Presentation by David J. Eschelman, MD, FSIR. Presented at the 2018 Eyes on a Cure: Patient & Caregiver Symposium, hosted by the Melanoma Research Foundation's CURE OM initiative.
This document discusses treatment options for metastatic uveal melanoma to the liver. It describes Jefferson's experience treating over 650 patients per year with metastatic uveal melanoma through a multidisciplinary team approach. Key treatments discussed include immunoembolization using GM-CSF, which has shown response rates of 32% and median overall survival of 14.4 months. Yttrium-90 microsphere radioembolization is also discussed as a salvage treatment for patients who have progressed on other therapies, with median overall survival of 10 months. The document emphasizes the importance of locoregional therapies for this disease given the lack of effective systemic therapies.
The document summarizes an update on the Emory Eye Tumor SPORE (Specialized Programs of Research Excellence), which aims to advance research on ocular melanoma through collaboration between basic and clinical scientists. It describes the origins and goals of the SPORE program and the Emory Eye Tumor SPORE in particular. The Emory SPORE has added conjunctival malignant melanoma to its research focus. It provides details on the principal investigators, projects, and scoring of the SPORE grant application to the NIH, noting strengths in significance, innovation, investigators, and environment.
Mohammaed Khan, MD, PhD, DABR, radiation oncologist at Winship Cancer Institute of Emory University presents Localized Treatment for Metastatic Disease at the 2016 CURE OM Patient & Caregiver Symposium.
This deals with novel molecular findings and their implications in Ewings sarcoma. The role of dose dense and dose intense chemotherapy and role of high dose chemotherapy. Additionally it also deals with survivor ship issues
The document discusses the role of radiation therapy in treating oligometastatic prostate cancer, noting that radiation can potentially achieve durable responses or even cure in some cases when metastases are limited. It reviews definitions of oligometastatic prostate cancer, the rationale for local and metastasis-directed radiation therapy, clinical evidence from studies on the use of external beam radiation therapy and stereotactic body radiation therapy to treat the primary tumor and metastases, and outcomes from these studies including local control rates, progression-free survival, and overall survival. The document concludes that radiation therapy plays an important role in the treatment of oligometastatic prostate cancer.
Journal club TACE vs SBRT in Hepatocellular carcinomaAnil Gupta
This study compared outcomes of stereotactic body radiation therapy (SBRT) and transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) with 1-2 tumors. SBRT resulted in superior local control compared to TACE. There was no significant difference in overall survival between the groups. Freedom from in-liver progression was significantly higher with SBRT. Grade 3 adverse events occurred in 13% with TACE and 8% with SBRT. Larger and prospective studies are still needed to validate these findings.
This document discusses treatment options for metastatic uveal melanoma to the liver. It describes Jefferson's experience treating over 650 patients per year with metastatic uveal melanoma through a multidisciplinary team approach. Key treatments discussed include immunoembolization using GM-CSF, which has shown response rates of 32% and median overall survival of 14.4 months. Yttrium-90 microsphere radioembolization is also discussed as a salvage treatment for patients who have progressed on other therapies, with median overall survival of 10 months. The document emphasizes the importance of locoregional therapies for this disease given the lack of effective systemic therapies.
The document summarizes an update on the Emory Eye Tumor SPORE (Specialized Programs of Research Excellence), which aims to advance research on ocular melanoma through collaboration between basic and clinical scientists. It describes the origins and goals of the SPORE program and the Emory Eye Tumor SPORE in particular. The Emory SPORE has added conjunctival malignant melanoma to its research focus. It provides details on the principal investigators, projects, and scoring of the SPORE grant application to the NIH, noting strengths in significance, innovation, investigators, and environment.
Mohammaed Khan, MD, PhD, DABR, radiation oncologist at Winship Cancer Institute of Emory University presents Localized Treatment for Metastatic Disease at the 2016 CURE OM Patient & Caregiver Symposium.
This deals with novel molecular findings and their implications in Ewings sarcoma. The role of dose dense and dose intense chemotherapy and role of high dose chemotherapy. Additionally it also deals with survivor ship issues
The document discusses the role of radiation therapy in treating oligometastatic prostate cancer, noting that radiation can potentially achieve durable responses or even cure in some cases when metastases are limited. It reviews definitions of oligometastatic prostate cancer, the rationale for local and metastasis-directed radiation therapy, clinical evidence from studies on the use of external beam radiation therapy and stereotactic body radiation therapy to treat the primary tumor and metastases, and outcomes from these studies including local control rates, progression-free survival, and overall survival. The document concludes that radiation therapy plays an important role in the treatment of oligometastatic prostate cancer.
Journal club TACE vs SBRT in Hepatocellular carcinomaAnil Gupta
This study compared outcomes of stereotactic body radiation therapy (SBRT) and transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) with 1-2 tumors. SBRT resulted in superior local control compared to TACE. There was no significant difference in overall survival between the groups. Freedom from in-liver progression was significantly higher with SBRT. Grade 3 adverse events occurred in 13% with TACE and 8% with SBRT. Larger and prospective studies are still needed to validate these findings.
How the role of radiotherapy has evaluated in pancreatic cancer. Now it has become indispensable for treatment in pancreatic cancer. Radiotherapy can be used in the form of EBRT/SBRT/IORT.
