Practical Radiation Oncology最新文献

{"title":"Centralized Quality Assurance of Stereotactic Body Radiation Therapy for the Veterans Affairs Cooperative Studies Program Study Number 2005: A Phase 3 Randomized Trial of Lung Cancer Surgery or Stereotactic Radiotherapy for Operable Early-Stage Non-Small Cell Lung Cancer (VALOR)","authors":"Timothy A. Ritter PhD, DABR ,&nbsp;Robert D. Timmerman MD ,&nbsp;Hena I. Hanfi MBA ,&nbsp;Hairong Shi PhD ,&nbsp;Matthew K. Leiner MS ,&nbsp;Hua Feng PhD, MS, BMed ,&nbsp;Vicki L. Skinner RN, MSN ,&nbsp;Lisa M. Robin MA ,&nbsp;Cheryl Odle MBA ,&nbsp;Gabriella Amador MPH ,&nbsp;Tom Sindowski BS ,&nbsp;Amanda J. Snodgrass PharmD ,&nbsp;Grant D. Huang MPH, PhD ,&nbsp;Domenic J. Reda PhD ,&nbsp;Christopher Slatore MD, MS ,&nbsp;Catherine R. Sears MD ,&nbsp;Lorraine D. Cornwell MD ,&nbsp;Tomer Z. Karas MD, FACS ,&nbsp;David H. Harpole MD ,&nbsp;Jatinder Palta PhD ,&nbsp;Drew Moghanaki MD, MPH","doi":"10.1016/j.prro.2024.07.010","DOIUrl":"10.1016/j.prro.2024.07.010","url":null,"abstract":"<div><h3>Purpose</h3><div>The phase 3 Veterans Affairs Lung Cancer Surgery Or Stereotactic Radiotherapy study implemented centralized quality assurance (QA) to mitigate risks of protocol deviations. This report summarizes the quality and compliance of the first 100 participants treated with stereotactic body radiation therapy (SBRT) in this study.</div></div><div><h3>Methods and Materials</h3><div>A centralized QA program was developed to credential and monitor study sites to ensure standard-of-care lung SBRT treatments are delivered to participants. Requirements were adapted from protocols established by the National Cancer Institute's Image and Radiation Oncology Core, which provides oversight for clinical trials sponsored by the National Cancer Institute's National Clinical Trials Network.</div></div><div><h3>Results</h3><div>The first 100 lung SBRT treatment plans were reviewed from April 2017 to October 2022. Tumor contours were appropriate in all submissions. Planning target volume (PTV) expansions were less than the minimum 5 mm requirement in 2% of cases. Critical organ-at-risk structures were contoured accurately for the proximal bronchial tree, trachea, esophagus, spinal cord, and brachial plexus in 75%, 92%, 100%, 100%, and 95% of cases, respectively. Prescriptions were appropriate in 98% of cases; 2 central tumors were treated using a peripheral tumor dose prescription while meeting organ-at-risk constraints. PTV V100% (the percentage of target volume that receives 100% or more of the prescription) values were above the protocol-defined minimum of 94% in all but 1 submission. The median dose maximum (Dmax) within the PTV was 125.4% (105.8%-149.0%; SD ± 8.7%), where values reference the percentage of the prescription dose. High-dose conformality (ratio of the volume of the prescription isodose to the volume of the PTV) and intermediate-dose compactness [R50% (ratio of the volume of the half prescription isodose to the volume of the PTV) and D2cm (the maximum dose beyond a 2 cm expansion of the PTV expressed as a percentage of the prescription dose)] were acceptable or deviation acceptable in 100% and 94% of cases, respectively.</div></div><div><h3>Conclusions</h3><div>The first 100 participants randomized to SBRT in this study were appropriately treated without safety concerns. A response to the incorrect prescriptions led to preventative measures without further recurrences. The program was developed in a health care system without prior experience with a centralized radiation therapy QA program and may serve as a reference for other institutions.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 1","pages":"Pages e29-e39"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134430","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":"Memory Tract Sparing Using Diffusion Tensor Imaging in Radiation Planning of Primary Brain Tumors","authors":"Ory Haisraely MD, MPH ,&nbsp;Arnaldo Mayer PhD ,&nbsp;Marcia Jaffe ,&nbsp;Maoz Ben-Ayun PhD ,&nbsp;Sergey Dubinsky PhD ,&nbsp;Alicia Taliansky MD ,&nbsp;Yaacov Lawrence MBBS, MA, MRCP","doi":"10.1016/j.prro.2024.08.005","DOIUrl":"10.1016/j.prro.2024.08.005","url":null,"abstract":"<div><h3>Purpose</h3><div>Radiation therapy (RT) is a critical treatment modality for both primary and metastatic brain tumors, yet ∼30% of patients experience cognitive decline post-RT. This cognitive toxicity is linked to low radiation doses affecting the hippocampal dentate gyrus. Hippocampal avoidance-whole brain RT combined with memantine has shown promising outcomes in preserving cognitive function and quality of life in patients with brain metastases. Nowadays, it is the standard of care for those with good performance status and no hippocampal metastases.