Advances in Radiation Oncology最新文献

{"title":"A Qualitative Exploration of Sacred Moments in Radiation Oncology","authors":"Kirin Saint MD ,&nbsp;Rachel Ehrlinger BA ,&nbsp;Jaime Gilliland MA ,&nbsp;Michael F. Barton MD, MPH ,&nbsp;Amy J. Xu MD, PhD ,&nbsp;Patricia Mae G. Santos MD, MS ,&nbsp;Divya Yerramilli MD, MBE","doi":"10.1016/j.adro.2024.101617","DOIUrl":"10.1016/j.adro.2024.101617","url":null,"abstract":"<div><h3>Purpose</h3><div>While there are many benefits to radiation oncology services, there can be emotional burdens in the care of patients with advanced cancer. Burnout is a prevalent problem in oncology. Existing literature suggests refocusing attention on providers’ sense of purpose to protect against burnout. “Sacred moments” are moments of deep interconnection between people with accompanying spiritual emotions such as awe, joy, and gratitude. These moments naturally occur in health care settings, offering potential benefits to both patient and provider. Little is known about the prevalence and impact of sacred moments among health care workers in a radiation oncology setting.</div></div><div><h3>Methods and Materials</h3><div>We conducted an exploratory qualitative study of 13 semi-structured interviews among physicians, registered nurses, and advanced practice providers of a radiation oncology consult service at a large National Cancer Institute-designated cancer center between March and May 2023. Interviews were recorded, transcribed, and analyzed to identify key themes. Data were systematically coded and analyzed in NVivo software and organized into a codebook organized by domains and themes.</div></div><div><h3>Results</h3><div>Of the 13 health care workers interviewed, 12 interviewees reported experiencing at least one sacred moment during their clinical careers. None of the interviewees were initially familiar with the term; however, all understood the concept once explained. Interview findings were organized into four domains: (1) common elements, (2) impact, (3) barriers, and (4) provider reactions. Common elements included a moment of deep interconnection between provider and patient, often involving end-of-life patients. The impact of these moments was most commonly described as an increased sense of purpose in their role. Lack of time with patients was the most common barrier.</div></div><div><h3>Conclusions</h3><div>Sacred moments are commonly experienced by health care workers in a radiation oncology consult service. They helped to humanize the patient, buffer against provider burnout, and increase a sense of purpose and job satisfaction.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 11","pages":"Article 101617"},"PeriodicalIF":2.2,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142358900","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":"Clinical and Dosimetric Comparison Between Non-image Guided Radiation Therapy and Fiducial-Based Image Guided Radiation Therapy With or Without Reduced Margin in Intensity Modulated Radiation Therapy for Prostate Cancer","authors":"Itsuko Serizawa PhD ,&nbsp;Takuyo Kozuka PhD ,&nbsp;Takashi Soyano MD ,&nbsp;Kazuma Sasamura MD ,&nbsp;Tatsuya Kamima Bsc ,&nbsp;Hiroaki Kunogi PhD ,&nbsp;Nozomi Kurihara MPh ,&nbsp;Noboru Numao PhD ,&nbsp;Shinya Yamamoto PhD ,&nbsp;Junji Yonese PhD ,&nbsp;Yasuo Yoshioka PhD","doi":"10.1016/j.adro.2024.101612","DOIUrl":"10.1016/j.adro.2024.101612","url":null,"abstract":"<div><h3>Purpose</h3><p>This study aimed to compare the outcomes and toxicities between patients treated with image guided radiation therapy (IGRT) using fiducial markers and non-IGRT in intensity modulated radiation therapy (IMRT) for prostate cancer.</p></div><div><h3>Methods and Materials</h3><p>In total, 518 patients with intermediate- and high-risk prostate cancer received IMRT with 78 Gy in 39 fractions after neoadjuvant androgen deprivation therapy for at least 3 months. Of these patients, 371 were in the non-IGRT group and 147 in the IGRT group, including the IGRT-A group using the same margins as the non-IGRT group and the IGRT-B group using reduced margins. The median follow-up periods for the non-IGRT, IGRT-A, and IGRT-B groups were 99 months, 88 months, and 63 months, respectively.