University of Wisconsin–Madison
Kristin Bradley, MD headshot

Kristin Bradley, MD

Associate Professor

Department of Human Oncology

I am an associate professor in the Department of Human Oncology. In my clinical practice, I specialize in treating patients with gynecologic, hematologic and pediatric malignancies. I have a very busy brachytherapy practice. I work closely with gynecologic oncologists, hematologists, pediatric oncologists, radiologists and other specialists to best meet my individual patients’ needs.

In addition to my clinical practice, I am the Radiation Oncology Residency Program director. I also am involved with teaching medical students and undergraduates. Fellows from gynecologic oncology and pediatric oncology work with me on clinical rotations yearly.

I perform clinical research, primarily in the area of gynecologic radiation oncology, but I also have served as the principal investigator for a Children’s Oncology Group study on pediatric pontine gliomas.

Education

Residency, University of Wisconsin–Madison, Radiation Oncology (2004)

Transitional Year Intern, St. Luke’s Medical Center, Milwaukee, (2000)

MD, University of Wisconsin–Madison, Medicine (1999)

BS, University of Wisconsin–Madison, Molecular Biology (1994)

Academic Appointments

Associate Professor (CHS), Human Oncology (2010)

Assistant Professor (CHS), Human Oncology (2004)

Selected Honors and Awards

Madison Magazine Top Doctors (multiple years)

UW Health Patient Experience Physician Champion Award (2016)

UW Health Clinical Practice Excellence Award (2015)

Teacher of the Year Award, The Association of Residents in Radiation Oncology (2007)

Chief Resident, Radiation Oncology, University of Wisconsin (2004)

National Institutes of Health (NIH) Physician-Scientist Training Grant (2002–2003)

Medical School Class Co-President (1995–1996)

Medical Scholars Program, University of Wisconsin (1991–1994)

University of Wisconsin Full Academic Scholarship (1991–1994)

Boards, Advisory Committees and Professional Organizations

American Society for Therapeutic Radiology and Oncology (ASTRO) (2000–pres.)

American Society for Clinical Oncology (ASCO) (2000–pres.)

Children’s Oncology Group (2004–pres.)

American Brachytherapy Society (2006–pres.)

Central Nervous System Tumor Committee, Children’s Oncology Group (COG) (2006–pres.)

Radiation Oncology Committee, Children’s Oncology Group (COG) (2006–pres.)

Scientific Committee and Abstract Reviewer, Gynecologic Section, for Annual Meeting, American Society for Therapeutic Radiology and Oncology (ASTRO) (2008–pres.)

Radiological Society of North America (RSNA) (2007–pres.)

Member, National Comprehensive Cancer Network (NCCN) Cervical, Vulvar, and Uterine Cancers Panel (2016–pres.)

Scientific Program Committee, Annual Meeting of the American Brachytherapy Society (ABS) (2016–2017)

President, Wisconsin Society of Radiation Oncology (2010–2013)

Radiation Oncology Committee, Gynecologic Oncology Group (GOG) (2006–2012)

Item Writing Committee, Gynecologic Section, American Board of Radiology (ABR) – writing questions for use in future ABR Radiation Oncology board certification exams (2007–2012)

Scientific Committee and Abstract Reviewer, Radiation Oncology and Radiobiology Subcommittee, for Annual Meeting, Radiological Society of North America (RSNA) (2007–2012)

Vice President, Wisconsin Society of Radiation Oncology (2008–2010)

Secretary, Wisconsin Society of Radiation Oncology (2007–2008)

International Working Group for Image-Guided Gynecologic Brachytherapy (2006–2008)

Research Focus

Gynecologic Cancer, Hematologic Malignancies, Pediatric Malignancies

I participate in clinical research, evaluating ways to improve cancer care in patients with gynecologic, hematologic or pediatric cancers who are receiving radiation as a component of their treatment.

Novel Use of 0.35T ViewRay MRI-guidance for High Dose Rate Brachytherapy in the Treatment of Cervical Cancer

Image-guided adaptive brachytherapy for cervical cancer has resulted in improved outcomes and/or decreased toxicity rates for many cervical patients compared to prior 2D/fluoroscopic-based planning. We sought to evaluate the 0.35T MRI on our ViewRay system for brachytherapy and to compare dosimetry, time to treatment and image quality relative to diagnostic MRI and CT.

Two graphs comparing 0.35T MRI on ViewRay system for brachytherapy and to compare dosimetry, time to treatment and image quality relative to diagnostic MRI and CT.

We presented our findings in abstract form at ASTRO 2017 and manuscript has been submitted.

Severe Late Toxicities Following Concomitant Chemoradiotherapy Compared to Radiotherapy Alone in Cervical Cancer: An Inter-Era Analysis

We sought to compare rates of severe late toxicities following concomitant chemoradiotherapy and radiotherapy alone for cervical cancer. We found that compared to radiotherapy alone, concomitant chemoradiotherapy is associated with higher rates of severe vaginal and skeletal late toxicities.

 

Locations

University Hospitals and Clinics

I am the Radiation Oncology Residency Program director. I also am involved with teaching medical students and undergraduates. Fellows from gynecologic oncology and pediatric oncology work with me on clinical rotations yearly.

 

Radiation Oncology Residency Page
  • In Reply to Lin and Golden. Int J Radiat Oncol Biol Phys
    Jang S, Rosenberg SA, Bradley KA, Kimple RJ
    2018 Nov 01; 102 (3): 672
  • Combining brachytherapy and immunotherapy to achieve in situ tumor vaccination: A review of cooperative mechanisms and clinical opportunities. Brachytherapy
    Patel RB, Baniel CC, Sriramaneni RN, Bradley K, Markovina S, Morris ZS
    2018 Aug 02; :
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      As immunotherapies continue to emerge as a standard component of treatment for a variety of cancers, the imperative for testing these in combination with other standard cancer therapies grows. Radiation therapy may be a particularly well-suited partner for many immunotherapies. By modulating immune tolerance and functional immunogenicity at a targeted tumor site, radiation therapy may serve as a method of in situ tumor vaccination. In situ tumor vaccination is a therapeutic strategy that seeks to convert a patient's own tumor into a nidus for enhanced presentation of tumor-specific antigens in a way that will stimulate and diversify an antitumor T cell response. The mechanisms whereby radiation may impact immunotherapy are diverse and include its capacity to simultaneously elicit local inflammation, temporary local depletion of suppressive lymphocyte lineages, enhanced tumor cell susceptibility to immune response, and immunogenic tumor cell death. Emerging data suggest that each of these mechanisms may display a distinct dose-response profile, making it challenging to maximize each of these effects using external beam radiation. Conversely, the highly heterogenous and conformal dose distribution achieved with brachytherapy may be optimal for enhancing the immunogenic capacity of radiation at a tumor site while minimizing off-target antagonistic effects on peripheral immune cells. Here, we review the immunogenic effects of radiation, summarize the clinical rationale and data supporting the use of radiation together with immunotherapies, and discuss the rationale and urgent need for further preclinical and clinical investigation specifically of brachytherapy in combination with immunotherapies. Harnessing these immunomodulatory effects of brachytherapy may offer solutions to overcome obstacles to the efficacy of immunotherapies in immunologically "cold" tumors while potentiating greater response in the context of immunologically "hot" tumors.

