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Practical Radiation Oncology

Daniel Morton, Michelle Hilts, Deidre Batchelar, Audrey Tetreault-Laflamme, Benjamin Mou, Juanita Crook
PURPOSE: To evaluate the relationship between seroma visualization and seed placement accuracy in permanent breast seed implant brachytherapy (PBSI). MATERIALS AND METHODS: At the time of planning CT, 10 patients receiving PBSI were imaged with spatially co-registered 3D ultrasound (US). Seromas were independently contoured by 3 radiation oncologists on CT and US. Intra- and inter-user conformity indices (CI) were used as a surrogate for seroma visualization. Inter-modality visualization differences were assessed by defining consensus contours, CTVCT and CTVUS , and evaluating the CI as well as centroid position and volume differences...
January 11, 2019: Practical Radiation Oncology
Chan-Kyung Jane Cho, Katherine Sunderland, Tom Pickles, Francois Bachand, Francois Bachand, Kim N Chi, Scott Tyldesley
OBJECTIVES: Increasing survival of patients with metastatic prostate cancer (PCa) may impact the demand for palliative radiation to bone (PRTB). Our aim was to characterize the use of PRTB in patients who died of PCa in British Columbia between 2003 and 2015. METHODS: All patients diagnosed with PCa that died in the period (n=23,260) were identified from a population-based provincial registry. Patient and treatment characteristics were analyzed. PRTB utilization rate was calculated by year and location...
January 11, 2019: Practical Radiation Oncology
Joshua C Farris, Alex Ritter, Michael D Craig, Nilay Shah, Lauren Veltri, Abraham S Kanate, Kelly Ross, John A Vargo
PURPOSE: We aimed to assess patterns of relapse in patients undergoing salvage ASCT for relapsed HL in the modern-era with the hypothesis that patients suffering relapse at initially involved sites are at increased risks of relapse post-ASCT that may help guide the application of peri-transplant RT. MATERIALS/METHODS: A retrospective review of 38 patients undergoing ASCT from 2002-2017 for relapsed or refractory HL. Site of relapse at time of ASCT and subsequent relapse were compared to sites of initial involvement at diagnosis using follow-up imaging most commonly PET/CT...
December 20, 2018: Practical Radiation Oncology
Justin M Famoso, Joel L Grow, Brady Laughlin, Emmanuel Katsanis, Baldassarre Stea
PURPOSE: Total Body Irradiation (TBI) is an integral part of the conditioning regimen for patients with Acute Lymphoblastic Leukemia (ALL) undergoing allogeneic hematopoietic cell transplantation (allo-HCT). There are conflicting data in the literature regarding the utility of a cranial irradiation boost in high risk adult ALL without evidence of preexisting central nervous system involvement. This study investigates the post-transplant clinical outcomes of high-risk adult ALL patients undergoing TBI conditioning for allo-HCT with, or without, whole brain boost in those patients without overt CNS involvement at diagnosis...
December 19, 2018: Practical Radiation Oncology
Lauren E Henke, Jessika A Contreras, Thomas Mazur, Olga Green, Nalini Daniel, Hilary Lashmett, Tammy Senter, H Michael Gach, Laura Ochoa, Sasa Mutic, Imran Zoberi, Jeffrey Bradley, Clifford Robinson, Maria A Thomas
INTRODUCTION: Cardiac radiation is associated with cardiotoxicity in patients with thoracic and breast malignancies. We conducted a prospective study using cine magnetic resonance imaging (cMRI) to evaluate heart motion. We hypothesized that cMRI could be used to define population-based cardiac planning organ-at-risk volumes (PRV). MATERIALS/METHODS: 16 real-time acquisitions were obtained per subject on a 1.5 Tesla MRI (Philips Ingenia). Planar cMRI was performed in four sequential sagittal and coronal planes at free-breathing (FB) and deep-inspiratory-breath-hold (DIBH)...
December 18, 2018: Practical Radiation Oncology
Jean L Wright, Sue S Yom, Musaddiq J Awan, Samantha Dawes, Benjamin Fischer-Valuck, Randi Kudner, Raymond Mailhot Vega, George Rodrigues
PURPOSE: Comprehensive identification and delineation of organs-at-risk (OAR) are vital to the quality of radiation therapy treatment planning and the safety of treatment delivery. This guidance aims to improve the consistency of contouring OARs in external beam radiation therapy (EBRT) treatment planning by providing a single standardized resource for information regarding specific OARs to be contoured for each disease site. The guidance is organized in a table format as a quality assurance tool for practices and a training resource for residents and other radiation oncology students...
