Practical Radiation Oncology最新文献

{"title":"Time to Slash SABR From Our Lexicon","authors":"Paul E. Wallner DO , Michael L. Steinberg MD","doi":"10.1016/j.prro.2024.10.015","DOIUrl":"10.1016/j.prro.2024.10.015","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 2","pages":"Pages 117-119"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640431","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":"Consensus Guidelines for Delineation of Clinical Target Volumes for Intensity Modulated Radiation Therapy for Intact Cervical Cancer: An Update","authors":"Emma C. Fields MD ,&nbsp;Walter R. Bosch PhD ,&nbsp;Kevin V. Albuquerque MD ,&nbsp;Rohini Bhatia MD ,&nbsp;Junzo Chino MD ,&nbsp;Brandon Dyer MD ,&nbsp;Beth Erickson MD ,&nbsp;Denise Fabian MD ,&nbsp;David Gaffney MD, PhD ,&nbsp;Scott Glaser MD ,&nbsp;Kathy Han MD, MSc ,&nbsp;Lara Hathout MD ,&nbsp;I-Chow Hsu MD ,&nbsp;Naresh Jegadeesh MD ,&nbsp;Jenna Kahn MD ,&nbsp;Elizabeth Kidd MD ,&nbsp;Ann Klopp MD, PhD ,&nbsp;Eric Leung MD ,&nbsp;Lilie Lin MD ,&nbsp;Michelle Ludwig MD, MPH, PhD ,&nbsp;Christine M. Fisher MD, MPH","doi":"10.1016/j.prro.2024.11.004","DOIUrl":"10.1016/j.prro.2024.11.004","url":null,"abstract":"<div><h3>Purpose</h3><div>Accurate target delineation is essential when using intensity modulated radiation therapy for intact cervical cancer. In 2011, the Radiation Therapy Oncology Group published a consensus guideline using magnetic resonance imaging (MRI). The current project expands on the previous atlas by including computed tomography (CT)-based contours, contours with MRI and positron emission tomography (PET) registrations, the addition of common and complex scenarios, and incorporating information on simulation and treatment planning techniques.</div></div><div><h3>Methods and Materials</h3><div>Twenty-eight experts in gynecologic radiation oncology contoured 3 cases, first on a noncontrast CT simulation scan and then with registered diagnostic scans. The cases included (1) International Federation of Gynecology and Obstetrics (FIGO) IIIC1 with a bulky tumor and vaginal metastasis, (2) FIGO IIB with calcified uterine fibromas, and (3) FIGO IIIC2 with large lymph nodes. The contours on all 6 data sets (3 CT simulations without diagnostic images and 3 with registered images) were analyzed for consistency of delineation using an expectation-maximization algorithm for simultaneous truth and performance level estimation with kappa statistics as a measure of agreement. The contours were reviewed, discussed, and edited in a group meeting prior to finalizing.</div></div><div><h3>Results</h3><div>Contours showed considerable agreement among experts in each of the cases, with kappa statistics from 0.67 to 0.72. For each case, diagnostic PET ± MRI was associated with an increase in volume. The largest increase was the clinical target volume (CTV) primary for case 2, with a 20% increase in volume and a 54% increase in simultaneous truth and performance level estimation volume, which may be due to variance in registration priorities. For the third case, 92.9% increased their CTVs based on the addition of the diagnostic PET scan. The main areas of variance were in determining the superior extent of CTV coverage, coverage of the mesorectum, and simulation and planning protocols.</div></div><div><h3>Conclusions</h3><div>This study shows the value and the challenges of using coregistered diagnostic imaging, with an average increase in volumes when incorporating MRI and PET.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 2","pages":"Pages 171-179"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640430","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":"Can We Have the Best of Both Worlds? Considerations for Combining Oncoplastic Reconstruction With Partial Breast Irradiation.","authors":"Hye Ri Han, Artur Manasyan, Iris Kang, Eloise Stanton, Sushil Beriwal, David A Daar, Diane C Ling","doi":"10.1016/j.prro.2025.02.008","DOIUrl":"10.1016/j.prro.2025.02.008","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":"143538167","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":"Transforming the Landscape of Clinical Information Retrieval Using Generative AI: An Application in Machine Fault Analysis.","authors":"Tyler Alfonzetti, Junyi Xia","doi":"10.1016/j.prro.2025.02.006","DOIUrl":"https://doi.org/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 AI techniques to assist medical physicists in troubleshooting Linear Accelerator (LINAC) issues. Google's NotebookLM, supplemented with background