Practical Radiation Oncology最新文献

{"title":"Experience From an Early Exposure Education Program in Radiation Oncology for High School and Undergraduate Students.","authors":"Andrew Tam, Colton Ladbury, Scott Glaser, Arya Amini, Yi-Jen Chen, Yun Rose Li","doi":"10.1016/j.prro.2024.04.023","DOIUrl":"10.1016/j.prro.2024.04.023","url":null,"abstract":"<p><p>Exposure to radiation oncology (RO), which is a small and highly subspecialized field of oncology, during undergraduate or medical education is often limited. Coupled with reduced elective exposures during the COVID-19 pandemic, unsubstantiated concerns regarding the RO job market have led to a noticeable decline in residency applications and medical students who express an interest in the field. Here, we describe a summer education program piloted in our RO department at a comprehensive cancer center to provide premedical school students (ranging from high school to postbaccalaureate) early exposure to the specialty through clinical shadowing, research opportunities, journal club, and formal didactic lectures. Pre- and postprogram surveys were administered to these students to evaluate the change in knowledge in RO. A total of 8 students participated in the program. We found an increase in understanding of the specialty, high levels of interest in considering RO as a career, and positive feedback regarding the program overall. This study supports the role of early exposure and education in stimulating interest in future medical students to pursue RO as a career. Future efforts are needed to further develop and evaluate these education programs as well as disseminate the program more broadly.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141176474","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":"Functional Lung Avoidance Planning Using Multicriteria Optimization.","authors":"Nicholas Bucknell, Nicholas Hardcastle, Lachlan McIntosh, David Ball, Michael S Hofman, Tomas Kron, Shankar Siva","doi":"10.1016/j.prro.2024.04.014","DOIUrl":"10.1016/j.prro.2024.04.014","url":null,"abstract":"<p><strong>Purpose: </strong>Functional lung avoidance (FLA) radiation therapy is an evolving field. The aim of FLA planning is to reduce dose to areas of functioning lung, with comparable target coverage and dose to organs at risk. Multicriteria optimization (MCO) is a planning tool that may assist with FLA planning. This study assessed the feasibility of using MCO to adapt radiation therapy plans to avoid functional regions of lung that were identified using a ⁶⁸Ga-4D-V/Q positron emission tomography/computed tomography.</p><p><strong>Methods and materials: </strong>A prospective clinical trial U1111-1138-4421 was performed in which patients had a ⁶⁸Ga-4D-V/Q positron emission tomography/computed tomography before radiation treatment. Of the 72 patients enrolled in this trial, 38 patients had stage III non-small cell lung cancer and were eligible for selection into this planning study. Functional lung target volumes HF lung (highly functioning lung) and F lung (functional lung) were defined using the ventilated and perfused lung. Using knowledge-based planning, a baseline anatomic plan was created, and then a functional adapted plan was generated using multicriteria optimization. The primary aim was to spare dose to HF lung. Using the MCO tools, a clinician selected the final FLA plan. Dose to functional lung, target volumes, organs at risk and measures of plan quality were compared using standard statistical methods.</p><p><strong>Results: </strong>The HF lung volume was successfully spared in all patients. The F lung volume was successfully spared in 36 of the 38 patients. There were no clinically significant differences in dose to anatomically defined organs at risk. There were differences in the planning target volume near maximum and minimum doses. Across the entire population, there was a statistically significant reduction in the functional mean lung dose but not in the functional volume receiving 20 Gy. All trade-off decisions were made by the clinician.</p><p><strong>Conclusions: </strong>Using MCO for FLA was achievable but did result in changes to planning target volume coverage. A distinct advantage in using MCO was that all decisions regarding the cost and benefits of FLA could be made in real time.