</p></div><div><h3>Results</h3><p>The 5-year biochemical recurrence-free survival rates in the non-IGRT, IGRT-A, and IGRT-B groups were 88%, 95%, and 98% (non-IGRT vs IGRT-A, <em>P</em> = .396; IGRT-A vs IGRT-B, <em>P</em> = .426), respectively. Those for intermediate- and high-risk patients were 94%, 93%, and 96% (non-IGRT vs IGRT-A, <em>P</em> = .916; IGRT-A vs IGRT-B, <em>P</em> = .646), respectively, and 87%, 96%, and 100% (non-IGRT vs IGRT-A, <em>P</em> = .500; IGRT-A vs IGRT-B, <em>P</em> = .483), respectively. For the non-IGRT and IGRT-A groups, the rates of acute grade ≥ 2 gastrointestinal toxicities and late grade ≥ 2 genitourinary toxicities were 17% and 7% (<em>P</em> = .019), respectively, and 28% and 16% (<em>P</em> = .028), respectively. In the IGRT-A and IGRT-B groups, the rates of acute grade ≥ 2 genitourinary toxicities were 45% and 21% (<em>P</em> = .003), respectively. All V60_Gy = the volume at least received 60Gy and V70_Gy = the volume at least received 70Gy values of the bladder and rectal walls in the IGRT-B group were smaller than those in the IGRT-A group.</p></div><div><h3>Conclusions</h3><p>IGRT with fiducial markers results in lower acute and late toxicities compared with non-IGRT in IMRT for intermediate- and high-risk prostate cancer. Moreover, the toxicities are further decreased by reducing the margins in the treatment planning under IGRT. These processes do not decrease the biochemical recurrence-free survival rates.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 10","pages":"Article 101612"},"PeriodicalIF":2.2,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001751/pdfft?md5=21c1fe3a4833e6fc62e3e79a2ce5fd19&pid=1-s2.0-S2452109424001751-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142239673","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":"Hippocampal-Sparing Radiation Therapy in Primary Sinonasal and Cutaneous Tumors of the Head and Neck","authors":"Jacob Hall MD ,&nbsp;Michael Dance MS ,&nbsp;Benjamin Huang MD ,&nbsp;Ethan Steele MD ,&nbsp;Lorie Nguyen ,&nbsp;Michael Repka MD ,&nbsp;Xuguang Chen MD, PhD ,&nbsp;Colette Shen MD, PhD","doi":"10.1016/j.adro.2024.101588","DOIUrl":"10.1016/j.adro.2024.101588","url":null,"abstract":"<div><h3>Purpose</h3><p>Patients with primary sinonasal and cutaneous head and neck (H&amp;N) malignancies often receive meaningful radiation dose to their hippocampi, but this not a classic avoidance structure in radiation planning. We aimed to characterize the feasibility and tradeoffs of hippocampal-sparing radiation therapy (HSRT) for patients with primary sinonasal and cutaneous H&amp;N malignancies.</p></div><div><h3>Methods and Materials</h3><p>We retrospectively selected patients who were treated definitively for primary sinonasal or cutaneous malignancies of the H&amp;N at an academic medical center. All received (chemo)radiation alone or adjuvantly and substantial radiation dose to 1 or both hippocampi. We created new HSRT plans for each patient with intensity modulated radiation therapy using the original target and organ-at-risk (OAR) volumes. Hippocampi were contoured based on Radiation Therapy Oncology Group guidelines and reviewed by a neuroradiologist. Absolute and relative differences in radiation dose to the hippocampi, planning target volumes (PTVs), and OARs were recorded and compared.</p></div><div><h3>Results</h3><p>There were 18 sinonasal and 12 cutaneous H&amp;N primary tumors (30 patients in total). Median prescription dose was 6600 cGy (range, 5000-7440 cGy), and 14 of the 30 patients received 120 cGy/fraction twice daily, 13 of the 30 patients received 200 cGy/fraction once daily, whereas others received 180-275 cGy/fraction once daily. The relative decrease in ipsilateral hippocampal D_max and D100% using HSRT was 44% (median, 2009 cGy from 3586 cGy) and 65% (median 434 cGy from 1257 cGy), respectively. There were no statistically significant or clinically meaningful differences in PTV V100%, PTV D1%, or radiation dose to other OARs between HSRT and non-HSRT plans.</p></div><div><h3>Conclusions</h3><p>HSRT is feasible and results in meaningful dose reduction to the hippocampi without reducing PTV coverage or increasing dose to other OARs. We suggest target hippocampal constraints of D_max &lt; 1600 cGy and D100% &lt; 500 cGy when feasible (without compromising PTV coverage or impacting other critical OARs). The clinical significance of HSRT in patients with primary H&amp;N tumors should be investigated prospectively.