Advances in Radiation Oncology最新文献

{"title":"Lumbosacral Plexopathy After Carbon-ion Radiation Therapy for Postoperative Pelvic Recurrence of Rectal Cancer: Subanalysis of a Prospective Observational Study (GUNMA 0801)","authors":"Takuya Kumazawa MD, PhD ,&nbsp;Shintaro Shiba MD, PhD ,&nbsp;Yuhei Miyasaka MD, PhD ,&nbsp;Masahiko Okamoto MD, PhD ,&nbsp;Daijiro Kobayashi MD, PhD ,&nbsp;Tatsuya Ohno MD, PhD","doi":"10.1016/j.adro.2024.101711","DOIUrl":"10.1016/j.adro.2024.101711","url":null,"abstract":"<div><h3>Purpose</h3><div>Data are lacking on the risk factors for radiation-induced lumbosacral plexopathy (RILSP) after carbon-ion radiation therapy (CIRT) for pelvic tumors, such as postoperative recurrence of rectal cancer. We investigated the incidence of RILSP and the associated dosimetric parameters using data from a prospective study of CIRT for postoperative pelvic recurrence of rectal cancer (GUNMA 0801).</div></div><div><h3>Methods and Materials</h3><div>The GUNMA 0801 study included 28 patients, of which we analyzed 20 without lumbosacral plexopathy prior to CIRT. The total dose of CIRT was 73.6 Gy (relative biological effectiveness [RBE]) in 16 fractions. The incidence of RILSP and parameters of the dose-volume histogram were evaluated for the lumbosacral plexuses. RILSP was graded according to the Common Terminology Criteria for Adverse Events version 4.0.</div></div><div><h3>Results</h3><div>Median follow-up was 24 months. The incidence of all RILSP (grades 1 and 2) and grade 2 RILSP was 22.5% (9/40) and 10% (4/40) of 40 lumbosacral plexuses in 20 patients, respectively, and no grade ≥ 3 toxicity was observed. Throughout the dose range, the volumes of the irradiated lumbosacral plexuses were significantly higher in patients with RILSP than in patients without RILSP (<em>P</em> &lt; .001 for Dmax, D0.5 cm³ − D2 cm³, V20 Gy(RBE) − V70 Gy(RBE)). D2 cm³ and V50 Gy(RBE) were considered useful for receiver operating characteristic analysis. Cutoff values for RILSP were 73.82 Gy(RBE) and 33.2% for D2 cm³ and V50 Gy(RBE), respectively.</div></div><div><h3>Conclusions</h3><div>We demonstrated the incidence and predictive dosimetric parameters for RILSP after CIRT and showed that D2 cm³ ≥ 73.82 Gy(RBE) and V50 Gy(RBE) = 33.2% are cutoff values for predicting RILSP. These results would improve treatment plans using CIRT for patients with pelvic recurrences of rectal cancer.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 3","pages":"Article 101711"},"PeriodicalIF":2.2,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143348953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Travel Burden of Radiation Therapy in the Philippines","authors":"Michelle Ann B. Eala MD ,&nbsp;Ethan Angelo S. Maslog MD ,&nbsp;Nicole Rose I. Alberto MD ,&nbsp;Isabelle Rose I. Alberto MD ,&nbsp;Frances Dominique V. Ho MD ,&nbsp;Edward Christopher Dee MD ,&nbsp;Ann Raldow MD, MPH ,&nbsp;Reno Eufemon Cereno MD","doi":"10.1016/j.adro.2024.101699","DOIUrl":"10.1016/j.adro.2024.101699","url":null,"abstract":"<div><h3>Purpose</h3><div>Travel burden negatively impacts the stage at diagnosis, treatment, outcome, and quality of life among patients with cancer. Travel burden—quantified as distance, time, and cost of travel—is magnified in low- and middle-income countries like the Philippines, where radiation therapy (RT) resources are lacking and are inequitably distributed.</div></div><div><h3>Methods and Materials</h3><div>We compared Philippine Radiation Oncology Society data and the population census to determine the distribution and density of RT facilities across the country's 17 regions. For distance and travel time, we used the Google Maps route planner to determine the best routes from each province to the nearest private and government RT facility. Travel cost was calculated by multiplying distance by the local price of diesel per liter and the mean fuel economy of passenger vehicles in the Philippines.