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Laughlin BS, Anderson JD, Gagneur JD, Chungbin SJ, Bues M, Hobbis D, Fatyga M, Korte SM, Carroll SE, Vora S, Sio TT, Wong WW, Keole SR, Rong Y. Implementation of Photon Treatment Back-Up Workflow at a High-Volume Proton Center: Safety, Quality, and Patient Considerations. Pract Radiat Oncol 2022; 12:e453-e459. [PMID: 35272078 DOI: 10.1016/j.prro.2022.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/11/2022] [Accepted: 01/19/2022] [Indexed: 11/30/2022]
Abstract
A successful proton beam therapy (PBT) center relies heavily on the proper function and maintenance of a proton beam therapy machine. However, when a PBT machine is non-operational, a proton facility is hindered with delays that can potentially lead to inferior treatment outcome due to treatment interruption. The implementation of a workflow for which proton plans are converted to photon plans so that patients can be treated using photon has been a successful strategy to reduce delays and mitigate its impact on patient care. This workflow was established through collaboration of physicians, physicists, dosimetrists, therapists, nurses, and schedulers. A tiered system established by disease site, number of fractions, and individualized circumstances is used to prioritize patients. This article provides an overview of workflow of conversion of PBT to photon when the PBT machine is down. Specific needs of patients undergoing proton beam therapy are addressed.
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Affiliation(s)
- Brady S Laughlin
- Department of Radiation Oncology, Mayo Clinic Arizona, 5881 E Mayo Boulevard, Phoenix, Arizona, 85054
| | - Justin D Anderson
- Department of Radiation Oncology, Mayo Clinic Arizona, 5881 E Mayo Boulevard, Phoenix, Arizona, 85054
| | - Justin D Gagneur
- Department of Radiation Oncology, Mayo Clinic Arizona, 5881 E Mayo Boulevard, Phoenix, Arizona, 85054
| | - Suzanne J Chungbin
- Department of Radiation Oncology, Mayo Clinic Arizona, 5881 E Mayo Boulevard, Phoenix, Arizona, 85054
| | - Martin Bues
- Department of Radiation Oncology, Mayo Clinic Arizona, 5881 E Mayo Boulevard, Phoenix, Arizona, 85054
| | - Dean Hobbis
- Department of Radiation Oncology, Mayo Clinic Arizona, 5881 E Mayo Boulevard, Phoenix, Arizona, 85054
| | - Mirek Fatyga
- Department of Radiation Oncology, Mayo Clinic Arizona, 5881 E Mayo Boulevard, Phoenix, Arizona, 85054
| | - Shawn M Korte
- Department of Radiation Oncology, Mayo Clinic Arizona, 5881 E Mayo Boulevard, Phoenix, Arizona, 85054
| | - Sarah E Carroll
- Department of Radiation Oncology, Mayo Clinic Arizona, 5881 E Mayo Boulevard, Phoenix, Arizona, 85054
| | - Sujay Vora
- Department of Radiation Oncology, Mayo Clinic Arizona, 5881 E Mayo Boulevard, Phoenix, Arizona, 85054
| | - Terence T Sio
- Department of Radiation Oncology, Mayo Clinic Arizona, 5881 E Mayo Boulevard, Phoenix, Arizona, 85054
| | - William W Wong
- Department of Radiation Oncology, Mayo Clinic Arizona, 5881 E Mayo Boulevard, Phoenix, Arizona, 85054
| | - Sameer R Keole
- Department of Radiation Oncology, Mayo Clinic Arizona, 5881 E Mayo Boulevard, Phoenix, Arizona, 85054
| | - Yi Rong
- Department of Radiation Oncology, Mayo Clinic Arizona, 5881 E Mayo Boulevard, Phoenix, Arizona, 85054.
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Combs SE, Belka C, Niyazi M, Corradini S, Pigorsch S, Wilkens J, Grosu AL, Guckenberger M, Ganswindt U, Bernhardt D. First statement on preparation for the COVID-19 pandemic in large German Speaking University-based radiation oncology departments. Radiat Oncol 2020; 15:74. [PMID: 32264908 PMCID: PMC7136995 DOI: 10.1186/s13014-020-01527-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 03/31/2020] [Indexed: 12/20/2022] Open
Abstract
The COVID-19 pandemic is challenging modern radiation oncology. At University Hospitals, we have a mandate to offer high-end treatments to all cancer patients. However, in times of crisis we must learn to prioritize resources, especially personnel. Compromising oncological outcome will blur all statistics, therefore all measures must be taken with great caution. Communication with our neighboring countries, within societies and between departments can help meet the challenge. Here, we report on our learning system and preparation measures to effectively tackle the COVID-19 challenge in University-Based Radiation Oncology Departments.
