Stephen Rosenberg

Moffitt Cancer Center

Despite magnetic resonance imaging (MRI) being a mainstay in the oncologic care for many disease sites, it has not routinely been used in early lung cancer diagnosis, staging, and treatment. While MRI provides improved soft tissue contrast compared to computed tomography (CT), an advantage in multiple organs, the physical properties of the lungs an...

Purpose: Current guidelines recommend surgery as standard of care for primary lung neuroendocrine tumor (LNET). Given that LNET is a rare clinical entity, there is a lack of literature regarding treatment of LNET with stereotactic body radiotherapy (SBRT). We hypothesized that SBRT could lead to effective locoregional tumor control and long-term o...

Introduction: The recent results from the Nordic-HILUS study indicate stereotactic body radiation therapy (SBRT) is associated with high-grade toxicity for ultracentral (UC) tumors. We hypothesized that magnetic resonance-guided SBRT (MRgSBRT) or hypofractionated radiation therapy (MRgHRT) enables the safe delivery of high-dose radiation to centra...

Background Definitive local therapy with stereotactic ablative radiation therapy (SABR) for ultracentral lung lesions is associated with a high risk of toxicity, including treatment related death. Stereotactic MR-guided adaptive radiation therapy (SMART) can overcome many of the challenges associated with SABR treatment of ultracentral lesions. Me...

Magnetic resonance imaging (MRI) is known for its accurate soft tissue delineation of tumors and normal tissues. This development has significantly impacted the imaging and treatment of cancers. Radiomics is the process of extracting high-dimensional features from medical images. Several studies have shown that these extracted features may be used...

Objectives Stereotactic body radiotherapy (SBRT) is widely used for localized prostate cancer and implementation of MR-guided radiotherapy has the advantage of tighter margins and improved sparing of organs at risk. Here we evaluate outcomes and time required to treat using non-adaptive MR-guided SBRT (MRgSBRT) for localized prostate cancer at our...

Simple Summary Breast MRI is a valuable imaging modality that plays a critical role in the detection, diagnosis, and treatment of breast cancer. The superior sensitivity of breast MRI allows for more accurate evaluation of the extent of disease for breast cancer, which is important in an era where de-escalation of treatment is being considered and...

Leading successful change efforts first requires assessment of the “before change” environment and culture. At our institution, the radiation oncology (RO) residents follow a longitudinal didactic learning program consisting of weekly 1-h lectures, case conferences, and journal clubs. The resident didactic education series format has not changed si...

Background Soft tissue sarcomas (STS), have significant inter- and intra-tumoral heterogeneity, with poor response to standard neoadjuvant radiotherapy (RT). Achieving a favorable pathologic response (FPR ≥ 95%) from RT is associated with improved patient outcome. Genomic adjusted radiation dose (GARD), a radiation-specific metric that quantifies t...

Purpose While dose escalation is associated with improved local control (LC) for adrenal gland metastases (AGMs), the proximity of gastrointestinal (GI) organs-at-risk (OARs) limits the dose that can be safely prescribed via CT-based stereotactic body radiation therapy (SBRT). The advantages of magnetic resonance-guided SBRT (MRgSBRT), including tu...

Purpose: NSCLC SBRT with 50 Gy/5 fractions is sometimes considered controversial, as the nominal BED of 100 Gy is felt by some to be insufficient for long-term local control of some lesions. In this study, we analyzed such patients using explainable deep learning techniques, and consequently proposed appropriate treatment planning criteria. These n...

Background and purpose Diffusion weighted imaging (DWI) allows for the interrogation of tissue cellularity, which is a surrogate for cellular proliferation. Previous attempts to incorporate DWI into the workflow of a 0.35 T MR-linac (MRL) have lacked quantitative accuracy. In this study, accuracy, repeatability, and geometric precision of apparent...

Simple Summary Magnetic resonance imaging (MRI) has several advantages over computerized tomography (CT) in the treatment planning of central nervous system (CNS) malignancies. The adoption of hybrid MRI and linear accelerators (MRLs) has allowed for more effective tumor control and reduced unnecessary neurotoxicity through precise daily adaptation...

