Chiara Lucrezia Deantoni MD , Claudio Fiorino MSc , Anna Chiara MD , Miriam Torrisi MD , Laura Giannini MD , Alessandro Loria MSc , Andrei Fodor MD , Sara Broggi MSc , Marcella Pasetti MD , Nadia Di Muzio MD , Italo Dell'Oca MD
{"title":"A Case of Radiotherapy During Pregnancy for Oropharyngeal Cancer: Long-Term Pediatric Outcome Evaluation and Literature Review","authors":"Chiara Lucrezia Deantoni MD , Claudio Fiorino MSc , Anna Chiara MD , Miriam Torrisi MD , Laura Giannini MD , Alessandro Loria MSc , Andrei Fodor MD , Sara Broggi MSc , Marcella Pasetti MD , Nadia Di Muzio MD , Italo Dell'Oca MD","doi":"10.1016/j.prro.2024.06.018","DOIUrl":"10.1016/j.prro.2024.06.018","url":null,"abstract":"<div><div>Oropharyngeal cancer (OphC) is extremely rare during pregnancy, although its incidence is expected to increase in the years to come. Any delay in treatment can heavily affect cancer control and survival. Information regarding radiation therapy during pregnancy and long-term pediatric outcomes is lacking. In this article, we discuss a case of OphC in a pregnant woman, treated with surgery and radiation therapy, offering also an updated review with respect to the limited current evidence of the feasibility and clinical results of radiation therapy during pregnancy. A 39-year-old pregnant woman (through assisted fertilization) with locally advanced OphC underwent surgery and subsequent radiation therapy. A special fetal shielding device and a modified planning optimization strategy were used to reduce the dose to the fetus as much as possible. Phantom and in vivo dosimetry were performed to estimate the dose to the fetus and the related risks, according to International Commission on Radiological Protection (ICRP) publication 90. Thanks to the actions taken, the mean dose to the fetus was estimated to be around 50 mSv. A healthy baby was born at 33 weeks of gestation + 6 days. After a 10-year follow-up, the patient is in complete remission, and her 16-year-old daughter is healthy with good school performance. Adjuvant radiation therapy in OphC during pregnancy may be optimized to reduce the dose to the fetus, and the measures taken represent a realistic option to ensure the mother and baby's health.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 2","pages":"Pages e95-e99"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
James G. Mechalakos PhD, Yu-Chi Hu PhD, Licheng Kuo MS, Lei Zhang PhD, Niral Shah MS, Ase Ballangrud PhD, Laura Cervino PhD, Ellen Yorke PhD, Yilin Liu PhD, Pengpeng Zhang PhD
{"title":"RAdiotherapy Dose Accumulation Routine (RADAR)-A Novel Dose Accumulation Script With Built-In Uncertainty","authors":"James G. Mechalakos PhD, Yu-Chi Hu PhD, Licheng Kuo MS, Lei Zhang PhD, Niral Shah MS, Ase Ballangrud PhD, Laura Cervino PhD, Ellen Yorke PhD, Yilin Liu PhD, Pengpeng Zhang PhD","doi":"10.1016/j.prro.2024.10.006","DOIUrl":"10.1016/j.prro.2024.10.006","url":null,"abstract":"<div><h3>Purpose</h3><div>To incorporate uncertainty into dose accumulation for reirradiation.</div></div><div><h3>Methods and Materials</h3><div>The RAdiotherapy Dose Accumulation Routine (RADAR) script for the Eclipse treatment planning system (Varian Medical Systems) is described, and the voxel-wise ellipsoid search algorithm is introduced as a means of incorporating uncertainty. RADAR is first demonstrated on a test patient reirradiated to the spine, illustrating the effect of the uncertainty algorithm. A summary of initial evaluation testing conducted by 11 users, each of whom ran a separate spine reirradiation case, follows. Finally, RADAR run times are reported for various conditions.