</div></div><div><h3>Methods and Materials</h3><div>We conducted a prospective trial approved by the institutional review board (SMC0307-23), including patients aged ≥18 years with primary brain tumors postresection or biopsy. Exclusion criteria included multifocal glioma crossing to the other hemisphere. RT was delivered to a total dose of 54 Gy in 30 fractions. Diffusion tensor imaging was performed to map hippocampal-associated white matter tracts. Using Eclipse treatment planning software, memory fiber tracts and hippocampi were contoured and integrated into RT planning. Dosimetric analyses compared 2 plans with memory fiber constraints and 1 without. The primary endpoints were safety and dosimetric feasibility.</div></div><div><h3>Results</h3><div>Twelve patients with low-grade gliomas were included, and the contouring of memory fibers and hippocampi was successful. Volumetric modulated arc therapy (VMAT) treatment plans met-dose constraints for memory fibers, with an average mean dose of 10.1 Gy. The average Montreal Cognitive Assessment score before RT was 27.1 and 26.4 at 8 months post-treatment, with a <em>P</em> value of .07. Excluding 1 patient, the scores were 27.1 and 26.6, respectively (<em>P</em> = .13).</div></div><div><h3>Conclusions</h3><div>Magnetic resonance imaging planning using diffusion tensor imaging for memory fiber detection and incorporation into RT planning via VMAT techniques enables hippocampal and associated white fiber sparing, potentially preserving cognitive function. Preliminary cognitive data are promising, supporting the need for further validation in a larger cohort.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 1","pages":"Pages e3-e9"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367430","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":"Hypofractionated Partial Breast Reirradiation in the Conservative Retreatment of Breast Cancer Local Recurrence","authors":"Maria Cristina Leonardi MD ,&nbsp;Simona Arculeo MD ,&nbsp;Samuele Frassoni MSc ,&nbsp;Maria Alessia Zerella MD ,&nbsp;Marianna Alessandra Gerardi MD ,&nbsp;Cristiana Fodor MSc ,&nbsp;Paolo Veronesi MD ,&nbsp;Viviana Enrica Galimberti MD ,&nbsp;Francesca Magnoni MD ,&nbsp;Ekaterina Milovanova MD ,&nbsp;Damaris Patricia Rojas MD ,&nbsp;Samantha Dicuonzo MD ,&nbsp;Anna Morra MD ,&nbsp;Mattia Zaffaroni MSc ,&nbsp;Maria Giulia Vincini MSc ,&nbsp;Federica Cattani MSc ,&nbsp;Vincenzo Bagnardi PhD ,&nbsp;Roberto Orecchia MD ,&nbsp;Barbara Alicja Jereczek-Fossa MD, PhD","doi":"10.1016/j.prro.2024.07.003","DOIUrl":"10.1016/j.prro.2024.07.003","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the outcome of partial breast reirradiation (re-PBI) with intensity modulated radiation therapy using a hypofractionated scheme for breast cancer (BC) local relapse (LR) operated on with repeat breast-conservative surgery.</div></div><div><h3>Methods and Materials</h3><div>Intensity modulated radiation therapy-based re-PBI was performed using either helical or step-and-shoot modality to deliver 37.05 Gy in 13 fractions in 2.5 weeks. Cumulative incidence of second LR, toxicity, disease-free survival (DFS), BC-specific survival, and overall survival were evaluated.</div></div><div><h3>Results</h3><div>Between May 2012 and May 2021, 70 patients had re-PBI. The median follow-up (FU) was 6.3 years (quartiles 1-3, 4.0-8.1.). The median age at first LR was 62 years. The median primary BC first LR interval was 12.4 years (range, 1.6-26.7 years). Luminal A-like first LR accounted for 41% of the cases, and the median size was 0.8 cm. During FU, 18 (26%) patients showed a subsequent event: 3 second LRs (corresponding to an 8-year cumulative rate of 4%), 3 regional nodal recurrences, 7 distant metastases, and 5 other primary tumors. At 8 years, DFS, BC-specific survival, and overall survival were 76%, 90%, and 90%, respectively. At multivariate analysis, grade 3 and extensive intraductal components were independent predictors for DFS. For 51 and 46 patients, chronic toxicity and cosmesis were evaluated, respectively: 4% had grade 3 fibrosis, and cosmesis was deemed good/excellent in just &gt;60% of the cases.</div></div><div><h3>Conclusions</h3><div>Re-PBI after repeat breast-conservative surgery represents a feasible alternative to mastectomy with regard to local control, showing an acceptable toxicity profile. A long-term FU is crucial to better understand the pattern of relapse and consolidate the position of re-PBI in clinical practice.