james oleson - Academia.edu (original) (raw)
Papers by james oleson
International Journal of Radiation Oncology*Biology*Physics, 1989
A Phase I study using deep regional hyperthermia (HT) with an annular phased array was conducted ... more A Phase I study using deep regional hyperthermia (HT) with an annular phased array was conducted in 14 U.S. medical centers from 1980 through 1986. There were 353 patients whose average age was 57 years. All patients had advanced recurrent or persistent tumors. Prior frequently complex, multimodality anti-cancer therapy was received by 71% of the patients. Gastrointestinal adenocarcinoma was present in 146 (41%) patients, genitourinary tumors in 86 (24%), soft tissue sarcomas in 46 (13%), malignant melanoma in 21 (6%) and 15% had other tumors. The sites treated included: pelvis 55%, abdomen 21%, liver 141, thorax 6%, and other sites 3%. All patients received deep regional HT with an average frequency of 55 MHz. A total of 1412 HT treatments was administered to these 353 patients with an aim to increase the temperature in the volume of interest to >42'C for 230 minutes. Thermal dose (TD in equivalent minutes at 42.5"C) was ~50 in 104 (29%), ~50 < 100 in 30 (ll%), 2100 in 26 (7%), and >200 in 34 (10%). The remaining 150 (42%) patients had TD = 0. In addition to HT, 260 (74%) received radiotherapy (RT). RT was given at 180 or 200 cGy daily with an average total dose of 33.4 Gy. A total of 42 (12%) patients were given chemotherapy (CI') with HT, and 15 (4%) CT + HT + RT/HT alone was given to 47 (13%) patients. Complete response (CR) was obtained in 35 (10%) and partial response (PR) in 59 (17%) patients. CR was 12% in patients who received RT, vs 2% in those who did not receive it, p = 0.003. Radintion dose was an important factor influencing response, p < 0.001. Thermal dose was not an important parameter influencing tumor response. A duration of CR ranged from 4 to 73 weeks with an average duration of 31 weeks and the median duration of 28 weeks. The overall 2-year survival was 13% with the median survival of 42 weeks. Patients with CR and PR had a 2 year survival of 41%, and a median survival of 71 weeks. This compared with 8% 2-year survival and 24 weeks median survival in patients who did not have CR or PR,p < 0.001. Of the patients presenting with significant pain, 62% had complete or partial pain relief. This treatment was well tolerated and there was no substantial toxicity recorded. Phase II prospective site specific trials in previously untreated patients are needed to further assess the value of HT-RT combination for patients with advanced locoregional tumors. Deep regional hyperthermia, Thermal dose.
International Journal of Radiation Oncology*Biology*Physics, 2016
To test whether oxygenation kinetics correlate with the likelihood for local tumor control after ... more To test whether oxygenation kinetics correlate with the likelihood for local tumor control after fractionated radiation therapy. We used diffuse reflectance spectroscopy to noninvasively measure tumor vascular oxygenation and total hemoglobin concentration associated with radiation therapy of 5 daily fractions (7.5, 9, or 13.5 Gy/d) in FaDu xenografts. Spectroscopy measurements were obtained immediately before each daily radiation fraction and during the week after radiation therapy. Oxygen saturation and total hemoglobin concentration were computed using an inverse Monte Carlo model. First, oxygenation kinetics during and after radiation therapy, but before tumor volumes changed, were associated with local tumor control. Locally controlled tumors exhibited significantly faster increases in oxygenation after radiation therapy (days 12-15) compared with tumors that recurred locally. Second, within the group of tumors that recurred, faster increases in oxygenation during radiation therapy (day 3-5 interval) were correlated with earlier recurrence times. An area of 0.74 under the receiver operating characteristic curve was achieved when classifying the local control tumors from all irradiated tumors using the oxygen kinetics with a logistic regression model. Third, the rate of increase in oxygenation was radiation dose dependent. Radiation doses ≤9.5 Gy/d did not initiate an increase in oxygenation, whereas 13.5 Gy/d triggered significant increases in oxygenation during and after radiation therapy. Additional confirmation is required in other tumor models, but these results suggest that monitoring tumor oxygenation kinetics could aid in the prediction of local tumor control after radiation therapy.
