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Boldrini L, D'Aviero A, De Felice F, Desideri I, Grassi R, Greco C, Iorio GC, Nardone V, Piras A, Salvestrini V. Artificial intelligence applied to image-guided radiation therapy (IGRT): a systematic review by the Young Group of the Italian Association of Radiotherapy and Clinical Oncology (yAIRO). LA RADIOLOGIA MEDICA 2024; 129:133-151. [PMID: 37740838 DOI: 10.1007/s11547-023-01708-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/16/2023] [Indexed: 09/25/2023]
Abstract
INTRODUCTION The advent of image-guided radiation therapy (IGRT) has recently changed the workflow of radiation treatments by ensuring highly collimated treatments. Artificial intelligence (AI) and radiomics are tools that have shown promising results for diagnosis, treatment optimization and outcome prediction. This review aims to assess the impact of AI and radiomics on modern IGRT modalities in RT. METHODS A PubMed/MEDLINE and Embase systematic review was conducted to investigate the impact of radiomics and AI to modern IGRT modalities. The search strategy was "Radiomics" AND "Cone Beam Computed Tomography"; "Radiomics" AND "Magnetic Resonance guided Radiotherapy"; "Radiomics" AND "on board Magnetic Resonance Radiotherapy"; "Artificial Intelligence" AND "Cone Beam Computed Tomography"; "Artificial Intelligence" AND "Magnetic Resonance guided Radiotherapy"; "Artificial Intelligence" AND "on board Magnetic Resonance Radiotherapy" and only original articles up to 01.11.2022 were considered. RESULTS A total of 402 studies were obtained using the previously mentioned search strategy on PubMed and Embase. The analysis was performed on a total of 84 papers obtained following the complete selection process. Radiomics application to IGRT was analyzed in 23 papers, while a total 61 papers were focused on the impact of AI on IGRT techniques. DISCUSSION AI and radiomics seem to significantly impact IGRT in all the phases of RT workflow, even if the evidence in the literature is based on retrospective data. Further studies are needed to confirm these tools' potential and provide a stronger correlation with clinical outcomes and gold-standard treatment strategies.
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Affiliation(s)
- Luca Boldrini
- UOC Radioterapia Oncologica, Fondazione Policlinico Universitario IRCCS "A. Gemelli", Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea D'Aviero
- Radiation Oncology, Mater Olbia Hospital, Olbia, Sassari, Italy
| | - Francesca De Felice
- Radiation Oncology, Department of Radiological, Policlinico Umberto I, Rome, Italy
- Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Isacco Desideri
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Roberta Grassi
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Carlo Greco
- Department of Radiation Oncology, Università Campus Bio-Medico di Roma, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | | | - Valerio Nardone
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Antonio Piras
- UO Radioterapia Oncologica, Villa Santa Teresa, Bagheria, Palermo, Italy.
| | - Viola Salvestrini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
- Cyberknife Center, Istituto Fiorentino di Cura e Assistenza (IFCA), 50139, Florence, Italy
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Montero A, Alvarez B. The 5Rs dilemma of radiotherapy for non-malignant diseases: 5Rs to darken OR 5Rs to shine. Rep Pract Oncol Radiother 2023; 28:74-78. [PMID: 37122917 PMCID: PMC10132200 DOI: 10.5603/rpor.a2023.0001] [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: 09/06/2022] [Accepted: 12/15/2022] [Indexed: 05/02/2023] Open
Abstract
Many benign diseases, so called because they are not a direct cause of death, nevertheless cause significant damage to the health of patients due to the associated pain, reduced functionality, increased disability and the negative impact they have on quality of life, which, together with the limited efficacy of many of the available treatments, make their management a challenge for every specialist. Radiotherapy, which has demonstrated its efficacy not only against cancer but also in many non-tumorous diseases, appears as a therapeutic option that deserves to be taken into account. However, there is still much resistance to considering the use of radiotherapy as a valid and acceptable alternative. The 5Rs to darken summarize the doubts and contradictions many specialists face to accept radiotherapy in non-neoplastic diseases. However, other 5Rs (to shine) can be argued to claim for the safety, reliability, and usefulness of radiation treatment for benign disease and as radiotherapy specialists we have to help the evidence shine and the darkness disappear.
