Practical Radiation Oncology

PURPOSE: We used a new web application for rapid review of radiotherapy (RT) target volumes to evaluate the relationship between target delineation compliance with the international guidelines and outcomes of definitive RT for nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS: The dataset consists of CT simulation scans, RT structures, and clinical data of 354 pathology-confirmed NPC patients treated with intensity-modulated RT between 2005 and 2017. Target volumes were peer-reviewed in RT QA rounds, and target contours were revised, if recommended, before treatment...

PURPOSE: Considering how commonly vaginal cuff brachytherapy is used, there is relatively little literature regarding the potential, albeit low, risk for complications. We present here three potentially serious mishaps, involving cylinder misplacement, dehiscence, and excessive normal tissue irradiation due to unique anatomy. METHODS: Three patients with potentially serious treatment errors were encountered in the authors' usual clinical practice. Each patient's records were reviewed for this report...

PURPOSE: TBI, a form of immunomodulation, improves treatment outcomes for rapidly progressive scleroderma. The landmark Scleroderma: Cyclophosphamide or Transplantation (SCOT) trial used strict 200 cGy lung and kidney dose restrictions to limit the likelihood of normal tissue toxicity. The protocol, as written, did not specify how or where the 200 cGy limit was to be measured, opening the door to variable techniques and outcomes. METHODS: Following the SCOT protocol, a validated 18 MV TBI beam model was used to evaluate lung and kidney doses with varying Cerrobend half-value layers (HVLs)...

Workplace culture is often overlooked in interventions to improve the delivery of healthcare efficiency. Burnout and employee morale have been long-standing issues in healthcare and can negatively affect both provider and patient health. In order to address employee wellness and promote department unity, a culture committee was established within a radiation oncology department. After the emergence of the 2019 coronavirus (COVID-19) pandemic, burnout and social isolation among healthcare workers have increased substantially, affecting job performance and stress levels...

PURPOSE: The proximity of tumors to the chest wall brings additional risks of chest wall pain during stereotactic body radiotherapy (SBRT). Herein, we dosimetrically compared alternated breath-hold (ABH) plans with single BH plans, as well as to determine the common characteristics of eligible patients who may obtain better chest wall sparing using this technique. METHODS AND MATERIALS: Twenty patients with lung lesions adjacent to the chest wall were enrolled and received respiratory training...

PURPOSE: The recently published Lung Adjuvant Radiotherapy Trial (Lung ART) reported increased rates of cardiac and pulmonary toxic effects in the postoperative radiation therapy (PORT) arm. It remains unknown whether the dosimetric parameters reported in Lung ART are representative of contemporary real-world practice, which remains relevant for patients undergoing PORT for positive surgical margins. The purpose of this study was to examine heart and lung dose exposure in patients receiving PORT for non-small cell lung cancer across a statewide consortium...

No abstract text is available yet for this article.

PURPOSE: Impending and actual pathologic fractures secondary to metastatic bone disease, lymphoma, or multiple myeloma often require intramedullary fixation followed by radiotherapy. Due to carbon's low atomic number, there is reduced CT-imaging artifacts and dose perturbation when planning postoperative radiation for carbon fiber (CF) rods. Herein, we characterize the dosimetric properties of CF implants compared to titanium-alloy (TA) for proton and photon. METHODS AND MATERIALS: TA and CF samples were acquired from an implant manufacturer...

BACKGROUND: In patients with newly diagnosed glioblastoma (GBM), tumor margins of at least 20 mm are the standard of care. We sought to determine the pattern of tumor progression in patients treated with 5 fraction stereotactic radiosurgery (SRS) with 5 mm margins. METHODS: Thirty adult patients with newly diagnosed GBM were treated with 5 fraction SRS in escalated doses from 25 Gy to 40 Gy with a 5 mm total treatment margin. Progression was scored as 'in-field' if the recurrent tumor was within or contiguous with the 5 mm margin, 'marginal' if between 5 and 20 mm, and 'distant' if entirely occurring greater than 20 mm...