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Affiliation(s)
- Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich (TUM), Klinikum rechts der Isar, Ismaninger Straße 22, D-81675 München, Munich, Germany. .,Department of Radiation Sciences (DRS), Institute of Radiation Medicine (IRM), Ingolstädter Landstraße 1, Neuherberg, Germany. .,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany.
| | - Claus Belka
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany.,Department of Radiation Oncology, University Hospital, LMU, Munich, Germany
| | - Maximilian Niyazi
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany.,Department of Radiation Oncology, University Hospital, LMU, Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU, Munich, Germany
| | - Steffi Pigorsch
- Department of Radiation Oncology, Technical University of Munich (TUM), Klinikum rechts der Isar, Ismaninger Straße 22, D-81675 München, Munich, Germany.,Department of Radiation Sciences (DRS), Institute of Radiation Medicine (IRM), Ingolstädter Landstraße 1, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
| | - Jan Wilkens
- Department of Radiation Oncology, Technical University of Munich (TUM), Klinikum rechts der Isar, Ismaninger Straße 22, D-81675 München, Munich, Germany
| | - Anca L Grosu
- Department of Radiation Oncology, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Freiburg, Freiburg im Breisgau, Germany
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ute Ganswindt
- Department of Radiation Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Denise Bernhardt
- Department of Radiation Oncology, Technical University of Munich (TUM), Klinikum rechts der Isar, Ismaninger Straße 22, D-81675 München, Munich, Germany.,Department of Radiation Sciences (DRS), Institute of Radiation Medicine (IRM), Ingolstädter Landstraße 1, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
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Agarwal J, Mummudi N, Tibdewal A, Ghosh-Laskar S. COVID-19 pandemic: Radiotherapy precautions and preparedness. J Cancer Res Ther 2020; 16:634-637. [DOI: 10.4103/jcrt.jcrt_405_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gay HA, Santiago R, Gil B, Remedios C, Montes PJ, López-Araujo J, Chévere CM, Imbert WS, White J, Arthur DW, Horton JK, Jagsi R, Rabinovich R, Beriwal S, Viswanathan A, Erickson BA, Rengan R, Palma D, Loo BW, Kavanaugh JA, Bradley J, Yom SS, Harari PM, Lee Burnett O. Lessons Learned From Hurricane Maria in Puerto Rico: Practical Measures to Mitigate the Impact of a Catastrophic Natural Disaster on Radiation Oncology Patients. Pract Radiat Oncol 2019; 9:305-321. [PMID: 30999000 DOI: 10.1016/j.prro.2019.03.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/24/2019] [Accepted: 03/13/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE Although the wind, rain, and flooding of Hurricane Maria in Puerto Rico abated shortly after its landfall on September 20, 2017, the disruption of the electrical, communications, transportation, and medical infrastructure of the island was unprecedented in scope and caused lasting harm for many months afterward. A compilation of recommendations from radiation oncologists who were in Puerto Rico during the disaster, and from a panel of American Society for Radiation Oncology (ASTRO) cancer experts was created. METHODS AND MATERIALS Radiation oncologists throughout Puerto Rico collaborated and improvised to continue treating patients in the immediate aftermath of the storm and as routine clinical operations were restored gradually. Empirical lessons from the experience of radiation therapy administration in this profoundly altered context of limited resources, impaired communication, and inadequate transportation were organized into a recommended template, applicable to any radiation oncology practice. ASTRO disease-site experts provided evidence-guidelines for mitigating the impact of a 2- to 3-week interruption in radiation therapy. RESULTS Practical measures to mitigate the medical impact of a disaster are summarized within the framework of "Prepare, Communicate, Operate, Compensate." Specific measures include the development of an emergency operations plan tailored to specific circumstances, prospective coordination with other radiation oncology clinics before a disaster, ongoing communications with emergency management organizations, and routine practice of alternate methods to disseminate information among providers and patients. CONCLUSIONS These recommendations serve as a starting point to assist any radiation oncology practice in becoming more resiliently prepared for a local or regional disruption from any cause. Disease-site experts provide evidence-based guidelines on how to mitigate the impact of a 2- to 3-week interruption in radiation therapy for lung, head and neck, uterine cervix, breast, and prostate cancers through altered fractionation or dose escalation.
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Affiliation(s)
- Hiram A Gay
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri.
| | | | - Betty Gil
- Radiation Therapy and Cancer Institute, San Juan, Puerto Rico
| | | | - Pedro J Montes
- Northern Radiotherapy Cancer Center, Arecibo, Puerto Rico
| | | | - Carlos M Chévere
- Centro Comprensivo de Cáncer de la Universidad de Puerto Rico, San Juan, Puerto Rico
| | | | - Julia White
- Department of Radiation Oncology, Ohio State University, Columbus, Ohio
| | - Douglas W Arthur
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia
| | - Janet K Horton
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Rachel Rabinovich
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | | | - Akila Viswanathan
- Johns Hopkins Radiation Oncology and Molecular Radiation Sciences, Baltimore, Maryland
| | - Beth A Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ramesh Rengan
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - David Palma
- London Regional Cancer Program, London, Ontario, Canada
| | - Billy W Loo
- Department of Radiation Oncology & Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - James A Kavanaugh
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Jeff Bradley
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Sue S Yom
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California
| | - Paul M Harari
- Department of Human Oncology, Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Omer Lee Burnett
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama
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Yom SS, Zietman AL. Radiation Therapy in a Time of Disaster. Int J Radiat Oncol Biol Phys 2019; 100:832-833. [PMID: 29485054 DOI: 10.1016/j.ijrobp.2017.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 12/01/2017] [Accepted: 12/03/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Sue S Yom
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California.
| | - Anthony L Zietman
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
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