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 10","pages":"Article 101588"},"PeriodicalIF":2.2,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001519/pdfft?md5=783f46d0790ba5d5231c8c37a73eaf44&pid=1-s2.0-S2452109424001519-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142050028","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":"Clinical, Pathologic, and Dosimetric Predictors of Head and Neck Lymphedema Following Definitive or Adjuvant Radiation Therapy for Head and Neck Cancer","authors":"Kevin R. Rogacki MD ,&nbsp;P. Troy Teo PhD ,&nbsp;Mahesh Gopalakrishnan MSc ,&nbsp;Suvidya Lakshmi Pachigolla MD ,&nbsp;Clayton E. Lyons MD ,&nbsp;Mohamed E. Abazeed MD, PHD ,&nbsp;Indra Das PhD ,&nbsp;Bharat B. Mittal MD ,&nbsp;Michelle Gentile MD, PhD","doi":"10.1016/j.adro.2024.101545","DOIUrl":"10.1016/j.adro.2024.101545","url":null,"abstract":"<div><h3>Purpose</h3><p>Head and neck lymphedema (HNL) following radiation therapy for head and neck cancer (HNC) causes patient morbidity. Predicting individual patients’ risk of HNL after treatment is challenging. We aimed to identify the demographic, disease-related, and treatment-related factors associated with external and internal HNL following treatment of HNC with definitive or adjuvant radiation therapy.</p></div><div><h3>Methods and Materials</h3><p>Relevant clinical, pathologic, and dosimetric data for 76 consecutive patients who received definitive or adjuvant radiation ± chemotherapy were retrospectively collected from a single institution. Multivariable models predictive of external and internal lymphedema using clinicopathologic variables alone and in combination with dosimetric variables were constructed and optimized using competing risk regression.</p></div><div><h3>Results</h3><p>After median follow-up of 550 days, the incidence of external and internal HNL at 360 days was 70% and 34%, respectively. When evaluating clinical and treatment-related factors alone, number of lymph nodes removed and advanced adenopathy status were predictive of external lymphedema. With incorporation of dosimetric variables, the optimized model included the percentage volume of the contralateral lymph node level VII receiving 30Gy V30 ≥50%, number of lymph nodes removed, and advanced adenopathy status. For internal lymphedema, our clinicopathologic model identified both adjuvant radiation, as opposed to definitive radiation, and advanced adenopathy status. With inclusion of a dosimetric variable, the optimized model included larynx V45 ≥50% and advanced adenopathy.</p></div><div><h3>Conclusions</h3><p>HNL following HNC treatment is common. For both external and internal lymphedema, nodal disease burden at diagnosis predicts increased risk. For external lymphedema, increasing extent of lymph node dissection prior to adjuvant therapy increases risk. The contralateral level VII lymph node region is also predictive of external lymphedema when radiation dose to V30 is ≥50%, meriting investigation. For internal lymphedema, we confirm that increasing radiation dose to the larynx is the most significant dosimetric predictor of mucosal edema when larynx V45 is ≥50%.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 9","pages":"Article 101545"},"PeriodicalIF":2.2,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001088/pdfft?md5=fad7885fed75232676e2688cdff94300&pid=1-s2.0-S2452109424001088-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141993813","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":"Integrating Audiovisual Immersion Into Pediatric Radiation Therapy Across Multiple Centers: Methodology, Timeliness, and Cost of the Audiovisual-Assisted Therapeutic Ambience in Radiation Therapy Prospective Multi-Institutional Trial","authors":"Justin Oh MD ,&nbsp;Lawrie Skinner PhD ,&nbsp;Paulina M. Gutkin BS ,&nbsp;Alice Jiang BA ,&nbsp;Sarah S. Donaldson MD ,&nbsp;Billy W. Loo Jr MD, PhD ,&nbsp;Yi Peng Wang BA ,&nbsp;Agnes Ewongwo MD ,&nbsp;Jeremy S. Bredfeldt PhD ,&nbsp;John C. Breneman MD ,&nbsp;Louis S. Constine MD ,&nbsp;Austin M. Faught PhD ,&nbsp;Daphne Haas-Kogan MD ,&nbsp;Jordan A. Holmes MD ,&nbsp;Matthew Krasin MD ,&nbsp;Charlene Larkin CCLS ,&nbsp;Karen J. Marcus MD ,&nbsp;Peter G. Maxim PhD ,&nbsp;Shearwood McClelland III MD ,&nbsp;Blair Murphy MD ,&nbsp;Susan M. Hiniker MD","doi":"10.1016/j.adro.2024.101589","DOIUrl":"10.1016/j.adro.2024.101589","url":null,"abstract":"<div><h3>Purpose</h3><p>The Audiovisual-Assisted Therapeutic Ambience in Radiotherapy (AVATAR) trial was a prospective multicenter study (NCT03991156) examining the combination of video immersion with radiation therapy and was successfully conducted through the collaboration of pediatric radiation oncology teams at 10 institutions independent of any pre-existing consortium. We sought to analyze and report the methodology of trial conception and development, process map, and cost.