Practical Radiation Oncology最新文献

{"title":"Empowering Hepatocellular Carcinoma Ablative Therapy: A Renaissance of Collaboration","authors":"Michele Fiore MD, Gabriele D'Ercole MD, Gian Marco Petrianni MD, Pasquale Trecca MD, Sara Ramella MD","doi":"10.1016/j.prro.2024.07.009","DOIUrl":"10.1016/j.prro.2024.07.009","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"14 6","pages":"Pages 603-604"},"PeriodicalIF":3.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142551863","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":"Order From Chaos: The Benefits of Standardized Nomenclature in Radiation Oncology","authors":"","doi":"10.1016/j.prro.2024.04.002","DOIUrl":"10.1016/j.prro.2024.04.002","url":null,"abstract":"<div><div>Although standardization has been shown to improve patient safety and improve the efficiency of workflows, implementation of standards can take considerable effort and requires the engagement of all clinical stakeholders. Engaging team members includes increasing awareness of the proposed benefit of the standard, a clear implementation plan, monitoring for improvements, and open communication to support successful implementation. The benefits of standardization often focus on large institutions to improve research endeavors, yet all clinics can benefit from standardization to increase quality and implement more efficient or automated workflow. The benefits of nomenclature standardization for all team members and institution sizes, including success stories, are discussed with practical implementation guides to facilitate the adoption of standardized nomenclature in radiation oncology.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"14 6","pages":"Pages 582-589"},"PeriodicalIF":3.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140791818","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":"Functional Lung Avoidance Planning Using Multicriteria Optimization","authors":"","doi":"10.1016/j.prro.2024.04.014","DOIUrl":"10.1016/j.prro.2024.04.014","url":null,"abstract":"<div><h3>Purpose</h3><div>Functional lung avoidance (FLA) radiation therapy is an evolving field. The aim of FLA planning is to reduce dose to areas of functioning lung, with comparable target coverage and dose to organs at risk. Multicriteria optimization (MCO) is a planning tool that may assist with FLA planning. This study assessed the feasibility of using MCO to adapt radiation therapy plans to avoid functional regions of lung that were identified using a ⁶⁸Ga-4D-V/Q positron emission tomography/computed tomography.</div></div><div><h3>Methods and Materials</h3><div><span>A prospective clinical trial U1111-1138-4421 was performed in which patients had a </span>⁶⁸Ga-4D-V/Q positron emission tomography/computed tomography before radiation treatment. Of the 72 patients enrolled in this trial, 38 patients had stage III non-small cell lung cancer and were eligible for selection into this planning study. Functional lung target volumes HF lung (highly functioning lung) and F lung (functional lung) were defined using the ventilated and perfused lung. Using knowledge-based planning, a baseline anatomic plan was created, and then a functional adapted plan was generated using multicriteria optimization. The primary aim was to spare dose to HF lung. Using the MCO tools, a clinician selected the final FLA plan. Dose to functional lung, target volumes, organs at risk and measures of plan quality were compared using standard statistical methods.</div></div><div><h3>Results</h3><div>The HF lung volume was successfully spared in all patients. The F lung volume was successfully spared in 36 of the 38 patients. There were no clinically significant differences in dose to anatomically defined organs at risk. There were differences in the planning target volume near maximum and minimum doses. Across the entire population, there was a statistically significant reduction in the functional mean lung dose but not in the functional volume receiving 20 Gy. All trade-off decisions were made by the clinician.</div></div><div><h3>Conclusions</h3><div>Using MCO for FLA was achievable but did result in changes to planning target volume coverage. A distinct advantage in using MCO was that all decisions regarding the cost and benefits of FLA could be made in real time.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"14 6","pages":"Pages e480-e486"},"PeriodicalIF":3.