851
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Eckl M, Hoppen L, Sarria GR, Boda-Heggemann J, Simeonova-Chergou A, Steil V, Giordano FA, Fleckenstein J. Evaluation of a cycle-generative adversarial network-based cone-beam CT to synthetic CT conversion algorithm for adaptive radiation therapy. Phys Med 2020; 80:308-316. [PMID: 33246190 DOI: 10.1016/j.ejmp.2020.11.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/29/2020] [Accepted: 11/05/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Image-guided radiation therapy could benefit from implementing adaptive radiation therapy (ART) techniques. A cycle-generative adversarial network (cycle-GAN)-based cone-beam computed tomography (CBCT)-to-synthetic CT (sCT) conversion algorithm was evaluated regarding image quality, image segmentation and dosimetric accuracy for head and neck (H&N), thoracic and pelvic body regions. METHODS Using a cycle-GAN, three body site-specific models were priorly trained with independent paired CT and CBCT datasets of a kV imaging system (XVI, Elekta). sCT were generated based on first-fraction CBCT for 15 patients of each body region. Mean errors (ME) and mean absolute errors (MAE) were analyzed for the sCT. On the sCT, manually delineated structures were compared to deformed structures from the planning CT (pCT) and evaluated with standard segmentation metrics. Treatment plans were recalculated on sCT. A comparison of clinically relevant dose-volume parameters (D98, D50 and D2 of the target volume) and 3D-gamma (3%/3mm) analysis were performed. RESULTS The mean ME and MAE were 1.4, 29.6, 5.4 Hounsfield units (HU) and 77.2, 94.2, 41.8 HU for H&N, thoracic and pelvic region, respectively. Dice similarity coefficients varied between 66.7 ± 8.3% (seminal vesicles) and 94.9 ± 2.0% (lungs). Maximum mean surface distances were 6.3 mm (heart), followed by 3.5 mm (brainstem). The mean dosimetric differences of the target volumes did not exceed 1.7%. Mean 3D gamma pass rates greater than 97.8% were achieved in all cases. CONCLUSIONS The presented method generates sCT images with a quality close to pCT and yielded clinically acceptable dosimetric deviations. Thus, an important prerequisite towards clinical implementation of CBCT-based ART is fulfilled.
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Affiliation(s)
- Miriam Eckl
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Germany
| | - Lea Hoppen
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Germany.
| | - Gustavo R Sarria
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Germany
| | - Judit Boda-Heggemann
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Germany
| | - Anna Simeonova-Chergou
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Germany
| | - Volker Steil
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Germany
| | - Frank A Giordano
- Department of Radiology and Radiation Oncology, University Hospital Bonn, Germany
| | - Jens Fleckenstein
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Germany
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852
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Damast S, Felder S, Fields E, Singer L. Feasibility of deploying a U.S. simulation-based gynecological brachytherapy educational workshop to an international setting. Brachytherapy 2020; 19:777-782. [PMID: 33221261 DOI: 10.1016/j.brachy.2020.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/24/2020] [Accepted: 09/28/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE A decline in brachytherapy (BT) use for cervical cancer has negatively affected cure rates in the United States and abroad. To improve trainee exposure to BT, a simulation-based educational curriculum incorporating a pelvic mannequin was developed and implemented at several U.S. residency programs. We sought to describe an initial experience with deployment of this curriculum to an international setting. METHODS AND MATERIALS The setting was in Israel, a middle eastern country with cervical cancer incidence of 5-8 cases per 100,000 women. Israel was selected for this pilot because of its desire to increase exposure to trainees, lack of mandatory BT case requirements, and few residencies nationally. In determining the feasibility of deployment to this setting, a partnership was formed between a U.S. and Israeli brachytherapist to understand cultural context and institutional and logistical needs. Feasibility was defined as successful completion of the workshop. Trainee comfort and knowledge with BT was assessed with preworkshop and postworkshop surveys, with changes compared. RESULTS The curriculum was incorporated into a 1-day course on gynecologic malignancies, with adaptation to local setting and routine. Among 15 attendees, eight were residents, from four programs. All completed the workshop. All domains assessed by the surveys improved and all respondents found the program to be helpful. CONCLUSIONS International deployment of the simulation-based educational BT curriculum was feasible and well-received. Further collaboration is needed to deploy and adapt the curriculum to countries of high cervical cancer incidence that could benefit from increased education.
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Affiliation(s)
| | | | - Emma Fields
- Virginia Commonwealth University, Richmond, VA
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853
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Radiation dermatitis assessment tools used in breast cancer: A systematic review of measurement properties. Support Care Cancer 2020; 29:2265-2278. [DOI: 10.1007/s00520-020-05889-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/09/2020] [Indexed: 10/23/2022]
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854
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Yang X, Ren H, Guo X, Hu C, Fu J. Radiation-induced skin injury: pathogenesis, treatment, and management. Aging (Albany NY) 2020; 12:23379-23393. [PMID: 33202382 PMCID: PMC7746368 DOI: 10.18632/aging.103932] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 07/30/2020] [Indexed: 12/15/2022]
Abstract
Radiation-induced skin injury (RSI) refers to a frequently occurring complication of radiation therapy. Nearly 90% of patients having received radiation therapy underwent moderate-to-severe skin reactions, severely reducing patients' quality of life and adversely affecting their disease treatment. No gold standard has been formulated for RSIs. In the present study, the mechanism of RSI and topical medications was discussed. Besides, this study can be referenced for clinicians to treat RSIs to guide subsequent clinical medicine.
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Affiliation(s)
- Xiaojing Yang
- Department of Radiation Oncology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Hanru Ren
- Department of Orthopedics, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Shanghai, China
| | - Xiaomao Guo
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Shanghai Medical College, Fudan University, Shanghai, China
| | - Chaosu Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jie Fu
- Department of Radiation Oncology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
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855
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Zhang Q, Li L, Lai Y, Zhao T. Silencing of SPP1 Suppresses Progression of Tongue Cancer by Mediating the PI3K/Akt Signaling Pathway. Technol Cancer Res Treat 2020; 19:1533033820971306. [PMID: 33174521 PMCID: PMC7672768 DOI: 10.1177/1533033820971306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: In the present study, we aimed to find an effective target for the treatment of tongue cancer using gene chip screening and signal pathway research. Methods: We used microarray screening and gene expression profile analyses to find important differentially expressed genes in tongue cancer. We constructed a protein-protein interaction network, and used enrichment analysis of the Kyoto Encyclopedia of Genes and Genomes to screen for important genes. We then silenced the genes of interest in SCC154 cells to study the relationship with the Phosphatidylinositol 3-kinase/Akt signal pathway. Western blot analyses, the 3-(4,5Dimethylthiazol-yl)-2,5Dimethylthiazol-2-yl)-2,5diphenyltetrazolium bromide (MTT) test, and immunofluorescence assays were used to compare the expression levels of Phosphatidylinositol 3-kinase/Akt signal pathway-related proteins, cell viability, and cell proliferation ability in normal SCC154 cells, Si-RNA SCC154 cells, and gene-silenced SCC154 cells. The scratch test, Transwell test, and western blotting were used to determine migration, invasion, and carcinogenesis. Results: Using GSE9844, GSE13601, and GSE31056 gene chips, we identified 93 upregulated genes and 76 downregulated genes in tongue cancer. Using the protein-protein interaction network and Kyoto Encyclopedia of Genes and Genomes enrichment analyses, we further identified 47 differentially expressed genes. Using Kaplan-Meier plotter online tools, we also identified 3 genes (SPP1, Recombinant Human Secreted Phosphoprotein 1; PLAU, plasminogen activator urinary; and APP, amyloid precursor protein). Compared with normal SCC154 cells and Si-RNA control SCC154 cells, the expressions of Phosphatidylinositol 3-kinase/Akt pathway proteins in si-SPP1 SCC154 cells were significantly decreased (*P < 0.05), and the protein activities and proliferation abilities were also significantly decreased (*P < 0.05), while the migration ability, invasion ability, and cancer forming ability were significantly increased (*P < 0.05). Conclusion: Inhibition of the SPP1 gene may have a therapeutic effect on tongue cancer, and could be an effective target for the treatment of this disorder.
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Affiliation(s)
- Qiaoli Zhang
- Department of Stomatology, The First People's Hospital of Fuyang Hangzhou, Hangzhou, Zhejiang, China
| | - Lifeng Li
- Department of Stomatology, The First People's Hospital of Fuyang Hangzhou, Hangzhou, Zhejiang, China
| | - Yueli Lai
- Department of Stomatology, The First People's Hospital of Fuyang Hangzhou, Hangzhou, Zhejiang, China
| | - Tong Zhao
- Department of Stomatology, The First People's Hospital of Fuyang Hangzhou, Hangzhou, Zhejiang, China
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856
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Figen M, Çolpan Öksüz D, Duman E, Prestwich R, Dyker K, Cardale K, Ramasamy S, Murray P, Şen M. Radiotherapy for Head and Neck Cancer: Evaluation of Triggered Adaptive Replanning in Routine Practice. Front Oncol 2020; 10:579917. [PMID: 33282734 PMCID: PMC7690320 DOI: 10.3389/fonc.2020.579917] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/13/2020] [Indexed: 12/30/2022] Open
Abstract
Purpose and Objective A proportion of patients receiving radiotherapy for head and neck squamous cell carcinoma (HNSCC) require ad hoc treatment re-planning. The aim of this retrospective study is to analyze the patients who required ad hoc re-planning and to identify factors, which may predict need for re-planning. Materials and Methods A single center evaluation of all patients receiving radical or adjuvant (chemo)radiotherapy (CRT) for HNSCC between January and December 2016 was undertaken. Patients who underwent ad hoc re-planning during the treatment were identified in electronic records. Reasons for re-planning were categorized as: weight loss, tumor shrinkage, changes in patient position and immobilization-related factors. Potential trigger factors for adaptive radiotherapy such as patient characteristics, primary tumor site, stage, concomitant chemotherapy, weight loss ratios, radical/adjuvant treatment, and nutritional interventions were investigated. Results 31/290 (10.6%) HNSCC patients who underwent radical/adjuvant radiotherapy required re-planning. The adaptive radiotherapy (ART) was performed at a mean fraction of 15. The most common documented reasons for re-planning were tumor shrinkage (35.5%) and weight loss (35.5%). Among the patient/tumor/treatment factors, nasopharyngeal primary site (p = 0.013) and use of concurrent chemotherapy with radiotherapy (p = 0.034) were found to be significantly correlated with the need for re-planning. Conclusion Effective on-treatment verification schedules and close follow up of patients especially with NPC primary and/or treated with concurrent chemoradiotherapy are crucial to identify patients requiring ART. We suggest an individualized triggered approach to ART rather than scheduled strategies as it is likely to be more feasible in terms of utilization of workload and resources.
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Affiliation(s)
- Metin Figen
- Department of Radiation Oncology Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Didem Çolpan Öksüz
- Department of Radiation Oncology, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Evrim Duman
- Department of Radiation Oncology Antalya Training and Research Hospital, Antalya, Turkey
| | - Robin Prestwich
- Department of Clinical Oncology, Leeds Cancer Center, St. James's Institute of Oncology, Leeds, United Kingdom
| | - Karen Dyker
- Department of Clinical Oncology, Leeds Cancer Center, St. James's Institute of Oncology, Leeds, United Kingdom
| | - Kate Cardale
- Department of Clinical Oncology, Leeds Cancer Center, St. James's Institute of Oncology, Leeds, United Kingdom
| | - Satiavani Ramasamy
- Department of Clinical Oncology, Leeds Cancer Center, St. James's Institute of Oncology, Leeds, United Kingdom
| | - Patrick Murray
- Department of Clinical Oncology, Leeds Cancer Center, St. James's Institute of Oncology, Leeds, United Kingdom
| | - Mehmet Şen
- Department of Clinical Oncology, Leeds Cancer Center, St. James's Institute of Oncology, Leeds, United Kingdom
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857
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Shahin MA, Al-Dubai SAR, Abdoh DS, Alahmadi AS, Ali AK, Hifnawy T. Burnout among nurses working in the primary health care centers in Saudi Arabia, a multicenter study. AIMS Public Health 2020; 7:844-853. [PMID: 33294486 PMCID: PMC7719557 DOI: 10.3934/publichealth.2020065] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/02/2020] [Indexed: 11/18/2022] Open
Abstract
Background: Burnout is a common psychosocial phenomenon among nursing. It has been attributed to prolonged exposure to stress in the work place. This study aimed to determine the prevalence and associated factors of burnout among nurses in the primary health care centers in Saudi Arabia. Methods: This cross-sectional study was conducted among 200 nurses by using a self-administered questionnaire. Maslach Burnout Inventory-Human Services Survey (MBI-HSS) was used to measure burnout. Results: Most participants were females (73.0%) and aged ≤35 years (52.0%). About 39% had high emotional exhaustion, 38% had high depersonalization and 85.5% had low personal accomplishment. About 89% (178) scored high at least on one subscale of burnout. Burnout was associated with age, educational level and sources of stress in the workplace. Conclusion: Level of burnout among nurses was high and was associated mainly with stressors in the workplace. Improving work environment and management of stress in the workplace should be a priority to minimize burnout among nurses.
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Affiliation(s)
- Mohammed Adeeb Shahin
- Joint Program of Preventive Medicine Post Graduate Studies, Ministry of Health, Al-Madinah 41311, Saudi Arabia
| | - Sami Abdo Radman Al-Dubai
- Joint Program of Preventive Medicine Post Graduate Studies, Ministry of Health, Al-Madinah 41311, Saudi Arabia
| | - Duoaa Seddiq Abdoh
- Joint Program of Preventive Medicine Post Graduate Studies, Ministry of Health, Al-Madinah 41311, Saudi Arabia
| | - Abdullah Saud Alahmadi
- Joint Program of Preventive Medicine Post Graduate Studies, Ministry of Health, Al-Madinah 41311, Saudi Arabia
| | - Ahmed Khalid Ali
- Joint Program of Preventive Medicine Post Graduate Studies, Ministry of Health, Al-Madinah 41311, Saudi Arabia
| | - Tamer Hifnawy
- Medical Education Department, College of Dentistry, Taibah University, Al-Madinah 41311, Saudi Arabia.,Faculty of Medicine, Beni-Suef University, Egypt
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858
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Education and training for image-guided adaptive brachytherapy for cervix cancer—The (GEC)-ESTRO/EMBRACE perspective. Brachytherapy 2020; 19:827-836. [DOI: 10.1016/j.brachy.2020.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/09/2020] [Indexed: 11/21/2022]
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859
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Ginex PK, Backler C, Croson E, Horrell LN, Moriarty KA, Maloney C, Vrabel M, Morgan RL. Radiodermatitis in Patients With Cancer: Systematic Review and Meta-Analysis. Oncol Nurs Forum 2020; 47:E225-E236. [PMID: 33063778 DOI: 10.1188/20.onf.e225-e236] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION A systematic review and meta-analysis was conducted to inform the development of guidelines on the management of radiodermatitis among patients with cancer. LITERATURE SEARCH The authors updated a systematic review to include available literature published through September 30, 2019. DATA EVALUATION Two investigators assessed risk of bias using the Cochrane Collaboration risk-of-bias tool and certainty of the evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. SYNTHESIS The use of deodorant/antiperspirant had no effect on development of radiodermatitis. Aloe vera and emu oil were equivalent or less effective than standard care. Oral curcumin had a minimal beneficial effect. Nonsteroidal topical interventions had a minimal beneficial effect on the development of moist desquamation and relief of itching while causing a small increase for grade 2 radiodermatitis. Topical calendula increased risk for the development of radiodermatitis. Topical steroids and dressings each showed benefits to minimize the development of radiodermatitis and moist desquamation while lowering rates of patient-reported symptoms, such as pain and pruritus. IMPLICATIONS FOR RESEARCH Symptom management strategies for radiodermatitis among patients with cancer that are likely to be effective include topical nonsteroidals, topical steroids, and dressings. SUPPLEMENTAL MATERIAL CAN BE FOUND AT&NBSP;HTTPS //bit.ly/2FWj3Kp.
