Browsing by Author "Munoz-Schuffenegger, Pablo"

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    Defining Minimum Treatment Parameters of Ablative Radiation Therapy in Patients With Hepatocellular Carcinoma: An Expert Consensus
    (2024) Yanagihara, Ted K.; Tepper, Joel E.; Moon, Andrew M.; Barry, Aisling; Molla, Meritxell; Seong, Jinsil; Torres, Ferran; Apisarnthanarax, Smith; Buckstein, Michael; Cardenes, Higinia; Chang, Daniel T.; Feng, Mary; Guha, Chandan; Hallemeier, Christopher L.; Hawkins, Maria A.; Hoyer, Morten; Iwata, Hiromitsu; Jabbour, Salma K.; Kachnic, Lisa; Kharofa, Jordan; Kim, Tae Hyun; Kirichenko, Alexander; Koay, Eugene J.; Makishima, Hirokazu; Mases, Joel; Meyer, Jeffrey J.; Munoz-Schuffenegger, Pablo; Owen, Dawn; Park, Hee Chul; Saez, Jordi; Sanford, Nina N.; Scorsetti, Marta; Smith, Grace L.; Wo, Jennifer Y.; Yoon, Sang Min; Lawrence, Theodore S.; Reig, Maria; Dawson, Laura A.
    Purpose: External beam radiation therapy (EBRT) is a highly effective treatment in select patients with hepatocellular carcinoma (HCC). However, the Barcelona Clinic Liver Cancer system does not recommend the use of EBRT in HCC due to a lack of sufficient evidence and intends to perform an individual patient level meta -analysis of ablative EBRT in this population. However, there are many types of EBRT described in the literature with no formal definition of what constitutes "ablative." Thus, we convened a group of international experts to provide consensus on the parameters that define ablative EBRT in HCC. Methods and Materials: Fundamental parameters related to dose, fractionation, radiobiology, target identification, and delivery technique were identified by a steering committee to generate 7 Key Criteria (KC) that would define ablative EBRT for HCC. Using a modified Delphi (mDelphi) method, experts in the use of EBRT in the treatment of HCC were surveyed. Respondents were given 30 days to respond in round 1 of the mDelphi and 14 days to respond in round 2. A threshold of >= 70% was used to define consensus for answers to each KC. Results: Of 40 invitations extended, 35 (88%) returned responses. In the first round, 3 of 7 KC reached consensus. In the second round, 100% returned responses and consensus was reached in 3 of the remaining 4 KC. The distribution of answers for one KC, which queried the a/b ratio of HCC, was such that consensus was not achieved. Based on this analysis, ablative EBRT for HCC was defined as a BED10 >= 80 Gy with daily imaging and multiphasic contrast used for target delineation. Treatment breaks (eg, for adaptive EBRT) are allowed, but the total treatment time should be <= 6 weeks. Equivalent dose when treating with protons should use a conversion factor of 1.1, but there is no single conversion factor for carbon ions. Conclusions: Using a mDelphi method assessing expert opinion, we provide the first consensus definition of ablative EBRT for HCC. Empirical data are required to define the a/b of HCC. (c) 2023 Published by Elsevier Inc. on behalf of American Society for Radiation Oncology.
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    Extensive Unpredictable Pancreas Cancer Inter-fraction Motion: A Case Report
    (2019) Lee, Sangjune L.; Velec, Michael; Munoz-Schuffenegger, Pablo; Stanescu, Teo; Dawson, Laura
    We present a case of locally advanced pancreatic cancer with duodenal invasion treated with consolidative chemoradiation, where extensive unpredictable interfraction motion was observed. Initially, two attempts were made to treat with volumetric modulated arc therapy technique. However, due to substantial interfractional motion of the pancreatic head mass relative to the regional nodal areas, the patient was eventually replanned and treated with a four-field box technique. This case highlights the difficulty in delivering conformal radiation to the pancreas and quantifies the movement of the target, the adjacent biliary stent, and regional nodes.
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    The Impact of Disease Progression on HealthRelated Quality of Life Outcomes in Patients With Oligometastatic Disease at 12 Months Post Stereotactic Body Radiation Therapy
    (2022) Barry, Aisling S.; Bezjak, Andrea; Helou, Joelle; Goodwin, Pamela; Kiss, Alex; Ringash, Jolie; Goody, Rebecca; Munoz-Schuffenegger, Pablo; Lindsay, Patricia E.; Pellizzari, Alana; Ponichtera, Jan; Liu, Zhi Hui; Wong, Rebecca
    Purpose: There is a paucity of published health-related quality of life (HRQOL) outcomes in patients with oligometastatic disease (OMD) who receive stereotactic body radiation therapy (SBRT) and no available data assessing the effect of disease progression post-SBRT on HRQOL in this patient population. Methods and Materials: Patients with OMD who received SBRT in a phase II single-arm research ethics board approved study were included. HRQOL was a secondary outcome. This study hypothesized that there is a different pattern of change from baseline HRQOL in patients with OMD treated with SBRT that have disease progression by 12 months (progressors) compared with those that do not progress by 12 months (nonprogressors), as measured by the European Organisation of Research and Treatment in Cancer Quality of Life Questionnaire Core 30. Results: A total of 107 patients were included in this analysis, 41 without progression and 66 with progression by 12 months; median time to progression was 7.7 (0.3-57) months. A statistically significant decline in the mean global health/quality of life (GHQOL) score (73 [SD, 21.8] to 67.2 [SD, 27.1]; P =.04) from baseline in the entire population at the 12-month follow-up was found. Mean GHQOL change score in nonprogressors was -0.8 and in progressors was -8.8 (P =.07). However, only progressors demonstrated a difference between baseline and 12-month mean GHQOL scores (71.2 vs 62.4; P =.01), which was both statistically and clinically significant (-8.8) in the range of small minimal clinically important difference. There was a higher proportion of patients who experienced a minimal clinically important difference deterioration in progressors compared Conclusions: Patients who progressed by 12 months did not have a statistical or clinically significant difference in mean GHQOL change score compared with nonprogressors. However, there were signals to suggest that patients who progressed by 12 months post-SBRT experienced a different pattern of change compared with nonprogressors, which was worse compared with baseline. (c) 2022 Elsevier Inc. All rights reserved.