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Affiliation(s)
- Angel Montero
- Department of Radiation Oncology, HM Hospitales, Madrid, Spain
- Faculty of Health Sciences, Universidad Camilo José Cela, Madrid, Spain
| | - Beatriz Alvarez
- Department of Radiation Oncology, HM Hospitales, Madrid, Spain
- Faculty of Health Sciences, Universidad Camilo José Cela, Madrid, Spain
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Santos M, Chavez-Nogueda J, Galvis JC, Merino T, Oliveira e Silva L, Rico M, Sarria G, Sisamon I, Garay O. Hypofractionation as a solution to radiotherapy access in latin america: expert perspective. Rep Pract Oncol Radiother 2022; 27:1094-1105. [PMID: 36632306 PMCID: PMC9826647 DOI: 10.5603/rpor.a2022.0108] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/24/2022] [Indexed: 12/12/2022] Open
Abstract
Background Limited radiation therapy resources have resulted in an interest in developing time and cost-saving innovations to expand access to cancer treatment, in Latin America. Therefore, hypofractionated radiotherapy (HRT) is a possible solution, as this modality delivers radiation over a shorter period of time. Materials and methods A selected panel of Latin American (LA) experts in fields related to HRT were provided with a series of relevant questions to address, prior to the multi-day conference. Within this meeting, each narrative was discussed and edited, through numerous rounds of discussion, until agreement was achieved. Results The challenges identified in increasing the adoption of HRT in LA include a lack of national and regional clinical practice guidelines and cancer registries; a lack of qualified human resources and personnel education; high up-front costs of equipment; disparate resource distribution and scarce HRT research. An analysis for these overarching challenges was developed and answered with recommendations. Conclusion Extending the adoption of HRT in LA can provide a path forward to increase access to radiotherapy and overcome the shortage of equipment. HRT has the potential to improve population health outcomes and patient centered care, while offering comparable local control, toxicity, palliation, and late effects for multiple indications, when compared to conventional RT. Concerted efforts from all involved stakeholders are needed to overcome the barriers in adopting this strategy in LA countries. The recommendations presented in this article can serve as a plan of action for HRT adoption in other countries in a similar situation.
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Affiliation(s)
- Marcos Santos
- ALATRO — Latin America Society of Therapeutic Radiation Oncology, Goiânia, Brasil
| | - Jessica Chavez-Nogueda
- Radiation Oncology Department, Hospital de Oncología, Centro Médico Nacional Siglo XXI, IMSS, México City, México
| | - Juan Carlos Galvis
- Division of Radiation Oncology, Clinica Los Nogales, Division of Clinical Research Clinica Los Nogales, Bogota, Colombia
| | - Tomas Merino
- Hemato-Oncology Department, Pontifícia Universidad Católica de Chile, Santiago, Chile
| | - Luis Oliveira e Silva
- Brasilia University Hospital (Hospital Universitário de Brasília — HUB), Brasília, Brasil
| | - Mariana Rico
- Americas Health Foundation (AHF), Washington, United States
| | - Gustavo Sarria
- Radiation Therapy Department, Oncosalud — AUNA, Lima, Peru
| | - Ignacio Sisamon
- Centro de Oncologia y Radioterapia and Hospital Privado de Comunidad, Mar del Plata, Argentina,School of Medicine, FASTA University, Mar del Plata, Argentina
| | - Onix Garay
- National Autonomous University of Mexico (UNAM)/Mexican Social Security Institute (IMSS), México City, Mexico
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Kao YS. Preoperative ultra-hypofractionation radiotherapy in extremity/trunk wall soft tissue sarcoma - A meta-analysis of prospective studies. Cancer Radiother 2022; 27:96-102. [PMID: 36028419 DOI: 10.1016/j.canrad.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/04/2022] [Accepted: 07/07/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The neoadjuvant radiotherapy is now standard treatment in soft tissue sarcoma. Using ultra-hypofractionation radiotherapy shorten the treatment time. In the era of COVID pandemic, using less fraction to treat patient is an urgent need. Thus, we aim to use meta-analysis to investigate the clinical efficacy of preoperative stereotactic body radiotherapy. MATERIAL AND METHODS PRISMA guideline was used in this study. PubMed, Cochrane and Embase were used. We include only prospective study. The main endpoint was set as wound complication rate. Other endpoints include R0 resection rate, overall survival, local control, and distant metastasis free survival. RESULTS Seven studies were included. The pooled wound complication rate is 0.30 (95% CI=0.26-0.35). The pooled R0 resection rate is 0.87(95%CI: 0.74-0.94). The pooled 2-year overall survival is 0.86 (95%CI: 0.72-0.94). The pooled 2-year local control rate is 0.96(95%CI: 0.89-0.99). The pooled 2-year distant metastasis free survival is 0.60 (95%CI=0.50-0.70). CONCLUSION Neoadjuvant ultra-hypofractionation radiotherapy in soft tissue sarcoma is a feasible and well tolerable treatment.