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860
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Gosselin T, Ginex PK, Backler C, Bruce SD, Hutton A, Marquez CM, McGee LA, Shaftic AM, Suarez LV, Moriarty KA, Maloney C, Vrabel M, Morgan RL. ONS Guidelines™ for Cancer Treatment-Related Radiodermatitis. Oncol Nurs Forum 2020; 47:654-670. [PMID: 33063779 DOI: 10.1188/20.onf.654-670] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Radiodermatitis is a side effect of radiation therapy. Evidence-based interventions to minimize severity or delay progression are important for clinical care. This guideline intends to support individuals with cancer, clinicians, and others in decisions regarding radiodermatitis treatment. METHODOLOGIC APPROACH A panel of healthcare professionals with patient representation was convened to develop a national clinical practice guideline for the management of radiodermatitis. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology and the National Academies of Sciences, Engineering, and Medicine criteria for trustworthy guidelines were followed. The Cochrane Collaboration risk-of-bias tool was used, and certainty of the evidence was assessed using the GRADE approach. A quantitative and narrative synthesis of the evidence was completed. FINDINGS The panel agreed on eight recommendations and made a conditional recommendation for deodorant/antiperspirant. Aloe vera and oral curcumin had knowledge gaps and were recommended only in the context of a clinical trial. The panel suggested against emu oil, calendula, and nonsteroidal interventions. IMPLICATIONS FOR NURSING This guideline summarizes evidence-based interventions for the management of radiodermatitis to guide clinical care. SUPPLEMENTARY MATERIAL CAN BE FOUND AT&NBSP;HTTPS //bit.ly/2GEwJtT.
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861
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Placidi L, Cusumano D, Boldrini L, Votta C, Pollutri V, Antonelli MV, Chiloiro G, Romano A, De Luca V, Catucci F, Indovina L, Valentini V. Quantitative analysis of MRI-guided radiotherapy treatment process time for tumor real-time gating efficiency. J Appl Clin Med Phys 2020; 21:70-79. [PMID: 33089954 PMCID: PMC7701108 DOI: 10.1002/acm2.13030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/13/2020] [Accepted: 09/08/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Magnetic Resonance-guided radiotherapy (MRgRT) systems allow continuous monitoring of therapy volumes during treatment delivery and personalized respiratory gating approaches. Treatment length may therefore be significantly affected by patient's compliance and breathing control. We quantitatively analyzed treatment process time efficiency (TE ) using data obtained from real-world patient treatment logs to optimize MRgRT delivery settings. METHODS Data corresponding to the first 100 patients treated with a low T hybrid MRI-Linac system, both in free breathing (FB) and in breath hold inspiration (BHI) were collected. TE has been computed as the percentage difference of the actual single fraction's total treatment time and the predicted treatment process time, as computed by the TPS during plan optimization. Differences between the scheduled and actual treatment room occupancy time were also evaluated. Finally, possible correlations with planning, delivery and clinical parameters with TE were also investigated. RESULTS Nine hundred and nineteen treatment fractions were evaluated. TE difference between BHI and FB patients' groups was statistically significant and the mean TE were 42.4%, and -0.5% respectively. No correlation was found with TE for BHI and FB groups. Planning, delivering and clinical parameters classified BHI and FB groups, but no correlation with TE was found. CONCLUSION The use of BHI gating technique can increase the treatment process time significantly. BHI technique could be not always an adequate delivery technique to optimize the treatment process time. Further gating techniques should be considered to improve the use of MRgRT.
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Affiliation(s)
- Lorenzo Placidi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Davide Cusumano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy
| | - Luca Boldrini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Claudio Votta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy
| | - Veronica Pollutri
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy
| | - Marco Valerio Antonelli
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy
| | - Giuditta Chiloiro
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy
| | - Angela Romano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy
| | - Viola De Luca
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy
| | - Francesco Catucci
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy
| | - Luca Indovina
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy
| | - Vincenzo Valentini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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862
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Hunt A, Hanson I, Dunlop A, Barnes H, Bower L, Chick J, Cruickshank C, Hall E, Herbert T, Lawes R, McQuaid D, McNair H, Mitchell A, Mohajer J, Morgan T, Oelfke U, Smith G, Nill S, Huddart R, Hafeez S. Feasibility of magnetic resonance guided radiotherapy for the treatment of bladder cancer. Clin Transl Radiat Oncol 2020; 25:46-51. [PMID: 33015380 PMCID: PMC7522378 DOI: 10.1016/j.ctro.2020.09.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/03/2020] [Accepted: 09/06/2020] [Indexed: 12/15/2022] Open
Abstract
Whole bladder magnetic resonance image-guided radiotherapy using the 1.5 Telsa MR-linac is feasible. Full online adaptive planning workflow based on the anatomy seen at each fraction was performed. This was delivered within 45 min. Intra-fraction bladder filling did not compromise target coverage. Patients reported acceptable tolerance of treatment.
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Affiliation(s)
- A. Hunt
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - I. Hanson
- The Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - A. Dunlop
- The Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - H. Barnes
- The Royal Marsden NHS Foundation Trust, London, UK
| | - L. Bower
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - J. Chick
- The Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - C. Cruickshank
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - E. Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - T. Herbert
- The Royal Marsden NHS Foundation Trust, London, UK
| | - R. Lawes
- The Royal Marsden NHS Foundation Trust, London, UK
| | - D. McQuaid
- The Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - H. McNair
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - A. Mitchell
- The Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - J. Mohajer
- The Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - T. Morgan
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - U. Oelfke
- The Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - G. Smith
- The Royal Marsden NHS Foundation Trust, London, UK
| | - S. Nill
- The Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - R. Huddart
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - S. Hafeez
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
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863
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Kumari S, Mukherjee S, Sinha D, Abdisalaam S, Krishnan S, Asaithamby A. Immunomodulatory Effects of Radiotherapy. Int J Mol Sci 2020; 21:E8151. [PMID: 33142765 PMCID: PMC7663574 DOI: 10.3390/ijms21218151] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 02/07/2023] Open
Abstract
Radiation therapy (RT), an integral component of curative treatment for many malignancies, can be administered via an increasing array of techniques. In this review, we summarize the properties and application of different types of RT, specifically, conventional therapy with x-rays, stereotactic body RT, and proton and carbon particle therapies. We highlight how low-linear energy transfer (LET) radiation induces simple DNA lesions that are efficiently repaired by cells, whereas high-LET radiation causes complex DNA lesions that are difficult to repair and that ultimately enhance cancer cell killing. Additionally, we discuss the immunogenicity of radiation-induced tumor death, elucidate the molecular mechanisms by which radiation mounts innate and adaptive immune responses and explore strategies by which we can increase the efficacy of these mechanisms. Understanding the mechanisms by which RT modulates immune signaling and the key players involved in modulating the RT-mediated immune response will help to improve therapeutic efficacy and to identify novel immunomodulatory drugs that will benefit cancer patients undergoing targeted RT.
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Affiliation(s)
- Sharda Kumari
- Division of Molecular Radiation Biology, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (S.K.); (D.S.); (S.A.)
| | - Shibani Mukherjee
- Division of Molecular Radiation Biology, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (S.K.); (D.S.); (S.A.)
| | - Debapriya Sinha
- Division of Molecular Radiation Biology, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (S.K.); (D.S.); (S.A.)
| | - Salim Abdisalaam
- Division of Molecular Radiation Biology, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (S.K.); (D.S.); (S.A.)
| | - Sunil Krishnan
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, FL 32224, USA;
| | - Aroumougame Asaithamby
- Division of Molecular Radiation Biology, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (S.K.); (D.S.); (S.A.)
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864
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Glide-Hurst CK, Lee P, Yock AD, Olsen JR, Cao M, Siddiqui F, Parker W, Doemer A, Rong Y, Kishan AU, Benedict SH, Li XA, Erickson BA, Sohn JW, Xiao Y, Wuthrick E. Adaptive Radiation Therapy (ART) Strategies and Technical Considerations: A State of the ART Review From NRG Oncology. Int J Radiat Oncol Biol Phys 2020; 109:1054-1075. [PMID: 33470210 DOI: 10.1016/j.ijrobp.2020.10.021] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 10/08/2020] [Accepted: 10/19/2020] [Indexed: 12/21/2022]
Abstract
The integration of adaptive radiation therapy (ART), or modifying the treatment plan during the treatment course, is becoming more widely available in clinical practice. ART offers strong potential for minimizing treatment-related toxicity while escalating or de-escalating target doses based on the dose to organs at risk. Yet, ART workflows add complexity into the radiation therapy planning and delivery process that may introduce additional uncertainties. This work sought to review presently available ART workflows and technological considerations such as image quality, deformable image registration, and dose accumulation. Quality assurance considerations for ART components and minimum recommendations are described. Personnel and workflow efficiency recommendations are provided, as is a summary of currently available clinical evidence supporting the implementation of ART. Finally, to guide future clinical trial protocols, an example ART physician directive and a physics template following standard NRG Oncology protocol is provided.
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Affiliation(s)
- Carri K Glide-Hurst
- Department of Human Oncology, University of Wisconsin-Madison, Madison, Wisconsin.
| | - Percy Lee
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Adam D Yock
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jeffrey R Olsen
- Department of Radiation Oncology, University of Colorado- Denver, Denver, Colorado
| | - Minsong Cao
- Department of Radiation Oncology, University of California-Los Angeles, Los Angeles, California
| | - Farzan Siddiqui
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, Michigan
| | - William Parker
- Department of Radiation Oncology, McGill University, Montreal, Quebec, Canada
| | - Anthony Doemer
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, Michigan
| | - Yi Rong
- Department of Radiation Oncology, University of California-Davis, Sacramento, California
| | - Amar U Kishan
- Department of Radiation Oncology, University of California-Los Angeles, Los Angeles, California
| | - Stanley H Benedict
- Department of Radiation Oncology, University of California-Davis, Sacramento, California
| | - X Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Beth A Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jason W Sohn
- Department of Radiation Oncology, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Ying Xiao
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Evan Wuthrick
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
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865
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Simões FV, Santos VO, Silva RND, Silva RCD. Effectiveness of skin protectors and calendula officinalis for prevention and treatment of radiodermatitis: an integrative review. Rev Bras Enferm 2020; 73:e20190815. [PMID: 33084806 DOI: 10.1590/0034-7167-2019-0815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 07/18/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE to analyze the effectiveness of skin protectors and Calendula officinalis for prevention and treatment of radiodermatitis. METHOD an integrative review conducted at CINAHL, Cochrane Library, Embase, MEDLINE/PubMed, IBECS, LILACS, and Web of Science. The final sample consisted of five studies, four clinical studies and one preclinical. Critical appreciation and narrative synthesis of the findings were carried out. RESULTS the Cavilon™ skin protector was more effective than Sorbolene (cream with 10% glycerin) and less effective than Mometasone Furoate cream. Calendula officinalis was more effective than Trolamine and essential fatty acids and less effective than Ching Wan Hung® for prevention and treatment of radiodermatitis. CONCLUSION data confirm the potential of Calendula officinalis for prevention and treatment of radiodermatitis and point to promising results regarding skin protector use; however, there is a need for further testing as to the effectiveness of such products.
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Affiliation(s)
| | - Valdete Oliveira Santos
- Instituto Nacional de Câncer José Alencar Gomes da Silva. Rio de Janeiro, Rio de Janeiro, Brazil
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866
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Duffton A, Li W, Forde E. The Pivotal Role of the Therapeutic Radiographer/Radiation Therapist in Image-guided Radiotherapy Research and Development. Clin Oncol (R Coll Radiol) 2020; 32:852-860. [PMID: 33087296 DOI: 10.1016/j.clon.2020.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/21/2020] [Accepted: 09/22/2020] [Indexed: 12/24/2022]
Abstract
The ability to personalise radiotherapy to fit the individual patient and their diagnosis has been realised through technological advancements. There is now more opportunity to utilise these technologies and deliver precision radiotherapy for more patients. Image-guided radiotherapy (IGRT) has enabled users to safely and accurately plan, treat and verify complex cases; and deliver a high dose to the target volume, while minimising dose to normal tissue. Rapid changes in IGRT have required a multidisciplinary team (MDT) approach, carefully deciding optimum protocols to achieve clinical benefit. Therapeutic radiographer/radiation therapists (RTTs) play a pivotal role in this MDT. There is already a great deal of evidence that illustrates the contribution of RTTs in IGRT development; implementation; quality assurance; and maintaining training and competency programmes. Often this has required the RTT to undertake additional roles and responsibilities. These publications show how the profession has evolved, expanding the scope of practice. There are now more opportunities for RTT-led IGRT research. This is not only undertaken in the more traditional aspects of practice, but in recent times, more RTTs are becoming involved in imaging biomarkers research and radiomic analysis. The aim of this overview is to describe the RTT contribution to the ongoing development of IGRT and to showcase some of the profession's involvement in IGRT research.
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Affiliation(s)
- A Duffton
- Department of Radiotherapy, Beatson West of Scotland Cancer Centre, Glasgow, UK.
| | - W Li
- University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - E Forde
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College Dublin, The University of Dublin, Dublin, Ireland
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867
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Colangelo MT, Galli C, Guizzardi S. Polydeoxyribonucleotide Regulation of Inflammation. Adv Wound Care (New Rochelle) 2020. [DOI: 10.1089/wound.2019.1031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Maria Teresa Colangelo
- Histology and Embryology Laboratory, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Carlo Galli
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Stefano Guizzardi
- Histology and Embryology Laboratory, Department of Medicine and Surgery, University of Parma, Parma, Italy
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868
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Chetiyawardana G, Hoskin PJ, Tsang YM. The implementation of an empty bladder filling protocol for localised prostate volumetric modulated arctherapy (VMAT): early results of a single institution service evaluation. Br J Radiol 2020; 93:20200548. [PMID: 32706990 DOI: 10.1259/bjr.20200548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To examine the impact of an empty bladder filling protocol on patients receiving radical RT for localised prostate cancer on post RT toxicity and biochemical progression free survival (bPFS). METHODS AND MATERIALS Records of patients receiving radical external beam RT (EBRT) for localised prostate cancer with a full or empty bladder were reviewed. These included the bladder size on planning CT, daily online image guided RT (IGRT) setup data, treatment time and post treatment follow up data.These included bPFS, gastrointestinal(GI) and genitourinary(GU) toxicity scoring post RT using the CTCAE v4.0 scoring system. All patients included in the study were planned and treated under the same departmental clinical protocol with VMAT and daily online IGRT corrections. RESULTS 90 patients were treated with 60 Gy in 20 fractions with a median follow up of 48 months. At 4 years bPFS in the empty bladder group was 100 and 98% in the full bladder group (p = 0.27). There were no statistically significant differences in cumulative ≥Grade 2GU (p = 0.10) and GI (p = 0.27) toxicity rates between the two bladder filling protocols. No statistically significant differences in the IGRT setup between the two groups of patients. Although the median treatment times per fraction were not statistically different between the two groups (p = 0.47), patients in the full bladder filling group were required to spend a longer time in the RT department per treatment session for bladder filling. CONCLUSION An empty bladder filling protocol has non-inferior bPFS, GI and GU toxicities at 4 years in patients with localised prostate cancer using advanced RT techniques in comparison to a full bladder filling protocol. A longer follow up with a larger sample size is required to validate this approach. ADVANCES IN KNOWLEDGE This study suggests that an empty bladder filling protocol can be used in external beam EBRT for localised prostate cancer with non-inferior treatment outcomes.
