Practical Radiation Oncology最新文献

{"title":"Effect of Treatment Delivery Schedule for Patients With Early-Stage Non-Small Cell Lung Cancer Treated With Stereotactic Ablative Radiation Therapy: A Population-Based Analysis.","authors":"John Paul Abrina, Sarah Baker, Ella Mae Cruz-Lim, Nick Chng, Allison Ye, Shrinivas Rathod, Julianna Caon, Devin Schellenberg, Mitchell Liu, Benjamin Mou","doi":"10.1016/j.prro.2024.07.012","DOIUrl":"10.1016/j.prro.2024.07.012","url":null,"abstract":"<p><strong>Purpose: </strong>The optimal SABR treatment delivery schedule in stage I non-small cell lung cancer (NSCLC) remains unclear. This population-based study investigated grade ≥2 toxicity rates, local failure (LF), and overall survival (OS) in patients treated with 48 Gy in 4 fractions scheduled every other day versus daily with weekends and consecutive daily without weekends.</p><p><strong>Methods and materials: </strong>Between January 2019 and June 2022, treatment records using 48 Gy in 4 fractions were extracted from a provincial cancer registry and grouped by delivery as every other day, daily with weekends, or consecutive daily without weekends. Toxicity events were recorded using National Cancer Institute Common Terminology Criteria for Adverse Events, version 5.0. The Kaplan-Meier method was used to compute OS and LF was calculated using cumulative incidence methods with death as a competing risk. Cox regression analyses and Fine-Gray modeling was used to assess for variables associated with OS and LF, respectively.</p><p><strong>Results: </strong>Of 404 patients meeting study criteria, 190, 111, and 103 received SABR every other day, daily with weekends, and consecutive daily without weekends, respectively. More patients receiving SABR daily with weekends were medically inoperable and more patients receiving SABR consecutive daily without weekends had tumors abutting the chest wall. Median follow-up time was 29.5 months (IQR, 19.2-38.4 months). Overall toxicity was low, with crude rates of acute and late grade ≥2 toxicity not being statistically different among the groups. No grade 4 or 5 toxicities were recorded. LF rates at 24 months were not different at 7.5% (95% CI, 3.7-11.3), 9.5% (95% CI, 3.9-15.1), and 11.0% (95% CI, 4.9-17.2) for the every other day, daily with weekends, and consecutive daily without weekends groups, respectively (P = .60). Schedules of daily with weekends and consecutive daily without weekends were not associated with LF. Similarly, no significant differences in median OS were found among the every other day, daily with weekends, and consecutive daily without weekends groups at 47.5 months (95% CI, 39.26-55.74), 52.7 months (95% CI, 34.7-70.7), and 49.0 months (95% CI, 31.6-66.4), respectively. Schedules of daily with weekends and consecutive daily without weekends were not associated with OS.</p><p><strong>Conclusions: </strong>This population-based study demonstrated no statistically significant differences in grade ≥2 toxicity rates, LF, and OS for patients with stage I NSCLC treated with lung SABR using 48 Gy in 4 fractions delivered every other day, daily with weekends, and consecutive daily without weekends. Patient convenience and optimization of resources may be considered when choosing a lung SABR treatment delivery schedule.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300799","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":"Quantitative Assessment of Full-Time Equivalent Effort for Kilovoltage-Cone Beam Computed Tomography Guided Online Adaptive Radiation Therapy for Medical Physicists.","authors":"Natalie N Viscariello, Kristen McConnell, Joseph Harms, Joel A Pogue, Xenia Ray, Eric Laugeman, Richard A Popple, Dennis N Stanley, Carlos E Cardenas","doi":"10.1016/j.prro.2024.08.007","DOIUrl":"10.1016/j.prro.2024.08.007","url":null,"abstract":"<p><strong>Purpose: </strong>With recent clinical adoption of online adaptive radiation therapy (oART) and the increased workload associated with adaptive radiation therapy (RT), proper staffing for medical physicists is paramount to safe clinical operation. However, there is currently no consensus on the full-time equivalent (FTE) requirements for safe administration of cone beam computed tomography (CBCT)-guided oART. This study aimed to quantitatively assess medical physics workload and staffing needs of a CBCT-guided oART program.