Practical Radiation Oncology最新文献

{"title":"Like a Glove: Dose Dependent Magnetic Resonance Signal Changes Following Liver Stereotactic Body Radiation Therapy in the Setting of Hemochromatosis","authors":"","doi":"10.1016/j.prro.2024.04.005","DOIUrl":"10.1016/j.prro.2024.04.005","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140762784","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 Oncology Ransomware Attack Response Risk Analysis Using Failure Modes and Effects Analysis","authors":"","doi":"10.1016/j.prro.2024.03.001","DOIUrl":"10.1016/j.prro.2024.03.001","url":null,"abstract":"<div><h3>Purpose</h3><p>There have been numerous significant ransomware attacks impacting Radiation Oncology in the past 5 years. Research into ransomware attack response in Radiation Oncology has consisted of case reports and descriptive articles and has lacked quantitative studies. The purpose of this work was to identify the significant safety risks to patients being treated with radiation therapy during a ransomware attack scenario, using Failure Modes and Effects Analysis.</p></div><div><h3>Methods and Materials</h3><p>A multi-institutional and multidisciplinary team conducted a Failure Modes and Effects Analysis by developing process maps and using Risk Priority Number (RPN) scores to quantify the increased likelihood of incidents in a ransomware attack scenario. The situation that was simulated was a ransomware attack that had removed the capability to access the Record and Verify (R&amp;V) system. Five situations were considered: 1) a standard treatment of a patient with and without an R&amp;V, 2) a standard treatment of a patient for the first fraction right after the R&amp;V capabilities are disabled, and 3) 3 situations in which a plan modification was required. RPN scores were compared with and without R&amp;V functionality.</p></div><div><h3>Results</h3><p>The data indicate that RPN scores increased by 71% (range, 38%-96%) when R&amp;V functionality is disabled compared with a nonransomware attack state where R&amp;V functionality is available. The failure modes with the highest RPN in the simulated ransomware attack state included incorrectly identifying patients on treatment, incorrectly identifying where a patient is in their course of treatment, treating the incorrect patient, and incorrectly tracking delivered fractions.</p></div><div><h3>Conclusions</h3><p>The presented study quantifies the increased risk of incidents when treating in a ransomware attack state, identifies key failure modes that should be prioritized when preparing for a ransomware attack, and provides data that can be used to guide future ransomware resiliency research.</p></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177682","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":"Handling Patient Emergencies During Radiopharmaceutical Therapy","authors":"","doi":"10.1016/j.prro.2023.12.014","DOIUrl":"10.1016/j.prro.2023.12.014","url":null,"abstract":"<div><h3>Purpose</h3><p>Radiopharmaceutical therapy (RPT) is a rapidly growing treatment modality. Though uncommon, patients may experience complications during their RPT treatment, which may trigger a rapid response from the hospital team. However, members of this team are typically not familiar with precautions for radiation safety. During these events, it is important to prioritize the patient's health over all else. There are some practices that can help minimize the risk of radiation contamination spread and exposure to staff while tending to the patient.</p></div><div><h3>Methods and Materials</h3><p>We formed a team to develop a standard protocol for handling patient emergencies during RPT treatment. This team consisted of an authorized user, radiation safety officer, medical physicist, nurse, RPT administration staff, and a quality/safety coordinator. The focus for developing this standardized protocol for RPT patient emergencies was 3-fold: (1) stabilize the patient; (2) reduce radiation exposure to staff; and (3) limit the spread of radiation contamination.