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Abdel-Wahab M, Giammarile F, Carrara M, Paez D, Hricak H, Ayati N, Li JJ, Mueller M, Aggarwal A, Al-Ibraheem A, Alkhatib S, Atun R, Bello A, Berger D, Delgado Bolton RC, Buatti JM, Burt G, Bjelac OC, Cordero-Mendez L, Dosanjh M, Eichler T, Fidarova E, Gondhowiardjo S, Gospodarowicz M, Grover S, Hande V, Harsdorf-Enderndorf E, Herrmann K, Hofman MS, Holmberg O, Jaffray D, Knoll P, Kunikowska J, Lewis JS, Lievens Y, Mikhail-Lette M, Ostwald D, Palta JR, Peristeris P, Rosa AA, Salem SA, Dos Santos MA, Sathekge MM, Shrivastava SK, Titovich E, Urbain JL, Vanderpuye V, Wahl RL, Yu JS, Zaghloul MS, Zhu H, Scott AM. Radiotherapy and theranostics: a Lancet Oncology Commission. Lancet Oncol 2024:S1470-2045(24)00407-8. [PMID: 39362232 DOI: 10.1016/s1470-2045(24)00407-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/18/2024] [Accepted: 07/19/2024] [Indexed: 10/05/2024]
Abstract
Following on from the 2015 Lancet Oncology Commission on expanding global access to radiotherapy, Radiotherapy and theranostics: a Lancet Oncology Commission was created to assess the access and availability of radiotherapy to date and to address the important issue of access to the promising field of theranostics at a global level. A marked disparity in the availability of radiotherapy machines between high-income countries and low-income and middle-income countries (LMICs) has been identified previously and remains a major problem. The availability of a suitably trained and credentialled workforce has also been highlighted as a major limiting factor to effective implementation of radiotherapy, particularly in LMICs. We investigated initiatives that could mitigate these issues in radiotherapy, such as extended treatment hours, hypofractionation protocols, and new technologies. The broad implementation of hypofractionation techniques compared with conventional radiotherapy in prostate cancer and breast cancer was projected to provide radiotherapy for an additional 2·2 million patients (0·8 million patients with prostate cancer and 1·4 million patients with breast cancer) with existing resources, highlighting the importance of implementing new technologies in LMICs. A global survey undertaken for this Commission revealed that use of radiopharmaceutical therapy-other than 131I-was highly variable in high-income countries and LMICs, with supply chains, workforces, and regulatory issues affecting access and availability. The capacity for radioisotope production was highlighted as a key issue, and training and credentialling of health professionals involved in theranostics is required to ensure equitable access and availability for patient treatment. New initiatives-such as the International Atomic Energy Agency's Rays of Hope programme-and interest by international development banks in investing in radiotherapy should be supported by health-care systems and governments, and extended to accelerate the momentum generated by recognising global disparities in access to radiotherapy. In this Commission, we propose actions and investments that could enhance access to radiotherapy and theranostics worldwide, particularly in LMICs, to realise health and economic benefits and reduce the burden of cancer by accessing these treatments.
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Affiliation(s)
- May Abdel-Wahab
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria.
| | - Francesco Giammarile
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Mauro Carrara
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Diana Paez
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Molecular Pharmacology Program, Sloan Kettering Institute, New York, NY, USA; Department of Radiology, Weill Cornell Medical College, New York, NY, USA; Gerstner Sloan Kettering Graduate School of Biomedical Sciences, New York, NY, USA
| | - Nayyereh Ayati
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Jing Jing Li
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | | | - Ajay Aggarwal
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Akram Al-Ibraheem
- Department of Nuclear Medicine, King Hussein Cancer Center, Amman, Jordan; Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan
| | - Sondos Alkhatib
- Department of Radiation Oncology, Henry Ford Health, Detroit, MI, USA
| | - Rifat Atun
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Abubakar Bello
- National Hospital, Abuja and Federal University of Health Sciences, Azare, Nigeria
| | - Daniel Berger
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Roberto C Delgado Bolton
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja, Logroño, Spain; Servicio Cántabro de Salud, Santander, Spain
| | - John M Buatti
- Department of Radiation Oncology, Holden Comprehensive Cancer Center, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | | | - Olivera Ciraj Bjelac
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Lisbeth Cordero-Mendez
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Manjit Dosanjh
- University of Oxford, Oxford, UK; European Organization for Nuclear Research, Geneva, Switzerland
| | - Thomas Eichler
- Department of Radiation Oncology, Massey Cancer Center Virginia Commonwealth University, Richmond, VA, USA
| | - Elena Fidarova
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | | | - Mary Gospodarowicz
- Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Surbhi Grover
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana; Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Varsha Hande
- Department of Global Health, Medicine and Welfare, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Ekaterina Harsdorf-Enderndorf
