Practical Radiation Oncology最新文献

{"title":"Radiotherapy Dose Accumulation Routine (RADAR)- A novel dose accumulation script with built-in uncertainty.","authors":"James G Mechalakos, Yu-Chi Hu, Licheng Kuo, Lei Zhang, Niral Shah, Ase Ballangrud, Laura Cervino, Ellen Yorke, Yilin Liu, Pengpeng Zhang","doi":"10.1016/j.prro.2024.10.006","DOIUrl":"https://doi.org/10.1016/j.prro.2024.10.006","url":null,"abstract":"<p><strong>Purpose: </strong>To incorporate uncertainty into dose accumulation for reirradiation.</p><p><strong>Methods: </strong>The RADAR script for the Eclipse treatment planning system (Varian Medical Systems, Palo Alto, CA) is described and the voxel-wise ellipsoid search algorithm is introduced as a means of incorporating uncertainty. RADAR is first demonstrated on a test patient reirradiated to the spine illustrating the effect of the uncertainty algorithm. A summary of initial evaluation testing by 11 users, each of whom ran a separate spine reirradiation case, follows. Finally, RADAR run times are reported for different conditions.</p><p><strong>Results: </strong>In the demonstration case in which a 3mm ellipsoid search was used, maximum RADAR 2 Gy equivalent (EQD2) accumulated spinal cord dose increased from 7244 cGy to 12689 cGy because the ellipsoid search pulled dose from closer to the adjacent target structure. When the ellipsoid search was restricted to voxels within the spinal cord, the maximum accumulated cord dose was reduced to 6523 cGy and did not exceed the sum of the maximum EQD2 spinal cord doses of the individual plans (6730 cGy). In the evaluation cases, the RADAR EQD2 maximum dose for the spinal cord increased an average of 31.6% with uncertainty applied compared to a conventional dose accumulation and decreased an average of 16.7% compared to a conventional dose accumulation when the uncertainty calculation was restricted to voxels within the spinal cord. RADAR run times depend on the number of plans being added and the type of uncertainty being used.</p><p><strong>Conclusion: </strong>RADAR offers a novel way to directly account for uncertainty in dose accumulation by means of a voxel-wise ellipsoid search algorithm. EQD2 dose accumulation with and without dose discounts is also available.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512855","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":"The Radiosurgery Society Working Groups on GRID, LATTICE, Microbeam, and FLASH Radiotherapies: 2022 - 2023 Advancements Symposium and Subsequent Progress Made.","authors":"J W Snider, Gwendolyn O Rustin, Nina A Mayr, Jason Molitoris, Arpit M Chhabra, Minglei Kang, Charles B Simone, Sina Mossahebi, Robert Griffin, Majid Mohiuddin, Hualin Zhang, Beatriz Amendola, Naipy Perez, Slavisa Tubin, Charles Limoli, Kimberly Marter, Anand Mahadevan, Norm Coleman, Mansoor Ahmed","doi":"10.1016/j.prro.2024.09.015","DOIUrl":"https://doi.org/10.1016/j.prro.2024.09.015","url":null,"abstract":"<p><strong>Purpose: </strong>Since the inaugural workshop \"Understanding High-Dose, Ultra-High Dose Rate and Spatially Fractionated Radiotherapy.\" hosted by the NCI and sponsored by the Radiosurgery Society (RSS), growing collaborations and investigations have ensued among experts, practitioners, and researchers. The RSS GRID, Lattice, Microbeam & FLASH (GLMF) Working Groups were formed as a framework for these efforts and have focused on advancing the understanding of the biology, technical/physical parameters, trial design, and clinical practice of these new radiation therapy modalities.</p><p><strong>Methods and materials: </strong>In view of the steadily increasing clinical interest in SFRT and FLASH, a full-day symposium entitled \"Advancements in GRID, LATTICE, and FLASH Radiotherapy Symposium\" was established in 2022 that immediately preceded the RSS scientific meeting. This well-attended symposium focused on clinical, technical, and physics approaches for SFRT, while closely examining relevant radiobiological underpinnings. Practical clinical trial development was a highlighted discussion. An additional section reviewed proton therapy and other particle-based techniques for the delivery of GRID and Lattice therapy. A treatment planning and delivery tutorial for GRID, Lattice, and proton GRID/Lattice was directed towards the real-world considerations for the development of new clinical GRID or LATTICE programs. An overall similar approach was applied to the discussion of FLASH. This report summarizes the content of the first GLMF Symposium and related work of the RSS GLMF Working Groups in the field of heterogeneous and ultra-high dose rate irradiation, over approximately 2 years.