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140867516","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":"Early and Intermediate Treatment Outcome After Postoperative External Beam Accelerated Partial Breast Irradiation in Patients With Early-Stage Breast Cancer","authors":"Anna Stenger-Weisser MD, PhD ,&nbsp;Olga Unterkirhere MD, PhD ,&nbsp;Christoph Glanzmann MD, PhD ,&nbsp;Tino Streller PhD ,&nbsp;Philippe Logaritsch PhD ,&nbsp;Gabriela Studer MD, PhD","doi":"10.1016/j.prro.2023.10.009","DOIUrl":"10.1016/j.prro.2023.10.009","url":null,"abstract":"<div><h3>Purpose</h3><p><span>To prospectively evaluate early and intermediate outcome after accelerated partial breast irradiation (APBI) </span>in patients early-with stage breast cancer.</p></div><div><h3>Methods and Materials</h3><p>Inclusion criteria were defined according to the APBI American Society for Radiation Oncology's<span> ASTRO Evidence-Based Consensus Statement. The prescribed dose was 26 to 28 Gy in 5 fractions on 5 consecutive days. Regular follow-up visits with objective and subjective evaluation of treatment tolerance were performed after 0 and 2 weeks, 6 months, and at annual intervals.</span></p></div><div><h3>Results</h3><p><span><span>Between February 2017 and January 2020, 175 patients with breast conserving surgery met the inclusion criteria for APBI. Mean age was 65.7 years (range, 46-88). Thirteen percent of patients received a diagnosis with </span>carcinoma in situ, 55%, 35%, and 37% with T1a/b/c, and 10% with T2 stages, respectively. The mean volume of planning target volume (PTV) was 119 cc (range, 45-465), the ratio of mean PTV: whole breast volume ratio was 21% (7%-53%). Mean follow-up was 42 months (median, 45, range, 0-67). </span>Acute toxicity<span> after 2 weeks was low with 69%, 26%, and 5% grade 0, 1, and 2. In addition, 1-, 2-, 3-, 4-, and 5-year follow-up data were available from 146, 134, 107, 73, and 25 patients. Patient-reported cosmetic outcomes were assessed excellent or good in 97.9%, 98.5%, 98.1%, 98.6%, and 100%. Regarding grade 2 toxicities, as by now 3%, 2%, 2%, 0%, and 0% G2 fibrosis, 1%, 1%, 0%, 0%, and 0% G2 atrophy, no G2 skin telangiectasia or breast edema occurred. So far, none of the patients have experienced G3 toxicity or higher. The remaining patients had grade 0 or 1 toxicity only. Five ipsilateral breast recurrences (1 marginally to PTV, 4 out-of-field) and 5 distant recurrences were recorded by March 2023. The 4-year in-breast recurrence rate was 2.5%. Eight patients died, with 2 of them from disease. For all patients, the 4-year overall, cancer specific and disease-free survival rates were 97.1%, 99.4%, and 95.3%, respectively.</span></p></div><div><h3>Conclusions</h3><p>We showed high early- and intermediate-term treatment tolerance and disease control of APBI using 26 to 28 Gy in five fractions in one week in carefully selected patients with early breast cancer. APBI is highly appreciated by patients and efficient, as an additional advantage for busy centers.</p></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71488919","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":"Academic and Geographic Employment Outcomes for Graduating Residents in Radiation Oncology: 2015-2022","authors":"Kunal K. Sindhu MD ,&nbsp;Kristin Hsieh MD ,&nbsp;Tayler M. Sindhu MD, MS ,&nbsp;Jared P. Rowley MD","doi":"10.1016/j.prro.2023.12.013","DOIUrl":"10.1016/j.prro.2023.12.013","url":null,"abstract":"<div><h3>Purpose</h3><p>Little is known about how the academic and geographic employment outcomes of new radiation oncology (RO) graduates have changed over time. In this study, we sought to trace the evolution of these outcomes for all RO residents who graduated between 2015 and 2022.</p></div><div><h3>Methods and Materials</h3><p>Using publicly available data sources, we identified the first permanent, clinical employment positions accepted by graduating members of the RO residency classes of 2015 to 2022. We additionally determined the medical school and residency program attended by each graduate. We then classified each clinical employment position by its rural-urban continuum code and core-based statistical area, and whether it was academic or nonacademic.