Pub Date : 2024-08-08DOI: 10.1016/j.prro.2024.07.005
Hiroaki Ikawa, Masashi Koto
{"title":"Displacement of the Tongue Base and Soft Palate Because of Breathing Patterns During Radiation Therapy for Head and Neck Cancer.","authors":"Hiroaki Ikawa, Masashi Koto","doi":"10.1016/j.prro.2024.07.005","DOIUrl":"10.1016/j.prro.2024.07.005","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914567","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}
Pub Date : 2024-07-31DOI: 10.1016/j.prro.2024.06.013
Derek A Mumaw, Thomas J Quinn
Purpose: Scientific literature is a vital tool that we rely on to communicate the findings of our studies; however, we rarely direct our study to the writing itself.
Methods and materials: Here, we make use of modern natural language processing algorithms coupled with the large, open access PubMed Central corpus to analyze trends in writing complexity within the field of radiation oncology from 2004 to 2024. Changes in 1) required grade level to comprehend, 2) lexical complexity, and 3) information content were assessed. Articles were also classified, and then analyzed, by disease subsite.
Results: We found significant increases in the 3 domains over the 20-year collection period. Genitourinary literature had the greatest readability, while gastrointestinal literature was the most complex.
Conclusions: This analysis reveals broad increases in the complexity of our writing. This study demonstrates metrics to use and benchmark values to refer to when evaluating the complexity of radiation oncology journal articles.
{"title":"Readability and Writing Quality in Radiation Oncology Journal Articles from 2004 to 2024.","authors":"Derek A Mumaw, Thomas J Quinn","doi":"10.1016/j.prro.2024.06.013","DOIUrl":"10.1016/j.prro.2024.06.013","url":null,"abstract":"<p><strong>Purpose: </strong>Scientific literature is a vital tool that we rely on to communicate the findings of our studies; however, we rarely direct our study to the writing itself.</p><p><strong>Methods and materials: </strong>Here, we make use of modern natural language processing algorithms coupled with the large, open access PubMed Central corpus to analyze trends in writing complexity within the field of radiation oncology from 2004 to 2024. Changes in 1) required grade level to comprehend, 2) lexical complexity, and 3) information content were assessed. Articles were also classified, and then analyzed, by disease subsite.</p><p><strong>Results: </strong>We found significant increases in the 3 domains over the 20-year collection period. Genitourinary literature had the greatest readability, while gastrointestinal literature was the most complex.</p><p><strong>Conclusions: </strong>This analysis reveals broad increases in the complexity of our writing. This study demonstrates metrics to use and benchmark values to refer to when evaluating the complexity of radiation oncology journal articles.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876721","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}
Pub Date : 2024-07-30DOI: 10.1016/j.prro.2024.06.015
Jared Pasetsky, J Alex Garcia-Young, Emilio Beatley, James B Yu
The approval of radiation oncology care by insurance companies is burdensome for providers. In this topic discussion, we attempt to provide practical recommendations for how to deal with peer-to-peer phone calls as well as how to improve the timeliness and quality of subsequent letters of appeal.
{"title":"Peer-to-Peer Phone Calls and Letters Appealing Insurance Denials of Service: Practical Tips and Resources.","authors":"Jared Pasetsky, J Alex Garcia-Young, Emilio Beatley, James B Yu","doi":"10.1016/j.prro.2024.06.015","DOIUrl":"10.1016/j.prro.2024.06.015","url":null,"abstract":"<p><p>The approval of radiation oncology care by insurance companies is burdensome for providers. In this topic discussion, we attempt to provide practical recommendations for how to deal with peer-to-peer phone calls as well as how to improve the timeliness and quality of subsequent letters of appeal.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876720","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}
Pub Date : 2024-07-26DOI: 10.1016/j.prro.2024.07.003
Maria Cristina Leonardi, Simona Arculeo, Samuele Frassoni, Maria Alessia Zerella, Marianna Alessandra Gerardi, Cristiana Fodor, Paolo Veronesi, Viviana Enrica Galimberti, Francesca Magnoni, Ekaterina Milovanova, Damaris Patricia Rojas, Samantha Dicuonzo, Anna Morra, Mattia Zaffaroni, Maria Giulia Vincini, Federica Cattani, Vincenzo Bagnardi, Roberto Orecchia, Barbara Alicja Jereczek-Fossa
Aim: to evaluate the outcome of partial breast re-irradiation (re-PBI) with intensity modulated RT (IMRT), using a hypofractionated scheme for breast cancer (BC) local recurrence (LR) operated on with repeat breast-conserving surgery (re-BCS).
Methods: IMRT-based re-PBI was performed using either helical or step-and-shoot modality to deliver 37.05 Gy in 13 fractions in 2.5 weeks. Cumulative incidence (CumI) of 2ndLR, toxicity, disease-free (DFS), BC specific (BCSS), and overall (OS) survival were evaluated.