Accurate information about cancer treatment is critical for individuals to make informed decisions about their health. Unfortunately, the rise of the internet and social media combined with patients' desire for autonomy as well as the increased availability and marketing of unproven/disproven therapies has made it easy for misinformation about cancer to spread. This can have grave consequences for patients, as individuals who rely on misinformation may make decisions that put their health at risk, including choosing to forego effective treatment in favor of unproven/disproven therapies...

Brachytherapy is an integral part of the definitive treatment for locally advanced cervical cancer (LACC) following external beam radiation therapy (EBRT). Placement of brachytherapy applicators is an important skill for radiation oncologists and care must be taken to place applicators appropriately to limit complications associated with the procedure and ensure that the radiation dose sufficiently covers the target while sparing the surrounding organs at risk (OARs). Using example cases, we discuss strategies for the placement of brachytherapy applicators in patients with anatomical considerations such as large obstructing uterine fibroids and the retroverted uterus...

Primary radiotherapy using interstitial brachytherapy (IBT) provides excellent local tumor control for early-stage squamous cell carcinoma (SCC) of the lip. Technical aspects of treatment are important to optimize outcomes. In this report, we discuss patient selection criteria, procedural details, and dosimetric considerations for performing IBT for cancers of the lip. Catheters are inserted across the length of tumor entering and exiting approximately 5 mm beyond the palpable tumor extent. A custom mouthpiece is fabricated to facilitate normal tissue sparing...

PURPOSE: Quality assurance (QA) is critical to the success of radiation therapy (RT) for cancer patients and impacts clinical outcomes. We report longitudinal findings of a prospective peer review evaluation system (PES) implemented at a major academic health system as part of RT QA over a ten-year period. MATERIALS/METHODS: All cases treated within our department undergo prospective multi-disciplinary peer review and are assigned a grade (A, B, C). "A" cases require no changes, "Bs" require minor modification, and "Cs" require major modification, prior to treatment planning...

PURPOSE: This study aimed to use deep learning-based dose prediction to assess head and neck (HN) plan quality and identify suboptimal plans. METHODS AND MATERIALS: A total of 245 volumetric modulated arc therapy HN plans were created using RapidPlan knowledge-based planning (KBP). A subset of 112 high-quality plans was selected under the supervision of an HN radiation oncologist. We trained a 3D Dense Dilated U-Net architecture to predict 3-dimensional dose distributions using 3-fold cross-validation on 90 plans...

No abstract text is available yet for this article.

Radiation vasculopathy is a well-recognized late complication of radiation therapy. We present a case of a stroke 29 years after high-dose proton radiation therapy for skull-base chordoma due to occlusion of bilateral internal carotid arteries.

BACKGROUND AND PURPOSE: To assess the degree of pathological complete response (pCR), post-operative surgical complication rates and oncological outcomes in women with locally advanced (LABC) or high-risk breast cancers treated with neoadjuvant radiotherapy (NART). MATERIALS AND METHODS: This retrospective multi-institutional review involved 138 clinically-staged patients with 140 breast cancers treated with NART between January 2014 and February 2021. Treatments involved sequential NACT and NART, followed by mastectomy with or without axillary surgery and immediate autologous breast reconstruction...

The purpose of this paper is to summarize the literature and practical recommendations from experienced centers for close margins following transoral robotic surgery (TORS) for HPV-positive oropharyngeal carcinoma.

PURPOSE: Dose constraints for reirradiation of recurrent primary brain tumors are not well-established. This study was conducted to prospectively evaluate composite dose constraints for conventionally fractionated brain reirradiation. METHODS AND MATERIALS: A single-institution, prospective study of adults with previously irradiated, recurrent brain tumors was performed. For 95% of patients, electronic dosimetry records from the first course of radiation (RT1) were obtained and deformed onto the simulation computed tomography for the second course of radiation (RT2)...

PURPOSE: This updated report on image guided radiation therapy (IGRT) is part of a series of consensus-based white papers previously published by the American Society for Radiation Oncology addressing patient safety. Since the first white papers were published, IGRT technology and procedures have progressed significantly such that these procedures are now more commonly used. The use of IGRT has now extended beyond high-precision treatments, such as stereotactic radiosurgery and stereotactic body radiation therapy, and into routine clinical practice for many treatment techniques and anatomic sites...