Papers by Jean-Claude Rwigema
International Journal of Radiation Oncology*Biology*Physics, 2011
ABSTRACT PURPOSE Radiation therapy has had a limited role in the treatment of many gastrointestin... more ABSTRACT PURPOSE Radiation therapy has had a limited role in the treatment of many gastrointestinal (GI) malignancies, including primary liver tumors and local or lymph node recurrences, due to the particular radiosensitivity of abdominal organs such as the small bowel and liver. Stereotactic body radiation therapy (SBRT) enables delivery of high doses of radiation to a tumor while limiting the dose received by critical surrounding organs. The purpose of this study was to evaluate the feasibility and efficacy of SBRT for primary and recurrent GI malignancies. METHOD AND MATERIALS Between February 2002 and February 2008, 46 lesions in 34 patients were treated with SBRT using a 6 MV linear accelerator (Novalis) and an infrared-based patient tracking system. The liver tumors included hepatocellular carcinoma (primary n = 7, recurrent n = 4) and cholangiocarcinoma (primary n = 3, recurrent n = 1). Additional sites treated were pancreas (n = 5), lymph nodes (n =10), and abdominopelvic recurrences (n = 4). SBRT was used as a boost treatment in 4 patients. The GTV size ranged from 1-11 cm (median 3.1cm). Median age was 67 years (range: 22-85 years). Dose per fraction ranged from 2.5-5Gy. A median total dose of 36 Gy (range: 8-50 Gy) was delivered in 2 to 16 fractions. Doses were prescribed to the 100% isodose line (IDL), with the 80% IDL covering the gross tumor volume plus a minimum margin of 7 mm. RESULTS The median follow-up was 7.7 months (range 0.2- 47.4 months). All patients completed treatment as prescribed. Thirty-one (91%) of the 34 patients were evaluable for response based on abdominal CT performed at a minimum of 2.5 months following completion of treatment. Response was evaluated using the Response Evaluation Criteria in Solid Tumors (RECIST) guidelines. The overall in-field local control rate was 77%. Complete response (CR) was seen in 5 patients, partial response (PR) in 6 patients, and stable disease (SD) in 13 patients. The mean and median survivals were 11.4 months and 7.7 months respectively. None of the patients developed grade 3 or higher toxicity. CONCLUSION In selected patients with primary or recurrent GI malignancies, SBRT provides excellent in-field control with minimal side effects
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Practical radiation oncology, Jan 27, 2015
The purpose of this study was to investigate the dosimetric feasibility of liver stereotactic bod... more The purpose of this study was to investigate the dosimetric feasibility of liver stereotactic body radiation therapy (SBRT) using a teletherapy system equipped with 3 rotating (60)Co sources (tri-(60)Co system) and a built-in magnetic resonance imager (MRI). We hypothesized tumor size and location would be predictive of favorable dosimetry with tri-(60)Co SBRT. The primary study population consisted of 11 patients treated with SBRT for malignant hepatic lesions whose linear accelerator (LINAC)-based SBRT plans met all mandatory Radiation Therapy Oncology Group (RTOG) 1112 organ-at-risk (OAR) constraints. The secondary study population included 5 additional patients whose plans did not meet the mandatory constraints. Patients received 36 to 60 Gy in 3 to 5 fractions. Tri-(60)Co system SBRT plans were planned with ViewRay system software. All patients in the primary study population had tri-(60)Co SBRT plans that passed all RTOG constraints, with similar planning target volume coverag...
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International Journal of Radiation Oncology*Biology*Physics, 2012
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International Journal of Radiation Oncology*Biology*Physics, 2012
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Journal of Cancer Research and Therapeutics, 2012
To analyze outcomes of reirradiation with stereotactic radiosurgery (SRS) for patients with brain... more To analyze outcomes of reirradiation with stereotactic radiosurgery (SRS) for patients with brain metastases from small cell lung cancer (SCLC). We reviewed the clinical outcomes of 27 patients with brain metastases from SCLC treated with CyberKnife® robotic radiosurgery (Accuray Inc., Sunnyvale, CA). Kaplan-Meier analyses were used to estimate local control (LC), intracranial control (IC), and overall survival (OS). The Graded Prognostic Assessment (GPA) prognostic index was determined with a Cox Regression analysis to model predictors of outcome. The median follow-up from SRS was 12 months (2-24 months). Nine patients (32.1%) had Graded Prognostic Assessment (GPA) scores 0-1 and 19 patients (67.9%) had GPA scores 1.5-2.5. 19 patients (70%) received whole brain radiation therapy (WBRT) and 8 patients (30%) received prophylactic cranial irradiation (PCI). The median SRS dose was 20.5 Gy (15-24 Gy) in 1 fraction. Actuarial LC at 6 months and 12 months was 76.5% and 76.5%, respectively. New metastases outside the treated area developed in 60% of assessable patients at a median 3.5 months; 78% received previous WBRT. The median OS was 3 months from SRS with actuarial 6-month and 12-month rates of 25% and 3.6%, respectively. On multivariate analysis no factors were associated with LC, IC, or OS. SRS for reirradiation of brain metastases from SCLC is safe and achieves local tumor control in the majority of patients. Despite SRS, these patients are at high risk of distant brain failure.
