Practical Radiation Oncology

Proper immobilization is critical for the delivery of high-quality radiotherapy. In cases when traditional immobilization is not feasible, 3D printing may provide a better tolerated custom immobilization that is comparably effective. We present the successful treatment of a patient with inoperable oropharyngeal squamous cell carcinoma (SCC) who was unable to tolerate traditional immobilization. In order to avoid covering the face, we created a 3D printed cradle for the back of his head and neck. This design enabled the patient to tolerate traditional simulation scans with and without IV contrast and was subsequently able to undergo volumetric modulated arc therapy (VMAT) treatment...

PURPOSE: For early-stage breast cancer (BC), the choice of radiotherapy duration (1- versus 3-weeks) is highly debated. Cost and financial toxicity are major concerns that BC patients face. Nonetheless, there remain limited discussions providing granular details of the role of insurance in the aggregate cost of 1 week versus 3 weeks of radiotherapy for patients. This project aims to disaggregate costs by plan to increase transparency of out-of-pocket (OOP) cost estimates in radiotherapy...

PURPOSE AND OBJECTIVES: Robustness evaluation is increasingly used in particle therapy planning to assess CTV coverage in the setting of setup and range uncertainty. However, no clear standard exists as to an acceptable degree of plan robustness. The aim of this study is to quantify X-ray robustness parameters, as this could inform proton planning when held to a similar standard. MATERIALS AND METHODS: Consecutive patients with prostate adenocarcinoma treated with definitive X-irradiation to the prostate alone at a single institution in 2019 were retrospectively reviewed...

PURPOSE: The timely delivery of health care is an important quality indicator that has been shown to correlate with outcomes for cancer patients. We present our single-institution experience with the implementation of a same-day-access scheduling initiative in outpatient radiation oncology. METHODS AND MATERIALS: From March 2021 to March 2023, a total of 4301 consecutive new patients referred for radiation oncology consultation were offered same-day appointments as part of a prospective pilot initiative conducted at a tertiary-based academic medical center...

PURPOSE: There are mixed and limited data regarding radiotherapy (RT) tolerance in carriers of a germline pathogenic or likely pathogenic (P/LP) ATM variant. We investigated RT-related toxic effects in carriers of an ATM variant who received treatment for breast cancer. METHODS AND MATERIALS: We identified 71 patients treated with adjuvant radiotherapy for breast cancer who were carriers of a variant in ATM: 15 were classified as P/LP and 56 classified as variants of unknown significance (VUS)...

No abstract text is available yet for this article.

As radiation oncologists, we often participate in discussions on work-life balance, are offered lectures and free meals, and complete hospital-mandated modules, all under the guise of physician wellness. But how often are these measures efficacious? How do we define being well in our demanding and fast-paced careers? What does it actually look like on a day-to-day basis to achieve work-life balance? Furthermore, is it even possible?

External beam radiotherapy is a safe and effective curative treatment modality for men with localized prostate cancer (PCa). While traditionally entailing long courses with low daily doses, an appreciation of prostate radiobiology and advancements in radiation delivery have allowed for more abbreviated courses of EBRT. Ultrahypofractionated radiotherapy, which involves the delivery of >5 Gy/fraction, is now considered a standard of care regimen for localized PCa, especially intermediate-risk disease. Stereotactic body radiotherapy (SBRT), a specific form of ultrahypofractionated radiotherapy that utilizes advanced planning, imaging, and treatment technology to deliver in ≤5 fractions, is in particular emerging as a cost-effective, convenient, and safe alternative to longer courses of radiotherapy...

The combination of intensity modulated radiation therapy (IMRT) and image guidance technique (IGRT) has enhanced the sparing of normal tissue during definitive radiotherapy (RT) for organ-confined prostate cancer, allowing for dose escalation and reduced recurrence rates and toxicities associated with treatment. However, challenges arise as the close proximity of the posterior prostate to the anterior rectal wall often results in high rectal doses that IGRT alone cannot remedy. To address this issue, biodegradable inflatable balloons, polyethylene-glycol (PEG) based hydrogel, and more recently hyaluronic acid (HA), have been employed to improve rectal dose volume histograms by displacing the anterior rectal wall away from the prostate gland...

No abstract text is available yet for this article.

This study presents an approach to external beam radiation therapy (EBRT) for treating penile cancer using a small water bath. This modified technique involves the use of an acrylic, cuboid-shaped water bath, with dimensions 6 × 6 × 8 cm3 . The water bath was filled with readily available saline solution maintained at room temperature. The patient is positioned in the prone position, and the penis is placed within the water bath. The isocenter is set at the center of the water bath, and bilateral beams are positioned at 89...

