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Guisantes R, Santos J, Ferreira AJ. Characterisation of Portuguese radiotherapy departments: Organisation, occupational exposure values and diagnostic reference levels for breast and prostate computed tomography planning. Radiography (Lond) 2024; 30:932-937. [PMID: 38657386 DOI: 10.1016/j.radi.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/25/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Portugal currently hosts 24 active radiotherapy departments, 8 public and 16 privates, presenting potential radiation exposure risks to multidisciplinary teams. Patients in these treatments also face ionising radiation during treatment planning and verification. METHODS Authorisation and ethical approval were secured for a national online survey, disseminated to radiotherapy departments across Portugal. The survey encompassed three sections: equipment, staff, and radiographer role characterisation; occupational exposure values for one month; and exposure parameters, including computed tomography (CT) dose values [CT dose index (CTDIvol) and dose length product (DLP)] for breast and prostate cancer CT planning. Local Diagnostic Reference Levels (DRLs) derived were based on the 75th percentile of median dose values. RESULTS The study garnered a 50% response rate from public institutions, 12,5% from private and 25% from all active radiotherapy institutions in Portugal. All departments employ Three-Dimensional Conformal Radiation Therapy (3D-CRT) and incorporate Intensity Modulated Radiation Therapy (IMRT) and/or Volumetric Modulated Arc Therapy (VMAT) irradiation techniques. Additionally, half of the departments also perform Brachytherapy (BT). Radiographers demonstrated an occupational dose of zero mSv. CT planning dose values were 13 mGy and 512 mGy cm for breast CT and 16 mGy and 689 mGy cm for prostate CT, pertaining to CTDIvol and DLP, respectively. CONCLUSION Most aspects of national radiotherapy characterisation align with the established literature. Occupational exposure values exhibited consistency across radiotherapy modalities. An approach to national DRLs was formulated for breast and prostate CT planning, yielding values congruent with recent European studies. IMPLICATIONS FOR PRACTICE This study offers vital insights for analysing occupational contexts and risk prevention, serving as the initial characterisation of the national radiotherapy landscape. It also pioneers the calculation of DRLs for CT planning in radiotherapy to optimise procedures.
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Affiliation(s)
- R Guisantes
- Unidade Local de Saúde de Coimbra, Radiotherapy Department, Praceta Mota Pinto, 3000-075, Coimbra, Portugal.
| | - J Santos
- Instituto Politécnico de Coimbra, ESTESC - Coimbra Health School, Medical Imaging and Radiotherapy, Rua 5 de Outubro, S. Martinho do Bispo, 3046-854, Coimbra, Portugal.
| | - A J Ferreira
- Faculty of Medicine, University of Coimbra, Portugal.
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Oliveira C, Barbosa B, Couto JG, Bravo I, Hughes C, McFadden S, Khine R, McNair HA. Advanced practice in radiotherapy across Europe: stakeholders' perceptions of implementation and evolution. Radiography (Lond) 2024; 30:896-907. [PMID: 38608565 DOI: 10.1016/j.radi.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/09/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024]
Abstract
INTRODUCTION Adapting radiotherapy services with workforce innovation using skills-mix or task-shifting optimises resources, supporting current and future demands. Advanced practitioners (APs) work at a different level of practice (beyond initial registration) across four pillars: clinical practice, leadership and management, education, and research. There is limited cross-country research on the advanced therapeutic radiographers/radiation therapists (TR/RTTs), particularly in Europe. This study aimed to investigate European radiotherapy stakeholders' perceptions regarding current and future advanced practice (AP). METHODS From June to September 2022, one-to-one online semi-structured interviews were conducted in English, and audio and video were recorded. Full verbatim audio files were independently transcribed and checked by interviewer and interviewees. Braun and Clarke's seven steps guided the thematic analysis (using NVivo). RESULTS Thirty-three interviewees working or studying in 16 European countries represented practitioners (n=14), managers (n=6), educators (n=4), professional bodies (n=4), students (n=3), and regulators (n=2). Four overarching themes emerged: "AP drivers and outcomes", "AP challenges vs enablers", "Current vs future AP", "Becoming and being advanced practitioner". Participants identified research as the neglected AP pillar due to a lack of protected time, limited staff skills, no research culture, no funding, workload, and clinical priorities. Interviewees highlighted the importance of consistency in job titles, harmonisation of education models and curricula, definition of AP requirements, and support for all AP pillars through job plans and workforce planning. CONCLUSION Neither the profession nor education of TR/RTTs are harmonised across Europe, which is highly reflected in advanced-level practice. Advanced TR/RTTs should work across all pillars, including research, and these should be embedded in master's programmes, including leadership. IMPLICATIONS FOR PRACTICE This study highlights a policy gap in the education and practice of APs in radiotherapy.
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Affiliation(s)
- C Oliveira
- Radiotherapy Department, Instituto Português de Oncologia do Porto (IPO Porto), Portugal; Escola Internacional de Doutoramento, Universidad de Vigo, Spain.
| | - B Barbosa
- Radiotherapy Department, Instituto Português de Oncologia do Porto (IPO Porto), Portugal; Escola Internacional de Doutoramento, Universidad de Vigo, Spain; Medical Physics, Radiobiology Group and Radiation Protection Group, IPO Porto Research Centre (CI-IPOP), Instituto Português de Oncologia do Porto (IPO Porto), Portugal.
| | - J G Couto
- Radiography Department, Faculty of Health Sciences, University of Malta, Malta.
| | - I Bravo
- Medical Physics, Radiobiology Group and Radiation Protection Group, IPO Porto Research Centre (CI-IPOP), Instituto Português de Oncologia do Porto (IPO Porto), Portugal.
| | - C Hughes
- School of Health Sciences, Ulster University, United Kingdom.
| | - S McFadden
- School of Health Sciences, Ulster University, United Kingdom.
| | - R Khine
- European Federation of Radiographer Societies, Utrecht, Netherlands; Institute of Health Sciences Education, Faculty of Medicine & Dentistry, Queen Mary, University of London, United Kingdom.
| | - H A McNair
- European Federation of Radiographer Societies, Utrecht, Netherlands; The Royal Marsden NHS Foundation Trust, Radiotherapy and the Institute of Cancer Research, Surrey, United Kingdom.
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Lievens Y. Modelling radiotherapy availability in the Asia-Pacific region. Lancet Oncol 2024; 25:152-154. [PMID: 38301685 DOI: 10.1016/s1470-2045(23)00655-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 02/03/2024]
Affiliation(s)
- Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Gent 9000, Belgium.
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Yang K, Lee JE, Park W, Ahn YC, Huh SJ. Recent trends in radiotherapy use for major cancers in Korea. Jpn J Clin Oncol 2023; 53:1177-1182. [PMID: 37599064 DOI: 10.1093/jjco/hyad106] [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: 04/21/2023] [Accepted: 08/03/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Although the trend in radiotherapy in all cancer patients has been studied, changes in radiotherapy modalities for specific cancer types have not been reported. This study aimed to analyze radiotherapy patterns for major cancers in Korea in recent years. MATERIALS AND METHODS We collected data from claims and reimbursement records of the Health and Insurance Review and Assessment Service from 2017 to 2020, according to initial diagnostic codes. The radiotherapy modalities for major cancers, such as lung, stomach, colorectal, breast and liver cancer, were analyzed. The radiotherapy modalities consisted of two-dimensional radiotherapy, three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, proton radiotherapy and stereotactic body radiotherapy. RESULTS Overall, from 2017 to 2020, the use of two-dimensional radiotherapy and three-dimensional conformal radiotherapy decreased, and intensity-modulated radiotherapy increased. In 2017, three-dimensional conformal radiotherapy accounted for approximately half of the radiotherapy in patients for lung and colorectal cancer, which was replaced by intensity-modulated radiotherapy in 2020. In 2020, stereotactic body radiotherapy also accounted for a large proportion of radiotherapy used in liver cancer cases. Intensity-modulated radiotherapy was most used, followed by three-dimensional conformal radiotherapy and two-dimensional radiotherapy for breast cancer in 2020. Among major cancers, radiotherapy utilization for breast cancer is the highest. Compared with other cancers, the number of patients receiving radiotherapy for stomach cancer was low. CONCLUSION The number of patients receiving radiotherapy for major cancers has increased. The use of advanced forms of radiotherapy, such as intensity-modulated radiotherapy, is rapidly increasing for major cancers. The rate of radiotherapy utilization was higher in major cancer patients than in all cancer patients.
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Affiliation(s)
- Kyungmi Yang
- Department of Radiation Oncology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Jeong Eun Lee
- Departments of Radiation Oncology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
- Healthcare Review and Assessment Committee, Health Insurance Review and Assessment Service, Seoul, Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Seung Jae Huh
- Healthcare Review and Assessment Committee, Health Insurance Review and Assessment Service, Seoul, Korea
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Boisbouvier S, Bayart É, Chamois J, Clavère P, Corbin S, De Oliveira A, Geffroy-Hulot C, Hannoun-Lévi JM, Hasbini A, Le Tallec P, Monpetit É, Santini JJ, Bougier C. [Survey by SFRO, SNRO and AFPPE about the evolution of the radiation therapist profession in France]. Cancer Radiother 2023; 27:712-717. [PMID: 37891038 DOI: 10.1016/j.canrad.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/09/2023] [Indexed: 10/29/2023]
Abstract
PURPOSE As part of the multidisciplinary team, radiation therapists are in charge of elements of treatment preparation and delivery of radiotherapy to cancer patients. Helping scientific and technological improvements, more and more patients with cancer were treated with radiotherapy including hypofractionnated radiotherapy, that explain the increase of demands on services. The professional impacted by this increase of demands are radiation oncologists and medical physicists. The opportunity to push forward the radiation therapist's competencies appears with the possibility to shift them some tasks. In this context, a first work was performed with objectives to have an overview of the tasks shifted to radiation therapists in France, the tasks that they could perform but also to evaluate some criteria of job satisfaction. MATERIAL AND METHODS The committee of "new status and value of status" including six radiation oncologists (the French society of radiation oncology [SFRO] et national union of radiation oncologists [SNRO]) and six radiation therapists committee members of the French association of radiation therapists (AFPPE), built a questionnaire including three parts: demographic characteristics, tasks shifted and job satisfaction criteria. In total, the questionnaire included 19 questions and 24 items assessed with a four point-Likert scale (ranging from "completely disagree" to "completely agree"). This survey, formatting with google form, was tested by the committee members and the final version was sent to the SFRO, AFPPE and SNRO members, before being disseminated on the social networks. RESULTS From November 18th 2022 to December 31st 2022, 492 responses were received (response rate=18.3%): 55 % of the respondents had at least 11 years of experience in radiotherapy. The respondents worked in different type of health facilities (36 % in specialized cancer centres, 19.5 % in private centers, 17.5% in university and general hospital, 10.2% in general hospital). More than ¼ of the respondents had a teaching lecturer activity, 20% had a management team activity and a research activity for 18%. Less than 10% of the respondents had another degree than that of radiation therapist: university degree (n=27), degree in dosimetry (n=11) and master (n=3). More than 76% would like to be trained and to have access to the advanced practice, more than 50% would like expend competencies with a university degree, 30% with a master and 67% would like to participate in research. Forty-two percent of the respondents were involved in a task shifting (excluding decree relating to acts and activities carried out by radiation therapists) and among the radiation therapists non-involved, 63% would be interested in being. Regarding job satisfaction, 53% of the respondents were satisfied with their job and their salary and 68% believed that their job occupation is in line with their professional aspirations. More than 2/3 of the respondents described a significant workload and mental load, 53% thought to have time for their patient care and 70% felt some organisational difficulties. CONCLUSION This survey shows: (i) A significant involvement of radiation therapists in the task shifting; (ii) A very strong demand for career development, in particular with existing degrees or to be created degree such as advanced practice; and (iii) The need to reinforce a job satisfaction for almost the half of the respondents, linked to a workload, a mental load and some organisational difficulties.