Int J Radiat Oncol Biol Phys, 1989
1. Int J Radiat Oncol Biol Phys. 1989 Mar;16(3):879. If we can't define the quality, can we ... more 1. Int J Radiat Oncol Biol Phys. 1989 Mar;16(3):879. If we can't define the quality, can we assure it? Oleson JR. PMID: 2921178 [PubMed - indexed for MEDLINE] Publication Types: Editorial. MeSH Terms: Humans; Hyperthermia ...
Int J Radiat Oncol Biol Phys, 1989
distributions with different source loadings can be recalculated in order to select the most suit... more distributions with different source loadings can be recalculated in order to select the most suitable one, with an overhead of only a few extra seconds (4 seconds per distribution on a 40 X 40 grid). Up to 20 points of interest may also be defined for dose monitoring. The treatment times are set initially to 60 seconds per channel and the dose to point A is calculated and asigned the 100% value. The final treatment dose can be prescribed to any isodose line, resulting in the renormalization of the treatment times and of the whole distribution (as well as of any points of interest which may have been defined). The system can be used for any kind of machine or applicator, high or low dose rate, rigid or flexible applicators, individual point sources or continues wire, with irradiation times adjustable either per individual channel or per individual source position. This system can be configured for the machines in use at the institution and the setup procedure is then reduced to a few single clicks of the pointing device, a mouse in this case, instead of having to go through a full sequence of general operations.
Cancer Research, Oct 1, 1984
International Journal of Hyperthermia, 1988
Experiments were performed to determine the dose-related effects of the intravenous administratio... more Experiments were performed to determine the dose-related effects of the intravenous administration of a vasodilator (hydralazine) on normal muscle blood perfusion during localized hyperthermia. Fourteen anaesthetized outbred canines were investigated, seven receiving the recommended dose level of 0.5 mg/kg and seven receiving one-quarter of that level. The changes in blood perfusion were estimated using two methods: calculation of an effective blood perfusion magnitude and the use of state and parameter estimation techniques. Both methods showed that the changes in blood perfusion induced by the hydralazine were significant, and that the differences between the results for the two drug doses were not significantly different. This suggests that low doses may be useful in humans, giving the same resultant blood perfusion increase but with a decreased patient risk relative to standard therapeutic doses of hydralazine. While the trends in the blood perfusion changes were the same for both calculation methods the effective perfusion method frequently yielded blood perfusion magnitudes significantly different from those obtained using the state and parameter estimation technique. The differences are postulated to be due to the fact that the effective perfusion values include conduction effects, thus overpredicting the amount of perfusion present. Thus, while the effective blood perfusion can be used as a qualitative indication of blood perfusion changes under certain conditions, we do not recommend its use as a quantitative measure of perfusion.
Measurements made on the interstitial microwave antennas used for hyperthermia cancer therapy ind... more Measurements made on the interstitial microwave antennas used for hyperthermia cancer therapy indicate that the heating patterns vary with the insertion depths (defined as the distance from the antenna tip to air-tissue interface). The antennas are made of thin coaxial cables with a radiation gap or gaps on the outer conductor. The antennas are inserted into small polypropylene catheters implanted in the tumour volume. This type of antenna may be simulated as an asymmetric dipole with one arm being the tip section consisting of the expanded extension of the inner conductor, and the other arm being the section of the outer conductor from the gap to the insertion point (air-tissue interface). We use four of the antennas to form a 2 cm x 2 cm array. The antennas are positioned on the corners of a 2 cm square. Measurements on both single antennas and multi-antenna arrays show that the maximum heating is not stationary with position along the antenna when the depth of insertion is changed. This paper investigates the theoretical prediction of the changes in heating patterns of interstitial microwave antennas at different insertion depths. Each of the antennas in the array is simulated as an asymmetric dipole. The SAR (specific absorption rate) is computed by using the insulated dipole theory. The temperature distribution in absence of perfusion is obtained through a thermal simulation routine to convert the SAR pattern into the temperature pattern. Excellent qualitative agreement is found between the theoretical heating pattern and the measured pattern in a non-perfused phantom on a 2 cm x 2 antenna array. Since the insertion depths of the interstitial antennas are different from patient to patient, it is recommended that simulation of the heating be done before treatments, to confirm the delivery of power to the target region.
