million in funding. From the 31 responding SCAROP institutions, there was a 28% average success rate for RO proposals submitted to the NIH during this period.

Conclusions: Though RO researchers from responding institutions were relatively successful in obtaining funding, the overall amount awarded remains small. Continued advocacy on behalf of RO is needed, as well as investment to make research careers more attractive areas for emerging faculty.
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http://dx.doi.org/10.1016/j.ijrobp.2018.07.2056DOI Listing
February 2019

Glioblastoma metastatic to the ovary, a very different Krukenberg tumor?

Pract Radiat Oncol 2018 Nov - Dec;8(6):373-375. Epub 2018 Apr 7.

Department of Radiation Oncology, Karmanos Cancer Institute, Detroit, Michigan.

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http://dx.doi.org/10.1016/j.prro.2018.04.002DOI Listing
January 2019

Contemporary Statewide Practice Pattern Assessment of the Palliative Treatment of Bone Metastasis.

Int J Radiat Oncol Biol Phys 2018 06 6;101(2):462-467. Epub 2018 Mar 6.

Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.

Purpose: Palliative radiation therapy for bone metastases is often viewed as a single entity, despite national guidelines providing input principally only for painful uncomplicated bone metastases. Data surrounding the treatment of bone metastases are often gleaned from questionnaires of what providers would theoretically do in practice or from population-based data lacking critical granular information. We investigated the real-world treatment of bone metastases with radiation therapy.

Methods And Materials: Twenty diverse institutions across the state of Michigan had data extracted for their 10 most recent cases of radiation therapy delivered for the treatment of bone metastases at their institution between January and February 2017. Uni- and multivariable binary logistic regression was used to assess the use of single fraction (8 Gy × 1) radiation therapy.

Results: A total of 196 cases were eligible for inclusion. Twenty-eight different fractionation schedules were identified. The most common schedule was 3 Gy × 10 fractions (n = 100; 51.0%), 4 Gy × 5 fractions (n = 32; 16.3%), and 8 Gy × 1 (n = 15; 7.7%). The significant predictors for the use of single fraction radiation therapy were the presence of oligometastatic disease (P = .008), previous overlapping radiation therapy (P = .050), and academic practice type (P = .039). Twenty-nine cases (14.8%) received >10 fractions (median 15, range 11-20). Intensity modulated radiation therapy was used in 14 cases (7.1%), stereotactic body radiation therapy in 11 (5.6%), and image guidance with cone beam computed tomography in 11 (5.6%). Of the cases of simple painful bone metastases (no previous surgery, spinal cord compression, fracture, soft tissue extension, or overlapping previous radiation therapy; n = 70), only 12.9% were treated with 8 Gy × 1.

Conclusions: Bone metastases represent a heterogeneous disease, and radiation therapy for bone metastases is similarly diverse. Future work is needed to understand the barriers to single fraction use, and clinical trials are necessary to establish appropriate guidelines for the breadth of this complex disease.
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http://dx.doi.org/10.1016/j.ijrobp.2018.02.037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6844366PMC
June 2018

…of Radiation Oncology, Biology, and Physics.

Int J Radiat Oncol Biol Phys 2018 04 31;100(5):1289-1290. Epub 2018 Jan 31.

Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan.

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http://dx.doi.org/10.1016/j.ijrobp.2018.01.045DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937706PMC
April 2018

Improving Research in Radiation Oncology through Interdisciplinary Collaboration.

Radiat Res 2018 07 25;190(1):1-4. Epub 2018 Apr 25.

a   Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, Michigan.