</div></div><div><h3>Results</h3><div>There are only 54 RT facilities in the Philippines (0.5 per 1 million population). More than a third are in the National Capital Region (NCR). Four regions do not have an RT facility. Nationally, the average distance to any RT facility is 101.02 km with a travel time of 2.66 hours and a travel cost of PHP 4811.11 ($85.91). Travel burden to any RT facility is the least in NCR and greatest in Visayas. Travel burden to a government RT facility is greater, with an average distance of 136.94 km, travel time of 3.05 hours, and travel cost of PHP 6353.43 ($113.45). Travel burden to a government RT facility is least in NCR and greatest in Mindanao.</div></div><div><h3>Conclusions</h3><div>The travel burden of RT in the Philippines is significant and varies regionally and by RT facility type (private or government). Data-driven installation of government RT facilities in underserved regions, alternative reimbursement systems to encourage hypofractionation when appropriate, patient subsidies for housing/transportation while on treatment, better public transportation, and patient navigation are needed.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 2","pages":"Article 101699"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751511/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Review of Tools Evaluating Quality of Life in Cervical Cancer Survivors Treated With Chemoradiation Therapy","authors":"Isabela Anawate BA ,&nbsp;Christian Lumley MD ,&nbsp;Sierra Silverwood BA ,&nbsp;Magdalena Anchondo MPA ,&nbsp;Kgosi Hughes BS ,&nbsp;Caroline Kernell BS ,&nbsp;Katharine Rendle PhD, MPH, MSW ,&nbsp;Rohini Bhatia MD ,&nbsp;Surbhi Grover MD, MPH","doi":"10.1016/j.adro.2024.101700","DOIUrl":"10.1016/j.adro.2024.101700","url":null,"abstract":"<div><h3>Purpose</h3><div>This systematic review aimed to identify and compare tools used to evaluate quality of life (QoL) after pelvic radiation for cervical cancer and to describe variations in results within commonly used instruments. This review hypothesized regional preferences in the selection of these tools and an absence of uniformity in their application globally.</div></div><div><h3>Methods and Materials</h3><div>A comprehensive search of 6 databases was conducted between the inception of each included database and June 14, 2023, focusing on studies evaluating the QoL of patients with cervical cancer during and after radiation. Excluded were studies involving cancers originating outside the cervix, those not exclusively undergoing radiation or chemoradiation therapy, such as patients who have undergone surgery, and non-English studies.</div></div><div><h3>Results</h3><div>Ultimately, 229 studies covering 25,693 patients and 51 countries were identified. Most studies were conducted in Asia (35.6%) and Europe (32.9%). Ninety-nine QoL instruments were identified, not including those that were specific to a single study. The European Organisation for Research and Treatment of Cancer QoL Questionnaire Core 30 (20.5%) and the European Organization for Research and Treatment of Cancer (EORTC) QoL questionnaire cervical cancer module (16.0%) were the most commonly used; however, US-based studies primarily used the Functional Assessment of Cancer Therapy-General surveys. Furthermore, there was significant variability in the timelines of survey usage in relation to when treatment was completed, further limiting the comparisons that can be made. Of the 127 studies that reported data on the time points after completion of treatment at which QoL was measured, 72.4% measured QoL within 1 year of treatment completion, and 48.8% measured QoL &gt;1 year after treatment completion, with some studies using multiple time points for their research.</div></div><div><h3>Conclusions</h3><div>This study revealed a fragmented landscape with significant variability in QoL survey use, limiting the generalizability and usefulness of these results to drive meaningful change. There is a need for a global standardized method to evaluate QoL after treatment of cervical cancer with radiation therapy for comparison across regions. Simplified tools may assist with the broader collection of data, which may lead to advancements for improvement of the QoL of these patients.