Practical Radiation Oncology最新文献

{"title":"Use of 3D Printing Technology to Improve Lead Shield Fabrication for Electron Therapy of the Face.","authors":"Igor Bundalevski, Amy S Harrison, Michael F Dzeda, Laura A Doyle, Hungcheng Chen","doi":"10.1016/j.prro.2024.12.008","DOIUrl":"https://doi.org/10.1016/j.prro.2024.12.008","url":null,"abstract":"<p><p>Superficial lesions of the face are often treated with an electron beam and surface collimation utilizing a conformal lead shield with an opening around the region of treatment (ROT). To fabricate the lead shield, an imprint of the patient face is needed. Historically, this was achieved using a laborious and time-consuming process that involved a gypsum imprinted model (GIM) of the patient topography. We propose utilization of 3-dimentional (3D) printing technology to create a 3-dimensional printed custom model (3D-PCM) of the patient facial topography as a more accurate and more efficient alternative to GIM. GIM and 3D-PCM were generated for three patients requiring en face electron therapy of the nose. The models for both methods were then CT-scanned and fused rigidly to the CT of the patient. The accuracy of the models was compared with the CT image of the patient via visual inspection and the Sørensen-Dice similarity coefficient (DSC). The efficiency of the two methods was evaluated by the average time needed to complete each process based on user-reported experience. The average DSC between the patient and GIM is 0.95336 (standard deviation (SD) = 0.0099479), while the average DSC of the patient and 3D-PCM is 0.97886 (SD = 0.0037441). With respect to efficiency, the average time to fabricate and dry GIM is 54.5 hours with hands-on time of 2.5 hours, while generation of 3D-PCM takes about 6.5 hours, with hands on time of approximately 2.5 hours. 3D-PCMs based on CT scan images are found to be an excellent substitute for GIMs by exhibiting a higher degree of fidelity with patient's anatomy, requiring significantly less time to complete, being less labor intensive, and allowing for greater patient comfort. The disadvantage of exposing the patient to radiation associated with the CT scan image acquisition for designing a 3D-PCM could be eliminated by employing 3D-camera scanning technology.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016255","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 Dupuytren Contracture.","authors":"Michael J Yunes","doi":"10.1016/j.prro.2024.11.010","DOIUrl":"https://doi.org/10.1016/j.prro.2024.11.010","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016268","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":"Anesthetic Considerations for Gynecologic High Dose Rate Brachytherapy.","authors":"Jill S Remick, Emma C Fields, Binoy P Bhatt","doi":"10.1016/j.prro.2024.12.009","DOIUrl":"10.1016/j.prro.2024.12.009","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973265","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-induced cardiac disease: Modern techniques to reduce cardiac toxicity.","authors":"Amichay Meirovitz, Kim Sheva","doi":"10.1016/j.prro.2024.12.007","DOIUrl":"https://doi.org/10.1016/j.prro.2024.12.007","url":null,"abstract":"<p><strong>Purpose: </strong>Continuous advancements in cancer management have resulted in increased long-term survival rates amongst cancer survivors and in turn have exposed the full extent of radiotherapy-associated morbidities. Radiation-induced coronary heart disease (RICHD) is one of the leading causes of morbidity and mortality in cancer survivors, particularly in those having undergone mediastinal radiation. While mediastinal radiation has been shown to substantially reduce both recurrence and mortality rates in multiple thoracic malignancies, the risk for the development of RICHD is of significant concern. Not only is the pathophysiology of RICHD yet to be fully elucidated but therapeutic options are lacking.</p><p><strong>Methods and materials: </strong>Literature was reviewed with a focus on RICHD in Hodgkin's Lymphoma, breast and lung cancer patients, and the current modern radiotherapeutic techniques used to minimize radiation exposure of the heart.