The contribution of radiation oncology to the future of cancer treatment depends significantly on our continued clinical progress and future research advancements. Such progress relies on multidisciplinary collaboration among radiation oncologists, medical physicists and radiobiologists. Cultivating collaborative educational and research opportunities among these three disciplines and further investing in the infrastructure used to train both clinicians and researchers will therefore help us improve the future of cancer care. This article evaluates the success of a short-term educational environment to foster multidisciplinary collaboration. The NIH-funded educational course developed at Wayne State University, called "Integration of Biology and Physics into Radiation Oncology" (IBPRO), was designed to facilitate the engagement of radiation oncologists, medical physicists and radiobiologists in activities that enhance collaborative investigation. Having now been delivered to nearly 200 participants over the past four years, the relative success of IBPRO in fostering productive interdisciplinary collaboration and producing tangible research outcomes can be evaluated. The 140 IBPRO participants from the first three years were surveyed to quantify the effectiveness of the course. In total, 62 respondents reported developing 23 institutional protocols, submitting more than 25 research grants (nine of which have been funded thus far), and publishing more than 30 research manuscripts attributable to participation in IBPRO. Nearly one-half (45%) of respondents reported generating at least one of these research metrics attributable to participation in IBPRO and these participants reported an average of over four such quantitative research metrics per respondent. This represents a very substantial contribution to radiation oncology research by a relatively small number of researchers within a relatively short time. Nearly one-half of respondents reported ongoing collaborative working relationships generated by IBPRO. In addition, approximately one-half of respondents stated that specific information presented at IBPRO changed the way they practice, and over 80% of respondents practicing in a clinical setting stated that, since participation in IBPRO, they have approached clinical dilemmas more collaboratively. We believe that educational opportunities such as IBPRO can have a significant impact on interdisciplinary collaborative research. In addition, such interventions have the ability to effect significant clinical change. Both of these should have a positive impact on future advancements in radiation oncology and affect the future contribution of radiation oncology to the treatment of cancer.
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http://dx.doi.org/10.1667/RR15023.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6052437PMC
July 2018

Radiation injury to cardiac arteries and myocardium is reduced by soy isoflavones.

J Radiat Oncol 2017 Sep 22;6(3):307-315. Epub 2017 Mar 22.

Department of Oncology, Division of Radiation Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Research Center, room 515, 4100 John R, Detroit, MI 48201, USA.

Objective: The negative effects of incidental radiation on the heart and its vessels, particularly in the treatment of locally advanced non-small cell lung cancer, esophageal cancer, left-sided breast cancer, and lymphoma, are known. Late cardiac events induced by radiotherapy including coronary artery disease, ischemia, congestive heart failure, and myocardial infarction can manifest months to years after radiotherapy. We have previously demonstrated that soy isoflavones mitigate inflammatory responses induced in lungs by thoracic irradiation resulting in decreased vascular damage, inflammation, and fibrosis. In the current study, we investigate the use of soy isoflavones to protect cardiac vessels and myocardium from radiation injury.

Methods: Mice received a single dose of 10-Gy thoracic irradiation and daily oral treatment with soy isoflavones. At different time points, hearts were processed for histopathology studies to evaluate the effect of soy isoflavones on radiation-induced damage to cardiac vessels and myocardium.

Results: Radiation damage to arteries and myocardium was detected by 16 weeks after radiation. Soy isoflavones given in conjunction with thoracic irradiation were found to reduce damage to the artery walls and radiation-induced fibrosis in the myocardium.

Conclusion: Our histopathological findings suggest a radioprotective role of soy isoflavones to prevent cardiac injury. This approach could translate to the use of soy isoflavones as a safe complement to thoracic radiotherapy with the goal of improving the overall survival in patients whose cancer has been successfully controlled by the radiotherapy but who otherwise succumb to heart toxicity.
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http://dx.doi.org/10.1007/s13566-017-0301-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6903690PMC
September 2017

The American Society for Radiation Oncology's 2015 Core Physics Curriculum for Radiation Oncology Residents.

Int J Radiat Oncol Biol Phys 2016 07 19;95(4):1298-303. Epub 2016 Mar 19.

Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania.

Purpose: The American Society for Radiation Oncology (ASTRO) Physics Core Curriculum Subcommittee (PCCSC) has updated the recommended physics curriculum for radiation oncology resident education to improve consistency in teaching, intensity, and subject matter.

