Practical Radiation Oncology最新文献

{"title":"Pharyngeal Constrictor-Sparing Salvage Stereotactic Body Radiation Therapy With Tongue-Out for In-Field Recurrence After Definitive Radiation Therapy for Head and Neck Cancer: Guide to Tongue-Out Radiation Therapy","authors":"Whoon Jong Kil MD ,&nbsp;Subarna Eisaman MD ,&nbsp;Christopher Wilke MD ,&nbsp;Yvonne Mowery MD ,&nbsp;Wyatt Smith CMD ,&nbsp;Craig Herndon PhD ,&nbsp;David Cousins MD","doi":"10.1016/j.prro.2024.06.014","DOIUrl":"10.1016/j.prro.2024.06.014","url":null,"abstract":"<div><div>This report details a pharyngeal constrictor muscle (PCM)–sparing stereotactic body radiation therapy (SBRT) using our institutional technique of “tongue-out” radiation therapy (TORT) for treating a local recurrent cancer in the uvula (GTV_uvula) in a patient with history of a definitive chemotherapy with radiation therapy (70 Gy with weekly cisplatin) for a locally advanced laryngeal cancer 4 years ago. TORT includes optimizing the patients’ reproducible tongue-out position using readily available medicine cup (30 cc) followed by sculping the thermoplastic mask with tongue-out, and real-time visual monitoring of the tongue position during the computed tomography simulation scan, cone beam computed tomography acquisition, and treatment. Between arcs during volumetric modulated arc therapy, time for tongue relaxation and saliva swallowing can be given to the patient. Without TORT, the patient's GTV_uvula abutted the medial aspect of superior PCM (medial-sPCM) and a substantial volume of the previously irradiated superior PCM (sPCM) would have received high radiation dose from this salvage SBRT (32.5 Gy in 5 fractions). Comparing without TORT, the shortest distance between medial-sPCM-to-GTV_uvula was increased by 13 mm with TORT, which reduced radiation dose to sPCM in the salvage SBRT plan. The mean dose to sPCM was decreased from 20.5 Gy without TORT to 12.7 Gy with TORT. With TORT, minimal sPCM volumes fell within higher isodose line: volume receiving ≥ 60% prescription dose (V_60%Rx), V_80%Rx, and V_100%Rx to sPCM was, 4.8 versus 0.7 cc (without vs with TORT, respectively), 2.9 versus 0.19 cc, and 1.6 versus 0.04 cc, respectively. Maximum dose (<em>D</em>_max) to medial-sPCM was 34.6 Gy without TORT versus 22.7 Gy with TORT. These high doses to the sPCM and intrafractional swallowing-related geographic misses of GTV_uvula were avoided through the application of TORT in this salvage reirradiation setting. The patient successfully finished salvage SBRT with TORT resulting in no dysphagia or mucositis and maintained complete response at 12 months after treatment.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 1","pages":"Pages e21-e28"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141762638","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}

{"title":"PROshot: Hypofractionated Postmastectomy Radiation, Palliative Liver Radiation, Celiac Plexus Radiosurgery, Perioperative Chemoradiation for Gastric Cancer, and Prostate Stereotactic Body Radiation Therapy Versus Prostatectomy","authors":"Caleb Dulaney MD ,&nbsp;Laura Dover MD, MSPH","doi":"10.1016/j.prro.2024.10.001","DOIUrl":"10.1016/j.prro.2024.10.001","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 1","pages":"Pages 3-7"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958694","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}

{"title":"The Black Car (Children Playing)","authors":"Stephan Bodis MD","doi":"10.1016/j.prro.2024.09.014","DOIUrl":"10.1016/j.prro.2024.09.014","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 1","pages":"Pages 8-9"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958699","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}

{"title":"Masthead/Sub page","authors":"","doi":"10.1016/S1879-8500(24)00311-4","DOIUrl":"10.1016/S1879-8500(24)00311-4","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 1","pages":"Page A1"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143129723","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}