</p></div><div><h3>Results</h3><p>Of 1478 RO graduates identified, 1396 first accepted clinical positions in the United States after residency. A majority accepted positions in the largest metropolitan areas (N = 878, 62.9%) and in nonacademic settings (N = 719, 51.5%). The proportion of graduates who accepted academic positions climbed steadily from 2015 to 2020 before dropping by 31% in 2021 and partially rebounding in 2022. Women and graduates of large-sized academic programs were more likely to have accepted academic positions. In contrast, graduates of small-sized residency programs were more likely than those of large-sized residency programs to have accepted positions in nonmetropolitan areas. At least 288 of the examined individuals (20.6%) had switched jobs at least once at the time of this analysis.</p></div><div><h3>Conclusions</h3><p>Most new RO graduates in this study accepted clinical positions in large metropolitan areas. A slight majority accepted nonacademic positions. While the RO job market was able to absorb the vast majority of these new graduates between 2015 and 2022, there is no guarantee that this equilibrium will hold in the future. Additional studies aiming to refine projections of future RO demand are needed.</p></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139491741","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":"Thoracic Reirradiation with Stereotactic Body Radiation Therapy (SBRT) for Recurrent Advanced Non-Small Cell Lung Cancer (NSCLC)","authors":"Dylan Ross BS ,&nbsp;Dennis Chan MD ,&nbsp;Ellen Kuo MD ,&nbsp;Matthew Harkenrider MD","doi":"10.1016/j.prro.2024.02.001","DOIUrl":"10.1016/j.prro.2024.02.001","url":null,"abstract":"<div><h3>Purpose</h3><p>Non-small cell lung cancer (NSCLC) local control remains suboptimal with rates around 75%. Stereotactic body radiation therapy (SBRT) is an option for isolated local recurrences of small-volume recurrences. This study investigates the safety and efficacy of 60 Gy in 8 fractions in large-volume local recurrences.</p></div><div><h3>Methods and Materials</h3><p>We conducted a retrospective chart review of patients treated with salvage SBRT for NSCLC lung parenchymal recurrence between July 2013 and February 2020. Reirradiation prescribed dose was 60 Gy in 8 fractions using the SBRT technique. The primary endpoint was local control at most recent follow-up or death. Secondary endpoints included overall survival, disease-free interval, cancer-specific survival, and treatment related toxicities.</p></div><div><h3>Results</h3><p>Seven patients met inclusion criteria. Median follow up time was 38 months (18.1-72.4). Median age was 67 years (63-80). Median time to reirradiation was 18.2 months (7.3-28.6). Retreatment median ITV was 57.9 cc (15.8-344.6), and PTV median was 113.6 cc (38.3-506.9). Local control was maintained in 4 of 7 patients (57.1%). Two of the 7 patients (28.6%) remained alive. Median disease-free interval was 22.5 months (11-65). Three of 7 patients (42.9%) had grade 2 toxicities. One patient (14.3%) had a grade 3 rib/chest wall toxicity with concurrent disease recurrence invading the chest wall.</p></div><div><h3>Conclusion</h3><p>This study reports that SBRT of 60 Gy in 8 fractions was delivered safely and effectively to large volume recurrent NSCLC previously treated with radiation therapy. The disease-free interval of nearly 2 years is meaningful for patients’ quality of life and duration of time off systemic therapy.</p></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139926748","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":"Evaluating the Quality-of-Life Effect of Apical Spacing with Hyaluronic Acid Prior to Hypofractionated Prostate Radiation Therapy: A Secondary Analysis","authors":"Martin T. King MD, PhD ,&nbsp;Michelle Svatos PhD ,&nbsp;Erik W. Chell PhD ,&nbsp;Vadim Pigrish MMP ,&nbsp;Katie Miller MS ,&nbsp;Daniel A. Low PhD ,&nbsp;Peter F. Orio III DO, MS","doi":"10.1016/j.prro.2023.11.010","DOIUrl":"10.1016/j.prro.2023.11.010","url":null,"abstract":"<div><h3>Purpose</h3><p>Recently, a randomized trial demonstrated that a hyaluronic acid (HA) spacer placed before prostate hypofractionated intensity modulated radiation therapy improved rectal dosimetry and reduced acute grade 2+ gastrointestinal toxicity. However, 26.5% of patients receiving the spacer experienced a minimal clinically important decline (MCID) in bowel quality-of-life (QOL). The purpose of this study is to evaluate whether certain characteristics of the rectal spacer, as determined on postimplant imaging, were associated with change in bowel QOL at 3-months.