Technical Innovations and Patient Support in Radiation Oncology最新文献

Training technical professionals for Radiotherapy is essential due to growing demand caused by early cancer diagnoses, global population aging, rising cancer rates, and evolving equipment and techniques. Our objective was to gather insights from graduates of various courses who are now working professionally, based on the principle that one way to assess educational training is by considering the attributes that trained and active professionals deem important in the improvement courses they have taken.

A cross-sectional study (approved at the local Research Ethics Committee) was conducted, involving an online survey for the opinion of professionals already qualified as radiotherapy technicians or technologists and engaged in this work. The questionnaire consisted of 12 objective multiple-choice questions and four open-ended questions.

Of the 59 received responses, 49 professionals completed some course. Thirty-one (64.6%) pursued improvement/enhancement, followed by specialization (15; 31.2%) and extension (two; 4.2%). Thirty-four (69.4%) respondents had not engaged in any practical activities during their training. As for course weaknesses, respondents cited: inflexible schedule (29; 59.2%), distance from residence (12; 24.5%), low hourly load (four; 8.2%), and other issues (four; 8.2%).

The data underscores the need to adjust technical training in Radiotherapy, emphasizing the importance of a recognized professional team, practical learning, flexible schedules, and financial viability.

The strategic perspective of radiotherapy technicians currently working in this job market, emphasized the need for an adjustment in the offering of courses. These insights provide more well-structured foundations for contemporary teaching and learning processes, considering current societal characteristics, technological advances, and future student demands.

The radiation therapy (RT) landscape is continuously evolving, necessitating adaptation in roles and responsibilities of radiation therapists (RTTs). Advanced Practice Radiation Therapists (APRTs) have taken on a proactive role in expanding services and assuming responsibilities within multi-professional teams.

A European Society for Radiotherapy and Oncology (ESTRO) brought geographically diverse and experienced RTTs together, to discuss how advanced practice (AP) in the RTT profession should be future-proofed and create a global platform for collaboration. Challenges in achieving consensus and standardisation of APRT was identified across jurisdictions, emphasising the importance of international collaboration.

Whilst highlighting the pivotal role of APRTs in driving innovation, improving patient care, and navigating the complexities of modern RT practice, this position paper presents outcomes and recommendations from the workshop. Discussions highlighted the need for standardised role definitions, education frameworks, regulatory support, and career development pathways to enable the advancement of APRT effectively. Increasing networks and collaboration is recommended to ensure APRTs can shape the future of RT.

Education is key in preparing healthcare professionals for the current and future needs of the clinical environment. Hence, ESTRO facilitated a workshop, with a track focusing on radiation therapists’ (RTT) education and whether it is fit for the current demands of RTTs. An international group of participants with academic and clinical backgrounds discussed the current situation in their respective working environments, evaluated the challenges in RTT education, and highlighted opportunities and possible solutions to meet current and future needs. Key outcomes highlighted the importance of strengthening collaboration between clinical and academic staff.

Introduction

The clinical implementation of deep inspiratory breath-hold (DIBH) radiotherapy to reduce cardiac exposure in patients with left-sided breast cancer is challenging with helical tomotherapy(HT) and has received little attention. We describe our novel approach to DIBH irradiation in HT using a specially designed frame and manual gating, and compare cardiac substructure doses with the free-breathing (FB) technique.

Material and methods

The workflow incorporates staggered junctions and a frame that provides tactile feedback to the patient and monitoring for manual cut-off. The treatment parameters and clinical outcome of 20 patients with left-sided breast cancer who have undergone DIBH radiotherapy as a part of an ongoing prospective registry are reported. All patients underwent CT scans in Free Breathing (FB) and DIBH using the in-house Respiframe, which incorporates a tactile feedback-based system with an indicator pencil. Plans compared target coverage, cardiac doses, synchronizing treatment with breath-hold and avoiding junction repetition. MVCT scans are used for patient alignment.