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Affiliation(s)
| | - Peter J Hoskin
- Mount Vernon Cancer Centre, Northwood, Middlesex HA6 2RN, UK.,Division of Cancer Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Yat Man Tsang
- Mount Vernon Cancer Centre, Northwood, Middlesex HA6 2RN, UK
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869
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Thorwarth D, Ege M, Nachbar M, Mönnich D, Gani C, Zips D, Boeke S. Quantitative magnetic resonance imaging on hybrid magnetic resonance linear accelerators: Perspective on technical and clinical validation. Phys Imaging Radiat Oncol 2020; 16:69-73. [PMID: 33458346 PMCID: PMC7807787 DOI: 10.1016/j.phro.2020.09.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/17/2020] [Accepted: 09/22/2020] [Indexed: 12/21/2022] Open
Abstract
Many preclinical and clinical observations support that functional magnetic resonance imaging (MRI), such as diffusion weighted (DW) and dynamic contrast enhanced (DCE) MRI, might have a predictive value for radiotherapy. The aim of this review was to assess the current status of quantitative MRI on hybrid MR-Linacs. In a literature research, four publications were identified, investigating technical feasibility, accuracy, repeatability and reproducibility of DW and DCE-MRI in phantoms and first patients. Accuracy and short term repeatability was < 5% for DW-MRI in current MR-Linac systems. Consequently, quantitative imaging providing accurate and reproducible functional information seems possible in MR-Linacs.
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Affiliation(s)
- Daniela Thorwarth
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Matthias Ege
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
| | - Marcel Nachbar
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
| | - David Mönnich
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Cihan Gani
- Department for Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
| | - Daniel Zips
- German Cancer Consortium (DKTK), Partner Site Tübingen, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department for Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
| | - Simon Boeke
- German Cancer Consortium (DKTK), Partner Site Tübingen, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department for Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
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870
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Zhang S, Xuan Z, Zhang L, Lu J, Song P, Zheng S. Splenic marginal zone lymphoma: a case report and literature review. World J Surg Oncol 2020; 18:259. [PMID: 33004051 PMCID: PMC7532117 DOI: 10.1186/s12957-020-02030-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Splenic marginal zone lymphoma (SMZL) is a rare non-Hodgkin lymphoma, and much little is known about its clinical characteristics and management strategies. Here we present a case of SMZL and review relevant literature to provide a better recognition of this disease entity. CASE PRESENTATION A 49-year-old Chinese female was admitted to our hospital with complaints of abdominal distension and acid reflux. Physical examinations and imaging investigations suggested the presence of splenomegaly. Laboratory workups revealed mildly reduced white blood cell count otherwise was not remarkable. The patient underwent splenectomy. Histological examination combined with immunohistochemical analysis of the resected spleen confirmed the diagnosis of SMZL. The patient recovered uneventfully during follow-ups. CONCLUSIONS Due to the rarity and unspecific clinical features, SMZL is extremely challenging to be diagnosed preoperatively. Patients with SMZL are generally associated with favorable prognosis. Combining the staging characteristics of non-Hodgkin's lymphoma and splenic primary lymphoma may assist in clinical staging management of SMZL.
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Affiliation(s)
- Shiyu Zhang
- The First Affiliated Hospital, Zhejiang University School of Medicine, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Zhejiang Province, China.,NHC Key Laboratory of Combined Multi-organ Transplantation, Zhejiang Province, China.,Key Laboratory of the diagnosis and treatment of organ Transplantation, Research Unit of Collaborative Diagnosis and Treatment For Hepatobiliary and Pancreatic Cancer, Chinese Academy of Medical Sciences, Beijing Province, China.,Key Laboratory of Organ Transplantation, Research Center for Diagnosis and Treatment of Hepatobiliary Diseases, Zhejiang Province, 310003, Hangzhou, China
| | - Zefeng Xuan
- The First Affiliated Hospital, Zhejiang University School of Medicine, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Zhejiang Province, China.,NHC Key Laboratory of Combined Multi-organ Transplantation, Zhejiang Province, China.,Key Laboratory of the diagnosis and treatment of organ Transplantation, Research Unit of Collaborative Diagnosis and Treatment For Hepatobiliary and Pancreatic Cancer, Chinese Academy of Medical Sciences, Beijing Province, China.,Key Laboratory of Organ Transplantation, Research Center for Diagnosis and Treatment of Hepatobiliary Diseases, Zhejiang Province, 310003, Hangzhou, China
| | - Liang Zhang
- The First Affiliated Hospital, Zhejiang University School of Medicine, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Zhejiang Province, China.,NHC Key Laboratory of Combined Multi-organ Transplantation, Zhejiang Province, China.,Key Laboratory of the diagnosis and treatment of organ Transplantation, Research Unit of Collaborative Diagnosis and Treatment For Hepatobiliary and Pancreatic Cancer, Chinese Academy of Medical Sciences, Beijing Province, China.,Key Laboratory of Organ Transplantation, Research Center for Diagnosis and Treatment of Hepatobiliary Diseases, Zhejiang Province, 310003, Hangzhou, China
| | - Jiahua Lu
- The First Affiliated Hospital, Zhejiang University School of Medicine, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Zhejiang Province, China.,NHC Key Laboratory of Combined Multi-organ Transplantation, Zhejiang Province, China.,Key Laboratory of the diagnosis and treatment of organ Transplantation, Research Unit of Collaborative Diagnosis and Treatment For Hepatobiliary and Pancreatic Cancer, Chinese Academy of Medical Sciences, Beijing Province, China.,Key Laboratory of Organ Transplantation, Research Center for Diagnosis and Treatment of Hepatobiliary Diseases, Zhejiang Province, 310003, Hangzhou, China
| | - Penghong Song
- The First Affiliated Hospital, Zhejiang University School of Medicine, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Zhejiang Province, China. .,NHC Key Laboratory of Combined Multi-organ Transplantation, Zhejiang Province, China. .,Key Laboratory of the diagnosis and treatment of organ Transplantation, Research Unit of Collaborative Diagnosis and Treatment For Hepatobiliary and Pancreatic Cancer, Chinese Academy of Medical Sciences, Beijing Province, China. .,Key Laboratory of Organ Transplantation, Research Center for Diagnosis and Treatment of Hepatobiliary Diseases, Zhejiang Province, 310003, Hangzhou, China.
| | - Shusen Zheng
- The First Affiliated Hospital, Zhejiang University School of Medicine, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Zhejiang Province, China. .,NHC Key Laboratory of Combined Multi-organ Transplantation, Zhejiang Province, China. .,Key Laboratory of the diagnosis and treatment of organ Transplantation, Research Unit of Collaborative Diagnosis and Treatment For Hepatobiliary and Pancreatic Cancer, Chinese Academy of Medical Sciences, Beijing Province, China. .,Key Laboratory of Organ Transplantation, Research Center for Diagnosis and Treatment of Hepatobiliary Diseases, Zhejiang Province, 310003, Hangzhou, China.
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871
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Bjarnason TA, Rees R, Kainz J, Le LH, Stewart EE, Preston B, Elbakri I, Fife IAJ, Lee T, Gagnon IMB, Arsenault C, Therrien P, Kendall E, Tonkopi E, Cottreau M, Aldrich JE. An international survey on the clinical use of rigid and deformable image registration in radiotherapy. J Appl Clin Med Phys 2020; 21:10-24. [PMID: 32915492 PMCID: PMC7075391 DOI: 10.1002/acm2.12957] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/13/2020] [Accepted: 05/14/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Rigid image registration (RIR) and deformable image registration (DIR) are widely used in radiotherapy. This project aims to capture current international approaches to image registration. METHODS A survey was designed to identify variations in use, resources, implementation, and decision-making criteria for clinical image registration. This was distributed to radiotherapy centers internationally in 2018. RESULTS There were 57 responses internationally, from the Americas (46%), Australia/New Zealand (32%), Europe (12%), and Asia (10%). Rigid image registration and DIR were used clinically for computed tomography (CT)-CT registration (96% and 51%, respectively), followed by CT-PET (81% and 47%), CT-CBCT (84% and 19%), CT-MR (93% and 19%), MR-MR (49% and 5%), and CT-US (9% and 0%). Respondent centers performed DIR using dedicated software (75%) and treatment planning systems (29%), with 84% having some form of DIR software. Centers have clinically implemented DIR for atlas-based segmentation (47%), multi-modality treatment planning (65%), and dose deformation (63%). The clinical use of DIR for multi-modality treatment planning and accounting for retreatments was considered to have the highest benefit-to-risk ratio (69% and 67%, respectively). CONCLUSIONS This survey data provides useful insights on where, when, and how image registration has been implemented in radiotherapy centers around the world. DIR is mainly in clinical use for CT-CT (51%) and CT-PET (47%) for the head and neck (43-57% over all use cases) region. The highest benefit-risk ratio for clinical use of DIR was for multi-modality treatment planning and accounting for retreatments, which also had higher clinical use than for adaptive radiotherapy and atlas-based segmentation.
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Affiliation(s)
- Thorarin A. Bjarnason
- Medical ImagingInterior Health AuthorityKelownaBCCanada
- RadiologyUniversity of British ColumbiaVancouverBCCanada
- PhysicsUniversity of British Columbia OkanaganKelownaBCCanada
| | - Robert Rees
- Occupational Health & SafetyYukon Workers' Compensation Health and Safety BoardWhitehorseYKCanada
| | - Judy Kainz
- Workers' Safety and Compensation Commission for Northwest Territories and NunavutYellowknifeNTCanada
| | - Lawrence H. Le
- Diagnostic ImagingAlberta Health ServicesCalgaryABCanada
- Radiology and Diagnostic ImagingUniversity of AlbertaEdmontonABCanada
| | | | - Brent Preston
- Radiation Safety UnitGovernment of SaskatchewanSaskatoonSKCanada
| | - Idris Elbakri
- Cancer Care ManitobaWinnipegMBCanada
- Physics and AstronomyUniversity of ManitobaWinnipegMBCanada
- RadiologyUniversity of ManitobaWinnipegMBCanada
| | - Ingvar A. J. Fife
- Cancer Care ManitobaWinnipegMBCanada
- Physics and AstronomyUniversity of ManitobaWinnipegMBCanada
- RadiologyUniversity of ManitobaWinnipegMBCanada
| | - Ting‐Yim Lee
- St Joseph’s Health Care LondonLondonONCanada
- Lawson Research InstituteLondonONCanada
- Medical ImagingMedical Biophysics, OncologyRobarts Research InstituteUniversity of Western OntarioLondonONCanada
| | | | - Clément Arsenault
- Hôpital Dr Georges–L. DumontCentre d'Oncologie Dr Léon–RichardMonctonNBCanada
| | | | | | - Elena Tonkopi
- Nova Scotia Health AuthorityHalifaxNSCanada
- Diagnostic RadiologyDalhousie UniversityHalifaxNSCanada
- Radiation OncologyDalhousie UniversityHalifaxNSCanada
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872
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Batista V, Meyer J, Kügele M, Al-Hallaq H. Clinical paradigms and challenges in surface guided radiation therapy: Where do we go from here? Radiother Oncol 2020; 153:34-42. [PMID: 32987044 DOI: 10.1016/j.radonc.2020.09.041] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 12/26/2022]
Abstract
Surface guided radiotherapy (SGRT) is becoming a routine tool for patient positioning for specific clinical sites in many clinics. However, it has not yet gained its full potential in terms of widespread adoption. This vision paper first examines some of the difficulties in transitioning to SGRT before exploring the current and future role of SGRT alongside and in concert with other imaging techniques. Finally, future horizons and innovative ideas that may shape and impact the direction of SGRT going forward are reviewed.
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Affiliation(s)
- Vania Batista
- Department of Radiation Oncology, Heidelberg University Hospital, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany.
| | - Juergen Meyer
- Seattle Cancer Care Alliance, University of Washington, Department of Radiation Oncology, United States.
| | - Malin Kügele
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden; Medical Radiation Physics, Department of Clinical Sciences, Lund University, Sweden.
| | - Hania Al-Hallaq
- The University of Chicago, Department of Radiation and Cellular Oncology, United States.
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873
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Yee C, Lam E, Gallant F, Karam I, Czarnota G, Soliman H, Wong G, Drost L, Vesprini D, Rakovitch E, Wronski M, Leung E, Szumacher E, Carothers K, Pon K, Gonzales G, Easton L, Lewis D, Zhang L, Chow E. A Feasibility Study of Mepitel Film for the Prevention of Breast Radiation Dermatitis in a Canadian Center. Pract Radiat Oncol 2020; 11:e36-e45. [PMID: 32949772 DOI: 10.1016/j.prro.2020.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/23/2020] [Accepted: 09/08/2020] [Indexed: 11/15/2022]
Abstract
PURPOSE Severe radiation dermatitis (RD) is distressing and may have adverse long-term effects including fibrosis and telangiectasia. Treatment interruptions due to severe RD may increase the risk of recurrence. Two randomized trials of Mepitel film demonstrated efficacy in preventing severe RD in breast cancer, but this product has not been widely adopted in North America. We aimed to assess the feasibility and efficacy of Mepitel film for prevention of breast RD at a Canadian center. METHODS AND MATERIALS Patients were stratified based on breast size and receipt of postmastectomy radiation therapy. The primary outcome was RD grade using the Common Terminology Criteria for Adverse Events. Secondary outcomes included moist desquamation, patient- and clinician-reported symptoms of skin toxicity, and cosmetic outcomes. RESULTS Thirty patients receiving external beam radiation therapy to the breast or chest wall were enrolled. Two patients (6.7%) discontinued use of the Mepitel film before completing radiation therapy. No patients developed grade 3 RD or higher. Five patients (17.9%) developed grade 2 RD: 3 (10.7%) had moist desquamation, and 2 (7.1%) had brisk erythema without moist desquamation. CONCLUSIONS Mepitel film completely prevented grade 3 RD. Rates of moist desquamation and grade 2 RD were lower with Mepitel film than in studies using aqueous cream, but unlike previous trials of Mepitel film we did not achieve complete prevention of moist desquamation. Further research is needed to confirm the efficacy of Mepitel film versus standard prophylaxis for RD and identify the patients who will benefit the most from the film.
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Affiliation(s)
- Caitlin Yee
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Emily Lam
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Francois Gallant
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Irene Karam
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Gregory Czarnota
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Hany Soliman
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Gina Wong
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Leah Drost
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Danny Vesprini
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Eileen Rakovitch
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Matt Wronski
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Eric Leung
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Ewa Szumacher
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Kathy Carothers
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Kucy Pon
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Glen Gonzales
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Linda Easton
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Donna Lewis
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Liying Zhang
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Edward Chow
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada.