</p></div><div><h3>Results</h3><p>We modified our hospital's existing rapid response protocol to account for the additional staff and tasks needed to accomplish all 3 of these goals. Each team member was assigned specific responsibilities, which include serving as a gatekeeper to restrict traffic, managing the crash cart, performing chest compressions, timing chest compressions, documenting the situation, and monitoring/managing radiation safety in the area. We developed a small, easy-to-read card for rapid response staff to read while they are en route to the area so they can be aware of and prepare for the unique circumstances that RPT treatments present.</p></div><div><h3>Conclusions</h3><p>Though rapid response events with RPT patients are uncommon, it is important to have a standardized protocol for how to handle these situations beforehand rather than improvise in the moment. We have provided an example of how our team adapted our hospital's current rapid response protocol to accommodate RPT patients.</p></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139736766","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":"PROshot: Immunotherapy for Cervical Cancer, Epidermal Growth Factor Receptor-Mutated Stage III Lung Cancer, Perioperative Chemotherapy for Esophageal Cancer, Salvage Postprostatectomy Radiation and Androgen Deprivation Therapy, and Immunotherapy for Head and Neck Cancer","authors":"Laura Dover MD, MSPH ,&nbsp;Caleb Dulaney MD","doi":"10.1016/j.prro.2024.06.001","DOIUrl":"10.1016/j.prro.2024.06.001","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142096505","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":"Exploring the Impact of Sodium-Glucose Cotransporter-2 Inhibitors on Genitourinary Toxicities in Prostate Cancer Patients Undergoing Radiation Therapy: A Case Study and Discussion","authors":"","doi":"10.1016/j.prro.2024.04.006","DOIUrl":"10.1016/j.prro.2024.04.006","url":null,"abstract":"<div><p><span><span>Radiation therapy is a common treatment modality offered to patients with localized prostate cancer. It can be associated with early radiation-induced toxicities including </span>dysuria<span><span>, nocturia<span>, frequency, urgency, spasm, and, rarely, hematuria. Early toxicities usually resolve once the treatment period has ended. </span></span>Chronic toxicities<span><span> are less common, and rarely, patients may experience radiation-induced hemorrhagic cystitis<span> and hematuria months or years after radiation. We herein describe the case of a 65-year-old man with a </span></span>past medical history<span><span> of type-2 diabetes mellitus who experienced hemorrhagic cystitis for months following his radiation therapy. The patient was on sodium-glucose cotransporter-2 inhibitor therapy (empagliflozin), which we highlight as a potential risk factor for hemorrhagic cystitis. After cessation of Jardiance and initiation of </span>semaglutide (GLP-1 agonist), his </span></span></span></span>urinary symptoms significantly improved. To the best of our knowledge, this is the first such case reported.</p></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946442","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":"External Beam Radiation Therapy for Palliation of Symptomatic Bone Metastases: An ASTRO Clinical Practice Guideline","authors":"","doi":"10.1016/j.prro.2024.04.018","DOIUrl":"10.1016/j.prro.2024.04.018","url":null,"abstract":"<div><h3>Purpose</h3><p>This guideline provides evidence-based recommendations for palliative external beam radiation therapy (RT) in symptomatic bone metastases.</p></div><div><h3>Methods</h3><p>The ASTRO convened a task force to address 5 key questions regarding palliative RT in symptomatic bone metastases. Based on a systematic review by the Agency for Health Research and Quality, recommendations using predefined consensus-building methodology were established; evidence quality and recommendation strength were also assessed.