      View details for PubMedID 30078541
  • Beyond 'charting outcomes' in the radiation oncology match: analysis of self-reported applicant data. Med Educ Online
    Jang S, Rosenberg SA, Hullett C, Bradley KA, Kimple RJ
    2018 Dec; 23 (1): 1489691
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      The Charting Outcomes resource is useful in gauging an applicant's competiveness for a given specialty. However, many variables are not reported in Charting Outcomes that may influence an applicant's ability to match. A significant proportion of applicants record their experiences in an anonymous, self-reported applicant spreadsheet. We analyzed factors associated with a successful match using this dataset to test the hypothesis that research productivity and high academic performance correlates with success rates. A retrospective analysis of "RadOnc Interview Spreadsheet" for the 2015, 2016, and 2017 radiation oncology match was performed. Data were accessed via studentdoctor.net. Board scores, research characteristics, Sub-I participation, and interview invitation rates were available. Mann-Whitney U, Kruskal-Wallis, and chi-square tests were used for statistical analysis. When possible, results were compared to those reported in the National Residency Match Program's "Charting Outcomes" report. A total of 158 applicants were examined for the applicant characteristics. Applicants applied to a median of 61 programs and received a median of 14 interviews. The mean step 1 score was 248 (range: 198 to 272) and most were in the highest grade point average quartile (68.3%). 21.7% participated in additional research year(s), and 19% obtained a PhD. The majority of applicants took three radiation oncology electives (48.7%). On multivariate analysis, alpha-omega-alpha (AOA) honors society status (p=0.033), participating in a research year (p=0.001) and number of journal publications (p=0.047) significantly correlated with higher interview invitation rates. In summary, this study identifies important considerations for radiation oncology applicants that have not been previously reported, such as induction into AOA and number of journal publications.

      View details for PubMedID 29943670
  • A New Era of Image Guidance with Magnetic Resonance-guided Radiation Therapy for Abdominal and Thoracic Malignancies. Cureus
    Mittauer K, Paliwal B, Hill P, Bayouth JE, Geurts MW, Baschnagel AM, Bradley KA, Harari PM, Rosenberg S, Brower JV, Wojcieszynski AP, Hullett C, Bayliss RA, Labby ZE, Bassetti MF
    2018 Apr 04; 10 (4): e2422
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      Magnetic resonance-guided radiation therapy (MRgRT) offers advantages for image guidance for radiotherapy treatments as compared to conventional computed tomography (CT)-based modalities. The superior soft tissue contrast of magnetic resonance (MR) enables an improved visualization of the gross tumor and adjacent normal tissues in the treatment of abdominal and thoracic malignancies. Online adaptive capabilities, coupled with advanced motion management of real-time tracking of the tumor, directly allow for high-precision inter-/intrafraction localization. The primary aim of this case series is to describe MR-based interventions for localizing targets not well-visualized with conventional image-guided technologies. The abdominal and thoracic sites of the lung, kidney, liver, and gastric targets are described to illustrate the technological advancement of MR-guidance in radiotherapy.

      View details for PubMedID 29872602
  • Novel use of ViewRay MRI guidance for high-dose-rate brachytherapy in the treatment of cervical cancer. Brachytherapy
    Ko HC, Huang JY, Miller JR, Das RK, Wallace CR, De Costa AA, Francis DM, Straub MR, Anderson BM, Bradley KA
    2018 May 14; :
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      PURPOSE: To characterize image quality and feasibility of using ViewRay MRI (VR)-guided brachytherapy planning for cervical cancer.

      METHODS AND MATERIALS: Cervical cancer patients receiving intracavitary brachytherapy with tandem and ovoids, planned using 0.35T VR MRI at our institution, were included in this series. The high-risk clinical target volume (HR-CTV), visible gross tumor volume, bladder, sigmoid, bowel, and rectum contours for each fraction of brachytherapy were evaluated for dosimetric parameters. Typically, five brachytherapy treatments were planned using the T2 sequence on diagnostic MRI for the first and third fractions, and a noncontrast true fast imaging with steady-state precession sequence on VR or CT scan for the remaining fractions. Most patients received 5.5 Gy × 5 fractions using high-dose-rate Ir-192 following 45 Gy of whole-pelvis radiotherapy. The plan was initiated at 5.5 Gy to point A and subsequently optimized and prescribed to the HR-CTV. The goal equivalent dose in 2 Gy fractions for the combined external beam and brachytherapy dose was 85 Gy. Soft-tissue visualization using contrast-to-noise ratios to distinguish normal tissues from tumor at their interface was compared between diagnostic MRI, CT, and VR.

      RESULTS: One hundred and forty-two fractions of intracavitary brachytherapy were performed from April 2015 to January 2017 on 29 cervical cancer patients, ranging from stages IB1 to IVA. The median HR-CTV was 27.78 cc, with median D90 HR-CTV of 6.1 Gy. The median time from instrument placement to start of treatment using VR was 65 min (scan time 2 min), compared to 105 min using diagnostic MRI (scan time 11 min) (t-test, p < 0.01). The contrast-to-noise ratio of tumor to cervix in both diagnostic MRI and VR had significantly higher values compared to CT (ANOVA and t-tests, p < 0.01).

      CONCLUSIONS: We report the first clinical use of VR-guided brachytherapy. Time to treatment using this approach was shorter compared to diagnostic MRI. VR also provided significant advantage in visualizing the tumor and cervix compared to CT. This presents a feasible and reliable manner to image and plan gynecologic brachytherapy.

      View details for PubMedID 29773331
  • In Reply to Hamstra. Int J Radiat Oncol Biol Phys
    Rosenberg SA, Bradley KA, Kimple RJ
    2018 Apr 01; 100 (5): 1293-1294
  • The role of radiation therapy in the treatment of Stage II endometrial cancer: A large database study. Brachytherapy
    Wojcieszynski AP, Hullett CR, Medlin EE, Taunk NK, Shabason JE, Brower JV, Chen S, Bekelman JE, Barroilhet LM, Bradley KA
    2018 Apr 21; :
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      PURPOSE: The optimum adjuvant treatment for Stage II endometrial cancer patients is unknown. External beam radiation therapy (EBRT) is often considered the standard of care; however, retrospective series suggest that brachytherapy (BT) alone may be sufficient for selected patients. As randomized data are lacking, we used a large database to explore this question.