Results: Between 5/2012 and 5/2021, 70 patients had re-PBI. Median follow-up (FU) was 6.3 years (Q1-Q3, 4.0-8.1.). Median age at 1stLR was 62. The median primary BC-1stLR interval was 12.4 years (range: 1.6-26.7). Luminal A-like 1stLR accounted for 41% of the cases and median size was 0.8 cm. During FU, 18 (26%) patients showed a subsequent event: three 2snLRs (corresponding to 8-y Cumulative rate of 4%), 3 regional nodal recurrences, 7 distant metastases, and 5 other primary tumors. At 8 years, DFS, BCSS and OS were 76%, 90%, and 90%, respectively. At multivariate analysis, Grade 3 and extensive intraductal component were independent predictors for DFS. For 51 and 46 patients, chronic toxicity and cosmesis were evaluated, respectively: 4% had grade 3 fibrosis and cosmesis was deemed good/excellent in just over 60% of the cases.
Conclusion: Re-PBI after re-BCS represents a feasible alternative to mastectomy with regard to local control, showing an acceptable toxicity profile. A long-term FU is crucial to better understand the pattern of relapse and consolidate the position of re-PBI in clinical practice.
{"title":"Hypofractionated partial breast re-irradiation in the conservative retreatment of breast cancer local recurrence.","authors":"Maria Cristina Leonardi, Simona Arculeo, Samuele Frassoni, Maria Alessia Zerella, Marianna Alessandra Gerardi, Cristiana Fodor, Paolo Veronesi, Viviana Enrica Galimberti, Francesca Magnoni, Ekaterina Milovanova, Damaris Patricia Rojas, Samantha Dicuonzo, Anna Morra, Mattia Zaffaroni, Maria Giulia Vincini, Federica Cattani, Vincenzo Bagnardi, Roberto Orecchia, Barbara Alicja Jereczek-Fossa","doi":"10.1016/j.prro.2024.07.003","DOIUrl":"https://doi.org/10.1016/j.prro.2024.07.003","url":null,"abstract":"<p><strong>Aim: </strong>to evaluate the outcome of partial breast re-irradiation (re-PBI) with intensity modulated RT (IMRT), using a hypofractionated scheme for breast cancer (BC) local recurrence (LR) operated on with repeat breast-conserving surgery (re-BCS).</p><p><strong>Methods: </strong>IMRT-based re-PBI was performed using either helical or step-and-shoot modality to deliver 37.05 Gy in 13 fractions in 2.5 weeks. Cumulative incidence (CumI) of 2ndLR, toxicity, disease-free (DFS), BC specific (BCSS), and overall (OS) survival were evaluated.</p><p><strong>Results: </strong>Between 5/2012 and 5/2021, 70 patients had re-PBI. Median follow-up (FU) was 6.3 years (Q1-Q3, 4.0-8.1.). Median age at 1stLR was 62. The median primary BC-1stLR interval was 12.4 years (range: 1.6-26.7). Luminal A-like 1stLR accounted for 41% of the cases and median size was 0.8 cm. During FU, 18 (26%) patients showed a subsequent event: three 2snLRs (corresponding to 8-y Cumulative rate of 4%), 3 regional nodal recurrences, 7 distant metastases, and 5 other primary tumors. At 8 years, DFS, BCSS and OS were 76%, 90%, and 90%, respectively. At multivariate analysis, Grade 3 and extensive intraductal component were independent predictors for DFS. For 51 and 46 patients, chronic toxicity and cosmesis were evaluated, respectively: 4% had grade 3 fibrosis and cosmesis was deemed good/excellent in just over 60% of the cases.</p><p><strong>Conclusion: </strong>Re-PBI after re-BCS represents a feasible alternative to mastectomy with regard to local control, showing an acceptable toxicity profile. A long-term FU is crucial to better understand the pattern of relapse and consolidate the position of re-PBI in clinical practice.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141789780","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}
Pub Date : 2024-07-26DOI: 10.1016/j.prro.2024.04.017
Jason Holmes, Lian Zhang, Yuzhen Ding, Hongying Feng, Zhengliang Liu, Tianming Liu, William W Wong, Sujay A Vora, Jonathan B Ashman, Wei Liu
Purpose: To introduce the concept of using large language models (LLMs) to relabel structure names in accordance with the American Association of Physicists in Medicine Task Group-263 standard and to establish a benchmark for future studies to reference.
