Predicting Tumor Related Liver Failure in Unresectable Intrahepatic Cholangiocarcinoma Patients through the Development of an Imaging Based Deep Learning Neural Network Model

https://openworks.mdanderson.org/sumexp21/1008/thumbnail.jp

Identifying Biomarkers to Select Patients with Borderline Resectable and Locally Advanced Pancreatic Ductal Adenocarcinoma (BRPC, LAPC) for Radiotherapy (RT)

https://openworks.mdanderson.org/sumexp22/1036/thumbnail.jp

Mathematical Modeling of CA19-9 Normalization in Pancreatic Cancer Patients

https://openworks.mdanderson.org/sumexp21/1077/thumbnail.jp

The Role of Radiotherapy In the Management of Massive Intrahepatic Cholangiocarcinoma

https://openworks.mdanderson.org/sumexp21/1005/thumbnail.jp

Prediction of Liver Regeneration Post-Radiotherapy Using Machine Learning and Deep Learning Models

Department of Imaging Physics Radiation Oncology Interventional Radiologyhttps://openworks.mdanderson.org/sumexp22/1136/thumbnail.jp

Single-cell transcriptomics of intrahepatic cholangiocarcinoma (iCC) reveals novel tumor epithelial-stromal interactions

https://openworks.mdanderson.org/sumexp21/1093/thumbnail.jp

Identifying Differences in Spatial Transcriptomics Between Subtypes of Pancreatic Ductal Adenocarcinoma

https://openworks.mdanderson.org/sumexp22/1072/thumbnail.jp

Dose escalation for locally advanced pancreatic cancer: How high can we go?

Purpose: There are limited treatment options for locally advanced, unresectable pancreatic cancer (LAPC) and no likelihood of cure without surgery. Radiation offers an option for local control, but radiation dose has previously been limited by nearby bowel toxicity. Advances in on-board imaging and treatment planning may allow for dose escalation not previously feasible and improve local control. In preparation for development of clinical trials of dose escalation in LAPC, we undertook a dosimetric study to determine the maximum possible dose escalation while maintaining known normal tissue constraints. Methods and Materials: Twenty patients treated at our institution with either SBRT or dose-escalated hypofractionated IMRT (DE-IMRT) were re-planned using dose escalated SBRT to 70 Gy in 5 fractions to the GTV and 40 Gy in 5 fractions to the PTV. Standard accepted organ at risk (OAR) constraints were used for planning. Descriptive statistics were generated for homogeneity, conformality, OAR's and GTV/PTV. Results: Mean iGTV coverage by 50 Gy was 91% (±0.07%), by 60 Gy was 61.3% (±0.08%) and by 70 Gy was 24.4% (±0.05%). Maximum PTV coverage by 70 Gy was 33%. Maximum PTV coverage by 60 Gy was 77.5%. The following organ at risk (OAR) constraints were achieved for 90% of generated plans: Duodenum V20 < 30 cc, V30 < 3 cc, V35 < 1 cc; Small Bowel V20 < 15 cc, V30 < 1 cc, V35 < 0.1 cc; Stomach V20 < 20 cc, V30 < 2 cc, V35 < 1 cc. V40 < 0.5 cc was achieved for all OAR. Conclusions: Dose escalation to 60 Gy is dosimetrically feasible with adequate GTV coverage. The identified constraints for OAR's will be used in ongoing clinical trials

Treatment of primary rectal adenocarcinoma after prior pelvic radiation: The role of hyperfractionated accelerated reirradiation

Purpose: Previous studies have reported that hyperfractionated accelerated reirradiation can be used as part of multimodality treatment of locally recurrent rectal cancer with acceptable toxicity and promising outcomes. The purpose of this study was to evaluate the outcomes and toxicity of hyperfractionated accelerated reirradiation for patients with primary rectal adenocarcinoma and a history of prior pelvic radiation for other primary malignancies. Methods and materials: We identified 10 patients with a prior history of pelvic radiation for other primary malignancies who were treated with hyperfractionated accelerated reirradiation for primary rectal adenocarcinoma. Radiation therapy was administered with 1.5 Gy twice daily fractions to a total dose of 39 Gy to 45Gy. Results: The median follow-up time was 3.2 years (range, 0.6-9.0 years). Seven of 10 patients received surgery after reirradiation. The 3-year freedom-from-local-progression rate was 62% for all patients and 80% for patients who underwent surgery. The 3-year overall survival rate was 100%, with 3 deaths occurring at 4.7, 6.5, and 9.0 years after reirradiation. One patient had an acute Grade 3 toxicity of diarrhea, and 1 patient experienced a late Grade 3 toxicity of sacral insufficiency fracture. Conclusions: Hyperfractionated accelerated reirradiation was well tolerated with promising rates of freedom from local progression and overall survival in patients with primary rectal cancer with a history of prior pelvic radiation therapy. This approach, along with concurrent chemotherapy and surgery, appears to be a viable treatment strategy for this patient population