information on LINAC issues/solutions was used as a Machine Troubleshooting Assistant for this purpose. Two board-certified Medical Physicists evaluated the LLM'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":"A Comparison of Radiosurgical Planning Techniques for the Treatment of Trigeminal Neuralgia.","authors":"Kati Doxsee, Ian Paddick, William A Friedman, Jonathan G Li, Alexandra De Leo, Matthew Koch, Frank J Bova","doi":"10.1016/j.prro.2024.11.014","DOIUrl":"10.1016/j.prro.2024.11.014","url":null,"abstract":"<p><strong>Purpose: </strong>To survey and analyze the current peer-reviewed literature on physical aspects of radiosurgical treatment of trigeminal neuralgia (TN), and objectively determine the comparative differences between common treatment planning techniques/modalities when variability in computed tomography and magnetic resonance imaging data sets and clinical approaches are minimized.</p><p><strong>Methods and materials: </strong>Example treatment plans were created from 8 distinct planning approaches on a unique computed tomography and magnetic resonance imaging data set. Treatment plan selection comprised Gamma Knife, physical cone, and multileaf collimator-based plans. The prescription was standardized between plans to 85 Gy at the isocenter, as well as the location of the treatment isocenter. Dose distributions were characterized using multiplanar isodose line comparisons, dose line profiles in 2 dimensions, gradient indices, dimensional and volumetric analysis of 50% and 80% isodose coverage, and maximum (0.1 cc) dose to the brainstem as singularly contoured on the unique imaging data set.</p><p><strong>Results: </strong>Dose coverage, distribution shape, dose line profiles, and gradients differ significantly between Gamma Knife, physical cone, and multileaf collimator-based planning techniques, even when dose prescription, treatment isocenter, and imaging data set/anatomy are identical between treatment plans. Gamma Knife (4 mm collimator) provides the broadest coverage of the trigeminal nerve, most closely approximated by the 5 mm physical cone linear accelerator (LINAC)-based plan. Contrastingly, the smallest cross-sectional coverage in this treatment plan selection was created by the 4 mm LINAC physical cone. All dose distributions were approximately spherical except the 11-arc physical cone LINAC-based plan, which produces a more elongated distribution (broadest adjacent to the brainstem).</p><p><strong>Conclusions: </strong>The selection of a radiosurgical technique for TN should be weighed in the context of differences in dose distributions between treatment techniques, as demonstrated by the plans analyzed in this study. It cannot be assumed that all TN radiosurgical techniques produce the same dose distribution, either to the trigeminal nerve or adjacent normal tissues. Differences between planning techniques may be amplified in real clinical scenarios with differences in clinical approach and anatomy.</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":"143525165","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 radiotherapy 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":"https://doi.org/10.1016/j.prro.2025.01.014","url":null,"abstract":"<p><strong>Background and 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 inter-physician variation in delineation of the lateral compartments, and the impact of training and implementation of standardized delineation protocols.</p><p><strong>Methods: </strong>Twenty-three radiation oncologists from 15 institutes delineated the clinical target volume (CTV) on CT-scan in one 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 re-delineated the same case. Variation was measured with the Dice-score and 95% Hausdorff distance.</p><p><strong>Results: </strong>Considerable inter-physician variation was present before guideline distribution; and larger in the anterior compartment than the posterior compartment (Dice score 0.66 vs 0.80, p<0.01). After training, there was a significant improvement in 95% Hausdorff distance for the lateral compartments together (0.71 vs 1.02, p=0.02), but not in Dice score (0.76 vs 0.78, p=0.31), and neither for the anterior and posterior compartment separately. While delineation variation in the ventral and lateral sides decreased, the variation in the caudal side of the anterior compartment increased.</p><p><strong>Conclusion: </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 anatomical 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}