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Practical Radiation Oncology

Benjamin D Smith, Jennifer R Bellon, Rachel Blitzblau, Gary Freedman, Bruce Haffty, Carol Hahn, Francine Halberg, Karen Hoffman, Kathleen Horst, Jean Moran, Caroline Patton, Jane Perlmutter, Laura Warren, Timothy Whelan, Jean L Wright, Reshma Jagsi
INTRODUCTION: The purpose of this guideline is to offer recommendations on fractionation for whole breast irradiation (WBI) with or without a tumor bed boost and guidance on treatment planning and delivery. METHODS AND MATERIALS: The American Society for Radiation Oncology (ASTRO) convened a task force to address 5 key questions focused on dose-fractionation for WBI, indications and dose-fractionation for tumor bed boost, and treatment planning techniques for WBI and tumor bed boost...
March 8, 2018: Practical Radiation Oncology
Leigh Conroy, Sarah Quirk, Elizabeth Watt, Gillian Ecclestone, Jessica L Conway, Ivo A Olivotto, Tien Phan, Wendy L Smith
PURPOSE: The purpose of this study was to evaluate the dosimetric effect of breath hold level variability and deformation on breast, chest wall, internal mammary chain (IMC) nodes, and heart. METHODS AND MATERIALS: Left-sided post-lumpectomy (n = 12) and postmastectomy (n = 3) patients underwent deep inspiration breath hold (DIBH) and exhale breath hold (EBH) computed tomography (CT) scans. Forward-planned locoregional breast plans were created on the DIBH scan...
February 13, 2018: Practical Radiation Oncology
Trevor J Royce, Ronald C Chen
No abstract text is available yet for this article.
January 12, 2018: Practical Radiation Oncology
Gary Ezzell, Bhisham Chera, Adam Dicker, Eric Ford, Louis Potters, Lakshmi Santanam, Sheri Weintraub
PURPOSE: The Radiation Oncology Incident Learning System (RO-ILS) receives event reports from facilities across the country. This effort extracted common error pathways seen in the data. These pathways, expressed as fault trees, demonstrate the need for, and opportunities for, preventing these errors and/or limiting their propagation to treatment. METHODS AND MATERIALS: As of the third quarter of 2016, 2344 event reports had been submitted to RO-ILS and reviewed...
January 9, 2018: Practical Radiation Oncology
Hester Lieng, Peter Chung, Tony Lam, Padraig Warde, Tim Craig
PURPOSE: Limited data exist on testicular dose measurements using modern radiation treatment techniques and volumes for testicular seminoma. The aim of this study was to report the testicular dose using in vivo measurements in men with testicular seminoma receiving abdominopelvic radiation therapy (APRT) and a modified dog-leg field with and without gonadal shielding. METHODS AND MATERIALS: Men with histologically confirmed testicular seminoma, either newly diagnosed stage II disease or isolated retroperitoneal relapse on surveillance for stage I disease, treated with APRT had testicular dose measurements recorded using MOSFET dosimeters...
January 3, 2018: Practical Radiation Oncology
Tobias R Chapman, Stephen R Bowen, Smith Apisarnthanarax
No abstract text is available yet for this article.
December 30, 2017: Practical Radiation Oncology
David J Eaton, Jonathan Lee, Ian Paddick
PURPOSE: Stereotactic radiosurgery is indicated for treatment of multiple brain metastases. Various treatment platforms are available, but most comparisons are limited to single-center studies. As part of a national commissioning program, benchmark planning cases were completed by 21 clinical centers, providing a unique dataset of current practice across a large number of providers and equipment platforms. METHODS AND MATERIALS: Two brain metastases cases were provided, with images and structures predrawn, involving 3 and 7 lesions...
December 30, 2017: Practical Radiation Oncology
Bogdan-Alexandru Manole, Daniel V Wakefield, Austin P Dove, Caleb R Dulaney, Samuel R Marcrom, David L Schwartz, Michael R Farmer
PURPOSE: The purpose of this study was to survey the accessibility and quality of prostate-specific antigen (PSA) screening information from National Cancer Institute (NCI) cancer center and public health organization Web sites. METHODS AND MATERIALS: We surveyed the December 1, 2016, version of all 63 NCI-designated cancer center public Web sites and 5 major online clearinghouses from allied public/private organizations (,,, USPSTF...