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg, Essen, Germany; German Cancer Consortium, University Hospital Essen, Essen, Germany
| | - Michael S Hofman
- Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Ola Holmberg
- Division of Radiation, Transport and Waste Safety, Department of Nuclear Safety and Security, International Atomic Energy Agency, Vienna, Austria
| | - David Jaffray
- Department of Radiation Physics and Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peter Knoll
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Jolanta Kunikowska
- Nuclear Medicine Department, Medical University of Warsaw, Warsaw, Poland
| | - Jason S Lewis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Molecular Pharmacology Program, Sloan Kettering Institute, New York, NY, USA; Department of Pharmacology, Weill Cornell Medical College, New York, NY, USA
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Miriam Mikhail-Lette
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Dennis Ostwald
- WifOR Institute, Darmstadt, Germany; Steinbeis School of International Business and Entrepreneurship, Herrenberg, Germany
| | - Jatinder R Palta
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Arthur A Rosa
- Radiation Oncology, Grupo Oncoclinicas, Salvador, Brazil
| | - Soha Ahmed Salem
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | | | - Mike M Sathekge
- Department of Nuclear Medicine, University of Pretoria, Pretoria, South Africa; Steve Biko Academic Hospital, Pretoria, South Africa; Nuclear Medicine Research Infrastructure, Pretoria, South Africa
| | | | - Egor Titovich
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Jean-Luc Urbain
- Department of Radiology, Division of Nuclear Medicine, Branford General Hospital, Ontario, Canada
| | - Verna Vanderpuye
- National Center for Radiotherapy Oncology and Nuclear Medicine Department of the Korlebu Teaching Hospital, Accra, Ghana
| | - Richard L Wahl
- Mallinckrodt Institute of Radiology, Department of Radiology, and Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Jennifer S Yu
- Department of Radiation Oncology and Department of Cancer Biology, Cleveland Clinic, Cleveland, OH USA
| | - Mohamed Saad Zaghloul
- Radiation Oncology Department, National Cancer Institute, Cairo University & Children's Cancer Hospital, Cairo, Egypt
| | - Hongcheng Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Andrew M Scott
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, VIC, Australia; Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia; School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia; Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia.
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Valentini V, Cellini F, Riddell A, Brunner TB, Roeder F, Giuliante F, Alfieri S, Manfredi R, Ardito F, Fiorillo C, Porziella V, Morganti AG, Haustermans K, Margaritora S, De Bari B, Matzinger O, Gkika E, Belka C, Allum W, Verheij M. ESTRO ACROP guidelines for the delineation of lymph nodal areas in upper gastrointestinal malignancies. Radiother Oncol 2021; 164:92-97. [PMID: 34547352 DOI: 10.1016/j.radonc.2021.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
The European SocieTy for Radiation and Oncology -Advisory Committee on Radiation Oncology Practice (ESTRO-ACROP) endorsed a project to provide guidelines (GL) for the identification and delineation of clinically negative lymph-nodal stations (LNs) involved in upper gastrointestinal clinical scenarios. The presented GL is focused on preoperative (or definitive) setting. The project aim is to improve the consistency of clinical target volume (CTV) delineation by providing: a description of the anatomical boundaries of the LNs; a radiological computed tomography-based atlas depicting the LNs areas; a free, web-based, interactive example case for independent training of radiation oncologists on LNs delineation according to the presented GL, by both qualitative and quantitative analysis (through the FALCON EduCase platform). This project was carried out with the intention to facilitate and improve uniformity of future upper gastrointestinal guidelines on nodal CTV delineation. We report methodology and results from the collaboration of a working group panel selected by the ESTRO-ACROP.
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Affiliation(s)
- Vincenzo Valentini
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Rome, Italy; Università Cattolica del Sacro Cuore, Dipartimento Universitario Diagnostica per immagini,. Radioterapia Oncologica ed Ematologia, Rome, Italy.
| | - Francesco Cellini
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Rome, Italy; Università Cattolica del Sacro Cuore, Dipartimento Universitario Diagnostica per immagini,. Radioterapia Oncologica ed Ematologia, Rome, Italy.
| | - Angela Riddell
- Department of Diagnostic Radiology, The Royal Marsden, London, United Kingdom.
| | - Thomas B Brunner
- Department of Radiation Oncology, University Hospital Magdeburg, Germany.
| | - Falk Roeder
- Department of Radiotherapy and Radiation Oncology, Paracelsus Medical University Salzburg, Landeskrankenhaus, Salzburg, Austria.
| | - Felice Giuliante
- Hepatobiliary Surgery Unit, Fondazione Policlinico A. Gemelli - IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore di Roma, Largo Francesco Vito 1, 00168, Rome, Italy.
| | - Sergio Alfieri
- Divisione di Chirurgia Digestiva, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS; Largo Agostino Gemelli, 8, 00168, Rome (Italy); CRMPG (Advanced Pancreatic Research Center), Largo Agostino Gemelli, 8, 00168, Rome (Italy); Università Cattolica del Sacro Cuore di Roma, Largo Francesco Vito 1, 00168, Rome (Italy).
