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Mulherkar R, Ling DC, Tendulkar R, Kamrava MR, Beriwal S. Quality of Radiotherapy Workforce Training within the USA. Clin Oncol (R Coll Radiol) 2024:S0936-6555(24)00048-7. [PMID: 38331669 DOI: 10.1016/j.clon.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/04/2024] [Accepted: 01/25/2024] [Indexed: 02/10/2024]
Abstract
The training, competency requirements and scope of practice of professionals within a radiation oncology department vary across countries. The purpose of this review is to shed light on the current status of radiotherapy training in the USA by discussing current benchmarks for medical residency, physics residency, radiation therapy and dosimetry training programmes. Although there are notable strengths, the US radiotherapy workforce training system also faces several challenges when it comes to standardising education to develop a competent workforce that meets societal needs. Continued efforts are needed at a systemic level to improve training in areas such as brachytherapy and proton therapy, promote research involvement and develop trainees who are equipped to form a competent radiation therapy workforce.
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Affiliation(s)
- R Mulherkar
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - D C Ling
- Department of Radiation Oncology, USC Keck School of Medicine, Los Angeles, CA, USA
| | - R Tendulkar
- Department of Radiation Oncology, Cleveland Clinic Cancer Center, Cleveland, OH, USA
| | - M R Kamrava
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - S Beriwal
- Department of Radiation Oncology, AHN Cancer Institute, Pittsburgh, PA, USA.
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Asha W, Alhilli Z, Djohan R, Budd G, Fleming-Hall E, Yang K, Tendulkar R, Shah C. 97P Modern outcomes with re-irradiation, systemic therapy and surgery for radiotherapy-associated angiosarcoma of the breast. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.101134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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3
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Ciezki J, Reddy C, Ulchaker J, Angermeier K, Stephans K, Tendulkar R, Stephenson A, Chehade N, Altman A, Klein E. Patterns of Care for the Definitive Management of Prostate Cancer in the U.S. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kittel J, Reddy C, Ulchaker J, Angermeier K, Stephans K, Tendulkar R, Chehade N, Altman A, Klein E, Ciezki J. A Significant Cause of Variability in Prostate Brachytherapy Outcomes as Demonstrated From a Single Institution Suggesting a Method for Uniform Reporting Among Institutions. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Stephans K, Tendulkar R, Reddy C, Stephenson A, Klein E, Kupelian P, Ciezki J. High-Risk Prostate Cancer: Radiation or Surgery? Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ferjani S, Stephans K, Tendulkar R, Xia P. SU-E-T-649: Planning Margins Validation for Concurrent Treatment of Prostate and Pelvic Lymph Nodes Under Daily Image Guided Delivery. Med Phys 2013. [DOI: 10.1118/1.4815076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Magnelli A, Tendulkar R, Macklis R, Xia P. SU-E-J-77: Clinical Evaluation of a Three-Dimensional Optical Surface Based Imaging Device for Breast Treatment Setup. Med Phys 2012; 39:3670. [DOI: 10.1118/1.4734912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Curtis W, Khan M, Stephans K, Tendulkar R, Xia P. Imaging Frequency And Planning Margins For Non Real Time Intra-fraction Monitoring Of Prostate Motion. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Ciezki J, Reddy C, Angermeier K, Ulchaker J, Stephans K, Tendulkar R, Altman A, Chehade N, Klein E. Long-term Toxicity and Associated Cost of Initial Treatment and Subsequent Toxicity-Related Intervention for Patients Treated with Prostatectomy, External Beam Radiotherapy, or Brachytherapy: A SEER-Medicare Database Study. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shang Q, Olsen LS, Stephans K, Tendulkar R, Xia P. SU-E-J-39: Daily Prostate Rotation Should Be Compensated in Translational Correction and Not to Be Ignored. Med Phys 2011. [DOI: 10.1118/1.3611807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Huang G, Yu N, Stephans K, Tendulkar R, Xia P. SU-E-T-534: Assessing Planning Margins Using Shifting Dose Matrix Method to Calculate Daily and Cumulative Doses under Imaging Guided Radiotherapy (IGRT). Med Phys 2011. [DOI: 10.1118/1.3612496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Huang G, Qi P, Shang Q, Olsen LS, Stephans K, Tendulkar R, Xia P. SU-E-T-616: Shifting MLC to Follow the Prostate Movements while Concurrently Treating Pelvic Lymph Nodes. Med Phys 2011. [DOI: 10.1118/1.3612579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Shukla ME, Brooks S, Reddy CA, Djohan R, Dietz J, Tendulkar R. Abstract P5-14-04: Patterns of Locoregional Failure in Women with Invasive Breast Cancer Treated with Mastectomy and Tissue Expander/Implant Reconstruction. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p5-14-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: Breast reconstruction with a tissue expander/implant (TE/I) following mastectomy for invasive breast cancer poses unique challenges in detecting local recurrence and in the technical delivery of post-mastectomy radiotherapy (PMRT). For women identified as having high risk disease, PMRT lowers the risk of locoregional failure (LRF) and enhances long-term survival. The aim of this study was to evaluate the patterns of LRF in women who underwent mastectomy and implant reconstruction, with or without adjuvant PMRT.
