Reports of Practical Oncology and Radiotherapy最新文献

Background: Oncology care is a complex, multidisciplinary process requiring coordinated collaboration among various healthcare professionals. The role of the Oncology Care Coordinator (OCC) has gained prominence as a key component in enhancing the quality and efficiency of cancer care. Coordinators assist patients in navigating the healthcare system, provide emotional support, and help minimize delays in diagnosis and treatment. The aim of this study was to analyze the level of professional competencies among oncology care coordinators working within the Polish healthcare system. The study assessed self-perceived proficiency across ten key domains and examined the relationships between these competencies and sociodemographic factors such as education level and work experience.

Materials and methods: This was a cross-sectional, quantitative study using a custom-designed self-assessment questionnaire (OCCCSAQ). Participants included a total of 300 coordinators from various healthcare institutions across Poland. The questionnaire measured competencies in communication, work organization, patient education, psychological support, knowledge of procedures and law, stress management, digital literacy, and conflict resolution. Data were analyzed using descriptive and inferential statistics (t-tests, ANOVA, Pearson correlations).

Results: The highest-rated competencies were interpersonal communication (M = 8.7), psychological support (M = 8.6), and both work organization and patient education (M = 8.5). The lowest-rated were legal knowledge (M = 7.2) and stress management (M = 7.5). Education level significantly influenced perceived competence, with higher-educated coordinators scoring better in procedural knowledge, digital systems, and conflict resolution. Experience positively affected knowledge of procedures and law, but not stress management.

Conclusions: Oncology care coordinators demonstrated high competence in key areas of patient interaction and care coordination. However, there are gaps in legal knowledge and stress management that should be addressed through targeted training. Specialized roles - for example, focusing on patient education or psychological support - may also enhance service quality and job performance.

Background: The purpose was to evaluate the efficacy of hypofractionated radiotherapy (HFRT) followed by conventional fractionated radiotherapy (CFRT) in glioblastoma multiforme (GBM) patients and identify prognostic factors.

Materials and methods: We conducted a retrospective analysis of 120 GBM patients treated postoperatively between 2010 and 2017 with HFRT (30 Gy in 3 Gy fractions) followed by CFRT (24 Gy in 2 Gy fractions), for a total dose of 60 Gy. All patients received concurrent and adjuvant temozolomide (TMZ).

Results: Median age was 62.5 years. Median overall survival (OS) was 11.3 months; 1-, 2-, and 3-year survival rates were 43.3%, 16.1%, and 4.6%, respectively. Full dose completion correlated with improved OS (12.2 vs. 7.3 vs. 4.6 months for ≥ 100%, 90-99%, and < 70% dose realization, respectively). Age ≤ 63 years and gros tumor volume (GTV) ≤ 44.5 cm³ were associated with significantly better survival. Gender had no significant impact.

Conclusions: HFRT followed by CFRT with TMZ is an effective alternative to standard CFRT in patients with subtotal or partial resection. Age and tumor volume are independent prognostic factors for overall survival.

Background: Online adaptive radiotherapy (oART) with cone-beam computed tomography (CBCT) enables real-time plan adaptation to daily anatomical changes in the patient. Synthetic CTs (sCTs), generated by deforming planning CTs (pCTs) to CBCTs, are crucial for precise dose calculations. However, variations such as gaseous volumes in the pelvis may impact alignment accuracy.

Materials and methods: This retrospective study analyzed 90 treatment fractions for nine patients with cancer in the pelvic region, treated with CBCT-guided oART on the Ethos system. SCTs were generated and compared to corresponding CBCTs using similarity metrics, focusing on bony structures, external body contours, and gaseous volumes. Symmetric differences and Dice Similarity Coefficients (DSC) were calculated to evaluate the registration accuracy.

Results: Bony structure deformations were minor (average volume change 0.2%, DSC 0.89). External body contours on sCTs aligned closely with CBCT (mean deviation 1.0 ± 0.4%), while gaseous volumes exhibited lower alignment (DSC < 0.5 in many fractions). Gaseous volume discrepancies were independent of the pCT and showed time-dependent variability, emphasizing the challenges in adapting density maps. Only a small portion of the gaseous volume differences overlapped with the planning target volume (PTV), suggesting limited direct impact on dose calculation.

