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In Regard to Shaitelman et al. 关于 Shaitelman et al.
IF 3.4 3区 医学 Q2 ONCOLOGY Pub Date : 2024-11-01 DOI: 10.1016/j.prro.2023.12.015
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引用次数: 0
Additive Value of Magnetic Resonance Simulation Before Chemoradiation in Evaluating Treatment Response and Pseudoprogression in High-Grade Gliomas 化疗前磁共振模拟在评估高级别胶质瘤治疗反应和假性进展中的附加价值
IF 3.4 3区 医学 Q2 ONCOLOGY Pub Date : 2024-11-01 DOI: 10.1016/j.prro.2024.04.009

Purpose

A dedicated magnetic resonance imaging simulation (MRsim) for radiation treatment (RT) planning in patients with high-grade glioma (HGG) can detect early radiologic changes, including tumor progression after surgery and before standard of care chemoradiation. This study aimed to determine the effect of using postoperative magnetic resonance imaging (MRI) versus MRsim as the baseline for response assessment and reporting pseudoprogression on follow-up imaging at 1 month (FU1) after chemoradiation.

Methods and Materials

Histologically confirmed patients with HGG were planned for 6 weeks of RT in a prospective study for adaptive RT planning. All patients underwent postoperative MRI, MRsim, and follow-up MRI scans every 2 to 3 months. Tumor response was assessed by 3 independent blinded reviewers using Response Assessment in Neuro-Oncology criteria when baseline was either postoperative MRI or MRsim. Interobserver agreement was calculated using Light's kappa.

Results

Thirty patients (median age, 60.5 years; IQR, 54.5-66.3) were included. Median interval between surgery and RT was 34 days (IQR, 27-41). Response assessment at FU1 differed in 17 patients (57%) when the baseline was postoperative MRI versus MRsim, including true progression versus partial response or stable disease in 11 (37%) and stable disease versus partial response in 6 (20%) patients. True progression was reported in 19 patients (63.3%) on FU1 when the baseline was postoperative MRI versus 8 patients (26.7%) when the baseline was MRsim (P = .004). Pseudoprogression was observed at FU1 in 12 (40%) versus 4 (13%) patients, when the baseline was postoperative MRI versus MRsim (P = .019). Interobserver agreement between observers was moderate (κ = 0.579; P < .001).

Conclusions

Our study demonstrates the value of acquiring an updated MR closer to RT in patients with HGG to improve response assessment, and accuracy in evaluation of pseudoprogression even at the early time point of first follow-up after RT. Earlier identification of patients with true progression would enable more timely salvage treatments including potential clinical trial enrollment to improve patient outcomes.
背景:在高级别胶质瘤(HGG)患者的放射治疗(RT)计划中使用专用的磁共振成像模拟(MRsim)可以检测早期放射学变化,包括手术后和标准治疗化疗前的肿瘤进展。本研究旨在确定使用术后 MRI 与 MRsim 作为反应评估基线的影响,以及化疗后一个月(FU1)随访影像报告假性进展的影响。所有患者都接受了术后 MRI、MRsim 和每 2-3 个月一次的随访 MRI 扫描。当基线为术后 MRI 或 MRsim 时,肿瘤反应由三名独立的盲审者使用神经肿瘤学反应评估(RANO)标准进行评估。观察者之间的一致性采用光度卡帕计算:共纳入30名患者(中位年龄60.5岁;IQR 54.5-66.3)。手术与 RT 之间的中位间隔为 34 天(IQR 27-41)。当基线为术后 MRI 与 MRsim 时,17 名患者(57%)在 FU1 时的反应评估有所不同,包括 11 名患者(37%)的真正进展与部分反应(PR)或疾病稳定(SD),以及 6 名患者(20%)的 SD 与 PR。当基线为术后 MRI 时,19 名患者(63.3%)在 FU1 出现真正进展,而当基线为 MRsim 时,8 名患者(26.7%)出现真正进展(p=.004)。当基线为术后 MRI 与 MRsim 时,在 FU1 观察到假性进展的患者分别为 12 人(40%)和 4 人(13%)(p=.019)。观察者之间的一致性为中等(κ = 0.579; p结论:我们的研究表明,在HGG患者接近RT时获得最新的MR,对改善反应评估和评估假性进展的准确性很有价值,即使在RT后首次随访的早期时间点也是如此。更早地识别出真正进展的患者,就能更及时地进行挽救治疗,包括潜在的临床试验,以改善患者的预后。
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引用次数: 0
A Case-based Guide for World Health Organization (WHO) Grade 2 Meningioma Radiosurgery and Radiation Therapy from The Radiosurgery Society 世界卫生组织(WHO)2 级脑膜瘤放射外科和放射治疗病例指南》,来自放射外科协会。
IF 3.4 3区 医学 Q2 ONCOLOGY Pub Date : 2024-11-01 DOI: 10.1016/j.prro.2024.02.009

Purpose

Meningiomas represent the most common primary tumor of the central nervous system. Current treatment options include surgical resection with or without adjuvant radiation therapy (RT), definitive RT, and observation. However, the radiation dose, fractionation, and margins used to treat patients with WHO grade 2 meningiomas, which account for approximately 20% of all meningiomas, are not clearly defined, and deciding on the optimal treatment modality can be challenging owing to the lack of randomized data.