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 1","pages":"Pages 31-47"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141789780","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":"ASTRO Guidelines for Partial Breast Irradiation for Patients With Early-Stage Invasive Breast Cancer: A Disturbing Change of Paradigm for Intraoperative Radiation Therapy. Editorial on Behalf of the International Society of Intraoperative Radiation Therapy Working Group","authors":"Gerd Fastner MD ,&nbsp;Samuel Larsen MD ,&nbsp;Falk Roeder MD ,&nbsp;Maria Cristina Leonardi MD ,&nbsp;Antoine Desmet MD ,&nbsp;John Grecula MD ,&nbsp;Catherine Philippson MD","doi":"10.1016/j.prro.2024.02.010","DOIUrl":"10.1016/j.prro.2024.02.010","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 1","pages":"Pages 48-49"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958685","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":"In Regard to Ghirardelli et al","authors":"Jacob Y. Shin MD,&nbsp;Andreas Rimner MD,&nbsp;Charles B. Simone II MD","doi":"10.1016/j.prro.2024.08.009","DOIUrl":"10.1016/j.prro.2024.08.009","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 1","pages":"Pages e90-e91"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958689","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":"Survival (Time-To-Event) Curve Names and Endpoints","authors":"Vincent D. Cassidy MD, MBA,&nbsp;Ryan J. Brisson MD,&nbsp;Robert J. Amdur MD","doi":"10.1016/j.prro.2024.08.002","DOIUrl":"10.1016/j.prro.2024.08.002","url":null,"abstract":"<div><div>In oncology, “survival curves” frequently appear in journal articles and meeting presentations. The most common labels on survival curves are overall survival, relapse-free survival, progression-free survival, distant metastasis-free survival, and local and/or regional control. Unfortunately, consistency in the definition of an event differs between authors for the same prescribed survival analyses. Furthermore, the quality of survival curves can be greatly impacted by the methodology used for endpoint selection. This paper will briefly explain widely used names and event endpoints for survival analyses in a way that will help radiation oncologists consistently present and interpret experimental findings that influence clinical practice decisions.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 1","pages":"Pages 25-30"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074541","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":"Vulvar Cancer: Histopathologic Considerations and Nuances to Management","authors":"Lindsay Burt MD ,&nbsp;Elke Jarboe MD ,&nbsp;David Gaffney MD, PhD ,&nbsp;Gita Suneja ,&nbsp;Cristina DeCesaris MD ,&nbsp;Sabrina Bedell MD ,&nbsp;Jeffrey Brower MD, PhD","doi":"10.1016/j.prro.2024.07.008","DOIUrl":"10.1016/j.prro.2024.07.008","url":null,"abstract":"<div><div>Vulvar cancer, although rare, poses significant challenges in diagnosis and treatment because of its histopathologic complexities and nuances. This paper reviewed key aspects of the management of vulvar cancer, focusing on histopathologic diagnosis, margin status interpretation, lymph node involvement assessment, and ongoing clinical trials.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 1","pages":"Pages 86-92"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114743","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":"Displacement of the Tongue Base and Soft Palate Because of Breathing Patterns During Radiation Therapy for Head and Neck Cancer","authors":"Hiroaki Ikawa DDS, PhD ,&nbsp;Masashi Koto MD, PhD","doi":"10.1016/j.prro.2024.07.005","DOIUrl":"10.1016/j.prro.2024.07.005","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 1","pages":"Pages 1-2"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914567","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":"Erratum to: Gaffney D, Suneja G, Weil C, Creutzberg C. International Federation of Gynecology and Obstetrics Endometrial 2023 Is Better For Radiation Oncology Patients. Pract Radiat Oncol 2024;14(6):574-581.","authors":"","doi":"10.1016/j.prro.2024.11.002","DOIUrl":"10.1016/j.prro.2024.11.002","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 1","pages":"Pages e92-e93"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774826","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":"Use of Radiation Therapy in the Management of Vulvar Cancers—Identification and Management of Acute and Late Toxicities","authors":"Cristina DeCesaris MD ,&nbsp;Sabrina Bedell MD ,&nbsp;Kristen Kelley MD ,&nbsp;David Gaffney MD, PhD ,&nbsp;Gita Suneja MD, MS ,&nbsp;Lindsay Burt MD ,&nbsp;Elke Jarboe MD ,&nbsp;Jeffrey Brower MD, PhD","doi":"10.1016/j.prro.2024.08.006","DOIUrl":"10.1016/j.prro.2024.08.006","url":null,"abstract":"<div><div>Radiation therapy plays a critical role in the management of locally advanced vulvar cancers but can lead to a unique spectrum of side effects, with &gt;25% of patients experiencing high-grade toxicities. The treatment phase requires meticulous perineal skincare and may require pharmacologic management of dysuria and cystitis, diarrhea, nausea, and dermatitis/mucositis. The addition of chemotherapy warrants close laboratory monitoring for hematologic and metabolic derangements.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 1","pages":"Pages e57-e62"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300802","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}