Advances in Radiation Oncology最新文献

{"title":"Outcomes After Stereotactic Body Radiation for Hepatocellular Carcinoma in Patients With Child-Pugh A Versus Child-Pugh B/C Cirrhosis","authors":"Brett H. Diamond MD ,&nbsp;Kara Banson MD ,&nbsp;Jonathan Ayash BS ,&nbsp;Peter Lee MD, PhD ,&nbsp;Utkarsh C. Shukla MD ,&nbsp;Gavin Jones MD ,&nbsp;Paul Rava MD, PhD ,&nbsp;Thomas J. Fitzgerald MD ,&nbsp;Shirin Sioshansi MD","doi":"10.1016/j.adro.2024.101631","DOIUrl":"10.1016/j.adro.2024.101631","url":null,"abstract":"<div><h3>Purpose</h3><div>For patients with hepatocellular carcinoma (HCC), stereotactic body radiation therapy (SBRT) has emerged as a locoregional treatment. Our purpose was to report outcomes in patients with HCC with Child-Pugh A (CP A) versus Child-Pugh B or C (CP B/C) liver dysfunction treated with SBRT.</div></div><div><h3>Methods and Materials</h3><div>A retrospective analysis of 80 patients with HCC, with a total of 94 tumors treated with SBRT, was conducted at a single institution. Outcomes were compared between patients with CP A (n = 51) and CP B/C (n = 29) liver dysfunction. Outcomes of interest included local control, overall survival (OS), and toxicity.</div></div><div><h3>Results</h3><div>Median tumor size was 3.2 cm. There were 59 tumors included in the CP A cohort and 35 tumors in the CP B/C cohort. Median radiation dose was 50 Gy in 5 fractions for the CP A cohort and 40 Gy in 5 fractions for the CP B/C cohort. The rates of pathologic complete response were similar between the 2 groups at 63% for the CP A group and 61% for the CP B/C group. The estimated 1-year local control rates were similar between the 2 groups at 93% for the CP A group and 91% for the CP B/C group (<em>P</em> = .59). The 1-year OS for the CP A group was 85%, whereas the 1-year OS for the CP B/C group was 61% (<em>P</em> = .19). There was a 5.9% rate of grade 3+ toxicity in the CP A group and a 20.7% rate of grade 3+ toxicity in the CPB/C group.</div></div><div><h3>Conclusions</h3><div>Our findings suggest that SBRT is feasible and effective in patients with both CP A and CP B/C liver dysfunction with similar rates of local control and pathologic complete response despite lower radiation doses in the CP B/C cohort. In patients with more advanced CP B/C cirrhosis, toxicities were higher and must be weighed against possible treatment benefits. Further studies characterizing the optimal role of SBRT in patients with advanced cirrhosis are warranted.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 12","pages":"Article 101631"},"PeriodicalIF":2.2,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pegylated Interferon Combined With Low-Dose Total Skin Electron Beam Therapy for Advanced Stage Mycosis Fungoides: Two Case Reports and Literature Review","authors":"Khaled Elsayad PhD ,&nbsp;Rudolf Stadler PhD ,&nbsp;Hans Theodor Eich PhD","doi":"10.1016/j.adro.2024.101663","DOIUrl":"10.1016/j.adro.2024.101663","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 1","pages":"Article 101663"},"PeriodicalIF":2.2,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142661572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cone Beam Computed Tomography-Based Online Adaptive Radiation Therapy of Esophageal Cancer: First Clinical Experience and Dosimetric Benefits","authors":"Nicolas Bachmann MD ,&nbsp;Daniel Schmidhalter BE ,&nbsp;Frédéric Corminboeuf MD ,&nbsp;Martin D. Berger MD ,&nbsp;Yves Borbély MD ,&nbsp;Ekin Ermiş MD ,&nbsp;Emanuel Stutz MD ,&nbsp;Binaya K. Shrestha MD ,&nbsp;Daniel M. Aebersold MD ,&nbsp;Peter Manser MD ,&nbsp;Hossein Hemmatazad MD","doi":"10.1016/j.adro.2024.101656","DOIUrl":"10.1016/j.adro.2024.101656","url":null,"abstract":"<div><h3>Purpose</h3><div>Radiation therapy (RT) plays a key role in the management of esophageal cancer (EC). However, toxicities caused by proximity of organs at risk (OAR) and daily target coverage caused by interfractional anatomic changes are of concern. Daily online adaptive RT (oART) addresses these concerns and has the potential to increase OAR sparing and improve target coverage. We present the first clinical experience and dosimetric investigations of cone beam CT-based oART in EC using the ETHOS platform.