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 2","pages":"Article 101700"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11733041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing the Impact of Race and Contemporary Redlining on Receipt of Guideline-Concordant Locoregional Therapy Among Older Women With Breast Cancer","authors":"Sara Beltrán Ponce MD ,&nbsp;Bethany Canales MPH ,&nbsp;Emily L. McGinley MS, MPH ,&nbsp;Tina W.F. Yen MD, MS ,&nbsp;Sergey Tarima PhD ,&nbsp;Yuhong Zhou PhD, MS, ME ,&nbsp;Jean C. Bikomeye MPH ,&nbsp;Kirsten M.M. Beyer PhD, MPH, MS","doi":"10.1016/j.adro.2024.101688","DOIUrl":"10.1016/j.adro.2024.101688","url":null,"abstract":"<div><h3>Purpose</h3><div>Improving locoregional control for breast cancer (BC) results in better overall survival. Contemporary redlining is associated with worse BC survival in older patients. Self-reported race is associated with survival, redlining, and access to care. We aim to examine the relationship between race, redlining, and the receipt of guideline-concordant locoregional therapy (LRT) in older women with BC.</div></div><div><h3>Methods and Materials</h3><div>Women aged 66 to 90 years with stage I to III BC diagnosed in 2010 to 2017 with known metropolitan statistical area were identified in Surveillance, Epidemiology, and End Results-Medicare. Redlining was estimated using Home Mortgage Disclosure Act data. Guideline-concordant LRT was assessed based on receipt of surgery and appropriate adjuvant radiation treatment. A logistic regression model was fitted to examine the relationship between redlining and receipt of guideline-concordant LRT, accounting for covariates. Cluster bootstrap at the MSA-level was used.</div></div><div><h3>Results</h3><div>The cohort included 64,987 women: 31% aged 66 to 70, 82% non-Hispanic (NH) White, 12% with dual Medicaid/Medicare enrollment. Ninety-four percent underwent surgical resection; 84% received guideline compliant LRT. NH Black race was associated with lower receipt of guideline-concordant LRT compared to NH White (odds ratio [OR], 0.78; 95% CI, 0.71-0.84). No significant differences were noted between NH White and NH Asian or Hispanic women. Residing in high-redlining areas was associated with lower odds of receiving guideline-concordant LRT compared to low-redlining areas (OR, 0.89; 95% CI, 0.82-0.95, <em>P</em> = .002).</div></div><div><h3>Conclusions</h3><div>In this cohort of older women with BC, NH Black race and redlining, even after adjusting for several important clinical and demographic factors, were associated with a lower likelihood of receiving guideline-concordant LRT. This finding demonstrates the profound impact of interpersonal racism and redlining on receipt of cancer-directed therapies and highlights the need for further work to combat systemic inequities and interpersonal racism.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 2","pages":"Article 101688"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance Comparison of 10 State-of-the-Art Machine Learning Algorithms for Outcome Prediction Modeling of Radiation-Induced Toxicity","authors":"Ramon M. Salazar PhD ,&nbsp;Saurabh S. Nair MS ,&nbsp;Alexandra O. Leone MBS ,&nbsp;Ting Xu PhD ,&nbsp;Raymond P. Mumme BS ,&nbsp;Jack D. Duryea BA ,&nbsp;Brian De MD ,&nbsp;Kelsey L. Corrigan MD ,&nbsp;Michael K. Rooney MD ,&nbsp;Matthew S. Ning MD ,&nbsp;Prajnan Das MD ,&nbsp;Emma B. Holliday MD ,&nbsp;Zhongxing Liao MD ,&nbsp;Laurence E. Court PhD ,&nbsp;Joshua S. Niedzielski PhD","doi":"10.1016/j.adro.2024.101675","DOIUrl":"10.1016/j.adro.2024.101675","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the efficacy of prominent machine learning algorithms in predicting normal tissue complication probability using clinical data obtained from 2 distinct disease sites and to create a software tool that facilitates the automatic determination of the optimal algorithm to model any given labeled data set.