Purpose Bladder preservation with trimodal therapy (TMT; maximal tumor resection followed by chemoradiation) is an effective paradigm for select patients with muscle invasive bladder cancer. We report our institutional experience of a TMT protocol using nonadaptive magnetic resonance imaging–guided radiation therapy (MRgRT) for partial bladder boos...

Stereotactic body radiotherapy (SBRT) is an effective radiation therapy technique that has allowed for shorter treatment courses, as compared to conventionally dosed radiation therapy. As its name implies, SBRT relies on daily image guidance to ensure that each fraction targets a tumor, instead of healthy tissue. Magnetic resonance imaging (MRI) of...

The treatment of central and ultracentral lung tumors with radiotherapy remains an ongoing clinical challenge. The risk of Grade 5 toxicity with ablative radiotherapy doses to these high-risk regions is significant as shown in recent prospective studies. Magnetic resonance (MR) image-guided adaptive radiotherapy (MRgART) is a new technology and may...

Introduction: We hypothesized that concurrent ipilimumab with chemoradiotherapy (chemoRT) followed by maintenance nivolumab would be safe for patients with unresectable stage III NSCLC. We aimed to assess the safety (phase I) and the 12-month progression-free survival (PFS) (phase II) in a multi-institution prospective trial. Methods: Eligible p...

Purpose/Objective(s) Stereotactic body radiation therapy (SBRT) is widely used for localized prostate cancer and implementation of MR-guided radiotherapy (MRgRT) has the advantage of smaller target margins and improved sparing of organs at risk. Here we evaluate outcomes and time required to treat using non-adaptive MRgRT for prostate SBRT at our i...

Purpose/Objective(s) Real world outcomes related to pneumonitis in patients with locally advanced (LA) non-resectable non-small cell lung cancer (NSCLC) treated with concurrent chemoradiation (chemoRT) and consolidative durvalumab (D) may differ from those seen in prospective trials given selection biases and other variables in clinical trials. We...

Purpose/Objective(s) MRgRT is used to treat UC lung lesions. Adaption is triggered if the original plan does not meet criteria of target coverage or organs at risk (OAR) constraints on recontoured anatomy of the day. Current MRgRT software does not provide composite dose delivered over the complete course, partly because daily anatomy changes make...

Purpose/Objective(s) While dose-escalation is associated with improved local control (LC) for adrenal gland metastases (AGM), the proximity of gastrointestinal (GI) structures limits the dose that can be safely prescribed via CT-based stereotactic body radiation therapy (SBRT). The relative advantages of magnetic resonance guided SBRT (MRgSBRT), in...

Purpose/Objective(s) Significant controversy remains over sufficient dose to minimize local failure (LF) for SBRT treatment of NSCLC treated to 50 Gy in 5 fractions (BED = 100). We hypothesized that dosimetric predictors can be determined by developing survival machine learning (SML) models, identifying highest impact features and determining cutof...

Purpose/Objective Magnetic resonance-guided radiation therapy (MRgRT) utilization is rapidly expanding worldwide, driven by advanced capabilities including continuous intrafraction visualization, automatic triggered beam delivery, and on-table adaptive replanning (oART). Our objective was to describe patterns of 0.35Tesla(T)-MRgRT (MRIdian) utiliza...

MRI-guided radiation therapy (MRgRT) enables real-time imaging during treatment and daily online adaptive planning. It is particularly useful for areas of treatment that have been previously excluded or restricted from ablative doses due to potential damage to adjacent normal tissue. In certain cases, ablative doses to metastatic lesions may be jus...

The increased adoption of stereotactic body radiation therapy (SBRT) has allowed for delivery of higher doses, potentially associated with better outcomes, but at the risk of higher toxicity. The intimate association of radiosensitive organs at risk (e.g., stomach, duodenum, bowel) has historically limited the delivery of ablative doses to the panc...

Purpose: Radiomics entails the extraction of quantitative imaging biomarkers (or radiomics features) hypothesized to provide additional pathophysiological and/or clinical information compared to qualitative visual observation and interpretation. This retrospective study explores the variability of radiomics features extracted from images acquired w...