Methods and Materials

In this manuscript, 3 cases of patients with WHO grade 2 meningiomas are presented with descriptions of treatment options after gross total resection, subtotal resection, and previous irradiation. Treatment recommendations were compiled from 9 central nervous system radiation oncology and neurosurgery experts from The Radiosurgery Society, and the consensus of treatment recommendations is reported.

Results

Both conventional and stereotactic RT are treatment options for WHO grade 2 meningiomas. The majority of prospective data in the setting of WHO grade 2 meningiomas involve larger margins. Stereotactic radiosurgery/hypofractionated stereotactic RT are less appropriate in this setting. Conventionally fractionated RT to at least 59.4 Gy is considered standard of care with utilization of preoperative and postoperative imaging to evaluate the extent of disease and possible osseous involvement. After careful discussion, stereotactic radiosurgery/hypofractionated stereotactic RT may play a role for the subset of patients who are unable to tolerate the standard lengthy conventionally fractionated treatment course, for those with prior RT, or for small residual tumors. However, more studies are needed to determine the optimal approach.

Conclusions

This case-based evaluation of the current literature seeks to provide examples for the management of grade 2 meningiomas and give examples of both conventional and stereotactic RT.
目的:脑膜瘤是中枢神经系统最常见的原发性肿瘤。目前的治疗方法包括手术切除并辅以或不辅以放射治疗(RT)、确定性 RT 和观察。然而,用于治疗WHO 2级脑膜瘤(约占所有脑膜瘤的20%)患者的放射剂量、分次和边缘尚未明确定义,而且由于缺乏随机数据,决定最佳治疗方式可能具有挑战性:本手稿介绍了3例WHO 2级脑膜瘤患者的病例,并描述了大体全切除、次全切除和先前照射区域内复发肿瘤后的治疗方案。治疗建议由放射外科协会的 9 位中枢神经系统放射肿瘤学和神经外科专家汇编而成,报告了大多数治疗指南的共识:结果:常规和立体定向 RT 都是治疗 WHO 2 级脑膜瘤的选择。大多数WHO 2级脑膜瘤的前瞻性数据涉及较大的边缘。立体定向放射手术/低分次立体定向 RT 不太适合这种情况。传统的分次放射治疗至少要达到 59.4 Gy,这被认为是标准的治疗方法,同时利用术前和术后成像来评估疾病的范围和可能的骨质受累情况。经过仔细讨论后,立体定向放射手术/低分次立体定向 RT 可能会在无法耐受漫长的标准常规分次治疗疗程、既往接受过 RT 治疗或残留肿瘤较小的患者中发挥作用。然而,还需要更多的研究来确定最佳方法:本文基于病例对现有文献进行评估,旨在为2级脑膜瘤的治疗提供范例,并给出常规和立体定向RT的范例。
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引用次数: 0
SBRT for Pancreatic Cancer: A Radiosurgery Society Case-Based Practical Guidelines to Challenging Cases 胰腺癌的立体定向体放射治疗(SBRT):放射外科协会的《挑战性病例实用指南》。
IF 3.4 3区 医学 Q2 ONCOLOGY Pub Date : 2024-11-01 DOI: 10.1016/j.prro.2024.06.004
The use of radiation therapy (RT) for pancreatic cancer continues to be controversial, despite recent technical advances. Improvements in systemic control have created an evolving role for RT and the need for improved local tumor control, but currently, no standardized approach exists. Advances in stereotactic body RT, motion management, real-time image guidance, and adaptive therapy have renewed hopes of improved outcomes in this devastating disease with one of the lowest survival rates. This case-based guide provides a practical framework for delivering stereotactic body RT for locally advanced pancreatic cancer. In conjunction with multidisciplinary care, an intradisciplinary approach should guide treatment of the high-risk cases outlined within these guidelines for prospective peer review and treatment safety discussions.
尽管近年来技术不断进步,但胰腺癌放射治疗(RT)的使用仍存在争议。全身控制的改善使 RT 的作用不断发展,同时也需要改善局部肿瘤控制,但目前还没有标准化的方法。立体定向体放射治疗(SBRT)、运动管理、实时图像引导和自适应治疗等方面的进步为改善这种生存率最低的毁灭性疾病的治疗效果带来了新的希望。本指南以病例为基础,为局部晚期胰腺癌的 SBRT 治疗提供了实用框架。在进行多学科治疗的同时,应采用学科内方法指导这些指南中概述的高风险病例的治疗,以便进行前瞻性同行评审和治疗安全性讨论。
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引用次数: 0
Quantifying the Risk of Technology-Driven Health Disparities in Radiation Oncology 量化技术驱动的差异风险。
IF 3.4 3区 医学 Q2 ONCOLOGY Pub Date : 2024-11-01 DOI: 10.1016/j.prro.2024.06.009