Stereotactic ablative radiotherapy (SABR) is a form of external beam radiotherapy that accurately delivers a high dose of irradiation in one or few fractions to extracranial tumors. Studies have shown SABR to be safe and effective for treating oligometastatic prostate cancer lesions, with low toxicity and good local tumor control. However, larger trials like STOMP and ORIOLE that compared SABR to surveillance found no reduction in metastatic progression, possibly due to limitations in accounting for disease aggressiveness between treatment groups. SABR remains a promising option for select oligometastatic prostate cancer patients.
The document discusses treatment strategies for hormone naive prostate cancer, including metastatic and non-metastatic disease. It summarizes several key trials comparing androgen deprivation therapy alone versus combinations with docetaxel or abiraterone/prednisone. For metastatic disease, combination therapy provided a survival benefit, especially for patients with high volume/high risk disease, but minimal benefit was seen for low volume/low risk disease. For non-metastatic PSA recurrence, early androgen deprivation provided no benefit over delayed treatment initiation.
Advances in immunotherapy, including checkpoint inhibitors targeting CTLA-4 and PD-1, have significantly improved outcomes for patients with metastatic melanoma. Combination immunotherapy with nivolumab and ipilimumab produces response rates over 60%, compared to around 40% for nivolumab alone and 11% for ipilimumab alone. Many patients receiving the combination immunotherapy continue to respond even after stopping treatment, achieving a state of treatment-free survival. While combination immunotherapy is more toxic than single-agent treatments, the toxicities are often manageable. Ongoing research continues to explore optimizing combination immunotherapy regimens to improve outcomes while reducing toxicity.
Personalized medicine in radiation oncology aims to individualize radiotherapy treatment through better imaging, genetics, and biomarkers. Newer radiotherapy techniques like IMRT and IGRT allow for more precise targeting of tumors while minimizing dose to normal tissues. Biomarkers can help characterize tumor hypoxia, proliferation, and a patient's inherent radiosensitivity at the genetic level. Radiogenomics research seeks genetic polymorphisms associated with radiation response and side effects. The goal is to predict treatment outcomes and tailor radiotherapy for each patient's unique biology and genetics.
On April 5, 2014 the MRF partnered with Seattle Cancer Care Alliance and Fred Hutchinson Cancer Research Center to provide a free educational event dedicated to melanoma patients and the people who support them.
Adjuvant Treatment of Pancreatic Cancer - August 2018Amr Sakr
This document summarizes the history and results of several major clinical trials evaluating different adjuvant treatment strategies for pancreatic cancer after surgical resection. It finds that adjuvant chemotherapy provides a survival benefit compared to observation alone. Specifically, gemcitabine alone and gemcitabine plus capecitabine were found to improve overall and disease-free survival compared to older regimens or observation. Most recently, a modified FOLFIRINOX regimen was shown to provide the longest median and 3-year survival compared to gemcitabine alone, establishing it as the new standard first-line adjuvant treatment for resectable pancreatic cancer when tolerability allows.
This document provides an overview of stereotactic body radiotherapy (SBRT). It begins with the history and introduction of SBRT, explaining how it differs from other radiotherapy modalities. It describes how SBRT works through its biological effects on tumor cells and blood vessels. Simulation, planning, patient immobilization and motion management are discussed. Common SBRT dose fractions and indications for various tumor sites are summarized, including lung, liver, spine, prostate and pancreas. Key challenges and dose constraints for each site are highlighted.
Lecture metastatic breast carcinoma to the spine (final version)Spiro Antoniades
This document discusses a case of metastatic breast cancer to the thoracic spine in a 74-year-old woman. She presented with mid-thoracic back pain and was later found to have a 5.5 cm breast mass, confirmed to be stage 4 breast cancer with metastases to the spine, ribs, and femur. The document provides historical background on cancer terminology and discusses treatment options and outcomes for spinal metastases, including surgery versus radiation. Prognostic scoring systems like Tokuhashi are mentioned. Overall, the summary discusses evaluation and management of a patient presenting with spinal metastases from breast cancer.
This document discusses pancreatic cancer and its treatment. It begins by stating that pancreatic cancer is most commonly diagnosed as locally advanced or metastatic. It then discusses the role of surgery, chemotherapy, and radiation therapy in the treatment of pancreatic cancer. It notes that the majority of surgically treated patients will have a recurrence, with a median survival of 15-20 months. The value of adjuvant and neoadjuvant therapy is debated. The document summarizes several clinical trials investigating chemotherapy and chemoradiation as adjuvant treatment after surgery. It also discusses neoadjuvant therapy and its potential advantages over adjuvant therapy. Emerging strategies discussed include induction chemotherapy followed by localized chemoradiation or second line therapy. The document concludes by describing modern radiation
This document provides information on the management of bone metastases. Some key points:
- Bone metastases are common in breast, prostate, and lung cancers and occur when cancer spreads from a primary site to the bone.
- Evaluation involves imaging like radiographs, CT, MRI, bone scans, and PET scans to determine the location and extent of bone lesions.
- Treatment objectives are to reduce pain, maintain mobility, and prevent fractures. Management includes bone-targeted agents like bisphosphonates, radiotherapy, surgery, and chemotherapy depending on the extent of disease.