Results

The mean dose (Dmean) to the heart was reduced by an average of 34 % in DIBH-HT compared to FB-HT plans (3.8 Gy vs 5.7 Gy). Similarly, 32 % and 67.8 % dose reduction were noted in the maximum dose (D0.02 cc) of the left anterior descending artery, mean 12.3 Gy vs 18.1 Gy, and mean left ventricle V5Gy 13.2 % vs 41.1 %, respectively. The mean treatment duration was 451.5 sec with a median 8 breath-holds; 3 % junction locations between successive breath-holds were replicated. No locoregional or distant recurrences were observed in the 9-month median follow-up.

Conclusion

Our workflow for DIBH with Helical-Tomotherapy addresses patient safety, treatment precision and challenges specific to this treatment unit. The workflow prevents junction issues by varying daily breath-hold durations and avoiding junction locations, providing a practical solution for left-sided breast cancer treatment with HT.

Technological advances in radiation therapy impact on the role and scope of practice of the radiation therapist. The European Society of Radiotherapy and Oncology (ESTRO) recently held two workshops on this topic and this position paper reflects the outcome of this workshop, which included radiation therapists from all global regions.

Workflows, quality assurance, research, IGRT and ART as well as clinical decision making are the areas of radiation therapist practice that will be highly influenced by advancing technology in the near future. This position paper captures the opportunities that this will bring to the radiation therapist profession, to the practice of radiation therapy and ultimately to patient care.

Background

Late effects of cancer treatment, such as neurocognitive deficits and fatigue, can be debilitating. Other than head and neck–specific functional deficits such as impairments in swallowing and speech, little is known about survivorship after oropharyngeal cancer. This study examines the lived experience of fatigue and neurocognitive deficits in survivors of oropharyngeal squamous cell cancer and impact on their daily lives.

Methods

This work is part of the multicentre mixed method ROC-oN study (Radiotherapy for Oropharyngeal Cancer and impact on Neurocognition), evaluating fatigue and neurocognitive function in patients following radiotherapy +/- chemotherapy for oropharyngeal cancer and impact on quality of life. Semi-structured interviews were conducted in adults treated with radiotherapy (+/-chemotherapy) for oropharyngeal squamous cell carcinoma >/=24 months from completing treatment. Reflexive thematic analysis performed.

Results

21 interviews (11 men and 10 women; median age 58 years and median time post-treatment 5 years) were conducted and analysed, yielding six themes: (1) unexpected burden of fatigue, (2) noticing changes in neurocognitive function, (3) the new normal, (4) navigating changes, (5)insufficient awareness and (6)required support. Participants described fatigue that persisted beyond the acute post-treatment period and changes in neurocognitive abilities across several domains. Paid and unpaid work, emotions and mood were impacted. Participants described navigating the new normal by adopting self-management strategies and accepting external support. They reported lack of recognition of these late effects, being poorly informed and being unprepared. Follow-up services were thought to be inadequate.

Conclusions

Fatigue and neurocognitive impairment were frequently experienced by survivors of oropharyngeal cancer, at least two years after treatment. Patients felt ill-prepared for these late sequelae, highlighting opportunities for improvement of patient information and support services.

We successfully implemented an APRT specializing in CBCT-guided online adaptive contouring. These data show statistical improvements in contouring time with APRT-led vs non-APRT led ART contouring, suggesting that an APRT specifically trained to manage the ART process may reduce physician workload and patient treatment time.

Purpose

An integrated magnetic resonance scanner and linear accelerator (MR-linac) was implemented with daily online adaptive radiation therapy (ART). This study evaluated patient-reported experiences with their overall hospital care as well as treatment in the MR-linac environment.

Methods

Patients pre-screened for MR eligibility and claustrophobia were referred to simulation on a 1.5 T MR-linac. Patient-reported experience measures were captured using two validated surveys. The 15-item MR-anxiety questionnaire (MR-AQ) was administered immediately after the first treatment to rate MR-related anxiety and relaxation. The 40-item satisfaction with cancer care questionnaire rating doctors, radiation therapists, the services and care organization and their outpatient experience was administered immediately after the last treatment using five-point Likert responses. Results were analyzed using descriptive statistics.

Results

205 patients were included in this analysis. Multiple sites were treated across the pelvis and abdomen with a median treatment time per fraction of 46 and 66 min respectively. Patients rated MR-related anxiety as “not at all” (87%), “somewhat” (11%), “moderately” (1%) and “very much so” (1%). Positive satisfaction responses ranged from 78 to 100% (median 93%) across all items. All radiation therapist-specific items were rated positively as 96–100%. The five lowest rated items (range 78–85%) were related to general provision of information, coordination, and communication. Overall hospital care was rated positively at 99%.