International Journal of Hyperthermia, Nov 1, 1989
Assessing the efficacy of hyperthermia treatments involves three distinct problems: (1) adequatel... more Assessing the efficacy of hyperthermia treatments involves three distinct problems: (1) adequately sampling the spatial temperature distribution in a region; (2) defining (a set of) 'descriptors', numerical values which could be used in comparing distinct treatments; (3) testing whether the predictions of prognosis are statistically significant. This paper addresses the first two problems. We use simple assumptions about the tumour geometry and heating pattern to obtain convenient mathematical representations of a temperature distribution, which are then used in defining scalar descriptors such as weighted average temperature TV, and the fraction of tumour volume heated above a given temperature VT/V. Two extreme cases are discussed. In the first, tumour geometry plays the dominant role, and in the second the specific absorption rate (SAR) distribution is assumed to have the greatest influence on the temperature distribution.
Strahlentherapie Und Onkologie, Nov 1, 1989
Cancer Research, Oct 1, 1984
Physical analysis of electromagnetic and ultrasonic fields is useful to define systems capable of... more Physical analysis of electromagnetic and ultrasonic fields is useful to define systems capable of depositing power in "deep" tumors extending more than a few cm from the skin surface. Several recent analyses of electromagnetic field configurations for treating such tumors are reviewed here. Most electromag netic systems result in exposure of substantial normal tissue volumes or regions to unfocused power absorption, and safely achieving intratumoral temperature elevation to >42°relies in part upon higher blood flow rates existing in normal tissue than in tumor. Optimizing therapeutic approaches to deep tumors with devices producing regional power deposition may thus require improved knowledge and control of regional blood flow distributions, along with further development of energy sources appropriate for specific deep sites. Multiple electric dipole sources with separate phase and amplitude control appear to be the most general noninvasive electromagnetic solution at present for deep heating. In specific locations, focused ultrasound is also theoretically capable of producing advantageous power deposi tion at depth. perthermia (28, 34).
We adapted a small sodium iodide scintillation detector for rapid, in vivo localization of a lost... more We adapted a small sodium iodide scintillation detector for rapid, in vivo localization of a lost brachytherapy seed. Using the detector, we were able to locate and remove an Ir-192 seed that was not visible to the unaided eye.
Amer J Clin Oncol Canc Clin T, 1991
During a 6-year period, 53 patients with advanced tumors of the genitourinary tract were treated ... more During a 6-year period, 53 patients with advanced tumors of the genitourinary tract were treated in Phase I protocols with deep regional hyperthermia in combination with irradiation (83%) or in combination with chemotherapy (11%). Primary tumors included those of bladder in 22 patients (41%), prostate in 20 patients (37%), kidney in 9 patients (17%), and ureter testicle or adrenal in 3 patients (5%). The majority (77%) had prior definitive therapy and had experienced treatment failure, and 11% had clinically important distant metastases. Treatment consisted of deep regional hyperthermia (mean of 4 sessions). In addition, 44 patients (83%) received irradiation (mean dose 39.2 Gy). The 1- and 3-year actuarial survival was 60% and 56%, respectively. Patients with carcinoma of the prostate had a 1- and 3-year survival of 82%. Complete response was observed in 7 patients (13%), partial response in 8 (15%), and nominal response in 13 (25%). Complete and partial response correlated well with histology of the tumor (adenocarcinoma), radiation dose (greater than 50 Gy), primary site (prostate, kidney), and treatment (hyperthermia-radiotherapy combination), (p = 0.02). There was no such correlation between response and thermal dose (p = 0.13). The treatment tolerance was good in 79% of patients. Treatment toxicity was limited to acute side effects, including pain during hyperthermia (47%), tachycardia greater than 140/min (7%), and blister formation in the treated area (4%). Phase II studies in previously untreated patients with locally advanced tumors of bladder, prostate, and kidney are needed for evaluation of the role of deep regional hyperthermia in the management of these cancers.