{"title":"Patient Positional Uncertainty and Margin Reduction in Lung Stereotactic Ablative Radiation Therapy Using Pneumatic Abdominal Compression.","authors":"Yohan A Walter, Chiachien J Wang, Daniel B Speir, William E Burrell, Carlos D Palomeque, James C Henry, Megan M Rodrigues, Troy D Jacobs, Bethany L Broekhoven, Joseph P Dugas, Anne N Hubbard, Philip F Durham, Hsinshun T Wu","doi":"10.1016/j.prro.2024.12.001","DOIUrl":"10.1016/j.prro.2024.12.001","url":null,"abstract":"<p><strong>Purpose: </strong>Motion management presents a significant challenge in thoracic stereotactic ablative radiation therapy (SABR). Currently, a 5.0-mm standard planning target volume (PTV) margin is widely used to ensure adequate dose to the tumor. Considering recent advancements in tumor localization and motion management, there is merit to reassessing the necessary PTV margins for modern techniques. This work presents a large-scale analysis of intrafraction repositioning for lung SABR under forced shallow breathing to determine the margin requirements for modern delivery techniques.</p><p><strong>Methods and materials: </strong>Treatment data for 124 lung SABR patients treated in 607 fractions on a linear accelerator were retrospectively collected for analysis. All patients were treated using pneumatic abdominal compression and intrafraction 4-dimensional (4D) cone beam computed tomography (4D CBCT)-guided repositioning halfway through treatment. Executed repositioning shifts were collected and used to calculate margin requirements using the 2-SD method and an analytical model which accounts for systematic and random errors in treatment.</p><p><strong>Results: </strong>A total of 85.7% of treated fractions had 3-dimensional repositioning shifts under 5.0 mm. Fifty-three fractions (8.7%) had shifts ≥ 5.0 mm in at least 1 direction. Margins in the right-left, inferior-superior, and posterior-anterior directions were 3.62 mm, 4.34 mm, and 3.50 mm, respectively, calculated using the 2-SD method. The analytical approach estimated that 4.01 mm, 4.37 mm, and 3.95 mm margins were appropriate for our workflow. Executing intrafraction repositioning reduced margin requirements by 0.73 ± 0.07 mm.</p><p><strong>Conclusions: </strong>Clinical data suggest that the uniform 5.0-mm margin is conservative for our workflow. Using modern techniques such as 4D CT, 4D CBCT, and effective motion management can significantly reduce required margins, and therefore necessary healthy tissue dose. However, the limitations of margin calculation models must be considered, and margin reduction must be approached with caution. Users should conduct a formal risk assessment prior to adopting new standard PTV margins.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903455","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}

{"title":"Radiopharmaceutical and Radioembolization Therapy: Clinical Guidance for Medical Physicists in Radiation Oncology.","authors":"Jonathan A Polignani, Kenneth J Nichols","doi":"10.1016/j.prro.2024.12.005","DOIUrl":"10.1016/j.prro.2024.12.005","url":null,"abstract":"<p><p>Recent advances in radiopharmaceutical therapy (RPT) and radioembolization (RE) will make these forms of therapy more prevalent in radiation oncology and nuclear medicine clinics. This article guides medical physicists in radiation oncology by summarizing current RPT and RE techniques, processes, safety, quality assurance, equipment, and others. The summarized guidance, which addresses technical considerations, may be applied broadly to develop a clinical RPT/RE program that offers multiple types of such therapies.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903660","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}