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American Journal of Clinical Oncology, 2013
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Current Cancer Therapy Reviews, 2015
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Medical dosimetry : official journal of the American Association of Medical Dosimetrists, Jan 2, 2016
We evaluated the feasibility of planning stereotactic body radiotherapy (SBRT) for large central ... more We evaluated the feasibility of planning stereotactic body radiotherapy (SBRT) for large central early-stage non-small cell lung cancer with a tri-cobalt-60 (tri-(60)Co) system equipped with real-time magnetic resonance imaging (MRI) guidance, as compared to linear accelerator (LINAC)-based SBRT. In all, 20 patients with large central early-stage non-small cell lung cancer who were treated between 2010 and 2015 with LINAC-based SBRT were replanned using a tri-(60)Co system for a prescription dose of 50Gy in 4 fractions. Doses to organs at risk were evaluated based on established MD Anderson constraints for central lung SBRT. R100 values were calculated as the total tissue volume receiving 100% of the dose (V100) divided by the planning target volume and compared to assess dose conformity. Dosimetric comparisons between LINAC-based and tri-(60)Co SBRT plans were performed using Student׳s t-test and Wilcoxon Ranks test. Blinded reviews by radiation oncologists were performed to assess...
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Practical radiation oncology, Jan 27, 2015
The purpose of this study was to investigate the dosimetric feasibility of liver stereotactic bod... more The purpose of this study was to investigate the dosimetric feasibility of liver stereotactic body radiation therapy (SBRT) using a teletherapy system equipped with 3 rotating (60)Co sources (tri-(60)Co system) and a built-in magnetic resonance imager (MRI). We hypothesized tumor size and location would be predictive of favorable dosimetry with tri-(60)Co SBRT. The primary study population consisted of 11 patients treated with SBRT for malignant hepatic lesions whose linear accelerator (LINAC)-based SBRT plans met all mandatory Radiation Therapy Oncology Group (RTOG) 1112 organ-at-risk (OAR) constraints. The secondary study population included 5 additional patients whose plans did not meet the mandatory constraints. Patients received 36 to 60 Gy in 3 to 5 fractions. Tri-(60)Co system SBRT plans were planned with ViewRay system software. All patients in the primary study population had tri-(60)Co SBRT plans that passed all RTOG constraints, with similar planning target volume coverag...
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In vivo (Athens, Greece)
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In vivo (Athens, Greece)
The effect of lung irradiation on reduction of lung stem cells and repopulation with bone marrow-... more The effect of lung irradiation on reduction of lung stem cells and repopulation with bone marrow-derived cells was measured. Expression of green fluorescent protein positive cells (GFP(+)) in the lungs of thoracic irradiated FVB/NHsd mice (Harlan Sprague Dawley, Indianapolis, IN, USA) was determined. This was compared to the repopulation of bone marrow-derived cells found in the lungs from naphthalene treated male FVB/NHsd mice and gangciclovir (GCV) treated FeVBN GFP(+) male marrow chimeric HSV-TK-CCSP. The level of mRNA for lung stem cell markers clara cell (CCSP), epithelium 1 (FOXJ1) and surfactant protein C (SP-C), and sorted single cells positive for marrow origin epithelial cells (GFP(+)CD45(-)) was measured. The expression of pulmonary stem cells as determined by PCR was reduced most by GCV, then naphthalene, and least by thoracic irradiation. Irradiation, like GCV, reduced mRNA expression of CCSP, CYP2F2, and FOXJ1, while naphthalene reduced that of CCSP and CYP2F2. Ultrast...
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In vivo (Athens, Greece)
The effect of lung irradiation on reduction of lung stem cells and repopulation with bone marrow-... more The effect of lung irradiation on reduction of lung stem cells and repopulation with bone marrow-derived cells was measured. Expression of green fluorescent protein positive cells (GFP(+)) in the lungs of thoracic irradiated FVB/NHsd mice (Harlan Sprague Dawley, Indianapolis, IN, USA) was determined. This was compared to the repopulation of bone marrow-derived cells found in the lungs from naphthalene treated male FVB/NHsd mice and gangciclovir (GCV) treated FeVBN GFP(+) male marrow chimeric HSV-TK-CCSP. The level of mRNA for lung stem cell markers clara cell (CCSP), epithelium 1 (FOXJ1) and surfactant protein C (SP-C), and sorted single cells positive for marrow origin epithelial cells (GFP(+)CD45(-)) was measured. The expression of pulmonary stem cells as determined by PCR was reduced most by GCV, then naphthalene, and least by thoracic irradiation. Irradiation, like GCV, reduced mRNA expression of CCSP, CYP2F2, and FOXJ1, while naphthalene reduced that of CCSP and CYP2F2. Ultrast...
