Practical Radiation Oncology最新文献

Purpose: This guideline provides evidence-based recommendations addressing the indications for radiation therapy (RT) for gastric cancer in a variety of clinical settings, ranging from patients with resectable locoregional disease to metastatic and symptomatic disease.

Methods: The American Society for Radiation Oncology convened a task force to address 3 key questions: (1) indications for and timing of RT for patients with resectable and nonmetastatic gastric cancer; (2) indications for and timing of RT in patients with unresectable locoregional disease, oligometastases, and/or requiring palliation; and (3) appropriate RT dose-fractionation regimens, target volumes, and techniques in these clinical settings. Recommendations are based on a systematic literature review and were created using a predefined consensus-based methodology with a system for grading evidence quality and recommendation strength.

Results: Multidisciplinary evaluation and decision-making are recommended for all patients. For patients with cT2-4 and/or N+ resectable gastric cancer, perioperative chemotherapy is recommended, preferably FLOT (5-fluorouracil, leucovorin, oxaliplatin, and docetaxel). Recently, perioperative durvalumab and FLOT has shown a significant improvement in event-free survival versus FLOT only for patients with resectable disease and is now being adopted as a standard of care. Preoperative chemoradiation is recommended for patients who are not candidates for perioperative chemotherapy and conditionally recommended if there is concern for a margin-positive (R1) or incomplete (R2) resection. Postoperative chemoradiation is conditionally recommended for patients who are not candidates for perioperative or postoperative chemotherapy or if a suboptimal resection was done (eg,

Conclusions: These evidence-based recommendations guide clinical practice on the use of RT for gastric cancer. Future studies will further refine the indications and role of RT in the management of these patients.

Purpose: Guidelines for women aged ≥65 years with early-stage, hormone receptor-positive cancer allow for a range of adjuvant strategies following breast-conserving surgery. These include hormone therapy (HT) with or without radiation therapy (RT), RT alone if HT is not desired or feasible, or even no adjuvant therapy. Although these options offer flexibility, they can also create uncertainty. To address this, we implemented a simple multidisciplinary clinic (s-MDC) with same-day medical and radiation oncology consultations, alongside a previsit questionnaire assessing decision-making preferences and treatment attitudes.

Methods and materials: We evaluated 95 patients aged ≥65 years with stage I, hormone receptor-positive breast cancer seen in the s-MDC from August 2020 to December 2023. All completed the Decision Autonomy Preference Scale, Medical Maximizing-Minimizing Scale, and e-Prognosis 10-year mortality risk estimates. We retrospectively reviewed demographics, clinical variables, and chosen treatments, examining associations using χ² tests, t tests, and regressions.

Results: Among 95 patients, adjuvant treatments included no therapy (16.8%), HT alone (16.8%), RT alone (20.0%), and HT+RT (45.3%). Older age, higher mortality risk, and a preference for decision autonomy correlated with omission of all therapy or omission of HT. "Minimizers" favored HT alone, whereas "maximizers" often chose RT or HT+RT. Neither baseline patient-reported data nor most clinicopathologic factors predicted the use of RT alone. The only clinicopathologic factor associated with choice was tumor size: patients with larger (T1b/T1c) tumors more commonly received HT+RT.

Conclusions: In this s-MDC setting, treatment decisions were driven largely by patient preferences, life expectancy, and treatment inclinations, rather than by baseline patient-reported measures or tumor features. These findings underscore the importance of integrating patient values into decision-making and support further research into RT-alone approaches for those forgoing HT, given the prevalence of this treatment choice.

Purpose: Although there is substantial evidence for prostate brachytherapy as an effective and efficient treatment option as monotherapy or part of multimodality regimens, brachytherapy numbers have decreased over the last decade. The purpose of this analysis is to describe prostate brachytherapy trends from 2013 to 2022 and its relationship with resident brachytherapy training.

Methods and materials: The Medicare Provider and Other Supplier Public Use File database was searched by provider and state for code 55875 (transperineal placement of needles or catheters into prostate for interstitial radio element application, with or without cystoscopy) for years 2013 to 2022. The top 10 states (and providers/organizations) for total contributions to nationwide total of providers and services were determined. Resident brachytherapy case log information was accessed from the Accreditation Council for Graduate Medical Education and included data until 2023/2024.

Results: Between 2013 and 2022, there was a 50% decrease in total providers, 30% decrease in patients, and 32% decrease in services. Thirty-eight states had decreases in providers and 32 had decreases in services. There were 15 states in the top 10 for providers and 14 states in the top 10 for services for at least 1 year during this period and had a significant contribution to both providers (62%) and services (66%). Highest volume providers were likely to be in private versus academic practices. Meanwhile, residents had a decrease in median low-dose-rate cases between 2017/2018 and 2023/2024 of 4 to 1 and in high dose rate, an increase from 0 to 1.

Conclusions: While there is significant evidence for the use of prostate brachytherapy in many treatment settings, there has been a decrease in the number of practicing providers and the number of patients treated over the last decade. With private practices contributing significantly to services provided, this may be partially responsible to low resident cases being logged. This highlights the need to improve resident training opportunities in academic centers.