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874
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Aoyama T, Shimizu H, Sasaki K, Ando M, Kaneda N, Tachibana H, Suzuki K, Kodaira T. A Relationship Between Cervical Vertebrae Twisting and Cranial Angle in Head and Neck Radiotherapy. In Vivo 2020; 34:2401-2406. [PMID: 32871765 DOI: 10.21873/invivo.12053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Because current image-guided radiotherapy systems can only correct six axes, it is impossible to correct the twisting of cervical vertebrae. The purpose of this study was to clarify the relationship between cervical vertebrae twisting and cranial angle. MATERIALS AND METHODS Nineteen patients who underwent intensity-modulated radiation therapy were retrospectively reviewed. Twisting of cervical vertebrae was analysed using planning computed tomography (CT) and megavoltage CT images for image-guided radiotherapy. RESULTS Although the cranial angle during planning CT was not strongly correlated with twisting (correlation coefficient <0.7), when the patients were divided into two groups by cranial angle, the twisting of the small-angle group was significantly reduced. Specifically, cranial angles of <25° significantly and efficiently reduced the twisting of the upper cervical vertebra compared with those of the other groups. CONCLUSION Twisting of the upper cervical vertebrae is reduced by using a cranial angle of <25° during planning CT.
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Affiliation(s)
- Takahiro Aoyama
- Department of Radiation Oncology, Aichi Cancer Centre Hospital, Nagoya, Japan .,Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
| | - Hidetoshi Shimizu
- Department of Radiation Oncology, Aichi Cancer Centre Hospital, Nagoya, Japan
| | - Koji Sasaki
- Graduate School of Radiological Technology, Gunma Prefectural College of Health Sciences, Maebashi, Japan
| | - Mio Ando
- Department of Radiological Technology, Aichi Medical University Hospital, Nagakute, Japan
| | - Naoki Kaneda
- Department of Radiological Technology, Aichi Medical University Hospital, Nagakute, Japan
| | - Hiroyuki Tachibana
- Department of Radiation Oncology, Aichi Cancer Centre Hospital, Nagoya, Japan
| | - Kojiro Suzuki
- Department of Radiology, Aichi Medical University, Aichi, Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer Centre Hospital, Nagoya, Japan
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875
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Tsang Y, Duffton A, Leech M, Rossi M, Scherer P. Meeting the challenges imposed by COVID-19: Guidance document by the ESTRO Radiation TherapisT Committee (RTTC). Tech Innov Patient Support Radiat Oncol 2020; 15:6-10. [PMID: 32514473 PMCID: PMC7242958 DOI: 10.1016/j.tipsro.2020.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 01/31/2023] Open
Abstract
COVID-19 - a novel coronavirus was firstly reported in December 2019. In response to threats imposed by COVID-19, the European society for radiotherapy and oncology Radiation TherapisT Committee (ESTRO RTTC) prepared this document in conjunction with an infographic with four main domains: patient care, RTT workflow, remote working and RT practice. In the context of the current COVID-19 pandemic, RTTs should be empowered with appropriate guidance and personal protection equipment in order to provide a safe radiotherapy service by limiting potential viral exposure to patients, healthcare workers and general public.
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Affiliation(s)
- Yat Tsang
- Radiotherapy Department, Mount Vernon Cancer Centre, Northwood, Middlesex, United Kingdom
| | - Aileen Duffton
- Radiotherapy Department, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Michelle Leech
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, School of Medicine, Trinity College, Dublin 2, Ireland
| | - Maddalena Rossi
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Philipp Scherer
- Department of Radiotherapy and Radio-Oncology, Paracelsus Medical University Hospital Salzburg, Landeskrankenhaus, Salzburg, Austria
| | - on behalf of ESTRO RTTC
- Radiotherapy Department, Mount Vernon Cancer Centre, Northwood, Middlesex, United Kingdom
- Radiotherapy Department, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, School of Medicine, Trinity College, Dublin 2, Ireland
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Radiotherapy and Radio-Oncology, Paracelsus Medical University Hospital Salzburg, Landeskrankenhaus, Salzburg, Austria
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876
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Hales RB, Rodgers J, Whiteside L, McDaid L, Berresford J, Budgell G, Choudhury A, Eccles CL. Therapeutic Radiographers at the Helm: Moving Towards Radiographer-Led MR-Guided Radiotherapy. J Med Imaging Radiat Sci 2020; 51:364-372. [PMID: 32600981 DOI: 10.1016/j.jmir.2020.05.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Magnetic resonance-guided adaptive radiotherapy (MRgART) has the potential to improve treatment processes and outcomes for a variety of tumour sites; however, it requires significant clinical resources. Magnetic resonance linear accelerator (MR-linac) treatments require a daily multidisciplinary presence for delivery. To facilitate sustainable MRgART models, agreed protocols facilitating therapeutic radiographer (RTT)-led delivery must be developed to establish a service similar to conventional image-guided radiotherapy (IGRT). This work provides a clinical perspective on the implementation of a protocol-driven 'clinician-lite' MRgART workflow at one institution. METHODS To identify knowledge, skills, and competence required at each step in the MRgART workflow, an interdisciplinary informal survey and needs assessment were undertaken to identify additional or enhanced skills required for MRgART, over and above those required for conventional cone-beam computed tomography-based IGRT. The MRgART pathway was critically evaluated by relevant professionals to encourage multidisciplinary input and discussion, allowing an iterative development of the RTT-led workflow. Starting with the simplest online adaptation strategy, consisting of a virtual couch shift and online replanning, clear guidelines were established for the delivery of radical prostate radiotherapy with a reduction in staff numbers present. RESULTS The MRgART-specific skills identified included MRI safety and screening, MR image acquisition, MRI-based anatomy, multimodality image interpretation and registration, and treatment plan evaluation. These skills were developed in RTTs via tutorials, workshops, focussed self-directed reading, teaching of colleagues, and end-to-end workflow testing. After initial treatments and discussions, roles and responsibilities of the three professional groups (clinicians, RTTs, and physicists) have evolved to achieve a 'clinician-lite' workflow for simple radical prostate treatments. DISCUSSION Through applying a definitive framework and establishing agreed threshold and action levels for action within anticipated treatment scenarios similar to those in cone-beam computed tomography-based IGRT, we have implemented a 'clinician-lite' workflow for simple adaptive treatments on the MR-linac. The responsibility for online plan evaluation and approval now rests with physicists and RTTs to streamline MRgART. Early evaluation of the framework after treatment of 10 patients has required minimal online clinician input (1.5% of 200 fractions delivered). CONCLUSION A 'clinician-lite' prostate treatment workflow has been successfully introduced on the MR-linac at our institution and will serve as a model for other tumour sites, using more complex adaptive strategies. Early indications are that this framework has the potential to improve patient throughput and efficiency. Further identification and validation of roles and responsibilities such as online contouring, and more interactive online planning, will facilitate RTTs to fully lead in the online workflow as adaptive radiotherapy becomes ever more complex.
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Affiliation(s)
- Rosie B Hales
- Radiotherapy, The Christie NHS Foundation Trust, Manchester, UK
| | - John Rodgers
- Radiotherapy, The Christie NHS Foundation Trust, Manchester, UK
| | - Lee Whiteside
- Radiotherapy, The Christie NHS Foundation Trust, Manchester, UK
| | - Lisa McDaid
- Radiotherapy, The Christie NHS Foundation Trust, Manchester, UK
| | - Joseph Berresford
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Geoff Budgell
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Ananya Choudhury
- Division of Cancer Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK; Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Cynthia L Eccles
- Radiotherapy, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK.
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877
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Yan J, Yuan L, Wang J, Li S, Yao M, Wang K, Herst PM. Mepitel Film is superior to Biafine cream in managing acute radiation-induced skin reactions in head and neck cancer patients: a randomised intra-patient controlled clinical trial. J Med Radiat Sci 2020; 67:208-216. [PMID: 32475079 PMCID: PMC7476193 DOI: 10.1002/jmrs.397] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 03/18/2020] [Accepted: 03/21/2020] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION We previously showed that Mepitel Film decreased the severity of acute radiation-induced skin reactions in head and neck cancer patients. In the current study, we compared the effect of Mepitel Film and Biafine cream on skin reaction severity in a larger cohort of head and neck cancer patients. METHODS A total of 44 head and neck cancer patients were recruited with 39 patients contributing full data sets for analysis. Patients received a dose of 50 Gy in 25 fractions to the bilateral lymph nodes in the neck. Left and right lymph node areas were randomised to either Mepitel Film or Biafine cream, applied prophylactically. Skin reaction severity was measured using Radiation-Induced Skin Reaction Assessment Scale (RISRAS) and expanded Radiation Oncology group (RTOG) grades. Skin dose was measured using gafchromic Film. RESULTS Skin reaction severity (combined RISRAS score) underneath Mepitel Film was decreased by 30% (P < 0.001) and moist desquamation rates by 41% (P < 0.001). Skin dose underneath Mepitel Film and Biafine cream was similar (P = 0.925) and unlikely to have affected skin reaction severity. The vast majority (80%) of patients preferred Mepitel Film over Biafine cream. Negative aspects of Mepitel Film included poor adherence (11/39) and discomfort (16/39) during hot weather and showering and itchy skin underneath Mepitel Film (12/39). CONCLUSIONS Mepitel Film was superior to Biafine cream in reducing the severity of acute radiation-induced skin reactions and moist desquamation incidence in our head and neck patient cohort.
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Affiliation(s)
- Jing Yan
- Comprehensive Cancer CentreDrum Tower Hospital/Clinical Cancer Institute of Nanjing UniversityNanjingChina
| | - Ling Yuan
- Comprehensive Cancer CentreDrum Tower Hospital/Clinical Cancer Institute of Nanjing UniversityNanjingChina
| | - Juan Wang
- Comprehensive Cancer CentreDrum Tower Hospital/Clinical Cancer Institute of Nanjing UniversityNanjingChina
| | - Shuangshuang Li
- Comprehensive Cancer CentreDrum Tower Hospital/Clinical Cancer Institute of Nanjing UniversityNanjingChina
| | - Mengdi Yao
- Comprehensive Cancer CentreDrum Tower Hospital/Clinical Cancer Institute of Nanjing UniversityNanjingChina
| | - Kongcheng Wang
- Comprehensive Cancer CentreDrum Tower Hospital/Clinical Cancer Institute of Nanjing UniversityNanjingChina
| | - Patries M. Herst
- Department of Radiation TherapyUniversity of OtagoWellingtonNew Zealand
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878
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Cusumano D, Boldrini L, Yadav P, Yu G, Musurunu B, Chiloiro G, Piras A, Lenkowicz J, Placidi L, Broggi S, Romano A, Mori M, Barbaro B, Azario L, Gambacorta MA, De Spirito M, Bassetti MF, Yang Y, Fiorino C, Valentini V. External Validation of Early Regression Index (ERI TCP) as Predictor of Pathologic Complete Response in Rectal Cancer Using Magnetic Resonance-Guided Radiation Therapy. Int J Radiat Oncol Biol Phys 2020; 108:1347-1356. [PMID: 32758641 DOI: 10.1016/j.ijrobp.2020.07.2323] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 07/08/2020] [Accepted: 07/29/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Tumor control probability (TCP)-based early regression index (ERITCP) is a radiobiological parameter that showed promising results in predicting pathologic complete response (pCR) on T2-weighted 1.5 T magnetic resonance (MR) images of patients with locally advanced rectal cancer. This study aims to validate the ERITCP in the context of low-tesla MR-guided radiation therapy, using images acquired with different magnetic field strength (0.35 T) and image contrast (T2/T1). Furthermore, the optimal timing for pCR prediction was estimated, calculating the ERI index at different biologically effective dose (BED) levels. METHODS AND MATERIALS Fifty-two patients with locally advanced rectal cancer treated with neoadjuvant chemoradiation therapy were enrolled in this multi-institutional retrospective study. For each patient, a 0.35 T T2/T1-weighted MR image was acquired during simulation and on each treatment day. Gross tumor volume was contoured according to International Commission on Radiation Units Report 83 guidelines. According to the original definition, ERITCP was calculated considering the residual tumor volume at BED = 25 Gy. ERI was also calculated in correspondence with several BED levels: 13, 21, 32, 40, 46, 54, 59, and 67. The predictive performance of the different ERI indices were evaluated in terms of receiver operating characteristic curve. The robustness of ERITCP with respect to the interobserver variability was also evaluated considering 2 operators and calculating the intraclass correlation index. RESULTS Fourteen patients showed pCR. ERITCP correctly 47 of 52 cases (accuracy = 90%), showing good results in terms of sensitivity (86%), specificity (92%), negative predictive value (95%), and positive predictive value (80%). The analysis at different BED levels shows that the best predictive performance is obtained when this parameter is calculated at BED = 25 Gy (area under the curve = 0.93). ERITCP results are robust with respect to interobserver variability (intraclass correlation index = 0.99). CONCLUSIONS This study confirmed the validity and the robustness of ERITCP as a pCR predictor in the context of low-tesla MR-guided radiation therapy and indicate 25 Gy as the best BED level to perform predictions.
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Affiliation(s)
- Davide Cusumano
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Luca Boldrini
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy.
| | - Poonam Yadav
- Department of Human Oncology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Gao Yu
- Department of Radiological Sciences, University of California, Los Angeles, California
| | - Bindu Musurunu
- Department of Human Oncology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Giuditta Chiloiro
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Antonio Piras
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Jacopo Lenkowicz
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Lorenzo Placidi
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Sara Broggi
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Angela Romano
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Martina Mori
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Brunella Barbaro
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Luigi Azario
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | | | - Marco De Spirito
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Michael F Bassetti
- Department of Human Oncology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Yingli Yang
- Department of Radiological Sciences, University of California, Los Angeles, California
| | - Claudio Fiorino
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
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879
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Rim CH, Shin IS, Yoon WS, Park S. Dose-response relationship of stereotactic body radiotherapy for ultracentral tumor and comparison of efficacy with central tumor: a meta-analysis. Transl Lung Cancer Res 2020; 9:1268-1284. [PMID: 32953504 PMCID: PMC7481588 DOI: 10.21037/tlcr-20-503] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Ultracentral (UC) tumors, a subset of central lung tumors defined as those that abut the proximal bronchial tree (PBT), have been contraindicated for stereotactic body radiotherapy (SBRT). The present meta-analysis evaluated the efficacy of SBRT for UC and central tumors, and dose-response for local control (LC) of UC tumors. Methods Databases including MEDLINE and EMBASE were searched up to March, 2020, to identify studies regarding SBRT for UC and/or central tumors. The primary endpoints were LC and overall survival (OS), while secondary endpoints were grade ≥3 and 5 complications. Results Fourteen studies including 892 patients were included. In the UC and central tumor groups, the 1-year OS rates were 82.2% and 85.4% (P=0.556), respectively, and the 2-year OS rates were 66.4% and 71.9% (P=0.522), respectively. The 1- and 2-year LC rates in the UC and central tumor groups were 93.9% and 97.8% (P=0.023) and 90.4% and 93.7% (P=0.459), respectively. The pooled grade ≥3 complication rates in the UC and central tumor groups were 9.0% and 4.4% (P=0.06), while the corresponding grade 5 complication rates were 5.7% and 2.1% (P=0.087). The dose-response for LC was shown in the meta-regression (P<0.0001), and 1-year LC rates were significantly different (94.4% vs. 59.3%, P<0.001) with very low heterogeneities in both subgroups, with threshold of 85 Gy10. Of the 28 fatalities, 12 (42.8%) were caused by hemorrhage or bronchial stenosis, and another 12 (42.8%) by pneumonia or respiratory failure. Conclusions The oncologic outcomes of patients with UC and central tumors were comparable post-SBRT. A dose of at least ≥85 Gy10 is recommended for SBRT of UC tumors. Causes of complications should be further studied as UC tumors are more prone to serious toxicities.