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Affiliation(s)
- S Boisbouvier
- Département de radiothérapie, centre Léon-Bérard, rue Laënnec, 69008 Lyon, France.
| | - É Bayart
- Société française de radiothérapie oncologique, centre Antoine-Béclère, 47, rue de la Colonie, 75013 Paris, France
| | - J Chamois
- Département de radiothérapie, centre hospitalier privé Saint-Grégoire, Saint-Grégoire, France
| | - P Clavère
- Département de radiothérapie, centre hospitalier universitaire de Limoges, Limoges, France
| | - S Corbin
- Département de radiothérapie, institut Gustave-Roussy, Villejuif, France
| | - A De Oliveira
- Département de radiothérapie, institut Curie, Paris, France
| | - C Geffroy-Hulot
- Département de radiothérapie, centre Eugène-Marquis, Rennes, France
| | - J-M Hannoun-Lévi
- Département de radiothérapie, centre Antoine-Lacassagne, Nice, France
| | - A Hasbini
- Département de radiothérapie, clinique Pasteur, Brest, France
| | - P Le Tallec
- Association française du personnel paramédical d'électroradiologie, Montrouge, France
| | - É Monpetit
- Département de radiothérapie, clinique Saint-Yves, Vannes, France
| | - J-J Santini
- Département de radiothérapie, Institut régional du cancer de Montpellier, Montpellier, France
| | - C Bougier
- Département de radiothérapie, Institut régional du cancer de Montpellier, Montpellier, France; Fédération universitaire de radiothérapie oncologie de Méditerranée Occitanie, institut du cancer de Montpellier, université de Montpellier, U1194, Inserm, Montpellier, France
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Rosa AA, de Sousa CFPM, Pimentel LCF, Martins HL, Moraes FY, Marta GN, Castilho MS. Radiotherapy resources in Brazil (RT2030): a comprehensive analysis and projections for 2030. Lancet Oncol 2023; 24:903-912. [PMID: 37541272 DOI: 10.1016/s1470-2045(23)00284-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/02/2023] [Accepted: 06/08/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND The demand for radiotherapy in Brazil is unfulfilled, and the scarcity of data on the national network hampers the development of effective policies. We aimed to evaluate the current situation, estimate demands and requirements, and provide an action plan to ensure access to radiotherapy for those in need by 2030. METHODS The Brazilian Society for Radiation Oncology created a task force (RT2030) including physicians, medical physicists, policy makers, patient advocates, and suppliers, all of whom were major stakeholders involved in Brazilian radiotherapy care. The group was further divided into seven working groups to address themes associated with radiotherapy care in Brazil. From March 1, 2019, to Aug 3, 2020, there were monthly meetings between the group's leaders and the Central Committee and six general meetings. First, a comprehensive search of all different national databases was done to identify all radiotherapy centres. Questionnaires evaluating radiotherapy infrastructure and human resources and assing the availability, distribution, capacity, and workload of resources were created and sent to the radioprotection supervisor of each centre. Results were analysed nationally and across the country's regions and health-care systems. A pre-planned review of available databases was done to gather data on active radiation oncology centres and the distribution of radiotherapy machines (linear accelerators [LINACs]) across Brazil. We used national population and cancer incidence projections, recommended radiotherapy usage from the medical literature, and national working patterns to project radiotherapy demands in 2030. An action plan was established with suggestions to address the gaps and meet the demands. FINDINGS The database search yielded 279 centres with an active radiotherapy registry. After applying predefined exclusion criteria, 263 centres were identified that provided external beam radiotherapy machines with or without brachytherapy. All 263 operational centres answered the questionnaires sent on Dec 9, 2019, which were then returned between Jan 1 and June 30, 2020. There were 409 therapy machines, 646 radiation oncologists, 533 physicists, and 230 989 patients undergoing radiotherapy (150 628 [65·2%] in the public health-care system and 80 937 [35·0%] in private). The mean annual occupation rate was 566 patients per treatment machine (SD 250). The number of residents per treatment machine ranged from 258 333 to 1 800 000. Technology availability varied considerably among regions and systems. In 2030, 639 994 new cancer cases are expected, which will require 332 797 radiotherapy courses. Therefore, 530 LINACs, 1079 radiation oncologists, and 1060 medical physicists will be needed. INTERPRETATION The expected increase in cancer incidence in the coming years will probably increase the disparities in cancer care and the burden for Brazilian patients. We provide a roadmap of the current situation and the particularities of the Brazilian radiotherapy network, which can serve as a starting point for cancer policy planning to improve this scenario. FUNDING Accuray, BRAINLAB, Elekta, IBA, ONE medical solution, SUN NUCLEAR corporation, VARIAN, and ZIGMA.
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Affiliation(s)
- Arthur Accioly Rosa
- Grupo Oncoclínicas, Salvador, Bahia, Brazil; Latin America Cooperative Oncology Group, Porto Alegre, Brazil
| | | | | | | | - Fabio Ynoe Moraes
- Latin America Cooperative Oncology Group, Porto Alegre, Brazil; Department of Oncology, Division of Radiation Oncology, Kingston General Hospital, Queen's University, Kingston, ON, Canada.
| | - Gustavo Nader Marta
- Latin America Cooperative Oncology Group, Porto Alegre, Brazil; Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil
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Shaaban SG, LeCompte MC, Kleinberg LR, Redmond KJ, Page BR. Recognition and Management of the Long-term Effects of Cranial Radiation. Curr Treat Options Oncol 2023; 24:880-891. [PMID: 37145381 DOI: 10.1007/s11864-023-01078-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 05/06/2023]
Abstract
OPINION STATEMENT Cranial radiation is ubiquitous in the treatment of primary malignant and benign brain tumors as well as brain metastases. Improvement in radiotherapy targeting and delivery has led to prolongation of survival outcomes. As long-term survivorship improves, we also focus on prevention of permanent side effects of radiation and mitigating the impact when they do occur. Such chronic treatment-related morbidity is a major concern with significant negative impact on patient's and caregiver's respective quality of life. The actual mechanisms responsible for radiation-induced brain injury remain incompletely understood. Multiple interventions have been introduced to potentially prevent, minimize, or reverse the cognitive deterioration. Hippocampal-sparing intensity modulated radiotherapy and memantine represent effective interventions to avoid damage to regions of adult neurogenesis. Radiation necrosis frequently develops in the high radiation dose region encompassing the tumor and surrounding normal tissue. The radiographic findings in addition to the clinical course of the patients' symptoms are taken into consideration to differentiate between tissue necrosis and tumor recurrence. Radiation-induced neuroendocrine dysfunction becomes more pronounced when the hypothalamo-pituitary (HP) axis is included in the radiation treatment field. Baseline and post-treatment evaluation of hormonal profile is warranted. Radiation-induced injury of the cataract and optic system can develop when these structures receive an amount of radiation that exceeds their tolerance. Special attention should always be paid to avoid irradiation of these sensitive structures, if possible, or minimize their dose to the lowest limit.
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Affiliation(s)
- Sherif G Shaaban
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins Medicine, 401 North Broadway, Suite 1440, Baltimore, MD, 21287, USA
| | - Michael C LeCompte
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins Medicine, 401 North Broadway, Suite 1440, Baltimore, MD, 21287, USA
| | - Lawrence R Kleinberg
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins Medicine, 401 North Broadway, Suite 1440, Baltimore, MD, 21287, USA
| | - Kristin J Redmond
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins Medicine, 401 North Broadway, Suite 1440, Baltimore, MD, 21287, USA
| | - Brandi R Page
- Department of Radiation Oncology-National Capitol Region, Johns Hopkins Medicine, 6420 Rockledge Drive Suite 1200, Bethesda, MD, 20817, USA.
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Colmenares R, Carrión-Marchante R, Martín ME, Salinas Muñoz L, García-Bermejo ML, Oller JC, Muñoz A, Blanco F, Rosado J, Lozano AI, Álvarez S, García-Vicente F, García G. Dependence of Induced Biological Damage on the Energy Distribution and Intensity of Clinical Intra-Operative Radiotherapy Electron Beams. Int J Mol Sci 2023; 24:10816. [PMID: 37445992 DOI: 10.3390/ijms241310816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
The survival fraction of epithelial HaCaT cells was analysed to assess the biological damage caused by intraoperative radiotherapy electron beams with varying energy spectra and intensities. These conditions were achieved by irradiating the cells at different depths in water using nominal 6 MeV electron beams while consistently delivering a dose of 5 Gy to the cell layer. Furthermore, a Monte Carlo simulation of the entire irradiation procedure was performed to evaluate the molecular damage in terms of molecular dissociations induced by the radiation. A significant agreement was found between the molecular damage predicted by the simulation and the damage derived from the analysis of the survival fraction. In both cases, a linear relationship was evident, indicating a clear tendency for increased damage as the averaged incident electron energy and intensity decreased for a constant absorbed dose, lowering the dose rate. This trend suggests that the radiation may have a more pronounced impact on surrounding healthy tissues than initially anticipated. However, it is crucial to conduct additional experiments with different target geometries to confirm this tendency and quantify the extent of this effect.
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Affiliation(s)
- Rafael Colmenares
- Servicio de Radiofísica, IRYCIS-Hospital Universitario Ramón y Cajal, Carretera de Colmenar Viejo km 9100, 28034 Madrid, Spain
| | - Rebeca Carrión-Marchante
- Grupo de Aptámeros, Departamento de Bioquímica-Investigación, IRYCIS-Hospital Universitario Ramón y Carretera de Colmenar Viejo km 9100, 28034 Madrid, Spain
| | - M Elena Martín
- Grupo de Aptámeros, Departamento de Bioquímica-Investigación, IRYCIS-Hospital Universitario Ramón y Carretera de Colmenar Viejo km 9100, 28034 Madrid, Spain
| | - Laura Salinas Muñoz
- Biomarkers and Therapeutic Targets Group, IRYCIS, RedinREN, Hospital Universitario Ramón y Cajal, Carretera de Colmenar km 9100, 28034 Madrid, Spain
| | - María Laura García-Bermejo
- Biomarkers and Therapeutic Targets Group, IRYCIS, RedinREN, Hospital Universitario Ramón y Cajal, Carretera de Colmenar km 9100, 28034 Madrid, Spain
| | - Juan C Oller
- Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas-CIEMAT, 28040 Madrid, Spain
| | - Antonio Muñoz
- Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas-CIEMAT, 28040 Madrid, Spain
| | - Francisco Blanco
- Departamento de Estructura de la Materia, Física Térmica y Electrónica e IPARCOS, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Jaime Rosado
- Departamento de Estructura de la Materia, Física Térmica y Electrónica e IPARCOS, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Ana I Lozano
- Instituto de Física Fundamental, Consejo Superior de Investigaciones Científicas, 28006 Madrid, Spain
| | - Sofía Álvarez
- Instituto de Física Fundamental, Consejo Superior de Investigaciones Científicas, 28006 Madrid, Spain
| | - Feliciano García-Vicente
- Servicio de Radiofísica, IRYCIS-Hospital Universitario Ramón y Cajal, Carretera de Colmenar Viejo km 9100, 28034 Madrid, Spain
| | - Gustavo García
- Instituto de Física Fundamental, Consejo Superior de Investigaciones Científicas, 28006 Madrid, Spain
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2522, Australia
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Verghote F, Van Praet C, De Maeseneer D, Berquin C, Vanneste B, De Visschere P, Verbeke SLJ, Fonteyne V. Radiotherapy Use in Muscle-Invasive Bladder Cancer: Review of the Guidelines and Impact of Increased Awareness in Patient Referral at a Tertiary Center in Belgium. Cancer Manag Res 2023; 15:511-521. [PMID: 37337479 PMCID: PMC10276995 DOI: 10.2147/cmar.s407031] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/04/2023] [Indexed: 06/21/2023] Open
Abstract
Purpose Pronounced underuse of radiotherapy (RT) in muscle-invasive bladder cancer (MIBC) is reported. This study aims to assess the awareness about the role of RT in different MIBC settings and see whether this has increased since 2017. Materials and Methods We reviewed the bladder cancer guidelines of the EAU, ESMO, NCCN, NICE, and AUA/ASCO/ASTRO/SUO, focusing on the role of RT in MIBC. In 2017, we evaluated the use of RT in MIBC in Belgium. This raised awareness about the indications of RT in different MIBC settings. Here, we present a retrospective pattern of care analysis of the RT use for MIBC patients at our center from January 2012 until December 2021. Frequency of RT use, patient, disease and treatment characteristics were compared between two 5-year periods (2012-2016 and 2017-2021). Results Review of the guidelines suggested that RT can be used as a treatment option in most MIBC settings. However, differences between guideline recommendations existed and high-level evidence was often lacking. Overall, 221 unique MIBC patients received RT at our center. RT use for MIBC was 39% higher in the second 5-year period (Between the same periods, the number of new MIBC registrations increased with 26%). The most pronounced increase, ie, 529%, was observed in the primary setting and was in parallel with patient preference becoming the main indication for RT. Participation in clinical trials seems to have had an important impact on the frequency of RT use in the adjuvant and metastatic setting. Conclusion We provide a critical overview of the RT indications in MIBC as recommended by the international guidelines. Increased awareness about RT as a treatment option in MIBC seems to have an impact on the treatment choice in clinical practice, as was observed in our tertiary center.
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Affiliation(s)
- Flor Verghote
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Charles Van Praet
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Daan De Maeseneer
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Camille Berquin
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Ben Vanneste
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Pieter De Visschere
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | | | - Valérie Fonteyne
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
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Pedretti S, De Santis MC, Vavassori V, Bortolato B, Colciago RR, Cagna E, Doino DP, Cocchi A, Gerardi MA, Alterio D, Magrini SM, Tonoli S. Image-guided radiotherapy (IGRT) in Lombardy, Italy: a survey by the Lombardy section of the Italian Association of Radiotherapy and Clinical Oncology (AIRO-Lombardy). Expert Rev Anticancer Ther 2023; 23:661-667. [PMID: 37129314 DOI: 10.1080/14737140.2023.2208864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Image-guided radiation therapy (IGRT) has changed clinical practice. We proposed a survey to radiotherapy centers in Lombardy to picture the current clinical practice of its use. RESEARCH DESIGN AND METHODS The survey consisted of 32 multiple-choice questions, divided into five topics: type of hospital, patients treated in 2019, number of LINACs; presence of protocols and staff involved in IGRT; IGRT in stereotaxis; IGRT in non-stereotactic treatments; availability of medical and technical staff. RESULTS Twenty-seven directors answered (77%). Most centers (74%) have produced protocols to ensure uniformity in the IGRT process. The most widely used IGRT modality (92%) is cone-beam CT. Daily IGRT control is favored for prostate (100%), head and neck (87%), and lung (78%) neoplasms. The resident doctors can always perform supervised IGRT matching in only six centers. Radiation therapists perform IGRT controls only for some sites in 12 cases (44%) and always in 9 cases (33%). Radiation oncologists are present in real time, in most cases. CONCLUSIONS Today, IGRT can be considered standard practice but at the price of more time-consuming procedures. A balance between a fully physician-controlled process and an increased role for specifically trained RTTs is actively being sought.