- Single fraction radiotherapy of 8 Gy provides similar pain relief as longer fractionated regimens but with higher retreatment rates. Multifraction
This document discusses treatment approaches for bladder cancer including radiotherapy and cystectomy. It summarizes results from several studies comparing outcomes of radiotherapy versus cystectomy, and studies combining radiotherapy with chemotherapy. The key findings are:
1) Long-term survival rates after radiotherapy or cystectomy are comparable.
2) A study found neoadjuvant chemotherapy prior to radiotherapy improved 2-year loco-regional disease-free survival compared to radiotherapy alone.
3) Bladder preserving therapy can provide good long-term bladder function for patients who are not candidates for cystectomy.
This document presents a case scenario for choosing the best management strategy for a 73-year-old male patient with hormone-naïve metastatic prostate cancer. The patient has bone metastases, a PSA of 115 ng/ml, and biopsy-confirmed Grade 4 prostate adenocarcinoma. Treatment options discussed include ADT alone, ADT plus abiraterone, ADT plus docetaxel, and newer approvals like apalutamide and enzalutamide. Key trials comparing these options are summarized. Factors to consider in choosing a treatment include availability, tolerability, differential toxicity profiles, and efficacy based on the patient's individual risk profile. For this patient who has completed ADT plus doc
1. Radical cystectomy is the gold standard treatment for muscle-invasive bladder cancer with curative intent. Extended pelvic lymph node dissection provides better cancer control outcomes compared to limited dissection.
2. Post-operative complications are common after radical cystectomy but can be reduced at high-volume centers. Long-term oncologic outcomes depend on accurate staging and removal of all detectable cancer.
3. Nerve-sparing and organ-preserving techniques during radical cystectomy aim to improve urinary and sexual function, but long-term oncologic safety requires further study.
Positron emission tomography (PET) uses radioactive tracers like fluorodeoxyglucose (FDG) to detect cancer cells in the body and can help stage and monitor gastrointestinal malignancies, though it has limitations for small or early lesions; PET is useful for detecting metastasis and predicting response to chemotherapy but is not adequate alone for local tumor staging; While PET provides valuable information, it works best as part of a multimodality approach using other imaging techniques.
This document discusses locally advanced high risk prostate cancer and evolving treatment options. It provides an overview of risk stratification, guidelines for biopsy from the European Association of Urology, options for imaging with multiparametric MRI, and options for treatment including radical prostatectomy, radiation therapy, and hormonal therapy. New advances in radiation therapy include stereotactic body radiation therapy and hypofractionated regimens. Advances in hormonal therapy include gonadotropin-releasing hormone antagonists and oral options like relugolix. Neoadjuvant docetaxel chemotherapy is also discussed for high risk localized disease.
This document provides information on the evaluation and treatment of metastatic bone disease and spinal cord compression. It discusses:
1. Common sites of bone metastases from various primary cancers. Imaging tools to evaluate bone metastases like x-rays, bone scans, CT, PET, and MRI scans are described.
2. A multi-disciplinary treatment approach is recommended, including medical treatment, surgery, radiotherapy, radionuclides, chemotherapy, and hormonal therapy.
3. Details are provided on conventional and advanced radiation therapy techniques for treating bone metastases and spinal cord compression, including stereotactic radiosurgery. Overall pain relief rates, time to pain relief, and the benefits of combining surgery and radiation therapy are
This document summarizes information about immunotherapy for non-small cell lung cancer (NSCLC). It provides data on key clinical trials that evaluated immunotherapy drugs like nivolumab and pembrolizumab in previously treated NSCLC. It shows the efficacy results including overall survival benefits from these trials compared to chemotherapy. Long-term survival outcomes are also presented from pooled analyses of nivolumab trials with over 3 years of follow-up data.
Uveal melanoma commonly spreads to the liver. This document discusses uveal melanoma (MUM) that has metastasized to the liver. It provides background on MUM, noting that half of patients develop metastases, usually first appearing in the liver. It describes genetic risk factors for metastasis and different risk classifications. The document advocates for locoregional therapies for liver metastases since there are no effective systemic therapies. It presents evidence that liver-directed therapies may prolong survival more than systemic treatments or surveillance alone.
Management of ewings sarcoma & osteosarcomaPRARABDH95
EBRT can play an important role in the management of Ewing sarcoma and osteosarcoma.
For Ewing sarcoma, radiotherapy is commonly used pre-operatively to sterilize the tumor bed, post-operatively for positive or close margins, or definitively when surgery is not possible. Treatment planning aims to cover the pre-treatment tumor volume plus a 2-2.5cm margin using IMRT or 3D-CRT.
For osteosarcoma, radiotherapy can be used definitively for unresectable tumors or adjuvantly after surgery if margins were positive. A dose of 70.2Gy is typically prescribed for definitive cases and 64.8Gy for
How the role of radiotherapy has evaluated in pancreatic cancer. Now it has become indispensable for treatment in pancreatic cancer. Radiotherapy can be used in the form of EBRT/SBRT/IORT.