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Affiliation(s)
- Chai Hong Rim
- Department of Radiation Oncology, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - In-Soo Shin
- Graduated School of Education, Dongguk University, Seoul, Republic of Korea
| | - Won Sup Yoon
- Department of Radiation Oncology, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Sunmin Park
- Department of Radiation Oncology, Korea University Ansan Hospital, Ansan, Republic of Korea
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880
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Dutta S, Dewan A, Mitra S, Sharma MK, Aggarwal S, Barik S, Mahammood Suhail M, Bhushan M, Sharma A, Wahi IK, Dobriyal K, Mukhee J. Dosimetric impact of variable bladder filling on IMRT planning for locally advanced carcinoma cervix. J Egypt Natl Canc Inst 2020; 32:31. [PMID: 32734431 DOI: 10.1186/s43046-020-00033-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/08/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND To evaluate the dosimetric impact of variable bladder filling on target and organ at risk (OARs) in cervical cancer patients undergoing chemoradiation. Forty consecutive patients with cervical cancer underwent radiotherapy planning as per the departmental protocol. All patients were asked to empty their bowel and bladder before simulation and catheterization was done. Normal saline was instilled into the bladder through Foleys till the patient had a maximal urge to urinate. Pelvic cast fabrication and CT simulation was done. Then, 30%, 50%, and 100% of the instilled saline was removed and rescans taken. Planning was done on full bladder (X) and the same plan applied to the contours with bladder volumes 0.7X (PLAN70), 0.5X (PLAN50), and empty (PLAN0). A dose of 50 Gy/25# was prescribed to the PTV and plans evaluated. Intensity-modulated radiotherapy plans with full bladder were implemented for each patient. Shifts in the center of mass (COM) of the cervix/uterus with variable bladder filling identified were noted. Statistical analysis was performed using SPSS software. A p value < 0.05 was considered significant. RESULTS Bladder volume in 70%, 50%, and empty bladder planning was 78.34% (388.35 + 117.44 ml), 64.44% (320.60 + 106.20 ml), and 13.63% (62.60 + 23.12 ml), respectively. The mean dose received by 95% PTV was 49.76 Gy + 1.30 Gy. Though the difference in target coverage was significant between PLAN100 and other plans, the mean difference was minimal. A decrease in bladder filling resulted in an increase in OAR dose. Variation in the increase in dose to OARs was not significant if bladder filling was > 78.34% and > 64.44% of a full bladder with respect to the bowel and rectal/bladder doses, respectively. Inconsistent bladder filling led to a maximal shift in COM (uterus/cervix) in the Y- and Z-axis. CONCLUSION Bladder filling variations have an impact on cervico-uterine motion/shape, thereby impacting the dose to the target and OARs. It is recommended to have a threshold bladder volume of at least 70-75% of optimally filled bladder during daily treatment. TRIAL REGISTRATION Institutional review board (IRB) registered by Drug Controller General (India) with registration number ECR/10/Ins/DC/2013. Trial Registration number - RGCIRC/IRB/44/2016, registered and approved on the 14th of May 2016.
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Affiliation(s)
- Soumya Dutta
- Department of Radiotherapy, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi, India
| | - Abhinav Dewan
- Department of Radiotherapy, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi, India.
| | - Swarupa Mitra
- Department of Radiotherapy, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi, India
| | - Manoj Kumar Sharma
- Department of Radiotherapy, Fortis Hospital, Noida, Uttar Pradesh, India
| | - Sumeet Aggarwal
- Department of Radiotherapy, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi, India
| | - Soumitra Barik
- Department of Radiotherapy, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi, India
| | - M Mahammood Suhail
- Department of Medical Physics, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Maninder Bhushan
- Department of Medical Physics, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Anurag Sharma
- Department of Medical Statistics, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Inderjeet Kaur Wahi
- Department of Radiotherapy, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi, India
| | - Kiran Dobriyal
- Department of Radiotherapy, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi, India
| | - Jwala Mukhee
- Department of Radiotherapy, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi, India
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881
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Lemanska A, Byford RC, Cruickshank C, Dearnaley DP, Ferreira F, Griffin C, Hall E, Hinton W, de Lusignan S, Sherlock J, Faithfull S. Linkage of the CHHiP randomised controlled trial with primary care data: a study investigating ways of supplementing cancer trials and improving evidence-based practice. BMC Med Res Methodol 2020; 20:198. [PMID: 32711460 PMCID: PMC7382082 DOI: 10.1186/s12874-020-01078-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 07/08/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Randomised controlled trials (RCTs) are the gold standard for evidence-based practice. However, RCTs can have limitations. For example, translation of findings into practice can be limited by design features, such as inclusion criteria, not accurately reflecting clinical populations. In addition, it is expensive to recruit and follow-up participants in RCTs. Linkage with routinely collected data could offer a cost-effective way to enhance the conduct and generalisability of RCTs. The aim of this study is to investigate how primary care data can support RCTs. METHODS Secondary analysis following linkage of two datasets: 1) multicentre CHHiP radiotherapy trial (ISRCTN97182923) and 2) primary care database from the Royal College of General Practitioners Research and Surveillance Centre. Comorbidities and medications recorded in CHHiP at baseline, and radiotherapy-related toxicity recorded in CHHiP over time were compared with primary care records. The association of comorbidities and medications with toxicity was analysed with mixed-effects logistic regression. RESULTS Primary care records were extracted for 106 out of 2811 CHHiP participants recruited from sites in England (median age 70, range 44 to 82). Complementary information included longitudinal body mass index, blood pressure and cholesterol, as well as baseline smoking and alcohol usage but was limited by the considerable missing data. In the linked sample, 9 (8%) participants were recorded in CHHiP as having a history of diabetes and 38 (36%) hypertension, whereas primary care records indicated incidence prior to trial entry of 11 (10%) and 40 (38%) respectively. Concomitant medications were not collected in CHHiP but available in primary care records. This indicated that 44 (41.5%) men took aspirin, 65 (61.3%) statins, 14 (13.2%) metformin and 46 (43.4%) phosphodiesterase-5-inhibitors at some point before or after trial entry. CONCLUSIONS We provide a set of recommendations on linkage and supplementation of trials. Data recorded in primary care are a rich resource and linkage could provide near real-time information to supplement trials and an efficient and cost-effective mechanism for long-term follow-up. In addition, standardised primary care data extracts could form part of RCT recruitment and conduct. However, this is at present limited by the variable quality and fragmentation of primary care data.
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Affiliation(s)
- Agnieszka Lemanska
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH UK
- Data Science, National Physical Laboratory, Teddington, UK
| | - Rachel C. Byford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Clare Cruickshank
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - David P. Dearnaley
- The Institute of Cancer Research and Royal Marsden NHS Trust, London, UK
| | - Filipa Ferreira
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Clare Griffin
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - William Hinton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC), London, UK
- School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Julian Sherlock
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sara Faithfull
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH UK
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882
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Adapting care for older cancer patients during the COVID-19 pandemic: Recommendations from the International Society of Geriatric Oncology (SIOG) COVID-19 Working Group. J Geriatr Oncol 2020; 11:1190-1198. [PMID: 32709495 PMCID: PMC7365054 DOI: 10.1016/j.jgo.2020.07.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/10/2020] [Indexed: 12/25/2022]
Abstract
The COVID-19 pandemic poses a barrier to equal and evidence-based management of cancer in older adults. The International Society of Geriatric Oncology (SIOG) formed a panel of experts to develop consensus recommendations on the implications of the pandemic on several aspects of cancer care in this age group including geriatric assessment (GA), surgery, radiotherapy, systemic treatment, palliative care and research. Age and cancer diagnosis are significant predictors of adverse outcomes of the COVID-19 infection. In this setting, GA is particularly valuable to drive decision-making. GA may aid estimating physiologic reserve and adaptive capability, assessing risk-benefits of either providing or temporarily withholding treatments, and determining patient preferences to help inform treatment decisions. In a resource-constrained setting, geriatric screening tools may be administered remotely to identify patients requiring comprehensive GA. Tele-health is also crucial to ensure adequate continuity of care and minimize the risk of infection exposure. In general, therapeutic decisions should favor the most effective and least invasive approach with the lowest risk of adverse outcomes. In selected cases, this might require deferring or omitting surgery, radiotherapy or systemic treatments especially where benefits are marginal and alternative safe therapeutic options are available. Ongoing research is necessary to expand knowledge of the management of cancer in older adults. However, the pandemic presents a significant barrier and efforts should be made to ensure equitable access to clinical trials and prospective data collection to elucidate the outcomes of COVID-19 in this population.
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883
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de Jong R, Crama KF, Visser J, van Wieringen N, Wiersma J, Geijsen ED, Bel A. Online adaptive radiotherapy compared to plan selection for rectal cancer: quantifying the benefit. Radiat Oncol 2020; 15:162. [PMID: 32641080 PMCID: PMC7371470 DOI: 10.1186/s13014-020-01597-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/11/2020] [Indexed: 12/21/2022] Open
Abstract
Background To compare online adaptive radiation therapy (ART) to a clinically implemented plan selection strategy (PS) with respect to dose to the organs at risk (OAR) for rectal cancer. Methods The first 20 patients treated with PS between May–September 2016 were included. This resulted in 10 short (SCRT) and 10 long (LCRT) course radiotherapy treatment schedules with a total of 300 Conebeam CT scans (CBCT). New dual arc VMAT plans were generated using auto-planning for both the online ART and PS strategy. For each fraction bowel bag, bladder and mesorectum were delineated on daily Conebeam CTs. The dose distribution planned was used to calculate daily DVHs. Coverage of the CTV was calculated, as defined by the dose received by 99% of the CTV volume (D99%). The volume of normal tissue irradiated with 95% of the prescribed fraction dose was calculated by calculating the volume receiving 95% of the prescribed fraction or more dose minus the volume of the CTV. For each fraction the difference between the plan selection and online adaptive strategy of each DVH parameter was calculated, as well as the average difference per patient. Results Target coverage remained the same for online ART. The median volume of the normal tissue irradiated with 95% of the prescribed dose dropped from 642 cm3 (PS) to 237 cm3 (online-ART)(p < 0.001). Online ART reduced dose to the OARs for all tested dose levels for SCRT and LCRT (p < 0.001). For V15Gy of the bowel bag the median difference over all fractions of all patients was − 126 cm3 in LCRT, while the average difference per patient ranged from − 206 cm3 to − 40 cm3. For SCRT the median difference was − 62 cm3, while the range of the average difference per patient was − 105 cm3 to − 51 cm3. For V15Gy of the bladder the median difference over all fractions of all patients was 26% in LCRT, while the average difference per patient ranged from − 34 to 12%. For SCRT the median difference of V95% was − 8%, while the range of the average difference per patient was − 29 to 0%. Conclusions Online ART for rectal cancer reduces dose the OARs significantly compared to a clinically implemented plan selection strategy, without compromising target coverage. Trial registration Medical Research Involving Human Subjects Act (WMO) does not apply to this study and was retrospectively approved by the Medical Ethics review Committee of the Academic Medical Center (W19_357 # 19.420; Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands).
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Affiliation(s)
- R de Jong
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands.
| | - K F Crama
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - J Visser
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - N van Wieringen
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - J Wiersma
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - E D Geijsen
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - A Bel
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
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884
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López-Torrecilla J, Pastor-Peidro J, Vicedo-González A, González-Sanchis D, Hernandez-Machancoses A, Almendros-Blanco P, García-Miragall E, Gordo-Partearroyo JC, García-Hernández T, Brualla-González L, Granero-Cabañero D, Rosello-Ferrando J. Patterns of treatment failure in patients with prostate cancer treated with 76-80 Gy radiotherapy to the prostate and seminal vesicles ± hormonotherapy. Clin Transl Oncol 2020; 23:481-490. [PMID: 32621208 DOI: 10.1007/s12094-020-02437-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/19/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE To assess the pattern of treatment failure in patients with prostate cancer (PCa) treated with radiotherapy (76-80 Gy) ± hormone therapy (HT). We also evaluated the influence of treatment failure on survival outcomes. METHODS Retrospective study of patients with PCa (n = 302) treated with radiotherapy (RT) ± HT at our centre between November 1999 and July 2007. The mean patient age was 70.2 years (range 51-87). Distribution by NCCN risk group was low (n = 80, 26.5%), intermediate (n = 86, 28.5%), high (n = 77, 25.5%), and very high (n = 49, 16.2%). Most patients (n = 273, 90.4%) received IMRT at a dose of 76-80 Gy. HT was administered in 237 patients (78.5%), in most cases (n = 167, 55.3%) for < 7 months RESULTS: Survival rates at 10 years were: overall survival (OS), 64.3%; biochemical disease-free survival, 83.9%; disease-free survival, 92.5%; and metastasis-free survival (MFS), 94.3%. Biochemical failure (BF) was observed in 55 cases (18.2%), 32 of whom subsequently developed clinical recurrence: metastasis (n = 17, 5.6%), local failure (n = 11, 3.6%), and regional failure (n = 4, 1.3%). The cause of death (n = 159) was intercurrent disease in 115 cases (72.3%), second cancer in 27 (17.0%), and PCa in 17 (10.7%). Biochemical failure-free survival ≤ 24 months was significantly associated with worse OS and MFS (p = 0.0001). Late genitourinary and gastrointestinal toxicity grade ≥ 3 (RTOG) was observed in 18 (6.0%) and 7 (2.3%) patients, respectively. CONCLUSIONS The main type of treatment failure after 76-80 Gy of radiotherapy ± HT is local or metastatic. In all cases, biochemical failure occurred prior to treatment failure. BF within 24 months of treatment completion was significantly associated with worse OS and MFS.