Methods and materials: Generative Pretrained Transformer (GPT)-4 was implemented within a Digital Imaging and Communications in Medicine server. Upon receiving a structure-set Digital Imaging and Communications in Medicine file, the server prompts GPT-4 to relabel the structure names according to the American Association of Physicists in Medicine Task Group-263 report. The results were evaluated for 3 disease sites: prostate, head and neck, and thorax. For each disease site, 150 patients were randomly selected for manually tuning the instructions prompt (in batches of 50), and 50 patients were randomly selected for evaluation. Structure names considered were those that were most likely to be relevant for studies using structure contours for many patients.
Results: The per-patient accuracy was 97.2%, 98.3%, and 97.1% for prostate, head and neck, and thorax disease sites, respectively. On a per-structure basis, the clinical target volume was relabeled correctly in 100%, 95.3%, and 92.9% of cases, respectively.
Conclusions: Given the accuracy of GPT-4 in relabeling structure names as presented in this work, LLMs are poised to become an important method for standardizing structure names in radiation oncology, especially considering the rapid advancements in LLM capabilities that are likely to continue.
{"title":"Benchmarking a Foundation Large Language Model on its Ability to Relabel Structure Names in Accordance With the American Association of Physicists in Medicine Task Group-263 Report.","authors":"Jason Holmes, Lian Zhang, Yuzhen Ding, Hongying Feng, Zhengliang Liu, Tianming Liu, William W Wong, Sujay A Vora, Jonathan B Ashman, Wei Liu","doi":"10.1016/j.prro.2024.04.017","DOIUrl":"https://doi.org/10.1016/j.prro.2024.04.017","url":null,"abstract":"<p><strong>Purpose: </strong>To introduce the concept of using large language models (LLMs) to relabel structure names in accordance with the American Association of Physicists in Medicine Task Group-263 standard and to establish a benchmark for future studies to reference.</p><p><strong>Methods and materials: </strong>Generative Pretrained Transformer (GPT)-4 was implemented within a Digital Imaging and Communications in Medicine server. Upon receiving a structure-set Digital Imaging and Communications in Medicine file, the server prompts GPT-4 to relabel the structure names according to the American Association of Physicists in Medicine Task Group-263 report. The results were evaluated for 3 disease sites: prostate, head and neck, and thorax. For each disease site, 150 patients were randomly selected for manually tuning the instructions prompt (in batches of 50), and 50 patients were randomly selected for evaluation. Structure names considered were those that were most likely to be relevant for studies using structure contours for many patients.</p><p><strong>Results: </strong>The per-patient accuracy was 97.2%, 98.3%, and 97.1% for prostate, head and neck, and thorax disease sites, respectively. On a per-structure basis, the clinical target volume was relabeled correctly in 100%, 95.3%, and 92.9% of cases, respectively.</p><p><strong>Conclusions: </strong>Given the accuracy of GPT-4 in relabeling structure names as presented in this work, LLMs are poised to become an important method for standardizing structure names in radiation oncology, especially considering the rapid advancements in LLM capabilities that are likely to continue.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146870","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}
Pub Date : 2024-07-23DOI: 10.1016/j.prro.2024.07.002
Roshan S Prabhu, Rachel Russek, James E McBride, Karen B Price, Danielle N Garland, Elizabeth Franklin, Derek R McHaffie, Matthew C Ward, Chelsea L Rowland, Courtney E Huffstetler, Amy S Hicks
Peptide receptor radionuclide therapy (PRRT) is a rapidly developing treatment modality. These treatments are indicated for patients who are either heavily pretreated and/or may have neurohormonal active disease, increasing the risk of acute adverse effects and the need for unplanned acute care. The goals of this report were to characterize the frequency of unplanned acute care utilization after PRRT infusion and detail a comprehensive standard operating procedure (SOP) for radioprotection during unplanned post-PRRT acute care. The records of patients treated with PRRT were reviewed. The event of interest was emergency department (ED) utilization and/or inpatient admission within 7 days of PRRT infusion. A multidisciplinary group developed a radioprotection SOP for all phases of unplanned acute care including the clinical infusion space and emergency medical services transport to the ED, within the ED, and on the inpatient floor. A total of 232 patients received 814 infusions of PRRT, with 134 (58%) receiving Lutathera and 98 (42%) receiving Pluvicto. Nineteen patients received unplanned acute care at an ED within 7 days of PRRT infusion (8% of patients, 2% of infusions), of which 10 received Lutathera (8% of patients, 2% of infusions). Two patients (2% of patients, 0.5% of infusions) experienced carcinoid crises within 24 hours of Lutathera infusion. The median and average intervals between infusion and ED visit were 0.5 days and 1.3 days, respectively. Nine patients received Pluvicto (9% of patients, 3% of infusions). The median and average intervals between infusion and ED visit were 4 and 4.7 days, respectively. Emergency room utilization and/or inpatient admission after PRRT administration are relatively infrequent events, but not unexpected. Centers that administer PRRT should have a comprehensive SOP in place to effectively care for radioactive patient emergencies while maximizing medical staff protection.