</p><p><strong>Results: </strong>The GLMF Working Groups have continued to expand in membership and attendance, and several resultant trial concepts, research efforts, academic discussions, and peer-reviewed publications have followed as the number of institutions and practitioners utilizing SFRT and FLASH continues to grow.</p><p><strong>Conclusions: </strong>The GLFM Working Groups and the RSS continue to demonstrate excellent progress in proliferating use of and improving understanding of SFRT and ultra-high dose rate radiotherapy techniques.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512857","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":"Metastatic site radiation therapy for Ewing sarcoma and rhabdomyosarcoma: Consensus guidelines from the National Pediatric Cancer Foundation.","authors":"Dana L Casey, Erin S Murphy, Colette J Shen, Sarah A Milgrom, Nicole A Larrier, Julie A Bradley, Matthew M Ladra, Daniel J Indelicato, Christine E Hill-Kayser, Scott C Borinstein, Leo Y Luo","doi":"10.1016/j.prro.2024.10.004","DOIUrl":"https://doi.org/10.1016/j.prro.2024.10.004","url":null,"abstract":"<p><strong>Background: </strong>Despite the urgent need for improved outcomes in patients with metastatic Ewing sarcoma (EWS) and rhabdomyosarcoma (RMS), it is unknown how to best approach metastatic site radiation therapy for these patients and whether such treatment provides a significant oncologic benefit that outweighs the toxicities.</p><p><strong>Methods: </strong>We gathered a panel of pediatric radiation oncologists from academic hospitals to identify and discuss current controversies regarding the role of radiation in the management of metastatic EWS and RMS. The panel reviewed existing clinical data and ongoing trials to address five key questions: 1) the role of whole lung irradiation (WLI) in treating lung metastases 2) number of metastatic sites warranting radiotherapy and the radicality of such an approach; 3) radiation techniques, including stereotactic body radiation therapy (SBRT); 4) the timing of metastatic-site radiation therapy; and 5) the utility of metastatic site radiation therapy for relapsed metastatic disease.</p><p><strong>Results: </strong>After a review of existing data, consensus recommendations were developed to support the decision-making process in metastatic-site irradiation with the goal of improving long-term disease control. Patients with pulmonary metastases should receive WLI. In patients with limited (<8 sites) metastatic disease, a comprehensive approach should be taken to treat all sites of metastatic disease diagnosed at presentation. SBRT should be considered as a preferred treatment technique. The timing of metastatic-site treatment should coincide with the end of systemic therapy. However, if there is a dosimetric advantage or improved compliance, concurrent treatment with the primary site may be preferred.</p><p><strong>Conclusions: </strong>A consensus guideline was established to address several critical questions regarding the role of radiation in the treatment of metastatic EWS and RMS. The study highlights the existing controversies, provides a structured approach, and underscores the need for future studies to further evaluate the therapeutic ratio of metastatic-site directed therapy.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512853","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":"Prospective Evaluation of Supplemental External Beam Radiation Therapy With Palladium-103 Prostate Brachytherapy: Long-Term Results of the 44/20/0 Trials.","authors":"Martin T King, Gregory S Merrick, Robert W Galbreath, Ryan Fiano, Wayne M Butler, Kent E Wallner, Peter F Orio","doi":"10.1016/j.prro.2024.10.005","DOIUrl":"10.1016/j.prro.2024.10.005","url":null,"abstract":"<p><strong>Purpose: </strong>The 44/20 and 20/0 randomized trials evaluated whether different external beam radiation therapy (EBRT) dosing regimens prior to brachytherapy affected biochemical failure (BF). We report long-term outcomes of both trials and evaluate whether biological equivalent dose (BED) was associated with reduced BF in the combined trial cohort.