Background Online adaptive radiation therapy (ART) allows real-time plan generation and delivery to account for daily anatomical changes. Due to the time intense nature of this process, physicians frequently cover adaptive treatments for patients whose original treatment plan was prescribed by another provider. There is currently no published guida...

Purpose/objective(s): Whole brain radiotherapy with hippocampal avoidance (HA-WBRT) is a technique utilized to treat metastatic brain disease while preserving memory and neurocognitive function. We hypothesized that the treatment planning and delivery of HA-WBRT plans is feasible with an MRI-guided linear accelerator (linac) and compared plan resu...

Objective: Two benefits of MR-guided radiotherapy (MRgRT) are the ability to track target structures while treatment is being delivered and the ability to adapt plans daily for some lesions based on changing anatomy. These unique capacities come at two costs: increased capital for acquisition and greatly decreased workflow. An adaptive gated stere...

Background Magnetic Resonance Image guided Stereotactic body radiotherapy (MRgRT) is an emerging technology that is increasingly used in treatment of visceral cancers, such as pancreatic adenocarcinoma (PDAC). Given the variable response rates and short progression times of PDAC, there is an unmet clinical need for a method to assess early RT respo...

Purpose: To monitor intrafraction motion during spine stereotactic body radiotherapy(SBRT) treatment delivery with readily available technology, we implemented triggered kV imaging using the on-board imager(OBI) of a modern medical linear accelerator with an advanced imaging package. Methods: Triggered kV imaging for intrafraction motion management...

Background: Epidermal growth factor receptor (EGFR) mutated non-small cell lung cancer (NSCLC) shows an impressive initial response to EGFR tyrosine kinase inhibitors (EGFR-TKI). However, resistance invariably develops, commonly involving the site of initial gross disease. Cytoreductive stereotactic body radiotherapy (SBRT) for thoracic oligoprogre...

Background and Purpose The study objective was to determine whether longitudinal changes in patient-reported outcomes (PROs) were associated with survival among early-stage, non-small cell lung cancer (NSCLC) patients undergoing stereotactic body radiation therapy (SBRT). Materials and Methods Data were obtained from January 2015 through March 202...

Purpose/Objective(s) Magnetic resonance imaging-guided radiation therapy (MRgRT) utilization is rapidly expanding worldwide, driven by advanced capabilities including continuous intrafraction visualization, automatic triggered beam delivery, and on-table adaptive replanning. Our objective was to describe patterns of 0.35T-MRgRT utilization in the U...

Purpose/Objective(s) Medical student education in radiation oncology traditionally takes place in-person during 3rd or 4th year of medical school. Due to the COVID-19 pandemic, onsite clerkships were placed on hold, leading to virtual medical student clerkships in radiation oncology which incorporated didactics and hands-on learning. We sought to i...

Purpose/Objective(s) Applications in radiation oncology residency have been on the decline in the past 3 years. This was attributed in part due to limited exposure to the field. We hypothesize that improving medical student enrollment into radiation oncology electives through virtual clerkships will increase interest and knowledge in the field. Ma...

Purpose/Objective(s) Magnetic resonance image guided stereotactic body radiotherapy (MRgSBRT) is an advanced technology that may provide radiomic feature changes during treatment of adrenal lesions feasible for adaptation. Materials/Methods A prospectively maintained database was retrospectively reviewed for 24 patients with adrenal lesions who un...

Purpose/Objective(s) We hypothesized that escalated biological effective dose (BED) via stereotactic body radiation therapy (SBRT) would improve outcomes for patients with borderline resectable (BRPC) and locally advanced pancreatic cancer (LAPC). Materials/Methods A retrospective review was performed on consecutive patients who received pancreas...

Purpose/Objective(s) We hypothesized that the addition of concurrent ipilimumab (IPI) with chemoradiotherapy followed by consolidative nivolumab (NIVO) would be safe and tolerable for patients with unresectable stage III non-small cell lung cancer (NSCLC). We report early outcomes and toxicity associated with this regimen in a phase I/II clinical t...