International Journal of Radiation Oncology*Biology*Physics, 2015
Hypofractionated radiation therapy (RT) has promising long-term biochemical relapse-free survival... more Hypofractionated radiation therapy (RT) has promising long-term biochemical relapse-free survival (bRFS) with comparable toxicity for definitive treatment of prostate cancer. However, data reporting outcomes after adjuvant and salvage postprostatectomy hypofractionated RT are sparse. Therefore, we report the toxicity and clinical outcomes after postprostatectomy hypofractionated RT. From a prospectively maintained database, men receiving image guided hypofractionated intensity modulated RT (HIMRT) with 2.5-Gy fractions constituted our study population. Androgen deprivation therapy was used at the discretion of the radiation oncologist. Acute toxicities were graded according to the Common Terminology Criteria for Adverse Events version 4.0. Late toxicities were scored using the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer scale. Biochemical recurrence was defined as an increase of 0.1 in prostate-specific antigen (PSA) from posttreatment nadir or an increase in PSA despite treatment. The Kaplan-Meier method was used for the time-to-event outcomes. Between April 2008 and April 2012, 56 men received postoperative HIMRT. The median follow-up time was 48 months (range, 21-67 months). Thirty percent had pre-RT PSA &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.1; the median pre-RT detectable PSA was 0.32 ng/mL. The median RT dose was 65 Gy (range, 57.5-65 Gy). Ten patients received neoadjuvant and concurrent hormone therapy. Posttreatment acute urinary toxicity was limited. There was no acute grade 3 toxicity. Late genitourinary (GU) toxicity of any grade was noted in 52% of patients, 40% of whom had pre-RT urinary incontinence. The 4-year actuarial rate of late grade 3 GU toxicity (exclusively gross hematuria) was 28% (95% confidence interval [CI], 16%-41%). Most grade 3 GU toxicity resolved; only 7% had persistent grade ≥3 toxicity at the last follow-up visit. Fourteen patients experienced biochemical recurrence at a median of 20 months after radiation. The 4-year bPFS rate was 75% (95% CI, 63%-87%). The biochemical control in this series appears promising, although relatively short follow-up may lead to overestimation. Late grade 3 GU toxicity was higher than anticipated with hypofractionated radiation of 65 Gy to the prostate bed, although most resolved.
Int J Radiat Oncol Biol Phys, 1993
Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, 1992
International Journal of Radiation Oncology Biology Physics, 1993
The purpose of this work is to better define thermal parameters related to tumor response in supe... more The purpose of this work is to better define thermal parameters related to tumor response in superficial malignancies treated with combined hyperthermia and radiation therapy. Patients were randomized to receive one or two hyperthermia treatments per week with hyperthermia given during each week of irradiation. Hyperthermia was given for 60 min with treatments begun within 1 hr following irradiation. Power
International Journal of Radiation Oncology*Biology*Physics, 1989
A Phase I study using deep regional hyperthermia (HT) with an annular phased array was conducted ... more A Phase I study using deep regional hyperthermia (HT) with an annular phased array was conducted in 14 U.S. medical centers from 1980 through 1986. There were 353 patients whose average age was 57 years. All patients had advanced recurrent or persistent tumors. Prior frequently complex, multimodality anti-cancer therapy was received by 71% of the patients. Gastrointestinal adenocarcinoma was present in 146 (41%) patients, genitourinary tumors in 86 (24%), soft tissue sarcomas in 46 (13%), malignant melanoma in 21 (6%) and 15% had other tumors. The sites treated included: pelvis 55%, abdomen 21%, liver 141, thorax 6%, and other sites 3%. All patients received deep regional HT with an average frequency of 55 MHz. A total of 1412 HT treatments was administered to these 353 patients with an aim to increase the temperature in the volume of interest to >42'C for 230 minutes. Thermal dose (TD in equivalent minutes at 42.5"C) was ~50 in 104 (29%), ~50 < 100 in 30 (ll%), 2100 in 26 (7%), and >200 in 34 (10%). The remaining 150 (42%) patients had TD = 0. In addition to HT, 260 (74%) received radiotherapy (RT). RT was given at 180 or 200 cGy daily with an average total dose of 33.4 Gy. A total of 42 (12%) patients were given chemotherapy (CI') with HT, and 15 (4%) CT + HT + RT/HT alone was given to 47 (13%) patients. Complete response (CR) was obtained in 35 (10%) and partial response (PR) in 59 (17%) patients. CR was 12% in patients who received RT, vs 2% in those who did not receive it, p = 0.003. Radintion dose was an important factor influencing response, p < 0.001. Thermal dose was not an important parameter influencing tumor response. A duration of CR ranged from 4 to 73 weeks with an average duration of 31 weeks and the median duration of 28 weeks. The overall 2-year survival was 13% with the median survival of 42 weeks. Patients with CR and PR had a 2 year survival of 41%, and a median survival of 71 weeks. This compared with 8% 2-year survival and 24 weeks median survival in patients who did not have CR or PR,p < 0.001. Of the patients presenting with significant pain, 62% had complete or partial pain relief. This treatment was well tolerated and there was no substantial toxicity recorded. Phase II prospective site specific trials in previously untreated patients are needed to further assess the value of HT-RT combination for patients with advanced locoregional tumors. Deep regional hyperthermia, Thermal dose.