December 24, 2017: Practical Radiation Oncology
Nrusingh C Biswal, Beth Swann, Michael G McKenna, Rachana Singh
No abstract text is available yet for this article.
December 24, 2017: Practical Radiation Oncology
James L Robar, Kathryn Moran, James Allan, James Clancey, Tami Joseph, Krista Chytyk-Praznik, R Lee MacDonald, John Lincoln, Parisa Sadeghi, Robert Rutledge
PURPOSE: This patient study evaluated the use of 3-dimensional (3D) printed bolus for chest wall radiation therapy compared with standard sheet bolus with regard to accuracy of fit, surface dose measured in vivo, and efficiency of patient setup. By alternating bolus type over the course of therapy, each patient served as her own control. METHODS AND MATERIALS: For 16 patients undergoing chest wall radiation therapy, a custom 5.0 mm thick bolus was designed based on the treatment planning computed tomography scan and 3D printed using polylactic acid...
December 24, 2017: Practical Radiation Oncology
Rosanna Yeung, Stephen R Bowen, Tobias R Chapman, Grayden T MacLennan, Smith Apisarnthanarax
PURPOSE: Normal liver-sparing with proton beam therapy (PBT) allows for dose escalation in the treatment of liver malignancies, but it may result in high doses to the chest wall (CW). CW toxicity (CWT) data after PBT for liver malignancies are limited, with most published reports describing toxicity after a combination of hypofractionated proton and photon radiation therapy. We examined the incidence and associated factors for CWT after hypofractionated PBT for liver malignancies. METHODS AND MATERIALS: We retrospectively reviewed the charts of 37 consecutive patients with liver malignancies (30 hepatocellular carcinoma, 6 intrahepatic cholangiocarcinoma, and 1 metastasis) treated with hypofractionated PBT...
December 24, 2017: Practical Radiation Oncology
Sean L Berry, Kevin P Tierney, Sharif Elguindi, James G Mechalakos
INTRODUCTION: An electronic checklist has been designed with the intention of reducing errors while minimizing user effort in completing the checklist. We analyze the clinical use and evolution of the checklist over the past 5 years and review data in an incident learning system (ILS) to investigate whether it has contributed to an improvement in patient safety. METHODS AND MATERIALS: The checklist is written as a standalone HTML application using VBScript. User selection of pertinent demographic details limits the display of checklist items only to those necessary for the particular clinical scenario...
December 24, 2017: Practical Radiation Oncology
Catherine A Pembroke, Joanne Alfieri, Alain Biron, Carolyn Freeman, Tarek Hijal
PURPOSE: Quality improvement (QI) is a pillar of good clinical governance and is at the center of modern health care. The Royal College of Physicians and Surgeons of Canada mandated, in CanMeds 2015, that QI should be taught and the competencies assessed in all postgraduate residency programs. The objective is to report on the feasibility and impact of teaching QI to radiation oncology residents at a single institution. METHODS AND MATERIALS: A QI team consisting of a clinical fellow, 3 staff physicians, and an expert in QI methods was created within our Department of Radiation Oncology...
March 2018: Practical Radiation Oncology
Timothy K Nguyen, Suresh Senan, Jeffery D Bradley, Kevin Franks, Meredith Giuliani, Matthias Guckenberger, Mark Landis, Billy W Loo, Alexander V Louie, Hiroshi Onishi, Heidi Schmidt, Robert Timmerman, Gregory M M Videtic, David A Palma
PURPOSE: Imaging after stereotactic ablative radiation therapy (SABR) for early-stage non-small cell lung cancer can detect recurrences and second primary lung cancers; however, the optimal follow-up practice of these patients remains unclear. We sought to establish consensus recommendations for surveillance after SABR. METHODS AND MATERIALS: International opinion leaders in thoracic radiation oncology and radiology were invited to participate (n = 31), with 11 accepting (9 radiation oncologists, 2 radiologists)...