Conclusions: CBCT-based sCT adaptation effectively aligns external contours but does not accurately handle gaseous volumes, which may vary in great extent. Minimizing the time between CBCT acquisition and treatment is crucial to maintain alignment accuracy. Advanced imaging solutions enabling direct dose calculation without involving sCT generation could further enhance dose reconstruction but may not resolve the time-sensitive nature of gaseous volume changes.

Background: The purpose of this investigation was to determine if the Halcyon linear accelerator could provide a comparable level of treatment quality and efficiency to the TrueBeam linear accelerator when used for brain stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) in individuals with multiple brain metastases. The goal was to evaluate Halcyon as a potential substitute for TrueBeam.

Materials and methods: A review of prior treatments was performed, examining data from 30 individuals (encompassing 64 lesions) who had undergone TrueBeam SRS and SRT procedures. These existing treatment plans were then replanned for the Halcyon platform. Both treatment platforms employed 6 MV-FFF beams; however, the TrueBeam utilized a maximum dose rate of 1400 MU/min, while the Halcyon operated at 800 MU/min. Various dosimetric parameters, such as target coverage, doses to organs at risk, and gradient index, were compared, along with treatment delivery efficiency metrics, including monitor units and beam-on time. Statistical analysis was used for comparisons. Portal dosimetry was implemented for quality assurance.

Results: Both platforms achieved comparable target coverage and organ at risk (OAR) sparing, meeting Hypofractionated Treatment Effects in the Clinic (HyTEC), Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC), and the American Association of Physicists in Medicine Task Group 101 (AAPM TG-101) guidelines. Halcyon showed statistically equivalent gros tumor volume/planning target volume (GTV/PTV) doses, but a slightly higher gradient index (clinically insignificant). Beam-on time was longer for Halcyon due to its lower dose rate, but overall treatment time was potentially shorter due to efficient setup. Halcyon exhibited better QA pass rates.

Conclusion: Halcyon offers comparable dosimetric quality and treatment efficiency to TrueBeam for brain SRS/SRT. Its streamlined workflow and reduced setup time offer clinical advantages in high-volume centers, despite limitations like the lack of rotational couch correction and lower maximum dose rate.

Oral rehabilitation after the curative treatment of oral cancer is challenging. Improvement of functional and cosmetic rehabilitation following surgery and radiotherapy for head and neck cancers has been continuously attempted. Advances in dental and prosthetic implants have significantly improved quality of life. To achieve the best oncological, functional, and aesthetic outcomes, a multidisciplinary approach should be used to treat patients with oral cancer. Oral surgeons, reconstructive surgeons, implantologists, and radiation oncologists should have a good understanding of each other's specialties. Radiation can interact with metallic implants and potentially increase the dose to tissues close to the implant, leading to undesirable complications, such as osteoradionecrosis. Radiation decreases implant survival by affecting osseointegration. Implant survival depends on the location and timing of the implant placement and the radiation dose received. Outcomes can be improved using adjunct hyperbaric oxygen, robust dental care before and during radiation, and modern radiotherapy techniques such as intensity-modulated radiotherapy.

The aim of this study was to assess the impact of androgen deprivation therapy (ADT) on muscle strength and physical performance in prostate cancer (PC) patients. The systematic search was carried out across four databases: PubMed, Embase, Web of Science, and Scopus. Out of 5239 studies, 6 were included, where the standardized functional tests assessing functional mobility were used. The protocol was registered on PROSPERO. Data indicated that the grip strength decreases most rapidly at the beginning of ADT therapy and does not return to its initial values. The gait speed decreases with the duration of ADT and indicates that the patients are at increased risk of adverse outcomes. According to the Short Physical Performance Battery and the time Up and Go test results PC patients present good performance and good mobility. Changes in muscle strength and physical performance in PC patients undergoing ADT are visible and need attention of professionals to prevent further body composition changes.

Background: Optimizing high dose rate intracavitary brachytherapy (HDR-ICBT) fractionation regimens remains elusive due to concerns about radiation toxicity, despite varied schedules being used across centers for decades. This study investigates the effectiveness of two different HDR brachytherapy schedules for treating cervical cancer, comparing their outcomes in terms of acute toxicities and local control.