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140867516","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 Practical Primer on Particle Therapy","authors":"","doi":"10.1016/j.prro.2024.05.005","DOIUrl":"10.1016/j.prro.2024.05.005","url":null,"abstract":"<div><h3>Purpose</h3><div><span>Particle therapy is a promising treatment technique that is becoming more commonly used. Although </span>proton beam therapy<span> remains the most commonly used particle therapy, multiple other heavier ions have been used in the preclinical and clinical settings, each with its own unique properties. This practical review aims to summarize the differences between the studied particles, discussing their radiobiological and physical properties with additional review of the available clinical data.</span></div></div><div><h3>Methods and Materials</h3><div>A search was carried out on the PubMed databases with search terms related to each particle. Relevant radiobiology, physics, and clinical studies were included. The articles were summarized to provide a practical resource for practicing clinicians.</div></div><div><h3>Results</h3><div>A total of 113 articles and texts were included in our narrative review. Currently, proton beam therapy has the most data and is the most widely used, followed by carbon, helium, and neutrons. Although oxygen, neon, silicon, and argon have been used clinically, their future use will likely remain limited as monotherapy.</div></div><div><h3>Conclusions</h3><div>This review summarizes the properties of each of the clinically relevant particles. Protons, helium, and carbon will likely remain the most commonly used, although multi-ion therapy is an emerging technique.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"14 6","pages":"Pages 590-602"},"PeriodicalIF":3.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285328","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 Versus Conventional Radiation Therapy for Painful Spinal Metastases: A Comparative Analysis of Randomized Trials and Practical Considerations","authors":"","doi":"10.1016/j.prro.2024.06.005","DOIUrl":"10.1016/j.prro.2024.06.005","url":null,"abstract":"<div><h3>Purpose</h3><div><span>Recent randomized trials have compared the efficacy and safety of stereotactic body radiation therapy<span> (SBRT) with those of standard conventional external beam radiation therapy (cEBRT) for the treatment of painful </span></span>spinal metastases. We conducted a composite analysis of these trials in order to inform current practice using pooled outcomes.</div></div><div><h3>Methods and Materials</h3><div><span>Data from each randomized trial were abstracted from the final publications with biologically effective doses (BEDs) recalculated for SBRT and cEBRT. Primary outcome measures were overall pain response (OR) and complete pain response (CR) rates at 1, 3, and 6 months and rates of vertebral </span>compression fracture. Random effects models were used to estimate primary outcome measures, and meta-regression assessed the effect of BED.</div></div><div><h3>Results</h3><div><span>Four prospective randomized clinical trials published between 2018 and 2024 were included, with a total of 686 patients (383 and 303 in the SBRT and cEBRT groups, respectively). Dose and fraction (fx) number ranged from 24 Gy/1 fx to 48.5 Gy/10 fx for the SBRT group (median BED using an α-to-β ratio of 10, 50 Gy) and from 8 Gy/1 fx to 30 Gy/10 fx for the cEBRT group (median BED using an α-to-β ratio of 10, 28 Gy). The 1-, 3-, and 6-month OR rates for SBRT and cEBRT were similar: 53.6%, 52.4%, and 58.8% versus 48.4%, 47.9%, and 43.8%, respectively (</span><em>p</em> &gt; .05). The 3-month CR rate was significantly higher for SBRT than for cEBRT (31.9% vs 14.8%; risk ratio, 2.26; 95% CI, 1.48-3.45; <em>p</em> &lt; .001), but not the 6-month rate (34.4% vs 16.3%; risk ratio, 1.83; 95% CI, 0.74-4.53; <em>p</em><span> = .194). Vertebral compression fracture rates were similar at 17.3% and 18.4% for SBRT and cEBRT, respectively. No significant dose-dependent effect was observed with increasing BED for any efficacy or safety outcomes.</span></div></div><div><h3>Conclusions</h3><div>OR rates are similar, but CR rates appear higher with SBRT than with cEBRT, yet no dose-dependent effects were identified despite approximately 1.8 × BED dose with SBRT.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"14 6","pages":"Pages 512-521"},"PeriodicalIF":3.