</div></div><div><h3>Methods and Materials</h3><div>Treatment fractions of the first 10 EC patients undergoing cone beam CT-based oART at our institution were retrospectively analyzed. The prescription dose was 50.4 Gy in 28 fractions. The same clinical target volume (CTV) and planning target volume (PTV) margins as for nonadaptive treatments were used. For all sessions, the timestamp of each oART workflow step, PTV size, target volume doses, mean heart dose, and lung V_20Gy of both the scheduled and the adapted treatment plan were analyzed.</div></div><div><h3>Results</h3><div>Following automatic propagation, the CTV was adapted by the physician in 164 (59%) fractions. The adapted treatment plan was selected in 276 (99%) sessions. The median time needed for an oART session was 28 minutes (range, 14.8-43.3). Compared to the scheduled plans, a significant relative reduction of 9.5% in mean heart dose (absolute, 1.6 Gy; <em>P</em> = .006) and 16.9% reduction in mean lung V_20Gy (absolute, 2.3%; <em>P</em> &lt; .001) was achieved with the adapted treatment plans. Simultaneously, we observed a significant relative improvement in D99%PTV and D99%CTV by 15.3% (<em>P</em> &lt; .001) and 5.0% (<em>P</em> = .008), respectively, along with a significant increase in D95%PTV by 5.1% (<em>P</em> = .003).</div></div><div><h3>Conclusions</h3><div>Although being resource-intensive, oART for EC is feasible in a reasonable timeframe and results in increased OAR sparing and improved target coverage, even without a reduction of margins. Further studies are planned to evaluate the potential clinical benefits.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 1","pages":"Article 101656"},"PeriodicalIF":2.2,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142661571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective Trial on the Impact of Weekly Cone Beam Computed Tomography-Guided Correction on Mean Heart Dose in Breast Cancer Breath-Hold Radiation Therapy","authors":"Adrian Wai Chan MBBS ,&nbsp;Anh Hoang BSc ,&nbsp;Hanbo Chen MD ,&nbsp;Merrylee McGuffin MSc ,&nbsp;Danny Vesprini MD ,&nbsp;Liying Zhang PhD ,&nbsp;Matt Wronski PhD ,&nbsp;Irene Karam MD","doi":"10.1016/j.adro.2024.101651","DOIUrl":"10.1016/j.adro.2024.101651","url":null,"abstract":"<div><h3>Purpose</h3><div>Surface guided radiation therapy (SGRT) in breast cancer radiation therapy (RT) may decrease the need for image guidance such as cone beam computed tomography (CBCT). The goal of this study was to evaluate the impact of CBCT image guidance on the cumulative and interfractional variation of mean heart dose (MHD) during breath-hold RT in patients with breast cancer. We hypothesized that weekly CBCT is not necessary for SGRT-assisted breath-hold but is still needed in patients treated with voluntary deep inspiration breath-hold (vDIBH) and active breathing control (ABC) to maintain a stable MHD.</div></div><div><h3>Methods and Materials</h3><div>This was a prospective, single-center trial that sequentially assigned breast cancer patients to adjuvant RT 40 to 50 Gy in 15 to 25 fractions using vDIBH, ABC, or SGRT to reproduce the breath-hold. The MHD was estimated on each of the weekly CBCT images before and after online correction. The cumulative and interfractional variation of MHD, which were represented by the average and SD of MHD in each patient, were compared in the series of CBCT before and after online correction to evaluate whether online CBCT-guided correction could lead to a more reproducible MHD.</div></div><div><h3>Results</h3><div>Fifty-five patients were included (vDIBH = 16, ABC = 19, and SGRT = 20). The CBCT-guided online correction was associated with a significant decrease in the interfractional variation of MHD in vDIBH (SD difference, 22.6 cGy; <em>p</em> = .0389) and ABC (SD difference, 9.9 cGy; <em>p</em> = .0262), but not in SGRT (<em>p</em> = .2272). The CBCT-guided online correction had no impact on the cumulative MHD in all 3 groups.</div></div><div><h3>Conclusions</h3><div>This study demonstrated that CBCT-guided online correction could reduce the interfractional variation of MHD in ABC or vDIBH. When SGRT was available, CBCT-guided correction had no impact on the stability of MHD across the treatment fractions. Future studies may explore whether the CBCT frequency could be reduced to less than weekly in SGRT to decrease treatment time and the radiation dose associated with CBCT.