</div></div><div><h3>Methods and Materials</h3><div>We obtained 3 sets of radiation toxicity data (478 patients) from our clinic: gastrointestinal toxicity, radiation pneumonitis, and radiation esophagitis. These data comprised clinicopathological and dosimetric information for patients diagnosed with non-small cell lung cancer and anal squamous cell carcinoma. Each data set was modeled using 11 commonly employed machine learning algorithms (elastic net, least absolute shrinkage and selection operator [LASSO], random forest, random forest regression, support vector machine, extreme gradient boosting, light gradient boosting machine, k-nearest neighbors, neural network, Bayesian-LASSO, and Bayesian neural network) by randomly dividing the data set into a training and test set. The training set was used to create and tune the model, and the test set served to assess it by calculating performance metrics. This process was repeated 100 times by each algorithm for each data set. Figures were generated to visually compare the performance of the algorithms. A graphical user interface was developed to automate this whole process.</div></div><div><h3>Results</h3><div>LASSO achieved the highest area under the precision-recall curve (0.807 ± 0.067) for radiation esophagitis, random forest for gastrointestinal toxicity (0.726 ± 0.096), and the neural network for radiation pneumonitis (0.878 ± 0.060). The area under the curve was 0.754 ± 0.069, 0.889 ± 0.043, and 0.905 ± 0.045, respectively. The graphical user interface was used to compare all algorithms for each data set automatically. When averaging the area under the precision-recall curve across all toxicities, Bayesian-LASSO was the best model.</div></div><div><h3>Conclusions</h3><div>Our results show that there is no best algorithm for all data sets. Therefore, it is important to compare multiple algorithms when training an outcome prediction model on a new data set. The graphical user interface created for this study automatically compares the performance of these 11 algorithms for any data set.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 2","pages":"Article 101675"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improved Efficacy of a Predictive Model for Swallowing-Induced Breakthrough Pain Based on a Redefined Delineation Method in Locally Advanced Nasopharyngeal Carcinoma","authors":"Jian-Da Sun MD ,&nbsp;Ze-Kai Chen MM ,&nbsp;Shu-Peng Liu PhD ,&nbsp;Feng Ye MD ,&nbsp;Ting-Xi Tang MD ,&nbsp;Zhen-Hua Zhou MD ,&nbsp;Han-Bin Zhang MM ,&nbsp;Long-Shan Zhang MD ,&nbsp;Ting Xiao BS ,&nbsp;Lin-Lin Xiao MM ,&nbsp;Xiao-Qing Wang MD ,&nbsp;Jian Guan MD","doi":"10.1016/j.adro.2024.101690","DOIUrl":"10.1016/j.adro.2024.101690","url":null,"abstract":"<div><h3>Purpose</h3><div>The objective of this study was to explore the performance of a predictive model for swallowing-induced breakthrough pain established using a redefined delineation method based on the common occurrence sites of radiation-induced oral mucositis (RIOM) in locally advanced nasopharyngeal carcinoma (NPC).</div></div><div><h3>Methods and Materials</h3><div>A total of 208 patients with locally advanced NPC were included in the study cohort, and the test cohort consisted of 88 patients. The oral mucosa structure was contoured using oral cavity contour (OCC), mucosal surface contour (MSC), and oral-pharyngeal mucosa (OPM) methods, and relevant dosimetric parameters were collected. Assessment of the severity of RIOM was made with the National Cancer Institute's Common Terminology Criteria for Adverse Events, version 4.0. The random forest classification method was chosen to establish and validate the predictive models based on 3 contouring methods.</div></div><div><h3>Results</h3><div>The area under the curve of the OPM-based model was higher than that of the OCC- and MSC-based models in both the validation cohort and the test cohort (0.800, 0.739, and 0.750; 0.670, 0.605, and 0.609, respectively). Better predictive performance could also be observed under the OPM method than the OCC and MSC methods in terms of accuracy. The OPM-based model showed high specificity (greater than 90%) in both the validation cohort and the test cohort. According to the mean decrease in the Gini index, the maximum dose was the most important predictor of severe oral mucositis in the OPM-based model.