International Journal of Radiation Oncology*Biology*Physics, 2016
To test whether oxygenation kinetics correlate with the likelihood for local tumor control after ... more To test whether oxygenation kinetics correlate with the likelihood for local tumor control after fractionated radiation therapy. We used diffuse reflectance spectroscopy to noninvasively measure tumor vascular oxygenation and total hemoglobin concentration associated with radiation therapy of 5 daily fractions (7.5, 9, or 13.5 Gy/d) in FaDu xenografts. Spectroscopy measurements were obtained immediately before each daily radiation fraction and during the week after radiation therapy. Oxygen saturation and total hemoglobin concentration were computed using an inverse Monte Carlo model. First, oxygenation kinetics during and after radiation therapy, but before tumor volumes changed, were associated with local tumor control. Locally controlled tumors exhibited significantly faster increases in oxygenation after radiation therapy (days 12-15) compared with tumors that recurred locally. Second, within the group of tumors that recurred, faster increases in oxygenation during radiation therapy (day 3-5 interval) were correlated with earlier recurrence times. An area of 0.74 under the receiver operating characteristic curve was achieved when classifying the local control tumors from all irradiated tumors using the oxygen kinetics with a logistic regression model. Third, the rate of increase in oxygenation was radiation dose dependent. Radiation doses ≤9.5 Gy/d did not initiate an increase in oxygenation, whereas 13.5 Gy/d triggered significant increases in oxygenation during and after radiation therapy. Additional confirmation is required in other tumor models, but these results suggest that monitoring tumor oxygenation kinetics could aid in the prediction of local tumor control after radiation therapy.
Int J Radiat Oncol Biol Phys, 1989
1. Int J Radiat Oncol Biol Phys. 1989 Mar;16(3):879. If we can't define the quality, can we ... more 1. Int J Radiat Oncol Biol Phys. 1989 Mar;16(3):879. If we can't define the quality, can we assure it? Oleson JR. PMID: 2921178 [PubMed - indexed for MEDLINE] Publication Types: Editorial. MeSH Terms: Humans; Hyperthermia ...
Int J Radiat Oncol Biol Phys, 1989
distributions with different source loadings can be recalculated in order to select the most suit... more distributions with different source loadings can be recalculated in order to select the most suitable one, with an overhead of only a few extra seconds (4 seconds per distribution on a 40 X 40 grid). Up to 20 points of interest may also be defined for dose monitoring. The treatment times are set initially to 60 seconds per channel and the dose to point A is calculated and asigned the 100% value. The final treatment dose can be prescribed to any isodose line, resulting in the renormalization of the treatment times and of the whole distribution (as well as of any points of interest which may have been defined). The system can be used for any kind of machine or applicator, high or low dose rate, rigid or flexible applicators, individual point sources or continues wire, with irradiation times adjustable either per individual channel or per individual source position. This system can be configured for the machines in use at the institution and the setup procedure is then reduced to a few single clicks of the pointing device, a mouse in this case, instead of having to go through a full sequence of general operations.
Cancer Research, Oct 1, 1984
International Journal of Hyperthermia, 1988
Experiments were performed to determine the dose-related effects of the intravenous administratio... more Experiments were performed to determine the dose-related effects of the intravenous administration of a vasodilator (hydralazine) on normal muscle blood perfusion during localized hyperthermia. Fourteen anaesthetized outbred canines were investigated, seven receiving the recommended dose level of 0.5 mg/kg and seven receiving one-quarter of that level. The changes in blood perfusion were estimated using two methods: calculation of an effective blood perfusion magnitude and the use of state and parameter estimation techniques. Both methods showed that the changes in blood perfusion induced by the hydralazine were significant, and that the differences between the results for the two drug doses were not significantly different. This suggests that low doses may be useful in humans, giving the same resultant blood perfusion increase but with a decreased patient risk relative to standard therapeutic doses of hydralazine. While the trends in the blood perfusion changes were the same for both calculation methods the effective perfusion method frequently yielded blood perfusion magnitudes significantly different from those obtained using the state and parameter estimation technique. The differences are postulated to be due to the fact that the effective perfusion values include conduction effects, thus overpredicting the amount of perfusion present. Thus, while the effective blood perfusion can be used as a qualitative indication of blood perfusion changes under certain conditions, we do not recommend its use as a quantitative measure of perfusion.
