Advances in Radiation Oncology最新文献

{"title":"Fuzzy Analytical Hierarchy Process-based Risk Priority Number Approach in Failure Modes and Effects Analysis for Magnetic Resonance Imaging-guided High-dose-rate Brachytherapy for Gynecologic Cancer","authors":"Jina Chang PhD ,&nbsp;Hayeon Kim PhD ,&nbsp;Ron Lalonde PhD ,&nbsp;Elangovan Doraisamy MS ,&nbsp;John Vargo MD","doi":"10.1016/j.adro.2025.101731","DOIUrl":"10.1016/j.adro.2025.101731","url":null,"abstract":"<div><h3>Purpose</h3><div>Failure modes and effects analysis (FMEA) is commonly used to identify, prioritize, and mitigate potential failure modes (FMs) by assigning a risk priority number (RPN). However, traditional RPN-based FMEA has limitations, particularly when handling the degree of interdependency within processes. To address this, we propose a fuzzy analytical hierarchy process (AHP)-based RPN method, designed to prioritize FMs by accurately weighing risk factors in magnetic resonance imaging (MRI)-guided high-dose-rate brachytherapy (BT) for gynecologic (GYN) cancer.</div></div><div><h3>Methods and Materials</h3><div>A process map covering all steps was developed for MRI-based GYN BT, and potential FMs were identified. Evaluators were given 2 questionnaires, one for conventional FMEA and another for AHP evaluation. For the AHP method, substeps were grouped by job specialty, with identical weights applied to FMs within each specialty group. Fuzzy linguistic terms helped evaluators handle uncertainties, and final fuzzy AHP-based RPN values were calculated by applying weighted risk factor scores.</div></div><div><h3>Results</h3><div>The process map included 6 primary steps, 33 substeps, and 82 FMs. In the fuzzy AHP RPN analysis, the top 5 FMs were identified as incorrect/suboptimal applicator insertion, incorrect applicator reconstruction, dose-volume histogram not meeting the physician's intent, incorrect/missing contours, and applicator/patient movement. By comparison, the conventional FMEA ranked the top 5 as incorrect/missing contours, incorrect/suboptimal applicator insertion, dose-volume histogram not meeting the physician's intent, applicator/patient movement, and incorrect applicator reconstruction. FMs with rank differences of 10 or more between methods were mostly related to applicator insertion and MRI.</div></div><div><h3>Conclusions</h3><div>This study demonstrates the feasibility and effectiveness of a fuzzy AHP-based RPN method for comprehensive FM prioritization, tailored to the clinical workflow of MRI-based GYN BT. Our findings provide a valuable reference for implementing fuzzy AHP-based risk assessment in MRI-guided BT.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 4","pages":"Article 101731"},"PeriodicalIF":2.2,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143521221","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":"Assessment of Approaches Promoting Virtual Radiation Oncology Educational Content to Medical Students","authors":"Malcolm D. Mattes MD ,&nbsp;Erin A. Kaya MD ,&nbsp;Rehema J. Thomas MD ,&nbsp;Avinash R. Chaurasia MD ,&nbsp;Sara E. Beltran Ponce MD ,&nbsp;Gabriel Vidal MD ,&nbsp;Idalid Franco MD, MPH ,&nbsp;John M. Longo MD ,&nbsp;Dayssy A. Diaz Pardo MD ,&nbsp;Raymond B. Mailhot Vega MD, MPH ,&nbsp;Pranshu Mohindra MD, MBBS ,&nbsp;Roberto Diaz MD, PhD ,&nbsp;Shilpen Patel MD ,&nbsp;Curtiland Deville Jr MD","doi":"10.1016/j.adro.2025.101734","DOIUrl":"10.1016/j.adro.2025.101734","url":null,"abstract":"<div><h3>Purpose</h3><div>Virtual learning in radiation oncology (RO) has potential to reach medical students who otherwise lack access to RO exposure or mentorship at their school. This study characterized the relative effectiveness of different methods of promoting virtual education content, to inform future efforts to expand access to RO education.</div></div><div><h3>Methods and Materials</h3><div>A 4-part “Oncology Virtual Series for Medical Students” was developed to emulate an oncology interest group (OIG). All academic RO department chairs and residency program directors were asked to engage their respective Dean's office or OIG to promote to <em>all</em> students, especially groups with primarily underrepresented in medicine membership. Promotional emails were also sent to the Diversity, Equity, and Inclusion office of all allopathic United States (US) medical schools, and Student National Medical Association (SNMA) and Latino Medical Student Association (LMSA) regional directors. The American Society for Radiation Oncology (ASTRO) promoted via ASTROgram, social media, and ROhub. Descriptive statistics are reported.