Materials and methods: 100 cervical carcinoma patients (stage IB3 to IVA, excluding IIIC2) were randomized into 2 arms and treated by concurrent chemo-radiotherapy followed by HDR brachytherapy, comparing 7 Gy per fraction per week for 3 fractions (Arm A) vs. 6Gy per fraction per week for 4 fractions (Arm B).

Results: The two fractionation schedules demonstrated similar efficacy for loco-regional control. While the mean equivalent dose at the bladder, sigmoid and bowel was higher in Arm B as compared to Arm A, the difference was statistically insignificant (p > 0.05). In contrast, the mean equivalent dose at the rectum was lower in Arm B as compared to Arm A but again statistically insignificant (p > 0.05). However, acute gastrointestinal toxicity (Grade 2 and 3) was found significantly lower (p < 0.001) in Arm B (46.0%) as compared to Arm A.

Conclusion: Both HDR brachytherapy schedules showed comparable efficacy with no significant difference in local control, but 6Gy per fraction for 4 fractions (Arm B) had a better toxicity profile and higher biologically equivalent dose, although long-term follow-up is needed to assess late toxicities.

Background: The aim of the study was to determine an ideal planning target volume (PTV) margin using the Van Herks formula by auditing and reporting the setup errors in 6 dimensions of patients undergoing curative radiation therapy to the brain in a newly set up Radiation Oncology Department in Southern India.

Materials and methods: All patients with intracranial neoplasms who underwent curative intracranial radiotherapy with an on board kV cone beam computed tomography (CBCT) in our department between December 2022 and December 2024 were selected for this retrospective analysis. Displacements in each direction - 3 translational and 3 rotational - were retrieved and recorded using the offline review feature of the radiation planning and delivery software. Clinical target volume (CTV) to PTV margin was calculated using the Van Herk formula (2.5 Σ + 0.7 σ) in the translational axes.

Results: We evaluated 474 on-board CBCT images of 21 patients who had undergone curative intracranial fractionated external beam radiotherapy (EBRT). Matching the CBCT and simulation CT was done and verified by 2 expert radiation oncologists. The mean setup errors in the lateral, longitudinal and vertical axes were 0.03, -0.01, and -0.06 cm, respectively, and the mean rotational errors for roll, pitch and yaw were 0.1, 0.2, and -0.28 degrees, respectively. Using the Van Herk formula, the calculated CTV to PTV margins in the lateral, longitudinal and vertical axes were 0.28, 0.37, and 0.34 cm, respectively. This was well below the institutional PTV margin of 5 mm.

Conclusions: The results showed that a reduced PTV Margin of 4mm is sufficient in intracranial malignancies. Daily Online image matching with a 6D couch further enhances the accuracy of the treatment.

Background: Surface guided radiotherapy (SGRT) aids to place the patient in the correct position before radiotherapy. The aim of this retrospective observational study was to investigate how modifying patient fixation devices and tightening SGRT tolerances reduces residual errors and interfractional positioning variability in patients' position and posture for deep inspiration breath hold radiotherapy (RT) of breast cancer.

Materials and methods: The patient fixation devices were changed by introducing a 10° wedge-shaped foam cushion under the patients' back and rotating the previously used knee wedge to support the pelvic position more tightly. Additionally, the SGRT tolerance values were tightened from 8 or 12 mm to 5 mm. Patient Group A (n = 25) had had breast-conserving surgery and Group B (n = 25) mastectomy before RT. Residual errors of bony landmarks, breast outline and indicators of patient posture were retrospectively analyzed in a treatment planning system from 472 and 467 fractions before, and from 571 and 665 fractions after modifications for Groups A and B, respectively.

Results: Statistically significant improvements (p < 0.05) in residual errors were found at the positions of the shoulder joint, T1 and T2 vertebrae (Group B), and the sternum (Groups A and B), as well as the rib cage (Group B) and the breast outline (Group A) in kV images. Systematic error for patient pitch decreased from 3.7 mm to 2.0 mm (Group A) and from 3.2 mm to 1.8 mm (Group B) (p < 0.05).

Conclusions: The modifications improved patients' position and pitch.