Practical Radiation Oncology最新文献

{"title":"Transforming the Landscape of Clinical Information Retrieval Using Generative Artificial Intelligence: An Application in Machine Fault Analysis.","authors":"Tyler Alfonzetti, Junyi Xia","doi":"10.1016/j.prro.2025.02.006","DOIUrl":"10.1016/j.prro.2025.02.006","url":null,"abstract":"<p><p>In a radiation oncology clinic, machine downtime can be a serious burden to the entire department. This study investigates using increasingly popular generative artificial intelligence (AI) techniques to assist medical physicists in troubleshooting linear accelerator issues. Google's NotebookLM, supplemented with background information on linear accelerator issues/solutions, was used as a machine troubleshooting assistant for this purpose. Two board-certified medical physicists evaluated the large language model's responses based on hallucination, relevancy, correctness, and completeness. Results indicated that responses improved with increasing source data context and more specific prompt construction. Keeping risk mitigation and the inherent limitations of AI in mind, this work offers a viable, low-risk method to improve efficiency in radiation oncology. This work uses a \"Machine Troubleshooting Assistance\" application to provide an adaptable example of how radiation oncology clinics can begin using generative AI to enhance clinical efficiency.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538170","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":"Experience.","authors":"John Mohan Mathew","doi":"10.1016/j.prro.2025.02.009","DOIUrl":"10.1016/j.prro.2025.02.009","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538168","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":"Radiation Therapy for Anal Squamous Cell Carcinoma: An ASTRO Clinical Practice Guideline.","authors":"Mary Feng, Christopher L Hallemeier, Camille Almada, Olivia Aranha, Jennifer Dorth, Seth Felder, Karyn A Goodman, Emma B Holliday, Krishan R Jethwa, Lisa A Kachnic, Eric D Miller, James D Murphy, Erqi Pollom, Terence T Sio, Horatio Thomas, Patricia Lindsay, Lisa Bradfield, Amanda R Helms, Brian G Czito","doi":"10.1016/j.prro.2025.02.001","DOIUrl":"10.1016/j.prro.2025.02.001","url":null,"abstract":"<p><strong>Purpose: </strong>This guideline provides evidence-based recommendations addressing the indications for definitive treatment of primary squamous cell carcinoma of the anal canal and anal margin.</p><p><strong>Methods: </strong>The American Society for Radiation Oncology convened a task force to address 4 key questions focused on (1) indications for radiation therapy (RT), concurrent systemic therapy and local excision/surgery, (2) appropriate RT techniques, (3) appropriate RT dose-fractionation regimens, target volumes, and dose constraints, and (4) appropriate surveillance strategies after definitive treatment. Recommendations are based on a systematic literature review and created using a predefined consensus-based methodology and system for grading evidence quality and recommendation strength.</p><p><strong>Results: </strong>Multidisciplinary evaluation and decision-making are recommended for all patients. Definitive treatment with combined modality therapy is recommended for most patients using concurrent 5-fluorouracil or capecitabine plus mitomycin, with cisplatin as a conditional alternative to mitomycin with RT. Select patients with early-stage disease may be considered for local excision alone. RT target volumes should include the primary tumor/anal canal and rectum, and mesorectal, presacral, internal and external iliac, obturator, and inguinal lymph nodes. Intensity modulated RT-based treatment approaches are recommended. The primary tumor should receive doses of 4500 to 5940 cGy in 25 to 33 fractions, and clinically involved lymph nodes should receive 5040 to 5400 cGy in 28 to 30 fractions, depending on disease stage and RT approach. Elective nodal volumes should receive 3600 to 4500 cGy in 20 to 30 fractions, depending on disease stage and RT approach. Dose guidance for normal tissues and measures to minimize acute and chronic treatment-related toxicity are provided. Treatment breaks should be minimized. Posttreatment surveillance strategies, including timing of clinical/digital exam, anoscopy, computed tomography, magnetic resonance imaging, and positron emission tomography/computed tomography, are discussed.</p><p><strong>Conclusions: </strong>These evidence-based recommendations guide clinical practice on the use of definitive therapy for localized anal squamous cell carcinoma. Future studies will further refine the optimal RT dose for early- and advanced-stage disease, use of alternative systemic agents, including immunotherapy, the role of adaptive RT, and other strategies to minimize long-term treatment-related toxicity.