      METHODS AND MATERIALS: The National Cancer Data Base was queried for patients with pathologic International Federation of Gynecology and Obstetrics Stage II disease. Demographic, clinic-pathologic, and treatment details were compared between patients. Multivariable analysis was used to determine factors associated with receiving radiation therapy (RT). To account for imbalances between groups, a matched-pair analysis was completed.

      RESULTS: Eight thousand one hundred forty patients were included. RT was associated with overall survival (OS), with EBRT (hazard ratio [HR] 0.64), BT (HR 0.47), and combination (HR 0.54) showing increased OS on univariate analysis. Facility, urban location, diagnosis year, hysterectomy type, and chemotherapy did not reach significance. On multivariate analysis, RT was associated with OS, with EBRT (HR 0.69), BT (HR 0.60), and combination (HR 0.54) showing benefit. Using propensity-score matching, RT continued to show improved OS regardless of type: BT (82% vs. 73% 5-year OS) and EBRT (77% vs. 71%). BT as compared to EBRT had equivalent survival (81% vs. 79%, not statistically significant).

      CONCLUSION: This study of over 8,000 patients demonstrates that adjuvant RT confers a survival benefit in Stage II endometrial cancer and supports the continued use of RT in these patients. BT alone may be reasonable in carefully selected patients.

      View details for PubMedID 29691149
  • Bone marrow suppression as a complication of total skin helical tomotherapy in the treatment of mycosis fungoides. Radiat Oncol
    Schaff EM, Rosenberg SA, Olson SJ, Howard SP, Bradley KA
    2018 Apr 13; 13 (1): 67
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      BACKGROUND: Total skin electron beam therapy (TSEBT) is an effective treatment in mycosis fungoides. Total skin helical tomotherapy (TSHT) may be an alternative to TSEBT and may offer several dosimetric and treatment advantages. There are currently very few published treatment results using TSHT in place of TSEBT for treatment of mycosis fungoides.

      CASE PRESENTATION: Two patients with mycosis fungoides were treated at our institution using TSHT. The first patient was a 69-year-old Caucasian female with stage IVA2 (T2 N3 M0 B2) disease who was treated to a dose of 12 Gy in 8 fractions, with a bone marrow mean dose of 1.66 Gy and V10 = 0.41%. Two weeks after ending treatment the patient developed myelosuppression including grade 4 thrombocytopenia and required blood and platelet transfusions. The second patient was a 29-year-old Caucasian female with stage I (T2 N0 M0 B0) disease. This patient previously had been treated for mycosis fungoides using helical tomotherapy (HT) at a dose of 20 Gy to a localized region and experienced mild thrombocytopenia at that time. The patient then underwent retreatment 17 months later with TSHT to a dose of 12 Gy in 6 fractions with a mean bone marrow dose of 2.3 Gy and V10 = 4.28%. This patient once again experienced myelosuppression that included grade 4 thrombocytopenia. She also required blood and platelet transfusions.

      CONCLUSIONS: Both patients treated with TSHT experienced severe bone marrow suppression including grade 4 thrombocytopenia. This was more severe than expected considering the relatively low overall prescription dose and despite a planning constraint placed on the bone marrow of a mean dose of < 2 Gy. These outcomes suggest that patients treated using TSHT should be closely monitored for myelosuppression and caution used even when treating to a dose of 12 Gy.

      View details for PubMedID 29653544
  • Value of Elective Radiation Oncology Rotations: How Many Is Too Many? Int J Radiat Oncol Biol Phys
    Jang S, Rosenberg SA, Hullet C, Bradley KA, Kimple RJ
    2018 Mar 01; 100 (3): 558-559
  • Neck Rhabdoid Tumors: Clinical Features and Consideration of Autologous Stem Cell Transplant. J Pediatr Hematol Oncol
    Wolfe AD, Capitini CM, Salamat SM, DeSantes K, Bradley KA, Kennedy T, Dehner LP, Patel NJ
    2018 Jan; 40 (1): e50-e54
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      Extrarenal malignant rhabdoid tumors (MRT) have a poor prognosis despite aggressive therapy. Adding high-dose chemotherapy with autologous stem cell rescue (HDC-ASCR) as consolidative therapy for MRT is controversial. We describe 2 patients, age 13 years and 19 months, with unresectable neck MRT. After chemotherapy and radiotherapy, both underwent HDC-ASCR and remain in remission over 4 years later. We reviewed all published cases of neck MRT, and found poorer outcomes and more variable age of presentation and time to progression than MRT at other sites. Neck MRT may represent a higher-risk subset of MRT, and addition of HDC-ASCR merits consideration.

      View details for PubMedID 28375943
  • Online patient information from radiation oncology departments is too complex for the general population. Pract Radiat Oncol
    Rosenberg SA, Francis DM, Hullet CR, Morris ZS, Brower JV, Anderson BM, Bradley KA, Bassetti MF, Kimple RJ
    2017 Jan - Feb; 7 (1): 57-62
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      PURPOSE: Nearly two-thirds of cancer patients seek information about their diagnosis online. We assessed the readability of online patient education materials found on academic radiation oncology department Web sites to determine whether they adhered to guidelines suggesting that information be presented at a sixth-grade reading level.

      METHODS AND MATERIALS: The Association of American Medical Colleges Web site was used to identify all academic radiation oncology departments in the United States. One-third of these department Web sites were selected for analysis using a random number generator. Both general information on radiation therapy and specific information regarding various radiation modalities were collected. To test the hypothesis that the readability of these online educational materials was written at the recommended grade level, a panel of 10 common readability tests was used. A composite grade level of readability was constructed using the 8 readability measures that provide a single grade-level output.

      RESULTS: A mean of 5605 words (range, 2058-12,837) from 30 department Web sites was collected. Using the composite grade level score, the overall mean readability level was determined to be 13.36 (12.83-13.89), corresponding to a collegiate reading level. This was significantly higher than the target sixth-grade reading level (middle school, t (29) = 27.41, P < .001).

      CONCLUSIONS: Online patient educational materials from academic radiation oncology Web sites are significantly more complex than recommended by the National Institutes of Health and the Department of Health and Human Services. To improve patients' comprehension of radiation therapy and its role in their treatment, our analysis suggests that the language used in online patient information should be simplified to communicate the information at a more appropriate level.

      View details for PubMedID 27663932
  • Readability of Online Patient Educational Resources Found on NCI-Designated Cancer Center Web Sites. J Natl Compr Canc Netw
    Rosenberg SA, Francis D, Hullett CR, Morris ZS, Fisher MM, Brower JV, Bradley KA, Anderson BM, Bassetti MF, Kimple RJ
    2016 Jun; 14 (6): 735-40
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      BACKGROUND: The NIH and Department of Health & Human Services recommend online patient information (OPI) be written at a sixth grade level. We used a panel of readability analyses to assess OPI from NCI-Designated Cancer Center (NCIDCC) Web sites.