Purpose/Objective(s) Prescription dose for lung SBRT remains a controversial topic. Based on previous experience, a BED of 100 Gy is necessary to maximize tumor control, though many have advocated higher prescription doses (or dosimetric “hot spots”). To analyze this "imbalanced" problem (few events) and identify which factors affect not only event...

Purpose/Objective(s) Whole brain radiotherapy with hippocampal avoidance (HA-WBRT) is a technique utilized to treat extensive metastatic brain disease while preserving memory and neurocognitive function. We hypothesized that the treatment planning and delivery of HA-WBRT plans is feasible with an MRI-guided linear accelerator (Linac) and compared p...

The implementation of the radiation oncology alternative payment model (RO-APM) has raised concerns regarding the development of MRI-guided adaptive radiotherapy (MRgART). We sought to compare technical fee reimbursement under Fee-For-Service (FFS) to the proposed RO-APM for a typical MRI-Linac (MRL) patient load and distribution of 200 patients. I...

Background: The use of stereotactic body radiation therapy (SBRT) is widely utilized for treatment of localized prostate cancer. Magnetic-resonance-guided radiotherapy (MRgRT) was introduced in 2014 and has recently been implemented in SBRT for prostate cancer as it provides an opportunity for smaller margins and adaptive daily planning. Currently...

Purpose The number of U.S. fourth year medical students applying to radiation oncology has decreased over the past few years. We conducted a survey of fourth year medical students in order to examine factors that may be impacting the decision to pursue radiation oncology. Methods and Materials An anonymous online survey was sent to medical student...

Introduction Pancreatic adenocarcinoma (PAC) has some of the worst treatment outcomes for any solid tumor. PAC creates substantial difficulty for effective treatment with traditional RT delivery strategies primarily secondary to its location and limited visualization using CT. Several of these challenges are uniquely addressed with MR-guided RT. We...

The increasing complexity of healthcare emphasizes the need for continued physician leadership and leadership training. This study aims to determine baseline attitudes toward the perceptions and utility of a leadership development curriculum (LDC) for radiation oncology (RO) residents. A novel longitudinal LDC was implemented for RO residents at ou...

Background: We hypothesized that the radiosensitivity index (RSI), would classify non-small cell lung cancer (NSCLC) patients into radioresistant (RR) or radiosensitive (RS). Methods: We identified resected pathologic stage III NSCLC. For the radiation group (RT) group, at least 45 Gy of external beam radiation was required. mRNA was extracted from...

External beam radiotherapy (XRT) is a widely used cancer treatment, yet responses vary dramatically among patients. These differences are not accounted for in clinical practice, partly due to a lack of sensitive early response biomarkers. We hypothesize that quantitative magnetic resonance imaging (MRI) measures reflecting tumor heterogeneity can p...

Aims To assess the safety and efficacy of MR-guided stereotactic body radiation therapy (MRgSBRT) for cardiac metastases. Materials/methods This single institution retrospective analysis evaluated our experience with MRgSBRT for cardiac metastases. Response rate was compared between pre-RT and post-RT imaging. Symptomatic changes were also tracked...

Emergence of the COVID-19 crisis has catalyzed rapid paradigm shifts throughout medicine. Even after the initial wave of the virus subsides, a wholesale return to the prior status quo is not prudent. As a specialty that values the proper application of new technology, radiation oncology should strive to be at the forefront of harnessing telehealth...

MR-guided adaptive radiation therapy (RT) is emerging as an integral treatment modality for certain applications and is poised to become an exciting opportunity for greater treatment precision and personalization. However, this is still a relatively nascent technology and only a few institutions and programs have access to this technology for clini...

Purpose: Consolidative thoracic radiotherapy (TRT) has been shown to improve outcomes for patients with extensive stage small cell lung cancer (ES-SCLC). We hypothesized that the addition of ipilimumab (IPI) and nivolumab (NIVO) after TRT would improve outcomes for patients with ES-SCLC. Materials and methods: Eligibility required stable disease...

Purpose External beam radiotherapy (XRT) is a widely used cancer treatment, yet responses vary dramatically between patients. These differences are not accounted for in clinical practice, in part due to a lack of sensitive biomarkers of early response. In this work, we test the hypothesis that quantification of intratumor heterogeneity is a sensiti...