</p></div><div><h3>Methods and Materials</h3><p>This is a secondary analysis of the 136 patients who received the HA spacer on the randomized trial. Postimplant spacer characteristics (ie, prostate-rectum spacing at superior/midgland/inferior/apex planes, symmetry, prostate volume, spacer volume) were systematically analyzed from structure sets using custom software code. Characteristics demonstrating significant associations with rectal V30 on multivariate linear regression were identified. Linear regression models were used to analyze the associations of such characteristics with change (baseline to 3 months) in both bowel and urinary QOL.</p></div><div><h3>Results</h3><p>Apical spacing (mean 9.4 (standard deviation 4.0)) was significantly smaller than spacing measurements at more superior planes. 95.6% of patients had a symmetrical implant. Apical spacing (<em>P</em> &lt; .001) and prostate volume (<em>P</em> = .01) were significantly associated with rectal V30 on multivariate analysis. However, only apical spacing (0.38/mm; <em>P</em> = .01) was associated with change in bowel QOL, even with adjustment of baseline bowel score (-0.33; <em>P</em> &lt; .01). Percentages of patients with bowel MCID were 14.8% for &gt;= 10 mm versus 36.6% for &lt;10 mm apical spacing (<em>P</em> = .01). Apical spacing was not associated with change in urinary QOL (-0.09; <em>P</em> = .72), when adjusted for baseline urinary QOL (-0.52; <em>P</em> &lt; .01).</p></div><div><h3>Conclusions</h3><p>Greater apical spacing was associated with improved rectal dosimetry and smaller decline in bowel QOL at 3-months. Further prospective data are needed to fully understand the ramifications of increased apical spacing.</p></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1879850023003387/pdfft?md5=462ddb4e11a79a8e628584d80f89b48b&pid=1-s2.0-S1879850023003387-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138479294","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}

{"title":"Novel Technology Allowing Cone Beam Computed Tomography in 6 Seconds: A Patient Study of Comparative Image Quality","authors":"James L. Robar PhD ,&nbsp;Amanda Cherpak PhD ,&nbsp;Robert Lee MacDonald PhD ,&nbsp;Abigail Yashayaeva MSc ,&nbsp;David McAloney BSc ,&nbsp;Natasha McMaster MSc ,&nbsp;Kenny Zhan BSc ,&nbsp;Slawa Cwajna MD ,&nbsp;Nikhilesh Patil MD ,&nbsp;Hannah Dahn MD","doi":"10.1016/j.prro.2023.10.014","DOIUrl":"10.1016/j.prro.2023.10.014","url":null,"abstract":"<div><h3>Purpose</h3><p>The goal of this study was to evaluate the image quality provided by a novel cone beam computed tomography (CBCT) platform (HyperSight, Varian Medical Systems), a platform with enhanced reconstruction algorithms as well as rapid acquisition times. Image quality was compared with both status quo CBCT for image guidance, and to fan beam CT (FBCT) acquired on a CT simulator (CTsim).</p></div><div><h3>Methods and Materials</h3><p>In a clinical study, 30 individuals were recruited for whom either deep inspiration (DIBH) or deep exhalation breath hold (DEBH) was used during imaging and radiation treatment of tumors involving liver, lung, breast, abdomen, chest wall, and pancreatic sites. All subjects were imaged during breath hold with CBCT on a standard image guidance platform (TrueBeam 2.7, Varian Medical Systems) and FBCT CT (CTsim, GE Optima). HyperSight imaging with both breath hold (HSBH) and free breathing (HSFB) was performed in a single session. The 4 image sets thus acquired were registered and compared using metrics quantifying artifact index, image nonuniformity, contrast, contrast-to-noise ratio, and difference of Hounsfield unit (HU) from CTsim.</p></div><div><h3>Results</h3><p>HSBH provided less severe artifacts compared with both HSFB and TrueBeam. The severity of artifacts in HSBH images was similar to that in CTsim images, with statistically similar artifact index values. CTsim provided the best image uniformity; however, HSBH provided improved uniformity compared with both HSFB and TrueBeam. CTsim demonstrated elevated contrast compared with HyperSight imaging, but both HSBH and HSFB imaging showed superior contrast-to-noise ratio characteristics compared with TrueBeam. The median HU difference of HSBH from CTsim was within 1 HU for muscle/fat tissue, 12 HU for bone, and 14 HU for lung.