Publication date: Available online 23 December 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Charles T. Lee, Yanqun Dong, Tianyu Li, Samuel Freedman, Jordan Anaokar, Thomas J. Galloway, Mark A. Hallman, Stephanie E. Weiss, Shelly B. Hayes, Robert A. Price, C-M Charlie Ma, Joshua E. Meyer
PurposeTo evaluate the efficacy and toxicity of external beam reirradiation using pulsed low-dose-rate (PLDR) technique.Methods/MaterialsWe evaluated patients treated with PLDR reirradiation between 2009-2016 at a single institution. Toxicity was graded based on CTCAE4.0 and local control was assessed using RECIST1.1. In the univariate analysis (UVA), Chi-square, and Fisher's Exact test were used to assess toxicity outcomes; competing risk analysis via cumulative incidence function estimates were used to assess local progression.ResultsThirty-nine patients were treated to 41 disease sites with PLDR reirradiation, with a median follow-up of 8.8 months (range 0.5-64.7 months). Targets were thoracic, abdominal and pelvic, including 36 symptomatic sites. The median time between the first radiation course and reirradiation was 26.2 months; the median doses of the first and second courses of radiation were 50.4 Gy and 50 Gy, respectively. Five patients (13%) received concurrent systemic therapy.Out of 39 patients, 9 (23%) developed grade 2+ acute toxicity, most commonly radiation dermatitis (5/9). None developed grade 4+ acute/subacute toxicity. The only grade 2+ late toxicity was 1 patient with grade 2 late skin toxicity. In UVA, toxicity was not significantly associated with dose of the first course of radiation or reirradiation, time interval to reirradiation, or reirradiation site.Of the 41 disease sites treated with PLDR, 32 had pre and post-PLDR scans to evaluate for local control. Local progression was 16.5% at 6 months and 23.8% at 12 months, and was not associated with the dose of reirradiation, reirradiation site, or concurrent systemic therapy in UVA. Of 36 symptomatic disease sites, 25 (69%) sites achieved symptomatic response after PLDR, including 6 (17%) with complete symptomatic relief.ConclusionReirradiation with PLDR is effective and well-tolerated. Risk of late toxicity and durability of local control was limited by the relatively short follow up in this cohort.
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Cancer Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Κυριακή 24 Δεκεμβρίου 2017
Local Control and Toxicity of External Beam Reirradiation with Pulsed Low-Dose-Rate Technique
Local Control and Toxicity of External Beam Reirradiation with Pulsed Low-Dose-Rate Technique
Publication date: Available online 23 December 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Charles T. Lee, Yanqun Dong, Tianyu Li, Samuel Freedman, Jordan Anaokar, Thomas J. Galloway, Mark A. Hallman, Stephanie E. Weiss, Shelly B. Hayes, Robert A. Price, C-M Charlie Ma, Joshua E. Meyer
PurposeTo evaluate the efficacy and toxicity of external beam reirradiation using pulsed low-dose-rate (PLDR) technique.Methods/MaterialsWe evaluated patients treated with PLDR reirradiation between 2009-2016 at a single institution. Toxicity was graded based on CTCAE4.0 and local control was assessed using RECIST1.1. In the univariate analysis (UVA), Chi-square, and Fisher's Exact test were used to assess toxicity outcomes; competing risk analysis via cumulative incidence function estimates were used to assess local progression.ResultsThirty-nine patients were treated to 41 disease sites with PLDR reirradiation, with a median follow-up of 8.8 months (range 0.5-64.7 months). Targets were thoracic, abdominal and pelvic, including 36 symptomatic sites. The median time between the first radiation course and reirradiation was 26.2 months; the median doses of the first and second courses of radiation were 50.4 Gy and 50 Gy, respectively. Five patients (13%) received concurrent systemic therapy.Out of 39 patients, 9 (23%) developed grade 2+ acute toxicity, most commonly radiation dermatitis (5/9). None developed grade 4+ acute/subacute toxicity. The only grade 2+ late toxicity was 1 patient with grade 2 late skin toxicity. In UVA, toxicity was not significantly associated with dose of the first course of radiation or reirradiation, time interval to reirradiation, or reirradiation site.Of the 41 disease sites treated with PLDR, 32 had pre and post-PLDR scans to evaluate for local control. Local progression was 16.5% at 6 months and 23.8% at 12 months, and was not associated with the dose of reirradiation, reirradiation site, or concurrent systemic therapy in UVA. Of 36 symptomatic disease sites, 25 (69%) sites achieved symptomatic response after PLDR, including 6 (17%) with complete symptomatic relief.ConclusionReirradiation with PLDR is effective and well-tolerated. Risk of late toxicity and durability of local control was limited by the relatively short follow up in this cohort.