Stereotactic ablative radiotherapy (SABR) is a form of external beam radiotherapy that accurately delivers a high dose of irradiation in one or few fractions to extracranial tumors. Studies have shown SABR to be safe and effective for treating oligometastatic prostate cancer lesions, with low toxicity and good local tumor control. However, larger trials like STOMP and ORIOLE that compared SABR to surveillance found no reduction in metastatic progression, possibly due to limitations in accounting for disease aggressiveness between treatment groups. SABR remains a promising option for select oligometastatic prostate cancer patients.
The document discusses treatment strategies for hormone naive prostate cancer, including metastatic and non-metastatic disease. It summarizes several key trials comparing androgen deprivation therapy alone versus combinations with docetaxel or abiraterone/prednisone. For metastatic disease, combination therapy provided a survival benefit, especially for patients with high volume/high risk disease, but minimal benefit was seen for low volume/low risk disease. For non-metastatic PSA recurrence, early androgen deprivation provided no benefit over delayed treatment initiation.
Advances in immunotherapy, including checkpoint inhibitors targeting CTLA-4 and PD-1, have significantly improved outcomes for patients with metastatic melanoma. Combination immunotherapy with nivolumab and ipilimumab produces response rates over 60%, compared to around 40% for nivolumab alone and 11% for ipilimumab alone. Many patients receiving the combination immunotherapy continue to respond even after stopping treatment, achieving a state of treatment-free survival. While combination immunotherapy is more toxic than single-agent treatments, the toxicities are often manageable. Ongoing research continues to explore optimizing combination immunotherapy regimens to improve outcomes while reducing toxicity.
Personalized medicine in radiation oncology aims to individualize radiotherapy treatment through better imaging, genetics, and biomarkers. Newer radiotherapy techniques like IMRT and IGRT allow for more precise targeting of tumors while minimizing dose to normal tissues. Biomarkers can help characterize tumor hypoxia, proliferation, and a patient's inherent radiosensitivity at the genetic level. Radiogenomics research seeks genetic polymorphisms associated with radiation response and side effects. The goal is to predict treatment outcomes and tailor radiotherapy for each patient's unique biology and genetics.
On April 5, 2014 the MRF partnered with Seattle Cancer Care Alliance and Fred Hutchinson Cancer Research Center to provide a free educational event dedicated to melanoma patients and the people who support them.
Adjuvant Treatment of Pancreatic Cancer - August 2018Amr Sakr
This document summarizes the history and results of several major clinical trials evaluating different adjuvant treatment strategies for pancreatic cancer after surgical resection. It finds that adjuvant chemotherapy provides a survival benefit compared to observation alone. Specifically, gemcitabine alone and gemcitabine plus capecitabine were found to improve overall and disease-free survival compared to older regimens or observation. Most recently, a modified FOLFIRINOX regimen was shown to provide the longest median and 3-year survival compared to gemcitabine alone, establishing it as the new standard first-line adjuvant treatment for resectable pancreatic cancer when tolerability allows.
This document provides an overview of stereotactic body radiotherapy (SBRT). It begins with the history and introduction of SBRT, explaining how it differs from other radiotherapy modalities. It describes how SBRT works through its biological effects on tumor cells and blood vessels. Simulation, planning, patient immobilization and motion management are discussed. Common SBRT dose fractions and indications for various tumor sites are summarized, including lung, liver, spine, prostate and pancreas. Key challenges and dose constraints for each site are highlighted.
Lecture metastatic breast carcinoma to the spine (final version)Spiro Antoniades
This document discusses a case of metastatic breast cancer to the thoracic spine in a 74-year-old woman. She presented with mid-thoracic back pain and was later found to have a 5.5 cm breast mass, confirmed to be stage 4 breast cancer with metastases to the spine, ribs, and femur. The document provides historical background on cancer terminology and discusses treatment options and outcomes for spinal metastases, including surgery versus radiation. Prognostic scoring systems like Tokuhashi are mentioned. Overall, the summary discusses evaluation and management of a patient presenting with spinal metastases from breast cancer.
This document discusses pancreatic cancer and its treatment. It begins by stating that pancreatic cancer is most commonly diagnosed as locally advanced or metastatic. It then discusses the role of surgery, chemotherapy, and radiation therapy in the treatment of pancreatic cancer. It notes that the majority of surgically treated patients will have a recurrence, with a median survival of 15-20 months. The value of adjuvant and neoadjuvant therapy is debated. The document summarizes several clinical trials investigating chemotherapy and chemoradiation as adjuvant treatment after surgery. It also discusses neoadjuvant therapy and its potential advantages over adjuvant therapy. Emerging strategies discussed include induction chemotherapy followed by localized chemoradiation or second line therapy. The document concludes by describing modern radiation
This document provides information on the management of bone metastases. Some key points:
- Bone metastases are common in breast, prostate, and lung cancers and occur when cancer spreads from a primary site to the bone.
- Evaluation involves imaging like radiographs, CT, MRI, bone scans, and PET scans to determine the location and extent of bone lesions.
- Treatment objectives are to reduce pain, maintain mobility, and prevent fractures. Management includes bone-targeted agents like bisphosphonates, radiotherapy, surgery, and chemotherapy depending on the extent of disease.