Purpose

New technologies are continuously emerging in radiation oncology. Inherent technological limitations can result in health care disparities in vulnerable patient populations. These limitations must be considered for existing and new technologies in the clinic to provide equitable care.

Materials and Methods

We created a health disparity risk assessment metric inspired by failure mode and effects analysis. We provide sample patient populations and their potential associated disparities, guidelines for clinics and vendors, and example applications of the methodology.

Results

A disparity risk priority number can be calculated from the product of 3 quantifiable metrics: the percentage of patients impacted, the severity of the impact of dosimetric uncertainty or quality of the radiation plan, and the clinical dependence on the evaluated technology. The disparity risk priority number can be used to rank the risk of suboptimal care due to technical limitations when comparing technologies and to plan interventions when technology is shown to have inequitable performance in the patient population of a clinic.

Conclusions

The proposed methodology may simplify the evaluation of how new technology impacts vulnerable populations, help clinics quantify the limitations of their technological resources, and plan appropriate interventions to improve equity in radiation treatments.
目的:放射肿瘤学领域的新技术不断涌现。固有的技术局限性会导致弱势患者群体在医疗保健方面的差异。为了提供公平的医疗服务,必须考虑到临床中现有技术和新技术的这些局限性:我们受故障模式与影响分析(FMEA)的启发,创建了一个健康差异风险评估指标。我们提供了样本患者人群及其潜在的相关差异、诊所和供应商指南以及该方法的应用实例:结果:差异风险优先级编号(dRPN)可由三个可量化指标的乘积计算得出:受影响患者的百分比(P)、剂量测定不确定性或辐射计划质量影响的严重程度(S)以及临床对评估技术的依赖程度(C)。在比较各种技术时,dRPN 可用来排序因技术限制而导致护理效果不理想的风险,当发现某种技术在诊所的患者群体中表现不公平时,还可用来规划干预措施:建议的方法可简化对新技术如何影响弱势群体的评估,帮助诊所量化其技术资源的局限性,并规划适当的干预措施以改善放射治疗的公平性。
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引用次数: 0
In Reply to Kaidar-Person et al. 答复 Kaidar-Person 等人
IF 3.4 3区 医学 Q2 ONCOLOGY Pub Date : 2024-11-01 DOI: 10.1016/j.prro.2024.02.004
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引用次数: 0
A retrospective study on the comparision of pathological tumour necrosis of conventional versus ultrahypofractionated preoperative radiotherapy in localised extremity soft tissue sarcoma and its correlation with clinical outcomes: A retrospective study on the comparision of pathological tumour necrosis of CONV-RT versus UHYPO-RT preoperative radiotherapy in localised extremity soft tissue sarcoma and its correlation with clinical outcomes. 一项关于局部四肢软组织肉瘤术前常规放疗与超高分次放疗的病理肿瘤坏死比较及其与临床疗效相关性的回顾性研究:一项关于局部四肢软组织肉瘤术前放疗CONV-RT与UHYPO-RT的病理肿瘤坏死比较及其与临床疗效相关性的回顾性研究。
IF 3.4 3区 医学 Q2 ONCOLOGY Pub Date : 2024-10-29 DOI: 10.1016/j.prro.2024.10.008
Hanis Hanafi, Carolyn R Freeman, James Tsui, Paul Ramia, Robert Turcotte, Ahmed Aoude, Anthony Bozzo, Fabio L Cury

Background and purpose: We aimed to determine if ultra-hypofractionated radiotherapy (UHYPO-RT) delivering 6Gy x 5 fractions yields similar tumour necrosis compared to conventional radiotherapy (CONV-RT) with 2Gy x 25 fractions in soft tissue sarcoma (STS). The clinical significance of tumor necrosis on loco-regional recurrence-free survival (LRFS), distant disease-free survival (DDFS), and overall survival (OS) were assessed.

Materials and methods: Patients with localised STS treated with CONV-RT or UHYPO-RT followed by surgery were included. Good response was defined as tumour necrosis ≥ 90%, and poor response as < 90%. Mann-Whitney U-test compared median tumour necrosis. Chi-squared analysis was used for categorical variables. Kaplan-Meier function estimated LRFS, DDFS, and OS.