</p><p><strong>Methods and materials: </strong>We conducted a detailed analysis of the CBCT-guided adaptive planning and treatment workflows, encompassing tasks such as patient consultation, treatment planning, plan review, training, quality assurance, and treatment delivery. Using data from machine logs, clinical database queries, and staff surveys, we present a framework for estimating FTE values for different staffing scenarios, considering medical physicists' roles as planners, adaptors, or both.</p><p><strong>Results: </strong>FTE calculations, based on an example workload of 100 adaptive and 200 nonadaptive patients per year, for 3 staffing scenarios were provided: medical physicists as planners and adaptors (2.9 FTE), medical physicists as planners but not adaptors (2.6 FTE), and medical physicists as adaptors but not planners (1.4 FTE). These findings offer calculation guidance and benchmarks for staffing requirements in CBCT-guided oART programs, emphasizing the need for specific staffing models to accommodate the complexities of adaptive RT.</p><p><strong>Conclusions: </strong>This study outlines a framework for calculating FTE requirements for medical physicists in a CBCT-guided oART program. By analyzing the processes for 3 common adaptive RT workflows, this work can provide effective workforce planning and resource allocation estimates. This analysis can be used either before the implementation of an oART program, for program development, or as a review of current practices to ensure operational efficiency and proper staffing levels are maintained.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300801","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":"Patterns of Locoregional Pancreatic Cancer Recurrence After Total Neoadjuvant Therapy and Implications on Optimal Neoadjuvant Radiation Treatment Volumes.","authors":"Sara E Beltran Ponce, Christina J Small, Talha Ahmad, Kishan Patel, Susan Tsai, Mandana Kamgar, Ben George, Jordan R Kharofa, Hina Saeed, Kulwinder S Dua, Callisia N Clarke, Mohammed Aldakkak, Douglas B Evans, Kathleen Christians, Eric S Paulson, Beth Erickson, William A Hall","doi":"10.1016/j.prro.2024.07.001","DOIUrl":"10.1016/j.prro.2024.07.001","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to generate a map of local recurrences after neoadjuvant chemotherapy and radiation (total neoadjuvant therapy [TNT]) followed by surgical resection for pancreatic ductal adenocarcinoma (PDAC). Such recurrence patterns will serve to inform radiation treatment planning volumes that should be given in the neoadjuvant setting.</p><p><strong>Methods and materials: </strong>Locoregional recurrences after TNT followed by surgery treated between 2009 and 2022 were radiologically identified. Recurrences were individually segmented using MIM software and complied in a single base scan. All contour compilations were used to create a threshold contour encompassing 80% of recurrences among all patients, head only, and body/tail only. The distance between organs at risk and the threshold contour were measured to design an optimal clinical target volume contour for patients treated with TNT. Recurrence patterns were also compared with existing adjuvant guidelines to assess coverage.</p><p><strong>Results: </strong>A database of 474 patients managed with TNT for PDAC was queried. While locoregional recurrences were rare in this cohort, we identified 80 patients with either isolated locoregional or simultaneous local and distant recurrences. Patients with diagnostic imaging at the time of recurrence were identified. The majority of recurrences were partially in the field of published contouring guidelines or volumetric expansions off of vessels, and volumetric coverage was low for all. Common areas of recurrence include the aorticodiaphragmatic junction, retropancreatic duodenal nodal basin, and the region to the right of the superior mesenteric artery. A novel set of proposed neoadjuvant contours was designed to cover the central-most 80% of recurrences.</p><p><strong>Conclusions: </strong>This is the largest collection of local/regional PDAC recurrences from a cohort of patients treated exclusively with TNT. Patterns of local/regional recurrence using TNT in PDAC vary significantly from those patients with PDAC treated with a surgery-first approach. Novel contouring guidelines presented in this study can help to ensure optimal coverage of high risk regions and avoid reliance on the current adjuvant guidelines to guide treatment planning.