</div></div><div><h3>Conclusions</h3><div>We redefined a delineation method for oral mucosa structure based on the common occurrence sites of RIOM in locally advanced NPC. The model for swallowing-induced breakthrough pain constructed based on this method demonstrated good predictive performance. New parameters were found as predictors of severe swallowing-induced breakthrough pain in locally advanced NPC.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 2","pages":"Article 101690"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11770509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cone Beam Online Adaptive Radiation Therapy: A Promising Approach for Gastric Mucosa-Associated Lymphoid Tissue Lymphoma?","authors":"Xinran Zhong PhD ,&nbsp;Mahbubur Rahman PhD ,&nbsp;Ambrosia Simmons MD, PhD,&nbsp;Xingzhe Li MD,&nbsp;Malgorzata Kozak MD,&nbsp;Neil Desai MD,&nbsp;Robert Timmerman MD,&nbsp;Andrew Godley PhD,&nbsp;Bin Cai PhD,&nbsp;David Parsons PhD,&nbsp;Kiran A. Kumar MD,&nbsp;Mu-Han Lin PhD","doi":"10.1016/j.adro.2024.101692","DOIUrl":"10.1016/j.adro.2024.101692","url":null,"abstract":"<div><h3>Purpose</h3><div>Daily online adaptive radiation therapy (oART) opens the opportunity to treat gastric mucosa-associated lymphoid tissue (MALT) lymphoma with a reduced margin. This study reports our early experience of cone beam computed tomography (CBCT)-based daily oART treating gastric MALT lymphoma with breath-hold and reduced margins.</div></div><div><h3>Methods and Materials</h3><div>Ten patients were treated on a CBCT-based oART system. Organs at risk (OARs) and the clinical target volume (CTV) were adjusted based on the daily CBCT. Planning target volume (PTV) was derived from the CTV with a 0.5 to 0.7 cm margin with breath-hold. Multiple beam arrangements were compared during the preplanning phase to ensure minimal monitor unit (MU) for patient comfort and breath-hold reproducibility. For 108 fractions from the 10 patients, the PTV, CTV coverage, and Paddick conformity index (CI) were compared between the adapted and scheduled plans. The MU, Paddick CI, and gradient index were compared using relative percentage differences between the adapted plans and preplans. The OAR doses from 106 fractions across 9 patients were reported for the preplans, adapted plans, and scheduled plans. The time statistics for each step of the clinical workflow were recorded and reported for 93 treatment fractions from 9 patients.</div></div><div><h3>Results</h3><div>The PTV volume varied from −37.1% to 90.5% (11.7% ± 18.5%) throughout treatments across all patients. The adapted plan was chosen as the treatment plan for each fraction because of superior PTV and CTV coverage while maintaining a similar OAR dose. The PTV and CTV coverage for the adapted and scheduled plans was V_Rx = 95.0% ± 0.3% versus 64.1 ± 19.6% and V_Rx = 99.9 ± 0.1% versus 74.0% ± 22.2%, respectively. The adapted plans’ MU, Paddick CI, and gradient index were, on average, 4.1%, 0.4%, and −4.2% of the preplan values, respectively. The console's adaptive workflow and physician time were 25 ± 7 and 19 ± 6 minutes, respectively.</div></div><div><h3>Conclusion</h3><div>A CBCT-based oART system with the proposed workflow is feasible for treating patients with gastric MALT lymphoma using a reduced PTV margin while maintaining excellent target coverage within a reasonable time, resulting in consistent adapted plan quality. This approach can be expanded to a larger cohort of gastrointestinal patients.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 2","pages":"Article 101692"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11733034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing Wellness Initiatives in Academic Radiation Oncology Departments","authors":"Sara Beltrán Ponce MD ,&nbsp;Crystal Seldon Taswell MD ,&nbsp;Idalid Franco MD, MPH ,&nbsp;Malcolm D. Mattes MD ,&nbsp;Tracy Kelly MD ,&nbsp;Leah Katz MD, MPH","doi":"10.1016/j.adro.2024.101691","DOIUrl":"10.1016/j.adro.2024.101691","url":null,"abstract":"<div><h3>Purpose</h3><div>Burnout is prevalent in radiation oncology (RO), and an increased focus on promoting physician wellness and formalizing wellness-directed efforts has transpired in recent years. We aimed to characterize current wellness leadership positions and efforts within academic RO departments.