Results: A total of 64 patients received CONV-RT, and 45 received UHYPO-RT. The median tumour size was 7.0 cm, with the lower extremity being the most common site (55%). Myxofibrosarcoma (39%) and undifferentiated pleomorphic sarcoma (16%) were the most frequent histologies. The median time from radiotherapy to surgery was 35 days. There was a significant difference in median tumour necrosis between CONV-RT and UHYPO-RT, with rates of 40% and 60%, respectively (p = 0.022). Patients receiving UHYPO-RT had a higher percentage of tumour necrosis at the 90% cutoff, achieving 27% compared to 6% for CONV-RT (p = 0.003). In a median follow-up of 32 months, 12 patients (9%) experienced loco-regional recurrence, 24 patients (19%) faced distant failure, and 19 patients (15%) died from metastatic disease. Patients with < 90% necrosis had higher rates of loco-regional (13% vs. 0%, p = 0.207) and distant failure (25% vs. 0%, p = 0.021). Three-year LRFS was 86% for < 90% necrosis and 100% for ≥ 90% necrosis (p = 0.160). DDFS was 75% for < 90% necrosis versus 100% for ≥ 90% (p = 0.036). OS rates were 79% and 93%, respectively (p = 0.290).

Conclusion: Preoperative RT with UHYPO-RT was associated with a higher rate of tumour necrosis ≥ 90% than CONV-RT. Our data suggest that more extensive necrosis is associated with better clinical outcomes.

背景和目的:我们旨在确定在软组织肉瘤(STS)中,6Gy x 5次分割的超高分次放射治疗(UHYPO-RT)与2Gy x 25次分割的常规放射治疗(CONV-RT)相比,是否能产生相似的肿瘤坏死。评估了肿瘤坏死对局部无区域复发生存率(LRFS)、远处无疾病生存率(DDFS)和总生存率(OS)的临床意义:纳入采用CONV-RT或UHYPO-RT治疗后再行手术的局部STS患者。肿瘤坏死≥90%为良好反应,<90%为不良反应。Mann-Whitney U检验比较了肿瘤坏死的中位数。对分类变量采用卡方分析。Kaplan-Meier函数估算了LRFS、DDFS和OS:共有64名患者接受了CONV-RT治疗,45名患者接受了UHYPO-RT治疗。肿瘤中位大小为7.0厘米,下肢是最常见的部位(55%)。肌纤维肉瘤(39%)和未分化多形性肉瘤(16%)是最常见的组织类型。从放疗到手术的中位时间为35天。CONV-RT和UHYPO-RT的中位肿瘤坏死率差异显著,分别为40%和60%(p = 0.022)。接受UHYPO-RT的患者在90%临界值的肿瘤坏死率更高,达到27%,而CONV-RT为6%(p = 0.003)。在中位 32 个月的随访中,12 名患者(9%)出现局部区域复发,24 名患者(19%)面临远处治疗失败,19 名患者(15%)死于转移性疾病。坏死率小于 90% 的患者的局部区域复发率(13% 对 0%,P = 0.207)和远处转移失败率(25% 对 0%,P = 0.021)较高。坏死率<90%的患者三年LRFS为86%,坏死率≥90%的患者三年LRFS为100%(P = 0.160)。坏死率< 90% 的 DDFS 为 75%,而坏死率≥ 90% 的 DDFS 为 100%(p = 0.036)。OS率分别为79%和93%(p = 0.290):结论:与CONV-RT相比,使用UHYPO-RT进行术前RT的肿瘤坏死率≥90%。我们的数据表明,更广泛的肿瘤坏死与更好的临床预后相关。
{"title":"A retrospective study on the comparision of pathological tumour necrosis of conventional versus ultrahypofractionated preoperative radiotherapy in localised extremity soft tissue sarcoma and its correlation with clinical outcomes: A retrospective study on the comparision of pathological tumour necrosis of CONV-RT versus UHYPO-RT preoperative radiotherapy in localised extremity soft tissue sarcoma and its correlation with clinical outcomes.","authors":"Hanis Hanafi, Carolyn R Freeman, James Tsui, Paul Ramia, Robert Turcotte, Ahmed Aoude, Anthony Bozzo, Fabio L Cury","doi":"10.1016/j.prro.2024.10.008","DOIUrl":"https://doi.org/10.1016/j.prro.2024.10.008","url":null,"abstract":"<p><strong>Background