{"title":"Defining an Undergraduate Radiation Oncology Microclerkship Using the Delphi Method.","authors":"Julia Willcox, Austin T Gregg, Steve Braunstein, Malcolm D Mattes, Jillian Gunther, Matthew Abrams","doi":"10.1016/j.prro.2024.12.003","DOIUrl":"10.1016/j.prro.2024.12.003","url":null,"abstract":"<p><strong>Purpose: </strong>Many medical students in the US lack formal exposure to radiation oncology (RO). In contrast to multi-week electives, microclerkships, defined here as brief (<1 week) observerships, could provide exposure to RO. The primary objective of this study was to establish expert consensus for the duration, curriculum, target audience, and goals/objectives of an RO microclerkship. With these components, the microclerkship aims to provide medical students with the necessary exposure to RO.</p><p><strong>Methods and materials: </strong>A needs assessment evaluating the demand for, and essential elements of, an RO microclerkship was distributed to medical student clerkship directors. Based on responses, the authors developed a preliminary set of 7 goals, 5 objectives, and 4 curricular items. These were refined through an iterative Delphi process. Three surveys were sent to 7 medical education experts across several institutions and medical specialties. Surveys asked experts to rank elements for inclusion, comment on clarity, and suggest new ones. The consensus threshold was defined as 83% of respondents selecting \"Definitely Include\" or \"Maybe Include.\" The final survey asked experts to explain the selection of exclusionary options.</p><p><strong>Results: </strong>Surveys demonstrated that third-year medical students and 3 to 5 days were the ideal target audience and duration for an RO microclerkship. The final goals emphasized the following: the role/value of RO, understanding of RO mechanisms, RO integration in care, interdisciplinary management, longitudinal care, and workflow. Final objectives included seeing a consult, follow-up, and on-treatment visit; participating in a simulation; and observing contouring, treatment planning, and radiation plan review. Curricular items were preclinic/postclinic quizzes, a 1-hour introduction to RO lecture, and a shadowing experience.</p><p><strong>Conclusions: </strong>Through the Delphi process, we have established a framework for an RO microclerkship with a consensus duration, curriculum, target audience, and goals/objectives. Integration of this 3- to 5-day microclerkship into third-year medical school curricula would provide an avenue for increased exposure to RO during undergraduate medical education.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142902870","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}

{"title":"Patterns of Recurrence Following Radiation and ADT for Pathologic Lymph Node-Positive Prostate Cancer: A Multi-institutional Study.","authors":"Leslie K Ballas, Chandana A Reddy, Hye Ri Han, Jelena B Makar, Omar Mian, James Broughman, Conchita de Bustamante, Scott Eggener, Stanley L Liauw, Matthew Abramowitz, Christopher Montoya, Rahul Tendulkar","doi":"10.1016/j.prro.2024.12.006","DOIUrl":"10.1016/j.prro.2024.12.006","url":null,"abstract":"<p><strong>Purpose: </strong>We evaluate prognostic factors and patterns of recurrence in patients who received RT ± androgen deprivation therapy (ADT) for pathologic node-positive (pN1) prostate cancer (PCa) in a multi-institutional cohort.</p><p><strong>Methods and materials: </strong>Data from patients with pN1 PCa and received RT with short-term (ST, ≤6 mo) or long-term (LT, >6 mo) ADT were obtained from 4 academic institutions. Biochemical progression-free survival (bPFS) and distant metastasis-free survival (DMFS) were evaluated.</p><p><strong>Results: </strong>Two hundred seventy patients were included, with a median follow-up of 48 months. Two hundred fifty-six (95%) patients had extracapsular extension, 70% had seminal vesicle invasion, 59% had positive surgical margins, 49% had grade group 5, and 64% had a detectable (>0.1 ng/mL) postoperative prostate-specific antigen (PSA). ADT was ST (20%) or LT (68%, median 24 months), whereas 26 (10%) received no ADT. Biochemical failure (bF) was observed in 29%, with 5% having pelvic nodal failure and 11% having distant metastases. The 4-year bPFS was 72% overall, and was 83% for a pre-RT PSA of <0.1 ng/mL, 76% for PSA 0.1 to <0.5 ng/mL, 60% for PSA 0.5 to 2 ng/mL, and 35% for PSA > 2 ng/mL (P < .0001). On multivariable analysis, pre-RT PSA > 0.5 (0.5-2.0 vs <0.1 hazard ratio (HR), 2.97; >2.0 vs <0.1 HR, 7.63), use of LT ADT versus no ADT (HR, 0.43) and use of LT ADT compared to ST ADT (HR, 0.34), Grade group 4 versus 2 (HR, 4.11), and positive surgical margins (HR, 1.773) were significantly associated with bPFS.</p><p><strong>Conclusions: </strong>Postprostatectomy RT at PSA < 0.5 ng/mL is associated with favorable bPFS in pN1 PCa.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903383","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}