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Affiliation(s)
- Y-S Kao
- Department of radiation oncology, China medical university hospital, Taichung, Taiwan.
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Piras A, Venuti V, D’Aviero A, Cusumano D, Pergolizzi S, Daidone A, Boldrini L. Covid-19 and radiotherapy: a systematic review after 2 years of pandemic. Clin Transl Imaging 2022; 10:611-630. [PMID: 35910079 PMCID: PMC9308500 DOI: 10.1007/s40336-022-00513-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/12/2022] [Indexed: 02/08/2023]
Abstract
Introduction Following the Covid-19 pandemic spread, changes in clinical practice were necessary to limit the pandemic diffusion. Also, oncological practice has undergone changes with radiotherapy (RT) treatments playing a key role.Although several experiences have been published, the aim of this review is to summarize the current evidence after 2 years of pandemic to provide useful conclusions for clinicians. Methods A Pubmed/MEDLINE and Embase systematic review was conducted. The search strategy was "Covid AND Radiotherapy" and only original articles in the English language were considered. Results A total of 2.733 papers were obtained using the mentioned search strategy. After the complete selection process, a total of 281 papers were considered eligible for the analysis of the results. Discussion RT has played a key role in Covid-19 pandemic as it has proved more resilient than surgery and chemotherapy. The impact of the accelerated use of hypofractionated RT and telemedicine will make these strategies central also in the post-pandemic period.
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Affiliation(s)
- Antonio Piras
- Radioterapia Oncologica, Villa Santa Teresa, Palermo, Italy
| | - Valeria Venuti
- Radioterapia Oncologica, Università degli Studi di Palermo, Palermo, Italy
| | - Andrea D’Aviero
- Radiation Oncology, Mater Olbia Hospital, Olbia, Sassari Italy
| | | | - Stefano Pergolizzi
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | | | - Luca Boldrini
- Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, UOC Radioterapia Oncologica - Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
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Does stereotactic body radiation improve outcomes compared to conventional radiation for liver cancer patients? Clin Transl Radiat Oncol 2022; 35:17-20. [PMID: 35510143 PMCID: PMC9058945 DOI: 10.1016/j.ctro.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/31/2022] [Accepted: 04/03/2022] [Indexed: 11/27/2022] Open
Abstract
There has been a paradigm shift to SBRT without evidence that these high-dose ultra-low fractions result in improved outcomes. This prospective cohort compares the survival of patients treated with conventional versus SBRT treatments for liver tumours. The SBRT group received an average of 5 fractions, and the conventional group received an average of 17 fractions. 397 patients were included. Overall survival was higher for SBRT patients at the 2-year time point (42% vs 27% p = 0.01).
Introduction Methods Results Conclusion
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Sigurdson S, Harrison M, Pearce A, Richardson H, Zaza K, Brundage M. One Fraction Size Does Not Fit All: Patient Preferences for Hypofractionated Radiation Therapy From a Discrete Choice Experiment. Pract Radiat Oncol 2022; 12:e24-e33. [PMID: 34991857 DOI: 10.1016/j.prro.2021.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/29/2021] [Accepted: 08/16/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Hypofractionated external beam radiation therapy (EBRT) is a standard of care option for localized prostate cancer. To inform clinical practice we quantified patients' preferences for convenience, efficacy, and toxicity risks, of conventional, moderate hypofractionation, and stereotactic radiation therapy regimens. METHODS AND MATERIALS We used a discrete choice experiment with a voluntary sample consisting of patients treated with EBRT for localized prostate cancer at our academic cancer center. In 2019, 58 participants, mean (SD) age of 72.9 (7.1) years, agreed to complete an in-person 1:1 discrete choice experiment. Each participant made 12 choices between 2 unique EBRT scenarios, each described by 5 attributes: (1) treatment time; (2) fiducial markers; and risk of (3) prostate specific antigen recurrence; (4) acute and (5) late GI or GU toxicity. Patient preferences were estimated using mixed multinomial logistic regression, and prespecified subgroups with conditional logistic regression. RESULTS All attributes were statistically significant, thus influenced participants' choices. Risks of prostate specific antigen recurrence (β = -2.581), late (β = -1.854), and acute (β = -1.005) toxicity were most important to participants (P < .001 for each), followed by EBRT length (β = -0.728; P = .017) and fiducial marker implantation (β = -0.563; P = .004). Older (β = -0.063; 95% confidence interval, -0.12, -0.01) and rural (β = -0.083; 95% CI -0.14, -0.02) participants significantly preferred shorter EBRT and were less willing-to-extend treatment to reduce toxicity risk. CONCLUSIONS Patients with prostate cancer place importance on EBRT attributes, and some are willing to trade-off increased risk of toxicity for improved convenience. Our findings promote shared clinical decision-making because patients are interested in learning about the trade-offs involved.