Measurements made on the interstitial microwave antennas used for hyperthermia cancer therapy ind... more Measurements made on the interstitial microwave antennas used for hyperthermia cancer therapy indicate that the heating patterns vary with the insertion depths (defined as the distance from the antenna tip to air-tissue interface). The antennas are made of thin coaxial cables with a radiation gap or gaps on the outer conductor. The antennas are inserted into small polypropylene catheters implanted in the tumour volume. This type of antenna may be simulated as an asymmetric dipole with one arm being the tip section consisting of the expanded extension of the inner conductor, and the other arm being the section of the outer conductor from the gap to the insertion point (air-tissue interface). We use four of the antennas to form a 2 cm x 2 cm array. The antennas are positioned on the corners of a 2 cm square. Measurements on both single antennas and multi-antenna arrays show that the maximum heating is not stationary with position along the antenna when the depth of insertion is changed. This paper investigates the theoretical prediction of the changes in heating patterns of interstitial microwave antennas at different insertion depths. Each of the antennas in the array is simulated as an asymmetric dipole. The SAR (specific absorption rate) is computed by using the insulated dipole theory. The temperature distribution in absence of perfusion is obtained through a thermal simulation routine to convert the SAR pattern into the temperature pattern. Excellent qualitative agreement is found between the theoretical heating pattern and the measured pattern in a non-perfused phantom on a 2 cm x 2 antenna array. Since the insertion depths of the interstitial antennas are different from patient to patient, it is recommended that simulation of the heating be done before treatments, to confirm the delivery of power to the target region.
International Journal of Hyperthermia, Nov 1, 1989
Assessing the efficacy of hyperthermia treatments involves three distinct problems: (1) adequatel... more Assessing the efficacy of hyperthermia treatments involves three distinct problems: (1) adequately sampling the spatial temperature distribution in a region; (2) defining (a set of) 'descriptors', numerical values which could be used in comparing distinct treatments; (3) testing whether the predictions of prognosis are statistically significant. This paper addresses the first two problems. We use simple assumptions about the tumour geometry and heating pattern to obtain convenient mathematical representations of a temperature distribution, which are then used in defining scalar descriptors such as weighted average temperature TV, and the fraction of tumour volume heated above a given temperature VT/V. Two extreme cases are discussed. In the first, tumour geometry plays the dominant role, and in the second the specific absorption rate (SAR) distribution is assumed to have the greatest influence on the temperature distribution.
Strahlentherapie Und Onkologie, Nov 1, 1989
Cancer Research, Oct 1, 1984
Physical analysis of electromagnetic and ultrasonic fields is useful to define systems capable of... more Physical analysis of electromagnetic and ultrasonic fields is useful to define systems capable of depositing power in "deep" tumors extending more than a few cm from the skin surface. Several recent analyses of electromagnetic field configurations for treating such tumors are reviewed here. Most electromag netic systems result in exposure of substantial normal tissue volumes or regions to unfocused power absorption, and safely achieving intratumoral temperature elevation to >42°relies in part upon higher blood flow rates existing in normal tissue than in tumor. Optimizing therapeutic approaches to deep tumors with devices producing regional power deposition may thus require improved knowledge and control of regional blood flow distributions, along with further development of energy sources appropriate for specific deep sites. Multiple electric dipole sources with separate phase and amplitude control appear to be the most general noninvasive electromagnetic solution at present for deep heating. In specific locations, focused ultrasound is also theoretically capable of producing advantageous power deposi tion at depth. perthermia (28, 34).
We adapted a small sodium iodide scintillation detector for rapid, in vivo localization of a lost... more We adapted a small sodium iodide scintillation detector for rapid, in vivo localization of a lost brachytherapy seed. Using the detector, we were able to locate and remove an Ir-192 seed that was not visible to the unaided eye.