- Single fraction radiotherapy of 8 Gy provides similar pain relief as longer fractionated regimens but with higher retreatment rates. Multifraction
This document discusses treatment approaches for bladder cancer including radiotherapy and cystectomy. It summarizes results from several studies comparing outcomes of radiotherapy versus cystectomy, and studies combining radiotherapy with chemotherapy. The key findings are:
1) Long-term survival rates after radiotherapy or cystectomy are comparable.
2) A study found neoadjuvant chemotherapy prior to radiotherapy improved 2-year loco-regional disease-free survival compared to radiotherapy alone.
3) Bladder preserving therapy can provide good long-term bladder function for patients who are not candidates for cystectomy.
This document presents a case scenario for choosing the best management strategy for a 73-year-old male patient with hormone-naïve metastatic prostate cancer. The patient has bone metastases, a PSA of 115 ng/ml, and biopsy-confirmed Grade 4 prostate adenocarcinoma. Treatment options discussed include ADT alone, ADT plus abiraterone, ADT plus docetaxel, and newer approvals like apalutamide and enzalutamide. Key trials comparing these options are summarized. Factors to consider in choosing a treatment include availability, tolerability, differential toxicity profiles, and efficacy based on the patient's individual risk profile. For this patient who has completed ADT plus doc
1. Radical cystectomy is the gold standard treatment for muscle-invasive bladder cancer with curative intent. Extended pelvic lymph node dissection provides better cancer control outcomes compared to limited dissection.
2. Post-operative complications are common after radical cystectomy but can be reduced at high-volume centers. Long-term oncologic outcomes depend on accurate staging and removal of all detectable cancer.
3. Nerve-sparing and organ-preserving techniques during radical cystectomy aim to improve urinary and sexual function, but long-term oncologic safety requires further study.
Positron emission tomography (PET) uses radioactive tracers like fluorodeoxyglucose (FDG) to detect cancer cells in the body and can help stage and monitor gastrointestinal malignancies, though it has limitations for small or early lesions; PET is useful for detecting metastasis and predicting response to chemotherapy but is not adequate alone for local tumor staging; While PET provides valuable information, it works best as part of a multimodality approach using other imaging techniques.
This document discusses locally advanced high risk prostate cancer and evolving treatment options. It provides an overview of risk stratification, guidelines for biopsy from the European Association of Urology, options for imaging with multiparametric MRI, and options for treatment including radical prostatectomy, radiation therapy, and hormonal therapy. New advances in radiation therapy include stereotactic body radiation therapy and hypofractionated regimens. Advances in hormonal therapy include gonadotropin-releasing hormone antagonists and oral options like relugolix. Neoadjuvant docetaxel chemotherapy is also discussed for high risk localized disease.
This document provides information on the evaluation and treatment of metastatic bone disease and spinal cord compression. It discusses:
1. Common sites of bone metastases from various primary cancers. Imaging tools to evaluate bone metastases like x-rays, bone scans, CT, PET, and MRI scans are described.
2. A multi-disciplinary treatment approach is recommended, including medical treatment, surgery, radiotherapy, radionuclides, chemotherapy, and hormonal therapy.
3. Details are provided on conventional and advanced radiation therapy techniques for treating bone metastases and spinal cord compression, including stereotactic radiosurgery. Overall pain relief rates, time to pain relief, and the benefits of combining surgery and radiation therapy are
This document summarizes information about immunotherapy for non-small cell lung cancer (NSCLC). It provides data on key clinical trials that evaluated immunotherapy drugs like nivolumab and pembrolizumab in previously treated NSCLC. It shows the efficacy results including overall survival benefits from these trials compared to chemotherapy. Long-term survival outcomes are also presented from pooled analyses of nivolumab trials with over 3 years of follow-up data.
Uveal melanoma commonly spreads to the liver. This document discusses uveal melanoma (MUM) that has metastasized to the liver. It provides background on MUM, noting that half of patients develop metastases, usually first appearing in the liver. It describes genetic risk factors for metastasis and different risk classifications. The document advocates for locoregional therapies for liver metastases since there are no effective systemic therapies. It presents evidence that liver-directed therapies may prolong survival more than systemic treatments or surveillance alone.
Management of ewings sarcoma & osteosarcomaPRARABDH95
EBRT can play an important role in the management of Ewing sarcoma and osteosarcoma.
For Ewing sarcoma, radiotherapy is commonly used pre-operatively to sterilize the tumor bed, post-operatively for positive or close margins, or definitively when surgery is not possible. Treatment planning aims to cover the pre-treatment tumor volume plus a 2-2.5cm margin using IMRT or 3D-CRT.
For osteosarcoma, radiotherapy can be used definitively for unresectable tumors or adjuvantly after surgery if margins were positive. A dose of 70.2Gy is typically prescribed for definitive cases and 64.8Gy for
Externalbeam rt in ews3.12.20 - frida yseminar-finallllPRARABDH95
1) Ewing sarcoma and osteosarcoma are rare bone cancers that typically affect children and young adults. Ewing sarcoma is the second most common primary bone cancer while osteosarcoma most commonly presents as a primary bone malignancy.
2) Both cancers are diagnosed through imaging, biopsy and staging workup. Management involves chemotherapy along with local therapy through surgery and/or radiation therapy.
3) Radiation therapy planning aims to adequately cover the tumor volume while sparing nearby organs at risk. Techniques such as 3D conformal radiation therapy and intensity modulated radiation therapy (IMRT) allow for improved dose distribution over conventional radiation.