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 12","pages":"Article 101651"},"PeriodicalIF":2.2,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142554264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early-Stage Extranodal NK/T-Cell Lymphoma, Nasal Type: A Role for Elective Nodal Irradiation?","authors":"Penny Fang MD, MBA ,&nbsp;Sonal S. Noticewala MD ,&nbsp;Susan Y. Wu MD ,&nbsp;Jillian R. Gunther MD, PhD ,&nbsp;Ethan B. Ludmir MD ,&nbsp;L. Jeffrey Medeiros MD ,&nbsp;Paolo Strati MD ,&nbsp;Ranjit Nair MD ,&nbsp;Chijioke Nze MD ,&nbsp;Loretta J. Nastoupil MD ,&nbsp;Sairah Ahmed MD ,&nbsp;Luis Malpica Castillo MD ,&nbsp;Luis Fayad MD ,&nbsp;Jason Westin MD ,&nbsp;Sattva Neelapu MD ,&nbsp;Christopher Flowers MD ,&nbsp;Auris Huen MD ,&nbsp;Swaminathan P. Iyer MD ,&nbsp;Bouthaina Dabaja MD ,&nbsp;Chelsea C. Pinnix MD, PhD","doi":"10.1016/j.adro.2024.101650","DOIUrl":"10.1016/j.adro.2024.101650","url":null,"abstract":"<div><h3>Purpose</h3><div>Extranodal NK/T-cell lymphoma (ENKTCL) is rare in the Western Hemisphere and is commonly treated with combined modality therapy (CMT).</div></div><div><h3>Methods and Materials</h3><div>We retrospectively reviewed 35 patients treated with Ann Arbor stage I/II ENKTCL between 1994 and 2015 at a large academic cancer center in the United States.</div></div><div><h3>Results</h3><div>With 11.6 years median follow-up, median overall survival and progression-free survival were 13.5 and 7.5 years, respectively. Eighteen (51%) patients experienced disease relapse, with 5 regional nodal relapses, of which 2 experienced combined regional and distant relapses. All 5 regional nodal relapses occurred exclusively among patients not treated with elective nodal irradiation (ENI). ENI was associated with improved progression-free survival (hazard ratio [HR], 0.21; 95% CI, 0.09-0.52; <em>P</em> = .018) without significant association with OS (HR, 0.33; 95% CI, 0.11-0.94; <em>P</em> = .11). There was a trend toward improved local control with radiation dose to the primary tumor ≥50 Gy (HR, 0.29; 95% CI, 0.08-1.08; <em>P</em> = .098).</div></div><div><h3>Conclusions</h3><div>In this Western Hemisphere cohort of early-stage ENKTCL patients treated with CMT, ENI may have a potential clinical benefit, particularly in patients who are treated with non–asparaginase-containing CMT, such as in patients treated with radiation alone, patients treated with less intensive chemotherapy concurrently, or patients who are unable to tolerate intensive chemotherapy.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 12","pages":"Article 101650"},"PeriodicalIF":2.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142572719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Relationship Between Travel Distance for Treatment and Outcomes in Patients Undergoing Radiation Therapy: A Systematic Review","authors":"Sierra M. Silverwood BA ,&nbsp;Kathleen Waeldner BA ,&nbsp;Sasha K. Demeulenaere BS ,&nbsp;Shavit Keren BA ,&nbsp;Jason To BS ,&nbsp;Jie Jane Chen MD ,&nbsp;Zakaria El Kouzi MD ,&nbsp;Alan Ayoub MD ,&nbsp;Surbhi Grover MD ,&nbsp;Katie E. Lichter MD, MPH ,&nbsp;Osama Mohamad MD, PhD","doi":"10.1016/j.adro.2024.101652","DOIUrl":"10.1016/j.adro.2024.101652","url":null,"abstract":"<div><h3>Purpose</h3><div>Although recent technological advances in radiation therapy have significantly improved treatment outcomes, the global distribution of radiation therapy is unbalanced, making access especially challenging for patients in rural or low-resource settings because of travel burden. This systematic review aimed to explore the impact of geographic distance to treatment facilities on survival, as well as other treatment outcomes, among patients undergoing radiation therapy.</div></div><div><h3>Methods and Materials</h3><div>A search of four databases (PubMed, Embase, CINAHL, and Web of Science) was performed. Studies were included if they were primary literature, published between May 2000 and May 2023, and reported the travel distances for patients undergoing radiation therapy for malignant conditions and its influence on survival outcomes. Studies were excluded if they did not report primary outcomes, were published before 2000, or were non-English.