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538169","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":"Improving Lung Stereotactic Body Radiation Therapy Dose Conformity Using a Simple Noncoplanar Volumetric Modulated Arc Therapy Technique.","authors":"Tiffany Kei, Kirk Luca, Oluwatosin Kayode, Kristin A Higgins, Jeffrey D Bradley, Joseph W Shelton, Ashish B Patel, Xiaofeng Yang, Eduard Schreibmann, Jiahan Zhang, Aparna H Kesarwala, Justin Roper","doi":"10.1016/j.prro.2025.02.007","DOIUrl":"10.1016/j.prro.2025.02.007","url":null,"abstract":"<p><p>This study characterizes lung stereotactic body radiation therapy (SBRT) dose conformity for a noncoplanar volumetric modulated arc therapy (VMAT) technique. Retrospectively, 288 previously treated lung SBRT cases were replanned using a VMAT technique of 2 ipsilateral 180° arcs separated by 30° couch angles. Two objectives were used for optimization: a lower objective to achieve planning target volume (PTV) coverage and a custom normal tissue objective to steepen the dose gradient. The dose was calculated using Acuros. PTV coverage was 95%. Doses to the spinal cord, chest wall, esophagus, great vessels, heart, lungs, and trachea were evaluated. Conformity index (CI, isodose volume/PTV) values were recorded at the 10% to 100% isodose levels. CI50% results were benchmarked against the corresponding clinical plans and evaluated using the Wilcoxon signed-rank test. Linear regression was performed to characterize the relationship between dose conformity and the following PTV features: Hounsfield Units, volume, surface area, surface-to-volume ratio, and compactness. Compared with the clinical plans, the 2-objective VMAT plans demonstrated comparable or superior sparing of organs at risk with improvements in CI at the 10% to 100% isodose levels, all of which were statistically significant (P < .001). The average reductions in CI30% and CI50% were 3.5 and 0.63, respectively. Compared with the clinical plans, cases exceeding Radiation Therapy Oncology Group CI50% limits were reduced from n = 10 to 0 unacceptable and n = 78 to 20 acceptable variations. At CI30% to CI60%, regression showed that PTV Hounsfield Units and surface-to-volume ratio were significant (P < .001) predictors of dose conformity. An easily implementable VMAT technique achieved improved conformity across a broad range of lung SBRT cases and is now the standard at our institution. Further, dose conformity was characterized at different isodose levels with consideration of PTV features. Results from this study supplement historic clinical trial guidelines by providing more comprehensive and patient-specific goals for lung SBRT dose conformity.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525241","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":"Analysis of U.S. Radiation Oncology Residency Program Websites: A Call for Further Improvements.","authors":"David J Lee, Danielle Cerbon, Cristiane Takita, Brandon A Mahal","doi":"10.1016/j.prro.2025.02.002","DOIUrl":"10.1016/j.prro.2025.02.002","url":null,"abstract":"<p><strong>Purpose: </strong>In 2015, only 13% of radiation oncology residency program websites were found to contain ≥80% of the crucial information sought by applicants. In a \"post-COVID-19 world\" in which many programs are continuing exclusively virtual interviews, digital resources often serve as first impressions of an organization. Therefore, our objective was to evaluate common website deficiencies and program website comprehensiveness, as well as to assess how they correlate with program characteristics.</p><p><strong>Methods and materials: </strong>Eighty-eight residency programs, their websites, and characteristics, including program size, match rate, accreditation status, and publication percentile, were identified using the FREIDA Residency Program Database, the Doximity Residency Navigator, a list of radiation oncology residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME), and the 2019-2023 National Resident Matching Program data. Website comprehensiveness was evaluated based on 16 criteria, including information on didactics, clinical rotations, application requirements, current residents, alumni, technology and research, and the presence of video resources. Relationships between program characteristics and website comprehensiveness were evaluated using a Kruskal-Wallis t test and linear regression.</p><p><strong>Results: </strong>Comprehensiveness scores had a mean and median of 76.3% and 81.3%, respectively, ranging from 18.8% to 100%. Of the 16 criteria, 9 were present in ≥80% of websites, and 3 (information about call responsibilities, medical student clerkships, and social opportunities) were present in ≤60% of websites. Programs accredited without warning had more comprehensive websites than programs accredited with a warning (P < .01). Programs with more current residents (P = .007), more spots offered in the Match (P = .008), and higher resident publication percentiles (P = .002) had more comprehensive websites.