</p></div><div><h3>Methods and Materials</h3><p>The study enrolled patients aged 3 to 10 years preparing to undergo radiation therapy, integrated the combination of AVATAR-based video immersion with radiation therapy at each institution, and offered AVATAR use as an alternative to anesthesia, with rates of anesthesia use and outcomes of serial standardized anxiety and quality-of-life assessments assessed among the 81 children enrolled. A process map was created based on the trial timeline with the following components: study development time (time from conception of the trial to the accrual of the first patient, including design phase, agreement and approval phase, and site preparation phase), and accrual duration time (time from the first to last accrual). Costs and institutional success rates were calculated.</p></div><div><h3>Results</h3><p>Time from inception of study to last accrual was 3.6 years (1313 days). The study development time was 417 days (31.7%), and accrual duration time was 896 days (68.3%), with the final 50% of accrual occurring in &lt;6 months. Equipment cost was approximately $550 per institution and was covered by funding from the lead study institution. All 10 centers were successful with AVATAR implementation, defined as ≥50% of patients able to avoid anesthesia with the use of AVATAR, including centers with both photon and proton therapy.</p></div><div><h3>Conclusions</h3><p>This report elaborates on the methodology and timeline of trial conception and development using data from a previously published supportive care study combining video immersion with radiation therapy among 10 cooperating pediatric oncology institutions. It highlights the potential for multicenter collaborations on prospective trials integrating supportive care therapies with radiation therapy.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 10","pages":"Article 101589"},"PeriodicalIF":2.2,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001520/pdfft?md5=9bbf4f3a7436f5d11219015d149b5337&pid=1-s2.0-S2452109424001520-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142162172","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":"Optimal Correction Strategy of Image Guided Radiation Therapy Including the Paraortic Lymph Node Region in Patients With Cervical Cancers","authors":"Kazuki Wakabayashi PhD ,&nbsp;Makoto Hirata PhD ,&nbsp;Hajime Monzen PhD ,&nbsp;Takaya Inagaki MD ,&nbsp;Tetsuo Sonomura MD, PhD","doi":"10.1016/j.adro.2024.101590","DOIUrl":"10.1016/j.adro.2024.101590","url":null,"abstract":"<div><h3>Purpose</h3><p>The clinically accepted planning target volume margin for radiation therapy to the paraortic nodal region in cervical cancer patients is 5 mm. However, the comprehensive alignment and variability from the pelvic bone to all lumbar vertebrae are undetermined. This study aims to quantify the residual setup errors between the pelvic bone and lumbar vertebrae and determine the optimal correction strategy for patients with cervical cancer.</p></div><div><h3>Materials and Methods</h3><p>Fifteen patients underwent pretreatment mega-voltage computed tomography scans (375 total fractions). Residual setup errors and required margins for each lumbar vertebra were calculated based on registrations accounting for pelvic rotation and translation.</p></div><div><h3>Results</h3><p>The systematic residual errors (1 SD) at L1, L2, L3, L4, and L5 using pelvic bone registration were 6.5, 4.9, 3.1, 1.5, and 0.6 mm in the anterior-posterior (AP) direction, 3.1, 2.3, 1.4, 0.6, and 0.3 mm in the right-left direction, and 2.7, 2.2, 1.7, 1.0, and 0.5 mm in the superior-inferior direction, respectively. The residual setup errors were the largest in the AP direction. Registration based on the pelvic bone required margins in the AP direction of 16.0, 12.1, 7.7, 3.6, and 1.3 mm for L1, L2, L3, L4, and L5, respectively, whereas registration based on L3 required margins of 8.8, 4.8, 4.4, 7.1, and 7.7 mm for L1, L2, L4, L5, and pelvic bone, respectively.</p></div><div><h3>Conclusions</h3><p>Considerable local setup variability was found in patients with cervical cancer. After reviewing the corrective strategies, we determined that L3-based registration effectively minimized the required margins.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 10","pages":"Article 101590"},"PeriodicalIF":2.2,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001532/pdfft?md5=a23932bd7bb3450bafaee5bff06a827c&pid=1-s2.0-S2452109424001532-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142229586","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":"Interobserver Variability in a Spanish Society of Radiation Oncology (SEOR) Head and Neck Course. Is Current Contouring Training Sufficient?","authors":"Victor De La Llana MSc ,&nbsp;Fernando Mañeru PhD ,&nbsp;Julián Librero MSc ,&nbsp;Santiago Pellejero MSc ,&nbsp;Fernando Arias MD, PhD","doi":"10.1016/j.adro.2024.101591","DOIUrl":"10.1016/j.adro.2024.101591","url":null,"abstract":"<div><h3>Purpose</h3><div>External beam radiation therapy has grown significantly, incorporating advanced techniques like intensity modulation or stereotactic treatments, which enhance precision and accuracy. Nevertheless, variability in target volume delineation by radiation oncologists remains a challenge, influencing dose distribution. This study analyzes an online training course by the Spanish Society of Radiation Oncology, focusing on head and neck tumor contouring, to evaluate interobserver variability.