This document discusses radiation therapy for non-small cell lung cancer. It begins with an overview of staging for lung cancer using the TNM system. For stage I/II disease, surgery is generally recommended when possible, along with radiation therapy or chemotherapy to reduce the risk of recurrence. For stage III disease, concurrent chemoradiation is often recommended. Stereotactic body radiation therapy is discussed as a technique for delivering high ablative doses of radiation to small tumors in a few fractions. The document concludes with details on the author's experience using SBRT to treat early stage lung cancers and metastases at their institution.
The document discusses prostate cancer including anatomy, staging, Gleason scoring, treatment options, and side effects. It covers imaging like CT and MRI scans to visualize the prostate and surrounding structures. Radiation treatments like IMRT, Tomotherapy, Cyberknife and seed implants are described in detail, noting their ability to precisely target the prostate gland and avoid nearby organs to minimize side effects. Typical radiation protocols are provided for low and higher risk prostate cancer cases.
MANAGEMENT 0F SEMINOMA CURRENT STATUS AND FUTURE DIRECTIONS.pdfadhilaamariyil
1) Seminoma is the most common germ cell tumor in young males. The standard treatment for stage I seminoma is either surveillance, radiotherapy, or chemotherapy.
2) For stage IIA/B seminoma, treatment options are radiotherapy or 3-4 cycles of chemotherapy. Radiotherapy provides better outcomes for stage IIA.
3) Advanced or metastatic seminoma (stage IIC/III) is treated with chemotherapy, with 5-year survival rates of 95% for good prognosis patients and 87% for intermediate prognosis.
This document discusses a trial investigating the role of local radiation therapy for metastatic prostate cancer. The main findings were:
1. No overall survival benefit was seen with radiation therapy, but survival improved in patients with low metastatic burden.
2. Failure-free survival improved with radiation therapy overall and in the low metastatic burden group.
3. Adverse effects from radiation therapy were modest.
The trial provides evidence that radiation therapy to the prostate improves outcomes for men with metastatic prostate cancer who have a low metastatic burden and does not negatively impact side effects.
This document discusses radiation safety and fetal dose from nuclear medicine procedures. It provides information on radiation dosing concepts like Bq, mCi, rad, gray, rem, and sieverts. It notes diagnostic nuclear medicine typically results in radiation doses of 100-330 mrem which is low risk. Doses above 100 mGy to the fetus are a reason to consider termination but below that level the risks are low. It emphasizes minimizing radiation exposure to pregnant women and fetuses as much as possible to avoid unnecessary health concerns and termination of pregnancies due to misperceptions of risk from low dose exposures.
This document discusses the management of oligometastatic breast cancer. It begins by providing historical context on the evolution of understanding and treatment of breast cancer. It then defines oligometastatic breast cancer as limited metastases that may be amenable to local treatment. The document reviews evidence that local ablative therapy combined with systemic therapy can improve outcomes for select patients. It also discusses several studies that provide randomized evidence supporting the use of stereotactic ablative radiotherapy to treat limited metastatic sites. In conclusion, the document emphasizes that careful patient selection is important to identify those most likely to benefit from localized treatment of oligometastatic disease.
This document provides an overview of palliative radiation therapy for cancer patients. It discusses the fundamentals of how radiation works and advances that have allowed it to more effectively treat cancer. It then focuses on how palliative radiation can effectively relieve symptoms from bone metastases, lung cancer, bleeding, and other cancers in 1-3 fractions rather than longer courses of treatment. Studies show short fractionation schedules provide pain relief comparable to longer schedules with fewer side effects and greater convenience. The document provides guidance on discussing palliative radiation options with radiation oncologists to help simplify the process for hospice patients.
Metastatic Tumors of the Spinal Column George Sapkas
This document discusses metastatic tumors of the spinal column, including their diagnosis and management. Some key points:
- The thoracolumbar region is the most common location for skeletal metastases, affecting around 70% of patients. The lumbar and sacral spine make up around 20% while the cervical spine is around 10%.
- Treatment options include medical therapies like chemotherapy, hormone therapy, biophosphonates and radiotherapy. Surgical options include decompression, debulking, or excision with or without stabilization. Factors like life expectancy, tumor type and location help determine the best treatment approach.
- Systems like Tokuhashi and Tomita aim to evaluate prognosis and help decide between palliative
How might basic research on low dose ionizing radiation influence future radi...Leishman Associates
This document discusses how basic research on low dose ionizing radiation could influence future radiation protection programs. It outlines the speaker's research interests in understanding the biological effects of exposure to low doses of radiation and how to translate this data to radiation risk assessments. It notes that the current paradigm for radiation risk extrapolates from high dose exposures, but low dose exposures are typically chronic and low dose rate, calling this approach into question. Non-targeted effects like bystander effects and genomic instability are discussed as important considerations. The complexity of communicating radiation risk when the scientific understanding remains uncertain is also addressed.
Nuclear medicine uses radioactive tracers and imaging techniques like PET and SPECT to produce functional images of the body. It has many clinical applications in areas like oncology, cardiology, and neurology. PET radiotracers like FDG are used to study glucose metabolism that can help identify cancer and other diseases. Nuclear medicine also has an important role in drug development by evaluating whether experimental drugs reach their targets and have the intended biological effect. It helps make drug development more efficient and cost-effective. However, expanding nuclear medicine in India faces challenges in training sufficient technical expertise across various disciplines needed to advance personalized medicine.