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Affiliation(s)
- Samantha Sigurdson
- Department of Radiation Oncology, Cancer Centre of Southeastern Ontario, Kingston, Ontario, Canada; Department of Public Health Sciences, Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada.
| | - Mark Harrison
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Alison Pearce
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia; Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Harriet Richardson
- Department of Public Health Sciences, Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada
| | - Khaled Zaza
- Department of Radiation Oncology, Cancer Centre of Southeastern Ontario, Kingston, Ontario, Canada
| | - Michael Brundage
- Department of Radiation Oncology, Cancer Centre of Southeastern Ontario, Kingston, Ontario, Canada; Department of Public Health Sciences, Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada
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Abi Jaoude J, Thunshelle CP, Kouzy R, Nguyen ND, Lin D, Prakash L, Bumanlag IM, Noticewala SS, Niedzielski JS, Beddar S, Ludmir EB, Holliday EB, Das P, Minsky BD, Herman JM, Katz M, Koong AC, Koay EJ, Taniguchi CM. Stereotactic Versus Conventional Radiation Therapy for Patients With Pancreatic Cancer in the Modern Era. Adv Radiat Oncol 2021; 6:100763. [PMID: 34934858 PMCID: PMC8655391 DOI: 10.1016/j.adro.2021.100763] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/19/2021] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Patients with pancreatic cancer often receive radiation therapy before undergoing surgical resection. We compared the clinical outcomes differences between stereotactic body radiation therapy (SBRT) and 3-dimensional (3D)/intensity-modulated radiation therapy (IMRT). METHODS AND MATERIALS We retrospectively collected data from the University of Texas MD Anderson Cancer Center. Patients with borderline resectable/potentially resectable or locally advanced pancreatic cancer receiving neoadjuvant SBRT (median, 36.0 Gy/5fx), 3D conformal radiation (median, 50.4 Gy/28 fx) or IMRT (median, 50.4 Gy/28 fx) were included. Overall survival (OS) and progression-free survival were analyzed using Cox regression. RESULTS In total, 104 patients were included in our study. Fifty-seven patients (54.8%) were treated with SBRT, and 47 patients (45.2%) were treated with 3D/IMRT. Patients in the SBRT group were slightly older (median age: 70.3 vs 62.7 in the 3D/IMRT group). Both groups had similar proportions of patients with locally advanced pancreatic cancer (SBRT: 30, 52.6%; 3D/IMRT: 24, 51.1%). All patients were treated with chemotherapy. Patients in the SBRT group underwent more surgical resection compared with the 3D/IMRT group (38.6% vs 23.4%, respectively). At a median follow-up of 22 months, a total of 60 patients (57.7%) died: 25 (25/57, 43.9%) in the SBRT group, and 35 (35/47, 74.5%) in the 3D/IMRT group. Median OS was slightly higher in the SBRT group (29.6 months vs 24.1 months in the 3D/IMRT group). On multivariable Cox regression, the choice of radiation therapy technique was not associated with differences in OS (adjusted hazard ratios [aHR] = 0.5; 95% confidence interval [CI], 0.2%-1.3%, P = .18). Moreover, patients that underwent surgical resection had better OS (aHR = 0.3, 95% CI, 0.1%-0.8%, P = .01). Furthermore, progression-free survival was also similar between patients treated with SBRT and those treated with 3D/IMRT (aHR = 0.9, 95% CI, 0.5%-1.8%, P = .81). CONCLUSIONS SBRT was associated with similar clinical outcomes compared with conventional radiation techniques, despite being delivered over a shorter period of time which would spare patients prolonged treatment burden. Future prospective data are still needed to better assess the role of SBRT in patients with pancreatic cancer.
