Technical Innovations and Patient Support in Radiation Oncology最新文献

The roles and responsibilities of radiation therapists (RTTs) are many and varied. Professional expectations are influenced by the technology available, as well as the level of autonomy RTTs have in their daily practice. This professional range requires RTTs to possess a unique set of ever evolving skills, posing challenges from an educational perspective.

Teaching these “advanced skills” has been the ambition the ESTRO Advanced Skills in Modern Radiotherapy course. In the 10th year of this course, the Faculty look back and reflect on how our programme has evolved and what it has achieved.

Objective

Continuation of smoking after a cancer diagnosis increases the burdensome side effects from cancer treatment, and decreases the chances of cure. Smoking cessation may improve oncological outcomes in cancer patients. This study aims to evaluate if radiation oncologists can be motivated by a smoking cessation awareness intervention to discuss smoking status more frequently and increase the referral rate for smoking cessation-support.

Study design and Setting:

A multifaceted approach was used to improve awareness: First, current practice was evaluated by a retrospective chart review of 282 patients referred for radiotherapy to ascertain smoking status, discussion of smoking cessation support and referral rates. Secondly, radiation oncologists were interviewed about their motives and barriers to discuss smoking status and smoking cessation support. The results were fed back in a teaching lecture to the doctors involved. Finally, the effect of this smoking cessation awareness intervention was prospectively evaluated in 100 patients.

Results

After the smoking cessation awareness intervention, smoking cessation was more frequently discussed compared to baseline (77% (10/13)) and 39.5% (17/43) respectively. The referral rate for smoking cessation increased from 2.3% (1/43) to 69.2% (9/13)

Conclusion

Without an active smoking prevention awareness policy, referral for smoking cessation support for cancer patients by radiation oncologists is low. A relatively short and simple smoking awareness intervention for radiation oncologist may result in a more frequent discussion with patients about smoking cessation and an even larger increase in referrals for smoking cessation support.

Background and Purpose

Online adaptive MR-guided radiotherapy (MRgRT) is a relatively new form of radiotherapy treatment, delivered using a MR-Linac. It is unknown what patients expect from this treatment and whether these expectations are met. This study evaluates whether patients’ pre-treatment expectations of MRgRT are met and reports patients’ on-table experience on a 1.5 T MR-Linac.

Materials and methods

All patients treated on the MR-Linac from November 2020 until April 2021, were eligible for inclusion. Patient expectation and experience were captured through questionnaires before, during, and three months after treatment. The on-table experience questionnaire included patient’ physical and psychological coping. Patient-expected side effects, participation in daily and social activity, disease outcome and, disease related symptoms were compared to post-treatment experience.

Results

We included 113 patients who were primarily male (n = 100, 89 %), with a median age of 69 years (range 52–90). For on-table experience, ninety percent of patients (strongly) agreed to feeling calm during their treatment. Six and eight percent of patients found the treatment position or bed uncomfortable respectively. Twenty-eight percent of patients felt tingling sensations during treatment. After treatment, 79 % of patients’ expectations were met. Most patients experienced an (better than) expected level of side effects (75 %), participation in daily- (83 %) and social activity (86 %) and symptoms (78 %). However, 33 % expected more treatment efficacy than experienced.

Conclusion

Treatment on the 1.5 T MR-Linac is well tolerated and meets patient expectations. Despite the fact that some patients expected greater treatment efficacy and the frequent occurrence of tingling sensations during treatment, most patient experiences were comparable or better than previously expected.

Purpose

Intrafractional motion constitutes a significant challenge in SBRT (Stereotactic Body Radiotherapy).The breath-hold (BH) technique is employed to mitigate tumor motion; however, ensuring reproducibility and consistency remains critically important. Surface tracking systems, integrated into the treatment process, facilitate motion tracking through three-dimensional camera technology. Surface guidance has been incorporated with Varian EDGE (Varian Medical Systems, Palo Alto, CA, USA) and has been utilized at multiple treatment sites within our department since 2018. Drawing on four years of experience, this study aims to publish patient experience, assess the feasibility, and evaluate the tolerability of breath-hold during SBRT with surface guided radiotherapy (SGRT), particularly focusing on a specific subgroup: patients with liver metastases.

Methods

Prospective evaluation was conducted on patients with liver metastases undergoing breath-hold SBRT with SGRT. A two-step survey consisting of seven questions was administered after CT simulation and treatment. Treatment duration and the number of breath-holds were recorded. Additionally, factors potentially influencing SGRT and treatment time were assessed.