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Editorial Board
Source:Cancer Treatment Reviews, Volume 62
http://ift.tt/2D52F3y
Acknowledgement to Reviewers 2017
Source:Cancer Treatment Reviews, Volume 62
http://ift.tt/2C28lfr
Quality of Prostate Cancer Screening Information on the Websites of Nationally-Recognized Cancer Centers and Health Organizations
Source:Practical Radiation Oncology
Author(s): Bogdan-Alexandru Manole, Daniel V. Wakefield, Austin Dove, Caleb R. Dulaney, Samuel R. Marcrom, David L. Schwartz, Michael R. Farmer
http://ift.tt/2DFrNPk
Chest wall toxicity after hypofractionated proton beam therapy for liver malignancies
Source:Practical Radiation Oncology
Author(s): Rosanna Yeung, Stephen R. Bowen, Tobias R. Chapman, Grayden T. MacLennan, Smith Apisarnthanarax
PurposeNormal liver-sparing with proton beam therapy (PBT) allows for dose escalation in the treatment of liver malignancies, but 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 radiotherapy. We examined the incidence and associated factors for CWT after hypofractionated PBT for liver malignancies.Methods and MaterialsWe retrospectively reviewed the charts of 37 consecutive patients with liver malignancies (30 hepatocellular carcinoma, 6 intrahepatic cholangiocarcinoma and 1 metastasis) treated with hypofractionated PBT. CWT was scored using CTCAEv4. Receiver-operating characteristic (ROC) curves were used to identify patient and dosimetric factors associated with CWT and to determine optimal DVH parameters/cut-offs. Cox regression univariate analysis was used to associate factors to time-dependent onset of CWT.ResultsThirty-nine liver lesions were treated with a median dose of 60 GyE (range, 35–67.5 GyE) in 15 fractions (range, 13–20 fractions). Median follow-up was 11months (range, 2–44months). Grade≥2 and 3 CW pain occurred in 7 (19%) and 4 (11%) patients, respectively. Median time to onset of pain was 6months (range, 1–14months). No patients had radiographic rib fracture. On univariate analysis, CW EQD2α/β=3V57>20cm3 (HR 2.7, p=0.004), V63>17cm3 (HR 2.7, p=0.003), and V78>8cm3 (HR 2.6, p=0.003) had the strongest association with grade≥2 CW pain as did tumor dose of >75Gy EQD2α/β=10 (HR 8.7, p=0.03). No other patient factors were associated with CWT.ConclusionsCWT after hypofractionated PBT for liver malignancies is clinically relevant. For a 15-fraction regimen, V47>20cm3, V50>17cm3, and V58>8cm3 were associated with higher rates of CWT. Further investigation of PBT techniques to reduce CW dose are warranted.
http://ift.tt/2pr4YvB
Urolift as a surrogate for fiducial markers in IGRT planning of prostate cancer in BPH patients
Source:Practical Radiation Oncology
Author(s): Nrusingh C. Biswal, Beth Swann, Michael McKenna, Rachana Singh
http://ift.tt/2DJeY6K
Five Years Experience with a Customized Electronic Checklist for Radiotherapy Planning Quality Assurance in a Multi-campus Institution
Source:Practical Radiation Oncology
Author(s): Sean L Berry, Kevin Tierney, Sharif Elguindi, James Mechalakos
IntroductionAn electronic checklist has been designed with the intention of reducing errors while minimizing the user effort in completing the checklist. We analyze the clinical use and evolution of the checklist over the past 5years and review data in an incident learning system (ILS) to investigate whether it has contributed to an improvement in patient safety.Methods and MaterialsThe checklist is written as a standalone HTML application utilizing VBScript. User selection of pertinent demographic details limits the display of checklist items only to those necessary for the particular clinical scenario. Ten common clinical scenarios were used to illustrate the difference between the maximum possible number of checklist items available in the code versus the number displayed to the user at any one time. An ILS database of errors and near misses was reviewed to evaluate whether the checklist influenced the occurrence of reported events.ResultsOver five years, the number of checklist items available in the code nearly doubled, while the number displayed to the user at any one time stayed constant. Events reported in our ILS related to the beam energy used with pacemakers, projection of anatomy on digitally reconstructed radiographs, orthogonality of setup fields, and field extension beyond matchlines, did not recur after the items were added to the checklist. Other events related to bolus documentation and breakpoints continued to be reported.ConclusionOur checklist is adaptable to the introduction of new technologies, transitions between planning systems, and to errors and near misses recorded in the ILS. The electronic format allows us to restrict user display to a small, relevant, subset of possible checklist items, limiting the planner effort needed to review and complete the checklist.SummaryAn electronic safety checklist for radiotherapy treatment planning has been in use at our institution for more than five years. We demonstrate that the electronic format allows the user display to be restricted to a small, relevant, subset of possible checklist items. The electronic checklist can be modified to adapt to the introduction of new technologies, transitions between planning systems, and in response to errors and near misses in the clinic.