METHODS: We performed a retrospective review of all patients undergoing mastectomy with TE/I reconstruction for non-metastatic invasive breast cancer from 2001-2006 at the Cleveland Clinic, after approval from the institutional review board. The presence and location of locoregional recurrence was noted. Kaplan-Meier curves were generated to estimate locoregional recurrence free survival (LRFS) and overall survival (OS) rates.
RESULTS: The study population consisted of 326 patients: 121 (37%) with pathologic stage I disease, 128 (39%) with stage II, 46 (14%) with stage III, and 31 (10%) who underwent neoadjuvant systemic therapy prior to mastectomy. The median number of lymph nodes dissected was 10 and the median follow-up was 5.5 years. The OS for all patients at 5 years was 92.4%. By stage, 5-year OS was 95.9% for stage I, 94.4% for stage II,87.2% for stage III, and 79.6% for those undergoing pre-operative systemic therapy. The LRFS at 5 years for all patients was 91.3%. The 5-year LRFS was 95.4% for stage I, 93.6% for stage II, 79.4% for stage III, and 87.4% for those who underwent pre-operative systemic therapy. 8% of all patients had a LRF. By lymph node status, node-negative patients (N0) had a LRF rate of 4.8% (9/189), those with 1-3 nodes positive (N1) had a LRF rate of 5.0% (4/80), those with 4-9 nodes positive (N2) had a LRF rate of 17.5% (7/40), and those with 10 or more nodes positive (N3) had a LRF rate of 50% (6/12).
The most common sites of LRF were cutaneous chest wall (8/26) and axilla (8/26), followed by the supraclavicular/cervical nodes (5/26) and chest wall with muscle involvement (3/26). The remaining 2/26 failed at a combination of the above sites.
21.2% of the total population (69/326) underwent PMRT to the chest wall and regional nodes. By nodal status, including those who received neoadjuvant systemic therapy, 7.4% of women with zero nodes positive underwent radiation, followed by 18.8% with 1-3 nodes positive, and 76.9% with 4 or more nodes positive.
CONCLUSIONS: The crude rate of LRF in this large institutional series is similar to what has been previously reported in the literature. In our population, LRF in the superficial chest wall occurred at the same rate as the axillary nodes, which was followed in frequency by the supraclavicular/cervical nodes. Nearly 1/4 of women with 4 or more positive axillary nodes underwent no adjuvant radiation therapy following mastectomy, despite being a population of women known to derive benefit from PMRT. Further investigation is required to determine whether the presence of a TE/I reconstruction alters decision-making for adjuvant local therapy and/or impacts the technical delivery of PMRT.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-14-04.
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Hunter G, Reddy C, Angermeier K, Ulchaker J, Zippe C, Stephans K, Tendulkar R, Kupelian P, Klein E, Ciezki J. Long-term (potential 10 year follow-up) Toxicity after Treatment for Prostate Cancer with Either External Beam Radiation Therapy, Interstitial Brachytherapy, or Radical Prostatectomy. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Djemil T, Gajdos S, Ouzidane M, Tendulkar R, Khan M, Xia P. SU-GG-J-66: A Single Phantom Study for the Evaluation of Accuracy of Three IGRT Techniques. Med Phys 2010. [DOI: 10.1118/1.3468290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Wang Y, Gajdos S, Tendulkar R, Vassil A, Bayouth J, Xia P. SU-GG-T-132: Application of Non Flat Beams for Breast Radiotherapy Using Direct Aperture Optimization. Med Phys 2010. [DOI: 10.1118/1.3468522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Burdick M, Neumann D, Pohlman B, Reddy C, Tendulkar R, Macklis R. External Beam Radiotherapy followed by Y90 Ibritumomab Tiuxetan in Relapsed Bulky Follicular Lymphoma. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.1100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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