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Radiation oncology (London, England), Jan 7, 2014
BackgroundGlioblastoma multiforme (GBM) frequently recurs at the same location after radiotherapy... more BackgroundGlioblastoma multiforme (GBM) frequently recurs at the same location after radiotherapy. Further dose escalation using conventional methods is limited by normal tissue tolerance. 4¿ non-coplanar radiotherapy has recently emerged as a new potential method to deliver highly conformal radiation dose using the C-arm linacs. We aim to study the feasibility of very substantial GBM dose escalation while maintaining normal tissue tolerance using 4¿.Methods11 GBM patients previously treated with volumetric modulated arc therapy (VMAT/RapidArc) on the NovalisTxTM platform to a prescription dose of either 59.4 Gy or 60 Gy were included. All patients were replanned with 30 non-coplanar beams using a 4¿ radiotherapy platform, which inverse optimizes both beam angles and fluence maps. Four different prescriptions were used including original prescription dose and PTV (4¿PTVPD), 100 Gy to the PTV and GTV (4¿PTV100Gy), 100 Gy to the GTV only while maintaining prescription dose to the rest...
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In vivo (Athens, Greece)
Antibiotic and antifungal agents used in supportive care regimens for bone marrow transplantation... more Antibiotic and antifungal agents used in supportive care regimens for bone marrow transplantation recipients contribute to a significant dose-modifying effect of otherwise lethal total body irradiation. To determine whether drugs used in supportive care and other commonly used antibiotics such as tetracycline function as radiation protectors or damage mitigators in vitro, 13 drugs were tested for radiation protection and radiation damage mitigation of 32D cl 3 hematopoietic progenitor cells in clonagenic survival curves in vitro. Antibiotic/Antifungal agents including cilastatin, amikacin, ceftazidine, vancomycin, tetracycline, doxycycline, ciprofloxacin, metronidazole, methacycline, minocycline, meclocycline, oxytetracycline and rolitetracycline were added in 1, 10, or 100 micromolar concentrations to murine interleukin-3-dependent hematopoietic progenitor cell line 32D cl 3 cells either before or after irradiation of 0 to 8 Gy. Control irradiated 32D cl 3 cells showed radiosensiti...
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Journal of Contemporary Brachytherapy, 2013
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Journal of Gastrointestinal Cancer, 2010
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Radiotherapy and Oncology, 2012
Stereotactic body radiotherapy (SBRT) has emerged as a promising salvage strategy for unresectabl... more Stereotactic body radiotherapy (SBRT) has emerged as a promising salvage strategy for unresectable, previously-irradiated recurrent squamous cell carcinomas of the head and neck (rSCCHN). Here-in, we report the first prospective evaluation of patient-reported quality-of-life (PR-QoL) following re-irradiation with SBRT±cetuximab for rSCCHN. From November 2004 to May 2011, 150 patients with unresectable, rSCCHN in a previously-irradiated field receiving >40 Gy were treated with SBRT to 40-50 Gy in 5 fractions ± concurrent cetuximab. PR-QoL was prospectively acquired using the University of Washington Quality-of-Life Revised (UW-QoL-R). Overall PR-QoL, health-related PR-QoL, and select domains commonly affected by re-irradiation progressively increase following an initial 1-month decline with statistically significant improvements noted in swallowing (p=0.025), speech (p=0.017), saliva (p=0.041), activity (p=0.032) and recreation (p=0.039). Especially for patients surviving >1-year, improved tumor control associated with SBRT re-irradiation may ameliorate decreased PR-QoL resulting from rSCCHN. These improvements in PR-QoL transcend all measured domains in a validated PR-QoL assessment tool independent of age, use of cetuximab, tumor volume, and interval since prior irradiation.
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Radiotherapy and Oncology, 2013
Few guidelines exist on stereotactic body radiation therapy (SBRT) treatment planning for recurre... more Few guidelines exist on stereotactic body radiation therapy (SBRT) treatment planning for recurrent head and neck cancer. We assessed the impact of retrospectively adding margins/automated PET volumes to the gross tumor volume (GTV) in patients with post-SBRT recurrences. We reviewed 89 patients with recurrent head and neck cancer treated with SBRT using no margin around the GTV. GTVs were recontoured with 1-5mm margins. PET-CT planned GTVs were also recontoured by adding PET-standardized uptake value (SUV)(3.5), SUV(4.5), SUV(40% max), and signal/background ratio (SBR) to the original GTV. We deformably registered recontoured GTVs to post-SBRT scans and assessed fraction of recurrence volume (RV) falling within the GTV, the "RV-GTV overlap." With non-PET-CT planning, median RV-GTV overlap increased from 11.7% to 48.2% using 5mm margins, and median GTV size increased by 41.8 cc (156%). With PET-CT planning, RV-GTV overlap increased from 45% to 93.6% using 5mm margins, and GTV size increased by 34.8 cc (140%). Adding SUV(3.5) and SBR increased RV-GTV overlap from 45% to 73.3% and 73.6%, with GTV size increases of 0.8 (3%) and 3.1 cc (11%), respectively. Recontouring increased recurrence coverage and also GTV size. Margins up to 5mm may reduce failures but could possibly increase toxicities. Automated PET contours may reduce near-miss failures with smaller increases in GTV size.
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International Journal of Radiation Oncology*Biology*Physics, 2012
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Papers by Jean-Claude Rwigema