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Affiliation(s)
- J López-Torrecilla
- Department of Radiation Oncology, ERESA, Hospital General Universitario de Valencia, Av. Tres Cruces, 2, 46014, Valencia, Spain.
| | - J Pastor-Peidro
- Department of Radiation Oncology, ERESA, Hospital General Universitario de Valencia, Av. Tres Cruces, 2, 46014, Valencia, Spain
| | - A Vicedo-González
- Medical Physics Department, ERESA, Hospital General Universitario de Valencia, Av. Tres Cruces, 2, 46014, Valencia, Spain
| | - D González-Sanchis
- Department of Radiation Oncology, ERESA, Hospital General Universitario de Valencia, Av. Tres Cruces, 2, 46014, Valencia, Spain
| | - A Hernandez-Machancoses
- Department of Radiation Oncology, ERESA, Hospital General Universitario de Valencia, Av. Tres Cruces, 2, 46014, Valencia, Spain
| | - P Almendros-Blanco
- Department of Radiation Oncology, ERESA, Hospital General Universitario de Valencia, Av. Tres Cruces, 2, 46014, Valencia, Spain
| | - E García-Miragall
- Department of Radiation Oncology, ERESA, Hospital General Universitario de Valencia, Av. Tres Cruces, 2, 46014, Valencia, Spain
| | - J C Gordo-Partearroyo
- Department of Radiation Oncology, ERESA, Hospital General Universitario de Valencia, Av. Tres Cruces, 2, 46014, Valencia, Spain
| | - T García-Hernández
- Department of Radiation Oncology, ERESA, Hospital General Universitario de Valencia, Av. Tres Cruces, 2, 46014, Valencia, Spain.,Medical Physics Department, ERESA, Hospital General Universitario de Valencia, Av. Tres Cruces, 2, 46014, Valencia, Spain
| | - L Brualla-González
- Medical Physics Department, ERESA, Hospital General Universitario de Valencia, Av. Tres Cruces, 2, 46014, Valencia, Spain
| | - D Granero-Cabañero
- Medical Physics Department, ERESA, Hospital General Universitario de Valencia, Av. Tres Cruces, 2, 46014, Valencia, Spain
| | - J Rosello-Ferrando
- Medical Physics Department, ERESA, Hospital General Universitario de Valencia, Av. Tres Cruces, 2, 46014, Valencia, Spain
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885
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Piro D, Boldrini L, Cornacchione P, Votta C, Bianchi M, Balducci M, Gambacorta MA, Valentini V, Pasini D. Radiation therapy technologists' involvement and opinion in research: A national survey in Italy. Tech Innov Patient Support Radiat Oncol 2020; 15:11-14. [PMID: 32613093 PMCID: PMC7322338 DOI: 10.1016/j.tipsro.2020.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/04/2020] [Accepted: 05/14/2020] [Indexed: 10/26/2022] Open
Abstract
Introduction This survey describes Italian RTTs' involvement and opinions in research activities related to radiation oncology. Primary aim was to assess the degree of involvement of the national RTTs community in research and to describe how RTTs can integrate their skills collaborating with other professionals. Materials and methods A ten-items multiple-choice questionnaire, with 2-8 possible responses, was developed by a steering committee and generated on a survey platform. Links were sent via email to Italian RTTs.The questions were divided in 3 domains: demographic data; scientific research and activity; opinions about RTTs role in scientific research. The survey started on October 1, 2018 and ended on January 31, 2019. Results One hundred thirty-five out of 509 (26.5%) RTTs responded to the questionnaire at its expiring date; 97.73% think to be valid contributors in radiation oncology research, expressing clear interest in "data collection" tasks (52.71%); 38.64% feel unsupported by other professionals in the research team and 59.85% of the respondents are not members in any scientific society. Conclusions The role of Italian RTTs in research is heterogeneous. Mainly RTTs in the age range from 30 to 40 years responded to the survey showing their interest in scientific research. This might be related to different informatics and educational skills as well as to personal attitudes. RTTs particular skills, like data management and technical hypothesis generation abilities, are of benefit to realize research projects. Therefore, engaging RTTs in research activities is strongly suggested.
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Affiliation(s)
- D Piro
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - L Boldrini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - P Cornacchione
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - C Votta
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - M Bianchi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - M Balducci
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - M A Gambacorta
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - V Valentini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - D Pasini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
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886
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Placidi L, Romano A, Chiloiro G, Cusumano D, Boldrini L, Cellini F, Mattiucci GC, Valentini V. On-line adaptive MR guided radiotherapy for locally advanced pancreatic cancer: Clinical and dosimetric considerations. Tech Innov Patient Support Radiat Oncol 2020; 15:15-21. [PMID: 32642565 PMCID: PMC7334416 DOI: 10.1016/j.tipsro.2020.06.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 02/07/2023] Open
Abstract
Introduction Magnetic Resonance-guided Radiation Therapy (MRgRT) allows online adaptations (OA) of the treatment plan to optimize daily dose distribution based on patient's anatomy, just before fraction delivery. The aim of this study is to evaluate feasibility and the dosimetric improvement of the OA workflow implemented in our institution for locally advanced pancreatic cancer (LAPC) patients, in terms of target coverage and organs at risk (OARs) sparing. Methods We retrospectively analysed 8 LAPC patients treated with MRgRT in combination with the OA approach, using video-assisted inspiratory breath-hold for a total of 38 fractions with a dose ranging from 30 Gy to 40 Gy in 5 fractions.Dose distribution of the baseline plan was first calculated based on daily anatomy, obtaining a "predicted" plan to assess the dosimetric improvement. If the dose distribution did not meet the constraints set in the planning phase, PTV, GTV and OARs were re-contoured within a distance of 3 cm from the PTV external edge and a new online "adaptive" plan was generated. Other clinical and planning parameters were also evaluated to assess the feasibility and the dosimetic benefit of the online adaptive workflow. Results Out of 38 total fractions, 26 (68.4%) were adapted online and 12 (31.6%) were delivered using the baseline plan. The use of the adaptive workflow resulted to be feasible in our clinical practice and advantageous in all the patients: mean PTV V95% increased by 10.8% (5.7-20.8) while mean CTV V98% of 12.6% (7.3-17.7). Also OARs V33 and V25 showed a positive trend avoiding unnecessary irradiation. Conclusion OA workflow improves the dosimetric benefit of MRgRT, preventing the occurrence of high-doses to OARs and increasing the safety of stereotactic treatment for LAPC, without any drawback for our daily clinical practice routine.
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Affiliation(s)
- Lorenzo Placidi
- Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168 Rome, Italy.,Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Largo Francesco Vito 1, 00168 Rome, Italy
| | - Angela Romano
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Largo Francesco Vito 1, 00168 Rome, Italy
| | - Giuditta Chiloiro
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Largo Francesco Vito 1, 00168 Rome, Italy
| | - Davide Cusumano
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Largo Francesco Vito 1, 00168 Rome, Italy
| | - Luca Boldrini
- Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168 Rome, Italy.,Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Largo Francesco Vito 1, 00168 Rome, Italy
| | - Francesco Cellini
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Largo Francesco Vito 1, 00168 Rome, Italy
| | - Gian Carlo Mattiucci
- Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168 Rome, Italy.,Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Largo Francesco Vito 1, 00168 Rome, Italy
| | - Vincenzo Valentini
- Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168 Rome, Italy.,Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Largo Francesco Vito 1, 00168 Rome, Italy
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887
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de Lusignan S, Jones N, Dorward J, Byford R, Liyanage H, Briggs J, Ferreira F, Akinyemi O, Amirthalingam G, Bates C, Lopez Bernal J, Dabrera G, Eavis A, Elliot AJ, Feher M, Krajenbrink E, Hoang U, Howsam G, Leach J, Okusi C, Nicholson B, Nieri P, Sherlock J, Smith G, Thomas M, Thomas N, Tripathy M, Victor W, Williams J, Wood I, Zambon M, Parry J, O'Hanlon S, Joy M, Butler C, Marshall M, Hobbs FDR. The Oxford Royal College of General Practitioners Clinical Informatics Digital Hub: Protocol to Develop Extended COVID-19 Surveillance and Trial Platforms. JMIR Public Health Surveill 2020; 6:e19773. [PMID: 32484782 PMCID: PMC7333793 DOI: 10.2196/19773] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Routinely recorded primary care data have been used for many years by sentinel networks for surveillance. More recently, real world data have been used for a wider range of research projects to support rapid, inexpensive clinical trials. Because the partial national lockdown in the United Kingdom due to the coronavirus disease (COVID-19) pandemic has resulted in decreasing community disease incidence, much larger numbers of general practices are needed to deliver effective COVID-19 surveillance and contribute to in-pandemic clinical trials. OBJECTIVE The aim of this protocol is to describe the rapid design and development of the Oxford Royal College of General Practitioners Clinical Informatics Digital Hub (ORCHID) and its first two platforms. The Surveillance Platform will provide extended primary care surveillance, while the Trials Platform is a streamlined clinical trials platform that will be integrated into routine primary care practice. METHODS We will apply the FAIR (Findable, Accessible, Interoperable, and Reusable) metadata principles to a new, integrated digital health hub that will extract routinely collected general practice electronic health data for use in clinical trials and provide enhanced communicable disease surveillance. The hub will be findable through membership in Health Data Research UK and European metadata repositories. Accessibility through an online application system will provide access to study-ready data sets or developed custom data sets. Interoperability will be facilitated by fixed linkage to other key sources such as Hospital Episodes Statistics and the Office of National Statistics using pseudonymized data. All semantic descriptors (ie, ontologies) and code used for analysis will be made available to accelerate analyses. We will also make data available using common data models, starting with the US Food and Drug Administration Sentinel and Observational Medical Outcomes Partnership approaches, to facilitate international studies. The Surveillance Platform will provide access to data for health protection and promotion work as authorized through agreements between Oxford, the Royal College of General Practitioners, and Public Health England. All studies using the Trials Platform will go through appropriate ethical and other regulatory approval processes. RESULTS The hub will be a bottom-up, professionally led network that will provide benefits for member practices, our health service, and the population served. Data will only be used for SQUIRE (surveillance, quality improvement, research, and education) purposes. We have already received positive responses from practices, and the number of practices in the network has doubled to over 1150 since February 2020. COVID-19 surveillance has resulted in tripling of the number of virology sites to 293 (target 300), which has aided the collection of the largest ever weekly total of surveillance swabs in the United Kingdom as well as over 3000 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serology samples. Practices are recruiting to the PRINCIPLE (Platform Randomised trial of INterventions against COVID-19 In older PeopLE) trial, and these participants will be followed up through ORCHID. These initial outputs demonstrate the feasibility of ORCHID to provide an extended national digital health hub. CONCLUSIONS ORCHID will provide equitable and innovative use of big data through a professionally led national primary care network and the application of FAIR principles. The secure data hub will host routinely collected general practice data linked to other key health care repositories for clinical trials and support enhanced in situ surveillance without always requiring large volume data extracts. ORCHID will support rapid data extraction, analysis, and dissemination with the aim of improving future research and development in general practice to positively impact patient care. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/19773.
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Affiliation(s)
- Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- Royal College of General Practitioners, London, United Kingdom
| | - Nicholas Jones
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Jienchi Dorward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Rachel Byford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Harshana Liyanage
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - John Briggs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Filipa Ferreira
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Oluwafunmi Akinyemi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | | | | | | | | | | | - Alex J Elliot
- Real-time Syndromic Surveillance Team, Field Service, Public Health England, Birmingham, United Kingdom
| | - Michael Feher
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | | | - Uy Hoang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Gary Howsam
- Royal College of General Practitioners, London, United Kingdom
| | - Jonathan Leach
- Royal College of General Practitioners, London, United Kingdom
| | - Cecilia Okusi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Brian Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Philip Nieri
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Julian Sherlock
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Gillian Smith
- Real-time Syndromic Surveillance Team, Field Service, Public Health England, Birmingham, United Kingdom
| | - Mark Thomas
- Royal College of General Practitioners, London, United Kingdom
| | - Nicholas Thomas
- Royal College of General Practitioners, London, United Kingdom
| | - Manasa Tripathy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - William Victor
- Royal College of General Practitioners, London, United Kingdom
| | - John Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Ian Wood
- Royal College of General Practitioners, London, United Kingdom
- EMIS Group, Leeds, United Kingdom
| | | | | | | | - Mark Joy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Chris Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Martin Marshall
- Royal College of General Practitioners, London, United Kingdom
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Dosimetric evaluation of whole-pelvis radiation therapy of prostate cancers: clinical experience. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396920000461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractBackground:The standard treatment modalities for prostate cancer include surgery, chemotherapy, hormonal therapy and radiation therapy or any combination depending on the stage of the tumour. Radiation therapy is a common and effective treatment modality for low-intermediate-risk patients with localised prostate cancer, to treat the intact prostate and seminal vesicles or prostate bed post prostatectomy. However, for high-risk patients with lymph node involvement, treatment with radiation will usually include treatment of the whole pelvis to cover the prostate and seminal vesicles or prostate bed and the pelvic lymph nodes followed by a boost delivery dose to the prostate and seminal vesicles or prostate bed.Materials and Methods:We retrospectively analysed the treatment plans for 179 prostate cancer patients treated at the cancer centre with the volumetric-modulated arc therapy (VMAT) technique via RapidArc using 6 MV photon beam. Patients were either treated with a total prescription dose of 78 Gy in 39 fractions for patients with intact prostate or 66 Gy in 33 fractions for post prostatectomy patients.Results:There were 114 (64%) patients treated with 78 Gy/39 and 65 (36%) treated with 66 Gy/34. The mean homogeneity index (HI), conformity index (CI) and uniformity index (UI) for the PTV-primary of patients treated with 78 Gy are 0.06 ± 0.01, 1.04 ± 0.01 and 0.99 ± 0.01, respectively, and the corresponding mean values for patients treated with 66 Gy are 0.06 ± 0.02, 1.05 ± 0.01 and 0.99 ± 0.01, respectively. The mean PTV-primary V95%, V100% and V105% are 99.5 ± 0.5%, 78.8 ± 12.2% and 0.1 ± 0.5%, respectively, for patients treated with 78 Gy and 99.3 ± 0.9%, 78.1 ± 10.6% and 0.1 ± 0.4%, respectively, for patients treated with 66 Gy. The rectal V50Gy, V65Gy, V66.6Gy, V70Gy, V75Gy and V80Gy are 26.8 ± 9.1%, 14.2 ± 5.3%, 13.1 ± 5.0%, 10.8 ± 4.3%, 6.9 ± 3.1% and 0.1 ± 0.1%, respectively, for patients treated with 78 Gy and 33.7 ± 8.4%, 14.1 ± 4.5%, 6.7 ± 4.5%, 0.0 ± 0.2%, 0.0% and 0.0%, respectively, for patients treated with 66 Gy.Conclusion:The use of VMAT technique for radiation therapy of high-risk prostate cancer patients is an efficient and reliable method for achieving superior dose conformity, uniformity and homogeneity to the PTV and minimal doses to the organs at risk. Results from this study provide the basis for the development and implementation of consistent treatment criteria in radiotherapy programs, have the potential to establish an evaluation process to define a consistent, standardised and transparent treatment path for all patients that reduces significant variations in the acceptability of treatment plans and potentially improve patient standard of care.
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889
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100% peer review in radiation oncology: is it feasible? Clin Transl Oncol 2020; 22:2341-2349. [PMID: 32557395 PMCID: PMC7299249 DOI: 10.1007/s12094-020-02394-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/12/2020] [Indexed: 11/06/2022]
Abstract
Purpose Peer review has been proposed as a strategy to ensure patient safety and plan quality in radiation oncology. Despite its potential benefits, barriers commonly exist to its optimal implementation in daily clinical routine. Our purpose is to analyze peer-review process at our institution. Methods and materials Based on our group peer-review process, we quantified the rate of plan changes, time and resources needed for this process. Prospectively, data on cases presented at our institutional peer-review conference attended by physicians, resident physicians and physicists were collected. Items such as time to present per case, type of patient (adult or pediatric), treatment intent, dose, aimed technique, disease location and receipt of previous radiation were gathered. Cases were then analyzed to determine the rate of major change, minor change and plan rejection after presentation as well as the median time per session. Results Over a period of 4 weeks, 148 cases were reviewed. Median of attendants was six physicians, three in-training-physicians and one physicist. Median time per session was 38 (4–72) minutes. 59.5% of cases presented in 1–4 min, 32.4% in 5–9 min and 8.1% in ≥ 10 min. 79.1% of cases were accepted without changes, 11.5% with minor changes, 6% with major changes and 3.4% were rejected with indication of new presentation. Most frequent reason of change was contouring corrections (53.8%) followed by dose or fractionation (26.9%). Conclusion Everyday group consensus peer review is an efficient manner to recollect clinical and technical data of cases presented to ensure quality radiation care before initiation of treatment as well as ensuring department quality in a feedback team environment. This model is feasible within the normal operation of every radiation oncology Department.