Amer J Clin Oncol Canc Clin T, 1991
During a 6-year period, 53 patients with advanced tumors of the genitourinary tract were treated ... more During a 6-year period, 53 patients with advanced tumors of the genitourinary tract were treated in Phase I protocols with deep regional hyperthermia in combination with irradiation (83%) or in combination with chemotherapy (11%). Primary tumors included those of bladder in 22 patients (41%), prostate in 20 patients (37%), kidney in 9 patients (17%), and ureter testicle or adrenal in 3 patients (5%). The majority (77%) had prior definitive therapy and had experienced treatment failure, and 11% had clinically important distant metastases. Treatment consisted of deep regional hyperthermia (mean of 4 sessions). In addition, 44 patients (83%) received irradiation (mean dose 39.2 Gy). The 1- and 3-year actuarial survival was 60% and 56%, respectively. Patients with carcinoma of the prostate had a 1- and 3-year survival of 82%. Complete response was observed in 7 patients (13%), partial response in 8 (15%), and nominal response in 13 (25%). Complete and partial response correlated well with histology of the tumor (adenocarcinoma), radiation dose (greater than 50 Gy), primary site (prostate, kidney), and treatment (hyperthermia-radiotherapy combination), (p = 0.02). There was no such correlation between response and thermal dose (p = 0.13). The treatment tolerance was good in 79% of patients. Treatment toxicity was limited to acute side effects, including pain during hyperthermia (47%), tachycardia greater than 140/min (7%), and blister formation in the treated area (4%). Phase II studies in previously untreated patients with locally advanced tumors of bladder, prostate, and kidney are needed for evaluation of the role of deep regional hyperthermia in the management of these cancers.
International Journal of Radiation Oncology*Biology*Physics, 2015
Hypofractionated radiation therapy (RT) has promising long-term biochemical relapse-free survival... more Hypofractionated radiation therapy (RT) has promising long-term biochemical relapse-free survival (bRFS) with comparable toxicity for definitive treatment of prostate cancer. However, data reporting outcomes after adjuvant and salvage postprostatectomy hypofractionated RT are sparse. Therefore, we report the toxicity and clinical outcomes after postprostatectomy hypofractionated RT. From a prospectively maintained database, men receiving image guided hypofractionated intensity modulated RT (HIMRT) with 2.5-Gy fractions constituted our study population. Androgen deprivation therapy was used at the discretion of the radiation oncologist. Acute toxicities were graded according to the Common Terminology Criteria for Adverse Events version 4.0. Late toxicities were scored using the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer scale. Biochemical recurrence was defined as an increase of 0.1 in prostate-specific antigen (PSA) from posttreatment nadir or an increase in PSA despite treatment. The Kaplan-Meier method was used for the time-to-event outcomes. Between April 2008 and April 2012, 56 men received postoperative HIMRT. The median follow-up time was 48 months (range, 21-67 months). Thirty percent had pre-RT PSA &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.1; the median pre-RT detectable PSA was 0.32 ng/mL. The median RT dose was 65 Gy (range, 57.5-65 Gy). Ten patients received neoadjuvant and concurrent hormone therapy. Posttreatment acute urinary toxicity was limited. There was no acute grade 3 toxicity. Late genitourinary (GU) toxicity of any grade was noted in 52% of patients, 40% of whom had pre-RT urinary incontinence. The 4-year actuarial rate of late grade 3 GU toxicity (exclusively gross hematuria) was 28% (95% confidence interval [CI], 16%-41%). Most grade 3 GU toxicity resolved; only 7% had persistent grade ≥3 toxicity at the last follow-up visit. Fourteen patients experienced biochemical recurrence at a median of 20 months after radiation. The 4-year bPFS rate was 75% (95% CI, 63%-87%). The biochemical control in this series appears promising, although relatively short follow-up may lead to overestimation. Late grade 3 GU toxicity was higher than anticipated with hypofractionated radiation of 65 Gy to the prostate bed, although most resolved.
Int J Radiat Oncol Biol Phys, 1993
Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, 1992
International Journal of Radiation Oncology Biology Physics, 1993
The purpose of this work is to better define thermal parameters related to tumor response in supe... more The purpose of this work is to better define thermal parameters related to tumor response in superficial malignancies treated with combined hyperthermia and radiation therapy. Patients were randomized to receive one or two hyperthermia treatments per week with hyperthermia given during each week of irradiation. Hyperthermia was given for 60 min with treatments begun within 1 hr following irradiation. Power