</div></div><div><h3>Methods and Materials</h3><div>Academic RO department chairs were contacted to inquire whether they had a departmental wellness leader with a request for leader contact information, if applicable. Wellness leaders were invited to complete an anonymous survey in January and February 2023 using Qualtrics. Questions assessed leader demographic characteristics, role structure and resources, current initiatives, and impacts to date. Descriptive statistics and summaries of free-text responses are reported.</div></div><div><h3>Results</h3><div>A total of 120 chairs were contacted. In total, 71 (59%) responded, with 43 (61%) having departmental wellness leaders, of which 17 (39.5%) responded, to the survey. A total of 70.6% were female, and 76.5% were physician faculty. Most respondents were early-career. The most common previously implemented initiatives included offering programming and education (33.3%) and improved access to mental health services (25%). The most common active initiatives include conducting studies to address root causes of burnout (41.7%), developing specific wellness goals (25%), performing a review of policies that encourage prolonged work hours (25%), and offering programming and education (25%). Challenges included limited bandwidth (66.7%), lack of funding (41.7%), and lack of departmental interest in organizing or attending events (33.3%). Leaders highlight the importance of a dedicated individual to tangibly implement changes and the unique opportunity of someone within RO to understand the specific challenges faced by those in our field.</div></div><div><h3>Conclusions</h3><div>Wellness leadership roles exist in many RO departments. As evidenced by a limited number of fully implemented initiatives, these roles are new and evolving. A focus on wellness has the potential to bring positive change to departments; however, the impact of newly established wellness roles on culture and balance requires longitudinal followup.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 2","pages":"Article 101691"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11757214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of External Beam Radiation Therapy and Brachytherapy on Circulating Myeloid-Derived Suppressor Cell Populations in Patients Treated Definitively for Cervical Cancer","authors":"Kelsey M. Wanhainen MD, PhD ,&nbsp;Matthew Berkseth PhD ,&nbsp;Nicole Sando BS ,&nbsp;Lydia Golden BS ,&nbsp;Amy Techam RN, PHN ,&nbsp;Jennifer Wieworka DNP ,&nbsp;Kyra M. Boorsma Bergerud BS ,&nbsp;Peter Argenta MD ,&nbsp;Andrea O'Shea MD ,&nbsp;Britt K. Erickson MD ,&nbsp;Sally Mullany MD ,&nbsp;Colleen Rivard MD ,&nbsp;Rahel Ghebre MD, MPH ,&nbsp;Deanna Teoh MD, MS ,&nbsp;Margaret Reynolds MD ,&nbsp;Stephanie Terezakis MD ,&nbsp;Jianling Yuan MD, PhD ,&nbsp;Lindsey Sloan MD, PhD","doi":"10.1016/j.adro.2024.101677","DOIUrl":"10.1016/j.adro.2024.101677","url":null,"abstract":"<div><h3>Purpose</h3><div>The immunosuppressive function of myeloid-derived suppressor cells (MDSCs) has been implicated in the regulation of immune responses against cancer and is associated with poor prognosis. Radiation treatment is known to alter immune cell populations within the tumor; however, whether this results in the recruitment of immunosuppressive MDSC populations is not well understood. Here we evaluate the response of circulating MDSC populations in patients treated per standard-of-care cisplatin chemoradiation therapy (CRT) for locally invasive cervical cancer.</div></div><div><h3>Methods and Materials</h3><div>Newly diagnosed, treatment-naïve patients with locally advanced cervical cancer were enrolled. Blood samples were collected from patients prior to starting CRT (T₀), after external beam radiation therapy (T₁), and after high-dose-rate brachytherapy (T₂). Samples from each time point were processed, and the prevalence of MDSC subsets was determined using flow cytometry. MDSC populations were identified using Live/Dead-CD11b+CD33+HLA-DR- staining. MDSC subsets were further subdivided into granulocytic (g-, CD15+CD14-), monocytic (m-, CD15-CD14+), or early-MDSCs (e-, CD15-CD14-).