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890
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Kearney M, Coffey M, Leong A. A review of Image Guided Radiation Therapy in head and neck cancer from 2009-201 - Best Practice Recommendations for RTTs in the Clinic. Tech Innov Patient Support Radiat Oncol 2020; 14:43-50. [PMID: 32566769 PMCID: PMC7296359 DOI: 10.1016/j.tipsro.2020.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/17/2020] [Accepted: 02/11/2020] [Indexed: 02/06/2023] Open
Abstract
Radiation therapy (RT) is beneficial in Head and Neck Cancer (HNC) in both the definitive and adjuvant setting. Highly complex and conformal planning techniques are becoming standard practice in delivering increased doses in HNC. A sharp falloff in dose outside the high dose area is characteristic of highly complex techniques and geometric uncertainties must be minimised to prevent under dosage of the target volume and possible over dosage of surrounding critical structures. CTV-PTV margins are employed to account for geometric uncertainties such as set up errors and both interfraction and intrafraction motion. Robust immobilisation and Image Guided Radiation Therapy (IGRT) is also essential in this group of patients to minimise discrepancies in patient position during the treatment course. IGRT has evolved with increased 2-Dimensional (2D) and 3-Dimensional (3D) IGRT modalities available for geometric verification. 2D and 3D IGRT modalities are both beneficial in geometric verification while 3D imaging is a valuable tool in assessing volumetric changes that may have dosimetric consequences for this group of patients. IGRT if executed effectively and efficiently provides clinicians with confidence to reduce CTV-PTV margins thus limiting treatment related toxicities in patients. Accumulated exposure dose from IGRT vary considerably and may be incorporated into the treatment plan to avoid excess dose. However, there are considerable variations in the application of IGRT in RT practice. This paper aims to summarise the advances in IGRT in HNC treatment and provide clinics with recommendations for an IGRT strategy for HNC in the clinic.
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Affiliation(s)
- Maeve Kearney
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College, Dublin 2, Ireland
| | - Mary Coffey
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College, Dublin 2, Ireland
| | - Aidan Leong
- Department of Radiation Therapy, University of Otago, Wellington, New Zealand.,Bowen Icon Cancer Centre, Wellington, New Zealand
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891
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Green M, Van Nest SJ, Soisson E, Huber K, Liao Y, McBride W, Dominello MM, Burmeister J, Joiner MC. Three discipline collaborative radiation therapy (3DCRT) special debate: We should treat all cancer patients with hypofractionation. J Appl Clin Med Phys 2020; 21:7-14. [PMID: 32602186 PMCID: PMC7324689 DOI: 10.1002/acm2.12954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Michael Green
- Department of Radiation OncologyUniversity of MichiganAnn ArborMIUSA
| | | | - Emilie Soisson
- Department of RadiologyUniversity of VermontBurlingtonVTUSA
| | - Kathryn Huber
- Department of Radiation OncologyTufts Medical CenterBostonMAUSA
| | - Yixiang Liao
- Department of Radiation OncologyRush University Medical CenterChicagoILUSA
| | - William McBride
- Department of Radiation OncologyUniversity of California at Los Angeles (UCLA)Los AngelesCAUSA
| | | | - Jay Burmeister
- Department of OncologyWayne State University School of MedicineDetroitMIUSA
- Gershenson Radiation Oncology CenterBarbara Ann Karmanos Cancer InstituteDetroitMIUSA
| | - Michael C. Joiner
- Department of OncologyWayne State University School of MedicineDetroitMIUSA
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892
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Hay LK, Paterson C, McLoone P, Miguel-Chumacero E, Valentine R, Currie S, Grose D, Schipani S, Wilson C, Nixon I, James A, Duffton A. Analysis of dose using CBCT and synthetic CT during head and neck radiotherapy: A single centre feasibility study. Tech Innov Patient Support Radiat Oncol 2020; 14:21-29. [PMID: 32226833 PMCID: PMC7093804 DOI: 10.1016/j.tipsro.2020.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/31/2020] [Accepted: 02/25/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The study aimed to assess the suitability of deformable image registration (DIR) software to generate synthetic CT (sCT) scans for dose verification during radiotherapy to the head and neck. Planning and synthetic CT dose volume histograms were compared to evaluate dosimetric changes during the treatment course. METHODS Eligible patients had locally advanced (stage III, IVa and IVb) oropharyngeal cancer treated with primary radiotherapy. Weekly CBCT images were acquired post treatment at fractions 1, 6, 11, 16, 21 and 26 over a 30 fraction treatment course. Each CBCT was deformed with the planning CT to generate a sCT which was used to calculate the dose at that point in the treatment. A repeat planning CT2 was acquired at fraction 16 and deformed with the fraction 16 CBCT to compare differences between the calculations mid-treatment. RESULTS 20 patients were evaluated generating 138 synthetic CT sets. The single fraction mean dose to PTV_HR between the synthetic and planning CT did not vary, although dose to 95% of PTV_HR was smaller at week 6 compared to planning (difference 2.0%, 95% CI (0.8 to 3.1), p = 0.0). There was no statistically significant difference in PRV_brainstem or PRV_spinal cord maximum dose, although greater variation using the sCT calculations was reported. The mean dose to structures based on the fraction 16 sCT and CT2 scans were similar. CONCLUSIONS Synthetic CT provides comparable dose calculations to those of a repeat planning CT; however the limitations of DIR must be understood before it is applied within the clinical setting.
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Key Words
- ART, adaptive radiotherapy
- CBCT, Cone Beam Computed Tomography
- CTV, Clinical Target Volume
- Cone-beam CT
- DIR, deformable image registration
- DVH, dose volume histogram
- Deformable
- Dose
- GTV, Gross Tumour Volume
- Head and neck cancer
- IGRT, Image Guided Radiotherapy
- OAR, Organs at Risk
- OPSCC, oropharyngeal squamous cell cancer
- PRV, planning organ at risk volume
- PTV, Planning Target Volume
- RT, radiotherapy
- Radiotherapy
- SCC, Squamous Cell Carcinoma
- Synthetic CT
- TPS, treatment planning system
- VMAT, volumetric arc therapy
- pCT, planning Computed Tomography
- sCT, synthetic Computed Tomography
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Affiliation(s)
- Lisa K Hay
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow 1053 Great Western Road, Glasgow G12 0YN, United Kingdom
| | - Claire Paterson
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow 1053 Great Western Road, Glasgow G12 0YN, United Kingdom
| | - Philip McLoone
- Institute of Health & Wellbeing, University of Glasgow, University Ave, Glasgow G12 8QQ, United Kingdom
| | - Eliane Miguel-Chumacero
- Department of Radiotherapy Physics, Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow G12 0YN, United Kingdom
| | - Ronan Valentine
- Department of Radiotherapy Physics, Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow G12 0YN, United Kingdom
| | - Suzanne Currie
- Department of Radiotherapy Physics, Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow G12 0YN, United Kingdom
| | - Derek Grose
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow 1053 Great Western Road, Glasgow G12 0YN, United Kingdom
| | - Stefano Schipani
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow 1053 Great Western Road, Glasgow G12 0YN, United Kingdom
| | - Christina Wilson
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow 1053 Great Western Road, Glasgow G12 0YN, United Kingdom
| | - Ioanna Nixon
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow 1053 Great Western Road, Glasgow G12 0YN, United Kingdom
| | - Allan James
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow 1053 Great Western Road, Glasgow G12 0YN, United Kingdom
| | - Aileen Duffton
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow 1053 Great Western Road, Glasgow G12 0YN, United Kingdom
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893
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Hafeez S, Patel E, Webster A, Warren-Oseni K, Hansen V, McNair H, Miles E, Lewis R, Hall E, Huddart R. Protocol for hypofractionated adaptive radiotherapy to the bladder within a multicentre phase II randomised trial: radiotherapy planning and delivery guidance. BMJ Open 2020; 10:e037134. [PMID: 32461298 PMCID: PMC7259864 DOI: 10.1136/bmjopen-2020-037134] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Patients with muscle invasive bladder cancer (MIBC) who are unfit and unsuitable for standard radical treatment with cystectomy or daily radiotherapy present a large unmet clinical need. Untreated, they suffer high cancer specific mortality and risk significant disease-related local symptoms. Hypofractionated radiotherapy (delivering higher doses in fewer fractions/visits) is a potential treatment solution but could be compromised by the mobile nature of the bladder, resulting in target misses in a significant proportion of fractions. Adaptive 'plan of the day' image-guided radiotherapy delivery may improve the precision and accuracy of treatment. We aim to demonstrate within a randomised multicentre phase II trial feasibility of plan of the day hypofractionated bladder radiotherapy delivery with acceptable rates of toxicity. METHODS AND ANALYSIS Patients with T2-T4aN0M0 MIBC receiving 36 Gy in 6-weekly fractions are randomised (1:1) between treatment delivered using a single-standard plan or adaptive radiotherapy using a library of three plans (small, medium and large). A cone beam CT taken prior to each treatment is used to visualise the anatomy and select the most appropriate plan depending on the bladder shape and size. A comprehensive radiotherapy quality assurance programme has been instituted to ensure standardisation of radiotherapy planning and delivery. The primary endpoint is to exclude >30% acute grade >3 non-genitourinary toxicity at 3 months for adaptive radiotherapy in patients who received >1 fraction (p0=0.7, p1=0.9, α=0.05, β=0.2). Secondary endpoints include local disease control, symptom control, late toxicity, overall survival, patient-reported outcomes and proportion of fractions benefiting from adaptive planning. Target recruitment is 62 patients. ETHICS AND DISSEMINATION The trial is approved by the London-Surrey Borders Research Ethics Committee (13/LO/1350). The results will be disseminated via peer-reviewed scientific journals, conference presentations and submission to regulatory authorities. TRIAL REGISTRATION NUMBER NCT01810757.
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Affiliation(s)
- Shaista Hafeez
- Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
- Radiotherapy and Imaging, The Royal Marsden Hospital NHS Trust, London, UK
| | - Emma Patel
- Mount Vernon Hospital, National Radiotherapy Trials Quality Assurance Group, Northwood, UK
| | - Amanda Webster
- Mount Vernon Hospital, National Radiotherapy Trials Quality Assurance Group, Northwood, UK
| | - Karole Warren-Oseni
- Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
- Radiotherapy and Imaging, The Royal Marsden Hospital NHS Trust, London, UK
| | - Vibeke Hansen
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - Helen McNair
- Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
- Radiotherapy and Imaging, The Royal Marsden Hospital NHS Trust, London, UK
| | - Elizabeth Miles
- Mount Vernon Hospital, National Radiotherapy Trials Quality Assurance Group, Northwood, UK
| | - Rebecca Lewis
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Robert Huddart
- Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
- Radiotherapy and Imaging, The Royal Marsden Hospital NHS Trust, London, UK
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894
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Does a radiographer-led palliative radiotherapy pathway provide an efficient service for patients with symptoms of advanced cancer? The Northampton experience. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s146039692000028x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractAim:To investigate whether a radiographer-led radiotherapy pathway can provide an efficient service for patients requiring treatment for symptomatic skeletal metastases.Materials and Methods:A retrospective review of 425 courses of palliative radiotherapy was conducted. Data was analysed assessing diagnosis, dose/fractionation, time from referral to treatment, gender, age, inpatient/outpatient status and referring clinic location for radiographer- and clinical oncologist-led cohorts.Results:Patients aged ≥70 years were more likely to be planned by radiographers (n = 162/57, p < 0·001). Patients were more likely to be treated with 8 Gy in single fraction than with 20 Gy in five fractions (n = 279/136, p = 0·012). The median referral to treatment time in 8-Gy single-fraction prescriptions was 3 days for radiographer-led versus 7 days for clinical oncologist-led cohorts. In all patients and in 20 Gy in five-fraction prescriptions, it was 4 versus 8 days. A comparison of all prescriptions (p < 0·001), 8 Gy in single-fraction (p < 0·001) and 20 Gy in five-fraction prescriptions (p = 0·001) showed radiographer-led procedures as enabling faster access to treatment in each category.Findings:A radiographer-led service can facilitate faster access to treatment than a clinical oncologist-led pathway for an appropriately selected patient caseload.
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895
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A comparative study between open-face and closed-face masks for head and neck cancer (HNC) in radiation therapy. Rep Pract Oncol Radiother 2020; 25:382-388. [PMID: 32322177 DOI: 10.1016/j.rpor.2020.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/09/2019] [Accepted: 03/12/2020] [Indexed: 11/20/2022] Open
Abstract
Aim To determine the setup reproducibility in the radiation treatment of Head and Neck (HN) patients using open face head and shoulder masks (OHSM) with customized headrest (CHR) versus standard closed head and shoulder masks (CHSM) and to determine the patient's level of comfort and satisfaction for both masks. Methods Forty patients were prospectively randomized into two groups using simple random sampling. Group 1 was assigned with CHSMs, immobilized with a standard HR (SHR) while Group 2 was assigned with OHSMs, and immobilized with CHR. Cone beam computed tomography (CBCT) was taken the first 3 days, followed by weekly CBCT (prior treatment) with results registered to the planning CT to determine translational and rotational inter-fraction shifts and to verify accuracy. Mean (M) and standard deviation (SD) of the systematic and random setup errors of the 2 arms in the translational and rotational directions were analyzed, using Independent t-test and Mann-Whitney U test. Patient comfort was measured using a Likert questionnaire. Results The vertical, lateral, longitudinal and Z/roll rotational shifts were not significantly different between the two masks. X/yaw and Y/pitch rotational shifts were significantly greater in Group 2 versus Group 1, for both systematic (p = 0.009 and 0.046, respectively) and random settings (p = 0.016 and 0.020) but still within three degrees. Patients reported higher neck and shoulder comfort (p = 0.020) and overall satisfaction (p = 0.026) using the OHSM with the CHR versus the CHSM with the SHR during CT simulation. Conclusion Open masks provide comparable yet comfortable immobilization to closed masks for HN radiotherapy.
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896
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Jmour O, Benna M, Champagnol P, Ben Mrad M, Hamrouni A, Obeid L, Lahmamssi C, Bousarsar A, Vial N, Rehailia-Blanchard A, Sotton S, Lan M, Langrand-Escure J, Vallard A, Magné N. CBCT evaluation of inter- and intra-fraction motions during prostate stereotactic body radiotherapy: a technical note. Radiat Oncol 2020; 15:85. [PMID: 32307017 PMCID: PMC7168857 DOI: 10.1186/s13014-020-01534-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 04/08/2020] [Indexed: 12/28/2022] Open
Abstract
Background In most clinical trials, gold fiducial markers are implanted in the prostate to tune the table position before each radiation beam. Yet, it is unclear if a cone-beam computed tomography (CBCT) should be performed before each beam to monitor a possible variation of the organs at risk (OARs) fullness, especially in case of recto-prostatic spacer implantation. The present study aimed at assessing the inter- and intra-fraction movements of prostate, bladder and rectum in patients implanted with a hyaluronic acid spacer and undergoing prostate stereotactic body radiotherapy (SBRT). Methods Data about consecutive patients undergoing prostate SBRT were prospectively collected between 2015 and 2019. Inter-and intra-fraction prostate displacements and volume variation of organs at risk (OARs) were assessed with CBCTs. Results Eight patients were included. They underwent prostate SBRT (37.5Gy, 5 fractions of 7.5Gy) guided by prostate gold fiducial markers. Inter-fraction variation of the bladder volume was insignificant. Intra-fraction mean increase of the bladder volume was modest (29 cc) but significant (p < 0.001). Both inter- and intra-fraction variations of the rectum volume were insignificant but for one patient. He had no rectal toxicity. The magnitude of table displacement necessary to match the prostate gold fiducial marker frequently exceeded the CTV/PTV margins (0.4 cm) before the first (35%) and the second arc (15%). Inter- and intra-fraction bladder and rectum volume variations did not correlate with prostate displacement. Conclusion Major prostate position variations were reported. In-room kV fiducial imaging before each arc seems mandatory. Intra-fraction imaging of the OARs appears unnecessary. We suggest that only one CBCT is needed before the first arc. Trial registration NCT02361515, February 11th, 2015.