December 18, 2018: Practical Radiation Oncology
James A Kavanaugh, Sarah Holler, Todd A DeWees, Clifford G Robinson, Jeffrey D Bradley, Puneeth Iyengar, Kristin A Higgins, Sasa Mutic, Lindsey A Olsen
PURPOSE: To evaluate the feasibility of using a single-institution knowledge based planning (KBP) model as a dosimetric plan quality control (QC) for multi-institutional clinical trials. The efficacy of this QC tool was retrospectively evaluated using a subset of plans submitted to RTOG 0617. METHODS AND MATERIALS: A single KBP model was created utilizing a commercially available software (RapidPlanTM , Varian Medical Systems, Palo Alto, CA) and data from 106 patients with non-small cell lung cancer (NSCLC) treated at a single institution...
December 15, 2018: Practical Radiation Oncology
Adam D Yock, Radhe Mohan, Stella Flampouri, Walter Bosch, Paige Taylor, David Gladstone, Siyong Kim, Jason Sohn, Robert Wallace, Ying Xiao, Jeff Buchsbaum
In external beam radiotherapy, uncertainties in treatment planning and delivery can result in an undesirable dose distribution delivered to the patient that can compromise the benefit of treatment. Techniques including geometric margins and probabilistic optimization have been used effectively to mitigate the effects of uncertainties. However, their broad application is inconsistent which can compromise the conclusions derived from cross-technique and cross-modality comparisons. This report describes robustness analysis as a framework that is applicable across treatment techniques and modalities...
December 15, 2018: Practical Radiation Oncology
Simon Brown, Chike O Abana, Hytham Hammad, Audrey Brown, Joyce Mhlanga, Christina Binder, Nima Nabavizadeh, Charles Thomas, Timur Mitin, Erin W Gilbert
No abstract text is available yet for this article.
December 15, 2018: Practical Radiation Oncology
Heather M McGee, Todd Carpenter, Umut Ozbek, Katherine Kirkwood, Tzeng Tzu-Chi, Seth Blacksburg, Isabelle M Germano, Sheryl Green, Michael Buckstein
PURPOSE: To evaluate the efficacy of stereotactic radiosurgery (SRS) for spinal metastases from hepatocellular carcinoma (HCC) compared with other radioresistant histologies (renal cell carcinoma (RCC), melanoma, and sarcoma) in terms of local control (LC) and pain control. METHODS: We performed a retrospective review of patients treated with SRS to the spine for metastatic HCC, RCC, melanoma, and sarcoma from January 2007 through May 2014. Radiographic assessment of LC, OS, and patient-reported pain control were analyzed as univariable analyses and with various patient- and treatment-related parameters as multivariable analyses (MVA)...
December 10, 2018: Practical Radiation Oncology
Bindu V Manyam, Gregory Mm Videtic, Kyle Verdecchia, Chandana A Reddy, Neil M Woody, Kevin L Stephans
PURPOSE/OBJECTIVE(S): Dosimetric parameters to limit CWT are not well defined in single-fraction stereotactic body radiation therapy (SF-SBRT) phase II trials. We sought to determine the relationship of tumor location and dosimetric parameters with CWT for SF-SBRT. MATERIALS/METHODS: From a prospective registry of 1,462 patients, we identified patients treated with 30 Gy or 34 Gy. Gross tumor volume was measured as abutting, ≤ 1 cm, 1-2 cm or > 2 cm from CW...
December 7, 2018: Practical Radiation Oncology
Madeline Grade, Julie Koenig, Yushen Qian, Navjot Sandhu, Yufei Liu, Brandon Turner, Rie von Eyben, Susan Knox, Sara Dudley
PURPOSE: Emergent palliative radiotherapy of symptomatic metastases can significantly increase quality of life for cancer patients. While in some contexts this treatment may be underutilized, in others it may represent excessively aggressive intervention. Characterization of the current use of emergent palliative radiotherapy is warranted for optimized value and patient-centered care. METHODS AND MATERIALS: This study is a cross-sectional retrospective analysis of all emergent palliative radiotherapy courses at a single academic tertiary institution across one year...