</div></div><div><h3>Results</h3><div>Most patients in our study were Caucasian nonsmokers with human papillomavirus-associated squamous cell carcinoma of the cervix. We saw a trend for increased MDSC frequency in patients with more advanced-stage disease at the time of initiating treatment. MDSCs increase in response to CRT and peak after brachytherapy (T₂). In particular, the g-MDSC subset increases by 6.44 times relative to the baseline. There was no correlation between MDSC expansion and response to therapy.</div></div><div><h3>Conclusion</h3><div>Our study confirms other reports that circulating MDSCs in patients with cervical cancer increase in response to CRT and are associated with more advanced stages. Additionally, we show that MDSC expansion is driven by the g-MDSC subset. We did not see any correlation between MDSC expansion and treatment response, though this may be because of the limited sample size for this study.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 2","pages":"Article 101677"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11653128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Noninvasive Mechanical Ventilation Is a Promising Way to Improve Lung Cancer Radiation Therapy","authors":"Johannes K. Veldman-Landegent MS ,&nbsp;Zdenko van Kesteren PhD ,&nbsp;Mike J. Parkes PhD ,&nbsp;Markus F. Stevens MD PhD ,&nbsp;Joost G. van den Aardweg MD, PhD ,&nbsp;Edith M.T. Dieleman MD ,&nbsp;Eva Versteijne MD, PhD ,&nbsp;Geertjan van Tienhoven MD, PhD ,&nbsp;Arjan Bel PhD ,&nbsp;Irma W.E.M. van Dijk PhD","doi":"10.1016/j.adro.2024.101679","DOIUrl":"10.1016/j.adro.2024.101679","url":null,"abstract":"<div><h3>Purpose</h3><div>Accurate radiation therapy (RT) for lung cancer is challenging because of the respiratory motion of the tumor and surrounding organs at risk. Recently, non-invasive mechanical ventilation (NIMV) has been investigated as a novel respiratory motion management strategy. Using NIMV, respiratory motion can be minimized, while a larger lung volume yields less overall lung dose. The purpose of this study was to determine the potential benefit of NIMV to improve lung cancer RT using magnetic resonance imaging (MRI) data of healthy volunteers.</div></div><div><h3>Methods and Materials</h3><div>Twelve healthy volunteers practiced NIMV at 60 breaths per minute (NIMV₆₀) with added positive end-expiratory pressure (PEEP) in 2 sessions and subsequently underwent NIMV₆₀ in 2 MRI sessions. We acquired single-slice sagittal 2-dimensional MRI images at 2.6 Hz for 6 minutes during free breathing and NIMV₆₀. We quantified the motion of all visible cross-sections of lung arteries, as a surrogate for lung tumors, in cranio-caudal and anterior-posterior directions using deformable image registration, distinguishing between 4 quadrants in the lungs (posterior-cranial, posterior-caudal, anterior-caudal, and anterior-cranial). Also, we analyzed average lung area, as a surrogate for lung volume, on the sagittal images using automatic segmentation.</div></div><div><h3>Results</h3><div>All volunteers were successfully trained to be ventilated with NIMV₆₀, and completed all sessions. The reduction of the median lung artery motion in each of the quadrants varied from 61% to 67% (from 10.7-29.9 to 3.8-11.7 mm) in cranio-caudal direction and from 51% to 68% (from 8.0-13.7 to 3.0-5.1 mm) in anterior-posterior direction using NIMV₆₀. NIMV₆₀ increased the sagittal lung area by 35% compared with free breathing.</div></div><div><h3>Conclusions</h3><div>NIMV₆₀ with added PEEP is a promising way to improve lung cancer RT because of reduced respiratory motion and increased lung area compared with free breathing.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 2","pages":"Article 101679"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11656083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}