{"title":"On-Table Virtual Reality to Reduce Anxiety/Distress during Radiation Treatments: A Pilot Randomized Trial.","authors":"Petra Woehrle, Bari Hillman, Nicole Herstad, Anna Hjelle, Xuan Li, Mark Ingram, Nils D Arvold","doi":"10.1016/j.prro.2024.12.004","DOIUrl":"10.1016/j.prro.2024.12.004","url":null,"abstract":"<p><p>We report the first randomized trial of a virtual reality (VR) headset used on-table during external beam radiation therapy (RT) treatments to reduce anxiety/distress during receipt of RT. A small pilot study was conducted among 10 patients, with VR randomized to start in the first week (\"immediate VR\") versus the second week (\"delayed VR\") of treatment. All patients (100%) in the immediate VR group had declines in measured distress scores after their first radiation treatment, compared to only 1 patient (16.7%) in the delayed VR group (P = .048), yet score declines generally did not meet the minimal clinically important difference threshold in the context of overall low distress scores at baseline. By day 5 of treatment, distress score changes were similar between immediate and delayed VR groups. Overall, 80% of patients in the study, including all patients with moderate or high levels of baseline anxiety/distress, reported that on-table VR improved their RT experience and/or they would recommend VR to others. We propose that on-table VR is a readily available, nonpharmacologic intervention that can be used to help reduce anxiety/distress associated with RT and may be particularly helpful at the start of treatment among those with moderate/high baseline levels of anxiety/distress.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899252","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}

{"title":"Highs and Lows of Spatially Fractionated Radiation Therapy: Dosimetry and Clinical Outcomes.","authors":"Dawn Owen, W Scott Harmsen, Safia K Ahmed, Ivy A Petersen, Michael G Haddock, Daniel J Ma, Sydney Pulsipher, Kimberly S Corbin, Scott C Lester, Sean S Park, Christopher L Deufel, James A Kavanaugh, Michael P Grams","doi":"10.1016/j.prro.2024.12.002","DOIUrl":"10.1016/j.prro.2024.12.002","url":null,"abstract":"<p><strong>Objectives: </strong>Spatially fractionated radiation therapy (SFRT) intentionally delivers a heterogeneous dose distribution characterized by alternating regions of high and low doses throughout a tumor. This modality may enhance response to subsequent whole tumor radiation in bulky and radioresistant lesions that are historically less responsive to conventional radiation doses alone. The current study presents a single institution experience with modern era SFRT using predominantly a volumetric modulated arc therapy (VMAT) lattice technique.</p><p><strong>Methods: </strong>Patients treated with SFRT between 10/2019 and 6/2022 were included for analysis. Patient characteristics, tumor characteristics, and dosimetric parameters were collected retrospectively as part of an institutional review board approved registry and protocol. Descriptive statistics were used to collate patient data and Kaplan Meier analysis were generated for overall survival and local control. Univariate analyses were used to investigate factors associated with outcomes.</p><p><strong>Results: </strong>A total of 176 patients with 186 sites treated were included. Median age was 64 and the most commonly treated histologies were non-small cell lung cancer and sarcoma. The most common SFRT dose was 20 Gy in 1 fraction with 88% of patients receiving follow-up whole tumor radiotherapy to a median EQD2 dose of 32.5 Gy (=10). Median gross tumor volume (GTV) was 480.5 cc (7.8-10,897.8). Median follow-up was 322 days with 1 year overall survival 37% and 1 year local control 81%. Local control was available in 138 treated sites (131 patients. SFRT factors including dose to 10% (D10%), dose to 90% (D90%), equivalent uniform dose, and mean dose were highly predictive of local control. Grade 3 toxicity occurred in 9 patients. All of these patients received follow-up whole tumor radiation and at least two of these were attributable to unexpected rapid regression of tumor.</p><p><strong>Conclusions: </strong>SFRT is a promising technique that appears to confer good local control across a disparate group of patients with bulky and radioresistant tumors. Dosimetric parameters of SFRT treatment plans may be independent predictors of local control. Further investigation is warranted as are prospective trials to evaluate the role of SFRT in both the palliative and definitive setting.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900445","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}