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Affiliation(s)
- Joseph Abi Jaoude
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Connor P. Thunshelle
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ramez Kouzy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nicholas D. Nguyen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Daniel Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Laura Prakash
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Isabela M. Bumanlag
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sonal S. Noticewala
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joshua S. Niedzielski
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sam Beddar
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ethan B. Ludmir
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Emma B. Holliday
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Prajnan Das
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bruce D. Minsky
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joseph M. Herman
- Department of Radiation Oncology, Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Lake Success, Hempstead, New York
| | - Matthew Katz
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Albert C. Koong
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eugene J. Koay
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Cullen M. Taniguchi
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Siavashpour Z, Goharpey N, Mobasheri M. Radiotherapy based management during Covid-19 pandemic - A systematic review of presented consensus and guidelines. Crit Rev Oncol Hematol 2021; 164:103402. [PMID: 34214608 PMCID: PMC8242203 DOI: 10.1016/j.critrevonc.2021.103402] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 02/17/2021] [Accepted: 06/18/2021] [Indexed: 01/18/2023] Open
Abstract
Treatment management of cancer patients in the radiation oncology departments during the current COVID-19 pandemic is challenging. A systematic review of published consensus/guidelines on the role of radiotherapy prioritization, suggested treatment protocols, and set up management was undertaken based on the PRISMA protocol and through PubMed/PMC, Scopus, Google Scholar, Web of Science databases until 01/20/2021. One hundred and sixty-eight publications or regional consensus were included. Summary of recommendations contained: (1) using hypo-fractionated (Hypo-F) regimens for therapeutic/palliative indications, (2) delaying radiotherapy for several weeks or until pandemic over, (3) omitting radiotherapy by replacement of alternative therapies or active surveillance, (4) applying safer patients' setup and preparation protocols, (5) developing telemedicine/telehealth service. To conclude, it is essential to carefully weigh the risk of exposure to COVID-19 infection and the benefit of treating cancer patients during the pandemic. Trying to have a global guideline facing this or any other probable crisis is crucial for health care service.
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Affiliation(s)
- Zahra Siavashpour
- Radiotherapy Oncology Department, Shohada-e Tajrish Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Neda Goharpey
- Radiotherapy Oncology Department, Shohada-e Tajrish Educational Hospital, Tehran, Iran.
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Bertholet J, Aznar MC, Garibaldi C, Thwaites D, Gershkevitsh E, Thorwarth D, Verellen D, Heijmen B, Hurkmans C, Muren L, Redalen KR, Siebert FA, Schwarz M, Van Elmpt W, Georg D, Jornet N, Clark CH. Professional practice changes in radiotherapy physics during the COVID-19 pandemic. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2021; 19:25-32. [PMID: 34179522 PMCID: PMC8216850 DOI: 10.1016/j.phro.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/29/2021] [Accepted: 06/12/2021] [Indexed: 11/11/2022]
Abstract
The experience of 433 medical physicists during COVID-19 was analysed. Changes in clinical practice had an impact on treatment planning and quality assurance tasks. The effects of the changes were perceived differently by management vs clinical medical physicists. There is a clear willingness to learn from this experience.
Background and purpose The COVID-19 pandemic has imposed changes in radiotherapy (RT) departments worldwide. Medical physicists (MPs) are key healthcare professionals in maintaining safe and effective RT. This study reports on MPs experience during the first pandemic peak and explores the consequences on their work. Methods A 39-question survey on changes in departmental and clinical practice and on the impact for the future was sent to the global MP community. A total of 433 responses were analysed by professional role and by country clustered on the daily infection numbers. Results The impact of COVID-19 was bigger in countries with high daily infection rate. The majority of MPs worked in alternation at home/on-site. Among practice changes, implementation and/or increased use of hypofractionation was the most common (47% of the respondents). Sixteen percent of respondents modified patient-specific quality assurance (QA), 21% reduced machine QA, and 25% moved machine QA to weekends/evenings. The perception of trust in leadership and team unity was reversed between management MPs (towards increased trust and unity) and clinical MPs (towards a decrease). Changes such as home-working and increased use of hypofractionation were welcomed. However, some MPs were concerned about pressure to keep negative changes (e.g. weekend work). Conclusion COVID-19 affected MPs through changes in practice and QA procedures but also in terms of trust in leadership and team unity. Some changes were welcomed but others caused worries for the future. This report forms the basis, from a medical physics perspective, to evaluate long-lasting changes within a multi-disciplinary setting.