</div></div><div><h3>Results</h3><div>A total of 660 students preregistered, and 140 attended, at least 1 session. Attendees represented 53 allopathic and 2 osteopathic US medical schools, and 18 international schools. One hundred six attendees (87%) were from schools with an affiliated RO department, and 79 (65%) with an affiliated RO residency. Fifteen schools had at least 3 students attend, with the highest number of attendees from the principal investigator's home institution (n = 10). These 15 schools accounted for 52% of all attendees, of which 10 had an affiliated RO residency. Two hundred eighty of six hundred sixty preregistered students (42%) described how they heard about the series: 87 (31%) medical school faculty, 75 (27%) social media post or email, 53 (19%) OIG, 16 (6%) SNMA or LMSA, and 15 (5%) ASTRO.</div></div><div><h3>Conclusions</h3><div>Disproportionately high attendance was from a few schools, suggesting that radiation oncologists’ individual efforts and pre-existing relationships with students, Dean's offices, and student groups are most effective for promoting nationwide virtual RO education.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 4","pages":"Article 101734"},"PeriodicalIF":2.2,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143463833","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":"Cell-Free Circulating Tumor DNA for NonInvasive Molecular Profiling Among Patients Undergoing Definitive Chemoradiation for Locally Advanced Lung Cancer","authors":"Emily S. Lebow MD ,&nbsp;Jordan Eichholz MS ,&nbsp;Lillian Boe PhD ,&nbsp;Zhigang Zhang PhD ,&nbsp;Leah B. Kratochvil BA ,&nbsp;Daphna Y. Gelblum MD ,&nbsp;Charles B. Simone II MD ,&nbsp;Annemarie F. Shepherd MD ,&nbsp;Puneeth Iyengar MD, PhD ,&nbsp;Jacob Y. Shin MD ,&nbsp;Andreas Rimner MD ,&nbsp;Bob T. Li MD, PhD, MPH ,&nbsp;James M. Isbell MD ,&nbsp;Narek Shaverdian MD ,&nbsp;Maria T. Thor PhD ,&nbsp;Daniel R. Gomez MD, MBA","doi":"10.1016/j.adro.2025.101727","DOIUrl":"10.1016/j.adro.2025.101727","url":null,"abstract":"<div><h3>Purpose</h3><div>We prospectively explored the utility of liquid biopsy for cell-free circulating tumor DNA (ctDNA) as a prognostic and predictive biomarker in patients with non-small cell lung cancer (NSCLC) treated with definitive chemoradiation therapy.</div></div><div><h3>Methods and Materials</h3><div>This prospective clinical cohort consisted of patients with unresectable, locally advanced NSCLC who had liquid biopsy testing before initiation of cancer therapy. Liquid biopsy testing was performed using an institutional assay that included 129 genes and paired white blood cell sequencing. Variant allele frequency was defined as the proportion of mutant alleles at a particular genetic locus. A US Food and Drug Administration-recognized database (OncoKB) was used to classify alterations. We evaluated progression-free survival from the start of radiation therapy using the log-rank test.</div></div><div><h3>Results</h3><div>Among 25 patients with prospective testing of ctDNA levels before therapy initiation, 18 patients had adenocarcinoma (72%), 7 patients had squamous cell carcinoma (28%), and 23 (92%) were former or current smokers. Twelve patients (48%) received adjuvant durvalumab. The median radiation dose was 60 Gy in 30 fractions (range, 55-66 Gy in 20-33 fractions). Seventy-six percent of patients (n = 18) had one or more alterations detected (median, 3 alterations, range, 1-8), including genomic markers of radiation response in 3 patients. The most common driver alteration detected was <em>KRAS</em> mutation in 24% of the cohort (n = 6). The detection of ctDNA levels was significantly associated with pretreatment 18F-fluorodeoxyglucose positron emission tomography standardized uptake value metrics, and the association was strengthened by integrating the number of mutations (compared with variant allele frequency) as the outcome variable. Among patients with baseline detectable ctDNA levels, the median progression-free survival was 21.3 months and was not reached among patients without baseline ctDNA level detection (hazard ratio, 4.54, <em>P</em> = .04).</div></div><div><h3>Conclusions</h3><div>Prospective liquid biopsy testing among patients treated with definitive chemoradiation therapy identifies driver alterations and markers of radiation response with direct implications for therapy personalization.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 4","pages":"Article 101727"},"PeriodicalIF":2.2,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143680216","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}