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141560351","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":"Target Volume Optimization for Localized Prostate Cancer","authors":"Krishnan R. Patel MD, MHS ,&nbsp;Uulke A. van der Heide PhD ,&nbsp;Linda G.W. Kerkmeijer MD, PhD ,&nbsp;Ivo G. Schoots MD ,&nbsp;Baris Turkbey MD ,&nbsp;Deborah E. Citrin MD ,&nbsp;William A. Hall MD","doi":"10.1016/j.prro.2024.06.006","DOIUrl":"10.1016/j.prro.2024.06.006","url":null,"abstract":"<div><h3>Purpose</h3><div>To provide a comprehensive review of the means by which to optimize target volume definition for the purposes of treatment planning for patients with intact prostate cancer with a specific emphasis on focal boost volume definition.</div></div><div><h3>Methods</h3><div>Here we conduct a narrative review of the available literature summarizing the current state of knowledge on optimizing target volume definition for the treatment of localized prostate cancer.</div></div><div><h3>Results</h3><div>Historically, the treatment of prostate cancer included a uniform prescription dose administered to the entire prostate with or without coverage of all or part of the seminal vesicles. The development of prostate magnetic resonance imaging (MRI) and positron emission tomography (PET) using prostate-specific radiotracers has ushered in an era in which radiation oncologists are able to localize and focally dose-escalate high-risk volumes in the prostate gland. Recent phase 3 data has demonstrated that incorporating focal dose escalation to high-risk subvolumes of the prostate improves biochemical control without significantly increasing toxicity. Still, several fundamental questions remain regarding the optimal target volume definition and prescription strategy to implement this technique. Given the remaining uncertainty, a knowledge of the pathological correlates of radiographic findings and the anatomic patterns of tumor spread may help inform clinical judgement for the definition of clinical target volumes.</div></div><div><h3>Conclusion</h3><div>Advanced imaging has the ability to improve outcomes for patients with prostate cancer in multiple ways, including by enabling focal dose escalation to high-risk subvolumes. However, many questions remain regarding the optimal target volume definition and prescription strategy to implement this practice, and key knowledge gaps remain. A detailed understanding of the pathological correlates of radiographic findings and the patterns of local tumor spread may help inform clinical judgement for target volume definition given the current state of uncertainty.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"14 6","pages":"Pages 522-540"},"PeriodicalIF":3.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141635736","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":"Salvage Breast-Conserving Surgery and Reirradiation With Intraoperative Electrons for Recurrent Breast Cancer: A Multicentric Study on Behalf of Italian Association of Radiotherapy and Clinical Oncology (AIRO)","authors":"Maria Cristina Leonardi MD ,&nbsp;Alexandru David Fodor MD ,&nbsp;Samuele Frassoni MSc ,&nbsp;Damaris Patricia Rojas MD ,&nbsp;Alessandra Fozza MD ,&nbsp;Gladys Blandino MD ,&nbsp;Antonella Ciabattoni MD ,&nbsp;Marina Alessandro MD ,&nbsp;Gianpiero Catalano MD ,&nbsp;Giovanni Battista Ivaldi MD ,&nbsp;Stefania Martini MD ,&nbsp;Fiorenza De Rose MD ,&nbsp;Cristiana Fodor MSc ,&nbsp;Paolo Veronesi MD ,&nbsp;Viviana Enrica Galimberti MD ,&nbsp;Mattia Intra MD ,&nbsp;Luigi Cornacchia MD ,&nbsp;Francesca Braga MD ,&nbsp;Stefano Durante MD ,&nbsp;Samantha Dicuonzo MD ,&nbsp;Barbara Alicja Jereczek-Fossa MD, PhD","doi":"10.1016/j.prro.2024.05.012","DOIUrl":"10.1016/j.prro.2024.05.012","url":null,"abstract":"<div><h3>Purpose</h3><div>Intraoperative radiation therapy with electrons (IOERT) may represent a viable choice for partial breast reirradiation after repeat quadrantectomy for local recurrence (LR) for primary breast cancer (BC) in lieu of mastectomy.</div></div><div><h3>Methods and Materials</h3><div>A database collecting data on partial breast reirradiation with IOERT from 8 Italian centers was set up in 2016 to 2018, providing data on cumulative incidence (CumI) of second LR and survival with a long follow-up.