Methods And Materials: The ASTRO PCCSC is composed of physicists and physicians involved in radiation oncology residency education. The PCCSC updated existing sections within the curriculum, created new sections, and attempted to provide additional clinical context to the curricular material through creation of practical clinical experiences. Finally, we reviewed the American Board of Radiology (ABR) blueprint of examination topics for correlation with this curriculum.

Results: The new curriculum represents 56 hours of resident physics didactic education, including a 4-hour initial orientation. The committee recommends completion of this curriculum at least twice to assure both timely presentation of material and re-emphasis after clinical experience. In addition, practical clinical physics and treatment planning modules were created as a supplement to the didactic training. Major changes to the curriculum include addition of Fundamental Physics, Stereotactic Radiosurgery/Stereotactic Body Radiation Therapy, and Safety and Incidents sections, and elimination of the Radiopharmaceutical Physics and Dosimetry and Hyperthermia sections. Simulation and Treatment Verification and optional Research and Development in Radiation Oncology sections were also added. A feedback loop was established with the ABR to help assure that the physics component of the ABR radiation oncology initial certification examination remains consistent with this curriculum.

Conclusions: The ASTRO physics core curriculum for radiation oncology residents has been updated in an effort to identify the most important physics topics for preparing residents for careers in radiation oncology, to reflect changes in technology and practice since the publication of previous recommended curricula, and to provide practical training modules in clinical radiation oncology physics and treatment planning. The PCCSC is committed to keeping the curriculum current and consistent with the ABR examination blueprint.
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http://dx.doi.org/10.1016/j.ijrobp.2016.03.012DOI Listing
July 2016

Pretreatment computed tomographic gross tumor volume as predictor of persistence of tracheostomy and percutaneous endoscopic gastrostomy tube in patients undergoing larynx preservation.

Head Neck 2016 10 30;38(10):1455-8. Epub 2016 Apr 30.

Department of Radiation Oncology, Wayne State University, Detroit Medical Center, Karmanos Cancer Center, Detroit, Michigan.

Background: Although larynx preservation affords patients improvements in laryngectomy-free survival, little has been reported regarding the functional outcomes after larynx preservation. The purpose of this study was to report the predictive value of pretreatment CT-gross tumor volume (GTV) for persistence of tracheostomy and percutaneous endoscopic gastrostomy (PEG) tube in larynx preservation patients.

Methods: Each patient had a CT scan before initiation of therapy and the GTV was contoured.

Results: Using recursive partitioning analysis (RPA), threshold GTVs of 27.16 cc and 12 cc were identified for association of time with tracheostomy and PEG tube, respectively. Median (95% confidence interval [CI]) times above and below these thresholds were 1.84 (1.06-not reached [NR]) and 0.75 (0.63-1.26) years, respectively (p = .03) for time with tracheostomy and 1.75 (1.34-NR) and 0.84 (0.46-NR) years, respectively (p = 0.10) for time with PEG tube.

Conclusion: This study demonstrates that pretreatment CT-GTV is predictive of an approximately 2.5-fold and approximately 2-fold, respectively, increase in time with tracheostomy and PEG tube. © 2016 Wiley Periodicals, Inc. Head Neck 38: First-1458, 2016.
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http://dx.doi.org/10.1002/hed.24458DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6857528PMC
October 2016

Patterns and predictors of failure following tri-modality therapy for locally advanced esophageal cancer.

Acta Oncol 2016 19;55(3):303-8. Epub 2015 Nov 19.

a Department of Radiation Oncology , Fox Chase Cancer Center , Philadelphia , PA , USA ;

Background: Although tri-modality therapy is an acceptable standard of care in patients with locally advanced esophageal cancer, data regarding patterns of failure is lacking. We report bi-institutional patterns of failure experience treating patients using tri-modality therapy.