      METHODS: Cancer.gov was used to identify 68 NCIDCC Web sites from which we collected both general OPI and OPI specific to breast, prostate, lung, and colon cancers. This text was analyzed by 10 commonly used readability tests: the New Dale-Chall Readability Formula, Flesch Reading Ease scale, Flesch-Kinaid Grade Level, FORCAST scale, Fry Readability Graph, Simple Measure of Gobbledygook test, Gunning Frequency of Gobbledygook index, New Fog Count, Raygor Readability Estimate Graph, and Coleman-Liau Index. We tested the hypothesis that the readability of NCIDCC OPI was written at the sixth grade level. Secondary analyses were performed to compare readability of OPI between comprehensive and noncomprehensive centers, by region, and to OPI produced by the American Cancer Society (ACS).

      RESULTS: A mean of 30,507 words from 40 comprehensive and 18 noncomprehensive NCIDCCs was analyzed (7 nonclinical and 3 without appropriate OPI were excluded). Using a composite grade level score, the mean readability score of 12.46 (ie, college level: 95% CI, 12.13-12.79) was significantly greater than the target grade level of 6 (middle-school: P<.001). No difference between comprehensive and noncomprehensive centers was identified. Regional differences were identified in 4 of the 10 readability metrics (P<.05). ACS OPI provides easier language, at the seventh to ninth grade level, across all tests (P<.01).

      CONCLUSIONS: OPI from NCIDCC Web sites is more complex than recommended for the average patient.

      View details for PubMedID 27283166
  • Pitfalls in Imaging of Cervical Cancer. Semin Roentgenol
    Robbins J, Kusmirek J, Barroilhet L, Anderson B, Bradley K, Sadowski E
    2016 Jan; 51 (1): 17-31
  • In regard to Wu and Vapiwala et al. Int J Radiat Oncol Biol Phys
    Meyer JE, Dilling TJ, Amdur RJ, Strasser JF, Tendulkar R, Lee WR, Jani AB, Elshaikh M, Poppe MM, Takita C, Currey A, Cheng SK, Jagsi R, Kuo JV, Chen AM, Dragun AE, Bradley K, Beriwal S, Smith RP, Chen RC, Rosenzweig K, Kim S, Mehta K
    2016 Mar 15; 94 (4): 858-9
  • Medical Student Perspectives on a Multi-institutional Clerkship Curriculum: A Report From the Radiation Oncology Education Collaborative Study Group. Int J Radiat Oncol Biol Phys
    Ye JC, Mohindra P, Spektor A, Krishnan MS, Chmura SJ, Howard AR, Viswanathan AN, MacDonald SM, Thaker NG, Das P, Mancini BR, Higgins SA, Braunstein S, Haas-Kogan D, Bradley KA, Hung AY, Thomas CR, Kharofa J, Wheatley M, Currey A, Parashar B, Du K, Jimenez RB, Golden DW
    2015 Jun 01; 92 (2): 217-9
  • Impact of adjuvant pelvic radiotherapy in stage I uterine sarcoma. Anticancer Res
    Magnuson WJ, Petereit DG, Anderson BM, Geye HM, Bradley KA
    2015 Jan; 35 (1): 365-70
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      BACKGROUND/AIM: The optimal adjuvant therapy for stage I uterine sarcoma remains unresolved and may consist of radiotherapy (RT), chemotherapy, hormonal therapy or observation. We analyzed the impact of adjuvant pelvic RT on overall survival (OS), cause-specific survival (CSS), disease-free survival (DFS), pelvic control (PC) and patterns of failure.

      PATIENTS AND METHODS: A retrospective analysis of 157 patients with International Federation of Gynecology and Obstetrics FIGO stage I uterine sarcoma was performed. RT was given postoperatively to a dose of 45-51 Gy in 28-30 fractions.

      RESULTS: The 5-year OS, CSS, DFS and PC was 58%, 62%, 47% and 72%, respectively. Adjuvant RT significantly improved PC (85% for RT group vs. 64% for non-RT group; p=0.02) but did not impact OS, CSS or DFS.

      CONCLUSION: The addition of adjuvant pelvic RT significantly improved PC for patients with stage I uterine sarcoma. As systemic therapies continue to improve, optimal locoregional control may result in improved patient outcomes.

      View details for PubMedID 25550573
  • Cervical brachytherapy technique for locally advanced carcinoma of the cervix in a patient with septate uterus. J Contemp Brachytherapy
    Platta CS, Wallace C, Gondi V, Das R, Straub M, Al-Niaimi A, Applegate G, Bradley KA
    2014 Mar; 6 (1): 76-81
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      PURPOSE: To describe an approach to cervical brachytherapy in a patient with congenital septate uterus and locally advanced cervical carcinoma.

      MATERIAL AND METHODS: The patient is a 34-year-old female with septate uterus presenting with pelvic pain. Workup demonstrated a stage IIB cervical adenocarcinoma with imaging evidence of an involved right external iliac lymph node. The patient received whole pelvic radiation, with concurrent weekly cisplatin (40 mg/m(2)), to a dose of 45 Gy in 25 fractions followed by a parametrial boost of 5.4 Gy and an additional nodal boost of 9 Gy.

      RESULTS: The patient was initiated on cervical brachytherapy following fraction 23 of pelvic radiation. To conform to her septated uterus, a Rotte-Y tandem was used. Additionally, 2 CT-compatible ovoids were placed in the vaginal apex to enhance dose distribution and coverage of the target volume. Each fraction of brachytherapy was performed with CT-based planning. A high-risk clinical target volume (HR-CTV) and normal structures were defined and constrained per American Brachytherapy Society (ABS) and Groupe Européen de Curiethérapie/European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) guidelines. The brachytherapy dose was 27.5 Gy in 5 fractions of 5.5 Gy each, prescribed to the HR-CTV.

      CONCLUSIONS: Herein, we report the first documented case of cervical brachytherapy in a patient with septate uterus and locally advanced cervical carcinoma. Using CT-guided planning, in conjunction with the ABS and GEC-ESTRO guidelines, the patient was effectively treated with adapted cervical brachytherapy, meeting criteria for HR-CTV coverage and normal tissue tolerances.

      View details for PubMedID 24790625
  • Predictive factors of recurrence following adjuvant vaginal cuff brachytherapy alone for stage I endometrial cancer. Gynecol Oncol
    Dunn EF, Geye H, Platta CS, Gondi V, Rose S, Bradley KA, Anderson BM
    2014 Jun; 133 (3): 494-8
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      PURPOSE: The purpose of this study is to identify risk factors for recurrence in a cohort of stage I endometrial cancer patients treated with vaginal cuff brachytherapy at a single academic institution.

