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The CT- and MRI-based brachytherapy tissue delineation seems adequate for evaluation of OAR and target tissues, although the shapes of HR-CTV and OAR do differ. When adopting volume-based prescription, these differences may lead to altered target dosing. The clinical impact of these differences seems to be small and may demonstrate that planning with CT, if combined with one MRI, may be sufficient.

International Journal of biology physics www.redjournal.org decrement. The results of the present study could help physicians better stratify patients for aggressive cardioprotective techniques. mortality with a subdistribution hazard ratio of 2.02 (95% CI 1. 23-3.34). No other outcome, including cardiac mortality for the entire cohort, showed a significant relationship with tumor laterality. Conclusions: For women with a history of cardiac disease, those with left-sided breast cancer who underwent radiation therapy had increased rates of PCI and a survival decrement if treated with PCI. The results of the present study could help cardiologists and radiation oncologists better stratify patients who need more aggressive cardioprotective techniques. Ó

Purpose/Objective(s): There have been over 19 randomized trials and three meta-analyses addressing the issue of concomitant chemoradiotherapy (CRT) in carcinoma cervix. The benefit was largely limited to early stage and in post-operative settings (FIGO IIIB accounting for \30%). In developing countries, advanced disease at presentation, poor nutrition including anemia, low tolerability and poor compliance, inadequate supportive therapy and financial constraints pose a major challenge for CRT practice. To evaluate the role of cisplatin based CRT in carcinoma cervix stage IIIB in our setting, we carried out this phase III randomized study. Materials/Methods: Patients with histologically proven FIGO IIIB carcinoma cervix (Sq Ca only) after obtaining written inform consent are randomized to radical radiation therapy (RT: standard arm) or CRT (study arm) with weekly cisplatin (40 mg/m 2 ). With a hypothesis of improvement in absolute survival by 10% with CRT, a-error of 0.05, power of detection of 80% and 10% patients more for attrition a total of 800 patients will be randomized and evaluated. Results: Until March 2010, 727 patients have been randomized. This is a report of first 631 patients treated until December 2008. Out of 631, 316 pts received RT while 315 received CRT. Mean (+ SD) overall treatment time for the whole group was 39 (+7) days. In CRT arm, 83% pts received $ 4 cycles of weekly CT while 17% did not complete planned CT. The treatment related acute grade II/III toxicities in the form of Gastrointestinal (14% vs. 17%), genitourinary (3% vs. 5%), anemia (1.5% vs. 7%), neutropenia (0.5% vs. 16%) and thrombocytopenia (1% vs. 10%) were higher in CRT and required active support more often than RT arm. There were two cisplatin related grade IV ototoxicity and two toxicity related deaths in CRT. With a median follow-up of 36 months (mean 39 months; 12-76), 129 (126 deaths) patients in RT while 110 (105 deaths) patients in CRT had failures. The patterns of failures were comparable. The DFS at 3 years is 52% in RT as compared to 60% in CRT arm (p = 0.051). Late rectal Grade II and III are 10 (2%) vs. 15 (3%) and 8 (0.6%) vs. 4 (0.8%) patients. Conclusions: CRT although feasible appears to be associated with higher incidence of hematological and gastrointestinal toxicities requiring active support. Disease outcome and late sequelae are comparable so far. Completion of accrual and final outcome analysis is essential to evaluate further the exact role of concurrent chemo-radiation in advance carcinoma cervix.Purpose/Objective(s): The ability to assess each tumor voxel with dynamic contrast-enhanced (DCE) MRI provides unique opportunity to characterize functional heterogeneity of tumors, including low-DCE tumor subregions that are likely hypoxic and therapy-resistant. However, quantitative assessment of these high-risk subvolumes has not been incorporated into outcome prediction. This study intended to functionally quantify the functional risk volume (FRV), the absolute subvolume characterized by low DCE, within th...

Background: Radiomics has been applied to predict recurrence in several disease sites, but current approaches are typically restricted to analyzing tumor features, neglecting non-tumor information in the rest of the body. The purpose of this work was to develop and validate a model incorporating non-tumor radiomics, including whole body features, to predict treatment outcomes in patients with previously untreated locoregionally advanced cervical cancer. Methods:We analyzed 127 cervical cancer patients treated definitively with chemoradiotherapy and intracavitary brachytherapy. All patients underwent pretreatment whole body 18 F-FDG PET/CT. To quantify effects due to the tumor itself, the gross tumor volume (GTV) was directly contoured on the PET/CT. Meanwhile, to quantify effects arising from the rest of the body, the planning target volume (PTV) was deformably registered from each planning CT to the PET/CT, and a semi-automated approach combining seed-growing and manual contour review generated whole body muscle, bone, and fat segmentations on each PET/CT. A total of 965 radiomic features were extracted for GTV, PTV, muscle, bone, and fat. 95 patients were used to train a Cox model of disease recurrence including both radiomic and clinical features (age, stage, tumor grade, histology, and baseline complete blood cell counts), using bagging and split-sample-validation for feature reduction and model selection. To further avoid overfitting, the resulting models were tested for generalization on the remaining 32 patients, by calculating a risk score based on Cox regression and evaluating the c-index (c-index > 0.5 indicates predictive power). Results: Optimal performance was seen in a Cox model including one clinical biomarker (whether or not a tumor was stage III-IVA), two GTV radiomic biomarkers (PET gray-level size-zone matrix small area low gray level emphasis and zone entropy), one PTV radiomic biomarker (major axis length) and one whole body radiomic biomarker (CT Bone root mean square). In particular, stratification into high-and lowrisk groups, based on the linear risk score from this Cox model, resulted in a hazard ratio [95% CI] of 0.019 [0.004, 0.082], an improvement over stratification based on clinical stage alone, which had a hazard ratio of 0.36 [0.16, 0.83]. Conclusions: Incorporating non-tumor radiomic biomarkers can improve the performance of prognostic models compared to using only clinical and tumor radiomic biomarkers. Future work should look to further test these models in larger, multiinstitutional cohorts.