{"title":"Unplanned Emergency Department or Inpatient Acute Care Within 1 Week After Administration of Peptide Receptor Radionuclide Therapy: Frequency of Occurrence and Standard Operating Procedures for Radioprotection in These Situations.","authors":"Roshan S Prabhu, Rachel Russek, James E McBride, Karen B Price, Danielle N Garland, Elizabeth Franklin, Derek R McHaffie, Matthew C Ward, Chelsea L Rowland, Courtney E Huffstetler, Amy S Hicks","doi":"10.1016/j.prro.2024.07.002","DOIUrl":"10.1016/j.prro.2024.07.002","url":null,"abstract":"<p><p>Peptide receptor radionuclide therapy (PRRT) is a rapidly developing treatment modality. These treatments are indicated for patients who are either heavily pretreated and/or may have neurohormonal active disease, increasing the risk of acute adverse effects and the need for unplanned acute care. The goals of this report were to characterize the frequency of unplanned acute care utilization after PRRT infusion and detail a comprehensive standard operating procedure (SOP) for radioprotection during unplanned post-PRRT acute care. The records of patients treated with PRRT were reviewed. The event of interest was emergency department (ED) utilization and/or inpatient admission within 7 days of PRRT infusion. A multidisciplinary group developed a radioprotection SOP for all phases of unplanned acute care including the clinical infusion space and emergency medical services transport to the ED, within the ED, and on the inpatient floor. A total of 232 patients received 814 infusions of PRRT, with 134 (58%) receiving Lutathera and 98 (42%) receiving Pluvicto. Nineteen patients received unplanned acute care at an ED within 7 days of PRRT infusion (8% of patients, 2% of infusions), of which 10 received Lutathera (8% of patients, 2% of infusions). Two patients (2% of patients, 0.5% of infusions) experienced carcinoid crises within 24 hours of Lutathera infusion. The median and average intervals between infusion and ED visit were 0.5 days and 1.3 days, respectively. Nine patients received Pluvicto (9% of patients, 3% of infusions). The median and average intervals between infusion and ED visit were 4 and 4.7 days, respectively. Emergency room utilization and/or inpatient admission after PRRT administration are relatively infrequent events, but not unexpected. Centers that administer PRRT should have a comprehensive SOP in place to effectively care for radioactive patient emergencies while maximizing medical staff protection.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141762639","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}
Pub Date : 2024-07-22DOI: 10.1016/j.prro.2024.06.014
Whoon Jong Kil, Subarna Eisaman, Christopher Wilke, Yvonne Mowery, Wyatt Smith, Craig Herndon, David Cousins
This report details a pharyngeal constrictor muscle (PCM)-sparing stereotactic body radiation therapy (SBRT) using our institutional technique of "tongue-out" radiation therapy (TORT) for treating a local recurrent cancer in the uvula (GTVuvula) in a patient with history of a definitive chemotherapy with radiation therapy (70 Gy with weekly cisplatin) for a locally advanced laryngeal cancer 4 years ago. TORT includes optimizing the patients' reproducible tongue-out position using readily available medicine cup (30 cc) followed by sculping the thermoplastic mask with tongue-out, and real-time visual monitoring of the tongue position during the computed tomography simulation scan, cone beam computed tomography acquisition, and treatment. Between arcs during volumetric modulated arc therapy, time for tongue relaxation and saliva swallowing can be given to the patient. Without TORT, the patient's GTVuvula abutted the medial aspect of superior PCM (medial-sPCM) and a substantial volume of the previously irradiated superior PCM (sPCM) would have received high radiation dose from this salvage SBRT (32.5 Gy in 5 fractions). Comparing without TORT, the shortest distance between medial-sPCM-to-GTVuvula was increased by 13 mm with TORT, which reduced radiation dose to sPCM in the salvage SBRT plan. The mean dose to sPCM was decreased from 20.5 Gy without TORT to 12.7 Gy with TORT. With TORT, minimal sPCM volumes fell within higher isodose line: volume receiving ≥ 60% prescription dose (V60%Rx), V80%Rx, and V100%Rx to sPCM was, 4.8 versus 0.7 cc (without vs with TORT, respectively), 2.9 versus 0.19 cc, and 1.6 versus 0.04 cc, respectively. Maximum dose (Dmax) to medial-sPCM was 34.6 Gy without TORT versus 22.7 Gy with TORT. These high doses to the sPCM and intrafractional swallowing-related geographic misses of GTVuvula were avoided through the application of TORT in this salvage reirradiation setting. The patient successfully finished salvage SBRT with TORT resulting in no dysphagia or mucositis and maintained complete response at 12 months after treatment.