</div></div><div><h3>Material and Methods</h3><div>Eight instructors provided clinical directives for 8 head and neck pathologies. Participants contoured structures using their own treatment planning systems, emphasizing gross tumor volume and high-, medium-, and low-risk clinical target volumes (CTV) contouring. Delineation variability was evaluated using the Dice similarity coefficient and volume relative change.</div></div><div><h3>Results</h3><div>The results reveal significant variability in contouring, with mean Dice similarity coefficient values ranging from 0.57 to 0.69. High-risk CTV demonstrated higher variability compared with medium-risk CTV. The presence of a gross tumor volume and supporting positron emission tomography/computed tomography or magnetic resonance imaging studies did not significantly improve the concordance. Parotid cases exhibited the greatest differences.</div></div><div><h3>Conclusions</h3><div>Despite the introduction of new automatic tools, this study points to the need for uniform contouring criteria. Training and standardization efforts are essential to enhance radiation therapy treatment consistency and quality.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 11","pages":"Article 101591"},"PeriodicalIF":2.2,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445131","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":"A Comprehensive Perspective on Educational and Economic Barriers for Utilization of Palliative Radiation Therapy in Hospice: A Narrative Review","authors":"Sarah J. Hendee BS ,&nbsp;Kareem Fakhoury MD ,&nbsp;Sana D. Karam MD, PhD","doi":"10.1016/j.adro.2024.101575","DOIUrl":"10.1016/j.adro.2024.101575","url":null,"abstract":"<div><h3>Purpose</h3><p>Despite the agreed-on efficacy and benefits of palliative radiation therapy (PRT) to alleviate end-of-life complications related to cancer progression, PRT remains an underused treatment in the hospice-care setting.^3-4,6-7 Common barriers for hospice patient use of PRT include educational and economic limitations. This paper discussed these barriers and ways to eliminate them based on previously published interventions.</p></div><div><h3>Methods and Materials</h3><p>Literature search on PubMed; 30 articles were selected by the authors. All articles included are published after the year 2000 in peer reviewed journals.</p></div><div><h3>Results</h3><p>Educational barriers for medical practitioners outside radiation oncology can be addressed by creating formal education programs that reduce knowledge gaps previously identified by survey-based research studies. For radiation oncologists, continued education should focus on increasing competence and comfort with end-of-life conversations and indications for use of single-fraction radiation for patients with advanced cancer. More information on radiation oncology options should be provided to patients. As for economic barriers, rapid-access programs that use advanced level practitioners can increase PRT access by the hospice population. Also, these programs can increase use of single-fraction radiation therapy (SFX RT) in patients with a shorter projected prognosis. SFX RT is beneficial in this setting because it decreases hospice expense and is as efficacious at palliating pain in patients with advanced cancer as multiple-fraction radiation.</p></div><div><h3>Conclusions</h3><p>The barriers of education and economic limitations can be addressed by: expanding the PRT curriculum for all practicing physicians, improving radiation oncologist palliative care knowledge, increasing PRT resources for patients, increasing number of rapid-access radiation therapy programs, and, when indicated, encouraging use of single-fraction radiation treatment for hospice patients.