Radioactive ablation in thyriod cancersDR Saqib Shah
This document discusses radioactive iodine ablation in thyroid cancers. It provides background on the discovery of thyroid cancer, epidemiology showing it is the most common endocrine malignancy. It reviews the classification, causes, risk factors, evaluation and guidelines for treatment of differentiated thyroid cancers. It discusses the use, goals, effectiveness and factors impacting decision making for radioactive iodine remnant ablation after surgery. It also covers administration, patient preparation, dosimetry approaches and uptake differences between cancer and normal thyroid tissue.
The document discusses uveal melanoma (UM) in Ireland. It notes that Ireland has the highest incidence rate of UM in the world at 17.2 cases per million population. An Irish Ocular Oncology Service was established in 2010 to treat UM patients in Dublin, as previously most were sent to Liverpool, UK for treatment. OcuMel Irl was formed in 2017 by three founding members to provide information, support, and advocacy for UM patients and their families, as there was a lack of verbal or written information from the health service. OcuMel Irl's goals are to continue advocating for UM patients, create awareness, support research collaborations, and work towards standardizing surveillance and treatment pathways.
The document summarizes the development of OcuMel UK, a charity that supports patients with ocular melanoma in the UK. It discusses how OcuMel UK was established in 2009, becoming registered as a charity in 2014. It grew its online community and now supports hundreds of patients through information on its website, a helpline, conferences, and by advocating for more research on ocular melanoma. Its priorities include reducing diagnosis delays, improving support for patients and medical professionals, and encouraging research.
Ocumel Canada presented at the Eyes on a Cure Patient & Caregiver Symposium in Raleigh, North Carolina on April 7, 2019. Their presentation discussed the results of a patient survey by the Save Your Skin Foundation to better understand ocular melanoma in Canada, with key goals being to improve patient support, emphasize emotional support, and live their organizational values. They thanked CureOM for their inspiration and support.
Kenny and Sue Colbert share the story of their daughter, Kenan Colbert Koll, and how it led to the initial investigation of ocular melanoma diagnoses in Huntersville, NC.
This document outlines the mission and initiatives of CURE OM, an organization dedicated to supporting research for ocular melanoma. Their mission is to support research to develop effective treatments and a cure for ocular melanoma through collaborations. They provide various programs for patients including an annual symposium, webinars, support groups and educational materials. CURE OM also funds research through grants and scientific meetings to bring experts together to advance the field. Their goals include continuing to develop a patient registry and expanding education, support and funding for ocular melanoma research.
This document provides an overview of targeted therapy approaches for uveal melanoma given by Dr. Marlana Orloff at a patient and caregiver symposium. It defines targeted therapy as drugs that interfere with specific cancer-related molecules and discusses examples of successful targeted therapies in other cancers. For uveal melanoma, the document outlines molecular targets like GNAQ/GNA11 mutations and discusses several targeted drug trials that have shown limited efficacy to date. It also presents emerging areas of interest like compounds targeting the GNAQ/GNA11 mutations directly and epigenetic approaches that could provide indirect targeting of difficult to target genes. In closing, the currently available clinical trials investigating targeted therapies for uveal melanoma are listed
This document summarizes a presentation on uveal melanoma given by Dr. Miguel Materin at a patient symposium. Some key points from the presentation include:
- The Collaborative Ocular Melanoma Study (COMS) showed high diagnostic accuracy for medium and large uveal melanoma tumors and found that for medium tumors, brachytherapy was not worse than enucleation. For large tumors, previous radiation before enucleation provided no benefit.
- Cutaneous and uveal melanoma have different risk factors, presentations, and treatments which are outlined in the NCCN guidelines.
- Dr. Materin discussed ongoing collaborative research including the Collaborative O
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Overview of radiology basics, scan types and pros and cons of each, presented by David J. Eschelman, MD, FSIR, Professor of Radiology, Sidney Kimmel Medical College of Thomas Jefferson University, Co-Director of Interventional Radiology, Thomas Jefferson University Hospital.
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Understanding Scans 101
1. Radiology Basics
David J. Eschelman, M.D., FSIR
Professor of Radiology,
Sidney Kimmel Medical College of Thomas Jefferson University
Co-Director of Interventional Radiology,
Thomas Jefferson University Hospital
5. CT
• Pros:
– Available everywhere, consistent quality, best option
for whole-body evaluation
– Fast
• Cons:
– Less sensitive for small liver metastases than MRI
– Radiation (10-15 mSv)
7. Ultrasound
• Pros:
– Relatively inexpensive.
– No radiation.
– Can be very sensitive for small lesions
• Cons:
– Variable quality, depending on site and on patient.
– Not useful for whole-body surveillance.
9. MRI
• Pros:
– Most sensitive for liver mets.
– No radiation. No known harmful effects
• Cons:
– Does not cover entire body
– Can’t use in SOME people with pacers, anxiety, etc.
– Variability in how studies are done.
– Slow, noisy, easily affected by motion, etc.