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Affiliation(s)
- Jenny Bertholet
- European Society for Radiotherapy and Oncology (ESTRO), Physics Committee, Brussels, Belgium
- Division of Medical Radiation Physics, Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Corresponding author.
| | - Marianne C. Aznar
- European Society for Radiotherapy and Oncology (ESTRO), Physics Committee, Brussels, Belgium
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, The Christie NHS Foundation Trust, Manchester, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Cristina Garibaldi
- European Society for Radiotherapy and Oncology (ESTRO), Physics Committee, Brussels, Belgium
- Unit of Radiation Research, IEO European Institute of Oncology, IRCCS, Milano, Italy
| | - David Thwaites
- European Society for Radiotherapy and Oncology (ESTRO), Physics Committee, Brussels, Belgium
- Institute of Medical Physics, School of Physics, University of Sydney, Sydney, Australia
- Medical Physics, Leeds Institute of Cancer and Pathology, School of Medicine, Leeds University, Leeds, UK
| | - Eduard Gershkevitsh
- European Society for Radiotherapy and Oncology (ESTRO), Physics Committee, Brussels, Belgium
- North Estonia Medical Centre, Tallinn, Estonia
| | - Daniela Thorwarth
- European Society for Radiotherapy and Oncology (ESTRO), Physics Committee, Brussels, Belgium
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital Tübingen, Germany
| | - Dirk Verellen
- European Society for Radiotherapy and Oncology (ESTRO), Physics Committee, Brussels, Belgium
- Iridium Network, Antwerp University (Faculty of Medicine and Health Sciences), Antwerp, Belgium
| | - Ben Heijmen
- European Society for Radiotherapy and Oncology (ESTRO), Physics Committee, Brussels, Belgium
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands
| | - Coen Hurkmans
- European Society for Radiotherapy and Oncology (ESTRO), Physics Committee, Brussels, Belgium
- Catharina Hospital, Department of Radiation Oncology, Eindhoven, The Netherlands
| | - Ludvig Muren
- European Society for Radiotherapy and Oncology (ESTRO), Physics Committee, Brussels, Belgium
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Kathrine Røe Redalen
- European Society for Radiotherapy and Oncology (ESTRO), Physics Committee, Brussels, Belgium
- Department of Physics, Norwegian University of Science and Technology, Trondheim, Norway
| | - Frank-André Siebert
- European Society for Radiotherapy and Oncology (ESTRO), Physics Committee, Brussels, Belgium
- Clinic of Radiotherapy, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - Marco Schwarz
- European Society for Radiotherapy and Oncology (ESTRO), Physics Committee, Brussels, Belgium
- Proton Therapy Department, Trento Hospital, TIFPA-INFN, Trento, Italy
| | - Wouter Van Elmpt
- European Society for Radiotherapy and Oncology (ESTRO), Physics Committee, Brussels, Belgium
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Dietmar Georg
- European Society for Radiotherapy and Oncology (ESTRO), Physics Committee, Brussels, Belgium
- Division Medical Radiation Physics, Department of Radiation Oncology, Medical University of Vienna, AKH Wien, Austria
| | - Nuria Jornet
- European Society for Radiotherapy and Oncology (ESTRO), Physics Committee, Brussels, Belgium
- Servei de Radiofísica i Radioprotecció, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Catharine H. Clark
- European Society for Radiotherapy and Oncology (ESTRO), Physics Committee, Brussels, Belgium
- Department of Radiotherapy Physics, University College London Hospital, UK
- Department of Medical Physics and Bioengineering, University College London, UK
- National Physical Laboratory, London, UK
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11
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Jones GP. "Physicians, not Technicians": Reflections on the Role of the Radiation Oncologist in an Era of Hypofractionation. Int J Radiat Oncol Biol Phys 2021; 109:830-831. [PMID: 33516440 DOI: 10.1016/j.ijrobp.2020.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/07/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Gavin P Jones
- University of Kentucky Chandler Hospital, Department of Radiation Medicine, Lexington, Kentucky.
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12
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Boersma LJ, Murrer LHP. Three large trials on radiotherapy for early breast cancer: What did we learn? Radiother Oncol 2021; 156:239-243. [PMID: 33359270 DOI: 10.1016/j.radonc.2020.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/07/2020] [Accepted: 12/10/2020] [Indexed: 11/19/2022]
Affiliation(s)
- L J Boersma
- Maastricht University Medical Centre+, Dept. of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands.
| | - L H P Murrer
- Maastricht University Medical Centre+, Dept. of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands
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