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Affiliation(s)
- Sara Pedretti
- Radiation Oncology Department, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Maria Carmen De Santis
- Radiation Oncology Department, Istituto Nazionale per lo Studio e la cura dei tumori, Milano, Italy
| | - Vittorio Vavassori
- Humanitas Gavazzeni Hospital, Radiation Oncology Department, Bergamo, Italy
| | - Barbara Bortolato
- Radiation Oncology Department, ASST della Valle Olona, Busto Arsizio, Italy
| | - Riccardo Ray Colciago
- Radiation Oncology Department, Istituto Nazionale per lo Studio e la cura dei tumori, Milano, Italy
| | - Emanuela Cagna
- Radiation Oncology Department, ASST Lariana, Como, Italy
| | | | | | | | - Daniela Alterio
- Radiation Oncology Department, European Institue of Oncology, Milno, Italy
| | | | - Sandro Tonoli
- Radiation Oncology Department, ASST Cremona, Cremona, Italy
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11
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Ghosh Laskar S, Sinha S, Gupta M, Karmakar S, Nivedha J M, Kannan S, Budrukkar A, Swain M, Kumar A, Gupta T, Murthy V, Chaukar D, Pai P, Chaturvedi P, Pantvaidya G, Nair D, Nair S, Thiagarajan S, Deshmukh A, Noronha V, Patil V, Joshi A, Prabhash K, Agarwal JP. Prophylactic versus reactive feeding approach in patients undergoing adjuvant radiation therapy for oral cavity squamous cell carcinoma: A propensity score matched-pair analysis. Head Neck 2023; 45:1226-1236. [PMID: 36912016 DOI: 10.1002/hed.27336] [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: 09/02/2022] [Revised: 01/18/2023] [Accepted: 02/27/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND To assess the efficacy of prophylactic versus reactive feeding strategy in oral cavity squamous cell carcinoma (OCSCC) patients receiving adjuvant radiation therapy (RT). METHODS This was a post hoc analysis of patients of OCSCC enrolled in a randomized trial comparing three adjuvant strategies. In this trial, till 2010, a prophylactic feeding approach was followed for all patients. Since January 2011, a reactive feeding approach was followed. RESULTS Two hundred and sixty-eight in each cohort (total n = 526) were eligible for analysis after propensity score matching. At 6 weeks post-RT completion, the median weight loss in the prophylactic versus reactive cohort was 5 versus 3 kg, p = 0.002. At all other time points until 1 year, the median weight loss was lesser in reactive than in the prophylactic cohort. CONCLUSIONS A reactive feeding tube approach should be preferred for OCSCC receiving adjuvant RT.
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Affiliation(s)
- Sarbani Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shwetabh Sinha
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Meetakshi Gupta
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shreyasee Karmakar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Meenakshi Nivedha J
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sadhana Kannan
- Clinical Research Secretariat, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Monali Swain
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Anuj Kumar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Devendra Chaukar
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Prathamesh Pai
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Gouri Pantvaidya
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Deepa Nair
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sudhir Nair
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shivakumar Thiagarajan
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Anuja Deshmukh
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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12
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De-Colle C, Kirby A, Russell N, Shaitelman S, Currey A, Donovan E, Hahn E, Han K, Anandadas C, Mahmood F, Lorenzen E, van den Bongard D, Groot Koerkamp M, Houweling A, Nachbar M, Thorwarth D, Zips D. Adaptive radiotherapy for breast cancer. Clin Transl Radiat Oncol 2023; 39:100564. [PMID: 36632056 PMCID: PMC9826896 DOI: 10.1016/j.ctro.2022.100564] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 12/07/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Research in the field of local and locoregional breast cancer radiotherapy aims to maintain excellent oncological outcomes while reducing treatment-related toxicity. Adaptive radiotherapy (ART) considers variations in target and organs at risk (OARs) anatomy occurring during the treatment course and integrates these in re-optimized treatment plans. Exploiting ART routinely in clinic may result in smaller target volumes and better OAR sparing, which may lead to reduction of acute as well as late toxicities. In this review MR-guided and CT-guided ART for breast cancer patients according to different clinical scenarios (neoadjuvant and adjuvant partial breast irradiation, whole breast, chest wall and regional nodal irradiation) are reviewed and their advantages as well as challenging aspects discussed.
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Affiliation(s)
- C. De-Colle
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
| | - A. Kirby
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, United Kingdom
| | - N. Russell
- Department of Radiotherapy, The Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - S.F. Shaitelman
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - A. Currey
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - E. Donovan
- Department of Radiation Oncology, Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Canada
| | - E. Hahn
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | - K. Han
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | - C.N. Anandadas
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - F. Mahmood
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - E.L. Lorenzen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | | | - M.L. Groot Koerkamp
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - A.C. Houweling
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - M. Nachbar
- Section for Biomedical Physics, Department of Radiation Oncology. University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
| | - D. Thorwarth
- Section for Biomedical Physics, Department of Radiation Oncology. University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), partner site Tübingen; and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - D. Zips
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), partner site Tübingen; and German Cancer Research Center (DKFZ), Heidelberg, Germany
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13
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Franco P, De Felice F, Kaidar-Person O, Gabrys D, Marta GN, Banini M, Livi L, Jagsi R, Coles CE, Poortmans P, Meattini I. Equity, Diversity, and Inclusion in Radiation Oncology: A Bibliometric Analysis and Critical Review. Int J Radiat Oncol Biol Phys 2023; 116:232-245. [PMID: 36841344 DOI: 10.1016/j.ijrobp.2023.02.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 02/12/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023]
Abstract
The promotion of equity, diversity, and inclusion (EDI) is being increasingly pursued in health care, both in general and within radiation oncology. Because bibliometrics is a powerful tool to reveal the scientific literature on a specific topic during a certain timespan, a systematic bibliometric analysis of the documents published on EDI in radiation oncology was performed, aiming at exploring common patterns in research and emerging trends, tracking collaborations and networks, and anticipating future directions in clinical research. Standard descriptive statistics and bibliometric techniques were used in the analysis. A collaboration network and thematic map were generated from the data. Four domains were represented: (1) motor themes, including themes well developed and important for the structuring of the research field; (2) niche themes, representing the isolated topics that do not share important external links with other themes; (3) emerging themes, referring to still weakly developed topics; and (4) basic themes, including the essential topics. EDI in the profession of radiation oncology is essential to ensure that the workforce delivering radiation oncology care both draws from the full talent pool of human capital and delivers the highest quality science and clinical care to all patients. The burgeoning literature on EDI in radiation oncology suggests that a large and growing cohort of scholars within radiation oncology are dedicated to addressing these important challenges.
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Affiliation(s)
- Pierfrancesco Franco
- Department of Translational Medicine (DIMET), University of Eastern Piedmont, Novara, Italy; Department of Radiation Oncology, Maggiore della Carità University Hospital, Novara, Italy
| | - Francesca De Felice
- Department of Radiotherapy, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Orit Kaidar-Person
- Breast Cancer Radiation Therapy Unit, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Dorota Gabrys
- Radiotherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Gustavo Nader Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo/Brasília, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Marco Banini
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | | | - Philip Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
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14
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Price P, Sullivan R, Ahmed A, Wishart GC. UK cancer care: a watershed moment and the need for urgent intervention. Lancet Oncol 2023; 24:133-138. [PMID: 36528033 DOI: 10.1016/s1470-2045(22)00754-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Pat Price
- Department of Surgery and Cancer, Imperial College, London, UK; Chairman of Trustees, Radiotherapy UK, London, UK.
| | | | | | - Gordon C Wishart
- Check4Cancer, Cambridge, UK; School of Medicine, Anglia Ruskin University, Cambridge, UK
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15
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Legouté F, Lesueur P, El Kabbaj O, Ghannam Y, Michalet M, Monpetit E, Azria D, Giraud P, Calais G, Pointreau Y, Ollivier L. [French careers in oncology radiotherapy: Crossing views]. Cancer Radiother 2023; 27:75-79. [PMID: 36008260 DOI: 10.1016/j.canrad.2022.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 02/06/2023]
Abstract
The French Society of Young Radiation Oncologists (SFjRO), the National Union of Radiation Oncologists (SNRO) and the French Society of Oncological Radiotherapy (SFRO) aim to reconcile career opportunities and demographic needs in oncology. In 2021, 932 radiation oncologists (RO) are in regular activity in France, this represents an increase of more than 20% in ten years. Physician distribution is changing in public hospitals, cancer centers and private clinics. Currently one third of ROs works in each sector. In addition, fifteen percent of ROs have a mixed activity. In 2021, 180 young RO (trainees and residents) were questioned by SFjRO board about their training, internship, coaching and career guidance. An interactive communication was organized during the 32nd SFRO Meeting in 2021. It was an opportunity to bring the results of this study. More than 70% RO interviewed answered to the survey, for 55% among them, career choice was difficult. In order to help young ROs in their professional approach, three RO made an oral presentation during this session, about radiotherapy in public hospitals, private centers or with a mixed practice. The aim of this article is to summarize the highlights of the last SFjRO/SFRO session: expectations of young RO, career prospects and trends.
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Affiliation(s)
- F Legouté
- Service de radiothérapie, centre hospitalier départemental Vendée, boulevard Stéphane-Moreau, 85000 La Roche-sur-Yon, France.
| | - P Lesueur
- Département de radiothérapie, centre François-Baclesse, Caen, France; Département de radiothérapie, centre Guillaume-le-Conquérant, Le-Havre, France
| | - O El Kabbaj
- Centre Saint-Yves-radiothérapie, 11, rue du Docteur-Audic, 56000 Vannes, France
| | - Y Ghannam
- Société française des jeunes radiothérapeutes oncologues (SFjRO), centre Antoine-Béclère, 47, rue de la Colonie, 75013 Paris, France; Département de radiothérapie, Institut de cancérologie de l'ouest, 15, rue André-Boquel, 49100 Angers, France
| | - M Michalet
- Société française des jeunes radiothérapeutes oncologues (SFjRO), centre Antoine-Béclère, 47, rue de la Colonie, 75013 Paris, France; Service d'oncologie radiothérapie, Institut du cancer de Montpellier, Montpellier, France
| | - E Monpetit
- Centre Saint-Yves-radiothérapie, 11, rue du Docteur-Audic, 56000 Vannes, France; Syndicat national des radiothérapeutes oncologues (SNRO), centre Saint-Yves radiothérapie, 11, rue du Docteur-Audic, 56000 Vannes, France
| | - D Azria
- Service d'oncologie radiothérapie, Institut du cancer de Montpellier, Montpellier, France; Société française de radiothérapie oncologique (SFRO), centre Antoine-Béclère, 47, rue de la Colonie, 75013 Paris, France
| | - P Giraud
- Société française de radiothérapie oncologique (SFRO), centre Antoine-Béclère, 47, rue de la Colonie, 75013 Paris, France; Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, université Paris Cité, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - G Calais
- Service de radiothérapie, centre régional universitaire de cancérologie Henry-S.-Kaplan, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - Y Pointreau
- Service de radiothérapie, centre régional universitaire de cancérologie Henry-S.-Kaplan, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Centre Jean-Bernard, clinique Victor-Hugo, (Institut interrégional de cancérologie), 9, rue Beauverger, 72000 Le Mans, France
| | - L Ollivier
- Société française des jeunes radiothérapeutes oncologues (SFjRO), centre Antoine-Béclère, 47, rue de la Colonie, 75013 Paris, France; Département de radiothérapie, Institut de cancérologie de l'ouest, boulevard Professeur-Jacques-Monod, 44800 Saint-Herblain, France
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16
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Call to the UK Government for a radical new cancer recovery plan. Lancet Oncol 2023; 24:e71. [PMID: 36566756 DOI: 10.1016/s1470-2045(22)00787-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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17
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Lara PC, Benstead K, Erikssen JG. Training in Radiation and Clinical Oncology in Europe. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231197982. [PMID: 37692557 PMCID: PMC10483962 DOI: 10.1177/23821205231197982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 08/11/2023] [Indexed: 09/12/2023]
Abstract
The European population is strongly affected by cancer. Radiotherapy is roughly used in 50% of cancer patients in European countries. The increased cancer burden demands a new generation of radiation/clinical oncologist (RO/CO) that, besides a strong evidence-based oncological knowledge, will be ready for leadership in cancer care. The mutual recognition of professional qualifications of Radiation/Clinical Oncology in the EU needs training harmonization. The European Society of Radiotherapy and Oncology (ESTRO) and the European Union for Medical Specialties (UEMS) made important efforts toward a European Common Curriculum for RO/CO leadership in cancer care. If qualifications are mutually recognized, the training supporting these qualifications should be also harmonized. Since 1991, ESTRO produced several editions of the Core Curriculum in Radiation Oncology (1991, 2004, 2012, 2019). These Core Curricula were endorsed as European Training Requirements by the UEMS in 2004, 2013, and 2019. A core curriculum for clinical oncology was also produced to provide this harmonization tool to countries where radiation oncology is practiced inside the broader specialty of clinical oncology. New initiatives are in place to continuously adapt the training programs to the rapidly evolving cancer care organization.
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Affiliation(s)
- Pedro C Lara
- Canarian Comprehensive Cancer Center, San Roque University Hospital, Fernando Pessoa Canarias University, Las Palmas, Spain
| | - Kim Benstead
- Gloucestershire Hospitals NHS Foundation Trust, Brockworth, UK
| | - Jesper Grau Erikssen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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18
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Thiotepa, busulfan and fludarabine conditioning-regimen is a promising approach for older adult patients with acute lymphoblastic leukemia treated with allogeneic stem cell transplantation. Bone Marrow Transplant 2023; 58:61-67. [PMID: 36224494 DOI: 10.1038/s41409-022-01841-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/21/2022] [Accepted: 09/26/2022] [Indexed: 01/07/2023]
Abstract
For acute lymphoblastic leukemia (ALL) patients, total body irradiation (TBI)- based conditioning regimens are the first choice specially in young population. However, several studies have shown an equivalence in clinical outcomes with thiotepa-based conditioning regimen. We performed a retrospective study to evaluate the outcome of adult ALL patients who received allogeneic hematopoietic stem cell transplantation (allo-HCT) with a thiotepa-busulfan-fludarabine (TBF) myeloablative conditioning regimen with reduced toxicity. Fifty-five patients received a TBF regimen. The median age of the patients was 51 years (range, 17 to 72.4). Most patients had a diagnosis of B-ALL (93%) with 7% having T-ALL. Two - and 5-year overall survival was 73.2% and 64%, respectively. At 2 years, leukemia-free survival and GVHD-free, relapse-free survival were 59.5% and 57.6%, and at 5 years, 53.4% and 51.8%, respectively. The 5-year non-relapse mortality was 15%. The day 180 cumulative incidence (CI) of grade II-IV acute GVHD and grade III-IV acute GVHD were 38.2% and 5.5%, respectively. At 2 years, the CI of chronic GVHD and extensive chronic GVHD was 16.9% and 1.9%, respectively. Our study results do suggest that using TBF as the conditioning regimen in adult ALL patients is a promising option with acceptable toxicity.