</div></div><div><h3>Results</h3><div>After review, 23 studies were included. Most studies were conducted in the United States, with cervical cancer being the most frequently studied disease site. Data suggested that travel distances vary significantly, with patients often traveling a median distance of 20 miles to radiation therapy. Among the studies, 5 reported a negative impact on overall survival, often associating greater travel with nonadherence to recommended care. Other survival metrics, including progression-free survival and all-cause mortality, were also assessed, demonstrating similar variability in relation to travel distance. Conversely, seven studies found no significant impact on overall survival, and four suggested a positive impact on overall survival, with improved outcomes at centers with higher case volumes. Some data also revealed an inverse correlation between travel distance and the likelihood of receiving guideline-concordant radiation therapy.</div></div><div><h3>Conclusions</h3><div>The impact of travel distance on radiation therapy outcomes is varied. Our findings underscore the challenges posed by travel in accessing radiation therapy and the disparities affecting particular patient demographic groups. Additional studies are needed to thoroughly assess the impacts of geographic disparities and to identify effective measures to address these challenges.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 12","pages":"Article 101652"},"PeriodicalIF":2.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automatic Treatment Planning for Radiation Therapy: A Cross-Modality and Protocol Study","authors":"Gregory Szalkowski PhD ,&nbsp;Xuanang Xu PhD ,&nbsp;Shiva Das PhD ,&nbsp;Pew-Thian Yap PhD ,&nbsp;Jun Lian PhD","doi":"10.1016/j.adro.2024.101649","DOIUrl":"10.1016/j.adro.2024.101649","url":null,"abstract":"<div><h3>Purpose</h3><div>This study investigated the applicability of 3-dimensional dose predictions from a model trained on one modality to a cross-modality automated planning workflow. Additionally, we explore the impact of integrating a multicriteria optimizer (MCO) on adapting predictions to different clinical preferences.</div></div><div><h3>Methods and Materials</h3><div>Using a previously created 3-stage U-Net in-house model trained on the 2020 American Association of Physicists in Medicine OpenKBP challenge data set (340 head and neck plans, all planned using 9-field static intensity modulated radiation therapy [IMRT]), we retrospectively generated dose predictions for 20 patients. These dose predictions were, in turn, used to generate deliverable IMRT, VMAT, and tomotherapy plans using the fallback plan functionality in Raystation. The deliverable plans were evaluated against the dose predictions based on primary clinical goals. A new set of plans was also generated using MCO-based optimization with predicted dose values as constraints. Delivery QA was performed on a subset of the plans to assure clinical deliverability.</div></div><div><h3>Results</h3><div>The mimicking approach accurately replicated the predicted dose distributions across different modalities, with slight deviations in the spinal cord and external contour maximum doses. MCO optimization significantly reduced doses to organs at risk, which were prioritized by our institution while maintaining target coverage. All tested plans met clinical deliverability standards, evidenced by a gamma analysis passing rate &gt;98%.</div></div><div><h3>Conclusions</h3><div>Our findings show that a model trained only on IMRT plans can effectively contribute to planning across various modalities. Additionally, integrating predictions as constraints in an MCO-based workflow, rather than direct dose mimicking, enables a flexible, warm-start approach for treatment planning, although the benefit is reduced when the training set differs significantly from an institution's preference. Together, these approaches have the potential to significantly decrease plan turnaround time and quality variance, both at high-resource medical centers that can train in-house models and smaller centers that can adapt a model from another institution with minimal effort.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 12","pages":"Article 101649"},"PeriodicalIF":2.