PURPOSE: Quantitative bibliometrics are increasingly used to evaluate faculty research productivity. This study benchmarks publication rates for Radiation Oncologists from highly ranked NCI designated cancer centers and reveals how productivity changes over the arc of a career and of the field over time. METHODS: Peer-reviewed articles from 1970-2022 were obtained using Scopus for the 348 Radiation Oncologists listed as faculty for the top-ten cancer hospitals ranked by US News and World Report in 2022...

PURPOSE: The goal of this study was to commission the use of an MR-Linac (Unity) for imaging of gynecological HDR brachytherapy. This included optimizing imaging protocols and workflow development. METHODS AND MATERIALS: T1-weighted and T2-weighted HDR imaging protocols were optimized on the Unity for HDR GYN imaging and treatment planning. Phantom measurements using these protocols were performed to determine geometric distortion and to assess reconstruction accuracy of the applicator compared to the ground truth CT image...

Recent advances in artificial intelligence (AI), such as generative AI and large language models (LLMs) have generated significant excitement about the potential of AI to revolutionize our lives, work, and interaction with technology. This article explores the practical applications of LLMs, particularly ChatGPT, in the field of radiation oncology. We offer a guide on how radiation oncologists can interact with LLMs like ChatGPT in their routine clinical and administrative tasks, highlighting potential use cases of the present and future...

Lingual artery (LA) stenosis or bleeding can be a potentially fatal consequence of stereotactic body radiation therapy of recurrent head and neck cancer. We aim to provide delineation guidelines for LA contouring during head and neck radiation. Three experienced radiation oncologists and 1 radiologist studied the course of LA and its anatomic relationships. A step-by-step guideline was formulated for its delineation on contrast-enhanced axial computed tomography scans. We recommend that LA should be considered an important organ at risk for stereotactic body radiation therapy of head and neck cancer...

The proposed recommendations are primarily based on the consensus opinion and in-field experience of the Ontario Health/Cancer Care Ontario (OH/CCO) stereotactic body radiotherapy (SBRT) for Spine Metastasis Guideline Development Group, and published literature when available. Primary consideration was given to the perceived benefits for patients and the small likelihood of harm arising from recommendation implementation. Apart from the MRI follow-up strategy, all evidence was considered indirect, and was provided by the Working Group in conjunction with their collective expertise in the field of SBRT...

PURPOSE: Patients with gynecologic malignancies have high psychosocial and symptom burden,1 Here we report data from a prospective trial evaluating patient reported outcome (PRO) metrics in women undergoing definitive chemoradiation with BT. METHODS: A single-institution prospective trial evaluating outcomes of gynecologic cancer patients undergoing BT. Questionnaires to assess PROs at baseline, post-BT, and 60-day-follow-up were collected, using EORTC-QLQ-C30 and EORTC-QLQ-CC24 validated metrics...

PURPOSE: This article describes a community-based hospital's policy for the management of patients with medical implanted electronic devices other than pacemakers or implanted cardiac defibrillators (ICDs). The policy may be adapted as needed for other radiation oncology groups requiring a practical solution for managing the care of patients with implanted devices, noting the need for changes for departments offering proton, neutron, heavy ion, or magnetic resonance-guided linear accelerator (MR-linac) treatment modalities...

Carbon-fiber reinforced (CFR) polyetheretherketone hardware is an alternative to traditional metal hardware used for spinal fixation surgeries before postoperative radiation therapy for patients with spinal metastases. CFR hardware's radiolucency decreases metal artifact, improving visualization and accuracy of treatment planning. We present the first clinical use and proof of principle of CFR spinal hardware with tantalum markers used for successful tracking of intrafraction motion (IM) using Varian TrueBeam IMR (Intrafraction Motion Review) software module during postoperative spine stereotactic radiation...

The physics curriculum is a source of anxiety both for medical students considering radiation oncology (RO) as a possible career and for current residents facing the physics boards. To improve the orientation process for residents and medical students, we created a physics boot camp using clinically relevant patient vignettes to teach physics fundamentals. The initial boot camp was a week-long program of 1.5 to 2 hours daily, with each day consisting of a didactic session and hands-on laboratory. Boot camp topics covered included physics fundamentals, electron treatments, photon treatments, brachytherapy, and urgent clinical setups...