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Intra-patient study comparing 3D printed bolus versus standard vinyl gel sheet bolus for postmastectomy chest wall radiation therapy
Source:Practical Radiation Oncology
Author(s): James L. Robar, Kathryn Moran, James Allan, James Clancey, Tami Joseph, Krista Chytyk-Praznik, R. Lee MacDonald, John Lincoln, Parisa Sadeghi, Robert Rutledge
PurposeThis patient study evaluated the use of 3D printed bolus for chest wall radiotherapy, with comparison to 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 materialsFor sixteen patients undergoing chest wall radiotherapy, custom 5.0mm thick bolus was designed based on the treatment planning CT and 3D printed using polylactic acid (PLA). Cone beam CT was used to image and quantify the accuracy of fit of the two bolus types with regard to air gaps between the bolus and skin. As a QA measure for the 3D printed bolus, Optically Stimulated Luminescent Dosimetry provided in vivo comparison of surface dose at seven points on the chest wall. Durations of patient setup and image guidance were recorded and compared.ResultsIn 13 of 16 patients the bolus was printed without user intervention and the median print time was 12.6hours. The accuracy of fit of the bolus to the chest wall was improved significantly relative to standard sheet bolus with the frequency of air gaps 5mm or greater reduced from 30% to 13% (p<0.001), and maximum air gap dimension diminished from 0.5 +/− 0.3mm to 0.3 +/− 0.3mm, on average. Surface dose was within 3% for both standard sheet and 3D printed bolus. On average, the use of 3D printed bolus reduced the setup time from 104 to 76seconds.ConclusionsThis study demonstrates 3D printed bolus in post-mastectomy radiation therapy improves fit of the bolus and reduces patient setup time marginally compared with standard vinyl gel sheet bolus. The time savings on patient setup must be weighed against the considerable time for the 3D printing process.
http://ift.tt/2DKusr4
Quality of Prostate Cancer Screening Information on the Websites of Nationally-Recognized Cancer Centers and Health Organizations
Source:Practical Radiation Oncology
Author(s): Bogdan-Alexandru Manole, Daniel V. Wakefield, Austin Dove, Caleb R. Dulaney, Samuel R. Marcrom, David L. Schwartz, Michael R. Farmer
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Chest wall toxicity after hypofractionated proton beam therapy for liver malignancies
Source:Practical Radiation Oncology
Author(s): Rosanna Yeung, Stephen R. Bowen, Tobias R. Chapman, Grayden T. MacLennan, Smith Apisarnthanarax
PurposeNormal liver-sparing with proton beam therapy (PBT) allows for dose escalation in the treatment of liver malignancies, but 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 radiotherapy. We examined the incidence and associated factors for CWT after hypofractionated PBT for liver malignancies.Methods and MaterialsWe retrospectively reviewed the charts of 37 consecutive patients with liver malignancies (30 hepatocellular carcinoma, 6 intrahepatic cholangiocarcinoma and 1 metastasis) treated with hypofractionated PBT. CWT was scored using CTCAEv4. Receiver-operating characteristic (ROC) curves were used to identify patient and dosimetric factors associated with CWT and to determine optimal DVH parameters/cut-offs. Cox regression univariate analysis was used to associate factors to time-dependent onset of CWT.ResultsThirty-nine liver lesions were treated with a median dose of 60 GyE (range, 35–67.5 GyE) in 15 fractions (range, 13–20 fractions). Median follow-up was 11months (range, 2–44months). Grade≥2 and 3 CW pain occurred in 7 (19%) and 4 (11%) patients, respectively. Median time to onset of pain was 6months (range, 1–14months). No patients had radiographic rib fracture. On univariate analysis, CW EQD2α/β=3V57>20cm3 (HR 2.7, p=0.004), V63>17cm3 (HR 2.7, p=0.003), and V78>8cm3 (HR 2.6, p=0.003) had the strongest association with grade≥2 CW pain as did tumor dose of >75Gy EQD2α/β=10 (HR 8.7, p=0.03). No other patient factors were associated with CWT.ConclusionsCWT after hypofractionated PBT for liver malignancies is clinically relevant. For a 15-fraction regimen, V47>20cm3, V50>17cm3, and V58>8cm3 were associated with higher rates of CWT. Further investigation of PBT techniques to reduce CW dose are warranted.