</div></div><div><h3>Results</h3><div>From 2002 to 2015, 109 patients underwent the conservative retreatment. The median primary BC first LR interval was 11.1 years (range, 2.4-27.7). The median first LR size was 0.9 cm (range, 0.3-3.0), and 43.6% cases were luminal A. Median IOERT dose was 18 Gy (range, 12-21), and median collimator diameter was 4 cm (range, 3-6). Median follow-up duration was 11.7 years (IQR, 7.7-14.6). The second LR CumI was 12.2% (95% CI, 6.8%-19.2%) at 5 years and 32.3% at 10 years (95% CI, 22.8%-42.2%), occurring in the same site as the first LR in about half of the cases. Human epidermal growth factor receptor 2 status and collimator size were independent LR predictors. The 5- and 10-year overall survival rates were 95.2% and 88.3%, respectively, whereas 5- and 10-year BC-specific survival rates were 98% and 94.5%, respectively. The development of a second LR significantly reduced BC-specific survival (hazard ratio, 9.40; <em>P</em> &lt; .001). Grade ≥3 fibrosis rate was 18.9%. Patient-reported cosmesis was good/excellent in 59.7% of the cases.</div></div><div><h3>Conclusions</h3><div>Second LR CumI was within the range of the literature but higher than expected, opening questions on radiation field extension and fractionation schedule. Because a second LR worsened the outcome, salvage modality must be carefully planned.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"14 6","pages":"Pages 484-498"},"PeriodicalIF":3.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735655","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":"International Federation of Gynecology and Obstetrics Endometrial 2023 Is Better For Radiation Oncology Patients","authors":"David Gaffney MD, PhD ,&nbsp;Gita Suneja MD, MS ,&nbsp;Chris Weil MD ,&nbsp;Carien Creutzberg MD","doi":"10.1016/j.prro.2024.05.010","DOIUrl":"10.1016/j.prro.2024.05.010","url":null,"abstract":"<div><div>The International Federation of Gynecology and Obstetrics (FIGO) 2023 staging system for endometrial cancer has marked changes from the previous staging system instituted 14 years prior in 2009. The new staging system includes nonanatomic factors for the first time (lymphovascular space invasion and histology) and molecular classification, which impacts the stage in early-stage disease (IAm<em>_POLE</em>_mut and IICm_p53abn). The purpose of these changes was to provide (1) high accuracy in the predictive prognosis for patients and (2) identification of distinct treatment-relevant subgroups. Our understanding of the biology and natural history of endometrial cancer has undergone a radical transformation since the Cancer Genome Atlas results in 2013. The 2023 FIGO staging system harmonizes and integrates old and new knowledge on anatomic, histopathologic, and molecular features. Moreover, FIGO 2023 has distinct substages that improve adjuvant treatment decision making. Although the practicality of the new staging system has been debated, we postulate that FIGO 2023 is more useful for radiation oncologists aiming to provide personalized care recommendations. FIGO 2023 requires a change in our perception of a staging system, from a traditional anatomic borders-based system to a staging system integrating anatomy and tumor biology as pivotal prognostic factors for patients while providing important information for treatment decision making.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"14 6","pages":"Pages 574-581"},"PeriodicalIF":3.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141635734","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":"Masthead/Sub page","authors":"","doi":"10.1016/S1879-8500(24)00227-3","DOIUrl":"10.1016/S1879-8500(24)00227-3","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"14 6","pages":"Page A1"},"PeriodicalIF":3.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142555622","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":"Peer-to-Peer Phone Calls and Letters Appealing Insurance Denials of Service: Practical Tips and Resources","authors":"Jared Pasetsky MD ,&nbsp;J. Alex Garcia-Young MD ,&nbsp;Emilio Beatley BS ,&nbsp;James B. Yu MD, MHS","doi":"10.1016/j.prro.2024.06.015","DOIUrl":"10.1016/j.prro.2024.06.015","url":null,"abstract":"<div><div>The approval of radiation oncology care by insurance companies is burdensome for providers. In this topic discussion, we attempt to provide practical recommendations for how to deal with peer-to-peer phone calls as well as how to improve the timeliness and quality of subsequent letters of appeal.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"14 6","pages":"Pages e434-e437"},"PeriodicalIF":3.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876720","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}