19. PET - CT
• Pros
– Unique: Images metabolic activity
– May give information about efficacy of treatment
• Cons
– Not universally available
– Expensive
– Not sensitive for small metastases
– Takes about 2 hours
– Radiation (30 mSv)
20.
21. Surveillance Imaging
• Surveillance Scheduling
– No consensus: Varies from center to center
– Depends on tumor histology and genetics
• Jefferson protocol
– Low/intermediate risk: MRI q6-12 mo, CXR q12 mo
for 5 years
– High risk: MRI q3 mo + CT chest q 6 mo for 2 years,
then MRI q6 mo + CT q 12 mo for 3 years
22. NCCN Guidelines v1.2018
RISK OF DISTANT METASTASIS -
Low risk:
• Class 1A(x)
• Disomy 3
• Gain of chromosome 6p
• EIF1AX mutation
• T1 (AJCC) (See ST-1 and ST-2)
• Spindle cells
SYSTEMIC IMAGING BASED ON RISK STRATIFICATION
• Imaging to evaluate signs or symptoms as clinically indicated
• Consider surveillance imaging(y)
23. NCCN Guidelines v1.2018
RISK OF DISTANT METASTASIS -
Medium risk:
• Class 1B(x)
• SF3B1 mutation
• T2 and T3 (AJCC) (See ST-1 and ST-2)
• Mixed histology (spindle and epithelioid cells)
SYSTEMIC IMAGING BASED ON RISK STRATIFICATION
• Imaging to evaluate signs or symptoms as clinically indicated
• Consider surveillance imaging(y) every 6–12 months for
10 years, then as clinically indicated
24. NCCN Guidelines v1.2018
RISK OF DISTANT METASTASIS -
High risk:
• Class 2(x) • PRAME mutation
• Monosomy 3 • Epithelioid cells
• Gain of chromosome 8q • Extraocular extension
• BAP1 mutation • Ciliary body involvement
• T4 (AJCC) (See ST-1 and ST-2)
SYSTEMIC IMAGING BASED ON RISK STRATIFICATION
• Imaging to evaluate signs or symptoms as clinically indicated
• Consider surveillance imaging(y) every 3-6 months for 5 years,
then every 6-12 months for 10 years, then as clinically
indicated
25. NCCN Guidelines v1.2018
Surveillance:
The most frequent sites of metastasis are liver, lungs, skin/soft tissue,
and bones. At minimum, all patients should have contrast-enhanced MR
or ultrasound of the liver, with modality preference determined by
expertise at the treating institution. Additional imaging modalities may
include chest/abdominal/pelvic CT with contrast. However, screening
should limit radiation exposure whenever possible. Scans should be
performed with IV contrast unless contraindicated.
. . . . . but also add:
(y) Recognizing that there are limited options for systemic recurrence and
that regular imaging may cause patient anxiety, some patients may elect
to forgo surveillance imaging.
26. Background Radiation
Sources:
• Cosmic radiation
• Naturally occurring radioactive materials (radon, radium)
• Fallout
Exposure in US:
• Approximately 3 mSv/yr (low altitude)
• 30-50% higher in Denver
• Transatlantic flight – 0.08 mSv (2-3x higher over poles)
• 2x higher in US Capitol (8 hrs/day) – granite, marble
27. Radiation
Imaging Examples Effective Dose Range
(mSv)
Background Equivalent
Radiation Time
Radiation Risk Descriptora Probability of Cancer From
Imaging (%)
Probability of No Cancer
From Imaging (%)
CT scan or nuclear
medicine scan
1-10 Years Minor ∼0.05 ∼99.95
Abdominal radiograph 0.1-1 Months Minimal ∼0.005 ∼99.995
Chest radiograph or
mammogram
< 0.1-0.1 Days to weeks Negligible ∼0.0005 ∼99.9995
aDescriptors are from [78]
Dauer L et al. AJR 2011, 196
28. Brenner: DJ, Hall EJ: Computed Tomography — An Increasing Source of
Radiation Exposure. N Engl J Med 357:2277, November 29, 2007
29. Contrast Risks
• CT contrast and MR contrast are completely
unrelated materials
• Risk of reaction to CT contrast is very low
(0.15%)
• Risk of reaction to MR contrast is extremely low
(0.04%)
• Most reactions are minor
31. FDA Drug Safety Communication:
FDA warns that gadolinium-based
contrast agents (GBCAs) are
retained in the body; requires new
class warnings
May 22, 2017, updated December 19,2017
32. Gadolinium Contrast for MRI
• Per FDA:
Gadolinium retention has not been directly linked
to adverse health effects in patients with normal
kidney function, and we have concluded that the
benefit of all approved GBCAs continues to
outweigh any potential risks.
• Linear vs. macrocyclic
• Eovist is one of the lower linear “accumulators”
(lower dose administered, excreted by kidneys
and liver, more stable than other linear agents)
33. RECIST Criteria
Complete Response (CR)
Disappearance of liver lesions
Partial Response (PR)
> 30% decrease in the sum of the longest diameters
(“sum LD”) relative to baseline sum
Stable Disease (SD)
Absence of change which would qualify as
response or progression
Progression (PD)
> 20% increase in the sum LD in liver lesions OR
appearance of one or more new liver lesions