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Affiliation(s)
- Omar Jmour
- Department of radiation oncology, Lucien Neuwirth Cancer Institute, 108 Bis, Avenue Albert Raimond, 42270, Saint Priest en Jarez, France
| | - Marouan Benna
- Department of radiation oncology, Lucien Neuwirth Cancer Institute, 108 Bis, Avenue Albert Raimond, 42270, Saint Priest en Jarez, France
| | - Pierre Champagnol
- Department of radiation oncology, Lucien Neuwirth Cancer Institute, 108 Bis, Avenue Albert Raimond, 42270, Saint Priest en Jarez, France
| | - Majed Ben Mrad
- Department of radiation oncology, Lucien Neuwirth Cancer Institute, 108 Bis, Avenue Albert Raimond, 42270, Saint Priest en Jarez, France
| | - Anis Hamrouni
- Department of radiation oncology, Lucien Neuwirth Cancer Institute, 108 Bis, Avenue Albert Raimond, 42270, Saint Priest en Jarez, France
| | - Layal Obeid
- Department of radiation oncology, Lucien Neuwirth Cancer Institute, 108 Bis, Avenue Albert Raimond, 42270, Saint Priest en Jarez, France
| | - Chaimaa Lahmamssi
- Department of radiation oncology, Lucien Neuwirth Cancer Institute, 108 Bis, Avenue Albert Raimond, 42270, Saint Priest en Jarez, France
| | - Amal Bousarsar
- Department of radiation oncology, Lucien Neuwirth Cancer Institute, 108 Bis, Avenue Albert Raimond, 42270, Saint Priest en Jarez, France
| | - Nicolas Vial
- Department of radiation oncology, Lucien Neuwirth Cancer Institute, 108 Bis, Avenue Albert Raimond, 42270, Saint Priest en Jarez, France
| | - Amel Rehailia-Blanchard
- Department of radiation oncology, Lucien Neuwirth Cancer Institute, 108 Bis, Avenue Albert Raimond, 42270, Saint Priest en Jarez, France
| | - Sandrine Sotton
- Department of radiation oncology, Lucien Neuwirth Cancer Institute, 108 Bis, Avenue Albert Raimond, 42270, Saint Priest en Jarez, France
| | - Meiling Lan
- Department of radiation oncology, Lucien Neuwirth Cancer Institute, 108 Bis, Avenue Albert Raimond, 42270, Saint Priest en Jarez, France
| | - Julien Langrand-Escure
- Department of radiation oncology, Lucien Neuwirth Cancer Institute, 108 Bis, Avenue Albert Raimond, 42270, Saint Priest en Jarez, France
| | - Alexis Vallard
- Department of radiation oncology, Lucien Neuwirth Cancer Institute, 108 Bis, Avenue Albert Raimond, 42270, Saint Priest en Jarez, France
| | - Nicolas Magné
- Department of radiation oncology, Lucien Neuwirth Cancer Institute, 108 Bis, Avenue Albert Raimond, 42270, Saint Priest en Jarez, France.
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897
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A systematic review of effectiveness of interventions applicable to radiotherapy that are administered to improve patient comfort, increase patient compliance, and reduce patient distress or anxiety. Radiography (Lond) 2020; 26:314-324. [PMID: 32245711 DOI: 10.1016/j.radi.2020.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 03/04/2020] [Accepted: 03/05/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of this review was to search existing literature to identify comfort interventions that can be used to assist an adult patient to undergo complex radiotherapy requiring positional stability for periods greater than 10 min. The objectives of this review were to; 1) identify comfort interventions used for clinical procedures that involve sustained inactivity similar to radiotherapy; 2) define characteristics of comfort interventions for future practice; and 3) determine the effectiveness of identified comfort interventions. The Preferred Reporting Items for Systematic Reviews and meta-analyses statement and the Template-for-Intervention-Description-and Replication guide were used. KEY FINDINGS The literature search was performed using PICO criteria with five databases (AMED, CINAHL EMBASE, MEDLINE, PsycINFO) identifying 5269 titles. After screening, 46 randomised controlled trials met the inclusion criteria. Thirteen interventions were reported and were grouped into four categories: Audio-visual, Psychological, Physical, and Other interventions (education/information and aromatherapy). The majority of aromatherapy, one audio-visual and one educational intervention were judged to be clinically significant for improving patient comfort based on anxiety outcome measures (effect size ≥ 0.4, mean change is greater than the Minimal-Important-Difference and low-risk-of-bias). Medium to large effect sizes were reported in many interventions where differences did not exceed the Minimal-Important-Difference for the measure. These interventions were deemed worthy of further investigation. CONCLUSION Several interventions were identified that may improve comfort during radiotherapy assisting patients to sustain and endure the same position over time. This is crucial for the continual growth of complex radiotherapy requiring a need for comfort to ensure stability for targeted treatment. IMPLICATIONS FOR PRACTICE Further investigation of comfort interventions is warranted, including tailoring interventions to patient choice and determining if multiple interventions can be used concurrently to improve effectiveness.
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898
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Olausson K, Sharp L, Fransson P, Nyholm T, Zackrisson B, Östlund U. What matters to you? - Free-text comments in a questionnaire from patients undergoing radiotherapy. Tech Innov Patient Support Radiat Oncol 2020; 13:11-16. [PMID: 32128457 PMCID: PMC7042152 DOI: 10.1016/j.tipsro.2019.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 10/13/2019] [Accepted: 11/22/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Most cancer patients undergo external radiotherapy (RT) at some stage during their treatment trajectory and RT is often associated with unfamiliar procedures in a highly technical environment. The purpose of this study was to explore how patients experience RT and the related processes, as described in free-text comments in a large Swedish survey with questionnaires including items on psychosocial climate and treatment environment. METHODS The data consisted of free-text comments from one open-ended question: "Is there anything else you want us to know" and were analysed using qualitative content analysis. RESULTS Of 825 returned questionnaires, 261 contained free-text comments from patients (32%). The hand-written, free-text comments reflected the patients' experience of the RT process and were abstracted into the four major categories with sub-categories: experiencing the high-tech RT environment, understanding the RT procedures and side effects, dealing with daily life during RT, and the nurses' role and performance. The categories reflect the patients' experiences and emphasize how important it is to evaluate what really matters to the patients when changing procedures, practices, and how to minimize disturbances in the patients' daily lives. CONCLUSION The main conclusions from this study are that the involvement of patients in choosing daily appointment times, providing good information during the RT process to make the patients feel safe, experience and attitude of the staff and respect for the patient's autonomy are highly ranked values for patients. An implementation of person-centred care may help relieve many of these problems.
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Affiliation(s)
| | - Lena Sharp
- Karolinska Institute, Department of Learning, Informatics, Management and Ethics, Stockholm, Sweden
- Regional Cancer Centre, Stockholm-Gotland, Sweden
| | - Per Fransson
- Umeå University, Department of Nursing, Umeå, Sweden
| | - Tufve Nyholm
- Umeå University, Department of Radiation Sciences, Umeå, Sweden
| | | | - Ulrika Östlund
- Centre for Research & Development, Uppsala University/Region Gävleborg, Sweden
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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899
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Iocolano M, Blacksburg S, Carpenter T, Repka M, Carbone S, Demircioglu G, Miccio M, Katz A, Haas J. Prostate Fiducial Marker Placement in Patients on Anticoagulation: Feasibility Prior to Prostate SBRT. Front Oncol 2020; 10:203. [PMID: 32175274 PMCID: PMC7056879 DOI: 10.3389/fonc.2020.00203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 02/06/2020] [Indexed: 12/17/2022] Open
Abstract
Background and Purpose: Fiducial marker placement is required in patients undergoing robotic-based Stereotactic Body Radiotherapy (SBRT) or image-guided radiation therapy (IGRT) for prostate cancer. Many patients take antiplatelet or anticoagulant medication due to other medical comorbidities. They are often required to temporarily discontinue these medications prior to invasive medical procedures as they are prone to bleed. Some patients are unable to discontinue therapy due to an elevated risk of thromboembolic events. The purpose of this study is to report this institution's experience placing fiducial markers in prostate cancer patients who are on chronic antiplatelet or anticoagulant medication. Materials and Methods: From August 2015-March 2019 57 patients on chronic antiplatelet or anticoagulation therapy who were not cleared to stop these medications underwent transrectal ultrasound guided (TRUS) fiducial marker placement for SBRT/IGRT. All patients were monitored by a registered nurse during the procedure for prolonged bleeding that required staff to hold pressure to the area with a 4 × 4 gauze until it resolved. All patients were also called the following day to assess for ongoing bleeding events. Treatment planning CT scan confirmed the ideal geometry of the marker placement. Results: All 57 patients on antiplatelet or anticoagulant medication who underwent fiducial marker placement were discharged home the same day of the procedure. Four patients experienced persistent bleeding that required a nurse to hold prolonged pressure to the area. No patient experienced significant bleeding the following day or any untoward cardiovascular event. Conclusions: This series suggests the use of antiplatelet or anticoagulant medication is not an absolute contraindication to fiducial marker placement in patients undergoing SBRT or IGRT for prostate cancer. These patients should be closely monitored after the procedure for bleeding complications. Practitioners may consider the patient's medical comorbidities, risk factors for thromboembolism, and overall functional status as there is no standardized protocol for discontinuing anticoagulant or antiplatelet therapy for fiducial marker placement.
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Affiliation(s)
- Michelle Iocolano
- Department of Radiation Oncology, NYU Winthrop Hospital, Mineola, NY, United States.,Stony Brook University School of Medicine, Stony Brook, NY, United States
| | - Seth Blacksburg
- Department of Radiation Oncology, NYU Winthrop Hospital, Mineola, NY, United States
| | - Todd Carpenter
- Department of Radiation Oncology, NYU Winthrop Hospital, Mineola, NY, United States
| | - Michael Repka
- Department of Radiation Oncology, NYU Winthrop Hospital, Mineola, NY, United States
| | - Susan Carbone
- Department of Radiation Oncology, NYU Winthrop Hospital, Mineola, NY, United States
| | - Gizem Demircioglu
- Department of Radiation Oncology, NYU Winthrop Hospital, Mineola, NY, United States
| | - Maryann Miccio
- Department of Radiation Oncology, NYU Winthrop Hospital, Mineola, NY, United States
| | - Aaron Katz
- Department of Urology, NYU Winthrop Hospital, Mineola, NY, United States
| | - Jonathan Haas
- Department of Radiation Oncology, NYU Winthrop Hospital, Mineola, NY, United States
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900
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van den Ende RPJ, Peters FP, Harderwijk E, Rütten H, Bouwmans L, Berbee M, Canters RAM, Stoian G, Compagner K, Rozema T, de Smet M, Intven MPW, Tijssen RHN, Theuws J, van Haaren P, van Triest B, Eekhout D, Marijnen CAM, van der Heide UA, Kerkhof EM. Radiotherapy quality assurance for mesorectum treatment planning within the multi-center phase II STAR-TReC trial: Dutch results. Radiat Oncol 2020; 15:41. [PMID: 32070386 PMCID: PMC7027245 DOI: 10.1186/s13014-020-01487-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 02/10/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The STAR-TReC trial is an international multi-center, randomized, phase II study assessing the feasibility of short-course radiotherapy or long-course chemoradiotherapy as an alternative to total mesorectal excision surgery. A new target volume is used for both (chemo)radiotherapy arms which includes only the mesorectum. The treatment planning QA revealed substantial variation in dose to organs at risk (OAR) between centers. Therefore, the aim of this study was to determine the treatment plan variability in terms of dose to OAR and assess the effect of a national study group meeting on the quality and variability of treatment plans for mesorectum-only planning for rectal cancer. METHODS Eight centers produced 25 × 2 Gy treatment plans for five cases. The OAR were the bowel cavity, bladder and femoral heads. A study group meeting for the participating centers was organized to discuss the planning results. At the meeting, the values of the treatment plan DVH parameters were distributed among centers so that results could be compared. Subsequently, the centers were invited to perform replanning if they considered this to be necessary. RESULTS All treatment plans, both initial planning and replanning, fulfilled the target constraints. Dose to OAR varied considerably for the initial planning, especially for dose levels below 20 Gy, indicating that there was room for trade-offs between the defined OAR. Five centers performed replanning for all cases. One center did not perform replanning at all and two centers performed replanning on two and three cases, respectively. On average, replanning reduced the bowel cavity V20Gy by 12.6%, bowel cavity V10Gy by 22.0%, bladder V35Gy by 14.7% and bladder V10Gy by 10.8%. In 26/30 replanned cases the V10Gy of both the bowel cavity and bladder was lower, indicating an overall lower dose to these OAR instead of a different trade-off. In addition, the bowel cavity V10Gy and V20Gy showed more similarity between centers. CONCLUSIONS Dose to OAR varied considerably between centers, especially for dose levels below 20 Gy. The study group meeting and the distribution of the initial planning results among centers resulted in lower dose to the defined OAR and reduced variability between centers after replanning. TRIAL REGISTRATION The STAR-TReC trial, ClinicalTrials.gov Identifier: NCT02945566. Registered 26 October 2016, https://clinicaltrials.gov/ct2/show/NCT02945566).
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Affiliation(s)
- Roy P. J. van den Ende
- Department of Radiation Oncology, Leiden University Medical Center, P.O. Box 9600 2300, RC, Leiden, the Netherlands
| | - Femke P. Peters
- Department of Radiation Oncology, Leiden University Medical Center, P.O. Box 9600 2300, RC, Leiden, the Netherlands
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ernst Harderwijk
- Department of Radiation Oncology, Leiden University Medical Center, P.O. Box 9600 2300, RC, Leiden, the Netherlands
| | - Heidi Rütten
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Liza Bouwmans
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Maaike Berbee
- Department of Radiation Oncology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Richard A. M. Canters
- Department of Radiation Oncology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Georgiana Stoian
- Department of Radiation Oncology, Isala Clinics, Zwolle, the Netherlands
| | - Kim Compagner
- Department of Radiation Oncology, Isala Clinics, Zwolle, the Netherlands
| | - Tom Rozema
- Department of Radiation Oncology, Verbeeten Institute, Tilburg, the Netherlands
| | - Mariska de Smet
- Department of Radiation Oncology, Verbeeten Institute, Tilburg, the Netherlands
| | - Martijn P. W. Intven
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rob H. N. Tijssen
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jacqueline Theuws
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | - Paul van Haaren
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | - Baukelien van Triest
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Dave Eekhout
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Corrie A. M. Marijnen
- Department of Radiation Oncology, Leiden University Medical Center, P.O. Box 9600 2300, RC, Leiden, the Netherlands
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Uulke A. van der Heide
- Department of Radiation Oncology, Leiden University Medical Center, P.O. Box 9600 2300, RC, Leiden, the Netherlands
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ellen M. Kerkhof
- Department of Radiation Oncology, Leiden University Medical Center, P.O. Box 9600 2300, RC, Leiden, the Netherlands
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