</p><p><strong>Methods and materials: </strong>Both trials enrolled patients with clinical T1c to T2b, Gleason scores 7 to 9, and/or a pretreatment prostate-specific antigen (PSA) 10 to 20 ng/mL disease. The 44/20 trial randomized patients to 44 Gy EBRT with 90 Gy palladium (Pd)-103 versus 20 Gy EBRT with 115 Gy Pd-103. The subsequent 20/0 trial randomized patients to the 20 Gy arm versus monotherapeutic 125 Gy Pd-103. For each trial, univariate Fine-Gray analysis evaluated whether the treatment arm was associated with BF for the entire cohort and the unfavorable intermediate-risk (UIR) subgroup. For the combined trial cohort, multivariate Fine-Gray analysis evaluated whether BED was associated with BF while adjusting for clinical factors.</p><p><strong>Results: </strong>There were 247 analyzable patients in the 44/20 trial. At a median follow-up of 13.7 years, there were no differences in BF for the entire cohort (subdistribution hazard ratio [sHR] 0.99; 95% CI, 0.43, 2.276; P = .97) or the UIR subgroup (sHR 0.72; 95% CI, 0.25, 2.08; P = .55). There were 383 analyzable patients in the 20/0 trial. At a median follow-up of 10.4 years, there were no differences in BF for the entire cohort (sHR 0.42; 95% CI, 0.13-1.80; P = .15) or the UIR subgroup (sHR 0.81; 95% CI, 0.16-4.03; P = .80). For the combined cohort (630 patients), BED was not associated with BF (1.00; 95% CI, 0.98-1.02; P = .88) on multivariate analyses while adjusting for androgen deprivation therapy utilization, 4-tiered National Comprehensive Cancer Network category, and year of treatment.</p><p><strong>Conclusions: </strong>Brachytherapy monotherapy should be a standard-of-care treatment for clinically localized, intermediate-risk prostate cancer, including UIR disease.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512854","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":"Single Fraction Radiosurgical Tolerance of Brainstem, Trigeminal Nerve, and Meckel's Cave for Facial Numbness.","authors":"Krishna C Monroe, Ronald L Hammers, Olivier C Blasi, Richard C Mallory, Alan T Monroe","doi":"10.1016/j.prro.2024.08.011","DOIUrl":"10.1016/j.prro.2024.08.011","url":null,"abstract":"<p><strong>Purpose: </strong>This article reviews toxicity outcomes for a series of patients treated with stereotactic radiosurgery for trigeminal neuralgia, focusing on dose to the brainstem, trigeminal nerve, and Meckel's cave as possible explanatory variables for the development of the most common posttreatment neuropathy, facial numbness.</p><p><strong>Methods and materials: </strong>A retrospective review of 136 cases treated with CyberKnife radiosurgery for trigeminal neuralgia was performed. Dose was initially (cohort 1) prescribed to 57 to 64 Gy covering a 6-mm cylindrical shaped target volume ≥2 mm from the dorsal root entry zone. Subsequently, a deliberate change to isocentric treatment planning occurred, resulting in delivery of 85 Gy to a spherical target (cohort 2). Brainstem, trigeminal nerve, and Meckel's cave were contoured, and a variety of dosimetric and clinical factors were analyzed for association with development of treatment-related facial numbness.</p><p><strong>Results: </strong>Treatment-related numbness occurred in 59 of 136 (43%) patients and did not differ between the treatment cohorts. Fifty-two patients experienced Barrow Neurological Institute (BNI) grade II toxicity, and 7 patients experienced BNI grade III toxicity. Time to numbness was 16.0 months for cohort 1 and 10.4 months for cohort 2 (P = .184). The median brainstem maximum dose was 26.1 Gy, ranging from 4.2 Gy to 57.3 Gy. Maximum dose to the trigeminal nerve was 85 Gy. Mean trigeminal nerve dose was 47.3 Gy. The median Meckel's cave maximum and mean doses were 26.0 Gy and 6.8 Gy, respectively. No definitive upper limit dose threshold was detected for the structures analyzed, but trends were noted for maximum trigeminal nerve dose of 85 Gy (P = .083) and for prescription dose (P = .057) and trigeminal nerve V40 (P = .077) in the type I subset.</p><p><strong>Conclusions: </strong>Brainstem, trigeminal nerve, and Meckel's cave tolerated doses within the range delivered. Discussion of the literature is provided to guide treatment planning and management.