      METHODS AND MATERIALS: From 1989 to 2011, 424 patients with stage I endometrial cancer underwent total hysterectomy and bilateral salpingo-oophorectomy, with or without lymphadenectomy (LND), followed by high-dose-rate vaginal cuff brachytherapy (VCB) to patients felt to be high or intermediate risk FIGO stage IA and IB disease. Covariates included: 2009 FIGO stage, age, grade, histology, presence of lymphovascular space invasion, LND, and receipt of chemotherapy.

      RESULTS: With a median follow-up of 3.7years, the 5 and 10-year disease free survival were 98.4% and 95.9%, respectively. A total of 30 patients developed recurrence, with the predominant pattern of isolated distant recurrence (57.0%). On multivariate analysis, grade 3 (p=0.039) and LND (p=0.048) independently predicted of increased recurrence risk. χ(2) analysis suggested that higher-risk patients were selected for LND, with significant differences in age, stage, and grade noted between cohorts. Distant metastatic rate was significantly higher for patients who qualified for GOG 0249 at 23.1% (95% CI 10.7-35.5%) compared to those who did not at 6.8% (95% CI 1.8-11.8%, p<0.001).

      CONCLUSION: Overall disease-free survival for this cohort of patients was >95% at 10years. Univariate analysis confirmed previously identified risk factors as predictors for recurrence. Multivariate analysis found that grade 3 and LND correlated with risk for recurrence. Of those that did recur, the initial site of relapse included distant metastasis in most cases.

      View details for PubMedID 24657301
  • Radiation oncology residency selection: a targeted assessment of factor importance among fourth-year medical students. Int J Radiat Oncol Biol Phys
    Brower JV, Mohindra P, Bradley KA, Golden DW
    2014 Mar 15; 88 (4): 967-8
  • Successful management of female urethral carcinoma with radiation therapy and concurrent chemotherapy. Gynecol Oncol Case Rep
    Magnuson WJ, Bradley K, Shaves M
    2011; 2 (1): 1-3
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      ► Successful treatment of locally advanced urethral carcinoma with chemoradiation as evidenced by patients alive NED at 90 and 47 months. ► 45 Gy of external beam RT followed by 15-25 Gy of interstitial brachytherapy. ► Concurrent chemotherapy with 5-fluorouracil and cisplatin.

      View details for PubMedID 24371597
  • Adjuvant and definitive radiation therapy for primary carcinoma of the vagina using brachytherapy and external beam radiation therapy. J Contemp Brachytherapy
    Platta CS, Anderson B, Geye H, Das R, Straub M, Bradley K
    2013 Jun; 5 (2): 76-82
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      PURPOSE: To report the outcomes of patients receiving vaginal brachytherapy and/or external beam radiation therapy (EBRT) for primary vaginal cancer.

      MATERIAL AND METHODS: Between 1983 and 2009, 63 patients received brachytherapy and/or EBRT for primary tumors of the vagina at a single tertiary center. Patient data was collected via chart review. The Kaplan-Meier method was used to calculate actuarial pelvic local control (LC), disease-free survival (DFS), overall survival (OS), and severe late toxicity rates. Acute and late toxicities were scored according to the Common Terminology Criteria for Adverse Events version 3 (CTCAE v3.0).

      RESULTS: Median follow up was 44.2 months. Patients with early stage disease (stages I and II) had significantly improved 5-year OS when compared to patients with locally advanced disease (stages III and IVA) (73.3 vs. 34.4%, p = 0.032). Patients with greater than 1/3 vaginal involvement had significantly worse prognosis than patients with tumors involving 1/3 or less of the vagina, with the later having superior DFS (84.0 vs. 52.4%, p = 0.007) and LC (86.9 vs. 60.4%, p = 0.018) at 5-years. Age, histology, and brachytherapy technique did not impact treatment outcomes. The 5-year actuarial grade 3 or higher toxicity rate was 23.1% (95% CI: 10.6-35.6%). Concurrent chemotherapy had no impact on outcomes or toxicity in this analysis.

      CONCLUSIONS: Success of treatment for vaginal cancer depends primarily on disease stage, but other contributing factors such as extent of vaginal involvement and tumor location significantly impact outcomes. Treatment of vaginal cancer with primary radiotherapy yields acceptable results with reasonable toxicity rates. Management of this rare malignancy requires a multidisciplinary approach to appropriately optimize therapy.

      View details for PubMedID 23878551
  • Effects of treatment duration during concomitant chemoradiation therapy for cervical cancer. Int J Radiat Oncol Biol Phys
    Shaverdian N, Gondi V, Sklenar KL, Dunn EF, Petereit DG, Straub MR, Bradley KA
    2013 Jul 01; 86 (3): 562-8
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      PURPOSE: To determine whether extended treatment duration (TD) impacts in-field relapse and survival in the setting of concomitant chemoradiation therapy (CRT) for cervical cancer.

      METHODS AND MATERIALS: A total of 480 consecutive cervical cancer patients treated with radiation therapy (RT) alone or concomitant CRT for curative intent were retrospectively analyzed. Relapse was defined as in-field with respect to external beam radiation therapy fields. The effects of TD on in-field relapse, disease-free survival (DFS), and overall survival (OS) rates were assessed continuously and categorically within the separate RT and CRT cohorts. Covariates included age, histology, stage, and cumulative dose to point A. In-field relapse, DFS, and OS rates were estimated with Kaplan-Meier analysis; comparisons used log-rank statistic. Multivariate analysis used the Cox proportional hazards model.

      RESULTS: A total of 372 patients (RT n=206, CRT n=166) were evaluable, with a median follow-up for relapse-free patients of 4.2 years (RT 4.4 years, CRT 4.2 years; P=.807). Treatment duration was longer in the RT cohort (median 55 days; range 35-99 days) versus the CRT cohort (median 51 days; range 35-92 days) (P=.001). In the RT cohort, TD ≥62 days trended to significance for predicting inferior DFS (hazard ratio 1.42, 95% confidence interval 0.86-1.98, P=.086). However, in the CRT cohort, TD assessed continuously or categorically across multiple cutoff thresholds did not predict for in-field relapse, DFS, or OS.

      CONCLUSION: With RT alone, extended TD ≥62 days may adversely impact treatment efficacy. With the addition of concomitant chemotherapy to RT, however, extended TD has no effect on treatment efficacy.

      View details for PubMedID 23561652
  • Motexafin-gadolinium and involved field radiation therapy for intrinsic pontine glioma of childhood: a children's oncology group phase 2 study. Int J Radiat Oncol Biol Phys
    Bradley KA, Zhou T, McNall-Knapp RY, Jakacki RI, Levy AS, Vezina G, Pollack IF
    2013 Jan 01; 85 (1): e55-60
    • More

      PURPOSE: To evaluate the effects on 1-year event-free survival (EFS) and overall survival (OS) of combining motexafin and gadolinium (MGd), a potent radiosensitizer, with daily fractionated radiation therapy in children with newly diagnosed intrinsic pontine gliomas.