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142572720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Artificial Intelligence-Based Autosegmentation of Organs at Risk in Low- and Middle-Income Countries","authors":"Solomon Kibudde MBChB, MMed ,&nbsp;Awusi Kavuma PhD ,&nbsp;Yao Hao PhD ,&nbsp;Tianyu Zhao PhD ,&nbsp;Hiram Gay MD ,&nbsp;Jacaranda Van Rheenen PhD ,&nbsp;Pavan Mukesh Jhaveri MD ,&nbsp;Minjmaa Minjgee MD, PhD ,&nbsp;Enkhsetseg Vanchinbazar MSc ,&nbsp;Urdenekhuu Nansalmaa MD, PhD, MPH ,&nbsp;Baozhou Sun PhD, MBA, DABR","doi":"10.1016/j.adro.2024.101638","DOIUrl":"10.1016/j.adro.2024.101638","url":null,"abstract":"<div><h3>Purpose</h3><div>Radiation therapy (RT) processes require significant human resources and expertise, creating a barrier to rapid RT deployment in low- and middle-income countries (LMICs). Accurate segmentation of tumor targets and organs at risk (OARs) is crucial for optimal RT. This study assessed the impact of artificial intelligence (AI)-based autosegmentation of OARs in 2 LMICs.</div></div><div><h3>Methods and Materials</h3><div>Ten patients, comprising 5 head and neck (HN) cancer patients and 5 prostate cancer patients, were randomly selected. Planning computed tomography images were subjected to autosegmentation using an Food and Drug Administration-approved AI software tool and manual segmentation by experienced radiation oncologists from 2 LMIC RT clinics. The control data, obtained from a large academic institution in the United States, consisted of contours obtained by an experienced radiation oncologist. The segmentation time, DICE similarity coefficient (DSC), Hausdorff distance, and mean surface distance were evaluated.</div></div><div><h3>Results</h3><div>AI significantly reduced segmentation time, averaging 2 minutes per patient, compared with 57 to 84 minutes for manual contouring in LMICs. Compared with the control data, the AI pelvic contours provided better agreement than did the LMIC manual contours (mean DSC of 0.834 vs 0.807 in LMIC1 and 0.844 vs 0.801 in LMIC2). For HN contours, AI provided better agreement for the majority of OAR contours than manual contours in LMIC1 (mean DSC: 0.823 vs 0.821) or LMIC2 (mean DSC: 0.792 vs 0.748). Neither the AI nor LMIC manual contours had good agreement with the control data (DSC &lt; 0.600) for the optic nerves, chiasm, and cochlea.</div></div><div><h3>Conclusions</h3><div>AI-based autosegmentation generates OAR contours of comparable quality to manual segmentation for both pelvic and HN cancer patients in LMICs, with substantial time savings.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 11","pages":"Article 101638"},"PeriodicalIF":2.2,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impacts of Intrafraction Virtual Reality-Based Environment Modification on Procedural Anxiety, Heart Rate, and Overall Radiation Therapy Experience During External Beam Radiation Therapy","authors":"Conley Kriegler MD ,&nbsp;Brock Debenham MD, FRCPC ,&nbsp;Michael Piva BSc, MRT(T) ,&nbsp;Michelle Bernardo BSc, MRT(T) ,&nbsp;Amanda Bylhouwer BSc, MRT(T) ,&nbsp;Tina Karim BSc, MRT(T) ,&nbsp;Yiming Michael Zhu MD ,&nbsp;Giselle Tucker Belliveau BHS, MHS ,&nbsp;Benjamin Merrick BSc, MBDC ,&nbsp;Mustafa Al Balushi MD, FRCPC","doi":"10.1016/j.adro.2024.101640","DOIUrl":"10.1016/j.adro.2024.101640","url":null,"abstract":"<div><h3>Purpose</h3><div>Procedural anxiety of cancer treatments may negatively impact patients and treatments. Mindfulness-promoting environment modification with virtual reality (VR) is increasingly used across medicine to minimize procedural anxiety. We aimed to assess the impacts of intrafraction mindfulness-promoting VR use during external beam radiation therapy (EBRT) on radiation therapy experience and physiological measures of distress.</div></div><div><h3>Methods and Materials</h3><div>Adult patients receiving EBRT between May and October 2023 at our institution without contraindications to wearing VR were eligible. Participants had heart rates recorded before and after EBRT and completed a post-EBRT survey for 1 treatment without intervention, and 1 using VR. Participants completed the Radiotherapy Experience Questionnaire and additional questions regarding VR. Quantitative data were compared between conditions using paired samples <em>t</em> test.