{"title":"Pharyngeal Constrictor-Sparing Salvage Stereotactic Body Radiation Therapy With Tongue-Out for In-Field Recurrence After Definitive Radiation Therapy for Head and Neck Cancer: Guide to Tongue-Out Radiation Therapy.","authors":"Whoon Jong Kil, Subarna Eisaman, Christopher Wilke, Yvonne Mowery, Wyatt Smith, Craig Herndon, David Cousins","doi":"10.1016/j.prro.2024.06.014","DOIUrl":"10.1016/j.prro.2024.06.014","url":null,"abstract":"<p><p>This report details a pharyngeal constrictor muscle (PCM)-sparing stereotactic body radiation therapy (SBRT) using our institutional technique of \"tongue-out\" radiation therapy (TORT) for treating a local recurrent cancer in the uvula (GTV<sub>uvula</sub>) in a patient with history of a definitive chemotherapy with radiation therapy (70 Gy with weekly cisplatin) for a locally advanced laryngeal cancer 4 years ago. TORT includes optimizing the patients' reproducible tongue-out position using readily available medicine cup (30 cc) followed by sculping the thermoplastic mask with tongue-out, and real-time visual monitoring of the tongue position during the computed tomography simulation scan, cone beam computed tomography acquisition, and treatment. Between arcs during volumetric modulated arc therapy, time for tongue relaxation and saliva swallowing can be given to the patient. Without TORT, the patient's GTV<sub>uvula</sub> abutted the medial aspect of superior PCM (medial-sPCM) and a substantial volume of the previously irradiated superior PCM (sPCM) would have received high radiation dose from this salvage SBRT (32.5 Gy in 5 fractions). Comparing without TORT, the shortest distance between medial-sPCM-to-GTV<sub>uvula</sub> was increased by 13 mm with TORT, which reduced radiation dose to sPCM in the salvage SBRT plan. The mean dose to sPCM was decreased from 20.5 Gy without TORT to 12.7 Gy with TORT. With TORT, minimal sPCM volumes fell within higher isodose line: volume receiving ≥ 60% prescription dose (V<sub>60%Rx</sub>), V<sub>80%Rx</sub>, and V<sub>100%Rx</sub> to sPCM was, 4.8 versus 0.7 cc (without vs with TORT, respectively), 2.9 versus 0.19 cc, and 1.6 versus 0.04 cc, respectively. Maximum dose (D<sub>max</sub>) to medial-sPCM was 34.6 Gy without TORT versus 22.7 Gy with TORT. These high doses to the sPCM and intrafractional swallowing-related geographic misses of GTV<sub>uvula</sub> were avoided through the application of TORT in this salvage reirradiation setting. The patient successfully finished salvage SBRT with TORT resulting in no dysphagia or mucositis and maintained complete response at 12 months after treatment.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141762638","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}
Pub Date : 2024-07-20DOI: 10.1016/j.prro.2024.05.011
Vishal R Dhere, David M Schuster, Subir Goyal, Eduard Schreibmann, Bruce W Hershatter, Sagar A Patel, Joseph W Shelton, Sheela Hanasoge, Pretesh R Patel, Nikhil T Sebastian, Omotayo A Adediran, Ismaheel O Lawal, Ashesh B Jani
Purpose: Whole-pelvis (WP) radiation therapy (radiation) improved biochemical relapse-free survival (bRFS) compared with prostate bed (PB)-only radiation in the Radiation Therapy Oncology Group 0534, but was performed in an era prior to positron emission tomography (PET) staging. Separately, 18F-fluciclovine PET/CT-guided postprostatectomy radiation improved 3-year bRFS versus radiation guided by conventional imaging alone. We hypothesized that patients who were changed from WP to PB-only radiation after PET would have bRFS that was: (a) no higher than patients initially planned for PB-only radiation; and (b) lower than patients planned for WP radiation without PET guidance.
Methods and materials: We conducted a post hoc analysis of a prospective, randomized trial comparing conventional (arm 1) versus PET-guided (arm 2) postprostatectomy radiation. In arm 2, pre-PET treatment field decisions were recorded and post-PET fields were defined per protocol; pathologic node negative (pN0) without pelvic or extrapelvic PET uptake received PB-only radiation. Three-year bRFS was compared in patients planned for WP with change to PB-only radiation (arm 2 [WP:PB]) vs arm 2 patients planned for PB-only with final radiation to PB-only (arm 2 [PB:PB]) and arm 1 pN0 patients treated with WP radiation (arm 1 [WP]) using the Z test and log-rank test. Demographics were compared using the chi-square test, Fisher exact test, or analysis of variance, as appropriate.