Purpose: This paper aimed to evaluate the integration of Cherenkov imaging into radiation therapy practices, focusing on its utility in enhancing treatment precision, patient safety, and clinical decision-making. The research highlights its application in quality and safety verification, breast treatment, and dose visualization, confirming the absence of radiation in unintended areas and its broader clinical impact.

Methods and materials: We employed 2 commercially available Cherenkov imaging systems, BeamSite and DoseRT, integrated with Varian and Elekta linear accelerators. The methodology involved real-time imaging during radiation therapy sessions for various treatments, capturing Cherenkov light with time-gated cameras synchronized with radiation pulses. Posttreatment, images were analyzed to assess treatment accuracy, dose distribution, and any deviations from the intended plan.

Results: Cherenkov imaging consistently provided high-quality images that allowed immediate visualization of the radiation dose distribution, detection of deviations in real time, and ensured no radiation was delivered to unintended areas. The results are presented, focusing on 5 main topics: quality and patient safety verification; breast treatment applications; dose visualization for treatment verification; verification of a negative dose in areas of concern; and observations with clinical impact. It was particularly beneficial in complex scenarios like breast cancer treatments and in cases where patient positioning was challenging. The technology facilitated immediate treatment adjustments, improved patient safety, and offered insights into treatment response without adding significant time to the clinical workflow.

Conclusions: Cherenkov imaging has shown substantial promise in enhancing radiation therapy by providing real-time, visual feedback on treatment delivery. It complements traditional verification methods by offering continuous monitoring, which can lead to fewer treatment errors and better patient outcomes. The findings suggest that Cherenkov imaging should be considered for broader clinical adoption to elevate the standard of care in radiation oncology, although further refinement of image processing and camera positioning could enhance its effectiveness.

Purpose: The Turkish Pediatric Oncology Group (TPOG) established a risk-adapted national neuroblastoma (NBL) treatment strategy in 2003 and updated it in 2009 and 2020 to optimize outcomes in NBL. With this study, we aimed to evaluate the oncological outcomes of our national protocol with a special emphasis on local control.

Methods and materials: We retrospectively evaluated 135 NBL patients who received adjuvant radiation therapy between May 2004 and May 2018 from 7 tertiary pediatric oncology centers in Türkiye. Patients were treated according to TPOG-NBL2003 and TPOG-NBL2009 protocols. All statistical analyses were performed using SPSS 23.0 software (SPSS).

Results: The median age was 42 months, and 58 (43%) patients were female. The adrenal medulla was the primary tumor location in 103 (76%) patients. Only 14 patients had intermediate-risk disease, whereas 121 had high-risk disease. The median follow-up was 67.3 months. The 2- and 5-year overall survival (OS) rates were 84% and 68%, locoregional recurrence-free survival (LRRFS) rates were 81% and 66%, distant metastasis-free survival rates were 76% and 56%, and event-free survival (EFS) rates were 74% and 54%, respectively. The International Neuroblastoma Staging System stage was a significant predictor of OS, while the International Neuroblastoma Staging System stage and lactate dehydrogenase level at diagnosis predicted EFS, and the lactate dehydrogenase level at diagnosis predicted LRRFS. There were no differences in OS, EFS, or LRRFS based on radiation therapy doses.

Conclusions: In this study, we evaluated the outcomes of our TPOG-NBL2003 and TPOG-NBL2009 protocols. Our survival outcomes are consistent with the current literature, which emphasizes the importance of establishing a national protocol. Effective NBL treatment necessitates a multidisciplinary approach, and standardization of treatment should be accomplished through protocols.

Magnetic resonance imaging-guided brachytherapy is an essential component of curative treatment in locally advanced cervical cancer. The use of interstitial needles improves local control rate for locally advanced cervical cancer compared to intracavitary brachytherapy alone. Bleeding is one of the most common complications from cervix interstitial brachytherapy, typically managed by pressure with surgical sponge/packing with or without a hemostatic agent. Herein, we present a case of stage IVA cervical cancer with retained surgical sponge in the pelvis from magnetic resonance imaging-guided intracavitary/interstitial brachytherapy, and recommendations for future brachytherapy procedures.

This case highlights the challenges of treating patients with non-small cell lung cancer who initially receive neoadjuvant chemoimmunotherapy (chemo-IO) and do not proceed to planned surgery. After multidisciplinary evaluation, a 58-year-old man with stage IIIA squamous cell carcinoma of the left lower lobe received neoadjuvant chemo-IO and was planned for definitive surgical resection. His neoadjuvant course was complicated by the development of IO-related dermatitis and colitis. He was ultimately not offered definitive surgery, representing the ∼20% of patients on neoadjuvant chemo-IO trials that do not proceed to planned surgical resection. The patient completed chemoradiation therapy with 60 Gy in 30 fractions. He subsequently developed multiple significant postradiation toxicities, including a grade 5 bronchial-esophageal fistula, which was managed with palliative intent. This case underscores the importance of comprehensive multidisciplinary discussion before definitive treatment, the data-free zone for the management of patients who receive neoadjuvant chemo-IO and do not undergo definitive resection, and the potential for increased completed chemoradiation toxicity in this setting.