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Urolift as a surrogate for fiducial markers in IGRT planning of prostate cancer in BPH patients
Source:Practical Radiation Oncology
Author(s): Nrusingh C. Biswal, Beth Swann, Michael McKenna, Rachana Singh
from Cancer via ola Kala on Inoreader http://ift.tt/2DJeY6K
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Five Years Experience with a Customized Electronic Checklist for Radiotherapy Planning Quality Assurance in a Multi-campus Institution
Source:Practical Radiation Oncology
Author(s): Sean L Berry, Kevin Tierney, Sharif Elguindi, James Mechalakos
IntroductionAn electronic checklist has been designed with the intention of reducing errors while minimizing the user effort in completing the checklist. We analyze the clinical use and evolution of the checklist over the past 5years and review data in an incident learning system (ILS) to investigate whether it has contributed to an improvement in patient safety.Methods and MaterialsThe checklist is written as a standalone HTML application utilizing VBScript. User selection of pertinent demographic details limits the display of checklist items only to those necessary for the particular clinical scenario. Ten common clinical scenarios were used to illustrate the difference between the maximum possible number of checklist items available in the code versus the number displayed to the user at any one time. An ILS database of errors and near misses was reviewed to evaluate whether the checklist influenced the occurrence of reported events.ResultsOver five years, the number of checklist items available in the code nearly doubled, while the number displayed to the user at any one time stayed constant. Events reported in our ILS related to the beam energy used with pacemakers, projection of anatomy on digitally reconstructed radiographs, orthogonality of setup fields, and field extension beyond matchlines, did not recur after the items were added to the checklist. Other events related to bolus documentation and breakpoints continued to be reported.ConclusionOur checklist is adaptable to the introduction of new technologies, transitions between planning systems, and to errors and near misses recorded in the ILS. The electronic format allows us to restrict user display to a small, relevant, subset of possible checklist items, limiting the planner effort needed to review and complete the checklist.SummaryAn electronic safety checklist for radiotherapy treatment planning has been in use at our institution for more than five years. We demonstrate that the electronic format allows the user display to be restricted to a small, relevant, subset of possible checklist items. The electronic checklist can be modified to adapt to the introduction of new technologies, transitions between planning systems, and in response to errors and near misses in the clinic.
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Intra-patient study comparing 3D printed bolus versus standard vinyl gel sheet bolus for postmastectomy chest wall radiation therapy
Source:Practical Radiation Oncology
Author(s): James L. Robar, Kathryn Moran, James Allan, James Clancey, Tami Joseph, Krista Chytyk-Praznik, R. Lee MacDonald, John Lincoln, Parisa Sadeghi, Robert Rutledge
PurposeThis patient study evaluated the use of 3D printed bolus for chest wall radiotherapy, with comparison to 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 materialsFor sixteen patients undergoing chest wall radiotherapy, custom 5.0mm thick bolus was designed based on the treatment planning CT and 3D printed using polylactic acid (PLA). Cone beam CT was used to image and quantify the accuracy of fit of the two bolus types with regard to air gaps between the bolus and skin. As a QA measure for the 3D printed bolus, Optically Stimulated Luminescent Dosimetry provided in vivo comparison of surface dose at seven points on the chest wall. Durations of patient setup and image guidance were recorded and compared.ResultsIn 13 of 16 patients the bolus was printed without user intervention and the median print time was 12.6hours. The accuracy of fit of the bolus to the chest wall was improved significantly relative to standard sheet bolus with the frequency of air gaps 5mm or greater reduced from 30% to 13% (p<0.001), and maximum air gap dimension diminished from 0.5 +/− 0.3mm to 0.3 +/− 0.3mm, on average. Surface dose was within 3% for both standard sheet and 3D printed bolus. On average, the use of 3D printed bolus reduced the setup time from 104 to 76seconds.ConclusionsThis study demonstrates 3D printed bolus in post-mastectomy radiation therapy improves fit of the bolus and reduces patient setup time marginally compared with standard vinyl gel sheet bolus. The time savings on patient setup must be weighed against the considerable time for the 3D printing process.
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