</p><p><strong>Results: </strong>Multiple approaches have been taken to minimize exposure of the heart to ionizing radiation in cancers that require mediastinal radiation, most notably Hodgkin's Lymphoma, breast and lung cancer. RICHD Protection strategies include optimized delineation protocols, utilization of the moderate deep inspiration breath hold (mDIBH), specialized mDIBH monitoring, continuous positive airway pressure and various other cardiac sparing techniques. A combination of medical prevention and therapy with physical protective approaches may be vital in achieving significant cardio-protection.</p><p><strong>Conclusion: </strong>Despite continuous advances and improvements in protective strategies, mainly by physically distancing the heart from radiation targets to minimize exposure and by sophisticated radiation dose planning, RICHD remains a significant challenge in cancer treatment rehabilitation and survivorship.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958702","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":"Treatment Time and Dosimetric Advantage in Cone Beam Computed Tomography-Guided Online Adaptive Radiation Therapy Considering Interfractional and Intrafractional Changes in Patients With Gastric Mucosa-Associated Lymphoid Tissue Lymphoma","authors":"Megumi Uto MD, PhD ,&nbsp;Hiraku Iramina PhD ,&nbsp;Takahiro Iwai MD,&nbsp;Michio Yoshimura MD, PhD,&nbsp;Takashi Mizowaki MD, PhD","doi":"10.1016/j.prro.2024.07.013","DOIUrl":"10.1016/j.prro.2024.07.013","url":null,"abstract":"<div><div>Radiation therapy is the standard treatment for localized gastric mucosa-associated lymphoid tissue (MALT) lymphoma. The ETHOS system (Varian Medical System) has enabled us to perform cone beam computed tomography (CBCT)-guided online adaptive radiation therapy (oART). This study presents a retrospective dosimetric analysis for interfractional and intrafractional change and treatment time in oART for gastric MALT lymphoma. We included 3 male patients with gastric MALT lymphoma who underwent exhalation breath-hold fasting oART using the SpiroDynr'X system. Treatment details and plans (3 reference [REF] plans, 51 scheduled [SCH] plans, and adapted [ADP] plans) were retrospectively analyzed. Doses to the clinical target volume in planning CT (CTV_REF), CTV1, and CTV2 (representing the stomach in planning and preirradiation CBCT, respectively) and planning target volume (PTV) in the planning CBCT were estimated. D_2%, D_98%, D_50%, and D_mean for these volumes, along with organ-at-risk doses, were examined across the 3 plans. The PTV dose coverage of CTV2 on preirradiation CBCT was calculated. CBCT-guided oART was completed within the scheduled period, using the ADP plans instead of the SCH plans on each treatment day in all cases. The average treatment time was approximately 45 minutes. CTV1 and CTV2 exhibited intrafractional and interfractional variations, fluctuating above and below CTV_REF. Some ADP plans resulted in incomplete PTV coverage of CTV2, but the unincluded volume was &lt;1% of CTV2. D_50%, D_98%, and D_mean of CTV1, CTV2, and PTV were significantly improved in the ADP plans than in the SCH plans. Moreover, the D_mean to the liver and kidneys was reduced in the ADP plans. CBCT-guided oART in patients with gastric MALT lymphoma demonstrated that ADP plans improved CTV1, CTV2, and PTV doses and reduced the mean bilateral kidney and liver doses, suggesting that it may offer enhanced treatment precision for gastric MALT lymphoma.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 1","pages":"Pages e40-e46"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332263","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 the Treatment of Osteoarthritis","authors":"James B. Yu MD, MHS ,&nbsp;David J. Grew MD ,&nbsp;Matthew B. Spraker MD, PhD ,&nbsp;Jason M. Beckta MD, PhD ,&nbsp;Chirag Shah MD ,&nbsp;Jeffrey V. Brower MD, PhD","doi":"10.1016/j.prro.2024.09.003","DOIUrl":"10.1016/j.prro.2024.09.003","url":null,"abstract":"<div><div>Osteoarthritis is a common cause of pain and disability in the United States. Many patients experience pain that is refractory or unable to be treated by traditional treatments such as exercise, physical therapy, nonsteroidal anti-inflammatory drugs, and/or cyclooxygenase-2 inhibitors. For patients with medically refractory disease, intra-articular corticosteroid therapy, hyaluronic acid, or surgery can be considered. However, for many older patients with significant impairment in quality of life related to osteoarthritis, radiation therapy is a noninvasive treatment option that has a long history of global use. In this topic discussion, we review the clinical evidence supporting treatment of osteoarthritis, as well as considerations for how to select which patient and joint to treat. We discuss technical considerations for treatment including dose and immobilization, assessment of treatment response, and the role of retreatment.