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Practical Radiation Oncology

Petra Grendarova, Michael Roumeliotis, Sarah Quirk, Mark Lesiuk, Peter Craighead, Hong-Wei Liu, James Pinilla, Jane Wilson, Katelyn Bignell, Tien Phan, Ivo A Olivotto
PURPOSE: To report one-year cosmesis and toxicity outcomes of a prospective, phase II trial of APBI using IMRT to deliver 27 Gy in five daily fractions. METHODS AND MATERIALS: Node-negative breast cancer patients after breast conserving surgery with clear excision margins, with physician-assessed Excellent or Good baseline cosmesis were invited to participate in a prospective clinical trial to receive 27 Gy in five daily fractions to the expanded primary site. Clinical photographs and EORTC cosmetic score were collected at baseline prior to RT and at one-year post-RT...
April 9, 2019: Practical Radiation Oncology
Vedang Murthy, Shwetabh Sinha, Sadhana Kannan, Debanjali Datta, Rabi Das, Ganesh Bakshi, Gagan Prakash, Rahul Krishnatry
PURPOSE: To determine the genitourinary (GU) toxicity outcomes in prostate cancer patients treated with stereotactic body radiotherapy (SBRT) who have undergone a prior transurethral resection of prostate (TURP) and compare it to a similar nonTURP cohort. MATERIALS AND METHODS: Fifty prostate cancer patients who had undergone a single TURP, had a good baseline urinary function and were subsequently treated with SBRT were chosen from a prospectively maintained database...
April 9, 2019: Practical Radiation Oncology
Michael J LaRiviere, Robert A Avery, J Gregory Dolan, Peter C Adamson, Deborah M Zarnow, Yunhe Xie, Stephen M Avery, Goldie A Kurtz, Christine E Hill-Kayser, Robert A Lustig, J Nicholas Lukens
Vision loss caused by leukemic infiltration of the optic nerve is an oncologic emergency. To maintain vision, radiotherapy must be initiated quickly. However, many pediatric acute lymphoblastic leukemia (ALL) patients with ophthalmic and central nervous system (CNS) relapse receive intrathecal methotrexate and/or cytarabine. Conflicting reports about intrathecal therapy potentiating radiation toxicity complicate decision-making. Here we present a teaching case to illustrate the safety and effectiveness of radiotherapy, even in the setting of concurrent intrathecal treatment...
April 9, 2019: Practical Radiation Oncology
Yijun Ding, Warren G Campbell, Moyed Miften, Yevgeniy Vinogradskiy, Karyn A Goodman, Tracey Schefter, Bernard L Jones
BACKGROUND AND PURPOSE: Tumor motion plays a key role in the safe delivery of Stereotactic Body Radiotherapy (SBRT) for pancreatic cancer. The purpose of this study was to use tumor motion data measured in patients to establish limits on motion magnitude for safe delivery of pancreatic SBRT, and to help guide motion-management decisions in potential dose-escalation scenarios. MATERIALS AND METHODS: Using 91 sets of pancreatic tumor motion data measured in patients, we calculated motion-convolved dose of the gross tumor volume (GTV), the duodenum and the stomach for 25 pancreatic cancer patients...
April 2, 2019: Practical Radiation Oncology
Michael C LeCompte, Scotty A Chung, Mahta Mirzaei McKee, Travis G Marshall, Bart Frizzell, Mandy Parker, A William Blackstock, Michael K Farris
PURPOSE: Three-dimensional (3D) printing has produced customized bolus during radiotherapy for superficial tumors along irregular skin surfaces. Traditional bolus materials, in comparison, are often difficult to manipulate for a proper fit. Current 3D printed boluses are made from either pre-existing computed tomography (CT) scans or complex surface scanning methods. Here, we introduce an inexpensive, convenient approach to generating 3D printed bolus from surface scanning technology available in common smartphones...
March 26, 2019: Practical Radiation Oncology
Mehran Yusuf, Jeremy Gaskins, Paul Tennant, Jeffrey Bumpous, Neal Dunlap
OBJECTIVE(S): To determine the impact of time to initiation (TTI) of adjuvant radiation therapy (RT) on overall survival (OS) for patients with stage I or II Merkel cell carcinoma (MCC). METHODS: The NCDB was queried for patients with MCC of the head and neck, trunk or extremities diagnosed from 2006 to 2014. Patients who did not undergo resection or who did not receive adjuvant RT within 180 days of surgery were excluded. TTI was defined as time from resection to first RT fraction...