</div></div><div><h3>Results</h3><div>In the demonstration case in which a 3-mm ellipsoid search was used, the maximum RADAR 2-Gy equivalent (EQD2) accumulated spinal cord dose increased from 7244 to 12,689 cGy because the ellipsoid search pulled dose from closer to the adjacent target structure. When the ellipsoid search was restricted to voxels within the spinal cord, the maximum accumulated cord dose was reduced to 6523 cGy and did not exceed the sum of the maximum EQD2 spinal cord doses of the individual plans (6730 cGy). In the evaluation cases, the RADAR EQD2 maximum dose for the spinal cord increased by an average of 31.6% with uncertainty applied compared to a conventional dose accumulation and decreased by an average of 16.7% compared to a conventional dose accumulation when the uncertainty calculation was restricted to voxels within the spinal cord. RADAR run times vary depending on the number of plans added and the type of uncertainty used.</div></div><div><h3>Conclusions</h3><div>RADAR offers a novel way to directly account for uncertainty in dose accumulation through a voxel-wise ellipsoid search algorithm. EQD2 dose accumulation with and without dose discounts is also available.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 2","pages":"Pages 187-195"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Megan Anna Carroll FRANZCR , Ryan Sommerville FRACS , Karen Hay BVSc, MEpi, PhD , Abigail Walker MBBS , Sarah Grigg MBBS , Lizbeth Kenny FRANZCR , Benjamin Chua FRANZCR , Jason Papacostas FRACS , Hamish Alexander FRACS , Charles Lin FRANZCR
{"title":"Survival and Patterns of Relapse of Cutaneous Squamous Cell Carcinoma With Large Nerve Perineural Spread After Skull Base Surgery and/or Radiation Therapy","authors":"Megan Anna Carroll FRANZCR , Ryan Sommerville FRACS , Karen Hay BVSc, MEpi, PhD , Abigail Walker MBBS , Sarah Grigg MBBS , Lizbeth Kenny FRANZCR , Benjamin Chua FRANZCR , Jason Papacostas FRACS , Hamish Alexander FRACS , Charles Lin FRANZCR","doi":"10.1016/j.prro.2024.09.007","DOIUrl":"10.1016/j.prro.2024.09.007","url":null,"abstract":"<div><h3>Purpose</h3><div>The aim of our study was to evaluate survival and patterns of relapse for patients with perineural spread (PNS) of cutaneous squamous cell carcinoma (cSCC), who have undergone curative intent skull base surgery and/or radiation therapy. In addition, we modified the classification of zone 2 disease into 2a and 2b and reported the respective outcome.</div></div><div><h3>Methods and Materials</h3><div>A review of a prospective database of patients who received diagnoses of PNS of cSCC and were treated with curative intent skull base surgery and/or radiation therapy between the years of 2013 and 2020 was conducted. Kaplan-Meier methods were used to estimate relapse-free survival (RFS), disease-specific survival (DSS), and overall survival (OS). Cox proportional hazard modeling was performed to test associations between patient factors and survival outcomes.</div></div><div><h3>Results</h3><div>Eighty patients with a median follow-up of 36 months were included in the study. The 5-year RFS was 61% (95% CI, 48%-71%), the DSS was 77% (95% CI, 63%-86%), and OS was 67% (95% CI, 53%-78%). In multivariable modeling, involvement of 2 or more nerves was strongly associated with worse 5-year RFS (HR, 4.0; <em>P</em> ≤ .001), DSS (HR, 4.5; <em>P</em> = .004), and OS (HR, 4.3; <em>P</em> = .002). Age group (≥65 years) (HR, 5.1; <em>P</em> = .010) and immune compromise (HR, 10.7; <em>P</em> = .001) were strongly associated with worse OS but not DSS or RFS. The majority of relapses (60%) occurred at the local skin sites.</div></div><div><h3>Conclusions</h3><div>Our study demonstrated surgery followed by radiation therapy was safe and effective in the management of cSCC with PNS. We did not detect a difference in outcome between zones 2a and 2b though further study is required. The most common mode of relapse was at the skin epidermis and/or adjacent dermis highlighting the importance of adequate local skin dose delivery.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 2","pages":"Pages e198-e210"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jennifer Y. Wo MD , Jonathan B. Ashman MD, PhD , Nishin A. Bhadkamkar MD , Lisa Bradfield BA , Daniel T. Chang MD , Nader Hanna MD , Maria Hawkins MD , Michael Holtz BS , Edward Kim MD , Patrick Kelly MD, PhD , Diane C. Ling MD , Jeffrey R. Olsen MD , Manisha Palta MD , Ann C. Raldow MD, MPH , Erika Ruiz-Garcia MD, PhD , Arshin Sheybani MD , Karyn B. Stitzenberg MD, MPH , Prajnan Das MD, MS, MPH