Results: We identified 10 arm 2 (WP:PB), 31 arm 2 (PB:PB) and 11 arm 1 (WP) patients. Androgen deprivation was used in 50.0% of arm 2 (WP:PB) and 3.2% of arm 2 (PB:PB) patients, P < .01. Median preradiation prostate-specific antigen was higher in arm 2 (WP:PB) vs arm 2 (PB:PB) patients (0.4 vs 0.2 ng/mL, P = .03); however, there were no significant differences in T stage, Gleason score, or margin positivity. Three-year bRFS was 80% in arm 2 (WP:PB) vs 87.4% in arm 2 (PB:PB), P = .47, respectively. Arm 1(WP) patients had significantly worse 3-year (23%) bRFS vs arm 2 (WP:PB), P < .01.
Conclusions: Patients initially planned for WP radiation with field decision change to PB-only radiation after PET showed (1) no significant difference in 3-year bRFS compared with patients initially planned for PB-only radiation; and (2) improved bRFS compared with patients receiving WP radiation without PET guidance. PET-guided volume de-escalation in selected patients may be 1 approach to mitigating toxicity without compromising outcomes.
目的:在RTOG 0534研究中,与单纯前列腺床(PB)放射治疗相比,全盆腔(WP)放射治疗(放疗)提高了无生化复发生存率(bRFS),但这是在PET分期之前的时代进行的。另外,18F-呋喃妥因 PET/CT (PET)引导的前列腺切除术后放射治疗与仅由传统成像引导的放射治疗相比,可提高 3 年无复发生存率(bRFS)。我们假设,在 PET 之后从 WP 改为纯 PB 放射治疗的患者的 bRFS3 将(a)不高于最初计划接受纯 PB 放射治疗的患者,(b)低于计划接受 WP 放射治疗但未接受 PET 指导的患者:我们对一项前瞻性随机试验进行了事后分析,比较了前列腺切除术后常规放射治疗(第 1 组)与 PET 指导下放射治疗(第 2 组)。在Arm 2中,记录了PET前治疗野的决定,并根据方案定义了PET后治疗野:病理结节阴性(pN0)且无盆腔或盆腔外PET摄取的患者接受纯PB放射治疗。使用 Z 检验和对数秩检验比较了计划接受 WP 放射治疗但最终改为纯 PB 放射治疗的患者[Arm 2 (WP:PB)] 与计划接受纯 PB 放射治疗但最终改为纯 PB 放射治疗的患者[Arm 2(PB:PB)] 和接受 WP 放射治疗的前臂 pN0 患者[Arm 1(WP)]的三年 bRFS。人口统计学数据采用卡方检验(Chi-square test)、费雪精确检验(Fisher's exact test)或方差分析(ANOVA)进行比较:我们确定了 10 名 Arm 2(WP:PB)、31 名 Arm 2(PB:PB)和 11 名 Arm 1(WP)患者。50.0%的Arm 2(WP:PB)和3.2%的Arm 2(PB:PB)患者使用了雄激素剥夺疗法,P结论:与最初计划接受纯PB放射治疗的患者相比,(a)3年bRFS无显著差异;(b)与未接受PET指导的WP放射治疗的患者相比,bRFS有所改善。在 PET 的指导下,对选定的患者减量可能是减轻毒性而不影响疗效的一种方法。
{"title":"Biochemical Relapse-Free Survival in Postprostatectomy Patients Receiving 18F-Fluciclovine-Guided Prostate Bed-Only Radiation: Post Hoc Analysis of a Prospective Randomized Trial.","authors":"Vishal R Dhere, David M Schuster, Subir Goyal, Eduard Schreibmann, Bruce W Hershatter, Sagar A Patel, Joseph W Shelton, Sheela Hanasoge, Pretesh R Patel, Nikhil T Sebastian, Omotayo A Adediran, Ismaheel O Lawal, Ashesh B Jani","doi":"10.1016/j.prro.2024.05.011","DOIUrl":"10.1016/j.prro.2024.05.011","url":null,"abstract":"<p><strong>Purpose: </strong>Whole-pelvis (WP) radiation therapy (radiation) improved biochemical relapse-free survival (bRFS) compared with prostate bed (PB)-only radiation in the Radiation Therapy Oncology Group 0534, but was performed in an era prior to positron emission tomography (PET) staging. Separately, 18F-fluciclovine PET/CT-guided postprostatectomy radiation improved 3-year bRFS versus radiation guided by conventional imaging alone. We hypothesized that patients who were changed from WP to PB-only radiation after PET would have bRFS that was: (a) no higher than patients initially planned for PB-only radiation; and (b) lower than patients planned for WP radiation without PET guidance.</p><p><strong>Methods and materials: </strong>We conducted a post hoc analysis of a prospective, randomized trial comparing conventional (arm 1) versus PET-guided (arm 2) postprostatectomy radiation. In arm 2, pre-PET treatment field decisions were recorded and post-PET fields were defined per protocol; pathologic node negative (pN0) without pelvic or extrapelvic PET uptake received PB-only radiation. Three-year bRFS was compared in patients planned for WP with change to PB-only radiation (arm 2 [WP:PB]) vs arm 2 patients planned for PB-only with final radiation to PB-only (arm 2 [PB:PB]) and arm 1 pN0 patients treated with WP radiation (arm 1 [WP]) using the Z test and log-rank test. Demographics were compared using the chi-square test, Fisher exact test, or analysis of variance, as appropriate.