</p><p><strong>Conclusions: </strong>While the comprehensiveness of US radiation oncology residency program websites has improved significantly on average over the past decade, there is still ample room for further improvement - only 26.1% and 54.5% of websites contained information about call responsibilities and student clerkships, respectively. Future investigations include relationships between match rates and program/location-specific characteristics (eg, region, cost of living, and salary/benefits).</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517282","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":"Variations in Radiation Therapy Delineation of the Lateral Compartments in Patients with Rectal Cancer: Results After an Updated National Guideline.","authors":"Eline G M van Geffen, Tania C Sluckin, Marnix G Witte, Sanne-Marije J A Hazen, Femke P Peters, Martijn P W Intven, Pieter J Tanis, Miranda Kusters, Corrie A M Marijnen","doi":"10.1016/j.prro.2025.01.014","DOIUrl":"10.1016/j.prro.2025.01.014","url":null,"abstract":"<p><strong>Purpose: </strong>In rectal cancer, accurate delineation is crucial for patients with enlarged lateral lymph nodes to minimize lateral local recurrence risk. This study aims to evaluate interphysician variation in delineation of the lateral compartments, and the impact of training and implementation of standardized delineation protocols.</p><p><strong>Methods and materials: </strong>Twenty-three radiation oncologists from 15 institutes delineated the clinical target volume (CTV) on computed tomography scan in 1 example of a patient with rectal cancer. Parallel to this, the national consensus guideline was updated. Participating radiation oncologists completed an e-learning and online training session. Subsequently, 12 radiation oncologists redelineated the same case. Variation was measured with the Dice score and 95% Hausdorff distance.</p><p><strong>Results: </strong>Considerable interphysician variation was present before guideline distribution; and larger in the anterior compartment than the posterior compartment (Dice score 0.66 vs 0.80, P < .01). After training, there was a significant improvement in 95% Hausdorff distance for the lateral compartments together (0.71 vs 1.02, P = .02), but not in Dice score (0.76 vs 0.78, P = .31), and neither for the anterior and posterior compartment separately. Whereas delineation variation in the ventral and lateral sides decreased, the variation in the caudal side of the anterior compartment increased.</p><p><strong>Conclusions: </strong>Substantial delineation variation in CTV of the lateral compartments in rectal cancer cases exists. This can be reduced by implementation of a delineation guideline with clear anatomic borders and subsequent training. Despite reduction in 95% Hausdorff distance, there is still need for further improvement in specific areas to assure adequate delineation.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460747","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":"Online Adaptive Five-Fraction Ablative Radiotherapy for Prostate Cancer Using a Conventional Linear Accelerator.","authors":"Juan-Francisco Calvo-Ortega, Coral Laosa-Bello, Sandra Moragues-Femenía, José Torices-Caballero, Miguel Pozo-Massó, Adam Jones, Marcelino Hermida-López","doi":"10.1016/j.prro.2025.01.013","DOIUrl":"10.1016/j.prro.2025.01.013","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the dosimetric results of an online adaptive stereotactic body radiation therapy (SBRT) program to treat patients with prostate cancer using a conventional linear accelerator.</p><p><strong>Methods and materials: </strong>Prostate SBRT with 5 fractions is performed at the Hospital Quirónsalud Barcelona using an online adaptive method previously described (Pract Radiat Oncol. 2022 Mar-Apr;12(2):e144-e152). A CBCT-based adaptive \"plan-of-the-day\" (POD) is generated for each treatment fraction, which consists of a single volumetric modulated arc therapy. A dosimetric evaluation of the PODs was performed for the first 20 patients and included analysis of the target (prostate), organs-at-risks (OARs), and patient-specific quality assurance (PSQA). Each of the PODs was also compared with the corresponding conventional image guided radiation therapy (IGRT) method. Finally, the adaptive treatment timing is analyzed for the 100 PODs in this study.