{"title":"Radiation Therapy for Rectal Cancer: An ASTRO Clinical Practice Guideline Focused Update","authors":"Jennifer Y. Wo MD , Jonathan B. Ashman MD, PhD , Nishin A. Bhadkamkar MD , Lisa Bradfield BA , Daniel T. Chang MD , Nader Hanna MD , Maria Hawkins MD , Michael Holtz BS , Edward Kim MD , Patrick Kelly MD, PhD , Diane C. Ling MD , Jeffrey R. Olsen MD , Manisha Palta MD , Ann C. Raldow MD, MPH , Erika Ruiz-Garcia MD, PhD , Arshin Sheybani MD , Karyn B. Stitzenberg MD, MPH , Prajnan Das MD, MS, MPH","doi":"10.1016/j.prro.2024.11.003","DOIUrl":"10.1016/j.prro.2024.11.003","url":null,"abstract":"<div><h3>Purpose</h3><div>With the results of several recently published clinical trials, this guideline focused update provides evidence-based recommendations for the indications and dose-fractionation regimens for neoadjuvant radiation therapy (RT), optimal sequencing of RT and systemic therapy in the context of total neoadjuvant therapy (TNT), and considerations for selective omission of RT and surgery for rectal cancer.</div></div><div><h3>Methods</h3><div>The American Society for Radiation Oncology convened a multidisciplinary task force to update 3 key questions that focused on the role of RT for patients with operable rectal cancer. The key questions addressed (1) indications for neoadjuvant RT, (2) selection of neoadjuvant regimens, and (3) indications for consideration of a nonoperative management (NOM) or local excision approach after definitive/preoperative chemoradiation. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and system for quality of evidence grading and strength of recommendation.</div></div><div><h3>Results</h3><div>For patients with stage II-III rectal cancer, neoadjuvant RT was strongly recommended; however, among patients deemed at lower risk of locoregional recurrence, consideration of omission of neoadjuvant RT was conditionally recommended in favor of neoadjuvant chemotherapy with a favorable treatment response or upfront surgery. For patients with T3-T4 and node-positive rectal cancer undergoing neoadjuvant RT, a TNT approach was strongly recommended. Among patients with higher risk of locoregional recurrence, TNT with chemotherapy before or after long-course chemoradiation was strongly recommended, whereas TNT with short-course RT followed by chemotherapy was conditionally recommended. For patients with rectal cancer for whom NOM is a priority, concurrent chemoradiation followed by consolidation chemotherapy was strongly recommended. Selection of RT dose-fractionation regimen, sequencing of therapies, and consideration of NOM should be determined by multidisciplinary consensus and based on disease extent, disease location, patient preferences, and quality of life considerations.</div></div><div><h3>Conclusions</h3><div>The task force proposed recommendations to inform best clinical practices on the use of RT for rectal cancer with strong emphasis on multidisciplinary care. Future studies should focus on further addressing optimal treatment regimens to allow for more personalized recommendations based on individual risk stratification and patient priorities regarding quality of life.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 2","pages":"Pages 124-143"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ted K. Yanagihara MD, PhD , Joel E. Tepper MD , Andrew M. Moon MD , Aisling Barry MD , Meritxell Molla MD , Jinsil Seong MD, PhD , Ferran Torres MD, PhD , Smith Apisarnthanarax MD , Michael Buckstein MD, PhD , Higinia Cardenes MD, PhD , Daniel T. Chang MD , Mary Feng MD , Chandan Guha MBBS, PhD , Christopher L. Hallemeier MD , Maria A. Hawkins MD , Morten Hoyer MD, PhD , Hiromitsu Iwata MD, PhD , Salma K. Jabbour MD , Lisa Kachnic MD , Jordan Kharofa MD , Laura A. Dawson MD