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480645","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 Liver Metastases: Systematic Review and Meta-Analysis With International Stereotactic Radiosurgery Society (ISRS) Practice Guidelines.","authors":"Ciro Franzese, Alexander V Louie, Rupesh Kotecha, Zhenwei Zhang, Matthias Guckenberger, Mi-Sook Kim, Alison C Tree, Ben J Slotman, Arjun Sahgal, Marta Scorsetti","doi":"10.1016/j.prro.2024.09.011","DOIUrl":"10.1016/j.prro.2024.09.011","url":null,"abstract":"<p><strong>Purpose: </strong>Liver metastases are a significant clinical challenge in cancer management, often representing a stage of disease in which curative treatment is still possible. Stereotactic body radiation therapy (SBRT) has emerged as a promising modality for treating these metastases, offering a noninvasive approach with potential for high efficacy. This systematic review and meta-analysis provides a comprehensive analysis of the efficacy and safety of SBRT in treating liver metastases, and practice recommendations are provided.</p><p><strong>Methods and materials: </strong>We performed a thorough literature review, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach, and included 33 studies with a total of 3101 patients and 4437 liver metastases.</p><p><strong>Results: </strong>The review revealed pooled local control rates at 1, 2, and 3 years of 85%, 75%, and 68% respectively, while overall survival rates were 79%, 54%, and 37%. Grade 3 and 4 side effects occurred in only 3% of patients. The review of the studies highlighted the importance of factors such as primary tumor histology, lesion characteristics, and radiation dose in predicting treatment outcomes.</p><p><strong>Conclusions: </strong>This review supports the growing body of evidence that SBRT is an efficacious and safe treatment option for liver metastases. It underscores the need for careful patient selection and personalized treatment planning to optimize outcomes.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480647","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 Lung Cancer and Metastases: A Case Based Discussion on Challenging Cases.","authors":"Colton Ladbury, Baho Sidiqi, Nate Cantrell, Gavin Jones, Karin A Skalina, Fatemeh Fekrmandi, Therese Y Andraos, Emile Gogineni, Jennifer Dolan, Shankar Siva, Ben Slotman, Percy Lee","doi":"10.1016/j.prro.2024.09.012","DOIUrl":"https://doi.org/10.1016/j.prro.2024.09.012","url":null,"abstract":"<p><strong>Purpose: </strong>Data informing the safety, efficacy, treatment logistics, and dosimetry of stereotactic body radiation therapy (SBRT) for lung tumors has primarily been derived from patients with favorably located solitary tumors. SBRT is now considered a standard-of-care treatment for inoperable early-stage non-small cell lung cancer and lung metastases, and therefore extrapolation beyond this limited foundational patient population remains an active source of interest.</p><p><strong>Materials and methods: </strong>This case-based discussion provides a practical framework for delivering SBRT to challenging, yet frequently encountered, cases in radiation oncology. The cases highlighted herein include the use of SBRT for ultracentral tumors, multiple tumors, and re-irradiation. Patient characteristics, fractionation, prescription dose, treatment technique, and dose constraints were discussed. Relevant literature to these cases was summarized to provide a framework for the treatment of similar patients.</p><p><strong>Results: </strong>Treatment of challenging cases with lung SBRT requires many considerations, including treatment intent, fractionation selection, tumor localization, and plan optimization. In such scenarios, patient selection is critical to understanding the risk-benefit profile of an SBRT approach despite significant advances in delivery techniques and safety.</p><p><strong>Conclusions: </strong>A case-based discussion was developed by the Radiosurgery Society to provide a practical guide to the common challenging scenarios noted above affecting patients with lung tumors. A multidisciplinary approach should guide the treatment of such cases to maximize the therapeutic window.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480646","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 Dose for Limited-stage Extranodal Marginal Zone Lymphomas of the Mucosa-associated Lymphoid Tissues of the Stomach: A Meta-analysis.","authors":"Song Heui Cho, Kyung-Sook Yang, Ka-Won Kang, Nam Kwon Lee","doi":"10.1016/j.prro.2024.09.008","DOIUrl":"10.1016/j.prro.2024.09.008","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the outcomes of 2 standard radiation therapy (RT) doses for limited-stage gastric extranodal marginal zone lymphoma (EMZL) of the mucosa-associated lymphoid tissues.