</p><p><strong>Results: </strong>The online adaptive treatment method ensured optimal target coverage in all treatment fractions for all patients. However, the simulated IGRT plans did not result in adequate prostate coverage (V40 Gy ≥ 95%) in 70% of fractions. Small average differences between PODs and IGRT plans were found in the OARs. The dose sparing in the rectum and bladder provided by some simulated IGRT plans, was associated with a compromised prostate coverage. The PSQA resulted in an excellent agreement between the online-calculated plans and the independent dose checks performed for all 100 PODs. The average duration of the plan adaptation was 20.1 ± 6.1 minutes and the average overall session time including adaptation and treatment delivery was 26.0 ± 6.3 minutes.</p><p><strong>Conclusions: </strong>The online adaptive program using a conventional linac to treat prostate cancer described in this study is clinically feasible and in adherence with the acceptance criteria set by the PACE B trial.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426612","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":"Radiation Reflection Rounds: A Departmental Initiative for Staff Well-being.","authors":"Benjamin Hopkins, Reshma Jagsi, Sheela Hanasoge","doi":"10.1016/j.prro.2024.11.012","DOIUrl":"https://doi.org/10.1016/j.prro.2024.11.012","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383297","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":"Neoadjuvant SBRT plus Elective Nodal Irradiation with Concurrent Capecitabine for Patients with Resectable Pancreatic Cancer: Survival Analysis of a Prospective Phase 1 Trial.","authors":"Mustafa M Basree, Jacob S Witt, Nataliya V Uboha, Meghan Lubner, Rebecca Minter, Sharon Weber, Sean Ronnekleiv-Kelly, Daniel Abbott, Jeremy Kratz, Monica Patel, Syed Nabeel Zafar, Noelle LoConte, Sam J Lubner, Dustin Deming, Mark A Ritter, Pranshu Mohindra, Michael F Bassetti","doi":"10.1016/j.prro.2025.01.011","DOIUrl":"10.1016/j.prro.2025.01.011","url":null,"abstract":"<p><strong>Background and purpose: </strong>Elective nodal irradiation (ENI) in resectable pancreatic cancer remains undefined, though occult nodal disease is common. This study investigated the use of neoadjuvant stereotactic body radiation therapy (SBRT) to primary disease with ENI, with concurrent capecitabine. Safety data for this protocol were previously reported. In this report, we provide an updated survival analysis.</p><p><strong>Materials and methods: </strong>This is a prospective, single institution, phase IA/B dose-escalation trial that enrolled patients with biopsy-proven, resectable, pancreatic adenocarcinoma between 2014 - 2019 (NCT1918644). Patients were enrolled into one of the 3 cohorts with escalating dose levels. Neoadjuvant SBRT to the primary tumor was delivered in 5 fractions of 5, 6, or 7 Gy with concomitant capecitabine (1650 mg/m2). All patients received ENI 5 Gy x 5 fractions. Our initial report found no dose-limiting toxicities. Clinicopathologic features were summarized using descriptive statistics. Kaplan-Meier (KM) curves were employed for survival analysis.</p><p><strong>Results: </strong>Of 17 enrolled patients, 16 were evaluable (94.1%). Thirteen (76.5%) proceeded to surgery. Median follow up was 28.0 months (1.7 - 71.9). Four patients (25.0%) received neoadjuvant chemotherapy and six (37.5%) received adjuvant chemotherapy. Pathologic nodal involvement (69.2%) was associated with a higher risk of any relapse (p<0.01) and distant metastasis (p=0.02). Local failure occurred in 4 (25%) patients with 2/4 of those failures occurring partially within the 25 Gy elective nodal field and 1/4 occurred in the 25 Gy elective nodal field and partially within the 35 Gy tumor field. The median overall survival (OS) and disease-free survival (DFS) were 31.1 months (range, 2.3 - 73.6) and 12.0 months (range, 0.4 - 71.9), respectively. Three-year OS and DFS were 50% and 31.3% overall, and 61.5% and 38.5% for the surgical cohort. Patients with pN+ had worse median OS (23.9 vs 69.3 months; p=0.002) and DFS (9.9 vs 58.9 months; p=0.002). No further radiation related toxicities were noted since the prior report.</p><p><strong>Conclusion: </strong>Neoadjuvant SBRT to the primary tumor with ENI and radiosensitizing chemotherapy is a feasible approach that may improve outcomes in patients with resectable and borderline pancreatic cancer, despite high rates of pathological nodal involvement. Further investigation of this strategy is warranted in a larger cohort.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384084","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":"Radiation Therapy Target Volume Definition for Myxopapillary Ependymoma of the Lumbosacral Spine Without Indication for Craniospinal Irradiation: The Question of Extending the Target Inferiorly to Include the Proximal Nerve Roots and Thecal Sac.","authors":"Anthony Casper, Daniel J Indelicato, Robert J Amdur, Alexandra N De Leo","doi":"10.1016/j.prro.2025.01.009","DOIUrl":"10.1016/j.prro.2025.01.009","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257379","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}