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 1","pages":"Pages 19-24"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142585346","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":"Flash and FLASH: In Short, an Imaginary Bridge","authors":"Benjamin W. Corn MD, FASTRO","doi":"10.1016/j.prro.2024.08.013","DOIUrl":"10.1016/j.prro.2024.08.013","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 1","pages":"Pages 10-11"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958687","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 Primary Renal Cell Carcinoma: A Case-Based Radiosurgery Society Practice Guide","authors":"Andrew B. Barbour MD, PhD ,&nbsp;Rituraj Upadhyay MD ,&nbsp;August C. Anderson MD ,&nbsp;Tugce Kutuk MD ,&nbsp;Ritesh Kumar MD ,&nbsp;Shang-Jui Wang MD, PhD ,&nbsp;Sarah P. Psutka MD ,&nbsp;Fatemeh Fekrmandi MD, MSc ,&nbsp;Karin A. Skalina MD, PhD ,&nbsp;Anna M.E. Bruynzeel MD, PhD ,&nbsp;Rohann J.M. Correa MD, PhD ,&nbsp;Alan Dal Pra MD ,&nbsp;Cesar Della Biancia PhD ,&nbsp;Raquibul Hannan MD, PhD ,&nbsp;Alexander Louie MD, PhD ,&nbsp;Anurag K. Singh MD ,&nbsp;Anand Swaminath MD ,&nbsp;Chad Tang MD ,&nbsp;Bin S. Teh MD ,&nbsp;Nicholas G. Zaorsky MD, MS ,&nbsp;Shankar Siva MBBS, PhD","doi":"10.1016/j.prro.2024.06.012","DOIUrl":"10.1016/j.prro.2024.06.012","url":null,"abstract":"<div><div>Traditionally, renal cell carcinoma (RCC) was considered a radioresistant tumor, thereby limiting definitive radiation therapy management options. However, several recent studies have demonstrated that stereotactic body radiation therapy (SBRT) can achieve high rates of local control for the treatment of primary RCC. In the setting of expanding use of SBRT for primary RCC, it is crucial to provide guidance on practical considerations such as patient selection, fractionation, target delineation, and response assessment. This is particularly important in challenging scenarios where a paucity of evidence exists, such as in patients with a solitary kidney, bulky tumors, or tumor thrombus. The Radiosurgery Society endorses this case-based guide to provide a practical framework for delivering SBRT to primary RCC, exemplified by 3 cases. This article explores topics of tumor size and dose fractionation, impact on renal function and treatment in the setting of a solitary kidney, and radiation's role in the management of inferior vena cava tumor thrombus. Additionally, we review existing evidence and expert opinion on target delineation, advanced techniques such as magnetic resonance imaging guided SBRT, and SBRT response assessment.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 1","pages":"Pages 74-85"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141635735","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":"Intrafraction Motion in Surface-Guided Breast Radiation Therapy and its Implications on a Single Planning Target Volume Margin Strategy","authors":"Ciaran Malone MSc ,&nbsp;Samantha Ryan BSc ,&nbsp;Jill Nicholson FFR RCSI, MBBS ,&nbsp;Orla McArdle FFR RCSI, MSc ,&nbsp;Sinead Brennan FFR RCSI ,&nbsp;Pat McCavana MSc ,&nbsp;Brendan McClean PhD ,&nbsp;Frances Duane FFR RCSI, DPhil","doi":"10.1016/j.prro.2024.06.017","DOIUrl":"10.1016/j.prro.2024.06.017","url":null,"abstract":"<div><h3>Purpose</h3><div>This study quantifies intrafraction motion in surface-guided radiation therapy (SGRT) for breast cancer and considers the need for individualized intrafraction motion measures when calculating planning target volume (PTV) margins.</div></div><div><h3>Methods and Materials</h3><div>SGRT was used to assess intrafraction motion in consecutive patients according to (1) site irradiated (whole-breast/chest wall vs whole-breast/chest wall + regional lymph nodes) and (2) the use of deep inspiration breath hold versus free breathing. Intrafraction motion variation was evaluated throughout the treatment course for all cases. Associations between intrafraction motion and patient-specific characteristics were explored. The usefulness of individualized intrafraction motion measures for PTV margin determination was considered.