Multiparametric MRI and [18F]fluorodeoxyglucose positron emission tomography imaging is a potential prognostic imaging biomarker in recurrent glioblastoma

Purpose/objectivesMultiparametric advanced MR and [18F]fluorodeoxyglucose (FDG)-positron emission tomography (PET) imaging may be important biomarkers for prognosis as well for distinguishing recurrent glioblastoma multiforme (GBM) from treatment-related changes.Methods/materialsWe retrospectively evaluated 30 patients treated with chemoradiation for GBM and underwent advanced MR and FDG-PET for confirmation of tumor progression. Multiparametric MRI and FDG-PET imaging metrics were evaluated for their association with 6-month overall (OS) and progression-free survival (PFS) based on pathological, radiographic, and clinical criteria.Results17 males and 13 females were treated between 2001 and 2014, and later underwent FDG-PET at suspected recurrence. Baseline FDG-PET and MRI imaging was obtained at a median of 7.5 months [interquartile range (IQR) 3.7–12.4] following completion of chemoradiation. Median follow-up after FDG-PET imaging was 10 months (IQR 7.2–13.0). Receiver-operator characteristic curve analysis identified that lesions characterized by a ratio of the SUVmax to the normal contralateral brain (SUVmax/NB index) >1.5 and mean apparent diffusion coefficient (ADC) value of ≤1,400 × 10−6 mm2/s correlated with worse 6-month OS and PFS. We defined three patient groups that predicted the probability of tumor progression: SUVmax/NB index >1.5 and ADC ≤1,400 × 10−6 mm2/s defined high-risk patients (n = 7), SUVmax/NB index ≤1.5 and ADC >1,400 × 10−6 mm2/s defined low-risk patients (n = 11), and intermediate-risk (n = 12) defined the remainder of the patients. Median OS following the time of the FDG-PET scan for the low, intermediate, and high-risk groups were 23.5, 10.5, and 3.8 months (p < 0.01). Median PFS were 10.0, 4.4, and 1.9 months (p = 0.03). Rates of progression at 6-months in the low, intermediate, and high-risk groups were 36, 67, and 86% (p = 0.04).ConclusionRecurrent GBM in the molecular era is associated with highly variable outcomes. Multiparametric MR and FDG-PET biomarkers may provide a clinically relevant, non-invasive and cost-effective method of predicting prognosis and improving clinical decision making in the treatment of patients with suspected tumor recurrence

ACR-ARS Practice Parameter on Informed Consent Radiation Oncology

OBJECTIVES: Consent is a communication process between the patient and a health care provider, in which both parties have the opportunity to ask questions and exchange information relevant to the patient\u27s diagnosis and treatment. The process of informed consent is designed to protect a patient\u27s autonomy in their medical decision-making in the context of an asymmetric relationship with the health care system. A proper consent process assures a patient\u27s individual autonomy, reduces the opportunity for abusive conduct or conflicts of interest, and raises trust levels among participants. This document was developed as an educational tool to facilitate these goals. METHODS: This practice parameter was produced according to the process described under the heading The Process for Developing ACR Practice Parameters and Technical Standards on the ACR website ( https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards ) by the Committee on Practice Parameters-Radiation Oncology of the ACR Commission on Radiation Oncology in collaboration with the ARS. Committee members were charged with reviewing the prior version of the informed consent practice parameter published in 2017 and recommending additions, modifications, or deletions. The committee met through remote access and subsequently through an online exchange to facilitate the development of the revised document. Focus was given on identifying new considerations and challenges with informed consent given the evolution of the practice of radiation oncology in part driven by the COVID-19 pandemic and other external factors. RESULTS: A review of the practice parameter published in 2017 confirmed the ongoing relevance of recommendations made at that time. In addition, the evolution of the practice of radiation oncology since the publication of the prior document resulted in the need for new topics to be addressed. These topics include remote consent either through telehealth or telephone and with the patient or their health care proxy. CONCLUSIONS: Informed consent is an essential process in the care of radiation oncology patients. This practice parameter serves as an educational tool designed to assist practitioners in optimizing this process for the benefit of all involved parties

ACR-ARS Practice Parameter for Communication: Radiation Oncology

This practice parameter was revised collaboratively by the American College of Radiology (ACR), and the American Radium Society (ARS). Timely, accurate, and effective communications are critical to quality and safety in contemporary medical practices. Radiation oncology incorporates the science and technology of complex, integrated treatment delivery and the art of providing care to individual patients. Through written physical and/or electronic reports and direct communication, radiation oncologists convey their knowledge and evaluation regarding patient care, clinical workup, and treatment provided to others in the management of the patient. Applicable practice parameters need to be revised periodically regarding medical record documentation for professional and technical components of services delivered. This practice parameter was developed and revised according to the process described under the heading "The Process for Developing ACR Practice Parameters and Technical Standards" on the ACR website (https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards) by the Committee on Practice Parameters-Radiation Oncology of the ACR Commission on Radiation Oncology in collaboration with the ARS. Both societies have reviewed and approved the document. 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. The radiation oncologist's participation in the multidisciplinary management of patients is reflected in timely, medically appropriate, and informative communication with patients, caregivers, referring physician, and other members of the health care team. The ACR-ARS Practice Parameter for Communication: Radiation Oncology is an educational tool designed to assist practitioners in providing appropriate communication regarding radiation oncology care for patients