      METHODS AND MATERIALS: Patients with newly diagnosed intrinsic pontine glioma were treated with MGd daily for 5 consecutive days each week, for a total of 30 doses. Patients received a 5- to 10-min intravenous bolus of MGd, 4.4 mg/kg/day, given 2 to 5 h prior to standard dose irradiation. Radiation therapy was administered at a daily dose of 1.8 Gy for 30 treatments over 6 weeks. The total dose was 54 Gy.

      RESULTS: Sixty eligible children received MGd daily, concurrent with 6 weeks of radiation therapy. The estimated 1-year EFS was 18%±5%, and the estimated 1-year OS was 53%±6.5%. The most common grade 3 to 4 toxicities were lymphopenia, transient elevation of liver transaminases, and hypertension.

      CONCLUSIONS: Compared to historical controls, the addition of MGd to a standard 6-week course of radiation did not improve the survival of pediatric patients with newly diagnosed intrinsic pontine gliomas.

      View details for PubMedID 23092726
  • Severe late toxicities following concomitant chemoradiotherapy compared to radiotherapy alone in cervical cancer: an inter-era analysis. Int J Radiat Oncol Biol Phys
    Gondi V, Bentzen SM, Sklenar KL, Dunn EF, Petereit DG, Tannehill SP, Straub M, Bradley KA
    2012 Nov 15; 84 (4): 973-82
    • More

      PURPOSE: To compare rates of severe late toxicities following concomitant chemoradiotherapy and radiotherapy alone for cervical cancer.

      METHODS AND MATERIALS: Patients with cervical cancer were treated at a single institution with radiotherapy alone or concomitant chemoradiotherapy for curative intent. Severe late toxicity was defined as grade≥3 vaginal, urologic, or gastrointestinal toxicity or any pelvic fracture, using Common Terminology Criteria for Adverse Events version 4.0 (CTCAE), occurring ≥6 months from treatment completion and predating any salvage therapy. Severe late toxicity rates were compared after adjusting for pertinent covariates.

      RESULTS: At 3 years, probability of vaginal severe late toxicity was 20.2% for radiotherapy alone and 35.1% for concomitant chemoradiotherapy (P=.026). At 3 years, probability of skeletal severe late toxicity was 1.6% for radiotherapy alone and 7.5% for concomitant chemoradiotherapy (P=.010). After adjustment for case mix, concomitant chemoradiotherapy was associated with higher vaginal (hazard ratio [HR] 3.0, 95% confidence interval [CI], 1.7-5.2, P<.001), and skeletal (HR 7.0, 95% CI 1.4-34.1, P=.016) severe late toxicity. Compared to high dilator compliance, moderate (HR 3.6, 95% CI 2.0-6.5, P<.001) and poor (HR 8.5, 95% CI 4.3-16.9, P<.001) dilator compliance was associated with higher vaginal severe late toxicity. Age>50 was associated with higher vaginal (HR 1.8, 95% CI 1.1-3.0, P=.013) and skeletal (HR 5.7, 95% CI 1.2-27.0, P=.028) severe late toxicity. Concomitant chemoradiotherapy was not associated with higher gastrointestinal (P=.886) or urologic (unadjusted, P=.053; adjusted, P=.063) severe late toxicity.

      CONCLUSION: Compared to radiotherapy alone, concomitant chemoradiotherapy is associated with higher rates of severe vaginal and skeletal late toxicities. Other predictive factors include dilator compliance for severe vaginal late toxicity and age for severe vaginal and skeletal late toxicities.

      View details for PubMedID 22898381
  • Patterns of pain and distress during high-dose-rate intracavity brachytherapy for cervical cancer. J Support Oncol
    Kwekkeboom KL, Dendaas NR, Straub M, Bradley KA
    2009 May-Jun; 7 (3): 108-14
    • More

      Over the past decade, outpatient high-dose-rate (HDR) brachytherapy has become increasingly common in the treatment of many women with cervical cancer. In our study, we explored women's experiences of pain and distress over a series of five HDR brachytherapy procedures given for cervical cancer. Seventeen patients receiving HDR cervical brachytherapy with conscious sedation for stages I-III cervical cancer completed ratings of pain intensity and distress and a measure of physical and emotional discomfort with each procedure. The majority of women reported worst pain in the mild to moderate range and similar ratings of worst distress across the series of procedures. The most physically uncomfortable aspect of treatment was removal of the instruments after the procedure, when sedatives had worn off. The most emotionally uncomfortable aspect was worry about the effects of treatment. A subset of women reported having recalled pain from previous procedures, despite the use of conscious sedation medications. Those women who recalled having had pain rated their worst pain during the procedure higher than women who did not recall having had pain. For most patients, HDR brachytherapy delivered with conscious sedation is well tolerated with only mild pain and distress. However, a small number of patients may experience more significant symptoms and may require additional medical and psychosocial support.

      View details for PubMedID 19507459
  • The impact of hybrid PET-CT scan on overall oncologic management, with a focus on radiotherapy planning: a prospective, blinded study. Technol Cancer Res Treat
    Kruser TJ, Bradley KA, Bentzen SM, Anderson BM, Gondi V, Khuntia D, Perlman SB, Tome WA, Chappell RJ, Walker WL, Mehta MP
    2009 Apr; 8 (2): 149-58
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      Functional imaging using fluorodeoxyglucose positron-emission tomography (FDG-PET) has been increasing incorporated into radiotherapy planning in conjunction with computed tomography (CT). Hybrid FDG-PET/CT scanners allow these images to be obtained in very close temporal proximity without the need for repositioning patients, thereby minimizing imprecision when overlying these images. To prospectively examine the impact of hybrid PET/CT imaging on overall oncologic impact, with a focus on radiotherapy planning, we performed a prospective, blinded trial in 111 patients. Patients with lung cancer (n=38), head-and-neck squamous cell carcinoma (n=23), breast (n=8), cervix (n=15), esophageal (n=9), and lymphoma (n=18) underwent hybrid PET/CT imaging at the time of radiation therapy planning. A physician blinded to the PET dataset designed a treatment plan using all clinical information and the CT dataset. The treating physician subsequently designed a second treatment plan using the hybrid PET/CT dataset. The two treatment plans were compared to determine if a major alteration in overall oncologic management occured. In patients receiving potentially curative radiotherapy the concordance between CT-based and PET/CT-based GTVs was quantified using an index of conformality (CI). In 76/111 (68%) of patients, the PET/CT data resulted in a change in one or more of the following: GTV volume, regional/local extension, prescribed dose, or treatment modality selection. In 35 of these 76 cases (46%; 31.5% of the entire cohort) the change resulted in a major alteration in the oncologic management (dose, field design, or modality change). Thus, nearly a third of all cases had a major alteration in oncologic management as a result of the PET/CT data, and 29 of 105 patients (27.6%) who underwent potentially curative radiotherapy had major alterations in either dose or field design. Hybrid PET/CT imaging at the time of treatment planning may be highly informative and an economical manner in which to obtain PET imaging, with the dual goals of staging and treatment planning.