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19
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Iturri L, Bertho A, Lamirault C, Juchaux M, Gilbert C, Espenon J, Sebrie C, Jourdain L, Pouzoulet F, Verrelle P, De Marzi L, Prezado Y. Proton FLASH Radiation Therapy and Immune Infiltration: Evaluation in an Orthotopic Glioma Rat Model. Int J Radiat Oncol Biol Phys 2022:S0360-3016(22)03639-2. [PMID: 36563907 DOI: 10.1016/j.ijrobp.2022.12.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 12/02/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE FLASH radiation therapy (FLASH-RT) is a promising radiation technique that uses ultrahigh doses of radiation to increase the therapeutic window of the treatment. FLASH-RT has been observed to provide normal tissue sparing at high dose rates and similar tumor control compared with conventional RT, yet the biological processes governing these radiobiological effects are still unknown. In this study, we sought to investigate the potential immune response generated by FLASH-RT in a high dose of proton therapy in an orthotopic glioma rat model. METHODS AND MATERIALS We cranially irradiated rats with a single high dose (25 Gy) using FLASH dose rate proton irradiation (257 ± 2 Gy/s) or conventional dose rate proton irradiation (4 ± 0.02 Gy/s). We first assessed the protective FLASH effect that resulted in our setup through behavioral studies in naïve rats. This was followed by a comprehensive analysis of immune cells in blood, healthy tissue of the brain, and tumor microenvironment by flow cytometry. RESULTS Proton FLASH-RT spared memory impairment produced by conventional high-dose proton therapy and induced a similar tumor infiltrating lymphocyte recruitment. Additionally, a general neuroinflammation that was similar in both dose rates was observed. CONCLUSIONS Overall, this study demonstrated that FLASH proton therapy offers a neuro-protective effect even at high doses while mounting an effective lymphoid immune response in the tumor.
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Affiliation(s)
- Lorea Iturri
- Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay, France.
| | - Annaïg Bertho
- Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay, France
| | - Charlotte Lamirault
- Institut Curie, PSL University, Département de Recherche Translationnelle, CurieCoreTech-Experimental Radiotherapy (RadeXp), Paris, France
| | - Marjorie Juchaux
- Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay, France
| | - Cristèle Gilbert
- Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay, France
| | - Julie Espenon
- Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay, France
| | - Catherine Sebrie
- CEA, CNRS, Inserm, Service Hospitalier Frédéric Joliot, BIOMAPS Université Paris-Saclay, Orsay, France
| | - Laurène Jourdain
- CEA, CNRS, Inserm, Service Hospitalier Frédéric Joliot, BIOMAPS Université Paris-Saclay, Orsay, France
| | - Frédéric Pouzoulet
- Institut Curie, PSL University, Département de Recherche Translationnelle, CurieCoreTech-Experimental Radiotherapy (RadeXp), Paris, France
| | - Pierre Verrelle
- Institut Curie, Campus Universitaire, PSL Research University, University Paris Saclay, INSERM LITO (U1288), Orsay, 91898 France; Centre de Protonthérapie d'Orsay, Radiation Oncology Department, Campus Universitaire, Institut Curie, PSL Research University, Orsay, 91898 France
| | - Ludovic De Marzi
- Institut Curie, Campus Universitaire, PSL Research University, University Paris Saclay, INSERM LITO (U1288), Orsay, 91898 France; Centre de Protonthérapie d'Orsay, Radiation Oncology Department, Campus Universitaire, Institut Curie, PSL Research University, Orsay, 91898 France
| | - Yolanda Prezado
- Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay, France
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Protective Role of Natural Compounds under Radiation-Induced Injury. Nutrients 2022; 14:nu14245374. [PMID: 36558533 PMCID: PMC9786992 DOI: 10.3390/nu14245374] [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: 11/11/2022] [Revised: 12/05/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
In recent years, evidence has shown the potential therapeutic effects of different natural compounds for the prevention and treatment of radiotherapy-induced mucositis (RIOM). RIOM represents one of the most frequent side effects associated with anti-neoplastic treatments affecting patients' quality of life and treatment response due to radiation therapy discontinuation. The innate radio-protective ability of natural products obtained from plants is in part due to the numerous antioxidants possessed as a part of their normal secondary metabolic processes. However, oxygen presence is a key point for radiation efficacy on cancer cells. The aim of this review is to describe the most recent evidence on radiation-induced injury and the emerging protective role of natural compounds in preventing and treating this specific damage without compromising treatment efficacy.
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Real-World Patterns and Decision Drivers of Radiotherapy for Lung Cancer Patients in Romania: RADIO-NET Study Results. Diagnostics (Basel) 2022; 12:diagnostics12123089. [PMID: 36553096 PMCID: PMC9777374 DOI: 10.3390/diagnostics12123089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/24/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
Radiotherapy (RT) plays a crucial role in all stages of lung cancer. Data on recent real-world RT patterns and main drivers of RT decisions in lung cancer in Romania is scarce; we aimed to address these knowledge gaps through this physician-led medical chart review in 16 RT centers across the country. Consecutive patients with lung cancer receiving RT as part of their disease management between May-October 2019 (pre-COVID-19 pandemic) were included. Descriptive statistics were generated for all variables. This cohort included 422 patients: median age 63 years, males 76%, stages I-II 6%, III 43%, IV 50%, mostly adeno- and squamous cell carcinoma (76%), ECOG 0-1 50% at the time of RT. Curative intent RT was used in 36% of cases, palliative RT in 64%. Delays were reported in 13% of patients, mostly due to machine breakdown (67%). Most acute reported RT toxicity was esophagitis (19%). Multiple disease-, patient-, physician- and context-related drivers counted in the decision-making process. This is the first detailed analysis of RT use in lung cancer in Romania. Palliative RT still dominates the landscape. Earlier diagnosis, coordinated multidisciplinary strategies, and the true impact of the multimodal treatments on survival are strongly needed to improve lung cancer outcomes.
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Calvo FA, Ayestaran A, Serrano J, Cambeiro M, Palma J, Meiriño R, Morcillo MA, Lapuente F, Chiva L, Aguilar B, Azcona D, Pedrero D, Pascau J, Delgado JM, Aristu J, Prezado Y. Practice-oriented solutions integrating intraoperative electron irradiation and personalized proton therapy for recurrent or unresectable cancers: Proof of concept and potential for dual FLASH effect. Front Oncol 2022; 12:1037262. [PMID: 36452493 PMCID: PMC9703091 DOI: 10.3389/fonc.2022.1037262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/26/2022] [Indexed: 11/15/2022] Open
Abstract
Background Oligo-recurrent disease has a consolidated evidence of long-term surviving patients due to the use of intense local cancer therapy. The latter combines real-time surgical exploration/resection with high-energy electron beam single dose of irradiation. This results in a very precise radiation dose deposit, which is an essential element of contemporary multidisciplinary individualized oncology. Methods Patient candidates to proton therapy were evaluated in Multidisciplinary Tumor Board to consider improved treatment options based on the institutional resources and expertise. Proton therapy was delivered by a synchrotron-based pencil beam scanning technology with energy levels from 70.2 to 228.7 MeV, whereas intraoperative electrons were generated in a miniaturized linear accelerator with dose rates ranging from 22 to 36 Gy/min (at Dmax) and energies from 6 to 12 MeV. Results In a period of 24 months, 327 patients were treated with proton therapy: 218 were adults, 97 had recurrent cancer, and 54 required re-irradiation. The specific radiation modalities selected in five cases included an integral strategy to optimize the local disease management by the combination of surgery, intraoperative electron boost, and external pencil beam proton therapy as components of the radiotherapy management. Recurrent cancer was present in four cases (cervix, sarcoma, melanoma, and rectum), and one patient had a primary unresectable locally advanced pancreatic adenocarcinoma. In re-irradiated patients (cervix and rectum), a tentative radical total dose was achieved by integrating beams of electrons (ranging from 10- to 20-Gy single dose) and protons (30 to 54-Gy Relative Biological Effectiveness (RBE), in 10-25 fractions). Conclusions Individual case solution strategies combining intraoperative electron radiation therapy and proton therapy for patients with oligo-recurrent or unresectable localized cancer are feasible. The potential of this combination can be clinically explored with electron and proton FLASH beams.
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Affiliation(s)
- Felipe A Calvo
- Department of Radiation Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | - Adriana Ayestaran
- Department of Radiation Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | - Javier Serrano
- Department of Radiation Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | - Mauricio Cambeiro
- Department of Radiation Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | - Jacobo Palma
- Department of Radiation Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | - Rosa Meiriño
- Department of Radiation Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | - Miguel A Morcillo
- Medical Applications Unit, Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Madrid, Spain
| | - Fernando Lapuente
- Department of Surgery, Clinica Universidad de Navarra, Madrid, Spain
| | - Luis Chiva
- Department of Gynecology and Obstretics, Clinica Universidad de Navarra, Madrid, Spain
| | - Borja Aguilar
- Department of Medical Physics, Clinica Universidad de Navarra, Madrid, Spain
| | - Diego Azcona
- Department of Medical Physics, Clinica Universidad de Navarra, Madrid, Spain
| | - Diego Pedrero
- Department of Medical Physics, Clinica Universidad de Navarra, Madrid, Spain
| | - Javier Pascau
- Department of Bioengineering and Aerospace Engineering, Universidad Carlos III de Madrid, Madrid, Spain
| | - José Miguel Delgado
- Department of Radiation Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | - Javier Aristu
- Department of Radiation Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | - Yolanda Prezado
- Translational Research Department. Institut Curie, Université PSL, CNRS UMR, Inserm, Signalisation, Radiobiologie et Cancer, Orsay, France.,Université Paris-Saclay, CNRS UMR, Inserm, Signalisation, Radiobiologie et Cancer, Orsay, France
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23
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Faillace L, Alesini D, Bisogni G, Bosco F, Carillo M, Cirrone P, Cuttone G, De Arcangelis D, De Gregorio A, Di Martino F, Favaudon V, Ficcadenti L, Francescone D, Franciosini G, Gallo A, Heinrich S, Migliorati M, Mostacci A, Palumbo L, Patera V, Patriarca A, Pensavalle J, Perondi F, Remetti R, Sarti A, Spataro B, Torrisi G, Vannozzi A, Giuliano L. Perspectives in linear accelerator for FLASH VHEE: Study of a compact C-band system. Phys Med 2022; 104:149-159. [PMID: 36427487 DOI: 10.1016/j.ejmp.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 10/10/2022] [Accepted: 10/23/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE In order to translate the FLASH effect in clinical use and to treat deep tumors, Very High Electron Energy irradiations could represent a valid technique. Here, we address the main issues in the design of a VHEE FLASH machine. We present preliminary results for a compact C-band system aiming to reach a high accelerating gradient and high current necessary to deliver a Ultra High Dose Rate with a beam pulse duration of 3μs. METHODS The proposed system is composed by low energy high current injector linac followed by a high acceleration gradient structure able to reach 60-160 MeV energy range. To obtain the maximum energy, an energy pulse compressor options is considered. CST code was used to define the specifications RF parameters of the linac. To optimize the accelerated current and therefore the delivered dose, beam dynamics simulations was performed using TSTEP and ASTRA codes. RESULTS The VHEE parameters Linac suitable to satisfy FLASH criteria were simulated. Preliminary results allow to obtain a maximum energy of 160 MeV, with a peak current of 200 mA, which corresponds to a charge of 600 nC. CONCLUSIONS A promising preliminary design of VHEE linac for FLASH RT has been performed. Supplementary studies are on going to complete the characterization of the machine and to manufacture and test the RF prototypes.