</p><p><strong>Results: </strong>We identified 10 arm 2 (WP:PB), 31 arm 2 (PB:PB) and 11 arm 1 (WP) patients. Androgen deprivation was used in 50.0% of arm 2 (WP:PB) and 3.2% of arm 2 (PB:PB) patients, P < .01. Median preradiation prostate-specific antigen was higher in arm 2 (WP:PB) vs arm 2 (PB:PB) patients (0.4 vs 0.2 ng/mL, P = .03); however, there were no significant differences in T stage, Gleason score, or margin positivity. Three-year bRFS was 80% in arm 2 (WP:PB) vs 87.4% in arm 2 (PB:PB), P = .47, respectively. Arm 1(WP) patients had significantly worse 3-year (23%) bRFS vs arm 2 (WP:PB), P < .01.</p><p><strong>Conclusions: </strong>Patients initially planned for WP radiation with field decision change to PB-only radiation after PET showed (1) no significant difference in 3-year bRFS compared with patients initially planned for PB-only radiation; and (2) improved bRFS compared with patients receiving WP radiation without PET guidance. PET-guided volume de-escalation in selected patients may be 1 approach to mitigating toxicity without compromising outcomes.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735653","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}
Pub Date : 2024-07-18DOI: 10.1016/j.prro.2024.06.008
M Caroprese, L Cella, A Barillaro, C Oliviero, S Clemente, P Mainenti, R Pacelli, M Conson
Presented here is a case report of a 77-year-old woman affected by rheumatoid arthritis (RA) who underwent breast-conserving surgery followed by radiation therapy (RT) for left-breast cancer and developed bronchiolitis obliterans organizing pneumonia (BOOP) after RT and during COVID-19 vaccination campaign. BOOP incidence is an uncommon morbidity after breast RT (1.2-2.9%), however, specific predisposing factors can play a role. In this patient, both, RA and vaccine may have predisposed her to an increased risk of organizing pneumonia, probably by triggering a pro-inflammatory cascade. Our report highlights the importance of factors that influence the occurrence of uncommon radiation induced morbidities such as BOOP in specific subsets of patients. Further studies are necessary to evaluate factors increasing radiation sensitivity.
{"title":"Bronchiolitis obliterans organizing pneumonia (BOOP) after breast radiation therapy.","authors":"M Caroprese, L Cella, A Barillaro, C Oliviero, S Clemente, P Mainenti, R Pacelli, M Conson","doi":"10.1016/j.prro.2024.06.008","DOIUrl":"https://doi.org/10.1016/j.prro.2024.06.008","url":null,"abstract":"<p><p>Presented here is a case report of a 77-year-old woman affected by rheumatoid arthritis (RA) who underwent breast-conserving surgery followed by radiation therapy (RT) for left-breast cancer and developed bronchiolitis obliterans organizing pneumonia (BOOP) after RT and during COVID-19 vaccination campaign. BOOP incidence is an uncommon morbidity after breast RT (1.2-2.9%), however, specific predisposing factors can play a role. In this patient, both, RA and vaccine may have predisposed her to an increased risk of organizing pneumonia, probably by triggering a pro-inflammatory cascade. Our report highlights the importance of factors that influence the occurrence of uncommon radiation induced morbidities such as BOOP in specific subsets of patients. Further studies are necessary to evaluate factors increasing radiation sensitivity.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735654","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}
Pub Date : 2024-07-18DOI: 10.1016/j.prro.2024.05.012
Maria Cristina Leonardi, Alexandru David Fodor, Samuele Frassoni, Damaris Patricia Rojas, Alessandra Fozza, Gladys Blandino, Antonella Ciabattoni, Marina Alessandro, Gianpiero Catalano, Giovanni Battista Ivaldi, Stefania Martini, Fiorenza De Rose, Cristiana Fodor, Paolo Veronesi, Viviana Enrica Galimberti, Mattia Intra, Luigi Cornacchia, Francesca Braga, Stefano Durante, Samantha Dicuonzo, Anna Morra, Mattia Zaffaroni, Federica Cattani, Liliana Belgioia, Isabella Palumbo, Mariangela Massaccesi, Vincenzo Bagnardi, Roberto Orecchia, Barbara Alicja Jereczek-Fossa
Purpose: Intraoperative radiation therapy with electrons (IOERT) may represent a viable choice for partial breast reirradiation after repeat quadrantectomy for local recurrence (LR) for primary breast cancer (BC) in lieu of mastectomy.
