Practical Radiation Oncology

Treatment options for patients with metastatic castration-resistant prostate cancer include use of radioligand therapy with 177Lu-PSMA-617. 177Lu-PSMA-617 is used to selectively target prostate cancer cells by targeting prostate specific membrane antigen (PSMA); however, PSMA is also expressed on lacrimal glands among other tissues. Herein, we report on a case of a CTCAE v5 grade 3 dry eye event with concomitant blepharitis following administration of 177Lu-PSMA-617. He was managed with neomycin-polymyxin-dexamethasone 3...

PURPOSE: Real time adaptation of thoracic radiation plans is compelling because offline adaptive experiences show that tumor volumes and lung anatomy can change during therapy. We present and analyze a novel adaptive-on-demand (AOD) workflow combining online adaptive radiotherapy (ART) on the ETHOS system with image-guided radiotherapy (IGRT) delivery on a Halcyon unit for conventional fractionated radiotherapy of locally advanced lung cancer (LALC). METHOD: We analyzed 26 LALC patients treated with the AOD workflow, adapting weekly...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

INTRODUCTION: There have been numerous significant ransomware attacks impacting Radiation Oncology in the last 5 years. Research into ransomware attack response in Radiation Oncology has consisted of case reports and descriptive articles and has lacked quantitative studies. The purpose of this work was to identify the significant safety risks to patients being treated with radiotherapy during a ransomware attack scenario, using Failure Modes and Effects Analysis (FMEA). METHODS: A multi-institutional and multi-disciplinary team conducted a FMEA by developing process maps and using Risk Priority Number (RPN) scores to quantify the increased likelihood of incidents in a ransomware attack scenario...

The purpose of this paper is to summarize three methods for treating adrenal metastases with stereotactic body radiotherapy (SBRT). This article is not meant to provide consensus guidelines, but rather to present four practical examples of treatment techniques using different treatment platforms from three institutions.

The 65th annual meeting of the American Association of Physicists in Medicine took place in July 2023 with a theme of "The Art of Science, The Science of Care." We review a sample of the more than 1000 talks and 1600 posters, focusing on a few topics of interest. Recent legislative changes across the country regarding reproductive health care have led to questions about how these regulations may affect your practice. A fantastic multidisciplinary session addressed these issues with experts in the areas of legal, administration, physics, and medicine...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

BACKGROUND: Non-small cell lung cancer (NSCLC) local control remains suboptimal with rates around 75%. Stereotactic body radiation therapy (SBRT) is an option for isolated local recurrences of small volume recurrences. This study investigates the safety and efficacy of 60 Gy in eight fractions in large volume local recurrences. METHODS: A retrospective chart review of patients treated with salvage SBRT for NSCLC lung parenchymal recurrence between July 2013 and February 2020...

PURPOSE: Radiopharmaceutical therapy (RPT) is a rapidly growing treatment modality. Though uncommon, patients may experience complications during their RPT treatment, which may trigger a rapid response from the hospital team. However, members of this team are typically not familiar with precautions for radiation safety. During these events, it is important to prioritize the patient's health over all else. There are some practices that can help minimize the risk of radiation contamination spread and exposure to staff while tending to the patient...

No abstract text is available yet for this article.

What are the factors that physicians could consider in an academic radiation oncology practice job offer? In this minireview, we discuss how prospective academic faculty could evaluate the "big 3" domains: (1) the compensation, including the direct and indirect payments; (2) the daily job, including aspects of the clinic, research, and education; and (3) the location, including geography, atmosphere, environment, and culture. If a prospective academic radiation oncologist believes that the academic practice is "great" in at least 2 of the 3 and "good" in the remaining 1, then they should likely sign the contract...

PURPOSE: A 3-dimensinal (3D) stereoscopic camera system developed by .decimal was commissioned and implemented into the clinic to improve the efficiency of clinical electron simulations. Capabilities of the camera allowed simulations to be moved from the treatment vault into any room with a flat surface that could accommodate patient positioning devices, eliminating the need for clinical patient setup timeslots on the treatment machine. This work describes the process used for these simulations and compares the treatment parameters determined by the system to those used in delivery...

PURPOSE: To evaluate the clinical applicability of a commercial artificial intelligence (AI)-driven deep learning auto-segmentation (DLAS) tool on enhanced iterative cone-beam CT (iCBCT) acquisitions for intact prostate and prostate bed treatments. METHODS AND MATERIALS: DLAS models were trained using 116 iCBCT datasets with manually delineated organs-at-risk (OARs - bladder, femoral heads, and rectum) and target volumes (intact prostate and prostate bed) adhering to institution-specific contouring guidelines...

PURPOSE: To evaluate outcomes after intraoperative radiation therapy (IORT) in high-risk neuroblastoma (NB), including local control, overall survival, and toxicity. METHODS AND MATERIALS: This was a single institution retrospective study of 92 pediatric patients with NB treated with IORT from 1995 to 2022. Each IORT application was considered a separate event for a total of 110 sites treated. Local failure was calculated using the cumulative incidence function and survival by Kaplan-Meier method from the day of surgery...

PURPOSE: Little is known about how the academic and geographic employment outcomes of new radiation oncology (RO) graduates have changed over time. In this study, we sought to trace the evolution of these outcomes for all RO residents who graduated between 2015 and 2022. METHODS AND MATERIALS: Using publicly available data sources, we identified the first permanent, clinical employment positions accepted by graduating members of the RO residency classes of 2015 to 2022...

PURPOSE: Significant heterogeneity exists in clinical quality assurance (QA) practices within radiation oncology departments, with most chart rounds lacking prospective peer-reviewed contour evaluation. This has the potential to significantly affect patient outcomes, particularly for head and neck cancers (HNC) given the large variance in target volume delineation. With this understanding, we incorporated a prospective systematic peer contour-review process into our workflow for all patients with HNC...

Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) have been used for the treatment of head and neck or skull base paraganglioma for a considerable time, demonstrating promising local control rates and a favorable safety profile compared with surgical approaches. Nevertheless, the choice of treatment must be carefully tailored to each patient's preferences, tumor location, and size, as well as anticipated treatment-related morbidity. This case-based review serves as a practical and concise guide for the use of SRS and FSRT in the management of head and neck or skull base paragangliomas, providing information on the diagnosis, treatment, follow-up considerations, and potential pitfalls...

The American Society for Radiation Oncology has proposed the Radiation Oncology Case Rate Program (ROCR) to advocate for fair reimbursement for radiation oncologists. ROCR would replace Medicare fee-for-service with a case rate payment for each of the 15 most common cancer types treated with external beam or stereotactic radiation therapy. This topic discussion attempts to provide a concise overview of the practical implications for radiation oncologists should the ROCR payment program be legislated by Congress and subsequently implemented by the Center for Medicare and Medicaid Services...