      View details for PubMedID 19334796
  • Motexafin gadolinium and involved field radiation therapy for intrinsic pontine glioma of childhood: a Children's Oncology Group phase I study. Neuro Oncol
    Bradley KA, Pollack IF, Reid JM, Adamson PC, Ames MM, Vezina G, Blaney S, Ivy P, Zhou T, Krailo M, Reaman G, Mehta MP, Children's Oncology Group
    2008 Oct; 10 (5): 752-8
    • More

      The purpose of this study was to determine the dose-limiting toxicities, maximum tolerated dose, pharmacokinetics, and intratumor and brain distribution of motexafin gadolinium (MGd) with involved field radiation therapy in children with newly diagnosed intrinsic pontine gliomas. MGd was administered as a 5-min intravenous bolus 2-5 h prior to standard radiation. The starting dose was 1.7 mg/kg. After first establishing that 5 doses/week for 6 weeks was tolerable, the dose of MGd was escalated until dose-limiting toxicity was reached. Radiation therapy was administered to 54 Gy in 30 once-daily fractions. Forty-four children received MGd at doses of 1.7 to 9.2 mg/kg daily prior to radiation therapy for 6 weeks. The maximum tolerated dose was 4.4 mg/kg. The primary dose-limiting toxicities were grade 3 and 4 hypertension and elevations in serum transaminases. Median elimination half-life and clearance values were 6.6 h and 25.4 ml/kg/h, respectively. The estimated median survival was 313 days (95% confidence interval, 248-389 days). The maximum tolerated dose of MGd and the recommended phase II dose was 4.4 mg/kg when administered as a daily intravenous bolus in conjunction with 6 weeks of involved field radiation therapy for pediatric intrinsic pontine gliomas.

      View details for PubMedID 18715950
  • The effect of laparoscopic guidance on gynecologic interstitial brachytherapy. J Minim Invasive Gynecol
    Engle DB, Bradley KA, Chappell RJ, Conner JP, Hartenbach EM, Kushner DM
    2008 Sep-Oct; 15 (5): 541-6
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      STUDY OBJECTIVE: To compare laparoscopic-assisted interstitial brachytherapy (LAIB) with traditional interstitial brachytherapy (TrIB) in the treatment of gynecologic malignancies.

      DESIGN: Retrospective review (Canadian Task Force classification II-3).

      SETTING: University hospital.

      PATIENTS: A total of 42 women undergoing interstitial brachytherapy for a gynecologic malignancy.

      INTERVENTIONS: Interstitial brachytherapy by traditional method versus laparoscopic guidance.

      MEASUREMENTS AND MAIN RESULTS: In all, 42 women underwent interstitial brachytherapy with a mean follow-up of 24 months. In all, 28 patients underwent TrIB and 14 underwent LAIB. The mean operating department time was 177 minutes for LAIB and 91 minutes for TrIB (p<.001). No intraoperative complications existed in either group. Of the 14 patients undergoing LAIB, 2 (14%) had carcinomatosis, and the brachytherapy was aborted. Of patients who proceeded with LAIB, 64% had clinically significant pelvic adhesions necessitating lysis of adhesions. Mean radiation doses were similar for both external beam (LAIB=54 Gy, TrIB=50 Gy; p=.12) and brachytherapy (LAIB=29 Gy, TrIB=30 Gy; p=.8). No difference existed in the mean follow-up between groups (p=.7). In regard to long-term grade 3/4 radiation toxicity, 1 (10%) patient undergoing LAIB had a rectovaginal fistula. Six (27%) patients (p=.39; 95% CI 9%-43%) undergoing TrIB experienced high-grade toxicity, including 2 rectovaginal fistulas, 1 rectal stricture, 1 necrotizing fasciitis, 1 urinary incontinence, and 1 soft-tissue necrosis.

      CONCLUSION: The LAIB procedure appears safe, but substantially increases operating department time. No significant decrease in late high-grade toxicities were detected in comparison with TrIB. The LAIB procedure allows for both lysis of adhesions and identification of unknown carcinomatosis.

      View details for PubMedID 18657479
  • Impact of hybrid fluorodeoxyglucose positron-emission tomography/computed tomography on radiotherapy planning in esophageal and non-small-cell lung cancer. Int J Radiat Oncol Biol Phys
    Gondi V, Bradley K, Mehta M, Howard A, Khuntia D, Ritter M, Tomé W
    2007 Jan 01; 67 (1): 187-95
    • More

      PURPOSE: The aim of this study was to investigate the impact of a hybrid fluorodeoxyglucose positron-emission tomography/computed tomography (FDG-PET/CT) scanner in radiotherapy planning for esophageal and non-small-cell lung cancer (NSCLC).

      METHODS AND MATERIALS: A total of 30 patients (16 with esophageal cancer, 14 with NSCLC) underwent an FDG-PET/CT for radiotherapy planning purposes. Noncontrast total-body spiral CT scans were obtained first, followed immediately by FDG-PET imaging which was automatically co-registered to the CT scan. A physician not involved in the patients' original treatment planning designed a gross tumor volume (GTV) based first on the CT dataset alone, while blinded to the FDG-PET dataset. Afterward, the physician designed a GTV based on the fused PET/CT dataset. To standardize PET GTV margin definition, background liver PET activity was standardized in all images. The CT-based and PET/CT-based GTVs were then quantitatively compared by way of an index of conformality, which is the ratio of the intersection of the two GTVs to their union.

      RESULTS: The mean index of conformality was 0.44 (range, 0.00-0.70) for patients with NSCLC and 0.46 (range, 0.13-0.80) for patients with esophageal cancer. In 10 of the 16 (62.5%) esophageal cancer patients, and in 12 of the 14 (85.7%) NSCLC patients, the addition of the FDG-PET data led to the definition of a smaller GTV.

      CONCLUSION: The incorporation of a hybrid FDG-PET/CT scanner had an impact on the radiotherapy planning of esophageal cancer and NSCLC. In future studies, we recommend adoption of a conformality index for a more comprehensive comparison of newer treatment planning imaging modalities to conventional options.

      View details for PubMedID 17189070
  • Radiation therapy for gynecologic malignancies. Hematol Oncol Clin North Am
    Bradley KA, Petereit DG
    2006 Apr; 20 (2): 347-61
    • More

      In the last century, radiation has been successfully used as primary and adjuvant treatment in the management of gynecologic malignancies. It is anticipated that radiation will continue as an integral component in the treatment of cervical,endometrial, vulvar, and vaginal carcinoma. Current efforts are directed at im-proving control rates while minimizing treatment-related toxicities through the use of more conformal external beam radiotherapy techniques, refinement of brachytherapy techniques, and the integration of chemotherapy.