Conclusion

In this large, single-institution prospective cohort, all patients had low MR-related anxiety and completed treatment as planned despite lengthy ART treatments with the MR-linac. Patients overall were highly satisfied with their cancer care involving ART using an MR-linac.

Introduction

Advancements in MRI-guided radiotherapy (MRgRT) enable clinical parallel workflows (CPW) for online adaptive planning (oART), allowing medical physicists (MPs), physicians (MDs), and radiation therapists (RTTs) to perform their tasks simultaneously. This study evaluates the impact of this upgrade on the total treatment time by analyzing each step of the current 0.35T-MRgRT workflow.

Methods

The time process of the workflow steps for 254 treatment fractions in 0.35 MRgRT was examined. Patients have been grouped based on disease site, breathing modality (BM) (BHI or FB), and fractionation (stereotactic body RT [SBRT] or standard fractionated long course [LC]). The time spent for the following workflow steps in Adaptive Treatment (ADP) was analyzed: Patient Setup Time (PSt), MRI Acquisition and Matching (MRt), MR Re-contouring Time (RCt), Re-Planning Time (RPt), Treatment Delivery Time (TDt). Also analyzed was the timing of treatments that followed a Simple workflow (SMP), without the online re-planning (PSt + MRt + TDt.).

Results

The time analysis revealed that the ADP workflow (median: 34 min) is significantly (p < 0.05) longer than the SMP workflow (19 min). The time required for ADP treatments is significantly influenced by TDt, constituting 40 % of the total time. The oART steps (RCt + RPt) took 11 min (median), representing 27 % of the entire procedure. Overall, 79.2 % of oART fractions were completed in less than 45 min, and 30.6 % were completed in less than 30 min.

Conclusion

This preliminary analysis, along with the comparative assessment against existing literature, underscores the potential of CPW to diminish the overall treatment duration in MRgRT-oART. Additionally, it suggests the potential for CPW to promote a more integrated multidisciplinary approach in the execution of oART.

Purpose

This study aims to develop and externally validate a clinically plausible Bayesian network structure to predict one-year erectile dysfunction in prostate cancer patients by combining expert knowledge with evidence from data using clinical and Patient-reported outcome measures (PROMs) data. In addition, compare and contrast structures that stem from PROM information and routine clinical data.

Summary of background

For men with localized prostate cancer, choosing the optimal treatment can be challenging since each option comes with different side effects, such as erectile dysfunction, which negatively impacts their quality of life. Our previous findings demonstrate that logistic regression models are able to identify patients at high risk of erectile dysfunction. However, methods such as Bayesian networks may be more successful, as they intricately represent the causal relations between the variables.

Patients and methods

946 prostate cancer patients from 65 Dutch hospitals were considered to develop the Bayesian network structure. Continuous variables were discretized before analysis based on expert opinions and literature. Patients with missing information and variables with more than 25% of missing information were excluded. Prostate cancer treating physicians first determined the relationships (arcs) between the available variables. The structures were then modified based on algorithmically derived structures using the hill-climbing algorithm. Structural Performance was evaluated based on the area under the curve (AUC) values and calibration plots on the training and test data.

Results

BMI and prostate volume via MRI were excluded from this analysis due to their high percentage of missingness (>45 %). The final cohort was reduced to 505 and 216 after excluding 157 and 68 patients with missing information, respectively. The AUC of the PROM structure was better than the clinical structure in both the train and test data. The structure that combined both sources of information had an AUC value of 0.94 (0.92 – 0.96) and 0.84171 (0.77 91) in the train and test data, respectively.

Conclusion

Bayesian network structures derived from PROM information by complimenting expert knowledge with evidence from the data produce a clinically plausible structure that is more performant than structures from clinical data. Our study supports the growing global recognition of incorporating the patient’s perspective in outcomes research for better decision-making and optimal outcomes. However, a structure that combines both sources of information gives a more holistic view of the patient with actionable insights and improved discriminative power.