Adaptive anatomical preservation optimal denoising for radiation therapy daily MRI

Low-field magnetic resonance imaging (MRI) has recently been integrated with radiation therapy systems to provide image guidance for daily cancer radiation treatments. The main benefit of the low-field strength is minimal electron return effects. The main disadvantage of low-field strength is increased image noise compared to diagnostic MRIs conducted at 1.5 T or higher. The increased image noise affects both the discernibility of soft tissues and the accuracy of further image processing tasks for both clinical and research applications, such as tumor tracking, feature analysis, image segmentation, and image registration. An innovative method, adaptive anatomical preservation optimal denoising (AAPOD), was developed for optimal image denoising, i. e., to maximally reduce noise while preserving the tissue boundaries. AAPOD employs a series of adaptive nonlocal mean (ANLM) denoising trials with increasing denoising filter strength (i. e., the block similarity filtering parameter in the ANLM algorithm), and then detects the tissue boundary losses on the differences of sequentially denoised images using a zero-crossing edge detection method. The optimal denoising filter strength per voxel is determined by identifying the denoising filter strength value at which boundary losses start to appear around the voxel. The final denoising result is generated by applying the ANLM denoising method with the optimal per-voxel denoising filter strengths. The experimental results demonstrated that AAPOD was capable of reducing noise adaptively and optimally while avoiding tissue boundary losses. AAPOD is useful for improving the quality of MRIs with low-contrast-to-noise ratios and could be applied to other medical imaging modalities, e.g., computed tomography. (C) 2017 Society of Photo-Optical Instrumentation Engineers (SPIE)AHRQ (Agency for Healthcare Research and Quality) [R01-HS022888]This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Multi-institutional analysis of vaginal brachytherapy without external beam radiation therapy for stage II endometrial cancer patients.

Purpose/Objective(s): Vaginal brachytherapy (VBT) and external beam radiotherapy (EBRT) improve locoregional recurrence for Stage I endometrial cancer, and risk factors for recurrence have been previously described. Limited data exist for the use of VBT without EBRT for Stage II patients. The aim of this study is to perform a multi-institutional analysis of Stage II endometrial cancer patients treated with VBT alone without EBRT. Purpose/Objective(s): We analyzed patients with stage II endometrial cancer treated with VBT without EBRT at five institutions. All patients had cervical stromal invasion concordant with 2009 FIGO staging. Univariate and multivariable frailty survival models that allow for clustering of patients within their study site were performed to assess clinicopathologic risk factors for recurrence and death. Results: One hundred seven patients met inclusion criteria with median follow-up of 57.9 (95% CI: 51.5-70.4) months. Median age was 61 years (range 42-89 years). Endometrioid, serous (USC), clear cell (CCC), and carcinosarcoma (CS) histologies comprised 83.2%, 11.2%, 4.7%, and 0.9%, respectively. Lymphovascular invasion (LVI) was present in 36.2% of patients. Pelvic and para-aortic node dissections were performed in 87.8% and 54.2%, respectively. Chemotherapy was delivered in 28.2% of patients. Seventy-seven patients had endometrioid type treated with VBT only without chemotherapy. The crude rates of vaginal failure, non-vaginal pelvic failure, and distant metastasis were 2.6%, 3.9%, and 6.5%, respectively. Thirty patients had USC/CCC/CS histologies and/or were treated with chemotherapy. These patients had vaginal failure, non-vaginal pelvic failure, and distant metastasis of 0%, 10.0%, and 20.0%, respectively. For the entire cohort, the 3-year estimate of vaginal failure, non-vaginal pelvic failure, and distant metastasis was 2.2%, 7.2%, and 7.4%, respectively. On UVA for distant metastasis, grade 3 (compared to grade 1) trended toward hazardous with HR 5.59 (95% CI: 0.83-37.55, P =.08). Three-year survival for the entire cohort was 85.9%. On UVA for survival, USC histology was the greatest predictor of death with HR 2.78 (95% CI: 1.06-7.14, P =.03) compared to endometrioid type. There was no difference in survival between CCC and endometrioid type (P = 0.18). Presence of LVI trended toward increased risk of death with HR 2.16 (95% CI: 0.97-4.17, P = 0.06). On UVA and MVA, receipt of chemotherapy trended toward hazard for death (95% CI: 0.12-1.05, P = 0.06). Conclusion: This is the largest report of Stage II endometrial cancer patients treated with VBT without EBRT. Patients with Stage II endometrial cancer treated with VBT without EBRT, with favorable clinicopathologic features, have low rates of vaginal and pelvic failures. VBT without EBRT may be a reasonable adjuvant treatment option for appropriately selected patients. Patients with higher risk histologies, including those treated with chemotherapy, have a higher risk of pelvic and distant failure and require additional study for improved adjuvant therapy