December 7, 2018: Practical Radiation Oncology
Clark Howell, Greg Tracton, Alison Amos, Bhishamjit Chera, Lawrence B Marks, Lukasz Mazur
PURPOSE: To present an innovative approach for quantifying, visualizing, and predicting radiation therapy (RT) process reliability using data captured from a voluntary incident learning system with an overall aim to improve patient safety outcomes. MATERIALS AND METHODS: We analyzed 111 reported deviations that were tripped and caught within 159 mapped RT process steps included within 7 major stages of RT delivery, 94 of those being any type of quality assurance (QA) controls...
December 7, 2018: Practical Radiation Oncology
Tetsuo Saito, Ryo Toya, Natsuo Oya
PURPOSE: To determine pain response rates following conventional radiation therapy for painful bone metastases in prospective non-randomized studies, which better reflect daily practice than randomized controlled trials. METHODS: A literature search was conducted in PubMed and Scopus for articles published from 2002 to 2018. We only included articles in which pain response following radiation therapy was assessed using the International Consensus Endpoint initially published in 2002, or that updated in 2012...
November 30, 2018: Practical Radiation Oncology
Ky-Nam B Nguyen, Destiny Hause, Jennifer Novak, Arta M Monjazeb, Megan E Daly
PURPOSE: Increased rates of toxicity have been described following stereotactic body radiotherapy (SBRT) for central lung tumors within 2 cm of the proximal bronchial tree (PBT). Recent studies have defined a new class of "ultracentral" tumors. We report our experience treating ultracentral, central, and paramediastinal tumors with SBRT and compare toxicity, disease control, and survival. METHODS AND MATERIALS: We reviewed the records of patients with central lung tumors treated with SBRT between September 2009-July 2017...
November 26, 2018: Practical Radiation Oncology
R L Haas, S van Beek, A Betgen, S Ali, C J Schneider, F Heres Diddens, A N Scholten, F Koetsveld, P Remeijer
INTRODUCTION: Many authors suggest that extremity soft tissue sarcomas (ESTS) do not change significantly in size during preoperative radiotherapy (RT). This conebeam CT study investigates the justification to deliver the entire course with one initial RT plan by observing anatomical changes during RT. METHODS: In 2015-2017, 99 ESTS patients were treated with either curative (n=80) or palliative intent (n=19) with a regimen of at least 6 fractions. CTV-to-PTV margin was 1cm...
November 14, 2018: Practical Radiation Oncology
Rachel Glicksman, Michelle Ang, Elizabeth Murray, Carina Simniceanu, Elizabeth Lockhart, Julie Gilbert, Eric Gutierrez, Padraig Warde
INTRODUCTION: In 2003/2004 XXX (XXX) divested its assets and staff to regional hospitals, leading to decreased contact between radiotherapy departments across Ontario's Regional Cancer Centres (RCC). The XX (XX) at XXX developed a communities of practice (CoPs) program to re-build the provincial radiotherapy community to facilitate collaboration amongst centres with goals of decreasing variation in practice and improving the quality of patient care. XX's CoPs are led and driven by volunteer front-line healthcare practitioners, who identify and prioritize key quality issues and select corresponding projects to pursue...
November 14, 2018: Practical Radiation Oncology
C Jillian Tsai, Sean M McBride, Nadeem Riaz, Nancy Y Lee
Data on the biology and radiosensitivity of human papillomavirus-related cancers have led many expert radiation oncologists to decrease the radiation dose to target areas in selected situations. At Memorial Sloan Kettering Cancer Center, we have altered our radiation guidelines to allow substantial dose reduction to elective treatment regions and to omit radiation completely in other regions that have historically been included in the elective treatment volume. Here we summarize our current dose prescriptions and briefly explain the rationale behind these choices, which we anticipate will change when additional data mature...
November 14, 2018: Practical Radiation Oncology
Robert J Amdur
No abstract text is available yet for this article.
November 12, 2018: Practical Radiation Oncology
Rohan Deraniyagala
No abstract text is available yet for this article.
November 12, 2018: Practical Radiation Oncology
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