</p></div><div><h3>Conclusions</h3><p>The HyperSight system provides 6-second CBCT acquisition with image artifacts that are significantly reduced compared with TrueBeam and comparable to those in CTsim FBCT imaging. HyperSight breath hold imaging was of higher quality compared with free breathing imaging on the same system. The median HU value in HyperSight breath hold imaging is within 15 HU of that in CTsim imaging for muscle, fat, bone, and lung tissue types, indicating the utility of image data for direct dose calculation in adaptive workflows.</p></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1879850023002953/pdfft?md5=4e36cefb38ef66ed3f52631d0c8b030a&pid=1-s2.0-S1879850023002953-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71523376","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}

{"title":"Intraoperative Radiation Therapy for Relapsed or Refractory High-Risk Neuroblastoma: A 27-Year Experience","authors":"Brianna Conte BS ,&nbsp;Dana L. Casey MD ,&nbsp;Kathryn R. Tringale MD ,&nbsp;Joshua Honeyman MD ,&nbsp;Nicole J.C. Narayan MD ,&nbsp;Michael P. LaQuaglia MD ,&nbsp;Justin Ted Gerstle MD ,&nbsp;Shakeel Modak MD ,&nbsp;Brian H. Kushner MD ,&nbsp;Kim Kramer MD ,&nbsp;Suzanne L. Wolden MD","doi":"10.1016/j.prro.2023.12.008","DOIUrl":"10.1016/j.prro.2023.12.008","url":null,"abstract":"<div><h3>Purpose</h3><p><span>To evaluate outcomes after intraoperative radiation therapy (IORT) in high-risk </span>neuroblastoma (NB), including local control, overall survival, and toxicity.</p></div><div><h3>Methods and Materials</h3><p>This was a single institution retrospective study of 92 pediatric patients with NB treated with IORT from 1995 to 2022. Each IORT application was considered a separate event for a total of 110 sites treated. Local failure was calculated using the cumulative incidence function and survival by Kaplan-Meier method from the day of surgery.</p></div><div><h3>Results</h3><p><span><span>All patients had high-risk relapsed or treatment refractory disease. Median age was 6 years (range, 2-34 years). Median follow-up for all patients and surviving patients was 16 months and 4 years, respectively. All patients previously received chemotherapy, 93% had prior </span>external beam radiation therapy to the site of IORT (median dose, 21.6 Gy; range, 10-36 Gy), and 94% had a prior surgery for tumor resection. The median IORT dose was 12 Gy (range, 8-18 Gy) and median area treated was 18 cm</span>² (range, 2.5-60 cm²). The cumulative incidence of local failure was 23% at 2 years and 29% at 5 years. The overall survival (OS) was 44% at 2 years and 29% at 5 years. Local failure after IORT was associated with worse OS <strong>(</strong>hazard ratio, 1.74; 95% CI, 1.07-2.84; <em>P</em><span> = .0267). Toxicity from IORT was rare, with postoperative complications likely related to IORT seen in 7 (8%) patients.</span></p></div><div><h3>Conclusions</h3><p>Our study represents the largest, most recent analysis of the efficacy and safety of IORT in patients with relapsed or refractory NB. Less than one-third of patients failed locally at 5 years, and achieving local control affected overall survival. Minimal toxicities directly related to IORT were observed. Overall, IORT is an effective and safe technique to achieve local control in high-risk relapsed or refractory neuroblastoma.</p></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139669148","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":"Stereotactic Body Radiation Therapy for Gynecologic Malignancies: A Case-Based Radiosurgery Society Practice Review","authors":"Colton Ladbury MD ,&nbsp;Mark H. Sueyoshi MD ,&nbsp;Nellie M. Brovold MS ,&nbsp;Ritesh Kumar MD ,&nbsp;Therese Y. Andraos MD ,&nbsp;Emile Gogineni DO ,&nbsp;Minsun Kim PhD ,&nbsp;Ann Klopp MD, PhD ,&nbsp;Kevin Albuquerque MD ,&nbsp;Charles Kunos MD ,&nbsp;Eric Leung MD ,&nbsp;Constantine Mantz MD ,&nbsp;Tithi Biswas MD ,&nbsp;Sushil Beriwal MD ,&nbsp;William Small Jr MD ,&nbsp;Beth Erickson MD ,&nbsp;David Gaffney MD, PhD ,&nbsp;Simon S. Lo MB, ChB ,&nbsp;Akila N. Viswanathan MD, MPH","doi":"10.1016/j.prro.2023.09.008","DOIUrl":"10.1016/j.prro.2023.09.008","url":null,"abstract":"<div><h3>Purpose</h3><p>The use of stereotactic body radiation therapy (SBRT) for gynecologic malignancies is controversial. We discuss certain circumstances when highly precise SBRT may be a useful tool to consider in the management of selected patients.