</p></div><div><h3>Results</h3><p>For palliative RT for symptomatic bone metastases, RT is recommended for managing pain from bone metastases and spine metastases with or without spinal cord or cauda equina compression. Regarding other modalities with RT, for patients with spine metastases causing spinal cord or cauda equina compression, surgery and postoperative RT are conditionally recommended over RT alone. Furthermore, dexamethasone is recommended for spine metastases with spinal cord or cauda equina compression. Patients with nonspine bone metastases requiring surgery are recommended postoperative RT. Symptomatic bone metastases treated with conventional RT are recommended 800 cGy in 1 fraction (800 cGy/1 fx), 2000 cGy/5 fx, 2400 cGy/6 fx, or 3000 cGy/10 fx. Spinal cord or cauda equina compression in patients who are ineligible for surgery and receiving conventional RT are recommended 800 cGy/1 fx, 1600 cGy/2 fx, 2000 cGy/5 fx, or 3000 cGy/10 fx. Symptomatic bone metastases in selected patients with good performance status without surgery or neurologic symptoms/signs are conditionally recommended stereotactic body RT over conventional palliative RT. Spine bone metastases reirradiated with conventional RT are recommended 800 cGy/1 fx, 2000 cGy/5 fx, 2400 cGy/6 fx, or 2000 cGy/8 fx; nonspine bone metastases reirradiated with conventional RT are recommended 800 cGy/1 fx, 2000 cGy/5 fx, or 2400 cGy/6 fx. Determination of an optimal RT approach/regimen requires whole person assessment, including prognosis, previous RT dose if applicable, risks to normal tissues, quality of life, cost implications, and patient goals and values. Relatedly, for patient-centered optimization of treatment-related toxicities and quality of life, shared decision making is recommended.</p></div><div><h3>Conclusions</h3><p>Based on published data, the ASTRO task force's recommendations inform best clinical practices on palliative RT for symptomatic bone metastases.</p></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1879850024000997/pdfft?md5=4ffebe89417a27c5b8708fef016dc86b&pid=1-s2.0-S1879850024000997-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141094082","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":"In Reply to Khan et al","authors":"Emile Gogineni DO,&nbsp;Dominic J. DiCostanzo PhD,&nbsp;Dukagjin M. Blakaj MD, PhD","doi":"10.1016/j.prro.2024.05.001","DOIUrl":"10.1016/j.prro.2024.05.001","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142096595","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 Reply to Akhtar et al","authors":"Ramez Kouzy MD,&nbsp;Ethan B. Ludmir MD,&nbsp;Karen E. Hoffman MD,&nbsp;Anuja Jhingran MD,&nbsp;Deborah A. Kuban MD","doi":"10.1016/j.prro.2024.05.002","DOIUrl":"10.1016/j.prro.2024.05.002","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142096593","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 HPV-Positive Oropharyngeal Squamous Cell Carcinoma: An ASTRO Clinical Practice Guideline","authors":"Danielle N. Margalit MD, MPH ,&nbsp;Christopher J. Anker MD ,&nbsp;Michalis Aristophanous PhD ,&nbsp;Musaddiq Awan MD ,&nbsp;Gopal K. Bajaj MD, MBA ,&nbsp;Lisa Bradfield BA ,&nbsp;Joseph Califano MD ,&nbsp;Jimmy J. Caudell MD, PhD ,&nbsp;Christina H. Chapman MD, MS ,&nbsp;Adam S. Garden MD ,&nbsp;Paul M. Harari MD ,&nbsp;Amanda Helms MLIS ,&nbsp;Alexander Lin MD ,&nbsp;Ellie Maghami MD ,&nbsp;Ranee Mehra MD ,&nbsp;Lance Parker MBA ,&nbsp;Yelizaveta Shnayder MD ,&nbsp;Sharon Spencer MD ,&nbsp;Paul L. Swiecicki MD ,&nbsp;Jillian Chiaojung Tsai MD, PhD ,&nbsp;David J. Sher MD, MPH","doi":"10.1016/j.prro.2024.05.007","DOIUrl":"10.1016/j.prro.2024.05.007","url":null,"abstract":"<div><h3>Purpose</h3><p>Human Papilloma Virus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) is a distinct disease from other head and neck tumors. This guideline provides evidence-based recommendations on the critical decisions in its curative treatment, including both definitive and postoperative radiation therapy (RT) management.</p></div><div><h3>Methods</h3><p>ASTRO convened a task force to address 5 key questions on the use of RT for management of HPV-associated OPSCC. These questions included indications for definitive and postoperative RT and chemoradiation; dose-fractionation regimens and treatment volumes; preferred RT techniques and normal tissue considerations; and posttreatment management decisions. The task force did not address indications for primary surgery versus RT. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and system for grading evidence quality and recommendation strength.