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057229","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":"Radiosurgery Society Case-Based Guide to Stereotactic Body Radiation Therapy for Challenging Cases of Spinal Metastases.","authors":"Khaled Aziz, Daniel Koffler, April Vassantachart, Abbas Rattani, Nii-Kwanchie Ankrah, Emile Gogineni, Therese Y Andraos, Arjun Sahgal, Balamurugan Vellayappan, Emma M Dunne, Shankar Siva, Fabio Y Moraes, Matthias Guckenberger, Daniel Lubelski, Samuel Chao, Stephanie Combs, Eric Chang, Anubhav G Amin, Matthew Foote, Iris Gibbs, Minsun Kim, Joshua Palmer, Simon Lo, Kristin J Redmond","doi":"10.1016/j.prro.2024.08.004","DOIUrl":"10.1016/j.prro.2024.08.004","url":null,"abstract":"<p><strong>Purpose: </strong>Spinal stereotactic body radiation therapy (SBRT) has become the standard of care in management of patients with limited sites of metastatic disease, radioresistant histologies, painful vertebral metastases with long life expectancy and cases of reirradiation. Our case-based guidelines aim to assist radiation oncologists in the appropriate utilization of SBRT for common, yet challenging, cases of spinal metastases.</p><p><strong>Methods and materials: </strong>Cases were selected to include scenarios of large volume sacral disease with nerve entrapment, medically inoperable disease abutting the thecal sac, and local failure after prior SBRT. Relevant literature was reviewed, and areas requiring further investigation were discussed to offer a framework for evidence-based clinical practice.</p><p><strong>Results: </strong>Spinal SBRT can be effectively delivered in challenging cases following multidisciplinary discussion by using a methodical approach to patient selection, appropriate dose selection, and adherence to evidence-based dose constraints.</p><p><strong>Conclusions: </strong>The Radiosurgery Society's case-based practice review offers guidance to practicing physicians treating technically challenging SBRT candidate patients with spinal metastases.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134432","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":"Comprehensive Clinical Usability-Oriented Contour Quality Evaluation for Deep Learning Auto-segmentation: Combining Multiple Quantitative Metrics Through Machine Learning.","authors":"Ying Zhang, Asma Amjad, Jie Ding, Christina Sarosiek, Mohammad Zarenia, Renae Conlin, William A Hall, Beth Erickson, Eric Paulson","doi":"10.1016/j.prro.2024.07.007","DOIUrl":"10.1016/j.prro.2024.07.007","url":null,"abstract":"<p><strong>Purpose: </strong>The current commonly used metrics for evaluating the quality of auto-segmented contours have limitations and do not always reflect the clinical usefulness of the contours. This work aims to develop a novel contour quality classification (CQC) method by combining multiple quantitative metrics for clinical usability-oriented contour quality evaluation for deep learning-based auto-segmentation (DLAS).</p><p><strong>Methods and materials: </strong>The CQC was designed to categorize contours on slices as acceptable, minor edit, or major edit based on the expected editing effort/time with supervised ensemble tree classification models using 7 quantitative metrics. Organ-specific models were trained for 5 abdominal organs (pancreas, duodenum, stomach, small, and large bowels) using 50 magnetic resonance imaging (MRI) data sets. Twenty additional MRI and 9 computed tomography (CT) data sets were employed for testing. Interobserver variation (IOV) was assessed among 6 observers and consensus labels were established through majority vote for evaluation. The CQC was also compared with a threshold-based baseline approach.</p><p><strong>Results: </strong>For the 5 organs, the average area under the curve was 0.982 ± 0.01 and 0.979 ± 0.01, the mean accuracy was 95.8% ± 1.7% and 94.3% ± 2.1%, and the mean risk rate was 0.8% ± 0.4% and 0.7% ± 0.5% for MRI and CT testing data set, respectively. The CQC results closely matched the IOV results (mean accuracy of 94.2% ± 0.8% and 94.8% ± 1.7%) and were significantly higher than those obtained using the threshold-based method (mean accuracy of 80.0% ± 4.7%, 83.8% ± 5.2%, and 77.3% ± 6.6% using 1, 2, and 3 metrics).</p><p><strong>Conclusions: </strong>The CQC models demonstrated high performance in classifying the quality of contour slices. This method can address the limitations of existing metrics and offers an intuitive and comprehensive solution for clinically oriented evaluation and comparison of DLAS systems.