{"title":"Erratum to: Defining Minimum Treatment Parameters of Ablative Radiation Therapy in Patients With Hepatocellular Carcinoma: An Expert Consensus. Yanagihara TK, Tepper JE, Moon AM, et al. Pract Radiat Oncol. 2024 Mar-Apr;14(2):134-145","authors":"Ted K. Yanagihara MD, PhD , Joel E. Tepper MD , Andrew M. Moon MD , Aisling Barry MD , Meritxell Molla MD , Jinsil Seong MD, PhD , Ferran Torres MD, PhD , Smith Apisarnthanarax MD , Michael Buckstein MD, PhD , Higinia Cardenes MD, PhD , Daniel T. Chang MD , Mary Feng MD , Chandan Guha MBBS, PhD , Christopher L. Hallemeier MD , Maria A. Hawkins MD , Morten Hoyer MD, PhD , Hiromitsu Iwata MD, PhD , Salma K. Jabbour MD , Lisa Kachnic MD , Jordan Kharofa MD , Laura A. Dawson MD","doi":"10.1016/j.prro.2025.01.002","DOIUrl":"10.1016/j.prro.2025.01.002","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 2","pages":"Pages 214-215"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143705175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
John Paul Abrina MD, MBA , Sarah Baker MD, PhD, FRCPC , Ella Mae Cruz-Lim MD , Nick Chng PhD, FCCPM , Allison Ye MD, FRCPC , Shrinivas Rathod MD, FRCPC , Julianna Caon MD, FRCPC , Devin Schellenberg MD, FRCPC , Mitchell Liu MD, FRCPC , Benjamin Mou MD, FRCPC
{"title":"Effect of Treatment Delivery Schedule for Patients With Early-Stage Non-Small Cell Lung Cancer Treated With Stereotactic Ablative Radiation Therapy: A Population-Based Analysis","authors":"John Paul Abrina MD, MBA , Sarah Baker MD, PhD, FRCPC , Ella Mae Cruz-Lim MD , Nick Chng PhD, FCCPM , Allison Ye MD, FRCPC , Shrinivas Rathod MD, FRCPC , Julianna Caon MD, FRCPC , Devin Schellenberg MD, FRCPC , Mitchell Liu MD, FRCPC , Benjamin Mou MD, FRCPC","doi":"10.1016/j.prro.2024.07.012","DOIUrl":"10.1016/j.prro.2024.07.012","url":null,"abstract":"<div><h3>Purpose</h3><div>The optimal SABR treatment delivery schedule in stage I non-small cell lung cancer (NSCLC) remains unclear. This population-based study investigated grade ≥2 toxicity rates, local failure (LF), and overall survival (OS) in patients treated with 48 Gy in 4 fractions scheduled every other day versus daily with weekends and consecutive daily without weekends.</div></div><div><h3>Methods and Materials</h3><div>Between January 2019 and June 2022, treatment records using 48 Gy in 4 fractions were extracted from a provincial cancer registry and grouped by delivery as every other day, daily with weekends, or consecutive daily without weekends. Toxicity events were recorded using National Cancer Institute Common Terminology Criteria for Adverse Events, version 5.0. The Kaplan-Meier method was used to compute OS and LF was calculated using cumulative incidence methods with death as a competing risk. Cox regression analyses and Fine-Gray modeling was used to assess for variables associated with OS and LF, respectively.</div></div><div><h3>Results</h3><div>Of 404 patients meeting study criteria, 190, 111, and 103 received SABR every other day, daily with weekends, and consecutive daily without weekends, respectively. More patients receiving SABR daily with weekends were medically inoperable and more patients receiving SABR consecutive daily without weekends had tumors abutting the chest wall. Median follow-up time was 29.5 months (IQR, 19.2-38.4 months). Overall toxicity was low, with crude rates of acute and late grade ≥2 toxicity not being statistically different among the groups. No grade 4 or 5 toxicities were recorded. LF rates at 24 months were not different at 7.5% (95% CI, 3.7-11.3), 9.5% (95% CI, 3.9-15.1), and 11.0% (95% CI, 4.9-17.2) for the every other day, daily with weekends, and consecutive daily without weekends groups, respectively (<em>P</em> = .60). Schedules of daily with weekends and consecutive daily without weekends were not associated with LF. Similarly, no significant differences in median OS were found among the every other day, daily with weekends, and consecutive daily without weekends groups at 47.5 months (95% CI, 39.26-55.74), 52.7 months (95% CI, 34.7-70.7), and 49.0 months (95% CI, 31.6-66.4), respectively. Schedules of daily with weekends and consecutive daily without weekends were not associated with OS.