and purpose: </strong>We aimed to determine if ultra-hypofractionated radiotherapy (UHYPO-RT) delivering 6Gy x 5 fractions yields similar tumour necrosis compared to conventional radiotherapy (CONV-RT) with 2Gy x 25 fractions in soft tissue sarcoma (STS). The clinical significance of tumor necrosis on loco-regional recurrence-free survival (LRFS), distant disease-free survival (DDFS), and overall survival (OS) were assessed.</p><p><strong>Materials and methods: </strong>Patients with localised STS treated with CONV-RT or UHYPO-RT followed by surgery were included. Good response was defined as tumour necrosis ≥ 90%, and poor response as < 90%. Mann-Whitney U-test compared median tumour necrosis. Chi-squared analysis was used for categorical variables. Kaplan-Meier function estimated LRFS, DDFS, and OS.</p><p><strong>Results: </strong>A total of 64 patients received CONV-RT, and 45 received UHYPO-RT. The median tumour size was 7.0 cm, with the lower extremity being the most common site (55%). Myxofibrosarcoma (39%) and undifferentiated pleomorphic sarcoma (16%) were the most frequent histologies. The median time from radiotherapy to surgery was 35 days. There was a significant difference in median tumour necrosis between CONV-RT and UHYPO-RT, with rates of 40% and 60%, respectively (p = 0.022). Patients receiving UHYPO-RT had a higher percentage of tumour necrosis at the 90% cutoff, achieving 27% compared to 6% for CONV-RT (p = 0.003). In a median follow-up of 32 months, 12 patients (9%) experienced loco-regional recurrence, 24 patients (19%) faced distant failure, and 19 patients (15%) died from metastatic disease. Patients with < 90% necrosis had higher rates of loco-regional (13% vs. 0%, p = 0.207) and distant failure (25% vs. 0%, p = 0.021). Three-year LRFS was 86% for < 90% necrosis and 100% for ≥ 90% necrosis (p = 0.160). DDFS was 75% for < 90% necrosis versus 100% for ≥ 90% (p = 0.036). OS rates were 79% and 93%, respectively (p = 0.290).</p><p><strong>Conclusion: </strong>Preoperative RT with UHYPO-RT was associated with a higher rate of tumour necrosis ≥ 90% than CONV-RT. Our data suggest that more extensive necrosis is associated with better clinical outcomes.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Management of de novo Metastatic Hormone-Sensitive Prostate Cancer (mHSPC) and the role of Radiotherapy: A Consensus by the Italian Association of Radiotherapy and Clinical Oncology (AIRO). 新发转移性激素敏感性前列腺癌(mHSPC)的治疗和放疗的作用:意大利放射治疗和临床肿瘤学协会(AIRO)共识》。
IF 3.4 3区 医学 Q2 ONCOLOGY Pub Date : 2024-10-26 DOI: 10.1016/j.prro.2024.10.007
Andrea Lancia, Anna Rita Alitto, Giovanni Pappagallo, Elisa Ciurlia, Giulio Francolini, Rolando D'Angelillo, Sergio Fersino, Niccolò Giaj Levra, Barbara Alicja Jereczek-Fossa, Alessandro Magli, Francesco Pasqualetti, Alessia Reali, Corrado Spatola, Luca Triggiani