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134431","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":"Centralized Quality Assurance of Stereotactic Body Radiation Therapy for the Veterans Affairs Cooperative Studies Program Study Number 2005: A Phase 3 Randomized Trial of Lung Cancer Surgery or Stereotactic Radiotherapy for Operable Early-Stage Non-Small Cell Lung Cancer (VALOR).","authors":"Timothy A Ritter, Robert D Timmerman, Hena I Hanfi, Hairong Shi, Matthew K Leiner, Hua Feng, Vicki L Skinner, Lisa M Robin, Cheryl Odle, Gabriella Amador, Tom Sindowski, Amanda J Snodgrass, Grant D Huang, Domenic J Reda, Christopher Slatore, Catherine R Sears, Lorraine D Cornwell, Tomer Z Karas, David H Harpole, Jatinder Palta, Drew Moghanaki","doi":"10.1016/j.prro.2024.07.010","DOIUrl":"10.1016/j.prro.2024.07.010","url":null,"abstract":"<p><strong>Purpose: </strong>The phase 3 Veterans Affairs Lung Cancer Surgery Or Stereotactic Radiotherapy study implemented centralized quality assurance (QA) to mitigate risks of protocol deviations. This report summarizes the quality and compliance of the first 100 participants treated with stereotactic body radiation therapy (SBRT) in this study.</p><p><strong>Methods and materials: </strong>A centralized QA program was developed to credential and monitor study sites to ensure standard-of-care lung SBRT treatments are delivered to participants. Requirements were adapted from protocols established by the National Cancer Institute's Image and Radiation Oncology Core, which provides oversight for clinical trials sponsored by the National Cancer Institute's National Clinical Trials Network.</p><p><strong>Results: </strong>The first 100 lung SBRT treatment plans were reviewed from April 2017 to October 2022. Tumor contours were appropriate in all submissions. Planning target volume (PTV) expansions were less than the minimum 5 mm requirement in 2% of cases. Critical organ-at-risk structures were contoured accurately for the proximal bronchial tree, trachea, esophagus, spinal cord, and brachial plexus in 75%, 92%, 100%, 100%, and 95% of cases, respectively. Prescriptions were appropriate in 98% of cases; 2 central tumors were treated using a peripheral tumor dose prescription while meeting organ-at-risk constraints. PTV V100% (the percentage of target volume that receives 100% or more of the prescription) values were above the protocol-defined minimum of 94% in all but 1 submission. The median dose maximum (Dmax) within the PTV was 125.4% (105.8%-149.0%; SD ± 8.7%), where values reference the percentage of the prescription dose. High-dose conformality (ratio of the volume of the prescription isodose to the volume of the PTV) and intermediate-dose compactness [R50% (ratio of the volume of the half prescription isodose to the volume of the PTV) and D2cm (the maximum dose beyond a 2 cm expansion of the PTV expressed as a percentage of the prescription dose)] were acceptable or deviation acceptable in 100% and 94% of cases, respectively.</p><p><strong>Conclusions: </strong>The first 100 participants randomized to SBRT in this study were appropriately treated without safety concerns. A response to the incorrect prescriptions led to preventative measures without further recurrences. The program was developed in a health care system without prior experience with a centralized radiation therapy QA program and may serve as a reference for other institutions.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Radiation Therapy in Patients with Systemic Sclerosis and Head and Neck Cancer","authors":"","doi":"10.1016/j.prro.2024.04.015","DOIUrl":"10.1016/j.prro.2024.04.015","url":null,"abstract":"<div><h3>Objective</h3><p>Systemic sclerosis (SSc) is considered a relative, or in some cases, absolute contraindication for radiation therapy for various cancers; however, radiation is the standard of care and the best option for tumor control for locally advanced head and neck (H&amp;N) cancer. We present a case series to document postradiation outcomes in patients with SSc and H&amp;N cancer.</p></div><div><h3>Methods</h3><p>Patients with SSc and H&amp;N cancer treated with radiation were identified from the Johns Hopkins Scleroderma<span><span> Center and the University of Pittsburgh Scleroderma Center research registries. Through chart review, we identified whether patients developed predetermined acute and late side effects or changes in SSc activity from radiation. We further describe therapies used to prevent and treat radiation-induced </span>fibrosis.