March 2018: Practical Radiation Oncology
Nitin Ohri, Wolfgang Tomé, Shalom Kalnicki, Madhur Garg
BACKGROUND: Stereotactic body radiation therapy (SBRT) is increasingly used to treat early-stage non-small cell lung cancer (NSCLC). A previous report introduced the term size-adjusted biologically effective dose (sBED), which accounts for tumor diameter and biologically effective dose (BED) and may be used to predict the likelihood of local control following SBRT. Here we seek to replicate those findings using a separate dataset. METHODS AND MATERIALS: We queried the RSSearch Patient Registry for patients treated with SBRT for stage I NSCLC...
March 2018: Practical Radiation Oncology
William C Jackson, Robert T Dess, Dale W Litzenberg, Pin Li, Matthew Schipper, Seth A Rosenthal, Garrick C Chang, Eric M Horwitz, Robert A Price, Jeff M Michalski, Hiram A Gay, John T Wei, Mary Feng, Felix Y Feng, Howard M Sandler, Robert E Wallace, Daniel E Spratt, Daniel A Hamstra
PURPOSE: The use of stereotactic body radiation therapy (SBRT) for prostate cancer has been reported predominantly from single institutional studies, although concerns for broader adoption exist. METHODS AND MATERIALS: From 2011 through 2013, 66 men were accrued to a phase 2 trial at 5 centers. SBRT consisted of 5 fractions of 7.4 Gy to a total dose of 37 Gy using conventional linear accelerators. Electromagnetic transponders were used for motion management. Health-related quality of life (HRQOL) was evaluated via the Expanded Prostate Cancer Index Composite 26 questionnaire...
January 2018: Practical Radiation Oncology
Kristina Demas Woodhouse, David Hashemi, Kathryn Betcher, Abigail Doucette, Allison Weaver, Brian Monzon, Seth A Rosenthal, Neha Vapiwala
PURPOSE: Radiation therapy is complex and demands high vigilance and precise coordination. Radiation therapists (RTTs) directly deliver radiation and are often the first to discover an error. Yet, few studies have examined the practices of RTTs regarding patient safety. We conducted a national survey to explore the perspectives of RTTs related to quality and safety. METHODS AND MATERIALS: In 2016, an electronic survey was sent to a random sample of 1500 RTTs in the United States...
January 2018: Practical Radiation Oncology
Daniel A Hamstra, Neil Mariados, John Sylvester, Dhiren Shah, Eric Gross, Richard Hudes, David Beyer, Steven Kurtzman, Jeffrey Bogart, R Alex Hsi, Michael Kos, Rodney Ellis, Mark Logsdon, Shawn Zimberg, Kevin Forsythe, Hong Zhang, Edward Soffen, Patrick Francke, Constantine Mantz, Peter Rossi, Theodore DeWeese, Stephanie Daignault-Newton, Benjamin W Fischer-Valuck, Anupama Chundury, Hiram A Gay, Walter Bosch, Jeff Michalski
BACKGROUND: We previously reported the results of a phase 3 trial evaluating a prostate/rectal hydrogel spacer during prostate intensity modulated radiation therapy, which resulted in decreased rectal dose and toxicity and less decline in bowel quality of life (QOL). A secondary analysis was performed to correlate penile bulb dose and sexual QOL. METHODS AND MATERIALS: Sexual QOL was measured with the Expanded Prostate Cancer Index Composite (EPIC) by mean scores, the proportion of patients with a minimal clinically important difference (MID), and analyses of the different items composing the sexual domain...
January 2018: Practical Radiation Oncology
Jennifer C Ho, Quynh-Nhu Nguyen, Heng Li, Pamela K Allen, Xiaodong Zhang, Zhongxing Liao, X Ronald Zhu, Daniel Gomez, Steven H Lin, Michael Gillin, Ritsuko Komaki, Stephen Hahn, Joe Y Chang
PURPOSE: Reirradiation of thoracic malignancies is a treatment challenge, with concerns for toxicity and the inability to deliver definitive doses. Intensity modulated proton therapy (IMPT) may allow safe delivery of a higher dose of radiation to the tumor while minimizing toxicities. METHODS AND MATERIALS: Between 2011 and 2016, 27 patients who received IMPT for reirradiation of thoracic malignancies with definitive intent were retrospectively analyzed. Patients were included if they received a prior thoracic radiation course...
January 2018: Practical Radiation Oncology
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