</div></div><div><h3>Conclusions</h3><div>This population-based study demonstrated no statistically significant differences in grade ≥2 toxicity rates, LF, and OS for patients with stage I NSCLC treated with lung SABR using 48 Gy in 4 fractions delivered every other day, daily with weekends, and consecutive daily without weekends. Patient convenience and optimization of resources may be considered when choosing a lung SABR treatment delivery schedule.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 2","pages":"Pages e143-e154"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ciro Franzese MD , Alexander V. Louie MD, PhD , Rupesh Kotecha MD , Zhenwei Zhang PhD , Matthias Guckenberger MD , Mi-Sook Kim MD , Alison C. Tree MD(Res) , Ben J. Slotman MD, PhD , Arjun Sahgal MD , Marta Scorsetti MD
{"title":"Stereotactic Body Radiation therapy for Liver Metastases: Systematic Review and Meta-Analysis With International Stereotactic Radiosurgery Society (ISRS) Practice Guidelines","authors":"Ciro Franzese MD , Alexander V. Louie MD, PhD , Rupesh Kotecha MD , Zhenwei Zhang PhD , Matthias Guckenberger MD , Mi-Sook Kim MD , Alison C. Tree MD(Res) , Ben J. Slotman MD, PhD , Arjun Sahgal MD , Marta Scorsetti MD","doi":"10.1016/j.prro.2024.09.011","DOIUrl":"10.1016/j.prro.2024.09.011","url":null,"abstract":"<div><h3>Purpose</h3><div>Liver metastases are a significant clinical challenge in cancer management, often representing a stage of disease in which curative treatment is still possible. Stereotactic body radiation therapy (SBRT) has emerged as a promising modality for treating these metastases, offering a noninvasive approach with potential for high efficacy. This systematic review and meta-analysis provides a comprehensive analysis of the efficacy and safety of SBRT in treating liver metastases, and practice recommendations are provided.</div></div><div><h3>Methods and Materials</h3><div>We performed a thorough literature review, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach, and included 33 studies with a total of 3101 patients and 4437 liver metastases.</div></div><div><h3>Results</h3><div>The review revealed pooled local control rates at 1, 2, and 3 years of 85%, 75%, and 68% respectively, while overall survival rates were 79%, 54%, and 37%. Grade 3 and 4 side effects occurred in only 3% of patients. The review of the studies highlighted the importance of factors such as primary tumor histology, lesion characteristics, and radiation dose in predicting treatment outcomes.</div></div><div><h3>Conclusions</h3><div>This review supports the growing body of evidence that SBRT is an efficacious and safe treatment option for liver metastases. It underscores the need for careful patient selection and personalized treatment planning to optimize outcomes.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 2","pages":"Pages e172-e188"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ambrosia Simmons MD, PhD , David Sher MD , Dr. Dong Wook Nathan Kim MD, PhD , Marilyn Leitch MD , Rachel Wooldridge MD , Sally Goudreau MD , Stephen Seiler MD , Sarah Neufeld MS , Maggie Stein BS , Kevin Albuquerque MD , Ann Spangler MD , John Heinzerling MD , Dan Garwood MD , Stella Stevenson BSRT(T) , Chul Ahn PhD , Chuxiong Ding PhD , Robert D. Timmerman MD , Asal Rahimi MD, MS
{"title":"Financial Toxicity and Quality-of-Life Outcomes on a Phase 1 5-fraction Stereotactic Partial Breast Irradiation Protocol for Early-Stage Breast Cancer","authors":"Ambrosia Simmons MD, PhD , David Sher MD , Dr. Dong Wook Nathan Kim MD, PhD , Marilyn Leitch MD , Rachel Wooldridge MD , Sally Goudreau MD , Stephen Seiler MD , Sarah Neufeld MS , Maggie Stein BS , Kevin Albuquerque MD , Ann Spangler MD , John Heinzerling MD , Dan Garwood MD , Stella Stevenson BSRT(T) , Chul Ahn PhD , Chuxiong Ding PhD , Robert D. Timmerman MD , Asal Rahimi MD, MS","doi":"10.1016/j.prro.2024.08.012","DOIUrl":"10.1016/j.prro.2024.08.012","url":null,"abstract":"<div><h3>Purpose</h3><div>We report the financial toxicity and quality-of-life outcomes of our prospective phase 1 dose-escalation study of 5-fraction stereotactic partial breast irradiation (S-PBI) for early-stage breast cancer.