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Affiliation(s)
- L Faillace
- INFN Laboratori Nazionali di Frascati, Italy.
| | - D Alesini
- INFN Laboratori Nazionali di Frascati, Italy
| | - G Bisogni
- INFN Sezione di Pisa, Italy; Department of Physics, University of Pisa, 56127 Pisa, Italy
| | - F Bosco
- SBAI Department, Sapienza University of Rome, Italy; INFN Sezione di Roma, Italy
| | - M Carillo
- SBAI Department, Sapienza University of Rome, Italy; INFN Sezione di Roma, Italy
| | - P Cirrone
- INFN Laboratori Nazionali del Sud, Catania, Italy
| | - G Cuttone
- INFN Laboratori Nazionali del Sud, Catania, Italy
| | - D De Arcangelis
- SBAI Department, Sapienza University of Rome, Italy; INFN Sezione di Roma, Italy
| | - A De Gregorio
- INFN Sezione di Roma, Italy; Department of Physics, Sapienza University, Piazzale Aldo Moro 2, 00185 Rome, Italy
| | - F Di Martino
- U.O. Fisica Sanitaria, Azienda Universitaria Ospedaliera Pisana, Pisa, Italy
| | - V Favaudon
- Institut Curie, Paris-Saclay University, PSL Research University, INSERM U1021/UMR3347, Orsay, France
| | - L Ficcadenti
- SBAI Department, Sapienza University of Rome, Italy; INFN Sezione di Roma, Italy
| | - D Francescone
- SBAI Department, Sapienza University of Rome, Italy; INFN Sezione di Roma, Italy
| | - G Franciosini
- INFN Sezione di Roma, Italy; Department of Physics, Sapienza University, Piazzale Aldo Moro 2, 00185 Rome, Italy
| | - A Gallo
- INFN Laboratori Nazionali di Frascati, Italy
| | - S Heinrich
- Institut Curie, Paris-Saclay University, PSL Research University, INSERM U1021/UMR3347, Orsay, France
| | - M Migliorati
- SBAI Department, Sapienza University of Rome, Italy; INFN Sezione di Roma, Italy
| | - A Mostacci
- SBAI Department, Sapienza University of Rome, Italy; INFN Sezione di Roma, Italy
| | - L Palumbo
- SBAI Department, Sapienza University of Rome, Italy; INFN Sezione di Roma, Italy
| | - V Patera
- SBAI Department, Sapienza University of Rome, Italy; INFN Sezione di Roma, Italy
| | - A Patriarca
- Institut Curie, PSL Research University, Proton Therapy Centre, Centre Universitaire, Orsay, France
| | - J Pensavalle
- INFN Sezione di Pisa, Italy; Department of Physics, University of Pisa, 56127 Pisa, Italy
| | - F Perondi
- SBAI Department, Sapienza University of Rome, Italy
| | - R Remetti
- SBAI Department, Sapienza University of Rome, Italy
| | - A Sarti
- SBAI Department, Sapienza University of Rome, Italy; INFN Sezione di Roma, Italy
| | - B Spataro
- INFN Laboratori Nazionali di Frascati, Italy
| | - G Torrisi
- INFN Laboratori Nazionali del Sud, Catania, Italy
| | - A Vannozzi
- INFN Laboratori Nazionali di Frascati, Italy
| | - L Giuliano
- SBAI Department, Sapienza University of Rome, Italy; INFN Sezione di Roma, Italy
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Turner S, Benstead K, Millar BA, Morris L, Seel M, Leech M, Eriksen JG, Giuliani M. A new wave of leaders: Early evaluation of the interdisciplinary Foundations of Leadership in Radiation Oncology (FLiRO) program. Tech Innov Patient Support Radiat Oncol 2022; 24:94-100. [PMID: 36338012 PMCID: PMC9633739 DOI: 10.1016/j.tipsro.2022.09.004] [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: 06/02/2022] [Revised: 09/04/2022] [Accepted: 09/15/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Effective leadership across all areas of radiation oncology (RO) is vital to fully realise the benefits of radiation therapy in cancer care. We report outcomes of a novel interdisciplinary leadership program designed for RO professionals under a global joint society initiative. METHODS The Foundations of Leadership in RO (FLiRO) program was designed for aspiring RO leaders. Initially delivered in a blended learning format, it was adapted to fully virtual in 2021. It comprised a webinar tutorial, on-line modules and homework followed by 'live' in-person/virtual workshops over an approximately 6-week period. Topics included personal awareness, effective teamwork, quality improvement skills, leading change and conflict management. An immediate post-program online survey was performed using Likert scales to measure self-reported educational value, interaction with others and the likely application of learning to practice. Open comments were invited. RESULTS 170 participants from 36 countries and 6 continents took part from 2018 to 2021 (99 doctors, 36 physicists, 32 radiation therapists/RTTs and 3 others). 141 (83%) participants responded to the post-program survey. Average weightings for responders' views on whether pre-determined learning objectives were met ranged from 4.30 to 4.61 on a 5-point scale (1 = 'not met at all' and 5 = completely met). For the question addressing potential value of learning for application to their workplace, 124 of 130 (95%) of responders indicated that FLIRO would be 'very useful' or 'extremely useful'. CONCLUSION Initial evaluation of the FLiRO program supports its continuation and expansion with ongoing evolution based on emerging evidence around leadership education and participant feedback.
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Affiliation(s)
- Sandra Turner
- Sydney West Radiation Oncology Network, Westmead, NSW, Australia,University of Sydney, Faculty of Health Sciences and Medicine, NSW, Australia,Corresponding author at: Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Hawksbury and Darcy Rds, Westmead NSW 2145, Australia.
| | - Kim Benstead
- Gloucestershire Hospitals NHS Foundation Trust, United Kingdom
| | - Barbara-Ann Millar
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | | | | | - Michelle Leech
- Applied Radiation Therapy Trinity, Trinity St. James’s Cancer Institute, Discipline of Radiation Therapy, Trinity College, Dublin, Ireland
| | - Jesper G Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Meredith Giuliani
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
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25
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Longitudinally Heterogeneous Tumor Dose Optimizes Proton Broadbeam, Interlaced Minibeam, and FLASH Therapy. Cancers (Basel) 2022; 14:cancers14205162. [PMID: 36291946 PMCID: PMC9601234 DOI: 10.3390/cancers14205162] [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: 09/09/2022] [Revised: 10/09/2022] [Accepted: 10/17/2022] [Indexed: 11/21/2022] Open
Abstract
Simple Summary The aim of any kind of external radiation therapy is to control a tumor with the highest possible probability of the lowest possible side effects. Here, we study further opportunities of reducing the side effects of proton therapy by applying longitudinally heterogeneous dose distributions in the tumor respecting the delivery of a minimum prescribed dose. In our simulations, the longitudinally heterogeneous dose distributions show a reduced dose in the healthy tissue already in the case of proton broadbeam irradiations, but a much higher (calculated) mean cell survival in the case of proton minibeam irradiation. This demonstrates its potential to substantially reduce side effects at a simultaneously higher tumor control probability, opening new opportunities of easier application when striving for high dose-rate applications of proton beams (>~10 Gy/s), in order to additionally profit from the so-called FLASH effects. Abstract The prerequisite of any radiation therapy modality (X-ray, electron, proton, and heavy ion) is meant to meet at least a minimum prescribed dose at any location in the tumor for the best tumor control. In addition, there is also an upper dose limit within the tumor according to the International Commission on Radiation Units (ICRU) recommendations in order to spare healthy tissue as well as possible. However, healthy tissue may profit from the lower side effects when waving this upper dose limit and allowing a larger heterogeneous dose deposition in the tumor, but maintaining the prescribed minimum dose level, particularly in proton minibeam therapy. Methods: Three different longitudinally heterogeneous proton irradiation modes and a standard spread-out Bragg peak (SOBP) irradiation mode are simulated for their depth-dose curves under the constraint of maintaining a minimum prescribed dose anywhere in the tumor region. Symmetric dose distributions of two opposing directions are overlaid in a 25 cm-thick water phantom containing a 5 cm-thick tumor region. Interlaced planar minibeam dose distributions are compared to those of a broadbeam using the same longitudinal dose profiles. Results and Conclusion: All longitudinally heterogeneous proton irradiation modes show a dose reduction in the healthy tissue compared to the common SOBP mode in the case of broad proton beams. The proton minibeam cases show eventually a much larger mean cell survival and thus a further reduced equivalent uniform dose (EUD) in the healthy tissue than any broadbeam case. In fact, the irradiation mode using only one proton energy from each side shows better sparing capabilities in the healthy tissue than the common spread-out Bragg peak irradiation mode with the option of a better dose fall-off at the tumor edges and an easier technical realization, particularly in view of proton minibeam irradiation at ultra-high dose rates larger than ~10 Gy/s (so-called FLASH irradiation modes).
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Racovita M, Wheeler E, Wait S, Albreht T, Baird AM, Jassem J, McNamara A, Novello S, Radu-Loghin C, van Meerbeeck JP. The need for a comprehensive and integrated approach to lung cancer policy in Europe. Eur J Cancer 2022; 175:54-59. [PMID: 36088672 DOI: 10.1016/j.ejca.2022.08.001] [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: 06/24/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 11/03/2022]
Abstract
Lung cancer is the leading cause of cancer-related deaths in Europe. Europe's Beating Cancer Plan calls for a comprehensive approach to the disease in general but not specifically to lung cancer. Such a comprehensive approach, integrating efforts to strengthen anti-tobacco policies, early detection and underlying models of care, is sorely needed for lung cancer - particularly considering disruptions to care during the COVID-19 pandemic. In a recently published think piece, a multidisciplinary group of experts proposed four key policy priority areas. First, to reduce stigma and improve awareness of potential symptoms, there is a need to foster a better understanding of lung cancer - among the public and healthcare professionals. Second, opportunities for early detection should be enhanced, and the implementation of targeted screening through low-dose computed tomography should be encouraged as a complement to smoking cessation services. This complementarity should be recognised and built into joint policy proposals, with development and better integration of screening and smoking cessation programmes on the ground. Third, the socioeconomic inequalities underpinning disparities in outcomes in people with lung cancer must be addressed, with targeted approaches to overcome barriers to access Finally, the overall quality of lung cancer care must be improved, making multidisciplinary care available to all and ensuring survivorship is given due attention.
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Affiliation(s)
- Monica Racovita
- The Health Policy Partnerships, 68-69 St Martin's Lane, London WC2N 4JS, United Kingdom.
| | - Eleanor Wheeler
- The Health Policy Partnerships, 68-69 St Martin's Lane, London WC2N 4JS, United Kingdom
| | - Suzanne Wait
- The Health Policy Partnerships, 68-69 St Martin's Lane, London WC2N 4JS, United Kingdom
| | - Tit Albreht
- University of Ljubljana, Faculty of Medicine, Vrazov Trg 2, 1000 Ljubljana, Slovenia
| | - Anne-Marie Baird
- Trinity College Dublin, The University of Dublin, College Green Dublin 2, Ireland.
| | - Jacek Jassem
- Medical University of Gdańsk, Mariana Smoluchowskiego 17, 80-214 Gdańsk, Poland
| | - Aoife McNamara
- Irish Cancer Society, 43 - 45 Northumberland Road, Dublin 4, Ireland.
| | - Silvia Novello
- University of Turin, Department of Oncology, AOU San Luigi, Via Verdi, 8 - 10124 Turin, Italy
| | - Cornel Radu-Loghin
- European Network for Smoking and Tobacco Prevention, Chaussée D'Ixelles 144, B-1050 Brussels, Belgium
| | - Jan P van Meerbeeck
- Department of Pulmonology & Thoracic Oncology, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium
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Morris L, O'Donovan A, Hashmi A, Agar M. Older adults and the unique role of the radiation therapist: Future directions for improving geriatric oncology training and education. Tech Innov Patient Support Radiat Oncol 2022; 23:21-26. [PMID: 36059564 PMCID: PMC9434163 DOI: 10.1016/j.tipsro.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 08/01/2022] [Accepted: 08/09/2022] [Indexed: 11/17/2022] Open
Abstract
This article reviews the status quo of the available evidence and guidance for geriatric oncology clinical practice, training and education for radiation therapists worldwide. We explore the unique clinical role that radiation therapists play in the management of older adults undergoing radiation therapy. We define multiple clinical care points in which the radiation therapists role could potentially expand or specialise into geriatric screening, assessment and intervention to optimise the care of older adults. Current GO educational offerings and future directions to improve RTT knowledge and skills around caring for older adults are outlined.
There is widespread recognition that the provision of high quality, appropriate and equitable care to older adults with cancer is a growing challenge in oncology practice. Radiation therapy (RT) is an effective and localised treatment that represents an attractive curative or palliative option for many older adults, and radiation therapists (RTT) play an important role in the delivery, support and quality of care for people during RT. The need to develop an evidence-based, global approach to improving all radiation oncology (RO) professionals’ knowledge and clinical practice in geriatric oncology (GO) has been previously identified. This article specifically focusses on the status quo of GO clinical practice and education for RTT worldwide. We explore the unique clinical role that RTT play in the management of older adults with cancer and define multiple clinical care points in which RTT could potentially participate in geriatric screening, geriatric assessment and intervention to optimise the care of older adults, with a focus on dementia. Directions for future efforts to improve the knowledge and clinical skills of RTT in caring for older adults are discussed.
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Affiliation(s)
- Lucinda Morris
- University of Technology Sydney (UTS), Faculty of Health, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Ultimo, NSW, Australia
- St George Cancer Care Centre, St George Hospital, Sydney, NSW, Australia
- Corresponding author at: University of Technology Sydney (UTS), Faculty of Health, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Ultimo, NSW, Australia.
| | - Anita O'Donovan
- Applied Radiation Therapy Trinity (ARTT), Discipline of Radiation Therapy, School of Medicine, Trinity St. James’s Cancer Institute, Trinity College, Dublin, Ireland
| | - Amira Hashmi
- Radiotherapy Department, The Christie NHS Foundation Trust, Manchester, UK
| | - Meera Agar
- University of Technology Sydney (UTS), Faculty of Health, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Ultimo, NSW, Australia
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Gaio-Lima C, Castedo J, Cruz M, Candeias M, Camacho Ó. The role of hyperbaric oxygen therapy in the treatment of radiation lesions. CLINICAL & TRANSLATIONAL ONCOLOGY : OFFICIAL PUBLICATION OF THE FEDERATION OF SPANISH ONCOLOGY SOCIETIES AND OF THE NATIONAL CANCER INSTITUTE OF MEXICO 2022; 24:2466-2474. [PMID: 35976581 DOI: 10.1007/s12094-022-02892-x] [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: 04/04/2022] [Accepted: 07/14/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Cancer remains one of the leading causes of death worldwide, with 50-60% of patients requiring radiotherapy during the course of treatment. Patients' survival rate has increased significantly, with an inevitable increase in the number of patients experiencing side effects from cancer therapy. One such effect is late radiation injuries in which hyperbaric oxygen therapy appears as complementary treatment. With this work we intend to divulge the results of applying hyperbaric oxygen therapy among patients presenting radiation lesions in our Hyperbaric Medicine Unit. MATERIALS AND METHODS Retrospective analysis of clinical records of patients with radiation lesions treated at the Hyperbaric Medicine Unit assessed by the scale Late Effects of Normal Tissues-Subjective, Objective, Management, Analytical (LENT-SOMA) before and after treatment, between October 2014 and September 2019 were included. Demographic characteristics, primary tumor site, subjective assessment of the LENT-SOMA scale before and after treatment were collected and a comparative analysis (Students t test) was done. RESULTS 88 patients included: 33 with radiation cystitis, 20 with radiation proctitis, 13 with osteoradionecrosis of the mandible and 22 with radiation enteritis. In all groups, there was a significant decrease (p < 0.005) in the subjective parameter of the LENT-SOMA scale. DISCUSSION Late radiation lesions have a major influence on patients' quality of life. In our study hyperbaric oxygen therapy presents as an effective therapy after the failure of conventional treatments. CONCLUSION Hyperbaric oxygen therapy is an effective complementary therapy in the treatment of refractory radiation lesions.