| | - Riccardo Manfredi
- Università Cattolica del Sacro Cuore, Dipartimento Universitario Diagnostica per immagini,. Radioterapia Oncologica ed Ematologia, Rome, Italy.
| | - Francesco Ardito
- Hepatobiliary Surgery Unit, Fondazione Policlinico A. Gemelli - IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore di Roma, Largo Francesco Vito 1, 00168, Rome, Italy.
| | - Claudio Fiorillo
- Divisione di Chirurgia Digestiva, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS; Largo Agostino Gemelli, 8, 00168, Rome (Italy); CRMPG (Advanced Pancreatic Research Center), Largo Agostino Gemelli, 8, 00168, Rome (Italy); Università Cattolica del Sacro Cuore di Roma, Largo Francesco Vito 1, 00168, Rome (Italy).
| | - Venanzio Porziella
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy.
| | - Alessio G Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna; Bologna, Italy; DIMES, Alma Mater Studiorum - Bologna University; Bologna, Italy.
| | | | - Stefano Margaritora
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Roma, Italy.
| | - Berardino De Bari
- Radiation Oncology Department, Réseau hospitalier Neuchâtelois, La Chaux-de-Fonds, Switzerland.
| | - Oscar Matzinger
- Department of Radiation Oncology, Genolier Clinic, Genolier, Switzerland.
| | - Eleni Gkika
- Department of Radiation Oncology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
| | - Claus Belka
- Department of Radiation Oncology, University of Munich (LMU), Munich, Germany.
| | - William Allum
- Dept of Academic Surgery Royal Marsden NHS Foundation Trust, London, United Kingdom.
| | - Marcel Verheij
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.
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5
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Boustani J, Rivin Del Campo E, Blanc J, Peiffert D, Benezery K, Pereira R, Rio E, Le Prisé E, Créhange G, Huguet F. Quality Assurance of Dose-Escalated Radiation Therapy in a Randomized Trial for Locally Advanced Oesophageal cancer. Int J Radiat Oncol Biol Phys 2019; 105:329-337. [PMID: 31299242 DOI: 10.1016/j.ijrobp.2019.06.2542] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/17/2019] [Accepted: 06/13/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE The ongoing phase 2/3 PRODIGE 26/CONCORDE trial compares chemoradiation therapy with and without dose escalation in patients with locally advanced or unresectable esophageal cancer. The results of a benchmark case procedure are reported here to evaluate the protocol compliance of participating centers as part of quality assurance for radiation therapy. METHODS AND MATERIALS Volume delineation, target coverage, and dose constraints to the organs at risk (OARs) were assessed on treatment plans of a common benchmark case performed by each participating center. The centers were classified in 3 categories: per protocol, minor acceptable deviation (MiD), or major unacceptable deviation (MaD). A plan was rejected if ≥4 MiDs or 1 MaD were found. RESULTS Thirty-5 centers submitted 43 plans. Among them, 14 (32.6%) were per protocol, 19 (44.2%) presented at least 1 MiD, 2 (4.6%) presented at least 1 MaD, and 8 (18.6%) presented both MiD and MaD. Overall, 11 (25.6%) plans were rejected. Only 1 plan was rejected because gross tumor volume was not correctly delineated. The OAR delineation was respected in all cases. Dose constraints to the OARs were respected in the majority of cases except for the heart, where one-third of the plans presented a deviation. As for the target volume, 3 plans (5.8%) had a major underdosage and 1 plan (1.9%) had a major overdosage. Overall, 58% of all treatments were planned with intensity modulated radiation therapy, whereas 42% were planned with 3-dimensional chemoradiation therapy. Significantly more plans in the intensity modulated radiation therapy group were accepted compared with the 3-dimensional chemoradiation therapy group (P = .03). CONCLUSION The high frequency of protocol deviations underlines the importance of a quality assurance program in clinical trials. Further work should assess the impact of quality assurance for radiation therapy on patient outcomes.
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Affiliation(s)
- Jihane Boustani
- Department of Radiation Oncology, University Hospital Jean Minjoz, Besançon, France; Department of Radiation Oncology, Unicancer-Georges François Leclerc Cancer Center, Dijon, France.
| | - Eleonor Rivin Del Campo
- Department of Radiation Oncology, Tenon Hospital, Hôpitaux Universitaires Est Parisien, Sorbonne University Medical Faculty, Paris, France
| | - Julie Blanc
- Department of Biostatistics, Unicancer-Georges François Leclerc Cancer Center, Dijon, France
| | - Didier Peiffert
- Department of Radiation Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France
| | - Karine Benezery
- Department of Radiation Oncology, Centre Antoine Lacassagne, Nice, France
| | - Renata Pereira
- Department of Radiation Oncology, Centre Guillaume Le Conquérant, Le Havre, France
| | - Emmanuel Rio
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | | | - Gilles Créhange
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Florence Huguet
- Department of Radiation Oncology, Tenon Hospital, Hôpitaux Universitaires Est Parisien, Sorbonne University Medical Faculty, Paris, France
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