Materials And Methods: We retrospectively reviewed patients who underwent chemoradiation followed by esophagectomy between 2006 and 2011 at two NCI-designated cancer centers. First failure sites were categorized as local, regional nodal, or distant. Statistical analysis was performed using Fisher's exact test, non-parametric Wilcoxon rank-sum test, and multiple logistic regression. Kaplan-Meier curves were generated for relapse-free survival (RFS) and overall survival.

Results: A total of 132 patients met the inclusion criteria with a median age of 62 (range 36-80) and median follow-up of 28 months (range 4-128). There were a total of six (4.5%) local, 13 (10%) regional nodal, and 32 (23.5%) distant failures. Local failure was correlated with fewer lymph nodes (LN) assessed (p = 0.01) and close/positive margins (p < 0.01). Regional nodal failure was correlated with fewer LN assessed (p < 0.01) and larger pretreatment tumor size (p = 0.04). Patients with ≤13 LN evaluated had an inferior locoregional RFS versus patients with >13 LN evaluated (p = 0.003). Distant recurrence was correlated with higher pathologic nodal stage (p < 0.001), ulceration (p = 0.017), perineural invasion (p = 0.029), residual disease (p = 0.004), and higher post-treatment PET SUV max (p = 0.049). Patients with a pathologic complete response (OR 0.19, 95% CI 0.05-0.68) were less likely to experience distant recurrence.

Conclusion: Tumor and treatment factors may predict for failure in patients undergoing tri-modality therapy for locally advanced esophageal cancer. Further data is needed to identify patterns of failure in these patients.
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http://dx.doi.org/10.3109/0284186X.2015.1110252DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6854665PMC
December 2016

Radiation-Induced Esophagitis is Mitigated by Soy Isoflavones.

Front Oncol 2015 21;5:238. Epub 2015 Oct 21.

Department of Immunology and Microbiology, Karmanos Cancer Institute, Wayne State University School of Medicine , Detroit, MI , USA ; Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine , Detroit, MI , USA.

Introduction: Lung cancer patients receiving radiotherapy present with acute esophagitis and chronic fibrosis, as a result of radiation injury to esophageal tissues. We have shown that soy isoflavones alleviate pneumonitis and fibrosis caused by radiation toxicity to normal lung. The effect of soy isoflavones on esophagitis histopathological changes induced by radiation was investigated.

Methods: C57BL/6 mice were treated with 10 Gy or 25 Gy single thoracic irradiation and soy isoflavones for up to 16 weeks. Damage to esophageal tissues was assessed by hematoxylin-eosin, Masson's Trichrome and Ki-67 staining at 1, 4, 10, and 16 weeks after radiation. The effects on smooth muscle cells and leukocyte infiltration were determined by immunohistochemistry using anti-αSMA and anti-CD45, respectively.

Results: Radiation caused thickening of esophageal tissue layers that was significantly reduced by soy isoflavones. Major radiation alterations included hypertrophy of basal cells in mucosal epithelium and damage to smooth muscle cells in muscularis mucosae as well as disruption of collagen fibers in lamina propria connective tissue with leukocyte infiltration. These effects were observed as early as 1 week after radiation and were more pronounced with a higher dose of 25 Gy. Soy isoflavones limited the extent of tissue damage induced by radiation both at 10 and 25 Gy.

Conclusion: Soy isoflavones have a radioprotective effect on the esophagus, mitigating the early and late effects of radiation injury in several esophagus tissue layers. Soy could be administered with radiotherapy to decrease the incidence and severity of esophagitis in lung cancer patients receiving thoracic radiation therapy.
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http://dx.doi.org/10.3389/fonc.2015.00238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4617099PMC
November 2015

Ten-year trends in safe radiation therapy delivery and results of a radiation therapy quality assurance intervention.

Pract Radiat Oncol 2015 Nov-Dec;5(6):e665-71. Epub 2015 Aug 28.

Department of Radiation Physics, Wayne State University, Barbara Ann Karmanos Cancer Center, Detroit, Michigan.