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Affiliation(s)
- Clara Gaio-Lima
- Serviço de Anestesiologia, ULSM (Unidade Local de Saúde de Matosinhos), Matosinhos, Portugal.
- ULSM (Unidade Local de Saúde de Matosinhos), Unidade de Medicina Hiperbárica, Matosinhos, Portugal.
| | - João Castedo
- Serviço de Anestesiologia, ULSM (Unidade Local de Saúde de Matosinhos), Matosinhos, Portugal
| | - Mafalda Cruz
- Serviço de Radioterapia, IPO Porto (Instituto Português de Oncologia do Porto Francisco Gentil), Porto, Portugal
| | | | - Óscar Camacho
- Serviço de Anestesiologia, ULSM (Unidade Local de Saúde de Matosinhos), Matosinhos, Portugal
- ULSM (Unidade Local de Saúde de Matosinhos), Unidade de Medicina Hiperbárica, Matosinhos, Portugal
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Schneider T, Fernandez-Palomo C, Bertho A, Fazzari J, Iturri L, Martin OA, Trappetti V, Djonov V, Prezado Y. Combining FLASH and spatially fractionated radiation therapy: The best of both worlds. Radiother Oncol 2022; 175:169-177. [PMID: 35952978 DOI: 10.1016/j.radonc.2022.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/23/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022]
Abstract
FLASH radiotherapy (FLASH-RT) and spatially fractionated radiation therapy (SFRT) are two new therapeutical strategies that use non-standard dose delivery methods to reduce normal tissue toxicity and increase the therapeutic index. Although likely based on different mechanisms, both FLASH-RT and SFRT have shown to elicit radiobiological effects that significantly differ from those induced by conventional radiotherapy. With the therapeutic potential having been established separately for each technique, the combination of FLASH-RT and SFRT could therefore represent a winning alliance. In this review, we discuss the state of the art, advantages and current limitations, potential synergies, and where a combination of these two techniques could be implemented today or in the near future.
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Affiliation(s)
- Tim Schneider
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France; Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France
| | | | - Annaïg Bertho
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France; Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France
| | - Jennifer Fazzari
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, 3012 Bern, Switzerland
| | - Lorea Iturri
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France; Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France
| | - Olga A Martin
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, 3012 Bern, Switzerland; Division of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000, Australia; University of Melbourne, Parkville, VIC 3010, Australia
| | - Verdiana Trappetti
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, 3012 Bern, Switzerland
| | - Valentin Djonov
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, 3012 Bern, Switzerland
| | - Yolanda Prezado
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France; Université Paris-Saclay, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, 91400 Orsay, France.
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Laskar SG, Sinha S, Krishnatry R, Grau C, Mehta M, Agarwal JP. Access to Radiation Therapy: From Local to Global and Equality to Equity. JCO Glob Oncol 2022; 8:e2100358. [PMID: 35960905 PMCID: PMC9470145 DOI: 10.1200/go.21.00358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The discipline of radiation oncology is the most resource-intensive component of comprehensive cancer care because of significant initial investments required for machines, the requirement of dedicated construction, a multifaceted workforce, and recurring maintenance costs. This review focuses on the challenges associated with accessible and affordable radiation therapy (RT) across the globe and the possible solutions to improve the current scenario. Most common cancers globally, including breast, prostate, head and neck, and cervical cancers, have a RT utilization rate of > 50%. The estimated annual incidence of cancer is 19,292,789 for 2020, with > 70% occurring in low-income countries and low-middle–income countries. There are approximately 14,000 teletherapy machines globally. However, the distribution of these machines is distinctly nonuniform, with low-income countries and low-middle–income countries having access to < 10% of the global teletherapy machines. The Directory of Radiotherapy Centres enlists 3,318 brachytherapy facilities. Most countries with a high incidence of cervical cancer have a deficit in brachytherapy facilities, although formal estimates for the same are not available. The deficit in simulators, radiation oncologists, and medical physicists is even more challenging to quantify; however, the inequitable distribution is indisputable. Measures to ensure equitable access to RT include identifying problems specific to region/country, adopting indigenous technology, encouraging public-private partnership, relaxing custom duties on RT equipment, global/cross-country collaboration, and quality human resources training. Innovative research focusing on the most prevalent cancers aiming to make RT utilization more cost-effective while maintaining efficacy will further bridge the gap. Improving global access to Radiotherapy: The current scenario and the road ahead
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Affiliation(s)
- Sarbani Ghosh Laskar
- Department of Radiation Oncology, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, India
| | - Shwetabh Sinha
- Department of Radiation Oncology, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, India
| | - Rahul Krishnatry
- Department of Radiation Oncology, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, India
| | - Cai Grau
- Department of Radiation Oncology and Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Minesh Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, India
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Wiedemann J, Coppes RP, van Luijk P. Radiation-induced cardiac side-effects: The lung as target for interacting damage and intervention. Front Oncol 2022; 12:931023. [PMID: 35936724 PMCID: PMC9354542 DOI: 10.3389/fonc.2022.931023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022] Open
Abstract
Radiotherapy is part of the treatment for many thoracic cancers. During this treatment heart and lung tissue can often receive considerable doses of radiation. Doses to the heart can potentially lead to cardiac effects such as pericarditis and myocardial fibrosis. Common side effects after lung irradiation are pneumonitis and pulmonary fibrosis. It has also been shown that lung irradiation has effects on cardiac function. In a rat model lung irradiation caused remodeling of the pulmonary vasculature increasing resistance of the pulmonary vascular bed, leading to enhanced pulmonary artery pressure, right ventricle hypertrophy and reduced right ventricle performance. Even more pronounced effects are observed when both, lung and heart are irradiated. The effects observed after lung irradiation show striking similarities with symptoms of pulmonary arterial hypertension. In particular, the vascular remodeling in lung tissue seems to have similar underlying features. Here, we discuss the similarities and differences of vascular remodeling observed after thoracic irradiation compared to those in pulmonary arterial hypertension patients and research models. We will also assess how this knowledge of similarities could potentially be translated into interventions which would be beneficial for patients treated for thoracic tumors, where dose to lung tissue is often unavoidable.
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Affiliation(s)
- Julia Wiedemann
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Robert P. Coppes
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Peter van Luijk
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- *Correspondence: Peter van Luijk,
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Interaction of Radiotherapy and Hyperthermia with the Immune System: a Brief Current Overview. CURRENT STEM CELL REPORTS 2022. [DOI: 10.1007/s40778-022-00215-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Abstract
Purpose of Review
This review focuses on the opposing effects on the immune system of radiotherapy (RT) and the consequences for combined cancer treatment strategies of RT with immunotherapies, including hyperthermia (HT). How RT and HT might affect cancer stem cell populations is also briefly outlined in this context.
Recent Findings
RT is one of the crucial standard cancer therapies. Most patients with solid tumors receive RT for curative and palliative purposes in the course of their disease. RT achieves a local tumor control by inducing DNA damage which can lead to tumor cell death. In recent years, it has become evident that RT does not only have local effects, but also systemic effects which involves induction of anti-tumor immunity and possible alteration of the immunosuppressive properties of the tumor microenvironment. Though, often RT alone is not able to induce potent anti-tumor immune responses since the effects of RT on the immune system can be both immunostimulatory and immunosuppressive.
Summary
RT with additional therapies such as HT and immune checkpoint inhibitors (ICI) are promising approaches to induce anti-tumor immunity effectively. HT is not only a potent sensitizer for RT, but it might also improve the efficacy of RT and certain chemotherapeutic agents (CT) by additionally sensitizing resistant cancer stem cells (CSCs).
Graphical abstract
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Claessens M, Vanreusel V, De Kerf G, Mollaert I, Löfman F, Gooding MJ, Brouwer C, Dirix P, Verellen D. Machine learning-based detection of aberrant deep learning segmentations of target and organs at risk for prostate radiotherapy using a secondary segmentation algorithm. Phys Med Biol 2022; 67. [PMID: 35561701 DOI: 10.1088/1361-6560/ac6fad] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 05/13/2022] [Indexed: 11/11/2022]
Abstract
Objective.The output of a deep learning (DL) auto-segmentation application should be reviewed, corrected if needed and approved before being used clinically. This verification procedure is labour-intensive, time-consuming and user-dependent, which potentially leads to significant errors with impact on the overall treatment quality. Additionally, when the time needed to correct auto-segmentations approaches the time to delineate target and organs at risk from scratch, the usability of the DL model can be questioned. Therefore, an automated quality assurance framework was developed with the aim to detect in advance aberrant auto-segmentations.Approach. Five organs (prostate, bladder, anorectum, femoral head left and right) were auto-delineated on CT acquisitions for 48 prostate patients by an in-house trained primary DL model. An experienced radiation oncologist assessed the correctness of the model output and categorised the auto-segmentations into two classes whether minor or major adaptations were needed. Subsequently, an independent, secondary DL model was implemented to delineate the same structures as the primary model. Quantitative comparison metrics were calculated using both models' segmentations and used as input features for a machine learning classification model to predict the output quality of the primary model.Main results. For every organ, the approach of independent validation by the secondary model was able to detect primary auto-segmentations that needed major adaptation with high sensitivity (recall = 1) based on the calculated quantitative metrics. The surface DSC and APL were found to be the most indicated parameters in comparison to standard quantitative metrics for the time needed to adapt auto-segmentations.Significance. This proposed method includes a proof of concept for the use of an independent DL segmentation model in combination with a ML classifier to improve time saving during QA of auto-segmentations. The integration of such system into current automatic segmentation pipelines can increase the efficiency of the radiotherapy contouring workflow.
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Affiliation(s)
- Michaël Claessens
- Department of Radiation Oncology, Iridium Network, Wilrijk (Antwerp), Belgium.,Centre for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Belgium
| | - Verdi Vanreusel
- Department of Radiation Oncology, Iridium Network, Wilrijk (Antwerp), Belgium
| | - Geert De Kerf
- Department of Radiation Oncology, Iridium Network, Wilrijk (Antwerp), Belgium
| | - Isabelle Mollaert
- Department of Radiation Oncology, Iridium Network, Wilrijk (Antwerp), Belgium
| | - Fredrik Löfman
- Department of Machine Learning, RaySearch Laboratories AB, Stockholm, Sweden
| | | | - Charlotte Brouwer
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, The Netherlands
| | - Piet Dirix
- Department of Radiation Oncology, Iridium Network, Wilrijk (Antwerp), Belgium.,Centre for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Belgium
| | - Dirk Verellen
- Department of Radiation Oncology, Iridium Network, Wilrijk (Antwerp), Belgium.,Centre for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Belgium
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Mirjolet C, Diallo I, Bertaut A, Veres C, Sargos P, Helfre S, Sunyach MP, Truc G, Le Pechoux C, Paumier A, Ducassou A, Jolnerovski M, Thariat J, Lapeyre M, Cordoba A, Mahé MA, Maingon P. Treatment related factors associated with the risk of breast radio-induced-sarcoma. Radiother Oncol 2022; 171:14-21. [DOI: 10.1016/j.radonc.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 03/14/2022] [Accepted: 04/03/2022] [Indexed: 10/18/2022]
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Jacob J, Feuvret L, Simon JM, Ribeiro M, Nichelli L, Jenny C, Ricard D, Psimaras D, Hoang-Xuan K, Maingon P. Neurological side effects of radiation therapy. Neurol Sci 2022; 43:2363-2374. [DOI: 10.1007/s10072-022-05944-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 02/05/2022] [Indexed: 10/19/2022]
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Dosanjh M, Ristova M, Gershan V, Georgieva P, Balin Kovacevic M, Bregu L, Coralic I, Djurovic T, Dosieva D, Foka Y, Fröbe A, Hatziioannou K, Hourdakis CJ, Kabashi Y, Kalev D, Kurtishi I, Litov L, Mezelxhiu B, Nestoroska Madjunarova S, Nikolova G, Skrk D, Smajlbegovic V, Smichkoska S, Stojkovski I, Strojan P, Tecic Z, Tešanović D, Todorovic V, Valerianova Z. Availability of technology for managing cancer patients in the Southeast European (SEE) region. Clin Transl Radiat Oncol 2022; 34:57-66. [PMID: 35345867 PMCID: PMC8956881 DOI: 10.1016/j.ctro.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 03/13/2022] [Indexed: 12/24/2022] Open
Abstract
Gap of public on-the-ground cancer data was addressed through questionnaires to professionals in the SEE region. There is a lack of diagnostic imaging and radiotherapy modalities in the SEE region in comparison to Western Europe. The Mortality to incidence ratio correlates inversely with the economic development and the availability of radiotherapy equipment. The cancer incidence in SEE countries was correlate directly with the life expectancy and the availability of diagnostic equipment. The need for reliable national and regional cancer registries in SEE countries for data collection and analysis has been emphasized.
Background The Southeast European (SEE) region of 10 countries and about 43 million people differs from Western Europe in that most SEE countries lack active cancer registries and have fewer diagnostic imaging devices and radiotherapy (RT) units. The main objective of this research is to initiate a common platform for gathering SEE regional cancer data from the ground up to help these countries develop common cancer management strategies. Methods To obtain detailed on-the-ground information, we developed separate questionnaires for two SEE groups: a) ONCO - oncologists regarding cancer treatment modalities and the availability of diagnostic imaging and radiotherapy equipment; and b) REG - national radiation protection and safety regulatory bodies regarding diagnostic imaging and radiotherapy equipment in SEE facilities. Results Based on responses from 13/17 ONCO participants (at least one from each country) and from 9/10 REG participants (all countries but Albania), cancer incidence rates are higher in those SEE countries that have greater access to diagnostic imaging equipment while cancer mortality-to-incidence (MIR) ratios are higher in countries that lack radiotherapy equipment. Conclusion By combining unique SEE region information with data available from major global databases, we demonstrated that the availability of diagnostic imaging and radiotherapy equipment in the SEE countries is related to their economic development. While immediate diagnostic imaging and radiation therapy capacity building is necessary, it is also essential to develop both national and SEE-regional cancer registries in order to understand the heterogeneity of each country’s needs and to establish regional collaborative strategies for combating cancer.