Results

Between April 2021 and May 2022, a total of 41 patients underwent 171 fractions of treatment. According to the questionnaire, prior training was found to be beneficial, and breath-holding during the procedure was tolerable. Patients reported experiencing slight stress due to their active participation in the treatment. Factors such as Karnofsky Performance Status (KPS), age, lung volume, conditions affecting lung capacity, previous breath-hold history, and being a native speaker showed no correlation with treatment time. Moreover, these factors did not correlate with the tolerability of breath-hold during SGRT. However, female patients showed better breath-holding performance in SGRT treatments compared to male patients (p: 0.02).

Conclusions

The application of breath-hold with SGRT procedures is tolerable and feasible in liver SBRT treatments. There exists no specific subgroup that cannot tolerate this method.

A female patient in her 50 s was found to have a 10-cm tumor resulting from locally advanced cervical cancer (LACC). Three-year relapse-free survival was achieved following a multimodal treatment strategy integrating chemoradiotherapy (CRT), regional hyperthermia (RHT), and interstitial brachytherapy (ISBT). Given the large size of the tumor, enhancement of the geometrical dose distribution was anticipated using ISBT. However, delivery of a sufficient dose to the high-risk clinical target volume was predicted to be challenging. Thus, RHT was incorporated to potentially augment the overall treatment effect. This unique combination of CRT, RHT and ISBT may be promising for management of large LACC and warrants further investigation.

Introduction

In this simulation study, we examined the effects of a de-escalation strategy with a reduced dose to subclinical nodal regions in patients with human papillomavirus (HPV)-associated oropharyngeal carcinoma (OPC).

Methods

We created two patterns of intensity-modulated radiotherapy for 16 patients with HPV-associated OPC. In the standard and de-escalation plans, the initial field including elective nodal regions received 46 and 30 Gy, followed by 20 and 36 Gy to the cutdown field, respectively. Comparison metrics were set for each organ at risk (OAR). We compared these metric values and the probability of adverse effects based on the normal tissue complication probability (NTCP) model between the two plans.

Results

Both plans generally met the dose constraints for the targets and all OAR. Among the comparison metrics, the mean doses to the brain, pharyngeal constrictor muscle, thyroid, and skin and the dose to a 1 % volume of the skin were higher in the standard plan than in the de-escalation plan (P = 0.031, 0.007, < 0.001, < 0.001, and 0.006, respectively). NTCP analyses revealed that the probability of adverse effects in the ipsilateral parotid gland and thyroid was higher in the standard plan than in the de-escalation plan (standard vs. de-escalation plans: ipsilateral parotid gland, 6.4 % vs. 5.0 %, P = 0.016; thyroid, 3.3 % vs. 0.5 %, P < 0.001).

Conclusions

A de-escalation strategy with elective nodal regions is a promising treatment to prevent a decline in the quality of life in patients with HPV-associated OPC, particularly xerostomia, dysphagia, and hypothyroidism.

We report the case of a medically inoperable patient with localised colon cancer. Due to symptomatic bleeding, definitive radiotherapy (5 daily fractions of 5 Gy) has been performed using cone-beam computed tomography-based online-adaptive radiotherapy (ART). Online-ART enables compensation of interfraction motion of abdominal organs by performing daily delineation of organs at risk (OARs) and target volumes. Daily treatment replanning maximised target volume coverage while lowering the dose to OARs. Intrafraction variation of the tumour was still significant and had to be incorporated in the planning target volume margin computation. After the treatment, the patient did not develop any acute radiotherapy-induced adverse events and had no further rectal bleeding either at the end of the radiotherapy or at oncological follow-up 4 months later. Online-ART for colon cancer is feasible and is a valuable alternative when surgery is not an option.

Patients who could benefit from palliative radiotherapy (PRT) may be in different phases of the cancer journey: they may have minimal symptoms and preserved functional status, or could be near end of life, with multiple complex care needs. Efficient triage at PRT referral is crucial to match patients with an appropriate provider and care setting as quickly as possible. Many centres have a dedicated PRT clinic, for which triage occurs by a Palliative Clinical Specialist Radiation Therapist (PCSRT). We performed an English-language literature search of 15 databases, without date limits, based on the PICO framework. After independent screening of titles and abstracts by two authors, relevant full text papers were reviewed. Twenty studies (15 publications and five abstracts) and one government report met inclusion criteria. Studies were published over a 21-year period by investigators from four countries. By identifying bottlenecks, screening out inappropriate referrals, and assessing patients in advance of consult, PSCRT triage decreased wait times by approximately 50%, on average, compared to standard pathways (range 30–82%). Increasing efficiency by pre-booking and coordinating appointments increases patient volumes and optimizes use of resources. A triage PCSRT serving a navigator role improves continuity of care, and in decreasing the number of handoffs, safety as well. Shifting triage to a PCSRT allows multidisciplinary team members to work to their maximum scope. In one clinic, after incorporation of PCSRT triage, use of on-call services decreased, as more patients were seen during daytime appointments, contributing to cost-savings.