</div></div><div><h3>Results</h3><div>One hundred two patients undergoing 1360 fractions were included. On a population level, average intrafraction motion was less than 0.4 mm and 0.2 degrees for translational and rotational directions, respectively, with 95th percentiles &lt;1.2 mm and 0.6 degrees, respectively. No clinically meaningful differences in intrafraction motion were observed according to the site irradiated or the use of deep inspiration breath hold. Consistency in intrafraction motion was noted for all patients throughout the treatment course. No clinically meaningful associations were found between intrafraction motion and patient-specific characteristics such as age, seroma volume, PTV volume, and mean body volume.</div></div><div><h3>Conclusions</h3><div>Intrafractional deviations with SGRT, using manufacturer-recommended regions of interest, are minimal, do not vary substantially for different treatment techniques or patient-specific characteristics, and remain constant throughout the treatment course. A universal intrafraction motion measure may be sufficient for calculating PTV margins. Further validation studies are needed to evaluate the impact of region of interest size and coverage.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 1","pages":"Pages e63-e71"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983918","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":"Feasibility of Left Anterior Descending Coronary Artery Sparing Radiation Therapy for Locally Advanced Lung Cancer","authors":"Samuel C. Zhang MD ,&nbsp;Katrina D. Silos BA ,&nbsp;Jordan O. Gasho BS ,&nbsp;Olivia Peony ,&nbsp;Tayisiya Polishchuk CMD ,&nbsp;Latifeh Semaan CMD ,&nbsp;Bradley Stiehl PhD ,&nbsp;Behrooz Hakimian MD ,&nbsp;Amin Mirhadi MD ,&nbsp;Mitchell Kamrava MD, MHDS ,&nbsp;Christian Guthier PhD ,&nbsp;Andriana Nikolova MD, PhD ,&nbsp;Elizabeth McKenzie PhD ,&nbsp;Jennifer Steers PhD ,&nbsp;Raymond H. Mak MD ,&nbsp;Katelyn M. Atkins MD, PhD","doi":"10.1016/j.prro.2024.05.008","DOIUrl":"10.1016/j.prro.2024.05.008","url":null,"abstract":"<div><h3>Abstract</h3><div><span>Efforts to mitigate radiation therapy (RT)-associated cardiotoxicity<span> have focused on constraining mean heart dose. However, recent studies have shown greater predictive power with cardiac substructure dose metrics, such as the left anterior descending (LAD) coronary artery volume (V) receiving 15 Gy (V15Gy) ≥10%. Herein, we investigated the feasibility of LAD radiation sparing in contemporary intensity modulated RT (IMRT)/volumetric modulated arc therapy (VMAT) lung cancer plans. Single institution retrospective analysis of 54 patients with locally advanced lung cancer treated with thoracic RT was conducted between February 2018 and August 2021. After excluding 33 (5 = non-IMRT/VMAT or intentionally LAD-optimized; 28 = LAD V15Gy &lt;10%), 21 plans with LAD V15Gy ≥10% were identified for LAD reoptimization with intent to meet LAD V15Gy &lt;10% while maintaining meeting organ at risk (OAR) metrics and target coverage with original plan parameters. Dosimetric variables were compared using paired </span></span><em>t</em> tests. Most patients (57.1%, 12/21) were treated with definitive RT, 8 of 21 patients (38.1%) with postoperative RT, and 1 with neoadjuvant RT. The median prescribed RT dose was 60 Gy (range, 50.4-66 Gy) in 30 fractions (range, 28-33 fractions). LAD reoptimized plans (vs original) led to significant reductions in mean LAD V15Gy (39.4% ± 13.9% vs 9.4% ± 13.0%; <em>P</em> &lt; .001) and mean LAD dose (12.9 Gy ± 4.6 Gy vs 7.6 Gy ± 2.8 Gy; <em>P</em><span> &lt; .001). Most (85.7%; 18/21) LAD reoptimized plans achieved LAD V15Gy &lt;10%. There were no statistically significant differences in overall lung, esophageal, or spinal cord dose metrics. Only 1 reoptimization (1/21) exceeded an OAR constraint that was initially met in the original plan. To our knowledge, this is the first report describing the feasibility of LAD-optimized lung cancer RT planning using the newly identified LAD V15Gy constraint. We observed that LAD V15Gy &lt;10% is achievable in more than 85% of plans initially exceeding this constraint, with minimal dosimetric tradeoffs. Our results support the feasibility of routine incorporation of the LAD as an OAR in modern thoracic IMRT/VMAT planning.</span></div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 1","pages":"Pages 103-110"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141545538","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}