      View details for PubMedID 16730298
  • Quality assurance of treatment plans for interstitial and intracavitary high-dose-rate brachytherapy. Brachytherapy
    Das RK, Bradley KA, Nelson IA, Patel R, Thomadsen BR
    2006 Jan-Mar; 5 (1): 56-60
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      PURPOSE: Quality assurance for complex high-dose-rate (HDR) treatment planning has always been a challenge to the physics community because of the time constraint between HDR planning and the delivery of the treatment. This study proposes an efficient, precise, and easy method for checking the complex computer calculation.

      METHODS AND MATERIALS: Posttreatment, three-dimensional dose-volume study was performed for 98 patients with 128 new treatment plans along with 30 library plans. Volumes covered by the 100% isodose line, source activity (Ci), total dwell time (s), and the prescription dose (100%) were recorded. Variation of R(V) defined as (irradiated time x activity/elongation factor x prescribed dose) with volume was studied for different catheter systems.

      RESULTS: Parametric fit of R(V) with volume for three different systems that cover most of the interstitial and intracavitary brachytherapy implants agrees within +/-6%.

      CONCLUSIONS: The excellent agreement of R(V) derived from this simplistic point source model with three-dimensional dose calculations for individual HDR treatment plans clearly establishes that for an implant with known number of catheters, the time needed to deliver a prescribed dose to a given prescription volume can be easily predicted.

      View details for PubMedID 16563998
  • Linear accelerator radiosurgery for trigeminal neuralgia. Neurosurgery
    Richards GM, Bradley KA, Tomé WA, Bentzen SM, Resnick DK, Mehta MP
    2005 Dec; 57 (6): 1193-200; discussion 1193-200
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      OBJECTIVE: To report the clinical outcomes following treatment of trigeminal neuralgia with linear accelerator-based radiosurgery.

      METHODS: Twenty-eight patients with medication refractory idiopathic trigeminal neuralgia were treated with a single fraction of 80 Gy to the trigeminal nerve root. For treatment delivery, a 4-mm collimator and a 7-arc technique were delivered using a stereotactic floor stand system with an isocenter stability of 0.2 +/- 0.1 mm to minimize dose to the brainstem. Treatment delivery time was approximately 55 minutes.

      RESULTS: With a median follow-up of 12 months (range, 1-40 mo), 57% of patients achieved complete pain relief and 75% (exact 95% confidence interval, 55 to 89%) had their pain reduced to 3 or less on a 10-point pain scale. Median time to pain relief was 1 month. Four patients did not respond to treatment. The actuarial mean time to pain recurrence in responders was 14 months, and the actuarial mean response duration in major to complete responders was 16 months. Women had significantly longer mean time to pain recurrence than men (16 versus 7 months; P = 0.05). Three patients reported new mild facial numbness after radiosurgery and one patient developed neurotrophic keratopathy.

      CONCLUSION: Linear accelerator-based radiosurgery for medication refractory trigeminal neuralgia provides effective pain relief with a low complication rate.

      View details for PubMedID 16331167
  • Radiation therapy for leptomeningeal cancer. Cancer Treat Res
    Mehta M, Bradley K
    2005; 125: 147-58
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      Radiotherapy has multiple roles in the treatment of leptomeningeal cancer. While it is uncommon for patients to experience regression of neurologic deficits due to leptomeningeal cancer, focal radiotherapy often provides significant palliation of pain, increased intracranial pressure and other focal symptoms. Focal radiotherapy may also be used to eliminate blockages of cerebrospinal fluid (CSF) and allow for safe administration of intrathecal chemotherapy. Craniospinal irradiation (CSI) is most often used as prophylaxis for patients at high risk of leptomeningeal tumor dissemination, but may result in symptom palliation and prolonged disease control for patients with active leptomeningeal tumor.

      View details for PubMedID 16211888
  • Management of brain metastases. Semin Oncol
    Bradley KA, Mehta MP
    2004 Oct; 31 (5): 693-701
    • More

      Patients with brain metastases have a generally poor outcome with a median survival after diagnosis of approximately 4 months. Management of brain metastases involves symptomatic treatment and definitive therapy, with the goal of stabilizing and improving neurologic function and survival. Traditional and novel therapies, including whole-brain radiation therapy (WBRT), surgery, radiosurgery, radiosensitizers, and chemotherapy are reviewed. The results of important clinical trials are discussed. In addition, current controversies in the management of brain metastases, such as the choice of surgery or radiosurgery for resectable lesions and the possible avoidance of (WBRT), are highlighted.

      View details for PubMedID 15497123
  • Megavoltage computed tomography imaging: a potential tool to guide and improve the delivery of thoracic radiation therapy. Clin Lung Cancer
    Welsh JS, Bradley K, Ruchala KJ, Mackie TR, Mañon R, Patel R, Wiederholt P, Lock M, Hui S, Mehta MP
    2004 Mar; 5 (5): 303-6
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      Helical tomotherapy is an innovative means of delivering intensity-modulated radiation therapy (IMRT) using a device that merges features of a linear accelerator and a helical computed tomography (CT) scanner. The tomotherapy unit can generate CT images from the megavoltage radiation it uses for treatment as often as needed during a course of radiation therapy. These megavoltage CT (MVCT) images offer verification of patient position prior to and potentially during radiation therapy, and provide considerably more anatomical detail than the conventional radiation therapy port films used for patient set-up verification. Also, MVCT imaging may enable reconstruction of the radiation dose delivered, thereby providing unprecedented verification of the actual treatment. These key features of helical tomotherapy distinguish it from other IMRT approaches. We report results from a pilot feasibility trial of 10 patients with non-small-cell lung cancer (NSCLC) on whom we obtained MVCT images using a prototype helical tomotherapy system. All patients underwent conventional CT imaging for radiation therapy treatment planning. Specific aims were to subjectively compare MVCT and conventional CT images and then to objectively compare the 2 modalities by contouring tumors and performing a volumetric comparison. Seven patients had disease located primarily in the lung parenchyma, 2 primarily in the mediastinum, and 1 in both. When evaluated by location, all 7 patients with lesions primarily in the lung parenchyma had subjectively high-quality MVCT images. Objectively, the volumetric agreement between conventional and MVCT for parenchymal lesions was excellent in 5 of the 7 patients. Megavoltage CT imaging via the helical tomotherapy prototype provided adequate information for use in verification of patient position and dose reconstruction for lesions within the pulmonary parenchyma, but presently appears suboptimal for primarily mediastinal disease. Further studies are ongoing to optimize MVCT imaging and better define its utility in patients with NSCLC.

      View details for PubMedID 15086969

Contact Information

Kristin Bradley, MD

600 Highland Avenue,
Madison, WI 53792