</div></div><div><h3>Materials and Methods</h3><div>Women with unifocal in situ or invasive epithelial histologies, clinical stages 0, I, or II with tumor size < 3 cm treated with lumpectomy were enrolled in our phase 1 5-fraction S-PBI dose-escalation trial. Our institutionally generated questionnaire on the “Patient Perspective Cost and Convenience of Care” and the EuroQol 5-Dimension 5-level questionnaire were administered to patients treated at follow-up.</div></div><div><h3>Results</h3><div>Between 2010 and 2015, 68 of the 75 patients who enrolled and completed treatment on trial completed at least some component of either the EuroQol 5-Dimension 5-level questionnaire or the “Patient Perspective Cost and Convenience of Care” questionnaire. Nearly all patients reported very high satisfaction with their treatment overall, particularly the shortened length of treatment. Over half of the patients reported some level of financial toxicity (FT) despite a significantly shortened treatment time. Patients who reported any FT were significantly younger than patients with no financial burden of treatment (means 59.2 and 63.7, respectively, <em>P</em> = .03). There was no difference in those who reported any level of FT based on patient race, ethnicity, marital, or employment status. This S-PBI regimen did not significantly affect quality of life over a 4-year follow-up.</div></div><div><h3>Conclusions</h3><div>These patient-reported outcomes suggest that the use of accelerated partial breast irradiation may offer low FT rates in breast cancer care, particularly for disadvantaged patient groups.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 2","pages":"Pages e115-e123"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Siqiu Wang PhD, Chien-Yi Liao PhD, Byongsu Choi PhD, Sean All MD, Ti Bai PhD, Justin Visak PhD, Dominic Moon MD, Arnold Pompos PhD, Vladmir Avkshtol MD, David Parsons PhD, Andrew Godley PhD, David Sher MD, Mu-Han Lin PhD
{"title":"Impact of Manual Contour Editing on Plan Quality for Online Adaptive Radiation Therapy for Head and Neck Cancer","authors":"Siqiu Wang PhD, Chien-Yi Liao PhD, Byongsu Choi PhD, Sean All MD, Ti Bai PhD, Justin Visak PhD, Dominic Moon MD, Arnold Pompos PhD, Vladmir Avkshtol MD, David Parsons PhD, Andrew Godley PhD, David Sher MD, Mu-Han Lin PhD","doi":"10.1016/j.prro.2024.09.005","DOIUrl":"10.1016/j.prro.2024.09.005","url":null,"abstract":"<div><h3>Purpose</h3><div>Online adaptive radiation therapy (oART) has high resource costs especially for head and neck (H&N) cancer, which requires recontouring complex targets and numerous organs-at-risk (OARs). Adaptive radiation therapy systems provide autocontours to help. We aimed to explore the optimal level of editing automatic contours to maintain plan quality in a cone beam computed tomography-based oART system for H&N cancer. In this system, influencer OAR contours are generated and reviewed first, which then drives the autocontouring of the remaining OARs and targets.</div></div><div><h3>Methods and materials</h3><div>Three-hundred-forty-nine adapted fractions of 44 patients with H&N cancer were retrospectively analyzed, with physician-edited OARs and targets. These contours and associated online-adapted plans served as the gold standard for comparison. We simulated 3 contour editing workflows: (1) no editing of contours; (2) only editing the influencers; and (3) editing the influencers and targets. The geometric difference was quantified using the Dice similarity coefficient (DSC) and Hausdorff distance (HD). The dosimetric differences in target coverage and OAR doses were calculated between the gold standard and these 3 simulated workflows.