Randomized trials of radiation therapy in adult low-grade gliomas

There are two central questions in the radiotherapeutic management of the adult patient with a supratentorial low-grade (WHO grade II) astrocytoma, oligo-astrocytoma, or oligodendroglioma. The first question is one of timing. Following tissue diagnosis with or without maximum surgical resection, should immediate postoperative radiation therapy (RT) be given, or should RT be deferred to the time of local recurrence? The second question is one of dose. Assuming RT is given, should lower doses (ie, approximately 45-50 Gray (Gy)) or higher doses (ie, approximately 60-65 Gy) be administered? One Phase III prospective randomized clinical trial addressing the first question and two addressing the second question have been performed. Their results suggest that delayed (versus immediate) RT and low-dose (versus high-dose) RT are both acceptable treatment strategies despite the bias amongst radiation oncologists (primarily based on retrospective data) that immediate and high-dose RT would result in better outcome. The schema of the ongoing Radiation Therapy Oncology Group study is presented.

Radiation exposure of anesthesiologists

STUDY OBJECTIVE

To determine the level of radiation exposure of anesthesiologists in the operating rooms and cardiac catheterization laboratory.

DESIGN

Prospective study of all anesthesia fellows.

SETTING

Operating rooms (ORs) and radiology department of a tertiary care pediatric hospital.

SUBJECTS

Anesthesiologists caring for patients in a pediatric hospital requiring anesthesia or monitored anesthesia care. (Patients were not directly studied.)

MEASUREMENTS AND MAIN RESULTS

Anesthesiologists wore standard radiation safety film badges, which were sensitive to cumulative doses of radiation greater than 10 mrem. In the ORs, anesthesiologists were exposed to less than 10 mrem/mon. In the cardiac catheterization laboratory, they had dosimetric readings that ranged from 20 to 180 mrem/mon and frequently exceeded the guidelines for nonradiation workers.

CONCLUSIONS

There is no need for routine dosimetric monitoring of anesthesiologists working in the OR setting, since this is associated with negligible radiation exposure. Monitoring of radiation film badges should be considered for anesthesiologists who frequently work in fluoroscopy areas, such as the cardiac catheterization laboratory. All personnel working near radiation sources should wear appropriate shielding and, whenever patient safety permits, distance themselves as far as possible from the source of radiation.