Purpose: This study reviews our institutional error data and assesses the effectiveness of a policy implemented January 1, 2011, as a "no rushed treatment" initiative to avoid universal, large-scale replanning for all patients in the event that a treatment unit is down for ≤1 day.

Methods And Materials: Radiation error data between January 1, 2004, and December 31, 2014, were reviewed to determine absolute delivery error rates. Variables were compared (using a χ(2) or Fisher exact test) before and after the policy change, including planning versus delivery error status and differences in error type. We also evaluated time of day in relation to therapist shift change, deviation from scheduled time, and weekend treatment as predictors of error using a test of proportions or χ(2) test.

Results: Treatment delivery error rate over the entire period was 0.18% per fraction; the rate before intervention was 0.24% and after was 0.08%, P < .001. For the 5 years for which detailed records were available (2010-2014), 109 delivery errors were reported. Delivery error rate was 0.09%; before intervention 0.15% versus after, 0.08% (P = .005) and 94% were level 1 errors. Fifty-six percent were primary planning errors and 44% were primary delivery errors. Before intervention, large-scale replanning occurred 18 times/year versus 4.5/year after, with 21% versus 12% of errors directly attributable to large-scale replanning. Fourteen error reports specifically implicated a rushed environment as causal. There was no significant difference in error rate based on time of day (P = .631). Error rates were higher for weekend simulation and treatments, 1.3% versus 0.09% per fraction (P < .001).

Conclusions: Delivery error rates at our institution were similar compared with published series from other academic institutions. A significant improvement in delivery error rate was appreciated after implementation of a "no rushed treatment" initiative. A significantly higher error rate for weekend treatments was noted, warranting consideration of additional quality assurance measures.
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http://dx.doi.org/10.1016/j.prro.2015.08.004DOI Listing
September 2016

Limitations of the bowel bag contouring technique in the definitive treatment of cervical cancer.

Pract Radiat Oncol 2014 Jan-Feb;4(1):e15-20. Epub 2013 May 21.

Department of Radiation Oncology, Wayne State University, Barbara Ann Karmanos Cancer, Detroit, Michigan.

Purpose: Incidence of acute grade 3 and 4 small bowel toxicity in the definitive treatment of cervical cancer is approximately 15%. Given uncertainties in position of the bowel at time of treatment, techniques including the contouring of a bowel bag have been suggested. The purpose of this study is to describe interfraction variability in bowel location for the female pelvis with intact reproductive organs and to characterize the ability of the bowel bag technique, as described in the Radiation Therapy Oncology Group pelvic normal tissue contouring guidelines, to account for organ motion in this specific clinical setting.

Methods And Materials: Bowel position was assessed for 45 computed tomographic scans used in treatment planning for 9 consecutive cervical cancer patients. After a single operator contoured bowel loops, most superior, anterior, posterior, and inferior positions of bowel were recorded. Mixed effects models were used to assess significance of interfraction variability. Frequency of bowel loop migration outside of the bowel bag was then considered for each patient given all potential bowel bag volumes. Standardized scoring was used to determine additional margins that would be required to account for 95%, 90%, and 85% of significant bowel motion.

Results: Interfraction variability in the inferior-most bowel position was significant (P = .002). Median maximum variation in the inferior bowel position was 2.1 cm (range, 0.9 cm-4.8 cm). When applying the bowel bag technique, 100% of bowel motion was accounted for as the bowel translated laterally, anteriorly, posteriorly, and superiorly, though accounted for just 70.3% of motion in the inferior direction. A 4-cm inferior margin was required to account for 90% of motion in the inferior direction.

Conclusions: In the intact female pelvis, the bowel bag technique is successful in accounting for most interfraction variability in bowel position but underestimates inferior motion. Until an improved approach to predicting small bowel motion can be routinely implemented, a focus on decreasing dose to potential bowel space should be emphasized.
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http://dx.doi.org/10.1016/j.prro.2013.04.003DOI Listing
January 2015