Background and objectives: Prostate cancer treatments paradigms are in continuous evolution, especially in metastatic setting. In this context, the Genito-Urinary (GU) Group of Italian Association of Radiotherapy and Clinical Oncology (AIRO) aimed to create a Consensus on radiotherapy indication in de novo metastatic hormone sensitive prostate cancer both on primary tumour and metastatic sites.

Methods: A panel of experts, involved in clinical management of prostate cancer, through the estimate-talk-estimate (ETE) method, developed a list of items and correspondent statements on the identified topic.

Key findings: Seven conclusive items were identified with 12 statements about the chosen topic, radiotherapy in metastatic hormone sensitive prostate cancer on primary tumour and metastatic sites.

Conclusions and clinical implications: This consensus might help clinicians in prostate cancer managing in daily clinical practice.

背景和目的:前列腺癌的治疗模式在不断演变,尤其是在转移性前列腺癌中。在此背景下,意大利放射治疗和临床肿瘤学协会(AIRO)泌尿生殖(GU)小组旨在就原发肿瘤和转移部位的新发转移性激素敏感性前列腺癌的放疗适应症达成共识:方法:由参与前列腺癌临床治疗的专家组成的专家小组,通过估计-谈话-估计(ETE)方法,就确定的主题制定了项目清单和相应声明:结论和临床意义:该共识可帮助临床医生在日常临床实践中管理前列腺癌。
{"title":"Management of de novo Metastatic Hormone-Sensitive Prostate Cancer (mHSPC) and the role of Radiotherapy: A Consensus by the Italian Association of Radiotherapy and Clinical Oncology (AIRO).","authors":"Andrea Lancia, Anna Rita Alitto, Giovanni Pappagallo, Elisa Ciurlia, Giulio Francolini, Rolando D'Angelillo, Sergio Fersino, Niccolò Giaj Levra, Barbara Alicja Jereczek-Fossa, Alessandro Magli, Francesco Pasqualetti, Alessia Reali, Corrado Spatola, Luca Triggiani","doi":"10.1016/j.prro.2024.10.007","DOIUrl":"https://doi.org/10.1016/j.prro.2024.10.007","url":null,"abstract":"<p><strong>Background and objectives: </strong>Prostate cancer treatments paradigms are in continuous evolution, especially in metastatic setting. In this context, the Genito-Urinary (GU) Group of Italian Association of Radiotherapy and Clinical Oncology (AIRO) aimed to create a Consensus on radiotherapy indication in de novo metastatic hormone sensitive prostate cancer both on primary tumour and metastatic sites.</p><p><strong>Methods: </strong>A panel of experts, involved in clinical management of prostate cancer, through the estimate-talk-estimate (ETE) method, developed a list of items and correspondent statements on the identified topic.</p><p><strong>Key findings: </strong>Seven conclusive items were identified with 12 statements about the chosen topic, radiotherapy in metastatic hormone sensitive prostate cancer on primary tumour and metastatic sites.</p><p><strong>Conclusions and clinical implications: </strong>This consensus might help clinicians in prostate cancer managing in daily clinical practice.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Survival and Patterns of Relapse of Cutaneous Squamous Cell Carcinoma With Large Nerve Perineural Spread After Skull Base Surgery and/or Radiation Therapy. 颅底手术和/或放疗后伴有大神经周围神经扩散的皮肤鳞状细胞癌的存活率和复发模式
IF 3.4 3区 医学 Q2 ONCOLOGY Pub Date : 2024-10-26 DOI: 10.1016/j.prro.2024.09.007
Megan Anna Carroll, Ryan Sommerville, Karen Hay, Abigail Walker, Sarah Grigg, Lizbeth Kenny, Benjamin Chua, Jason Papacostas, Hamish Alexander, Charles Lin

Purpose: The aim of our study was to evaluate survival and patterns of relapse for patients with perineural spread (PNS) of cutaneous squamous cell carcinoma (cSCC), who have undergone curative intent skull base surgery and/or radiation therapy. In addition, we modified the classification of zone 2 disease into 2a and 2b and reported the respective outcome.

Methods and materials: A review of a prospective database of patients who received diagnoses of PNS of cSCC and were treated with curative intent skull base surgery and/or radiation therapy between the years of 2013 and 2020 was conducted. Kaplan-Meier methods were used to estimate relapse-free survival (RFS), disease-specific survival (DSS), and overall survival (OS). Cox proportional hazard modeling was performed to test associations between patient factors and survival outcomes.

Results: Eighty patients with a median follow-up of 36 months were included in the study. The 5-year RFS was 61% (95% CI, 48%-71%), the DSS was 77% (95% CI, 63%-86%), and OS was 67% (95% CI, 53%-78%). In multivariable modeling, involvement of 2 or more nerves was strongly associated with worse 5-year RFS (HR, 4.0; P ≤ .001), DSS (HR, 4.5; P = .004), and OS (HR, 4.3; P = .002). Age group (≥65 years) (HR, 5.1; P = .010) and immune compromise (HR, 10.7; P = .001) were strongly associated with worse OS but not DSS or RFS. The majority of relapses (60%) occurred at the local skin sites.

Conclusions: Our study demonstrated surgery followed by radiation therapy was safe and effective in the management of cSCC with PNS. We did not detect a difference in outcome between zones 2a and 2b though further study is required. The most common mode of relapse was at the skin epidermis and/or adjacent dermis highlighting the importance of adequate local skin dose delivery.