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 10","pages":"Article 101575"},"PeriodicalIF":2.2,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001386/pdfft?md5=89870e3bc3c2d8a82529ca51896f7824&pid=1-s2.0-S2452109424001386-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142168749","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":"Clinical Outcomes of Proton Beam Therapy for Unresectable Locally Advanced Pancreatic Cancer: A Single-Center Retrospective Study","authors":"Ichiro Seto MD, DMD, PhD ,&nbsp;Hisashi Yamaguchi MD, PhD ,&nbsp;Yoshiaki Takagawa MD, PhD ,&nbsp;Yusuke Azami MD, PhD ,&nbsp;Kanako Takayama DMD, PhD ,&nbsp;Motohisa Suzuki MD, PhD ,&nbsp;Masanori Machida MD ,&nbsp;Yuntao Dai MD, PhD ,&nbsp;Nor Shazrina Binti Sulaiman MD, PhD ,&nbsp;Yasuhiro Kikuchi MD, PhD ,&nbsp;Takahiro Kato PhD ,&nbsp;Noriyuki Nishino MD, PhD ,&nbsp;Yasushi Teranishi MD, PhD ,&nbsp;Masao Murakami MD, PhD","doi":"10.1016/j.adro.2024.101577","DOIUrl":"10.1016/j.adro.2024.101577","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;p&gt;We retrospectively researched the treatment outcome of proton beam therapy (PBT) and assessed its efficacy for inoperable locally advanced pancreatic cancer (LAPC) at our institution.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods and Materials&lt;/h3&gt;&lt;p&gt;Fifty-four patients (28 men and 26 women, median age 67 years ranging from 40-88 years) were diagnosed with unresectable stage III LAPC and administered PBT from April 2009 to March 2020. Patients who could not complete PBT, had new distant metastases during the treatment, or did not have enough follow-up time were excluded from this study. All patients were clinically staged based on the International Union of Cancer TNM staging system (eighth edition) using computed tomography, magnetic resonance imaging, and positron emission tomography and were diagnosed as stage III (histologic type: 18 patients with adenocarcinoma and 36 clinically diagnosed patients). PBT was performed using the passive method, with a median total dose of 67.5 GyE (range, 50-77 GyE/25-35 fractions).&lt;/p&gt;&lt;p&gt;Chemotherapy was used in combination during PBT in 46 patients (85.2%). Overall survival (OS), local progression-free survival (LPFS), progression-free survival, and median OS time were analyzed by Kaplan-Meier and log-rank tests. Univariate and multivariate analyses were performed for the following factors: maximum standardized uptake value (SUVmax), Eastern Cooperative Group performance status (PS), tumor site, total irradiation dose, concurrent chemotherapy, and primary tumor site. Cutoff values for SUVmax and tumor diameter were estimated using receiver operating characteristic curves and the area under the curve based on OS. Multivariate analysis was evaluated using the Cox proportional hazards models. Adverse events were evaluated using the National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;The median observation period was 17.4 months, ranging from 4.0 to 89.7 months. The median tumor diameter was 36.5 mm, ranging from 15 to 90 mm, the median SUVmax was 5.85 (range, 2.1-27.6), and their cutoff values were estimated to be 37 mm and 4.8 mm, respectively. The 1- and 2-year OS was 77.8% and 35.2%, respectively, with a median OS time of 18.2 months, and only one patient survived &gt;5 years. Twelve patients (22.2%) developed local recurrence, and 1- and 2-year LPFS rates were 89.7% and 74.5%, respectively; progression-free survival at 1 year was 58.8%. The PS score, tumor site, and irradiation dose were the prognostic factors related to OS that showed a significant difference. On the other hand, there was a significant difference in factors involved in LPFS, at 96.7%/77.9% in the first year and 86.6%/54.4% in the second year in the groups with tumor dose ≥67.5 GyE and &lt;67.5 GyE, respectively (&lt;em&gt;P&lt;/em&gt; = .015). Treatment-related acute toxicities were neutropenia (grade 1/2/3 at 3.7%/11.1%/31.5%, respectively), leukopenia (grade 1/2/3 at 1.8%/7.4%/20","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 10","pages":"Article 101577"},"PeriodicalIF":2.2,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001404/pdfft?md5=e7c85154553e6d1c892b6de3f91dc27a&pid=1-s2.0-S2452109424001404-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142167085","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":"Editor's Note: A Look to the Future","authors":"Rachel B. Jimenez MD","doi":"10.1016/j.adro.2024.101539","DOIUrl":"10.1016/j.adro.2024.101539","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 8","pages":"Article 101539"},"PeriodicalIF":2.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001027/pdfft?md5=cca1b6169bdfc25d459c939589825c12&pid=1-s2.0-S2452109424001027-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141991209","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}