March 26, 2019: Practical Radiation Oncology
Émilie Brouillard, Mathilde Chamula, Caroline Lavoie, Nicolas Varfalvy, Louis Archambault
BACKGROUND: The prevalence of patients with cardiovascular implantable electronic devices (CIED) receiving radiation treatment for cancer is increasing. External beam radiotherapy can affect the electronic components. OBJECTIVE: To evaluate the incidence and predictors of new onset CIED dysfunction in patients treated with radiotherapy (RT). METHODS: We retrospectively analyzed 230 patients with CIED that received radiation treatment at the Radiation Oncology Center of XXX XXXXXX XXXX XXX between February 2007 and November 2013...
March 25, 2019: Practical Radiation Oncology
Susan Kost, Bingqi Guo, Ping Xia, Chirag Shah
PURPOSE: To determine setup accuracy using anatomic landmarks for breast irradiation with and without surface guided radiation therapy (SGRT) and to assess setup time with SGRT. METHODS AND MATERIALS: This study included 115 patients with 1,945 treatment fractions. Patients were treated with four techniques: tangents, tangents using deep inspiration breath-hold (DIBH), and tangents with regional nodal irradiation with and without DIBH. A total of 915 portal verification images were analyzed to determine setup errors for the skin, chest wall (CW), and heart...
March 23, 2019: Practical Radiation Oncology
Suzanne B Evans, Daylian Cain, Ajay Kapur, Derek Brown, Todd Pawlicki
No abstract text is available yet for this article.
March 21, 2019: Practical Radiation Oncology
Trevor J Royce, Kathleen T Davenport, James M Dahle
Physician burnout is reported in more than one out of every two practicing clinicians and is just as prevalent in training physicians. Burnout severity is also associated with increasing levels of financial debt. Medical professionals are notable for their high and rising levels of debt - despite this, financial literacy is poor among physicians and financial education is largely absent from medical education. Radiation oncologists (RO) are no different in this regard, with 33% of residents reporting high levels of burnout symptoms, 33% carrying more than $200,000 of educational debt, and 75% reporting being unprepared to handle future financial decisions...
March 7, 2019: Practical Radiation Oncology
Molly M McCulloch, Choonik Lee, Benjamin S Rosen, Justin D Kamp, Chrissy M Lockhart, Jae Y Lee, Daniel F Polan, Peter G Hawkin, Carlos J R Anderson, Jolien Heukelom, Jan-Jakob Sonke, Clifton D Fuller, James M Balter, Randall K Ten Haken, Avi Eisbruch, Kristy K Brock
PURPOSE: To improve the understanding of deviations between planned and accumulated dose and establish metrics to predict for clinically significant dosimetric deviations mid-way through treatment to evaluate the potential need to replan during fractionated radiation therapy (RT). METHODS AND MATERIALS: 100 head and neck cancer patients were retrospectively evaluated. Contours were mapped from the planning CT to each fraction CBCT via deformable image registration (DIR)...
March 2, 2019: Practical Radiation Oncology
Michael J LaRiviere, Timothy C Zhu, John P Christodouleas
No abstract text is available yet for this article.
March 2, 2019: Practical Radiation Oncology
Jean-Pierre Obeid, Paulina M Gutkin, Jonathan Lewis, Lawrie Skinner, Erica B Wang, Michael S Khodadoust, Youn H Kim, Wen-Kai Weng, Richard T Hoppe, Susan M Hiniker
Patients with extensive dermal and subcutaneous disease present a technical challenge for treatment with radiation therapy (RT). Volumetric arc therapy (VMAT) can effectively treat disease on circumferential surfaces while minimizing dose to the core structures. However, treatment of extensive areas of the bilateral lower extremities with this technique has not been previously reported. Here we report the successful treatment of a patient with primary cutaneous gamma-delta T-cell lymphoma of the bilateral legs using VMAT and a custom 3-dimensional printed bolus...
March 2, 2019: Practical Radiation Oncology
Robert Kaderka, Robert C Mundt, Nan Li, Benjamin Ziemer, Victoria N Bry, Mariel Cornell, Kevin L Moore
PURPOSE: Knowledge-based planning (KBP) clinical implementation necessitates significant up-front effort even within a single disease site. The purpose of this study was to demonstrate an efficient method for clinicians to (a) assess the non-inferiority of KBP across multiple disease sites and (b) estimate any systematic dosimetric differences post-implementation. We sought to establish these endpoints in a plurality of previously treated patients (the "validation set") with both closed-loop (training set overlapping validation set) and open-loop (independent training set) KBP routines...