</div></div><div><h3>Results</h3><div>Workflow 1 resulted in significantly inferior contour quality for all OARs (mean DSC, 0.85 ± 0.17 and HD95, 3.10 ± 5.80mm); hence, dosimetric data was not calculated for workflow 1. In workflow 2, the frequency of physician editing targets and remaining OARs were 80.8% to 95.7% and 2.3% (brachial plexus) to 67.7% (oral cavity), respectively, where the OAR differences were geometrically minor (mean DSC >0.95 with std ≤0.09). However, because of the unedited target contours of workflow 2 (mean DSC, 0.86-0.92 and mean HD95, 2.56-3.30 mm vs the ground-truth targets), plans were inadequate with insufficient coverage. In workflow 3, when both targets and influencers were edited (noninfluencer OARs were unedited), >95.5% of the adapted plans achieved the patient-specific dosimetry goals.</div></div><div><h3>Conclusions</h3><div>The cone beam computed tomography-based H&N oART workflow can be meaningfully accelerated by only editing the influencers and targets while omitting the remaining OARs without compromising the quality of the adaptive plans.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 2","pages":"Pages e211-e219"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dana L. Casey MD , Erin S. Murphy MD , Colette J. Shen MD, PhD , Sarah A. Milgrom MD , Nicole A. Larrier MD, MS , Julie A. Bradley , Matthew M. Ladra MD, MPH , Daniel J. Indelicato MD , Christine E. Hill-Kayser MD , Scott C. Borinstein MD, PhD , Leo Y. Luo MD
{"title":"Metastatic-Site Radiation Therapy for Ewing Sarcoma and Rhabdomyosarcoma: Consensus Guidelines From the National Pediatric Cancer Foundation","authors":"Dana L. Casey MD , Erin S. Murphy MD , Colette J. Shen MD, PhD , Sarah A. Milgrom MD , Nicole A. Larrier MD, MS , Julie A. Bradley , Matthew M. Ladra MD, MPH , Daniel J. Indelicato MD , Christine E. Hill-Kayser MD , Scott C. Borinstein MD, PhD , Leo Y. Luo MD","doi":"10.1016/j.prro.2024.10.004","DOIUrl":"10.1016/j.prro.2024.10.004","url":null,"abstract":"<div><h3>Purpose</h3><div>Despite the urgent need for improved outcomes in patients with metastatic Ewing sarcoma (EWS) and rhabdomyosarcoma (RMS), it is unknown how to best approach metastatic-site radiation therapy for these patients and whether such treatment provides a significant oncologic benefit that outweighs the toxicities.</div></div><div><h3>Methods and Materials</h3><div>We gathered a panel of pediatric radiation oncologists from academic hospitals to identify and discuss current controversies regarding the role of radiation in the management of metastatic EWS and RMS. The panel reviewed existing clinical data and ongoing trials to address 5 key questions: (1) the role of whole lung irradiation (WLI) in treating lung metastases; (2) the number of metastatic sites warranting radiation therapy and the radicality of such an approach; (3) radiation techniques, including stereotactic body radiation therapy (SBRT); (4) the timing of metastatic-site radiation therapy; and (5) the utility of metastatic-site radiation therapy for relapsed metastatic disease.</div></div><div><h3>Results</h3><div>After a review of existing data, consensus recommendations were developed to support the decision-making process in metastatic-site irradiation, aiming to improve long-term disease control. Patients with pulmonary metastases should receive WLI. In patients with limited (<8 sites) metastatic disease, a comprehensive approach should be taken to treat all sites of metastatic disease diagnosed at presentation. SBRT should be considered as a preferred treatment technique. The timing of metastatic-site treatment should coincide with the end of systemic therapy. However, if there is a dosimetric advantage or improved compliance, concurrent treatment with the primary site may be preferred.</div></div><div><h3>Conclusions</h3><div>A consensus guideline was established to address several critical questions regarding the role of radiation in the treatment of metastatic EWS and RMS. The study highlights the existing controversies, provides a structured approach, and underscores the need for future studies to further evaluate the therapeutic ratio of metastatic-site directed therapy.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 2","pages":"Pages 180-186"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}