</div></div><div><h3>Results</h3><div>Fifty-two participants completed the project. Between pre- and post-EBRT, a significant decrease in heart rate with VR was noted (80.35 bpm vs 71.79 bpm; <em>P</em> &lt; .0001*), but not in the control condition (78.90 bpm vs 78.10 bpm; <em>P</em> = .44). Post-EBRT heart rate was significantly lower with VR than without (71.79 bpm vs 78.10 bpm; <em>P</em> &lt; .01*). Radiotherapy Experience Questionnaire responses showed participants had significantly lower situational unease (1.46 vs 2.02; <em>P</em> &lt; .001*), a more beneficial situational response (1.55 vs 2.12; <em>P</em> &lt; .01*), and improved environment acceptance (1.30 vs 1.60; <em>P</em> &lt; .01*) when using VR. Most endorsed VR as comfortable (94%), improved treatment experience (86%), and would recommend it to others (86%).</div></div><div><h3>Conclusions</h3><div>We report the first evidence of the impacts of intrafraction mindfulness-promoting VR use during EBRT. Physiological measures of distress and patient perspectives suggest that VR can minimize procedural anxiety, is well tolerated, and improves the overall treatment experience. Further research should explore modifying this tool for patients unable to wear headsets and determining where the most clinically significant benefits can be found.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 11","pages":"Article 101640"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microboost in Localized Prostate Cancer: Analysis of a Statewide Quality Consortium","authors":"Samuel N. Regan MD ,&nbsp;Michael Dykstra MD ,&nbsp;Huiying Yin MS ,&nbsp;Margaret Grubb MS ,&nbsp;Neil Vaishampayan BS ,&nbsp;Mark Zaki MD ,&nbsp;Mazen Mislmani MD ,&nbsp;Patrick McLaughlin MD ,&nbsp;Danielle Kendrick BS ,&nbsp;Steven Miller MD ,&nbsp;Daniel Dryden MS ,&nbsp;Murshed Khadija MS ,&nbsp;Dale Litzenberg PhD ,&nbsp;Melissa Mietzel MS ,&nbsp;Vrinda Narayana PhD ,&nbsp;David Heimburger MD ,&nbsp;Matthew Schipper PhD ,&nbsp;William C. Jackson MD ,&nbsp;Robert T. Dess MD","doi":"10.1016/j.adro.2024.101629","DOIUrl":"10.1016/j.adro.2024.101629","url":null,"abstract":"<div><h3>Purpose</h3><div>Prospective trials have reported isotoxicity and improved oncologic outcomes with external beam radiation therapy (EBRT) microboost to a dominant intraprostatic lesion. There is often variability in the rate of adoption of new treatments, and current microboost practice patterns are unknown. We leveraged prospectively collected data from the multicenter Michigan Radiation Oncology Quality Consortium to understand the current state of microboost usage for localized prostate cancer.</div></div><div><h3>Materials and Methods</h3><div>Men with intermediate- and high-risk prostate adenocarcinoma treated with curative-intent radiation between October, 26, 2020, and June, 26, 2023, were included across 26 centers. Demographic-, tumor-, and treatment-related data along with DICOM files were prospectively collected. Microboost intent was prospectively documented and DICOM-confirmed. Multivariable analyses were used to evaluate associations with microboost receipt, and mixed-effects modeling evaluated facility-level variation.</div></div><div><h3>Results</h3><div>Most patients received EBRT without brachytherapy (71%, n = 524/741). Of those, a minority received an EBRT microboost (10%, n = 53/524) at a subset of sites (27%, n = 7/26), without a change in rate over the study period (<em>P</em> = .62). Grade group 4/5 (odds ration [OR] = 2.35; 95% confidence interval [CI]: 1.02-5.28), magnetic resonance imaging planning (OR = 6.34; 95%CI: 2.16-27.12), and fiducial marker/rectal spacer placement (OR = 2.59; 95% CI: 1.14-6.70) were associated with microboost use. Significant facility-level variability was present (minimum 0%; 95% CI: 0.0-10.7 to maximum 71%; 95% CI: 55.5-83.2, unadjusted, <em>P</em> &lt; .0001). Median boost volume was 20.7cc, and median boost D98% was 94.4 EQD2Gy. Compared with non-microboost cases, intermediate doses to rectum in the microboost cohort were increased (eg, V20Gy [EQD2] of 53.8% vs 36.5%, <em>P</em> = .03). However, the proportion exceeding NRG/RTOG bladder/rectal constraints was low and not significantly different between cohorts.</div></div><div><h3>Conclusions</h3><div>Despite prospective data demonstrating its benefit, EBRT microboost was used within a diverse statewide quality consortium in only 10% of cases at 27% of sites with significant facility-level heterogeneity. Concerted efforts are required to understand current barriers to microboost utilization, and results from trials such as PIVOTALboost (ISRCTN80146950) are eagerly awaited.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 11","pages":"Article 101629"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}