</p><p><strong>Methods and materials: </strong>A database search was performed to identify articles published from database inception to August 31, 2023. Based on the current standard dose of 24.0 to 30.0 Gy, doses of approximately 30.0 Gy were classified as standard dose (SD), while those of approximately 24.0 Gy were classified as low dose (LD). Pooled estimates of the complete remission (CR) and local recurrence (LR) rates were calculated and compared.</p><p><strong>Results: </strong>Data from 1072 patients across 30 included studies were analyzed. SD was used in 28 studies (n = 987), while LD was used in 6 studies (n = 85), and both regimens were used in 4 studies. In all included studies, the CR rate was 0.96 (95% CI, 0.94-0.97), and the LR rate was 0.05 (95% CI, 0.04-0.06), showing no significant between-study heterogeneity (τ² = 0 and I² = 0% for both; P = .8447 and .9998, respectively). SD and LD resulted in no significant differences in the CR rates (0.96 [95% CI, 0.94-0.97] vs 0.96 [95% CI, 0.89-0.99]; P = .9174) or LR rates (0.05 [95% CI, 0.04-0.06] vs 0.03 [95% CI, 0.01-0.10]; P = .5495).</p><p><strong>Conclusions: </strong>Both the SD and LD groups achieved excellent CR and LR rates. These results indicate that the RT dose for limited-stage gastric EMZL may be safely de-escalated without compromising local tumor control.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407141","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":"Partially Ablative Body Radiation Therapy: A Widely Applicable Planning Technique for Palliation of Locally Advanced Unresectable Tumors.","authors":"David Jong, Mark Burns, Sarat Chander, Therese Chesson, Siena Williams, Adam U Yeo","doi":"10.1016/j.prro.2024.09.010","DOIUrl":"10.1016/j.prro.2024.09.010","url":null,"abstract":"<p><p>Patients with locally advanced, bulky, and unresectable tumors frequently exhibit frailty and endure symptomatic burdens arising from the mass effect of their tumors. Conservative approaches may often fail to provide symptomatic benefits in relatively radioresistant, slower-growing tumors such as sarcomas. A novel technique termed partially ablative body radiation therapy (PABR) administers a highly centralized ablative dose through the utilization of a simultaneous integrated boost while delivering a low and safe palliative dose to the peripheral regions of tumors. The purpose of this paper was to describe a widely applicable radiation therapy protocol in detail for the PABR technique, of which clinical results are available in previous work.⁷ In summary, a PABR prescription of 20 Gy in 5 fractions is applied to the planning target volume and is planned for 95% of the volume to be covered by 95% of the prescribed dose. A dose of 50 Gy is planned to the boost target volume, with an allowed maximum dose of up to 65 to 70 Gy, using volumetric modulated arc therapy. Daily Cone-Beam Computed Tomography images are used for delivery verification and imaging study. The centrally located volume exceeding 50 Gy effectively achieved the desired outcomes of symptom relief and tumor size reduction. The PABR approach is widely accessible and can be readily implemented in a routine clinical setting to address a pressing need for the challenging palliative patient cohort.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407140","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 the Timely Delivery of Postoperative Radiation in Head and Neck Cancer: [Timely Postoperative Radiation].","authors":"Christopher Brett","doi":"10.1016/j.prro.2024.09.009","DOIUrl":"https://doi.org/10.1016/j.prro.2024.09.009","url":null,"abstract":"<p><p>The time that elapses between a patient's ablative tumor resection and indicated adjuvant radiation has a significant impact on an individual's local control and survival, and its optimization is in the best interest of the patient. Furthermore, it is a recognized treatment related quality metric which can have bearing on future provider compensation. Despite these important driving considerations, compliance rates with established goals are low, recently measured below 50%. Making meaningful and lasting improvements in this requires a systems based approach. This article seeks to provide clinicians practical tools to apply lean healthcare and flow management principles to identify chief obstacles to timely care in their systems, and effective strategies to overcome common bottlenecks.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407139","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}