目的:我们的研究旨在评估已接受治愈性颅底手术和/或放疗的皮肤鳞状细胞癌(cSCC)神经周围扩散(PNS)患者的生存率和复发模式。此外,我们还将2区疾病的分类修改为2a和2b,并报告了各自的结果:我们对2013年至2020年期间接受治愈性颅底手术和/或放射治疗的cSCC PNS患者的前瞻性数据库进行了回顾性研究。研究采用卡普兰-梅耶法估算无复发生存期(RFS)、疾病特异性生存期(DSS)和总生存期(OS)。采用 Cox 比例危险模型检验患者因素与生存结果之间的关联:研究共纳入80名患者,中位随访时间为36个月。5年RFS为61%(95% CI,48%-71%),DSS为77%(95% CI,63%-86%),OS为67%(95% CI,53%-78%)。在多变量建模中,2条或更多神经受累与较差的5年RFS(HR,4.0;P≤ .001)、DSS(HR,4.5;P = .004)和OS(HR,4.3;P = .002)密切相关。年龄组(≥65 岁)(HR,5.1;P = .010)和免疫受损(HR,10.7;P = .001)与较差的 OS 密切相关,但与 DSS 或 RFS 无关。大多数复发(60%)发生在局部皮肤部位:我们的研究表明,在治疗伴有PNS的cSCC时,先手术后放疗是安全有效的。我们没有发现 2a 区和 2b 区的治疗效果有差异,但仍需进一步研究。最常见的复发部位是皮肤表皮和/或邻近的真皮层,这凸显了充分的局部皮肤剂量给药的重要性。
{"title":"Survival and Patterns of Relapse of Cutaneous Squamous Cell Carcinoma With Large Nerve Perineural Spread After Skull Base Surgery and/or Radiation Therapy.","authors":"Megan Anna Carroll, Ryan Sommerville, Karen Hay, Abigail Walker, Sarah Grigg, Lizbeth Kenny, Benjamin Chua, Jason Papacostas, Hamish Alexander, Charles Lin","doi":"10.1016/j.prro.2024.09.007","DOIUrl":"https://doi.org/10.1016/j.prro.2024.09.007","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of our study was to evaluate survival and patterns of relapse for patients with perineural spread (PNS) of cutaneous squamous cell carcinoma (cSCC), who have undergone curative intent skull base surgery and/or radiation therapy. In addition, we modified the classification of zone 2 disease into 2a and 2b and reported the respective outcome.</p><p><strong>Methods and materials: </strong>A review of a prospective database of patients who received diagnoses of PNS of cSCC and were treated with curative intent skull base surgery and/or radiation therapy between the years of 2013 and 2020 was conducted. Kaplan-Meier methods were used to estimate relapse-free survival (RFS), disease-specific survival (DSS), and overall survival (OS). Cox proportional hazard modeling was performed to test associations between patient factors and survival outcomes.</p><p><strong>Results: </strong>Eighty patients with a median follow-up of 36 months were included in the study. The 5-year RFS was 61% (95% CI, 48%-71%), the DSS was 77% (95% CI, 63%-86%), and OS was 67% (95% CI, 53%-78%). In multivariable modeling, involvement of 2 or more nerves was strongly associated with worse 5-year RFS (HR, 4.0; P ≤ .001), DSS (HR, 4.5; P = .004), and OS (HR, 4.3; P = .002). Age group (≥65 years) (HR, 5.1; P = .010) and immune compromise (HR, 10.7; P = .001) were strongly associated with worse OS but not DSS or RFS. The majority of relapses (60%) occurred at the local skin sites.</p><p><strong>Conclusions: </strong>Our study demonstrated surgery followed by radiation therapy was safe and effective in the management of cSCC with PNS. We did not detect a difference in outcome between zones 2a and 2b though further study is required. The most common mode of relapse was at the skin epidermis and/or adjacent dermis highlighting the importance of adequate local skin dose delivery.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Reducing Patient Care Delays in Radiation Oncology Via Optimization of Insurance Pre-Authorization: Reducing Delays via Optimization of Pre-Auth. 通过优化保险预授权减少放射肿瘤学患者护理的延误:通过优化保险预授权减少放射肿瘤科患者护理延误
IF 3.4 3区 医学 Q2 ONCOLOGY Pub Date : 2024-10-25 DOI: 10.1016/j.prro.2024.10.002
Maxwell Tran, Bhisham Chera, Kevin Shrake, Bradley Depaoli, Edward Duffy Iii, Michael Hall, Justin Steinman, Stephanie Myers, Osagie Igiebor, Jay Callahan, Daniel McDonald, Jennifer Harper, Samuel Lewis Cooper

Purpose/objectives: Difficulties and delays in insurance pre-authorization (pre-auth) can negatively impact patient care, resulting in postponing, modifying, or even cancelling radiation therapy for patients. We aimed to perform a root cause analysis for pre-auth delays in our department and implement solutions to optimize our workflow. Our primary objectives were to decrease mean time for clinical treatment plan (CTP) completion, and for number of cases delayed/denied, by 50% each.

Materials/methods: We performed a root cause analysis for pre-auth delays, and used the PDSA & A3 quality improvement methods. We sampled ∼2 cases per disease site (19 cases from July - Aug 2022) to determine the baseline. Countermeasures included: 1) optimizing our CTP templates per disease site to contain the specific clinical information required for pre-auth, 2) formalizing earlier completion of CTPs in our Care Path®, and 3) formalizing the pre auth workflow in our Care Path®. We tracked various metrics, including mean time for CTP completion, % usage of our Care Path®, % usage of revised CTP templates, mean time until pre-auth initiated & completed, and % of cases delayed/denied. Two-tailed T-tests and Chi-squared tests were used to generate p-values comparing mean values and percentages, respectively.