February 28, 2019: Practical Radiation Oncology
Pehr E Hartvigson, Aaron S Kusano, Matthew J Nyflot, Loucille Jordan, Tru-Khang Dinh, Patricia A Sponseller, Ashlee Schindler, Gabrielle M Kane, Eric C Ford
PURPOSE: Incident learning systems (ILS) require substantial time and effort to maintain, risking staff burnout and ILS disuse. Here we assess the durability of ILS-associated safety culture improvements and ILS engagement at five years. METHODS AND MATERIALS: A validated survey assessing safety culture was administered to all staff of an academic radiation oncology department prior to starting ILS and annually thereafter for five years. The survey consists of 70 questions assessing key cultural domains, overall patient safety grade, and barriers to incident reporting...
February 28, 2019: Practical Radiation Oncology
Rakesh Jalali, Madan Maitre, Tejpal Gupta, Jayant S Goda, Nalini Shah, Uday Krishna, Jamema Swamidas, Sadhna Kannan, Debnarayan Dutta, Rajiv Sarin
PURPOSE: We report a possible dose-constraint model to predict long-term neuroendocrine dysfunction following cranial irradiation in children and young adults with benign and low-grade brain tumors treated with stereotactic conformal radiotherapy (SCRT) in a prospective clinical trial. METHODS AND MATERIALS: Patients treated with SCRT (54 Gy in 30 fractions) were included for analysis if their co-registered planning CT and MRI scans were available along with baseline and post-RT endocrine assessment for at least 2 years...
February 28, 2019: Practical Radiation Oncology
Laura A Dawson, Kathryn A Winter, Alan W Katz, Michael C Schell, James Brierley, Yuhchyau Chen, Neil Kopek, Christopher H Crane, Christopher G Willett
PURPOSE: To determine the feasibility and the maximally tolerated dose (MTD) of hypofractionated, conformal radiation therapy (RT) in patients with liver metastases. METHODS: Eligibility criteria included non-surgical pts with ≤ 5 liver metastases; sum of maximal diameter of all lesions ≤ 8 cm. There were four dose levels: 35 Gy, 40 Gy (starting level), 45 Gy and 50 Gy in 10 fractions. The clinical target volume (CTV) included metastases identified on contrast CT or MRI with a 5 mm margin within the liver...
February 27, 2019: Practical Radiation Oncology
Tairo Kashihara, Naoya Murakami, Sakura Iizumi, Yasunari Sakamoto, Satoshi Nakamura, Kotaro Iijima, Kana Takahashi, Koji Inaba, Kae Okuma, Hiroshi Igaki, Yuko Nakayama, Takuji Okusaka, Takashi Uno, Jun Itami
INTRODUCTION: Previous studies have shown that simultaneous treatment with sorafenib, a vascular endothelial growth factor receptor tyrosine-kinase inhibitor (VEGFR-TKI), and radiation therapy (RT) can cause gastrointestinal hemorrhage (GH) as an adverse event. However, it is known that sorafenib monotherapy can cause GH. Thus it is essential to know the association between the radiation field and the bleeding site. CASE PRESENTATION: We report a case of bleeding ulcers on the ascending colon in a patient undergoing simultaneous RT and sorafenib administration...
February 27, 2019: Practical Radiation Oncology
Laura Freedman
No abstract text is available yet for this article.
February 27, 2019: Practical Radiation Oncology
Shahed N Badiyan, Michael S Rutenberg, Bradford S Hoppe, Pranshu Mohindra, Gary Larson, William F Hartsell, Henry Tsai, Jing Zeng, Ramesh Rengan, Erica Glass, Sanford Katz, Carlos Vargas, Steven J Feigenberg, Charles B Simone
PURPOSE: We sought to assess clinical outcomes and toxicities of patients enrolled on two prospective registry trials with recurrent lung cancer reirradiated with PBT. MATERIALS/METHODS: Seventy-nine consecutive patients were reirradiated with PBT at 8 institutions. Conventionally fractionated radiotherapy was used to treat the previous lung cancer in 68% of patients (median equivalent dose in 2 Gy fractions (EQD2) 60.2 Gy) or hypofractionated/stereotactic body radiation therapy in 32% (median EQD2 83...
February 22, 2019: Practical Radiation Oncology
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