</p></div><div><h3>Methods and Materials</h3><p>Case selection included the following scenarios, the first 2 with palliative intent, para-aortic nodal oligorecurrence of ovarian cancer, pelvic sidewall oligorecurrence of cervical cancer, and inoperable endometrial cancer boost after intensity modulated radiation to the pelvis treated with curative intent. Patient characteristics, fractionation, prescription dose, treatment technique, and dose constraints were discussed. Relevant literature to these cases was summarized to provide a framework for treatment of similar patients.</p></div><div><h3>Results</h3><p>Treatment of gynecologic malignancies with SBRT requires many considerations, including treatment intent, optimal patient selection, fractionation selection, tumor localization, and plan optimization. Although other treatment paradigms including conventionally fractionated radiation therapy and brachytherapy remain the standard-of-care for definitive treatment of gynecologic malignancies, SBRT may have a role in palliative cases or those where high doses are not required due to the unacceptable toxicity that may occur with SBRT.</p></div><div><h3>Conclusions</h3><p>A case-based practice review was developed by the Radiosurgery Society to provide a practical guide to the common scenarios noted above affecting patients with gynecologic malignancies.</p></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1879850023002801/pdfft?md5=2829a466103f1a08c7dc10a77f1fc932&pid=1-s2.0-S1879850023002801-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50159245","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}

{"title":"Association Between Symptom Burden and Early Lymphatic Abnormalities After Regional Nodal Irradiation for Breast Cancer","authors":"Alison K. Yoder MD ,&nbsp;Tianlin Xu PhD ,&nbsp;Peter Youssef BS ,&nbsp;Sarah DeSnyder MD ,&nbsp;Kathryn E. Marqueen MD ,&nbsp;Lynn Isales MHA, BSN ,&nbsp;Ruitao Lin PhD ,&nbsp;Benjamin D. Smith MD ,&nbsp;Wendy A. Woodward MD PhD ,&nbsp;Michael C. Stauder MD ,&nbsp;Eric A. Strom MD ,&nbsp;Melissa B. Aldrich PhD ,&nbsp;Simona F. Shaitelman MD","doi":"10.1016/j.prro.2023.10.008","DOIUrl":"10.1016/j.prro.2023.10.008","url":null,"abstract":"<div><h3>Purpose</h3><p>Dermal backflow visualized on near-infrared fluorescence lymphatic imaging (NIRF-LI) signals preclinical lymphedema that precedes the development of volumetrically defined lymphedema. We sought to evaluate whether dermal backflow correlates with patient-reported lymphedema outcomes (PRLO) surveys in breast cancer patients treated with regional nodal irradiation (RNI).</p></div><div><h3>Methods and Materials</h3><p>Patients with breast cancer planned for axillary dissection and RNI prospectively underwent perometry, NIRF-LI, and PRLOs (the Lymphedema Symptom Intensity and Distress Survey [LSIDS] and QuickDASH) at baseline, after surgery, and at 6, 12, and 18 months after radiation. Clinical lymphedema was defined as an arm volume increase ≥5% over baseline. Trends over time were assessed using analysis of variance testing. The association between survey responses and both dermal backflow and lymphedema was assessed using a linear mixed-effects model.</p></div><div><h3>Results</h3><p><span>Sixty participants completed at least 2 sets of measurements and surveys and were eligible for analysis. Fifty-four percent of patients had cT3-T4 disease, 53% cN3 disease, and 75% had a body mass index &gt;25. Dermal backflow and clinical lymphedema increased from 10% to 85% and from 0% to 40%, respectively, from baseline to 18 months. In the adjusted model, soft tissue sensation, neurologic sensation, and functional LSIDS subscale scores were associated with presence of dermal backflow (all </span><em>P</em> &lt; .05). Both dermal backflow and lymphedema were associated with QuickDASH score (<em>P</em> &lt; .05).</p></div><div><h3>Conclusions</h3><p>In this high-risk cohort, we found highly prevalent early signs of lymphedema, with increased symptom burden from baseline. Presence of dermal backflow correlated with PRLO measures, highlighting a potential NIRF-LI use to identify patients for early intervention trials after RNI.</p></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71429163","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}