</span></p></div><div><h3>Results</h3><p><span>Thirteen patients with SSc who received radiation therapy for H&amp;N cancer were included. Five-year survival was 54%. Nine patients (69%) developed local radiation-induced skin thickening, and 7 (54%) developed reduced neck range of motion. Two patients required long-term percutaneous endoscopic gastrostomy<span> use due to radiation therapy complications. No patients required respiratory support<span> related to radiation therapy. Regarding SSc disease activity among the patients with established SSc before radiation therapy, none experienced interstitial lung </span></span></span>disease progression<span><span><span> in the postradiation period. After radiation, one patient had worsening skin disease outside the radiation field; however, this patient was within the first year of SSc, when progressive skin disease is expected. Treatment strategies to prevent radiation fibrosis included </span>pentoxifylline<span>, amifostine, and </span></span>vitamin E, while intravenous immunoglobulin (IVIG) was used to treat it.</span></p></div><div><h3>Conclusion</h3><p>Although some patients with SSc who received radiation for H&amp;N cancer developed localized skin thickening and reduced neck range of motion, systemic flares of SSc were uncommon. This observational study provides evidence to support the use of radiation therapy for H&amp;N cancer in patients with SSc when radiation is the best treatment option.</p></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"14 5","pages":"Pages e334-e343"},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140864403","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)00168-1","DOIUrl":"10.1016/S1879-8500(24)00168-1","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"14 5","pages":"Page A1"},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142096577","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":"To pass away on leap day","authors":"","doi":"10.1016/j.prro.2024.01.008","DOIUrl":"10.1016/j.prro.2024.01.008","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"14 5","pages":"Pages 368-370"},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140121335","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 Radiation Therapy Contouring Atlas for Delineation of the Level I and II Axillae in the Prone Position: A Single-Institution Experience","authors":"","doi":"10.1016/j.prro.2024.04.016","DOIUrl":"10.1016/j.prro.2024.04.016","url":null,"abstract":"<div><h3>Purpose</h3><p><span>With transition from supine to prone position, tenting of the pectoralis major occurs, displacing the muscle from the chest wall and shifting the level I and II axillary spaces. For patients for whom we aim to treat the level I and II </span>axillae<span><span> using the prone technique, accurate delineation of these nodal regions is necessary. Although different consensus guidelines exist for delineation of nodal anatomy in </span>supine position, to our knowledge, there are no contouring guidelines in the prone position that account for this change in nodal anatomy.</span></p></div><div><h3>Methods and Materials</h3><p>The level I and II nodal contours from the Radiation Therapy Oncology<span> Group (RTOG) breast cancer supine atlas were adapted for prone position by 2 radiation oncologists and a breast radiologist based on anatomic changes observed from supine to prone positioning on preoperative diagnostic imaging. Forty-three patients from a single institution treated with prone high tangents from 2012 to 2018 were identified as representative cases to delineate the revised level I and II axillae on noncontrast computed tomography (CT) scans obtained during radiation simulation. The revised nodal contours were reviewed by an expanded expert multidisciplinary panel including breast radiologists, radiation oncologists, and surgical oncologists for consistency and reproducibility.</span></p></div><div><h3>Results</h3><p>Consensus was achieved among the panel in order to create modifications from the RTOG breast atlas for CT–based contouring of the level I and II axillae in prone position using bone, muscle, and skin as landmarks. This atlas provides representative examples and accompanying descriptions for the changes described to the caudal and anterior borders of level II and the anterior, posterior, medial, and lateral borders of level I. A step-by-step guide is provided for properly identifying the revised anterior border of the level I axilla.</p></div><div><h3>Conclusions</h3><p>The adaptations to the RTOG breast cancer atlas for prone positioning will enable radiation oncologists to more accurately target the level I and II axillae when the axillae are targets in addition to the breast.</p></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"14 5","pages":"Pages 426-434"},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140905189","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}