Methods and materials: A database collecting data on partial breast reirradiation with IOERT from 8 Italian centers was set up in 2016 to 2018, providing data on cumulative incidence (CumI) of second LR and survival with a long follow-up.
Results: From 2002 to 2015, 109 patients underwent the conservative retreatment. The median primary BC first LR interval was 11.1 years (range, 2.4-27.7). The median first LR size was 0.9 cm (range, 0.3-3.0), and 43.6% cases were luminal A. Median IOERT dose was 18 Gy (range, 12-21), and median collimator diameter was 4 cm (range, 3-6). Median follow-up duration was 11.7 years (IQR, 7.7-14.6). The second LR CumI was 12.2% (95% CI, 6.8%-19.2%) at 5 years and 32.3% at 10 years (95% CI, 22.8%-42.2%), occurring in the same site as the first LR in about half of the cases. Human epidermal growth factor receptor 2 status and collimator size were independent LR predictors. The 5- and 10-year overall survival rates were 95.2% and 88.3%, respectively, whereas 5- and 10-year BC-specific survival rates were 98% and 94.5%, respectively. The development of a second LR significantly reduced BC-specific survival (hazard ratio, 9.40; P < .001). Grade ≥3 fibrosis rate was 18.9%. Patient-reported cosmesis was good/excellent in 59.7% of the cases.
Conclusions: Second LR CumI was within the range of the literature but higher than expected, opening questions on radiation field extension and fractionation schedule. Because a second LR worsened the outcome, salvage modality must be carefully planned.
{"title":"Salvage Breast-Conserving Surgery and Reirradiation With Intraoperative Electrons for Recurrent Breast Cancer: A Multicentric Study on Behalf of Italian Association of Radiotherapy and Clinical Oncology (AIRO).","authors":"Maria Cristina Leonardi, Alexandru David Fodor, Samuele Frassoni, Damaris Patricia Rojas, Alessandra Fozza, Gladys Blandino, Antonella Ciabattoni, Marina Alessandro, Gianpiero Catalano, Giovanni Battista Ivaldi, Stefania Martini, Fiorenza De Rose, Cristiana Fodor, Paolo Veronesi, Viviana Enrica Galimberti, Mattia Intra, Luigi Cornacchia, Francesca Braga, Stefano Durante, Samantha Dicuonzo, Anna Morra, Mattia Zaffaroni, Federica Cattani, Liliana Belgioia, Isabella Palumbo, Mariangela Massaccesi, Vincenzo Bagnardi, Roberto Orecchia, Barbara Alicja Jereczek-Fossa","doi":"10.1016/j.prro.2024.05.012","DOIUrl":"10.1016/j.prro.2024.05.012","url":null,"abstract":"<p><strong>Purpose: </strong>Intraoperative radiation therapy with electrons (IOERT) may represent a viable choice for partial breast reirradiation after repeat quadrantectomy for local recurrence (LR) for primary breast cancer (BC) in lieu of mastectomy.</p><p><strong>Methods and materials: </strong>A database collecting data on partial breast reirradiation with IOERT from 8 Italian centers was set up in 2016 to 2018, providing data on cumulative incidence (CumI) of second LR and survival with a long follow-up.</p><p><strong>Results: </strong>From 2002 to 2015, 109 patients underwent the conservative retreatment. The median primary BC first LR interval was 11.1 years (range, 2.4-27.7). The median first LR size was 0.9 cm (range, 0.3-3.0), and 43.6% cases were luminal A. Median IOERT dose was 18 Gy (range, 12-21), and median collimator diameter was 4 cm (range, 3-6). Median follow-up duration was 11.7 years (IQR, 7.7-14.6). The second LR CumI was 12.2% (95% CI, 6.8%-19.2%) at 5 years and 32.3% at 10 years (95% CI, 22.8%-42.2%), occurring in the same site as the first LR in about half of the cases. Human epidermal growth factor receptor 2 status and collimator size were independent LR predictors. The 5- and 10-year overall survival rates were 95.2% and 88.3%, respectively, whereas 5- and 10-year BC-specific survival rates were 98% and 94.5%, respectively. The development of a second LR significantly reduced BC-specific survival (hazard ratio, 9.40; P < .001). Grade ≥3 fibrosis rate was 18.9%. Patient-reported cosmesis was good/excellent in 59.7% of the cases.</p><p><strong>Conclusions: </strong>Second LR CumI was within the range of the literature but higher than expected, opening questions on radiation field extension and fractionation schedule. Because a second LR worsened the outcome, salvage modality must be carefully planned.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735655","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}