Results: 495 patients completed CT simulation in our department between October 2022 and February 2023. Mean time for CTP completion (Day 0 = day of CT simulation scheduling) improved from 16 days at baseline to 4 days (p<0.001). Care Path® usage improved from 16% to 97% (p<0.001), as did usage of our revised CTP templates, from 0% to 97% (p<0.001). The mean time from insurance pre-auth initiation to completion improved from 5 days to 1 day. The percent of cases that were delayed/denied was reduced significantly from 32% to 8% (p<0.001).

Conclusions: Improving timeliness and details of CTP documentation and pre-auth by using our Care Path® and optimizing CTP templates improved efficiency of insurance pre-auth completion and reduced the number of cases delayed/denied.

目的/目标:保险预授权(pre-auth)的困难和延误会对患者护理产生负面影响,导致患者推迟、修改甚至取消放射治疗。我们旨在对本部门预授权延误的根本原因进行分析,并实施优化工作流程的解决方案。我们的主要目标是将完成临床治疗计划(CTP)的平均时间和延迟/拒绝病例的数量各减少 50%:我们采用 PDSA 和 A3 质量改进方法,对批准前延误进行了根本原因分析。我们在每个病区抽取了 2 个病例(2022 年 7 月至 8 月共 19 个病例),以确定基线。对策包括1)优化每个疾病部位的 CTP 模板,使其包含预认证所需的特定临床信息;2)在 Care Path® 中正式规定提前完成 CTP;3)在 Care Path® 中正式规定预认证工作流程。我们跟踪了各种指标,包括完成 CTP 的平均时间、Care Path® 的使用率、修订后的 CTP 模板的使用率、启动和完成预审的平均时间以及延迟/拒绝病例的百分比。双尾 T 检验和卡方检验分别用于比较平均值和百分比的 P 值:2022年10月至2023年2月期间,495名患者在我科完成了CT模拟。CTP完成的平均时间(第0天=CT模拟安排日)从基线时的16天缩短至4天(P结论:通过使用我们的 Care Path® 和优化 CTP 模板,改善了 CTP 文件和预审的及时性和细节,提高了保险预审的完成效率,减少了延迟/拒绝病例的数量。
{"title":"Reducing Patient Care Delays in Radiation Oncology Via Optimization of Insurance Pre-Authorization: Reducing Delays via Optimization of Pre-Auth.","authors":"Maxwell Tran, Bhisham Chera, Kevin Shrake, Bradley Depaoli, Edward Duffy Iii, Michael Hall, Justin Steinman, Stephanie Myers, Osagie Igiebor, Jay Callahan, Daniel McDonald, Jennifer Harper, Samuel Lewis Cooper","doi":"10.1016/j.prro.2024.10.002","DOIUrl":"https://doi.org/10.1016/j.prro.2024.10.002","url":null,"abstract":"<p><strong>Purpose/objectives: </strong>Difficulties and delays in insurance pre-authorization (pre-auth) can negatively impact patient care, resulting in postponing, modifying, or even cancelling radiation therapy for patients. We aimed to perform a root cause analysis for pre-auth delays in our department and implement solutions to optimize our workflow. Our primary objectives were to decrease mean time for clinical treatment plan (CTP) completion, and for number of cases delayed/denied, by 50% each.</p><p><strong>Materials/methods: </strong>We performed a root cause analysis for pre-auth delays, and used the PDSA & A3 quality improvement methods. We sampled ∼2 cases per disease site (19 cases from July - Aug 2022) to determine the baseline. Countermeasures included: 1) optimizing our CTP templates per disease site to contain the specific clinical information required for pre-auth, 2) formalizing earlier completion of CTPs in our Care Path®, and 3) formalizing the pre auth workflow in our Care Path®. We tracked various metrics, including mean time for CTP completion, % usage of our Care Path®, % usage of revised CTP templates, mean time until pre-auth initiated & completed, and % of cases delayed/denied. Two-tailed T-tests and Chi-squared tests were used to generate p-values comparing mean values and percentages, respectively.</p><p><strong>Results: </strong>495 patients completed CT simulation in our department between October 2022 and February 2023. Mean time for CTP completion (Day 0 = day of CT simulation scheduling) improved from 16 days at baseline to 4 days (p<0.001). Care Path® usage improved from 16% to 97% (p<0.001), as did usage of our revised CTP templates, from 0% to 97% (p<0.001). The mean time from insurance pre-auth initiation to completion improved from 5 days to 1 day. The percent of cases that were delayed/denied was reduced significantly from 32% to 8% (p<0.001).</p><p><strong>Conclusions: </strong>Improving timeliness and details of CTP documentation and pre-auth by using our Care Path® and optimizing CTP templates improved efficiency of insurance pre-auth completion and reduced the number of cases delayed/denied.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Practical Radiation Oncology
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