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Affiliation(s)
- Manjit Dosanjh
- CERN, Geneva, Switzerland
- International Cancer Expert Corps, Washington, DC, USA
| | - Mimoza Ristova
- CERN, Geneva, Switzerland
- Faculty of Natural Sciences and Mathematics, Ss Cyril and Methodius University in Skopje, North Macedonia
- SEEIIST Association, Geneva, Switzerland
| | - Vesna Gershan
- Faculty of Natural Sciences and Mathematics, Ss Cyril and Methodius University in Skopje, North Macedonia
| | - Petya Georgieva
- CERN, Geneva, Switzerland
- SEEIIST Association, Geneva, Switzerland
| | | | | | - Irma Coralic
- State Regulatory Agency for Radiation and Nuclear Safety, Bosnia and Herzegovina
| | - Tamara Djurovic
- Ministry of Ecology, Spatial Planning and Urbanism, Montenegro
| | | | - Yiota Foka
- CERN, Geneva, Switzerland
- GSI, Darmstadt, Germany
| | - Ana Fröbe
- University Hospital Clinic, Sestre Milisrdnice, Zagreb, Croatia
| | | | | | - Yllka Kabashi
- Institute of Oncology, University Clinical Center of Kosovo
| | - Dimitar Kalev
- SHATOD "Dr. Marko Markov", Varna Ltd, Varna, Bulgaria
| | - Ilir Kurtishi
- Institute of Oncology, University Clinical Center of Kosovo
| | - Leandar Litov
- CERN, Geneva, Switzerland
- Sofia University St. Kliment Ohridski, Sofia, Bulgaria
| | - Beqir Mezelxhiu
- Kosovo Agency for Radiation Protection and Nuclear Safety, Kosovo
| | | | | | - Damijan Skrk
- Slovenian Radiation Protection Administration and Faculty of Mathematics and Physics, Slovenia
| | | | - Snezana Smichkoska
- University Clinic of Radiotherapy and Oncology, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Igor Stojkovski
- University Clinic of Radiotherapy and Oncology, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Primož Strojan
- Dept. of Radiotherapy, Institute of Oncology Ljubljana, Slovenia
| | - Zdravka Tecic
- Ministry of the Interior, Civil Protection Directorate, Sector for Radiological and Nuclear Safety, Croatia
| | - Dušanka Tešanović
- Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
- Medical Faculty, Novi Sad University, Serbia
| | - Vladimir Todorovic
- SEEIIST Association, Geneva, Switzerland
- Clinical Center of Montenegro (KCCG), Podgorica, Montenegro
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Abstract
AbstractSpatially fractionated radiation therapy (SFRT) challenges some of the classical dogmas in conventional radiotherapy. The highly modulated spatial dose distributions in SFRT have been shown to lead, both in early clinical trials and in small animal experiments, to a significant increase in normal tissue dose tolerances. Tumour control effectiveness is maintained or even enhanced in some configurations as compared with conventional radiotherapy. SFRT seems to activate distinct radiobiological mechanisms, which have been postulated to involve bystander effects, microvascular alterations and/or immunomodulation. Currently, it is unclear which is the dosimetric parameter which correlates the most with both tumour control and normal tissue sparing in SFRT. Additional biological experiments aiming at parametrizing the relationship between the irradiation parameters (beam width, spacing, peak-to-valley dose ratio, peak and valley doses) and the radiobiology are needed. A sound knowledge of the interrelation between the physical parameters in SFRT and the biological response would expand its clinical use, with a higher level of homogenisation in the realisation of clinical trials. This manuscript reviews the state of the art of this promising therapeutic modality, the current radiobiological knowledge and elaborates on future perspectives.
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Ward TH, Gilbert DC, Higginbotham G, Morris CM, Speirs V, Curtin NJ. Radiotherapy biobanking: current landscape, opportunities, challenges, and future aspirations. J Pathol Clin Res 2022; 8:3-13. [PMID: 34658150 PMCID: PMC8682944 DOI: 10.1002/cjp2.246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/09/2021] [Accepted: 09/21/2021] [Indexed: 01/01/2023]
Abstract
Half of all cancer patients receive radiotherapy, which makes a substantial contribution to their long-term disease control/cure. There are significant inter-patient differences in response, both in terms of efficacy and toxicity (frequently delayed onset) which are difficult to predict. With the introduction of technological improvements (e.g. stereotactic body radiotherapy and proton therapy) and development of combination therapies (e.g. radiotherapy and immune checkpoint inhibition), predictive biomarkers are needed even more. Whilst genomic studies have contributed significantly to predictions of response to anticancer therapy, there is no doubt that more information can be gathered from patient tissue samples. Patients are willing to donate their tissues to biobanks and wish them to be used as widely as possible for high-quality research. We report here a survey of the current practices in the UK from several groups collecting material from patients in radiotherapy trials and have identified barriers to collecting and sharing data and samples. We believe the current situation represents a significant missed opportunity to improve the personalisation of radiotherapy. We propose a greater involvement of patients and/or their advocates, a standardisation of the patient information leaflet, consent form content and data set, with easy linkage to clinical data, which would facilitate widespread sample and data discovery and availability to other researchers. The greater sharing of data and samples, nationally and internationally, would facilitate robust multicentre studies and avoid duplication of effort.
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Affiliation(s)
- Tim H Ward
- Patient AdvocateNational Cancer Research Institute (NCRI)LondonUK
| | - Duncan C Gilbert
- Sussex Cancer CentreRoyal Sussex County HospitalBrightonUK
- MRC Clinical Trials Unit at UCLLondonUK
| | | | - Chris M Morris
- Newcastle Brain Tissue Resource, Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Valerie Speirs
- Institute of Medical Sciences, School of Medicine, Medical Sciences and NutritionUniversity of AberdeenAberdeenUK
| | - Nicola J Curtin
- Newcastle Centre for Cancer, Translational and Clinical Research Institute, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
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Prezado Y. Proton minibeam radiation therapy: a promising therapeutic approach for radioresistant tumors. C R Biol 2021; 344:409-420. [DOI: 10.5802/crbiol.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/01/2021] [Indexed: 11/24/2022]
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In-vitro 3D modelling for charged particle therapy - Uncertainties and opportunities. Adv Drug Deliv Rev 2021; 179:114018. [PMID: 34688685 DOI: 10.1016/j.addr.2021.114018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/07/2021] [Accepted: 10/18/2021] [Indexed: 12/26/2022]
Abstract
Radiation therapy is a critical component of oncologic management, with more than half of all cancer patients requiring radiotherapy at some point during their disease course. Over the last decade, there has been increasing interest in charged particle therapy due to its advantageous physical and radiobiologic properties, with the therapeutic use of proton beam therapy (PBT) expanding worldwide. However, there remain large gaps in our knowledge of the radiobiologic mechanisms that underlie key aspects of PBT, such as variations in relative biologic effectiveness (RBE), radioresistance, DNA damage response and repair pathways, as well as immunologic effects. In addition, while the emerging technique of ultra-high dose rate or FLASH radiotherapy, with its potential to further reduce normal tissue toxicities, is an exciting development, in-depth study is needed into the postulated biochemical mechanisms that underpin the FLASH effect such as the oxygen depletion hypothesis as well as the relative contributions of immune responses and the tumor microenvironment. Further investigation is also required to ensure that the FLASH effect is not diminished or lost in PBT. Current methods to evaluate the biologic effects of charged particle therapy rely heavily on 2D cell culture systems and/or animal models. However, both of these methods have well-recognized limitations which limit translatability of findings from bench to bedside. The advent of novel three-dimensional in-vitro tumor models offers a more physiologically relevant and high throughput in-vitro system for the study of tumor development as well as novel therapeutic approaches such as PBT. Advances in 3D cell culture methods, together with knowledge of disease mechanism, biomarkers, and genomic data, can be used to design personalized 3D models that most closely recapitulate tumor microenvironmental factors promoting a particular disease phenotype, moving 3D models and PBT into the age of precision medicine.
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Ristova MM, Gershan V, Schopper H, Amaldi U, Dosanjh M. Patients With Cancer in the Countries of South-East Europe (the Balkans) Region and Prospective of the Particle Therapy Center: South-East European International Institute for Sustainable Technologies (SEEIIST). Adv Radiat Oncol 2021; 6:100772. [PMID: 34805620 PMCID: PMC8581504 DOI: 10.1016/j.adro.2021.100772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/19/2021] [Accepted: 07/28/2021] [Indexed: 01/02/2023] Open
Abstract
PURPOSE A recent initiative was launched for establishing the South-East European International Institute for Sustainable Technologies (SEEIIST), which will provide a cutting-edge Hadron radiation therapy treatment and research institute for treating cancer patients with Hadron therapy (HT). To justify the initiative for building the SEEIIST facility, a study was conducted to estimate the number of patients with cancer from the SEE region that would be eligible for HT. METHODS AND MATERIALS Two different methods for projecting the future annual cancer incidence have been applied: (1) using the International Agency on Research on Cancer@World Health Organization's (WHO) Globocan model which uses country's demographic factors, and (2) averaging the crude incidence data of 3 SEE countries with available national cancer registries, using a linear regression model of combined incidence per 100,000, and applying it to the entire SEE region. Cancer epidemiology data were collected and studied by using the countries' cancer datasheets from WHO. The top 10 cancers were presented for the SEE region. Studies of other countries were used to develop a primordial model for estimating the number of SEE patients who could be treated most successfully with HT upon SEEIIST commissioning in 2030. RESULTS A model was developed to estimate the number of eligible patients for HT from SEE. It is estimated that 2900 to 3200 patients per year would be eligible for HT in the new SEEIIST facility in 2030. CONCLUSIONS After commissioning, SEEIIST will initially treat approximately 400 patients per year, progressing toward 1000. Creation of SEEIIST dedicated patient selection criteria will be both necessary and highly challenging.
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Affiliation(s)
- Mimoza M. Ristova
- Faculty of Natural Sciences and Mathematics, Physics Department, University Ss Cyril and Methodius in Skopje, North Macedonia
- SEEIIST Association, Geneva, Switzerland
- CERN, Geneva, Switzerland
| | - Vesna Gershan
- Faculty of Natural Sciences and Mathematics, Physics Department, University Ss Cyril and Methodius in Skopje, North Macedonia
| | - Herwig Schopper
- SEEIIST Association, Geneva, Switzerland
- CERN, Geneva, Switzerland
| | | | - Manjit Dosanjh
- CERN, Geneva, Switzerland
- Department of Physics, University of Oxford, Oxford, United Kingdom
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Medenwald D, Fietkau R, Klautke G, Langer S, Würschmidt F, Vordermark D. Trends in radiotherapy inpatient admissions in Germany: a population-based study over a 10-year period. Strahlenther Onkol 2021; 197:865-875. [PMID: 34477888 PMCID: PMC8458212 DOI: 10.1007/s00066-021-01829-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 07/16/2021] [Indexed: 12/15/2022]
Abstract
Objective With the increasing complexity of oncological therapy, the number of inpatient admissions to radiotherapy and non-radiotherapy departments might have changed. In this study, we aim to quantify the number of inpatient cases and the number of radiotherapy fractions delivered under inpatient conditions in radiotherapy and non-radiotherapy departments. Methods The analysis is founded on data of all hospitalized cases in Germany based on Diagnosis-Related Group Statistics (G-DRG Statistics, delivered by the Research Data Centers of the Federal Statistical Office). The dataset includes information on the main diagnosis of cases (rather than patients) and the performed procedures during hospitalization based on claims of reimbursement. We used linear regression models to analyze temporal trends. The considered data encompass the period from 2008 to 2017. Results Overall, the number of patients treated with radiotherapy as inpatients remained constant between 2008 (N = 90,952) and 2017 (N = 88,998). Starting in January 2008, 48.9% of 4000 monthly cases received their treatment solely in a radiation oncology department. This figure decreased to 43.7% of 2971 monthly cases in October 2017. We found a stepwise decrease between December 2011 and January 2012 amounting to 4.3%. Fractions received in radiotherapy departments decreased slightly by 29.3 (95% CI: 14.0–44.5) fractions per month. The number of days hospitalized in radiotherapy departments decreased by 83.4 (95% CI: 59.7, 107.0) days per month, starting from a total of 64,842 days in January 2008 to 41,254 days in 2017. Days per case decreased from 16.2 in January 2008 to 13.9 days in October 2017. Conclusion Our data give evidence to the notion that radiotherapy remains a discipline with an important inpatient component. Respecting reimbursement measures and despite older patients with more comorbidities, radiotherapy institutions could sustain a constant number of cases with limited temporal shifts. Supplementary Information The online version of this article (10.1007/s00066-021-01829-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniel Medenwald
- Department of Radiation Oncology, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
| | - Rainer Fietkau
- Department of Radiation Oncology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Gunther Klautke
- Department of Radiation Oncology, Chemnitz Hospital, Chemnitz, Germany
| | - Susan Langer
- Department of Radiation Oncology, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | | | - Dirk Vordermark
- Department of Radiation Oncology, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
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Value-based radiotherapy: A new chapter of the ESTRO-HERO project. Radiother Oncol 2021; 160:236-239. [PMID: 33992629 DOI: 10.1016/j.radonc.2021.05.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/09/2021] [Indexed: 01/19/2023]
Abstract
Radiotherapy interventions are rapidly evolving and improving, holding promise for better patient outcomes, yet at the possible detriment of higher societal costs. The ESTRO-HERO value-based radiotherapy project aims to develop a framework defining and assessing the value of radiotherapy innovations, to support clinical implementation and equitable access, within a sustainable healthcare system.