</p></div><div><h3>Results</h3><p>Concurrent cisplatin is recommended for patients receiving definitive RT with T3-4 disease and/or 1 node &gt;3 cm, or multiple nodes. For similar patients who are ineligible for cisplatin, concurrent cetuximab, carboplatin/5-fluorouracil, or taxane-based systemic therapy are conditionally recommended. In the postoperative setting, RT with concurrent cisplatin (either schedule) is recommended for positive surgical margins or extranodal extension. Postoperative RT alone is recommended for pT3-4 disease, &gt;2 nodes, or a single node &gt;3 cm. Observation is conditionally recommended for pT1-2 disease and a single node ≤3 cm without other risk factors. For patients treated with definitive RT with concurrent systemic therapy, 7000 cGy in 33 to 35 fractions is recommended, and for patients receiving postoperative RT without positive surgical margins and extranodal extension, 5600 to 6000 cGy is recommended. For all patients receiving RT, intensity modulated RT over 3-dimensional techniques with reduction in dose to critical organs at risk (including salivary and swallowing structures) is recommended. Reassessment with positron emission tomography-computed tomography is recommended approximately 3 months after definitive RT/chemoradiation, and neck dissection is recommended for convincing evidence of residual disease; for equivocal positron emission tomography-computed tomography findings, either neck dissection or repeat imaging is recommended.</p></div><div><h3>Conclusions</h3><p>The role and practice of RT continues to evolve for HPV-associated OPSCC, and these guidelines inform best clinical practice based on the available evidence.</p></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1879850024001395/pdfft?md5=a1d7e2c5f4c1194bde3ba35988eed051&pid=1-s2.0-S1879850024001395-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141794000","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":"Increase in Hypofractionated Radiation Therapy Among Patients with Invasive Breast Cancer or Ductal Carcinoma In Situ: Who is Left Behind?","authors":"","doi":"10.1016/j.prro.2024.04.010","DOIUrl":"10.1016/j.prro.2024.04.010","url":null,"abstract":"<div><h3>Purpose</h3><p><span>We aimed to update the trend of hypofractionated whole-breast irradiation (HF-WBI) use over time in the US and examine factors associated with lack of HF-WBI adoption for patients with early-stage invasive breast cancer (IBC) or ductal carcinoma in situ (DCIS) undergoing a </span>lumpectomy.</p></div><div><h3>Methods and Materials</h3><p>Among patients who underwent a lumpectomy, we identified 928,034 patients with early-stage IBC and 330,964 patients with DCIS in the 2004 to 2020 National Cancer Database. We defined HF-WBI as 2.5-3.33 Gy/fraction to the breast and conventionally fractionated WBI as 1.8-2.0 Gy/fraction. We evaluated the trend of HF-WBI utilization using a generalized linear model with the log link and binomial distribution. Factors associated with HF-WBI utilization were assessed using multivariable logistic regression in patients diagnosed between 2018 and 2020.</p></div><div><h3>Results</h3><p>Among patients with IBC, HF-WBI use has significantly increased from 0.7% in 2004 to 63.9% in 2020. Similarly, HF-WBI usage among patients with DCIS has also increased significantly from 0.4% in 2004 to 56.6% in 2020. Black patients with IBC were less likely than White patients to receive HF-WBI (adjusted odds ratio [AOR] 0.81; 95% CI, 0.77-0.85). Community cancer programs were less likely to administer HF-WBI to patients with IBC (AOR, 0.80; 95% CI, 0.77-0.84) and to those with DCIS (AOR, 0.87; 95% CI, 0.79-0.96) than academic/research programs. Younger age, positive nodes, larger tumor size, low volume programs, and facility location were also associated with lack of HF-WBI adoption in both patient cohorts.</p></div><div><h3>Conclusions</h3><p>HF-WBI utilization among postlumpectomy patients has significantly increased from 2004 to 2020 and can finally be considered standard of care in the US. We found substantial disparities in adoption within patient and facility subgroups. Reducing disparities in HF-WBI adoption has the potential to further alleviate health care costs while improving patients’ quality of life.</p></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140864402","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}