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Grilo AM, Santos B, Baptista I, Monsanto F. Exploring the cancer patients' experiences during external radiotherapy: A systematic review and thematic synthesis of qualitative and quantitative evidence. Eur J Oncol Nurs 2021; 52:101965. [PMID: 34023669 DOI: 10.1016/j.ejon.2021.101965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 03/28/2021] [Accepted: 04/14/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the subjective experience of adult cancer patients undergoing external radiotherapy and provide evidence for better practices in radiotherapy services. METHODS A systematic review was performed according to the PRISMA Statement Guidelines. Qualitative and mixed studies were identified through five electronic databases (CINAHL, PsychINFO, Medline, Scopus and Web of Science), between March and April 2020, using defined criteria. Methodological quality assessment was conducted, and the data integrated into a thematic synthesis. RESULTS Of the 886 studies identified, 13 met our inclusion criteria. Patients experiences were described into four main themes: (1) Time, (2) Physical Environment, (3) Treatment Concerns and (4) Radiotherapy Team. Time refers to waiting time and treatment time; Physical Environment states temperature in the treatment room and equipment; Treatment Concerns included side effects, daily activities, positioning and immobilization and treatment preparation (e.g., bladder filling); radiotherapy team comprised patients support; response to patients needs and recognized team. The generating analytical phase of thematic analysis allowed us to recognize that the effectiveness of the radiotherapy team operates as a facilitator of the patients' experience. In contrast, time in the waiting room, the treatment preparation when is required, and the positioning and immobilization, specifically for the neck and head patients, act as barriers. CONCLUSION Four distinct themes were identified to be positively and negatively associated with patients' experience during external radiotherapy. The evidence provides valuable recommendations to improved radiotherapy services organization, as well as to the delivery of more patient-centred care adjusted to the concerns and needs of patients.
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Affiliation(s)
- Ana Monteiro Grilo
- H&TRC-Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Portugal; CICPsi - Research Center for Psychological Science, Faculty of Psychology, University of Lisbon, Portugal.
| | - Bárbara Santos
- Medical Imaging and RT Degree, Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Portugal.
| | - Inês Baptista
- Medical Imaging and RT Degree, Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Portugal.
| | - Fátima Monsanto
- H&TRC-Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Portugal.
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O’Brien RM, Cannon A, Reynolds JV, Lysaght J, Lynam-Lennon N. Complement in Tumourigenesis and the Response to Cancer Therapy. Cancers (Basel) 2021; 13:1209. [PMID: 33802004 PMCID: PMC7998562 DOI: 10.3390/cancers13061209] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 12/16/2022] Open
Abstract
In recent years, our knowledge of the complement system beyond innate immunity has progressed significantly. A modern understanding is that the complement system has a multifaceted role in malignancy, impacting carcinogenesis, the acquisition of a metastatic phenotype and response to therapies. The ability of local immune cells to produce and respond to complement components has provided valuable insights into their regulation, and the subsequent remodeling of the tumour microenvironment. These novel discoveries have advanced our understanding of the immunosuppressive mechanisms supporting tumour growth and uncovered potential therapeutic targets. This review discusses the current understanding of complement in cancer, outlining both direct and immune cell-mediated roles. The role of complement in response to therapies such as chemotherapy, radiation and immunotherapy is also presented. While complement activities are largely context and cancer type-dependent, it is evident that promising therapeutic avenues have been identified, in particular in combination therapies.
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Affiliation(s)
- Rebecca M. O’Brien
- Department of Surgery, Trinity St. James’s Cancer Institute, Trinity Translational Medicine Institute, Trinity College Dublin and St. James’s Hospital, Dublin 8, Ireland; (R.M.O.); (A.C.); (J.V.R.); (J.L.)
- Cancer Immunology and Immunotherapy Group, Trinity St. James’s Cancer Institute, Trinity Translational Medicine Institute, Trinity College Dublin and St. James’s Hospital, Dublin 8, Ireland
| | - Aoife Cannon
- Department of Surgery, Trinity St. James’s Cancer Institute, Trinity Translational Medicine Institute, Trinity College Dublin and St. James’s Hospital, Dublin 8, Ireland; (R.M.O.); (A.C.); (J.V.R.); (J.L.)
| | - John V. Reynolds
- Department of Surgery, Trinity St. James’s Cancer Institute, Trinity Translational Medicine Institute, Trinity College Dublin and St. James’s Hospital, Dublin 8, Ireland; (R.M.O.); (A.C.); (J.V.R.); (J.L.)
| | - Joanne Lysaght
- Department of Surgery, Trinity St. James’s Cancer Institute, Trinity Translational Medicine Institute, Trinity College Dublin and St. James’s Hospital, Dublin 8, Ireland; (R.M.O.); (A.C.); (J.V.R.); (J.L.)
- Cancer Immunology and Immunotherapy Group, Trinity St. James’s Cancer Institute, Trinity Translational Medicine Institute, Trinity College Dublin and St. James’s Hospital, Dublin 8, Ireland
| | - Niamh Lynam-Lennon
- Department of Surgery, Trinity St. James’s Cancer Institute, Trinity Translational Medicine Institute, Trinity College Dublin and St. James’s Hospital, Dublin 8, Ireland; (R.M.O.); (A.C.); (J.V.R.); (J.L.)
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Vieira B, Demirtas D, van de Kamer JB, Hans EW, Jongste W, van Harten W. Radiotherapy treatment scheduling: Implementing operations research into clinical practice. PLoS One 2021; 16:e0247428. [PMID: 33606831 PMCID: PMC7894882 DOI: 10.1371/journal.pone.0247428] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/05/2021] [Indexed: 12/24/2022] Open
Abstract
Background Every week, radiotherapy centers face the complex task of scheduling hundreds of treatment sessions amongst the available linear accelerators. With the increase in cancer patient numbers, manually creating a feasible and efficient schedule has shown to be a difficult, time-consuming task. Although operations research models have been increasingly reported upon to optimize patient care logistics, there is almost no scientific evidence of implementation in practice. Methods A mathematical operations research model was adapted to generate radiotherapy treatment schedules in two Dutch centers. The model was iteratively adjusted to fulfill the technical and medical constraints of each center until a valid model was attained. Patient data was collected for the planning horizon of one week, and the feasibility of the obtained schedules was verified by the staff of each center. The resulting optimized solutions are compared with the ones manually developed in practice. Results The weekly schedule was improved in both centers by decreasing the average standard deviation between sessions’ starting times from 103.0 to 50.4 minutes (51%) in one center, and the number of gaps in the schedule from 18 to 5 (72%) in the other. The number of patients requiring linac switching between sessions has also decreased from 71 to 0 patients in one center, and from 43 to 2 in the other. The automated process required 5 minutes and 1.5 hours of computation time to find an optimal weekly patient schedule, respectively, as opposed to approximately 1.5 days when performed manually for both centers. Conclusions The practical application of a theoretical operations research model for radiotherapy treatment scheduling has provided radiotherapy planners a feasible, high-quality schedule in an automated way. Iterative model adaptations performed in small steps, early engagement of stakeholders, and constant communication proved to facilitate the implementation of operations research models into clinical practice.
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Affiliation(s)
- Bruno Vieira
- Department of Radiation Oncology, Netherlands Cancer Institute—Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente, Enschede, The Netherlands
| | - Derya Demirtas
- Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente, Enschede, The Netherlands
- Faculty of Behavioural Management and Social Sciences, Department Industrial Engineering and Business Information Systems, University of Twente, Enschede, The Netherlands
| | - Jeroen B. van de Kamer
- Department of Radiation Oncology, Netherlands Cancer Institute—Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Erwin W. Hans
- Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente, Enschede, The Netherlands
- Faculty of Behavioural Management and Social Sciences, Department Industrial Engineering and Business Information Systems, University of Twente, Enschede, The Netherlands
| | | | - Wim van Harten
- Department of Radiation Oncology, Netherlands Cancer Institute—Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Department of Health Technology and Services Research, School of Governance and Management, University of Twente, Enschede, The Netherlands
- * E-mail:
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Nilsson V, Gruselius H, Zhang T, De Kerf G, Claessens M. Probabilistic dose prediction using mixture density networks for automated radiation therapy treatment planning. Phys Med Biol 2021; 66:055003. [PMID: 33470973 DOI: 10.1088/1361-6560/abdd8a] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
We demonstrate the application of mixture density networks (MDNs) in the context of automated radiation therapy treatment planning. It is shown that an MDN can produce good predictions of dose distributions as well as reflect uncertain decision making associated with inherently conflicting clinical tradeoffs, in contrast to deterministic methods previously investigated in the literature. A two-component Gaussian MDN is trained on a set of treatment plans for postoperative prostate patients with varying extents to which rectum dose sparing was prioritized over target coverage. Examination on a test set of patients shows that the predicted modes follow their respective ground truths well, both spatially and in terms of their dose-volume histograms. A special dose mimicking method based on the MDN output is used to produce deliverable plans and thereby showcase the usability of voxel-wise predictive densities. Thus, this type of MDN may serve to support clinicians in managing clinical tradeoffs and has the potential to improve the quality of plans produced by an automated treatment planning pipeline.
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Affiliation(s)
- Viktor Nilsson
- RaySearch Laboratories, Stockholm, Sweden. Department of Mathematics, KTH Royal Institute of Technology, Stockholm, Sweden
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Willmann J, Poortmans P, Monti AF, Grant W, Clementel E, Corning C, Reynaert N, Hurkmans CW, Andratschke N. Development of staffing, workload and infrastructure in member departments of the European Organisation for Research and Treatment of Cancer (EORTC) radiation oncology group. Radiother Oncol 2021; 155:226-231. [DOI: 10.1016/j.radonc.2020.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/04/2020] [Accepted: 11/08/2020] [Indexed: 10/23/2022]
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Voshart DC, Wiedemann J, van Luijk P, Barazzuol L. Regional Responses in Radiation-Induced Normal Tissue Damage. Cancers (Basel) 2021; 13:cancers13030367. [PMID: 33498403 PMCID: PMC7864176 DOI: 10.3390/cancers13030367] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 12/16/2022] Open
Abstract
Normal tissue side effects remain a major concern in radiotherapy. The improved precision of radiation dose delivery of recent technological developments in radiotherapy has the potential to reduce the radiation dose to organ regions that contribute the most to the development of side effects. This review discusses the contribution of regional variation in radiation responses in several organs. In the brain, various regions were found to contribute to radiation-induced neurocognitive dysfunction. In the parotid gland, the region containing the major ducts was found to be critical in hyposalivation. The heart and lung were each found to exhibit regional responses while also mutually affecting each other's response to radiation. Sub-structures critical for the development of side effects were identified in the pancreas and bladder. The presence of these regional responses is based on a non-uniform distribution of target cells or sub-structures critical for organ function. These characteristics are common to most organs in the body and we therefore hypothesize that regional responses in radiation-induced normal tissue damage may be a shared occurrence. Further investigations will offer new opportunities to reduce normal tissue side effects of radiotherapy using modern and high-precision technologies.
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Affiliation(s)
- Daniëlle C. Voshart
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (D.C.V.); (J.W.)
- Department of Biomedical Sciences of Cells & Systems–Section Molecular Cell Biology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
| | - Julia Wiedemann
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (D.C.V.); (J.W.)
- Department of Biomedical Sciences of Cells & Systems–Section Molecular Cell Biology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
| | - Peter van Luijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (D.C.V.); (J.W.)
- Department of Biomedical Sciences of Cells & Systems–Section Molecular Cell Biology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
- Correspondence: (P.v.L.); (L.B.)
| | - Lara Barazzuol
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (D.C.V.); (J.W.)
- Department of Biomedical Sciences of Cells & Systems–Section Molecular Cell Biology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
- Correspondence: (P.v.L.); (L.B.)
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White K, Henson CC. Endoscopically delivered Purastat for the treatment of severe haemorrhagic radiation proctopathy: a service evaluation of a new endoscopic treatment for a challenging condition. Frontline Gastroenterol 2021; 12:608-613. [PMID: 34925747 PMCID: PMC8640411 DOI: 10.1136/flgastro-2020-101735] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/29/2020] [Accepted: 01/07/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND A total of 30 000 people are treated with pelvic radiotherapy annually in the UK. Rectal bleeding is common following pelvic radiotherapy and one of the main causes is radiation proctopathy (RP). Six per cent develop severe bleeding from RP, leading to anaemia requiring iron +/- blood transfusion. There are very few safe, effective, evidence-based treatments. Purastat is a haemostatic agent licensed for gastrointestinal bleeding. It is a self-assembling peptide that forms a molecular mesh in contact with blood, thereby sealing blood vessels. There are numerous studies showing its efficacy and safety in various surgical/endoscopic settings. This service evaluation reports the first experience of the use of Purastat in RP. METHODS Consecutive patients attending pelvic radiation disease clinic with severe refractory RP were offered treatment with Purastat. This was defined as rectal bleeding into the pan±anaemia with no response to rectal sucralfate. Purastat was applied endoscopically at four weekly intervals up to three times, with more as required. Bleeding severity, endoscopic grade and haemoglobin were recorded. RESULTS Twenty-one patients were treated (18 men, median age 76 years) with a median of three treatments. Ten were on antithrombotics, 1 had thrombocytopenia and 13 had anaemia at baseline. Median episodes of bleeding reduced from 4.5 (0-27) to 2 (0-16) in the 7 days prior to the first and third treatment, respectively. Endoscopic grade was improved. Mean haemoglobin increased from 116.0 to 122.7. There were no complications. CONCLUSION Even in this cohort of severe refractory RP, there was an improvement in bleeding and endoscopic grade with Purastat. A randomised controlled trial is planned.
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